title: Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a randomized study Withdrawal of red meat from the usual diet reduces albuminuria and improves serum fatty acid profile in type 2 diabetes patients with macroalbuminuria. Effects of a vegetarian diet and treatment preference on biochemical and dietary variables in overweight and obese adults: a randomized clinical trial. Cardiovascular disease risk factors in free-living men: comparison of two prudent diets, one based on lactoovovegetarianism and the other allowing lean meat. Association of loss-of-function mutations in the ABCA1 gene with high-density lipoprotein cholesterol levels and risk of ischemic heart disease. Vegetarian diet-induced increase in linoleic acid in serum phospholipids is associated with improved insulin sensitivity in subjects with type 2 diabetes Divergent changes in serum sterols during a strict uncooked vegan diet in patients with rheumatoid arthritis. A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study Nutrition intervention for migraine: a randomized crossover trial A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. The Effects of an Intensive Lifestyle Modification Program on Carotid Artery Intima-Media Thickness: A Randomized Trial Intensive lifestyle changes for reversal of coronary heart disease. A Multicomponent Intervention Reduces Body Weight and Cardiovascular Risk at a GEICO Corporate Site Serum fatty acid, lipid profile and dietary intake of Hong Kong Chinese omnivores and vegetarians Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a lowfat, vegetarian diet. Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. Plasma lipids and lipoproteins in vegetarians and controls. The Effect of a Plant-Based Diet on Plasma Lipids in Hypercholesterolemic Adults
abstract: CONTEXT To enhance the effectiveness of diet in lowering cholesterol , recommendations of the Adult Treatment Panel III of the National Cholesterol Education Program emphasize diets low in saturated fat together with plant sterols and viscous fibers , and the American Heart Association supports the use of soy protein and nuts . OBJECTIVE To determine whether a diet containing all of these recommended food components leads to cholesterol reduction comparable with that of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors ( statins ) . DESIGN R and omized controlled trial conducted between October and December 2002 . SETTING AND PARTICIPANTS Forty-six healthy , hyperlipidemic adults ( 25 men and 21 postmenopausal women ) with a mean ( SE ) age of 59 ( 1 ) years and body mass index of 27.6 ( 0.5 ) , recruited from a Canadian hospital-affiliated nutrition research center and the community . INTERVENTIONS Participants were r and omly assigned to undergo 1 of 3 interventions on an outpatient basis for 1 month : a diet very low in saturated fat , based on milled whole-wheat cereals and low-fat dairy foods ( n = 16 ; control ) ; the same diet plus lovastatin , 20 mg/d ( n = 14 ) ; or a diet high in plant sterols ( 1.0 g/1000 kcal ) , soy protein ( 21.4 g/1000 kcal ) , viscous fibers ( 9.8 g/1000 kcal ) , and almonds ( 14 g/1000 kcal ) ( n = 16 ; dietary portfolio ) . MAIN OUTCOME MEASURES Lipid and C-reactive protein levels , obtained from fasting blood sample s ; blood pressure ; and body weight ; measured at weeks 0 , 2 , and 4 and compared among the 3 treatment groups . RESULTS The control , statin , and dietary portfolio groups had mean ( SE ) decreases in low-density lipoprotein cholesterol of 8.0 % ( 2.1 % ) ( P = .002 ) , 30.9 % ( 3.6 % ) ( P<.001 ) , and 28.6 % ( 3.2 % ) ( P<.001 ) , respectively . Respective reductions in C-reactive protein were 10.0 % ( 8.6 % ) ( P = .27 ) , 33.3 % ( 8.3 % ) ( P = .002 ) , and 28.2 % ( 10.8 % ) ( P = .02 ) . The significant reductions in the statin and dietary portfolio  groups were all significantly different from changes in the control group . There were no significant differences in efficacy between the statin and dietary portfolio treatments . CONCLUSION In this study , diversifying cholesterol-lowering components in the same dietary portfolio increased the effectiveness of diet as a treatment of hypercholesterolemia Introduction The purpose of this study was to investigate the effects of vegan diet in patients with rheumatoid arthritis ( RA ) on blood lipids oxidized low-density lipoprotein ( oxLDL ) and natural atheroprotective antibodies against phosphorylcholine ( anti-PCs ) . Methods Sixty-six patients with active RA were r and omly assigned to either a vegan diet free of gluten ( 38 patients ) or a well-balanced non-vegan diet ( 28 patients ) for 1 year . Thirty patients in the vegan group completed more than 3 months on the diet regimen . Blood lipids were analyzed by routine methods , and oxLDL and anti-PCs were analyzed by enzyme-linked immunosorbent assay . Data and serum sample s were obtained at baseline and after 3 and 12 months . Results Mean ages were 50.0 years for the vegan group and 50.8 years for controls .  