Improving cardiometabolic risk by dietary quality changes in secondary care patients in cardiology: four-year follow-up from BALANCE Program Trial

We aimed to assess whether changes in the Brazilian Cardioprotective Nutritional Program Trial diet quality through the Dietary Inflammatory Index (DII), dietary Total Antioxidant Capacity (dTAC), overall, healthy and unhealthy Plant-Based Diet Index (PDI, hPDI and uPDI, respectively), and modified Alternative Healthy Eating Index (mAHEI) contributed to the improvement of cardiometabolic risk markers in patients with established CVD during 48 months of follow-up. The delta (changes) of DII and dTAC were positively and negatively associated, respectively, with the body mass index and waist-to-height ratio (WHtR) deltas. Also, the PDI and hPDI deltas were negatively associated with total cholesterol, low-density lipoprotein cholesterol, and fasting glucose deltas. Finally, the uPDI delta was positively associated with fasting glucose and systolic blood pressure deltas and the mAHEI delta was also negatively associated with the WHtR and triglycerides deltas. Thus, adherence to a healthier dietary pattern may impact positively cardiometabolic risk factors in this sample.