{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T22:21:38Z","timestamp":1793398898697,"version":"4.5.0"},"reference-count":53,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T00:00:00Z","timestamp":1747785600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T00:00:00Z","timestamp":1747785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["181403"],"award-info":[{"award-number":["181403"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["320135"],"award-info":[{"award-number":["320135"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Portfolio Diet, a dietary pattern of cholesterol-lowering foods, has been shown to reduce cardiovascular disease (CVD) risk factors in clinical trials and lower CVD risk in observational cohorts of mainly white men and women. However, evidence on mortality outcomes in diverse populations is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the association of the Portfolio dietary pattern with CVD mortality in a racially diverse cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 14,835 US adults from the National Health and Nutrition Examination Survey, NHANES (1988\u20131994), were included. Diet was assessed by a 24-h dietary recall which was supplemented with a food frequency questionnaire at baseline using the Portfolio Diet Score (PDS), with positive points for nuts, plant protein, viscous fiber, phytosterols, and plant monounsaturated fatty acid sources, and negative points for foods high in saturated fat and cholesterol (range, 6\u201330 points). The primary outcome was CVD mortality. Other mortality outcomes included coronary heart disease (CHD), stroke, and all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During 22\u00a0years of follow-up, 2300 CVD deaths, including 1887 CHD deaths, 413 stroke deaths, and 6238 all-cause deaths were documented. Greater adherence was inversely associated with risk factors including blood lipids, glycemia, and inflammation. Treated as a continuous variable, an increase in PDS by 8 points was associated with a 12% (hazard ratio 0.88 [95% confidence intervals:0.78, 0.99]), 14% (0.86 [0.78, 0.96]), and 12% (0.88 [0.82, 0.95]) lower risk of CVD, CHD, and all-cause mortality after adjustments for known CVD risk factors. Comparing the highest to lowest tertiles of the PDS, higher PDS was associated with 16% (0.84 [0.73, 0.98]), 18% (0.82 [0.72, 0.95]) and 14% (0.86 [0.78, 0.96]) lower risk of CVD, CHD, and all-cause mortality, respectively. As part of exploratory analyses, an interaction between PDS and race\/ethnicity was observed, emphasizing the necessity of future research involving underserved groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among a national cohort of racially diverse adults in the US, greater adherence to the Portfolio dietary pattern was inversely and prospectively associated with CVD, CHD, and all-cause mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-025-04067-1","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T19:02:26Z","timestamp":1747767746000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The portfolio dietary pattern and risk of cardiovascular disease mortality during 1988\u20132019 in US adults: a prospective cohort study"],"prefix":"10.1186","volume":"23","author":[{"given":"Meaghan E.","family":"Kavanagh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Zurbau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea J.","family":"Glenn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julianah O.","family":"Oguntala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Josse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasanti S.","family":"Malik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Chiavaroli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyril W. C.","family":"Kendall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J. A.","family":"Jenkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L.","family":"Sievenpiper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"issue":"8","key":"4067_CR1","doi-asserted-by":"publisher","first-page":"e93","DOI":"10.1161\/CIR.0000000000001123","volume":"147","author":"CW Tsao","year":"2023","unstructured":"Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. Heart Disease and Stroke Statistics- 2023 Update: A Report From the American Heart Association. Circulation. 