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Are All Plant-based Diets Created Equally (in Terms of Health Benefits)?

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Dr. Feldman reports no financial relationships relevant to this field of study.


* Dietary data from the Nurses’ Health Study and the Health Professionals Follow-Up Study included information from more than 200,000 health professionals in the United States; foods consumed were categorized according to health benefits and derivation (plant or animal.)* Three general dietary indices allowing for gradation within each were created: a generic plant-based diet index (PDI); a healthy plant-based diet index emphasizing whole grains, fruits, and vegetables (hPDI); and an unhealthy, plant-based diet containing more processed foods and sweetened foods (uPDI).* Researchers used a statistical analysis to study the development of cardiac heart disease over time in each decile of each index and accounted for variables including development of disease over time, smoking, exercise, and aging.* The strongest inverse association with coronary heart disease was found in the top decile with hPDI (P < 0.001) and less so with PDI (P = 0.003); on the contrary, there was a positive association with uPDI and coronary heart disease (P < 0.001).

SOURCE: Satijam A, Bhupathiraju S, Spiegelman D, et al. Healthful and unhealthful plant-based diets and the risk of coronary heart disease in U.S. adults. J Am Coll Cardiol 2017;70:411-422.

It is widely accepted that vegetarian diets are associated with lower risk of coronary heart disease (CHD). 1 Or are they? Although many studies have demonstrated this association, Satijam et al noted two crucial limitations of these earlier studies. Specifically, they postulated that all plant-based foods are not equally protective of cardiovascular risk and noted that even incremental shifts in composition of diet may affect the degree of cardiovascular protection. Furthermore, they ascertained that previous studies were not designed to discern these subtleties of diet.

To investigate further, the researchers obtained dietary data from the Nurses’ Health Study...