Childhood plant-based diet quality and cardiometabolic health, metabolite profiles, and dietary costs: A population-based cohort study.

BACKGROUND

Evidence on how plant-based diet quality relates to children's cardiometabolic health, metabolic profiles, and dietary costs is scarce.

OBJECTIVE

We investigated plant-based diet quality and cardiometabolic health in children, integrating metabolites and dietary costs to link biological mechanisms with public health implications.

METHODS

We analyzed data from 3990 children in the Dutch Generation R Study. Dietary intake was assessed with food-frequency questionnaires at age 8. We constructed overall, healthful, and unhealthful plant-based diet indices (PDI, hPDI, uPDI). Multivariable linear regression estimated associations of these indices with cardiometabolic measures at age 10, standardized for sex and age, and with serum metabolites and dietary costs. In 402 children, LC-MS/MS quantified serum amino acids, fatty acids, phospholipids, and carnitines. Dietary costs were estimated from a Dutch food price database.

RESULTS

Higher hPDI scores were associated with lower systolic blood pressure (β = -0.05 standard deviation score [SDS] per 10-hPDI score increment, 95% CI: -0.10, -0.01) and diastolic blood pressure (β = -0.07 SDS , 95% CI: -0.11, -0.02). Higher scores on each plant-based diet index were associated with lower total cholesterol (e.g., hPDI: β = -0.06 SDS, 95% CI: -0.12, -0.01), but not with insulin and triglycerides. Metabolomic analyses showed that PDI was inversely associated with two amino acids, while uPDI was inversely associated with phospholipids and carnitines, including only nine phospholipids positively associated with total cholesterol. Higher uPDI was associated with lower dietary costs, while hPDI was not associated with higher costs. Processed and red meat, sweets and desserts, fruits, and vegetables were consistently the largest contributors to total dietary costs across all dietary patterns.

CONCLUSIONS

Gradual shifts toward healthy plant-based diets may support children's cardiometabolic health without clear evidence of changes in dietary costs, whereas unhealthy plant-based diets tended to have lower dietary costs but less favorable metabolic profiles.