Metabolic and Environmental Benefits of Following the Healthy and Sustainable Dietary Recommendations for the Spanish Population: The AWHS Study

<b>Background/Objectives:</b> Emerging approaches aim to protect both human and environmental health. Therefore, we hypothesise that adherence to the Healthy and Sustainable Dietary Recommendations for the Spanish Population Index (HS-DRSI) is inversely associated with the occurrence of Metabolic Syndrome (MetS) and promotes environmental sustainability. <b>Methods</b>: A cross-sectional analysis was performed with 2286 middle-aged men, with no previous cardiovascular disease and belonging to the Aragon Workers' Health Study (AWHS). Diet was collected with a 136-item food-frequency questionnaire. Adherence to the recommendation was assessed with the HS-DRSI, which assigns one point for each of 19 food categories. The National Cholesterol Education Programme-Adult Treatment Panel III (NCEP-ATP III) definition was used to define MetS. Logistic regressions were used to estimate the association between adherence to the HS-DRSI and presence of MetS. Environmental assessment was calculated based on the 2016 European database. <b>Results</b>: Higher adherence to the HS-DRSI was inversely associated with MetS and elevated waist circumference. The odds ratio (OR) of having MetS for participants in the highest (8-13 points) vs. lowest (1-5 points) quartile of adherence to the diet score was 0.72 (95% CI, 0.52-0.99) and the OR of elevated waist circumference was 0.69 (95% CI, 0.48-0.99), with consistent results per 1 SD increase (2 points). In addition, greenhouse gas emissions (GHGE) decreased progressively across adherence quartiles (from 6.10 to 5.70 kg CO₂-eq/day). <b>Conclusions</b>: Adherence to the HS-DRSI was associated with a lower risk of MetS and may contribute to lower GHGE production.