2023;147(8):e93-e621.","journal-title":"Circulation"},{"key":"4067_CR2","doi-asserted-by":"publisher","unstructured":"Rittiphairoj T, Reilly A, Reddy CL, Barrenho E, Colombo F, Atun R.The State of Cardiovascular Disease in G20+ countries. Health Systems Innovation Lab, Harvard University, May 2022. https:\/\/doi.org\/10.54111\/0001\/HSIL\/cvdg20.","DOI":"10.54111\/0001\/HSIL\/cvdg20"},{"issue":"8","key":"4067_CR3","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1161\/CIR.0b013e31820a55f5","volume":"123","author":"PA Heidenreich","year":"2011","unstructured":"Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the Future of Cardiovascular Disease in the United States. Circulation. 2011;123(8):933-44.","journal-title":"Circulation"},{"issue":"9","key":"4067_CR4","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1016\/j.jacc.2021.06.011","volume":"78","author":"SS Virani","year":"2021","unstructured":"Virani SS, Morris PB, Agarwala A, Ballantyne CM, Birtcher KK, Kris-Etherton PM, et al. 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021;78(9):960-93.","journal-title":"J Am Coll Cardiol"},{"issue":"2","key":"4067_CR5","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1161\/CIRCULATIONAHA.115.018585","volume":"133","author":"D Mozaffarian","year":"2016","unstructured":"Mozaffarian D. Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review. Circulation. 2016;133(2):187-225.","journal-title":"Circulation"},{"issue":"8","key":"4067_CR6","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1016\/j.jacc.2018.02.085","volume":"72","author":"E Yu","year":"2018","unstructured":"Yu E, Malik VS, Hu FB. Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series. J Am Coll Cardiol. 2018;72(8):914-26.","journal-title":"J Am Coll Cardiol"},{"issue":"10","key":"4067_CR7","doi-asserted-by":"publisher","first-page":"e56","DOI":"10.1161\/CIR.0000000000000659","volume":"139","author":"EJ Benjamin","year":"2019","unstructured":"Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics- 2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528.","journal-title":"Circulation"},{"issue":"8","key":"4067_CR8","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1016\/j.cjca.2021.03.016","volume":"37","author":"GJ Pearson","year":"2021","unstructured":"Pearson GJ, Thanassoulis G, Anderson TJ, Barry AR, Couture P, Dayan N, et al. 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. Can J Cardiol. 2021;37(8):1129-50.","journal-title":"Can J Cardiol"},{"issue":"4","key":"4067_CR9","first-page":"502","volume":"290","author":"DJ Jenkins","year":"2003","unstructured":"Jenkins DJ, Kendall CW, Marchie A, Faulkner DA, Wong JM, de Souza R, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. J Am Coll Cardiol. 2003;290(4):502.","journal-title":"J Am Coll Cardiol"},{"key":"4067_CR10","doi-asserted-by":"crossref","unstructured":"Yang G, Mason AM, Wood AM, Schooling CM, Burgess S. Dose-Response Associations of Lipid Traits With Coronary Artery Disease and Mortality. JAMA Network Open. 2024;7(1):e2352572-e.","DOI":"10.1001\/jamanetworkopen.2023.52572"},{"key":"4067_CR11","doi-asserted-by":"crossref","unstructured":"Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459\u201372.","DOI":"10.1093\/eurheartj\/ehx144"},{"issue":"1","key":"4067_CR12","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.pcad.2018.05.004","volume":"61","author":"L Chiavaroli","year":"2018","unstructured":"Chiavaroli L, Nishi SK, Khan TA, Braunstein CR, Glenn AJ, Mejia SB, et al. Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Prog Cardiovasc Dis. 2018;61(1):43-53.","journal-title":"Prog Cardiovasc Dis"},{"issue":"16","key":"4067_CR13","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.021515","volume":"10","author":"AJ Glenn","year":"2021","unstructured":"Glenn AJ, Lo K, Jenkins DJA, Boucher BA, Hanley AJ, Kendall CWC, et al. Relationship Between a Plant-Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study. J Am Heart Assoc. 