Association between EAT-Lancet diet adherence and incident type 2 diabetes in Shanghai adults: a prospective cohort...

The global rise in Type 2 Diabetes (T2D) is a particularly evident in China, where dietary patterns have shifted towards a Western diet, potentially exacerbating the issue. This necessitates effective prevention strategies, and objective dietary pattern analysis can inform such strategies.

To preliminarily reveal the health benefits of the EAT-Lancet Diet in preventing T2D among adults in Shanghai, China.

Information gathered from the Shanghai Suburban Adult Cohort and Biobank (SSACB) were utilized, encompassing 29 507 participants with complete dietary and health assessments. Adherence to the EAT-Lancet diet was quantified by employing a semi-quantitative Food Frequency Questionnaire (FFQ) that included 29 food categories based on participants' responses recalling food frequency and average consumption amount over a 12-month period. The EAT-Lancet Index (ELDI) was obtained based on the intake level and reference range of 14 food components defined in the EAT-Lancet Diet (0-3 points per component; 0-42 points in total). Incident T2D cases were identified through medical records until February 28, 2023. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed by Cox proportional hazards models. Restricted cubic splines (RCS) were implemented to analyze the dose-response correlation.

Over a median follow-up duration of 5.6 years (maximum 6.9 years), 977 new cases of T2D were recorded. A downward trend in the incidence rate was observed across different categories of the ELDI, ranging from 6.7 to 4.6 per 1000 person-years. Participants with top adherence to the EAT-Lancet diet (≥ 33) had a significantly lower risk of T2D compared to those with the lowest adherence (≤ 26), with a hazard ratio (HR) of 0.70 (95% CI: 0.52, 0.95). The incidence risk of T2D was reduced by 2% for each one-unit increment in the ELDI across adjusted models (HR: 0.98, 95% CI: 0.96, 0.99; p-value < 0.05). A nonlinear correlation between the ELDI and T2D was observed, indicating that higher adherence to the EAT-Lancet diet, particularly with an index above 32, was associated with a decreased likelihood of T2D.

This study provides compelling evidence that greater adherence to the EAT-Lancet diet is associated with a reduced likelihood of T2D events among Shanghai residents. This highlights the critical importance of sustainable dietary patterns in preventing diabetes within the demographic context of China.