doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

ObjectiveIn 2019 the EAT-Lancet Commission proposed a dietary pattern, defined to be globally environmentally sustainable, but untested directly in population studies with regards to health. We investigated adherence to the EAT-Lancet diet and risk of incident type 2 diabetes in a Danish setting.Research design and methodsIn total, 54,232 participants aged 50-64 years at inclusion (1993-1997) with no previous cancer or diabetes diagnoses were included. Dietary data were collected using a validated 192-item food frequency questionnaire, and scored 0 (non-adherence) or 1 (adherence) point for each of the 14 dietary components of the EAT-Lancet diet (range 0-14 points). Incident type 2 diabetes cases were identified using the Danish National Diabetes Register. Hazard ratios and 95% confidence intervals (CI) were estimated using multivariable-adjusted Cox proportional hazards models.ResultsDuring follow-up (median 15 years), 7130 participants developed type 2 diabetes. There was a 22% (95% CI: 14%; 29%) lower risk of type 2 diabetes among those with the greatest adherence to the EAT-Lancet diet (11-14 points) compared to those with the lowest adherence (0-7 points). After further adjusting for potential mediators, the corresponding risk was 17% (95% CI: 8%; 24%) lower.ConclusionAdherence to the EAT-Lancet diet was associated with a lower risk of developing type 2 diabetes in a middle-aged Danish population.