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Peer-reviewedCC BY-NC-NDNutrition & metabolism

Adherence to the planetary health diet index and risk of glycemic progression or regression in prediabetic individuals: a longitudinal study.

  • Farzam Kamrani1
  • Elahe Etesami2
  • Matin Ghanavati3
  • Fatemeh Zare Nejad4,5
  • Nazanin Zahra Nourian4,5
  • Jalaledin Mirzay Razzaz6,7
  • Reza Homayounfar8,9
  • Ali Nikparast10,11
11 affiliations
  1. 1Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
  2. 2Department of Nutrition, SR.C, Islamic Azad University, Tehran, Iran.
  3. 3Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Shahid Beheshti University of Medical Sciences, P.O. 19395- 4741, Tehran, Iran.
  4. 4Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition & Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  5. 5Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  6. 6Nutrition and Health Research Center, Nasim Institute, Tehran, Iran.
  7. 7Department of Community Nutrition, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  8. 8Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Shahid Beheshti University of Medical Sciences, P.O. 19395- 4741, Tehran, Iran. [email protected].
  9. 9Nutrition and Health Research Center, Nasim Institute, Tehran, Iran. [email protected].
  10. 10Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition & Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran. [email protected].
  11. 11Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran. [email protected].
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Abstract

Background

Whether adherence to the Planetary Health Diet Index (PHDI)-a dietary pattern jointly promoting human and environmental health-influences glycemic trajectories among individuals with prediabetes remains unknown. This study examined associations between PHDI adherence and odds of regression to normoglycemia and progression to type 2 diabetes mellitus (T2DM) in prediabetic adults.Methods

We conducted a prospective cohort analysis among 4,143 prediabetic adults (age range 19-70 years, 46.2% men, mean age 43.3 ± 10.1 years) enrolled in the Tehran MMRT study between 2017 and 2018 and followed for 5 years. PHDI scores were derived from validated food-frequency questionnaires. Multinomial logistic regression estimated odds ratios (ORs) for glycemic regression and progression across PHDI quartiles, adjusting for demographic, lifestyle, metabolic, and dietary covariates. Component‑level and subgroup analyses, as well as restricted cubic spline modeling, were conducted.Results

Over follow‑up, 1,288 participants regressed to normoglycemia; 775 progressed to T2DM. In fully adjusted multinomial logistic regression models, the highest versus lowest PHDI quartile exhibited 28% greater odds of regression (OR 1.28; 95% CI: 1.04-1.58; P‑trend = 0.003). Each standard‑deviation increase in PHDI conferred a 10% higher likelihood of regression (OR 1.10; 95% CI: 1.02-1.18). This association was significantly stronger among men than women (P‑interaction < 0.001). Higher intakes of legumes, vegetables, dairy, vegetable oils, and poultry were independently associated with regression, whereas red meat intake was inversely associated. This relationship was attenuated after HOMA‑IR adjustment, suggesting partial mediation by insulin sensitivity. No independent association was observed with diabetes progression after full adjustment (OR 1.04; 95% CI: 0.82-1.31; P‑trend = 0.840).Conclusions

Greater adherence to the PHDI was prospectively associated with higher odds of returning to normoglycemia, but not with reduced diabetes progression, in prediabetic adults. Insulin sensitivity may partly mediate this benefit. These findings underscore the importance of considering glycemic directionality when evaluating sustainable dietary interventions.

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Cite

BibTeXRIS
BibTeX
@article{kamrani2026adherence,
  title = {{Adherence to the planetary health diet index and risk of glycemic progression or regression in prediabetic individuals: a longitudinal study.}},
  author = {Farzam Kamrani and Elahe Etesami and Matin Ghanavati and Fatemeh Zare Nejad and Nazanin Zahra Nourian and Jalaledin Mirzay Razzaz and Reza Homayounfar and Ali Nikparast},
  journal = {Nutrition \& metabolism},
  year = {2026},
  month = jul,
  doi = {10.1186/s12986-026-01176-3},
  url = {https://europepmc.org/article/MED/42902288},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Adherence to the planetary health diet index and risk of glycemic progression or regression in prediabetic individuals: a longitudinal study.
AU  - Farzam Kamrani
AU  - Elahe Etesami
AU  - Matin Ghanavati
AU  - Fatemeh Zare Nejad
AU  - Nazanin Zahra Nourian
AU  - Jalaledin Mirzay Razzaz
AU  - Reza Homayounfar
AU  - Ali Nikparast
PY  - 2026
DA  - 2026/07/01
JO  - Nutrition & metabolism
DO  - 10.1186/s12986-026-01176-3
UR  - https://europepmc.org/article/MED/42902288
AB  - Background  Whether adherence to the Planetary Health Diet Index (PHDI)-a dietary pattern jointly promoting human and environmental health-influences glycemic trajectories among individuals with prediabetes remains unknown. This study examined associations between PHDI adherence and odds of regression to normoglycemia and progression to type 2 diabetes mellitus (T2DM) in prediabetic adults.Methods  We conducted a prospective cohort analysis among 4,143 prediabetic adults (age range 19-70 years, 46.2% men, mean age 43.3 ± 10.1 years) enrolled in the Tehran MMRT study between 2017 and 2018 and followed for 5 years. PHDI scores were derived from validated food-frequency questionnaires. Multinomial logistic regression estimated odds ratios (ORs) for glycemic regression and progression across PHDI quartiles, adjusting for demographic, lifestyle, metabolic, and dietary covariates. Component‑level and subgroup analyses, as well as restricted cubic spline modeling, were conducted.Results  Over follow‑up, 1,288 participants regressed to normoglycemia; 775 progressed to T2DM. In fully adjusted multinomial logistic regression models, the highest versus lowest PHDI quartile exhibited 28% greater odds of regression (OR 1.28; 95% CI: 1.04-1.58; P‑trend = 0.003). Each standard‑deviation increase in PHDI conferred a 10% higher likelihood of regression (OR 1.10; 95% CI: 1.02-1.18). This association was significantly stronger among men than women (P‑interaction < 0.001). Higher intakes of legumes, vegetables, dairy, vegetable oils, and poultry were independently associated with regression, whereas red meat intake was inversely associated. This relationship was attenuated after HOMA‑IR adjustment, suggesting partial mediation by insulin sensitivity. No independent association was observed with diabetes progression after full adjustment (OR 1.04; 95% CI: 0.82-1.31; P‑trend = 0.840).Conclusions  Greater adherence to the PHDI was prospectively associated with higher odds of returning to normoglycemia, but not with reduced diabetes progression, in prediabetic adults. Insulin sensitivity may partly mediate this benefit. These findings underscore the importance of considering glycemic directionality when evaluating sustainable dietary interventions.
SN  - 1743-7075
ER  -