Decreasing the share of protein contributed by animal-based foods is recommended to move towards more sustainable and healthier diets. This study aimed to assess the potential environmental impacts of diets with a lower share of animal protein. The diets were modeled to include the minimum share of animal protein in total protein that met nutrient requirements and did not increase costs. The new diets also minimized the difference in the quantity of food from those of observed (OBS) diets. They were modeled for five adult subpopulations (defined by sex and age) using mathematical optimization. The model was created by combining the INCA2 database (to model OBS diets in the French population) and a database of 207 food items to adjust nutritional and price parameters. All modeled diets satisfied nutritional and cost constraints. A low-animal-protein (LAP) diet was identified for each subpopulation by progressively decreasing the share of animal protein by steps of 5% until the recommended quantity of protein and/or consumption constraints were no longer satisfied. Potential environmental impacts of the LAP diets in eight impact categories were calculated using life cycle assessment and life cycle inventories from Agribalyse® 3.0. A LAP diet for the entire population was calculated as a weighted mean of the subpopulations' LAP diets. The share of animal protein decreased from 70% in the OBS diet to 50% in the LAP diet. Compared to the OBS diet, the LAP diet decreased five environmental impacts: climate change (greenhouse gas emissions), acidification (emissions of acidifying compounds) and land occupation (all by more than 30%), cumulative energy demand (by 23%) and marine eutrophication (by 13%). Conversely, it increased three environmental impacts: freshwater eutrophication and water use (both by ca. 40%) and biodiversity damage potential (potential loss of species associated with land use) (by 66%). These results suggest that decreasing the share of animal protein to 50% is compatible with nutritional requirements, affordability and consumption constraints, but would have mixed effects on the environment.

INTRODUCTION:Stress is nearly ubiquitous in everyday life; however, it imposes a tremendous burden worldwide by acting as a risk factor for most physical and mental diseases. The effects of geographic environments on stress are supported by multiple theories acknowledging that natural environments act as a stress buffer and provide deeper and quicker restorative effects than most urban settings. However, little is known about how the temporalities of exposure to complex urban environments (duration, frequency and sequences of exposures) experienced in various locations - as shaped by people's daily activities - affect daily and chronic stress levels. The potential modifying effect of activity patterns (ie, time, place, activity type and social company) on the environment-stress relationship also remains poorly understood. Moreover, most observational studies relied quasi-exclusively on self-reported stress measurements, which may not accurately reflect the individual physiological embodiment of stress. The FragMent study aims to assess the extent to which the spatial and temporal characteristics of exposures to environments in daily life, along with individuals' activity patterns, influence physiological and psychological stress. METHODS AND ANALYSIS:A sample of 2000 adults aged 18-65 and residing in the country of Luxembourg completed a traditional and a map-based questionnaire to collect data on their perceived built, natural and social environments, regular mobility, activity patterns and chronic stress at baseline. A subsample of 200 participants engaged in a 15-day geographically explicit ecological momentary assessment (GEMA) survey, combining a smartphone-enabled global positioning system (GPS) tracking and the repeated daily assessment of the participants' momentary stress, activities and environmental perceptions. Participants further complete multiple daily vocal tasks to collect data on vocal biomarkers of stress. Analytical methods will include machine learning models for stress prediction from vocal features, the use of geographic information systems (GIS) to quantify dynamic environmental exposures in space and time, and statistical models to disentangle the environment-stress relationships. ETHICS AND DISSEMINATION:Ethical approval (LISER REC/2021/024.FRAGMENT/4-5-9-10) was granted by the Research Ethics Committee of the Luxembourg Institute of Socio-Economic Research (LISER), Luxembourg. Results will be disseminated via conferences, peer-review journal papers and comic strips. All project outcomes will be made available at https://www.fragmentproject.eu/.

