#584: EAT-柳叶刀：地球健康饮食能否改善人类健康？

大家好，欢迎收听新一期的Sigma营养电台。

Hello, and welcome to another episode of Sigma Nutrition Radio.

我是丹尼·列侬，今天和我一起的是艾伦·弗拉纳根博士。

My name is Danny Lennon, and with me is doctor Alan Flanagan.

艾伦，你最近怎么样？

Alan, how are you doing?

我很好。

I'm very well.

谢谢。

Thanks.

我记得上次我们做节目时，我的实验室研究还在进行中，现在这项研究已经完成了。

I think the last time we were on, we were in the middle of the study, my recent lab study that has now finished.

希望在不久的将来，我们能有一些相关数据可以讨论。

So hopefully at some point in the near future, we'll we'll have some data to discuss on that.

是的。

Yeah.

但一切顺利，谢天谢地。

But all went well, thankfully.

恭喜你。

Congratulations on that.

而且值得松一口气的是，数据收集既干净又可靠，这方面一切都很顺利。

And a sigh of relief that there was a clean and robust data collection and everything passed well on on that front.

是的。

Yes.

对。

Yeah.

这很好。

It's nice.

完整样本量12例，统计功效达到10例需求。

Full n of 12 powered for 10.

所以在这种小型研究中，分析时多出两例数据总是件好事。

So the two extra in the analysis is always nice with small studies like this.

而且，是的，恒定作息条件下的样本采集相当完整。

And, yeah, pretty complete sample collection for the constant routine.

这样我们将拥有一个非常好的数据集，可以比较进餐时长与夜间禁食对昼夜节律和代谢结果的影响。

So we'll have a really nice data set to compare the the difference in the meal durations and the overnight fasting in terms of any impact we see on circadian rhythms in metabolic outcomes.

所以与参与者共事和开展试验的兴奋阶段已经结束，现在要重新切换回写作和数据分析模式一段时间了。

So the excitement of working with the participants and having the trial running is all done and now it's switching back into writing and drafting data analysis mode for a while.

是啊。

Yeah.

这就是研究从非常人性化的阶段转向Excel表格和R语言的阶段。

This is the research goes from being very human to very Excel spreadsheet and R.

没错，我们现在要面对冷冰冰的数字了。

So yeah, we're into the we're into the the cold hard numbers now.

好的，等更多数据结果出来并且你们可以分享时，我们肯定会再讨论这个话题。

Well, we will certainly revisit that once we have more of that data that comes to light and that you can share with us.

我相信我们不仅会讨论这个，还会讨论你们即将发表的其他研究成果。

We'll I'm sure we will go through that in addition to some of your other publications that are coming down the line as well.

不过今天，我们想重点讨论近期热议的话题——2025年EAT-Lancet最新报告，这份报告引发了广泛讨论。

Today, though, we wanted to put our focus on something that has been talked about quite a bit recently, and that is the recent 2025 EAT Lancet updated report, which has generated a bit of discussion.

因此我们想针对其中提出的若干观点进行探讨，提供一些见解，或许会与2019年发布的旧版报告做些比较，真正从营养与健康结果的角度剖析这些内容。

And so we wanted to address some of the things that have been brought up and give an insight to that, maybe make some comparisons with the previous report published back in 2019, and really address some of these aspects from the nutrition and health outcome side.

因为正如我们将要讨论的，报告当然高度关注地球健康、可持续性等方面——这些我们会提及，但并非本次讨论的核心重点。

Because as we'll discuss, of course, there's a strong focus on planetary health, some aspects, right, sustainability, which we will touch on, but is not necessarily gonna be the main thrust here.

为了让讨论顺利展开，我想先为不熟悉的听众介绍一下：这份报告由EAT-Lancet委员会发布，该委员会本身是由《柳叶刀》医学期刊与EAT基金会联合组建的多学科科学家小组——名称由此而来，其目标是开发或推广一种对人类健康和地球健康都有益的饮食模式。

But to get us started, I suppose for people who aren't familiar, we have this report that was published by the EAT Lancet Commission, which in of itself is a scientific panel of many different researchers across different disciplines jointly set up by the Lancet Medical Journal as well as the EAT Foundation, hence the name that we have, with the goal of developing or promoting a diet that can be beneficial for both human health as well as planetary health.

这个专家团队由近40位来自不同国家的专家组成，涵盖营养科学、气候研究、政策制定等多个领域，他们通力合作发布这些报告以提出相关建议。

And so we have this group of experts, nearly 40 experts across many different countries, some within nutrition science, some within climate research, some within policy, etcetera, and coming together to try and put out these reports to put forward some of these recommendations.

2019年发布的首份报告我们稍后可能会提到。

So we had the first report in 2019, which we'll maybe mention in a moment.

而最新报告在六年后问世，人们可能已经看到了相关新闻，其中包含了环境影响的更新数据，以及部分慢性病结果数据，因此某些营养目标及其变化情况也有所调整。

The most recent one, which people have maybe have seen news about coming six years later with new data on both the environmental impact as well as some of the chronic disease outcomes and therefore some of the nutrient targets and how they've changed.

从饮食模式的角度，他们推荐的正是使用PHD这个缩写的'星球健康饮食'。

And the recommendation from a diet pattern perspective is this planetary health diet using the acronym PHD.

那么，这里或许可以从几个要点开始切入。

So maybe a good point to start here is a couple of things.

首先是让大家熟悉一下最初那份报告以及这份更新报告的一些基础知识。

One is getting people familiar with maybe some of the basics around that initial report as well as this updated one.

然后从饮食模式的角度来看，这个星球健康饮食的基本结构究竟是什么，这些食物和饮食模式的建议最终呈现为何种形态，以及需要先厘清的一些基础拼图。

And then from that diet pattern perspective, this planetary health diet, what that basic structure actually is, what that recommendation in terms of those foods and diet pattern ends up looking like, and some of those first pieces of the puzzle to to get clear on.

嗯。

Yeah.

我认为2019年的报告在出版界引起了巨大反响，可以说是首个被推广为'行星健康饮食'的膳食模式，其明确意图在于整合我们对膳食模式及食品系统生产对环境影响的认知，同时基于既往知识构建一种预期能促进人类健康的饮食框架。

I think the the 2019 report was quite quite a big splash in terms of publication, arguably the first dietary pattern that was promoted as a, as you call it, planetary health diet with a specific intention to incorporate our understanding of the impact of dietary patterns and food systems and production on the environment in the context of also framing a dietary pattern based on prior knowledge that would be expected to be associated with also improving human health.

因此其根本理念在于：这是一种既能从公共卫生营养角度降低慢性病患病率和发病率（这是我们全球性的目标，尤其考虑到过去二十年间中低收入国家慢性病也在增加），又能同步应对日益严峻的环境问题（例如饮食对温室气体排放的影响）的膳食模式。

And so that's the fundamental big picture thrust is that it's a diet that is compatible both with the reductions in prevalence and incidence of chronic disease that we desire from a kind of public health nutrition standpoint, and that's a global aim, of course, as we see increasing chronic disease in low to middle income countries now as well over the past couple of decades, and a diet that concomitantly then addresses the increasing environmental concerns and with the role of diet and contributing to, for example, greenhouse gas emissions.

初始报告的典型特征是基于食物组别和特定食物摄入量，这些数据源自先前关于食物与疾病关联的更广泛营养学研究。

The initial report characteristically was based on food groups and intakes of specific foods based on previous wider nutrition research of the associations with those foods and disease.

2025年报告的有趣之处在于：随着初始报告发布后数年的积累，现在已有前瞻性队列研究将EAT-Lancet饮食或行星健康饮食的特征应用于数据集，并观察其与长期慢性病风险的关联。

What makes the recent 2025 report interesting is that now with several years under the belt, post the initial report, we have prospective cohorts who have applied the characteristics of the EAT Lancet diet or the planetary health diet to datasets and looked at relationships then with long term chronic disease risk.

因此，过去主要依赖特定食物组间关系的先验知识，而现在我们有了近几年来新出现的证据体系，专门研究作为饮食模式评分的'星球健康饮食评分'与各种健康结果之间的关系。

So where previously it was largely based on prior knowledge of the relationships between specific food groups, now we have a body of evidence recently emerged over the last few years specifically looking at the Planetary Health Diet score as a dietary pattern score and various health outcomes.

此外，在旧报告与当前版本之间还存在一些细微差异，例如膳食能量摄入——2019年报告中，EAT-Lancet基于食物的建议被调整为建议成人每日摄入2500卡路里的群体水平标准。

There's also within the difference between the previous report versus now some subtle differences, dietary energy intake, for example, so the Eat Lancet food based recommendations were adjusted to a population level recommended adult daily energy intake of 2,500 calories per day in the 2019 report.

最新报告将此标准更新为2400卡路里，仅相差100卡路里，这主要基于更近期的双标水能量消耗测量数据，并综合考虑了群体理想BMI目标值和身体活动水平。

The recent report updates that to 2,400 calories, just 100 calories in the difference, which was largely based on more recent doubly labeled water energy expenditure estimates and measurements and considerations as well of target ideal population wide BMI levels and physical activity levels.

