Plant-based Diet Index Research Articles

Degree of adherence to plant-based diet and total and cause-specific mortality: prospective cohort study in the Million Veteran Program.

To examine the association between adherence to plant-based diets and mortality. Prospective study. We calculated a plant-based diet index (PDI) by assigning positive scores to plant foods and reverse scores to animal foods. We also created a healthful PDI (hPDI) and an unhealthful PDI (uPDI) by further separating the healthy plant foods from less-healthy plant foods. The VA Million Veteran Program. 315 919 men and women aged 19-104 years who completed a FFQ at the baseline. We documented 31 136 deaths during the follow-up. A higher PDI was significantly associated with lower total mortality (hazard ratio (HR) comparing extreme deciles = 0·75, 95 % CI: 0·71, 0·79, Ptrend < 0·001]. We observed an inverse association between hPDI and total mortality (HR comparing extreme deciles = 0·64, 95 % CI: 0·61, 0·68, Ptrend < 0·001), whereas uPDI was positively associated with total mortality (HR comparing extreme deciles = 1·41, 95 % CI: 1·33, 1·49, Ptrend < 0·001). Similar significant associations of PDI, hPDI and uPDI were also observed for CVD and cancer mortality. The associations between the PDI and total mortality were consistent among African and European American participants, and participants free from CVD and cancer and those who were diagnosed with major chronic disease at baseline. A greater adherence to a plant-based diet was associated with substantially lower total mortality in this large population of veterans. These findings support recommending plant-rich dietary patterns for the prevention of major chronic diseases.

Abstract MP13: Serum Metabolomic Signatures Of Plant-based Diets And Incident Chronic Kidney Disease

Introduction: Greater adherence to plant-based diets is associated with a lower risk of incident chronic kidney disease (CKD). Metabolomics can help identify blood biomarkers of plant-based diets and understand the underlying mechanisms. Objectives: Using untargeted metabolomics, we aimed to identify metabolites associated with 4 plant-based diet indices (PDI) [overall PDI, provegetarian, healthful PDI, and unhealthful PDI] and incident CKD in 2 subgroups within the Atherosclerosis Risk in Communities Study. Methods: Participants (n 1 =1,762; n 2 =2,152) reported usual dietary intake using a food frequency questionnaire. We used linear regression models to examine the association between 4 PDIs and 374 individual metabolites. We used Cox regression models to evaluate associations between PDI-related metabolites and incident CKD. Estimates were meta-analyzed across 2 subgroups. We calculated C-statistics to assess whether metabolites improved the prediction of those in the highest quintile vs. lower 4 quintiles of PDIs, and whether PDI-related metabolites predicted incident CKD. Results: We identified 82 significant PDI-metabolite associations (overall PDI=27; provegetarian=17; healthful PDI=20; unhealthful PDI=18); 11 metabolites overlapped across the overall PDI, provegetarian, and healthful PDI. The addition of metabolites improved prediction of those in the highest quintile vs. lower 4 quintiles of PDIs compared to participant characteristics alone ( P -value ≤0.001 for all tests). Six PDI-related metabolites representing 2 pathways were significantly associated with incident CKD ( Table ) and improved prediction of incident CKD beyond traditional risk factors (difference in C-statistics for all 6 metabolites=0.005, P -value=0.006). Conclusions: In a community-based study of US adults, we identified metabolites that were related to plant-based diets that predicted incident CKD. These metabolites highlight pathways through which plant-based diets are associated with incident CKD.

Abstract 066: A Healthy Plant-based Diet Was Associated With Slower Cognitive Decline In African Americans: A Biracial Community-based Cohort Of Older Adults

