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).
Open accessAbstract
BACKGROUND Despite the rising popularity of plant-based alternative meats, there is limited evidence of the health effects of these products. OBJECTIVES We aimed to compare the effect of consuming plant-based alternative meat (Plant) as opposed to animal meat (Animal) on health factors. The primary outcome was fasting serum trimethylamine-N-oxide (TMAO). Secondary outcomes included fasting insulin-like growth factor 1, lipids, glucose, insulin, blood pressure, and weight. METHODS SWAP-MEAT (The Study With Appetizing Plantfood-Meat Eating Alternatives Trial) was a single-site, randomized crossover trial with no washout period. Participants received Plant and Animal products, dietary counseling, lab assessments, microbiome assessments (16S), and anthropometric measurements. Participants were instructed to consume ≥2 servings/d of Plant compared with Animal for 8 wk each, while keeping all other foods and beverages as similar as possible between the 2 phases. RESULTS The 36 participants who provided complete data for both crossover phases included 67% women, were 69% Caucasian, had a mean ± SD age 50 ± 14 y, and BMI 28 ± 5 kg/m2. Mean ± SD servings per day were not different by intervention sequence: 2.5 ± 0.6 compared with 2.6 ± 0.7 for Plant and Animal, respectively (P = 0.76). Mean ± SEM TMAO concentrations were significantly lower overall for Plant (2.7 ± 0.3) than for Animal (4.7 ± 0.9) (P = 0.012), but a significant order effect was observed (P = 0.023). TMAO concentrations were significantly lower for Plant among the n = 18 who received Plant second (2.9 ± 0.4 compared with 6.4 ± 1.5, Plant compared with Animal, P = 0.007), but not for the n = 18 who received Plant first (2.5 ± 0.4 compared with 3.0 ± 0.6, Plant compared with Animal, P = 0.23). Exploratory analyses of the microbiome failed to reveal possible responder compared with nonresponder factors. Mean ± SEM LDL-cholesterol concentrations (109.9 ± 4.5 compared with 120.7 ± 4.5 mg/dL, P = 0.002) and weight (78.7 ± 3.0 compared with 79.6 ± 3.0 kg, P < 0.001) were lower during the Plant phase. CONCLUSIONS Among generally healthy adults, contrasting Plant with Animal intake, while keeping all other dietary components similar, the Plant products improved several cardiovascular disease risk factors, including TMAO; there were no adverse effects on risk factors from the Plant products.This trial was registered at clinicaltrials.gov as NCT03718988.
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In this study as well as several previous trials, clinically relevant changes in cardiovascular risk factors (eg, LDL-C and weight) were observed as early as 4 weeks into the intervention.
“Third, study duration was short (8 weeks); however, in this study as well as several previous trials,46,56 clinically relevant changes in cardiovascular risk factors (eg, LDL-C and weight) were observed as early as 4 weeks into the intervention.”
From Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial (2023) · cites this paper as [46]
In the SWAP-MEAT crossover trial, participants consuming plant-based alternative meat vs animal meat had significantly lower TMAO concentrations.
“In a recent crossover dietary trial (Study With Appetizing Plantfood-Meat Eating Alternative Trial [SWAP-MEAT]),46 participants consuming plant-based alternative meat vs animal meat had significantly lower TMAO concentrations.”
From Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial (2023) · cites this paper as [46]
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- Authors
- Crimarco, A., Springfield, S., Petlura, C., Streaty, T., Cunanan, K., Lee, J., Fielding-Singh, P., Carter, M. M., Topf, M. A., Wastyk, H. C., Sonnenburg, E. D., Sonnenburg, J. L., & Gardner, C. D.
- Affiliations
- Stanford Medicine (US)
- Chan Zuckerberg Biohub San Francisco (US)
- Corresponding author
- Gardner, Christopher D
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 112
- Issue
- 5
- Pages
- 1188-1199
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC7657338
- OpenAlex
- W3048835825
- Semantic Scholar
- baef07f6f9c782d052a8d345e0a079a125a67535
- Cited by
- 286
- References
- 46
- Citations by year
- 2026: 39 · 2025: 52 · 2024: 56 · 2023: 51 · 2022: 44 · 2021: 33 · 2020: 11
- FWCI
- 26.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Beyond Meat Inc.
- National Heart, Lung, and Blood Institute (T32HL007034)
- Stanford Clinical and Translational Science
- NIH (UL1 TR001085)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
- Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Meat and Animal Product Quality
- Keywords
- animal meat, trimethylamine N-oxide, cardiovascular risk factors, gut microbiota, insulin-like growth factor I, LDL cholesterol, blood pressure, insulin resistance, nutrition counseling, meat consumption, order effects, dietary intervention, dietary adherence
- MeSH terms
- Adult, Animals, Cardiovascular Diseases, Cattle, Chickens, Female, Humans, Male, Meat, Methylamines, Middle Aged, Risk Factors, Diet, Vegetarian, Exercise, Cross-Over Studies
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