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Effect of a diet high in vegetables, fruit, and nuts on serum lipids

  • David J.A. Jenkins
    Correspondence
    Address reprint requests to David J.A. Jenkins, MD, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, 61 Queen St E, Toronto, Ontario, Canada M5C 2T2.
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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  • David G. Popovich
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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  • Cyril W.C. Kendall
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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  • Edward Vidgen
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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  • Nauman Tariq
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Thomas P.P. Ransom
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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  • Thomas M.S. Wolever
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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  • Vladimir Vuksan
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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  • Christine C. Mehling
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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  • Dana L. Boctor
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Claudia Bolognesi
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • James Huang
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Robert Patten
    Affiliations
    Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital, Toronto, Ontario Canada

    Divisions of Endocrinology and Clinical Biochemistry, St. Michael's Hospital, Toronto, Ontario Canada

    Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
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      Abstract

      We assessed the effect of a diet high in leafy and green vegetables, fruit, and nuts on serum lipid risk factors for cardiovascular disease. Ten healthy volunteers (seven men and three women aged 33 ± 4 years [mean ± SEM]; body mass index, 23 ± 1 kg/m2) consumed their habitual diet (control diet, 29% ± 2% fat calories) and a diet consisting largely of leafy and other low-calorie vegetables, fruit, and nuts (vegetable diet, 25% ± 3% fat calories) for two 2-week periods in a randomized crossover design. After 2 weeks on the vegetable diet, lipid risk factors for cardiovascular disease were significantly reduced by comparison with the control diet (low-density lipoprotein [LDL] cholesterol, 33% ± 4%, P < .001; ratio of total to high-density lipoprotein [HDL] cholesterol, 21% ± 4%, P < .001; apolipoprotein [apo] B:A-I, 23% ± 2%, P < .001; and lipoprotein (a) [Lp(a)], 24% ± 9%, P = .031). The reduction in apo B was related to increased intakes of soluble fiber (r = .84, P = .003) and vegetable protein (r = −.65, P = .041). On the vegetable compared with the control diet, the reduction in total serum cholesterol was 34% to 49% greater than would be predicted by differences in dietary fat and cholesterol. A diet consisting largely of low-calorie vegetables and fruit and nuts markedly reduced lipid risk factors for cardiovascular disease. Several aspects of such diets, which may have been consumed early in human evolution, have implications for cardiovascular disease prevention.
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      References

