Planetary Health Diet Research Articles

Dietary inflammatory index mediates the association between planetary health diet index and periodontitis.

With global shifts in diet and environment, understanding how dietary factors and inflammation affect oral diseases like periodontitis is essential for prevention. The Planetary Health Diet Index (PHDI) promotes a plant-based diet for both health and sustainability, while the Dietary Inflammatory Index (DII) measures a diet's inflammatory potential. This study examines the link between PHDI and periodontitis and assesses DII's moderating role. This study conducted a cross-sectional analysis of 9,016 participants from the 2009-2014 NHANES database. We used subgroup analysis, restricted cubic splines (RCS), and multivariable logistic regression to investigate the association between PHDI and periodontitis prevalence. Additionally, mediation analysis was performed to explore the potential relationship between DII, PHDI, and periodontitis. This study included 9,016 participants, of whom 4,521 were diagnosed with periodontitis. After adjusting for potential confounders in multivariable logistic regression models, a 10-point increase in PHDI was associated with a 6% lower prevalence of periodontitis (odds ratio [OR] = 0.94, 95% confidence interval [CI]: 0.89-0.99). Conversely, each one-unit increase in DII was associated with a 6% higher prevalence of periodontitis (OR = 1.06, 95% CI: 1.01-1.10). These associations remained robust when PHDI and DII were categorized into tertiles. RCS analysis demonstrated a significant linear relationship between PHDI and periodontitis. Mediation analysis indicated that DII mediated 21.74% of the association between PHDI and periodontitis (P = 0.004). The results of this study show a strong negative correlation between PHDI and the prevalence of periodontitis. Additionally, DII appears to mediate this relationship, suggesting that an anti-inflammatory diet may offer benefits.

Effects of nutrition education on dietary quality and prediabetes-related metabolic parameters in female University students

ABSTRACT This study aimed to evaluate the effects of nutrition education on the Healthy Eating Index-2020 (HEI-2020), Planetary Health Diet Index (PHDI), Dietary Carbohydrate Quality Index (CQI), Low-Carbohydrate Diet Score (LCDS), Glycemic Index (GI), and Glycemic Load (GL). Additionally, it assessed its impact on fasting blood glucose, fasting insulin levels, Homeostasis Model Assessment (HOMA-IR), and Quantitative Insulin Sensitivity Check Index (QUICKI), which are biomarkers associated with prediabetes. The case-control study was conducted with female university students in the case (n = 39) and control (n = 37) groups who received nutrition education; dietary components were calculated over 24-hour dietary recall. Findings revealed that HEI-2020 scores were significantly higher (p = 0.006); insulin (p = 0.035), glucose (p = 0.023) and HOMA-IR (p = 0.026) levels were lower, and QUICKI values were higher (p = 0.025) in the case group. In adjusted models, higher tertiles of PHDI (T2-AOR = 12.039; 95%CI: 2.266–63.866), HEI-2020 (T2-AOR = 0.002; 95%CI: 0–0.462 and T3-AOR = 0.010; 95%CI: 0–0.457), and CQI (T2-AOR = 64.713; 95%CI: 4.585–91.775) were associated with lower odds of insulin resistance. Furthermore, a positive association was observed between dietary GI and the odds of insulin resistance (T2-AOR = 7.286; 95%CI: 2.349–52.6054). It was determined that nutrition education improved dietary quality and had positive effects on prediabetes-related metabolic parameters.

Association between habitual adherence to the planetary-health diet and mortality and major chronic disease risk among UK Biobank participants.

Association between habitual adherence to the planetary-health diet and mortality and major chronic disease risk among UK Biobank participants.

Planetary boundaries under a land-based climate change mitigation scenario with a food demand transformation: a modelling study.

Planetary boundaries under a land-based climate change mitigation scenario with a food demand transformation: a modelling study.

Adherence to the EAT-Lancet diet and its association with micronutrient intake in the urban population of eight Latin American countries.

Adherence to the EAT-Lancet diet and its association with micronutrient intake in the urban population of eight Latin American countries.

