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A plant-based diet and hypertension

Journal of Geriatric Cardiology (2017) 14: 327330
©2017 JGC All rights reserved;; | Journal of Geriatric Cardiology
Perspective Open Access
A plant-based diet and hypertension
Sarah Alexander1,*, Robert J Ostfeld2, Kathleen Allen3, Kim A Williams1
1Rush University Medical Center, Division of Cardiology, Chicago, IL, USA
2Montefiore Medical Center, Division of Cardiology, Bronx, NY, USA
3New York University, Department of Nutrition & Food Studies, NY, USA
J Geriatr Cardiol 2017; 14: 327330. doi:10.11909/j.issn.1671-5411.2017.05.014
Keywords: Hypertension; Vegan; Vegetarian; Plant-based diet
Hypertension is an insidious, common, and deadly dis-
ease, often detected incidentally at a routine doctor’s visit or
workplace health screening. Worldwide, it is estimated that
one billion people have hypertension and approximately 80
million Americans 20 years of age and older are hyperten-
sive.[1] The National Health and Nutrition Data Examination
Survey found that only 54% of hypertensive adults in the
United States had their high blood pressure controlled and
17% remained undiagnosed.[1] These findings translate into
poor outcomes as the number of deaths due to hypertension
increased by 35% from 2003–2013.[1] In the Global Burden
of Disease 2010 study, hypertension was identified as the
number one risk factor worldwide for deaths and disabil-
ity-adjusted life years.[2] In the United States, clinic visits,
medications and the treatment of complications from hy-
pertension, including heart failure, stroke, and renal disease
now account for a substantial portion of the Medicare
First line therapies for all stages of hypertension include
exercise and weight loss.[4] However, results from one small
cross-sectional study suggest that a plant-based diet is the
more important intervention. This study compared the blood
pressure of sedentary vegans, endurance athletes (matched
for body mass index with the vegan group) consuming a
Western diet and running an average of 48 miles per week,
and sedentary subjects consuming a Western diet. Blood
pressure was significantly lower in the vegan group.[5] Al-
though the benefits of exercise and weight loss seem to be
inherently understood by most, the definition and perception
of a “healthy” diet is one that has not yet reached consensus.
In the late 1930 s, Dr. Walter Kempner of Duke Univer-
sity introduced the “rice diet” as therapy for renal failure
and hypothesized that “we could radically alter the patients’
diets and thereby save lives.”[6] The rice diet was high in
*Correspondence to:
complex carbohydrates, consisting mainly of rice and fruit,
and low in fat, protein (< 20 g/day) and sodium (< 150
mg/day). He first demonstrated its effectiveness in a dia-
betic, hypertensive patient with renal and congestive heart
failure: post intervention, this patient exhibited decreased
cardiac silhouette size as measured by chest X-ray, nor-
malization of a left ventricular strain pattern on ECG, and
improvement in hypertensive retinopathy. Similarly, in his
first cohort of hypertensive patients, 107 of 192 patients
demonstrated marked improvement, including decreased
blood pressure, cholesterol levels, retinopathy, and cardiac
silhouette size. Despite his findings, Kempner’s work was
not widely accepted by the scientific community, which
favored randomized control trials to substantiate these findings.
The first, major randomized control trial to evaluate diet
and hypertension was the Dietary Approaches to Stop Hy-
pertension (DASH) study of the mid-1990s. DASH, a con-
trolled feeding study, examined three different diets: (1) a
control diet, representative of a “typical” American diet, (2)
the DASH diet, high in fruits and vegetables and low in
saturated and total fat, and (3) a diet high in fruits and vege-
tables but otherwise similar to the control diet. Patients were
given standardized meals, and their weight and dietary so-
dium intake were kept stable.[7] The DASH diet reduced
both systolic and diastolic blood pressure by 5.5 mmHg and
3.0 mmHg, respectively, when compared to control. The
diet high in fruits and vegetables but otherwise similar to the
control diet also lowered blood pressure but not to the same
extent as the DASH diet. The DASH collaborative research
group stated that they could not identify the individual
components of the DASH diet that made it effective, but
other studies have shown that specific components of the
DASH diet, such as fruits, vegetables, whole grains, and
nuts were each associated with decreased blood pres-
328 Alexander S. Plant-based diet and hypertension
Journal of Geriatric Cardiology |;
The Coronary Artery Risk Development in Young Adults
(CARDIA) study prospectively followed 5115 young (aged
18 to 30 years), black and white men and women over a 15
year time period and monitored them for the development of
cardiovascular disease risk factors.[10] A CARDIA hyper-
tension sub-study of 4304 subjects revealed a dose de-
pendent inverse relationship between plant-based food con-
sumption, including fruits, whole grains, and nuts, and blood
pressure. The opposite relationship was found, however,
with meat intake. Greater red and processed meat intake
was associated with higher blood pressure. Accordingly, in
a cross-sectional analysis of 11,004 British men and women
in the European Prospective Investigation into Cancer and
Nutrition-Oxford study, among four dietary types: (1) meat
eaters, (2) fish eaters, (3) vegetarians, and (4) vegans, the
vegans had the lowest prevalence of hypertension.[17]
Similarly, Borgi, et al.,[18] found a positive association
between animal flesh consumption and hypertension risk in
an analysis of three prospective cohorts [Nurses’ Health
Study I (NHS I), Nurses’ Health Study II (NHS II), and
Health Professionals Follow-up Study (HPFS)] totaling
188,518 participants with 2,936,359 person-years of fol-
low-up. In this largest prospective study to date on animal
consumption and incident hypertension, the positive rela-
tionship between animal flesh (including red and processed
meat, poultry and seafood) and hypertension was inde-
pendent of fruit, vegetable, and whole grain consumption.
