Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort

Florine Berthy; Hafsa Toujgani; Pauline Duquenne; Léopold K. Fezeu; Denis Lairon; Philippe Pointereau; Mathilde Touvier; Serge Hercberg; Pilar Galan; Benjamin Allès; Julia Baudry; Emmanuelle Kesse-Guyot

doi:10.1016/j.ajcnut.2025.06.013

Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort

Florine Berthy, Hafsa Toujgani, Pauline Duquenne, Léopold K. Fezeu, Denis Lairon, Philippe Pointereau, Mathilde Touvier, Serge Hercberg, Pilar Galan, Benjamin Allès, Julia Baudry, Emmanuelle Kesse-Guyot^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

BACKGROUND: Obesity has emerged as a significant public health issue globally. In response to the dual health and environmental challenges posed by dietary patterns, the EAT-Lancet Commission recommended a planetary health diet that promotes well-being.

OBJECTIVES: This study aimed to investigate the association of the EAT-Lancet reference diet with body weight (BW) changes, incidences of overweight [body mass index (BMI) ≥25 kg/m 2], and obesity (BMI ≥30 kg/m 2), in a large French cohort.

METHODS: The study analyzed data from 51,711 adults who participated in the French NutriNet-Santé cohort between 2009 and 2023. Exposure was measured by the level of adherence to the EAT-Lancet reference diet, evaluated through the EAT-Lancet Diet Index (ELD-I), categorized into sex-specific quintiles (Qs), and as a continuous variable. The relationship between ELD-I and changes in BW was examined using multivariable linear mixed models. For the incidences of overweight and obesity, multivariable Cox proportional hazards models were employed.

RESULTS: During follow-up (median = 8.7 y), 4250 and 1604 persons became overweight and obese, respectively. We observed an inverse association between the level of ELD-I and gain in BW (in kg) [β Q5 × time = -0.18; 95% confidence interval (CI): -0.20, -0.16; P < 0.0001]. Higher level of ELD-I was associated with lower risks of reaching overweight [hazard ratio (HR) Q5 compared with Q1: 0.60; 95% CI: 0.54, 0.66; P-trend<0.0001] and obesity status (HR Q5 compared with Q1: 0·54; 95% CI: 0.45, 0.63; p -trend <0.0001) during follow-up.

CONCLUSIONS: This comprehensive prospective observational study revealed that a stronger adherence to the EAT-Lancet reference diet is associated with lower BW and reduced risks of overweight and obesity. Promoting a sustainable plant-based diet seems to be an effective strategy for addressing the global public health challenge of obesity. This trial was registered at clinicaltrials.gov as NCT03335644.

Original language	English
Pages (from-to)	450-459
Number of pages	10
Journal	American Journal of Clinical Nutrition
Volume	122
Issue number	2
Early online date	17 Jun 2025
DOIs	https://doi.org/10.1016/j.ajcnut.2025.06.013
Publication status	Published - Aug 2025
Externally published	Yes

Keywords

epidemiology
guidelines
prevention
sustainable diet
weight management

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10.1016/j.ajcnut.2025.06.013

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Berthy, F., Toujgani, H., Duquenne, P., Fezeu, L. K., Lairon, D., Pointereau, P., Touvier, M., Hercberg, S., Galan, P., Allès, B., Baudry, J., & Kesse-Guyot, E. (2025). Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort. American Journal of Clinical Nutrition, 122(2), 450-459. https://doi.org/10.1016/j.ajcnut.2025.06.013

@article{44e51ecf58ae49b4872213301be7a240,

title = "Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort",

abstract = "BACKGROUND: Obesity has emerged as a significant public health issue globally. In response to the dual health and environmental challenges posed by dietary patterns, the EAT-Lancet Commission recommended a planetary health diet that promotes well-being.OBJECTIVES: This study aimed to investigate the association of the EAT-Lancet reference diet with body weight (BW) changes, incidences of overweight [body mass index (BMI) ≥25 kg/m 2], and obesity (BMI ≥30 kg/m 2), in a large French cohort. METHODS: The study analyzed data from 51,711 adults who participated in the French NutriNet-Sant{\'e} cohort between 2009 and 2023. Exposure was measured by the level of adherence to the EAT-Lancet reference diet, evaluated through the EAT-Lancet Diet Index (ELD-I), categorized into sex-specific quintiles (Qs), and as a continuous variable. The relationship between ELD-I and changes in BW was examined using multivariable linear mixed models. For the incidences of overweight and obesity, multivariable Cox proportional hazards models were employed.RESULTS: During follow-up (median = 8.7 y), 4250 and 1604 persons became overweight and obese, respectively. We observed an inverse association between the level of ELD-I and gain in BW (in kg) [β Q5 × time = -0.18; 95\% confidence interval (CI): -0.20, -0.16; P < 0.0001]. Higher level of ELD-I was associated with lower risks of reaching overweight [hazard ratio (HR) Q5 compared with Q1: 0.60; 95\% CI: 0.54, 0.66; P-trend<0.0001] and obesity status (HR Q5 compared with Q1: 0·54; 95\% CI: 0.45, 0.63; p -trend <0.0001) during follow-up. CONCLUSIONS: This comprehensive prospective observational study revealed that a stronger adherence to the EAT-Lancet reference diet is associated with lower BW and reduced risks of overweight and obesity. Promoting a sustainable plant-based diet seems to be an effective strategy for addressing the global public health challenge of obesity. This trial was registered at clinicaltrials.gov as NCT03335644.",

keywords = "epidemiology, guidelines, prevention, sustainable diet, weight management",

author = "Florine Berthy and Hafsa Toujgani and Pauline Duquenne and Fezeu, \{L{\'e}opold K.\} and Denis Lairon and Philippe Pointereau and Mathilde Touvier and Serge Hercberg and Pilar Galan and Benjamin All{\`e}s and Julia Baudry and Emmanuelle Kesse-Guyot",

year = "2025",

month = aug,

doi = "10.1016/j.ajcnut.2025.06.013",

language = "English",

volume = "122",

pages = "450--459",

journal = "American Journal of Clinical Nutrition",

issn = "0002-9165",

publisher = "Elsevier B.V.",

number = "2",

}

Berthy, F, Toujgani, H, Duquenne, P, Fezeu, LK, Lairon, D, Pointereau, P, Touvier, M, Hercberg, S, Galan, P, Allès, B, Baudry, J & Kesse-Guyot, E 2025, 'Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort', American Journal of Clinical Nutrition, vol. 122, no. 2, pp. 450-459. https://doi.org/10.1016/j.ajcnut.2025.06.013