这些调整主要涉及食物组实际参考值及其范围的变化。

There were also then largely in relation to the actual reference values for foods groups and the ranges of those.

接下来我们将详细讨论EAT-Lancet饮食中14项基于食物的建议，其中包含特定的中位平均摄入量及其浮动范围。

So within the 14 food based recommendations for the EAT Lancet diet, which we'll go through now, there are specific median average intakes and then a range around that.

这些建议大体相似，但部分经过细微调整和重新排序，以促进该饮食方案的实际应用。

They're largely similar, some have been subtly reordered and grounded to facilitate the translation of the diet.

我认为2019年报告发布后，早期需要重点考虑的一个关键反馈是关于营养充足性的问题——因为这个饮食方案是基于既有知识提出的假设性方案，并未经过实际试验验证。

And one of the kind of, I think, early responses to the 2019 report that was important to consider was the question of nutrient adequacy because, again, this was not this was a diet proposed based on a posteriori knowledge, like prior knowledge being applied to put this together and had not necessarily been trialed.

因此本质上是对营养充足性进行的模型推演。

So it was essentially modeling nutritional adequacy.

而最近的报告则将饮食相关营养素的估计摄入量与饮食的营养密度相结合，与特定人群对这些营养素的平均需求量进行比较。

Whereas the recent report is pairing estimated intakes of the nutrients of the nutrients associated with the diet with nutrient density related to the diet to compare them to average population requirements for specific population groups and for those nutrients.

这种略微更新、更为全面的方法，考虑了饮食质量和膳食模式的累积营养充足性。

So this slightly updated, slightly more comprehensive approach, and it considers the cumulative nutritional adequacy of the diet quality and dietary pattern.

但就整体基于食物的饮食建议而言，大体上是相似的。

But, I mean, in terms of the overall food based recommendations of the diet, it's broadly similar.

这些基于食物的建议包含14类食物成分：谷物、土豆、蔬菜、水果、乳制品、红肉、禽肉、蛋类、鱼和海鲜、豆类、扁豆、豌豆、大豆制品、坚果和花生、添加糖、添加脂肪以及棕榈油不饱和脂肪。

Those food based recommendations are there's 14 food components, grains, potatoes, vegetables, fruits, dairy products, red meat, poultry, eggs, fish and seafood, beans, lentils, peas, soy based foods, nuts and peanuts, added sugar, added fats, and palm oil unsaturated fats.

其中针对每2400卡路里能量提出了建议摄入量，并为每项建议设定了摄入量范围。

Within those, there are proposed intakes per energy per 2,400 calories, and there are proposed ranges of intakes around that, around each proposed recommendation.

例如水果蔬菜类别中，水果的推荐日摄入量约为200克，范围在100至300克之间，其他食物成分也依此类推。

So for example, for something like fruits and veg or fruits specifically as a category, recommended intake of around two hundred grams per day with a range of a 100 to 300 and so on and so forth across all of these foods.

在流行病学分析中，这14类食物成分可用于根据预定义的摄入阈值或建议摄入范围创建膳食模式评分。

And then for epidemiological analysis, the 14 food components can then be used to create a diet pattern score based on predefined thresholds of intake or based on those proposed ranges of intake.

我们可以在讨论部分结果数据时探讨不同的评分方法。

And there are different scoring methods that we can discuss as we go through some of the outcome data.

有些评分方法会简单地用1或0来打分，然后将14类食物的得分相加。

Some will just score crudely for a one or a zero and then add it up for a total of 14.

有些则会根据食物组内的实际摄入范围进行评分，得分从0到100不等，分数越高表示对这14类食物成分的遵循程度越高。

Some will score based on the actual intake ranges within a food group where you get like a higher or lower score, you know, anywhere from as low as zero to a 100, and then obviously higher scores indicating higher adherence across all of the various 14 food components.

我们可以根据即将看到的结果数据，讨论与之相关的不同评分方法。

And we can discuss the different scoring methods as it's relevant to some of the outcome data that we'll look at.

以上就是这种饮食模式的大致框架。

And so that's the broad contours of the diet.

正如我们所说，现在已将'行星健康饮食指数'和'饮食评分指数'应用于流行病学数据集和持续的前瞻性队列研究中，以观察结果数据。

And like we said, we now have the application of the Planetary Health Diet Index, Diet Scoring Index, to datasets in epidemiology and ongoing prospective cohort studies looking at outcome data.

通过这些分析，我们可以将其与其他健康参考饮食模式（如地中海饮食）进行比较。

With some of those analyses, we can see comparisons to other healthy reference dietary patterns like the Mediterranean diets.

我们可以讨论行星健康饮食在健康影响方面是否存在额外优势。

We can discuss whether there's anything over and above or over and beyond in terms of health impacts of the planetary health diet.

当然，该建议中的主要考量因素是采用这种基于14类食物成分的行星健康饮食对环境可能产生的影响。

And then, of course, the major factor within the recommendation for it is the potential environmental impact of following a diet or adopting a diet to this planetary health 14 food based components.

嗯。

Mhmm.

我们将结合部分现有成果和证据逐步展开讨论，同时提及评分方法及与其他饮食模式的比较。

And we'll work our way through that with reference to some of those outcomes and some of the evidence we have to date whilst mentioning some of the scoring and the comparison to other diets.

不过为了让听众更清楚理解，关于你刚才提到的14种食物类别及其推荐摄入量，是否有任何特别引人注目之处？比如与人们预期不同、或区别于常规建议的地方？或者这种饮食模式中是否存在某些独特亮点？

But maybe to give people an idea just to get some clarity over some of the things you just said across those 14 different food groups with the recommended levels of intake, is there anything that stands out or that for maybe some people caught their attention when seeing this that might be different to either what they expected or different to typical recommendations we see elsewhere or stands out as a something particular to what we're seeing with this diet?

我认为，考虑到目前已有充分证据表明饮食与食品体系对温室气体排放的影响——这一关联已基本无争议——

I I think the big given the relationships that we fairly, I think, have uncontroversially now established within the kind of evidence of the impacts of diet and food systems on greenhouse gas emissions.

我们会将这种饮食定义为以植物为主（但非完全纯植物）的膳食模式。

We would characterize this diet as a diet that is plant predominant, not necessarily plant exclusive.

它确实包含动物源性食品，但摄入量范围相当低。

So it does incorporate animal sourced foods, but these are in intake ranges that are quite low.

在星球健康饮食中，动物源性食品的最高摄入量是乳制品，日均推荐250克（范围0-500克）。

The highest intake range for any animal sourced food in the Planetary Health Diet would be for dairy foods, and that's given an average daily intake of 250 grams a day with a range of zero to 500.

而红肉（包括牛肉、猪肉和羊肉）的推荐摄入量仅为每天15克（范围0-30克）。

Whereas, for example, red meat, which we would characterize as beef, pork, or lamb, has a recommended intake of 15 grams per day in a range of zero to 30.

显然，这是该饮食方案引发争议的一个方面，不仅是从健康角度为动物源性食品辩护，更多是从实际执行层面考虑。

Now this is obviously one of the aspects of the diet that drew some criticism, not necessarily even just defending the role of animal sourced foods from a health perspective, but really more from a pragmatic and implementation perspective.

15克的分量基本就相当于一叉子。

15 grams of it's basically a fork.

因此在实际操作层面，与其说是15克，不如直接视为零。

So for all intents and purposes, at a practical level, it might as well be a zero rather than the 15.

所以整体来看——我们不妨先搁置动物源性食品这个话题，因为有时会陷入不必要的争论泥潭。

And so what you end up with across the board and even let's move away from the animal sourced foods because that's where we can sometimes get unnecessarily bogged down in in some argumentation.

即便是植物源性食品也存在明显的摄入限制，这本身就可能带来挑战。

But even in relation to plant sourced foods, there are limitations on intake that are evident, and that can itself be be tricky.

比如大豆类食品在饮食模式中被限制在每日50克左右——这对正在调整饮食结构的人来说，

I think for people if they were making changes to diet, like for example, you could have something like soy based food intake, which in has has in the diet pattern been given a limitation of about 50 grams a day.

特别是那些有运动习惯或训练需求、正从以动物性食品为主转向植物性食品为主的人群，

And for anyone, for example, if they're transitioning from a more animal predominant diet to a plant predominant diet is likely, especially if they're recreationally active or involved in training.

我很难想象有人能仅靠每天50克豆制品或75克豆类来满足需求。

I can't imagine anyone being within 50 grams of soy food intake or legumes 75 grams a day.

我认为任何转向这种饮食模式并开始增加例如扁豆或其他食物类别摄入的人

I would say anyone who's shifting to that kind of dietary pattern and starting to increase consumption of, for example, lentils or other food groups.

