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Vegetarian Dietary Patterns and Cardiovascular Disease
Abstract
Cardiovascular (CV) disease (CVD) is the leading global cause of mortality, being responsible for 46% of non-communicable disease deaths. It has been estimated that about 85.6 million Americans are living with some form of CVD, which continues to rise. Healthy lifestyle choices may reduce the risk of myocardial infarction by >80%, with nutrition playing a key role. Vegetarian dietary patterns reduce CVD mortality and the risk of coronary heart disease (CHD) by 40%. Plant-based diets are the only dietary pattern to have shown reversal of CHD. Additionally, evidence suggests benefits of vegetarian dietary patterns in both the prevention and the treatment of heart failure and cerebrovascular disease. Plant-based diets are associated with lower blood pressure, lower blood lipids, and reduced platelet aggregation than non-vegetarian diets and are beneficial in weight management, reduce the risk of developing metabolic syndrome, and type 2 diabetes. They have also been shown an effective treatment method in diabetes management. Well planned vegetarian diets provide benefits in preventing and reversing atherosclerosis and in decreasing CVD risk factors and should be promoted through dietary guidelines and recommendations.
... These dietary habits contribute to the reduction of cardiovascular disease risks such as hypertension, hypercholesterolemia, and obesity (5,6). Although the MD is wellestablished, other dietary patterns have gained popularity (7,8), and their health impacts are currently the subject of various studies (9)(10)(11)(12)(13)(14)(15)(16)(17). The most noticeable are the plant-based diets (PBD) (18,19), which include a range of different diets characterized by reduced animalbased food consumption (20). ...
... The most noticeable are the plant-based diets (PBD) (18,19), which include a range of different diets characterized by reduced animalbased food consumption (20). PBDs have gained popularity for their perceived health benefits (9)(10)(11)17), environmental sustainability (21,22), and ethical considerations (23). ...
... Depending on individual philosophies and goals (26), the RD may include fruits, vegetables, nuts, seeds, eggs, fish, meat, and dairy, often excluding pasteurized or processed foods (27). While vegetarian and vegan diets have been widely studied (9)(10)(11)17), there is limited research on the RD in humans compared to animals (28,29), highlighting the need for further investigation. ...
Background
Although Spain has traditionally followed the Mediterranean diet, in recent years, changes have become noticeable in the food preferences of the population. These changes include adopting new diets and dietary trends, such as plant-based diets, intermittent fasting and raw food diets. These choices are influenced by cultural, social and socio-demographic factors, and their impact on health should be studied in detail.
Aim
The objectives of this research are: (1) to study the prevalence of different dietary patterns among the Spanish population, (2) to explore the dependence of dietary choice on socio-demographic factors, (3) to investigate the relationship between the social habits and lifestyle choices of the population and how it affects health.
Methods
A descriptive cross-sectional study was carried out on the Spanish population. Using a questionnaire constructed and validated by the research team, socio-demographic data were collected and different nutritional, social and lifestyle habits of the targeted population were explored.
Results
A valid sample of 22,181 people was collected among which 17,573 (79.2%) people claimed to follow a Mediterranean dietary pattern, 1,425 (6.4%) people followed a plant-based diet, 365 (1.6%) people are vegans, 1,018 people (4.6%) practiced intermittent fasting, 252 (1.1%) people followed a raw food diet and 1,548 people (7%) claimed to follow other types of diets. The data show that younger people (18–25 years old) tend to adopt more often a plant-based diet than older people and that women tend to follow this type of diet more often than men. On the other hand, men seem to practice intermittent fasting more frequently. A higher tendency to practice a raw food diet was found among people living in villages than those living in cities. Moreover, some trends were found in different regions of Spain, with greater adherence to a plant-based diet in Catalonia, while intermittent fasting is more common in the Region of Murcia. Finally, the results indicate that individuals who pay attention to their diet and experiment with various dietary patterns are generally more health-conscious. This is reflected in their adoption of healthier behaviors, such as exercising more and reducing their intake of alcohol and sugary drinks.
