Montpellier Interdisciplinary center on Sustainable Agri-food systems: social and nutritional sciences

OBJECTIVE: To assess the prospective associations between consumption of ultra-processed food and risk of cancer. DESIGN: Population based cohort study. SETTING AND PARTICIPANTS: 104 980 participants aged at least 18 years (median age 42.8 years) from the French NutriNet-Santé cohort (2009-17). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants' usual consumption for 3300 different food items. These were categorised according to their degree of processing by the NOVA classification. MAIN OUTCOME MEASURES: Associations between ultra-processed food intake and risk of overall, breast, prostate, and colorectal cancer assessed by multivariable Cox proportional hazard models adjusted for known risk factors. RESULTS: Ultra-processed food intake was associated with higher overall cancer risk (n=2228 cases; hazard ratio for a 10% increment in the proportion of ultra-processed food in the diet 1.12 (95% confidence interval 1.06 to 1.18); P for trend<0.001) and breast cancer risk (n=739 cases; hazard ratio 1.11 (1.02 to 1.22); P for trend=0.02). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis). CONCLUSIONS: In this large prospective study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer. Further studies are needed to better understand the relative effect of the various dimensions of processing (nutritional composition, food additives, contact materials, and neoformed contaminants) in these associations. STUDY REGISTRATION: Clinicaltrials.gov NCT03335644.

Abstract Objective To assess the prospective associations between consumption of ultra-processed foods and risk of cardiovascular diseases. Design Population based cohort study. Setting NutriNet-Santé cohort, France 2009-18. Participants 105 159 participants aged at least 18 years. Dietary intakes were collected using repeated 24 hour dietary records (5.7 for each participant on average), designed to register participants’ usual consumption of 3300 food items. These foods were categorised using the NOVA classification according to degree of processing. Main outcome measures Associations between intake of ultra-processed food and overall risk of cardiovascular, coronary heart, and cerebrovascular diseases assessed by multivariable Cox proportional hazard models adjusted for known risk factors. Results During a median follow-up of 5.2 years, intake of ultra-processed food was associated with a higher risk of overall cardiovascular disease (1409 cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet 1.12 (95% confidence interval 1.05 to 1.20); P&lt;0.001, 518 208 person years, incidence rates in high consumers of ultra-processed foods (fourth quarter) 277 per 100 000 person years, and in low consumers (first quarter) 242 per 100 000 person years), coronary heart disease risk (665 cases; hazard ratio 1.13 (1.02 to 1.24); P=0.02, 520 319 person years, incidence rates 124 and 109 per 100 000 person years, in the high and low consumers, respectively), and cerebrovascular disease risk (829 cases; hazard ratio 1.11 (1.01 to 1.21); P=0.02, 520 023 person years, incidence rates 163 and 144 per 100 000 person years, in high and low consumers, respectively). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (saturated fatty acids, sodium and sugar intakes, dietary fibre, or a healthy dietary pattern derived by principal component analysis) and after a large range of sensitivity analyses. Conclusions In this large observational prospective study, higher consumption of ultra-processed foods was associated with higher risks of cardiovascular, coronary heart, and cerebrovascular diseases. These results need to be confirmed in other populations and settings, and causality remains to be established. Various factors in processing, such as nutritional composition of the final product, additives, contact materials, and neoformed contaminants might play a role in these associations, and further studies are needed to understand better the relative contributions. Meanwhile, public health authorities in several countries have recently started to promote unprocessed or minimally processed foods and to recommend limiting the consumption of ultra-processed foods. Study registration ClinicalTrials.gov NCT03335644 .

