OBJECTIVES: Plant-based diets have been linked to favorable metabolic and immune regulation, suggesting their potential role in sepsis prevention. However, evidence supporting this association remains limited. This study aimed to examine the associations between adherence to plant-based dietary patterns and risk of sepsis. DESIGN: A large-scale cohort study. SETTING: This was a prospective cohort study including participants of the UK Biobank. PATIENTS: A total of 180,442 participants from the UK Biobank. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The overall, healthy, and unhealthy plant-based diet indices (PDI, hPDI, and uPDI, respectively) were constructed leveraging self-reported data on 17 major food groups. Multivariable-adjusted Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95% CIs for the associations between PDIs and risk of sepsis. During a median follow-up of 13 years, 4031 incident cases of sepsis were identified. A greater adherence to PDI or hPDI was associated with a lower risk of sepsis (PDI: HR, 0.87; 95% CI, 0.79-0.96; p-trend = 0.003 and hPDI: HR, 0.84; 95% CI, 0.77-0.93; p-trend < 0.001) after multivariable adjustment. In contrast, a greater adherence to uPDI was associated with an increased sepsis risk (HR, 1.15; 95% CI, 1.05-1.27; p-trend < 0.001). These associations were generally consistent across stratified and sensitivity analyses. Mediation analysis revealed that 2.5-31.6% of the association between hPDI and sepsis and 1.7-13.7% of the association between uPDI and sepsis were mediated via metabolic and inflammatory biomarkers, including body mass index and C-reactive protein. CONCLUSIONS: Adherence to a healthy plant-based diet was associated with a lower risk of sepsis, whereas adherence to an unhealthy plant-based diet was associated with an increased risk, independently of other traditional risk factors. The associations may be partly mediated through metabolic and inflammatory pathways. These findings underscore the role of high-quality plant-based diet in sepsis prevention.
Xu et al. (Mon,) studied this question.