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Healthful dietary patterns and risks of microvascular complications among individuals with type 2 diabetes: a
1Tongji Hospital, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Centre for Obesity and Diabetes Research, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Background:
Diet plays a key role in diabetes management; however, evidence on healthful dietary patterns and diabetic microvascular complications is scarce.
Objectives:
This study aimed to evaluate and compare associations of 8 healthful dietary pattern scores with risks of diabetic microvascular complications and explore the mediating role of circulating biomarkers.
Methods:
This prospective cohort study included 6119 participants with type 2 diabetes from the UK Biobank. Dietary pattern scores were assessed based on 24-h dietary questionnaires. Diabetic kidney diseases (DKDs), diabetic retinopathy (DR), and diabetic neuropathy (DN) were identified via electronic health records. Hazard ratios (HRs) and 95% confidence intervals (CIs) were evaluated using multivariable-adjusted Cox models. Stratified analyses were performed by age group, sex, obesity status, and various medical conditions. Mediation analyses assessed the potential mediating role of 23 circulating biomarkers.
Results:
During a median follow-up of 9.9 y, higher healthful dietary patterns scores were associated with lower risk of DKD, with healthful plant-based index (HPDI) demonstrating the strongest association [HR (95% CI) for highest compared with lowest quintile: 0.55 (0.43, 0.70)]. Moreover, when compared with the same reference group, HPDI remained the top-ranked dietary pattern that was strongly associated with the risk of DKD. Among 8 dietary patterns, only HPDI was associated with lower risks of DR and DN [HR (95% CI) for highest compared with lowest quintile: 0.74 (0.58, 0.96) and 0.61 (0.39, 0.95)]. Furthermore, cystatin C and C-reactive protein play a primary mediating role in these associations.
Conclusions:
Higher healthful dietary pattern scores were associated with lower risk of DKD, whereas inverse associations with risks of DR and DN were mainly observed for HPDI. These associations were mainly mediated through pathways relating to renal function and inflammation.
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