Adherence to the Planetary Health Diet and Its Association with Diet Quality and Environmental Outcomes in Croatian University Students: A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Procedure
2.2. Participants
2.3. Measures
2.3.1. Participants’ Characteristics
2.3.2. Anthropometric Measurements
2.3.3. Dietary Assessment
2.3.4. The Planetary Health Diet Index
2.3.5. Mediterranean Diet Score
2.3.6. Dietary Inflammatory Index
2.3.7. Environmental Impact Indicators
2.4. Statistical Analysis
3. Results
4. Discussion
4.1. Strengths and Limitations
4.2. Implications and Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
NCDs | Non-Communicable Diseases |
PHD | Planetary Health Diet |
MD | Mediterranean Diet |
IPAQ-LF | International Physical Activity Questionnaire—Long Form |
FFQ | Food Frequency Questionnaire |
MET | Metabolic Equivalent of Task |
BMI | Body Mass Index |
PHDI | Planetary Health Diet Index |
MDS | Mediterranean Diet Score |
DII | Dietary Inflammatory Index |
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Variable | N (%) | p-Value | Planetary Health Diet Index | p-Value | Quartile 1 (20–45) | Quartile 2 (46–55) | Quartile 3 (56–65) | Quartile 4 (66–100) | p-Value |
---|---|---|---|---|---|---|---|---|---|
N | 224 (100) | 55.54 ± 13.30 | 57 (25) | 72 (32) | 57 (25) | 38 (17) | 0.019 | ||
Men | 121 (54) | 0.229 | 56.96 ± 11.10 | 0.086 | 23 (40) | 41 (57) | 38 (67) | 19 (50) | 0.038 |
Women | 103 (46) | 53.87 ± 15.48 | 34 (60) | 31 (43) | 19 (33) | 19 (50) | |||
Age (years) | 22.67 ± 2.19 | 22.44 ± 1.97 | 22.89 ± 2.33 | 22.67 ± 2.25 | 22.58 ± 2.18 | 0.704 | |||
Level of study | |||||||||
Undergraduate | 118 (53) | 0.423 | 54.87 ± 12.50 | 0.188 | 45 (79) | 37 (51) | 27 (47) | 20 (53) | 0.004 |
Graduate | 106 (47) | 56.27 ± 14.16 | 12 (21) | 35 (49) | 30 (53) | 18 (47) | |||
Nonsmokers | 168 (75) | <0.001 | 55.83 ± 13.62 | 0.563 | 46 (81) | 51 (71) | 41 (72) | 30 (79) | 0.521 |
Smokers | 56 (25) | 54.64 ± 12.35 | 11 (19) | 21 (29) | 16 (28) | 8 (21) | |||
Body mass index (kg/m2) | 24.11 ± 3.50 | 23.29 ± 2.93 | 24.55 ± 3.86 | 24.08 ± 3.50 | 24.65 ± 3.50 | 0.181 | |||
Underweight | 6 (3) | <0.001 | 53.33 ± 10.33 | 0.750 | 3 (5) | 1 (1) | 1 (2) | 1 (2) | 0.653 |
Normal weight | 139 (62) | 54.93 ± 13.12 | 37 (65) | 43 (60) | 39 (68) | 20 (53) | |||
Overweight | 64 (28) | 56.56 ± 13.74 | 15 (26) | 23 (32) | 12 (21) | 14 (37) | |||
Obesity | 15 (7) | 57.67 ± 14.74 | 2 (4) | 5 (7) | 5 (9) | 3 (8) | |||
Physical activity level | |||||||||
Low | 45 (20) | <0.001 | 57.13 ± 11.32 | 0.101 | 11 (19) | 15 (21) | 12 (21) | 7 (18) | 0.001 |
