‘Nutritionally rich’ plant-based diet lowers CVD risk
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A plant-based diet was associated with a reduced risk for CVD among adults, but a diet of mostly low-fat foods was not, according to a study that spanned 3 decades.
However, both diets were linked to lower LDL cholesterol (LDL-C) levels, researchers reported.
Maintaining low cholesterol to prevent coronary heart disease has been a medical tenet since the 1950s, Yuni Choi, PhD, a postdoctoral researcher in the division of epidemiology and community health at the University of Minnesota, told Healio Primary Care. In the 1980s, dietary guidelines encouraged Americans to avoid saturated fats to help prevent coronary heart disease, she said.
“However, several recently published meta-analyses of prospective studies and randomized controlled trials consistently reported that saturated fat was not associated with CVD outcomes,” she said.
Choi and colleagues analyzed data from 4,700 participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. According to the researchers, CARDIA comprised Black and white men who were aged 18 to 30 years when they were recruited from four American cities during the mid-1980s. Specifically, the researchers analyzed how closely adults in CARDIA adhered to either a low saturated fat diet or a plant-based diet. They also examined how each diet lowered LDL-C in their blood and assessed participants’ diet quality by using the A Priori Diet Quality Score (APDQS). According to study co-author David R. Jacobs, Jr., PhD, a professor of public health in the division of epidemiology and community health at the University of Minnesota, a higher APDQS signifies higher intake of nutritionally rich plant foods and less consumption of high-fat meat products and less healthy plant foods.
The researchers also determined participants’ nutrient levels by using a keys score, since “it is a good formulation of the low saturated fat message, driven by saturated fat, but also including [polyunsaturated fats] and dietary cholesterol,” Jacobs said.
Results showed that during 32 years of follow up, there were 280, 135 and 92 documented cases of CVD, CHD and stroke, respectively. Over a period of 7 years, 13-point increases in APDQS corresponded with improved LDL-C levels (0.91 mg/dL lower) in participants’ blood. In addition, multivariable-adjusted models showed that each 13-point increment in APDQS was associated with a 19% (95% CI, 4-32) risk reduction for CVD, a 22% (95% CI, 0-39) risk reduction for CHD and a 29% (95% CI, 2-48) risk reduction for stroke. These models also indicated that for each one-point increase in APDQS, HRs were 0.81 (95% CI, 0.68-0.96) for CVD, 0.78 (95% CI, 0.61-1) for CHD and 0.71 (95% CI, 0.52-0.98) for stroke.
“Our message is a nutritionally rich plant-centered diet is beneficial for cardiovascular health,” Jacobs said. “For the purpose of understanding blood cholesterol changes, saturated fat may be helpful but is not complete. Single-nutrient messaging overlooks many aspects of diets and does not predict CVD.”
The findings were presented virtually during Nutrition Live Online, the annual meeting of the American Society of Nutrition.
Perspective
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David S. Seres, MD, ScM, PNS, FASPEN
Choi and colleagues conducted a very thorough and long-term study. The findings are compelling and can help educate us on the value of fat restriction. However, data suggesting that substituting carbohydrates for fats has detrimental effects has created controversy. It is reasonable for physicians to continue to recommend a low-fat diet. Importantly, that advice should be accompanied by expert nutritional and behavioral advisement that most general practitioners lack, and referral to a nutrition specialist should be considered.
Observational studies such as this one by Choi and colleagues have the potential to have far more confounders than a randomized trial. So, the possibility remains that certain characteristics may predispose people to follow either diet and to have better health outcomes.
Past chair of the American Society for Nutrition's Medical Nutrition Council
Professor of medicine at the Institute of Human Nutrition
Director of medical nutrition and associate clinical ethicist at Columbia University Irving Medical Center
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