What makes a plant-based diet? a review of current concepts and proposal for a standardized plant-based dietary intervention checklist

Bowel health, defecation patterns and nutrient intake following adoption of a vegan diet: a randomized-controlled trial

BACKGROUND

The beneficial effects of a plant-based diet on gut microbiota diversity are well documented, however, its impact on clinical bowel health and defecation patterns are less well understood. Vegetarian diets have been associated with a higher bowel movement (BM) frequency as well as softer stools in cross-sectional studies. The effects of the de-novo adoption of a vegan diet on bowel health, however, have never been investigated in a randomized-controlled trial.

MATERIALS AND METHODS

The present study examined bowel health and defecation patterns in relation to diet and nutrient intake in a young and healthy sample of n = 65 physically-active German university students who were randomly assigned to either a vegan or a meat-rich diet for eight weeks. Bowel health assessment included the Bristol Stool Form Scale (BSFS), the Gastrointestinal Quality of Life Index (GIQLI) and the Cleveland Clinic Fecal Incontinence Score (CCFIS). Nutrient intake was assessed using weighed food diaries. The study was prospectively registered at the German Clinical Trial Register (DRKS00031541).

RESULTS

Weekly BM frequency slightly increased in vegans, whereas it remained unaltered in participants assigned to a meat-rich diet. Fiber intake increased significantly in vegans (34.89 (18.46) g/d) whereas it decreased in those assigned to the meat-rich group (22.79 (12.5) g/d). No significant intergroup differences in BSFS and CCFIS patterns were observed. Adoption of a vegan diet neither resulted in a transient increase in abdominal discomfort nor in a decreased gastrointestinal quality of life, which was comparable across the diet groups.

CONCLUSIONS

The short-term de-novo adoption of a vegan diet did not negatively affect markers of bowel health in this study.

The role of plant-based dietary patterns in reducing COVID-19 risk and/or severity in adults: A systematic review and meta-analysis of observational studies

BACKGROUND & AIMS

Plant-based dietary patterns (PBDs) might protect against COVID-19 risk and reduce severity of infection. This systematic review with meta-analysis aimed to examine the association between PBDs and risk of COVID-19 infection, hospitalization, intensive care unit (ICU) admission, and/or mortality, in adults.

METHODS

Pubmed, Embase, CINAHL and Web of Science were searched for observational studies, published in English up to 3rd April 2023, comparing the highest with the lowest adherence to a specific PBD. Data were screened, extracted, and risk of bias assessed using the Newcastle-Ottawa Quality Assessment Scale, by independent reviewers.

RESULTS

Seven studies (one cross-sectional, three case-control, and three prospective cohort), reporting on 649,315 participants, were eligible. Across them, there were 8512 events of COVID-19 infection (six studies), and 206 events of COVID-19 hospitalization (four studies), in addition to one study reporting on a composite hospitalization outcome (740 events). The pooled analysis showed that PBDs are associated with a 59% (odds ratio (OR) = 0.41, 95% confidence intervals (CI) 0.23-0.59; two studies) and 18% (OR = 0.82, 95% CI 0.78-0.85; three studies) reduction in COVID-19 infection risk in case-control and cohort studies, respectively. The pooled analysis of one case-control and two cohort studies showed an inverse association between high adherence to a PBD and risk of COVID-19 hospitalization (OR = 0.38, 95% CI 0.04-0.72).

CONCLUSION

Findings suggest a protective role of PBDs against the risk of COVID-19 infection and severity. More studies are needed to establish the association between PBDs and risk of ICU admission and mortality due to COVID-19.

A Healthful Plant-Based Diet as an Alternative Dietary Approach in the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease

Plant-based diets (PBDs) are gaining attention as a sustainable and health-conscious alternative for managing various chronic conditions, including metabolic dysfunction-associated steatotic liver disease (MASLD). In the absence of pharmacological treatments, exploring the potential of lifestyle modifications to improve biochemical and pathological outcomes becomes crucial. The adoption of PBDs has demonstrated beneficial effects such as weight control, increased metabolic health and improved coexisting diseases. Nonetheless, challenges persist, including adherence difficulties, ensuring nutritional adequacy, and addressing potential deficiencies. The aim of this review is to provide a comprehensive overview of the impact of PBDs on MASLD, emphasizing the need for tailored dietary interventions with professional support to optimize their effectiveness in preventing and treating metabolic diseases.

A plant-based diet index to study the relation between diet and disease risk among adults: a narrative review

Plant-based diets (PBD) may offer various health benefits and contribute to a sustainable way of life, but, if not planned correctly, may also confer risks, e.g., by focusing on plant foods with low nutrient density, such as foods primarily consisting of refined carbohydrates. A plant-based diet index (PDI) differentiating between a healthful, unhealthful, and overall PBD, offers a promising approach to standardize and compare studies and integrate results. In this review we (1) summarize current evidence on the PDI and disease risk of relevance to public health, (2) discuss the methodology of the PDI and how it can be sensibly applied in further studies and (3) indicate areas with a lack of knowledge, such as vulnerable populations. In summary, our amalgamation shows, that adherence to a healthier plant-based diet is associated with an 8-68% lower risk for metabolic risk factors, diabetes, and cardiovascular disease, while adherence to an unhealthier plant-based diet is associated with a 10-63% higher risk. Although differences in calculation methods and underlying diet patterns between populations should be accounted for, the PDI can be a useful tool to assess adherence to different plant-based diet patterns and their association with health outcomes in cohort studies across cultures.

Vegetarian, vegan, or plant-based? Comparing how different labels influence consumer evaluations of plant-based foods

Market actors have a role to play in enabling sustainable food transitions. One challenge for these actors is how to promote plant-based foods in ways that appeal to a growing number of consumers. Here we test how different plant-based related labels affect consumer appraisals of a range of foods (cookies, sausages, cheese, chocolate, pasta). In two studies (pre-registered; NUSA = 1148, NGermany = 491), we examined the effects of a 'vegetarian', 'vegan', or 'plant-based' label (compared to no label) on five attributes (healthy, tasty, ethical, pure, environmentally friendly) related to the products. We also measured self-reported likelihood to purchase the products. Overall, the results indicated that the 'plant-based' label was slightly more appealing to participants than the 'vegetarian' and 'vegan' labels. However, contrary to our expectations, neither consumers' information-seeking tendencies nor their pre-existing attitudes toward plant-based foods influenced (i.e., moderated) the effects of the labels. Anticipated taste was a strong and consistent predictor of purchase likelihood for all labeled products, but the ethical and pure attributes also accounted for unique variance in this outcome variable. Taken together, our findings and discussion provide insights into the role of labels and label terminology on consumer appraisals of plant-based foods.

