Similar Benefits of Planetary Health Diet and Mediterranean Diet for Survival and Sustainability

Recent research presented at the European Society of Cardiology (ESC) Preventive Cardiology 2025 has revealed that the Planetary Health Diet (PHD) and the Mediterranean Diet offer comparable benefits for longevity and environmental sustainability.

Diet plays a critical role in the mortality rates associated with cardiovascular diseases. Studies indicate that optimizing dietary habits could prevent approximately one in five premature deaths across Europe. The PHD, introduced in 2019, aims to enhance global dietary quality while ensuring food production remains within sustainable environmental limits. Dr. Mercedes Sotos Prieto from the Autonomous University of Madrid highlighted the necessity of understanding how the PHD stacks up against the Mediterranean Diet, which is well-established for its health and ecological advantages in Mediterranean regions.

The PHD recommends an energy intake of roughly 2,500 kcal/day, emphasizing a high consumption of fruits, vegetables, whole grains, legumes, nuts, and unsaturated fats. It advises moderate intake of dairy, starchy vegetables, poultry, and fish, while minimizing saturated fats, red meat, and added sugars. In contrast, the Mediterranean Diet is characterized by seasonal fruits and vegetables, legumes, whole grains, and nuts, with olive oil as the primary fat source. It promotes a higher consumption of white meat over red or processed meats, alongside moderate dairy, fish, and egg intake.

The analysis involved data from 11,488 participants in the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA), which followed individuals from 2008 to 2010. Researchers calculated the PHD Index based on participants' consumption across 15 food categories, including whole grains, fruits, vegetables, and dairy, among others. Adherence to the Mediterranean Diet was assessed through a 14-item MEDAS score, which evaluated dietary practices such as the use of olive oil, the consumption of lean meats, and the intake of fruits, vegetables, and legumes.

Environmental impacts of each diet were examined using the SHARP-Indicators Database, which tracks greenhouse gas emissions and land use. Mortality data were sourced from the National Death Index of Spain. The analysis adjusted for potential confounding factors to assess the relationship between diet adherence and mortality rates.

The study participants had an average age of 47.5 years, with about 52.5% being women. Over a mean follow-up period of 14.4 years, there were 1,157 deaths recorded. The findings indicated that higher adherence to both the PHD and the Mediterranean Diet was linked to reduced all-cause mortality. Individuals in the highest adherence tier for the PHD had a 22% lower risk of mortality compared to those in the lowest tier. Similarly, those adhering closely to the Mediterranean Diet had a 21% reduced risk.

Specific components from both diets, such as fruits, dairy, and unsaturated oils from the PHD, as well as nuts and low consumption of sugary products from the Mediterranean Diet, were independently associated with lower mortality rates.

From an environmental perspective, both diets exhibited low ecological footprints. The PHD contributed an average of 4.15 kg of CO2 emissions daily and required 5.54 m² of land for food intake. In contrast, the Mediterranean Diet, including dairy, produced 4.36 kg of CO2 per day and used 5.43 m² of land. Notably, dairy and meat products were identified as significant contributors to the carbon footprint.

Dr. Sotos Prieto concluded that greater adherence to either diet correlates with lower all-cause mortality and similar environmental benefits, underscoring the health and ecological advantages of these plant-based dietary patterns.