Serum cholesterol and triglyceride levels in Australian adolescent vegetarians

Plant-based diets for children as a means of improving adult cardiometabolic health

Cardiovascular disease (CVD) is the largest contributor to global mortality, and this trend is expected to continue. Although mortality rates have been falling, adverse developments in obesity and diabetes threaten to reverse this. It has been estimated that the only viable strategy to reduce the epidemic is to focus on population-wide risk factor reduction. Primordial prevention, a strategy aimed at avoiding the development of risk factors before the disease onset, has been shown to reduce the CVD epidemic substantially. Plant-based diets appear beneficial for prevention of cardiometabolic diseases, with adult vegetarians and vegans having lower CVD risk than omnivores. Atherosclerosis starts in childhood and progresses in relation to classical CVD risk factors, which, along with dietary habits, track to adulthood. Based on this evidence, it is proposed that plant-based diets in childhood could promote cardiometabolic health in adults and thereby reduce CVD and promote longevity and health. However, the need for additional research to establish the safety of predominantly or exclusively plant-based diets in children is noted.

Cardiovascular Disease Risk Factors Profile Among Australian Vegetarian and Nonvegetarian Teenagers

Atherosclerosis develops over a long period of time and often begins in childhood. The goal of this study was to make a cross-sectional assessment of the pattern of cardiovascular disease risk factors among Australian vegetarian (n = 49) and nonvegetarian (n = 639) 14- to 17-year-old participants from New South Wales, Australia. Vegetarians had statistically significant lower mean total (4.05 vs 4.4 mmol/L;P < .001) and low-density lipoprotein (LDL) cholesterol (2.18 vs 2.55 mmol/L; P < .001) and lower incidence of abnormal total and LDL cholesterol (31.1% vs 46.2%, P = .036, having total cholesterol ≥4.4 mmol/L and 13.3% vs 29.6%, P = .021, having LDL cholesterol ≥2.84 mmol/L). Vegetarians had a higher diastolic BP (72.0 vs 69.7 mm Hg; P = .038). No statistically significant difference was found in other risk factors including high-density lipoprotein cholesterol (P = .83), triglycerides (P = .601), systolic blood pressure (P = .727), body mass index (P = .159), plasma glucose (P = .09), C-reactive protein (P = .527), or homocysteine (P = .45). The prevalence rate with 3 or more risk factors was 12.2% among vegetarians and 13.9% among nonvegetarians (P = .156). The high percentage of abnormal total cholesterol in both diet groups and, in addition, LDL cholesterol in nonvegetarians is a cause of concern and underlines the need for lifestyle change.

Prevalence of dyslipidemia and associated factors in the Yi farmers and migrants of Southwestern China

There are scant data on serum lipid profile in the Yi people in China. The Yi farmers and migrants provide an unusual opportunity to estimate effects of environmental factors on serum lipid levels. We conducted a cross-sectional study in the Yi people to estimate prevalence of dyslipidemia and associated factors. It was found that prevalence of high total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), abnormal ratio of TC/HDL-C and low high-density lipoprotein-cholesterol (HDL-C) were 1.82%, 5.07%, 1.56%, 9.30% and 39.47%, respectively in the Yi farmers. And those in the Yi migrants were 4.81%, 22.21%, 3.24%, 26.56% and 40.53%. Prevalence of dyslipidemia increased with time period in the Yi farmers after their emigrating to urban areas for less than 25 years, except high TC. It was also found that prevalence of dyslipidemia of the Yi migrants increased with time period before their emigration, including hypertriglyceridemia, low HDL-C and high ratio of TC/HDL-C. Their body mass index (BMI), history of type 2 diabetes mellitus (T2DM), gender, ever alcohol drinking and physical activity all were associated with dyslipidemia, but no factors associated with high LDL-C was found. In conclusion, all these results suggest that the Yi migrants have a higher prevalence of dyslipidemia than the Yi farmers do, which possibly can attribute to their urbanized lifestyles.