... A plant-based diet has been shown to be an effective means of improving plasma lipid profile and reducing the incidence of hypertension, ischemic heart disease, stroke, metabolic syndrome, and diabetes (32)(33)(34)(35)(36). Atherosclerotic cardiovascular disease (ASCVD) is defined as atherosclerotic vascular disease, which mainly includes coronary atherosclerotic heart disease, ischemic stroke, etc. ...
... A plant-based diet has been shown to be an effective means of improving plasma lipid profile and reducing the incidence of hypertension, ischemic heart disease, stroke, metabolic syndrome, and diabetes (32)(33)(34)(35)(36). Atherosclerotic cardiovascular disease (ASCVD) is defined as atherosclerotic vascular disease, which mainly includes coronary atherosclerotic heart disease, ischemic stroke, etc. It remains the leading cause of death worldwide, and a well-planned plant-based diet offers benefits in preventing and reversing atherosclerosis and reducing risk factors for ASCVD (7,34,37). Risk factors for ASCVD primarily include hyperlipidemia, hypertension, diabetes, obesity, etc. The American Heart Association/American College of Cardiology (AHA/ACC) has issued dietary recommendations, including the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet and the vegetarian diet, which help to fulfill the AHA/ACC guidelines. ...
... They also show effects on the prevention and treatment of cerebrovascular disease. A plant-based diet is also associated with lower blood lipid levels and lower blood pressure and may reduce the risk of type 2 diabetes (7,34). Dinu M et al. concluded that the risk of ischemic heart disease incidence and/ or mortality is lower in vegetarians and vegans compared to omnivores (RR 0.75, 95% CI: 0.68 to 0.82) (32). ...
Introduction
The association between a plant-based diet and weight loss and atherosclerotic cardiovascular disease (ASCVD) has not been fully elucidated. We performed a pooled analysis and Mendelian randomization (MR) analysis to investigate this question.
Methods
We searched for randomized controlled trials on the effects of a plant-based diet on weight loss compared with a non-plant-based diet. In addition, a two-sample MR study was conducted. IVs were obtained from the genome-wide association studies (GWAS) on the exposures, and we obtained summary statistics on the outcomes. The inverse-variance weighted (IVW) method was used as the main analysis and other MR methods were performed as supplementary analyses.
Results
Individuals on the plant-based diet lost more weight than the non-plant-based diet group (WMD −0.96 kg; 95% CI: −1.32 to −0.60). Population conditions and energy restriction were identified as the study-level factors that influenced the pooling results in the subgroup analyses. Increased consumption of raw vegetables was significantly associated with lower BMI (IVW, β −0.35, 95% CI: −0.62 to −0.08, p = 0.012) and lower risk of obesity (IVW, OR 0.11, 95% CI: 0.01 to 0.99, p = 0.048), coronary heart disease (IVW, OR 0.44, 95% CI: 0.21 to 0.92, p = 0.029) and myocardial infarction (IVW, OR 0.39,95% CI: 0.15 to 0.98, p = 0.045) and a higher HDL-C (IVW, β 0.47, 95% CI: 0.24 to 0.70, p = 4×10⁻⁵).
Discussion
The present findings suggest that raw vegetable intake is beneficial for weight loss and prevention of ASCVD.
... A vegetarian diet lowers the threat of Coronary Heart Disease (CHD) and Cardiovascular Disease (CVD) death by 40 %. (11) Programs and research centered on food and lifestyle choices, as well as chronic illnesses like type 2 diabetes mellitus (T2DM), are becoming more and more necessary due to rising disease burden and prevalence. In a randomized forced trial, the impact of a 6-month web-based diet involvement on Fasting Blood Glucose (FBG), glycosylated hemoglobin (HbA1c), Dietary Knowledge, Attitude and Behaviour (DKAB), Dietary Stages of Change (DSOC), and patients with uncontrolled HbA1c (> 7,0 %) were assessed. ...