2021;10(16):e021515.","journal-title":"J Am Heart Assoc"},{"issue":"22","key":"4067_CR14","doi-asserted-by":"publisher","first-page":"1750","DOI":"10.1161\/CIRCULATIONAHA.123.065551","volume":"148","author":"AJ Glenn","year":"2023","unstructured":"Glenn AJ, Guasch-Ferr\u00e9 M, Malik VS, Kendall CWC, Manson JE, Rimm EB, et al. Portfolio Diet Score and Risk of Cardiovascular Disease: Findings From 3 Prospective Cohort Studies. Circulation. 2023;148(22):1750-63.","journal-title":"Circulation"},{"key":"4067_CR15","unstructured":"Plan and operation of the Third National Health and Nutrition Examination Survey, 1988\u201394. Series 1: programs and collection procedures. Vital Health Stat 1. 1994(32):1\u2013407."},{"issue":"1","key":"4067_CR16","doi-asserted-by":"publisher","first-page":"121","DOI":"10.3945\/an.115.009258","volume":"7","author":"N Ahluwalia","year":"2016","unstructured":"Ahluwalia N, Dwyer J, Terry A, Moshfegh A, Johnson C. Update on NHANES Dietary Data: Focus on Collection, Release, Analytical Considerations, and Uses to Inform Public Policy. Adv Nutr. 2016;7(1):121-34.","journal-title":"Adv Nutr"},{"key":"4067_CR17","doi-asserted-by":"crossref","unstructured":"Kipnis V, Subar AF, Midthune D, Freedman LS, Ballard-Barbash R, Troiano RP, et al. Structure of dietary measurement error: results of the OPEN biomarker study. Am J Epidemiol. 2003;158(1):14\u201321; discussion 2\u20136.","DOI":"10.1093\/aje\/kwg091"},{"issue":"4","key":"4067_CR18","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1093\/aje\/kwr317","volume":"175","author":"RJ Carroll","year":"2012","unstructured":"Carroll RJ, Midthune D, Subar AF, Shumakovich M, Freedman LS, Thompson FE, et al. Taking Advantage of the Strengths of 2 Different Dietary Assessment Instruments to Improve Intake Estimates for Nutritional Epidemiology. American Journal of Epidemiology. 2012;175(4):340-7.","journal-title":"Am J Epidemiol"},{"key":"4067_CR19","doi-asserted-by":"crossref","unstructured":"Glenn AJ, Boucher BA, Kavcic CC, Khan TA, Paquette M, Kendall CWC, et al. Development of a Portfolio Diet Score and Its Concurrent and Predictive Validity Assessed by a Food Frequency Questionnaire. Nutrients. 2021;13(8):2850.","DOI":"10.3390\/nu13082850"},{"key":"4067_CR20","unstructured":"U.S. Department of Agriculture, Agricultural Research Service. USDA Food and Nutrient Database for Dietary Studies 2015\u20132016. Food Surveys Research Group Home Page2018. Available from: http:\/\/www.ars.usda.gov\/nea\/bhnrc\/fsrg."},{"issue":"4","key":"4067_CR21","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1079\/BJN20041234","volume":"92","author":"LM Valsta","year":"2004","unstructured":"Valsta LM, Lemstr\u00f6m A, Ovaskainen ML, Lampi AM, Toivo J, Korhonen T, et al. Estimation of plant sterol and cholesterol intake in Finland: quality of new values and their effect on intake. Br J Nutr. 2004;92(4):671-8.","journal-title":"Br J Nutr"},{"issue":"8","key":"4067_CR22","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1177\/2047487314554864","volume":"22","author":"RT Ras","year":"2015","unstructured":"Ras RT, van der Schouw YT, Trautwein EA, Sioen I, Dalmeijer GW, Zock PL, et al. Intake of phytosterols from natural sources and risk of cardiovascular disease in the European Prospective Investigation into Cancer and Nutrition-the Netherlands (EPIC-NL) population. Eur J Prev Cardiol. 2015;22(8):1067-75.","journal-title":"Eur J Prev Cardiol"},{"key":"4067_CR23","unstructured":"U.S. Department of Agriculture. Food Data Central Food Composition Table. Available from: https:\/\/fdc.nal.usda.gov\/."