A nutrition-based approach to reduce heart disease risk among overweight African Americans: Use of soul food plant-based or omnivorous diets to address cardiovascular disease

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African Americans (AAs) are disproportionately affected by cardiovascular disease (CVD), having the highest death rates from CVD as compared with other racial/ethnic groups. In addition, AAs have the highest rates of obesity as compared to whites and Hispanics. People following plant-based dietary approaches, particularly vegan or vegetarian diets, have lower risks of CVD and lower body weights than omnivores. Vegan and vegetarian diets have been used effectively for weight loss and maintenance and for reversing CVD. Although intervention trials have shown a significant weight-loss and cholesterol-lowering effect of adoption of plant-based diets, t o date, most of these large randomized trials have had limited participation from AA participants. AAs tend to lose less weight during behavioral interventions than their white counterparts. In addition, most research has shown that AAs are more likely to discontinue participation in behavioral dietary interventions. This combination of higher attrition and lower weight loss may be due to a failure to address issues that are culturally relevant to the AA population. Our recent 6-month trial examined the use of a vegan diet as compared to 4 other plant-based dietary approaches (vegetarian, pesco-vegetarian, semi-vegetarian, or omnivorous). Weight loss among AAs in the vegan diet was significantly greater (-8.5±3.3%, n=3) than AAs randomized to diet approaches that will be similar to the omnivorous approach in our proposed study (semi- vegetarian/omnivorous groups, 1.4±1.8%, n=3). Of the 12 AA participants who began the study, only one did not complete the study (8% attrition rate) compared to 12 out of the 49 white participants (24% attrition). In total, these results point to the potential of an entirely plant-based dietary intervention to overcome two barriers encountered in previous studies aiming to improve dietary intake and weight loss among overweight AAs for CVD prevention: low weight loss results and high attrition rates. The goal of this proposed study is to apply these findings in a CVD prevention intervention specifically for AAs living in the southeast U.S. We have developed a partnership with the owners of two soul food restaurants in Columbia, SC (one vegan, the other traditional).These restaurants, which focus on southern cuisine, are owned and operated by local AA families, and will assist with developing culturally-appropriate recipes for our intervention. W e will conduct a two-year dietary trial among overweight AA adults (N=130) randomized to follow one of two diets both emphasizing southern food culture and low-glycemic index and low-fat foods: Vegan or Omnivorous (omni) diet. This study will compare the impact of these diet patterns on changes in CVD risk factors, including LDL cholesterol and blood pressure, and body weight. If this intervention proves to be successful at reducing weight and CVD risk factors among AAs, it has the potential to be disseminated through a variety of locations throughout the US, including restaurants, federally qualified health clinics, churches, or neighborhood community centers.