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Plant-based and planetary-health diets, environmental burden, and risk of mortality: a prospective cohort study of middle-aged and older adults in China

Authors

Chen,  Hui
External Organizations;

Wang,  Xiaoxi
External Organizations;

Ji,  John S
External Organizations;

Huang,  Liyan
External Organizations;

Qi,  Ye
External Organizations;

Wu,  You
External Organizations;

He,  Pan
External Organizations;

Li,  Yanping
External Organizations;

/persons/resource/Bodirsky

Bodirsky,  Benjamin Leon
Potsdam Institute for Climate Impact Research;

/persons/resource/Christoph.Mueller

Müller,  Christoph
Potsdam Institute for Climate Impact Research;

Willett,  Walter C
External Organizations;

Yuan,  Changzheng
External Organizations;

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Citation

Chen, H., Wang, X., Ji, J. S., Huang, L., Qi, Y., Wu, Y., He, P., Li, Y., Bodirsky, B. L., Müller, C., Willett, W. C., Yuan, C. (2024): Plant-based and planetary-health diets, environmental burden, and risk of mortality: a prospective cohort study of middle-aged and older adults in China. - The Lancet Planetary Health, 8, 8, e545-e553.
https://doi.org/10.1016/S2542-5196(24)00143-8


Cite as: https://publications.pik-potsdam.de/pubman/item/item_30158
Abstract
Background: Plant-based diets (PBDs) and planetary-health diets (PHDs) are recommended for their potential health and environmental benefits, but population-based evidence in diverse cultures is scarce. - Methods: We included 9364 adults aged 45 years and older (52·3% female, 47·7% male) from the open cohort of the China Health and Nutrition Survey. Dietary intake was assessed using 3-day 24 h dietary recalls combined with weighing methods from 1997 to 2011, and mortality was documented from 1997 to 2015. We calculated the overall PBD index (PDI), healthful PBD index (hPDI), and unhealthful PBD index (uPDI; ranges 18–90), and the PHD score (range 0–140). We also estimated the related greenhouse gas emissions, land appropriation, and total water footprint and examined their associations with mortality. - Findings: PBD indices were inversely related to greenhouse gas emissions, land appropriation, and total water footprint, whereas higher PHD score was related to higher environmental burdens (p<0·0001). During follow-up (mean 9·2 years), 792 (8·5%) death cases were documented. PDI (HR 1·08 [95% CI 0·88–1·32]) and hPDI (0·98 [0·80–1·21]) were not significantly associated with mortality, whereas higher uPDI was related to a higher mortality risk (1·55 [1·26–1·91]). In contrast, higher PHD score was associated with lower mortality risk (0·79 [0·63–0·99]). - Interpretation: The PBDs showed environmental benefits, but are not necessarily associated with lower mortality risk. The PHD, developed mainly in western populations, was related to lower mortality risk but higher environmental burdens in the Chinese population.