... The probability value represented, by the mathematical equation, decreases linearly from 1 to 0, and Ob j ensures a gradual transition from broad treatment exploration to focused refinement for improved patient outcomes. Finally, to maintain a balance between adaptive exploration of different treatment techniques and targeted intervention (exploitation) the adjustment and reevaluation stages of the therapy process are randomly switched based on the following equation (11). ⃗⃗⃗ , ℎ (12) Where, Ob 2 the mathematical equation represents a predefined value within the range [0, 1] to determine the probability of selecting a targeted treatment adjustment within the optimization process. ...
Personalized health diets play a crucial role in infection management by tailoring diet recommendation systems to routine data, genetic factors, and specific medical conditions. Research introduces the Intelligent Nutcracker Optimized Effective Decision Tree (INO-EDT) model, designed to provide individualized nutritional guidance for managing chronic illnesses, particularly diabetes and heart disease. Medical files, questionnaires, wearable devices, and food journals serve as sources of patient data standardization and cleaning to ensure accuracy and stability. Machine Learning (ML) techniques analyze individual patient profiles to develop personalized nutrition plans that are effective, sustainable, and adaptable. The INO-EDT model incorporates a nutcracker-inspired optimization technique to enhance decision tree accuracy, fine-tuning diet recommendations based on patient-specific factors. This optimization ensures proper diet interventions with enhanced efficacy of dietary interventions in disease organization. The outcome confirms that the INO-EDT model was more accurate (98.40%), demonstrating its ability to generate proper, data-backed dietary advice. By optimizing personalized nutritional interventions, the INO-EDT model enables healthcare providers to offer more effective, patient-centered solutions, reducing complications connected with chronic diseases. This approach enhances patient outcomes by integrating intellectual algorithms that consider multiple health parameters to create a customized diet strategy. The results highlight the potential of AI-driven dietary recommendation systems in enhancing disease management, improving adherence to medical diet systems, and elevating overall quality of life. Future research will aim to expand the model's capabilities by integrating additional health markers for broader clinical applications.
... 4,10 Other proposed mechanisms include increased insulin sensitivity, improved gastrointestinal hormone response, lower oxidative stress, endothelial disfunction and inflammation. 17,[26][27][28] Some recent studies have also hypothesized that changes in the gut microbiome induced by the diet may play a role. 4,[28][29][30] Unfortunately, despite the body of evidence supporting the several health benefits of plant-based diets, these are often perceived to be too extreme, difficult, and unacceptable. ...
... 17,[26][27][28] Some recent studies have also hypothesized that changes in the gut microbiome induced by the diet may play a role. 4,[28][29][30] Unfortunately, despite the body of evidence supporting the several health benefits of plant-based diets, these are often perceived to be too extreme, difficult, and unacceptable. 31,32 Health care providers frequently assume their patients will be unwilling to adopt such diets. ...
... Vegetarian-style dietary patterns are typically low in saturated fats and cholesterol while providing health-promoting foods rich in fiber, antioxidants, and phytochemicals. These dietary attributes are key factors in maintaining cardiovascular health, including improved lipid profiles, blood pressure (BP) regulation, enhancing endothelial function, inflammation control, as well as contributing to a diverse microbiome [9][10][11][12]. However, a poorly planned vegetarian-style dietary pattern can limit specific nutrients such as vitamin B12, iron, and calcium or include an excess of refined carbohydrates, added sugar, or saturated fat which can contribute to increased CVD risk [7,13,14]. ...
... There is robust evidence supporting vegetarian and vegan dietary patterns to promote cardiometabolic health [9,10,13]. Individuals may choose to adopt a vegetarian-style dietary pattern for a variety of reasons, including ethical concerns for the treatment of animals and protection of the environment, mitigation of green-house gas emissions, and to therapeutically manage or lower the risk of several chronic diseases [52,53]. Similar to other dietary patterns, vegetarian dietary patterns can be followed in healthy and less healthy ways [14]. ...
