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Lyon Diet Heart Study : Benefits of a Mediterranean-Style, National Cholesterol Education Program/American Heart Association Step I Dietary Pattern on Cardiovascular Disease
Abstract
Diet is a cornerstone of cardiovascular disease (CVD) prevention and treatment efforts. Step I and Step II diets are widely recommended as the first line of CVD intervention.1 At the core of this dietary guidance are the recommendations to decrease saturated fat and cholesterol and to consume more fruits, vegetables, and whole grain products. Information from an extensive database, especially regarding saturated fat, indicates that these diets significantly lower blood cholesterol levels, a major risk factor for CVD. Consequently, it is beyond debate that these diets reduce CVD risk. Since the advent of Step I and Step II diets, nutritionists have sought to develop effective implementation strategies, including identifying dietary patterns that augment the beneficial effects of these diets. Recent findings indicate that we are making impressive progress in attaining these goals. There is provocative evidence from the Lyon Diet Heart Study2 suggesting that a Mediterranean-style, Step I diet (emphasizing more bread, more root vegetables and green vegetables, more fish, less beef, lamb and pork replaced with poultry, no day without fruit, and butter and cream replaced with margarine high in α-linolenic acid) has effects that may be superior to those observed for the usual Step I diet. These findings raise the interesting, but not yet corroborated, question of whether a modified Step I diet (ie, a Mediterranean-style Step I diet) that features a dietary pattern consistent with the new American Heart Association (AHA) Dietary Guidelines may augment the Step I or Step II diets that are presently implemented in clinical practice.
Defining a Mediterranean-style diet is challenging given the broad geographical region, including at least 16 countries, that borders the Mediterranean Sea. As would be expected, there are cultural, ethnic, religious, economic, and agricultural production differences that result in different dietary practices in these areas and that …
... In HF patients, the DASH diet can also improve 6-min walking test performance, compliance of artery, exercise capacity, and quality of life scores evaluated after an intervention for 3 months [91]. The Mediterranean diet describes the shared diet pattern among at least 16 countries bordering the Mediterranean Sea [92]. Besides being rich in fruits and vegetables, which is similar to that of the DASH diet, the Mediterranean diet is also characterized by bread, cereals of other forms, potatoes, beans, nuts, seeds, olive oil, little red meat, and low to moderate amounts of dairy products, fish, poultry and wine [92]. ...
... The Mediterranean diet describes the shared diet pattern among at least 16 countries bordering the Mediterranean Sea [92]. Besides being rich in fruits and vegetables, which is similar to that of the DASH diet, the Mediterranean diet is also characterized by bread, cereals of other forms, potatoes, beans, nuts, seeds, olive oil, little red meat, and low to moderate amounts of dairy products, fish, poultry and wine [92]. Although the Mediterranean diet was linked with lower all-cause mortality in CVD patients, a pre-specified secondary analysis from the PREvención con DIeta MEDiterránea (PREDIMED) trial did not find a significant decrease in HF incidence [93,94]. ...
Heart failure (HF) is a sophisticated syndrome with structural or functional impairment of ventricular filling or ejection of blood, either causing symptoms and signs or being asymptomatic. HF is a major global health issue affecting about 64.3 million people worldwide. The gut microbiota refers to the complex ecosystem of microorganisms, mainly bacteria, in the gut. Studies have revealed that the gut microbiota is associated with many diseases ranging from neurodegenerative diseases to inflammatory bowel disease and cardiovascular diseases. The gut hypothesis of HF suggests that low cardiac output and systemic circulation congestion would cause insufficient intestinal perfusion, leading to ischemia and intestinal barrier dysfunction. The resulting bacterial translocation would contribute to inflammation. Recent studies have refined the hypothesis that changes of metabolites in the gut microbiota have a close relationship with HF. Thus, the gut microbiota has emerged as a potential therapeutic target for HF due to both its critical role in regulating host physiology and metabolism and its pivotal role in the development of HF. This review article aims to provide an overview of the current understanding of the gut microbiota's involvement in HF, including the introduction of the gut hypothesis of HF, its association with HF progression, the potential mechanisms involved mediated by the gut microbiota metabolites, and the impact of various interventions on the gut microbiota, including dietary interventions, probiotic therapy, fecal microbiota transplantation, antibiotics, and so on. While the gut hypothesis of HF is refined with up-to-date knowledge and the gut microbiota presents a promising target for HF therapy, further research is still needed to further understand the underlying mechanisms between gut microbiota and HF, the efficacy of these interventions, and contribute to the health of HF patients.
... Kris-Etherton et al. (2001); en el ensayo controlado aleatorizado "Lyon Diet Heart", observaron que las personas post-infarto de miocardio, que fueron asignadas aleatoriamente a dieta mediterránea (n=204) tuvieron una reducción del 72% en muerte cardíaca e infarto de miocardio no fatal y reducción del 56% en la morbilidad total a los 4 años de seguimiento en comparación con aquellos asignados al azar a una dieta con recomendaciones de la American Heart Association (AHA), con un porcentaje de grasa total <30% (n=219). Así demostró además ser beneficiosa en el campo de la prevención secundaria en la estabilización de placa aterosclerótica 45 . ...
... Ninguna dieta excepto la mediterránea, se ha asociado con un aumento estadísticamente significativo en el colesterol c-HDL o la reducción de la PCR 45 . ...
ID ID ID ID Resumen Introducción: las enfermedades cardiovasculares no sólo son la primera causa de muerte con un 30% de todas ellas en el mundo, sino que el importante aumento de su incidencia en estos últimos años las sitúa en una urgencia sanitaria. Estas patologías están muy relacionadas con patrones alimentarios poco saludables (consumo intensivo de sodio, azúcares, grasas saturadas; y un bajo consumo de frutas y verduras, cereales, fibra, legumbres, pescado y frutos secos). Un patrón dietético adecuado y ajustado individualmente a las características clínicas de cada paciente pueden ayudarnos a reducir tanto el peso corporal como el riesgo cardiovascular. Objetivo: Analizar y comparar la eficacia de los principales patrones dietéticos en la reducción del riesgo cardiovascular. Resultados: La dieta mediterránea sigue siendo el patrón con mayor evidencia y mejores resultados sobre la reducción de dicho riesgo cardiovascular y su mortalidad. Sin embargo, la dieta DASH es una buena alternativa sobre todo para pacientes hipertensos, a su vez, la dieta vegetariana ha demostrado multitud de beneficios cardiovasculares, presentando escasas desventajas. Otra alternativa más compleja pero muy de moda actualmente es la dieta cetogénica, que todavía no cuenta con suficiente respaldo científico en la reducción del riesgo cardiovascular. Conclusiones: Realizar un adecuado patrón dietético es la medida más importante para prevenir la primera causa de muerte en el mundo, para ello disponemos de varios patrones alimentarios entre los que destaca la dieta mediterránea.
... The investigators presented results of an extended follow-up, and the striking reduction of CV evens was maintained for up to 4 years [195]. Table 5 shows the comparison of nutritional data in the intervention and control groups at the end of the study (27 months after the randomization) [82,195,196]. ...
... Comparison of nutritional data in the intervention and control groups in the Lyon Diet Heart study at the end of the study (27 months after the randomization) [82,195,196]. ...
Diet is a foundation of treatment for lifestyle-related diseases, such as high blood pressure, diabetes, and dyslipidemia. For these diseases, diet therapy has been disregarded in management of hyperlipidemia. Fat has more diversity of biological effects compared to those of protein and carbohydrate. New emerging evidences have resulted in a clear shift of recognition of fatty acids in diet therapy. The PREDIMED study has shown recently the amazing result that a calorie-unlimited, high-fat Mediterranean diet caused about 30% reduction in cardiovascular disease in obese subjects compared with a low-fat diet. Many authorities have removed restriction of intake of fat from their guidelines. The important, new message from recent medical and nutritional science is that people need to consume more “good fat” rather than limiting intake of fat to prevent cardiometabolic diseases. In this chapter, I would like to focus on the role of fatty acids with special relation on their effects on blood lipids and cardiovascular events.
... The MD is recognized as a good evidence-based model for the prevention of cardiovascular disease (CD) [1][2][3][4][5]. Two major randomized trials in secondary prevention (the Lyon Heart study [6] and the CORDIOPREV study [7]) and one primary prevention trial (the PREDIMED study [8]) have demonstrated these benefits. Also, there are several prospective studies that support the health benefits of the MD [9][10][11][12]. ...
