The Portfolio Diet in the Prevention and Management of Cardiovascular Disease

Authors

Keywords:

Portfolio diet, Nutrition, Sustainability, Cardiovascular disease

Abstract

Cardiovascular disease (CVD) ranks as the primary cause of global mortality. The present review is designed to provide a comprehensive evaluation of the portfolio dietary pattern—an approach endorsed in the Canadian Cardiovascular Society (CCS) guidelines emphasizing viscous fiber, plant sterols, soy/plant protein, nuts, and monounsaturated fatty acids (MUFA)—with respect to its multifaceted impacts on lipid profiles, blood pressure, body weight, glycemic regulation, systemic inflammation, and environmental sustainability. A comprehensive literature search was conducted across the PubMed/MEDLINE, ScienceDirect, Google Scholar, and ResearchGate databases to identify randomized controlled trials (RCTs), cohort studies, and meta-analyses published between 2000 and 2026. Current evidence indicates that the most pronounced and robust clinical efficacy of the portfolio diet lies in improving serum lipid profiles, highlighted by low-density lipoprotein cholesterol (LDL-C) reductions comparable to those achieved with low-dose statin therapy. In contrast, evidence regarding the diet's effects on body weight management, blood pressure control, blood glucose levels, and inflammatory markers, as well as its environmental sustainability, remains limited, preliminary, and variable. In conclusion, the portfolio dietary pattern should be framed as a complementary therapeutic nutrition strategy to support standard pharmacological interventions rather than a substitute. Further large-scale clinical studies are required to confirm its long-term clinical efficacy and evaluate its cultural feasibility with regional dietary alternatives (e.g., soy substitutes).

References

Anderson, T. J., Grégoire, J., Pearson, G. J., Barry, A. R., Couture, P., Dawes, M., Francis, G.A., Genest, J., Grover, S., Gupta, M., Hegele, R. A., Lau, D. C., Leiter, L. A., Lonn, E., Mancini, G. B. J., McPherson, R., Ngui, D., Poirier, P., Sievenpiper, J. L., … Ward, R. (2016). 2016 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult. Canadian Journal of Cardiology, 32(11), 1263–1282. https://doi.org/10.1016/j.cjca.2016.07.510

Canadian Cardiovascular Society. (2023). The portfolio diet: An evidence-based eating plan for lower cholesterol [Infographic]. https://ccs.ca/wp-content/uploads/2023/11/portfolio-Infographic-EN_7Nov2023.pdf

Chen, V., Chiavaroli, L., Glenn, A. J., Kavanagh, M. E., Zeitoun, T., Mahdavi, S., Kendall, C. W. C., Jenkins, D. J. A., El-Sohemy, A., & Sievenpiper, J. L. (2025). Portfolio diet and LDL-C in a young, multiethnic cohort: Cross-sectional analyses with cumulative exposure modeling. BMC Public Health, 25(1), 1761. https://doi.org/10.1186/S12889-025-22479-9

Chiavaroli, L., Kavanagh, M., Back, S., Chen, V., Sievenpiper, J., Kendall, C., & Jenkins, D. (2023). The association between the clinical portfolio diet score and A1c in type 2 diabetes mellitus: An exploratory analysis of two randomized dietary trials. Canadian Journal of Diabetes, 47(7), S122. https://doi.org/10.1016/j.jcjd.2023.10.400

Chiavaroli, L., Nishi, S. K., Khan, T. A., Braunstein, C. R., Glenn, A. J., Mejia, S. B., Rahelić, D., Kahleová, H., Salas-Salvadó, J., Jenkins, D. J. A., Kendall, C. W. C., & Sievenpiper, J. L. (2018). Portfolio dietary pattern and cardiovascular disease: A systematic review and meta-analysis of controlled trials. Progress in Cardiovascular Diseases, 61(1), 43–53. https://doi.org/10.1016/j.pcad.2018.05.004

