Overall and quality-specific plant-based dietary patterns and all-cause mortality in older adults with cardiovascular disease: a prospective cohort study from the CLHLS

Abstract

Aims To examine the associations of overall plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI) with all-cause mortality among older Chinese adults with cardiovascular disease using data from the China Longitudinal Healthy Longevity Survey (CLHLS). Methods and results We analyzed 1,526 participants aged 65 years or older from the 2008 wave of the CLHLS cardiovascular disease population, with mortality follow-up through 2019 (heart disease without stroke: n = 856; cerebrovascular disease without heart disease: n = 480; both: n = 190). Dietary intake was assessed using a food frequency questionnaire and converted into PDI, hPDI, and uPDI. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. The proportional hazards assumption was evaluated using Schoenfeld residuals, and dose-response relationships were examined using restricted cubic splines. Conclusion Among older Chinese adults with cardiovascular disease, greater adherence to an overall plant-based dietary pattern was associated with lower all-cause mortality, whereas greater adherence to an unhealthy plant-based dietary pattern was associated with higher mortality.