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Cited by 993Nutritional Studies and DietAgriculture Sustainability and Environmental ImpactCardiovascular Health and Risk Factors

Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults

Open access
Satija, Ambika, Bhupathiraju, Shilpa N., Spiegelman, Donna, Chiuve, Stephanie E., Manson, JoAnn E., Willett, Walter, Rexrode, Kathryn M., Rimm, Eric B. +1 more·2017·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2017.05.047PMC PMC5555375
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Abstract

Background Plant-based diets are recommended for coronary heart disease (CHD) prevention. However, not all plant foods are necessarily beneficial for health. Objectives To examine associations between plant-based diet indices and CHD incidence. Methods We included 73,710 women in Nurses’ Health Study (NHS) (1984–2012), 92,329 women in NHS2 (1991–2013), and 43,259 men in Health Professionals Follow-up Study (1986–2012), free of chronic diseases at baseline. We created an overall plant-based diet index (PDI) from repeated semi quantitative food-frequency questionnaire data, by assigning positive scores to plant foods and reverse scores to animal foods. We also created a healthful PDI (hPDI) where healthy plant foods (whole grains, fruits/vegetables, nuts/legumes, oils, tea/coffee) received positive scores, while less-healthy plant foods (juices/sweetened beverages, refined grains, potatoes/fries, sweets) and animal foods received reverse scores. To create an unhealthful PDI (uPDI), we gave positive scores to less-healthy plant foods and reverse scores to animal and healthy plant foods. Results Over 4,833,042 person-years of follow-up, we documented 8,631 incident CHD cases. In pooled multivariable analysis, higher adherence to PDI was independently inversely associated with CHD (HR comparing extreme deciles: 0.92, 95% CI: 0.83–1.01; p trend=0.003). This inverse association was stronger for hDPI (HR: 0.75, 95% CI: 0.68–0.83; p trend<0.001). Conversely, uPDI was positively associated with CHD (HR: 1.32, 95% CI: 1.20–1.46; p trend<0.001). Conclusions Higher intake of a plant-based diet index rich in healthier plant foods is associated with substantially lower CHD risk, while a plant-based diet index that emphasizes less-healthy plant foods is associated with higher CHD risk.

AI snapshot

Written from the paper’s full text.

TL;DR

In three large US prospective cohorts, greater adherence to an overall plant-based diet index was modestly associated with lower coronary heart disease (CHD) risk, but the association depended on plant food quality. A healthful plant-based diet index was associated with substantially lower CHD risk, whereas an unhealthful plant-based diet index was associated with higher CHD risk.

Key findings

  • Over 4,833,042 person-years of follow-up, 8,631 incident CHD cases occurred.
  • Higher overall plant-based diet index (PDI) adherence was modestly inversely associated with CHD: HR comparing extreme deciles 0.92 (95% CI 0.83–1.01); p trend=0.003.
  • Higher healthful plant-based diet index (hPDI) adherence was more strongly inversely associated with CHD: HR comparing extreme deciles 0.75 (95% CI 0.68–0.83); p trend<0.001.
  • Higher unhealthful plant-based diet index (uPDI) adherence was positively associated with CHD: HR comparing extreme deciles 1.32 (95% CI 1.20–1.46); p trend<0.001.

Methods

  • Prospective cohort analysis including 73,710 women in Nurses’ Health Study, 92,320 women in NHS2, and 43,259 men in Health Professionals Follow-up Study, free of chronic diseases at baseline.
  • Diet was assessed with repeated semi-quantitative food-frequency questionnaires; three indices were created by assigning positive or reverse scores to 18 food groups: PDI, hPDI, and uPDI.
  • Cox proportional-hazards regression estimated hazard ratios for CHD by deciles of each index, with cumulative averaging of diet over follow-up; cohort-specific results were pooled using a fixed effects model.

