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Impact of α-Linolenic Acid, the Vegetable ω-3 Fatty Acid, on Cardiovascular Disease and Cognition.
Sala-Vila, A, Fleming, J, Kris-Etherton, P, Ros, E
Advances in nutrition (Bethesda, Md.). 2022;13(5):1584-1602
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α-Linolenic acid (ALA) is an omega-3 fatty acid found in seeds and nuts such as flaxseeds, chia seeds, and walnuts and in oils such as canola oil, soybean oil, flaxseed oil and walnut oil. It has been shown to reduce the risk of coronary heart disease and cardiovascular disease. This meta-analysis examined the results of various studies, including epidemiologic studies, randomized controlled trials, and systematic reviews, to evaluate the beneficial effects of ALA in improving cognitive function and reducing the risk of cardiovascular disease and coronary heart disease. The included studies showed a correlation between ALA intake and a decreased risk of cardiovascular disease and coronary heart disease, possibly due to ALA's anti-inflammatory properties, as well as its ability to reduce total cholesterol, LDL cholesterol, triglycerides, and blood pressure. The analysis also found that ALA intake may reduce the risk of type 2 diabetes and cognitive impairment. Healthcare professionals can leverage the findings of this analysis to educate individuals about the benefits of dietary ALA in improving cardiovascular and cognitive outcomes. However, further studies are necessary to establish definitive conclusions and determine therapeutic dosage.
Abstract
Given the evidence of the health benefits of plant-based diets and long-chain n-3 (ω-3) fatty acids, there is keen interest in better understanding the role of α-linolenic acid (ALA), a plant-derived n-3 fatty acid, on cardiometabolic diseases and cognition. There is increasing evidence for ALA largely based on its major food sources (i.e., walnuts and flaxseed); however, this lags behind our understanding of long-chain n-3 fatty acids. Meta-analyses of observational studies have shown that increasing dietary ALA is associated with a 10% lower risk of total cardiovascular disease and a 20% reduced risk of fatal coronary heart disease. Three randomized controlled trials (RCTs) [AlphaOmega trial, Prevención con Dieta Mediterránea (PREDIMED) trial, and Lyon Diet Heart Study] all showed benefits of diets high in ALA on cardiovascular-related outcomes, but the AlphaOmega trial, designed to specifically evaluate ALA effects, only showed a trend for benefit. RCTs have shown that dietary ALA reduced total cholesterol, LDL cholesterol, triglycerides, and blood pressure, and epidemiologic studies and some trials also have shown an anti-inflammatory effect of ALA, which collectively account for, in part, the cardiovascular benefits of ALA. A meta-analysis reported a trend toward diabetes risk reduction with both dietary and biomarker ALA. For metabolic syndrome and obesity, the evidence for ALA benefits is inconclusive. The role of ALA in cognition is in the early stages but shows promising evidence of counteracting cognitive impairment. Much has been learned about the health benefits of ALA and with additional research we will be better positioned to make strong evidence-based dietary recommendations for the reduction of many chronic diseases.
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Adherence to Mediterranean Diet and NAFLD in Patients with Metabolic Syndrome: The FLIPAN Study.
Montemayor, S, Mascaró, CM, Ugarriza, L, Casares, M, Llompart, I, Abete, I, Zulet, MÁ, Martínez, JA, Tur, JA, Bouzas, C
Nutrients. 2022;14(15)
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Non-alcoholic fatty liver disease (NAFLD) is characterised by fat deposition that is not linked to excessive alcohol intake. This condition is often linked to other health issues such as obesity, metabolic syndrome, type 2 diabetes and cardiovascular disease, and they share common diagnostic biomarkers. An unhealthy diet and lifestyle are also linked to the progression of NAFLD. Mediterranean diet is a predominantly plant-based diet that may have an association with lower risk and reduced severity of NAFLD. This multicentre, prospective, randomised controlled trial included one hundred and thirty-six NAFLD patients to analyse the effect of Mediterranean diet adherence on NAFLD in patients with metabolic syndrome. The NAFLD patients followed a personalised Mediterranean diet and physical activity interventions for six months. Individuals with greater adherence to the Mediterranean diet and physical activity interventions showed improvements in body mass index, body weight, waist circumference, blood pressure and intrahepatic fat content after six months of intervention. Healthcare professionals can use the results of this study to understand the benefits of adherence to the Mediterranean diet and physical activity interventions in reducing NAFLD severity and metabolic irregularities. However, due to the small sample size of this study, further robust studies are required to evaluate the benefits of different dietary strategies, the therapeutic value of different food items and the intervention duration required to achieve improvements in NAFLD and metabolic syndrome.
