|Year : 2021 | Volume
| Issue : 1 | Page : 19-24
Plant-based diet: A solution to the sustainability of life and environment
Vikas Bhatia1, Gokul Gopi2, Priyamadhaba Behera3
1 Executive Director, AIIMS, Bibinagar, Telangana, India
2 The Brooklyn Hospital Centre, New York, USA
3 Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
|Date of Submission||22-Oct-2020|
|Date of Acceptance||14-May-2021|
|Date of Web Publication||29-Jun-2021|
Dr. Priyamadhaba Behera
Department of Community Medicine and Family Medicine, Room No: 304, 3rd Floor, Academic Block, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha
Source of Support: None, Conflict of Interest: None
The entirety of food and drink that an individual continually expends is called a diet. Proper nutrition – a sufficient, all-around offset diet with regular physical activity, frames the establishment for good health. The majority of the currently prevalent dietary recommendations are based on the health benefits of different individual food products. With the rising concern regarding climate change and evidence highlighting the influence of our nutritional practices on the environment, the time has come to redefine the dietary guidelines and recommendations considering the environmental impact of diet along with the health benefits. Studies have been reliably consistent with demonstrating that an equicaloric diet rich in plant-based products and lower in animal products is beneficial to health and put a lesser burden on the earth. There are five Sustainable Developmental Goals that can be linked with our dietary practices (no poverty, no hunger, good health and well-being, responsible consumption and production, and climate change). A plant-based diet is a suitable solution to the current crisis of noncommunicable diseases and climate change. Moving on to such a dietary practice would require immense changes in the currently prevalent food system with an emphasis on better production and waste management strategies along with improvement in food delivery and consumption practices worldwide. This article brings insight regarding the benefits of a plant-based diet and the need to address the ecological impact of animal-based foods.
Keywords: Disease, environment, nutrition, vegan, vegetarian
|How to cite this article:|
Bhatia V, Gopi G, Behera P. Plant-based diet: A solution to the sustainability of life and environment. Indian J Community Fam Med 2021;7:19-24
|How to cite this URL:|
Bhatia V, Gopi G, Behera P. Plant-based diet: A solution to the sustainability of life and environment. Indian J Community Fam Med [serial online] 2021 [cited 2021 Jul 25];7:19-24. Available from: https://www.ijcfm.org/text.asp?2021/7/1/19/319930
| Introduction|| |
The aggregate of food and drinks that an individual continually expends is called diet. Numerous factors influence individual dietary practices such as moral and religious convictions, clinical need, or a wish to control weight. The objective of dietary practices should be to improve our well-being. There are two broad dietary patterns: an omnivorous and a vegetarian diet. Two significant variations of the vegetarian diet include the lacto-ovo-vegetarian diet, where meats are avoided, yet the utilization of milk and egg is permitted, and the vegan diet, where all items that stem from animals are avoided. Gussow in 1978 first used the term “Nutritional Ecology,” and is defined as “a scientific area of research that encompasses the entire food chain, as well as its relations with health, environment, society, and economy.” It is a field of nutrition science dealing with the local and global impact of food production, processing, trade, and consumption. At present, nutrition sciences are dominated by the quality and health aspects of the food, with most of the currently prevalent dietary guidelines based predominantly on the physiologic requirement and toxicological considerations.
It is undeniable that food choices play a crucial role in human health, but in the past decade, awareness has grown regarding the impact of our dietary practices on the environment., Although the environmental impact of food has been agreed upon, the real influence of the whole diet (the combination of food) on various indexes of ecological impact is still not established. Theoretical analysis of the extent to which a diet affects the environment is usually derived by using the Life-Cycle Assessment (LCA) method to individual food products or class of the food. LCA analysis, being based upon the dietary recommendations, average population consumption, and hypothetical/model diet, fails to reflect the actual eating habit of a population. The data on the impact of individual food products such as meat and vegetables on the environment have been increasing as of the past decade. Still, there is a significant shortage of data regarding how a combination of this food which a population consumes influences the environment. The nutritional system has an impact on the environment, which in turn influences the quality of food. Numerous studies demonstrate that plant-based diets are more environmentally friendly than animal-based diets.,, With growing evidence, the time has come for us to consider the impact of dietary practices on our environment and incorporate the same while preparing dietary recommendations/guidelines. Our article aims to bring insight regarding the benefits of a plant-based diet and the urgent need to address the ecological impact of meat-based foods.