Limitations

  • The paper states that measurement error in diet assessment is likely, although cumulative averaging reduces random errors; residual and unmeasured confounding are possible in this observational study, and modest effect sizes such as those for PDI should be interpreted with caution.
  • Evident from the text: the study is observational, so causality cannot be established; diet and covariates were largely self-reported.
  • Evident from the text: participants were US health professionals, which may limit generalizability to other populations.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jacc.2017.05.047

Cites

36 of 36 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 58 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The results were largely unchanged upon red meat adjustment (pooled HRs: PDI 0.93, 95% CI 0.84-1.03; hPDI 0.76, 95% CI 0.68-0.84; uPDI 1.32, 95% CI 1.19-1.46).

    “The results were largely unchanged upon red meat adjustment: [pooled HR for extreme deciles of (PDI, 0.93; 95% CI, 0.84–1.03; p trend=0.01) (hPDI, 0.76; 95% CI, 0.68, 0.84; p trend<0.001) (uPDI, 1.32; 95% CI, 1.19, 1.46; p trend<0.001)]”
    Quote in the paperSubstantial claim
  • Findingown data

    In the same three US cohorts, the inverse association with CHD incidence was stronger for the healthful plant-based diet index (hPDI) (HR comparing extreme deciles: 0.75, 95% CI: 0.68-0.83; p trend<0.001).

    “This inverse association was stronger for hDPI (HR: 0.75, 95% CI: 0.68–0.83; p trend<0.001).”
    • Also stated in: § Results · plain
      “we found a stronger inverse association between hPDI and CHD incidence (HR comparing extreme deciles: 0.75, 95% CI: 0.68–0.83; HR per 10-unit increase: 0.88, 95% CI: 0.85–0.91; p trend<0.001)”
    • Also stated in: § Discussion · boosted
      “This inverse association was considerably stronger for adherence to a healthier version (hPDI) [0.75 (0.68–0.83)]”
    Quote in the paperSubstantial claim
  • Findingown data

    Associations of both hPDI and uPDI with CHD were significantly stronger among more active relative to less active participants (p interaction=0.002 for both).

    “Associations of both indices were significantly stronger among more active relative to less active participants (p interaction=0.002 for both);”
    Quote in the paperNot a substantial claim
  • Findingown data

    The association of uPDI with CHD was non-linear (p for test of curvature=0.01; p for non-linear association<0.001).

    “The association of uPDI with CHD was non-linear (p for test of curvature=0.01; p for non-linear association<0.001) (Central Illustration panel A and Online Figure 1).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Modifying hPDI to score fish intake positively yielded similar results (pooled HR for extreme deciles: 0.74, 95% CI: 0.67-0.81; p trend<0.001).

    “Given the previously observed inverse association between fish intake and CHD,(23) we modified hPDI to score fish intake positively, and found similar results (pooled HR for extreme deciles, 0.74; 95% CI, 0.67–0.81; p trend<0.001).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 14
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 14

  • May combine two claims.

    Findingown data

    When the three food categories were entered together in place of the indices, healthy plant foods were inversely associated with CHD, while animal foods and less healthy plant foods were positively associated with CHD.

    “When, in place of the indices, we entered variables for the three food categories together into the fully adjusted model, we found an inverse association for healthy plant foods, and positive associations for animal foods and less healthy plant foods (Central Illustration panel B and Online Table 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was no evidence of deviation from linearity for PDI and hPDI (p for test of curvature>0.20 for both; p for linearity=0.001 for PDI, and <0.001 for hPDI).

    “We found no evidence of deviation from linearity for PDI and hPDI (p for test of curvature>0.20 for both; p for linearity=0.001 for PDI, and <0.001 for hPDI).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    With SSB adjustment, the results changed in expected directions (pooled HRs: PDI 0.90, 95% CI 0.81-0.99; hPDI 0.79, 95% CI 0.71-0.88; uPDI 1.22, 95% CI 1.10-1.36).

