Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial

Dietary habits and self-reported health outcomes in a cross-sectional survey of health-conscious adults eating a plant-based diet

BACKGROUND

Given the growing popularity of plant-based diets, this study investigated the dietary habits and self-reported health outcomes of health-conscious adults consuming plant-based diets.

METHODS

A cross-sectional online survey (n = 315) was distributed to members of Plant-Based Health Professionals UK, a community interest company. Dietary intake was assessed through a food frequency questionnaire. Data were summarised descriptively. Dietary habits among respondents following a whole food plant-based (WFPB) and vegan diet were compared using hypothesis tests.

RESULTS

Respondents reported following a WFPB (61%), vegan (28%) and semi plant-based (11%) diet. Median time on current dietary pattern was 5 years. Daily or more frequent consumption was reported for the following foods: fruits 77%, berries 51%, green vegetables 48%, cruciferous vegetables 45%, other vegetables 64%, beans/legumes 41%, whole grains 62%, nuts and all seeds 63%. Consumption of ultra-processed foods and plant-based meat alternatives was low. About 93% of those on a WFPB or vegan diet supplemented with vitamin B12 and 61% with vitamin D. The median body mass index was 22.4 kg/m2. Fifty per cent of participants reported weight loss after adopting a plant-based diet, with a median loss of 6.4 kg. Thirty-five per cent reported reversing or improving an underlying health condition, and 15% were able to stop or reduce prescribed medication use as a result of dietary changes.

CONCLUSIONS

This study suggests that a well-planned plant-based diet is achievable and sustainable in a community setting and can be associated with health benefits. How to best encourage such sustainable diets among the broad population requires further research.

A Review of Plant-Based Diets for Obesity Management

OBJECTIVE

Obesity is the most prevalent chronic disease in the United States with over 70% of the American population suffering from overweight/obesity. Recently, the popularity of plant-based diets (PBDs) has grown, with individuals adopting these diets for ethical, health and environmental reasons. Our aim is to evaluate the effect of a PBD on weight loss among patients who are overweight or obese.

METHODS

A literature review of PBDs for the treatment of obesity was conducted using PubMed and Scopus. Our search yielded 27 intervention trials (3361 participants) and 6 metanalyses (9168 participants, 61 trials).

RESULTS

Among the intervention trials evaluated, 75% showed a significant increase in weight loss or decrease in weight in the intervention group, on average -5.0 kg (range -1.8 to -12.1 kg). Other outcomes included energy intake (-420 Kcal/d), systolic blood pressure (-3.78 mmHg), fasting plasma glucose (-2.0 mmol/L), hemoglobin A1c (-0.5%, -3.4 mmol/L), total cholesterol (-0.40 mmol/L), low-density lipoprotein (-0.38 mmol/L), triglyceride levels (+0.13 mmol/L), and fiber intake (+10.8 g/d). The 6 meta-analyses showed weight loss (average -2.9 kg, range -2.02 kg to -4.1 kg), body mass index reduction, and improvements in hemoglobin A1c, low-density lipoprotein, and total cholesterol.

CONCLUSION

PBDs result in significant weight loss and improve metabolic outcomes. PBDs offer a sustainable approach to long-term weight loss maintenance. Health care providers should encourage open discussions with their patients regarding their dietary habits to assist them in setting feasible lifestyle goals and consider shared medical appointments to support patients in transitioning to PBDs.

Impact of Lipids on Insulin Resistance: Insights from Human and Animal Studies

Insulin resistance (IR) is a complex pathological condition central to metabolic diseases such as type 2 diabetes mellitus (T2DM), cardiovascular disease, non-alcoholic fatty liver disease, and polycystic ovary syndrome (PCOS). This review evaluates the impact of lipids on insulin resistance (IR) by analyzing findings from human and animal studies. The articles were searched on the PubMed database using two keywords: (1) "Role of Lipids AND Insulin Resistance AND Humans" and (2) "Role of Lipids AND Insulin Resistance AND Animal Models". Studies in humans revealed that elevated levels of free fatty acids (FFAs) and triglycerides (TGs) are closely associated with reduced insulin sensitivity, and interventions like metformin and omega-3 fatty acids show potential benefits. In animal models, high-fat diets disrupt insulin signaling and increase inflammation, with lipid mediators such as diacylglycerol (DAG) and ceramides playing significant roles. DAG activates protein kinase C, which eventually impairs insulin signaling, while ceramides inhibit Akt/PKB, further contributing to IR. Understanding these mechanisms is crucial for developing effective prevention and treatment strategies for IR-related diseases.

Crosstalk between skeletal muscle ratio and cholesterol metabolism disorders: a cross-section study

BACKGROUND

Dysfunction of cholesterol metabolism may be associated with low skeletal muscle mass.  This study aimed to explore the relationship between skeletal muscle mass and cholesterol metabolic disorders in adults.

METHODS

The data of a total of 5949 people with complete medical history data, biochemical data and body composition analysis were recruited. According to the serum cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL) and nonHDL, the population was divided into a disorder group and a normal group. Independent sample t tests, chi-square tests, Pearson's correlation analyses and binary logistic regression analyses were used to study the effect of body composition on abnormal cholesterol metabolism. According to BMI and sex, the population was divided into different subgroups, and binary logistic regression analysis was used to study the effect of the skeletal mass ratio on cholesteral metabolic disorders in different subgroups.

RESULTS

There were significant differences in sex, alcohol consumption, body weight, BMI, skeletal muscle mass index (SMI) [total skeletal muscle mass (kg)/height 2 (m2)] and skeletal muscle mass ratio (SMR) [total skeletal muscle mass (kg)/weight (kg) *100] between the disorder group (hypercholesterolemia, hyper-LDL, lower-HDL and hyper-nonHDL) and the normal group. Pearson correlation analysis revealed that the SMR was negatively correlated, while the SMI was positively correlated with cholesterol metabolic disorders in both sexes. The overweight group was older and had a greater SMI, abnormal cholesteral metabolism ratio and lower SMR than the normal-weight group. In the normal-weight group, the SMR was an independent protective factor against different kinds of cholesteral metabolic disorders in both sexes, while the SMI was a risk factor. In the overweight subgroup, the protective effect on HDL and nonHDL metabolism remained in the male subgroup but disappeared in the female subgroup. However, the SMI was an independent risk factor for different kinds of cholesteral metabolic disorders in both sexes.

CONCLUSIONS

SMR was an independent protective factor against cholesterol metabolic disorders in both males and females, especially in the normal weight group. SMI was an independent risk factor, especially in the overweight group.

Effects of Plant-Based Diets on Markers of Insulin Sensitivity: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

The aim of this systematic review and meta-analysis was to examine the effects of plant-based diets on markers of insulin sensitivity in people with overweight/obesity, prediabetes, or type 2 diabetes (T2D). A systematic literature search in MEDLINE, Embase, CINAHL, and CENTRAL was conducted, and randomised controlled trials (RCTs) investigating the effect of plant-based diets (vegan, ovo-vegetarian, lacto-vegetarian, and lacto-ovo-vegetarian) for ≥14 d on markers of insulin sensitivity in adults (≥18 years) with BMI ≥ 25 kg/m2, prediabetes, or T2D were eligible. We identified eight RCTs, including 716 participants. In comparison with control diets, plant-based diets improved Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (-0.97, 95% confidence interval (CI) (-1.67, -0.27), p = 0.007) and fasting insulin (-4.13 µU/mL, 95% CI (-7.22, -1.04), p = 0.009) in people with overweight/obesity. In people with prediabetes, one study compared vegan and vegetarian diets and found no difference in HOMA-IR, or fasting insulin. One study of people with T2D reported no difference in immunoreactive insulin and metabolic glucose clearance compared with a conventional diabetes diet. In conclusion, adhering to plant-based diets for ≥14 d improved HOMA-IR and fasting insulin in people with overweight/obesity. Long-term RCTs are needed to determine whether plant-based diets can result in prolonged improvements in insulin sensitivity in people at risk of or with T2D.

Plant-based and Early Time-restricted Eating for Prevention and Treatment of Type 2 Diabetes in Adults: A Narrative Review

Type 2 diabetes (T2D) is a significant public health challenge for which effective lifestyle interventions are needed. A growing body of evidence supports the use of both plant-based eating patterns and early time-restricted eating (eTRE) for the prevention and treatment of T2D, but research has not yet explored the potential of these dietary strategies in combination. In this narrative review, we assessed the evidence by which plant-based diets, in conjunction with eTRE, could support T2D care. The electronic databases MEDLINE and the Web of Science were searched for relevant articles published throughout the last decade. Observational research has shown that healthy plant-based eating patterns and eTRE are associated with reductions in T2D risk. Interventional trials demonstrated that plant-based diets promote improvements in glycated hemoglobin, insulin resistance, glycemic management, and cardiometabolic risk factors. These changes may be mediated, in part, by reductions in oxidative stress, dietary acid load, and hepatocellular and intramyocellular lipids. The eTRE strategies were also shown to improve insulin resistance and glycemic management, and mechanisms of action included enhanced regulation of circadian rhythm and increased metabolic flexibility. Integrating these dietary strategies may produce additive benefits, mediated by reduced visceral adiposity and beneficial shifts in gut microbiota composition. However, potential barriers to concurrent implementation of these interventions may exist, including social challenges, scheduling constraints, and tolerance. Prospective trials are needed to examine their acceptability and clinical effects.

