Healthful Plant-based Diet Index Research Articles

Diet Quality and the Risk of Impaired Speech Reception Threshold in Noise: The UK Biobank cohort.

Previous studies have examined the association between several diet quality indexes and risk of hearing loss, based on self-reported information or on audiometry test, with inconsistent results. However, the impact of healthy diets on the capacity to listening in noise, a proxy of disability due to hearing loss, is unknown. This research assessed the prospective association between five diet quality indexes and the speech reception threshold in noise in the UK Biobank study. Prospective cohort with 105,592 participants aged ≥40 years. At baseline, adherence to the Mediterranean Diet Adherence Screener, the alternate Mediterranean Diet score, the Dietary Approaches to Stop Hypertension, the Alternate Healthy Eating Index-2010, and the healthful Plant-Based Diet Index were assessed. Functional auditory capacity was measured with a digit triplet test, and impairment was defined as a speech reception threshold in noise >-3.5 dB in any physical exam during the follow-up. Over a median follow-up of 3.2 (SD: 2.1) years, 1704 participants showed impaired speech reception threshold in noise. After adjusting for potential confounders, the hazard ratios (95% confidence interval) of impairment per 1-SD increase in the Mediterranean Diet Adherence Screener, alternate Mediterranean Diet score, Dietary Approaches to Stop Hypertension, Alternate Healthy Eating Index-2010 and healthful Plant-Based Diet Index scores were, respectively, 0.98 (0.94 to 1.03), 1.01 (0.96 to 1.06), 1.02 (0.97 to 1.07), 1.01 (0.96 to 1.06), and 1.00 (0.96 to 1.05). Results were similar when analyses were restricted to those >60 years, with British ethnicity, without chronic disease, without tinnitus or with optimal cognitive function. Adherence to a healthy diet did not show an association with the speech reception threshold in noise. More research is needed to identify the impact of individual foods or nutrients on this outcome.

Impact of Plant-Based Diet on PSA Level: Data From the National Health and Nutrition Examination Survey

ObjectiveTo determine the potential association between plant-based dietary content and PSA levels among men enrolled in the National Health and Nutrition Examination Survey (NHANES). MethodsData on demographics, diet, and PSA levels was acquired from the NHANES database. Plant-based diet index (PDI) and healthful plant-based diet index (hPDI) were calculated using food frequency questionnaires. A higher score on PDI and hPDI indicates higher consumption of plant foods or healthy plant foods, respectively. Multivariable-adjusted logistic regression analysis was performed to determine the association between elevated PSA, clinical variables, demographics, and plant-based diet indices. ResultsA total of 1399 men were included in the final cohort. Median age of participants was 54 [46-63] years. Median PSA level was 0.9 [0.6-1.5] ng/dL, and 69 (4.9%) men had a PSA level ≥4 ng/dL. Although there was no association between elevated PSA and PDI, on multivariable analysis patients with higher consumption of healthy plant-based diet (high hPDI scores) had a decreased probability of having an elevated PSA (OR = 0.47, 95% CI: 0.24-0.95; P = .034). ConclusionThere is a significant association between increased consumption of a healthy plant-based diet and lower PSA levels. This finding may be incorporated into the shared-decision making process with patients to promote healthier lifestyle choices to reduce the likelihood of prostate biopsy and potential treatment-related morbidity.

Healthful and Unhealthful Plant-Based Diets and Risk of Breast Cancer in U.S. Women: Results from the Nurses' Health Studies.

Plant-based diets have been associated with lower risk of various diseases, including type 2 diabetes, cardiovascular disease, and other cardiometabolic risk factors. However, the association between plant-based diet quality and breast cancer remains unclear. We prospectively followed 76,690 women from the Nurses' Health Study (NHS, 1984-2016) and 93,295 women from the NHSII (1991-2017). Adherence to an overall plant-based diet index (PDI), a healthful PDI (hPDI), and an unhealthful PDI (uPDI) was assessed using previously developed indices. Cox proportional hazards models were used to estimate HR and 95% confidence intervals (CI) for incident invasive breast cancer. Over 4,841,083 person-years of follow-up, we documented 12,482 incident invasive breast cancer cases. Women with greater adherence to PDI and hPDI were at modestly lower risk of breast cancer [(HRQ5 vs. Q1, 0.89; 95% CI, 0.84-0.95); (HRQ5 vs. Q1, 0.89; 95% CI, 0.83-0.94)]. We observed significant heterogeneity by estrogen receptor (ER) status, with the strongest inverse association between hPDI and breast cancer observed with ER-negative tumors [HRQ5 vs. Q1, 0.77; 95% CI, 0.65-0.90; P trend < 0.01]. We also found an inverse association between extreme quintiles of healthy plant foods and ER-negative breast cancer [HR, 0.74; 95% CI, 0.61-0.88; P trend < 0.01]. This study provides evidence that adherence to a healthful plant-based diet may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors. This is the first prospective study investigating the relation between healthful and unhealthful plant-based dietary indices and risk of total and subtype-specific breast cancer.

