Evidence for plant-based diets in cardiovascular health and lipid management
Plant-based diets, especially when rich in high quality plant foods such as whole grains, fruits, vegetables, pulses and nuts, have been associated with lower risk of cardiovascular outcomes and intermediate risk factors[i],[ii],[iii],[iv] including lipids[v],[vi].
Studies examining plant-based dietary patterns – which use plant-based indices to give higher scores for greater consumption of plant foods and lower consumption of animal foods – have found that greater adherence to these diets was associated with a lower risk of coronary heart disease and all‐cause mortality[vii],[viii],[ix].
Effects of plant proteins on lipids
A review[x] of published meta-analyses of RCTs[xi-xviii] found that tree nuts improved total cholesterol and LDL-C relative to a range of comparison diets. Soya containing foods or soya protein improved all lipid and lipoprotein parameters, and legumes reduced LDL-C when measured against comparison diets.
[i] Ambika Satija a , Frank B. Hu (2018) Plant-based diets and cardiovascular health Trends in Cardiovascular Medicine 28 (2018) 437–441
[ii] Dinu M, Abbate R, Gensini GF, et al (2017) Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr.22;57(17):3640-3649. doi: 10.1080/10408398.2016.1138447.
[iii] Kahleova H, Levin S, Barnard N.(2017) Cardio-Metabolic Benefits of Plant-Based Diets. Nutrients.9;9(8). pii: E848. doi: 10.3390/nu9080848.
[iv] Appleby PN, Crowe FL, Bradbury KE, et al. (2016) Mortality in vegetarians and comparable nonvegetarians in the United Kingdom. Am J Clin Nutr. 103(1):218-30. doi: 10.3945/ajcn.115.119461. Epub 2015 Dec 9.
[v] Yokoyama Y, Levin SM, Barnard ND. (2017) Association between plant-based diets and plasma lipids: a systematic review and meta-analysis. Nutr Rev.75:683–698. doi: 10.1093/nutrit/nux030
[vi] Wang F, Zheng J, Yang B, Jiang J, et al (2015) Effects of vegetarian diets on blood lipids: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 4(10):e002408. doi: 10.1161/JAHA.115.002408.
[vii] Martínez‐González MA, Sánchez‐Tainta A, Corella D, et al; PREDIMED Group (2014) A provegetarian food pattern and reduction in total mortality in the Prevención con Dieta Mediterránea (PREDIMED) study. Am J Clin Nutr. 100:320S–328S
[viii] Satija A, Bhupathiraju SN, Rimm EB, et al. (2016) Plant‐based dietary patterns and incidence of type 2 diabetes in US men and women: results from three prospective cohort studies. PLoS Med. 13:e1002039
[ix] Satija A, Bhupathiraju SN, Spiegelman D, et al. (2017) Healthful and unhealthful plant‐based diets and the risk of coronary heart disease in U.S. adults. J Am Coll Cardiol. 70:411–422
[x] Marta Guasch-Ferré, Ambika Satija, et al (2019) Meta-Analysis of Randomized Controlled Trials of Red Meat Consumption in Comparison With Various Comparison Diets on Cardiovascular Risk Factors. Circulation;139:1828–1845 https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.118.035225
[xi] Del Gobbo LC, Falk MC, Feldman R, Lewis K, Mozaffarian D. (2015) Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis, and dose-response of 61 controlled intervention trials. Am J Clin Nutr.102:1347–1356. doi: 10.3945/ajcn.115.110965
[xii] Blanco Mejia S, Kendall CW, Viguiliouk E, Augustin LS, et al (2014) Effect of tree nuts on metabolic syndrome criteria: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 4:e004660. doi: 10.1136/bmjopen-2013-004660
[xiii] Guasch-Ferré M, Li J, Hu FB, et al (2018) Effects of walnut consumption on blood lipids and other cardiovascular risk factors: an updated meta-analysis and systematic review of controlled trials. Am J Clin Nutr. 108:174–187. doi: 10.1093/ajcn/nqy091
[xiv] Phung OJ, Makanji SS, White CM, Coleman CI (2009) Almonds have a neutral effect on serum lipid profiles: a meta-analysis of randomized trials. J Am Diet Assoc.109:865–873. doi: 10.1016/j.jada.2009.02.014
[xv] Harland JI, Haffner TA. (2008) Systematic review, meta-analysis and regression of randomised controlled trials reporting an association between an intake of circa 25 g soya protein per day and blood cholesterol. Atherosclerosis. 200:13–27. doi: 10.1016/j.atherosclerosis.2008.04.006
[xvi] Anderson JW, Bush HM. (2011) Soy protein effects on serum lipoproteins: a quality assessment and meta-analysis of randomized, controlled studies. J Am Coll Nutr. 30:79–91.
[xvii] Tokede OA, Onabanjo TA, Yansane A, et al (2015) Soya products and serum lipids: a meta-analysis of randomised controlled trials. Br J Nutr.114:831–843. doi: 10.1017/S0007114515002603
[xviii] Ha V, Sievenpiper JL, de Souza RJ, et al (2014) Effect of dietary pulse intake on established therapeutic lipid targets for cardiovascular risk reduction: a systematic review and meta-analysis of randomized controlled trials. CMAJ.186:E252–E262. doi: 10.1503/cmaj.131727