Glycaemic index and glycaemic load of selected packaged vegan foods

While there are data regarding the glycaemic index (GI) and glycaemic load (GL) of many foods in the literature, the values for packaged vegan analogue foods have not been previously published, although processed vegan foods usually contain more carbohydrates than their animal-based counterparts. This study was carried out to determine the GI and GL values of a selection of packaged vegan foods popular in Türkiye. To determine the GI and GL of test foods, 12 healthy volunteer females participated in the study. Participants randomly consumed test and reference foods (glucose and white bread) on each trial day, and capillary blood glucose was measured at baseline, 15, 30, 45, 60, 90 and 120 mins in duplicate. The GIs of vegan schnitzel, vegan chickpea burger, vegan mince pita, vegan chocolate, vegan snack bar and vegan cheese were 26.1 ± 19.61 (low), 27.1 ± 17.21 (low), 65.1 ± 28.60 (moderate), 42.7 ± 22.32 (low), 63.6 ± 45.86 (moderate), 36.4 ± 16.85 (low), respectively, according to the glucose reference, and were 28.2 ± 16.17 (low), 34.7 ± 18.26 (low), 81.2 ± 31.96 (high), 48.8 ± 12.87 (low), 82.0 ± 54.05 (high), 46.7 ± 28.66 (low), respectively, according to the white bread reference. GLs were 3.5 ± 2.66 (low), 8.6 ± 5.46 (low), 26.6 ± 11.67 (high), 6.1 ± 3.19 (low), 14.2 ± 10.28 (moderate), 5.7 ± 2.63 (low), respectively, according to the glucose reference, and were 3.8 ± 2.19 (low), 11.0 ± 5.80 (moderate), 33.1 ± 13.04 (high), 7.0 ± 1.84 (low), 18.4 ± 12.12 (moderate), 7.3 ± 4.47 (low), respectively, according to the white bread reference. The data from this study provide preliminary data for the GIs and GLs of packaged and processed vegan foods and show that the GIs and GLs of meat and cheese vegan analogues, while still low or moderate, tend to be higher than their animal-based counterparts which have lower or no glycaemic responses. Further research on the GIs and GLs of more vegan foods is needed.

A Healthful Plant-Based Diet as an Alternative Dietary Approach in the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease

Plant-based diets (PBDs) are gaining attention as a sustainable and health-conscious alternative for managing various chronic conditions, including metabolic dysfunction-associated steatotic liver disease (MASLD). In the absence of pharmacological treatments, exploring the potential of lifestyle modifications to improve biochemical and pathological outcomes becomes crucial. The adoption of PBDs has demonstrated beneficial effects such as weight control, increased metabolic health and improved coexisting diseases. Nonetheless, challenges persist, including adherence difficulties, ensuring nutritional adequacy, and addressing potential deficiencies. The aim of this review is to provide a comprehensive overview of the impact of PBDs on MASLD, emphasizing the need for tailored dietary interventions with professional support to optimize their effectiveness in preventing and treating metabolic diseases.

Plant foods, healthy plant-based diets, and type 2 diabetes: a review of the evidence

Type 2 diabetes (T2D) is a metabolic chronic disease in which insulin resistance and insufficient insulin production lead to elevated blood glucose levels. The prevalence of T2D is growing worldwide, mainly due to obesity and the adoption of Western diets. Replacing animal foods with healthy plant foods is associated with a lower risk of T2D in prospective studies. In randomized controlled trials, the consumption of healthy plant foods in place of animal foods led to cardiometabolic improvements in patients with T2D or who were at high risk of the disease. Dietary patterns that limit or exclude animal foods and focus on healthy plant foods (eg, fruits, vegetables, whole grains, nuts, legumes), known as healthy, plant-based diets, are consistently associated with a lower risk of T2D in cohort studies. The aim of this review is to examine the differential effects of plant foods and animal foods on T2D risk and to describe the existing literature about the role of healthy, plant-based diets, particularly healthy vegan diets, in T2D prevention and management. The evidence from cohort studies and randomized controlled trials will be reported, in addition to the potential biological mechanisms that seem to be involved.

Impact of vegetarianism on cognition and neuropsychological status among urban community-dwelling adults in Telangana, South India: a cross-sectional study

PURPOSE

The potential benefits of vegetarian diets in reducing cognitive impairment have garnered attention due to existing mixed results; hence, our study aims to examine the impact of vegetarianism on cognitive function and neuropsychological status among urban community-dwelling adults from Telangana.

METHODS

The dietary patterns were self-reported and dietary data collected using a Food Frequency Questionnaire while cognitive function was assessed using Mini-Mental State Examination (MMSE) and depression, anxiety, and stress (DASS-21) questionnaire for psychological measures. Adults (N = 304) aged 40 years and above, who followed either a vegetarian or non-vegetarian diet for at least 6 months prior to data collection, scored MMSE ≥ 19 indicating mild cognitive impairment, and were recruited using convenience sampling.

RESULTS

Among the participants, vegetarians (n = 155) exhibited significantly better mood states compared to non-vegetarians (n = 149), as indicated by lower scores on the DASS subscales for depression (10.0 ± 0.06 vs. 17.0 ± 0.07, p =  < 0.001), anxiety (4.0 ± 0.05 vs. 6.0 ± 0.07, p = 0.005), and stress (8.0 ± 0.02 vs. 10.0 ± 0.05, p = 0.007). Vegetarians also demonstrated superior cognitive functioning compared to non-vegetarians, as indicated by higher MMSE scores (26.0 ± 0.04 vs. 24.0 ± 0.03, p =  < 0.001). MMSE scores were inversely correlated with depression, anxiety, and stress for vegetarians (ρ = - 0.371, p = 0.000; ρ = - 0.027, p = 0.734; and ρ = - 0.105, p = 0.914), respectively. Similar to the vegetarians group, MMSE scores were negatively correlated with depression (ρ = - 0.059), but the correlation is not significant.

CONCLUSION

Vegetarianism exerted a positive influence on the cognitive and neuropsychological status of the investigated population. Nevertheless, additional research is required to comprehend the underlying mechanisms that elucidate the long-term effects of vegetarianism and plant-based nutritional interventions on brain health.

The Evolution in Non-Alcoholic Fatty Liver Disease Patients' Profile and the Associated Sustainable Challenges: A Multidisciplinary Perspective

The prevalence and incidence of NAFLD is rising due to the obesity pandemic, caused by the widespread availability of ultra-processed foods and the decrease of physical activity. Factors such as socioeconomic status (SES), ethnicity and geographical location are associated with NAFLD, with lower SES correlating with higher incidence, particularly in regions like America or Europe. Beside the quality of food, the quantity also plays a crucial role. The World Health Organization (WHO) recommends a Mediterranean diet with a balanced energy intake. Since no hard medical treatment is available for NAFLD, lifestyle adjustments are key. Patient empowerment by providing relevant information and co-ownership of the therapy will increase the implementation rate and enhance the quality of medical follow-up and medication adherence, as studies report a good adherence to medication among patients who are well-aware of the severity of their disease. Regarding sustainability, patients with NAFLD have a high load of ambulatory follow-up, which, since the COVID-19 pandemic, can be partially provided by teleconsulting. Both patients' lifestyle modifications and healthcare practitioners' therapeutical strategy can decrease the carbon footprint.

Duration of Morning Hyperinsulinemia is Key to the Enhancement of Hepatic Glucose Uptake and Glycogen Storage Later in the Day

The second meal phenomenon refers to the improvement in glucose tolerance seen following a second identical meal. We previously showed that 4 hours of morning (AM) hyperinsulinemia, but not hyperglycemia, enhanced hepatic glucose uptake (HGU) and glycogen storage during an afternoon (PM) hyperinsulinemic hyperglycemic clamp (HIHG). Our current aim was to determine if the duration or pattern of morning hyperinsulinemia is important for the PM response to a HIHG clamp. To determine this, we administered the same total amount of insulin either over 2h in the first half of the morning (Ins2h-A), over 2h in the 2nd half of the morning (Ins2h-B), or over the entire 4h (Ins4h) of the morning. In the 4h PM period, all three groups had 4x basal insulin, 2x basal glycemia, and portal glucose infusion to simulate a meal. During the PM clamp, there was a marked increase in the mean hepatic glucose uptake and hepatic glycogen synthesis in the Ins4h group compared to the Ins2h-A and Ins2h-B groups, despite matched hepatic glucose and insulin loads. Thus, the longer duration (Ins4h) of mild hyperinsulinemia in the morning seems to be the key to much greater liver glucose uptake during the PM clamp.

