Abstract P235: A Healthy Plant-Based Diet Index is Favorably Associated With Cardiometabolic Risk Factors in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study
Authors: Shilpa N Bhupathiraju, Zhilei Shan, Frank B Hu, Namratha R Kandula, Alka M Kanaya
Journal: Circulation (2019)

Introduction: Plant-based diets are recommended for the prevention of type 2 diabetes (T2D) and cardiovascular disease (CVD). South Asians primarily consume a plant-based diet but also have a disproportionately high risk of cardiometabolic disease. Because not all plant foods are beneficial to health, we previously developed a healthy plant-based diet index (hPDI) to reflect consumption of high quality plant foods. To create the hPDI, we assigned healthy plant foods (whole grains, fruits, vegetables, herbs/spices, nuts, legumes, tea/coffee) positive scores, while less healthy plant foods (juices, sugar sweetened beverages, refined grains, deep fried snacks/pickles, potatoes, coconut, and sweets) and animal foods received reverse scores. We examined cross-sectional and prospective associations between the hPDI and cardiometabolic risk markers (dyslipidemia, glycemia, inflammation, body composition, subclinical atherosclerosis, and incident T2D) among South Asians in the US. We hypothesized that those with higher scores on the hPDI will have a better cardiometabolic risk profile. Methods: We included 891 South Asians (mean age=55 y, 53% male) who completed the baseline visit in MASALA with reliable food frequency questionnaire data. The prospective analysis included 735 South Asians who completed exam 2 (~5 y after baseline). We used multivariable general linear or logistic regression to examine cross-sectional and prospective associations between hPDI and cardiometabolic risk adjusting for age, sex, education, income, medication use, calories, BMI, and various lifestyle, dietary, and cultural factors. In prospective analyses, we adjusted for the baseline value of the corresponding outcome variable. Results: At baseline, the hPDI was inversely associated with HOMA-IR and HbA1C [% decrease ± SE for every 5 unit higher hPDI: HOMA-IR=-2.76 ± 1.39, HbA1c = -0.37 ± 0.14]. There were no associations with beta-cell function, fasting and 2-h glucose, triglycerides, HDL-C, C-reactive protein, adiponectin, or subclinical atherosclerosis. A higher score on the hPDI (β ± SE for 5 unit increase) was associated with lower LDL-C (-1.50 ± 0.66 mg/dL), BMI (-0.20 ± 0.09 kg/m 2 ), weight (-0.54 ± 0.25 kg), visceral fat (-1.92 ± 0.94 cm 2 ), a lower likelihood of fatty liver (OR=0.78, 95% CI: 0.65-0.93), and obesity (OR=0.91, 95% CI: 0.82-1.00). Prospectively, we found no associations between hPDI and measures of glycemia (glucose, HbA1C) and dyslipidemia (triglycerides, HDL-C, and LDL-C). The hPDI was inversely, but non-significantly, associated with a lower risk of incident T2D [RR (95% CI) per 5 unit hPDI =0.87 (0.71-1.08), n=45 cases]. Conclusions: A higher intake of healthful plant-based foods was associated with a favorable cardiometabolic risk profile. Continued follow-up of the MASALA cohort will determine if the hPDI is associated with lower incident T2D and CVD events.