<b>Objective</b>
<p>We evaluated the
associations between changes in plant-based diets and subsequent risk of type 2
diabetes.</p>
<p><b>Methods</b></p>
<p>We prospectively
followed 76,530 women in the Nurses’ Health Study (NHS, 1986-2012), 81,569
women in NHS II (1991-2017), and 34,468 men in the Health Professionals’
Follow-up Study (1986-2016). Adherence to plant-based diets was assessed every
4 years using the overall plant-based diet index (PDI), healthful PDI (hPDI),
and unhealthful PDI (uPDI). We used multivariable Cox proportional hazards
models to estimate hazard ratios (HRs). Results of the three cohorts were
pooled using meta-analysis.</p>
<p><b>Results</b></p>
<p>We documented 12,627
cases of type 2 diabetes during 2,955,350 person-years of follow-up. <a>After adjustment for initial BMI, initial and 4-year
changes in alcohol intake, smoking, physical activity, and other factors, </a><a>compared with participants whose indices remained
relatively stable (±3%), </a><a>participants with the largest decrease (>10%) in PDI and hPDI
over 4 years had a 12%-23% higher diabetes risk in the subsequent 4 years (pooled
HR: PDI, 1.12 (95% CI 1.05, 1.20), hPDI, 1.23 (1.16, 1.31)). </a>Each
10% increment in PDI and hPDI over 4 years was associated with a 7%-9% lower risk
(PDI, 0.93 (0.91, 0.95), hPDI, 0.91 (0.87, 0.95)). Changes in uPDI were not
associated with diabetes risk. Weight changes accounted for 6.0%-35.6% of the
associations between changes in PDI and hPDI and diabetes risk. </p>
<p><b>Conclusions</b></p>
<p>Improving adherence
to overall and healthful plant-based diets was associated with a lower risk of
type 2 diabetes, whereas decreased adherence to such diets was associated with a
higher risk. </p>