Abstract
BackgroundLow levels of high-density lipoproteins (HDL) are considered an important risk factor for cardiovascular disease and constitute one of the criteria for the Metabolic Syndrome (MetS). Lifestyle interventions promoting a low-fat, plant-based eating pattern appear to paradoxically reduce cardiovascular risk but also HDL levels. This study examined the changes in MetS risk factors, in particular HDL, in a large cohort participating in a 30-day lifestyle intervention that promoted a low-fat, plant-based eating pattern.MethodsIndividuals (n = 5,046; mean age = 57.3 ± 12.9 years; 33.5% men, 66.5% women) participating in a in a Complete Health Improvement Program (CHIP) lifestyle intervention within the United States were assessed at baseline and 30 days for changes in body mass index (BMI), blood pressure (BP), lipid profile and fasting plasma glucose (FPG).ResultsHDL levels decreased by 8.7% (p<0.001) despite significant reductions (p<0.001) in BMI (-3.2%), systolic BP (-5.2%), diastolic BP (-5.2%), triglycerides (TG; -7.7%), FPG (-6.3%), LDL (-13.0%), total cholesterol (TC, -11.1%), TC: HDL ratio (-3.2%), and LDL: HDL ratio (-5.3%). While 323 participants classified as having MetS at program entry no longer had this status after the 30 days, 112 participants acquired the MetS classification as a result of reduction in their HDL levels.ConclusionsWhen people move towards a low-fat, plant-based diet, HDL levels decrease while other indicators of cardiovascular risk improve. This observation raises questions regarding the value of using HDL levels as a predictor of cardiovascular risk in populations who do not consume a typical western diet. As HDL is part of the assemblage of risk factors that constitute MetS, classifying individuals with MetS may not be appropriate in clinical practice or research when applying lifestyle interventions that promote a plant-based eating pattern.
Highlights
Epidemiological studies indicate that low levels of plasma or serum high-density lipoproteins (HDL) is an important risk factor in the development of cardiovascular disease (CVD) [1]
It has been suggested that low-fat, plant-based diets may not be ideal for people suffering CVD [9,10], despite being well established to reduce other CVD risk factors including body mass, blood pressure (BP), Total cholesterol (TC) and Low-density lipoprotein (LDL) [4,5,6,7,8]
The purpose of this study was to further explore the changes in CVD risk factors, especially HDL, in a large cohort of individuals participating in a lifestyle intervention that advocated a low-fat, plant-based eating pattern—the Complete Health Improvement Program (CHIP)
Summary
Epidemiological studies indicate that low levels of plasma or serum HDL is an important risk factor in the development of cardiovascular disease (CVD) [1]. Lowered HDL has Lifestyle interventions that promote a low-fat, plantbased eating pattern have been shown to reduce HDL levels [4,5,6,7,8]. Long-term intervention studies involving low-fat, plant-based diets have even been shown to regress atherosclerotic plaques [4,7] and reduce cardiac events [4], despite lowering HDL levels. This apparently conflicting observation has led to debate surrounding the merits of a low-fat, plant-based diet for the management of CVD. Lifestyle interventions promoting a low-fat, plant-based eating pattern appear to paradoxically reduce cardiovascular risk and HDL levels. This study examined the changes in MetS risk factors, in particular HDL, in a large cohort participating in a 30-day lifestyle intervention that promoted a low-fat, plant-based eating pattern
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