(1) The main aim of this study was to analyze the relationship of the Mediterranean diet (MD) with vascular function in participants with and without increased insulin resistance (IR) in the Spanish population. A secondary aim was to study differences by gender. (2) Methods: Data were analyzed from 3401 subjects in the EVA, MARK, and EVIDENT studies (mean age = 60 years and 57% men). IR was evaluated with the triglyceride and glucose index (TyG index). TyG index = Ln [(fasting triglyceride mg/dL × fasting glucose mg/dL)/2]. The MD was measured against the MEDAS questionnaire, with the 14 items used in the PREDIMED study. Vascular stiffness was estimated with the brachial–ankle pulse wave velocity (baPWV) and the cardio ankle vascular index (CAVI) using the Vasera VS-1500®. (3) Results: The mean MEDAS value was 5.82 ± 2.03; (men: 5.66 ± 2.06; women: 6.04 ± 1.99; p < 0.001). MD adherence was 36.8% (men: 34.2%; women: 40.3%; p < 0.001). The mean baPWV value was 14.39 ± 2.78; (men: 14.50 ± 2.65; women: 14.25 ± 2.93; p = 0.005). A baPWV value ≥ 14.5 m/s was found in 43.4% (men: 43.6%; women: 40.0%; p = 0.727). The mean CAVI value was 8.59 ± 1.28; (men: 8.75 ± 1.28; women: 8.37 ± 1.26; p < 0.001). CAVI values ≥ 9 were present in 39.0% (men: 44.4%; women: 31.7%; p < 0.001). The mean value of the TGC/G index was 10.93 ± 1.39; (men: 11.08 ± 1.33; women: 10.73 ± 1.43; p < 0.001). IR was found in 49.9%. The average value of the MD score value was negatively associated with baPWV and CAVI in all groups analyzed (<0.05), except in the group of women with insulin resistance. (4) Conclusions: The results suggest that MD adherence is negatively associated with the vascular stiffness parameters analyzed in all the groups studied except the group of women with insulin resistance.
... Based on the findings of the above-mentioned studies and on many other large trials, official medical bodies introduced the importance of a heart-healthy diet in their educational programs (7). This was included in guidelines too (8). ...
... Históricamente, la producción de aceite de oliva estaba limitada a la región mediterránea, pero la tecnología moderna ha permitido desarrollar aceites con composiciones similares, como los de girasol, soja y colza, altos en ácido oleico. Esto ha dado lugar a variaciones de la DM, como la dieta del Estudio de Lyon (Kris-Etherton, 2001) o la indomediterránea (Singh, 2003), que incorporan estos aceites alternativos. (LDL-C), LDL oxidado (ox-LDL), triglicéridos y colesterol HDL (HDL-C) antes y 2 horas después de la comida (Violi, 2015). ...
El aceite de oliva, un componente esencial de la dieta mediterránea destaca por ser la principal fuente de grasas en esta alimentación y por aportar componentes de alto valor nutricional. Más allá de su impacto en el perfil lipídico, el aceite de oliva también juega un papel importante en el control de los niveles de azúcar en la sangre y la presión arterial. Entre sus propiedades destacan sus efectos antioxidantes y antiinflamatorios, la reducción del riesgo de formación de trombos y la promoción de la vasodilatación, todos contribuyentes significativos a la salud cardiovascular. Estos efectos beneficiosos del aceite de oliva se deben principalmente a su alto contenido de grasas monoinsaturadas y micronutrientes, en particular los compuestos fenólicos. A nivel clínico, la mayoría de las evidencias sobre estos beneficios provienen de estudios observacionales, que han servido para reafirmar la posición del aceite de oliva como uno de los alimentos más beneficiosos para la salud humana. La variedad de ventajas que ofrece hace que sea un elemento indispensable en una dieta saludable y equilibrada.
... Mead acid is not itself considered an essential fatty acid, but in the absence of adequate essential fatty acids in human tissues, the fatty acid MG(0:0/20:3(5Z,8Z,11Z)/0:0) is metabolised to mead acid (Gramlich et al., 2019;Kinoshita et al., 2016;Mead acid, 2021;Strandvik, 2006). Given that MG(0:0/20:3(5Z,8Z,11Z)/0:0) is significantly negatively correlated with MDS potentially indicates that some individuals in the 'low' MDS group, particularly those with very high MG(0:0/20:3(5Z,8Z,11Z)/0:0) levels, may exhibit deficiency in essential fatty acids (Kaur et al., 2014;Kris-Etherton et al., 2001). Adherence to MD has proved an enhancement in essential fatty acid levels (Hagfors et al., 2005;Ristic-Medic et al., 2020). ...
Introduction
Consumption of a Mediterranean diet (MD) has established health benefits, and the identification of novel biomarkers could enable objective monitoring of dietary pattern adherence.
Objectives
The present investigation performed untargeted metabolomics on blood plasma from a controlled study of MD adherence, to identify novel blood-based metabolite biomarkers associated with the MD pattern, and to build a logistic regression model that could be used to characterise MD adherence.
Methods
A hundred and thirty-five plasma samples from n = 58 patients collected at different time points were available. Using a 14-point scale MD Score (MDS) subjects were divided into ‘high’ or ‘low’ MDS adherence groups and liquid chromatography-mass spectrometry (LC–MS/MS) was applied for analysis.
Results
The strongest association with MDS was pectenotoxin 2 seco acid (r = 0.53; ROC = 0.78), a non-toxic marine xenobiotic metabolite. Several lipids were useful biomarkers including eicosapentaenoic acid, the structurally related lysophospholipid (20:5(5Z,8Z,11Z,14Z,17Z)/0:0), a phosphatidylcholine (P-18:1(9Z)/16:0) and also xi-8-hydroxyhexadecanedioic acid. Two metabolites negatively correlated with MDS, these were the monoacylglycerides (0:0/16:1(9Z)/0:0) and (0:0/20:3(5Z,8Z,11Z)/0:0). By stepwise elimination we selected a panel of 3 highly discriminatory metabolites and developed a linear regression model which identified ‘high MDS’ individuals with high sensitivity and specificity [AUC (95% CI) 0.83 (0.76–0.97)].
Conclusion
Our study highlights the utility of metabolomics as an approach for developing novel panels of dietary biomarkers. Quantitative profiling of these metabolites is required to validate their utility for evaluating dietary adherence.
... Grasas saturadas (%) 8 12 Grasas poliinsaturadas (%) 5 6 Grasas Monoinsaturadas (%) 13 11 Colesterol ( Resultados del estudio: La tasa de muertes cardíacas y de infarto no fatal fue de 1.24/100 pacientes/año, luego de 46 meses en el grupo experimental, muy similar a la observada después de 27 meses, la cual fue de 1.32 en ese mismo grupo; por lo tanto la disminución en el riesgo de un nuevo evento cardiovascular fue de 50 a 70%, mientras que en el grupo control se presentó una tasa de 4.07 por 100 pacientes al año con muertes cardíacas o infarto no fatal después de 46 meses, y de 5.55 luego de 27 meses. Lo anterior indica que al seguir una dieta estilo mediterráneo, se disminuye la incidencia de sufrir un nuevo infarto o de morir (17). ...
Existe evidencia científica que confirma la relación entre los diferentes componentes de la dieta mediterránea y la prevención de enfermedades crónicas no trasmisibles, como es el caso de la obesidad, la diabetes mellitus tipo 2, la dislipidemia, las enfermedades cardio-vasculares, el cáncer y aunque faltan más estudios, también se ha encontrado asociación con la prevención de la artritis reumatoidea. Se ha sugerido que este estilo de alimentación tradicional del mediterráneo sea adoptado como un todo y no cada componente por separado, no obstante, se deben hacer modificaciones en el estilo de vida, al igual que en el entorno, para mejorar las condiciones de salud de una población y prevenir la incidencia de las enfermedades crónicas que tienen su origen principalmente, en unos hábitos de alimentación inadecuados. Entre las sustancias nutritivas y no nutritivas que ofrece esta dieta y que tienen una relación directa con el mantenimiento de la salud se destacan: Los ácidos grasos monoinsaturados, que se encuentran en el aceite de oliva y en frutos secos como las nueces; los polifenoles y el resveratrol, antioxidantes que están presentes en el vino rojo; la fibra soluble e insoluble, la cual hace parte de las frutas, de las verduras y de los cereales integrales, al igual que los ácidos grasos omega 3 presentes en el pescado y también en las nueces.
... Mead acid is not itself considered an essential fatty acid, but in the absence of adequate essential fatty acids in human tissues, the fatty acid MG(0:0/20:3(5Z,8Z,11Z)/0:0) is metabolised to mead acid (24)(25)(26)(27). Given that MG(0:0/20:3(5Z,8Z,11Z)/0:0) is signi cantly negatively correlated with MDS potentially indicates that some individuals in the 'low' MDS group, particularly those with very high MG(0:0/20:3(5Z,8Z,11Z)/0:0) levels, may exhibit de ciency in essential fatty acids (28,29). Adherence to MD has proved an enhancement in essential fatty acid levels (30,31). ...
• Introduction: Consumption of a Mediterranean diet (MD) has established health benefits, and the identification of novel biomarkers could enable objective monitoring of dietary pattern adherence.
• Objectives: The present investigation performed untargeted metabolomics on blood plasma from a controlled study of MD adherence, to identify novel blood-based metabolite biomarkers associated with the MD pattern, and to build a logistic regression model that could be used to characterise MD adherence.
