{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:47:57Z","timestamp":1782712077702,"version":"3.54.5"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To explore the association between plant-based diets, diet-related metabolic signatures, and the risk of total and specific musculoskeletal disorders (MSDs), while accounting for genetic susceptibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from 107,983 participants in the UK Biobank. Plant-based diet indices [PDI, unhealthy PDI (uPDI), and healthy PDI (hPDI)] were calculated via 24-h dietary recalls. Elastic net regression was applied to generate PDIs-related metabolic signatures. Polygenic risk score (PRS) was constructed to quantify genetic susceptibility to MSDs. Cox proportional hazards regression models were used to evaluate the associations of PDIs, metabolic signatures, and PRS with the risk of incident MSDs. Mediation analysis was conducted to assess whether metabolic signatures mediated the PDIs\u2013MSDs relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a median follow-up of 11.6 years, 31,097 participants developed any MSDs. Higher PDI was associated with a reduced risk of total MSDs (HR = 0.98, 95% CIs = 0.96\u20131.00) whereas higher uPDI was associated with an increased risk of total MSDs (HR = 1.02, 95% CIs = 1.00\u20131.04). The magnitude of effect became more pronounced when using the corresponding PDI-related metabolic signature as exposure (HR = 0.97, 95% CIs = 0.95\u20130.98). While no significant effect was found for hPDI (HR = 1.00, 95% CIs = 0.98\u20131.02), its metabolic signature was associated with a lower risk of total MSDs (HR = 0.98, 95% CIs = 0.96\u20131.00). Results remained consistent across different genetic risk strata. No significant mediating effects of metabolic signatures on the PDIs-MSDs associations were observed. When extended to the five specific MSDs (rheumatoid arthritis, osteoarthritis, lower back pain, neck pain and gout), similar patterns of results were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adherence to a healthy plant-based diet as reflected by higher PDI and hPDI is associated with a lower risk of total and specific MSDs, while an unhealthy plant-based diet increases is associated with an elevated risk of these conditions. Our findings support the potential of a healthy plant-based diet in maintaining musculoskeletal health as well as the utility of metabolic signatures for optimizing dietary assessment and guiding personalized dietary interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1803631","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:39:57Z","timestamp":1782711597000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Plant-based diet, metabolic signature, genetic susceptibility, and risk of musculoskeletal disorders: a large-scale population-based prospective cohort study"],"prefix":"10.3389","volume":"14","author":[{"given":"Sirui","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University","place":["Chengdu, Sichuan, 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