Physical Activity Reduces Type 2 Diabetes Risk in Aging Independent of Body Weight Change

2004 ◽  
Vol 1 (1) ◽  
pp. 19-28 ◽  
Author(s):  
James Dziura ◽  
Stanislav V. Kasl ◽  
Loretta Di Pietro
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Body Weight ◽  
Older People ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Protective Role ◽  
Cox Proportional Hazards ◽  
Diabetes Risk

Background:It is not clear whether physical activity can exert a protective role on diabetes risk in older people that is independent of the changes in body weight that occur with both aging and disuse. The purpose of this analysis was to determine the relation between current physical activity, 3-year change in body weight, and the subsequent risk of type 2 diabetes in an older cohort.Methods:We studied prospectively 2,135 older (≥65 years) persons living in New Haven, CT, between 1982 and 1994. Physical activity was self-reported in 1982 and again in 1985; body weight and diabetes were self-reported annually over 12 years. Data were analyzed using multivariable Cox Proportional Hazards modeling with adjustments for age, sex, race, education, body mass index (BMI), smoking, chronic conditions, physical function, and alcohol intake.Results:Although an inverse graded relation was observed between level of activity and rate of diabetes, this dose–response relation did not reach statistical significance. However, older people who reported at least some activity at baseline experienced a significantly lower rate of diabetes between 1983 and 1994 compared to those reporting no activity (RR = 0.55; 95%CI = 0.35, 0.87). When 3-year changes in physical activity and body weight between 1982 and 1985 were added to the model, the relation between physical activity and reduced diabetes risk was unchanged (RR = 0.49; 95%CI = 0.24, 0.99).Conclusions:Even in advanced age, physical activity exerts an important and independent role in the prevention of type 2 diabetes. Continued physician counseling on the health effects of physical activity and referrals to community-based exercise programs should be encouraged among older people.

scholarly journals Association Between Change in Accelerometer-Measured and Self-Reported Physical Activity and Cardiovascular Disease in the Look AHEAD Trial

2022 ◽  
Author(s):  
John M. Jakicic ◽  
Robert I. Berkowitz ◽  
Paula Bolin ◽  
George A. Bray ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Self Report ◽  
Look Ahead ◽  
The Look

OBJECTIVE: To conduct <i>post-hoc</i> secondary analysis examining the association between change in physical activity (PA), measured with self-report and accelerometry, from baseline to 1 and 4 years and cardiovascular disease (CVD) outcomes in the Look AHEAD Trial. <p>RESEARCH DESIGN AND METHODS: Participants were adults with overweight/obesity and type 2 diabetes with PA data at baseline and year 1 or 4 (n = 1,978). Participants were randomized to diabetes support and education or intensive lifestyle intervention. Measures included accelerometry-measured moderate-to-vigorous PA (MVPA), self-reported PA, and composite (morbidity and mortality) CVD outcomes.</p> <p>RESULTS: In pooled analyses of all participants, using Cox proportional hazards models, each 100 MET-min/wk increase in accelerometry-measured MVPA from baseline to 4 years was associated with decreased risk of the subsequent primary composite outcome of CVD. Results were consistent for changes in total MVPA [HR=0.97 (95% CI: 0.95, 0.99)] and MVPA accumulated in <u>></u>10-minute bouts [HR=0.95 (95% CI: 0.91, 0.98)], with a similar pattern for secondary CVD outcomes. Change in accelerometry-measured MVPA at 1 year and self-reported change in PA at 1 and 4 years were not associated with CVD outcomes.</p> <p>CONCLUSIONS: Increased accelerometry-measured MVPA from baseline to year 4 is associated with decreased risk of CVD outcomes. This suggests the need for long-term engagement in MVPA to reduce the risk of CVD in adults with overweight/obesity and type 2 diabetes.</p>

scholarly journals Restricted AccessChanges in Plant-Based Diet Indices and Subsequent Risk of Type 2 Diabetes in Women and Men: Three U.S. Prospective Cohorts

