Dietary species richness, environmental impact, and cardiovascular risk: evaluating trade-offs

Background

Dietary patterns are both drivers of cardiovascular disease (CVD) and environmental degradation. While dietary quality indicators are well studied, the role of food biodiversity — operationalised as dietary species richness (DSR) — remains underexplored. This study (1) quantifies associations between DSR across food groups and incident CVD, (2) assesses the environmental impacts of DSR (greenhouse gas emissions and land use), and (3) applies multi-objective optimization to identify biodiversity scenarios that minimize CVD risk and environmental burden.

Methods

We used data from the EPIC cohort (266,473 participants). DSR was calculated as the count of unique biological species consumed, derived using the EFSA FoodEx2 system. Incident CVD was defined as first fatal or non-fatal coronary heart disease or stroke. Dietary GHGe and land use were estimated via the SHARP-ID database. Cox models assessed associations with incident CVD; linear mixed-effects models examined environmental outcomes. Multi-objective optimization generated a Pareto frontier that jointly maximised DSR and minimized CVD risk, GHGe or land use, and deviation from observed food consumption.

Preliminary Results

Among 266,473 participants (11,519 CVD events), greater DSR in dairy was associated with lower CVD risk (HR 0.89, 95% CI 0.82–0.97), while diversity in added sugars, hard and soft added fats increased risk. Added sugar diversity was the strongest predictor of higher GHGe and land use. Optimization revealed GHGe and CVD risk reduction are largely aligned, while higher overall dietary biodiversity carries an emissions cost.

Conclusions

This study integrates food biodiversity metrics, prospective CVD outcomes, and environmental impact assessment in a large pan-European cohort. By applying multi-objective optimization, it maps trade-offs between human and planetary health, contributing actionable evidence for diets that are both heart-healthy and environmentally sustainable.

Key messages

• Food biodiversity can play a role in lowering cardiovascular risk while balancing environmental burdens.

• It is possible to develop diverse diets that are both heart-healthy and environmentally sustainable.