Chiavaroli, L., Viguiliouk, E., Nishi, S. K., Mejia, S. B., Rahelić, D., Kahleová, H., Salas-Salvadó, J., Kendall, C. W. C., & Sievenpiper, J. L. (2019). DASH dietary pattern and cardiometabolic outcomes: An umbrella review of systematic reviews and meta-analyses. Nutrients, 11(2), 338. https://doi.org/10.3390/nu11020338

EFSA Panel on Dietetic Products, Nutrition, and Allergies. (2010). Scientific opinion on dietary reference values for carbohydrates and dietary fibre. EFSA Journal, 8(3), 1462. https://doi.org/10.2903/j.efsa.2010.1462

Ghavami, A., Ziaei, R., Talebi, S., Barghchi, H., Nattagh-Eshtivani, E., Moradi, S., Rahbarinejad, P., Mohammadi, H., Ghasemi-Tehrani, H., Marx, W., & Askari, G. (2023). Soluble fiber supplementation and serum lipid profile: A systematic review and dose-response meta-analysis of randomized controlled trials. Advances in Nutrition, 14(3), 465–474. https://doi.org/10.1016/j.advnut.2023.01.005

Glenn, A. J., Hernández-Alonso, P., Kendall, C. W. C., Martínez-González, M. Á., Corella, D., Fitó, M., Martínez, J. A., Alonso-Gómez, Á. M., Wärnberg, J., Vioque, J., Romaguera, D., López-Miranda, J., Estruch, R., Tinahones, F. J., Lapetra, J., Serra-Majem, J. L., Bueno-Cavanillas, A., Tur, J. A., Celada, S. R., … Salas-Salvadó, J. (2021a). Longitudinal changes in adherence to the portfolio and DASH dietary patterns and cardiometabolic risk factors in the PREDIMED-Plus study. Clinical Nutrition, 40(5), 2825–2836. https://doi.org/10.1016/j.clnu.2021.03.016

Glenn, A. J., Lo, K., Jenkins, D. J. A., Boucher, B. A., Hanley, A. J., Kendall, C. W., Manson, J. E., Vitolins, M. Z., Snetselaar, L. G., Liu, S., & Sievenpiper, J. L. (2021b). Relationship between a plant-based dietary portfolio and risk of cardiovascular disease: Findings from the women’s health initiative prospective cohort study. Journal of the American Heart Association, 10, e021515. https://doi.org/10.1161/JAHA.121.021515

Glenn, A. J., Boucher, B. A., Kavcic, C. C., Khan, T. A., Paquette, M., Kendall, C. W. C., Hanley, A. J., Jenkins, D. J. A., & Sievenpiper, J. L. (2021c). Development of a portfolio diet score and its concurrent and predictive validity assessed by a food frequency questionnaire. Nutrients, 13(8), 2850. https://doi.org/10.3390/nu13082850

Glenn, A. J., Guasch-Ferré, M., Malik, V. S., Kendall, C. W. C., Manson, J. A. E., Rimm, E. B., Willett, W. C., Sun, Q., Jenkins, D. J. A., Hu, F. B., & Sievenpiper, J. L. (2023a). Portfolio diet score and risk of cardiovascular disease: Findings from 3 prospective cohort studies. Circulation, 148(22), 1750–1763. https://doi.org/10.1161/CIRCULATIONAHA.123.065551

Glenn, A. J., Li, J., Lo, K., Jenkins, D. J. A., Boucher, B. A., Hanley, A. J., Kendall, C. W. C., Shadyab, A. H., Tinker, L. F., Chessler, S. D., Howard, B. V, Liu, S., & Sievenpiper, J. L. (2023b). The portfolio diet and incident Type 2 Diabetes: Findings from the women’s health initiative prospective cohort study. Diabetes Care, 46(1), 28–37. https://doi.org/10.2337/dc22-1029

Ho, X. L., & Loke, W. M. (2017). Dietary plant sterols supplementation increases in vivo nitrite and nitrate production in healthy adults: A randomized, controlled study. Journal of Food Science, 82(7), 1750–1756. https://doi.org/10.1111/1750-3841.13752

International Diabetes Federation. (2025). IDF diabetes atlas (11th ed.). https://diabetesatlas.org/resources/idf-diabetes-atlas-2025

