Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women
TL;DR: In healthy premenopausal women, a low-fat vegetarian diet led to rapid and sizable reductions in serum total, LDL, and HDL cholesterol concentrations, and the LDL/HDL ratio remained unchanged.
Abstract: Few controlled trials have studied cholesterol-lowering diets in premenopausal women. None has examined the cholesterol-lowering effect of a low-fat vegetarian diet, which, in other population groups, leads to marked reductions in serum cholesterol concentrations and, in combination with other life-style changes, a regression of atherosclerosis. We tested the hypothesis that a low-fat, vegetarian diet significantly reduces serum total and low-density lipoprotein (LDL) cholesterol concentrations in premenopausal women. In a crossover design, 35 women, aged 22 to 48, followed a low-fat vegetarian diet deriving approximately 10% of energy from fat for 2 menstrual cycles. For 2 additional cycles, they followed their customary diet while also taking a "supplement" (placebo) pill. Serum lipid concentrations were assessed at baseline and during each intervention phase. Mean serum LDL, high-density lipoprotein (HDL), and total cholesterol concentrations decreased 16. 9%, 16.5%, and 13.2%, respectively, from baseline to the intervention diet phase (p<0.001), whereas mean serum triacylglycerol concentration increased 18.7% (p<0.01). LDL/HDL ratio remained unchanged. Thus, in healthy premenopausal women, a low-fat vegetarian diet led to rapid and sizable reductions in serum total, LDL, and HDL cholesterol concentrations.
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Emory University1, DePaul University2, University of Miami3, Baylor College of Medicine4, Pennsylvania State University5, University of California, Irvine6, Duke University7, University of Colorado Denver8, Medical University of South Carolina9, University of Oklahoma10, University of Texas Southwestern Medical Center11, University of Illinois at Chicago12, Tulane University13, University of California, San Francisco14, Icahn School of Medicine at Mount Sinai15, Harvard University16, Virginia Commonwealth University17, University of Pennsylvania18, Rush University Medical Center19, Oregon Health & Science University20
TL;DR: This document represents a continuation of the National Lipid Association recommendations developed by a diverse panel of experts who examined the evidence base and provided recommendations regarding the following topics: lifestyle therapies and strategies to improve patient outcomes by increasing adherence and using team-based collaborative care.
690 citations
Cites background from "Effectiveness of a low-fat vegetari..."
...The therapeutic vegetarian dietary patterns most studied are the portfolio diet(29); a very-low-fat vegetarian diet, such as the Ornish Plan with ,10% of energy from fat(30,31); and lowfat vegan diet plans.(32,33)...
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TL;DR: Evidence is provided that vegetarian diets effectively lower blood concentrations of total cholesterol, low‐density lipoprotein cholesterol, high‐ density lipop Protein cholesterol, and non–high‐density cholesterol cholesterol, which could be a useful nonpharmaceutical means of managing dyslipidemia, especially hypercholesterolemia.
Abstract: Background Vegetarian diets exclude all animal flesh and are being widely adopted by an increasing number of people; however, effects on blood lipid concentrations remain unclear. This meta‐analysis aimed to quantitatively assess the overall effects of vegetarian diets on blood lipids.
Methods and Results We searched PubMed, Scopus, Embase, ISI Web of Knowledge, and the Cochrane Library through March 2015. Studies were included if they described the effectiveness of vegetarian diets on blood lipids (total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, and triglyceride). Weighted mean effect sizes were calculated for net changes by using a random‐effects model. We performed subgroup and univariate meta‐regression analyses to explore sources of heterogeneity. Eleven trials were included in the meta‐analysis. Vegetarian diets significantly lowered blood concentrations of total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, and non–high‐density lipoprotein cholesterol, and the pooled estimated changes were −0.36 mmol/L (95% CI −0.55 to −0.17; P <0.001), −0.34 mmol/L (95% CI −0.57 to −0.11; P <0.001), −0.10 mmol/L (95% CI −0.14 to −0.06; P <0.001), and −0.30 mmol/L (95% CI −0.50 to −0.10; P =0.04), respectively. Vegetarian diets did not significantly affect blood triglyceride concentrations, with a pooled estimated mean difference of 0.04 mmol/L (95% CI −0.05 to 0.13; P =0.40).
