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ALETHA AYU 1710221018

Tina H.T. Chiu, Wen-Ham Pan, Ming-Nan Lin and Chin-Lon Lin


Dr. dr. Pugud Samodro, SpPD-KEMD FINASIM


• Vegetarian diets are • Study : Prospective • Consistent vegetarian Vegetarian diet and
inversely associated
. • Inclusion criteria : 2918 non- diet was associated with converting to vegetarian
with diabetes in smoking, non-alcohol drinking 35% lower hazards (HR: diet may protect against
Westerners but their Buddhists free of diabetes, cancer, 0.65, 95% CI: 0.46, 0.92) diabetes independent of
impact on Asians is and cardiovascular diseases at BMI
unknown. baseline, for a median of 5 years, • Converting from a among Taiwanese.
with 183 incident diabetes cases nonvegetarian to a
• We aim to investigate confirmed. vegetarian pattern was
the association • Instrument : a validated FFQ  at associated with 53%
between a vegetarian baseline, a simple questionnaire lower hazards (HR: 0.47,
diet, change in dietary  during follow-ups. Incident 95% CI:0.30, 0.71) for
patterns and diabetes cases of diabetes - follow-up diabetes,
risk in a Taiwanese questionnaires, fasting glucose
Buddhist population and HbA1C. the effect of diets on
risk of diabetes  Stratified Cox
Proportional Hazards Regression
- The rapid growth of diabetes creates - High blood glucose accounts is the highest
tremendous health & economic burdens adult mortality among major metabolic,
worldwide lifestyle, and environmental factors
- In Taiwan, diabetes patients incur 2.8 - Preventive strategies are desperately
times more medical expense & used up needed, particularly in Asia, where the
29% of total healthcare expenditure largest number of diabetes cases is
expected, and diabetes tend to occur
despite lower BMI
- Our primary aim is to examine the association
between a vegetarian diet, converting from a
- Vegetarian diets and plant-based dietary patterns
nonvegetarian to a vegetarian dietary pattern,
have been shown to dramatically reduce diabetes
and diabetes risk in a prospective cohort study.
risks in American populations, but their effect in
Asians is less clear. - Our secondary aim is to explore potential
interaction between dietary patterns and
baseline metabolic status (BMI, metabolic
syndrome, and other metabolic characteristics).
• Prospective cohort study that recruited Assement of
4625 Tzu Chi volunteers (age 18 - 87 Metabolic
years) from 2007 - 2009 at the Buddhist Characteritic
Dalin Tzu Chi Hospital
• This cohort is equipped with a unique • Fasting glucose and TG, HDL-C and
opportunity to distinguish disease risk other cholesterol were assessed
between true vegetarians and those with by the Integra 800 system at
little to modest meat consumption baseline and Dimension RxL Maxat
• Participants were followed from 2010 to follow-ups
2012 (1st follow-up), and from 2013 to • HbA1C was assessed by Variant
mid-2016 (2nd follow-up) Turbo
• The study was approved by the • Heights and weights were
Institutional Review Board for ethics in measured using an electronic scale
the Buddhist Dalin Tzu Chi Hospital. while participants stood in an
• The study has been registered upright position without shoes
ClinicalTrials.gov (ID: NCT: 03204552). • Waist circumference was
Study Design & measured at navel
Assesment of Metabolic
Blood pressures were assessed using
VP1000 system

Metabolic syndrome was defined by using the
Taiwanese cut points for waist circumference (≥90
cm for men, ≥80 cm for women).

Fatty liver was assessed using

ultrasonography by hospital
Assesment of Diet
Not vegetarian, breakfast vegetarian,
vegetarian on 1st and 15th day of each
At baseline, participants were At follow-ups, all participants
lunar month), irregular dates of
interviewed on a 64-item vegetarian diets,that
answered a simple questionnaire full time
quantitative food frequency they are vegetarians and the type
questionnaire (FFQ) of vegetarian diet
vegan, lacto-ovo vegetarian, lacto-
vegetarian, ovo-vegetarian.

