Development of an EAT-Lancet index and its relation to mortality in a Swedish population

Abstract

Background Current global food systems threaten human health and environmental sustainability. In 2019, the EAT—Lancet Commission on healthy diets from sustainable food systems defined the first global reference diet to improve both areas, but there is no consensus on how to quantify the EAT-Lancet reference diet as a diet index and its relation to mortality has not been widely studied. Objective To develop a new dietary index to quantify adherence to the EAT-Lancet diet and assess its association with mortality in a large population-based Swedish cohort. We also examined food components included in the index and their individual associations with mortality. Design We used the Malmö Diet and Cancer cohort (n = 22,421, 45–73 years at baseline). Dietary data were collected using a modified diet history method. The EAT-Lancet index was developed based on intake levels and reference intervals of 14 food components defined in the EAT-Lancet diet (0–3 points per component, 0–42 points in total). Associations with mortality were examined based on registers during a mean of 20 years of follow-up and were adjusted for potential confounders. Results Divided into five adherence groups, the highest adherence to the EAT-Lancet diet (≥23 points) was associated with lower all-cause mortality (HR: 0.75; 95% CI: 0.67, 0.85), cancer mortality (HR 0.76; 95% CI: 0.63, 0.92) and cardiovascular mortality (HR 0.68; 95% CI: 0.54, 0.84) than the lowest adherence (≤13 points). Several food components included in the index contributed to the observed reductions in mortality. Conclusions We developed a new dietary index to investigate adherence to the EAT-Lancet diet. The findings indicate a 25% lower risk of mortality among those with the highest adherence to the EAT-Lancet diet, as defined using our index, which adds to the evidence base for the development of sustainable dietary guidelines.

Low Adherence to the EAT-Lancet Sustainable Reference Diet in the Brazilian Population: Findings from the National Dietary Survey 2017–2018

“…In this population-based study, the average PHDI total score was 45.9 (95% CI 45.6-46.1) points, on a total score that can range from 0 to 150. Higher scores were observed in women compared to men, in those with 31 years or older (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)46-56, and ≥60 years) compared to those with 30 years or younger (<19 and 19-30 years), in those overweight compared to those with an adequate BMI, in individuals with higher per capita income compared to those with a lower one (1st quartile) and in those living in the urban area, when compared to those living in rural area. Moreover, higher adherence to the planetary health diet proposed by EAT-Lancet Commission occurred among individuals in the Southeast and Middle-West regions, while the lowest was found among those in the Northeast region, as presented in Table 1.…”

“…The release of the EAT Lancet report [ 3 ] has catalyzed the debate about the need of transformation of contemporary food systems and the comprehension that promoting sustainable diets through sustainable food choices is essential for achieving the sustainable development goals (SDG) set by the United Nations. In this sense, establishing a practical tool that can measure and score sustainable and healthy eating was considered highly important, and some indexes were proposed in the literature [ 7 , 30 , 31 , 32 , 33 ]. However, these indexes are difficult to compare directly with ours, since they have distinct features, both in terms of components scoring and type of dietary survey.…”

“…Participants were assigned a point for meeting each of the recommendations. In addition, Stubbendorff et al [ 32 ] developed an index based on intake levels and reference intervals of 14 food components defined in the EAT-Lancet diet (0–3 points per component; 0–42 points in total). They do not report mean scores of the population, but instead, optimum outcomes for cardiometabolic diseases [ 31 ] and a lower risk of mortality [ 32 ] for higher adherence to their indexes.…”

“…In addition, Stubbendorff et al [ 32 ] developed an index based on intake levels and reference intervals of 14 food components defined in the EAT-Lancet diet (0–3 points per component; 0–42 points in total). They do not report mean scores of the population, but instead, optimum outcomes for cardiometabolic diseases [ 31 ] and a lower risk of mortality [ 32 ] for higher adherence to their indexes. Seconda et al [ 30 ] proposed a composite index, with four sub-indices (nutritional, environmental, economic, and food practices), which are scored from 1 to 5 points, resulting in an overall Sustainable Diet Index (SDI) score of 4 to 20 points, and used to assess the relationship between the SDI and excess weight and obesity in French adults participating in the NutriNet-Santé study [ 34 ].…”

Association Between the EAT-Lancet Diet Pattern and Risk of Type 2 Diabetes: A Prospective Cohort Study

“…It consists of whole grains, fruits, vegetables, legumes, nuts, unsaturated oils, low-to-moderate amount of seafood and poultry, and includes no or a low quantity of red meat, processed meat, added sugar, refined grains, and starchy vegetables (19). To date, few prospective studies have investigated the association between the EAT-LDP and adverse health conditions (20,21). In this study, we further explored the association between EAT-LDP and incident T2D among the UK adults over a more than 10year follow-up.…”