The Association of Planetary Health Diet with the Risk of Type 2 Diabetes and Related Complications: A Systematic Review

Ojo O., Wang X., Ojo O.O., Brooke J., Jiang Y., Dong Q., Thompson T.

Background: Nutritional interventions such as the use of prebiotics can promote eubiosis of gut microbiome and maintain glucose homeostasis in patients with type 2 diabetes (T2D). However, it would appear that results of the effects of prebiotics on the community of microbes in the gut are not consistent. Aim: To examine the effect of prebiotics and oral antidiabetic agents on gut microbiome in patients with T2D. Methods: The PRISMA Extension Statement for Systematic Reviews and Network Meta-analyses was used to conduct this review. Searches were carried out in EMBASE, EBSCO-host databases, Google Scholar and the reference lists of articles for studies that are relevant to the research question, from database inception to 15 August 2022. The search strategy was based on PICOS framework. Network Meta-analysis which allows the estimation of relative treatment effects by combing both direct trial evidence (e.g., treatment A vs. treatment B) and indirect evidence was conducted. Furthermore, pairwise meta-analysis was also carried out to estimate effect sizes based on head-to-head comparisons of treatments and/or control conditions. Results: Findings of the Network meta-analysis revealed that prebiotics significantly reduced HbA1c compared with control and the SMD was −0.43 [95% CI, −0.77, −0.08; p = 0.02], whereas there was no significant difference (p > 0.05) between the other treatments and control. In addition, anti-diabetic agents including glipizide and metformin also reduced HbA1C, although these were not significantly different (p > 0.05) from control. While prebiotics promoted Bifidobacterium and Akkermansia, the improvements were not significantly different (p > 0.05) from control. On the other hand, metformin decreased the relative abundance of Bifidobacterium, but increased Lactobacillus and Akkermansia, although the differences were not significant (p > 0.05) compared with control. With respect to fasting blood glucose and BMI, the effects of prebiotics and oral antidiabetic agents did not differ significantly (p > 0.05) from controls. Conclusions: The findings of the systematic review and Network meta-analysis demonstrated prebiotics were significantly (p < 0.05) more effective in reducing HbA1c than control in patients with T2D. However, the effects of prebiotics and oral antidiabetic agents did not differ significantly (p > 0.05) from the controls in relation to fasting blood glucose, post-prandial blood glucose, body mass index and the genera of gut bacteria examined. More studies are required to fully investigate the effects of prebiotics and oral antidiabetic agents in patients with T2D

Hendrie G.A., Rebuli M.A., James-Martin G., Baird D.L., Bogard J.R., Lawrence A.S., Ridoutt B.

There is increasing focus on moving populations towards healthier and more environmentally sustainable dietary patterns. The Australian Dietary Guidelines provide dietary patterns that promote health and wellbeing. It is unclear how these guidelines align with the more recently published global recommendations of the EAT-Lancet Planetary Health Reference Diet, and how Australian diets compare to both sets of recommendations. Data from one 24-h recall collected for the 2011–13 National Nutrition and Physical Activity Survey were analysed for 5,920 adults aged 19–50 years. Subgroups of this population were identified by diet quality and lower or higher consumption of foods often considered to be environmentally intensive (higher animal meat and dairy foods) or associated with healthiness (higher vegetables and lower discretionary choices). Food group and nutrient composition of Australian diets were compared to diets modelled on the Australian Dietary Guidelines and Planetary Health Reference Diet. The environmental impacts of diets were estimated using an index of combined metrics. Compared with the Planetary Health Reference Diet, the Australian Dietary Guidelines contained more servings of the vegetable, dairy and alternatives, fruit, and discretionary choices. The amount of meat and alternatives was higher in the Planetary Health Reference Diet than Australian Dietary Guidelines due to the inclusion of more plant-based meat alternatives. The average Australian diet contained two to almost four times the Australian Dietary Guidelines and Planetary Health Reference Diet maximum recommended intake of discretionary choices, and provided inadequate amounts of the vegetables, cereals, unsaturated fats and meats and alternatives food groups, primarily due to lower intakes of plant-based alternatives. The average Australian diet also contained less dairy and alternatives than the Australian Dietary Guidelines. In the average Australian diet, red meat and poultry contributed 73% to the total servings of meat and alternatives compared to 33% and 10% for the Australian Dietary Guidelines and Planetary Health Reference Diet respectively. The modelled Australian Dietary Guidelines diet met the relevant nutrient reference value for all 22 nutrients examined, whereas the Planetary Health Reference Diet contained an inadequate amount of calcium. The environmental impact scores of the Planetary Health Reference Diet and Australian Dietary Guidelines were 31% and 46% lower than the average Australian diet. Significant changes are required for Australians’ dietary intake to align more closely with national and global dietary recommendations for health and environmental sustainability.

Berthy F., Brunin J., Allès B., Fezeu L.K., Touvier M., Hercberg S., Galan P., Pointereau P., Lairon D., Baudry J., Kesse-Guyot E.

