https://doi.org/10.47108/jidhealth.Vol6.Iss1.267 Çelikkaya EB, Journal of Ideas in Health (2023); 6(1):806-813 © The Author(s). 2023 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. e ISSN: 2645-9248 Journal homepage: www.jidhealth.com Open Access Evaluation of oncology-related healthcare professionals' knowledge and practices on sustainable nutrition, Ankara, Turkey Emine Balyan Çelikkaya1* Abstract Background: Increasing population, limited resources, and climate change require adopting more sustainable diets. This study aims to evaluate health professionals' knowledge levels and practices on sustainable nutrition. Methods: A cross-sectional study was conducted between January 2022 and May 2022 at Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital in Ankara. The research was performed by using the "Stretched Sampling Method". A semi-structured and self-reported online survey was recruited to collect data from healthcare professionals. Data from 298 participants were subjected to descriptive and univariate analyses to evaluate differences in knowledge mean scores and SCOFI scores. The data analysis results with the SPSS 26.0 program were accepted as a 95% confidence interval, with significance p≤0.05. Results: A total of 298 people participated in the study. The mean age of respondents was 36 years (13±10.8). More than two-thirds (79.2%) were females, more than half (52%) were nurses, 20.5% were doctors, 60.4% had a bachelor's degree, % and 12.8 had a master's degree. Sustainable nutrition knowledge and SCOFI mean scores were 10.71±5.3 (0-24) and 54.09±13.2, respectively. 37.9% of the participants stated that they had heard of the concept of sustainable nutrition before. The sustainable nutrition knowledge of females was lower, and the SCOFI score was higher (P>0.05). The SCOFI score of the 18-25 age group was lower than the other age groups (P<0.05). Sustainable nutrition knowledge means scores increased as the education level increased (P<0.05). Dieticians had the highest sustainable nutrition knowledge and SCOFI score (P<0.05). The SCOFI score of those working in the surgery room and intensive care unit was lower than the other units (P<0.05). Conclusion: Training for healthcare professionals might increase sustainable nutrition knowledge and awareness. Keywords: Environment, Hospital, Oncology, Healthcare professional, Sustainable nutrition, Turkey Background The concept of sustainability is a term it has been heard in many areas recently. It first appeared in the Brundtland Report titled "Our Common Future," prepared by United Nations (UN) World Commission on Environment and Development in 1987. The concept of sustainability was mentioned as sustainable development. It was defined as "development that meets the needs of the present without compromising the ability of future generations to meet their needs" [1]. This requires the effective use of our existing resources by current and future generations. The concept of sustainability was born with the concern that our natural resources could not meet our needs [2]. The increasing population, climate changes, and limited resources raise the question of whether we can reach healthy and safe food in the future. What kind of problems will arise 100 years from now if our current nutritional status continues? What can be the impact of food on the environment from production to our table? These questions reveal the concept of sustainable nutrition. The Food and Agriculture Organization (FAO) of The United Nations developed the concept of sustainable nutrition within the scope of the symposium held in 2010, and the following definition was accepted. Sustainable diets are "diets with a low environmental impact that contribute to food and nutrition security and wellness for current and future generations. Sustainable diets are protective and respectful of biodiversity and ecosystems; culturally acceptable, accessible, economically fair and affordable; diets that use natural and human resources appropriately" [3]. ___________________________________________________ dyteminebalyan@gmail.com 1Department of Public Health, Ankara Yildirim Beyazıt University Institute of Health Sciences, Ankara, Turkey. 