Efficacy of a Culturally Adapted High-Legume Plant-Based Diet for LDL-Cholesterol Reduction in Pakistani Adults With Hypercholesterolemia

Abstract

Background: Dietary strategies using culturally familiar plant foods may provide a practical approach to lipid management in populations with hypercholesterolemia. Objective: To evaluate the effect of replacing habitual daily meat intake with locally available legumes on serum low-density lipoprotein cholesterol (LDL-C) in Pakistani adults with moderate hypercholesterolemia. Methods: This single-blind, parallel-group randomized controlled trial enrolled 84 adults aged 30–65 years from tertiary outpatient cardiology clinics in Chitral District, Pakistan. Participants were randomized 1:1 to replace daily meat intake with 150–200 g of cooked legumes or continue their usual diet for 12 weeks. Seventy-nine participants completed follow-up and were included in the reported analysis. Results: LDL-C decreased from 158.1 ± 13.9 to 139.4 ± 12.1 mg/dL in the intervention group and from 157.2 ± 13.5 to 155.8 ± 12.9 mg/dL in controls. At week 12, LDL-C was 16.4 mg/dL lower in the intervention group (95% CI −22.0 to −10.8; p<0.001). Total cholesterol was also lower, whereas between-group differences in HDL-C, triglycerides, body mass index, blood pressure, and waist circumference were not statistically significant. Conclusion: A 12-week culturally adapted legume-based dietary substitution was associated with lower LDL-C and total cholesterol compared with usual diet among completers with moderate hypercholesterolemia