Conclusions This systematic review and meta‐analysis provides evidence that vegetarian diets effectively lower blood concentrations of total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, and non–high‐density lipoprotein cholesterol. Such diets could be a useful nonpharmaceutical means of managing dyslipidemia, especially hypercholesterolemia.
222 citations
Cites methods from "Effectiveness of a low-fat vegetari..."
...Eight trials used a parallel design, and the other 3 trials used a crossover design.(16,24,25)...
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TL;DR: Plant-based diets are associated with decreased total cholesterol, low-density cholesterol, and high-density lipoprotein cholesterol, but not with decreased triglycerides, as previously reported.
Abstract: Context Although a recent meta-analysis of randomized controlled trials showed that adoption of a vegetarian diet reduces plasma lipids, the association between vegetarian diets and long-term effects on plasma lipids has not been subjected to meta-analysis. Objective The aim was to conduct a systematic review and meta-analysis of observational studies and clinical trials that have examined associations between plant-based diets and plasma lipids. Data Sources MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for articles published in English until June 2015. Study Selection The literature was searched for controlled trials and observational studies that investigated the effects of at least 4 weeks of a vegetarian diet on plasma lipids. Data Extraction Two reviewers independently extracted the study methodology and sample size, the baseline characteristics of the study population, and the concentrations and variance measures of plasma lipids. Mean differences in concentrations of plasma lipids between vegetarian and comparison diet groups were calculated. Data were pooled using a random-effects model. Results Of the 8385 studies identified, 30 observational studies and 19 clinical trials met the inclusion criteria (N = 1484; mean age, 48.6 years). Consumption of vegetarian diets was associated with lower mean concentrations of total cholesterol (-29.2 and -12.5 mg/dL, P < 0.001), low-density lipoprotein cholesterol (-22.9 and -12.2 mg/dL, P < 0.001), and high-density lipoprotein cholesterol (-3.6 and -3.4 mg/dL, P < 0.001), compared with consumption of omnivorous diets in observational studies and clinical trials, respectively. Triglyceride differences were -6.5 (P = 0.092) in observational studies and 5.8 mg/dL (P = 0.090) in intervention trials. Conclusions Plant-based diets are associated with decreased total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, but not with decreased triglycerides. Systematic Review Registration PROSPERO number CRD42015023783. Available at: https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015023783.
205 citations
Cites background from "Effectiveness of a low-fat vegetari..."
...…name Subgroup within study Comparison Outcome Statistics for each study Difference in means and 95% CI Difference Lower Upper in means limit limit Barnard et al., 2000 (45) Vegan Omnivorous HDL -11.000 -17.000 -5.000 Miller et al., 2009 (56) Lacto-ovo Mediterranean HDL -9.800 -17.007 -2.593…...
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...…-19.829 Ling et al., 1992 (54) Vegan Omnivorous LDL -28.616 -63.682 6.450 Kestin et al., 1989 (44) Lacto-ovo Omnivorous LDL -23.589 -43.395 -3.782 Barnard et al., 2000 (45) Vegan Omnivorous LDL -14.000 -26.168 -1.832 de Mello et al., 2006 (40) Lacto-ovo Omnivorous LDL -13.148 -36.950 10.654…...
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...…2013 (52) Vegan Omnivorous TG 10.700 1.489 19.911 Burke et al., 2007 (50), pref yes Lacto-ovo Carorie restricted, low fat TG 12.400 -18.911 43.711 Barnard et al., 2000 (45) Vegan Omnivorous TG 16.000 -3.600 35.600 Nicholson et al., 1999 (53) Vegan Omnivorous TG 16.828 -106.031 139.687 Dansinger…...
