The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes

N Wright, L Wilson, M Smith, B Duncan, P McHugh, N Wright, L Wilson, M Smith, B Duncan, P McHugh

Abstract

Background/objective: There is little randomised evidence using a whole food plant-based (WFPB) diet as intervention for elevated body mass index (BMI) or dyslipidaemia. We investigated the effectiveness of a community-based dietary programme. Primary end points: BMI and cholesterol at 6 months (subsequently extended).

Subjects: Ages 35-70, from one general practice in Gisborne, New Zealand. Diagnosed with obesity or overweight and at least one of type 2 diabetes, ischaemic heart disease, hypertension or hypercholesterolaemia. Of 65 subjects randomised (control n=32, intervention n=33), 49 (75.4%) completed the study to 6 months. Twenty-three (70%) intervention participants were followed up at 12 months.

Methods: All participants received normal care. Intervention participants attended facilitated meetings twice-weekly for 12 weeks, and followed a non-energy-restricted WFPB diet with vitamin B12 supplementation.

Results: At 6 months, mean BMI reduction was greater with the WFPB diet compared with normal care (4.4 vs 0.4, difference: 3.9 kg m-2 (95% confidence interval (CI)±1), P<0.0001). Mean cholesterol reduction was greater with the WFPB diet, but the difference was not significant compared with normal care (0.71 vs 0.26, difference: 0.45 mmol l-1 (95% CI±0.54), P=0.1), unless dropouts were excluded (difference: 0.56 mmol l-1 (95% CI±0.54), P=0.05). Twelve-month mean reductions for the WFPB diet group were 4.2 (±0.8) kg m-2 BMI points and 0.55 (±0.54, P=0.05) mmol l-1 total cholesterol. No serious harms were reported.

Conclusions: This programme led to significant improvements in BMI, cholesterol and other risk factors. To the best of our knowledge, this research has achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy intake or mandate regular exercise.

Conflict of interest statement

NW is employed by the Royal NZ college of GPs, which is a position funded by Health Workforce New Zealand. MS and NW report being directors/shareholders in Plant Based Lifestyles Ltd, which was initiated after the completion of the BROAD study. BD, NW, MS and PMH report being trustees of the Plant Based New Zealand Health Charitable Trust. PMH reports he is a trustee on the Tairāwhiti Traditional and Complementary Therapies Research Charitable Trust (TTCTRT). LW reports being director/shareholder in Two Zesty Bananas Ltd, which was initiated after the intervention.

Figures

Figure 1
Figure 1
Patient flow.

