Vegetarian Diets and Weight Status

The role of plant-based dietary patterns in reducing COVID-19 risk and/or severity in adults: A systematic review and meta-analysis of observational studies

BACKGROUND & AIMS

Plant-based dietary patterns (PBDs) might protect against COVID-19 risk and reduce severity of infection. This systematic review with meta-analysis aimed to examine the association between PBDs and risk of COVID-19 infection, hospitalization, intensive care unit (ICU) admission, and/or mortality, in adults.

METHODS

Pubmed, Embase, CINAHL and Web of Science were searched for observational studies, published in English up to 3rd April 2023, comparing the highest with the lowest adherence to a specific PBD. Data were screened, extracted, and risk of bias assessed using the Newcastle-Ottawa Quality Assessment Scale, by independent reviewers.

RESULTS

Seven studies (one cross-sectional, three case-control, and three prospective cohort), reporting on 649,315 participants, were eligible. Across them, there were 8512 events of COVID-19 infection (six studies), and 206 events of COVID-19 hospitalization (four studies), in addition to one study reporting on a composite hospitalization outcome (740 events). The pooled analysis showed that PBDs are associated with a 59% (odds ratio (OR) = 0.41, 95% confidence intervals (CI) 0.23-0.59; two studies) and 18% (OR = 0.82, 95% CI 0.78-0.85; three studies) reduction in COVID-19 infection risk in case-control and cohort studies, respectively. The pooled analysis of one case-control and two cohort studies showed an inverse association between high adherence to a PBD and risk of COVID-19 hospitalization (OR = 0.38, 95% CI 0.04-0.72).

CONCLUSION

Findings suggest a protective role of PBDs against the risk of COVID-19 infection and severity. More studies are needed to establish the association between PBDs and risk of ICU admission and mortality due to COVID-19.

Cardiovascular health and cancer risk associated with plant based diets: An umbrella review

CONTEXT

Cardiovascular diseases (CVDs) and cancer are the two main leading causes of death and disability worldwide. Suboptimal diet, poor in vegetables, fruits, legumes and whole grain, and rich in processed and red meat, refined grains, and added sugars, is a primary modifiable risk factor. Based on health, economic and ethical concerns, plant-based diets have progressively widespread worldwide.

OBJECTIVE

This umbrella review aims at assessing the impact of animal-free and animal-products-free diets (A/APFDs) on the risk factors associated with the development of cardiometabolic diseases, cancer and their related mortalities.

DATA SOURCES

PubMed and Scopus were searched for reviews, systematic reviews, and meta-analyses published from 1st January 2000 to 31st June 2023, written in English and involving human subjects of all ages. Primary studies and reviews/meta-analyses based on interventional trials which used A/APFDs as a therapy for people with metabolic diseases were excluded.

DATA EXTRACTION

The umbrella review approach was applied for data extraction and analysis. The revised AMSTAR-R 11-item tool was applied to assess the quality of reviews/meta-analyses.

RESULTS

Overall, vegetarian and vegan diets are significantly associated with better lipid profile, glycemic control, body weight/BMI, inflammation, and lower risk of ischemic heart disease and cancer. Vegetarian diet is also associated with lower mortality from CVDs. On the other hand, no difference in the risk of developing gestational diabetes and hypertension were reported in pregnant women following vegetarian diets. Study quality was average. A key limitation is represented by the high heterogeneity of the study population in terms of sample size, demography, geographical origin, dietary patterns, and other lifestyle confounders.

CONCLUSIONS

Plant-based diets appear beneficial in reducing cardiometabolic risk factors, as well as CVDs, cancer risk and mortality. However, caution should be paid before broadly suggesting the adoption of A/AFPDs since the strength-of-evidence of study results is significantly limited by the large study heterogeneity alongside the potential risks associated with potentially restrictive regimens.

Association between plant and animal proteins intake with lipid profile and anthropometric indices: A cross-sectional study

BACKGROUND

Results of studies on the effects of plant and animal proteins on lipid profile are controversial. So we aimed to assess the relationship between plant and animal protein intake with lipid profile and novel anthropometric indices in healthy individuals.

METHOD

In this cross-sectional study, 236 participants have selected from Shiraz medical centers (Iran) through random cluster sampling. Food intakes were assessed using a 168-items food frequency questionnaire (FFQ). Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were measured. Anthropometric indices including a body shape index (ABSI), abdominal volume index (AVI), buddy roundness index (BRI), and conicity index (CI) were calculated.

RESULTS

In the crude and fully adjusted models, more consumption of plant proteins was associated with TG levels (OR = 2.31; 95% CI: 1.08, 4.95; P = 0.03 and OR = 2.39; 95% CI: 1.03, 5.15; P = 0.04). Also, there was a significant direct association between plant proteins and BRI in the curd model (OR = 3.55; 95% CI: 1.32, 9.54; P = 0.01), and after adjusting for age and energy intake (OR = 3.32; 95% CI: 1.21, 9.14; P = 0.01). More consumption of plant proteins was related to higher CI in the crude model (OR = 3.06; 95% CI: 1.12, 8.31; P = 0.03), but not in the fully adjusted model.

CONCLUSION

We found that a higher intake of plant proteins was associated with a higher TG level, BRI, and CI index. However, more research is needed to confirm these relations and provide the evidence needed to exert these findings into clinical practice.

Lifestyle Medicine: An Antidote to Cardiovascular Diseases

Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't been much decline in heart disease related mortality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals' focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3-10 min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.

Plant-based dietary patterns and fasting insulin: a cross-sectional study from NHANES 2017-2018

BACKGROUND

Previous studies have created plant-based diet indices to assess the health effects of specific dietary patterns.

OBJECTIVE

To examine the association between the plant-based content of diet and fasting insulin in adults from the NHANES 2017-2018 database.

METHODS

Demographic, dietary, lab and clinical data and fasting insulin were obtained from the NHANES 2017-2018 database. From two 24-h dietary recalls, we created a plant-based diet index (PDI) and a healthy plant-based diet index (hPDI). A high PDI score indicated more plants were consumed versus animal foods. A high hPDI score indicated healthier, plant materials (whole grains, whole fruits, vegetables, legumes, vegetable oils, seeds and nuts) were consumed. The relationships between the natural log of fasting insulin, PDI, and hPDI were analyzed using multiple linear regression adjusting for body mass index (BMI) and alanine aminotransferase (ALT).

RESULTS

Analyses were based on 1,714 participants, 897 women and 817 men with a median age of 52 years. In this sample, 610 (35.6%) were white, 407 (23.8%) were black, 231 (13.5%) were Mexican, 207 (12.1%) were Asian, 157 (9.2%) were other Hispanic, and 102 (6%) were other or mixed race. Median fasting insulin was 9.74 μU/mL (IQR: 6.2, 15.56). For every 1 unit increase in PDI, the natural log of fasting insulin decreased 0.0068 ± 0.003 μU/mL (CI: -0.00097, -0.013) (p = 0.02). After adjusting for BMI and ALT, the PDI did not significantly predict fasting insulin as the association was not robust due to multicollinearity. The hPDI was inversely and significantly associated with the natural log of fasting insulin (-0.0027 ± 0.00134, CI: -0.000087, -0.0053) (p = 0.043) in a multivariable model including BMI and ALT.

CONCLUSION

A healthy plant-based diet is associated with a decrease in fasting insulin levels. Healthfulness of the diet is an important factor when considering the benefit of a plant-based diet.

An Unhealthy Plant-Based Diet Increases Risk of Hypertension but not Framingham Risk Score in Adults

Backgrounds

We investigated the relation of plant-based diets (PDs) with hypertension (HTN) and Framingham risk score (FRS) in Iranian adults.

