Adherence to the EAT-Lancet Healthy Reference Diet in relation to Coronary Heart Disease, All-Cause Mortality Risk and Environmental Impact: Results from the EPIC-NL Cohort

Abstract

Objectives: To construct a diet-score measuring the level of adherence to the Healthy Reference Diet (HRD), to explore whether adherence to the HRD is associated with coronary heart disease (CHD), all-cause mortality risk, and to calculate its environmental impact. Design: Prospective cohort study. Setting: The Dutch contribution to the European Prospective Investigation into Cancer and Nutrition (EPIC-NL). Participants: 37,349 adults (20-70y) without CHD at baseline. Main outcome measures: Primary outcomes were incident CHD and all-cause mortality. Secondary outcomes were greenhouse gas emission (GHGE), land use, blue water use, freshwater eutrophication, marine eutrophication, and terrestrial acidification. Results: During a median 15.3-year follow-up, 2,543 cases of CHD occurred, and 5,648 individuals died from all causes. The average HRD-score was 73 (SD=10). High adherence to the HRD was associated with a 15% lower risk of CHD (hazard ratio 0.85, 95% confidence interval 0.75 to 0.96), as well as a 17% lower risk of all-cause mortality (hazard ratio 0.83, 95% confidence interval 0.77 to 0.90) in multivariable-adjusted models. Better adherence to the HRD was associated with lower environmental impact from GHGE (β= -0.10 kg CO2-eq, 95% confidence interval -0.13 to -0.07), land use (β= -0.11 m2 per year, 95% confidence interval -0.12 to -0.09), freshwater eutrophication (β= -0.000002 kg P-eq, 95% confidence interval -0.000004 to -0.000001), marine eutrophication (β= -0.00035 kg N-eq, 95% confidence interval -0.00042 to -0.00029), and terrestrial acidification (β = -0.004 kg SO2-eq, 95% confidence interval -0.004 to -0.003), but with higher environmental impact from blue water use (β=0.044 m3, 95% confidence interval 0.043 to 0.045). Conclusion: High adherence to the HRD was associated with lower risk of CHD and all-cause mortality. Additionally, increasing adherence to the HRD could lower some aspects of the environmental impact of diets, but attention is needed for the associated increase in blue water use.

Adherence to a Planetary Health Diet, Environmental Impacts, and Mortality in Chinese Adults

“…We found that higher PHD-S was associated with lower GHG emissions, which was in line with other studies . This association was largely driven by lower consumption of total grains (mostly refined grains) and red meat, and was consistent with the findings that rice, as the main crop on a global scale, emits more GHG than other crops, and shifting to a diet free of animal products (especially red meat) could reduce GHG emissions by 49% .…”

“…Moreover, these studies were conducted only in Western populations, without considering each individual’s energy intake and different levels of adherence to PHD . To date, only a few studies using individualized data have linked PHD to both environmental impacts and mortality outcomes . Laine et al revealed that higher adherence to PHD was associated with lower GHG emissions, land use, and mortality risk among Europeans.…”

“…Although several studies have developed scoring methods to assess adherence to PHD, no consensus has been formed. Moreover, these studies were conducted only in Western populations, without considering each individual’s energy intake 7 , 8 , 9 , 10 , 11 and different levels of adherence to PHD. 12 , 13 To date, only a few studies using individualized data have linked PHD to both environmental impacts and mortality outcomes.…”

Association between adherence to the EAT-Lancet diet and risk of cancer and cardiovascular outcomes in the prospective NutriNet-Santé cohort

“…It would be relevant to study them to confirm or infirm this association in our study population. However, a Dutch study, which included 2,543 cases, reported a 15% reduction in coronary heart disease risk with a higher adherence to EAT-Lancet recommendations (60). Metaanalyses on the MEDI-Lite (62,63), also reported negative associations between diet quality scores and risk of all CVD while it was not the case in our study, nor in the Lazarova's study, which also did not find an association between adherence to the EAT-Lancet diet and the occurrence of all-cause stroke (64).…”

“…Regarding CVD, the relationships between stroke, some subtypes both ischemic and hemorrhagic, and the EAT-Lancet recommendations have been studied (28,59), however to our knowledge, only one study on coronary diseases has been conducted (60). Whether carried out in the elderly or in the general population, no association was found between a better adherence to the EAT-Lancet recommendations and the risk of stroke (28,59).…”