{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T23:26:16Z","timestamp":1769556376710,"version":"3.49.0"},"reference-count":63,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T00:00:00Z","timestamp":1747785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Minas Gerais Research Foundation\u2014FAPEMIG","award":["CDS-APQ-00571\/13"],"award-info":[{"award-number":["CDS-APQ-00571\/13"]}]},{"name":"Minas Gerais Research Foundation\u2014FAPEMIG","award":["CDS-APQ-02407\/16"],"award-info":[{"award-number":["CDS-APQ-02407\/16"]}]},{"name":"Minas Gerais Research Foundation\u2014FAPEMIG","award":["CDS-APQ-00424\/17"],"award-info":[{"award-number":["CDS-APQ-00424\/17"]}]},{"name":"Minas Gerais Research Foundation\u2014FAPEMIG","award":["001"],"award-info":[{"award-number":["001"]}]},{"DOI":"10.13039\/501100002322","name":"CAPES Foundation","doi-asserted-by":"publisher","award":["CDS-APQ-00571\/13"],"award-info":[{"award-number":["CDS-APQ-00571\/13"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"CAPES Foundation","doi-asserted-by":"publisher","award":["CDS-APQ-02407\/16"],"award-info":[{"award-number":["CDS-APQ-02407\/16"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"CAPES Foundation","doi-asserted-by":"publisher","award":["CDS-APQ-00424\/17"],"award-info":[{"award-number":["CDS-APQ-00424\/17"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"CAPES Foundation","doi-asserted-by":"publisher","award":["001"],"award-info":[{"award-number":["001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Global food systems are contributing to a shift toward unhealthy diets, which is linked to the three components of the global syndemic. This cross-sectional study evaluates how dietary patterns in Brazil are associated with the components of the global syndemic. Anthropometric and food intake data were obtained from the CUME Study\u2014a prospective cohort conducted with a sample of Brazilian university graduates. BMI was used to assess obesity. Insufficient intake of micronutrients was considered undernutrition. Carbon, water, and ecological footprints were used to assess the environmental impact of dietary patterns. Dietary patterns were identified through principal components analysis. Linear regression models were used to evaluate associations between dietary patterns and the components of the global syndemic. The Unhealthy Dietary Pattern was positively associated with BMI and had the highest environmental impact. The Brazilian Dietary Pattern was also positively associated with BMI but had the lowest environmental impact. The Healthy Dietary Pattern was the most protective against micronutrient inadequacy. Diet affected the environment and people\u2019s health in this sample. The dietary patterns identified here as contributing to poor health and environmental damage can help the government develop policies that incorporate the costs of these effects into the prices of food.<\/jats:p>","DOI":"10.3390\/ijerph22050805","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T07:44:57Z","timestamp":1747813497000},"page":"805","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Relationship Between Brazilian Dietary Patterns and the Global Syndemic: Data from the CUME Study"],"prefix":"10.3390","volume":"22","author":[{"given":"J\u00e9ssica","family":"Bevenuto Mattar","sequence":"first","affiliation":[{"name":"Department of Nutrition and Health, Universidade Federal de Vi\u00e7osa (UFV), Vi\u00e7osa 36570-900, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6874-9315","authenticated-orcid":false,"given":"Marcos","family":"Heil Costa","sequence":"additional","affiliation":[{"name":"Department of Agricultural Engineering, Universidade Federal de Vi\u00e7osa (UFV), Vi\u00e7osa 36570-900, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7010-0574","authenticated-orcid":false,"given":"Ana Luiza","family":"Gomes Domingos","sequence":"additional","affiliation":[{"name":"School of Arts, Sciences and Humanities, University of S\u00e3o Paulo, 1000 Arlindo Bettio Avenue, S\u00e3o Paulo 03828-000, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4441-6572","authenticated-orcid":false,"given":"Helen Hermana","family":"Miranda Hermsdorff","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health, Universidade Federal de Vi\u00e7osa (UFV), Vi\u00e7osa 36570-900, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriano","family":"Mar\u00e7al Pimenta","sequence":"additional","affiliation":[{"name":"Department of Nursing, Universidade Federal do Paran\u00e1 (UFPR), Curitiba 80035-050, PR, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4993-9436","authenticated-orcid":false,"given":"Josefina","family":"Bressan","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health, Universidade Federal de Vi\u00e7osa (UFV), Vi\u00e7osa 36570-900, MG, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/S0140-6736(18)32822-8","article-title":"The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission Report","volume":"393","author":"Swinburn","year":"2019","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"20260","DOI":"10.1073\/pnas.1116437108","article-title":"Global