Dietary Habits and Race Day Strategies among Flexitarian, Vegetarian, and Vegan Recreational Endurance Runners: A Cross-Sectional Investigation from The NURMI Study (Step 2)

Many of today's recreational runners have changed their diet from omnivorous to vegetarian or vegan for reasons like better sport performance, animal ethics, positive health, eco-aspects, or male infertility. Others have constructed the flexitarian diet due to current trends in sustainable eating. The aim of this investigation was to analyze the dietary habits and race day strategies of recreational endurance runners following current sustainable dietary trends. Recreational endurance runners (18+ years) were invited to complete the standardized online survey on socio-demography/anthropometry, motivations, running/racing history, food frequency, and race day dietary strategy. Chi-squared tests and Wilcoxon tests were used for the statistical analysis. In total, 289 participants submitted the survey; 146 subjects following flexitarian (n = 34), vegetarian (n = 50), or vegan (n = 62) diets were included in the final sample. Significant differences were found across the diet types: BMI (p = 0.018), fruit/vegetable consumption (p < 0.001), and the dietary motive of performance (p = 0.045). The findings suggest that the flexitarian diet may be appropriate for health- and environmentally conscious populations living in a meat-centered society and lacking social support to eat completely vegetarian/vegan. Following a plant-based diet is perceived as easy for health-conscious, athletic populations, and the vegan diet does not require a particularly effortful/complex race day strategy for endurance runners.

Impact of vitamin B12 supplement intake cessation on vitamin B12 status in a healthy vegan: A close interval monitoring case study

BACKGROUND

Healthy plant-based diets, such as the lacto-ovo-vegetarian and the vegan diet, offer numerous benefits to human health. Poorly designed plant-based diets, however, bear the risk for vitamin- and micronutrient deficiencies. Vitamin B12 (B12, cobalamin) is a nutrient of particular concern in both diets, and should be readily supplemented on a continuous basis to ensure adequate B12 levels and to prevent deficiencies.

CASE REPORT

This case reports describes the history of a healthy man in his mid-30s who adopted a vegan diet approximately 10 y ago. Well informed about the risks of vitamin B12 deficiency on a plant-based diet, he regularly supplemented methylcobalamin for years (single oral dose: 500 µg, 3-4 times a week) in order to maintain an adequate vitamin B12 status. In late 2023, however, he decided to cease B12 supplementation for undisclosed reasons. Subsequent to this decision, we closely monitored his B12 status and longitudinally measured serum B12, homocysteine, and holotranscobalamin (holo-TC). Total serum folate was also determined as it is a modifier of homocysteine concentration. A gradual decrease in holo-TC and vitamin B12 levels was observed after 4 weeks and supplements had to be re-introduced after 16 weeks. Homocysteine increased concomitantly up to 18.2 μmol/L after 20 weeks.

CONCLUSIONS

While a short-term B12 supplement intake cessation might be well tolerated by vegans with an adequate B12 status, an interruption of more than 8 weeks could signify B12 loss approaching suboptimal status. This case report reiterates the need for continuous B12 supplementation in persons following an unfortified plant-based diet.

The Future of Plant-Based Diets: Aligning Healthy Marketplace Choices with Equitable, Resilient, and Sustainable Food Systems

The future of plant-based diets is a complex public health issue inextricably linked to planetary health. Shifting the world's population to consume nutrient-rich, plant-based diets is among the most impactful strategies to transition to sustainable food systems to feed 10 billion people by 2050. This review summarizes how international expert bodies define sustainable diets and food systems and describes types of sustainable dietary patterns. It also explores how the type and proportion of plant- versus animal-source foods and alternative proteins relate to sustainable diets to reduce diet-related morbidity and mortality. Thereafter, we synthesize evidence for current challenges and actions needed to achieve plant-based sustainable dietary patterns using a conceptual framework with principles to promote human health, ecological health, social equity, and economic prosperity. We recommend strategies for governments, businesses, and civil society to encourage marketplace choices that lead to plant-rich sustainable diets within healthy, equitable, and resilient agroecological food systems.

Plant-Based Diet and Glycemic Control in Type 2 Diabetes: Evidence from a Thai Health-Promoting Hospital

The prevalence of type 2 diabetes (T2DM) is associated with diet. While consumption of plant-based foods may reduce blood sugar levels, the impact of consuming plant-based foods on fasting blood sugar levels has not been well defined. This cross-sectional study was conducted at the Health-Promoting Hospital in Pak Phun Municipality, Thailand. It included 61 patients with T2DM and 74 controls matched for age and gender. Dietary intake levels among T2DM and controls were assessed by a validated food-frequency questionnaire from which plant-based-food scores were calculated. This study found significant differences between specific plant foods and fasting blood sugar levels in patients with T2DM. Adherence to a plant-based diet appeared to influence fasting blood sugar levels. Patients who consumed higher amounts of certain vegetables and fruits showed lower fasting blood sugar levels. Diabetic patients consumed more legumes than controls, but the consumption of cereals and nuts/seeds in the two groups were similar. Consumption of nuts and seeds was also associated with a 76.3% reduction in the risk of a T2DM diagnosis. These findings suggest the potential efficacy of glycemic control in T2DM patients. More work is required to explore strategies for preventing and treating metabolic disorders through dietary modification.

White Blood Cell and C-Reactive Protein Levels Are Similar in Obese Hispanic White Women Reporting Adherence to a Healthy Plant, Unhealthy Plant, or Animal-Based Diet, unlike in Obese Non-Hispanic White Women

While modifying dietary patterns can reduce the effects of inflammation in obesity, less is known about the impact of dietary patterns on inflammation levels in women of different ethnicities. This study investigated the link between dietary patterns and mediators associated with inflammation, such as C-reactive protein (CRP) and white blood cells (WBCs), among obese Hispanic and Non-Hispanic White women. CRP and WBC counts were extracted from the National Health and Nutrition Examination Survey conducted between 2003 and 2010. Based on their recorded responses to two 24 h recall interviews, individuals were grouped into one of three dietary patterns: healthy plant-based, less healthy plant-based, or animal-based. Comparisons were run between obese Hispanic and Non-Hispanic women assigned to the same dietary pattern groups and between dietary pattern groups within ethnic groups. CRP and WBCs increased in obese Non-Hispanics as dietary patterns moved from healthy plant-based to animal-based (pCRP = 0.002 and pWBC = 0.017). Regardless of the dietary pattern, CRP and WBC expression were similar in Hispanic women. In addition, WBCs were higher in Hispanics compared to Non-Hispanics when both populations adhered to healthy plant and less healthy plant dietary patterns. The results indicate that dietary patterns may influence Hispanics' inflammation differently than Non-Hispanics.