• Methods: A hundred and thirty-five plasma samples from n = 58 patients collected at different time points were available. Using a 14-point scale MD Score (MDS) subjects were divided into ‘high’ or ‘low’ MDS adherence groups and liquid chromatography-mass spectrometry (LC-MS/MS) was applied for analysis.
• Results: The strongest association with MDS was pectenotoxin 2 seco acid (r = 0.53; ROC = 0.78), a non-toxic marine xenobiotic metabolite. Several lipids were useful biomarkers including eicosapentaenoic acid, the structurally related lysophospholipid (20:5(5Z,8Z,11Z,14Z,17Z)/0:0), a phosphatidylcholine (P-18:1(9Z)/16:0) and also xi-8-hydroxyhexadecanedioic acid. Two metabolites negatively correlated with MDS, these were the monoacylglycerides (0:0/16:1(9Z)/0:0) and (0:0/20:3(5Z,8Z,11Z)/0:0). By stepwise elimination we selected a panel of 3 highly discriminatory metabolites and developed a linear regression model which identified ‘high MDS’ individuals with high sensitivity and specificity (AUC (95% CI) = 0.83 (0.76–0.97)).
• Conclusion: Our study highlights the utility of metabolomics as an approach for developing novel panels of dietary biomarkers. Quantitative profiling of these metabolites is required to validate their utility for evaluating dietary adherence.
... The Mediterranean diet also recommends daily consumption of fruits and vegetables (3-8 servings) (Lin and Morrison 2002;Alonso et al. 2004;Crowe et al. 2011). The Mediterranean diet has been reported to lower blood pressure and improve cardiovascular health (Kris-Etherton et al. 2001). Other health benefits include the prevention of diabetes, obesity, some cancers, and age-related cognitive decline (Guasch-Ferré and Willett 2021). ...
The gradual ageing of the world population has been accompanied by a dramatic increase in the prevalence of obesity and metabolic diseases, especially type 2 diabetes. The adipose tissue dysfunction associated with ageing and obesity shares many common physiological features, including increased oxidative stress and inflammation. Understanding the mechanisms responsible for adipose tissue dysfunction in obesity may help elucidate the processes that contribute to the metabolic disturbances that occur with ageing. This, in turn, may help identify therapeutic targets for the treatment of obesity and age-related metabolic disorders. Because oxidative stress plays a critical role in these pathological processes, antioxidant dietary interventions could be of therapeutic value for the prevention and/or treatment of age-related diseases and obesity and their complications. In this chapter, we review the molecular and cellular mechanisms by which obesity predisposes individuals to accelerated ageing. Additionally, we critically review the potential of antioxidant dietary interventions to counteract obesity and ageing.KeywordsAgeingObesityMetabolic syndromeOxidative stressInflammationNutraceuticalsDietary interventions
... 32 The authors found a greater than 70% reduction in recurrent non-fatal MI and greater than 50% reduction in mortality in the group adhering to the Mediterranean diet, compared to a prudent diet control group, over a 4-year period. 32,33 The Prevención con Dieta Mediterránea (PREDIMED) trial was a RCT that aimed to assess the role of the Mediterranean diet for the primary prevention of CVD among 7,447 patients at elevated cardiovascular risk. 34 Participants were randomized to one of three diets: the Mediterranean diet with higher amounts of EVOO, the Mediterranean diet with higher amounts of nuts, or a standard diet that was low in fat, with dietary guidance. ...
Purpose of Review
The relationship between cardiovascular health and diet is evolving. Lifestyle modifications including diet changes are the primary approach in managing cardiometabolic risk factors. Thus, understanding different diets and their impact on cardiovascular health is important in guiding primary and secondary prevention of cardiovascular disease (CVD). Yet, there are many barriers and limitations to adopting a heart healthy diet.
Recent Findings
Diets rich in fruits, vegetables, legumes, whole grains, and lean protein sources, with minimization/avoidance of processed foods, trans-fats, and sugar sweetened beverages, are recommended by prevention guidelines. The Mediterranean, DASH, and plant-based diets have all proven cardioprotective in varying degrees and are endorsed by professional healthcare societies, while other emerging diets such as the ketogenic diet and intermittent fasting require more long-term study. The effects of diet on the gut microbiome and on cardiovascular health have opened a new path for precision medicine to improve cardiometabolic risk factors. The effects of certain dietary metabolites, such as trimethylamine N-oxide, on cardiometabolic risk factors, along with the changes in the gut microbiome diversity and gene pathways in relation to CVD management, are being explored.
Summary
In this review, we provide a comprehensive up-to-date overview on established and emerging diets in cardiovascular health. We discuss the effectiveness of various diets and most importantly the approaches to nutritional counseling where traditional and non-traditional approaches are being practiced, helping patients adopt heart healthy diets. We address the limitations to adopting a heart healthy diet regarding food insecurity, poor access, and socioeconomic burden. Lastly, we discuss the need for a multidisciplinary team-based approach, including the role of a nutrition specialist, in implementing culturally-tailored dietary recommendations. Understanding the limitations and finding ways to overcome the barriers in implementing heart-healthy diets will take us miles in the path to CVD prevention and management.
... Our results are reminiscent of findings from a longitudinal study of diet quality with metabolic outcomes in adult men and women, whereby an increase in a priori dietary scores (e.g., the Portfolio diet, the Dietary Approaches to Stop Hypertension diet score, or the healthy diet score) was associated with a lowering of several CMRMs [33] (e.g., triglycerides, cholesterol, glucose, HbA1c, and blood pressure) as well as a lower risk of T2DM [34]. These results, when considered together with findings from randomized control trials (e.g., the PREDIMED study [35] and the Lyon Diet Heart study [36]) support improvements in overall diet as an important strategy to improve CMRMs. In our study, we found that a large improvement in diet quality, rather than a small improvement, is required to achieve favorable changes in CMRMs, which can be achieved by changing multiple dietary factors such as consuming greater amounts and varieties of fruit and vegetables, more whole grains, and less fat and saturated fat. ...
Adopting a healthy diet during and after pregnancy is important for women’s cardiometabolic health. We related changes in diet quality from pregnancy to 6 years postpregnancy to cardiometabolic markers 8 years postpregnancy. In 652 women from the GUSTO cohort, we assessed dietary intakes at 26–28 weeks’ gestation and 6 years postpregnancy using 24 h recall and a food frequency questionnaire, respectively; diet quality was scored using a modified Healthy Eating Index for Singaporean women. Diet quality quartiles were derived; stable, large/small improvement/decline in diet quality as no change, >1 or 1 quartile increase/decrease. Fasting triglyceride (TG), total-, high- and low-density-lipoprotein cholesterol (TC, HDL- and LDL-C), glucose and insulin were measured 8 years postpregnancy; homeostatic model assessment for insulin resistance (HOMA-IR) and TG: HDL-C ratio were derived. Linear regressions examined changes in diet quality quartiles and cardiometabolic markers. Compared to a stable diet quality, a large improvement was associated with lower postpregnancy TG [−0.17 (−0.32, −0.01) mmol/L], TG: HDL-C ratio [−0.21 (−0.35, −0.07) mmol/L], and HOMA-IR [−0.47 (−0.90, −0.03)]; a large decline was associated with higher postpregnancy TC and LDL-C [0.25 (0.02, 0.49); 0.20 (0.004, 0.40) mmol/L]. Improving or preventing a decline in diet quality postpregnancy may improve lipid profile and insulin resistance.
... Исследования убедительно подтвердили эту точку зрения, особенно специфичную для умеренного потребления красного вина [14]. Известно, что традиционные красные вина содержат большое количество природных фенолов флавоноидной и нефлавоноидной природы [14,46,60], витаминов и пр. [61]. ...
Это исследование направлено на то, чтобы подчеркнуть, что география является ценным ресурсом для развития нашего рассмотрения важных отношений между временем, здоровьем, местом и их характеристиками. Таким образом, исследования проблем со здоровьем и вспышек заболеваний имеют географический контекст. В этом исследовании также подчеркивается важность географического анализа для выявления экологических рисков и других воздействий на здоровье. География, в свою очередь, считается одной из ключевых областей в выявлении и изучении типов проблем со здоровьем, связанных с конкретными людьми или группами людей. С социально-экономической точки зрения географический подход необходим для поиска решений различных болезней и проблем, имеющих глобальные последствия. Проводится небольшой кейс, связанный с основной темой.
... The Diet and Reinfarction Trial (DART) [35] was the first RCT to show a reduction in mortality during the two years after myocardial infarction (MI) among men who were advised to eat about 300 g of FO per week or who took an equivalent amount of n-3 fatty acids in the form of FO supplements. Later, these findings were confirmed by the GISSI-Prevenzione trial [36], the Lyon Diet Heart Study [37], and various cohort studies. ...
