The effect of a plant-based diet on plasma lipids in hypercholesterolemic adults: a randomized trial

Ann Intern Med. 2005 May 3;142(9):725-33. doi: 10.7326/0003-4819-142-9-200505030-00007.

Abstract

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 (LDL) 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 LDL cholesterol-lowering effect of a low-fat diet.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Cholesterol / blood
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood*
  • Diet, Fat-Restricted*
  • Female
  • Humans
  • Hypercholesterolemia / blood*
  • Hypercholesterolemia / diet therapy*
  • Male
  • Middle Aged
  • Patient Compliance
  • Patient Dropouts
  • Plants, Edible*
  • Triglycerides / blood

Substances

  • Cholesterol, HDL
  • Cholesterol, LDL
  • Triglycerides
  • Cholesterol