Association between changes in adherence to the planetary health diet and adiposity and body fat distribution: a...

The longitudinal relationship between planetary heath diets and adiposity remains understudied in Europeans. We investigated the association between changes in adherence to the EAT-Lancet planetary health diet (PHD) and changes in adiposity and body fat distribution.

We evaluated 6845 adults (mean age 49.4 years, 51% women), with repeat assessments in the Fenland Study at baseline (2005-2015) and follow-up (2014-2020). Diet was assessed with food frequency questionnaires and scaled to the PHD Index (PHDI) as a measure of adherence to the PHD (range: 0-140 points). Anthropometry, total fat, visceral, subcutaneous fat and lean mass, and liver fat score was measured at both visits. Multivariable-adjusted linear regression, adjusted for sociodemographic, lifestyle and clinical variables, assessed the association between changes in the PHDI and concurrent changes in adiposity.

The mean (standard deviation) change in PHDI was 2.1 (±9.1) points. An increase in the PHDI (per 10 points, equivalent to ∼1 standard deviation), was associated negatively with changes in adiposity indices: total body weight (adjusted beta-coefficient: -0.47 kg; 95% confidence interval: -0.63, -0.31), waist circumference (-0.55 cm; -0.73, -0.37), fat mass (-0.43 kg; -0.56, -0.30), subcutaneous fat (-24.5 g; -34.0, 15.0), visceral fat (-40.0 g; -51.5, -28.5), liver fat score (-0.12; -0.15, -0.09), and lean mass (-0.08 kg; -0.13, -0.02). After further adjustment for changes in total body weight, inverse associations persisted for waist circumference, visceral fat, and liver fat. We found stronger associations among those with a BMI ≥30 kg/m² for body weight, fat mass, lean mass, subcutaneous fat, visceral fat, and liver fat score (p for interaction<0.05).

Increasing adherence to the PHD in midlife may reduce or slow gaining adiposity and improve body fat distribution, with greater magnitude in those already obese. These findings suggest a beneficial impact of adherence to the PHD on adiposity in Europeans.

Funded by the UK Medical Research Council, NIHR Cambridge Biomedical Research Centre and the Independent Research Fund Denmark (1057-00016B) and Danish Diabetes Association.