Prospective Study of Plant-Based Dietary Patterns and Diabetes in Puerto Rican Adults

Abstract

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.

Association between adherence to plant-based dietary patterns and obesity risk: a systematic review of prospective cohort studies

“…Chen et al, 2018;Laouali et al, 2021;A. Satija et al, 2016) Similar to type 2 diabetes, (Flores et al, 2021;Laouali et al, 2021;A. Satija et al, 2016) we found the association between the uPDI with obesity to be less apparent than has been demonstrated with cardiovascular disease.…”

Higher Adherence to Plant-Based Diet Lowers Type 2 Diabetes Risk among High and Non-High Cardiovascular Risk Populations: A Cross-Sectional Study in Shanxi, China

“…In addition, higher PDI values were associated with lower T2D risk in Chinese individuals in the SCHS, Henan Rural Cohort Study, and CHNS [ 14 , 18 , 24 ]. However, unlike our results, the Korean Genome and Epidemiology Study (KoGES) and Puerto Rico Cohort study demonstrated that PDI was not associated with T2D incidence [ 17 , 19 ]. These differences may be due to dietary habits, adjusted covariates, study inclusion criteria, and nondietary lifestyle risk factors.…”

“…However, there are some gaps in previous studies on the relationship between a plant-based diet and T2D risk. First, studies on the correlation between PDI and T2D have presented inconclusive results, which are negative [ 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ] or absent [ 19 , 20 , 21 ]. Second, the majority of research participants were from Western populations, whose dietary patterns and metabolic responses are different from those of Asian populations [ 22 ].…”

Plant-based dietary patterns and lung cancer mortality: a perspective cohort study

“…3 Three plantbased diet indices (an overall plant-based diet index (PDI), a healthy PDI (hPDI), and a less-healthy (unhealthy) PDI (uPDI)) were created by Satija et al, 4 and they captured synergistic and graded intake of healthy (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea/coffee) and less healthy plantbased foods (fruit juices, refined grains, potatoes, sugar-sweetened beverages (SSBs), and sweets/desserts), as well as animal foods (dairy, animal fat, eggs, meat, fish or seafood, and miscellaneous animal-based foods). Many previous studies have examined the association between plant-based diet indices and chronic diseases such as cardiovascular diseases, 5,6 diabetes 4,7 and certain types of cancers [8][9][10] including lung cancer. 10 However, the results were inconsistent, and some studies demonstrated that high-quality plant based-diets were associated with a substantially lower risk of developing cardiovascular diseases, 5 diabetes, 4,7 breast cancer, 8,9 and digestive cancer, 10 while others showed no associations with cardiovascular diseases 6 and breast cancer.…”

“…Many previous studies have examined the association between plant-based diet indices and chronic diseases such as cardiovascular diseases, 5,6 diabetes 4,7 and certain types of cancers [8][9][10] including lung cancer. 10 However, the results were inconsistent, and some studies demonstrated that high-quality plant based-diets were associated with a substantially lower risk of developing cardiovascular diseases, 5 diabetes, 4,7 breast cancer, 8,9 and digestive cancer, 10 while others showed no associations with cardiovascular diseases 6 and breast cancer. 10 For lung cancer, only one study reported a pro plant-based dietary score, consisting of healthy plant foods and animal foods, which was associated with decreased risks of lung cancer (HR t3 vs. t1, 0.47; 95% CI, 0.25-0.90; the P-value for trend, 0.02).…”