2Dr. Abdurrahman Yurtaslan Oncology TRH, Ankara, Turkey. Full list of author information is available at the end of the article 10.47108/jidhealth.Vol6.Iss1.267 http://www.jidhealth.com/ Çelikkaya EB, Journal of Ideas in Health (2023); 6(1):806-813 807 The number of undernourished people around the world is substantial. One out of every three people has symptoms of malnutrition, such as hunger and stunting, and being overweight or obese. More than 830 million people go to bed hungry every day [4]. Four million people lose their life worldwide each year due to being overweight, obesity, and related diseases. At the same time, the global burden of foodborne diseases is that all forms of malnutrition cost US$3.5 trillion per year, and overweight and obesity alone cost US$500 billion per year [5]. Sustainable diets are not only concerned with people's health and nutritional status but also with the environmental effects of food [6]. From production to distribution, the global food system is responsible for approximately one-third of anthropogenic greenhouse gas emissions worldwide [7]. Agricultural lands use 70% of freshwater [8]. However, agriculture is an essential source of water pollution from pesticides and other pollutants [9]. One-third of the food produced worldwide is wasted, which puts an extra burden on the environment [10]. This study was carried out to evaluate the knowledge and practices of health professionals, who are expected to be an example to society about sustainable nutrition, and to examine its relationship with sociodemographic characteristics. Methods Study design A cross-sectional study was conducted between January 2022 and May 2022 at Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital in Ankara. The data were prepared electronically due to the Covid-19 pandemic, and the access address of questionnaires was sent to participants via email or SMS. Inclusion and Exclusion criteria All healthcare professionals who graduated from any department of health working in Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, both gender and willing to participate, were included in the research. However, health professionals working in other hospitals, non-health workers, missing data, and those unwilling to participate were included in the study. Sample size The population of the research is N:1305. The sample size calculator arrived at 297 participants, using a margin of error of ±5.0%, a confidence level of 95%, a 50% response distribution, and 1305 people [11]. A total of 298 people responded to the survey. Study tool First Section: In this section, questions were asked to determine demographic characteristics such as gender, age, marital status, educational status, occupation, and income level. Second Sections: In this section, there are 13 main questions and 11 sub-questions to measure the level of knowledge about sustainable nutrition. Since there is no scale measuring the level of sustainable nutrition knowledge, the researcher prepared the questions in accordance with the literature [3, 4, 12, 13]. Scoring is calculated as 1 point for the "Yes" answer, 0 for "No" and "I have no idea answer". There are three negative statements, and these statements are scored as 1 point for the "No" answer and 0 points for the "Yes" and "I have no idea" answers. Cronbach's Alpha value was found to be 0.890. Third Sections: In this section, the Sustainable Food Consumption Index (SCOFI) prepared as the 2nd Intellectual Output of the project titled "Assessment and Changing Adult Behaviors on Sustainable Consumption of Food Products" implemented within the scope of Erasmus + KA204 Strategic Partnerships Adult Education on sustainable nutrition practices was used. SCOFI aims to measure the practices of individuals on sustainable food consumption [14]. The reliability analysis of the scale found the Cronbach's Alpha value for Turkey to be 0.9. The construct validity of the Index was tested with exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). KMO value is .95, and Bartlett Sphericity Test (χ2 = 12500.96; p = .00) was found significant. When the findings obtained from the CFA were evaluated, the χ2 / SD ratio (2336,38 / 626) was found to be 3.73 [15]. In our reliability analysis, Cronbach's Alpha value was 0.931. Dependent