A related editorial discusses the findings of this study, raising the important issue of isocaloric replacements: “the relevant question is not whether to consume more plant-based foods or not, but to know which are the detrimental foods that should be replaced by fruits, vegetables, and legumes and in what amount. Importantly, fruits and vegetables are consumed as part of an overall dietary pattern. It has been observed that plant-based diets can have differential effects if these plant-based diets fall on the healthier or unhealthier side of the spectrum. Therefore, a healthy diet rich in fruits and vegetables needs to be considered as part of a high-quality overall eating pattern, and this pattern should be based on country-specific dietary traditions to be fostered as an effective tool for prevention of cardiovascular disease and premature mortality”.