Evidence map›Paper›PMID 40394599›Full record

ArticleBMC medicine2025

The portfolio dietary pattern and risk of cardiovascular disease mortality during 1988-2019 in US adults: a prospective cohort study.

Meaghan E Kavanagh, Andreea Zurbau, Andrea J Glenn, Julianah O Oguntala, Robert G Josse, Vasanti S Malik, Laura Chiavaroli, Simin Liu, Cyril W C Kendall, David J A Jenkins and 1 more

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Article in BMC medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

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4citing papers in PubMed
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1 · What the graph read from it

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3 · Its place in the literature

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4 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

11 authors.

Meaghan E KavanaghDepartment of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Andreea ZurbauDepartment of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Andrea J GlennDepartment of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Julianah O OguntalaDepartment of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Robert G JosseDivision of Endocrinology and Metabolism, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
Vasanti S MalikDepartment of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Laura ChiavaroliDepartment of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Simin LiuDepartment of Epidemiology & Biostatistics, Joe C. Wen School of Population and Public Health, University of California, Irvine, CA, USA.
Cyril W C KendallDepartment of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
David J A JenkinsDepartment of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
John L SievenpiperDepartment of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. john.sievenpiper@utoronto.ca.

Funding

CIHR 181403CIHR 320135
6 · The paper itself

Abstract

backgroundThe Portfolio Diet, a dietary pattern of cholesterol-lowering foods, has been shown to reduce cardiovascular disease (CVD) risk factors in clinical trials and lower CVD risk in observational cohorts of mainly white men and women. However, evidence on mortality outcomes in diverse populations is limited.

objectiveTo examine the association of the Portfolio dietary pattern with CVD mortality in a racially diverse cohort.

methodsA total of 14,835 US adults from the National Health and Nutrition Examination Survey, NHANES (1988-1994), were included. Diet was assessed by a 24-h dietary recall which was supplemented with a food frequency questionnaire at baseline using the Portfolio Diet Score (PDS), with positive points for nuts, plant protein, viscous fiber, phytosterols, and plant monounsaturated fatty acid sources, and negative points for foods high in saturated fat and cholesterol (range, 6-30 points). The primary outcome was CVD mortality. Other mortality outcomes included coronary heart disease (CHD), stroke, and all-cause mortality.

resultsDuring 22 years of follow-up, 2300 CVD deaths, including 1887 CHD deaths, 413 stroke deaths, and 6238 all-cause deaths were documented. Greater adherence was inversely associated with risk factors including blood lipids, glycemia, and inflammation. Treated as a continuous variable, an increase in PDS by 8 points was associated with a 12% (hazard ratio 0.88 [95% confidence intervals:0.78, 0.99]), 14% (0.86 [0.78, 0.96]), and 12% (0.88 [0.82, 0.95]) lower risk of CVD, CHD, and all-cause mortality after adjustments for known CVD risk factors. Comparing the highest to lowest tertiles of the PDS, higher PDS was associated with 16% (0.84 [0.73, 0.98]), 18% (0.82 [0.72, 0.95]) and 14% (0.86 [0.78, 0.96]) lower risk of CVD, CHD, and all-cause mortality, respectively. As part of exploratory analyses, an interaction between PDS and race/ethnicity was observed, emphasizing the necessity of future research involving underserved groups.

conclusionsAmong a national cohort of racially diverse adults in the US, greater adherence to the Portfolio dietary pattern was inversely and prospectively associated with CVD, CHD, and all-cause mortality.

Indexed as

Cardiovascular DiseasesDietAdultAgedFemaleHumansMaleMiddle AgedNutrition SurveysProspective StudiesRisk FactorsUnited StatesAll-cause mortalityCardiovascular disease mortalityCholesterol reductionDietary patternDietary portfolioPlant-basedPortfolio dietProspective cohort study

Identifiers

PMID40394599
PMCPMC12093672

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.