Amiri, 2022 Revisao

Maturitas 155 (2022) 40–53
Contents lists available at ScienceDirect
Maturitas
journal homepage: www.elsevier.com/locate/maturitas
Review article
Whole-diet interventions and cardiovascular risk factors in postmenopausal

women: A systematic review of controlled clinical trials
Mojgan Amiri a, Irma Karabegović a, a, Anniek C. van Westing a, b, #, Auke J.C.F. Verkaar b,
Sara Beigrezaei c, d, Macarena Lara a, Wichor M. Bramer e, Trudy Voortman a, b, *
a
Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
b
Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
c
Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
d
Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
e
Medical Library, Erasmus MC University Medical Center, Rotterdam, The Netherlands
A R T I C L E I N F O A B S T R A C T
Keywords: Objectives: Menopause is accompanied by many metabolic changes, increasing the risk of cardiometabolic dis
Dietary intervention eases. The impact of diet, as a modifiable lifestyle factor, on cardiovascular health in general populations has
Post-menopause been well established. The purpose of this systematic review is to summarize the evidence on the effects of whole
Menopause
diet on lipid profile, glycemic indices, and blood pressure in postmenopausal women.
Cardiovascular risk factors
Cardiometabolic health
Methods: Embase, Medline, Cochrane Central Register of Controlled Trials, and Google Scholar were searched
Blood lipids from inception to February 2021. We included controlled clinical trials in postmenopausal women that assessed
Glycemic indices the effect of a whole-diet intervention on lipid profile, glycemic indices, and/or blood pressure. The risk of bias in
Blood pressure individual studies was assessed using RoB 2 and ROBINS-I tools.
Summary of evidence: Among 2,134 references, 21 trials met all eligibility criteria. Overall, results were heter
ogenuous and inconsistent. Compared to control diets, some studies showed that participants experienced im
provements in total cholesterol (TC), low-density lipoprotein cholesterol (LDL), systolic blood pressure (SBP),
fasting blood sugar (FBS), and apolipoprotein A (Apo-A) after following fat-modified diets, but some adverse
effects on triglycerides (TG), very low-density lipoprotein cholesterol (VLDL), lipoprotein(a) (Lp(a)), and high-
density lipoprotein cholesterol (HDL) concentrations were also observed. A limited number of trials found
some effects of the Paleolithic, weight-loss, plant-based, or energy-restricted diets, or of following American
Heart Association recommendations on TG, TC, HDL, insulin, FBS, or insulin resistance.
Conclusion: Current evidence suggests that diet may affect levels of some lipid profile markers, glycemic indices,
and blood pressure among postmenopausal women. However, due to the large heterogeneity in intervention
diets, comparison groups, intervention durations, and population characteristics, findings are inconclusive.
Further well-designed clinical trials are needed on dietary interventions to reduce cardiovascular risk in post
menopausal women.
1. Introduction age [5], resulting in increased risk of cardiovascular, osteoarthritis,

diabetes, cancers, and chronic kidney diseases [6–11]. Although
Menopause is reflected by reduced secretion of progesterone and menopause is a part of women life and its subsequent symptoms could
estrogen hormones [1]. Reduced estrogen may result in unfavorable affect their quality of life, this topic has only recently gained momentum
weight gain, changes in body fat distribution, reduced glucose tolerance, in the scientific literature.
and adverse changes in lipoprotein pattern [2–4]. The cumulative effect Dietary intervention is widely considered to be one of the most
of these changes might explain the consistently observed adverse asso important modifiable lifestyle factors as primary prevention for car
ciations between menopause and metabolic syndrome, independent of diovascular events in the general population [12]. In women, it has been
* Corresponding author.
E-mail address: [email protected] (T. Voortman).
#
These authors contributed equally in this systematic review.
https://doi.org/10.1016/j.maturitas.2021.10.001
Received 10 June 2021; Received in revised form 21 September 2021; Accepted 1 October 2021
Available online 9 October 2021
0378-5122/© 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
M. Amiri et al. Maturitas 155 (2022) 40–53
suggested that the dietary intakes are also associated with menopausal irrespective of health or disease status (in both intervention and control
symptoms severity, although the findings are inconsistent and incon groups); 4) reported at least one of the following outcomes: total
clusive [13]. cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol
So far, the majority of studies have investigated the effects of sup (HDL), non-HDL, low-density lipoprotein cholesterol (LDL), very low-
plements, nutrients, or isolated single foods on menopausal health issues density lipoprotein cholesterol (VLDL), lipoprotein (a) (Lp(a)), apoli
in postmenopausal women [14–18] and fewer studies have paid atten poprotein A and B (Apo A and Apo B), FBS, Insulin, Hemoglobin A1C
tion to the impact of a whole diet on cardiovascular risk factors in this (HbA1C), insulin sensitivity and resistance indices (Homeostatic Model
population. In this regard, several controlled clinical trials with various Assessment for Insulin Resistance (HOMA), quantitative insulin sensi
intervention diets and different findings on cardiovascular risk factors tivity check index (QUICKI)), systolic blood pressure (SBP), or diastolic
were published. For example, findings of Women’s Health Initiative blood pressure (DBP); 5) published in English.
Dietary Modification Trial (WHI-DM), designed to assess the effects of a We excluded all studies that 1) were uncontrolled clinical trials,
low-fat dietary pattern during 6 years in comparison with dietary observational, editorials, reviews, or conference abstracts; 2) were
guidelines for Americans, showed no considerable differences between designed to assess the impacts of only specific food components, nutri
intervention and control groups on cardiovascular risk factors [19, 20]. ents, supplements, or combined interventions (e.g. combination of diet
A parallel comparison between a healthy diet and habitual dietary in and physical activity/exercise, stress management, smoking cessation);
takes showed decreases in fasting blood sugar (FBS), total cholesterol 3) were conducted in men or women other than post-menopausal
(TC), and triglyceride (TG) levels in intervention group without any women.
considerable differences compared to the control group [21]. On the
other hand, a diet providing less than 30 % of energy from fats could 2.4. Study Selection and Data Extraction
considerably improve FBS, insulin, and insulin sensitivity in comparison
with habitual dietary intakes [22]. Also, a meta-analysis of clinical trials, Studies were selected in duplicate by independent researchers (MA,
published in 2014, observed no considerable effects following a low-fat IK, AVW, AV, ML) in two steps. In the first step, the titles/abstracts of the
diet intake on lipid markers in postmenopausal women [23]. identified articles were screened according to the eligibility criteria.
There is a lack of consensus regarding an optimal diet for improving Afterward, the full-texts of the included articles from the previous step
cardiometabolic health in postmenopausal women. Although previous were screened to identify the final number of eligible studies. Five re
reviews focused on of the role of supplements or single food compo searchers (MA, IK, AVW, AV, SB) extracted the following data from each
nents, the impacts of a whole diet on cardiovascular risk factors in this study: 1) general information (first author, publication year, country); 2)
population have been scarcely investigated. Thus, the purpose of this trial characteristics (design, sample size, intervention duration, inter
systematic review is to summarize current evidence from controlled vention/control details, feeding/nonfeeding, isocaloric or not); 3) par
clinical trials on the effects of dietary interventions on lipid profile, ticipants’ characteristics (health status and age); 4) summary of results
glycemic indices, and blood pressure in postmenopausal women. This regarding the mentioned lipid profile markers, glycemic indices, and
knowledge could assist further research in dietary intervention studies blood pressure, and any adjustments. On condition that multiple articles
and inform the development of dietary guidelines specifically for post reporting on the same outcomes from the same study, the information of
menopausal women. the article reporting the most complete groups of outcomes was
extracted. In the case of several intervention durations, findings of the
2. Methods longest period were extracted. Any lack of consensus about study se
lection or data extraction was adjudicated by a discussion with the
2.1. Review Design principal investigator (TV).
The current systematic review was conducted and reported based on 2.5. Quality Assessment
the Preferred Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) guidelines [24, 25]. The protocol of this review The quality of the included trials was assessed using Cochrane tool
was registered in PROSPERO (CRD42021242980). for assessing risk of bias in randomized trials (RoB 2 tool) [26] and Risk
Of Bias In Non-randomized Studies of Intervention (ROBINS-I) [27]. RoB
2.2. Data Sources and Search Strategy 2 tool estimates the risk of bias based on five domains, including 1)
randomization process; 2) deviations from intended interventions; 3)
A systematic search in Embase, Medline, Cochrane Central Register missing outcome data; 4) measurement of the outcome; 5) selection of
of Controlled Trials, and Google Scholar was performed to identify the reported result. ROBINS-I assesses the quality of the studies in spe
controlled clinical trials examining the effects of the whole diet cific domains in three levels, pre-intervention (bias due to confounding
compared to other diets, habitual diets, or general recommendations on and selection of participants), at intervention (bias in classification of
lipid profile, glycemic indices, and blood pressure in postmenopausal interventions), and post-intervention (bias due to deviations from
women irrespective of health status, from inception to February 2021. intended interventions, missing data, measurement of outcomes, selec
Related key terms to post-menopause, diet, lipid profile, glycemic tion of the reported result). Two investigators (SB and MA) performed
indices, blood pressure, and clinical trials were used to build the search the quality assessments and disagreements were resolved by discussion.
strategy. More information on PICO details and search strategy is pro
vided in the Supplementary Tables 1 and 2. A librarian expert (WMB) 3. Results
was involved in developing the search strategy. Additionally, the
reference lists of the eligible studies were screened to identify relevant 3.1. Search Outcome
articles.
Our search strategy yielded 2,134 references. Ninety-one articles
2.3. Inclusion and Exclusion Criteria were included after titles/abstracts screening. Full-texts screening
resulted in exclusion of 63 articles, of which ten studies were conference
Studies were included if they met the following criteria: 1) were abstracts [28–37], eight were conducted in populations other than
randomized or non-randomized controlled clinical trials; 2) designed to post-menopausal women [38–45], twenty-three did not meet our
assess the effects of a whole diet (e.g. low-fat, plant-based, low/high- intervention criteria [46–68], and twenty-two were excluded since they
carbohydrates diets); 3) conducted only in post-menopausal women were derived from the same projects and/or did not report relevant
41
outcomes [69–90]. Also, one full-text, published in 1987, could not be diet [22], and energy-restricted diet [114]. Four trials provided isoca
retrieved [91]. Eventually, 27 articles, reporting on 21 unique trials, loric diets [97, 101, 108, 112], and the diets of five trials were ad libitum
were included in the current systematic review [19–22, 92–114]. or self-selected, or were not isocaloric [93, 94, 103, 107, 109]. The rest
Figure 1 represents the study selection procedure. of included studies did not provide information on whether diets were
isocaloric. In six trials, prepared meals or raw food ingredients were
provided to the participants [92, 99–101, 108, 112] and in one study
3.2. Study Characteristics only the pre-prepared meals were obtained for the control group [98].
The remaining trials included nutrition counseling, individual goals, and
The included studies were published between 1990 and 2018. meals/cooking classes as the intervention methods. The intervention
Studies were conducted in Poland [92], Mexico [99], Sweden [109], the duration ranged between 3 weeks to 12 months for most studies, one
United States [19, 22, 93–95, 97, 98, 101, 102, 108, 112], Iran [21], study lasted for 2 years and one for 6 years [19, 109]. Fourteen trials
Canada [113], Australia [100], Ireland [96], Italy [103], Denmark were designed as parallel [19, 21, 22, 92–94, 99, 100, 102, 103, 107,
[114], and one study was conducted in several centers (Miami, Atlanta, 109, 113, 114] and seven were designed as cross-over [95–98, 101, 108,
Birmingham, and Seattle) [107]. Nine trials included an apparently 112]. Characteristics of the included studies are presented in Table 1.
healthy or general population of postmenopausal women [19, 21,
96–98, 103, 107, 108, 112]. Twelve studies included women with a 3.3. Quality and Risk of Bias
specific risk factor or history or disease only: six studies included obese
or overweight participants only [22, 93, 101, 109, 113, 114], one The details of risk of bias of 19 trials based on RoB 2 domains are
included only postmenopausal women with metabolic syndrome [92], summarized in Table 2. Among the included studies, 2 trials did not
one with hypertension [100], one only moderate hypercholesterolemia provide any information on randomization, thus we assumed them as
[95], and three studies were conducted on women with a history of non-randomized trials. The quality of these studies are presented in
breast cancer [94, 99, 102]. Regarding dietary interventions, most of the Table 3 using ROBINS-I tool. For randomized controlled trials, overall
trials intervened low/modified fat/fatty acids diets [19, 93–95, 97–99, risk identified “High risk” for two studies [21, 114] and the rest of
102, 107, 108, 112] and other interventions included Mediterranean studies were identified as “Some concerns”. Concerning the
diet [92], Paleolithic diet [109], healthy diet [21], diet based on non-randomized trials, one scored as “Critical” [95] and the other one as
American Heart Association recommendations [113], low-sodium “Serious” [98].
DASH-type diet [100], very low-carbohydrates diet [101],
high-sodium, high- protein diet [96], plant-based diet [103], weight-loss
Fig. 1. Study selection process.
42
M. Amiri et al.
Table 1
Characteristics of the included studies.
Source Country/ Study Design/ No. of Age2 (years) Health status Intervention Control Duration Dietary Results
name1 Randomization Participants/ intake
Intervention assessment
General/healthy
population of
postmenopausal
women
Young3, 2013 [1] United states C/ R 17/ 17 57±6 Healthy 1- Low-fat diet: 20 E% fats, 65 High-fat diet: 40 E% fat, 45 8w Daily Insulin, FBS,
E% CHO, 15 E% Pr 2- Low-fat, E% CHO, 15 E% Pr compliance HOMA
high n-3 diet:23 E fats, 62 E% records
CHO, 15 E% Pr
McColley3, 2011 United states C/ R 16/ 16 56.3±1.5 Healthy 1- Low-fat diet: 20 E% fats, 65 High-fat diet: 40 E% fat, 45 8w Daily TG↓C
[2] E% CHO, 15 E% Pr. 2- Low- E% CHO, 15 E% Pr compliance
fat, high n-3 diet: 23 E fats, 62 records
E% CHO, 15 E% Pr
Jeppesen, 1997 [3] United states C/ R 10/5 66±5 Healthy, non-diabetic Low-fat, high- CHO diet: 25 E High-fat, low-CHO diet: 45 E 3w NM TG↑*, TC,
% fats, 60 E% CHO, 5 E% Pr % fats, 40 E% CHO, 15 E% VLDL↑*, LDL,
Pr HDL↓*,TC:HDL↑
*
Kasim-Karakas£, United states C/ NR 54/ 54 61±11 Healthy Low-fat diet: 15E% fats 1- 35%-fat diet 2- 25%-fat 8m 7-day food Insulin, FBS↓*,
2000 [4] diet records HbA1C
Shikany4, 2011 [5] United states/ P/ R 2,263/ 892 I:61.5±6.9 General population, Low-fat diet: reducing total Dietary Guidelines for 6y FFQ Insulin, FBS,
WHI DM C:61.6±6.8 without T1DM and fat intake to 20% of energy, Americans and other health- HOMA, QUICKI
43
cancer increasing vegetable and fruit related materials

