EAT-Lancet Commission Research Articles

How to improve sustainability of nutrient dense diets for children and adolescents: an exemplary assessment in Germany

BackgroundThe global climate crisis requires a paradigm shift in dietary concepts, respecting the needs of children. A global reference diet has been suggested by the EAT-Lancet Commission. On this basis, the detailed “Planetary Health Diet Index” (PHDI) has been proposed. The objective of this assessment is (1) to apply the PHDI to the Food-Based Dietary Guidelines, the so-called Optimized Mixed Diet (OMD) for children and adolescents in Germany in its original composition and (2) to check how the planetary value of the OMD could be improved by modifying food selection within meals while keeping the high nutrient densities of the guideline diet.MethodsThe PHDI specifies 16 food groups and their proportion of total daily energy intake. The PHDI of the original OMD was calculated by assigning the foods of the 7-day menu to the PHDI food groups in order to score them. In this way, it became apparent which food groups had the potential to improve the sustainability. The diet was then updated by either reducing or increasing individual foods from these food groups in the meals and deriving the resulting PHDI. The nutrient densities of the original and updated daily OMD were calculated.ResultsThe original diet obtained a PHDI score of 68.24 points, representing 45.5% of the theoretical maximum of 150 points. The following food groups achieved 9.9 to 10 out of 10 points: fruits, total vegetables, fish & seafood, vegetable oils, chicken (and substitutes). Conversely, food groups receiving a zero score included tubers & potatoes, dairy, red meat, animal fat, and added sugars. The updated diet resulted in increased consumption of ‘nuts & peanuts’, ‘legumes’, ‘green vegetables’, ‘whole grains’, and decreased consumption of ‘tubers & potatoes’ and ‘red meat’. Overall, the PHDI increased from 68.24 to 81.51 points with the updated OMD, reflecting a 13.27% increase compared to the original diet. The nutrient densities were not significantly affected, but even slightly increased for most nutrients.ConclusionsThe PHDI was applied to demonstrate how the sustainability of the guideline diet for children and adolescents in Germany could be improved through changes in individual food groups that can be easily implemented in practice while maintaining high nutrient densities and acceptability for children.Trial registrationNA.

Associations between the EAT-Lancet Index, nutrient intake and compliance with UK dietary guidance in UK adults

The EAT-Lancet Commission has identified a diet that aims to optimise both human health and environmental sustainability, known as the “planetary health diet”, which aims to improve the health of the population and meet sustainable food production targets by 2050(1). However, evidence suggests that following the planetary health diet may lead to micronutrient deficiencies associated with a plant-based diet(2). This research explores associations between adherence to the planetary health diet (assessed by the EAT-Lancet Index), habitual diet and adherence to dietary guidance in UK adults.Data from disease-free UK adults aged ≥18 years (n = 425) was pooled from five cross-sectional analyses that recorded habitual dietary intake using the eNutri food frequency questionnaire (FFQ)(3). Using daily nutrient and food group intakes from eNutri, EAT-Lancet Index scores were calculated(4), where higher scores represent greater adherence to the planetary health diet, which were then stratified into quartiles (Q), with the highest scores in Q4. Nutrients of interest were energy, total fat, saturated fats (SFA), protein, carbohydrates and free sugars, (all percentage of total energy (%TE)), long-chain n-3 polyunsaturated fats, fibre, sodium, potassium, calcium, iron, zinc, iodine, selenium, and vitamins B12 and D. ANCOVA (adjusting for sex, age, physical activity, ethnicity, employment status, and body mass index (BMI)) compared nutrient intakes across quartiles. If significant (p≤0.01), pairwise comparisons with Bonferroni correction identified significant differences between Q1 and Q4 (p≤0.01 accounting for multiple comparisons; results shown below). Percentages of each quartile group (Q1-Q4) meeting UK dietary guidelines were also calculated and compared using Chi-square tests (p≤0.05 for significance).Study participants had a mean (SD) age of 44 (19) years and a BMI of 25.7 (6.0) kg/m2 and 79.6% were female. Compared to Q1, Q4 had lower intakes of energy (-335 kcal/d), SFA (-3.0 %TE), free sugars (-4.2 %TE), sodium (-454 mg/d), and vitamin B12 (-2.2 mg/d) (all p≤0.006), while intakes of dietary fibre were 8.8 g/d higher (p<0.001). Furthermore, those with the highest EAT-Lancet scores were more likely to meet the UK dietary recommendations for total fat (36.2% in Q4 vs 24.3% in Q1, p = 0.035), free sugars (29.5% vs 13.0%, p = 0.001), sodium (66.7% vs 46.1%, p = 0.008), and potassium (61.9% vs 49.6%, p = 0.02).The highest EAT-Lancet Index scores were associated with more favourable intakes of dietary fibre and lower energy, SFA, free sugars, and sodium, and more participants met the UK dietary recommendations for free sugars and sodium compared with the lowest scores. Although intakes of vitamin B12 were lower with higher EAT-Lancet scores, the percentage of participants consuming the recommended intakes did not differ between quartiles. These findings suggest that greater adherence to the planetary health diet is associated with a more healthful diet that aligns more closely with dietary guidance in UK adults.