我的意思是，75克作为一份餐食根本无法维持任何稍有体力活动的人

I mean, 75 grams is not going to sustain anyone that I that is remotely physically active as a serving.

因此我认为这是一种有趣的饮食模式，因为大多数其他先验饮食质量评分都基于消费水平，这些评分在不受限制的背景下追求更高摄入量

And so I think it's an interesting dietary pattern insofar as most other a priori dietary pattern quality scores are based on levels of consumption that are scoring for higher levels of intake within the context of not being defined by restriction.

而《柳叶刀》饮食则更像是一种负向评分的饮食模式

Whereas the Eat Lancet diet is almost like a negative scoring dietary pattern.

这是一种主要基于对所有评分食物进行限制的饮食模式

Like, it is a dietary pattern that is based primarily on restriction of across all foods that it scores for.

与其他饮食模式不同，比如替代健康饮食指数会逆向评分与不良长期健康风险相关的特定食物

So it's not whereas other dietary patterns, if you're looking at the alternate healthy eating index, for example, will inversely score for certain foods associated with adverse long term health outcome risk.

所以它会负面评价钠的摄入

So it'll negatively score for sodium.

它会对含糖饮料进行负面评价

It'll negative negatively score for sugar sweetened beverages.

它会对红肉的高摄入量给予负面评分，而对水果蔬菜、低脂乳制品等则给予正面评分。

It'll negative negatively score for higher intakes of red meat, and then it'll positively score for fruits and vegetables and low fat dairy and stuff like that.

而这种饮食模式则完全基于全面限制，其推荐摄入量似乎严重缺乏对普通人群日常饮食习惯的任何实际考量。

Whereas this is entirely across the board a diet pattern where the recommended intakes are based on a degree of restriction that seems to really lack any sort of pragmatic consideration for how people eat in the day to day their day to day life in the general population.

我认为这一直是我对此的主要批评点。

I think that's always been my kind of major critique of this.

关于这个问题有两个方面。

Two parts of that.

第一，我们是否看到对某些食物的限制，比如大豆类食品或豆类——这些通常被认为是健康促进型食物，且肯定不会与负面健康结果相关联。

One, are we seeing limits on, say, certain foods, like whether it's a soy based food or legumes, which we would generally say are within that health promoting category and certainly aren't associated with negative health outcomes.

这种限制是否仅仅因为该框架的设定理念是从可持续性角度最小化对地球的影响，而非基于超过特定摄入阈值会导致负面健康结果的考量。

Are we seeing limitations placed on that just as a function of how this kind of framework is set up with the idea of minimizing impact to the plan hours from a sustainability point of view rather than saying that there's a negative health outcome from going beyond a certain threshold of intake.

是的。

Yeah.

确实如此。

That's so yeah.

这一点需要澄清清楚。

That's important to clarify.

不。

No.

举例来说，我们并未看到对豆类的限制，也没有针对树坚果、花生、水果或蔬菜设定严格的摄入范围，仅仅基于某种健康评估。

We're not seeing, for example, restrictions on lagoons or really specified tight ranges on tree nuts and peanuts, for example, or fruits or vegetables simply based on some sort of health assessment.

显然，这些食物都与积极的健康结果相关。

Obviously, these are foods that are associated with positive health outcomes.

我们总体上希望人们增加这类食物的摄入。

We want people to increase consumption generally.

整体范围和推荐摄入量是为了提炼饮食对环境的影响、营养充足性与健康效应之间的关系，最终形成一种能兼顾所有这些方面的饮食模式。

The overall ranges and recommendations are the attempt to distill the relationship between environmental impacts, nutritional adequacy of the diet, and the health effects into a diet that essentially covers all of those bases.

这意味着该模式能显著减少饮食对环境足迹的影响，同时满足营养充足性要求，并总体上促进人类健康——只要人们遵循这些建议。

That is that it has meaningful reductions on environmental impacts of a diet in terms of footprint, also covers basis for nutritional adequacy and promotes human health overall as far as adherence to those goes.

正因如此，这种试图将多方面因素融合提炼的饮食模式才显得如此独特。

And so that's what makes it quite unique as far as an attempt for a dietary pattern to distill those various aspects together.

而显然，之前的饮食模式——无论是采用地中海饮食评分、替代健康饮食指数、健康饮食指数，还是MIND饮食评分——都未考虑饮食对环境的影响。

Whereas obviously previous dietary patterns, if we're using a Mediterranean dietary pattern score, if we're using the alternate healthy eating index or the healthy eating index, if we're using the MIND diet score, none of these include any consideration the impacts of diet.

它们只是基于食物及食物组与健康结果之间的先验关系进行评分，这是唯一的考量因素。

They are simply scoring a priori based on relationships between foods and foods groups and health outcomes, and that's the only consideration within that.

甚至没有将营养充足性纳入考虑范围。

It's not even a consideration of nutritional adequacy.

地球健康饮食必须更加聚焦于营养充足性，因为其隐含目标是在构建饮食框架时，既要同步降低饮食的环境足迹，又不能损害人类健康，还要促进健康，这使得平衡更为困难。

The planetary health diet has to consider nutritional adequacy with much more focus because implicit in attempting to frame a diet that concomitantly reduces the environmental footprint of diet while also not compromising human health and indeed promoting human health, that makes it a bit trickier.

因此，除了整体饮食对健康的潜在影响外，营养充足性评估成为其中的重要组成部分。

And so the nutritional adequacy assessment becomes a huge component of this in addition to the potential health impacts of the overall diet.

所以，建模中内置的核心逻辑是：如果我们推动人群转向某种饮食框架，就能在该规模上看到部分效益。

So, and that's what's built into that modeling is the inherent idea that if we shift the population to a certain type of eating framework, hence we will see some of the benefits at that scale.

但正因如此，我们需要确保如果大规模推广，这些食物种类都有充足的供应。

But given that, hence why we need to make sure that there's enough provision for all of those types of foods if it was done at a large scale across populations.

可能需要补充的另一点是：虽然某些上限以每日克数为单位标注，但可以将其视为平均值来理解。

And probably one of the other points just to cover off it that also gets raised is with some of those upper limits, let's say, whilst they might be noted in grams per day, you could think of that as an average.

如果有人不是每天都摄入这些食物组，他们可以考虑用周平均值来代替日平均值。

Someone might be able to think of a weekly average instead of that if they weren't consuming those food groups every day.

虽然影响不大，但这意味着可以灵活安排特定的一餐。

Doesn't make it incredibly big, but it would mean that, okay, there's a way to fit in a certain meal.

但你提出的那些实际难题依然存在，比如你提到的大豆制品上限，即使我们以周为单位而非日限值来考虑。

But those potential pragmatic problems you raise are still present there because if you, like, take those soy based limits that you mentioned, even if we were to look at that on a weekly timescale instead of the daily limit and think of that over the course of a week.

如果有人一周吃一两次正常分量的豆腐，可能就已经接近推荐的上限量了。

If someone had a reasonably sized serving of some tofu even once or twice, they might be getting close to some of these limits that are recommended.

再者，如果有人试图将其作为蛋白质来源，从个人实践角度而言，确实可能存在潜在问题。

And again, if someone is trying to rely on that as a protein source, again, pragmatically for individuals, there could be potential issues there.

是的。

Yeah.

我认为这种饮食方式...确实如此。

And the I think the diet within that, like yeah.

正如你所说，从周摄入量的宏观层面来思考，可能是考量这些以日均克数设定阈值更好的方式。

The thinking in terms of the weekly macro level of intake, as you described, is probably, I think, a better way to consider some of these thresholds that are established in the average gram per day range and indeed yeah.

抱歉。

Sorry.

平均每日摄入克数及其浮动范围。

The average gram per day intake and the range around that.

但即便转向以植物为主的饮食，某些食物仍极易在单日摄入量上超标，这意味着任何周均估算或推算同样会超出限制。

But it's still a diet that with some of those foods that if people are naturally shifting to a more plant predominant diet would be very easy to exceed on that even at a daily level, meaning that any weekly approximation or extrapolation of that is going to exceed that as well.

因此，这是一种以灵活性为特征的饮食模式。

So it's a it's a dietary pattern that is characterised by its flexibility.

他们确实讨论了2025年报告的一个重点，即它涵盖了所有这些不同的饮食模式。

And they do discuss a big focus of the 2025 report is that actually this covers all these different dietary patterns.

它可以应用于类似鱼素主义的饮食场景。

It can be applied in a kind of pescatarian context.

它同样适用于纯素食或素食场景，并且涵盖了不同饮食文化——在提供的摄入量范围内，能满足这种广泛的灵活性。

It can be applied in a vegan or vegetarian context, and it also covers different food cultures within different within the ranges that are provided provide an intake range for that satisfies this broad flexibility.

我认为这其中有一定道理。

I think there's a degree of truth in that.

我的意思是，对于动物源性食品，甚至包括各种植物源性食品，如豆类、树坚果、花生、块茎和淀粉根类。

I mean, with the animal sourced foods, mean, with even with various of the plant sourced foods like legumes, tree nuts, peanuts, and tubers and starchy roots.