BACKGROUND: There is a growing trend for vegetarian and vegan diets in many Western countries. Epidemiological evidence suggesting that such diets may help in maintaining good health is rising. However, dietary and sociodemographic characteristics of vegetarians and vegans are not well known. The aim of this cross-sectional study was to describe sociodemographic and nutritional characteristics of self-reported, adult vegetarians and vegans, compared to meat-eaters, from the French NutriNet-Santé study. METHODS: Participants were asked if they were following a specific diet. They were then classified into three self-reported diet groups: 90,664 meat-eaters, 2370 vegetarians, and 789 vegans. Dietary data were collected using three repeated 24-h dietary records. Multivariable polytomic logistic regression models were perfomed to assess the association between the sociodemographic characteristics and type of diet. The prevalence of nutrient intake inadequacy was estimated, by sex and age for micronutrients, as well as by type of self-reported diet. RESULTS: Compared with meat-eaters, vegetarians were more likely to have a higher educational level, whereas vegans had a lower education level. Compared with meat-eaters, vegetarians were more likely to be women, younger individuals, and to be self-employed or never employed rather than managerial staff. Vegetarians and vegans substituted animal protein-dense products with a higher consumption of plant protein-dense products (e.g., soy-based products or legumes). Vegetarians had the most balanced diets in terms of macronutrients, but also had a better adherence to French dietary guidelines. Vegetarians exhibited a lower estimated prevalence of inadequacies for micronutrients such as antioxidant vitamins (e.g., for vitamin E, 28.9% for vegetarian women <55 years of age vs. 41.6% in meat-eaters) while vegans exhibited a higher estimated prevalence of inadequacies for some nutrients, in particular vitamin B12 (69.9% in men and 83.4% in women <55 years of age), compared to meat-eaters. CONCLUSIONS: Our study highlighted that, overall, self-reported vegetarians and vegans may meet nutritional recommendations.

The Food and Agriculture Organization defines sustainable diets as nutritionally adequate, safe, healthy, culturally acceptable, economically affordable diets that have little environmental impact. This review summarizes the studies assessing, at the individual level, both the environmental impact and the nutritional quality or healthiness of self-selected diets. Reductions in meat consumption and energy intake were identified as primary factors for reducing diet-related greenhouse gas emissions. The choice of foods to replace meat, however, was crucial, with some isocaloric substitutions possibly increasing total diet greenhouse gas emissions. Moreover, nutritional adequacy was rarely or only partially assessed, thereby compromising the assessment of diet sustainability. Furthermore, high nutritional quality was not necessarily associated with affordability or lower environmental impact. Hence, when identifying sustainable diets, each dimension needs to be assessed by relevant indicators. Finally, some nonvegetarian self-selected diets consumed by a substantial fraction of the population showed good compatibility with the nutritional, environmental, affordability, and acceptability dimensions. Altogether, the reviewed studies revealed the scarcity of standardized nationally representative data for food prices and environmental indicators and suggest that diet sustainability might be increased without drastic dietary changes.

Shifting from a linear to a circular economy in the agrifood domain requires innovative business models, including reverse logistics, new visions on customer-supplier relationships, and new forms of organization and marketing strategies at the crossroads of various value chains. This research aims to identify and characterise different types of business models that create value from agricultural waste and by-products via cascading or closing loops. Conceptual and management insights into circular business models are still sparse. In total, 39 cases have been studied that convert agro-waste and by-products into valuable products via a circular economy approach. Semi-structured interviews and on-site visits of six representative cases have been done, and secondary data been collected. Data has been treated with content analysis. Cases are presented according to the type of organisational structure, resources, transformation processes, value propositions, key partners, customers, strategic approaches and innovation. Six types of circular business models are identified and discussed: biogas plant, upcycling entrepreneurship, environmental biorefinery, agricultural cooperative, agropark and support structure. They differ in their way of value creation and organisational form, but strongly depend on partnerships and their capacity to respond to changing external conditions. This study offers the first circular business model typology within the agricultural domain, revealing the interconnectedness of the six different business model types. It provides options for managers in positioning and adapting their business strategies. It highlights the potential of using biomass first for higher added-value products before exploiting it as energy source. Cascading biomass valorisation at a territorial level will increasingly be important for locally cooperating actors within a circular bioeconomy approach.