Objectives

We hypothesized that healthy PDs might have positive effects on blood pressure (BP) and FRS, whereas less-healthy plant-based foods might have negative effects.

Methods

The current cross-sectional study was performed on 527 middle-aged adults (45.7% women), who were selected through a multistage cluster random-sampling method. The assessment of dietary intakes was performed by using a validated food-frequency questionnaire. Twelve-hour fasting blood samples were collected to evaluate total cholesterol and high-density lipoprotein concentrations. BP was measured through the standard method and HTN was defined as BP ≥130/80 mmHg. FRS was used to predict the 10-y risk for development of cardiovascular disease (CVD).

Results

The prevalence of HTN and high FRS among study participants were, respectively, 62% and 15.6%. After adjustment for potential confounders, plant-based diet index (PDI) and healthy plant-based diet index (hPDI) were not significantly associated with HTN [odds ratio (OR): 0.99; 95% confidence interval (CI): 0.55, 1.79 and OR: 0.83; 95% CI: 0.45, 1.53, respectively)]. However, those in the highest tertile of unhealthy plant-based diet index (uPDI) in comparison with those in the bottom tertile had a 100% increased odds of HTN (OR: 2.00; 95% CI: 1.04, 3.88). Greater adherence to PDI, hPDI, and uPDI was not related to high FRS chance, in fully adjusted model (OR: 0.50; 95% CI: 0.15, 1.65; OR: 1.03; 95% CI: 0.26, 4.04; and OR: 2.05; 95% CI: 0.56, 7.52, respectively).

Conclusions

This study demonstrated that less-healthy PDs would enhance the chance of HTN in Iranian adults, although PDIs were not significantly related to the 10-y risk of developing CVD.

Plant Proteins: Methods of Quality Assessment and the Human Health Benefits of Pulses

As countries increase their standard of living and individual income levels rise, there is a concomitant increase in the demand for animal-based protein. However, there are alternative sources. One of the alternatives available is that of increased direct human consumption of plant proteins. The quality of a dietary protein is an important consideration when discussing the merits of one protein source over another. The three most commonly used methods to express protein quality are the protein efficiency ratio (PER), a weight gain measurement; protein digestibility-corrected amino acid score (PDCAAS); and the digestible indispensable amino acid score (DIAAS). The possibility that alterations in the quality and quantity of protein in the diet could generate specific health outcomes is one being actively researched. Plant-based proteins may have additional beneficial properties for human health when compared to animal protein sources, including reductions in risk factors for cardiovascular disease and contributions to increased satiety. In this paper, the methods for the determination of protein quality and the potential beneficial qualities of plant proteins to human health will be described.

A comprehensive review of healthy effects of vegetarian diets

AIMS

A comprehensive review comparing the effect of vegetarian (V) and non-vegetarian (NV) diets on the major cardiometabolic diseases' outcomes was performed.

DATA SYNTHESIS

We performed literature research (up to December 31, 2022) of the evidence separately for vascular disease (VD), obesity (OB), dyslipidemia (Dysl), hypertension (HPT), type 2 diabetes (T2D), metabolic syndrome (MetS), analyzing only cohort studies and randomized controlled studies (RCTs) and comparing the effect of V and NV diets. Cohort studies showed advantages of V diets compared to NV diets on incidence and/or mortality risk for ischemic heart disease, overweight and OB risk. Most cohort studies showed V had lower risk of HPT and lower blood pressure (BP) than NV and V diets had positive effects on T2D risk or plasma parameters. The few cohort studies on the risk of MetS reported mixed results. In RCTs, V diets, mainly low-fat-vegan ones, led to greater weight loss and improved glycemic control than NV diets and in the only one RCT a partial regression of coronary atherosclerosis. In most RCTs, V diets significantly reduced LDL-C levels (but also decreased HDL-C levels) and BP.

CONCLUSIONS

In this comprehensive review of the association between V diets and cardiometabolic outcomes, we found that following this type of diet may help to prevent most of these diseases. However, the non-uniformity of the studies, due to ethnic, cultural, and methodological differences, does not allow for generalizing the present results and drawing definitive conclusions. Further, well-designed studies are warranted to confirm the consistency of our conclusions.

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.

The associations of plant-based food and metabolic syndrome using NHANES 2015-16 data

BACKGROUND

Consuming a diet rich in plant-based foods (PBFs) may be protective for risk of metabolic syndrome (MetS) and chronic disease. However, the impact of consuming healthy versus all types of PBF on MetS is unknown.

METHODS

The relationship between consumption of PBF (both healthy and all) was examined using data from the 2015 to 2016 National Health and Nutrition Examination Survey (NHANES). The amount of PBFs consumed was calculated as average daily servings, whereas dichotomous MetS variables were based on the National Cholesterol Education Adult Program Treatment Panel III (2005). After weighting and multiple imputation, adjusted associations were examined using logistic regression and marginal probabilities.

RESULTS

Consumption of healthy PBF was significantly associated with reduced risk for elevated waist circumference (P = 0.017; odds ratio, OR 0.96, 95% confidence interval, CI 0.94-0.98) and MetS (P = 0.006; OR 0.96, 95% CI 0.93-0.99). Interactions revealed significant protective effects for females who were $\ge$ 60 years.

CONCLUSIONS

In the adjusted model, a 1-unit increase in daily servings of healthy PBF was associated with a 4% lower risk for prevalence of elevated waist circumference and a 4% decrease in risk for prevalence of MetS. Increasing consumption of PBF may offer a viable strategy for reducing risk of MetS.

Assessment of Oxidant and Antioxidant Status in Prepubertal Children following Vegetarian and Omnivorous Diets

Oxidant-antioxidant balance is crucial for maintaining one’s health, and the diet is possibly one of the most important factors affecting this balance. Therefore, the aim of this study was to determine the oxidant-antioxidant balance in children on a lacto-ovo-vegetarian diet. The study was conducted between January 2020 and December 2021. The concentrations of total oxidant capacity (TOC), total antioxidant capacity (TAC), reduced (GSH), and oxidized (GSSG) glutathione, as well as C-reactive protein (CRP) and calprotectin were measured in serum samples of 72 healthy prepubertal children (32 vegetarians and 40 omnivores). The oxidative stress index (OSI) and the GSH/GSSG ratio (R-index) were calculated. Children on a vegetarian diet had significantly lower median values of TOC, GSH, and GSSG, and higher TAC compared with the omnivores. OSI was significantly lower in vegetarians, while R-index, as well as median values of CRP and calprotectin did not differ between both groups of children. Significant negative correlations were observed between TOC and TAC levels in the whole group of children and in vegetarians. GSH and GSSG levels correlated positively in the groups of vegetarians, omnivores, and in all the children. There were significant positive correlations between TOC and GSH, as well as GSSG levels in all the studied groups of children. Our study results suggest that the vegetarian model of nutrition allows to maintain the oxidant-antioxidant balance in the serum of prepubertal children.

School health programs of physical education and/or diet among pupils of primary and secondary school levels I and II linked to body mass index: A systematic review protocol within the project From Science 2 School

The most common causes of death in Western countries today are preventable diseases mainly attributed to daily behavior. It has been well documented that genetics are influential but not the deciding factor for developing non-communicable diseases. Ideally, the public should be educated to perform methods of optimal health and wellbeing independently, meaning that individuals should be in control of their health without relying on others. As behavior is known to be consistent over time, good or poor health behavior will track from childhood into adulthood. Physical activity and diet are permanently linked to the individual's state of health, and when properly balanced, the effects on personal health summate, resulting in greater benefits from this dual-approach for public health. The objective is to highlight the different approaches (physical intervention, nutritional intervention, and dual-approach of diet and exercise) and identify effective interventions for sustainable body weight and healthy body mass index in school children. A systematic review will be conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The review will assess school-based diet and exercise interventions on children in primary and secondary school levels I and II. Overweight and obesity develop as a result of a prolonged imbalance in the energy balance model, with both physical activity and diet being influential in the fluctuation of body weight. A dual-approach including physical activity and diet could therefore be a very promising method to promote sustainable healthy body weight in school children.