Association between the Planetary Health Diet Index and biological aging among the U.S. population.

The Planetary Health Diet (PHD) is a novel dietary pattern proposed by the EAT-Lancet Commission in 2019, yet a limited study has investigated the anti-aging effects of PHD to date. This study aimed to explore the association between adherence to PHD, as quantified by the Planetary Health Diet Index (PHDI), and biological aging in American populations. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) for 1999-2018. Food consumption information was relied on two 24-h diet recall questionnaires. The biological aging condition was comprehensively assessed by four biological markers, including phenotypic age, biological age, telomere length, and klotho concentration. Weighted multivariate linear models, restricted cubic spline (RCS), and subgroup analysis were subsequently carried out to evaluate the influence of PHDI on biological aging. 44,925 participants with complete data were finally enrolled in our study. The fully adjusted models showed decreased 0.20 years in phenotypic age [-0.20 (-0.31, -0.10)] and declined 0.54 years in biological age [-0.54 (-0.69, -0.38)] correlated with PHDI per 10 scores increment. Klotho concentration [6.2 (1.0, 11.0)] was positively related to PHDI. In Model 2, telomere length increased by 0.02 bp for every 10-point rise in PHDI. Besides, the RCS analysis results exhibited a curvilinear relationship between PHDI and four indicators. Our study explored a significant correlation between PHDI and biological aging, indicating that adherence to PHD may prevent biological aging.

Sustainable Dietary Patterns and Alternative Food Sources

Sustainable nutrition ensures optimal dietary intake by evaluating the life cycle of foods and their environmental impacts, aiming to meet current needs without jeopardizing the ability of future generations to do the same. It is characterized by low greenhouse gas emissions, minimal water footprint, efficient energy and land use, and reduced food waste. Sustainable dietary models, which have become increasingly important in the face of rising food demand and climate change challenges, include the Mediterranean Diet, Nordic Diet, DASH Diet, Double Pyramid Model, Flexitarian Diet, EAT-Lancet Commission Reference Diet, and Vegetarian and Vegan diets. Alternative protein sources such as algae, insects, and cultured meat are also significant. Algae offer sustainability through ocean use but have unclear metabolic impacts. Insects are efficient and environmentally friendly but require safety assessments. Cultured meat promises environmental benefits but faces cost and acceptance hurdles. Promoting sustainable eating habits requires a collective effort and is a shared responsibility towards our planet and ourselves.

