Abstract
BACKGROUND: The global rise in Type 2 Diabetes (T2D) is a particularly evident in China, where dietary patterns have shifted towards a Western diet, potentially exacerbating the issue. This necessitates effective prevention strategies, and objective dietary pattern analysis can inform such strategies. OBJECTIVE: To preliminarily reveal the health benefits of the EAT-Lancet Diet in preventing T2D among adults in Shanghai, China. METHODS: Information gathered from the Shanghai Suburban Adult Cohort and Biobank (SSACB) were utilized, encompassing 29 507 participants with complete dietary and health assessments. Adherence to the EAT-Lancet diet was quantified by employing a semi-quantitative Food Frequency Questionnaire (FFQ) that included 29 food categories based on participants' responses recalling food frequency and average consumption amount over a 12-month period. The EAT-Lancet Index (ELDI) was obtained based on the intake level and reference range of 14 food components defined in the EAT-Lancet Diet (0-3 points per component; 0-42 points in total). Incident T2D cases were identified through medical records until February 28, 2023. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed by Cox proportional hazards models. Restricted cubic splines (RCS) were implemented to analyze the dose-response correlation. RESULTS: Over a median follow-up duration of 5.6 years (maximum 6.9 years), 977 new cases of T2D were recorded. A downward trend in the incidence rate was observed across different categories of the ELDI, ranging from 6.7 to 4.6 per 1000 person-years. Participants with top adherence to the EAT-Lancet diet (≥ 33) had a significantly lower risk of T2D compared to those with the lowest adherence (≤ 26), with a hazard ratio (HR) of 0.70 (95% CI: 0.52, 0.95). The incidence risk of T2D was reduced by 2% for each one-unit increment in the ELDI across adjusted models (HR: 0.98, 95% CI: 0.96, 0.99; p-value < 0.05). A nonlinear correlation between the ELDI and T2D was observed, indicating that higher adherence to the EAT-Lancet diet, particularly with an index above 32, was associated with a decreased likelihood of T2D. CONCLUSION: This study provides compelling evidence that greater adherence to the EAT-Lancet diet is associated with a reduced likelihood of T2D events among Shanghai residents. This highlights the critical importance of sustainable dietary patterns in preventing diabetes within the demographic context of China.