Efficacy of vitamin D2 in maintaining serum total vitamin D concentrations and bone mineralisation in adult dogs fed a plant-based (vegan) diet in a 3-month randomised trial

Dogs are considered omnivores based on their evolution consuming diets including animal tissue. Few feeding trials evaluating the nutritional suitability of exclusively plant-based (vegan) diets in dogs have been published, and the efficacy of vitamin D2 in maintaining canine serum vitamin D levels has not been clearly determined. A blinded dietary trial included sixty-one healthy desexed adult dogs: thirty-one fed an experimental extruded vegan diet (PLANT) and thirty fed a commercial extruded meat-based diet (MEAT) for 3 months. Dogs were screened via veterinary examination and routine laboratory analyses prior to enrolment, at baseline and exit timepoints. Body composition was measured by dual-energy X-ray absorptiometry and blood was collected for vitamin D profiling. All dogs maintained health parameters, body weight and composition throughout the study. Dogs maintained on PLANT demonstrated a significant reduction in platelet count, creatinine, blood urea nitrogen and cholesterol, though values remained within normal reference ranges. Dogs fed PLANT also demonstrated a shift from vitamin D3 to vitamin D2 metabolites, though total vitamin D analogue levels were unchanged, with the exception of 24,25-dihydroxyvitamin D. Bone mineral content and density did not differ from baseline values. Health status was maintained in dogs fed PLANT and vitamin D2 appeared efficacious in maintaining serum total vitamin D concentrations and bone mineralisation. Findings support the hypothesis that PLANT was comparable to MEAT for maintenance of healthy adult dogs for at least 3 months and identified areas where further research is warranted to elucidate the potential risks and benefits of plant-based (vegan) diets.

Reducing meat and/or dairy consumption in adults: a systematic review and meta-analysis of effects on protein intake, anthropometric values, and body composition

CONTEXT

Consumers are increasingly encouraged to reduce meat and dairy consumption. However, few meta-analyses of randomized controlled trials (RCTs) on the effect of reducing meat and/or dairy on (absolute) protein intake, anthropometric values, and body composition are available.

OBJECTIVE

The aim of this systematic review and meta-analysis was to evaluate the effect of reducing meat and/or dairy consumption on (absolute) protein intake, anthropometric values, and body composition in adults aged ≥ 45 years.

DATA SOURCES

The MEDLINE, Cochrane CENTRAL, Embase, ClinicalTrials.gov, and International Clinical Trials Registry Platform databases were searched up to November 24, 2021.

DATA EXTRACTION

Randomized controlled trials reporting protein intake, anthropometric values, and body composition were included.

DATA ANALYSIS

Data were pooled using random-effects models and expressed as the mean difference (MD) with 95%CI. Heterogeneity was assessed and quantified using Cochran's Q and I2 statistics. In total, 19 RCTs with a median duration of 12 weeks (range, 4-24 weeks) and a total enrollment of 1475 participants were included. Participants who consumed meat- and/or dairy-reduced diets had a significantly lower protein intake than those who consumed control diets (9 RCTs; MD, -14 g/d; 95%CI, -20 to -8; I2 = 81%). Reducing meat and/or dairy consumption had no significant effect on body weight (14 RCTs; MD, -1.2 kg; 95%CI, -3 to 0.7; I2 = 12%), body mass index (13 RCTs; MD, -0.3 kg/m2; 95%CI, -1 to 0.4; I2 = 34%), waist circumference (9 RCTs; MD, -0.5 cm; 95%CI, -2.1 to 1.1; I2 = 26%), amount of body fat (8 RCTs; MD, -1.0 kg; 95%CI, -3.0 to 1.0; I2 = 48%), or lean body mass (9 RCTs; MD, -0.4 kg; 95%CI, -1.5 to 0.7; I2 = 0%).

CONCLUSION

Reduction of meat and/or dairy appears to reduce protein intake. There is no evidence of a significant impact on anthropometric values or body composition. More long-term intervention studies with defined amounts of meat and dairy are needed to investigate the long-term effects on nutrient intakes and health outcomes.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020207325.

Protein content and amino acid composition in the diet of Danish vegans: a cross-sectional study

BACKGROUND

A growing proportion of the population are replacing their dietary animal protein with plant protein. A particular example of this trend is the vegan diet, which excludes all food items of animal origin. However, the DIAAS score for individual plant proteins is generally lower than that of animal proteins due to an unbalanced amino acid composition and lower bioavailability. Care must therefore be taken to meet the nutritional recommendations in the daily food intake.

METHODS

A three-day dietary food record was carried out by 40 Danish vegans in a cross-sectional study. The data were analysed, with particular emphasis on protein requirements and the essential amino acid composition of the diet.

RESULTS

The protein recommendations were met on all three days by 60% of the participants. In contrast, 18% did not meet the protein recommendations on any of the three days and 7% met the recommendations on only one of the days. Lysine was the most limiting amino acid (only 50% met the recommendations every day) followed by the sulphur-containing amino acids (recommendations met by 67.5%), leucine and valine (recommendations met by 70%). Combining both the amount of protein and the intake of the essential amino acids showed that less than half of the participants met the recommendations on all three days (47.5%) and 35% did not meet the recommendations on any days or on one day only.

CONCLUSION

In conclusion, our study showed that many of the participants in the present study failed to meet the daily protein intake requirements, both on single days and on all three days. Furthermore, the food intake was found to have an inadequate amino acid composition and was particularly limited by the essential amino acids lysine, the sulphur-containing amino acids, and leucine and valine. This could be ascribed to the fact that only a limited number of protein sources were consumed during a day.

Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial

Importance

Increasing evidence suggests that, compared with an omnivorous diet, a vegan diet confers potential cardiovascular benefits from improved diet quality (ie, higher consumption of vegetables, legumes, fruits, whole grains, nuts, and seeds).

Objective

To compare the effects of a healthy vegan vs healthy omnivorous diet on cardiometabolic measures during an 8-week intervention.