ABSTRACT Objective: Increased out-of-home consumption may elevate sodium (Na) intake, but self-reported dietary assessments limit evidence. This study explored associations between neighbourhood exposure to fast-food and sit-down restaurants and estimated 24-hour urinary Na excretion. Design: A cross-sectional analysis from the ORISCAV-LUX 2 study (2016-2017). 24-hour urinary Na was estimated from a morning spot urine sample using the INTERSALT formula. Spatial access to fast-food and sit-down restaurants was derived from GIS data around participants’ addresses within 800-m and 1000-meter road-network buffers by summing up the inverse of the road-network distance between their residential address and all restaurants within the corresponding buffer size. Multi-adjusted linear models were used to assess the association between spatial access to restaurants and estimated 24-hour urinary Na excretion. Setting: Luxembourg Participants: Urban adults age over 18 years (n=464). Results: Fast-food and sit-down restaurants accounted for 58.5% of total food outlets. Mean 24-hour urinary Na excretion was 3564 mg/d for men and 2493 mg/d for women. Health-conscious eating habits moderated associations between spatial access to fast-food and sit-down restaurants and Na excretion. For participants who did not attach great importance to having a balanced diet, greater spatial access to restaurants, combining both density and accessibility, was associated with increased urinary Na excretion at 800 m (βhighvslow = 259, 95% CI: 47–488) and 1000 m (βhighvslow = 270, 95% CI: 21–520). Conclusions: Neighbourhood exposure to fast-food and sit-down restaurants influences sodium intake, especially among individuals with less health-conscious eating habits, potentially exacerbating diet-related health disparities.

Abstract Background Greenness exposure has been associated with many health benefits, for example through the pathway of providing opportunities for physical activity (PA). Beside the limited body of longitudinal research, most studies overlook to what extent different types of greenness exposures may be associated with varying levels of PA and sedentary behavior (SB). In this study, we investigated associations of greenness characterized by density, diversity and vegetation type with self-reported PA and SB over a 9-year period, using data from the ORISCAV-LUX study (2007–2017, n = 628). Methods The International Physical Activity Questionnaire (IPAQ) short form was used to collect PA and SB outcomes. PA was expressed as MET-minutes/week and log-transformed, and SB was expressed as sitting time in minutes/day. Geographic Information Systems (ArcGIS Pro, ArcMap) were used to collect the following exposure variables: Tree Cover Density (TCD), Soil-adjusted Vegetation Index (SAVI), and Green Land Use Mix (GLUM). The exposure variables were derived from publicly available sources using remote sensing and cartographic resources. Greenness exposure was calculated within 1000m street network buffers around participants’ exact residential address. Results Using Random Effects Within-Between (REWB) models, we found evidence of negative within-individual associations of TCD with PA (β = − 2.60, 95% CI − 4.75; − 0.44), and negative between-individual associations of GLUM and PA (β = − 2.02, 95% CI − 3.73; − 0.32). There was no evidence for significant associations between greenness exposure and SB. Significant interaction effects by sex were present for the associations between TCD and both PA and SB. Neighborhood socioeconomic status (NSES) did not modify the effect of greenness exposure on PA and SB in the 1000 m buffer. Discussion Our results showed that the relationship between greenness exposure and PA depended on the type of greenness measure used, which stresses the need for the use of more diverse and complementary greenness measures in future research. Tree vegetation and greenness diversity, and changes therein, appeared to relate to PA, with distinct effects among men and women. Replication studies are needed to confirm the relevance of using different greenness measures to understand its’ different associations with PA and SB.

Background and objectives: Increasing evidence suggests that complex measures of exposure accounting for the relative presence of healthy and unhealthy food outlets are more strongly associated with dietary pattern that absolute measures of the food environment, although evidence is limited by the cross-sectional design of existing studies. This study examined the long-term associations between absolute and relative measures of neighbourhood food environment and diet quality in Luxembourg. Methods: We used data of 566 adults participating in both waves of the population-based ORISCAV-LUX study (Wave 1: 2007–2009, Wave 2: 2016–2017). Diet quality was estimated in both waves using the Diet Quality Index-International (DQI-I), assessed with a 174-item food frequency questionnaire. Exposure to healthy and less healthy food outlets was computed within a 1000 m street network buffer around the participants’ home address using both absolute (density, spatial access) and relative (proportion) GIS-based measurements. We used linear mixed models adjusted on individual-level covariates and neighbourhood socioeconomic status to estimate associations between cumulative exposure and change in local retail food environment and DQI-I, and tested modification by neighbourhood socioeconomic status. Results: There was a significant decrease in DQI over 10 years from 62.4 to 60.9 (p < 0.0001). Less healthy food outlets increased by +56% over the 10-year. The results showed a 56% increase in less-healthy food outlets over the period. In an adjusted mixed-effects linear regression, high (vs. low) cumulative exposure to less-healthy food outlets is associated with lower DQI-I, when examining spatial access (β = −1.25, 95% CI: −2.29, −0.22) and proportions (β = −1.24, 95% CI: −2.15, −0.33). Stratification shows these associations to be significant only among urban residents. There was no association between change in exposure to less-healthy food outlets and DQI-I. Among rural residents, increased exposure to healthy food outlets over time was associated with worsened DQI-I when examining absolute measurements (density and spatial access). This unexpected result brings into question the ability of absolute measurements to fully capture the healthiness of food environments. Neighborhood socioeconomic status did not moderate the above associations. Discussion: Our results suggest that the relative contribution of unhealthy food outlets in the neighbourhood may play a role in the deterioration of the quality of the population’s diet over time, and should be given special attention by public authorities.

