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. 2024 Jan 10;19(1):e0296069.
doi: 10.1371/journal.pone.0296069. eCollection 2024.

Dietary quality and cardiometabolic indicators in the USA: A comparison of the Planetary Health Diet Index, Healthy Eating Index-2015, and Dietary Approaches to Stop Hypertension

Sarah M Frank  1   2 , Lindsay M Jaacks  2 , Christy L Avery  1   3 , Linda S Adair  1   4 , Katie Meyer  4   5 , Donald Rose  6 , Lindsey Smith Taillie  1   4
Affiliations

Dietary quality and cardiometabolic indicators in the USA: A comparison of the Planetary Health Diet Index, Healthy Eating Index-2015, and Dietary Approaches to Stop Hypertension

Sarah M Frank et al. PLoS One. .

Abstract

Background: The Planetary Health Diet Index (PHDI) measures adherence to the sustainable dietary guidance proposed by the EAT-Lancet Commission on Food, Planet, Health. To justify incorporating sustainable dietary guidance such as the PHDI in the US, the index needs to be compared to health-focused dietary recommendations already in use. The objectives of this study were to compare the how the Planetary Health Diet Index (PHDI), the Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to cardiometabolic risk factors.

Methods and findings: Participants from the National Health and Nutrition Examination Survey (2015-2018) were assigned a score for each dietary index. We examined disparities in dietary quality for each index. We used linear and logistic regression to assess the association of standardized dietary index values with waist circumference, blood pressure, HDL-C, fasting plasma glucose (FPG) and triglycerides (TG). We also dichotomized the cardiometabolic indicators using the cutoffs for the Metabolic Syndrome and used logistic regression to assess the relationship of the standardized dietary index values with binary cardiometabolic risk factors. We observed diet quality disparities for populations that were Black, Hispanic, low-income, and low-education. Higher diet quality was associated with improved continuous and binary cardiometabolic risk factors, although higher PHDI was not associated with high FPG and was the only index associated with lower TG. These patterns remained consistent in sensitivity analyses.

Conclusions: Sustainability-focused dietary recommendations such as the PHDI have similar cross-sectional associations with cardiometabolic risk as HEI-2015 or DASH. Health-focused dietary guidelines such as the forthcoming 2025-2030 Dietary Guidelines for Americans can consider the environmental impact of diet and still promote cardiometabolic health.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Bland-Altman plots comparing rescaled PHDI, HEI-2015, and DASH values.
Planetary Health Diet Index, Healthy Eating Index-2015, and Dietary Approaches to Stop Hypertension scores were rescaled from 0 to 100 for comparability.
Fig 2
Fig 2. Percent agreement for quintiles of PHDI, HEI-2015 and DASH, NHANES 2015–2018.
Values are percent in a given quintile of one index that are in the same quintile of the other index. Perfect correlation would be 20.00% down the diagonal.
See this image and copyright information in PMC

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