Association between EAT-Lancet diet adherence and cancer incidence/mortality: a systematic review and meta-analysis

Cancer is a major threat to public health around the world. Diet is a key factor that we can change to help prevent it. This study explores the association between adherence to the EAT-Lancet diet and cancer incidence and mortality.

A systematic search was conducted across PubMed, Web of Science, Embase, and the Cochrane Library for cohort studies published from January 2019 to September 2025. In the primary analyses, we pooled adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) for the association between EAT-Lancet diet adherence scores and cancer outcomes, prioritizing linear score-increment estimates and using categorical adherence contrasts only when linear estimates were unavailable. Subgroup analyses were performed by cancer type and adherence level; adherence-level subgroup analyses used categorical contrasts reported in the original studies. Sensitivity analysis and publication-bias assessment were conducted.

A total of 15 cohort studies were included. In the primary analyses, higher EAT-Lancet diet adherence scores were linearly associated with lower overall cancer incidence and overall cancer mortality (incidence: HR = 0.90, 95% CI: 0.84-0.95, P<0.001; mortality: HR = 0.92, 95% CI: 0.90-0.95, P<0.001). The clearest site-specific associations were observed for lung cancer incidence (HR = 0.93, 95% CI: 0.90-0.95, P<0.001) and lung cancer mortality (HR = 0.94, 95% CI: 0.90-0.97, P<0.001). No statistically significant associations were observed for breast, prostate, or colorectal cancer incidence (P>0.05).

Higher EAT-Lancet diet adherence scores may be associated with lower overall cancer incidence and mortality, with the clearest association observed for lung cancer. These findings should be interpreted cautiously because of heterogeneity, residual confounding, and differences in adherence assessment across cohorts.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251141170.