Abstract
The Portfolio Diet has demonstrated its cardiovascular benefit from interventions, but the association between Portfolio Diet adherence and the risk of all-cause and cause-specific mortality has not been examined in Chinese population. The present study has collected Portfolio Diet adherence (assessed by food frequency questionnaire), lifestyle factors and mortality status of 3991 participants in the Mr. Osteoporosis (OS) and Ms. OS Study. Cox regression models were used to examine the association between the Portfolio Diet adherence and mortality risk (all-cause, cardiovascular disease or cancer). The highest quartile of the Portfolio Diet score was associated with a 28% lower risk of all-cause (hazard ratio, HR: 0.72) and cancer (HR: 0.72) mortality, respectively. The association between Portfolio Diet adherence and cardiovascular disease mortality did not reach statistical significance (HR: 0.90, 95% CI = 0.64, 1.26). Among male participants, the highest adherence to the Portfolio Diet was also associated with a lower risk of all-cause (HR: 0.63) and cancer mortality (HR: 0.59), and there was an inverse association between food sources of plant protein and the risk of cardiovascular mortality (HR: 0.50). However, most associations between the Portfolio Diet and mortality were not significant among females. The protection for cancer mortality risk might reach the plateau at the highest adherence to the Portfolio Diet for females. To conclude, greater adherence to the Portfolio Diet was significantly associated with a lower risk of mortality in Hong Kong older adults, and the associations appeared stronger among males.
Highlights
Maintaining a healthy diet is a major lifestyle factor to prevent diabetes and cardiovascular diseases (CVD), two chronic diseases that have resulted in a huge public health burden worldwide
The present study has evaluated how the adherence to the Portfolio Diet may have sex-specific associations with the risk of all-cause, CVD and cancer mortality among a prospective cohort of Hong Kong older adults, an ageing Chinese population with high life expectancy [11]
Dietary assessment has been administered as an food frequency questionnaires (FFQ) to all participants at baseline, and the data on mortality statistics has been obtained from the Death Registry collected through March 2014 [12]
Summary
Maintaining a healthy diet is a major lifestyle factor to prevent diabetes and cardiovascular diseases (CVD), two chronic diseases that have resulted in a huge public health burden worldwide. Amongst dietary patterns that may improve cardiovascular health, the Dietary Portfolio, or the Portfolio Diet, is a plant-based dietary pattern developed in the early 2000s to lower low-density lipoprotein cholesterol (LDL-C) [4,5]. The Portfolio Diet is low in saturated fat and cholesterol, as in the National Cholesterol Education Program Adult. Treatment Panel III (NCEP ATP III) diet [6], with added plant-based foods or nutrients with cholesterol-lowering properties, namely nuts, plant protein (soy and pulses), viscous fiber sources (oats, barley, psyllium, eggplant, okra, and recently apples, oranges and berries), plant sterols and monounsaturated fats (olive oil, sunflower oil, canola oil, avocado). In 2018, a meta-analysis of randomized controlled trials showed that the Portfolio
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