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

Wang, Dong D.; Li, Yanping; Nguyen, Xuan‐Mai T.; Song, Rebecca J; Ho, Yuk‐Lam; Hu, Frank B.; Willett, Walter C.; Wilson, Peter W.F.; Cho, Kelly; Gaziano, J. Michael; Djoussé, Luc

doi:10.1017/s1368980022000659

Cited by 11 publications

(8 citation statements)

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“…Our findings are generally in line with those from previous US studies on hPDI and uPDI in relation to myocardial infarction, ischemic stroke, CVD mortality, and total mortality . Importantly, we observed that inverse associations between the hPDI and CVD end points (total CVD, myocardial infarction, and stroke) were independent of genetic disease risk.…”

Section: Discussionsupporting

confidence: 92%

Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK

et al. 2023

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ImportancePlant-based diets have gained popularity for both environmental and health reasons, but a comprehensive assessment of their quality in relation to risk of mortality and major chronic diseases is lacking.ObjectiveTo examine whether healthful vs unhealthful plant-based dietary patterns are associated with mortality and major chronic diseases among UK adults.Design, Setting, and ParticipantsThis prospective cohort study used data from adults in the UK Biobank, a large-scale population-based study. Participants were recruited between 2006 and 2010 and followed up using record linkage data until 2021; follow-up for different outcomes ranged between 10.6 and 12.2 years. Data analysis was conducted from November 2021 to October 2022.ExposuresAdherence to a healthful vs unhealthful plant-based diet index (hPDI vs uPDI) derived from 24-hour dietary assessments.Main Outcomes and MeasuresThe main outcomes were hazard ratios (HRs) and 95% CIs of mortality (overall and cause specific), cardiovascular disease (CVD [total, myocardial infarction, ischemic stroke, and hemorrhagic stroke]), cancer (total, breast, prostate, and colorectal), and fracture (total, vertebrae, and hip) across quartiles of hPDI and uPDI adherence.ResultsThis study included 126 394 UK Biobank participants. They had a mean (SD) age of 56.1 (7.8) years; 70 618 (55.9%) were women. The majority of participants (115 371 [91.3%]) were White. Greater adherence to the hPDI was associated with lower risks of total mortality, cancer, and CVD, with HRs (95% CIs) of 0.84 (0.78-0.91), 0.93 (0.88-0.99), and 0.92 (0.86-0.99), respectively, for participants in the highest hPDI quartile compared with the lowest. The hPDI was also associated with lower risks of myocardial infarction and ischemic stroke, with HRs (95% CIs) of 0.86 (0.78-0.95) and 0.84 (0.71-0.99), respectively. By contrast, higher uPDI scores were associated with higher risks of mortality, CVD, and cancer. The associations observed did not show heterogeneity across strata of sex, smoking status, body mass index, or socioeconomic status or with polygenic risk scores (specifically with regard to CVD end points).Conclusions and RelevanceThe findings of this cohort study of middle-aged UK adults suggest that a diet characterized by high-quality plant-based foods and lower intakes of animal products may be beneficial for health, irrespective of established chronic disease risk factors and genetic predisposition.

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Section: Discussionsupporting

confidence: 92%

Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK

et al. 2023

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“…Taken together, the beneficial effects of PBDs on chronic disease risk factors found in controlled trials, and their associations with lower chronic disease risk found in prospective cohort studies provide strong support for the implementation of PBDs for chronic disease prevention. In a prospective cohort of 315,919 participants, high hPDI scores were associated with a 36% lower risk of mortality and each 10-point increase was associated with a 19% lower risk [57]. On the other hand, high uPDI scores were associated with a 41% increase in mortality risk and each 10-point increase was associated with a 15% increase in risk.…”

Section: Cvd Preventionmentioning

confidence: 94%

Plant-Based Dietary Patterns for Human and Planetary Health

Gibbs

Cappuccio

2022

Nutrients

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The coronavirus pandemic has acted as a reset on global economies, providing us with the opportunity to build back greener and ensure global warming does not surpass 1.5 °C. It is time for developed nations to commit to red meat reduction targets and shift to plant-based dietary patterns. Transitioning to plant-based diets (PBDs) has the potential to reduce diet-related land use by 76%, diet-related greenhouse gas emissions by 49%, eutrophication by 49%, and green and blue water use by 21% and 14%, respectively, whilst garnering substantial health co-benefits. An extensive body of data from prospective cohort studies and controlled trials supports the implementation of PBDs for obesity and chronic disease prevention. The consumption of diets high in fruits, vegetables, legumes, whole grains, nuts, fish, and unsaturated vegetable oils, and low in animal products, refined grains, and added sugars are associated with a lower risk of all-cause mortality. Meat appreciation, health concerns, convenience, and expense are prominent barriers to PBDs. Strategic policy action is required to overcome these barriers and promote the implementation of healthy and sustainable PBDs.

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“…* Association with outcome was significant if p < 0.05, favorable if the highest level of the index (e.g., quartile, quintile, decile) was associated with a more favorable outcome than the lowest level, unfavorable if associated with a more unfavorable outcome. † Number of comparisons for the specific index, which exceeds the number of studies ( 95 ) because of multiple comparisons in most studies.…”

Section: Resultsmentioning

confidence: 99%

Scoping review of the association of plant-based diet quality with health outcomes

2023

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IntroductionThe association of plant-based dietary patterns with health outcomes has traditionally been assessed without considering nutritional value. The plant-based dietary index (PDI), first published in 2016, overcomes this limitation with both a healthful PDI (hPDI) and an unhealthful PDI (uPDI), based on the quality of plant foods consumed plus the frequency of animal foods. We sought to summarize the breadth of research using the hPDI and uPDI to gain insight into how the quality of plant-based dietary patterns might be associated with health outcomes.MethodsScoping review of studies that used the PDI, hPDI, or uPDI to report associations with health outcomes. Multiple databases were searched from 2010 through April 2023 with 2 authors independently assessing eligibility and extracting data. In addition to assessing the association of the indices to health outcomes, we determined the frequency of concordant or discordant findings for hPDI versus PDI and for hPDI versus uPDI.ResultsWe included 95 articles (54% longitudinal, 37% cross-sectional, and 9% case–control) with a median sample size of 3,646. Higher hPDI levels were associated with favorable health outcomes in 36% of comparisons (most often for obesity, mortality, diabetes, cardiovascular disease, and psychiatric disorders), compared to 25% for the PDI and only 2% for the uPDI. Conversely, higher levels of the uPDI were associated with unfavorable health outcomes in 33% of comparisons, in contrast to under 1% for the hPDI and 2% for the PDI. When the hPDI association to an outcome was discordant with the uPDI or PDI, the significance and directionality always favored the hPDI over the uPDI, and nearly always favored the hPDI over the PDI.DiscussionDietary indices that account for the quality of plant foods can show health benefits that might be missed by a generic plant-based index. A greater focus on the quality of plant foods could improve nutrition guidelines, raise awareness about the benefits of adding unrefined plant foods to the diet, and empower consumers to make incremental additions of such foods to displace unhealthy foods. We anticipate increasing use of indices that address food quality in future research.

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

Cited by 11 publications

References 45 publications

Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK

Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK

Plant-Based Dietary Patterns for Human and Planetary Health

Scoping review of the association of plant-based diet quality with health outcomes

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