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Associations of healthful and unhealthful plant-based diets with plasma markers of cardiometabolic risk

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European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

Plant-based diets, particularly when rich in healthy plant foods, have been associated with a lower risk of type 2 diabetes and cardiovascular disease. However, the impact of plant-based diets that distinguish between healthy and unhealthy plant foods on cardiometabolic biomarkers remains unclear.

Methods

Dietary information was collected by two 24-h recalls among 34,785 adults from a nationwide cross-sectional study. Plasma levels of insulin, C-peptide, glucose, C-reactive protein (CRP), white blood cell (WBC) count, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) were measured. Linear regression was used to evaluate the percentage difference in plasma marker concentrations by three plant-based diet indices, namely the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI).

Results

Greater hPDI-adherence scores (comparing extreme quartiles) were associated with lower levels of insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), TG/HDL-C ratio, CRP, WBC count, and TG, and higher levels of HDL-C, with the percentage differences of  – 14.55,  – 15.72,  – 11.57,  – 14.95,  – 5.26,  – 7.10, and 5.01, respectively (all Ptrend ≤ 0.001). Conversely, uPDI was associated with higher levels of insulin, C-peptide, HOMA-IR, TG/HDL-C ratio, CRP, WBC count, and TG, but lower HDL-C, with the percentage differences of 13.71, 14.00, 14.10, 10.43, 3.32, 8.00, and  – 4.98 (all Ptrend ≤ 0.001), respectively. Overall PDI was only associated with lower levels of CRP and WBC count (all Ptrend ≤ 0.001).

Conclusion

Our findings suggest that hPDI may have positive, whereas uPDI may have negative impacts on multiple cardiometabolic risk markers, and underscore the need to consider the quality of plant foods in future PDI studies.

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Availability of data and material

Data described in the manuscript can be made publicly and freely available without restriction at https://www.cdc.gov/nchs/nhanes/index.htm.

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Funding

This work was supported by the National Natural Science Foundation of China (82073651), Anhui Provincial Natural Science Foundation (2008085MH262 and 2108085QH357), Anhui Provincial Education Department (gxyqZD2021099), and grants from Anhui Medical University (2021xkjT007, 2020lcxk033, XJ201935, and 2019xkj161).

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Author notes

  1. Yong Huang and Xiude Li are contributed equally as co-first authors for this article.

Authors and Affiliations

  1. Department of Nutrition, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China

    Yong Huang, Xiude Li, Tengfei Zhang, Xueke Zeng, Meiling Li, Haowei Li, Hu Yang, Chenghao Zhang, Zhihao Zhou, Yu Zhu, Zhuang Zhang & Wanshui Yang

  2. Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People’s Republic of China, Hefei, Anhui, China

    Yong Huang & Wanshui Yang

  3. NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, Hefei, Anhui, China

    Yong Huang & Wanshui Yang

  4. Anhui Provincial Key Laboratory of Population Health and Aristogenics/Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, China

    Yong Huang, Xiude Li & Wanshui Yang

  5. Anhui Provincial Institute of Translational Medicine, Hefei, Anhui, China

    Xiude Li

  6. Department of Gastroenterology and Hepatology and Clinical Nutrition, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, 230000, Anhui, China

    Min Tang

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Contributions

All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: WY, YH. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: YH, WY. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: YH, XL. Obtained funding: WY, MT. Administrative, technical, or material support: WY. Study supervision: WY.

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Correspondence to Wanshui Yang.

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The NCHS Research Ethics Review Board approved the NHANES study protocols (#98–12, #2005–06, and #2011–17).

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Huang, Y., Li, X., Zhang, T. et al. Associations of healthful and unhealthful plant-based diets with plasma markers of cardiometabolic risk. Eur J Nutr 62, 2567–2579 (2023). https://doi.org/10.1007/s00394-023-03170-4

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