Whole-diet interventions and cardiovascular risk factors in postmenopausal women: A systematic review of controlled clinical trials

•This systematic review summarizes current evidence about the effects of whole-diet interventions on cardiovascular risk factors among postmenopausal women.•Due to the large heterogeneity in intervention diets, comparison groups, intervention durations, and population characteristics in the limited number of studies that are currently available, overall findings are inconclusive.•Fat-modified diets are the most studied dietary interventions, and may improve concentrations of total and low-density lipoprotein cholesterol, systolic blood pressure, fasting blood sugar, and apolipoprotein A in comparison with the control diets.•Some adverse effects of fat-modified diets on other lipid profile markers and insignificant effects on glycemic indices and blood pressure were also observed.•Further well-designed clinical trials to find optimal diets for cardiovascular disease prevention in postmenopausal women are urgently needed. Menopause is accompanied by many metabolic changes, increasing the risk of cardiometabolic diseases. The impact of diet, as a modifiable lifestyle factor, on cardiovascular health in general populations has been well established. The purpose of this systematic review is to summarize the evidence on the effects of whole diet on lipid profile, glycemic indices, and blood pressure in postmenopausal women. Embase, Medline, Cochrane Central Register of Controlled Trials, and Google Scholar were searched from inception to February 2021. We included controlled clinical trials in postmenopausal women that assessed the effect of a whole-diet intervention on lipid profile, glycemic indices, and/or blood pressure. The risk of bias in individual studies was assessed using RoB 2 and ROBINS-I tools. Among 2,134 references, 21 trials met all eligibility criteria. Overall, results were heterogenuous and inconsistent. Compared to control diets, some studies showed that participants experienced improvements in total cholesterol (TC), low-density lipoprotein cholesterol (LDL), systolic blood pressure (SBP), fasting blood sugar (FBS), and apolipoprotein A (Apo-A) after following fat-modified diets, but some adverse effects on triglycerides (TG), very low-density lipoprotein cholesterol (VLDL), lipoprotein(a) (Lp(a)), and high-density lipoprotein cholesterol (HDL) concentrations were also observed. A limited number of trials found some effects of the Paleolithic, weight-loss, plant-based, or energy-restricted diets, or of following American Heart Association re