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...…-20.514 Ling et al., 1992 (54) Vegan Omnivorous TC -29.776 -74.068 14.516 Kestin et al., 1989 (44) Lacto-ovo Omnivorous TC -23.589 -44.644 -2.534 Barnard et al., 2000 (45) Vegan Omnivorous TC -21.000 -36.652 -5.348 Bunner et al., 2014 (47) Vegan Omnivorous TC -14.400 -26.797 -2.003 Miller et…...
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TL;DR: Consumption of vegetarian diets is associated with improved glycemic control in type 2 diabetes and this relationship is well established.
Abstract: Introduction: Previous studies have suggested an association between vegetarian diets and improvements in glycemic control in diabetes, although this relationship is not well established. No meta-analysis of these studies has been performed.
Methods: To conduct a systematic review and meta-analysis of controlled clinical trials examining the association between vegetarian diets and glycemic control in type 2 diabetes. Data source: The electronic databases Medline, Web of Science, Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials were searched for articles published in any language through December 9, 2013. Study selection: The following criteria were used for study inclusion: (I) age of participants >20 years; (II) vegetarian diet as intervention; (III) mean difference in hemoglobin A1c (HbA1c) and/or fasting blood glucose levels used as outcomes; and (IV) controlled trials, duration ≥4 weeks. Exclusion criteria were: (I) not an original investigation; (II) duplicate samples; (III) diabetes other than type 2; (IV) multiple interventions; and (V) uncontrolled studies. Data extraction and synthesis: The data collected included study design, baseline population characteristics, dietary data, and outcomes. Data were pooled using a random-effects model. Main outcomes and measures: Differences in HbA1c and fasting blood glucose levels associated with vegetarian diets were assessed.
Results: Of 477 studies identified, six met the inclusion criteria (n=255, mean age 42.5 years). Consumption of vegetarian diets was associated with a significant reduction in HbA1c [−0.39 percentage point; 95% confidence interval (CI), −0.62 to −0.15; P=0.001; I 2 =3.0; P for heterogeneity =0.389], and a non-significant reduction in fasting blood glucose concentration (−0.36 mmol/L; 95% CI, −1.04 to 0.32; P=0.301; I 2 =0; P for heterogeneity =0.710), compared with consumption of comparator diets.
Conclusions: Consumption of vegetarian diets is associated with improved glycemic control in type 2 diabetes. PROSPERO registration number is CRD42013004370.
202 citations
Cites background from "Effectiveness of a low-fat vegetari..."
...Vegetarian (including vegan) diets have benefits for cardiovascular health (24), hypertension (25), body weight (26), and plasma lipids (27), and also provide nutritional advantages compared with omnivorous diets (28)....
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TL;DR: Of the 4 types of plant-based diets considered, interventions testing a combination diet demonstrated the greatest effects (up to 35% plasma low-density lipoprotein cholesterol reduction), followed by vegan and ovolactovegetarian diets.
Abstract: Dyslipidemia is a primary risk factor for cardiovascular disease, peripheral vascular disease, and stroke. Current guidelines recommend diet as first-line therapy for patients with elevated plasma cholesterol concentrations. However, what constitutes an optimal dietary regimen remains a matter of controversy. Large prospective trials have demonstrated that populations following plant-based diets, particularly vegetarian and vegan diets, are at lower risk for ischemic heart disease mortality. The investigators therefore reviewed the published scientific research to determine the effectiveness of plant-based diets in modifying plasma lipid concentrations. Twenty-seven randomized controlled and observational trials were included. Of the 4 types of plant-based diets considered, interventions testing a combination diet (a vegetarian or vegan diet combined with nuts, soy, and/or fiber) demonstrated the greatest effects (up to 35% plasma low-density lipoprotein cholesterol reduction), followed by vegan and ovolactovegetarian diets. Interventions allowing small amounts of lean meat demonstrated less dramatic reductions in total cholesterol and low-density lipoprotein levels. In conclusion, plant-based dietary interventions are effective in lowering plasma cholesterol concentrations.
184 citations
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TL;DR: For both CHD and total mortality, serum cholesterol was similar to diastolic blood pressure in the shape of the risk curve and in the size of the high-risk group, which supports the policy of a moderate fat intake for the general population and intensive treatment for those at high risk.
1,089 citations