Domestic dogs maintain clinical, nutritional, and hematological health outcomes when fed a commercial plant-based diet for a year

Domestic dogs can maintain health on complete and well-balanced canine plant-based nutrition (K9PBN). Novel insight on health outcomes in dogs consuming K9PBN is of relevance to veterinary professionals and consumers given a growing interest in non-traditional dog foods with perceived health benefits, while considering potential safety concerns. We aimed to investigate nutritional equivalence by measuring clinical health outcomes in adult dogs fed K9PBN over twelve months compared to a meat-based diet at baseline. We enrolled fifteen clinically healthy adult dogs living in households in Los Angeles County, California in a prospective cohort study and evaluated clinical, hematological, and nutritional parameters in dogs at 0, 6, and 12 months, including complete blood count (CBC), blood chemistry, cardiac biomarkers, plasma amino acids, and serum vitamin concentrations. The study found that clinically healthy, client-owned, adult dogs maintain health, based on physical exams, complete blood count, serum chemistry, plasma amino acids, serum vitamins, and cardiac biomarkers combined with client-reported observations, when fed commercial K9PBN over a twelve-month period. This study is the most comprehensive and longest known K9PBN investigation to date and provides clinically relevant evidence-based nutrition data and new knowledge on outcomes in clinically healthy dogs who thrive without consumption of animal-derived ingredients. These results also provide a valuable foundation for the future study of K9PBN as a potential nutritional intervention for clinically relevant pathologies in canine medicine. Lastly, it is of major relevance to One Health paradigms since ingredients produced independent of industrial food animal production are both more sustainable and help to circumvent ethical dilemmas for maintenance of health in domestic dogs.

Effect of a Dietary Intervention on Insulin Requirements and Glycemic Control in Type 1 Diabetes: A 12-Week Randomized Clinical Trial

This study compared the effects of a low-fat vegan diet to those of a portion-controlled diet in people with type 1 diabetes. Over 12 weeks, the average total daily dose of insulin decreased significantly and insulin sensitivity increased significantly in the vegan group, while no significant changes were observed in the group receiving the portion-controlled diet. Total and LDL cholesterol decreased in the vegan group, as did the ratio of blood urea nitrogen to creatinine. A1C decreased in both groups. These findings suggest that a low-fat vegan diet may yield improvements in insulin sensitivity, insulin requirements, glycemic control, and markers of cardiovascular and renal health compared with a portion-controlled diet in people with type 1 diabetes.

Associations of Lower-Carbohydrate and Lower-Fat Diets with Mortality among People with Cardiovascular Disease

BACKGROUND

Although low-carbohydrate and low-fat diets have been shown to have short-term metabolic benefits, the associations of these dietary patterns, particularly different food sources and macronutrient quality, with mortality in people with cardiovascular disease (CVD) remain unclear.

OBJECTIVES

To examine the associations of different types of lower-carbohydrate diets (LCDs) and lower-fat diets (LFDs) with mortality in individuals with CVD.

METHODS

This study included 3971 adults with CVD from the NHANES 1999-2014. Mortality status was linked to National Death Index mortality data through 31 December 2019. Overall, unhealthy and healthy LCD and LFD scores were determined based on the percentages of energy from total and subtypes of carbohydrate, fat, and protein. Cox proportional hazards regression models were applied to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Higher healthy LCD score was associated with favorable blood lipids and higher homeostasis model assessment of insulin resistance, whereas higher unhealthy LFD score was associated with lower high-density lipoprotein and higher C-reactive protein at baseline (all P-trend < 0.05). During 35,150 person-years of follow-up, 2163 deaths occurred. For per 20-percentile increment in dietary scores, the multivariate-adjusted HRs of all-cause mortality were 0.91 (95% CI: 0.86, 0.96) for healthy LCD score (P < 0.001), 0.94 (95% CI: 0.89, 1.00) for healthy LFD score (P = 0.04), and 1.07 (95% CI: 1.00, 1.14) for unhealthy LFD score (P = 0.04).

CONCLUSIONS

Overall LCD and LFD scores are not associated with total mortality. Unhealthy LFD scores are associated with higher total mortality, whereas healthy LCD and LFD scores are associated with lower mortality in people with CVD.

Does diet quality matter? A secondary analysis of a randomized clinical trial

This secondary analysis assessed the association of a plant-based index (PDI), healthful (hPDI), and unhealthful (uPDI), with weight loss in overweight adults. Participants (n = 244) were randomly assigned to a vegan (n = 122) or control group (n = 122) for 16 weeks. Three-day dietary records were analyzed and PDI indices were calculated. A repeated measure ANOVA was used for statistical analysis. All three scores increased in the vegan group; the effect sizes were: PDI +10.6 (95% CI +8.6 to +12.6; p < 0.001); hPDI +10.9 (95% CI +8.4 to +13.4; p < 0.001); and uPDI +5.4 (95% CI +3.4 to +7.4; p < 0.001). The change in all three scores significantly correlated with change in body weight: PDI (r = -0.40; p < 0.001); hPDI (r = -0.37; p < 0.001); and uPDI (r = -0.21; p = 0.002). These findings suggest that minimizing the consumption of animal products and oil may be an effective weight loss strategy in overweight adults. ClinicalTrials.gov number, NCT02939638.

Reducing meat and/or dairy consumption in adults: a systematic review and meta-analysis of effects on protein intake, anthropometric values, and body composition

CONTEXT

Consumers are increasingly encouraged to reduce meat and dairy consumption. However, few meta-analyses of randomized controlled trials (RCTs) on the effect of reducing meat and/or dairy on (absolute) protein intake, anthropometric values, and body composition are available.

OBJECTIVE

The aim of this systematic review and meta-analysis was to evaluate the effect of reducing meat and/or dairy consumption on (absolute) protein intake, anthropometric values, and body composition in adults aged ≥ 45 years.

DATA SOURCES

The MEDLINE, Cochrane CENTRAL, Embase, ClinicalTrials.gov, and International Clinical Trials Registry Platform databases were searched up to November 24, 2021.

DATA EXTRACTION

Randomized controlled trials reporting protein intake, anthropometric values, and body composition were included.

DATA ANALYSIS

Data were pooled using random-effects models and expressed as the mean difference (MD) with 95%CI. Heterogeneity was assessed and quantified using Cochran's Q and I2 statistics. In total, 19 RCTs with a median duration of 12 weeks (range, 4-24 weeks) and a total enrollment of 1475 participants were included. Participants who consumed meat- and/or dairy-reduced diets had a significantly lower protein intake than those who consumed control diets (9 RCTs; MD, -14 g/d; 95%CI, -20 to -8; I2 = 81%). Reducing meat and/or dairy consumption had no significant effect on body weight (14 RCTs; MD, -1.2 kg; 95%CI, -3 to 0.7; I2 = 12%), body mass index (13 RCTs; MD, -0.3 kg/m2; 95%CI, -1 to 0.4; I2 = 34%), waist circumference (9 RCTs; MD, -0.5 cm; 95%CI, -2.1 to 1.1; I2 = 26%), amount of body fat (8 RCTs; MD, -1.0 kg; 95%CI, -3.0 to 1.0; I2 = 48%), or lean body mass (9 RCTs; MD, -0.4 kg; 95%CI, -1.5 to 0.7; I2 = 0%).

CONCLUSION

Reduction of meat and/or dairy appears to reduce protein intake. There is no evidence of a significant impact on anthropometric values or body composition. More long-term intervention studies with defined amounts of meat and dairy are needed to investigate the long-term effects on nutrient intakes and health outcomes.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020207325.

Effects of a Short-Term Vegan Challenge in Older Adults on Metabolic and Inflammatory Parameters-A Randomized Controlled Crossover Study

SCOPE

A long-term vegan diet carries the risk of insufficient protein and micronutrient intake for older adults. However, even a short-term (48 h) vegan diet exerts positive metabolic effects in younger adults. In this study, we investigate the feasibility and effects of a short-term vegan challenge on metabolic and inflammatory markers in older adults.

METHOD AND RESULTS

In this randomized controlled crossover-study, 30 healthy older adults (≥65 years) are assigned to either a 48 h ad libitum vegan or omnivorous diet. During the vegan diet, participants exhibit lower protein (p = 0.001) and fat intake as well as higher carbohydrate and dietary fiber intake, resulting in a lower caloric intake (all p < 0.001). Insulin concentrations (p = 0.042) and insulin resistance (p = 0.036) decline only after the vegan diet. The study observes reductions in serum glucose (p < 0.001), triglyceride (p = 0.005), and hsCRP (p = 0.044) concentrations and weight (p < 0.001), independent of the diet. Participants with low-grade inflammation exhibit notable metabolic improvements after the vegan diet.

CONCLUSION

Improvements in insulin homeostasis are observed after the vegan diet, but meeting protein requirements are not feasible during the short-term vegan challenge despite dietary counseling, which warrants concern.

