(OR25-03-26) Plant-Based Diets With Differential Food Processing Levels and Risk of Cardiovascular Disease, Type 2 Diabetes, and Mortality

Tuesday, July 28, 2026

8:54 AM - 9:06 AM ET

Location: Maryland Ballroom D

Nutrition Translation Award Competition for Early Career Investigators

Presenting Author(s)

Xiaowen Wang, PhD (she/her/hers)

Postdoctoral Research Fellow
Harvard T.H. Chan School of Public Health
Brookline, Massachusetts, United States

Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

Co-Author(s)

BL

Binkai Liu

Harvard T.H. Chan School of Public Health
Boston, United States
YH

Yang Hu

Harvard University
Boston, United States
NK

Neha Khandpur

University of São Paulo, Brazil
QQ

Qibin Qi

Albert Einstein College of Medicine, United States
LB

Lorraine Brennan

University College Dublin, Ireland
JW

Jayne V. Woodside

Queen's University Belfast, United Kingdom
LL

Liming Liang

Harvard T.H. Chan School of Public Health
Boston, United States
MW

Molin Wang

Harvard T.H. Chan School of Public Health
Boston, United States
ER

Eric B. Rimm, ScD

Professor
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
MS

Meir J. Stampfer

Harvard T.H. Chan School of Public Health
Boston, United States
Frank B. Hu, MD, MPH, PhD (he/him/his)

Chair, Department of Nutrition; Fredrick J. Stare Professor of Nutrition and Epidemiology
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
QS

Qi Sun

Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital and Harvard Medical School, United States

Disclosure(s):

Xiaowen Wang, PhD: No relevant financial relationship(s) with ineligible companies to disclose.

Frank B. Hu, MD, MPH, PhD: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: To distinguish health effects according to food processing levels by deriving healthy or unhealthy plant-based diet indices (hPDI or uPDI) emphasizing ultra-processed foods (UPF) versus non-UPF and subsequently examine their associations with incident cardiovascular disease (CVD), type 2 diabetes (T2D), and all-cause mortality.

Methods: Data were used from three large US cohorts, the Nurses’ Health Study (1984 -2018), Nurses’ Health Study II (1991-2021), and Health Professionals Follow-Up Study (1986-2020), including 160,690 women and 42,585 men who were free of cancer, CVD, and T2D at baseline. We constructed six PDIs with contrasting levels of UPF intake, including UPF-PDI, non-UPF-PDI, UPF-hPDI, non-UPF-hPDI, UPF-uPDI, and non-UPF-uPDI, by jointly considering PDI classification and UPF status. The associations of interests were evaluated using Cox proportional hazards models.

Results: We documented 26,209 CVD cases, 21,006 T2D cases, and 55,493 deaths. Both UPF-hPDI and non-UPF-hPDI were significantly associated with a lower risk of CVD (hazard ratio [HR] comparing the highest with the lowest quintiles of scores: 0.86 and 0.82, respectively), T2D (HRs: 0.67 and 0.66), and mortality (HRs: 0.89 and 0.93). Conversely, non-UPF-uPDI and UPF-uPDI were associated with significantly higher risks of CVD (HRs 1.21 and 1.17), and T2D (HRs 1.14 and 1.11), while only UPF-uPDI was significantly associated with higher mortality (HR 1.07).

Conclusions: The associations of healthy or unhealthy PDIs with the risks of CVD, T2D, and mortality may not depend on the food processing levels, highlighting the critical importance of diet quality in mitigating the risk of major chronic cardiometabolic diseases.

Funding Sources: National Institutes of Health