ArticlePLoS medicine2025
The association of the planetary health diet with type 2 diabetes incidence and greenhouse gas emissions: Findings from the EPIC-Norfolk prospective cohort study.
Article in PLoS medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Plant-Based Nutrition and Type 2 Diabetes Mellitus: Prevention, Risk, Metabolic Health and the Role of Legumes, Dietary Fiber, and Red Meat.Nutrients · 2026Review
- Association between changes in adherence to the planetary health diet and adiposity and body fat distribution: a cohort study.The Lancet regional health. Europe · 2026Article
- Planetary Health Diet Index and self-reported kidney stones in US adults: mediating role of high-density lipoprotein cholesterol.Frontiers in nutrition · 2025Article
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6 authors.
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Abstract
backgroundThe planetary health diet (PHD) has been proposed as a dietary index with potential co-benefits for human and planetary health. Evidence is limited on its association with type 2 diabetes (T2D) incidence and greenhouse gas (GHG) emissions. Our objective was to assess the associations of adherence to the PHD with incident T2D and GHG emissions. METHODS AND
findingsWe analysed data from 23,722 participants (55% female), with a mean (standard deviation, SD) age of 59.1 (9.3) in the UK-based EPIC-Norfolk prospective cohort study. Dietary intake was assessed across three time points (1993-1997, 1998-2000 and 2004-2011) using a food frequency questionnaire. We assessed adherence to the PHD (theoretical score range 0-140 points) based on the consumption of 13 food groups and two nutrients. Cox proportional hazards regression models, which accounted for time-varying covariates, were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for T2D. Linear regression models were used to analyse the association between the PHD and estimated GHG emissions. During a mean follow-up period of 19.4 (SD 6.8) years, 3,496 cases of incident T2D were recorded over 461,086 person-years. Greater adherence to the PHD was associated with lower T2D incidence; comparing the highest PHD quintile (85.7-117.8 points) to the lowest (33.9-68.4 points), the HR (95% CI) was 0.68 (0.61, 0.76) in the most adjusted model including socio-demographic, behavioural factors, energy intake, adiposity, and prevalent cardiovascular disease or cancer. The estimated population attributable fraction (PAF) for incident T2D due to adherence below the 80th percentile (85.7 points) was 12.3% (95% CI: 9.2%, 15.3%). Those in the highest quintile of the PHD had approximately 18% lower GHG emissions compared to those in the lowest (β5th/1st -18.4% (95% CI: -19.3%, -17.5%)). The main limitation of this research is the possibility of residual confounding due to the observational design of this study.
conclusionsOur findings of a lower incidence of T2D and reduced GHG emissions among those with higher adherence to the PHD support the promotion of this diet for the population-level prevention of T2D and for planetary sustainability.
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