Department of Endocrinology, The Second Affiliated Hospital, School of Public Health, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
BMC Med. 2024 Oct 23;22(1):485. doi: 10.1186/s12916-024-03683-7.
The role of plant-based dietary patterns in preventing cardiovascular disease (CVD) among individuals with prediabetes and diabetes remains unclear. We aimed to evaluate the associations of plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) with cardiovascular disease (CVD) risk and explore potential contributing factors among people with prediabetes and diabetes.
A total of 17,926 participants with prediabetes and 7798 with diabetes were enrolled from the UK Biobank between 2006 and 2010 and followed until the end of 2020. We calculated the PDI, hPDI, and uPDI based on 18 major food groups including plant-based foods and animal-based foods and applied Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD risk related to PDI, hPDI, and uPDI. Decomposition analysis was performed to assess the role of dietary components, and mediation analysis was performed to assess the potential mediating role of serum biomarkers underlying these associations.
A total of 2324 CVD events were documented among individuals with prediabetes, while 1461 events occurred among patients with diabetes. An inverse association was found between hPDI and CVD risk among individuals with prediabetes (HR T3 vs. T1 = 0.88, 95% CI = 0.79-0.98, P = 0.025) but not those with diabetes. A positive association was found between uPDI and CVD risk among individuals with prediabetes (HR T3 vs. T1 = 1.17, 95% CI = 1.05-1.30, P = 0.005) and those with diabetes (HR T3 vs. T1 = 1.14, 95% CI = 1.00-1.29, P = 0.043). High-sugar-sweetened beverages (SSB) intake accounted for 35% of the hPDI-CVD association and 15% of the uPDI-CVD association among individuals with prediabetes, whereas low intake of whole grain accounted for 36% of the association among patients with diabetes. Elevated cystatin C levels explained the largest proportion of the association between uPDI and CVD risk among individuals with prediabetes (15%, 95% CI = 7-30%) and diabetes (44%, 95% CI = 9-86%).
Adherence to an unhealthy plant-based diet is associated with a higher CVD risk in people with prediabetes or diabetes, which may be partially attributed to low consumption of whole grains, high intake of SSB, and high blood cystatin C levels.
植物性饮食模式在预防糖尿病前期和糖尿病患者心血管疾病（CVD）方面的作用尚不清楚。我们旨在评估植物性饮食指数（PDI）、健康 PDI（hPDI）和不健康 PDI（uPDI）与心血管疾病（CVD）风险的关系，并探讨糖尿病前期和糖尿病患者中潜在的促成因素。
共纳入 17926 例糖尿病前期患者和 7798 例糖尿病患者，他们于 2006 年至 2010 年期间参加英国生物库研究，并随访至 2020 年底。我们根据包括植物性食物和动物性食物在内的 18 种主要食物组计算了 PDI、hPDI 和 uPDI，并应用 Cox 比例风险模型计算了与 PDI、hPDI 和 uPDI 相关的 CVD 风险的风险比（HR）和 95%置信区间（CI）。进行分解分析以评估饮食成分的作用，进行中介分析以评估这些关联背后血清生物标志物的潜在中介作用。
在糖尿病前期患者中记录了 2324 例 CVD 事件，而在糖尿病患者中记录了 1461 例 CVD 事件。在糖尿病前期患者中，hPDI 与 CVD 风险呈负相关（HR T3 vs. T1=0.88，95%CI=0.79-0.98，P=0.025），但在糖尿病患者中无此相关性。在糖尿病前期患者中，uPDI 与 CVD 风险呈正相关（HR T3 vs. T1=1.17，95%CI=1.05-1.30，P=0.005），在糖尿病患者中亦呈正相关（HR T3 vs. T1=1.14，95%CI=1.00-1.29，P=0.043）。高糖甜味饮料（SSB）摄入占糖尿病前期患者 hPDI-CVD 关联的 35%，占 uPDI-CVD 关联的 15%，而全谷物摄入不足占糖尿病患者关联的 36%。胱抑素 C 水平升高解释了糖尿病前期患者 uPDI 与 CVD 风险之间关联的最大比例（15%，95%CI=7-30%）和糖尿病患者的最大比例（44%，95%CI=9-86%）。
糖尿病前期或糖尿病患者坚持不健康的植物性饮食与 CVD 风险增加相关，这可能部分归因于全谷物摄入不足、高糖甜味饮料摄入过多以及血胱抑素 C 水平升高。