| Summary of History and Evolution of Dietary Practices Among Primates|| |
Humans largely resemble other primates in that they are omnivorous and have specific dietary necessities that feature adjustments to a diet composed mostly of fruits and vegetables (e.g. cannot synthesize Vitamin C). The dietary pattern of most primates can be grouped as faunivory (other animals, insects, and invertebrates), gumnivory (saps and gums), frugivory (fruits), gramnivory (nuts and seeds), and folivory (leaves and other plant parts). The eating regimens of most primates contain food from no less than two of these classes to meet both protein and caloric requirements. Leonard, in his book, mentions “Environmental variations in accessibility to adequate nourishment has consistently been a major stressor all through the evolutionary history, and continues to emphatically shape the nature of human populations today.” Contrasted with the preceding species of ancient humans, the emergence of Homo erectus showed (1) striking increment in brain volume and body estimate, (2) decrease in size of the posterior tooth and craniofacial stronghold, (3) the development of humanlike appendages, and (4) critical changes in scavenging/survival conduct., Meat seems to have been progressively incorporated in the dietary pattern of H. erectus than its predecessors. Besides the energetic gains of utilizing more animal foods, Cordain has noticed that he would likewise have gained an increased level of key unsaturated fats that are fundamental for supporting brain development and capacity. Mammalian brain development is dependent on adequate availability of two explicit long-chain polyunsaturated fatty acids: docosahexaenoic acid (DHA) and arachidonic acid (AA). Bigger cranial capacity necessitates more DHA and AA; yet, all mammals have a constrained ability to synthesize these unsaturated fats from dietary precursors., Thus, to advance bigger hominin brain sizes, more noteworthy utilization of DHA and AA would have been fundamental. Cordain et al. found that wild plant supplies from the African grasslands contained practically zero AA and DHA, though muscle tissue and organ meat of huge African herbivores gave moderate to high amounts of these essential unsaturated fats. To outline, the current proof proposes that early H. erectus devoured a blended eating routine containing a more significant proportion of animal food than their forerunners. With the movement of time and advancement, people have built up a high level of dietary versatility, and human eating regimens extend from totally vegetarian (as in numerous populaces of South Asia) to ones centered almost exclusively on meat and animal foods (e.g. customary Eskimo/Inuit populaces of the cold). This capacity to use a different combination of plant and animal resources as sustenance is one of the highlights that allowed people to spread and colonize biological systems all through the world.
| Plant-Based Diet: Evidence for Lesser Morbidity and Mortality|| |
The correlation between nutrition and health has always been a field of intense research and evidence continues to accumulate, showing the undisputable health benefit of plant-based diets. A meta-analysis by Yokoyama et al., published in 2017, summarizes 30 observational studies and 19 clinical trials that investigated the influence of a plant-based diet on lipid profile. The meta-analysis concluded that compared with an omnivorous diet, vegetarian diet consumption was associated with lower total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol but with no significant triglyceride concentration difference. Thus, the consumption of a vegetarian diet offers a useful option in reducing coronary artery diseases. Another meta-analysis by Bechthold et al. reviewed 123 reports and reiterates the benefits of whole grain, nuts, legumes, fruits, and vegetables in the prevention of coronary heart diseases (CHD), heart failure, and stroke. Dinu et al., in their systematic review with meta-analysis of 108 articles, found out a significantly lower risk of cancer incidence among vegetarians and vegans compared to omnivores. After analysis for localization of cancer was done, a nonsignificant reduction in the incidence of breast cancer, as well as mortality from breast, colorectal, prostate, and lung cancers, was reported among vegetarians compared to omnivores. From these reports, it can be concluded that the health benefits associated with a plant-based diet have been consistently proven positive over time by various studies in this field. [Panel 1] summarizes the major health benefits associated with a plant-based diet.
| Diet and the Environment|| |
The past decade showed an increasing awareness and concern regarding climate change and how human activities have put a massive toll on our environment. Evidences have been steadily increasing to demonstrate that dietary patterns rich in plant-based sources (e.g. vegetables, fruits, seeds, nuts, whole grains, and legumes) and lower in animal-based products (particularly red meat), just as lower in total calories, are healthier and come with a lesser environmental burden on the earth.