Position of the American Dietetic Association and Dietitians of Canada: vegetarian diets

It is the position of the American Dietetic Association and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases. Approximately 2.5% of adults in the United States and 4% of adults in Canada follow vegetarian diets. A vegetarian diet is defined as one that does not include meat, fish, or fowl. Interest in vegetarianism appears to be increasing, with many restaurants and college foodservices offering vegetarian meals routinely. Substantial growth in sales of foods attractive to vegetarians has occurred and these foods appear in many supermarkets. This position paper reviews the current scientific data related to key nutrients for vegetarians including protein, iron, zinc, calcium, vitamin D, riboflavin, vitamin B-12, vitamin A, n-3 fatty acids, and iodine. A vegetarian, including vegan, diet can meet current recommendations for all of these nutrients. In some cases, use of fortified foods or supplements can be helpful in meeting recommendations for individual nutrients. Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life-cycle including during pregnancy, lactation, infancy, childhood, and adolescence. Vegetarian diets offer a number of nutritional benefits including lower levels of saturated fat, cholesterol, and animal protein as well as higher levels of carbohydrates, fibre, magnesium, potassium, folate, antioxidants such as vitamins C and E, and phytochemicals. Vegetarians have been reported to have lower body mass indices than non-vegetarians, as well as lower rates of death from ischemic heart disease, lower blood cholesterol levels, lower blood pressure, and lower rates of hypertension, type 2 diabetes, and prostate and colon cancer. While a number of federally funded and institutional feeding programs can accommodate vegetarians, few have foods suitable for vegans at this time. Because of the variability of dietary practices among vegetarians, individual assessment of dietary intakes of vegetarians is required. Dietetics professionals have a responsibility to support and encourage those who express an interest in consuming a vegetarian diet. They can play key roles in educating vegetarian clients about food sources of specific nutrients, food purchase and preparation, and any dietary modifications that may be necessary to meet individual needs. Menu planning for vegetarians can be simplified by use of a food guide that specifies food groups and serving sizes.

Position of the American Dietetic Association and Dietitians of Canada: Vegetarian diets

It is the position of the American Dietetic Association and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases. Approximately 2.5% of adults in the United States and 4% of adults in Canada follow vegetarian diets. A vegetarian diet is defined as one that does not include meat, fish, or fowl. Interest in vegetarianism appears to be increasing, with many restaurants and college foodservices offering vegetarian meals routinely. Substantial growth in sales of foods attractive to vegetarians has occurred, and these foods appear in many supermarkets. This position paper reviews the current scientific data related to key nutrients for vegetarians, including protein, iron, zinc, calcium, vitamin D, riboflavin, vitamin B-12, vitamin A, n-3 fatty acids, and iodine. A vegetarian, including vegan, diet can meet current recommendations for all of these nutrients. In some cases, use of fortified foods or supplements can be helpful in meeting recommendations for individual nutrients. Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life cycle, including during pregnancy, lactation, infancy, childhood, and adolescence. Vegetarian diets offer a number of nutritional benefits, including lower levels of saturated fat, cholesterol, and animal protein as well as higher levels of carbohydrates, fiber, magnesium, potassium, folate, and antioxidants such as vitamins C and E and phytochemicals. Vegetarians have been reported to have lower body mass indices than nonvegetarians, as well as lower rates of death from ischemic heart disease; vegetarians also show lower blood cholesterol levels; lower blood pressure; and lower rates of hypertension, type 2 diabetes, and prostate and colon cancer. Although a number of federally funded and institutional feeding programs can accommodate vegetarians, few have foods suitable for vegans at this time. Because of the variability of dietary practices among vegetarians, individual assessment of dietary intakes of vegetarians is required. Dietetics professionals have a responsibility to support and encourage those who express an interest in consuming a vegetarian diet. They can play key roles in educating vegetarian clients about food sources of specific nutrients, food purchase and preparation, and any dietary modifications that may be necessary to meet individual needs. Menu planning for vegetarians can be simplified by use of a food guide that specifies food groups and serving sizes.

Impact of nondigestible carbohydrates on serum lipoproteins and risk for cardiovascular disease

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the U.S. and in most developed countries. Many nutritional factors contribute to risk for ASCVD including total and saturated fat consumption, fruits and vegetables in the diet and dietary fiber intake. This review will focus on the relationship of dietary fiber intake to risk for coronary heart disease (CHD) and ASCVD (which includes, principally, CHD, cerebral vascular disease and peripheral vascular disease). Fiber-rich foods such as vegetables, fruits, whole-grain cereals and legumes are rich sources of nutrients, phytochemicals and antioxidants. For example, most high fiber foods contain soluble and insoluble fiber, minerals, vitamins, other micronutrients and phytochemicals. Cereals and legumes also contain complex carbohydrates and unsaturated fatty acids. Some high fiber foods are rich in monounsaturated fatty acids, whereas others provide (n-3) fatty acids. Legumes and certain vegetables provide oligosaccharides. When assessing the health benefits of dietary fiber, one should consider the potential effects of associated nutrients, micronutrients and phytochemicals. These interactions will be reviewed as we discuss relationships of dietary fiber to ASCVD.

