Stubbendorff, A., E. Sonestedt, et al. (2021). “Development of an EAT-Lancet index and its relation to mortality in a Swedish population.” The American Journal of Clinical Nutrition.
Open access link to article:
Community, Dietetic Educator, Public Health, Researcher
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.
Bottom line for nutrition practice:
A large population study from Lund University in Sweden has shown that more sustainable dietary habits are linked to health benefits, such as a reduced risk of premature death from cardiovascular disease and cancer.
- 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.
Details of results:
Participants received between 5-35 points of the possible maximum of 42 points.
- Mean score for women was 18.5 and 16.8 for men.
- Less than 1% of the study population reached the target intake of the EAT-Lancet diet for legumes and nuts.
- Less than 5% reached the target intakes for whole grains, beef and lamb, and pork.
- Adherence was highest for poultry and fish, where 77% and 66% of the population reached the target intakes, respectively.
- Comparing the group with the highest score to the lowest score shows a decrease in total mortality of 25%, cancer mortality of 24% and cardiovascular mortality of 32% in the fully adjusted model.
- In the less adjusted model the magnitude of the results were even larger.
- Adherence to each of the 14 food group components included in the EAT-Lancet index and mortality were also tested separately. High intakes of whole grains, vegetables, and fruits, compared to low intakes, were associated with lower risks of all-cause mortality, whereas high intake of eggs was associated with a higher risk.
Of additional interest:
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Conflict of interest/ Funding:
The authors have no conflict of interest. The study was funded by the Swedish Heart-Lung Foundation, Crafoord Foundation, and Agenda 2030 Graduate School at Lund University.
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