Article

Patterns of plant and animal protein intake are strongly associated with cardiovascular mortality: the Adventist Health Study-2 cohort

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Abstract

Background: Current evidence suggests that plant and animal proteins are intimately associated with specific large nutrient clusters that may explain part of their complex relation with cardiovascular health. We aimed at evaluating the association between specific patterns of protein intake with cardiovascular mortality. Methods: We selected 81 337 men and women from the Adventist Health Study-2. Diet was assessed between 2002 and 2007, by using a validated food frequency questionnaire. Dietary patterns based on the participants' protein consumption were derived by factor analysis. Cox regression analysis was used to estimate multivariate-adjusted hazard ratios (HRs) adjusted for sociodemographic and lifestyle factors and dietary components. Results: There were 2276 cardiovascular deaths during a mean follow-up time of 9.4 years. The HRs for cardiovascular mortality were 1.61 [98.75% confidence interval (CI), 1.12 2.32; P-trend < 0.001] for the 'Meat' protein factor and 0.60 (98.75% CI, 0.42 0.86; P-trend < 0.001) for the 'Nuts & Seeds' protein factor (highest vs lowest quintile of factor scores). No significant associations were found for the 'Grains', 'Processed Foods' and 'Legumes, Fruits & Vegetables' protein factors. Additional adjustments for the participants' vegetarian dietary pattern and nutrients related to cardiovascular disease outcomes did not change the results. Conclusions: Associations between the 'Meat' and 'Nuts & Seeds' protein factors and cardiovascular outcomes were strong and could not be ascribed to other associated nutrients considered to be important for cardiovascular health. Healthy diets can be advocated based on protein sources, preferring low contributions of protein from meat and higher intakes of plant protein from nuts and seeds.

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... A limited number of studies have examined longterm risk of mortality in relation to specific animal and plant protein sources, except red meat, and they have yielded inconsistent results. [24][25][26][27][28][29] Consistent with our study, previous studies showed that major animal protein sources such as red meats and eggs were associated with higher risk of all-cause and CVD mortality, 24,25,28 and dairy products were associated with higher risk of CVD mortality. 25 There was only 1 previous study investigating the associations of all major protein sources and mortality, and the effects of substitution of animal proteins with nuts in Americans, using data from the Nurses' Health Study and the Health Professionals Follow-up Study. ...
... A limited number of studies have examined longterm risk of mortality in relation to specific animal and plant protein sources, except red meat, and they have yielded inconsistent results. [24][25][26][27][28][29] Consistent with our study, previous studies showed that major animal protein sources such as red meats and eggs were associated with higher risk of all-cause and CVD mortality, 24,25,28 and dairy products were associated with higher risk of CVD mortality. 25 There was only 1 previous study investigating the associations of all major protein sources and mortality, and the effects of substitution of animal proteins with nuts in Americans, using data from the Nurses' Health Study and the Health Professionals Follow-up Study. ...
... Two previous studies reported inverse associations of major plant protein intake including legumes and nuts with CVD or cancer mortality. 24 However, legumes or nuts were not significantly associated with mortality risk in our study, consistent with a study in Finland. 29 Nonetheless, we found that substitution of total red meat with nuts was associated with lower risk of all-cause mortality. ...
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Background Dietary recommendations regarding protein intake have been focused on the amount of protein. However, such recommendations without considering specific protein sources may be simplistic and insufficient. Methods and Results We included 102 521 postmenopausal women enrolled in the Women’s Health Initiative between 1993 and 1998, and followed them through February 2017. During 1 876 205 person‐years of follow‐up, 25 976 deaths occurred. Comparing the highest with the lowest quintile, plant protein intake was inversely associated with all‐cause mortality (hazard ratio [HR], 0.91 [0.86, 0.96]), cardiovascular disease mortality (HR, 0.88 [0.79, 0.97]), and dementia mortality (HR, 0.79 [0.67, 0.94]). Among major protein sources, comparing the highest with the lowest quintile of consumption, processed red meat (HR, 1.06 [1.01, 1.10]) or eggs (HR, 1.14 [1.10, 1.19]) was associated with higher risk of all‐cause mortality. Unprocessed red meat (HR, 1.12 [1.02, 1.23]), eggs (HR, 1.24 [1.14, 1.34]), or dairy products (HR, 1.11 [1.02, 1.22]) was associated with higher risk of cardiovascular disease mortality. Egg consumption was associated with higher risk of cancer mortality (HR, 1.10 [1.02, 1.19]). Processed red meat consumption was associated with higher risk of dementia mortality (HR, 1.20 [1.05, 1.32]), while consumption of poultry (HR, 0.85 [0.75, 0.97]) or eggs (HR, 0.86 [0.75, 0.98]) was associated with lower risk of dementia mortality. In substitution analysis, substituting of animal protein with plant protein was associated with a lower risk of all‐cause mortality, cardiovascular disease mortality, and dementia mortality, and substitution of total red meat, eggs, or dairy products with nuts was associated with a lower risk of all‐cause mortality. Conclusions Different dietary protein sources have varying associations with all‐cause mortality, cardiovascular disease mortality, and dementia mortality. Our findings support the need for consideration of protein sources in future dietary guidelines.
... Findings from the Adventist Health Study-2 (AHS-2) cohort have been prominent among epidemiologic studies linking a vegetarian dietary pattern to lower risks of diabetes, metabolic syndrome, and coronary heart disease [1][2][3][4][5] as well as lower risks of gastrointestinal and prostate cancers, among others [6][7][8]. Besides avoiding meat, vegetarians and particularly vegans in this cohort have markedly higher consumption of plant-based foods including fruits, vegetables, whole grains, soy, ...
... Individual CpGs may have been represented in more than one region when determining gene methylation of a given region.3 Number of genes estimated to show non-null differences in methylation.4 Fold change represents ratio of the mean methylation of vegans to that of non-vegetarians for differentially methylated (hypomethylated or hypermethylated) genes in a given region. ...
... Some CpG sites represented in more than one gene region.3 Number of CpG sites estimated to show non-null differences in methylation.4 Fold change represents ratio of the mean methylation of vegans to that of non-vegetarians for differentially methylated (hypomethylated or hypermethylated) sites for a given region. ...
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We sought to determine if DNA methylation patterns differed between vegans and non-vegetarians in the Adventist Health Study-2 cohort. Genome-wide DNA methylation derived from buffy coat was profiled in 62 vegans and 142 non-vegetarians. Using linear regression, methylation of CpG sites and genes was categorized or summarized according to various genic/intergenic regions and CpG island-related regions, as well as the promoter. Methylation of genes was measured as the average methylation of available CpG’s annotated to the nominated region of the respective gene. A permutation method defining the null distribution adapted from Storey et al. was used to adjust for false discovery. Differences in methylation of several CpG sites and genes were detected at a false discovery rate < 0.05 in region-specific and overall analyses. A vegan diet was associated predominantly with hypomethylation of genes, most notably methyltransferase-like 1 (METTL1). Although a limited number of differentially methylated features were detected in the current study, the false discovery method revealed that a much larger proportion of differentially methylated genes and sites exist, and could be detected with a larger sample size. Our findings suggest modest differences in DNA methylation in vegans and non-vegetarians, with a much greater number of detectable significant differences expected with a larger sample.
... The Adventist Health Study, which used data collected from 2002 to 2007, concluded that a high contribution of "meat" in the diet increases risk of CVD-related mortality. 20 However, the "meat" pattern used for the Adventist ...
... 3 study included animal-based fat such as butter, and other foods high in saturated fat, which are known to increase total blood cholesterol values, specifically LDL cholesterol. 20 Despite the recent popularity of exclusive PLP intake for health, confirmation of the disparate health effects attached to PLP compared to ABP are mixed and based on patterns including "high red meat" which not only included red meat but also potatoes and gravy. 21 The primary aim was of this study was to examine relationships for both siMS score and siMS risk score with PA level and dietary protein source (i.e., ABP or PLP) among young and middle-aged adult females. ...
... 19 These influences could contribute to dietary choices of foods that contain less bioavailable forms of iron and vitamin B12 than ABP foods such as lean meat. 20 Both iron and vitamin B12 are nutrients of concern for young females who are at an increased risk for deficiency related to monthly menstrual cycles. 20 A significantly higher energy intake percentage of fat was observed in middle-aged females (38.4 ± 7.1 %) compared to young females (35.1 ± 6.2 %). ...
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Background Metabolic syndrome (MetS) increases risk for morbidity and premature mortality. Blood pressure, waist circumference, and fasting triglycerides (TG), blood glucose (BG), and high-density lipoprotein cholesterol (HDL) are factors for determining MetS. The Simple Method for Quantifying Metabolic Syndrome (siMS) score and risk score estimate risk of MetS. The purpose for this study was to exam the relationship of animal-based (ABP) and plant-based protein (PLP) with MetS as estimated by siMS score and risk score. Physical activty is another important consideration in MetS as it can reduce blood pressure, waist circumference and blood glucose, and affect blood lipid and lipoprotein concentrations. Methods A cross-sectional study examined whether physical activity (PA) level and dietary protein source (i.e., animal- or plant-based) among young (18-24 years) and middle-aged (45-60 years) females were associated with siMS score and siMS risk score. Average time spent in sedentary, light, and moderate-to-vigorous PA (MVPA; min/wk), steps (steps/day), energy intake (kcal/day), percent dietary protein to total energy intake, ABP and PLP dietary intake, and ABP:PLP ratio (g/day) were included in the analysis. Volunteers were recruited from North Dakota and Minnesota from 2017 to 2019. Results Eighty-one female participants (mean ± SD; young, n = 38, 20.4 ± 1.7 years, middle-aged, 52.5 ± 4.8 years) were included in the independent t-tests used to examine group differences in age, body mass index, HDL, BG, TG, systolic blood pressure, waist circumference, energy intake, energy intake percentage of total carbohydrates, fat, protein, ABP, and PLP, ABP:PLP, siMS score, and siMS risk score. Stepwise linear regressions were used to evaluate whether PA level and dietary protein source were predictors of siMS score and siMS risk score among young and middle-aged adult females. There was an inverse relationship between PLP intake and siMS score. The model explained 6.9% of the variance in siMS risk score (F 1, 80 = 5.93). Plant-based protein intake was inversely related to siMS risk score while light PA was positively associated with siMS risk score. The model explained 16% of the variance in siMS risk score (F 1, 80 = 7.53). Animal-based dietary protein intake did not impact siMS score ( p = 0.180) and siMS risk score ( p = 0.283). Conclusions Plant-based protein intake was associated with a lower risk of MetS via siMS scores, while ABP was not associated. Given the nature of the cross-sectional design of this study, no causal relationship can be determined, but longitudinal studies or randomized control trials to confirm the results from this study are needed in the future.
... However, it is important to note that a diet must be adequately planned to ensure appropriate intake of all required nutrients regardless of dietary pattern, although this is critical with restricted dietary patterns such as plant-based diets (7). A well-balanced and adequately planned plant-based diet has been shown to be superior in comparison to an omnivore diet in various health outcomes (1,2,6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). A plant-based diet is generally defined as a diet that is largely focused on vegetable and fruit consumption with very limited or no intake of foods sourced from animals (1-3, 6, 7, 10, 12-14, 23, 24). ...
... The number of Canadians affected by these chronic conditions will continue to rise due to our aging population, sedentary lifestyles, and unhealthy dietary patterns (2,26). Recently, increasing amounts of scientific evidence have classified plantbased diets as superior for supporting human health and wellness, as well as for limiting chronic diseases in comparison to an omnivore dietary pattern (1,2,6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)28). This is seen in the recent publication of the 2019 Canadian Food Guide, as it recommends plant-based food options should be chosen more frequently to improve nutrient intakes and health (2). ...
... Two of the 3 eligible sources on cardiovascular disease (CVD) outcomes again focused on the population of Seventh-day Adventist church members. The role of diet and exposure to animal products was determined to have a substantial effect on CVD outcome measures, as well as on CVD mortality (18,20). For example, Black members of the church who practiced vegetarian-style diets had a significantly reduced risk of high total cholesterol, high LDL cholesterol, and hypertension compared with their nonvegetarian counterparts (20). ...
Article
In Canada, unhealthy diets are associated with several chronic conditions, such as type 2 diabetes, cardiovascular disease, and obesity, and thus negatively impact the health and well-being of Canadians. Consequently, unhealthy diets are associated with an increased risk of morbidity and mortality in Canada. Recently, plant-based diets have gained in popularity due to their ability to provide a diet that is nutritionally adequate and health-conscious in addition to supporting environmental sustainability. The adoption of plant-based diets may address the substantial need to improve the health and well-being of Canadians, while also having a positive global environmental impact such as reducing greenhouse gas emissions. The aim of this scoping review was to identify current knowledge on the nutritional adequacy of plant-based diets and their relation with chronic conditions to support improved health and well-being of Canadians while identifying gaps in knowledge. Canadian peer-reviewed literature on diet, nutritional quality, and chronic conditions published between the years 2010 and 2020 were systematically examined. Sixteen articles met the inclusion criteria, with the majority pertaining to the relation between animal- or plant-based nutrition and cancer. Epidemiological studies support the practice of plant-based diets, in comparison to omnivore diets, as a strategy to improve nutritional adequacy and reduce the development of chronic conditions such as obesity, type 2 diabetes, cardiovascular diseases, osteoporosis, and select cancers such as endometrial, colorectal, and breast cancers. Overall, plant-based diets offer an opportunity to improve the health and well-being of Canadians while simultaneously working to counteract climate change, which may have a global reach. Gaps in knowledge were identified and mainly pertained to the lack of valid Canadian quantitative assessments of the long-term health impacts of plant-based diets. Further research should be completed to quantify the long-term health effects of the practice of a plant-based diet across all demographics of the Canadian population.
