Plant foods intake and risk of type 2 diabetes: Findings from a registry-based prospective cohort study

Abstract

BackgroundLifestyle intervention or dietary modification has been the cornerstone of primary prevention and management of type 2 diabetes (T2D).ObjectiveTo investigate the associations of plant foods intake with the risk of incident T2D.MethodsBased on a general population cohort, the Shanghai Suburban Adult Cohort and Biobank (SSACB), dietary data were collected for each participant in Songjiang District of Shanghai at enrollment with a validated Food Frequency Questionnaire (FFQ), and plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) were calculated. Incident T2D cases were identified according to physician diagnosis (fasting blood glucose ≥7.0 mmol·L−1, or 2 h value during a 75-g oral glucose tolerance test ≥11.1 mmol·L−1, or glycosylated hemoglobin ≥6.5%, or with typical symptoms of hyperglycemia or hyperglycemic crisis, accompanied by a random plasma glucose ≥11.1 mmol·L−1) or medication records, obtained from the electronic information system for residents' medical insurance. Multivariable-adjusted Cox proportional hazards models and restricted cubic splines were used to evaluate the associations of foods from different sources with the risk of incident T2D.ResultsA total of 29016 participants [age at baseline (55.3±11.6) years] with a median follow-up duration of 5.688 years until 21 September 2022 were included. Plant foods (unprocessed) intake was associated with a decreased risk of incident T2D [HR (95%CI): 0.983 (0.969, 0.998)]. In comparison with participants in the highest quartile (≥859.3 g) of plant foods daily intake, the risk of incident T2D for those in the lowest quartile (<500.9 g) was higher [HR (95%CI): 1.250 (1.012, 1.544)]. No significant associations of animal foods [HR (95%CI): 1.006 (0.987, 1.026)] and processed foods [HR (95%CI): 0.978 (0.944, 1.014)] intakes were found with the risk of incident T2D. Replacing 50 g animal foods [HR (95%CI): 0.982 (0.968, 0.996)] or processed foods [HR (95%CI): 0.983 (0.969, 0.998)] with 50 g plant foods was associated with significantly decreased risks of incident T2D. Additionally, non-linear associations of PDI (Pnonlinear=0.023) and hPDI (Pnonlinear=0.016) with the risk of incident T2D were found in the SSACB.ConclusionPlant foods intake, especially healthful plant foods intake, is significantly associated with a decreased risk of incident T2D.

Keywords

• plant foods
• plant-based diet index
• type 2 diabetes
• cohort study
• cox proportional hazards model