Life Course Evaluation of a Plant-Centered Diet and Risk of Type 2 Diabetes, Weight Gain, Cardiovascular Diseases, All-Cause Mortality, and Markers of Chronic Kidney Disease: The Coronary Artery Risk Development in Young Adults (CARDIA) Cohort

Abstract

OBJECTIVE: To examine the association of plant-centered diet quality with risk of type 2 diabetes (T2D), weight gain, cardiovascular disease (CVD), all-cause mortality, and markers of chronic kidney disease (CKD)−estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR).METHODS: Data from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort were used. This US multicenter, community-based prospective study involved 5,115 Black and White men and women aged 18-30 years old at baseline assessment in 1985–1986 and followed through to 2018. Diet was assessed by an interviewer-administered, validated diet history questionnaire. Plant-centered diet quality was assessed using the A Priori Diet Quality Score (APDQS); higher index scores represent higher consumption of nutritionally-rich plant foods and limited consumption of high-fat meat products and unhealthy plant foods. Cox regression models were used to assess risk of T2D, CVD, and all-cause mortality, and linear regression models were used to examine change in body size, eGFR, ACR, and combination of eGFR and ACR. RESULTS: For every 1–SD increase in the APDQS (over a 20-year period for T2D and a 13-year period for CVD), there was a reduction in subsequent risk of T2D (Hazard Ratio [HR]= 0.71; 95% CI: 0.59–0.86) and CVD (HR=0.75; 95% CI: 0.57–1.00), independent of the baseline APDQS. In addition, each 1–SD increase in the APDQS over 20 years was associated with concurrent changes in body mass index (-0.39±0.14 kg/m2; P=0.004), waist circumference (-0.90±0.27 cm; P <0.001), and body weight (-1.14±0.33 kg; P <0.001). The time-updated average APDQS was associated with lower risk of CVD (HR=0.80; 95% CI: 0.67–0.95), lower ln(ACR) (β±SE at Y30: -0.09±0.02 mg/g; P<0.001), higher eGFR (1.64±0.47 mL/min/1.73m2; P<0.001), and lower the combined markers (for ln(ACR) z-score - eGFR z-score: -0.19±0.03; P<0.001). However, there was a suggestive, but not statistically significant, inverse association between the APDQS and risk of all-cause mortality. CONCLUSIONS: Consumption of a plant-centered, high-quality diet starting in young adulthood is associated with a lower risk of developing diet-related chronic disease by middle age.