Abstract
Unhealthy diet is an important factor in the progression of non-alcoholic fatty liver disease (NAFLD). Previous studies showed the benefits of a Mediterranean diet (MedDiet) on Metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM), and cardiovascular diseases, which usually have a pathophysiological relationship with NAFLD. To assess the effect of adherence to a MedDiet on NAFLD in MetS patients after lifestyle intervention, this multicentre (Mallorca and Navarra, Spain) prospective randomized trial, with personalized nutritional intervention based on a customized MedDiet, coupled with physical activity promotion was performed to prevent, and reverse NAFLD among patients with MetS. The current analysis included 138 patients aged 40 to 60 years old, Body Mass Index (BMI) 27-40 kg/m2, diagnosed with NAFLD using MRI, and MetS according to the International Diabetes Federation (IDF). A validated food frequency questionnaire was used to assess dietary intake. Adherence to Mediterranean diet by means of a 17-item validated questionnaire, anthropometrics, physical activity, blood pressure, blood biochemical parameters, and intrahepatic fat contents (IFC) were measured. The independent variable used was changes in MedDiet adherence, categorized in tertiles after 6 months follow-up. Subjects with high adherence to the MedDiet showed higher decreases in BMI, body weight, WC, SBP, DBP, and IFC. An association between improvement in adherence to the MedDiet and amelioration of IFC after 6-month follow-up was observed. High adherence to the MedDiet is associated with better status of MetS features, and better values of IFC.
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Vegan diet in young children remodels metabolism and challenges the statuses of essential nutrients.
Hovinen, T, Korkalo, L, Freese, R, Skaffari, E, Isohanni, P, Niemi, M, Nevalainen, J, Gylling, H, Zamboni, N, Erkkola, M, et al
EMBO molecular medicine. 2021;13(2):e13492
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As vegan diets gain popularity amongst families, there is little known about the impact of strict plant-based diets on metabolism and micronutrient status in children, apart from reduced average growth within the norm. This small study looked at 40 Finnish children from one day centre, and compared children following an omnivore or vegetarian diet to those raised on a vegan diet. The diets were analysed, and biomarkers and metabolites were measured. The metabolic profile and nutrient status of children who followed a vegan diet from birth were distinctively different to other diet patterns, including vegetarians. The authors suggest that little animal source foods are enough to shift the metabolism of children. Dietary analysis showed that vegan children had higher folate consumption and lower protein and saturated fats intake. Despite intake appearing adequate, serum markers for fat-soluble vitamins A and D were low. While the fatty acid ALA was higher compared to omnivores, DHA and overall cholesterol were decreased. The authors concluded that the bodies own cholesterol production does not seem to compensate for a lack of dietary cholesterol in this case and it remains to be established whether lower cholesterol in vegan children are negative to health. Furthermore, the circulating amino acids pool was decreased in vegan children, particularly branch chained amino acids. The most distinct difference, however, was seen in the variance of bile acid patterns. The physiological functions of bile acids go beyond digestion, yet the consequences of diverging bile acid profiles in children’s health are unknown. In conclusion, the data shows that a strict vegan diet affects the metabolism of healthy children, but much of the long-term impact on health is currently still unclear. This article highlights some of the differences, risks and uncertainties that come with raising young children on a strictly vegan diet.
