Is the Planetary Health Diet the solution for mitigating noncommunicable diseases?

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NCDs include 4 groups: cardiovascular, responsible for most deaths (17.9 million every year), cancer (9 million), respiratory diseases (3.9 million) and type 2 diabetes mellitus (1.6 million) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Although NCDs occur mainly in older age groups, they have been observed in younger age groups, especially among more vulnerable socioeconomic populations. Unhealthy lifestyles play a fundamental role as triggers for NCD, especially physical inactivity, unhealthy eating, exposure to tobacco smoke and environmental pollution. Tobacco is known to cause 7 million deaths each year, and 4 million deaths are attributable annually to excessive salt intake.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> There are other factors that are considered less often but are still crucial, such as excessive and unplanned urbanization and the aging of the population.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>In 2015, the United Nations General Assembly adopted the 2030 Agenda for Sustainable Development, in which NCDs were identified as a significant obstacle for achieving planetary sustainability. This Agenda contains 17 universally applicable objectives that, since January 2016, govern the countries’ efforts to achieve a sustainable world by 2030.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> To achieve these objectives, the Paris Agreement was signed in 2016, which established measures to reduce the emission of greenhouse gases, employing a strategy aimed at ensuring healthy lives and promoting universal wellbeing. In the health setting in particular, the World Health Organization (WHO) assumed leadership for promoting and monitoring worldwide action against NCDs. To this end, the WHO developed a global action plan with the commitment to reduce premature mortality from these diseases by a third by 2030.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>One of the key factors in this struggle for human and planetary health is the human diet, due to its considerable importance for preventing the onset of NCDs and because the production, processing, transport and management of food threatens climate stability and ecosystem resilience. In fact, it is estimated that the food industry is responsible for more than 22% of the worldwide production of greenhouse gases and is therefore a key factor in the planet’s deterioration.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> In this context, our proposed issue is that a transformation of the global food system is urgently required, adopting a new model that, in addition to the traditional concept of being healthy for the human population, is also healthy for the planet itself. This type of diet is what Willet et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> have called the Planetary Health Diet, which is able to preserve the planet’s ecosystem and reduce NCD. In an effort to define the general outline of this diet, the aforementioned authors consider that the diet corresponds to a flexitarian diet, given that it should be based mainly on food of plant origin, with fruits, various vegetables, legumes, whole-grain cereals, nuts and only small quantities of animal protein. The food should be locally grown and in season. Of these considerations, one of the most relevant points is reducing meat products, especially red meat (highly processed or not), given that livestock production is the most significant source of greenhouse gas emission<a class="elsevierStyleCrossRef" href="#bib0025">5</a> and entails significant water consumption and overexploitation of the planet. Other foods that should be excluded from the Planetary Health Diet are products with added sugar and those that are highly processed (meat or otherwise), including the considerable majority of precooked food, all of which are involved in the worldwide NCD epidemic (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<a class="elsevierStyleCrossRef" href="#bib0025">5</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Although the efforts by Willet et al. in this proposed Planetary Health Diet are of considerable value, there is still a long way to go, among other reasons because this dietary model has to adapt to geographical conditions, culinary traditions and personal preferences. An example of healthy vegetable products for Spain would be asparagus, which when grown locally in Spain would be a highly desirable food; however, most asparagus consumed in Spain are grown in China or Peru, which entails a severe burden in terms of the consumption of kerosene, diesel or fuel. Additionally, in-season and locally grown products have a greater richness of micronutrients, usually require fewer additives and preserve their natural taste, which improves their palatability and greater acceptance by consumers. The Lancet Commission<a class="elsevierStyleCrossRef" href="#bib0025">5</a> therefore recommended that the global food system should ensure healthy diets based on sustainable food systems for approximately 10 billion people by 2050, thereby preventing 11 million premature deaths annually, most related to NCDs.From a practical perspective for Spain’s geographical area, it would be tempting to simplify the Planetary Health Diet recommendation by proposing a Mediterranean Diet to the general population. However, as we have previously indicated,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> the flexitarian diet is not comparable to the Mediterranean diet for several reasons. Firstly, the Mediterranean diet model initial proposed precisely by Willet<a class="elsevierStyleCrossRef" href="#bib0035">7</a> has gradually incorporated a greater proportion of animal protein. Secondly, the Mediterranean diet has focused on a healthy diet for humans and now has to be healthy for both humans and the planet, which is not always the case. An example of this is the situation with fish, whose fishing system requires limits to its consumption, due to being a source of greenhouse gas production,<a class="elsevierStyleCrossRefs" href="#bib0030">6,8</a> as well as the vast quantity of food from of all parts of the world that are transported thousands of kilometers to reach the consumer, at the cost of high fossil fuel consumption.At this point, it is worth reflecting on our role as healthcare providers in mitigating the prevalence of NCDs. We might initially assume that we are unable to influence the use of fossil fuels or to prevent the overexploitation of the planet. However, health professionals enjoy a high degree of credibility and have a considerable capacity for influencing society and spreading messages. We therefore consider it crucially important that healthcare practitioners commit to the social promotion and implementation of the diet of the future and implement research studies to deepen the scientific understanding of the benefits of this diet and, within its parameters, define the model that would best adapt to our environment. The fact that the strategies for preventing obesity have been a failure in the past should not dissuade us from this task. The problem now is different, in considerable measure because we know that this global challenge, which requires changing both the production system and the nutritional model for the population, is not solved just by developing new drugs or investigating the molecular basis of NCD.A recent report in the 2019 Lancet Countdown on health and climate change warned that children are one of the groups most affected by the consequences of this change.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Our involvement as healthcare practitioners should consider this an ethical imperative for preserving the future of humanity and ensuring that our children and grandchildren will enjoy a full life and a healthy planet. In this task, we will encounter numerous institutions, corporations, foundations, associations and public and private companies that will align their agenda, as a priority, to commit to the future of the planet and that of its population.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Pérez-Martínez P, Gómez-Huelgas R, Pérez-Jiménez F. ¿Es la dieta saludable planetaria la solución para mitigar las enfermedades no transmisibles? Rev Clin Esp. 2020;220:573–575." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 720 "Ancho" => 2754 "Tamanyo" => 109646 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Noncommunicable diseases (NCDs) are currently the main public health problem worldwide, contributing to 70% of deaths throughout the world." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 935 "Ancho" => 2943 "Tamanyo" => 162797 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "There is an urgent need to transform the global food system into one that can preserve the planet’s ecosystem and reduce noncommunicable diseases. A healthy planet diet is one that is flexitarian, consisting mainly of plant foods, with fruits, various vegetables, legumes, whole-grain cereals, nuts and only small quantities of animal protein." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "GBD 2015 Risk Factors Collaborators" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(16)31679-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2016" "volumen" => "388" "paginaInicial" => "1659" "paginaFinal" => "1724" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27733284" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "<a target="_blank" href="https://www.who.int/topics/sustainable-development-goals/es/">https://www.who.int/topics/sustainable-development-goals/es/</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "<a target="_blank" href="https://www.who.int/topics/sustainable-development-goals/targets/es/">https://www.who.int/topics/sustainable-development-goals/targets/es/</a>." ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Food, livestock production, energy, climate change, and health" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.J. 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