The Effectiveness of the Mediterranean Diet and Plant-Based Diets in Improving the Lipid Profile of Patients with Dyslipidemia: A Narrative Review

Suandy; Adinda Nazwhanda Alvito  Sitorus; Reghita Claudia  Malau

doi:10.54783/influencejournal.v8i3.425

Authors

Suandy Universitas Prima Indonesia, Medan, Indonesia
Adinda Nazwhanda Alvito Sitorus Universitas Prima Indonesia, Medan, Indonesia
Reghita Claudia Malau Universitas Prima Indonesia, Medan, Indonesia

DOI:

https://doi.org/10.54783/influencejournal.v8i3.425

Keywords:

Dyslipidemia; Mediterranean Diet; Plant-Based Diet; LDL Cholesterol; HDL Cholesterol.

Abstract

Dyslipidemia contributes to atherosclerotic cardiovascular risk, particularly through elevated low-density lipoprotein cholesterol (LDL-C). Mediterranean and plant-based dietary patterns may improve circulating lipids. This narrative review examines their effects on total cholesterol, LDL-C, HDL-C, and triglycerides, together with biological mechanisms and limitations of the evidence. Targeted literature identification focused on traceable PubMed-indexed studies and publisher records, encompassing randomized trials, meta-analyses, and relevant reviews. Randomized-trial meta-analyses indicate that vegetarian and vegan diets reduce total cholesterol and LDL-C compared with omnivorous diets, while triglyceride changes are less consistent. Direct comparisons suggest greater LDL-C reductions with low-calorie vegetarian diets and greater triglyceride improvements with Mediterranean diets in certain settings. Mediterranean dietary interventions may also improve HDL function and LDL-related properties. Variation in participant characteristics, actual dietary composition, weight change, medication use, and intervention duration limits broad generalization. Both patterns can support dyslipidemia management, but currently available direct evidence does not establish universal superiority of either approach among patients with diagnosed dyslipidemia. Additional trials in hypercholesterolemia and recent meta-analyses strengthen the assessment of LDL changes, while also highlighting heterogeneous HDL and triglyceride responses and null findings in selected comparisons.

References

Babio et al. (2014). Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. CMAJ. https://doi.org/10.1503/cmaj.140764

Barnard et al. (2022). A Mediterranean diet and low-fat vegan diet to improve body weight and cardiometabolic risk factors: a randomized, cross-over trial. Journal of the American Nutrition Association. https://doi.org/10.1080/07315724.2020.1869625

Blanco Mejia et al. (2019). A meta-analysis of 46 studies identified by the FDA demonstrates that soy protein decreases circulating LDL and total cholesterol concentrations in adults. The Journal of Nutrition. https://doi.org/10.1093/jn/nxz020

Brown, L., Rose, K., & Campbell, A. (2022). Healthy plant-based diets and their short-term effects on weight loss, nutrient intake and serum cholesterol levels. Nutrition Bulletin, 47(2), 199–207. https://doi.org/10.1111/nbu.12554

Chiavaroli et al. (2018). Portfolio dietary pattern and cardiovascular disease: a systematic review and meta-analysis of controlled trials. Progress in Cardiovascular Diseases. https://doi.org/10.1016/j.pcad.2018.05.004

Del Gobbo et al. (2015). Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis, and dose-response of 61 controlled intervention trials. American Journal of Clinical Nutrition. https://doi.org/10.3945/ajcn.115.110965

Dinu et al. (2020). Effects of a dietary intervention with Mediterranean and vegetarian diets on hormones that influence energy balance: results from the CARDIVEG study. International Journal of Food Sciences and Nutrition. https://doi.org/10.1080/09637486.2019.1658723

Dinu et al. (2021). Effects of vegetarian versus Mediterranean diet on kidney function: findings from the CARDIVEG study. European Journal of Clinical Investigation. https://doi.org/10.1111/eci.13576

Dybvik et al. (2023). Vegetarian and vegan diets and the risk of cardiovascular disease, ischemic heart disease and stroke: a systematic review and meta-analysis of prospective cohort studies. European Journal of Nutrition. https://doi.org/10.1007/s00394-022-02942-8

Estruch et al. (2006). Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Annals of Internal Medicine. https://doi.org/10.7326/0003-4819-145-1-200607040-00004

Estruch et al. (2018). Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa1800389

Fitó et al. (2007). Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial. Archives of Internal Medicine. https://doi.org/10.1001/archinte.167.11.1195

Gardner, C. D., Coulston, A., Chatterjee, L., Rigby, A., Spiller, G., & Farquhar, J. W. (2005). The effect of a plant-based diet on plasma lipids in hypercholesterolemic adults: A randomized trial. Annals of Internal Medicine, 142(9), 725–733. https://doi.org/10.7326/0003-4819-142-9-200505030-00007

Guasch-Ferré et al. (2017). The PREDIMED trial, Mediterranean diet and health outcomes: how strong is the evidence?. Nutrition, Metabolism and Cardiovascular Diseases. https://doi.org/10.1016/j.numecd.2017.05.004

Guasch-Ferré et al. (2023). Effects of nut consumption on blood lipids and lipoproteins: a comprehensive literature update. Nutrients. https://doi.org/10.3390/nu15030596

Hernáez et al. (2017). Mediterranean diet improves high-density lipoprotein function in high-cardiovascular-risk individuals: a randomized controlled trial. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.116.023712

