BACKGROUND: Mental and behavioral disorders are a major public health concern and represent the most prevalent psychiatric conditions among youth. Although the Planetary Health Diet (PHD) was developed to promote both human and planetary health, the role of sustainable dietary patterns in neurodevelopment remains unclear. This retrospective cohort study investigated the association between adherence to a child-adapted PHD index (PHDI-C) and cognitive-behavioral health among children and adolescents. METHODS: Data from 1,744 participants aged 7-18 years in the 2013-2016 Nutrition and Health Survey in Taiwan were analyzed and linked to the 2013-2021 National Health Insurance database to identify incident cognitive-behavioral disorders. Dietary intake was assessed using 24-h recalls, yielding PHDI-C scores. Nutrient adequacy was evaluated using the Mean Adequacy Ratio (MAR). Cox proportional hazards models estimated hazard ratios (HRs) for incident cognitive-behavioral disorders across PHDI-C tertiles. RESULTS: Participants in the highest tertile (T3) of the PHDI-C were more likely to be aged 7-12 years, fathers with higher education and sufficient household income, and exhibited greater height-for-age z-scores. Compared with T1, T3 showed lower fat but higher protein and micronutrient intakes (except vitamin B-12 and sodium) and a higher MAR (p < 0.0001). Over nine years of follow-up, T3 participants had a 68% lower risk of cognitive-behavioral disorders compared with T1 (HR = 0.32, 95% confidence intervals (CI): 0.15-0.67). Each 5-point increase in PHDI-C score corresponded to an 16% lower risk (HR = 0.84, 95% CI: 0.75-0.94). Age-stratified analyses showed stronger protective effects among adolescents aged 13-18 years (HR = 0.10, 95% CI: 0.02-0.60). CONCLUSIONS: Greater PHD adherence was associated with better nutrient adequacy and reduced risk of cognitive-behavioral disorders in children and adolescents aged 13-18 years. These findings underscore the potential of sustainable dietary patterns to promote youth mental health.
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