American Diabetes Association
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Restricted AccessChanges in Plant-Based Diet Indices and Subsequent Risk of Type 2 Diabetes in Women and Men: Three U.S. Prospective Cohorts

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posted on 2021-01-13, 23:58 authored by Zhangling Chen, Jean-Philippe Drouin-Chartier, Yanping Li, Megu Y. Baden, JoAnn E. Manson, Walter C. Willett, Trudy Voortman, Frank B. Hu, Shilpa N. Bhupathiraju

We evaluated the associations between changes in plant-based diets and subsequent risk of type 2 diabetes.


We prospectively followed 76,530 women in the Nurses’ Health Study (NHS, 1986-2012), 81,569 women in NHS II (1991-2017), and 34,468 men in the Health Professionals’ Follow-up Study (1986-2016). Adherence to plant-based diets was assessed every 4 years using the overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). We used multivariable Cox proportional hazards models to estimate hazard ratios (HRs). Results of the three cohorts were pooled using meta-analysis.


We documented 12,627 cases of type 2 diabetes during 2,955,350 person-years of follow-up. After adjustment for initial BMI, initial and 4-year changes in alcohol intake, smoking, physical activity, and other factors, compared with participants whose indices remained relatively stable (±3%), participants with the largest decrease (>10%) in PDI and hPDI over 4 years had a 12%-23% higher diabetes risk in the subsequent 4 years (pooled HR: PDI, 1.12 (95% CI 1.05, 1.20), hPDI, 1.23 (1.16, 1.31)). Each 10% increment in PDI and hPDI over 4 years was associated with a 7%-9% lower risk (PDI, 0.93 (0.91, 0.95), hPDI, 0.91 (0.87, 0.95)). Changes in uPDI were not associated with diabetes risk. Weight changes accounted for 6.0%-35.6% of the associations between changes in PDI and hPDI and diabetes risk.


Improving adherence to overall and healthful plant-based diets was associated with a lower risk of type 2 diabetes, whereas decreased adherence to such diets was associated with a higher risk.


This study was funded by the National Institutes of Health with research grants UM1 CA186107, P01 CA87969, R01 CA49449, R01 DK112940, R01 HL60712, P30 DK46200, R01 HL034594, R01 HL088521, U01 CA176726, R01 CA67262, and U01 CA167552. Z.C. was partially supported by a fellowship from the Nutricia Research Foundation (2019-T2). J.-P.D.-C. was supported by a Banting Postdoctoral Fellowship from the Canadian Institutes of Health Research (BPF-156628). M.Y.B. was supported by a fellowship from the Manpei Suzuki Diabetes Foundation. The funders had no role to play in the design of the study and in the interpretation of the results.


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