Moderate | 99 (44) | 53.98 ± 13.98 | 35 (62) | 37 (51) | 16 (28) | 11 (29) | |||
Vigorous | 80 (36) | 58.27 ± 12.56 | 11 (19) | 20 (28) | 29 (51) | 20 (53) | |||
Energy intake (kcal/day) | 2397.59 ± 1197.53 | 1951.67 ± 1233.90 | 2465.86 ± 1164.32 | 2692.25 ± 1135.83 | 2495.12 ± 1151.53 | 0.007 | |||
Mediterranean Diet Score (MDS) | 4.00 ± 1.47 | 3.04 ± 1.27 | 3.96 ± 1.41 | 4.46 ± 1.39 | 4.82 ± 1.20 | <0.001 | |||
Low adherence (MDS ≤ 4) | 141 (63) | <0.001 | 51.63 ± 12.78 | <0.001 | 49 (86) | 49 (68) | 29 (51) | 14 (37) | <0.001 |
High adherence (MDS ≥ 5) | 83 (37) | 62.17 ± 11.45 | 8 (14) | 23 (32) | 28 (49) | 24 (63) | |||
Dietary Inflammatory Index (DII) | 1.07 ± 2.62 | 3.03 ± 2.13 | 1.25 ± 2.49 | −0.19 ± 2.13 | −0.31 ± 2.29 | <0.001 | |||
Pro-inflammatory diet (DII > 0) | 139 (62) | <0.001 | 51.12 ± 13.28 | <0.001 | 53 (93) | 47 (65) | 25 (44) | 14 (37) | <0.001 |
Anti-inflammatory diet (DII < 0) | 85 (38) | 62.76 ± 9.71 | 4 (7) | 25 (35) | 32 (14) | 24 (63) |
Variable | Carbon Footprint (kg CO2 eqv.)/1000 kcal | Water Footprint (m3)/1000 kcal | Ecological Footprint (m2·year)/1000 kcal |
---|---|---|---|
Total | 2.22 ± 0.53 | 1.90 ± 0.34 | 4.83 ± 1.37 |
Men | 2.33 ± 0.53 | 1.95 ± 0.34 | 5.13 ± 1.33 |
Women | 2.11 ± 0.50 | 1.74 ± 0.34 | 4.47 ± 1.33 |
p-value | 0.002 | 0.017 | <0.001 |
Level of study | |||
Undergraduate | 2.27 ± 0.43 | 1.93 ± 0.31 | 4.98 ± 1.22 |
Graduate | 2.17 ± 0.57 | 1.87 ± 0.37 | 4.65 ± 1.50 |
p-value | 0.137 | 0.186 | 0.077 |
Smoking status | |||
Smokers | 2.25 ± 0.55 | 1.89 ± 0.34 | 4.81 ± 1.34 |
Nonsmokers | 2.21 ± 0.53 | 1.90 ± 0.34 | 4.83 ± 1.38 |
p-value | 0.643 | 0.812 | 0.920 |
BMI category | |||
Underweight | 2.26 ± 0.29 | 1.86 ± 0.12 | 4.76 ± 0.66 |
Normal weight | 2.22 ± 0.57 | 1.91 ± 0.37 | 4.83 ± 1.48 |
Overweight | 2.15 ± 0.48 | 1.85 ± 0.30 | 4.67 ± 1.23 |
Obesity | 2.49 ± 0.32 | 2.05 ± 0.21 | 5.43 ± 0.78 |
p-value | 0.176 | 0.242 | 0.278 |
Physical activity level | |||
Low | 2.18 ± 0.52 | 1.86 ± 0.34 | 4.72 ± 1.31 |
Moderate | 2.27 ± 0.54 | 1.92 ± 0.35 | 4.90 ± 1.41 |
Vigorous | 2.13 ± 0.51 | 1.88 ± 0.32 | 4.71 ± 1.32 |
p-value | 0.216 | 0.632 | 0.587 |
Mediterranean Diet Score | |||
Low adherence (MDS ≤ 4) | 2.24 ± 0.57 | 1.93 ± 0.37 | 4.87 ± 1.44 |
High adherence (MDS ≥ 5) | 2.19 ± 0.45 | 1.85 ± 0.27 | 4.75 ± 1.24 |
p-value | 0.462 | 0.052 | 0.535 |
Dietary Inflammatory Index | |||
Pro-inflammatory diet (DII > 0) | 2.20 ± 0.60 | 1.91 ± 0.39 | 4.76 ± 1.48 |
Anti-inflammatory diet (DII < 0) | 2.25 ± 0.41 | 1.88 ± 0.24 | 4.93 ± 1.11 |
p-value | 0.492 | 0.448 | 0.333 |
Planetary Health Diet Index | |||
Quartile 1 | 2.46 ± 0.53 | 2.07 ± 0.36 | 5.43 ± 1.30 |
