(OR19-03-23) Substitution of Animal-Based With Plant-Based Foods on Cardiometabolic Health and All-Cause Mortality – A Systematic Review and Meta-Analysis

Objectives: The aim of this systematic review and meta-analysis was to summarize and evaluate the evidence on the associations of substituting animal-based with plant-based foods with cardiometabolic health and all-cause mortality.

Methods: The databases Medline, Embase and Web of Science were searched until December 2021. Prospective observational studies investigating the substitution of animal-based with plant-based foods on cardiovascular diseases (CVD), type 2 diabetes (T2D) and all-cause mortality were included. Study characteristics and risks estimates were extracted from each article and summary relative risks (SRRs) with 95% confidence intervals (95% CI) were calculated using random-effects meta-analyses. Risk of bias was assessed by using the ROBINS-I tool and the certainty of evidence (CoE) by the GRADEpro tool.

Results: In total, 34 eligible studies were identified. Risk of bias was mostly moderate. The CoE was moderate for a lower incidence of total CVD when substituting processed meat with whole grains (n=7 cohorts), legumes (n=8), or nuts (n=8) [SRR (95% CI): 0.64 (0.54, 0.75), 0.77 (0.68, 0.87) and 0.73 (0.59, 0.91)], as well when replacing eggs with nuts (n=8) [SRR (95% CI): 0.83 (0.78, 0.89] and butter with olive oil (n=3) [SRR (95% CI): 0.96 (0.95, 0.98)]. For T2D, there was moderate CoE for a lower incidence when substituting red and processed meat with whole grains/cereals (n=5) or nuts (n=4) [SRR (95% CI): 0.94 (0.92, 0.97) and 0.89 (0.87, 0.91)], and replacing butter with olive oil (n=3) [SRR (95% CI): 0.94 (0.91, 0.98)]. We found moderate CoE for reduced all-cause mortality, when replacing red meat with whole grains (n=3) or nuts (n=9) [SRR (95% CI): 0.96 (0.95, 0.98) and 0.93 (0.91, 0.95)], and processed meat with whole grains (n=8), legumes (n=9) or nuts (n=9) [SRR (95% CI): 0.89 (0.85, 0.94), 0.91 (0.85, 0.98), 0.79 (0.71, 0.88)]. Similar associations of the same magnitude were observed for the replacement of eggs or dairy products with nuts/legumes and of butter with olive oil.

Conclusions: Our findings indicate that replacing animal-based foods, especially red and processed meat, with plant-based food has the potential to improve cardiometabolic health and premature death.

Funding Sources: This project was funded by research grant of the Alpro Foundation.