Higher adherence to the EAT-Lancet reference diet is associated with higher nutrient adequacy in the NutriNet-Sante cohort: a cross-sectional study

Background: In 2019, the EAT-Lancet Commission proposed a planetary and healthy reference diet; however, its nutritional quality has been rarely evaluated.Objective: Across different adherence levels to the EAT-Lancet reference diet, the following were our objectives:1) describe the food and nutritional intakes of the French population, 2) evaluate the nutrient quality, and 3) investigate the consistency between the French national recommendations and the EAT-Lancet reference diet. Methods: This cross-sectional study was conducted among participants of the NutriNet-Sante ⠁ cohort, and the sample was weighted on the characteristics of the general French population. Adherence to the EAT-Lancet reference diet was estimated using the EAT-Lancet Diet Index (ELD-I). Usual nutrient intakes were obtained using the variance reduction method. We used the estimated average requirements cut-point method to estimate the proportion of participants who meet their respective nutritional requirements. Furthermore, the adequacy of the French food-based dietary recommendations [Pro -gramme National Nutrition Sante ⠁ (PNNS)] according to adherence to the EAT-Lancet reference diet was studied. Results: The weighted sample was composed of 98,465 participants. Except for bioavailable zinc and vitamin B12, we observed a decrease in the nutrient inadequacy prevalence when the adherence to the EAT-Lancet reference diet increased, particularly for vitamin B9 (Q1 = 37.8% compared with Q5 = 5.5%, P < 0.0001) and vitamin C (Q1 = 59.0% compared with Q5 = 10.8 %, P < 0.0001). However, inadequacy prevalence remained high in all ELD-I quintiles, particularly for fiber (95.9%), vitamin B1 (70.8%), iodine (48.4%), and magnesium (76.8%). Higher ELD-I score was associated with higher adherence for most components of the PNNS, except for food groups that are not specifically included in the EAT-Lancet reference diet and are typical of the French diet, including alcohol, processed meat, and salt. Conclusion: In the French context, although issues with the intake of certain nutrients may occur, a diet that remains within the planetary limits as the EAT-Lancet reference diet allows a favorable nutritional quality.This trial was registered at clinicaltrials.gov as NCT03335644.

Automated summary

The nutritional quality of the EAT-Lancet reference diet has been rarely evaluated. This study examined the food and nutritional intakes of the French population and investigated the consistency between the French national recommendations and the EAT-Lancet reference diet. The results showed that adherence to the EAT-Lancet diet was associated with a decrease in nutrient inadequacy, but certain nutrients remained inadequate in all adherence levels.