Research Article

Received: 4 July 2018 Revised: 28 December 2018 Accepted article published: 13 January 2019 Published online in Wiley Online Library: 12 March 2019

(wileyonlinelibrary.com) DOI 10.1002/jsfa.9591

Healthy diet: a step toward a sustainable diet

by reducing water footprint
Seyyed Reza Sobhani,a Arezoo Rezazadeh,b Nasrin Omidvarb
and Hassan Eini-Zinabb*

Abstract
BACKGROUND: This paper aims to assess different scenarios that reduce water use by following healthy diet recommendations.
In this study, a food frequency questionnaire was used to assess the usual food intake of a sample of 723 individuals, aged
20–64 years, from Urmia, Iran. In order to calculate water use for production of food items, the water footprint method was
applied. A linear programming technique was used to find a healthy diet with low blue water footprint in three scenarios.

RESULTS: The biggest decline in water use compared with real intake (57%) was found in scenario 1, where the model-generated
consider energy intake equal to usual energy intake. In scenario 2, in which the proportion of each food group was allowed to be
in accordance with the Iranian food pyramid, the reduction in water use was less than for scenario 1 (47%). In scenario 3, where
the Recommended Dietary Allowance values were also added to the set of model restrictions, the water usage was 51% of the
real diet.

CONCLUSION: A healthy diet with greater proportion of energy from fruit and dairy instead of a diet with high proportion
of energy from ‘meat–fish–poultry–eggs’ and ‘bread–cereal–rice–pasta’ can supply all Recommended Dietary Allowances
while reducing water use.
© 2019 Society of Chemical Industry

Keywords: sustainable diet; water shortage; linear programming; Urmia; Iran

INTRODUCTION Iran is experiencing a rapid nutrition transition alongside other

Water shortage is one of the most important crises facing human-
ity in the 21st century, as it affects general welfare, public health,
and ecosystems.1 Two-thirds of the global population (4 billion)
live under conditions in which they face severe water scarcity at
least 1 month of a year.2 Water shortage results from increasing
world population, economic growth, improving living standards,
changing consumption patterns, expansion of irrigated agricul-
ture, and unsustainable decisions to supply the increasing water
demands.3–6
During the last few decades, an unprecedented increase in food
production has been achieved. The increasing food production
comes with high environmental costs as well. Rapid soil depletion,
high water consumption, and changes in climate conditions are a
few instances of the environmental costs.7,8 Previous studies show
changes in people’s diet can lead to reduction in water usage
and other environmental effects.9 The concept of a sustainable
diet is advocated by the Food and Agriculture Organization of
the United Nations to reduce the environmental costs of human
diets. It provides environmental-friendly food recommendations
to consumers and policy makers alike.10 According to the Food
and Agriculture Organization of the United Nations definition,
‘sustainable diets are those diets with low environmental impacts
which contribute to food and nutrition security and to the healthy
life for present and future generations’.10 The sustainable diet
approach could be used for dietary recommendations with less
social transitions, including changes in fertility, mortality, and
urbanization. Whereas about 28% of households in Iran suffer from
mild food insecurity, another one-third consumes more food than
needed.11,12 On the other hand, Iran is located in an area that suf-
fers from a shortage of water resources. The average rainfall in
the country (228 mm year−1 ) is less than a third of the world aver-
age (990 mm year−1 ).13 According to the survey of climatic drought
trend in Iran, except the northern and northeastern areas around
the Caspian Sea, the severity of drought has increased during the
last 30 years.14,15 The declining rainfall and water resources are best
seen by a huge decline in water level at Urmia Lake, the second
largest saline lake in the world. Building dams and diverting water
resources for human and agricultural use, alongside overuse of
surface water resources, seem to be the main contributors to this
problem.16
∗ Correspondence to: H Eini-Zinab, Department of Community Nutrition,
National Nutrition and Food Technology Research Institute, Faculty of Nutri-
tion Sciences & Food Technology, Shahid Beheshti University of Medical
Sciences, Tehran, Iran. E-mail: hassan.eini@sbmu.ac.ir
a Student Research Committee, Faculty of Nutrition Sciences & Food Technology,
Shahid Beheshti University of Medical Sciences, Tehran, Iran
b Department of Community Nutrition, National Nutrition and Food Technology
Research Institute, Faculty of Nutrition Sciences & Food Technology, Shahid
3769

