Clinical dietary guidelines consistently promote plant-based foods

Key takeaways:

• Governments, medical societies and stakeholders worldwide agree that plant-based foods help prevent and treat chronic diseases.
• The findings should increase physicians’ confidence in making dietary recommendations.

Of nearly 80 dietary clinical practice guidelines, most were aligned in their recommendations for consumption of plant-based diets and avoidance of salt, sodium and alcohol, a recent study found.

“There is so much consumer confusion surrounding nutrition, and since physicians frequently receive very limited nutrition education as part of medical training, this study can provide assurance that the key messages to impart to patients are to focus on eating more whole, plant foods,” Micaela C. Karlsen, PhD, MPSH, research director of the American College of Lifestyle Medicine, told Healio.

Uncertainty on nutritional management has also extended to patients, who “have reported feeling confused by conflicting nutrition messaging,” Karlsen and colleagues wrote in Advances in Nutrition. “Therefore, investigating the alignment of dietary guidance among [clinical practice guidelines (CPGs)] and elucidating dietary recommendations largely supported by these evidence-based documents could benefit patients and clinicians as well those who guide and develop clinical care policies.”

The researchers analyzed 78 CGPs, published across the globe from 2010 to 2022, which provided guidance on several food groups, diets and patterns for populations that are generally healthy or possess certain chronic conditions.

Of the total CPGs, 83% were from major medical professional societies, 12% were from governments and 5% were from health stakeholder associations. Additionally, 41% of CPGs were from North America and 64% targeted adults aged 18 years and older.

“Nearly half of included guidelines focused on the prevention, management or treatment of CVD or related conditions,” the researchers wrote, while others frequently focused on conditions such as type 2 diabetes, digestive diseases and autoimmune diseases.

Overall, 91% of CPGs made dietary pattern recommendations, while 49% advocated for diets centered around plant foods. The most frequently recommended diets included the:

• Mediterranean diet (33%);
• DASH diet (26%); and
• a healthy eating pattern (24%).

“While 38% of guidelines recommended a single dietary pattern, 53% recommended multiple dietary patterns,” Karlsen and colleagues wrote.

Vegetables were the most promoted food group by CGPs at 74%, followed by fruit and whole grains at 68% and 58%, respectively. Also recommended were:

• legumes and pulses (47%);
• any nuts or seeds (44%);
• low-fat dairy (38%); and
• any fish or seafood (36%).

The researchers pointed out that trends in recommendations “varied somewhat” among CPGs on chronic conditions compared with overall guidance. For CPGs that focused on diabetes, 75% recommended legumes and nuts. CPGs targeting CVD populations similarly supported the consumption of that food group (60%), in addition to nuts and seeds (67%).

“The guidelines were also consistent in their cautions about certain components: 62% recommended decreasing or limiting alcohol, and 56% reducing salt or sodium,” Karlsen said.

Additionally, more than 30% cautioned against sugar sweetened beverages and added sweets or sugars.

Karlsen and colleagues wrote that the consistency of messaging across CGPs “becomes clear in the context of typical U.S. dietary intakes.”

“On average, American adults consume fewer vegetables, fruits, whole grains and legumes than the [Dietary Guidelines for Americans] standards,” they wrote. “Thus, it is essential that consistent messaging around healthy eating be at the forefront of medical treatment as done in the field of lifestyle medicine.”

The researchers concluded that future guideline developers should follow standards of methodology and reporting to ensure trustworthiness.

“Based on current evidence, clinicians should feel confident making these recommendations in accordance with their respective practice guidelines,” they wrote.

References:

• Cara K, et al. Adv Nutr. 2023;doi:10.1016/j.advnut.2023.03.007.
• Consistency in clinical practice guidelines: Eat more plant foods. https://lifestylemedicine.org/consistency-in-clinical-practice-guidelines/. Accessed March 28, 2023.