Nutritional adequacy of the EAT-Lancet diet: a Swedish population-based cohort study

The EAT-Lancet planetary health diet emphasises plant-based foods while including moderate amounts of animal-sourced foods. Simulation-based modelling studies suggest that the diet can provide adequate micronutrients, but concerns remain about potential deficiencies as studies have used different methodologies and few have assessed nutrient intakes using both dietary and biomarker data in population-based studies. This study aimed to evaluate nutrient adequacy, defined as the ability of a diet to provide sufficient essential vitamins and minerals to meet physiological requirements, in relation to adherence to the EAT-Lancet diet and assess how methodological differences in measuring adherence impact the findings.

Data was derived from the Swedish Malmö Diet and Cancer cohort (baseline 1991-96), including 25 970 participants. Dietary intake was assessed through a validated diet history method, and nutrient intakes were calculated. Seven different EAT-Lancet diet scores were used to measure adherence. Associations with micronutrient intake and nutrient biomarkers in subgroups (folate, vitamin D, selenium, zinc, and haemoglobin) were evaluated using linear and logistic regression models.

Higher adherence to the EAT-Lancet diet was generally associated with nutrient intakes above recommended intake, although results varied by scoring method and modelling approach. Energy adjustment increased the likelihood of attaining nutrient adequacy, and higher adherence increased the likelihood of adequate intake for vitamin A, vitamin E, thiamine, vitamin B6, folate, vitamin C, calcium, magnesium, potassium, iron, and zinc. For nutrient biomarkers, higher adherence was linked to a reduced risk of folate deficiency, but a slightly increased risk of anaemia in women. No differences in deficiency risk were observed for selenium, zinc, or vitamin D among women, whereas men showed a slightly lower risk of vitamin D deficiency. For one score, there was a lower risk of zinc deficiency.

The EAT-Lancet diet can provide sufficient micronutrient intake without increasing deficiency risk, except for anaemia in women. Differences in outcomes between scoring methods and energy adjustment modelling highlight the need for standardised frameworks in assessing sustainable diets.

The Swedish Heart-Lung Foundation, the Pålsson Foundation, Crafoord Foundation, the Agenda 2030 Graduate School, Lund University, the Independent Research Fund Denmark, and the Danish Diabetes Association.