This area of our website is for healthcare professionals only

Please click below to declare your professional status:

YES, I am a healthcare professional  NO, I am not a healthcare professional

Donate

Plant-based diets

This HEART UK Nutrition Academy webpage has been funded by Novartis Pharmaceuticals UK Ltd who have had no input into the content or development of this material.
 

Plant-based diets prioritise plant foods over animal foods and encompass dietary patterns proven to improve blood lipids and cardiovascular outcomes such as DASH, Portfolio and Mediterranean diet.

Take home messages

  • ‘Plant-based diets’ is an umbrella term encompassing dietary patterns that are predominantly made up of healthy plant foods. Meat and animal products are kept to a minimum or avoided altogether. 
  • The term 'plant-based' includes anything from flexitarian diets right through to vegan diets.
  • Many diets developed specifically for lipid-lowering and cardiovascular health such as the Mediterranean diet, Portfolio diet and DASH come under the umbrella of plant-based diets.
  • The evidence strongly demonstrates that it is not plant-based diets per se that result in cardiovascular benefits, but their nutritional quality.
  • Healthy plant-based diets: 
    • are rich in whole grains, fruit and vegetables, nuts, seeds, beans and pulses
    • prioritise plant-proteins such as soya, mycoproteins, nuts, beans and pulses over animal proteins
    • use vegetable oils in place of animal fats
    • are low in refined carbohydrates such as sugars and pastries
    • are low in meat and other animal foods
    • are low in foods that are high in saturated fat, salt and/or sugars.
  • Plant-based diets have the right fat balance: they are low in saturated fat and include mainly unsaturated fats – this is the critical dietary factor to improving blood lipids.
  • Plant-based diets are:
    • rich in fibre: some fibres are proven to actively lower blood cholesterol
    • rich in fruit and vegetables: evidence supports a dose-response link between fruit and vegetable intake and lowered CVD risk
    • low in meat: red and processed meats have been associated with an increased risk of CVD.

Diversity of plant-based diets    Food components    Not all are equal   Lipids & cardiovascular health   

Saturated & unsaturated fat    Low calorie    Fibre    Plant proteins    Meat    Fruit and veg 

Whole grains    Phytochemicals    CPD e-learning

Plant-based diets – dietary patterns that mainly rely on plant foods1,2 – have gained popularity recently amid growing concerns about our food system and the environment3,4.  As well as having environmental benefits, plant-based diets form the basis of dietary guidelines for lipid management and the primary and secondary prevention of cardiovascular disease (CVD)5,6.

The diversity of plant-based diets

Contrary to popular belief, plant-based diets vary widely and are not synonymous with vegan diets only. The umbrella term includes any dietary pattern based mainly on healthy plant foods, and where meat and animal products are kept to a minimum or completely excluded1,2. 

Plant-based diets include:
  • Flexitarian diets: these reflect food-based dietary guidelines – mainly based on healthy plant foods whilst allowing moderate intakes of lean meat, fish, poultry and lower fat dairy.
  • Sustainable diets: these take into account multiple factors including health, environment, animal welfare, economy and equality. They prioritise plant foods for their health and environmental benefits, actively promote plant proteins over animal proteins, and include meat in limited quantities.
  • Pescatarian diets: exclude meat and poultry but include fish and seafood. Pescatarians may also consume eggs and some dairy.
  • Vegetarian and vegan diets
    • Lacto-vegetarian: excludes meat, poultry and fish, but includes dairy products.
    • Ovo-vegetarian: excludes meat, poultry, fish and dairy, but includes eggs.
    • Lacto-ovo-vegetarian: excludes meat, poultry and fish but includes eggs and dairy.
    • Vegan: excludes all animal-derived foods, relying exclusively on plant-based foods.
Key components of healthy plant-based diets
Mainly made up of  Moderate amounts of Kept to a minimum
  • Fruit and vegetables – especially red, orange and green
  • Whole grains
  • Tubers
  • Nuts and seeds
  • Legumes
  • Plant-based meat alternatives
  • Plant oils (except coconut and palm which are high in saturated fats)
  • Optional - Fish (white and oil-rich)
  • Optional – poultry and lean meats
  • Optional – lower fat dairy
  • Red and processed meat
  • Refined carbohydrates
  • Foods high in salt, sugars and/or saturated fats
  • Coconut and palm oils

Human intervention and cohort studies

Numerous large cohort studies and randomised controlled trials (RCTs) have repeatedly demonstrated that healthy plant-based diets reduce overall CVD risk7–13. They also reduce metabolic risk factors2,14,15 including raised blood lipids, high blood pressure and high body weight.

