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Session: Dietary Patterns and Health Outcomes (Oral 19)

(OR19-01-23) Planetary Health Diet and Risk of Incident Cardiovascular Disease: Findings From Two Cohorts of US Women

Monday, July 24, 2023
2:00 PM – 2:12 PM ET
Location:  Constitution B
PRAC ELPC

    Presenting Author(s)

  • Caleigh Sawicki, PhD, MPH (she/her/hers)

    Postdoctoral Research Fellow
    Brigham and Women's Hospital and Harvard Medical School
    Boston, Massachusetts, United States

    Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • GR

    Gautam Ramesh

    Harvard T.H. Chan School of Public Health; School of Medicine, University of California, San Diego

  • LB

    Linh P. Bui, MPH (she/her/hers)

    Graduate student
    Harvard T.H. Chan School of Public Health
    Fairfax, Virginia, United States

  • NN

    Nile Nair

    Harvard T.H. Chan School of Public Health

  • Frank B. Hu, MD, MPH, PhD

    Chair, Department of Nutrition Harvard T.H. Chan School of Public Health Fredrick J. Stare Professor of Nutrition and Epidemiology at Harvard T.H. Chan School of Public Health Professor of Medicine, Harvard Medical School and Brigham and Women’s Hospital
    Harvard T.H. Chan School of Public Health
    Boston, Massachusetts, United States

  • WW

    Walter c. Willett, DrPH, MPH, MD

    Professor
    Harvard T.H. Chan School of Public Health
    Boston, Massachusetts, United States

  • Shilpa N. Bhupathiraju, PhD

    Assistant Professor
    Harvard Medical School and Brigham and Women's Hospital
    Boston, Massachusetts, United States

Disclosure(s):
Caleigh Sawicki, PhD, MPH: No relevant financial relationship(s) with ineligible companies to disclose.
Linh P. Bui, MPH: No relevant financial relationship(s) with ineligible companies to disclose.
Frank B. Hu, MD, MPH, PhD: No relevant financial relationship(s) with ineligible companies to disclose.
Shilpa N. Bhupathiraju, PhD: No relevant financial relationship(s) with ineligible companies to disclose.
Objectives: In 2019, the EAT-Lancet Commission on healthy diets from sustainable food systems proposed a Planetary Health Diet (PHD) that is optimal for both chronic disease prevention as well as global environmental health. In this study, we aim to examine the association between a dietary index based on the PHD and risk of cardiovascular disease (CVD).

Methods: We included 62,919 women from the Nurses' Health Study (NHS, 1986-2016) and 77,928 women from the Nurses' Health Study II (NHS II, 1991-2017) who were free of type 2 diabetes, CVD, and cancer at baseline. Dietary data were collected every 4 years using a validated, semi-quantitative food frequency questionnaire. The PHD was based on 15 food groups: whole grains, vegetables, fruit, fish/shellfish, nuts/seeds, non-soy legumes, soy foods, and unsaturated oils were scored positively; starchy vegetables, dairy, red/processed meat, poultry, eggs, saturated fats and trans fat, and added sugar received negative scores. Scores for each food group were summed to get a total score of 0-140. Higher scores indicated greater adherence to the PHD. We used Cox proportional hazards regression with time-varying covariates to evaluate the association between PHD score and incident CVD [defined as fatal and non-fatal myocardial infarction (MI) and stroke], adjusting for demographic, health, and lifestyle confounders. Cohort-specific estimates were combined using inverse variance-weighted fixed effects meta-analyses.

Results: A total of 5863 cases of CVD were reported over 2,767,750 person-years of follow-up. PHD score ranged from 60.7 ± 5.1 (mean ± SD) to 90.3 ± 5.3 in the lowest versus highest quintile in NHS and 55.6 ± 4.9 to 86.3 ± 6.3 in NHSII. In the multivariable-adjusted meta-analysis, women in the highest quintile of PHD score had a 19% lower risk of incident CVD compared to those in the lowest quintile [HR (95% CI): 0.81 (0.74, 0.88), p < 0.0001)]. When we examined CVD subtypes, the highest quintile of PHD was also associated with a lower risk of total MI [HR (95% CI): 0.78 (0.69, 0.89), p =0.0001)], and total stroke [HR (95% CI): 0.83 (0.74, 0.94), p =0.0037)] compared to the lowest quintile.

Conclusions: We found that adherence to the PHD, a more environmentally sustainable dietary pattern, was associated with lower risk of CVD among two large cohorts of women in the U.S.

Funding Sources: CMS and RG are supported NIH grants