Abstract 837: Healthful and unhealthful plant-based diets and risk of breast cancer in U.S. women: Results from the Nurses' Health Studies

Abstract Purpose: Plant-based diets have been associated with lower risk of various diseases, including type 2 diabetes, cardiovascular disease and other cardiometabolic risk factors and are recommended for both health and environmental benefits. However, the association between plant-based diet quality and breast cancer remains unclear. Therefore, we examined the associations of plant-based diet quality with risk of total and subtypes of breast cancer. Methods: We followed 74,516 women from the Nurses' Health Study (NHS, 1984-2016), and 93,915 women from the Nurses' Health Study II (NHSII, 1991-2017), without cancer at baseline. Incident invasive breast cancer cases were confirmed with medical records, and subtypes were determined by tissue microarray data and pathology reports. We assessed an overall plant-based diet index (PDI) from dietary data collected using repeated semi-quantitative food-frequency questionnaires (FFQ), by assigning positive scores to plant foods and reverse scores to animal foods. We also investigated a healthful PDI (hPDI) where healthy plant foods (whole grains, fruits/vegetables, nuts/legumes, oils, tea/coffee) received positive scores, while less healthy plant foods (juices/sweetened beverages, refined grains, potatoes/fries, sweets) and animal foods received reverse scores. We also assessed an unhealthful PDI (uPDI), assigning positive scores to less healthy plant foods, and reverse scores to healthy plant foods and animal foods. Multivariable hazard ratios (HRs) and 95% confidence intervals (CI) were calculated with Cox proportional hazards models using data pooled across cohorts, adjusting for breast cancer risk factors. Results: Over 4,193,915 person-years of follow-up, we documented 11,281 incident invasive breast cancer cases. Women with greater adherence to PDI were at modestly lower risk of breast cancer [HR Q5vsQ1 0.92; 95% CI 0.86, 0.99; p trend=0.02]. Furthermore, greater adherence to a hPDI was associated with a decreased risk of overall breast cancer [HR Q5vsQ1 0.90; 95% CI 0.85, 0.96, p trend=&amp;lt;0.001]. We observed significant heterogeneity by estrogen receptor (ER) status (p=0.01), with the strongest inverse association between hPDI and breast cancer observed with ER-negative tumors [HR Q5vsQ1 0.75; 95% CI 0.64, 0.89; p trend=&amp;lt;0.001]. Moreover, higher uPDI was positively associated with a higher risk of ER-negative breast cancer [HR Q5vsQ1 1.21; 95% CI 1.02, 1.44; p trend=0.02] (p for heterogeneity=0.03). Conclusions: This study provides evidence that adherence to a plant-based dietary pattern and, specifically, its healthful version, may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors. In contrast, a low-quality plant-based diet may be associated with an increased risk of ER-negative breast cancer. Citation Format: Andrea Romanos-Nanclares, Walter C. Willett, Bernard Rosner, Laura C. Collins, Frank B. Hu, Estefania Toledo, A. Heather Eliassen. Healthful and unhealthful plant-based diets and risk of breast cancer in U.S. women: Results from the Nurses' Health Studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 837.

Association of plant-based diet index with inflammatory markers and sleep quality in overweight and obese female adults: A cross-sectional study.

