Determining ecological sustainability of individual diets and plant-based diet patterns in childhood and adolescence, and their prospective associations with metabolic health in young adulthood: analyses in the DONALD Study (SusDietDONALD)

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Environmental and health impacts of diets play a significant role in the current debate about planetary health. Plant-based dietary patterns have become increasingly societally relevant due to their lower impact on greenhouse-gas emissions (GHGE) and land use (LU) as well as their favourable effects with respect to chronic disease prevention. However, there is considerable variation in plant-based diets in populations, which calls for exploration of environmental and health associations of individual dietary practices to support behaviour change for the societal transformation needed. Early in 2019 the EAT-Lancet commission endorsed a recommended diet which was developed drawing on environmental targets. The corridors of food intake were meant to offer the required adaptation to regional habits. Other plant-based dietary indices have been constructed differentiating healthful and unhealthful patterns focusing on the human health aspect. Nutritional epidemiological studies offer the exploration of variations in plant-based diets and their linkage to health and environmental impacts. With respect to the latter, linking individual food intakes with the ecological indicators GHGE and LU has become feasible in recent years. Next to the overall patterns of plant-based diets, the use of plant-based meat and milk alternatives is becoming increasingly popular, though the environmental and health benefits of such food alternatives as yet are unclear. The current project will set out to comprehensively investigate variation in plant-based, sustainable dietary patterns in the DONALD Study. The DONALD Study is an ongoing, open cohort study including children and adolescents with follow-up into adulthood. The analyses for the current project will use annually collected 3-day dietary records of about 850 children and adolescents from the year 2000 until today. We will analyse variation, determinants, sex differences, age and time trends of the sustainable diet indicators GHGE and LU of the habitual diets reported. Subsequently, we will derive a differentiated food pattern maximising variation in GHGE and LU using the method of reduced rank regression. We will analyse the human health relevance of this pattern by investigating associations with indicators of (cardio)metabolic health (e.g. lipid and inflammatory biomarkers, fatty liver indices) in young adulthood. We will complement this exploratory work by adopting the EAT-Lancet reference diet, and ‘healthful’ and ‘unhealthful plant-based diets’ to compare environmental impacts and nutritional quality. Finally, we will investigate the use of dairy and meat alternative food products in the study participants’ diets in this context. With the DONALD Study we will focus on childhood and adolescence, time periods of particular interest for establishing nutritional behaviour and with specific vulnerability. With its unique design in Germany, the DONALD Study offers an in depth exploration of the research questions.