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A healthful plant-based diet is associated with lower type 2 diabetes risk via improved metabolic state and organ function: A prospective cohort study - 28/11/23

Doi : 10.1016/j.diabet.2023.101499 
Alysha S. Thompson 1, #, Catharina J. Candussi 2, 3, #, Anna Tresserra-Rimbau 1, 4, 5, Amy Jennings 1, Nicola P. Bondonno 1, 6, 7, Claire Hill 8, Solomon A. Sowah 9, Aedín Cassidy 1, , Tilman Kühn 1, 2, 3,
1 The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, UK 
2 Department of Nutritional Sciences, University of Vienna, Vienna, Austria 
3 Center for Public Health, Medical University of Vienna, Vienna, Austria 
4 Department of Nutrition, Food Science and Gastronomy, XIA, School of Pharmacy and Food Sciences, INSA, University of Barcelona, 08921 Barcelona, Spain 
5 Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain 
6 Danish Cancer Institute, Copenhagen, Denmark 
7 Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia 
8 Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom 
9 Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK 

Corresponding authors: Aedín Cassidy and Prof Dr Tilman Kuhn, Queen's University Belfast, Institute for Global Food Security (IGFS) / School of Biological Sciences, 19 Chlorine Gardens, Belfast BT9 5DL, UK. Tel.: +44 28 9097 1387Queen's University Belfast, Institute for Global Food Security (IGFS) / School of Biological Sciences19 Chlorine GardensBelfastBT9 5DLUK
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Highlights

A healthful plant-based diet is associated with lower type 2 diabetes risk, not only because of beneficial effects on weight control, but also due to improved liver and kidney function, lower basal inflammation, and lower IGF-1
By contrast, an unhealthful plant-based diet also low in animal products but high in processed and sugary foods is associated with a higher risk of type 2 diabetes, with greater BMI and higher triglyceride levels mediating this association
A shift towards more environmentally friendly plant-based diets can have co-benefits in diabetes prevention beyond lower BMI among people following healthful plant-based diets

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ABSTRACT

Background

Plant-based diets are becoming increasingly popular due to favourable environmental footprints and have been associated with lower risk of type 2 diabetes (T2DM). Here, we investigated the potential mechanisms to explain the lower T2DM risk observed among individuals following plant-based diets.

Methods

Prospective data from the UK Biobank, a cohort study of participants aged 40 to 69 years at baseline, was evaluated. Associations between healthful and unhealthful plant-based indices (hPDI and uPDI) and T2DM risk were analysed by multivariable Cox regression models, followed by causal mediation analyses to investigate which cardiometabolic risk factors explained the observed associations.

Results

Of 113,097 study participants 2,628 developed T2DM over 12 years of follow-up. Participants with the highest hPDI scores (Quartile 4) had a 24% lower T2DM risk compared to those with the lowest scores (Quartile 1) [Hazard Ratio (HR): 0.76, 95% Confidence Interval (CI): 0.68-0.85]. This association was mediated by a lower BMI (proportion mediated: 28%), lower waist circumference (28%), and lower concentrations of HBA1c (11%), triglycerides (9%), alanine aminotransferase (5%), gamma glutamyl transferase (4%), C-reactive protein (4%), insulin-like growth factor 1 (4%), cystatin C (4%) and urate (4%). Higher uPDI scores were associated with a 37% higher T2DM risk [HR: 1.37, 95% CI:1.22- 1.53], with higher waist circumference (proportion mediated: 17%), BMI (7%), and higher concentrations of triglycerides (13%) potentially playing mediating roles.

Conclusion

Healthful plant-based diets may protect against T2DM via lower body fatness, but also via normoglycaemia, lower basal inflammation as well as improved kidney and liver function.

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Keywords : Diabetes mellitus Type 2, Dietary pattern, Mediation analysis, Plant-based diet index, Prospective cohort study

Abbreviations : ALT, AST, BMI, CRP, GGT, hPDI, IGF-1, LDL, Lip A, NAFLD, PDI, SD, T2DM, uPDI, UK


Plan


 Funding Source: Alysha S. Thompson holds a PhD studentship of the Department for the Economy (DfE), Northern Ireland.


© 2023  Publié par Elsevier Masson SAS.
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