Quartile 2 | 2.20 ± 0.50 | 1.89 ± 0.28 | 4.73 ± 1.27 |
Quartile 3 | 2.15 ± 0.57 | 1.83 ± 00.39 | 4.66 ± 1.45 |
Quartile 4 | 2.01 ± 0.41 | 1.77 ± 0.25 | 4.35 ± 1.26 |
p-value | <0.001 | <0.001 | <0.001 |
Environmental Impact Indicator | PDHI (z-Score) | |||
---|---|---|---|---|
β | 95% CI | p-Value | ||
Carbon footprint (kg CO2 equivalent)/1000 kcal | ||||
Model crude | −7.24 | −10.41 | −4.06 | <0.001 |
Model adjusted | −7.94 | −11.17 | −4.72 | <0.001 |
Water footprint (m3)/1000 kcal | ||||
Model crude | −12.96 | −17.81 | −8.11 | <0.001 |
Model adjusted | −13.88 | −18.76 | −8.99 | <0.001 |
Ecological footprint (m2·year)/1000 kcal | ||||
Model crude | −2.80 | −4.03 | −1.56 | <0.001 |
Model adjusted | −3.15 | −4.41 | −1.89 | <0.001 |
PHDI Quartile 1 | ||||
Carbon footprint (kg CO2 equivalent)/1000 kcal | ||||
Model crude | −3.14 | −6.87 | −0.59 | 0.097 |
Model adjusted | −3.76 | −7.5 | −0.25 | 0.048 |
Water footprint (m3)/1000 kcal | ||||
Model crude | −6.08 | −11.48 | −0.69 | 0.028 |
Model adjusted | −6.93 | −12.27 | 1.59 | 0.012 |
Ecological footprint (m2·year)/1000 kcal | ||||
Model crude | −1.55 | −3.05 | −0.05 | 0.044 |
Model adjusted | −1.57 | −3.06 | −0.09 | 0.038 |
PHDI Quartile 2 | ||||
Carbon footprint (kg CO2 equivalent)/1000 kcal | ||||
Model crude | 0.80 | −0.38 | −1.98 | 0.180 |
Model adjusted | 0.84 | −0.47 | −2.15 | 0.203 |
Water footprint (m3)/1000 kcal | ||||
Model crude | 1.70 | −0.38 | −3.79 | 0.108 |
Model adjusted | 1.74 | −0.51 | 4.00 | 0.127 |
Ecological footprint (m2·year)/1000 kcal | ||||
Model crude | 0.35 | −0.11 | 0.81 | 0.138 |
Model adjusted | 0.38 | −0.14 | 0.90 | 0.148 |
PHDI Quartile 3 | ||||
Carbon footprint (kg CO2 equivalent)/1000 kcal | ||||
Model crude | 0.62 | −0.57 | 1.81 | 0.303 |
Model adjusted | 0.50 | −0.70 | 1.69 | 0.408 |
Water footprint (m3)/1000 kcal | ||||
Model crude | 0.14 | −1.62 | 1.90 | 0.875 |
Model adjusted | −0.05 | −1.82 | 1.72 | 0.955 |
Ecological footprint (m2·year)/1000 kcal | ||||
Model crude | 0.21 | −0.25 | 0.68 | 0.361 |
Model adjusted | 0.14 | −0.33 | 0.60 | 0.548 |
PHDI Quartile 4 | ||||
Carbon footprint (kg CO2 equivalent)/1000 kcal | ||||
Model crude | −3.16 | −8.23 | 1.90 | 0.213 |
Model adjusted | −4.72 | −8.83 | −0.61 | 0.025 |
Water footprint (m3)/1000 kcal | ||||
Model crude | −7.25 | −15.6 | −1.11 | 0.087 |
Model adjusted | −7.98 | −7.44 | −5.42 | 0.005 |
Ecological footprint (m2·year)/1000 kcal | ||||
Model crude | −1.78 | −3.37 | −0.19 | 0.029 |
Model adjusted | −2.79 | −7.86 | −0.27 | 0.056 |
PDHI (z-Score) | ||||||
---|---|---|---|---|---|---|
Mean | SD | β | 95% CI | p-Value | ||
