201
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Ha K, Kim K, Sakaki JR, Chun OK. Relative Validity of Dietary Total Antioxidant Capacity for Predicting All-Cause Mortality in Comparison to Diet Quality Indexes in US Adults. Nutrients 2020; 12:E1210. [PMID: 32344879 PMCID: PMC7282024 DOI: 10.3390/nu12051210] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/12/2020] [Accepted: 04/22/2020] [Indexed: 01/17/2023] Open
Abstract
While traditionally diet quality index scores (DQIS) as noted later in this abstract have been used to predict health outcomes, dietary total antioxidant capacity (TAC), a useful tool for assessing total antioxidant power in the diet, may also be a novel predictor. This study evaluated the associations between dietary TAC and DQIS and all-cause mortality. Based on the National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2006, 23,797 US adults were followed-up until 2015. Dietary TAC and DQIS including the Healthy Eating Index-2015 (HEI-2015), Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH) were calculated using a 1-day 24 h dietary recall. US adults in the highest quintiles of DQIS had lower rates of all-cause mortality compared to those in the lowest quintiles (HEI-2015 hazard ratio (HR): 0.87, 95% confidence interval (CI): 0.77-0.98; AHEI-2010 HR: 0.84, 95% CI: 0.74-0.94; aMED HR: 0.79, 95% CI: 0.69-0.90; DASH HR: 0.80, 95% CI: 0.70-0.92). Similarly, those in the highest quintile of dietary TAC also had a lower all-cause mortality than those in the lowest quintile (HR: 0.88, 95% CI: 0.79-0.98). These findings suggest that dietary TAC might be a relatively valid predictor of all-cause mortality in the US population compared to the DQIS.
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Affiliation(s)
- Kyungho Ha
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA; (K.H.); (K.K.); (J.R.S.)
| | - Kijoon Kim
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA; (K.H.); (K.K.); (J.R.S.)
- Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, Korea
| | - Junichi R. Sakaki
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA; (K.H.); (K.K.); (J.R.S.)
| | - Ock K. Chun
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA; (K.H.); (K.K.); (J.R.S.)
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202
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Mediterranean Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases. Nutrients 2020; 12:nu12041066. [PMID: 32290535 PMCID: PMC7230471 DOI: 10.3390/nu12041066] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 12/11/2022] Open
Abstract
Insulin resistance (IR), defined as an attenuated biological response to circulating insulin, is a fundamental defect in obesity and type 2 diabetes (T2D), and is also linked to a wide spectrum of pathological conditions, such as non-alcoholic fatty liver disease (NAFLD), cognitive impairment, endothelial dysfunction, chronic kidney disease (CKD), polycystic ovary syndrome (PCOS), and some endocrine tumors, including breast cancer. In obesity, the unbalanced production of pro- and anti-inflammatory adipocytokines can lead to the development of IR and its related metabolic complications, which are potentially reversible through weight-loss programs. The Mediterranean diet (MedDiet), characterized by high consumption of extra-virgin olive oil (EVOO), nuts, red wine, vegetables and other polyphenol-rich elements, has proved to be associated with greater improvement of IR in obese individuals, when compared to other nutritional interventions. Also, recent studies in either experimental animal models or in humans, have shown encouraging results for insulin-sensitizing nutritional supplements derived from MedDiet food sources in the modulation of pathognomonic traits of certain IR-related conditions, including polyunsaturated fatty acids from olive oil and seeds, anthocyanins from purple vegetables and fruits, resveratrol from grapes, and the EVOO-derived, oleacein. Although the pharmacological properties and clinical uses of these functional nutrients are still under investigation, the molecular mechanism(s) underlying the metabolic benefits appear to be compound-specific and, in some cases, point to a role in gene expression through an involvement of the nuclear high-mobility group A1 (HMGA1) protein.
