Plant-based dietary patterns and age-specific risk of multimorbidity of cancer and cardiometabolic diseases: a prospective analysis

Reynalda Córdova; Jihye Kim; Alysha S Thompson; Hwayoung Noh; Sanam Shah; Christina C Dahm; Christopher F Jensen; Lene Mellemkjær; Anne Tjønneland; Verena Katzke; Charlotte Le Cornet; Christine El-Khoury; Matthias B Schulze; Giovanna Masala; Claudia Agnoli; Vittorio Simeon; Rosario Tumino; Fulvio Ricceri; W M Monique Verschuren; Yvonne T van der Schouw; Carlota Castro-Espin; Maria-José Sánchez; Amaia Aizpurua; Daniel Rodríguez Palacios; Marcela Guevara; Keren Papier; Tammy Y N Tong; Inge Huybrechts; Karl-Heinz Wagner; Komodo Matta; Nikos Papadimitriou; Alicia Heath; Dagfinn Aune; Marc J Gunter; Pietro Ferrari; Tilman Kühn; Heinz Freisling

doi:10.1016/j.lanhl.2025.100742

Plant-based dietary patterns and age-specific risk of multimorbidity of cancer and cardiometabolic diseases: a prospective analysis

Reynalda Córdova
, Jihye Kim
, Alysha S Thompson
, Hwayoung Noh
, Sanam Shah
, Christina C Dahm
, Christopher F Jensen
, Lene Mellemkjær
, Anne Tjønneland
, Verena Katzke
, Charlotte Le Cornet
, Christine El-Khoury
, Matthias B Schulze
, Giovanna Masala
, Claudia Agnoli
, Vittorio Simeon
, Rosario Tumino
, Fulvio Ricceri
, W M Monique Verschuren
, Yvonne T van der Schouw

Carlota Castro-Espin, Maria-José Sánchez, Amaia Aizpurua, Daniel Rodríguez Palacios, Marcela Guevara, Keren Papier, Tammy Y N Tong, Inge Huybrechts, Karl-Heinz Wagner, Komodo Matta, Nikos Papadimitriou, Alicia Heath, Dagfinn Aune, Marc J Gunter, Pietro Ferrari, Tilman Kühn, Heinz Freisling

Department für Ernährungswissenschaften

Veröffentlichungen: Beitrag in Fachzeitschrift › Artikel › Peer Reviewed

Abstract

BACKGROUND: It is currently unknown whether plant-based dietary patterns influence disease progression to multimorbidity after an initial non-communicable disease, and whether the associated risk of multimorbidity varies with age. This study aimed to investigate associations of plant-based diets with the risk of multimorbidity, defined as the co-occurrence of at least two chronic diseases in an individual (either cancer at any site, cardiovascular disease, or type 2 diabetes).

METHODS: This prospective cohort study used data from EPIC and UK Biobank across six European countries, with participants aged 35-70 years at recruitment. We excluded participants from these cohorts who had cancer, cardiovascular disease, or type 2 diabetes at baseline or those with missing data on diet or health outcomes. Data on dietary habits were assessed either at baseline through a validated dietary questionnaire about habits in the previous 12 months or through several 24-h recall questionnaires during approximately a year of follow-up. Multistate modelling with Cox regression was used to estimate the risk of multimorbidity according to a healthful plant-based diet index (hPDI) and, separately, an unhealthful plant-based diet index (uPDI). Risk differences in adults younger than 60 years and those age 60 years and older were estimated.

