Tsaban Gal, Yaskolka Meir Anat, Rinott Ehud, Zelicha Hila, Kaplan Alon, Shalev Aryeh, Katz Amos, Rudich Assaf, Tirosh Amir, Shelef Ilan, Youngster Ilan, Lebovitz Sharon, Israeli Noa, Shabat May, Brikner Dov, Pupkin Efrat, Stumvoll Michael, Thiery Joachim, Ceglarek Uta, Heiker John T, Körner Antje, Landgraf Kathrin, von Bergen Martin, Blüher Matthias, Stampfer Meir J, Shai Iris
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Department of Medicine, Soroka University Medical Center, Beer Sheva, Israel.
Heart. 2021 Jun 11;107(13):1054-1061. doi: 10.1136/heartjnl-2020-317802.
A Mediterranean diet is favourable for cardiometabolic risk.
To examine the residual effect of a green Mediterranean diet, further enriched with green plant-based foods and lower meat intake, on cardiometabolic risk.
For the DIRECT-PLUS parallel, randomised clinical trial we assigned individuals with abdominal obesity/dyslipidaemia 1:1:1 into three diet groups: healthy dietary guidance (HDG), Mediterranean and green Mediterranean diet, all combined with physical activity. The Mediterranean diets were equally energy restricted and included 28 g/day walnuts. The green Mediterranean diet further included green tea (3-4 cups/day) and a (Mankai strain; 100 g/day frozen cubes) plant-based protein shake, which partially substituted animal protein. We examined the effect of the 6-month dietary induction weight loss phase on cardiometabolic state.
Participants (n=294; age 51 years; body mass index 31.3 kg/m; waist circumference 109.7 cm; 88% men; 10 year Framingham risk score 4.7%) had a 6-month retention rate of 98.3%. Both Mediterranean diets achieved similar weight loss ((green Mediterranean -6.2 kg; Mediterranean -5.4 kg) vs the HDG group -1.5 kg; p<0.001), but the green Mediterranean group had a greater reduction in waist circumference (-8.6 cm) than the Mediterranean (-6.8 cm; p=0.033) and HDG (-4.3 cm; p<0.001) groups. Stratification by gender showed that these differences were significant only among men. Within 6 months the green Mediterranean group achieved greater decrease in low-density lipoprotein cholesterol (LDL-C; green Mediterranean -6.1 mg/dL (-3.7%), -2.3 (-0.8%), HDG -0.2 mg/dL (+1.8%); p=0.012 between extreme groups), diastolic blood pressure (green Mediterranean -7.2 mm Hg, Mediterranean -5.2 mm Hg, HDG -3.4 mm Hg; p=0.005 between extreme groups), and homeostatic model assessment for insulin resistance (green Mediterranean -0.77, Mediterranean -0.46, HDG -0.27; p=0.020 between extreme groups). The LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio decline was greater in the green Mediterranean group (-0.38) than in the Mediterranean (-0.21; p=0.021) and HDG (-0.14; p<0.001) groups. High-sensitivity C-reactive protein reduction was greater in the green Mediterranean group (-0.52 mg/L) than in the Mediterranean (-0.24 mg/L; p=0.023) and HDG (-0.15 mg/L; p=0.044) groups. The green Mediterranean group achieved a better improvement (-3.7% absolute risk reduction) in the 10-year Framingham Risk Score (Mediterranean-2.3%; p0.073, HDG-1.4%; p<0.001).
The green MED diet, supplemented with walnuts, green tea and Mankai and lower in meat/poultry, may amplify the beneficial cardiometabolic effects of Mediterranean diet.
This study is registered under ClinicalTrials.gov Identifier no NCT03020186.
地中海饮食对心血管代谢风险有益。
研究进一步富含绿色植物性食物且减少肉类摄入的绿色地中海饮食对心血管代谢风险的残余影响。
在DIRECT-PLUS平行随机临床试验中，我们将腹部肥胖/血脂异常个体按1:1:1比例分配到三个饮食组：健康饮食指导（HDG）组、地中海饮食组和绿色地中海饮食组，所有组均结合体育活动。地中海饮食组的能量摄入同样受限，且每天包含28克核桃。绿色地中海饮食组还进一步包括绿茶（每天3 - 4杯）和一种基于小球藻（Mankai品种；每天100克冷冻块）的植物蛋白奶昔，部分替代动物蛋白。我们研究了为期6个月的饮食诱导减重阶段对心血管代谢状态的影响。
参与者（n = 294；年龄51岁；体重指数31.3kg/m²；腰围109.7cm；88%为男性；10年弗明汉风险评分4.7%）的6个月留存率为98.3%。两种地中海饮食组的减重效果相似（绿色地中海饮食组减重6.2千克；地中海饮食组减重5.4千克，而HDG组减重1.5千克；p < 0.001），但绿色地中海饮食组的腰围减少幅度（-8.6厘米）大于地中海饮食组（-6.8厘米；p = 0.033）和HDG组（-4.3厘米；p < 0.001）。按性别分层显示，这些差异仅在男性中显著。在6个月内，绿色地中海饮食组的低密度脂蛋白胆固醇（LDL-C）降低幅度更大（绿色地中海饮食组降低6.1mg/dL（-3.7%），地中海饮食组降低2.3mg/dL（-0.8%），HDG组升高0.2mg/dL（+1.8%）；极端组之间p = 0.012）、舒张压（绿色地中海饮食组降低7.2mmHg，地中海饮食组降低5.2mmHg，HDG组降低3.4mmHg；极端组之间p = 0.005）以及胰岛素抵抗的稳态模型评估指标（绿色地中海饮食组降低0.77，地中海饮食组降低0.46，HDG组降低0.27；极端组之间p = 0.020）。绿色地中海饮食组的LDL-C/高密度脂蛋白胆固醇（HDL-C）比值下降幅度（-0.38）大于地中海饮食组（-0.21；p = 0.021）和HDG组（-0.14；p < 0.001）。绿色地中海饮食组的高敏C反应蛋白降低幅度（-0.52mg/L）大于地中海饮食组（-0.24mg/L；p = 0.023）和HDG组（-0.15mg/L；p = 0.044）。绿色地中海饮食组在10年弗明汉风险评分方面的改善更好（绝对风险降低3.7%）（地中海饮食组降低2.3%；p = 0.073，HDG组降低1.4%；p < 0.001）。
补充了核桃、绿茶和小球藻且肉类/家禽摄入量较低的绿色地中海饮食，可能会增强地中海饮食对心血管代谢的有益影响。
本研究已在ClinicalTrials.gov注册，标识符为NCT03020186。
