Fresán Ujué, Martínez-González Miguel A, Segovia-Siapco Gina, Sabaté Joan, Bes-Rastrollo Maira
University of Navarra, Medical School, Department of Preventive Medicine and Public Health, Irunlarrea 1, 31008 Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBER-ESP), Instituto de Salud Carlos III, Monforte de Lemos Avenue 5, 28029 Madrid, Spain; Instituto de Salud Pública y Laboral de Navarra, Calle Leyre 15, 31003 Pamplona, Spain; Loma Linda University, School of Public Health, 24951 Circle Dr Nichol Hall, Loma Linda, CA 92350-1718, USA.
University of Navarra, Medical School, Department of Preventive Medicine and Public Health, Irunlarrea 1, 31008 Pamplona, Spain; Harvard University, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA; Navarra Institute for Health Research (IdisNa), Irunlarrea 3, 31008 Pamplona, Spain; CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute of Health, Monforte de Lemos Avenue 5, 28029 Madrid, Spain.
Prev Med. 2020 Aug;137:106124. doi: 10.1016/j.ypmed.2020.106124. Epub 2020 May 8.
Several healthy diet indices have been associated with mortality risk. However, the ideal diet should not only be healthy but also environmentally friendly and affordable. The study aimed to determine if a new Sustainable Diet Index (SDI), which takes into account the nutritional quality, environmental impacts and market price of diets, was associated with all-cause and cause-specific mortality. Using data from the "Seguimiento Universidad de Navarra" Project, a prospective cohort study of Spanish university graduates, the study included 15,492 participants who were recruited between December 1999 and March 2014 and followed-up for a median of 10 years. Cox regression was used to determine the relationship of SDI and its components with all-cause and cause-specific mortality risk. Hazard ratios with adjustment for several confounders were calculated. The weights for the foods contributing to the SDI were assessed with multiple regression analyses and variability with nested regression analyses. The highest quartile of the SDI scores was associated with a 59% relative reduction in all-cause mortality (HR 0.41, 95% CI 0.23-0.75; p < 0.001) and 79% reduction in cardiovascular mortality (HR 0.21, 95% CI 0.05-0.85; p < 0.001). SDI was positively correlated with beans and potato consumption but negatively correlated with red meat intake. Red and processed meats, fatty dairy products and fish consumption accounted for most of the variability in the SDI. Altogether, dietary patterns accounting not only for nutritional quality of the food but also the impact on the environment and affordability could still provide health benefits.
几种健康饮食指数与死亡风险相关。然而，理想的饮食不仅应该健康，还应该环保且价格实惠。该研究旨在确定一种新的可持续饮食指数（SDI）是否与全因死亡率和特定病因死亡率相关，该指数考虑了饮食的营养质量、环境影响和市场价格。利用“纳瓦拉大学跟踪”项目的数据，这是一项对西班牙大学毕业生的前瞻性队列研究，该研究纳入了15492名参与者，他们于1999年12月至2014年3月期间招募，并进行了为期10年的中位数随访。采用Cox回归来确定SDI及其组成部分与全因死亡率和特定病因死亡风险之间的关系。计算了调整多个混杂因素后的风险比。通过多元回归分析评估了对SDI有贡献的食物的权重，并通过嵌套回归分析评估了变异性。SDI得分的最高四分位数与全因死亡率相对降低59%（风险比0.41，95%置信区间0.23 - 0.75；p < 0.001）以及心血管死亡率降低79%（风险比0.21，95%置信区间0.05 - 0.85；p < 0.001）相关。SDI与豆类和土豆的摄入量呈正相关，但与红肉摄入量呈负相关。红肉和加工肉类、高脂肪乳制品以及鱼类消费占SDI变异性的大部分。总之，不仅考虑食物营养质量，还考虑对环境和可承受性影响的饮食模式仍能带来健康益处。