Plant-based diets: nutritional profile

Healthy plant-based diets tend to be lower in calorie density and the nutritional profile is characterised by lower saturated fats and salt, and higher levels of fruits, vegetables, whole grains, fibre, polyunsaturated fatty acids (PUFA) and plant phytochemicals. This has been associated with improved cardiovascular outcomes1,4,13,14,16,17.

Not all plant-based diets are equal

The cardiovascular benefits of plant-based diets depend on the quality of the diet, rather than the fact that they are plant-based. Despite the health halo, 'plant-based' foods vary significantly in their nutritional quality.

If they are not well-planned, plant-based patterns' nutritional profile can resemble unhealthy omnivorous diets, with excessive refined carbs, free sugars, added salt and saturated fats from coconut and palm oils. This has been highlighted by recent research using plant-based diet healthy index scoring systems7,10,18,19:

  • Plant-based diet Index (PDI): higher scores are given to diets with a greater proportion of plant foods (healthy and unhealthy) and a lower proportion of meat and animal products.
  • Healthy plant-based diet Index (hPDI): higher scores are given to diets with a greater content of healthy plant foods (such as fruit and vegetables, nuts and whole grains) and low intakes of meat, other animal foods and unhealthy plant foods (such as refined carbohydrates, confectionary and sugars).
  • Unhealthy plant-based diet Index (uPDI): higher scores are given to diets that are high in unhealthy plant foods but low in meat, other animal foods and healthy plant foods.

Research has consistently demonstrated that diets with high PDI and hPDI scores are associated with significantly improved cardiovascular and metabolic outcomes compared to those with low scores. The evidence also shows that high uPDI scores have no benefit to cardiovascular or other health outcomes.

What is significant is the quality of plant-based diets – those that are mainly made up of unhealthy plant foods have no positive impact, whilst those that are mainly made up of healthy plant foods have clear benefits.

Plant-based diets improve lipid profiles and cardiovascular health

Plant-based diets are made up of foods and nutrients proven to benefit lipid profiles and cardiovascular health.

1. Right balance of fats

2. Lower energy density

3. Fibre

4. Plant proteins

5. Less red and processed meat

6. Fruit and vegetables

7. Whole grains

1. The right balance of saturated and unsaturated fats

The key factor contributing to improved blood lipids and cardiovascular protection in plant-based diets is the right balance of dietary fats6,24,25. 

Healthy plant-based diets tend to be: 

  • low in saturated fatty acids (SFA)
  • with most fats coming from unsaturated fats. Notably, these include polyunsaturated fatty acids (PUFA).

A diet high in saturated fat is directly linked to raised LDL cholesterol, a key risk factor for CVD6, so cutting down on saturated fat is essential for lowering the risk of CVD. More importantly, swapping saturated fats for unsaturated fats, particularly PUFA, has consistently been shown to bring about the most substantial drop in LDL cholesterol and CVD risk5,6,20–23. 

For every 1% dietary energy as saturated fat replaced with an equivalent amount of PUFA20:
  • Total cholesterol can fall by 0.064 mmol/L
  • LDL cholesterol can fall by 0.055 mmol/L

Find out more

Read our short review on dietary saturated fat

Watch our e-module on dietary fats and getting the balance right 

Download our practical saturated fat swaps
 

2.  Lower in energy density

Well planned plant-based diets tend to be lower in energy (calories) so can help manage overall calorie intake and help reduce risk of obesity – a key metabolic risk factor to CVD.