        • Burkitt DP
        • Trowell HC
        Refined Carbohydrate and Disease.
        Academic, New York, NY1975
        • Cleave TL
        • Campbell GD
        • Painter NS
        Diabetes, Coronary Thrombosis and the Saccharine Disease.
        Wright, Bristol, UK1969
        • Eaton SB
        • Konner M
        Paleolithic nutrition.
        in: A consideration of its nature and current implications. ed 6. N Engl J Med. 312. 1985: 283-289
        • Horai S
        • Satta Y
        • Hayasaka K
        • et al.
        Man's place in hominidea revealed by mitochondrial DNA genealogy.
        J Mol Evol. 1992; 35: 32-43
        • Pilbeam D
        The descent of hominoids and hominids.
        Sci Am. 1984; 250: 84-96
        • Conroy GC
        Miocene primates.
        in: Conroy GC Primate Evolution. Norton, New York, NY1990: 184-269
        • Sibley CG
        • Ahlquist J
        The phylogeny of the hominoid primates as indicated by DNA-DNA hybridization.
        J Mol Evol. 1984; 20: 2-15
        • Leakey R
        The Origin of Humankind.
        Basic Books, New York, NY1994
        • Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults
        ed 6. Report of the National Cholesterol Education Program (NCEP). US Government Printing Office, US Department of Health and Human Services, Washington, DC1989 (NIH Publication No. 89-2925)
        • McGuire JT
        • Dierenfeld ES
        • Poppenga RH
        • et al.
        Plasma alpha-tocopherol, retinol, cholesterol, and mineral concentrations in captive gorillas.
        J Med Primatol. 1989; 18: 155-161
        • Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults
        Summary of the Second Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection.
        in: Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). ed 6. JAMA. 269. 1993: 3015-3023
        • Singh RB
        • Niaz MA
        • Ghosh S
        • et al.
        Effect on mortality and reinfarction of adding fruits and vegetables to a prudent diet in the Indian Experiment of Infarct Survival (IEIS).
        J Am Coll Nutr. 1993; 12: 255-261
        • Gillman MW
        • Cupples LA
        • Gagnon D
        • et al.
        Protective effect of fruits and vegetables on development of stroke in men.
        JAMA. 1995; 273: 1113-1117
        • Hertog MG
        • Feskens EJ
        • Hollman PC
        • et al.
        Dietary antioxidant flavonoids and risk of coronary heart disease: The Zutphen Elderly Study.
        Lancet. 1993; 342: 1007-1011
        • Block G
        • Patterson B
        • Subar A
        Fruit, vegetables, and cancer prevention: A review of the epidemiological evidence.
        Nutr Cancer. 1992; 18: 1-29
        • Tavani A
        • La Vecchia C
        Fruit and vegetable consumption and cancer risk in a Mediterranean population.
        Am J Clin Nutr. 1995; 61 (suppl): 1374S-1377S
        • Giovannucci E
        • Ascherio A
        • Rimm EB
        • et al.
        Intake of carotenoids and retinol in relation to risk of prostate cancer.
        J Natl Cancer Inst. 1995; 87: 1767-1776
        • Chiu BC
        • Cerhan JR
        • Folsom AR
        • et al.
        Diet and risk of non-Hodgkin lymphoma in older women.
        JAMA. 1996; 275: 1315-1321
        • Health Canada
        ed 6. Canada's Food Guide to Healthy Eating. Ministry of Supply and Services Canada, Ottawa, Ontario, Canada1992 (Catalog No. H39-253/1992E)
        • Suber A
        • Heimendinger J
        • Krebs-Smith S
        • et al.
        5-a-Day for Better Health: A Baseline Study of American's Fruit and Vegetable Consumption.
        National Cancer Institute, Washington, DC1992
        • The Agricultural Research Service
        ed 6. Composition of Foods, Agriculture Handbook No 8. US Department of Agriculture, Washington, DC1992
        • Anderson JW
        • Bridges SR
        Dietary fiber content of selected foods.
        Am J Clin Nutr. 1988; 47: 440-447
        • Lipid Research Clinics Program
        ed 6. Manual of Laboratory Operations, Lipid and Lipoprotein Analysis. vol 1. US Government Printing Office, US Department of Health, Education, and Welfare Publication No. (NIH) 75-628, Washington, DC1982 (revised)
        • Friedewald WT
        • Levy RI
        • Fredrickson DS
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without the use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Fink PC
        • Romer M
        • Haeckel R
        • et al.
        Measurement of proteins with the Behring nephelometer.
        in: A multicenter evaluation. ed 6. J Clin Chem Clin Biochem. 27. 1989: 261-276
        • Kuzuya T
        • Saito T
        • Yoshida S
        • et al.
        Human C-peptide immunoreactivity (CPR) in blood and urine—Evaluation of a radioimmunoassay method and its clinical applications.
        Diabetologia. 1976; 12: 511-518
        • Guerrant GO
        • Lambert MA
        • Moss CW
        Analysis of short-chain acids from anaerobic bacteria by high-performance liquid chromatography.
        J Clin Microbiol. 1982; 16: 355-360
        • Tollinger CD
        • Vreman HJ
        • Weiner MW
        Measurement of acetate in human blood by gas chromatography: Effects of sample preparation, feeding and various diseases.
        Clin Chem. 1979; 25: 1787-1790
        • Schaefer EJ
        • Lichtenstein AH
        • Lamon-Fava S
        • et al.
        Effect of National Cholesterol Education Program step 2 diets relatively low or relatively high in fish derived fatty acids on plasma lipoproteins in middle aged and elderly subjects.
        Am J Clin Nutr. 1996; 63: 234-241
        • SAS Institute
        ed 6. SAS/STAT User's Guide. SAS Institute, Cary, NC1985
        • Illingworth DR
        Therapeutic use of lovastatin in the treatment of hypercholesterolemia.
        Clin Ther. 1994; 16: 2-26
        • Berglund L
        Diet and drug therapy for lipoprotein(a).
        Curr Opin Lipidol. 1995; 6: 48-56
        • Amtzenius AC
        • Kromhout D
        • Barth JD
        • et al.
        Diet, lipoproteins, and the progression of coronary atherosclerosis.
        in: The Leiden Intervention Trial. N Engl J Med. 312. 1985: 805-811