Gluten-free vegan diet induced lower body mass index ( BMI ) and low-density lipoprotein ( LDL ) and higher anti-PC IgM than control diet ( p < 0.005 ) . In the vegan group , BMI , LDL , and cholesterol decreased after both 3 and 12 months ( p < 0.01 ) and oxLDL after 3 months ( p = 0.021 ) and trendwise after 12 months ( p = 0.090 ) . Triglycerides and high-density lipoprotein did not change . IgA anti-PC levels increased after 3 months ( p = 0.027 ) and IgM anti-PC levels increased trendwise after 12 months ( p = 0.057 ) . There was no difference in IgG anti-PC levels . In the control diet group , IgM anti-PC levels decreased both after 3 and 12 months ( p < 0.01 ) . When separating vegan patients into clinical responders and non-responders at 12 months , the effects on oxLDL and anti-PC IgA were seen only in responders ( p < 0.05 ) . Conclusion A gluten-free vegan diet in RA induces changes that are potentially atheroprotective and anti-inflammatory , including decreased LDL and oxLDL levels and raised anti-PC IgM and IgA levels BACKGROUND Replacement of red meat in the diet with chicken has reduced the urinary albumin excretion rate ( UAER ) and serum cholesterol in microalbuminuric type 2 diabetes patients . The effects of withdrawing red meat are unknown in the more advanced stages of diabetic nephropathy . OBJECTIVE Our objective was to assess the effects of replacing red meat in the usual diet ( UD ) with chicken ( CD ) and of consuming a lactovegetarian low-protein diet ( LPD ) on renal function , fatty acid , and lipid profile in macroalbuminuric type 2 diabetes patients . DESIGN A crossover controlled trial was conducted in 17 type 2 diabetes patients with macroalbuminuria ( 24-h UAER > or = 200 microg/min ) . Each patient followed the UD , CD , and LPD in a r and om order for 4 wk . After each diet , glomerular filtration rate , UAER , serum fatty acid , lipid profile , glycemic control , anthropometric indexes , and blood pressure were measured . RESULTS UAER [ median CD : 269.4 ( range : 111 - 1128 ) microg/min ; LPD : 229.3 ( 76.6 - 999.3 ) microg/min ; UD : 312.8 ( 223.7 - 1223.7 ) microg/min ; P < 0.01 ] and mean ( + /-SD ) non-HDL cholesterol ( CD : 3.92 + /- 0.99 mmol/L ; LPD : 3.92 + /- 0.93 mmol/L ; UD : 4.23 + /- 1.06 mmol/L ; P = 0.042 ) were lower after CD and LPD than after UD . Compared with the UD , an increase in serum total polyunsaturated fatty acids was also observed ( CD : 39.8 + /- 2.6 % ; LPD : 39.7 + /- 4.4 % ; UD : 37.3 + /- 3.1 % ; P = 0.029 ) . CONCLUSION In macroalbuminuric patients with type 2 diabetes , withdrawing red meat from the diet reduces the UAER BACKGROUND A vegetarian diet may lead to numerous health benefits , including weight loss . OBJECTIVE We examined the joint effects of personal preference of dietary treatment and a calorie-restricted , low-fat lactoovovegetarian diet ( LOV-D ) compared with a st and ard calorie-restricted , low-fat omnivorous diet ( STD-D ) on changes in weight , total cholesterol , ratio of LDL to HDL cholesterol ( LDL : HDL cholesterol ) , triacylglycerols , insulin resistance , and macronutrient intake during an 18-mo study . DESIGN This was a r and omized clinical trial of 176 overweight and obese adults who were recruited and r and omly assigned first to 1 of 2 preference conditions ( yes or no ) . If assigned to Preference-No , they were r and omly assigned to 1 of the 2 diet conditions ( STD-D or LOV-D ) . If assigned to Preference-Yes , they were assigned to the diet they indicated as preferred at screening . The 12-mo intervention was followed by a 6-mo maintenance phase . RESULTS Participants were mainly women ( 86.9 % ) and white ( 70.5 % ) ; 75 % completed the 18-mo study . A significant interaction between preference and dietary treatment was not observed for any of the outcome variables . However , participants in the Preference-No groups significantly decreased their triacylglycerols ( P = 0.04 ) . The only effect observed for diet was a borderline significant decrease in LDL : HDL cholesterol for the LOV-D group ( P = 0.06 ) . Within the LOV-D groups , those who were 100 % adherent to the LOV-D had significant and marginally significant reductions in monounsaturated fat ( P = 0.02 ) and total fat ( P = 0.05 ) intakes at 18 mo . CONCLUSIONS Our findings suggest that neither prescribing a vegetarian diet nor allowing persons to choose their preferred diet had a significant effect on outcome measures . However , all participants had a significant reduction in total energy and fat intakes and an increase in energy expenditure , which was reflected in reduced body weight . This clinical trial was registered at www . clinical trials.gov as NCT00330629 In general , vegetarians have lower serum lipids and blood pressures than omnivores have . We tested the blood pressure and serum lipid lowering effects of two fat-modified diets differing primarily in their source of protein . Twenty-six men were r and omized in an incomplete block design to two of three diets : a high-fat diet , a fat-modified lactoovovegetarian diet ( LOV ) and a diet in which 60 % of plant protein in the LOV was replaced with lean meat ( LM ) . Compared with the high-fat diet both prudent diets significantly lowered blood pressure , serum total cholesterol ( TC ) , and LDL cholesterol but significantly increased serum triglycerides . The LOV diet had a significantly greater cholesterol-lowering effect than did the LM diet ( 10 % vs 5 % decrease ) but blood pressure reductions were similar . The partial substitution of lean meat for plant protein in a fat-modified diet did not negate the overall cardiovascular-risk lowering of the lactoovovegetarian diet CONTEXT Low levels of high-density lipoprotein ( HDL ) cholesterol are inversely related to cardiovascular risk . Whether this is a causal effect is unclear . OBJECTIVE To determine whether genetically reduced HDL cholesterol due to heterozygosity for 4 loss-of-function mutations in ABCA1 cause increased risk of ischemic heart disease ( IHD ) . DESIGN , SETTING , AND