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. 2022 Mar 4;115(3):705-716.
doi: 10.1093/ajcn/nqab369.

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

Anna Stubbendorff  1 , Emily Sonestedt  1 , Stina Ramne  1 , Isabel Drake  1 , Elinor Hallström  2 , Ulrika Ericson  1
Affiliations

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

Anna Stubbendorff et al. Am J Clin Nutr. .

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.

Objectives: We sought 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.

Methods: We used the Malmö Diet and Cancer cohort (n = 22,421; 45-73 years old 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 5 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.

Keywords: diet; environment; healthy eating; mortality; nutrition; survival; sustainable development.

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Figures

FIGURE 1
FIGURE 1
Distribution of points among 8,568 men (m) and 13,853 women (w) in the Malmö Diet and Cancer Study (possible range, 0–42 points). The population was divided into 5 categories in the analyses (≤13, 14–16, 17–19, 20–22, ≥23), and n indicates the number of participants in each group.
FIGURE 2
FIGURE 2
Distribution of EAT-Lancet index points for 14 food groups in 22,421 participants from the Malmö Diet and Cancer Study. A very low percentage (<5%) of the participants reached the target intakes defined in the EAT-Lancet diet (3 points) for legumes, nuts, whole grains, pork, and beef and lamb, whereas most of the participants reached the target intakes for poultry and fish (<65%).
FIGURE 3
FIGURE 3
Recommended range and targets in the EAT-Lancet diet, compared with the average intake among 22,421 participants in the MDCS. Abbreviation: MDCS, Malmö Diet and Cancer Study.
FIGURE 4
FIGURE 4
EAT-Lancet score and HR with 95% CI in 22,421 participants in Malmö Diet and Cancer Study, based on the fully adjusted model (Model 3). High adherence to the EAT-Lancet diet (≥23 points) was associated with 25% lower all-cause mortality, 24% lower cancer mortality, and 32% lower cardiovascular mortality than low adherence (≤13 points).
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