... Эта мера отражает уровень потребления этанола, при котором значительно нарушаются психомоторные и когнитивные функции. Кроме того, было показано, что злоупотребление алкоголем ассоциировано с увеличением риска смертности [21]. ...
... Существует большое количество наблюдательных и эпидемиологических исследований, демонстрирующих влияние изменения в диете на снижение заболеваемости и смертности от ССЗ [21][22][23]. Средиземноморская диета состоит из большого количества свежего оливкового масла первого холодного отжима; овощей (особенно листовая зелень), фруктов, цельнозерновых, орехов и бобовых; умеренного потребления рыбы, нежирного мяса, нежирных молочных продуктов, птицы, вина; и низкого потребления красного мяса и сладостей. Взрослые, соблюдающие средиземноморскую диету, имеют более низкий риск смертности по сравнению с таковыми, придерживающимися стандартной западной диеты [24]. ...
... Взрослые, соблюдающие средиземноморскую диету, имеют более низкий риск смертности по сравнению с таковыми, придерживающимися стандартной западной диеты [24]. Диеты, богатые сахаром и рафинированными углеводами, транс-и насыщенные жиры, натрий, углеводы и мясные продукты (гамбургеры, хот-доги, мясные деликатесы) связаны с повышенным риском ССЗ [21,23]. Различия рекомендаций касаются ограничений транс-жиров: в соответствии с Российскими и Европейскими рекомендациями их содержание в рационе питания должно составлять <1%, тогда как в Американских рекомендациях подчеркивается полный отказ от их употребления [1,2]. ...
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Public health strategies for the detection, prevention and treatment of cardiovascular diseases (CVDs) can be implemented at many levels as follows: from individual behavioral alterations to population-based strategies that affect different national and cultural communities. Despite the fact that the priority of primary prevention is treating hypertension and hyperlipidemia, great importance is given to improving behavioral and biological risk factors. Dietary modification, exercise and smoking cessation are specific interventions that can be targeted to reduce CVD risk at both the individual and population levels. Following a healthy lifestyle can potentially change factors such as overweight/obesity, hyperlipidemia, type 2 diabetes, and hypertension. The aim of this review was to present and summarize new data on the primary cardiovascular prevention with a focus on improving behavioral risk factors considered in the current guidelines.
... In Tharrey et al. (27), 18 protein food groups were defined according to their origin and their contribution (in percentage) to total protein intake. Then five protein dietary patterns (factors) were identified using factor analysis (PCA and varimax rotation methods). ...
... Then three AAs dietary patterns were identified using factor analysis (PCA and varimax rotation methods) and AA factors were principal components, defined as a linear combination of AA weighted by loadings. In cox proportional hazard regressions models, factor 1 and factor 3 were associated with cardiovascular health when adjusting for several confounders (listed above) plus the five protein dietary patterns identified in (27) to decipher the specific effect of AAs dietary patterns effects from that of the protein package. ...
... It was particularly rich in aspartic acid and proline. Inversely, leucine, lysine and methionine were included at the level of nutritional requirements only (Figure 4), in line with their negative weighting in the targeted profile (27). The constraint on the methionine content was active ( Table 1) which means that it limited the possible range of solutions to be found during linear programming. ...
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Although plant proteins are often considered to have less nutritional quality because of their suboptimal amino acid (AA) content, the wide variety of their sources, both conventional and emerging, suggests potential opportunities from complementarity between food sources. This study therefore aimed to explore whether, and to what extent, combinations of protein ingredients could reproduce an AA profile set as a nutritional objective, and to identify theoretical solutions and limitations. We collected compositional data on protein ingredients and raw plant foods (n = 151), and then ran several series of linear optimization to identify protein ingredient mixes that maximized the content in indispensable AA and reproduced various objective profiles: a “balanced profile,” based on AA requirements for adults; “animal profiles” corresponding to conventional animal protein compositions, and a “cardioprotective profile,” which has been associated with a lower cardiovascular risk. We assumed a very good digestibility of plant protein isolates. As expected, obtaining a balanced profile was obvious, but we also identified numerous plant protein mixtures that met demanding AA profiles. Only for particularly demanding profiles, such as mimicking a particular animal protein, did solutions require the use of protein fractions from more specific sources such as pea or canola. Optimal plant blends could mimic animal proteins such as egg white, cow milk, chicken, whey or casein with a similarity reaching 94.2, 98.8, 86.4, 92.4, and 98.0%, respectively. The limiting constraints were mainly isoleucine, lysine, and histidine target contents. These different solutions offer potential for the formulation of mixtures adapted to specific populations or the design of plant-based substitutes. Some ingredients are not commercially available but they could be developed.
... Recently, to further explore the role of habitual dietary protein intake in overall health, several previous epidemiological prospective cohort studies have examined the associations between protein intake and all-cause and cause-specific mortality [7][8][9][10][11][12][13][14][15]. Although generally pointing towards harmful or null associations for animal protein and beneficial or null associations for plant protein, the results are not entirely consistent. ...
... In contrast, Kelemen et al. [8] and Budhathoki et al. [16], reported null associations of total and animal protein with risk of all-cause and CVD mortality and beneficial association of plant protein with CVD mortality in the Iowa Women's Health Study and the Japan Public Health Center-based Prospective Cohort, respectively. And Tharrey et al. observed that higher animal protein intake was associated with higher CVD mortality, but plant protein intake was not associated with CVD mortality in the Adventist Health Study-2 [14]. Furthermore, evidence for protein intake from more specific animal food sources (e.g. protein from meat and dairy) and plant food sources (e.g. protein from legumes, nuts, and grains) and mortality, which may partly explain the inconsistencies in the previous studies is more limited [11] and remains to be further clarified. ...
... As sensitivity analysis, we examined the influence of individual studies on the overall risk estimates comparing quantiles by recalculating the pooled estimates after excluding one study at a time. As a second set of sensitivity analyses, we additionally incorporated studies reporting estimations not expressed in E% in the dose-response meta-analysis, for which we could only approximate protein intake in E% [14]. Additionally, publication bias was evaluated through a funnel plot [36] and Egger's test [37,38]. ...
Article
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Evidence for associations between long-term protein intake with mortality is not consistent. We aimed to examine associations of dietary protein from different sources with all-cause and cause-specific mortality. We followed 7786 participants from three sub-cohorts of the Rotterdam Study, a population-based cohort in the Netherlands. Dietary data were collected using food-frequency questionnaires at baseline (1989–1993, 2000–2001, 2006–2008). Deaths were followed until 2018. Associations were examined using Cox regression. Additionally, we performed a highest versus lowest meta-analysis and a dose–response meta-analysis to summarize results from the Rotterdam Study and previous prospective cohorts. During a median follow-up of 13.0 years, 3589 deaths were documented in the Rotterdam Study. In this cohort, after multivariable adjustment, higher total protein intake was associated with higher all-cause mortality [e.g. highest versus lowest quartile of total protein intake as percentage of energy (Q4 versus Q1), HR = 1.12 (1.01, 1.25)]; mainly explained by higher animal protein intake and CVD mortality [Q4 versus Q1, CVD mortality: 1.28 (1.03, 1.60)]. The association of animal protein intake and CVD was mainly contributed to by protein from meat and dairy. Total plant protein intake was not associated with all-cause or cause-specific mortality, mainly explained by null associations for protein from grains and potatoes; but higher intake of protein from legumes, nuts, vegetables, and fruits was associated with lower risk of all-cause and cause-specific mortality. Findings for total and animal protein intake were corroborated in a meta-analysis of eleven prospective cohort studies including the Rotterdam Study (total 64,306 deaths among 350,452 participants): higher total protein intake was associated with higher all-cause mortality [pooled RR for highest versus lowest quantile 1.05 (1.01, 1.10)]; and for dose–response per 5 energy percent (E%) increment, 1.02 (1.004, 1.04); again mainly driven by an association between animal protein and CVD mortality [highest versus lowest, 1.09 (1.01, 1.18); per 5 E% increment, 1.05 (1.02, 1.09)]. Furthermore, in the meta-analysis a higher plant protein intake was associated with lower all-cause and CVD mortality [e.g. for all-cause mortality, highest versus lowest, 0.93 (0.87, 0.99); per 5 E% increment, 0.87 (0.78, 0.98), for CVD mortality, highest versus lowest 0.86 (0.73, 1.00)]. Evidence from prospective cohort studies to date suggests that total protein intake is positively associated with all-cause mortality, mainly driven by a harmful association of animal protein with CVD mortality. Plant protein intake is inversely associated with all-cause and CVD mortality. Our findings support current dietary recommendations to increase intake of plant protein in place of animal protein.Clinical trial registry number and website NTR6831, https://www.trialregister.nl/trial/6645
... A unique contribution of this work is the review of the relationship between dairy protein consumption and inflammation. Some studies have suggested that animal protein intake is associated with increased CVD and mortality (78)(79)(80). For example, Tharrey et al. (79) examined data from the Adventist Health Study-2 cohort and reported that "Meat" protein was associated with an increased hazard ratio for cardiovascular mortality. ...
... Some studies have suggested that animal protein intake is associated with increased CVD and mortality (78)(79)(80). For example, Tharrey et al. (79) examined data from the Adventist Health Study-2 cohort and reported that "Meat" protein was associated with an increased hazard ratio for cardiovascular mortality. We identified eight trials which evaluated the effects of dairy proteins on markers of inflammation. ...
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Systemic inflammation is associated with obesity and chronic disease risk. Intake of dairy foods is associated with reduced risk of type 2 diabetes and cardiovascular disease; however, the impact of dairy foods on inflammation is not well-established. The objective of this study was to conduct a systematic review to evaluate the effect of dairy product (milk, cheese, and yogurt) and dairy protein consumption on low-grade systemic inflammation in adults without severe inflammatory disorders. A literature search was completed in September 2019 using PubMed and CENTRAL as well as inspection of reference lists from relevant review articles. The search resulted in the identification of 27 randomized controlled trials which were included in this analysis. In the 19 trials which evaluated dairy products, 10 reported no effect of the intervention, while 8 reported a reduction in at least one biomarker of inflammation. All 8 trials that investigated dairy protein intake on markers of inflammation reported no effect of the intervention. The available literature suggests that dairy products and dairy proteins have neutral to beneficial effects on biomarkers of inflammation. Additional clinical studies designed using inflammatory biomarkers as the primary outcome are needed to fully elucidate the effects of dairy intake on inflammation.
... A recent combined analysis from both the Health Professional's Follow-up and the Nurses' Health indicated that the consumption of SSBs was positively associated with mortality, primarily through cardiovascular mortality and a graded association with dose was shown [43]. However, other prospective studies such as the Singapore Chinese Health Study cohort [44], Adventist Health Study-2 in North America [45] and even the rural-based Bangladesh study [12] indicated that animal protein-rich diets were positively associated with cardiovascular events and mortality. A reverse association with plant-based diets has also been noted [45,46]. ...
... However, other prospective studies such as the Singapore Chinese Health Study cohort [44], Adventist Health Study-2 in North America [45] and even the rural-based Bangladesh study [12] indicated that animal protein-rich diets were positively associated with cardiovascular events and mortality. A reverse association with plant-based diets has also been noted [45,46]. ...
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Cardiometabolic risk is scarcely explored related to dietary patterns (DPs) in Asian populations. Dietary data (n = 562) from the cross-sectional Malaysia Lipid Study were used to derive DPs through principal component analysis. Associations of DPs were examined with metabolic syndrome (MetS), atherogenic, inflammation and insulinemic status. Four DPs with distinctive eating modes were Home meal (HM), Chinese traditional (CT), Plant foods (PF) and Sugar-sweetened beverages (SSB). Within DP tertiles (T3 vs. T1), the significantly lowest risk was associated with CT for hsCRP (AOR = 0.44, 95% CI 0.28, 0.70, p < 0.001) levels. However, SSB was associated with the significantly highest risks for BMI (AOR = 2.01, 95% CI 1.28, 3.17, p = 0.003), waist circumference (AOR = 1.81, 95% CI 1.14, 2.87, p = 0.013), small LDL-C particles (AOR= 1.69, 95% CI 1.02, 2.79, p = 0.043), HOMA2-IR (AOR = 2.63, 95% CI 1.25, 5.57, p = 0.011), hsCRP (AOR = 2.21, 95% CI 1.40, 3.50, p = 0.001), and MetS (AOR = 2.78, 95% CI 1.49, 5.22, p = 0.001). Adherence behaviors to SSBs (T3) included consuming coffee/tea with condensed milk (29%) or plain with sugar (20.7%) and eating out (12 ± 8 times/week, p < 0.001). Overall, the SSB pattern with a highest frequency of eating out was detrimentally associated with cardiometabolic risks.
... Food production from animal sources has often been associated with climate change, reduction of fresh water, loss of biodiversity, and risks to human health, especially cardiovascular diseases ( Tharrey et al., 2018 ). Furthermore, the costs of obtaining raw materials of animal origin have increased due to the high consumption of water, energy, and agricultural inputs ( Poji ć et al., 2018a ;Sá et al., 2020 ;Tharrey et al., 2018 ). ...
... Food production from animal sources has often been associated with climate change, reduction of fresh water, loss of biodiversity, and risks to human health, especially cardiovascular diseases ( Tharrey et al., 2018 ). Furthermore, the costs of obtaining raw materials of animal origin have increased due to the high consumption of water, energy, and agricultural inputs ( Poji ć et al., 2018a ;Sá et al., 2020 ;Tharrey et al., 2018 ). Such facts have triggered the development of groups that seek more sustainable food and cause less environmental impacts. ...