Background
Diet significantly influences the risk of developing cardiovascular disease (CVD), the leading cause of death in the United States. As vegetarian dietary patterns are increasingly being included within clinical practice guidelines, there is a need to review the most recent evidence regarding if and how these dietary patterns mitigate CVD risk.
Objective
This umbrella review of systematic reviews compared the relationships between vegetarian, vegan and non-vegetarian dietary patterns and CVD health outcomes and risk factors among presumably healthy adults (≥18 years) in the general population.
Methods
MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, Food Science Source and SportsDiscus databases were searched for systematic reviews (SRs) published from 2018 until March 2024. Eligible SRs and meta-analyses examined relationships between vegetarian or vegan diets and CVD risk factors and disease outcomes compared to non-vegetarian diets. SRs were screened in duplicate, and SR quality was assessed with AMSTAR2. The overall certainty of evidence (COE) was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) method.
Results
There were 758 articles identified in the databases’ search and 21 SRs met inclusion criteria. SRs targeting the general population had primarily observational evidence. Vegetarian, including vegan, dietary patterns were associated with reduced risk for CVD incidence [Relative Risk: 0.85 (0.79, 0.92)] and CVD mortality [Hazard Ratio: 0.92 (0.85, 0.99)] compared to non-vegetarian diets. Vegan dietary patterns were associated with reductions in CVD risk factors including blood pressure [systolic mean difference (95 % CI): -2.56 mmHg (-4.66, -0.445)], low-density lipoprotein cholesterol [-0.49 mmol/l (-0.62, -0.36)], and body mass index [-1.72 kg/m² (-2.30, -1.16)] compared to non-vegetarian dietary patterns, as well as c-reactive protein concentrations in a novel meta-analysis [-0.55 mg/l (-1.07, -0.03)].
Conclusion
Practitioners can consider recommending vegetarian dietary patterns to reduce cardiometabolic risk factors and risk of CVD incidence and mortality.
... Cardiovascular disease (CVD) represents the most significant cause of mortality and morbidity worldwide, accounting for 32.9% of non-communicable diseaserelated deaths globally and approximately 18 million deaths annually [1][2][3]. The number of deaths from CVD increased by approximately 19% between 2010 and 2020 on a global scale. ...
Objective
The objective is to evaluate the temporal trends in the burden of cardiovascular diseases attributable to metabolic risk factors from 1990 to 2021 and to project the burden over the subsequent 30 years.
Methods
A joinpoint regression model was employed to estimate the annual percentage change in cardiovascular disease mortality attributable to metabolic risk factors, utilizing data from the Global Burden of Disease (GBD) 2021. An age-period-cohort analysis was conducted to evaluate the effects of age, period, and cohort. A frontier analysis was employed to investigate the correlation between the prevalence of cardiovascular disease attributable to metabolic risk factors and socio-demographic trends. An autoregressive integrated moving average (ARIMA) model was subsequently constructed to forecast future cardiovascular disease burden.
Results
Between 1990 and 2021, the global age-standardized mortality rate (ASMR) of cardiovascular diseases attributable to metabolic factors exhibited a consistent decline (Average Annual Percent Change (AAPC) = -1.28, 95% CI [-1.42, -1.14], P < 0.01). However, the absolute number of deaths increased from 8.326 million to 13.595 million. The most substantial reduction in ASMR was observed in the High Socio-Demographic Index (SDI) region (AAPC = -2.98, 95% CI [-3.10, -2.86], P < 0.01), whereas the reductions were relatively smaller in the Low-middle SDI and Low SDI regions. The ARIMA model predicts a decline in global cardiovascular disease mortality over the next three decades, with the most pronounced decrease anticipated in the high-middle SDI region and smaller declines expected in the middle SDI and low SDI regions.