PARTICIPANTS Three studies of white individuals from Copenhagen , Denmark , were used : the Copenhagen City Heart Study ( CCHS ) , a 31-year prospect i ve general population study ( n = 9022 ; 28 heterozygotes ) ; the Copenhagen General Population Study ( CGPS ) , a cross-sectional general population study ( n = 31,241 ; 76 heterozygotes ) ; and the Copenhagen Ischemic Heart Disease Study ( CIHDS ) , a case-control study ( n = 16,623 ; 44 heterozygotes ) . End points in all 3 studies were recorded during the period of January 1 , 1976 , through July 9 , 2007 . MAIN OUTCOME MEASURES Levels of HDL cholesterol in the general population , cellular cholesterol efflux , and the association between IHD and HDL cholesterol and genotype . RESULTS Heterozygotes vs noncarriers for 4 ABCA1 mutations ( P1065S , G1216V , N1800H , R2144X ) had HDL cholesterol levels of 41 mg/dL ( interquartile range , 31 - 50 mg/dL ) vs 58 mg/dL ( interquartile range , 46 - 73 mg/dL ) , corresponding to a reduction in HDL cholesterol of 17 mg/dL ( P < .001 ) . A 17-mg/dL lower HDL cholesterol level in the CCHS was associated with a multifactorially adjusted hazard ratio for IHD of 1.70 ( 95 % confidence interval [ CI ] , 1.57 - 1.85 ) . However , for IHD in heterozygotes vs noncarriers , the multifactorially adjusted hazard ratio was 0.67 ( 95 % CI , 0.28 - 1.61 ; 1741 IHD events ) in the CCHS , the multifactorially adjusted odds ratio was 0.82 ( 95 % CI , 0.34 - 1.96 ; 2427 IHD events ) in the CGPS , and the multifactorially adjusted odds ratio was 0.86 ( 95 % CI , 0.32 - 2.32 ; 2498 IHD cases ) in the CIHDS . The corresponding odds ratio for IHD in heterozygotes vs noncarriers for the combined studies ( n = 41,961 ; 6666 cases ; 109 heterozygotes ) was 0.93 ( 95 % CI , 0.53 - 1.62 ) . CONCLUSION Lower plasma levels of HDL cholesterol due to heterozygosity for loss-of-function mutations in ABCA1 were not associated with an increased risk of IHD BACKGROUND AND AIMS : Fatty acids are important cellular constituents that may affect many metabolic processes relevant for the development of diabetes and its complications . We showed previously that vegetarian diet leads to greater increase in metabolic clearance rate of glucose ( MCR ) than conventional hypocaloric diet . The aim of this secondary analysis was to explore the role of changes in fatty acid composition of serum phospholipids in diet- and exercise-induced changes in MCR in subjects with type 2 diabetes ( T2D ) . METHODS : Subjects with T2D ( n=74 ) were r and omly assigned into a vegetarian group ( VG , n=37 ) following vegetarian diet or a control group ( CG , n=37 ) following a conventional diet . Both diets were calorie restricted ( −500 kcal day–1 ) . Participants were examined at baseline , 12 weeks of diet intervention and 24 weeks ( subsequent 12 weeks of diet were combined with aerobic exercise ) . The fatty acid composition of serum phospholipids was measured by gas liquid chromatography . MCR was measured by hyperinsulinemic isoglycemic clamp . Visceral fat ( VF ) was measured by magnetic resonance imaging . RESULTS : Linoleic acid ( LA ; 18:2n6 ) increased in VG ( P=0.04 ) , whereas it decreased in CG ( P=0.04 ) in response to dietary interventions . It did not change significantly after the addition of exercise in either group ( group × time P<0.001 ) . In VG , changes in 18:2n6 correlated positively with changes in MCR ( r=+0.22 ; P=0.04 ) and negatively with changes in VF ( r=−0.43 ; P=0.01 ) . After adjustment for changes in body mass index , the association between 18:2n6 and MCR was no longer significant . The addition of exercise result ed in greater changes of phospholipid fatty acids composition in VG than in CG . CONCLUSION : We demonstrated that the insulin-sensitizing effect of a vegetarian diet might be related to the increased proportion of LA in serum phospholipids The effects of a strict uncooked vegan diet on serum lipid and sterol concentrations were studied in patients with rheumatoid arthritis . The subjects were r and omized into a vegan diet group ( n 16 ) , who consumed a vegan diet for 2 - 3 months  ,  or  into  a control group ( n 13 )  , who continued their usual omnivorous diets .  Serum total and LDL-cholesterol and -phospholipid concentrations were significantly decreased by the vegan diet . The levels of serum cholestanol and lathosterol also decreased , but serum cholestanol : total cholesterol and lathosterol : total cholesterol did not change . The effect of a vegan diet on serum plant sterols was divergent as the concentration of campesterol decreased while that of sitosterol increased . This effect result ed in a significantly greater sitosterol : campesterol value in the vegan diet group than in the control group ( 1.48 ( SD 0.39 ) v. 0.72 ( SD 0.14 ) ; P < 0.001 ) . A higher concentration of campesterol compared with sitosterol is normal in omnivorous subjects and can be explained by lower absorption and esterification rates of sitosterol . Our results suggest that a strict uncooked vegan diet changes the relative absorption rates of these sterols and /or their biliary clearance Background / objectives : To determine the effects of a low-fat plant-based diet program on anthropometric and biochemical measures in a multicenter corporate setting .Subjects/ methods : Employees from 10 sites of a major US company with body mass index ⩾25 kg/m2 and /or previous diagnosis of type 2 diabetes were r and omized to either follow a low-fat vegan diet , with weekly group support and work cafeteria