Effect of a Plant-based Intervention Among Black Individuals in the Deep South: A Pilot Study

Published:November 02, 2022DOI:



      To explore the feasibility, acceptability, and clinical/behavioral outcomes of a remotely-delivered, culturally-tailored plant-based nutrition and lifestyle intervention designed to improve cardiovascular risk among Black adults in a rural, Black Belt community.


      We implemented a 12-week intervention with weekly educational sessions, cooking lessons, social support, exercise, and food items.


      Body mass index, waist circumference, total cholesterol, low-density lipoprotein, high-density lipoprotein, high-sensitivity C-reactive protein, trimethylamine N-oxide, diet/physical activity. Paired t tests analyzed preintervention and postintervention differences (n = 24).


      Body mass index and waist circumference were reduced (P < 0.001), and total and low-density lipoprotein cholesterol decreased by 10.8% and 13.9%, respectively (P < 0.05). There was a 25.8% reduction in high-sensitivity C-reactive protein (P = 0.02). Diet and physical activity were also improved.

      Conclusions and Implications

      This pilot study demonstrated the feasibility and acceptability of a remotely-delivered intervention focused on improving cardiovascular risk through plant-based nutrition, physical activity/wellness, social support, and cultural adaptability. Larger scale and longer-term studies are needed.


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        • Carnethon MR
        • Pu J
        • Howard G
        • et al.
        Cardiovascular health in African Americans: a scientific statement from the American Heart Association.
        Circulation. 2017; 136: e393-e423
        • US Department of Health and Human Services
        Office of Minority Health.
        Obesity and African Americans. 2022; (Accessed January 3, 2022)
        • Williams WM
        • Yore MM
        • Whitt-Glover MC.
        Estimating physical activity trends among Blacks in the United States through examination of four national surveys.
        AIMS Public Health. 2018; 5: 144-157
        • Sterling SR
        • Bowen SA.
        The potential for plant-based diets to promote health among Blacks living in the United States.
        Nutrients. 2019; : 11
        • Judd SE
        • Gutiérrez OM
        • Newby PK
        • et al.
        Dietary patterns are associated with incident stroke and contribute to excess risk of stroke in black Americans.
        Stroke. 2013; 44: 3305-3311
        • Turner-McGrievy G
        • Wilcox S
        • Frongillo EA
        • et al.
        The Nutritious Eating with Soul (NEW Soul) Study: study design and methods of a two-year randomized trial comparing culturally adapted soul food vegan vs omnivorous diets among African American adults at risk for heart disease.
        Contemp Clin Trials. 2020; 88105897
        • Turner-McGrievy G
        • Mandes T
        • Crimarco A.
        A plant-based diet for overweight and obesity prevention and treatment.
        J Geriatr Cardiol. 2017; 14: 369-374
        • Airhihenbuwa CO
        • Kumanyika S
        • Agurs TD
        • Lowe A
        • Saunders D
        • Morssink CB.
        Cultural aspects of African American eating patterns.
        Ethn Health. 1996; 1: 245-260
        • Blocker DE
        • Freudenberg N.
        Developing comprehensive approaches to prevention and control of obesity among low-income, urban, African-American women.
        J Am Med Womens Assoc (1972). 2001; 56: 59-64
        • Kilanowski JF.
        Breadth of the socio-ecological model.
        J Agromedicine. 2017; 22: 295-297
        • Staten LK
        • Scheu LL
        • Bronson D
        • Peña V
        • Elenes J.
        Pasos Adelante: the effectiveness of a community-based chronic disease prevention program.
        Prev Chronic Dis. 2005; 2: A18
      1. American Heart Association. Healthy for Life Welcome Toolkit. American Heart Association; 2018. Accessed January 3, 2022.

      2. US Census Bureau. Quick facts: Albany city, GA; 2019. Accessed January 3, 2022.

      3. Georgia Department of Public Health, Office of Health Indicators for Planning. Ranked causes and state/county comparison, age-adjusted death rate, Georgia, 2017–2021. OASIS Community Health Needs Assessment Dashboard. Accessed July 10, 2022.

        • Marlatt KL
        • Redman LM
        • Burton JH
        • Martin CK
        • Ravussin E.
        Persistence of weight loss and acquired behaviors 2 y after stopping a 2-y calorie restriction intervention.
        Am J Clin Nutr. 2017; 105: 928-935
        • Dod HS
        • Bhardwaj R
        • Sajja V
        • et al.
        Effect of intensive lifestyle changes on endothelial function and on inflammatory markers of atherosclerosis.
        Am J Cardiol. 2010; 105: 362-367
        • Tseng CH
        • Sim D.
        Sample Size Planning for Pilot Studies.
        Sage Publications, 2020 (Accessed July 10, 2022)
        • Piercy KL
        • Troiano RP
        • Ballard RM
        • et al.
        The physical activity guidelines for Americans.
        JAMA. 2018; 320: 2020-2028
        • WHO Expert Committee
        Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee.
        World Health Organ Tech Rep Ser. 1995; 854: 1-452
      4. LabCorp. Blood specimens: chemistry and hematology. Accessed July 10, 2022.

