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The Portfolio Diet and Incident Type 2 Diabetes: Findings From the Women's Health Initiative Prospective Cohort Study.

Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA. Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI. Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada. Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Dalla Lana School of Public Health and Department of Medicine, University of Toronto, Toronto, Ontario, Canada. College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA. Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of California, Irvine, CA. MedStar Health Research Institute, Washington, DC. Georgetown/Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Departments of Surgery and Medicine, Alpert School of Medicine, Brown University, Providence, RI.

Diabetes care. 2023;(1):28-37
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Abstract

OBJECTIVE A plant-based dietary pattern, the Portfolio Diet, has been shown to lower LDL cholesterol and other cardiovascular disease risk factors. However, no study has evaluated the association of this diet with incident type 2 diabetes. RESEARCH DESIGN AND METHODS This analysis included 145,299 postmenopausal women free of diabetes at baseline in the Women's Health Initiative (WHI) Clinical Trials and Observational Study from 1993 to 2021. Adherence to the diet was assessed with a score based on six components (high in plant protein [soy and pulses], nuts, viscous fiber, plant sterols, and monounsaturated fat and low in saturated fat and cholesterol) determined from a validated food-frequency questionnaire. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs of the association of the Portfolio Diet, alongside the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets, with incident type 2 diabetes, with adjustment for potential confounders. RESULTS Over a mean follow-up of 16.0 years, 13,943 cases of incident type 2 diabetes were identified. In comparisons of the highest with the lowest quintiles of adherence, the HRs for risk of incident type 2 diabetes were 0.77 (95% CI 0.72, 0.82) for the Portfolio Diet, 0.69 (0.64, 0.73) for the DASH diet, and 0.78 (0.74, 0.83) for the Mediterranean diet. These findings were attenuated by 10% after additional adjustment for BMI. CONCLUSIONS Greater adherence to the plant-predominant Portfolio, DASH, and Mediterranean diets was prospectively associated with lower risk of type 2 diabetes in postmenopausal women.

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Publication Type : Observational Study

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