Interaction of family history of atherosclerosis with atherogenic lipid traits in men with non-coronary atherosclerosis

Family history of atherosclerosis has been recognised as an nonmodifiable cardiovascular risk factor. Lipid levels, together with hypertension and diabetes, appear to have an inheritable component. The aim of the study was to ascertain whether lipoprotein abnormalities of 169 adult patients with non-coronary atherosclerosis were associated with a family history of atherosclerosis. Besides intermediate density lipopoprotein composition and Lp(a) levels, we focused on apo(a) and apo E phenotypes, LDL cholesterol/apo B ratio, VLDL triglyceride/HDL cholesterol ratio, and environmental factors. We found that patients with a family history of atherosclerosis had a higher prevalence of VLDL triglyceride/HDL cholesterol ratio above 1.8 (51.3% vs 34.7%) than patients without. Similarly, there was a significant inverse correlation between both considered ratios (r = -0.24, p < 0.05). The odds ratio of the presence of both abnormal ratios (4.60, 95% CI, 1.41-15.00) and low molecular weight apo(a) isoforms (3.30, 95% CI, 1.05-10.30 and family history of atherosclerosis was independent of smoking and hypertension. Apo(a) isoform size seems to be more important than Lp(a) concentrations in the family history of atherosclerosis risk determination. Subsequent analysis showed that patients with a family history of atherosclerosis had a greater-than-fourfold increased risk of having one or both abnormal ratios reflecting metabolic disturbances which probably constitute a combined trait. Family history of atherosclerosis may constitute a specific lipoprotein-related marker of atherosclerosis. Such a marker often precedes the onset of overt disease and may contribute to identifying patients with an atherogenic lipoprotein profile even in the absence of classical lipid risk factors.

Atherogenic markers in the offspring vis-à-vis family history of coronary heart disease

The object of the study was to determine if atherogenic markers in the offspring reflected family history of coronary heart disease (CHD). Two hundred and four male subjects aged 9-18 years, mean age 13.3 +/- 1.7 (S.D.) years, and apparently healthy and normolipidemic, were selected for the study. Information on their family history of fatal or non-fatal heart attack or stroke was obtained on a questionnaire, and a scoring system was devised to grade the positivity of family history. The boys having the highest decile values of triglyceride, ratios of LDL/HDL-cholesterol, total/HDL-cholesterol and apolipoprotein B/A-I, and cumulative skin-fold thickness, a marker of obesity, had higher family history scores and increased occurrence of myocardial infarction in their families than the boys with the lowest decile values of these variables. The reverse was true with variables such as HDL-cholesterol and apolipoprotein A-I, high levels of which are known to be cardioprotective by virtue of controlling reverse cholesterol transport. The mean values of triglyceride and total/HDL-cholesterol ratio were significantly elevated in the boys with positive parental history of CHD as compared with those with negative parental history. Thus, although the boys were normolipidemic, their lipoprotein markers and an obesity marker exhibited a variation which in turn reflected family history of CHD.

The advisability of the prudent diet in adolescence

Risk factor status for cardiovascular disease is affected by life style. Adolescence is a time during which long term life-style habits, including dietary habits, are established. Physicians who treat adolescent patients have a responsibility to be aware of the scientific evidence on the diet-heart question so that they can provide their patients with sound dietary advice. The American Heart Association has recommended that Americans consume a "prudent diet" in which daily consumption of cholesterol is no more than 300 mg with up to 30-35% of calories derived from fat, and less than 10% of calories derived from saturated fat and less than 10% from polyunsaturated fat. This paper reviews this recommendation with particular reference to studies of adolescents. This review centers around four main issues: 1) the estimated effect on serum cholesterol levels of a switch from the usual American diet to the prudent diet; 2) the effect of a predicted decrease in serum cholesterol on the risk of developing cardiovascular disease; 3) evaluation of the evidence of possible adverse effects of the prudent diet; 4) feasibility of the prudent diet. Based on a review of these four issues, the authors feel that the American Heart Association's prudent diet should be strongly recommended for all healthy adolescents.