Conclusion
Notwithstanding a global decline in age-standardized mortality and disability-adjusted life year (DALY) rates, the burden of cardiovascular diseases attributable to metabolic factors remains significant worldwide. Targeted interventions must be implemented without delay, particularly for males and populations in low and middle SDI regions, to mitigate the impact of metabolic factors on public health.
... Despite a lower n-3 PUFA status among vegans and vegetarians, these diets do not result in a deterioration of the inflammatory profile in comparison to omnivores. This is in line with the fact that plant-based diets are discussed to prevent or counteract inflammatory state underlying numerous chronic diseases [70,71]. Previous meta-analyses have also indicated that plant-based diets are associated with lower hsCRP levels compared to meat-based diets, while no significant effects were observed for the markers IL-6, TNF-α, and adiponectin [72][73][74]. ...
Background
Different dietary choices can influence blood fatty acid profiles, which are crucial for maintaining physiological health and reducing disease risk. In particular, the exclusion of animal foods in vegetarian diets is associated with a higher risk of undersupply of long-chain omega (n)-3 fatty acids, which could, potentially, have a negative effect on inflammation. This study aimed to examine differences in plasma and erythrocyte fatty acid profiles as well as inflammation-related biomarkers between various plant-based diets and a regular omnivores diet.
Methods
The Nutritional Evaluation (NuEva) study is a is a parallel-designed trial. Here screening data was used to investigate differences in plasma and erythrocyte fatty acid profiles across omnivores (Western diet; n = 62), flexitarians (n = 69), vegetarians (n = 64) and vegans (n = 57). Furthermore, markers associated with inflammation are investigated and correlated with selected fatty acids.
Results
Flexitarians showed lower erythrocyte saturated fatty acids (SFA) than omnivores, while vegans had the lowest plasma SFA. Vegans had higher erythrocyte monounsaturated fatty acids proportions, like oleic acid, than flexitarians and vegetarians. n-6 fatty acids, particularly linoleic acid, were highest in vegans and vegetarians. Conversely, omnivores had higher arachidonic acid in erythrocytes. Vegans had lower n-3 fatty acids in both plasma and erythrocytes, also reflected in a lower n-3 index (eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA)) values, indicating a trend with restriction of animal foods: omnivores/flexitarians > vegetarians > vegans. While interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-α and high-sensitive C-reactive protein (hsCRP) did not differ between groups, and vegans had lower leptin levels compared to omnivores.
Conclusions
The NuEva study revealed significant impact of dietary patterns on fatty acid profiles, with vegans and vegetarians displaying lower concentrations of SFA and n-3 fatty acids, including EPA and DHA, compared to omnivores and flexitarians. Despite the clear differences in fatty acid profiles across the diets, the inflammatory markers measured in our healthy collective are comparable.
Trial registration
Registered under ClinicalTrials.gov Identifier no. NCT03582020.
... A vegan diet may have a beneficial effect on human health by reducing the risk of diseases like cardiovascular diseases, type 2 diabetes, and some cancers [3,4]. Approximately 1.5 % of the population in the Netherlands follows a vegan diet [5]. ...
... A progressive transition to plant-based diets emerges as the most effective strategy to (i) mitigate the environmental impact of the global food systems [10,19,59] and (ii) provide nutritional benefits [45,54]. Appropriately planned and supplemented vegan and vegetarian diets are nutritionally adequate for individuals in all stages of life and may provide health benefits in disease prevention [30,65]. In contrast, the consumption of animal-based meals is a core driver of large shares of carbon emissions [28,67] and has been associated with between 3% to 7% higher risk of cardiovascular disease and mortality from all causes [41,49,68]. ...