Design, Setting, and Participants

This single-center, population-based randomized clinical trial of 22 pairs of twins (N = 44) randomized participants to a vegan or omnivorous diet (1 twin per diet). Participant enrollment began March 28, 2022, and continued through May 5, 2022. The date of final follow-up data collection was July 20, 2022. This 8-week, open-label, parallel, dietary randomized clinical trial compared the health impact of a vegan diet vs an omnivorous diet in identical twins. Primary analysis included all available data.

Intervention

Twin pairs were randomized to follow a healthy vegan diet or a healthy omnivorous diet for 8 weeks. Diet-specific meals were provided via a meal delivery service from baseline through week 4, and from weeks 5 to 8 participants prepared their own diet-appropriate meals and snacks.

Main Outcomes and Measures

The primary outcome was difference in low-density lipoprotein cholesterol concentration from baseline to end point (week 8). Secondary outcome measures were changes in cardiometabolic factors (plasma lipids, glucose, and insulin levels and serum trimethylamine N-oxide level), plasma vitamin B12 level, and body weight. Exploratory measures were adherence to study diets, ease or difficulty in following the diets, participant energy levels, and sense of well-being.

Results

A total of 22 pairs (N = 44) of twins (34 [77.3%] female; mean [SD] age, 39.6 [12.7] years; mean [SD] body mass index, 25.9 [4.7]) were enrolled in the study. After 8 weeks, compared with twins randomized to an omnivorous diet, the twins randomized to the vegan diet experienced significant mean (SD) decreases in low-density lipoprotein cholesterol concentration (-13.9 [5.8] mg/dL; 95% CI, -25.3 to -2.4 mg/dL), fasting insulin level (-2.9 [1.3] μIU/mL; 95% CI, -5.3 to -0.4 μIU/mL), and body weight (-1.9 [0.7] kg; 95% CI, -3.3 to -0.6 kg).

Conclusions and Relevance

In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet. Clinicians can consider this dietary approach as a healthy alternative for their patients.

Trial Registration

ClinicalTrials.gov Identifier: NCT05297825.

A cross-sectional study of nutritional status in healthy, young, physically-active German omnivores, vegetarians and vegans reveals adequate vitamin B12 status in supplemented vegans

BACKGROUND/OBJECTIVE

Plant-based diets reduce the risk of cardiovascular disease but also increase the risk of certain micronutrient deficiencies, particularly, of vitamin B12 (B12). The extent to which the unsupervised use of oral nutrient supplements is sufficient to prevent these deficiencies is not well established. We analyzed nutrient intake, laboratory biomarkers, supplementation behavior, and B12 status adequacy amongst young, healthy, physically active omnivores, lacto-ovo-vegetarians and vegans from Germany.

METHODS

We recruited 115 participants (n = 40 omnivores; n = 37 lacto-ovo-vegetarians, and n = 38 vegans) with comparable age, sex, marital status, physical activity and educational levels through online advertisements and local newspapers in Freiburg, Germany.

RESULTS

Energy intake and macronutrient distribution were comparable across diets. Major differences included intake of fiber, cholesterol, and several vitamins. Vegans had the lowest intake of B12 from foods (0.43 (0.58) µg/d), compared to omnivores (2.14 (2.29) µg/d) and lacto-ovo-vegetarians (0.98 (1.34) µg/day). Multivariate analysis of 36 blood biomarkers revealed that three major classes of biomarkers contributed the most to the clustering of individuals by dietary group, namely, biomarkers of B12 status (B12, holoTC, Hcy), iron (iron, ferritin, transferrin) and lipid metabolism (vitamin A, HDL, LDL, total cholesterol, TAG). This suggests that nutrients that modify the metabolic pathways represented by these biomarkers have the most penetrating effect on health status across diets. Analysis of B12 status (including 4cB12) revealed adequacy in omnivores and vegans, and a poorer B12 status amongst lacto-ovo-vegetarians. Fewer lacto-ovo-vegetarians used B12 supplements compared to vegans (51% versus 90%).

CONCLUSIONS

Even amongst homogeneously healthy Germans, each diet manifested with measurable differences in dietary intakes and biomarkers of health. Plant-based diets, in particular the vegan diet, exhibited the most favorable patterns of lipid metabolism and glycemic control, but the lowest food intake of B12. Supplementation of healthy vegans with B12 (median 250 µg B12/day, over 2 years) secured an adequate B12 status that was comparable to that of healthy omnivores.Clinical Trial Registry: German Clinical Trial register number: DRKS00027425.

The effects of plant-based dietary patterns on the risk of developing gestational diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

The worldwide prevention of gestational diabetes mellitus (GDM) is a significant health challenge. Plant-based dietary patterns are a series dietary habits that emphasized foods derived from plant sources more and from animal foods less. Now, no consensus exists on the effects of plant-based dietary patterns on the incident of GDM.

OBJECTIVE

This study aimed to estimate the effects of plant-based dietary patterns on the risk of developing GDM.

METHODS

This systematic review was conducted following the checklist of PRISMA. Six electronic databases including PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wangfang, and Chinese Scientific Journals Database were searched from inception to November 20, 2022. A fixed or random effect model was used to synthesize results of included studies. Then, subgroup analysis, meta-regression and sensitivity analysis were performed to assure the reliability and stability of the results.

RESULTS

Ten studies including 32,006 participants were identified. The results of this study showed that the better adherence to the plant-based dietary patterns was related to the lower risk of developing GDM (RR = 0.88[0.81 to 0.96], I2 = 14.8%). The slightly stronger association between plant-based diets and the risk of developing GDM was found when healthy plant-based dietary pattern index was included in pooled estimate (RR = 0.86[0.79 to 0.94], I2 = 8.3%), compared with that unhealthy one was included (RR = 0.90[0.82 to 0.98], I2 = 8.3%).

CONCLUSION

The plant-based dietary patterns are associated with a lower risk of developing GDM. Furthermore, healthy plant-based dietary patterns are more recommended than unhealthy one. It is significant to help medical staff to guide pregnant women to choose reasonable diets.

