EAT-Lancet Planetary Health Diet – evidence of improved health outcomes in practice

Data from over 14,000 participants in the ELSA-Brazil, a multi-centre ongoing study across six Brazilian cities, confirms the significant health impact of adhering to the EAT Lancet Planetary Health Diet (PHD).

The authors collected 114-item food frequency questionnaires from 14,515 ELSA-Brazil cohort and applied the PHD Index (PHDI).

The PHDI assesses adherence to the EAT Lancet recommendations. A calorie-based index, made up of 16 components categorised into four groups:

• Adequacy component: nuts, peanuts, legumes, fruits, total vegetables and cereals.

• Optimum components: eggs, dairy products, fish and seafood, tubers and potatoes and vegetable oils

• Ratio component: contribution from dark green vegetables and contribution from orange/red vegetables to total vegetable intakes

• Moderation components: red meat, chicken and substitutes, animal fats, added sugars

The components within the adequacy, optimum and moderation categories can score between 0 to 5 points whilst the ratio components can score 0 to 10 points – resulting in total score range of 0-150. The higher the score, the greater adherence to the PHD.

BMI and waist circumference of the participants were compared to quintiles of the PHDI scores.

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Results

Those in the highest quintile for PHDI had the greatest adherence to the PHD were more likely to be 60 years and older, with a higher income, lower incidence of diabetes and hypertension and followed healthy lifestyles overall (non-smokers, consumed alcohol in moderation, were more physically active and had lower energy intakes).

The PHDI quintile were also directly associated with a lower BMI, waist circumference and incidence of overweight and obesity.

Compared to the first PHDI quintile, those in the 5th quintile had:

• BMI values 0.5kg/m2 lower (95%CI -0.73:-0.27)

• waist circumference values 1.7cm lower (95% CI -2.28:-1.12)

• 24% less likely to be overweight (95% CI 0.67:0.85) or obese (95% CI 0.65:0.88) – fully adjusted model

• an overall linear trend was observed for both BMI and waist circumference across the 5 quintiles.

For each 10-point increase in PHDI score there was an associated:

• 0.15kg/m2 drop in BMI (95% CI -0.21:-0.08) and a 0.52 cm reduction in waist circumference (95% CI -0.68:-0.36)

• 7% lower likelihood of being overweight (95% CI 0.90:0.97)

• 8% lower likelihood of obesity (95% CI 0.88:0.96)

• 5% lower likelihood of increased abdominal obesity (95% CI 0.92:0.99)

In summary

EAT Lancet PHD recommendations were modelled on findings from published studies and had not been applied in clinical trials. This study, using the PHDI, demonstrates that the recommendations do result in significant health benefits. The benefits demonstrated in this study on reducing central obesity has significant metabolic benefits including heart health and glycaemic control.

What the study also demonstrates, is that even small shifts in dietary patterns towards the EAT Lancet PHD recommendations can bring about clinically significant reductions in body weight and central adiposity.

From a behaviour strategy perspective, this can be an important motivating factor for consumers, as it allows gradual adaptations to their usual dietary habits, with each step providing them with a measurable improvement from their efforts.

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