Background: A healthy eating pattern characterized by a higher intake of healthy plant foods has been associated with a lower risk of premature mortality, but whether this applies to individuals with varying glycemic status remains unclear. Methods: This study included 4621 participants with diabetes and 8061 participants with prediabetes from the US National Health and Nutrition Examination Survey (2007–2016). Using the dietary data assessed by two 24 h dietary recalls, a healthful plant-based diet index (hPDI) and an unhealthful plant-based diet index (uPDI) were created based on 15 food groups and were assessed for their relationships with mortality risk. Results: Over a median follow-up of 7.2 years, there were 1021 deaths in diabetes and 896 deaths in prediabetes. A higher hPDI (highest vs. lowest quartile) was associated with a 41% (HR = 0.59, 95% CI: 0.49–0.72; P-trend < 0.001) lower risk of all-cause mortality in diabetes and a 31% (HR = 0.69, 95% CI: 0.55–0.85; P-trend < 0.001) lower risk in prediabetes. A higher uPDI was associated with an 88% (HR = 1.88, 95% CI: 1.55–2.28; P-trend < 0.001) higher risk of mortality in diabetes and a 63% (HR = 1.63, 95% CI: 1.33–1.99; P-trend < 0.001) higher risk in prediabetes. Mediation analysis suggested that C-reactive protein and γ-glutamine transaminase explained 6.0% to 10.9% of the relationships between hPDI or uPDI and all-cause mortality among participants with diabetes. Conclusions: For adults with diabetes as well as those with prediabetes, adhering to a plant-based diet rich in healthier plant foods is associated with a lower mortality risk, whereas a diet that incorporates less healthy plant foods is associated with a higher mortality risk.

中文翻译：

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植物性饮食、调节生物标志物和成人糖尿病或糖尿病前期患者的死亡风险

背景：以摄入更多健康植物性食品为特征的健康饮食模式与较低的过早死亡风险相关，但这是否适用于血糖状况不同的个体仍不清楚。方法：本研究纳入了美国国家健康和营养检查调查（2007-2016 年）中的 4621 名糖尿病患者和 8061 名糖尿病前期患者。利用两次 24 小时饮食回顾评估的饮食数据，根据 15 个食物组创建了健康植物性饮食指数 (hPDI) 和不健康植物性饮食指数 (uPDI)，并评估了它们与死亡风险的关系。结果：在中位随访 7.2 年中，有 1021 人死于糖尿病，896 人死于糖尿病前期。较高的 hPDI（最高与最低四分位数）与糖尿病全因死亡率风险降低 41%（HR = 0.59，95% CI：0.49–0.72； P趋势 < 0.001）相关，并且与糖尿病全因死亡率风险降低 31%（HR = 0.59，95% CI：0.49–0.72；P 趋势 < 0.001）相关。 = 0.69，95% CI：0.55–0.85；P-趋势 < 0.001) 糖尿病前期风险较低。 uPDI 越高，糖尿病患者的死亡风险增加 88%（HR = 1.88，95% CI：1.55–2.28； P趋势 < 0.001），死亡率增加 63%（HR = 1.63，95% CI：1.33–1.99） ; P -趋势 < 0.001) 糖尿病前期风险较高。中介分析表明，C 反应蛋白和 γ-谷氨酰胺转氨酶解释了糖尿病参与者中 hPDI 或 uPDI 与全因死亡率之间关系的 6.0% 至 10.9%。结论：对于患有糖尿病和糖尿病前期的成年人来说，坚持富含健康植物性食物的植物性饮食与较低的死亡风险相关，而包含不太健康的植物性食物的饮食与较高的死亡风险相关。