More plants, less cardiovascular disease

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While a low-fat diet will reduce LDL (lousy) cholesterol, years of research suggest that this type of diet is not associated with less risk of CVD as once thought, but a plant-based diet is.

Keeping cholesterol in check has been a recommendation since the 1950s according to Yuni Choi, Ph.D., a postdoctoral researcher in the division of epidemiology and community health at the University of Minnesota.

US Dietary Guidelines in the 1980s advised Americans to avoid saturated fats to help prevent coronary heart disease. Surprisingly, many recently published meta-analyses of prospective studies and randomized control trials found that saturated fat was not necessarily linked with cases of CVD.

Data from 4700 subjects of the Coronary Artery Risk Development in Young Adults (CARDIA) study was evaluated by Choi and her colleagues. CARDIA included black and white men aged 18 to 30 that were recruited from four US cities in the mid-1980s.

The researchers analyzed adults’ adherence to either low saturated fat or plant-based diet in the CARDIA study. How each diet reduced blood LDL-cholesterol was also assessed as was subjects’ diet quality. A Priori Diet Quality Score (APDQS) was used.

A higher APDQS indicated increased consumption of nutritious plant-based foods and reduced intake of high-fat meat products and less healthy plant foods, according to David R Jacobs Jr., Ph.D., a public health professor in the University of Minnesota division of epidemiology and community health. Less healthy plant foods included processed carbohydrates and snacks, for example.

The study subject’s nutrient levels were also determined using a keys score as it is an appropriate formula of low saturated fat that also includes polyunsaturated fat and dietary cholesterol.

In 32 years of follow-up, research indicated 280, 135, and 92 documented cases of CVD, CHF, and stroke, respectively.

Over a 7-year period, 13-point increases in APDQS were linked with improved LDL-cholesterol levels in subjects’ blood. (.91 mg/dL lower). In further multivariable-adjusted models, a 13-point deviation in APDQS was linked with a 19% risk reduction for CVD, 22% risk reduction for CHD, and 29% risk reduction for stroke.

The bottom line is a nutritionally dense, plant-based diet is beneficial in reducing the risk of cardiovascular disease. When looking at blood lipid changes, saturated fat does not give a complete picture.

Focusing on one nutrient (i.e. saturated fat) dismisses several other aspects of a healthy diet and does not predict CVD.

While it’s prudent to advise a diet low in saturated fat, referring clients to nutrition professionals (Registered Dietitians) for further diet education is warranted by physicians.

Our next series will focus on several seasonal ways to work in more fruits and vegetables and will include hands-on tips and video clips. Stay tuned!

Lisa Andrews, MEd, RD, LD

Choi Y, et al. Which predicts incident cardiovascular disease better: A plant-centered diet or a low-saturated-fat diet? The Coronary Artery Risk Development in Young Adults (CARDIA) study. Presented at: Nutrition Live Online 2021. June 7-10, 2021

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