BACKGROUND: Ultra-processed food (UPF) consumption has increased drastically worldwide and already represents 50%-60% of total daily energy intake in several high-income countries. In the meantime, the prevalence of overweight and obesity has risen continuously during the last century. The objective of this study was to investigate the associations between UPF consumption and the risk of overweight and obesity, as well as change in body mass index (BMI), in a large French cohort. METHODS AND FINDINGS: A total of 110,260 adult participants (≥18 years old, mean baseline age = 43.1 [SD 14.6] years; 78.2% women) from the French prospective population-based NutriNet-Santé cohort (2009-2019) were included. Dietary intakes were collected at baseline using repeated and validated 24-hour dietary records linked to a food composition database that included >3,500 different food items, each categorized according to their degree of processing by the NOVA classification. Associations between the proportion of UPF in the diet and BMI change during follow-up were assessed using linear mixed models. Associations with risk of overweight and obesity were assessed using Cox proportional hazard models. After adjusting for age, sex, educational level, marital status, physical activity, smoking status, alcohol intake, number of 24-hour dietary records, and energy intake, we observed a positive association between UPF intake and gain in BMI (β Time × UPF = 0.02 for an absolute increment of 10 in the percentage of UPF in the diet, P < 0.001). UPF intake was associated with a higher risk of overweight (n = 7,063 overweight participants; hazard ratio (HR) for an absolute increase of 10% of UPFs in the diet = 1.11, 95% CI: 1.08-1.14; P < 0.001) and obesity (n = 3,066 incident obese participants; HR10% = 1.09 (1.05-1.13); P < 0.001). These results remained statistically significant after adjustment for the nutritional quality of the diet and energy intake. Study limitations include possible selection bias, potential residual confounding due to the observational design, and a possible item misclassification according to the level of processing. Nonetheless, robustness was tested and verified using a large panel of sensitivity analyses. CONCLUSIONS: In this large observational prospective study, higher consumption of UPF was associated with gain in BMI and higher risks of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption. TRIAL REGISTRATION: ClinicalTrials.gov NCT03335644 (https://clinicaltrials.gov/ct2/show/NCT03335644).

Abstract Consumers are faced with an increasing number of sustainable food labels. These different labels may be complementary or add to the increasing competition of product information in consumers' minds. We investigate: (1) the perceptions that consumers in the UK have about sustainable labels vs. other labels, such as origin or nutrition labels; and (2) consumers' reactions to combinations of different sustainable labels. Overall, the findings from two focus groups conducted in the UK indicate that consumers have positive perceptions of organic and fair trade labels but tend to be sceptical about unfamiliar labels and general claims such as ‘climate friendly’. The results also indicate the importance of familiarity, trust and fit between combinations of labels as well as between associating a label with a brand. While the combination of certain labels can enhance the value of a food product, this study also indicates that other label combinations (e.g. private and sustainable label) can detract from a label's value. Implications and recommendations are suggested for managers to counter the image of greenwashing, and for policy makers to facilitate sustainable food choices.

The processes underlying environmental, economic, and social unsustainability derive in part from the food system. Building sustainable food systems has become a predominating endeavor aiming to redirect our food systems and policies towards better-adjusted goals and improved societal welfare. Food systems are complex social-ecological systems involving multiple interactions between human and natural components. Policy needs to encourage public perception of humanity and nature as interdependent and interacting. The systemic nature of these interdependencies and interactions calls for systems approaches and integrated assessment tools. Identifying and modeling the intrinsic properties of the food system that will ensure its essential outcomes are maintained or enhanced over time and across generations, will help organizations and governmental institutions to track progress towards sustainability, and set policies that encourage positive transformations. This paper proposes a conceptual model that articulates crucial vulnerability and resilience factors to global environmental and socio-economic changes, postulating specific food and nutrition security issues as priority outcomes of food systems. By acknowledging the systemic nature of sustainability, this approach allows consideration of causal factor dynamics. In a stepwise approach, a logical application is schematized for three Mediterranean countries, namely Spain, France, and Italy.

