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Quality of plant-based diets and risk of hypertension: a Korean genome and examination study

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Abstract

Background and aims

Plant-based diets have been suggested to have beneficial effects on various health outcomes. However, the evidence on the association of plant-based diet quality with health outcomes is very limited in Asian populations, who may have a different dietary pattern than western populations. This study explored the prospective association between different types of plant-based diets and risk of hypertension using recently established indices in South Koreans.

Methods

Analyses were based on a community-based cohort of 5636 men and women (40–69 years of age at baseline, mean ± SD 50.6 ± 8.5 years) living in Ansan and Ansung, South Korea (2001–2016) without hypertension and related chronic diseases at baseline. Registration card and telephone registration number were used for the sampling. Dietary intakes were assessed using a validated food frequency questionnaire. Based on the questionnaire, scores of three plant-based diet indices [overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI)] were calculated.

Results

Over a follow-up of 14 years, 2244 participants developed hypertension. Individuals in the highest vs. lowest quintile of hPDI had 35% lower incidence of hypertension [hazard ratio (HR) 0.65, 95% CI 0.57, 0.75] and uPDI had 44% higher incidence of hypertension (HR 1.44, 95% CI 1.24, 1.67), adjusting for demographic characteristics, and lifestyle factors (P trend ≤ 0.0001 for both indices). A similar inverse association of hPDI was observed with risk of hypertension by age, sex, residence area, and obesity. The PDI was not associated with hypertension.

Conclusions

Our results highlight the importance of considering the quality of plant foods (relatively higher healthy plant foods and relatively lower less healthy plant foods consumption) for the prevention of hypertension in a population with a long-term adherence to predominantly plant-based diets.

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Abbreviations

BMI:

Body mass index

CVD:

Cardiovascular disease

DBP:

Diastolic blood pressure

FFQ:

Food frequency questionnaire

hPDI:

Healthful plant-based diet index

HR:

Hazard ratio

KoGES:

Korean Genome and Epidemiology Study

MET:

Metabolic equivalent of task

PDI:

Overall plant-based diet index

SBP:

Systolic blood pressure

SD:

Standard deviation

uPDI:

Unhealthful plant-based diet index

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Acknowledgements

Data used in this study were obtained from the Korean Genome and Epidemiology Study (KoGES; 4851-302), National Research Institute of Health, Centers for Disease Control and Prevention, Ministry for Health and Welfare, Republic of Korea. We would like to thank the study participants and staff.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government(Ministry of Science and ICT) (No. 2021R1A2C1003211, to JK). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Gyeonggi-do, 17104, South Korea

    Jihye Kim

  2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Hyunju Kim

  3. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA

    Hyunju Kim

  4. Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health and Harvard Medical School, Boston, MA, USA

    Edward L. Giovannucci

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  1. Jihye Kim
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  3. Edward L. Giovannucci
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Contributions

JK designed the study, analyzed the data and wrote first draft of the manuscript. HK was involved in research methodology and revising manuscript. EG was involved in designing study and revising the manuscript. All authors critically reviewed and approved the final manuscript. None of the authors declare a financial or personal conflict of interest related to this work. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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Correspondence to Jihye Kim.

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Kim, J., Kim, H. & Giovannucci, E.L. Quality of plant-based diets and risk of hypertension: a Korean genome and examination study. Eur J Nutr 60, 3841–3851 (2021). https://doi.org/10.1007/s00394-021-02559-3

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