Jenkins, D. J. A., Chiavaroli, L., Wong, J. M. W., Kendall, C., Lewis, G. F., Vidgen, E., Connelly, P. W., Leiter, L. A., Josse, R. G., & Lamarche, B. (2010). Adding monounsaturated fatty acids to a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. Canadian Medical Association Journal, 182(18), 1961-1967. https://doi.org/10.1503/cmaj.092128

Jenkins, D. J. A., Jones, P. J., Frohlich, J., Lamarche, B., Ireland, C., Nishi, S. K., Srichaikul, K., Galange, P., Pellini, C., Faulkner, D., De Souza, R. J., Sievenpiper, J. L., Mirrahimi, A., Jayalath, V. H., Augustin, L. S., Bashyam, B., Leiter, L. A., Josse, R., Couture, P. … Kendall, C. W. C. (2015). The effect of a dietary portfolio compared to a DASH-type diet on blood pressure. Nutrition, Metabolism & Cardiovascular Diseases, 25(12), 1132-1139. https://doi.org/10.1016/j.numecd.2015.08.006

Jenkins, D. J. A., Kendall, C. W. C., Faulkner, D. A., Nguyen, T., Kemp, T., Marchie, A., Wong, J. M. W., De Souza, R., Emam, A., Vidgen, E., Trautwein, E. A., Lapsley, K. G., Holmes, C., Josse, R. G., Leiter, L. A., Connelly, P. W., & Singer, W. (2006). Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. The American Journal of Clinical Nutrition, 83(3), 582–591. https://doi.org/10.1093/ajcn.83.3.582

Jenkins, D. J. A., Kendall, C. W. C., Faulkner, D., Vidgen, E., Trautwein, E. A., Parker, T. L., Marchie, A., Koumbridis, G., Lapsley, K. G., Josse, R. G., Leiter, L. A., & Connelly, P. W. (2002). A dietary portfolio approach to cholesterol reduction: Combined effects of plant sterols, vegetable proteins, and viscous fibers in hypercholesterolemia. Metabolism: Clinical and Experimental, 51(12), 1596–1604. https://doi.org/10.1053/meta.2002.35578

Jenkins, D. J. A., Kendall, C. W. C., Marchie, A., Faulkner, D. A., Wong, J. M. W., De Souza, R., Emam, A., Parker, T. L., Vidgen, E., Lapsley, K. G., Trautwein, E. A., Josse, R. G., Leiter, L. A., & Connelly, P. W. (2003). Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA, 290(4), 502–510. https://doi.org/10.1001/jama.290.4.502

Johnston, J. L., Fanzo, J. C., & Cogill, B. (2014). Understanding sustainable diets: A descriptive analysis of the determinants and processes that influence diets and their impact on health, food security, and environmental sustainability. Advances in Nutrition, 5(4), 418–429. https://doi.org/10.3945/AN.113.005553

Kavanagh, M. E., Back, S., Chen, V., Glenn, A. J., Viscardi, G., Houshialsadat, Z., Sievenpiper, J. L., Kendall, C. W. C., Jenkins, D. J. A., & Chiavaroli, L. (2024). The portfolio diet and HbA1c in adults living with type 2 diabetes mellitus: A patient-level pooled analysis of two randomized dietary trials. Nutrients, 16(17), 2817. https://doi.org/10.3390/NU16172817

Kavanagh, M. E., Zurbau, A., Glenn, A. J., Oguntala, J. O., Josse, R. G., Malik, V. S., Chiavaroli, L., Liu, S., Kendall, C. W. C., Jenkins, D. J. A., & Sievenpiper, J. L. (2025). The portfolio dietary pattern and risk of cardiovascular disease mortality during 1988–2019 in US adults: a prospective cohort study. BMC Medicine, 23(1), 287. https://doi.org/10.1186/s12916-025-04067-1

Kent, G., Kehoe, L., Flynn, A., & Walton, J. (2022). Plant-based diets: a review of the definitions and nutritional role in the adult diet. Proceedings of the Nutrition Society, 81(1), 62–74. https://doi.org/10.1017/S0029665121003839

