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Whole-food plant pattern

Eating patterns built mostly on whole plant foods (vegetables, fruits, whole grains, legumes, nuts) are linked in large cohort studies with lower cardiovascular, type 2 diabetes and all-cause mortality risk, and randomised trials show vegetarian and vegan diets lower LDL cholesterol. The quality of the plant foods matters: plant patterns heavy in refined and ultra-processed plant foods are linked with higher, not lower, risk.

  • Longevity
  • Vegan

Evidence retrieved up to

What the research shows

Among middle-aged and older adults, higher adherence to a healthful plant-based eating pattern is associated with a lower risk of cardiovascular disease; as part of a healthy lifestyle, such a pattern may help reduce the risk of heart disease.

Low certaintyFurther research is likely to change this.
No known concerns at usual amountsBenefit

Who this is about

middle-aged and older adults

Practical note

Graded low: pooled prospective cohort studies (25 in a 2025 meta-analysis; hPDI CVD risk ratio 0.81) with consistent direction, but observational design leaves residual confounding by wider health behaviours.

Vegan note

Healthful plant-based indices reward plant foods and score animal foods down, so they do not require a fully vegan diet.

Sources

In prospective cohort studies of adults, higher adherence to a healthful plant-based eating pattern is associated with lower all-cause mortality.

Low certaintyFurther research is likely to change this.
No known concerns at usual amountsBenefit

Who this is about

adults in prospective cohort studies

Practical note

Graded low: a 2025 dose-response meta-analysis of 25 cohort studies (hPDI all-cause mortality risk ratio 0.86 across 21 studies) with a monotonic dose-response; observational evidence that cannot rule out healthy-user confounding.

Sources

Adults with higher adherence to plant-based eating patterns have a lower risk of developing type 2 diabetes, and the association is stronger when the pattern emphasises fruits, vegetables, whole grains, legumes and nuts; as part of a healthy lifestyle, such a pattern may help reduce the risk of type 2 diabetes.

Low certaintyFurther research is likely to change this.
No known concerns at usual amountsBenefit

Who this is about

adults

Practical note

Graded low: a 2019 meta-analysis of 9 prospective studies (307 099 participants) found a risk ratio of 0.77, with modest heterogeneity (I2 44.5 percent) and a linear dose-response; observational design.

Sources

Among adults, plant-based eating patterns high in refined or ultra-processed plant foods are associated with higher cardiovascular and all-cause mortality risk, so the benefits linked with plant patterns depend on the plant foods being mostly whole or minimally processed.

Low certaintyFurther research is likely to change this.
No known concerns at usual amountsRisk

Who this is about

adults

Practical note

Graded low: consistent signal from a UK Biobank cohort (126 842 adults, 9 years; each 10 percentage points of energy from plant-sourced ultra-processed foods linked with 5 percent higher cardiovascular risk) and pooled unhealthful plant-based index data (all-cause mortality risk ratio 1.20 across 19 studies); all observational. A small inpatient crossover trial of ultra-processed diets in general found higher energy intake, which is indirect support.

Vegan note

Plant-based meat and dairy alternatives, sweets and refined snacks count as plant-sourced ultra-processed foods in these studies; being vegan or vegetarian does not by itself mean a whole-food pattern.

Sources

In randomised trials of adults, vegetarian and vegan diets lowered total cholesterol, LDL cholesterol and apolipoprotein B compared with omnivorous diets, with no clear change in triglycerides.

Moderate certaintyFurther research may change the size of the effect.
No known concerns at usual amountsBenefit

Who this is about

adults

Practical note

Graded moderate: a 2023 meta-analysis of 30 randomised trials found consistent effects across age, continent, duration and health status (LDL cholesterol about 0.3 mmol/L lower); downgraded one level for risk of bias because diet trials cannot be blinded. A 2023 trial in 22 identical twin pairs found an LDL difference of about 14 mg/dL after 8 weeks when both arms ate a healthy diet.

Vegan note

A well-planned vegan diet includes a reliable vitamin B12 source; see the vitamin B12 topic.

Sources