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Sustainability analysis of French dietary guidelines using multiple criteria


Sustainability is now accounted for in certain food-based dietary guidelines (FBDG). In 2017, the French FBDG were updated to incorporate environmental preservation. We conducted a multi-indicator evaluation of the 2001 and 2017 FBDG, based on data from 28,340 participants in the NutriNet-Santé cohort who completed an organic food frequency questionnaire. Indicators related to nutrition, environment (three indicators and the synthetic partial ReCiPe (pReCiPe) score) and economy were used, to distinguish organic and conventional farming systems. To estimate compliance with the 2001 and 2017 FBDG, we used two validated adherence scores (PNNS-GS1 and PNNS-GS2, respectively). We estimated numbers of averted deaths by adhering to the FBDG using a competing risk assessment model. Higher adherence to the 2017 guidelines was related to higher plant-based diet, cost and deaths averted and lower energy intake, synthetic environmental score and exposure to certain pesticides. Overall, larger differences between lowest and highest PNNS-GS2 were observed than between lowest and highest PNNS-GS1. Our results suggest that the 2017 guidelines are in line overall with the multiple dimensions of diet sustainability, including health, although at a slight cost increase. If adopted by a large part of the population, these dietary guidelines might contribute to the prevention of chronic diseases while reducing food-related environmental pressures.

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Fig. 1: Relative differences for sustainable indicators between high and low adherence to PNNS-GS1 and PNNS-GS2.
Fig. 2: Relative differences for dietary exposure to pesticides between high and low adherence to PNNS-GS1 and PNNS-GS2.
Fig. 3: Estimated number of deaths averted or delayed (for year 2014) through use of the EpiDiet comparing high and low adherence to the 2017 FBDG.
Fig. 4: Estimated number of deaths averted or delayed (for year 2014) through use of the EpiDiet comparing high adherence to 2017 dietary guidelines and high adherence to 2001 dietary guidelines.

Data availability

Data are available from the corresponding author upon reasonable request.

Code availability

Code and programmes are available from the corresponding author upon reasonable request.


  1. Willett, W. et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet 393, 447–492 (2019).

    Article  Google Scholar 

  2. Diet, Nutrition, and the Prevention of Chronic Diseases: Report of a WHO–FAO Expert Consultation (World Health Organization, 2003).

  3. Mozaffarian, D., Rosenberg, I. & Uauy, R. History of modern nutrition science—implications for current research, dietary guidelines, and food policy. BMJ 361, k2392 (2018).

    Article  Google Scholar 

  4. Burlingame, B. Preface. In Proc. International Scientific Symposium Sustainable Diets and Biodiversity United against Hunger (eds Burlingame, B. et al.) 6–8 (FAO, 2012).

  5. Tilman, D. & Clark, M. Global diets link environmental sustainability and human health. Nature 515, 518–522 (2014).

    Article  CAS  Google Scholar 

  6. Garnett, T. Where are the best opportunities for reducing greenhouse gas emissions in the food system (including the food chain)? Food Policy 36, S23–S32 (2011).

    Article  Google Scholar 

  7. Burlingame, B. & Dernini, S. Sustainable diets: the Mediterranean diet as an example. Public Health Nutr. 14, 2285–2287 (2011).

    Article  Google Scholar 

  8. Sofi, F., Macchi, C., Abbate, R., Gensini, G. F. & Casini, A. Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr. 17, 2769–2782 (2014).

    Article  Google Scholar 

  9. Lindgren, E. et al. Sustainable food systems–a health perspective. Sustain. Sci. 13, 1505–1517 (2018).

    Article  Google Scholar 

  10. Meybeck, A., Redfern, S., Paoletti, F. & Strassner, C. Assessing sustainable diets within the sustainability of food systems. Mediterranean diet, organic food: new challenges. In Proc. International Workshop (eds Meybeck, A. et al.) 167–173 (FAO, 2014).

  11. Springmann, M., Godfray, H. C. J., Rayner, M. & Scarborough, P. Analysis and valuation of the health and climate change cobenefits of dietary change. Proc. Natl Acad. Sci. USA 113, 4146–4151 (2016).

    Article  CAS  Google Scholar 

  12. Swinburn, B. A. et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet 393, 791–846 (2019).

    Article  Google Scholar 

  13. Tuomisto, H. L. Importance of considering environmental sustainability in dietary guidelines. Lancet Planet. Health 2, e331–e332 (2018).

    Article  Google Scholar 

  14. Lang, T. & Mason, P. Sustainable diet policy development: implications of multi-criteria and other approaches, 2008–2017. Proc. Nutr. Soc. 77, 331–346 (2018).