and independent variables Dependent variables are the sustainable nutrition knowledge mean score and sustainable food consumption index (SCOFI) score, while independent variables are gender, marital status, age, education level, occupation, etc. demographic features. Statistical analysis The collected data were analyzed by using the SPSS version 26.0 program. In the descriptive results section, categorical variables were presented as numbers and percentages, and continuous variables were presented as mean ± standard deviation. We found that the knowledge level-dependent variables had a Kolmogorov-Smirnov normal distribution. However, the sustainable food consumption index (SCOFI) dependent variable did not have a Kolmogorov-Smirnov normal distribution. Mann-Whitney U test, Kruskal-Wallis test, Independent Sample T-Test, and One-way ANOVA (One-Way Analysis of Variance) test were used for statistical analysis. The statistical significance threshold was determined as p≤0.05. Results Sociodemographic characteristics 236 (79.2%) and 62 (20.8%) of the 298 people who participated in the study were female and male, respectively. The mean age was 36.13±10.8 years. 57.4% of the participants are married, 60.4% have a bachelor's degree, 52.0% are nurses, and 56% have a monthly income of 7001-10000TL. 45.3%of they work in the clinical unit. The characteristics of the participants are shown in Table 1. 62.1% declared that they had not heard of the concept of sustainable nutrition before. Those who stated that they heard received information from internet sources. The opinions of the health professionals participating in the study about the elements of sustainable nutrition were analyzed statistically. Considering the responses, the statement "should promote a healthy life" was market at the most 245 (14.3%), and the statement "should have a low environmental impact" was marked the least by 73 (4.3%) (Table 2, Table 3). Çelikkaya EB, Journal of Ideas in Health (2023); 6(1):806-813 808 Level of knowledge The sustainable nutrition knowledge mean score was 10.71±5.3 (range: 0-24). The participants generally gave 44.62% (10.71/24*100) correct answers. Sustainable nutrition knowledge mean scores of men (11.31±5.5), 46-55 age group (12.30±5.3), widowed individuals (13±0), monthly income of 10001 TL and above (11.89 ± 5.7) are higher (p> 0.05). Sustainable nutrition knowledge mean scores increase as the education level increases (P=0.003). Dietitians are the occupational group with the highest sustainable nutrition knowledge scores (15.09 ± 6.5, P=0.001). The distribution of the participants' mean knowledge scores by sociodemographic structure is shown in Table 4. Sustainable nutrition practices Sustainable nutrition practices mean score was 54.09±13.2 (0- 100). Participants generally gave correct answers by 54.09% (54.09/100*100). The sustainable food consumption index score of females, widowed persons, and doctorate degrees is higher (p>0.05). The SCOFI score of the 18-25 age group (49.64±14.6) was lower than the other age groups (p=0.01). Dietitians have the highest SCOFI score (66.25±6.7, p=0.047) among the health professionals. The SCOFI score of individuals in the operating room and intensive care unit (48.46±12.8) was lower than those in other units (p=0.033). The distribution of the participants' SCOFI scores by sociodemographic structure is shown in Table 5. Table 1. The distribution of participants according to sociodemographic characteristics (N=298) Variable Categorized Variables N % Gender Female 236 79.2 Male 62 20.8 Age Group 18-25 68 22.8 26-35 85 28.5 36-45 83 27.9 46-55 46 15.4 56-65 16 5.4 Marital Status Married 171 57.4 Single 110 36.9 Divorced 15 5 Widow 2 0.7 Education Vocational School of Health 5 1.7 Associate Degree 29 9.7 Bachelor’s Degree 180 60.4 Master’s Degree 38 12.8 Doctorate Degree 46 15.4 Job Specialist Doctor 42 14.1 Doctor 19 6.4 Nurse 155 52 Health Officer 26 8.7 Nutritionist 11 3.7 Pharmacist 10 3.4 Laboratory Technician 14 4.7 Other* 21 7 Monthly Income 3001-5000 TL 6 2 5001-7000 TL 63 21.1 7001-10000 TL 167 56 10001 TL or more 62 20.8 Unit of Work Policlinic 67 22.5 Clinic 135 45.3 Emergency 12 4 Lab 26 8.7 Operating Room-IC*** 27 9.1 Other** 31 10.4 Total 298 100 