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.