Twenty percent of deaths in the United States are secondary to cardiovascular diseases (CVD). In patients with hyperlipidemia and hypertriglyceridemia, studies have shown high atherosclerotic CVD (ASCVD) event rates despite the use of statins. Given the association of high triglyceride (TG) levels with elevated cholesterol and low levels of high-density lipoprotein cholesterol, the American Heart Association (AHA)/American College of Cardiology (ACC) cholesterol guidelines recommend using elevated TGs as a “risk-enhancing factor” for ASCVD and using omega 3 fatty acids (Ω3FAs) for patients with persistently elevated severe hypertriglyceridemia. Ω3FA, or fish oils (FOs), have been shown to reduce very high TG levels, hospitalizations, and CVD mortality in randomized controlled trials (RCTs). We have published the largest meta-analysis to date demonstrating significant effects on several CVD outcomes, especially fatal myocardial infarctions (MIs) and total MIs. Despite the most intensive research on Ω3FAs on CVD, their benefits have been demonstrated to cluster across multiple systems and pathologies, including autoimmune diseases, infectious diseases, chronic kidney disease, central nervous system diseases, and, most recently, the COVID-19 pandemic. A review and summary of the controversies surrounding Ω3FAs, some of the latest evidence-based findings, and the current and most updated recommendations on Ω3FAs are presented in this paper.
... It has been shown that dietary patterns with high intake of red meat, refined grain, snacks, sweets and fried foods increased the risk of type 2 diabetes (12,13). In contrast, dietary patterns with high intake of non-refined cereals, fruits, and vegetables, moderate intake of dairy, poultry, and fish could reduce the incidence of diabetes (14,15). Since the pattern of dietary intake in Iran is different from western countries and also due to the importance of nutritional knowledge in controlling of diabetes complications, this study was undertaken to investigate the association between nutritional knowledge and food habits in relation to cardiometabolic risk factors in patients with diabetes. ...
Background: Diabetes is an increasing health problem. Diet and nutritional knowledge are the most important factors in diabetes. This study was done to investigate the association between nutritional knowledge and food habits in relation to cardiometabolic risk factors in the patients with diabetes. Methods: This cross-sectional study was conducted on 260 subjects with diabetes in Motahhari Diabetes Clinic in Shiraz, southern Iran. Dietary intakes were evaluated using a 147-item food frequency questionnaire (FFQ). Also socioeconomic , demographic and nutritional knowledge questionnaires were completed. Weight, height and waist circumference were measured. Fasting blood glucose (FBG), low density lipoprotein cholesterol (LDL), high density lipoproteincholesterol (HDL) and triglyceride TG were extracted from patients' medical records. Results: Of 73 male and 187 female patients, 39.2% were overweight and 33.5% were obese. There was a significant correlation between nutritional knowledge and vegetables intake. Also, getting more dairies and fats were significantly correlated to the levels of FBS. A positive significant correlation was seen between serum HDL and beans and cereals intake. Conclusion: Nutritional awareness cannot lead to a healthy diet alone because socioeconomic status, motivation, and other factors also affect dietary intake. Dietary habits can affect blood lipids and FBG. Therefore, improving the diet of diabetic patients is essential.
... Because ADF may aggravate muscle loss in those at risk for sarcopenia, this should be taken into consideration. According to certain research, adequate/excessive protein consumption during weight loss can help to prevent lean mass loss [37], [38], [39], [40], [41], [42]. ...
Fasting is one of the five pillars of Islam. Fasting entails more than abstaining from food and drink, fasting improves impulse control and aids in the development of good behavior. The holy month of Ramadan falls on the 9th month of the lunar calendar. Ramadan is a month-long fasting period that takes place between dawn and sunset. Some people with diabetes and those who are sick or have certain medical conditions may be exempt. The majority of people with diabetes, on the other hand, choose to fast; even against medical advice. Many studies have been conducted to determine the health benefits of fasting. Apart from the benefits to the body’s organs, Ramadan fasting is also beneficial for the growth of the gut microbiota and gene expression and is believed to impact the body’s autophagy process. Furthermore, Ramadan fasting has an impact on mental health; TC and LDL were lower, while HDL and TG were higher, lowers inflammation, and oxidative stress markers.
... For this it is advisable to keep the intake of CHL as low as possible in order to maintain good health [63]. On the basis of FA composition, AI and TI are the most essential indices to evaluate the nutritional value of food [64]. Our results showed that AI decreased significantly in all fried tissues with corn, olive and margarine for all studied fractions (TFA, TAG, CHL and FFA). ...
This investigation was aimed to assess and evaluate the effect of frying process with three different oils (corn, olive and margarine) on fatty acids and lipid classes’ composition of clam and their impact on the nutritional value and tissues quality. The results indicated that the contents of saturated, monounsaturated and polyunsaturated fatty acids varied significantly in fried clams and frying oil. Our data demonstrated that all lipid classes’ contents increased significantly after all frying processes. It was concluded that the frying process decreased the n-3/n-6 and DHA+EPA and increased the levels of atherogenic; thrombogenic indices. Additionally, these culinary processes promoted lipid peroxidation through the enhancement of TBARs, PV and FFA. These changes were more significant and intensive after frying with margarine and corn oils followed by virgin olive oil. These results suggest that clam fried with olive oil can be classified as highly nutritive in regard to its lipid content, major fatty acid profile; and nutritional value.
... The Mediterranean Diet is not a defined "diet," but rather a generalized term describing several meal pattern variants. The Mediterranean Diet has among the most consistent and robust scientific support in reducing atherosclerotic cardiovascular disease risk [68][69][70][71]. ...
Background
This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on Nutrition and Physical Activity provides clinicians an overview of nutrition and physical activity principles applicable to the care of patients with increased body fat, especially those with adverse fat mass and adiposopathic metabolic consequences.
Methods
The scientific information and clinical guidance is based upon referenced evidence and derived from the clinical perspectives of the authors.
Results
This OMA CPS on Nutrition and Physical Activity provides basic clinical information regarding carbohydrates, proteins, fats (including trans fats, saturated fats, polyunsaturated fats, and monounsaturated fats), general principles of healthful nutrition, nutritional factors associated with improved health outcomes, and food labels. Included are the clinical implications of isocaloric substitution of refined carbohydrates with saturated fats and vice-versa, as well as definitions of low-calorie, very low-calorie, carbohydrate-restricted, and fat-restricted dietary intakes. Specific dietary plans discussed include carbohydrate-restricted diets, fat-restricted diets, very low-calorie diets, the Mediterranean diet, Therapeutic Lifestyle diet, Dietary Approaches to Stop Hypertension (DASH), ketogenic (modified Atkins) diet, Ornish diet, Paleo diet, vegetarian or vegan diet (whole food/plant-based), intermittent fasting/time restricted feeding, and commercial diet programs. This clinical practice statement also examines the health benefits of physical activity and provides practical pre-exercise medical evaluation guidance as well as suggestions regarding types and recommended amounts of dynamic (aerobic) training, resistance (anaerobic) training, leisure time physical activity, and non-exercise activity thermogenesis (NEAT). Additional guidance is provided regarding muscle physiology, exercise prescription, metabolic equivalent tasks (METS), and methods to track physical activity progress.
Conclusion
This Obesity Medicine Association Clinical Practice Statement on Nutrition and Physical Activity provides clinicians an overview of nutrition and physical activity. Implementation of appropriate nutrition and physical activity in patients with pre-obesity and/or obesity may improve the health of patients, especially those with adverse fat mass and adiposopathic metabolic consequences.
... Epidemiological analyses and interventional trials have shown that, among many life-style factors, the differences in food preferences and dietary patterns contribute to the inhibition of aging-associated diseases and senescence. Among them, what has been carefully examined is that the relationship between increased consumption of soybeans and decreases in the incidence of cardiovascular diseases (CVDs) [1,2] and malignancies such as breast [3][4][5] and colon cancer [6][7][8][9], or a Mediterranean diet and increased vegetable intake are associated with a decreased incidence of lifestyle-related diseases, such as CVDs [10][11][12] and breast and colon cancer [13][14][15][16]. These findings indicate that ingredients contained in these foods play an important role in the inhibition of agingassociated pathologies. ...
Polyamines, spermidine and spermine, are synthesized in every living cell and are therefore contained in foods, especially in those that are thought to contribute to health and longevity. They have many physiological activities similar to those of antioxidant and anti-inflammatory substances such as polyphenols. These include antioxidant and anti-inflammatory properties, cell and gene protection, and autophagy activation. We have first reported that increased polyamine intake (spermidine much more so than spermine) over a long period increased blood spermine levels and inhibited aging-associated pathologies and pro-inflammatory status in humans and mice and extended life span of mice. However, it is unlikely that the life-extending effect of polyamines is exerted by the same bioactivity as polyphenols because most studies using polyphenols and antioxidants have failed to demonstrate their life-extending effects. Recent investigations revealed that aging-associated pathologies and lifespan are closely associated with DNA methylation, a regulatory mechanism of gene expression. There is a close relationship between polyamine metabolism and DNA methylation. We have shown that the changes in polyamine metabolism affect the concentrations of substances and enzyme activities involved in DNA methylation. I consider that the increased capability of regulation of DNA methylation by spermine is a key of healthy long life of humans.
