Abstract
BackgroundPrior studies have documented lower cardiovascular disease (CVD) risk among people with a higher adherence to a plant-based dietary pattern. Non-Hispanic black Americans are an understudied group with high burden of CVD, yet studies of plant-based diets have been limited in this population.Methods and findingsWe conducted an analysis of prospectively collected data from a community-based cohort of African American adults (n = 3,635) in the Jackson Heart Study (JHS) aged 21–95 years, living in the Jackson, Mississippi, metropolitan area, US, who were followed from 2000 to 2018. Using self-reported dietary data, we assigned scores to participants’ adherence to 3 plant-based dietary patterns: an overall plant-based diet index (PDI), a healthy PDI (hPDI), and an unhealthy PDI (uPDI). Cox proportional hazards models were used to estimate associations between plant-based diet scores and CVD incidence and all-cause mortality. Over a median follow-up of 13 and 15 years, there were 293 incident CVD cases and 597 deaths, respectively. After adjusting for sociodemographic characteristics (age, sex, and education) and health behaviors (smoking, alcohol intake, margarine intake, physical activity, and total energy intake), no significant association was observed between plant-based diets and incident CVD for overall PDI (hazard ratio [HR] 1.06, 95% CI 0.78–1.42, p-trend = 0.72), hPDI (HR 1.07, 95% CI 0.80–1.42, p-trend = 0.67), and uPDI (HR 0.95, 95% CI 0.71–1.28, p-trend = 0.76). Corresponding HRs (95% CIs) for all-cause mortality risk with overall PDI, hPDI, and uPDI were 0.96 (0.78–1.18), 0.94 (0.76–1.16), and 1.06 (0.86–1.30), respectively. Corresponding HRs (95% CIs) for incident coronary heart disease with overall PDI, hPDI, and uPDI were 1.09 (0.74–1.61), 1.11 (0.76–1.61), and 0.79 (0.52–1.18), respectively. For incident total stroke, HRs (95% CIs) for overall PDI, hPDI, and uPDI were 1.00 (0.66–1.52), 0.91 (0.61–1.36), and 1.26 (0.84–1.89) (p-trend for all tests > 0.05). Limitations of the study include use of self-reported dietary intake, residual confounding, potential for reverse causation, and that the study did not capture those who exclusively consume plant-derived foods.ConclusionsIn this study of black Americans, we observed that, unlike in prior studies, greater adherence to a plant-based diet was not associated with CVD or all-cause mortality.
Highlights
Plant-based diets are gaining attention as more studies suggest both health and environmental sustainability benefits of dietary patterns characterized by lower meat consumption and higher consumption of fruit, vegetables, legumes, whole grains, nuts, and seeds [1]
After adjusting for sociodemographic characteristics and health behaviors, no significant association was observed between plant-based diets and incident cardiovascular disease (CVD) for overall plant-based diet index (PDI), healthy PDI (hPDI) (HR 1.07, 95% CI 0.80–1.42, p-trend = 0.67), and unhealthy PDI (uPDI) (HR 0.95, 95% CI 0.71–1.28, ptrend = 0.76)
In this study of black Americans, we observed that, unlike in prior studies, greater adherence to a plant-based diet was not associated with CVD or all-cause mortality
Summary
Plant-based diets are gaining attention as more studies suggest both health and environmental sustainability benefits of dietary patterns characterized by lower meat consumption and higher consumption of fruit, vegetables, legumes, whole grains, nuts, and seeds [1]. Observational studies have consistently found that vegetarians and vegans tend to have lower cardiometabolic risk factors and lower risk of heart disease, diabetes, kidney disease, and some cancers, there have been mixed findings among prospective studies investigating the association of plant-based diets with cardiovascular disease (CVD) and CVD risk factors [2,3,4,5]. These conflicting findings may be related to the attributes of the populations studied and variability in the healthiness of the vegetarian or vegan diets studied. Non-Hispanic black Americans are an understudied group with high burden of CVD, yet studies of plant-based diets have been limited in this population
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