Alimentação whole-food plant-based e saúde no contexto da medicina do estilo de vida
DOI:
https://doi.org/10.61661/BJLM.2023.v2.86Palavras-chave:
ciência da nutrição, dieta saudável, estilo de vida, saúde, promoção da saúdeResumo
A alimentação saudável, um dos pilares da medicina do estilo de vida (MEV), é fundamental para uma série de processos de saúde e doença, impactando de forma importante a qualidade de vida. Apesar da importância da alimentação para a prevenção e promoção da saúde, a formação e treinamento dos profissionais de saúde em geral para avaliar, interpretar e aconselhar estratégias relacionadas à alimentação saudável durante a prática clínica é escassa e insuficiente. Assim, o objetivo do presente trabalho é sintetizar as principais recomendações baseadas em evidências sobre o pilar da alimentação no contexto da MEV, identificando as bases de um padrão de alimentação saudável Whole-Food Plant-Based (WFPB), ou seja, composta predominantemente por alimentos vegetais e integrais (in natura ou minimamente processados). Por meio de uma revisão de literatura, as evidências encontradas indicam que, apesar da falta de uma definição única e em comum sobre o que representa especificamente o padrão de alimentação WFPB, o consumo de seus principais grupos alimentares está associado a benefícios para a saúde, incluindo saúde cardiovascular, diabetes tipo 2 e sobrepeso/obesidade. Além disso, os grupos alimentares predominantes na alimentação WPPB parecem ser o elo em comum de diferentes padrões alimentares saudáveis e de diretrizes e recomendações internacionais. Por fim, a alimentação WFPB, se bem planejada, parece ter boa adequação nutricional, com exceção da vitamina B12. Recomenda-se que profissionais de saúde em geral, e particularmente da MEV, se apropriem de tais conhecimentos baseados em evidências da área de alimentação e nutrição para melhores e mais efetivas orientações durante a prática clínica.
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Referências
Lianov L, Johnson M. Physician competencies for prescribing lifestyle medicine. JAMA. 2010;304(2):202-3. https://doi.org/10.1001/jama.2010.903 PMID:20628134
Kelly J, Karlsen MC, Lianov L. Establishing competencies for physicians who specialize in the practice of lifestyle medicine. Am J Lifestyle Med. 2019;14(2):150-4. https://doi.org/10.1177/1559827619856542 PMID:32231481 PMCID:PMC7092408
Sagner M, Katz D, Egger G, Lianov L, Schulz KH, Braman M, Behbod B, Phillips E, Dysinger W, Ornish D. Lifestyle medicine potential for reversing a world of chronic disease epidemics: from cell to community. Int J Clin Pract. 2014;68(11):1289-92. https://doi.org/10.1111/ijcp.12509 PMID:25348380
Rippe JM. Lifestyle medicine: the health promoting power of daily habits and practices. Am J Lifestyle Med. 2018;12(6):499-512. https://doi.org/10.1177/1559827618785554 PMID:30783405 PMCID:PMC6367881
Arena R, Smirmaul BPC. Infographic: the need for a global healthy living medicine strategy. Br J Sports Med. 2019;53(18):1193-4. https://doi.org/10.1136/bjsports-2018-099696 PMID:30315119
Smirmaul BPC, Chamon RF, Moraes FM, Rozin G, Moreira ASB, Almeida R, Guimarães ST. Lifestyle medicine during (and after) the covid-19 pandemic. Am J Lifestyle Med. 2020;15(1):60-7. https://doi.org/10.1177/1559827620950276 PMID:33456421 PMCID:PMC7781056
World Health Organization. Determinants of health. Geneva: World Health Organization; 2017. https://www.who.int/news-room/q-a-detail/determinants-of-health
GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393(10184):1958-72. https://doi.org/10.1016/s0140-6736(19)30041-8 PMID:30954305 PMCID:PMC6899507
GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-49. https://doi.org/10.1016/s0140-6736(20)30752-2 PMID:33069327 PMCID:PMC7566194
Hivert MF, Arena R, Forman DE, Kris-Etherton PM, McBride PE, Pate RR, Spring B, Trilk J, Van Horn LV, Kraus WE; American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health; Behavior Change Committee, a joint committee of the Council on Lifestyle and Cardiometabolic Health and the Council on Epidemiology and Prevention; Exercise, Cardiac Rehabilitation, and Secondary Prevention Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing. Medical training to achieve competency in lifestyle counseling: an essential foundation for prevention and treatment of cardiovascular diseases and other chronic medical conditions: a scientific statement from the American Heart Association. Circulation. 2016;134(15):e308-27. https://doi.org/10.1161/CIR.0000000000000442 PMID:27601568
Mondala MM, Sannidhi D. Catalysts for change: accelerating the lifestyle medicine movement through professionals in training. Am J Lifestyle Med. 2019;13(5):487-94. https://doi.org/10.1177/1559827619844505 PMID:31523214 PMCID:PMC6732878
Trilk J, Nelson L, Briggs A, Muscato D. Including lifestyle medicine in medical education: rationale for American College of Preventive Medicine/American Medical Association Resolution 959. Am J Prev Med. 2019;56(5):e169-75. https://doi.org/10.1016/j.amepre.2018.10.034 PMID:31003604
Santos-Lobato EAV, Santos-Lobato BL, Caldato MCF. Medicina do estilo de vida na educação médica: uma revisão narrativa. Rev Eletrônica Acervo Saude. 2020;12(1):e2786. https://doi.org/10.25248/reas.e2786.2020
American College of Lifestyle Medicine. American College of Lifestyle Medicine announces dietary lifestyle position statement for treatment and potential reversal of disease. Chesterfield: American College of Lifestyle Medicine; 2018. https://www.prweb.com/releases/American_College_of_Lifestyle_Medicine_Announces_Dietary_Lifestyle_Position_Statement_for_Treatment_and_Potential_Reversal_of_Disease/prweb15786205.htm
Colégio Brasileiro de Medicina do Estilo de Vida. Nutrição: alimentação saudável que nutre o corpo e satisfaz a mente. São Paulo: Colégio Brasileiro de Medicina do Estilo de Vida; [citado em 7 nov 2023]. https://cbmev.org.br/portfolio-item/nutricao/
Hark LA, Deen D. Position of the Academy of Nutrition and Dietetics: interprofessional education in nutrition as an essential component of medical education. J Acad Nutr Diet. 2017;117(7):1104-13. https://doi.org/10.1016/j.jand.2017.04.019 PMID:28648264
Aspry KE, Van Horn L, Carson JAS, Wylie-Rosett J, Kushner RF, Lichtenstein AH, Devries S, Freeman AM, Crawford A, Kris-Etherton P; American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Stroke Council. Medical nutrition education, training, and competencies to advance guideline-based diet counseling by physicians: a science advisory from the American Heart Association. Circulation. 2018;137(23):e821-41. https://doi.org/10.1161/cir.0000000000000563 PMID:29712711
Van Horn L, Lenders CM, Pratt CA, Beech B, Carney PA, Dietz W, DiMaria-Ghalili R, Harlan T, Hash R, Kohlmeier M, Kolasa K, Krebs NF, Kushner RF, Lieh-Lai M, Lindsley J, Meacham S, Nicastro H, Nowson C, Palmer C, Paniagua M, Philips E, Ray S, Rose S, Salive M, Schofield M, Thompson K, Trilk JL, Twillman G, White JD, Zappalà G, Vargas A, Lynch C. Advancing nutrition education, training, and research for medical students, residents, fellows, attending physicians, and other clinicians: building competencies and interdisciplinary coordination. Adv Nutr. 2019;10(6):1181-200. https://doi.org/10.1093/advances/nmz083 PMID:31728505 PMCID:PMC6855992
