A recent JACC: Heart Failure study determines whether the EAT-Lancet diet index influences the risk of heart failure (HF) and the plasma proteins that may influence this association.
Study: The EAT-Lancet Diet Index, Plasma Proteins, and Risk of Heart Failure in a Population-Based Cohort. Image Credit: monticello / Shutterstock.com
Background
The rapid rise in the prevalence of HF, particularly among the growing elderly population, remains a global health concern. Patients with HF often experience reduced quality of life and are at a greater risk of severe morbidity and mortality. Therefore, it is imperative to identify effective modifiable risk factors that can prevent HF.
Previous studies have shown that diet is a modifiable factor that can significantly influence the risk of HF. In 2019, the EAT-Lancet Commission proposed the EAT-Lancet that prevents specific diseases and promotes environmental sustainability.
The EAT-Lancet reference diet encourages a higher intake of fruits, vegetables, legumes, nuts, and whole grains while also reducing the intake of sugary and animal-sourced foods. As compared to the Mediterranean diet, the EAT-Lancet diet involves a greater emphasis on cereals and legumes.
It is important to understand whether adherence to the EAT-Lancet diet could reduce the risk of HF. To date, few studies have assessed the association between the EAT-Lancet diet and the risk of HF.
About the study
The current study hypothesized that adherence to the EAT-Lancet diet would reduce the risk of developing HF. Since plasma proteins play an important role in disease manifestations and are impacted by environmental factors, proteomics could be used to elucidate mechanisms that may connect diet and certain diseases.
The current study obtained all relevant data from the Malmö Diet and Cancer (MDC) and MDC Cardiovascular Cohort (MDC-CC) study. At baseline, blood samples were collected, and the participants' diets were assessed.
A total of 23,260 participants fulfilled all eligibility criteria and were included in the study. A proteomic study of 4,742 individuals was also performed.
The EAT-Lancet diet index included less than 13, 14-16, 17-19, 20-22, and over 23 points. Study participants were divided into five groups in accordance with their degree of adherence to the baseline EAT-Lancet diet index.
The International Classification of Diseases (ICD) coding system from the Swedish Hospital Discharge Register was used to assess the prevalence and incidence of HF cases in Sweden. Blood samples were used to extract plasma, and a total of 149 plasma proteins were evaluated using the Olink proximity extension assays.
Study findings
The mean age of the study cohort was 57.8 years, approximately 39% of whom were male. Female participants with university degrees were more likely to adhere to the EAT-Lancet diet index, consume fewer calories, be non-smokers, and engage more in leisure-time physical activity.
The current prospective cohort study lasted for nearly thirty years. Greater adherence to the EAT-Lancet diet index was associated with a reduced risk of HF development.
This association was more significant among participants who did not have a family history of myocardial infarction (MI), thus implying that the protective effect of the EAT-Lancet diet on HF could be weakened due to genetic factors. In the future, more research is needed to elucidate the association between the EAT-Lancet diet and HF in the context of different genetic susceptibilities.
Eight plasma proteins including adrenomedullin (AM), interleukin 6 (IL-6), growth differentiation factor 15 (GDF15), transmembrane immunoglobulin and mucin domain (TIM), chemokine (C-C) motif ligand 20 (CCL20), cathepsin D (CTSD), follistatin (FS), and ferric uptake regulator (FUR) were associated with the EAT-Lancet diet index and risk of HF.
The study findings are consistent with previous studies indicating that plant-based diets, which are similar to the EAT-Lancet diet, reduce the risk of HF. Several components of the EAT-Lancet diet index, particularly fruits and unsaturated oils, significantly contribute to the inverse association between the EAT-Lancet diet and the risk of HF. As compared to higher intake, a moderate dairy intake at baseline also lowered the risk of HF.
Conclusions
The current study highlights that adherence to the EAT-Lancet diet reduces the risk of developing HF, in addition to promoting a sustainable environment by decreasing land/water use and greenhouse gas emissions. The identified plasma proteins also indicate the underlying mechanisms that lead to an inverse association between the EAT-Lancet diet and lower HF risk.
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