Whereas, red and processed meats were associated with
increased hypertension risk in all three cohorts, poultry and
seafood intake were correlated with higher rates in two
(NHS II, HPFS). The findings of greater animal flesh (red
meat, processed meat, and poultry) consumption and in-
creased hypertension risk are consistent with other prospec-
tive cohort studies.[1921] In the few published prospective
studies of seafood consumption and hypertension risk, greater
seafood consumption appears either positively associated
with hypertension risk or neutral.[18,20,22]
The first study to compare blood pressure among habit-
ual vegans, lacto-ovo vegetarians, and non-vegetarians was
the Adventist Health Study-2 (AHS-2) calibration sub-study,
which included a cohort of 500 mostly white subjects.[23] Of
note, non-vegetarian Seventh Day Adventists tend to consume
less meat than persons consuming a typical Western diet.[24,25]
Nevertheless, the investigators found that vegans and
lacto-ovo vegetarians had significantly lower systolic and
diastolic blood pressure, and significantly lower odds of
hypertension (0.37 and 0.57, respectively), when compared
to non-vegetarians. Furthermore, the vegan group, as com-
pared to lacto-ovo vegetarians, not only was taking fewer
antihypertensive medications but, after adjustment for body
mass index, also had lower blood pressure readings. An-
other sub-study of AHS-2 examined hypertension in a black
population and found that the combined vegetarian/vegan
group had significantly lower odds of hypertension (0.56)
compared to non-vegetarians.[26]
Other studies found similar results. In a prospective co-
hort study of 1546 non-hypertensive subjects followed for
three years, those consuming more phytochemical rich
foods (plant-based foods) had lower risk of developing hy-
pertension.[27] In a matched cohort study of 4109 non-hy-
pertensive subjects followed for a median of 1.6 years,
vegetarians had a 34% lower risk of developing hyperten-
sion than non-vegetarians.[28] In studies of 5046 and 1615
subjects encouraged to adopt a plant-based diet as part of a
health improvement program for 30 days and 7 days, re-
spectively, systolic and diastolic blood pressure fell signifi-
cantly in both.[29,30] In a study of 26 subjects with medically
treated hypertension and then placed on a vegan diet for one
year, blood pressure fell, and 20 of the 26 subjects were able
to discontinue their anti-hypertensive medications.[31] In a
cohort study of 272 non-hypertensive men followed for five
years, greater plant protein intake was associated with lower
blood pressure.[32] The totality of evidence taken from these
studies indicates that plant-based diets have a meaningful
effect on both prevention and treatment of hypertension.
There are a variety of mechanisms proposed by which
plant-based nutrition leads to decrease in blood pressure.
They include improved vasodilation,[3336] greater antioxidant
content and anti-inflammatory effects,[3744] improved insu-
lin sensitivity,[33,4548] decreased blood viscosity,[49,50] altered
baroreceptors,[33] modifications in both the renin-angioten-
sin,[36,5153] and sympathetic nervous systems,[33,54] and mo-
dification of the gut microbiota.[53]
Long-term randomized controlled trials examining the
impact of plant-based diets on various health outcomes,
including hypertension, will further inform medical guide-
line creation and refine our understanding of the relationship
between diet and disease. However, in lieu of such informa-
tion and in the context of the data within this Special Issue,
we believe that consuming a diet that is mostly or exclu-
sively plant-based appears prudent for the prevention and
treatment of hypertension.
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This article is part of a Special Issue “A plant-based diet and cardiovascular disease”.