From production until consumption, food systems have an environmental impact throughout the supply chain. Accounting for about 30% of the total greenhouse gas (GHG) emissions at the global level, the contribution of ecological food chains to global warming is significant. Among the human diet, animal products, mainly processed meat, have a higher environmental burden than other food types, particularly considering energy utilization and GHG production matched with food mass, and protein. De Vries and De Boer demonstrated that, of the various types of meat, generation of 1 kg beef utilized most land and resources, trailed by the production of 1 kg of pork, chicken, eggs, and milk. There are various global (e.g. the Kyoto protocol) and national (e.g. Climate Change Act UK 2008) programs to lessen GHG emissions. Achievement of goals set by these agreements would require significant amendments in the currently prevalent global dietary patterns. Because of the high environmental burden from meat, numerous literature works have supported the advancement of vegetarian diets.,, Plant-based dietary practices are less demanding on nature and require fewer natural resources for production, thereby addressing a portion of these environmental issues from the roots.
| Current Scenario|| |
Every United Nations Member States in 2015 embraced the 2030 Agenda for Sustainable Development that gives a mutual outline to harmony and success among individuals and the planet, presently and later on. The 17 Sustainable Development Goals (SDGs), which frame the core, are an urgent call for action by all nations – developed and developing – through worldwide collaboration. They acknowledge that mitigating poverty and different hardships must run in melody with policies that improve well-being and education, lessen disparity, and goad financial development – all while going up against climate change and attempting to protect our seas and woodlands.
There are at least five SDGs that can be benefitted if we can alter the dietary practices
- No poverty
- No hunger
- Good health and well-being
- Responsible consumption and production
- Climate change.
Moving on to a more plant-based diet could help prevent the wastage of natural resources and financial burdens associated with the production of processed meat, which is a significant content in most of the currently prevailing dietary patterns. Channeling the hence saved resources to increase the production of more plant-based food products will help address the issues of poverty and hunger. Decreasing production of meat and the promotion of plant-based food would also help reduce the GHG output and help control the crisis of climate change. Plant-based diet being healthier, would enhance overall health and well-being. All these changes would also require a massive transformation of the currently existing global food system with an emphasis on responsible production and consumption. Various organizations and scientists around the globe, have acknowledged that moving toward less GHG-releasing food production and utilization practice is of most extreme significance to safeguard the ability of the earth to deliver nourishment for the generations to come,, yet globally set scientific targets are absent for healthy diet and sustainable food production. The EAT-Lancet Commission was set up to address this crisis and convened a panel of experts from throughout the world to develop global scientific targets for the food system. The Commission published the Food, Planet, Health report, recognizing food as the single most influential lever in optimizing human health and environmental sustainability on the earth. The committee acknowledges that transformation to healthy diets by 2050 will require substantial dietary shifts and would require more than doubling the consumption of fruits, vegetables, legumes, and nuts and above 50% reduction in global consumption of processed sugars and red meat.
The idea of a sustainable diet, is a problematic issue, and there are as yet numerous incongruities in our comprehension of what a sustainable diet might include. Recently, the Food and Agriculture Organization defined a sustainable diet as “those diets with low environmental impacts which contribute to food and nutrition security and healthy life for present and future generations. Sustainable diets are protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable; nutritionally adequate, safe and healthy; while optimizing natural and human resources.” The EAT-Lancet Commission proposed regulations and restrictions in global food production to decrease the risk of irreversible and potentially catastrophic damage to the earth's ecosystem. These boundaries in food productions are based on the global efforts to address climate change as per the Paris agreement (to keep global warming below 2°C). This would require widespread adaptation of mostly plant-based dietary practices along with significant improvement in the food production practices, all while reducing food losses and wastage. The committee suggested actions for the reduction of environmental impact by food production: (a) dietary shift – a more plant-based and less animal-based diet; (b) half wastage and reduced food loss; (c) improved production practices; and (d) improving water management, phasing out biofuels, rebalance of nitrogen and phosphorus through fertilizers, and implementation of all available options to mitigate food-related GHG emissions. Plant-based diet thus addresses a considerable portion of the current crisis in public health and environmental sustainability and has proven its superiority in this regard compared with animal-based diet. Revolutionizing the currently prevalent conventional and broad dietary propensities, where meat is one of the wholesome primary sources and ensuring that the population eats a healthy and balanced diet, with the least toll on our environment, remains a challenge to public health.
