Planetary health diet and cardiovascular disease: results from three large prospective cohort studies in the USA

IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Lancet Planetary Health Pub Date : 2024-09-01 DOI:10.1016/S2542-5196(24)00170-0
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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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.

Funding

National Institutes of Health.

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行星健康饮食与心血管疾病:美国三项大型前瞻性队列研究的结果
背景2019年,EAT-Lancet可持续食品系统健康饮食委员会提出了一种旨在优化慢性疾病预防和全球环境健康的 "行星健康饮食"。在这项研究中,我们旨在研究基于 "行星健康饮食 "的饮食指数与心血管疾病风险之间的关联。方法我们纳入了护士健康研究(NHS I;1986-2016 年)中的女性、护士健康研究 II(NHS II;1991-2017 年)中的女性以及健康专业人员随访研究(HPFS;1986-2016 年)中的男性,他们在基线时都没有心血管疾病、癌症和糖尿病。饮食数据每 4 年使用经过验证的半定量食物频率调查问卷收集一次。行星健康饮食指数(PHDI)基于 15 个食物组:全谷物、蔬菜、水果、鱼类和贝类、坚果和种子、非大豆豆类、大豆食品和不饱和油类为正分;淀粉类蔬菜、乳制品、红肉或加工肉类、家禽、蛋类、饱和脂肪和反式脂肪以及添加糖类为负分。每组食物的得分相加得出 0-140 分的总分。分数越高,表明越遵守 PHDI。我们使用具有时变协变量的 Cox 比例危险度回归来评估 PHDI 分数(累计平均值)与心血管疾病(定义为致命和非致命心肌梗死和中风)之间的关系,并对所有提供数据的参与者的人口统计学、健康和生活方式混杂因素进行了调整。在 NHS I 纳入的 62 919 名女性、NHS II 纳入的 88 535 名女性和 HPFS 纳入的 42 164 名男性中,在 4 541 980 人年的随访中,共有 9831 例心血管疾病得到确诊。在 NHS I 中,最低五分位数与最高五分位数的 PHDI 平均得分介于 60-7 (SD 5-1) 到 90-6 (5-3) 之间;在 NHS II 中,最低五分位数与最高五分位数的 PHDI 平均得分介于 55-6 (4-9) 到 86-3 (6-3) 之间;在 HPFS 中,最低五分位数与最高五分位数的 PHDI 平均得分介于 59-6 (5-9) 到 94 (5-9) 之间。在经多变量调整的荟萃分析中,PHDI 评分最高的五分位参与者发生心血管疾病的风险低于最低的五分位参与者(危险比 [HR] 0-83 [95% CI 0-78-0-89];p-trend <0-0001)。当我们研究心血管疾病亚型时,与最低五分位数相比,PHDI 最高五分位数也与较低的冠心病风险(HR 0-81 [95% CI 0-74-0-88];p-trend <0-0001)和总中风风险(HR 0-86 [0-78-0-95];p-trend=0-0004)相关。解释我们发现,在美国的三个大型男性和女性队列中,坚持行星健康饮食(旨在成为更环保的可持续饮食模式)与较低的心血管疾病风险有关。这些观察结果表明,行星健康饮食是促进人类和地球健康的一种有前途的策略。
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来源期刊
CiteScore
28.40
自引率
2.30%
发文量
272
审稿时长
8 weeks
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.
期刊最新文献
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