Inflammation and sleep disturbances increase the risk of multiple diseases, including cardiovascular disease, type 2 diabetes and dementia. Since diet plays a significant role in inflammatory responses and sleep quality, this study aimed to investigate the association of a plant-based diet index (PDI) with sleep quality and inflammatory markers in overweight and obese women. 390 overweight and obese women aged 18-48 years participated in this cross-sectional study. A validated food frequency questionnaire (FFQ) was used to create an overall PDI, healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI). Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI). Higher scores on the PSQI were indicative of poor sleep. Anthropometric measurements and serum concentrations of high-sensitivity C-reactive protein (hs-CRP), interleukin 1 beta (IL-1β) and transforming growth factor-beta (TGF-β) were evaluated. Linear regression models were used to determine the association between exposure and outcomes. After taking potential confounders into account, we found a significant inverse association between adherence to hPDI and hs-CRP (β = -0.14, 95% confidence interval [CI]: -0.22,0.06, P = .001) and a significant positive association between uPDI and hs-CRP (β = 0.13, 95% CI: 0.05,0.21, P = .001). Overall, PDI was significantly associated with TGF-β (β = 2.04, 95% CI: 0.54,3.55, P = .008). No association was detected between PDI indices and IL-1β. Higher adherence to uPDI was significantly associated with higher PSQI score (lower sleep quality) (β= 0.20, 95% CI:0.007,0.40, P = .04). A significant positive association was found between TGF-β (β = 0.05, 95% CI:0.005,0.10, P = .03) and hs-CRP (β = 0.32, 95% CI:0.02,0.62, P = .03) with PSQI. Our findings indicated a significant association between adherence to a plant-based diet with inflammation and sleep quality in obese and overweight females. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Sleep is an essential part of life, and sleep quality has a significant impact on individual well-being and performance. There is a bidirectional relationship between disturbed sleep and elevated levels of inflammatory markers. Diet plays a major part in sleep quality and its related health consequences. Plant-based diets are associated with lower risk of chronic diseases such as coronary artery disease (CAD), type 2 diabetes, obesity and reduced level of inflammation. WHAT DOES THIS ARTICLE ADD?: Adherence to a healthful plant-based diet is associated with lower level of hs-CRP, while adherence to an unhealthful plant-based diet is associated with higher concentrations of hs-CRP. Adherence to an unhealthful plant-based diet is associated with lower sleep quality.

Healthful plant-based dietary patterns, genetic risk of obesity, and cardiovascular risk in the UK biobank study

People with a higher genetic risk for obesity are more likely to develop cardiovascular disease (CVD), and healthy plant-based dietary patterns may be associated with decreased risks of obesity and cardiovascular events. We investigated whether adherence to healthy plant-foods-rich dietary patterns might attenuate risks of obesity and related cardiovascular abnormalities for people at genetically higher risk of obesity. This study included 121,799 middle-aged adults in UK Biobank who were initially free of metabolic diseases and cancer. We calculated a healthful plant-based diet index (hPDI) based on 17 major food groups as well as a genetic risk score (GRS) for obesity consisting of body mass index (BMI)-associated variants. The incidence of cardiovascular events (myocardial infarction, MI, or stroke) was prospectively followed during a mean (SD) 5.1 (0.9) years. We found significant interactions between GRS and hPDI on adiposity (Pinteraction <0.0001); adherence to hPDI was more strongly associated with lower levels of adiposity among participants with higher GRS than those with lower GRS. Further, we found a similar pattern of GRS-hPDI interactions on untreated hypertension (Pinteraction=0.0036). When we tested GRS-hPDI interactions on cardiovascular events, adherence to hPDI was more strongly associated with a decreased risk of MI among people with high GRS (above median) than those with low GRS (Pinteraction=0.006). Among participants with high GRS, high adherence to hPDI (the top tertile of hPDI) was associated with an HR 0.54 (95% CI: 0.39, 0.74) for MI, as compared to low adherence. Adherence to healthy plant-based dietary patterns significantly attenuated risks of cardiovascular abnormalities for people at genetically higher risk of obesity. Our results support the precision medicine strategies considering genetics and dietary habits to modify cardiovascular health for people at higher risk of genetically determined obesity.

Plant-Based Dietary Patterns and the Incidence of Diabetes in the Boston Puerto Rican Health Study

Abstract Objectives To examine the associations between the plant-based diet and risk of developing diabetes in participants of the Boston Puerto Rican Health Study. Methods Included were 691 Puerto Ricans aged 45–75 years who were free of diabetes at baseline. Dietary intake was assessed via a validated food frequency questionnaire. Three plant-based dietary indices were then calculated, including an overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Incident diabetes was defined as fasting plasma glucose 126 mg/dL [7.0 mmol/L], hemoglobin A1c 6.5% [48 mmol/mol] or use of any hypoglycemic agents during follow-up. Cox proportional hazards models were used to evaluate the associations between the plant-based dietary patterns and the incidence of diabetes, adjusting for potential confounders, such as age, sex, socioeconomic status, lifestyle factors, obesity, total energy intake, depression, and plasma concentrations of c-reactive protein and lipid profiles. Results During the 5-years of follow-up, we identified 139 incident diabetes cases. After adjustment for covariates, hPDI was inversely associated with the risk for developing diabetes (P-trend = 0.04). The adjusted hazard ratio (HR) for the highest vs lowest tertiles of hPDI was 0.56 (95% confidence interval: 0.32–0.96). In contrast, The PDI and uPDI dietary indices were not significantly associated with the risk of diabetes (P-trend &amp;gt; 0.2 for both). Conclusions The healthful plant-based dietary index was associated with a lower risk of diabetes. These findings suggest that the healthful plant-based dietary index may be beneficial for the prevention of the development of diabetes. Funding Sources This project was supported by the National Institute on Aging, the National Heart, Lung, and Blood Institue, and the National Center for Advancing Translational Sciences.