该范围的低端为零。

The low end of the range is zero.

对于每一种动物源性食品——乳制品、家禽、高效海鲜、蛋类和红肉，其摄入量参考范围的低限都是零。

For the animal sourced foods, for every single one of them, milk or dairy, chicken and poultry, efficient seafood, eggs, and red meat, the low intake reference range is zero.

因此，你可以看到这种饮食模式如何在纯素食背景下具有适应性。

So, yes, you can see how that dietary pattern can be adaptable in a vegan context.

你可以看到在这些范围内存在适应不同需求的灵活性。

You can see how there's flexibility within the ranges to accommodate different.

显然它可以涵盖一种鱼素饮食。

It obviously could encompass a pescatarian diet.

但再次强调，平均摄入量——让我们以鱼素饮食为例，因为我认为这能说明即使我们推算到每周摄入量时也可能略显棘手。

But again, the average intake let's take a pescatarian diet for a second because this is I think is instructive of where this can even when we extrapolate up to weekly intake could be slightly tricky.

假设一个人是鱼素者，现在要遵循这种饮食模式，那么他们将排除所有动物性食品，转而强调植物源性食品和脂肪成分的摄入，并且确实会食用鱼类。

So assuming that an individual is a pescatarian and is now going to follow this dietary pattern, so they're excluding all animal foods and then they're emphasizing the rest of the diet in terms of the plant sourced foods and the fat components and they do have intake of fish.

鱼类推荐摄入量为每天30克，范围是0到100克。

So recommended intake of fish is thirty grams a day, zero to 100 as the range.

因此在鱼素饮食背景下，人们可能并不需要每天都吃鱼——比如一块三文鱼排大约就有180克。

So that's still going to be a diet in a pescatarian context where someone's likely not eating fish necessarily every I mean, one salmon darn, for example, like a salmon fillet is probably going to be around a 180 grams.

即便你将其推算到每周摄入量，许多遵循鱼素饮食的人可能刚好处于这个范围的上限，但即便如此也未必能做到每天都吃鱼——如果他们想严格遵守这个标准的话。

So even when you extrapolate out to a weekly level, it's likely that a lot of people following pescadarian diets would be actually right up at the maximum amount of that range in order to be accommodating this diet and would probably still not necessarily be in a position to consume fish every single day, for example, if they were going to comply with that.

是的，它确实具有灵活性，但这种灵活性是建立在所有食物类别都非常严格的摄入参数基础上的。

So, yes, it does have flexibility, but that flexibility is in the context of very tight parameters of intake across all food groups.

正如我所说，这不仅限于《柳叶刀》饮食中动物性食物部分。

Like I said, this is not exclusive to the animal sourced components of the Elancet diet.

所以我们认为这不是一个规定性饮食，而是一个需要遵守这些摄入量范围的框架。

So we have this as not being a prescriptive diet, rather this framework with these ranges to fall within.

就像你说的，这确实在名义上提供了灵活性——你可以根据任何特定饮食类型进行调整。

And like you say, that does give flexibility nominally in a sense that, okay, you can adapt that to whatever particular type of diet.

但从实际角度来看可能缺乏灵活性，因为真正实施这个饮食方案需要你进行大量思考才能满足所有要求。

But also there's maybe a lack of flexibility in a pragmatic sense in that actually trying to implement this requires you to have a lot of thought perhaps to be able to formulate that, to tick all the boxes, so to speak.

你不能简单地遵循，哦，我要在这种背景下继续我平常的鱼素饮食。

You can't just follow, oh, I'm gonna follow my typical pescatarian diet in this context.

突然间你一周吃了三份鱼，假设吃了三份三文鱼，就已经达到了一周100或700克的上限。

And suddenly you have three servings of fish across the week and you've already hit that upper limit of a 100 or 700 grams across the week after having three salmon dairns, let's say.

仅举一个例子，不包括其他任何东西。

Just as an example, without including anything else.

所以你确实有灵活性来安排任何你想要的饮食，但可能需要一定程度的细节关注，以确保它保持在给定的参考范围内。

And so you do have flexibility to to set up whatever you want, but may require a certain amount of attention to detail in order to make sure it is staying within those references that are given.

是的。

Yeah.

没错。

Exactly.

这就是为什么在流行病学和应用基于PhD的饮食质量评分时，大多数情况下。

And this is why for the most part in the epidemiology and the application of a diet quality score that's based on the PhD so far.

我认为我们经常看到PhD与其他参考健康饮食模式评分系统观察到的关联之间差异不大，主要是因为它们最终评分的是相对相似的特征。

I think we see often relatively little meaningful difference between associations observed for the PhD versus associations observed for other reference healthy dietary pattern scoring systems that we have, largely because they're actually ultimately scoring for relatively similar characteristics.

因此在《柳叶刀》饮食指南背景下，比如更高的全谷物摄入量、更多的水果蔬菜摄入、鱼类消费等。

And so that will be in the context of the Eat Lancet diet, like higher whole grain intake, higher fruit and vegetable intake, fish consumption, for example.

所以这些食物因摄入量较高而得分，但可能这些食物各自的摄入范围甚至不在饮食指南推荐范围内。

And so they're being scored for higher intakes of these foods, but possibly in ranges that are not even individually for these foods within ranges recommended in the diet itself.

因此在流行病学背景下，行星健康饮食评分本质上可能基于所研究人群的饮食习惯在许多方面是可互换的。

So the planetary health diet score in an epidemiological context is essentially possibly interchangeable in many respects based on the population diets that they're being examined in.

对吧？

Right?

因为应用该评分的队列研究人群并非都遵循这种特定饮食模式。

Cause it's not as if the cohort studies in which it's being applied are people following this particular dietary pattern.

对吧？

Right?

这是将评分系统应用于他们现有的饮食习惯。

It's the application of a scoring system to their existing diets.

这就是我们目前掌握的与此相关的证据。

That's the evidence that we have so far in relation to this.

显然，我们目前还没有任何干预性证据能具体展示这种饮食在高依从性背景下的应用效果。

And we obviously don't have any intervention evidence specifically applying this diet in like high adherence context, at least yet.

因此我们采用了一个评分系统，这与流行病学中膳食模式评分的应用方式一致，但我们是基于观察到的实际人群饮食结构进行评分。

So we're applying a scoring system, which is consistent with how diet diet pattern scores are applied in epidemiology, but we're applying it to a population diet as we find the population diet.

这种饮食模式中某些方面自然会在大众摄入量中更普遍，因而可能获得更高评分。

And there are naturally aspects of the dietary pattern that are going to be more prevalent within that intake and possibly scored higher.

而该饮食模式中某些方面可能默认就处于建议范围内。

There are aspects to the dietary pattern that maybe by default are within range.

例如，在《柳叶刀》饮食评分体系中，坚果和花生部分的实际应用很少见到人群每日摄入量超过75克——这是建议范围的上限值。

For example, like it would be rare to see the application of the nuts and peanuts and tree nuts component of the Eat Lancet diet score and a range of seeing people consume, for example, over 75 grams per day in a population diet, which is the upper range.

75克/日是这个摄入范围的上限。

Seventy five grams per day is the upper limit of the range.

所以平均而言，人们可能连建议的每日50克摄入量都达不到。

So, yeah, on average, people are probably not even consuming the recommended gram intake for that, which is fifty grams a day.

在普通人群的日常饮食中，这个数值甚至可能更低。

And kind of average population diets, it might even be less than that.

确实如此，这种情况在饮食模式评分中总是发生。

So you do and this is the this always happens with dietary pattern scores.

你会得到默认评分，这并不一定直接反映对饮食的遵循程度。

You get default scoring that's not necessarily a reflection of direct adherence to the diet.

它更多反映的是应用评分时所在群体的普遍背景饮食状况。

It's just more a reflection of the general background population diet in which you're applying the score.

这是个重要的方法论要点，在我们梳理这些研究时需要特别注意。

That that's already important point on methodologically that people should keep an eye out for as we walk through some of these studies.

正如你从2019年的初始报告中已经注意到的，我们有很多假设是基于某些模型建立的。

And as you've noted already from that initial 2019 report, we had a lot of the presumptions based on some modelling.

从那时到最近的报告之间的这些年里，正如你所说，我们获得了更多数据——虽然不是直接通过实验测试这一点，而是通过观察大型队列研究，运用这些评分方法来检验我们是否遵循了某种评分模式，从而激活了我们正在研究的内容，以及我们可能看到的健康结果类型。

In the intervening years from then until the more recent report, we've got more data coming through now that have, as you said, not experimentally tested this per se directly, but rather looking at large cohorts that we have using some of this scoring to see if we have adherence to a scoring pattern that activifies what we're looking at here, what type of health outcomes we may see.

因此我们或许可以开始梳理其中一些内容，看看是否能从中提取出有用的信息。

So we can maybe start working through some of these to see if there's anything useful to take out from this.