ABSTRACT Background The EAT-Lancet commission proposed, in 2019, a planetary, healthy, and universal dietary pattern. However, this diet has rarely been studied in relation to various health outcomes. Objectives We aimed to prospectively estimate the association between the EAT-Lancet diet and cancer and cardiovascular disease (CVD) risk. Methods The study was conducted in participants of the NutriNet-Santé cohort (2009–2021). The endpoints were the incident outcomes (cancer and CVDs and mortality from these diseases), combined and separately. Adherence to the EAT-Lancet diet was estimated using the EAT-Lancet Diet Index (ELD-I) modeled as quintiles (Qs). Multivariable Cox proportional hazard models were used to estimate HRs and 95% CIs, adjusted for potential confounders and moderators. Results A total of 62,382 subjects were included; 2475 cases of cancer and 786 cases of cardiovascular events occurred during a median follow-up of 8.1 y. The sample was 76% female, the mean ± SD age at inclusion was 51.0 ± 10.2 y. The ELD-I ranged from −162 to 332 points with a mean ± SD score of 45.4 ± 25.6 points. In multivariable models, no significant association between the EAT-Lancet diet and the risk of cancer and CVD combined, and separately, was observed. Alcohol consumption was an effect modifier of the association. A significant association was observed among low drinkers (HRQ5vs.Q1: 0.86; 95% CI: 0.73, 1.02; P-trend = 0.02). A higher ELD-I was significantly associated with a lower risk of overall cancer only among females (HRQ5vs.Q1: 0.89; 95% CI: 0.75, 1.05; P-trend = 0.03). Both associations were largely attenuated by BMI. Conclusions Contrary to our hypothesis, our results documented significant associations between adherence to the EAT-Lancet diet and incidence of cancer only in some subgroups, and no association with CVD. This trial was registered at clinicaltrials.gov as NCT03335644.

Montejano Vallejo R., Schulz C., van de Locht K., Oluwagbemigun K., Alexy U., Nöthlings U.

ABSTRACT Background Validation of the EAT–Lancet reference diet (ELR-diet), recently proposed by the EAT–Lancet Commission, within the context of real-life studies is necessary to elucidate its feasibility, nutritional value, sustainability, and health effects. Objectives We aimed to develop a dietary index (DI) score to measure adherence to the ELR-diet. We further aimed to study the association between the DI score and 1) nutritional characteristics, 2) indicators of ecological sustainability, and 3) anthropometric markers and biomarkers for cardiometabolic health. Methods A DI score was constructed by comparing the categories defined by the ELR-diet with the dietary data of 2–5 sets of 3-d weighed dietary records from DONALD (Dortmund Nutritional and Anthropometric Longitudinal Designed) study participants (n = 298; ≥15 y of age). Prospective associations between the DI score and risk markers (anthropometric and cardiometabolic) in young adulthood (≥18 y old) were investigated using multivariate linear regression. Results Adherence to the DI score components was considerable (majority &gt; 50%), but varied within the population (2%–100%). The highest tertile of the DI score was inversely associated with the intake of protein (tertile 3 compared with tertile 1: 13.5 compared with 14.5 energy %), added sugars (10.5 compared with 12.4 energy %), and cholesterol (100 compared with 116 mg/1000 kcal), but positively associated with fiber intake (10.0 compared with 8.82 g/1000 kcal) (all P &lt; 0.05). The DI score was inversely associated with greenhouse-gas emissions (tertile 1 compared with tertile 3: 6.48 compared with 5.85 kg of carbon dioxide equivalents/2500 kcal; P &lt; 0.001) and land use (8.24 compared with 7.16 m2 × y/2500 kcal; P &lt; 0.001). Inverse associations between the DI score and anthropometric markers during young adulthood were observed (e.g., BMI: tertile 1 compared with tertile 3: 22.9 compared with 21.9 kg/m2; P = 0.03) (all P &lt; 0.05). No associations between the DI score and cardiometabolic risk markers were found (all P ≥ 0.05). Conclusions Adherence to the ELR-diet was associated with favorable nutritional characteristics and reduced environmental impact. Adherence to the DI score in adolescence was also beneficial with respect to anthropometric markers in early adulthood, although not for further cardiometabolic risk markers.

Veit M., van Asten R., Olie A., Prinz P.

Nowadays, there is still a popular belief that dietary sugars, in particular sucrose, are directly linked to the development of type 2 diabetes mellitus (T2DM). Furthermore, since insulin action is impaired in T2DM, it is still believed that excluding dietary sugars from the diet can adequately treat T2DM. This might be based on the assumption that dietary sugars have a stronger impact on blood glucose levels than other carbohydrates. Therefore, the aim of this review is to discuss the effects of dietary sugars intake, including sugar-sweetened beverages (SSBs) against the background of overall energy intake and weight gain in the development of T2DM. Furthermore, the effect of dietary sugars, including SSBs on glycemic control will be discussed. Results from various systematic reviews and meta-analyses do not support the idea that the intake of sucrose and other dietary sugars is linked to T2DM. Long-chain or complex carbohydrates can have a greater impact on postprandial glycemic response than sucrose. SSBs do not affect glycemic control if substituted for other calorie sources. Current scientific evidence clearly points toward excess energy intake followed by excess body fat gain being most relevant in the development of T2DM.