Behavioral intention toward planetary health diet among adult users of government worksite cafeterias in Seoul, South Korea: a mixed-methods study based on the theory of planned behavior and focus groups interviews

Objectives: To reduce urban carbon emissions, in this study, we aimed to suggest strategies for disseminating the planetary health diet (PHD) guidelines to adult cafeterias in a government worksite in Seoul based on the theory of planned behavior (TPB) and focus group interviews (FGI).Methods: A total of 132 adults who worked at a government worksite in Seoul and used its cafeteria were included for a TPB-based survey. Factor analyses and multiple regression were used to investigate the relationships between attitude (cognitive•affective), subjective norms, and perceived behavioral control (PBC, internal•external) and the behavioral intention to adopt the PHD. To identify the contextual factors related to PHD dissemination, 14 participants underwent in-depth interviews.Results: Affective attitudes and PBC (internal•external) constructs of the TPB were significantly related with the intention to adopt PHD: external PBC (β = 0.324, P < 0.001), internal PBC (β = 0.269, P < 0.01), and affective attitudes (β = 0.226, P < 0.05). The FGI results highlighted the insufficiency of simply providing healthy meals to encourage the adoption of PHDs, but that menu development and natural acceptance strategies are needed to increase palatability. In addition, the need for strategies to promote PHDs at an organizational level was identified, as it is directly influenced by the company of partners with whom one dines. Furthermore, users' perceptions of how “Meals for the Planet” are delivered and suggestions for its improvement were also interpreted. Conclusion: Our results suggest that users' beliefs, convictions, and emotions are important while promoting or educating individuals about sustainable PHDs. Our findings are expected to help local governments or private group cafeterias that wish to introduce PHDs in the future, given the growing importance of environmentally conscious eating.

Sustainability of Diets Consumed by UK Adolescents and Associations Between Diet Sustainability and Meeting Nutritional Requirements.

Background/Objectives: The EAT-Lancet Commission proposed a healthy and sustainable 'planetary health diet' (PHD) based on the nutritional needs of adults, but recommended for all population groups over the age of two years. This study investigated the extent to which UK adolescent diets meet these recommendations, and the association between meeting recommendations and nutritional intake. Methods: Dietary intake data collected from students aged 11-15 years between 2019 and 2022 as part of the Food provision, cUlture and Environment in secondary schooLs (FUEL) study was used. Specifically, 24 h intakes of food groups and key nutrients were summarised for each participant, and micronutrient intake was expressed as a percentage of the reference nutrient intake (RNI). The proportion of participants meeting each PHD recommendation was calculated. A PHD index score was developed to measure the overall adherence to recommendations. Multilevel linear regression models were fitted to explore the association between the PHD score and intake of each nutrient. Results: No participants fully met the recommendations. The mean PHD score was 14.2 (3.3) out of 39. Adherence was low for the emphasised foods, and lowest for nuts (1.3%) and unsaturated oils (0.2%). Higher PHD index scores were associated with lower intakes of all micronutrients, with the largest association for vitamin B12 [regression coefficient: -12.9% (95% CI: -16.3, -9.4) of RNI] and the smallest for vitamin D [regression coefficient: -0.4 (95% CI: -0.7, -0.2) of RNI]. Conclusions: Substantial dietary changes are needed for this population group to meet the PHD guidelines. Further research should focus on why these recommendations may lead to the inadequate intake of some nutrients in this age group. We propose that the PHD guidance needs to be reviewed and potentially adapted for this specific population, with consideration of the typical dietary behaviours of this age group.

Sex differences in the association of planetary health diet, genetic risk, with overall cancer incidence: a prospective study from UK Biobank.

The effect of Planetary Health Diet (PHD) may differ by sexes, and the associations with cancer risk remain unclear. This study aimed to investigate sex differences in the associations between PHD and overall cancer risk, as well as the joint effects of PHD and genetic risk. This study included 177,441 participants from the UK Biobank. The PHD score was calculated by summing the scores of 14 dietary components, each assessed on an adjustable 0-10 scoring system. To evaluate genetic risk, an overall cancer polygenic risk score (CPRS) was constructed using 1,025 single-nucleotide polymorphisms. The outcome was overall cancer, defined by 20 site-specific cancers. During a median follow-up of 12.98years, 15,476 cancer cases were identified, comprising 82,146 men and 95,295 women. In the multivariable-adjusted model, participants in the highest quintile of PHD adherence showed a borderline significant reduction in overall cancer risk (hazard ratio [HR]: 0.95, 95% confidence intervals [CI]: 0.90-1.00) relative to the lowest quintile. Additionally, each standard deviation increase in PHD score was associated with a 4% reduction in overall cancer risk (HR: 0.96, 95% CI: 0.95-0.98). When stratified by sex, individuals with the highest PHD score were associated with lower cancer risk in men (HR: 0.92, 95% CI: 0.86-0.99), but not in women (HR: 0.96, 95% CI: 0.89-1.03). In the joint analysis, individuals with high PHD scores and low CPRS had the relatively lowest risk of overall cancer compared to those with low PHD scores and high CPRS, in both men (HR: 0.39, 95% CI: 0.33-0.46) and women (HR: 0.55, 95% CI: 0.47-0.65). The PHD was associated with a reduced overall cancer risk among men. Individuals with high PHD scores and low CPRS had the relatively lowest cancer risk. These findings highlight that the PHD may be particularly beneficial in men for cancer prevention.