Guest Editors: Robert J Ostfeld & Kathleen E Allen
... Dietary factors do not appear to confer substantially to AF risk, and it is possible that any association with AF may be through indirect pathways where poor dietary habits increase the susceptibility to comorbidities that enhance an individual's risk for AF. It has been previously demonstrated that adherence to a plantbased diet reduces the likelihood of primary AF risk factors, including hypertension, obesity, diabetes, and coronary heart disease [36][37][38][39][40][41]. Blood pressure is reduced due to improved vasodilation and increased potassium intake [36,42,43]. ...
... It has been previously demonstrated that adherence to a plantbased diet reduces the likelihood of primary AF risk factors, including hypertension, obesity, diabetes, and coronary heart disease [36][37][38][39][40][41]. Blood pressure is reduced due to improved vasodilation and increased potassium intake [36,42,43]. Improvements in blood glucose control are thought to be due to the lower content of advanced glycation endproducts [44]. ...
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Background We examined whether the risk of incident atrial fibrillation (AF) in a large, biracial, prospective cohort is lower in participants who adhere to heart-healthy dietary patterns and higher in participants who adhere to less heart-healthy diets. Methods Between 2003 and 2007, the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study enrolled 30,239 Black and White Americans aged 45 years or older. Dietary patterns (convenience, plant-based, sweets, Southern, and alcohol and salads) and the Mediterranean diet score (MDS) were derived based on food frequency questionnaire data. The primary outcome was incident AF at the follow-up visit 2013–2016, defined by either electrocardiogram or self-reported medical history of a physician diagnosis. Results This study included 8977 participants (mean age 63 ± 8.3 years; 56% women; 30% Black) free of AF at baseline who completed the follow-up exam an average of 9.4 years later. A total of 782 incident AF cases were detected. In multivariable logistic regression analyses, neither the MDS score (odds ratio (OR) per SD increment = 1.03; 95% confidence interval (CI) 0.95–1.11) or the plant-based dietary pattern (OR per SD increment = 1.03; 95% CI 0.94–1.12) were associated with AF risk. Additionally, an increased AF risk was not associated with any of the less-healthy dietary patterns. Conclusions While specific dietary patterns have been associated with AF risk factors, our findings fail to show an association between diet patterns and AF development.
... Plant-based diet has antioxidant and anti-in ammatory properties and therefore has bene cial effects on cell cycle regulation, immune cells, hormones and vascular endothelium [12]. Moreover, previous studies have examined the association of Plant-based diet with cardiovascular diseases (CVD), T2DM, hypertension and obesity Our hypothesis was that a plant-based diet may have positive effects on kidney function [12][13][14][15]. Our hypothesis is that people who follow a plant-based diet have better kidney function. ...
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Background: Plant-based diet has antioxidant and anti-inflammatory properties. Therefore, this hypothesis is raised that following a plant-based diet may improve the functioning of the kidneys. The aim of study was to determine the association between plant-based diet index (PDI) and chronic kidney disease (CKD). Methods: This cross-sectional study was conducted using data from Ravansar non-communicable diseases (RaNCD) cohort study on 9,746 participants aged 35-65 years, in western Iran. CKD was assessed by glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation. The PDI was calculated based on food intake using a food frequency questionnaire (FFQ), and The food items were distributed into 18 food groups. We used multivariable logistic regression models to estimate odds ratio (ORs). Results: 1,058 (10.86%) of participants had CKD (eGFR<60 ml/min/1.73 m²), and the mean of PDI was 54.22± 6.68. The mean of eGFR in the group with high PDI score was significantly higher than the group with low PDI score (forth quartile: 79.20± 0.36 vs. first quartile: 72.95± 0.31, P<0.001). Adherence to a plant-based diet was more prevalent in the higher socioeconomic status (P<0.001). After adjusting for potential confounders, the odds of CKD in the third and fourth quartile of PDI was 25% (OR: 0.75; 95% CI: 0.62- 0.91) and 39% (OR: 0.61; 95% CI: 0.48- 0.78, P trend<0.001) lower than the first quartile, respectively. Conclusions: The findings of this study suggest that having a plant-based diet may be preventing the development of CDK. However, further studies are recommended.
... The proposed mechanisms that are involved in lowering of the blood pressure by adopting vegetarian diets include factors such as improvement in the vasodilatation, reduced blood viscosity, and improved rennin angiotensin systems. [40] Many studies indicate that reducing sodium intake in the diet and weight loss may be linked directly to low BP. [41] The result of the EPIC-Oxford study, a cohort in the United Kingdom, addressed that non-meat eaters had a lower incidence of hypertension (that is lowered systolic and diastolic BP) than meat eaters. ...
