The Health and Environmental Impacts, Safety, and Affordability of the EAT-Lancet Planetary Health Diet: A Multidisciplinary Systematic Review and Meta-Analysis
12 affiliations
- 1Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China
- 2Department of Nutrition and Food Hygiene, School of Public Health, Capital Medical University, Beijing, China
- 3Institute for Global Health and Development, Peking University, Beijing, China
- 4Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- 5Laboratory of Biomass and Bioprocessing Engineering, College of Engineering, China Agricultural University, Beijing, China
- 6Department of Data Science and Engineering, College of Information and Electrical Engineering, China Agricultural University, Beijing, China
- 7Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- 8Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain; Precision Nutrition and Cardiometabolic Health Program, IMDEA-Nutrition Institute (Madrid Institute for Advanced Studies), CEI UAM + CSIC, Madrid, Spain; Department of Medicine and Endocrinology, University of Valladolid, Valladolid, Spain
- 9Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
- 10School of Life and Environmental Sciences and Charles Perkins Centre, the University of Sydney, Sydney, New South Wales, Australia
- 11Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China. Electronic address: [email protected]
- 12Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China. Electronic address: [email protected]
Abstract
In 2019, the EAT-Lancet Commission proposed transition to the planetary health diet, whereas the health and environmental benefits, safety, and affordability of the diet have recently been challenged. This systematic review and meta-analysis aimed to provide a quantitative summary of the EAT-Lancet diet and population health and environmental sustainability; and to review safety (nutrient deficiencies) and affordability of the diet. We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Library, and ClinicalTrials.gov from 1 January 2019 to 19 June 2025 for quantitative studies. Of the eligible studies, epidemiological studies on population health or environmental sustainability were further used for meta-analysis. The risk of bias of the included studies was assessed using the Newcastle–Ottawa Scale tool. A total of 227 studies were included in the systematic review and 79 of them were used for the meta-analysis. Most prospective cohort studies and half the cross-sectional studies were of high quality. The EAT-Lancet diet was associated with lower risks of all-cause mortality [pooled hazard ratio = 0.80, 95% confidence interval (CI): 0.76, 0.85; n = 17, 1,063,289 participants], cardiovascular disease (0.83, 95% CI: 0.74, 0.94; n = 10, 1,027,822 participants), and type 2 diabetes, but not risks of all cancers or dementia. The EAT-Lancet diet was associated with a reduction of 1.55 (0.22, 2.89) kg CO 2 eq/d/person of greenhouse gas emission ( n = 12, 882,673 participants), whereas no strong evidence supported the benefits to water or land use. On a global average, the EAT-Lancet diet would induce deficiencies in vitamin B 12 , calcium, iron, and zinc in adults, especially in pregnant women. Globally, 1.6–3.0 billion people were not able to afford the diet. In conclusion, adoption of the EAT-Lancet diet may modestly reduce global chronic disease and environmental burden, whereas nutrient deficiencies and economic inequality across regions should be addressed before dietary transition. Trial registration number This study was registered at PROSPERO as CRD42024540867 (URL of registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024540867 ).
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BibTeX
@article{zhu2026health,
title = {{The Health and Environmental Impacts, Safety, and Affordability of the EAT-Lancet Planetary Health Diet: A Multidisciplinary Systematic Review and Meta-Analysis}},
author = {Ruixin Zhu and Langrun Wang and Huiyu Chen and Jiale Ren and Ran Wang and Yifan Gong and Yiran Guan and Qingbo Wang and Meng Liu and Zhihu Xu and Liwei Zhang and Peng An and Jie Guo and Xueqin He and Miao Xie and Keji Li and J. Alfredo Martinez and Anne Raben and Jennie Cecile Brand-Miller and Fazheng Ren and Jingjing He},
journal = {Advances in Nutrition},
year = {2026},
month = jun,
doi = {10.1016/j.advnut.2026.100666},
url = {https://doi.org/10.1016/j.advnut.2026.100666},
note = {CC BY},
}
RIS
TY - JOUR
TI - The Health and Environmental Impacts, Safety, and Affordability of the EAT-Lancet Planetary Health Diet: A Multidisciplinary Systematic Review and Meta-Analysis
AU - Ruixin Zhu
AU - Langrun Wang
AU - Huiyu Chen
AU - Jiale Ren
AU - Ran Wang
AU - Yifan Gong
AU - Yiran Guan
AU - Qingbo Wang
AU - Meng Liu
AU - Zhihu Xu
AU - Liwei Zhang
AU - Peng An
AU - Jie Guo
AU - Xueqin He
AU - Miao Xie
AU - Keji Li
AU - J. Alfredo Martinez
AU - Anne Raben
AU - Jennie Cecile Brand-Miller
AU - Fazheng Ren
AU - Jingjing He
PY - 2026
DA - 2026/06/01
JO - Advances in Nutrition
DO - 10.1016/j.advnut.2026.100666
UR - https://doi.org/10.1016/j.advnut.2026.100666
AB - In 2019, the EAT-Lancet Commission proposed transition to the planetary health diet, whereas the health and environmental benefits, safety, and affordability of the diet have recently been challenged. This systematic review and meta-analysis aimed to provide a quantitative summary of the EAT-Lancet diet and population health and environmental sustainability; and to review safety (nutrient deficiencies) and affordability of the diet. We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Library, and ClinicalTrials.gov from 1 January 2019 to 19 June 2025 for quantitative studies. Of the eligible studies, epidemiological studies on population health or environmental sustainability were further used for meta-analysis. The risk of bias of the included studies was assessed using the Newcastle–Ottawa Scale tool. A total of 227 studies were included in the systematic review and 79 of them were used for the meta-analysis. Most prospective cohort studies and half the cross-sectional studies were of high quality. The EAT-Lancet diet was associated with lower risks of all-cause mortality [pooled hazard ratio = 0.80, 95% confidence interval (CI): 0.76, 0.85; n = 17, 1,063,289 participants], cardiovascular disease (0.83, 95% CI: 0.74, 0.94; n = 10, 1,027,822 participants), and type 2 diabetes, but not risks of all cancers or dementia. The EAT-Lancet diet was associated with a reduction of 1.55 (0.22, 2.89) kg CO 2 eq/d/person of greenhouse gas emission ( n = 12, 882,673 participants), whereas no strong evidence supported the benefits to water or land use. On a global average, the EAT-Lancet diet would induce deficiencies in vitamin B 12 , calcium, iron, and zinc in adults, especially in pregnant women. Globally, 1.6–3.0 billion people were not able to afford the diet. In conclusion, adoption of the EAT-Lancet diet may modestly reduce global chronic disease and environmental burden, whereas nutrient deficiencies and economic inequality across regions should be addressed before dietary transition. Trial registration number This study was registered at PROSPERO as CRD42024540867 (URL of registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024540867 ).
SN - 2156-5376
SN - 2161-8313
ER -