Health outcomes, environmental impacts, and diet costs of adherence to the EAT-Lancet Diet in China in 1997-2015: a health and nutrition survey

Measuring Global Dietary Diversity by Considering Nutritional Functional Dissimilarity and Dietary Guidelines

Dietary diversity is essential for healthy diets and crucial for academic research and policymaking. However, existing measures often lack conceptual clarity, which limits their interpretability. This study proposes a new framework that classifies dietary diversity indices along two dimensions: whether they account for nutritional functional dissimilarity and whether they incorporate dietary guidelines. Based on this framework, four index types are defined. Using per capita consumption data for 14 food categories across countries from 1981 to 2022, eight indices were applied to assess global dietary diversity and its variation across 13 dietary patterns. The results show a general upward trend in global dietary diversity and dietary quality, with notable regional disparities influenced by dietary patterns, resources, culture, and socioeconomic factors. This study also finds non-linear links between dietary diversity, income, and urbanization, consistent with Bennett's Law and empirical evidence. These findings underscore the utility of the proposed indices in capturing complex dietary dynamics. This study recommends context-specific use of indices, policy attention in developing countries to maintain diversity during dietary transitions, and the development of more inclusive dietary guidelines that emphasize not only variety but also balance and nutritional function.

Exploring Environmental and Cardiometabolic Impacts Associated with Adherence to the Sustainable EAT-Lancet Reference Diet: Findings from the China Health and Nutrition Survey

BACKGROUND

To contribute to the growing evidence on the potential co-benefits of the EAT-Lancet reference diet for cardiometabolic health and sustainability, we investigated this topic in a nationwide prospective cohort of Chinese adults. Adherence to this diet has been measured using several indices, including the World Index for Sustainability and Health (WISH) and the Planetary Health Diet Index (PHDI).

OBJECTIVES

We aimed to investigate the associations between adherence to the EAT-Lancet reference diet, as evaluated by WISH and PHDI, with risk of new-onset cardiometabolic diseases (CMDs), risk of all-cause mortality, and greenhouse gas (GHG) emissions.

METHODS

We included adults (n = 14,652 for CMDs and 15,318 for all-cause mortality) from the China Health and Nutrition Survey (1997-2015) in the analysis. Dietary intake data were collected, and WISH and PHDI scores were computed with established methods. CMDs included myocardial infarction (MI), type 2 diabetes mellitus (T2DM), and stroke. We used Cox proportional hazard regression models to analyze data with a mean of 10 years of follow-up from the date of baseline to the end of study or until the occurrence of the event of interest, whichever came first. We adjusted for sociodemographic, anthropometric, lifestyle, and dietary characteristics of participants as confounders.

RESULTS

Greater adherence to the EAT-Lancet reference diet, as reflected by higher WISH or PHDI scores, was inversely associated with risk of MI {Q4 vs. Q1: hazard ratio  ( HR ) = 0.68 [95% confidence interval (CI): 0.48, 0.96] for WISH and 0.14 (95% CI: 0.07, 0.29) for PHDI}, T2DM [Q4 vs. Q1: HR = 0.81 (95% CI: 0.67, 0.96) for WISH and 0.68 (95% CI: 0.57, 0.82) for PHDI], and all-cause mortality [Q4 vs. Q1: HR = 0.80 (95% CI: 0.68, 0.95) for WISH and 0.60 (95% CI: 0.46, 0.80) for PHDI] in fully adjusted models (all p -trend < 0.05 ). Both WISH and PHDI were inversely associated with GHG emissions in fully adjusted models (all p -trend < 0.05 ). WISH and PHDI were not significantly associated with risk of stroke.

CONCLUSIONS

Our findings supported the co-benefits of the EAT-Lancet reference diet for both cardiometabolic health and environmental sustainability. Long-term adherence to this reference diet as effectively indicated by either higher WISH or PHDI scores may reduce the risk and burden of CMDs and all-cause mortality in Chinese adults. https://doi.org/10.1289/EHP15006.

Temporal trends in the planetary health diet index and its association with cardiovascular, kidney, and metabolic diseases: A comprehensive analysis from global and individual perspectives

BACKGROUND

Diet plays a critical role in human health and environmental sustainability, particularly in cardiovascular, kidney, and metabolic (CKM) diseases. However, the variations in the Planetary Health Diet Index (PHDI) across populations, regions, and over time, as well as its association with CKM disease burdens, remain insufficiently explored.

METHODS

We assessed PHDI scores using data from 185 countries (1990-2018) from the Global Dietary Database, examining demographic characteristics and temporal trends. The Global Burden of Disease Study was used to evaluate the associations between PHDI and CKM disease burdens, including incidence, prevalence, mortality, and disability-adjusted life years. CKM syndrome was defined by the American Heart Association. Individual-level data from the National Health and Nutrition Examination Survey (NHANES) were also used to assess the impact of PHDI on CKM risks and mortality.