},{"key":"4067_CR24","doi-asserted-by":"publisher","unstructured":"National Center for Health Statistics Division of Analysis and Epidemiology. NHANES III Public-use Linked Mortality Files. Available from: https:\/\/www.cdc.gov\/nchs\/data-linkage\/mortality-public.htm. https:\/\/doi.org\/10.15620\/cdc:117141. Accessed 10 June 2022.","DOI":"10.15620\/cdc:117141"},{"issue":"5","key":"4067_CR25","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1001\/jamacardio.2020.0013","volume":"5","author":"M Sampson","year":"2020","unstructured":"Sampson M, Ling C, Sun Q, Harb R, Ashmaig M, Warnick R, et al. A New Equation for Calculation of Low-Density Lipoprotein Cholesterol in Patients With Normolipidemia and\/or Hypertriglyceridemia. JAMA Cardiol. 2020;5(5):540-8.","journal-title":"JAMA Cardiol"},{"key":"4067_CR26","unstructured":"National Center for Health Statistics Centers for Disease Control and Prevention. Analytic and Reporting Guidelines: The Third National Health and Nutrition Examination Survey, NHANES III (1988-94). Available from: https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/analyticguidelines\/88-94-analytic-reporting-guidelines.pdf Published 1996. Accessed 18 Apr 2023."},{"issue":"2","key":"4067_CR27","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1080\/00031305.2016.1154108","volume":"70","author":"RL Wasserstein","year":"2016","unstructured":"Wasserstein RL, Lazar NA. The ASA Statement on p-Values: Context, Process, and Purpose. The American Statistician. 2016;70(2):129-33.","journal-title":"Am Stat"},{"key":"4067_CR28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpc.2020.100094","volume":"4","author":"W Zhang","year":"2020","unstructured":"Zhang W, Ahmad MI, Soliman EZ. The role of traditional risk factors in explaining the social disparities in cardiovascular death: The national health and Nutrition Examination Survey III (NHANES III). Am J Prev Cardiol. 2020;4:100094.","journal-title":"Am J Prev Cardiol"},{"issue":"1","key":"4067_CR29","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1186\/s12872-024-04091-8","volume":"24","author":"Y Liu","year":"2024","unstructured":"Liu Y, He W, Ji Y, Wang Q, Li X. A linear positive association between high-sensitivity C-reactive protein and the prevalence of cardiovascular disease among individuals with diabetes. BMC Cardiovasc Disord. 2024;24(1):411.","journal-title":"BMC Cardiovasc Disord"},{"issue":"15","key":"4067_CR30","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.023690","volume":"11","author":"S Rong","year":"2022","unstructured":"Rong S, Li B, Chen L, Sun Y, Du Y, Liu B, et al. Association of Low-Density Lipoprotein Cholesterol Levels with More than 20-Year Risk of Cardiovascular and All-Cause Mortality in the General Population. J Am Heart Assoc. 2022;11(15):e023690.","journal-title":"J Am Heart Assoc"},{"issue":"10","key":"4067_CR31","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.1016\/j.amjcard.2011.07.005","volume":"108","author":"JI Reddigan","year":"2011","unstructured":"Reddigan JI, Ardern CI, Riddell MC, Kuk JL. Relation of Physical Activity to Cardiovascular Disease Mortality and the Influence of Cardiometabolic Risk Factors. Am J Cardiol. 2011;108(10):1426-31.","journal-title":"Am J Cardiol"},{"issue":"1","key":"4067_CR32","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/1471-2288-8-70","volume":"8","author":"I Shrier","year":"2008","unstructured":"Shrier I, Platt RW. Reducing bias through directed acyclic graphs. BMC Med Res Methodol. 2008;8(1):70.","journal-title":"BMC Med Res Methodol"},{"issue":"6","key":"4067_CR33","first-page":"1887","volume":"45","author":"J Textor","year":"2017","unstructured":"Textor J, van der Zander B, Gilthorpe MS, Li\u015bkiewicz M, Ellison GT. Robust causal inference using directed acyclic graphs: the R package \u2018dagitty\u2019. Int J Epidemiol. 2017;45(6):1887","journal-title":"Int J Epidemiol"},{"issue":"1","key":"4067_CR34","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.cmpb.2003.10.004","volume":"75","author":"SR Cole","year":"2004","unstructured":"Cole SR, Hern\u00e1n MA. Adjusted survival curves with inverse probability weights. Comput Methods Programs Biomed. 