Operational Differences in Plant-Based Diet Indices Affect the Ability to Detect Associations with Incident Hypertension in Middle-Aged US Adults

Hyunju Kim; Casey M. Rebholz; Vanessa Garcia-Larsen; Lyn M. Steffen; Josef Coresh; Laura E. Caulfield

doi:10.1093/jn/nxz275

Operational Differences in Plant-Based Diet Indices Affect the Ability to Detect Associations with Incident Hypertension in Middle-Aged US Adults

Hyunju Kim, Casey M. Rebholz, Vanessa Garcia-Larsen, Lyn M. Steffen, Josef Coresh, Laura E. Caulfield

Epidemiology

Research output: Contribution to journal › Article › peer-review

36 Scopus citations

Abstract

Background: Several distinct plant-based diet indices (PDIs) have been developed to characterize adherence to plant-based diets. Objective: We contrasted 5 PDIs in a community-based cohort by assessing characteristics of the diet and evaluating whether these PDIs are associated with risk of incident hypertension. Methods: Using FFQ data from adults (45-64 y, n = 8041) without hypertension at baseline in the Atherosclerosis Risk in Communities (ARIC) Study, we scored participants' diets using the overall PDI (oPDI), healthy PDI (hPDI), less healthy (unhealthy) PDI (uPDI), provegetarian diet index, and PDI from the Rotterdam Study (PDI-Rotterdam). For the oPDI, provegetarian diet, and PDI-Rotterdam, higher intakes of all or selected plant foods received higher scores. For the hPDI, higher intakes of plant foods identified as healthful received higher scores. For the uPDI, higher intakes of less healthy plant foods received higher scores. All indices scored higher intakes of animal foods lower. We examined agreement between indices, and whether scores on these indices were associated with risk of hypertension using Cox proportional hazard models. Results: The PDIs were moderately-to-strongly correlated and largely ranked subjects consistently, except for the uPDI. Over a median follow-up of 13 y, 6044 incident hypertension cases occurred. When adjusted for sociodemographic characteristics, other dietary factors, and health behaviors, the highest compared with the lowest quintile for adherence to the oPDI, hPDI, and provegetarian diet was associated with a 12-16% lower risk of hypertension (all P-trend <0.05). Highest adherence to the uPDI was associated with a 13% higher risk of hypertension, when clinical factors were further adjusted for (P-trend = 0.03). No significant association was observed with the PDI-Rotterdam. The oPDI, hPDI, and provegetarian diet moderately improved the prediction of hypertension. Conclusions: In middle-aged US adults, despite moderate agreement in ranking subjects across PDIs, operational differences can affect the ability to detect diet-disease associations, such as hypertension.

Original language	English (US)
Pages (from-to)	842-850
Number of pages	9
Journal	Journal of Nutrition
Volume	150
Issue number	4
DOIs	https://doi.org/10.1093/jn/nxz275
State	Published - Apr 1 2020

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities Study was supported by National Heart, Lung, and Blood Institute (NHLBI), NIH, Department of Health and Human Services awards HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I (to JC). HK was supported by the Department of International Health Tuition Scholarship, Bacon Chow Endowed Award, Harry D Kruse Fellowship, Harry J Prebluda Fellowship, and the Richard and Barbara Hall Student Award from the Program in Human Nutrition in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. CMR was supported by National Institute of Diabetes and Digestive and Kidney Diseases Mentored Research Scientist Development Award K01 DK107782 and NHLBI grant R21 HL143089. Author disclosures: The authors report no conflicts of interest. The funding agencies had no role in study design, data collection, analysis, drafting of the manuscript, and the decision to submit this manuscript for publication. Supplemental Tables 1–5 and Supplemental Figures 1–3 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/jn/. In the Supplementary data, oPDI is labeled PDI. Address correspondence to LEC (e-mail: lcaulfi1@jhu.edu). Abbreviations used: ARIC, Atherosclerosis Risk in Communities; DASH, Dietary Approaches to Stop Hypertension; hPDI, healthy plant-based diet index; oPDI, overall plant-based diet index; PDI, plant-based diet index; PDI-Rotterdam, plant-based diet index from the Rotterdam Study; SSB, sugar-sweetened beverage; uPDI, less healthy (unhealthy) plant-based diet index.

Publisher Copyright:
Copyright © The Author(s) 2019.

Keywords

Adults
Comparison
Diet indices
Hypertension
Plant-based diets

Access

10.1093/jn/nxz275

OpenUrl availability

Full text

Cite this

@article{83852a5021b543faaffb8f9155a2ebf3,

title = "Operational Differences in Plant-Based Diet Indices Affect the Ability to Detect Associations with Incident Hypertension in Middle-Aged US Adults",

abstract = "Background: Several distinct plant-based diet indices (PDIs) have been developed to characterize adherence to plant-based diets. Objective: We contrasted 5 PDIs in a community-based cohort by assessing characteristics of the diet and evaluating whether these PDIs are associated with risk of incident hypertension. Methods: Using FFQ data from adults (45-64 y, n = 8041) without hypertension at baseline in the Atherosclerosis Risk in Communities (ARIC) Study, we scored participants' diets using the overall PDI (oPDI), healthy PDI (hPDI), less healthy (unhealthy) PDI (uPDI), provegetarian diet index, and PDI from the Rotterdam Study (PDI-Rotterdam). For the oPDI, provegetarian diet, and PDI-Rotterdam, higher intakes of all or selected plant foods received higher scores. For the hPDI, higher intakes of plant foods identified as healthful received higher scores. For the uPDI, higher intakes of less healthy plant foods received higher scores. All indices scored higher intakes of animal foods lower. We examined agreement between indices, and whether scores on these indices were associated with risk of hypertension using Cox proportional hazard models. Results: The PDIs were moderately-to-strongly correlated and largely ranked subjects consistently, except for the uPDI. Over a median follow-up of 13 y, 6044 incident hypertension cases occurred. When adjusted for sociodemographic characteristics, other dietary factors, and health behaviors, the highest compared with the lowest quintile for adherence to the oPDI, hPDI, and provegetarian diet was associated with a 12-16% lower risk of hypertension (all P-trend <0.05). Highest adherence to the uPDI was associated with a 13% higher risk of hypertension, when clinical factors were further adjusted for (P-trend = 0.03). No significant association was observed with the PDI-Rotterdam. The oPDI, hPDI, and provegetarian diet moderately improved the prediction of hypertension. Conclusions: In middle-aged US adults, despite moderate agreement in ranking subjects across PDIs, operational differences can affect the ability to detect diet-disease associations, such as hypertension.",

keywords = "Adults, Comparison, Diet indices, Hypertension, Plant-based diets",

author = "Hyunju Kim and Rebholz, {Casey M.} and Vanessa Garcia-Larsen and Steffen, {Lyn M.} and Josef Coresh and Caulfield, {Laura E.}",

note = "Funding Information: The Atherosclerosis Risk in Communities Study was supported by National Heart, Lung, and Blood Institute (NHLBI), NIH, Department of Health and Human Services awards HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I (to JC). HK was supported by the Department of International Health Tuition Scholarship, Bacon Chow Endowed Award, Harry D Kruse Fellowship, Harry J Prebluda Fellowship, and the Richard and Barbara Hall Student Award from the Program in Human Nutrition in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. CMR was supported by National Institute of Diabetes and Digestive and Kidney Diseases Mentored Research Scientist Development Award K01 DK107782 and NHLBI grant R21 HL143089. Author disclosures: The authors report no conflicts of interest. The funding agencies had no role in study design, data collection, analysis, drafting of the manuscript, and the decision to submit this manuscript for publication. Supplemental Tables 1–5 and Supplemental Figures 1–3 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/jn/. In the Supplementary data, oPDI is labeled PDI. Address correspondence to LEC (e-mail: lcaulfi1@jhu.edu). Abbreviations used: ARIC, Atherosclerosis Risk in Communities; DASH, Dietary Approaches to Stop Hypertension; hPDI, healthy plant-based diet index; oPDI, overall plant-based diet index; PDI, plant-based diet index; PDI-Rotterdam, plant-based diet index from the Rotterdam Study; SSB, sugar-sweetened beverage; uPDI, less healthy (unhealthy) plant-based diet index. Publisher Copyright: Copyright {\textcopyright} The Author(s) 2019.",

year = "2020",

month = apr,

day = "1",

doi = "10.1093/jn/nxz275",

language = "English (US)",

volume = "150",

pages = "842--850",

journal = "Journal of Nutrition",

issn = "0022-3166",

publisher = "American Society for Nutrition",

number = "4",

}

TY - JOUR

T1 - Operational Differences in Plant-Based Diet Indices Affect the Ability to Detect Associations with Incident Hypertension in Middle-Aged US Adults

AU - Kim, Hyunju

AU - Rebholz, Casey M.

AU - Garcia-Larsen, Vanessa

AU - Steffen, Lyn M.

AU - Coresh, Josef

AU - Caulfield, Laura E.

N1 - Funding Information: The Atherosclerosis Risk in Communities Study was supported by National Heart, Lung, and Blood Institute (NHLBI), NIH, Department of Health and Human Services awards HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I (to JC). HK was supported by the Department of International Health Tuition Scholarship, Bacon Chow Endowed Award, Harry D Kruse Fellowship, Harry J Prebluda Fellowship, and the Richard and Barbara Hall Student Award from the Program in Human Nutrition in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. CMR was supported by National Institute of Diabetes and Digestive and Kidney Diseases Mentored Research Scientist Development Award K01 DK107782 and NHLBI grant R21 HL143089. Author disclosures: The authors report no conflicts of interest. The funding agencies had no role in study design, data collection, analysis, drafting of the manuscript, and the decision to submit this manuscript for publication. Supplemental Tables 1–5 and Supplemental Figures 1–3 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/jn/. In the Supplementary data, oPDI is labeled PDI. Address correspondence to LEC (e-mail: lcaulfi1@jhu.edu). Abbreviations used: ARIC, Atherosclerosis Risk in Communities; DASH, Dietary Approaches to Stop Hypertension; hPDI, healthy plant-based diet index; oPDI, overall plant-based diet index; PDI, plant-based diet index; PDI-Rotterdam, plant-based diet index from the Rotterdam Study; SSB, sugar-sweetened beverage; uPDI, less healthy (unhealthy) plant-based diet index. Publisher Copyright: Copyright © The Author(s) 2019.