    “and changed in expected directions with SSB adjustment [pooled HR for extreme deciles of (PDI, 0.90; 95% CI, 0.81–0.99; p trend=0.001) (hPDI, 0.79; 95% CI, 0.71, 0.88; p trend<0.001) (uPDI, 1.22; 95% CI, 1.10, 1.36; p trend=0.005)]”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Adjustment for additional potential intermediates (updated history of hypertension, hypercholesterolemia, and diabetes instead of baseline history) slightly attenuated associations of hPDI and uPDI with CHD (pooled HRs: PDI 0.92, 95% CI 0.83-1.02; hPDI 0.80, 95% CI 0.73-0.89; uPDI 1.24, 95% CI 1.12-1.37; proportion explained by intermediates 9.5% in NHS to 4.9% in HPFS).

    “Adjustment for additional potential intermediates in the causal pathway, (updated history of hypertension, hypercholesterolemia, and diabetes instead of baseline history) slightly attenuated associations of hPDI and uPDI with CHD [pooled HR for extreme deciles of (PDI, 0.92; 95% CI, 0.83–1.02; p trend=0.003) (hPDI, 0.80; 95% CI, 0.73–0.89; p trend<0.001) (uPDI, 1.24; 95% CI, 1.12, 1.37; p trend=0.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    When the plant-based diet indices were created with quintiles of energy-adjusted food groups instead of unadjusted food groups, the association of PDI with CHD became slightly stronger, but that of uPDI with CHD was slightly attenuated.

    “When we created the plant-based diet indices with quintiles of energy-adjusted food groups (instead of with quintiles of unadjusted food groups as we had originally done), the association of PDI with CHD became slightly stronger, but that of uPDI with CHD was slightly attenuated (Online Table 4).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When the three food categories were examined, less healthy plant foods and animal foods were both associated with increased CHD risk, with a potentially stronger association for less healthy plant foods.

    “When we examined associations of the three food categories with CHD risk, less healthy plant foods and animal foods were both associated with increased risk, with a potentially stronger association for less healthy plant foods.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    These dietary factors could aid in weight loss/maintenance, enhance glycemic control and insulin regulation, improve lipid profile, reduce blood pressure, improve vascular health, decrease inflammation, and foster more favorable diet-gut microbiome interactions, thereby lowering CHD risk.

    “all of which could aid in weight loss/maintenance, enhance glycemic control and insulin regulation, improve lipid profile, reduce blood pressure, improve vascular health, decrease inflammation, and foster more favorable diet- gut microbiome interactions (e.g. through lowered levels of trimethylamine N-oxide), thereby lowering CHD risk.”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [2] McEvoy, 2012, Vegetarian diets, low-meat diets and health: a review, Public Health Nutr source

      Not checked in the free run.

    • cites [24] Jenkins, 2003, Type 2 diabetes and the vegetarian diet, Am J Clin Nutr source

      Not checked in the free run.

    • cites [25] Hu, 2003, Plant-based foods and prevention of cardiovascular disease: an overview, Am J Clin Nutr source

      Not checked in the free run.

    • cites [26] Jenkins, 2003, Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein, JAMA source

      Not checked in the free run.

    • cites [27] Levine, 2014, Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population, Cell Metab source

      Not checked in the free run.

    • cites [28] Salonen, 1992, High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men, Circulation source

      Not checked in the free run.

    • cites [29] Hunnicutt, 2014, Dietary iron intake and body iron stores are associated with risk of coronary heart disease in a meta-analysis of prospective cohort studies, J Nutr

      Not checked in the free run.

    • cites [30] Tang, 2013, Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk, N Engl J Med source

      Not checked in the free run.

    • cites [31] Baer, 2011, Risk factors for mortality in the Nurses’ Health Study: a competing risks analysis, Am J Epidemiol source

      Not checked in the free run.

    • cites [32] Song, 2016, Association of animal and plant protein intake with all-cause and cause-specific mortality, JAMA Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    There is wide variation in nutritional quality of plant foods, making it crucial to consider the quality of plant foods consumed in plant-rich diets.