Crowley J, Ball L, Hiddink GJ. Nutrition in medical education: a systematic review. Lancet Planet Health. 2019;3(9):e379-89. https://doi.org/10.1016/s2542-5196(19)30171-8 PMID:31538623
Greaney ML, Cohen SA, Xu F, Ward-Ritacco CL, Riebe D. Healthcare provider counselling for weight management behaviours among adults with overweight or obesity: a cross-sectional analysis of National Health and Nutrition Examination Survey, 2011-2018. BMJ Open. 2020;10(11):e039295. https://doi.org/10.1136/bmjopen-2020-039295 PMID:33234635 PMCID:PMC7684803
Frame LA. Nutrition, a tenet of lifestyle medicine but not medicine? Int J Environ Res Public Health. 2021;18(11):5974. https://doi.org/10.3390/ijerph18115974 PMID:34199529 PMCID:PMC8199717
Storz MA. What makes a plant-based diet? A review of current concepts and proposal for a standardized plant-based dietary intervention checklist. Eur J Clin Nutr. 2022;76(6):789-800. https://doi.org/10.1038/s41430-021-01023-z PMID:34675405 PMCID:PMC9187516
Betageri O, Al-Turk B, Freeman AM, Aggarwal M. Prevention and reversal of morbidity in today's cardiovascular patient: role of lifestyle modification and nutrition in the current era. Curr Cardiol Rep. 2021;23(10):143. https://doi.org/10.1007/s11886-021-01577-1 PMID:34410533
Storz MA. Is there a lack of support for whole-food, plant-based diets in the medical community? Perm J. 2018;23(1):18-068. https://doi.org/10.7812/tpp/18-068 PMID:30589405 PMCID:PMC6307547
Ostfeld RJ. Definition of a plant-based diet and overview of this special issue. J Geriatr Cardiol. 2017;14(5):315. https://doi.org/10.11909/j.issn.1671-5411.2017.05.008 PMID:28630607 PMCID:PMC5466934
Satija A, Hu FB. Plant-based diets and cardiovascular health. Trends Cardiovasc Med. 2018;28(7):437-41. https://doi.org/10.1016/j.tcm.2018.02.004 PMID:29496410 PMCID:PMC6089671
Hemler EC, Hu FB. Plant-based diets for cardiovascular disease prevention: all plant foods are not created equal. Curr Atheroscler Rep. 2019;21(5):18. https://doi.org/10.1007/s11883-019-0779-5 PMID:30895476
Jafari S, Hezaveh E, Jalilpiran Y, Jayedi A, Wong A, Safaiyan A, Barzegar A. Plant-based diets and risk of disease mortality: a systematic review and meta-analysis of cohort studies. Crit Rev Food Sci Nutr. 2022;62(28):7760-72. https://doi.org/10.1080/10408398.2021.1918628 PMID:33951994
Gan ZH, Cheong HC, Tu YK, Kuo PH. Association between plant-based dietary patterns and risk of cardiovascular disease: a systematic review and meta-analysis of prospective cohort studies. Nutrients. 2021;13(11):3952. https://doi.org/10.3390/nu13113952 PMID:34836208 PMCID:PMC8624676
Lopez PD, Cativo EH, Atlas SA, Rosendorff C. The effect of vegan diets on blood pressure in adults: a meta-analysis of randomized controlled trials. Am J Med. 2019;132(7):875-883.e7. https://doi.org/10.1016/j.amjmed.2019.01.044 PMID:30851264
Lee KW, Loh HC, Ching SM, Devaraj NK, Hoo FK. Effects of vegetarian diets on blood pressure lowering: a systematic review with meta-analysis and trial sequential analysis. Nutrients. 2020;12(6):1604. https://doi.org/10.3390/nu12061604 PMID:32486102 PMCID:PMC7352826
Shah B, Newman JD, Woolf K, Ganguzza L, Guo Y, Allen N, Zhong J, Fisher EA, Slater J. Anti-inflammatory effects of a vegan diet versus the American Heart Association-recommended diet in coronary artery disease trial. J Am Heart Assoc. 2018;7(23):e011367. https://doi.org/10.1161/jaha.118.011367 PMID:30571591 PMCID:PMC6405545