2021 ◽  
Author(s):  
Zhangling Chen ◽  
Jean-Philippe Drouin-Chartier ◽  
Yanping Li ◽  
Megu Y. Baden ◽  
JoAnn E. Manson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lower Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Diabetes Risk ◽  
Health Study ◽  
Weight Changes ◽  
Subsequent Risk

<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>

Abstract 022: Plasma Metabolome Related To Plant-based Diets And The Association With Type 2 Diabetes: A Prospective Cohort Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Fenglei Wang ◽  
Megu Y Baden ◽  
Jun Li ◽  
Marta Guasch-Ferré ◽  
Yanping Li ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lower Risk ◽  
Proportional Hazards ◽  
Metabolic Response ◽  
Cox Proportional Hazards ◽  
Diabetes Risk ◽  
Health Study ◽  
Inverse Association ◽  
Plasma Metabolome

Background: Plant-based diets have been associated with a lower risk of type 2 diabetes. However, the underlying mechanisms are not completely understood, and the evidence using objective approaches to assess the adherence of plant-based diets is limited. Methods: In the Nurses’ Health Study (NHS), NHSII, and Health Professionals Follow-Up Study, we characterized the plasma metabolome related to plant-based diets and examined its association with the incidence of type 2 diabetes among 10 699 participants. Plasma metabolomic profiling was conducted by liquid chromatography-tandem mass spectrometry. Adherence to plant-based diets was assessed by three plant-based diet indices derived from the food frequency questionnaire: an overall plant-based diet index (PDI), a healthful PDI (hPDI), and an unhealthful PDI (uPDI). Metabolomic signatures reflecting the adherence to plant-based diets were created using elastic net regression, and their associations with risk of type 2 diabetes were subsequently evaluated using multivariable Cox proportional hazards regression. Results: Among 263 metabolites measured, nearly half were significantly associated with PDI (41.4%, 109 of 263), hPDI (51.7%, 136 of 263), and uPDI (40.3%, 106 of 263) after Bonferroni correction. We developed a metabolomic signature comprising 53 metabolites for PDI, 76 metabolites for hPDI, and 88 metabolites for uPDI, each robustly correlated with the corresponding diet index (r=0.34-0.36 for PDI, 0.43-0.44 for hPDI, and 0.36-0.37 for uPDI). We observed an inverse association of PDI metabolomic signature (HR 0.86, 95% CI 0.79-0.93 per one standard deviation) and hPDI metabolomic signature (0.79, 0.72-0.86) with type 2 diabetes risk after adjustment for body mass index and other potential confounders. These two inverse associations remained significant even further adjusting for the corresponding diet index PDI and hPDI. The metabolomic signature for uPDI was not associated with type 2 diabetes risk (1.00, 0.93-1.09). Conclusion: Plasma metabolome can robustly reflect adherence and metabolic response to plant-based diets. Metabolomic signatures reflecting greater adherence to an overall plant-based diet, especially a healthful plant-based diet, were associated with a lower risk of type 2 diabetes. These findings support and provide mechanistic insights on the important role of healthful plant-based diets in diabetes prevention.

scholarly journals Changes in Plant Based Diets and Subsequent Risk of Type 2 Diabetes: Results from 3 Large US Cohorts

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1387-1387
Author(s):  
Zhangling Cheng ◽  
Jean-Philippe Drouin-Chartier ◽  
Yanping Li ◽  
Megu Baden ◽  
JoAnn Manson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Proportional Hazards ◽  
Meta Analysis ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Weight Changes ◽  
Cox Proportional Hazards Models

