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Adherence to the EAT-Lancet diet is associated with a lower risk of type 2 diabetes: the Danish Diet, Cancer and Health cohort

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Abstract

Purpose

Type 2 diabetes is a global health problem. While a healthy diet lowers risk of type 2 diabetes, less is known about diets with low climate impact. This study aimed to investigate adherence to the EAT-Lancet diet and risk of type 2 diabetes in a Danish setting.

Methods

In the Danish Diet, Cancer and Health cohort, dietary data were collected using a validated 192-item food frequency questionnaire, at recruitment in 1993–1997. In total, 54,232 participants aged 50–64 years at baseline with no previous cancer or diabetes diagnoses were included in the current analyses. The EAT-Lancet diet score was used to assess adherence to the EAT-Lancet diet. Participants scored 0 (non-adherence) or 1 (adherence) point for each of the 14 dietary components of the diet score (range 0–14 points). Participants were followed through register linkage until type 2 diabetes diagnosis or censoring. Hazard ratios and 95% confidence intervals (CI) were estimated using multivariable-adjusted Cox regression models.

Results

During a median 15-year follow-up period, 7130 participants developed type 2 diabetes. The hazard ratio for developing type 2 diabetes was 0.78 (95% CI 0.71; 0.86) for those with highest EAT-Lancet diet scores (11–14 points) compared to those with lowest scores (0–7 points) after adjusting for potential confounders. After further adjusting for potential mediators, including BMI, the corresponding hazard ratio was 0.83 (95% CI 0.76; 0.92).

Conclusion

Greater adherence to the EAT-Lancet diet was associated with a lower risk of developing type 2 diabetes in a middle-aged Danish population.

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Data availability

This study was based on data from the Diet, Cancer and Health Cohort and are not publicly available due to personal information content, but can be acquired upon reasonable request from the Danish Cancer Society (dchdata@cancer.dk).

References

  1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, Stein C, Basit A, Chan JCN, Mbanya JC, Pavkov ME, Ramachandaran A, Wild SH, James S, Herman WH, Zhang P, Bommer C, Kuo S, Boyko EJ, Magliano DJ (2022) IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 183:109119. https://doi.org/10.1016/j.diabres.2021.109119

    Article  PubMed  Google Scholar 

  2. Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Al-Kaabi J (2020) Epidemiology of type 2 diabetes - global burden of disease and forecasted trends. J Epidemiol Glob Health. 10(1):107–111. https://doi.org/10.2991/jegh.k.191028.001

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, Song X, Ren Y, Shan P-F (2020) Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep 10(1):14790. https://doi.org/10.1038/s41598-020-71908-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Qian F, Liu G, Hu FB, Bhupathiraju SN, Sun Q (2019) Association between plant-based dietary patterns and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA Intern Med 179(10):1335–1344. https://doi.org/10.1001/jamainternmed.2019.2195

    Article  PubMed  PubMed Central  Google Scholar 

  5. Neuenschwander M, Ballon A, Weber KS, Norat T, Aune D, Schwingshackl L, Schlesinger S (2019) Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies. BMJ 366:l2368. https://doi.org/10.1136/bmj.l2368

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hu FB (2003) Plant-based foods and prevention of cardiovascular disease: an overview. Am J Clin Nutr 78(3):544S-551S. https://doi.org/10.1093/ajcn/78.3.544S

    Article  CAS  PubMed  Google Scholar 

  7. Kahleova H, Levin S, Barnard N (2017) Cardio-metabolic benefits of plant-based diets. Nutrients. https://doi.org/10.3390/nu9080848

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kahleova H, Pelikanova T (2015) Vegetarian diets in the prevention and treatment of type 2 diabetes. J Am Coll Nutr 34(5):448–458. https://doi.org/10.1080/07315724.2014.976890

    Article  CAS  PubMed  Google Scholar 

  9. Mozaffarian D (2016) Dietary and policy priorities for cardiovascular disease, diabetes, and obesity. Circulation 133(2):187–225. https://doi.org/10.1161/circulationaha.115.018585

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Hemler EC, Hu FB (2019) Plant-based diets for cardiovascular disease prevention: all plant foods are not created equal. Curr Atheroscler Rep 21(5):18. https://doi.org/10.1007/s11883-019-0779-5

