cardiovascular health benefits of plant-based eating · 2019-09-30 · plant-based eating &...
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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
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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
Harland J & Garton L. The Plant‐based Plan (2015)
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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.
Harland J & Garton L. The Plant‐based Plan (2015)
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)
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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Plant-based eating & benefits for health
Weight management
Cardiovascular benefits
Managing blood glucose
Healthy ageing
Bone health
Cancer incidence
Harland J & Garton L. The Plant‐based Plan (2015)
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
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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
Harland J & Garton L. The Plant‐based Plan (2015)
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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
Mor
talit
y ra
te /
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son-
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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
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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.
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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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Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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)
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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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
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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Consumer behavior change- the UK approach
the Danish approach!
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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www.reading.ac.uk
The Alpro Foundation approach-The Plant-based Plan
comprehensive review of the scientific literature to date
Harland J & Garton L. The Plant‐based Plan (2015)
Alpro Foundation student symposium ‐ Leeds March 15, 2017
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www.alprofoundation.org
Acknowledgements
Lynne GartonJanice Harland