SEARCHSYSTEMATIC_REVIEWnutrition, epidemiology

systematic_review·nutrition, epidemiology, public health, systematic review, cardiology·PMC10447911

Scoping review of the association of plant-based diet quality with health outcomes

Frontiers in Nutrition · 3 authors, 1 centre

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This scoping review synthesized 95 observational articles, including longitudinal (54%), cross-sectional (37%), and case-control (9%) studies, to map evidence on the plant-based dietary index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). The median sample size was 3,646. The central finding was that a higher hPDI level was associated with favorable health outcomes in 36.2% of comparisons, significantly more than the PDI (24.6%) and the uPDI (2.0%). Conversely, a higher uPDI level was associated with unfavorable outcomes in 32.5% of comparisons. When associations for hPDI and uPDI were discordant, results always favored the hPDI. Limitations include the observational design of all included studies, preventing causal inference, and the descriptive, non-quantitative synthesis. The findings suggest that accounting for plant food quality in dietary indices reveals stronger health associations than generic plant-based measures, with implications for nutrition guidelines.

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systematic_review

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nutrition

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ORIGINAL PAPER

PMC10447911

Scoping review of the association of plant-based diet quality with health outcomes

Frontiers in Nutrition

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ABSTRACT

Introduction The association of plant-based dietary patterns with health outcomes has traditionally been assessed without considering nutritional value. The plant-based dietary index (PDI), first published in 2016, overcomes this limitation with both a healthful PDI (hPDI) and an unhealthful PDI (uPDI), based on the quality of plant foods consumed plus the frequency of animal foods. We sought to summarize the breadth of research using the hPDI and uPDI to gain insight into how the quality of plant-based dietary patterns might be associated with health outcomes. Methods Scoping review of studies that used the PDI, hPDI, or uPDI to report associations with health outcomes. Multiple databases were searched from 2010 through April 2023 with 2 authors independently assessing eligibility and extracting data. In addition to assessing the association of the indices to health outcomes, we determined the frequency of concordant or discordant findings for hPDI versus PDI and for hPDI versus uPDI. Results We included 95 articles (54% longitudinal, 37% cross-sectional, and 9% case–control) with a median sample size of 3,646. Higher hPDI levels were associated with favorable health outcomes in 36% of comparisons (most often for obesity, mortality, diabetes, cardiovascular disease, and psychiatric disorders), compared to 25% for the PDI and only 2% for the uPDI. Conversely, higher levels of the uPDI were associated with unfavorable health outcomes in 33% of comparisons, in contrast to under 1% for the hPDI and 2% for the PDI. When the hPDI association to an outcome was discordant with the uPDI or PDI, the significance and directionality always favored the hPDI over the uPDI, and nearly always favored the hPDI over the PDI. Discussion Dietary indices that account for the quality of plant foods can show health benefits that might be missed by a generic plant-based index. A greater focus on the quality of plant foods could improve nutrition guidelines, raise awareness about the benefits of adding unrefined plant foods to the diet, and empower consumers to make incremental additions of such foods to displace unhealthy foods. We anticipate increasing use of indices that address food quality in future research.

CITATION EXPORT

Richard M. Rosenfeld, Hailey M. Juszczak, Michele A. Wong. Scoping review of the association of plant-based diet quality with health outcomes. Frontiers in Nutrition. (2023). https://doi.org/10.3389/fnut.2023.1211535

AUTHORS

3 · 1 CENTRES

Richard M. Rosenfeld, Hailey M. Juszczak, Michele A. Wong

Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States