For a transition from a linear, ‘take-make-dispose’ economy to a sustainable usage of all constituents of renewable resources in cascading and circular pathways, new business models valorising streams that are currently considered as waste are needed. The aim of this article is to understand critical success and risk factors of eco-innovative business models that contribute to a circular economy via agricultural unavoidable waste or by-products valorisation. 39 cases were studied focusing on agricultural side stream conversion into valuable products. Semi-structured interviews were performed and secondary data collected. Cases were analysed according to types of initiatives, main objectives, resources and valorisation pathways, as well as external and internal factors that have influenced the businesses over time. Following success and risk factor categories are identified: (1) technical and logistic, (2) economic, financial and marketing, (3) organisational and spatial, (4) institutional and legal, (5) environmental, social and cultural. Herein, specific factors for the agricultural sector are innovative conversion technologies, flexible in and out logistics, joint investments in R&D, price competitiveness for bio-based products, partnerships with research organisations, space availability, subsidies, agricultural waste management regulations, local stakeholder involvement and acceptance of bio-based production processes. Insights from this study can help farmers and agribusiness managers by defining and adapting their strategies within their local contexts. They also show that for shifting from linear agro-food chains to a circular system, individual businesses need to evolve towards more dynamic and integrated business models, in which the macro-environment sets the boundary conditions for successful operations.

Pulses display nutritional benefits and are recommended in sustainable diets. Indeed, they are rich in proteins and fibers, and can contain variable amounts of micronutrients. However, pulses also contain bioactive compounds such as phytates, saponins, or polyphenols/tannins that can exhibit ambivalent nutritional properties depending on their amount in the diet. We characterized the nutritional composition and bioactive compound content of five types of prepared pulses frequently consumed in France (kidney beans, white beans, chickpeas, brown and green lentils, flageolets), and specifically compared the effects of household cooking vs. canning on the composition of pulses that can be consumed one way or the other. The contents in macro-, micronutrients, and bioactive compounds highly varied from one pulse to another (i.e., 6.9 to 9.7 g/100 g of cooked product for proteins, 4.6 to 818.9 µg/100 g for lutein or 15.0 to 284.3 mg/100 g for polyphenols). The preparation method was a key factor governing pulse final nutritional composition in hydrophilic compounds, depending on pulse species. Canning led to a greater decrease in proteins, total dietary fibers, magnesium or phytate contents compared to household cooking (i.e., −30%, −44%, −33% and −38%, p &lt; 0.05, respectively, in kidney beans). As canned pulses are easy to use for consumers, additional research is needed to improve their transformation process to further optimize their nutritional quality.

Abstract In many Sub‐Saharan African countries, farmers typically have a choice between selling their products to traders who travel between villages and markets and transporting their products to the nearest market themselves. Because of communities’ remoteness and poor communications with marketplaces, farmers’ uncertainty about market prices is usually high. Traders may take advantage of farmers’ ignorance of the market price and extract a rent from them by offering very low prices for their products. In this article, we model bargaining interactions between farmers and traders meeting at the farmgate and we study how price information affects the bargain and the balance of power. We show the conditions for Market Information Services (MIS) to be profitable for farmers and examine efficiency issues associated with asymmetric information. Finally, we test the model's prediction that information results in positive individual gain for farmers using original survey data collected in the Northern region of Ghana. Specifically, we estimate the causal effect of a mobile‐based MIS program on farmers’ marketing performances and find that farmers who have benefited from the MIS program received significantly higher prices for maize and groundnuts: about 10% more for maize and 7% more for groundnuts than what they would have received had they not participated in the MIS program. These results suggest that the theoretical conditions for successful farmer use of MIS may be met in the field.

Abstract This research addresses the interaction between the components of brand. More specifically, the authors evaluate how the region of origin as a component of a wine brand adds value to a wine purchaser. Previous research suggests that the region of origin equity is significantly moderated by the other wine attributes with which it is combined on the wine label: commercial brand, level of price, type of bottler, grape variety. The authors test whether the moderating effects depend on self‐perceived consumer expertise. They use a discrete choice method to survey 1,162 European wine purchasers, about equally selected from France, Austria, Germany, and the UK. Results show that the region of origin equity is indeed significantly moderated by the other wine attributes. They also show these moderating effects are more important for consumers who perceive themselves as “more expert” than for consumers who feel they are “novices.” [EconLit citation: M310]. © 2006 Wiley Periodicals, Inc. Agribusiness 22: 323–341, 2006.