Abstract
Vegan diets are gaining popularity, also in families with young children. However, the effects of strict plant-based diets on metabolism and micronutrient status of children are unknown. We recruited 40 Finnish children with a median age 3.5 years-vegans, vegetarians, or omnivores from same daycare centers-for a cross-sectional study. They enjoyed nutritionist-planned vegan or omnivore meals in daycare, and the full diets were analyzed with questionnaires and food records. Detailed analysis of serum metabolomics and biomarkers indicated vitamin A insufficiency and border-line sufficient vitamin D in all vegan participants. Their serum total, HDL and LDL cholesterol, essential amino acid, and docosahexaenoic n-3 fatty acid (DHA) levels were markedly low and primary bile acid biosynthesis, and phospholipid balance was distinct from omnivores. Possible combination of low vitamin A and DHA status raise concern for their visual health. Our evidence indicates that (i) vitamin A and D status of vegan children requires special attention; (ii) dietary recommendations for children cannot be extrapolated from adult vegan studies; and (iii) longitudinal studies on infant-onset vegan diets are warranted.
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Plant-based diets, insulin sensitivity and inflammation in elderly men with chronic kidney disease.
González-Ortiz, A, Xu, H, Avesani, CM, Lindholm, B, Cederholm, T, Risérus, U, Ärnlöv, J, Espinosa-Cuevas, A, Carrero, JJ
Journal of nephrology. 2020;33(5):1091-1101
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Consumption of a plant-based diet in individuals with chronic kidney disease (CKD) is associated with lower risk of disease progression and death, however how this occurs is not fully understood. This cross-sectional study of 418 men with CKD aimed to determine whether a plant-based diet is associated with inflammation and the ability to adequately maintain blood-sugar balance. The results showed that individuals who had a higher intake of plant-based foods were associated with lower levels of inflammation and an increased ability to balance blood sugar levels, which was inversed when lower amounts of plant-based foods were consumed. It was concluded that plant-based diets may have a role in lowering the risk of disease progression and death in individuals with CKD. However, an adequately designed study needs to be performed to investigate If this is due to the reduction in inflammation and increased ability to balance blood-sugars observed in the trial. This study could be used by health care professionals to recommend increased consumption of plant-based foods to individuals with CKD to improve disease outcomes.
Abstract
BACKGROUND In persons with CKD, adherence to plant-based diets is associated with lower risk of CKD progression and death, but underlying mechanisms are poorly characterized. We here explore associations between adherence to plant-based diets and measures of insulin sensitivity and inflammation in men with CKD stages 3-5. METHODS Cross-sectional study including 418 men free from diabetes, aged 70-71 years and with cystatin-C estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 and not receiving kidney-specific dietetic advice. Information from 7-day food records was used to evaluate the adherence to a plant-based diet index (PBDi), which scores positively the intake of plant-foods and negatively animal-foods. Insulin sensitivity and glucose disposal rate were assessed with the gold-standard hyperinsulinemic euglycemic glucose clamp technique. Inflammation was evaluated by serum concentrations of C-reactive protein (CRP) and interleukin (IL)-6. Associations were explored through linear regression and restricted cubic splines. RESULTS The majority of men had CKD stage 3a. Hypertension and cardiovascular disease were the most common comorbidities. The median PBDi was 38 (range 14-55). Across higher quintiles of PBDi (i.e. higher adherence), participants were less often smokers, consumed less alcohol, had lower BMI and higher eGFR (P for trend <0.05 for all). Across higher PBDi quintiles, patients exhibited higher insulin sensitivity and lower inflammation (P for trend <0.05). After adjustment for eGFR, lifestyle factors, BMI, comorbidities and energy intake, a higher PBDi score remained associated with higher glucose disposal rate and insulin sensitivity as well as with lower levels of IL-6 and CRP. CONCLUSION In elderly men with non-dialysis CKD stages 3-5, adherence to a plant-based diet was associated with higher insulin sensitivity and lower inflammation, supporting a possible role of plant-based diets in the prevention of metabolic complications of CKD.