1429-P: Planetary Health Diet—Associations with Cardiovascular Disease and Type 2 Diabetes Risks, and Long-Term Weight Change in Women with a History of Gestational Diabetes

Introduction and Objective: The Planetary Health Diet (PHD), introduced in 2019 by the EAT-Lancet Commission, promotes chronic disease prevention and environmental sustainability. However, evidence on PHD adherence and its association with type 2 diabetes (T2D), cardiovascular disease (CVD), and weight gain is scarce, especially among women with a history of gestational diabetes mellitus (GDM). Methods: We followed 4,637 women with a history of GDM in the Nurses’ Health Study II (1991-2019). The PHD index (PHDI) was derived from 15 food groups based on food frequency questionnaires every 4 years. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of T2D and CVD (myocardial infarction (MI) and stroke combined), respectively. Associations between PHDI changes and concurrent 4-year weight changes were evaluated using multivariable marginal models with generalized estimating equations. Results: Over 120,563 person-years, 92 CVD and 1,051 T2D cases were observed. Women in the highest tertile of the PHDI had a 43% lower risk of CVD [HR (95%CI)=0.57 (0.32-0.99), P-trend=0.04] and a 62% lower risk of MI [HR (95%CI)=0.38 (0.16-0.89), P-trend=0.02], compared to those in the lowest tertile. The highest quintiles of PHDI was associated with a reduced risk of T2D [HR (95%CI)=0.83 (0.67-1.03), P-trend=0.03], though this association became non-significant after adjusting for BMI. BMI was estimated to mediate 63% (95%CI=27-89%, P<0.01) of this association. Decreasing PHDI was associated with greater weight gain (P-trend<0.01), with the largest PHDI drop (-10±6) resulting in a mean of 2.3kg weight gain (95% CI=2.0-2.6). Conclusion: Higher PHDI was significantly associated with lower CVD and T2D risks and better weight management in this high-risk population. Our findings also emphasize the importance of weight management in reducing the risk of progressing from GDM to T2D. Disclosure X. Yin: None. J. Yang: None. C. Zhang: None.

Adherence to the EAT-Lancet Diet Among Urban and Rural Latin American Adolescents: Associations with Micronutrient Intake and Ultra-Processed Food Consumption

Background/Objectives: Adolescents in Latin America are experiencing rising rates of overweight/obesity and non-communicable diseases, while public health nutrition efforts targeting this group remain limited. This study explores adherence to the EAT-Lancet diet and its relationship with micronutrient adequacy and ultra-processed food (UPF) consumption. Methods: Cross-sectional data from national nutrition surveys of 19,601 adolescents across six Latin American countries were analyzed. Data on sociodemographics, anthropometrics, and dietary habits were collected using standardized questionnaires and 24 h dietary recalls or food records. Nutrient intake was estimated via statistical modeling, and nutrient adequacy ratios were based on age- and sex-specific requirements. UPF intake was classified using the NOVA system, and adherence to the EAT-Lancet diet was assessed with the Planetary Health Diet Index. Results: Overall adherence to the EAT-Lancet diet was low (mean score: 28.3%). Rural adolescents had higher adherence than urban adolescents, and those aged 10–13 and 17–19 showed better adherence compared to adolescents aged 14–16. Adolescents from lower socioeconomic backgrounds adhered more than those from higher socioeconomic backgrounds. Adherence varied from 20.2% in Argentina to 30.2% in Brazil and Chile. Higher adherence was associated with lower UPF intake. Among urban adolescents, greater adherence was linked to a higher risk of inadequate riboflavin, niacin, and cobalamin intake, a trend not observed in rural adolescents. Conclusions: Adherence to the EAT-Lancet diet is low among Latin American adolescents, particularly in urban areas. Public health efforts should prioritize reducing UPF consumption, improving access to nutrient-dense, culturally appropriate foods, and supporting fortified staple foods.