Academy of Plant-based Physical Therapy: overdue to address a nutrition crisis with a transformative population approach

This timely evidence synthesis supports the need for an Academy of Plant-based Physical Therapy. Given epidemiological and empirical evidence and the profession's values and practice scope, the time has come for a specialty of plant-based physical therapy based on population health principles. This review connects these factors. Non-communicable diseases (NCDs) are largely nutrition-related resulting from unnatural elements of our diet (i.e., heart disease, several cancers, hypertension, stroke, diabetes, obesity, gastrointestinal diseases, autoimmune diseases, renal disease, and Alzheimer's disease). Most adults, even children, have NCD risk factors or manifestations. Alternatively, plant-based nutrition can prevent, manage, as well as potentially reverse these diseases, as well as augment conventional physical therapy outcomes by reducing inflammation and pain. Proposed competencies for plant-based physical therapists include high-level competency in health and NCD risk assessments/evaluations, to establish population health-informed nutrition needs for maximal health, healing and repair, in turn, function and wellbeing; and assessment of patients' nutrition-related knowledge, beliefs/attitudes, self-efficacy, and readiness-to-change. Population-informed nutritional counseling is initiated as indicated. An Academy of Plant-based Physical Therapy could advance the profession globally at this point in history and also serve as a role model to other health professions through practicing evidence-based, plant-based nutrition built upon population health principles.

Plant-Based Nutrition: Exploring Health Benefits for Atherosclerosis, Chronic Diseases, and Metabolic Syndrome-A Comprehensive Review

Atherosclerosis, chronic non-communicable diseases, and metabolic syndrome are highly interconnected and collectively contribute to global health concerns that reduce life expectancy and quality of life. These conditions arise from multiple risk factors, including inflammation, insulin resistance, impaired blood lipid profile, endothelial dysfunction, and increased cardiovascular risk. Adopting a plant-based diet has gained popularity as a viable alternative to promote health and mitigate the incidence of, and risk factors associated with, these three health conditions. Understanding the potential benefits of a plant-based diet for human health is crucial, particularly in the face of the rising prevalence of chronic diseases like diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer. Thus, this review focused on the plausible advantages of consuming a type of food pattern for the prevention and/or treatment of chronic diseases, emphasizing the dietary aspects that contribute to these conditions and the evidence supporting the benefits of a plant-based diet for human health. To facilitate a more in-depth analysis, we present separate evidence for each of these three concepts, acknowledging their intrinsic connection while providing a specific focus on each one. This review underscores the potential of a plant-based diet to target the underlying causes of these chronic diseases and enhance health outcomes for individuals and populations.

Trends in research on dietary behavior and cardiovascular disease from 2002 to 2022: a bibliometric analysis

Background

Dietary behaviors and cardiovascular disease are two major health issues that have attracted a lot of attention from researchers worldwide. In this study, we aimed to provide a comprehensive analysis of the publication trends, authorship patterns, institutional affiliations, country/region contributions, journal outlets, highly cited documents, and keyword clusters in the field of dietary behaviors and cardiovascular disease research over the past two decades.

Methods

We conducted a systematic literature review of peer-reviewed articles published from 2002 to 2022 in the Web of Science Core Collection database. We extracted and analyzed data on the annual publication volume, authorship patterns, institutional affiliations, country/region contributions, journal outlets, highly cited documents, and keyword clusters using bibliometric methods and visualization tools.

Results

Our study analyzed 3,904 articles, including 702 reviews and 3,202 research articles. The results revealed a continuous increase in the number of publications in this field over the past two decades. The top 10 authors, institutions, and countries/regions with the highest publication output were identified, indicating the leading contributors to this field. Moreover, the most frequently cited documents and highly clustered keywords were identified, providing insights into the research themes and topics in this field.

Conclusion

Our study provides a comprehensive analysis of the publication trends, authorship patterns, institutional affiliations, country/region contributions, journal outlets, highly cited documents, and keyword clusters in the field of dietary behaviors and cardiovascular disease research over the past two decades. The findings provide valuable information for researchers, policymakers, and stakeholders to understand the research landscape, identify research gaps, and develop future research directions in this field.

Soy Milk Consumption in the United States of America: An NHANES Data Report

With the increasing adoption of plant-based diets in the United States, more and more individuals replace cow milk with plant-based milk alternatives. Soy milk is a commonly used cow milk substitute, which is characterized by a higher content of polyunsaturated fatty acids and fibers. Despite these favorable characteristics, little is known about the current prevalence of soy milk consumption the United States. We used data from the National Health and Nutrition Examination Surveys (NHANES) to assess soy milk usage in the United States and identified potential predictors for its consumption in the US general population. The proportion of individuals reporting soy milk consumption in the NHANES 2015-2016 cycle was 2%, and 1.54% in the NHANES 2017-2020 cycle. Non-Hispanic Asian and Black ethnicities (as well as other Hispanic and Mexican American ethnicities in the 2017-2020 cycle) significantly increased the odds for soy milk consumption. While a college degree and weekly moderate physical activity were associated with significantly higher odds for consuming soy milk (OR: 2.21 and 2.36, respectively), sex was not an important predictor. In light of the putative health benefits of soy milk and its more favorable environmental impact as compared to cow milk, future investigations should attempt to identify strategies that may help promote its consumption in selected populations.

Believe It or 'Nut': Why It Is Time to Set the Record Straight on Nut Protein Quality: Pistachio (Pistacia vera L.) Focus

There are growing public health movements to transition towards diets that are plant-based. However, confusion exists with concerns that plant-based proteins (including nuts) may be inferior with respect to protein quality. The present publication evaluates the evolution of protein quality concepts and explains the protein science related to pistachios. Pistachio nuts are a plant-based complete protein providing all nine EAAs in addition to an array of nutrients and phytochemicals. They have a PDCAAS of 73 and 81%, (raw and roasted pistachios, respectively), higher than that of many other tree nuts. From an environmental perspective transitioning towards plant-based diets (including nuts) could have potential to reduce total/green water footprints. Dietary guidelines are evolving yet nuts such as pistachios do not always have a clear place within these. Now appears to be a pertinent time to look at protein quality from the perspective of whole daily diets and dietary patterns, factoring in both health and environmental outcomes. Given updated modes of thinking, nuts such as pistachios have an important role to play in terms of providing ready-to-eat, good-quality, plant-based protein within daily diets.