    “This highlights the wide variation in nutritional quality of plant foods, making it crucial to consider the quality of plant foods consumed in plant-rich diets.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Dietary recommendations based on the hPDI would also be environmentally sustainable, as plant-based food systems use fewer resources than food systems that are heavily reliant on animal foods.

    “Dietary recommendations based on the hPDI would also be environmentally sustainable, as plant-based food systems use fewer resources than food systems that are heavily reliant on animal foods.(34)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Pimentel, 2003, Sustainability of meat-based and plant-based diets and the environment, Am J Clin Nutr source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The results of this study are in line with the 2015 Dietary Guidelines for Americans, which recommends higher consumption of high quality plant foods.

    “The results of this study are in line with the recently released 2015 Dietary Guidelines for Americans,(33) which recommends higher consumption of high quality plant foods.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans 2015. Available at: http://health.gov/dietaryguidelines/2015/guidelines/. Accessed June 10, 2017.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Greater adherence to hPDI leads to diets high in dietary fiber, antioxidants, unsaturated fat, and micronutrient content, and low in saturated fat and heme iron content.

    “Specifically, greater adherence to hPDI would lead to diets high in dietary fiber, antioxidants, unsaturated fat, and micronutrient content, and low in saturated fat and heme iron content (Online Table 1), all of which could aid in weight loss/maintenance, enhance glycemic control and insulin regulation, improve lipid profile, reduce blood pressure, improve vascular health, decrease inflammation,”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Greater adherence to uPDI leads to diets with higher glycemic load and index, and added sugar, and lower levels of dietary fiber, unsaturated fats, micronutrients, and antioxidants, which could result in higher CHD risk through the above-mentioned pathways.

    “Greater adherence to uPDI, on the other hand, leads to diets with higher glycemic load and index, and added sugar, and lower levels of dietary fiber, unsaturated fats, micronutrients, and antioxidants, which could result in higher CHD risk through the above-mentioned pathways.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The proportional hazards assumption was tested by including interaction terms between the indices, and age and calendar year.

    “The proportional hazards assumption was tested by including interaction terms between the indices, and age and calendar year.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Plant-based diets have been associated with a lower risk of various diseases, including coronary heart disease.

    “Plant-based diets have been associated with a lower risk of various diseases,(1–3) including coronary heart disease (CHD),(4–9) the leading global cause of death.(10)”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [1] Fraser, 2009, Vegetarian diets: what do we know of their effects on common chronic diseases?, Am J Clin Nutr source

      Not checked in the free run.

    • cites [2] McEvoy, 2012, Vegetarian diets, low-meat diets and health: a review, Public Health Nutr source

      Not checked in the free run.

    • cites [3] Martinez-Gonzalez, 2014, A provegetarian food pattern and reduction in total mortality in the Prevencion con Dieta Mediterranea (PREDIMED) study, Am J Clin Nutr source

      Not checked in the free run.

    • cites [4] Huang, 2012, Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review, Ann Nutr Metab source

      Not checked in the free run.

    • cites [5] Key, 1999, Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies, Am J Clin Nutr source

      Not checked in the free run.

    • cites [6] Kwok, 2014, Vegetarian diet, Seventh Day Adventists and risk of cardiovascular mortality: a systematic review and meta-analysis, Int J Cardiol source

      Not checked in the free run.

    • cites [7] Orlich, 2013, Vegetarian dietary patterns and mortality in Adventist Health Study 2, JAMA Internal Med source

      Not checked in the free run.

    • cites [8] Crowe, 2013, Am J Clin Nutr source

      Not checked in the free run.

    • cites [9] Fraser, 1995, Effect of risk factor values on lifetime risk of and age at first coronary event: the Adventist Health Study, Am J Epidemiol source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    CHD cases were confirmed through blinded review by study physicians.

