Cambeses Franco, CristinaGonzález García, SaraFeijoo Costa, GumersindoMoreira Vilar, María Teresa2022-03-142022-03-142021Science of The Total Environment 781 (2021) 146717. https://doi.org/10.1016/j.scitotenv.2021.146717http://hdl.handle.net/10347/27646It is no secret that the world is facing the challenge of transitioning to healthy diets, which link human and planetary health and the economy. Among the wide variety of diets, Palaeolithic diet has become so popular in social media. The main goal of this study is to evaluate the environmental and health sustainability of the Paleo diet, incorporating the health dimension to the economic, nutritional, and environmental indicators. Results were compared with those of the other dietary patterns in Spain: Mediterranean Diet (MD), Southern European Atlantic Diet (SEAD) and the Spanish Dietary Guidelines (NAOS). It was concluded that the Paleo diet is a diet low in carbohydrates (24.5% of energy intake) and high in protein (29.6% of energy intake), cholesterol (835 mg·day−1) and polyunsaturated fatty acids (15.3% of energy intake). The diet quality score was 260, a result above the recommended. Regarding the health assessment of the food categories that contribute most to the Paleo diet, vegetables and fruits were associated with a lower risk of cardiovascular disease (CVD), type 2 diabetes mellitus (T2D), colorectal cancer (CRCA), obesity and stroke. The opposite result was observed for red meat. Fish and seafood, as well as poultry, were associated with a relative risk higher than one for T2D and obesity, but not for CVD, CRCA or stroke. Based on the economic assessment, a higher dietary cost was estimated for Paleo diet (8.6 €·person−1·day−1). The environmental metrics in terms of carbon footprint (CF) and water footprint (WF) were estimated in 5.44 kg CO2·person−1·day−1 and 3499 L·person−1·day−1 respectively, a worse environmental profile than that of MD, SEAD and NAOS. Environmental and health sustainability assessments can help policy makers set targets for improving dietary guidelines at national level. They are recognized as a very useful tool to guide citizens towards the most appropriate dieteng© 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)http://creativecommons.org/licenses/by-nc-nd/4.0/Sustainable dietCaloric profileChronic diseaseRelative riskCarbon footprintWater footprintjournal article10.1016/j.scitotenv.2021.1467170048-9697open access