或许我们可以先从关于死亡率的数据开始，已有几项分析通过大型队列研究（包括NHANES数据、英国生物银行数据，以及我们可能会提到的几个瑞典队列）对此进行了研究，并观察了与全因死亡率以及其他可能出现的慢性病风险相关的结果。

Maybe if we start first with some of the data around mortality, we've had a couple of analyses look at this that have taken large cohorts, whether that's we have NHANES data, UK Biobank data, we've got a couple of the Swedish cohorts we might mention that have gone through some of this and looked at outcomes related to all cause mortality as well as some of the other chronic disease risk that we might see as well.

那么在这部分文献中，有哪些特别值得强调的研究可以帮助我们理解这些结果背后的机制？

So from this area of literature, there any in particular that are worth highlighting here that can be instructive to give us an idea of what might be going on with some of these outcomes?

是的。

Yeah.

我认为2025年王和同事的论文（实际上非常新，9月份发表的）是个很有用的切入点，因为该分析包含了两项前瞻性队列研究。

I think the there's a 2025 paper, actually very recent, September, from Wang and colleagues, which I think is quite a useful point of departure because the analysis included two prospective cohort studies.

这项研究基于美国国家健康与营养调查（NHANES）的数据。

So it was based on The US National Health and Examination Survey data.

具体是1999年至2018年间的NHANES数据。

So the NHANES data between 1999 and 2018.

同时还纳入了2006至2010年招募的英国生物银行数据。

Also included data from the UK Biobank between 2006, 2010 enrollment.

在单独分析行星健康饮食依从性与全因死亡率风险、特定原因（如心血管疾病和癌症死亡率）关联的基础上，他们还对37项已发表的队列研究进行了荟萃分析，这些研究都应用了行星健康饮食。

And then it also in looking individually at the associations between adherence to the planetary health diet and risk of all cause mortality and cause specifics of, for example, cardiovascular disease and cancer mortality in those individual cohorts, it also then conducted a meta analysis of 37 published cohort studies in which the planetary health diet has been applied.

在此过程中，他们通过14个膳食成分的评分系统对行星健康饮食进行了评分。

Within this, they scored the planetary health diet by giving a score based on the 14 dietary components.

他们将摄入量分为充足、适度和最佳三个等级，这些等级基于不同的摄入范围。

They had adequate, moderate, and optimal categories with a range of intake that was based and it differed.

这一点对于所应用的队列研究来说非常重要。

This is again important relative to the cohort being applied.

因此他们将依从性评分分为五等分。

So they divided the adherence scores into quintiles.

在NHANES数据中，最低五分位数的评分介于10到35分之间，最高则是51到95分。

In the NHANES data, the lowest quintile was a score between ten and thirty five, the highest was between 51 to 95.

在英国生物银行数据中，最低评分是17到52分，最高五分位数是68到110分。

In the UK Biobank, the lowest score was 17 to 52, and the highest quintile was 68 to 110.

因此饮食模式评分的应用就是基于这些摄入量五分位数进行高低对比分析。

And so the application of the diet pattern score was the high versus low analysis based on those quintiles of intake.

其中，对NHANES数据的分析显示，与最低依从性相比，对地球健康饮食最高依从性可使全因死亡率风险降低23%，心脏病风险降低19%。

And within that, the analysis of the NHANES data, for example, showed all cause mortality twenty three percent lower risk comparing the highest level of adherence to the planetary health diet to the lowest, nineteen percent lower risk of heart disease.

在英国生物银行数据中也观察到类似的关联强度，全因死亡率风险降低16%，他们特别研究的癌症死亡率风险也降低了16%。

In the UK Biobank there were similar strength of association broadly, all cause mortality sixteen percent lower risk, cancer mortality which they looked at in the UK Biobank sixteen percent lower risk of mortality.

随后进行的荟萃分析得出了大体相似的结论，该分析基于37项队列研究，涵盖超过300万参与者，比较了对行星健康饮食最高与最低依从性之间的差异。

And then the meta analysis producing largely similar examination, which is based on 37 cohort studies, including over 3,000,000 participants comparing highest versus lowest adherence to the planetary health diet.

这种最高与最低依从性的对比在营养学荟萃分析中很典型，其定义方式各有不同，这也是我提及NHANES和生物库研究的原因。

That highest versus lowest as is typical in nutrition meta analysis is characterised and defined differently, is why I mention it in relation to NHANES and Biobank.

例如在英国生物库数据中，高五分位数组的日常饮食评分更高。

So for example in the UK Biobank there's higher habitual scores in that higher quintile.

但我们观察到相似的结果：荟萃分析显示心血管疾病死亡率风险显著降低17%，癌症死亡率风险降低11%，而特定癌症部位如结直肠癌、肺癌的风险降低幅度也相近。

But we're seeing similar outcomes cardiovascular disease mortality was looked at in the meta analysis and seventeen percent lower risk statistically significantly lower risk of cardiovascular mortality, cancer mortality eleven percent lower risk, and then specific cancer sites such as colorectal cancer, lung cancer were associated with similar magnitudes of risk reduction.

肺癌的实际风险降低更为显著，总体风险降低达32%。

Lung cancer actually a stronger risk reduction overall was thirty two percent lower risk.

在心血管疾病中，冠心病风险同样降低17%，糖尿病风险也有所下降。

Coronary heart disease, specifically within cardiovascular diseases, seventeen percent lower risk as well, lower risk of diabetes.

剂量反应关系显示出明确的线性负相关，即对行星健康饮食的依从性越高，这些相应结局的风险就越低。

So dose response relationships showed a clear linear inverse relationship, so increasing adherence to the planetary health diet associated with lower risk of these respective outcomes.

这些发现在排除早期（两年或五年内）死亡病例后仍保持相对一致。

And these were relatively consistent across, for example, exclusion of early mortality cases within two or five years.

在NHANES数据中，与大多数结局的关联尤其体现在癌症死亡率上，而心脏病死亡率的关联在排除早期死亡病例后不再显著。

The association with most outcomes in the NHANES data held for cancer mortality in particular, the relationship with heart disease mortality did not remain after exclusion of those early deaths.

这表明，可能是入组时较高的风险水平解释了这些关联。

So that indicates that perhaps higher risk coming into the cohort may have explained those associations.

但总体而言，无论是分别分析英国和美国这两个高收入国家人群的队列研究，还是结合荟萃分析，都相对清晰地表明：更高的行星健康饮食评分依从性与全因死亡率、心血管疾病死亡率及癌症相关死亡率的降低存在关联。

But again, overall with the either the two individually analyzed cohort studies in different populations, UK and US, so both high income country populations, And then the added meta analysis providing a relatively clear picture or at least consistent picture in these cohorts that higher adherence to the planetary health diet score was associated with lower risk of all cause mortality, cardiovascular mortality, and cancer related mortality.

该饮食模式还与更低的温室气体排放相关，这体现了其在行星健康和人类健康双重维度上的价值。

It was also associated with lower greenhouse gas emissions, so that's the dual component aspect of the diet in terms of the planetary and human health component.

如果我们考虑这些死亡率结局以及心血管疾病或其他代谢疾病，其他队列研究也呈现类似的图景。

So if we think of those outcomes of mortality as well as things like cardiovascular disease or other metabolic disease, we also have other cohorts that kind of show us a similar picture.

瑞典有几项研究显示，当采用行星健康饮食指数评分时，与全因死亡率相关的某些结局存在类似关联。

There's a few from Sweden that have a similar type of associations when we're looking at this scoring of these planetary health diet indices and some of these outcomes related to all cause mortality.

其中包括卡罗林斯卡学院团队的一项分析。

There's one of those, analyses by the group from the Karolinska Institute.

我们还有马尔默饮食与癌症队列研究。

We also have the Malmo Diet and Cancer Cohort.

关于这些具体分析或出版物，我们是否发现任何与众不同或值得特别评论的内容，这些内容在您提到的王分析及其对英国和美国数据的研究中未被涵盖？

With regard to any of these particular, analyses or publications, do we see anything different or that jumps out as something that's worthy of comment that isn't covered from what you would have referenced with regards to, let's say, the Wang analysis and the Wang analysis of UK and The US data.

皮特及其同事的论文关注的是两个瑞典队列。

Pitt and colleagues' paper, they were looking at two Swedish cohorts.

一个是瑞典男性队列，另一个是瑞典乳腺X光摄影队列。

One is the cohort of Swedish men and the other is the Swedish mammography cohort.

因此这些队列要么完全由男性参与者组成（如瑞典男性队列名称所示），要么完全由女性参与者组成（瑞典乳腺X光摄影队列）。

So these are cohorts that are either exclusively, obviously as the name implies for the cohort of Swedish men, male participants and the Swedish mammography female participants.

这是一项按性别分层结果的分析。

So this is an analysis then who in which the outcomes were stratified by sex.