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203
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Kim H, Rebholz CM, Garcia-Larsen V, Steffen LM, Coresh J, Caulfield LE. Operational Differences in Plant-Based Diet Indices Affect the Ability to Detect Associations with Incident Hypertension in Middle-Aged US Adults. J Nutr 2020; 150:842-850. [PMID: 31722418 PMCID: PMC7138677 DOI: 10.1093/jn/nxz275] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/08/2019] [Accepted: 10/11/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Several distinct plant-based diet indices (PDIs) have been developed to characterize adherence to plant-based diets. OBJECTIVE We contrasted 5 PDIs in a community-based cohort by assessing characteristics of the diet and evaluating whether these PDIs are associated with risk of incident hypertension. METHODS Using FFQ data from adults (45-64 y, n = 8041) without hypertension at baseline in the Atherosclerosis Risk in Communities (ARIC) Study, we scored participants' diets using the overall PDI (oPDI), healthy PDI (hPDI), less healthy (unhealthy) PDI (uPDI), provegetarian diet index, and PDI from the Rotterdam Study (PDI-Rotterdam). For the oPDI, provegetarian diet, and PDI-Rotterdam, higher intakes of all or selected plant foods received higher scores. For the hPDI, higher intakes of plant foods identified as healthful received higher scores. For the uPDI, higher intakes of less healthy plant foods received higher scores. All indices scored higher intakes of animal foods lower. We examined agreement between indices, and whether scores on these indices were associated with risk of hypertension using Cox proportional hazard models. RESULTS The PDIs were moderately-to-strongly correlated and largely ranked subjects consistently, except for the uPDI. Over a median follow-up of 13 y, 6044 incident hypertension cases occurred. When adjusted for sociodemographic characteristics, other dietary factors, and health behaviors, the highest compared with the lowest quintile for adherence to the oPDI, hPDI, and provegetarian diet was associated with a 12-16% lower risk of hypertension (all P-trend <0.05). Highest adherence to the uPDI was associated with a 13% higher risk of hypertension, when clinical factors were further adjusted for (P-trend = 0.03). No significant association was observed with the PDI-Rotterdam. The oPDI, hPDI, and provegetarian diet moderately improved the prediction of hypertension. CONCLUSIONS In middle-aged US adults, despite moderate agreement in ranking subjects across PDIs, operational differences can affect the ability to detect diet-disease associations, such as hypertension.
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Affiliation(s)
- Hyunju Kim
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vanessa Garcia-Larsen
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura E Caulfield
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Address correspondence to LEC (e-mail: )
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204
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205
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Affiliation(s)
- J David Spence
- From the Stroke Prevention & Atherosclerosis Research Centre (J.D.S.), Robarts Research Institute, Western University, London, Canada; and Departments of Clinical Nutrition & Preventive Medicine, College of Health Sciences (C.T.), Rush University Medical Center, Chicago, IL.
| | - Christy Tangney
- From the Stroke Prevention & Atherosclerosis Research Centre (J.D.S.), Robarts Research Institute, Western University, London, Canada; and Departments of Clinical Nutrition & Preventive Medicine, College of Health Sciences (C.T.), Rush University Medical Center, Chicago, IL
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206
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Butler T, Kerley CP, Altieri N, Alvarez J, Green J, Hinchliffe J, Stanford D, Paterson K. Optimum nutritional strategies for cardiovascular disease prevention and rehabilitation (BACPR). Heart 2020; 106:724-731. [PMID: 32098809 PMCID: PMC7229899 DOI: 10.1136/heartjnl-2019-315499] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/28/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022] Open
Abstract
Nutrition has a central role in both primary and secondary prevention of cardiovascular disease yet only relatively recently has food been regarded as a treatment, rather than as an adjunct to established medical and pharmacotherapy. As a field of research, nutrition science is constantly evolving making it difficult for patients and practitioners to ascertain best practice. This is compounded further by the inherent difficulties in performing double-blind randomised controlled trials. This paper covers dietary patterns that are associated with improved cardiovascular outcomes, including the Mediterranean Diet but also low-carbohydrate diets and the potential issues encountered with their implementation. We suggest there must be a refocus away from macronutrients and consideration of whole foods when advising individuals. This approach is fundamental to practice, as clinical guidelines have focused on macronutrients without necessarily considering their source, and ultimately people consume foods containing multiple nutrients. The inclusion of food-based recommendations aids the practitioner to help the patient make genuine and meaningful changes in their diet. We advocate that the cardioprotective diet constructed around the traditional Mediterranean eating pattern (based around vegetables and fruits, nuts, legumes, and unrefined cereals, with modest amounts of fish and shellfish, and fermented dairy products) is still important. However, there are other approaches that can be tried, including low-carbohydrate diets. We encourage practitioners to adopt a flexible dietary approach, being mindful of patient preferences and other comorbidities that may necessitate deviations away from established advice, and advocate for more dietitians in this field to guide the multi-professional team.