water-intensive food items as well. Beheshti University of Medical, Tehran, Iran

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 www.soci.org
Although all food produced in this area is not consumed locally,
a sustainable diet approach can lead to better water resource
management by increasing the general awareness of the effects of
agricultural production. This paper aims to suggest a healthy diet
with low water use for the Urmia population.
MATERIAL AND METHODS
This study uses secondary data on the usual food intake of a
sample from Urmia, capital city of the West Azerbaijan province
in Iran.4,17,18 The sample size of the project was 723 (427 women
and 296 men), aged 20–64 years. The procedures for sample selec-
tion and data collection are presented elsewhere.18 Dietary intake
data were collected with a semi-quantitative 168-item food fre-
quency questionnaire (FFQ). The validity and reproducibility of this
questionnaire have been reported19,20 and approved for the Ira-
nian population.21 Additionally, content validity of the FFQ was
assessed by five local nutrition experts at the nutrition depart-
ment of Urmia University of Medical Sciences. Questionnaires with
missing information for more than 50% of food items on the FFQ
and/or those with misreported energy intake, as suggested by
Goldberg et al., were excluded from the study.22 After convert-
ing the reported frequency of each food item to its daily intake
value, portion sizes of consumed food were converted to grams
using household measures.23 Then, an adopted version of Nutri-
tionist IV software for Iranian foods (version 7.0; N-Squared Com-
puting, Salem, OR, USA) was used in order to assess the nutrient
and energy intakes.
In order to calculate water use for production of food items, the
water footprint method was applied. The water footprint is defined
as ‘the total volume of freshwater that is used to produce the
goods and services consumed by an individual or community’24 .
Footprint data for each food item is usually reported as water
volume, in cubic meters per ton. The water footprint data were
available for Iran and in some cases for West Azerbaijan.24–26 The
water footprint consists of three components; namely blue, green,
and gray. The blue water foot print includes water from surface or
groundwater resources that is used throughout the supply chain
of a product. The green water footprint refers to use of water from
precipitation in so far as it does not become run-off. The gray
water footprint refers to the amount of freshwater that is needed to
dilute pollutants to meet specific water quality standards.27 In this
research, water footprint data were converted to water volume in
cubic meters per gram. The amount of water used for any food item
was calculated by multiplying the water footprint by the mean
consumption of the sample. For example:
( )
Water used for rice = Water footprint of rice m3 g−1
× Average rice consumption (g)
The linear programming (LP) technique is used to model the
optimal food pattern while considering the water footprint. MS
Excel (version 2013) Solver add-on (Microsoft, Redmond, WA, USA)
was used to incorporate the LP technique. LP for designing sce-
narios has been described in greater detail elsewhere.28 In the
present study, LP models were utilized to obtain healthy diets with
low water use. The main elements of LP models are objective,
decision variables, and constraints. The objective sets the opti-
mal goal. Decision variables are those decision variables manip-
ulated in order to reach the objective by considering constraints.
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The constraints are those conditions that must be fulfilled in order
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SR Sobhani et al.
to reach the objective goal. To find a healthy diet with low water
use for the Urmia population, three scenarios were investigated.
The scenarios and their constraints are presented in Table 1. The
objectives and decision variables for all three scenarios were min-
imizing the blue water use and intake of food items respectively.
Since only one variable can be considered as an objective variable
in LP and blue water is more related to irrigated agriculture, indus-
try, and domestic water, among the three types of water footprint
(blue, green, and gray), the blue water footprint was selected as
the objective variable.29 To consider dietary habits of the popula-
tion, in all scenarios the decision variables are constrained to vary
between first and third quartile cut points of usual food intake.
In some cases where the third quartile cut point was less than
a serving size, the latter is used as a maximum. Additional con-
straints for each scenario are set as follows. For scenario 1, the
model-produced diet should have energy intake equal to that
of the usual intake. In scenario 2, in addition to the energy con-
straint of scenario 1, the decision variables are constrained to fol-
low the advised serving size of food groups by the food dietary
pyramid. The recommended amounts (minimum–maximum) in
the Food-Based Dietary Guidelines for Iran are as follows: cere-
als, 6–11 servings; vegetables, three–five; fruit, two–four; dairy,
two–three; and meat, beans, and eggs, two–three.30,31 In addition
to the constraints of scenario 2, Dietary Reference Intakes (DRIs) for
macronutrients and micronutrients were considered as constraints
in scenario 3.32–34 Unlike scenarios 1 and 2, the energy intake was
allowed to follow the DRI in this scenario. Detailed information on
these additional constraints of the third scenario is listed at Table 2.
‘Real diet’ refers to the average observed diet in the study
population. These three scenarios were compared with ‘real diet’
based on the contribution of each food group on total energy
for each scenario, macro and micronutrient composition, and the
amount of blue, green, gray, and total water used.
RESULTS
Data were analyzed for 695 participants. Twenty-eight individu-
als (4·9%) were excluded due to misreporting of energy intake
and incomplete FFQ (>50% of items blank). The results are orga-
nized by model-generated diets of different scenarios and were
compared with real intake or Recommended Dietary Allowance
(RDA). For each real and model-generated diet, first, the contribu-
tion of each food group on total energy is presented (Fig. 1). Then,
macro and micronutrient composition of each diet is compared
with RDA (Table 2). Finally, the daily average amount of blue, green,
gray, and total water used to follow each diet is presented (Table 3)
and compared with real diet water use (Fig. 2).
The average energy intake for the real diet of the sample was
2920 kcal. The highest proportion of daily calories was supplied
by bread, cereal, rice, and pasta (i.e. 39%). The lowest contribution
belongs to ‘fruit’ and ‘vegetables’ groups (i.e. 8% contribution for
each group). The amounts of all macro and micronutrients and
calorie intake of the real diet were higher than the RDAs. The
amount of water to supply the daily diet for a person was 4.11 m3
in the sample (blue 29%, green 59%, and gray 12%). As mentioned
earlier, to optimize the real diet in terms of water use while taking
into account the nutritional recommendations, three scenarios
were generated using LP.
The LP goal for scenario 1 was to minimize the water use, while
taking the same amount of daily energy (2920 kcal) and no addi-
tional considerations of nutritional requirements. In this model,
the share of bread, cereal, rice, and pasta, ‘vegetables’, and ‘fruit’
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Step toward a healthy, sustainable diet www.soci.org