Background: African Americans (AAs) are about twice as likely to develop dementia compared to non-Hispanic whites (NHWs). Dietary modification is an effective preventive strategy to reduce the rate of cognitive decline, a hallmark feature of dementia; however, evidence from diverse populations focusing on AAs is minimal. Objective: To evaluate the association between a plant-based diet and the rate of cognitive decline in a population-based sample of AAs and NHWs. Method: This study consisted of 4753 participants (62% African American, 63% female) in a biracial population-based study in the United States (Chicago Health and Aging Project, 1993 to 2012). Plant-based diet quality was evaluated by the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI). Global cognition was assessed using a composite score of four tests of cognition. We used mixed models to examine the association between PDI, hPDI, and uPDI with the rate of decline in global cognition, perceptual speed, and episodic memory. Models were adjusted for age, sex, apoE genotype, education, cognitive activities, smoking status, calorie intake, risk factors of cardiovascular disease, time, and an interaction term of time with each covariate. Results: We demonstrated that there were distinct differences in the association of dietary patterns with cognitive decline in AAs and NHWs. AAs had higher intakes of egg, fish or seafood, sugar-sweetened beverages, and whole grains compared to NHWs (p&lt;0.001 for all). Higher hPDI was associated with a slower rate of decline in global cognition, perceptual speed, and episodic memory in AAs but not NHWs. AAs in the highest quintile of hPDI had significantly slower rates of decline in global cognition, β = 0.0183 (p=0.032), perceptual speed β = 0.0179 (p=0.04), and episodic memory β=0.0183 (p=0.04) compared to individuals in the lowest quintile of hPDI. The rate of global cognitive decline in the highest quintile was slowed by 28.4% when compared to individuals in the lowest quintile of hPDI in AAs. There were no associations with either PDI or uPDI and the rate of cognitive decline in either racial group. Conclusion: AAs and NHWs have distinct dietary patterns. A healthy plant-based diet was associated with a slower rate of decline in global cognition, perceptual speed, and episodic memory in AAs. These results are informative in facilitating the development of tailored dietary recommendations for the prevention of cognitive decline in diverse populations.

Association of plant-based diet index with prostate cancer risk

Plant-based diets are associated with multiple health benefits and a favorable environmental impact. For prostate cancer, previous studies suggest a beneficial role of specific plant-based foods (e.g., tomatoes) and a potentially harmful role of specific animal-based foods (e.g., meat, dairy). However, less is known about plant-based dietary patterns. We sought to examine the relation between plant-based diet indices and prostate cancer risk, including clinically relevant disease. This was a prospective cohort study including 47,239 men in the Health Professionals Follow-Up Study (1986-2014). Overall and healthful plant-based diet indices were calculated from FFQs. Cox proportional hazards models were used to estimate HRs and 95% CIs to examine the risk of incident prostate cancer (total and by clinical category), among men ages <65 and ≥65 y. Of the 47,239 men, 6655 men were diagnosed with prostate cancer over follow-up, including 515 with advanced-stage disease at diagnosis, 956 with lethal disease (metastasis or death), and 806 prostate cancer deaths. Greater overall plant-based consumption was associated with a significantly lower risk of fatal prostate cancer (HR: 0.81; 95% CI: 0.64, 1.01; P-trend = 0.04). In men aged <65, a higher plant-based diet index was associated with a lower risk of advanced, lethal, and fatal prostate cancer. Moreover, greater consumption of a healthful plant-based diet was associated with lower risks of total (HR: 0.84; 95% CI: 0.73, 0.98; P-trend = 0.046) and lethal prostate cancer (HR: 0.56; 95% CI: 0.34, 0.94; P-trend = 0.03) at age <65. There were no associations between overall or healthful plant-based diet indices with prostate cancer among men ≥65 y. Fewer than 1% of participants followed a strict vegetarian or vegan diet. This prospective study provides supportive evidence that greater consumption of healthful plant-based foods is associated with a lower risk of aggressive forms of prostate cancer, with stronger benefit among men aged <65 y.

Abstract P214: Plant-based Diets And Risk Of Hospitalization With Respiratory Infection: Results From The Atherosclerosis Risk In Communities (ARIC) Study

Introduction: The benefits of plant-based diets may depend on the type of plant; unhealthy plant foods, such as sugar and refined grains, have detrimental health consequences. Micronutrients in plants decrease inflammation and are essential for proper immune function. Deficiencies in these nutrients can contribute to a pro-inflammatory state and may increase risk of infection. Methods: We conducted a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) Study. Participants completed food frequency questionnaires in 1993-1996 (visit 3). We used reported intakes to calculate a plant-based diet index (PDI), healthy plant-based diet index (hPDI), and an unhealthy plant-based diet (uPDI). Active surveillance is conducted for all hospitalizations. We used Cox models to examine the associations of three plant-based diet indices (in quintiles) with risk of pneumonia and influenza, and other infection-related hospitalizations identified by ICD codes. Results: In our sample of 11,956 adults there were 2522 hospitalizations with respiratory infections and 4308 hospitalizations with any infection during a median follow-up of ~22 years. The incidence of hospitalization with respiratory infections and any infection was lower among those adults consuming more plant-based foods (Table) . Higher hPDI was associated with a lower risk of hospitalization with any infection or respiratory infection. Higher PDI was associated with a lower risk of hospitalization with any infection. Significant associations were not observed with the uPDI. Conclusions: Adults who adhere to diets high in any plant foods, as well as healthy plant foods, have a lower risk of hospitalization with infections. Adherence to diets high in healthy plant foods specifically is associated with lower risk of hospitalizations with respiratory infections.

