The effect of distinct dietary interventions on proximal aortic stiffness; the DIRECT-PLUS randomized controlled trial

Abstract Background Proximal aortic stiffness (PAS) reflects arterial aging and is strongly associated with increased cardiovascular risk. Plant-rich, specifically Mediterranean-style, diets are reduced The effect of dietary interventions on PAS remains unclear. Methods We randomized participants abdominal-obesity/dyslipidemia to healthy-dietary-guidelines (HDG), Mediterranean, or green-Mediterranean combined physical activity (PA). Both Mediterranean were similarly hypocaloric included 28g/day walnuts. group also consumed green tea (3–4 cups/day) a Wolffia-globosa (Mankai) plant green-shake. was estimated based aortic-arch pulse-wave-velocity using magnetic resonance imaging (MRI) at baseline after 18-months. Results Among 294 [age=51±10.6 years, body-mass-index 31.3±4.0 kg/m2, = 6.1±2.7 m/sec, retention rate 89.8%], 281 had valid measurements. Higher mostly aging, hypertension, dyslipidemia, diabetes, visceral adiposity (p<0.05 for all). After 18-months intervention, all diet groups significantly their ([HDG: −4.8% (interquartile-range [IQR]: −22.3 8.7); Mediterranean: −7.3%, IQR (−20.8 11.9); green-Mediterranean: −14.0%, (−27.0 2.4); p<0.05 within-groups changes). Green-Mediterranean dieters greater reduction than HDG (p=0.007), controlling age, sex, baseline-PAS, Δweight. Further adjustment hypertension revealed significant differences in between (p=0.027). Specifically, consumption regression (p=0.04). ΔPAS improvements Δlow-density-lipoprotein cholesterol Δtotal-cholesterol (p<0.05, multivariable models). All lifestyle intervention showed age as compared the expected (1.8±0.14 years vs.: HDG: −2.9±7.5 years; MED: −4.1±7.4 green-MED:-4.9±8.0 p<0.001). Conclusions related traditional risk factors. Lifestyle promotes reduction. may be more remarkable rejuvenation. Funding Acknowledgement Type funding sources: Foundation. Main source(s): Deutsche Forschungsgemeinschaft (DFG, German Research Foundation); Israel Ministry Health