Lopez-Jimenez, F., Di Cesare, M., Powis, J., Shrikhande, S., Adeoye, M., Codato, E., Zhou, B., Bixby, H., Evans, N., Lara-Breitinger, K., Rodriguez, M. A., Hadeed, L., Barquera, S., Taylor, S., Perel, P., Pineiro, D., Narula, J., & Pinto, F. (2025). The weight of cardiovascular diseases: Addressing the global cardiovascular crisis associated with obesity. Global Heart, 20(1), Article 68. https://doi.org/10.5334/gh.1451

Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Casula, M., Badimon, L., Chapman, M. J., De Backer, G. G., Delgado, V., Ference, B. A., Graham, I. M., Halliday, A., Landmesser, U., Mihaylova, B., Pedersen, T. R., Riccardi, G., Richter, D. J., Sabatine, M. S., Taskinen, M.-R., … Wiklund, O. (2020). 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal, 41(1), 111–188. https://doi.org/10.1093/eurheartj/ehz455

Malmir, H., Hosseinpour-Niazi, S., Gaeini, Z., Mirmiran, P., & Azizi, F. (2025). Adherence to portfolio diet and risk of type 2 diabetes mellitus in a population-based prospective cohort study. Journal of Diabetes and Metabolic Disorders, 24(2), 178. https://doi.org/10.1007/S40200-025-01695-5

Mensink, R. P. (2016). Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and regression analysis. World Health Organization. https://iris.who.int/handle/10665/246104

Meybeck, A., & Gitz, V. (2017). Sustainable diets within sustainable food systems. Proceedings of the Nutrition Society, 76(1), 1–11. https://doi.org/10.1017/S0029665116000653

Ministry of Health (MoH) of the Republic of Türkiye. (2022). Türkiye beslenme rehberi (TÜBER) 2022 [dietary guidelines for Türkiye (TÜBER) 2022]. https://hsgm.saglik.gov.tr/tr/web-uygulamalarimiz/357.html

Rockström, J., Thilsted, S. H., Willett, W. C., Gordon, L. J., Herrero, M., Hicks, C. C., Mason-D’Croz, D., Rao, N., Springmann, M., Wright, E. C., Agustina, R., Bajaj, S., Bunge, A. C., Carducci, B., Conti, C., Covic, N., Fanzo, J., Forouhi, N. G., Gibson, M. F., … DeClerck, F. (2025). The EAT–Lancet Commission on healthy, sustainable, and just food systems. The Lancet, 406(10512), 1625–1700. https://doi.org/10.1016/s0140-6736(25)01201-2

Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., Barengo, N. C., Beaton, A., Benjamin, E. J., Benziger, C. P., Bonny, A., Brauer, M., Brodmann, M., Cahill, T. J., Carapetis, J. R., Catapano, A. L., Chugh, S., Cooper, L. T., Coresh, J., … Fuster, V. (2020). Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology, 76(25), 2982-3021. https://doi.org/10.1016/J.JACC.2020.11.010

Society of Endocrinology and Metabolism of Turkey (SEMT). (2024). Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu 2024. [Guidelines for the diagnosis, treatment, and follow-up of diabetes mellitus and its complications 2024]. https://file.temd.org.tr/Uploads/publications/guides/documents/diabetesmellitus2024.pdf

Trautwein, E. A., & McKay, S. (2020). The role of specific components of a plant-based diet in management of dyslipidemia and the impact on cardiovascular risk. Nutrients, 12(9), 2671. https://doi.org/10.3390/NU12092671

Turkish Statistical Institute. (2026a). Ölüm ve ölüm nedeni istatistikleri, 2025 [Death and causes of death statistics, 2025] (Press Release No. 58233). https://veriportali.tuik.gov.tr/tr/press/58233/metadata

Turkish Statistical Institute. (2026b). Türkiye sağlık araştırması, 2025 [Türkiye health survey, 2025] (Press Release No. 53990). https://veriportali.tuik.gov.tr/tr/press/53990

