Abstract 14297: The Portfolio Dietary Pattern and Risk of Cardiovascular Disease Mortality During 1988-2019 in US Adults: Findings From the Third National Health and Nutrition Examination Survey

Abstract

Introduction: The Portfolio Diet, a dietary pattern that combines cholesterol-lowering plant foods, reduces several cardiovascular disease (CVD) risk factors in clinical trials and has been associated with reduced CVD risk predominately in White populations. As NHANES III (1988-1994) purposely over-sampled non-Hispanic Blacks and Mexican Americans, undertaking an analysis of the Portfolio Dietary Pattern in NHANES III will expand the generalizability of previous findings. Objective: To examine the relation of the Portfolio Dietary Pattern with CVD and all-cause mortality in NHANES III. Methods: We included 14,035 adults (76% non-Hispanic White, 11% non-Hispanic Blacks, 5% Mexican Americans, 8% other) without reported CVD. Diet was assessed by a 24-hour recall and supplemented with a food frequency questionnaire using the Portfolio Diet Score (PDS), with positive points given to nuts, plant protein, viscous fibre, phytosterols and plant monosaturated fat sources, and negative points given to foods high in saturated fat and cholesterol. To identify cause of death we used the NHANES III Linked Morality File (2019). SAS PROC SURVEYPHREG was used to run Cox proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) by tertiles of PDS for CVD and all-cause mortality with adjustment for behavioral, sociodemographic, family history, and baseline clinical and dietary characteristics. Results: During a median follow-up of 23 years, a total of 1,809 CVD deaths were documented over 321,950 person-years. After multivariable adjustment, higher PDS was associated with a lower risk of CVD mortality (HR 0.85; 95% CI: 0.73-0.99) and all-cause mortality (HR 0.86; 95% CI: 0.77-0.95) when comparing the highest to lowest tertiles of intake. A 25-percentile increase in PDS (6 points) tended towards an association with a lower risk of CVD mortality (HR: 0.88; 95% CI: 0.76-1.01) and was associated with lower risk of all-cause mortality (HR: 0.90; 95% CI: 0.85-0.96). Conclusion: Among US adults greater adherence to the Portfolio Dietary Pattern was inversely associated with CVD and all-cause mortality. These findings improve the generalizability of the Portfolio Dietary Pattern for CVD prevention in diverse populations.