Plant-based portfolio diet linked to fewer heart-related deaths

Plant-based portfolio diet linked to fewer heart-related deaths

New research shows that the Portfolio Diet can boost everyday food choices, reduce your risk of heart disease and help you live longer.

Study: The Portfolio Dietary Pattern and Risk of Cardiovascular Disease Mortality from 1988 to 2019 in US Adults: A Prospective Cohort Study. Photo credit: Rimma Bondarenko/Shutterstock.com

In a recently published study inBMC medicinePresentResearchers examined the long-term effects of the portfolio diet on cardiovascular outcomes and all-cause mortality.

background

Cardiovascular diseases (CVDs), particularly coronary heart disease (CHD) and stroke, are the leading causes of disability and mortality worldwide, accounting for an estimated 17.9 million human deaths annually. The financial burden of CVDs is similarly alarming, accounting for 11% and 15% of all health-related expenditure in the Group of Twenty (G20).

Poor environmental (e.g., pollution) and behavioral (e.g., diet, sleep, and physical activity) trends are expected to further increase CVD burden, prompting ongoing research into preventive strategies. Noninvasive behavioral interventions, particularly dietary modifications, represent a leading strategy for reducing the risk of CVD and treating its risk factors (e.g., dyslipidemia).

While the physiological benefits of popular "healthy" dietary patterns (e.g., the Mediterranean diet) over their "unhealthy" alternatives (e.g., the Western-style dietary pattern) are established, the effects of lesser-known CVD prevention (e.g., the Portfolio Diet) have been less well-precautious, particularly for long-term morpern outfittality in the circumstances.

The Portfolio Diet is a novel plant-based diet that includes increased soy protein, nuts, soluble fiber and plant sterols to moderate cholesterol and lipids, thereby promoting long-term cardiovascular health.

About the study

The study aimed to examine the impact of adherence to portfolio medications on CVD, CHD, and all-cause mortality in a large cohort of adult US participants and to inform future public health and nutrition recommendations.

Study data were obtained from the National Health and Nutrition Examination Survey (NHANES 1988–1994), with methodology approved by the US Centers for Disease Control and Prevention (CDC).

Criteria for participant inclusion included non-pregnant adults (over 20 years of age) with the 24-hour food recall and first day mortality follow-up data (22 years of age). Individuals with missing sociodemographic data, a food frequency questionnaire (FFQ), or a low body mass index (BMI <18.5 kg/m²) were excluded from subsequent analyses.

Study results focused on CVD mortality (primary outcome) alongside stroke, CHD and all-cause mortality (secondary outcomes). Dietary estimates were conducted using 24-hour recall interviews with FFQs, which were used together to calculate a Portfolio Diet Score (PDS; 6-30 points), indicating the relative influence of soy protein, nuts, and soluble fiber on participants' long-term mortality risk. Notably, FFQs are not designed to assess plant sterols (phytosterols) metrics, limiting phytosterol analyzes to only 24-hour recall estimates.

PDS was used to categorize participants into three groups. COX proportional hazard models were used to calculate hazard ratios (HRS) and adjust for potential confounders (e.g., demographic factors, physical activity, socioeconomic status, smoking, alcohol consumption, clinical risk factors, and BMI).

It is important to note that dietary triggers were measured at a single baseline time point using self-reported methods, including a single 24-hour recall and FFQ, which are subject to under- and over-reporting and may not fully capture participant habits, introducing the potential for bias and measurement error.

Study results

The study inclusion criteria identified 14,835 participants with complete data. Median follow-up (22 years) revealed 6,238 deaths, including 2300 CVD-related, 1,887 CHD-related, CHD-related CVD, and 413 strokes.

Assessments of portfolio diets (leveraging PDS metrics) demonstrated a strong inverse association between dietary adherence and mortality risk. Each 8-point increase in PDS resulted in lower CVD mortality (-12%), CHD mortality (-14%), and all-cause mortality (-12%).

Participants assigned to the highest group of PDs demonstrated a 16% lower risk of CVD death, an 18% lower risk of CHD death, and a 14% lower all-cause mortality than those assigned to the lowest group. These associations remained significant after statistical adjustments for various demographic, lifestyle, and clinical confounders.

Subgroup and sensitivity analyzes confirmed these results, suggesting that even partial adherence to a portfolio diet may provide meaningful long-term cardiovascular benefits.

Surprisingly, the study was unable to identify a relationship between the Portfolio diet and strokes, suggesting that alternative, currently unknown pathophysiological mechanisms determine stroke risk. This may reflect limited statistical power due to the number of stroke events in the cohort, and other studies have shown possible associations.

Additionally, subgroup analyzes demonstrated an association between race/ethnicity and mortality outcomes, suggesting that population-specific effects exist that future research should examine. These subgroup findings are exploratory and inconclusive and do not inform tailored intervention recommendations.

In addition to mortality outcomes, higher portfolio diet adherence is associated with favorable changes in several cardiometabolic biomarkers, including LDL cholesterol, non-HDL cholesterol, C-reactive protein, and hemoglobin A1c.

As with all observational studies, causality cannot be established and results could be affected by confounding and measurement limitations.

Conclusions

The large cohort study shows a long-term association with cardiovascular benefits and greater adherence to a portfolio diet, supporting the diet as a non-invasive behavioral intervention to reduce cardiovascular and all-cause mortality.

However, the study's observational design, reliance on dietary recall on alone time points, and focus on the US population mean that the results are not definitive for the broader population. Nevertheless, the Portfolio diet may provide benefits with partial adherence, but its broader applications require further study.

Further research, including prospective and intervention studies in diverse populations and adaptation of this diet, is needed to better understand the full potential and limitations of the portfolio diet.

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