Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials.

Abstract

BACKGROUND:

The evidence for the Portfolio dietary pattern, a plant-based dietary pattern that combines recognized cholesterol-lowering foods (nuts, plant protein, viscous fibre, plant sterols), has not been summarized.

OBJECTIVE:

To update the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of controlled trials using GRADE of the effect of the Portfolio dietary pattern on the primary therapeutic lipid target for cardiovascular disease prevention, low-density lipoprotein cholesterol (LDL-C), and other established cardiometabolic risk factors.

METHODS:

We searched MEDLINE, EMBASE, and The Cochrane Library through April 19, 2018. We included controlled trials ≥ 3-weeks assessing the effect of the Portfolio dietary pattern on cardiometabolic risk factors compared with an energy-matched control diet free of Portfolio dietary pattern components. Two independent reviewers extracted data and assessed risk of bias. The primary outcome was LDL-C. Data were pooled using the generic inverse-variance method and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q statistic) and quantified (I2-statistic). GRADE assessed the certainty of the evidence.

RESULTS:

Eligibility criteria were met by 7 trial comparisons in 439 participants with hyperlipidemia, in which the Portfolio dietary pattern was given on a background of a National Cholesterol Education Program (NCEP) Step II diet. The combination of a portfolio dietary pattern and NCEP Step II diet significantly reduced the primary outcome LDL-C by ~17% (MD, -0.73 mmol/L, [95% CI, -0.89 to -0.56 mmol/L]) as well as non-high-density lipoprotein cholesterol, apolipoprotein B, total cholesterol, triglycerides, systolic and diastolic blood pressure, C-reactive protein, and estimated 10-year coronary heart disease (CHD) risk, compared with an NCEP Step 2 diet alone (p < 0.05). There was no effect on high-density lipoprotein cholesterol or body weight. The certainty of the evidence was high for LDL-cholesterol and most lipid outcomes and moderate for all others outcomes.

CONCLUSIONS:

Current evidence demonstrates that the Portfolio dietary pattern leads to clinically meaningful improvements in LDL-C as well as other established cardiometabolic risk factors and estimated 10-year CHD risk.

• Authors: Laura Chiavaroli, Stephanie K Nishi, Tauseef A Khan, Catherine R Braunstein, Andrea J Glenn, Sonia Blanco Mejia, Dario Rahelić, Hana Kahleová, Jordi Salas-Salvadó, David J A Jenkins, Cyril W C Kendall, John L Sievenpiper
• Journal: Progress in cardiovascular diseases (Prog Cardiovasc Dis) 2018 May - Jun Vol. 61 Issue 1 Pg. 43-53 ISSN: 1873-1740 [Electronic] United States
• PMID: 29807048 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: Copyright © 2018. Published by Elsevier Inc.

Chemical References

• Inflammation Mediators
• Lipids

Topics

• Blood Pressure
• Body Weight
• Cardiovascular Diseases (blood, mortality, physiopathology, prevention & control)
• Diet, Healthy
• Diet, Vegetarian
• Evidence-Based Medicine
• Feeding Behavior
• Humans
• Inflammation Mediators (blood)
• Lipids (blood)
• Nutritional Status
• Nutritive Value
• Prognosis
• Protective Factors
• Randomized Controlled Trials as Topic
• Risk Factors
• Risk Reduction Behavior