Linking the Planetary Health Diet Index to sarcopenia: the mediating effect of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR)

BackgroundThe Planetary Health Diet Index (PHDI), which promotes plant-based food consumption and limits red meat and processed food intake, aligns with goals for human health and environmental sustainability. Sarcopenia, characterized by progressive muscle loss, has been increasingly associated with dietary and metabolic factors. This study aims to explore the relationship between PHDI and sarcopenia and investigates the potential mediating role of the non-high-density lipoprotein to high-density lipoprotein cholesterol ratio (NHHR).MethodsA total of 9,094 individuals from the National Health and Nutrition Examination Survey (NHANES), conducted between 2011 and 2018, were included in this analysis. Multivariable logistic regression, smooth curve fitting, and subgroup analyses were applied to explore the association between the PHDI and the likelihood of sarcopenia. Additionally, mediation analysis was performed to assess the potential mediating role of NHHR.ResultsThe findings indicated a notable negative association between PHDI and sarcopenia. After adjusting for confounding factors, a 10-unit increase in PHDI was associated with an 14% lower likelihood of sarcopenia [Odds Ratio (OR) = 0.86, 95% Confidence Interval (CI): 0.79, 0.94]. Participants in the highest PHDI tertile (T3) were observed to have a 38% reduced likelihood of sarcopenia compared to those in the lowest tertile (T1) [OR = 0.62, 95% CI: 0.43, 0.90]. Analysis of the dose–response curve suggested a linear relationship between PHDI and sarcopenia. Furthermore, a significant positive association was identified between NHHR and sarcopenia [OR = 1.09, 95% CI: 1.03, 1.16], with NHHR found to decrease as PHDI increased [beta coefficient (β) = −0.09, 95% CI: −0.11, −0.06]. Mediation analysis revealed that NHHR partially mediated the relationship between PHDI and sarcopenia, accounting for 8.33% of the total effect.ConclusionThis study highlights the observed negative correlation between PHDI and sarcopenia, with NHHR acting as a partial mediator. These findings emphasize the potential importance of dietary patterns in strategies aimed at preventing sarcopenia.

661-P: Comparative Analysis of Physical Activity and Dietary Behavior between Prediabetes and Normoglycemic Population

Introduction and Objective: Prediabetes (preDM) among adults is on the rise, physical activity (PA) and healthy diet as modifiable lifestyle influencing factors can help prevent or delay progression to type 2 diabetes in adults with preDM, but it is unclear whether these factors vary by prediabetic status. Methods: Cross-sectional study of Chines adults without DM who attended at a tertiary A hospital in Guangzhou from December 2023 to August 2024, we classified the participants into PreDM group (n=151), Non-preDM group (n=302). We calculated means or medians for PA (from one week of recall data), Planetary Health Diet Score (PHD-S) (from one month of recall data, higher score indicates healthier diet). After controlling for confounders using propensity score matching, independent samples t-tests, rank-sum tests, chi-square tests, or Fisher’s exact probability methods were used to compare PA and dietary differences between the preDM and non-preDM groups. Using R software for statistical analysis. Results: Compared with non-preDM group, the preDM group had more metablic equivalent (MET) for light physical activity (p<0.001), but fewer the number of days per week involving moderate (p<0.001) and vigorous physical activity (p=0.032). PA levels did not significantly vary across the 2 groups (p=0.315). The PHD-S of saturated oils (p=0.007) and added sugars (p=0.011) were higher in the preDM group, but the PHD-S of fish (p=0.021), soy foods (p=0.002) and nuts (p<0.001) were lower. Mediation analysis revealed that in preDM group BMI significantly mediated the relationship of diet to uric acid with mediation proportions of 29.3%. Conclusion: There were differences in PA and diet between the preDM and non-preDM groups. Among adults with preDM, their status of light physical activity, intake of saturated oils and added sugars were better, but they still did not meet the guidelines, and more standardized individualized health interventions should be given to them in the future. Disclosure J. Lin: None. X. Hu: None. Funding National natural science foundation of China (72204277); Nursing innovation development research project (YJYZ202304); 3rd Affiliated Hospital of Sun Yat-sen University, Clinical Research Program (YHJH202404)

Association Between Health Literacy and Adherence to the Eat-Lancet Sustainable Reference Diet Among Cancer Survivors

This study aimed to investigate whether there is an association between the health literacy of breast and prostate cancer survivors and their feeding, considering the planetary diet recommendation. This cross-sectional study utilized secondary data from 201 women with breast cancer and 106 men with prostate cancer. Health literacy was evaluated using the Brazilian version of the Health Literacy Questionnaire. The EAT-Lancet diet adherence was assessed using the Planetary Health Diet Index (PHDI). The mean PHDI score was 45.3 (9.0) points, without differences in consumption between men and women. The health literacy status and PHDI score were unassociated among cancer survivors. Adherence to a healthy and sustainable diet and health literacy were low among the studied population. Further studies should evaluate these conditions in other populations.