To acquire a healthfully adjusted eating routine, individuals should initially have appropriate learning of what establishes a healthfully modified and balanced diet. Second, openness is a crucial factor – the accessibility of specific ingredients and foods fortified with critical supplements that are otherwise lacking in the diet. The availability varies enormously, contingent upon the geographic district because distinctive nations have diverse fortification laws. A plant-based diet can have numerous subtypes based on individual preferences. A recent study published from the United States evaluating the cardiovascular benefits of different plant-based diet showed that not all plant-based diets are associated with a decreased cardiovascular disease risk. Unhealthy plant-based foods such as refined grains and sugar-sweetened beverages have been in fact associated with a higher risk for cardiovascular diseases.,, Greater adherence to this food often leads to diets with higher glycemic load and index, added sugar, lower levels of dietary fiber, unsaturated fats, micronutrients, and antioxidants, which could result in higher CHD risk. It is therefore important that in addition to promoting a plant-based diet, people need to be sensitized about the healthy plant-based foods such as whole grains, vegetables, nuts, and legumes. Vegan diet, which completely excludes all animal products (including animal derived), is such a dietary pattern that has gained immense popularity lately.
| The Way Forward|| |
The WHO has recently released the Global Nutrition policy review that analyzed the information on nutritional policy and programs by different countries. Data were collected regarding the implementation of such policies, its coverage, stakeholders, and coordination mechanisms and how they were monitored and evaluated. Most of the countries (more than 90%) did have programs that addressed key nutrition issues (like undernutrition, vitamin and mineral deficiencies, obesity, and diet-related noncommunicable diseases [NCDs]). The review succeeded in identifying the significant gaps in the design and contents of some policies and programs. The report emphasizes the need to strengthen nutrition governance like developing better program coordination, the collaboration between different ministries, agencies, and other developmental partners. They have also found out that most of the vitamin and mineral supplementation and fortification programs were inconsistent and inadequate in most of the countries. Programs to address obesity and diet-related NCDs are not given due importance and had less implementation. Better programs are needed to counter this rising epidemic of obesity, along with proper interventions. Market regulation of foods and beverages, limit on salt/sodium or trans-fatty acids, providing general awareness, implementing dietary guidelines, and promotion of healthy nutritional practices through media are some of the ways in which the government can tackle the problem of malnutrition. The concept of a healthy diet and counseling need to be integrated with all levels of existing health systems. Capacity building and allocation of adequate financial resources to the nutrition programs should be enhanced.
As quoted by the EAT-Lancet Commission, “Transformation to healthy diets by 2050 will require significant dietary shifts. Global consumption of fruits, vegetables, nuts, and legumes will have to double, and consumption of ingredients such as red meat and sugar will have to be decreased greater than 50%. A food regimen rich in plant-based meals and with fewer animal source ingredients confers both improved health and environmental benefits.” The concept of a balanced diet and the benefits of a plant-based diet have been around for the past few decades. Further research to understand the environmental impact of a plant-based diet will be highly useful. Behavioral change communication and awareness regarding climate change and the benefits of a plant-based diet are needed for people to accept these new modifications to their lifestyle. The various issues that might arise when such a difference in dietary patterns include nutritional deficiency, the taste, and quality of meat compared to plant-based foods and people's mindset regarding the need for such a change. An international collaboration between different governments and agencies will yield a significant boost toward the goal of attaining sustainable development worldwide. Further operational research is needed to develop food policies which are cost-effective, culture-sensitive, keeping in mind the local availability of resources, the taste and preferences of the target population.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Gussow JD. The Feeding Web: Issues in Nutritional Ecology. New York, U.S: Bull Publishing Co.; 1978.
