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

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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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.

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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.

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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.

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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.

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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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