intakes to ≥5 servings and
grain
Howard4, 2010 [6] United states/ P/ R 2,730/ 1,068 I:61.6±6.9 General population, Low-fat diet: reducing total Dietary Guidelines for 6y FFQ TC, LDL, HDL,
WHI DM C:61.8±6.9 without T1DM and fat intake to 20% of energy, Americans and other Health- TG, non-HDL,
cancer increasing vegetable and fruit related materials TC:HDL, Lp[a]
grain
Tinker4, 2008 [7] United states/ P/ R 45,887/18,376 I:62.2±6.9 General population, Low-fat diet: reducing total Dietary Guidelines for 6y FFQ SBP, DBP
WHI DM C:62.2±6.9 without T1DM and fat intake to 20% of energy, Americans and other Health-
cancer increasing vegetable and fruit related materials
grain
Bhargava5, 2006 Multicenter#/ P/ R 994/ 615 50-79 General population low-fat diet: Reducing energy General dietary guideline 12 m FFQ LDL↓IC*,
[8] WHTFSMP intakes from fat to 20% and recommendations HDL↓IC*
increasing the consumption of
fruits, vegetables, and grain
products
Dallas Hall5, 2003 Multicenter#/ P/ R Glycemic: 50-79 General population low-fat diet: Reducing energy General dietary guideline 6m FFQ Insulin, FBS,
[9] WHTFSMP 1,067/660 BP: intakes from fat to 20% and recommendations SBP↓*, DBP
1,749/ 1,101 increasing the consumption of
Maturitas 155 (2022) 40–53

fruits, vegetables, and grain
products
(continued on next page)
M. Amiri et al.
Table 1 (continued )
Ginsberg, 1998 Multicenter##/ C/ R 18/ 18 57.5 Healthy 1- NCEP: 30 E% fats (9 E% Average American diet: 37 E 8w NM TC↓*, LDL↓*,
[10] DELTA SFA, 14 E% MUFA, and 7 E% % fats (16 E% SFA, 14 E% HDL↓*, TG, Apo
PUFA), 55 E% CHO, 15 E% Pr. MUFA, and 7 E% PUFA), 48 A-1↓*^, Apo B, Lp
2- Low-Sat diet: 26 E% fats (5 E% CHO, 15 E% Pr (a) ↑*^, TC:HDL
E% SFA, 14 E% MUFA, and 7
E% PUFA), 59 E% CHO, 15 E
% Pr
Harrington, 2004 Ireland C/ R 26/26 57.1±5.1 Healthy High-sodium, high- protein Low- sodium, usual-protein 4w 4-day food SBP, DBP
[11] diet: 180 mmol/d day of Na intake records
and 90 g/day of Pr
Abedi, 2012 [12] Iran P/ R 64/ 35 I:51.4 ±4.9 Healthy Healthy diet: fruits and Habitual intakes 6m 24-hour TC↓IC, TG↓I, LDL,
C:51.6±5.7 vegetables ≥5 servings, whole recall HDL, FBS↓I, SBP,
grain foods, high fiber foods, DBP
fish (two times per week),
<10 E% SFA, cholesterol
<300 mg/day, salt <5 g/day
Muti6, 2003 [13] Italy/ DIANA P/ R 99/ 50 50-65 Healthy Plant based diet: A leaflet based on Europe 18 w 24-h diaries TC↓*
Mediterranean vegetarian against Cancer program:
and macrobiotic recipes were advised to increase the
fruit and vegetables
consumption.
Berrino6, 2001 Italy/ DIANA P/ R 99/ 50 50-65 Healthy Plant based diet: A leaflet based on Europe 18 w 24-h diaries Insulin, FBS
44
[14] Mediterranean vegetarian against Cancer program:

and macrobiotic recipes. were advised to increase the
fruit and vegetables
consumption.
Postmenopausal
women with
cardiovascular
risk factors
Barnard, 2005 United states P/ R 59/ 29 I:57.4 Overweight Low-fat, plant-based diet: 10 NCEP: 30 E% fat (7 E% SFA), 14 w 3-day food Insulin↓I, FBS↓I,
[15] C:55.6 E% fats, 75 E% CHO, 15 E% 55 E% CHO, 15 E% Pr, record Insulin
Pr Cholesterol <200 mg/day sensitivity↑I
Denke, 1994 [16] United states C/ NR 39/ 39 61±6 Moderate Fat-modified step 1 diet: High-Sat diet: 40 E% fats, 16 3m 7-day food TC↓I*, LDL↓I*,
hypercholesterolemia Based on NCEP and AHA E% SFA, 450 mg/d dietary records VLDL, HDL, TG
recommendations (30 E% cholesterol
fats, 10 E% saturated fats,
<300 mg/d dietary
cholesterol )
C J Segal-Isaacson United states C/ R 4/2 52.3±3.8 Overweight/obese Very low-CHO diet: 5 E% to Low-fat diet: Same energy 6w FFQ TC↓IC, TG↓I,
2004 [17] 10 E% CHO and protein content LDL↓IC, HDL↓IC,
Insulin, FBS↓IC
Svendsen, 1993 Denmark P/ R 72/51 53.8±2.5 Overweight Energy-restricted Diet: Up to Habitual intakes 12 w 7-day food TG↓*, TC↓*,
[18] 4.2 MJ/day. diary HDL, VLDL↓*,
Maturitas 155 (2022) 40–53

LDL↓*, HDL:
LDL↑*, SBP↓*,
DBP
M. Amiri et al.
Mason, 2011 [19] United states/ P/ R 185/ 105 I:58.1±5.9 Overweight/obese 1200–2000 kcal/day, <30 E% Habitual intakes 12 m FFQ Insulin↓*, FBS↓*,
NEW C:57.4±4.4 fats, and 10% weight loss HOMA↓*
Seńećhal, 2012 Canada P/ R 19/ 9 62.6±4.1 Obese AHA recommendations: 30 E Habitual intakes 12 w Food diary TC↓I, TG↓I,
[20] % fats, 55 E% CHO, 15 E% Pr HDL↓I*, LDL↓I,
TC:HDL, Insulin,
FBS, HOMA,
QUICKI, SBP↓I,
DBP↓I
Bajerska, 2018 Poland P/ R 144/ 72 60.5 Metabolic Syndrome Mediterranean diet: 37 E% Central European diet: 16 w 3-day food TC↓IC, LDL↓I,
[21] fats (20 E% MUFA, 9 E% Based on NCEP and AHA diary HDL↓C, TG↓IC,
PUFA, 8 E% SFA), 45 E% recommendations (27 E% Insulin↓IC,
CHO, 18 E% Pr fats [10 E% MUFA, 9 E% FBS↓IC,
PUFA, 8 E% SFA], 55 E% HOMA↓IC,
CHO, 18 E% Pr. Emphasis on SBP↓IC, DBP↓IC
dietary fiber)
Otten7, 2016 [22] Sweden P/ R 41/ 25 I:61±6 Obese Paleolithic diet: 40 E% fats, Nordic Nutrition 24 m 4-day food HOMA
C:62±6 30 E% CHO, 30 E% Pr. Recommendations (4th records
Recommended to intake edition): 25–30 E% fats,
higher MUFA and PUFA 55–60 E% CHO, 15 E% Pr.
Emphasis on low-fat dairy
products and high-fiber
products
45
Mellberg7, 2014 Sweden P/ R 49/ 27 I:59.5±5.5 Obese Paleolithic diet: 40 E% fats, Nordic Nutrition 24 m 4-day food TC, HDL, LDL,
[23] C:60.3±5.9 30 E% CHO, 30 E% Pr. Recommendations (4th records TG↓I*, Insulin,
Recommended to intake edition): 25–30 E% fats, FBS, SBP, DBP,
higher MUFA and PUFA 55–60 E% CHO, 15 E% Pr.
Emphasis on low-fat dairy
products and high-fiber
products
Nowson, 2009 Australia P/ R 95/46 I:60±0.7 Hypertensive Low-sodium DASH-type diet: Higher acid load healthy 14 w 3-day food SBP↓IC, DBP↓IC,
[24] C:58.4±0.7 with a low dietary acid load diet: based on general record
containing 6 servings of 100g dietary guidelines to reduce
lean red meat/week. Rich in fat intake and increase
fruit and vegetables and had a intake of breads and cereals
higher potassium and
magnesium content.
Postmenopausal
women with
breast cancer
Buzzard, 1990 United states P/ R 28/ 17 I:60±2 Breast cancer Low-fat diet: Reducing total No counseling regarding fat 3m 4-day food TC↓I
[25] C:61±3 fat intake, using combination intake records
of education, goal setting,
evaluation, feedback, and
participant self-monitoring.
Maturitas 155 (2022) 40–53

Thomson 2010 United states P/ R 38/20 57.8±9.3 Breast cancer survivors Low-fat diet: 25 E% fats, Low-CHO diet: Modified 24 w FFQ TC↓I, LDL↓I,
[26] 55–60 E% CHO, 15–20 E% Pr Atkins diet (35–40 E% fats HDL↑I, TC:HDL,
with greater MUFA, 35 E% TG↓C, FBS,
CHO, 25–30 E% Pr) HbA1c↓C,
3.4. Summary of Evidence
If available, the name of the studies are reported. 2 Age is presented as either mean ± SD or min-max as years. R: Randomized; NR: Non-Randomized; P: Parallel; C: Cross-over; m: Months; w: Weeks; NM: Not mentioned; y:
Both articles were conducted on a same project. 4 These papers were published from findings of the Women’s Health Initiative Randomized Controlled Dietary Modification Trial (WHI DM). 5 These papers were derived
Three clinical centers (Miami, Atlanta, Birmingham) and the Fred Hutchinson Cancer Research Center in Seattle. ## Columbia University, Pennington Biomedical Research Center, Pennsylvania State University, and
Although this study reported some other outcomes of interest, we decided to only use glycemic indices results. In this study, dietary intervention accrued in two phases: 15% fat diet (as the intervention) and low-fat diets
Years; E%: Percent of energy intake; CHO: Carbohydrates; Pr: Proteins; PUFA: Polyunsaturated fatty acids; MUFA: Monounsaturated fatty acids; BP: Blood pressure; FFQ: Food frequency questionnaire; AHA: American
in which fat intake was reduced in a stepwise manner from 35% to 15% (as the control). The last diet in the control duration (15%) was similar to the intervention diet, so we decided to extract only findings that compare
density lipoprotein cholesterol; HDL: High-density lipoprotein cholesterol; Apo: Apo lipoprotein; TC:HDL: TC to HDL ratio; Lp(a): Lipoprotein(a); FBS: Fasting blood sugar; HOMA: Homeostatic Model Assessment for
Heart Association; NCEP: National Cholesterol Education Program; DASH: dietary approaches to stop hypertension; TG: Triglyceride; TC: Total cholesterol; LDL: Low-density lipoprotein cholesterol; VLDL: Very low-
QUICKI↓I, SBP↓I,
Due to the nature of the data, limited number of studies, and large
HOMA↓IC,
Insulin↓C,
heterogeneity among studies, including various designs, population
from Women’s Health Trial: Feasibility Study in Minority Populations (WHT:FSMP). 6 These papers were derived from Diet and Androgens Study (DIANA). 7 These papers are derived from the same project.
Results
characteristics, and comparisons, we decided to systematically sum
FBS↓I
DBP, marize current evidence and to not perform a quantitative meta-
analysis. In the following paragraphs, the findings of the included
studies are explicated. If available, within and/or between mean
assessment
changes are reported.