Article
Innovative food products containing new ingredients have been designed to meet nutritional needs and new consumption trends. In this way, different vegetable species, named unconventional food plants (UFPs), are being studied in the literature and are emerging as candidates to provide foods containing a better composition, providing greater healthiness. Furthermore, specific vegetable tissues discarded in post-harvest and/or industrial pre-processing operations can be considered UFPs adequate for human consumption. Therefore, this review presents UFPs as alternative sources of nutrients, especially proteins and bioactive compounds. For food purposes, white acacia (Moringa oleifera), ora-pro-nobis (Pereskia aculeata Miller), jatropha (Jatropha curcas L.), bamboo (Bambusa vulgaris and Gramineae bambusoideae), and edible flowers, among others, are considered as UFPs with interesting nutritional components such as fibers, proteins, phenolic compounds, and carotenoids. We believe that studies on new food sources with a focus on UFPs can be a breakthrough for developing nutritious and sustainable foods and stimulating their acceptability by consumers.
... The relationship between diet and several health outcomes was also examined in the AHS-2 cohort, showing multiple health benefits associated with a vegetarian diet. For example, the risk of colon cancer and coronary heart disease increased with meat consumption, and the risk of coronary heart disease decreased with nut consumption [7][8][9]. Vegetarian dietary patterns were also associated with improved health outcomes including lower body mass index, and a lower prevalence of adverse health conditions such as diabetes mellitus, metabolic syndrome, and hypertension as well as lower all-cause mortality [4]. These findings are consistent with other studies on the effects of vegetarian diets on health [10,11]. ...
... Zatímco evropská doporučení zůstávají spíše na úrovni potravin, konkrétně ovoce, zeleniny a ryb, americká doporučení hovoří ještě ve vyšší kategorii, zaměřujíce se na přínos rostlinné, případně středomořské stravy, kdy jejich hlavním bodem je doporučení "stravy zdůrazňující příjem zeleniny, ovoce, luštěnin, ořechů, celozrnných potravin a ryb", což dokládají řadou citací o přínosu takové stravy (35,38,(40)(41)(42)(43)(44)(45)(46)(47)(48). Hovoří také přímo o přínosu "provegeteriánského" způsobu stravování a dokonce o nahrazení živočišných bílkovin rostlinnými. ...
... The latter has lower production costs and are less resource intensive, and more environmental friendly than animal ones (Fasolin et al. 2019;van der Spiegel et al. 2013). From a nutritional point of view, it is widely accepted that a partial replacement of animal proteins with vegetable ones is associated with the reduction of health diseases such as type 2 diabetes and cardiovascular disease (Song et al. 2016;Tharrey et al. 2018). However, it is a matter of fact that the valuable protein fraction of many plant sources is currently underutilized or lost as waste (Papargyropoulou et al. 2014). ...
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Aim The effect of moderate-intensity pulsed electric fields (MIPEF) was evaluated on vegetable protein concentrates from pea, rice, and gluten. Methods Five percent (w/w) suspensions of protein concentrates (pH 5 and 6) were exposed to up to 60,000 MIPEF pulses at 1.65 kV/cm. Both structural modifications (absorbance at 280 nm, free sulfhydryl groups, FT-IR-spectra) and functional properties (solubility, water and oil holding capacity, foamability) were analyzed. Results MIPEF was able to modify protein structure by inducing unfolding, intramolecular rearrangement, and formation of aggregates. However, these effects were strongly dependent on protein nature and pH. In the case of rice and pea samples, structural changes were associated with negligible modifications in functional properties. By contrast, noticeable changes in these properties were observed for gluten samples, especially after exposure to 20,000 pulses. In particular, at pH 6, an increase in water and oil holding capacity of gluten was detected, while at pH 5, its solubility almost doubled. Conclusion These results suggest the potential of MIPEF to steer structure of proteins and enhance their technological functionality.
... There have been a number of recent long-term studies evaluating the impacts of animal-vs. plant-derived proteins on human health (80)(81)(82)(83). Similarly, there have been many studies that show diet quality follows socioeconomic gradients (84). ...
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Significance As Americans, our diets have among the highest protein consumption rates and we are experiencing increased rates of obesity across all age groups. Here we reveal that consumption of corn-fed animal proteins are more common among lower socioeconomic status populations, which places these populations at a potentially greater risk for increased health problems.
... According to a recent systematic review, soy protein may reduce the risk of cardiovascular diseases such as hypercholesterolemia and hypertension [16]. Similarly, recent longitudinal studies showed that high intake of protein from nuts and seeds in US adults was associated with decreased mortality from cardiovascular disease [17]; moreover, animal protein intake in Australian adults was associated with an increased incidence of metabolic syndrome, whereas plant protein intake showed the opposite association [18]. However, few studies have explored the effect of moderate-carbohydrate diets according to protein source in Asian populations, who typically consume a high-carbohydrate low-fat diet. ...
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Background: Because a moderate-carbohydrate diet reportedly has minimal risks, the substitution of carbohydrate for protein has been emphasized. Few studies have explored the effect of moderate-carbohydrate diets with higher protein intake in Asians, who typically consume a high-carbohydrate low-fat diet. Therefore, this study evaluated the associations of moderate- versus high- carbohydrate diets with cardiovascular risk factors among Korean adults by protein source. Methods: This study included 7965 adults (3196 men, 4769 women) aged ≥ 19 years who participated in the 2013-2017 Korea National Health and Nutrition Examination Survey. Dietary intake was assessed by a 24-h recall method and four types of diet were defined: a moderate-carbohydrate diet with plant protein (MCP) or animal protein (MCA) and a high-carbohydrate diet with plant protein (HCP) or animal protein (HCA). Results: Compared with the MCP group, men in the other three groups had significantly higher odds ratios (ORs) for elevated total cholesterol, reduced high-density lipoprotein (HDL)-cholesterol, and metabolic syndrome. Among women, only the HCP group had an increased OR for reduced HDL-cholesterol, compared with the MCP group. Similar associations were observed in younger adults (19-49 years). In addition, younger adults in the MCA group exhibited higher ORs for elevated triglycerides in men and elevated total cholesterol in women, compared with those in the MCP group. Conclusions: A moderate-carbohydrate diet with a high intake of plant protein was inversely associated with cardiovascular risk factors, especially among younger Korean adults. Further intervention studies are required to confirm this relationship and develop the optimal diet for cardiovascular health in the Korean population.
... Since cholesterol-containing foods are usually rich in saturated fat and animal protein, which have been associated with increased CVD mortality risk in previous reports [40,41], we also accounted for such nutrients but found that proteins were unlikely to attenuate the relationship between eggs and mortality risk, while saturated fats played a limited role. These results should be interpreted in light of the fact that eggs contain high-quality protein with minimal saturated fatty acids. ...
... Plant proteins were defined as those proteins coming from legumes, grains, peanuts, soy, tree nuts and seeds, fruits, vegetables, potatoes, and other vegetables (e.g. condiments, spices, etc.) [36]. Although plant-based diet has been shown to possess antioxidant, antiinflammatory potential [37] that is expected to be linked with improved immunity and reduced rates of infection and hence lowered incidence and mortality rates of COVID- 19; it seemed that low-quality protein poor with essential amino acids (AA) from plant sources plays a more profound role than the bioactive phytochemicals in reducing the ability to combat immunocompromising and to enhance bodily resistance against various infections [38]. ...
Article
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Background: Case-fatality rate (CFR) of the COVID-19 pandemic varied from one country to another. We aimed to describe the association between the global mortality rates of COVID-19 cases (as expressed in terms of CFR) in different countries and dietary intakes of different food groups. Methodology: We used an ecological study design. Based on data from a total of 144 countries, we applied the Bayesian regression model, using the Random-walk Metropolis-Hastings sampling. Food availability data for 144 countries we obtained from the Food and Agriculture Organization of the United Nations. The food balance sheet was downloaded for the analysis; with a total of ten food groups were included and expressed in terms of kilocalories per person per day. Food commodity availability was compared against the CFR values using Bayesian regression analysis. Results: The results suggest that COVID-19 case-fatality rates were associated with cereal grains, oils and fats, sugars, meats, dairy and eggs, fruits and vegetables, and starchy roots expressed in term so f kilocalories per capita per day. Conclusion: Our findings imply that nutritional factors available at the country level could have a role in the mortality resulted from the COVID-19 pandemic. Local public health authorities have the responsibility to issue balanced healthy eating recommendations.
... A subgroup analysis from the PREDIMED study demonstrated that a significant 41% mortality reduction was observed in the two quintiles with the highest pro-vegetarian eating behavior [15]. These results are supported by the Adventist Health Study II cohort, which showed similar positive effects for Adventists in the USA who prefer a diet based on vegetable protein (nuts, whole grains, seeds) [16]. The Mediterranean-style diet also demonstrated beneficial effects on glycemic control, weight loss, and CVD risk factors (reduction in total cholesterol, triglycerides, and blood pressure) [17,18]. ...
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Purpose of Review Cardiometabolic syndrome is characterized by abdominal adiposity, insulin resistance, hypertension, and dyslipidemia. There is a growing burden of cardiometabolic disease in many parts of the world. This review highlights the critical preventive and therapeutic measures that need to be implemented to reduce the impact of cardiometabolic syndrome on cardiovascular health. Recent Findings Recent cardiovascular outcome trials demonstrated that newer glucose-lowering medications reduce cardiovascular and renal events in patients with type 2 diabetes mellitus (T2DM). These medications should be considered in patients with T2DM and atherosclerotic cardiovascular disease (ASCVD). These novel drugs may also play a role in primary prevention of cardiovascular disease (CVD) and renal disease in high-risk patients without T2DM. To manage dyslipidemia associated with cardiometabolic syndrome, in addition to lifestyle interventions and statin therapy, ezetimibe, and proprotein convertase subtilisin/Kexin type 9 (PCSK9), inhibitors can be used to reduce the risk of major adverse cardiovascular outcomes (MACE) especially in patients with T2DM and coronary artery disease (CAD). The residual risk of MACE in such a high-risk population can be further mitigated by treatment with an omega-3 fatty acid such as icosapent ethyl. Summary Lifestyle modifications and the use of proven pharmacological therapies are essential for the prevention and progression of diabetes and ASCVD in those with the cardiometabolic syndrome.
... Food items from the 3DDRs were classified into either animal or plant protein categories 25 . The animal protein group consisted of the following food items: fish, shellfish, eggs, poultry, red meat, milk, dairy products, processed or preserved meat, seafood, and eggs. ...
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Sources of dietary phosphate differentially contribute to hyperphosphatemia in maintenance haemodialysis (MHD) patients. This cross-sectional study in Malaysia investigated association between dietary patterns and serum phosphorus in MHD patients. Dietary patterns were derived by principal component analysis, based on 27 food groups shortlisted from 3-day dietary recalls of 435 MHD patients. Associations of serum phosphorus were examined with identified dietary patterns. Three dietary patterns emerged: Home foods (HFdp), Sugar-sweetened beverages (SSBdp), and Eating out noodles (EO-Ndp). The highest tertile of patients in HF (T3-HFdp) pattern significantly associated with higher intakes of total protein (p = 0.002), animal protein (p = 0.001), and animal-based organic phosphate (p < 0.001), whilst T3-SSBdp patients had significantly higher intakes of total energy (p < 0.001), inorganic phosphate (p < 0.001), and phosphate:protein ratio (p = 0.001). T3-EO-Ndp patients had significantly higher intakes of total energy (p = 0.033), total protein (p = 0.003), plant protein (p < 0.001), but lower phosphate:protein ratio (p = 0.009). T3-SSBdp patients had significantly higher serum phosphorus (p = 0.006). The odds ratio of serum phosphorous > 2.00 mmol/l was significantly 2.35 times higher (p = 0.005) with the T3-SSBdp. The SSBdp was associated with greater consumption of inorganic phosphate and higher serum phosphorus levels.
... , duration of diabetes(62), education(63), social class(64). **Canada, Sweden, United Arab Emirates, Argentina, Brazil, Chile, China, Colombia, Iran, Malaysia, occupied Palestinian territory, Poland, South Africa, Turkey, Bangladesh, India, Pakistan, and Zimbabwe. ...
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Objective To examine and quantify the potential dose-response relation between intake of total, animal, and plant protein and the risk of mortality from all causes, cardiovascular disease, and cancer. Design Systematic review and meta-analysis of prospective cohort studies. Data sources PubMed, Scopus, and ISI Web of Science until December 2019, and references of retrieved relevant articles. Study selection Prospective cohort studies that reported the risk estimates for all cause, cardiovascular, and cancer mortality in adults aged 18 or older. Data synthesis Random effects models were used to calculate pooled effect sizes and 95% confidence intervals for the highest versus lowest categories of protein intake and to incorporate variation between studies. Linear and non-linear dose-response analyses were done to evaluate the dose-response relations between protein intake and mortality. Results 32 prospective cohort studies were included in the systematic review and 31 in the meta-analysis. During the follow-up period of 3.5 to 32 years, 113 039 deaths (16 429‬ from cardiovascular disease and 22 303‬ from cancer) occurred among 715 128 participants. Intake of total protein was associated with a lower risk of all cause mortality (pooled effect size 0.94, 95% confidence interval 0.89 to 0.99, I ² =58.4%, P<0.001). Intake of plant protein was significantly associated with a lower risk of all cause mortality (pooled effect size 0.92, 95% confidence interval 0.87 to 0.97, I ² =57.5%, P=0.003) and cardiovascular disease mortality (pooled hazard ratio 0.88, 95% confidence interval 0.80 to 0.96, I ² =63.7%, P=0.001), but not with cancer mortality. Intake of total and animal protein was not significantly associated with risk of cardiovascular disease and cancer mortality. A dose-response analysis showed a significant inverse dose-response association between intake of plant protein and all cause mortality (P=0.05 for non-linearity). An additional 3% energy from plant proteins a day was associated with a 5% lower risk of death from all causes. Conclusions Higher intake of total protein was associated with a lower risk of all cause mortality, and intake of plant protein was associated with a lower risk of all cause and cardiovascular disease mortality. Replacement of foods high in animal protein with plant protein sources could be associated with longevity.