Plant-based dietary patterns in relation to mortality among older adults in China.

A plant-based dietary pattern has been recommended for its potential health and environmental benefits, but its relation to mortality warrants further exploration1. We examined this association among 13,154 adults aged 65 years and older (57.4% female) in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The overall plant-based diet index (PDI), healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI) were calculated using dietary data collected by a simplified food frequency questionnaire (FFQ). Compared with the lowest quintile, participants in the highest quintile of PDI and hPDI had a decreased risk of all-cause mortality (hazard ratio (HR) = 0.92; 95% confidence interval (CI) 0.86, 0.98 for PDI; HR = 0.81, 95% CI, 0.76, 0.87 for hPDI), whereas participants with the highest uPDI scores had a 17% (95% CI, 9%, 26%) increased risk. Among plant foods, fresh fruits, fresh vegetables, legumes, garlic, nuts and tea were the main protective contributors, whereas preserved vegetables and sugar were associated with a higher risk of mortality. These findings support the beneficial roles of overall and healthful plant-based dietary patterns. The quality, and not only quantity, of plant foods should be emphasized in relevant public health recommendations.

Reproducibility and validity of diet quality scores derived from food-frequency questionnaires

Diet quality scores (DQSs) are frequently used to study diet-disease relations but the validity of these scores derived from FFQs has rarely been evaluated. To evaluate the validity and reproducibility of 6 commonly used DQSs derived from the FFQ, including the Alternate Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension Trial score, alternative Mediterranean diet score, and 3 plant-based diet indices (overall, healthful, and unhealthful). This analysis included 1394 participants from the Men's Lifestyle Validation Study (N = 652) and the Women's Lifestyle Validation Study (N = 742). Participants completed a 152-item FFQ at the beginning of the study and 1 y later, as well as completed 2 weighed 7-d dietary records (7DDRs) and donated 2 blood samples 6 mo apart between FFQ assessments. The reproducibility of the FFQs was evaluated by rank intraclass correlation coefficients (ICCs). The validity was assessed by comparing FFQ-derived DQSs with those from the average of two 7DDRs using Spearman rank correlation coefficients deattenuated for random measurement error in the 7DDRs (rs). Furthermore, we calculated the correlations between DQSs and plasma biomarkers of diet, including fatty acids, folate, carotenoids, retinol, and α- and γ-tocopherol. Six FFQ-derived DQSs demonstrated moderate to high reproducibility (energy-adjusted ICCs: 0.61-0.84) and validity (energy-adjusted, deattenuated rs = 0.56-0.80) in both men and women. We consistently observed expected correlations between FFQ-derived DQSs with plasma fatty acids, including long-chain n-3 (ω-3) and trans fatty acids, most carotenoids, and γ-tocopherol (rs > 0.2). Our study demonstrates the validity of the FFQ to evaluate overall diet quality using 6 commonly used DQSs. In addition, these DQSs have qualitatively demonstrated biological relevance, as indicated by their correlations with circulating biomarkers.

Abstract MP36: Association Between The Quality Of Plant-based Diets And Risk Of Frailty

