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ludc web

Stina Ramne


ludc web

Development of an EAT-Lancet index and its relation to mortality in a Swedish population


  • Anna Stubbendorff
  • Emily Sonestedt
  • Stina Ramne
  • Isabel Drake
  • Elinor Hallström
  • Ulrika Ericson

Summary, in English

BACKGROUND: Current global food systems threaten human health and environmental sustainability. In 2019, the EAT-Lancet Commission on healthy diets from sustainable food systems defined the first global reference diet to improve both areas, but there is no consensus on how to quantify the EAT-Lancet reference diet as a diet index and its relation to mortality has not been widely studied.

OBJECTIVE: To develop a new dietary index to quantify adherence to the EAT-Lancet diet and assess its association with mortality in a large population-based Swedish cohort. We also examined food components included in the index and their individual associations with mortality.

DESIGN: We used the Malmö Diet and Cancer cohort (n = 22,421, 45-73 years at baseline). Dietary data were collected using a modified diet history method. The EAT-Lancet index was developed based on intake levels and reference intervals of 14 food components defined in the EAT-Lancet diet (0-3 points per component, 0-42 points in total). Associations with mortality were examined based on registers during a mean of 20 years of follow-up and were adjusted for potential confounders.

RESULTS: Divided into five adherence groups, the highest adherence to the EAT-Lancet diet (≥23 points) was associated with lower all-cause mortality (HR: 0.75; 95% CI: 0.67, 0.85), cancer mortality (HR 0.76; 95% CI: 0.63, 0.92) and cardiovascular mortality (HR 0.68; 95% CI: 0.54, 0.84) than the lowest adherence (≤13 points). Several food components included in the index contributed to the observed reductions in mortality.

CONCLUSIONS: We developed a new dietary index to investigate adherence to the EAT-Lancet diet. The findings indicate a 25% lower risk of mortality among those with the highest adherence to the EAT-Lancet diet, as defined using our index, which adds to the evidence base for the development of sustainable dietary guidelines.


  • EpiHealth: Epidemiology for Health
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • Nutrition Epidemiology
  • LUCC: Lund University Cancer Centre
  • Diabetes - Cardiovascular Disease

Publishing year





The American journal of clinical nutrition

Document type

Journal article


Oxford University Press


  • Nutrition and Dietetics
  • Public Health, Global Health, Social Medicine and Epidemiology




  • Lund University Agenda 2030 Graduate School
  • Mat för människa och planet (inom forskarskolan Agenda 2030)

Research group

  • Nutrition Epidemiology
  • Diabetes - Cardiovascular Disease


  • ISSN: 1938-3207