Nutritional Assessment of the Symptomatic Patient on a Plant-Based Diet: Seven Key Questions

Plant-based diets, both vegan and vegetarian, which emphasize grains, vegetables, fruits, legumes, nuts, and seeds are increasingly popular for health as well as financial, ethical, and religious reasons. The medical literature clearly demonstrates that whole food plant-based diets can be both nutritionally sufficient and medically beneficial. However, any person on an intentionally restrictive, but poorly-designed diet may predispose themselves to clinically-relevant nutritional deficiencies. For persons on a poorly-designed plant-based diet, deficiencies are possible in both macronutrients (protein, essential fatty acids) and micronutrients (vitamin B12, iron, calcium, zinc, and vitamin D). Practitioner evaluation of symptomatic patients on a plant-based diet requires special consideration of seven key nutrient concerns for plant-based diets. This article translates these concerns into seven practical questions that all practitioners can introduce into their patient assessments and clinical reasoning. Ideally, persons on plant-based diets should be able to answer these seven questions. Each serves as a heuristic prompt for both clinician and patient attentiveness to a complete diet. As such, these seven questions support increased patient nutrition knowledge and practitioner capacity to counsel, refer, and appropriately focus clinical resources.

The Association between Plant-Based Diet Indices and Metabolic Syndrome in Chinese Adults: Longitudinal Analyses from the China Health and Nutrition Survey

Objectives: To investigate the association between a plant-based diet and metabolic syndrome (MetS) among Chinese adults. Methods: Based on the data from the 2004–2015 China Health and Nutrition Survey and the corresponding edition of China Food Composition, we calculated the healthy plant-based diet indices (hPDI) and unhealthy plant-based diet indices (uPDI). The Cox proportional hazards regression model was used to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs) for MetS. Mediation analysis was further conducted to explore the mediator role of Body Mass Index (BMI) in the association between hPDI and MetS. Results: We included 10,013 participants, and over a median follow-up of 5 years, 961 patients (9.60%) developed MetS. Compared to those in the lowest quintile of hPDI score, we found that those in the highest quintile of hPDI score had a 28% lower ([HR]: 0.72, 95% CI 0.56–0.93, Ptrend = 0.021) risk of developing MetS and had a 20% lower (hazard ratio [HR]: 0.80, 95% CI 0.70–0.92, Ptrend = 0.004) risk of developing abdominal obesity. No significant associations were observed between uPDI and the MetS, but those in the highest quintile of uPDI score had a 36% higher (hazard ratio [HR]: 1.36, 95% CI 1.20–1.64, Ptrend < 0.001) risk of developing abdominal obesity, compared to those in the lowest quintile of uPDI score. In exploratory analysis, we observed that BMI at baseline mediated 27.8% of the association between hPDI and incident MetS, and BMI at baseline mediated 29.7% of the association between hPDI and abdominal obesity. Conclusion: The current findings reveal a possible causal relationship between a healthy plant-based diet and a reduced risk of MetS, especially abdominal obesity. It is observed that BMI may mediate the relationship between hPDI score and MetS. Controlling early dietary patterns and BMI may help reduce the risk of MetS.

Higher Adherence to Plant-Based Diet Lowers Type 2 Diabetes Risk among High and Non-High Cardiovascular Risk Populations: A Cross-Sectional Study in Shanxi, China

This study aimed to investigate the association between the plant-based diet index (PDI) score and T2D risk among residents of Shanxi Province, China, and explore whether the association was influenced by different levels of cardiovascular risk. A total of 50,694 participants aged 35-75 years were recruited between 2017 and 2019, and they were further divided into the high cardiovascular risk population (HCRP; n = 17,255) and the non-high cardiovascular risk population (non-HCRP; n = 33,439). The PDI was calculated based on food frequency from a food frequency questionnaire (FFQ). Incident T2D was defined based on elevated plasma glucose (≥7 mmol/L) or hypoglycemic medicine use. We investigated the association of the PDI andT2D risk using a two-level generalized estimating equation and restricted cubic splines model. The results showed that quartile 4 of the PDI indicated significantly reduced T2D risk in the total population (OR: 0.83; 95% CI: 0.75-0.92), HCRP (OR: 0.80; 95% CI: 0.71-0.91), and non-HCRP (OR: 0.80; 95% CI: 0.74-0.87) compared with corresponding quartile 1 (OR = 1). In stratified analysis, the negative associations between PDI and T2D risk were stronger in the total population with the elderly (age > 60 years), BMI < 24, and men, and in the non-HCRP with men and BMI 24-28, and in the HCRP with the elderly and BMI < 24 than those with corresponding subgroups (p_interaction < 0.05). Linear curves were observed for the total population and non-HCRP, but an L-shaped association was observed for the HCRP. Therefore, our results suggest that higher PDI scores may effectively attenuate the T2D risk in the Chinese population and non-HCRP, and a beneficial association of PDI with T2D risk was observed in the HCRP at a certain threshold level. Longitudinal studies and intervention trials are required to validate our study findings.

Plant-based diets and the risk of pancreatic cancer: a large prospective multicenter study

BACKGROUND

Plant-based diets have been recommended for improving health outcomes, including cancer. However, previous studies on plant-based diets and the risk of pancreatic cancer are scarce and fail to consider plant food quality.

OBJECTIVES

We sought to examine the potential associations of 3 plant-based diet indices (PDIs) with the risk of pancreatic cancer in a US population.

METHODS

A population-based cohort of 101,748 US adults was identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. The overall PDI, healthful PDI (hPDI), and unhealthful PDI (uPDI) were constructed to qualify adherence to overall, healthy, and less healthy plant-based diets, respectively, with higher scores indicating better adherence. Multivariable Cox regression was used to compute hazard ratios (HRs) for pancreatic cancer incidence. Subgroup analysis was conducted to identify the potential effect modifiers.

RESULTS

Over a mean follow-up of 8.86 years, 421 pancreatic cancer cases occurred. Participants in the highest compared with the lowest quartiles of overall PDI had a lower risk of pancreatic cancer [HR_{quartile 4 versus 1}: 0.74; 95% confidence interval (CI): 0.57, 0.96; P_trend = 0.023]. A stronger inverse association was observed for hPDI (HR_{quartile 4 versus 1}: 0.56; 95% CI: 0.42, 0.75; P_trend < 0.001). Conversely, uPDI was positively associated with the risk of pancreatic cancer (HR_{quartile 4 versus 1}: 1.38; 95% CI: 1.02, 1.85; P_trend = 0.012). Subgroup analyses revealed a stronger positive association for uPDI in participants with BMI <25 (HR_{quartile 4 versus 1}: 3.22; 95% CI: 1.56, 6.65) than in those with BMI ≥25 (HR_{quartile 4 versus 1}: 1.08; 95% CI: 0.78, 1.51) (P_interaction = 0.001).

CONCLUSIONS

In this US population, adherence to a healthy plant-based diet confers a lower risk of pancreatic cancer, whereas adherence to a less healthy plant-based diet confers a higher risk. These findings highlight the importance of considering plant food quality in preventing pancreatic cancer.

