• Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
• Department of Anesthesia and Operation Room, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
• Urinary Nephropathy Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
• Department of Clinical Nutrition, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
• Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: dr_shijiang@163.com.
• Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: ght302211@hospital.cqmu.edu.cn.

OBJECTIVES: The EAT-Lancet diet (ELD) has shown potential in reducing obesity and type 2 diabetes, both of which are closely associated with the development of renal cancer. However, the specific relationship between this dietary pattern and renal cancer remains largely unexplored. This study aims to address this gap in knowledge by investigating the association between ELD adherence and renal cancer risk.

STUDY DESIGN: A population-based prospective study of 101,755 American adults from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.

METHODS: Cox proportional hazards models were utilized to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between ELD adherence and renal cancer risk, adjusting for potential confounders. Restricted cubic spline plots visualized the dose-response relationship. Subgroup analyses evaluated potential effect modifiers, and sensitivity analyses assessed the robustness of findings.

RESULTS: Over 899,337.5 person-years of follow-up, 446 cases of renal cancer were identified. In the fully adjusted model, a significant inverse association was observed between higher ELD adherence and renal cancer risk (HR for highest vs. lowest quartile: 0.65; 95 % CI: 0.49-0.88; P for trend = 0.002). A restricted cubic spline plot revealed a nonlinear, inverse dose-response relationship (P for nonlinearity = 0.046). Subgroup analyses showed consistent findings across participant characteristics. Sensitivity analyses further reinforced the robustness of the primary association.

CONCLUSIONS: In this large prospective study, adherence to the EAT-Lancet diet was inversely associated with the risk of developing renal cancer, suggesting the potential benefits of this dietary pattern in mitigating renal cancer burden.