Association between Different Types of Plant-Based Diets and Risk of Dyslipidemia: A Prospective Cohort Study

Abstract

We evaluated the associations among different types of plant-based diet indices, risk of dyslipidemia, and individual lipid disorders in Asian populations with different dietary patterns from Western populations. Participants included 4507 Korean adults aged ≥40 years without dyslipidemia and related chronic diseases at baseline (2001-2002). Dietary intakes were assessed using an average of validated food frequency questionnaires measured twice. We calculated three plant-based diet indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). During a follow-up of 14 years, 2995 incident dyslipidemia cases occurred. Comparing the highest with lowest quintiles, the multivariable-adjusted hazard ratios (HRs) for incident dyslipidemia were 0.78 (95% CI, 0.69-0.88) for PDI, 0.63 (95% CI, 0.56-0.70) for hPDI, and 1.48 (95% CI, 1.30-1.69) for uPDI (P-trend < 0.0001 for all). Associations between PDI and individual lipid disorders differed by sex. The PDI was inversely associated with risk of developing hypertriglyceridemia in men and with risk of developing low high-density lipoprotein cholesterol in women. The hPDI was inversely associated with risk of all lipid disorders, whereas the uPDI was positively associated with individual lipid disorders. The quality of plant foods is important for prevention of dyslipidemia in a population that consumes diets high in plant foods.

Keywords: Asians; dyslipidemia; plant food quality; plant-based diets; prospective study.

Figure 1

Multivariable adjusted hazard ratios and 95% confidence intervals for incident dyslipidemia according to the continuous plant-based diet index using restricted cubic splines. The histogram in gray shows the distribution of plant-based diet scores. The solid lines represent the multivariable adjusted hazard ratios for incident dyslipidemia, modeled using restricted cubic splines with 4 knots (5th, 35th, 65th, 95th percentiles). The reference was point was set at the 5th percentile of each score. The dashed lines represent 95% confidence intervals. (A) Overall plant-based diet score, (B) healthful plant-based diet score, (C) unhealthful plant-based diet score. Hazard ratios were adjusted for age (year, continuous), sex (men/women), residence area (rural/urban), education (≤6, 7–12, >12 years), physical activity (MET/day, continuous), pack-years of cigarettes (continuous), alcohol intake (g/day, continuous), body mass index (kg/m², continuous), and total energy intake (kcal/day, continuous).