cardiovascular health benefits of plant-based eating · 2019-09-30 · plant-based eating &...

Alpro Foundation student symposium ‐ Leeds March 15, 2017

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Cardiovascular health benefits of plant-based eating

Alpro Foundation Student Symposium March 2017 Leeds

Ian Rowland

University of Reading

Overview

What is plant-based eating?

Cardiovascular disease

Benefits of plant based diets for health

Benefits for CVD – evidence from epidemiology and intervention studies


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What is plant-based eating?

Harland J & Garton L. The Plant‐based Plan (2015)

Plant-based eating: huge variety of foods

Pulses Wholegrains Vegetables

Fruit Nuts and seeds Plant-based alternatives to meat and dairy



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Plant based eating healthy balance of nutrients

Plant-based eating patterns

tend to be low in total fat and SFA,

include a good level of unsaturated fats

leading to better overall fat quality,

are high in fibre

all in line with global dietary recommendations for maintaining/improving health.


Cardiovascular disease

• Leading cause of death worldwide ~30% of deaths due to CVD

• In Europe > 4m deaths per year; In EU ~1.9m

• In UK, CVD is main cause of death in women (28%), second most common in men (29%)

• NHS cost in England > £6.8 billion (2012/13)


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Plant-based eating & benefits for health

Weight management

Cardiovascular benefits

Managing blood glucose

Healthy ageing

Bone health

Cancer incidence


Not only the reduction in animal products, but also the wide variety of nutrients (fibre, complex carbohydrates, mono- and poly-unsat fats, plant proteins, vitamins and minerals) and non-nutrients (eg polyphenols) found in plant-based foods are thought to contribute to the potential health benefits of plant-based eating.

Reduced risk of CVD

Plant-based eating & weight management

Lower incidence of obesity reduced risk of cardiovascular disease, diabetes and cancer

AHS-2: As people progress from a vegan diet to animal-based diets there is a gradual increase in BMI.

Plant-based foods have a lower energy density, are low in saturated fat and higher in fibre all associated with lower body weight and less weight gain

Sabate and Wien, AJCN 2010


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Plant-based eating & cardiovascular benefits

Studies demonstrate plant-based eating is associated with reduced risk of heart disease. Typically incidence is ~ 20-30% lower in those following a plant-based eating pattern.

Epi studies of vegetarians vs non-vegetarians

Epi studies comparing plant based eating patterns

Mediterranean diet & CVD– epi and intervention studies

Intervention studies with CVD biomarkers as endpoints

Community-based interventions



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Vegetarians vs non-vegetariansMeta analysis of cohort studies

6 studies (~120,000 subjects) from UK, Germany, Netherlands, USA, Huang et al Ann Nutr Metab 60:233, 2012 (ES= effect size)

29% reduction in risk

All cause & CVD mortality across increasing plant based eating pattern

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Pro‐veg food pattern categoryV.low low mod high

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PREDIMED study,7216 subjects (57%f) at high CVD risk. Follow up for 4.8y: 323 deaths (76 from CVD) . Martinez‐Gonzales, et al (2014) Am J Clin Nutr, 100(S1);320S

Adjusted HRVeg category all cause CVD

Very low 1 1

Low 0.71 0.48(0.50,1.02) (0.24, 0.99)

Moderate 0.68 0.44(0.48, 0.96) (0.22, 0.90)

High 0.59 0.47(0.40, 0.88) (0.21,1.02)

P trend 0.027 0.039


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Mediterranean diet and lifestyle – a good example of plant based eating

Traditional Mediterranean diet is part of a lifestyle incorporating

• High intake of fruit and veg

• High intake of whole grains and nuts

• Low amounts of red meat, refined CHO

• High consumption extra virgin olive oil

• Social eating patterns

• Exercise

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In the Mediterranean region:

Plant based eatingCVD cancer diabetes

Med diet and CVD - Epidemiology

Fung T T et al. Circulation 2009;119:1093-1100Copyright © American Heart Association

• The aMed score is a Mediterranean diet scale

• Higher the score (0-9) the closer to Med diet

• Points given for intake above median for Med diet components inc moderate alcohol, (or below for red meat).

• Nurses’ Health study (n=74886; 5231 CVD cases)

• Adjusted RR of CVD incidence & death by quintiles of aMed.


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Med diet and heart disease – intervention study

The Lyon Heart Study (2001)

Randomized secondary prevention study in patients with CHD. 5 year follow up of subjects on Med diet high MUFA, ALA diet vs low fat PUFA (control) deLorgeril et al Circulation 99, 779 (1999)

High LDL‐C

High TG

Low HDL

High BP

obesity

Inflammarkers

CVD risk

Plant based eating and CVD risk factors

Insulin resist‐ance


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Plant-based eating & CVD risk factors

• Epi studies: Meta-analysis of CVD risk factors (Ferdowsian & Barnard 2009)13 observational studies (4772 M & W) of varying age and ethnicity, from 6 countries.