Importance: The Mediterranean diet, and other dietary patterns rich in fruits and vegetables, have been linked to lower risk of frailty in older adults. However, not all plant-based diets are necessarily healthful, and no previous study has evaluated the role of the quality of plant-based dietary patterns in frailty risk. Objective: To assess the association between plant-based diet quality and risk of frailty. Design, setting, and participants: Prospective cohort with 82,234 women aged ≥60y from the Nurses’ Health Study, who were followed from 1990 through 2014. The dates of analysis were April 14 to -June 23, 2021. Exposures: Dietary data were collected every 4-y using a validated semi-quantitative food frequency questionnaire. The plant-based diet quality was assessed with 2 indices (range 18 - 90 points).: a) Healthful Plant-Based Diet Index (hPDI), where healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea/coffee) received positive scores, while less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, sweets/desserts) and animal foods received reverse scores; and b) Unhealthful Plant-Based Diet Index (uPDI) where positive scores were given to less healthy plant foods and reverse scores to healthy plant foods and animal foods. Main outcomes: Frailty incidence was assessed every 4 years, being defined as having ≥3 of the following 5 criteria from the FRAIL scale: fatigue, low strength, reduced aerobic capacity, having ≥5 illnesses, and weight loss ≥5%. Methods: Multivariable-adjusted Cox proportional-hazards models were used to estimate hazard ratios (HRs), and their 95% confidence interval (CI). Results: We identified 12,910 incident cases of frailty over 1,176,401 person-year follow-up. In the multivariable analysis, the hPDI was inversely associated with the risk of frailty (HR for the highest vs. lowest quintile: 0.69, 95% CI: 0.65-0.73; p-trend&lt;0.001). In addition, a 10-unit increment in the hPDI was associated with a relative 20% lower risk of frailty. Conversely, a direct association was found between the uPDI and risk of frailty (HR highest vs. lowest quintile: 1.41, 95% CI: 1.32-1.49]; p-trend&lt;0.001). These associations were consistent for each frailty criterion, among participants with no frailty criteria at baseline, after excluding participants with diabetes, cancer, and CVD at baseline, for alternative versions of the PDIs, in subgroup analysis by categories of potential confounders, and in latency analysis. Conclusions and relevance: A healthful plant-based diet was associated with lower risk of frailty whereas an unhealthful plant-based diet was associated with higher risk.

Abstract 020: Healthy Dietary Patterns And Risk Of Cardiovascular Disease In Us Hispanics/latinos: The Hispanic Community Health Study/study Of Latinos (HCHS/SOL)

Introduction: Multiple healthy eating patterns have been recommended by the Dietary Guidelines for Americans (2015-2020) for the prevention of cardiovascular disease (CVD). However, adherence to these dietary patterns and its relationship with risk of CVD remains unclear among US Hispanic/Latinos. Hypothesis: We aimed to evaluate three healthy eating patterns measured by three dietary quality indices (the Alternate Mediterranean diet (aMED), the Healthy Eating Index (HEI)-2015, and the healthful Plant-based Diet Index (hPDI)), and assessed the hypothesis that higher adherence to healthy eating patterns is associated with lower risk of CVD in US Hispanic/Latinos. Methods: We included 10,766 adult participants representing six Hispanic/Latino backgrounds (Mexican, Puerto Rican, Cuban, Dominican, Central American and South American), free of CVD or cancer at baseline, from the Hispanic Community Health Study/Study of Latinos. Dietary pattern scores were derived using information collected by two 24-hour dietary recalls at baseline (2008-11). The primary outcome was major incident CVD (n=248), comprised of coronary heart disease and stroke, during an average 6-year follow-up period. Relative risks for CVD were estimated using survey Poisson regression after adjustment for demographic, socioeconomic, and behavioral variables and sampling weights. Results: Mean scores of all three dietary quality indices were significantly different across six Hispanic/Latino background groups (all P &lt;0.001), with the highest (healthier) in Mexicans and lowest in Puerto Ricans. Compared to Hispanics/Latinos who were born outside the mainland US, US-born Hispanics/Latinos had significantly lower dietary quality scores (all P &lt;0.001), especially in Mexican, Dominican, and Central American background groups. The differences in dietary scores between the non-US-born and US-born Hispanics/Latinos were primarily driven by intakes of healthy plant-based foods (e.g., whole grains, fruits, vegetables, legumes and nuts). We found significant inverse associations across tertiles of the three dietary indices with risk of CVD. After multivariable adjustment, the relative risk of CVD was 0.54 (95% CI 0.37-0.81; P -trend=0.002) for aMED, 0.64 (95% CI 0.39-1.05; P -trend=0.033) for HEI-2015, and 0.56 (95% CI, 0.35-0.88; P -trend=0.009) for hPDI when comparing highest to lowest tertiles in the overall sample. The associations between dietary quality scores and risk of CVD were not different across Hispanic/Latino backgrounds (all P for interaction ≥0.24) or not by US-born status (all P for interaction ≥0.25). Conclusions: Adherence to healthy eating patterns reflected by three diet quality indices varied by Hispanic/Latino background and immigrant generation, and higher compliance to healthy eating patterns was associated with lower risk of CVD risk in the US Hispanic/Latino population.

