Unhealthy plant-based diet is associated with a higher cardiovascular disease risk in patients with prediabetes and diabetes: a large-scale population-based study.

IF 7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL BMC Medicine Pub Date : 2024-10-23 DOI:10.1186/s12916-024-03683-7

Pan Zhuang, Fenglei Wang, Jianxin Yao, Xiaohui Liu, Yin Li, Yang Ao, Hao Ye, Xuzhi Wan, Yu Zhang, Jingjing Jiao

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Abstract

Background: 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.

Methods: 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.

Results: 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_trend = 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_trend = 0.005) and those with diabetes (HR T3 vs. T1 = 1.14, 95% CI = 1.00-1.29, P_trend = 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%).

Conclusions: 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.

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不健康的植物性饮食与糖尿病前期和糖尿病患者较高的心血管疾病风险有关：一项大规模人群研究。

背景：在糖尿病前期和糖尿病患者中，植物性膳食模式在预防心血管疾病（CVD）方面的作用仍不明确。我们旨在评估植物性膳食指数（PDI）、有益健康的植物性膳食指数（hPDI）和有害健康的植物性膳食指数（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诱因：2006年至2010年期间，英国生物数据库共登记了17926名糖尿病前期患者和7798名糖尿病患者，并对他们进行了随访，直至2020年底。我们根据包括植物性食物和动物性食物在内的18种主要食物类别计算了PDI、hPDI和uPDI，并应用Cox比例危险模型计算了与PDI、hPDI和uPDI相关的心血管疾病风险的危险比（HRs）和95%置信区间（CIs）。分解分析用于评估膳食成分的作用，中介分析用于评估血清生物标志物在这些关联中的潜在中介作用：结果：糖尿病前期患者共发生了2324起心血管疾病事件，而糖尿病患者则发生了1461起心血管疾病事件。在糖尿病前期患者中发现，hPDI 与心血管疾病风险呈反向关系（HR T3 vs. T1 = 0.88, 95% CI = 0.79-0.98, Ptrend = 0.025），而糖尿病患者则没有发现。在糖尿病前期患者（HR T3 vs. T1 = 1.17，95% CI = 1.05-1.30，Ptrend = 0.005）和糖尿病患者（HR T3 vs. T1 = 1.14，95% CI = 1.00-1.29，Ptrend = 0.043）中，uPDI 与心血管疾病风险呈正相关。在糖尿病前期患者中，高糖含糖饮料（SSB）摄入量占 hPDI-CVD 关联的 35%，占 uPDI-CVD 关联的 15%，而在糖尿病患者中，低全谷物摄入量占关联的 36%。在糖尿病前期患者（15%，95% CI = 7-30%）和糖尿病患者（44%，95% CI = 9-86%）中，胱抑素C水平升高解释了uPDI与心血管疾病风险之间关系的最大比例：结论：坚持不健康的植物性饮食与糖尿病前期或糖尿病患者较高的心血管疾病风险有关，其部分原因可能是全谷物摄入量低、固态饮料摄入量高以及血液中胱抑素C水平高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Medicine 医学-医学：内科

CiteScore

13.10

自引率

1.10%

发文量

435

审稿时长

4-8 weeks

期刊介绍： BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.