Spitzmüller EM, Schönfelder-Pflug KL. Ernährungsökologie: Essen Zwischen Genuss und Verantwortung. Nutrition Ecology: Eating between Relish and Responsibility. Germany: Haug, Heidelberg; 1993.
Stehfest E. Diet: Food choices for health and planet. Nature 2014;515:501-2.
Duchin F. Sustainable consumption of food: A framework for analyzing scenarios about changes in diets. J Ind Ecol 2008;9:99-114.
Roy P, Nei D, Orikasa T, Xu Q, Okadome H, Nakamura N, et al
. A review of life cycle assessment (LCA) on some food products. J Food Eng 2009;90:1-10.
Hallström E, Carlsson-Kanyama A, Börjesson P. Environmental impact of dietary change: A systematic review. J Clean Prod 2015;91:1-11.
Carlsson-Kanyama A. Climate change and dietary choices – How can emissions of greenhouse gases from food consumption be reduced? Food Policy 1998;23:277-93.
Leitzmann C. Nutrition ecology: The contribution of vegetarian diets. Am J Clin Nutr 2003;78:657S-9.
Pimentel D, Pimentel M. Sustainability of meat-based and plant-based diets and the environment. Am J Clin Nutr 2003;78:660S-3.
Reijnders L, Soret S. Quantification of the environmental impact of different dietary protein choices. Am J Clin Nutr 2003;78:664S-8.
Leonard WR. Human nutritional evolution. In: Human Biology. Hoboken, NJ, USA: John Wiley and Sons, Inc.; 2012. p. 251-324.
Henke W, Tattersall I. In: Handbook of Paleoanthropology. Henke W, Tattersall I, editors. Berlin, Heidelberg: Springer Berlin Heidelberg; 2015.
Norton CJ, Braun DR, editors. Asian Paleoanthropology: From Africa to China and Beyond, Vertebrate Paleobiology and Paleoanthropology, DOI 10.1007/978-90-481-9094-2_1, © Springer Science+Business Media B.V. 2010.
Cordain L. Implications of plio-pleistocene hominin diets for modern humans. In: Evol Hum Diet Known, Unknown, Unknowable. 2007. p. 363-83.
Crawford MA. The role of dietary fatty acids in biology: Their place in the evolution of the human brain. Nutr Rev 1992;50:3-11.
Crawford MA, Bloom M, Broadhurst CL, Schmidt WF, Cunnane SC, Galli C, et al
. Evidence for the unique function of docosahexaenoic acid during the evolution of the modern hominid brain. Lipids 1999;34 Suppl: S39-47.
Cordain L, Watkins BA, Mann NJ. Fatty acid composition and energy density of foods available to African hominids. Evolutionary implications for human brain development. World Rev Nutr Diet 2001;90:144-61.
Leonard WR, Robertson ML. Nutritional requirements and human evolution: A bioenergetics model. Am J Hum Biol 1992;4:179-95.
Yokoyama Y, Levin SM, Barnard ND. Association between plant-based diets and plasma lipids: A systematic review and meta-analysis. Nutr Rev 2017;75:683-98.
Bechthold A, Boeing H, Schwedhelm C, Hoffmann G, Knüppel S, Iqbal K, et al
. Food groups and risk of coronary heart disease, stroke and heart failure: A systematic review and dose-response meta-analysis of prospective studies. Crit Rev Food Sci Nutr 2019;59:1071-90.
Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr 2017;57:3640-9.
Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis 2013;23:292-9.
Rizzo NS, Sabaté J, Jaceldo-Siegl K, Fraser GE. Vegetarian dietary patterns are associated with a lower risk of metabolic syndrome: the adventist health study 2. Diabetes Care 2011;34:1225-7.
Toohey ML, Harris MA, DeWitt W, Foster G, Schmidt WD, Melby CL. Cardiovascular disease risk factors are lower in African-American vegans compared to lacto-ovo-vegetarians. J Am Coll Nutr 1998;17:425-34.
Fraser GE. Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am J Clin Nutr 1999;70:532S-8.
Tantamango-Bartley Y, Jaceldo-Siegl K, Fan J, Fraser G. Vegetarian diets and the incidence of cancer in a low-risk population. Cancer Epidemiol Biomarkers Prev 2013;22:286-94.