Food Demand and the Sustainable Intensification of Agriculture","volume":"108","author":"Tilman","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1038\/nature10452","article-title":"Solutions for a Cultivated Planet","volume":"478","author":"Foley","year":"2011","journal-title":"Nature"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1126\/science.aba7357","article-title":"Global Food System Emissions Could Preclude Achieving the 1.5\u00b0 and 2 \u00b0C Climate Change Targets","volume":"370","author":"Clark","year":"2020","journal-title":"Science"},{"key":"ref_5","unstructured":"Intergovernmental Panel on Climate Change (IPCC) (2019). Climate Change and Land: An IPCC Special Report on Climate Change, Desertification, Land Degradation, Sustainable Land Management, Food Security, and Greenhouse Gas Fluxes in Terrestrial Ecosystems. Summary for Policymakers, IPCC."},{"key":"ref_6","unstructured":"FAO, IFAD, UNICEF, WFP, and WHO (2020). The State of Food Security and Nutrition in the World 2020, Transforming Food Systems for Affordable Healthy Diets, Food and Agriculture Organization."},{"key":"ref_7","unstructured":"FAO (2013). THE STATE OF FOOD AND AGRICULTURE: 2013, Food Systems for Better Nutrition, Food and Agriculture Organization."},{"key":"ref_8","unstructured":"Belik, W. (2020). Estudo Sobre a Cadeia de Alimentos, Instituto Ibirapitanga."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1038\/s43016-021-00225-9","article-title":"Food Systems Are Responsible for a Third of Global Anthropogenic GHG Emissions","volume":"2","author":"Crippa","year":"2021","journal-title":"Nat. Food"},{"key":"ref_10","unstructured":"der Pahlen, C.T. (2017). Sustainable Diets for Healthy People and a Healthy Planet, UNSCN."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"de Oliveira Neta, R.S., Lima, S.C.V.C., do Nascimento, L.L., de Souza, C.V.S., de Oliveira Lyra, C., Marchioni, D.M.L., and da Costa Oliveira, A.G.R. (2023). Indices for Measurement of Sustainable Diets: A Scoping Review. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0296026"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Wang, Y.Y., Tian, T., Pan, D., Zhang, J.X., Xie, W., Wang, S.K., Xia, H., Dai, Y., and Sun, G. (2021). The Relationship between Dietary Patterns and Overweight and Obesity among Adult in Jiangsu Province of China: A Structural Equation Model. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-11341-3"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1017\/S1368980019005202","article-title":"Cross-Country Comparison of Dietary Patterns and Overweight and Obesity among Adult Women in Urban Sub-Saharan Africa","volume":"24","author":"Bliznashka","year":"2021","journal-title":"Public Health Nutr."},{"key":"ref_14","first-page":"778","article-title":"Association of Dietary Patterns, Number of Daily Meals and Anthropometric Measures in Women in Age of Menopause","volume":"65","author":"Mendes","year":"2021","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e775","DOI":"10.1016\/S2542-5196(21)00254-0","article-title":"Greenhouse Gas Emissions, Water Footprint, and Ecological Footprint of Food Purchases According to Their Degree of Processing in Brazilian Metropolitan Areas: A Time-Series Study from 1987 to 2018","volume":"5","author":"Garzillo","year":"2021","journal-title":"Lancet Planet. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.jclepro.2016.06.080","article-title":"Environmental Impacts of Food Consumption in Europe","volume":"140","author":"Notarnicola","year":"2017","journal-title":"J. Clean. Prod."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1017\/S1368980014002833","article-title":"Comparing the Water, Energy, Pesticide and Fertilizer Usage for the Production of Foods Consumed by Different Dietary Types in California","volume":"18","author":"Marlow","year":"2015","journal-title":"Public Health Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1093\/ije\/dyy152","article-title":"Cohort Profile: The Cohort of Universities of Minas Gerais (CUME)","volume":"47","author":"Domingos","year":"2018","journal-title":"Int. J. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Azarias, H.G.D.A., Marques-Rocha, J.L., Miranda, A.E.D.S., Dos Santos, L.C., Gomes Domingos, A.L., Hermsdorff, H.H.M., Bressan, J., Oliveira, F.L.P.D., Leal, A.C.G., and Pimenta, A.M. (2021). Online Food Frequency Questionnaire From the Cohort of Universities of Minas Gerais (CUME Project, Brazil): Construction, Validity, and Reproducibility. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.709915"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1590\/1980-5497201600010013","article-title":"Dietary Intake of Antioxidant in ELSA-Brasil Population: Baseline Results","volume":"19","author":"Teixeira","year":"2016","journal-title":"Rev. Bras. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1093\/ije\/dyu027","article-title":"Cohort Profile: Longitudinal Study of Adult Health (ELSA-Brasil)","volume":"44","author":"Schmidt","year":"2015","journal-title":"Int. J. Epidemiol."