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Relative validity of the Planetary Health Diet Index by comparison with usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet among European adolescents: the HELENA study

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Abstract

Purpose

The EAT-Lancet Commission proposed an evidence-based global reference diet to improve human health within planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) was developed based on the EAT-Lancet recommendations and validated among Brazilian adults. However, the relative validity of the PHDI in adolescents has yet to be assessed. Thus, we aimed to evaluate the relative validity of the PHDI in European adolescents.

Methods

We used cross-sectional data from 1804 adolescents (12.5–17.5 years) enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. The PHDI (0–150 points) was calculated based on dietary intake data from two non-consecutive 24-h dietary recalls. Associations between the PHDI and usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet were evaluated using multivariable-adjusted mixed-effects linear regression models.

Results

Higher PHDI score was associated with greater intakes of nutrients predominantly from plant-source foods, such as vegetable protein, vitamin E, and folate and with lower intake of nutrients predominately from animal-source foods, such as total and saturated fat, cholesterol, and animal protein. Furthermore, a higher PHDI score was also positively associated with plasma β-carotene, vitamin C, vitamin D, folate, and ferritin concentrations, while negatively associated with trans-fatty acids concentration. Moreover, higher PHDI was related to a greater adherence to the Mediterranean dietary pattern.

Conclusions

The PHDI showed good relative validity among adolescents in the HELENA study. Hence, future research should assess adherence to the PHDI and long-term health outcomes.

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Data availability

The analytic code of the PHDI computation will be made available upon request pending to the corresponding author.

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Funding

The HELENA study received funding from the European Union’s Sixth RTD Framework Program (contracts FOODCT-2007-036196-2 and FOODCT-2005-007034, respectively). Additional support was obtained from the Spanish Ministry of Education (AGL2007-29784-E/ALI). LTC received a research internship abroad scholarship (grant number 2020/12326-1) from the Sao Paulo Research Foundation (FAPESP).

Author information

Authors and Affiliations

  1. Growth, Exercise, Nutrition and Development (GENUD) Research Group, Facultad de Ciencias de La Salud, Universidad de Zaragoza, Zaragoza, Spain

    Leandro Teixeira Cacau & Luis A. Moreno

  2. Department of Nutrition, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, Cerqueira César, São Paulo, SP, 01246-904, Brazil

    Leandro Teixeira Cacau & Dirce Maria Marchioni

  3. Department of Public Health and Primary Care, Ghent University, Ghent, Belgium

    Leandro Teixeira Cacau & Stefaan De Henauw

  4. Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium

    Giles T. Hanley-Cook & Carl Lachat

  5. Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France

    Inge Huybrechts

  6. Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, Ruhr-University Bochum, Bochum, Germany

    Mathilde Kersting

  7. Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

    Marcela Gonzalez-Gross & Luis A. Moreno

  8. ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain

    Marcela Gonzalez-Gross

  9. Institute for Translational Research in Inflammation (INFINITE), University Lille, Lille, France

    Frederic Gottrand

  10. Council for Agricultural Research and Economics, Research Center for Food and Nutrition, Rome, Italy

    Marika Ferrari

  11. Department of Metabolism and Nutrition, Institute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain

    Esther Nova

  12. Department of Physiology, Faculty of Medicine, University of Granada, Granada, Spain

    Manuel J. Castillo

  13. Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary

    Dénes Molnár

  14. Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

    Kurt Widhalm

  15. Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece

    Odysseas Androutsos & Yannis Manios

  16. Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece

    Odysseas Androutsos

  17. Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece

    Yannis Manios

  18. Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany

    Peter Stehle

  19. Instituto Agroalimentario de Aragon (IA2), Zaragoza, Spain

    Luis A. Moreno

  20. Instituto de Investigacion Sanitaria Aragon (IIS Aragon), Zaragoza, Spain

    Luis A. Moreno

Authors
  1. Leandro Teixeira Cacau
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  2. Giles T. Hanley-Cook
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  3. Inge Huybrechts
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  4. Stefaan De Henauw
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  5. Mathilde Kersting
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  6. Marcela Gonzalez-Gross
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  7. Frederic Gottrand
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  8. Marika Ferrari
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  9. Esther Nova
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  10. Manuel J. Castillo
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  11. Dénes Molnár
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  12. Kurt Widhalm
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  13. Odysseas Androutsos
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  14. Yannis Manios
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  15. Peter Stehle
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  16. Carl Lachat
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  17. Dirce Maria Marchioni
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  18. Luis A. Moreno
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Contributions

The authors’ contributions were as follows. LTC, DMM, and LAM designed the research; IH advised on the data curation; LTC carried out the data analyses; LTC developed the first draft and revised the manuscript; GTH-C supported with written the draft. DMM and LAM advised on statistical analyses. LAM supervised LTC. GTH-C, IH, SDH, MK, MG-G, FG, MF, EN, MJC, DM, KW, OA, YM, PS, CL, DMM, and LAM critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Leandro Teixeira Cacau.

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Conflict of interest

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Cacau, L.T., Hanley-Cook, G.T., Huybrechts, I. et al. Relative validity of the Planetary Health Diet Index by comparison with usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet among European adolescents: the HELENA study. Eur J Nutr 62, 2527–2539 (2023). https://doi.org/10.1007/s00394-023-03171-3

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