    “Participants self-reporting newly diagnosed CHD on the biennial questionnaires were asked permission to access their medical records to confirm diagnosis, which was done through blinded review by study physicians.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The plant-based diet indices were cumulatively averaged over follow-up to better capture long-term diet.

    “Indices were cumulatively averaged over follow-up to better capture long-term diet; for instance, for the 2001–2003 risk set, plant-based diet index scores in 1991, 1995, and 1999 were averaged to predict CHD risk”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Fish intake is inversely associated with CHD.

    “Given the previously observed inverse association between fish intake and CHD,(23) we modified hPDI to score fish intake positively, and found similar results”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Zheng, 2012, Fish consumption and CHD mortality: an updated meta-analysis of seventeen cohort studies, Public Health Nutr source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Diet updating was stopped upon diagnosis of type 2 diabetes, stroke, or cancer because these conditions could change diet and be associated with underlying CHD risk.

    “Because diagnosis of conditions such as type 2 diabetes, stroke, and cancer could change an individual’s diet and potentially be associated with the underlying risk of CHD, we stopped updating diet upon diagnosis of these conditions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    Measurement error in diet assessment is likely, although evaluating cumulatively averaged intake reduces random errors.

    “However, measurement error in diet assessment is likely, although evaluating cumulatively averaged intake reduces random errors(17) while allowing for the examination of long-term dietary intake.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Willett, 2013

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Prior studies have defined plant-based diets as vegetarian diets, which exclude some or all animal foods.

    “With the exception of a recent investigation,(3) prior studies(4–9) have defined plant-based diets as ‘vegetarian’ diets, which constitute a family of dietary patterns that exclude some or all animal foods.”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [4] Huang, 2012, Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review, Ann Nutr Metab source

      Not checked in the free run.

    • cites [5] Key, 1999, Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies, Am J Clin Nutr source

      Not checked in the free run.

    • cites [6] Kwok, 2014, Vegetarian diet, Seventh Day Adventists and risk of cardiovascular mortality: a systematic review and meta-analysis, Int J Cardiol source

      Not checked in the free run.

    • cites [7] Orlich, 2013, Vegetarian dietary patterns and mortality in Adventist Health Study 2, JAMA Internal Med source

      Not checked in the free run.

    • cites [8] Crowe, 2013, Am J Clin Nutr source

      Not checked in the free run.

    • cites [9] Fraser, 1995, Effect of risk factor values on lifetime risk of and age at first coronary event: the Adventist Health Study, Am J Epidemiol source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The analysis adjusted for time-varying covariates including smoking status, alcohol intake, physical activity, CHD family history, multivitamin use, aspirin use, energy intake, margarine intake, BMI, postmenopausal status and hormone use, and oral contraceptive use.

    “We adjusted for time-varying covariates including smoking status, alcohol intake, physical activity, CHD family history, multivitamin use, aspirin use, energy intake, margarine intake, body mass index (BMI), postmenopausal status and hormone use (women), and oral contraceptive use (NHS2).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The 2015 Dietary Guidelines for Americans recommends higher consumption of high quality plant foods.

    “The results of this study are in line with the recently released 2015 Dietary Guidelines for Americans,(33) which recommends higher consumption of high quality plant foods.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans 2015. Available at: http://health.gov/dietaryguidelines/2015/guidelines/. Accessed June 10, 2017.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In three US cohorts, the PDI was previously found to be inversely associated with type 2 diabetes risk, with a stronger inverse association for hPDI and a positive association for uPDI.

    “In three US cohorts, we previously documented that the PDI was inversely associated with type 2 diabetes risk with a stronger inverse association for hPDI, and a positive association for uPDI(14).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Satija, 2016, Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: results from Three Prospective Cohort Studies, PLoS Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    The analysis was carried out separately for each cohort and combined using a fixed effects model; heterogeneity was examined using the Cochrane Q statistic and the I2 statistic.

