Inflammatory, Insulinemic, and Plant-Based Dietary Patterns and Diabetes Among Patients with Acute Pancreatitis: A Cross-Sectional Analysis of the DREAM Study

Background/Objectives: Plant-based diets are widely recommended for lowering the risk of type 2 diabetes, with the caveat that their health benefits depend on the quality of the foods consumed. This analysis examined associations between five dietary patterns and pre-existing diabetes among patients with acute pancreatitis (AP), a population in which the relationship between diet and diabetes has not been well characterized. Methods: Participants were drawn from the Diabetes RElated to Acute Pancreatitis and its Mechanisms (DREAM) study, an ongoing multicenter study of adults aged 18 to 75 years with AP in the U.S. This cross-sectional analysis evaluated five dietary patterns using food frequency questionnaires (FFQ): the reverse Empirical Dietary Index for Hyperinsulinemia (rEDIH), the reverse Empirical Dietary Inflammatory Pattern (rEDIP), the overall plant-based diet index (PDI), the healthful plant-based diet index (hPDI), and the unhealthful plant-based diet index (uPDI). We used multivariable logistic regression models to estimate odds ratios (ORs) for pre-existing diabetes (i.e., prior to the AP episode). Results: A total of 647 participants (mean age 49.1 ± 14.5 years) were included. In multivariable-adjusted analyses, participants in the highest versus lowest tertile of PDI had 55% lower odds of pre-existing diabetes (adjusted OR: 0.45; 95% CI: 0.25–0.80; p-trend = 0.005). No statistically significant associations were detected for rEDIP, rEDIH, hPDI, or uPDI. Conclusions: Higher overall PDI scores were associated with lower odds of prevalent diabetes. Among patients with AP, further studies are needed to evaluate dietary contributions to future diabetes development following AP and identify potential dietary strategies for diabetes prevention.