Dietary sulfur amino acid restriction in humans with overweight and obesity: a translational randomized controlled trial

BACKGROUND

Dietary sulfur amino acid restriction (SAAR) improves metabolic health in animals. In this study, we investigated the effect of dietary SAAR on body weight, body composition, resting metabolic rate, gene expression profiles in white adipose tissue (WAT), and an extensive blood biomarker profile in humans with overweight or obesity.

METHODS

N = 59 participants with overweight or obesity (73% women) were randomized stratified by sex to an 8-week plant-based dietary intervention low (~ 2 g/day, SAAR) or high (~ 5.6 g/day, control group) in sulfur amino acids. The diets were provided in full to the participants, and both investigators and participants were blinded to the intervention. Outcome analyses were performed using linear mixed model regression adjusted for baseline values of the outcome and sex.

RESULTS

SAAR led to a ~ 20% greater weight loss compared to controls (β 95% CI - 1.14 (- 2.04, - 0.25) kg, p = 0.013). Despite greater weight loss, resting metabolic rate remained similar between groups. Furthermore, SAAR decreased serum leptin, and increased ketone bodies compared to controls. In WAT, 20 genes were upregulated whereas 24 genes were downregulated (FDR < 5%) in the SAAR group compared to controls. Generally applicable gene set enrichment analyses revealed that processes associated with ribosomes were upregulated, whereas processes related to structural components were downregulated.

CONCLUSION

Our study shows that SAAR leads to greater weight loss, decreased leptin and increased ketone bodies compared to controls. Further research on SAAR is needed to investigate the therapeutic potential for metabolic conditions in humans.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04701346, registered Jan 8th 2021, https://www.

CLINICALTRIALS

gov/study/NCT04701346.

Prevalence and impact of diabetes on survival of patients with multiple myeloma in different racial groups

ABSTRACT

Multiple myeloma (MM) is twice as common in Black individuals compared with in White individuals, and diabetes mellitus (DM) disproportionately affects Black patients. Although numerous studies have shown a correlation between DM and MM, this has not been studied in the context of race and in vivo mechanisms. We conducted a retrospective clinical study of 5383 patients with MM of which 15% had DM (White, 12% and Black, 25%). Multivariable Cox models showed reduced overall survival (OS) for patients with DM (hazard ratio, 1.27; 95% confidence interval, 1.11-1.47; P < .001). This appeared to be driven by a marked difference in OS between White patients with and without DM but not in Black patients. In contrast, obesity was associated with better OS in Black patients but not in White patients. To complement this analysis, we assessed MM growth in a genetically engineered immunocompromised nonobese diabetic (Rag1-/-/muscle creatinine kinase promoter expression of a human IGF1R [M] with a lysine [K] to arginine [R] point mutation) mouse model to evaluate the mechanisms linking DM and MM. MM.1S xenografts grew in more Rag1-/-/MKR mice and grew more rapidly in the Rag1-/-/MKR mice compared with in controls. Western blot analysis found that MM1.S xenografts from Rag1-/-/MKR mice had higher phosphorylated S6 ribosomal protein (Ser235/236) levels, indicating greater activation of the mammalian target of rapamycin pathway. Our study is, to our knowledge, the first to evaluate racial differences in DM prevalence and survival in MM, as well as the effect of DM on tumor growth in mouse models. Our results suggest that DM may contribute to the higher incidence of MM in Black patients; and to improve survival in MM, DM management cannot be ignored.

Poor vitamin D status was associated with increased appendicular fat deposition in US Adults: Data from 2011-2018 National Health and Nutrition Examination Survey

The aim of the study was to explore the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and regional body fat deposition in 2011-2018 National Health and Nutrition Examination Survey participants aged 18 to 59 years. We hypothesized that serum 25(OH)D concentrations were negatively associated with total, appendicular, and truncal fat deposition. Serum 25(OH)D concentration was categorized into sufficient (≥75.0 nM), insufficient (50.0-74.9 nM), and deficient (<50.0 nM) groups. Fat mass (FM) was measured by dual-energy X-ray absorptiometry, and FM index (FMI) was calculated by dividing FM (kg) with height2 (m2). Multivariant linear regression and Granger causal analysis were performed to assess the causal relationship between vitamin D status and regional FMIs. Overall serum 25(OH)D concentrations were negatively associated with total (β = -0.029, standard error [SE] = 0.002), trunk (β = -0.015, SE = 0.001), arms (β = -0.004, SE = 3.09 × 10-4), and legs (β = -0.010, SE = 0.001) FMIs in all participants (P < .001, respectively); however, after stratified by vitamin D status and BMI, the negative associations were only observed in individuals with vitamin D deficiency and obesity. The causal analysis indicated that serum 25(OH)D concentrations may causally reduce the arms (F = 4.917, probability [P] = 0.007), legs (F = 5.783, P = 0.003), and total (F = 3.202, P = 0.041) FMIs except for trunk FMI but not vice versa. In conclusion, poor vitamin D status was associated with increased total and appendicular body fat deposition in US adults, particularly in participants with obesity.

Diabesity and Dietary Interventions: Evaluating the Impact of Mediterranean Diet and Other Types of Diets on Obesity and Type 2 Diabetes Management

BACKGROUND

Diabesity, the intersection of obesity and diabetes, presents a global health crisis with profound implications. Addressing diabesity requires multifaceted strategies, with diet playing a pivotal role. Over the last 15 years, clinical studies have intensified their exploration of various dietary approaches in diabesity management. This literature review aims to synthesize findings from clinical studies conducted in the last 15 years, shedding light on the efficacy, mechanisms, and nuances of different diet types in diabesity management with special focus on the Mediterranean diet (MD).

METHODS

Thorough research of academic databases yielded a collection of relevant clinical studies. These studies encompassed a range of dietary strategies, including the MD, low-carbohydrate diets, plant-based diets, high-protein diets, low-fat regimens, and intermittent fasting. Key findings, methodologies, and outcomes were thoroughly extracted and analyzed.

RESULTS

The last 15 years have witnessed considerable improvements in recognizing the role of human nutritional habits in diabesity management. The MD appears to be the most well-recognized diet, exerting favorable effects against both obesity and diabetes. Low-carbohydrate diets were found to enhance glycemic regulation and decrease insulin resistance. Plant-based diets demonstrated potential benefits in weight management and cardiometabolic health. High-protein, low-fat dietary models exhibited positive effects on satiety and body weight decline. Intermittent fasting regimens also exerted metabolic improvements and body weight decline. Personalization emerged as a crucial factor in dietary recommendations.

CONCLUSIONS

Clinical studies from the last 15 years underscore the intricate relationship between diet types and diabesity management. The above results contribute to an increasing body of evidence, emphasizing the need for tailored dietary approaches and especially the MD. Healthcare providers can utilize this knowledge to offer personalized dietary recommendations for individuals with diabesity, potentially curbing the rise of these twin epidemics and improving the well-being of affected populations.

Diet and odor hedonic ratings: comparative study between vegetarians, flexitarians, and omnivores

OBJECTIVES

Odor hedonic perception is well known to exhibit great variability and to depend on several parameters, i.e. stimulus, context, and subject characteristics. As hedonic perception (pleasant/unpleasant character) of food odors is considered one of the most prominent dimensions in eating behavior, the question of hedonic variability in this context arises. Thus, the aim of the present study was to compare odor hedonic ratings in three populations with regard to diet (i.e. omnivore, vegetarian, and flexitarian diets).

METHODS

Four categories of odors were compared: meat, vegetable, other food, and non-food odors.

RESULTS

The results showed that vegetarian and flexitarian individuals rated meat odors as more unpleasant than omnivores, while no significant difference was found for other categories of odors.

DISCUSSION

The question of whether the diet influences the hedonic perception or/and inversely is discussed, regarding several aspects of food consumption such as eating disorders, food education, … and could further serve to manage eating behaviors.

PRACTICAL APPLICATIONS

This study evidenced that vegetarians and flexitarians specifically rated meat odors as being more unpleasant than those of omnivores. Because of the growing number of vegetarians and flexitarians in the general population, it could be suggested to take into account the odor hedonic perception (especially regarding food odors) in studies related to diets. Besides, the present results could further serve research in several aspects of food consumption such as eating disorders (anorexia, bulimia … etc.) or food education as well as the management of eating behaviors, especially in an elderly population.

Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability

Unhealthy dietary patterns are directly linked to the current Global Syndemic consisting of non-communicable diseases, undernutrition and climate change. The dietary shift towards healthier and more sustainable plant-based diets is essential. However, plant-based diets have wide intra differences; varying from vegan diets that totally exclude meat and animal products to traditional ones such as the Mediterranean diet and the new Nordic diet. It is acknowledged that plant-based diets may contribute simultaneously to improving population health as well as to decreasing the environmental impact of food systems. Evidence from cohort and randomized-controlled trials suggests that plant-based dietary patterns have beneficial effects on bodyweight control, cardiovascular health and diabetes prevention and treatment. On the other hand, micronutrient requirements may not be met, if some plant-based diets are not well-planned. Additionally, studies showed that lower consumption of meat and animal products results in lower environmental impacts. Consequently, plant-based diets could be a key factor to increase diet sustainability. This narrative review addresses the advantages of adherence to plant-based diets on human and planetary health considering strains and barriers to achieve this dietary transition, including cultural acceptability and affordability factors. Finally, potential intervention and policy recommendations are proposed, focusing on the update of current national food-based dietary guidelines.

