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Background This study examined the association between adherence to the Planetary Health Diet and the risk of gastrointestinal (GI) cancers in a nationally representative sample of U.S. adults.Methods Data on adults aged ≥20 years were obtained from the National Health and Nutrition Examination Survey cycles 2005–2006 through 2017–2020 (pre-pandemic). GI cancer survivors were identified based on self-reported diagnoses of stomach, liver, oesophageal, pancreatic, or colorectal cancer. Dietary intake data were linked to the Food Patterns Equivalents Database, and Planetary Health Diet scores were calculated according to the EAT–Lancet Commission reference diet. Survey-weighted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic spline (RCS) models assessed potential dose–response relationships.Results A total of 34,893 participants were included, among whom 351 reported a diagnosis of GI cancer. When modelled as a continuous variable, higher Planetary Health Diet scores were significantly associated with lower odds of GI cancer (OR = 0.98; 95% CI: 0.97–0.99). Compared with participants in the highest tertile of Planetary Health Diet score (Tertile 3), those in the lowest tertile (Tertile 1) had 86% higher odds of GI cancer (OR = 1.86; 95% CI: 1.23–2.82). Conversely, using Tertile 1 as the reference group, participants in Tertile 3 had 46% lower odds of GI cancer (OR = 0.54; 95% CI: 0.35–0.81). RCS analyses showed a significant linear inverse association between Planetary Health Diet score and GI cancer risk, with no evidence of nonlinearity (P for nonlinearity = 0.89; P for overall association < 0.01, IDDF2026-ABS-0064 Figure 1. Restricted cubic spline analysis of the association between Planetary Health Diet score and gastrointestinal cancer risk).Conclusions Greater adherence to the Planetary Health Diet was associated with a lower likelihood of GI cancers in U.S. adults, supporting the potential role of sustainable dietary patterns in cancer prevention.Abstract IDDF2026-ABS-0064 Figure 1