Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China.
JAMA Netw Open. 2023 Oct 2;6(10):e2339468. doi: 10.1001/jamanetworkopen.2023.39468.
Although the EAT-Lancet Commission has recently proposed a planetary health diet (PHD) to promote human and environmental health, little is known about how PHD affects environment and mortality risk among an Asian population.
To investigate whether a PHD score is associated with environmental impacts and mortality outcomes in a Chinese cohort living in Singapore.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Singapore Chinese Health Study. Eligible participants were without known cardiovascular disease and cancer at baseline; they were recruited between 1993 and 1998 and followed up using record linkage data until 2020. Data were analyzed from September 2022 to April 2023.
PHD score was calculated based on the reference consumption of 14 dietary components in PHD and individual energy intake assessed using a validated food frequency questionnaire in this cohort.
Diet-related environmental impacts were estimated using a food frequency questionnaire. Mortality outcomes (all-cause, cardiovascular disease, cancer, and respiratory disease) were identified via linkage with a nationwide registry.
A total of 57 078 participants were included in this study (mean [SD] age, 56.1 (7.9) years; 31 958 women [56.0%]). During a median (IQR) follow-up of 23.4 (18.7-26.2) years, 22 599 deaths occurred. Comparing the highest and lowest quintiles, higher PHD scores were associated with lower greenhouse gas emissions (β = -0.13 kg CO2 equivalent; 95% CI, -0.14 to -0.12 kg CO2 equivalent), but with higher total water footprint (β = 0.12 m3; 95% CI, 0.11-0.13 m3) and land use (β = 0.29 m2; 95% CI, 0.28-0.31 m2). In the adjusted multivariable model, compared with the lowest quintile, participants in the highest quintile of PHD score had lower risk of all-cause mortality (hazard ratio [HR], 0.85; 95% CI, 0.81-0.89), cardiovascular disease mortality (HR, 0.79; 95% CI, 0.73-0.85), cancer mortality (HR, 0.93; 95% CI, 0.86-1.00), and respiratory disease mortality (HR, 0.81; 95% CI, 0.74-0.89).
In this study of Singapore Chinese adults, higher adherence to PHD was associated with reduced risk of chronic disease mortality. However, environmental impacts were uncertain, as higher adherence was associated with lower greenhouse gas emissions but higher total water footprint and land use.
尽管 EAT-柳叶刀委员会最近提出了一种促进人类和环境健康的行星健康饮食（PHD），但对于 PHD 如何影响亚洲人群的环境和死亡率风险知之甚少。
调查 PHD 评分是否与新加坡居住的中国人群的环境影响和死亡结局有关。
设计、地点和参与者：这项队列研究使用了来自新加坡华人健康研究的数据。合格的参与者在基线时没有已知的心血管疾病和癌症；他们于 1993 年至 1998 年期间招募，并通过记录链接数据进行随访，直到 2020 年。数据于 2022 年 9 月至 2023 年 4 月进行分析。
PHD 评分是根据 PHD 中 14 种饮食成分的参考摄入量和本队列中使用验证后的食物频率问卷评估的个体能量摄入计算得出的。
使用食物频率问卷估计与饮食相关的环境影响。通过与全国性登记处的链接确定死亡结局（全因、心血管疾病、癌症和呼吸道疾病）。
本研究共纳入 57078 名参与者（平均[SD]年龄，56.1[7.9]岁；31958 名女性[56.0%]）。在中位数（IQR）随访 23.4（18.7-26.2）年期间，发生了 22599 例死亡。与最高和最低五分位相比，较高的 PHD 评分与较低的温室气体排放有关（β=-0.13kg CO2 当量；95%CI，-0.14 至 -0.12kg CO2 当量），但与更高的总水足迹（β=0.12m3；95%CI，0.11-0.13m3）和土地利用（β=0.29m2；95%CI，0.28-0.31m2）有关。在调整后的多变量模型中，与最低五分位相比，PHD 评分最高五分位的参与者全因死亡率风险较低（风险比[HR]，0.85；95%CI，0.81-0.89）、心血管疾病死亡率（HR，0.79；95%CI，0.73-0.85）、癌症死亡率（HR，0.93；95%CI，0.86-1.00）和呼吸道疾病死亡率（HR，0.81；95%CI，0.74-0.89）。
在这项对新加坡华人成年人的研究中，较高的 PHD 依从性与慢性病死亡率降低有关。然而，环境影响尚不确定，因为较高的依从性与较低的温室气体排放有关，但与更高的总水足迹和土地利用有关。
