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Plant-Based Diets and All-cause and Cardiovascular Mortality in a Nationwide Cohort in Spain

The ENRICA Study
  • M. Delgado-Velandia
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain

    Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
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  • J. Maroto-Rodríguez
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
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  • R. Ortolá
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
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  • E. García-Esquinas
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain

    Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain

    National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
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  • F. Rodríguez-Artalejo
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain

    Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain

    IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
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  • M. Sotos-Prieto
    Correspondence
    Correspondence: Address to Mercedes Sotos-Prieto, PhD, Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain.
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain

    Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain

    IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain

    Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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      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)
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