A Whole-Diet Approach Affects Not Only Fasting but Also Postprandial Cardiometabolic Risk Markers in Overweight and Obese Adults: A Randomized Controlled Trial

Abstract

Background Current dietary recommendations for cardiovascular disease (CVD) prevention focus more on dietary patterns than on single nutrients. However, randomized controlled trials using whole-diet approaches to study effects on both fasting and postprandial CVD risk markers are limited. Objective This randomized parallel trial compared the effects of a healthy diet (HD) with those of a typical Western diet (WD) on fasting and postprandial CVD risk markers in overweight and obese adults. Methods After a 2-wk run-in period, 40 men and women (50–70 y; BMI: 25–35 kg/m2) consumed the HD (high in fruit and vegetables, pulses, fibers, nuts, fatty fish, polyunsaturated fatty acids; low in salt and high-glycemic carbohydrates; n = 19) or the WD (less fruit, vegetables, and fibers; no nuts and fatty fish; and more saturated fatty acids and simple carbohydrates; n = 21) for 6 wk. Fasting and postprandial cardiometabolic risk markers were assessed as secondary outcome parameters during a 5-h mixed-meal challenge, and a per protocol analysis was performed using 1-factor ANCOVA or linear mixed models. Results Differences in diet-induced changes are expressed relative to the HD group. Changes in fasting plasma total cholesterol (–0.57 ± 0.12 mmol/L, P < 0.001), LDL cholesterol (–0.41 ± 0.12 mmol/L, P < 0.01), apolipoprotein B100 (–0.09 ± 0.03 g/L, P < 0.01), and apolipoprotein A1 (–0.06 ± 0.03 g/L, P = 0.05) were significantly different between the diet groups. Changes in postprandial plasma triacylglycerol (diet × time, P < 0.001) and apolipoprotein B48 (P < 0.01) differed significantly between the groups with clear improvements on the HD, although fasting triacylglycerols (–0.24 ± 0.13 mmol/L, P = 0.06) and apolipoprotein B48 (1.04 ± 0.67 mg/L, P = 0.40) did not. Significant differences between the diets were also detected in fasting systolic (–6.9 ± 3.1 mmHg, P < 0.05) and 24-h systolic (–5.0 ± 1.7 mmHg, P < 0.01) and diastolic (–3.3 ± 1.1 mmHg, P < 0.01) blood pressure. Conclusion A whole-diet approach targeted multiple fasting and postprandial CVD risk markers in overweight and obese adults. In fact, the postprandial measurements provided important additional information to estimate CVD risk. This trial is registered at clinicaltrials.gov as NCT02519127.

Comparing The Effects of Plant-Based Diets and Western Diets on Cardiovascular Disease Risk Factors: A Review

“…Of the seven papers included in this report, five investigated only PBD interventions, and two examined both PBD and WD interventions. Additionally, four articles evaluated BP [16,18,21,22], five examined LDL [17,[19][20][21][22], and four analyzed triglycerides as outcome measures [18][19][20][21]. Finally, five articles examined obese, overweight, or at-risk patients [16,18,19,21,22], while two investigated healthy patients [17,20] (Table 1).…”

“…Decreases in BP were also reported in "healthy diets" mainly consisting of fruits, vegetables, nuts, fibers and fatty fish [18]. Specifically, BP measurements were significantly lower in patients adhering to a PBD compared to a WD [18]. Finally, the study by Wade et al noted no significant change in BP measurements after adhering to a PBD supplemented with lean pork for eight weeks [22].…”

“…The remaining 59 articles were evaluated for eligibility based on the following criteria (I) included a PBD or WD intervention and (ii) used BP or LDL levels as outcome measure(s). A total of 7 articles were included in the review (Figure 1) [16][17][18][19][20][21][22].…”

“…Two studies reported a significant decrease in systolic blood pressure (SBP) and diastolic blood pressure (DBP) following a MD [16,21]. Decreases in BP were also reported in "healthy diets" mainly consisting of fruits, vegetables, nuts, fibers and fatty fish [18]. Specifically, BP measurements were significantly lower in patients adhering to a PBD compared to a WD [18].…”

“…Three studies indicated decreased levels of LDL associated with adherence to a PBD [17,18,20]. Contrastingly, LDL levels of participants following a WD were suggested to be higher in comparison to those following a PBD [17,18]. However, several studies found no changes in LDL in PBD groups [16,19,22].…”