Planetary Health Diet Index and risk of total and cause-specific mortality in three prospective cohorts

Jul 3, 2024The American journal of clinical nutrition

Planetary Health Diet and risk of overall and specific causes of death in three long-term studies

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Abstract

Among 66,692 females and 47,274 males, a higher Planetary Health Diet Index (PHDI) was associated with a 0.77 hazard ratio for all-cause mortality when comparing the highest and lowest quintiles.

A higher PHDI is linked to a reduced risk of deaths from cardiovascular diseases (HR: 0.86) and cancer (HR: 0.90).
Significant associations were found between higher PHDI and lower mortality from respiratory diseases (HR: 0.53) and neurodegenerative diseases (HR: 0.72).
In females, a high PHDI was additionally associated with a lower risk of deaths from infectious diseases (HR: 0.62), while this was not observed in males.
PHDI scores demonstrated an inverse relationship with greenhouse gas emissions and other environmental impacts.

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BACKGROUND: 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.

OBJECTIVES: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

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Planetary Health Diet Index and risk of total and cause-specific mortality in three prospective cohorts

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