options available , or make no diet changes for 18 weeks . Dietary intake , body weight , plasma lipid concentrations , blood pressure and glycated hemoglobin ( HbA1C ) were determined at baseline and 18 weeks . Results : Mean body weight fell 2.9 kg and 0.06 kg in the intervention and control groups , respectively ( P<0.001 ) . Total and low-density lipoprotein ( LDL ) cholesterol fell 8.0 and 8.1 mg/dl in the intervention group and 0.01 and 0.9 mg/dl in the control group ( P<0.01 ) . HbA1C fell 0.6 percentage point and 0.08 percentage point in the intervention and control group , respectively (P<0.01).Among study completers , mean changes in body weight were −4.3 kg and −0.08 kg in the intervention and control groups , respectively ( P<0.001 ) . Total and LDL cholesterol fell 13.7 and 13.0 mg/dl in the intervention group and 1.3 and 1.7 mg/dl in the control group ( P<0.001 ) . HbA1C levels decreased 0.7 percentage point and 0.1 percentage point in the intervention and control group , respectively ( P<0.01 ) . Conclusions : An 18-week dietary intervention using a low-fat plant-based diet in a corporate setting improves body weight , plasma lipids , and , in individuals with diabetes , glycemic control Background Limited evidence suggests that dietary interventions may offer a promising approach for migraine . The purpose of this study was to determine the effects of a low-fat plant-based diet intervention on migraine severity and frequency . Methods Forty-two adult migraine sufferers were recruited from the general community in Washington , DC , and divided r and omly into two groups . This 36-week crossover study included two treatments : dietary instruction and placebo supplement . Each treatment period was 16 weeks , with a 4-week washout between . During the diet period , a low-fat vegan diet was prescribed for 4 weeks , after which an elimination diet was used . Participants were assessed at the beginning , midpoint , and end of each period . Significance was determined using student ’s t-tests . Results Worst headache pain in last 2 weeks , as measured by visual analog scale , was initially 6.4/10 cm ( SD 2.1 cm ) , and declined 2.1 cm during the diet period and 0.7 cm during the supplement period ( p=0.03 ) . Average headache intensity ( 0–10 scale ) was initially 4.2 ( SD 1.4 ) per week , and this declined by 1.0 during the diet period and by 0.5 during the supplement period ( p=0.20 ) . Average headache frequency was initially 2.3 ( SD 1.8 ) per week , and this declined by 0.3 during the diet period and by 0.4 during the supplement period ( p=0.61 ) . The Patient ’s Global Impression of Change showed greater improvement in pain during the diet period ( p<0.001 ) . Conclusions These results suggest that a nutritional approach may be a useful part of migraine treatment , but that method ologic issues necessitate further research .Trial registration Clinical trials.gov , NCT01699009 and NCT01547494 BACKGROUND Low-fat vegetarian and vegan diets are associated with weight loss , increased insulin sensitivity , and improved cardiovascular health . OBJECTIVE We compared the effects of a low-fat vegan diet and conventional diabetes diet recommendations on glycemia , weight , and plasma lipids . DESIGN Free-living individuals with type 2 diabetes were r and omly assigned to a low-fat vegan diet ( n = 49 ) or a diet following 2003 American Diabetes Association guidelines ( conventional , n = 50 ) for 74 wk . Glycated hemoglobin ( Hb A(1c ) ) and plasma lipids were assessed at weeks 0 , 11 , 22 , 35 , 48 , 61 , and 74 . Weight was measured at weeks 0 , 22 , and 74 . RESULTS Weight loss was significant within each diet group but not significantly different between groups ( -4.4 kg in the vegan group and -3.0 kg in the conventional diet group , P = 0.25 ) and related significantly to Hb A(1c ) changes ( r = 0.50 , P = 0.001 ) . Hb A(1c ) changes from baseline to 74 wk or last available values were -0.34 and -0.14 for vegan and conventional diets , respectively ( P = 0.43 ) . Hb A(1c ) changes from baseline to last available value or last value before any medication adjustment were -0.40 and 0.01 for vegan and conventional diets , respectively ( P = 0.03 ) . In analyses before alterations in lipid-lowering medications , total cholesterol decreased by 20.4 and 6.8 mg/dL in the vegan and conventional diet groups , respectively ( P = 0.01 ) ; LDL cholesterol decreased by 13.5 and 3.4 mg/dL in the vegan and conventional groups , respectively ( P = 0.03 ) . CONCLUSIONS Both diets were associated with sustained reductions in weight and plasma lipid concentrations . In an analysis controlling for medication changes , a low-fat vegan diet appeared to improve glycemia and plasma lipids more than did conventional diabetes diet recommendations . Whether the observed differences provide clinical benefit for the macro- or microvascular complications of diabetes remains to be established . This trial was registered at clinical trials.gov as NCT00276939 Purpose . This study evaluated the effect of the Dr. Dean Ornish Program for Reversing Heart Disease on cardiovascular disease as measured by the intima-media thickness of the common carotid artery and compared this effect to outcomes from patients participating in traditional cardiac rehabilitation . Design . R and omized clinical trial . Setting . SwedishAmerican Health System . Subjects . Ninety three patients with clinical ly confirmed coronary artery disease were r and omly assigned to the intervention ( n = 46 ) or