Abstract
Objective
To investigate the associations of a healthful plant-based diet index (hPDI) and an
unhealthful plant-based diet index (uPDI) with all-cause and cardiovascular disease
(CVD) mortality in Spanish adults.
Patients and Methods
We analyzed data from 11,825 individuals 18 years of age or older, representative
of the Spanish population, recruited between 2008 and 2010 and followed-up to 2020.
Food consumption was collected at baseline using a validated dietary history, which
served to calculate two plant-based diet indices based on 18 major food groups (range,
18-90 points). For (1) hPDI only the consumption of healthy plant foods (whole grains,
fruits, vegetables, nuts, legumes, vegetable oils, and tea/coffee) received positive
scores; whereas for (2) uPDI, only the consumption of less healthy plant foods (fruit
juices, sugar-sweetened beverages, refined grains, potatoes, and sweets/desserts)
received positive scores. Multivariable-adjusted Cox models were used to estimate
HRs and their 95% CIs.
Results
After a median follow-up of 10.9 and 9.8 years, 699 all-cause and 157 CVD deaths were
ascertained, respectively. Each 10-point increase in hPDI was associated with 14%
lower risk of all-cause death (HR, 0.86; 95% CI, 0.74 to 0.99), and 37% lower risk
of CVD death (HR, 0.63; 95% CI, 0.46 to 0.85). No significant associations were found
for uPDI.
Conclusion
Higher adherence to an hPDI diet, but not to a uPDI, was associated with lower all-cause
and CVD mortality. This suggests that the quality of the plant food consumed is paramount
to achieve diet-related benefits in mortality.
Trial registration
clinicaltrials.gov Identifier: NCT02804672
Abbreviations and Acronyms:
BMI (body mass index), CVD (cardiovascular disease), ENRICA (Study on Nutrition and Cardiovascular Risk in Spain), hPDI (healthful plant-based diet index), MD (Mediterranean diet), MDS (Mediterranean Dietary score), NHANES (National Health and Nutrition Examination Survey), PDI (plant-based diet index), uPDI (unhealthful plant-based diet index)To read this article in full you will need to make a payment
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Article info
Footnotes
Grant Support: This work was supported by FIS grants 19/319 and 20/00896 from the Carlos III Health Institute, the Secretary of R+D+I, and the European Regional Development Fund/European Social Fund; by the National Plan on Drugs 2020/17, Spanish Ministry of Health, Spain; by REACT EU Program, Comunidad de Madrid and European Regional Development Fund (ERDF); and by FACINGLCOVID-CM project, Comunidad de Madrid and European Regional Development Fund (ERDF), European Union. M.S-P. holds a Ramón y Cajal contract (RYC-2018-025069-I) from the Spanish Ministry of Science, Innovation and Universities. M.D-V. holds a “Predoctoral Training in Health Research” contract (FI20/00162) from the Carlos III Health Institute and the European Social Fund - “Investing in your future”. J.M-R. holds a “Predoctoral Research Training” contract from the Universidad Autónoma de Madrid. The Carlos III Health Institute belongs to the Spanish Ministry of Science, Innovation and Universities. The funders had no role in study design, data collection and analysis, interpretation of results, preparation of the manuscript or decision to publish.
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