Protecting children's health through universal and sustainable school meals: European and US urban policy experiences.

School meal policies can protect children's health by reducing food insecurity, and they can also increase social justice, school attendance and food systems sustainability if designed to do so. This study analysed school meal policies in Vienna, Copenhagen, Madrid, and New York City (NYC) designed to improve nutritional health, sustainability and accessibility to school meals for vulnerable children. Child poverty is a growing and worrying reality in high-income countries. In 2022/2023, the prevalence of child poverty reached 17.7%, 17.9%, 34.5 and 23% in Vienna, Copenhagen, Madrid and NYC, respectively. Data collection and policy analysis involved reviewing peer-reviewed journal articles, official national and local reports and food strategies from the past decade (2014-2024) focusing on educational centres serving children and adolescents for each city. Nutritional dimensions of school food remained central, focusing on the EAT model, that builds upon the concept ofplanetary health and puts forth the new term 'planetary health diet,' healthy cooking techniques, food education and childhood obesity prevention. Climate change mitigation goals were reflected in sustainable food procurement, plant-forward menus and waste reduction policies. Accessibility to school meals for vulnerable children remained the main food policy challenge in all four cities analysed with the universal free school meal programmes implemented in NYC, offering a useful policy experience. Multidimensional school meal policies can improve children's nutrition-related health and sustainability while reaching vulnerable children. As cities face childhood poverty, migration, food insecurity and climate change, reorienting school food systems remains crucial for addressing children's health, environmental resilience and social justice.

Effects of a cafeteria-based sustainable diet intervention on wellbeing at a large German hospital: a quasi-experimental study

SummaryPurposeSustainable diets are vital to tackle climate change and promote health. They may also offer significant benefits for mental and physical wellbeing. Creating a sustainable food environment at the working place could therefore contribute to the wellbeing of employees. In this quasi-experiment, we investigated effects of providing vegan menus and nutritional information in a cafeteria of Heidelberg University Hospital on mental wellbeing and health-related quality of life (HRQoL) among customers.MethodsRegular customers (> one visit/week) in the largest cafeteria (intervention group, n = 121) and in all other cafeterias (control group, n = 128) completed a questionnaire before and after the 3-month intervention period (16/01/2023–06/04/2023). We measured mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), HRQoL using the Short Form- 36 Questionnaire (SF-36) and adherence to the Planetary Health Diet (PHD) using a Food Frequency Questionnaire. Difference-in-differences (DID) were calculated for the intervention effects on WEMWBS and SF-36 scores. Cross-sectional associations of the PHD-Index with these scores were calculated at baseline.ResultsIn this study population (N = 249; women: 65%), the mean baseline WEMWBS was 54.46 (standard deviation, SD: 7.13) in the control group and 55.19 (SD: 6.41) in the intervention group. The difference-in-differences was 0.61 (95% confidence interval, CI: - 0.78, 1.99; p = 0.39). Effects were insignificant for all SF-36 outcomes. Adherence to the PHD-Index was positively associated with self-rated health (beta: 0.48; 95% CI: 0.20, 0.75; p <.001).ConclusionThis worksite cafeteria-based diet intervention yielded nominal improvements in mental and physical wellbeing among customers; this could be mediated by increased adherence to the PHD. These trends warrant verification in larger-sized intervention studies with more intense intervention dosages. Our findings underline the importance of sustainable food environments for planetary health.The protocol was registered at the German-Clinical-Trial-Register on 22/04/2024 (DRKS00032620).

Assessing sustainable and healthy diets in large-scale surveys: validity and applicability of a dietary index based on a brief food group propensity questionnaire representing the EAT-Lancet planetary health diet.

Assessing sustainable and healthy diets in large-scale surveys: validity and applicability of a dietary index based on a brief food group propensity questionnaire representing the EAT-Lancet planetary health diet.

Adherence to the Modified Planetary Health Diet among the Working-Age Population in 185 Countries from 1990 to 2018: A Population-Based Study.

Adherence to the Modified Planetary Health Diet among the Working-Age Population in 185 Countries from 1990 to 2018: A Population-Based Study.

Adherence to the EAT-Lancet Planetary Health Diet and Cardiometabolic Risk Markers in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study.

Adherence to the EAT-Lancet Planetary Health Diet and Cardiometabolic Risk Markers in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study.

Planetary health diet and cognitive decline in Chinese older adults: Balancing health benefits and environmental sustainability

Planetary health diet and cognitive decline in Chinese older adults: Balancing health benefits and environmental sustainability

Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort.

Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort.