Vicky Wai Ki Chan, Gebretsadkan Gebremedhin Gebretsadik, Michael T H Tse, Gianna Zhiyang Lai, Leona Yuen-Ling Leung, Andrea J Glenn, Cyril W C Kendall, Meaghan E Kavanagh, Laura Chiavaroli, David J A Jenkins, John L Sievenpiper, Kenneth Ka Hei Lo
Emerging evidence suggests the Portfolio diet may confer benefits beyond managing hyperlipidemia. This systematic review and meta-analysis evaluated the association between adherence to the Portfolio diet and disease outcomes in observational studies. Four databases were searched through September 2025, and 10 studies consisting of 513,284 participants were included. Data from 4 prospective cohort studies (n = 352,396) were pooled using random-effects models for disease outcomes. Each 1-standard deviation increase in the Portfolio Diet Score (PDS) was associated with a 6% lower risk of cardiovascular disease (CVD) (RR = 0.94, 95% CI: 0.92 to 0.96) and a 10% lower risk of all-cause mortality (RR = 0.90, 95% CI: 0.86 to 0.95). Qualitative synthesis suggested that higher adherence to the Portfolio diet was associated with lower type 2 diabetes (T2D) risk and lower odds of cancer. In conclusion, higher adherence to the Portfolio diet is inversely associated with risks of CVD and mortality, while the favorable associations with T2D and cancer remain preliminary and hypothesis-generating.