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Vegetarian has its origin in the Latin word "vigitore" meaning "to give strength and health. " Modern concise Oxford dictionary defines a vegetarian to be "a person who doesn't eat meat or fish for moral, religious, or health reasons. " Vegetarianism has very ancient roots and its history comprises many diverse characters and events. The practice has been apparent in many cultures all over the world. In Asia, particularly India, absenteeism from meat was the core of early religious philosophies such as Hinduism, Brahmanism, Zoroastrianism, and Jainism. With time and scientific advancements, there were a greater understanding and linking of vegetarian diets with health apart from its association with religion and spiritual contexts. There exist many differences between an Indian vegetarian diet and a Western vegetarian diet. Some of the prominent features of which are lower intake of fruits and vegetables, high-carbohydrate and high-glycemic diets, higher intake of milk and milk products, quality and nature of fat, and snacking behavior.
... Natural agricultural resources should be considered in the management of hypertension among farmers. The basic principles of hypertension care among farmers should be developed through optimizing the agricultural sector's potential by consuming a PBD that prioritizes vegetables and fruits [14]. Therefore, it is necessary to formulate the basic concepts and principles of a PBD in nursing care management for farmers with hypertension based on the agronursing approach. ...
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Background: Farmers in Indonesia have a high risk for hypertension owing to their lifestyle and working environment. Diet management is a solution to reduce hypertension, and Indonesia has natural resources in the agricultural sector that could help manage hypertension. Optimizing vegetable and fruit intake in a plant-based diet (PBD) could help maintain blood pressure among farmers in Indonesia. Objective: This study aims to explore the health problem of hypertension and the characteristics of local food sources to formulate a PBD menu for treating hypertension, as well as assess the prevalence of hypertension, level of acceptability of a PBD, and associated sociodemographic factors. Further, we want to examine the effectiveness of a community-based nursing program for managing hypertension using a PBD. Methods: We will use the exploratory sequential mixed methods approach. There will be a qualitative study (phase I) in 2022 and a quantitative study (phase II) in 2023. We will analyze data using a thematic framework in phase I. In phase II, the study will involve (1) questionnaire development and validation; (2) examination of the prevalence of hypertension, the level of acceptability of a PBD, and the associated factors; and (3) a randomized controlled trial. We will recruit farmers with hypertension who meet the study criteria. Moreover, in phase II, we will invite expert nurses and nutritionists to assess the face and content validity of the questionnaire. We will use multiple logistic regression models to estimate the associated sociodemographic factors and the level of acceptability of a PBD. Furthermore, a linear generalized estimating equation will be used to estimate the parameters of a generalized linear model with a possible unmeasured correlation between observations from different time points for systolic and diastolic blood pressure. Results: A model PBD for hypertension management is expected to be developed. In 2022, we will collect information on hypertension and the characteristics of local food sources for managing hypertension, and will formulate a PBD menu to treat hypertension among farmers. In 2023, we will develop a questionnaire to assess the acceptability of a PBD to manage hypertension among farmers, the prevalence of hypertension, and the sociodemographic factors associated with hypertension among farmers. We will implement a community-based nursing program for managing hypertension using a PBD among farmers. Conclusions: The PBD model will not be readily available for other agricultural areas since validation of local food variation is required to design the menu. We expect contributions from the local government to implement the intervention as one of the policies in the management of hypertension for farmers in the agricultural plantation areas of Jember. This program may also be implemented in other agricultural countries with similar problems, so that hypertension can be optimally treated among farmers. International registered report identifier (irrid): PRR1-10.2196/41146.
... Traditional lifestyle changes include weight management, smoking cessation, low-sodium diets, and decreasing alcohol and caffeine consumption [6]. Plant-based diets are also associated with lower risk of HTN [64]. However, it is becoming increasingly clear that functional ingredients in foods, such as dietary fibers, phenolic acids, functional peptides, and amino acids, can impact BP through numerous mechanisms (Figure 1). ...
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Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD) and cognitive decline. Elevations in blood pressure (BP) leading to HTN can be found in young adults with increased prevalence as people age. Oats are known to decrease CVD risk via an established effect of β-glucan on the attenuation of blood cholesterol. Many past studies on CVD and oats have also reported a decrease in BP; however, a thorough assessment of oats and BP has not been conducted. Moreover, oats deliver several beneficial dietary components with putative beneficial effects on BP or endothelial function, such as β-glucan, γ-amino butyric acid (GABA), and phytochemicals such as avenanthramides. We conducted a comprehensive search for systematic reviews, meta-analyses, and clinical intervention studies on oats and BP and identified 18 randomized controlled trials (RCTs) and three meta-analyses that supported the role of oats in decreasing BP. Emerging data also suggest oat consumption may reduce the use of anti-hypertensive medications. The majority of these studies utilized whole oats or oat bran, which include a vast array of oat bioactives. Therefore, we also extensively reviewed the literature on these bioactives and their putative effect on BP-relevant mechanisms. The data suggest several oat components, such as GABA, as well as the delivery of high-quality plant protein and fermentable prebiotic fiber, may contribute to the anti-HTN effect of oats. In particular, GABA is enhanced in oat sprouts, which suggests this food may be particularly beneficial for healthy BP management.
