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

Laine, Jessica E. ; Huybrechts, Inge ; Gunter, Marc J. ; Ferrari, Pietro ; Weiderpass, Elisabete ; Tsilidis, Kostas ; Aune, Dagfinn ; Schulze, Matthias B. ; Bergmann, Manuela and Temme, Elisabeth H.M. , et al. (2021) In The Lancet Planetary Health 5(11). p.786-796
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... (More)

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 all-cause 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. Funding: European Commission (DG-SANCO), the International Agency for Research on Cancer (IARC), MRC Early Career Fellowship (MR/M501669/1).

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publication status
published
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The Lancet Planetary Health
volume
5
issue
11
pages
786 - 796
publisher
Elsevier
external identifiers
  • pmid:34688354
  • scopus:85118746338
ISSN
2542-5196
DOI
10.1016/S2542-5196(21)00250-3
project
Lund University Agenda 2030 Graduate School
language
English
LU publication?
yes
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Funding Information: The coordination of EPIC is financially supported by IARC and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre. The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, INSERM (France); German Cancer Aid, German Cancer Research Center, German Institute of Human Nutrition Potsdam-Rehbruecke, Federal Ministry of Education and Research (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports, Netherlands Cancer Registry, LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund, Statistics Netherlands (The Netherlands); Health Research Fund - Instituto de Salud Carlos III, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology - ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017 to EPIC-Oxford), Medical Research Council (MRC; 1000143 to EPIC-Norfolk; MR/M012190/1 to EPIC-Oxford; UK). JEL was supported by an MRC Early Career Fellowship (MR/M501669/1). We acknowledge the Netherlands Cancer Registry and Statistics Netherlands (The Netherlands) for contributions to data acquisition. KP and AK are supported by the Wellcome Trust (Livestock, Environment and People, LEAP; grant number 205212/Z/16/Z). We acknowledge Corinne Casagrande and Genevieve Nicolas who assisted in the matching of the dietary intake data with the Greenhouse Gas and Landuse data. We also acknowledge Bertrand Hemon for database compilation and Carine Biessy for her contribution to the sensitivity analyses. Where authors are identified as personnel of the IARC or WHO, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy, or views of the IARC or WHO. Funding Information: The coordination of EPIC is financially supported by IARC and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre. The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle G?n?rale de l'Education Nationale, INSERM (France); German Cancer Aid, German Cancer Research Center, German Institute of Human Nutrition Potsdam-Rehbruecke, Federal Ministry of Education and Research (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports, Netherlands Cancer Registry, LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund, Statistics Netherlands (The Netherlands); Health Research Fund - Instituto de Salud Carlos III, Regional Governments of Andaluc?a, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology - ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Sk?ne and V?sterbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017 to EPIC-Oxford), Medical Research Council (MRC; 1000143 to EPIC-Norfolk; MR/M012190/1 to EPIC-Oxford; UK). JEL was supported by an MRC Early Career Fellowship (MR/M501669/1). We acknowledge the Netherlands Cancer Registry and Statistics Netherlands (The Netherlands) for contributions to data acquisition. KP and AK are supported by the Wellcome Trust (Livestock, Environment and People, LEAP; grant number 205212/Z/16/Z). We acknowledge Corinne Casagrande and Genevieve Nicolas who assisted in the matching of the dietary intake data with the Greenhouse Gas and Landuse data. We also acknowledge Bertrand Hemon for database compilation and Carine Biessy for her contribution to the sensitivity analyses. Where authors are identified as personnel of the IARC or WHO, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy, or views of the IARC or WHO. Publisher Copyright: © 2021 International Agency for Research on Cancer
id
155b11b9-6a72-4707-be3a-b120e112d884
date added to LUP
2021-11-22 14:04:33
date last changed
2024-02-20 16:51:23
@article{155b11b9-6a72-4707-be3a-b120e112d884,
  abstract     = {{<p>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 all-cause 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. Funding: European Commission (DG-SANCO), the International Agency for Research on Cancer (IARC), MRC Early Career Fellowship (MR/M501669/1).</p>}},
  author       = {{Laine, Jessica E. and Huybrechts, Inge and Gunter, Marc J. and Ferrari, Pietro and Weiderpass, Elisabete and Tsilidis, Kostas and Aune, Dagfinn and Schulze, Matthias B. and Bergmann, Manuela and Temme, Elisabeth H.M. and Boer, Jolanda M.A. and Agnoli, Claudia and Ericson, Ulrika and Stubbendorff, Anna and Ibsen, Daniel B. and Dahm, Christina Catherine and Deschasaux, Mélanie and Touvier, Mathilde and Kesse-Guyot, Emmanuelle and Sánchez Pérez, Maria Jose and Rodríguez Barranco, Miguel and Tong, Tammy Y.N. and Papier, Keren and Knuppel, Anika and Boutron-Ruault, Marie Christine and Mancini, Francesca and Severi, Gianluca and Srour, Bernard and Kühn, Tilman and Masala, Giovanna and Agudo, Antonio and Skeie, Guri and Rylander, Charlotta and Sandanger, Torkjel M. and Riboli, Elio and Vineis, Paolo}},
  issn         = {{2542-5196}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{786--796}},
  publisher    = {{Elsevier}},
  series       = {{The Lancet Planetary Health}},
  title        = {{Co-benefits from sustainable dietary shifts for population and environmental health : an assessment from a large European cohort study}},
  url          = {{http://dx.doi.org/10.1016/S2542-5196(21)00250-3}},
  doi          = {{10.1016/S2542-5196(21)00250-3}},
  volume       = {{5}},
  year         = {{2021}},
}