Background:Inadequate maternal dietary intakes remain a public health challenge in low-income countries like Malawi and can cause adverse birth outcomes. Objectives:To improve maternal dietary intakes and thus reduce the prevalence of adverse birth outcomes in rural Malawi. Methods:We performed a 2-armed (1:1) cluster-randomized controlled trial in Southern Malawi, enrolling pregnant women at gestational age 12-18 wk. Twenty villages (clusters) were randomly assigned to an intervention or a control group. A nutrition education and counseling (NEC) intervention consisted of education sessions followed by cooking demonstrations and counseling sessions. The women were encouraged to use locally available nutrient-dense foods to enhance dietary adequacy and -diversity. We applied linear programming to identify food combinations that could increase micronutrient intakes. The control group received standard antenatal health education. Results:Among the 311 women recruited, 187 (60%) completed the trial. We found no significant difference in mean birth weights recorded within 1 or 24 h of birth between the intervention and control groups. Intervention infants had greater birth length (P = 0.043) and abdominal circumference (P = 0.007) compared to controls, whereas other birth outcomes did not differ significantly. Notably, a quantile analysis revealed that the NEC intervention favored birth weight among mothers with a height below the mean height of the participant sample (156 cm) (P-interaction = 0.043). Conclusions:Tailoring NEC in food-insecure communities did not result in a significant difference in birth weight among infants of the participating mothers, but mean birth length and abdominal circumference were greater in the intervention group compared to controls. We noted that the NEC intervention favored birth weight among mothers with a lower height than the mean sample height. Our results warrant further investigation into offering tailored NEC early in pregnancy and on a larger scale.This trial was registered at clinicaltrials.gov as NCT03136393.

A growing body of evidence suggests that urban densification may be protective against obesity, type 2 diabetes, and cardiometabolic diseases, yet studies on how built environmental features relate to metabolic syndrome (MetS) and its components are scarce. This longitudinal study examines the associations of baseline urban density and densification over 9 years with MetS and MetS components, among 510 participants enrolled in both waves of the ORISCAV-LUX study (2007-2017) in Luxembourg. A continuous MetS score (siMS) was calculated for each participant. Six features of residential built environments were computed around participants' home address: street connectivity, population density, density of amenities, street network distance to the nearest bus station, density of public transport stations, and land use mix. A composite index of urban densification (UDI) was calculated by averaging the six standardized built environment variables. Using adjusted generalized estimating equation (GEE) models, one-SD increase in UDI was associated with a worsening of the siMS score (& beta; = 0.07, 95% CI: 0.02, 0.13), higher triglyceride levels (& beta; = 0.05, 95% CI: 0.02, 0.09), and lower HDL-c levels (& beta; = -1.29, 95% CI: -2.20, -0.38). The detrimental effect of UDI on lipid levels was significant only for participants living in dense areas at baseline. Higher baseline UDI, as well as increased UDI over time among movers, were also associated with greater waist circumference. There were no associations between UDI, fasting plasma glucose and systolic blood pressure. Sex and neighborhood socio-economic status did not moderate the associations between UDI and the cardiometabolic outcomes. Overall, we found limited evidence for an effect of urban densification on MetS and its components. Understanding urban dynamics remains a challenge, and more research investigating the independent and joint health effect of built environment features is needed to support urban planning and design that promote cardiometabolic health.

