Chen Victoria, Chiavaroli Laura, Glenn Andrea J, Kavanagh Meaghan E, Zeitoun Tara, Mahdavi Sara, Kendall Cyril W C, Jenkins David J A, El-Sohemy Ahmed, Sievenpiper John L
Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.
BMC Public Health. 2025 May 13;25(1):1761. doi: 10.1186/s12889-025-22479-9.
The Portfolio Diet is a plant-based dietary pattern of cholesterol-lowering foods that has demonstrated clinically meaningful reductions in low-density lipoprotein cholesterol (LDL-C) and other cardiovascular risk factors. However, the Portfolio Diet has not been assessed in an ethnoculturally diverse population of young adults.
To examine the association of the Portfolio Diet Score (PDS) with LDL-C and other established cardiovascular risk factors in a young adult population.
This cross-sectional analysis included 1,507 men and women (mean age, 23 ± 3 years) of diverse ethnocultural backgrounds from the Toronto Nutrigenomics and Health Study. Diet was assessed by a validated Toronto-modified Harvard 196-item food frequency questionnaire with adherence to the Portfolio Diet measured using the Portfolio Diet Score. Data were analyzed using multiple linear regressions with adjustment for potential confounders. Modeling analyses related LDL-C levels according to absolute adherence to the Portfolio Diet with cumulative LDL-C and onset of rising cardiovascular risk by age.
Participants were Caucasian (49%), East Asian (34%), South Asian (11%), or other (7%) with a mean LDL-C of 2.3 ± 0.7mmol/L. A 1-point higher PDS and higher PDS tertiles were associated with lower LDL-C (ß [95% CI] per 1-point: -0.009mmol/L [-0.016, -0.002], P = 0.013; P across tertiles =0.040), non-HDL-C (-0.010mmol/L [-0.018, -0.002], P = 0.014; P=0.028), total cholesterol (-0.011mmol/L [-0.019, -0.003], P = 0.011; P=0.038), systolic blood pressure (-0.150mmHg [-0.250, -0.050], P = 0.003; P<0.001) and diastolic blood pressure (-0.133mmHg [-0.219, -0.046], P = 0.003; P<0.001). Higher PDS tertiles were associated with lower triglycerides (P=0.039). A 1-point higher PDS was also associated with lower BMI (-0.038 kg/m [-0.071, -0.004], P = 0.026), waist circumference (-0.092cm [-0.171, -0.013], P = 0.022), body weight (-0.124 kg [-0.229, -0.019], P = 0.021) and FMI (-0.019 kg/m [-0.037, -0.001], P =0.039). There was no association with HDL-C, CRP, or fasting glucose. Modeling analyses suggest that compared to low adherence, 50% and 100% adherence to the Portfolio Diet may delay the onset of rising cardiovascular risk by an estimated 6 and 13 years, respectively.
Among young adults, the PDS was inversely associated with LDL-C and several other established cardiovascular risk factors. Early adherence to the Portfolio Diet may limit lifetime exposure to LDL-C and could delay the age at which cardiovascular events begin.
组合饮食是一种以植物为基础的降胆固醇饮食模式，已证明在临床上能显著降低低密度脂蛋白胆固醇（LDL-C）及其他心血管危险因素。然而，尚未在具有不同种族文化背景的年轻成年人群中对组合饮食进行评估。
研究组合饮食评分（PDS）与年轻成年人群中LDL-C及其他已确定的心血管危险因素之间的关联。
这项横断面分析纳入了来自多伦多营养基因组学与健康研究的1507名不同种族文化背景的男性和女性（平均年龄23±3岁）。通过经过验证的多伦多改良版哈佛196项食物频率问卷评估饮食情况，并使用组合饮食评分衡量对组合饮食的依从性。使用多元线性回归分析数据，并对潜在混杂因素进行调整。根据对组合饮食的绝对依从情况、累积LDL-C以及心血管风险随年龄上升的起始情况，进行建模分析以关联LDL-C水平。
参与者包括白种人（49%）、东亚人（34%）、南亚人（11%）或其他种族（7%），平均LDL-C为2.3±0.7mmol/L。PDS每增加1分以及PDS三分位数较高与较低的LDL-C相关（每增加1分的β[95%CI]：-0.009mmol/L[-0.016，-0.002]，P = 0.013；三分位数间P = 0.040）、非HDL-C（-0.010mmol/L[-0.018，-0.002]，P = 0.014；P = 0.028）、总胆固醇（-0.011mmol/L[-0.019，-0.003]，P = 0.011；P = 0.038）、收缩压（-0.150mmHg[-0.250，-0.050]，P = 0.003；P<0.001）和舒张压（-0.133mmHg[-0.219，-0.046]，P = 0.003；P<0.001）。较高的PDS三分位数与较低的甘油三酯相关（P = 0.039）。PDS每增加1分还与较低的体重指数（-0.038kg/m[-0.071，-0.004]，P = 0.026）、腰围（-0.092cm[-0.171，-0.013]，P = 0.022）、体重（-0.124kg[-0.229，-0.019]，P = 0.021）和体脂指数（-0.019kg/m[-0.037，-0.001]，P = 0.039）相关。与HDL-C、CRP或空腹血糖无关联。建模分析表明，与低依从性相比，50%和100%依从组合饮食可能分别将心血管风险上升起始时间推迟约6年和13年。
在年轻成年人中，PDS与LDL-C及其他几种已确定的心血管危险因素呈负相关。早期依从组合饮食可能会限制一生当中暴露于LDL-C的时间，并可能延迟心血管事件开始发生的年龄。