Plant-based diets in gastrointestinal diseases: Which evidence?

Plant-based diets (PBDs), rich in high-quality plant foods, offer multiple benefits for the overall and gastrointestinal health. Recently, it has been demostrated that the positive effects of PBDs on gastrointestinal health can be mediated by the gut microbiota, in particular, by inducing a greater diversity of bacteria. This review summarizes current knowledge on the relationship between nutrition, the gut microbiota, and host metabolic status. We discussed how dietary habits modify the composition and physiological activity of the gut microbiota and how gut dysbiosis affects the most prevalent gastrointestinal diseases, including inflammatory bowel diseases, functional bowel disorders, liver disorders, and gastrointestinal cancer. The beneficial role of PBDs is being increasingly recognized as potentially useful in the management of most diseases of the gastrointestinal tract.

Effect of Animal Protein Intake on Meeting Recommendations for Nutrient Intake among US Adults, What We Eat in America, NHANES 2015-2018

Background

Replacing some animal sources of protein with plant foods is encouraged. Nutrient intake may reflect changes in the protein source. The adequacy of habitual nutrient intake among US adults has not been evaluated by the level of animal protein (AP) intake.

Objectives

The objective of this study was to compare food consumption and nutrient intake and adequacy among quintiles of percent AP intake.

Methods

Dietary intake data of adults 19+ y (N = 9706) from What We Eat in America, National Health and Nutrition Examination Survey 2015-2018 were used. Proportions of protein from animal and plant sources were estimated from ingredients in the Food and Nutrient Database for Dietary Studies 2015-2018, and then applied to dietary intakes. Intakes were classified by Q of percent AP. Food intake was described using the United States Department of Agriculture Food Patterns components. Usual nutrient intakes were estimated using the National Cancer Institute Method and compared with age and gender-specific Dietary Reference Intakes (DRIs). Comparisons between quintiles were made using t-tests. Results were considered significant at P < 0.01.

Results

Total protein intake was higher as the Q of AP intake increased. Among the higher quintiles of percent AP, <1% did not meet their DRIs for protein than 17% in Q1 and 5% in Q2 (P < 0.01). In quintiles with lower compared with higher percent AP, there were significantly higher percentages not meeting DRIs for vitamins A, B12, choline, zinc, and calcium but meeting recommendations for folate, vitamin C, saturated fat, cholesterol, and fiber (P < 0.01). Among all quintiles, over one-third did not meet DRIs for fiber, vitamins A, C, D, E, K, choline, calcium, and potassium.

Conclusions

Replacing protein from animal sources with plant foods may result in lower intakes of protein and some nutrients but a better intake of dietary components associated with reducing chronic disease risk. The current intake of US adults indicates dietary improvements are needed, regardless of protein source.

Does a Plant-Based Diet Stand Out for Its Favorable Composition for Heart Health? Dietary Intake Data from a Randomized Controlled Trial

A plant-based diet (PBD) can provide numerous health benefits for patients with cardiovascular risk factors. However, an inadequately planned PBD also bear the potential for deficiencies in certain macro- and micronutrients. The present study analyzed nutrient profiles of individuals who adopted a PBD as part of the CardioVeg study. Participants with cardiovascular risk factors were randomly assigned to either a whole-food PBD intervention (n = 36; eight 90 min group meetings including two 120 min cooking sessions) or a control group asked to maintain an omnivorous diet (n = 34) for eight weeks. Food intake data were collected using three-day weighed food records and analyzed with NutriGuide software, including the German Nutrient Data Base (German: Bundeslebensmittelschlüssel). Nutrient intake was compared before and after eight weeks as well as between the groups. The results for both groups were then contrasted to the current dietary recommendations published by the societies for nutrition in Germany, Austria, and Switzerland. Moreover, anthropometric/laboratory data and ambulatory blood pressure monitoring were determined at baseline and after 8 weeks. Data of a subsample (n = 18 in the PBD group and n = 19 in the control group) were used for the present analyses of the dietary intake data. A PBD yielded several benefits including (but not limited to) a lower energy density, a lower intake of cholesterol and saturated fat, an increased consumption of fiber, and a lower intake of salt. Recommended intakes of most vitamins and minerals were generally met, except for vitamin B12 in the PBD group. A low intake of several other critical nutrients (vitamin D, iodine) was observed in both groups. Compared with the control group, PBD resulted in a significant decrease in body weight, body mass index, waist circumference, HbA1c, and fasting blood glucose after 8 weeks. Overall, it can be concluded that a PBD had a more favorable nutrient composition for cardiovascular health than the omnivorous dietary pattern of the control group.

Plant-Based Innovations for the Transition to Sustainability: A Bibliometric and in-Depth Content Analysis

Plants maintain the ecological equilibrium of the earth and stabilize the ecosystem. Today, traditional commodities and new value-added markets can be served simultaneously. There is significant biosource and bioprocess innovation for biobased industrial products. Furthermore, plant-based innovation is associated with the transition to sustainability. This study performed a bibliometric and in-depth content analysis to review plant-based innovations in the research field between 1995 and 2022. A set of 313 articles was identified from the Scopus and Web of Science databases. Different analytical scientometric tools (topic mapping and overlay visualization networks) were used to analyze 124 articles; the most influential countries, institutions, authors, journals and articles were identified. Through in-depth studies, based on the grounded theory approach, five leading research areas related to plant-based innovation were determined: (1) agricultural/environmental innovation, (2) plant-based food or feed innovation, (3) innovation within the medical/pharmaceutical research area, (4) technology-related innovation and (5) economic/business aspects of plant-based innovations. Future research directions include exploring less examined and new topics, such as the sustainability implications of incorporating various plant-based foods and Industry 4.0 in plant-based innovation, and linking and developing findings from different research areas.