    Article  PubMed  Google Scholar 

  11. Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, Garnett T, Tilman D, DeClerck F, Wood A, Jonell M, Clark M, Gordon LJ, Fanzo J, Hawkes C, Zurayk R, Rivera JA, De Vries W, Majele Sibanda L, Afshin A, Chaudhary A, Herrero M, Agustina R, Branca F, Lartey A, Fan S, Crona B, Fox E, Bignet V, Troell M, Lindahl T, Singh S, Cornell SE, Srinath Reddy K, Narain S, Nishtar S, Murray CJL (2019) Food in the anthropocene: the EAT-Lancet commission on healthy diets from sustainable food systems. Lancet 393(10170):447–492. https://doi.org/10.1016/s0140-6736(18)31788-4

    Article  PubMed  Google Scholar 

  12. Ibsen DB, Laursen ASD, Lauritzen L, Tjønneland A, Overvad K, Jakobsen MU (2017) Substitutions between dairy product subgroups and risk of type 2 diabetes: the Danish Diet, Cancer and Health cohort. Br J Nutr 118(11):989–997. https://doi.org/10.1017/s0007114517002896

    Article  CAS  PubMed  Google Scholar 

  13. Namazi N, Brett NR, Bellissimo N, Larijani B, Heshmati J, Azadbakht L (2019) The association between types of seafood intake and the risk of type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies. Health Promot Perspect 9(3):164–173. https://doi.org/10.15171/hpp.2019.24

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gijsbers L, Ding EL, Malik VS, de Goede J, Geleijnse JM, Soedamah-Muthu SS (2016) Consumption of dairy foods and diabetes incidence: a dose-response meta-analysis of observational studies. Am J Clin Nutr 103(4):1111–1124. https://doi.org/10.3945/ajcn.115.123216

    Article  CAS  PubMed  Google Scholar 

  15. Zhang M, Picard-Deland E, Marette A (2013) Fish and marine Omega-3 polyunsatured fatty acid consumption and incidence of type 2 diabetes: a systematic review and meta-analysis. Int J Endocrinol. 2013:501015. https://doi.org/10.1155/2013/501015

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Knuppel A, Papier K, Key TJ, Travis RC (2019) EAT-Lancet score and major health outcomes: the EPIC-Oxford study. Lancet 394(10194):213–214. https://doi.org/10.1016/s0140-6736(19)31236-x

    Article  PubMed  Google Scholar 

  17. Xu C, Cao Z, Yang H, Hou Y, Wang X, Wang Y (2021) Association between the EAT-Lancet diet pattern and risk of type 2 diabetes: a prospective cohort study. Front Nutr 8:784018. https://doi.org/10.3389/fnut.2021.784018

    Article  PubMed  Google Scholar 

  18. Tjønneland A, Olsen A, Boll K, Stripp C, Christensen J, Engholm G, Overvad K (2007) Study design, exposure variables, and socioeconomic determinants of participation in Diet, Cancer and Health: a population-based prospective cohort study of 57,053 men and women in Denmark. Scand J Public Health. 35(4):432–441. https://doi.org/10.1080/14034940601047986

    Article  PubMed  Google Scholar 

  19. Pedersen CB (2011) The Danish Civil Registration System. Scand J Public Health. 39(7 Suppl):22–25. https://doi.org/10.1177/1403494810387965

    Article  PubMed  Google Scholar 

  20. Kyrø C, Tjønneland A, Overvad K, Olsen A, Landberg R (2018) Higher whole-grain intake is associated with lower risk of type 2 diabetes among middle-aged men and women: the Danish Diet, Cancer, and Health cohort. J Nutr 148(9):1434–1444. https://doi.org/10.1093/jn/nxy112

    Article  PubMed  Google Scholar 

  21. Tjønneland A, Overvad K, Haraldsdóttir J, Bang S, Ewertz M, Jensen OM (1991) Validation of a semiquantitative food frequency questionnaire developed in Denmark. Int J Epidemiol 20(4):906–912. https://doi.org/10.1093/ije/20.4.906

    Article  PubMed  Google Scholar 

  22. DTU Food (2019) Danish National Food Tables. Available from: https://frida.fooddata.dk/?lang=en. Accessed 7 Oct 2021

  23. Lauritsen A (2019) FoodCalc. Available from: https://www.cancer.dk/dchdata/access-to-data-and-biobank/foodcalc/. Accessed 7 Oct 2021

