Association Between the EAT-Lancet Diet Pattern and Risk of Type 2 Diabetes: A Prospective Cohort Study

Abstract

Background:The EAT-Lancet Commission has promulgated a sustainable dietary guideline and recommended that it was designed to improve the human health and support environmental sustainability.Objective:This research was designed to explore the association between this healthy diet pattern (EAT-Lancet diet pattern, EAT-LDP) and risk of type 2 diabetes (T2D).Methods:Between 2006 and 2010, a total of 59,849 participants from the UK Biobank without diabetes, cardiovascular disease, or cancers were included at baseline. The EAT-LDP score was constructed on the sum of 14 food components and then categorized into three tertiles. Multivariable Cox proportional hazards regression models were conducted to explore the association between EAT-LDP score and the risk of incident T2D. A mediation analysis was also implemented to disentangle the role of body mass index (BMI) and waist circumference in the relationship between EAT-LDP score and T2D.Results:During a median follow-up of 10 years, 2,461 incident T2D cases were recorded. In analyses that compared tertile 3 of the EAT-LDP score (highest) with tertile 1 (lowest), the hazard ratio (HR) for T2D was 0.81 (95% CI: 0.72–0.90) after adjusting for sociodemographic status and health-related factors. Participants who reported a one-point increase in the diet score were associated with a 6% decrease in risk of T2D (HR: 0.94, 95% CI: 0.91–0.97). A significant indirect association was observed between the EAT-LDP score and T2D (β: 0.66, 95% CI: 0.65–0.67), indicating that 44% of the association of EAT-LDP score with T2D was mediated by BMI. Additionally, 40% of the association of EAT-LDP score with T2D was mediated by waist circumference was also observed.Conclusions:Our findings indicate that a higher adherence to EAT-LDP contributes to lower risk of T2D. Further independent validation is needed to be conducted before applying the EAT-LDP to inform dietary guidelines.

Types of diet, obesity, and incident type 2 diabetes: Findings from the UK Biobank prospective cohort study

“…The current study meaningfully extends the literature by showing that adiposity, as indicated by BMI and WC, is indeed a mediator for fish diets. This finding mirrors a study conducted on healthy diet patterns and the risk of type 2 diabetes that concluded adiposity was a sizeable mediator 37 . Further studies should explore other potential mediators, such as blood pressure and lipid profile.…”

“…This finding mirrors a study conducted on healthy diet patterns and the risk of type 2 diabetes that concluded adiposity was a sizeable mediator. 37 Further studies should explore other potential mediators, such as blood pressure and lipid profile.…”

Cardiometabolic diseases, total mortality, and benefits of adherence to a healthy lifestyle: a 13-year prospective UK Biobank study

“…A healthy diet pattern potentially interactive and cumulative associations of different dietary components, and could reflect the numerous and multifaceted combinations of nutrient and food consumption [ 24 ]. Several published observational studies have found a beneficial effect of greater adherence to a healthy diet pattern on CMDs [ 25 – 28 ]. Randomised controlled trials have also strengthened the beneficial impact of physical exercise and healthy diet on cardiorespiratory fitness, and cardiometabolic health in adults [ 29 , 30 ].…”

Response to Boonpor et al: Types of diet, obesity, and incident type 2 diabetes: Findings from the UK Biobank prospective cohort study

“…On the other hand, some previous studies have assessed the mediating role of weight change using total energy intake-adjusted estimates for foods or dietary variables (for example [2][3][4] ). As the energy-adjusted estimate implies an isocaloric comparison of foods or diet compositions at that time point, it is unclear how changes in weight would be achieved under this model.…”

“…A number of previous studies have assessed a potential mediating role of BMI (or weight change, as the modelling implies that a change in diet would cause a change in weight) with regards to diet and disease using observational data. [2][3][4] It is well known that adjustment for total energy intake in these analyses implies an isocaloric comparison between diets, that is, the average relative causal effect of the exposure. 5 Studies can also consider the effect of increasing intake of some foods or macronutrients on top of the usual diet, that is, the total causal effect.…”