Long-term study shows plant-based diet sharply reduces CVD risk

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Eddy Edson

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Newly published fairly large study with 30+ year follow up. As always, if you want to engage with the study read & critique the methods section. If you just want to give your priors an airing, type away.

Background

The association between diets that focus on plant foods and restrict animal products and cardiovascular disease (CVD) is inconclusive. We investigated whether cumulative intake of a plant‐centered diet and shifting toward such a diet are associated with incident CVD.

Methods and Results

Participants were 4946 adults in the CARDIA (Coronary Artery Risk Development in Young Adults) prospective study. They were initially 18 to 30 years old and free of CVD (1985–1986, exam year [year 0]) and followed until 2018. Diet was assessed by an interviewer‐administered, validated diet history. Plant‐centered diet quality was assessed using the A Priori Diet Quality Score (APDQS), in which higher scores indicate higher consumption of nutritionally rich plant foods and limited consumption of high‐fat meat products and less healthy plant foods. Proportional hazards models estimated hazard ratios of CVD associated with both time‐varying average APDQS and a 13‐year change in APDQS score (difference between the year 7 and year 20 assessments). During the 32‐year follow‐up, 289 incident CVD cases were identified. Both long‐term consumption and a change toward such a diet were associated with a lower risk of CVD. Multivariable‐adjusted hazard ratio was 0.48 (95% CI, 0.28–0.81) when comparing the highest quintile of the time‐varying average ADPQS with lowest quintiles. The 13‐year change in APDQS was associated with a lower subsequent risk of CVD, with a hazard ratio of 0.39 (95% CI, 0.19–0.81) comparing the extreme quintiles. Similarly, strong inverse associations were found for coronary heart disease and hypertension‐related CVD with either the time‐varying average or change APDQS.

Conclusions

Consumption of a plant‐centered, high‐quality diet starting in young adulthood is associated with a lower risk of CVD by middle age.
 
Would be interesting to see some examples of the sorts of foods they preferred, and (perhaps more importantly) frowned on.

I’ve not ventured into to the paper itself - are these detailed from what you have seen?
 
Thanks for that @Eddy Edson 😎

@everydayupsanddowns It’s very readable 🙂 They explain how they rated the foods and give some examples:

Plant‐centered diet quality was assessed using the APDQS, which is a hypothesis‐driven index based on 46 food groups, which are derived from individual foods collected. The APDQS reflects a theoretical concept that how foods affect human health does not act in isolation, but in concert, where nutrients and bioactive compounds in a mixture of individual foods consumed over time work together to produce health outcomes.17 The food groups were classified into beneficial (20), adverse (13), and neutral (13) on the basis of their presumed prior known association with CVD.18, 19There was general, though not perfect, agreement of ratings of food groups done independently by 4 experts in the field. These ratings used only prior knowledge of the literature. The beneficially rated food group includes fruit, avocado, beans/legumes, green vegetables, yellow vegetables, tomatoes, other vegetables, nuts and seeds, soy products, whole grains, vegetable oil, fatty fish, lean fish, poultry, alcohol (beer, wine, and liquor), coffee, tea, and low‐fat milk/cheese/yogurt. In practice, the amount of alcohol consumed was rarely more than a moderate level. The adversely rated food group includes fried potatoes, grain dessert, salty snacks, pastries, sweets, high‐fat red meats, processed meats, organ meats, fried fish/poultry, sauces, soft drink, whole‐fat milk/cheese/yogurt, and butter. The neutrally rated food group includes potatoes, refined grains, margarine, chocolate, meal replacements, pickled foods, sugar substitutes, lean meats, shellfish, eggs, soups, diet drinks, and fruit juices. Each of the 46 food groups was divided into quintiles of consumption…..”
 
Would be interesting to see some examples of the sorts of foods they preferred, and (perhaps more importantly) frowned on.

I’ve not ventured into to the paper itself - are these detailed from what you have seen?
Don't think there are any big surprises:

The food groups were classified into beneficial (20), adverse (13), and neutral (13) on the basis of their presumed prior known association with CVD.18,19 There was general, though not perfect, agreement of ratings of food groups done independently by 4 experts in the field. These ratings used only prior knowledge of the literature.

The beneficially rated food group includes fruit, avocado, beans/legumes, green vegetables, yellow vegetables, tomatoes, other vegetables, nuts and seeds, soy products, whole grains, vegetable oil, fatty fish, lean fish, poultry, alcohol (beer, wine, and liquor), coffee, tea, and low-fat milk/cheese/yogurt. In practice, the amount of alcohol consumed was rarely more than a moderate level.

The adversely rated food group includes fried potatoes, grain dessert, salty snacks, pastries, sweets, highfat red meats, processed meats, organ meats, fried fish/poultry, sauces, soft drink, whole-fat milk/cheese/ yogurt, and butter.

The neutrally rated food group includes potatoes, refined grains, margarine, chocolate, meal replacements, pickled foods, sugar substitutes, lean meats, shellfish, eggs, soups, diet drinks, and fruit juices.
 
Oops - @Inka beat me!
 
I guess you could summarise pretty much as: "Eating in accordance with standard dietary guidelines, and changing your eating to comply more closely with them, are associated with sharply reduced CVD risks."
 
If they are validating against a score or "adverse" or such wording, it could influence consumption, or declarations/disclosures. That would apply no matter what the dietary focus in play. Just saying

I haven't read the paper, but I just hope the participants didn't have to keep food diaries for 30 years. 🙂🙂😎😎
 
I guess you could summarise pretty much as: "Eating in accordance with standard dietary guidelines, and changing your eating to comply more closely with them, are associated with sharply reduced CVD risks."

I'll take that as a win.
Good post.
 
How many other factors were either ignored or not recorded, such as obesity, smoking etc in the meat eating crowd they were compared to? Who were they compared to? Historical records? And self reporting diets are the bane of Weight Watchers, let alone academic studies.
 
How many other factors were either ignored or not recorded, such as obesity, smoking etc in the meat eating crowd they were compared to? Who were they compared to? Historical records? And self reporting diets are the bane of Weight Watchers, let alone academic studies.
Are meat eaters more prone to being obese and smokers?
Is it all part of the same lifestyle?
Are those that choose to "eat healthily" more prone to being active in other avoidances of unhealthy habits?

I take the triple win there then.
 
How many other factors were either ignored or not recorded, such as obesity, smoking etc in the meat eating crowd they were compared to? Who were they compared to? Historical records? And self reporting diets are the bane of Weight Watchers, let alone academic studies.
Yeah, I wouldn't bother reading the paper. Just assume the authors and peer reviewers are yowling morons too stupid to consider this kind of stuff.
 
Yeah, I wouldn't bother reading the paper. Just assume the authors and peer reviewers are yowling morons too stupid to consider this kind of stuff.
The sad thing is this is where our health care was based. I believe mikeyB was a doctor years ago?
 
I haven't read the paper, but….food diaries for 30 years.

Why not read it then? Why ponder what they might have done or might not have done when you could simply look at the relevant section of the study? No, they didn’t keep food diaries for 30 years btw.
 
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