Health status of recreational runners over 10-km up to ultra-marathon distance based on data of the NURMI Study Step 2

Endurance running is well-documented to affect health beneficially. However, data are still conflicting in terms of which race distance is associated with the maximum health effects to be obtained. Therefore, the aim of this study was to compare the health status of endurance runners over different race distances. A total of 245 recreational runners (141 females, 104 males) completed an online survey. Health status was assessed by measuring eight dimensions in two clusters of health-related indicators (e.g., body weight, mental health, chronic diseases and hypersensitivity reactions, medication intake) and health-related behaviors (e.g., smoking habits, supplement intake, food choice, healthcare utilization). Each dimension consisted of analytical parameters derived to a general domain score between 0 and 1. Data analysis was performed by using non-parametric ANOVA and MANOVA. There were 89 half-marathon (HM), 65 marathon/ultra-marathon (M/UM), and 91 10-km runners. 10-km runners were leaner than both the HM and M/UM runners (p ≤ 0.05). HM runners had higher health scores for six dimensions (body weight, mental health, chronic diseases and hypersensitivity reactions, medication intake, smoking habits, and health care utilization), which contributed to an average score of 77.1% (score range 62–88%) for their overall state of health. Whereas 10-km and M/UM runners had lesser but similar average scores in the overall state of health (71.7% and 72%, respectively). Race distance had a significant association with the dimension “chronic diseases and hypersensitivity reactions” (p ≤ 0.05). Despite the null significant associations between race distance and seven (out of eight) multi-item health dimensions, a tendency towards better health status (assessed by domain scores of health) among HM runners was found compared to other distance runners. However, the optimal state of health across all race distances supported the notion that endurance running contributed to overall health and well-being.

Trial registration number: ISRCTN73074080. Retrospectively registered 12th June 2015.

Owner perception of health of North American dogs fed meat- or plant-based diets

BACKGROUND

Some dog owners elect to feed their dog a plant-based food either as part of or for their entire dietary intake. Being omnivores or facultative carnivores, a strictly plant-based diet is not the natural type of food dogs evolved to consume, leaving some question as to whether this feeding management strategy is safe and healthy for dogs.

OBJECTIVES

This study surveyed owner perceptions of health and wellbeing of dogs and compared between those fed meat-based and plant-based diets.

METHODS

A web-based questionnaire was distributed to pet owners to collect data on dog characteristics, husbandry, health and wellbeing. Univariate comparisons between diet groups was made by chi square analyses or Kaplan-Meier tests as appropriate, with a significance cut-off value of 0.05. Multivariate models were negative binomial and logistic regression for count and categorical data, respectively.

RESULTS

Owners feeding plant-based diets to their dog reported fewer health disorders, specifically with respect to ocular or gastrointestinal and hepatic disorders. Dog longevity was reported to be greater for dogs fed plant-based diets. Owners feeding plant-based diets to their dogs relied less on veterinary associates for nutrition information, versus dog owners feeding meat-based diets.

CONCLUSIONS

Dog owners feeding a plant-based diet did not perceive adverse health effects in their dogs. The results might suggest an association between feeding a plant-based diet and perceived health and longevity, however inherent bias and limitations associated with surveys of owner perception must be considered, and objective research is required to determine if plant-based diets truly affect canine health.

Comparison between Different Groups of Vegetarianism and Its Associations with Body Composition: A Literature Review from 2015 to 2021

BACKGROUND

Vegetarian and vegan diets have become increasingly popular in the last years for many reasons, including their association with various health benefits when compared to omnivorous diets. The main objective of the study was to collect recent (2015-2021) scientific evidence for potential implications between a vegetarian/vegan diet and an individuals' body composition.

METHODS

A literature search was conducted in PubMed, with 22 studies selected for inclusion in our collective evaluation. Of the 22 studies included, there were 12 randomized controlled trials, 1 nonrandomized controlled trial, 1 comparative study, and 8 cross-sectional. The overall sample included in this study consists of 436,178 participants, 10,090 of whom were vegetarians, 5044 vegans, and 421,044 omnivores.

RESULTS

Most studies, 17 out of 22, reported a significant positive relationship between a plant-based diet and body composition.

CONCLUSION

There is scientifically sound evidence that vegan or vegetarian diets are associated with weight and body mass index reduction and, in some cases, fat mass distribution changes.

Inflammatory, oxidative and DNA damage status in vegetarians: is the future of human diet green?

The health benefit of a vegetarian diet is still under debate as it may result in a higher intake of some beneficial micronutrients, while others may be reduced, thus influencing various metabolic pathways and health-related biomarkers. This scoping review discusses inflammatory, oxidative and DNA damage status in vegetarians and vegans compared to omnivores. Most of the reviewed studies indicated favorable effects of a vegetarian diet on oxidative status compared to omnivores but did not clearly associate particular dietary habits to genome damage. The evidence on the effect of vegetarian diet on the inflammatory and immunological biomarkers is poor, which could at least partly be explained by methodological constraints such as small sample size, short duration of vegetarianism and inconsistent definitions of the omnivorous diet. The only inflammatory biomarker that seems to be associated with the vegetarian diet was inflammatory mediator C-reactive protein, which in several studies showed lower values in vegetarians as compared to omnivores. There were very few studies on immunological markers and the results on the difference between vegetarians and omnivores were inconclusive. Although several biomarkers involved in oxidative stress and inflammation showed a beneficial association with the vegetarian diet, further research in well-defined and sufficiently sized cohorts is needed to provide more evidence.

New-onset vegetarian diet shows differences in fatty acid metabolites in European American and African American women

BACKGROUND AND AIMS

The type of fat consumed in animal-based western diets, typically rich in the saturated fat palmitate, has been implicated in cardiometabolic disease risk. In contrast, the most abundant mono- and polyunsaturated fats, more typical in a vegetarian or plant-based diet, potentiate less deleterious effects. This study determined differences in plasma and urine metabolites when switching from omnivorous to vegetarian diet, including metabolites involved in fatty acid utilization.

METHODS AND RESULTS

A prospective cohort of 38 European (EA) and African American (AA) omnivorous females were matched by age (25.7 ± 5.3y) and BMI (22.4 ± 1.9 kg/m²). Pre-intervention samples were collected while subjects consumed habitual animal-based diet. Changes in metabolites were assessed by ultra-high-performance liquid chromatography-tandem mass spectroscopy (Metabolon, Inc.) upon completing four days of novel vegetarian diet provided by the Vanderbilt Metabolic Kitchen. Changes in several diet-derived metabolites were observed, including increases in compounds derived from soy food metabolism along with decreases in metabolites of xanthine and histidine. Significant changes occurred in metabolites of saturated, monounsaturated and polyunsaturated fatty acids along with significant differences between EA and AA women in changes in plasma concentrations of acylcarnitines, which reflect the completeness of fatty acid oxidation (versus storage).

CONCLUSION

These data suggest improvements in fatty acid metabolism (oxidation vs storage), a key factor in energy homeostasis, may be promoted rapidly by adoption of a vegetarian (plant-based) diet. Mechanistic differences in response to diet interventions must be understood to effectively provide protection against the widespread development of obesity and cardiometabolic disease in population subgroups, such as AA women.