Find out more

 

Watch our e-module on energy balance and portion control

3. Fibre

Eating more fibre by eating plant foods such as whole grains, nuts, legumes, fruit and vegetables can help bridge the gap between actual intakes (19g) and daily recommendations (30g)26. A comprehensive review of the evidence has demonstrated that every 7g of total dietary fibre eaten per day can lower the risk of CVD and CHD events by 8-18%, and stroke incidence by 7%-18%27.

Beta-glucans are a viscous-gel-like fibre present in barley and oats. Extensive research shows they significantly reduce total cholesterol (TC), LDL cholesterol and fasting triglycerides. They are also associated with a 21% lower risk of type 2 diabetes, another risk factor for CVD27.

Find out more

Read our short review on oats and barley

Watch our e-module on Beyond fats - Part 4: Fibre - what's all the fuss about? 

4. Plant proteins

The evidence consistently indicates that substituting red meat with healthy plant protein foods in the diet is associated with improved cardiovascular health outcomes29–32. The benefit has been attributed to the healthier and more complex nutrient profile of plant proteins compared to animal proteins8,13,30.  

Compared to animal proteins, plant proteins: 

  • tend to be lower in calories
  • tend to be lower in saturated fat 
  • provide more polyunsaturated fat
  • they are rich in different types of fibre
  • provide numerous phytochemicals such as isoflavones and phytosterols.
Specific plant proteins have been associated with both a reduced risk of CVD and improved blood lipids
  Reduced CVD risk 

Reduced CHD

risk

 Total cholesterol mmol/L No. of studies LDL-C mmol/L No. of studies TG mmol/L No. of studies
Nuts33,34  19% RR = 0.81, 95% CI: 0.74-0.8935 24% RR = 0.76, 95% CI: 0.69-0.8435

-0.09
(-0.11 to -0.08)

 38 -0.11
(0.13 to -0.09)		 38 -0.02
(-0.04 to 0.00)		 37
Soya protein36–38 13% TRR = 0.87, 95% CI: 0.81-0.9439 21% (TRR = 0.79, 95% CI: 0.71-0.88)39 -0.22
(-0.14 to -0.29)		 28 -0.23
(-0.16 to 0.31)*		 29 -0.09
(0.00 to 0.16)		 26
Dietary pulses40 8% (RR 0.92; 95% CI 0.85-0.99)41 10% (RR 0.90; 95% CI 0.83, 0.99)41 -0.14
(-0.22 to -0.06)*		 35 -0.13
(0.19 to 0.06)*		 35 -0.06 (-0.09 to -0.02)* 35

5. Reduced intakes of red and processed meat

  • Meta-analyses with 43,272 to over 4 million participants, demonstrate higher CVD risk with greater intakes of processed and unprocessed red meat30,32,42.  Additionally, substituting red and processed meat with plant-proteins reduces CVD risk.  
  • RCTs have also demonstrated a correlation between higher red meat intakes and raised LDL cholesterol, non-HDL cholesterol, apolipoprotein B and type 2 diabetes42,43. 
Other harmful effects associated with red and processed meat13,30,31
  • The high salt content of processed meat is linked to an increased risk of hypertension.
  • Gut microflora can metabolise the high quantities of L-carnitine and choline found in red meat, producing trimethylamine-N-oxide which promotes atherosclerosis.
  • Excessive haem iron (iron present in animal foods) intake has been associated with oxidative stress and CHD risk.

Find out more

Read our review on red meat and CVD

 

Watch our e-module on Beyond fats - Part 3: Prioritising plant proteins

6. Fruits and vegetables

Fruits and veg are44–46: 

  • rich in antioxidant vitamins and different fibres 
  • low in energy-density (low in calories)
  • associated with a lower risk of CVD. 

A recent meta-analysis, pooling data from 100,000 subjects, showed that fruit lowered CVD risk by 6-15%. The effect was dose-dependent – the more they ate, the greater the benefit. This reached a plateau at intakes of 600g (about eight servings) of fruit and veg daily44, where higher intakes had no further benefit. 