Emerging EAT-Lancet planetary health diet is associated with major cardiovascular diseases and all-cause mortality: A global systematic review and meta-analysis

Background & aimsIn 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. MethodsA 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 I2 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. ResultsWe 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 (I2 = 94.0 %), all-cause mortality (I2 = 85.5 %), and cancer incidence (I2 = 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. ConclusionFollowing 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.

Prospects of Food Taxes for Planetary Health: A Systematic Review of Modeling Studies.

The aim of this study was to analyze the modeling methodologies of fiscal policies on food with health or environmental outcomes. Evidence suggests that fiscal policies on food can contribute to addressing the growing burden of noncommunicable diseases and climate change. These policies should be modeled in advance to see the implications for the environment and health. A systematic review was conducted of studies that modeled fiscal policies on the food groups targeted by the EAT-Lancet Commission and examined their health or environmental outcomes. The Scopus and PubMed databases were searched on November 30, 2021. The records were double-screened and data on modeling methods were extracted from the included studies. A total of 55 studies were included in the review. The most frequently modeled interventions were fruit and vegetable subsidies (n = 19) and carbon taxes on food (n = 17). One study also included a consumer education campaign to enhance the effect of fiscal policy. The outcomes are highly sensitive to consumption change and price elasticities. None of the studies modeled the health effects of environmental outcomes. A model that covered all the relevant aspects of the issue was not found. Some parts were missing from all the included models. It is advisable to model the stability of the amount of diet consumed, either by keeping the amount of food in the diet stable or by taking a more conservative approach and keeping the consumed calories stable. It is preferable to keep the included diseases and environmental boundaries broad to have more valid outcome estimates on this complex issue. A more comprehensive understanding of fiscal policies would allow us to better anticipate the impact of our actions and inactions and thus could lead to more sophisticated measures taken by policymakers. PROSPERO registration no. 2022 CRD42022291945/.

Effects of Replacing Cow's Milk with Plant-Based Beverages on Potential Nutrient Intake in Sustainable Healthy Dietary Patterns: A Case Study.

More consumers are replacing cow's milk (CM) with plant-based drinks (PBD), but data indicating the nutritional impact are limited. This theoretical study aims to assess the effect of substituting CM with PBD sold in Italy on nutrient intake within two dietary patterns: one aligned with the EAT-Lancet Commission reference diet adapted to Italian food habits (EAT-IT) and another one in line with the Italian Dietary Guidelines (IDG). Nutrition information from 368 PBD were collected and categorized according to their descriptive name and their fortification or not with calcium (Ca- and nCa-fortified). The substitution of CM with each PBD category in both dietary patterns was conducted, and an analysis of nutrient content and adequacy was performed. Substituting CM with all PBD resulted in reduced protein intake, except for nCa-fortified soy drinks, decreased saturated fat and vitamins B2 and B12, and increased fiber intake. Replacing CM with nCa-fortified PBD within both diets decreased Ca intake. Following the substitution of CM with Ca-fortified PBD, variations in vitamin D intake depended on the PBD category. The main risk of nutritional inadequacy was observed in Ca and vitamin D levels, which may even be amplified considering the different bioavailability based on the source of nutrients. This study highlighted the important role of CM in meeting calcium requirements and the potential unintended consequences of substituting CM with PBD without considering their nutritional differences.

Association of adherence to the EAT-Lancet diet with risk of dementia according to social economic status: a prospective cohort in UK Biobank.

The EAT-Lancet Commission has proposed a reference diet aiming to promote human health and environmental sustainability. Socioeconomic disadvantage and poor diet are well-known risk factors for dementia; however, whether the effect of this reference diet on dementia varies by socioeconomic status has not been investigated. The dietary habits of 190,893 participants from UK-Biobank were assessed; the association of EAT-Lancet diet with incident dementia across socioeconomic status was determined by Cox models. One thousand seven hundred twenty-eight dementia cases were identified during a median of 12.24 years follow-up. An inverse association between adherence to EAT-Lancet diet and all-cause dementia (high vs. low; hazard ratio [HR], 95% confidence interval [CI]: 0.82, 0.72-0.94) or late-onset dementia (high vs. low; HR, 95% CI: 0.78, 0.68-0.91) was observed only in individuals with high socioeconomic status. On the contrary, no protective effects of EAT-Lancet diet on early-onset dementia were observed, regardless of the socioeconomic status. Our findings indicated that adherence to an environment-friendly diet helps attenuate risk of dementia only in individuals with high socioeconomic level.

