Changes in Plant-Based Diet Quality and Total and Cause-Specific Mortality
Changes in Plant-Based Diet Quality and Total and Cause-Specific Mortality
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DOI：
10.1161/circulationaha.119.041014
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发表时间：
2019-09-17
期刊：
影响因子：
37.8
通讯作者：
Bhupathiraju, Shilpa N.
中科院分区：
文献类型：
--
作者：
Baden, Megu Y.;Liu, Gang;Bhupathiraju, Shilpa N.
背景资料：植物性饮食与2型糖尿病和心血管疾病（CVD）的风险降低有关，并被推荐用于健康和环境效益。然而，植物性饮食质量的变化与死亡率之间的关系仍不清楚。研究方法：我们调查了12年（从1986年到1998年）植物性饮食质量变化之间的关联，这些变化通过3种植物性饮食指数（评分范围，18-90）进行评估-总体植物性饮食指数（PDI），健康的PDI和不健康的PDI-以及随后的总死亡率和特定原因死亡率（1998-2014）。参与者是49407名护士健康研究（NHS）的女性和25907名健康专业人员随访研究（HPFS）的男性，他们在1998年没有心血管疾病和癌症。使用多变量校正的考克斯比例风险模型估计风险比（HR）和95% CI。结果如下：我们记录了10686例死亡，其中包括2046例CVD死亡和3091例癌症死亡，在NHS中随访超过725316人年，在HPFS中随访超过371322人年的6490例死亡，其中包括1872例CVD死亡和1772例癌症死亡。与那些指数保持稳定的参与者相比，在那些饮食分数增加最多的参与者中，（最高五分位数），总死亡率的合并多变量校正HR为0.95（95%CI，0.90-1.00），健康PDI为0.90（95%CI，0.85-0.95），不健康PDI为1.12（95%CI，1.07-1.18）。在降幅最大（最低五分位数）的受试者中，多变量调整后的HR为：PDI为1.09（95% CI，1.04-1.15），健康PDI为1.10（95% CI，1.05-1.15），不健康PDI为0.93（95% CI，0.88-0.98）。对于CVD死亡率，与每个PDI增加10分相关的风险对于PDI降低7%（95%CI，1-12%），对于健康的PDI降低9%（95%CI，4-14%），对于不健康的PDI升高8%（95%CI，2-14%）。植物性饮食指数的变化与癌症死亡率之间没有一致的联系。结论：在12年的时间里，改善植物性饮食质量与总死亡率和CVD死亡率的风险降低相关，而不健康的植物性饮食的消费增加与总死亡率和CVD死亡率的风险升高相关。
Background: Plant-based diets have been associated with lower risk of type 2 diabetes mellitus and cardiovascular disease (CVD) and are recommended for both health and environmental benefits. However, the association between changes in plant-based diet quality and mortality remains unclear. Methods: We investigated the associations between 12-year changes (from 1986 to 1998) in plant-based diet quality assessed by 3 plant-based diet indices (score range, 18-90)-an overall plant-based diet index (PDI), a healthful PDI, and an unhealthful PDI-and subsequent total and cause-specific mortality (1998-2014). Participants were 49 407 women in the Nurses' Health Study (NHS) and 25 907 men in the Health Professionals Follow-Up Study (HPFS) who were free from CVD and cancer in 1998. Multivariable-adjusted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% CIs. Results: We documented 10 686 deaths including 2046 CVD deaths and 3091 cancer deaths in the NHS over 725 316 person-years of follow-up and 6490 deaths including 1872 CVD deaths and 1772 cancer deaths in the HPFS over 371 322 person-years of follow-up. Compared with participants whose indices remained stable, among those with the greatest increases in diet scores (highest quintile), the pooled multivariable-adjusted HRs for total mortality were 0.95 (95% CI, 0.90-1.00) for PDI, 0.90 (95% CI, 0.85-0.95) for healthful PDI, and 1.12 (95% CI, 1.07-1.18) for unhealthful PDI. Among participants with the greatest decrease (lowest quintile), the multivariable-adjusted HRs were 1.09 (95% CI, 1.04-1.15) for PDI, 1.10 (95% CI, 1.05-1.15) for healthful PDI, and 0.93 (95% CI, 0.88-0.98) for unhealthful PDI. For CVD mortality, the risk associated with a 10-point increase in each PDI was 7% lower (95% CI, 1-12%) for PDI, 9% lower (95% CI, 4-14%) for healthful PDI, and 8% higher (95% CI, 2-14%) for unhealthful PDI. There were no consistent associations between changes in plant-based diet indices and cancer mortality. Conclusions: Improving plant-based diet quality over a 12-year period was associated with a lower risk of total and CVD mortality, whereas increased consumption of an unhealthful plant-based diet was associated with a higher risk of total and CVD mortality.