Adherence to the EAT-Lancet diet and risk of chronic kidney disease among middle-aged and older adults: insights from two nationwide cohort studies

BACKGROUND: Adherence to the EAT-Lancet diet has been associated with a lower risk of adverse health outcomes. However, its relationship with chronic kidney disease (CKD) risk remains unclear. We aimed to investigate the association between adherence to the EAT-Lancet diet and CKD risk among middle-aged and older adults. METHODS: This study included 19,991 participants from the US NHANES cohort for cross-sectional analysis and 119,820 participants from the UK Biobank cohort for longitudinal analysis, all aged 40 years or older. Dietary data were collected using 24-hour dietary recall questionnaires, and a modified EAT-Lancet diet index was constructed based on the EAT-Lancet reference diet. Multivariable poisson regression models and Cox proportional hazards regression models were employed to examine the associations between the EAT-Lancet diet index and CKD risk. RESULTS: In the US NHANES cohort, 4,640 (23.21%) participants were diagnosed with CKD. Within the multivariable model, the relative risk for CKD in the highest adherence group of the EAT-Lancet diet index was 0.78 (95% CI: 0.70, 0.87) compared to those in the lowest adherence group. During a mean follow-up of 13.19 years, 3,658 (3.05%) incident cases of CKD were identified in the UK Biobank cohort. After adjusting for covariates, the Q2, Q3, Q4, and Q5 groups exhibited significantly lower risks for incident CKD compared to the Q1 group, with hazard ratios (95% CI) of 0.94 (0.85, 1.03), 0.85 (0.77, 0.94), 0.82 (0.74, 0.91), and 0.71 (0.64, 0.79), respectively. A clear dose-response relationship between EAT-Lancet diet index and CKD risk was observed in two cohorts. CONCLUSIONS: Adherence to the EAT-Lancet diet is associated with a lower prevalence and risk of CKD in middle-aged and older adults, with a dose-response relationship. These findings highlight the importance of adopting the EAT-Lancet diet to lower the risk burden of CKD.