Association of plant-based diet with cardiometabolic multimorbidity trajectory: A prospective study in UK Biobank

BACKGROUND: Plant-based diets have been consistently associated with a lower risk of several individual cardiometabolic diseases (CMDs). However, whether such dietary patterns differentially influence the progression from health to first-occurrence cardiometabolic disease (FCMD), cardiometabolic multimorbidity (CMM), and ultimately mortality remains unclear. METHODS: The present study analyzed data from 83,610 participants in the UK Biobank cohort who were not diagnosed with diabetes, ischaemic heart disease (IHD), or stroke at baseline. Multi-state models were employed to examine the impact of plant-based diets on trajectories of cardiometabolic multimorbidity. RESULTS: During a median follow-up period of 15.61 years, the median age of the participants at baseline was 57 years (IQR: 50 years-62 years), 42.72% were male. 9298 participants developed at least one CMD, 1,045 participants progressed to CMM, and 4169 participants ultimately died. The finding of the multi-state model suggest that, compared with Q1, both the overall plant-based diet index (PDI)[HR (95%CI): 0.88 (0.83, 0.94) for baseline to FCMD, 0.85 (0.83, 0.94) for baseline to CMM] and the healthy plant-based diet index (hPDI) [HR (95%CI): 0.60 (0.41, 0.89) for baseline to FCMD, 0.79 (0.53, 1.17) for baseline to CMM] were negatively associated with the risk of transitioning from health to FCMD and CMM. When grouping FCMD into disease-specific analyses, it was found that the three plant-based indices also exerted differential effects on the transition from health to diabetes. CONCLUSION: In the progression of CMM, high adherence of PDI and hPDI has been demonstrated to reduce the risk of transitioning from CMD-free to FCMD, particularly in diabetes, and lowers the risk of CMM with a much lower incidence risk from CMD-free to CMM compared to CMD-free to FCMD. The present study hypothesizes that both hPDI and unhealthy plant-based index (uPDI) are associated with the risk from baseline to death.