Background: Plant-based diets offer co-benefits for human health and the environment, but assessments often consider only specific aspects. This study comprehensively examines the links between diet-related environmental pressures and risk of chronic diseases as well as mortality.
Methods: Data from a population study of 34,077 participants to the NutriNet-Santé French cohort were used. Dietary data were collected using a food frequency questionnaire, distinguishing between organic and conventional foods, and were merged with food production environmental indicators. The associations between greenhouse gas emissions (GHGe), energy demand, land occupation (LO), ecological infrastructures (EI), water use, and pesticide treatment frequency and a synthetic environmental pressures index (EPI) and incidence of cancer, cardiovascular diseases (overall, coronary and cerebrovascular diseases), type 2 diabetes and mortality were estimated using weighted multivariable cox proportional risk model.
Findings: Over a mean median follow-up of 8.39 years (IQR = 5.62, 256,891 person-year), the diet's overall environmental pressures (EPI) was positively associated with the risk of all tested chronic diseases except stroke. The HR for 1 SD increment ranging from 1.15 (95% CI = 1.03-1.28) for cancer (all locations) to 1.50 (95% CI = 1.29-1.73) for coronary heart disease and type 2 diabetes, but no association with stroke or death was detected.
Interpretation: Diets with low overall environmental pressures are associated with important health benefits, suggesting that food systems with lower environmental impacts could be key drivers of both environmental and health sustainability.
Funding: Data were collected in the context of the BioNutriNet and TRANSFood projects supported by the French National Research Agency (ANR-13-ALID-0001 and ANR-21-CE21-0011-01).
Keywords: Chronic diseases; Climate; Cohort; Diet; Environmental indicators; Epidemiology.
© 2025 The Author(s).