},{"key":"ref_22","first-page":"1","article-title":"Valida\u00e7\u00e3o da s\u00edndrome metab\u00f3lica e de seus componentes autodeclarados no estudo cume","volume":"21","author":"Miranda","year":"2017","journal-title":"REME-Rev. Min. Enferm."},{"key":"ref_23","unstructured":"WHO (2000). Obesity: Preventing and Managing the Global Epidemic, World Health Organization."},{"key":"ref_24","unstructured":"Universidade de Campinas (2011). Tabela Brasileira de Composicao de Alimentos-TACO 4 Edicao Ampliada e Revisada, NEPA\u2014N\u00facleo de Estudos e Pesquisas em Alimenta\u00e7\u00e3o."},{"key":"ref_25","unstructured":"IBGE (2011). Pesquisa de Or\u00e7amentos Familiares 2008-2009: Tabela de Composi\u00e7\u00e3o Nutricional Dos Alimentos Consumidos No Brasil, IBGE."},{"key":"ref_26","unstructured":"Institute of Medicine (2019). Dietary Reference Intakes for Sodium and Potassium, National Academies Press."},{"key":"ref_27","unstructured":"Institute of Medicine (2011). Dietary Reference Intakes for Calcium and Vitamin D, National Academies Press."},{"key":"ref_28","unstructured":"Institute of Medicine (2000). Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids, National Academies Press."},{"key":"ref_29","unstructured":"Institute of Medicine (1997). Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride, National Academies Press."},{"key":"ref_30","unstructured":"Institute of Medicine (2001). Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc, National Academies Press."},{"key":"ref_31","unstructured":"Institute of Medicine (1998). Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline, National Academies Press."},{"key":"ref_32","unstructured":"Garzillo, J.M.F., Machado, P.P., Louzada, M.L.D.C., Levy, R.B., and Monteiro, C.A. (2019). Pegadas Dos Alimentos e Das Prepara\u00e7\u00f5es Culin\u00e1rias Consumidos No Brasil, FSP\/USP."},{"key":"ref_33","first-page":"28","article-title":"NOVA. A Estrela Brilha","volume":"7","author":"Monteiro","year":"2016","journal-title":"World Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1079\/PHN2005745","article-title":"Validation of the Spanish Version of the Physical Activity Questionnaire Used in the Nurses\u2019 Health Study and the Health Professionals\u2019 Follow-up Study","volume":"8","author":"Varo","year":"2005","journal-title":"Public Health Nutr."},{"key":"ref_35","unstructured":"WHO (2010). Global Recommendations on Physical Activity for Health, World Health Organization."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"101054","DOI":"10.1016\/j.rineng.2023.101054","article-title":"A Comprehensive Review on Carbon Footprint of Regular Diet and Ways to Improving Lowered Emissions","volume":"18","author":"Ahmed","year":"2023","journal-title":"Results Eng."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1017\/S1368980014002377","article-title":"The Environmental Cost of Protein Food Choices","volume":"18","author":"Sranacharoenpong","year":"2015","journal-title":"Public Health Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Berardy, A., Fres\u00e1n, U., Matos, R.A., Clarke, A., Mejia, A., Jaceldo-Siegl, K., and Sabat\u00e9, J. (2020). Environmental Impacts of Foods in the Adventist Health Study-2 Dietary Questionnaire. Sustainability, 12.","DOI":"10.3390\/su122410267"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"6","DOI":"10.11606\/s1518-8787.2022056004551","article-title":"Ultra-Processed Food Intake and Diet Carbon and Water Footprints: A National Study in Brazil","volume":"56","author":"Garzillo","year":"2022","journal-title":"Rev. Saude Publica"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"110635","DOI":"10.1016\/j.nut.2019.110635","article-title":"Dietary Inflammatory Index and Prevalence of Overweight and Obesity in Brazilian Graduates from the Cohort of Universities of Minas Gerais (CUME Project)","volume":"71","author":"Oliveira","year":"2020","journal-title":"Nutrition"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s00394-019-01898-6","article-title":"Red Meat Consumption and Metabolic Syndrome in the Costa Rica Heart Study","volume":"59","author":"Luan","year":"2020","journal-title":"Eur. J. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.cmet.2019.05.008","article-title":"Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake","volume":"30","author":"Hall","year":"2019","journal-title":"Cell Metab."