Adoption of region-specific diets in China can help achieve gains in health and environmental sustainability.

The vast heterogeneity in dietary practices across China has led to profound regional disparities in health and environment. To address this issue, we developed a region-specific reference diet (RRD) that is better aligned with Chinese culinary traditions, affordable, sparing of natural and environmental resources, and contributes to health. The adoption of the RRD has proven to be a viable solution to facilitate a rapid transition towards a healthy and environmentally sustainable diet across the country when compared to dietary guidelines from the World Health Organization, the EAT-Lancet Commission and the Chinese Nutrition Society. The RRD improved health in all regions and resulted in reductions of all five environmental impacts measured. Given China's huge population and its major impact on global sustainability, the widespread adoption of the RRD would not only yield substantial health benefits domestically, but also contribute significantly to global food security and sustainability efforts.

Dietaryindex: a user-friendly and versatile R package for standardizing dietary pattern analysis in epidemiological and clinical studies

BackgroundFew standardized and open-source tools exist for calculating multiple dietary pattern indexes from dietary intake data in epidemiological and clinical studies. ObjectivesThe primary aim is to develop and validate dietaryindex, a user-friendly and versatile R package that standardizes the calculation of dietary indexes. MethodsDietaryindex can calculate multiple dietary indexes of high interest in research, including the Healthy Eating Index (HEI)-2020, the Alternative HEI 2010, the Dietary Approaches to Stop Hypertension Index, the Alternate Mediterranean Diet Score, the Dietary Inflammatory Index, the American Cancer Society 2020 dietary index, and the Planetary Health Diet Index from the EAT-Lancet Commission. The package includes generic dietary index calculation functions that accept any dietary assessment with preprocessed serving sizes of food groups and nutrients as defined by the research group that developed each index. For ease of use and to eliminate any need for data preprocessing, dietaryindex also offers 1-step functions that directly reference common datasets and tools, including the National Health and Nutrition Examination Survey (NHANES), the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24), the Diet History Questionnaire III (DHQ3), and the Block Food Frequency Questionnaire. At least 2 independent researchers validated the serving size definitions and scoring algorithms of dietaryindex. ResultsIn our validation process, dietaryindex demonstrated full accuracy (100%) in all generic functions with 2-decimal rounding precision when compared with hand-calculated results. Similarly, using NHANES 2017–2018 data and ASA24 and DHQ3 example data, the HEI-2015 outputs from dietaryindex aligned (99.95%–100%) with results using the Statistical Analysis System codes from the National Cancer Institute. ConclusionsDietaryindex is a user-friendly, versatile, and validated informatics tool for standardized dietary index calculations. We have open-sourced all validation files and codes with detailed tutorials on GitHub (https://github.com/jamesjiadazhan/dietaryindex).

Adherence to EAT-Lancet reference diet and risk of premature coronary artery diseases: a multi-center case-control study.

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. To determine the association between the EAT-Lancet Reference Diet (ELD) and premature coronary artery disease (PCAD) risk and its severity. 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. 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. 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.

Is Nutrient Quality of the Locally-Existing, EAT-Lancet-like Plant-Based Diet Better or Worse than the Average Diet in Taiwan? An Example of Local Translation.