Analysing the nutritional and environmental impacts of our current diets and promoting sustainable dietary shifts require quantified data on the characteristics of foods. We have jointly studied environmental and nutritional performances of more than 200 generic foods consumed in France, by combining and completing different databases. Several environmental issues calculated by Life Cycle Assessment (LCA) were selected, including impacts on biodiversity. This required to (1) model diets for given subpopulations; (2) adapt the LCA database of food products, Agribalyse 3.0, to link selected food and environmental inventories (3) compile characterization factors to assess impacts on biodiversity. Additionally, modifying Agribalyse 3.0 required to also modify the characterization method on Land Competition. This data paper compiles all the data used to obtain the results presented in the companion article entitled: Environmental trade-offs of fulfilling nutritionally adequacy with reduced animal protein share for French adult populations [1]; i.e. (i) the characterization methods used, (ii) the modifications made to Agribalyse 3.0 and (iii) the nutrient content and quantities consumed of generic foods (iv) the optimized quantities of simulated diets reaching nutrient recommendations with low share of animal-based proteins. It also comprises (iv) Life Cycle Impact Assessment for all Agribalyse 3.0 processes of food having a CIQUAL code (2,497 processes).

BACKGROUND:Monitoring population physical activity (PA) and sedentary behavior over time is important to guide public health actions. The objective of this study was to investigate the changes in PA and sedentary behavior of adult residents in Luxembourg over 10 years. We also investigated variations in change over time across sociodemographic subgroups. METHODS:Two population-based cross-sectional studies of adults living in Luxembourg (Observation of Cardiovascular Risk Factors in Luxembourg [ORISCAV-LUX] [2007-2008] and ORISCAV-LUX 2 [2016-2018]) were considered. Multilevel mixed-effects models were used to investigate changes over time between the studies with regard to self-reported total PA (metabolic equivalent of task-min/week), PA levels (inactive/sufficiently active/highly active), total sitting time, recreational television viewing, and personal computer (PC) use outside of work (in minutes per day). RESULTS:The ORISCAV-LUX study included 1318 participants and the ORISCAV-LUX 2 study involved 1477 participants; 573 adults took part in both studies. The proportion of participants categorized as highly active increased over time by 6.9%. Total PA (761 metabolic equivalent of task-min/wk), television viewing (12 min/d), and PC use outside of work (13 min/d) also increased, whereas the total sitting time decreased by 25 minutes per day. Variations in change over time were observed by sex, country of birth, education, employment status, and perceived financial difficulty. CONCLUSIONS:Over a 10-year period, PA increased and total sitting time decreased in adults living in Luxembourg. With regard to specific sedentary behaviors, television viewing, and PC use outside of work increased. Specific population subgroups will benefit the most from targeted efforts to increase PA and minimize sedentary behavior.

Growing evidence shows a beneficial effect of exposure to greenspace on cardiometabolic health, although limited by the cross-sectional design of most studies. This study examined the long-term associations of resi-dential greenness exposure with metabolic syndrome (MetS) and MetS components within the ORISCAV-LUX study (Wave 1: 2007-2009, Wave 2: 2016-2017, n = 395 adults). Objective exposure to residential greenness was measured in both waves by the Soil-Adjusted Vegetation Index (SAVI) and by Tree Cover Density (TCD). Linear mixed models were fitted to estimate the effect of baseline levels and change in residential greenness on MetS (continuous score: siMS score) and its components (waist circumference, triglycerides, HDL-cholesterol, fasting plasma glucose and systolic blood pressure), respectively. This study provides evidence that an in-crease in SAVI, but not TCD, may play a role in preventing MetS, as well as improving HDL-cholesterol and fasting plasma glucose levels. Greater baseline SAVI was also associated with lower fasting plasma glucose levels in women and participants living in municipalities with intermediate housing price, and greater baseline TCD was associated with larger waist circumference. Overall, findings suggest a mixed impact of increased greenness on cardiometabolic outcomes. Further longitudinal research is needed to better understand the potential effects of different types of greenness exposure on cardiometabolic outcomes.