    “The analysis was carried out separately for each cohort, and combined using a fixed effects model; heterogeneity was examined using the Cochrane Q statistic(21) and the I2 statistic.(22)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [21] Cochran, 1954, The combination of estimates from different experiments, Biometrics source

      Not checked in the free run.

    • cites [22] Higgins, 2003, Measuring inconsistency in meta-analyses, BMJ source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The analysis additionally adjusted for baseline self-reported hypertension, hypercholesterolemia, and diabetes.

    “We additionally adjusted for baseline self-reported hypertension, hypercholesterolemia, and diabetes.”
    Quote in the paperSubstantial claim
25 of 25

  • The paper relies on this without support.

    Recommendations based on incremental dietary changes are easier to adopt.

    “As recommendations based on incremental dietary changes are easier to adopt, it is important to understand how gradual reductions in animal food intake with concomitant increases in consumption of plant foods affect cardiovascular health.”

  • The paper relies on this without support.

    CHD has a long etiologic period.

    “However, these studies have examined plant-based diets at a single time point, making it difficult to fully capture the association of a time-varying exposure such as diet on the development of CHD which has a long etiologic period.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A poorly formulated vegan diet can include low-quality plant foods, such as refined carbohydrates and added sugars.

    “In addition, a poorly formulated vegan diet can include low-quality plant foods, such as refined carbohydrates and added sugars.22”

    From Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial (2023) · cites this paper as [22]

  • Excluding all meats and/or dairy products may not be necessary because research suggests that cardiovascular benefits can be achieved with modest reductions in animal foods and increases in healthy plant-based foods compared with typical diets.

    “Although our findings suggest that vegan diets offer a protective cardiometabolic advantage compared with a healthy, omnivorous diet, excluding all meats and/or dairy products may not be necessary because research22,50 suggests that cardiovascular benefits can be achieved with modest reductions in animal foods and increases in healthy plant-based foods compared with typical diets.”

    From Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial (2023) · cites this paper as [22]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • NHS2 sample size differs between abstract and Methods

    Minor

    The abstract reports 92,329 NHS2 participants, while the Methods report 92,320.

  • Animal-food intake is assigned to opposite PDI deciles

    Minor

    The Results assign 5-6 daily servings of animal foods to the highest decile and 3-4 to the lowest. The Discussion instead assigns 5-6 servings to the lowest PDI decile and 3 to the highest.

2 of 2

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Authors
Satija, A., Bhupathiraju, S. N., Spiegelman, D., Chiuve, S. E., Manson, J. E., Willett, W., Rexrode, K. M., Rimm, E. B., & Hu, F. B.
Affiliations
  • Harvard University (US)
  • Brigham and Women's Hospital (US)
Corresponding author
Satija, Ambika
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2017-07
Volume
70
Issue
4
Pages
411-422
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2017.05.047
PMC
PMC5555375
OpenAlex
W2735659721
Semantic Scholar
8da1730e179d8b18025a96b300c15dfac3a7f532
Cited by
991
References
36
Citations by year
2026: 107 · 2025: 146 · 2024: 157 · 2023: 133 · 2022: 119 · 2021: 118 · 2020: 110 · 2019: 57 · 2018: 38 · 2017: 6
FWCI
54.18
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Department of Agriculture
  • National Institutes of Health (UM1-CA-176726, UM1-CA167552, CA176726, CA-167552, CA186107)
  • National Heart, Lung, and Blood Institute (R01HL060712, R01HL035464, R01HL034594)
  • National Cancer Institute (UM1CA176726, UM1CA186107, UM1CA167552)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
plant-based diet, coronary artery disease, whole grains, fruits and vegetables, legumes and nuts, refined grains, sweetened beverages, animal food, Nurses' Health Study, Health Professionals Follow-up Study, dietary adherence, cardiovascular disease prevention, dietary quality assessment, food frequency questionnaire
MeSH terms
Adult, Aged, Coronary Disease, Female, Follow-Up Studies, Forecasting, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, United States, Diet, Vegetarian, Incidence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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