Adherence to the EAT-Lancet diet and risk of colorectal cancer in the general population and among individuals with diabetes: a cohort study.

BACKGROUND: Healthy and sustainable diets, such as the EAT-Lancet diet, may benefit planetary and human health, though evidence for colorectal cancer (CRC) is limited. This study examined the association between EAT-Lancet diet adherence and CRC risk in middle-aged Danes, including subgroup analysis among individuals with diabetes. METHODS: Based on data from the Danish Diet, Cancer, and Health cohort (1993–1997), we included 55,651 participants aged 50–64 without cancer at baseline. Adherence to the EAT-Lancet diet was evaluated using a diet score (0–42 points, 42 indicating highest adherence) from a validated food frequency questionnaire. Cox proportional hazard models were used to estimate hazard ratios (HR) for CRC, colon cancer, and rectal cancer. The pseudo-observation method was used to estimate risk differences after 20 years. RESULTS: In total 1877 participants were diagnosed with CRC (median follow-up: 18.7 years). Multivariable-adjusted HRs for CRC, colon cancer, and rectal cancer were 0.75 (95% CI: 0.60, 0.93), 0.73 (95% CI: 0.57, 0.95), and 0.76 (95% CI: 0.50, 1.16) for highest (24–34 points) versus lowest adherence (9–16 points), respectively. The 20-year RD for CRC was -0.60% (95% CI: -1.27, 0.06). CONCLUSIONS: Higher adherence to the EAT-Lancet diet was associated with lower risk of CRC in middle-aged Danes.