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Micronutrient Status of Recreational Runners with Vegetarian or Non-Vegetarian Dietary Patterns.
Nebl, J, Schuchardt, JP, Ströhle, A, Wasserfurth, P, Haufe, S, Eigendorf, J, Tegtbur, U, Hahn, A
Nutrients. 2019;11(5)
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There is current debate as to whether plant-based nutrition can provide all the required nutrients in adequate amounts for athletes. The aim of this cross-sectional study was to evaluate the micronutrient status among omnivore, vegetarian and vegan recreational runners. In this study, fasting blood levels of vitamin B12, folate, vitamin D, iron, calcium, magnesium and zinc were assessed in 27 omnivores, 26 vegetarians and 28 vegans. These results showed there were no significant differences between vegan and vegetarian diets compared with the omnivore diet. Based on these results, the authors conclude a well-planned vegetarian and vegan diet, including supplementation, can meet the recreational runner’s requirements of important micronutrients. The authors suggest further research be done on a larger sample size and on athletes of differing levels of performance intensity.
Abstract
Vegetarian diets have gained popularity in sports. However, few data exist on the status of micronutrients and related biomarkers for vegetarian and vegan athletes. The aim of this cross-sectional study was to compare the micronutrient status of omnivorous (OMN, n = 27), lacto-ovo-vegetarian (LOV, n = 26), and vegan (VEG, n = 28) recreational runners. Biomarkers of vitamin B12, folate, vitamin D, and iron were assessed. Additionally, serum levels of calcium, magnesium, and zinc were examined. Lifestyle factors and supplement intake were recorded via questionnaires. About 80% of each group showed vitamin B12 adequacy with higher levels in supplement users. Mean red blood cell folate exceeded the reference range (>340 nmol/L) in all three groups (OMN: 2213 ± 444, LOV: 2236 ± 596, and VEG: 2354 ± 639 nmol/L; not significant, n.s.). Furthermore, vitamin D levels were comparable (OMN: 90.6 ± 32.1, LOV: 76.8 ± 33.7, and VEG: 86.2 ± 39.5 nmol/L; n.s.), and we found low prevalence (<20%) of vitamin D inadequacy in all three groups. Less than 30% of each group had depleted iron stores, however, iron deficiency anemia was not found in any subject. Our findings suggest that a well-planned, health-conscious lacto-ovo-vegetarian and vegan diet, including supplements, can meet the athlete's requirements of vitamin B12, vitamin D and iron.
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Health Biomarkers in Adults Are More Closely Linked to Diet Quality Attributes Than to Plant-Based Diet Categorization.
Mayra, S, Ugarte, N, Johnston, CS
Nutrients. 2019;11(6)
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Plant-based diets rich in fruits, vegetables, whole grains, nuts, and legumes are consistently linked to reduced risk for chronic disease, improved cognition, and longevity. The aim of the study was to examine the diet quality and blood metabolites of vegetarian and omnivore adults to determine adherence to plant-based diets compared to high-quality eating patterns. The study is a cross-sectional investigation. Thirty-three participants (17 vegetarians: 3 men/14 women; 16 omnivores: 3 men/13 women) aged between 18 and 65 years were enrolled for the study. Results indicate the health biomarkers did not differ between vegetarians and omnivores matched for gender, age, and adiposity. However, when participants were regrouped by low-quality versus high-quality diets, data suggests that several common health biomarkers are more closely aligned with diet quality attributes than with plant-based diet categorisation. Authors conclude that healthcare practitioners should emphasize diet quality in their messages to their clients and discuss the importance of eating whole, minimally processed foods with less added fat and sugars.
