From evidence to action: implementing the Nordic Nutrition Recommendations in national policy.

The Nordic Nutrition Recommendations 2023 (NNR2023) serve as the scientific foundation for national dietary guidelines and nutrient recommendations across the Nordic and Baltic countries. We reviewed how NNR2023 was adapted into national food-based dietary guidelines (FBDG) in the Nordic countries and Estonia, focusing specifically on sustainability considerations and policy implications. National FBDG integrated both health and environmental aspects in all countries, except Norway, which addressed environmental aspects only in a separate report. Health impacts served as the primary principle in all countries. Additionally, national policy perspectives, such as domestic food security, were addressed in some countries, while the integration of social and economic sustainability remained very limited. In adopting NNR2023, all countries modelled how implementation would affect nutrient adequacy or health within their food environments, making minor adjustments based on these findings. Guidelines for animal source food groups showed the most variation between countries; Estonia and Denmark established the strictest recommended limits for red meat and total meat, respectively, while Norway was most liberal regarding milk products. Stakeholders participated in the consultation process. The agricultural sector and meat industry primarily maintained pro-meat discourse, which was particularly intense in Norway and Sweden. Transition towards healthy and sustainable diets demands multiple policy instruments - FBDG being just one - alongside a supportive environment and participation from all food system actors.