Abstract MP32: Healthy Dietary Patterns Are Associated With The Gut Microbiome In The Hispanic Community Health Study/Study Of Latinos (HCHS/SOL)

Introduction: Dietary patterns high in healthy plant foods play an important role in modulating the gut microbiome and promoting cardiometabolic health. Little is known on the diet-gut microbiome relationship in U.S. Hispanics/Latinos, who have a high burden of obesity and diabetes. Hypothesis: Three healthy dietary patterns - the alternate Mediterranean diet (aMED), the Healthy Eating Index (HEI)-2015, and the healthful Plant-based Diet Index (hPDI), will be associated with gut microbiome composition in U.S. Hispanic/Latino adults, and healthy-diet-related species will be related to favorable cardiometabolic traits. Methods: HCHS/SOL is a multi-site community-based cohort. At baseline (2008-11), diet was assessed via two 24-hr recalls. Shotgun sequencing was performed on stool samples collected in 2014-17 (n=2,985). Analysis of Compositions of Microbiomes 2 (ANCOM2) was used to identify associations of dietary pattern scores with gut microbiome species and functions, adjusting for sociodemographic, behavioral, and clinical covariates. Results: Better diet quality according to multiple healthy dietary patterns was associated with higher abundance of species from class Clostridia, including [Eubacterium] eligens , Butyrivibrio crossotus , and Lachnospiraceae bacterium TF01-11 , as well as functions related to fiber fermentation (e.g. pyruvate:ferredoxin oxidoreductase). Poorer diet quality was associated with higher abundance of Acidaminococcus intestini , as well as functions of manganese/iron transport, adhesin protein transport, and nitrate reduction. Healthy diet pattern-enriched Clostridia species were related to more favorable cardiometabolic traits such as lower triglycerides ( Figure 1 ). Conclusions: Healthy dietary patterns in this population are associated with a fiber-fermenting gut microbiome, consistent with previous studies in other racial/ethnic groups. Gut microbiota may be involved in the beneficial effect of higher diet quality on cardiometabolic disease risk.

Prepregnancy adherence to plant-based diet indices and exploratory dietary patterns in relation to fecundability

Modest associations have been reported between specific food groups or nutrients and fecundability [measured by time to pregnancy (TTP)]. Examining overall diets provides a more holistic approach towards understanding their associations with fecundability. It is not known whether plant-based diets indices or exploratory dietary patterns are associated with fecundability. We examine the associations between adherence to 1) plant-based diet indices; and 2) exploratory dietary patterns and fecundability among women planning pregnancy. Data were analyzed from the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) study. Prepregnancy diet was assessed using a semi-quantitative FFQ from which the overall, healthful, and unhealthful plant-based diet indices (oPDI, hPDI, and uPDI, respectively) were calculated. Exploratory dietary patterns were derived using factor analysis based on 44 predefined food groups. Participants were categorized into quintiles based on their dietary pattern scores. TTP (expressed in menstrual cycles) was ascertained within a year from the prepregnancy dietary assessment. Discrete-time proportional hazard models, adjusted for confounders, were used to estimate fecundability ratios (FRs) and 95% CIs, with FR>1 indicating a shorter TTP. Among 805 women, 383 pregnancies were confirmed by ultrasound scans. Compared with women in the lowest quintile, those in the highest quintile of the uPDI had reduced fecundability (FR of Q5 compared with Q1, 0.65; 95% CI, 0.46-0.91; P trend, 0.009). Conversely, greater adherence to the hPDI was associated with increased fecundability (1.46; 95% CI, 1.02-2.07; P trend, 0.036). The oPDI was not associated with fecundability. Among the 3 exploratory dietary patterns, only greater adherence to the Fast Food and Sweetened Beverages (FFSB) pattern was associated with reduced fecundability (0.61; 95% CI, 0.40-0.91; P trend, 0.018). Greater adherence to the uPDI or the FFSB dietary pattern was associated with reduced fecundability among Asian women. Greater adherence to the hPDI may be beneficial for fecundability, though this requires confirmation by future studies.

Plant-based diets and incident cardiovascular disease and all-cause mortality in African Americans: A cohort study.

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.

Interaction between plant-based dietary pattern and air pollution on cognitive function: a prospective cohort analysis of Chinese older adults