2004;75(1):45-9.","journal-title":"Comput Methods Programs Biomed"},{"issue":"1","key":"4067_CR35","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1097\/EDE.0b013e3181c1ea43","volume":"21","author":"MA Hern\u00e1n","year":"2010","unstructured":"Hern\u00e1n MA. The hazards of hazard ratios. Epidemiology. 2010;21(1):13-5.","journal-title":"Epidemiology"},{"issue":"9","key":"4067_CR36","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1002\/sim.3841","volume":"29","author":"L Desquilbet","year":"2010","unstructured":"Desquilbet L, Mariotti F. Dose-response analyses using restricted cubic spline functions in public health research. Stat Med. 2010;29(9):1037-57.","journal-title":"Stat Med"},{"key":"4067_CR37","doi-asserted-by":"publisher","unstructured":"National Academies of Sciences, Engineering, and Medicine. 2025. Rethinking race and ethnicity in biomedical research. Washington, DC: National Academies Press. https:\/\/doi.org\/10.17226\/27913.","DOI":"10.17226\/27913"},{"key":"4067_CR38","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n604","volume":"373","author":"YB Zhang","year":"2021","unstructured":"Zhang YB, Chen C, Pan XF, Guo J, Li Y, Franco OH, et al. Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies. BMJ. 2021;373:n604.","journal-title":"BMJ"},{"issue":"12","key":"4067_CR39","doi-asserted-by":"publisher","first-page":"2569","DOI":"10.1016\/S0022-2275(20)37461-7","volume":"37","author":"SM Marcovina","year":"1996","unstructured":"Marcovina SM, Albers JJ, Wijsman E, Zhang Z, Chapman NH, Kennedy H. Differences in Lp[a] concentrations and apo[a] polymorphs between black and white Americans. Journal of Lipid Research. 1996;37(12):2569-85.","journal-title":"J Lipid Res"},{"issue":"2","key":"4067_CR40","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2022-002060","volume":"9","author":"EN Steven","year":"2022","unstructured":"Steven EN, Kathy W, Leslie C, Stephen JN, John K, Eran L, et al. Lipoprotein(a) levels in a global population with established atherosclerotic cardiovascular disease. Open Heart. 2022;9(2):e002060.","journal-title":"Open Heart"},{"issue":"2","key":"4067_CR41","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1016\/j.atherosclerosis.2009.12.035","volume":"210","author":"SJ Carter","year":"2010","unstructured":"Carter SJ, Roberts MB, Salter J, Eaton CB. Relationship between Mediterranean Diet Score and atherothrombotic risk: Findings from the Third National Health and Nutrition Examination Survey (NHANES III), 1988\u20131994. Atherosclerosis. 2010;210(2):630-6.","journal-title":"Atherosclerosis"},{"issue":"4","key":"4067_CR42","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1038\/ajh.2009.10","volume":"22","author":"A Parikh","year":"2009","unstructured":"Parikh A, Lipsitz SR, Natarajan S. Association between a DASH-like diet and mortality in adults with hypertension: findings from a population-based follow-up study. Am J Hypertens. 2009;22(4):409-16.","journal-title":"Am J Hypertens"},{"issue":"10","key":"4067_CR43","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1016\/j.mayocp.2016.06.022","volume":"91","author":"YM Park","year":"2016","unstructured":"Park YM, Fung TT, Steck SE, Zhang J, Hazlett LJ, Han K, et al. Diet Quality and Mortality Risk in Metabolically Obese Normal-Weight Adults. Mayo Clin Proc. 2016;91(10):1372-83.","journal-title":"Mayo Clin Proc"},{"issue":"1","key":"4067_CR44","doi-asserted-by":"publisher","first-page":"28","DOI":"10.2337\/dc22-1029","volume":"46","author":"AJ Glenn","year":"2023","unstructured":"Glenn AJ, Li J, Lo K, Jenkins DJA, Boucher BA, Hanley AJ, et al. The Portfolio Diet and Incident Type 2 Diabetes: Findings From the Women's Health Initiative Prospective Cohort Study. Diabetes Care. 2023;46(1):28-37.","journal-title":"Diabetes Care"},{"issue":"5","key":"4067_CR45","doi-asserted-by":"publisher","first-page":"2825","DOI":"10.1016\/j.clnu.2021.03.016","volume":"40","author":"AJ Glenn","year":"2021","unstructured":"Glenn AJ, Hern\u00e1ndez-Alonso P, Kendall CWC, Mart\u00ednez-Gonz\u00e1lez M, Corella D, Fit\u00f3 M, et al. Longitudinal changes in adherence to the portfolio and DASH dietary