Background The Healthy Purchase Index (HPI) assesses the nutritional quality of food purchases (FP) from food group expenditure shares only. However, it was developed from the FP of a disadvantaged population. Objective To adapt and validate the HPI for a general population. Methods FP were obtained from a representative sample of French households (Kantar WorldPanel) subdivided into two subsamples. The first sample ( n = 4375) was used to adapt and validate the score; the second sample ( n = 2188) was used to test external validity. The revised-HPI (r-HPI) includes 2 subscores: the diversity subscore and the quality subscore. Diversity subscore points were awarded when expenditure shares were above the 25th percentile for 5 food groups (“Fruits”, “Vegetables”, “Starches”, “Dairy”, “Meat, Fish and Eggs”). Regression models between the expenditure shares of each food group and the Mean Adequacy Ratio (MAR) and the Mean Excess Ratio (MER) of FP were used to select quality subscore components and define cut-offs for point allocation. Construct validity was assessed on the first sample using Spearman’s correlations between the r-HPI and the four nutritional quality indicators (NRF9.3, MAR, MER, energy density), and also by comparing the r-HPI of monthly FP of sub-populations defined by criteria known to influence diet quality (age, gender, income, education) and between households having a monthly food basket of higher (MAR > median and MER and energy density < median) vs. lower nutritional quality within the population, using Wilcoxon tests or pairwise comparisons of contrasts. External validity was tested by performing the same analyses on the 2nd sample of 2188 households. Results The adaptation led to include new components (e.g. red meat) and define new cut-offs (e.g. − 1 point when budget share for red meat > 21%). The r-HPI (mean = 6.50 ± 3.58) was strongly correlated with NRF9.3, MAR, MER and energy density (0.59, 0.52, − 0.41 and − 0.65, respectively, p < 0.01) and poorly correlated with total energy content (− 0.096, p < 0.001). The r-HPI was significantly higher in women ( β = 1.41 [0.20], p < 0.01), households having a food basket of higher nutritional quality ( β = 4.15 [0.11], p < 0.001), and increased significantly with age, income and education levels. Similar results were obtained in the 2nd sample. Conclusion We showed the validity of the r-HPI in a large sample of French households. As it does not require food quantity or nutrient content, it can be used as a valuable tool to explore FP behaviours. Cut-offs can be used in health promotion to provide nutri-economic counselling.

PURPOSE:The purpose of this study was to assess whether the retail food environment, measured by multiple indicators around the home and in activity space, was associated with the nutritional quality of food purchases.METHODS:This cross-sectional study included 462 households from a quota sampling survey conducted in the south of France (Montpellier Metropolitan Area). The revised Healthy Purchase Index was implemented in order to assess the nutritional quality of food purchases. Food environment indicators (presence, number, relative density and proximity of food outlets) were calculated around the home and in activity space using a geographical information system. Six different types of food outlets were studied: supermarkets, markets, greengrocers, bakeries, other specialized food stores (butcher's, fishmonger's and dairy stores) and small grocery stores. Associations between food environment and the nutritional quality of food purchases were assessed using multilevel models, and geographically weighted regressions to account for spatial non-stationarity. Models were adjusted for households' socioeconomic and demographic characteristics.RESULTS:The nutritional quality of food purchases was positively associated with the number of greengrocers around the home (1 vs. 0: β = 0.25, 95%CI = [0.01, 0.49]; >1 vs. 0: β = 0.25, 95%CI = [0.00, 0.50]), but negatively associated with the number of markets around the home (1 vs. 0: β = -0.20, 95%CI = [-0.40, 0.00]; >1 vs. 0: β = -0.37, 95%CI = [-0.69, -0.06]). These associations varied across space in the area studied. For lower income households, the number of greengrocers in activity space was positively associated with the nutritional quality of food purchases (1 vs. 0: β = 0.70, 95%CI = [0.12, 1.3]; >1 vs. 0: β = 0.67, 95%CI = [0.22, 1.1]).CONCLUSIONS:Greengrocers might be an effective type of food store for promoting healthier dietary behaviors. Further studies, particularly interventional studies, are needed to confirm these results in order to guide public health policies in actions designed to improve the food environment.

