Plant-Based Dietary Patterns and Cardiometabolic Risk: A Systematic Review and Meta-Analysis of Prospective Cohort Studies
Bibliographic record
Abstract
Plant-based diets defined by limited animal food consumption have been extensively associated with cardiometabolic health benefits in Western nations. Diet indices are increasingly used to distinguish the protective characteristics of a plant-based diet at different levels of adherence. We aimed to synthesize evidence on the association between adherence to plant-based diet indices and cardiometabolic risk. A plant-based diet index (PDI) is hypothesized to be inversely associated with type 2 diabetes (T2D) and cardiovascular disease (CVD) with a stronger association with the healthful index (hPDI) that emphasizes higher quality plant-based foods. We systematically searched MEDLINE, EMBASE and CINAHL databases through January 2021. Prospective cohort studies assessing the association of plant-based diet indices with T2D and CVD in adults were included and appraised for risk of bias and quality (NutriGrade). We followed the PRISMA-P, Cochrane and MOOSE guidelines. Random and fixed-effects meta-analyses were conducted to pool risk ratios (RR) of extreme quantiles. Dose-response meta-analyses were conducted after harmonizing all diet index scores. I2-values of 30–60%, 50–90%, and 75–100% denoted moderate, substantial, and considerable heterogeneity respectively. We included a total of 10 studies from 5927 retrievals. Across 6 studies there were 22 135 cases of T2D over 4 817 308 person-years. Across 7 studies there were 15 077 cases of CVD over 6 117 016 person-years. The PDI was associated with a lower risk of T2D (RR = 0.82, 95% CI [0.75, 0.91], I2 = 55.4%), and CVD (RR = 0.88, 95% CI [0.8, 0.96], I2 = 16.2%). The hPDI had a stronger inverse association with T2D (RR = 0.73, 95% CI [0.68, 0.77], I2 = 84.3%) and CVD (RR = 0.8, 95% CI [0.77, 0.88], I2 = 55.9%). All dose-response relationships were linear (except hPDI with CVD). All studies had acceptable risk of bias and the quality of evidence was moderate. Adherence to a plant-based diet was inversely associated with T2D and CVD with a stronger association for a healthful plant-based diet pattern. Since highest quantiles of the index still included moderate meat consumption, linear dose-responses emphasized potential benefits on risk of T2D and CVD with any incremental progression towards a plant-based diet. Nora Martin Fellowship, Ontario Graduate Scholarship.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.034 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.027 |
| Bibliometrics | 0.010 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".