Hernáez et al. (2017). The Mediterranean diet decreases LDL atherogenicity in high cardiovascular risk individuals: a randomized controlled trial. Molecular Nutrition & Food Research. https://doi.org/10.1002/mnfr.201601015

Ilari et al. (2025). Dietary patterns, oxidative stress, and early inflammation: a systematic review and meta-analysis comparing Mediterranean, vegan, and vegetarian diets. Nutrients. https://doi.org/10.3390/nu17030548

Jenkins et al. (2003). Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA. https://doi.org/10.1001/jama.290.4.502

Jenkins et al. (2011). Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial. JAMA. https://doi.org/10.1001/jama.2011.1202

Jones et al. (2005). Effects of a diet high in plant sterols, vegetable proteins, and viscous fibers (dietary portfolio) on circulating sterol levels and red cell fragility in hypercholesterolemic subjects. Lipids. https://doi.org/10.1007/s11745-005-1372-6

Keshani, M., Sadeghi, N., Dadkhah Tehrani, S., Ramezani Ahmadi, A., & Sharma, M. (2024). Mediterranean diet enriched with olive oil shows no consistent benefits on cardiometabolic and anthropometric parameters: A systematic review with meta-analysis of randomized controlled trials. European Journal of Nutrition, 63(8), 2835–2857. https://doi.org/10.1007/s00394-024-03478-9

Koch et al. (2023). Vegetarian or vegan diets and blood lipids: a meta-analysis of randomized trials. European Heart Journal. https://doi.org/10.1093/eurheartj/ehad211

Landry et al. (2023). Cardiometabolic effects of omnivorous vs vegan diets in identical twins: a randomized clinical trial. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2023.44457

Lee, J.-W., et al. (2021). Effects of a calorie-restricted Mediterranean-style diet on plasma lipids in hypercholesterolemic South Korean patients. Nutrients, 13(10), 3393. https://doi.org/10.3390/nu13103393

Lessard-Lord, J., et al. (2026). Impact of a whole food, plant-based diet on LDL-cholesterol and cardiovascular risk factors in adults with heterozygous familial hypercholesterolemia: A randomized, two-period, two-treatment, crossover, fully controlled feeding trial. Nature Communications, 17, 6632. https://doi.org/10.1038/s41467-026-73468-4

López-Moreno et al. (2024). The OMNIVEG STUDY: Health outcomes of shifting from a traditional to a vegan Mediterranean diet in healthy men. A controlled crossover trial. Nutrition, Metabolism and Cardiovascular Diseases. https://doi.org/10.1016/j.numecd.2024.08.008

Martínez-González et al. (2015). Benefits of the Mediterranean diet: insights from the PREDIMED study. Progress in Cardiovascular Diseases. https://doi.org/10.1016/j.pcad.2015.04.003

Nishi et al. (2025). Effect of nut consumption on blood lipids: an updated systematic review and meta-analysis of randomized controlled trials. Nutrition, Metabolism and Cardiovascular Diseases. https://doi.org/10.1016/j.numecd.2024.10.009

Padhi, E. M. T., et al. (2015). Whole soy flour incorporated into a muffin and consumed at 2 doses of soy protein does not lower LDL cholesterol in a randomized, double-blind controlled trial of hypercholesterolemic adults. The Journal of Nutrition, 145(12), 2665–2674. https://doi.org/10.3945/jn.115.219873

Papadaki, A., Nolen-Doerr, E., & Mantzoros, C. S. (2020). The effect of the Mediterranean diet on metabolic health: A systematic review and meta-analysis of controlled trials in adults. Nutrients, 12(11), 3342. https://doi.org/10.3390/nu12113342

Pourrajab, B., Mirdar Harijani, A., Asghari, P., & Shidfar, F. (2025). Effect of the Mediterranean diet supplemented with olive oil versus the Mediterranean diet supplemented with mixed nuts on blood pressure and serum lipid indexes among adults: A systematic review and meta-analysis of randomized controlled trials. Nutrition, Metabolism and Cardiovascular Diseases, 35(11), 104166. https://doi.org/10.1016/j.numecd.2025.104166

Ros et al. (2014). Mediterranean diet and cardiovascular health: teachings of the PREDIMED study. Advances in Nutrition. https://doi.org/10.3945/an.113.005389

Scholle et al. (2009). The effect of adding plant sterols or stanols to statin therapy in hypercholesterolemic patients: systematic review and meta-analysis. Journal of the American College of Nutrition. https://doi.org/10.1080/07315724.2009.10719784

Shaghaghi et al. (2013). Cholesterol-lowering efficacy of plant sterols/stanols provided in capsule and tablet formats: results of a systematic review and meta-analysis. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2013.07.006

Sofi et al. (2018). Low-calorie vegetarian versus Mediterranean diets for reducing body weight and improving cardiovascular risk profile: CARDIVEG Study. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.117.030088

Trautwein & McKay (2020). The role of specific components of a plant-based diet in management of dyslipidemia and the impact on cardiovascular risk. Nutrients. https://doi.org/10.3390/nu12092671

Wang et al. (2015). Effects of vegetarian diets on blood lipids: a systematic review and meta-analysis of randomized controlled trials. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.115.002408

Whitehead et al. (2014). Cholesterol-lowering effects of oat beta-glucan: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition. https://doi.org/10.3945/ajcn.114.086108

Yokoyama et al. (2017). Association between plant-based diets and plasma lipids: a systematic review and meta-analysis. Nutrition Reviews. https://doi.org/10.1093/nutrit/nux030