Table 1. Objectives, changing variables, and constraints of different scenarios

Scenario 1 Scenario 2 Scenario 3

Objective Minimum of blue water Minimum of blue water
Decision variable Intake of food items Intake of food items
Constraints Minimum level ≥ first quartile of Minimum level ≥ first quartile of
usual intake usual intake
Maximum level ≤ third quartile of Maximum level ≤ third quartile of
usual intake or weight of one usual intake or weight of one
serving serving
Energy intake = usual energy intake Energy intake = usual energy intake
Minimum recommended serving by
food pyramid ≤ intake of food
items ≤ maximum recommended
serving by food pyramid
Minimum of blue water
Intake of food items
Minimum level ≥ first quartile of usual
intake
Maximum level ≤ third quartile of usual
intake or weight of one serving
Energy intake = recommended energy
intake
Minimum recommended serving by food
pyramid ≤ intake of food
items ≤ maximum recommended
serving by food pyramid
Nutrient intakes of macronutrients,
micronutrient ≥ RDA; Nutrient intakes of
macronutrients, micronutrient ≤ UL

Note: Since the water footprint for fish is zero, the real consumption was used for all scenarios.
RDA: Recommended Dietary Allowance; UL: upper level.

Table 2. Micronutrient, macronutrient, and energy content of real diet and different scenarios