patterns and cardiometabolic risk factors in the PREDIMED-Plus study. Clin Nutr. 2021;40(5):2825-36.","journal-title":"Clin Nutr"},{"issue":"18","key":"4067_CR46","doi-asserted-by":"publisher","first-page":"1961","DOI":"10.1503\/cmaj.092128","volume":"182","author":"DJ Jenkins","year":"2010","unstructured":"Jenkins DJ, Chiavaroli L, Wong JM, Kendall C, Lewis GF, Vidgen E, et al. Adding monounsaturated fatty acids to a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. CMAJ. 2010;182(18):1961-7.","journal-title":"CMAJ"},{"issue":"10","key":"4067_CR47","doi-asserted-by":"publisher","first-page":"1777","DOI":"10.1017\/S1368980018003890","volume":"22","author":"H Kim","year":"2019","unstructured":"Kim H, Hu EA, Rebholz CM. Ultra-processed food intake and mortality in the USA: results from the Third National Health and Nutrition Examination Survey (NHANES III, 1988 -\u20091994). Public Health Nutr. 2019;22(10):1777-85.","journal-title":"Public Health Nutr"},{"issue":"12","key":"4067_CR48","doi-asserted-by":"publisher","first-page":"1986","DOI":"10.1016\/j.jand.2015.08.016","volume":"115","author":"FE Thompson","year":"2015","unstructured":"Thompson FE, Kirkpatrick SI, Subar AF, Reedy J, Schap TE, Wilson MM, et al. The National Cancer Institute's Dietary Assessment Primer: A Resource for Diet Research. J Acad Nutr Diet. 2015;115(12):1986-95.","journal-title":"J Acad Nutr Diet"},{"issue":"4","key":"4067_CR49","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1111\/j.1541-0420.2009.01223.x","volume":"65","author":"V Kipnis","year":"2009","unstructured":"Kipnis V, Midthune D, Buckman DW, Dodd KW, Guenther PM, Krebs-Smith SM, et al. Modeling data with excess zeros and measurement error: application to evaluating relationships between episodically consumed foods and health outcomes. Biometrics. 2009;65(4):1003-10.","journal-title":"Biometrics"},{"key":"4067_CR50","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.jclinepi.2018.02.023","volume":"98","author":"TB Brakenhoff","year":"2018","unstructured":"Brakenhoff TB, Mitroiu M, Keogh RH, Moons KGM, Groenwold RHH, van Smeden M. Measurement error is often neglected in medical literature: a systematic review. J Clin Epidemiol. 2018;98:89-97.","journal-title":"J Clin Epidemiol"},{"issue":"2b","key":"4067_CR51","doi-asserted-by":"publisher","first-page":"1456","DOI":"10.1214\/10-AOAS446","volume":"5","author":"S Zhang","year":"2011","unstructured":"Zhang S, Midthune D, Guenther PM, Krebs-Smith SM, Kipnis V, Dodd KW. A new multivariate measurement error model with zero-inflated dietary data, and its application to dietary assessment Ann Appl Stat. 2011;5(2b):1456-1487","journal-title":"Ann Appl Stat"},{"issue":"1","key":"4067_CR52","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1471-2288-12-21","volume":"12","author":"C Bennette","year":"2012","unstructured":"CBennette C, Vickers A. Against quantiles: categorization of continuous variables in epidemiologic research, and its discontents BMC Med Res Methodol. 2012;12(1):21.","journal-title":"BMC Med Res Methodol"},{"key":"4067_CR53","doi-asserted-by":"crossref","unstructured":"Flanagin A, Frey T, Christiansen SL, Committee AMoS. Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals. JAMA. 2021;326(7):621\u20137.","DOI":"10.1001\/jama.2021.13304"}],"container-title":["BMC Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-025-04067-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12916-025-04067-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-025-04067-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T19:02:30Z","timestamp":1747767750000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedicine.biomedcentral.com\/articles\/10.1186\/s12916-025-04067-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,21]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4067"],"URL":"https:\/\/doi.org\/10.1186\/s12916-025-04067-1","relation":{},"ISSN":["1741-7015"],"issn-type":[{"value":"1741-7015","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,21]]},"assertion":[{"value":"18 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"NHANES III received institutional review board approval from the National Center for Health Statistics Research Ethics Review Board (USA CDC, 2015) and required the provision of written informed consent to participate.