Adherence to the EAT-Lancet Planetary Health Diet and Cardiometabolic Risk Markers in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

IF 3.2 Q2 NUTRITION & DIETETICS

Current Developments in Nutrition Pub Date : 2025-06-01 DOI:10.1016/j.cdnut.2025.107468

Nilendra K Nair , Linh P Bui , Caleigh M Sawicki , Namratha R Kandula , Alka M Kanaya , Kyu Ha Lee , Meir J Stampfer , Walter C Willett , Shilpa N Bhupathiraju

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Abstract

Background

The global food system significantly impacts environmental and human health, contributing to substantial greenhouse gas emissions.

Objective

We examined associations between a novel Planetary Health Diet Index (PHDI) that reflects adherence to the EAT-Lancet recommendations and cardiometabolic risk in a cohort of South Asians.

Methods

We analyzed data from MASALA study participants with baseline (n = 891) and 5-y follow-up (n = 735) data. The PHDI comprised 15 food components and ranged from 0 to a maximum of 140, with higher scores indicating greater adherence to the PHDI. We used multivariable linear and logistic regression models to examine cross-sectional and prospective (5-y) associations between baseline PHDI and cardiometabolic risk factors, adjusting for demographic, health, and lifestyle factors and baseline values of the outcome (prospective analyses only).

Results

Among MASALA study participants (47% female, mean age 55 y), the mean PHDI score was 88.8 (SD 9.47). Prospectively, higher PHDI was associated with lower percentage difference in fasting glucose (−0.29 ± 0.15 %), glycated hemoglobin (HbA1c) (−0.08 ± 0.04%), higher high-density lipoprotein (0.40 ± 0.17 mmol/L), lower body weight (−0.37 ± 0.12 kg), body mass index (BMI) (−0.08 ± 0.03 kg/m²), waist circumference (−0.49 ± 0.17 cm), and systolic blood pressure (−0.65 ± 0.30 mmHg) (P < 0.05 for all). Each 10-unit higher PHDI was associated with a 20% lower likelihood of incident type 2 diabetes (OR [95% CI]: 0.80 [0.54, 0.86]). Cross-sectionally, at baseline, 10 unit higher PHDI was associated with (β ± SE) lower percentage difference in fasting glucose (−0.45 ± 0.22 %) and HbA1c (−0.49 ± 0.22%), lower LDL (−0.015 ± 0.007 mmol/L), CRP (−5.40 ± 2.42 ug/L), higher adiponectin (4.67 ± 2.02 mg/dL), lower body weight (−0.59 ± 0.26 kg), BMI (−0.27 ± 0.11 kg/m²), waist circumference (−025 ± 0.29 cm), visceral fat (−1.37 ± 1.32 cm²), and pericardial fat (−0.58 ± 0.43 cm³) (P < 0.05 for all). Higher PHDI scores were associated with lower odds of obesity (OR [95% CI]: 0.80 [0.71, 0.92]) and overweight (0.77 [0.74, 0.85]).

Conclusions

Greater adherence to a planetary healthy diet was associated with lower cardiometabolic risk factors and risk of incident type 2 diabetes.

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在美国生活的南亚人（MASALA）研究中，遵守EAT-Lancet行星健康饮食和动脉粥样硬化介质中的心脏代谢风险标志物

全球粮食系统对环境和人类健康产生重大影响，造成大量温室气体排放。目的：在南亚人群中，我们研究了反映EAT-Lancet推荐的新型行星健康饮食指数（PHDI）与心脏代谢风险之间的关系。方法我们分析来自MASALA研究参与者的基线数据（n = 891）和5年随访数据（n = 735）。PHDI包括15种食品成分，范围从0到最高140，得分越高表明对PHDI的遵守程度越高。我们使用多变量线性和逻辑回归模型来检验基线PHDI与心脏代谢危险因素之间的横断面和前瞻性（5-y）关联，调整了人口统计学、健康和生活方式因素以及结果的基线值（仅限前瞻性分析）。结果在MASALA研究参与者中（47%为女性，平均年龄55岁），平均PHDI评分为88.8 （SD 9.47）。前瞻性地，较高的PHDI与较低的空腹血糖（- 0.29±0.15%）、糖化血红蛋白（- 0.08±0.04%）、较高的高密度脂蛋白（0.40±0.17 mmol/L）、较低的体重（- 0.37±0.12 kg）、体重指数（BMI）（- 0.08±0.03 kg/m2）、腰围（- 0.49±0.17 cm）和收缩压（- 0.65±0.30 mmHg） (P <；0.05)。PHDI每升高10个单位，发生2型糖尿病的可能性降低20% （OR [95% CI]: 0.80[0.54, 0.86]）。横断面上，基线时，高10个单位的PHDI与（β±SE）空腹血糖（- 0.45±0.22%）和HbA1c（- 0.49±0.22%）、低密度脂蛋白（- 0.015±0.007 mmol/L）、CRP（- 5.40±2.42 ug/L）、高脂联素（4.67±2.02 mg/dL）、低体重（- 0.59±0.26 kg）、BMI（- 0.27±0.11 kg/m2）、腰围（- 025±0.29 cm）、内脏脂肪（- 1.37±1.32 cm2）和心包脂肪（- 0.58±0.43 cm3） (P <；0.05)。PHDI评分越高，肥胖（OR [95% CI]: 0.80[0.71, 0.92]）和超重（0.77[0.74,0.85]）的几率越低。结论：更坚持行星健康饮食与较低的心脏代谢危险因素和发生2型糖尿病的风险相关。

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