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Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.
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The prevalence of non-communicable diseases (NCD) increases continuously everyyear and this is the biggest factor causing death. Based on WHO data in 2020, 73% of deaths inIndonesia were caused by NCD. Hypertension belongs to NCD and the main cause of death inthe world. The consumption pattern of the plant-based diet contains a lot of fiber, magnesium,folic acid, Fe3+, vitamins C and E, n-6 polyunsaturated fatty acids (PUFA), antioxidants,carotenoids, flavonoids, and other phytochemicals so can prevent hypertension. The purpose ofthis article was to find out the benefits of implementing a plant-based diet in reducing the risk ofhypertension, based on the results of research that has been performed. The method used inthis article is randomized control trials (RCTs) on articles published with sources from GoogleSchoolar, PubMed, and Elsevier. The results of the review showed that there was a significantrelationship in the application of the plant-based diet to the reduction of blood pressure and therisk of hypertension in various age groups. However, the application of a plant-based diet cancause micronutrient deficiencies. Therefore, the application of a plant-based diet was good forpreventing the risk of hypertension and accompanied by the selection of various types of food. Keywords : hipertensi, plant-based diet, vegetarian diet
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With the changed Indian generation, the dietary habits and lifestyle patterns are changing. Coupled with this, owing to prevalence of enormous temperature variation with ecological imbalance, different physical ailments have become imminent. Normal range of blood pressure in the body is 130/85 mmHg (for adults >18 years) where, 130 is systolic and 85 is diastolic blood pressure. Hypertension (HTN) is an asymptomatic condition, symptoms do not rise unless the complications develop which results in delayed diagnosis and treatment especially among the uneducated and unexplained social groups such as rural population. prevalence of HTN in rural Indian population also showed that prevalence (%) of HTN was maximum in Kerela (36%) followed by Himachal Pradesh (35.9%), Assam (33.0%), and Uttarakhand (32.3%). The scenario was better in the states like Maharashtra (7.2%), Haryana (9.3%) and Delhi (14%). This article attempts to review the meaning and spread of HTN, relation between diet and HTN, life style and HTN, obesity and HTN and the associated risk of HTN. Also, what planned awareness programmes have been intervened globally for managing HTN has been reviewed in this article
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Penyakit kardiovaskular merupakan penyebab utama kematian dan kecacatan di dunia, salah satunya adalah hipertensi. Hipertensi tidak selalu menimbulkan gejala, sehingga penderita tidak menyadari dan tidak mendapatkan pengobatan. Untuk mengurangi risiko hipertensi, dapat dilakukan dengan modifikasi pola hidup dengan diet sehat yaitu makan dengan kalori seimbang, perbanyak buah dan sayur, mengonsumsi produk rendah lemak jenuh, rendah kolesterol, juga rendah garam dan gula. Diet vegetarian sebagian besar, rendah ataupun tidak mengandung produk hewani, juga lebih rendah lemak total, lemak jenuh dan kolesterol dibandingkan diet non vegetarian. Studi ini berupa analitik cross-sectional yang dilakukan terhadap 68 subjek dengan tujuan untuk melihat adanya perbedaan rerata tekanan darah antara kelompok vegetarian dan non-vegetarian. Data diperoleh menggunakan Food Frequency Questionnaire (FFQ) dan Food Recall 24 hour serta pengukuran tekanan darah. Studi ini memperoleh hasil secara statistik signifikan dengan p-value 0,0001 bahwa terdapat perbedaan tekanan darah yang bermakna antara kelompok vegetarian dan non-vegetarian, dengan hasil tekanan darah pada kelompok non vegetarian lebih tinggi dibandingkan kelompok vegetarian.