... caloric intake, lower saturated fat, and proportionally higher mono and poly-unsaturated fats intake, and a higher proportion of vegetable protein compared to animal protein [9,14,[24][25][26]. ...
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Background: Vegetarianism is an increasingly common practice worldwide. Despite good evidence from other countries regarding vegetarians' diet quality, data from the Brazilian population is still scarce. Objective: To characterize the vegetarian Brazilian population and evaluate their diet quality compared to the general Brazilian population. Methods: We performed a nationwide cross-sectional study using an online self-administered questionnaire, previously validated for the Brazilian population, to evaluate diet quality markers of vegetarians. The invitation to participate in the survey was spread nationwide, aimed at vegetarian communities. Individuals who considered themselves vegetarians and were at least 18 years old were eligible to participate. The results on regular intake and intake adequacy were compared among vegetarians and between genders using the Pearson's chi-square test. The body mass index (BMI) were analyzed by the Analysis of Variance (ANOVA) followed by Tukey post-hoc test. The Kolmogorov-Smirnov test verified normality. All analyses considered bilateral hypotheses and a significance level of 5% (p <0.05). Results: Brazilian vegetarians presented better diet quality markers, such as higher regular weekly intake and adequate daily intake of fruits and vegetables, and lower regular intake of soft drinks when compared to the general Brazilian population. Vegetarians also presented a proportionally higher consumption of natural foods and lower consumption of processed foods. Among vegetarians, a higher proportion of vegans showed positive results regarding diet markers analysis, when compared to vegetarians, pesco-vegetarians, and semi-vegetarians. Conclusions: Vegetarians showed better results of diet adequacy when compared to the general population in Brazil, and vegans fared better when compared with other vegetarians. Despite the good results found, a large proportion of the participants still did not achieve the fruits and vegetables daily intake, according to the World Health Organization recommendations.
... The studies suggested that low protein intake or plant protein intake was associated with a reduced risk of all-cause and CVD-related mortality [47][48][49]. Also, Studies found a potential increased risk of CVD mortality associated with high or animal protein intake, which was also reported in three previous US cohorts [47,50]. Higher intake of red or processed meat, major sources of animal protein and high amount protein, was associated with higher all-cause and CVD-related mortality [49,51]. ...
Article
Aim To assess the efficacy of low-protein diets (LPD) on cardiovascular risk factors and kidney function in diabetic nephropathy (DN) based on randomized controlled trials (RCTs). Methods A comprehensive systematic search was undertaken in PubMed/MEDLINE, Web of Science, SCOPUS and Embase databases from inception until January 2022 without using time or language restrictions. RCTs which reported the effects of LPD on cardiovascular risk factors and kidney function in DN were considered. Results The results of the present study showed that a LPD significantly reduces urinary urea (WMD: -244.49 g/day, 95% CI: -418.83, -70.16, P=0.006) and HbA1c (WMD: -0.20, 95% CI: -0.39, -0.01, P=0.036) levels. However, the results did not show neither significant nor beneficial effect on other renal function and cardiovascular risk factors. Furthermore, the results of subgroup analysis showed LPD caused a further decrease in HbA1c during the follow-up period of ≤24 weeks, protein intake less than 0.8 g/kg/d and in individuals younger than 50 years. Albuminuria also showed a greater reduction in people under the age of 50 with type 1 diabetes (DMT1) following a LPD. Conclusion The results of the present study showed that LPD significantly reduces urinary urea and HbA1c.
... 28 The Adventist Health Study2 cohort reported a provegetarian diet composed predominantly of vegetables and plant-based protein in place of meat provided a 40% reduction in mortality. 29 Consuming a plant-based or Mediterranean diet and avoiding the damaging inflammatory trans fats/hydrogenated oils, sugar, sweeteners, refined grains, and processed red meats have been shown to decrease the inflammatory response and reverse obesity, hyperlipidemia, diabetes, and hypertension. 30 Regular physical activity has numerous health benefits. ...
Article
Preventative strategies of atherosclerotic cardiovascular disease are discussed based on the recent guidelines for the assessment and treatment of cardiovascular risks and the implications for nurse practitioners. This article uses a clinical approach to enhance the discussion on ways to use primary, secondary, and tertiary preventative strategies of lifestyle and pharmacologic interventions for atherosclerotic cardiovascular disease.
... Since cholesterol-containing foods are usually rich in saturated fat and animal protein, which have been associated with increased CVD mortality risk in previous reports [40,41], we also accounted for such nutrients but found that proteins were unlikely to attenuate the relationship between eggs and mortality risk, while saturated fats played a limited role. These results should be interpreted in light of the fact that eggs contain high-quality protein with minimal saturated fatty acids. ...
Article
Full-text available
Purpose Dietary guidelines recommend to limit egg consumption to 4 servings per week but the relation between egg intake and health outcomes is still controversial. To evaluate the association of egg consumption and mortality risk in Italian adults and to investigate nutritional factors and serum lipids as potentially explaining such associations. Methods Longitudinal analysis on 20,562 men and women aged ≥ 35y, free from cardiovascular disease (CVD) and cancer belonging to the Moli-sani Study cohort (enrolled 2005–2010) followed up for a median of 8.2 years. Results In multivariable-adjusted analysis as compared to low intake (> 0 ≤ 1 egg/week), eating > 4 eggs/week led to an increased risk of all-cause (Hazard ratio [HR] = 1.50; 95%CI 1.13–1.99), CVD (HR = 1.75; 1.07–2.87) and cancer mortality (HR = 1.52; 0.99–2.33). Similarly, an intake of 2–4 eggs/week was associated with higher all-cause (HR = 1.22; 1.01–1.46) and CVD mortality risk (HR = 1.43; 1.03–1.97). An increase of 1 egg per week was associated with higher mortality risk among high-risk individuals, such as those with hypertension and hyperlipidaemia. Dietary cholesterol explained about 43.0% and 39.3% ( p values < 0.0001) of the association of eggs with all-cause and CVD mortality, respectively, while serum lipids ( e.g., total cholesterol) accounted for a small proportion of egg-mortality relation. Conclusions Among Italian adults, high egg consumption leads to an increased risk of all-cause and CVD mortality, with the risk being evident even at the recommended intake of 2–4 eggs per week. A substantial part of this association was likely due to the egg contribution to dietary cholesterol. Our findings suggest limiting the consumption of eggs in the diet and these results should be considered in the development of dietary guidelines and updates.
... Within this study, cereal protein intake was not associated with lower cardiovascular mortality, but a beneficial impact was associated with the protein intake from nuts and seeds. 111 The association depends strongly on the consumption patterns of the target population. However, a large number of observational studies have shown consistent inverse associations between high whole-grain intake and the risk of developing noncommunicable diseases such as type 2 diabetes, cardiovascular disease, colorectal cancer, and total and cause-specific mortality. ...
Article
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Cereal grains are the main dietary source of energy, carbohydrates, and plant proteins world-wide. Currently, only 41% of grains are used for human consumption, and up to 35% are used for animal feed. Cereals have been overlooked as a source of environmentally sustainable and healthy plant proteins and could play a major role in transitioning towards a more sustainable food system for healthy diets. Cereal plant proteins are of good nutritional quality, but lysine is often the limiting amino acid. When consumed as whole grains, cereals provide health-protecting components such as dietary fiber and phytochemicals. Shifting grain use from feed to traditional foods and conceptually new foods and ingredients could improve protein security and alleviate climate change. Rapid development of new grain-based food ingredients and use of grains in new food contexts, such as dairy replacements and meat analogues, could accelerate the transition. This review discusses recent developments and outlines future perspectives for cereal grain use.
... Several studies have indicated that MUFA derived from plant (e.g., olive oil) or animal (e.g., lard) sources is not equivalent to PUFA with respect to the effect on CVD [24][25][26]. The 2019 American College of Cardiology (ACC) and American Heart Association (AHA) guideline on the primary prevention of CVD recommended the replacement of SFs with dietary MUFA-and PUFA-rich oils [31] and also recommended plant-based diets, which are associated with lower mortality than animal-based diets [32,33]. This guidance is similar to that issued by the European Society of Cardiology (ESC) [34]. ...
Article
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The health effects of saturated fat, particularly tropical oil, on cardiovascular disease are unclear. We investigated the effect of tropical oil (palm and coconut oils), lard, and other common vegetable oils (soybean and rice bran oils) that are widely used in tropical and Asian countries on lipid profiles. We performed an umbrella review of meta-analyses and systematic reviews. Electronic databases (Medline, Scopus, Embase, and Cochrane) were searched up to December 2018 without language restriction. We identified nine meta-analyses that investigated the effect of dietary oils on lipid levels. Replacement of polyunsaturated fatty-acid-rich oils (PUFAs) and monounsaturated FA-rich oils (MUFAs) with palm oil significantly increased low-density lipoprotein cholesterol (LDL-c), by 3.43 (0.44-6.41) mg/dL and 9.18 (6.90-11.45) mg/dL, respectively, and high-density lipoprotein cholesterol (HDL-c), by 1.89 (1.23-2.55) mg/dL and 0.94 (-0.07-1.97) mg/dL, respectively. Replacement of PUFAs with coconut oil significantly increased HDL-c and total cholesterol -by 2.27 (0.93-3.6) mg/dL and 5.88 (0.21-11.55) mg/dL, respectively-but not LDL-c. Substituting lard for MUFAs and PUFAs increased LDL-c-by 8.39 (2.83-13.95) mg/dL and 9.85 (6.06-13.65) mg/dL, respectively-but not HDL-c. Soybean oil substituted for other PUFAs had no effect on lipid levels, while rice bran oil substitution decreased LDL-c. Our findings show the deleterious effect of saturated fats from animal sources on lipid profiles. Replacement of unsaturated plant-derived fats with plant-derived saturated fats slightly increases LDL-c but also increases HDL-c, which in turn may exert a neutral effect on cardiovascular health.
... Plant-based diets have been studied for their potential to help prevent numerous chronic diseases, including cancer [23][24][25][26][27]. However, not all plant-based diets are equal, meaning not all include plentiful amounts of whole plant foods. ...
Article
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Purpose of Review The purpose of this review is to summarize the recent (past 5 years) available evidence regarding the association between plant-based diets on cancer risk from clinical trials and observational studies. Biological mechanisms and gaps in the current literature will also be discussed. Recent Findings There is a lack of intervention studies but there are abundant observational studies assessing the association between plant-based diets and cancer risk, including multiple longitudinal cohort studies and similar data from case–control studies that demonstrate a decreased overall cancer risk with plant-based diets. Case–control studies support a decreased risk of colorectal and breast cancers with plant-based diets, but results for specific cancers remain inconsistent in cohort studies. Summary Current evidence from observational studies indicates an inverse association between plant-based diets and overall cancer risk. Future research should include intervention studies, address inconsistencies in dietary assessment methods and provide greater detail on underrepresented groups.
... The relationship between diet and several health outcomes was also examined in the AHS-2 cohort, showing multiple health benefits associated with a vegetarian diet. For example, the risk of colon cancer and coronary heart disease increased with meat consumption, and the risk of coronary heart disease decreased with nut consumption [7][8][9]. Vegetarian dietary patterns were also associated with improved health outcomes including lower body mass index, and a lower prevalence of adverse health conditions such as diabetes mellitus, metabolic syndrome, and hypertension as well as lower all-cause mortality [4]. These findings are consistent with other studies on the effects of vegetarian diets on health [10,11]. ...
Article
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Introduction: Alzheimer’s disease (AD) is a progressive neurodegenerative disease that results in cognitive impairment. As there are no treatments available so far, identification of risk factors are crucial. A link has been proposed between defective insulin signaling in the brain and the cognitive decline observed in AD. Our purpose is to determine the relationship between homeostatic model of insulin resistance (HOMA-IR) and cognitive status among population ≥50 years. Hypothesis: Increase in insulin resistance is associated with lower cognitive status in the population ≥50 years. Methods: We analyzed data from the NHANES 1999-2002 population ≥50 years. Cognitive status was measured by the digit symbol substitution exercise score. The main independent variable was HOMA-IR. We used bivariate analysis and multiple linear regression adjusting for age, gender, race, triglyceride levels, systolic and diastolic blood pressure, total cholesterol, LDL, HDL levels, and diabetes. SAS V9.3 was used to analyze the data taking into consideration the design, strata and weight. Results: Of the 2,975 participants ≥50 years old, 45% were male and 80% were white. The mean age was 70.5+/- 0.30 years. Their average HOMA-IR was 5.0+/- 0.54 and they had a mean of 48+/-0.99 correct score in the cognitive test. Adjusting for the confounding variables, HOMA-IR was associated with decline in cognitive status (adjusted B=-0.34, 95% confidence interval=-0.58 to - 0.09, p=0.01). Significant predictors of decline in cognitive status among population ≥50 years were older age, male gender, high systolic and low diastolic blood pressure, non-white race (p=0.01). The association between HOMA-IR and decline in cognitive status was also found among non-diabetic population ≥50 years old (adjusted B=-0.54, 95% confidence interval=-1.1 to - 0.02, p=0.04). Conclusions: In the national representative sample, Insulin resistance as measured by HOMA-IR was independently associated with lower cognitive status score among participants ≥50 years and also found among non-diabetic population. Prospective studies are needed to determine the causal relationship.
... Imai et al. 2014; Thorisdottir et al. 2014;Eilert 2020;Yuan et al. 2021) or stigmatisation of animal-source foods in the context of health and/or sustainability (e.g. Tharrey et al. 2018;Sabaté et al. 2015;Chung et al. 2020;Huang et al. 2020;Zhao et al. 2020). ...
