In 2019, the EAT-Lancet Commission on healthy diets from sustainable food systems proposed a Planetary Health Diet that seeks to optimise both chronic disease prevention as well as global environmental health. In this study, we aimed to examine the association between a dietary index based on the Planetary Health Diet and risk of cardiovascular disease. We included women from the Nurses' Health Study (NHS I; 1986-2016), women from the Nurses' Health Study II (NHS II; 1991-2017), and men from the Health Professionals Follow-up Study (HPFS; 1986-2016) who were free of cardiovascular disease, cancer, and diabetes at baseline. Dietary data were collected every 4 years using a validated, semi-quantitative food frequency questionnaire. The Planetary Health Diet Index (PHDI) was based on 15 food groups: whole grains, vegetables, fruit, fish and shellfish, nuts and seeds, non-soy legumes, soy foods, and unsaturated oils were scored positively; starchy vegetables, dairy, red or 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 PHDI. We used Cox proportional hazards regression with time-varying covariates to evaluate the association between PHDI score, cumulatively averaged, and incident cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), adjusting for demographic, health, and lifestyle confounders in all participants with available data. Cohort-specific estimates were combined using inverse variance-weighted fixed effects meta-analyses. Of the 62 919 women included from the NHS I, 88 535 women included from the NHS II, and 42 164 men included from the HPFS, a total of 9831 cases of cardiovascular disease were confirmed over 4 541 980 person-years of follow-up. Mean PHDI scores ranged from 60·7 (SD 5·1) to 90·6 (5·3) in the lowest versus highest quintile in NHS I, 55·6 (4·9) to 86·3 (6·3) in NHS II, and 59·6 (5·9) to 94 (5·9) in HPFS. In the multivariable-adjusted meta-analysis, participants in the highest quintile of PHDI score had a lower risk of incident cardiovascular disease than did those in the lowest quintile (hazard ratio [HR] 0·83 [95% CI 0·78-0·89]; p-trend <0·0001). When we examined cardiovascular disease subtypes, the highest quintile of PHDI was also associated with a lower risk of coronary heart disease (HR 0·81 [95% CI 0·74-0·88]; p-trend <0·0001) and total stroke (HR 0·86 [0·78-0·95]; p-trend=0·0004) compared with the lowest quintile. We found that adherence to the Planetary Health Diet, designed to be a more environmentally sustainable dietary pattern, was associated with a lower risk of cardiovascular disease in three large cohorts of men and women in the USA. These observations support the Planetary Health Diet as a promising strategy to promote both human and planetary health. National Institutes of Health.

Plant-based diets are recommended for chronic disease prevention, yet there has been little focus on plant-based diet quality among participants of South Asian ancestry who consume a predominantly plant-based diet. We evaluated cross-sectional and prospective associations between plant-based diet quality and cardiometabolic risk among participants of South Asian ancestry who are living in the US. We included 891 participants of South Asian ancestry who completed the baseline visit in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. The prospective analysis included 735 participants who completed exam 2 (∼5 y after baseline). Plant-based diet quality was assessed using 3 indices - an overall plant-based diet index (PDI) that summarizes the consumption of plant foods, a healthful PDI (hPDI) that measures consumption of healthy plant foods, and an unhealthful PDI (uPDI) that reflects consumption of less-healthy plant foods. At baseline, the PDI was inversely associated with fasting glucose. We observed an inverse association between PDI and hPDI with HOMA-IR, LDL-C, weight, and BMI (all P<0.05). Higher scores on the hPDI, but not PDI, were associated with lower glycated hemoglobin, higher adiponectin, lower visceral fat area and pericardial fat volume. Each 5-unit higher hPDI was associated with a lower likelihood of fatty liver (odds ratio [OR] 0.76 [95% CI: 0.64, 0.90]), and obesity (OR 0.88 [95% confidence interval (CI): 0.80, 0.97]). There were no associations between uPDI and cardiometabolic risk. Prospectively, after covariate adjustment for baseline values, each 5-unit higher hPDI was associated with an 18% lower risk of incident type 2 diabetes (OR 0.82 [95% CI: 0.67, 1.00]). A higher intake of healthful plant-based foods was associated with a favorable cardiometabolic risk profile. Dietary recommendations to lower chronic disease risk among participants of South Asian ancestry should focus on the quality of plant-based foods.

Whether egg consumption is associated with the risk of type 2 diabetes (T2D) remains unsettled. We evaluated the association between egg consumption and T2D risk in 3 large US prospective cohorts, and performed a systematic review and meta-analysis of prospective cohort studies. We followed 82,750 women from the Nurses’ Health Study (NHS; 1980–2012), 89,636 women from the NHS II (1991–2017), and 41,412 men from the Health Professionals Follow-up Study (HPFS; 1986–2016) who were free of T2D, cardiovascular disease, and cancer at baseline. Egg consumption was assessed every 2–4 y using a validated FFQ. We used Cox proportional hazard models to estimate HRs and 95% CIs. During a total of 5,529,959 person-years of follow-up, we documented 20,514 incident cases of T2D in the NHS, NHS II, and HPFS. In the pooled multivariable model adjusted for updated BMI, lifestyle, and dietary confounders, a 1-egg/d increase was associated with a 14% (95% CI: 7%, 20%) higher T2D risk. In random-effects meta-analysis of 16 prospective cohort studies (589,559 participants; 41,248 incident T2D cases), for each 1 egg/d, the pooled RR of T2D was 1.07 (95% CI: 0.99, 1.15; I² = 69.8%). There were, however, significant differences by geographic region (P for interaction = 0.01). Each 1 egg/d was associated with higher T2D risk among US studies (RR: 1.18; 95% CI: 1.10, 1.27; I² = 51.3%), but not among European (RR: 0.99; 95% CI: 0.85, 1.15; I² = 73.5%) or Asian (RR: 0.82; 95% CI: 0.62, 1.09; I² = 59.1%) studies. Results from the updated meta-analysis show no overall association between moderate egg consumption and risk of T2D. Whether the heterogeneity of the associations among US, European, and Asian cohorts reflects differences in egg consumption habits warrants further investigation. This systematic review was registered at www.crd.york.ac.uk/prospero as CRD42019127860.