  24. Slimani N, Ferrari P, Ocké M, Welch A, Boeing H, van Liere M, Pala V, Amiano P, Lagiou A, Mattisson I, Stripp C, Engeset D, Charrondière R, Buzzard M, van Staveren W, Riboli E (2000) Standardization of the 24-hour diet recall calibration method used in the European Prospective Investigation into Cancer and Nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr 54(12):900–917. https://doi.org/10.1038/sj.ejcn.1601107

    Article  CAS  PubMed  Google Scholar 

  25. Ibsen DB, Christiansen AH, Olsen A, Tjønneland A, Overvad K, Wolk A, Mortensen JK, Dahm CC (2022) Adherence to the EAT-Lancet diet and risk of stroke and stroke subtypes: a cohort study. Stroke 53(1):154–163. https://doi.org/10.1161/strokeaha.121.036738

    Article  PubMed  Google Scholar 

  26. Chiuve SE, Fung TT, Rimm EB, Hu FB, McCullough ML, Wang M, Stampfer MJ, Willett WC (2012) Alternative dietary indices both strongly predict risk of chronic disease. J Nutr 142(6):1009–1018. https://doi.org/10.3945/jn.111.157222

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Carstensen B, Kristensen JK, Marcussen MM, Borch-Johnsen K (2011) The National Diabetes Register. Scand J Public Health. 39(7 Suppl):58–61. https://doi.org/10.1177/1403494811404278

    Article  PubMed  Google Scholar 

  28. Green A, Sortsø C, Jensen PB, Emneus M (2014) Validation of the danish national diabetes register. Clin Epidemiol 7:5–15. https://doi.org/10.2147/clep.S72768

    Article  PubMed  PubMed Central  Google Scholar 

  29. Andersen JLM, Halkjær J, Rostgaard-Hansen AL, Martinussen N, Lund AQ, Kyrø C, Tjønneland A, Olsen A (2021) Intake of whole grain and associations with lifestyle and demographics: a cross-sectional study based on the Danish Diet, Cancer and Health-Next Generations cohort. Eur J Nutr 60(2):883–895. https://doi.org/10.1007/s00394-020-02289-y

    Article  CAS  PubMed  Google Scholar 

  30. Textor J, van der Zander B, Gilthorpe MK, Liskiewicz M, Ellison GTH (2016) Robust causal inference using directed acyclic graphs: the R package “dagitty.” Int J Epidemiol 45(6):1887–1894. https://doi.org/10.1093/ije/dyw341

    Article  PubMed  Google Scholar 

  31. Chunsen W, Bach CC, Matthiesen NB, Olsen J (2017) A short introduction to the use of directed acyclic graphs (DAGs) in Epidemiology, 3 edn

  32. Astrup A, Andersen NL, Stender S, Trolle E (2005) Kostrådene 2005. 2005, Ernæringsrådet og Danmarks Fødevareforskning: København

  33. Stubbendorff A, Sonestedt E, Ramne S, Drake I, Hallström E, Ericson U (2022) Development of an EAT-Lancet index and its relation to mortality in a Swedish population. Am J Clin Nutr 115(3):705–716. https://doi.org/10.1093/ajcn/nqab369

    Article  PubMed  Google Scholar 

  34. Vander Weele TJ, Ding P (2017) Sensitivity analysis in observational research: introducing the E value. Ann Internal Med. 167(4):268–274. https://doi.org/10.7326/M16-2607

    Article  Google Scholar 

  35. StataCorp (2019) Stata statistical software: release 16.1, StataCorp. StataCorp LLC, College Station

    Google Scholar 

  36. Yland JJ, Wesselink AK, Lash TL, Fox MP (2022) Misconceptions about misclassification: non-differential misclassification does not always bias results toward the null. Am J Epidemiol. https://doi.org/10.1093/aje/kwac035

    Article  PubMed  PubMed Central  Google Scholar 

  37. Schatzkin A, Kipnis V, Carroll RJ, Midthune D, Subar AF, Bingham S, Schoeller DA, Troiano RP, Freedman LS (2003) A comparison of a food frequency questionnaire with a 24-h recall for use in an epidemiological cohort study: results from the biomarker-based Observing Protein and Energy Nutrition (OPEN) study. Int J Epidemiol 32(6):1054–1062. https://doi.org/10.1093/ije/dyg264

    Article  PubMed  Google Scholar 

  38. Subar AF, Kipnis V, Troiano RP, Midthune D, Schoeller DA, Bingham S, Sharbaugh CO, Trabulsi J, Runswick S, Ballard-Barbash R, Sunshine J, Schatzkin A (2003) Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study. Am J Epidemiol 158(1):1–13. https://doi.org/10.1093/aje/kwg092

