Degree of adherence to plant-based diet and total and cause-specific mortality: prospective cohort study in the Million Veteran Program

Objective: To examine the association between adherence to plant-based diets and mortality. Design: Prospective study. We calculated a plant-based diet index (PDI) by assigning positive scores to plant foods and reverse scores to animal foods. We also created a healthful PDI (hPDI) and an unhealthful PDI (uPDI) by further separating the healthy plant foods from less-healthy plant foods. Setting: The VA Million Veteran Program. Participants: 315 919 men and women aged 19-104 years who completed a FFQ at the baseline. Results: We documented 31 136 deaths during the follow-up. A higher PDI was significantly associated with lower total mortality (hazard ratio (HR) comparing extreme deciles = 0 center dot 75, 95 % CI: 0 center dot 71, 0 center dot 79, P (trend) < 0 center dot 001]. We observed an inverse association between hPDI and total mortality (HR comparing extreme deciles = 0 center dot 64, 95 % CI: 0 center dot 61, 0 center dot 68, P (trend) < 0 center dot 001), whereas uPDI was positively associated with total mortality (HR comparing extreme deciles = 1 center dot 41, 95 % CI: 1 center dot 33, 1 center dot 49, P (trend) < 0 center dot 001). Similar significant associations of PDI, hPDI and uPDI were also observed for CVD and cancer mortality. The associations between the PDI and total mortality were consistent among African and European American participants, and participants free from CVD and cancer and those who were diagnosed with major chronic disease at baseline. Conclusions: A greater adherence to a plant-based diet was associated with substantially lower total mortality in this large population of veterans. These findings support recommending plant-rich dietary patterns for the prevention of major chronic diseases.