The DOI matches its Crossref record; 36 of the 36 references it cites were found in a registry or an index; none of the 58 sources its claims cite is checked for support yet.
Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults
Open accessAbstract
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.
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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.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)]”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
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In the paper
“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)]”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Abstract > Results
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In the paper
“Associations of both indices were significantly stronger among more active relative to less active participants (p interaction=0.002 for both);”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
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In the paper
“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).”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The results were slightly attenuated when we modified hPDI to score healthy animal foods positively (dairy except ice cream, egg, and fish) (HR comparing extreme deciles: 0.78, 95% CI: 0.71–0.86; HR per 10-unit increase: 0.91, 95% CI: 0.89–0.94; p trend<0.001).”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the association of uPDI with CHD was slightly stronger among ever smokers compared with never smokers (p interaction=0.04).”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“HR per 10-unit increase: 0.93, 95% CI: 0.90–0.97”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“HR per 10-unit increase: 0.88, 95% CI: 0.85–0.91”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The associations of hPDI and uPDI with risk of CHD were consistently observed across strata defined by age, BMI, family history of CHD, and sex (Figure 1).”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
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- It may state two separate claims as one. 14
- The quote only partly states this claim. 1
- Probably not a substantial claim. 14
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
Strength:plain· not yet calibratedn = 8,631Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)]”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results > Sensitivity analyses
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
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In the paper
“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).”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results > Sensitivity analyses
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Discussion
What the sources say
- Not checked yetcites [2] McEvoy, 2012, Vegetarian diets, low-meat diets and health: a review, Public Health Nutr source
- Not checked yetcites [24] Jenkins, 2003, Type 2 diabetes and the vegetarian diet, Am J Clin Nutr source
- Not checked yetcites [25] Hu, 2003, Plant-based foods and prevention of cardiovascular disease: an overview, Am J Clin Nutr source
- Not checked yetcites [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 yetcites [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 yetcites [28] Salonen, 1992, High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men, Circulation source
- Not checked yetcites [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 yetcites [30] Tang, 2013, Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk, N Engl J Med source
- Not checked yetcites [31] Baer, 2011, Risk factors for mortality in the Nurses’ Health Study: a competing risks analysis, Am J Epidemiol source
- Not checked yetcites [32] Song, 2016, Association of animal and plant protein intake with all-cause and cause-specific mortality, JAMA Intern Med source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Discussion
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In the paper
“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)”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Discussion
What the sources say
- Not checked yetcites [34] Pimentel, 2003, Sustainability of meat-based and plant-based diets and the environment, Am J Clin Nutr source
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Discussion
What the sources say
- Not checked yetcites [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.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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,”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Discussion
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In the paper
“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.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Discussion
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In the paper
“The proportional hazards assumption was tested by including interaction terms between the indices, and age and calendar year.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Methods > Statistical analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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)”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Introduction
What the sources say
- Not checked yetcites [1] Fraser, 2009, Vegetarian diets: what do we know of their effects on common chronic diseases?, Am J Clin Nutr source
- Not checked yetcites [2] McEvoy, 2012, Vegetarian diets, low-meat diets and health: a review, Public Health Nutr source
- Not checked yetcites [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 yetcites [4] Huang, 2012, Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review, Ann Nutr Metab source
- Not checked yetcites [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 yetcites [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 yetcites [7] Orlich, 2013, Vegetarian dietary patterns and mortality in Adventist Health Study 2, JAMA Internal Med source
- Not checked yetcites [8] Crowe, 2013, Am J Clin Nutr source
- Not checked yetcites [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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Methods > Outcome ascertainment
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Methods > Statistical analysis
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In the paper
“Given the previously observed inverse association between fish intake and CHD,(23) we modified hPDI to score fish intake positively, and found similar results”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Results
What the sources say
- Not checked yetcites [23] Zheng, 2012, Fish consumption and CHD mortality: an updated meta-analysis of seventeen cohort studies, Public Health Nutr source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Methods > Statistical analysis
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“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.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Discussion > Potential study limitations
What the sources say
- Not checked yetcites [17] Willett, 2013
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Introduction
What the sources say
- Not checked yetcites [4] Huang, 2012, Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review, Ann Nutr Metab source
- Not checked yetcites [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 yetcites [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 yetcites [7] Orlich, 2013, Vegetarian dietary patterns and mortality in Adventist Health Study 2, JAMA Internal Med source
- Not checked yetcites [8] Crowe, 2013, Am J Clin Nutr source
- Not checked yetcites [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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Methods > Statistical analysis
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“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.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Discussion
What the sources say
- Not checked yetcites [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.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Introduction
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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)”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Methods > Statistical analysis
What the sources say
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We additionally adjusted for baseline self-reported hypertension, hypercholesterolemia, and diabetes.”
§ Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults > Methods > Statistical analysis
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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.”
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In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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
MinorThe abstract reports 92,329 NHS2 participants, while the Methods report 92,320.
“92,329 women in NHS2 (1991–2013)”
“92,320 women in NHS2”
Animal-food intake is assigned to opposite PDI deciles
MinorThe 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.
“Animal food intake ranged from 5–6 servings/day in the highest decile to 3–4 servings/day in the lowest decile of the indices.”
“those in the lowest decile of PDI consumed 5–6 servings of animal foods per day, while those in the highest decile consumed 3 servings of animal foods per day.”
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Feedlot diet for Americans that results from a misspecified optimization algorithm
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Metadata
- 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)
- 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
- bronze
- doi.org
- 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.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
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