Sustainable, planetary healthy dietary patterns are associated with lower 20-year incidence of cardiovascular disease: the ATTICA study (2002-2022).

Background/objectives: Nutrition epidemiology research scarcely focuses on the relationship between dietary patterns that are beneficial for both planet and human health. This study aimed to examine the association between adherence to a sustainable, planetary-healthy dietary pattern, i.e., the EAT-Lancet Reference Diet (EAT-LD), and 20-year cardiovascular disease (CVD) incidence, in a Mediterranean population.
Subjects/methods: Τhe ATTICA study is a prospective cohort study with a baseline phase in 2002 and 3 consecutive follow-ups (in 2006, 2012, 2022). The EAT-Lancet Index (EAT-LI) and the MedDietScore scales were calculated based on previously published guidelines to assess the adherence to the respective dietary pattern. The current sample consisted of 1,988 Greek adults initially free-of-CVD at baseline. The development of a cardiovascular event was assessed throughout the 20-year period (WHO-ICD-10 classification).
Results: The 20-year incidence of CVD was 3600 cases/10,000 individuals (95%Confidence Interval-CI: 3506 to 3695/10,000). Median (interquartile range) values for EAT-LI and MedDietScore were 17 (6.2) out of possible 42 points and 27 (2.9) out of possible 55 points, respectively. Both diet scales were inversely associated with 20-year CVD incidence [Hazard Ratio-HR (95% CI) per 1 point (of possible 42 points) of EAT-LI: 0.83 (0.77-0.90) and per 1 point (of possible 55 points) of MedDietScore: 0.90 (0.84-0.93)].
Conclusion: Our findings highlight that diets that are good for planetary health, are also healthy for humans. Promoting diets that are culturally acceptable, economically viable, easily accessible, planet-friendly, and sustainable should be a key strategy for enhancing both public and planetary health.
Competing Interests: Competing interests: The authors declare no competing interests. Ethical approval: The ATTICA study was carried out in accordance with the Declaration of Helsinki (1989) of the World Medical Association and was approved by the Institutional Ethics committee of Athens Medical School (#017/1.5.2001), and the Bioethics Committee of Harokopio University (#38/29.03.2022). All participants provided written consent to participate in the study.
(© 2025. The Author(s), under exclusive licence to Springer Nature Limited.)