Whole-diet interventions and cardiovascular risk factors in postmenopausal women: A systematic review of controlled clinical trials

Abstract Objectives Menopause is accompanied by huge metabolic changes, increasing the risk of cardiometabolic diseases. The impact of diet, as a modifiable lifestyle factor, on cardiovascular health in general populations has been well established. The purpose of this systematic review is to summarize the evidence on the effects of whole diet on lipid profile, glycemic indices, and blood pressure in postmenopausal women. Methods Embase, Medline, Cochrane Central Register of Controlled Trials, and Google Scholar were searched from inception to February 2021. We included controlled clinical trials in postmenopausal women that assessed the effect of a whole-diet intervention on lipid profile, glycemic indices, and/or blood pressure. The risk of bias in individual studies was assessed using RoB 2 and ROBINS-I tools. Summary of evidence Among 2,134 references, 21 trials met all eligibility criteria. Compared with the control diets, some studies showed that participants experienced improvements 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)), high-density lipoprotein cholesterol (HDL), and the TC:HDL levels were also observed. A limited number of trials found significant effects of the Paleolithic, weight-loss, plant-based, energy-restricted diets, and American Heart Association recommendations on TG, TC, HDL, insulin, FBS, and 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, comparisons, and population characteristics in the limited number of studies, findings are inconclusive. Hence, this systematic review shows the urgent need for further well-designed clinical trials on cardiovascular risk factors in this population.