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Adherence to the planetary health diet and cognitive decline: findings from the ELSA-Brasil study

Nature Aging (2024)Cite this article

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Abstract

The EAT–Lancet Commission proposed a planetary health diet to improve human health within planetary boundaries; however, little is known about the association between adherence to this diet and cognitive decline. We used data from three waves of the Brazilian Longitudinal Study of Adult Health to evaluate the association between the planetary health diet and cognitive decline using linear mixed-effects models. Here we show that in 11,737 participants (mean (s.d.) age 51.6 (9.0) years, 54% women and 53% white), higher adherence to the planetary health diet was associated with slower memory decline (P = 0.046) and that income was a modifier in this association (P < 0.001). Adherence to the planetary health diet was associated with slower decline of memory (P = 0.040) and global cognition (P = 0.009) in high-income participants. No association was found among low-income participants. The results of our study highlight that the promotion of healthy dietary patterns should take into consideration income barriers as well as differences in dietary habits to achieve high adherence.

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Fig. 1: Association of quintiles of the PHDI and cognitive decline.
Fig. 2: Association of quintiles of the PHDI adherence score at the study baseline with cognitive decline in participants with high and low income.
Fig. 3: Histogram of the PHDI adherence scores for participants with high and low income at the study baseline.
Fig. 4: Association between individual components of the PHDI adherence and global cognitive decline.
Fig. 5: Association between individual components of the PHDI adherence and global cognitive decline stratified for high and low income.

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Data availability

Data from the ELSA-Brasil study were used under license for the current study due to privacy reasons, therefore the data are not publicly available. Researchers can apply for data access at http://elsabrasil.org/. This study complies with the GATHER statement.

Code availability

The code used for the main analysis of this paper is available at https://github.com/NattyGG/EAT-Lancet.

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Acknowledgements

The ELSA-Brasil study was supported by the Brazilian Ministry of Health, the Ministry of Science Technology and Innovation and the National Council for Scientific and Technological Development (CNPq). Drs Barreto, Bensenor, Goulart, Marchioni and Suemoto receive support from CNPq, Brazil (research productivity fellowship). The funders had no role in the study design, data collection, management, analysis, interpretation, writing of the manuscript and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil

    Natalia Gomes Gonçalves & Claudia Kimie Suemoto

  2. Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil

    Leandro Teixeira Cacau & Dirce Maria Marchioni

  3. Amazônia Adventist College, Pará, Brazil

    Naomi Vidal Ferreira

  4. Center for Clinical and Epidemiological Research, Hospital Universitario, University of São Paulo, São Paulo, Brazil

    Paulo Andrade Lotufo, Alessandra Carvalho Goulart & Isabela Martins Bensenor

  5. Department of Social Medicine, Federal University of Espírito Santo, Vitória, Brazil

    Maria Carmen Viana

  6. Preventive and Social Medicine Department, Clinical Hospital/ EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil

    Sandhi Maria Barreto

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Contributions

N.G.G., C.K.S., D.M.M. and L.T.C. conceptualized the study. N.G.G., C.K.S. and L.T.C. curated data. N.G.G. conducted the formal analysis. P.A.L., S.M.B. and I.M.B. acquired funding. C.K.S. supervised the study. N.G.G. was responsible for data visualization. N.G.G., L.T.C. and N.V.F. wrote the original draft. L.T.C., N.V.F., P.A.L., A.C.G., M.C.V., S.M.B., I.M.B., D.M.M. and C.K.S. reviewed and edited the manuscript. N.G.G. and C.K.S. directly accessed and verified the underlying data reported in the manuscript. All authors had full access to all the data in the study and had the final responsibility to submit it for publication.

Corresponding author

Correspondence to Claudia Kimie Suemoto.

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Nature Aging thanks Weili Xu, Changzheng Yuan and the other, anonymous, reviewer(s) for their contributions to the peer review of this work.

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Extended data

Extended Data Table 1 Association between quintiles of the Planetary Health Diet Index adherence score at the study baseline and annual cognitive decline (n = 11,737)
Full size table
Extended Data Table 2 Association between quintiles of the Planetary Health Diet Index adherence score at the study baseline and annual cognitive decline stratified according to participants’ age (n = 11,737)
Full size table

Extended Data Fig. 1

Flowchart of the study participants during the follow-up period.

Extended Data Fig. 2 Association of quintiles of the Planetary Health Index (PHDI) adherence score at the study baseline with (A) memory, (B) verbal fluency, (C) executive function, and (D) global cognition trajectories over a median of eight years of follow-up in participants < 60 years (n = 9,382) and ≥ 60 years (n = 2,355).

Linear mixed-effects models adjusted for age, sex, education, income, race, alcohol consumption, smoking, diabetes, hypertension, cardiovascular disease, physical activity, depressive symptoms, BMI, and total calories. We used inverse probability weighting to correct for attrition bias related to mortality and missing participation at each wave. PHDI score ranged from 0 to 150 and was categorized into quintiles (1st quintile: 26.22–50.53, 2nd quintile 2: 50.54–57.00, 3rd quintile: 57.01–62.96, 4th quintile: 62.98–69.90, 5th quintile: 69.91–109.98). Data are presented as mean values for each quintile. P values represent the interaction terms among quintiles of PHDI, age, and the timescale calculated using the Wald test (two-sided). Exact p values: (A) 1.1 × 10−8, (D) 1.0 × 10−6.

Extended Data Fig. 3 Brazilian map indicating where ELSA-Brasil recruitment centers were located.

The number of participants in each center was Salvador: 2,025 participants; Belo Horizonte: 3,115 participants; Vitória: 1,055 participants; Rio de Janeiro: 1,784 participants; São Paulo: 5,061 participants; Porto Alegre: 2,061 participants.

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Supplementary Tables 1–7 and Supplementary References.

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Gomes Gonçalves, N., Cacau, L.T., Ferreira, N.V. et al. Adherence to the planetary health diet and cognitive decline: findings from the ELSA-Brasil study. Nat Aging (2024). https://doi.org/10.1038/s43587-024-00666-4

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