TY - JOUR

T1 - Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort

AU - Berthy, Florine

AU - Toujgani, Hafsa

AU - Duquenne, Pauline

AU - Fezeu, Léopold K.

AU - Lairon, Denis

AU - Pointereau, Philippe

AU - Touvier, Mathilde

AU - Hercberg, Serge

AU - Galan, Pilar

AU - Allès, Benjamin

AU - Baudry, Julia

AU - Kesse-Guyot, Emmanuelle

PY - 2025/8

Y1 - 2025/8

N2 - BACKGROUND: Obesity has emerged as a significant public health issue globally. In response to the dual health and environmental challenges posed by dietary patterns, the EAT-Lancet Commission recommended a planetary health diet that promotes well-being.OBJECTIVES: This study aimed to investigate the association of the EAT-Lancet reference diet with body weight (BW) changes, incidences of overweight [body mass index (BMI) ≥25 kg/m 2], and obesity (BMI ≥30 kg/m 2), in a large French cohort. METHODS: The study analyzed data from 51,711 adults who participated in the French NutriNet-Santé cohort between 2009 and 2023. Exposure was measured by the level of adherence to the EAT-Lancet reference diet, evaluated through the EAT-Lancet Diet Index (ELD-I), categorized into sex-specific quintiles (Qs), and as a continuous variable. The relationship between ELD-I and changes in BW was examined using multivariable linear mixed models. For the incidences of overweight and obesity, multivariable Cox proportional hazards models were employed.RESULTS: During follow-up (median = 8.7 y), 4250 and 1604 persons became overweight and obese, respectively. We observed an inverse association between the level of ELD-I and gain in BW (in kg) [β Q5 × time = -0.18; 95% confidence interval (CI): -0.20, -0.16; P < 0.0001]. Higher level of ELD-I was associated with lower risks of reaching overweight [hazard ratio (HR) Q5 compared with Q1: 0.60; 95% CI: 0.54, 0.66; P-trend<0.0001] and obesity status (HR Q5 compared with Q1: 0·54; 95% CI: 0.45, 0.63; p -trend <0.0001) during follow-up. CONCLUSIONS: This comprehensive prospective observational study revealed that a stronger adherence to the EAT-Lancet reference diet is associated with lower BW and reduced risks of overweight and obesity. Promoting a sustainable plant-based diet seems to be an effective strategy for addressing the global public health challenge of obesity. This trial was registered at clinicaltrials.gov as NCT03335644.

AB - BACKGROUND: Obesity has emerged as a significant public health issue globally. In response to the dual health and environmental challenges posed by dietary patterns, the EAT-Lancet Commission recommended a planetary health diet that promotes well-being.OBJECTIVES: This study aimed to investigate the association of the EAT-Lancet reference diet with body weight (BW) changes, incidences of overweight [body mass index (BMI) ≥25 kg/m 2], and obesity (BMI ≥30 kg/m 2), in a large French cohort. METHODS: The study analyzed data from 51,711 adults who participated in the French NutriNet-Santé cohort between 2009 and 2023. Exposure was measured by the level of adherence to the EAT-Lancet reference diet, evaluated through the EAT-Lancet Diet Index (ELD-I), categorized into sex-specific quintiles (Qs), and as a continuous variable. The relationship between ELD-I and changes in BW was examined using multivariable linear mixed models. For the incidences of overweight and obesity, multivariable Cox proportional hazards models were employed.RESULTS: During follow-up (median = 8.7 y), 4250 and 1604 persons became overweight and obese, respectively. We observed an inverse association between the level of ELD-I and gain in BW (in kg) [β Q5 × time = -0.18; 95% confidence interval (CI): -0.20, -0.16; P < 0.0001]. Higher level of ELD-I was associated with lower risks of reaching overweight [hazard ratio (HR) Q5 compared with Q1: 0.60; 95% CI: 0.54, 0.66; P-trend<0.0001] and obesity status (HR Q5 compared with Q1: 0·54; 95% CI: 0.45, 0.63; p -trend <0.0001) during follow-up. CONCLUSIONS: This comprehensive prospective observational study revealed that a stronger adherence to the EAT-Lancet reference diet is associated with lower BW and reduced risks of overweight and obesity. Promoting a sustainable plant-based diet seems to be an effective strategy for addressing the global public health challenge of obesity. This trial was registered at clinicaltrials.gov as NCT03335644.

KW - epidemiology

KW - guidelines

KW - prevention

KW - sustainable diet

KW - weight management

UR - https://www.scopus.com/pages/publications/105009884038

U2 - 10.1016/j.ajcnut.2025.06.013

DO - 10.1016/j.ajcnut.2025.06.013

M3 - Article

C2 - 40553762

AN - SCOPUS:105009884038

SN - 0002-9165

VL - 122

SP - 450

EP - 459

JO - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

IS - 2

ER -

Prospective association of the EAT-Lancet reference diet with body weight changes and incidence of overweight and obesity in a French cohort

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