Is it time to align adolescent diets with the Planetary Health Diet? An observational study on early cardiovascular health

Abstract

<p><strong>Background: </strong></p><p>As the impact of early adoption of a sustainable plant-based diet on cardiometabolic biomarkers remains unexplored, we assessed whether they are associated with the Planetary Health Diet Index (PHDI) in adolescents.</p><p><strong>Methods: </strong></p><p>This prospective study was conducted within the SI! Program for Secondary Schools trial (SI! Program) in 886 adolescents (12 years ± 0.4 at cohort entry; 49.1% female) followed during 4 years in Spain. The PHDI scores were derived from validated food frequency questionnaires. Multivariable-adjusted Cox proportional-hazards models (HRs) analyzed the association between PHDI and risk of new-onset high blood pressure (BP), obesity, and elevated plasma cardiometabolic biomarkers. Additionally, mixed models assessed changes in those parameters.</p><p><strong>Results: </strong></p><p>High adherence to the PHDI_{(Q4 vs. Q1)} is associated with a reduced risk of high BP by 81% (HR: 0.19 [95% CI: 0.11, 0.34]), plasma glucose by 47% (HR: 0.53 [95% CI: 0.48, 0.58]), triglycerides (TG) by 66% (HR: 0.34 [95% CI: 0.18, 0.65]), total cholesterol by 51% (HR: 0.49 [95% CI: 0.34, 0.69]), and non-high density lipoprotein cholesterol (non-HDL-C) by 74% (HR: 0.26 [95% CI: 0.13, 0.50]) in Cox models. Mixed models show inverse associations with higher PHDI and blood glucose (−5.23 mg/dL [95% CI: −10.35, −0.10]), TG (−2.48 mg/dL [95% CI: −3.65, −1.30]), and body mass index (BMI) z-score (−0.02 [95% CI: −0.03, 0.00]).</p><p><strong>Conclusion: </strong></p><p>This study stands out as greater adherence to the PHDI is inversely associated with cardiometabolic biomarkers in adolescents, highlighting nutritional benefits of the Planetary Health Diet and its role in preventing the development of cardiovascular diseases and early detection.</p>