Adherence to the EAT-Lancet reference diet and risk of type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, and their co-occurrence

Abstract

Background and aims: The EAT-Lancet Commission proposed a healthy dietary pattern to prevent diet-related diseases while promoting planetary sustainability, but little is known regarding its associations with type 2 diabetes (T2D) and MASLD, both of which are highly prevalent and frequently co-exist. We aimed to assess associations of this diet with risk of T2D, MASLD, and their co-occurrence. Methods: This study included 170,811 UK Biobank participants (prospective design) and 212 Chinese biopsy-proven MASLD patients (cross-sectional design). Adherence to the EAT-Lancet reference diet was quantified using three different diet indices. Cox and logistic models were applied to estimate the corresponding effect size. Results: During follow-up in the UK Biobank, we identified 4,240 T2D cases, 1,164 MASLD cases, and 215 co-incidents of the two diseases. The multivariable HRs (95% CIs) per SD increase in the Planetary Health Diet Index were 0.85 (0.82, 0.87) for T2D, 0.80 (0.75, 0.85) for MASLD, and 0.84 (0.74, 0.97) for the co-occurrence of the two conditions. The associations were attenuated after additional adjustment for BMI. In addition, 96 (45.3%) patients with biopsy-proven MASLD had prevalent T2D; adjusted ORs (95% CIs) per SD of T2D were 0.72 (0.51, 1.00) for Planetary Health Diet Index. Similar association patterns were observed in the other two indices. Conclusions: Greater adherence to the EAT-Lancet reference diet was not only associated with lower risks of incident T2D, MASLD, and the co-occurrence of the two conditions in the general adult population but was also associated with lower prevalence of T2D among in biopsy-proven MASLD patients.