U.S. Department of Agriculture, & U.S. Department of Health and Human Services. (2026). Dietary guidelines for Americans, 2025–2030. https://cdn.realfood.gov/DGA.pdf

Wang, Y. B., Page, A. J., Gill, T. K., & Melaku, Y. A. (2023). The association between diet quality, plant-based diets, systemic inflammation, and mortality risk: Findings from NHANES. European Journal of Nutrition, 62(7), 2723–2737. https://doi.org/10.1007/S00394-023-03191-Z

Willett, W., Rockström, J., Loken, B., Springmann, M., Lang, T., Vermeulen, S., Garnett, T., Tilman, D., DeClerck, F., Wood, A., Jonell, M., Clark, M., Gordon, L. J., Fanzo, J., Hawkes, C., Zurayk, R., Rivera, J. A., De Vries, W., Majele Sibanda, L., … Murray, C. J. L. (2019). Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. The Lancet, 393(10170), 447–492. https://doi.org/10.1016/S0140-6736(18)31788-4

Wood, A. D., Strachan, A. A., Thies, F., Aucott, L. S., Reid, D. M., Hardcastle, A. C., Mavroeidi, A., Simpson, W. G., Duthie, G. G., & Macdonald, H. M. (2014). Patterns of dietary intake and serum carotenoid and tocopherol status are associated with biomarkers of chronic low-grade systemic inflammation and cardiovascular risk. British Journal of Nutrition, 112(8), 1341–1352. https://doi.org/10.1017/S0007114514001962

World Health Organization. (2007). Prevention of cardiovascular disease: Guidelines for assessment and management of total cardiovascular risk. https://www.who.int/publications/i/item/9789241547178

World Health Organization. (2025a). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

World Health Organization (2025b). Global report on hypertension 2025: high stakes - turning evidence into action. https://www.who.int/publications/i/item/9789240115569

World Health Organization (2025c). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension

World Health Organization. (2026a). Dyslipidaemia. https://www.who.int/news-room/fact-sheets/detail/dyslipidaemia

World Health Organization. (2026b). Healthy diet. https://www.who.int/news-room/fact-sheets/detail/healthy-diet

Wu, X., Tjahyo, A. S., Volchanskaya, V. S. B., Wong, L. H., Lai, X., Yong, Y. N., Osman, F., Tay, S. L., Govindharajulu, P., Ponnalagu, S., Tso, R., Teo, H. S., Khoo, K., Fan, H., Goh, C. C., Yap, C. P. L., Leow, M. K. S., Henry, C. J., Haldar, S., & Lim, K. J. (2025). A legume-enriched diet improves metabolic health in prediabetes mediated through gut microbiome: a randomized controlled trial. Nature Communications, 16(1), Article 942. https://doi.org/10.1038/s41467-025-56084-6

Xu, Y., Sutanto, C. N., Xia, X., Toh, D. W. K., Gan, A. X., Deng, Q., Ling, L. H., Khoo, C. M., Foo, R. S. Y., & Kim, J. E. (2025). Consumption of plant sterols-enriched soy milk with a healthy dietary pattern diet lowers blood pressure in adults with metabolic syndrome: A randomized controlled trial. Nutrition, Metabolism and Cardiovascular Diseases, 35(1), 103773. https://doi.org/10.1016/j.numecd.2024.10.011

Downloads

Published

2026-10-20

How to Cite

Kılıç, S., & Eşer Durmaz, S. (2026). The Portfolio Diet in the Prevention and Management of Cardiovascular Disease. Journal of Nutritional Research & Dietetics, 1(1), 29–39. Retrieved from https://www.nutritionalresearchdietetics.com/index.php/jnrd/article/view/9

Issue

Vol. 1 No. 1 (2026): December 2026 (In progress)

Section

Review Article

License

Copyright (c) 2026 Sinem Kılıç, Sevinç Eşer Durmaz

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

All articles are published under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). This license permits others to share, adapt, and build upon the work for non-commercial purposes, provided appropriate credit is given to the authors and the journal, and a link to the license is included.

Authors retain copyright of their work and grant the journal the right to publish and distribute the article.