Abstract Body: Introduction
In 2019, the EAT-Lancet Commission proposed a reference diet as a way to mitigate the impact of what we eat on the planet by lowering agricultural greenhouse gas emissions, and land and water use. Overconsumption of sodium has been well described to increase CVD risk. Little is known about how following this recommended eating pattern relates to sodium intake in the United States.

Hypothesis
We hypothesized that closer alignment with the Eat-Lancet Commission reference diet would be inversely associated with sodium intake.

Methods
Dietary recalls from the 2017-2020 Pre-Pandemic dataset from the National Health and Nutrition Examination Survey (NHANES) were used for this analysis. Participants without two 24-hour dietary recalls, those younger than 3, or with implausible average energy intake (<500 or >8000 kcals/day) were excluded, giving us a sample size of N=9800. The Planetary Health Diet Index (PHDI), based on caloric density, has been created as a measure of alignment with the EAT-Lancet reference diet. The PHDI has 14 components, each scored proportionally between 0 and 10; sodium is not one of the scored components. The components are grouped into adequacy, optimum, and moderation categories. PHDI is scored 0-140, with a higher score more closely aligned with the EAT-Lancet reference diet. We calculated the PHDI score and its component scores for each participant using the 2-day averages for 24-hour dietary recall. We then assessed the associations between PHDI score and the 2-day averages of sodium using survey-weighted correlations and multivariate linear regression.

Results
In our sample, the average age was 40 years, with 51% identifying as women. The mean PHDI score was 68 (27-124), mean sodium intake was 3250 (298-14435) mg/day, and mean energy intake was 2026 kcals/day. With unadjusted analysis, an inverse correlation between PHDI score and sodium was observed (r = -0.18). After adjusting for gender, age, education, and income the significant inverse association persisted (r=-0.17). For every 10 point increase in PHDI, sodium intake decreased by 140 mg.

Conclusions
While the EAT-Lancet recommended diet does not explicitly include a recommended limit on sodium intake, these findings suggest that if someone adheres to the recommended diet they are apt to have a lower sodium diet in comparison to someone who does not. These results are specific to the American context and we cannot be sure they would extrapolate to other countries.