Dietary
intake
NM
3.4.1. General/healthy population of postmenopausal women

Out of 21 trials, 9 reported the effects of diet on lipid profile, gly
Duration
cemic indices, and blood pressure in general/healthy population of

6m
postmenopausal women. Among these trials, low-fat diets were the most
diet as the intervention and dietary recommendations were used as the
Significant changes within intervention group. C Significant changes within control group. *Significant changes in the intervention group compared to the control group.
Association: 30 E% fats, 50 E
most comparisons.
A cross-over trial assessed the effects of two low-fat diets (low-fat
diet and low-fat, high n-3 diet) compared to a high-fat diet in 17 healthy
American Dietetic
% CHO, 20 E% Pr
Insulin Resistance; QUICKI: Quantitative insulin sensitivity check index; HbA1c: Hemoglobin A1c; SBP: Systolic blood pressure; DBP: Diastolic blood pressure;
postmenopausal women for 8 weeks. The authors reported no significant

differences following the treatment periods compared to the control
period for serum insulin levels, FBS, and HOMA (p > 0.05) [112].
Control
Additionally, finding of this study on 16 participants demonstrated that

the high-fat diet reduced TG level considerably (-35.5 mg/dl, p < 0.05)
without any significant between-group differences [111].
Low-fat diet: 12 E% fats, 68 E
Another cross-over trial observed significant increases for TG (p <

0.001), VLDL (p < 0.05) levels, and TC:HDL (p < 0.002) and a signifi
cant decrease in HDL (p < 0.05) concentration following a low-fat, high-
% CHO, 20 E% Pr
carbohydrate diet compared to a high-fat, low-carbohydrates diet after 3

weeks of intervention. No considerable effects were observed on TC and
Intervention
LDL levels in this small sample (n = 10) [97].

A cross-over study on 54 healthy postmenopausal women investigate
the effects of a 15 % fat diet compared to 25 and 35% fat diets. This
study showed no significant changes in insulin and HbA1c levels while
the intervention diet considerably reduced FBS in comparison with the
control diets [98].
Findings of three sub-studies of 6-year WHI-DM trial are presented in
Breast cancer
Health status
the following paragraphs. This clinical trial aimed at investigating the

effects of a reduced-fat diet in comparison to a control group (Dietary
Guidelines for Americans) on glycemic indices, lipid profile, and blood
pressure. Statistical analysis on 2,263 postmenopausal women without
Age2 (years)
C:52.3±6.1
diabetes and cancer showed no significant differences for FBS, insulin

I:50.5±7.9
sensitivity, and insulin resistance between the intervention and control

the effects of intervention diet to 35% and 25% fat diets as the control periods.
groups (p > 0.05) [105]. Also, a sub-study by Howard et al. among 2,730
participants, did not find any significant within or between-arms
changes in the levels of either TC, LDL, HDL, TG, non-HDL, TC:HDL,
^ Only one of the interventions (low-Sat diet) compared to the control.
Participants/
Intervention
and Lp(a) (p > 0.05), when comparing the intervention and control
groups [19]. And Tinker et al. showed the insignificant effect of the
100/ 50
No. of
intervention on SBP and DBP in (p > 0.05) 45,887 participants as well

[20].
Another intervention with a low-fat diet compared to general dietary
Randomization
guideline recommendations on 994 participants of Women’s Health

Trial: Feasibility Study in Minority Populations (WHTFSMP) reported
Design/
significant reductions in LDL and HDL levels in both intervention and

P/ R
control groups as well as between groups after 12 months (p < 0.05)

[106]. In addition, according to the findings of this trial reported by
Country/ Study
Dallas Hall et al. on 1,067 participants no considerable changes in FBS

(-0.2 vs -0.1 mmol/L, p > 0.05) and insulin (-0.5 vs 0.3 µlU/mL, p >
0.05) levels after 6 months of intervention compared to the control diet
Mexico
name1
were observed. However, adhering to the low-fat diet showed a signif

University of Minnesota.
icant reduction in SBP compared to the general dietary recommenda

tion, while no significant effect on DBP was reported [107]. And neither
a high-sodium, high- protein diet nor a low-sodium, usual-protein diet
Murillo-Ortiz,
significantly affected DBP or SBP levels in 26 postmenopausal women in

2017 [27]
a 4-week cross-over trial [96].

