The Portfolio Diet and Cardiovascular Disease Risk Reduction: Insights from International Prospective Cohort Studies
Bibliographic record
Abstract
The Portfolio Diet significantly lowered low-density lipoprotein cholesterol (LDL-C) and several other cardiovascular disease (CVD) risk factors in randomized controlled trials of patients with hyperlipidemia. However, it is not known if the diet lowers CVD risk in other populations. To examine the long-term health effects of the diet in broader populations, we developed a Portfolio Diet Score (PDS) using a food frequency questionnaire (FFQ). The PDS gives positive scores for foods and nutrients recommended in the diet (plant protein, viscous fibre, nuts, phytosterols, and monounsaturated fatty acids), and reverse scores for foods limited in the diet (those high in saturated fat and dietary cholesterol). This dissertation describes the development of and examines the validity of the PDS, and then evaluates the PDS’ associations with incident CVD outcomes and cardiometabolic risk factors in two prospective cohort studies. In chapter 1, we used data from the Toronto Healthy Diet Study to develop and examine the predictive and concurrent validity of the PDS. We found the PDS from the FFQ was associated with LDL-C in the expected direction. The PDS from the FFQ also had reasonable correlations and good agreement with a PDS determined from a 7-day diet record. In chapter 2, we examined associations of the PDS with incident CVD outcomes in the Women’s Health Initiative (WHI). We included ~120,000 postmenopausal women from 1993 through 2017 with a mean follow-up of 15.3 years. In the multivariable-adjusted analysis, the PDS was inversely associated with incident total CVD, coronary heart disease (CHD), and heart failure, but not stroke and atrial fibrillation. In chapter 3, we examined associations of the PDS with several cardiometabolic risk factors in PREDIMED-Plus, a cohort of ~6,000 older adults with metabolic syndrome. Over one year of follow-up, the PDS was inversely associated with markers of glycemic control and adiposity, and triglycerides, but not with LDL-C or other cardiometabolic risk factors. In conclusion, we found reasonable validity of the PDS as determined by an FFQ. The findings suggest that the Portfolio Diet is associated with lower risk of CVD and CHD, and several cardiometabolic risk factors, in different populations.
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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 | 0.019 | 0.024 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".