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Background/objectives: The Planetary Health Diet Index (PHDI) was recently introduced to assess adherence to the EAT-Lance recommendations. In this study, we aimed to evaluate the relationship between PHDI and metabolic syndrome (MS). Subjects/methods: We used the data of 6465 participants from the PERSIAN cohort study at Mashhad University of Medical Sciences, Mashhad, Iran. Diet was assessed using a 130-item Food Frequency Questionnaire (FFQ). The PHDI comprises sixteen components and is scored between 0 and 150 points. We first assessed the validity and reliability of the PHDI for this population. We used regression logistic models to assess the relationships between PHDI and MS and its related indicators. Results: The average PHDI score was 52.3 ± 9. The Cronbach’s alpha value was 0.53. After controlling for age and sex, the PHDI was positively related to the Diet Quality Index-International (DQI-I) and was negatively related to carbon and water footprints (p < 0.001). PHDI quartile was negatively associated with MS, hypo-HDL cholesterolemia, and abdominal obesity after controlling for confounders (P < 0.05). Conclusion: The validity and reliability of the PHDI were found to be satisfactory for the Iranian population we studied. Our results showed that a higher PHDI was potentially related to a reduced likelihood of MS, hypo-HDL cholesterolemia, and abdominal obesity. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested a link between diet and mental health. However, there is a lack of evidence regarding the association between emerging diets such as the EAT-Lancet reference diet (ELD) and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, and mental health in different societies. This study aimed to determine the association between adherence to ELD and MIND diets and the risk of depression, anxiety, and stress. Methods: This research involved 4579 participants from the PERSIAN Organizational Cohort Study in Mashhad (POCM). To assess dietary intake, a comprehensive 118-item semi-quantitative food frequency questionnaire (FFQ) was employed. The Planetary Health Diet Index (PHDI) was used to assess adherence to the ELD. Mental health status was evaluated using the Depression, Anxiety, and Stress Scale-21 items (DASS-21) questionnaire. Binary logistic regression was utilized to examine the relationship between these scores and mental health indicators. Results: In the adjusted model, the highest quartile of PHDI showed a 35% reduced risk of depression compared to those in the lowest quartile (OR: 0.653, 95% CI: 0.483–0.883; P = 0.008). However, compared to the reference quartile, participants in the highest quartile of MIND diet exhibited significantly lower risks of depression (OR: 0.611, 95% CI: 0.447–0.836; P = 0.005), anxiety (OR: 0.559, 95% CI: 0.418–0.746; P < 0.001), and stress (OR: 0.629, 95% CI: 0.419–0.944; P = 0.008). Conclusions: The ELD and MIND diet were both associated with reduced odds of depression. Additionally, MIND diet was associated with decreased likelihood of anxiety and stress. However, no connection was observed between ELD and anxiety or stress. Further large-scale interventions are required to confirm these findings. Association between EAT-Lancet reference diet (ELD) and MIND Diet with Stress, Anxiety, and Depression. PHDI: planetary health diet index, MIND diet: Mediterranean-DASH Intervention for Neurodegenerative Delay diet [ABSTRACT FROM AUTHOR]

Purpose: To describe adherence to sustainable healthy diets among a sample of 958 Chilean pre-schoolers (3–6 years) and explore associations between adherence and child and maternal sociodemographic and anthropometric characteristics. Methods: Children's adherence to sustainable healthy diets was calculated from single multiple-pass 24-h dietary recalls using the Planetary Health Diet Index for children and adolescents (PHDI-C). Higher PHDI-C scores (max score = 150 points) represent greater adherence. Adjusted linear regression models were fitted to explore associations between PHDI-C scores and child and maternal characteristics. Results: Children obtained low total PHDI-C scores (median 50.0 [IQR 39.5–59.8] points). This resulted from low consumption of nuts & peanuts, legumes, vegetables, whole cereals, and vegetable oils; a lack of balance between dark green and red & orange vegetables, inadequate consumption of tubers & potatoes and eggs & white meats, and excess consumption of dairy products, palm oil, red meats, and added sugars. Mean PHDI-C total score was significantly higher (50.6 [95%CI 49.6, 51.7] vs 47.3 [95%CI 45.0, 49.5]) among children whose mothers were ≥ 25 years compared to those with younger mothers. Positive associations were observed between scores for fruits and maternal education, vegetables and maternal age, added sugars and child weight status, while negative associations were observed between fruits and child age, and vegetable oils and maternal education. Scores for dairy products PHDI-C component were lower among girls. Conclusion: Adherence to sustainable healthy diets was low among this sample of Chilean children and was significantly associated with maternal age, being lower among children whose mothers were younger. [ABSTRACT FROM AUTHOR]

Background: The EAT-Lancet diet is a diet aimed at promoting population and planetary health from the perspective of sustainable diets in terms of environmental and health aspects. This study aimed to assess the association between adherence to the EAT-Lancet diet and cardiometabolic risk factors among adults and elderly individuals in a capital city in the northeastern region of Brazil. Methods: This is an analytical cross-sectional observational study from a population-based sample conducted between 2019 and 2020, involving 398 non-institutionalized adults and elderly people, of both sexes from "Brazilian Usual Consumption Assessment" study (Brazuca-Natal). There was a 38% response rate due to the suspension of data collection due to the covid-19 pandemic, but According to the comparative analysis of socioeconomic and demographic variables between the surveyed and non-surveyed sectors, losses were found to be random (p = 0.135, Little's MCAR test). Socioeconomic and lifestyle data, anthropometric measurements, and dietary consumption were collected. We used the Planetary Health Diet Index (PHDI) and the Cardiovascular Health Diet Index (CHDI) for cardiovascular health to assess adherence to the diet's sustainability. The evaluated cardiometabolic parameters included fasting blood glucose, triglycerides, total cholesterol, HDL-C, LDL-C, and systolic and diastolic blood pressure measurements. We also assessed the presence of type 2 diabetes mellitus, arterial hypertension, and dyslipidemia. For the data analyses, sample weights and the effect of the study design were taken into account. Pearson's chi-square test was used to evaluate the statistical significance of frequencies. Multiple linear regression models assessed the associations between PHDI and CHDI and its components and the cardiometabolic parameters. Results: The mean PHDI was 29.4 (95% CI 28.04:30.81), on a total score ranging from 0 to 150 points and the mean CHDI was 32.63 (95% CI 31.50:33.78), on a total score ranging from 0 to 110 points. PHDI showed a significant positive association with the final CHDI score and components of fruits, vegetables, and legumes, and a negative association with Ultra-processed Food (UPF) (p < 0.05). Notably, among the most consumed UPF, the following stand out: "packaged snacks, shoestring potatoes, and crackers" (16.94%), followed by margarine (14.14%). The PHDI exhibited a significant association with diabetes and dyslipidemia, as well as with systolic blood pressure, total cholesterol, and LDL-C. Conclusions: The results suggest that adopting the EAT-Lancet diet is associated with the improvement of key cardiovascular health indicators. [ABSTRACT FROM AUTHOR]