参与者数量相对接近，瑞典男性队列有略超过3.55万名男性，瑞典乳腺X光摄影队列有3.25万名女性。

And there was relatively similar part numbers of participants who had just over 35 and a half thousand men in the cohort of Swedish men and 32 and a half thousand women from the Swedish mammography cohort.

观察EAT-Lancet饮食模式评分时，这个评分体系有所不同。

Looking at an EAT Lancet dietary pattern score, this did score differently.

它采用了与王及其同事研究中NHANES和英国生物银行数据不同的依从性评分矩阵，其中14个食物组分各设0到10分以反映该食物组的依从程度，所有组分总分相加后使得实际评分范围要大得多。

It used a different adherence scoring matrix to the previous application in the Wang and colleagues study of the NHANES and UK Biobank data, which within each of the 14 food components had a score of zero to 10 relative to adherence within that food group, and then the sum of all of those across all 14 added up to so that the actual scoring range was a lot larger.

而在这里，他们仅采用了0到14分的评分标准。

Whereas in this, they simply had a zero to 14 score.

基本上，如果遵循了《EAT-Lancet》饮食中基于性别的建议就得1分，不遵循则得0分。

So it was basically a one if there was adherence to the sex based recommendations of the Eat Lancet diet or a zero if they weren't adherent to that.

因此，他们记录的每日膳食摄入量或推荐摄入量（以克为单位）是相对于每日推荐总能量摄入而言的。

And so they had the dietary intake or the recommended intake in grams per day was relative to the recommended total daily energy intake.

这就是存在性别差异的原因。

So that's why there's the sex specific difference.

男性以每日2500卡路里为参考标准，

So for men, it was a reference of two and a half thousand calories a day.

女性则以每日2000卡路里为参考标准，其中各食物组分的克数摄入量也略有不同。

For women, it was a reference of 2,000 calories per day, and the gram intake of each of the component food groups within that was slightly different.

例如，谷物的摄入量男性为232克，女性为185克。

So for example, for the intake of grains, that was 232 for men under 185 for women.

以水果类别为例，男性的摄入量范围为100至300克，女性则为80至240克。

If it was, for example, the fruit category, there's an intake range of a 100 to 300 for men and 80 to 240 for women.

这些就是作为示例的差异类型。

So they're the kind of differences as an example.

然后，若在该范围内遵循中位数则得1分，否则得0分。

And then it was either a one for adherence within that range, the median within that range, or zero.

总分14分被划分为：低依从性0-4分，中等依从性5-7分，高依从性8-11分及以上。

So either a total score of 14 categorized then as low zero to four, moderate adherence a score of five to seven, or high adherence a score of eight to 11 or over.

他们主要观察的结局指标包括新发癌症、心血管事件和全因死亡率。

And they were looking at primary outcome of incident cancer, cardiovascular events and all cause mortality.

以全因死亡率为例，最高依从性组男性与最低依从性组相比——

And for the outcomes of for example all cause mortality, with men the highest adherence compared to the lowest.

再次强调，超过11分的评分显示：低依从性组全因死亡率风险降低12%（点估计值），但无统计学显著性。

So again this score of over 11 points, so low adherence associated with the point estimate as a twelve percent lower risk of all cause mortality, but it wasn't statistically significant.

置信区间包含1。

The confidence intervals included one.

置信区间上限为1.02，但行星健康饮食评分每增加3分，男性全因死亡率风险显著降低7%。

They went the upper bound of the confidence interval was 1.02, but per three point increase in the planetary health diet score showed a significant association of seven percent lower risk of all cause mortality in men.

因此，风险比为0.93，置信区间范围在0.9到0.95之间。

So the hazard ratio of 0.93 in the confidence intervals range from 0.9 to 0.95.

在女性中，高依从性与低依从性相比，全因死亡率差异显著，高风险组风险降低19%，置信区间上限为0.9，离数值1更远，表明该发现具有更高可信度。

In women, there was the high adherence, high versus low adherence for all cause mortality was significant in the high versus low analysis, nineteen percent lower risk, the upper bound of the confidence interval was 0.9, so slightly further away from one and more confidence in that finding.

每增加三分值，风险同样显著降低9%。

The three point increase was a similar significant 9% lower risk.

在心血管死亡率方面，性别差异同样明显。

With cardiovascular mortality, the sex based differences were also evident.

对男性而言，点估计值显示风险降低17%，但不显著，置信区间上限达到1.08。

So for men, the point estimate indicated a seventeen percent lower risk, but it wasn't significant, the upper band of confidence interval went up to 1.08.

女性风险降低15%，置信区间上限正好落在1.0。

For women fifteen percent lower risk, the confidence interval upper bound was right on one point zero.

因此，在瑞典队列的这项特定分析中，全因死亡率的关联性在效应大小和方向上相对一致——虽然男性组未达统计学显著，但女性组显著。

So the associations for all cause mortality in this particular analysis within the Swedish cohort is relatively consistent with the magnitude of the association and the direction of association, although it's not statistically significant in men, it is in women.

就心血管死亡率而言，其效应方向与Warring及其同事的荟萃分析结果相似。

For cardiovascular mortality, it's again a similar direction of effect to the Warring and colleagues meta analysis.

点估计值的大小相似，但同样不具有统计学显著性。

Similar magnitude of a point estimate, but also not significant.

可能在这个特定队列中，影响这种关系的因素之一是全因死亡率结果具有更高的统计效力。

It could be that in this particular cohort, one of the factors potentially influencing this relationship is the fact that the all cause mortality outcome was better powered.

这项研究进行了22年随访，期间心血管疾病发病率相对较低，特别是在高依从性组中。

There was twenty two years of follow-up in this within which there is a fairly low incidence rate of cardiovascular disease, particularly in the high adherence group.

例如心血管疾病仅有60个病例。

So for example for cardiovascular disease there were sixty cases.

因此这可能是限制整体分析效力的一个因素。

So this could be a factor that limits the power of this analysis overall.

但我认为这仍然很有趣。

But I think it's still interesting.

正如这个团队已经发表了几篇论文，结合两个队列的数据并展示了性别特异性关联的结果。

And as this group have published several papers combining data from both of these cohorts and presenting the data for sex specific associations.

有趣的是看到全因死亡率和心血管死亡率在关联强度上都存在性别差异。

And it is interesting to see those sex differences in the strength of the associations across both the all cause and cardiovascular mortality.

在男性或女性中，高依从性甚至仅模拟线性剂量反应关系均未发现与癌症死亡率存在关联。

There was no association with cancer mortality in either men or women with high adherence or even just modelling a linear dose response relationship.

他们在这项分析中还考虑了食品污染物暴露问题，这可能是相对于其他研究而言具有新颖性的组成部分之一。

They did also in this analysis, which is probably one of the novel components of it relative to some other studies, consider food contaminant exposure.

研究显示，对《柳叶刀》饮食指南更高依从性与膳食中镉、甲基汞、农药及农药残留物暴露增加相关。

And they showed that higher adherence to the Eat Lancet diet was associated with increased dietary exposure to cadmium, methylmercury, pesticide and pesticide residues.

高依从性组的中位/平均暴露水平比低依从性组高出22%至135%。

And that median or average exposure in the high adherence group was between 22 to a 135% higher than in the low adherence groups.

但我认为，尽管这可能成为某些营养学界团体关注的焦点，平均暴露水平仍远低于镉和甲基汞等物质的每周耐受摄入量。

But I think, although this could be something that certain groups in nutrition jump on, the average exposure was still well below the tolerable weekly intake levels, for example, for cadmium and methylmercury.

虽然高依从性组暴露水平相对较高，但可能尚未达到对人体健康结局产生特别关注的范围内，且总体效应方向似乎并未削弱或抵消这种饮食模式带来的积极关联。

So relatively higher with higher adherence, but probably not in a range that's necessarily of particular concern in terms of human health outcomes and certainly in the overall direction of effect does not appear to attenuate or wipe away the positive associations with the dietary pattern within this.

不过这个案例很好地说明：至少在该人群中，这种关联的强度与显著性（相较于Wang等人研究中NHANES或英国生物银行数据）的说服力较弱，且性别特异性差异也值得关注。

But I think it is a good example necessarily that the strength and significance of the association is not necessarily, at least in this population, was less convincing as far as the strength of associations compared to, say, the NHANES or UK Biobank data in the Wang and colleagues study, and the sex specific differences are also interesting.

当我们讨论这项研究整体意义时，可能会再回到这个话题。

And we may return to that when we talk about some of the implications of this in its totality.

不过或许我们可以谈谈其他结果之一，从心血管疾病死亡率事件转向二型糖尿病，我记得张和同事们做过一项分析，研究了多个不同队列，并特别关注了胰岛素相关的二型糖尿病。

But to maybe talk about one of the other outcomes, so moving on from the CVD mortality events, if we look at type two diabetes, there's one analysis that was done by Zhang and colleagues, I believe, that looked at multiple different cohorts and looked specifically at insulin type two diabetes.