The EAT-Lancet commission advocated a planetary health diet in 2019. Some have raised concerns about its nutrient adequacy. This study used data from recent Nutrition and Health Surveys in Taiwan-from 2017 to 2020 (n = 6538)-to assess food intake and nutrient adequacy among three red meat consumption levels (low/medium/high). The low red meat group, whose diet was similar to the EAT-Lancet reference, showed significantly higher/better levels of vitamins C and E, calcium, magnesium, sodium, dietary fiber, and the polyunsaturated to saturated fatty acids ratio. However, protein, B vitamins, phosphorus for females, and zinc were slightly compromised, but they were still near or above 100% of the Daily Reference Intakes (DRIs), except for zinc (74~75%). The intake levels of vitamin D, calcium, and dietary fiber in all three groups at times did not reach 70% of the DRIs, but this was more pronounced in the high red meat group compared to the low red meat group. Replacing ultra-processed foods (UPFs) with whole/healthy foods improved levels of zinc, calcium, and dietary fiber, but not vitamin D. Finally, a proposed local planetary health dietary construct was provided, suggesting maintaining the original distribution of the food groups recommended by the Taiwan Food Guide while specifying amounts of protein sources in line with the EAT-Lancet principles. The proposed diet, according to our estimation and comparison with Taiwanese DRIs, was nearly perfect in its nutrient composition.

Evaluating the diet in Germany with two indices focusing on healthy eating and planetary healthy eating using nationwide cross-sectional food intake data from DEGS1 (2008-2011).

To improve sustainability, adjustments to current diets are necessary. Therefore, limited planetary resources are considered within the healthy reference diet proposed by the EAT-Lancet Commission. The agreement with nationwide food intake was evaluated with two indices which reflect this reference and German food intake recommendations. A healthy eating index (HEI-MON) reflecting the dietary guidelines of the German nutrition society and a planetary healthy eating index (PHEI-MON) reflecting the healthy reference diet were developed, with scores from 0 to 100. Both indices were applied to data from a nationally representative sample of the German population aged 18-79 years for which data from a 53-item food frequency questionnaire are available. Mean scores for the indices were 53 for HEI-MON and 39 for PHEI-MON. A better adherence to either guideline could be found among women, persons of older age as well as persons with higher education level. The sub-scores for HEI-MON showed high agreement with the recommendations for side dishes, fruit/nuts, (processed) meat and cereals, but low agreement with the recommendations for free sugar and vegetables/legumes. PHEI-MON sub-scores were highest for poultry, fruits and potatoes, and lowest for nuts, red meat and legumes. High scores in one index do not necessarily correspond to high scores in the other index. Individuals with more plantbased diets had higher scores in both indices, while high sugar and meat consumption led to lower scores. More plant-based diets are crucial for individual and planetary health. Both indices reflect such diets which consider already health and sustainability aspects. At an individual level, the scores for both indices may differ considerably, but overall there is a huge potential in the population to adapt to a diet more in line with both guidelines.

Associations of the EAT-Lancet reference diet with metabolic dysfunction-associated steatotic liver disease and its severity: A multicohort study.

The EAT-Lancet Commission devised a globally sustainable dietary pattern to jointly promote human health and sustainability. However, the extent to which this diet supports metabolic dysfunction-associated steatotic liver disease (MASLD) has not yet been assessed. This study aimed to investigate the association between the EAT-Lancet diet and the risk of MASLD and its severity. This prospective multicohort study included 15,263 adults from the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) cohort, 1137 adults from the Guangzhou Nutrition and Health Study (GNHS) cohort, and 175,078 adults from the UK Biobank. In addition, 228 Chinese adults from the Prospective Epidemic Research Specifically of Non-alcoholic Steatohepatitis (PERSONS) with biopsy-proven MASLD were included. An EAT-Lancet diet index was created to reflect adherence to the EAT-Lancet reference diet. The TCLSIH cohort recorded 3010 MASLD cases during 53,575 person-years of follow-up, the GNHS cohort documented 624 MASLD cases during 6454 person-years of follow-up, and the UK Biobank developed 1350 MASLD cases during 1,745,432 person-years of follow-up. In multivariable models, participants in the highest tertiles of the EAT-Lancet diet index had a lower risk of MASLD compared with those in the lowest tertiles (TCLSIH: HR = 0.87, 95% CI: 0.78, 0.96; GNHS: HR = 0.79, 95% CI: 0.64, 0.98; UK Biobank: HR = 0.73, 95% CI: 0.63, 0.85). Moreover, liver-controlled attenuation parameter decreased with increasing the diet index in individuals with biopsy-proven MASLD (β = -5.895; 95% CI: -10.014, -1.775). Adherence to the EAT-Lancet reference diet was inversely associated with the risk of MASLD as well as its severity.