Summary: Background: Poor diet quality contributes to morbidity and mortality and affects environmental sustainability. The EAT-Lancet reference diet offers a healthy and sustainable solution. This study aimed to estimate the association between diet cost and dietary quality, measured with an EAT-Lancet Index. Methods: An EAT-Lancet index was adapted to assess adherence to this dietary pattern from 24-h recalls data from the 2012 and 2016 Mexican National Health and Nutrition Surveys (n = 14,242). Prices were obtained from the Consumer Price Index. We dichotomized cost at the median (into low- and high-cost) and compared the EAT-Lancet index scores. We also used multivariate linear regression models to explore the association between diet cost and diet quality. Results: Individuals consuming a low-cost diet had a higher EAT-Lancet score than those consuming a high-cost diet (20.3 vs. 19.4 from a possible scale of 0 to 42; p < 0.001) due to a lower intake of beef and lamb, pork, poultry, dairy, and added sugars. We found that for each one-point increase in the EAT-Lancet score, there was an average decrease of MXN$0.4 in the diet cost (p < 0.001). This association was only significant among low- and middle-SES individuals. Conclusions: Contrary to evidence from high-income countries, this study shows that in Mexico, adhering to the EAT-Lancet reference diet is associated with lower dietar costs, particularly in lower SES groups. These findings suggest the potential for broader implementation of healthier diets without increasing the financial burden. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the relationship between the EAT-Lancet diet (ELD) and head and neck cancers (HNCs) in 101,755 Americans enrolled in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Prospective cohort study. ELD score was calculated to assess participant's adherence to ELD. Cox hazard regression models were utilised to evaluate the association of ELD and dietary components with HNC risk. Restricted cubic spline (RCS) plots were employed to explore the linearity of the relationships. Predefined subgroup analyses and sensitivity analyses were performed to identify potential effect modifiers and to assess the stability of the findings, respectively. After a mean follow-up of 8.84 years, 279 cases of HNCs, including 169 cases of oral cavity and pharyngeal cancers and 110 cases of laryngeal cancer were recorded. This study observed a dose–response negative correlation between ELD and HNCs (hazard ratio [HR] Q4 vs Q1 : 0.52; 95% confidence interval [CI]: 0.34, 0.80; P -trend = 0.003; HR per SD increment : 0.80; 95% CI: 0.71, 0.91), and oral cavity and pharyngeal cancers (HR Q4 vs Q1 : 0.52; 95% CI: 0.31, 0.88; P -trend = 0.008; HR per SD increment : 0.78; 95% CI: 0.66, 0.92). Analysis using RCS plots indicated a significant linear association between adherence to the ELD and reduced risk of HNCs and oral cavity and pharyngeal cancers (P -nonlinearity > 0.05). Subgroup analysis did not reveal significant interaction factors (P -interaction > 0.05), and sensitivity analysis confirmed the robustness of this study. Additionally, negative correlations were found between the consumption of fruits and whole grains and HNCs (fruits: HR Q4 vs Q1 : 0.58; 95% CI: 0.40, 0.84; P -trend = 0.010; whole grains: HR Q4 vs Q1 : 0.51; 95% CI: 0.26, 0.97; P -trend = 0.004). Adherence to ELD contributes to the prevention of HNCs. [ABSTRACT FROM AUTHOR]

Background: Food consumption and diet are strongly associated with sustainability. The Sustainable HEalthy Diet index was developed to measure the nutritional, environmental, and sociocultural components of sustainable diets and healthy eating patterns. However, a methodological approach has yet to be proposed for Turkish adults. This study aimed to determine the validity and reliability of the SHED index in Turkish adults. Methods: Data were collected from 558 healthy adults using a web-based questionnaire. Internal consistency reliability was evaluated using Cronbach's alpha coefficient, and repeatability was evaluated using the test-retest method. Construct validity was investigated using the EAT-Lancet diet and the Mediterranean Diet Adherence Screener (MEDAS), and the adapted SHED index structures' accordance was evaluated with confirmatory factor analysis. Results: Good reliability and repeatability were found (r = 0.758 and 0.795, respectively). A higher SHED index score was related to a greater intake of grains, fruits, and vegetables and a lower intake of meat, eggs, and dairy compared to EAT-Lancet diet food groups. A higher SHED index score was associated with a lower saturated fat and added sugar intake. While the SHED index was associated with greater adherence to the Mediterranean diet (r = 0.334, p < 0.001), it was negatively associated with non-alcoholic and diet non-alcoholic beverage consumption (r = −0.257 and −0.264, respectively; p < 0.001). Conclusion: The SHED index showed good validity and reliability in Turkish adults. Our results suggest that the SHED index can be used in epidemiological and intervention studies because it allows the measurement of diets in terms of health and sustainability to propose adaptations accordingly. [ABSTRACT FROM AUTHOR]

Abstract Background/objectives The Planetary Health Diet Index (PHDI) was recently introduced to assess adherence to the EAT-Lance recommendations. In this study, we aimed to evaluate the relationship between PHDI and metabolic syndrome (MS). Subjects/methods We used the data of 6465 participants from the PERSIAN cohort study at Mashhad University of Medical Sciences, Mashhad, Iran. Diet was assessed using a 130-item Food Frequency Questionnaire (FFQ). The PHDI comprises sixteen components and is scored between 0 and 150 points. We first assessed the validity and reliability of the PHDI for this population. We used regression logistic models to assess the relationships between PHDI and MS and its related indicators. Results The average PHDI score was 52.3 ± 9. The Cronbach’s alpha value was 0.53. After controlling for age and sex, the PHDI was positively related to the Diet Quality Index-International (DQI-I) and was negatively related to carbon and water footprints (p

Abstract Background Previous studies have suggested a link between diet and mental health. However, there is a lack of evidence regarding the association between emerging diets such as the EAT-Lancet reference diet (ELD) and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, and mental health in different societies. This study aimed to determine the association between adherence to ELD and MIND diets and the risk of depression, anxiety, and stress. Methods This research involved 4579 participants from the PERSIAN Organizational Cohort Study in Mashhad (POCM). To assess dietary intake, a comprehensive 118-item semi-quantitative food frequency questionnaire (FFQ) was employed. The Planetary Health Diet Index (PHDI) was used to assess adherence to the ELD. Mental health status was evaluated using the Depression, Anxiety, and Stress Scale-21 items (DASS-21) questionnaire. Binary logistic regression was utilized to examine the relationship between these scores and mental health indicators. Results In the adjusted model, the highest quartile of PHDI showed a 35% reduced risk of depression compared to those in the lowest quartile (OR: 0.653, 95% CI: 0.483–0.883; P = 0.008). However, compared to the reference quartile, participants in the highest quartile of MIND diet exhibited significantly lower risks of depression (OR: 0.611, 95% CI: 0.447–0.836; P = 0.005), anxiety (OR: 0.559, 95% CI: 0.418–0.746; P

Abstract Background The EAT-Lancet diet is a diet aimed at promoting population and planetary health from the perspective of sustainable diets in terms of environmental and health aspects. This study aimed to assess the association between adherence to the EAT-Lancet diet and cardiometabolic risk factors among adults and elderly individuals in a capital city in the northeastern region of Brazil. Methods This is an analytical cross-sectional observational study from a population-based sample conducted between 2019 and 2020, involving 398 non-institutionalized adults and elderly people, of both sexes from “Brazilian Usual Consumption Assessment” study (Brazuca-Natal). There was a 38% response rate due to the suspension of data collection due to the covid-19 pandemic, but According to the comparative analysis of socioeconomic and demographic variables between the surveyed and non-surveyed sectors, losses were found to be random (p = 0.135, Little’s MCAR test). Socioeconomic and lifestyle data, anthropometric measurements, and dietary consumption were collected. We used the Planetary Health Diet Index (PHDI) and the Cardiovascular Health Diet Index (CHDI) for cardiovascular health to assess adherence to the diet’s sustainability. The evaluated cardiometabolic parameters included fasting blood glucose, triglycerides, total cholesterol, HDL-C, LDL-C, and systolic and diastolic blood pressure measurements. We also assessed the presence of type 2 diabetes mellitus, arterial hypertension, and dyslipidemia. For the data analyses, sample weights and the effect of the study design were taken into account. Pearson’s chi-square test was used to evaluate the statistical significance of frequencies. Multiple linear regression models assessed the associations between PHDI and CHDI and its components and the cardiometabolic parameters. Results The mean PHDI was 29.4 (95% CI 28.04:30.81), on a total score ranging from 0 to 150 points and the mean CHDI was 32.63 (95% CI 31.50:33.78), on a total score ranging from 0 to 110 points. PHDI showed a significant positive association with the final CHDI score and components of fruits, vegetables, and legumes, and a negative association with Ultra-processed Food (UPF) (p

Summary Background Poor diet quality contributes to morbidity and mortality and affects environmental sustainability. The EAT-Lancet reference diet offers a healthy and sustainable solution. This study aimed to estimate the association between diet cost and dietary quality, measured with an EAT-Lancet Index. Methods An EAT-Lancet index was adapted to assess adherence to this dietary pattern from 24-h recalls data from the 2012 and 2016 Mexican National Health and Nutrition Surveys (n = 14,242). Prices were obtained from the Consumer Price Index. We dichotomized cost at the median (into low- and high-cost) and compared the EAT-Lancet index scores. We also used multivariate linear regression models to explore the association between diet cost and diet quality. Results Individuals consuming a low-cost diet had a higher EAT-Lancet score than those consuming a high-cost diet (20.3 vs. 19.4 from a possible scale of 0 to 42; p

