1. Co-benefits from sustainable dietary shifts for population and environmental health: an assessment from a large European cohort study
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Manuela M. Bergmann, Tammy Y.N. Tong, Anna Stubbendorff, Elisabeth H. M. Temme, Claudia Agnoli, Ulrika Ericson, Antonio Agudo, Mélanie Deschasaux, Elisabete Weiderpass, Konstantinos K. Tsilidis, Dagfinn Aune, Guri Skeie, Giovanna Masala, Torkjel M. Sandanger, Emmanuelle Kesse-Guyot, Gianluca Severi, Charlotta Rylander, Francesca Mancini, Miguel A. Rodríguez Barranco, Marie-Christine Boutron-Ruault, Paolo Vineis, Mathilde Touvier, Pietro Ferrari, Marc J. Gunter, Daniel B Ibsen, Jolanda M. A. Boer, María José Pérez, Inge Huybrechts, Matthias B. Schulze, Anika Knuppel, Keren Papier, Elio Riboli, Bernard Srour, Christina C. Dahm, Jessica E. Laine, Tilmann Kühn, Medical Research Council (MRC), Imperial College London, University of Bern, Centre international de Recherche sur le Cancer (CIRC), Bjørknes University College [Oslo, Norvège], Oslo University Hospital [Oslo], University of Potsdam, German Institute of Human Nutrition Potsdam-Rehbruecke [Nuthetal, Germany] (GIHNP-R), National Institute for Public Health and the Environment [Bilthoven] (RIVM), IRCCS Istituto Nazionale dei Tumori [Milano], Lund University [Lund], Aarhus University [Aarhus], Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Conservatoire National des Arts et Métiers [CNAM] (CNAM), Espace régional de réflexion éthique de Normandie (EREN), Escuela Andaluza de Salud Pública [Granada, Spain] (EASP), ibs.GRANADA Instituto de Investigación Biosanitaria [Granada, Spain], Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), University of Granada [Granada], University of Oxford [Oxford], Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Università degli Studi di Firenze = University of Florence [Firenze] (UNIFI), German Cancer Research Center - Deutsches Krebsforschungszentrum [Heidelberg] (DKFZ), Istituto per lo Studio, la Prevenzione e la rete Oncologica [Florence, Italy] (ISPRO), Institut d'Investigació Biomèdica de Bellvitge [Barcelone] (IDIBELL), The Arctic University of Norway (UiT), Italian Institute of Technology (IIT), International Arctic Research Center, University of Alaska, Fairbanks, IARC, Kræftens Bekæmpelse, DCS, Deutsches Krebsforschungszentrum, DKFZ, Wellcome Trust, WT: 205212/Z/16/Z, National Research Council, NRC, University of Maryland School of Public Health, SPH, Medical Research Council, MRC: MR/M012190/1, MR/M501669/1, Cancer Research UK, CRUK: C8221/A29017, World Cancer Research Fund, WCRF, Institut National de la Santé et de la Recherche Médicale, Inserm, Bundesministerium für Bildung und Forschung, BMBF, Cancerfonden, Ministerie van Volksgezondheid, Welzijn en Sport, VWS, Ligue Contre le Cancer, Vetenskapsrådet, VR, Instituto de Salud Carlos III, ISCIII, Associazione Italiana per la Ricerca sul Cancro, AIRC, Deutsche Krebshilfe, Institut Gustave-Roussy, Mutuelle Générale de l'Education Nationale, MGEN, NIHR Imperial Biomedical Research Centre, BRC, The coordination of EPIC is financially supported by IARC and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre. The national cohorts are supported by: Danish Cancer Society (Denmark), Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, INSERM (France), German Cancer Aid, German Cancer Research Center, German Institute of Human Nutrition Potsdam-Rehbruecke, Federal Ministry of Education and Research (Germany), Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy), Dutch Ministry of Public Health, Welfare and Sports, Netherlands Cancer Registry, LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund, Statistics Netherlands (The Netherlands), Health Research Fund - Instituto de Salud Carlos III, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology - ICO (Spain), Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden), Cancer Research UK (14136 to EPIC-Norfolk, C8221/A29017 to EPIC-Oxford), Medical Research Council (MRC, 1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford, UK). JEL was supported by an MRC Early Career Fellowship (MR/M501669/1). We acknowledge the Netherlands Cancer Registry and Statistics Netherlands (The Netherlands) for contributions to data acquisition. KP and AK are supported by the Wellcome Trust (Livestock, Environment and People, LEAP, grant number 205212/Z/16/Z). We acknowledge Corinne Casagrande and Genevieve Nicolas who assisted in the matching of the dietary intake data with the Greenhouse Gas and Landuse data. We also acknowledge Bertrand Hemon for database compilation and Carine Biessy for her contribution to the sensitivity analyses. Where authors are identified as personnel of the IARC or WHO, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy, or views of the IARC or WHO., Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle G?n?rale de l'Education Nationale, INSERM (France), Health Research Fund - Instituto de Salud Carlos III, Regional