Real diet Scenario 1 Scenario 2 Scenario 3 RDA

Energy intake (kcal day−1 ) 2920.17 2920.17 2920.17 2675.24 2675.24

Protein (g day−1 ) 111.30 83.14 75.74 77.82 ≥50.1
Carbohydrate (g day−1 ) 426.12 466.50 399.02 367.84 ≥367.84a
Fat, total (g day−1 ) 93.15 86.65 92.57 83.57 ≤89.17b
Sodium (mg day−1 ) 3704.89 4787.12 3489.98 1500 ≤1500
Vitamin A (RAE) (mg day−1 ) 860.00 133.56 1149.85 782 ≥782
Vitamin C (mg day−1 ) 187.30 44.82 65.91 81.15 ≥81.15
Calcium (mg day−1 ) 1450.84 1009.20 1266.86 1000 ≥1000
Iron (mg day−1 ) 23.97 26.64 18.01 17.84 ≥13.9
Thiamin (mg day−1 ) 2.86 3.13 2.25 1.66 ≥1.14
Riboflavin (mg day−1 ) 2.89 2.03 2.19 2.06 ≥1.18
Niacin (mg day−1 ) 32.45 31.74 21.81 17.23 ≥14.82
Vitamin B6 (mg day−1 ) 2.36 1.54 1.39 1.3 ≥1.3
Folate (total) (mg day−1 ) 701.05 653.53 511.25 400 ≥400
Vitamin B12 (μg day−1 ) 6.59 0.96 1.68 2.4 ≥2.4
Vitamin K (mg day−1 ) 250.37 83.08 97.87 583.42 ≥102.3
Magnesium (mg day−1 ) 476.24 527.03 366.42 452.17 ≥346.9
Zinc (mg day−1 ) 15.58 14.50 11.03 10.62 ≥9.23
Fiber (total) (g day−1 ) 78.74 101.18 70.40 37.02 ≥30.33
Cholesterol (mg day−1 ) 366.42 94.43 135.12 202.56 ≤300
Saturated fat (g day−1 ) 32.51 21.50 26.34 29.72 ≤29.72
a This amount is based on the Food and Agriculture Organization of the United Nations (FAO) recommendation of a minimum 55% of total energy
from carbohydrate.
b This amount is based on the FAO recommendation of a maximum 30% of total energy from total fat.
RAE: retinol activity equivalent; RDA: Recommended Dietary Allowance.

in supplying daily energy increases by 44%, 58% and 4% respec-
tively compared with real diet. On the other hand, the contribution
of milk, yoghurt, and cheese, meat, poultry, and fish, and fats, oils,
and sweets decreased by 92%, 31%, and 28% respectively. In terms
of nutritional components, protein, carbohydrate, calcium, iron,
vitamins B1 , B2 , B3 , B6 , B9 , magnesium, zinc, and total fiber were
higher than the RDA, as in the real diet. Vitamins A, C, K, and B12
were less than the recommended values and the real diet. Choles-
sodium, which was higher. The lowest amount of water needed to
provide the 2920 kcal average daily intake was 1.78 m3 . It shows a
57% decline in water use compared with real intake (74% in blue,
56% in green, and 23% in gray waters) (Fig. 3).
The model-generated diet for scenario 2 adds a new constraint
to the earlier model in order to adhere to the food pyramid
guidelines. Compared with the real diet, the share of bread, cereal,
rice, and pasta, meat, poultry, fish, legumes, eggs, and nuts, and
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terol and saturated fats were below the upper limit, conversely to fats, oils, and sweets in providing the daily energy of 2920 kcal have

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 www.soci.org SR Sobhani et al.

Real Diet First Scenario

Fats, Oils, & Meat, Fats, Oils, &
Sweets Poultry, Fish, Sweets
16% Legumes 11%
Eggs, & Nuts
10%
Meat,
Poultry, Fish,
Bread, Milk, Yogurt,
Legumes Cereal, Rice, & Cheese Bread,
Eggs, & Nuts
& Pasta 1% Cereal, Rice,
14%
39% Fruit & Pasta
9% 57%
Fruit
Milk, Yogurt, 8% Vegetable
& Cheese Vegetable 12%
15% 8%

Second Scenario Third Scenario

Fats, Oils, &
Sweets
16%
Bread,
Meat, Bread, Fats,
Meat, Cereal, Rice,
Poultry, Fish, Cereal, Oils, &
Poultry, Fish, & Pasta
Legumes Rice, & Sweets
Legumes 25%
Eggs, & Nuts Pasta 17%
11% 28% Eggs, & Nuts Vegetable
Milk, 11% 4%
Yogurt, & Vegetable Milk, Yogurt,
15% Fruit
Cheese & Cheese
14%
20% Fruit 29%
10%

Figure 1. Contribution of different food groups in energy intake for different scenarios. Note 1: In the first scenario, energy intake was equal to that of
usual intake. Note 2: In the second scenario, the constraints included as total energy equal to usual energy intake and the advised serving size of food
groups by Iranian food pyramid. Note 3: In the third scenario, the constraints included as advised serving size of food groups by the Iranian food pyramid
and Dietary Reference Intake for energy, macronutrients, and micronutrients.