Background: In 2019, a globally sustainable dietary pattern that primarily emphasizes the consumption of plant-based foods was proposed by the EAT-Lancet Commission. However, there is limited evidence regarding the association of this diet with coronary events. Objectives: To determine the association between the EAT-Lancet Reference Diet (ELD) and premature coronary artery disease (PCAD) risk and its severity. Methods: This multi-center, case-control study was conducted within the framework of the Iran premature coronary artery disease (I-PAD). A total of 3185 participants aged under 70 years in women and 60 years in men were included. Cases were those whose coronary angiography showed stenosis ≥ 75% in at least one vessel or ≥ 50% in the left main artery (n = 2033), while the controls had normal angiography results (n = 1152). Dietary intake was assessed using a validated food frequency questionnaire. Logistic regression was utilized to examine the association between ELD and presence of PCAD. Results: Compared with individuals in the first quartile, those in the highest quartile of ELD (OR = 0.29, 95% CI: 0.21, 0.39; P for trend < 0.001) and ELD calculated with minimum intake (OR = 0.39, 95% CI: 0.29, 0.52; P < 0.001) had lower risk of PCAD. Individuals in the highest quartile of adherence to the ELD and ELD with minimum intake had 78% and 72% lower risk of having severe PCAD compared with those in the lowest quartile, respectively. Conclusion: An inverse association was observed between adherence to the ELD and PCAD risk and its severity. Large-scale prospective cohort studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Abstract Background While healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the current Brazilian diet (CBD) and compare it with healthy and sustainable diets. Methods Data from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database were used for a modeling study comparing the cost of healthy and sustainable diets (based on the Brazilian Dietary Guidelines (BDG) diet and the EAT-Lancet diet) versus the CBD. The DIETCOST program generated multiple food baskets for each scenario (Montecarlo simulations). Nutritional quality, cost, and environmental impact measures (carbon footprint (CF) and water footprint (WF)) were estimated for all diets and compared by ANOVA. Simple linear regressions used standardized environmental impacts measures to estimate differentials in costs and environmental impacts among diets scenarios. Results We observed significant differences in costs/1000 kcal. The BDG diet was cheaper (BRL$4.9 (95%IC:4.8;4.9) ≈ USD$1.5) than the CBD (BRL$5.6 (95%IC:5.6;5.7) ≈ USD$1.8) and the EAT-Lancet diet (BRL$6.1 (95%IC:6.0;6.1) ≈ USD$1.9). Ultra-processed foods (UPF) and red meat contributed the most to the CBD cost/1000 kcal, while fruits and vegetables made the lowest contribution to CBD. Red meat, sugary drinks, and UPF were the main contributors to the environmental impacts of the CBD. The environmental impact/1000 kcal of the CBD was nearly double (CF:3.1 kg(95%IC: 3.0;3.1); WF:2,705 L 95%IC:2,671;2,739)) the cost of the BDG diet (CF:1.4 kg (95%IC:1.4;1.4); WF:1,542 L (95%IC:1,524;1,561)) and EAT-Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF:1,448 L (95%IC:1,428;1,469)). A one standard deviation increase in standardized CF corresponded to an increase of BRL$0.48 in the cost of the CBD, similar to standardized WF (BRL$0.56). A similar relationship between the environmental impact and the cost of the BDG (CF: BRL$0.20; WF: BRL$0.33) and EAT-Lancet (CF: BRL$0.04; WF: BRL$0.18) was found, but with a less pronounced effect. Conclusions The BDG diet was cost-effective, while the EAT-Lancet diet was slightly pricier than the CBD. The CBD presented almost double the CF and WF compared to the BDG and EAT-Lancet diets. The lower cost in each diet was associated with lower environmental impact, particularly for the BDG and EAT-Lancet diets. Multisectoral public policies must be applied to guide individuals and societies towards healthier and more sustainable eating patterns.

Background: While healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the current Brazilian diet (CBD) and compare it with healthy and sustainable diets. Methods: Data from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database were used for a modeling study comparing the cost of healthy and sustainable diets (based on the Brazilian Dietary Guidelines (BDG) diet and the EAT-Lancet diet) versus the CBD. The DIETCOST program generated multiple food baskets for each scenario (Montecarlo simulations). Nutritional quality, cost, and environmental impact measures (carbon footprint (CF) and water footprint (WF)) were estimated for all diets and compared by ANOVA. Simple linear regressions used standardized environmental impacts measures to estimate differentials in costs and environmental impacts among diets scenarios. Results: We observed significant differences in costs/1000 kcal. The BDG diet was cheaper (BRL$4.9 (95%IC:4.8;4.9) ≈ USD$1.5) than the CBD (BRL$5.6 (95%IC:5.6;5.7) ≈ USD$1.8) and the EAT-Lancet diet (BRL$6.1 (95%IC:6.0;6.1) ≈ USD$1.9). Ultra-processed foods (UPF) and red meat contributed the most to the CBD cost/1000 kcal, while fruits and vegetables made the lowest contribution to CBD. Red meat, sugary drinks, and UPF were the main contributors to the environmental impacts of the CBD. The environmental impact/1000 kcal of the CBD was nearly double (CF:3.1 kg(95%IC: 3.0;3.1); WF:2,705 L 95%IC:2,671;2,739)) the cost of the BDG diet (CF:1.4 kg (95%IC:1.4;1.4); WF:1,542 L (95%IC:1,524;1,561)) and EAT-Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF:1,448 L (95%IC:1,428;1,469)). A one standard deviation increase in standardized CF corresponded to an increase of BRL$0.48 in the cost of the CBD, similar to standardized WF (BRL$0.56). A similar relationship between the environmental impact and the cost of the BDG (CF: BRL$0.20; WF: BRL$0.33) and EAT-Lancet (CF: BRL$0.04; WF: BRL$0.18) was found, but with a less pronounced effect. Conclusions: The BDG diet was cost-effective, while the EAT-Lancet diet was slightly pricier than the CBD. The CBD presented almost double the CF and WF compared to the BDG and EAT-Lancet diets. The lower cost in each diet was associated with lower environmental impact, particularly for the BDG and EAT-Lancet diets. Multisectoral public policies must be applied to guide individuals and societies towards healthier and more sustainable eating patterns. [ABSTRACT FROM AUTHOR]

Background Food consumption and diet are strongly associated with sustainability. The Sustainable HEalthy Diet index was developed to measure the nutritional, environmental, and sociocultural components of sustainable diets and healthy eating patterns. However, a methodological approach has yet to be proposed for Turkish adults. This study aimed to determine the validity and reliability of the SHED index in Turkish adults. Methods Data were collected from 558 healthy adults using a web-based questionnaire. Internal consistency reliability was evaluated using Cronbach’s alpha coefficient, and repeatability was evaluated using the test-retest method. Construct validity was investigated using the EAT-Lancet diet and the Mediterranean Diet Adherence Screener (MEDAS), and the adapted SHED index structures’ accordance was evaluated with confirmatory factor analysis. Results Good reliability and repeatability were found (r = 0.758 and 0.795, respectively). A higher SHED index score was related to a greater intake of grains, fruits, and vegetables and a lower intake of meat, eggs, and dairy compared to EAT-Lancet diet food groups. A higher SHED index score was associated with a lower saturated fat and added sugar intake. While the SHED index was associated with greater adherence to the Mediterranean diet (r = 0.334, p < 0.001), it was negatively associated with non-alcoholic and diet non-alcoholic beverage consumption (r = −0.257 and −0.264, respectively; p < 0.001). Conclusion The SHED index showed good validity and reliability in Turkish adults. Our results suggest that the SHED index can be used in epidemiological and intervention studies because it allows the measurement of diets in terms of health and sustainability to propose adaptations accordingly.

