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

## TL;DR

Following the EAT-Lancet diet may reduce colorectal cancer risk in middle-aged people, including those with diabetes.

## Contribution

First cohort study to assess EAT-Lancet diet adherence and colorectal cancer risk in a general population and diabetes subgroup.

## Key findings

- Higher EAT-Lancet diet adherence was linked to a 25% lower CRC risk.
- The 20-year risk difference for CRC was -0.60% with high diet adherence.
- Findings were consistent for colon cancer but not statistically significant for rectal cancer.

## Abstract

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.

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.

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).

Higher adherence to the EAT-Lancet diet was associated with lower risk of CRC in middle-aged Danes.

The online version of this article (10.1007/s00394-026-03936-6) contains supplementary material, which is available to authorized users.