Kowalsky T.O., Morilla Romero de la Osa R., Cerrillo I.

Background. Climate change and global health are inextricably linked. Thus, health systems and their professionals must adapt and evolve without losing quality of care. Aim(s). To identify health and environmental co-benefits derived from a sustainable diet and promotion strategies that favor its implementation. Methods. A systematic search for articles published on sustainable diets and human/planetary health published between 2013 and 2020 was conducted on the databases PubMed, Cinahl, Scopus and Trip from 4 to 7 May 2020 in accordance with the PRISMA guideline. Results. A total of 201 articles was retrieved, but only 21 were included. A calorie-balanced diet mainly based on food of plant origin that would allow the attainment of 60% of daily caloric requirements and a low protein intake from animal foods (focusing in fish and poultry) could significantly reduce global morbi-mortality and the dietary environmental impact maintaining a framework of sustainability conditioned by the consumption of fresh, seasonal, locally produced and minimally packaged products. Discussion. The implementation of sustainable diets requires working on the triangulation of concepts of food–health–environment from schools and that is permanently reinforced during all stages of the life by healthcare workers, who should establish the appropriate modifications according to the age, gender and health situation.

Xu C., Cao Z., Yang H., Hou Y., Wang X., Wang Y.

Background:The EAT-Lancet Commission has promulgated a sustainable dietary guideline and recommended that it was designed to improve the human health and support environmental sustainability.Objective:This research was designed to explore the association between this healthy diet pattern (EAT-Lancet diet pattern, EAT-LDP) and risk of type 2 diabetes (T2D).Methods:Between 2006 and 2010, a total of 59,849 participants from the UK Biobank without diabetes, cardiovascular disease, or cancers were included at baseline. The EAT-LDP score was constructed on the sum of 14 food components and then categorized into three tertiles. Multivariable Cox proportional hazards regression models were conducted to explore the association between EAT-LDP score and the risk of incident T2D. A mediation analysis was also implemented to disentangle the role of body mass index (BMI) and waist circumference in the relationship between EAT-LDP score and T2D.Results:During a median follow-up of 10 years, 2,461 incident T2D cases were recorded. In analyses that compared tertile 3 of the EAT-LDP score (highest) with tertile 1 (lowest), the hazard ratio (HR) for T2D was 0.81 (95% CI: 0.72–0.90) after adjusting for sociodemographic status and health-related factors. Participants who reported a one-point increase in the diet score were associated with a 6% decrease in risk of T2D (HR: 0.94, 95% CI: 0.91–0.97). A significant indirect association was observed between the EAT-LDP score and T2D (β: 0.66, 95% CI: 0.65–0.67), indicating that 44% of the association of EAT-LDP score with T2D was mediated by BMI. Additionally, 40% of the association of EAT-LDP score with T2D was mediated by waist circumference was also observed.Conclusions:Our findings indicate that a higher adherence to EAT-LDP contributes to lower risk of T2D. Further independent validation is needed to be conducted before applying the EAT-LDP to inform dietary guidelines.

Ibsen D.B., Christiansen A.H., Olsen A., Tjønneland A., Overvad K., Wolk A., Mortensen J.K., Dahm C.C.

Background and Purpose: We investigated the association between adherence to the EAT-Lancet diet, a sustainable and mostly plant-based diet, and risk of stroke and subtypes of stroke in a Danish population. For comparison, we also investigated the Alternate Healthy Eating Index-2010 (AHEI). Methods: We used the Danish Diet, Cancer and Health cohort (n=55 016) including adults aged 50 to 64 years at baseline (1993–1997). A food frequency questionnaire was used to assess dietary intake and group participants according to adherence to the diets. Stroke cases were identified using a national registry and subsequently validated by review of medical records (n=2253). Cox proportional hazards models were used to estimate hazard ratios and 95% CIs for associations with the EAT-Lancet diet or the AHEI and risk of stroke and stroke subtypes. Results: Adherence to the EAT-Lancet diet was associated with a lower risk of stroke, although not statistically significant (highest versus lowest adherence: hazard ratio, 0.91 [95% CI, 0.76–1.09]). A lower risk was observed for AHEI (0.75 [95% CI, 0.64–0.87]). For stroke subtypes, we found that adherence to the EAT-Lancet diet was associated with a lower risk of subarachnoid hemorrhage (0.30 [95% CI, 0.12–0.73]), and the AHEI was associated with a lower risk of ischemic stroke (0.76 [95% CI, 0.64–0.90]) and intracerebral hemorrhage (0.58 [95% CI, 0.36–0.93]). Conclusions: Adherence to the EAT-Lancet diet in midlife was associated with a lower risk of subarachnoid stroke, and the AHEI was associated with a lower risk of total stroke, mainly ischemic stroke and intracerebral hemorrhage.

Stubbendorff A., Sonestedt E., Ramne S., Drake I., Hallström E., Ericson U.