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Background & Aims: The EAT-Lancet Commission in 2019 advocated a plant-centric diet for health and environmental benefits, but its relation to metabolic dysfunction-associated steatotic liver disease (MASLD) is unclear. We aimed to discover the metabolite profile linked to the EAT-Lancet diet and its association with MASLD risk, considering genetic predisposition. Methods: We analyzed data from 105,752 UK Biobank participants with detailed dietary and metabolomic information. We constructed an EAT-Lancet diet index and derived a corresponding metabolomic signature through elastic net regression. A weighted polygenic risk score for MASLD was computed from associated risk variants. The Cox proportional hazards model was employed to estimate hazard ratios (HRs) and 95% CIs for the risk of MASLD (defined as hospital admission or death). Results: During a median follow-up period of 11.6 years, 1,138 cases of MASLD were documented. Participants in the highest group for the EAT-Lancet diet index had a multivariable HR of 0.79 (95% CI 0.66–0.95) for MASLD compared to the lowest group. The diet's impact was unaffected by genetic predisposition to MASLD (p = 0.42). Moreover, a robust correlation was found between the metabolomic signature and the EAT-Lancet diet index (Pearson r = 0.29; p

Abstract Background Tools for measuring adherence to sustainable healthy diets among children and adolescents are lacking. Objective To advance methods for measuring adherence to sustainable healthy diets among children and adolescents by adapting an existing index, compare scores obtained using the original and adapted versions of the index in a sample of Chilean children, and describe the adapted index association with diet characteristics. Methods The Planetary Health Diet Index (PHDI) was adapted to better reflect children's and adolescents’ nutritional requirements. The adapted index (PHDI-C) comprises 16 components with a maximum score of 150 points. PHDI-C was piloted among a sample of 958 Chilean children (3–6 years) using dietary data collected in 2016 through single 24-h recalls. A decision tree and food disaggregation methodology were developed to guide the calculation of scores. Scores obtained using the original and adapted versions of the index were compared. Linear regression models adjusted by child’s gender and age were fitted to explore associations between total PHDI-C score, dietary recall characteristics and nutritional composition of children’s diets. Results PHDI accounted for 75.7% of children’s total caloric intake, whereas PHDI-C accounted for 99.6%. PHDI & PHCI-C scores were low among this sample of children; however, mean total score was lower when using PHDI compared to PHDI-C [40.7(12.1) vs 50.1(14.6)]. Children’s scores were very low for nuts & peanuts, legumes, dark green vegetables, whole cereals, tubers & potatoes, and added sugars components across both indices, but were higher for dairy products and eggs & white meats components when using the PHDI-C due to adjustments made to ensure nutritional adequacy. Mean total PHDI-C score was significantly lower on weekends and special occasions, and significantly higher when children reported having a special diet (e.g., vegetarian). Total PHDI-C score was negatively associated with total sugars, saturated fats, trans fats, and animal-based protein intake, and positively associated with total protein, plant-based protein, total carbohydrates, and total fibre intake. Conclusions This study provides a replicable method for measuring adherence to sustainable healthy diets among children and adolescents that can be used to monitor trends and measure the effectiveness of actions targeting improving children’s diets.

Background: Tools for measuring adherence to sustainable healthy diets among children and adolescents are lacking. Objective: To advance methods for measuring adherence to sustainable healthy diets among children and adolescents by adapting an existing index, compare scores obtained using the original and adapted versions of the index in a sample of Chilean children, and describe the adapted index association with diet characteristics. Methods: The Planetary Health Diet Index (PHDI) was adapted to better reflect children's and adolescents' nutritional requirements. The adapted index (PHDI-C) comprises 16 components with a maximum score of 150 points. PHDI-C was piloted among a sample of 958 Chilean children (3–6 years) using dietary data collected in 2016 through single 24-h recalls. A decision tree and food disaggregation methodology were developed to guide the calculation of scores. Scores obtained using the original and adapted versions of the index were compared. Linear regression models adjusted by child's gender and age were fitted to explore associations between total PHDI-C score, dietary recall characteristics and nutritional composition of children's diets. Results: PHDI accounted for 75.7% of children's total caloric intake, whereas PHDI-C accounted for 99.6%. PHDI & PHCI-C scores were low among this sample of children; however, mean total score was lower when using PHDI compared to PHDI-C [40.7(12.1) vs 50.1(14.6)]. Children's scores were very low for nuts & peanuts, legumes, dark green vegetables, whole cereals, tubers & potatoes, and added sugars components across both indices, but were higher for dairy products and eggs & white meats components when using the PHDI-C due to adjustments made to ensure nutritional adequacy. Mean total PHDI-C score was significantly lower on weekends and special occasions, and significantly higher when children reported having a special diet (e.g., vegetarian). Total PHDI-C score was negatively associated with total sugars, saturated fats, trans fats, and animal-based protein intake, and positively associated with total protein, plant-based protein, total carbohydrates, and total fibre intake. Conclusions: This study provides a replicable method for measuring adherence to sustainable healthy diets among children and adolescents that can be used to monitor trends and measure the effectiveness of actions targeting improving children's diets. [ABSTRACT FROM AUTHOR]

Background: The "EAT-Lancet Commission Summary Report" commission remodeled the concept of healthy and sustainable diets by proposing a "diet for the Anthropocene", encouraging the development of indices that measure adherence to sustainable diets with a planetary scope. We aimed to report the adherence of adults and elderly people in a northeastern Brazilian capital to the EAT-Lancet recommendations. Methods: We used data from 411 participants in the population-based study. The dietary data were collected with Globodiet, over a standardized 24 h. The diet sustainability data were verified using the Planetary Health Diet Index (PHDI). A Pearson correlation test verified the correlation between the PHDI and the independent variables. We conducted linear regression models that were adjusted for potential confounding variables to examine the correlation between the adherence to the PHDI and the independent variables. Results: The mean total score for the adherence to the PHDI was 29.4 points in a score with a possible range from 0 to 150. Regarding the component scores, the highest scores in the adequacy component were for fruits, followed by legumes and vegetables, while the lowest scores in the moderation group were for animal fat and red meat. We observed, in the final model, that the explanatory variables for the PHDI were being male and not consuming alcohol, which were directly related to the PHDI, while having 1 to 9 years of study and being food insecure were indirectly related to the score. Conclusions: Our results showed a low adherence to a sustainable eating pattern, far from the EAT-Lancet recommendations. [ABSTRACT FROM AUTHOR]

Abstract Background The EAT-Lancet Commission proposed a global reference diet with both human health benefits and environmental sustainability in 2019. However, evidence regarding the association of such a diet with the risk of atrial fibrillation (AF) is lacking. In addition, whether the genetic risk of AF can modify the effect of diet on AF remains unclear. This study aimed to assess the association of the EAT-Lancet diet with the risk of incident AF and examine the interaction between the EAT-Lancet diet and genetic susceptibility of AF. Methods This prospective study included 24,713 Swedish adults who were free of AF, coronary events, and stroke at baseline. Dietary habits were estimated with a modified diet history method, and an EAT-Lancet diet index was constructed to measure the EAT-Lancet reference diet. A weighted genetic risk score was constructed using 134 variants associated with AF. Cox proportional hazards regression models were applied to estimate the hazard ratio (HR) and 95% confidence interval (CI). Results During a median follow-up of 22.9 years, 4617 (18.7%) participants were diagnosed with AF. The multivariable HR (95% CI) of AF for the highest versus the lowest group for the EAT-Lancet diet index was 0.84 (0.73, 0.98) (P for trend

Abstract Objective: To evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet in a representative sample of the Brazilian population. Design: The study used data from the Brazilian National Dietary Survey 2017–2018 and employed linear regression models to evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet, as measured by the Nova food system and Planetary Health Diet Index (PHDI), respectively. Setting: Nationally representative sample of the Brazilian population. Participants: The study included 46 164 Brazilians ≥ 10 years old. Results: The average PHDI total score was 45·9 points (95 % CI 45·6, 46·1). The ultra-processed food consumption was, with dose-response, inversely associated with the adherence to the EAT-Lancet diet. The PHDI total score was 5·38 points lower (95 % CI –6·01, –4·75) in individuals in the highest quintile of consumption of ultra-processed foods, as compared to those in the first quintile. The PHDI score was also inversely associated with the share of processed culinary ingredients and processed foods and positively associated with the share of unprocessed or minimally processed foods. Conclusions: Our study showed an inverse relationship between the consumption of ultra-processed foods and the adherence to a healthy and sustainable diet.

