Prev Med. 2026 Mar 18:108551. doi: 10.1016/j.ypmed.2026.108551. Online ahead of print.
ABSTRACT
OBJECTIVES: The Planetary Health Diet (PHD) is associated with lower mortality and cardiovascular disease (CVD) risk, but evidence on specific CVD subtypes and risk patterns across the full range of adherence remains limited. To assess associations between PHD adherence and all-cause mortality, cardiovascular mortality, and CVDs, and to evaluate dose-response relationships.
METHODS: We searched four databases from inception to January 2026 for prospective cohort studies in adults. Hazard ratios were pooled using random-effects models for highest vs. lowest adherence. Bayesian hierarchical dose-response models with centered RIDIT scores assessed graded associations. Study quality and evidence certainty were evaluated using the Newcastle-Ottawa Scale and NutriGrade.
RESULTS: 23 studies were included. Highest adherence was associated with reduced risk of all-cause mortality (17%), cardiovascular mortality (16%), and total CVDs (18%). Dose-response analyses revealed risk reductions beginning at quintile 3 for all-cause mortality and total CVDs, and at quintile 4 for cardiovascular mortality. Highest adherence was associated with lower risks of coronary heart disease, ischemic heart disease, heart failure, and atrial fibrillation, but not myocardial infarction. Most studies were of high quality; the meta-evidence ranged from moderate to high.
CONCLUSIONS: Randomized trials are needed to confirm causality and assess clinical effectiveness.
PMID:41862101 | DOI:10.1016/j.ypmed.2026.108551