Perspective: Plant-Based Eating Pattern for Type 2 Diabetes Prevention and Treatment: Efficacy, Mechanisms, and Practical Considerations

A plant-based eating pattern is associated with a reduced risk of developing type 2 diabetes and is highly effective in its treatment. Diets that emphasize whole grains, vegetables, fruits, and legumes and exclude animal products improve blood glucose concentrations, body weight, plasma lipid concentrations, and blood pressure and play an important role in reducing the risk of cardiovascular and microvascular complications. This article reviews scientific evidence on the effects of plant-based diets for the prevention and treatment of type 2 diabetes. The mechanisms by which plant-based diets improve body weight, insulin sensitivity, and β-cell function are described. Practical considerations including education, nutrition adequacy, and adjusting medications will enhance the success of patients who have diabetes.

Vegan Diet Health Benefits in Metabolic Syndrome

Plant-based diets (PBDs) are increasingly consumed by the Italian population and around the world. In particular, among PBDs, the vegan diet is a food pattern characterized by the exclusion of all animal-origin foods. What drives people to adopt this model are mainly ethical, health and environmental reasons. A vegan diet, if well-balanced and varied, can help in achieving and maintaining an optimal state of health. However, this nutritional approach, if not well-balanced, can cause deficiencies in proteins, ω-3 fatty acids, iron, vitamin D and calcium, zinc, iodine and, above all, vitamin B12. Oral food supplements especially fortified foods are recommended in these cases to restore the nutritional deficiencies. A vegan diet generally reduces the risk of developing chronic non-communicable degenerative diseases, such as metabolic syndrome (MetS) and, in addition, requires fewer natural resources for food production than an omnivorous diet. The aim of this review is to analyze the possible impact of the vegan diet on MetS onset and its treatment.

Role of plant protein in nutrition, wellness, and health

Plant-based diets, and more specifically plant-based proteins, have been the subject of growing interest from researchers and consumers because of their potential health benefits as well as their positive environmental impact. Of course, plant proteins are found in plant foods, and positive health benefits of plant foods are linked to dietary fiber, vitamins, minerals, and phytochemicals. In epidemiological studies it is not possible to separate out the health benefits of plant foods in general as opposed to plant proteins specifically. Additionally, few vegans, who consume only plant-based proteins, are included in existing prospective cohort studies. Isolated plant proteins (soy, pea) have been used in intervention trials, but often to improve biomarkers linked to disease risk, including serum lipids or blood pressure. This review is an overview of plant proteins, the whole foods they are associated with, and the potential health benefits linked to consumption of protein from plant sources. Plant proteins and their potential for reducing the risk of developing metabolic syndrome, diabetes management, cancer prevention, and weight management are each discussed, as are the various rating systems currently used to determine protein quality from plant sources. Although additional research is needed that focuses specifically on the role that plant protein plays in the prevention and management of these chronic illnesses, rather than the role played by a more general plant-based diet, evidence suggests that plant proteins offer nutritional benefits to those who consume them. Limitations to plant proteins, including lower protein quality, must also be considered in this discussion.

The effect of plant-based dietary patterns on blood pressure: a systematic review and meta-analysis of controlled intervention trials

OBJECTIVES

The consumption of strict vegetarian diets with no animal products is associated with low blood pressure (BP). It is not clear whether less strict plant-based diets (PBDs) containing some animal products exert a similar effect. The main objective of this meta-analysis was to assess whether PBDs reduce BP in controlled clinical trials.

METHODS

We searched Cumulative Index to Nursing and Allied Health Literature, Medline, Embase, and Web of Science to identify controlled clinical trials investigating the effect of PBDs on BP. Standardized mean differences in BP and 95% confidence intervals were pooled using a random effects model. Risk of bias, sensitivity, heterogeneity, and publication bias were assessed.

RESULTS

Of the 790 studies identified, 41 clinical trials met the inclusion criteria (8416 participants of mean age 49.2 years). In the pooled analysis, PBDs were associated with lower SBP [Dietary Approach to Stop Hypertension -5.53 mmHg (95% confidence intervals -7.95,-3.12), Mediterranean -0.95 mmHg (-1.70,-0.20), Vegan -1.30 mmHg (-3.90,1.29), Lacto-ovo vegetarian -5.47 mmHg (-7.60,-3.34), Nordic -4.47 mmHg (-7.14,-1.81), high-fiber -0.65 mmHg (-1.83,0.53), high-fruit and vegetable -0.57 mmHg (-7.45,6.32)]. Similar effects were seen on DBP. There was no evidence of publication bias and some heterogeneity was detected. The certainty of the results is high for the lacto-ovo vegetarian and Dietary Approach to Stop Hypertension diets, moderate for the Nordic and Mediterranean diets, low for the vegan diet, and very low for the high-fruit and vegetable and high-fiber diets.

CONCLUSION

PBDs with limited animal products lower both SBP and DBP, across sex and BMI.

Vegetarian and omnivorous diets: A cross-sectional study of motivation, eating disorders, and body shape perception

Vegetarianism, which is increasingly widespread in Western societies, is underpinned by various motivations (ethical, environmental, health concerns …) and the question of its association with eating disorders continues to divide the literature. This cross-sectional study aimed to explore and compare eating motives/attitudes and bodily preoccupations of vegetarian and omnivorous participants from the general population. Forty-nine vegetarians and 52 omnivores, aged between 18 and 70 years, completed a battery of questionnaires including sociodemographic characteristics, Body Mass Indexes (BMI - current, ideal, lifetime lowest, and lifetime highest), the Food Choice Questionnaire (FCQ), the Eating Attitudes Test-26 (EAT-26), and the Body Shape Questionnaire (BSQ). Compared to omnivores, vegetarians reported lower current (p = .017), ideal (p = .009), and lifetime lowest (p = .005) BMIs, more motivations related to health (p = .001) and natural content (p < .0001), but less weight control motivations (p = .015). While no differences were observed in EAT-26 scores, vegetarians had lower BSQ total scores (p = .043), and lower scores on the Body Dissatisfaction related to Lower body parts (p = .025) and Unsuited Cognitions and Behaviors (p = .015) subscales compared to omnivores. Separate gender comparisons revealed that these differences existed only among women. Hierarchical regressions revealed that the natural content motivation was the strongest positive statistical predictor of the vegetarian group (Expβ = 1.18, p = .002), while the weight control motivation was a negative statistical predictor (Expβ = .710, p = .023). Results demonstrated that vegetarians expressed motivation for a healthy and natural diet, and were less concerned about controlling their weight than the omnivores. Vegetarian women had lower BMIs but expressed fewer psychological concerns associated with eating disorders than omnivorous women. Vegetarian diets appeared to be associated with health benefits and less body and weight concerns, particularly among women in the general population.

Higher dietary phytochemical index is associated with anthropometric indices in children and adolescents: the weight disorders survey of the CASPIAN-IV study

Objectives: The present study aimed to determine the association of total dietary phytochemical intake with generalized and abdominal obesity in children and adolescents. Material and methods: This nationwide cross-sectional study was conducted in 4296 students aged 6-18 years. Dietary phytochemical index (DPI) was calculated as a percentage of daily energy derived from phytochemical-rich foods divided by total daily energy intake. Results: The mean ± standard error of DPIs in the first, second, third and fourth quartiles were 12.70 ± 3.28, 20.36 ± 1.84, 27.52 ± 0.08 and 41.10 ± 0.26, respectively. Anthropometric measures including weight Z-score (-0.04 vs. 0.05, P = 0.023), body mass index (BMI) Z-score (-0.05 vs. 0.06, P = 0.013), waist circumference (WC) (65.80 cm vs. 66.95 cm P = 0.022), hip circumference (HC) (80.20 cm vs. 81.37 cm, P = 0.046), and neck circumference (NC) (30.06 cm vs. 30.45 cm, P = 0.031) were significantly lower among participants in the upper DPI quartile compared to those in the lower quartiles. In overweight and obese children, higher adjusted DPI scores had inverse correlation with BMI, WC, HC, wrist circumference, and NC (βs = -0.077, -0.10, -0.119, -0.01, and -0.032, respectively; P < 0.05). Comparison of the fourth quartile with the first quartile of DPI revealed beneficial effects of higher phytochemical intake on reducing the risk of obesity/overweight and abdominal obesity. However, these results were not statistically significant (P = 0.073). Conclusion: Higher DPI score was associated with lower risk of generalized and abdominal obesity in children and adolescents. However, the results were not statistically significant. Consuming phytochemical-rich foods can be encouraged to prevent childhood obesity.