The EAT-Lancet diet is a groundbreaking and comprehensive dietary framework that has garnered significant attention in the fields of nutrition, sustainability, and public health. We aimed to conduct a bibliometric study to investigate current status and hotspots in the field of EAT-Lancet diet based on the Web of Science Core Collection (WOSCC) database, and the documents of EAT-Lancet diet published from Jan 1, 2019 to Sep 1.2023 were extracted. The bibliometric and visualized analysis were performed by VOSviewer 1.6.16 and WOSCC Online Analysis Platform. In total, 155 documents from 62 journals were included, and 735 authors from 389 institutions and 53 countries/regions contributed to the field of EAT-Lancet diet. The most productive countries/regions, institutions, authors, and journals were the USA, Wageningen University & Research, Johan Rockström, and Nutrients, respectively. The first high-cited document was published in Lancet and authored by Willett et al. in 2019. This is also the first study about EAT-Lancet diet. The article firstly proposed the “EAT-Lancet Diet” emphasizing balanced, plant-based eating to improve human health while addressing environmental concerns. In conclusion, in the field of EAT-Lancet diet, the main research hotspots and frontiers are the adaptation of EAT-Lancet diet, the composition of EAT-Lancet diet, and the benefits of EAT-Lancet diet for human health. The number of research on the EAT-Lancet diet is currently limited. There is a pressing need for further studies to broaden our understanding of the EAT-Lancet diet and its potential to enhance human health.

Previous research has shown that adhering to the Eat‐Lancet diet (ELD) is associated with a lower risk of chronic diseases and mortality. However, the associations between ELD and lung cancer incidence and mortality are unclear. To address this gap, we conducted a prospective cohort study involving 101,755 adults from the Prostate, Lung, Colorectal, and Ovarian (PLCO) trial in the USA. The ELD score was utilized to assess compliance with the ELD, with higher scores indicating greater compliance. We employed Cox regression analyses to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of ELD score with the incidence and mortality of lung cancer and its subtypes. In addition, sensitivity analyses were performed to ensure the robustness of our findings. In total, 1706 cases of lung cancer and 1217 lung cancer‐associated deaths were recorded during the study period. Our analysis revealed that higher ELD scores were significantly associated with a reduced incidence (HRQuartile 4 vs. Quartile 1: 0.73; 95% CI: 0.60, 0.89; ptrend = 0.001) and mortality (HRQuartile 4 vs. Quartile 1: 0.74; 95% CI: 0.59, 0.93; ptrend = 0.005) of lung cancer in a dose–response manner (all pnonlinearity > 0.05). The reliability of these results was supported by sensitivity analyses. Notably, these associations were primarily observed in non–small‐cell lung cancer. In conclusion, our findings suggest that adherence to the ELD may be associated with a reduced risk of lung cancer incidence and mortality. [ABSTRACT FROM AUTHOR]

Several studies have explored the association between diabetes and the EAT–Lancet diet. Thus, the objective of our study was to conduct a systematic review to analyze and summarize all clinical studies concerning the association between diabetes and the EAT–Lancet diet. We undertook a comprehensive search of the Embase, Cochrane, and PubMed databases up to 15 August 2023. All clinical studies concerning the association between diabetes and the EAT–Lancet diet were summarized and analyzed. In total, our systematic review included five studies of four prospective studies and one cross-sectional study, encompassing 259,315 participants. All the included studies were evaluated as high quality. The outcomes from all studies indicated that adherence to the EAT–Lancet diet was correlated with a reduced risk of diabetes. In conclusion, the EAT–Lancet diet may be an effective dietary intervention for diabetes. Nevertheless, the number of studies examining the association between diabetes and the EAT–Lancet diet is limited. Further high-quality studies are required to expand our understanding of the benefits of the EAT–Lancet diet for patients with diabetes. [ABSTRACT FROM AUTHOR]

Purpose: The EAT-Lancet Commission proposed an evidence-based global reference diet to improve human health within planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) was developed based on the EAT-Lancet recommendations and validated among Brazilian adults. However, the relative validity of the PHDI in adolescents has yet to be assessed. Thus, we aimed to evaluate the relative validity of the PHDI in European adolescents. Methods: We used cross-sectional data from 1804 adolescents (12.5–17.5 years) enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. The PHDI (0–150 points) was calculated based on dietary intake data from two non-consecutive 24-h dietary recalls. Associations between the PHDI and usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet were evaluated using multivariable-adjusted mixed-effects linear regression models. Results: Higher PHDI score was associated with greater intakes of nutrients predominantly from plant-source foods, such as vegetable protein, vitamin E, and folate and with lower intake of nutrients predominately from animal-source foods, such as total and saturated fat, cholesterol, and animal protein. Furthermore, a higher PHDI score was also positively associated with plasma β-carotene, vitamin C, vitamin D, folate, and ferritin concentrations, while negatively associated with trans-fatty acids concentration. Moreover, higher PHDI was related to a greater adherence to the Mediterranean dietary pattern. Conclusions: The PHDI showed good relative validity among adolescents in the HELENA study. Hence, future research should assess adherence to the PHDI and long-term health outcomes. [ABSTRACT FROM AUTHOR]

BackgroundThe EAT-Lancet diet (ELD) is a recommended dietary pattern for achieving simultaneous improvements in both individual health and environmental sustainability. While research on the association between ELD and colorectal cancer (CRC) remains scarce, the potential impact of nutrition on CRC prevention and progression is a topic of growing interest. This study aims to investigate the relationship between adherence to the ELD and the risk of CRC, shedding light on the role of nutrition in CRC prevention.MethodsA total of 98,415 participants were included. A Diet History Questionnaire (DHQ) was used to collect dietary information, and an ELD score was used to assess adherence to ELD. Higher scores indicated greater adherence. Cox hazard regression analyses were conducted to examine whether there were associations between the ELD score and CRC risk. The restricted cubic spline (RCS) model was used to further explore the dose-response association between the ELD score and CRC incidence. Subgroup analyses were conducted to identify potential modifiers that interacted with ELD on CRC incidence, and sensitivity analyses were performed to evaluate the robustness of the established association.ResultsDuring a mean follow-up of 8.82 years, a total of 1,054 CRC cases were documented. We found a statistically significant correlation between the ELD score and CRC risk (Q4 vs. Q1: HR 0.81, 95% CI 0.67–0.98; P for trend = 0.034) after adjusting for potential confounders. No statistically significant associations were discovered between ELD adherence and CRC by anatomical site. Subgroup analyses found no interactional factor, sensitivity analyses, and the RCS model showed a robustness and linearity association (P-linearity >0.05).ConclusionWe concluded that adherence to ELD contributes to the prevention of CRC.

Background: The EAT-Lancet Commission proposed a global reference diet with both human health benefits and environmental sustainability in 2019. However, evidence regarding the association of such a diet with the risk of atrial fibrillation (AF) is lacking. In addition, whether the genetic risk of AF can modify the effect of diet on AF remains unclear. This study aimed to assess the association of the EAT-Lancet diet with the risk of incident AF and examine the interaction between the EAT-Lancet diet and genetic susceptibility of AF. Methods: This prospective study included 24,713 Swedish adults who were free of AF, coronary events, and stroke at baseline. Dietary habits were estimated with a modified diet history method, and an EAT-Lancet diet index was constructed to measure the EAT-Lancet reference diet. A weighted genetic risk score was constructed using 134 variants associated with AF. Cox proportional hazards regression models were applied to estimate the hazard ratio (HR) and 95% confidence interval (CI). Results: During a median follow-up of 22.9 years, 4617 (18.7%) participants were diagnosed with AF. The multivariable HR (95% CI) of AF for the highest versus the lowest group for the EAT-Lancet diet index was 0.84 (0.73, 0.98) (P for trend < 0.01). The HR (95% CI) of AF per one SD increment of the EAT-Lancet diet index for high genetic risk was 0.92 (0.87, 0.98) (P for interaction = 0.15). Conclusions: Greater adherence to the EAT-Lancet diet index was significantly associated with a lower risk of incident AF. Such association tended to be stronger in participants with higher genetic risk, though gene-diet interaction was not significant. [ABSTRACT FROM AUTHOR]