SummaryBackgroundAir pollution is a risk factor for poor cognitive function, while a plant-based dietary pattern is associated with better cognitive function. We aimed to explore their interaction with cognitive function among older adults.MethodsWe used a prospective cohort of old individuals, including 6525 participants of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), aged 65-110 years and with normal cognition at baseline. Air pollution measurement was derived using satellite-derived annual average fine particulate matter (PM2.5) concentrations based on residential locations. Plant-based diet index (PDI) was calculated using survey responses to assess the dietary pattern. Repeated measures of the Mini-Mental State Examination (MMSE) were utilized to assess cognitive function. We applied the Cox proportional hazard regression to explore the associations and further stratified the analysis by PDI.FindingsDuring a median of 5·6-year follow-up, 1537 (23·6%) out of 6525 participants with normal cognition at baseline developed poor cognitive function (MMSE <18). Living in areas with the highest quintile of cumulative PM2.5 was associated with a 46% increase in the risk of developing poor cognitive function (hazard ratio (HR): 1·46, 95% confidence interval (CI): 1·20, 1·77), compared to those living in areas with the lowest quintile. We observed a significant interaction between cumulative PM2.5 and PDI (p-interaction: 0·04), with the corresponding associations of cumulative PM2.5 being more pronounced among participants with lower PDI (HR: 1·68, 95% CI: 1·26, 2·24) than those with higher PDI (HR: 1·28, 95% CI: 0·98, 1·68).InterpretationPlant-based dietary pattern may attenuate detrimental impacts of PM2.5 on cognitive function among older adults. Adherence to the plant-based dietary pattern could be used to prevent adverse neurological effects caused by air pollution, especially in developing regions.

Consumption of a Healthy Plant-based Diet is Associated With a Decreased Risk of Erectile Dysfunction: A Cross-sectional Study of the National Health and Nutrition Examination Survey

ObjectiveTo investigate the association between the plant-based content of diet and erectile dysfunction in men from the National Health and Nutrition Examination Survey (NHANES). MethodsWe collected de-identified information from the NHANES database on demographics, comorbidities, diet, and erectile dysfunction (ED). Exclusion criteria were age <20 or >70 years, incomplete plant-based diet index information, history of prostate cancer, or other missing information. Using the food frequency questionnaire, an overall plant-based diet index (PDI) and healthful plant-based diet index (hPDI) were developed. A higher score on the PDI and hPDI is indicative of greater consumption of plant-based foods. ResultsA total of 2549 men were analyzed, of those 1085 (42.6%) have good erectile function and 1464 (57.4%) have some degree of ED [usually have erections 521 (20.4%), sometimes have erection 690 (27.1%), or never have erections 253 (9.9%)]. The median age and BMI were 54 [41-64] years and 28.8 [25.5-32.6] kg/m2, respectively. The median PDI and hPDI were 50 [46-54] and 50 [45-56], respectively. In multivariable adjusted logistic regression analysis, hPDI was negatively associated with ED (OR = 0.98, 95% CI: 0.96-0.99; P = .001). There was no association between PDI and ED. ConclusionIn a well characterized national database, we showed that a healthful plant-based diet is associated with less chance of having erectile dysfunction. Whether interventions with a plant-based diet will improve erectile function remains to be studied.

Prospective Study of Plant-Based Dietary Patterns and Diabetes in Puerto Rican Adults

BackgroundVegetarian-type dietary patterns have been associated with reducing the risk of developing diabetes and may function as an effective strategy for diabetes management. ObjectivesWe aimed to examine the associations between adherence to plant-based diet indices and the risk of developing diabetes in the Boston Puerto Rican Health Study. MethodsPuerto Rican adults (n = 646), aged 45–75 y and free of diabetes at baseline, were included. Dietary intake was assessed via a validated FFQ. Three plant-based dietary indices were calculated: an overall plant-based diet index (PDI), a 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), glycated hemoglobin ≥ 6.5% (48 mmol/mol), or use of hypoglycemic agents during follow-up. Cox proportional hazards were used to evaluate associations between the dietary patterns and incidence of diabetes, adjusting for potential confounders, such as age, sex, socioeconomic status, lifestyle factors, obesity, total energy intake, depressive symptomatology, and plasma concentrations of lipids. ResultsDuring a mean of 4.2 y of follow-up, we identified 134 diabetes cases. After adjustment for covariates, higher hPDI was associated with lower risk of developing diabetes (adjusted HR for the highest compared with the lowest tertile: 0.54; 95% CI: 0.31, 0.94; P-trend = 0.03). In contrast, the PDI and uPDI were not significantly associated with the risk of diabetes (P-trend > 0.3 for both). ConclusionsThe healthful plant-based dietary index, but not the total plant-based dietary index, was inversely associated with diabetes risk. These findings suggest that the quality of plant-based diets must be considered when recommending plant-based diets for the prevention of diabetes.This trial was registered at clinicaltrials.gov as NCT01231958.