Governments of Andaluc?a, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology - ICO (Spain), Swedish Cancer Society, Swedish Research Council and County Councils of Sk?ne and V?sterbotten (Sweden), University of Potsdam = Universität Potsdam, Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke (DifE), Leibniz Association, HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Universidad de Granada = University of Granada (UGR), Nuffield Department of Population Health [Oxford], University of Oxford, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Università degli Studi di Firenze = University of Florence (UniFI), Institut Gustave Roussy (IGR), The Arctic University of Norway [Tromsø, Norway] (UiT), European Commission (DG-SANCO), the International Agency for Research on Cancer (IARC), MRC Early Career Fellowship (MR/M501669/1), and HAL UVSQ, Équipe
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Health (social science) ,030309 nutrition & dietetics ,[SDV]Life Sciences [q-bio] ,Population ,Medicine (miscellaneous) ,610 Medicine & health ,Population health ,Cohort Studies ,Greenhouse Gases ,03 medical and health sciences ,Clinical trials ,0302 clinical medicine ,360 Social problems & social services ,Environmental health ,11. Sustainability ,Canvi climàtic ,Humans ,Medicine ,VDP::Medisinske Fag: 700 ,Prospective Studies ,030212 general & internal medicine ,education ,2. Zero hunger ,Public health ,0303 health sciences ,education.field_of_study ,Land use ,business.industry ,Health Policy ,Hazard ratio ,Public Health, Environmental and Occupational Health ,Salut pública ,Climatic change ,Diet ,3. Good health ,European Prospective Investigation into Cancer and Nutrition ,[SDV] Life Sciences [q-bio] ,VDP::Medical disciplines: 700 ,Quartile ,13. Climate action ,Greenhouse gas ,Attributable risk ,Dieta ,business ,Environmental Health ,Assaigs clínics - Abstract
Funding European Commission (DG-SANCO) , the International Agency for Research on Cancer (IARC) , MRC Early Career Fellowship (MR/M501669/1) ., Background Unhealthy diets, the rise of non-communicable diseases, and the declining health of the planet are highly intertwined, where food production and consumption are major drivers of increases in greenhouse gas emissions, substantial land use, and adverse health such as cancer and mortality. To assess the potential co-benefits from shifting to more sustainable diets, we aimed to investigate the associations of dietary greenhouse gas emissions and land use with all-cause and cause-specific mortality and cancer incidence rates. Methods Using data from 443 991 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a multicentre prospective cohort, we estimated associations between dietary contributions to greenhouse gas emissions and land use and all-cause and cause-specific mortality and incident cancers using Cox proportional hazards regression models. The main exposures were modelled as quartiles. Co-benefits, encompassing the potential effects of alternative diets on all-cause mortality and cancer and potential reductions in greenhouse gas emissions and land use, were estimated with counterfactual attributable fraction intervention models, simulating potential effects of dietary shifts based on the EAT–Lancet reference diet. Findings In the pooled analysis, there was an association between levels of dietary greenhouse gas emissions and allcause mortality (adjusted hazard ratio [HR] 1·13 [95% CI 1·10–1·16]) and between land use and all-cause mortality (1·18 [1·15–1·21]) when comparing the fourth quartile to the first quartile. Similar associations were observed for cause-specific mortality. Associations were also observed between all-cause cancer incidence rates and greenhouse gas emissions, when comparing the fourth quartile to the first quartile (adjusted HR 1·11 [95% CI 1·09–1·14]) and between all-cause cancer incidence rates and land use (1·13 [1·10–1·15]); however, estimates differed by cancer type. Through counterfactual attributable fraction modelling of shifts in levels of adherence to the EAT–Lancet diet, we estimated that up to 19–63% of deaths and up to 10–39% of cancers could be prevented, in a 20-year risk period, by different levels of adherence to the EAT–Lancet reference diet. Additionally, switching from lower adherence to the EAT–Lancet reference diet to higher adherence could potentially reduce food-associated greenhouse gas emissions up to 50% and land use up to 62%. Interpretation Our results indicate that shifts towards universally sustainable diets could lead to co-benefits, such as minimising diet-related greenhouse gas emissions and land use, reducing the environmental footprint, aiding in climate change mitigation, and improving population health., European Commission European Commission Joint Research Centre, World Health Organization, UK Research & Innovation (UKRI) Medical Research Council UK (MRC) MR/M501669/1
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- 2021