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Epidemiology and Population Health

Association between adherence to EAT-Lancet diet and risk of sarcopenia and sarcopenic obesity in adults

International Journal of Obesity volume 50, pages 229–237 (2026)Cite this article

Subjects

Abstract

Objective

This study aims to investigate the association between adherence to the EAT-Lancet diet and the prevalence of sarcopenia as well as sarcopenic obesity in adults.

Methods

This study included 9672 participants from the National Health and Nutrition Examination Survey. We developed an EAT-Lancet score based on 24-hour dietary recall data and grouped the participants according to the quartiles of this score. Weighted multivariate logistic regression models and restricted cubic splines were employed to assess the association between the EAT-Lancet diet and sarcopenia and sarcopenic obesity. Additionally, mediation analysis was conducted to evaluate the mediating role of inflammatory biomarkers in this relationship.

Results

Among the 9672 participants, 910 (9.41%) were identified with sarcopenia, and 607 (6.28%) were identified with sarcopenic obesity. After adjusting for potential confounders, the odds ratios (OR) and 95% confidence intervals (CI) for sarcopenia and sarcopenic obesity in the highest quartile groups were 0.72 (0.54–0.95) and 0.58 (0.42–0.82), respectively, compared to those in the lowest quartile group. A 10-point increase in the EAT-Lancet diet score was significantly associated with a reduced risk of sarcopenia and sarcopenic obesity, with OR (95% CI) of 0.90 (0.84–0.98) and 0.86 (0.79–0.93), respectively. Furthermore, white blood cell count demonstrated the strongest mediating effect on this association, followed by C-reactive protein, systemic inflammation response index and systemic inflammatory index.

Conclusion

Our study indicated that adherence to the EAT-Lancet diet was associated with a lower risk of sarcopenia and sarcopenic obesity, with this association partially mediated by inflammatory biomarkers.

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Fig. 1
Fig. 2: Restricted cubic spline analysis of association between EAT-Lancet diet score and sarcopenia and sarcopenic obesity.
Fig. 3: Subgroup analysis for association between EAT-Lancet diet and sarcopenia.
Fig. 4: Mediating effect and proportions of inflammatory biomarkers between EAT-Lancet diet and sarcopenia.

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Data availability

The data supporting the findings of this study are openly available in: https://www.cdc.gov/nchs/nhanes/. The analysis code is publicly accessible on GitHub, and the specific link can be obtained from the corresponding author upon reasonable request.

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Acknowledgements

We sincerely thank all the NHANES participants and staff for their valuable efforts.

Funding

ZHL was funded by the National Natural Science Foundation of China (No. 82200442), and Science and Technology Program of Guangzhou (No. 2025A04J3768).

Author information

Author notes

  1. These authors contributed equally: Liheng Chen, Yushan Liao, Zehua Li.

Authors and Affiliations

  1. Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China

    Liheng Chen, Jing Yan & Jingbin Guo

  2. Department of Cardiology, People’s Hospital of NanHai Economic Development Zone, Foshan, China

    Yushan Liao

  3. Department of Endoscopy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, China

    Zehua Li

  4. Department of Ultrasonic Diagnosis, Zhujiang Hospital, Southern Medical University, Guangzhou, China

    Peng Liu

  5. Department of Cardiac Intensive Care Unit, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China

    Yu Sun & Wen Jin

  6. Institute for Healthcare Artificial Intelligence Application, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China

    Weibin Cheng

  7. Faculty of Health Sciences, City University of Macau, Macao SAR, China

    Weibin Cheng

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Contributions

LHC, WBC and JBG were integral to the conception and design of this study. LHC, YSL, ZHL, JY and PL were involved in the acquisition, analysis, and interpretation of the data. LHC, YSL, ZHL, YS and WJ contributed to checking data, making charts and drafting the manuscript. All authors participated in reviewing, editing and providing approval for the final version of the manuscript. WBC and JBG assume the role of guarantors for this work, thereby possessing full access to all study data, shouldering responsibility for data integrity and ensuring the precision of data analysis.

Corresponding authors

Correspondence to Weibin Cheng or Jingbin Guo.

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Competing interests

The authors declare no competing interests.

Ethical approval

NHANES was approved by the Ethics Review Committee of the National Center for Health Statistics, and all participants have provided written informed consent upon enrollment.

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Chen, L., Liao, Y., Li, Z. et al. Association between adherence to EAT-Lancet diet and risk of sarcopenia and sarcopenic obesity in adults. Int J Obes 50, 229–237 (2026). https://doi.org/10.1038/s41366-025-01940-0

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