ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2021) 18 12.11 | DOI: 10.1530/ey.18.12.11

Heart. 2020 Nov 23:heartjnl-2020-317802. doi: 10.1136/heartjnl-2020-317802. PMID: 33234670.

In brief: This parallel-arm trial randomly assigned 294 adults with abdominal obesity/dyslipidemia to 1 of 3 dietary guidelines: healthy diet; Mediterranean diet; or ‘green Mediterranean’ diet. All groups received physical activity guidelines. Weight loss was higher in the two Mediterranean diet groups, but the green Mediterranean diet produced the greatest reduction in waist circumference (−8.6 cm), compared to Mediterranean diet (−6.8 cm; P=0.033) and healthy diet (−4.3 cm; P<0.001). The green Mediterranean diet also showed greater decreases in LDL-C, diastolic blood pressure, insulin resistance, high-sensitivity C-reactive protein and the 10-year Framingham Risk Score, compared with the healthy diet.

Comment: In 2010, the Mediterranean diet was inscribed into the United Nations Educational, Scientific and Cultural Organization (UNESCO) Representative List of Intangible Cultural Heritage of Humanity. The Mediterranean diet involves knowledge and traditions concerning crops, harvesting, fishing, animal husbandry, conservation, processing, cooking and eating together. The foundation of the Mediterranean diet is vegetables, fruits, herbs, nuts, beans, whole grains, seafood, poultry and eggs; whereas red meat is eaten only occasionally. The Mediterranean diet has been shown to prevent cardiovascular disease. The current study assessed the impact of a ‘green Mediterranean’ diet.

Participants in the green Mediterranean diet group were guided to consume 3–4 cups/day of green tea and 100 g/day of frozen Wolffia globosa as a green shake replacing dinner. Processed and red meat were restricted. Wolffia globosa is a flowering plant known commonly as Asian watermeal, or duckweed, or Mankai. It is a very tiny, less than one-millimetre wide, oval-shaped plant with no leaves, stems or roots. Its dry matter has high protein content (> 45%), contains all 9 essential and 6 conditional amino acids, and is rich in polyphenols (flavonoids, phenolic acid), dietary fiber, iron, zinc and vitamin B12.

The green Mediterranean diet showed greater benefits on metabolic syndrome parameters, including waist circumference, lipid profile and overall cardiovascular risk score. In addition, in a later study, the same group reported the impact of the green Mediterranean diet on non-alcoholic fatty liver disease (NAFLD) prevalence, which declined to: 54.8%, 47.9% and 31.5% in the healthy diet, Mediterranean diet and green Mediterranean diet groups, respectively (P=0.012) (1). Furthermore, despite similar moderate weight-loss, the green Mediterranean compared to the Mediterranean diet showed almost 2-fold reduction in intrahepatic fat (−38.9% vs. −19.6%, respectively, P=0.035, adjusted for weight loss).

Reference: 1. Yaskolka Meir A, et al. Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial. Gut. 2021 Jan 18:gutjnl-2020-323106. PMID: 33461965.

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