A Comprehensive Review of the Benefits of and the Barriers to the Switch to a Plant-Based Diet

In recent decades, the food industry has been faced with new challenges, and it has had to develop new types of diets and produce new types of foods that can slow down the spread of chronic diseases. The aim of our research was to identify the characteristics of plant-based nutrition, based on international and Hungarian literature. The comprehensive analysis was performed based on the theoretical model called Theory of Planned Behavior, in the course of which the perceived and objective benefits of and barriers to the conversion to a plant-based diet were examined. According to our results, the main benefits of plant-based nutrition are its many factors associated with a reduction in risk of developing numerous chronic diseases. This is followed by benefits of well-being and satisfaction, followed by ethical and environmental benefits. The most commonly reported inhibitory factor of a vegetarian diet is the enjoyment of eating meat and the difficulty in giving up meat consumption. This is followed by health considerations, e.g., lack of various ingredients in foods. Convenience and taste factors are also important disincentives, as well as the irrelevant nature of some plant-based nutrition information sources. Besides, social barriers, negative discrimination, and negative effect on mental health associated with them can also be a hindrance, as can financial barriers. The classification developed during our analysis can serve as a relevant guideline for decision-makers, and also as a basis for further primary qualitative and quantitative research.

Which Is a Good Diet-Veg or Non-veg? Faith-Based Vegetarianism for Protection From Obesity-a Myth or Actuality?

INTRODUCTION

India ranks first among nations with the largest population of vegetarians, and 40% of Asian Indians are vegetarian. There seems to occur a "nutrition transition" among vegetarians in India with a decline in the consumption of whole plant food content and replacement with processed foods, fried foods, and refined carbohydrates. This study evaluates the association between the consumption of a vegetarian diet and the prevalence of morbid obesity necessitating bariatric surgery in Asian Indians.

MATERIAL AND METHODS

This is a retrospective cohort study analyzing records of 235 Indian patients suffering from morbid obesity and who underwent bariatric surgery at our center through the years 2015 to 2017. Pearson's chi-square test for independence of attributes was applied to analyze the difference between a number of vegetarians versus non-vegetarians undergoing bariatric surgery.

RESULTS

The difference in the number of vegetarians versus non-vegetarians undergoing bariatric surgery was not significant for years 2015 and 2017, but the number was numerically higher for vegetarians. The difference was significantly higher for vegetarians in the year 2016. The difference in female vegetarians versus female non-vegetarians undergoing bariatric surgery was not significant for the year 2017 but was significantly higher for vegetarians during the years 2015 and 2016. The difference in male vegetarians versus non-vegetarians undergoing bariatric surgery was not significant for all the years.

CONCLUSION

In an Asian Indian cohort, we found that vegetarian dietary patterns were associated with a higher incidence of morbid obesity culminating in bariatric surgery. Our study is a myth breaker that all vegetarian diets are healthy diets. Our findings can be utilized to discourage refined and processed food consumption and promote healthy vegetarian food choices.

Effects of Plant-Based Diets on Outcomes Related to Glucose Metabolism: A Systematic Review

According to the rising prevalence of obesity and metabolic disorders leading to impaired glucose metabolism, effective strategies to prevent and/or delay the onset of disease are of great need. A plant-based diet has been suggested as an effective lifestyle change that may reduce the degree of obesity and improve outcomes related to glucose metabolism. This systematic review aimed to evaluate the effect of a plant-based diet on outcomes related to glucose metabolism. A literature search was conducted in the database PubMed until January 30, 2020. Randomized controlled trials investigating the effect of a plant-based dietary intervention on outcomes related to glucose metabolism in human subjects compared to an omnivorous diet were eligible for inclusion. Of 65 publications identified, nine trials on subjects with overweight/obesity, type 2 diabetes mellitus, or cardiovascular disease were included. Five studies reported that the plant-based intervention significantly improved markers of glycemic control from baseline to end point, of which four revealed a significant improvement in the intervention group compared to the control intervention. The remaining four studies did not observe a significant effect of a plant-based intervention on outcomes related to glucose metabolism. Our findings suggest that a shift to a plant-based diet may lead to favorable effects on glycemic control in individuals diagnosed with type 2 diabetes mellitus and/or obesity. The data were however somewhat conflicting, and the included trials reported results based on different intervention diets and study populations. Overall, no clear conclusions regarding effects of different plant-based diets can be drawn based on the current findings alone.

Mung Bean Protein Supplement Improves Muscular Strength in Healthy, Underactive Vegetarian Adults

Although vegetarian diets are considered generally protective against chronic disease, nutrient deficiencies, including protein, are possible due to low bioavailability from plant-based sources. The consequences of inadequate dietary protein include reduced lean body mass (LBM) and muscle weakness. This study examined relationships between protein intake, strength, and LBM in 37 underactive vegetarians and recorded the impact of protein supplementation (18 g/day mung bean protein) on these indices utilizing an eight-week, randomized, controlled, feeding trial. Both handgrip and knee flexor and extensor strength were measured at baseline and week eight. At baseline, LBM was significantly related to grams of protein consumed daily. LBM was also correlated to grip strength (r = 0.569, p < 0.001) and lower body strength (r = 0.763 to 0.784; p < 0.001). Twenty-five vegetarians completed the feeding trial, including 11 in the protein supplementation group (PRO) and 14 in the control group (CON). At the end of the trial, LBM and strength did not differ significantly between groups. However, the average percent change for grip, flexor, and extensor strength did differ between PRO and CON participants (+2.9 ± 7.2% and −2.6 ± 7.3% respectively, p = 0.05). Thus, there were strong associations between dietary protein, LBM, and strength in vegetarians and an indication that supplementary vegetarian protein increased strength in the absence of exercise and independent of LBM.

Lifestyle Interventions and Carotid Plaque Burden: A Comparative Analysis of Two Lifestyle Intervention Programs in Patients with Coronary Artery Disease

BACKGROUND

The cardioprotective effects of intensive lifestyle regimens in primary prevention have been elucidated; however, there is a paucity of data comparing the effects of different lifestyle regimens in patients with established coronary artery disease (CAD) or CAD equivalent, specifically vis-à-vis carotid plaque regression.

METHODS

We performed a randomized, single-center, single-blind study in 120 patients with established CAD. Patients were randomly assigned to either 9 months of the Complete Health Improvement Program (CHIP), an outpatient lifestyle enrichment program that focuses on improving dietary choices, enhancing daily exercise, increasing support systems, and decreasing stress; or to 9 months of an ad hoc, nonsequential combination of various healthy living classes offered separately through a health maintenance organization and referred to as the Healthy Heart program. Baseline and 9-month change in carotid intima-media thickness (CIMT) were measured.

