Editor’s Note
With the global rise in obesity, diabetes, and metabolic syndrome, the prevalence of metabolic-associated fatty liver disease (MASLD) is also increasing. Statistics show that MASLD has become one of the most common chronic liver diseases worldwide. The incidence of MASLD varies across different regions, possibly due to differences in dietary habits, lifestyles, and genetic factors. Studies have found that the widespread consumption of high-carbohydrate, high-fat, and high-sugar diets correlates with a relatively high incidence of MASLD. Improving dietary habits is therefore considered one of the primary preventive measures against MASLD.
Currently, several healthy dietary patterns are highly recommended, including the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet. These diets emphasize plant-based foods rich in vegetables, fruits, whole grains, and healthy fats, along with moderate intake of high-quality proteins. They also advocate limiting processed foods, red meat, saturated fats, and added sugars, aiming to promote overall health and reduce the risk of chronic diseases.
In 2019, the EAT-Lancet Commission on Food, Planet, and Health proposed a global sustainable healthy diet known as the EAT-Lancet reference diet. This predominantly plant-based diet recommends primary intake of vegetables, fruits, legumes, whole grains, nuts, and plant oils, with limited or moderate consumption of animal-derived foods (such as red meat, poultry, dairy products, and eggs), added sugars, and saturated fats. Compared to strictly plant-based diets that completely exclude animal products like dairy and fish, the EAT-Lancet diet is more attainable for many people as it allows for moderate inclusion of animal foods and sugars while still emphasizing healthy plant-based choices.
Moreover, modeling studies have shown that adhering to the EAT-Lancet diet not only reduces the risk of diet-related chronic diseases and mortality but also enhances the sustainability of food systems by lowering greenhouse gas emissions and freshwater usage compared to dietary patterns like the Mediterranean and DASH diets. However, the specific impact of this dietary pattern on metabolic diseases such as MASLD has not been comprehensively evaluated, necessitating further exploration into the relationship between the EAT-Lancet diet, MASLD risk, and disease severity.
Recently, a multi-cohort study led by the School of Public Health , Xi’an Jiaotong University Health Science Center revealed a significant inverse association between adherence to the EAT-Lancet reference diet and both the risk and severity of MASLD, underscoring the health-promoting effects of the EAT-Lancet dietary pattern.
Study Overview
This prospective study incorporated data from multiple cohorts, including the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) cohort, the Guangzhou Nutrition and Health Study (GNHS) cohort, the UK Biobank, and the Prospective Epidemic Research Specifically Of NASH (PERSONS) study cohort, which consisted of adult participants with biopsy-confirmed MASLD. Researchers developed an EAT-Lancet Diet Index to reflect adherence to the EAT-Lancet reference diet.
During 53,575 person-years of follow-up in the TCLSIH cohort, 3,010 cases of MASLD were documented. In the GNHS cohort, 624 MASLD cases were recorded over 6,454 person-years of follow-up. The UK Biobank cohort reported 1,350 MASLD cases over 1,745,432 person-years of follow-up.
Key Findings
The study found that participants in the highest tertile of the EAT-Lancet Diet Index had a significantly lower risk of developing MASLD compared to those in the lowest tertile. This conclusion was consistently validated across multiple cohorts, enhancing the reliability of the results:
- TCLSIH Cohort: Hazard Ratio (HR) = 0.87; 95% Confidence Interval (CI): 0.78–0.96
- GNHS Cohort: HR = 0.79; 95% CI: 0.64–0.98
- UK Biobank Cohort: HR = 0.73; 95% CI: 0.63–0.85
Additionally, among biopsy-confirmed MASLD patients, an increase in the EAT-Lancet Diet Index was associated with a significant reduction in liver-controlled attenuation parameter (CAP) values (β = −5.895; 95% CI: −10.014 to −1.775), indicating an alleviation in disease severity. This finding provides robust support for the potential application of the EAT-Lancet dietary pattern in the treatment and management of MASLD.
Expert Commentary
Dr. Shunming Zhang, the first author of the study from the School of Public Health, Xi’an Jiaotong University Health Science Center, stated: “Our research provides strong evidence for the effectiveness of the EAT-Lancet dietary pattern in preventing metabolic-associated fatty liver disease. This discovery further emphasizes the critical role of healthy eating in maintaining human health. We look forward to future studies that will continue to explore the role of the EAT-Lancet diet in preventing other chronic diseases.”
Further Reading
Multiple Benefits of the EAT-Lancet Dietary Pattern
The EAT-Lancet dietary pattern emphasizes the sustainability of food systems. It is estimated that food production accounts for 25%–30% of global greenhouse gas emissions. By reducing the intake of red meat, added sugars, and saturated fats, and encouraging increased consumption of plant-based foods, the EAT-Lancet diet contributes to lower greenhouse gas emissions and reduced freshwater usage, thereby positively impacting the environment.
Moreover, numerous studies have confirmed the broad benefits of the EAT-Lancet dietary pattern. This diet not only helps reduce the risk of cancer, all-cause mortality, and diabetes but also has a positive effect on mental health. One study found that adherence to the EAT-Lancet diet was associated with a reduced risk of depression and anxiety, further demonstrating its role in promoting overall well-being.
As global attention to sustainable diets and healthy lifestyles continues to grow, the EAT-Lancet dietary pattern is poised for more widespread adoption and application, simultaneously advancing human health and environmental sustainability.
