Differential associations of dietary patterns with estimated 10-year cardiovascular risk in diabetes subtypes

Diet impacts cardiovascular disease risk, but the association across diabetes subtypes is unclear. We thus aimed to assess the association between dietary factors and estimated 10-year cardiovascular disease risk across diabetes subtypes in the German Diabetes Study (GDS). Participants with recent-onset diabetes and from the 5-year follow-up examination were combined (n=635, mean age 47.5±12.9 years, 60% male) and classified into diabetes subtypes. Subtypes with prevalence >10% were included in cross-sectional analyses: severe autoimmune diabetes (39%), mild obesity-related diabetes (31%), and mild age-related diabetes (30%). Carbohydrate quality parameters and adherence to dietary patterns were assessed from food frequency questionnaires. Differences in associations between these dietary factors and 10-year cardiovascular risk estimated by SCORE2-Diabetes across subtypes were examined using multivariable-adjusted linear regression models including an interaction term. In people with severe autoimmune diabetes, the overall and the healthful plant-based diet index were associated with lower estimated 10-year cardiovascular risk (ß [95% CI] -6.8 [-12.1; -1.2] and -8.8% [-14.0; -3.2] per 1-standard deviation increases, respectively), while these associations were not evident among the remaining two subtypes (p-value for interaction between subtypes <0.05). Our findings suggest subtype-specific associations of plant-based dietary patterns with estimated cardiovascular risk, warranting further research from longitudinal and intervention studies. Trial registration: Clinicaltrials.gov: NCT01055093.