Virtual Vegan Culinary Medicine Randomized Crossover Trial Improves Diet Quality in Patients at Risk for Heart Disease

Background Dietary risk factors contribute to over half of all deaths resulting from cardiovascular disease (CVD), the leading cause of mortality and morbidity worldwide. Relationships between diet intake and CVD can be assessed by diet quality indices (DQIs). While higher diet quality is typically observed in vegetarian diets compared to standard omnivorous patterns, improving diet quality among communities remains challenging. We hypothesized a plant-based culinary medicine (CM) intervention may enhance adoption of a healthful dietary pattern. Objective To determine changes in diet quality in clinical patients after participating in a vegan CM intervention. Study Design, Settings, Participants In a randomized crossover clinical trial, adults at risk for CVD recruited from medical clinics were assigned to follow two vegan diet patterns either high (4 tablespoons/day) or low (<1 teaspoon/day) in extra virgin olive oil (EVOO) for 4 weeks each, separated by a 1-week washout period. Participants were asked to complete 5-7 consecutive days of dietary recalls assessed by the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24®) at baseline and during each diet period. Weekly virtual CM group cooking classes coincided with both diet phases. Measurable Outcome/Analysis Diet recalls were analyzed to confirm diet compliance and calculate Whole Plant Food Density (WPFD) DQI and subcomponents. Paired t-tests compared differences from baseline and between diets. Results Of 40 participants (75% female, BMI 32+7 kg/m2, 64+8 years mean+sd), WPFD increased from 2.93+1.48 cup/oz-equivalents per 1000 kcal pre-intervention to 4.96+1.37 and 6.41+2.05 cup/oz-equivalents per 1000 kcal during the high and low EVOO phases, respectively (p<0.0001). All subcomponents (whole grains, legumes, whole fruit, vegetables, and nuts/seeds) significantly increased compared to baseline (p<0.001). Conclusion Participation in a virtual vegan CM intervention increased diet quality through greater intake of whole plant foods. Enhanced diet quality may reduce CVD risk factors (reported elsewhere), which correlate to measures of WPFD. Beneficial findings warrant further research on the use of WPFD as a DQI and CM for supporting nutritional adherence in diverse populations. Funding University of Florida Food Science and Human Nutrition Department; Purjes Foundation; Dr. Monica Aggarwal Preventive Foundation Dietary risk factors contribute to over half of all deaths resulting from cardiovascular disease (CVD), the leading cause of mortality and morbidity worldwide. Relationships between diet intake and CVD can be assessed by diet quality indices (DQIs). While higher diet quality is typically observed in vegetarian diets compared to standard omnivorous patterns, improving diet quality among communities remains challenging. We hypothesized a plant-based culinary medicine (CM) intervention may enhance adoption of a healthful dietary pattern. To determine changes in diet quality in clinical patients after participating in a vegan CM intervention. In a randomized crossover clinical trial, adults at risk for CVD recruited from medical clinics were assigned to follow two vegan diet patterns either high (4 tablespoons/day) or low (<1 teaspoon/day) in extra virgin olive oil (EVOO) for 4 weeks each, separated by a 1-week washout period. Participants were asked to complete 5-7 consecutive days of dietary recalls assessed by the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24®) at baseline and during each diet period. Weekly virtual CM group cooking classes coincided with both diet phases. Diet recalls were analyzed to confirm diet compliance and calculate Whole Plant Food Density (WPFD) DQI and subcomponents. Paired t-tests compared differences from baseline and between diets. Of 40 participants (75% female, BMI 32+7 kg/m2, 64+8 years mean+sd), WPFD increased from 2.93+1.48 cup/oz-equivalents per 1000 kcal pre-intervention to 4.96+1.37 and 6.41+2.05 cup/oz-equivalents per 1000 kcal during the high and low EVOO phases, respectively (p<0.0001). All subcomponents (whole grains, legumes, whole fruit, vegetables, and nuts/seeds) significantly increased compared to baseline (p<0.001). Participation in a virtual vegan CM intervention increased diet quality through greater intake of whole plant foods. Enhanced diet quality may reduce CVD risk factors (reported elsewhere), which correlate to measures of WPFD. Beneficial findings warrant further research on the use of WPFD as a DQI and CM for supporting nutritional adherence in diverse populations.