ABSTRACT Background Current global food systems threaten human health and environmental sustainability. In 2019, the EAT-Lancet Commission on healthy diets from sustainable food systems defined the first global reference diet to improve both areas, but there is no consensus on how to quantify the EAT-Lancet reference diet as a diet index, and its relation to mortality has not been widely studied. Objectives We sought to develop a new dietary index to quantify adherence to the EAT-Lancet diet and assess its association with mortality in a large, population-based Swedish cohort. We also examined food components included in the index and their individual associations with mortality. Methods We used the Malmö Diet and Cancer cohort (n = 22,421; 45–73 years old at baseline). Dietary data were collected using a modified diet history method. The EAT-Lancet index was developed based on intake levels and reference intervals of 14 food components defined in the EAT-Lancet diet (0–3 points per component; 0–42 points in total). Associations with mortality were examined based on registers during a mean of 20 years of follow-up and were adjusted for potential confounders. Results Divided into 5 adherence groups, the highest adherence to the EAT-Lancet diet (≥23 points) was associated with lower all-cause mortality (HR, 0.75; 95% CI, 0.67–0.85), cancer mortality (HR, 0.76; 95% CI, 0.63–0.92), and cardiovascular mortality (HR, 0.68; 95% CI, 0.54–0.84) than the lowest adherence (≤13 points). Several food components included in the index contributed to the observed reductions in mortality. Conclusions We developed a new dietary index to investigate adherence to the EAT-Lancet diet. The findings indicate a 25% lower risk of mortality among those with the highest adherence to the EAT-Lancet diet, as defined using our index, which adds to the evidence base for the development of sustainable dietary guidelines.

Cacau L.T., Benseñor I.M., Goulart A.C., Cardoso L.O., Lotufo P.A., Moreno L.A., Marchioni D.M.

The EAT-Lancet Commission has proposed a model diet to improve the health of human beings and that of the planet. Recently, we proposed the Planetary Health Diet Index (PHDI) to assess adherence of the population to this model diet. In this study, we aimed to evaluate adherence to the PHDI and obesity outcomes using baseline data from 14,515 participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The dietary data were assessed using a 114-item FFQ. Body mass index (BMI) and waist circumference (WC) were both used continuously and categorized. Linear and multinomial regression models adjusted for potential confounding factors were performed to assess the relationship between adherence to PHDI and outcomes. An inverse association was observed between adherence to PHDI and obesity indicators. Individuals with high adherence to the PHDI had lower BMI (β−0.50 95% CI−0.73:−0.27) and WC (β−1.70 95% CI−2.28:−1.12) values. They were also 24% less likely to be overweight (OR 0.76 95% CI 0.67:0.85) or obese (OR 0.76 95% CI 0.65:0.88), and they were 14% and 27% less likely to have increased WC (OR 0.86 95% CI 0.75:0.98) or substantially increased WC (OR 0.73 95% CI 0.64:0.83) than those with lower adherence. Our results showed that higher adherence to the PHDI may decrease obesity indicators.

Bäck S., Skaffari E., Vepsäläinen H., Lehto R., Lehto E., Nissinen K., Ray C., Nevalainen J., Roos E., Erkkola M., Korkalo L.

The EAT-Lancet reference diet is a healthy plant-based diet produced within planetary boundaries. To inform the food system transformation, we compared Finnish pre-schoolers’ food consumption with the reference diet’s food group targets. Food record data for 3- to 6-year-old pre-schoolers were collected in the cross-sectional DAGIS survey. Ingredients of composite dishes were available in the data. In addition, we manually decomposed industrial products such as sausages and biscuits by estimating the shares of ingredients. We also estimated the consumption of added sugars and converted the consumption of dairy products into milk equivalents. We used usual intake modelling to estimate the mean consumption and the proportion of children who met the reference diet’s targets. We set the target amounts separately for 3- to 4-year-olds and 5- to 6-year-olds in grams by proportioning the published target amounts (assuming a 2500 kcal diet) to the children’s mean reported energy intake. For both age groups (3- to 4-year-olds, n = 460; 5- to 6-year-olds, n = 402), the daily mean consumption of whole grains, vegetables, legumes, nuts, and unsaturated oils was below targets, whereas the consumption of red meat, dairy foods, tubers, and added sugars was above targets. The consumption of fruit and fish was in line with targets. To comply with the reference diet’s targets, major changes in the diets of Finnish children are needed. The key food groups targeted for higher consumption are whole grains and legumes and targeted for lower consumption red meat and dairy products.

Ojo O., Ojo O.O., Zand N., Wang X.