Source
The delta Study, a multicenter 8-week cross-over study, on 18

healthy postmenopausal women compared the effects of two diets (one
#
1
£
I
46
Table 2
Risk of bias in randomized trials (RoB 2 tool).
First author, year Randomization deviations from intended missing outcome measurement of the selection of the Overall
process interventions data outcome reported result assessment
McColley et al., 2011 Some concerns Some concerns Low risk of bias Some concerns Low risk of bias Some concerns
[1]
Jeppesen et al., 1997 Some concerns Some concerns Low risk of bias Some concerns Low risk of bias Some concerns
[2]
Howard et al., 2006 [3] Some concerns Some concerns Low risk of bias Low risk of bias Low risk of bias Some concerns
Dallas Hall et al., 2003 Some concerns Some concerns Some concerns Low risk of bias Low risk of bias Some concerns
[4]
Ginsberg et al., 1998 Some concerns Low risk of bias Some concerns Some concerns Low risk of bias Some concerns
[5]
Harrington et al., 2004 Some concerns Some concerns Low risk of bias Some concerns Low risk of bias Some concerns
[6]
Abedi et al., 2010 [7] Some concerns Some concerns High risk of bias Some concerns Low risk of bias High risk of bias
Berrino et al., 2001 [8] Some concerns Some concerns Low risk of bias Low risk of bias Low risk of bias Some concerns
Barnard et al., 2005 [9] Some concerns Some concerns Low risk of bias Some concerns Low risk of bias Some concerns
C J Segal-Isaacson 2004 Some concerns Some concerns Some concerns Some concerns Low risk of bias Some concerns
[10]
Svendsen et al., 1993 High risk of bias Some concerns Low risk of bias Low risk of bias Low risk of bias High risk of bias
[11]
Mason et al, 2011 [12] Some concerns Some concerns Low risk of bias Low risk of bias Low risk of bias Some concerns
Seńećhal et al. 2011 Some concerns Some concerns Low risk of bias Some concerns Low risk of bias Some concerns
[13]
Bajerska et al., 2018 Low risk of bias Some concerns Low risk of bias Low risk of bias Low risk of bias Some concerns
[14]
Mellberg et al., 2014 Low risk of bias Some concerns Low risk of bias Low risk of bias Low risk of bias Some concerns
[15]
Nowson et al., 2009 Some concerns Some concerns Low risk of bias Some concerns Low risk of bias Some concerns
[16]
Buzzard et al., 1990 Some concerns Some concerns Some concerns Some concerns Low risk of bias Some concerns
[17]
Thomson et al., 2010 Some concerns Some concerns Low risk of bias Some concerns Low risk of bias Some concerns
[18]
Murillo-Ortiz et al., Some concerns Some concerns Low risk of bias Some concerns Low risk of bias Some concerns
2017 [19]
Table 3
Risk of bias in non-randomized trials (ROBINS-I).
First author, Risk of Risk of Risk of Misclassification Risk of deviation from Risk of Risk of Risk of Overall
year confounding selection of interventions intended interventions missing data misclassification of reporting risk of bias
bias outcomes bias
Denke, 1994 Critical Low Low Low Low Low Low Critical
[20]
Kasim- Serious Low Low Low Moderate Low Low Serious
Karakas,
2000 [21]
based on national Cholesterol Education Program (NCEP) and the other who followed a plant-based diet compared to the control group (-14% vs
one, a low-saturated-fat diet) with the average American dietary intakes. -4%, p = 0.005). In this study, the control women were not given any
TC, LDL, and HDL concentrations were significantly decreased in both specific dietary instruction, they were advised to increase the con
intervention groups in comparison with the control group (p < 0.05) sumption of fruit and vegetables [104]. Also, another report from
while no considerable differences were observed in TG, Apo B, and TC: DIANA study performed by Berrino et al. revealed insignificant effects of
HDL levels (p > 0.05). This study also indicated that the low-saturated- this plant-based diet compared to the control group on insulin (-10,6%
fat diet significantly reduced Apo A-1 and increased Lp(a) levels vs 5.2%, p = 0.72) and FBS (-5.7% vs -1.2%, p = 0.05) levels [103].
compared to the control group (p < 0.05) [108].
A 6-month intervention on 64 healthy postmenopausal women 3.4.2. Postmenopausal women with cardiovascular risk factors
compared the effects of a healthy diet with habitual dietary intakes. Among included studies, 9 trails investigated the effects of diet on
After comparing pre and post-intervention values of this parallel study, the outcomes of interest in postmenopausal women with CVD risk fac
significant decreases in serum levels of TC were found in both inter tors, including obesity/overweight, metabolic syndrome, hypertension,
vention (-12 mg/dl) and control (-12 mg/dl) groups (p < 0.05) and and hypercholesterolemia. A variety of diets were intervened in this
significant decrease in TG levels was only found in the healthy diet arm population, such as fat-modified, energy-restricted, Mediterranean,
(-18.9 mg/dl, p < 0.05). No considerable effect was shown on HDL and DASH, and Paleolithic diets.
LDL concentration (0.40 vs -0.1 mg/dl, -6 vs -7 mg/dl, respectively, p > A parallel trial assessed the effects of a low-fat, plant-based diet
0.05) as well as FBS level. However, FBS was significantly decreased compared to the NCEP recommendation in 59 overweight post
within the healthy diet group (-4.5 mg/dl, p < 0.05) [21]. menopausal women. After 14 weeks of intervention, FBS and insulin
Findings of the Diet and Androgens Randomized Trial (DIANA), an levels were significantly decreased and insulin sensitivity was increased
18-week intervention on 99 healthy postmenopausal women done by in the low-fat, plant-based group without any considerable differences
Muti et al., showed a considerable reduction of TC level in participants with the control group [93].
47
Results of a 3-month cross-over trial on 39 postmenopausal women improvements of TC (-5.2 mg/dl, p = 0.02), LDL (-7.8 mg/dl, p = 0.007),
with moderate hypercholesterolemia showed significant decreases in TC HDL (0.4 mg/dl, p = 0.002) and SBP (− 8.6 mmHg, p = 0.03) levels in
(-5%) and LDL (-6%) levels (p < 0.005) within the fat-modified step 1 the low-fat diet group. A considerable within-group decreases in TG
diet and in comparison with the high-fat, high-saturated diet. Between (-31.1 mg/dl, p = 0.01), insulin (-2.6 µU/ml, p = 0.002), and HbA1c
and within-group changes for VLDL, HDL and TG were not statically (-0.1, p = 0.006) was noted in low-carbohydrate arm. The reductions of
considerable (p > 0.05) [95]. HOMA in both diets (-1.2, -0.7, p = 0.03) and QUICKI in low-fat diet (p
Segal-Isaacson et al. showed that both a very low-carbohydrate diet = 0.005) were observed. TC:HDL, FBS, and DBP were not affected
and a low-fat diet resulted in significant decreases of TC, LDL, HDL, and considerably by intervention or control arms. No changes were observed
FBS levels (p ≤ 0.05) during 6 weeks follow up in 4 overweight or obese between the two groups during a follow up of 24 weeks [102].
postmenopausal women. The concentration of TG was significantly Also, another parallel clinical trial in which 28 postmenopausal
reduced only in the very low-carbohydrate diet group. Neither of the women with breast cancer received either counseling to lower their fat
diets affected the insulin level significantly. No statistically considerable intake or not. After 3 months, TC concentration significantly decreased
differences between intervention and control groups were observed for with 0.48 mmol/L (p < 0.01) in intervention arm and no considerable
any of the outcomes (p > 0.05) [101]. between groups changes were reported [94].
Svendsen et al. noted that an energy-restriction diet in post Murillo-Ortiz et al. performed a clinical trial investigating the effects
menopausal women with overweight improved TG, TC, LDL, HDL:LDL, of a reduced-fat diet compared to a ADA recommendation on 100
VLDL, and SBP levels in comparison with a usual diet (p < 0.001). No postmenopausal women with breast cancer. After 6 months, a significant
differences were observed for HDL and DBP in 72 women during the 12 decrease in FBS was observed in the intervention group compared to its
weeks follow up period [114]. baseline level (-7.5 mg/dl, p < 0.0001) [99].
Findings from Mason et al. in 185 overweight or obese post
menopausal women which investigated the effect of a weight loss diet 4. Discussion
(providing 1200–2000 kcal/day, and less than 30% of energy intake
from fats) compared to the habitual intakes for 12 months indicated the This systematic review summarizes the available evidence on the
reducing effects of the intervention group compared to the control group effect of whole diets on cardiovascular risk factors in postmenopausal
for FBS, insulin and HOMA levels [22]. women. We observed that various types of diet have been used in
Seńećhal et al. compared the effects of AHA recommendations to intervention studies in this population, which the majority focused on
habitual dietary intakes on 19 obese postmenopausal women. Twelve modified-fat diets. To summarize, some studies showed that fat-
weeks of intervention caused significant improvements in TC, TG, LDL, modified diets led to improvements of some risk factors such as LDL,
SBP, and DBP levels in the intervention group, while no differences were TC, SBP, FBS, or Apo A; however, harmful effects on TG, VLDL, Lp(a)
observed between groups (p > 0.05). Additionally, AHA recommenda and HDL were also observed. Furthermore, some interventions other
tions led to a significant reduction of HDL levels in comparison with the than fat-modified diets, including the Paleolithic diet, AHA recom
control group (p ≤ 0.05) and no significant changes were observed with mendations, a plant-based diet, and energy-restricted or weight-loss
respect to TC:HDL. Also, intervention diet resulted in no significant diets, found benificial effects on some cardiovascular risk factors such
within or between differences in the levels of insulin, FBS, HOMA, and as TG, TC, HDL, insulin, FBS, HOMA compared to the control diets.
QUICKI (p > 0.05) [113]. However, these findings should be interpreted with caution due to the
Findings of a study done by Bajerska et al. in 144 women with large heterogeneity between intervention diets, comparison groups,
metabolic syndrome showed decreases in TG (-33.9 vs -38.8 mg/dl), TC intervention durations, and population characteristics. Additionally,
(-15.5 vs -11.2 mg/dl), FBS (-6.4 and -5.4 mg/dl), insulin (-3.5 and -3.1 some of these findings are based on single studies only.
µU/ml), HOMA (-0.46 and -0.42), DBP (-6.7 and -8.1 mmHg), and SBP Chronic diseases are the leading causes of morbidity and mortality
(-10.02 and -10.04 mmHg) for either of the Mediterranean diet and worldwide and aging is one of its greatest risk factors. Additionally, in
Central European diet without any considerable differences between women, physiological manifestations resulting from menopause could
them. Within groups decrease in LDL concentration was noted for lead to long-term chronic diseases such as CVD [115]. Diet has been
women consuming Mediterranean diet (-9.4 mg/dl, p < 0.05) while the studied as an modifiable lifestyle factor for cardiometabolic health.
women consuming Central European diet showed a decrease in HDL Findings of the Brisighella Heart Study, a prospective population-based
level (-2 mg/dl, p < 0.05) after 16 weeks intervention [92]. cohort, are suggestive of protective effects of nutritional education
A 24-month parallel comparison between the Paleolithic diet and 4th against SBP elevation, hypercholesterolemia, and prevalence of meta
edition Nordic nutrition recommendations done by Mellberg et al. bolic syndrome related to menopause [116]. However, healthy dietary
illustrated the insignificant effects of the Paleolithic diet on TC, LDL, patterns assessed with various diet quality scores (such as DASH, MED,
HDL, insulin, FBS, HOMA, and blood pressure levels in 49 obese post aMED, HEI-2010, MDS, MexD), were not associated with risk of meta
menopausal women in comparison with the control. A significant bolic syndrome in the recent Women’s Health Initiative observational
reduction of TG levels was observed in the intervention group (-0.23 vs prospective cohort study [117]. Nonetheless, a higher healthy eating
-0.01 mmol/L, p = 0.004) compared to the control group [109, 110]. index (HEI-2010) score was significantly associated with lower levels of
Nowson and colleagues compared a vitality diet and a higher acid TG and FBS and higher level of HDL. Moreover, better adherence to the
load healthy diet in 95 women with hypertension followed for 14 weeks. DASH diet was associated with lower glucose levels and higher HDL
Decreases in SBP (-5.6 mmHg, p < 0.001 and -2.7 mmHg, p < 0.01) and levels [117]. The association of HEI with metabolic risk factors in
DBP (-4.1 mmHg, p < 0.001, and -2.9 mmHg, p < 0.001) were observed postmenopausal women were studied by two cross-sectional studies,
in both groups without any significant differences between groups concluding that inappropriate dietary habits may negatively affect car
[100]. diometabolic indicators/ risk factors [118, 119]. The impacts of diets on
cardiovascular health could be defined by different mechanisms. For
3.4.3. Breast cancer survivors instance, increasing the consumption of some food groups like whole
The findings of 3 trials in post-menopausal women with breast can grains and legumes might improve TC, blood glucose, and insulin due to
cer are presented below. In all 3 trials the effects of a low-fat diet were the high content of soluble fiber [120, 121]. Several nutrients such as
investigated. Habitual intake, low-carbohydrate diet and American Di vitamin C, folic acid, potassium, magnesium, flavonoids, and caroten
etetic Association (ADA) were recommended as the comparisons. oids have been suggested to improve endothelial function or to cause
Findings of a parallel comparison between a low-fat diet and a low- vasodilation, which may play a role in the blood pressure lowering ef
carbohydrate diet in 38 breast cancer survivors demonstrated fects of fruits and vegetables [122, 123]. Higher intake of n-3 fatty acids
48
may result in a reduction of cardiovascular risk factors [124, 125] and a interventions specifically with the mentioned diets using well-designed
lower intake of saturated fats may cause a reduction in cardiovascular controlled clinical trials in different regions exclusively in this
events [126]. In this regard, according to a presidential advisory from population.
the American Heart Association, randomized controlled trials that
replaced dietary saturated fats intake with polyunsaturated vegetable Conclusion
oils reduced the risk of CVD by about 30%; however, no association was
observed when these fats were replaced by refined carbohydrates and To the best of our knowledge, this is the first review that systemat
sugar. Additionally, in both population-based studies and trials, ically summarizes the effects of whole diet interventions on lipid profile,
replacement of saturated fats with unsaturated fats lowered the con glycemic indices, and blood pressure exclusively in postmenopausal
centration of LDL, as a cause of atherosclerosis [127]. women. This study confirmed that this area has a limited level of evi
On a higher level, dietary interventions may be part of larger overall dence. Even though some diets showed considerable effects on various
lifestyle interventions. Some studies suggested that lifestyle modifica cardiometabolic risk factors, the number of trials for each diet are too
tion may reduce the risk of diseases such as diabetes and coronary heart limited to draw firm conclusions.
diseases and improve cardiovascular risk factors in different populations This systematic review highlights the need to conduct well-designed
[128–132]. A 6-month clinical trial on postmenopausal women controlled clinical trials with a larger population and stronger statistical
concluded that lifestyle intervention may be also an effective tool for approaches in this underrepresented population, helping to develop