我们能否讨论一下这方面的有趣发现，特别是以糖尿病为结果指标，以及我们观察到的与饮食框架依从性相关的内容？

Can we maybe talk about any of the interesting elements around this and with specific reference to diabetes as an outcome and what we're seeing with the adherence to the framework?

好的。

Yeah.

这篇2023年的论文同样是前瞻性队列研究，基于马尔默饮食与癌症研究队列，但特别将二型糖尿病发病作为观察结果。

So this 2023 paper was, again, prospective cohort looking at the within the Malmo diet and cancer study or cohort, but looking specifically at type two incident type two diabetes as an outcome.

这个中等规模或适度规模的队列研究或许可以这样描述：参与者约24,500人，均为瑞典成年人，其中女性占主导（男性参与者占38%）。

Moderately or modestly sized cohort is probably a good way of putting it with just about 24 and a half thousand participants, also Swedish adults, predominantly female cohort in terms of thirty eight percent were male participants.

再次审视EAT-Lancet或行星健康饮食评分时，这项研究采用了不同的指标范围，总饮食模式评分区间为0至42分。

And again looking at an EAT Lancet or planetary health diet score and this was looking at a different range of index where with the total diet pattern score ranged from zero to 42 points.

目前我们已经看到三四项研究，每项研究在评估饮食质量时都采用了略有不同的饮食评分体系。

So we're what, three or four studies in, and each of the studies so far has applied a slightly different scoring matrix for the diet as far as capturing the diet quality goes.

在这个特定的饮食模式评分系统中，评分标准略有不同：高分更倾向于饮食中以植物为主的成分（如全谷物、蔬菜、水果、豆类），而在动物性食品中，只有鱼类和其他不饱和脂肪获得正向评分。

So within this particular dietary pattern scoring system, slightly differed where higher scores were indicating adherence more to the plant based component aspects of the diet in terms of whole grains, vegetables, fruits, legumes, and the primary animal sourced food component that was positively scored for was fish and additionally other unsaturated fats.

这更类似于我们在其他饮食模式评分中看到的情况，其中限制其他动物源性食品、添加糖或饱和脂肪的摄入会被纳入评分，更强调以植物性成分为主（鱼类除外）的饮食结构。

So this is more akin to what we see with some of the other dietary pattern scores where your limited other animal sourced foods or added sugars or saturated fats are scored within that and it's an emphasis more to the kind of plant based, with the exception of fish, components of the diet.

该研究关注了随访期间发生的二型糖尿病病例，约有四千例左右（略多或略少于四千例）。

And so this was looking at insulin type two diabetes during the follow-up period in which there was about four thousand, just over, just under, or just over, sorry, four thousand cases of type two diabetes.

这约占整个队列的17%，可以说是较高的发病率。

This is about seventeen percent of the overall cohort, if you call it a high incidence rate.

在最高依从性组（该队列评分范围为0至42分），得分23分及以上被视为高依从性组。

And in the highest adherence, which for this cohort the range as I said was zero to a maximum of 42 points, the high adherence group was considered a score of 23 points or over.

与依从性低于13分（最低依从性组）相比，高依从性组的二型糖尿病风险降低了18%。

There was an eighteen percent lower risk of type two diabetes compared to an adherence group of less than 13 points, so that was the lowest adherence group.

置信区间显示风险降低幅度在4%至30%之间。

Confidence intervals ranged from 4% to 30% lower.

这项分析的有趣之处在于它还考察了二型糖尿病的遗传风险评分——较高的遗传风险评分会使患病风险独立增加一倍。

And this was an interesting analysis insofar as it also looked at genetic risk score of type two diabetes, so higher genetic risk score independently doubled the risk of type two diabetes.

随后研究人员对高遗传风险评分与低饮食依从性进行了联合分析。

What they did then was look at a joint analysis of the high genetic risk score and low adherence to the diet.

因此，同时具有高遗传风险的2型糖尿病和低依从性的行星健康饮食质量评分的人群，其2型糖尿病风险最高——相比低遗传风险且高饮食依从性群体，风险高出79%。

So the combination of being high genetic risk for type two diabetes and low adherence to the diet quality score for the planetary health diet had the highest type two diabetes risk, seventy nine percent higher risk compared to low genetic risk and high diet adherence.

这是分析中一个有趣的组成部分，考虑到我们现在普遍接受遗传风险是这些疾病中一个已确立的重要因素。

So that was an interesting component of the analysis, think factoring in what we would now accept as a well established aspect to any of these conditions is genetic risk.

他们采用了多基因风险评分，该评分基于多个与糖尿病风险相关的独立基因变异来综合计算遗传风险总分。

They used a polygenic risk score, which scores a total genetic risk score based on several individual genetic variants associated with diabetes risk.

某种程度上这个发现并不意外，基础遗传风险可以通过饮食质量来调节，我们在心血管疾病结局中也观察到类似现象。

And in some ways that finding is not necessarily surprising, like a baseline genetic risk can be modified by diet quality and we would see that with cardiovascular outcomes as well.

但该分析的一个有趣补充在于，相比先前瑞典男性队列和女性乳腺X光检查队列的研究，这项关于长期坚持Eat-Lancet饮食评分与降低2型糖尿病风险关联的分析具有更强的统计效力来检测此类关联。

But an interesting addition to that analysis and again more indicative of the long term adherence to the Eat Lancet diet score associated with lower type two diabetes risk in an analysis that had more power to detect such an association compared to the previous, I think, Swedish cohort of men and mammography cohort in women.

除了慢性病结局（如心血管疾病、糖尿病或全因死亡率）之外，你提到的Samuelson团队今年早些时候发表的关于神经影像生物标志物和认知功能结果的论文也很有意思。

Now beyond some of those outcomes of chronic disease, like cardiovascular disease, diabetes, or even all cause mortality, One of the interesting papers that you brought up was the Samuelson and colleagues paper from earlier this year looking at neuroimaging biomarkers and some cognitive outcomes.

同样基于那些我们可以逐步整合分析的队列数据。

Again, on some of those cohort data that we can start piecing some of this together.

对你而言，为什么这项研究特别引人关注？

Why for you is this a particularly interesting study?

我们能从中获取什么信息？

What can we glean from this?

或许你能带我们了解其中的一些有趣之处？

Maybe can you bring us through some of the interesting elements of that?

是的。

Yeah.

我认为这项研究之所以有趣，是因为之前我们主要关注的是心脏代谢、全因或癌症相关的结果。

So this I think why this study is interesting, just because obviously with the previous papers we've largely been emphasizing cardiometabolic, all cause or cancer related outcomes.

这是少数几项将地球健康饮食模式评分应用于神经退行性风险和大脑模式风险的研究之一，特别使用了MRI脑部测量来观察大脑皮层厚度或阿尔茨海默病特征性皮层厚度。

This is one of the studies that has or one of the few studies that has applied the planetary health diet pattern score in the context of neurodegenerative risk and brain pattern risk, specifically looking at this was using MRI brain measures to look at brain cortical thickness or Alzheimer's disease signature cortical thickness.

这是与阿尔茨海默病相关的特定脑区皮层厚度研究，同时观察了海马体体积。

So this is cortical thickness in specific brain regions associated with Alzheimer's disease and looking at hippocampal volume.

这是少数几项通过脑部MRI和认知测试来研究大脑结构的研究之一，但使其值得关注的不仅是研究结果，还在于这是一项对比研究。

So one of the few studies to look at are brain structures by reference to brain MRIs and also some cognitive tests, but not just the outcome that makes it interesting to consider, but the fact that it's a comparative study.

神经退行性疾病研究绝大多数要么涉及MIND饮食（一种针对已知或先前与认知衰退风险较低或阿尔茨海默病痴呆风险较低相关的特定食物进行评分的饮食模式），但本质上它是将地中海饮食和DASH饮食模式相结合。

The vast majority of research in neurodegenerative disease relates either to the MIND diet, which is a diet pattern scoring for certain foods that are known or previously associated with lower cognitive decline risk or lower risk of Alzheimer's dementia in cohort studies, but it's fundamentally adding those to a combination of the Mediterranean diet and DASH dietary patterns.

因此，这一领域的大多数研究要么专门关注地中海饮食，要么关注MIND饮食。

So most of the research in this area is either looking specifically at the Mediterranean diet or is looking at the MIND diet.

而这项分析为我们提供的是，因为它采用了与之前研究相同的Eat Lancet饮食评分体系（0到42分），以及一个以0到9分计分的地中海饮食评分。

And what this analysis then provides us with, because it applied the Eat Lancet diet score, similar to the previous study we've used at the same scoring measures, so zero to 42, and a Mediterranean diet score which is scored on the zero to nine scale.

由于不同饮食模式的绝对分值范围存在差异，研究者为每种饮食模式创建了标准化评分，并将结果表示为每种饮食模式评分每增加10%的影响。

So because there are obviously different scoring ranges in terms of the absolute numbers, so what they did was they created standardised scores for each of the diet patterns and then expressed the outcomes per 10% increase in each respective diet pattern scores.