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Reductionist approaches to food focus on isolated nutritional criteria, ignoring the broader physiological and societal benefits and trade-offs involved. They can lead to the inadvertent or, potentially, intentional labelling of foods as good or bad. Both can be considered worrisome. Among our present-day array of issues is the disproportionate stigmatisation of animal-source foods as harmful for human and planetary health. The case for a protein transition reinforces this trend, overemphasising one particular nutritional constituent (even if an important one). In its strongest formulation, animal-source foods (reduced to the notion of 'animal protein') are represented as an intrinsically harmful food category that needs to be minimised, thereby falsely assuming that 'proteins' are nutritionally interchangeable. We caution against using the word 'protein' in food policy-making to describe a heterogenous set of foods. Rather, we suggest referring to said foods as 'protein-rich foods', while acknowledging the expanded pool of non-protein nutrients that they provide and their unique capabilities to support a much broader range of bodily functions. Several essential or otherwise beneficial nutrients are generally more bioavailable in animal-source foods than in plant-source foods. A similar complementarity exists in reverse. Nutritional and environmental metrics should be carefully interpreted, as considerable contextuality is involved. This needs to be undertaken, for instance, with respect to the biochemistry of food and in light of individual and genetically inherited human physiology. Also, the assessments of the environmental impact need a fine-grained approach, especially when examining a product at the system scale. Harms and benefits are multiple, multi-dimensional, and difficult to measure on the basis of the narrow sets of descriptive metrics that are often used (e.g. CO 2-eq/kg). A more appropriate way forward would consist of combining and integrating the best of animal and plant solutions to reconnect with wholesome and nourishing diets that are rooted in undervalued benefits such as conviviality and shared traditions, thus steering away from a nutrient-centric dogma. Humans do not consume isolated nutrients, they consume foods, and they do so as part of culturally complex dietary patterns that, despite their complexity, need to be carefully considered in food policy making.
... 7 The Adventist Health Study 2 cohort also showed that consuming plant-based protein in place of meat provided a 40% reduction in mortality. 8 Older adults are encouraged to prevent additional weight gain and reduce the risk of chronic disease and disabilities. Some studies recommend time-restricted consumption of two meals within 12 hours, enabling the body to combat inflammation and improve glycemic control. ...
... Substitution of plant protein for animal protein was associated with lower mortality in a prospective cohort study of US health-care workers that included 131,342 subjects from the Nurses' Health Study (Song et al., 2016). A healthy diet is inversely associated with cardiovascular mortality and NFS can be used to recommend the type of protein sources, preferring low protein contributions from meat and higher intakes of plant proteins from nuts and seeds (Tharrey et al., 2018). ...
Article
Purpose The menopausal transition (MT) is a period when there may be an increase in visceral fat mass and a worsening of cardiometabolic risk factors. Few studies have evaluated the efficacy of plant-based low-calorie diets on groups of women at different stages of MT. The purpose of this study is to compare the effectiveness of a high plant-to-animal protein ratio diet in women of similar age but with different fertility statuses. Design/methodology/approach Subjects were divided into three groups according to their fertility status at the baseline: “premenopausal” (n = 11), “perimenopause” (n = 14) and “postmenopause” (n = 18). Body composition (BC) was measured at the beginning and after eight months of treatment. Individualised lifestyle treatment included a strong component of plant-based foods. Findings Forty-three overweight or obese Caucasian women (age 52.3 ± 4.5 years, body mass index 30.6 ± 5.4 kg/m2, fat mass 33.1 ± 9.3 kg data presented as means ± SD) were included in the study. Mean physical activity was 8.4 ± 7.6 metabolic equivalent of tasks/week. Subjects had an improvement in BC (fat mass −5.6 ± 4.0 kg, p < 0.001 protein −0.3 ± 0.5 kg, p < 0.001), HDL-C and systolic blood pressure values. Waist circumference and hip circumference decreased by 4.1 ± 3.1 cm and −6.0 ± 4.3 cm, respectively. Weight loss resulted in a significant improvement in some blood lipid values, such as total and high-density lipoprotein cholesterol. Adherence to a high plant protein diet helps adult women with different fertility statuses to improve BC and reduce cardiovascular risk factors. Long-term studies with larger sample sizes are needed to confirm these findings. Originality/value In pre-peri- and post-menopausal adult women, a diet high in plant proteins improves body composition and reduces cardiovascular risk factors.
Article
Cardiovascular diseases are the leading cause of death worldwide. Adherence to a healthy lifestyle lifelong is capable of significantly reducing the cardiovascular risk by up to 70% and is therefore a key component in primary prevention of cardiovascular disease. According to the European and American guidelines lifestyle interventions include not smoking, daily physical activity of ≥150 min/week at moderate intensity or 75 min/week for higher intensity physical activity, a cardioprotective nutrition (high proportion of unsaturated fatty acids, low amounts of saturated fatty acids and low salt intake), normal body weight (body mass index 20-25 kg/m2), arterial blood pressure <140/90 mm Hg (optimum <130/80 mm Hg), low-density lipoprotein (LDL)-cholesterol target values depending on the cardiovascular risk and a normal glucose metabolism in type 2 diabetes mellitus with adjustment of a HbA1c to <7%. Lifestyle measures with weight reduction and intensification of physical activity can improve the cardiometabolic risk factors. In this way reduction of the systolic and diastolic blood pressures by approximately 10-15 mm Hg, reduction of HbA1c by approximately 1 % and reduction of triglycerides by ca. 30-40 % are possible. The LDL-cholesterol and lipoprotein(a) levels cannot be easily influenced. Beyond the recommendations for a cardioprotective lifestyle, additional pharmacological therapy may have to be added depending on the cardiovascular risk profile.
Article
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.
Article
Background and Aims The relationships between dietary protein intake and risk of all-cause, cardiovascular disease (CVD) and cancer mortality are still unclear. We conducted a systematic review with meta-analysis of cohort studies to summarize the evidence. Methods and Results We searched PubMed and Web of Science for relevant studies through February 2020. The associations of total, animal and plant proteins with all-cause, CVD and cancer mortality were evaluated. Study-specific relative risks (RR) were pooled using the fixed effect model when no significant heterogeneity was detected; otherwise the random effect model were employed. Twelve cohort studies were eligible for the study. Increased total protein showed no clear association with risk of all-cause, CVD and cancer mortality. In the stratified analysis by protein sources, higher plant protein intake was associated with a reduced risk of all-cause mortality (highest vs lowest intake: RR=0.92; 95%CI: 0.88, 0.96; each 3% increment of intake: RR=0.97; 95%CI: 0.94, 0.99), and may be associated with a reduced risk of CVD mortality (highest vs lowest intake: RR=0.90; 95%CI: 0.80, 1.01; each 3% increment of intake: RR= 0.95; 95%CI: 0.91, 0.99). Moreover, higher intake of animal protein may be associated with an increased risk of CVD mortality (highest vs lowest intake: RR=1.11; 95%CI: 1.01, 1.22; each 3% increment of intake: RR=1.02; 95%CI: 0.98, 1.06). Conclusion This study demonstrates that higher plant protein intake is associated with reduced risk of all-cause and CVD-related mortality. Persons should be encouraged to increase their plant protein intake to potentially decrease their risk of death.
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As part of a population-based approach to combating obesity, the American Heart Association (AHA) has published specific dietary guidelines for the management of obesity and cardiovascular disease prevention. These guidelines give a primary view of healthy dietary changes and goals which may reduce cardiovascular risk. The AHA guideline on Cardiovascular Prevention focuses on the benefits of a Plant-Based Diet and the Mediterranean diet. In addition to these recommendations, several other diets exist with variable long-term cardiovascular outcomes. In recent years, the ketogenic and intermittent fasting diets have been emerging and have garnered their own respective followings as weight loss strategies, and we will include them in our discussion of the potential long-term benefits related to cardiovascular risks. As the guidelines emphasize, all of the diets we will cover throughout this review must be discussed at the level of the individual patient with their primary care provider, and cannot be exercised without informed consent regarding the potential outcomes. Further research is required, and caution is advised before prescribing any of these diets to patients in the long-term, due to the potential to exacerbate cardiovascular risk factors.
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Background The association between dietary protein intake and the risk of mortality is still controversial. The present study aimed to examine the associations between dietary total, animal and plant protein intake and all-cause and cause-specific mortality. Methods Community-dwelling men aged ≥ 70 years were recruited from local government areas surrounding Concord Hospital in Sydney, New South Wales for the Concord Health and Ageing in Men Project (CHAMP). The research dietitian administered a standardised validated diet history questionnaire to capture baseline dietary intake. In total, 794 men participated in a detailed diet history interview at the third wave. Adequacy of protein intake was assessed by comparing participant intake with the Nutrient Reference Values. Total protein intake was categorised into quintiles. Sources of protein were also captured. Mortality was ascertained through the New South Wales death registry. Cox proportional hazard models were used to assess the association between dietary total, animal and plant protein intake and risk of mortality. Results The mean age of the CHAMP men was 81 years. In total, 162 men died during a median follow-up of 3.7 years. Of these, 54 (33.3%) and 49 (30.2%) men died due to cancer and cardiovascular disease, respectively. There were U-shaped associations between protein intake and all-cause and cancer mortality. In multiple adjusted analysis, the second (hazard ratio [HR] = 0.38; 95% confidence interval [CI] = 0.18–0.82) and third (HR = 0.36; 95% CI = 0.16–0.82) quintiles of protein intakes were significantly associated with reduced risk of all-cause and only second quintile (HR = 0.47; 95% CI = 0.10–0.93) of protein intake was significantly associated with cancer mortality. Each serve increase in animal protein was significantly associated with 12% (HR = 1.12; 95% CI = 1.00–1.26) and 23% (HR = 1.23; 95% CI = 1.02–1.49) increased risk of all-cause mortality and cancer mortality respectively. Conversely, each serve increase in plant protein intake was significantly associated with 25% (HR = 0.75; 95% CI 0.61–0.92) and 28% (HR = 0.72; 95% CI = 0.53–0.97) reduced risk of all-cause and cancer mortality, respectively. No such associations were observed for cardiovascular disease mortality. Conclusions Both second and third quintiles of total protein intake were associated with reduced all-cause and cancer mortality. Plant protein was inversely associated with all-cause and cancer mortality, whereas animal protein intake was positively associated with mortality. Key points • Our findings suggest a U-shaped association between life expectancy and total protein intake, in which lifespan is greatest among people with 93–113 g day–1 total protein intake, a level that might be considered moderate in Australia but high in other countries. • Both second and third quintiles of total protein intake (range between 79.23 and 107.19 g day–1) were associated with reduced risk of all-cause and cancer mortality. • Higher consumption of animal-derived proteins was associated with greater mortality risk, whereas this association was reversed when protein consumption was replaced with plant-derived protein.
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Dietary proteins exert a wide range of nutritional and biological functions. Apart from their nutritional roles as the source of amino acids for protein synthesis, they take part mainly in the regulation of food intake, blood pressure, bone metabolism, glucose and lipid metabolism, and immune functions. The interaction of dietary proteins with the gastrointestinal (GI) tract plays a chief role in determining the physiological properties of proteins. The enzymes protease and peptidase hydrolyze dietary protein to generate dipeptides, tripeptides, and amino acids in the lumen of the gastrointestinal tract. These products digested from dietary proteins are utilized in the small intestine by microbes. Moreover, the microbes also convert the macro and micronutrients from the diet into an enormous number of compounds that may have either beneficial or adverse effects on human health. The present review discusses the various impacts caused by both dietary plant and animal protein sources on microbiota in the GI tract.Keywords: Animal protein; Plant protein; Dietary proteins; Gut microbiota; Human health.
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Purpose of review: A healthy lifestyle throughout one's lifespan is the core foundation for both primary and secondary prevention of cardiovascular disease (CVD). Risk-based decisions for pharmacological therapy is added on-top of lifestyle management. Thus, understanding lifestyle-based recommendations is central to CVD prevention. Recent findings: In 2018 and 2019, the American Heart Association (AHA) and American College of Cardiology (ACC) published new guidelines for lipid management and primary prevention of cardiovascular disease (CVD), respectively. The European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) published new guidelines on lipids and diabetes management in 2019. These guidelines provide recommendations on diet and lifestyle for reducing cardiovascular risk. Both encourage heart-healthy diets consistent with Mediterranean, DASH, or healthy vegetarian patterns. Both provide guidance for recommended physical activity levels but acknowledge any physical activity, even less than recommended, is better than inactivity. Although both ACC/AHA and ESC/EAS guidelines have similar approaches to achieve the same goal of CVD prevention, there were some differences between them. Summary: In this review, we discussed similarities and differences between the American and European guidelines to familiarize clinicians with both sets of lifestyle recommendations in an effort to provide best practices in individualized patient-care for CVD prevention.
Chapter
Magnesium (Mg) is one of the most important cations in the human organism playing an important role in many vital processes, including neuromuscular, enzymatic reactions, neurotransmitter release, or chronic kidney disease (CKD) mineral and bone disease metabolism. Moreover, higher levels of magnesium in the body are positively correlated with improved survival, while hypomagnesemia is significantly associated with cardiovascular and all-cause mortality in patients with CKD and end-stage renal disease (ESRD). Although serum Mg may increase in the setting of advance CKD due to the insufficient compensatory mechanism, epidemiological studies show that in real life both CKD and ESRD patients have normal and sometimes even low-serum Mg concentration. This is due to the intake of Mg coupled with other dietary intake which might interfere with intestinal absorption and dialysate Mg concentration or some drugs such as loop and thiazide diuretics, proton-pump inhibitors, chemotherapy, antimicrobials, or calcineurin inhibitors. Diet also plays a crucial role in maintaining a normal Mg balance. Magnesium is widely found in green vegetables, beans, legume, and nuts, while processed foods are poor in this cation. A plant-based diet is often discouraged in advanced CKD in an attempt to limit the potassium intake. This approach could lead to a low-Mg intake; therefore these patients should be encouraged to consume more plant-based proteins since it is well known that meat-based diets are typically much more acidic than plant-based diets, and there are health benefits associated with changing the acid–base balance in the diet. Growing evidence supports the health benefits of plant-based diets that are high in Mg and fiber and low in saturated fat and have low levels of sodium for preventing heart disease, hypertension and could even slow the progression of CKD.
