Introduction: The continued obesity pandemic and its associated risks for non-communicable chronic diseases (NCDs) have been linked to various dietary components, diet quality, and availability of healthy foods. However, several dietary patterns, including the Mediterranean, Portfolio, Nordic, Dietary Approach to Stop Hypertension (DASH) etc., continue to be evaluated for their protective effects against NCD risk. Yet, much remains to be learnt about the impact of specific macronutrients on NCDs, particularly in diverse populations from low-and middle-income countries. Moreover, the abundance of relatively inexpensive calorie-dense foods in a global Westernized environmental culture presents a major challenge for individuals to adopt healthy eating behaviours. In this review, we critically examined available studies to determine carbohydrate quality, which included metrics such as glycemic index (GI), glycemic load (GL), and glycemic control; the LDL-cholesterol lowering effect; and overall diet quality. These metrics were reconciled against morbidity and mortality outcomes including NCD risk reduction.
Methods: Assessment of the available literature with specific emphasis on the roles of healthy dietary patterns in the prevention and management of NCDs
Results: Except for the DASH diet that allows for generous servings of lean meats, the dietary patterns evaluated were all rich in minimally processed whole grains and plant-based foods. The strongest evidence to date comes from the PREDIMED study, one of the largest randomized-controlled foods-based trial of Europeans, demonstrating exceptionally effective of the Mediterranean diet in reducing the incidence of major cardiovascular events while significantly lowering dietary GL and GI. This is consistent with a large of body of literature showing that a diet with a high GI and GL was associated with an increased risk of NCDs and mortality. In parallel, these studies also show that the plant-based, low GI and GL, Portfolio Diet was equally effective in reducing LDL-C, glycemic control and cardiovascular risk. There is currently ongoing implementation of the Portfolio Diet as part of food-based dietary interventions in free-living at-risk individuals; preliminary results show high efficacy in NCD risk reduction. In contrast, diets high in refined carbohydrates, particularly free or added sugars, have been associated with significantly increased NCD risk.
Discussion: Plant-based dietary patterns with small amounts of lean meats, fish and healthy fats improve diet carbohydrate quality, reduce dyslipidemia and are associated with lower NCD risk and a decrease in CVD mortality.