Association between adherence to the EAT ‐Lancet diet and risk of microvascular complications in type 2 diabetes: A cohort study

AIM: This study aimed to investigate the association between adherence to the EAT-Lancet diet and the incidence of microvascular complications in type 2 diabetes (T2D). MATERIALS AND METHODS: This prospective study included 7525 individuals with T2D who were free of diabetic microvascular complications (including diabetic retinopathy, neuropathy and nephropathy) at baseline from the UK Biobank cohort. Dietary data were collected via a web-based 24-hour dietary recall questionnaire. The EAT-Lancet diet index, ranging from 0 to 14 points, was constructed based on the EAT-Lancet reference diet. Cox proportional hazard models were used to examine the relationship between the EAT-Lancet diet index and the incidence of microvascular complications among individuals with T2D. RESULTS: During a mean follow-up of 12.58 years, 1217 participants developed diabetic microvascular complications. After adjusting for potential confounders, participants in the highest adherence group of the EAT-Lancet diet index had a significantly lower risk of developing microvascular complications (hazard ratio: 0.76, 95% CI: 0.64-0.88) compared to those in the lowest adherence group. Subtype analyses for incident diabetic retinopathy, neuropathy and nephropathy yielded consistent results. Additionally, each 1-point increase in the EAT-Lancet diet index was associated with an 8% lower risk of microvascular complications. These findings remained robust across several sensitivity analyses and nearly all subgroups. CONCLUSION: Our findings demonstrate a significant inverse association between adherence to the EAT-Lancet diet and the risk of microvascular complications in individuals with T2D.