Abstract Body (Do not enter title and authors here): Introduction/Background: The role of plant-based dietary patterns in preventing cardiovascular disease (CVD) among individuals with prediabetes and diabetes remains unclear.
Research Questions/Hypothesis: 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/Approach: A total of 18,145 participants with prediabetes and 7,922 with diabetes were enrolled from the UK Biobank 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.
Results/Data: A positive association was found between uPDI and CVD risk among individuals with prediabetes (HR T3 VS. T1=1.14, 95% CI=1.03–1.27, P trend=0.012) and those with diabetes (HRT3 VS. T1=1.16, 95% CI=1.03–1.31, P trend=0.016), but not for PDI (P trend=0.621) or hPDI (P trend=0.914) (Table 1). High sugar-sweetened beverages (SSB) intake accounted for 16.7% of the uPDI-CVD association, whereas low intake of whole grain accounted for 26.9% 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 (18.1%, 95% CI=7.1%–39.1%) and diabetes (32.8%, 95% CI=11.5%–64.6%) (Table 2).
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 level.