Plant-based diets and incident cardiovascular disease and all-cause mortality in African Americans: A cohort study.
Plant-based diets and incident cardiovascular disease and all-cause mortality in African Americans: A cohort study.
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DOI：
10.1371/journal.pmed.1003863
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发表时间：
2022-01
期刊：
影响因子：
15.8
通讯作者：
Rebholz CM
中科院分区：
文献类型：
--
作者：
Weston LJ;Kim H;Talegawkar SA;Tucker KL;Correa A;Rebholz CM
先前的研究表明，坚持植物性饮食模式的人患心血管疾病（CVD）的风险较低。非西班牙裔美国黑人是一个未被充分研究的CVD高负担群体，然而植物性饮食的研究在这一人群中有限。我们对杰克逊心脏研究（JHS）中年龄21-95岁的非裔美国成年人（n = 3,635）的前瞻性数据进行了分析，这些成年人居住在美国密西西比州杰克逊大都会区，从2000年到2018年进行了随访。使用自我报告的饮食数据，我们对参与者坚持三种植物性饮食模式进行了评分：总体植物性饮食指数（PDI），健康PDI （hPDI）和不健康PDI （uPDI）。Cox比例风险模型用于估计植物性饮食评分与心血管疾病发病率和全因死亡率之间的关系。在13年和15年的中位随访中，分别有293例心血管疾病病例和597例死亡。在调整了社会人口统计学特征（年龄、性别和受教育程度）和健康行为（吸烟、饮酒、人造黄油摄入、体力活动和总能量摄入）后，在总体PDI（风险比[HR] 1.06, 95% CI 0.78-1.42, p-trend = 0.72）、hPDI（风险比[HR] 1.07, 95% CI 0.80-1.42, p-trend = 0.67）和uPDI（风险比[HR] 0.95, 95% CI 0.71-1.28, p-trend = 0.76）方面，植物性饮食与CVD发生率之间没有显著关联。与总PDI、hPDI和uPDI相关的全因死亡风险hr （95% ci）分别为0.96（0.78-1.18）、0.94（0.76-1.16）和1.06（0.86-1.30）。冠心病发生率与总PDI、hPDI和uPDI的相应hr （95% ci）分别为1.09（0.74-1.61）、1.11（0.76-1.61）和0.79（0.52-1.18）。对于事件总卒中，总PDI、hPDI和uPDI的hr （95% ci）分别为1.00（0.66-1.52）、0.91（0.61-1.36）和1.26(0.84-1.89)（所有测试的p趋势为0.05）。该研究的局限性包括使用自我报告的饮食摄入量，残留混淆，反向因果关系的可能性，以及该研究没有捕获那些只食用植物性食物的人。在这项针对美国黑人的研究中，我们观察到，与之前的研究不同，更坚持植物性饮食与心血管疾病或全因死亡率无关。在一项队列研究中，Leah J. Weston及其同事调查了非裔美国人食用植物性饮食与心血管疾病和全因死亡率之间的关系。通过对“素食”饮食的研究，人们发现植物性饮食对健康有益，包括降低患心脏病的风险；然而，在更普通的人群中对这些关联的研究产生了不同的结果。对植物性饮食模式的调查使研究人员能够研究坚持植物性饮食模式的水平和植物性饮食的健康程度与心血管疾病（CVD）风险之间的关系。这项研究的目的是扩大在遵循南方饮食模式的美国非裔美国男性和女性中关于植物性饮食和心血管疾病风险的结论的普遍性。我们使用来自杰克逊心脏研究的3,635名非裔美国成年人的数据，平均随访13年，以评估3种植物性饮食模式（整体，健康和不健康）与心血管疾病发病率和全因死亡率的关系。所有参与者的整体饮食质量都很低，饮食中植物含量最高的参与者仍然经常食用动物性食物。饮食与植物性饮食模式最相似的参与者和饮食中植物性饮食最少的参与者的心血管疾病发病率和全因死亡率相同。在单独的食物组中，豆类与心血管疾病的风险较低有关，而植物油与心血管疾病的风险较高有关，全谷物和含糖饮料与较高的全因死亡率有关。植物性饮食指数评分因其描述整体饮食模式的能力而受到研究人员的欢迎；然而，在参与者饮食中植物丰富度梯度最小的人群中，它们的使用可能受到限制。与植物性饮食相关的健康益处可能取决于个人饮食的整体健康状况，并且可能需要更高水平的坚持植物性饮食，而不是居住在美国南部地区的非洲裔美国人中最富含植物性饮食的人通常所做的。
Prior studies have documented lower cardiovascular disease (CVD) risk among people with a higher adherence to a plant-based dietary pattern. Non-Hispanic black Americans are an understudied group with high burden of CVD, yet studies of plant-based diets have been limited in this population. We conducted an analysis of prospectively collected data from a community-based cohort of African American adults (n = 3,635) in the Jackson Heart Study (JHS) aged 21–95 years, living in the Jackson, Mississippi, metropolitan area, US, who were followed from 2000 to 2018. Using self-reported dietary data, we assigned scores to participants’ adherence to 3 plant-based dietary patterns: an overall plant-based diet index (PDI), a healthy PDI (hPDI), and an unhealthy PDI (uPDI). Cox proportional hazards models were used to estimate associations between plant-based diet scores and CVD incidence and all-cause mortality. Over a median follow-up of 13 and 15 years, there were 293 incident CVD cases and 597 deaths, respectively. After adjusting for sociodemographic characteristics (age, sex, and education) and health behaviors (smoking, alcohol intake, margarine intake, physical activity, and total energy intake), no significant association was observed between plant-based diets and incident CVD for overall PDI (hazard ratio [HR] 1.06, 95% CI 0.78–1.42, p-trend = 0.72), hPDI (HR 1.07, 95% CI 0.80–1.42, p-trend = 0.67), and uPDI (HR 0.95, 95% CI 0.71–1.28, p-trend = 0.76). Corresponding HRs (95% CIs) for all-cause mortality risk with overall