2020 SCIENTIFIC UPDATE ON PLANT-BASED EATING AND CARDIOMETABOLIC HEALTH Authors: Hana Kahleova, MD, PhD; Nerea Becerra-Tomas, RD, PhD; Sonia Blanco Mejia, MD, MSc; Andrea J Glenn, MSc, RD; Stephanie De Vriese, PhD; David JA Jenkins, MD, PhD; Cyril WC Kendall PhD; Jordi Salas-Salvadó, MD, PhD; John L Sievenpiper MD, PhD September 2020 Affiliations of the authors: Hana Kahleova 1, MD, PhD; Nerea Becerra-Tomas 2-3, RD, PhD; Sonia Blanco Mejia 4-5, MD, MSc; Andrea J Glenn 4-5, MSc, RD; Stephanie De Vriese 6, PhD; David JA Jenkins 4-5, MD, PhD; Cyril WC Kendall 4-5 PhD; Jordi Salas-Salvadó 2-3, MD, PhD; John L Sievenpiper 4-5 MD, PhD 1 Department of Medicine, Physicians Committee for Responsible Medicine, Washington, DC, USA. 2 Department of Biochemistry and Biotechnology, Human Nutrition Unit, Pere Virgili Institute for Health Research (IISPV), University Hospital of Sant Joan de Reus, Rovira i Virgili University, Reus, Spain 3 Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain 4 St. Michael's Hospital, Toronto, Canada 5 Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Canada 6 Alpro Foundation; Ghent, Belgium This review is fully supported by the Scientific Advisory Committee of the Alpro Foundation: Harry Aiking (VU University Amsterdam); Anna Arnoldi (University Milano); Christine Debeuf (Alpro); Peter Clarys (Vrije Universiteit Brussel); Helmut Heseker (University Paderborn); Sander Kersten (University Wageningen); Ian Rowland (University Reading); Cesare Sirtori (University Milano); Bregt Uyttenhove (Alpro) and Kurt Widhalm (University Vienna) Date: September 2020 2 CONTENT Global Health Burden of Cardiometabolic Disease......................................................................................................................... 5 Cardiovascular Disease ........................................................................................................................................................................................... 6 Type 2 Diabetes ......................................................................................................................................................................................................... 8 Stroke ............................................................................................................................................................................................................................. 8 Metabolic Syndrome ............................................................................................................................................................................................... 8 Non-Alcoholic Fatty Liver Disease ...................................................................................................................................................................... 8 Types of Plant-Based Dietary patterns .............................................................................................................................................. 11 Healthy and Unhealthy Plant-Based Diet Index ............................................................................................................................................ 13 Pro-Vegetarian Food Pattern .............................................................................................................................................................................. 14 Cardiometabolic Risk Factors ............................................................................................................................................................. 15 Blood Pressure ...........................................................................................................................................................................................................16 Lipid Profile ................................................................................................................................................................................................................. 17 Inflammation and Endothelial Function ........................................................................................................................................................... 17 Obesity/Overweight/ Adiposity ....................................................................................................................................................................... 18 Glucose Metabolism ...............................................................................................................................................................................................19 Non-Alcoholic Fatty Liver Disease ....................................................................................................................................................................20 Plant Components and Food Groups ............................................................................................................................................... 21 Nuts ............................................................................................................................................................................................................................... 22 Soy .................................................................................................................................................................................................................................24 Legumes...................................................................................................................................................................................................................... 27 Whole grains and Fiber ......................................................................................................................................................................................... 29 Fruits and Vegetables ............................................................................................................................................................................................. 31 Different Plant-Based Food Patterns ................................................................................................................................................ 33 Portfolio Diet ............................................................................................................................................................................................................. 34 Portfolio Diet and Cardiometabolic Risk Factors .................................................................................................................................. 34 Portfolio Diet and Cardiometabolic Diseases ........................................................................................................................................ 38 Mediterranean Diet ................................................................................................................................................................................................ 38 Mediterranean Diet and Cardiometabolic Risk Factors ......................................................................................................................39 Mediterranean Diet and Cardiometabolic Diseases ........................................................................................................................... 40 Nordic Diet ................................................................................................................................................................................................................ 43 3 Nordic Diet and Cardiometabolic Risk Factors ..................................................................................................................................... 43 Nordic Diet and Cardiometabolic Diseases ........................................................................................................................................... 44 Vegetarian and Vegan Diets .............................................................................................................................................................................. 45 Vegetarian Diets and Cardiometabolic Diseases ................................................................................................................................. 45 Vegetarian Diets and Cardiometabolic Risk Factors ........................................................................................................................... 46 Conclusion ................................................................................................................................................................................................................. 47 Plant-Based Food Patterns have positive effects on cardiometabolic diseases and their risk factors ............................ 47 Benefits and Barriers of a Plant-Based Diet .................................................................................................................................................. 47 Link Between Diet, Gut Microbiome Diversity and Cardiometabolic Health ..........................................................................48 Short-Chain Fatty Acids .......................................................................................................................................................................................