Journal Article

Healthful plant-based diet and incidence of hypertension in Brazilian adults: A six-year follow-up of the CUME study

Hermsdorff, Helen Hermana Miranda, Juvanhol, Leidjaira Lopes, Pimenta, Adriano Marçal, Bressan, Josefina, da Silva, Fernanda Maria Oliveira

2025

Overview

Studies demonstrate that consuming plant-based diets has beneficial effects on several health outcomes. However, the evaluation of the healthiness of plant-based diets and the incidence of hypertension has still been little explored in the literature. Objectives: Thus, this study aimed to evaluate the association between plant-based diet indices and the incidence of hypertension in Brazilian adults and test whether the interaction between hPDI, sociodemographic, and lifestyle variables modifies this association. Methods: This longitudinal study included 3192 (F = 2125, average age 34 years) participants from the Cohort of Universities of Minas Gerais (CUME Study, Brazil, 2016-2022). Dietary intakes were assessed using a validated food frequency questionnaire. We measured three plant-based diet indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). Participants were classified as new cases of hypertension if they were free of this disease at baseline, had a systolic blood pressure ≥ 140 mmHg, a diastolic blood pressure ≥90 mmHg, were using antihypertensive medications, or had a diagnosis of hypertension by a physician in at least one of the follow-ups. Crude and adjusted Cox regression models were used to evaluate the relationship between plant-based diet indices and hypertension incidence and a multiplicative interaction was tested. Results: The incidence of hypertension was 19,8/1000 person-years total. The mean follow-up time was 3.36 years. There was an inverse association between the highest quintiles of hPDI (HR = 0.56, 95% CI = 0.37–0.86; HR = 0.55, 95% CI = 0.35–0.88) and hypertension. In subgroup analysis, inverse associations between hPDI and hypertension risk were stronger in participants who were insufficiently active and overweight (p-interaction < 0.05). Conclusion: Greater consumption of healthful plant foods, reduced consumption of animal-source foods, and less consumption of unhealthful plant foods are important for hypertension prevention in the Brazilian population. •Adherence to a healthy plant-based diet is associated with a lower risk of hypertension.•It involves greater consumption of whole grains, fruits, vegetables, nuts and legumes.•Implies lower consumption of fruit juices, refined grains, potatoes, sugary drinks, and sweets.•It implies less consumption of all foods of animal origin.•Insufficiently active or overweight individuals may be more likely to benefit from its consumption.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Adults / Animal-based foods / Antihypertensives / Beverages / Blood pressure / Brazil - epidemiology / Chronic illnesses / Dairy products / Data collection / Desserts / Diet / Diet, Healthy - methods / Diet, Healthy - statistics & numerical data / Diet, Plant-Based / Diet, Vegetarian - statistics & numerical data / Evaluation / Female / Follow-Up Studies / Food consumption / Food intake / Food sources / Grain / Healthful plant-based diet index / Humans / Hypertension / Hypertension - epidemiology / Hypertension - prevention & control / Incidence / Legumes / Life Style / Lifestyles / Longitudinal Studies / Male / Middle Aged / plant-based diet / Plant-based foods / Questionnaires / Registration / Regression analysis / Regression models / Risk Factors / Sociodemographics / Software / Subgroups / Variables