The EAT-Lancet diet associated cardiovascular health parameters: evidence from a Brazilian study

Bui L.P., Pham T.T., Wang F., Chai B., Sun Q., Hu F.B., Lee K.H., Guasch-Ferre M., Willett W.C.

In 2019, the EAT-Lancet Commission proposed a healthy dietary pattern that, along with reductions in food waste and improved agricultural practices, could feed the increasing global population sustainably. We developed a Planetary Health Diet Index (PHDI) to quantify adherence to the EAT-Lancet reference diet. We aimed to assess associations between PHDI and total and cause-specific mortality in 3 prospective cohorts of males and females in the United States. We followed 66,692 females from the Nurses' Health Study (1986–2019), 92,438 females from the Nurses' Health Study II (1989–2019), and 47,274 males from the Health Professionals Follow-up Study (1986–2018) who were free of cancer, diabetes, and major cardiovascular diseases at baseline. The PHDI was calculated every 4 y using a semiquantitative food frequency questionnaire. Hazard ratios (HRs) were calculated using multivariable proportional-hazards models. During follow-up, we documented 31,330 deaths among females and 23,206 among males. When comparing the highest with the lowest quintile of PHDI, the pooled multivariable-adjusted HRs were 0.77 [95% confidence interval (CI): 0.75, 0.80] for all-cause mortality (P-trend < 0.0001). The PHDI was associated with lower risk of deaths from cardiovascular diseases (HR: 0.86; 95% CI: 0.81, 0.91), cancer (HR: 0.90; 95% CI: 0.85, 0.95), respiratory diseases (HR: 0.53; 95% CI: 0.48, 0.59), and neurodegenerative diseases (HR: 0.72; 95% CI: 0.67, 0.78). In females, but not males, the PHDI was also significantly associated with a lower risk of deaths from infectious diseases (HR: 0.62; 95% CI: 0.51, 0.76). PHDI scores were also associated inversely with greenhouse gas emissions and other environmental impacts. In 3 large United States-based prospective cohorts of males and females with up to 34 y of follow-up, a higher PHDI was associated with lower risk of total and cause-specific mortality and environment impacts.

Biscarrat P., Cassandre B., Philippe L., Claire C.

The gap between recommended and actual dietary fiber consumption in Western societies is increasing largely, due to a shift towards a Western dietary pattern. This has resulted in a marked deficit in dietary fiber intake that can negatively impact the intestinal microbiota and thereby increase susceptibility to various diseases. This review investigates the potential of pulses, rich in dietary fiber and protein, to bridge this fiber gap. It highlights the role of pulses in enriching the human gut microbiota through their prebiotic properties, supporting sustainable diets, and contributing to environmental sustainability. Furthermore, we delve into the impact of diverse pulse processing methods and explore the breadth of industrially produced pulse-based products. Pulses emerge as a compelling strategy to combat dietary fiber deficiency. They serve a dual purpose of promoting health through their prebiotic properties and sustainability through their high protein content and low environmental impact. The versatility of pulses enables their integration into an array of dietary patterns, making them a significant catalyst in the shift towards healthier, more sustainable diets. Despite the appeal of pulses, their underutilization highlights a missed opportunity for improving dietary fiber intake and enhancing gut health in Western societies. The broadening array of pulse-based products points towards a promising avenue for increasing pulse consumption and bridging the fiber gap.

Teixeira C.D., Marchioni D.M., Motta V.W., Chaves V.M., Gomes S.M., Jacob M.C.