Abstract Objectives Plant-based diets may lower type 2 diabetes (T2D) risk. Whether changes in adherence to plant-based diets are associated with subsequent T2D risk remains unknown. We aimed to evaluate the associations between 4 year changes in plant based diets and subsequent 4 year risk of T2D. Methods We prospectively followed 76,530 women in the Nurses’ Health Study (NHS, 1986–2012), 81,586 women in NHS II (1991–2017), and 34,468 men in the Health Professionals’ Follow-up Study (1986–2016). Diet was assessed every 4 years using validated food-frequency questionnaires. Adherence to plant-based diets was assessed using previously developed indices – the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI). Self reported T2D cases were validated by supplementary questionnaires. We used multivariable time dependent Cox proportional hazards models to estimate hazard ratios (HR) and 95% CIs for T2D associated with 4 year changes in adherence to plant based diets. Results of the three cohorts were pooled using an inverse variance-weighted meta-analysis. Results We documented 12,016 cases of T2D during 2818,485 person-years of follow-up. After adjustment for initial BMI, initial and 4-year changes in lifestyle and other factors, compared with participants whose indices remained relatively stable (±3%), participants with the largest 4-year decrease (&gt;10%) in PDI and hPDI had a 12%-23% higher T2D risk in the subsequent 4 years (HR for PDI, 1.12 (95% CI 1.05, 1.20), HR for hPDI, 1.23 (1.16, 1.31)). Conversely, each 10% incremental increase in PDI and hPDI over 4 years was associated with a 7%–9% lower T2D risk in subsequent 4 years (HR for PDI, 0.93 (0.90, 0.95), HR for hPDI, 0.91 (0.87, 0.95)). Changes in uPDI were not associated with T2D risk. Further adjustment for concurrent changes in body weight, a potential mediator, modestly attenuated the associations but results remained significant. We estimated that body weight changes explained 6.0%–36% of the associations between 4 year changes in PDI and hPDI and subsequent T2D risk. Conclusions Improving adherence to overall and healthful plant based diets over a 4 year period was associated with a lower T2D risk, whereas decreased adherence to overall and healthful plant based diets was associated with a higher T2D risk. Funding Sources Nutricia Research Foundation/NIH.

scholarly journals Association Between Change in Accelerometer-Measured and Self-Reported Physical Activity and Cardiovascular Disease in the Look AHEAD Trial

2022 ◽  
Author(s):  
John M. Jakicic ◽  
Robert I. Berkowitz ◽  
Paula Bolin ◽  
George A. Bray ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Self Report ◽  
Look Ahead ◽  
The Look

OBJECTIVE: To conduct <i>post-hoc</i> secondary analysis examining the association between change in physical activity (PA), measured with self-report and accelerometry, from baseline to 1 and 4 years and cardiovascular disease (CVD) outcomes in the Look AHEAD Trial. <p>RESEARCH DESIGN AND METHODS: Participants were adults with overweight/obesity and type 2 diabetes with PA data at baseline and year 1 or 4 (n = 1,978). Participants were randomized to diabetes support and education or intensive lifestyle intervention. Measures included accelerometry-measured moderate-to-vigorous PA (MVPA), self-reported PA, and composite (morbidity and mortality) CVD outcomes.</p> <p>RESULTS: In pooled analyses of all participants, using Cox proportional hazards models, each 100 MET-min/wk increase in accelerometry-measured MVPA from baseline to 4 years was associated with decreased risk of the subsequent primary composite outcome of CVD. Results were consistent for changes in total MVPA [HR=0.97 (95% CI: 0.95, 0.99)] and MVPA accumulated in <u>></u>10-minute bouts [HR=0.95 (95% CI: 0.91, 0.98)], with a similar pattern for secondary CVD outcomes. Change in accelerometry-measured MVPA at 1 year and self-reported change in PA at 1 and 4 years were not associated with CVD outcomes.</p> <p>CONCLUSIONS: Increased accelerometry-measured MVPA from baseline to year 4 is associated with decreased risk of CVD outcomes. This suggests the need for long-term engagement in MVPA to reduce the risk of CVD in adults with overweight/obesity and type 2 diabetes.</p>

scholarly journals Do adolescent sedentary behavior levels predict type 2 diabetes risk in adulthood?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jillian A. Scandiffio ◽  
Ian Janssen
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Sedentary Behavior ◽  
Smoking Status ◽  
Cox Proportional Hazards ◽  
Diabetes Risk ◽  
Sedentary Behaviors ◽  
Increased Risk ◽  
Incident Cases