improving cardiovascular risk factors in this population. In this study, better targeted dietary recommendations for postmenopausal women.
exercise, nutrition education, eating behavior self-monitoring, attitudes,
and relationships were modified as lifestyle factors [133]. Also, a com Contributors
bination of a Mediterranean low-saturated fat diet, stress management,
exercise, group support, and smoking cessation improved HbA1c and Mojgan Amiri contributed to the conception and design of the study,
body composition in postmenopausal women with type 2 diabetes screened titles/abstracts and full texts, determined the eligibility of the
[134]. articles, extracted the data, assessed the quality of the included studies,
Although the beneficial effects of different diets on cardiometabolic participated in drafting the manuscript, and revised and finalized the
health have been established [135–137], this study shows inconsistent manuscript.
findings and lack of high-quality information on the effects of whole Irma Karabegović screened titles/abstracts and full texts, extracted
diets on cardiovascular risk factors specifically in postmenopausal the data, and participated in drafting the manuscript.
women. Some of the included trials have shown benefits of diet on some Anniek C. van Westing screened titles/abstracts and full texts,
lipid profile makers, glycemic indices, and blood pressure in post determined the eligibility of the articles, extracted the data, and
menopausal women [21, 22, 92, 93, 99, 101, 102, 104, 106, 108, 109, participated in drafting the manuscript.
113]; however, others have not [19, 20, 96, 103, 105, 107, 109, 110, Auke J.C.F Verkaar screened titles/abstracts and full texts, and
112] and the majority of them did not find any considerable differences extracted the data.
between the intervention diets and the controls. Underrepresentation of Sara Beigrezaei extracted the data and assessed the quality of the
the elderly population and women in cardiovascular clinical trials has included studies.
been discussed for several years [138–140] while due to the hormonal Macarena Lara screened titles/abstracts and full texts.
changes and lipid abnormalities, like increased concentrations of LDL Wichor M. Bramer developed and applied the search strategy.
and TC [141], the development of CVD is higher after menopause Trudy Voortman contributed to the conception and design of the
[142–144] and CVD is a major health issue at older ages in women study, and revised and finalized the manuscript.
[145]. Also, despite sharing lipid abnormalities, for example in in All authors read and approved the final version of manuscript.
dividuals with diabetes, women suffer from a more aggressive form of
coronary artery disease and are more susceptible to death from CVD in Funding
comparison to men [146, 147]. These consequences and complications
associated with menopause show the importance of exclusive attention No funding from an external source was received for the preparation
to women and optimized treatment of comorbidities not only to alleviate of this review.
risk factors but also to decrease the cardiovascular mortality in this
population [145], which diet is a promising way to reduce risks of
Provenance and peer review
various of these risk factors and consequences.
In order to achieve more conclusive results regarding the impact of
This article was commissioned and was externally peer reviewed.
diet on cardiovascular risk factors and consequently to find the most
relevant diet for postmenopausal women, the limitations of the current
Declaration of competing interests
evidence should be noted to improve future research. The assessments of
risks of bias demonstrated the low quality of the included studies in
The authors declare that they have no competing interests.
design or conducting. The majority of the studies did not report infor
mation on the randomization and concealment methods, increasing the
risk of selection bias. For those studies that were not randomized, po Supplementary materials
tential confounding could be present. Additionally, participants were
not blinded to the diets in most studies; however, for whole diet in Supplementary material associated with this article can be found, in
terventions that is hardly possible. We also observed that most of the the online version, at doi:10.1016/j.maturitas.2021.10.001.
studies were conducted in the United States. Concerning the lifestyle and
genetic background differences and their effects on the findings of the References
research, more studies in other societies are granted. Finally, most in
[1] HD. Nelson, Menopause. Lancet. 371 (9614) (2008) 760–770.
terventions are on low/modified fats while studies on other promising [2] GM Rosano, C Vitale, G Marazzi, M. Volterrani, Menopause and cardiovascular
dietary interventions such as Paleolithic, plant-based, DASH, Mediter disease: the evidence, Climacteric: the journal of the International Menopause
ranean, low/high carbohydrates, and etc. are more lacking. Considering Society 10 (1) (2007) 19–24. Suppl.
[3] CJ Crandall, E. Barrett-Connor, Endogenous sex steroid levels and cardiovascular
that menopause worsens the CVD risk factors and diet, as an inseparable disease in relation to the menopause: a systematic review, Endocrinol Metab Clin
part of lifestyle, is a way to control them, we recommended more North Am 42 (2) (2013) 227–253.
49
[4] D Zhao, E Guallar, P Ouyang, V Subramanya, D Vaidya, CE Ndumele, et al., [31] R Jumpertz-von Schwartzenberg, U Zeitz, D Hampel, M Boschmann, F Luft,
Endogenous Sex Hormones and Incident Cardiovascular Disease in Post- J Spranger, et al., Glucose regulation during weight loss under dissociation of
Menopausal Women, J Am Coll Cardiol 71 (22) (2018) 2555–2566. negative energy balance and changed body composition: preliminary data from
[5] MC. Carr, The emergence of the metabolic syndrome with menopause, J Clin an ongoing randomized controlled trial, Diabetologie und stoffwechsel 9 (2014).
Endocrinol Metab 88 (6) (2003) 2404–2411. [32] LS Kinzel, FM Averbach, KS Clark, WS Pappert, MA Boraz, AM Buhari, et al.,
[6] AS Karlamangla, SM Burnett-Bowie, CJ. Crandall, Bone Health During the A high carbohydrate, low fat, hypocaloric eating pattern using functional foods
Menopause Transition and Beyond, Obstet Gynecol Clin North Am 45 (4) (2018) along with increased physical activity in postmenopausal women decreases
695–708. cardiovascular risk factors, Journal of the american dietetic association 104
[7] AR Assaf, AG Bushmakin, N Joyce, MJ Louie, M Flores, M. Moffatt, The Relative (2004) 31.
Burden of Menopausal and Postmenopausal Symptoms versus Other Major [33] AM May, W Van Gemert, P Peeters, J Van Der Palen, J Schuit, E. Monninkhof,
Conditions: A Retrospective Analysis of the Medical Expenditure Panel Survey Effects of equivalent weight loss, with or without exercise, on sex hormones
Data, Am Health Drug Benefits 10 (6) (2017) 311–321. related to breast cancer risk in postmenopausal women: the SHAPE-2 trial,
[8] R Slopien, E Wender-Ozegowska, A Rogowicz-Frontczak, B Meczekalski, Journal of clinical oncology 32 (1) (2014), 15 SUPPL.
D Zozulinska-Ziolkiewicz, JD Jaremek, et al., Menopause and diabetes: EMAS [34] A McTiernan, C Duggan, JDD Tapsoba, C Mason, CY. Wang, Long-term effects of
clinical guide, Maturitas 117 (2018) 6–10. weight loss on breast cancer biomarkers in postmenopausal women, Cancer
[9] PA. Ganz, Breast cancer, menopause, and long-term survivorship: critical issues research 77 (4) (2017).
for the 21st century, Am J Med 118 (12B) (2005) 136–141. Suppl. [35] E Normandin, M Senechal, D Prud’homme, R Rabasa-lhoret, M. Brochu,
[10] K Vellanki, S. Hou, Menopause in CKD, Am J Kidney Dis 71 (5) (2018) 710–719. Metabolic effects of resistance training with or without caloric restriction in
[11] SR El Khoudary, B Aggarwal, TM Beckie, HN Hodis, AE Johnson, RD Langer, et dynapenic/obese postmenopausal women, Canadian journal of diabetes 37
al., Menopause Transition and Cardiovascular Disease Risk: Implications for (2013) S24.
Timing of Early Prevention: A Scientific Statement From the, American Heart [36] C Nowson, S O’Connell, N Mundell, C Grimes, D Dunstan, R. Daly, A protein-
Association. Circulation. 142 (25) (2020) e506–ee32. enriched diet favourably affects cardiovascular health in elderly women
[12] E Yu, VS Malik, FB. Hu, Cardiovascular Disease Prevention by Diet Modification: undertaking progressive resistance training, Annals of nutrition & metabolism 63
JACC Health Promotion Series, J Am Coll Cardiol 72 (8) (2018) 914–926. (2013) 657.
[13] P Noll, CAS Campos, C Leone, J Zangirolami-Raimundo, M Noll, EC Baracat, et [37] AL Pattinson, RV Seimon, A Grech, C Harper, E Santoso, J Franklin, et al., Diet
al., Dietary intake and menopausal symptoms in postmenopausal women: a quality following meal replacement vs food-based weight loss diets in
systematic review, Climacteric: the journal of the International Menopause postmenopausal women with obesity: a secondary analysis of TheTEMPO Diet
Society 24 (2) (2021) 128–138. Trial, Obesity reviews 21 (SUPPL 1) (2020).
[14] RL Prentice, M Pettinger, ML Neuhouser, D Raftery, C Zheng, GAN Gowda, et al., [38] Boers I, Muskiet FAJ, Berkelaar E, Schut E. Favourable effects of consuming a
Biomarker-Calibrated Macronutrient Intake and Chronic Disease Risk among Palaeolithic-type diet on characteristics of the metabolic syndrome: a randomized
Postmenopausal Women, J Nutr (2021). controlled pilot-study: Springer; 2014.
[15] M Moradi, E Daneshzad, L. Azadbakht, The effects of isolated soy protein, isolated [39] E Christiansen, S Schnider, B Palmvig, E Tauber-Lassen, O. Pedersen, Intake of a
soy isoflavones and soy protein containing isoflavones on serum lipids in diet high in trans monounsaturated fatty acids or saturated fatty acids. Effects on
postmenopausal women: A systematic review and meta-analysis, Crit Rev Food postprandial insulinemia and glycemia in obese patients with NIDDM, Diabetes
Sci Nutr 60 (20) (2020) 3414–3428. Care 20 (5) (1997) 881–887.
[16] C Liu, X Kuang, K Li, X Guo, Q Deng, D. Li, Effects of combined calcium and [40] LH Kuller, LR Simkin-Silverman, RR Wing, EN Meilahn, DG. Ives, Women’s
vitamin D supplementation on osteoporosis in postmenopausal women: a healthy lifestyle project: A randomized clinical trial: Results at 54 months,
systematic review and meta-analysis of randomized controlled trials, Food Funct Circulation 103 (1) (2001) 32–37.
11 (12) (2020) 10817–10827. [41] MEJ Lean, TS Han, T Prvan, PR Richmond, A. Avenell, Weight loss with high and
[17] Patade A, Devareddy L, Lucas EA, Korlagunta K, Daggy BP, Arjmandi BH. low carbohydrate 1200 heal diets in free living women, EUR J CLIN NUTR 51 (4)
Flaxseed reduces total and LDL cholesterol concentrations in Native American (1997) 243–248.
postmenopausal women. Journal of women’s health (2002). 2008;17(3):355-66. [42] M Miettinen, O Turpeinen, MJ Karvonen, M Pekkarinen, E Paavilainen, R. Elosuo,
[18] M Glisic, N Kastrati, J Musa, J Milic, E Asllanaj, E Portilla Fernandez, et al., Dietary prevention of coronary heart disease in women: the Finnish mental
Phytoestrogen supplementation and body composition in postmenopausal hospital study, Int J Epidemiol 12 (1) (1983) 17–25.
women: A systematic review and meta-analysis of randomized controlled trials, [43] CL Rock, SW Flatt, B Pakiz, EL Quintana, DD Heath, BK Rana, et al., Effects of diet
Maturitas 115 (2018) 74–83. composition on weight loss, metabolic factors and biomarkers in a 1-year weight
[19] BV Howard, JD Curb, CB Eaton, C Kooperberg, J Ockene, JB Kostis, et al., Low-fat loss intervention in obese women examined by baseline insulin resistance status,
dietary pattern and lipoprotein risk factors: The Women’s Health Initiative Metab Clin Exp 65 (11) (2016) 1605–1613.
Dietary Modification Trial, Am J Clin Nutr 91 (4) (2010) 860–874. [44] LR Simkin-Silverman, RR Wing, MA Boraz, EN Meilahn, LH. Kuller, Maintenance
[20] LF Tinker, DE Bonds, KL Margolis, JE Manson, BV Howard, J Larson, et al., Low- of cardiovascular risk factor changes among middle-aged women in a lifestyle
fat dietary pattern and risk of treated diabetes mellitus in postmenopausal intervention trial, Womens Health 4 (3) (1998) 255–271.
women: The women’s health initiative randomized controlled dietary [45] M Skouroliakou, D Grosomanidis, P Massara, C Kostara, P Papandreou,
modification trial, Arch Intern Med 168 (14) (2008) 1500–1511. D Ntountaniotis, et al., Serum antioxidant capacity, biochemical profile and body
[21] P Abedi, M Huang Soo Lee, Z Yasin, M Kandiah, Diet intervention to improve composition of breast cancer survivors in a randomized Mediterranean dietary
cardiovascular risk factors among iranian postmenopausal women, Maturitas 71 intervention study, Eur J Nutr 57 (6) (2018) 2133–2145.
(2012). S26-. [46] H Arguin, IJ Dionne, M Sénéchal, DR Bouchard, AC Carpentier, JL Ardilouze, et
[22] C Mason, KE Foster-Schubert, I Imayama, A Kong, L Xiao, C Bain, et al., Dietary al., Short- and long-term effects of continuous versus intermittent restrictive diet
weight loss and exercise effects on insulin resistance in postmenopausal women, approaches on body composition and the metabolic profile in overweight and
Am J Prev Med 41 (4) (2011) 366–375. obese postmenopausal women: A pilot study, Menopause 19 (8) (2012) 870–876.
[23] L Wu, D Ma, B Walton-Moss, Z. He, Effects of low-fat diet on serum lipids in [47] Azadbakht L, Kimiagar M, Mehrabi Y. Soy inclusion in the diet improves features
premenopausal and postmenopausal women: a meta-analysis of randomized of the metabolic syndrome: a randomized crossover study in postmenopausal
controlled trials, Menopause 21 (1) (2014) 89–99. women. … American journal of …. 2007.
[24] A Liberati, DG Altman, J Tetzlaff, C Mulrow, PC Gøtzsche, JP Ioannidis, et al., The [48] NT Bendsen, E Chabanova, HS Thomsen, TM Larsen, JW Newman, S Stender, et
PRISMA statement for reporting systematic reviews and meta-analyses of studies al., Effect of trans fatty acid intake on abdominal and liver fat deposition and
that evaluate health care interventions: explanation and elaboration, PLoS Med 6 blood lipids: A randomized trial in overweight postmenopausal women, Nutr
(7) (2009), e1000100. Diabetes 1 (1) (2011).
[25] D Moher, A Liberati, J Tetzlaff, DG Altman, P. Group, Preferred reporting items [49] NT Bendsen, SB Haugaard, TM Larsen, E Chabanova, S Stender, A. Astrup, Effect
for systematic reviews and meta-analyses: the PRISMA statement, PLoS Med 6 (7) of trans-fatty acid intake on insulin sensitivity and intramuscular lipids - A
(2009), e1000097. randomized trial in overweight postmenopausal women, Metab Clin Exp 60 (7)
[26] JAC Sterne, J Savović, MJ Page, RG Elbers, NS Blencowe, I Boutron, et al., RoB 2: (2011) 906–913.
a revised tool for assessing risk of bias in randomised trials, BMJ (Clinical [50] LM Chiechi, G Secreto, A Vimercati, P Greco, E Venturelli, F Pansini, et al., The
research ed) 366 (2019) l4898. effects of a soy rich diet on serum lipids: The Menfis randomized trial, Maturitas
[27] JA Sterne, MA Hernán, BC Reeves, J Savović, ND Berkman, M Viswanathan, et al., 41 (2) (2002) 97–104.
ROBINS-I: a tool for assessing risk of bias in non-randomised studies of [51] LA Gilmore, SF Crouse, A Carbuhn, J Klooster, JA Calles, T Meade, et al., Exercise
interventions, BMJ (Clinical research ed) 355 (2016) i4919. attenuates the increase in plasma monounsaturated fatty acids and high-density
[28] MA Allison, A Aragaki, C Eaton, S Wassertheil-Smoller, W Li, L Van Horn, et al., lipoprotein cholesterol but not high-density lipoprotein 2b cholesterol caused by
Dietary intervention to reduce fat intake does not result in lower incident carotid high-oleic ground beef in women, Nutr Res 33 (12) (2013) 1003–1011.
artery disease: the women’s health initiative diet modification trial, Circulation [52] BR Goldin, E Brauner, H Adlercreutz, LM Ausman, AH. Lichtenstein, Hormonal
128 (1) (2013), 22 SUPPL. response to diets high in soy or animal protein without and with isoflavones in