Anchored in an empirically-grounded anthropology, this book explores the notion of governance in a non-normative way. It describes and analyses the institutional and political processes through which social actors and groups - be they state, private or 'third-sector' - contribute to the provision of public and collective goods or services. The book draws on case studies from Anglophone and Francophone Africa, crossing anthropological traditions that have too often evolved in parallel directions and dealing with a range of topics such as health, water supply, sanitation and waste management, security, humanitarian aid, land issues and decentralisation. Beyond African boundaries, it contributes to current debates about governmentality, public policy, subject making, public/private boundaries, and the role of the state.

A sustainable diet is, by definition, nutritionally adequate, economically affordable, culturally acceptable, and environmentally respectful. Designing such a diet has to integrate different dimensions of diet sustainability that may not be compatible with each other. Among multicriteria assessment methods, diet optimization is a whole-diet approach that simultaneously combines several metrics for dimensions of diet sustainability. This narrative review based on 67 published studies shows how mathematical diet optimization can help with understanding the relations between the different dimensions of diet sustainability and how it can be properly used to identify sustainable diets. Diet optimization aims to find the optimal combination of foods for a population, a subpopulation, or an individual that fulfills a set of constraints while minimizing or maximizing an objective function. In the studies reviewed, diet optimization was used to examine the links between dimensions of diet sustainability, identify the minimum cost or environmental impact of a nutritionally adequate diet, or identify food combinations able to combine ≥2 sustainability dimensions. If some constraints prove difficult to fulfill, this signals an incompatibility between nutrient recommendations, over-monotonous food-consumption patterns, an inadequate supply of nutrient-rich foods, or an incompatibility with other dimensions. If diet optimization proves successful, it can serve to design nutritionally adequate, culturally acceptable, economically affordable, and environmentally friendly diets. Diet optimization results can help define dietary recommendations, tackle food security issues, and promote sustainable dietary patterns. This review emphasizes the importance of carefully choosing the model parameters (variables, objective function, constraints) and input data and the need for appropriate expertise to correctly interpret and communicate the results. Future research should make improvements in the choice of metrics used to assess each aspect of a sustainable diet, especially the cultural dimension, to improve the practicability of the results.

Background Social isolation, the relative absence of or infrequency of contact with different types of social relationships, and loneliness (perceived isolation) are associated with adverse health outcomes. Objective To review observational and intervention research that examines the impact of social isolation and loneliness on cardiovascular and brain health and discuss proposed mechanisms for observed associations. Methods We conducted a systematic scoping review of available research. We searched 4 databases, PubMed, PsycInfo, Cumulative Index of Nursing and Allied Health, and Scopus. Findings Evidence is most consistent for a direct association between social isolation, loneliness, and coronary heart disease and stroke mortality. However, data on the association between social isolation and loneliness with heart failure, dementia, and cognitive impairment are sparse and less robust. Few studies have empirically tested mediating pathways between social isolation, loneliness, and cardiovascular and brain health outcomes using appropriate methods for explanatory analyses. Notably, the effect estimates are small, and there may be unmeasured confounders of the associations. Research in groups that may be at higher risk or more vulnerable to the effects of social isolation is limited. We did not find any intervention studies that sought to reduce the adverse impact of social isolation or loneliness on cardiovascular or brain health outcomes. Conclusions Social isolation and loneliness are common and appear to be independent risk factors for worse cardiovascular and brain health; however, consistency of the associations varies by outcome. There is a need to develop, implement, and test interventions to improve cardiovascular and brain health for individuals who are socially isolated or lonely.

