Sustainable diets and long-term cardiovascular disease outcomes; insights from the 20-year follow-up ATTICA study (2002–2022) - European Journal of Nutrition

Purpose To identify habitual dietary patterns within a Mediterranean population-based cohort, examine their associations with cardiovascular disease (CVD) risk factors and outcomes over 20 years, and interpret them in sustainability terms. Methods A total of 3,042 CVD-free adults from the ATTICA Study were enrolled in 2001–2002. Dietary intake was assessed using a validated food frequency questionnaire, and principal component analysis was utilized to derive a posteriori dietary patterns. Participants were followed for 20 years, with complete CVD data available for 1988 individuals. CVD incidence, lifetime risk, and disability-adjusted life years (DALYs) were calculated. Multivariate Cox proportional hazards, beta and gamma regression models examined associations between dietary patterns and CVD outcomes. Results Three dietary patterns were identified, explaining 46.5% of variance in consumption: a plant-based, sustainable pattern; a Western pattern rich in animal-sourced and processed foods; and a high-calorie, low-white-meat pattern. Higher adherence to the plant-based pattern was associated with a 26% (HR: 0.74, 95% CI 0.55–0.99) lower 20-year CVD risk. The high-calorie, low-white-meat pattern was linked to increased lifetime risk (β = 0.066, p < 0.001) and DALYs (β = 0.13, p = 0.009). No significant associations were observed for the Western pattern after adjustments. Conclusions A plant-based dietary pattern was protective against long-term CVD outcomes, while a high-calorie, low-white-meat pattern was detrimental. These findings underscore the importance of promoting culturally acceptable, sustainable dietary patterns to reduce CVD risk and support environmental sustainability.

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