Background Vegetarian-type dietary patterns have been associated with reducing the risk of developing diabetes and may function as an effective strategy for diabetes management. Objectives We aimed to examine the associations between adherence to plant-based diet indices and the risk of developing diabetes in the Boston Puerto Rican Health Study. Methods Puerto Rican adults (n = 646), aged 45–75 y and free of diabetes at baseline, were included. Dietary intake was assessed via a validated FFQ. Three plant-based dietary indices were calculated: an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Incident diabetes was defined as fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L), glycated hemoglobin ≥ 6.5% (48 mmol/mol), or use of hypoglycemic agents during follow-up. Cox proportional hazards were used to evaluate associations between the dietary patterns and incidence of diabetes, adjusting for potential confounders, such as age, sex, socioeconomic status, lifestyle factors, obesity, total energy intake, depressive symptomatology, and plasma concentrations of lipids. Results During a mean of 4.2 y of follow-up, we identified 134 diabetes cases. After adjustment for covariates, higher hPDI was associated with lower risk of developing diabetes (adjusted HR for the highest compared with the lowest tertile: 0.54; 95% CI: 0.31, 0.94; P-trend = 0.03). In contrast, the PDI and uPDI were not significantly associated with the risk of diabetes (P-trend > 0.3 for both). Conclusions The healthful plant-based dietary index, but not the total plant-based dietary index, was inversely associated with diabetes risk. These findings suggest that the quality of plant-based diets must be considered when recommending plant-based diets for the prevention of diabetes. This trial was registered at clinicaltrials.gov as NCT01231958.
Background Achieving and maintaining cardiovascular health of individuals has a significant impact on reducing cardiovascular disease (CVD) and mortality at the population level. Methods We performed a cross-sectional community survey of 2,612 adult respondents in the Republic of Moldova. The American Heart Association cardiovascular health metrics score was used in total and by its two components: (1) health factors (blood pressure, total cholesterol, glucose, body mass index); (2) health behaviors (nonsmoking, physical activity, healthy diet score). The prevalence of CVD was identified as the main outcome measure. Results The prevalence of CVD was lower in study participants having all 7 cardiovascular health metrics (14.7%; 95% CI, 2.8% to 26.6%) compared to those with 0 to 1 cardiovascular health metrics (78.2%; 95% CI, 67.3% to 89.1%). Among participants who met all health factor metrics, the prevalence of CVD was lower (15.1%; 95% CI, 5.5% to 24.7%) compared to those with 0 to 1 health factor metrics (72.5 %; 95% CI, 69.9% to 75.0%). Study respondents who engaged in all health behaviors and those who engaged in 0 to 1 health behaviors had a similarly high prevalence of CVD (60.1%; 95% CI, 57.4% to 62.8% and 60.4%; 95% CI, 55.3% to 65.4%, respectively). Conclusions Lower prevalence of CVD was related to a greater total score of cardiovascular health metrics and with health factor components. While those diagnosed CVD appear willing to improve their behaviors, the population at risk is not likely to engage in health behaviors to prevent the onset of CVD. Key messages Increasing individual’s responsibility in addressing their own health implies improvement of community health. Strategies for health promotion should focus more on an individual’s motivation to assume personal responsibility for behaviors affecting their health.
Objectives To examine the associations between the plant-based diet and risk of developing diabetes in participants of the Boston Puerto Rican Health Study. Methods Included were 691 Puerto Ricans aged 45–75 years who were free of diabetes at baseline. Dietary intake was assessed via a validated food frequency questionnaire. Three plant-based dietary indices were then calculated, including an overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Incident diabetes was defined as fasting plasma glucose 126 mg/dL [7.0 mmol/L], hemoglobin A1c 6.5% [48 mmol/mol] or use of any hypoglycemic agents during follow-up. Cox proportional hazards models were used to evaluate the associations between the plant-based dietary patterns and the incidence of diabetes, adjusting for potential confounders, such as age, sex, socioeconomic status, lifestyle factors, obesity, total energy intake, depression, and plasma concentrations of c-reactive protein and lipid profiles. Results During the 5-years of follow-up, we identified 139 incident diabetes cases. After adjustment for covariates, hPDI was inversely associated with the risk for developing diabetes (P-trend = 0.04). The adjusted hazard ratio (HR) for the highest vs lowest tertiles of hPDI was 0.56 (95% confidence interval: 0.32–0.96). In contrast, The PDI and uPDI dietary indices were not significantly associated with the risk of diabetes (P-trend > 0.2 for both). Conclusions The healthful plant-based dietary index was associated with a lower risk of diabetes. These findings suggest that the healthful plant-based dietary index may be beneficial for the prevention of the development of diabetes. Funding Sources This project was supported by the National Institute on Aging, the National Heart, Lung, and Blood Institue, and the National Center for Advancing Translational Sciences.
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