    Article  PubMed  Google Scholar 

  39. Kipnis V, Subar AF, Midthune D, Freedman LS, Ballard-Barbash R, Troiano RP, Bingham S, Schoeller DA, Schatzkin A, Carroll RJ (2003) Structure of dietary measurement error: results of the OPEN biomarker study. Am J Epidemiol 158(1):14–21. https://doi.org/10.1093/aje/kwg091

    Article  PubMed  Google Scholar 

  40. Graeff TR (2005) Response bias. In: Kempf-Leonard K (ed) Encyclopedia of social measurement. Elsevier, New York, pp 411–418

    Chapter  Google Scholar 

  41. Briançon-Marjollet A, Weiszenstein M, Henri M, Thomas A, Godin-Ribuot D, Polak J (2015) The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms. Diabetol Metab Syndr 7(1):25. https://doi.org/10.1186/s13098-015-0018-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Chaput JP, Després JP, Bouchard C, Tremblay A (2011) The association between short sleep duration and weight gain is dependent on disinhibited eating behavior in adults. Sleep 34(10):1291–1297. https://doi.org/10.5665/sleep.1264

    Article  PubMed  PubMed Central  Google Scholar 

  43. McNeil J, Doucet É, Chaput JP (2013) Inadequate sleep as a contributor to obesity and type 2 diabetes. Can J Diabetes 37(2):103–108. https://doi.org/10.1016/j.jcjd.2013.02.060

    Article  PubMed  Google Scholar 

  44. Cappuccio FP, D’Elia L, Strazzullo P, Miller MA (2010) Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 33(2):414–420. https://doi.org/10.2337/dc09-1124

    Article  PubMed  Google Scholar 

  45. Joseph JJ, Golden SH (2017) Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes mellitus. Ann N Y Acad Sci 1391(1):20–34. https://doi.org/10.1111/nyas.13217

    Article  PubMed  Google Scholar 

  46. Hackett RA, Kivimäki M, Kumari M, Steptoe A (2016) Diurnal cortisol patterns, future diabetes, and impaired glucose metabolism in the Whitehall II cohort study. J Clin Endocrinol Metab 101(2):619–625. https://doi.org/10.1210/jc.2015-2853

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors acknowledge the participants that provided data and the members of the study team that collected the data. The authors thank Lone Fredslund for assistance on data management.

Funding

The Diet, Cancer, and Health Cohort study was funded by the Danish Cancer Society. This study was funded by Aarhus University. DBI was funded by a grant from the Independent Research Fund Denmark (1057-00016B). The sponsors had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Department of Public Health, Aarhus University, Aarhus, Denmark

    Fie Langmann, Daniel B. Ibsen, Anja Olsen, Kim Overvad & Christina C. Dahm

  2. Steno Diabetes Center Aarhus, Aarhus, Denmark

    Daniel B. Ibsen

  3. Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark

    Daniel B. Ibsen

  4. Danish Cancer Society, Copenhagen, Denmark

    Anne Tjønneland & Anja Olsen

  5. Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Anne Tjønneland

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  1. Fie Langmann
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  6. Christina C. Dahm
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Contributions

The Danish Diet, Cancer and Health cohort was initiated by KO and AT as principal investigators. CCD, DBI, FL, and AO conceived the research question. CCD, FL, and DBI designed the analysis plan. FL and DBI did the data analysis. FL, DBI, and CCD drafted the manuscript. All authors interpreted the results and critically revised the article for important intellectual content and gave final approval of the version to publish. CCD takes responsibility for the contents of this article.

Corresponding author

Correspondence to Christina C. Dahm.

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Conflict of interest

The authors have no competing interests to declare of relevance for the content of this article.

Ethical approval

The Diet, Cancer and Health Cohort was approved by relevant ethics committees and the Danish Data Protection Agency. All participants received information about the purpose and process of the study before inclusion. Participants were further informed about the voluntariness of their participation before giving written informed consent prior to inclusion in accordance with the ethical standards of the Declaration of Helsinki.

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Langmann, F., Ibsen, D.B., Tjønneland, A. et al. Adherence to the EAT-Lancet diet is associated with a lower risk of type 2 diabetes: the Danish Diet, Cancer and Health cohort. Eur J Nutr 62, 1493–1502 (2023). https://doi.org/10.1007/s00394-023-03090-3

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