Abstract Background The objective was to determine whether time spent in different types of sedentary behavior during adolescence are associated with the risk of developing type 2 diabetes in adulthood. Methods Participants were 3942 adolescents aged 16 years who were part of the 1970 British Cohort Study. Sedentary behavior was assessed using a questionnaire that asked participants to indicate how much time they spent watching TV and videos, using the computer, reading, and doing homework. Incident cases of type 2 diabetes were determined quadrennially until 46 years of age. The association between adolescent sedentary behaviors and type 2 diabetes was determined using Cox proportional hazards regression that controlled for sex, body mass index, sugary beverage consumption, smoking status, physical activity at baseline, and physical activity in adulthood . Results There were 91 incident cases of type 2 diabetes with an incidence rate of 9 cases/10,000 person-years. By comparison to those who watched TV and videos for 2 or less hours/day, type 2 diabetes risk was not different in those who watched for 2.1–4.0 h/day (HR = 0.89, 95% CI = 0.54, 1.47) but was increased by 2.06-fold (95% CI = 1.24, 3.43) in those who watched for more than 4 h/day. Time spent using a computer, reading, and doing homework were not significantly associated with type 2 diabetes. Conclusion Spending more than 4 h/day watching television and videos at age 16 was associated with an increased risk of type 2 diabetes. Conversely, using a computer and non-screen based sedentary behaviors were not associated with type 2 diabetes risk.

scholarly journals Anti-Müllerian hormone levels and risk of type 2 diabetes in women

Diabetologia ◽  
2020 ◽  
Author(s):  
Renée M. G. Verdiesen ◽  
N. Charlotte Onland-Moret ◽  
Carla H. van Gils ◽  
Rebecca K. Stellato ◽  
Annemieke M. W. Spijkerman ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Proportional Hazards ◽  
Ovarian Follicle ◽  
Cox Proportional Hazards ◽  
Diabetes Risk ◽  
Diabetes Research ◽  
Age Related ◽  
Reproductive Ageing

Abstract Aims/hypothesis Given its role in ovarian follicle development, circulating anti-Müllerian hormone (AMH) is considered to be a marker of reproductive ageing. Although accelerated reproductive ageing has been associated with a higher risk of type 2 diabetes, research on the relationship between AMH and type 2 diabetes risk is scarce. Therefore, we aimed to investigate whether age-specific AMH levels and age-related AMH trajectories are associated with type 2 diabetes risk in women. Methods We measured AMH in repeated plasma samples from 3293 female participants (12,460 samples in total), aged 20–59 years at recruitment, from the Doetinchem Cohort Study, a longitudinal study with follow-up visits every 5 years. We calculated age-specific AMH tertiles at baseline to account for the strong AMH–age correlation. Cox proportional hazards models adjusted for confounders were used to assess the association between baseline age-specific AMH tertiles and incident type 2 diabetes. We applied linear mixed models to compare age-related AMH trajectories for women who developed type 2 diabetes with trajectories for women who did not develop diabetes. Results During a median follow-up of 20 years, 163 women developed type 2 diabetes. Lower baseline age-specific AMH levels were associated with a higher type 2 diabetes risk (HRT2vsT3 1.24 [95% CI 0.81, 1.92]; HRT1vsT3 1.62 [95% CI 1.06, 2.48]; ptrend = 0.02). These findings seem to be supported by predicted AMH trajectories, which suggested that plasma AMH levels were lower at younger ages in women who developed type 2 diabetes compared with women who did not. The trajectories also suggested that AMH levels declined at a slower rate in women who developed type 2 diabetes, although differences in trajectories were not statistically significant. Conclusions/interpretation We observed that lower age-specific AMH levels were associated with a higher risk of type 2 diabetes in women. Longitudinal analyses did not show clear evidence of differing AMH trajectories between women who developed type 2 diabetes compared with women who did not, possibly because these analyses were underpowered. Further research is needed to investigate whether AMH is part of the biological mechanism explaining the association between reproductive ageing and type 2 diabetes.

scholarly journals Body Weight Fluctuation as a Risk Factor for Type 2 Diabetes: Results from a Nationwide Cohort Study

