Healthful and unhealthful plant-based dietary patterns and their role on 10-year transition to metabolically unhealthy status in obese participants of the ATTICA prospective (2002–2012) study
Authors: Kouvari M , Panagiotakos D.B , Chrysohoou C , Georgousopoulou E.N , Pitsavos C , Tousoulis D 
Published: November 2020

Abstract

Background/Introduction
Plant-based diets have been widely promoted for their protective role on cardiometabolic health. However, in the recent literature it is highly suggested that the quality of plant-based diets varies.

Purpose
The association between plant-based diet indices and 10-year transition to metabolically unhealthy status in metabolically healthy obese (MHO) individuals was assessed.

Methods
A prospective study was conducted during 2001–2012 studying n=1,514 males and n=1,528 females (aged &gt;18 years old) free of CVD. Healthy metabolic status was defines as absence of all NCEP ATP III (2005) metabolic syndrome components (excluding waist circumference). Follow-up CVD assessment (2011–2012) was achieved in n=2,020 participants (n=317 cases). Overall, healthful and unhealthful plant-based dietary indices (PDI, hPDI and uPDI) were created through a standard procedure; hPDI was principally characterized by increased consumption of fruits/vegetables, whole grains, nuts, legumes, oils, tea/coffee while uPDI was related with increased intake of juices, sweetened beverages, refined grains, potatoes and sweets.

Results
MHO prevalence reached 4.8% (n=146) (4.9% in men and 4.7% in women, p=0.198). 28.2% of obese participants presented a metabolically benign status. Within the decade, almost half of MHO participants resulted as metabolically unhealthy obese (45% in men and 54% in women, p=0.04). Ranking from 1st to 3rd PDI tertile, transition to metabolically unhealthy status was for men, 63%, 48% and 22% (p&lt;0.001) and for women 67%, 58% and 34% (p&lt;0.001). Multiadjusted analysis revealed significant inverse associations between PDI and 10-year transition to metabolically unhealthy status for men [Hazard Ratio (HR) (3rd vs. 1st tertile)=0.63 95% Confidence Interval (95% CI) (0.41, 0.95)] yet –borderline significantly– for women [HR (3rd vs. 1st PDI tertile) = 0.82 95% CI (0.67, 1.09)]. When the indices for quality of plant-based patterns were used (hPDI and uPDI), only participants assigned to the higher level of adherence to healthful plant-based pattern retained their metabolically healthy profile with this relation being stronger in women; [HR (3rd vs. 1st hPDI tertile) = 0.55 95% CI (0.37, 0.84), for women] and [HR (3rd vs. 1st hPDI tertile) = 0.79 95% CI (0.64, 1.03), for men]. Similarly, the aggravating effect of high adherence to less healthful plant-based food choices was higher for women [HR (3rd vs. 1st uPDI tertile) = 1.68 95% CI (1.23, 1.99)].

Conclusions
Higher adherence to plant-based diet was associated with substantially higher likelihood for an obese individual to long-term retain its healthy metabolic status. Most importantly, the healthy or unhealthy food choices within this pattern seemed to determine cardiometabolic status with stronger remarks in women.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This work was supported by a research grant from Hellenic Atherosclerosis Society. The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].