Co-benefits from sustainable dietary shifts for population and environmental health: an assessment from a large European cohort study

Abstract

Background Unhealthy diets, the rise of non-communicable diseases, and the declining health of the planet are highly intertwined, where food production and consumption are major drivers of increases in greenhouse gas emissions, substantial land use, and adverse health such as cancer and mortality. To assess the potential co-benefits from shifting to more sustainable diets, we aimed to investigate the associations of dietary greenhouse gas emissions and land use with all-cause and cause-specific mortality and cancer incidence rates.Methods Using data from 443 991 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a multicentre prospective cohort, we estimated associations between dietary contributions to greenhouse gas emissions and land use and all-cause and cause-specific mortality and incident cancers using Cox proportional hazards regression models. The main exposures were modelled as quartiles. Co-benefits, encompassing the potential effects of alternative diets on all-cause mortality and cancer and potential reductions in greenhouse gas emissions and land use, were estimated with counterfactual attributable fraction intervention models, simulating potential effects of dietary shifts based on the EAT-Lancet reference diet. Findings In the pooled analysis, there was an association between levels of dietary greenhouse gas emissions and allcause mortality (adjusted hazard ratio [HR] 1•13 [95% CI 1•10-1•16]) and between land use and all-cause mortality (1•18 [1•15-1•21]) when comparing the fourth quartile to the first quartile. Similar associations were observed for cause-specific mortality. Associations were also observed between all-cause cancer incidence rates and greenhouse gas emissions, when comparing the fourth quartile to the first quartile (adjusted HR 1•11 [95% CI 1•09-1•14]) and between all-cause cancer incidence rates and land use (1•13 [1•10-1•15]); however, estimates differed by cancer type. Through counterfactual attributable fraction modelling of shifts in levels of adherence to the EAT-Lancet diet, we estimated that up to 19-63% of deaths and up to 10-39% of cancers could be prevented, in a 20-year risk period, by different levels of adherence to the EAT-Lancet reference diet. Additionally, switching from lower adherence to the EAT-Lancet reference diet to higher adherence could potentially reduce food-associated greenhouse gas emissions up to 50% and land use up to 62%.Interpretation Our results indicate that shifts towards universally sustainable diets could lead to co-benefits, such as minimising diet-related greenhouse gas emissions and land use, reducing the environmental footprint, aiding in climate change mitigation, and improving population health.

Development of an EAT-Lancet index and its relation to mortality in a Swedish population

“…In contrast to our results, Knuppel et al ( 10 ) did not observe an association with all-cause mortality in the European Prospective Investigation into Cancer and Nutrition (EPIC) Oxford cohort (46,069 participants and 4214 deaths). Their index has also been used for the whole EPIC cohort, suggesting that 19%–63% of all deaths could be prevented by adherence to the EAT-Lancet diet (comparing the groups with lowest and highest adherence) ( 27 ). Their index differed from ours since it was built on binary assessments of each diet component; thus, the possible range was narrower (0–14 points) and different levels of adherence to the proposed intake ranges could not be examined.…”

Plant-Based Diets Are Not Enough? Understanding the Consumption of Plant-Based Meat Alternatives Along Ultra-processed Foods in Different Dietary Patterns in Germany

“…In addition, salt content as well as sodium levels were found to be significantly higher in the plant-based meat alternatives than in the corresponding meat product ( 17 ). In contrast, replacing red meat with unprocessed alternative sources of protein such as nuts, legumes, whole grains, and vegetables improves overall diet quality ( 11 , 18 ) and lowers the risk of diet-related disease ( 19 , 20 ). When addressing the health effects of plant-based meat alternatives, it is also necessary to consider how and why these products are consumed.…”

The Need for A Multidisciplinary Approach to Face Challenges Related to Food, Health, and Sustainability: The Contribution of CRC I-WE

“…This project aims to impact scientific knowledge as well as consumers and all other stakeholders of the agri-food and related sectors. Promoting food quality within balanced and sustainable diets is an effective tool to reduce environmental impact and prevent chronic diseases, as also recently reported in a scenario analysis showing that adherence to a sustainable healthy diet could prevent up to 19-63% deaths in a 20-year period while reducing greenhouse gas emission and land use up to 50% and 62%, respectively [13]. In addition, the dietary shift could represent an important goal that can create new opportunities, businesses, and innovations (including digitalisation and agri-tech) while reducing environmental impacts and preserving biodiversity.…”