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The Association Between Overall, Healthy, and Unhealthy Plant-Based Diet Indexes and Risk of All-Cause and Cause-Specific Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies Publisher Pubmed



Etesami E1, 2 ; Nikparast A3, 4 ; Rahmani J2 ; Rezaei M5 ; Ghanavati M4
Authors
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Authors Affiliations
  1. 1. Department of Nutrition, Islamic Azad University, Science and Research Branch, Tehran, Iran
  2. 2. Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  3. 3. Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, P.O. 19395-4741, Tehran, Iran
  5. 5. Genomic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: Food and Function Published:2025


Abstract

Background: recent dietary guidelines recommend a diet that mainly includes plant-based foods and a moderate amount of animal products. Therefore, we hypothesized that plant-based diet indices (overall plant-based diet index (oPDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI)) might be associated with risk of all-cause and cause-specific mortality. Methods: a systematic review was conducted using PubMed, Web of Science, Scopus, and Embase databases until December 2024. Meta-analysis was performed utilizing random-effects models to calculate relative risk (RR) with the corresponding 95% confidence intervals (95% CIs). Results: from 436 initial records, 25 prospective studies met the inclusion criteria. The findings of our study indicated a modest inverse association between the adherence to oPDI and risk of all-cause mortality (RR [95% CI]: 0.89 [0.83-0.94]; n = 15 studies) as well as mortality related to cardiovascular diseases, chronic heart disease, and total cancer. Also, adherence to hPDI was found to reduce risk of all-cause (RR [95% CI]: 0.86 [0.82-0.90]; n = 21 studies), cardiovascular disease, chronic heart disease, total-cancer, and prostate cancer mortality, whereas uPDI was associated with higher risk of all-cause (RR [95% CI]: 1.20 [1.13-1.27]; n = 19 studies), cardiovascular disease, chronic heart disease, and total-cancer mortality. Our dose-response meta-analysis showed a monotonic inverse association between adherence to oPDI and hPDI and a positive linear association between adherence to uPDI and risk of all-cause mortality. Conclusion: our findings highlight the importance of evaluating the quality of plant-based foods as either healthy or unhealthy in relation to the risk of all-cause and cause-specific mortality. © 2025 The Royal Society of Chemistry.
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