The effect of a polyphenol-rich green-Mediterranean diet on cardiometabolic risk; a randomized controlled trial
2Internal Medicine E, Soroka University Medical Center, Beer-Sheva, Israel
3Cardiology Division, Soroka University Medical Center, Beer-Sheva, Israel
4Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashome, Israel
5Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
6Radiology and Imaging Division, Soroka University Medical Center, Beer-Sheva, Israel
7Center for Microbiome Research, Assaf HaRofe Medical Center, Be’er Ya’akov, Israel
8Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
9Department of Medicine, Nuclear Research Center Negev, Dimona, Israel
10Department of Medicine, University of Leipzig, Leipzig, Germany
11Faculty of Life Sciences, University of Leipzig, Leipzig, Germany
12Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research, Leipzig, Germany
13T.H. Chan School of Public Health, Harvard Medical School, Boston, MA, USA
Background: Mediterranean (MED) diet is associated with reduced cardiometabolic risk. Polyphenols, a group of phytochemicals in which MED diet is abundant, have been suggested to mediate some of its beneficial effects. The impact of dietary polyphenol content amplification with parallel decrease in meat/poultry on cardiometabolic risk remains of question. We aimed to examine the effect of lifestyle interventions, distinguished by incremental polyphenol content and parallel decrease in meat/poultry on cardiometabolic risk.
Methods: We randomized 294 participants with abdominal-obesity/dyslipidemia (age=51years, body-mass-index=31.3kg/m2, waist-circumference (WC)=109.7cm, 88% men, 10y-Framingham-risk-score (10yFRS)=4.7%), into physical-activity (PA)+healthy-dietary-guidance, PA+MED, and PA+green-MED diet groups. Both MED and green-MED diets were iso-caloric and included 28g/day walnuts (+440mg polyphenols). The green-MED dieters further consumed green tea (4 cups/day) and a Wolffia globosa (100g/day) green shake (+800mg polyphenols vs. MED-diet). This is a 6-month mid-term report focused on cardiometabolic effects during the dietary-induction weight-loss phase.
Results: Six-month retention-rate was 98.3%. While both MED diets achieved similar reduction in body weight [(PA+green-MED:-6.2kg; PA+MED:-5.4kg) vs.-1.5kg in the PA group (p<0.05)], the PA+green-MED group exhibited a greater reduction in WC (-8.6cm) vs. the PA+MED (-6.8cm; p=0.027) and PA (-4.3cm; p<0.001) groups. The PA+green-MED group achieved greater decrease in low-density-lipoprotein-cholesterol/high-density-lipoprotein-cholesterol (LDL-c/HDL-c) ratio(-0.38), compared to the PA+MED (-0.21,p=0.014) and the PA (-0.14,p=0.001), and a greater decline in resting-pulse (-5beats/minute) vs. the PA+MED (-1.9beats/minute;p=0.026) and PA (-2beats/minute;p=0.022) groups. The PA+green-MED group had larger decreases in systolic blood-pressure (PA:-4.2mmHg,PA+MED:-6.9mmHg,PA+green-MED:-9.3mmHg;p=0.003 between PA and PA+green-MED groups) and diastolic blood-pressure (PA:-3.4mmHg,PA+MED:-5.1mmHg,PA+green-MED:-7.2mmHg;p=0.004 between PA and PA+green-MED groups). Overall, the PA+green-MED group had the greatest reduction in 10yFRS (from 4.9% to 3.5%) compared with the others [(ΔPA:-0.5%(p<0.001);ΔPA+MED:-0.8%(p=0.017)].
Conclusions: For individuals with abdominal obesity, polyphenol-rich Green-MED diet, lower in meat/poultry and supplemented with green plants, may amplify beneficial cardiometabolic effects of MED diet.
This study is registered in clinicaltrials.gov (NCT03020186)
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