traditional cardiac rehabilitation ( n = 47 ) . Intervention . Dr. Dean Ornish Program for Reversing Heart Disease . Measures . Ultrasound of the carotid artery and other cardiovascular risk factors were measured at baseline , 6 , and 12 months . Analysis . Intent-to-treat analysis . Results . There was no significant reduction in the carotid intima-media thickness of the carotid artery in the Ornish group or the cardiac rehabilitation group . Ornish Program participants had significantly improved dietary habits ( p < .001 ) , weight ( p < .001 ) , and body mass index ( p < .001 ) as compared with the rehabilitation group . The decrease in the number of patients with angina from baseline to 12 months was 44 % in Ornish and 12 % in cardiac rehabilitation . Conclusions . The Ornish Program appears to causes improvements in cardiovascular risk factors but does not appear to change the atherosclerotic process as it affects the carotid artery CONTEXT The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year . OBJECTIVES To determine the feasibility of patients to sustain  intensive lifestyle changes  for a total of 5 years and the effects of these lifestyle changes ( without lipid-lowering drugs ) on coronary heart disease . DESIGN R and omized controlled trial conducted from 1986 to 1992 using a r and omized invitational design . PATIENTS Forty-eight patients with moderate to severe coronary heart disease were r and omized to an  intensive lifestyle change group  or to a  usual-care control group  , and 35 completed the 5-year follow-up quantitative coronary arteriography . SETTING Two tertiary care university medical centers . INTERVENTION Intensive lifestyle changes ( 10 % fat whole foods vegetarian diet , aerobic exercise , stress management training , smoking cessation , group psychosocial support ) for 5 years . MAIN OUTCOME MEASURES Adherence to intensive lifestyle changes , changes in coronary artery percent diameter stenosis , and cardiac events . RESULTS Experimental group patients ( 20 [ 71 % ] of 28 patients completed 5-year follow-up ) made and maintained comprehensive lifestyle changes for 5 years , whereas control group patients ( 15 [ 75 % ] of 20 patients completed 5-year follow-up ) made more moderate changes . In the experimental group , the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year ( a 4.5 % relative improvement ) and by 3.1 absolute percentage points after 5 years ( a 7.9 % relative improvement ) . In contrast , the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year ( a 5.4 % relative worsening ) and by 11.8 percentage points after 5 years ( a 27.7 % relative worsening ) ( P=.001 between groups . Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up ( risk ratio for any event for the control group , 2.47 [ 95 % confidence interval , 1.48 - 4.20 ] ) . CONCLUSIONS More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group . In contrast , in the control group , coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred Purpose . To determine whether a multicomponent nutrition intervention program at a corporate site reduces body weight and improves other cardiovascular risk factors in overweight individuals . Design . Prospect i ve clinical intervention study . Subjects/ Setting . Employees of the Government Employees Insurance Company ( GEICO ) ( N = 113 ) , aged 21 to 65 years , with a body mass index ≥ 25 kg/m2 and /or previous diagnosis of type 2 diabetes . Intervention . A 22-week intervention including a low-fat , vegan diet . Measures . Changes in body weight , anthropometric measures , blood pressure , lipid profile , and dietary intake . Analysis . Multivariate analyses of variance were calculated for clinical and nutrient measures , followed by univariate analyses of variance , to determine the significance of differences between groups in changes over time . Results . Intervention-group participants  experienced greater weight changes compared with control-group participants ( mean , – 5.1 [ SE , .6 ] kg vs. + .1 [ SE , .6 ] kg , p < .0001 ) , as well as greater changes in waist circumference ( mean , – 4.7 [ SE , .6 ] cm vs. + .8 [ SE , .6 ] cm , p < .0001 ) and waist : hip ratio ( mean , – .006 [ SE , .003 ] vs. + .014 [ SE , .005 ] , p = .0007 ) . Weight loss of 5 % of body weight was more frequently observed in the intervention group ( 48.5 % ) compared with the control group ( 11.1 % ) ( χ2[1 , N= 113 ] = 16.99 , p < .0001 ) . Conclusions . Among individuals volunteering for a 22-week worksite research study , an intervention using a low-fat , vegan diet effectively reduced body weight and waist circumference Objective : To examine the serum fatty acid and lipid profiles and dietary intake of  Hong Kong Chinese omnivores and vegetarians  with respect to cardiovascular health . Design : R and om population survey stratified by age and sex . Subjects : One-hundred and ninety-four omnivore subjects ( 81 men , 113 women ) age 25–70 y , and 60 ovo-lacto-vegetarian adults ( 15 men , 45 women ) age 30–55 y. Measurements : Nutrient quantitation was by a food frequency method . Serum fatty acids were analysed by  gas chromatography , and serum lipid  by st and ard laboratory methods . Results : Compared with omnivores , vegetarians had higher serum concentrations of polyunsaturated ( PUFA ) and monosaturated fatty acids ( MUFA ) , and lower saturated fatty acids ( SFA ) , long chain omega-3 and trans fatty acids ( TFA ) . They also had lower serum cholesterol and higher apoA-I concentrations , but the LDL/HDL ratio