Adherence to the EAT-Lancet sustainable reference diet and cardiometabolic risk profile: cross-sectional results from the ELSA-Brasil cohort study

Eur J Nutr. 2023 Mar;62(2):807-817. doi: 10.1007/s00394-022-03032-5. Epub 2022 Oct 21.


Purpose: The EAT-Lancet Commission released a reference sustainable diet to improve human health and respect the planetary boundaries. The Planetary Health Diet Index (PHDI) was developed with the purpose of evaluate the adherence to this reference diet. The aim of the present study was to evaluate the association between adherence to the EAT-Lancet diet with cardiometabolic risk profile.

Methods: We used the cross-sectional baseline data from 14,155 participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter ongoing cohort study. Dietary data were collected using a 114-item validated food frequency questionnaire. The PHDI was used to assess the adherence to the EAT-Lancet diet. It consists of 16 components and the total score can range from 0 to 150 points. Linear, logistic and quasi-Poisson regression models were built to evaluate the associations between PHDI and the outcomes.

Results: Individuals with higher adherence to EAT-Lancet diet (PHDI, 5th quintile) had lower values for systolic blood pressure (β - 0.84; 95% CI - 1.66: - 0.01), diastolic blood pressure (β - 0.70; 95% CI - 1.24: - 0.15), total cholesterol (β - 3.15; 95% CI - 5.30: - 1.01), LDL-c (β - 4.10; 95% CI - 5.97: - 2.23), and non-HDL-cholesterol (β - 2.57; 95% CI - 4.62: - 0.52). No association was observed for HDL-c, triglycerides and HOMA-IR.

Conclusions: Our results indicate that higher adherence to the EAT-Lancet diet is associated with lower levels of blood pressure, total cholesterol, LDL-c, and non-HDL-c.

Keywords: Blood pressure; Cardiovascular diseases; Diet indexes; EAT-Lancet diet; Lipid profile; Sustainable diet.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Brazil
  • Cardiovascular Diseases*
  • Cholesterol
  • Cohort Studies
  • Cross-Sectional Studies
  • Diet*
  • Humans
  • Longitudinal Studies
  • Risk Factors


  • Cholesterol