FINDINGS: 407 618 participants (226 324 from EPIC and 181 294 from UK Biobank) were included in this study. During a median follow-up time of 10·9 years in EPIC and 11·4 years in UK Biobank, 6604 cancer-cardiometabolic multimorbidity events occurred in both cohorts combined. A ten-point increment of the hPDI score was associated with a lower risk of multimorbidity, with a hazard ratio (HR) of 0·89 (95% CI 0·83-0·96) in EPIC and 0·81 (0·76-0·86) in UK Biobank. This inverse association was marginally weaker in older adults than in middle-aged adults in both cohorts. In UK Biobank, a ten-point increment of the hPDI score was associated with multivariable-adjusted HRs of 0·71 (95% CI 0·65-0·79) in adults younger than 60 years and 0·86 (0·80-0·92) in those aged 60 years and older (p interaction=0·0016). The respective HRs in EPIC were 0·86 (95% CI 0·78-0·95) and 0·92 (0·84-1·02; p interaction=0·32). A higher adherence to an unhealthy plant-based diet was positively associated with multimorbidity risk in UK Biobank (HR per ten-point increment of uPDI 1·22, 95% CI 1·16-1·29), but this was not replicated in EPIC (1·00, 0·94-1·08).

INTERPRETATION: A healthy plant-based diet might reduce the burden of multimorbidity of cancer and cardiometabolic diseases among middle-aged and older adults.

FUNDING: The Korean Government (Ministry of Science and ICT).

Originalsprache	Englisch
Aufsatznummer	100742
Fachzeitschrift	The Lancet. Healthy Longevity
Jahrgang	6
Ausgabenummer	8
DOIs	https://doi.org/10.1016/j.lanhl.2025.100742
Publikationsstatus	Veröffentlicht - Aug. 2025

Fördermittel

This work was supported by the National Research Foundation of Korea grant funded by the South Korean government ( Ministry of Science and ICT ; grant number 2021R1A2C1003211 and RS-2025–00513735 to Jihye Kim). The coordination of EPIC–Europe is financially supported by International Agency for Research on Cancer and by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre. The national cohorts are supported by the Danish Cancer Society; Ligue Nationale Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale, French National Research Agency (reference ANR-10-COHO-0006), and French Ministry for Higher Education (subsidy 2102918823, 2103236497, and 2103586016); German Cancer Aid, German Cancer Research Center, German Institute of Human Nutrition Potsdam-Rehbruecke, and Federal Ministry of Education and Research; Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Italian Ministry of Health, Italian Ministry of University and Research, and Compagnia di San Paolo; Dutch Ministry of Public Health, Welfare and Sports, the Netherlands Organisation for Health Research and Development, and World Cancer Research Fund; UiT The Arctic University of Norway; Health Research Fund—Instituto de Salud Carlos III, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology; Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten; and Cancer Research UK (C864/A14136 to EPIC–Norfolk and C8221/A29017 to EPIC–Oxford), Medical Research Council (MR/N003284/1, MC-UU_12015/1, and MC_UU_00006/1 to EPIC–Norfolk; MR/Y013662/1 to EPIC–Oxford). Previous support has come from the Europe Against Cancer Programme of the European Commission (DG SANCO). We acknowledge the use of data from the EPIC–Asturias cohort, the EPIC-Norfolk cohort, and thank the National Institute for Public Health and the Environment, Bilthoven, the Netherlands, for their contribution and ongoing support to the EPIC Study. This research has been done with the UK Biobank Resource under Application Number 55870 and we express our gratitude to the participants and those involved in building the resource. Where authors are identified as personnel of the International Agency for Research on Cancer or WHO, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer or WHO. This work was supported by the National Research Foundation of Korea grant funded by the South Korean government (Ministry of Science and ICT; grant number 2021R1A2C1003211 and RS-2025–00513735 to Jihye Kim). The coordination of EPIC–Europe is financially supported by International Agency for Research on Cancer and by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre. The national cohorts are supported by the Danish Cancer Society; Ligue Nationale Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale, French National Research Agency (reference ANR-10-COHO-0006), and French Ministry for Higher Education (subsidy 2102918823, 2103236497, and 2103586016); German Cancer Aid, German Cancer Research Center, German Institute of Human Nutrition Potsdam-Rehbruecke, and Federal Ministry of Education and Research; Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Italian Ministry of Health, Italian Ministry of University and Research, and Compagnia di San Paolo; Dutch Ministry of Public Health, Welfare and Sports, the Netherlands Organisation for Health Research and Development, and World Cancer Research Fund; UiT The Arctic University of Norway; Health Research Fund—Instituto de Salud Carlos III, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology; Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten; and Cancer Research UK (C864/A14136 to EPIC–Norfolk and C8221/A29017 to EPIC–Oxford), Medical Research Council (MR/N003284/1, MC-UU_12015/1, and MC_UU_00006/1 to EPIC–Norfolk; MR/Y013662/1 to EPIC–Oxford). Previous support has come from the Europe Against Cancer Programme of the European Commission (DG SANCO). We acknowledge the use of data from the EPIC–Asturias cohort, the EPIC-Norfolk cohort, and thank the National Institute for Public Health and the Environment, Bilthoven, the Netherlands, for their contribution and ongoing support to the EPIC Study. This research has been done with the UK Biobank Resource under Application Number 55870 and we express our gratitude to the participants and those involved in building the resource. Where authors are identified as personnel of the International Agency for Research on Cancer or WHO, the authors alone are responsible for the views expressed in this Article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer or WHO.