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Eating less meat would benefit environmental sustainability, human health, and animal welfare. Providing information about this, however, does often not lead people to adopt according beliefs, attitudes or behaviors. In fact, dietary changes are often prevented by dissonance reduction (i.e. moral disengagement) if information elicits a conflict regarding meat. In the present investigation we thus aimed to address moral disengagement via a communication strategy that consisted of two stages: In Stage I, we presented information by showing distressing scenes from animal agriculture. In Stage II, we then counteracted moral disengagement in a dialog. Two studies indicate that, following the dialog, people’s evaluations of meat changed and their willingness to eat meat decreased; this seemed to result from lowered moral disengagement. By providing an empirically tested communication strategy for addressing moral disengagement on the exemplary conflict regarding meat, we hope to inspire research and interventions that intend to communicate (environmental) issues.
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In a time of food abundance and waste, and when sedentarism is the norm, metabolic-associated fatty liver disease (MAFLD) has become a major health threat in the Western world. While research is committed to finding a pharmacological treatment for MAFLD, it is time to go back to the basis and address the behavioral pathogenesis of MAFLD. All patients with MAFLD, irrespective of body weight, should be submitted to thorough dietary counseling. Diet is a learned behavior and should be addressed holistically and in a personalized fashion. The benefits of a suitable diet surpass an improvement of liver disease, having the potential to improve cardiovascular- and cancer-related mortality, in patients with MAFLD. This review summarizes the current state of the art of diet on MAFLD, presenting straightforward recommendations for everyday practice.
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Zusammenfassung Zielsetzung Anhand einer systematischen Literaturrecherche soll eine evidenzbasierte Ernährungsempfehlung zur Vorbeugung von zerebrovaskulären und kardiovaskulären Erkrankungen erarbeitet werden. Methoden Pubmed-Recherche bis Oktober 2019 zu nationalen und internationale Leitlinien, Metaanalysen, randomisierten Studien und Registerstudien der letzten 10 Jahre. Nur Veröffentlichungen, die den Einfluss der Ernährung auf den primären Studienendpunkt einer Herz-Kreislauf-Erkrankung untersuchten, wurden berücksichtigt. Folgende Schlagwörter wurden für die Literaturrecherche verwendet: „diet“, „cardiovascular disease“, „nutrition“, „stroke“. Ergebnisse Es fanden sich 30 Studien, 41 Metaanalysen und 15 Registerstudien. Es konnte kein signifikanter Zusammenhang zwischen dem Verzehr von mehrfach ungesättigten Fettsäuren und einem reduzierten Schlaganfallrisiko festgestellt werden. Lediglich der Verzehr von einfach ungesättigten Fettsäuren zeigte ein signifikant reduziertes Risiko für einen hämorrhagischen Schlaganfall. Der Verzehr von Kohlenhydraten sowie von Proteinen hat keinen direkten Einfluss auf das Schlaganfallrisiko. Jedoch ist der Verzehr pflanzlicher Proteine dem tierischer möglicherweise vorzuziehen. Eine vermehrte Zufuhr von Kalium durch den Verzehr von Obst und Gemüse und eine verringerte Natriumaufnahme durch eine Salzreduzierung sind zur Vorbeugung eines Schlaganfalls zu empfehlen. Sowohl die mediterrane Diät als auch die DASH(„Dietary Approaches to Stop Hypertension“)-Diät reduzieren deutlich das Risiko eines Schlaganfalls. Zusätzlich lässt sich durch folgendes Risikoprofil die Gefahr eines Schlaganfalls so gering wie möglich halten: Nichtraucher, optimales Körpergewicht (BMI) und Bauchumfang, sportliche Aktivität, moderater Alkoholkonsum Folgerung Die Inzidenz von zerebrovaskulären und kardiovaskulären Erkrankungen könnte bei entsprechender Ernährung signifikant gesenkt werden.
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Are you interested in the state of our world? In the future of humanity? Have you ever wondered how the major developments of our time are connected? Are you, in fact, interested in exploring the big picture? The world we live in is undergoing enormous change, and it can feel overwhelming to grasp what it all means, to you, to your family, to your business or job, and to humanity as a whole. Explore The Big Picture takes a deep dive into some of the most significant matters we’re facing today, including climate change, the impact of technology, the development of the world economy, pressing societal challenges, and life beyond Earth. Doing away with complexity, each topic is explored in such a way that it relates to the other topics. Celebrating our achievements and drawing attention to our challenges, Explore The Big Picture cuts through the clutter, leaving readers with a clear vision of what’s at stake and what’s to gain. Using this book enhances your skills in critical thinking, strategic foresight, and interdisciplinary thinking – all vital skills required for addressing complex challenges such as achieving the Sustainable Development Goals. Explore The Big Picture is an open invitation to look beyond the horizon and challenge your thoughts and beliefs, allowing you to take meaningful action that leads to positive change.
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Purpose of review: (1) To provide commentary on the 2017 update to the Kidney Disease Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD); (2) to apply the evidence-based guideline update for implementation within the Canadian health care system; (3) to provide comment on the care of children with chronic kidney disease (CKD); and (4) to identify research priorities for Canadian patients. Sources of information: The KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of CKD-MBD. Methods: The commentary committee co-chairs selected potential members based on their knowledge of the Canadian kidney community, aiming for wide representation from relevant disciplines, academic and community centers, and different geographical regions. Key findings: We agreed with many of the recommendations in the clinical practice guideline on the diagnosis, evaluation, prevention, and treatment of CKD-MBD. However, based on the uncommon occurrence of abnormalities in calcium and phosphate and the low likelihood of severe abnormalities in parathyroid hormone (PTH), we recommend against screening and monitoring levels of calcium, phosphate, PTH, and alkaline phosphatase in adults with CKD G3. We suggest and recommend monitoring these parameters in adults with CKD G4 and G5, respectively. In children, we agree that monitoring for CKD-MBD should begin in CKD G2, but we suggest measuring ionized calcium, rather than total calcium or calcium adjusted for albumin. With regard to vitamin D, we suggest against routine screening for vitamin D deficiency in adults with CKD G3-G5 and G1T-G5T and suggest following population health recommendations for adequate vitamin D intake. We recommend that the measurement and management of bone mineral density (BMD) be according to general population guidelines in CKD G3 and G3T, but we suggest against routine BMD testing in CKD G4-G5, CKD G4T-5T, and in children with CKD. Based on insufficient data, we also recommend against routine bone biopsy in clinical practice for adults with CKD or CKD-T, or in children with CKD, although we consider it an important research tool. Limitations: The committee relied on the evidence summaries produced by KDIGO. The CSN committee did not replicate or update the systematic reviews.
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Introduction:Cardiovascular disease is a leading cause of death and chronic disability and optimizing its prevention and management remains a priority. This review aims to provide a critical analysis on the positive and negative aspects concerning the impact of a vegetarian diet in cardiovascular risk. Results:Overall, vegetarian population presents better cardiovascular risk profile, expressed by lower body mass index, better blood pressure control, reduced pro-atherogenic lipids and better glycaemic control and insulin sensitivity. Other atherogenic paths seem to be influenced, such as chylomicron remnants removal from circulation, oxidative and inflammation profile, blood fluidity and intestinal microbiota. Furthermore, imaging methods have shown better structural and functional vascular properties among vegetarians. However, a non-balanced vegetarian diet might lead to nutrients deficit, which could nullify these advantages. These limitations may be overcome through a carefully planned diet and, in some cases, supplements or fortified foods. Ultimately, a beneficial effect is associated with a healthy vegetarian concept, with scarce intake of refined and processed food products, avoiding overconsumption of sugar and trans fats. Conclusion:Vegetarian diet brings a positive impact in several independent cardiovascular risk factors. Despite the additional challenge in reaching specific macro and micronutrients which are less available in plant-based foods, their shortage can be avoided by planning a well-balanced and complete diet, based on healthy and natural food components. As there is the acknowledgment of its limitations and corresponding precautions are taken, a vegetarian diet could be used as an effective weapon towards prevention and management of cardiovascular disease
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Context Cardiometabolic diseases are leading causes of death and morbidity. Aging increases the risk of disease development. Diet has protective and causal effects on cardiometabolic health. Objective To consolidate the current evidence on the short- and long-term effects of dietary patterns on cardiometabolic health in adults aged ≥ 65 years. Data Sources The Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, Global Health, and Pre-Medline databases, along with ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched. Data Extraction A total of 40 042 records were identified. Quality assessment involved using the revised Cochrane risk-of-bias tool for randomized trials and Joanna Briggs Institute checklists. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation. Results Thirteen articles were included (n = 5 cohort studies and n = 3 randomized controlled trials). The low-fat dietary pattern reduced adiposity; however, no effects were evident for hypertension incidence, composite coronary heart disease incidence (including myocardial infarction, coronary heart disease, and coronary revascularization), high-density lipoprotein cholesterol level, and increased blood pressure in the long term. The Mediterranean dietary pattern resulted in reduced triglyceride levels and systolic blood pressure, and had no effects on diastolic blood pressure and glucose in the short term. Other dietary patterns had inconclusive effects. Conclusions The Mediterranean dietary pattern showed the most benefits without harm on cardiometabolic health in older adults. The current body of evidence is small, indicating the need for more research to confirm these findings at a high certainty of evidence, and to include dietary patterns combined with other dietary components, subgroups with cardiometabolic disease or risk factors, longer follow-up, and outcomes that have not yet been investigated. Studies including these factors may help identify the most effective dietary pattern for cardiometabolic health benefits in older adults, to inform future guidelines. Systematic Review Registration PROSPERO registration no. CRD42020141400.
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Αbstract Background Vegan diets, where animal- and all their by-products are excluded from the diet, have gained popularity, especially in the last decade. However, the evaluation of this type of diet has not been well addressed in the scientific literature. This study aimed to investigate the adequacy of vegan diets in European populations and of their macro- and micronutrient intakes compared to World Health Organization recommendations. Methods A systematic search in PubMed, Web of Science, IBSS, Cochrane library and Google Scholar was conducted and 48 studies (12 cohorts and 36 cross-sectional) were included. Results Regarding macronutrients, vegan diets are lower in protein intake compared with all other diet types. Veganism is also associated with low intake of vitamins B2, Niacin (B3), B12, D, iodine, zinc, calcium, potassium, selenium. Vitamin B12 intake among vegans is significantly lower (0.24–0.49 μg, recommendations are 2.4 μg) and calcium intake in the majority of vegans was below recommendations (750 mg/d). No significant differences in fat intake were observed. Vegan diets are not related to deficiencies in vitamins A, B1, Β6, C, E, iron, phosphorus, magnesium, copper and folate and have a low glycemic load. Conclusions Following a vegan diet may result in deficiencies in micronutrients (vitamin B12, zinc, calcium and selenium) which should not be disregarded. However, low micro- and macronutrient intakes are not always associated with health impairments. Individuals who consume a vegan diet should be aware of the risk of potential dietary deficiencies.
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Fundamento: Sabe-se que o futebol de várzea, principalmente na forma recreativa, ou seja, não realizado de forma contínua, torna-se uma prática irregular de exercício físico, que em conjunto com maus hábitos de vida e uma má alimentação torna os seus praticantes expostos a eventos cardiovasculares. Objetivo: Verificar a existência de fatores de risco para eventos cardiovasculares relacionados ao consumo alimentar e composição corporal de jogadores de futebol de várzea. Metodologia: Foram avaliados 17 jogadores do gênero masculino, acima de 18 anos. Para aferição da taxa metabólica basal e avaliação da composição corporal, foi utilizado o aparelho de bioimpedância elétrica (BIA) da marca Bydinamics modelo p450. Foi aferido a circunferência de cintura (CC) e IMC, a partir das medidas de peso e altura. Foi realizado um recordatório alimentar de 24 horas e para cálculo destes, foi utilizado software Avanutri® online. E a frequência de consumo dos grupos alimentares foi analisada através do teste “Como está sua alimentação?”. Além disso, foram calculados o Índice de conicidade e a relação cintura-estatura. Resultados: A alimentação dos jogadores caracterizou-se hiperprotéica (23,75% do VCT), hipoglicídica (49,45% do VCT) e normolipídica (27,03%), porém deficitária a nível de micronutrientes. O perfil antropométrico da população foi de sobrepeso em 76,5% dos participantes, 5,9% obesos e 16,6% eutrófico. Também 82,4% apresentou relação cintura-estatura elevada e 70,6% dos indivíduos possuíam Índice de conicidade acima do recomendado. Conclusão: Os jogadores analisados apresentaram comprometimento no padrão alimentar e antropométrico, podendo refletir negativamente nas funções vitais dos indivíduos, tornando-os potencialmente suscetíveis a eventos cardiovasculares.
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Clinical guidelines have long been one of the working tools of the modern doctor, helping him quickly navigate the most effective proven methods of treatment and prevention of various diseases, and also to adapt these methods to the specific tasks of their patients and to achieve maximum personalization of treatment. Clinical practice guidelines are drawn up by professional non-profit associations and are approved by the Scientific Council of the Ministry of Health of the Russian Federation, while often one recommendation is prepared by two or even three associations. The peculiarity of the recommendations offered to your attention is that not only endocrinologists, but also therapists, cardiologists, gynecologists, gastroenterologists, and experts of many other specialties are involved in the prevention and treatment of obesity. The Multidisciplinary Working Group presents this a project in a multidisciplinary journal to bring together the efforts of several professional associations that associated with the need to pay attention not only to obesity itself but also to comorbid conditions. We are looking forward to constructive criticism and a comprehensive discussion of the problem on the pages of our journal. © 2021 Russian Association of Endocrinologists. All rights reserved.
