Plant-based diets have been consistently associated with a lower risk of several individual cardiometabolic diseases (CMDs). However, whether such dietary patterns differentially influence the progression from health to first-occurrence cardiometabolic disease (FCMD), cardiometabolic multimorbidity (CMM), and ultimately mortality remains unclear.

The present study analyzed data from 83,610 participants in the UK Biobank cohort who were not diagnosed with diabetes, ischaemic heart disease (IHD), or stroke at baseline. Multi-state models were employed to examine the impact of plant-based diets on trajectories of cardiometabolic multimorbidity.

During a median follow-up period of 15.61 years, the median age of the participants at baseline was 57 years (IQR: 50 years-62 years), 42.72% were male. 9298 participants developed at least one CMD, 1,045 participants progressed to CMM, and 4169 participants ultimately died. The finding of the multi-state model suggest that, compared with Q1, both the overall plant-based diet index (PDI)[HR (95%CI): 0.88 (0.83, 0.94) for baseline to FCMD, 0.85 (0.83, 0.94) for baseline to CMM] and the healthy plant-based diet index (hPDI) [HR (95%CI): 0.60 (0.41, 0.89) for baseline to FCMD, 0.79 (0.53, 1.17) for baseline to CMM] were negatively associated with the risk of transitioning from health to FCMD and CMM. When grouping FCMD into disease-specific analyses, it was found that the three plant-based indices also exerted differential effects on the transition from health to diabetes.

In the progression of CMM, high adherence of PDI and hPDI has been demonstrated to reduce the risk of transitioning from CMD-free to FCMD, particularly in diabetes, and lowers the risk of CMM with a much lower incidence risk from CMD-free to CMM compared to CMD-free to FCMD. The present study hypothesizes that both hPDI and unhealthy plant-based index (uPDI) are associated with the risk from baseline to death.