这项研究的有趣之处在于，虽然关联性略有不同，但总体结果大体相似。

And what was interesting about this study was slightly different associations, but largely similar outcomes overall.

例如，就皮质厚度而言，EAT-Lancet饮食评分和行星健康饮食评分每增加10%，就与大脑皮质厚度及阿尔茨海默病特定脑区皮质厚度的显著增加相关。

So for example, for cortical thickness, each 10% increase in the EAT Lancet diet scores and the Planetary Health diet scores was associated with a significant increase in cortical thickness in the brain and in Alzheimer's disease specific cortical brain regions.

地中海饮食评分每增加10%，就与整体认知得分的提升相关，而对比饮食则与这些相应结果没有显著关联。

Each 10% increase in the Mediterranean diet score was associated with a higher global cognitive scores, whereas the comparison diet were either not as not significantly associated with those respective outcomes.

以皮质厚度为例，EAT-Lancet饮食与显著增加相关，但地中海饮食则不然。

So for example, for the cortical thickness, the EAT Lancet diet was associated with a significant increase but the Mediterranean diet was not.

在认知得分方面，地中海饮食与认知测试得分的提升显著相关，而EAT-Lancet饮食则无此关联。

For the cognitive scores the Mediterranean diet was significantly associated with increased cognitive test scores but the EAT Lancet diet was not.

我认为当你考虑到这两种饮食模式评分存在高度重叠时，EAT-Lancet饮食同样强调饮食模式中的积极食物，包括蔬菜、水果、全谷物、坚果、鱼类和不饱和脂肪。

And I think when you consider the fact that there's strong overlap between these two dietary pattern scores, so the EAT Lancet diet was similarly was scoring for positive emphasized foods in the diet pattern, which includes vegetables, fruits, whole grains, nuts, fish, and unsaturated fats.

地中海饮食评分也因强调蔬菜、水果、全谷物、坚果、鱼类和不饱和脂肪而获得正向评分。

The Mediterranean diet score scores positively for emphasizing vegetables, fruits, whole grains, nuts, fish, and unsaturated fats.

因此这两种饮食模式评分在概念上存在高度重叠，实际上很难强调这两种饮食模式之间可能存在的差异。

So you've really strong conceptual overlap between both of these diet pattern scores, and there's really not much to emphasize in terms of differences that may be present between these two dietary patterns.

所以我认为这个例子说明，在特定饮食模式的流行病学关联研究中，它们所评分的饮食特征从根本上说是高度相似的。

So I think it's an example of how when it comes to epidemiological associations of specific dietary patterns, the characteristics of diet that they are scoring for are fundamentally largely similar.

因此你未必能区分出两种饮食模式之间根本性的独特成分，特别是当你将其应用于人群时——基于他们的日常饮食背景，可以说你是在基础饮食之上应用饮食质量评分。

And so you're not necessarily picking apart aspects of diet that are fundamentally unique between the two dietary patterns, particularly if you're applying it in a population where you're taking them by default of their background diet, you're applying the diet quality score over the background diet, so to speak.

因此你看到的结果大体相似。

So you're largely seeing similar outcomes.

就目前的流行病学研究而言，我并不完全相信行星健康饮食能捕捉到地中海饮食评分或替代健康饮食指数未能捕捉的内容。

And so I think as far as the epidemiology to date goes, I'm not entirely convinced that the planetary health diet is capturing anything that the Mediterranean diet isn't, the Mediterranean diet score, or that the alternate healthy eating index isn't capturing.

我认为这就是为什么我们会在各种饮食模式质量指数与健康结果之间看到相对一致的关联。

And I think that's why largely we'd see relatively consistent associations between various of these dietary pattern quality indices and health outcomes.

基于我们刚才讨论的数据以及2025年发布的报告，你认为人们应该从中获取哪些主要信息？特别是关于EAT-Lancet报告提出的地球健康饮食，我们能得出什么结论？

So with that, and you've maybe already answered this really, but taken that data that we've just discussed together with the 2025 report that's came out as well, For you, what are some of the main things people should take from this in terms of what can we conclude about this planetary health diet put forward by the EAT Lancet report?

我们如何将这一点与我们讨论的其他内容区分开来？

How do we disentangle that from the rest of the stuff we've discussed?

从实践角度来看，目前还有哪些问题尚未解决或未被明确阐明？

And practically, what are some of those things that are still left open or aren't really clarified from what we have to date?

我认为他们采用的方法有很多可取之处，特别是2025年报告展现的工作——这是项跨越多学科领域的综合性巨著，而不仅仅是营养科学。鉴于饮食与全球疾病负担之间压倒性的关联，以及特定膳食成分对此的影响，地球健康饮食的营养构成并不令人意外：这种提倡增加植物性食物（如水果、蔬菜、豆类、坚果等）和鱼类摄入的饮食模式，确实会与降低全球疾病负担和总死亡率相关联。

I think that I think there's a lot to like about the kind of approach that they've taken, and there's absolutely no doubt that the work that has gone into to both, but particularly, I think it's quite evident with the 2025 report, is it's comprehensive work, voluminous work across multiple domains of science and not just nutrition science Based on the overwhelming relationships that we have between diet and global burden of disease and specific dietary components that contribute to that, the planetary health diet and the components of it nutritionally are not particularly surprising that a diet that promotes a kind of shift to higher increases or higher intakes of plant predominant foods like fruits and vegetables and legumes and tree nuts and peanuts and these kinds of foods or fish for example would be associated with lower risk of global burden of disease and total mortality.

例如2025年报告预测，转向地球健康饮食将促成全球总死亡率降低13%至27%，其中半数归因于膳食结构的改善——特别是全谷物、水果、蔬菜、豆类和坚果摄入增加，以及红肉和加工肉制品摄入减少。

And that is something that for example in the 2025 report, the shift to a planetary health diet they predicted would contribute to a thirteen between a thirteen to twenty cent twenty seven percent reduction in global total mortality, half of which would be attributed to specific components of improved diet composition, specifically the whole grains, fruits, vegetables, legumes, and nuts, and lower intake of reduced or lower intake of red and processed meat.

他们提出的环境模型显示，采用地球健康饮食将实现约70%的全球农药使用量下降，并减少畜牧业中抗菌药物使用等，这些都将对食品系统和生产体系产生积极改善。

The environmental modelling would that they proposed would be that a shift to the planetary health diet would contribute to around a 70% global reduction in pesticide application and antimicrobial use in livestock and all of these kind of various components that would be positive improvements in food systems and food production.

就健康结果而言，我认为他们的建模方法存在一定局限性（虽然我对环境方面的建模没有足够专业能力进行评价）...

I think if there's a limitation to some of their modelling methods for purely for the health outcomes, like I don't have enough expertise to really comment at all on the modeling used for the environmental aspects of the planetary health diet.

不过我对健康结果建模的批评是——虽然这个遗漏可以理解——他们的健康评估方法未纳入钠摄入量的影响。

I think if there's a criticism though that I would have of the modeling for the health outcomes, although it's an understandable omission, it's that the health assessment methods excluded effects of sodium intake.

这一点我们之前在多个播客中讨论过，由于在群体层面准确测量钠摄入量需要多次重复的24小时尿液样本，操作上存在困难。

And this is we've discussed this in several podcasts before due to the difficulties of accurately measuring sodium at population levels where you really require multiple repeated twenty four hour urine samples.

当你需要同时涵盖高收入和低收入国家的人群时，这就更具挑战性了。

And when you're including populations from both high and low middle income countries, that can be challenging.

但尽管我理解数据收集的难度，根据2023年全球疾病负担报告，钠摄入确实是饮食相关疾病负担的主要驱动因素。

But that's that is itself as as much as I appreciate the difficulty of that collection, the contribution if you look at global the global burden of disease report 2023, like sodium is the major dietary contributor to that.

因此这可能低估了饮食转变的潜在效果，虽然不确定具体程度，但排除钠的影响确实是个遗憾，因为从饮食角度看，钠是导致全球疾病负担的重要因素。

So how this perhaps either underestimates the potential effects of the shift, I don't know, but it is an unfortunate exclusion because sodium is such a driver of the global burden of disease from a dietary perspective.

这将是模型的主要局限性所在。

So that would be the major limitation to the modelling.

但这是否从根本上改变了我们的总体结论——即转向这种饮食模式预计会降低疾病负担？

But does it fundamentally alter the overall summation that we would have that a shift to this kind of dietary pattern would be predicted to lower disease burden?

我认为并非如此。

I don't think so.

尽管如此，他们在报告中强调，这种转变本质上绝非易事，需要在国家层面实施转型，显然在全球层面还需要国际协调，通过多方政策行动与广泛联盟的不同参与者和利益团体共同推动才能实现。

And I think for all of that, though, they do highlight in the report that this is not something that is going to be easy, essentially, that that that is going to the transformation and the shift requires at a domestic national level and then obviously at a global level requires global coordination, requires multiple policy actions with a wide coalition of different actors and interested bodies in order to bring this about.