        • Yeh ET.
        High-sensitivity C-reactive protein as a risk assessment tool for cardiovascular disease.
        Clin Cardiol. 2005; 28: 408-412
        • Liu Y
        • Dai M.
        Trimethylamine N-oxide generated by the gut microbiota is associated with vascular inflammation: new insights into atherosclerosis.
        Mediators Inflamm. 2020; 20204634172
        • Park Y
        • Dodd KW
        • Kipnis V
        • et al.
        Comparison of self-reported dietary intakes from the Automated Self-Administered 24-h recall, 4-d food records, and food-frequency questionnaires against recovery biomarkers.
        Am J Clin Nutr. 2018; 107: 80-93
        • Lee PH
        • Macfarlane DJ
        • Lam TH
        • Stewart SM.
        Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): a systematic review.
        Int J Behav Nutr Phys Act. 2011; 8: 115
        • DeMay TD
        • NN Ui-Jeen Y
        • Schumacher J
        Examination of nutrition knowledge,attitude, and dietary behaviors of college student vegetarians, semi-vegetarians, andnon-vegestarians.
        Sci J Food Sci Nutr. 2019; 5: 006-014
        • Satija A
        • Hu FB.
        Plant-based diets and cardiovascular health.
        Trends Cardiovasc Med. 2018; 28: 437-441
        • Turner-McGrievy GM
        • Barnard ND
        • Scialli AR.
        A two-year randomized weight loss trial comparing a vegan diet to a more moderate low-fat diet.
        Obesity (Silver Spring). 2007; 15: 2276-2281
        • Turner-McGrievy GM
        • Davidson CR
        • Wingard EE
        • Wilcox S
        • Frongillo EA.
        Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets.
        Nutrition. 2015; 31: 350-358
        • Crimarco A
        • Springfield S
        • Petlura C
        • et al.
        A randomized crossover trial on the effect of plant-based compared with animal-based meat on trimethylamine-N-oxide and cardiovascular disease risk factors in generally healthy adults: Study With Appetizing Plantfood-Meat Eating Alternative Trial (SWAP-MEAT).
        Am J Clin Nutr. 2020; 112: 1188-1199
        • Sequi-Dominguez I
        • Alvarez-Bueno C
        • Martinez-Vizcaino V
        • Fernandez-Rodriguez R
        • Del Saz Lara A
        • Cavero-Redondo I
        Effectiveness of mobile health interventions promoting physical activity and lifestyle interventions to reduce cardiovascular risk among individuals with metabolic syndrome: systematic review and meta-analysis.
        J Med Internet Res. 2020; 22: e17790
        • Ahmeidi AA
        • Musa A
        • Ahmed HS
        • et al.
        Inflammatory markers as predictors of mortality in COVID-19 infection.
        Afr J Lab Med. 2020; 9: 1298
        • Sutliffe JT
        • Wilson LD
        • de Heer HD
        • Foster RL
        • Carnot MJ.
        C-reactive protein response to a vegan lifestyle intervention.
        Complement Ther Med. 2015; 23: 32-37
        • Uchino BN
        • Trettevik R
        • Kent de Grey RG
        • Cronan S
        • Hogan J
        • Baucom BRW
        Social support, social integration, and inflammatory cytokines: a meta-analysis.
        Health Psychol. 2018; 37: 462-471
        • Obeid R
        • Awwad HM
        • Keller M
        • Geisel J.
        Trimethylamine-N-oxide and its biological variations in vegetarians.
        Eur J Nutr. 2017; 56: 2599-2609
        • Farmer N
        • Gutiérrez-Huerta CA
        • Turner BS
        • et al.
        Neighborhood environment associates with trimethylamine-N-oxide (TMAO) as a cardiovascular risk marker.
        Int J Environ Res Public Health. 2021; 18: 4296
        • Kent L
        • Morton D
        • Rankin P
        • et al.
        The effect of a low-fat, plant-based lifestyle intervention (CHIP) on serum HDL levels and the implications for metabolic syndrome status - a cohort study.
        Nutr Metab (Lond). 2013; 10: 58
        • Yokoyama Y
        • Levin SM
        • Barnard ND.
        Association between plant-based diets and plasma lipids: a systematic review and meta-analysis.
        Nutr Rev. 2017; 75: 683-698
        • Raina SK.
        Limitations of 24-hour Recall Method: micronutrient Intake and the Presence of the Metabolic Syndrome.
        N Am J Med Sci. 2013; 5: 498
        • Carson TL
        • Desmond R
        • Hardy S
        • et al.
        A study of the relationship between food group recommendations and perceived stress: findings from black women in the Deep South.
        J Obes. 2015; 2015203164