The effect of green Mediterranean diet on cardiometabolic risk; a randomised controlled trial

Abstract

BackgroundA Mediterranean diet is favourable for cardiometabolic risk.ObjectiveTo examine the residual effect of a green Mediterranean diet, further enriched with green plant-based foods and lower meat intake, on cardiometabolic risk.MethodsFor the DIRECT-PLUS parallel, randomised clinical trial we assigned individuals with abdominal obesity/dyslipidaemia 1:1:1 into three diet groups: healthy dietary guidance (HDG), Mediterranean and green Mediterranean diet, all combined with physical activity. The Mediterranean diets were equally energy restricted and included 28 g/day walnuts. The green Mediterranean diet further included green tea (3–4 cups/day) and a Wolffia globosa (Mankai strain; 100 g/day frozen cubes) plant-based protein shake, which partially substituted animal protein. We examined the effect of the 6-month dietary induction weight loss phase on cardiometabolic state.ResultsParticipants (n=294; age 51 years; body mass index 31.3 kg/m2; waist circumference 109.7 cm; 88% men; 10 year Framingham risk score 4.7%) had a 6-month retention rate of 98.3%. Both Mediterranean diets achieved similar weight loss ((green Mediterranean −6.2 kg; Mediterranean −5.4 kg) vs the HDG group −1.5 kg; p<0.001), but the green Mediterranean group had a greater reduction in waist circumference (−8.6 cm) than the Mediterranean (−6.8 cm; p=0.033) and HDG (−4.3 cm; p<0.001) groups. Stratification by gender showed that these differences were significant only among men. Within 6 months the green Mediterranean group achieved greater decrease in low-density lipoprotein cholesterol (LDL-C; green Mediterranean −6.1 mg/dL (−3.7%), −2.3 (-0.8%), HDG −0.2 mg/dL (+1.8%); p=0.012 between extreme groups), diastolic blood pressure (green Mediterranean −7.2 mm Hg, Mediterranean −5.2 mm Hg, HDG −3.4 mm Hg; p=0.005 between extreme groups), and homeostatic model assessment for insulin resistance (green Mediterranean −0.77, Mediterranean −0.46, HDG −0.27; p=0.020 between extreme groups). The LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio decline was greater in the green Mediterranean group (−0.38) than in the Mediterranean (−0.21; p=0.021) and HDG (−0.14; p<0.001) groups. High-sensitivity C-reactive protein reduction was greater in the green Mediterranean group (−0.52 mg/L) than in the Mediterranean (−0.24 mg/L; p=0.023) and HDG (−0.15 mg/L; p=0.044) groups. The green Mediterranean group achieved a better improvement (−3.7% absolute risk reduction) in the 10-year Framingham Risk Score (Mediterranean−2.3%; p=0.073, HDG−1.4%; p<0.001).ConclusionsThe green MED diet, supplemented with walnuts, green tea and Mankai and lower in meat/poultry, may amplify the beneficial cardiometabolic effects of Mediterranean diet.Trial registration numberThis study is registered under ClinicalTrials.gov Identifier no NCT03020186.

A Mediterranean Diet and Low-Fat Vegan Diet to Improve Body Weight and Cardiometabolic Risk Factors: A Randomized, Cross-over Trial

“…However, all 5 reviewed studies included either added exercise or calorie restriction, confounding the effects of the dietary change. A later randomized trial reported significant weight loss with a Mediterranean diet, but the study also included a substantial energy restriction and physical exercise (6). In the Lyon Diet Heart Study (7), a Mediterranean diet supplemented with an alpha-linolenic-acid-rich margarine reduced cardiac deaths and nonfatal myocardial infarctions in individuals who had survived a myocardial infarction but led to a small weight gain (1.4 kg) during the 2-year study, rather than weight loss (8).…”

The Metabolomic-Gut-Clinical Axis of Mankai Plant-Derived Dietary Polyphenols

“…In this study, we demonstrated the polyphenols found in Mankai. Our previous work described the beneficial effect of Mankai on glycemic response [52], cardiovascular risk [29], the gut microbiome [53] and liver steatosis [30]. Our previous and current observations regarding the Mankai plant may contribute to better understanding the effect of this plant on health.…”

“…The mean body mass index (BMI) of the participants was 31.3 ± 4.0 kg/m 2 , and the mean WC was 110.6 ± 9.1 cm for men and 103.3 ± 9.6 cm for women. All baseline characteristics (e.g., weight: 93.7 ± 14.3, WC: 109.7 ± 9.5, systolic blood pressure: 130.3 ± 14.0, diastolic blood pressure: 81.1 ± 10.2; data presented for the entire study population) did not differ between the intervention groups [29,30]. Ten polyphenols were detected in the participants' baseline plasma samples, with no significant differences between groups (Table 2).…”

“…Inclusion criteria were age above 30 years with abdominal obesity or dyslipidemia. Exclusion criteria and ethical issues are described elsewhere [22,29,30].…”

“…The samples from the same participants were handled identically and assayed in the same batch to avoid systematic biases. Details regarding other measurements, including anthropometric parameters, electronic questionnaires and blood biomarkers, are available elsewhere [29,30].…”