Abstract
Background
The EAT-Lancet Commission proposed a global reference diet to promote healthy diets within planetary boundaries. Studies evaluating the associations between the reference diet with health outcomes among adolescents are scarce. Thus, our aim was to assess the association between adherence to the EAT-Lancet diet and cardiovascular health among European adolescents.
Methods
Data from the HELENA study were used. Usual dietary intake was assessed using two 24-h dietary recalls and adherence to the EAT-Lancet diet was assessed using the Planetary Health Diet Index (PHDI), a 16-component index that ranges from 0 to 150 points. Cardiovascular health was assessed through the seven-component Ideal Cardiovascular Health (ICH) score: never smoked, eutrophic body mass index, moderate-to-vigorous physical activity, healthy dietary pattern, low blood pressure, low fasting plasma glucose, and low total cholesterol. Total ICH score was categorized into ideal (5–7) and non-ideal (0–4).
Results
A 10-point increment in the PHDI was associated with a lower probability of a non-ideal ICH status (OR 0.84, [95% CI: 0.75, 0.94]) among European adolescents, after adjusting for age, sex, socio-economic status, and total energy intake. Furthermore, a 10-point increment in the PHDI was associated with lower probability of high blood pressure (OR: 0.87 [0.79, 0.96]) and a lower probability of high blood cholesterol (OR: 0.88 [0.78, 0.99]).
Conclusion
Our study suggests that a higher PHDI may be associated with a better cardiovascular health status among European adolescents.
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Data availability
The data described in the manuscript can be made available upon request pending application and approval by the chair of the steering committee for the HELENA study. The analytic code of the PHDI computation will be made available upon request pending to the corresponding author.
References
Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019. J Am Coll Cardiol. 2020;76:2982–3021.
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary. J Am Coll Cardiol. 2019;74:1376–414.
Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction. Circulation. 2010;121:586–613.
Fang N, Jiang M, Fan Y. Ideal cardiovascular health metrics and risk of cardiovascular disease or mortality: a meta-analysis. Int J Cardiol. 2016;214:279–83.
Pahkala K, Hietalampi H, Laitinen TT, Viikari JSA, Rönnemaa T, Niinikoski H, et al. Ideal cardiovascular health in adolescence: effect of lifestyle intervention and association with vascular intima-media thickness and elasticity (the Special Turku Coronary Risk Factor Intervention Project for Children [STRIP] study). Circulation. 2013;127:2088–96.
Laitinen TT, Pahkala K, Magnussen CG, Viikari JSA, Oikonen M, Taittonen L, et al. Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood. Circulation. 2012;125:1971–8.
González-Gil EM, Santabárbara J, Ruiz JR, Bel-Serrat S, Huybrechts I, Pedrero-Chamizo R, et al. Ideal cardiovascular health and inflammation in European adolescents: the HELENA study. Nutr Metab Cardiovasc Dis. 2017;27:447–55.
Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447–92.
Laine JE, Huybrechts I, Gunter MJ, Ferrari P, Weiderpass E, Tsilidis K, et al. Co-benefits from sustainable dietary shifts for population and environmental health: an assessment from a large European cohort study. Lancet Planet Health. 2021;5:e786–e796.
Wang DD, Li Y, Afshin A, Springmann M, Mozaffarian D, Stampfer MJ, et al. Global improvement in dietary quality could lead to substantial reduction in premature death. J Nutr. 2019;149:1065–74.
Food and Agriculture Organization of the United Nations and World Health Organization. Sustainable Healthy Diets: Guiding Principles. Rome: Food and Agriculture Organization of the United Nations and World Health Organization; 2019.
Springmann M, Spajic L, Clark MA, Poore J, Herforth A, Webb P, et al. The healthiness and sustainability of national and global food based dietary guidelines: modelling study. BMJ. 2020;370:m2322.
Cacau LT, Benseñor IM, Goulart AC, Cardoso LO, Lotufo PA, Moreno LA, et al. Adherence to the Planetary Health Diet Index and obesity indicators in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Nutrients. 2021;13:3691.
Stubbendorff A, Sonestedt E, Ramne S, Drake I, Hallström E, Ericson U. Development of an EAT-Lancet index and its relation to mortality in a Swedish population. Am J Clin Nutr. 2022;115:705–16.
Xu C, Cao Z, Yang H, Hou Y, Wang X, Wang Y. Association between the EAT-Lancet diet pattern and risk of type 2 diabetes: a prospective cohort Study. Front Nutr. 2022;8:784018.
Cacau LT, Benseñor IM, Goulart AC, de Oliveira Cardoso L, de Souza Santos I, Lotufo PA, et al. Adherence to the EAT-Lancet sustainable reference diet and cardiometabolic risk profile: cross-sectional results from the ELSA-Brasil cohort study. Eur J Nutr. 2022. https://doi.org/10.1007/s00394-022-03032-5.