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"AZ is a part-time employee at INQUIS Clinical Research, Ltd., a contract research organization. She has received consulting fees from Glycemic Index Foundation. AJG has received honoraria or travel support from the Good Food Institute, the\u00a0British Nutrition Society, Vinasoy, and the Academy of Nutrition and Dietetics. VSM is on the Advisory board of the Canadian Institutes of Health Research Institute of Nutrition metabolism and diabetes and is on the Scientific Advisory Committee for Healthy Eating Research at Robert Wood Johnson Foundation for the consensus statement on beverages for children. LC has received research funding from the Canadian Institutes of Health Research (CIHR), Protein Industries Canada (a Government of Canada Global Innovation Cluster), the United Soybean Board (The United States Department of Agriculture Soybean \u201cCheck-off\u201d Program) and the Alberta Pulse Growers. She has received honoraria from the Arkansas Children\u2019s Hospital and travel funding from the World Sugars Research Organization for an internal presentation in 2022. CWCK has received grants or research support from the Advanced Food Materials Network, Agriculture and Agri-Foods Canada (AAFC), Almond Board of California, Barilla, Canadian Institutes of Health Research (CIHR), Canola Council of Canada, International Nut and Dried Fruit Council, International Tree Nut Council Research and Education Foundation, Loblaw Brands Ltd, the Peanut Institute, Pulse Canada and Unilever. He has received in-kind research support from the Almond Board of California, Barilla, California Walnut Commission, Kellogg Canada, Loblaw Companies, Nutrartis, Quaker (PepsiCo), the Peanut Institute, Primo, Unico, Unilever, White\u00a0Wave Foods\/Danone. He has received travel support and\/or honoraria from the Barilla, California Walnut Commission, Canola Council of Canada, General Mills, International Nut and Dried Fruit Council, International Pasta Organization, Lantmannen, Loblaw Brands Ltd, Nutrition Foundation of Italy, Oldways Preservation Trust, Paramount Farms, the Peanut Institute, Pulse Canada, Sun-Maid, Tate & Lyle, Unilever and White Wave Foods\/Danone. He has served on the scientific advisory board for the International Tree Nut Council, International Pasta Organization, McCormick Science Institute and Oldways Preservation Trust. He is a founding member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), is on the Clinical Practice Guidelines Expert Committee for Nutrition Therapy of the EASD and is a Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. DJAJ has received research grants from Loblaw Companies Ltd., the Almond Board of California, Soy Nutrition Institute (SNI), and the Canadian Institutes of Health Research (CIHR). He has received in-kind supplies for trials as a research support from the Almond board of California, Walnut Council of California, American Peanut Council, Barilla, Unilever, Unico, Primo, Loblaw Companies, Quaker (Pepsico), Pristine Gourmet, Bunge Limited, Kellogg Canada, White\u00a0Wave Foods. He has been on the speaker\u2019s panel, served on the scientific advisory board and\/or received travel support and\/or honoraria from the Lawson Centre Nutrition Digital Series, 19th Annual Stare-Hegsted Lecture, 2024 Diabetes Canada Conference,\u00a0Nutritional Fundamentals for Health (NFH)-Nutramedica, Saint Barnabas Medical Center, The University of Chicago, 2020 China Glycemic Index (GI) International Conference, Atlantic Pain Conference, Academy of Life Long Learning, the Almond Board of California, Canadian Agriculture Policy Institute, the Loblaw Companies Ltd, the Griffin Hospital (for the development of the NuVal scoring system), the Coca-Cola