The EAT-Lancet diet in relation nutrient intake among older adults: insights from the Gothenburg H70 birth cohort study

Abstract Background The EAT-Lancet Commission has proposed a global reference diet aimed at promoting both human health and environmental sustainability. While adherence to this dietary pattern has been associated with reduced risks of chronic disease and lower environmental impact, concerns remain about its ability to meet nutritional requirements - particularly among older adults. The aim was to explore the association between adherence to the EAT-Lancet diet and nutrient intake and adequacy among 70-year-old adults in Gothenburg, Sweden. Methods This cross-sectional study included 861 participants from the Swedish population-based Gothenburg H70 Birth Cohort Study (mean age 70.5 years, 55% women). Dietary intake was assessed using a validated diet history interview, and adherence to the EAT-Lancet diet was scored based on 14 food components. Nutrient intake was evaluated against age- and sex-specific recommended intake (RI) levels. Cardiometabolic risk markers and biomarkers of nutritional status, including homocysteine and haemoglobin, were measured. Linear and logistic regression models were used to examine trends across sex-specific tertiles of diet adherence, with sensitivity analyses adjusting for energy intake and comparing adequacy based on average requirement (AR) thresholds. Results Higher adherence to the EAT-Lancet diet was linked to higher intake of fibre and polyunsaturated fats, and lower intake of saturated fat and alcohol. Mean protein intake per kilogram body weight/day was similar across adherence tertiles. Intake of beta-carotene, folate, vitamin C, magnesium, potassium, and iron was higher with greater adherence, while retinol equivalents, vitamin B12, niacin equivalents was lower– patterns that remained consistent after energy adjustment. Despite lower B12 intake, homocysteine levels were lowest in the group with highest adherence, and anaemia prevalence did not differ. Micronutrient adequacy improved with higher adherence for vitamin E, folate, vitamin C, magnesium, potassium, and iron. Similar results were observed using average requirement (AR) thresholds in sensitivity analyses. Conclusions Adherence to the EAT-Lancet diet was associated with a more favourable nutrient profile in this cohort of older adults, without evidence of widespread micronutrient inadequacy. These findings suggest that environmentally sustainable diets can support adequate nutrition when well-balanced, even in nutritionally vulnerable populations such as older adults.