Body Fat Distribution, Diabetes Mellitus, and Cardiovascular Disease: an Update

PURPOSE OF REVIEW

Specific measures of body fat distribution may have particular value in the development and treatment of cardiometabolic conditions, such as cardiovascular disease (CVD) and diabetes mellitus (DM). Here, we review the pathophysiology, epidemiology, and recent advances in the identification and management of body fat distribution as it relates to DM and CVD risk.

RECENT FINDINGS

Accumulation of visceral and ectopic fat is a major contributor to CVD and DM risk above and beyond the body mass index (BMI), yet implementation of fat distribution assessment into clinical practice remains a challenge. Newer imaging-based methods offer improved sensitivity and specificity for measuring specific fat depots. Lifestyle, pharmacological, and surgical interventions allow a multidisciplinary approach to reduce visceral and ectopic fat. A focus on implementation of body fat distribution measurements into clinical practice should be a priority over the next 5 to 10 years, and clinical assessment of fat distribution can be considered to refine risk evaluation and to develop improved and effective preventive and therapeutic strategies for high-risk obesity.

Remission of Type 2 Diabetes After Treatment With a High-Fiber, Low-Fat, Plant-Predominant Diet Intervention: A Case Series

Background: Prevalence of type 2 diabetes (T2D) is rising, and its burden on the healthcare system remains a challenge. Consumption of a plant-predominant diet is a promising approach for achieving remission, which has emerged as a therapeutic target. Objective: To establish feasibility of achieving T2D remission with a plant-predominant diet in a cohort of free-living individuals. Methods: Patients referred to a wellness clinic were treated with a low-fat, whole food, plant-predominant diet while receiving standard medical treatment. Included patients were adults, mostly elderly, with HbA1c > 6.5%, with or without use of antidiabetic medications. Results: N = 59 patients were included in this analysis, with mean age 71.5 years (range 41-89). Twenty-two (37%) patients achieved T2D remission. Mean differences showed a significant decrease post-lifestyle change (T2) compared to prior to lifestyle change (T1) for the following outcomes [least squares mean difference (95% CI)]: BMI [-2.6 (-4.8, -.3)] kg/m2; HbA1c [ -1.3 (-1.6, -1.0)] %; and fasting glucose [-29.6 (-41.8, -17.5)] mg/dL. No significant differences were observed for systolic or diastolic blood pressure, HDL, LDL, or triglycerides. Conclusion: A lifestyle-based treatment intervention promoting adherence to a plant-predominant diet and integrated as part of routine care can successfully achieve T2D remission in wellness clinic patients.

Vegetarian diets on anthropometric, metabolic and blood pressure outcomes in people with overweight and obesity: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

It is unknown whether vegetarian diets (VDs) may improve outcomes in people with overweight and obesity.

OBJECTIVE

To systematically assess the effects of VDs vs. omnivore diets on anthropometric, metabolic, and blood pressure outcomes in people with overweight and obesity.

METHODS

We searched for randomized controlled trials (RCTs) in EMBASE, PubMed, Web of Science, and Scopus until February 2, 2022. Primary outcomes were anthropometric risk factors (weight, body mass index [BMI], waist circumference [WC], hip circumference [HC], and body fat percentage). Secondary outcomes were metabolic risk factors (fasting serum glucose, HbA1c, insulin levels) and blood pressure (systolic blood pressure [SBP], diastolic blood pressure [DBP]). Random-effects meta-analyses were performed and effects were expressed as mean difference (MD) and their 95% confidence intervals (CI). The quality of evidence was assessed using GRADE methods.

RESULTS

Nine RCTs (n = 1628) were included. VDs decreased weight (MD -3.60 kg, 95%CI -4.75 to -2.46) and glucose (MD -10.64 mg/dL, 95%CI -15.77 to -5.51), but did not decrease WC (MD -3.00 cm, 95%CI -6.20 to 0.20), BMI (MD -0.87 kg/m2, 95%CI -1.80 to 0.06), or HC (MD: -0.86 cm, 95%CI -3.46 to 1.74). VDs did not decrease HbA1c (MD -0.40%, 95%CI -0.89 to 0.10), insulin (MD -3.83 mU/L, 95%CI -8.06 to 0.40), SBP (MD -0.25 mmHg, 95%CI -2.58 to 2.07), or DBP (MD -1.57 mmHg, 95%CI -3.93 to 0.78). Subgroup analyses by type of VD (four RCTs evaluated lacto-ovo-vegetarian diets and five RCTs vegan diets) showed similar results to the main analyses. QoE was very low for most of the outcomes.

CONCLUSIONS

In comparison to an omnivorous diet, VDs may reduce weight and glucose, but not blood pressure or other metabolic or anthropometric outcomes. However, the QoE was mostly very low. Larger RCTs are still needed to evaluate the effects of VD on anthropometric, metabolic factors, and blood pressure in people with overweight and obesity.

Influence of Plant-Based Diet on the Cardiovascular System: A Narrative Review

A plant-based diet (PBD) includes multiple dietary patterns such as vegetarianism, veganism, lacto-ovo-vegetarianism, etc. A well-balanced PBD has positive effects on body mass index, hyperlipidemia, and type 2 diabetes, and it is associated with decreased risk of cardiovascular diseases. Due to its high fiber content, which lowers levels of low-density lipoprotein cholesterol, high antioxidant content, which prevents capillary wall damage; the presence of polyunsaturated fatty acids, which have an anti-inflammatory effect, improvement in glucose homeostasis through improved insulin sensitivity, and impact on the gut microbiota, it has been proven to be beneficial for the heart. Despite their possible benefits, PBDs can be low in essential nutrients such as vitamin B12, zinc, vitamin D, iodine, and amino acids. This review aims to analyze the influence of PBDs on the cardiovascular system and associated disease progression.

Vegan Diet and Food Costs Among Adults With Overweight: A Secondary Analysis of a Randomized Clinical Trial

This secondary analysis of a randomized clinical trial investigates the effects of a vegan diet on total food costs per day.

Vegetarian Diets and Cardiovascular Risk Reduction: Pros

There is an ongoing need for public health interventions aimed at further mitigating the risk of cardiovascular disease (CVD) through changes in dietary patterns and other lifestyle habits. Plant-based diets (PBDs) are effective in reducing CVD risk factors, a benefit evidenced by the favorable cardio-metabolic profiles observed in vegetarians who abstain from consuming meat, fish, and poultry compared to omnivores. Numerous studies have demonstrated that PBDs, particularly when rich in high-quality plant foods such as whole grains, fruits, vegetables, and nuts, are associated with a lower risk of adverse cardiovascular outcomes. Herein, we briefly review the current evidence regarding the relationship between CVD and PBDs, as well as the potential underlying biological mechanisms.

Association between Mediterranean Diet and Type 2 Diabetes: Multiple Cross-Sectional Analyses

AIM

To assess whether the Mediterranean diet (MD) is associated with lower levels of type 2 diabetes (T2D) in a non-Mediterranean population.

METHODS

Cross-sectional analysis of follow-ups 1 (FU1, 2009-2012, n = 4398, 45.7% men, 57.7 ± 10.5 years), 2 (FU2, 2014-2017, n = 3154, 45.0% men, 61.7 ± 9.9 years), and 3 (FU3, 2018-2021, n = 2394, 45.2% men, 65.0 ± 9.6 years) of the Colaus|PsyCoLaus study (Lausanne, Switzerland). Two MD scores (Trichopoulou, noted MD1, and Sofi, noted MD2) were calculated using participants' dietary data. T2D was defined as a fasting plasma glucose ≥7 mmol/L and/or the presence of an antidiabetic drug treatment.

RESULTS

Participants with the highest MD adherence had a higher educational level, a lower BMI, were less frequent smokers, presented less frequently with hypertension, and were more frequent alcohol consumers. After multivariable adjustment, no differences were found between participants with and without T2D regarding MD scores: 3.93 ± 0.07 vs. 3.97 ± 0.02; 4.08 ± 0.10 vs. 3.98 ± 0.03, and 3.83 ± 0.11 vs. 3.97 ± 0.03, respectively, for the MD1 score in FU1, FU2, and FU3. In addition, no association was found between adherence to MD and T2D: odds ratio (and 95% confidence interval) for medium and high relative to low adherence to MD1: 0.87 (0.68-1.10) and 0.89 (0.64-1.24) in FU1, 1.04 (0.76-1.42) and 1.07 (0.68-1.67) in FU2, and 0.73 (0.53-1.03) and 0.61 (0.37-1.02) in FU3, respectively. Corresponding results for MD2 were 0.90 (0.70-1.15) and 1.03 (0.69-1.53) in FU1, 1.16 (0.82-1.63) and 1.40 (0.81-2.41) in FU2, and 0.93 (0.65-1.34) and 0.55 (0.28-1.08) in FU3.

