The Green Mediterranean Diet May Relieve Aortic Stiffness

A green adaptation to the traditional Mediterranean diet improves proximal aortic stiffness (PAS), a distinct marker of vascular aging and increased cardiovascular risk, according to an exploratory post hoc analysis of the DIRECT-PLUS randomized clinical trial.

The Green Mediterranean diet differs from the traditional Mediterranean diet due to its more abundant dietary polyphenols and low consumption of red or processed meat.

Regardless of weight loss, the modified green Mediterranean diet regressed SBP by 15%, the traditional Mediterranean diet died by 7.3%, and the healthy diet based on dietary recommendations by 4.8%, observed the study team.

Iris Shai, Dt.P., Ph.D.

“The DIRECT-PLUS trial research team was the first to introduce the concept of a green-Mediterranean/high-polyphenol diet,” said lead researcher Iris Shai, RD, PhD, of Ben- Negev Gurion, Beer-Sheva, Israel, says lecoeur.org | Medscape Cardiology.

This diet promoted “dramatic slippage of the proximal aorta”, as assessed by MRI over 18 months in approximately 300 participants with abdominal obesity/dyslipidemia. “To date, no dietary strategy has impacted the physiology of vascular aging,” Shai said.

The analysis was published online April 17 in the Journal of the American College of Cardiology.

Not all a healthy diet s Are equal

After 18 months of intervention (89.8% retention rate), all diet groups showed significant reductions in SBP: -0.05 m/s with the standard healthy diet (4.8%), – 0.08 m/s with the traditional Mediterranean diet (7.3%) and -0.15 with the green Mediterranean diet (15%).

In the multivariate model, people on the green Mediterranean diet had a greater reduction in SBP than people on the healthy, Mediterranean diet (P = 0.003 and P = 0.032, respectively).

The researchers caution that DIRECT-PLUS had multiple endpoints and that this exploratory post hoc analysis could be susceptible to Type I statistical error and should be considered “hypothesis generating”.

High quality study, credible results

Reached for comment on the study, Deepak L. Bhatt, MD, MPH, director of Mount Sinai Heart in New York, said, “There isn’t a lot of high-quality research on diet, and I would call This is high quality research in that they used randomization, which most dietary studies don’t do.”

“The greener Mediterranean diet appeared to be best on the surrogate marker of MRI-defined aortic stiffness,” said Bhatt, professor of cardiovascular medicine at the Icahn School of Medicine at Mount Sinai Health System, who did not participate. in the study. lecoeur.org | Medscape Cardiology.

“It makes sense that a diet that contains more greens, more polyphenols, is healthier. It has been shown in other studies, that these plant-based polyphenols may have various cardiovascular protective aspects,” Bhatt said. .

Overall, he said the results are “quite believable, with the caveat that it would be nice to see the results replicated in a more diverse and larger sample.”

“There is emerging evidence that diets high in fresh fruits and vegetables and whole grains and low in overall calorie intake, in general, appear to be good diets for reducing cardiovascular risk factors and possibly even reducing the risk real cardiovascular,” Bhatt added.

The study was funded by grants from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation), the Rosetrees Trust, the Israeli Ministry of Health, the Israeli Ministry of Science and Technology, and the California Walnuts Commission. Shai and Bhatt have no relevant conflicts of interest.

J Am Coll Cardiol. Published online April 17, 2023. Abstract

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