Department of Epidemiology, Erasmus University Medical Center, Office Na-2903, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
Eur J Epidemiol. 2018 Sep;33(9):883-893. doi: 10.1007/s10654-018-0414-8. Epub 2018 Jun 8.
Vegan or vegetarian diets have been suggested to reduce type 2 diabetes (T2D) risk. However, not much is known on whether variation in the degree of having a plant-based versus animal-based diet may be beneficial for prevention of T2D. We aimed to investigate whether level of adherence to a diet high in plant-based foods and low in animal-based foods is associated with insulin resistance, prediabetes, and T2D. Our analysis included 6798 participants (62.7 ± 7.8 years) from the Rotterdam Study (RS), a prospective population-based cohort in the Netherlands. Dietary intake data were collected with food-frequency questionnaires at baseline of three sub-cohorts of RS (RS-I-1: 1989-1993, RS-II-1: 2000-2001, RS-III-1: 2006-2008). We constructed a continuous plant-based dietary index (range 0-92) assessing adherence to a plant-based versus animal-based diet. Insulin resistance at baseline and follow-up was assessed using homeostasis model assessment of insulin resistance (HOMA-IR). Prediabetes and T2D were collected from general practitioners' records, pharmacies' databases, and follow-up examinations in our research center until 2012. We used multivariable linear mixed models to examine association of the index with longitudinal HOMA-IR, and multivariable Cox proportional-hazards regression models to examine associations of the index with risk of prediabetes and T2D. During median 5.7, and 7.3 years of follow-up, we documented 928 prediabetes cases and 642 T2D cases. After adjusting for sociodemographic and lifestyle factors, a higher score on the plant-based dietary index was associated with lower insulin resistance (per 10 units higher score: β = -0.09; 95% CI: - 0.10; - 0.08), lower prediabetes risk (HR = 0.89; 95% CI: 0.81; 0.98), and lower T2D risk [HR = 0.82 (0.73; 0.92)]. After additional adjustment for BMI, associations attenuated and remained statistically significant for longitudinal insulin resistance [β = -0.05 (- 0.06; - 0.04)] and T2D risk [HR = 0.87 (0.79; 0.99)], but no longer for prediabetes risk [HR = 0.93 (0.85; 1.03)]. In conclusion, a more plant-based and less animal-based diet may lower risk of insulin resistance, prediabetes and T2D. These findings strengthen recent dietary recommendations to adopt a more plant-based diet.Clinical Trial Registry number and website NTR6831, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6831 .
素食或 vegetarian 饮食被认为可以降低 2 型糖尿病（T2D）的风险。然而，对于饮食中植物性食物和动物性食物的比例变化是否对 T2D 的预防有益，我们知之甚少。我们旨在研究饮食中植物性食物含量高、动物性食物含量低的程度与胰岛素抵抗、糖尿病前期和 T2D 之间的关系。我们的分析包括来自荷兰鹿特丹研究（RS）的 6798 名参与者（62.7±7.8 岁），这是一个前瞻性的基于人群的队列研究。在 RS 的三个亚队列的基线时（RS-I-1：1989-1993，RS-II-1：2000-2001，RS-III-1：2006-2008），我们使用食物频率问卷收集了饮食摄入数据。我们构建了一个连续的植物性饮食指数（范围 0-92），用于评估饮食中植物性食物与动物性食物的比例。使用稳态模型评估的胰岛素抵抗（HOMA-IR）来评估基线和随访时的胰岛素抵抗。糖尿病前期和 T2D 从全科医生的记录、药店的数据库和我们研究中心的随访检查中收集，直到 2012 年。我们使用多变量线性混合模型来检验指数与纵向 HOMA-IR 的关联，使用多变量 Cox 比例风险回归模型来检验指数与糖尿病前期和 T2D 风险的关联。在中位 5.7 年和 7.3 年的随访期间，我们记录了 928 例糖尿病前期病例和 642 例 T2D 病例。在调整了社会人口统计学和生活方式因素后，植物性饮食指数越高，胰岛素抵抗越低（每增加 10 个单位：β=-0.09；95%CI：-0.10；-0.08），糖尿病前期风险越低（HR=0.89；95%CI：0.81；0.98），T2D 风险越低[HR=0.82（0.73；0.92）]。在进一步调整 BMI 后，相关性减弱，但仍具有统计学意义，与纵向胰岛素抵抗[β=-0.05（-0.06；-0.04）]和 T2D 风险[HR=0.87（0.79；0.99）]相关，但与糖尿病前期风险[HR=0.93（0.85；1.03）]无关。总之，更植物性和更少动物性的饮食可能会降低胰岛素抵抗、糖尿病前期和 T2D 的风险。这些发现加强了最近采用更植物性饮食的饮食建议。临床试验注册号和网站 NTR6831，http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6831。
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