Reducing meat consumption is crucial for achieving global environmental and nutritional targets. Meat-Free Day (MFD) is a widely adopted strategy to address this challenge by encouraging plant-based diets through the removal of animal-based meals. We assessed the environmental, behavioral, and nutritional impacts of MFD by implementing 67 MFDs over 18 months (once a week on a randomly chosen day) across 12 cafeterias on a large university campus, analyzing over 400,000 food purchases. MFD reduced on-campus food-related greenhouse gas (GHG) emissions on treated days by 52.9% and contributed to improved fiber (+26.9%) and cholesterol (-4.5%) consumption without altering caloric intake. These nutritional benefits were, however, accompanied by a 27.6% decrease in protein intake and a 34.2% increase in sugar consumption. Moreover, the increase in plant-based meals did not carry over to subsequent days, as evidenced by a 3.5% rebound in animal-based meal consumption on days immediately following treated days. MFD also led to a 16.8% drop in on-campus meal sales on treated days.Monte Carlo simulations suggest that if 8.7% of diners were to eat burgers off-campus on treated days, MFD's GHG savings would be fully negated. As our analysis identifies on-campus customer retention as the main challenge to MFD effectiveness, we recommend combining MFD with customer retention interventions to ensure environmental and nutritional benefits.
... [8] An improved lipid profile, including LDL reduction, and reduces the risk of atherosclerosis, metabolic syndrome and cardiovascular and cerebrovascular incidents. [9] Furthermore, this diet increases insulin sensitivity, which reduces the risk of diabetes, however, the type of food that should be eaten while following this diet is crucial to achieving therapeutic effects [10]. A wide range of evidence points to a link between the consumption of specific plant products, such as fruit and vegetables, and a reduced risk of cancer diagnosis and recurrence. ...
Introduction and Purpose of Research: Vegetarianism, characterized by the exclusion of meat, poultry, fish, seafood, and their derivatives, has gained popularity as studies continue to highlight its positive impact on health. This study aims to comprehensively evaluate the health and lifestyle impacts of vegetarian diets by examining both the benefits and potential risks. Review Methods: The review is grounded in findings from 40 recent studies sourced through a systematic search of open-access databases, including PubMed and Google Scholar, focusing on literature published between 2000 and 2024. Abbreviated description of the state of knowledge: Vegetarian diets are associated with significant health benefits, including reduced risks of chronic diseases such as heart disease, type 2 diabetes, and obesity, largely due to their high content of fiber, antioxidants, and healthy fats. Additionally, vegetarians tend to have lower BMI and improved cholesterol and blood pressure levels. However, unbalanced vegetarian diets may lead to deficiencies in essential nutrients such as protein, vitamin B12, iron, zinc, and omega-3 fatty acids, which can impact overall health. Conclusion: Properly planned vegetarian diets are healthy, nutritionally correct and can be beneficial in the prevention and treatment of certain diseases. Careful selection of meal ingredients and adequate supplementation are key to maximising the benefits and counteracting the potential risks associated with such diets.
... Yet by the late 20 th century, empirical support for the health benefits of vegetarianism increased, and research suggested that the avoidance of meat-especially red meat (beef)-could be used to prevent or treat disease (Key et al., 1999;Singh et al., 2003;Viguiliouk et al., 2019;Kahleova et al., 2018;Tong et al., 2019). Additionally, epidemiologic studies showed that the mortality and morbidity of vegetarians compared positively with the general population (Appleby and Key, 2016;. ...
Background
Over the past two decades, there has been an increase in the prevalence of psychological conditions, such as depression, anxiety, disordered eating, and body image disturbances. In concert with this trend, there was a substantial rise in the advocacy and practice of restrictive dietary patterns, such as veganism and vegetarianism. These parallel developments suggest a relation between diet and mental health, but to date, research has failed to offer clear answers on whether these associations are causal, coincidental, or more complex than superficial analyses suggest.
Aim
Given this context, the purpose of this commentary is to offer a consilient perspective on the role of vegan and vegetarian diets in mental health.