Liu RH. Potential synergy of phytochemicals in cancer prevention: mechanism of action. J Nutr 2004;134:3479S-85.
Liu RH. Health benefits of fruit and vegetables are from additive and synergistic combinations of phytochemicals. Am J Clin Nutr 2003;78:517S-20.
Warri A, Saarinen NM, Makela S, Hilakivi-Clarke L. The role of early life genistein exposures in modifying breast cancer risk. Br J Cancer 2008;98:1485-93.
Singh PN, Sabaté J, Fraser GE. Does low meat consumption increase life expectancy in humans? Am J Clin Nutr 2003;78:526S-32.
Garnett T. Where are the best opportunities for reducing greenhouse gas emissions in the food system (including the food chain)? Food Policy 2011;36:S23-32.
Tilman D, Clark M. Global diets link environmental sustainability and human health. Nature 2014;515:518-22.
Pelletier N, Audsley E, Brodt S, Garnett T, Henriksson P, Kendall A, et al
. Energy intensity of agriculture and food systems. Annu Rev Environ Resour 2011;36:233-46.
González AD, Frostell B, Carlsson-Kanyama A. Protein efficiency per unit energy and per unit greenhouse gas emissions: Potential contribution of diet choices to climate change mitigation. Food Policy 2011;36:562-70.
de Vries M, de Boer IJ. Comparing environmental impacts for livestock products: A review of life cycle assessments. Livest Sci 2010;128:1-11.
Macdiarmid JI, Kyle J, Horgan GW, Loe J, Fyfe C, Johnstone A, et al
. Sustainable diets for the future: Can we contribute to reducing greenhouse gas emissions by eating a healthy diet? Am J Clin Nutr 2012;96:632-9.
Macdiarmid JI, Douglas F, Campbell J. Eating like there's no tomorrow: Public awareness of the environmental impact of food and reluctance to eat less meat as part of a sustainable diet. Appetite 2016;96:487-93.
Reisch L, Eberle U, Lorek S. Sustainable food consumption: An overview of contemporary issues and policies. Sustain Sci Pract Policy 2013;9:7-25.
Coley DA, Goodliffe E, Macdiarmid JI. The embodied energy of food: The role of diet. Energy Policy 1998;26:455-9.
Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al
. Food in the anthropocene: the EAT-lancet commission on healthy diets from sustainable food systems. Lancet 2019;393:447-92.
Forum E. The EAT-Lancet Commission on Food, Planet, Health. EAT Forum; 2019.
Riley H, Buttriss JL. A UK public health perspective: What is a healthy sustainable diet? Nutr Bull 2011;36:426-31.
Burlingame B, Dernini S, Nutrition and Consumer Protection Division, FAO., editors. Sustainable diets and biodiversity – Directions and solutions for policy research and action. In: Proceedings of the International Scientific Symposium Biodiversity and Sustainable Diets United Against Hunger. Rome, Italy: FAO; 2010. p. 40.
Satija A, Bhupathiraju SN, Spiegelman D, Chiuve SE, Manson JA, Willett W, et al
. Healthful and unhealthful plant-based diets and the risk of coronary heart disease in U.S. adults. J Am Coll Cardiol 2017;70:411-22.
Aune D, Norat T, Romundstad P, Vatten LJ. Whole grain and refined grain consumption and the risk of type 2 diabetes: A systematic review and dose-response meta-analysis of cohort studies. Eur J Epidemiol 2013;28:845-58.
Hu EA, Pan A, Malik V, Sun Q. White rice consumption and risk of type 2 diabetes: Meta-analysis and systematic review. BMJ 2012;344:e1454.
Huang C, Huang J, Tian Y, Yang X, Gu D. Sugar sweetened beverages consumption and risk of coronary heart disease: A meta-analysis of prospective studies. Atherosclerosis 2014;234:11-6.
World Health Organization. Global Nutrition Policy Review 2016-2017: Country Progress in Creating Enabling Policy Environments for Promoting Healthy Diets and Nutrition; 2018. Available from: https://www.who.int/publications/i/item/9789241514873
. [Last accessed on 2021 May 11].