PMID- 38036055 OWN - NLM STAT- MEDLINE DCOM- 20240216 LR - 20240216 IS - 1878-1780 (Electronic) IS - 1262-3636 (Linking) VI - 50 IP - 1 DP - 2024 Jan TI - A healthful plant-based diet is associated with lower type 2 diabetes risk via improved metabolic state and organ function: A prospective cohort study. PG - 101499 LID - S1262-3636(23)00081-2 [pii] LID - 10.1016/j.diabet.2023.101499 [doi] AB - BACKGROUND: Plant-based diets are becoming increasingly popular due to favourable environmental footprints and have been associated with lower risk of type 2 diabetes mellitus (T2DM). Here, we investigated the potential mechanisms to explain the lower T2DM risk observed among individuals following plant-based diets. METHODS: Prospective data from the UK Biobank, a cohort study of participants aged 40 to 69 years at baseline, was evaluated. Associations between healthful and unhealthful plant-based indices (hPDI and uPDI) and T2DM risk were analysed by multivariable Cox regression models, followed by causal mediation analyses to investigate which cardiometabolic risk factors explained the observed associations. RESULTS: Of 113,097 study participants 2,628 developed T2DM over 12 years of follow-up. Participants with the highest hPDI scores (Quartile 4) had a 24 % lower T2DM risk compared to those with the lowest scores (Quartile 1) [Hazard Ratio (HR): 0.76, 95 % Confidence Interval (CI): 0.68-0.85]. This association was mediated by a lower BMI (proportion mediated: 28 %), lower waist circumference (28 %), and lower concentrations of HBA1c (11 %), triglycerides (9 %), alanine aminotransferase (5 %), gamma glutamyl transferase (4 %), C-reactive protein (4 %), insulin-like growth factor 1 (4 %), cystatin C (4 %) and urate (4 %). Higher uPDI scores were associated with a 37 % higher T2DM risk [HR: 1.37, 95 % CI:1.22- 1.53], with higher waist circumference (proportion mediated: 17 %), BMI (7 %), and higher concentrations of triglycerides (13 %) potentially playing mediating roles. CONCLUSION: Healthful plant-based diets may protect against T2DM via lower body fatness, but also via normoglycaemia, lower basal inflammation as well as improved kidney and liver function. CI - Copyright (c) 2023 Elsevier Masson SAS. All rights reserved. FAU - Thompson, Alysha S AU - Thompson AS AD - The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom. FAU - Candussi, Catharina J AU - Candussi CJ AD - Department of Nutritional Sciences, University of Vienna, Vienna, Austria; Center for Public Health, Medical University of Vienna, Vienna, Austria. FAU - Tresserra-Rimbau, Anna AU - Tresserra-Rimbau A AD - The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom; Department of Nutrition, Food Science and Gastronomy, XIA, School of Pharmacy and Food Sciences, INSA, University of Barcelona, 08921 Barcelona, Spain; Centro de Investigacion Biomedica en Red Fisiopatologia de la Obesidad y la Nutricion (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain. FAU - Jennings, Amy AU - Jennings A AD - The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom. FAU - Bondonno, Nicola P AU - Bondonno NP AD - The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom; Danish Cancer Institute, Copenhagen, Denmark; Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia. FAU - Hill, Claire AU - Hill C AD - Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom. FAU - Sowah, Solomon A AU - Sowah SA AD - Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK. FAU - Cassidy, Aedin AU - Cassidy A AD - The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom. Electronic address: a.cassidy@qub.ac.uk. FAU - Kuhn, Tilman AU - Kuhn T AD - The Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Northern Ireland, United Kingdom; Department of Nutritional Sciences, University of Vienna, Vienna, Austria; Center for Public Health, Medical University of Vienna, Vienna, Austria. Electronic address: t.kuhn@qub.ac.uk. LA - eng GR - MC_UU_00006/3/MRC_/Medical Research Council/United Kingdom PT - Journal Article DEP - 20231128 PL - France TA - Diabetes Metab JT - Diabetes & metabolism JID - 9607599 RN - 0 (Triglycerides) SB - IM MH - Humans MH - *Diabetes Mellitus, Type 2/epidemiology/etiology MH - Cohort Studies MH - Prospective Studies MH - Diet, Plant-Based MH - Diet MH - Triglycerides OTO - NOTNLM OT - Diabetes mellitus Type 2 OT - Dietary pattern OT - Mediation analysis OT - Plant-based diet index OT - Prospective cohort study COIS- Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: None EDAT- 2023/12/01 00:43 MHDA- 2024/02/16 06:43 CRDT- 2023/11/30 21:54 PHST- 2023/09/29 00:00 [received] PHST- 2023/11/15 00:00 [revised] PHST- 2023/11/21 00:00 [accepted] PHST- 2024/02/16 06:43 [medline] PHST- 2023/12/01 00:43 [pubmed] PHST- 2023/11/30 21:54 [entrez] AID - S1262-3636(23)00081-2 [pii] AID - 10.1016/j.diabet.2023.101499 [doi] PST - ppublish SO - Diabetes Metab. 2024 Jan;50(1):101499. doi: 10.1016/j.diabet.2023.101499. Epub 2023 Nov 28.