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Environmentally sustainable diets and human health - Nutritional adequacy, disease risk, and mortality

Stubbendorff, Anna LU orcid (2026) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Introduction: Food systems strongly influence both human and planetary health. Unhealthy diets are
major risk factors for chronic disease and mortality, while food production contributes substantially to
greenhouse gas emissions (GHGE), and other negative environmental impacts. Adopting more
sustainable dietary patterns, such as the EAT-Lancet diet, has been proposed as part of the solution, but
uncertainties remain regarding their long-term health effects, nutri-tional adequacy, and optimal methods
for assessment.
Aim: The aim of this thesis was to examine associations between environmentally sustainable diets,
nutritional adequacy, and major health outcomes, with a focus on mortality, cardiovascular... (More)
Introduction: Food systems strongly influence both human and planetary health. Unhealthy diets are
major risk factors for chronic disease and mortality, while food production contributes substantially to
greenhouse gas emissions (GHGE), and other negative environmental impacts. Adopting more
sustainable dietary patterns, such as the EAT-Lancet diet, has been proposed as part of the solution, but
uncertainties remain regarding their long-term health effects, nutri-tional adequacy, and optimal methods
for assessment.
Aim: The aim of this thesis was to examine associations between environmentally sustainable diets,
nutritional adequacy, and major health outcomes, with a focus on mortality, cardiovascular disease,
diabetes, and micronutrient intake and status.
Methods: The analyses were mainly based on the Malmö Diet and Cancer Study, including about 26,000
adults followed for up to 30 years. Dietary intake was assessed using a validated diet history method
combining a 7-day food diary, questionnaire, and interview. Health outcomes were retrieved from national
registers. Nutrient adequacy was evaluated using both dietary data and blood biomarkers. Life cycle
assessment (LCA) was used to estimate dietary GHGE, and adherence to the EAT-Lancet diet was
assessed using dietary scores.
Results: Higher adherence to the EAT-Lancet diet was associated with lower risks of mortality, reduced
stroke risk, and lower GHGE. Lower dietary GHGE were most consistently associated with decreased
risk of diabetes, while associations with mortality were weaker and partly non-linear. Diets with lower
environmental impact were generally compatible with adequate micronutrient intake and status and were
sometimes linked to nutritional benefits, such as a reduced risk of folate deficiency, though a slightly
higher risk of anaemia was observed.
Conclusion: Environmentally sustainable diets can promote health, reduce mor-tality, and do not
substantially increase the risk of micronutrient deficiencies. These findings underscore the co-benefits of
aligning nutrition and climate poli-cies and support the integration of sustainability into dietary guidelines. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Assistant Professor in Human Nutrition and Health Biesbroek, Sander, Wageningen University, the Netherlands
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Sustainable diets, Climate friendly diets, Climate change, Sustainable development, Non-communicable disease, Micronutrients, EAT-Lancet diet, Nutrition, Mortality
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2026:4
pages
158 pages
publisher
Lund University, Faculty of Medicine
defense location
Agardh föreläsningssal, CRC, Jan Waldenströms gata 35, Skånes Universitetssjukhus i Malmö.
defense date
2026-01-16 09:00:00
ISSN
1652-8220
ISBN
978-91-8021-802-3
project
Lund University Agenda 2030 Graduate School
Mat för människa och planet (inom forskarskolan Agenda 2030)
language
English
LU publication?
yes
id
42f8553e-741d-405a-88bf-f7bfeefcd14f
date added to LUP
2025-12-16 11:35:40
date last changed
2025-12-16 12:13:05
@phdthesis{42f8553e-741d-405a-88bf-f7bfeefcd14f,
  abstract     = {{Introduction: Food systems strongly influence both human and planetary health. Unhealthy diets are<br/>major risk factors for chronic disease and mortality, while food production contributes substantially to<br/>greenhouse gas emissions (GHGE), and other negative environmental impacts. Adopting more<br/>sustainable dietary patterns, such as the EAT-Lancet diet, has been proposed as part of the solution, but<br/>uncertainties remain regarding their long-term health effects, nutri-tional adequacy, and optimal methods<br/>for assessment.<br/>Aim: The aim of this thesis was to examine associations between environmentally sustainable diets,<br/>nutritional adequacy, and major health outcomes, with a focus on mortality, cardiovascular disease,<br/>diabetes, and micronutrient intake and status.<br/>Methods: The analyses were mainly based on the Malmö Diet and Cancer Study, including about 26,000<br/>adults followed for up to 30 years. Dietary intake was assessed using a validated diet history method<br/>combining a 7-day food diary, questionnaire, and interview. Health outcomes were retrieved from national<br/>registers. Nutrient adequacy was evaluated using both dietary data and blood biomarkers. Life cycle<br/>assessment (LCA) was used to estimate dietary GHGE, and adherence to the EAT-Lancet diet was<br/>assessed using dietary scores.<br/>Results: Higher adherence to the EAT-Lancet diet was associated with lower risks of mortality, reduced<br/>stroke risk, and lower GHGE. Lower dietary GHGE were most consistently associated with decreased<br/>risk of diabetes, while associations with mortality were weaker and partly non-linear. Diets with lower<br/>environmental impact were generally compatible with adequate micronutrient intake and status and were<br/>sometimes linked to nutritional benefits, such as a reduced risk of folate deficiency, though a slightly<br/>higher risk of anaemia was observed.<br/>Conclusion: Environmentally sustainable diets can promote health, reduce mor-tality, and do not<br/>substantially increase the risk of micronutrient deficiencies. These findings underscore the co-benefits of<br/>aligning nutrition and climate poli-cies and support the integration of sustainability into dietary guidelines.}},
  author       = {{Stubbendorff, Anna}},
  isbn         = {{978-91-8021-802-3}},
  issn         = {{1652-8220}},
  keywords     = {{Sustainable diets; Climate friendly diets; Climate change; Sustainable development; Non-communicable disease; Micronutrients; EAT-Lancet diet; Nutrition; Mortality}},
  language     = {{eng}},
  number       = {{2026:4}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Environmentally sustainable diets and human health - Nutritional adequacy, disease risk, and mortality}},
  url          = {{https://lup.lub.lu.se/search/files/236004867/Anna_Stubbendorff_doctoral_thesis.pdf}},
  year         = {{2026}},
}