RESULTS

Among 120 participants, data were analyzed for 79, of which 68 (86%) completed the study. Both average CIMT and average maximum CIMT increased over 9 months, but the changes between groups were insignificant. There were marked differences in the mean body mass index favoring the CHIP group (-1.9 [standard deviation = 1.9]; p < 0.001) and statistically significant within-group improvements in blood pressure, triglyceride level, 6-minute walk test result, self-assessment well-being score, and Patient Health Questionnaire-9 score that were not observed between groups.

CONCLUSION

Neither the CHIP nor Healthy Heart was effective in inducing plaque regression in patients with established CAD after a 9-month period. However, both were effective in improving several CAD risk factors, which shows that the nonsequential offering of healthy lifestyle programs can lead to similar outcomes as a formal, sequential, established program (CHIP) in many aspects. These results have important implications as to how lifestyle changes will be implemented as tertiary prevention measures in the future.

Effect of different dietary patterns on glycemic control in individuals with type 2 diabetes mellitus: A systematic review

Different dietary patterns have been positively related to the glycemic control of individuals with type 2 diabetes mellitus. However, consensual dietary pattern for these individuals is not established. We aimed to evaluate the effects of adopting different dietary patterns on glycemic control markers of individuals with type 2 diabetes mellitus. PubMed, Scopus, MEDLINE, Lilacs, Open Thesis and Google Scholar databases were searched using the Medical Subject Headings and terms related to dietary pattern and glycemic control in individuals with type 2 diabetes mellitus. Interventional studies with adults of this population without diabetes-related complications, presenting data on percentage of glycated hemoglobin, and dietary patterns were included. In vitro, animal, reviews, observational, and studies with children, adolescents, pregnant and breastfeeding women were excluded. The time of adoption dietary patterns ranged from eight weeks to four years in randomized clinical trials, and six months in the cohort study. Vegetarian, vegan, Mediterranean, and Dietary Approaches to Stop Hypertension dietary patterns reduced 0.8% on average of percentage of glycated hemoglobin, considering all included studies. It was also observed reduction in fasting glycemia and improvement in Homeostasis Model Assessment of Insulin Sensitivity. However, more randomized clinical trials are required for a full elucidation of these questions.

Comparison of the effects of a liquid breakfast meal with varying doses of plant-based soy protein on appetite profile, energy metabolism and intake

A dose dependent satiating and thermogenic effect of animal-based protein has been observed, however, less is known wherever plant-based protein elicits same response. The purpose of the study was to examine the effects of a breakfast meal containing varying doses of plant-based soy protein (SP) on appetite profile, hormone response, energy metabolism and energy intake.

METHODS

Seventeen participants (age: 27 ± 7 y, body fat: 21.5 ± 6.9%) in randomized order consumed one of three isoenergetic liquid breakfast meals (482 ± 5 kcals): high SP (HSP; 50 g), low SP (LSP; 25 g) and control (CON; 50 g carbohydrate) followed by an ad libitum lunch 3 h later. Appetite profile was measured before, immediately after and hourly during the 3 h postprandial period. Plasma concentrations of leptin and insulin were measured before, at 30 and 180 min.

RESULTS

Energy intake at lunch per kilogram of body weight was significantly higher after CON (11 ± 3.6 kcal/kg) compared to HSP (9.1 ± 3.0 kcal/kg) but not compared to LSP (10.2 ± 2.7 kcal/kg). Participants hunger was higher, whereas, satiety and fullness were lower after CON (p < 0.05). There were no significant differences (p > 0.05) observed in leptin or insulin responses between meals, however, a significant change over time was observed for insulin (p = 0.02) but not leptin (p > 0.05).

CONCLUSION

Liquid breakfast meals with higher dose of soy protein reduced energy intake when adjusted by body weight at lunch and was rated as more satiating compared to an isoenergetic CON meal.

Effect of diet composition on insulin sensitivity in humans

Diet composition has a marked impact on the risk of developing type 2 diabetes and cardiovascular disease. Prospective studies show that dietary patterns with elevated amount of animal products and low quantity of vegetable food items raise the risk of these diseases. In healthy subjects, animal protein intake intensifies insulin resistance whereas plant-based foods enhance insulin sensitivity. Similar effects have been documented in patients with diabetes. Accordingly, pre-pregnancy intake of meat (processed and unprocessed) has been strongly associated with a higher risk of gestational diabetes whereas greater pre-pregnancy vegetable protein consumption is associated with a lower risk of gestational diabetes. Population groups that modify their traditional dietary habit increasing the amount of animal products while reducing plant-based foods experience a remarkable rise in the frequency of type 2 diabetes. The association of animal protein intake with insulin resistance is independent of body mass index. In obese individuals that consume high animal protein diets, insulin sensitivity does not improve following weight loss. Diets aimed to lose weight that encourage restriction of carbohydrates and elevated consumption of animal protein intensify insulin resistance increasing the risk of developing type 2 diabetes and cardiovascular disease. The effect of dietary components on insulin sensitivity may contribute to explain the striking impact of eating habits on the risk of type 2 diabetes and cardiovascular disease. Insulin resistance predisposes to type 2 diabetes in healthy subjects and deteriorates metabolic control in patients with diabetes. In nondiabetic and diabetic individuals, insulin resistance is a major cardiovascular risk factor.

Health Status of Female and Male Vegetarian and Vegan Endurance Runners Compared to Omnivores-Results from the NURMI Study (Step 2)

Health effects of vegetarian and vegan diets are well known. However, data is sparse in terms of their appropriateness for the special nutritional demands of endurance runners. Therefore, the aim of this study was to investigate the health status of vegetarian (VER) and vegan endurance runners (VGR) and compare it to omnivorous endurance runners (OR). A total of 245 female and male recreational runners completed an online survey. Health status was assessed by measuring health-related indicators (body weight, mental health, chronic diseases, and hypersensitivity reactions, medication intake) and health-related behavior (smoking habits, supplement intake, food choice, healthcare utilization). Data analysis was performed by using non-parametric ANOVA and MANOVA. There were 109 OR, 45 VER and 91 VGR. Significant differences (p < 0.05) were determined for the following findings: (i) body weight for VER and VGR was less than for OR, (ii) VGR had highest food choice scores, and (iii) VGR reported the lowest prevalences of allergies. There was no association (p > 0.05) between diet and mental health, medication intake, smoking habits, supplement intake, and healthcare utilization. These findings support the notion that adhering to vegetarian kinds of diet, in particular to a vegan diet, is associated with a good health status and, thus, at least an equal alternative to an omnivorous diet for endurance runners.

The effects of whey and soy liquid breakfast on appetite response, energy metabolism, and subsequent energy intake

OBJECTIVES

The aim of this study was to examine the effects of animal-based protein (whey; WP) compared with plant-based protein (soy; SP) and carbohydrate (CHO) liquid breakfast on appetite, energy metabolism, and subsequent energy intake.

METHODS

Seventeen healthy individuals consumed three isocaloric breakfast smoothies with whey, soy, or carbohydrate (no protein) in a double-blind, randomized crossover design. Participants completed an 11-point rating scale of appetite profile (before, 0, 60, 120, and 180 min). Indirect calorimetry was used to determine the thermic effect of a meal (TEM; at 45-60, 105-120, and 165-180 min). An ad libitum lunch was offered at 180 min after breakfast and energy intake was assessed.

RESULTS

There was a significant difference in hunger (P = 0.033), fullness (P = 0.002), satiety (P = 0.001), desire to eat (P = 0.024), and prospective food consumption (P = 0.021) between the three breakfast meals. Fullness and SP compared with CHO. A higher (P < 0.001) TEM and lower (P < 0.05) respiratory exchange ratio (RER) was observed after WP and SP compared with CHO. In addition, a higher (P = 0.022) energy intake at lunch was observed after CHO (769 ± 259 kcal) compared with WP (654 ± 252 kcal) and SP (664 ± 296 kcal), with no difference (P = 0.966) between WP and SP. Consuming SP at breakfast exerts comparable effects to WP on appetite profile, energy metabolism, and subsequent energy intake, suggesting that SP is a reasonable alternative to WP as a protein supplement source to aid in body weight control.