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Affiliation(s)
- Tom Butler
- Department of Clinical Sciences and Nutrition, University of Chester, Chester, UK .,BACPR Diet Working Group
| | - Conor P Kerley
- BACPR Diet Working Group.,Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Nunzia Altieri
- BACPR Diet Working Group.,Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Joe Alvarez
- BACPR Diet Working Group.,Whittington Health NHS Trust, London, UK
| | - Jane Green
- BACPR Diet Working Group.,Doddington Hospital - Cambridgeshire and Peterborough NHS Foundation Trust, Doddington, UK
| | - Julie Hinchliffe
- BACPR Diet Working Group.,Salford Royal NHS Foundation Trust, Salford, UK
| | - Dell Stanford
- BACPR Diet Working Group.,Department of Community Cardiology, Central London Community NHS Trust, Berkhamstead, UK
| | - Katherine Paterson
- BACPR Diet Working Group.,Norfolk and Norwich University Hospital, Norwich, UK
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207
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Nusrat AZ, Majd I, Wayne PM. Integrative Medicine Is a Good Prescription for Patients and Planet. J Altern Complement Med 2019; 25:1151-1155. [PMID: 31855469 DOI: 10.1089/acm.2019.0421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aterah Z Nusrat
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Iman Majd
- Osher Clinic for Integrative Medicine, University of Washington, Seattle, Washington
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
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208
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Farmaki AE, Rayner NW, Kafyra M, Matchan A, Ntaoutidou K, Feritoglou P, Athanasiadis A, Gilly A, Mamakou V, Zengini E, Karaleftheri M, Zeggini E, Dedoussis G. A Dietary Pattern with High Sugar Content Is Associated with Cardiometabolic Risk Factors in the Pomak Population. Nutrients 2019; 11:E3043. [PMID: 31847144 PMCID: PMC6950453 DOI: 10.3390/nu11123043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022] Open
Abstract
The present study describes the geographically isolated Pomak population and its particular dietary patterns in relationship to cardiovascular risk factors. We collected a population-based cohort in a cross-sectional study, with detailed anthropometric, biochemical, clinical, and lifestyle parameter information. Dietary patterns were derived through principal component analysis based on a validated food-frequency questionnaire, administered to 1702 adult inhabitants of the Pomak villages on the Rhodope mountain range in Greece. A total of 69.9% of the participants were female with a population mean age of 44.9 years; 67% of the population were overweight or obese with a significantly different prevalence for obesity between men and women (17.5% vs. 37.5%, respectively, p < 0.001). Smoking was more prevalent in men (45.8% vs. 2.2%, p < 0.001), as 97.3% of women had never smoked. Four dietary patterns emerged as characteristic of the population, and were termed "high in sugars", "quick choices", "balanced", and "homemade". Higher adherence to the "high in sugars" dietary pattern was associated with increased glucose levels (p < 0.001) and increased risk of hypertension (OR (95% CI) 2.61 (1.55, 4.39), p < 0.001) and nominally associated with high blood glucose levels (OR (95% CI) 1.85 (1.11, 3.08), p = 0.018), compared to lower adherence. Overall, we characterize the dietary patterns of the Pomak population and describe associations with cardiovascular risk factors.
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Affiliation(s)
- Aliki-Eleni Farmaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece or (M.K.); (K.N.); (P.F.)
- MRC Unit for Lifelong Health & Ageing, Institute of Cardiovascular Science, University College London, London WC1E 7HB, UK
| | - Nigel W Rayner
- Institute of Translational Genomics, Helmholtz Zentrum Munchen, German Research Center for Environmental Health, D-85764 Neuherberg, Germany; (N.W.R.); (A.G.); (E.Z.)
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford OX3 7LE, UK
- Wellcome Sanger Institute, The Morgan Building, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1HH, UK
| | - Maria Kafyra
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece or (M.K.); (K.N.); (P.F.)
| | - Angela Matchan
- Genomics England, Queen Mary University of London, Dawson Hall, Charterhouse Square, London EC1M 6BQ, UK;
| | - Kyriaki Ntaoutidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece or (M.K.); (K.N.); (P.F.)
| | - Pournar Feritoglou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece or (M.K.); (K.N.); (P.F.)
| | | | - Arthur Gilly
- Institute of Translational Genomics, Helmholtz Zentrum Munchen, German Research Center for Environmental Health, D-85764 Neuherberg, Germany; (N.W.R.); (A.G.); (E.Z.)
- Wellcome Sanger Institute, The Morgan Building, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1HH, UK
| | - Vasiliki Mamakou
- Dromokaiteio Psychiatric Hospital of Athens, Chaidari, Athens 12461, Greece; (V.M.); (E.Z.)