Plasma Leptin and Adiponectin after a 4-Week Vegan Diet: A Randomized-Controlled Pilot Trial in Healthy Participants

Adiponectin and leptin are important mediators of metabolic homeostasis. The actions of these adipokines extend beyond adipocytes and include systemic modulation of lipid and glucose metabolism, nutrient flux, and the immune response to changes in nutrition. Herein, we hypothesized that short-term intervention with a vegan diet might result in an improvement of plasma concentrations of adiponectin and leptin and the leptin/adiponectin ratio. We investigated the response of plasma adiponectin and leptin to a 4-week intervention with a vegan or meat-rich diet and its associations with sex, BMI and nutritional intake. Fifty-three healthy, omnivore participants (62% female, average age 31 years and BMI 23.1 kg/m²) were randomly assigned to a vegan or meat-rich diet for 4 weeks. Plasma adiponectin and leptin were lower in men compared to women both at the beginning and end of the trial. The concentration of adiponectin in women was significantly higher both when comparing their transition from omnivorous to vegan diet (p = 0.023) and also for vegan versus meat-rich diet at the end of the trial (p = 0.001), whereas plasma leptin did not vary significantly. No changes in adiponectin were identified in men, yet an increase in leptin occurred upon their transition from an omnivorous to a meat-rich diet (p = 0.019). Examination of plasma adiponectin/leptin ratio, a proposed marker of cardiovascular risk, did not differ after 4-weeks of dietary intervention. Our study revealed that adiponectin and leptin concentrations are sensitive to short-term dietary intervention in a sex-dependent manner. This dietary modification of leptin and adiponectin not only occurs quickly as demonstrated in our study, but it remains such as published in studies with individuals who are established (long-term) vegetarians compared to omnivorous.

Nutrient Intake and Dietary Acid Load of Special Diets in the NHANES: A Descriptive Analysis (2009-2018)

Western diets are characterized by a high dietary acid load (DAL), which has been associated with adverse clinical outcomes, including type-2-diabetes and metabolic syndrome. Effective dietary strategies to lower DAL are urgently warranted. Plant-based diets (PBD), including vegetarian and vegan diets, are an effective measure to reduce DAL. Notably, not every individual wishes to adopt a PBD. Instead, many people rely on special diets promising comparable health benefits. The effects of those diets on DAL have rarely been investigated. Using data from the National Health and Nutrition Examination Surveys, we aimed to quantify DAL and nutrient intake in the most popular special diets in the United States, including weight-loss, low fat, low salt, low sugar, and diabetic diets. Our analysis included 3552 individuals on a special diet. The most popular diets were the weight-loss diet (n = 1886 individuals) and the diabetic diet (n = 728). Energy intake was below 2000 kcal/d for all diets; however, there were no statistically significant intergroup differences. DAL scores were positive for all special diets (>9 mEq/d), suggesting acidifying properties. Acid load scores of special diets did not differ significantly and were comparable to a standard Western diet. None of the examined diets was associated with alkaline properties.

Bowel Health in U.S. Vegetarians: A 4-Year Data Report from the National Health and Nutrition Examination Survey (NHANES)

Dietary fiber is of paramount importance in the prevention of large-bowel diseases, yet fiber intake in many high income countries is well below daily recommendations. Vegetarian diets high in fiber-rich plant-foods have been associated with a higher frequency of bowel movements and softer stools. Thus, vegetarians appear to suffer less frequently from constipation and other bowel disorders. The number of studies investigating these associations, however, is limited. The present study sought to investigate bowel health and constipation prevalence in a self-identified vegetarian population from the U.S. National Health and Nutrition Examination Survey (2007−2010). Bowel health assessment included Bristol Stool Scale (BSS), Bowel Movement (BM) frequency and Fecal Incontinence Severity Index (FISI). The present study included 9531 non-vegetarians and 212 vegetarians. We found no associations between vegetarian status and all examined bowel health items (BM frequency, BSS and FISI). Vegetarians consumed significantly more fiber than omnivores (21.33 vs. 16.43 g/d, p < 0.001) but had a lower moisture intake (2811.15 vs. 3042.78 g/d, p = 0.045). The lack of an association of vegetarian status and bowel health is surprising, and may be a result of the relatively low fiber intake in this particular vegetarian cohort, which did not meet the daily fiber recommendations.

Placing a Well-Designed Vegan Diet for Slovenes

Interest in vegan diets has increased globally as well as in Slovenia. The quantity of new scientific data requires a thorough synthesis of new findings and considerations about the current reserved position of the vegan diet in Slovenia. There is frequently confusion about the benefits of vegetarian diets that are often uncritically passed on to vegan diets and vice versa. This narrative review aims to serve as a framework for a well-designed vegan diet. We present advice on how to maximize the benefits and minimize the risks associated with the vegan diet and lifestyle. We highlight the proper terminology, present the health effects of a vegan diet and emphasize the nutrients of concern. In addition, we provide guidance for implementing a well-designed vegan diet in daily life. We conducted a PubMed search, up to November 2021, for studies on key nutrients (proteins, vitamin B12, vitamin D, omega-3 long chain polyunsaturated fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), calcium, iron, zinc, iodine and selenium) in vegan diets. Given the limited amount of scientific evidence, we focus primarily on the general adult population. A well-designed vegan diet that includes a wide variety of plant foods and supplementation of vitamin B12, vitamin D in the winter months and potentially EPA/DHA is safe and nutritionally adequate. It has the potential to maintain and/or to improve health. For physically active adult populations, athletes or individuals with fast-paced lifestyles, there is room for further appropriate supplementation of a conventional vegan diet according to individuals' health status, needs and goals without compromising their health. A healthy vegan lifestyle, as included in government guidelines for a healthy lifestyle, includes regular physical activity, avoidance of smoking, restriction of alcohol and appropriate sleep hygiene.

Association between Plant-Based Dietary Patterns and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Plant-based diets, characterized by a higher consumption of plant foods and a lower consumption of animal foods, are associated with a favorable cardiovascular disease (CVD) risk, but evidence regarding the association between plant-based diets and CVD (including coronary heart disease (CHD) and stroke) incidence remain inconclusive. A literature search was conducted using the PubMed, EMBASE and Web of Science databases through December 2020 to identify prospective observational studies that examined the associations between plant-based diets and CVD incidence among adults. A systematic review and a meta-analysis using random effects models and dose–response analyses were performed. Ten studies describing nine unique cohorts were identified with a total of 698,707 participants (including 137,968 CVD, 41,162 CHD and 13,370 stroke events). Compared with the lowest adherence, the highest adherence to plant-based diets was associated with a lower risk of CVD (RR 0.84; 95% CI 0.79–0.89) and CHD (RR 0.88; 95% CI 0.81–0.94), but not of stroke (RR 0.87; 95% CI 0.73–1.03). Higher overall plant-based diet index (PDI) and healthful PDI scores were associated with a reduced CVD risk. These results support the claim that diets lower in animal foods and unhealthy plant foods, and higher in healthy plant foods are beneficial for CVD prevention. Protocol was published in PROSPERO (No. CRD42021223188).