Water needed for one person per day (m3)

Table 3. The amount of water needed for one person per day in 4.50
different scenarios 4.00
3.50
Water use (m3 ) 3.00
2.50
Water footprint Real diet Scenario 1 Scenario 2 Scenario 3
2.00
1.50
Green 2.42 1.07 1.26 1.40 1.00
Blue 1.18 0.31 0.48 0.41 0.50
Gray 0.51 0.39 0.44 0.29 0.00
Real Diet First Scenario Second Scenario Third scenario
Total water 4.11 1.78 2.17 2.10
Green Blue Gray

decreased by 28%, 21%, and 0.1% respectively in this scenario.
Furthermore, the contribution of ‘vegetable’ (86%), ‘fruit’ (21%),
and milk, yogurt, and cheese (40%) have increased in providing
the daily energy. The amount of protein, carbohydrate, vitamins
A, B1 , B2 , B3 , B6 , B9 , calcium, iron, magnesium, zinc, and total fiber
were higher than the RDA suggestions, whereas vitamins K, C,
and B12 were less than the recommended values. Cholesterol and
saturated fats were below the upper limit, unlike total fat and
sodium, which were higher. The total volume of water needed
to supply one person for a day in this scenario was 2.17 m3 ,
which shows a decline of about 47% from the real intake (59% in
3772
Figure 2. The amount of water needed for one person in 1 day in different
scenarios.
into account the food pyramid guidelines, the amount of water
increases compared with scenario 1, where the model was not
restricted by these references.
Finally, to account for nutritional recommendations, a new set
of restrictions was added to the model in scenario 3; namely,
RDA. In this scenario, the share of bread, cereal, rice, and pasta,
meat, poultry, fish, legumes eggs, and nuts, and ‘vegetable’ in
providing average daily energy has decreased by 37%, 28% and
45% respectively compared with the real diet. Despite the decline

blue, 48% in green, and 14% in gray water) (Fig. 3). As one takes in the meat, fish, poultry, legumes and eggs group, the share of