- Medical School, National and Kapodistrian University of Athens, Goudi, Athens 11527, Greece
| | - Eleni Zengini
- Dromokaiteio Psychiatric Hospital of Athens, Chaidari, Athens 12461, Greece; (V.M.); (E.Z.)
- Department of Human Metabolism, University of Sheffield, Sheffield S10 2TN, UK
| | | | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum Munchen, German Research Center for Environmental Health, D-85764 Neuherberg, Germany; (N.W.R.); (A.G.); (E.Z.)
- Wellcome Sanger Institute, The Morgan Building, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1HH, UK
| | - George Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece or (M.K.); (K.N.); (P.F.)
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209
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Sterling SR, Bowen SA. The Potential for Plant-Based Diets to Promote Health Among Blacks Living in the United States. Nutrients 2019; 11:E2915. [PMID: 31810250 PMCID: PMC6949922 DOI: 10.3390/nu11122915] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/13/2019] [Accepted: 11/21/2019] [Indexed: 02/07/2023] Open
Abstract
Plant-based diets are associated with reduced risks of various chronic diseases in the general population. However, it is unclear how these benefits translate to Blacks living in the United States, who are disproportionately burdened with heart disease, cancer, diabetes, obesity, and chronic kidney disease. The objectives of this study were to: (1) review the general evidence of plant-based diets and health outcomes; (2) discuss how this evidence translates to Blacks following a plant-based diet; and (3) provide recommendations and considerations for future studies in this area. Interestingly, although the evidence supporting plant-based diets in the general population is robust, little research has been done on Blacks specifically. However, the available data suggests that following a plant-based diet may reduce the risk of heart disease and possibly cancer in this population. More research is needed on cardiovascular disease risk factors, cancer subtypes, and other chronic diseases. Further, attention must be given to the unique individual, familial, communal, and environmental needs that Blacks who follow plant-based diets may have. Interventions must be culturally appropriate in order to achieve long-term success, and providing low-cost, flavorful, and nutritious options will be important.
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210
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Carro A, Panisello JM. Deciphering the Riddles in Nutrition and Cardiovascular Disease. Eur Cardiol 2019; 14:141-150. [PMID: 31933681 PMCID: PMC6950215 DOI: 10.15420/ecr.2019.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular disease is the leading global cause of death in Western countries, and its development is largely associated with unhealthy dietary patterns. A large body of scientific evidence has reported that nutrition might be the most preventive factor of cardiovascular disease death and could even reverse heart disease. Processes of chronic inflammation and oxidative distress share triggers that are modifiable by nutrition. This review aimed to identify potential targets (food patterns, single foods or individual nutrients) for cardiovascular disease prevention, and analyse the mechanisms implicated in their cardioprotective effects.
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211
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Kim H, Caulfield LE, Garcia-Larsen V, Steffen LM, Coresh J, Rebholz CM. Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults. J Am Heart Assoc 2019; 8:e012865. [PMID: 31387433 PMCID: PMC6759882 DOI: 10.1161/jaha.119.012865] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Previous studies have documented the cardiometabolic health benefits of plant‐based diets; however, these studies were conducted in selected study populations that had narrow generalizability. Methods and Results We used data from a community‐based cohort of middle‐aged adults (n=12 168) in the ARIC (Atherosclerosis Risk in Communities) study who were followed up from 1987 through 2016. Participants’ diet was classified using 4 diet indexes. In the overall plant‐based diet index and provegetarian diet index, higher intakes of all or selected plant foods received higher scores; in the healthy plant‐based diet index, higher intakes of only the healthy plant foods received higher scores; in the less healthy plant‐based diet index, higher intakes of only the less healthy plant foods received higher scores. In all indexes, higher intakes of animal foods received lower scores. Results from Cox proportional hazards models showed that participants in the highest versus lowest quintile for adherence to overall plant‐based diet index or provegetarian diet had a 16%, 31% to 32%, and 18% to 25% lower risk of cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality, respectively, after adjusting for important confounders (all P<0.05 for trend). Higher adherence to a healthy plant‐based diet index was associated with a 19% and 11% lower risk of cardiovascular disease mortality and all‐cause mortality, respectively, but not incident cardiovascular disease (P<0.05 for trend). No associations were observed between the less healthy plant‐based diet index and the outcomes. Conclusions Diets higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population.
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Affiliation(s)
- Hyunju Kim
- Center for Human Nutrition Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Laura E Caulfield
- Center for Human Nutrition Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Vanessa Garcia-Larsen
- Center for Human Nutrition Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Lyn M Steffen
- Division of Epidemiology and Community Health University of Minnesota School of Public Health Minneapolis MN
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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