UN SDGs

Dieser Output leistet einen Beitrag zu folgendem(n) Ziel(en) für nachhaltige Entwicklung

SDG 3 – Gesundheit und Wohlergehen

ÖFOS 2012

303009 Ernährungswissenschaften

Zugriff auf Dokument

10.1016/j.lanhl.2025.100742

Andere Dateien und Links

Verknüpfung zur Publikation in Scopus

Zitationsweisen

Córdova, R., Kim, J., Thompson, A. S., Noh, H., Shah, S., Dahm, C. C., Jensen, C. F., Mellemkjær, L., Tjønneland, A., Katzke, V., Le Cornet, C., El-Khoury, C., Schulze, M. B., Masala, G., Agnoli, C., Simeon, V., Tumino, R., Ricceri, F., Verschuren, W. M. M., ... Freisling, H. (2025). Plant-based dietary patterns and age-specific risk of multimorbidity of cancer and cardiometabolic diseases: a prospective analysis. The Lancet. Healthy Longevity, 6(8), Artikel 100742. https://doi.org/10.1016/j.lanhl.2025.100742

@article{9021b8ef3ed8403a9675d511016cd723,

title = "Plant-based dietary patterns and age-specific risk of multimorbidity of cancer and cardiometabolic diseases: a prospective analysis",

abstract = "BACKGROUND: It is currently unknown whether plant-based dietary patterns influence disease progression to multimorbidity after an initial non-communicable disease, and whether the associated risk of multimorbidity varies with age. This study aimed to investigate associations of plant-based diets with the risk of multimorbidity, defined as the co-occurrence of at least two chronic diseases in an individual (either cancer at any site, cardiovascular disease, or type 2 diabetes).METHODS: This prospective cohort study used data from EPIC and UK Biobank across six European countries, with participants aged 35-70 years at recruitment. We excluded participants from these cohorts who had cancer, cardiovascular disease, or type 2 diabetes at baseline or those with missing data on diet or health outcomes. Data on dietary habits were assessed either at baseline through a validated dietary questionnaire about habits in the previous 12 months or through several 24-h recall questionnaires during approximately a year of follow-up. Multistate modelling with Cox regression was used to estimate the risk of multimorbidity according to a healthful plant-based diet index (hPDI) and, separately, an unhealthful plant-based diet index (uPDI). Risk differences in adults younger than 60 years and those age 60 years and older were estimated.FINDINGS: 407 618 participants (226 324 from EPIC and 181 294 from UK Biobank) were included in this study. During a median follow-up time of 10·9 years in EPIC and 11·4 years in UK Biobank, 6604 cancer-cardiometabolic multimorbidity events occurred in both cohorts combined. A ten-point increment of the hPDI score was associated with a lower risk of multimorbidity, with a hazard ratio (HR) of 0·89 (95\% CI 0·83-0·96) in EPIC and 0·81 (0·76-0·86) in UK Biobank. This inverse association was marginally weaker in older adults than in middle-aged adults in both cohorts. In UK Biobank, a ten-point increment of the hPDI score was associated with multivariable-adjusted HRs of 0·71 (95\% CI 0·65-0·79) in adults younger than 60 years and 0·86 (0·80-0·92) in those aged 60 years and older (p interaction=0·0016). The respective HRs in EPIC were 0·86 (95\% CI 0·78-0·95) and 0·92 (0·84-1·02; p interaction=0·32). A higher adherence to an unhealthy plant-based diet was positively associated with multimorbidity risk in UK Biobank (HR per ten-point increment of uPDI 1·22, 95\% CI 1·16-1·29), but this was not replicated in EPIC (1·00, 0·94-1·08). INTERPRETATION: A healthy plant-based diet might reduce the burden of multimorbidity of cancer and cardiometabolic diseases among middle-aged and older adults.FUNDING: The Korean Government (Ministry of Science and ICT).",