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Background: Plant-based diets have been recommended to reduce the risk of type 2 diabetes (T2D). However, not all plant foods are necessarily beneficial. We examined the association of an overall plant-based diet and hypothesized healthful and unhealthful versions of a plant-based diet with T2D incidence in three prospective cohort studies in the US. Methods and findings: We included 69,949 women from the Nurses' Health Study (1984-2012), 90,239 women from the Nurses' Health Study 2 (1991-2011), and 40,539 men from the Health Professionals Follow-Up Study (1986-2010), free of chronic diseases at baseline. Dietary data were collected every 2-4 y using a semi-quantitative food frequency questionnaire. Using these data, we created an overall plant-based diet index (PDI), where plant foods received positive scores, while animal foods (animal fats, dairy, eggs, fish/seafood, poultry/red meat, miscellaneous animal-based foods) received reverse scores. We also created a healthful plant-based diet index (hPDI), where healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea/coffee) received positive scores, while less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, sweets/desserts) and animal foods received reverse scores. Lastly, we created an unhealthful plant-based diet index (uPDI) by assigning positive scores to less healthy plant foods and reverse scores to healthy plant foods and animal foods. We documented 16,162 incident T2D cases during 4,102,369 person-years of follow-up. In pooled multivariable-adjusted analysis, both PDI and hPDI were inversely associated with T2D (PDI: hazard ratio [HR] for extreme deciles 0.51, 95% CI 0.47-0.55, p trend < 0.001; hPDI: HR for extreme deciles 0.55, 95% CI 0.51-0.59, p trend < 0.001). The association of T2D with PDI was considerably attenuated when we additionally adjusted for body mass index (BMI) categories (HR 0.80, 95% CI 0.74-0.87, p trend < 0.001), while that with hPDI remained largely unchanged (HR 0.66, 95% CI 0.61-0.72, p trend < 0.001). uPDI was positively associated with T2D even after BMI adjustment (HR for extreme deciles 1.16, 95% CI 1.08-1.25, p trend < 0.001). Limitations of the study include self-reported diet assessment, with the possibility of measurement error, and the potential for residual or unmeasured confounding given the observational nature of the study design. Conclusions: Our study suggests that plant-based diets, especially when rich in high-quality plant foods, are associated with substantially lower risk of developing T2D. This supports current recommendations to shift to diets rich in healthy plant foods, with lower intake of less healthy plant and animal foods.
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Proteins from plant-based compared with animal-based food sources may have different effects on cardiovascular disease (CVD) risk factors. Numerous epidemiologic and intervention studies have evaluated their respective health benefits; however, it is difficult to isolate the role of plant or animal protein on CVD risk. This review evaluates the current evidence from observational and intervention studies, focusing on the specific protein-providing foods and populations studied. Dietary protein is derived from many food sources, and each provides a different composite of nonprotein compounds that can also affect CVD risk factors. Increasing the consumption of protein-rich foods also typically results in lower intakes of other nutrients, which may simultaneously influence outcomes. Given these complexities, blanket statements about plant or animal protein may be too general, and greater consideration of the specific protein food sources and the background diet is required. The potential mechanisms responsible for any specific effects of plant and animal protein are similarly multifaceted and include the amino acid content of particular foods, contributions from other nonprotein compounds provided concomitantly by the whole food, and interactions with the gut microbiome. Evidence to date is inconclusive, and additional studies are needed to further advance our understanding of the complexity of plant protein vs. animal protein comparisons. Nonetheless, current evidence supports the idea that CVD risk can be reduced by a dietary pattern that provides more plant sources of protein compared with the typical American diet and also includes animal-based protein foods that are unprocessed and low in saturated fat.
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Although data suggest that intake of total protein, and specific amino acids (AAs) reduces blood pressure, data on other cardiovascular disease risk factors are limited. We examined associations between intake of AAs with known mechanistic links to cardiovascular health and direct measures of arterial stiffness, central blood pressure, and atherosclerosis. In a cross-sectional study of 1898 female twins aged 18-75 y from the TwinsUK registry, intake of 7 cardioprotective AAs (arginine, cysteine, glutamic acid, glycine, histidine, leucine, and tyrosine) was calculated from food-frequency questionnaires. Direct measures of arterial stiffness and atherosclerosis included central systolic blood pressure (cSBP), mean arterial pressure (MAP), augmentation index (AI), pulse wave velocity (PWV), and intima-media thickness (IMT). ANCOVA was used to assess the associations between endpoints of arterial stiffness and intake (per quintile), adjusting for potential confounders. In multivariable analyses, higher intake of total protein and 7 potentially cardioprotective AAs was associated with lower cSBP, MAP, and PWV. Higher intake of glutamic acid, leucine, and tyrosine was most strongly associated with PWV, with respective differences of -0.4 ± 0.2 m/s (P-trend = 0.02), -0.4 ± 0.2 m/s (P-trend = 0.03), and -0.4 ± 0.2 m/s (P-trend = 0.03), comparing extreme quintiles. There was a significant interaction between AA intake and protein source, and higher intake of AAs from vegetable sources was associated with lower central blood pressure and AI. Higher intake of glutamic acid, leucine, and tyrosine from animal sources was associated with lower PWV. These data provide evidence to suggest that intake of several AAs is associated with cardiovascular benefits beyond blood pressure reduction in healthy women. The magnitude of the observed associations was similar to those previously reported for other lifestyle factors. Increasing intake of these AAs could be an important and readily achievable way to reduce cardiovascular disease risk.
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Recent pooled analyses supported a beneficial impact of nut consumption on health, but to our knowledge, whether nuts are associated with overall decreased mortality has not been previously reviewed. We aimed to systematically review prospective studies that explored the effects of nut consumption on all-cause, cardiovascular disease (CVD), and cancer mortality and quantify the size effect through a meta-analysis. We also reviewed confounding factors associated with nut consumption to assess potential clustering with other covariates. We searched PubMed and EMBASE for studies published up to June 2014. Study characteristics, HRs, and 95% CIs were generated on the basis of quantitative analyses. A dose-response analysis was performed when data were available. Seven studies for all-cause mortality, 6 studies for CVD mortality, and 2 studies for cancer mortality were included in the meta-analysis with a total of 354,933 participants, 44,636 cumulative incident deaths, and 3,746,534 cumulative person-years. Nut consumption was associated with some baseline characteristics such as lower body mass index and smoking status as well as increased intakes of fruit, vegetables, and alcohol. One-serving of nuts per week and per day resulted in 4% (RR: 0.96; 95% CI: 0.93, 0.98) and 27% (RR: 0.73; 95% CI: 0.60, 0.88) decreased risk of all-cause mortality, respectively, and decreased risk of CVD mortality [RR: 0.93 (95% CI: 0.88, 0.99) and 0.61 (95% CI: 0.42, 0.91), respectively]. Effects were primarily driven by decreased coronary artery disease deaths rather than stroke deaths. Nut consumption was also associated with decreased risk of cancer deaths when highest compared with lowest categories of intake were compared (RR: 0.86; 95% CI: 0.75, 0.98), but no dose-effect was shown. Nut consumption is associated with lower risk of all-cause, CVD, and cancer mortality, but the presence of confounding factors should be taken into account when considering such findings. © 2015 American Society for Nutrition.
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Background The healthiest dietary pattern for myocardial infarction (MI) survivors is not known. Specific long‐term benefits of a low‐carbohydrate diet (LCD) are unknown, whether from animal or vegetable sources. There is a need to examine the associations between post‐MI adherence to an LCD and all‐cause and cardiovascular mortality. Methods and Results We included 2258 women from the Nurses' Health Study and 1840 men from the Health Professional Follow‐Up Study who had survived a first MI during follow‐up and provided a pre‐MI and at least 1 post‐MI food frequency questionnaire. Adherence to an LCD high in animal sources of protein and fat was associated with higher all‐cause and cardiovascular mortality (hazard ratios of 1.33 [95% CI: 1.06 to 1.65] for all‐cause mortality and 1.51 [95% CI: 1.09 to 2.07] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to an animal‐based LCD prospectively assessed from the pre‐ to post‐MI period was associated with higher all‐cause mortality and cardiovascular mortality (hazard ratios of 1.30 [95% CI: 1.03 to 1.65] for all‐cause mortality and 1.53 [95% CI: 1.10 to 2.13] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to a plant‐based LCD was not associated with lower all‐cause or cardiovascular mortality. Conclusions Greater adherence to an LCD high in animal sources of fat and protein was associated with higher all‐cause and cardiovascular mortality post‐MI. We did not find a health benefit from greater adherence to an LCD overall after MI.
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Background: Vegetarian diets have been associated with reduced mortality. Because a pure vegetarian diet might not easily be embraced by many individuals, consuming preferentially plant-derived foods would be a more easily understood message. A provegetarian food pattern (FP) emphasizing preference for plant-derived foods might reduce all-cause mortality. Objective: The objective was to identify the association between an a priori-defined provegetarian FP and all-cause mortality. Design: We followed 7216 participants (57% women; mean age: 67 y) at high cardiovascular risk for a median of 4.8 y. A validated 137-item semiquantitative food-frequency questionnaire was administered at baseline and yearly thereafter. Fruit, vegetables, nuts, cereals, legumes, olive oil, and potatoes were positively weighted. Added animal fats, eggs, fish, dairy products, and meats or meat products were negatively weighted. Energy-adjusted quintiles were used to assign points to build the provegetarian FP (range: 12-60 points). Deaths were confirmed by review of medical records and the National Death Index. Results: There were 323 deaths during the follow-up period (76 from cardiovascular causes, 130 from cancer, 117 for noncancer, noncardiovascular causes). Higher baseline conformity with the provegetarian FP was associated with lower mortality (multivariable-adjusted HR for ≥ 40 compared with <30 points: 0.59; 95% CI: 0.40, 0.88). Similar results were found with the use of updated information on diet (RR: 0.59; 95% CI: 0.39, 0.89). Conclusions: Among omnivorous subjects at high cardiovascular risk, better conformity with an FP that emphasized plant-derived foods was associated with a reduced risk of all-cause mortality. This trial was registered at www.controlled-trials.com as ISRCTN35739639.
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The sustainability of dietary plant and animal protein consumption is an important issue, but few data are available to ascertain the health-related impact of animal and plant protein intake. The objective was to study the relationships between animal and plant protein intake and diet quality, as reflected by an integrated index of nutrient adequacy. Using data on 1912 adults from the French Individual and National Consumption Survey 2 (2006-2007), we assessed diet quality by using the PANDiet, a unique score combining 35 probabilities of having an adequate nutrient intake, and used multiple regression analysis to study the relationship with intakes of plant, animal, and related food source proteins. After adjustments for intakes of energy, alcohol, and protein from other sources and sociodemographic factors, plant protein intake was positively associated with the PANDiet, irrespective of sex (β = 0.50, P < 0.0001). By contrast, total and animal protein intakes were differently associated with the PANDiet according to sex, with a positive association in women (β = 0.07 and β = 0.08, respectively; P < 0.01) and an inverse association in men (β = -0.07 and β = -0.05, respectively; P < 0.01). The relationships between the PANDiet and intakes of protein from animal food sources varied: for instance, associations were inverse for red meat and poultry in men but not in women, whereas irrespective of sex, they were positive for fish, milk, and yogurt and inverse for processed meat, cheese, and eggs. These findings show that plant protein is a robust marker of a healthy diet, whereas total animal protein includes different subtypes of animal protein that largely vary in their relationship with diet quality. These data could help refine protein recommendations from a qualitative and dietary standpoint.
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Importance Some evidence suggests vegetarian dietary patterns may be associated with reduced mortality, but the relationship is not well established.Objective To evaluate the association between vegetarian dietary patterns and mortality.Design Prospective cohort study; mortality analysis by Cox proportional hazards regression, controlling for important demographic and lifestyle confounders.Setting Adventist Health Study 2 (AHS-2), a large North American cohort.Participants A total of 96 469 Seventh-day Adventist men and women recruited between 2002 and 2007, from which an analytic sample of 73 308 participants remained after exclusions.Exposures Diet was assessed at baseline by a quantitative food frequency questionnaire and categorized into 5 dietary patterns: nonvegetarian, semi-vegetarian, pesco-vegetarian, lacto-ovo–vegetarian, and vegan.Main Outcome and Measure The relationship between vegetarian dietary patterns and all-cause and cause-specific mortality; deaths through 2009 were identified from the National Death Index.Results There were 2570 deaths among 73 308 participants during a mean follow-up time of 5.79 years. The mortality rate was 6.05 (95% CI, 5.82-6.29) deaths per 1000 person-years. The adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs nonvegetarians was 0.88 (95% CI, 0.80-0.97). The adjusted HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73-1.01); in lacto-ovo–vegetarians, 0.91 (95% CI, 0.82-1.00); in pesco-vegetarians, 0.81 (95% CI, 0.69-0.94); and in semi-vegetarians, 0.92 (95% CI, 0.75-1.13) compared with nonvegetarians. Significant associations with vegetarian diets were detected for cardiovascular mortality, noncardiovascular noncancer mortality, renal mortality, and endocrine mortality. Associations in men were larger and more often significant than were those in women.Conclusions and Relevance Vegetarian diets are associated with lower all-cause mortality and with some reductions in cause-specific mortality. Results appeared to be more robust in males. These favorable associations should be considered carefully by those offering dietary guidance.