Energy (kcal/d) | 2397.59 | 1197.53 | 2.15 | 0.59 | 3.70 | 0.007 |
Protein (g/d) | 99.48 | 61.85 | −0.38 | −0.69 | −0.07 | 0.017 |
Animal protein (g/d) | 71.06 | 54.23 | −0.46 | −0.71 | −0.22 | <0.001 |
Vegetable protein (g/d) | 28.42 | 13.80 | 1.94 | 1.24 | 2.64 | <0.001 |
Total fat (g/d) | 114.46 | 64.96 | 0.14 | −0.14 | 0.32 | 0.324 |
Saturated fat (g/d) | 38.58 | 26.95 | −1.67 | −2.24 | −1.10 | <0.001 |
Monounsaturated fat (g/d) | 41.57 | 23.31 | 0.80 | 0.36 | 1.23 | <0.001 |
Polyunsaturated fat (g/d) | 22.08 | 11.42 | 12.47 | 4.18 | 20.77 | 0.003 |
Omega-3 fatty acids (g/d) | 1.24 | 0.93 | 19.26 | 13.92 | 24.61 | <0.001 |
Omega-6 fatty acids (g/d) | 0.82 | 0.67 | −39.76 | −55.4 | −24.11 | <0.001 |
Trans fatty acids (g/d) | 2.13 | 1.35 | −14.50 | −20.70 | −8.31 | <0.001 |
Cholesterol (mg/d) | 560.25 | 330.95 | 0.01 | −0.01 | 0.03 | 0.211 |
Carbohydrates (g/d) | 219.50 | 97.56 | −0.10 | −0.21 | 0.02 | 0.105 |
Dietary fibres (g/d) | 21.45 | 10.95 | 2.59 | 1.99 | 3.19 | <0.001 |
Alcohol (g/d) | 13.08 | 18.02 | 0.36 | 0.06 | 0.66 | 0.020 |
Thiamine (mg/d) | 2.10 | 1.36 | 7.67 | −3.76 | 19.09 | 0.187 |
Riboflavin (mg/d) | 2.62 | 1.36 | 4.34 | −1.18 | 11.05 | 0.113 |
Niacin (mg/d) | 24.36 | 13.66 | 0.49 | −0.46 | 1.44 | 0.312 |
Folate (μg/d) | 313.55 | 176.85 | 0.13 | 0.09 | 0.16 | <0.001 |
Pyridoxine (mg/d) | 3.76 | 2.18 | 1.17 | −2.59 | 4.94 | 0.539 |
Cobalamin (μg/d) | 5.69 | 4.09 | −0.51 | −2.53 | 1.51 | 0.622 |
Vitamin C (mg/d) | 109.81 | 65.47 | 0.19 | 0.12 | 0.27 | <0.001 |
Beta-carotene (mg/d) | 3869.23 | 3074.19 | 0.04 | 0.02 | 0.06 | <0.001 |
Retinol (RE/d) | 412.37 | 237.49 | −0.01 | −0.02 | 0.07 | 0.518 |
Vitamin D (μg/d) | 3.44 | 2.59 | 1.31 | −1.22 | 3.84 | 0.308 |
Vitamin E (mg/d) | 14.61 | 12.72 | 1.57 | 1.20 | 1.94 | <0.001 |
Sodium (mg/d) | 4512.87 | 3606.90 | −0.01 | −0.03 | −1.96 | 0.027 |
Potassium (mg/d) | 3485.65 | 1620.74 | 0.02 | 0.01 | 0.03 | <0.001 |
Calcium (mg/d) | 1056.49 | 748.60 | −0.03 | −0.02 | 0.11 | 0.684 |
Phosphorus (mg/d) | 1415.71 | 980.39 | −0.02 | −0.00 | −0.15 | 0.815 |
Magnesium (mg/d) | 370.97 | 187.42 | 0.18 | 0.13 | 0.22 | <0.001 |
Iron (mg/d) | 19.79 | 9.60 | 2.68 | 1.71 | 3.64 | <0.001 |
Zinc (mg/d) | 14.29 | 8.98 | 0.88 | −1.00 | 2.77 | 0.357 |
Selenium (mg/d) | 36.39 | 20.83 | 0.21 | −0.11 | 0.52 | 0.206 |
Iodine (μg/d) | 55.42 | 37.42 | −0.19 | −0.42 | 0.04 | 0.109 |
Caffeine (mg/d) | 195.64 | 190.46 | −0.10 | −0.21 | 0.01 | 0.084 |
Flavan-3-ols (mg/d) | 37.71 | 40.99 | 0.15 | 0.04 | 0.26 | 0.010 |
Flavones (mg/d) | 2.51 | 2.23 | 7.16 | 5.20 | 9.13 | <0.001 |
Flavanols (mg/d) | 132.10 | 97.72 | 0.16 | 0.11 | 0.21 | <0.001 |
Flavonones (mg/d) | 70.15 | 57.08 | 0.11 | 0.03 | 0.20 | 0.008 |
