American Heart Association approves the EAT-Lancet diet

The American Heart Association (AHA) has acknowledged the need to incorporate environmental factors within their dietary recommendations for cardiovascular disease (CVD).

Aim

The AHA wanted to establish whether the EAT Lancet Healthy Reference Diet's proposed cardioprotective benefits based on theoretical models, could be replicated using findings from a large prospective cohort study. The aim was to investigate the correlation between the degree of adherence to the Healthy Reference Diet (HRD) and risk of CVD. In addition, they aimed to establish associated environmental impacts.

Study design

Food frequency questionnaire data from the large Dutch arm of the European Prospective Investigation into Cancer and Nutrition (EPIC) study with almost 35,500 male and female participants were collected.

FFQ were assigned a HRD adherence score. A score of 0-10 was allocated depending on the degree of adherence to each of the 14 food group recommendations of the HRD. The scores for the 14 food groups were then summed to provide a total potential score of 0 (no adherence) to a maximum of 140 for optimum adherence to all HRD recommendations.

Disease outcomes. The HRD adherence score was compared to total CVD fatal and non-fatal events and separately for coronary heart disease (CHD) and strokes.

Environmental impacts. The impact on greenhouse gas (GHG) emissions, land use, blue water use, acidification and eutrophication was also calculated based on a Dutch life cycle analysis database.

Other measures undertaken included baseline body weight and height, serum cholesterol levels and blood pressure. Additionally age, sex, education, smoking status, physical activity and medication were also noted.

Results

The average HRD score was 73 indicating moderate adherence, but the range was significant from 32-116.

The median follow-up period was 15.1 years in which time 4,153 CVD events were registered.

HRD adherence scores were inversely correlated to CVD events. Compared to the lowest adherence to the HRD, the groups with the highest adherence had a:

• 14% lower risk of CVD [HR 0.86, 95% CI, 0.78-0.94]

• 12% lower incidence of CHD [HR 0.88, 95% CI, 0.78-1.00]

• 11% lower incidence of total stroke events [HR 0.89, 95% CI, 0.72–1.10] - not significant

When confounding factors were considered, the associated benefits were enhanced.

As well as the CVD benefits, the higher adherence to HRD was associated with lower environmental impacts on all parameter measured with the exception of blue water use.

"...higher adherence to the HRD (Healthy Reference Diet) as proposed by the EAT-Lancet Commission was associated with a 14% lower risk of CVD and a 12% lower risk of CHD."

Conclusion

High adherence to the HRD was associated with lower risk of cardiovascular disease, coronary heart disease, and modestly lower levels of most environmental indicators but a higher level of blue water use.

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