Seventh-Day Adventist adolescents--life-style patterns and cardiovascular risk factors

The life-style of adolescents attending a Seventh-Day Adventist boarding school was evaluated as it related to cardiovascular risk factors. The diet contained 34% calories as fat, with 11% derived from saturated fat. Total serum cholesterol levels were low (mean, standard deviation=138+/-15 mg per dl), and apolipoprotein B level was low as well (46+/-9 mg per dl). The high-density lipoprotein cholesterol level was within the usual range (52.4+/-13.3 mg per dl). Mean blood pressures were also low (systolic, 104.1+/-9.6 mm of mercury; diastolic, 65.7+/-9.7 mm of mercury). There was no self-reported use of cigarettes. If this life-style were to continue through adulthood, the incidence of premature atherosclerotic disease, particularly coronary artery disease, for this group might well be reduced, compared with other North Americans, as suggested by findings from previous studies of adult Seventh-Day Adventists.

Apolipoprotein E levels in vegetarians

Vegetarians are known to have low lipoprotein lipid and apolipoprotein Al and B levels. Since dietary cholesterol has recently been shown to have important effects on apolipoprotein E (apo E) metabolism, we measured plasma apo E levels in three groups of vegetarians. Group I (n = 36) consumed less than 10 mg cholesterol daily and 42% of calories as fat (P:S ratio 2.6). Group II (n = 10) and Group III (n = 18) consumed 97 and 179 mg cholesterol daily, and 35% of calories as fat (P:S ratios 0.7 and 0.9) respectively. Compared to control values, vegetarian plasma cholesterol and triglyceride levels were decreased by 10%-30% and 30%-55%. Plasma apo E levels were decreased equally in all groups by 35% (2.4 +/- 0.1 mg/dl versus 3.6 +/0 0.1 mg/kl, P less than .001). Plasma apo E levels were increased in parallel with lipid levels in pregnant vegetarians but were not different from non-lactating vegetarians in postpartum lactating women. Decreased apo E levels did not correlate with relative body weight, P:S ratio or intake of fat, carbohydrates or protein. Since all vegetarian diets studied were low cholesterol diets, decreased cholesterol intake may contribute to the low apo E levels. The apparent modification of apo E metabolism by vegetarian diets may be important in mediating effects of lipid lowering diets on atherogenesis.

Low density and high density lipoprotein kinetics and sterol balance in vegetarians

Vegetarians have lower than average plasma lipid levels. Possible mechanisms were studied by measuring the kinetics of LDL-B protein and HDL-AI protein in 7 young male vegetarians and 6 omnivorous control subjects; sterol balances were also determined in a further study with the 6 additional control subjects whose intake of cholesterol was low. Plasma total cholesterol, LDL cholesterol and LDL-B protein were significantly lower in the vegetarians and plasma AI protein concentrations also tended to be lower. The flux or production of LDL was significantly lower, 9.1 +/- 2.3 mg/kg/d (mean +/- SD) compared to 11.8 +/- 0.6 mg/kg/d in the controls and appeared to explain the low levels of LDL. The fractional removal rate of HDL-AI protein was significantly greater in the vegetarians (0.043 +/- 0.011 versus 0.027 +/- 0.011 for the fractions of pool 1 cleared per hour) and appeared to account for the low plasma AI levels. In the second study, bile acid excretion was significantly lower in the vegetarians and estimated cholesterol synthesis was in the low normal range. Low rates of LDL-B protein formation have been reported in other subjects with low LDL cholesterol concentrations and in the vegetarians presumably reflect the composite of several dietary factors.

The effect of a virtually cholesterol-free, high-linoleic-acid vegetarian diet on serum lipoproteins of children with familial hypercholesterolemia (type II-A)

The effect of a virtually cholesterol-free, high-linoleic-acid vegetarian diet and a high-linoleic-acid "normal" diet with a moderate cholesterol content was tested in 39 children heterozygote for hypercholesterolemia type II-A. The diets were administered in an outpatient cross-over design of two periods of 10 weeks each and the serum lipoproteins were analyzed at the end of the two 10-week periods. The vegetarian diet induced a decrease in serum concentrations of LDL-II total and free cholesterol and of apo-B, by an average of 10%, whereas HDL cholesterol and apo-A-I decreased by 4%. The disproportionately large change in LDL compared to the small change in HDL was interpreted as an antiatherogenic effect of the vegetarian diet.

