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

https://doi.org/10.1016/j.pcad.2018.05.004Get rights and content
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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.

Abbreviations and Acronyms

ApoB
Apolipoprotein B
BMI
Body mass index
CRP
C-reactive protein
CCS
Canadian Cardiovascular Society
CV
Cardiovascular
CVD
Cardiovascular disease
CTT Collaboration
Cholesterol Treatment Trialists'
CIs
Confidence intervals
CHD
Coronary heart disease
DNSG
Diabetes and Nutrition Study Group
DBP
Diastolic blood pressure
DASH
Dietary Approaches to Stop Hypertension
EAS
European Atherosclerosis Society
EFSA
European Food Safety Authority
ESC
European Society of Cardiology
EASD
European Association for the Study of Diabetes
FDA
Food and Drug Administration
GRADE
Grading of Recommendations Assessment, Development, and Evaluation
non-HDL-C
High-density lipoprotein cholesterol
LDL-C
Low-density lipoprotein
MID
Minimally important difference
MUFAs
Monounsaturated fatty acids
NCEP
National Cholesterol Education Program
non-HDL-C
Non-high density lipoprotein cholesterol
PREDIMED
Prevención con Dieta Mediterránea
PRISMA
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
RevMan
Review Manager
SBP
Systolic blood pressure
TC
Total cholesterol
TG
Triglycerides

Keywords

Portfolio diet
Dietary Portfolio
Dietary pattern
Plant sterols
Plant protein
Viscous fibre
Nuts
LDL-cholesterol
Cardiovascular risk
Cardiometabolic risk
Systematic review and meta-analysis

Cited by (0)

Statement of Conflict of Interest: see page 51.

☆☆

Protocol registration: Clinicaltrials.gov identifier, NCT03534414.