Abstract
SummaryBackgroundUnhealthy 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.MethodsUsing 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.FindingsIn the pooled analysis, there was an association between levels of dietary greenhouse gas emissions and all-cause 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%.InterpretationOur 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.FundingEuropean Commission (DG-SANCO), the International Agency for Research on Cancer (IARC), MRC Early Career Fellowship (MR/M501669/1).
Highlights
Diets are a key link between population health and environmental sustainability, as unhealthy diets, the rise of non-communicable diseases, and the declining health of the planet are highly intertwined
By simulating a dietary intervention that considers nutritional needs and environmental footprints, the EAT–Lancet diet, we found that all-cause mortality and all cancers could be substantially reduced, together with reductions in greenhouse gas emissions and land use
To address the populationlevel health implications of dietary contributions to higher environmental footprints and the potential co-benefits from shifting to alternative, more sustainable diets, we aimed to investigate the associations of dietary greenhouse gas emissions and land use with health outcomes of allcause and cause-specific mortality and cancer incidence rates
Summary
Diets are a key link between population health and environmental sustainability, as unhealthy diets, the rise of non-communicable diseases, and the declining health of the planet are highly intertwined. A Stubbendorff BSc); Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center – University of Paris (CRESS), Bobigny, France (M Deschasaux PhD, M Touvier PhD, E Kesse-Guyot PhD); Escuela Andaluza de Salud Pública (EASP), Granada, Spain (M-J Sánchez Pérez PhD, M Rodríguez Barranco PhD); Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain Pública (CIBERESP), Madrid, Spain (M-J Sánchez Pérez, M Rodríguez Barranco); Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain (M-J Sánchez Pérez, M Rodríguez Barranco); Cancer Epidemiology Unit, Nuffield
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