This aligns with an earlier meta-analysis, using data from over 4 million subjects, which found higher intakes of fruit and vegetables were associated with reduced risk of CVD (-7%), coronary heart disease (CHD) (-12%), and stroke (-18%)45. 

The benefits of fruit and vegetables have been attributed to their positive nutrient profile including the role of the viscous fibre pectin and its impact on lowering LDL cholesterol47–50.

Find out more

Read our review of fruit and vegetables

 

Watch our e-module on Beyond fats - Part 1: Fruit and vegetables

7. Whole grains 

Whole grains include oats, barely, brown rice, quinoa and wholemeal flour, and products made from them.

Replacing refined carbohydrates (such as white bread, sugars, pastries and white rice) with whole grains has been associated with improved blood lipids51 and a lower risk of CVD events and mortality52. This has been attributed to whole grains' nutrient rich profile: they contain various fibres, B vitamins, zinc, magnesium, phytochemicals and vitamin E – a potent antioxidant.

Find out more

Read our review on whole grains

 

Watch our e-module on Beyond fats - Part 2: whole grains and healthy carbs 

Phytochemicals such as flavonoids, isoflavones and phytosterols have also been linked to improved cardiovascular outcomes4,28. Phytochemicals are found in all plant foods. Proposed mechanisms include anti-inflammatory properties, improved endothelial function and reduced oxidation of LDL cholesterol.

In summary

Healthy plant-based diets, with or without small amounts of meat and animal products, improve blood lipids and CVD outcomes. The positive nutritional profile of plant foods, characterised by low saturated fat and relatively high unsaturated fats, fibre, antioxidants, fruits, vegetables and whole grains, underscores their holistic benefits. The evidence also emphasises that the positive impact of plant-based diets on CVD outcomes is driven more by the quality of the diet than the fact that they are plant-based.

Explore our CPD e-learning modules

Learn about the impact of diet on lipid management, with lots of practical advice for you and your patients: 

  1. Why focus on diet? 
  2. The fundamentals for a heart-healthy diet
  3. Dietary fats – getting the balance right
  4. Beyond fats: other fundamental dietary considerations
  5. The four complementary cholesterol lowering foods.

Learn more 

References

  1. Kent G, Kehoe L, Flynn A, Walton J. Plant-based diets: a review of the definitions and nutritional role in the adult diet. Proc Nutr Soc. 2022;81(1):62-74. doi:10.1017/S0029665121003839

  2. Chew HSJ, Heng FKX, Tien SA, et al. Effects of Plant-Based Diets on Anthropometric and Cardiometabolic Markers in Adults: An Umbrella Review. Nutrients. 2023;15(10):2331. doi:10.3390/nu15102331

  3. Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. The Lancet. 2019;393(10170):447-492. doi:10.1016/S0140-6736(18)31788-4

  4. Thomas MS, Calle M, Fernandez ML. Healthy plant-based diets improve dyslipidemias, insulin resistance, and inflammation in metabolic syndrome. A narrative review. Adv Nutr. 2023;14(1):44-54. doi:10.1016/j.advnut.2022.10.002

  5. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678

  6. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). European Heart Journal. 2021;42(34):3227-3337. doi:10.1093/eurheartj/ehab484

  7. Thompson AS, Tresserra-Rimbau A, Karavasiloglou N, et al. Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK. JAMA Netw Open. 2023;6(3):e234714. doi:10.1001/jamanetworkopen.2023.4714

  8. Salehin S, Rasmussen P, Mai S, et al. Plant Based Diet and Its Effect on Cardiovascular Disease. Int J Environ Res Public Health. 2023;20(4):3337. doi:10.3390/ijerph20043337

  9. Huang C, Liang Z, Ma J, Hu D, Yao F, Qin P. Total sugar, added sugar, fructose, and sucrose intake and all-cause, cardiovascular, and cancer mortality: A systematic review and dose-response meta-analysis of prospective cohort studies. Nutrition. 2023;111:112032. doi:10.1016/j.nut.2023.112032