Context: Collective gardens are increasingly considered a tool to promote health and well-being. Objective: In this systematic review, we critically appraise quantitative studies exploring the potential health benefits of urban collective garden participation. Data Sources: Articles published between January 2000 and August 2020 were used. Data Extraction: All original research studies reporting at least 1 health outcomes associated with urban collective gardening in free-living adults from Western and other high-income countries were included. Of 1261 articles identified, 15 were included in the systematic review. Methodological quality was assessed by applying the criteria of the Quantitative Study Quality Assessment Tool. Analysis: A wide range of health indicators was used. Collective gardening was associated with higher fruit and vegetable consumption than was nongardening. Mixed results were found for physical activity and physiological health. A positive association was found in most studies with mental health and social health. However, the vast majority of included studies were cross-sectional and presented selection bias (n = 13 of 15 for both) and very few used objective measurement methods (n = 3 of 15). Conclusions: Longitudinal studies allowing the exploration of causal relationships are needed before the health benefits of collective garden participation suggested by existing studies can be confirmed.

We compare interviews with 30 new community gardeners in Denver, Colorado and Montpellier, France, using Self-determination theory, a general theory of motivation, to determine how new community gardeners may or may not have felt motivated based on psychological needs of autonomy, competence, and relatedness. Relatedness as a motivational feature carried through the interview data at both sites. Participants' success or failure to relate to other gardeners was a major influence for how autonomous and competent as a community gardener they expressed feeling. As the evidence grows that community gardening is beneficial for health and wellbeing, our findings are critical to understanding how community gardening could serve as a health promotion strategy. With the presence of ongoing, friendly support from others, more individuals may adhere to this socially connective, nature-based practice.

W ith over 70% of Europe’s population living in cities, there is an urgent need to promote sustainable urban development that ensures community health, social inclusion, environmental protection and economic development. Urban green spaces are recognized as a vital element in the design of sustainable cities. They provide many health, social and environmental benefits, especially for the most vulnerable segments of the population (WHO Regional Office for Europe, 2016). Community gardens are among the different forms of green spaces. They may be individual and/or collective plots of land cultivated and managed by people living in the neighbourhood. These gardens may be developed within the framework of city policies or urban renewal programmes. They mainly have a social and cultural function, but also contribute to more sustainable food systems by providing access to fresh and highly nutritional seasonal produce. The overall aim is thus to achieve more sustainable food systems. The literature suggests that community gardens have many health benefits for users, including enhanced fruit and vegetable consumption, physical activity, as well as mental wellbeing and social bonding (Alaimo et al., 2016). Studies conducted to date have, however, mainly used qualitative or self-declared data and were cross-sectional, i.e. monitoring gardeners at a given time, sometimes comparing them with simultaneously monitored control non-gardeners. Yet the design of these cross-sectional studies does not enable assessment of causal links between community garden access and the adoption of healthier ● The results of the JArDinS study—conducted in the Greater Montpellier area—did not reveal any changes towards more sustainable lifestyles among community garden users a year after they began participating in the garden. ● Novice gardeners mentioned several difficulties in getting involved in their community garden, which they visited irregularly. This could explain why no lifestyle impact was noted. ● The organization of community gardens should be revised to promote long-term integration and active participation of city dwellers (location close to their households, support and regular activities), thereby enhancing lifestyle sustainability. KEY POINTS POLICY BRIEF N° 13 • JANUARY 2021 The UNESCO Chair in World Food Systems breaks down the barriers of knowledge on food. The So What? collection translates the results of research into straightforward conclusions for action.

De nombreuses villes implantent des jardins collectifs sur leurs territoires dans le but de promouvoir la santé et le bien-être des habitants. Nous avons conduit une revue systématique de la littérature des études s’appuyant sur des méthodes quantitatives pour explorer le lien entre participation à jardin collectif et santé des citadins adultes. Sur les 1430 articles identifiés, 18 ont été retenus. L’outil « d’évaluation de la qualité des études quantitatives » développé par l’EPHPP a été utilisé pour évaluer la qualité méthodologique des études. La participation à un jardin collectif était associée à une plus grande consommation de fruits et légumes, ainsi qu’à un bien-être mental et social accru. Les résultats étaient mitigés pour l’IMC, l’activité physique et d’autres indicateurs de la santé physique. Les études étaient de faible qualité, principalement en raison de leur design transversal (n=14/18) et de leur risque élevé de biais de sélection (n=15/18). Davantage d’études longitudinales avec évaluation avant/après et présence d’un groupe contrôle sont nécessaires pour déterminer si les jardins collectifs peuvent être un outil efficace pour promouvoir la santé des citadins.