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Step toward a healthy, sustainable diet
80
70
60
50
40
30
20
10
0 ham et al.9 concluded that a healthy European diet conforming to a
Green Blue Gray
First Scenario Second Scenario Third scenario
Figure 3. Percentage reduction in water use by the three scenarios com-
pared with real diet.
legumes increased by 14%. Likewise, the contributions of fats,
oils, and sweets (8%), ‘fruit’ (68%), and milk, yogurt, and cheese
(99%) in total energy have increased. This increase was only due
to the decline in total calorie intake of this scenario, and there
was no increase in the amount of these food groups. The amount
of water to supply a diet that takes into account RDA nutritional
recommendations and food pyramid guidelines was 2.1 m3 . This
volume is 49% less than the amount of water needed to supply
the existing diet (66% in blue, 42% in green, and 43% in gray water)
(Fig. 3). In this scenario, sodium, vitamins A, C, B6 , B9 , and B12 were
exactly at the recommended level values, which means that are the
most difficult RDA to fulfill for a minimum blue water footprint.
DISCUSSION
This paper utilizes food intake data from a representative sample
of Urmia city in the West Azerbaijan province of Iran. After ana-
lyzing the nutritional components and water use of real intake
data, three different scenarios were studied to get an optimum
level of water use, in accordance with a sustainable diet approach.
The biggest decline in water use was observed in scenario 1 where
the model-generated diet did not consider the nutritional recom-
mendations and food guidelines. Compared with the real diet,
the amount of vitamins A, C, K, and B12 were decreased in this sce-
nario. In scenario 2, where the proportion of each food group is
allowed to be in accordance with the food pyramid, reduction in
water use was less than in scenario 1. Considering food pyramid
guidelines alone did not ensure RDA for all mineral and vitamins.
In scenario 3, where RDA values were also added to the set of
model restrictions, the water usage is more than half of the real
diet. As this scenario takes into account more nutritional recom-
mendations, it was considered to be closer to the sustainable diet
framework. In this scenario, the share of dairy and fruit in total
energy increases, compared with the real diet of the sample, but
the share of other food groups declines. An increase in the share
of dairy and fruit was only due to the decline in total calorie intake
of this scenario, and there was no increase in the amount of these
food groups. A healthy diet with greater proportion of energy from
fruits, and lower ratio from bread, cereal, rice, and pasta, and sub-
stitution of meats with beans can supply all recommended dietary
allowances while reducing water use. Sodium, vitamins A, C, B6 ,
B9 , and B12 were the most problematic nutrients to obtain in a
healthy diet at minimum water footprint. Therefore, the fulfillment
of these nutrients strongly influences the food content in the opti-
mized diet.
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Our finding is in accordance with Vanham’s35 study that ana-
lyzes the water footprint of different diets, which concluded that,
although the vegetarian diet has the lowest water footprint, a
healthy diet also leads to reduction of water consumption. It
should be noted that in this study a theoretical approach is used
to compare diets. A similar study in the USA finds that shifting
from the current US diet to a diet with recommended caloric intake
without changes in the share of food groups reduces blue water
footprint by around 9%, while shifting to US Department of Agri-
culture recommended food patterns has the reverse effect.36 Van-
Total Water
regional recommendations diet compared with a usual diet could
save 3–30% in total water used for food production in Europe.
Jalava et al.37 reported a 13% decrease in total water consumption
for Europe, by compliance with dietary recommendations.
The decline in water consumption in the recommended diet of
this study is mainly due to a decrease in the share of animal prod-
ucts, as presented in the Appendix, which shows the contribution
of food groups to the blue water footprint. Typically, meat-based
diets have a larger water footprint than vegetarian diets do. The
water footprint per calorie or per protein of frequently used ani-
mal products like beef, milk, egg, and chicken is larger than crop
products like starchy roots and pulses. The global average water
footprints per ton of some crops and animal foods are as follows:
sugar crops, ∼200 m3 ton−1 ; vegetables, ∼300 m3 ton−1 ; pulses,
∼4000 m3 ton−1 ; nuts, ∼9000 m3 ton−1 ; milk, ∼1000 m3 ton−1 ; egg,
∼3300 m3 ton−1 ; and beef, ∼15 400 m3 ton−1 .27 A high proportion
of the water footprint for animal products is due to their consump-
tion of feed, which accounts for 98% of the total water footprint.27
In the agricultural sector in the world, 29% of the total water foot-
print is related to the production of animal products; one-third
of the global water footprint of animal production is related to
beef cattle.25,27 Replacing all meat by an equivalent amount of
crop products such as pulses and nuts will result in a 30% reduc-
tion of the food-related water footprint of the average American
citizen.27 In the present study, despite the decline in the proportion
of energy from the meat, fish, poultry, legumes, and eggs group
of the recommended diet, the share of legumes in total energy
increased. Limiting animal product consumption is frequently sug-
gested as one of the solutions to alleviate water scarcity. Another
study suggests a 50% reduction in animal product content of the
American diet reduces total water use by 37%. This study also sug-
gests a lacto-ovo vegetarian diet leads to a 52% reduction in water
use.38 Omitting all animal products except fish in the Jalava et al.
study led to a 35% reduction of the water footprint.37 Although
dairy products have a higher water footprint compared with veg-
etables and fruit, their contribution increased in this study’s recom-
mended healthy and sustainable diet. Dairy products are rich in a
large variety of essential nutrients, such as minerals, vitamins, and
easily digestible proteins with balanced amino acid profiles that
are important to support overall body function.39 The proportional
consumption of vegetables, despite their low water footprint, did
not increase in this study. The declining contribution of vegetables
in total energy was mainly due to the upper limit constraint on
serving sizes and that the consumption of vegetables in the real
diet was above this limit.
All in all, diet change is an important component of a sustainable
future.40 The findings of our study show changing some food
consumption habits (e.g. less meat and increase in fruits and
dairy products) can help towards a more sustainable diet that is
3773
healthier and with a lower water use.
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This study has some limitations. First, using FFQ in dietary assess-
ment has some limitations, such as underreporting of the usual
intake or invalid reporting due to social desirability bias.41 Sec-
ond, a sustainable diet includes different dimensions, such as
agriculture, health, sociocultural, environmental, and socioeco-
nomic aspects.42 The present study includes only health (i.e. rec-
ommended diet) and environmental (i.e. water usage) dimensions
of this concept. Third, West Azerbaijan province is one of the main
producers of agricultural products with high nutritional intakes.43
Therefore, substantial dietary changes will be required in the gen-
eral population of Iran to have a more sustainable diet.
ACKNOWLEDGEMENT
This study is related to the project no. 1396/46452 from the Stu-
dent Research Committee, Shahid Beheshti University of Medi-
cal Sciences, Tehran, Iran. We also thank the Student Research
Committee and the Research & Technology Chancellor in Shahid
Beheshti University of Medical Sciences for their financial support
of this study.
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