  10. Kouvari M, Tsiampalis T, Chrysohoou C, et al. Quality of plant-based diets in relation to 10-year cardiovascular disease risk: the ATTICA cohort study. Eur J Nutr. 2022;61(5):2639-2649. doi:10.1007/s00394-022-02831-0

  11. Jafari S, Hezaveh E, Jalilpiran Y, et al. Plant-based diets and risk of disease mortality: a systematic review and meta-analysis of cohort studies. Crit Rev Food Sci Nutr. 2022;62(28):7760-7772. doi:10.1080/10408398.2021.1918628

  12. Kim H, Caulfield LE, Garcia‐Larsen V, Steffen LM, Coresh J, Rebholz CM. Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults. Journal of the American Heart Association. 2019;8(16):e012865. doi:10.1161/JAHA.119.012865

  13. Satija A, Hu FB. Plant-based diets and cardiovascular health. Trends Cardiovasc Med. 2018;28(7):437-441. doi:10.1016/j.tcm.2018.02.004

  14. Aljuraiban G, Chan Q, Gibson R, et al. Association between plant-based diets and blood pressure in the INTERMAP study. BMJ Nutr Prev Health. 2020;3(2):133-142. doi:10.1136/bmjnph-2020-000077

  15. Thompson AS, Candussi CJ, Tresserra-Rimbau A, et al. A healthful plant-based diet is associated with lower type 2 diabetes risk via improved metabolic state and organ function: A prospective cohort study. Diabetes & Metabolism. 2024;50(1):101499. doi:10.1016/j.diabet.2023.101499

  16. 16. Zaragoza-Martí A, Cabañero-Martínez MJ, Hurtado-Sánchez JA, Laguna-Pérez A, Ferrer-Cascales R. Evaluation of Mediterranean diet adherence scores: a systematic review. BMJ Open. 2018;8(2):e019033. doi:10.1136/bmjopen-2017-019033

  17. Wang T, Kroeger CM, Cassidy S, et al. Vegetarian Dietary Patterns and Cardiometabolic Risk in People With or at High Risk of Cardiovascular Disease: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023;6(7):e2325658. doi:10.1001/jamanetworkopen.2023.25658

  18. Marchese LE, McNaughton SA, Hendrie GA, Wingrove K, Dickinson KM, Livingstone KM. A scoping review of approaches used to develop plant-based diet quality indices. Curr Dev Nutr. 2023;7(4):100061. doi:10.1016/j.cdnut.2023.100061

  19. Huang Y, Li X, Zhang T, et al. Associations of healthful and unhealthful plant-based diets with plasma markers of cardiometabolic risk. Eur J Nutr. 2023;62(6):2567-2579. doi:10.1007/s00394-023-03170-4

  20. Mensink RP, World Health Organization. Effects of Saturated Fatty Acids on Serum Lipids and Lipoproteins: A Systematic Review and Regression Analysis. World Health Organization; 2016. Accessed October 16, 2023. https://iris.who.int/handle/10665/246104

  21. Feingold KR. The Effect of Diet on Cardiovascular Disease and Lipid and Lipoprotein Levels. In: Feingold KR, Anawalt B, Blackman MR, et al., eds. Endotext. MDText.com, Inc.; 2000. Accessed January 3, 2024. http://www.ncbi.nlm.nih.gov/books/NBK570127/

  22. SACN. Saturated fats and health. GOV.UK. Published August 2019. Accessed October 16, 2023. https://www.gov.uk/government/publications/saturated-fats-and-health-sacn-report

  23. Li Y, Hruby A, Bernstein AM, et al. Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study. Journal of the American College of Cardiology. 2015;66(14):1538-1548. doi:10.1016/j.jacc.2015.07.055

  24. Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. European Heart Journal. 2017;38(32):2459-2472. doi:10.1093/eurheartj/ehx144

  25. Prospective Studies Collaborative. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55 000 vascular deaths. The Lancet. 2007;370(9602):1829-1839. doi:10.1016/S0140-6736(07)61778-4