Other*Physiotherapist, Psychologist, Medical Secretary, Audiometry Technician, Health Technician, Occupational Therapist, Biologist, Speech and Language Therapist Other** Outpatient Chemotherapy Unit, Clinical Research Unit, Dining Hall, Patient Rights, Social Service Unit, Transfusion Center, Audiology, Administrative Unit *** Intensive Care Çelikkaya EB, Journal of Ideas in Health (2023); 6(1):806-813 809 Table 2. Distribution of health professionals’ hearing about the concept of sustainable nutrition and distribution of the resources they heard Hearing the Concept of Sustainable Nutrition N (%) Yes 113(37.9) No 185(62.1) Information Resources Internet 69(28.7) TV news 26(10.8) Social media 43(17.9) friend/environment 20(8.3) Newspaper/magazine 9(3.8) Scientific publications 31(12.9) from health professionals 39(16.3) Other 3(1.3) Table 3. Distribution of statements made by health professionals within the scope of the elements included in sustainable nutrition Statements N (%) It should have a low environmental impact 73(4.3) Include Seasonal Foods 205(12.0) Promote healthy living 245(14.3) It should be economical 179(10.4) Provide food safety 194(11.3) It should be suitable for traditional foods 89(5.2) Prevent food waste 192(11.2) It should be accessible to everyone 188(11.0) Must meet nutritional needs 159(9.3) Local production should be supported 77(4.5) Prevent nutritional diseases 111(6.5) Other 2(9.1) Discussion The literature on sustainable nutrition is quite scarce. This indicates that it is a developing field of study. The literature has not found a study on sustainable nutrition in healthcare workers. Our study can help fill this gap in the literature. In a study conducted by Gülsöz on individuals aged 20 and over in Turkey in 2017, 76.0% (n=312) of the participants stated that they had not heard of the concept of sustainable nutrition before, while 24.0% (n=100) stated that they had heard of it [12]. It is thought that the higher rate of hearing the concept of sustainable nutrition in our study is because our sample is health professionals. In the study conducted by Engin on bachelor's degree students in Turkey in 2022, it was seen that the concept of sustainable nutrition was heard on social media at a rate of 33.0%. It is estimated that it may be related to the fact that bachelor's degree students spend more time on social media due to their age. They stated that they heard this from health professionals (16.0%), publications such as newspapers and magazines (14.0%), scientific publications (14.0%), courses and training they took in bachelor's degree education (12%), and television (9.0%), respectively [16]. The rate of courses taken in bachelor's degree education was higher than that of health professionals. This may be because sustainable nutrition has been included in the course contents of some health departments recently. When the answers of the health professionals participating in the study about the elements of sustainable nutrition were examined, the statement "Promote healthy life" was marked the most, and the statement "Should have a low environmental impact" was marked the least. The data from Akay's study (Turkey) on university students studying health in 2020 resembles the current study. The students declared that sustainable nutrition should again most often promote healthy living and have the least environmental impact [13]. In another study, the Spanish population surveyed most associated a sustainable diet with "plenty of fresh produce", " respect for biodiversity," and "rich in vegetables"; least associated with "cultural aspects of diet", "simple (consist of few ingredients) and "environmental impact" [17]. This shows that the relationship between sustainable nutrition and the environment is not absolutely known. Studies are needed to inform health professionals about the environmental impact of sustainable nutrition. No significant relationship was found between healthcare professionals' sustainable nutrition knowledge levels and practices and gender and marital status. Considering similar studies; In a study with the participation of 388 people from 5 different countries (Slovakia, Turkey, Denmark, Sweden, and Austria), which was prepared within the scope of the