2019 ◽  
Vol 8 (7) ◽  
pp. 950 ◽  
Author(s):  
Kye-Yeung Park ◽  
Hwan-Sik Hwang ◽  
Kyung-Hwan Cho ◽  
Kyungdo Han ◽  
Ga Eun Nam ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Risk Factor ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
National Health Insurance System ◽  
Weight Fluctuation

We aimed to investigate how body weight fluctuation affects the risk of developing type 2 diabetes by conducting a nationwide cohort study. A total of 3,855,884 participants from the National Health Insurance System health check-up data from 2012 were included in this study, and follow-up continued until 2016. Body weight was measured at least thrice between 2009 and 2012. Body weight variability (BWV) was estimated using average successive variability (ASV) indices. Cox proportional hazards regression models were used to evaluate the association of BWV with the risk of type 2 diabetes using hazard ratios (HRs) and 95% confidence intervals (CIs). Body weight fluctuation was associated with a higher risk of incident diabetes after adjustment for confounders (HR 1.10, 95% CI 1.07, 1.12 in the highest BWV quartile compared to the lowest). Regardless of the weight change status, the highest ASV quartile of BWV increased the risk for diabetes. Even subjects with a normal glucose tolerance status and those aged under 65 years had a higher risk of diabetes if their body weight highly fluctuated during the follow-up years. Our results suggest that body weight variability is an independent risk factor for diabetes. It is important to pay attention to frequent body weight fluctuations.

scholarly journals Carbohydrate intake and incidence of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study

2008 ◽  
Vol 99 (5) ◽  
pp. 1107-1116 ◽  
Author(s):  
Matthias B. Schulze ◽  
Mandy Schulz ◽  
Christin Heidemann ◽  
Anja Schienkiewitz ◽  
Kurt Hoffmann ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Statistical Significance ◽  
Cox Proportional Hazards ◽  
Diabetes Risk ◽  
Carbohydrate Intake ◽  
Long Term Effects ◽  
Monounsaturated Fat ◽  
Full Cohort ◽  
Incident Cases

It remains unclear what long-term effects of substituting carbohydrates at the expense of protein or fat may have with regard to diabetes risk. Our objective was to evaluate carbohydrate intake in predicting type 2 diabetes using substitution models for fat and protein. We conducted a prospective cohort study of 9702 men and 15 365 women aged 35–65 years and free of diabetes at baseline (1994–8) who were followed for incident type 2 diabetes until 2005. Dietary intake of macronutrients was estimated with a validated FFQ. We estimated the relative risk (RR) using Cox proportional hazards analysis. During 176 117 person-years of follow-up we observed 844 incident cases of physician-confirmed type 2 diabetes. After adjustment for age, BMI, waist circumference, potential lifestyle and dietary confounders, substituting 5 % of energy intake from total, saturated, or monounsaturated fat with carbohydrates was not associated with diabetes risk. In contrast, substituting carbohydrates for protein or PUFA was inversely related to diabetes risk (RR for 5 % energy substitution of protein 0·77 (95 % CI 0·64, 0·91); RR for PUFA 0·83 (95 % CI 0·70, 0·98)). These associations appeared to be similar for men and women, but gained statistical significance only among men for protein (RR 0·78 (95 % CI 0·61, 0·99)). Restricted cubic spline regression did not indicate non-linearity of these associations (P for non-linearity in full cohort was 0·353 and 0·349). In conclusion, a higher carbohydrate intake at the expense of protein and PUFA might be associated with decreased diabetes risk.

scholarly journals Restricted AccessChanges in Plant-Based Diet Indices and Subsequent Risk of Type 2 Diabetes in Women and Men: Three U.S. Prospective Cohorts

2021 ◽  
Author(s):  
Zhangling Chen ◽  
Jean-Philippe Drouin-Chartier ◽  
Yanping Li ◽  
Megu Y. Baden ◽  
JoAnn E. Manson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lower Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Diabetes Risk ◽  
Health Study ◽  
Weight Changes ◽  
Subsequent Risk

<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>

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