Plant-Based Diet Quality and Risk of Crohn’s Disease and Ulcerative Colitis in US Women

Abstract Objectives Several plant-based foods have been associated with a lower risk of Crohn's disease (CD) and ulcerative colitis (UC), but not all plant-based foods are healthy. We aimed to examine the association of various plant-based diets with the risk of CD and UC. Methods We followed 169 945 women in the Nurses’ Health Study and Nurses’ Health Study II for up to 32 years. Plant-based diets were assessed by three indices derived from the food frequency questionnaires: an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Self-reported CD and UC were confirmed through medical record review. Results We documented 320 incident CD cases and 404 incident UC cases during 4 317 561 person-years. A higher hPDI was associated with a lower risk of UC (hazard ratio [HR] comparing extreme quintiles: 0.67; 95% confidence interval [CI]: 0.47–0.94; P-trend = 0.02). In contrast, the uPDI was associated with an increased risk of CD (HR: 1.67; 95% CI: 1.11–2.51; P-trend = 0.002) and UC (HR: 1.65; 95% CI: 1.15–2.35; P-trend = 0.03). Replacing refined grains, sugar-sweetened beverages, and sweets/desserts with an equal serving of fruits or vegetables was associated with lower risk of CD and UC. Conclusions A healthful plant-based diet rich in fruits and vegetables was associated with a lower UC risk, whereas a plant-based diet emphasizing less healthy plant foods such as refined grains, sugar-sweetened beverages, and sweets/desserts was associated with a higher CD and UC risk. Funding Sources National Institutes of Health.

Abstract 022: Plasma Metabolome Related To Plant-based Diets And The Association With Type 2 Diabetes: A Prospective Cohort Study

Background: Plant-based diets have been associated with a lower risk of type 2 diabetes. However, the underlying mechanisms are not completely understood, and the evidence using objective approaches to assess the adherence of plant-based diets is limited. Methods: In the Nurses’ Health Study (NHS), NHSII, and Health Professionals Follow-Up Study, we characterized the plasma metabolome related to plant-based diets and examined its association with the incidence of type 2 diabetes among 10 699 participants. Plasma metabolomic profiling was conducted by liquid chromatography-tandem mass spectrometry. Adherence to plant-based diets was assessed by three plant-based diet indices derived from the food frequency questionnaire: an overall plant-based diet index (PDI), a healthful PDI (hPDI), and an unhealthful PDI (uPDI). Metabolomic signatures reflecting the adherence to plant-based diets were created using elastic net regression, and their associations with risk of type 2 diabetes were subsequently evaluated using multivariable Cox proportional hazards regression. Results: Among 263 metabolites measured, nearly half were significantly associated with PDI (41.4%, 109 of 263), hPDI (51.7%, 136 of 263), and uPDI (40.3%, 106 of 263) after Bonferroni correction. We developed a metabolomic signature comprising 53 metabolites for PDI, 76 metabolites for hPDI, and 88 metabolites for uPDI, each robustly correlated with the corresponding diet index (r=0.34-0.36 for PDI, 0.43-0.44 for hPDI, and 0.36-0.37 for uPDI). We observed an inverse association of PDI metabolomic signature (HR 0.86, 95% CI 0.79-0.93 per one standard deviation) and hPDI metabolomic signature (0.79, 0.72-0.86) with type 2 diabetes risk after adjustment for body mass index and other potential confounders. These two inverse associations remained significant even further adjusting for the corresponding diet index PDI and hPDI. The metabolomic signature for uPDI was not associated with type 2 diabetes risk (1.00, 0.93-1.09). Conclusion: Plasma metabolome can robustly reflect adherence and metabolic response to plant-based diets. Metabolomic signatures reflecting greater adherence to an overall plant-based diet, especially a healthful plant-based diet, were associated with a lower risk of type 2 diabetes. These findings support and provide mechanistic insights on the important role of healthful plant-based diets in diabetes prevention.

Quality of plant-based diets and risk of hypertension: a Korean genome and examination study.

