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Recent research presented at ESC Preventive Cardiology 2025 has highlighted the survival benefits and minimal environmental impacts of two plant-based diets: the Planetary Health Diet (PHD) and the Mediterranean Diet. Both diets were found to provide similar advantages in a study involving a substantial representative sample from Spain.
Diet plays a crucial role in mortality related to cardiovascular diseases, with findings suggesting that an optimized diet could prevent approximately one in five premature deaths across Europe.
Dr. Mercedes Sotos Prieto from the Autonomous University of Madrid stated, “The Planetary Health Diet was designed in 2019 to enhance global dietary quality while ensuring food production remains within sustainable environmental limits.” Despite its formulation, there had been little evidence comparing the PHD with the traditional Mediterranean Diet, which is well-documented for its health benefits and environmental sustainability. Our study aimed to examine the impacts of these diets on overall mortality and environmental factors in a large cohort of Spanish participants.
The PHD framework recommends an energy intake of approximately 2,500 kcal per day, emphasizing a high intake of fruits, vegetables, whole grains, legumes, nuts, and healthy oils, while advocating for moderate consumption of dairy, starchy vegetables, poultry, and fish. It also encourages limited intake of saturated fats, red meats, and added sugars.
Conversely, the Mediterranean Diet is based on a rich array of seasonal fruits and vegetables, legumes, whole grains, and nuts, with olive oil as the primary fat source. It promotes a greater intake of white meats compared to red and processed meats, alongside moderate inclusion of dairy products, fish, and eggs.
The study analyzed food consumption data from 11,488 individuals participating in the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA), which collected data from June 2008 to October 2010. To evaluate adherence to the PHD, the PHD Index was calculated based on the intake of 15 food groups, while adherence to the Mediterranean Diet was assessed through the 14-item MEDAS score. The environmental impact of each diet was gauged using the SHARP-Indicators Database, focusing on factors such as greenhouse gas emissions and land use. Mortality information was sourced from the National Death Index of Spain, and results were adjusted for various confounding variables.
Participants in the study had an average age of 47.5 years, with women comprising 52.5% of the sample. Throughout an average follow-up period of 14.4 years, there were 1,157 recorded deaths from all causes.
The findings revealed that higher adherence to both the PHD and Mediterranean Diet correlated with lower all-cause mortality rates. Specifically, participants who closely followed the PHD exhibited a 22% reduced likelihood of mortality compared to those with the least adherence (adjusted hazard ratio [HR] 0.78; 95% confidence interval [CI] 0.66-0.91). Likewise, those with strong adherence to the Mediterranean Diet had a 21% lower mortality risk (adjusted HR 0.79; 95% CI 0.68-0.93). Certain dietary components of both diets, such as fruits, dairy, and unsaturated oils in the PHD, as well as nuts and limited sugar intake in the Mediterranean Diet, were independently linked to decreased mortality.
From an environmental perspective, both diets demonstrated low ecological footprints. The PHD was associated with average greenhouse gas emissions of 4.15 kg of CO2 per day and land use of 5.54 m² per day of food intake. In comparison, the Mediterranean Diet, which included dairy, had slightly higher emissions at 4.36 kg of CO2 per day and land use of 5.43 m² per daily food intake. Notably, dairy and meat products emerged as the most significant contributors to environmental impact.
Dr. Sotos Prieto emphasized that “Adherence to either diet was linked to lower all-cause mortality rates and demonstrated comparably low environmental impacts, underscoring the health benefits and ecological importance of embracing these plant-based dietary patterns.”
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