PY - 2020/4/1

Y1 - 2020/4/1

N2 - Background: Several distinct plant-based diet indices (PDIs) have been developed to characterize adherence to plant-based diets. Objective: We contrasted 5 PDIs in a community-based cohort by assessing characteristics of the diet and evaluating whether these PDIs are associated with risk of incident hypertension. Methods: Using FFQ data from adults (45-64 y, n = 8041) without hypertension at baseline in the Atherosclerosis Risk in Communities (ARIC) Study, we scored participants' diets using the overall PDI (oPDI), healthy PDI (hPDI), less healthy (unhealthy) PDI (uPDI), provegetarian diet index, and PDI from the Rotterdam Study (PDI-Rotterdam). For the oPDI, provegetarian diet, and PDI-Rotterdam, higher intakes of all or selected plant foods received higher scores. For the hPDI, higher intakes of plant foods identified as healthful received higher scores. For the uPDI, higher intakes of less healthy plant foods received higher scores. All indices scored higher intakes of animal foods lower. We examined agreement between indices, and whether scores on these indices were associated with risk of hypertension using Cox proportional hazard models. Results: The PDIs were moderately-to-strongly correlated and largely ranked subjects consistently, except for the uPDI. Over a median follow-up of 13 y, 6044 incident hypertension cases occurred. When adjusted for sociodemographic characteristics, other dietary factors, and health behaviors, the highest compared with the lowest quintile for adherence to the oPDI, hPDI, and provegetarian diet was associated with a 12-16% lower risk of hypertension (all P-trend <0.05). Highest adherence to the uPDI was associated with a 13% higher risk of hypertension, when clinical factors were further adjusted for (P-trend = 0.03). No significant association was observed with the PDI-Rotterdam. The oPDI, hPDI, and provegetarian diet moderately improved the prediction of hypertension. Conclusions: In middle-aged US adults, despite moderate agreement in ranking subjects across PDIs, operational differences can affect the ability to detect diet-disease associations, such as hypertension.

AB - Background: Several distinct plant-based diet indices (PDIs) have been developed to characterize adherence to plant-based diets. Objective: We contrasted 5 PDIs in a community-based cohort by assessing characteristics of the diet and evaluating whether these PDIs are associated with risk of incident hypertension. Methods: Using FFQ data from adults (45-64 y, n = 8041) without hypertension at baseline in the Atherosclerosis Risk in Communities (ARIC) Study, we scored participants' diets using the overall PDI (oPDI), healthy PDI (hPDI), less healthy (unhealthy) PDI (uPDI), provegetarian diet index, and PDI from the Rotterdam Study (PDI-Rotterdam). For the oPDI, provegetarian diet, and PDI-Rotterdam, higher intakes of all or selected plant foods received higher scores. For the hPDI, higher intakes of plant foods identified as healthful received higher scores. For the uPDI, higher intakes of less healthy plant foods received higher scores. All indices scored higher intakes of animal foods lower. We examined agreement between indices, and whether scores on these indices were associated with risk of hypertension using Cox proportional hazard models. Results: The PDIs were moderately-to-strongly correlated and largely ranked subjects consistently, except for the uPDI. Over a median follow-up of 13 y, 6044 incident hypertension cases occurred. When adjusted for sociodemographic characteristics, other dietary factors, and health behaviors, the highest compared with the lowest quintile for adherence to the oPDI, hPDI, and provegetarian diet was associated with a 12-16% lower risk of hypertension (all P-trend <0.05). Highest adherence to the uPDI was associated with a 13% higher risk of hypertension, when clinical factors were further adjusted for (P-trend = 0.03). No significant association was observed with the PDI-Rotterdam. The oPDI, hPDI, and provegetarian diet moderately improved the prediction of hypertension. Conclusions: In middle-aged US adults, despite moderate agreement in ranking subjects across PDIs, operational differences can affect the ability to detect diet-disease associations, such as hypertension.

KW - Adults

KW - Comparison

KW - Diet indices

KW - Hypertension

KW - Plant-based diets

UR - http://www.scopus.com/inward/record.url?scp=85083876790&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85083876790&partnerID=8YFLogxK

U2 - 10.1093/jn/nxz275

DO - 10.1093/jn/nxz275

M3 - Article

C2 - 31722418

AN - SCOPUS:85083876790

SN - 0022-3166

VL - 150

SP - 842

EP - 850

JO - Journal of Nutrition

JF - Journal of Nutrition

IS - 4

ER -

Operational Differences in Plant-Based Diet Indices Affect the Ability to Detect Associations with Incident Hypertension in Middle-Aged US Adults

Abstract

Bibliographical note

Keywords

Access

OpenUrl availability

Other files and links

Fingerprint

Cite this