Anthocyanidins (mg/d) | 23.72 | 19.70 | 0.23 | 0.07 | 0.38 | 0.004 |
PDHI (z-Score) | ||||||
---|---|---|---|---|---|---|
Mean | SD | β | 95% CI | p-Value | ||
Nuts and peanuts | 22.23 | 27.21 | 1.38 | 1.03 | 1.74 | <0.001 |
Legumes | 53.02 | 53.19 | 1.41 | 1.43 | 2.40 | 0.005 |
Fruits | 173.29 | 156.38 | 1.40 | 0.86 | 1.94 | <0.001 |
Vegetables | 214.60 | 132.54 | 3.56 | 2.34 | 4.78 | <0.001 |
Whole grains | 28.85 | 23.71 | 0.18 | −0.31 | 0.67 | 0.465 |
Eggs | 40.18 | 37.08 | 0.44 | −0.19 | 1.07 | 0.167 |
Fish | 47.34 | 45.05 | 0.90 | 0.41 | 1.40 | <0.001 |
Tubers and potatoes | 148.75 | 114.59 | −0.03 | −0.44 | 0.38 | 0.876 |
Dairy | 389.78 | 283.52 | −0.46 | −0.69 | −0.23 | <0.001 |
Vegetable oils | 41.57 | 23.31 | 0.90 | 0.43 | 1.37 | <0.001 |
Dark green vegetable ratio | 69.24 | 20.63 | −0.02 | −0.11 | 0.06 | 0.577 |
Red-to-orange vegetable ratio | 30.32 | 20.20 | 0.06 | −0.02 | 0.10 | 0.158 |
Red meat | 158.19 | 147.83 | −0.21 | −0.56 | 0.14 | 0.234 |
Poultry and substitutes | 86.88 | 60.77 | −0.90 | −1.42 | −0.38 | <0.001 |
Animal fats | 38.58 | 26.95 | −18.11 | −24.47 | −11.77 | <0.001 |
Added sugars | 46.48 | 43.32 | −0.57 | −0.84 | −0.27 | <0.001 |
Mediterranean Diet Score | 4.00 | 1.47 | 4.29 | 3.22 | 5.36 | <0.001 |
Dietary Inflammatory Index | 1.07 | 2.62 | −2.91 | −3.51 | −2.32 | <0.001 |
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Kenđel Jovanović, G.; Krešić, G.; Dujmić, E.; Pavičić Žeželj, S. Adherence to the Planetary Health Diet and Its Association with Diet Quality and Environmental Outcomes in Croatian University Students: A Cross-Sectional Study. Nutrients 2025, 17, 1850. https://doi.org/10.3390/nu17111850
Kenđel Jovanović G, Krešić G, Dujmić E, Pavičić Žeželj S. Adherence to the Planetary Health Diet and Its Association with Diet Quality and Environmental Outcomes in Croatian University Students: A Cross-Sectional Study. Nutrients. 2025; 17(11):1850. https://doi.org/10.3390/nu17111850
Chicago/Turabian StyleKenđel Jovanović, Gordana, Greta Krešić, Elena Dujmić, and Sandra Pavičić Žeželj. 2025. "Adherence to the Planetary Health Diet and Its Association with Diet Quality and Environmental Outcomes in Croatian University Students: A Cross-Sectional Study" Nutrients 17, no. 11: 1850. https://doi.org/10.3390/nu17111850
APA StyleKenđel Jovanović, G., Krešić, G., Dujmić, E., & Pavičić Žeželj, S. (2025). Adherence to the Planetary Health Diet and Its Association with Diet Quality and Environmental Outcomes in Croatian University Students: A Cross-Sectional Study. Nutrients, 17(11), 1850. https://doi.org/10.3390/nu17111850