SUSCOF Erasmus+ Project, to evaluate the attitudes and behaviors of adults towards sustainable food consumption, no significant difference was found between the gender variable. Considering marital status, it is stated that married individuals have more positive behaviors toward sustainable consumption [18]. A study conducted with 230 bachelor's degree students in California stated no significant difference between men and females, single and married students in food sustainability knowledge [19]. In Gülsöz's study in Turkey, a significant difference was observed between gender and the level of sustainable nutrition knowledge, and it was seen that 38.0% of females and 22.0% of men had adequate, sustainable nutrition levels [12]. The reason for the difference may be that most of the sample in our study was female, which may have prevented a statistical difference from occurring. While people's sustainable food consumption index score increases with age, surprisingly, the 56-65 age group scores decreased. In Atar’s study in Turkey, no significant relationship was found between sustainable nutrition knowledge levels and age; as age increases, the proportion of participants with a higher-than-average level of knowledge decreases [20]. Dietitians are important health professionals to promote sustainable nutrition in health institutions [21]. In one-on-one consultancy services, they can create sustainable diets that have a low environmental impact and encourage healthy eating, minimize food waste in kitchen services in their institutions, plan menus suitable for sustainable diets, and increase the awareness of employees and patients by providing both in- house and external training. In our study, dietitians' sustainable nutrition knowledge and practice scores were higher than other occupational groups. This is an expected result, but whether dietitians reflect sustainable nutrition knowledge and practices in their work is unknown. In the study conducted by Wilson et al. in Canada, it is seen that dietitians' recommendations about sustainable diets are left to their own self-efficacy and personal preferences. In the same study, it was stated that the reason why dietitians recommend reducing meat consumption is related to health rather than environmental impact [22]. Çelikkaya EB, Journal of Ideas in Health (2023); 6(1):806-813 810 Table 4. Distribution of sustainable nutrition knowledge levels of health professionals according to sociodemographic characteristics Variable Categorized Variables N Mean Knowledge Score (± SD) Gender Female 236 10.56±5.3 Male 62 11.31±5.5 t / p 0.196/0.658 Age Group 18-25 68 10.44±5 26-35 85 10.67±5.2 36-45 83 10±5.4 46-55 46 12.30±5.3 56-65 16 11.19±6.1 F / p 1.496/0.203 Marital Status Married 171 10.231±5.2 Single 110 11.59±5.3 Divorced 15 9.47±5.8 Widow 2 13±0 F / p 1.895/0.131 Education Vocational School of Health¹ 5 7.8±3.4 Associate Degree² 29 7.83±4.3 Bachelor’s Degree³ 180 10.67±5.1 Master’s Degree⁴ 38 11.34±5.5 Doctorate Degree⁵ 46 12.48±5.8 F / p* 4.090/0.003 PostHoc 5>2 Job Specialist Doctor¹ 42 11.93 ± 5.6 Doctor² 19 13.11 ± 5.7 Nurse³ 155 9.97 ± 4.9 Health Officer⁴ 26 12.19 ± 5.7 Nutritionist⁵ 11 15.09 ± 6.5 Pharmacist⁶ 10 9.8 ± 5 Laboratory Technician⁷ 14 8.36 ± 4 Other⁸ 21 9.48 ± 4.8 F / p** 3.446/0.001 PostHoc 5>3 5>7 Monthly Income 3001-5000 TL 6 10.33 ± 7.5 5001-7000 TL 63 10.56 ± 4.8 7001-10000 TL 167 10.35 ± 5.3 10001 TL or more 62 11.89 ± 5.7 F / p 1.308/0.272 Unit of Work Policlinic 67 11.72 ± 5.1 Clinic 135 10.16 ± 5.2 Emergency 12 11.92 ± 7.5 Lab 26 10.31 ± 4.8 Operating Room-IC 27 10.74 ± 5 Other 31 10.81 ± 6.1 F / p 0.931/0.461 In the study conducted by Wang et al. [23]in China by using sustainability assessment of food consumption of a group of more than 30,000 people, whose food consumption data and socioeconomic information were obtained from the China Health and Nutrition Survey for the period 1997–2011, although the low-income and low-education group is much more sustainable than the higher income and higher education group, is has been stated that the sustainability of food consumption has decreased significantly over the years in all groups [23]. The sustainable food consumption index score of participants in the operating room and intensive