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1017\/S1368980018000861","article-title":"Consumption of Ultra-Processed Food and Obesity: Cross Sectional Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Cohort (2008\u20132010)","volume":"21","author":"Silva","year":"2018","journal-title":"Public Health Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.clnesp.2022.08.021","article-title":"Sugar Sweetened Beverages Intake and Risk of Obesity and Cardiometabolic Diseases in Longitudinal Studies: A Systematic Review and Meta-Analysis with 1.5 Million Individuals","volume":"51","author":"Santos","year":"2022","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_45","first-page":"4835","article-title":"Alcohol Consumption and Overweight in Brazilian Adults-CUME Project","volume":"26","author":"Hermsdorff","year":"2021","journal-title":"Ci\u00eancia Sa\u00fade Coletiva"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Albani, V., Bradley, J., Wrieden, W.L., Scott, S., Muir, C., Power, C., Fitzgerald, N., Stead, M., Kaner, E., and Adamson, A.J. (2018). Examining Associations between Body Mass Index in 18\u221225 Year-Olds and Energy Intake from Alcohol: Findings from the Health Survey for England and the Scottish Health Survey. Nutrients, 10.","DOI":"10.3390\/nu10101477"},{"key":"ref_47","first-page":"1","article-title":"The Traditional Lunch Pattern Is Inversely Correlated with Body Mass Index in a Population-Based Study in Brazil","volume":"18","author":"Vieira","year":"2017","journal-title":"BMC Public Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1007\/s00394-015-1022-y","article-title":"Dietary Patterns Are Associated with Excess Weight and Abdominal Obesity in a Cohort of Young Brazilian Adults","volume":"55","author":"Kac","year":"2016","journal-title":"Eur. J. Nutr."},{"key":"ref_49","unstructured":"Kac, G., Sichiery, R., and Gigante, D.P. (2007). Epidemiologia Nutricional, Editora FIOCRUZ\/Atheneu."},{"key":"ref_50","unstructured":"Minist\u00e9rio da Sa\u00fade (2014). Guia Alimentar Para a Popula\u00e7\u00e3o Brasileira."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"90","DOI":"10.11606\/s1518-8787.2021055003614","article-title":"Carbon Footprint of the Brazilian Diet","volume":"55","author":"Garzillo","year":"2021","journal-title":"Rev. Saude Publica"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1093\/ajcn\/nqab258","article-title":"Balancing a Sustained Pursuit of Nutrition, Health, Affordability and Climate Goals: Exploring the Case of Indonesia","volume":"114","author":"Hardinsyah","year":"2021","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Fres\u00e1n, U., Craig, W.J., Mart\u00ednez-Gonz\u00e1lez, M.A., and Bes-Rastrollo, M. (2020). Nutritional Quality and Health Effects of Low Environmental Impact Diets: The \u201cSeguimiento Universidad de Navarra\u201d (SUN) Cohort. Nutrients, 12.","DOI":"10.3390\/nu12082385"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.ajcnut.2023.01.009","article-title":"Popular Diets as Selected by Adults in the United States Show Wide Variation in Carbon Footprints and Diet Quality","volume":"117","author":"Rose","year":"2023","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1007\/s00394-024-03350-w","article-title":"Dietary Patterns and Adiposity over Time-Analysis of the ELSA-Brasil","volume":"63","author":"Alves","year":"2024","journal-title":"Eur. J. Nutr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"111626","DOI":"10.1016\/j.nut.2022.111626","article-title":"Dietary Patterns and Cardiovascular Risk Factors among Brazilians: A Population-Based Study in Vi\u00e7osa, Minas Gerais","volume":"98","author":"Longo","year":"2022","journal-title":"Nutrition"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2076","DOI":"10.1017\/S1368980023001064","article-title":"Dietary Patterns, Obesity Markers and Leukocyte Telomere Length among Brazilian Civil Servants: Cross-Sectional Results from the Pro-Saude Study","volume":"26","author":"Naspolini","year":"2023","journal-title":"Public Health Nutr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"S380","DOI":"10.1093\/advances\/nmz019","article-title":"Vegetarian Diets: Planetary Health and Its Alignment with Human Health","volume":"10","year":"2019","journal-title":"Adv. Nutr."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"137672","DOI":"10.1016\/j.scitotenv.2020.137672","article-title":"Evaluation of Environmental Performance of Dietary Patterns in the United States Considering Food Nutrition and Satiety","volume":"722","author":"Chapa","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Gleick, P.H. (2014). The World\u2019s Water, Springer.","DOI":"10.5822\/978-1-61091-483-3"},{"key":"ref_61","unstructured":"Wilderer, P.A. (2010). Treatise on Water Science, Elsevier."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/B978-0-12-384703-4.00506-2","article-title":"State of the World\u2019s Water Resources","volume":"Volume 5","author":"Fekete","year":"2013","journal-title":"Climate Vulnerability: Understanding and Addressing Threats to Essential Resources"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1093\/ije\/dyt103","article-title":"Commentary: Representativeness Is Usually Not Necessary and Often Should Be Avoided","volume":"42","author":"Richiardi","year":"2013","journal-title":"Int. J. Epidemiol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/5\/805\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:36:23Z","timestamp":1760031383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/5\/805"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,21]]},"references-count":63,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["ijerph22050805"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22050805","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,21]]}}}