    Article  Google Scholar 

  15. Gussow, J. D. & Clancy, K. L. Dietary guidelines for sustainability. J. Nutr. Educ. 18, 1–5 (1986).

    Article  Google Scholar 

  16. Statement Related to the Revision of the 2017–2021 French Nutrition and Health Programme’s Dietary Guidelines for Adults (High Council for Public Health, 2017);

  17. Estaquio, C. et al. Adherence to the French Programme National Nutrition Santé Guideline Score is associated with better nutrient intake and nutritional status. J. Am. Diet. Assoc. 109, 1031–1041 (2009).

    Article  Google Scholar 

  18. Chaltiel, D. et al. Programme National Nutrition Santé – guidelines score 2 (PNNS-GS2): development and validation of a diet quality score reflecting the 2017 French dietary guidelines. Br. J. Nutr. 122, 331–342 (2019).

    Article  CAS  Google Scholar 

  19. Vanham, D. et al. Environmental footprint family to address local to planetary sustainability and deliver on the SDGs. Sci. Total Environ. 693, 133642 (2019).

    Article  CAS  Google Scholar 

  20. Baudry, J. et al. Improvement of diet sustainability with increased level of organic food in the diet: findings from the BioNutriNet cohort. Am. J. Clin. Nutr. 109, 1173–1188 (2019).

    Article  Google Scholar 

  21. Blüher, M. Obesity: global epidemiology and pathogenesis. Nat. Rev. Endocrinol. 15, 288–298 (2019).

    Article  Google Scholar 

  22. Poore, J. & Nemecek, T. Reducing food’s environmental impacts through producers and consumers. Science 360, 987–992 (2018).

    Article  CAS  Google Scholar 

  23. Reganold, J. P. & Wachter, J. M. Organic agriculture in the twenty-first century. Nat. Plants 2, 15221 (2016).

    Article  Google Scholar 

  24. Gomiero, T., Pimentel, D. & Paoletti, M. G. Environmental impact of different agricultural management practices: conventional vs. organic agriculture. Crit. Rev. Plant Sci. 30, 95–124 (2011).

    Article  Google Scholar 

  25. Étude de Santé sur l’Environnement, la Biosurveillance, l’Activité Physique et la Nutrition (Esteban), 2014–2016. Volet Nutrition. Chapitre Consommations (Santé Publique France, 2019);

  26. Baudry, J. et al. Dietary intakes and diet quality according to levels of organic food consumption by French adults: cross-sectional findings from the NutriNet-Santé Cohort Study. Public Health Nutr. 20, 638–648 (2017).

    Article  Google Scholar 

  27. Rao, M., Afshin, A., Singh, G. & Mozaffarian, D. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open 3, e004277 (2013).

    Article  Google Scholar 

  28. Boizot-Szantai, C., Hamza, O. & Soler, L.-G. Organic consumption and diet choice: an analysis based on food purchase data in France. Appetite 117, 17–28 (2017).

    Article  Google Scholar 

  29. EFSA. The 2015 European Union report on pesticide residues in food. EFSA J. 11, 4791 (2017).

  30. Bechthold, A. 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. 59, 1071–1090 (2017).

    Article  CAS  Google Scholar 

  31. Cancer preventability estimates for diet, nutrition, body fatness, and physical activity. World Cancer Research Fund (2017).

  32. Kesse-Guyot, E. et al. Higher adherence to French dietary guidelines and chronic diseases in the prospective SU.VI.MAX cohort. Eur. J. Clin. Nutr. 65, 887–894 (2011).

    Article  CAS  Google Scholar 

  33. Lavalette, C. et al. Cancer-specific and general nutritional scores and cancer risk: results from the prospective NutriNet-Santé cohort. Cancer Res. 78, 4427–4435 (2018).

    Article  CAS  Google Scholar 

  34. Assmann, K. E. et al. Dietary scores at midlife and healthy ageing in a French prospective cohort. Br. J. Nutr. 116, 666–676 (2016).

    Article  CAS  Google Scholar 

  35. Baudry, J. et al. Association of frequency of organic food consumption with cancer risk: findings from the NutriNet-Santé Prospective Cohort Study. JAMA Intern. Med. 178, 1597 (2018).

    Article  Google Scholar 

  36. Bradbury, K. E. et al. Organic food consumption and the incidence of cancer in a large prospective study of women in the United Kingdom. Br. J. Cancer 110, 2321–2326 (2014).

    Article  Google Scholar 

  37. Hallström, E., Carlsson-Kanyama, A. & Börjesson, P. Environmental impact of dietary change: a systematic review. J. Clean. Prod. 91, 1–11 (2016).

