背景:2019年美国心脏病学会/美国心脏协会(ACC/AHA)预防指南强调减少饮食钠,胆固醇,精制碳水化合物,饱和脂肪和加糖饮料。我们假设,在城市非裔美国人(AA)社区教堂的一组志愿者中,实施这种饮食模式可以降低心血管风险。在为期5周的ACC/AHA风格的营养干预中,通过测量风险标志物和依从性来评估,称为HEART-LENS(帮助每个人评估今天的风险,四旬期营养研究)。
方法:研究人群由53名志愿者组成,他们承诺只吃家庭提供的非乳制品素食(平均每日卡路里1155,钠1285毫克,胆固醇0毫克;58%的碳水化合物,17%蛋白质,25%脂肪)。测量身体质量指数(BMI)和心脏代谢和危险因素的空腹血清标志物,收集任何饮食偏差。
结果:在53名志愿者中,44(平均年龄60.2岁,37名妇女)完成了试验(88%);1名妇女对膳食不耐受,1完成了两次抽血,但没有吃交付的食物,7没有返回测试。据报道,其余44人中,对饮食的依从性为93%。心血管代谢危险因素显著改善,以血清胰岛素显着降低(-43%,p=0.000),血红蛋白A1c(6.2%至6.0%,p=0.000),体重和BMI(-10.2磅,33至31kg/m2,p=0.000),但空腹血糖略有下降(-6%,p=0.405)和甘油三酯水平(-4%,p=0.408)。此外,改进的是三甲胺-N-氧化物(5.1至2.9μmol/L,-43%,p=0.001),低密度脂蛋白胆固醇(LDL)(24.2至19.1mg/dL,-21%,p=0.000),LDL(121至104mg/dL,-14%,p=0.000),总胆固醇(TC)(190至168mg/dL,-12%,p=0.000),和脂蛋白(a)(LP(a))(56至51mg/dL,-11%,p=0.000);高敏C反应蛋白(hs-CRP)变化很大,但降低了16%(2.5至2.1ng/mL,p=NS)在40名无炎性病症的受试者中。可溶性尿激酶型纤溶酶原激活剂(suPAR)水平无明显变更。计算了41和36名志愿者的ACC/AHA合并队列动脉粥样硬化性心血管疾病(ASCVD)风险评分,分别,因为无法计算基线时3例低脂含量受试者和干预后8例受试者的ASCVD风险(p=0.184).在剩下的科目中,平均10年风险从10.8%降至8.7%,下降19.4%(p=0.006),主要是由于低密度脂蛋白胆固醇降低了14%,收缩压降低了10mmHg(6%)。
结论:在这项为期5周的前瞻性非乳制品素食营养干预中,在有风险的AA人群中具有良好的依从性,符合2019年ACC/AHA指南,心血管风险的标志物,心脏代谢,体重显著下降,包括肥胖,低密度脂蛋白胆固醇(LDLc)密度,LP(a),炎症,以及摄取介导三甲胺-N-氧化物(TMAO)生产的底物。尽管减少了,hs-CRP和suPAR,并没有持续降低。这导致该AA队列中10年ASCVD风险的显着降低。如果被广泛采用,这可以大大减少甚至根除,ASCVD事件和死亡率的种族差异,如果21%的增长中有19%被这种生活方式的改变所消除。
BACKGROUND: The 2019 American College of Cardiology/American Heart Association (ACC/AHA) Prevention
Guidelines emphasize reduction in dietary sodium, cholesterol, refined carbohydrates, saturated fat and sweetened beverages. We hypothesized that implementing this dietary pattern could reduce cardiovascular risk in a cohort of volunteers in an urban African American (AA) community church, during a 5-week ACC/AHA-styled nutrition intervention, assessed by measuring risk markers and adherence, called HEART-LENS (Helping Everyone Assess Risk Today Lenten Nutrition Study).
METHODS: The study population consisted of 53 volunteers who committed to eat only home-delivered non-dairy vegetarian meals (average daily calories 1155, sodium 1285 mg, cholesterol 0 mg; 58% carbohydrate, 17% protein, 25% fat). Body mass index (BMI) and fasting serum markers of cardiometabolic and risk factors were measured, with collection of any dietary deviation.
RESULTS: Of 53 volunteers, 44 (mean age 60.2 years, 37 women) completed the trial (88%); 1 was intolerant of the meals, 1 completed both blood draws but did not eat delivered food, and 7 did not return for the tests. Adherence to the diet was reported at 93% in the remaining 44. Cardiometabolic risk factors improved significantly, highlighted by a marked reduction in serum insulin (-43%, p = 0.000), hemoglobin A1c (6.2% to 6.0%, p = 0.000), weight and BMI (-10.2 lbs, 33 to 31 kg/m2, p = 0.000), but with small reductions of fasting glucose (-6%, p = 0.405) and triglyceride levels (-4%, p = 0.408). Additionally, improved were trimethylamine-N-oxide (5.1 to 2.9 µmol/L, -43%, p = 0.001), small dense low-density lipoprotein cholesterol (LDL) (24.2 to 19.1 mg/dL, -21%, p = 0.000), LDL (121 to 104 mg/dL, -14%, p = 0.000), total cholesterol (TC) (190 to 168 mg/dL, -12%, p = 0.000), and lipoprotein (a) (LP(a)) (56 to 51 mg/dL, -11%, p = 0.000); high sensitivity C-reactive protein (hs-CRP) was widely variable but reduced by 16% (2.5 to 2.1 ng/mL, p = NS) in 40 subjects without inflammatory conditions. Soluble urokinase plasminogen activator (suPAR) levels were not significantly changed. The ACC/AHA pooled cohort atherosclerotic cardiovascular disease (ASCVD) risk scores were calculated for 41 and 36 volunteers, respectively, as the ASCVD risk could not be calculated for 3 subjects with low lipid fractions at baseline and 8 subjects after intervention (p = 0.184). In the remaining subjects, the mean 10-year risk was reduced from 10.8 to 8.7%, a 19.4% decrease (p = 0.006), primarily due to a 14% decrease in low-density lipoprotein cholesterol and a 10 mm Hg (6%) reduction in systolic blood pressure.
CONCLUSIONS: In this prospective 5-week non-dairy vegetarian nutrition intervention with good adherence consistent with the 2019 ACC/AHA
Guidelines in an at-risk AA population, markers of cardiovascular risk, cardiometabolism, and body weight were significantly reduced, including obesity, low-density lipoprotein cholesterol (LDLc) density, LP(a), inflammation, and ingestion of substrates mediating production of trimethylamine-N-oxide (TMAO). Albeit reduced, hs-CRP and suPAR, were not lowered consistently. This induced a significant decrease in the 10-year ASCVD risk in this AA cohort. If widely adopted, this could dramatically reduce and possibly eradicate, the racial disparity in ASCVD events and mortality, if 19% of the 21% increase is eliminated by this lifestyle change.