Plant-based diets have been suggested to have beneficial effects on various health outcomes. However, the evidence on the association of plant-based diet quality with health outcomes is very limited in Asian populations, who may have a different dietary pattern than western populations. This study explored the prospective association between different types of plant-based diets and risk of hypertension using recently established indices in South Koreans. Analyses were based on a community-based cohort of 5636 men and women (40-69years of age at baseline, mean ± SD 50.6 ± 8.5years) living in Ansan and Ansung, South Korea (2001-2016) without hypertension and related chronic diseases at baseline. Registration card and telephone registration number were used for the sampling. Dietary intakes were assessed using a validated food frequency questionnaire. Based on the questionnaire, scores of three plant-based diet indices [overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI)] were calculated. Over a follow-up of 14years, 2244 participants developed hypertension. Individuals in the highest vs. lowest quintile of hPDI had 35% lower incidence of hypertension [hazard ratio (HR) 0.65, 95% CI 0.57, 0.75] and uPDI had 44% higher incidence of hypertension (HR 1.44, 95% CI 1.24, 1.67), adjusting for demographic characteristics, and lifestyle factors (P trend ≤ 0.0001 for both indices). A similar inverse association of hPDI was observed with risk of hypertension by age, sex, residence area, and obesity. The PDI was not associated with hypertension. Our results highlight the importance of considering the quality of plant foods (relatively higher healthy plant foods and relatively lower less healthy plant foods consumption) for the prevention of hypertension in a population with a long-term adherence to predominantly plant-based diets.

Adherence to plant-based dietary pattern and risk of breast cancer among Iranian women.

Previous studies assessed the link between plant based diet and breast cancer risk rather than healthy and unhealthy plant based diet. This study examined the relation between plant-based dietary pattern and risk of breast cancer among Iranian women. This hospital-based case-control study was conducted among 412 women with pathologically confirmed breast cancer within the past year and 456 apparently healthy controls. Dietary data were collected using a validated and reliable 168-item FFQ. We created three patterns including overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). The risk of breast cancer was compared across quartiles of PDI, hPDI, and uPDI. we did not find significant association between adherence to PDI and uPDI score and odds of breast cancer among women. However, a greater score of hPDI was inversely associated to the risk of breast cancer (OR: 0.63; 95% CI: 0.43-0.93, P = 0.01), in the crude model. After adjustment for age and energy, we saw stronger association between breast cancer risk and higher hPDI score (OR: 0.55; 95% CI: 0.37-0.82, P = 0.002). After stratified by menopausal status, we did not find significant association between PDI and uPDI score and risk of breast cancer. However, pre- and postmenopausal women in the highest quartile of hPDI score had lower risk of breast cancer than those in the lowest quartile. we found an inverse significant association between hPDI and odds of breast cancer in the whole population of study. After stratifying by menopausal status, this correlation was also seen both in pre and postmenopausal women.

The association between plant-based diet and erectile function in Chinese young healthy men: A population-based study.

The study was designed and conducted to evaluate the plant-based diet status and its association with erectile function (EF) in Chinese young healthy men. From July 2018 to May 2020, 116 objectively proved physically and psychologically healthy men were selected. Clinical questionnaires, detailed physical examinations and blood tests were all assessed. An overall plant-based diet index (PDI) and a healthful plant-based diet index (hPDI) were developed from each participant to measure plant-based diet quantitatively. The EF was measured by both the International Index of Erectile Function-5 (IIEF-5) and the surrogated measures of endothelial function, peripheral levels of nitric oxide (NO) and E-selectin. In subjects, the mean PDI and hPDI were 53.8±8.2 and 54.7±8.9 respectively. Results of multivariate analysis showed that both PDI and hPDI were negatively associated with BMI (all p<.05), but had no relationships with NO, E-selectin, TT levels and IIEF-5 scores (all p>.05). In a subgroup of male population, Chinese young healthy men, the plant-based diet, measured by PDI and hPDI, was not related to erectile function. The population can adhere to plant-based diet to keep healthy without concerns of negative influence on erectile function.

Quality of Plant-Based Diet and Risk of Total, Ischemic, and Hemorrhagic Stroke.

To determine whether a healthful plant-based diet is related to lower stroke risk, we examined the associations of plant-based diet quality with risk of total, ischemic, and hemorrhagic stroke. The participants were 73,890 women in Nurses' Health Study (NHS; 1984-2016), 92,352 women in NHSII (1991-2017), and 43,266 men in Health Professionals Follow-Up Study (1986-2012) without cardiovascular disease and cancer at baseline. Plant-based diet quality was evaluated by the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI). Participants who reported that their meat and/or fish intakes were 0 or <1 serving per month were categorized as vegetarians, and others were classified as nonvegetarians. Strokes with available medical records were subtyped as ischemic or hemorrhagic. During the follow-up, 6,241 total stroke cases (including 3,015 ischemic and 853 hemorrhagic strokes) were documented. Compared to participants with the lowest PDIs, among participants with the highest PDIs, the hazard ratios (HRs) for total stroke were 0.94 (95% confidence interval 0.86-1.03) for PDI, 0.90 (0.83-0.98) for hPDI, and 1.05 (0.96-1.15) for uPDI. Participants in the highest hPDI showed marginally lower HR for ischemic stroke (0.92 [0.82-1.04]) and no consistent associations for hemorrhagic stroke. We observed no association between a vegetarian diet and total stroke (1.00 [0.76-1.32]), although the number of cases was small. Lower risk of total stroke was observed by those who adhered to a healthful plant-based diet.