... The traditional MedDiet reduces cardiovascular mortality [17,18]. The Lyon randomized trial [19] and the large primary-prevention PREDIMED trial have demonstrated that a MedDiet intervention reduces the incidence of major cardiovascular events [20,21]. Several molecular mechanisms seem to be involved in the risk-reduction effect of MedDiet in primary cardiovascular prevention [22][23][24][25][26]. Epidemiological evidence [27] and clinical trials [28] suggest that cardiovascular protection is achieved by consuming either extra-virgin olive oil (EVOO) or nuts, together with an emphasis in plant-derived foodskey elements of the MedDiet. ...
Background
Primary prevention trials have demonstrated that the traditional Mediterranean diet is associated with a reduction in cardiovascular mortality and morbidity. However, this benefit has not been proven for secondary prevention after an acute coronary syndrome (ACS). We hypothesized that a high-intensity Mediterranean diet intervention after an ACS decreases the vulnerability of atherosclerotic plaques by complex interactions between anti-inflammatory effects, microbiota changes and modulation of gene expression.
Methods
The MEDIMACS project is an academically funded, prospective, randomized, controlled and mechanistic clinical trial designed to address the effects of an active randomized intervention with the Mediterranean diet on atherosclerotic plaque vulnerability, coronary endothelial dysfunction and other mechanistic endpoints. One hundred patients with ACS are randomized 1:1 to a monitored high-intensity Mediterranean diet intervention or to a standard-of-care arm. Adherence to diet is assessed in both arms using food frequency questionnaires and biomarkers of compliance. The primary endpoint is the change (from baseline to 12 months) in the thickness of the fibrous cap of a non-significant atherosclerotic plaque in a non-culprit vessel, as assessed by repeated optical coherence tomography intracoronary imaging. Indices of coronary vascular physiology and changes in gastrointestinal microbiota, immunological status and protein and metabolite profiles will be evaluated as secondary endpoints.
Discussion
The results of this trial will address the key effects of dietary habits on atherosclerotic risk and will provide initial data on the complex interplay of immunological, microbiome-, proteome- and metabolome-related mechanisms by which non-pharmacological factors may impact the progression of coronary atherosclerosis after an ACS.
Trial registration
ClinicalTrials.gov NCT03842319 . Registered on 13 May 2019
... 14 One of the most studied dietary patterns is the Mediterranean diet, a plant-based diet that consists mostly of fruits, vegetables, whole grains, fatty fish, extra virgin olive oil, and nuts as its primary sources of fat, which has also been shown to reduce the incidence of major cardiac events in both primary and secondary prevention patients. 15,16 Stricter vegetarian and vegan (plantbased) diets have also been shown to improve modifiable CVD risk markers such as plasma lipids, 17 blood pressure, [18][19][20] and glycemic control 21 and reduce weight. 22,23 A low-fat vegetarian diet in a structured cardiac rehabilitation (CR) program that included other healthy lifestyle modifications such as focused exercise and mindfulness has been shown to reduce angina, 24,25 improve myocardial perfusion via positron emission tomography (PET) scan, 26 and potentially reverse coronary atherosclerosis. ...
Cardiovascular disease and its associated risk factors such as hypertension, obesity, and diabetes are contributing to a large portion of morbidity, mortality, and health care costs in the United States. Diet and lifestyle education have been shown to be beneficial in reducing cost, mortality, and morbidity associated with these diseases. However, the lack of implementation of diet and lifestyle tools into clinical practices and into hospital systems leaves much room for improvement. Obstacles such as poor physician education, financial concerns, patient preference, and social resistance to change have made it difficult to promote healthy lifestyle and nutrition practices throughout all aspects of health systems. Some hospital systems and hospital-based clinical practices have had important successes in creating prevention clinic models, implementing plant-based menus in their hospital systems, and incorporating intensive rehabilitation programs that will pave the way for more future change. This review describes the current deficits, obstacles, and innovative strategies for implementing lifestyle medicine into hospital systems.
... Further, the Lyon Diet Heart Study was a randomized controlled trial that evaluated the role of the MedDiet, with emphasis on α-linolenic acid, in secondary prevention [18]. Slightly over 600 patients were randomized to MedDiet versus a control group, respectively. ...
Purpose of Review
The prevalence of cardiovascular disease despite good medical therapy is on the rise, driven by risk factors such as hypertension, diabetes, hypercholesterolemia, and obesity. As healthcare providers, we must seek to better advise patients on preventative strategies through lifestyle changes.
Recent Findings
Guideline recommendations have been published by professional societies on the prevention of heart disease through lifestyle changes; however, limited education and experience with these lifestyle-modifying methods hinders appropriate counseling and treatment of patients.
Summary
Robust data support the use of lifestyle medicine to reduce cardiovascular morbidity and risk. These include, a more plant-based whole food diet, regular exercise, stress relief, connectedness, and other lifestyle approaches. This review will help further the understanding of the front-line clinician in cardiovascular prevention.
... There were criticisms of the study including lack of dietary information at baseline on the control group, and dietary data were reported only for less than 50% of the experimental group and 30% of the control group. Despite its success and calls for increased funding for studying dietary interventions from even the Nutrition Committee of the American Heart Association [65], it took two decades before additional randomized trials evaluating the Mediterranean diet were conducted. ...
Purpose of Review
To provide an overview of nutrition studies evaluating the association of dietary saturated fat and meat intake with the development of coronary artery disease (CAD) and discuss implications of recent data.
Recent Findings
Recent studies have led to the re-evaluation of the role of saturated fat in CAD. Randomized controlled trials (RCTs) support Mediterranean diet to reduce cardiovascular risk. Recent data revealed significant association of intake of meat or poultry with increased risk, but fish consumption was associated with lower risk of incident CAD.
Summary
In this review, we provide a brief overview of the studies and data that have led to the re-evaluation of the link between saturated fat and CAD. Due to conflicting data from long-term prospective cohort studies and significant heterogeneity, associations of unprocessed meat with CAD are less clear compared to the role of processed meat. Pooled data from prospective cohort studies have overcome some of these limitations and show association of both processed and unprocessed meat and poultry intake but not fish consumption with incident CAD. These findings were also validated recently in a large UK Biobank prospective study. While recognizing the limitations of these cohort studies, we discuss relevant landmark RCTs. We finally consider the challenges with RCTs in nutrition research to improve the quality of evidence and need for evidence-based dietary guidelines with respect to saturated fat intake from a clinical perspective.
... Research has indicated that the Mediterranean diet is associated with a reduced CVD morbidity and mortality risk through direct or indirect paths [7]. The Lyon Diet Heart Study was a pioneer randomized controlled trial (RCT) that highlighted the protective effect of the Mediterranean dietary patterns after a first myocardial infarction [18,19]. Most recently, the primary prevention large-scale PREDIMED (PREvención con DIeta MEDiterránea) RCT in individuals with metabolic syndrome reported that adherence to the Mediterranean diet significantly decreased CVD risk [20]. ...
Background/objectives
To quantify the changes in 10-year cardiovascular disease (CVD) onset, recurrence, and mortality, in relation to transitioning from low to a higher level of adherence to the Mediterranean diet.
Subjects/methods
An individual-level microsimulation was created based on ATTICA (2002–2012, n = 3042 subjects free-of-CVD) and GREECS (2004–2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of the level of adherence to the Mediterranean diet (corresponding to one to ten point increases in MedDietScore) were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths.
Results
Improving adherence to the Mediterranean diet in at least 10% of the population, a significant relative percentage reduction could be observed in 10-year CVD onset, recurrence, and mortality. At least 851 first CVD events, 374 recurrent CVD events, and 205 CVD deaths per 100,000 of the population could be averted or delayed. In addition, Mediterranean diet clustering revealed that scoring higher in fruits, vegetables, whole wheat products, and legumes was more important than achieving higher scores in low consumption of meat and full-fat dairy products against CVD (all HRs in the former cluster were lower than the latter, indicating a stronger protective effect).
Conclusions
This microsimulation process confirms the added value of the Mediterranean diet in primary and secondary CVD prevention having great achievements even with modifications in a small part of the population (10%), while challenges the orientation of Mediterranean-diet interventions giving higher weights to plant-based part.
... Following the first observation by Seven Country Study that adherence to Med D is inversely associated to CVD mortality, Med D acquired increasing importance in cardiovascular epidemiology. [22,23,24] In 2001, the American Heart Association qualified the Mediterranean Food Pattern as potentially effective for the prevention of CHD, though emphasizing the need of more studies before suggesting people to pursue a MD pattern [25] More recently, the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease underlines that plant-based and Mediterranean diets, along with increased fruit, nut, vegetable, legume, and lean vegetable or animal protein (preferably fish) consumption, with the inherent soluble and insoluble vegetable fiber, have consistently been associated with lower risk of all-cause mortality than control or standard diets in observational studies. [2] Similarly in the recently published 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD, "A Mediterranean diet, rich in polyunsaturated and monounsaturated fats, should be considered to reduce CV events" has a Class IIa indication. ...