RESULTS

From 1990 to 2018, while overall PHDI scores remained relatively stable between sexes, the composition of PHDI scores shifted across different age groups. In 2018, the mean PHDI score was 42.80 (95% uncertainty interval [UI] 42.49-46.50) for males and 44.65 (95% UI 44.53-47.82) for females. Higher PHDI scores were observed among females, older adults, urban residents, individuals with higher education, and those from South Asia. Globally, consumption of red/processed meat, saturated oils/trans fats, and added sugars substantially exceeded the EAT-Lancet Commission's reference values. Higher PHDI scores were generally associated with lower CKM disease burdens, although these associations varied by disease subtype. In individual-level analysis, including 45,460 NHANES participants (weighted mean age: 47.21 years, 51.4% female), each 10-point increase in PHDI was linked to a 13.7% reduction in stage 3/4 CKM syndrome risk, an 11.1% reduction in stage 4 CKM syndrome risk, and lower incidences and mortality rates for cardiovascular diseases, metabolic diseases, and chronic kidney disease.

CONCLUSIONS

From 1990 to 2018, significant changes occurred in the components of the PHDI, with notable variations by demographics and region. Higher PHDI scores may reduce CKM disease burdens, warranting further investigation into specific disease subtypes.

Association between adherence to the EAT-Lancet diet and risk of microvascular complications in type 2 diabetes: A cohort study

AIM

This study aimed to investigate the association between adherence to the EAT-Lancet diet and the incidence of microvascular complications in type 2 diabetes (T2D).

MATERIALS AND METHODS

This prospective study included 7525 individuals with T2D who were free of diabetic microvascular complications (including diabetic retinopathy, neuropathy and nephropathy) at baseline from the UK Biobank cohort. Dietary data were collected via a web-based 24-hour dietary recall questionnaire. The EAT-Lancet diet index, ranging from 0 to 14 points, was constructed based on the EAT-Lancet reference diet. Cox proportional hazard models were used to examine the relationship between the EAT-Lancet diet index and the incidence of microvascular complications among individuals with T2D.

RESULTS

During a mean follow-up of 12.58 years, 1217 participants developed diabetic microvascular complications. After adjusting for potential confounders, participants in the highest adherence group of the EAT-Lancet diet index had a significantly lower risk of developing microvascular complications (hazard ratio: 0.76, 95% CI: 0.64-0.88) compared to those in the lowest adherence group. Subtype analyses for incident diabetic retinopathy, neuropathy and nephropathy yielded consistent results. Additionally, each 1-point increase in the EAT-Lancet diet index was associated with an 8% lower risk of microvascular complications. These findings remained robust across several sensitivity analyses and nearly all subgroups.

CONCLUSION

Our findings demonstrate a significant inverse association between adherence to the EAT-Lancet diet and the risk of microvascular complications in individuals with T2D.

The Role of the Planetary Diet in Managing Metabolic Syndrome and Cardiovascular Disease: A Narrative Review

Introduction: The planetary health diet, introduced by the EAT-Lancet Commission, aims to address global health and sustainability challenges by promoting a plant-based diet with reduced consumption of animal-sourced foods. This diet not only contributes to environmental sustainability but also offers significant health benefits, including prevention and management of abdominal obesity, carbohydrate metabolism disorders, dyslipidemia, and elevated blood pressure. These metabolic disorders are components of metabolic syndrome, a cluster of risk factors for cardiovascular disease. Objectives: This narrative review aims to gather the most recent findings on the impact of the planetary diet on individual components of metabolic syndrome and on the prevention and treatment of cardiovascular disease. Methods: The available research on the topic was identified via searches in PubMed, Scopus, and Google Scholar. Results: Abdominal obesity, a major risk factor for a range of chronic diseases, can be effectively mitigated by adhering to plant-based dietary patterns, which have been shown to reduce waist circumference and improve overall cardiometabolic health. Furthermore, the planetary diet plays a crucial role in reducing the risk of type-2 diabetes and improving glycemic control, with specific dietary components such as whole grains and fiber, demonstrating positive effects on blood glucose levels. This diet is additionally associated with favorable lipid profiles, including lower levels of LDL cholesterol and total cholesterol, which are critical in the prevention of atherosclerosis and cardiovascular diseases. Conclusions: These multiple benefits highlight that the planetary diet may be an effective strategy for managing and preventing metabolic syndrome and cardiovascular disease. However, further research is needed to confirm its long-term efficacy and applicability across diverse populations.