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

Alysha S. Thompson, Catharina J. Candussi, Anna Tresserra-Rimbau, Amy Jennings, Nicola P. Bondonno, Claire Hill, Solomon A. Sowah, Aedín Cassidy*, Tilman Kühn*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
9 Downloads (Pure)

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.

Original languageEnglish
Article number101499
JournalDiabetes and Metabolism
Volume50
Issue number1
Early online date07 Dec 2023
DOIs
Publication statusPublished - Jan 2024

Keywords

  • diabetes mellitus type 2
  • dietary pattern
  • mediation analysis
  • plant-based diet index
  • prospective cohort study

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