Sustainable diets and long-term cardiovascular disease outcomes; insights from the 20-year follow-up ATTICA study...

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.

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.

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.

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.