  26. NDNS: results from years 9 to 11 (2016 to 2017 and 2018 to 2019). GOV.UK. Accessed January 3, 2024. https://www.gov.uk/government/statistics/ndns-results-from-years-9-to-11-2016-to-2017-and-2018-to-2019

  27. Public Health England. SACN Carbohydrates and Health Report. GOV.UK. Published 2015. Accessed December 15, 2023. https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report

  28. Szabo Z, Koczka V, Marosvolgyi T, et al. Possible Biochemical Processes Underlying the Positive Health Effects of Plant-Based Diets-A Narrative Review. Nutrients. 2021;13(8):2593. doi:10.3390/nu13082593

  29. Guasch-Ferré M, Satija A, Blondin SA, et al. Meta-Analysis of Randomized Controlled Trials of Red Meat Consumption in Comparison With Various Comparison Diets on Cardiovascular Risk Factors. Circulation. 2019;139(15):1828-1845. doi:10.1161/CIRCULATIONAHA.118.035225

  30. Al-Shaar L, Satija A, Wang DD, et al. Red meat intake and risk of coronary heart disease among US men: prospective cohort study. BMJ. Published online December 2, 2020:m4141. doi:10.1136/bmj.m4141

  31. Naghshi S, Sadeghi O, Willett WC, Esmaillzadeh A. Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ. Published online July 22, 2020:m2412. doi:10.1136/bmj.m2412

  32. Hidayat K, Chen JS, Wang HP, et al. Is replacing red meat with other protein sources associated with lower risks of coronary heart disease and all-cause mortality? A meta-analysis of prospective studies. Nutrition Reviews. 2022;80(9):1959-1973. doi:10.1093/nutrit/nuac017

  33. Del Gobbo LC, Falk MC, Feldman R, Lewis K, Mozaffarian D. Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis, and dose-response of 61 controlled intervention trials 123. The American Journal of Clinical Nutrition. 2015;102(6):1347-1356. doi:10.3945/ajcn.115.110965

  34. Blanco Mejia S, Kendall CWC, Viguiliouk E, et al. Effect of tree nuts on metabolic syndrome criteria: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2014;4(7):e004660. doi:10.1136/bmjopen-2013-004660

  35. Glenn AJ, Aune D, Freisling H, et al. Nuts and Cardiovascular Disease Outcomes: A Review of the Evidence and Future Directions. Nutrients. 2023;15(4):911. doi:10.3390/nu15040911

  36. Blanco Mejia S, Messina M, Li SS, et al. A Meta-Analysis of 46 Studies Identified by the FDA Demonstrates that Soy Protein Decreases Circulating LDL and Total Cholesterol Concentrations in Adults. The Journal of Nutrition. 2019;149(6):968-981. doi:10.1093/jn/nxz020

  37. Jenkins DJA, Blanco Mejia S, Chiavaroli L, et al. Cumulative Meta‐Analysis of the Soy Effect Over Time. Journal of the American Heart Association. 2019;8(13):e012458. doi:10.1161/JAHA.119.012458

  38. Tokede OA, Onabanjo TA, Yansane A, Gaziano JM, Djoussé L. Soya products and serum lipids: a meta-analysis of randomised controlled trials. British Journal of Nutrition. 2015;114(6):831-843. doi:10.1017/S0007114515002603

  39. Zuo X, Zhao R, Wu M, Wan Q, Li T. Soy Consumption and the Risk of Type 2 Diabetes and Cardiovascular Diseases: A Systematic Review and Meta-Analysis. Nutrients. 2023;15(6):1358. doi:10.3390/nu15061358

  40. Ha V, Sievenpiper JL, de Souza RJ, et al. Effect of dietary pulse intake on established therapeutic lipid targets for cardiovascular risk reduction: a systematic review and meta-analysis of randomized controlled trials. CMAJ. 2014;186(8):E252-262. doi:10.1503/cmaj.131727

  41. Viguiliouk E, Glenn AJ, Nishi SK, et al. Associations between Dietary Pulses Alone or with Other Legumes and Cardiometabolic Disease Outcomes: An Umbrella Review and Updated Systematic Review and Meta-analysis of Prospective Cohort Studies. Adv Nutr. 2019;10(Suppl_4):S308-S319. doi:10.1093/advances/nmz113

