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Research Article: Adherence to the EAT-Lancet diet and the risk of heart failure in individuals with cardiovascular-kidney-metabolic syndrome stages 0–3: A prospective cohort study

Date Published: 2026-05-13

Abstract:
In 2019, the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems proposed the EAT-Lancet planetary health diet as a universal reference dietary pattern aimed at promoting human health while minimizing environmental degradation. However, epidemiological evidence regarding the association between adherence to the EAT-Lancet diet and the risk of heart failure (HF), particularly among individuals with cardiovascular-kidney-metabolic syndrome (CKMs) stages 0–3, remains limited. Therefore, this study aimed to examine the associations between adherence to the EAT-Lancet dietary pattern, its individual dietary components, and the risk of HF among individuals at CKMs stages 0–3. In this prospective study, a total of 120,849 participants with CKMs stages 0–3 from the UK Biobank cohort were included. Dietary data were collected using an online 24-h dietary recall questionnaire. The EAT-Lancet Diet Index, ranging from 0 to 14, was constructed based on the EAT-Lancet reference diet to evaluate adherence. Cox proportional hazards models and restricted cubic spline functions were used to assess the associations between the EAT-Lancet Diet Index, its dietary components, and HF risk. Over a median follow-up of 14.88?years, 2,454 participants developed HF. A higher EAT-Lancet Diet Index was significantly associated with a lower risk of HF compared to the lowest index group (hazard ratio [HR]: 0.88; 95% confidence interval [CI]: 0.80, 0.97). This association remained robust across subgroup and multiple sensitivity analyses. Restricted cubic spline analysis revealed a significant inverse linear relationship between the EAT-Lancet Diet Index and HF risk. Among dietary components, reduced intake of red meat (beef, lamb, and pork) (HR: 0.90; 95% CI: 0.83, 0.98) and increased intake of peanuts or other nuts (HR: 0.76; 95% CI: 0.60, 0.95) were significantly associated with lower HF risk. This study demonstrates that greater adherence to the EAT-Lancet diet is significantly associated with a reduced relative hazard of HF among individuals with CKM stages 0–3, particularly through reduced consumption of red meat and increased intake of peanuts or other nuts.

Introduction:
In 2019, the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems proposed the EAT-Lancet planetary health diet as a universal reference dietary pattern aimed at promoting human health while minimizing environmental degradation. However, epidemiological evidence regarding the association between adherence to the EAT-Lancet diet and the risk of heart failure (HF), particularly among individuals with cardiovascular-kidney-metabolic syndrome (CKMs) stages 0–3, remains limited. Therefore, this study…

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