Lower C-reactive protein and IL-6 associated with vegetarian diets are mediated by BMI

BACKGROUND AND AIMS

The mechanism by which vegetarian diets are associated with less inflammation is not clear. We investigated the role of BMI as a mediator in the relationship between vegetarian diet and concentrations of C-reactive protein (CRP), and the cytokines IL-6, IL-10 and TNF-α.

METHODS AND RESULTS

We used data from participants of the Adventist Health Study 2 (AHS-2) Calibration (n = 893) and Biological Manifestations of Religion (n = 478) sub-studies. Vegetarian diet variations were determined based on reported intake of animal products assessed by FFQ. Combining all participants, the proportion of non-vegetarians (NVs), partial vegetarians (PVs), lacto-ovo vegetarians (LOVs), and strict vegetarians (SVs) was 44%, 16%, 31%, and 9%, respectively. NV and PV participants were older than other dietary groups, and non-vegetarians had the highest BMI. Mediation analyses supported the mediating effect of BMI in associations of vegetarian diet with CRP (p < 0.001 each for PV, LOV and SV), and with IL-6 (p < 0.05 each for PV, LOV and SV). Mediation by BMI was not evident between vegetarian diet and the biomarkers IL-10 and TNF-α. A direct pathway was significant only in the association between strict vegetarians and CRP (p = 0.017).

CONCLUSION

The lower CRP and IL-6 concentrations among vegetarians may be mediated by BMI.

Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival

By ignoring the root causes of disease and neglecting to prioritize lifestyle measures for prevention, the medical community is placing people at harm. Advanced nations, influenced by a Western lifestyle, are in the midst of a health crisis, resulting largely from poor lifestyle choices. Epidemiologic, ecologic, and interventional studies have repeatedly indicated that most chronic illnesses, including cardiovascular disease, cancer, and type 2 diabetes, are the result of lifestyles fueled by poor nutrition and physical inactivity.In this article, we describe the practice of lifestyle medicine and its powerful effect on these modern instigators of premature disability and death. We address the economic benefits of prevention-based lifestyle medicine and its effect on our health care system: A system on the verge of bankruptcy. We recommend vital changes to a disastrous course. Many deaths and many causes of pain, suffering, and disability could be circumvented if the medical community could effectively implement and share the power of healthy lifestyle choices. We believe that lifestyle medicine should become the primary approach to the management of chronic conditions and, more importantly, their prevention. For future generations, for our own health, and for the Hippocratic Oath we swore to uphold ("First do no harm"), the medical community must take action. It is our hope that the information presented will inspire our colleagues to pursue lifestyle medicine research and incorporate such practices into their daily care of patients. The time to make this change is now.

Vegetarian Dietary Patterns and Cardiovascular Disease

Cardiovascular (CV) disease (CVD) is the leading global cause of mortality, being responsible for 46% of non-communicable disease deaths. It has been estimated that about 85.6 million Americans are living with some form of CVD, which continues to rise. Healthy lifestyle choices may reduce the risk of myocardial infarction by >80%, with nutrition playing a key role. Vegetarian dietary patterns reduce CVD mortality and the risk of coronary heart disease (CHD) by 40%. Plant-based diets are the only dietary pattern to have shown reversal of CHD. Additionally, evidence suggests benefits of vegetarian dietary patterns in both the prevention and the treatment of heart failure and cerebrovascular disease. Plant-based diets are associated with lower blood pressure, lower blood lipids, and reduced platelet aggregation than non-vegetarian diets and are beneficial in weight management, reduce the risk of developing metabolic syndrome, and type 2 diabetes. They have also been shown an effective treatment method in diabetes management. Well planned vegetarian diets provide benefits in preventing and reversing atherosclerosis and in decreasing CVD risk factors and should be promoted through dietary guidelines and recommendations.

A defined, plant-based diet utilized in an outpatient cardiovascular clinic effectively treats hypercholesterolemia and hypertension and reduces medications

BACKGROUND

Cardiovascular disease (CVD) is a major economic burden in the United States. CVD risk factors, particularly hypertension and hypercholesterolemia, are typically treated with drug therapy. Five-year efficacy of such drugs to prevent CVD is estimated to be 5%. Plant-based diets have emerged as effective mitigators of these risk factors.

HYPOTHESIS

The implementation of a defined, plant-based diet for 4 weeks in an outpatient clinical setting may mitigate CVD risk factors and reduce patient drug burden.

METHODS

Participants consumed a plant-based diet consisting of foods prepared in a defined method in accordance with a food-classification system. Participants consumed raw fruits, vegetables, seeds, and avocado. All animal products were excluded from the diet. Participant anthropometric and hemodynamic data were obtained weekly for 4 weeks. Laboratory biomarkers were collected at baseline and at 4 weeks. Medication needs were assessed weekly. Data were analyzed using paired-samples t tests and 1-way repeated-measures ANOVA.

RESULTS

Significant reductions were observed for systolic (-16.6 mmHg) and diastolic (-9.1 mmHg) blood pressure (P < 0.0005), serum lipids (P ≤ 0.008), and total medication usage (P < 0.0005). Other CVD risk factors, including weight (P < 0.0005), waist circumference (P < 0.0005), heart rate (P = 0.018), insulin (P < 0.0005), glycated hemoglobin (P = 0.002), and high-sensitivity C-reactive protein (P = 0.001) were also reduced.

CONCLUSION

A defined, plant-based diet can be used as an effective therapeutic strategy in the clinical setting to mitigate cardiovascular risk factors and reduce patient drug burden.

Cardio-Metabolic Benefits of Plant-Based Diets

Cardio-metabolic disease, namely ischemic heart disease, stroke, obesity, and type 2 diabetes, represent substantial health and economic burdens. Almost one half of cardio-metabolic deaths in the U.S. might be prevented through proper nutrition. Plant-based (vegetarian and vegan) diets are an effective strategy for improving nutrient intake. At the same time, they are associated with decreased all-cause mortality and decreased risk of obesity, type 2 diabetes, and coronary heart disease. Evidence suggests that plant-based diets may reduce the risk of coronary heart disease events by an estimated 40% and the risk of cerebral vascular disease events by 29%. These diets also reduce the risk of developing metabolic syndrome and type 2 diabetes by about one half. Properly planned vegetarian diets are healthful, effective for weight and glycemic control, and provide metabolic and cardiovascular benefits, including reversing atherosclerosis and decreasing blood lipids and blood pressure. The use of plant-based diets as a means of prevention and treatment of cardio-metabolic disease should be promoted through dietary guidelines and recommendations.

Red meat, diseases, and healthy alternatives: A critical review

Meat is an important food for human nutrition, by especially providing high-quality protein and also some essential micronutrients, in front iron, zinc, and vitamin B₁₂. However, a high intake of red and processed meat is associated with an increased risk for diseases, especially type 2 diabetes and colorectal cancer, as several epidemiological studies and meta-analyses have shown. This review summarizes meta-analyses of publications studying the association between red and processed meat intake and type 2 diabetes, cardiovascular diseases, colorectal and other cancers, and all-cause mortality. Various potential mechanisms involved in the increased disease risk are discussed. Furthermore, the beneficial effects of healthy alternatives for meat, like fish, nuts, vegetables and fruits, pulses and legumes, whole grains, and dairy products are reviewed by including selected papers and recent meta-analyses.