The typical Western diet, high in processed and animal-based foods, is nutritionally and ethically problematic. Beyond the well-documented cruelty to animals that characterizes the practices of the factory-farming industry, current patterns of meat consumption contribute to medical and moral harm in humans on both an individual level and a public health scale. We aim to deconstruct, by highlighting their fallacies, the common positive and normative arguments that are used to defend current nutritional patterns. Animal-based foods promote the mechanisms that underlie chronic cardiometabolic disease, whereas whole-food plant-based nutrition can reverse them. Factory farming of animals also contributes to climate change, antibiotic resistance, and the spread of infectious diseases. Finally, the current allocation of nutritional resources in the United States is unjust. A societal shift toward more whole-food plant-based patterns of eating stands to provide significant health benefits and ethical advantages, and the medical profession has a duty to advocate accordingly. Although it remains important for individuals to make better food choices to promote their own health, personal responsibility is predicated on sound advice and on resource equity, including the availability of healthy options. Nutrition equity is a moral imperative and should be a top priority in the promotion of public health.
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Background: -Dietary intake of fruit and vegetables is associated with lower incidence of hypertension, but the mechanisms involved have not been elucidated. Here we evaluated the effect of a high fibre diet and supplementation with the short-chain fatty acid (SFCA) acetate on the gut microbiota and the prevention of cardiovascular disease. Methods: -Gut microbiome, cardiorenal structure/function and blood pressure were examined in sham and mineralocorticoid-excess treated mice with a control diet, high fibre diet or acetate supplementation. We also determined the renal and cardiac transcriptome of mice treated with the different diets. Results: -We found that high consumption of fibre modified the gut microbiota populations and increased the abundance of acetate-producing bacteria, independently of mineralocorticoid-excess. Both fibre and acetate decreased gut dysbiosis, measured by the ratio of Firmicutes to Bacteroidetes, and increased the prevalence of Bacteroides acidifaciens Compared to mineralocorticoid-excess mice fed a control diet, both high fibre diet and acetate supplementation significantly reduced systolic and diastolic blood pressure, cardiac fibrosis and left ventricular hypertrophy. Acetate had similar effects and also markedly reduced renal fibrosis. Transcriptome analyses showed that the protective effects of high fibre and acetate were accompanied by the down-regulation of cardiac and renal Egr1, a master cardiovascular regulator involved in cardiac hypertrophy, cardiorenal fibrosis and inflammation. We also observed the up-regulation of a network of genes involved in circadian rhythm in both tissues, while down-regulated the renin-angiotensin system in the kidney and mitogen-activated protein kinases (MAPK) signalling in the heart. Conclusions: -A diet high in fibre led to changes in the gut microbiota which played a protective role in the development of cardiovascular disease. The favourable effects of fibre may be explained by the generation and distribution of one of the main metabolites of the gut microbiota, the SCFA acetate. Acetate effected several molecular changes associated with improved cardiovascular health and function.
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Objectives: A vegetarian diet may prevent elevation of blood pressures and lower the risk for hypertension through lower degrees of obesity, inflammation, and insulin resistance. This study investigated the association between a vegetarian diet and hypertension incidence in a cohort of Taiwanese adult nonsmokers and examined whether this association was mediated through inflammation, abdominal obesity, or insulin resistance (using fasting glucose as a proxy). Methods: This matched cohort study was from the 1994-2008 MJ Health Screening Database. Each vegetarian was matched with five nonvegetarians by age, sex, and study site. The analysis included 4109 nonsmokers (3423 nonvegetarians and 686 vegetarians), followed for a median of 1.61 years. The outcome includes hypertension incidence, as well as SBP and DBP levels. Regression analysis was performed to assess the association between vegetarian diet and hypertension incidence or future blood pressure levels in the presence/absence of potential mediators. Results: Vegetarians had a 34% lower risk for hypertension, adjusting for age and sex (odds ratio: 0.66, 95% confidence interval: 0.50-0.87; SBP: -3.3 mmHg, P < 0.001; DBP: -1.5 mmHg, P < 0.001). The results stay statistically significant after further adjustment for C-reactive protein, waist circumference, and fasting glucose (odds ratio: 0.72, 95% confidence interval: 0.55-0.86; SBP: -2.4 mmHg, P < 0.05; DBP: -1.1 mmHg, P < 0.05). The protective association between vegetarian diet and hypertension appeared to be consistent across age groups. Conclusion: Taiwanese vegetarians had lower incidence of hypertension than nonvegetarians. Vegetarian diets may protect against hypertension beyond lower abdominal obesity, inflammation, and insulin resistance.
