{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:58:08Z","timestamp":1793213888755,"version":"4.5.0"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate whether a PHD score is associated with environmental impacts and mortality outcomes in a Chinese cohort living in Singapore.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 57\u202f078 participants were included in this study (mean [SD] age, 56.1 (7.9) years; 31\u202f958 women [56.0%]). During a median (IQR) follow-up of 23.4 (18.7-26.2) years, 22\u202f599 deaths occurred. Comparing the highest and lowest quintiles, higher PHD scores were associated with lower greenhouse gas emissions (\u03b2\u2009=\u2009\u22120.13 kg CO\n 2<\/jats:sub>\n equivalent; 95% CI, \u22120.14 to \u22120.12 kg CO\n 2<\/jats:sub>\n equivalent), but with higher total water footprint (\u03b2\u2009=\u20090.12 m\n 3<\/jats:sup>\n ; 95% CI, 0.11-0.13 m\n 3<\/jats:sup>\n ) and land use (\u03b2\u2009=\u20090.29 m\n 2<\/jats:sup>\n ; 95% CI, 0.28-0.31 m\n 2<\/jats:sup>\n ). 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).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.39468","type":"journal-article","created":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T11:41:41Z","timestamp":1698147701000},"page":"e2339468","source":"Crossref","is-referenced-by-count":69,"title":["Adherence to a Planetary Health Diet, Environmental Impacts, and Mortality in Chinese Adults"],"prefix":"10.1001","volume":"6","author":[{"given":"Yi-Xiang","family":"Ye","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting-Ting","family":"Geng","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan-Feng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Social Medicine and Health Management, School of Public Health, Guangxi Medical University, Nanning, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pan","family":"He","sequence":"additional","affiliation":[{"name":"School of Earth and Environmental Sciences, Cardiff University, Cardiff, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Juan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Willett","sequence":"additional","affiliation":[{"name":"Harvard T.H. 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