        • Ornish D
        • Brown SE
        • Scherwitz LW
        • et al.
        Can lifestyle changes reverse coronary heart disease?.
        in: The Lifestyle Heart Trial. Lancet. 336. 1990: 624-626
        • Fraser GE
        • Sabate J
        • Beeson WL
        • et al.
        A possible protective effect of nut consumption on risk of coronary heart disease.
        in: The Adventist Health Study. Arch Intern Med. 152. 1992: 1416-1424
        • Willett WC
        Diet and health: What should we eat?.
        Science. 1994; 264: 532-537
        • Keys A
        • Anderson JT
        • Grande F
        Serum cholesterol responses to changes in the diet.
        Metabolism. 1965; 14: 747-787
        • Hegsted DM
        • McGandy RB
        • Myers ML
        • et al.
        Quantitative effects of dietary fat on serum cholesterol in men.
        Am J Clin Nutr. 1965; 17: 281-295
        • Keys A
        • Grande F
        • Anderson JT
        Bias and misrepresentation revisited: Perspective on saturated fat.
        Am J Clin Nutr. 1974; 27: 188-212
        • Keys A
        Serum cholesterol response to dietary cholesterol.
        Am J Clin Nutr. 1986; 44 (letter): 309
        • Dattilo AM
        • Kris-Etherton PM
        Effects of weight reduction on blood lipids and lipoproteins: A meta-analysis.
        Am J Clin Nutr. 1992; 56: 320-328
        • Sacks FM
        • Ornish D
        • Rosner B
        • et al.
        Plasma lipoprotein levels in vegetarians.
        JAMA. 1985; 254: 1337-1341
        • Anderson JW
        • Garrity TF
        • Wood CL
        • et al.
        Prospective, randomized, controlled comparison of the effects of low-fat and low-fat plus high-fiber diets on serum lipid concentrations.
        Am J Clin Nutr. 1992; 56: 887-894
        • Kritchevsky D
        • Tepper SA
        • Goodman G
        Diet, nutrition intake, and metabolism in populations at high and low risk of colon cancer: Relationship of diet to serum lipids.
        Am J Clin Nutr. 1984; 40: 921-926
        • Werch SC
        • Ivy AC
        On the fate of ingested pectin.
        Am J Dig Dis. 1941; 8: 101-105
        • Thacker PA
        • Solomon MO
        • Aherne FX
        • et al.
        Influence of propionic acid on the cholesterol metabolism of pigs fed hypercholesterolemic diets.
        Can J Anim Sci. 1981; 61: 969-975
        • Wright RS
        • Anderson JW
        • Bridges SR
        Propionate inhibits hepatocyte lipid synthesis.
        in: Proc Soc Exp Biol Med. 195. 1990: 26-29
        • Wolever TMS
        • Spadafora PJ
        • Cunnane SC
        • et al.
        Propionate inhibits incorporation of colonic [1,2-13C] acetate into plasma lipids in humans.
        Am J Clin Nutr. 1995; 61: 1241-1247
        • Krtichevsky D
        • Story JA
        Binding of bile salts in vitro by nonnutritive fiber.
        J Nutr. 1974; 104: 458-462
        • Everson GT
        • Daggy BP
        • McKinley C
        • et al.
        Effects of psyllium hydrophilic mucilloid on LDL-cholesterol and bile acid synthesis in hypercholesterolemic men.
        J Lipid Res. 1992; 33: 1183-1192
        • Marlett JA
        • Hosig KB
        • Vollendorf NW
        • et al.
        Mechanism of serum cholesterol reduction by oat bran.
        Hepatology. 1994; 20: 1450-1457
        • Anderson JW
        • Johnstone BM
        • Cook-Newell ME
        Meta-analysis of the effects of soy protein intake on serum lipids.
        N Engl J Med. 1995; 333: 276-282
        • Spiller GA
        • Jenkins DJA
        • Cragen LN
        • et al.
        Effect of a diet high in monounsaturated fat from almonds on plasma cholesterol and lipoproteins.
        J Am Coll Nutr. 1992; 11: 126-130
        • Sabate J
        • Fraser GE
        • Burke K
        • et al.
        Effects of walnuts on serum lipid levels and blood pressure in normal men.
        N Engl J Med. 1993; 328: 603-607
        • Stampfer MJ
        • Hennekens CH
        • Manson JE
        • et al.
        Vitamin E consumption and the risk of coronary disease in women.
        N Engl J Med. 1993; 328: 1444-1449
        • Rimm EB
        • Stampfer MJ
        • Ascherio A
        • et al.
        Vitamin E consumption and the risk of coronary disease in men.
        N Engl J Med. 1993; 328: 1450-1456
        • Coronary Drug Project Research Group
        Serum uric acid: Its association with other risk factors and with mortality in coronary heart disease.
        J Chronic Dis. 1976; 29: 557-569
        • Brand FN
        • McGee DL
        • Kannel WB
        • et al.
        Hyperuricemia as a risk factor of coronary heart disease: The Framingham Study.
        Am J Epidemiol. 1985; 121: 11-18
        • Facchini G
        • Chen YD
        • Hollenbeck CB
        • et al.
        Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance and plasma uric acid concentration.
        JAMA. 1991; 266: 3008-3011
        • Wagner JR
        • Motchnik PA
        • Stocker R
        • et al.
        The oxidation of blood plasma and low density lipoprotein components by chemically generated singlet oxygen.
        J Biol Chem. 1993; 268: 18502-18506
        • Cummings JH
        Short chain fatty acids in the human colon.
        Gut. 1981; 22: 763-779
        • Rampton DS
        • Cohen SL
        • Crammond VD
        • et al.
        Treatment of chronic renal failure with dietary fiber.
        Clin Nephrol. 1984; 21: 159-163
        • Jenkins DJA
        • Reynolds D
        • Slavin B
        • et al.
        Dietary fiber and blood lipids: Treatment of hypercholesterolemia with guar crispbread.
        Am J Clin Nutr. 1980; 33: 575-581
        • Jenkins DJA
        • Wolever TMS
        • Rao AV
        • et al.
        Effect on blood lipids of very high intakes of fiber in diets low in saturated fat and cholesterol.
        N Engl J Med. 1993; 239: 21-26
        • Schaefer EJ
        • Lichtenstein AH
        • Lamon-Fava S
        • et al.
        Efficacy of a National Cholesterol Education Program Step 2 diet in normolipidemic and hypercholesterolemic middle-aged and elderly men and women.
        Arterioscler Thromb Biol. 1995; 15: 1078-1085