Background: A disequilibrium of the gut microbial community has been closely associated with systemic inflammation and metabolic syndromes including type 2 diabetes. While low fibre and high fat diets may lead to dysbiosis of the gut microbiome as a result of the loss of useful microbes, it has been reported that a high fibre diet may prevent the fermentation of protein and may promote eubiosis of gut microbiota. Aim: This review aims to evaluate the effect of dietary fibre (DF) on gut microbiota, lipid profile, and inflammatory markers in patients with type 2 diabetes. Methods: The PRISMA framework was relied on to conduct this systematic review and meta-analysis. Searches were carried out using electronic databases and reference list of articles. Results: Eleven studies were included in the systematic review, while ten studies were included in the meta-analysis. The findings revealed five distinct areas including the effects of DF on (a) gut microbiota (122 participants); (b) lipopolysaccharides (LPS, 79 participants) and lipopolysaccharides binding protein (LBP, 81 participants); (c) lipid profile; (d) inflammatory markers; and (e) body mass index (BMI, 319 participants). The relative abundance of Bifidobacterium increased by 0.73 (95% CI: 0.57, 0.89) in the DF group in contrast to the control (p < 0.05). With respect to LPS, the level was lower in the DF group than the control and the difference was significant (p < 0.05). The standardised mean difference for LPS was −0.45 (95% CI: −0.90, −0.01) although the difference between the two groups in relation to LBP was not significant (p = 0.08) and the mean difference was 0.92 (95% CI: −0.12, 1.95). While there was a decrease of −1.05 (95% CI: −2.07, −0.02) with respect to total cholesterol (356 participants) in the DF group as compared with the control (p < 0.05), both groups were not significantly different (p > 0.05) in the other lipid parameters. The difference between the groups was significant (p < 0.05) in relation to C-reactive protein, and the mean difference was 0.43 (95% CI: 0.02, 0.84). This could be due to the short duration of the included studies and differences in participants’ diets including the amount of dietary fibre supplements. However, the groups were not significantly different (p > 0.05) with respect to the other inflammatory markers. The meta-analysis of the BMI showed that the DF group decreased by −0.57 (95% CI: −1.02, −0.12) as compared with the control and this was significant (p < 0.01). Conclusion: DF significantly (p < 0.05) increased the relative abundance of Bifidobacterium and significantly decreased (p < 0.05) LPS, total cholesterol, and BMI as compared with the control. However, DF did not seem to have an effect that was significant on LBP, triglyceride, HDL cholesterol, LDL cholesterol, IL-6, TNF-α, adiponectin, and leptin. These findings have implications for public health in relation to the use of dietary fibre in nutritional interventions and as strategies for managing type 2 diabetes.

Cacau L.T., De Carli E., de Carvalho A.M., Lotufo P.A., Moreno L.A., Bensenor I.M., Marchioni D.M.

The EAT-Lancet Commission has proposed a planetary health diet. We propose the development of the Planetary Health Diet Index (PHDI) based on this proposed reference diet. We used baseline dietary data obtained through a 114-item FFQ from 14,779 participants of the Longitudinal Study on Adult Health, a multicenter cohort study conducted in Brazil. The PHDI has 16 components and a score from 0 to 150 points. Validation and reliability analyses were performed, including principal component analyses, association with selected nutrients, differences in means between groups (for example, smokers vs. non-smokers), correlations between components and total energy intake, Cronbach’s alpha, item-item correlations, and linear regression analysis between PHDI with carbon footprint and overall dietary quality. The mean PHDI was 60.4 (95% CI 60.2:60.5). The PHDI had six dimensions, was associated in an expected direction with the selected nutrients and was significantly (p < 0.001) lower in smokers (59.0) than in non-smokers (60.6). Cronbach’s alpha value was 0.51. All correlations between components were low, as well as between components and PHDI with total energy intake. After adjustment for age and sex, the PHDI score remained associated (p < 0.001) with a higher overall dietary quality and lower carbon footprint. Thus, we confirmed the PHDI validity and reliability.

Borg M., Coneyworth L., Welham S.

Ghorbani Y., Schwenger K.J., Allard J.P.

Increasing evidence suggests that the intestinal microbiome (IM) and bacterial metabolites may influence glucose homeostasis, energy expenditure and the intestinal barrier integrity and lead to the presence of systemic low-grade inflammation, all of which can contribute to insulin resistance (IR) and type 2 diabetes (T2D). The purpose of this review is to explore the role of the IM and bacterial metabolites in the pathogenesis and treatment of these conditions. This review summarizes research focused on how to modulate the IM through diet, prebiotics, probiotics, synbiotics and fecal microbiota transplant in order to treat IR and T2D. There is an abundance of evidence suggesting a role for IM in the pathogenesis of IR and T2D based on reviewed studies using various methods to modulate IM and metabolites. However, the results are inconsistent. Future research should further assess this relationship.

Aydoğdu G.S., Gezmen Karadağ M.

Abstract Purpose of Review Protecting the planet is protecting the future. Food production systems are among the most important human activities threatening planetary health. Diet, food systems, the environment, and health are interconnected. Accordingly, this review aims to assess the effects of nutrition on the planet and the relationship between some types of diets defined as sustainable and the planet and human health. Recent Findings Many diets have been proposed to protect the planet and human health, but there is no consensus on which diet is best. It should not be forgotten that planetary health diets, plant-based diets, and vegetarian/vegan diets can reduce environmental pressure. Still, they cannot have the same effect in every country, and these diets may have different effects depending on the differences in the countries' income level, nutritional culture, and food systems. Moreover, it should not be overlooked that these diets may cause difficulties in terms of adaptation, cause deficiencies in some nutrients, and may not be suitable for all segments of society. Sustainable diets such as the Mediterranean and New Nordic, as well as Dietary Approaches to Stop Hypertension, are more flexible and acceptable. Summary Instead of a globally recommended reference diet to protect the planet and human health, each country can analyze its food systems and choose the most appropriate food production methods and sustainable diet style to reduce environmental burden, improve health, and create policies accordingly, which can help achieve sustainable goals faster.