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Hypertension is a major risk factor for cardiovascular disease and has a prevalence of about one billion people worldwide. It has been shown that adherence to a diet rich in fruits and vegetables helps in decreasing blood pressure (BP). This study aimed to investigate the effect of raw beet juice (RBJ) and cooked beet (CB) on BP of hypertensive subjects. In this randomized crossover study, 24 hypertensive subjects aged 25-68 years old were divided into two groups. One group took RBJ for 2 weeks and the other group took CB. After 2 weeks of treatment, both groups had a washout for 2 weeks then switched to the alternate treatment. Each participant consumed 250 ml day(-1) of RBJ or 250 g day(-1) of CB each for a period of 2 weeks. Body weight, BP, flow-mediated dilation (FMD), lipid profile and inflammatory parameters were measured at baseline and after each period. According to the results, high-sensitivity C-reactive protein (hs-CRP) and tumour necrosis factor alpha (TNF-α) were significantly lower and FMD was significantly higher after treatment with RBJ compared with CB (P<0.05). FMD was significantly (P<0.05) increased, but systolic and diastolic BP, intracellular adhesion molecule-1 (ICAM-1), vascular endothelial adhesion molecule-1 (VCAM-1), hs-CRP, interleukin-6, E-selectin and TNF-α were significantly (P<0.05) decreased with RBJ or CB. Total antioxidant capacity was increased and non-high-density lipoprotein (HDL), low-density lipoprotein (LDL) and total cholesterol (TC) were decreased with RBJ but not with CB. Although both forms of beetroot were effective in improving BP, endothelial function and systemic inflammation, the raw beetroot juice had greater antihypertensive effects. Also more improvement was observed in endothelial function and systemic inflammation with RBJ compared with CB.Journal of Human Hypertension advance online publication, 9 June 2016; doi:10.1038/jhh.2016.34.
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Unlabelled: Previous research on the effect of replacing sources of animal protein with plant protein on glycemic control has been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of this replacement on glycemic control in individuals with diabetes. We searched MEDLINE, EMBASE, and Cochrane databases through 26 August 2015. We included RCTs ≥ 3-weeks comparing the effect of replacing animal with plant protein on HbA1c, fasting glucose (FG), and fasting insulin (FI). Two independent reviewers extracted relevant data, assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I²-statistic). Thirteen RCTs (n = 280) met the eligibility criteria. Diets emphasizing a replacement of animal with plant protein at a median level of ~35% of total protein per day significantly lowered HbA1c (MD = -0.15%; 95%-CI: -0.26, -0.05%), FG (MD = -0.53 mmol/L; 95%-CI: -0.92, -0.13 mmol/L) and FI (MD = -10.09 pmol/L; 95%-CI: -17.31, -2.86 pmol/L) compared with control arms. Overall, the results indicate that replacing sources of animal with plant protein leads to modest improvements in glycemic control in individuals with diabetes. Owing to uncertainties in our analyses there is a need for larger, longer, higher quality trials. Trial registration: registration number: NCT02037321.
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Optimized nutrition through supplementation of diet with plant derived phytochemicals has attracted significant attention to prevent the onset of many chronic diseases including cardiovascular impairments, cancer, and metabolic disorder. These phytonutrients alone or in combination with others are believed to impart beneficial effects and play pivotal role in metabolic abnormalities such as dyslipidemia, insulin resistance, hypertension, glucose intolerance, systemic inflammation, and oxidative stress. Epidemiological and preclinical studies demonstrated that fruits, vegetables, and beverages rich in carotenoids, isoflavones, phytoestrogens, and phytosterols delay the onset of atherosclerosis or act as a chemoprotective agent by interacting with the underlying pathomechanisms. Phytochemicals exert their beneficial effects either by reducing the circulating levels of cholesterol or by inhibiting lipid oxidation, while others exhibit anti-inflammatory and antiplatelet activities. Additionally, they reduce neointimal thickening by inhibiting proliferation of smooth muscle cells and also improve endothelium dependent vasorelaxation by modulating bioavailability of nitric-oxide and voltage-gated ion channels. However, detailed and profound knowledge on specific molecular targets of each phytochemical is very important to ensure safe use of these active compounds as a therapeutic agent. Thus, this paper reviews the active antioxidative, antiproliferative, anti-inflammatory, or antiangiogenesis role of various phytochemicals for prevention of chronic diseases.
