Introduction and Objective: The Planetary Health Diet (PHD), introduced in 2019 by the EAT-Lancet Commission, promotes chronic disease prevention and environmental sustainability. However, evidence on PHD adherence and its association with type 2 diabetes (T2D), cardiovascular disease (CVD), and weight gain is scarce, especially among women with a history of gestational diabetes mellitus (GDM).Methods: We followed 4,637 women with a history of GDM in the Nurses’ Health Study II (1991-2019). The PHD index (PHDI) was derived from 15 food groups based on food frequency questionnaires every 4 years. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of T2D and CVD (myocardial infarction (MI) and stroke combined), respectively. Associations between PHDI changes and concurrent 4-year weight changes were evaluated using multivariable marginal models with generalized estimating equations.Results: Over 120,563 person-years, 92 CVD and 1,051 T2D cases were observed. Women in the highest tertile of the PHDI had a 43% lower risk of CVD [HR (95%CI)=0.57 (0.32-0.99), P-trend=0.04] and a 62% lower risk of MI [HR (95%CI)=0.38 (0.16-0.89), P-trend=0.02], compared to those in the lowest tertile. The highest quintiles of PHDI was associated with a reduced risk of T2D [HR (95%CI)=0.83 (0.67-1.03), P-trend=0.03], though this association became non-significant after adjusting for BMI. BMI was estimated to mediate 63% (95%CI=27-89%, P<0.01) of this association. Decreasing PHDI was associated with greater weight gain (P-trend<0.01), with the largest PHDI drop (-10±6) resulting in a mean of 2.3kg weight gain (95% CI=2.0-2.6).Conclusion: Higher PHDI was significantly associated with lower CVD and T2D risks and better weight management in this high-risk population. Our findings also emphasize the importance of weight management in reducing the risk of progressing from GDM to T2D.
X. Yin: None. J. Yang: None. C. Zhang: None.
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