Yusof B.M., Talib R.A., Hamdy O.

Muszalska A., Wiecanowska J., Michałowska J., Pastusiak-Zgolińska K.M., Polok I., Łompieś K., Bogdański P.

Introduction: The planetary health diet, introduced by the EAT–Lancet Commission, aims to address global health and sustainability challenges by promoting a plant-based diet with reduced consumption of animal-sourced foods. This diet not only contributes to environmental sustainability but also offers significant health benefits, including prevention and management of abdominal obesity, carbohydrate metabolism disorders, dyslipidemia, and elevated blood pressure. These metabolic disorders are components of metabolic syndrome, a cluster of risk factors for cardiovascular disease. Objectives: This narrative review aims to gather the most recent findings on the impact of the planetary diet on individual components of metabolic syndrome and on the prevention and treatment of cardiovascular disease. Methods: The available research on the topic was identified via searches in PubMed, Scopus, and Google Scholar. Results: Abdominal obesity, a major risk factor for a range of chronic diseases, can be effectively mitigated by adhering to plant-based dietary patterns, which have been shown to reduce waist circumference and improve overall cardiometabolic health. Furthermore, the planetary diet plays a crucial role in reducing the risk of type-2 diabetes and improving glycemic control, with specific dietary components such as whole grains and fiber, demonstrating positive effects on blood glucose levels. This diet is additionally associated with favorable lipid profiles, including lower levels of LDL cholesterol and total cholesterol, which are critical in the prevention of atherosclerosis and cardiovascular diseases. Conclusions: These multiple benefits highlight that the planetary diet may be an effective strategy for managing and preventing metabolic syndrome and cardiovascular disease. However, further research is needed to confirm its long-term efficacy and applicability across diverse populations.

Smith H., Thomas D.T., Vázquez-Morales G.N., Puckett L., Del Mar Rodriguez M., Stromberg A., Shaddox L.M., Santamaria M.P., Pearce K., Andriankaja O.M.

ObjectivesType 2 Diabetes (T2D) is recognized as a risk factor for periodontal disease (PD), with evidence supporting a bidirectional relationship. Food choices are thought to influence both conditions, but research on their impact specifically on PD remains limited. This study aimed to explore whether food choices were linked to higher prevalence of adverse periodontal parameters and poorly controlled glucose levels among Hispanic adults with T2D.MethodsA cross-sectional study was conducted with 260 Puerto Rican adults aged 40–65 years, all diagnosed with T2D. Dietary habits were assessed by weekly frequencies of food choices deemed healthy or unhealthy over the past year. Periodontal health was evaluated by the percentage of sites with probing pocket depth (PPD) ≥4 mm and bleeding on probing (BOP) at corresponding teeth. Glucose control was measured by glycated hemoglobin (HbA1c) levels, with uncontrolled glucose defined as HbA1c ≥ 7%. Linear regression models adjusted for demographic and clinical variables estimated associations with PD. Logistic regression assessed associations with glucose control.ResultsThe median Healthy Eating Score was 0.5 (Q1, Q3: −3.9, 4.5). A higher Healthy Eating Score was significantly associated with fewer sites exhibiting PPD ≥ 4 mm and BOP (adjusted β: −0.02; SE: 0.01; p = 0.035), and reduced odds of uncontrolled glucose (adjusted odds ratio: 0.94; 95% CI: 0.89–0.98; p = 0.007).ConclusionsAdherence to a healthier dietary pattern appears to correlate with lower periodontal inflammation and greater glucose control among Hispanics with T2D. Prospective studies are needed to confirm causality and long-term effects.

Ueda Yamaguchi N., de Almeida L., Carvalho Gomes Corrêa R., Grossi Milani R., Ueda Yamaguchi M.

Obesity and being overweight are significant risk factors for diseases and disabilities, making it crucial to address malnutrition in all its forms to ensure health and well-being for all, as well as to achieve sustainable development. This study conducted a bibliometric analysis of research on obesity in relation to Sustainable Development Goals (SDGs) using data from the Web of Science database from 2015 to 2024 and the VOSviewer software. The findings revealed that while research on obesity and SDGs has grown slowly, SDG 3 (Good Health and Well-Being) is predominant in the literature. This study highlighted the fragmentation of research due to the complex, multifactorial nature of obesity, emphasizing the need for a more holistic approach. Furthermore, international collaborations were found to be vital for advancing research and formulating effective public policies. This analysis also identified gaps in the research related to several SDGs, including education (SDG 4), affordable and clean energy (SDG 7), and partnerships (SDG 17), suggesting the need for a broader, more holistic approach. Additionally, emerging research related to SDG 11 (Sustainable Cities and Communities) underscores the importance of urban environments in tackling obesity. In conclusion, future research should adopt an interdisciplinary approach to address these gaps and contribute to advancing the 2030 Agenda.