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Although several studies have assessed the effects of nut consumption (tree nuts, peanuts, and soy nuts) on blood pressure (BP), the results are conflicting. The aim was to conduct a systematic review and meta-analysis of published randomized controlled trials (RCTs) to estimate the effect of nut consumption on BP. The databases MEDLINE, SCOPUS, ISI Web of Science, and Google Scholar were searched for RCTs carried out between 1958 and October 2013 that reported the effect of consuming single or mixed nuts (including walnuts, almonds, pistachios, cashews, hazelnuts, macadamia nuts, pecans, peanuts, and soy nuts) on systolic BP (SBP) or diastolic BP (DBP) as primary or secondary outcomes in adult populations aged ≥18 y. Relevant articles were identified by screening the abstracts and titles and the full text. Studies that evaluated the effects for <2 wk or in which the control group ingested different healthy oils were excluded. Mean ± SD changes in SBP and DBP in each treatment group were recorded for meta-analysis. Twenty-one RCTs met the inclusion criteria. Our findings suggest that nut consumption leads to a significant reduction in SBP in participants without type 2 diabetes [mean difference (MD): -1.29; 95% CI: -2.35, -0.22; P = 0.02] but not in the total population. Subgroup analyses of different nut types suggest that pistachios, but not other nuts, significantly reduce SBP (MD: -1.82; 95% CI: -2.97, -0.67; P = 0.002). Our study suggests that pistachios (MD: -0.80; 95% CI: -1.43, -0.17; P = 0.01) and mixed nuts (MD: -1.19; 95% CI: -2.35, -0.03; P = 0.04) have a significant reducing effect on DBP. We found no significant changes in DBP after the consumption of other nuts. Total nut consumption lowered SBP in participants without type 2 diabetes. Pistachios seemed to have the strongest effect on reducing SBP and DBP. Mixed nuts also reduced DBP. © 2015 American Society for Nutrition.
Background In Western populations, a higher level of fruit consumption has been associated with a lower risk of cardiovascular disease, but little is known about such associations in China, where the consumption level is low and rates of stroke are high. Methods Between 2004 and 2008, we recruited 512,891 adults, 30 to 79 years of age, from 10 diverse localities in China. During 3.2 million person-years of follow-up, 5173 deaths from cardiovascular disease, 2551 incident major coronary events (fatal or nonfatal), 14,579 ischemic strokes, and 3523 intracerebral hemorrhages were recorded among the 451,665 participants who did not have a history of cardiovascular disease or antihypertensive treatments at baseline. Cox regression yielded adjusted hazard ratios relating fresh fruit consumption to disease rates. Results Overall, 18.0% of participants reported consuming fresh fruit daily. As compared with participants who never or rarely consumed fresh fruit (the “nonconsumption” category), those who ate fresh fruit daily had lower systolic blood pressure (by 4.0 mm Hg) and blood glucose levels (by 0.5 mmol per liter [9.0 mg per deciliter]) (P<0.001 for trend for both comparisons). The adjusted hazard ratios for daily consumption versus nonconsumption were 0.60 (95% confidence interval [CI], 0.54 to 0.67) for cardiovascular death, and 0.66 (95% CI, 0.58 to 0.75), 0.75 (95% CI, 0.72 to 0.79), and 0.64 (95% CI, 0.56 to 0.74), respectively, for incident major coronary events, ischemic stroke, and hemorrhagic stroke. There was a strong log-linear dose–response relationship between the incidence of each outcome and the amount of fresh fruit consumed. These associations were similar across the 10 study regions and in subgroups of participants defined by baseline characteristics. Conclusions Among Chinese adults, a higher level of fruit consumption was associated with lower blood pressure and blood glucose levels and, largely independent of these and other dietary and nondietary factors, with significantly lower risks of major cardiovascular diseases. (Funded by the Wellcome Trust and others.)
Prospective data are scarce on the relation of red meat, seafood, and poultry consumption with hypertension risk. Although red and processed meats are generally considered to have adverse cardiovascular consequences, seafood is believed to be protective and poultry's effect is controversial. We prospectively examined the independent association of long-term intake of animal flesh with incident hypertension in three longitudinal cohort studies of nonhypertensive individuals: Nurses' Health Study (NHS, n = 62 273 women), Nurses' Health Study II (NHS II, n = 88 831 women), and Health Professionals Follow-Up Study (HPFS, n = 37 414 men). We used multivariable Cox proportional hazards regression to study the associations of different types of animal flesh with the risk of developing hypertension while controlling for other hypertension risk factors. We then used fixed-effects meta-analysis to derive pooled estimates of effect. Compared with participants whose consumption was less than 1 serving/month, the pooled hazard ratios among those whose intake was at least 1 serving/day were 1.30 (95% confidence interval 1.23-1.39) for total meat (a combination of processed and unprocessed red meat), 1.22 (1.12-1.34) for poultry, and 1.05 (0.98-1.13) for seafood. Seafood was associated with an increased risk of hypertension in HPFS and NHS II, but not NHS. Consumption of any animal flesh at least 1 serving/day was associated with an increased hypertension risk [pooled hazard ratio = 1.30 (1.16-1.47)]. Long-term intake of meat and poultry were associated with increased risk of hypertension. In contrast to our hypothesis, we found a weak but significant trend toward an increased risk of hypertension with increasing seafood consumption.