Moreno LA, Gottrand F, Huybrechts I, Ruiz JR, González-Gross M, DeHenauw S. Nutrition and lifestyle in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Adv Nutr. 2014;5:615S–623S.
Moreno LA, de Henauw S, González-Gross M, Kersting M, Molnár D, Gottrand F, et al. Design and implementation of the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study. Int J Obes. 2008;32:S4–S11.
Béghin L, Castera M, Manios Y, Gilbert CC, Kersting M, de Henauw S, et al. Quality assurance of ethical issues and regulatory aspects relating to good clinical practices in the HELENA cross-sectional study. Int J Obes. 2008;32:S12–S18.
Vereecken CA, Covents M, Sichert-Hellert W, Alvira JMF, le Donne C, de Henauw S, et al. Development and evaluation of a self-administered computerized 24-h dietary recall method for adolescents in Europe. Int J Obes. 2008;32:S26–S34.
Dehne LI, Klemm C, Henseler G, Hermann-Kunz E. The German Food Code and Nutrient Data Base (BLS II.2). Eur J Epidemiol. 1999;15:355–9.
Harttig U, Haubrock J, Knüppel S, Boeing H. The MSM program: web-based statistics package for estimating usual dietary intake using the Multiple Source Method. Eur J Clin Nutr. 2011;65:S87–S91.
Haubrock J, Nöthlings U, Volatier JL, Dekkers A, Ocké M, Harttig U, et al. Estimating usual food intake distributions by using the multiple source method in the EPIC-Potsdam Calibration Study. J Nutr. 2011;141:914–20.
Cacau LT, Marchioni DM. The planetary health diet index scores proportionally and considers the intermediate values of the EAT-Lancet reference diet. Am J Clin Nutr. 2022;115:1237.
Cacau LT, De Carli E, de Carvalho AM, Lotufo PA, Moreno LA, Bensenor IM, et al. Development and validation of an index based on EAT-Lancet recommendations: the Planetary Health Diet Index. Nutrients. 2021;13:1698.
Cacau LT, Hanley-Cook GT, Huybrechts I, De Henauw S, Kersting M, Gonzalez-Gross M, et al. Relative validity of the Planetary Health Diet Index by comparison with usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet among European adolescents: the HELENA study. Eur J Nutr. 2023;62:2527–39.
Henriksson P, Henriksson H, Gracia-Marco L, Labayen I, Ortega FB, Huybrechts I, et al. Prevalence of ideal cardiovascular health in European adolescents: the HELENA study. Int J Cardiol. 2017;240:428–32.
Henriksson P, Henriksson H, Labayen I, Huybrechts I, Gracia-Marco L, Ortega FB, et al. Correlates of ideal cardiovascular health in European adolescents: the HELENA study. Nutr Metab Cardiovasc Dis. 2018;28:187–94.
Nagy E, Vicente-Rodriguez G, Manios Y, Béghin L, Iliescu C, Censi L, et al. Harmonization process and reliability assessment of anthropometric measurements in a multicenter study in adolescents. Int J Obes. 2008;32:S58–S65.
World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-forheight and body mass index-for-age: methods and development. 2006.
Hagströmer M, Bergman P, De Bourdeaudhuij I, Ortega FB, Ruiz JR, Manios Y, et al. Concurrent validity of a modified version of the International Physical Activity Questionnaire (IPAQ-A) in European adolescents: the HELENA study. Int J Obes. 2008;32:S42–S48.
González-Gross M, Breidenassel C, Gómez-Martínez S, Ferrari M, Béghin L, Spinneker A, et al. Sampling and processing of fresh blood samples within a European multicenter nutritional study: evaluation of biomarker stability during transport and storage. Int J Obes. 2008;32:S66–S75.
Iliescu C, Béghin L, Maes L, De Bourdeaudhuij I, Libersa C, Vereecken C, et al. Socioeconomic questionnaire and clinical assessment in the HELENA cross-sectional study: methodology. Int J Obes. 2008;32:S19–S25.
Iguacel I, Börnhorst C, Michels N, Breidenassel C, Dallongeville J, González-Gross M, et al. Socioeconomically disadvantaged groups and metabolic syndrome in European adolescents: the HELENA study. J Adolesc Health. 2021;68:146–54.
Iguacel I, Fernández-Alvira JM, Bammann K, de Clercq B, Eiben G, Gwozdz W, et al. Associations between social vulnerabilities and dietary patterns in European children: the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study. Br J Nutr. 2016;116:1288–97.
Hallström L, Vereecken CA, Ruiz JR, Patterson E, Gilbert CC, Catasta G, et al. Breakfast habits and factors influencing food choices at breakfast in relation to socio-demographic and family factors among European adolescents. the HELENA study. Appetite. 2011;56:649–57.
Montejano Vallejo R, Schulz C-A, van de Locht K, Oluwagbemigun K, Alexy U, Nöthlings U. Associations of adherence to a dietary index based on the EAT– Lancet reference diet with nutritional, anthropometric, and ecological sustainability parameters: results from the German DONALD cohort study. J Nutr. 2022;152:1763–72.
