Association between EAT-Lancet diet and all-cause and cardiovascular mortality risk among individuals with cardiovascular-kidney-metabolic syndrome stages 0–3: mediating role of inflammatory indicators

Although the EAT-Lancet diet is widely acknowledged for its co-benefits to human health and environmental sustainability, its potential to reduce the mortality risk associated with cardiovascular-kidney-metabolic (CKM) syndrome stages 0–3 has yet to be determined. This study aimed to investigate the association between adherence to the EAT‑Lancet diet and the risk of all‑cause and cardiovascular mortality in this population. Data were sourced from 9,979 participants in the National Health and Nutrition Examination Survey. The EAT‑Lancet diet score was derived from 24‑hour dietary recall data, and participants were categorized by score quartiles. Weighted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Mediation analyses were further performed to explore the role of inflammatory markers in the observed associations. During a median follow‑up of 7.83 years, 919 all‑cause deaths occurred, including 263 attributed to cardiovascular disease (CVD). After multivariable adjustment, using the lowest quartile as the reference, the HR (95% CI) for all‑cause mortality across Q2, Q3, and Q4 were 0.99 (0.80–1.23), 0.67 (0.54–0.84), and 0.75 (0.58–0.96), respectively. For CVD mortality, the association was less robust, and the corresponding estimates were 1.14 (0.83–1.58), 0.70 (0.47–1.06), and 0.66 (0.44–0.85), respectively. Restricted cubic spline analysis revealed an inverse relationship between increasing diet scores and both mortality endpoints. Notably, the systemic immune‑inflammation index showed the strongest mediation of the association with all‑cause mortality, while the neutrophil‑to‑lymphocyte ratio was the predominant mediator for CVD mortality. Greater adherence to the EAT‑Lancet diet was associated with reduced risks of all‑cause and CVD mortality in individuals with CKM syndrome stages 0–3, with inflammatory markers partially mediating these associations. Not applicable.