Adherence to plant-based diets and long-term changes in cardiometabolic markers: a longitudinal analysis in a population-based cohort.

BACKGROUND

The evidence on the association between adherence to plant-based diets and longitudinal changes in preclinical cardiometabolic markers among general population is sparse.

OBJECTIVES

This study investigates the associations of plant-based diet indices (PDIs) with repeated measurements of cardiometabolic markers, including systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, high-density lipoprotein (HDL) cholesterol, triglycerides, and total:HDL cholesterol ratio.

METHODS

This longitudinal study used data from the population-based Rotterdam Study. Relatively healthy aging participants from The Netherlands with baseline dietary data and ≥1 measurement of cardiometabolic markers at baseline and during follow-up. Specifically, participants were analyzed for blood pressure (N = 3670), lipid levels (N = 3274), and glucose metabolism (N = 5369), provided they were free of hypertension, hyperlipidemia or diabetes at baseline, respectively. To reflect diets higher in healthy and unhealthy plant-based foods, and lower in animal foods, an overall PDI, healthy PDI (hPDI) and unhealthy PDI (uPDI) were created. Multivariable linear mixed models were used to assess the associations.

RESULTS

Higher hPDI scores at baseline were associated with, on average, lower SBP [β: -0.43 mmHg (95% confidence interval -0.82, -0.04), per standard deviation of hPDI score], DBP [-0.25 mmHg (-0.49, -0.01)], fasting glucose [-0.03 mmol/L (-0.05, -0.01)], triglycerides [-0.04 mmol/L (-0.07, -0.02)] and total:HDL cholesterol ratio [-0.10 (-0.13, -0.06)] and with higher HDL cholesterol [0.04 mmol/L (0.02, 0.05)], over the follow-up period (median 5 y, range 0.0-24.7 y). Similar associations were observed for the overall PDI, whereas no associations of uPDI scores with any of the cardiometabolic markers were found.

CONCLUSIONS

Greater adherence to more plant-based dietary patterns, particularly those rich in healthy plant-based foods, is associated with favorable long-term changes in early cardiometabolic markers. Our findings provide further support for recommendations to transition to more healthy plant-based diets for early prevention of cardiometabolic risk.