Mishra S, Xu J, Agarwal U, Gonzales J, Levin S, Barnard ND. A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study. Eur J Clin Nutr. 2013;67(7):718-24. https://doi.org/10.1038/ejcn.2013.92 PMID:23695207 PMCID:PMC3701293
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Munoz D, Smith SC Jr, Virani SS, Williams KA Sr, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2019;74(10):1376-414. https://doi.org/10.1016/j.jacc.2019.03.009 PMID:30894319 PMCID:PMC8344373
Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Back M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B; ESC National Cardiac Societies; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-337. https://doi.org/10.1093/eurheartj/ehab484 PMID:34458905
Jardine MA, Kahleova H, Levin SM, Ali Z, Trapp CB, Barnard ND. Perspective: plant-based eating pattern for type 2 diabetes prevention and treatment: efficacy, mechanisms, and practical considerations. Adv Nutr. 2021;12(6):2045-55. https://doi.org/10.1093/advances/nmab063 PMID:34113961 PMCID:PMC8634508
American Diabetes Association. 3. Prevention or delay of type 2 diabetes: standards of medical care in Diabetes-2021. Diabetes Care. 2021;44 Suppl 1:S34-9. https://doi.org/10.2337/dc21-s003 PMID:33298414
Rinaldi S, Campbell EE, Fournier J, O'Connor C, Madill J. A comprehensive review of the literature supporting recommendations from the Canadian Diabetes Association for the use of a plant-based diet for management of type 2 diabetes. Can J Diabetes. 2016;40(5):471-7. https://doi.org/10.1016/j.jcjd.2016.02.011 PMID:27476051
Qian F, Liu G, Hu FB, Bhupathiraju SN, Sun Q. Association between plant-based dietary patterns and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA Intern Med. 2019;179(10):1335-44. https://doi.org/10.1001/jamainternmed.2019.2195 PMID:31329220 PMCID:PMC6646993
Viguiliouk E, Kendall CW, Kahleová H, Rahelic D, Salas-Salvadó J, Choo VL, Mejia SB, Stewart SE, Leiter LA, Jenkins DJ, Sievenpiper JL. Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 2019;38(3):1133-45. https://doi.org/10.1016/j.clnu.2018.05.032 PMID:29960809
Turner-McGrievy G, Mandes T, Crimarco A. A plant-based diet for overweight and obesity prevention and treatment. J Geriatr Cardiol. 2017;14(5):369-74. https://doi.org/10.11909/j.issn.1671-5411.2017.05.002 PMID:28630616 PMCID:PMC5466943
Barnard ND, Kahleova H, Levin SM. The use of plant-based diets for obesity treatment. Int J Dis Reversal Prev. 2019;1(1):[12 p.]. https://doi.org/10.22230/ijdrp.2019v1n1a11
Greger M. A whole food plant-based diet is effective for weight loss: the evidence. Am J Lifestyle Med. 2020;14(5):500-10. https://doi.org/10.1177/1559827620912400 PMID:32922235 PMCID:PMC7444011
Barnard ND, Levin SM, Yokoyama Y. A systematic review and meta-analysis of changes in body weight in clinical trials of vegetarian diets. J Acad Nutr Diet. 2015;115(6):954-69. https://doi.org/10.1016/j.jand.2014.11.016 PMID:25620754
Huang RY, Huang CC, Hu FB, Chavarro JE. Vegetarian diets and weight reduction: a meta-analysis of randomized controlled trials. J Gen Intern Med. 2016;31(1):109-16. https://doi.org/10.1007/s11606-015-3390-7 PMID:26138004 PMCID:PMC4699995
Wright N, Wilson L, Smith M, Duncan B, McHugh P. The BROAD study: a randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes. Nutr Diabetes. 2017;7(3):e256. https://doi.org/10.1038/nutd.2017.3 PMID:28319109 PMCID:PMC5380896
Hall KD, Guo J, Courville AB, Boring J, Brychta R, Chen KY, Darcey V, Forde CG, Gharib AM, Gallagher I, Howard R, Joseph PV, Milley L, Ouwerkerk R, Raisinger K, Rozga I, Schick A, Stagliano M, Torres S, Walter M, Walter P, Yang S, Chung ST. Effect of a plant-based, low-fat diet versus an animal-based, ketogenic diet on ad libitum energy intake. Nat Med. 2021;27(2):344-53. https://doi.org/10.1038/s41591-020-01209-1 PMID:33479499