    Article  Google Scholar 

  38. Aleksandrowicz, L., Green, R., Joy, E. J., Smith, P. & Haines, A. The impacts of dietary change on greenhouse gas emissions, land use, water use, and health: a systematic review. PLoS ONE 11, e0165797 (2016).

    Article  CAS  Google Scholar 

  39. Auestad, N. & Fulgoni, V. L. III. What current literature tells us about sustainable diets: emerging research linking dietary patterns, environmental sustainability, and economics. Adv. Nutr. 6, 19–36 (2015).

    Article  CAS  Google Scholar 

  40. Perignon, M., Vieux, F., Soler, L. G., Masset, G. & Darmon, N. Improving diet sustainability through evolution of food choices: review of epidemiological studies on the environmental impact of diets. Nutr. Rev. 75, 2–17 (2017).

    Article  Google Scholar 

  41. Healthy and Sustainable Diets for European Countries (European Public Health Association – EUPHA, 2017);

  42. Health Canada Canada’s Dietary Guidelines for Health Professionals and Policy Makers (Government of Canada, 2019).

  43. Batlle-Bayer, L. et al. The Spanish Dietary Guidelines: a potential tool to reduce greenhouse gas emissions of current dietary patterns. J. Clean. Prod. 213, 588–598 (2019).

    Article  Google Scholar 

  44. Cobiac, L. J. & Scarborough, P. Modelling the health co-benefits of sustainable diets in the UK, France, Finland, Italy and Sweden. Eur. J. Clin. Nutr. 73, 624–633 (2019).

    Article  Google Scholar 

  45. Baudry, J. et al. Urinary pesticide concentrations in French adults with low and high organic food consumption: results from the general population-based NutriNet-Santé. J. Expo. Sci. Environ. Epidemiol. 29, 366–378 (2018).

    Article  CAS  Google Scholar 

  46. Baudry, J. et al. Some differences in nutritional biomarkers are detected between consumers and nonconsumers of organic foods: findings from the BioNutriNet project. Curr. Dev. Nutr. 3, nzy090 (2019).

    Article  CAS  Google Scholar 

  47. Clune, S., Crossi, E. & Verghese, K. Systematic review of greenhouse gas emissions for different fresh food categories. J. Clean. Prod. 140, 766–783 (2017).

    Article  CAS  Google Scholar 

  48. Weidema, B. & Meeusen, M. J. G. Agricultural Data for Life Cycle Assessments (Agricultural Economics Research Institute (LEI), 2010).

  49. Kramer, G. F., Tyszler, M., Veer, P. V. & Blonk, H. Decreasing the overall environmental impact of the Dutch diet: how to find healthy and sustainable diets with limited changes. Public Health Nutr. 20, 1699–1709 (2017).

    Article  Google Scholar 

  50. Springmann, M. et al. Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: a global modelling analysis with country-level detail. Lancet Planet. Health 2, e451–e461 (2018).

    Article  Google Scholar 

  51. Vanham, D., Comero, S., Gawlik, B. M. & Bidoglio, G. The water footprint of different diets within European sub-national geographical entities. Nat. Sustain. 1, 518–525 (2018).

    Article  Google Scholar 

  52. Hercberg, S. et al. The Nutrinet-Sante Study: a web-based prospective study on the relationship between nutrition and health and determinants of dietary patterns and nutritional status. BMC Public Health 10, 242 (2010).

    Article  Google Scholar 

  53. Kesse-Guyot, E., Castetbon, K., Touvier, M., Hercberg, S. & Galan, P. Relative validity and reproducibility of a food frequency questionnaire designed for French adults. Ann. Nutr. Metab. 57, 153–162 (2010).

    Article  CAS  Google Scholar 

  54. Baudry, J. et al. Contribution of organic food to the diet in a large sample of French adults (the NutriNet-Santé Cohort Study). Nutrients 7, 8615–8632 (2015).

    Article  Google Scholar 

  55. Etude Nutrinet-Santé Nutrinet-Santé Study Food Composition Database (Economica, 2013).

  56. Schofield, W. N. Predicting basal metabolic rate, new standards and review of previous work. Hum. Nutr. Clin. Nutr. 39, 5–41 (1985).

    Google Scholar 

  57. Hercberg, S., Chat-Yung, S. & Chauliac, M. The French National Nutrition and Health Program: 2001–2006–2010. Int. J. Public Health 53, 68–77 (2008).

    Article  Google Scholar 

  58. Gavelle, E. de, Huneau, J.-F. & Mariotti, F. Patterns of protein food intake are associated with nutrient adequacy in the general French adult population. Nutrients 10, 226 (2018).

