Paris-Saclay University, UVSQ, University Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP, Villejuif, France.
Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, Amherst, MA, USA.
J Nutr. 2021 Sep 4;151(9):2731-2740. doi: 10.1093/jn/nxab158.
Few studies have evaluated the quality of plant-based diets in relation to chronic diseases, and the potential role of BMI is not clearly explored.
To study the associations between plant-based diet indices and type 2 diabetes (T2D) and hypertension risks, as well as the extent to which the associations were modified and/or mediated by BMI.
The study included 74,522 women from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale prospective cohort [mean (SD): age, 52.94 (6.7) years; BMI, 22.970 (3.328) kg/m2]. Dietary data were collected at baseline (1993) via an FFQ. Overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) were developed. Multivariable Cox regression models were used to derive HRs and 95% CIs. Effect modification and mediation by BMI were explored.
There were 3292 (4.64%) incident cases of T2D and 12,504 (27.14%) incident cases of hypertension over ∼20 years of follow-up. In the multivariable model further adjusted for BMI, higher adherence to PDI and hPDI was associated with lower T2D and hypertension risks, with an HR per 1-SD increase (95% CI) of 0.88 (0.85, 0.91) and 0.96 (0.94, 0.98) for PDI and 0.88 (0.85, 0.92) and 0.94 (0.92, 0.95) for hPDI, respectively. uPDI was not associated with T2D [0.98 (0.94, 1.01)], whereas a positive association was observed with hypertension: 1.04 (1.02, 1.06). There was interaction between PDI and uPDI, as well as BMI, on T2D (P-interaction < 0.001) but not on hypertension (P-interaction > 0.05). In addition, BMI mediated 26-59% and 0.2-59% of diet-T2D and diet-hypertension associations, respectively.
Differential associations between plant-based diets and T2D and hypertension risks were observed among women in this large prospective study. Only healthier plant foods were associated with lower risks, partly through decreasing BMI. The protocol was registered at clinicaltrials.gov as NCT03285230.
很少有研究评估植物性饮食与慢性病的关系，而 BMI 的潜在作用也未得到明确探讨。
研究植物性饮食指数与 2 型糖尿病（T2D）和高血压风险之间的关联，以及这些关联在多大程度上受到 BMI 的改变和/或中介作用的影响。
这项研究纳入了来自法国教育妇女前瞻性队列研究（Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale prospective cohort）的 74522 名女性（平均[标准差]年龄为 52.94[6.7]岁，BMI 为 22.970[3.328]kg/m2）。基线（1993 年）时通过 FFQ 收集饮食数据。制定了总体植物性饮食指数（PDI）、健康 PDI（hPDI）和不健康 PDI（uPDI）。使用多变量 Cox 回归模型得出 HR 和 95%CI。探索了 BMI 的效应修饰和中介作用。
在大约 20 年的随访期间，共有 3292 例（4.64%）发生 T2D，12504 例（27.14%）发生高血压。在进一步调整 BMI 的多变量模型中，PDI 和 hPDI 较高与 T2D 和高血压风险降低相关，PDI 每增加 1-SD（95%CI）的 HR 为 0.88（0.85，0.91）和 0.96（0.94，0.98），hPDI 的 HR 分别为 0.88（0.85，0.92）和 0.94（0.92，0.95）。uPDI 与 T2D 无关[0.98（0.94，1.01）]，而与高血压相关则呈正相关：1.04（1.02，1.06）。PDI 和 uPDI 与 BMI 之间存在交互作用，对 T2D 有影响（P 交互<0.001），对高血压无影响（P 交互>0.05）。此外，BMI 部分介导了饮食与 T2D 之间 26-59%和饮食与高血压之间 0.2-59%的关联。
在这项大型前瞻性研究中，观察到女性的植物性饮食与 T2D 和高血压风险之间存在差异关联。只有更健康的植物性食物与较低的风险相关，部分原因是 BMI 降低。该方案在 clinicaltrials.gov 上注册为 NCT03285230。