Plant‐based dietary patterns and cognitive function in U.S. adults: A prospective evaluation

AbstractBackgroundA plant‐based dietary patterns focus on foods primarily from plant sources. However, not all plant‐based foods are necessarily beneficial for health. We aim to examine the relationship between plant‐based diet quality and cognitive function.MethodAnalyses were conducted among 701 participants from the Memory and Aging Project. Food Frequency Questionnaires (FFQ) were incorporated into the studies in 2004 and collected annually thereafter. Individuals with mild cognitive impairment, missing food‐frequency questionnaire (FFQ) at baseline, extreme BMI, and less than two cognitive assessments during 10 years of follow‐up were excluded for these analyses. Plant‐based diet quality were assessed by 3 plant‐based diet indices (score range, 18‐90) including 1) an overall plant‐based diet index (PDI) by assigning positive scores to all plant foods and reverse scores to animal foods; 2) a healthful PDI (hPDI) where positive scores were given to only healthy plant foods, less‐healthy plant foods and animal foods received reverse scores; 3) an unhealthful PDI (uPDI), where less‐healthy plant foods received positive scores and animal and healthy plant foods received reverse scores. Our primary outcome was composite global cognition z score. We used liner mixed model examining the association between PDI (as a continuous and categorical) and cognitive decline.ResultHigher hPDI was associated with a better cognitive functioning during follow‐up. Compared to individuals in the first tertile of hPDI, individuals in the third tertile had slower cognitive decline by 0.03 units per year (β = 0.03, p=0.017). Similarly, when we evaluated the hPDI as continuous variable, each10‐points increase in hPDI was associated with 0.01 units/year slower cognitive decline. In contrast, higher adherence to uPDI was associated with faster cognitive decline. Individuals in the third tertile of uPDI had a faster decline by 0.04 unites per year (β = 0.04 , p=0.017). Every 10‐point increase in uPDI was associated with a 0.01 unit per year faster cognitive decline.ConclusionHigher intake of a plant‐based diet index rich in healthier plant foods was associated with slower cognitive decline. This supports current recommendations to shift to diets rich in healthy plant foods, with lower intake of less healthy plant and animal foods.

Prepregnancy plant-based diets and the risk of gestational diabetes mellitus: a prospective cohort study of 14,926 women

Emerging evidence suggests beneficial impacts of plant-based diets on glucose metabolism among generally healthy individuals. Whether adherence to these diets is related to risk of gestational diabetes mellitus (GDM) is unknown. We aimed to examine associations between plant-based diets and GDM in a large prospective study. We included 14,926 women from the Nurses' Health Study II (1991-2001), who reported ≥1 singleton pregnancy and without previous GDM before the index pregnancy. Prepregnancy adherence to plant-based diets was measured by an overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) as assessed by FFQs every 4 y. Incident first-time GDM was ascertained from a self-reported physician diagnosis, which was previously validated by review of medical records. We used log-binomial models with generalized estimating equations to calculate RRs and 95% CIs for associations of PDIs with GDM. We documented 846 incident GDM cases over the 10-y follow-up among 20,707 pregnancies. Greater adherence to the PDI and hPDI was associated with lower GDM risk. For the PDI, the multivariable-adjusted RR (95% CI) comparing the highest and lowest quintiles (Q5 compared with Q1) was 0.70 (0.56, 0.87) (Ptrend=0.0004), and for each 10-point increment was 0.80 (0.71, 0.90). For the hPDI, the RR (95% CI) of Q5 compared with Q1 was 0.75 (0.59, 0.94) (Ptrend=0.009) and for each 10-point increment was 0.86 (0.77, 0.95). After further adjustment for prepregnancy BMI, the associations were attenuated but remained significant: for the PDI, the RR (95% CI) for each 10-point increment was 0.89 (0.79, 1.00) and the corresponding RR (95% CI) was 0.89 (0.80, 0.99) for the hPDI. The uPDI was not associated with GDM. Our study suggests that greater prepregnancy adherence to a healthful plant-based diet was associated with lower risk of GDM, whereas an unhealthful plant-based diet was not related to GDM risk.

Association between Unhealthful Plant-Based Diets and Possible Risk of Dyslipidemia.

