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Original research
Health impacts and environmental footprints of diets that meet the Eatwell Guide recommendations: analyses of multiple UK studies
  1. Pauline Scheelbeek1,2,
  2. Rosemary Green1,2,
  3. Keren Papier3,
  4. Anika Knuppel3,
  5. Carmelia Alae-Carew2,
  6. Angela Balkwill3,
  7. Timothy J Key3,
  8. Valerie Beral3,
  9. Alan D Dangour1,2
  1. 1Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
  2. 2Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
  3. 3Nuffield Department of Population Health, Oxford University, Oxford, UK
  1. Correspondence to Dr Pauline Scheelbeek; Pauline.Scheelbeek{at}lshtm.ac.uk

Abstract

Objectives To assess the health impacts and environmental consequences of adherence to national dietary recommendations (the Eatwell Guide (EWG)) in the UK.

Design and setting A secondary analysis of multiple observational studies in the UK.

Participants Adults from the European Prospective Investigation into Cancer - Oxford(EPIC-Oxford), UK Biobank and Million Women Study, and adults and children aged 5 and over from the National Diet and Nutrition Survey (NDNS).

Primary and secondary outcome measures risk of total mortality from Cox proportional hazards regression models, total greenhouse gas emissions (GHGe) and blue water footprint (WF) associated with ‘very low’ (0–2 recommendations), ‘low’ (3–4 recommendations) or ‘intermediate-to-high’ (5–9 recommendations) adherence to EWG recommendations.

Results Less than 0.1% of the NDNS sample adhere to all nine EWG recommendations and 30.6% adhere to at least five recommendations. Compared with ‘very low’ adherence to EWG recommendations, ‘intermediate-to-high adherence’ was associated with a reduced risk of mortality (risk ratio (RR): 0.93; 99% CI: 0.90 to 0.97) and −1.6 kg CO2eq/day (95% CI: −1.5 to −1.8), or 30% lower dietary GHGe. Dietary WFs were similar across EWG adherence groups. Of the individual Eatwell guidelines, adherence to the recommendation on fruit and vegetable consumption was associated with the largest reduction in total mortality risk: an RR of 0.90 (99% CI: 0.88 to 0.93). Increased adherence to the recommendation on red and processed meat consumption was associated with the largest decrease in environmental footprints (−1.48 kg CO2eq/day, 95% CI: −1.79 to 1.18 for GHGe and −22.5 L/day, 95% CI: −22.7 to 22.3 for blue WF).

Conclusions The health and environmental benefits of greater adherence to EWG recommendations support increased government efforts to encourage improved diets in the UK that are essential for the health of people and the planet in the Anthropocene.

  • epidemiology
  • nutrition & dietetics
  • preventive medicine
  • public health
  • planetary health
  • environment
  • sustainability
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Footnotes

  • Contributors PS: literature search, study design, data analysis, data interpretation and manuscript writing. RG, KP and AK: study design, data analysis, data interpretation and manuscript writing. CA-C and AB: data analysis and commenting on manuscript. TJK, VB and ADD: study design and commenting on manuscript.

  • Funding This work was supported by the Wellcome Trust, Our Planet Our Health Programme (Sustainable and Health Food Systems (grant number 205200/Z/16/Z) and Livestock, Environment and People (grant number 205212/Z/16/Z)); Cancer Research UK (grant numbers C8211/A19170 and C570/A11692) and the UK Medical Research Council (grant numbers MR/M012190/1 and MR/K02700X/1). The views expressed in this publication are those of the authors and not necessarily those of the Public Health England or the Wellcome Trust. The final version of the report and ultimate decision to submit for publication was determined by the authors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All relevant data to the study are included in the article or uploaded as supplementary information. Raw data from National Diet and Nutrition Survey are available (upon request) from UK Data Service https://beta.ukdataservice.ac.uk/datacatalogue/series/series?id=2000033. Raw data from UK Biobank (UKB), Million Women Study (MWS) and European Prospective Investigation into Cancer - Oxford (EPIC-Oxford) are made available for selected research requests only. (UKB: https://www.ukbiobank.ac.uk/principles-of-access/; MWS: http://www.millionwomenstudy.org/files/07112018Datasharingpolicy.pdf; EPIC-Ox: http://www.epic-oxford.org/data-access-sharing-and-collaboration/).