Diabetes cases were identified if Vegetarian

participants reported diabetes
diagnosis at follow-up questionnaires, The reverted DIETARY
or if their HbA1C ≥6.5%, and further
reviewed their medical records
The converted
Non vegetarian
Statistical Analysis

Baseline characteristics Cox regression was used to analyze the

between different dietary association between dietary patterns and
risk of diabetes
patterns were compared using
Proportional hazard assumption with
ANOVA test (for continuous Stratification used for LTPA and follow-up
variables) and Chi square test methods (questionnaire only vs health
(for categorical variables). examination)
To calculate the incidence of diabetes and avoid bias related with
comorbidities, we excluded participants with:
1. Baseline diabetes/ fasting blood gicose >= 7 mmol/L (n=322)
2. History of cancer (n =172)
3. Coronary Heart Disease (n=94)
4. Stroke (n=26)
5. Cigarette (n=691)
6. Alcohol (n=606)
7. Lost to follow-up (n=210)
8. Didn’t know about their diabetes status in followup questionnaire
9. Missed item diagnosis in questionnaire (n=42)
10. Unconfirmed diabetes (n=25)

2918 participants
In this prospective cohort study, both vegetarian diet and
nonvegetarians switching to vegetarian diets are
associated with ~50% reduction in risk of diabetes.

This is the 1st study that examined the prospective association

between a vegetarian diet and diabetes in high risk Asians, and
addressed how switching from a nonvegetarian diet to a vegetarian diet
may influences diabetes risk

• The magnitude of protective association between a vegetarian diet and

diabetes in our study is comparable to the Adventist Health Study
• In all these studies, BMI appears to account for only a small portion of
the protective association
• Vegetarians in our cohort and in AHS-2 consumed more whole grains
and vegetables than nonvegetarians and these may protect against
diabetes through higher fiber and magnesium
• Soy has been shown to improve insulin resistance when replacing meat
in randomized controlled trials
• Soy and legume are inversely associated with risk of diabetes in a
Chinese cohort.
Meat is high in saturated fats, which have been shown to trigger human β-cell

Fatty acids from meat have been adversely associated with insulin secretion and
Disposition Index (β-cell function accounting for insulin sensitivity)

A trial showed that while plant polyphenol improves glucose metabolism, fish
omega-3 fatty acids decreases insulin secretion and postprandial GLP-1

High intakes of animal protein may induce insulin resistance through 3-

Hydroxyinsbutyrate (a valine metabolite) and fibroblast growth factor

However, the association between meat and diabetes is equivocal among Asian
women: meat was not associated with diabetes risk in Japanese women
Potential the protective association between a vegetarian diet and diabetes is likely similar for
both genders.
and effect
In our subgroup analysis, however, the association between a vegetarian diet and
diabetes did not differ significantly across categories of BMI or metabolic syndrome.

The effect of lifestyle interventions tend to be more obvious for individuals at high risk
than those at low Risk.

Interestingly, we found that the association between converting to vegetarian diet and
risk to be quite strong for those with supposedly healthier metabolic status: normal TG
(HR = 0.32), without metabolic syndrome (HR = 0.32), and BMI < 24 (HR = 0.24).
Change in Diet
The strong inverse association
between converting to Switching to a complete plant-
vegetarian diet and diabetes based diet may increase
suggests that diabetes risk or butyrate and will improve
protection may be influenced by glucose metabolism
recent diets

Converting vegetarian diet (53% reduction These findings, together, suggest that
in diabetes risk compared with a persistent a powerful diabetes preventive
nonvegetarian diet) in our population is potential may be achieved by either a
comparable to the Diabetes Prevention Trial
healthy plant-based diet (calorically
(58% reduction in diabetes risk through
lifestyle changes aiming at weight non-restrictive) or a BMIlowering
reduction), which is more effective than use intervention aiming to reduce
of metformin (31% reduction) among high calories and increase physical
risk individuals activities

1. Our study suggests that a vegetarian diet may

immensely reduce the risk of diabetes in lean
Asian populations.

2. A vegetarian diet may be a stunning solution to the

diet–environment–health trilemma that our globe
urgently need to tackle, for the welfare, if not the
survival, of many who are deeply threatened by
climate change and diabetes