The association of the planetary health diet with type 2 diabetes incidence and greenhouse gas emissions: Findings from the EPIC-Norfolk prospective cohort study

1. Higher adherence to the planetary health diet was associated with lower risk of type 2 diabetes and greenhouse gas emissions. 

Evidence Rating Level: 2 (Good)

The rising prevalence of type 2 diabetes (T2D) has been driven by increasing obesity, largely linked to unhealthy diets. The planetary health diet (PHD) has been recommended by the EAT-Lancet Commission on Food, Planet, Health to improve human health and protect the environment. PHD involves eating higher amounts of healthful plant foods and lower amounts of less animal-derived foods. However, the association between the PHD and risk of T2D and diet-related GHG emissions is inconsistent. This study thus examined whether adherence to the planetary health diet was associated with incident T2D and GHG emissions. Data was analyzed from the EPIC-Norfolk prospective cohort study in the UK, which recruited adults aged 40-79. Dietary intake was assessed at baseline (1993–1997) and two follow-up phases (1998–2000 and 2004–2011) using a food frequency questionnaire. Adherence to the PHD was scored by assessing intake of 13 food groups and 2 nutrients. Incident cases of T2D occurring up to March 31, 2020 were analyzed. This study included 23,722 participants (mean [SD] age = 59.1 [9.3] years, 55% female, mean BMI = 26.3 [3.9] kg/m2.), with 3,496 cases of incident T2D recorded over a mean (SD) follow-up of 19.4 (6.8) years. Compared to participants in the lowest PHD quintile (score 33.9–68.4), participants in the highest quintile (score 85.7–117.8) had a lower risk of T2D (adjusted hazard ratio [aHR] [95% CI] = 0.68 [0.61, 0.76]). The estimated population attributable fraction (PAF) for incident T2D due to adherence below the 80th percentile (85.7 points) was 12.3% (95% CI: 9.2%, 15.3%), indicating about 12% of new T2D cases could have been prevented had all participants reached this level. Compared to participants in the lowest PHD quintile, those in the highest quintile had about 18% lower GHG emissions (β5th/1st −18.4%, [95% CI −19.3%, −17.5%]). Overall, this study found that adherence to the PHD was associated with lower incidence of T2D and lower diet-related GHG emissions. 

Click to read this study in PLOS One

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