Katz DL, Meller S. Can we say what diet is best for health? Annu Rev Public Health. 2014;35:83-103. https://doi.org/10.1146/annurev-publhealth-032013-182351 PMID:24641555
Willett W, Rockstrom J, Loken B, Springmann M, Lang T, Vermeulen S, Garnett T, Tilman D, DeClerck F, Wood A, Jonell M, Clark M, Gordon LJ, Fanzo J, Hawkes C, Zurayk R, Rivera JA, De Vries W, Majele Sibanda L, Afshin A, Chaudhary A, Herrero M, Agustina R, Branca F, Lartey A, Fan S, Crona B, Fox E, Bignet V, Troell M, Lindahl T, Singh S, Cornell SE, Srinath Reddy K, Narain S, Nishtar S, Murray CJL. Food in the anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447-92. https://doi.org/10.1016/s0140-6736(18)31788-4 PMID:30660336
Cena H, Calder PC. Defining a healthy diet: evidence for the role of contemporary dietary patterns in health and disease. Nutrients. 2020;12(2):334. https://doi.org/10.3390/nu12020334 PMID:32012681 PMCID:PMC7071223
Brasil, Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Guia alimentar para a população brasileira. 2. ed. Brasília: Ministério da Saúde; 2014. https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf
Canada, Health Canada. Canada's dietary guidelines for health professionals and policy makers. Ottawa: Health Canada; 2019. https://publications.gc.ca/collections/collection_2019/sc-hc/H164-231-2019-eng.pdf
Rose D, Heller MC, Roberto CA. Position of the society for nutrition education and behavior: the importance of including environmental sustainability in dietary guidance. J Nutr Educ Behav. 2019;51(1):3-15.e1. https://doi.org/10.1016/j.jneb.2018.07.006 PMID:30635107 PMCID:PMC6326035
Garber AJ, Handelsman Y, Grunberger G, Einhorn D, Abrahamson MJ, Barzilay JI, Blonde L, Bush MA, DeFronzo RA, Garber JR, Garvey WT, Hirsch IB, Jellinger PS, McGill JB, Mechanick JI, Perreault L, Rosenblit PD, Samson S, Umpierrez GE. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2020 executive summary. Endocr Pract. 2020;26(1):107-39. https://doi.org/10.4158/cs-2019-0472 PMID:32022600
Dietary Guidelines Advisory Committee. Scientific report of the 2020 dietary guidelines advisory committee: advisory report to the Secretary of Agriculture and Secretary of Health and Human Services. Washington: Department of Agriculture; 2020. https://doi.org/10.52570/DGAC2020
Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: vegetarian diets. J Acad Nutr Diet. 2016;116(12):1970-80. https://doi.org/10.1016/j.jand.2016.09.025 PMID:27886704
Karlsen MC, Rogers G, Miki A, Lichtenstein AH, Folta SC, Economos CD, Jacques PF, Livingston KA, McKeown NM. Theoretical food and nutrient composition of whole-food plant-based and vegan diets compared to current dietary recommendations. Nutrients. 2019;11(3):625. https://doi.org/10.3390/nu11030625 PMID:30875784 PMCID:PMC6471973
Jakse B, Jakse B, Pinter S, Pajek J, Godnov U, Mis NF. Nutrient and food intake of participants in a whole-food plant-based lifestyle program. J Am Coll Nutr. 2021;40(4):333-48. https://doi.org/10.1080/07315724.2020.1778584 PMID:32706327
United States, Department of Agriculture; Department of Health and Human Services. Dietary guidelines for americans, 2020-2025. 9th ed. Washington: Department of Agriculture; 2020. https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf
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Brazilian Journal of Lifestyle Medicine = Revista Brasileira de Medicina do Estilo de Vida permite que o(s) autor(es) mantenha(m) seus direitos autorais.
