Mediterranean versus vegetarian diet for cardiovascular disease prevention (the CARDIVEG study): study protocol for a randomized controlled trial

Francesco Sofi, Monica Dinu, Giuditta Pagliai, Francesca Cesari, Rossella Marcucci, Alessandro Casini, Francesco Sofi, Monica Dinu, Giuditta Pagliai, Francesca Cesari, Rossella Marcucci, Alessandro Casini

Abstract

Background: Nutrition is able to alter the cardiovascular health of the general population. However, the optimal dietary strategy for cardiovascular disease prevention is still far from being defined. Mediterranean and vegetarian diets are those reporting the greatest grade of evidence in the literature, but no experimental studies comparing these two dietary patterns are available.

Methods/design: This is an open randomized crossover clinical trial including healthy subjects with a low-to-medium cardiovascular risk profile, characterized by being overweight and by the presence of at least an additional metabolic risk factor (abdominal obesity, high total cholesterol, high LDL cholesterol, high triglycerides, impaired glucose fasting levels) but free from medications. A total of 100 subjects will be included and randomly assigned to two groups: Mediterranean calorie-restricted diet (n = 50) and vegetarian calorie-restricted diet (n = 50). The intervention phases will last 3 months each, and at the end of intervention phase I the groups will be crossed over. The two diets will be isocaloric and of three different sizes (1400 - 1600 - 1800 kcal/day), according to specific energy requirements. Adherence to the dietary intervention will be established through questionnaires and 24-h dietary recall. Anthropometric measurements, body composition, blood samples and stool samples will be obtained from each participant at the beginning and at the end of each intervention phase. The primary outcome measure will be change in weight from baseline. The secondary outcome measures will be variations of anthropometric and bioelectrical impedance variables as well as traditional and innovative cardiovascular biomarkers.

Discussion: Despite all the data supporting the efficacy of Mediterranean and vegetarian diets on the prevention of cardiovascular diseases, no studies have directly compared these two dietary profiles. The trial will test whether there are statistically significant differences between these dietary profiles in reducing the cardiovascular risk burden for the general population.

Trial registration: ClinicalTrials.gov NCT02641834.

Keywords: Cardiovascular disease; Diet; Mediterranean; Prevention; Vegetarian.

Figures

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Fig. 1
Organization of the intervention study

References

    1. GBD 2013 Risk Factors Collaborators Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:2287–323. doi: 10.1016/S0140-6736(15)00128-2.
    1. Oliveira GBF, Avezum A, Roever L. Cardiovascular disease burden: evolving knowledge of risk factors in myocardial infarction and stroke through population-based research and perspectives in global prevention. Front Cardiovasc Med. 2015;2:32. doi: 10.3389/fcvm.2015.00032.
    1. Jacobs DR, Tapsell LC. Food, not nutrients, is the fundamental unit in nutrition. Nutr Rev. 2007;65:439–50.
    1. Chahoud G, Aude W, Mehta JL. Dietary recommendation in prevention and treatment of coronary artery disease. Do we have the ideal diet yet? Am J Cardiol. 2004;94:1260–7. doi: 10.1016/j.amjcard.2004.07.109.
    1. WHO . Prevention of cardiovascular disease. Guideline for assessment and management of cardiovascular risk. 2007.
    1. Rees K, Hartley L, Flowers N, Clarke A, Hooper L, Thorogood M, et al. ‘Mediterranean’ dietary pattern for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;8:CD009825.
    1. Ha V, de Souza RJ. “Fleshing out” the benefits of adopting a vegetarian diet. J Am Heart Assoc. 2015;4:e002654. doi: 10.1161/JAHA.115.002654.
    1. Keys A, Menotti A, Karvonen MJ, Aravanis C, Blackburn H, Buzina R, et al. The diet and 15-year death rate in the Seven Countries Study. Am J Epidemiol. 1986;124:903–15.
    1. Sofi F, Macchi C, Abbate R, Gensini GF, Casini A. Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr. 2014;17:2769–82. doi: 10.1017/S1368980013003169.
    1. Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2016
    1. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)’ The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2012;33:1635–1701.
    1. Mishra S, Xu J, Agarwal U, Gonzales J, Levin S, Barnard ND. A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study. Eur J Clin Nutr. 2013;67:718–24. doi: 10.1038/ejcn.2013.92.
    1. Abete I, Romaguera D, Vieira AR, Lopez De Munain A, Norat T. Association between total, processed, red and white meat consumption and all-cause, CVD and IHD mortality: a meta-analysis of cohort studies. Br J Nutr. 2014;112:762–75. doi: 10.1017/S000711451400124X.
    1. Lippi G, Mattiuzzi C, Cervellin G. Meat consumption and cancer risk: a critical review of published meta-analyses. Crit Rev Oncol Hematol. 2016;97:1–14. doi: 10.1016/j.critrevonc.2015.11.008.
    1. Kim Y, Keogh J, Clifton P. A review of potential metabolic etiologies of the observed association between red meat consumption and development of type 2 diabetes mellitus. Metabolism. 2015;64:768–79. doi: 10.1016/j.metabol.2015.03.008.
    1. Wang X, Lin X, Ouyang YY, Liu J, Zhao G, Pan A, et al. Red and processed meat consumption and mortality: dose-response meta-analysis of prospective cohort studies. Public Health Nutr. 2015;6:1–13. doi: 10.1017/S1368980015003225.
    1. Leitzmann C. Vegetarian nutrition: past, present, future. Am J Clin Nutr. 2014;100:496S–502S. doi: 10.3945/ajcn.113.071365.
    1. De Backer CJ, Hudders L. From meatless Mondays to meatless Sundays: motivations for meat reduction among vegetarians and semi-vegetarians who mildly or significantly reduce their meat intake. Ecol Food Nutr. 2014;53:639–57. doi: 10.1080/03670244.2014.896797.

Source: PubMed

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