[29] D Fitzmaurice, L. Doyle, The effect of a low-carbohydrate diet on biomarkers of moderately hypercholesterolemic subjects, Nutr Cancer 51 (1) (2005) 1–6.
bone health in pre-and post-menopausal females: a randomized control crossover [53] AR Gonciulea, D. Sellmeyer, The effect of dietary protein source on serum lipids,
trial, Proceedings of the nutrition society 70 (6) (2011) E355. Endocrine reviews (2015) 36.
[30] A Jagim, M Byrd, B Lockard, C Baetge, K Levers, E Galvan, et al., Adherence to a [54] AR Gonciulea, DE. Sellmeyer, The effect of dietary protein source on serum lipids:
high protein and low fat energy-restricted diet while participating in a circuit Secondary data analysis from a randomized clinical trial, J Clin Lipidology 11 (1)
resistance-exercise program promotes positive changes in blood glucose and (2017) 46–54.
lipids in postmenopausal women, FASEB journal (2013) 27.
50
[55] H Jacques, L Noreau, S. Moorjani, Effects on plasma lipoproteins and endogenous [79] DJ Bowen, CK Clifford, R Coates, M Evans, Z Feng, M Fouad, et al., The women’s
sex hormones of substituting lean white fish for other animal-protein sources in health trial feasibility study in minority populations: Design and baseline
diets of postmenopausal women, American journal of clinical nutrition 55 (4) descriptions, ANN EPIDEMIOL 6 (6) (1996) 507–519.
(1992) 896–901. [80] SM Camhi, ML Stefanick, PT Katzmarzyk, DR. Young, Metabolic syndrome and
[56] JB Labat, MC Martini, TP Carr, BM Elhard, BA Olson, SD Bergmann, et al., changes in body fat from a low-fat diet and/or exercise randomized controlled
Cholesterol-lowering effects of modified animal fats in postmenopausal women, trial, Obesity 18 (3) (2010) 548–554.
J Am Coll Nutr 16 (6) (1997) 570–577. [81] SM Camhi, ML Stefanick, PM Ridker, DR. Young, Changes in C-reactive protein
[57] AK Mahon, MG Flynn, LK Stewart, BK McFarlin, HB Iglay, RD Mattes, et al., from low-fat diet and/or physical activity in men and women with and without
Protein intake during energy restriction: Effects on body composition and metabolic syndrome, Metab Clin Exp 59 (1) (2010) 54–61.
markers of metabolic and cardiovascular health in postmenopausal women, J Am [82] C Castaneda, GG Dolnikowski, GE Dallal, WJ Evans, MC. Crim, Protein turnover
Coll Nutr 26 (2) (2007) 182–189. and energy metabolism of elderly women fed a low-protein diet, AM J CLIN
[58] FJ Sanchez-Muniz, MC Merinero, S Rodriguez-Gil, JM Ordovas, S Rodenas, NUTR 62 (1) (1995) 40–48.
C. Cuesta, Dietary fat saturation affects apolipoprotein AII levels and HDL [83] C Castaneda, PL Gordon, RA Fielding, WJ Evans, MC. Crim, Marginal protein
composition in postmenopausal women, J Nutr 132 (1) (2002) 50–54. intake results in reduced plasma IGF-I levels and skeletal muscle fiber atrophy in
[59] JL Thompson, GE Butterfield, UK Gylfadottir, J Yesavage, R Marcus, RL Hintz, et elderly women, J Nutr Health Aging 4 (2) (2000) 85–90.
al., Effects of human growth hormone, insulin-like growth factor I, and diet and [84] A Chmurzynska, A Muzsik, P Krzyzanowska-Jankowska, J Walkowiak,
exercise on body composition of obese postmenopausal women, J Clin Endocrinol J. Bajerska, The effect of habitual fat intake, IL6 polymorphism, and different diet
Metab 83 (5) (1998) 1477–1484. strategies on inflammation in postmenopausal women with central obesity,
[60] DJ Toobert, RE Glasgow, LA Strycker, M Barrera Jr, JL Radcliffe, RC Wander, et Nutrients 11 (7) (2019).
al., Biologic and quality-of-life outcomes from the Mediterranean Lifestyle [85] JO Christensen, OL Svendsen, C Hassager, C. Christiansen, Leptin in overweight
Program: A randomized clinical trial, Diabetes Care 26 (8) (2003) 2288–2293. postmenopausal women: No relationship with metabolic syndrome X or effect of
[61] D Chao, MA Espeland, D Farmer, TC Register, L Lenchik, WB Applegate, et al., exercise in addition to diet, Int J Obes 22 (3) (1998) 195–199.
Effect of voluntary weight loss on bone mineral density in older overweight [86] C Colombo, P Muti, V Pala, A Cavalleri, E Venturelli, M Locardi, et al., Plant-
women, J Am Geriatr Soc 48 (7) (2000) 753–759. based diet, serum fatty acid profile, and free radicals in postmenopausal women:
[62] LH Kuller, LS Kinzel, KK Pettee, AM Kriska, LR Simkin-Silverman, MB Conroy, et The diet and androgens (DIANA) randomized trial, Int J Biol Markers 20 (3)
al., Lifestyle intervention and coronary heart disease risk factor changes over 18 (2005) 169–176.
months in postmenopausal women: The women on the move through activity and [87] K Foster-Schubert, K Campbell, M Kratz, KW Makar, D Hagman, EA Schur, et al.,
nutrition (WOMAN study) clinical trial, J Women’s Health 15 (8) (2006) Gene-expression changes in adipose tissue with diet-and/or exercise-induced
962–974. weight loss: a randomized controlled trial, Cancer research 72 (8) (2012).
[63] O Perichart-Perera, M Balas-Nakash, C Muñoz-Manrique, J Legorreta-Legorreta, [88] KA Franklin, M Eriksson, C Larsson, B Lindahl, C Mellberg, C Sahlin, et al.,
A Rodríguez-Cano, J Mier-Cabrera, et al., Structured hypocaloric diet is more Palaeolithic diet and obstructive sleep apnoea in overweight females: a
effective than behavioral therapy in reducing metabolic syndrome in Mexican randomised controlled trial, European respiratory journal (2016).
postmenopausal women: A randomized controlled trial, Menopause 21 (7) (2014) [89] BV Howard, L Van Horn, J Hsia, JE Manson, ML Stefanick, S Wassertheil-Smoller,
711–720. et al., Low-fat dietary pattern and risk of cardiovascular disease: The Women’s
[64] J Sbierski-Kind, K Mai, J Kath, A Jurisch, M Streitz, L Kuchenbecker, et al., Health Initiative randomized controlled dietary modification trial, J Am Med
Association between subcutaneous adipose tissue inflammation, insulin Assoc 295 (6) (2006) 655–666.
resistance, and calorie restriction in obese females, J Immunol 205 (1) (2020) [90] SK Raatz, LR Young, MJ Picklo, ER Sauter, W Qin, MS. Kurzer, Total dietary fat
45–55. and fatty acid content modifies plasma phospholipid fatty acids, desaturase
[65] HJ Thompson, SM Sedlacek, D Paul, P Wolfe, JN McGinley, MC Playdon, et al., activity indices, and urinary prostaglandin E in women, Nutr Res 32 (1) (2012)
Effect of dietary patterns differing in carbohydrate and fat content on blood lipid 1–7.
and glucose profiles based on weight-loss success of breast-cancer survivors, [91] DM Ingram, FC Bennett, D Willcox, N. De Klerk, Effect of low-fat diet on female
Breast Cancer Res 14 (1) (2012) R1. sex hormone levels, J NATL CANCER INST 79 (6) (1987) 1225–1229.
[66] DJ Toobert, RE Glasgow, JL. Radcliffe, Physiologic and related behavioral [92] Bajerska J, Chmurzynska A, Muzsik A. Weight loss and metabolic health effects
outcomes from the women’s lifestyle heart trial, Ann Behav Med 22 (1) (2000) from energy-restricted Mediterranean and Central-European diets in
1–9. postmenopausal women: A randomized …: nature.com; 2018.
[67] Toobert DJ, Glasgow RE, Strycker LA, Barrera M. Biologic and quality-of-life [93] ND Barnard, AR Scialli, G Turner-McGrievy, AJ Lanou, J. Glass, The effects of a
outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial. low-fat, plant-based dietary intervention on body weight, metabolism, and insulin
Diabetes …. 2003. sensitivity, Am J Med 118 (9) (2005) 991–997.
[68] AT Toriola, J Liu, PA Ganz, GA Colditz, L Yang, S Izadi, et al., Effect of weight loss [94] IM Buzzard, EH Asp, RT Chlebowski, AP Boyar, RW Jeffery, DW Nixon, et al., Diet
on bone health in overweight/obese postmenopausal breast cancer survivors, intervention methods to reduce fat intake: nutrient and food group composition
Breast Cancer Res Treat 152 (3) (2015) 637–643. of self-selected low-fat diets, J Am Diet Assoc 90 (1) (1990) 42–50, 3.
[69] C Abbenhardt, A McTiernan, CM Alfano, MH Wener, KL Campbell, C Duggan, et [95] MA. Denke, Individual responsiveness to a cholesterol-lowering diet in
al., Effects of individual and combined dietary weight loss and exercise postmenopausal women with moderate hypercholesterolemia, ARCH INTERN
interventions in postmenopausal women on adiponectin and leptin levels, MED 154 (17) (1994) 1977–1982.
J Intern Med (GBR) 274 (2) (2013) 163–175. [96] M Harrington, T Bennett, J Jakobsen, L Ovesen, C Brot, A Flynn, et al., The effect
[70] C Abbenhardt, JD Potter, CE Mason, L Xiao, GL Blackburn, C Bain, et al., Effects of of a high-protein, high-sodium diet on calcium and bone metabolism in
individual and combined diet and exercise intervention in postmenopausal postmenopausal women and its interaction with vitamin D receptor genotype,
women on adiponectin and leptin, Cancer prevention research (philadelphia, pa) The British journal of nutrition 91 (1) (2004) 41–51.
4 (10) (2011). [97] J Jeppesen, P Schaaf, C Jones, MY Zhou, YD Ida Chen, GM Reaven, Effects of low-
[71] J Andersson, C Mellberg, J Otten, M Ryberg, D Rinnström, C Larsson, et al., Left fat, high-carbohydrate diets on risk factors for ischemic heart disease in
ventricular remodelling changes without concomitant loss of myocardial fat after postmenopausal women, AM J CLIN NUTR 65 (4) (1997) 1027–1033.
long-term dietary intervention, Int J Cardiol 216 (2016) 92–96. [98] SE Kasim-Karakas, RU Almario, WM Mueller, J. Peerson, Changes in plasma
[72] ND Barnard, AR Scialli, G Turner-McGrievy, AJ. Lanou, Acceptability of a low-fat lipoproteins during low-fat, high-carbohydrate diets: effects of energy intake, Am
vegan diet compares favorably to a step II diet in a randomized, controlled trial, J Clin Nutr 71 (6) (2000) 1439–1447.
J Cardiopulm Rehabil 24 (4) (2004) 229–235. [99] B Murillo-Ortiz, S Martinez-Garza, VC Landeros, GC Velazquez, DS. Garcia, Effect
[73] SAA Beresford, KC Johnson, C Ritenbaugh, NL Lasser, LG Snetsclaar, HR Black, et of reduced dietary fat on estradiol, adiponectin, and IGF-1 levels in
al., Low-fat dietary pattern and risk of colorectal cancer: The women’s health postmenopausal women with breast cancer, Breast cancer: targets and therapy 9
initiative randomized controlled dietary modification trial, Obstet Gynecol Surv (2017) 359–364.
61 (7) (2006) 456–458. [100] CA Nowson, N Wattanapenpaiboon, A. Pachett, Low-sodium Dietary Approaches
[74] L Berglund, EH Oliver, N Fontanez, S Holleran, K Matthews, PS Roheim, et al., to Stop Hypertension-type diet including lean red meat lowers blood pressure in
HDL-subpopulation patterns in response to reductions in dietary total and postmenopausal women, Nutr Res 29 (1) (2009) 8–18.
saturated fat intakes in healthy subjects, Am J Clin Nutr 70 (6) (1999) 992–1000. [101] Segal-Isaacson CJ, Johnson S, Tomuta V. A randomized trial comparing low-fat
[75] F Berrino, C Bellati, S Ooldani, A Mastroianni, G Allegro, E Berselli, et al., DIANA and low-carbohydrate diets matched for energy and protein. Obesity …. 2004.
trials on diet and endogenous hormones, IARC Sci Publ 156 (2002) 439–444. [102] CA Thomson, AT Stopeck, JW Bea, E Cussler, E Nardi, G Frey, et al., Changes in
[76] F Berrino, C Bellati, G Secreto, E Camerini, V Pala, S Panico, et al., Reducing body weight and metabolic indexes in overweight breast cancer survivors
bioavailable sex hormones through a comprehensive change in diet: The diet and enrolled in a randomized trial of low-fat vs. reduced carbohydrate diets, Nutr
androgens (DIANA) randomized trial, Cancer Epidemiol Biomarkers Prev 10 (1) Cancer 62 (8) (2010) 1142–1152.
(2001) 25–33. [103] F Berrino, C Bellati, G Secreto, E Camerini, V. Pala, Reducing bioavailable sex
[77] A Bhargava, J. Hays, Behavioral variables and education are predictors of dietary hormones through a comprehensive change in diet: the diet and androgens
change in the Women’s Health Trial: Feasibility Study in Minority Populations, (DIANA) randomized trial, Cancer Epidemiol Biomarkers Prev (2001).
Prev Med 38 (4) (2004) 442–451. [104] P Muti, AB Awad, H Schünemann, CS Fink, K Hovey, JL Freudenheim, et al.,
[78] CJ Boraxbekk, A Stomby, M Ryberg, B Lindahl, C Larsson, L Nyberg, et al., Diet- A Plant Food-Based Diet Modifies the Serum β-Sitosterol Concentration in
Induced Weight Loss Alters Functional Brain Responses during an Episodic Hyperandrogenic Postmenopausal Women, J Nutr 133 (12) (2003) 4252–4255.
Memory Task, Obes Facts 8 (4) (2015) 261–272. [105] JM Shikany, KL Margolis, M Pettinger, RD Jackson, MC Limacher, S Liu, et al.,
Effects of a low-fat dietary intervention on glucose, insulin, and insulin resistance
51
in the Women’s Health Initiative (WHI) dietary modification trial, Am J Clin Nutr [132] ARG Look, RR. Wing, Long-term effects of a lifestyle intervention on weight and
94 (1) (2011) 75–85. cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year
[106] A. Bhargava, Fiber intakes and anthropometric measures are predictors of results of the Look AHEAD trial, Arch Intern Med 170 (17) (2010) 1566–1575.
circulating hormone, triglyceride, and cholesterol concentrations in the women’s [133] RA Carels, LA Darby, HM Cacciapaglia, OM. Douglass, Reducing cardiovascular
health trial, J Nutr 136 (8) (2006) 2249–2254. risk factors in postmenopausal women through a lifestyle change intervention,
[107] W Dallas Hall, Z Feng, VA George, CE Lewis, A Oberman, M Huber, et al., Low-fat Journal of Women’s Health 13 (4) (2004) 412–426.
diet: Effect on athropometrics, blood pressure, glucose, and insulin in older [134] DJ Toobert, RE Glasgow, LA Strycker, M Barrera, JL Radcliffe, RC Wander, et al.,
women, Ethni Dis 13 (3) (2003) 337–343. Biologic and quality-of-life outcomes from the Mediterranean Lifestyle Program: a
[108] HN Ginsberg, P Kris-Etherton, B Dennis, PJ Elmer, A Ershow, M Lefevre, et al., randomized clinical trial, Diabetes care 26 (8) (2003) 2288–2293.
Effects of reducing dietary saturated fatty acids on plasma lipids and lipoproteins [135] M Siervo, J Lara, S Chowdhury, A Ashor, C Oggioni, JC. Mathers, Effects of the
in healthy subjects: The delta study, protocol 1, Arterioscler Thromb Vasc Biol 18 Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk
(3) (1998) 441–449. factors: a systematic review and meta-analysis, The British journal of nutrition
[109] C Mellberg, S Sandberg, M Ryberg, M Eriksson, S Brage, C Larsson, et al., Long- 113 (1) (2015) 1–15.
term effects of a Palaeolithic-type diet in obese postmenopausal women: A 2-year [136] X Yuan, J Wang, S Yang, M Gao, L Cao, X Li, et al., Effect of the ketogenic diet on
randomized trial, Eur J Clin Nutr 68 (3) (2014) 350–357. glycemic control, insulin resistance, and lipid metabolism in patients with T2DM:
[110] J Otten, C Mellberg, M Ryberg, S Sandberg, J Kullberg, B Lindahl, et al., Strong a systematic review and meta-analysis, Nutr Diabetes 10 (1) (2020) 38.
and persistent effect on liver fat with a Paleolithic diet during a two-year [137] MH Sohouli, S Fatahi, A Lari, M Lotfi, M Seifishahpar, MA Găman, et al., The
intervention, Int J Obes 40 (5) (2016) 747–753. effect of paleolithic diet on glucose metabolism and lipid profile among patients
[111] SP McColley, A Georgopoulos, LR Young, MS Kurzer, JB Redmon, SK. Raatz, with metabolic disorders: a systematic review and meta-analysis of randomized
A high-fat diet and the threonine-encoding allele (Thr54) polymorphism of fatty controlled trials, Crit Rev Food Sci Nutr (2021) 1–12.
acid-binding protein 2 reduce plasma triglyceride-rich lipoproteins, Nutr Res 31 [138] C Vitale, G Rosano, M. Fini, Are elderly and women under-represented in
(7) (2011) 503–508. cardiovascular clinical trials? Implication for treatment, Wien Klin Wochenschr
[112] LR Young, MS Kurzer, W Thomas, JB Redmon, SK. Raatz, Low-fat diet with 128 (7) (2016) 433–438. Suppl.
omega-3 fatty acids increases plasma insulin-like growth factor concentration in [139] SU Khan, MZ Khan, C Raghu Subramanian, H Riaz, MU Khan, AN Lone, et al.,
healthy postmenopausal women, Nutr Res 33 (7) (2013) 565–571. Participation of Women and Older Participants in Randomized Clinical Trials of
[113] M Sénéchal, DR Bouchard, IJ Dionne, M. Brochu, The effects of lifestyle Lipid-Lowering Therapies: A Systematic Review, JAMA Netw Open 3 (5) (2020),
