The Effect of a Plant-Based Diet on Plasma Lipids in Hypercholesterolemic Adults

Gardner, Christopher D.; Coulston, Ann; Chatterjee, Lorraine; Rigby, Alison; Spiller, Gene; Farquhar, John W.
May 2005
Annals of Internal Medicine;5/3/2005, Vol. 142 Issue 9, p725
Academic Journal
Background: A variety of food combinations can be used to meet national U.S. guidelines for obtaining 30% of energy or less from total fat and 10% of energy or less from saturated fat. Objective: To contrast plasma lipid responses to 2 low-fat diet patterns. Design: Randomized clinical trial. Setting: 4-week outpatient feeding study with weight held constant. Participants: 120 adults 30 to 65 years of age with prestudy low-density lipoprotein (LOL) cholesterol concentrations of 3.3 to 4.8 mmol/L (130 to 190 mg/dL), body mass index less than 31 kg/m2, estimated dietary saturated fat at least 10% of calories, and otherwise general good health. Measurements: Plasma lipid levels. Intervention: Two diets, the Low-Fat diet and the Low-Fat Plus diet, designed to be identical in total fat, saturated fat, protein, carbohydrate, and cholesterol content consistent with former American Heart Association Step I guidelines. The Low-Fat diet was relatively typical of a low-fat U.S. diet. The Low-Fat Plus diet incorporated considerably more vegetables, legumes, and whole grains, consistent with the 2000 American Heart Association revised guidelines. Results: Four-week changes in the Low-Fat and Low-Fat Plus groups were -0.24 mmol/L (-9.2 mg/dL) versus -0.46 mmol/L (-17.6 mg/dL) for total cholesterol (P = 0.01) and -0.18 mmol/L (-7.0 mg/dL) versus -0.36 mmol/L (-13.8 mg/dL) for LDL cholesterol (P= 0.02); between-group differences were -0.22 mmol/L (-9 mg/dL) (95% CI, -0.05 to -0.39 mmol/L [-2 to -15 mg/dL]) and -0.18 mmol/L (-7 mg/dL) (CI, -0.04 to -0.32 mmol/L [-2 to -12 mg/dL]) for total and LDL cholesterol, respectively. The 2 diet groups did not differ significantly in high-density lipoprotein cholesterol and triglyceride levels. Limitations: 4-week duration. Conclusions: Previous national dietary guidelines primarily emphasized avoiding saturated fat and cholesterol; as a result, the guidelines probably underestimated the potential LDL cholesterol-lowering effect of diet. In this study, emphasis on including nutrient-dense plant-based foods, consistent with recently revised national guidelines, increased the total and LOL cholesterol-lowering effect of a low-fat diet.


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