Among 3,990 children in the Dutch Generation R cohort, a higher healthful plant-based diet index (hPDI) score at age 8 was associated with meaningfully lower systolic blood pressure (β = −0.05 SDS per 10-point increment), lower diastolic blood pressure (β = −0.07 SDS), and lower total cholesterol (β = −0.06 SDS) by age 10. Crucially, unhealthful plant-based diets (uPDI) — high in refined grains, sugars, and processed plant foods — showed inverse associations with phospholipids and carnitines, and a less favorable metabolic fingerprint, despite being cheaper. Neither triglycerides nor insulin were significantly affected by any dietary pattern.
This is a well-powered cohort study with metabolomic depth rarely seen in pediatric dietary research, making it more than incremental. The key insight for adult health is longitudinal: cardiometabolic risk trajectories are established early, and blood pressure and cholesterol patterns in childhood track into adulthood. The findings underscore that food quality within plant-based eating matters enormously — swapping meat for ultra-processed plant foods does not confer the same benefit. The cost analysis is particularly valuable for public health: healthy plant-based diets were not more expensive than conventional diets, challenging a common barrier argument. Limitations include the observational design, single dietary assessment, and a predominantly Dutch population limiting global generalizability. Still, the convergence of clinical markers and metabolomics strengthens causal plausibility.