Healthful and unhealthful plant-based diets and their associa-tion with cardiometabolic targets in women diagnosed with breast cancer participating in a multicentric lifestyle trial: a cross-sectional analysis.

Background Plant-based diets are recommended for the prevention of cancer and cardiometabolic diseases which remain major causes of death in breast cancer survivors (BCS). Since not all plant-foods are healthy, we calculated the plant-based dietary index (PDI), healthy (hPDI) and unhealthy (uPDI), and their associations with cardiometabolic targets in BCS. Methods Baseline dietary and cardiometabolic data were derived from 492 female BCS participating in a multicentric lifestyle trial conducted in Italy. Dietary data were collected with 7-day food records. PDI, hPDI, and uPDI were calculated by assigning positive scores to all plant foods, healthy plant foods, or less healthy plant foods, respectively, as defined by the literature (scores ranged from 18 to 90). Using logistic or multinomial regression models we estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) between PDIs and cardiometabolic risk factors. Results The OR of being obese (BMI≥30Kg/m2) was 0.47 (95%CI: 0.29-0.77), 0.37 (95%CI: 0.22-0.61) and 1.38 (95%CI: 0.83-2.28) with higher PDI, hPDI and uPDI, respectively. The OR of having a large waist circumference (≥ 88cm) was 0.64 (95%CI: 0.42-1.00) with higher hPDI. The OR for hypercholesterolemia (≥200mg/dL) was 1.80 (95%CI: 1.16-2.78) with higher uPDI. The ORs of hypertriglyceridemia (≥150mg/dL) and metabolic syndrome were 0.38 (95%CI: 0.20-0.71) and 0.59 (95%CI: 0.35-0.97), respectively, with higher PDI. No other significant associations were observed. Conclusions Maintaining cardiometabolic risk factors within normal ranges is clinically relevant in BCS and this may be more likely when a plant-based diet is consumed especially if low in unhealthy plant foods.背景 植物性饮食被推荐用于预防癌症与心血管代谢疾病——二者仍是乳腺癌幸存者（breast cancer survivors, BCS）的主要致死原因。由于并非所有植物性食物均属健康范畴，本研究计算了植物性饮食指数（plant-based dietary index, PDI）、健康植物性饮食指数（healthy plant-based dietary index, hPDI）与不健康植物性饮食指数（unhealthy plant-based dietary index, uPDI），并分析其与乳腺癌幸存者心血管代谢指标的关联。 方法 本研究的基线膳食与心血管代谢数据来自意大利一项多中心生活方式试验中的492名女性乳腺癌幸存者。膳食数据通过7天食物记录法收集。依据已发表文献的定义，分别对所有植物性食物、健康植物性食物及不健康植物性食物赋予正向评分，以此计算PDI、hPDI与uPDI，评分范围为18~90。采用logistic回归与多项logistic回归模型，估算不同植物性饮食指数与心血管代谢危险因素之间的比值比（odds ratios, OR）及对应95%置信区间（confidence intervals, CI）。 结果 较高的PDI、hPDI与uPDI对应的肥胖（BMI≥30kg/m²）风险比值比分别为0.47（95%CI：0.29~0.77）、0.37（95%CI：0.22~0.61）与1.38（95%CI：0.83~2.28）。较高的hPDI与腰围≥88cm的风险比值比为0.64（95%CI：0.42~1.00）。较高的uPDI与高胆固醇血症（≥200mg/dL）的风险比值比为1.80（95%CI：1.16~2.78）。较高的PDI与高甘油三酯血症（≥150mg/dL）及代谢综合征的风险比值比分别为0.38（95%CI：0.20~0.71）与0.59（95%CI：0.35~0.97）。未观察到其他显著关联。 结论 维持心血管代谢危险因素处于正常范围对乳腺癌幸存者具有临床意义，而遵循植物性饮食，尤其是减少不健康植物性食物摄入时，更易实现这一目标。