Rapid dietary transitions in India have been associated with an alarming rise in cardiometabolic diseases. Using data from the national Indian Council of Medical Research–India Diabetes survey (18,090 adults), we examined India’s dietary profile and the effect of isocaloric substitution of carbohydrates with other macronutrients on metabolic risk. Indian diets are characterized by high intakes of low-quality carbohydrates (white rice, milled whole grains and added sugar), high levels of saturated fat and low intakes of protein. Compared to those with the least carbohydrate intakes, those with the highest intakes had higher risk of newly diagnosed type 2 diabetes (T2D; odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.14,1.47), prediabetes (OR = 1.20, 95% CI = 1.06,1.33), generalized obesity (OR = 1.22, 95% CI = 1.07,1.37) and abdominal obesity (OR = 1.15, 95% CI = 1.01, 1.30). Replacing refined cereals with whole wheat or millet flour without decreasing overall carbohydrate quantity was not associated with lower risk for T2D (OR = 0.94, 95% CI = 0.57, 1.56) or abdominal obesity (OR = 1.08, 95% CI = 0.66, 1.76). Modeled isocaloric substitution of carbohydrates for plant, dairy, egg or fish protein was associated with lower likelihood of T2D (ranging from OR = 0.89, 95% CI = 0.83, 0.95—for dairy to OR = 0.91, 95% CI = 0.82, 0.99—egg) and prediabetes (ranging from OR = 0.82, 95% CI = 0.72, 0.92—for dairy to OR = 0.94, 95% CI = 0.89, 0.99—for fish). Public health strategies that reduce overall carbohydrates and saturated fat while increasing intake of plant and dairy proteins could mitigate the risk of metabolic diseases in India.

(1) Background: Branched-chain and aromatic amino acids (BCAAs/AAAs) have been considered as markers of type 2 diabetes (T2D); however, studies on associations between these metabolites and T2D and cardiometabolic traits in Hispanic populations are limited. The aim of this study was to examine the associations between baseline BCAAs (isoleucine, leucine, valine)/AAAs (phenylalanine, tyrosine) and prevalent and incident T2D, as well as baseline and longitudinal (2 year) changes in cardiometabolic traits (measures of glycemia, dyslipidemia, inflammation, and obesity) in two large cohorts of adults of Puerto Rican descent. (2) Methods: We included participants of the Boston Puerto Rican Health Study (BPRHS, n = 670) and San Juan Overweight Adult Longitudinal study (SOALS, n = 999) with available baseline metabolite and covariate data. T2D diagnosis was defined based on American Diabetes Association criteria. Multivariable logistic (for baseline T2D), Poisson (for incident T2D), and linear (for cardiometabolic traits) regression models were used; cohort-specific results were combined in the meta-analysis and adjusted for multiple comparisons. (3) Results: Higher baseline BCAAs were associated with higher odds of prevalent T2D (OR_{1SD BCAA score} = 1.46, 95% CI: 1.34–1.59, p < 0.0001) and higher risk of incident T2D (IRR_{1SD BCAA score} = 1.24, 95% CI: 1.13–1.37, p < 0.0001). In multivariable longitudinal analysis, higher leucine and valine concentrations were associated with 2-year increase in insulin (beta _{1SD leucine} = 0.37 mcU/mL, 95% CI: 0.11–0.63, p < 0.05; beta _{1SD valine} = 0.43 mcU/mL, 95% CI: 0.17–0.68, p < 0.01). Tyrosine was a significant predictor of incident T2D (IRR = 1.31, 95% CI: 1.09–1.58, p < 0.05), as well as 2 year increases in HOMA-IR (beta _{1SD tyrosine} = 0.13, 95% CI: 0.04–0.22, p < 0.05) and insulin concentrations (beta _{1SD tyrosine} = 0.37 mcU/mL, 95% CI: 0.12–0.61, p < 0.05). (4) Conclusions: Our results confirmed the associations between BCAAs and prevalent and incident T2D, as well as concurrent measures of glycemia, dyslipidemia, and obesity, previously reported in predominantly White and Asian populations. Baseline leucine, valine, and tyrosine were predictors of 2 year increases in insulin, whereas tyrosine was a significant predictor of deteriorating insulin resistance over time. Our study suggests that BCAAs and tyrosine could serve as early markers of future glycemic changes in Puerto Ricans.