Background: Nutritional interventions such as the planetary health diet, which the EAT-Lancet commission proposed, may be an effective strategy for reducing type 2 diabetes risks and its associated complications. The planetary health diet demonstrates the significant role of diet in associating human health with environmental sustainability and the significance of transforming food systems in order to ensure that the UN's Sustainable Development Goals and the Paris Agreement are achieved. Therefore, the aim of this review is to examine the association of the planetary health diet (PHD) with the risk of type 2 diabetes and its related complications. Method: The systematic review was conducted in line with established guidelines. The searches were carried out in health sciences research databases through EBSCOHost. The population, intervention, comparator and outcomes framework was used in order to define the research question and the search terms. The searches were carried out from the inception of the databases to 15 November 2022. Search terms including synonyms and medical subject headings were combined using Boolean operators (OR/AND). Results: Seven studies were included in the review and four themes were identified, including incidence of diabetes; cardiovascular risk factors and other disease risks; indicators of obesity and indicators of environmental sustainability. Two studies examined the association between the PHD and the incidence of type 2 diabetes and found that high adherence to the reference diet (EAT-Lancet reference diet) was correlated with a lower incidence of type 2 diabetes. High adherence to the PHD was also associated with some cardiovascular risk factors and environmental sustainability. Conclusion: This systematic review has shown that high adherence to the PHD is associated with a reduced risk of type 2 diabetes and may be associated with a lower risk of subarachnoid stroke. In addition, an inverse relationship was found between adherence to the PHD and markers of obesity and environmental sustainability. Adherence to the reference diet was also associated with lower values of some markers of cardiovascular risk. More studies are needed to fully examine the relationship between the planetary health diet, type 2 diabetes and its related conditions. [ABSTRACT FROM AUTHOR]

Purpose: Type 2 diabetes is a global health problem. While a healthy diet lowers risk of type 2 diabetes, less is known about diets with low climate impact. This study aimed to investigate adherence to the EAT-Lancet diet and risk of type 2 diabetes in a Danish setting. Methods: In the Danish Diet, Cancer and Health cohort, dietary data were collected using a validated 192-item food frequency questionnaire, at recruitment in 1993–1997. In total, 54,232 participants aged 50–64 years at baseline with no previous cancer or diabetes diagnoses were included in the current analyses. The EAT-Lancet diet score was used to assess adherence to the EAT-Lancet diet. Participants scored 0 (non-adherence) or 1 (adherence) point for each of the 14 dietary components of the diet score (range 0–14 points). Participants were followed through register linkage until type 2 diabetes diagnosis or censoring. Hazard ratios and 95% confidence intervals (CI) were estimated using multivariable-adjusted Cox regression models. Results: During a median 15-year follow-up period, 7130 participants developed type 2 diabetes. The hazard ratio for developing type 2 diabetes was 0.78 (95% CI 0.71; 0.86) for those with highest EAT-Lancet diet scores (11–14 points) compared to those with lowest scores (0–7 points) after adjusting for potential confounders. After further adjusting for potential mediators, including BMI, the corresponding hazard ratio was 0.83 (95% CI 0.76; 0.92). Conclusion: Greater adherence to the EAT-Lancet diet was associated with a lower risk of developing type 2 diabetes in a middle-aged Danish population. [ABSTRACT FROM AUTHOR]

Purpose: The EAT-Lancet Commission released a reference sustainable diet to improve human health and respect the planetary boundaries. The Planetary Health Diet Index (PHDI) was developed with the purpose of evaluate the adherence to this reference diet. The aim of the present study was to evaluate the association between adherence to the EAT-Lancet diet with cardiometabolic risk profile. Methods: We used the cross-sectional baseline data from 14,155 participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter ongoing cohort study. Dietary data were collected using a 114-item validated food frequency questionnaire. The PHDI was used to assess the adherence to the EAT-Lancet diet. It consists of 16 components and the total score can range from 0 to 150 points. Linear, logistic and quasi-Poisson regression models were built to evaluate the associations between PHDI and the outcomes. Results: Individuals with higher adherence to EAT-Lancet diet (PHDI, 5th quintile) had lower values for systolic blood pressure (β − 0.84; 95% CI − 1.66: − 0.01), diastolic blood pressure (β − 0.70; 95% CI − 1.24: − 0.15), total cholesterol (β − 3.15; 95% CI − 5.30: − 1.01), LDL-c (β − 4.10; 95% CI − 5.97: − 2.23), and non-HDL-cholesterol (β − 2.57; 95% CI − 4.62: − 0.52). No association was observed for HDL-c, triglycerides and HOMA-IR. Conclusions: Our results indicate that higher adherence to the EAT-Lancet diet is associated with lower levels of blood pressure, total cholesterol, LDL-c, and non-HDL-c. [ABSTRACT FROM AUTHOR]

The environmental gains of dietary change are often assessed in relation to average national diets, overlooking differences in individual consumption habits and people’s willingness to change. This study combines microdata on food intake and consumer behaviour to elicit the likely environmental gains of dietary shifts. We focus on the Netherlands owing to the country’s ambition to halve its dietary footprint by 2050. Linking food recall survey data from a cross-section of the population ( n = 4313), life cycle inventory analysis for 220 food products, and behavioural survey data ( n = 1233), we estimate the dietary footprints of consumer groups across water, land, biodiversity and greenhouse gas (GHG). We find that meat and dairy significantly contribute to the dietary GHG footprint (59%), land footprint (54%), and biodiversity footprint (59%) of all consumer groups and that male consumers impose a 30%–32% greater burden than women across these impact areas. Our scenario analysis reveals that simply replacing cow milk with soy milk could reduce the GHG, land and biodiversity footprints by ≈8% if widely adopted by the Dutch adult population. These footprints could be further reduced to ≈20% with full adoption of the EAT-Lancet diet but with a significantly increased blue water footprint. However, when incorporating gender- and age-specific willingness to reduce meat and dairy consumption, the environmental gains resulting from partial adoption of the No-Milk diet and EAT diet diminish to a mere ≈0.8% and ≈4.5%, respectively. Consequently, consumer motivation alone is insufficient to realise the significant environmental gains often promised by dietary change. Yet, substituting high-impact food products offers a near-term opportunity to accelerate a rapid sustainable dietary transition. Future studies on sustainable dietary transition must incorporate consumer behaviour to fully comprehend the lock-in of food consumption patterns and targeted policy action required to secure a sustainable food future.

Globally, about 21–37% of total greenhouse gas (GHG) emissions are attributable to food systems. Dietary-related non-communicable diseases have increased significantly from 1990–2019 at a global scale. To achieve carbon emissions targets, increase resilience, and improve health there is a need to increase the sustainability of agricultural practises and change dietary habits. By considering these challenges together and focusing on a closer connection between consumers and sustainable production, we can benefit from a positive interaction between them. Using the 2019 EAT Lancet Commission dietary guidelines, this study analysed interview data and food diaries collected from members of Community Supported Agriculture (CSA) schemes and the wider UK population. By comparing the environmental sustainability and nutritional quality of their respective diets, we found that CSA members consumed diets closer to the EAT Lancet recommendations than controls. We identified significant differences in daily intakes of meat; dairy; vegetables; legumes; and sugar, and the diets of CSA members emitted on average 28% less CO2 compared to controls. We propose that agricultural and wider social and economic policies that increase the accessibility of CSAs for a more diverse demographic could support achieving health, biodiversity, and zero-emission policy targets.

Several studies have explored the association between diabetes and the EAT–Lancet diet. Thus, the objective of our study was to conduct a systematic review to analyze and summarize all clinical studies concerning the association between diabetes and the EAT–Lancet diet. We undertook a comprehensive search of the Embase, Cochrane, and PubMed databases up to 15 August 2023. All clinical studies concerning the association between diabetes and the EAT–Lancet diet were summarized and analyzed. In total, our systematic review included five studies of four prospective studies and one cross-sectional study, encompassing 259,315 participants. All the included studies were evaluated as high quality. The outcomes from all studies indicated that adherence to the EAT–Lancet diet was correlated with a reduced risk of diabetes. In conclusion, the EAT–Lancet diet may be an effective dietary intervention for diabetes. Nevertheless, the number of studies examining the association between diabetes and the EAT–Lancet diet is limited. Further high-quality studies are required to expand our understanding of the benefits of the EAT–Lancet diet for patients with diabetes.