care unit were significantly lower than those in other units. In Alemdağ's study in Turkey [24], it was stated that the healthy lifestyle behaviors of the health personnel working in the operating room were moderate, they could not use their knowledge in daily life, and the reason for this could be related to the intense work schedule and the stress of the cases [24]. In Kalın's study in Turkey [24], it was observed that as the stress level of operating room nurses increased, healthy lifestyle behaviors decreased [25]. Çelikkaya EB, Journal of Ideas in Health (2023); 6(1):806-813 811 Table 5. Distribution of SCOFI scores of healthcare professionals by sociodemographic characteristics Variable Categorized Variables N Mean SCOFI Score (± SD) p Value Gender Female 236 54.86±12.4 0.103 Male 62 51.14±15.9 Age Group 18-25 68 49.64±14.6 0.01** 26-35 85 53.69±13.7 36-45 83 55.45±12 46-55 46 58.57±11.1 56-65 16 54.09±13.2 Marital Status Married 171 54.79±12.9 0.129 Single 110 52.51±14.6 Divorced 15 55.9±8.7 Widow 2 67.82±3.3 Education Vocational School of Health 5 54.24±13.8 0.18 Associate Degree 29 48.95±13.4 Bachelor’s Degree 180 54.12±13.6 Master’s Degree 38 54.53±12.8 Doctorate Degree 46 56.81±11.6 Job Specialist Doctor 42 56.09±11.7 0.047* Doctor 19 55.23±11.8 Nurse 155 52.46±13.8 Health Officer 26 54.46±13.2 Nutritionist 11 66.25±6.7 Pharmacist 10 50.62±19.9 Laboratory Technician 14 56.77±8.6 Other 21 54.43±11.6 Monthly Income 3001-5000 TL 6 54.01±14.8 0.829 5001-7000 TL 63 51.93±15.78 7001-10000 TL 167 54.27±12.7 10001 TL or more 62 55.81±11.5 Unit of Work Policlinic 67 56.16±11.4 0.033* Clinic 135 52.77±14.3 Emergency 12 58.35±14 Lab 26 56.93±9.6 Operating Room-IC 27 48.46±12.8 Other 31 54.09±13.2 In the study of Gençgün in Turkey [26], he mentioned that the healthy lifestyle behaviors of the operating room and intensive care nurses are still at a moderate level. This situation is lower than expected, possibly because the difficulty of working conditions prevents them from experiencing their knowledge in daily life [26]. Due to similar reasons, operating room and intensive care workers may have lower scores than other units because they cannot spare time for sustainable practices. More detailed studies can be done on this subject. Studies have shown that diet can prevent most cancer cases [27]. Vineis et al. [28] examined the relationship between cancer and climate change. They mentioned that reducing the compounds released into the atmosphere and contributing to climate change will reduce the risk of many non-communicable diseases, including cancer [28]. Considering the positive effects of sustainable diets on the environment and health, it is important for the health professionals working in the oncology hospital to have sufficient knowledge of sustainable nutrition for their patients. Simões et al.'s study [29] determined that Insulin-like growth factor 1 (IGF-1), glycemia, and total cholesterol decreased at Çelikkaya EB, Journal of Ideas in Health (2023); 6(1):806-813 812 the end of the intervention in a breast cancer patient who switched from a western-style diet to a plant-based diet [29]. Sustainable diets that encourage the overconsumption of plant foods may benefit cancer patients. The lack of a standard scale to measure the level of sustainable nutrition knowledge in the literature and the inability to reach our entire universe due to COVID-19 conditions constitute the limitations of the research. A large number of females impacted our study. The height and weight status of the participants were taken according to their statements. In addition, the fact that our study has a cross- sectional design creates a limitation in revealing causality. Conclusion As a result, 62.1% of healthcare professionals have yet to hear of sustainable nutrition. It was observed that only 44.6% of the participants had sufficient sustainable nutrition knowledge, and 54.1% had sufficient sustainable nutrition practices. More than sustainable nutrition knowledge and practices of health professionals is required. Hospitals are important institutions for promoting sustainable nutrition. Training should be given to increase health professionals' sustainable nutrition knowledge level, who is expected to be an example