Cardiovascular health benefits of plant-based eating

Transcription

1 Cardiovascular health benefits of plant-based eating Ian Rowland University of Reading Alpro Foundation Student Symposium March 2017 Leeds Overview What is plant-based eating? Cardiovascular disease Benefits of plant based diets for health Benefits for CVD evidence from epidemiology and intervention studies 1

2 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) 2

3 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) 3

4 Plant-based eating & benefits for health Weight management Cardiovascular benefits Managing blood glucose Healthy ageing Bone health Cancer incidence Reduced risk of CVD 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. Harland J & Garton L. The Plant based Plan (2015) 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

5 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) 5

6 Vegetarians vs non-vegetarians Meta analysis of cohort studies 29% reduction in risk 6 studies (~120,000 subjects) from UK, Germany, Netherlands, USA, Huang et al Ann Nutr Metab 60:233, 2012 (ES= effect size) Mortality rate /1000 person-years V.low low mod high Pro veg food pattern category All cause & CVD mortality across increasing plant based eating pattern Adjusted HR Veg category all cause CVD Very low 1 1 Low (0.50,1.02) (0.24, 0.99) Moderate (0.48, 0.96) (0.22, 0.90) High (0.40, 0.88) (0.21,1.02) P trend 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 6

7 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 In the Mediterranean region: Plant based eating CVD cancer diabetes 13 Med diet and CVD - Epidemiology 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. Copyright American Heart Association Fung T T et al. Circulation 2009;119:

8 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) Plant based eating and CVD risk factors High LDL C High BP CVD risk Insulin resistance Inflam markers Low HDL High TG obesit y 8

9 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. % change 0 2y Med diet and CVD risk- Intervention study vs prudent (low fat) diet 6,00 4,00 2,00 0,00 2,00 4,00 6,00 8,00 10,00 12,00 Med Pru 180 subjects with metabolic syndrome followed Med diet (whole grain, F&V, olive oil) or prudent diet (CHO 50-60%, fat <30%) for 2 years Exposito et al JAMA. 2004;292(12):

10 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 LIGNANS (pinoresinol, lariciresinol) SECOIRIDOIDS (hydroxytyrosol,oleuropein) ISOTHIOCYANATES Olive oil, olives, wine Olive oil, cereals, sesame seeds, OH OH Broccoli Rocket, Watercress FLAVONOIDS HO (epicatechin, quercetin, naringenin OH O OH CAROTENOIDS (Bcarotene, lycopene, cryptoxanthin Berries, citrus fruits, onions, red wine, tea, cocoa Tomato, carrots, mango

11 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: BMI: 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) 22 11

12 Study design High Flavonoid F&V Low Flavonoid F&V Habitual diet Wk 0 Visit 1 Urine Vasc func Wk 6 Visit 2 Urine Vasc func Wk 12 Visit 3 Urine Vasc func Wk 18 Visit 4 Urine Vasc func Addition of F&V increased intake to ~5, 6.5 and 7.5 portions/d 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 = ), 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) 12

13 F&V impact on arterial stiffness measured by PWA Additional F&V portions HF and LF attenuated increase shown in CT group P=0.009 LDL Strong evidence Clinical studies, portfolio diets studies, Epi studies High LDL C Evidence HDL C maintained total:hdl ratio improved Portfolio studies + MUFA beneficial CVD risk factors Some evidence Clinical studies, portfolio diets studies, Epi studies High BP CVD risk Insulin resistance Limited evidence from clinical studies. Epi studies show improved glycaemia with plant based regimes Inflam markers Limited evidence from Med diets, interventions Low HDL Evidence from Epi studies, Med diets, High TG obesit y Good evidence Epi studies show lower BMI on veg diets 13

14 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 14

15 Consumer behavior change - the UK approach the Danish approach! 15

16 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) 16

17 Acknowledgements Lynne Garton Janice Harland 17