References

    1. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet 2011; 377: 557–567.
    1. Mitchell N, Catenacci V, Wyatt HR, Hill JO. Obesity: overview of an epidemic. Psychiatr Clin N Am 2011; 34: 717–732.
    1. WHO. Obesity and Overweight [Internet]. WHO [cited 19 March 2015]. Available at .
    1. Obesity data and stats [Internet]. Ministry of Health NZ [cited 3 December 2015]. Available at .
    1. WHO. NCD mortality and morbidity [Internet]. WHO [cited 19 March 2015]. Available at .
    1. Sarwer DB, Moore RH, Diewald LK, Chittams J, Berkowitz RI, Vetter M et al. The impact of a primary care-based weight loss intervention on quality of life. Int J Obes (Lond) 2013; 37: S25–S30.
    1. Wider economic and social costs of obesity to New Zealand. 12 February 2015 [cited 19 March 2015]. Available at .
    1. Atallah R, Filion KB, Wakil SM, Genest J, Joseph L, Poirier P et al. Long-term effects of 4 popular diets on weight loss and cardiovascular risk factors: a systematic review of randomized controlled trials. Circ Cardiovasc Qual Outcomes 2014; 7: 815–827.
    1. Makris A, Foster GD. Dietary approaches to the treatment of obesity. Psychiatr Clin N Am 2011; 34: 813–827.
    1. Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA et al. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA, 2014; 312: 923–933.
    1. Newborg B. Walter Kempner and the Rice Diet: Challenging Conventional Wisdom. Carolina Academic Press: Durham, NC, 2011, p 274.
    1. Kempner W, Newborg BC, Peschel RL, Skyler JS. Treatment of massive obesity with rice/reduction diet program. An analysis of 106 patients with at least a 45-kg weight loss. Arch Intern Med 1975; 135: 1575–1584.
    1. McDougall J, Thomas LE, McDougall C, Moloney G, Saul B, Finnell JS et al. Effects of 7 days on an ad libitum low-fat vegan diet: the McDougall Program cohort. Nutr J 2014; 13: 99.
    1. Esselstyn CB Jr. Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure. Penguin Group, 2008; , p 65.
    1. Tuso PJ, Ismail MH, Ha BP, Bartolotto C. Nutritional update for physicians: plant-based diets. Perm J 2013; 17: 61–66.
    1. Esselstyn CB, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract 2014; 63: 356–364b.
    1. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280: 2001–2007.
    1. Ferdowsian HR, Barnard ND, Hoover VJ, Katcher HI, Levin SM, Green AA et al. A multicomponent intervention reduces body weight and cardiovascular risk at a GEICO corporate site. Am J Health Promot 2010; 24: 384–387.
    1. Kent L, Morton D, Hurlow T, Rankin P, Hanna A, Diehl H. Long-term effectiveness of the community-based Complete Health Improvement Program (CHIP) lifestyle intervention: a cohort study. BMJ Open 2013; 3: e003751.
    1. Turner-McGrievy GM, Barnard ND, Scialli AR. A two-year randomized weight loss trial comparing a vegan diet to a more moderate low-fat diet. Obesity (Silver Spring) 2007; 15: 2276–2281.
    1. Berkow SE, Barnard N, Eckart J, Katcher H. Four therapeutic diets: adherence and acceptability. Can J Diet Pract Res 2010; 71: 199–204.
    1. Ornish D, Weidner G, Fair WR, Marlin R, Pettengill EB, Raisin CJ et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol 2005; 174: 1065–1069.
    1. Oppenlander RA. Food Choice and Sustainability: Why Buying Local, Eating Less Meat, and Taking Baby Steps Won't Work. Langdon St Press: Minneapolis, MN, 2013; p 470.
    1. Scarborough P, Appleby PN, Mizdrak A, Briggs ADM, Travis RC, Bradbury KE et al. Dietary greenhouse gas emissions of meat-eaters, fish-eaters, vegetarians and vegans in the UK. Clim Change 2014; 125: 179–192.
    1. FAO. News Article: Key facts and findings [Internet]. [cited 16 November 2015]. Available at .
    1. Goodland R, Anhang J. Livestock and Climate Change [Internet]. World Watch Institute, 2009 [cited 4 December 2015]. Available at .
    1. Steinfeld H, Gerber P, Wassenaar T, Castel V, Rosales M, de Haan C Livestock's long shadow —environmental issues and options [Internet]. Food and Agriculture Organization of the United Nations, 2006 [cited 29 March 2015]. Available at .
    1. Springmann M, Godfray HCJ, Rayner M, Scarborough P. Analysis and valuation of the health and climate change cobenefits of dietary change. Proc Natl Acad Sci USA 2016; 113: 4146–4151.
    1. Atkinson J, Salmond C, Crampton P. NZDep2013 Index of Deprivation [Internet]. Socioeconomic Deprivation Indexes: NZDep and NZiDep, Department of Public Health [cited 18 April 2015]. Available at .