  59. Seconda, L. et al. Comparing nutritional, economic, and environmental performances of diets according to their levels of greenhouse gas emissions. Clim. Change 148, 155–172 (2018).

    Article  CAS  Google Scholar 

  60. Pointereau, P., Langevin, B. & Gimaret, M. DIALECTE, a comprehensive and quick tool to assess the agro-environmental performance of farms. In 10th European IFSA Symposium 1–11 (IFSA, 2012);

  61. Goedkoop, M. et al. ReCiPe 2008: A Life Cycle Impact Assessment Method Which Comprises Harmonised Category Indicators at the Midpoint and the Endpoint Level (Ruimte en Milieu, Ministerie van Volkshuisvesting, Ruimtelijke Ordening en Milieubeheer, 2013).

  62. Consumer panels. Kantat Worlpanel

  63. CVUA Stuttgart. UA-BW

  64. Nougadère, A., Reninger, J.-C., Volatier, J.-L. & Leblanc, J.-C. Chronic dietary risk characterization for pesticide residues: a ranking and scoring method integrating agricultural uses and food contamination data. Food Chem. Toxicol. 49, 1484–1510 (2011).

    Article  CAS  Google Scholar 

  65. Traoré, T. et al. To which mixtures are French pregnant women mainly exposed? A combination of the second French total diet study with the EDEN and ELFE cohort studies. Food Chem. Toxicol. 111, 310–328 (2018).

    Article  CAS  Google Scholar 

  66. Lee, D. D. & Seung, H. S. in Advances in Neural Information Processing Systems 13 (eds Leen, T. K. et al.) 556–562 (MIT Press, 2001).

  67. La macro SAS CALMAR (INSEE, 2015).

  68. Scarborough, P., Harrington, R. A., Mizdrak, A., Zhou, L. M. & Doherty, A. The preventable risk integrated model and its use to estimate the health impact of public health policy scenarios. Scientifica (Cairo) 2014, 748750 (2014).

    Google Scholar 

  69. Murray, C. J. L. & Lopez, A. D. Measuring the global burden of disease. N. Engl. J. Med. 369, 448–457 (2013).

    Article  CAS  Google Scholar 

  70. Micha, R. et al. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA 317, 912–924 (2017).

    Article  Google Scholar 

  71. Gaujoux, R. & Seoighe, C. A flexible R package for nonnegative matrix factorization. BMC Bioinformatics 11, 367 (2010).

    Article  CAS  Google Scholar 

  72. World Health Organization ICD-10: International Statistical Classification of Diseases and Related Health Problems: Tenth Revision 2nd edn (WHO, 2004).

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We thank O. Hamza, C. Boizot-Santai, L.-G. Soler and Bioconsom’acteurs’ members for price collection and data management, CVUA for the pesticide residue database and N. Soton for her contribution to data management of the CVUA database. We also thank C. Agaesse (dietitian); T. H. Van Duong, Y. Esseddik (IT manager), R. Gatibelza, D. Lamri, J. Mohinder and A. Timera (computer scientists); J. Allegre, N. Arnault, L. Bourhis and F. Szabo de Edelenyi (supervision and data/statistics management) for their technical contribution to the NutriNet-Santé study; and N. Druesne-Pecollo (operational coordination). We thank all volunteers of the NutriNet-Santé cohort. The NutriNet-Santé study is funded by French Ministry of Health and Social Affairs, Santé Publique France, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Conservatoire National des Arts et Métiers and Paris 13 University. The BioNutriNet project was supported by the French National Research Agency (Agence Nationale de la Recherche) in the context of the 2013 Programme de Recherche Systèmes Alimentaires Durables (no. ANR-13-ALID-0001). The funders had no role in study design, data collection, analysis, interpretation of data, preparation of the manuscript or decision to submit the paper.

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Authors and Affiliations



E.K.-G., B.A., M.T., C.J. and S.H. conducted the study. E.K.-G., P.P., B.L., R.V., D.L. and J.B. conducted the research and implemented databases. J.W. and F.M. conducted the EPIDiet simulation. E.K.-G. performed statistical analyses and drafted the manuscript. All authors critically helped in the interpretation of results, revised the manuscript and provided relevant intellectual input. They all read and approved the final manuscript.

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Correspondence to Emmanuelle Kesse-Guyot.

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Transparency statement E.K.-G. (the guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

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Kesse-Guyot, E., Chaltiel, D., Wang, J. et al. Sustainability analysis of French dietary guidelines using multiple criteria. Nat Sustain 3, 377–385 (2020).

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