The EAT-Lancet Commission proposed a dietary framework aimed at reducing the ecological footprint of diets worldwide, but research on adherence to this diet in Latin America is limited. This study aimed to describe the adherence of urban diets in 8 Latin American countries to the EAT-Lancet diet and its association with micronutrient intake inadequacy. This cross-sectional study analyzed baseline data from the Latin American Study of Nutrition and Health, involving 6835 participants from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela. Data collection included two 24-hour recalls, alongside socio-demographic variables. Usual dietary intake was estimated via the Multiple Source Method and micronutrient inadequacy was evaluated with the Nutrient Adequacy Ratio. The Planetary Health Diet Index (PHDI; ranged between 0 and 150) assessed adherence to the EAT-Lancet diet. Adherence was low (29.7%) across the region, with an average PHDI score of 44.6 ± 9.2 points. Costa Rica had the highest adherence (32.9%), while Argentina had the lowest (25.8%). Older participants, those with overweight/obesity, and with higher socioeconomic status, education, and physical activity had higher adherence. Higher adherence was associated with increased inadequacy risks for cobalamin, vitamin D, and calcium, but decreased risks for pyridoxine, folate, vitamin C, magnesium, and zinc. The study suggests that low adherence may stem from a disconnect between culturally ingrained dietary habits and the EAT-Lancet recommendations, which are primarily informed by nutritional epidemiology and environmental considerations. Recognizing and honoring diverse food cultures is crucial for promoting dietary practices that support human health and environmental sustainability.