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. 2021 Mar;44(3):663-671.
doi: 10.2337/dc20-1636. Epub 2021 Jan 13.

Changes in Plant-Based Diet Indices and Subsequent Risk of Type 2 Diabetes in Women and Men: Three U.S. Prospective Cohorts

Zhangling Chen  1   2 , Jean-Philippe Drouin-Chartier  3   4 , Yanping Li  3 , Megu Y Baden  3 , JoAnn E Manson  5   6   7 , Walter C Willett  3   5   7 , Trudy Voortman  2 , Frank B Hu  1   5   7 , Shilpa N Bhupathiraju  1   7
Affiliations

Changes in Plant-Based Diet Indices and Subsequent Risk of Type 2 Diabetes in Women and Men: Three U.S. Prospective Cohorts

Zhangling Chen et al. Diabetes Care. 2021 Mar.

Abstract

Objective: We evaluated the associations between changes in plant-based diets and subsequent risk of type 2 diabetes.

Research design and methods: We prospectively followed 76,530 women in the Nurses' Health Study (NHS) (1986-2012), 81,569 women in NHS II (1991-2017), and 34,468 men in the Health Professionals Follow-up Study (1986-2016). Adherence to plant-based diets was assessed every 4 years with the overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). We used multivariable Cox proportional hazards models to estimate hazard ratios (HRs). We pooled results of the three cohorts using meta-analysis.

Results: We documented 12,627 cases of type 2 diabetes during 2,955,350 person-years of follow-up. After adjustment for initial BMI and initial and 4-year changes in alcohol intake, smoking, physical activity, and other factors, compared with participants whose indices remained relatively stable (±3%), participants with the largest decrease (>10%) in PDI and hPDI over 4 years had a 12-23% higher diabetes risk in the subsequent 4 years (pooled HR, PDI 1.12 [95% CI 1.05, 1.20], hPDI 1.23 [1.16, 1.31]). Each 10% increment in PDI and hPDI over 4 years was associated with a 7-9% lower risk (PDI 0.93 [0.91, 0.95], hPDI 0.91 [0.87, 0.95]). Changes in uPDI were not associated with diabetes risk. Weight changes accounted for 6.0-35.6% of the associations between changes in PDI and hPDI and diabetes risk.

Conclusions: Improving adherence to overall and healthful plant-based diets was associated with a lower risk of type 2 diabetes, whereas decreased adherence to such diets was associated with a higher risk.

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Figures

Figure 1
Figure 1
Subgroup analyses between changes in plant-based diets and subsequent type 2 diabetes risk per 10% score increase in each index score. Values are reported as HR (95% CI). Results were adjusted for age, adjusted for initial corresponding plant-based diet score (overall, healthful, or unhealthful, quintiles), stratified by calendar year in 4-year intervals, and adjusted for ethnicity (White, non-White), family history of diabetes (yes/no), initial and change in total energy (kcal/day, quintiles), initial and change in alcohol intake (g/day, quintiles), initial and change in margarine intake (serving/day, quintiles), initial and change in physical activity (MET h/week [w], quintiles), change in smoking status (never to never, never to current, past to past, past to current, current to past, current to current, or missing indicator), initial BMI (<21.0, 21.0–24.9, 25.0–29.9, 30.0–31.9, ≥32.0 kg/m2), medical history of hypertension (yes/no, updated every 4 years), medical history of hypercholesterolemia (yes/no, updated every 4 years), menopausal status and postmenopausal hormone use (premenopausal, postmenopausal + current use, postmenopausal + past use, postmenopausal + never use, missing indicator) (NHS and NHS II), and oral contraceptive use (never, current, past, missing indicator) (NHS II) (based on model 2 as defined in Table 2). P values for interaction were calculated with use of the likelihood ratio test. Given the potential for multiple testing, the statistical level for significance was set at 0.005 (0.05/10 comparisons).
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