CONCLUSION

We found no association between Mediterranean diet adherence and T2D in a non-Mediterranean population.

Maternal Exercise Impacts Offspring Metabolic Health in Adulthood: A Systematic Review and Meta-Analysis of Animal Studies

Maternal exercise benefits offspring's metabolic health with long-term repercussions. Here, we systematically reviewed the effects of maternal exercise on offspring obesity outcomes in adulthood. The primary outcome is body weight. The secondary outcomes are glucose and lipid profiles. Two independent authors performed a search in the databases PubMed, EMBASE, and Web of Science. A total of nine studies with 17 different cohorts consisting of 369 animals (two species) were included. Study quality was assessed using the SYRCLE risk of bias. The PRISMA statement was used to report this systematic review. The results showed that maternal exercise contributes to improved glucose tolerance, reduced insulin concentration, and lower total cholesterol and low density lipoprotein levels in adult offspring in mice, which are independent of maternal body weight and offspring dietary condition. Additionally, in rats, maternal exercise leads to a higher body weight in adult offspring, which might be attributed to the high-fat diet of offspring after weaning. These findings further support the metabolic beneficial role of maternal exercise on offspring in adulthood, although the issue of translating the results to the human population is still yet to be addressed.

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022)

Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.

Dietary advanced glycation products and their associations with insulin sensitivity and body weight: A 16-week randomized clinical trial

Background

Evidence suggests that changes in advanced glycation end-products (AGEs) may influence body weight. Previous studies have focused on cooking methods as the primary way how to reduce the dietary AGEs but little is known about the effects of a change in diet composition.

Objective

The aim of this study was to assess the effects of a low-fat plant-based diet on dietary AGEs and test the association with body weight, body composition, and insulin sensitivity.

Methods

Participants who were overweight (n = 244) were randomly assigned to an intervention (low-fat plant-based) (n = 122) or control group (n = 122) for 16 weeks. Before and after the intervention period, body composition was measured by dual X-ray absorptiometry. Insulin sensitivity was assessed with the predicted insulin sensitivity index (PREDIM). Three-day diet records were analyzed using the Nutrition Data System for Research software and dietary AGEs were estimated, using a database. Repeated measure ANOVA was used for statistical analysis.

Results

Dietary AGEs decreased in the intervention group by 8768 ku/day on average (95% -9611 to -7925; p < 0.001), compared with the control group (-1608; 95% CI -2709 to -506; p = 0.005; treatment effect -7161 ku/day [95% CI -8540 to -5781]; Gxt, p < 0.001). Body weight decreased by 6.4 kg in the intervention group, compared with 0.5 kg in the control group (treatment effect -5.9 kg [95% CI -6.8 to -5.0]; Gxt, p < 0.001), largely due to a reduction in fat mass, notably visceral fat. PREDIM increased in the intervention group (treatment effect +0.9 [95% CI + 0.5 to +1.2]; p < 0.001). Changes in dietary AGEs correlated with changes in body weight (r = +0.41; p < 0.001), fat mass (r = +0.38; p < 0.001), visceral fat (r = +0.23; p < 0.001), and PREDIM (r = -0.28; p < 0.001), and remained significant even after adjustment for changes in energy intake (r = +0.35; p < 0.001 for body weight; r = +0.34; p < 0.001 for fat mass; r = +0.15; p = 0.03 for visceral fat; and r = -0.24; p < 0.001 for PREDIM).

Conclusions

Dietary AGEs decreased on a low-fat plant-based diet, and this decrease was associated with changes in body weight, body composition, and insulin sensitivity, independent of energy intake. These findings demonstrate positive effects of qualitative dietary changes on dietary AGEs and cardiometabolic outcomes.

Clinical Trial Registry Number

NCT02939638.

Vegetarian or vegan diets and blood lipids: a meta-analysis of randomized trials

AIMS

Due to growing environmental focus, plant-based diets are increasing steadily in popularity. Uncovering the effect on well-established risk factors for cardiovascular diseases, the leading cause of death worldwide, is thus highly relevant. Therefore, a systematic review and meta-analysis were conducted to estimate the effect of vegetarian and vegan diets on blood levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoprotein B.

METHODS AND RESULTS

Studies published between 1980 and October 2022 were searched for using PubMed, Embase, and references of previous reviews. Included studies were randomized controlled trials that quantified the effect of vegetarian or vegan diets vs. an omnivorous diet on blood lipids and lipoprotein levels in adults over 18 years. Estimates were calculated using a random-effects model. Thirty trials were included in the study. Compared with the omnivorous group, the plant-based diets reduced total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B levels with mean differences of -0.34 mmol/L (95% confidence interval, -0.44, -0.23; P = 1 × 10-9), -0.30 mmol/L (-0.40, -0.19; P = 4 × 10-8), and -12.92 mg/dL (-22.63, -3.20; P = 0.01), respectively. The effect sizes were similar across age, continent, duration of study, health status, intervention diet, intervention program, and study design. No significant difference was observed for triglyceride levels.

CONCLUSION

Vegetarian and vegan diets were associated with reduced concentrations of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B-effects that were consistent across various study and participant characteristics. Plant-based diets have the potential to lessen the atherosclerotic burden from atherogenic lipoproteins and thereby reduce the risk of cardiovascular disease.

Effects of Plant-Based Diets on Anthropometric and Cardiometabolic Markers in Adults: An Umbrella Review

We conducted an umbrella review to consolidate the evidence of adopting plant-based diets on anthropometric and cardiometabolic outcomes. Six electronic databases (CINAHL, EMBASE, PubMed, Scopus, the Cochrane Library, and Web of Science) were searched for systematic reviews with meta-analysis (SRMAs) published from each journal's inception until 1 October 2022. Effect sizes from SRMAs and primary studies were pooled separately using random effects models. Overlapping primary studies were removed for primary studies' analyses. Seven SRMAs representing 51 primary studies were included, suggesting significant benefits of plant-based diets on weight (-2.09 kg, 95% CI: -3.56, -0.62 kg, p = 0.01, I² = 95.6%), body mass index (-0.95 kg/m², 95% CI: -1.26, -0.63 kg/m², p = 0.002; I² = 45.1%), waist circumference (-2.20 cm, 95% CI: -0.08, 0.00 cm, p = 0.04; I² = 88.4%), fasting blood glucose (-0.11 mmol/L, 95% CI: -0.13, -0.09 mmol/L, p < 0.001, I² = 18.2%), and low-density lipoprotein cholesterol (-0.31 mmol/L, 95% CI: -0.41, -0.20 mmol/L, p < 0.001, I² = 65.6%). Changes in high-density lipoprotein cholesterol, triglycerides, and blood pressure were not statistically significant. Generally, plant-based diets were recommended to improve anthropometry, lipid profile, and glucose metabolism. However, findings should be interpreted with caution, because most of the reviews were rated to be of low credibility of evidence and were largely based on Western eating habits and traditions, which may limit the generalizability of findings.

Dyslipidemia in Muscular Dystrophy: A Systematic Review and Meta-Analysis

BACKGROUND

Muscular dystrophies (MDs) are characterized by chronic muscle wasting but also poorly understood metabolic co-morbidities. We have recently shown that Duchenne MD (DMD) patients, dogs and asymptomatic carriers are affected by a new form of dyslipidemia that may exacerbate muscle damage.

OBJECTIVE

We aimed to perform a systematic review and meta-analysis for evidence that other types of MDs are associated with dyslipidemia compared to healthy controls.

METHODS

Search was conducted using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials for reports that compare plasma/serum lipids from MD patients and controls, and meta-analysis of cross-sectional studies quantifying total cholesterol, high-density lipoprotein, low density lipoprotein and triglycerides was performed.

RESULTS

Out of 749 studies, 17 met our inclusion criteria for meta-analysis. 14 of the 17 studies (82% ) included investigated myotonic dystrophy (DM); other studies were on pseudohypertrophic MD (PMD) or DMD. As a whole, MD individuals had significantly higher levels of circulating total cholesterol (Hedges' g with 95% confidence interval [CI], 0.80 [0.03 - 1.56]; p = 0.04) and triglycerides (Hedges' g with 95% confidence interval [CI], 2.28[0.63 - 3.92]; p = 0.01) compared to controls. Meta-regression analysis showed the percentage of male gender was significantly associated with the difference in total cholesterol (beta = 0.05; 95% CI, - 0.02 to 0.11; p = 0.043) and high-density lipoprotein (beta = - 9.38; 95% CI, - 16.26 to - 2.50; p = 0.028).

