Triple burden battle: Researchers highlight need for sustainable healthy diet in Lebanon to alleviate food insecurity

Since 2019, Lebanon had been facing civil unrest, sudden restriction on access to foreign currencies, coupled with the COVID-19 pandemic and the massive explosion at the Port of Beirut in 2020, which have worsened people's livelihoods, food security, and health situation.

These factors combined have affected food security including availability, access, and utilisation, made worst by movement restrictions, loss of income, and price inflation of food and non-food items.

For a country which relies heavily on food imports, the United Nations estimates that over 50% of the Lebanese population might be at risk of failing to access basic food needs.

Adding to the existing triple-burden of malnutrition in the country including hunger, micronutrient deficiencies, and escalating obesity and non-communicable diseases, researchers have developed an evidence-based sustainable and healthy diet that promote human health and at the same time control cost and mitigate environmental impact.

It was achieved using an optimisation mathematical model that generates optimal diet solutions that are healthy, of low cost and satisfy the adequate nutrient needs of adults in Lebanon, while taking into consideration environmental sustainability aspects.

In this study partially funded by FAO, researchers from Lebanon, Italy and UAE have optimised the average Lebanon diet to include a higher intake of whole grain bread, dark green vegetables, dairy products, and legumes, and lower intake of refined bread, meat, poultry, added sugars, saturated fat.

“The findings highlight the need for the development of sustainable food based dietary guidelines for Lebanon to promote diets that are healthy, sustainable, culturally acceptable, and affordable and that can alleviate food insecurity among the general population​,” they wrote in Frontiers in Nutrition​.

Optimising diet​

For this study, baseline dietary data was derived from a national cross-sectional survey conducted in Lebanon during 2008/2009.

Researchers then optimised the diet to make it healthier, affordable, and more sustainable.

The optimised diet involved a significant increase in the consumption of whole grain bread (+599%), dark green vegetables (+81%), dairy products (+131%), and legumes (+303%), and a significant decrease in the consumption of refined grain bread (−57%), meat (−80%), poultry (−44%), and added sugars (−57%).

This would result in an increase of carbohydrate (+18%), protein (+22%), and fiber (+80%), and a decrease in total fat (−33%), saturated fat (−7%), and trans-fat (−76%) as compared to the usual diet, while still satisfying the daily nutritional requirements.

In addition, the optimised diet will satisfy the micronutrient needs of Lebanese adults by significantly increasing the intake of vitamin A (+202%), vitamin C (+114%), calcium (+106%), iron (+77%), and folate (+174%).

According to researchers, “The reduction of trans-fat, saturated fat and higher fiber intake may reduce the risk of developing coronary heart disease, stroke, hypertension, diabetes, obesity, and certain gastrointestinal disorders​,

“The suggested healthy and sustainable dietary pattern may also contribute toward alleviating the burden of micronutrient deficiencies that are highly prevalent in Lebanon​.”

Environmental impact​

In order to ensure that the healthy diet does not use more environmental resources compared to the usual food consumption, its environmental footprint was estimated.

The optimised diet was found to decrease water consumption (−6%) and greenhouse gas emissions (−22%) compared to the usual diet.

While strong evidence highlights the need to align health and environmental objectives in dietary guidelines and recommendations, currently only four countries (Germany, Brazil, Sweden, and Qatar) have included environmental sustainability aspects in their dietary guidelines.

Cost ​

The cost of the optimised diet was also not different from that of the usual intake, suggesting that the healthy and sustainable diet is not more expensive than the usual national diet, therefore affordable for the population under study, according to researchers.

In all, the recommended changes in food consumption patterns for Lebanon will result in a higher consumption of whole grain bread, bulgur, fruits, vegetables, dairy products, fish, eggs, nuts, and legumes.

This diet will result in a decrease in negative environmental footprint while keep cost constant and meeting the nutritional needs for adults.

However, a successful transition to healthy and more sustainable dietary patterns would require actions by key stakeholders, and policies to encourage the adoption of the new diet.

Some policy recommendations include devising a national food security plan and subsidising the proposed healthy and affordable dietary options.

Researchers added: “The findings of this study are not to facilitate “policy drift” to focus on lifestyle choices, but rather to provide a framework to support cross-sectoral food and health policy discussions, particularly in relation to dietary guidelines in Lebanon​.”

They said it may help to investigate the willingness and readiness of the Lebanese population to adapt the proposed shifts toward healthy and sustainable diets towards the successful development and implementation of any policy recommendations.

Limitations​

Meanwhile, there were several limitations to the study, of which comprised data dated back to 2009.

“However, these data come from the most recent national food consumption survey, given that, since that date, no such national surveys have been conducted. More recent studies on population subgroups in Lebanon showed that dietary intake seemed to continue to shift toward a more Western type of diet with a concomitant erosion of the traditional Lebanese diet​.”

Researchers said a regular national food-consumption survey is warranted to provide updated information on various aspects of dietary intake in Lebanon.

In addition, the estimation of water and greenhouse gas consumption relied on data from other countries due to the absence of data in Lebanon.

“Every effort was exerted to identify life-cycle assessments (LCAs) within neighbouring countries in the MENA region, or, otherwise, use LCAs from other countries that have comparable climate and environmental conditions to Lebanon​.”

Source: Frontiers in Nutrition

https://doi.org/10.3389/fnut.2021.697225

“Promoting Sustainable and Healthy Diets to Mitigate Food Insecurity Amidst Economic and Health Crises in Lebanon​”

Authors: Nahla Hwalla, et al.