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Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results from Three Prospective Cohort Studies.
PLoS Med 2016; 13(6):e1002039PM

Abstract

BACKGROUND

Plant-based diets have been recommended to reduce the risk of type 2 diabetes (T2D). However, not all plant foods are necessarily beneficial. We examined the association of an overall plant-based diet and hypothesized healthful and unhealthful versions of a plant-based diet with T2D incidence in three prospective cohort studies in the US.

METHODS AND FINDINGS

We included 69,949 women from the Nurses' Health Study (1984-2012), 90,239 women from the Nurses' Health Study 2 (1991-2011), and 40,539 men from the Health Professionals Follow-Up Study (1986-2010), free of chronic diseases at baseline. Dietary data were collected every 2-4 y using a semi-quantitative food frequency questionnaire. Using these data, we created an overall plant-based diet index (PDI), where plant foods received positive scores, while animal foods (animal fats, dairy, eggs, fish/seafood, poultry/red meat, miscellaneous animal-based foods) received reverse scores. We also created a healthful plant-based diet index (hPDI), where healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea/coffee) received positive scores, while less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, sweets/desserts) and animal foods received reverse scores. Lastly, we created an unhealthful plant-based diet index (uPDI) by assigning positive scores to less healthy plant foods and reverse scores to healthy plant foods and animal foods. We documented 16,162 incident T2D cases during 4,102,369 person-years of follow-up. In pooled multivariable-adjusted analysis, both PDI and hPDI were inversely associated with T2D (PDI: hazard ratio [HR] for extreme deciles 0.51, 95% CI 0.47-0.55, p trend < 0.001; hPDI: HR for extreme deciles 0.55, 95% CI 0.51-0.59, p trend < 0.001). The association of T2D with PDI was considerably attenuated when we additionally adjusted for body mass index (BMI) categories (HR 0.80, 95% CI 0.74-0.87, p trend < 0.001), while that with hPDI remained largely unchanged (HR 0.66, 95% CI 0.61-0.72, p trend < 0.001). uPDI was positively associated with T2D even after BMI adjustment (HR for extreme deciles 1.16, 95% CI 1.08-1.25, p trend < 0.001). Limitations of the study include self-reported diet assessment, with the possibility of measurement error, and the potential for residual or unmeasured confounding given the observational nature of the study design.

CONCLUSIONS

Our study suggests that plant-based diets, especially when rich in high-quality plant foods, are associated with substantially lower risk of developing T2D. This supports current recommendations to shift to diets rich in healthy plant foods, with lower intake of less healthy plant and animal foods.

Authors+Show Affiliations

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Department of Global Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America. Harvard Medical School, Boston, Massachusetts, United States of America.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

27299701

Citation

Satija, Ambika, et al. "Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results From Three Prospective Cohort Studies." PLoS Medicine, vol. 13, no. 6, 2016, pp. e1002039.
Satija A, Bhupathiraju SN, Rimm EB, et al. Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results from Three Prospective Cohort Studies. PLoS Med. 2016;13(6):e1002039.
Satija, A., Bhupathiraju, S. N., Rimm, E. B., Spiegelman, D., Chiuve, S. E., Borgi, L., ... Hu, F. B. (2016). Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results from Three Prospective Cohort Studies. PLoS Medicine, 13(6), pp. e1002039. doi:10.1371/journal.pmed.1002039.
Satija A, et al. Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results From Three Prospective Cohort Studies. PLoS Med. 2016;13(6):e1002039. PubMed PMID: 27299701.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results from Three Prospective Cohort Studies. AU - Satija,Ambika, AU - Bhupathiraju,Shilpa N, AU - Rimm,Eric B, AU - Spiegelman,Donna, AU - Chiuve,Stephanie E, AU - Borgi,Lea, AU - Willett,Walter C, AU - Manson,JoAnn E, AU - Sun,Qi, AU - Hu,Frank B, Y1 - 2016/06/14/ PY - 2015/12/22/received PY - 2016/04/22/accepted PY - 2016/6/15/entrez PY - 2016/6/15/pubmed PY - 2017/6/1/medline SP - e1002039 EP - e1002039 JF - PLoS medicine JO - PLoS Med. VL - 13 IS - 6 N2 - BACKGROUND: Plant-based diets have been recommended to reduce the risk of type 2 diabetes (T2D). However, not all plant foods are necessarily beneficial. We examined the association of an overall plant-based diet and hypothesized healthful and unhealthful versions of a plant-based diet with T2D incidence in three prospective cohort studies in the US. METHODS AND FINDINGS: We included 69,949 women from the Nurses' Health Study (1984-2012), 90,239 women from the Nurses' Health Study 2 (1991-2011), and 40,539 men from the Health Professionals Follow-Up Study (1986-2010), free of chronic diseases at baseline. Dietary data were collected every 2-4 y using a semi-quantitative food frequency questionnaire. Using these data, we created an overall plant-based diet index (PDI), where plant foods received positive scores, while animal foods (animal fats, dairy, eggs, fish/seafood, poultry/red meat, miscellaneous animal-based foods) received reverse scores. We also created a healthful plant-based diet index (hPDI), where healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea/coffee) received positive scores, while less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, sweets/desserts) and animal foods received reverse scores. Lastly, we created an unhealthful plant-based diet index (uPDI) by assigning positive scores to less healthy plant foods and reverse scores to healthy plant foods and animal foods. We documented 16,162 incident T2D cases during 4,102,369 person-years of follow-up. In pooled multivariable-adjusted analysis, both PDI and hPDI were inversely associated with T2D (PDI: hazard ratio [HR] for extreme deciles 0.51, 95% CI 0.47-0.55, p trend < 0.001; hPDI: HR for extreme deciles 0.55, 95% CI 0.51-0.59, p trend < 0.001). The association of T2D with PDI was considerably attenuated when we additionally adjusted for body mass index (BMI) categories (HR 0.80, 95% CI 0.74-0.87, p trend < 0.001), while that with hPDI remained largely unchanged (HR 0.66, 95% CI 0.61-0.72, p trend < 0.001). uPDI was positively associated with T2D even after BMI adjustment (HR for extreme deciles 1.16, 95% CI 1.08-1.25, p trend < 0.001). Limitations of the study include self-reported diet assessment, with the possibility of measurement error, and the potential for residual or unmeasured confounding given the observational nature of the study design. CONCLUSIONS: Our study suggests that plant-based diets, especially when rich in high-quality plant foods, are associated with substantially lower risk of developing T2D. This supports current recommendations to shift to diets rich in healthy plant foods, with lower intake of less healthy plant and animal foods. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/27299701/full_citation L2 - http://dx.plos.org/10.1371/journal.pmed.1002039 DB - PRIME DP - Unbound Medicine ER -