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Research paves the way for sustainable dietary guidelines

vegitables on a plate. photo.
Foto: iStock/Magda Tymczyj.

The EAT-Lancet diet is a framework designed to promote environmental sustainability while also preventing common diseases such as type 2 diabetes. How do we know if the diet actually works? An international research team studied seven dietary scores and found that two of them were particularly good at evaluating adherence to the diet. Reliable diet scores are important when developing sustainable dietary guidelines.

Within the healthcare system, diet scores are used to assess whether a person has unhealthy eating habits. Such scores are also essential for researchers when assessing how the degree of adherence  to a certain diet affects health. Reliable diet scores are important for researchers to draw the right conclusions from studies and for authorities to develop dietary recommendations that address sustainablity.

The EAT-Lancet diet emphasises a plant-based diet where whole grains, vegetables, fruits, and legumes comprise a greater proportion of foods consumed, and meat and dairy products are consumed in significantly smaller proportions. Previous research has shown that high adherence to this diet can prevent 54-63 percent of premature deaths and lower greenhouse gas emissions by 50 percent.
"Such findings can form the basis for future nutrition recommendations, but there is currently no consensus of how adherence to the EAT-Lancet diet should be evaluated, and this makes it difficult to follow up the effects of the diet," says Anna Stubbendorff, doctoral student in nutritional epidemiology at Lund University Diabetes Centre, who has led the study published in the journal The Lancet Planetary Health.

Sustainable nutrition guidelines

Since the EAT-Lancet commission published its recommendations in 2019, several diet scores that can be used to evaluate adherence have been constructed. The research team has examined how useful seven of these diet scores are, and found that two were particularly good at evaluating adherence to the diet.
"We need reliable diet scores in order to develop evidence-based nutrition recommendations that can help prevent disease and premature death. In this study, we have used the diet scores on three population studies to determine which scores are best at evaluating adherence to the EAT-Lancet diet. The study shows that the results differ greatly depending on which score we use," says Daniel Borch Ibsen, researcher in nutritional epidemiology at Steno Diabetes Center Aarhus, who led the study.

Two dietary scores performed best

The researchers have investigated how useful the diet scores are at assessing adherence to the diet in the population studies the Malmö Diet Cancer (MDC) in Sweden, a similar cohort in Denmark and a population study in Mexico. The two diet scores that performed best were the Stubbendorff score and the Colizzi score. These two scores grouped participants consistently when comparing high and low adherence to the EAT-Lancet reference diet. When the two scores were used to assess adherence, the researchers found a reduced risk of premature death in three cohorts, a reduced risk of stroke in two cohorts, and lower greenhouse emissions in MDC, which had access to such data. Since Anna Stubbendorff has developed the Stubbendorff score, she did not participate in the assessment of how useful her dietary score is.

"A desired feature of a diet score that assesses adherence to this diet is that individuals with a high intake of the recommended diet receive high scores, whereas individuals with a low intake receive low scores. The Stubbendorff score and the Colizzi score had this feature and were best at assessing adherence to the diet," says Daniel Borch Ibsen.
The EAT-Lancet diet is a science-based diet and research has shown health benefits with adherence to the diet.

"Our previous research has shown, for example, that people who had high adherence to the EAT-Lancet diet had a lower risk of developing type 2 diabetes. In our future studies, we also plan to investigate whether there may be disadvantages of the diet, as a result of possible deficiencies of vitamins and minerals," says Anna Stubbendorff, who is a dietitian.


A systematic evaluation of seven different scores representing the EAT–Lancet reference diet and mortality, stroke, and greenhouse gas emissions in three cohorts
Review article, The Lancet Planetary Health, juni 2024.

Declaration of interests 
Anna Stubbendorff, Ulrika Ericson, and Emily Sonestedt at Lund University are three of the researchers who have developed the Stubbendorff score, which is also known as the EAT-Lancet index. Anna Stubbendorff was part of the group that analysed the diet scores, but she did not participate in the qualitative assessment of how useful the Stubbendorff score is. The other authors have not declared any conflicts of interest.

Short facts about the study: nutritional epidemiology // epidemiological research // qualitative-, quantitative-, researcher-initiated and register-based study // prospective, cross-sectional study, cohort study // number of patients in the study: 103,576 healthy volunteers, of which 20,973 from Malmö Diet Cancer (MDC), 52,452 from DCH (Diet, Cancer and Health) and 30,151 from MTC (the Mexican Teacher's Cohort) 



portrait anna stubbendorff. photo.

Anna Stubbendorff, PhD studenti n nutritional epidemiology at Lund University andaffiliated with the strategic research area EXODIAB. 
Profile in Lund University Research Portal

EXODIAB: A significant part of diabetes research at Lund University is conducted within EXODIAB, which is a strategic research area (SRA) in Sweden. The overall aim is to develop individualised treatments and drugs that can prevent or cure diabetes. Within EXODIAB, the researchers study the role of eating habits on health in people with and without diabetes. An important aim with this research is to develop individualised dietary recommendations to reduce the risk of obesity and type 2 diabetes. 
EXODIAB on Lund University's website 

portrait Daniel Borch Ibsen. photo.

Daniel Borch Ibsen, researcher in nutritional epidemiology at Steno Diabetes Center Aarhus, affiliated with Aarhus University Denmark and University of Cambridge UK, dbi [at] ph [dot] au [dot] dk (dbi[at]ph[dot]au[dot]dk)