| Title: | Plant-based diet quality, fat mass, and cardiovascular disease: A mediation analysis of mid-aged adults in the UK Biobank |
| Journal: | European Journal of Clinical Nutrition |
| Published: | 1 Apr 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41922530/ |
| DOI: | https://doi.org/10.1038/s41430-026-01731-4 |
| URL: | https://www.nature.com/articles/s41430-026-01731-4.pdf |
Publication 18145
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Abstract
Background/objectivesEvidence supports plant-based diets for preventing cardiovascular diseases (CVD). Fat mass is a strong predictor of CVD, however it is unclear whether this mediates the relationship between plant-based diets and CVD. Thus, this study aimed to determine if longitudinal associations between plant-based diet quality indices and incidence of CVD events, CVD mortality and all-cause mortality were mediated by fat mass in mid-aged adults.Subjects/methodsDietary data (Oxford WebQ) from 14,233 adults from the UK Biobank were used to calculate adherence to three plant-based diet quality indices: an overall plant-based diet (PDI), a healthy plant-based diet (hPDI), and a less healthy plant-based diet (uPDI). Dual X-ray absorptiometry measured percentage fat mass. Cox proportional hazard ratios (95% CI) identified associations between the indices and CVD events, CVD mortality or all-cause mortality, and mediation analyses determined overall, direct, and indirect effects of fat mass.ResultsThe PDI and hPDI were inversely associated with fat mass, and the uPDI was positively associated (p < 0.001). In several models, fat mass was associated with CVD events, CVD mortality, and all-cause mortality after controlling for the plant-based diet quality indices. No association was found between the indices and health outcomes, with (direct effect) or without (total effect) the fat mass mediator (p ≥ 0.1). In several models there was a significant negative indirect effect for the PDI or hPDI on CVD events or CVD mortality via the fat mass mediator, and a significant positive indirect effect for the uPDI on CVD events and CVD mortality.ConclusionsNo evidence was found for an association between the plant-based diet quality indices on the outcomes without, as well as after accounting for fat mass. However, the significant indirect effects found suggest that fat mass may be a key mechanism linking plant-based diets to CVD.</p>
6 Authors
- Laura E. Marchese
- Sarah A. McNaughton
- Gilly A. Hendrie
- Barbara Brayner
- Kacie M. Dickinson
- Katherine M. Livingstone
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