interventions in dynapenic-obese postmenopausal women, Menopause 19 (9) e205202.
(2012) 1015–1021. [140] C Melloni, JS Berger, TY Wang, F Gunes, A Stebbins, KS Pieper, et al.,
[114] OL Svendsen, C Hassager, C. Christiansen, Effect of an energy-restrictive diet, Representation of women in randomized clinical trials of cardiovascular disease
with or without exercise, on lean tissue mass, resting metabolic rate, prevention, Circ Cardiovasc Qual Outcomes 3 (2) (2010) 135–142.
cardiovascular risk factors, and bone in overweight postmenopausal women, AM [141] KA Matthews, SL Crawford, CU Chae, SA Everson-Rose, MF Sowers, B Sternfeld, et
J MED 95 (2) (1993) 131–140. al., Are changes in cardiovascular disease risk factors in midlife women due to
[115] N Santoro, CN Epperson, SB. Mathews, Menopausal symptoms and their chronological aging or to the menopausal transition? J Am Coll Cardiol 54 (25)
management, Endocrinology and Metabolism Clinics 44 (3) (2015) 497–515. (2009) 2366–2373.
[116] AF Cicero, A Dormi, S D’Addato, AV Gaddi, C Borghi, Long-term effect of a [142] WB Kannel, MC Hjortland, PM McNamara, T. Gordon, Menopause and risk of
dietary education program on postmenopausal cardiovascular risk and metabolic cardiovascular disease: the Framingham study, Ann Intern Med 85 (4) (1976)
syndrome: the Brisighella Heart Study, Journal of women’s health (2002) 19 (1) 447–452.
(2010) 133–137. [143] G. Bulliyya, Risk of coronary heart disease in women after menopause, J Indian
[117] M Santiago-Torres, Z Shi, LF Tinker, JW Lampe, MA Allison, W Barrington, et al., Med Assoc 99 (9) (2001) 478–480, 82.
Diet quality indices and risk of metabolic syndrome among postmenopausal [144] EJ Benjamin, MJ Blaha, SE Chiuve, M Cushman, SR Das, R Deo, et al., Heart
women of Mexican ethnic descent in the Women’s Health Initiative Observational Disease and Stroke Statistics-2017 Update: A Report From the American Heart
Study, Nutr Healthy Aging 5 (4) (2020) 261–272. Association, Circulation 135 (10) (2017) e146–e603.
[118] A Ventura Dde, M Fonseca Vde, EG Ramos, LP Marinheiro, RA Souza, CR Chaves, [145] MIH Fonseca, IT da Silva, SRG. Ferreira, Impact of menopause and diabetes on
et al., Association between quality of the diet and cardiometabolic risk factors in atherogenic lipid profile: is it worth to analyse lipoprotein subfractions to assess
postmenopausal women, Nutr J 13 (1) (2014) 121. cardiovascular risk in women? Diabetol Metab Syndr 9 (2017) 22.
[119] AP Tardivo, J Nahas-Neto, EA Nahas, N Maesta, MA Rodrigues, Orsatti FL. [146] R Huxley, F Barzi, M. Woodward, Excess risk of fatal coronary heart disease
Associations between healthy eating patterns and indicators of metabolic risk in associated with diabetes in men and women: meta-analysis of 37 prospective
postmenopausal women, Nutr J 9 (2010) 64. cohort studies, BMJ (Clinical research ed) 332 (7533) (2006) 73–78.
[120] M Galisteo, J Duarte, A. Zarzuelo, Effects of dietary fibers on disturbances [147] P Ballotari, SC Ranieri, F Luberto, S Caroli, M Greci, P Giorgi Rossi, et al., Sex
clustered in the metabolic syndrome, J Nutr Biochem 19 (2) (2008) 71–84. differences in cardiovascular mortality in diabetics and nondiabetic subjects: a
[121] SS Jonnalagadda, L Harnack, RH Liu, N McKeown, C Seal, S Liu, et al., Putting the population-based study (Italy), Int J Endocrinol 2015 (2015), 914057.
whole grain puzzle together: health benefits associated with whole
grains–summary of American Society for Nutrition 2010 Satellite Symposium,
J Nutr 141 (5) (2011) 1011S–1022S.
Further reading
[122] JW. Lampe, Health effects of vegetables and fruit: assessing mechanisms of action
in human experimental studies, Am J Clin Nutr 70 (3) (1999) 475S–490S. Suppl. 1 Young LR, Kurzer MS, Thomas W, Redmon JB, Raatz SK. Low-fat diet with omega-3
[123] AL Macready, TW George, MF Chong, DS Alimbetov, Y Jin, A Vidal, et al., fatty acids increases plasma insulin-like growth factor concentration in healthy
Flavonoid-rich fruit and vegetables improve microvascular reactivity and postmenopausal women. Nutr Res. 2013;33(7):565-71.
inflammatory status in men at risk of cardiovascular disease–FLAVURS: a 2 McColley SP, Georgopoulos A, Young LR, Kurzer MS, Redmon JB, Raatz SK. A high-fat
randomized controlled trial, Am J Clin Nutr 99 (3) (2014) 479–489. diet and the threonine-encoding allele (Thr54) polymorphism of fatty acid-binding
[124] C Dawczynski, KA Massey, C Ness, M Kiehntopf, S Stepanow, M Platzer, et al., protein 2 reduce plasma triglyceride-rich lipoproteins. Nutr Res. 2011;31(7):503-8.
Randomized placebo-controlled intervention with n-3 LC-PUFA-supplemented 3 Jeppesen J, Schaaf P, Jones C, Zhou MY, Ida Chen YD, Reaven GM. Effects of low-fat,
yoghurt: effects on circulating eicosanoids and cardiovascular risk factors, high-carbohydrate diets on risk factors for ischemic heart disease in postmenopausal
Clinical nutrition (Edinburgh, Scotland) 32 (5) (2013) 686–696. women. AM J CLIN NUTR. 1997;65(4):1027-33.
[125] P Saravanan, NC Davidson, EB Schmidt, PC. Calder, Cardiovascular effects of 4 Kasim-Karakas SE, Almario RU, Mueller WM, Peerson J. Changes in plasma
marine omega-3 fatty acids, Lancet 376 (9740) (2010) 540–550. lipoproteins during low-fat, high-carbohydrate diets: effects of energy intake. Am J
[126] L Hooper, N Martin, OF Jimoh, C Kirk, E Foster, Abdelhamid AS. Reduction in Clin Nutr. 2000;71(6):1439-47.
saturated fat intake for cardiovascular disease, Cochrane Database Syst Rev 5 (5) 5 Shikany JM, Margolis KL, Pettinger M, Jackson RD, Limacher MC, Liu S, et al. Effects
(2020), CD011737. of a low-fat dietary intervention on glucose, insulin, and insulin resistance in the
[127] FM Sacks, AH Lichtenstein, JHY Wu, LJ Appel, MA Creager, PM Kris-Etherton, et Women’s Health Initiative (WHI) dietary modification trial. Am J Clin Nutr. 2011;94
al., Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the (1):75-85.
American Heart Association, Circulation 136 (3) (2017) e1–e23. 6 Howard BV, Curb JD, Eaton CB, Kooperberg C, Ockene J, Kostis JB, et al. Low-fat
[128] WC Knowler, E Barrett-Connor, SE Fowler, RF Hamman, JM Lachin, EA Walker, et dietary pattern and lipoprotein risk factors: The Women’s Health Initiative Dietary
al., Reduction in the incidence of type 2 diabetes with lifestyle intervention or Modification Trial. Am J Clin Nutr. 2010;91(4):860-74.
metformin, The New England journal of medicine 346 (6) (2002) 393–403. 7 Tinker LF, Bonds DE, Margolis KL, Manson JE, Howard BV, Larson J, et al. Low-fat
[129] DJ Toobert, LA Strycker, RE. Glasgow, Lifestyle change in women with coronary dietary pattern and risk of treated diabetes mellitus in postmenopausal women: The
heart disease: What do we know? Journal of women’s health 7 (6) (1998) women’s health initiative randomized controlled dietary modification trial. Arch
685–699. Intern Med. 2008;168(14):1500-11.
[130] J Tuomilehto, J Lindström, JG Eriksson, TT Valle, H Hämäläinen, P Ilanne- 8 Bhargava A. Fiber intakes and anthropometric measures are predictors of circulating
Parikka, et al., Prevention of type 2 diabetes mellitus by changes in lifestyle hormone, triglyceride, and cholesterol concentrations in the women’s health trial. J
among subjects with impaired glucose tolerance, New England Journal of Nutr. 2006;136(8):2249-54.
Medicine 344 (18) (2001) 1343–1350. 9 Dallas Hall W, Feng Z, George VA, Lewis CE, Oberman A, Huber M, et al. Low-fat diet:
[131] J Salas-Salvadó, A Díaz-López, M Ruiz-Canela, J Basora, M Fitó, D Corella, et al., Effect on athropometrics, blood pressure, glucose, and insulin in older women. Ethni
Effect of a Lifestyle Intervention Program With Energy-Restricted Mediterranean Dis. 2003;13(3):337-43.
Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year 10 Ginsberg HN, Kris-Etherton P, Dennis B, Elmer PJ, Ershow A, Lefevre M, et al. Effects
Results of the PREDIMED-Plus Trial, Diabetes Care 42 (5) (2019) 777–788. of reducing dietary saturated fatty acids on plasma lipids and lipoproteins in healthy
52
subjects: The delta study, protocol 1. Arterioscler Thromb Vasc Biol. 1998;18(3):441- 30 Howard BV, Curb JD, Eaton CB, Kooperberg C, Ockene J, Kostis JB, et al. Low-fat
9. dietary pattern and lipoprotein risk factors: The Women’s Health Initiative Dietary
11 Harrington M, Bennett T, Jakobsen J, Ovesen L, Brot C, Flynn A, et al. The effect of a Modification Trial. Am J Clin Nutr. 2010;91(4):860-74.
high-protein, high-sodium diet on calcium and bone metabolism in postmenopausal 31 Dallas Hall W, Feng Z, George VA, Lewis CE, Oberman A, Huber M, et al. Low-fat
women and its interaction with vitamin D receptor genotype. Br J Nutr. 2004;91(1): diet: Effect on athropometrics, blood pressure, glucose, and insulin in older women.
41-51. Ethni Dis. 2003;13(3):337-43.
12 Abedi P, Huang Soo Lee M, Yasin Z, Kandiah M. Diet intervention to improve 32 Ginsberg HN, Kris-Etherton P, Dennis B, Elmer PJ, Ershow A, Lefevre M, et al. Effects
cardiovascular risk factors among iranian postmenopausal women. Maturitas. 2012; of reducing dietary saturated fatty acids on plasma lipids and lipoproteins in healthy
71:S26-. subjects: The delta study, protocol 1. Arterioscler Thromb Vasc Biol. 1998;18(3):441-
13 Muti P, Awad AB, Schünemann H, Fink CS, Hovey K, Freudenheim JL, et al. A Plant 9.
Food-Based Diet Modifies the Serum β-Sitosterol Concentration in Hyperandrogenic 33 Harrington M, Bennett T, Jakobsen J, Ovesen L, Brot C, Flynn A, et al. The effect of a
Postmenopausal Women. J Nutr. 2003;133(12):4252-5. high-protein, high-sodium diet on calcium and bone metabolism in postmenopausal
14 Berrino F, Bellati C, Secreto G, Camerini E, Pala V. Reducing bioavailable sex women and its interaction with vitamin D receptor genotype. Br J Nutr. 2004;91(1):
hormones through a comprehensive change in diet: the diet and androgens (DIANA) 41-51.
randomized trial. Cancer Epidemiol Biomarkers Prev. 2001. 34 Abedi P, Huang Soo Lee M, Yasin Z, Kandiah M. Diet intervention to improve
15 Barnard ND, Scialli AR, Turner-McGrievy G, Lanou AJ, Glass J. The effects of a low- cardiovascular risk factors among iranian postmenopausal women. Maturitas. 2012;
fat, plant-based dietary intervention on body weight, metabolism, and insulin 71:S26-.
sensitivity. Am J Med. 2005;118(9):991-7. 35 Berrino F, Bellati C, Secreto G, Camerini E, Pala V. Reducing bioavailable sex
16 Denke MA. Individual responsiveness to a cholesterol-lowering diet in hormones through a comprehensive change in diet: the diet and androgens (DIANA)
postmenopausal women with moderate hypercholesterolemia. ARCH INTERN MED. randomized trial. Cancer Epidemiol Biomarkers Prev. 2001.
1994;154(17):1977-82. 36 Barnard ND, Scialli AR, Turner-McGrievy G, Lanou AJ, Glass J. The effects of a low-
17 Segal-Isaacson CJ, Johnson S, Tomuta V. A randomized trial comparing low-fat and fat, plant-based dietary intervention on body weight, metabolism, and insulin
low-carbohydrate diets matched for energy and protein. Obesity …. 2004. sensitivity. Am J Med. 2005;118(9):991-7.
18 Svendsen OL, Hassager C, Christiansen C. Effect of an energy-restrictive diet, with or 37 Segal-Isaacson CJ, Johnson S, Tomuta V. A randomized trial comparing low-fat and
without exercise, on lean tissue mass, resting metabolic rate, cardiovascular risk low-carbohydrate diets matched for energy and protein. Obesity …. 2004.
factors, and bone in overweight postmenopausal women. AM J MED. 1993;95(2): 38 Svendsen OL, Hassager C, Christiansen C. Effect of an energy-restrictive diet, with or
131-40. without exercise, on lean tissue mass, resting metabolic rate, cardiovascular risk
19 Mason C, Foster-Schubert KE, Imayama I, Kong A, Xiao L, Bain C, et al. Dietary factors, and bone in overweight postmenopausal women. AM J MED. 1993;95(2):
weight loss and exercise effects on insulin resistance in postmenopausal women. Am 131-40.
J Prev Med. 2011;41(4):366-75. 39 Mason C, Foster-Schubert KE, Imayama I, Kong A, Xiao L, Bain C, et al. Dietary
20 Sénéchal M, Bouchard DR, Dionne IJ, Brochu M. The effects of lifestyle interventions weight loss and exercise effects on insulin resistance in postmenopausal women. Am
in dynapenic-obese postmenopausal women. Menopause. 2012;19(9):1015-21. J Prev Med. 2011;41(4):366-75.
21 Bajerska J, Chmurzynska A, Muzsik A. Weight loss and metabolic health effects from 40 Sénéchal M, Bouchard DR, Dionne IJ, Brochu M. The effects of lifestyle interventions
energy-restricted Mediterranean and Central-European diets in postmenopausal in dynapenic-obese postmenopausal women. Menopause. 2012;19(9):1015-21.
women: A randomized …: nature.com; 2018. 41 Bajerska J, Chmurzynska A, Muzsik A. Weight loss and metabolic health effects from
22 Otten J, Mellberg C, Ryberg M, Sandberg S, Kullberg J, Lindahl B, et al. Strong and energy-restricted Mediterranean and Central-European diets in postmenopausal
persistent effect on liver fat with a Paleolithic diet during a two-year intervention. Int women: A randomized …: nature.com; 2018.
J Obes. 2016;40(5):747-53. 42 Mellberg C, Sandberg S, Ryberg M, Eriksson M, Brage S, Larsson C, et al. Long-term
23 Mellberg C, Sandberg S, Ryberg M, Eriksson M, Brage S, Larsson C, et al. Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: A 2-year
effects of a Palaeolithic-type diet in obese postmenopausal women: A 2-year randomized trial. Eur J Clin Nutr. 2014;68(3):350-7.
randomized trial. Eur J Clin Nutr. 2014;68(3):350-7. 43 Nowson CA, Wattanapenpaiboon N, Pachett A. Low-sodium Dietary Approaches to
24 Nowson CA, Wattanapenpaiboon N, Pachett A. Low-sodium Dietary Approaches to Stop Hypertension-type diet including lean red meat lowers blood pressure in
Stop Hypertension-type diet including lean red meat lowers blood pressure in postmenopausal women. Nutr Res. 2009;29(1):8-18.
postmenopausal women. Nutr Res. 2009;29(1):8-18. 44 Buzzard IM, Asp EH, Chlebowski RT, Boyar AP, Jeffery RW, Nixon DW, et al. Diet
25 Buzzard IM, Asp EH, Chlebowski RT, Boyar AP, Jeffery RW, Nixon DW, et al. Diet intervention methods to reduce fat intake: nutrient and food group composition of
intervention methods to reduce fat intake: nutrient and food group composition of self-selected low-fat diets. J Am Diet Assoc. 1990;90(1):42-50, 3.
self-selected low-fat diets. J Am Diet Assoc. 1990;90(1):42-50, 3. 45 Thomson CA, Stopeck AT, Bea JW, Cussler E, Nardi E, Frey G, et al. Changes in body
26 Thomson CA, Stopeck AT, Bea JW, Cussler E, Nardi E, Frey G, et al. Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a
weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs. reduced carbohydrate diets. Nutr Cancer. 2010;62(8):
randomized trial of low-fat vs. reduced carbohydrate diets. Nutr Cancer. 2010;62(8): 1142-52.
1142-52. 46 Murillo-Ortiz B, Martinez-Garza S, Landeros VC, Velazquez GC, Garcia DS. Effect of
27 Murillo-Ortiz B, Martinez-Garza S, Landeros VC, Velazquez GC, Garcia DS. Effect of reduced dietary fat on estradiol, adiponectin, and IGF-1 levels in postmenopausal
reduced dietary fat on estradiol, adiponectin, and IGF-1 levels in postmenopausal women with breast cancer. Breast cancer: targets and therapy. 2017;9:359-64.
women with breast cancer. Breast cancer: targets and therapy. 2017;9:359-64. 47 Denke MA. Individual responsiveness to a cholesterol-lowering diet in
28 SP, Georgopoulos A, Young LR, Kurzer MS, Redmon JB, Raatz SK. A high-fat diet and postmenopausal women with moderate hypercholesterolemia. ARCH INTERN MED.
the threonine-encoding allele (Thr54) polymorphism of fatty acid-binding protein 2 1994;154(17):1977-82.
reduce plasma triglyceride-rich lipoproteins. Nutr Res. 2011;31(7):503-8. 48 Kasim-Karakas SE, Almario RU, Mueller WM, Peerson J. Changes in plasma
29 Jeppesen J, Schaaf P, Jones C, Zhou MY, Ida Chen YD, Reaven GM. Effects of low-fat, lipoproteins during low-fat, high-carbohydrate diets: effects of energy intake. Am J
high-carbohydrate diets on risk factors for ischemic heart disease in postmenopausal Clin Nutr. 2000;71(6):1439-47.
women. AM J CLIN NUTR. 1997;65(4):1027-33.
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Maturitas 155 (2022) 40–53