The EAT-Lancet Diet Index Is Associated with Lower Obesity and Incidence of Type 2 Diabetes in the Multiethnic Cohort

BackgroundThe EAT-Lancet Commission has developed dietary recommendations, named the EAT-Lancet diet, to promote healthy nutrition and sustainable food production worldwide. ObjectivesWe developed an adapted score for the EAT-Lancet diet for participants of the Multiethnic Cohort (MEC) Study and its relation with incidence of obesity and type 2 diabetes (T2D). MethodsThe MEC includes 5 ethnic groups followed since 1993–1996. Anthropometric characteristics and dietary intake were assessed by questionnaire at cohort entry (Qx1) and 10 y later (Qx3). To create the EAT-Lancet index (range: 0–48 points), a 3-point scoring system for 16 food groups standardized to 2500 kcal/d was applied. T2D cases were identified through repeated self-reports and administrative data. In a prospective design, obesity at Qx3 and T2D incidence were evaluated using Cox regression to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) while adjusting for relevant covariates. ResultsAmong 193,379 MEC participants, the overall mean of the EAT-Lancet index score was 25 ± 4 points and 46,140 new T2D cases were identified. Higher adjusted means were observed in females than males, in participants of Japanese American and Native Hawaiian ancestry, and in those with healthy weight than overweight or obese. Obesity was lower in cohort members with higher EAT-Lancet scores (HR: 0.76; 95% CI: 0.73, 0.79 for tertile 3 compared with 1). Although T2D incidence was 10% lower among participants in the highest (27–42 points) compared with the lowest (9–23 points) EAT-Lancet index tertile (HR: 0.90; 95% CI: 0.88, 0.92), the association was attenuated after BMI adjustment (HR: 0.97; 95% CI: 0.94, 0.99). This inverse association with T2D was restricted to African American and European American participants. ConclusionsThese findings support the hypothesis that adherence to the EAT-Lancet diet is related to a lower risk of obesity, which may be partially responsible for the small reduction in T2D incidence.

Planetary Health Diet Compared to Dutch Dietary Guidelines: Nutritional Content and Adequacy.

In 2019, the EAT-Lancet Commission proposed a Planetary Health Diet (PHD) to address challenges toward sustainable and healthy diets. However, its suitability within the Dutch context and a comparison with the Dutch Dietary Guidelines (DDG) needs investigation. Our study aimed to compare the PHD with DDG in terms of food groups, servings, nutritional content, and adequacy in adults. We modeled two theoretical diets, the PHD (PHD-NL) and another based on the DDG (DDG-NL), using the Dutch National Food Consumption Survey (FCS-2016) and Dutch Food Composition Database to calculate the nutritional content and compared it with the Dutch Dietary Reference Values (DRVs). The PHD included higher quantities of vegetables, fish, legumes, and nuts, while the DDG suggested more significant amounts of cereals, tubers, starchy vegetables, dairy, and red meat. We observed differences in macronutrient distribution; while both diets lacked sufficient vitamin D, calcium content was lower in the PHD-NL. The PHD-NL had higher levels of fiber, vegetable protein, unsaturated fats, and non-heme iron, while vitamins B2, B6, B12, and calcium were lower than the DDG-NL diet. The PHD-NL has nutritional adequacy in the Dutch context, except for vitamin D and calcium, although it is essential to be cautious with iron because of the bioavailability of non-heme iron in plant-based diets. These findings have implications for the adoption of a sustainable diet according to nutritional requirements, population health status, and sociocultural context, as well as compliance with specific dietary behaviors of populations.

