Changes in Food and Nutrient Intake and Diet Quality on a Low-Fat Vegan Diet Are Associated with Changes in Body Weight, Body Composition, and Insulin Sensitivity in Overweight Adults: A Randomized Clinical Trial

Authors

Lelia Crosby, Nutrition Education Program Manager, Physicians Committee for Responsible Medicine (Physicians Committee), 5100 Wisconsin Ave, NW, Suite 400, Washington, DC 20016.
Emilie Rembert, Clinical Research Consultant, Physicians Committee (when work started), Medical Student, Rush Medical College (current), 903 South Ashland Ave, #413, Chicago, IL 60607.
Susan Levin, Director of Nutrition Education, Physicians Committee, 5100 Wisconsin Ave, NW, Suite 400, Washington, DC 20016.
Amber Green, Nutrition Consultant, Physicians Committee, 5100 Wisconsin Ave, NW, Suite 400, Washington, DC 20016.
Zeeshan Ali, Program Specialist, Physicians Committee, 5100 Wisconsin Ave, NW, Suite 400, Washington, DC 20016.
Meghan Jardine, Associate Director of Diabetes Nutrition Education, Physicians Committee (when work started), Nutrition Consultant, Physicians Committee (current), 7035 Southridge Drive, Dallas, TX, 75214.
Minh Nguyen, Registered Dietitian, Physicians Committee (when work started), Unaffiliated (current), 5100 Wisconsin Ave, NW, Suite 400, Washington, DC 20016, USA.
Patrick Elliott, Clinical Research Intern, Physicians Committee (when work started), Unaffiliated (current), 24 Weston Court, Weston Park, Lucan, Co. Dublin, Ireland. K78 T622.
Daniel Goldstein, Clinical Research Intern, Physicians Committee (when work started), MS student, Tufts Friedman School of Nutrition (current), 6015 Spirit St., #424 Pittsburgh, PA 15206.
Amber Freeman, Clinical Research Intern, Physicians Committee, 5100 Wisconsin Ave, NW, Suite 400, Washington, DC 20016, USA.
Meka Bradshaw, Clinical Research Intern, Physicians Committee, 5100 Wisconsin Ave, NW, Suite 400, Washington, DC 20016, USA.
Danielle N. Holtz, Clinical Research Associate, Physicians Committee, 5100 Wisconsin Ave, NW, Suite 400, Washington, DC 20016, USA.
Richard Holubkov, Biostatistician, School of Medicine, University of Utah, Salt Lake City, UT, USA, 30 N. 1900 E, Salt Lake City, UT 84132.
Neal D. Barnard, President, Physicians Committee, 5100 Wisconsin Ave, NW, Suite 400, Washington, DC 20016, USA, Adjunct faculty, George Washington University School of Medicine and Health Sciences., 2150 Pennsylvania Avenue, NW, Suite 8-416, Washington, DC, 20037.
Hana Kahleova, Director of Clinical Research, Physicians Committee, 5100 Wisconsin Ave, NW, Suite 400, Washington, DC 20016, USA. Electronic address: hkahleova@pcrm.org.

Document Type

Journal Article

Publication Date

4-19-2022

Journal

Journal of the Academy of Nutrition and Dietetics

DOI

10.1016/j.jand.2022.04.008

Keywords

diet quality; food groups; plant-based; vegan; weight loss

Abstract

BACKGROUND: Consuming different food groups and nutrients can have differential effects on body weight, body composition, and insulin sensitivity. OBJECTIVE: The aim was to identify how food group, nutrient intake, and diet quality change relative to usual-diet controls after 16 weeks on a low-fat vegan diet and what associations those changes have with changes in body weight, body composition, and measures of metabolic health. DESIGN: Secondary analysis of a randomized clinical trial conducted between October 2016 and December 2018 in four replications. PARTICIPANTS/SETTING: Participants included in this analysis were 219 healthy, community-based adults in the Washington, DC, area, with a body mass index (BMI) between 28 and 40 kg/m, who were randomly assigned to follow either a low-fat vegan diet or make no diet changes. INTERVENTION: A low-fat, vegan diet deriving approximately 10% of energy from fat, with weekly classes including dietary instruction, group discussion, and education on the health effects of plant-based nutrition. Control group participants continued their usual diets. MAIN OUTCOME MEASURES: Changes in food group intake, macro- and micronutrient intake, and dietary quality as measured by Alternate Healthy Eating Index-2010 (AHEI-2010), analyzed from 3-day diet records, and associations with changes in body weight, body composition, and insulin sensitivity were assessed. STATISTICAL ANALYSES PERFORMED: A repeated measure analysis of variance (ANOVA) model that included the factors group, subject, and time, was used to test the between-group differences throughout the 16-week study. Interaction between group and time (Gxt) was calculated for each variable. Within each diet group, paired comparison t-tests were calculated to identify significant changes from baseline to 16 weeks. Spearman correlations were calculated for the relationship between changes in food group intake, nutrient intake, AHEI-2010 score, and changes in body weight, body composition, and insulin sensitivity. The relative contribution of food groups and nutrients to weight loss was evaluated using linear regression. RESULTS: Fruit, vegetable, legume, meat alternative, and whole grain intake significantly increased in the vegan group. Intake of meat, fish and poultry; dairy products; eggs; nuts and seeds; and added fats decreased. Decreased weight was most associated with increased intake of legumes (r=-0.38; p<.0001) and decreased intake of total meat, fish, and poultry (r=+0.43; p<.0001). Those consuming a low-fat vegan diet also increased their intake of carbohydrates, fiber, and several micronutrients and decreased fat intake. Reduced fat intake was associated with reduced body weight (r=+0.15; p=0.02) and, after adjustment for changes in BMI and energy intake, with reduced fat mass (r=+0.14; p=0.04). The intervention group's AHEI-2010 increased by 6.0 points on average in contrast to no significant change in the control group (treatment effect +7.2 [95% CI +3.7 to +10.7]; p<0.001). Increase in AHEI-2010 correlated with reduction in body weight (r=0.14; p=0.04), fat mass (r=-0.14; p=0.03), and insulin resistance as measured by HOMA-IR (r=-0.17; p=0.02), after adjustment for changes in energy intake. CONCLUSIONS: When compared with participants' usual diets, intake of plant foods increased, and consumption of animal foods, nuts and seeds, and added fats decreased on a low-fat vegan diet. Increased legume intake was the best single food group predictor of weight loss. Diet quality as measured by AHEI-2010 improved on the low-fat vegan diet, which was associated with improvements in weight and metabolic outcomes. These data suggest that increasing low-fat plant foods and minimizing high-fat and animal foods is associated with decreased body weight and fat loss, and that a low-fat vegan diet can improve measures of diet quality and metabolic health.

APA Citation

Crosby, Lelia; Rembert, Emilie; Levin, Susan; Green, Amber; Ali, Zeeshan; Jardine, Meghan; Nguyen, Minh; Elliott, Patrick; Goldstein, Daniel; Freeman, Amber; Bradshaw, Meka; Holtz, Danielle N.; Holubkov, Richard; Barnard, Neal D.; and Kahleova, Hana, "Changes in Food and Nutrient Intake and Diet Quality on a Low-Fat Vegan Diet Are Associated with Changes in Body Weight, Body Composition, and Insulin Sensitivity in Overweight Adults: A Randomized Clinical Trial" (2022). GW Authored Works. Paper 775.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/775

Department

Medicine