The Association between Plant-Based Diet Indices and Metabolic Syndrome in Chinese Adults: Longitudinal Analyses from the China Health and Nutrition Survey

Abstract

Objectives: To investigate the association between a plant-based diet and metabolic syndrome (MetS) among Chinese adults. Methods: Based on the data from the 2004–2015 China Health and Nutrition Survey and the corresponding edition of China Food Composition, we calculated the healthy plant-based diet indices (hPDI) and unhealthy plant-based diet indices (uPDI). The Cox proportional hazards regression model was used to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs) for MetS. Mediation analysis was further conducted to explore the mediator role of Body Mass Index (BMI) in the association between hPDI and MetS. Results: We included 10,013 participants, and over a median follow-up of 5 years, 961 patients (9.60%) developed MetS. Compared to those in the lowest quintile of hPDI score, we found that those in the highest quintile of hPDI score had a 28% lower ([HR]: 0.72, 95% CI 0.56–0.93, Ptrend = 0.021) risk of developing MetS and had a 20% lower (hazard ratio [HR]: 0.80, 95% CI 0.70–0.92, Ptrend = 0.004) risk of developing abdominal obesity. No significant associations were observed between uPDI and the MetS, but those in the highest quintile of uPDI score had a 36% higher (hazard ratio [HR]: 1.36, 95% CI 1.20–1.64, Ptrend < 0.001) risk of developing abdominal obesity, compared to those in the lowest quintile of uPDI score. In exploratory analysis, we observed that BMI at baseline mediated 27.8% of the association between hPDI and incident MetS, and BMI at baseline mediated 29.7% of the association between hPDI and abdominal obesity. Conclusion: The current findings reveal a possible causal relationship between a healthy plant-based diet and a reduced risk of MetS, especially abdominal obesity. It is observed that BMI may mediate the relationship between hPDI score and MetS. Controlling early dietary patterns and BMI may help reduce the risk of MetS.

Association between plant-based diets and metabolic syndrome in obese adults from Iran: a cross-sectional study

“…Our results were compared with those from several studies assessing the relationship between MetS risk and: (1) overall diet, which includes animal-based and plant components, or (2) vegetarian diets. In line with our study, Huo et al [ 40 ] in a cohort study in Chinese adults also revealed no significant relationship between uPDI and MetS, however, they found an inverse association between the hPDI and MetS. They reported that participants in the highest quintile of hPDI score had a 20% lower risk of developing high WC and had a 28% lower risk of developing MetS.…”

The Interplay between Metabolic Syndrome and Religious Fasting in Postmenopausal Women

“…According to our knowledge, this is one of the first studies that focused on the effects of COC fasting on MetS and showed promising protective effects. In addition, studies that focus on vegetarian diets [50], such as the Adventist Health Study 2 [51] and the China Health and Nutrition Survey [52], have found that following a more plant-based dietary pattern may have a protective role against MetS, thus further supporting our study findings.…”

The association between plant-based diet indices and metabolic syndrome: a systematic review and dose–response meta-analysis

“…Table 1 describes the characteristics of eligible studies [including 7 cross-sectional studies ( 3 , 5 , 21 , 22 , 24 – 26 ) and 2 cohort studies ( 4 , 23 )], which included a total of 34,953 participants. The eligible studies have been conducted in Iran ( 5 , 21 , 22 , 26 ), South Korea ( 23 , 24 ), China ( 4 ), Denmark ( 25 ), and the United States ( 3 ). These studies were published between 2020 and 2023.…”

“…Dietary intakes were assessed in seven studies using the food frequency questionnaire ( 3 , 5 , 21 – 24 , 26 ), as well as in two studies using a 24-h recall ( 4 , 25 ). Among the 9 included studies, MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) in 3 studies ( 21 – 23 ), the Joint Interim Statement (JIS) in 4 studies ( 5 , 24 – 26 ), and the National Chinese guidelines in 1 study ( 4 ). However, 1 study did not provide the method by which MetS was defined ( 3 ).…”

“…In addition, the results of a meta-analysis study conducted on longitudinal investigations including 698,707 participants who predominantly lived in the United States and the United Kingdoms indicated that individuals who were in the highest categories of plant-based diets compared to those in the lowest ones had a 14% lower risk of cardiovascular diseases ( 35 ). In recent years, several studies have been conducted to demonstrate whether adherence to PDIs is associated with MetS and its related components ( 3 , 4 , 22 , 24 , 26 ). Huo et al performed a longitudinal study among 9,949 Chinese adults in the framework of the China Health and Nutrition Survey, which demonstrated that throughout a five-year follow-up period, participants who were in the highest quintile of H-PDI compared to those in the lowest quintile of H-PDI had a 28% lower risk of MetS after controlling for cardiometabolic and lifestyle confounders ( 4 ).…”