Ojo O., Otunola G.A., Oshungade O.R., Joshua B.

Background: Type 2 Diabetes (T2D) is increasingly becoming a critical healthcare priority globally. Medical interventions are primary strategies for managing diabetes, but more recently, diet/nutrition therapy, including the use of functional food products such as cinnamon and/or cinnamon products, has garnered considerable attention. The focus of this systematic review and meta-analysis is to examine whether cinnamon improves blood glucose parameters, body mass index, and inflammatory markers in people with T2DM. Method: PRISMA and PICOS frameworks were used for the review. EBSCOhost was used to search for relevant literature in health science research databases, while EMBASE and reference lists were used to access other relevant articles. Results: For systematic review and meta-analysis, 14 and 12 studies, respectively, were included (five from Iran, two each from the USA and India, and one each from the UK, China, Germany, Portugal, and Iraq). All participants had T2DM with ages ranging from ≥30–65 years. The effect of cinnamon on glycaemic control and other parameters did not follow a regular pattern. Effect on HbA1c (nine studies and 605 participants; MD of −0.07 (95% CI, −0.13, −0.01, p = 0.02), postprandial blood glucose (PBG) and BMI showed significant (p < 0.05) reductions. However, cinnamon exhibited no significant (p > 0.05) impact on FBG (MD of −1.73 (95% CI, −3.98, 0.52, p = 0.13), CRP, TNF-α, and IL-6 in people with T2D; neither did the sensitivity test reveal any change in relation to these parameters. Conclusions: Cinnamon or cinnamon extracts/products are significantly effective in diabetes management through reduction in HbA1c, PBG, and BMI.

Bretschneider M.P., Roth L.M., Steckhan N., Schwarz P.E.

Skurk T., Grünerbel A., Hummel S., Kabisch S., Keuthage W., Müssig K., Nussbaumer H., Rubin D., Simon M., Tombek A., Weber K.S.

Murat-Ringot A., Lan R., Fraticelli L., Fayet Y., Bourgeois D., Nugem R., Piton M., Goetz E., Préau M., Dutertre F., Bernoud-Hubac N., Basbous L., Lastmann A., Charreyre M., Carrouel F.

Background/Objectives: The “One Health” approach underscores the connection between human, animal, and environmental health, promoting solutions to global challenges like climate change and biodiversity loss. The Planetary Health Diet (PHD) promotes a plant-based diet with organically grown plants to reduce the environmental impact of meat production and decrease the risk of non-communicable diseases (NCDs). The BIOQUALIM project will evaluate the PHD’s effectiveness in preventing NCDs like periodontal diseases and cancers through four inter-related studies. Methods: The clinical study will involve volunteers reducing their meat consumption and incorporating einkorn into their diet, allow for analysis of their interdental microbiota, oral health, general health, and quality of life. The chemical analysis will study nutrients and anti-cancer compounds in einkorn and common wheat varieties. The behavioral study will explore PHD knowledge, attitudes, and behaviors related to PHD. The psycho-social study will evaluate the impact of peer-support workshops on plant-based dietary cooking among post-therapy cancer patients. Results: The results are expected to demonstrate that einkorn varieties possess nutritional properties that, when incorporated into the PHD enriched with einkorn, can enhance health markers. This study will identify barriers to and facilitators of PHD adoption and highlight how peer-support workshops can improve dietary adherence. Conclusions: BIOQUALIM’s transdisciplinary approach will demonstrate the PHD’s role in preventing NCDs.

de Oliveira Neta R.S., Lima S.C., Medeiros M.F., Araújo D.B., Bernardi N., de Araújo A.A., Jacob M.C., Neta A.D., Marchioni D.M., Lyra C.D., da Costa Oliveira A.G.

