Quality of plant-based diets is associated with liver steatosis, which predicts type 2 diabetes incidence ten years later: Results from the ATTICA prospective epidemiological study

Matina Kouvari; Thomas Tsiampalis; Rena I Kosti; Nenad Naumovski; Christina Chrysohoou; John Skoumas; Christos S Pitsavos; Demosthenes B Panagiotakos; Christos S Mantzoros

doi:10.1016/j.clnu.2022.07.026

Quality of plant-based diets is associated with liver steatosis, which predicts type 2 diabetes incidence ten years later: Results from the ATTICA prospective epidemiological study

Clin Nutr. 2022 Oct;41(10):2094-2102. doi: 10.1016/j.clnu.2022.07.026. Epub 2022 Aug 7.

Authors

Matina Kouvari¹, Thomas Tsiampalis², Rena I Kosti³, Nenad Naumovski¹, Christina Chrysohoou⁴, John Skoumas⁴, Christos S Pitsavos⁴, Demosthenes B Panagiotakos⁵, Christos S Mantzoros⁶

Affiliations

¹ Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia; Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, Ngunnawal Country, ACT 2617, Australia.
² Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
³ Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece.
⁴ First Cardiology Clinic, School of Medicine, University of Athens, Greece.
⁵ Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia.
⁶ Department of Medicine, Boston VA Healthcare System and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. Electronic address: cmantzor@bidmc.harvard.edu.

PMID: 36087518
DOI: 10.1016/j.clnu.2022.07.026

Abstract

Background & aims: Plant-based diets have recently risen in popularity due to their proposed health benefits. We evaluated the association of plant-based diet quality with non alcoholic fatty liver (NAFL) prevalence and their interaction on risk for developing type 2 diabetes ten years later.

Ethods: A post-hoc analysis of data collected in the ATTICA study. In 2001-02, 3042 participants from the Attica region of Greece were recruited. NAFL was assessed through hepatic steatosis index (HSI). Overall, healthful (hPDI), and unhealthful (uPDI) plant-based dietary indices (PDI) were calculated through standard procedures. N = 1485 participants free of type 2 diabetes at baseline completed the follow-up evaluation ten years later (n = 191 cases).

Results: Unhealthy plant-based diet was significantly associated with likelihood for NAFL; the NAFL prevalence was 32.7%, 33.2% and 40.0%, respectively (p = 0.01), ranking from 1st to 3rd uPDI tertile. Multi-adjusted analysis revealed an inverse association between PDI and NAFL [OR_{(per 5 units increase in PDI)} = 0.85 95%CI (0.76, 0.94)] and hPDI [HR_{(per 5 units increase in hPDI)} = 0.91 95%CI (0.83, 0.99)] and a positive association in the case of uPDI [HR_{(per 5 units increase in uPDI)} = 1.12 95%CI (1.01, 1.25)]. Multi-adjusted analysis revealed that baseline NAFL was associated with 2.95 times higher 10-year type 2 diabetes risk. No significant interaction of baseline liver steatosis with plant-based diet indices was observed (p for interaction > 0.05) in predicting type 2 diabetes.

Conclusions: Plant-based diet quality is of importance for NAFL and affects long-term risk for incident type 2 diabetes.

Keywords: Animal food; Diabetes; Food pattern; Liver disease; Nutrition; Plant-based diet.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Diabetes Mellitus, Type 2* / epidemiology
Diet, Vegetarian / methods
Humans
Incidence
Non-alcoholic Fatty Liver Disease*
Prospective Studies