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Original research
Association between plant-based diets and blood pressure in the INTERMAP study
  1. Ghadeer Aljuraiban1,2,
  2. Queenie Chan2,3,
  3. Rachel Gibson2,4,
  4. Jeremiah Stamler5,
  5. Martha L Daviglus6,
  6. Alan R Dyer5,
  7. Katsuyuki Miura7,
  8. Yangfeng Wu8,
  9. Hirotsugu Ueshima7,
  10. Liancheng Zhao9,
  11. Linda Van Horn5,
  12. Paul Elliott2,3 and
  13. Linda M Oude Griep2,10
  14. for the INTERMAP Research Group
  1. 1Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
  2. 2Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
  3. 3MRC Centre for Environment and Health, Imperial Biomedical Research Centre, Imperial College London, London, UK
  4. 4Department of Nutritional Sciences, King's College London, London, UK
  5. 5Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  6. 6College of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
  7. 7Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
  8. 8Clinical Research Institute and School of Public Health, Peking University, Beijing, Beijing, China
  9. 9Division 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. 10NIHR Biomedical Research Centre, Diet, Anthropometry, and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
  1. Correspondence to Ghadeer Aljuraiban, Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; galjuraiban{at}ksu.edu.sa

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.

  • blood pressure lowering
  • dietary patterns
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjnph-2020-000077

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    Footnotes

    • Contributors ARD, HU, JS, KM, LZ and PE designed the INTERMAP, conducted the fieldwork and collected data; GA and LMOG performed the analysis, interpreted the data and prepared the manuscript; HU, JS, KM, LVH, LZ, MLD, QC, PE, RG and YW revised the work critically for important intellectual content; GA and LMOG were responsible for final content and all authors: read and approved the final manuscript.

    • Funding INTERMAP was supported by grants R01-HL50490, R01-HL65461, R01-HL84228 and R01-HL135486 from the National Heart, Lung, and Blood Institute, NIH (Bethesda, MD, USA) and by the Ministry of Education, Culture, Sports, Science, and Technology of Japan (Grant-in-Aid for Scientific Research [A], No. 090357003 and No. 17H01553) and the UK (a project grant from the West Midlands National Health Service Research and Development, and grant R2019EPH from the Chest, Heart and Stroke Association). PE is Director of the MRC Centre for Environment and Health and acknowledges support from the Medical Research Council (MR/S019669/1). LOG is supported by the NIHR Cambridge Biomedical Research Centre (IS-BRC-1215–20014).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Approved by St. Mary’s Research Ethics Committee, REC reference number: EC3169. INTERMAP was approved by the Institutional Review Board of Northwestern University (STU00204462-CR0002) and the Research Ethics Committee of the Health Research Authority (UK, #EC3169).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.