Abstract Background The EAT-Lancet diet is a diet aimed at promoting population and planetary health from the perspective of sustainable diets in terms of environmental and health aspects. This study aimed to assess the association between adherence to the EAT-Lancet diet and cardiometabolic risk factors among adults and elderly individuals in a capital city in the northeastern region of Brazil. Methods This is an analytical cross-sectional observational study from a population-based sample conducted between 2019 and 2020, involving 398 non-institutionalized adults and elderly people, of both sexes from “Brazilian Usual Consumption Assessment” study (Brazuca-Natal). There was a 38% response rate due to the suspension of data collection due to the covid-19 pandemic, but According to the comparative analysis of socioeconomic and demographic variables between the surveyed and non-surveyed sectors, losses were found to be random (p = 0.135, Little’s MCAR test). Socioeconomic and lifestyle data, anthropometric measurements, and dietary consumption were collected. We used the Planetary Health Diet Index (PHDI) and the Cardiovascular Health Diet Index (CHDI) for cardiovascular health to assess adherence to the diet’s sustainability. The evaluated cardiometabolic parameters included fasting blood glucose, triglycerides, total cholesterol, HDL-C, LDL-C, and systolic and diastolic blood pressure measurements. We also assessed the presence of type 2 diabetes mellitus, arterial hypertension, and dyslipidemia. For the data analyses, sample weights and the effect of the study design were taken into account. Pearson’s chi-square test was used to evaluate the statistical significance of frequencies. Multiple linear regression models assessed the associations between PHDI and CHDI and its components and the cardiometabolic parameters. Results The mean PHDI was 29.4 (95% CI 28.04:30.81), on a total score ranging from 0 to 150 points and the mean CHDI was 32.63 (95% CI 31.50:33.78), on a total score ranging from 0 to 110 points. PHDI showed a significant positive association with the final CHDI score and components of fruits, vegetables, and legumes, and a negative association with Ultra-processed Food (UPF) (p < 0.05). Notably, among the most consumed UPF, the following stand out: “packaged snacks, shoestring potatoes, and crackers” (16.94%), followed by margarine (14.14%). The PHDI exhibited a significant association with diabetes and dyslipidemia, as well as with systolic blood pressure, total cholesterol, and LDL-C. Conclusions The results suggest that adopting the EAT-Lancet diet is associated with the improvement of key cardiovascular health indicators.

Bretschneider M.P., Roth L.M., Steckhan N., Schwarz P.E.

Pan W., Wu S., Chang P.

The EAT-Lancet commission advocated a planetary health diet in 2019. Some have raised concerns about its nutrient adequacy. This study used data from recent Nutrition and Health Surveys in Taiwan—from 2017 to 2020 (n = 6538)—to assess food intake and nutrient adequacy among three red meat consumption levels (low/medium/high). The low red meat group, whose diet was similar to the EAT-Lancet reference, showed significantly higher/better levels of vitamins C and E, calcium, magnesium, sodium, dietary fiber, and the polyunsaturated to saturated fatty acids ratio. However, protein, B vitamins, phosphorus for females, and zinc were slightly compromised, but they were still near or above 100% of the Daily Reference Intakes (DRIs), except for zinc (74~75%). The intake levels of vitamin D, calcium, and dietary fiber in all three groups at times did not reach 70% of the DRIs, but this was more pronounced in the high red meat group compared to the low red meat group. Replacing ultra-processed foods (UPFs) with whole/healthy foods improved levels of zinc, calcium, and dietary fiber, but not vitamin D. Finally, a proposed local planetary health dietary construct was provided, suggesting maintaining the original distribution of the food groups recommended by the Taiwan Food Guide while specifying amounts of protein sources in line with the EAT-Lancet principles. The proposed diet, according to our estimation and comparison with Taiwanese DRIs, was nearly perfect in its nutrient composition.

Willett W., Springmann M.

Brimblecombe J., Ferguson M., McMahon E., Fredericks B., Turner N., Pollard C., Maple-Brown L., Batstone J., McCarthy L., Miles E., De Silva K., Barnes A., Chatfield M., Hill A., Christian M., et. al.

Abstract Background Aboriginal and Torres Strait Islander communities in remote Australia have initiated bold policies for health-enabling stores. Benchmarking, a data-driven and facilitated ‘audit and feedback’ with action planning process, provides a potential strategy to strengthen and scale health-enabling best-practice adoption by remote community store directors/owners. We aim to co-design a benchmarking model with five partner organisations and test its effectiveness with Aboriginal and Torres Strait Islander community stores in remote Australia. Methods Study design is a pragmatic randomised controlled trial with consenting eligible stores (located in very remote Northern Territory (NT) of Australia, primary grocery store for an Aboriginal community, and serviced by a Nutrition Practitioner with a study partner organisation). The Benchmarking model is informed by research evidence, purpose-built best-practice audit and feedback tools, and co-designed with partner organisation and community representatives. The intervention comprises two full benchmarking cycles (one per year, 2022/23 and 2023/24) of assessment, feedback, action planning and action implementation. Assessment of stores includes i adoption status of 21 evidence-and industry-informed health-enabling policies for remote stores, ii implementation of health-enabling best-practice using a purpose-built Store Scout App, iii price of a standardised healthy diet using the Aboriginal and Torres Strait Islander Healthy Diets ASAP protocol; and, iv healthiness of food purchasing using sales data indicators. Partner organisations feedback reports and co-design action plans with stores. Control stores receive assessments and continue with usual retail practice. All stores provide weekly electronic sales data to assess the primary outcome, change in free sugars (g) to energy (MJ) from all food and drinks purchased, baseline (July-December 2021) vs July-December 2023. Discussion We hypothesise that the benchmarking intervention can improve the adoption of health-enabling store policy and practice and reduce sales of unhealthy foods and drinks in remote community stores of Australia. This innovative research with remote Aboriginal and Torres Strait Islander communities can inform effective implementation strategies for healthy food retail more broadly. Trial registration ACTRN12622000596707, Protocol version 1.

Skurk T., Grünerbel A., Hummel S., Kabisch S., Keuthage W., Müssig K., Nussbaumer H., Rubin D., Simon M., Tombek A., Weber K.S.