Association between adherence to EAT-Lancet diet and risk of gastric cancer in the StoP project

Abstract Background In 2019, the EAT-Lancet Commission proposed a diet promoting plant-based foods, while reducing red meat and added sugars, aiming to improve health outcomes for both humans and the environment. Within the StoP Project, a global consortium of epidemiologic studies on gastric cancer (GC), we investigated the association between adherence to the EAT-Lancet Diet and the risk of GC. Methods We included four Southern European studies (two from Italy, one from Portugal and Spain) with available Food Frequency Questionnaire data and total energy intake (TEI). Adherence to the EAT-Lancet Diet was evaluated using four different indices: EAT-Lancet Index (EATL), Planetary Health Diet Indexes (PHDI) developed by Cacau and Bui, and World Index for Sustainability and Health (WISH). A two-stage approach was applied: study-specific odds ratios (ORs) for GC per 1-SD increase in score were estimated using multiple logistic regression models adjusted for confounders (age, sex, BMI, socioeconomic status, smoking, alcohol and TEI), and pooled using random-effects meta-analysis. Heterogeneity assessed with I². Results Among 6031 individuals (2271 cases, 3760 controls), 63.4% of cases and 54.2% of controls were male, with a mean age of 65.0 ± 11.1 and 60.2 ± 12.3 years, and BMI of 25.3 ± 4.1 of 26.3 ± 4.3 kg/m², respectively. Low socioeconomic status was 78.9% and 57.4%, never smokers 43.7% and 47.2%, and intermediate alcohol consumers 54.4% and 44.7%, respectively. Higher adherence to EAT-Lancet Diet was associated with lower GC risk across all indices: EATL (OR = 0.92; 95% CI: 0.85-0.99; I² = 0.0%), PHDI by Cacau (OR = 0.87; 95% CI: 0.81-0.94; I² = 0.0%), PHDI by Bui (OR = 0.81; 95% CI: 0.72-0.91; I² = 40.6%), and WISH (OR = 0.86; 95% CI: 0.79-0.93; I² = 0.0%). Conclusions Adherence to plant-based, sustainable dietary patterns may protect from GC. These results highlight the potential role of dietary changes in cancer prevention, particularly in reducing the burden of GC. Key messages • Sustainable dietary patterns are associated with a lower risk of gastric cancer in Southern Europe. • Diets rich in plant-based foods and low in red meat and added sugars may reduce the risk of gastric cancer.