TY - JOUR
T1 - BMI in the Associations of Plant-Based Diets with Type 2 Diabetes and Hypertension Risks in Women
T2 - The E3N Prospective Cohort Study
AU - Laouali, Nasser
AU - Shah, Sanam
AU - Macdonald, Conor James
AU - Mahamat-Saleh, Yahya
AU - El Fatouhi, Douae
AU - Mancini, Francesca
AU - Fagherazzi, Guy
AU - Boutron-Ruault, Marie Christine
N1 - This work was supported by a grant for the Nutriperso Project (IDEX Paris Saclay). This research was carried out using data from Inserm's E3N cohort with the support of the MGEN, the Institut GUSTAVE ROUSSY, and the Ligue contre le Cancer for the constitution and maintenance of the E3N cohort. This work has also benefited from state aid managed by the National Research Agency under the program "Investissement d'avenir" under the reference ANR-10-COHO0006 as well as a subsidy from the "Ministere de l'enseignement superieur, de la recherche et de l'innovation" for public service charges under reference n. 2102 918823.
Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.
PY - 2021/9/4
Y1 - 2021/9/4
N2 - Background: Few studies have evaluated the quality of plant-based diets in relation to chronic diseases, and the potential role of BMI is not clearly explored. Objectives: To study the associations between plant-based diet indices and type 2 diabetes (T2D) and hypertension risks, as well as the extent to which the associations were modified and/or mediated by BMI. Methods: The study included 74,522 women from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale prospective cohort [mean (SD): age, 52.94 (6.7) years; BMI, 22.970 (3.328) kg/m2]. Dietary data were collected at baseline (1993) via an FFQ. Overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) were developed. Multivariable Cox regression models were used to derive HRs and 95% CIs. Effect modification and mediation by BMI were explored. Results: There were 3292 (4.64%) incident cases of T2D and 12,504 (27.14%) incident cases of hypertension over ∼20 years of follow-up. In the multivariable model further adjusted for BMI, higher adherence to PDI and hPDI was associated with lower T2D and hypertension risks, with an HR per 1-SD increase (95% CI) of 0.88 (0.85, 0.91) and 0.96 (0.94, 0.98) for PDI and 0.88 (0.85, 0.92) and 0.94 (0.92, 0.95) for hPDI, respectively. uPDI was not associated with T2D [0.98 (0.94, 1.01)], whereas a positive association was observed with hypertension: 1.04 (1.02, 1.06). There was interaction between PDI and uPDI, as well as BMI, on T2D (P-interaction < 0.001) but not on hypertension (P-interaction > 0.05). In addition, BMI mediated 26-59% and 0.2-59% of diet-T2D and diet-hypertension associations, respectively. Conclusions: Differential associations between plant-based diets and T2D and hypertension risks were observed among women in this large prospective study. Only healthier plant foods were associated with lower risks, partly through decreasing BMI. The protocol was registered at clinicaltrials.gov as NCT03285230.
AB - Background: Few studies have evaluated the quality of plant-based diets in relation to chronic diseases, and the potential role of BMI is not clearly explored. Objectives: To study the associations between plant-based diet indices and type 2 diabetes (T2D) and hypertension risks, as well as the extent to which the associations were modified and/or mediated by BMI. Methods: The study included 74,522 women from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale prospective cohort [mean (SD): age, 52.94 (6.7) years; BMI, 22.970 (3.328) kg/m2]. Dietary data were collected at baseline (1993) via an FFQ. Overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) were developed. Multivariable Cox regression models were used to derive HRs and 95% CIs. Effect modification and mediation by BMI were explored. Results: There were 3292 (4.64%) incident cases of T2D and 12,504 (27.14%) incident cases of hypertension over ∼20 years of follow-up. In the multivariable model further adjusted for BMI, higher adherence to PDI and hPDI was associated with lower T2D and hypertension risks, with an HR per 1-SD increase (95% CI) of 0.88 (0.85, 0.91) and 0.96 (0.94, 0.98) for PDI and 0.88 (0.85, 0.92) and 0.94 (0.92, 0.95) for hPDI, respectively. uPDI was not associated with T2D [0.98 (0.94, 1.01)], whereas a positive association was observed with hypertension: 1.04 (1.02, 1.06). There was interaction between PDI and uPDI, as well as BMI, on T2D (P-interaction < 0.001) but not on hypertension (P-interaction > 0.05). In addition, BMI mediated 26-59% and 0.2-59% of diet-T2D and diet-hypertension associations, respectively. Conclusions: Differential associations between plant-based diets and T2D and hypertension risks were observed among women in this large prospective study. Only healthier plant foods were associated with lower risks, partly through decreasing BMI. The protocol was registered at clinicaltrials.gov as NCT03285230.
KW - BMI
KW - hypertension
KW - mediation analysis
KW - plant-based diets
KW - type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85116364881&partnerID=8YFLogxK
UR - https://www.ncbi.nlm.nih.gov/pubmed/34236437
U2 - 10.1093/jn/nxab158
DO - 10.1093/jn/nxab158
M3 - Article
C2 - 34236437
AN - SCOPUS:85116364881
SN - 0022-3166
VL - 151
SP - 2731
EP - 2740
JO - Journal of Nutrition
JF - Journal of Nutrition
IS - 9
ER -