Effects of an Ad Libitum Consumed Low-Fat Plant-Based Diet Supplemented with Plant-Based Meal Replacements on Body Composition Indices

Objective. To document the effect of a diet free from animal-sourced nutrients on body composition indices. Methods. This was a nonrandomized interventional (n = 241)-control (n = 84) trial with a 10-week, low-fat, plant-based diet supplemented with two daily meal replacements. The meals were allowed to be eaten to full satiety without prespecified calorie restrictions. Control subjects received weekly lectures on the rationale and expected benefits of plant-based nutrition. Body composition indices were measured with bioimpedance analysis. Results. Relative to controls, in cases, postintervention body fat percentage was reduced by 4.3 (95% CI 4.1–4.6)% points (a relative decrement of −13.4%), visceral fat by 1.6 (95% CI 1.5–1.7) fat cross-sectional surface units, and weight by 5.6 kg (95% CI 5.2–6), while muscle mass was reduced by 0.3 kg (95% CI 0.06–0.5) with a relative increase of muscle mass percentage of 4.2 (3.9–4.4)% points. Analysis of covariance showed significantly larger adjusted fat reductions in cases compared to controls. Late follow-up revealed further weight loss in 60% of cases and no significant change in controls. Conclusions. Low-fat, plant-based diet in free-living nonresidential conditions eaten ad libitum enables significant and meaningful body fat reductions with relative preservation of muscle mass. This trial is registered with NCT02906072, ClinicalTrials.gov.

Red Meat and Health

Despite its nutritional benefits, there is an increasing body of evidence to suggest that regular consumption of red meat may negatively impact health and disease risk, including the risk of most common chronic diseases. This chapter reviews the current evidence linking red and processed meat intakes with chronic disease, obesity and mortality risks and discusses possible mechanisms to explain these associations. Research on the health benefits of diets low in red meat, including vegetarian, vegan, Mediterranean and other plant-based diets, is also reviewed.

Cardiorespiratory Fitness and Peak Torque Differences between Vegetarian and Omnivore Endurance Athletes: A Cross-Sectional Study

In spite of well-documented health benefits of vegetarian diets, less is known regarding the effects of these diets on athletic performance. In this cross-sectional study, we compared elite vegetarian and omnivore adult endurance athletes for maximal oxygen uptake (VO2 max) and strength. Twenty-seven vegetarian (VEG) and 43 omnivore (OMN) athletes were evaluated using VO2 max testing on the treadmill, and strength assessment using a dynamometer to determine peak torque for leg extensions. Dietary data were assessed using detailed seven-day food logs. Although total protein intake was lower among vegetarians in comparison to omnivores, protein intake as a function of body mass did not differ by group (1.2 ± 0.3 and 1.4 ± 0.5 g/kg body mass for VEG and OMN respectively, p = 0.220). VO2 max differed for females by diet group (53.0 ± 6.9 and 47.1 ± 8.6 mL/kg/min for VEG and OMN respectively, p < 0.05) but not for males (62.6 ± 15.4 and 55.7 ± 8.4 mL/kg/min respectively). Peak torque did not differ significantly between diet groups. Results from this study indicate that vegetarian endurance athletes’ cardiorespiratory fitness was greater than that for their omnivorous counterparts, but that peak torque did not differ between diet groups. These data suggest that vegetarian diets do not compromise performance outcomes and may facilitate aerobic capacity in athletes.

Red Meat and Health

Despite its nutritional benefits, there is an increasing body of evidence to suggest that regular consumption of red meat may negatively impact health and disease risk, including the risk of most common chronic diseases. This chapter reviews the current evidence linking red and processed meat intakes with chronic disease, obesity and mortality risks and discusses possible mechanisms to explain these associations. Research on the health benefits of diets low in red meat, including vegetarian, vegan, Mediterranean and other plant-based diets, is also reviewed.

Comparative Study of Serum Leptin and Insulin Resistance Levels Between Korean Postmenopausal Vegetarian and Non-vegetarian Women

The present study was conducted to compare serum leptin and insulin resistance levels between Korean postmenopausal long-term semi-vegetarians and non-vegetarians. Subjects of this study belonged to either a group of postmenopausal vegetarian women (n = 54), who maintained a semi-vegetarian diet for over 20 years or a group of non-vegetarian controls. Anthropometric characteristics, serum leptin, serum glucose, serum insulin, insulin resistance (HOMA-IR; Homeostasis Model Assessment of Insulin Resistance), and nutrient intake were compared between the two groups. The vegetarians showed significantly lower body weight (p < 0.01), body mass index (p < 0.001), percentage (%) of body fat (p < 0.001), and serum levels of leptin (p < 0.05), glucose (p < 0.001), and insulin (p < 0.01), than the non-vegetarians. The HOMA-IR of the vegetarians was significantly lower than that of the non-vegetarians (p < 0.01) after adjustment for the % of body fat. A long-term vegetarian diet might be related to lower insulin resistance independent of the % of body fat in postmenopausal women.

A dietary intervention for chronic diabetic neuropathy pain: a randomized controlled pilot study

Background:

Diabetic neuropathy is a common and often debilitating condition for which available treatments are limited. Because a low-fat plant-based diet has been shown to improve glycemic control in individuals with type 2 diabetes, we hypothesized that such a diet would reduce painful symptoms of diabetic neuropathy.

Methods:

In this 20-week pilot study, individuals with type 2 diabetes and painful diabetic neuropathy were randomly assigned to two groups. The intervention group was asked to follow a low-fat, plant-based diet, with weekly classes for support in following the prescribed diet, and to take a vitamin B12 supplement. The control group was asked to take the same vitamin B12 supplement, but received no other intervention. At baseline, midpoint and 20 weeks, clinical, laboratory and questionnaire data were collected. Questionnaires included an analog ‘worst pain' scale, Michigan Neuropathy Screening Instrument, global impression scale, Short Form McGill Pain Questionnaire, Neuropathy Total Symptom Score, a weekly pain diary and Norfolk Quality of Life Questionnaire.

Results:

After 20 weeks, body weight change with the intervention was −6.4 kg (95% confidence interval (CI) −9.4 to −3.4, P<0.001) in an effect size analysis. Electrochemical skin conductance in the foot improved by an average of 12.4 microseimens (95% CI 1.2–23.6, P=0.03) with the intervention in an effect size analysis. The between-group difference in change in pain, as measured by the McGill pain questionnaire, was −8.2 points (95% CI −16.1 to −0.3, P=0.04). Michigan Neuropathy Screening Instrument questionnaire score change was −1.6 points (95% CI −3.0 to −0.2, P=0.03).

Conclusions:

Improvements were seen in some clinical and pain measures. This pilot study suggests the potential value of a plant-based diet intervention, including weekly support classes, for treating painful diabetic neuropathy.

Meeting the nutrient reference values on a vegetarian diet

Surveys over the past 10 years have shown that Australians are increasingly consuming more plant-based vegetarian meals. Many studies demonstrate the health benefits of vegetarian diets. As with any type of eating plan, vegetarian diets must be well planned to ensure nutritional needs are being met. This clinical focus project shows that well planned vegetarian diets can meet almost all the nutritional needs of children and adults of all ages. Sample single-day lacto-ovo-vegetarian meal plans were developed to comply with the nutrient reference values - including the increased requirements for iron and zinc at 180% and 150%, respectively, for vegetarians - for both sexes and all age groups set by Australia's National Health and Medical Research Council and the New Zealand Ministry of Health. With the exception of vitamin D, long-chain omega-3 fatty acids and extended iron requirements in pregnancy for vegetarians, the meal plans meet key requirements with respect to energy; protein; carbohydrate; total fat; saturated, poly- and monounsaturated fats; α-linolenic acid; fibre; iron; zinc; calcium; folate; and vitamins A, C, E and B₁₂.