  42. Shi W, Huang X, Schooling CM, Zhao JV. Red meat consumption, cardiovascular diseases, and diabetes: a systematic review and meta-analysis. European Heart Journal. 2023;44(28):2626-2635. doi:10.1093/eurheartj/ehad336

  43. Li SS, Blanco Mejia S, Lytvyn L, et al. Effect of Plant Protein on Blood Lipids: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. JAHA. 2017;6(12):e006659. doi:10.1161/JAHA.117.006659

  44. Wang J, Liu F, Li J, et al. Fruit and vegetable consumption, cardiovascular disease, and all-cause mortality in China. Sci China Life Sci. 2022;65(1):119-128. doi:10.1007/s11427-020-1896-x

  45. Zurbau A, Au-Yeung F, Blanco Mejia S, et al. Relation of Different Fruit and Vegetable Sources With Incident Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc. 2020;9(19):e017728. doi:10.1161/JAHA.120.017728

  46. Aune D, Giovannucci E, Boffetta P, et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017;46(3):1029-1056. doi:10.1093/ije/dyw319

  47. Brouns F, Theuwissen E, Adam A, Bell M, Berger A, Mensink RP. Cholesterol-lowering properties of different pectin types in mildly hyper-cholesterolemic men and women. Eur J Clin Nutr. 2012;66(5):591-599. doi:10.1038/ejcn.2011.208

  48. López-González L, Becerra-Tomás N, Babio N, et al. One-year changes in fruit and vegetable variety intake and cardiometabolic risk factors changes in a middle-aged Mediterranean population at high cardiovascular risk. Eur J Clin Nutr. 2022;76(10):1393-1402. doi:10.1038/s41430-022-01124-3

  49. van der Gronde T, Hartog A, van Hees C, Pellikaan H, Pieters T. Systematic review of the mechanisms and evidence behind the hypocholesterolaemic effects of HPMC, pectin and chitosan in animal trials. Food Chemistry. 2016;199:746-759. doi:10.1016/j.foodchem.2015.12.050

  50. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on the substantiation of health claims related to pectins and reduction of post-prandial glycaemic responses (ID 786), maintenance of normal blood cholesterol concentrations (ID 818) and increase in satiety leading to a reduction in energy intake (ID 4692) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal. 2010;8(10):1747. doi:10.2903/j.efsa.2010.1747

  51. Marshall S, Petocz P, Duve E, et al. The Effect of Replacing Refined Grains with Whole Grains on Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with GRADE Clinical Recommendation. Journal of the Academy of Nutrition and Dietetics. 2020;120(11):1859-1883.e31. doi:10.1016/j.jand.2020.06.021

  52. Hu H, Zhao Y, Feng Y, et al. Consumption of whole grains and refined grains and associated risk of cardiovascular disease events and all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. The American Journal of Clinical Nutrition. 2023;117(1):149-159. doi:10.1016/j.ajcnut.2022.10.010

Published: June 2024

Our cookies

We use cookies, which are small text files, to improve your experience on our website.
You can allow or reject non essential cookies or manage them individually.

Manage cookiesAllow all

Cookie policy

Our cookies

Allow all

We use cookies, which are small text files, to improve your experience on our website. You can allow all or manage them individually.

You can find out more on our cookie page at any time.

EssentialThese cookies are needed for essential functions such as logging in and making payments. Standard cookies can't be switched off and they don't store any of your information.
AnalyticsThese cookies help us collect information such as how many people are using our site or which pages are popular to help us improve customer experience. Switching off these cookies will reduce our ability to gather information to improve the experience.
FunctionalThese cookies are related to features that make your experience better. They enable basic functions such as social media sharing. Switching off these cookies will mean that areas of our website can't work properly.
AdvertisingThese cookies help us to learn what you're interested in so we can show you relevant adverts on other websites and track the effectiveness of our advertising.
PersonalisationThese cookies help us to learn what you're interested in so we can show you relevant content.

Save preferences