The relationship between the various types of diets derived from plants and vulnerability of dyslipidemia has rarely been investigated, and limited data exist in Asians whose dietary pattern is fairly different from that of the Western population. We aim to analyze the relationship between three plant-based diet indices (PDI) and the risk of dyslipidemia. Participants included 173,209 Korean adults who were aged ≥40 years from the Korean Genome and Epidemiology Study_Health Examination (2004–2013). A food frequency questionnaire (FFQ) was used to assess dietary intake. Three PDI were quantified for the study: overall PDI, healthful PDI (hPDI), and unhealthful PDI (uPDI). Among the 147,945 included, 48,166 (32.6%) of participants had dyslipidemia. Great adherence to uPDI was related with 15% greater odds of having dyslipidemia (OR: 1.15; 95% CI: 1.11–1.20, p-trend < 0.0001). No significant association was observed between PDI, hPDI, and dyslipidemia. The association between uPDI and dyslipidemia was significantly stronger among participants aged ≥55 years when compared to participants aged <55 years (p-value for interaction = 0.001). The quality of plant foods is vital in preventing dyslipidemia among people consuming high plant-based food diets.

Association of plant-based diets with lipid profile and anthropometric indices: a cross-sectional study

PurposePlant-based diets have been related to decreasing morbidity and mortality of many non-communicable diseases. The purpose of this study was to investigate the relationship between plant-based diets and lipid profiles and anthropometric indices.Design/methodology/approachThis cross-sectional study was performed on 236 men and women selected from Shiraz health-care centers. This study used a 168-item food frequency questionnaire to calculate plant-based diet index (PDI), healthy plant-based diet index (hPDI) and unhealthy plant-based diet index (uPDI). Total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol and triglycerides were measured. Furthermore, body mass index, a body shape index and conicity index (CI) were calculated after measuring weight, height and waist circumference.FindingsHigher score of PDI was significantly related to higher triglycerides level (OR = 2.16; 95% CI: 1.04, 4.48; P = 0.03). In the fully adjusted model, there was a significant association between ABSI and hPDI (OR = 4.88; 95% CI: 1.17, 20.24; P = 0.03). A significant inverse association was observed between uPDI and high-density lipoprotein (HDL) (OR = 0.45; 95% CI = 0.21, 0.98; P = 0.03). Also, this study found a decreasing, but insignificant trend in relation of ABSI (OR = 0.72; 95% CI = 0.22, 2.34) and CI (OR = 0.41; 95% CI = 0.06, 0.56) with PDI.Research limitations/implicationsFurther studies are needed to explore the association of PDI with anthropometric indices and lipid profile and also to assess the potential causality of the observed associations. Plant-based diets according to their contents could affect triglycerides, HDL and anthropometric properties.Practical implicationsHence, dietitians should consider the findings of this study such as the inverse effect of unhealthy plant-based diets on HDL and the relation between healthy plant-based diets and WC and abdominal obesity.Originality/valueThis study showed that adherence to a plant-based diet was related to higher triglycerides levels. Also, uPDI was inversely associated with HDL level. Furthermore, participants who adhered more to a healthy plant-based diet had higher abdominal adiposity.

Plasma boron concentrations in the general population: a cross-sectional analysis of cardio-metabolic and dietary correlates

PurposeExperimental evidence suggests positive effects of boron on health and metabolism, but human data are still scarce. We aimed to identify dietary and cardio-metabolic correlates of plasma boron concentrations in the general population.MethodsIn a community-based sample (n = 899, 57% men, mean age 61 years), plasma boron (median [IQR]: 33.80 µg/L [25.61; 44.65]) concentrations were measured by inductively coupled plasma-mass spectrometry. Overall (PDI), healthy (hPDI), and unhealthy (uPDI) plant-based diet indices were derived from a validated food frequency questionnaire. Reduced rank regression (RRR) yielded a dietary pattern explaining 30% of the variation of circulating boron. Cross-sectional associations of dietary indices and cardio-metabolic traits with plasma boron concentrations were assessed using multivariable-adjusted linear regression analysis.ResultsThe RRR pattern was characterized by high intake of fruits, nuts/seeds, tea, wine and low intake of e.g. bread, poultry, processed meat, chocolate/sweets, and soft drinks. 10-point increments in PDI, hPDI, and uPDI were associated with 8.7% (95% CI: 4.2; 13.4), 10.4% (95% CI: 6.6; 14.3), and −8.8% (95% CI: −12.1; −5.4) change in plasma boron concentrations, respectively. Age and phosphate were directly, while BMI, plasma lipid concentrations, and CRP were inversely associated with circulating boron. Plasma boron concentrations were higher in summer vs. winter, in individuals taking vs. not taking antihypertensive medication, and in individuals with high or medium vs. low education level.ConclusionHigher plasma boron concentrations appeared to associate with a healthier diet, were related to lower BMI and a more favorable cardio-metabolic risk profile, and showed seasonal variations.