was not different . The ratio of polyunsaturated to saturated fatty acids intake was higher in vegetarians . Compared with results from population s with higher incidences of coronary heart disease , while lower myristic and palmitic acid concentrations and higher eicosapentaneoic ( EPA ) and docosahexanoic acid ( DHA ) may partly account for the difference in incidence , linoleic acid concentration was higher . Although the Chinese vegetarian diet may be beneficial for heart health in that antioxidant and fibre intakes are higher and saturated fat lower , the low EPA and DHA due to omission from dietary source and suppressed formation by high linoleic acid level , and the presence of TFA in the diet , may exert an opposite effect . Conclusion : There are some favourable features in the serum fatty acid profile in the Hong Kong Chinese population with respect to cardiovascular health , but the consumption of TFA is of concern . The Chinese vegetarian diet also contains some adverse features . Sponsorship : This study is partly sponsored by the Hong Kong Health Services Research Grant . European Journal Of Clinical Nutrition ( 2000 ) 24 , OBJECTIVE To investigate whether glycemic and lipid control in patients with non-insulin-dependent diabetes ( NIDDM ) can be significantly improved using a low-fat , vegetarian ( vegan ) diet in the absence of recommendations regarding exercise or other lifestyle changes . METHODS Eleven subjects with NIDDM recruited from the Georgetown University Medical Center or the local community were r and omly assigned to a low-fat vegan diet ( seven subjects ) or a conventional low-fat diet ( four subjects ) . Two additional subjects assigned to the control group failed to complete the study . The diets were not design ed to be isocaloric . Fasting serum glucose , body weight , medication use , and blood pressure were assessed at baseline and biweekly thereafter for 12 weeks . Serum lipids , glycosylated hemoglobin , urinary albumin , and dietary macronutrients were assessed at baseline and 12 weeks . RESULTS Although the sample was intentionally small in accordance with the pilot study design , the 28 % mean reduction in fasting serum glucose of the experimental group , from 10.7 to 7.75 mmol/L ( 195 to 141 mg/dl ) , was significantly greater than the 12 % decrease , from 9.86 to 8.64 mmol/L ( 179 to 157 mg/dl ) , for the control group ( P < 0.05 ) . The mean weight loss was 7.2 kg in the experimental group , compared to 3 . 8 kg for the control group ( P < 0.005 ) . Of six experimental group subjects on oral hypoglycemic agents , medication use was discontinued in one and reduced in three . Insulin was reduced in both experimental group patients on insulin . No patient in the control group reduced medication use . Differences between the diet groups in the reductions of serum cholesterol and 24-h microalbuminuria did not reach statistical significance ; however , high-density lipoprotein concentration fell more sharply ( 0.20 mmol/L ) in the experimental group than in the control group ( 0.02 mmol/L ) ( P < 0.05 ) . CONCLUSION The use of a low-fat , vegetarian diet in patients with NIDDM was associated with significant reductions in fasting serum glucose concentration and body weight in the absence of recommendations for exercise . A larger study is needed for confirmation Few controlled trials have studied cholesterol-lowering diets in premenopausal women . None has examined the cholesterol-lowering effect of a low-fat vegetarian diet , which , in other population groups , leads to marked reductions in serum cholesterol concentrations and , in combination with other life-style changes , a regression of atherosclerosis . We tested the hypothesis that a low-fat , vegetarian diet significantly reduces serum total and low-density lipoprotein ( LDL ) cholesterol concentrations in premenopausal women . In a crossover design , 35 women , aged 22 to 48 , followed a low-fat vegetarian diet deriving approximately 10 % of energy from fat for 2 menstrual cycles . For 2 additional cycles , they followed their customary diet while also taking a " supplement " ( placebo ) pill .  Serum lipid concentrations were assessed at baseline and during each intervention phase . Mean serum LDL , high-density lipoprotein ( HDL ) , and total cholesterol concentrations decreased 16 . 9 % , 16.5 % , and 13.2 % , respectively , from baseline to the intervention diet phase ( p<0.001 ) , whereas mean serum triacylglycerol concentration increased 18.7 % ( p<0.01 ) . LDL/HDL ratio remained unchanged . Thus , in healthy premenopausal women , a low-fat vegetarian diet led to rapid and sizable reductions in serum total , LDL , and HDL cholesterol concentrations The possible effect of diet on plasma lipids was investigated in a group of vegetarians . Seventy-three men and 43 women who had adhered to a vegetarian diet for an average of three years were studied in the fasting state and compared with a r and omly selected group of controls matched for age and sex . Mean cholesterol levels in milligrams per deciliter for vegetarians and controls , respectively , were 126 and 184 ; low-density lipoprotein , 73 and 118 ; very-low-density lipoprotein , 11.8 and 17.2 ; high-density lipoproteins , 42 and 49 ; and mean triglyceride levels 59 and 86 . Mean weight and subscapular skinfold thicknesses were 58 kg and 6 mm for vegetarians and 73 kg and 17 mm for controls . Similar differences in lipid levels were found between subgroups of 42 vegetarians and controls with identical