Lei Lifu, Qin Haixia, Chen Yushi, Sun Yu, Yin Wenwei, Tong Shiwen
Department of Clinical Nutrition, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
J Am Nutr Assoc. 2025 Jan;44(1):40-49. doi: 10.1080/27697061.2024.2399826. Epub 2024 Sep 5.
The EAT-Lancet Commission has proposed an EAT-Lancet diet (ELD), also known as a planetary health diet (PHD), which is environmentally sustainable and promotes human health. However, the association between this diet and the risk of hypertension remains unclear. This study aimed to determine whether adherence to ELD was associated with a lower risk of hypertension.
11,402 adults without hypertension at baseline from the China Health and Nutrition Survey were included. The PHD score was used to evaluate ELD adherence, with higher scores reflecting better compliance. Cox proportional hazards regression analysis was utilized to estimate the hazard ratio (HR) with a 95% confidence interval (CI). Additionally, a subgroup analysis was performed to identify the possible effect modifiers, and a mediation analysis was conducted to explore the mediation effects of anthropometric measurements on the association between ELD and hypertension.
A total of 3993 participants (35%) developed hypertension during 93,058 person-years of follow-up. In the covariate-adjusted model, hypertension risk was reduced in the highest quartile participants compared to the lowest quartile of the PHD score (adjusted HR: 0.79, 95%CI: 0.71-0.87; -trend < 0.001), which remained significant after sensitivity analysis. Notably, the association was also observed in isolated systolic hypertension, isolated diastolic hypertension, and systolic-diastolic hypertension. Subgroup analysis revealed that the inverse association between the PHD score and hypertension risk was more pronounced in nonsmokers and high-sodium intake consumers than in smokers and low-sodium consumers (-interaction < 0.05). Additionally, mediation analysis revealed that 23.3% of the association between the PHD score and hypertension risk was mediated by the waist-to-height ratio.
Our findings suggest that a higher adherence to ELD is associated with a lower risk of hypertension. These results emphasize that ELD may serve as a potential strategy to prevent hypertension.
“柳叶刀 - 饮食委员会”提出了一种“柳叶刀 - 饮食”（ELD），也称为“行星健康饮食”（PHD），这种饮食在环境方面具有可持续性并能促进人类健康。然而，这种饮食与高血压风险之间的关联仍不明确。本研究旨在确定坚持ELD是否与较低的高血压风险相关。
纳入了来自中国健康与营养调查的11402名基线时无高血压的成年人。采用PHD评分来评估对ELD的依从性，分数越高表明依从性越好。利用Cox比例风险回归分析来估计风险比（HR）及95%置信区间（CI）。此外，进行了亚组分析以确定可能的效应修饰因素，并进行了中介分析以探讨人体测量指标对ELD与高血压关联的中介作用。
在93058人年的随访期间，共有3993名参与者（35%）患上了高血压。在协变量调整模型中，与PHD评分最低四分位数的参与者相比，最高四分位数的参与者高血压风险降低（调整后HR：0.79，95%CI：0.71 - 0.87；趋势P < 0.001），敏感性分析后该结果仍然显著。值得注意的是，在单纯收缩期高血压、单纯舒张期高血压和收缩期 - 舒张期高血压中也观察到了这种关联。亚组分析显示，与吸烟者和低钠摄入者相比，PHD评分与高血压风险之间的负相关在非吸烟者和高钠摄入者中更为明显（交互作用P < 0.05）。此外，中介分析显示，PHD评分与高血压风险之间23.3%的关联是由腰高比介导的。
我们的研究结果表明，更高程度地坚持ELD与较低的高血压风险相关。这些结果强调ELD可能是预防高血压的一种潜在策略。