In January 2019, the EAT–Lancet Commission defined a universal reference diet to promote human and environmental health. However, in doing so, the potential consequences for brain health were not considered. Whilst plant-based diets are generally associated with better cognitive and affective outcomes, those that severely limit animal products are not. Therefore, the potential ramifications of the EAT–Lancet diet on cognition, mood, and heart rate variability were considered (N = 328). Adherence to the Alternative Healthy Eating Index (AHEI) was associated with having a better mood, focused attention, working and episodic memory, and higher heart rate variability. However, when the EAT–Lancet diet was considered, the effects were either smaller or not significant. Cluster analysis identified a dietary style characterised by a strong adherence to the EAT–Lancet recommendation to limit meat intake, representing a sixth of the present sample. This group had a lower Mean Adequacy Ratio (MAR); did not meet the Recommended Nutrient Intake (RNI) for a range of nutrients including protein, selenium, zinc, iron, and folate; and reported a poorer mood. These data highlight the potential unintended consequences of the EAT–Lancet recommendations for nutritional adequacy and affective health in some individuals. There is a need to better optimise the EAT–Lancet diet to support brain health. As we move towards more sustainable diets, these findings emphasise the need to consider how such diets might affect the brain. [ABSTRACT FROM AUTHOR]

Background & Aims: In 2019, the EAT-Lancet Commission promoted a plant-based diet, emphasizing its potential to enhance human health and environmental sustainability. Nevertheless, a thorough evaluation of health benefits associated with EAT-Lancet diet requires robust statistical backing. This synthesis seeks to compile evidence related to the effects of the EAT-Lancet diet on major cardiovascular disease (CVD) and mortality., Methods: A systematic review and meta-analysis were conducted utilizing data from MEDLINE, EMBASE, PubMed, Web of Science, and medRxiv, covering the period from January 2019 to October 8, 2024. We included all cohort and case-control studies that investigated the association between the emerging EAT-Lancet diet and outcomes such as diabetes, CVD, all-cause mortality, and cancer. Summary effect size estimates are presented as hazard ratios (HRs) and were analyzed using random-effects models. Study heterogeneity was assessed with the Q statistic and I 2 statistic. Subgroup analyses were performed to identify potential sources of variability, while publication bias was evaluated using Begg's and Egger's tests. Additionally, sensitivity analyses were conducted to assess the robustness of the results., Results: We identified 28 publications that included a total of over 2.21 million participants. Adhering to the EAT-Lancet dietary patterns was negatively associated with diabetes, CVD (mortality), all-cause mortality, and cancer (mortality), with HRs of 0.78 (95 % CI: 0.65-0.92), 0.84 (95 % CI: 0.81-0.87), 0.83 (95 % CI: 0.78-0.89), and 0.86 (95 % CI: 0.80-0.92), respectively. Significant heterogeneity was observed for diabetes (I 2  = 94.0 %), all-cause mortality (I 2  = 85.5 %), and cancer incidence (I 2  = 79.3 %). Importantly, no evidence of publication bias was found for any of the clinical outcomes analyzed. Sensitivity analyses confirmed the robustness of the results across various dietary scoring systems for CVD mortality, all-cause mortality, and cancer., Conclusion: Following the EAT-Lancet diet was significantly associated with reduced odds of diabetes, CVD, cancer and mortality. These findings are clinically important, highlighting the beneficial effects of the recent EAT-Lancet diet on various health outcomes., Competing Interests: Conflict of interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: To evaluate the association between ultra-processed food consumption and adherence to the EAT- Lancet diet in a representative sample of the Brazilian population., Design: The study used data from the Brazilian National Dietary Survey 2017-2018 and employed linear regression models to evaluate the association between ultra-processed food consumption and adherence to the EAT- Lancet diet, as measured by the Nova food system and Planetary Health Diet Index (PHDI), respectively., Setting: Nationally representative sample of the Brazilian population., Participants: The study included 46 164 Brazilians ≥ 10 years old., Results: The average PHDI total score was 45·9 points (95 % CI 45·6, 46·1). The ultra-processed food consumption was, with dose-response, inversely associated with the adherence to the EAT- Lancet diet. The PHDI total score was 5·38 points lower (95 % CI -6·01, -4·75) in individuals in the highest quintile of consumption of ultra-processed foods, as compared to those in the first quintile. The PHDI score was also inversely associated with the share of processed culinary ingredients and processed foods and positively associated with the share of unprocessed or minimally processed foods., Conclusions: Our study showed an inverse relationship between the consumption of ultra-processed foods and the adherence to a healthy and sustainable diet.

Scope: The association between a planetary and sustainable EAT-Lancet diet and lung cancer remains inconclusive, with limited exploration of the role of genetic susceptibility and inflammation., Methods and Results: The study includes 175 214 cancer-free participants in the UK Biobank. Fourteen food components are collected from a 24-h dietary recall questionnaire. A polygenic risk score is constructed through capturing the overall risk variants for lung cancer. Sixteen inflammatory biomarkers are assayed in blood samples. Participants with the highest EAT-Lancet diet scores (≥12) have a lower risk of lung cancer incidence (hazard ratio [HR] = 0.64, 95% confidence interval [CI]: 0.51-0.80) and mortality (HR = 0.65, 95% CI: 0.48-0.88), compared to those with the lowest EAT-Lancet diet scores (≤8). Interestingly, there is a significantly protective trend against both lung adenocarcinoma and lung squamous cell carcinoma with higher EAT-Lancet diet scores. Despite no significant interactions, a risk reduction trend for lung cancer is observed with increasing EAT-Lancet diet scores and decreasing genetic risk. Ten inflammatory biomarkers partially mediate the association between the EAT-Lancet diet and lung cancer risk., Conclusion: The study depicts a lower risk of lung cancer conferred by the EAT-Lancet diet associated with lower inflammation levels among individuals with diverse genetic predispositions., (© 2024 Wiley‐VCH GmbH.)

Objective: The EAT-Lancet Commission has proposed an EAT-Lancet diet (ELD), also known as a planetary health diet (PHD), which is environmentally sustainable and promotes human health. However, the association between this diet and the risk of hypertension remains unclear. This study aimed to determine whether adherence to ELD was associated with a lower risk of hypertension., Methods: 11,402 adults without hypertension at baseline from the China Health and Nutrition Survey were included. The PHD score was used to evaluate ELD adherence, with higher scores reflecting better compliance. Cox proportional hazards regression analysis was utilized to estimate the hazard ratio (HR) with a 95% confidence interval (CI). Additionally, a subgroup analysis was performed to identify the possible effect modifiers, and a mediation analysis was conducted to explore the mediation effects of anthropometric measurements on the association between ELD and hypertension., Results: A total of 3993 participants (35%) developed hypertension during 93,058 person-years of follow-up. In the covariate-adjusted model, hypertension risk was reduced in the highest quartile participants compared to the lowest quartile of the PHD score (adjusted HR: 0.79, 95%CI: 0.71-0.87; P -trend < 0.001), which remained significant after sensitivity analysis. Notably, the association was also observed in isolated systolic hypertension, isolated diastolic hypertension, and systolic-diastolic hypertension. Subgroup analysis revealed that the inverse association between the PHD score and hypertension risk was more pronounced in nonsmokers and high-sodium intake consumers than in smokers and low-sodium consumers ( P -interaction < 0.05). Additionally, mediation analysis revealed that 23.3% of the association between the PHD score and hypertension risk was mediated by the waist-to-height ratio., Conclusion: Our findings suggest that a higher adherence to ELD is associated with a lower risk of hypertension. These results emphasize that ELD may serve as a potential strategy to prevent hypertension.