Contents lists available at ScienceDirect

Whole-diet interventions and cardiovascular risk factors in postmenopausal

1. Introduction age [5], resulting in increased risk of cardiovascular, osteoarthritis,

Fig. 1. Study selection process.

cancer increasing vegetable and fruit related materials

Maturitas 155 (2022) 40–53

[14] Mediterranean vegetarian against Cancer program:

Maturitas 155 (2022) 40–53

Maturitas 155 (2022) 40–53

3.4. Summary of Evidence

characteristics, and comparisons, we decided to systematically sum­

changes are reported.

3.4.1. General/healthy population of postmenopausal women

cemic indices, and blood pressure in general/healthy population of

postmenopausal women for 8 weeks. The authors reported no significant

Additionally, finding of this study on 16 participants demonstrated that

Another cross-over trial observed significant increases for TG (p <

carbohydrate diet compared to a high-fat, low-carbohydrates diet after 3

LDL levels in this small sample (n = 10) [97].

the following paragraphs. This clinical trial aimed at investigating the

diabetes and cancer showed no significant differences for FBS, insulin

sensitivity, and insulin resistance between the intervention and control

intervention on SBP and DBP in (p > 0.05) 45,887 participants as well

guideline recommendations on 994 participants of Women’s Health

significant reductions in LDL and HDL levels in both intervention and

control groups as well as between groups after 12 months (p < 0.05)

Dallas Hall et al. on 1,067 participants no considerable changes in FBS

were observed. However, adhering to the low-fat diet showed a signif­

icant reduction in SBP compared to the general dietary recommenda­

significantly affected DBP or SBP levels in 26 postmenopausal women in

a 4-week cross-over trial [96].

The delta Study, a multicenter 8-week cross-over study, on 18

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characteristics, and comparisons, we decided to systematically sum

were observed. However, adhering to the low-fat diet showed a signif

icant reduction in SBP compared to the general dietary recommenda