Plasma cholesterol, triglyceride and uric acid in urban and rural communities in Papua New Guinea

Fasting plasma cholesterol, triglycerides and uric acid were measured in 109 Melanesian residents of Port Moresby and 71 residents of a Papuan coastal village. Cholesterol and triglyceride levels were low, mean cholesterol 3 . 74 and 3 . 70 mM/l and triglycerides 0 . 64 and 0 . 59 mM/l respectively in urban and rural residents, with no relation to age or sex. Uric acid was higher in urban men (0 . 37 mM/l) than either urban women (0 . 26 mM/l) or rural men and women (0 . 25 and 0 . 24 mM/l). The levels of plasma cholesterol found in this study are similar to previous reports on rural populations in Papua New Guinea. The apparent failure of plasma lipids to increase significantly in urbanised residents of port Moresby who had a significantly higher prevalence of both diabetes mellitus and obesity is unexplained.

Health status of Seventh-Day Adventists

A comparison of health status between 779 Seventh-day Adventists, who have a strong commitment to heal-related life styles, and two other groups of people--8363 persons referred by general practitioners and 9825 volunteers--was made. The Seventh-day Adventists showed less impairment of systolic and diastolic blood pressures, of plasma cholesterol and plasma urate concentrations, and of lung ventilatory capacity; and less obesity at most specific ages. With increasing age, the level of breathlessness, reported heart disease, hypertension, and hypertensive and diuretic therapy in this sample approached that of the comparative groups, possibly because of natural attrition of high-risk persons in the latter. Depression, sleeplessness, use of sedatives and tranquillizers were lower in the Seventh-day Adventists; although, once again, a drawing together of the three groups in older age categories was evident. It is concluded that the life style of Seventh-day Adventists is conducive to lessened morbidity, delayed mortality, and decreased call on health services in comparison with the general population.

The interaction of dietary fibers and cholesterol upon the plasma lipids and lipoproteins, sterol balance, and bowel function in human subjects

To identify any metabolic effects of dietary fiber upon cholesterol metabolism in man, six adult volunteer subjects were fed eucaloric cholesterol-free formula diets, with and without added dietary fiber for two 4-wk periods. A large quantity of dietary fiber was fed, some 60 g of plant cell wall material (or 16 g of crude fiber) derived from corn, beans, bran, pectin, and purified cellulose. This provided about five times the fiber intake of the typical American diet. The addition of fiber to the cholesterol-free diet did not change either the plasma cholesterol level (171+/-21 mg/dl, SEM, to 167+/-18) or the triglyceride (103+/-39 to 93+/-27 mg/dl). The excretion of both endogenous neutral steroids and bile acids were unchanged with fiber (505+/-41 to 636+/-75 mg/day and 194+/-23 to 266+/-47 mg/day, respectively.) However, total fecal steroid excretion was increased 699+/-29 to 902+/-64 mg/day, P < 0.025). With fiber, intestinal transit time was decreased (59+/-9 to 35+/-8 h, P < 0.005), and both the wet and dry stool weights were greatly increased.A second group of six subjects was fed similar diets containing 1,000 mg cholesterol derived from egg yolk. The addition of fiber to the 1,000-mg cholesterol diet did not alter either plasma cholesterol level (233+/-26 to 223+/-36 mg/dl) or triglyceride (102+/-19 to 83+/-11 mg/dl). The excretion of endogenous neutral steroids (618+/-84 to 571+/-59 mg/day), of bile acids (423+/-122 to 401+/-89 mg/day), and of total fecal steroids (1,041+/-175 to 972+/-111 mg/day) were unchanged by fiber. The absorption of dietary cholesterol was not altered when fiber was added to the 1,000-mg cholesterol diet (44.0+/-3.3 to 42.9+/-2.5%). A two-way analysis of variance utilizing both groups of subjects indicated a significant (P < 0.001) effect of dietary cholesterol upon the plasma cholesterol concentration. We concluded that a large quantity of dietary fiber from diverse sources had little or no effect upon the plasma lipids and sterol balance in man in spite of the fact that intestinal transit time and stool bulk changed greatly.

Soybean-protein diet in the treatment of type-II hyperlipoproteinaemia

A soybean textured protein induced a 14% decrease of plasma-cholesterol levels after two weeks and 21% after three when substituted for animal proteins in a group of 20 patients with type-II hyperlipoproteinaemia. Comparison of soybean diet with a standard low-lipid diet in the same patients, according to a cross-over protocol, indicated that this hypocholesterolaemic effect was not due to differences in the lipid composition of the two diets. The hypothesis that a soy protein has a hypocholesterolaemic action per se is supported by the results of a subsequent experiment in 8 type-II patients in whom the addition of cholesterol (500 mg/day) to soy protein did not modify the hypocholesterolaemic response.