keywords = "Humans, Middle Aged, Male, Female, Aged, Prospective Studies, Adult, Neoplasms/epidemiology, Multimorbidity, Cardiovascular Diseases/epidemiology, Diet, Vegetarian/statistics \& numerical data, Age Factors, Europe/epidemiology, Diabetes Mellitus, Type 2/epidemiology, United Kingdom/epidemiology, Risk Factors",

author = "Reynalda C{\'o}rdova and Jihye Kim and Thompson, \{Alysha S\} and Hwayoung Noh and Sanam Shah and Dahm, \{Christina C\} and Jensen, \{Christopher F\} and Lene Mellemkj{\ae}r and Anne Tj{\o}nneland and Verena Katzke and \{Le Cornet\}, Charlotte and Christine El-Khoury and Schulze, \{Matthias B\} and Giovanna Masala and Claudia Agnoli and Vittorio Simeon and Rosario Tumino and Fulvio Ricceri and Verschuren, \{W M Monique\} and \{van der Schouw\}, \{Yvonne T\} and Carlota Castro-Espin and Maria-Jos{\'e} S{\'a}nchez and Amaia Aizpurua and \{Rodr{\'i}guez Palacios\}, Daniel and Marcela Guevara and Keren Papier and Tong, \{Tammy Y N\} and Inge Huybrechts and Karl-Heinz Wagner and Komodo Matta and Nikos Papadimitriou and Alicia Heath and Dagfinn Aune and Gunter, \{Marc J\} and Pietro Ferrari and Tilman K{\"u}hn and Heinz Freisling",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s)",

year = "2025",

month = aug,

doi = "10.1016/j.lanhl.2025.100742",

language = "English",

volume = "6",

journal = "The Lancet. Healthy Longevity",

issn = "2666-7568",

publisher = "Elsevier",

number = "8",

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Córdova, R, Kim, J, Thompson, AS, Noh, H, Shah, S, Dahm, CC, Jensen, CF, Mellemkjær, L, Tjønneland, A, Katzke, V, Le Cornet, C, El-Khoury, C, Schulze, MB, Masala, G, Agnoli, C, Simeon, V, Tumino, R, Ricceri, F, Verschuren, WMM, van der Schouw, YT, Castro-Espin, C, Sánchez, M-J, Aizpurua, A, Rodríguez Palacios, D, Guevara, M, Papier, K, Tong, TYN, Huybrechts, I, Wagner, K-H, Matta, K, Papadimitriou, N, Heath, A, Aune, D, Gunter, MJ, Ferrari, P, Kühn, T & Freisling, H 2025, 'Plant-based dietary patterns and age-specific risk of multimorbidity of cancer and cardiometabolic diseases: a prospective analysis', The Lancet. Healthy Longevity, Jg. 6, Nr. 8, 100742. https://doi.org/10.1016/j.lanhl.2025.100742

