METHODS: A taskforce convened by APAGE proposed provisional statements. Twenty-two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process.
RESULTS: There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single-use endoscopes.
CONCLUSION: The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability.
RESEARCH AIMS: To (1) describe exploratory estimates of greenhouse gas emission factors for all infant and young child milk formula products and (2) estimate national greenhouse gas emission association with commercial milk formulas sold in selected countries in the Asia Pacific region.
METHOD: We used a secondary data analysis descriptive design incorporating a Life Cycle Assessment (LCA) concepts and methodology to estimate kg CO2 eq. emissions per kg of milk formula, using greenhouse gas emission factors for milk powder, vegetable oils, and sugars identified from a literature review. Proportions of ingredients were calculated using FAO Codex Alimentarius guidance on milk formula products. Estimates were calculated for production and processing of individual ingredients from cradle to factory gate. Annual retail sales data for 2012-2017 was sourced from Euromonitor International for six purposively selected countries; Australia, South Korea, China, Malaysia, India, Philippines.
RESULTS: Annual emissions for milk formula products ranged from 3.95-4.04 kg CO2 eq. Milk formula sold in the six countries in 2012 contributed 2,893,030 tons CO2 eq. to global greenhouse gas emissions. Aggregate emissions were highest for products (e.g., toddler formula), which dominated sales growth. Projected 2017 emissions for milk formula retailed in China alone were 4,219,052 tons CO2 eq.
CONCLUSIONS: Policies, programs and investments to shift infant and young child diets towards less manufactured milk formula and more breastfeeding are "Triple Duty Actions" that help improve dietary quality and population health and improve the sustainability of the global food system.