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Red meat consumption has been associated with an increased risk of chronic diseases. However, its relationship with mortality remains uncertain. We prospectively observed 37 698 men from the Health Professionals Follow-up Study (1986-2008) and 83 644 women from the Nurses' Health Study (1980-2008) who were free of cardiovascular disease (CVD) and cancer at baseline. Diet was assessed by validated food frequency questionnaires and updated every 4 years. We documented 23 926 deaths (including 5910 CVD and 9464 cancer deaths) during 2.96 million person-years of follow-up. After multivariate adjustment for major lifestyle and dietary risk factors, the pooled hazard ratio (HR) (95% CI) of total mortality for a 1-serving-per-day increase was 1.13 (1.07-1.20) for unprocessed red meat and 1.20 (1.15-1.24) for processed red meat. The corresponding HRs (95% CIs) were 1.18 (1.13-1.23) and 1.21 (1.13-1.31) for CVD mortality and 1.10 (1.06-1.14) and 1.16 (1.09-1.23) for cancer mortality. We estimated that substitutions of 1 serving per day of other foods (including fish, poultry, nuts, legumes, low-fat dairy, and whole grains) for 1 serving per day of red meat were associated with a 7% to 19% lower mortality risk. We also estimated that 9.3% of deaths in men and 7.6% in women in these cohorts could be prevented at the end of follow-up if all the individuals consumed fewer than 0.5 servings per day (approximately 42 g/d) of red meat. Red meat consumption is associated with an increased risk of total, CVD, and cancer mortality. Substitution of other healthy protein sources for red meat is associated with a lower mortality risk.
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Nuts (tree nuts and peanuts) are nutrient dense foods with complex matrices rich in unsaturated fatty and other bioactive compounds: high-quality vegetable protein, fiber, minerals, tocopherols, phytosterols, and phenolic compounds. By virtue of their unique composition, nuts are likely to beneficially impact health outcomes. Epidemiologic studies have associated nut consumption with a reduced incidence of coronary heart disease and gallstones in both genders and diabetes in women. Limited evidence also suggests beneficial effects on hypertension, cancer, and inflammation. Interventional studies consistently show that nut intake has a cholesterol-lowering effect, even in the context of healthy diets, and there is emerging evidence of beneficial effects on oxidative stress, inflammation, and vascular reactivity. Blood pressure, visceral adiposity and the metabolic syndrome also appear to be positively influenced by nut consumption. Thus it is clear that nuts have a beneficial impact on many cardiovascular risk factors. Contrary to expectations, epidemiologic studies and clinical trials suggest that regular nut consumption is unlikely to contribute to obesity and may even help in weight loss. Safety concerns are limited to the infrequent occurrence of nut allergy in children. In conclusion, nuts are nutrient rich foods with wide-ranging cardiovascular and metabolic benefits, which can be readily incorporated into healthy diets.
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To assess race-specific validity of food and food group intakes measured using an FFQ. Calibration study participants were randomly selected from the Adventist Health Study-2 (AHS-2) cohort by church, and then by subject-within-church. Intakes of forty-seven foods and food groups were assessed using an FFQ and then compared with intake estimates measured using six 24 h dietary recalls (24HDR). We used two approaches to assess the validity of the questionnaire: (i) cross-classification by quartile and (ii) de-attenuated correlation coefficients. Seventh-day Adventist church members geographically spread throughout the USA and Canada. Members of the AHS-2 calibration study (550 whites and 461 blacks). The proportion of participants with exact quartile agreement in the FFQ and 24HDR averaged 46 % (range: 29-87 %) in whites and 44 % (range: 25-88 %) in blacks. The proportion of quartile gross misclassification ranged from 1 % to 11 % in whites and from 1 % to 15 % in blacks. De-attenuated validity correlations averaged 0·59 in whites and 0·48 in blacks. Of the forty-seven foods and food groups, forty-three in whites and thirty-three in blacks had validity correlations >0·4. The AHS-2 questionnaire has good validity for most foods in both races; however, validity correlations tend to be higher in whites than in blacks.
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Despite the well-established observation that substitution of saturated fats for carbohydrates or unsaturated fats increases low-density lipoprotein (LDL) cholesterol in humans and animal models, the relationship of saturated fat intake to risk for atherosclerotic cardiovascular disease in humans remains controversial. A critical question is what macronutrient should be used to replace saturated fat. Substituting polyunsaturated fat for saturated fat reduces LDL cholesterol and the total cholesterol to high-density lipoprotein cholesterol ratio. However, replacement of saturated fat by carbohydrates, particularly refined carbohydrates and added sugars, increases levels of triglyceride and small LDL particles and reduces high-density lipoprotein cholesterol, effects that are of particular concern in the context of the increased prevalence of obesity and insulin resistance. Epidemiologic studies and randomized clinical trials have provided consistent evidence that replacing saturated fat with polyunsaturated fat, but not carbohydrates, is beneficial for coronary heart disease. Therefore, dietary recommendations should emphasize substitution of polyunsaturated fat and minimally processed grains for saturated fat.
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To validate a 204-item quantitative FFQ for measurement of nutrient intake in the Adventist Health Study-2 (AHS-2). Calibration study participants were randomly selected from the AHS-2 cohort by church, and then subject-within-church. Each participant provided two sets of three weighted 24 h dietary recalls and a 204-item FFQ. Race-specific correlation coefficients (r), corrected for attenuation from within-person variation in the recalls, were calculated for selected energy-adjusted macro- and micronutrients. Adult members of the AHS-2 cohort geographically spread throughout the USA and Canada. Calibration study participants included 461 blacks of American and Caribbean origin and 550 whites. Calibration study subjects represented the total cohort very well with respect to demographic variables. Approximately 33 % were males. Whites were older, had higher education and lower BMI compared with blacks. Across fifty-one variables, average deattenuated energy-adjusted validity correlations were 0.60 in whites and 0.52 in blacks. Individual components of protein had validity ranging from 0.40 to 0.68 in blacks and from 0.63 to 0.85 in whites; for total fat and fatty acids, validity ranged from 0.43 to 0.75 in blacks and from 0.46 to 0.77 in whites. Of the eighteen micronutrients assessed, sixteen in blacks and sixteen in whites had deattenuated energy-adjusted correlations >or=0.4, averaging 0.60 and 0.53 in whites and blacks, respectively. With few exceptions validity coefficients were moderate to high for macronutrients, fatty acids, vitamins, minerals and fibre. We expect to successfully use these data for measurement error correction in analyses of diet and disease risk.
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Although dietary factors are suspected to be important determinants of coronary heart disease (CHD) risk, the direct evidence is relatively sparse. The Adventist Health Study is a prospective cohort investigation of 31,208 non-Hispanic white California Seventh-Day Adventists. Extensive dietary information was obtained at baseline, along with the values of traditional coronary risk factors. These were related to risk of definite fatal CHD or definite nonfatal myocardial infarction. Subjects who consumed nuts frequently (more than four times per week) experienced substantially fewer definite fatal CHD events (relative risk, 0.52; 95% confidence interval [CI], 0.36 to 0.76) and definite nonfatal myocardial infarctions (relative risk, 0.49; 95% CI, 0.28 to 0.85), when compared with those who consumed nuts less than once per week. These findings persisted on covariate adjustment and were seen in almost all of 16 different subgroups of the population. Subjects who usually consumed whole wheat bread also experienced lower rates of definite nonfatal myocardial infarction (relative risk, 0.56; 95% CI, 0.35 to 0.89) and definite fatal CHD (relative risk, 0.89; 95% CI, 0.60 to 1.33) when compared with those who usually ate white bread. Men who ate beef at least three times each week had a higher risk of definite fatal CHD (relative risk, 2.31; 95% CI, 1.11 to 4.78), but this effect was not seen in women or for the nonfatal myocardial infarction end point. Our data strongly suggest that the frequent consumption of nuts may protect against risk of CHD events. The favorable fatty acid profile of many nuts is one possible explanation for such an effect.
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The authors examined the relation between low intakes of saturated fat and animal protein and risk of intraparenchymal hemorrhage in a 14-year prospective study (ending in 1997) of 4,775 Japanese aged 40-69 years who undertook a single 24-hour dietary recall. Compared with the highest quartile of energy-adjusted saturated fat intake (median, 17 g/day), multivariate relative risks, after adjustment for age, sex, community, total energy intake, and known cardiovascular risk factors, were 0.77 (95% confidence interval (CI): 0.42, 1.42) for the second quartile (12 g/day), 0.66 (95% CI: 0.34, 1.25) for the third quartile (8 g/day), and 0.30 (95% CI: 0.12, 0.71) for the lowest quartile (5 g/day); p for trend = 0.005. An inverse relation was observed among both hypertensives and nonhypertensives; the respective relative risks with a one standard deviation increase in saturated fat intake (15.4 g/day) were 0.72 (95% CI: 0.52, 1.00) and 0.36 (95% CI: 0.14, 0.95). Intake of animal protein tended to correlate inversely with risk; the relative risk with a one standard deviation increase in animal protein intake (17.6 g/day) was 0.79 (95% CI: 0.61, 1.02); p = 0.07. Results are similar to those recently reported for US women and together help to explain the high rate of this stroke subtype in Asian countries, where intakes of these nutrients are low.
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To support food security for current and future generations, there is a need to understand the relation between sustainable diets and the health of a population. In recent years, a number of studies have investigated and compared different dietary patterns to better understand which foods and eating patterns have less of an environmental impact while meeting nutritional needs and promoting health. This systematic review (SR) of population-level dietary patterns and food sustainability extends and updates the SR that was conducted by the 2015 US Dietary Guidelines Advisory Committee, an expert committee commissioned by the federal government to inform dietary guidance as it relates to the committee's original conclusions. In the original SR, 15 studies met the criteria for inclusion; since then, an additional 8 studies have been identified and included. The relations between dietary intake patterns and both health and environmental outcomes were compared across studies, with methodologies that included modeling, life cycle assessment, and land use analysis. Across studies, consistent evidence indicated that a dietary pattern higher in plant-based foods (e.g., vegetables, fruits, legumes, seeds, nuts, whole grains) and lower in animal-based foods (especially red meat), as well as lower in total energy, is both healthier and associated with a lesser impact on the environment. This dietary pattern differs from current average consumption patterns in the United States. Our updated SR confirms and strengthens the conclusions of the original US Dietary Guidelines Advisory Committee SR, which found that adherence to several well-characterized dietary patterns, including vegetarian (with variations) diets, dietary guidelines-related diets, Mediterranean-style diets, the Dietary Approaches to Stop Hypertension (DASH) diet, and other sustainable diet scenarios, promotes greater health and has a less negative impact on the environment than current average dietary intakes.
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Importance: Defining what represents a macronutritionally balanced diet remains an open question and a high priority in nutrition research. Although the amount of protein may have specific effects, from a broader dietary perspective, the choice of protein sources will inevitably influence other components of diet and may be a critical determinant for the health outcome. Objective: To examine the associations of animal and plant protein intake with the risk for mortality. Design, setting, and participants: This prospective cohort study of US health care professionals included 131 342 participants from the Nurses' Health Study (1980 to end of follow-up on June 1, 2012) and Health Professionals Follow-up Study (1986 to end of follow-up on January 31, 2012). Animal and plant protein intake was assessed by regularly updated validated food frequency questionnaires. Data were analyzed from June 20, 2014, to January 18, 2016. Main outcomes and measures: Hazard ratios (HRs) for all-cause and cause-specific mortality. Results: Of the 131 342 participants, 85 013 were women (64.7%) and 46 329 were men (35.3%) (mean [SD] age, 49 [9] years). The median protein intake, as assessed by percentage of energy, was 14% for animal protein (5th-95th percentile, 9%-22%) and 4% for plant protein (5th-95th percentile, 2%-6%). After adjusting for major lifestyle and dietary risk factors, animal protein intake was weakly associated with higher mortality, particularly cardiovascular mortality (HR, 1.08 per 10% energy increment; 95% CI, 1.01-1.16; P for trend = .04), whereas plant protein was associated with lower mortality (HR, 0.90 per 3% energy increment; 95% CI, 0.86-0.95; P for trend < .001). These associations were confined to participants with at least 1 unhealthy lifestyle factor based on smoking, heavy alcohol intake, overweight or obesity, and physical inactivity, but not evident among those without any of these risk factors. Replacing animal protein of various origins with plant protein was associated with lower mortality. In particular, the HRs for all-cause mortality were 0.66 (95% CI, 0.59-0.75) when 3% of energy from plant protein was substituted for an equivalent amount of protein from processed red meat, 0.88 (95% CI, 0.84-0.92) from unprocessed red meat, and 0.81 (95% CI, 0.75-0.88) from egg. Conclusions and relevance: High animal protein intake was positively associated with mortality and high plant protein intake was inversely associated with mortality, especially among individuals with at least 1 lifestyle risk factor. Substitution of plant protein for animal protein, especially that from processed red meat, was associated with lower mortality, suggesting the importance of protein source.
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Large observational epidemiologic studies and randomized trials support the benefits of a Mediterranean dietary pattern on cardiovascular disease (CVD). Mechanisms postulated to mediate these benefits include the reduction of low-grade inflammation, increased adiponectin concentrations, decreased blood coagulation, enhanced endothelial function, lower oxidative stress, lower concentrations of oxidized LDL, and improved apolipoprotein profiles. However, the metabolic pathways through which the Mediterranean diet influences CVD risk remain largely unknown. Investigating specific mechanisms in the context of a large intervention trial with the use of high-throughput metabolomic profiling will provide more solid public health messages and may help to identify key molecular targets for more effective prevention and management of CVD. Although metabolomics is not without its limitations, the techniques allow for an assessment of thousands of metabolites, providing wide-ranging profiling of small molecules related to biological status. Specific candidate plasma metabolites that may be associated with CVD include branched-chain and aromatic amino acids; the glutamine-to-glutamate ratio; some short- to medium-chain acylcarnitines; gut flora metabolites (choline, betaine, and trimethylamine N-oxide); urea cycle metabolites (citrulline and ornithine); and specific lipid subclasses. In addition to targeted metabolites, the role of a large number of untargeted metabolites should also be assessed. Large intervention trials with the use of food patterns for the prevention of CVD provide an unparalleled opportunity to examine the effects of these interventions on plasma concentrations of specific metabolites and determine whether such changes mediate the benefits of the dietary interventions on CVD risk.