Mediterranean diet modified with more plant-based foods may reduce CV risk
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Decreased meat intake supplemented with a parallel increase in plant-based foods may amplify the beneficial cardiometabolic effects of the Mediterranean diet and reduce CV risk, according to a study published in Heart.
“The Mediterranean (MED) diet, based on higher consumption of plant-based foods, has been proved to be better than the previously widely recommended low-fat diet for reduction in cardiometabolic risk and prevention of cardiovascular diseases. Accordingly, the MED diet has gained popularity in clinical settings and is currently the backbone of clinical cardiology dietary guidelines,” Gal Tsaban, MD, internal medicine senior physician and PhD student at Ben-Gurion University of the Negev in Beer-Sheva, Israel, and colleagues wrote. “It remains unclear whether a modified MED diet, higher in green plant nutritional sources with further restriction of meat, could offer cardiometabolic benefits beyond these found with the conventional MED diet.”
To further examine the effect of a green MED diet, researchers randomly assigned 294 participants (mean age, 51 years; 88% men) with abdominal obesity or dyslipidemia (BMI, 31.3 kg/m²; waist circumference, 109.7 cm) from a previous trial to either adhere to the healthy dietary guidance (HDG) diet, the MED diet or the green MED diet.
The researchers found both the MED diet group and the green MED diet group achieved similar weight loss compared with the HDG diet group (–5.4 kg vs. –6.2 kg vs. –1.5 kg, respectively; P < .001), but the green MED diet group had the greatest reduction in waist circumference (green MED, –8.6 cm; MED, –6.8 cm; HDG, –4.3 cm; P for green MED vs. MED = .033; P for green MED vs. HDG < .001).
Further analysis showed within 6 months, patients on the green MED diet achieved the greatest decreases in LDL (green MED, –6.1 mg/dL; MED, –2.3 mg/dL, HDG, –0.2 mg/dL; P = .012), diastolic BP (green MED, –7.2 mm Hg; MED, –5.2 mm Hg; HDG, –3.4 mm Hg; P = .005), homeostatic model assessment for insulin resistance (–0.77, –0.46 and –0.21, respectively; P= .02) and LDL/HDL ratio (–0.38, –0.21 and –0.14, respectively).
Of the three groups, the green MED group also had the greatest reduction in high-sensitivity C-reactive protein (P for green MED vs. MED = .023; P for green MED vs. HDG = .044) and the greatest improvement in Framingham 10-year risk score (P for green MED vs. MED = .073; P for green MED vs. HDG < .001).
“This study’s results suggest that while calorie-restricted MED diets promote weight loss and benefit metabolic state, the green MED diet provides a significant improvement in cardiovascular risk,” Tsaban and colleagues wrote. “Additional restriction of meat intake with a parallel increase in plant-based, protein-rich foods may further benefit the cardiometabolic state ... beyond the known beneficial effects of the traditional MED diet.”
Perspective
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Monica Aggarwal, MD, FACC
This is a study looking at obese patients and randomizing them to a control who received dietary guidance vs. two interventions: Mediterranean diet and a green MED diet, which was supposed to be a more plant-based Mediterranean diet. In the study, there was significant retention to the diet interventions over 6 months and improvement in the clinical parameters with both the MED and the green MED diet.
This is another study showing the benefits of actively moving away from a standard Western diet, which is classically high in red meat, processed foods and refined carbohydrates, and implementing a Mediterranean diet, which is abundant in fruits and vegetables, whole grains, legumes and lean meats.
It seems that food intake was very similar between the two intervention groups other than the addition of green tea and a green protein supplement (Mankai) in the green MED group. I am not sure what to think about the benefits of these two items above eating a plant-based Mediterranean diet. I am also not sure how to consider this green shake addition and how to generalize this to a larger U.S. audience.
The bottom line continues to be that moving away from a standard American diet and moving toward more plants, more whole grains, nuts and seeds and legumes with lean meats is the optimal diet for improvement of cardiometabolic health. Eating more plants, more high-fiber legumes and whole grains and removing processed foods, red meats and refined carbohydrates is very doable. In this study and others, the retention rate to this style of eating is very doable.
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