    1. Parliamentary Library Parliament L and P. Obesity and diabetes in New Zealand [Internet]. 2014 Oct [cited 25 June 2015]. Available at .
    1. Schwarzer R, Jerusalem M. Causal and Control Beliefs. Measures in Health Psychology: A User's Portfolio. NFER-Nelson: Windsor, England, 1995, pp; 35–37.
    1. Schwarzer R, Renner B. Social-cognitive predictors of health behavior: action self-efficacy and coping self-efficacy. Health Psychol 2000; 19: 487–495.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977; 84: 191–215.
    1. John OP, Naumann LP, Soto CJ. Paradigm shift to the integrative big-five trait taxonomy: history, measurement, and conceptual issues. Handbook of Personality: Theory and Research. Guilford Press: New York, NY, 2008, pp; 114–158.
    1. John OP, Donahue EM, Kentle RL. The Big Five Inventory-Versions 4a and 54. University of California, Berkeley, Institute of Personality and Social Research: Berkeley, CA, 1991.
    1. Impellizzeri FM, Rampinini E, Coutts AJ, Sassi A, Marcora SM. Use of RPE-based training load in soccer. Med Sci Sports Exerc 2004; 36: 1042–1047.
    1. The New Zealand Society for the Study of Diabetes. CVD risk assessment for people with type 2 diabetes in New Zealand [Internet] [cited 1 June 2016]. Available at .
    1. New Zealand Primary Care Handbook 2012 [Internet]. Ministry of Health NZ [cited 8 April 2016]. Available at .
    1. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013; 46: 81–95.
    1. Esselstyn CB, Ellis SG, Medendorp SV, Crowe TD. A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician's practice. J Fam Pract 1995; 41: 560–568.
    1. Barnard ND, Levin SM, Yokoyama Y. A systematic review and meta-analysis of changes in body weight in clinical trials of vegetarian diets. J Acad Nutr Diet 2015; 115: 954–969.
    1. Ello-Martin JA, Roe LS, Ledikwe JH, Beach AM, Rolls BJ. Dietary energy density in the treatment of obesity: a year-long trial comparing 2 weight-loss diets. Am J Clin Nutr 2007; 85: 1465–1477.
    1. Kent L, Morton D, Rankin P, Ward E, Grant R, Gobble J et al. The effect of a low-fat, plant-based lifestyle intervention (CHIP) on serum HDL levels and the implications for metabolic syndrome status – a cohort study. Nutr Metab (Lond) 2013; 10: 58.
    1. Lea EJ, Crawford D, Worsley A. Public views of the benefits and barriers to the consumption of a plant-based diet. Eur J Clin Nutr 2006; 60: 828–837.
    1. Johansson K, Neovius M, Hemmingsson E. Effects of anti-obesity drugs, diet, and exercise on weight-loss maintenance after a very-low-calorie diet or low-calorie diet: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2014; 99: 14–23.
    1. Tsai AG, Wadden TA. The evolution of very-low-calorie diets: an update and meta-analysis. Obesity (Silver Spring) 2006; 14: 1283–1293.
    1. Tsai AG, Wadden TA. Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med 2005; 142: 56–66.
    1. Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014; 8: CD003641.
    1. Gribsholt SB, Pedersen AM, Svensson E, Thomsen RW, Richelsen B. Prevalence of self-reported symptoms after gastric bypass surgery for obesity. JAMA Surg 2016; 6: 1–9.
    1. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS, Brehm BJ et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006; 166: 285–293.
    1. Yancy WS, Olsen MK, Guyton JR, Bakst RP, Westman EC. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med 2004; 140: 769–777.
    1. Foster GD, Wyatt HR, Hill JO, Makris AP, Rosenbaum DL, Brill C et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet. Ann Intern Med 2010; 153: 147–157.
    1. Luley C, Blaik A, Götz A, Kicherer F, Kropf S, Isermann B et al. Weight loss by telemonitoring of nutrition and physical activity in patients with metabolic syndrome for 1 year. J Am Coll Nutr 2014; 33: 363–374.
    1. Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS ONE 2013; 8: e55030.
    1. Schwingshackl L, Hoffmann G. Low-carbohydrate diets impair flow-mediated dilatation: evidence from a systematic review and meta-analysis. Br J Nutr 2013; 110: 969–970.
    1. Fleming RM. The effect of high-protein diets on coronary blood flow. Angiology 2000; 51: 817–826.
    1. Andreou E, Philippou C, Papandreou D. Effects of an intervention and maintenance weight loss diet with and without exercise on anthropometric indices in overweight and obese healthy women. Ann Nutr Metab 2011; 59: 187–192.
    1. Pasman WJ, Saris WH, Westerterp-Plantenga MS. Predictors of weight maintenance. Obes Res 1999; 7: 43–50.

Source: PubMed

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