In this study, we conducted the first scientific investigation focusing on Brazilian flexitarians, aiming to characterize their socio-economic and demographic profiles, motivations for adopting flexitarianism, the frequency of animal-based meat consumption, and the primary meat substitutes they consume. To accomplish this, we distributed an online questionnaire with the assistance of university students and researchers from various regions of the country. Data were collected from 1029 individuals in Brazil who self-identified as flexitarians. Our findings reveal that the flexitarian dietary model is primarily adopted by women, constituting 76% of the sample (n = 786). Their motivations include concerns about the environmental impact of meat consumption (n = 361, 35%), personal health (n = 344, 33%), and animal welfare (n = 219, 21%). Flexitarians exhibit varying consumption patterns, which can be categorized into three groups: light flexitarians (consuming meat 36 times a week), medium flexitarians (consuming meat 7 times a week), and heavy flexitarians (consuming meat 4 times a week). The flexitarian dietary pattern is characterized by reduced beef consumption (less than 2 times per week) and higher consumption of chicken (3 times per week). It is complemented by plant-based protein sources and eggs as the primary meat substitutes. The recognition of legumes as the principal meat substitutes opens avenues for an expanded discussion on sustainable food systems and alternative meat products in Brazil. This provides opportunities to enhance the availability and accessibility of these foods and to develop nutritional interventions that prioritize plant-based proteins.

Oliveira Neta R.S., Lima S.C., Medeiros M.F., Neta A.D., Jacob M.C., Marchioni D.M., Lyra C.D., Oliveira A.G.

Background: The “EAT-Lancet Commission Summary Report” commission remodeled the concept of healthy and sustainable diets by proposing a “diet for the Anthropocene”, encouraging the development of indices that measure adherence to sustainable diets with a planetary scope. We aimed to report the adherence of adults and elderly people in a northeastern Brazilian capital to the EAT-Lancet recommendations. Methods: We used data from 411 participants in the population-based study. The dietary data were collected with Globodiet, over a standardized 24 h. The diet sustainability data were verified using the Planetary Health Diet Index (PHDI). A Pearson correlation test verified the correlation between the PHDI and the independent variables. We conducted linear regression models that were adjusted for potential confounding variables to examine the correlation between the adherence to the PHDI and the independent variables. Results: The mean total score for the adherence to the PHDI was 29.4 points in a score with a possible range from 0 to 150. Regarding the component scores, the highest scores in the adequacy component were for fruits, followed by legumes and vegetables, while the lowest scores in the moderation group were for animal fat and red meat. We observed, in the final model, that the explanatory variables for the PHDI were being male and not consuming alcohol, which were directly related to the PHDI, while having 1 to 9 years of study and being food insecure were indirectly related to the score. Conclusions: Our results showed a low adherence to a sustainable eating pattern, far from the EAT-Lancet recommendations.

Wang Y., Liu B., Han H., Hu Y., Zhu L., Rimm E.B., Hu F.B., Sun Q.

Abstract Background Plant-based dietary patterns are gaining more attention due to their potential in reducing the risk of developing major chronic diseases, including type 2 diabetes (T2D), cardiovascular disease (CVD), cancer, and mortality, while an up-to-date comprehensive quantitative review is lacking. This study aimed to summarize the existing prospective observational evidence on associations between adherence to plant-based dietary patterns and chronic disease outcomes. Methods We conducted a systematic review and meta-analysis of evidence across prospective observational studies. The data sources used were PubMed and MEDLINE, Embase, Web of Science, and screening of references. We included all prospective observational studies that evaluated the association between adherence to plant-based dietary patterns and incidence of T2D, CVD, cancer, and mortality among adults (≥ 18 years). Results A total of 76 publications were identified, including 2,230,443 participants with 60,718 cases of incident T2D, 157,335 CVD cases, 57,759 cancer cases, and 174,435 deaths. An inverse association was observed between higher adherence to a plant-based dietary pattern and risks of T2D (RR, 0.82 [95% CI: 0.77–0.86]), CVD (0.90 [0.85–0.94]), cancer (0.91 [0.87–0.96]), and all-cause mortality (0.84 [0.78–0.92]) with moderate to high heterogeneity across studies (I2 ranged: 47.8–95.4%). The inverse associations with T2D, CVD and cancer were strengthened when healthy plant-based foods, such as vegetables, fruits, whole grains, and legumes, were emphasized in the definition of plant-based dietary patterns (T2D: 0.79 [0.72–0.87]; CVD: 0.85 [0.80–0.92]; cancer: 0.86 [0.80–0.92]; I2 ranged: 53.1–84.1%). Association for mortality was largely similar when the analyses were restricted to healthy plant-based diets (0.86 [0.80–0.92], I2 = 91.9%). In contrast, unhealthy plant-based diets were positively associated with these disease outcomes. Among four studies that examined changes in dietary patterns, increased adherence to plant-based dietary patterns was associated with a significantly reduced risk of T2D (0.83 [0.71–0.96]; I2 = 71.5%) and a marginally lower risk of mortality (0.95 [0.91–1.00]; I2 = 0%). Conclusions Better adherence to plant-based dietary patterns, especially those emphasizing healthy plant-based foods, is beneficial for lowering the risks of major chronic conditions, including T2D, CVD, cancer, as well as premature deaths. Registration of review protocol This review was registered at the PROSPERO International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/PROSPERO/) with the registration number CRD42022290202.