Effect of a Two-Week Diet without Meat and Poultry on Serum Coenzyme Q10 Levels

Coenzyme Q10 (CoQ10) is an essential compound for energy production in the mitochondria and the antioxidation of lipid-soluble substances in cells. As it can be biosynthesized in cells, CoQ10 is not an essential nutrient. However, its intake through meals contributes to the maintenance of CoQ10 levels in the body. Therefore, understanding the effects of daily diet on serum CoQ10 levels is crucial. This study investigated the effect of a two-week diet without meat or poultry, which are rich in CoQ10 content, on serum CoQ10 levels of 22 young women aged 20–21 years. Upon restricting the intake of meat and poultry, the participants’ average daily intake of CoQ10 from meals decreased from 2.1 ± 0.6 to 1.1 ± 0.5 mg/day. Simultaneously, the average serum reduced, oxidized, and total CoQ10 levels decreased by 14%, 31%, and 16%, respectively, after the two-week dietary intervention, whereas the reduced serum CoQ10 ratio increased significantly. These results suggest that meat and poultry are significant sources of CoQ10 in the diet. Dietary habits affect serum CoQ10 levels; however, further research is required to determine whether people who follow long-term diets with lower serum CoQ10 levels, such as a healthy reference diet proposed by the EAT-Lancet Commission in addition to vegetarian and vegan diets, need CoQ10 supplementation to maintain health and achieve healthy longevity.

Adherence to a planetary health diet, genetic susceptibility, and incident cardiovascular disease: a prospective cohort study from the UK Biobank

BackgroundThe 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. ObjectiveWe aimed to investigate the association between adherence to PHD and CVD, and to evaluate the interaction between PHD and genetic predisposition to CVD. MethodsThis 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). ResultsDuring 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%). ConclusionsThese 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.

Adherence to the planetary health diet and cognitive decline: findings from the ELSA-Brasil study.

The EAT-Lancet Commission proposed a planetary health diet to improve human health within planetary boundaries; however, little is known about the association between adherence to this diet and cognitive decline. We used data from three waves of the Brazilian Longitudinal Study of Adult Health to evaluate the association between the planetary health diet and cognitive decline using linear mixed-effects models. Here we show that in 11,737 participants (mean (s.d.) age 51.6 (9.0) years, 54% women and 53% white), higher adherence to the planetary health diet was associated with slower memory decline (P = 0.046) and that income was a modifier in this association (P < 0.001). Adherence to the planetary health diet was associated with slower decline of memory (P = 0.040) and global cognition (P = 0.009) in high-income participants. No association was found among low-income participants. The results of our study highlight that the promotion of healthy dietary patterns should take into consideration income barriers as well as differences in dietary habits to achieve high adherence.

Dietary pattern modifies the risk of MASLD through metabolomic signature

Background & AimsThe 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. MethodsWe 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% confidence intervals (CIs) for the risk of MASLD (defined as hospital admission or death). ResultsDuring a median follow-up period of 11.6 years, 1,138 cases of MASLD were documented. The multivariable HR (95% CI) of MASLD for the highest versus the lowest group for the EAT-Lancet diet index was 0.79 (0.66, 0.95). 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 with the highest group for the metabolomic signature showing a multivariable HR (95% CI) of 0.46 (0.37, 0.58) for MASLD, in comparison to those with the lowest group. ConclusionsHigher 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 implicationsOur analysis leveraging the UK Biobank study showed higher adherence to the EAT-Lancet diet was associated with a reduced risk of 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.