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The effect of green Mediterranean diet on cardiometabolic risk; a randomised controlled trial.

Authors :
Tsaban G
Yaskolka Meir A
Rinott E
Zelicha H
Kaplan A
Shalev A
Katz A
Rudich A
Tirosh A
Shelef I
Youngster I
Lebovitz S
Israeli N
Shabat M
Brikner D
Pupkin E
Stumvoll M
Thiery J
Ceglarek U
Heiker JT
Körner A
Landgraf K
von Bergen M
Blüher M
Stampfer MJ
Shai I
Source :
Heart (British Cardiac Society) [Heart] 2021 Jun 11; Vol. 107 (13), pp. 1054-1061. Date of Electronic Publication: 2021 Jun 11.
Publication Year :
2021

Abstract

Background: A Mediterranean diet is favourable for cardiometabolic risk.<br />Objective: To examine the residual effect of a green Mediterranean diet, further enriched with green plant-based foods and lower meat intake, on cardiometabolic risk.<br />Methods: For the DIRECT-PLUS parallel, randomised clinical trial we assigned individuals with abdominal obesity/dyslipidaemia 1:1:1 into three diet groups: healthy dietary guidance (HDG), Mediterranean and green Mediterranean diet, all combined with physical activity. The Mediterranean diets were equally energy restricted and included 28 g/day walnuts. The green Mediterranean diet further included green tea (3-4 cups/day) and a Wolffia globosa (Mankai strain; 100 g/day frozen cubes) plant-based protein shake, which partially substituted animal protein. We examined the effect of the 6-month dietary induction weight loss phase on cardiometabolic state.<br />Results: Participants (n=294; age 51 years; body mass index 31.3 kg/m <superscript>2</superscript> ; waist circumference 109.7 cm; 88% men; 10 year Framingham risk score 4.7%) had a 6-month retention rate of 98.3%. Both Mediterranean diets achieved similar weight loss ((green Mediterranean -6.2 kg; Mediterranean -5.4 kg) vs the HDG group -1.5 kg; p<0.001), but the green Mediterranean group had a greater reduction in waist circumference (-8.6 cm) than the Mediterranean (-6.8 cm; p=0.033) and HDG (-4.3 cm; p<0.001) groups. Stratification by gender showed that these differences were significant only among men. Within 6 months the green Mediterranean group achieved greater decrease in low-density lipoprotein cholesterol (LDL-C; green Mediterranean -6.1 mg/dL (-3.7%), -2.3 (-0.8%), HDG -0.2 mg/dL (+1.8%); p=0.012 between extreme groups), diastolic blood pressure (green Mediterranean -7.2 mm Hg, Mediterranean -5.2 mm Hg, HDG -3.4 mm Hg; p=0.005 between extreme groups), and homeostatic model assessment for insulin resistance (green Mediterranean -0.77, Mediterranean -0.46, HDG -0.27; p=0.020 between extreme groups). The LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio decline was greater in the green Mediterranean group (-0.38) than in the Mediterranean (-0.21; p=0.021) and HDG (-0.14; p<0.001) groups. High-sensitivity C-reactive protein reduction was greater in the green Mediterranean group (-0.52 mg/L) than in the Mediterranean (-0.24 mg/L; p=0.023) and HDG (-0.15 mg/L; p=0.044) groups. The green Mediterranean group achieved a better improvement (-3.7% absolute risk reduction) in the 10-year Framingham Risk Score (Mediterranean-2.3%; p = 0.073, HDG-1.4%; p<0.001).<br />Conclusions: The green MED diet, supplemented with walnuts, green tea and Mankai and lower in meat/poultry, may amplify the beneficial cardiometabolic effects of Mediterranean diet.<br />Trial Registration Number: This study is registered under ClinicalTrials.gov Identifier no NCT03020186.<br />Competing Interests: Competing interests: IrS advises the nutritional committee of Hinoman, Ltd. All other authors have no relevant conflict of interest to disclose.<br /> (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Details

Language :
English
ISSN :
1468-201X
Volume :
107
Issue :
13
Database :
MEDLINE
Journal :
Heart (British Cardiac Society)
Publication Type :
Academic Journal
Accession number :
33234670
Full Text :
https://doi.org/10.1136/heartjnl-2020-317802