1 Willett W

Rockström J

Loken B

et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. The goal of the EAT–Lancet Commission report on food in the Anthropocene by Walter Willett and colleaguesis laudable given the immediate need for action on climate change and the growing burden of non-communicable diseases on global health. Unfortunately, omissions in the documentation, together with methodological flaws in assumptions, data collection, and modelling, are substantial enough to alter the conclusions of the report.

2 Stevens GA

Alkema L

Black RE

et al. Guidelines for accurate and transparent health estimates reporting: the GATHER statement. 3 Feskens EJM

Sluik D

van Woudenbergh GJ Meat consumption, diabetes, and its complications. 4 Springmann M

Wiebe K

Mason-D'Croz D

Sulser TB

Rayner M

Scarborough P Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: a global modelling analysis with country-level detail. The Lancet requires studies of global health estimates to adhere to the guidelines for accurate and transparent health estimates,but the report did not describe systematic methods for selecting health impacts of foods and corresponding risk ratios (RRs) that were fundamental to their findings. Basic inclusion and exclusion criteria for selection of evidence, methods of data identification, provision of the data input into the model, and description of potential biases from the aforementioned were missing from the report and associated papers, limiting the replicability and reliability of the study results. Furthermore, some of the described RRs—eg, the association between red meat and type 2 diabetes—do not match the values in the source studiesor were based on a different definition of meat consumption (eg, conflating effects from red and processed meat). Additionally, modelling projections compare the authors' proposed reference diet with perfect calorie intake for each consumer worldwide against the status quo diet with overnutrition and undernutrition—a biased comparison that is likely to result in the overestimation of mortality reduction for the reference diet. The mortality analysis only accounts for statistical uncertainty in RRs because, the authors argue, it has the greatest magnitude,but this approach ignores the compound impact of several other uncertainties when correctly propagated. We replicated their analysis for the USA while also including all uncertain variables (eg, mortality rates, population estimates, amount of foods consumed, and prevalence of consumption) and found that the avoided mortalities if the population adopted the proposed reference diet were not statistically significantly different from avoided mortalities based only on preventing overnutrition and undernutrition.

5 Forouzanfar MH

Afshin A

Alexander LT

et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The combined effect of the aforementioned issues suggests that the recommended diet from the EAT–Lancet report is based on a misspecified modelling approach that might at best overpromise on the mortalities avoided, and at worst promote a solution favouring high-income countries that does not address the pressing issues of maternal and child malnutrition. These issues contribute 3·5 times the total disability-adjusted life-years than dietary factors in low, and middle–low Socio-demographic Index countries, according to the Global Burden of Disease project.A truly effective global solution to the problem of human nutrition and environmental impact must be replicable, transparent, and supported with correct quantification of its impact. Unfortunately, the report did not meet these criteria.

FJZ, JGP, and SC report a consulting and research engagement for MatPrat; a grant from the Beef Checkoff through the National Cattlemen's Beef Association; and grant from the National Cattlemen's Beef Association outside the submitted work. FJZ is a member of the US National Advisory Committee on Microbial Criteria for Foods. Outside the submitted work, he reports consulting and research engagements with US Department of Agriculture food safety and inspection services, UK Food Standards Agency, Hawaii Department of Agriculture, DSM nutritional products, Janssen Pharma, Teva Pharmaceuticals, and Hortifruit. SC reports consulting engagements for the Hawaii Department of Agriculture and Teva Pharmaceuticals, outside the submitted work. JGP reports consulting engagements for Tillotts Pharma outside the submitted work.