Lares-Michel M., Reyes-Castillo Z., Housni F.E.

Zhang S., Dukuzimana J., Stubbendorff A., Ericson U., Borné Y., Sonestedt E.

The EAT-Lancet Commission proposed a globally environmentally sustainable dietary pattern featuring mainly plant-based foods in 2019. However, evidence on this dietary pattern in preventing coronary events is minimal.We aimed to examine the association between the EAT-Lancet diet and risk of coronary events.The Malmö Diet and Cancer cohort study (recruited between 1991 and 1996) included 23,877 participants aged 44.5-73.6 y (62.5% women) without CVDs and diabetes at baseline. A modified diet history was used to collect the dietary data. An EAT-Lancet diet index (range, 0-42 points) was applied on the basis of 14 food components scored 0 (nonadherence) to 3 (adherence). Coronary events were extracted from the registers. Cox proportional hazards models were used to estimate the HRs and 95% confidential intervals (CIs).Over a median of 24.9 y of follow-up, 3031 coronary events occurred (incidence rate: 5.89/1000 person-years). After adjusting for age, sex, dietary assessment methods, season, total energy intake, leisure-time physical activity, alcohol consumption, smoking status, educational level, and BMI, the multivariable HR (95% CI) for coronary events among participants who had the highest adherence to the EAT-Lancet diet index (≥23 points, 8.1%) was 0.80 (0.67, 0.96) compared with those who had the lowest adherence (≤13 points, 9.7%) (P-trend = 0.01 across 5 groups of the EAT-Lancet diet). The inverse association was consistent in men and women and was robust after excluding those with misreported energy and significant diet changes or excluding coronary events occurred within the first 2 y of follow-up.Our data indicate that adherence to the EAT-Lancet diet was associated with a lower risk of coronary events.

Ojo O., Jiang Y., Ojo O.O., Wang X.

Background: Nutritional interventions such as the planetary health diet, which the EAT-Lancet commission proposed, may be an effective strategy for reducing type 2 diabetes risks and its associated complications. The planetary health diet demonstrates the significant role of diet in associating human health with environmental sustainability and the significance of transforming food systems in order to ensure that the UN’s Sustainable Development Goals and the Paris Agreement are achieved. Therefore, the aim of this review is to examine the association of the planetary health diet (PHD) with the risk of type 2 diabetes and its related complications. Method: The systematic review was conducted in line with established guidelines. The searches were carried out in health sciences research databases through EBSCOHost. The population, intervention, comparator and outcomes framework was used in order to define the research question and the search terms. The searches were carried out from the inception of the databases to 15 November 2022. Search terms including synonyms and medical subject headings were combined using Boolean operators (OR/AND). Results: Seven studies were included in the review and four themes were identified, including incidence of diabetes; cardiovascular risk factors and other disease risks; indicators of obesity and indicators of environmental sustainability. Two studies examined the association between the PHD and the incidence of type 2 diabetes and found that high adherence to the reference diet (EAT-Lancet reference diet) was correlated with a lower incidence of type 2 diabetes. High adherence to the PHD was also associated with some cardiovascular risk factors and environmental sustainability. Conclusion: This systematic review has shown that high adherence to the PHD is associated with a reduced risk of type 2 diabetes and may be associated with a lower risk of subarachnoid stroke. In addition, an inverse relationship was found between adherence to the PHD and markers of obesity and environmental sustainability. Adherence to the reference diet was also associated with lower values of some markers of cardiovascular risk. More studies are needed to fully examine the relationship between the planetary health diet, type 2 diabetes and its related conditions.

