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This randomized, cross-over trial aims to assess changes in body weight, plasma lipids, insulin sensitivity, and postprandial metabolism with a low-fat, plant-based diet and a Mediterranean diet, both followed for 4 months.
In a 36-week cross-over trial, overweight adults will consume a low-fat vegan diet and a Mediterranean diet in two separate 16-week phases. Changes in body weight will be the primary dependent variable. In addition, plasma lipid concentrations, insulin sensitivity, and postprandial metabolism will also be assessed and changes over time will be compared between the two diets.
Participants will be randomly assigned to start either a low-fat vegan diet or a Mediterranean diet for 16 weeks. Both groups will receive weekly classes and support, and will be asked to make no changes to their exercise patterns for the study period. After a 4-week washout period, participants will cross over to the second dietary intervention for another 16 weeks.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Plant-based diet | Active Comparator | The diet group will be asked to follow a low-fat, vegan diet for 16 weeks. |
|
| Mediterranean diet | Active Comparator | The diet group will be asked to follow a Mediterranean diet for 16 weeks. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Plant-based diet | Other | Weekly instructions will be given to the participants in the intervention group about following the vegan diet. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Body weight | Body weight will be assessed at the baseline and at the completion of both interventions. | Change in body weight from Baseline at 4 months |
| Plasma lipids | Plasma cholesterol, triglycerides, and HbA1c will be measured in a fasting state. | Change in plasma cholesterol, triglycerides, and HbA1c from Baseline at 4 months |
| Insulin sensitivity | Insulin sensitivity will be assessed by the HOMA index. | Change in insulin sensitivity from Baseline at 4 months |
| Metabolism | Participants will be asked to report to the laboratory within 60 minutes of waking and after a 12-hour fast. Following 30 minutes of quiet rest in a dimly lit room, pulse, respiratory rate, and body temperature will be measured. REE will be measured for 20 minutes through indirect calorimetry (Cosmed Quark RMR, Chicago, IL) utilizing a ventilated hood system. The laboratory temperature will be maintained at 23 degrees C throughout, and precautions will be taken to minimize any disturbances that could affect the metabolic rate. For premenopausal women, measures will be timed so as to occur in the luteal phase of the menstrual cycle. Postprandial metabolism will be measured for three hours after the standard meal. | Changes in metabolism from Baseline at 4 months |
| Measure | Description | Time Frame |
|---|---|---|
| Levels of Advanced Glycosylation Endproducts (AGEs) | An AGE reader will be used to measure the Levels of the AGEs in the skin | Change in Advanced Glycosylation Endproducts (AGEs) from Baseline at 4 months |
| Endothelial function |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Neal Barnard | Physicians Committee for Responsible Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Physicians Committee for Responsible Medicine | Washington D.C. | District of Columbia | 20016 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41346691 | Derived | Kahleova H, Smith R, Fischer I, Brennan H, Znayenko-Miller T, Holubkov R, Barnard ND. Plant-based dietary index on the Mediterranean and a vegan diet: a secondary analysis of a randomized, cross-over trial. Front Nutr. 2025 Nov 19;12:1666807. doi: 10.3389/fnut.2025.1666807. eCollection 2025. | |
| 40635898 | Derived |
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| ID | Term |
|---|---|
| D050177 | Overweight |
| D009765 | Obesity |
| D007333 | Insulin Resistance |
| ID | Term |
|---|---|
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
| D001835 | Body Weight |
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| ID | Term |
|---|---|
| D000095500 | Diet, Plant-Based |
| D000067269 | Diet, Vegan |
| D038441 | Diet, Mediterranean |
| ID | Term |
|---|---|
| D004035 | Diet Therapy |
| D044623 | Nutrition Therapy |
| D013812 | Therapeutics |
| D004032 | Diet |
| D009747 |
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| Mediterranean Diet | Other | Weekly instructions will be given to the participants in the intervention group about following the Mediterranean diet. |
|
Endothelial function will be measured using the EndoPAT.
| Change in Endothelial function from Baseline at 4 months |
| Microbiome analysis | Microbiome analysis will be performed from participant-provided stool sample. Anticipated changes in the dietary intervention group include changes in the microbiome composition that correlate with changes in insulin sensitivity. | Change in Microbiome from Baseline at 4 months |
| Dietary Advanced Glycation End Products (AGEs) | Explore the effectiveness of a vegan diet in reducing dietary AGEs. | 16 weeks |
| PDI, hPDI, uPDI | Assess the total plant-based index (PDI), healthy PDI, and unhealthy PDI, and their relationship with weight loss. | 16 weeks |
| Ultraprocessed foods | The consumption of ultraprocessed foods will be assessed, using the NOVA classification, at baseline and 16 weeks. | 16 weeks |
| Carbon Footprint | The greenhouse gas emissions (GHGE) and cumulative energy demand (CED) will be assessed, using the database of Food Impacts on the Environment for Linking to Diets (dataFIELD) and What We Eat In America (WWEIA) database, at baseline and 16 weeks. | 16 weeks |
| Food costs | Food costs will be assessed, using the U.S. Department of Agriculture Thrifty Food Plan, 2021, at baseline and 16 weeks. | 16 weeks |
| Kahleova H, Maracine C, Himmelfarb J, Jayaraman A, Znayenko-Miller T, Holubkov R, Barnard ND. Dietary acid load on the Mediterranean and a vegan diet: a secondary analysis of a randomized, cross-over trial. Front Nutr. 2025 Jun 25;12:1634215. doi: 10.3389/fnut.2025.1634215. eCollection 2025. |
| 39176029 | Derived | Kahleova H, Znayenko-Miller T, Motoa G, Eng E, Prevost A, Uribarri J, Holubkov R, Barnard ND. Dietary advanced glycation end-products and their associations with body weight on a Mediterranean diet and low-fat vegan diet: a randomized, cross-over trial. Front Nutr. 2024 Aug 8;11:1426642. doi: 10.3389/fnut.2024.1426642. eCollection 2024. |
| 34330460 | Derived | Kahleova H, McCann J, Alwarith J, Rembert E, Tura A, Holubkov R, Barnard ND. A plant-based diet in overweight adults in a 16-week randomized clinical trial: The role of dietary acid load. Clin Nutr ESPEN. 2021 Aug;44:150-158. doi: 10.1016/j.clnesp.2021.05.015. Epub 2021 May 29. |
| 33544066 | Derived | Barnard ND, Alwarith J, Rembert E, Brandon L, Nguyen M, Goergen A, Horne T, do Nascimento GF, Lakkadi K, Tura A, Holubkov R, Kahleova H. A Mediterranean Diet and Low-Fat Vegan Diet to Improve Body Weight and Cardiometabolic Risk Factors: A Randomized, Cross-over Trial. J Am Nutr Assoc. 2022 Feb;41(2):127-139. doi: 10.1080/07315724.2020.1869625. Epub 2021 Feb 5. |
| D012816 |
| Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006946 | Hyperinsulinism |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| Nutritional Physiological Phenomena |
| D000066888 | Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |
| D014676 | Diet, Vegetarian |