Caleigh M Sawicki PhD , Gautam Ramesh MD , Linh Bui MD , Nilendra K Nair PhD , Prof Frank B Hu MD , Prof Eric B Rimm ScD , Prof Meir J Stampfer MD , Prof Walter C Willett MD , Shilpa N Bhupathiraju PhD
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引用次数: 0
Abstract
Background
In 2019, the EAT–Lancet Commission on healthy diets from sustainable food systems proposed a Planetary Health Diet that seeks to optimise both chronic disease prevention as well as global environmental health. In this study, we aimed to examine the association between a dietary index based on the Planetary Health Diet and risk of cardiovascular disease.
Methods
We included women from the Nurses’ Health Study (NHS I; 1986–2016), women from the Nurses’ Health Study II (NHS II; 1991–2017), and men from the Health Professionals Follow-up Study (HPFS; 1986–2016) who were free of cardiovascular disease, cancer, and diabetes at baseline. Dietary data were collected every 4 years using a validated, semi-quantitative food frequency questionnaire. The Planetary Health Diet Index (PHDI) was based on 15 food groups: whole grains, vegetables, fruit, fish and shellfish, nuts and seeds, non-soy legumes, soy foods, and unsaturated oils were scored positively; starchy vegetables, dairy, red or processed meat, poultry, eggs, saturated fats and trans fat, and added sugar received negative scores. Scores for each food group were summed to get a total score of 0–140. Higher scores indicated greater adherence to the PHDI. We used Cox proportional hazards regression with time-varying covariates to evaluate the association between PHDI score, cumulatively averaged, and incident cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), adjusting for demographic, health, and lifestyle confounders in all participants with available data. Cohort-specific estimates were combined using inverse variance-weighted fixed effects meta-analyses.
Findings
Of the 62 919 women included from the NHS I, 88 535 women included from the NHS II, and 42 164 men included from the HPFS, a total of 9831 cases of cardiovascular disease were confirmed over 4 541 980 person-years of follow-up. Mean PHDI scores ranged from 60·7 (SD 5·1) to 90·6 (5·3) in the lowest versus highest quintile in NHS I, 55·6 (4·9) to 86·3 (6·3) in NHS II, and 59·6 (5·9) to 94 (5·9) in HPFS. In the multivariable-adjusted meta-analysis, participants in the highest quintile of PHDI score had a lower risk of incident cardiovascular disease than did those in the lowest quintile (hazard ratio [HR] 0·83 [95% CI 0·78–0·89]; p-trend <0·0001). When we examined cardiovascular disease subtypes, the highest quintile of PHDI was also associated with a lower risk of coronary heart disease (HR 0·81 [95% CI 0·74–0·88]; p-trend <0·0001) and total stroke (HR 0·86 [0·78–0·95]; p-trend=0·0004) compared with the lowest quintile.
Interpretation
We found that adherence to the Planetary Health Diet, designed to be a more environmentally sustainable dietary pattern, was associated with a lower risk of cardiovascular disease in three large cohorts of men and women in the USA. These observations support the Planetary Health Diet as a promising strategy to promote both human and planetary health.
期刊介绍:
The Lancet Planetary Health is a gold Open Access journal dedicated to investigating and addressing the multifaceted determinants of healthy human civilizations and their impact on natural systems. Positioned as a key player in sustainable development, the journal covers a broad, interdisciplinary scope, encompassing areas such as poverty, nutrition, gender equity, water and sanitation, energy, economic growth, industrialization, inequality, urbanization, human consumption and production, climate change, ocean health, land use, peace, and justice.
With a commitment to publishing high-quality research, comment, and correspondence, it aims to be the leading journal for sustainable development in the face of unprecedented dangers and threats.