Zhang S., Stubbendorff A., Olsson K., Ericson U., Niu K., Qi L., Borné Y., Sonestedt E.

In 2019, the EAT-Lancet Commission proposed a mainly plant-based diet that nurtures human health and supports environmental sustainability. However, its association with type 2 diabetes (T2D) has not been widely studied, and it remains unclear whether genetic susceptibility for T2D can modify this association. The aim was therefore to investigate the association between the EAT-Lancet diet and risk of T2D and assess whether the association differs by the genetic predisposition to T2D.A total of 24,494 participants from the Malmö Diet and Cancer study were analyzed. Dietary intake was assessed using a modified diet history methodology, and an EAT-Lancet diet index (range from 0 to 42 points) was constructed based on the EAT-Lancet reference diet. National and local registers were used to identify T2D cases during follow-up. Cox proportional hazards regression model was applied to estimate the association between the EAT-Lancet diet index and risk of T2D. Genetic predisposition to T2D was captured based on 116 single nucleotide polymorphisms.During a median of 24.3 years of follow-up, 4197 (17.1 %) T2D cases were documented. Compared with those with the lowest adherence to the EAT-Lancet diet (≤13 points), participants who had the highest adherence (≥23 points) showed an 18 % (95 % CI: 4 %-30 %) lower risk of T2D (P for trend

Tristan Asensi M., Napoletano A., Sofi F., Dinu M.

Low-grade inflammation alters the homeostasis of the organism and favors the onset of many chronic diseases. The global growth in the prevalence of noncommunicable diseases in recent years has been accompanied by an increase in the consumption of ultra-processed foods (UPF). Known to be hyperpalatable, economic and ready-to-eat, increased consumption of UPF has already been recognized as a risk factor for several chronic diseases. Different research groups have tried to investigate whether UPF consumption could promote low-grade inflammation and thus favor the development of noncommunicable diseases. Current evidence highlights the adverse health effects of UPF characteristics, not only due to the nutrients provided by a diet rich in UPF, but also due to the non-nutritive components present in UPF and the effect they may have on gut health. This review aims to summarize the available evidence on the possible relationship between excessive UPF consumption and modulation of low-grade inflammation, as potential promoters of chronic disease.

Mezhal F., Oulhaj A., Abdulle A., AlJunaibi A., Alnaeemi A., Ahmad A., Leinberger-Jabari A., Al Dhaheri A.S., AlZaabi E., Al-Maskari F., Alanouti F., Alameri F., Alsafar H., Alblooshi H., Alkaabi J., et. al.

Abstract Background Cardiovascular disease (CVD) is the leading cause of death in the world. In the United Arab Emirates (UAE), it accounts for 40% of mortality. CVD is caused by multiple cardiometabolic risk factors (CRFs) including obesity, dysglycemia, dyslipidemia, hypertension and central obesity. However, there are limited studies focusing on the CVD risk burden among young Emirati adults. This study investigates the burden of CRFs in a sample of young Emiratis, and estimates the distribution in relation to sociodemographic and behavioral determinants. Methods Data was used from the baseline data of the UAE Healthy Future Study volunteers. The study participants were aged 18 to 40 years. The study analysis was based on self-reported questionnaires, anthropometric and blood pressure measurements, as well as blood analysis. Results A total of 5167 participants were included in the analysis; 62% were males and the mean age of the sample was 25.7 years. The age-adjusted prevalence was 26.5% for obesity, 11.7% for dysglycemia, 62.7% for dyslipidemia, 22.4% for hypertension and 22.5% for central obesity. The CRFs were distributed differently when compared within social and behavioral groups. For example, obesity, dyslipidemia and central obesity in men were found higher among smokers than non-smokers (p < 0.05). And among women with lower education, all CRFs were reported significantly higher than those with higher education, except for hypertension. Most CRFs were significantly higher among men and women with positive family history of common non-communicable diseases. Conclusions CRFs are highly prevalent in the young Emirati adults of the UAE Healthy Future Study. The difference in CRF distribution among social and behavioral groups can be taken into account to target group-specific prevention measures.