Med diet and CVD risk- Intervention study vs prudent (low fat) diet

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180 subjects with metabolic syndrome followed Med diet (whole grain, F&V, olive oil) or prudent diet (CHO 50-60%, fat <30%) for 2 yearsExposito et al JAMA. 2004;292(12):1440-1446


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Plant-based eating & CVD risk factors –Intervention studies

Portfolio Diet studies (Jenkins et al):

• Diet based on plant foods: soya protein, nuts, viscous fibre (oats), plant stanols/sterols

• ~12 studies, 4 – 80 weeks in duration

• LDL-C 7 - 30% (P<0.001)

• In longer term and more practical environment ~15% + improved Total: HDL-C ratio (P<0.001)

• Limited evidence BP

Factors involved - Phytochemicals

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CAROTENOIDS(Bcarotene, lycopene,

cryptoxanthin

SECOIRIDOIDS(hydroxytyrosol,oleuropein)

Olive oil, olives, wine

LIGNANS(pinoresinol, lariciresinol)

Olive oil, cereals, sesame seeds,

ISOTHIOCYANATES

Broccoli Rocket, Watercress

Tomato, carrots, mango

FLAVONOIDS(epicatechin, quercetin,

naringenin

Berries, citrus fruits, onions, red wine, tea, cocoa

O

OH

OH

OH

OH

HO


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Flavonoids and CVD risk

Flavonoid group RR (95% CI)

Anthocyanidins 0·89 (0·83, 0·96),

Proanthocyanidins 0·90 (0·82, 0·98),

Flavones 0·88 (0·82, 0·96),

Flavanones 0·88 (0·82, 0·96)

Flavan-3-ols 0·87 (0·80, 0·95)

• Meta analysis of 14 prospective cohort studies

• Wang et al BJN 111, 1-11, 2014

Flavonoids and CVD risk factors –intervention study (FLAVURS)

• 174 subjects 106 m, 68 f

• RR of CVD >1.5, based on Framingham CVD risk scoring tool

• Consumed < av UK F&V intake (4.4 portions/d)

• Age: 48 11.7 BMI: 28.4 3.66

• Parallel design, 2 treatment groups (HF & LF) with increasing amounts of F&V + control (habitual diet)

• End points:Primary: Vascular function - laser-doppler iontophoresis

Secondary: LDL-C, HDL-C, CRP, VCAM (Vascular cell adhesion molecule), E-selectin, vascular stiffness by PWA

Macready et al AM J Clin Nutr 99, 479, (2014)

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Low Flavonoid F&V

High Flavonoid F&V+2 + 4

+2

+ 6

+ 4 + 6

Habitual diet

Wk 0

Visit 1Wk 6

Visit 2Wk 12

Visit 3Wk 18

Visit 4

Study design

Addition of F&V increased intake to ~5, 6.5 and 7.5 portions/d

UrineVasc func

UrineVasc func

UrineVasc func

UrineVasc func

Results

In men, the HF F&V diet:

• Increased vascular function (+2 portions/d) (~20%;P = 0.017)

• Reduced C-reactive protein (~37%;P = 0.001), E-selectin (P = 0.0005), and VCAM (P = 0.046) with +4-6 portions/d.

• Increased plasma NO (~20%;P = 0.024) with +4 portions/d (M&F)

In all subjects increased F&V (HF & LF):

• Attenuated increase in vascular stiffness (~10%;P=006)


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HF and LF attenuated increase shown in CT group P=0.009

+2 +4 +6Additional F&V portions

F&V impact on arterial stiffness measured by PWA

High LDL‐C

High TG

Low HDL

High BP

obesity

Inflammarkers

CVD risk

CVD risk factors LDL Strong evidence Clinical studies, portfolio diets studies, Epistudies

Some evidence Clinical studies, portfolio diets studies, Epi studies

Good evidence Epi studies show lower BMI on vegdiets

Limited evidence from clinical studies. Epi studies show improved glycaemia with plant‐based regimes

Evidence from Epistudies, Med diets,

Evidence HDL‐C maintained total:HDL ratio improved ‐Portfolio studies + MUFA beneficial

Limited evidence from Med diets, interventions

Insulin resist‐ance


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Plant-based eating & CVD markers

Community‐based interventions

• 4 community‐based (uncontrolled) lifestyle interventions with plant based diets

�Reduction in LDL‐C of 7‐15% vs baseline

�Reduction in SDP and DBP of ~ 5%

Summary - Plant based diets and health

Plant-based eating patterns:

have a role in maintaining body weight / lower prevalence of obesity

are associated with a lower overall mortality

are associated lower heart disease risk, typically by ~ 20-30%

improve a variety of CVD risk factors (LDL-C, HDL-C, BP, TG) thus contribute to a healthy heart

Specific components found intrinsically in plant foods are thought to be involved, e.g. polyphenols (esp flavonoids), fibre, phytosterols, soy protein


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Consumer behavior change- the UK approach

the Danish approach!


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www.reading.ac.uk

The Alpro Foundation approach-The Plant-based Plan

comprehensive review of the scientific literature to date



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www.alprofoundation.org

Acknowledgements

Lynne GartonJanice Harland

cardiovascular health benefits of plant-based eating · 2019-09-30 · plant-based eating &...

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