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. (25th November 2020)

• Record Type: Journal Article
• Authors: Kouvari, M; Panagiotakos, D.B; Chrysohoou, C; Georgousopoulou, E.N; Pitsavos, C; Tousoulis, D
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Nutrition, Malnutrition and Heart Disease; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.2854
• Languages: English
• ISSNs: 0195-668X

Abstract

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 >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<0.001) and for women 67%, 58% and 34% (p<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].