The association between plant-based diet indices and metabolic syndrome in Iranian older adults.

We investigated the association between plant-based diets indices - an overall plant-based diet index; a healthful plant-based diet index; and an unhealthful plant-based diet index - and metabolic syndrome among Iranian older adults. We aimed to examine the relationship between plant-based diet indices and metabolic syndrome. This cross-sectional study included 178 older adults (51 men and 127 women), with a mean age of 67.04 (60-83) who were referred to health centers in Tehran, Iran. Blood and urine samples were collected to measure serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. We created an overall plant-based diet index, healthful plant-based diet index, and unhealthful plant-based diet index from semi-quantitative food-frequency questionnaire data. Anthropometric measures were done. Our crude model results showed that triglycerides, systolic and diastolic blood pressure, fasting blood sugar, high-density lipoprotein cholesterol, and waist circumference did not significantly differ between tertiles of plant-based diet index and healthful plant-based diet index; also triglycerides, systolic and diastolic blood pressure, fasting blood sugar, and waist circumference did not significantly differ between tertiles of unhealthful plant-based diet index, but high-density lipoprotein cholesterol significantly differed between tertiles of unhealthful plant-based diet index. After adjusting for confounders the results remained non-significant for plant-based diet index but high-density lipoprotein cholesterol was significant for healthful and unhealthful plant-based diet indices. There was also no significant association between plant-based diet index (OR: 1.11; 95% CI: 0.53-2.33), healthful plant-based diet index (OR: 0.81; 95% CI: 0.39-1.68), and unhealthful plant-based diet index (OR: 0.81; 95% CI: 0.38-1.72) with metabolic syndrome, even after adjustment for confounders. Our findings showed that plant-based diets are not significantly associated with risk of metabolic syndrome in older adults. To confirm the veracity of these findings, more studies should be conducted.

Association between Different Types of Plant-Based Diets and Risk of Dyslipidemia: A Prospective Cohort Study.

We evaluated the associations among different types of plant-based diet indices, risk of dyslipidemia, and individual lipid disorders in Asian populations with different dietary patterns from Western populations. Participants included 4507 Korean adults aged ≥40 years without dyslipidemia and related chronic diseases at baseline (2001–2002). Dietary intakes were assessed using an average of validated food frequency questionnaires measured twice. We calculated three plant-based diet indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). During a follow-up of 14 years, 2995 incident dyslipidemia cases occurred. Comparing the highest with lowest quintiles, the multivariable-adjusted hazard ratios (HRs) for incident dyslipidemia were 0.78 (95% CI, 0.69–0.88) for PDI, 0.63 (95% CI, 0.56–0.70) for hPDI, and 1.48 (95% CI, 1.30–1.69) for uPDI (P-trend < 0.0001 for all). Associations between PDI and individual lipid disorders differed by sex. The PDI was inversely associated with risk of developing hypertriglyceridemia in men and with risk of developing low high-density lipoprotein cholesterol in women. The hPDI was inversely associated with risk of all lipid disorders, whereas the uPDI was positively associated with individual lipid disorders. The quality of plant foods is important for prevention of dyslipidemia in a population that consumes diets high in plant foods.

Changes in Plant-Based Diet Indices and Subsequent Risk of Type 2 Diabetes in Women and Men: Three U.S. Prospective Cohorts.

We evaluated the associations between changes in plant-based diets and subsequent risk of type 2 diabetes. We prospectively followed 76,530 women in the Nurses' Health Study (NHS) (1986-2012), 81,569 women in NHS II (1991-2017), and 34,468 men in the Health Professionals Follow-up Study (1986-2016). Adherence to plant-based diets was assessed every 4 years with the overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). We used multivariable Cox proportional hazards models to estimate hazard ratios (HRs). We pooled results of the three cohorts using meta-analysis. We documented 12,627 cases of type 2 diabetes during 2,955,350 person-years of follow-up. After adjustment for initial BMI and initial and 4-year changes in alcohol intake, smoking, physical activity, and other factors, compared with participants whose indices remained relatively stable (±3%), participants with the largest decrease (>10%) in PDI and hPDI over 4 years had a 12-23% higher diabetes risk in the subsequent 4 years (pooled HR, PDI 1.12 [95% CI 1.05, 1.20], hPDI 1.23 [1.16, 1.31]). Each 10% increment in PDI and hPDI over 4 years was associated with a 7-9% lower risk (PDI 0.93 [0.91, 0.95], hPDI 0.91 [0.87, 0.95]). Changes in uPDI were not associated with diabetes risk. Weight changes accounted for 6.0-35.6% of the associations between changes in PDI and hPDI and diabetes risk. Improving adherence to overall and healthful plant-based diets was associated with a lower risk of type 2 diabetes, whereas decreased adherence to such diets was associated with a higher risk.