CONCLUSIONS

MD is associated with significantly higher circulating levels of total cholesterol and triglycerides. However, caution on the interpretation of these findings is warranted and future longitudinal research is required to better understand this relationship.

Calorie-restricted diet mitigates weight gain and metabolic abnormalities in obese women with schizophrenia: a randomized controlled trial

Background

Obesity is a prevalent health problem in patients with schizophrenia, and calorie restriction diet (CRD) achieved effective weight loss and metabolic improvement; however, these have not been rigorously evaluated in obese patients with schizophrenia.

Objective

To measure the effects of CRD on weight loss and metabolic status in hospitalized obese women with schizophrenia during a 4-week period.

Methods

Participants were randomly assigned to two groups in a 1:1 ratio. The intervention group (n = 47) was asked to follow a CRD and the control group (n = 48) a normal diet for 4 weeks. Outcomes of body weight, body composition, as well as metabolic parameters were measured at baseline and following the intervention period.

Results

Forty-five participants completed the 4-week research in both the intervention and control groups. Compared to the normal diet, adherence to the CRD significantly decreased body weight (2.38 ± 1.30 kg), body mass index (0.94 ± 0.52 kg/m²), waist circumference (4.34 ± 2.75 cm), hip circumference (3.37 ± 2.36 cm), mid-upper circumferences, triceps skin-fold thickness, fat mass and free fat mass with large effect sizes (p = <0.001, ηp² range between 0.145 and 0.571), as well as total cholesterol (0.69 ± 0.70 mmol/L) with a medium effect size (p = 0.028, ηp² = 0.054). There were no differences between the CRD and control groups in terms of pre-post changes in triglycerides, high- and low-density lipoprotein-cholesterols, as well as systolic and diastolic blood pressures (p > 0.05).

Conclusion

CRD is preventative of weight gain, but not apparent in intervention for metabolic status in hospitalized obese women with schizophrenia.Clinical trial registration: http://www.chictr.org.cn, ChiCTR-INR-16009185.

The VegPlate for Sports: A Plant-Based Food Guide for Athletes

Background: Nutrition strategies improve physiological and biochemical adaptation to training, facilitate more intense workouts, promote faster recoveries after a workout in anticipation of the next, and help to prepare for a race and maintain the body’s hydration status. Although vegetarianism (i.e., lacto-ovo and veganism) has become increasingly popular in recent years, the number of vegetarian athletes is not known, and no specific recommendations have been made for vegetarian dietary planning in sports. Well-planned diets are mandatory to obtain the best performance, and the available literature reports that those excluding all types of flesh foods (meat, poultry, game, and seafood) neither find advantages nor suffer from disadvantages, compared to omnivorous diets, for strength, anaerobic, or aerobic exercise performance; additionally, some benefits can be derived for general health. Methods: We conceived the VegPlate for Sports, a vegetarian food guide (VFG) based on the already-validated VegPlate facilitating method, designed according to the Italian dietary reference intakes (DRIs). Results: The VegPlate for Sports is suitable for men and women who are active in sports and adhere to a vegetarian (i.e., lacto-ovo and vegan) diet, and provides weight-based, adequate dietary planning. Conclusions: The VegPlate for Sports represents a practical tool for nutrition professionals and gives the possibility to plan diets based on energy, carbohydrate (CHO), and protein (PRO) necessities, from 50 to 90 Kg body weight (BW).

The effects of vegetarian diets on glycemia and lipid parameters in adult patients with overweight and obesity: a systematic review and meta-analysis

Several randomized controlled trials have reported the effects of vegetarian diets on blood lipids and glucose homeostasis in adults, but not in overweight or obese individuals. Thus, the purpose of this study was to evaluate the effects of vegetarian diets on blood lipids and glucose homeostasis in overweight or obese adults by systematic review and meta-analysis. We searched Medline, Embase, and the Cochrane Library through October 2021. We chose to include overweight or obese patients in the studies of the vegetarian diet for metabolic control. Seven trials with a total of 783 overweight or obese adult were included in the meta-analysis. The analysis of the data revealed that the vegetarian diets significantly reduced low-density lipoprotein cholesterol (LDL-C) (WMD, -0.31; 95% CI, -0.46 to -0.16), total cholesterol (TC) (WMD, -0.37; 95% CI, -0.52 to -0.22), and HbA1c (WMD (%), -0.33; 95% CI, -0.55 to -0.11). The vegetarian diets had an elevated effect on blood triglycerides (WMD, 0.29; 95% CI, 0.11-0.47). However, there were no significant effects of vegetarian diets on high-density lipoprotein cholesterol (HDLC), Fasting plasma glucose(FPG), and HOMA-IR in these individuals. The results of this study suggest that vegetarian diets effectively reduce LDL-C, TC, and HbA1c levels, thus functioning as a promising therapeutic strategy for improving the metabolic dysfunction in overweight or obese individuals. However, further large-scale clinical trials are required to confirm the validity of these findings.

The Role of Phytochemicals and Plant-Based Diets in Gestational Diabetes: Evidence from Clinical Trials

Gestational diabetes mellitus (GDM) is defined as glucose intolerance identified during pregnancy. The increased risk of pregnancy complications and the adverse health effects for the mother and baby associated with GDM require urgent and effective ways to control the condition. The primary goal of this semi-quantitative review was to examine the effects of phytochemicals and plant-based diets on GDM in clinical studies involving women undergoing pregnancy and to summarize the findings for application in clinical practice and disease management. The articles included in this review show that intervention strategies, including fruits, vegetables, whole grains, nuts and seeds, and tea, may be beneficial in the management of GDM and lower blood glucose and improve adverse pregnancy outcomes in these women. The randomized controlled trials reviewed collectively show improved glycemic control markers, blood lipid values, and body weight and composition when supplemented with phytochemical-rich supplements and foods compared to those in the control groups. The findings support the clinical observations of lower GDM risks in women consuming plant-derived diets rich in phytochemicals. Nutrition interventions involving plant-based foods and diets are thus a practical way to reduce hyperglycemia both in patients diagnosed with GDM and those at high risk for the development of GDM.

Dietary patterns and cardiometabolic health: Clinical evidence and mechanism

For centuries, the search for nutritional interventions to underpin cardiovascular treatment and prevention guidelines has contributed to the rapid development of the field of dietary patterns and cardiometabolic disease (CMD). Numerous studies have demonstrated that healthy dietary patterns with emphasis on food-based recommendations are the gold standard for extending lifespan and reducing the risks of CMD and mortality. Healthy dietary patterns include various permutations of energy restriction, macronutrients, and food intake patterns such as calorie restriction, intermittent fasting, Mediterranean diet, plant-based diets, etc. Early implementation of healthy dietary patterns in patients with CMD is encouraged, but an understanding of the mechanisms by which these patterns trigger cardiometabolic benefits remains incomplete. Hence, this review examined several dietary patterns that may improve cardiometabolic health, including restrictive dietary patterns, regional dietary patterns, and diets based on controlled macronutrients and food groups, summarizing cutting-edge evidence and potential mechanisms for CMD prevention and treatment. Particularly, considering individual differences in responses to dietary composition and nutritional changes in organ tissue diversity, we highlighted the critical role of individual gut microbiota in the crosstalk between diet and CMD and recommend a more precise and dynamic nutritional strategy for CMD by developing dietary patterns based on individual gut microbiota profiles.

Efficacy of Submicron Dispersible Free Phytosterols on Non-Alcoholic Fatty Liver Disease: A Pilot Study

BACKGROUND

No pharmacological treatment is yet approved for non-alcoholic fatty liver disease (NAFLD). Plant sterols have shown healthy properties beyond lowering LDL-cholesterol, including lowering triglycerides and lipoprotein plasma levels. Despite pre-clinical data suggesting their involvement in liver fat control, no clinical study has yet been successful.

AIMS

Testing a sub-micron, free, phytosterol dispersion efficacy on NAFLD.

METHODS

A prospective, uncontrolled pilot study was carried out on 26 patients with ≥17.4% liver steatosis quantified by magnetic resonance imaging. Subjects consumed daily a sub-micron dispersion providing 2 g of phytosterols. Liver fat, plasma lipids, lipoproteins, liver enzymes, glycemia, insulinemia, phytosterols, liposoluble vitamins and C-reactive protein were assessed at baseline and after one year of treatment.

RESULTS

Liver steatosis relative change was -19%, and 27% of patients reduced liver fat by more than 30%. Statistically and clinically significant improvements in plasma triglycerides, HDL-C, VLDL and HDL particle number and C-reactive protein were obtained, despite the rise of aspartate aminotransferase, glycemia and insulinemia. Though phytosterol plasma levels were raised by >30%, no adverse effects were presented, and even vitamin D increased by 23%.

CONCLUSIONS

Our results are the first evidence in humans of the efficacy of submicron dispersible phytosterols for the treatment of liver steatosis, dyslipidemia and inflammatory status in NAFLD.