... The traditional MedDiet reduces cardiovascular mortality (17,18). The Lyon randomized trial (19) and, the large primary-prevention PREDIMED trial, have demonstrated that a MedDiet intervention, reduces the incidence of major cardiovascular events (20,21). Several molecular mechanisms seem to be involved in the risk-reduction effect of MedDiet in primary cardiovascular prevention (22)(23)(24)(25)(26). Epidemiological evidence (27) and clinical trials (28) suggest that cardiovascular protection is achieved by consuming either extra-virgin olive oil (EVOO) or nuts, together with an emphasis in plant-derived foods -key elements of the MedDiet. ...
Background: Primary prevention trials have demonstrated that the traditional Mediterranean diet is associated with a reduction in cardiovascular mortality and morbidity. However, this benefit has not been proven for secondary prevention after an acute coronary syndrome (ACS). We hypothesized that a high-intensity Mediterranean diet intervention after an ACS decreases the vulnerability of atherosclerotic plaques by complex interactions between anti-inflammatory effects, microbiota changes and modulation of gene expression.
Methods: The MEDIMACS project is an academically funded, prospective, randomized, controlled and mechanistic clinical trial designed to address the effects of an active randomized intervention with the Mediterranean diet on atherosclerotic plaque vulnerability, coronary endothelial dysfunction, and other mechanistic endpoints. One hundred patients with ACS are randomized 1:1 to a monitored high-intensity Mediterranean diet intervention or to standard-of-care arm. Adherence to diet is assessed in both arms using food frequency questionnaires and biomarkers of compliance. The primary endpoint is the change (from baseline to 12 months) in the thickness of the fibrous cap of a non-significant atherosclerotic plaque in a non-culprit vessel, as assessed by repeated optical-coherence-tomography intracoronary imaging. Indices of coronary vascular physiology and changes in gastrointestinal microbiota, immunological status, and protein and metabolite profiles will be evaluated as secondary endpoints.
Discussion: The results of this trial will address the key effects of dietary habits on atherosclerotic risk and will provide initial data on the complex interplay of immunological, microbiome-, proteome- and metabolome-related mechanisms by which non-pharmacological factors may impact the progression of coronary atherosclerosis after an ACS.
Trial registration: ClinicalTrials.gov, NCT03842319. Registered on 13 May 2019. https://clinicaltrials.gov/ct2/show/NCT03842319
... To our knowledge, the Mediterranean and certain low carbohydrate diets help maintain a healthy weight and reduce the risks of coronary heart disease. If ADF were combined with a Mediterranean diet or a low-carbohydrate diet, it would be meaningful to observe how it affects weight loss and cardiovascular outcomes in future studies (48,49). To improve lipid, the combination of diet and exercise is more effective than diet or exercise alone (50). ...
Background: Alternate-day fasting (ADF) method is becoming more and more popular among adults. This meta-analysis aims to evaluate the effects of ADF on adults.
Methods: Randomized controlled trials (RCTs) of ADF were searched using PubMed (1988 to March 2020), EMBASE (1995 to March 2020), and the Cochrane Controlled Trials Register. A systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The datum was calculated by RevMan version 5.3.0. The original references for relating articles were also reviewed.
Results: Seven randomized controlled trials involving 269 participants (152 in the ADF group and 117 in the control group) were studied. In this meta-analysis, compared with the control group, the ADF group showed statistically significant reductions in weight (p < 0.00001) and body mass index (p < 0.00001). Besides, the ADF group showed significant differences in terms of total cholesterol (p = 0.001), low-density lipoprotein (p = 0.01), triglycerides (p = 0.02), fat mass (p = 0.002), lean mass (p = 0.002), systolic blood pressure (p = 0.003), diastolic blood pressure (p = 0.007), and total calorie intake (p = 0.007). At the same time, the analysis demonstrated that the ADF group had a same effect compared with control group in aspects of high-density lipoprotein (p = 0.27), homeostasis model assessment-insulin resistance (p = 0.55), and fasting blood sugar (p = 0.09).
Conclusions: This meta-analysis suggests that ADF is a viable diet strategy for weight loss, and it has a substantial improvement in risk indicators for diseases in obese or normal people.
Eurasian clinical practice guidelines for dietary management of cardiovascular diseases include actual healthy diet recommendations and modern dietary approaches for prevention and treatment of cardiovascular diseases. Nutritional assessment and interventions based on pathogenesis of atherosclerosis and cardiovascular diseases are presented.
Modern nutritional and dietary recommendations for patients with arterial hypertension, coronary heart disease, chronic heart failure, heart rhythm disorders, dyslipidemia and gout are summarized in present recommendations. Particular attention is paid to the dietary management of cardiovascular patients with obesity and/or diabetes mellitus. This guide would be interesting and intended to a wide range of readers, primarily cardiologists, dietitians and nutritionists, general practitioners, endocrinologists, and medical students.
Aims
This study aimed to review meta‐analyses of randomised controlled trials that evaluated the effectiveness of the Mediterranean Diet for the primary and secondary prevention of cardiovascular disease.
Methods
Five databases (Medline, Embase, Cochrane, CINAHL and ProQuest) were searched from inception to November 2022. Inclusion criteria were: (i) systematic review of randomised controlled studies with metanalysis; (ii) adults ≥18 years from the general population with (secondary prevention) and without (primary prevention) established cardiovascular disease; (iii) Mediterranean Diet compared with another dietary intervention or usual care. Review selection and quality assessment using AMSTAR‐2 were completed in duplicate. GRADE was extracted from each review, and results were synthesised narratively.
Results
Eighteen meta‐analyses of 238 randomised controlled trials were included, with an 8% overlap of primary studies. Compared to usual care, the Mediterranean Diet was associated with reduced cardiovascular disease mortality ( n = 4 reviews, GRADE low certainty; risk ratio range: 0.35 [95% confidence interval: 0.15–0.82] to 0.90 [95% confidence interval: 0.72–1.11]). Non‐fatal myocardial infarctions were reduced ( n = 4 reviews, risk ratio range: 0.47 [95% confidence interval: 0.28–0.79] to 0.60 [95% confidence interval: 0.44–0.82]) when compared with another active intervention. The methodological quality of most reviews ( n = 16/18; 84%) was low or critically low and strength of evidence was generally weak.
Conclusions
This review showed that the Mediterranean Diet can reduce fatal cardiovascular disease outcome risk by 10%–67% and non‐fatal cardiovascular disease outcome risk by 21%–70%. This preventive effect was more significant in studies that included populations with established cardiovascular disease. Better quality reviews are needed.
Background
Life's Essential 8 (LE8) is an enhanced metric for cardiovascular health. The interrelations among LE8, biomarkers of aging, and disease risks are unclear.
Methods and Results
LE8 score was calculated for 5682 Framingham Heart Study participants. We implemented 4 DNA methylation‐based epigenetic age biomarkers, with older epigenetic age hypothesized to represent faster biological aging, and examined whether these biomarkers mediated the associations between the LE8 score and cardiovascular disease (CVD), CVD‐specific mortality, and all‐cause mortality. We found that a 1 SD increase in the LE8 score was associated with a 35% (95% CI, 27–41; P =1.8E‐15) lower risk of incident CVD, a 36% (95% CI, 24–47; P =7E‐7) lower risk of CVD‐specific mortality, and a 29% (95% CI, 22–35; P =7E‐15) lower risk of all‐cause mortality. These associations were partly mediated by epigenetic age biomarkers, particularly the GrimAge and the DunedinPACE scores. The potential mediation effects by epigenetic age biomarkers tended to be more profound in participants with higher genetic risk for older epigenetic age, compared with those with lower genetic risk. For example, in participants with higher GrimAge polygenic scores (greater than median), the mean proportion of mediation was 39%, 39%, and 78% for the association of the LE8 score with incident CVD, CVD‐specific mortality, and all‐cause mortality, respectively. No significant mediation was observed in participants with lower GrimAge polygenic score.
Conclusions
DNA methylation‐based epigenetic age scores mediate the associations between the LE8 score and incident CVD, CVD‐specific mortality, and all‐cause mortality, particularly in individuals with higher genetic predisposition for older epigenetic age.
All recent guidelines on cardiovascular prevention have highlighted the role of a healthy diet and lifestyle advocating an holistic approach to reduce the cardiovascular burden among the population. Despite these efforts, registries have reported that only a minority of healthcare professionals provide advice on diet and lifestyle, and, in most cases, counseling is suboptimal for several reasons. Cardiovascular benefits linked to lifestyle and nutrition seem to be underestimated by many patients and doctors. This overview aims to summarize well-established benefits related to lifestyle and nutrition, discuss the current debates in this field in order to improve awareness among the medical community and promote better implementation of non-pharmaceutical measures to prevent the occurrence of atherothrombotic events, by reducing cardiovascular risk factors such as hypertension, diabetes, dyslipidemia, and obesity.
