Journal Article

The effect of high-polyphenol Mediterranean diet on visceral adiposity: the DIRECT PLUS randomized controlled trial

Diotallevi, Camilla, Tsaban, Gal, Shelef, Ilan, Chassidim, Yoash, Isermann, Berend, Quayson, Rita Nana, Ceglarek, Uta, Engelmann, Beatrice, Yaskolka Meir, Anat, Rolle-Kampczyk, Ulrike E., von Bergen, Martin, Zelicha, Hila, Kloting, Nora, Kaplan, Alon, Tuohy, Kieran M., Stampfer, Meir J., Stumvoll, Michael, Haange, Sven-Bastiaan, Hu, Frank B., Shai, Iris, Rinott, Ehud, Bluher, Matthias

2022

Overview

Background Mediterranean (MED) diet is a rich source of polyphenols, which benefit adiposity by several mechanisms. We explored the effect of the green-MED diet, twice fortified in dietary polyphenols and lower in red/processed meat, on visceral adipose tissue (VAT). Methods In the 18-month Dietary Intervention Randomized Controlled Trial PoLyphenols UnproceSsed (DIRECT-PLUS) weight-loss trial, 294 participants were randomized to (A) healthy dietary guidelines (HDG), (B) MED, or (C) green-MED diets, all combined with physical activity. Both isocaloric MED groups consumed 28 g/day of walnuts (+ 440 mg/day polyphenols). The green-MED group further consumed green tea (3–4 cups/day) and Wolffia globosa (duckweed strain) plant green shake (100 g frozen cubes/day) (+ 800mg/day polyphenols) and reduced red meat intake. We used magnetic resonance imaging (MRI) to quantify the abdominal adipose tissues. Results Participants (age = 51 years; 88% men; body mass index = 31.2 kg/m 2 ; 29% VAT) had an 89.8% retention rate and 79.3% completed eligible MRIs. While both MED diets reached similar moderate weight (MED: − 2.7%, green-MED: − 3.9%) and waist circumference (MED: − 4.7%, green-MED: − 5.7%) loss, the green-MED dieters doubled the VAT loss (HDG: − 4.2%, MED: − 6.0%, green-MED: − 14.1%; p < 0.05, independent of age, sex, waist circumference, or weight loss). Higher dietary consumption of green tea, walnuts, and Wolffia globosa ; lower red meat intake; higher total plasma polyphenols (mainly hippuric acid ), and elevated urine urolithin A polyphenol were significantly related to greater VAT loss ( p < 0.05, multivariate models). Conclusions A green-MED diet, enriched with plant-based polyphenols and lower in red/processed meat, may be a potent intervention to promote visceral adiposity regression. Trial registration ClinicalTrials.gov , NCT03020186

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abdomen / Adipose tissue / Adipose tissues / Age / Aquatic plants / Biomarkers / Biomedicine / Blood pressure / Body fat / Body mass / Body mass index / Body size / Body weight loss / Clinical trials / Cubes / Diabetes / Diet / Dietary fiber / Duckweed / Fatty acids / Floating plants / Food intake / Green tea / Health aspects / Hippuric acid / Hypertension / Intervention / Magnetic resonance imaging / Measurement / Meat / Medicine / Medicine & Public Health / Mediterranean / Metabolism / Metabolites / Methods / Obesity / Physical activity / Plant-based diet / Plasma / Polyphenols / Research Article / Tea / Triglycerides / Visceral adipose tissue / Vitamin B / Weight control / Weight loss / Wolffia globosa