Association between plant-based diets and blood pressure in the INTERMAP study

Ghadeer Aljuraiban; Queenie Chan; Rachel Gibson; Jeremiah Stamler; Martha L Daviglus; Alan R Dyer; Katsuyuki Miura; Yangfeng Wu; Hirotsugu Ueshima; Liancheng Zhao; Linda Van Horn; Paul Elliott; Linda M Oude Griep; INTERMAP Research Group

doi:10.1136/bmjnph-2020-000077

Association between plant-based diets and blood pressure in the INTERMAP study

BMJ Nutr Prev Health. 2020 Jul 8;3(2):133-142. doi: 10.1136/bmjnph-2020-000077. eCollection 2020 Dec.

Authors

Ghadeer Aljuraiban^{1

2}, Queenie Chan^{2

3}, Rachel Gibson^{2

4}, Jeremiah Stamler⁵, Martha L Daviglus⁶, Alan R Dyer⁵, Katsuyuki Miura⁷, Yangfeng Wu⁸, Hirotsugu Ueshima⁷, Liancheng Zhao⁹, Linda Van Horn⁵, Paul Elliott^{2

3}, Linda M Oude Griep^{2

10}; INTERMAP Research Group

Affiliations

¹ Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
² Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
³ MRC Centre for Environment and Health, Imperial Biomedical Research Centre, Imperial College London, London, UK.
⁴ Department of Nutritional Sciences, King's College London, London, UK.
⁵ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁶ College of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA.
⁷ Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan.
⁸ Clinical Research Institute and School of Public Health, Peking University, Beijing, Beijing, China.
⁹ Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
¹⁰ NIHR Biomedical Research Centre, Diet, Anthropometry, and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.

Abstract

Background: Plant-based diets are associated with a lower risk of cardiovascular diseases; however, little is known how the healthiness of the diet may be associated with blood pressure (BP). We aimed to modify three plant -based diet indices: overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI) according to country-specific dietary guidelines to enable use across populations with diverse dietary patterns - and assessed their associations with BP.

Design: We used cross-sectional data including 4,680 men and women ages 40-59y in Japan, China, the United Kingdom, and the United States from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP). During four visits, eight BP measurements, and four 24-h dietary recalls were collected. Multivariable regression coefficients were estimated, pooled, weighted, and adjusted extensively for lifestyle/dietary confounders.

Results: Modified PDI was not associated with BP. Consumption of hPDI higher by 1SD was inversely associated with systolic (-0.82 mm Hg;95% CI:-1.32,-0.49) and diastolic BP (-0.49 mm Hg; 95% CI:-0.91, -0.28). In contrast, consumption of an uPDI was directly associated with systolic (0.77 mm Hg;95% CI:0.30,1.20). Significant associations between hPDI with BP were attenuated with separate adjustment for vegetables and whole grains; associations between uPDI and BP were attenuated after adjustment for refined grains, sugar-sweetened beverages, and meat.

Conclusion: An hPDI is associated with lower BP while a uPDI is adversely related to BP. Plant-based diets rich in vegetables and whole grains and limited in refined grains, sugar-sweetened beverages, and total meat may contribute to these associations. In addition to current guidelines, the nutritional quality of consumed plant foods is as important as limiting animal-based components.

Trial registration number: The observational INTERMAP study was registered at www.clinicaltrials.gov as NCT00005271.

Keywords: blood pressure lowering; dietary patterns.

Associated data

ClinicalTrials.gov/NCT00005271

Abstract

Associated data

Grants and funding