to society. Sustainable nutrition should be added to the bachelor’s degree education curriculum, especially in health departments. Strategies and policies for sustainable nutrition should be developed, and health professionals should be pioneers.. Abbreviation TRH: Training and Research Hospital; SCOFI: Sustainable Food Consumption Index; SPSS: Statistical Package for the Social Sciences; UN: United Nations; WCED: World Commission on Environment and Development; FAO: Food and Agriculture Organization; ABD: United States of America; SD: Standard Deviation; SUSCOF: Sustainable Consumption of Food; IGF-1: Insulin-like growth factor; COVID-19: Coronavirus Disease-2019 Declaration acknowledgment We thank all the health personnel who participated in our survey. Funding The authors received no financial support for their research, authorship, and/or publication of this article. Availability of data and materials Data will be available by emailing dyteminebalyan@gmail.com Authors’ contributions Emine Balyan Çelikkaya (EBC) is the responsible author for the concept, design, literature search, data analysis, data acquisition, manuscript writing, editing, and reviewing. EBC has read and approved the final manuscript. Ethics approval and consent to participate We conducted the research following the Declaration of Helsinki. The protocol was approved by Ankara Yıldırım Beyazıt University Ethics Committee (Ref: SR/33 at 29- November-2021); In addition, web-based informed consent was obtained from each participant after the study objectives and confidentiality guarantee was explained. Consent for publication Not applicable Competing interest The authors declare that they have no competing interest. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Author details 1Department of Public Health, Ankara Yildirim Beyazıt University Institute of Health Sciences, Ankara, Turkey. 2Dr. Abdurrahman Yurtaslan Oncology TRH, Ankara, Turkey. Article Info Received: 07 December 2022 Accepted: 15 February 2023 Published: 18 March 2023 References 1. WCED U. Brundtland Report-Our Common Future; 1987. Available from: https://sustainabledevelopment.un.org/content/documents/ 5987our-common-future.pdf [Accessed on 5 November 2022] 2. Şen H, Kaya A, Alpaslan B. A historical and current perspective on sustainability (Sürdürülebilirlik üzerine tarihsel ve güncel bir perspektif). Ekonomik Yaklaşım Derneği. 2018; 29:1-47. doi: 10.5455/ey.39101 3. FAO. Sustaınable Dıets and Bıodıversıty; 2010. Roma. Available from: https://www.fao.org/3/i3004e/i3004e00.pdf [Accessed on 13 November 2022] 4. FAO/WHO. Sustainable healthy diets – Guiding principles; 2019. Roma. Available from: https://www.fao.org/3/ca6640en/ca6640en.pdf [Accessed on 16 November 2022] 5. Global Panel on Agriculture and Food Systems for Nutrition. The Cost of Malnutrition; 2016. London, UK. Available from: https://www.glopan.org/cost-of- malnutrition/#:~:text=The%20estimated%20impact%20on %20the,or%20US%24500%20per%20individual. [Accessed on 16 November 2022] 6. Perignon M, Vieux F, Soler LG, Masset G, Darmon N. Improving diet sustainability through evolution of food choices: review of epidemiological studies on the environmental impact of diets. Nutrition Reviews. 2017;75(1):2-17. doi: 10.1093/nutrit/nuw043 7. Tubiello FN, Rosenzweig C, Conchedda G, Karl K, Gütschow J, Xueyao P, et al. Greenhouse gas emissions Çelikkaya EB, Journal of Ideas in Health (2023); 6(1):806-813 813 from food systems: building the evidence base. Environmental Research Letters. 2021;16(6):065007. doi: 10.1088/1748-9326/ac018e 8. FAO. The State of the World's Land and Water Resources for Food and Agrıculture; 2011. Available from: https://www.fao.org/land-water/solaw2021/en/ [Accessed on 5 November 2022] 9. FAO. Water for Sustainable Food and Agriculture; 2017. Roma. Available from: https://www.fao.org/3/i7959e/i7959e.pdf [Accessed on 5 November 2022] 10. Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the Anthropocene: the EAT- Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447-92. doi: 10.1016/s0140-6736(18)31788-4 11. Sample Size Calculator by Raosoft, Inc.; 2021. Available from: http://www.raosoft.com/samplesize.html [Accessed on 15 February 2023] 12. Gülsöz S. The evaluation of the levels of knowledge and practice on sustainable nutrition of individuals' aged twenty years and over. M.Sc. Thesis, The University of Başkent.2017. Available from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYe ni.jsp [Accessed on 22 November 2022] 13. Akay G. Evaluation of the knowledge levels of university students studying health about sustainable nutrition and environment relationship. M.Sc. Thesis, The University of Necmettin Erbakan.2020. Available from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYe ni.jsp [Accessed on 22 November 2022] 14. Erasmus+ Program of the European Union. Sustainable Consumption of Food Index; 2020. Available from: http://suscof.com/index.php/cikti-2-scofi-indeks/ [Accessed on 21 November 2022] 15. Erasmus+ Program of the European Union. The SCOFI Tecnical Notes and Calculatıon; 2020. Available from: http://suscof.com/index.php/en/output-2-the-scofi-index/ [Accessed on 21 November 2022] 16. Engin Ş. The relationship between knowledge and behaviors on sustainable nutrition with food preferences of Bahçeşehir University undergraduate students. M.Sc. Thesis, The University of Bahçeşehir.2022. Available from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYe ni.jsp [Accessed on 22 November 2022] 17. García-González Á, Achón M, Carretero Krug A, Varela- Moreiras G, Alonso-Aperte E. Food sustainability knowledge and attitudes in the Spanish adult population: A cross-sectional study. Nutrients. 2020;12(10). doi: 10.3390/nu12103154 18. Erasmus+ Program of the European Union. Sustainable Consumption of Food Need Analysıs Report; 2019. Available from: http://suscof.com/index.php/en/output-1- 2/ [Accessed on 22 November 2022] 19. Torabian-Riasati S, Lippman S, Nisnevich Y, Plunkett S. Food sustainability knowledge and ıts relationship with dietary habits of college students. Austin J Nutri Food Sci. 2017;5(2): 1089. 20. Atar A. Evaluation of corporate company employees' knowledge, attitudes and behaviors about sustainable nutrition. M.Sc. Thesis, The University of İstanbul Medipol.2021. Available from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYe ni.jsp [Accessed on 22 November 2022] 21. Alberdi G, Begiristain-Zubillaga M. The promotion of sustainable diets in the healthcare system and ımplications for health professionals: A scoping review. Nutrients. 2021;13(3):747. doi: 10.3390/nu13030747 22. Wilson ED, Garcia AC. Environmentally friendly health care food services: a survey of beliefs, behaviours, and attitudes. Can J Diet Pract Res. 2011;72(3):117-22. doi: 10.3148/72.3.2011.117 23. Wang L, Huang W, Zhao C, Hu Y, Cui S. Exploring the environment-nutrition-obesity effects associated with food consumption in different groups in China. J Environ Manage. 2022; 317:115287. doi: 10.1016/j.jenvman.2022.115287 24. Alemdağ M. Health promoting lifestyle behaviors of healthcare personnel working in the operating theatre and determination of the related factors. M.Sc. Thesis, The University of Ankara Yıldırım Beyazıt.2019. Available from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYe ni.jsp [Accessed on 22 November 2022] 25. Kalın Z. The effect of stress levels of operating room nurses on healthy lifestyle behaviors in the COVİD-19 pandemic. M.Sc. Thesis, The University of İstanbul.2022. Available from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYe ni.jsp [Accessed on 22 November 2022] 26. Gençgün F. An assessment of healthy lifestyle behaviour in surgical and intensive care nurses. M.Sc. Thesis, The University of Okan.2018. Available from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYe ni.jsp [Accessed on 23 November 2022] 27. El-Sherif A, El-Sherif S, Taylor AH, Ayakannu T. Ovarian Cancer: Lifestyle, Diet and Nutrition. Nutrition and Cancer. 2021;73(7):1092-107. doi: 10.1080/01635581.2020.1792948 28. Vineis P, Huybrechts I, Millett C, Weiderpass E. Climate change and cancer: converging policies. Molecular Oncology. 2021;15(3):764-9. doi: https://doi.org/10.1002/1878-0261.12781 29. Simões LMFR, Tavares NAR, Ferreira-Pêgo C. Plant- Based Diet and IGF-1 Modulation on HER2-Positive Breast Cancer: A Lifestyle Medicine Nutrition Approach in Oncology. American Journal of Lifestyle Medicine. 2021;16(1):36-45. doi: 10.1177/15598276211023048