Abstract
Although plant-based diets are promoted for healthy outcomes, these diets are not synonymous with high-quality diets. Plant-based diets can include highly processed, less healthful foods, including savory snacks, pastries, and sugary fruit drinks. This cross-sectional study examined the diet quality of vegetarian and omnivorous adults, matched for gender, age, and adiposity, and related diet quality to standard health biomarkers. Diet quality was assessed using the Rapid Eating and Activity Assessment for Participants Short Version questionnaire. Participants (17 vegetarians and 16 omnivores; 28.2 ± 8.9 years; 22.5 ± 2.7 kg/m2) were non-smokers and healthy by self-report. The median duration of adherence to the vegetarian diet was 27 months. Physical activity level and diet quality did not differ significantly between diet groups. Moreover, health biomarkers did not differ by diet groups. When participants were regrouped by low versus high diet quality, health biomarkers differed significantly between groups for fasting insulin, HOMA-IR, triglyceride (TG)/HDL ratio, and blood folate, with more favorable levels in the group with high diet quality. These data suggest that health biomarkers more closely align with diet quality attributes than with plant-based diet categorization. Thus, messaging focused on healthy diet attributes may lead to better health outcomes than the simple promotion of plant-based diets.
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Dietary Intakes and Cardiovascular Health of Healthy Adults in Short-, Medium-, and Long-Term Whole-Food Plant-Based Lifestyle Program.
Jakše, B, Jakše, B, Pinter, S, Jug, B, Godnov, U, Pajek, J, Fidler Mis, N
Nutrients. 2019;12(1)
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A plant-based diet (PBD) has been shown to benefit cardiovascular health. However previous research has reported incidences of gout, questioning its safety in certain individuals. Previous studies have mainly focused on the outcomes of short-term changes to a PBD. This study aimed to determine the effects of a whole- food PBD (WFPBD) on cardiovascular health in the short, medium and long-terms. This cross-sectional study split 151 healthy adults depending on how long they had followed a PBD. The results showed that regardless of the amount of time on a WFPBD, markers for cardiovascular health are improved. Long-term PBD (5-10 years) in women was associated with significantly lower LDL-cholesterol, which is a cholesterol that can increase heart attack risk. Significant improvements to blood pressure were also observed in women but again this was not time dependent. Indicators of gout development were not significant, although they were raised in a small number of participants. It was concluded that regardless of time, a WFPBD may be associated with long-term cardiovascular health. This study could be used by practitioners to recommend a WFPBD to healthy individuals who would like to reduce their cardiovascular risk. However, caution should be taken in individuals with gout.
Abstract
An effective lifestyle strategy to reduce cardiovascular diseases risk (CVD) factors is needed. We examined the effects of a whole-food plant-based (WFPB) lifestyle program on dietary intake and cardiovascular (CV) risk factors in 151 adults (mean 39.6 (SD 12.5) years). Adherence was categorised into short-, medium- and long-term (years: (0.5-<2), (2-<5) and (5-10)), for both genders separately. Dietary intakes were assessed, fasting blood lipids and blood pressure (BP) were measured, and % participants reaching guideline recommended targets for LDL-cholesterol, triglycerides and BP in the primary CVD prevention was assessed. There were no statistically significant differences in intakes of energy and most nutrients among participants (both genders), that were short-, medium- and long term in our program. Diet was mainly composed of unprocessed vegetables/fruits, whole grains, legumes, potatoes, and nuts/seeds. LDL-cholesterol, triglycerides, systolic and diastolic BP were within targets for: 93%, 97%, 88% and 95% participants, respectively. In females (vs. males), total- and HDL-cholesterol were higher (mean): 3.8 (SD 0.7) vs. 3.4 (SD 0.9), p = 0.002 and 1.5 (SD 0.3) vs. 1.1 (SD 0.2) mmol/L, p < 0.001), systolic BP was lower (113 (SD 11) vs. 120 (SD 10) mmHg, p = 0.001), while there was no difference in diastolic BP (71 (SD 9) vs. 72 (SD 8) mmHg, p = 0.143). More females vs. males reached target triglycerides (99% vs. 91%, p = 0.021) and systolic BP (92% vs. 79%, p = 0.046), while similar females and males reached target LDL-cholesterol (94% vs. 91%, p = 0.500) and diastolic BP (93% vs. 100%, p = 0.107). Participation in our WFPB lifestyle program is associated with favourable dietary intakes, safety markers, and CV risk factor profiles.