Hase Ueta M., Tanaka J., Marchioni D.M., Verly E., Carvalho A.M.

The responsibility and vulnerability of challenges in planetary health are unequally distributed across countries. In Brazil, meat carries an important cultural value even if from an environmental perspective its production is related to negative impacts. We explored Brazilian meat consumption over time, according to income groups from the perspective of the food inequalities and food justice and we analyzed its impacts on the environment. We used data from the 2008 and 2017 Household Budget Surveys to estimate meat intake and meat prices according to income level. The environmental impact indicators were based on the WWF Report. We analyzed the relationship between income, meat price, and its consumption by linear regression model. Brazilian meat intake was 86 g/1000 kcal in 2008, which is considered high intake and Brazilians increased meat intake by 12% from 2008 to 2017, with variations according to types of meat and income levels. Individuals of the lowest income stratum did not increase their meat consumption, and they spent around 17 times more of their income to buy one kilogram of beef compared to people from the highest income group. There was a significant positive relationship between purchasing power and intake of meat across income groups. In 2017, meat contributed to 86% of the Brazilian diet’s carbon footprint. In Brazil, relevant factors for meat intake may be associated with restricted purchasing power, food affordability, rising prices and income inequalities. Our findings indicate the relevance not only of food availability and intake but also the local variables such as socio-economic inequalities and cultural meanings food can assume.

Neufeld L.M., Hendriks S., Hugas M.

AbstractThe aim of this chapter is to propose a definition of “healthy diets”and provide related evidence, thus permitting the alignment of terminology for the Food Systems Summit and beyond.Dietsare combinations offoods and beverages(referred to as foods hereafter, for simplicity) consumed by individuals. However, the specific combination of foods that make up healthy diets is context-specific and depends on many cultural, economic, and other factors. We provide a definition and overview of approaches that have been used to translate this into food-based recommendations. We also provide a brief review highlighting evidence, gaps and controversies related to defining healthy diets. The evidence for potential solutions to making healthy diets more available, affordable, and their production environmentally sustainable is the subject of much literature (Herforth 2020; Chaudhary et al. 2018; Smetana et al. 2019; Badiane and Makombe 2020; Program of Accompanying Research for Agricultural Innovation 2020), and is not discussed here in detail.

Louzada M.L., Costa J.C., Costa C.D., Wendt A., Azeredo C.M.

ObjectiveTo evaluate changes in socioeconomic inequalities in food consumption in Brazil over a 10-year period.MethodsData on 24-h recalls of adults (aged 20 years or more) from the 2008/9 (n = 26,327) and 2017/8 (n = 37,689). Brazilian Dietary Survey were analyzed. We used the Nova classification system to group food items and estimate the percentage of total energy from ultra-processed foods and plant-based natural or minimally processed foods. For sex and area of residence, we calculated the percentage points (p.p.) difference between the estimates for women and men, and rural and urban populations. Negative values indicate higher consumption among men or urban residents, positive values indicate higher consumption among women or rural residents, and zero indicates equality. For education and wealth levels we calculated the slope index of inequality (SII). The SII varies from −100 to 100, with positive values indicating higher consumption among more educated or wealthiest groups, negative values indicating higher consumption among less educated or poorest groups, and zero equality.ResultsOver the period, we observed a reduction in the percentage of total energy from plant-based natural/minimally processed foods from 13.0 to 12.2% and an increase in that of ultra-processed foods from 17.0 to 18.3%. The urban population and those in the wealthier and more educated groups presented higher consumption of ultra-processed foods and lower consumption of plant-based natural/minimally processed foods in both survey years. Over the 10-year period, there was an overall reduction of the socioeconomic inequalities, mainly explained by the greater increase in ultra-processed food consumption by the rural population and those from the poorest and less educated groups (difference for area −7.2 p.p. in 2008/9 and −5.9 p.p. in 2017/8; SII for education 17.7 p.p. in 2008/9 and 13.8 p.p. in 2017/8; SII for wealth 17.0 p.p. in 2008/9 and 11.2 p.p. in 2017/8).ConclusionSocioeconomic inequalities in food consumption decreased in Brazil, but it may lead to the overall deterioration of the dietary quality of the more vulnerable groups.

