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Nutrition and Health (including climate and ecological aspects)

EAT-Lancet Healthy Reference Diet score and diabetes incidence in a cohort of Mexican women


To improve the health of our planet and develop sustainable food policies, it is important to understand the health impact of a diet pattern that considers planetary and population health. We used data from the Mexican Teachers’ Cohort (MTC) to estimate the association between the EAT-Lancet healthy reference diet (EAT-HRD) and type 2 diabetes (T2D) incidence. We included 74,671 women aged ≥25 years, free of T2D at baseline. A validated food frequency questionnaire (FFQ) was used to assess dietary intake. We created an EAT-HRD score based on 15 food groups recommended by the EAT-Lancet Commission (range from 0 to 15). T2D cases were identified through self-report and cross-linkage with clinical and administrative databases. We used Cox proportional hazards models to estimate the association between categories of the EAT-HRD score with T2D incidence. During a median follow-up of 2.16 y (IQR 1.8–4.3 y), we identified 3241 T2D incident cases. The median EAT-HRD score was 6 (IQR 5–7). In multivariable analyses, when comparing extreme categories, higher adherence to the EAT-HRD score was associated with lower T2D incidence (HR 0.90; 95% CI 0.75, 1.10), yet, the estimation was imprecise. Compared to those who did not meet the EAT-HRD recommendations, adhering to the red meat, legumes, and fish recommendations was associated with lower T2D incidence. Meeting the recommendation of dairy and added sugars was associated with an increased incidence of T2D. Higher adherence to a diet designed to promote environmental and human health may help prevent T2D incidence among women in a middle-income country.

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Data availability

The data that supports the findings of this study are available from the corresponding author (DS) upon request.

Code availability

The code that supports the findings of this study is available from the corresponding author (DS) upon request.


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We thank Antonio García-Anaya and Adrian Cortes for exceptional assistance with data management. We also thank ISSSTE (Social Security and Services Institute for Employees of the State) and Victor Sastre from Mexico’s Ministry of Education for their support over the years. In particular, we would like to thank Dr. Vesta Louise Richardson López Collada from ISSSTE for providing the MTC access to the Comprehensive Management of Diabetes by Stages (MIDE) program and the Observatory of Diabetes and Chronic Diseases (ODEC). We are extremely grateful to the Mexican Teachers’ Cohort participants, as, without their participation, this study would not have been possible.

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GEL and DS designed the work, GEL performed the analysis with supervision of DS, GEL and DS drafted the manuscript, and CB, CG, MC, ACV, RLR and ML revised the manuscript.

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Correspondence to Dalia Stern.

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López, G.E., Batis, C., González, C. et al. EAT-Lancet Healthy Reference Diet score and diabetes incidence in a cohort of Mexican women. Eur J Clin Nutr (2022).

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