Dietary Habits and Lifestyle, Including Cardiovascular Risk among Vegetarians and Omnivores during the COVID-19 Pandemic in the Polish Population

Background: This study assessed how two food groups—omnivores (OMN) and vegetarians (VEGE)—differ in lifestyle changes, including dietary habits during the COVID-19 pandemic. Materials: A total of 861 persons participated in the survey and were divided into two groups: persons following a mixed diet (n = 489) and vegetarians, including vegans (n = 372). The mean age shows no significant differences. Methods: An online survey was conducted on the Polish population during the COVID-19 pandemic. Data was collected using social media; the survey was intended for adults and included separate sheets for different diets (OMN vs. VEGE). Results: The results in both groups were similar regarding the burden of premature diseases. Most respondents (~90%) did not indicate cardiovascular disease abnormalities. In the OMN group, overweight and obesity occurred more often, and the OMN group also showed a higher percentage of people reporting weight gain (OMN 42.7% vs. VEGE 35.9%). The results disclosed the VEGE group significantly more frequently chose products, i.e., vegetables (p = 0.029), legumes (p < 0.001), and dairy products or their plant substitutes (p = 0.002), compared to the OMN group. Conclusions: The VEGE group revealed the most regularities in dietary habits during the pandemic.

Effects of a Diet Containing Sources of Prebiotics and Probiotics and Modification of the Gut Microbiota on the Reduction of Body Fat

In 2022, according to the World Health Organization (WHO) report, overweight and obesity have reached epidemic proportions in the WHO European Region, affecting almost 60% of adults. Based on the assessment of BMI (Body Mass Index), a group of 56 women aged 25-45 years (31 women group A average BMI 34.9 ± 4.86 kg/m2 and 25 women group B average BMI 33.4 ± 4.02 kg/m2) were qualified for the study. In a multi-center, two-arm, parallel, non-randomized study, two types of weight-reduction diets (A and B) were used over a 3-month period. In group A, a standard low-energy diet was used with individually adjusted caloric intake of 1100-1300 kcal, with an increase in the amount and frequency of consumption of sauerkraut and groats and a daily intake of fermented milk drinks (300-400 g), fermented cucumbers (100 g), mineral water (1 L) and cod liver oil (5 mL). In group B, a standard low-energy diet with individually adjusted caloric intake of 1100-1300 kcal with daily intake of fermented milk products (150 g), highly mineralized water (0.5 L), once a week fermented cucumbers, and once a week buckwheat groats was used. The following measurements were taken: body weight, body fat mass, water content, body height, waist circumference, and hip circumference. Body weight and body composition were measured using the Tanita MC-780 MA and TANITA BC-601 analyzer using the bioelectric bioimpedance method. The stool samples were analyzed in the microbiology laboratory where quantification of Bifidobcaterium spp., Bacteroides spp., Faecalibacterium prausnitzii species, Akkermansia muciniphila and total bacterial count (TBC) was performed. Under the influence of the introduced nutritional intervention, a statistically significant reduction in body weight, body fat, waist circumference, and hip circumference was demonstrated after 3 months. Under the influence of weight reduction, as well as dietary changes, there was an increase in the number of Akkermansia muciniphila bacteria in the women studied. The low-energy diet containing sources of natural prebiotics and probiotics had a more favorable effect on the number of Faecalibacterium prausnitzii bacteria compared to the standard diet.

Diet's Role in Modifying Risk of Alzheimer's Disease: History and Present Understanding

Diet is an important nonpharmacological risk-modifying factor for Alzheimer's disease (AD). The approaches used here to assess diet's role in the risk of AD include multi-country ecological studies, prospective and cross-sectional observational studies, and laboratory studies. Ecological studies have identified fat, meat, and obesity from high-energy diets as important risk factors for AD and reported that AD rates peak about 15-20 years after national dietary changes. Observational studies have compared the Western dietary pattern with those of the Dietary Approaches to Stop Hypertension (DASH), Mediterranean (MedDi), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets. Those studies identified AD risk factors including higher consumption of saturated and total fats, meat, and ultraprocessed foods and a lower risk of AD with higher consumption of fruits, legumes, nuts, omega-3 fatty acids, vegetables, and whole grains. Diet-induced factors associated with a significant risk of AD include inflammation, insulin resistance, oxidative stress, elevated homocysteine, dietary advanced glycation end products, and trimethylamine N-oxide. The molecular mechanisms by which dietary bioactive components and specific foods affect risk of AD are discussed. Given most countries' entrenched food supply systems, the upward trends of AD rates would be hard to reverse. However, for people willing and able, a low-animal product diet with plenty of anti-inflammatory, low-glycemic load foods may be helpful.

Plant-Based Diets and Lipid, Lipoprotein, and Inflammatory Biomarkers of Cardiovascular Disease: A Review of Observational and Interventional Studies

Plant-based diets (PBDs) are becoming increasingly popular. Thus far, the literature has focused on their association with lipid profiles, with less investigation of lipoprotein and inflammatory profiles. Because pro-atherogenic lipid, lipoprotein, and inflammatory processes may facilitate the development of atherosclerosis, understanding the relation between PBDs and these processes is important to inform risk mitigation strategies. Therefore, the objective of this paper was to review the literature on PBDs and lipid, lipoprotein, and inflammatory biomarkers of cardiovascular disease (CVD). A structured literature search was performed, retrieving 752 records, of which 43 articles were included. Plant-based diets generally associated with favourable lipid and lipoprotein profiles, characterised by decreased total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B concentrations, and less low-grade inflammation, characterised by decreased C-reactive protein concentrations. Effect sizes from PBD interventions were greatest compared to habitual dietary patterns, and for non-low-fat vegan and tightly controlled dietary interventions. Associations between PBD indices and the reviewed biomarkers were less consistent. Findings are discussed with reference to the literature on PBDs and PBD indices and CVD risk, the associations between specific plant food groups and CVD outcomes and the reviewed biomarker outcomes, and the potential mechanisms underpinning associations between PBDs and reduced CVD risk.

Effect of a Vegan Diet on Alzheimer's Disease

There is evidence indicating that a vegan diet could be beneficial in the prevention of neurodegenerative disorders, including Alzheimer's disease (AD). The purpose of this review is to summarize the current knowledge on the positive and negative aspects of a vegan diet regarding the risk of AD. Regarding AD prevention, a vegan diet includes low levels of saturated fats and cholesterol, contributing to a healthy blood lipid profile. Furthermore, it is rich in phytonutrients, such as vitamins, antioxidants, and dietary fiber, that may help prevent cognitive decline. Moreover, a vegan diet contributes to the assumption of quercetin, a natural inhibitor of monoamine oxidase (MAO), which can contribute to maintaining mental health and reducing AD risk. Nonetheless, the data available do not allow an assessment of whether strict veganism is beneficial for AD prevention compared with vegetarianism or other diets. A vegan diet lacks specific vitamins and micronutrients and may result in nutritional deficiencies. Vegans not supplementing micronutrients are more prone to vitamin B12, vitamin D, and DHA deficiencies, which have been linked to AD. Thus, an evaluation of the net effect of a vegan diet on AD prevention and/or progression should be ascertained by taking into account all the positive and negative effects described here.

Nutritional Status of Slovene Adults in the Post-COVID-19 Epidemic Period

Background: Monitoring nutritional status data in the adult population is extremely important to mediate their health status. Unfortunately, for Slovenia (2.1 million European Union citizens), data on the body composition status of the general adult population are currently rare or nonexistent in scientific journals. Furthermore, dietary intake was last assessed several years before the COVID-19 epidemic period. Methods: We randomly recruited 844 adult Slovenes from all regions of Slovenia. The primary aim of the cross-sectional study was to examine body composition status (using a medically approved electrical bioimpedance monitor) during the post-COVID-19 epidemic period. In addition, we assessed dietary intake (using a standardized food frequency questionnaire) and compared the obesity propensity for both sexes separately using the body mass index (BMI) and body fat percentage (FAT%) obesity classification of the World Health Organization. Results: Regarding BMI classification, 43% of the whole sample was overweight (28%) or obese (15%), and there were more older adults than adults (64% vs. 42%, p < 0.001). The average FAT% of adult females and males was 26.9% and 19.5% (p < 0.001), respectively, while for older adult females and males, it was 32.7% and 23% (p < 0.001). In addition, a comparison of the proportions of obese people between the two cut-off obesity classifications (BMI vs. FAT%) showed a significantly underestimated proportion of obese female participants based on BMI classification (13% vs. 17%, p = 0.005). In terms of the dietary intake of the assessed nutrients in comparison with the national dietary reference values for energy and nutrient intake, the participants, on average, had lower intake than the recommended values for carbohydrates, fiber, vitamins C, D and E (for males) and calcium, and higher intake than the recommended values for total fat, saturated fatty acids, cholesterol, sodium and chloride (for males). Conclusions: The results urgently call for the need to not only improve the overall national nutritional status but also for regular national monitoring of body composition and dietary intake statuses.