(P02-052-23) Planetary Healthy Diet, Environmental Impacts, and Mortality Outcomes in the Chinese Adults

Objectives: The EAT-Lancet Commission has proposed a planetary healthy diet (PHD). We aimed to develop a new dietary score and investigate the associations between PHD, environmental burden, and mortality outcomes in a Chinese population.

Methods: A total of 42057 Chinese adults from the Singapore Chinese Health Study without hypertension, diabetes, cancer, stroke, and coronary artery disease at baseline were included in this study. Dietary data were collected through a validated food frequency questionnaire at baseline and used to estimate the food-related environmental impacts. The PHD score was calculated based on the intakes of 14 food components defined in this reference diet and total energy intakes of the population in the current study. Mortality outcomes were identified via linkage with the nationwide registry of births and deaths in Singapore. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: During a median follow-up of 23.8 years, 14701 deaths occurred (3923 cardiovascular diseases, 5405 cancer, and 3428 respiratory diseases). The PHD score ranged from 13.79 to 98.89 points with a mean (standard deviation) score of 60.27 (9.36) points. Higher adherence to the PHD was associated with lower greenhouse gas emissions and higher total water footprint and land use. Compared with the lowest quintiles, the multivariable-adjusted HRs (95% CIs) of the highest quintiles of PHD score for all-cause mortality, cardiovascular mortality, and respiratory diseases mortality were 0.84 (0.79-0.88), 0.73 (0.66-0.82), and 0.77 (0.69-0.86), respectively (all P_trend ≤0.001). The inverse associations were stronger in women, smokers, and drinkers (P_interaction < 0.001). Association was observed between greenhouse gas emissions and respiratory diseases mortality (0.78 [0.63–0.98]) when comparing the first quintile to the fifth quintile.

Conclusions: Higher adherence to the PHD was associated with lower greenhouse gas emissions and risk of chronic diseases mortality in the Singapore Chinese population. More studies in other populations are needed to explore co-benefits for human and environment health from PHD.

Funding Sources: This study was supported by the National Natural Science Foundation of China.