TY - JOUR

T1 - Plant-based dietary patterns and age-specific risk of multimorbidity of cancer and cardiometabolic diseases

T2 - a prospective analysis

AU - Córdova, Reynalda

AU - Kim, Jihye

AU - Thompson, Alysha S

AU - Noh, Hwayoung

AU - Shah, Sanam

AU - Dahm, Christina C

AU - Jensen, Christopher F

AU - Mellemkjær, Lene

AU - Tjønneland, Anne

AU - Katzke, Verena

AU - Le Cornet, Charlotte

AU - El-Khoury, Christine

AU - Schulze, Matthias B

AU - Masala, Giovanna

AU - Agnoli, Claudia

AU - Simeon, Vittorio

AU - Tumino, Rosario

AU - Ricceri, Fulvio

AU - Verschuren, W M Monique

AU - van der Schouw, Yvonne T

AU - Castro-Espin, Carlota

AU - Sánchez, Maria-José

AU - Aizpurua, Amaia

AU - Rodríguez Palacios, Daniel

AU - Guevara, Marcela

AU - Papier, Keren

AU - Tong, Tammy Y N

AU - Huybrechts, Inge

AU - Wagner, Karl-Heinz

AU - Matta, Komodo

AU - Papadimitriou, Nikos

AU - Heath, Alicia

AU - Aune, Dagfinn

AU - Gunter, Marc J

AU - Ferrari, Pietro

AU - Kühn, Tilman

AU - Freisling, Heinz

PY - 2025/8

Y1 - 2025/8

N2 - BACKGROUND: It is currently unknown whether plant-based dietary patterns influence disease progression to multimorbidity after an initial non-communicable disease, and whether the associated risk of multimorbidity varies with age. This study aimed to investigate associations of plant-based diets with the risk of multimorbidity, defined as the co-occurrence of at least two chronic diseases in an individual (either cancer at any site, cardiovascular disease, or type 2 diabetes).METHODS: This prospective cohort study used data from EPIC and UK Biobank across six European countries, with participants aged 35-70 years at recruitment. We excluded participants from these cohorts who had cancer, cardiovascular disease, or type 2 diabetes at baseline or those with missing data on diet or health outcomes. Data on dietary habits were assessed either at baseline through a validated dietary questionnaire about habits in the previous 12 months or through several 24-h recall questionnaires during approximately a year of follow-up. Multistate modelling with Cox regression was used to estimate the risk of multimorbidity according to a healthful plant-based diet index (hPDI) and, separately, an unhealthful plant-based diet index (uPDI). Risk differences in adults younger than 60 years and those age 60 years and older were estimated.FINDINGS: 407 618 participants (226 324 from EPIC and 181 294 from UK Biobank) were included in this study. During a median follow-up time of 10·9 years in EPIC and 11·4 years in UK Biobank, 6604 cancer-cardiometabolic multimorbidity events occurred in both cohorts combined. A ten-point increment of the hPDI score was associated with a lower risk of multimorbidity, with a hazard ratio (HR) of 0·89 (95% CI 0·83-0·96) in EPIC and 0·81 (0·76-0·86) in UK Biobank. This inverse association was marginally weaker in older adults than in middle-aged adults in both cohorts. In UK Biobank, a ten-point increment of the hPDI score was associated with multivariable-adjusted HRs of 0·71 (95% CI 0·65-0·79) in adults younger than 60 years and 0·86 (0·80-0·92) in those aged 60 years and older (p interaction=0·0016). The respective HRs in EPIC were 0·86 (95% CI 0·78-0·95) and 0·92 (0·84-1·02; p interaction=0·32). A higher adherence to an unhealthy plant-based diet was positively associated with multimorbidity risk in UK Biobank (HR per ten-point increment of uPDI 1·22, 95% CI 1·16-1·29), but this was not replicated in EPIC (1·00, 0·94-1·08). INTERPRETATION: A healthy plant-based diet might reduce the burden of multimorbidity of cancer and cardiometabolic diseases among middle-aged and older adults.FUNDING: The Korean Government (Ministry of Science and ICT).