Healthful and Unhealthful Plant-Based Diets in Relation to Mortality Among Older Adults in China: A National Community-Based Prospective Study (2008-2018)

Background: Plant-based dietary pattern has been recommended for its potential health and environmental benefits. However, the relation of plant-based diet patterns to mortality warrants further exploration. Our study aimed to examine the prospective association of plant-based dietary patterns with all-cause mortality among older adults in China. Methods: In the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we included a total of 13,154 participants with a mean follow-up of 5·7 years in our analysis. Death cases were ascertained through close family members or official death certificates during follow-up. Overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) were calculated to assess the dietary patterns. Multivariable time-varying Cox proportional hazard model was applied to estimate the corresponding hazard ratios (HRs) of mortality.Findings8,937 (67·94%) deaths occurred during a total of 74,056 person-years of follow-up. Compared with the lowest quintile, those in the highest quintile of PDI and hPDI had a decreased risk of all-cause mortality (HR pdi = 0·92, 95%CI: 0·87, 0·98; HR hpdi = 0·81, 95%CI: 0·76, 0·87), whereas higher uPDI was associated with an increased risk (HR Q5vsQ1 = 1·17, 95%CI: 1·10,1·26). Associations of PDIs with mortality risk were consistently observed across strata defined by gender, residence, smoking status, and history of major non-communicable disease. Interpretation: Higher adherence to a healthful plant-based diet was associated with a decreased risk of mortality, whereas an opposite association was observed for higher adherence to unhealthful plant-based diets. The quality, not only quantity, of plant-based diet should be emphasized in relevant public health recommendations. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: The study was approved by the Biomedical Ethics Committee of Peking University, Beijing, China (IR1052-13074).

Plant-based diets and incident metabolic syndrome: Results from a South Korean prospective cohort study

BackgroundPrior studies have shown that plant-based diets are associated with lower risk of cardiovascular risk factors and incident cardiovascular disease, but risks differed by quality of plant-based diets. No prospective studies have evaluated the associations between different types of plant-based diets and incident metabolic syndrome (MetS) and components of MetS. Furthermore, limited evidence exists in Asian populations who have habitually consumed a diet rich in plant foods for a long period of time.Methods and findingsAnalyses were based on a community-based cohort of 5,646 men and women (40–69 years of age at baseline) living in Ansan and Ansung, South Korea (2001–2016) without MetS and related chronic diseases at baseline. Dietary intake was assessed using a validated food frequency questionnaire. Using the responses in the questionnaire, we calculated 4 plant-based diet indices (overall plant-based diet index [PDI], healthful plant-based diet index [hPDI], unhealthful plant-based diet index [uPDI], and pro-vegetarian diet index). Higher PDI score represented greater consumption of all types of plant foods regardless of healthiness. Higher hPDI score represented greater consumption of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, tea and coffee) and lower consumption of less-healthy plant foods (refined grains, potatoes, sugar-sweetened beverages, sweets, salty foods). Higher uPDI represented lower consumption of healthy plant foods and greater consumption of less-healthy plant foods. Similar to PDI, higher pro-vegetarian diet score represented greater consumption of plant foods but included only selected plant foods (grains, fruits, vegetables, nuts, legumes, potatoes). Higher scores in all plant-based diet indices represented lower consumption of animal foods (animal fat, dairy, eggs, fish/seafood, meat). Over a median follow-up of 8 years, 2,583 participants developed incident MetS. Individuals in the highest versus lowest quintile of uPDI had 50% higher risk of developing incident MetS, adjusting for demographic characteristics and lifestyle factors (hazard ratio [HR]: 1.50, 95% CI 1.31–1.71, P-trend < 0.001). When we further adjusted for body mass index (BMI), those in the highest quintile of uPDI had 24%–46% higher risk of 4 out of 5 individual components of MetS (abdominal obesity, hypertriglyceridemia, low high-density lipoprotein [HDL], and elevated blood pressure) (P-trend for all tests ≤ 0.001). Greater adherence to PDI was associated with lower risk of elevated fasting glucose (HR: 0.80, 95% CI 0.70–0.92, P-trend = 0.003). No consistent associations were observed for other plant-based diet indices and MetS. Limitations of the study may include potential measurement error in self-reported dietary intake, inability to classify a few plant foods as healthy and less-healthy, lack of data on vegetable oil intake, and possibility of residual confounding.ConclusionsIn this study, we observed that greater adherence to diets consisting of a high intake of refined carbohydrates, sugars, and salty foods in the framework of plant-based diets was associated with an elevated risk of MetS. These results suggest that considering the quality of plant foods is important for prevention of MetS in a population that habitually consumes plant foods.