Company, Epicure, Danone, Diet Quality Photo Navigation (DQPN), Better Therapeutics (FareWell), Verywell, True Health Initiative (THI), Heali AI Corp, Institute of Food Technologists (IFT), Soy Nutrition Institute (SNI), Herbalife Nutrition Institute (HNI), Herbalife International, Pacific Health Laboratories, Nutritional Fundamentals for Health (NFH), the Soy Foods Association of North America, the Nutrition Foundation of Italy (NFI), the Toronto Knowledge Translation Group (St. Michael\u2019s Hospital), the Canadian College of Naturopathic Medicine, The Hospital for Sick Children, the Canadian Nutrition Society (CNS), and the American Society of Nutrition (ASN). He is a member of the International Carbohydrate Quality Consortium (ICQC). His wife, Alexandra L Jenkins, is senior scientist of INQUIS Clinical Research Inc. (Clinical Research Organization), his 2 daughters, Wendy Jenkins and Amy Jenkins, have published a vegetarian book that promotes the use of the low glycemic index plant foods advocated here, The Portfolio Diet for Cardiovascular Risk Reduction (Academic Press\/Elsevier 2020 ISBN:978 -\u20090- 12 -\u2009810510 -\u20098)and his sister, Caroline Brydson, received funding through a grant from the St. Michael\u2019s Hospital Foundation to develop a cookbook for one of his studies. JLS has received research support from the Canadian Foundation for Innovation, Ontario Research Fund, Province of Ontario Ministry of Research and Innovation and Science, Canadian Institutes of health Research (CIHR), Diabetes Canada, American Society for Nutrition (ASN), National Honey Board (U.S. Department of Agriculture [USDA] honey \u201cCheckoff\u201d program), Institute for the Advancement of Food and Nutrition Sciences (IAFNS), Pulse Canada, Quaker Oats Center of Excellence, INC International Nut and Dried Fruit Council Foundation, The United Soybean Board (USDA soy \u201cCheckoff\u201d program), Protein Industries Canada (a Government of Canada Global Innovation Cluster), Almond Board of California, European Fruit Juice Association, The Tate and Lyle Nutritional Research Fund at the University of Toronto, The Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund established by the Alberta Pulse Growers), The Plant Protein Fund at the University of Toronto (a fund which has received contributions from IFF among other donors), The Plant Milk Fund at the University of Toronto (a fund established by the Karuna Foundation through Vegan Grants), and The Nutrition Trialists Network Fund at the University of Toronto (a fund established by donations from the Calorie Control Council, Physicians Committee for Responsible Medicine, and Login5 Foundation). He has received food donations to support randomized controlled trials from the Almond Board of California, California Walnut Commission, Danone, Nutrartis, Soylent, and Dairy Farmers of Canada. He has received travel support, speaker fees and\/or honoraria from FoodMinds LLC, Nestl\u00e9, Abbott, General Mills, Nutrition Communications, International Food Information Council (IFIC), Arab Beverage Association, International Sweeteners Association, Calorie Control Council, Phynova, and Collaborative CME and Research Network (CCRN). He has or has had ad hoc consulting arrangements with Almond Board of California, Perkins Coie LLP, Tate & Lyle, Ingredion, and Brightseed. He is on the Clinical Practice Guidelines Expert Committees of Diabetes Canada, European Association for the study of Diabetes (EASD), Canadian Cardiovascular Society (CCS), and Obesity Canada\/Canadian Association of Bariatric Physicians and Surgeons. He serves as an unpaid member of the Board of Trustees of IAFNS. He is a Director at Large of the Canadian Nutrition Society (CNS), founding member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the EASD, and Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His spouse is a former employee of Nestle Health Science and AB InBev. MEK, JOO, SL, and RGJ report no relevant competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"287"}}