AB - BACKGROUND: It is currently unknown whether plant-based dietary patterns influence disease progression to multimorbidity after an initial non-communicable disease, and whether the associated risk of multimorbidity varies with age. This study aimed to investigate associations of plant-based diets with the risk of multimorbidity, defined as the co-occurrence of at least two chronic diseases in an individual (either cancer at any site, cardiovascular disease, or type 2 diabetes).METHODS: This prospective cohort study used data from EPIC and UK Biobank across six European countries, with participants aged 35-70 years at recruitment. We excluded participants from these cohorts who had cancer, cardiovascular disease, or type 2 diabetes at baseline or those with missing data on diet or health outcomes. Data on dietary habits were assessed either at baseline through a validated dietary questionnaire about habits in the previous 12 months or through several 24-h recall questionnaires during approximately a year of follow-up. Multistate modelling with Cox regression was used to estimate the risk of multimorbidity according to a healthful plant-based diet index (hPDI) and, separately, an unhealthful plant-based diet index (uPDI). Risk differences in adults younger than 60 years and those age 60 years and older were estimated.FINDINGS: 407 618 participants (226 324 from EPIC and 181 294 from UK Biobank) were included in this study. During a median follow-up time of 10·9 years in EPIC and 11·4 years in UK Biobank, 6604 cancer-cardiometabolic multimorbidity events occurred in both cohorts combined. A ten-point increment of the hPDI score was associated with a lower risk of multimorbidity, with a hazard ratio (HR) of 0·89 (95% CI 0·83-0·96) in EPIC and 0·81 (0·76-0·86) in UK Biobank. This inverse association was marginally weaker in older adults than in middle-aged adults in both cohorts. In UK Biobank, a ten-point increment of the hPDI score was associated with multivariable-adjusted HRs of 0·71 (95% CI 0·65-0·79) in adults younger than 60 years and 0·86 (0·80-0·92) in those aged 60 years and older (p interaction=0·0016). The respective HRs in EPIC were 0·86 (95% CI 0·78-0·95) and 0·92 (0·84-1·02; p interaction=0·32). A higher adherence to an unhealthy plant-based diet was positively associated with multimorbidity risk in UK Biobank (HR per ten-point increment of uPDI 1·22, 95% CI 1·16-1·29), but this was not replicated in EPIC (1·00, 0·94-1·08). INTERPRETATION: A healthy plant-based diet might reduce the burden of multimorbidity of cancer and cardiometabolic diseases among middle-aged and older adults.FUNDING: The Korean Government (Ministry of Science and ICT).

KW - Humans

KW - Middle Aged

KW - Male

KW - Female

KW - Aged

KW - Prospective Studies

KW - Adult

KW - Neoplasms/epidemiology

KW - Multimorbidity

KW - Cardiovascular Diseases/epidemiology

KW - Diet, Vegetarian/statistics & numerical data

KW - Age Factors

KW - Europe/epidemiology

KW - Diabetes Mellitus, Type 2/epidemiology

KW - United Kingdom/epidemiology

KW - Risk Factors

UR - https://www.scopus.com/pages/publications/105013551090

U2 - 10.1016/j.lanhl.2025.100742

DO - 10.1016/j.lanhl.2025.100742

M3 - Article

C2 - 40845891

SN - 2666-7568

VL - 6

JO - The Lancet. Healthy Longevity

JF - The Lancet. Healthy Longevity

IS - 8

M1 - 100742

ER -

Plant-based dietary patterns and age-specific risk of multimorbidity of cancer and cardiometabolic diseases: a prospective analysis

Abstract

Fördermittel

UN SDGs

ÖFOS 2012

Zugriff auf Dokument

Andere Dateien und Links

Fingerprint

Zitationsweisen