mean weights . Multiple regression analyses showed that consumption of dairy foods and eggs , but not body weight , was associated with the lipoprotein and cholesterol findings Context People can achieve recommended fat intake while consuming high or low amounts of vegetables , fruits , legumes , and whole grains . Contribution This 4-week r and omized trial compared 2 diets with different vegetable , fruit , legume , and whole-grain content but identical total fat , saturated fat , protein , carbohydrate , and cholesterol content . The 59 adults who consumed high amounts of vegetables , fruits , legumes , and whole grains  had greater improvements in total and low-density lipoprotein cholesterol levels than the 61 adults who ate low amounts of these foods . Implication s At least over the short term , greater improvements in low-density lipoprotein and total cholesterol are an additional benefit of diets high in vegetables , fruits , legumes , and whole grains . The Editors It is well established that elevated low-density lipoprotein ( LDL ) cholesterol concentrations are a risk factor for cardiovascular diseases and that dietary modification is considered a first approach to their treatment and control ( 1 , 2 ) . For several decades , dietary modification for lipid management traditionally focused on avoiding saturated fat and cholesterol ( 3 - 5 ) . Previous examples of dietary interventions targeting LDL cholesterol level often reported only modest lipid improvements , leading some to consider diet a relatively ineffective therapy ( 6 ) . However , recent developments have suggested that the traditional focus of lipid management may have been overly simplistic and that diets might be more effective if more attention was focused on including certain foods or factors rather than just avoiding saturated fat and cholesterol . Effective refinements of dietary strategies for lipid management could decrease the gap in effectiveness between dietary approaches and drug therapy . Several dietary factors or foods , including soy protein , soy isoflavones , plant sterols , soluble fiber , oats , nuts , and garlic , have established or potential lipid benefits ( 7 - 13 ) . Each is derived from plant food sources , and it is inclusion of these factors , rather than avoidance , that is reported to confer benefits . However , given that most plant foods contain low or negligible amounts of saturated fat and that all plant foods are devoid of cholesterol , it follows that a plant-based diet is inherently low in saturated fat and cholesterol . Therefore , it is difficult to distinguish between plasma lipid benefits derived from the actual plant-based dietary components and those derived from avoidance of saturated fat and cholesterol . Several studies have been design ed to test the effects on plasma lipids of diets with identical saturated fat and cholesterol intake but varied amounts of 1 or 2 additional dietary components ( 14 - 16 ) . Data are more limited on dietary approaches that hold saturated fat and cholesterol intake constant while modifying multiple other dietary components simultaneously ( 17 ) . Modifying multiple dietary components simultaneously ( for example , increasing intake of vegetables , fruits , and low-fat dairy ) while holding sodium intake constant has been shown to effectively lower elevated blood pressure in the Dietary Approaches to Stop Hypertension trials ( DASH I and II ) ( 18 , 19 ) . Testing a parallel approach to refining dietary intervention for lipid management is warranted . In 2000 , the American Heart Association ( AHA ) reported revised dietary guidelines that substantially modified its 1993 and 1996 guidelines ( 2 , 4 , 5 ) . All 3 versions of the guidelines recommended keeping saturated fat intake at less than 10 % of energy and cholesterol intake below 300 mg/d . A notable modification of the 2000 guidelines was to emphasize foods and overall eating patterns , including increased intakes of vegetables and whole grains ( in general , a plant-based diet ) . It was our hypothesis that a plant-based diet consistent with the revised AHA 2000 guidelines would increase the LDL cholesterol-lowering benefits of the previous AHA Step I guidelines . We theorized that this improvement would be independent of the plant-based diet 's saturated fat and cholesterol content . Therefore , we design ed 2 diets that had identical levels of total fat ( 30 % of energy ) , saturated fat ( 10 % of energy ) , and cholesterol ( < 300 mg/d ) but differed substantially in content of nutrient- and phytochemical-dense plant-based foods . The purpose of the study was to determine whether LDL cholesterol-lowering benefits among adults with moderately elevated cholesterol levels  would be greater under weight-stable conditions with a plant-based low-fat diet than with a more typical , convenience-oriented low-fat diet that was identical in intake of total fat , saturated fat , and cholesterol . Methods Participants Participants were recruited from the local community , primarily through newspaper advertisements , letters to previous study participants , and flyers sent to university employees . Men and women were invited to enroll if they were 30 to 65 years of age with fasting plasma LDL cholesterol levels of 3.3 to 4.8 mmol/L ( 130 to 190 mg/dL ) , fasting plasma triglyceride levels less than 2.83 mmol/L ( < 250 mg/dL ) , body mass index between 19 and 31 kg/m2 , and a current diet estimated to derive at least 10 % of energy from saturated fat . Pregnant