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A Plant-Based High-Carbohydrate, Low-Fat Diet in Overweight Individuals in a 16-Week Randomized Clinical Trial: The Role of Carbohydrates.
Kahleova, H, Dort, S, Holubkov, R, Barnard, ND
Nutrients. 2018;10(9)
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The prevalence of obesity has reached epidemic proportions. As a result, the risk of obesity-related diseases is rapidly increasing, and increased body weight is associated with a higher all-cause mortality. The aim of the study is to determine whether high carbohydrate and fibre intakes in the context of a plant-based diet are associated with weight loss, reduction in fat mass, and decrease in insulin resistance. The study is a single-centre, randomised controlled study. The participants recruited for the study were adults with a BMI between 28 and 40 kg/m2. Results demonstrated that increased consumption of carbohydrates and dietary fibre, as part of a plant-based high-carbohydrate, low-fat diet, was associated with reduced body weight, fat mass, and insulin resistance in overweight individuals. Authors conclude that increased consumption of total carbohydrates and total fibre, particularly insoluble fibre, was linked with lower body mass index and volume in visceral fat. Furthermore, increased fibre intake is also associated with decrease in fat mass.
Abstract
The effects of carbohydrates on body weight and insulin sensitivity are controversial. In this 16-week randomized clinical trial, we tested the role of a low-fat, plant-based diet on body weight, body composition and insulin resistance. As a part of this trial, we investigated the role of changes in carbohydrate intake on body composition and insulin resistance. Participants (n = 75) were randomized to follow a plant-based high-carbohydrate, low-fat (vegan) diet (n = 38) or to maintain their current diet (n = 37). Dual-energy X-ray absorptiometry was used to measure body composition. Insulin resistance was assessed with the Homeostasis Model Assessment (HOMA-IR) index. A repeated measure ANOVA model was used to test the between-group differences from baseline to 16 weeks. A linear regression model was used to test the relationship between carbohydrate intake, and body composition and insulin resistance. Weight decreased significantly in the vegan group (treatment effect -6.5 [95% CI -8.9 to -4.1] kg; Gxt, p < 0.001). Fat mass was reduced in the vegan group (treatment effect -4.3 [95% CI -5.4 to -3.2] kg; Gxt, p < 0.001). HOMA-IR was reduced significantly in the vegan group (treatment effect -1.0 [95% CI -1.2 to -0.8]; Gxt, p = 0.004). Changes in consumption of carbohydrate, as a percentage of energy, correlated negatively with changes in BMI (r = -0.53, p < 0.001), fat mass (r = -0.55, p < 0.001), volume of visceral fat (r = -0.35, p = 0.006), and HOMA (r = -0.27, p = 0.04). These associations remained significant after adjustment for energy intake. Changes in consumption of total and insoluble fiber correlated negatively with changes in BMI (r = -0.43, p < 0.001; and r = -0.46, p < 0.001, respectively), fat mass (r = -0.42, p < 0.001; and r = -0.46, p < 0.001, respectively), and volume of visceral fat (r = -0.29, p = 0.03; and r = -0.32, p = 0.01, respectively). The associations between total and insoluble fiber and changes in BMI and fat mass remained significant even after adjustment for energy intake. Increased carbohydrate and fiber intake, as part of a plant-based high-carbohydrate, low-fat diet, are associated with beneficial effects on weight, body composition, and insulin resistance.