PDI, hPDI, and uPDI were 0.96 (0.78–1.18), 0.94 (0.76–1.16), and 1.06 (0.86–1.30), respectively. Corresponding HRs (95% CIs) for incident coronary heart disease with overall PDI, hPDI, and uPDI were 1.09 (0.74–1.61), 1.11 (0.76–1.61), and 0.79 (0.52–1.18), respectively. For incident total stroke, HRs (95% CIs) for overall PDI, hPDI, and uPDI were 1.00 (0.66–1.52), 0.91 (0.61–1.36), and 1.26 (0.84–1.89) (p-trend for all tests > 0.05). Limitations of the study include use of self-reported dietary intake, residual confounding, potential for reverse causation, and that the study did not capture those who exclusively consume plant-derived foods. In this study of black Americans, we observed that, unlike in prior studies, greater adherence to a plant-based diet was not associated with CVD or all-cause mortality. In a cohort study, Leah J. Weston and colleagues investigate the associations between consumption of plant-based diets and incident cardiovascular disease and all-cause mortality in African Americans. Plant-based diets have been linked, largely through studies of “vegetarian” diets, with health benefits, including lower risk of heart disease; however, studies of these associations among more general populations have produced mixed results. Investigating plant-based dietary patterns has allowed researchers to study how levels of adherence to plant-based dietary patterns and the healthfulness of plant-based diets correlate with cardiovascular disease (CVD) risk. This study was conducted to expand the generalizability of conclusions about plant-based diets and CVD risk in African American men and women in the US who were following a southern dietary pattern. We used data on 3,635 African American adults from the Jackson Heart Study with a mean follow-up of 13 years to assess the association of 3 plant-based dietary patterns (overall, healthy, and unhealthy) with CVD incidence and all-cause mortality. Overall diet quality was low for all participants, and participants with the most plant-rich diets still regularly included animal-based foods. Incidence of CVD and all-cause mortality was the same among participants whose diets were most similar to a plant-based dietary pattern and among those whose diets were least plant-based. Among individual food groups, legumes were associated with a lower risk for CVD, while vegetable oils were associated with higher risk for CVD, and whole grains and sugar-sweetened beverages were associated with higher all-cause mortality. Plant-based diet index scores have gained popularity among researchers for their ability to characterize overall dietary patterns; however, their use may be limited in populations with minimal gradations in the plant richness of participants’ diets. Health benefits linked to plant-based diets may depend on the overall healthfulness of an individual’s diet and might require higher levels of adherence to a plant-based diet than what is typically practiced among those with the most plant-rich diets in this cohort of African Americans residing in the southern region of the US.
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DOI：
10.1053/j.jrn.2014.07.008
发表时间：
2015-03
期刊：
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation
影响因子：
--
作者：
Crews DC;Kuczmarski MF;Miller ER 3rd;Zonderman AB;Evans MK;Powe NR
通讯作者：
Powe NR
影响因子：
12.7
作者：
BLOCK, G;ROSENBERGER, WF;PATTERSON, BH
通讯作者：
PATTERSON, BH
影响因子：
7
作者：
Appleby, Paul N.;Key, Timothy J.
通讯作者：
Key, Timothy J.
影响因子：
7.1
作者：
Key, Timothy J.;Appleby, Paul N.;Allen, Naomi E.
通讯作者：
Allen, Naomi E.
影响因子：
5
作者：
Judd SE;Letter AJ;Shikany JM;Roth DL;Newby PK
通讯作者：
Newby PK