Author + information
- Received February 14, 2017
- Revision received April 27, 2017
- Accepted May 23, 2017
- Published online July 17, 2017.
- Ambika Satija, ScDa,∗ (, )
- Shilpa N. Bhupathiraju, PhDa,b,
- Donna Spiegelman, ScDa,b,c,d,e,
- Stephanie E. Chiuve, ScDa,f,
- JoAnn E. Manson, MD, DrPHc,g,h,
- Walter Willett, MD, DrPHa,b,c,
- Kathryn M. Rexrode, MD, MPHi,
- Eric B. Rimm, ScDa,b,c and
- Frank B. Hu, MD, PhDa,b,c
- aDepartment of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- bChanning Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- cDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- dDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- eDepartment of Global Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- fBenefit-Risk Management, Innovative Platforms & Epidemiology, Pharmacovigilance & Patient Safety, AbbVie, North Chicago, Illinois
- gDepartment of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- hDepartment of Medicine, Brigham and Womens' Hospital, Harvard Medical School, Boston, Massachusetts
- iDivision of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Ambika Satija, Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, Massachusetts 02115.
Background Plant-based diets are recommended for coronary heart disease (CHD) prevention. However, not all plant foods are necessarily beneficial for health.
Objectives This study sought to examine associations between plant-based diet indices and CHD incidence.
Methods We included 73,710 women in NHS (Nurses’ Health Study) (1984 to 2012), 92,329 women in NHS2 (1991 to 2013), and 43,259 men in Health Professionals Follow-up Study (1986 to 2012), free of chronic diseases at baseline. We created an overall plant-based diet index (PDI) from repeated semiquantitative food-frequency questionnaire data, by assigning positive scores to plant foods and reverse scores to animal foods. We also created a healthful plant-based diet index (hPDI) where healthy plant foods (whole grains, fruits/vegetables, nuts/legumes, oils, tea/coffee) received positive scores, whereas less-healthy plant foods (juices/sweetened beverages, refined grains, potatoes/fries, sweets) and animal foods received reverse scores. To create an unhealthful PDI (uPDI), we gave positive scores to less-healthy plant foods and reverse scores to animal and healthy plant foods.
Results Over 4,833,042 person-years of follow-up, we documented 8,631 incident CHD cases. In pooled multivariable analysis, higher adherence to PDI was independently inversely associated with CHD (hazard ratio [HR] comparing extreme deciles: 0.92; 95% confidence interval [CI]: 0.83 to 1.01; p trend = 0.003). This inverse association was stronger for hDPI (HR: 0.75; 95% CI: 0.68 to 0.83; p trend <0.001). Conversely, uPDI was positively associated with CHD (HR: 1.32; 95% CI: 1.20 to 1.46; p trend <0.001).
Conclusions Higher intake of a plant-based diet index rich in healthier plant foods is associated with substantially lower CHD risk, whereas a plant-based diet index that emphasizes less-healthy plant foods is associated with higher CHD risk.
Supported by research grants from the National Institutes of Health (UM1 CA186107, UM1 CA176726, UM1 CA167552, HL034594, HL60712, and HL35464). Dr. Chiuve is an employee of AbbVie, Inc. Dr. Rimm has received a research grant from the U.S. Department of Agriculture/Blueberry Highbush Council; and has served on the Scientific Advisory Committees of IKEA, Take C/O, and SPE. Dr. Hu has received research support from the California Walnut Commission and Metagenics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 14, 2017.
- Revision received April 27, 2017.
- Accepted May 23, 2017.
- 2017 American College of Cardiology Foundation