Abstract Products certified according to their environmental and social sustainability are becoming an important feature of production, trade and consumption in the agro‐food sector. ‘Sustainability networks’ are behind the emergence and growth of these new product forms, often evolving into multi‐stakeholder initiatives that establish and manage base codes, standards, certifications and labels. As sustainability moves into the mainstream, understanding the governance of these networks is essential because they partly reshape the structure and characteristics of commodity flows. In this article, we examine the role of expert knowledge and process management in governing two multi‐stakeholder initiatives (the Marine Stewardship Council and the Roundtable for Sustainable Palm Oil) and in shaping their distributional effects. We find that the ability of developing countries, especially small‐scale actors within them, to shape standard setting and management to their advantage depends not only on overcoming important structural differences in endowments and access to resources, but also on more subtle games. These include promoting the enrolment of one expert group or kind of expert knowledge over another, using specific formats of negotiation, and legitimating particular modes of engagement over others.

Dietary diversity has long been recognized as a key component of diet quality and many dietary diversity indicators (DDIs) have been developed. This systematic scoping review aimed to present a comprehensive inventory of DDIs and summarize evidence linking DDIs and dietary adequacy or health outcomes in adolescents and adults. Two search strategies were developed to identify peer-reviewed articles published in English up until June 2018 and were applied to Medline, Web of Science, and Scopus. A 2-stage screening process was used to select the studies to be reviewed. Four types of DDIs were identified among 161 articles, the majority of them belonging to the food group-based indicator type (n = 106 articles). Fifty studies indicated that DDIs were proxies of nutrient adequacy, but there was a lack of evidence about their relation with nutrients to limit. Associations between DDIs and health outcomes were largely inconsistent among 137 studies, especially when the outcomes studied were body weight (n = 60) and noncommunicable diseases (n = 41). We conclude that the ability of DDIs to reflect diet quality was found to be principally limited to micronutrient adequacy and that DDIs do not readily relate to health outcomes. These findings have implications for studies in low- and lower-middle-income economies where DDIs are often used to assess dietary patterns and overall diet quality.

This paper presents a qualitative study of the trade-offs made by organic food product consumers in the Chinese Metropolis of Shanghai. More precisely, this article deals with trade-offs that consumers make between three types of products: (1) locally produced organic food products, (2) products that are locally and conventionally produced and (3) imported organic food products. We used a qualitative methodology using open questions and projective techniques and based on 23 individual interviews. Local organic products are the products best perceived by the Chinese interviewees, who think that organic food is beneficial to health and makes agriculture more environmentally friendly. The fact that food is produced locally is another positive argument for many interviewees who do not perceive any important differences between local and imported, more expensive, organic food products. Local and conventionally produced food products give rise to worries related to health and consumers buy them only because they are much cheaper than organic products. The reasons for choosing organic products are mostly related to health issues. Altruistic motives such as environmental concerns, food miles concerns or support for small producers are only emerging. This study mostly highlighted consumers' trade-offs between different individual benefits, mainly health vs. economic benefits. However, some trade-offs between altruistic (environmental concerns) and individual (economic) benefits are apparent, confirming emerging altruistic motives behind organic food consumption.

We elicit the risk preferences of a sample of French farmers in a field-experiment setting, considering both expected utility and cumulative prospect theory. Under the EU framework, our results show that farmers are characterised by a concave utility function for gain outcomes implying risk aversion. The CPT framework confirms this result, but also suggests that farmers are twice as sensitive to losses as to gains and tend to pay undue attention to unlikely extreme outcomes. Accounting for loss aversion and probability weighting can make a difference in the design of effective and efficient policies, contracts or insurance schemes.

This article describes the development of vegetable marketing in Ho Chi Minh City (Vietnam), where modern distribution outlets are competing fiercely with traditional traders for wholesale and retail customers. Data from interviews with supply chain stakeholders and a survey of vegetable wholesalers have been used to compare the performance of modern and traditional chains, and the findings reveal the chains as segmented in their product focus, the modern sector focusing exclusively on quality. Modern marketing channels are generally more efficient than traditional ones but still account for only around 2% of vegetable distribution. The article argues that policy-makers should not promote the ‘modernisation’ of food systems at the expense of traditional channels which meet important consumer needs.