Background: The influence of adherence to a planetary health diet (PHD) proposed by the EAT-Lancet Commission on cardiovascular disease (CVD) is inconclusive. Besides, whether genetic susceptibility to CVD can modify the association of PHD with CVD remains unknown., Objective: We aimed to investigate the association between adherence to PHD and CVD, and to evaluate the interaction between PHD and genetic predisposition to CVD., Methods: This study included 114,165 participants who completed at least two 24-h dietary recalls and were initially free of CVD from the UK Biobank. PHD score was calculated to assess adherence to PHD. Genetic risk was evaluated using the polygenic risk score. Incidence of total CVD, ischemic heart disease (IHD), atrial fibrillation (AF), heart failure (HF), and stroke were identified via electronic health records. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs)., Results: During a median follow-up of 9.9 y, 10,071 (8.8%) incident CVD cases were documented. Compared with participants with the lowest adherence to PHD, HRs (95% CIs) for total CVD, IHD, AF, HF, and stroke among those with the highest adherence were 0.79 (0.74, 0.84), 0.73 (0.67, 0.79), 0.90 (0.82, 0.99), 0.69 (0.59, 0.82), and 0.88 (0.75, 1.04), respectively. No significant interaction between the genetic risk of CVD and PHD was observed. Participants with high genetic risk and low PHD score, as compared with those with low genetic risk and high PHD score, had a 48% (95% CI: 40%, 56%) higher risk of CVD. The population-attributable risk (95% CI) of CVD for poor adherence to PHD ranged from 8.79% (5.36%, 12.51%) to 14.00% (9.00%, 18.88%)., Conclusions: These findings suggest that higher adherence to PHD was associated with lower risk of total CVD, IHD, AF, and HF in populations across all genetic risk categories., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Background: Nutritional interventions such as the planetary health diet, which the EAT-Lancet commission proposed, may be an effective strategy for reducing type 2 diabetes risks and its associated complications. The planetary health diet demonstrates the significant role of diet in associating human health with environmental sustainability and the significance of transforming food systems in order to ensure that the UN’s Sustainable Development Goals and the Paris Agreement are achieved. Therefore, the aim of this review is to examine the association of the planetary health diet (PHD) with the risk of type 2 diabetes and its related complications. Method: The systematic review was conducted in line with established guidelines. The searches were carried out in health sciences research databases through EBSCOHost. The population, intervention, comparator and outcomes framework was used in order to define the research question and the search terms. The searches were carried out from the inception of the databases to 15 November 2022. Search terms including synonyms and medical subject headings were combined using Boolean operators (OR/AND). Results: Seven studies were included in the review and four themes were identified, including incidence of diabetes; cardiovascular risk factors and other disease risks; indicators of obesity and indicators of environmental sustainability. Two studies examined the association between the PHD and the incidence of type 2 diabetes and found that high adherence to the reference diet (EAT-Lancet reference diet) was correlated with a lower incidence of type 2 diabetes. High adherence to the PHD was also associated with some cardiovascular risk factors and environmental sustainability. Conclusion: This systematic review has shown that high adherence to the PHD is associated with a reduced risk of type 2 diabetes and may be associated with a lower risk of subarachnoid stroke. In addition, an inverse relationship was found between adherence to the PHD and markers of obesity and environmental sustainability. Adherence to the reference diet was also associated with lower values of some markers of cardiovascular risk. More studies are needed to fully examine the relationship between the planetary health diet, type 2 diabetes and its related conditions.

Diets are simultaneously connected with population health and environment. The EAT-Lancet Commission proposed a sustainable reference diet to improve population health and respect the planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) has been developed to assess the adherence to this reference diet. In the present study, we aimed to evaluate the adherence to the EAT-Lancet diet through the PHDI in a nationwide population-based study carried out in Brazil. We used data from the National Dietary Survey conducted through the Household Budget Survey in 2017–2018, with 46,164 Brazilians aged over 10 years old. Food consumption was evaluated with a 24 h dietary recall. The average PHDI total score in the Brazilian population was 45.9 points (95% CI 45.6:46.1) on a total score that can range from 0 to 150 points. The adherence to EAT-Lancet diet was low among all Brazilian regions. Women, elderly, those overweighed/obese, with higher per capita income and living in the urban area had higher scores in the PHDI. In general, the Brazilian population presented low adherence to a healthy and sustainable dietary pattern and seems far from meeting the EAT-Lancet recommendations. [ABSTRACT FROM AUTHOR]

Background: The landmark EAT-Lancet Commission proposed that a planetary health diet is comprised mainly of plant-based foods. However, studies examining whether this diet is associated with heart failure (HF) are currently lacking. In addition, the potential proteomics mechanism on the association between diet and HF warrants further elucidation., Objectives: This study aims to both examine the association between the EAT-Lancet diet index and risk of HF and identify plasma proteins underlying such an association., Methods: This prospective cohort study included 23,260 participants. HF cases during the follow-up were identified through the Swedish national register. An EAT-Lancet diet index (score range: 0-42) was created to assess adherence to the EAT-Lancet reference diet. In a subcohort (n = 4,742), fasting plasma proteins were quantified., Results: During a median follow-up of 25.0 years, 1,768 incident HF cases were documented. After adjusting for sociodemographic, lifestyle, diabetes, hypertension, use of lipid-lowering drugs, and body mass index, the HR per 3-point increase of the EAT-Lancet diet index was 0.93 (95% CI: 0.88-0.97). This association was robust in several sensitivity analyses. Among the included 136 plasma proteins, a total of 8 proteins (AM, GDF15, IL-6, TIM, CTSD, CCL20, FS, and FUR) were both inversely associated with the EAT-Lancet diet index and positively associated with risk of HF; the overall proteomic score mediated 9.4% (95% CI: 2.2%-32.1%) of the association., Conclusions: Higher adherence to the EAT-Lancet diet was associated with a lower risk of HF. The identified eight plasma proteins provide information on potential pathways mediating such an association., Competing Interests: Funding Support and Author Disclosures This study was funded by the Swedish Research Council (2020-01412), Heart and Lung Foundation (20190555 and 20200482), and Crafoord Foundation (20210674). The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background & Aims: The EAT-Lancet Commission in 2019 advocated a plant-centric diet for health and environmental benefits, but its relation to metabolic dysfunction-associated steatotic liver disease (MASLD) is unclear. We aimed to discover the metabolite profile linked to the EAT-Lancet diet and its association with MASLD risk, considering genetic predisposition., Methods: We analyzed data from 105,752 UK Biobank participants with detailed dietary and metabolomic information. We constructed an EAT-Lancet diet index and derived a corresponding metabolomic signature through elastic net regression. A weighted polygenic risk score for MASLD was computed from associated risk variants. The Cox proportional hazards model was employed to estimate hazard ratios (HRs) and 95% CIs for the risk of MASLD (defined as hospital admission or death)., Results: During a median follow-up period of 11.6 years, 1,138 cases of MASLD were documented. Participants in the highest group for the EAT-Lancet diet index had a multivariable HR of 0.79 (95% CI 0.66-0.95) for MASLD compared to the lowest group. The diet's impact was unaffected by genetic predisposition to MASLD ( p  = 0.42). Moreover, a robust correlation was found between the metabolomic signature and the EAT-Lancet diet index (Pearson r = 0.29; p <0.0001). Participants in the highest group for the metabolomic signature had a multivariable HR of 0.46 (95% CI 0.37-0.58) for MASLD, in comparison to those in the lowest group., Conclusions: Higher intake of the EAT-Lancet diet and its associated metabolite signature are both linked to a reduced risk of MASLD, independently of traditional risk factors., Impact and Implications: Our analysis leveraging the UK Biobank study showed higher adherence to the EAT-Lancet diet was associated with a reduced risk of metabolic dysfunction-associated steatotic liver disease (MASLD). We identified a unique metabolite signature comprising 81 metabolites associated with the EAT-Lancet diet, potentially underlying the diet's protective mechanism against MASLD. These findings suggest the EAT-Lancet diet may offer substantial protective benefits against MASLD., (© 2024 The Author(s).)

Background To guide the transformation of food systems to provide for healthy and sustainable diets, countries need to assess their current diet and food supply in comparison to nutrition, health, affordability, and environmental goals. Objectives We sought to compare Indonesia's food utilization to diets optimized for nutritional value and cost and to diets that are increasingly plant-based in order to meet further health and environmental goals, including the EAT-Lancet planetary health diet, to explore whether multiple goals could be achieved simultaneously. Methods We compared 13 dietary scenarios (2 current, 7 optimized, 3 increasingly plant-based, 1 EAT-Lancet) for nutrient content, cost, greenhouse gas emissions (GHGe), and water footprints, using the FAO food balance sheet, Indonesia Household Income and Expenditure Survey household food expenditure, food composition, life cycle assessment, food losses, and trade data. Results The diversity of modeled scenarios was higher than that of current consumption, reflecting nutritional deficiencies underlying Indonesia's burden of different forms of malnutrition. Nutrient intake targets were met best by nutrient- and cost-optimized diets, followed by the EAT-Lancet diet. Those diets also had high GHGe, although less than 40% of a scenario in which Indonesia would adopt a typical high-income country's diet. Only the low food chain diet had a GHGe below the 2050 target set by the EAT-Lancet commission. Its nutrient content was comparable to that of a no-dairy diet, slightly above those of fish-and-poultry and current diets, and somewhat below those of the EAT-Lancet diets. To meet nutrient needs, some animal-source foods had to be included. Costs of all except the optimized diets were above the current national average food expenditure. No scenario met all goals simultaneously. Conclusions Indonesia's consumption of rice and unhealthy foods should decrease; food production, trade, and processing should prioritize diversification, (bio)fortification, and limiting environmental impacts; and consumer and institutional demands for healthy, nutritious, and sustainable foods should be stimulated. More granular data and tools are required to develop and assess more detailed scenarios to achieve multiple goals simultaneously. [ABSTRACT FROM AUTHOR]