Adherence to the EAT-Lancet diet and risk of coronary events in the Malmo Diet and Cancer cohort study

BACKGROUND: The EAT-Lancet Commission proposed a globally environmentally sustainable dietary pattern featuring mainly plant-based foods in 2019. However, evidence on this dietary pattern in preventing coronary events is minimal.

OBJECTIVE: We aimed to examine the association between the EAT-Lancet diet and risk of coronary events.

METHODS: The Malmö Diet and Cancer cohort study (recruited between 1991 and 1996) included 23,877 participants aged 44.5-73.6 years (62.5% females) without cardiovascular diseases and diabetes at baseline. A modified diet history was used to collect dietary data. An EAT-Lancet diet index (range 0-42 points) was applied based on 14 food components scored 0 (non-adherence) to 3 (adherence). Coronary events were extracted from registers. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidential intervals (CIs).

RESULTS: Over a median of 24.9 years of follow-up, 3,031 coronary events occurred (incidence rate: 5.89/1000 person-year). After adjusting for age, sex, dietary assessment methods, season, total energy intake, leisure-time physical activity, alcohol consumption, smoking status, educational level, and body mass index, the multivariable HR (95% CI) for coronary events among participants who had the highest adherence to the EAT-Lancet diet index (≥23 points, 8.1%) was 0.80 (0.67, 0.96) compared with those who had the lowest adherence (≤13 points, 9.7%) (P for trend =0.01 across five groups of the EAT-Lancet diet). The inverse association was consistent in males and females and was robust after excluding those with misreported energy and significant diet changes or excluding coronary events occurred within the first two years of follow-up.

CONCLUSIONS: Our data indicate that adherence to the EAT-Lancet diet was associated with a lower risk of coronary events.