# Adherence to the Planetary Health Diet and Its Association with Diet Quality and Environmental Outcomes in Croatian University Students: A Cross-Sectional Study

## TL;DR

This study examines how Croatian university students' diets align with the Planetary Health Diet and their environmental impact, finding moderate adherence and significant links between diet quality and sustainability.

## Contribution

The study provides new insights into the relationship between diet quality and environmental outcomes among Croatian university students using the Planetary Health Diet Index.

## Key findings

- Higher PHDI scores were associated with better diet quality and lower environmental footprints.
- Male students had higher PHDI scores but greater environmental impacts compared to female students.
- Nutrient and food group analysis confirmed the health benefits of diets aligned with the PHDI.

## Abstract

Background/Objectives: University students are at a critical life stage in terms of establishing lifelong dietary habits, yet little is known about the sustainability of their diets, especially in Croatia. This study aimed to assess the sustainability and environmental impacts of university students’ dietary patterns at the University of Rijeka using the Planetary Health Diet Index (PHDI) and to explore the associations with demographic, lifestyle, nutritional, and environmental variables. Methods: A cross-sectional study was conducted from October 2023 to March 2024 among 224 students (54% male, mean age 22.7 ± 2.2 years). Data collection included sociodemographic information, physical activity, and dietary intake (semi-quantitative FFQ). Diet quality was assessed using the PHDI, Mediterranean Diet Score (MDS), and Dietary Inflammatory Index. Environmental impact indicators (carbon, water, and ecological footprints) were calculated using energy-adjusted intake data and standardized life cycle assessment data. Results: Students exhibited moderate adherence to the Planetary Health Diet (mean PHDI: 55.5). Higher PHDI scores were significantly associated with vigorous physical activity, higher MDS, and anti-inflammatory dietary patterns (all p < 0.001). Despite male students showing slightly higher PHDI scores, their diets had significantly greater environmental impacts. A one-point increase in the PHDI correlated with smaller environmental footprints (carbon: β = −7.94; water: β = −13.88; ecological: β = −3.15; all p < 0.001), with a significant decrease observed particularly in the lowest- and highest-adherence groups, while no consistent or significant effects were found in the intermediate groups. The nutrient and food group analysis supported the health-promoting profile of diets aligned with the PHDI. Conclusions: This study highlights the moderate sustainability of students’ diets, with significant associations between diet quality and environmental impacts. University settings present key opportunities for the promotion of sustainable, health-oriented eating behaviors among young adults.