The effects of the Green-Mediterranean diet on cardiometabolic health are linked to gut microbiome modifications; a randomized controlled trial. DIRECT PLUS trial, 6-month period

In the DIRECT-PLUS study, 294 participants with abdominal obesity/dyslipidemia were randomized to one of three intervention groups: healthy dietary guidelines, MED, and Green-MED, with plant foods increasing and meat intake decreasing in a stepwise manner. Both iso-caloric MED and Green-MED groups were supplemented with 28g/day walnuts. The Green-MED group was further provided with daily polyphenol-rich green tea and Mankai aquatic plant. Gut microbiota was profiled by 16S rRNA for all stool samples and shotgun sequencing for a selected subset of samples.