women , persons who smoked , persons with prevalent heart disease or diabetes , or persons who had been using lipid-lowering or blood pressure-lowering medications within the past month ( all determined through self-report ) were excluded . During the recruitment phase , 1096 individuals were screened by telephone interview and 345 who met the initial inclusion criteria were considered eligible for cholesterol testing . Of these 345 persons , 188 who were found to have eligible concentrations of LDL cholesterol and triglycerides attended an orientation meeting . Fifty-one persons decided not to participate ( primarily because of the time commitment ) , and an additional 12 potential participants were excluded after a 3-day food record showed that their estimated average intake of saturated fat was already less than 10 % of energy . One hundred twenty-five participants were r and omly assigned to 1 of the 2 diet groups . The Stanford University Human Subjects Committee review ed and approved the investigation , all participants signed an informed consent form before enrollment , and the study was performed according to Declaration of Helsinki guidelines ( 20 ) . Design The trial used a parallel design . We r and omly assigned participants in blocks of 20 by selecting , without replacement , from a set of indistinguishable envelopes containing 10 assignments to each of the 2 diet groups . R and omization of the envelopes was done by h and , without a computer algorithm . No stratification criteria were used . Each participant was provided with meals , snacks , and beverages on an outpatient basis for 28 days , as described later . Diets Both study diets were design ed to provide 30 % of energy from total fat , 10 % of energy from saturated fat , and approximately 100 mg of cholesterol per 1000 kcal per day . During the menu- design ing stage of the study , the nutrient composition of the diets was determined by using the data base of Food Processor software , version 7.0 ( ESHA Research , Salem , Oregon ) . Menus were design ed by using commonly available foods from local markets . The Low-Fat diet was design ed to include many reduced-fat prepared-food items ( for example , reduced-fat cheeses , low-fat frozen lasagna , and low-fat and sugar-rich snack foods ) . In contrast , the Low-Fat Plus diet was design ed to include considerably more vegetables , legumes , whole grains , and fruits . Butter , cheese , and eggs were added to the daily menus for the Low-Fat Plus diet , increasing the saturated fat and cholesterol content to match the Low-Fat diet . A 7-day menu cycle was design ed for each of the 2 study diets ; therefore , each menu was repeated 4 times during the 28 days . The diets included breakfast , lunch , dinner , beverages , and snacks for each day . Each weekday , the participants ate either lunch or dinner at the dining facility of the Stanford General Clinical Research Center . After their on-site meal , they were given coolers that contained meals and snacks to be consumed off-site . On Fridays , participants received weekend meals to be consumed off-site . Appendix Table 1 and Appendix Table 2 list the daily menus . One free-choice evening meal was allowed each weekend . For this meal , participants were given guidelines for choosing low-fat meals consistent with their diet assignments and were required to keep a record of foods consumed . These records were analyzed for nutritional content and were used to determine the impact of the free-choice meals on the overall study diets . Adherence was measured by using daily log sheets kept by participants that tracked incomplete consumption of study foods or consumption of any non study foods . The 28 daily food logs for each participant were examined for deviations from the diets . The energy contribution of each deviation was determined and then totaled for the entire 28-day protocol period . Each of the 14 daily menus ( 7-day cycle 2 diets ) was analyzed chemically for nutrient content before the study and then again during the study ( Covance Laboratories , Madison , Wisconsin ) . The chemical analyses performed before the study confirmed that the average composition of the daily menus provided 30 % of energy from total fat , 10 % of energy from saturated fat , and approximately 100 mg of cholesterol per 1000 kcal per day . When the 2 diets were first design ed , we attempted to match their mono- and polyunsaturated fat content . However , the data base used in the design phase was missing values for these nutrients for approximately 20 % of the foods . In addition , many of the specific products purchased locally for the study provided incomplete information for the content of these unsaturated fats . The first round of chemical analyses of the diets , performed before enrollment began , indicated a modest discrepancy
target: Conclusions Plant-based diets are associated with decreased total cholesterol , low-density lipoprotein cholesterol , and high-density lipoprotein cholesterol , but not with decreased triglycerides .
background: Context Although a recent meta- analysis of r and omized controlled trials showed that adoption of a vegetarian diet reduces plasma lipids , the association between vegetarian diets and long-term effects on plasma lipids has not been subjected to meta- analysis .
  Objective The aim was to conduct a systematic review and meta- analysis of observational studies and clinical trials that have examined associations between plant-based diets and plasma lipids .