BACKGROUND
Diet is a key modifiable risk factor of coronary artery disease (CAD). However, the causal effects of specific dietary traits on CAD risk remain unclear. With the expansion of dietary data in population biobanks, Mendelian randomization (MR) could help enable the efficient estimation of causality in diet-disease associations.
OBJECTIVES
The primary goal was to test causality for 13 common dietary traits on CAD risk using a systematic 2-sample MR framework. A secondary goal was to identify plasma metabolites mediating diet-CAD associations suspected to be causal.
METHODS
Cross-sectional genetic and dietary data on up to 420,531 UK Biobank and 184,305 CARDIoGRAMplusC4D individuals of European ancestry were used in 2-sample MR. The primary analysis used fixed effect inverse-variance weighted regression, while sensitivity analyses used weighted median estimation, MR-Egger regression, and MR-Pleiotropy Residual Sum and Outlier.
RESULTS
Genetic variants serving as proxies for muesli intake were negatively associated with CAD risk (OR: 0.74; 95% CI: 0.65–0.84; P = 5.385 × 10⁻⁴). Sensitivity analyses using weighted median estimation supported this with a significant association in the same direction. Additionally, we identified higher plasma acetate levels as a potential mediator (OR: 0.03; 95% CI: 0.01–0.12; P = 1.15 × 10⁻⁴).
CONCLUSIONS
Muesli, a mixture of oats, seeds, nuts, dried fruit, and milk, may causally reduce CAD risk. Circulating levels of acetate, a gut microbiota-derived short-chain fatty acid, could be mediating its cardioprotective effects. These findings highlight the role of gut flora in cardiovascular health and help prioritize randomized trials on dietary interventions for CAD.
Lifestyle Medicine (LM) is a rapidly growing discipline that focuses on the role of lifestyle factors in preventing, managing, and reversing chronic disease. At this point in the field’s evolution, there is strong evidence that the 6 pillars of LM—a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections—are central in the creation and maintenance of health. Previous publications, many of them randomized controlled studies and meta-analyses, have solidified the evidence base for the use of the 6 pillars within the field of LM. As data emerged, so did its governing body, the American College of Lifestyle Medicine (ACLM), and with it a rich history began to unfold. Several articles have been written on the early history of the ACLM and the growth of the field; however, this review article explores the history and foundation of LM, aiming to provide a comprehensive understanding of its relevance and impact on health care. It underscores landmark studies that have defined the field and provides a road map detailing national and global barriers and areas of potential future growth.
The role of vascular endothelial cells in acute and chronic vascular inflammatory response has long been recognized. Therefore, persistent vascular inflammation may lead to endothelial dysfunction, thus resulting in the release of pro-inflammatory cytokines and the expression of adhesion molecules, which in turn promote monocyte/macrophage adhesion. Inflammation serves a key role in the development of vascular diseases, such as atherosclerosis. Tyrosol is a natural polyphenolic compound with diverse biological functions, found in large quantities in olive oil or in Rhodiola rosea. The current study aimed to investigate the regulatory in vitro effects of tyrosol on pro-inflammatory phenotypes using Cell Counting Kit-8, cell adhesion assay, wound healing, ELISA, western blotting, duel-luciferase, reverse transcription-quantitative PCR and flow cytometry. The results showed that tyrosol significantly inhibited the adhesion of THP-1 human umbilical vein endothelial cells, reduced lipopolysaccharide-induced cell migration and decreased the release of pro-inflammatory factors and the expression levels of adhesion-related molecules, such as TNF-α, monocyte chemotactic protein-1, intercellular adhesion molecule-1 and vascular cell adhesion molecule-1. Previous studies indicate that NF-κB could serve a pivotal role in initiating the inflammatory responses of endothelial cells and particularly in regulating the expression of adhesion molecules and inflammatory factors. The results of the current study demonstrated that tyrosol was associated with decreased expression of adhesion molecules and monocyte-endothelial cell adhesion, thus suggesting that tyrosol could be a novel pharmacological approach for treating inflammatory vascular diseases.
Background
Several reports of individual extracts of Garcina kola and Kigelia africana beneficial effects against several factors related with development of diabetes mellitus abound. However, there is still lack of information about the combined effects of these extracts on Insulin and Paraoxonase 1 (PON-1) in Streptozotocin-Nicotinamide induced type-2 diabetic Wistar rats.
Methods
Forty-two young male rats (180-200g) were randomly divided into six groups (n=7/group). Diabetes was intraperitoneally induced with 110 mg/kg of nicotinamide constituted in distilled water andfifteen minutes after with 65mg/kg of streptozocin freshly prepared in 0.1M citrate buffer (pH of 4.5) and treated for six weeks as follows: the control rats received either 0.9% normal saline (NS) or 250mg/kg extract by gavage. The remaining animals were diabetic induced and subsequently treated with either NS, graded doses of the extract (250mg/kg and 500mg/kg) or 5mg/kg Glibenclamide + 100mg/kg Metformin. Gas chromatography mass spectrometry (GCMS) of the combined extracts was also analyzed to identify the bioactive compounds present. Insulin, PON-1 levels, lipid profiles and atherogenic index were assessed.
Results
Our findings show that Insulin and PON-1 levels in the plasma of diabetic rats treated with the combined extracts were significantly increased when compared to the control rats. Moreover, the GCMS of the extract show the presence of both monosaturated (oleic acid) and polyunsaturated (linoleic acid) fatty acids.
Conclusion
The current findings suggest that the extract may help improve glucose homeostasis, prevent atherosclerosis through established mechanism of the identified bioactive compounds.
Peripheral artery disease (PAD) is associated with substantial morbidity including a high risk of cardiovascular and limb events, and death. A growing body of evidence has demonstrated the benefits of antithrombotic therapy, lipid-lowering, blood pressure control, diabetes management, smoking cessation, and exercise programs on improving symptoms and reducing these complications. Guidelines make specific recommendations on how to use these strategies to prevent adverse cardiovascular and limb outcomes in patients with PAD. Unfortunately, antithrombotic therapy, statins, optimal antihypertensives, smoking cessation counselling and therapies, and exercise programs, have all been consistently shown to be underutilized in PAD patients both in Canada and globally. A variety of barriers to optimal utilization of evidence-based medical therapies have been described at the patient, healthcare provider, and system levels. These include lack of knowledge among patients and healthcare providers, and lack of access to secondary prevention programs. In this manuscript, the evidence for preventive therapies in PAD, evidence for underuse of these therapies, and barriers to their use, are reviewed. Core elements of PAD secondary prevention clinics are proposed, and a summary of optimal medical therapies and relevant tools is provided. This manuscript may help clinicians who treat patients with PAD to develop a “Tool Kit” to overcome these barriers in order to improve utilization of medical therapies, with the ultimate goal of improving outcomes for PAD patients.
Introduction
Women with gestational diabetes are at increased risk of developing type 2 diabetes later in life. In at-risk general populations, Mediterranean-style diet helps prevent type 2 diabetes. But its effect on postnatal women with a history of gestational diabetes is not known. Prior to a full-scale trial on Mediterranean-style diet in the postnatal period to prevent type 2 diabetes, a feasibility study is required to assess the acceptability of the diet and evaluate the trial processes.
Methods and analysis
MEditerranean diet for pReventIon of type 2 diabeTes is a single-arm feasibility study (65 women) with qualitative evaluation of women who have recently given birth and had gestational diabetes. The intervention is a Mediterranean-style diet supplemented with nuts and olive oil, with dietary advice and an action plan. A dedicated Health Coach will interact with participants through an interactive lifestyle App. Women will follow the intervention from 6 to 13 weeks post partum until 1 year post partum. The primary outcomes are rates of recruitment, follow-up, adherence and attrition. The secondary outcomes are maternal dysglycaemia, cost and quality of life outcomes, and acceptability of the intervention to participants, and to healthcare professionals delivering the intervention. Feasibility outcomes will be reported using descriptive statistics.
Ethics and dissemination
Ethical approval was obtained through the South Central—Berkshire Research Ethics Committee (19/SC/0064). Study findings will be disseminated via publication in peer-reviewed journals, as well as via newsletters made available to participants and members of Katie’s Team (a women’s health patient and public advisory group).
Trial registration number
ISRCTN40582975 .
The worldwide increase in the prevalence of obesity and adiposity-related comorbidities has required a novel approach to cardiometabolic risk mitigation focused on the key mechanistic drivers of disease. The current manuscript presents the case of a 74-year-old male with obesity complicated by coronary artery disease, hypertriglyceridemia, hypertension, nonalcoholic fatty liver disease, obstructive sleep apnea, and type 2 diabetes. Expert panelists discuss optimal diagnostic and treatment strategies focused on lifestyle modifications including dietary interventions such as the Mediterranean dietary pattern, medications that target multiple drivers of disease, as well as procedural options.