Kesse-Guyot E., Allès B., Brunin J., Fouillet H., Dussiot A., Berthy F., Perraud E., Hercberg S., Julia C., Mariotti F., Deschasaux-Tanguy M., Srour B., Lairon D., Pointereau P., Baudry J., et. al.

Our recognition of the environmental pressures associated with dietary patterns has grown considerably over the past decade. However, few studies have analysed the impacts associated with the consumption of ultra-processed food (UPF) and which steps in the food chain contribute the most. Here, using a representative sample of French adults (2,121 enrolled in the Third French Individual and National Food Consumption survey), we investigate the environmental pressures of diets according to UPF consumption. Food intakes were analysed to define the %UPF by weight in the diet according to the NOVA food-classification system. Using detailed environmental data from Agribalyse, we assessed the contribution of UPF to 14 environmental pressure indicators and the contributions of the different food chain stages to these impacts: production, processing, storage, packaging, transport and retailing. The data were described according to quintiles of %UPF in the diet and analysed using crude and energy-adjusted models. Overall, UPF represented 19% of the diet yet contributed 24% to the diet’s greenhouse gas emissions, 23% to water use, 23% to land use and 26% to energy demand. Compared with low consumers of UPF (quintile 1; median UPF, 7%), high consumers (quintile 5; median UPF, 35%) consumed more caloric energy (+22%). Caloric intake partially explained the higher environmental pressures from high-UPF consumers. After we adjusted for calories consumed, the associations with greenhouse gas emissions and land use vanished, and the associations with water use and energy demand became negative. However, the processing and packaging stages contributed significantly to energy demand. Post-farm stages, such as final-product creation and packaging, contributed greater environmental impacts of UPF-rich diets. Human diets exert a range of pressures on the environment. This study, using a sample of French adults, finds that the processing and packaging behind diets rich in ultra-processed foods create pressures involving energy use in particular.

Tang H., Zhang X., Luo N., Huang J., Yang Q., Lin H., Lin M., Wu S., Wen J., Hong J., Chen P., Jiang L., Chen Y., Tan X.

Muszalska A., Wiecanowska J., Michałowska J., Pastusiak-Zgolińska K.M., Polok I., Łompieś K., Bogdański P.

Introduction: The planetary health diet, introduced by the EAT–Lancet Commission, aims to address global health and sustainability challenges by promoting a plant-based diet with reduced consumption of animal-sourced foods. This diet not only contributes to environmental sustainability but also offers significant health benefits, including prevention and management of abdominal obesity, carbohydrate metabolism disorders, dyslipidemia, and elevated blood pressure. These metabolic disorders are components of metabolic syndrome, a cluster of risk factors for cardiovascular disease. Objectives: This narrative review aims to gather the most recent findings on the impact of the planetary diet on individual components of metabolic syndrome and on the prevention and treatment of cardiovascular disease. Methods: The available research on the topic was identified via searches in PubMed, Scopus, and Google Scholar. Results: Abdominal obesity, a major risk factor for a range of chronic diseases, can be effectively mitigated by adhering to plant-based dietary patterns, which have been shown to reduce waist circumference and improve overall cardiometabolic health. Furthermore, the planetary diet plays a crucial role in reducing the risk of type-2 diabetes and improving glycemic control, with specific dietary components such as whole grains and fiber, demonstrating positive effects on blood glucose levels. This diet is additionally associated with favorable lipid profiles, including lower levels of LDL cholesterol and total cholesterol, which are critical in the prevention of atherosclerosis and cardiovascular diseases. Conclusions: These multiple benefits highlight that the planetary diet may be an effective strategy for managing and preventing metabolic syndrome and cardiovascular disease. However, further research is needed to confirm its long-term efficacy and applicability across diverse populations.