Association of the Planetary Health Diet Index with self-reported infertility among U.S. women: An exploratory analysis of adiposity indices.

Authors

Rongze Sun, Jian Liu, Xiaoyu Liu, Boning Liu, Xinyu Zhang, Enzhi Fan

Published in

The Journal of international medical research. Volume 54. Issue 10. Pages 3000605261493759. Epub Oct 07, 2026.

Abstract

ObjectiveTo examine the association between adherence to the Planetary Health Diet Index and self-reported infertility among U.S. women of reproductive age and, secondarily, to explore adiposity-related indirect associations involving the body mass index, waist-to-height ratio, weight-adjusted waist index, and body roundness index.MethodsThis cross-sectional study included 2256 women aged 18-44 years from the 2013-2018 National Health and Nutrition Examination Survey. Planetary Health Diet Index scores were derived from two 24-h dietary recalls, and infertility was identified based on self-reported Reproductive Health Questionnaire responses. Associations were estimated using multivariable logistic regression that incorporated survey weights, strata, and primary sampling units. Restricted cubic spline analyses were performed to assess functional form. Exploratory survey-replicate statistical decompositions were used to evaluate adiposity-related indirect probability contrasts.ResultsAmong the 2256 female study participants, 310 reported infertility. In the fully adjusted model, a 10-point higher Planetary Health Diet Index score was associated with an odds ratio of 0.895 for self-reported infertility (95% confidence interval, 0.768-1.043; p = 0.149). Compared with women in the lowest weighted Planetary Health Diet Index quartile, those in the highest quartile had lower odds of self-reported infertility (odds ratio, 0.536; 95% confidence interval, 0.309-0.931; p = 0.028). Restricted cubic spline analyses did not provide clear evidence of a nonlinear association. Exploratory statistical decompositions yielded negative indirect estimates through all four adiposity indices; however, every corresponding 95% confidence interval included the null.ConclusionsHigher Planetary Health Diet Index scores demonstrated an inverse association with self-reported infertility, with the clearest evidence observed for the highest-versus-lowest weighted quartile; however, the continuous association was imprecisely estimated, and no clear exposure-response pattern was identified. Adiposity-related indirect estimates were exploratory and imprecise. Given the cross-sectional design, causal and temporal interpretations cannot be derived. Prospective studies are needed to clarify the temporality and potential explanatory processes.

PMID:
42844593
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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