Adherence to the EAT‐Lancet Diet, Genetically Predicted Gut Butyrate and the Risk of Incident Cardiometabolic Multimorbidity: A Prospective Analysis

ABSTRACT Our study aimed to explore the correlation between the EAT‐Lancet diet and cardiometabolic multimorbidity (CMM) risk and the potential role of gut butyrate in this relationship. Our study encompassed 136,910 UK Biobank participants who had completed at least one validated 24‐h online dietary recall questionnaire and had at most one cardiometabolic disease at recruitment. The EAT‐Lancet diet index, scaled from 0 to 42, was used to categorize adherence into quartiles: Q1: <19, Q2: 19–22, Q3: 22–25, and Q4: ≥25 points. We employed COX proportional hazard models to calculate hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs). An inverse association was observed between the EAT‐Lancet and CMM risk (HR: 0.95; 95% CI: 0.91–0.99), with a significant linear trend ( p for trend = 0.021). A more pronounced relationship between the EAT‐Lancet diet and CMM was found in those with lower genetically predicted gut butyrate levels. Joint analysis showed that those with high genetically predicted gut butyrate and high EAT‐Lancet adherence had the lowest CMM risk (HR: 0.82, 95% CI: 0.69–0.96). Higher adherence to the EAT‐Lancet diet was associated with a lower risk of incident CMM, with a stronger protective effect observed among individuals with lower genetically predicted gut butyrate levels.