Dalla seconda metà del XX secolo sono intervenute modificazioni nelle abitudini alimentari e nello stile di vita, tali da determinare variazioni anche nello stato di salute della popolazione. Numerose evidenze scientifiche indicano la necessità di dover rivedere l'alimentazione, ritornando a preferire i cibi tipici della Dieta Mediterranea, che, unitamente all'attività fisica, all'astensione dal fumo o da altre dipendenze e alla convivialità, possono influire anche sulla progressione delle malattie cronico-degenerative e certamente sulla Qualità della Vita. È noto che la dieta iperproteica a elevato contenuto di sodio, unitamente all'abuso di alcool, costituisce un determinante della progressione della malattia renale. Al contrario, l'adesione alla Dieta Mediterranea, ricca di frutta, verdura, legumi, cereali e olio d'oliva e moderata nel consumo di proteine animali e alcool, gioca un ruolo protettivo della funzione renale. La Dieta Mediterranea si è mostrata in grado di ridurre malattie cardiovascolari e stress ossidativo, pertanto esistono i presupposti per valutare se l'alimentazione di tipo mediterraneo sia in grado di ridurre in maniera significativa l'attivazione dello stress ossidativo anche in pazienti con ADPKD e, quindi, il loro rischio cardiovascolare.
Hyperlipidemia is defined as measuring serum cholesterol and/or triglyceride levels above normal values. Hyperlipidemia, is the leading changeable risk factors of cardiovascular diseases, due to genetic and/or environmental causes. Research shows that nutrition is a significant effect on lipid levels and is important in lowering the risk of cardiovascular disease. The first approach for people with hyperlipidemia in primary care is lifestyle modification which includes nutrition regulation, weight control, and physical activity. The total amount of fat consumed by the diet and the fatty acids composition affects the blood lipid profile. While high saturated fatty acids containing diets increasing total and LDL cholesterol levels, monounsaturated fatty acids consumption increase HDL cholesterol levels. To reduce the LDL cholesterol levels polyunsaturated fatty acids should be preferred instead of saturated fatty acids. Omega-3 fatty acids, reduce blood triglyceride levels by reducing the production of LDL cholesterol. 10% of the daily energy, that is set to sustain the ideal body weight, should be met from polyunsaturated fatty acids, 15-20% from monounsaturated fatty acids and saturated fatty acids rate is suggested to be less than 7%. Fibre, known to be beneficial for cardiovascular diseases, is recommended to consume 20-30g per day. A healthy diet should be rich in vegetables and fruits, whole grain products, high fiber foods, contain fish and very low in saturated fatty acids and trans fatty acids.
Introduction:
Dietary patterns are an important factors in the progress of cardiovascular disease. This study aimed to assess the association between dietary patterns and coronary artery disease (CAD).
Methods:
A case-control study was carried on 550 participants. Food expenditure was collected using a validated 168-item food-frequency questionnaire. Dietary patterns were extracted by principal component analysis (PCA). Multiple logistic regressions was used to assess the association between dietary patterns and the risk of CAD.
Results:
Three major dietary patterns were identified: the "Quasi-Western Pattern" was characterized by higher intakes of sweets and desserts, snacks, legumes, honey or jam, ketchup, mayonnaise, yellow vegetables, potatoes, red meat, refined grains; the "Sugar and Fast foods Pattern" was characterized by higher intakes of sugar, soft drinks, fast foods, high-fat dairy, hydrogenated fats, and the "Quasi-Mediterranean Pattern" was characterized by higher intakes of fruits, cruciferous vegetables, green leafy vegetables, other vegetables, nuts, coffee. In both sexes, the "Quasi-Western Pattern" and the "Sugar and Fast foods Pattern" were positively associated with the risk of CAD. For "Quasi-Western Pattern", adjusted-ORs were (OR: 1.35, 95% CI: 0.99-1.83, P = 0.05) and (OR: 1.38, 95% CI: 1.03-1.83, P = 0.03)for men and women respectively. The ORs were for "Sugar and Fast foods Pattern" (OR: 3.64, 95% CI:2.25-5.89, P < 0.001) and (OR: 3.91, 95% CI: 2.42-6.63, P < 0.001) for men and women respectively.There was a significant inverse relationship among "Quasi-Mediterranean pattern" and CAD in the crude model in women (OR: 0.7, 95% CI: 0.55-0.89, P = 0.0.004).
Conclusion:
High adherence to the "Quasi-Western Pattern" and "Sugar-Fast foods Pattern" dietary patterns were associated with a higher risk of CAD. The "Quasi-Mediterranean pattern" reduced the risk of CAD.
Several countries have issued dietary recommendations about total and specific fatty acids (FAs) intake for the prevention of coronary heart disease (CHD). For many years until today, controversies have existed especially about the deleterious effect or not of saturated FAs, and the protective effect or not of n-3 polyunsaturated FAs, so that some authors have criticized these recommendations. There are many reasons for these controversies, including the different conclusions of prospective cohorts compared to randomized clinical trials (RCTs), the contradictory conclusions of meta-analyses depending on the quality, number, and type of studies included. The interrelationships between different FAs in the diet make it difficult to analyse the specific effect of a particular class of FAs on CHD. Furthermore, based on clinical practice and effectiveness of population-based prevention, it is very difficult at the individual level to assess in personal dietary intake the actual percentage and/or amount of SFAs contained in each meal or consumed daily/weekly. In this critical narrative review, we try to answer the question of whether it would not be more relevant, in 2020, to promote dietary patterns, rather than FAs intake recommendations. We critically analyze past and recent data on the association of FAs with CHD, then propose that Mediterranean diet and Japanese Diet should be revitalized for Westerners and Asian populations respectively. This does not exclude the usefulness of continuing research about effects of FAs towards CHD, and accepting that what seems true today might be revised, at least partially tomorrow.
Over the last several decades, obesity has become one of the most pervasive issues plaguing the United States. The vast amount of comorbidities associated with obesity, ranging from breathing problems to severe cardiovascular disease, place individuals at further risk of developing adverse effects later in life. Currently, clinicians use tools and indices such as body mass index (BMI), percent body fat (%BF) and waist circumference to classify the obesity level of their patients. In 2018 however, the Obesity Medical Association amended its previous algorithms to include two distinct pathologies that fall within the category of obesity: Fat Mass Disease (FMD) and Adiposopathy. These two diagnoses are now classified under obesity, not otherwise specified ICD-10 Code (E66.9). In this article, we discuss the updated methods to classify, identify and manage patients with these disorders
The Lyon Diet Heart Study is a randomized secondary prevention trial aimed at testing whether a Mediterranean-type diet may reduce the rate of recurrence after a first myocardial infarction. An intermediate analysis showed a striking protective effect after 27 months of follow-up. This report presents results of an extended follow-up (with a mean of 46 months per patient) and deals with the relationships of dietary patterns and traditional risk factors with recurrence.
Three composite outcomes (COs) combining either cardiac death and nonfatal myocardial infarction (CO 1), or the preceding plus major secondary end points (unstable angina, stroke, heart failure, pulmonary or peripheral embolism) (CO 2), or the preceding plus minor events requiring hospital admission (CO 3) were studied. In the Mediterranean diet group, CO 1 was reduced (14 events versus 44 in the prudent Western-type diet group, P=0.0001), as were CO 2 (27 events versus 90, P=0.0001) and CO 3 (95 events versus 180, P=0. 0002). Adjusted risk ratios ranged from 0.28 to 0.53. Among the traditional risk factors, total cholesterol (1 mmol/L being associated with an increased risk of 18% to 28%), systolic blood pressure (1 mm Hg being associated with an increased risk of 1% to 2%), leukocyte count (adjusted risk ratios ranging from 1.64 to 2.86 with count >9x10(9)/L), female sex (adjusted risk ratios, 0.27 to 0. 46), and aspirin use (adjusted risk ratios, 0.59 to 0.82) were each significantly and independently associated with recurrence.
The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infarction, confirming previous intermediate analyses. Major traditional risk factors, such as high blood cholesterol and blood pressure, were shown to be independent and joint predictors of recurrence, indicating that the Mediterranean dietary pattern did not alter, at least qualitatively, the usual relationships between major risk factors and recurrence. Thus, a comprehensive strategy to decrease cardiovascular morbidity and mortality should include primarily a cardioprotective diet. It should be associated with other (pharmacological?) means aimed at reducing modifiable risk factors. Further trials combining the 2 approaches are warranted.
AHA Science Advisory diet cardiovascular diseases Kris-Etherton et al Mediterranean Diet
- Key Words
KEY WORDS: AHA Science Advisory diet cardiovascular diseases
Kris-Etherton et al
Mediterranean Diet
Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II)
National Cholesterol Education Program. Second Report of the Expert
Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Bethesda, Md: National
Institutes of Health, National Heart, Lung and Blood Institute; 1993. NIH
Publication No. 93-3095.