Association Between Dietary Patterns in Midlife and Healthy Ageing in Chinese Adults: The Singapore Chinese Health Study

ObjectiveTo examine the associations between dietary patterns in midlife and likelihood of future healthy ageing in Chinese older adults. DesignProspective population-based study. Setting and ParticipantsWe included 14,159 participants aged 45-74 years who were free from cancer, cardiovascular disease, or diabetes at baseline (1993-1998) from the Singapore Chinese Health Study. MethodsDietary intakes in midlife were assessed by a validated food frequency questionnaire at baseline. Diet quality was scored according to the alternate Mediterranean diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) diet, the alternative Healthy Eating Index (AHEI)–2010, overall plant-based diet index (PDI), and healthful plant-based diet index (hPDI). Healthy ageing was assessed at the third follow-up visit (2014-2016), which occurred about 20 years after the baseline visit, and was defined as the absence of 10 chronic diseases, no impairment of cognitive function, no limitations in instrumental activities of daily living, no clinical depression at screening, good overall self-perceived health, good physical functioning, and no function-limiting pain among participants who had survival to at least 65 years of age. Multivariable-adjusted logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between each dietary pattern score and healthy ageing. ResultsAbout 20.0% of participants met the healthy ageing criteria. The OR (95% CI) for healthy ageing comparing the highest with the lowest quartile of diet quality scores was 1.52 (1.31-1.77) for aMED, 1.53 (1.35-1.73) for DASH, 1.39 (1.23-1.57) for AHEI-2010, 1.34 (1.18-1.53) for PDI, and 1.45 (1.27-1.65) for hPDI (all P-trend < .001). Each standard deviation increment in different diet quality scores was associated with 12% to 18% higher likelihood of healthy ageing. Conclusions and ImplicationsIn this Chinese population, adherence to various healthy dietary patterns at midlife is associated with higher likelihood of healthy ageing at later life.

Genetic susceptibility, plant-based dietary patterns, and risk of cardiovascular disease

Plant-based dietary patterns may be related to better cardiovascular profiles. Whether a healthy plant-based dietary index is predictive of future cardiovascular disease (CVD) across people with different genetic susceptibility remains uncertain. We investigated associations of adherence to healthy plant-based diets with the incidence of CVD considering the genetic susceptibility. This prospective cohort study included a total of 156,148 adults initially free of CVD and cancer. We calculated a healthful plant-based diet index (healthful-PDI) in which healthy plant foods received positive scores, and less healthy plant foods and animal foods received reverse scores. Genetic risk scores (GRSs) for myocardial infarction (MI) and stroke were calculated to assess interactions between healthful-PDI and GRSs. During 5 y of follow-up, we observed 1812 incident cases of CVD. Higher healthful-PDI was associated with a lower CVD risk [HR per 10-unit increment: 0.87 (95% CI: 0.81, 0.93) after adjusting for demographic, lifestyle, and other dietary factors (model 1); HR 0.90 (0.84, 0.97) after further adjusting for obesity and metabolic factors (model 2)]. The risk of CVD was gradually decreased in association with higher adherence to healthful-PDI, regardless of genetic susceptibility. The inverse associations of healthful-PDI with CVD were consistently observed in people with low GRS-MI [HR 0.85 (95% CI: 0.76, 0.94) in model 1; HR 0.88 (0.79, 0.97) in model 2] and those with high GRS-MI [HR 0.91 (0.82, 0.99) in model 1; HR 0.94 (0.86, 1.04) in model 2], without significant interactions (Pinteraction=0.59 in model 1; Pinteraction=0.66 in model 2). Similarly, higher healthful-PDI was related to a lower risk of CVD, regardless of low/high GRS-stroke. Adherence to healthy plant-based diets may be associated with a decreased incidence of CVD in the entire population, suggesting that plant-based dietary patterns may modify the risk of CVD, regardless of genetic susceptibility.