Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Association between adherence to the EAT-Lancet sustainable reference diet and cardiovascular health among European adolescents: the HELENA study

European Journal of Clinical Nutrition volume 78, pages 202–208 (2024)Cite this article

Subjects

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flowchart of adolescents in the Healthy Lifestyle in Europe by Nutrition in Adolescence study included in the present study.
Fig. 2: Overview of the Planetary Health Diet Index’s components, cut-off points (i.e., % kcal/d), and calculation of the total score.
Fig. 3: Mean PHDI total score according to ICH status.
Fig. 4: Adjusted odds ratios between a 10-point increase in the Planetary Healthy Diet Index score and Ideal Cardiovascular Health components.

Similar content being viewed by others

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

  1. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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.

  12. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 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.

  17. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. 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.

    Article  Google Scholar 

  21. 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.

    Article  CAS  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  CAS  PubMed  Google Scholar 

  24. 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.

    Article  CAS  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 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.

    Article  CAS  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  CAS  PubMed  Google Scholar 

  29. 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.

    Article  Google Scholar 

  30. 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.

  31. 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.

    Article  Google Scholar 

  32. 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.

    Article  Google Scholar 

  33. 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.

    Article  Google Scholar 

  34. 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.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  CAS  PubMed  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. Knuppel A, Papier K, Key TJ, Travis RC. EAT-Lancet score and major health outcomes: the EPIC-Oxford study. Lancet. 2019;394:213–4.

    Article  PubMed  Google Scholar 

  41. 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.

    Article  CAS  PubMed  Google Scholar 

  42. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Ocké MC. Evaluation of methodologies for assessing the overall diet: dietary quality scores and dietary pattern analysis. Proc Nutr Soc. 2013;72:191–9.

    Article  PubMed  Google Scholar 

  44. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  45. 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.

    Article  PubMed  Google Scholar 

  46. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  47. 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.

    Article  PubMed  Google Scholar 

  48. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  49. 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.

    Article  PubMed  Google Scholar 

  50. 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.

    Article  PubMed  Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

IARC Disclaimer: Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization.

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.

Author information

Authors and Affiliations

  1. Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil

    Leandro Teixeira Cacau & Dirce Maria Marchioni

  2. Growth, Exercise, Nutrition and Development (GENUD) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain

    Leandro Teixeira Cacau, Alba Santaliestra-Pasias & Luis A. Moreno

  3. Department of Public Health and Primary Care, Ghent University, Ghent, Belgium

    Leandro Teixeira Cacau & Stefaan De Henauw

  4. Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium

    Giles T. Hanley-Cook & Carl Lachat

  5. Department of Epidemiology and Public Health, Scientific Institute of Public Health (Sciensano), Brussels, Belgium

    Stefanie Vandevijvere

  6. Council for Agricultural Research and Economics - Research Center for Food and Nutrition (CREA - Food and Nutrition), Rome, Italy

    Catherine Leclercq

  7. Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain

    Alba Santaliestra-Pasias, Marcela Gonzalez-Gross & Luis A. Moreno

  8. Instituto Agroalimentario de Aragon (IA2), 50013, Zaragoza, Spain

    Alba Santaliestra-Pasias & Luis A. Moreno

  9. Instituto de Investigacion Sanitaria Aragon (IIS Aragon), 50009, Zaragoza, Spain

    Alba Santaliestra-Pasias & Luis A. Moreno

  10. Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671, Athens, Greece

    Yannis Manios & Niki Mourouti

  11. Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, 71410, Heraklion, Greece

    Yannis Manios

  12. Department of Nutrition and Dietetics, Hellenic Mediterranean University, 72300, Sitia, Greece

    Niki Mourouti

  13. Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition (ICTAN)—CSIC, 28040, Madrid, Spain

    Ligia Esperanza Díaz

  14. ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain

    Marcela Gonzalez-Gross

  15. Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

    Kurt Widhalm

  16. Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary

    Dénes Molnar

  17. Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany

    Peter Stehle

  18. Faculty of Medicine, University of Crete, Crete, 71500, Heraklion, Greece

    Anthony Kafatos

  19. Institute for Translational Research in Inflammation (INFINITE), University Lille, Lille, France

    Frederic Gottrand

  20. Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, Ruhr-University Bochum, Bochum, Germany

    Mathilde Kersting

  21. Department of Medical Physiology, Faculty of Medicine, University of Granada, Granada, Spain

    Manuel Castillo

  22. Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France

    Inge Huybrechts

Authors
  1. Leandro Teixeira Cacau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giles T. Hanley-Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefanie Vandevijvere
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Catherine Leclercq
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefaan De Henauw
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alba Santaliestra-Pasias
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yannis Manios
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Niki Mourouti
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ligia Esperanza Díaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marcela Gonzalez-Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kurt Widhalm
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Dénes Molnar
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Peter Stehle
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Anthony Kafatos
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Frederic Gottrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Mathilde Kersting
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Manuel Castillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Carl Lachat
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Dirce Maria Marchioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Inge Huybrechts
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Luis A. Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Leandro Teixeira Cacau.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

Food and Agriculture Organization of the United Nations and World Health Organization

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

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.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-023-01379-4

Search

Advanced search

Quick links