Berthy F, Brunin J, Allès B, Fezeu LK, Touvier M, Hercberg S, et al. Association between adherence to the EAT-Lancet diet and risk of cancer and cardiovascular outcomes in the prospective NutriNet-Santé cohort. Am J Clin Nutr. 2022;116:980–91.
Ibsen DB, Christiansen AH, Olsen A, Tjønneland A, Overvad K, Wolk A, et al. Adherence to the EAT-Lancet diet and risk of stroke and stroke subtypes: a cohort study. Stroke. 2022;53:154–63.
Knuppel A, Papier K, Key TJ, Travis RC. EAT-Lancet score and major health outcomes: the EPIC-Oxford study. Lancet. 2019;394:213–4.
Zhang S, Dukuzimana J, Stubbendorff A, Ericson U, Borné Y, Sonestedt E. Adherence to the EAT-Lancet diet and risk of coronary events in the Malmö Diet and Cancer cohort study. Am J Clin Nutr. 2023;117:903–9.
Burggraf C, Teuber R, Brosig S, Meier T. Review of a priori dietary quality indices in relation to their construction criteria. Nutr Rev. 2018;76:747–64.
Ocké MC. Evaluation of methodologies for assessing the overall diet: dietary quality scores and dietary pattern analysis. Proc Nutr Soc. 2013;72:191–9.
Marchioni DM, Cacau LT, de Carli E, de Carvalho AM, Rulli MC. Low adherence to the EAT-Lancet sustainable reference diet in the brazilian population: findings from the National Dietary Survey 2017–2018. Nutrients. 2022;14:1187.
Bäck S, Skaffari E, Vepsäläinen H, Lehto R, Lehto E, Nissinen K, et al. Sustainability analysis of Finnish pre-schoolers’ diet based on targets of the EAT-Lancet reference diet. Eur J Nutr. 2022;61:717–28.
Zagmutt FJ, Pouzou JG, Costard S. The EAT-Lancet commission’s dietary composition may not prevent noncommunicable disease mortality. J Nutr. 2020;150:985–8.
Seferidi P, Scrinis G, Huybrechts I, Woods J, Vineis P, Millett C. The neglected environmental impacts of ultra-processed foods. Lancet Planet Health. 2020;4:e437–e438.
Lawrence MA, Baker PI, Pulker CE, Pollard CM. Sustainable, resilient food systems for healthy diets: the transformation agenda. Public Health Nutr. 2019;22:2916–20.
Hirvonen K, Bai Y, Headey D, Masters WA. Affordability of the EAT–Lancet reference diet: a global analysis. Lancet Glob Health. 2020;8:e59–e66.
Semba RD, de Pee S, Kim B, McKenzie S, Nachman K, Bloem MW. Adoption of the ‘planetary health diet’ has different impacts on countries’ greenhouse gas emissions. Nat Food. 2020;1:481–4.
Tuninetti M, Ridolfi L, Laio F. Compliance with EAT–Lancet dietary guidelines would reduce global water footprint but increase it for 40% of the world population. Nat Food. 2022;3:143–51.
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Funding
The HELENA study received funding from the European Union’s Sixth RTD Framework Programme (contracts FOODCT-2007-036196-2 and FOODCT-2005-007034, respectively). Additional support was obtained from the Spanish Ministry of Education (AGL2007-29784-E/ALI). LTC received a doctoral scholarship (grant number 2019/13424-0) and a research internship abroad scholarship (grant number 2020/12326-1) from the Sao Paulo Research Foundation (FAPESP). No funding agencies had a role in the study design, data collection, analysis, decision to publish, or preparation of the article.
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LTC, DMM, and LAM designed the research; IH advised on the data curation; LTC carried out the data analyses; LTC developed the first draft and revised the manuscript; GTH-C supported with writing the draft. GTH-C, SDH, CL, and LAM advised on statistical analyses. LAM supervised LTC. GTH-C, SV, CL, SDH, AMS-P, YM, NM, LEDP, MG-G, KW, DM, PS, AK, FG, MK, MJC, CL, DMM, IH, and LAM critically reviewed and revised the manuscript. All authors read and approved the final manuscript.
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41430_2023_1379_MOESM1_ESM.docx
Supplementary Figure 1. Crude odds ratios between a 10-point increase in the Planetary Healthy Diet Index score and Ideal Cardiovascular Health components. CI, confidence interval.
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Cacau, L.T., Hanley-Cook, G.T., Vandevijvere, S. et al. Association between adherence to the EAT-Lancet sustainable reference diet and cardiovascular health among European adolescents: the HELENA study. Eur J Clin Nutr 78, 202–208 (2024). https://doi.org/10.1038/s41430-023-01379-4
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DOI: https://doi.org/10.1038/s41430-023-01379-4