Association between adherence to the EAT-Lancet diet and risk o cancer and cardiovascular outcomes in the prospective NutriNet-Sante cohort

Background: The EAT-Lancet commission proposed, in 2019, a planetary, healthy and universal dietary. However, this diet has been rarely studied in relation to various health outcomes. Objectives: We aimed to prospectively estimate the association between the EAT-Lancet diet and cancer and cardiovascular disease (CVD) risk. Design: The study was conducted among participants of the NutriNet-Sante cohort (2009-2021). The endpoints were the incident outcomes (cancer and cardiovascular diseases (CVD) and mortality from these diseases), combined and separately. Adherence to the EAT-Lancet diet was estimated using the EAT-Lancet Diet Index (ELD-I) modelled as quintiles (Qs). Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs), adjusted for potential confounders and moderators. Results: A total of 62,382 subjects were included, 2,475 cases of cancer and 786 cases of cardiovascular occurred during a median follow-up of 8.1 years. The sample was 76% female, the mean age at inclusion was 51 years (Standard Deviation (SD) = 10.2 years). The ELD-I ranged from -162 to 332 points with a mean score of 45.4 points (SD = 25.6 points). In multivariable models, no significant association between the EAT-Lancet diet and the risk of cancer and CVD combined, and separately, was observed. Alcohol consumption was an effect modifier of the association. A significant association was observed among low drinkers (HRQ5vs.Q1 = 0.86, (95% CI 0.73, 1.02), p-trend = 0.02). A higher ELD-I was significantly associated with a lower risk of overall cancer only among females, (HRQ5vs.Q1 = 0.89, (95% CI 0.75, 1.05), p-trend = 0.03). Both associations were largely attenuated by BMI. Conclusion: Contrary to our hypothesis, our results documented significant associations between adherence to the EAT-Lancet diet and incidence of cancer only in some subgroups, and no association with CVD.