Methods
We performed a broad qualitative synthesis of the current literature on diet and mental health from sociologic and psychologic perspectives.
Results
Several empirically supported hypotheses were presented with equivocal support.
Conclusion
The current evidence suggests that if a nutritionally adequate diet is consumed, the avoidance/consumption of meat and other animal foods will have no significant effects on physical and mental health.
... Plant-based diets are rich in nutrients beneficial for overall health [4][5][6][7][8] but typically do not provide sufficient calories to meet the energy requirements of some individuals. This can result in a lower BMI and potentially increase the risk of reduced bone density, osteopenia, and osteoporosis. ...
The vegetarian tradition has very ancient origins. This type of nutritional pattern first “appeared” in the countries of the Far East. Switching from the typical modern Western diet to a vegetarian diet offers benefits, but this does not necessarily mean that such a diet can be considered “ideal” for all aspects of individual health. Thus, while a vegetarian/vegan diet plays a significant role in optimizing several specific issues related to metabolic and chronic disorders, there are controversial data regarding its potential risks to bone tissue. Thus, this review examines the potential issues associated with this type of nutritional pattern and bone health. KEYWORDS Skeleton, vegetarian, vegan, protein, minerals.
... An unhealthy diet is one of the leading preventable causes of death and disability globally [1]. Adherence to healthy dietary patterns such as vegetarian and Mediterranean diets are associated with a lower risk of all-cause and cause-specific mortality [2,3]. In addition, emerging evidence revealed that inflammation plays crucial roles in the development of CVDs. ...
Purpose
Balanced dietary patterns, sufficient physical activity, and other healthy lifestyle behaviors are increasingly recognized as a complimentary strategy for the prevention of cardiovascular disease (CVD). We aim to explore the joint association of anti-inflammatory diet and vigorous leisure-time physical activity (LTPA) on all-cause and CVD mortality.
Methods
This retrospective cohort study included 16,068 adults from the National Health and Nutrition Examination Survey (2007–2014). Participants were categorized into four lifestyle patterns based on the inflammatory properties of the diet and the degree of vigorous LTPA: pro-inflammatory diet and insufficient vigorous LTPA (pattern 1), anti-inflammatory diet and insufficient vigorous LTPA (pattern 2), pro-inflammatory diet and sufficient vigorous LTPA (pattern 3), anti-inflammatory diet and sufficient vigorous LTPA (pattern 4). Multivariable Cox proportional hazards models were used to estimate the hazards ratio (HR) and 95% confidence intervals (CI).
Results
Compared to pattern 1, pattern 4 showed an obvious lower risk of all-cause (HR, 0.51; 95% CI 0.32–0.81) and CVD mortality (HR, 0.31; 95% CI 0.12–0.80). In addition, pattern 2 also had a significantly decreased all-cause (0.80; 0.69–0.92) and CVD mortality risk (0.71; 0.53–0.95). However, t there was no significant reduction in all‐cause mortality (0.75; 0.54–1.06) and CVD mortality (0.60; 0.32–1.13) among pattern 3. Consistent results were obtained in subgroup and sensitivity analyses.
Conclusion
Adhering to the anti-inflammatory diet and sufficient vigorous LTPA was associated with lowest all-cause and CVD mortality. Anti-inflammatory diet can counteract the hazards caused by insufficient vigorous LTPA, while sufficient vigorous LTPA fails to offset the detrimental effect of pro-inflammatory diet.
... Some epidemiological studies [10,11] have directly linked dietary patterns to CVD events in different populations. For instance, the Mediterranean diet has been shown to reduce the risk of CVD in randomized clinical trials (RCTs) [12]; a Western diet high in ultra-processed foods is associated with a higher risk of coronary heart disease (CHD) [13]; a vegetarian diet can reduce CVD and CHD mortality by 40% [14]; and the dietary approach to stop hypertension (DASH) diet has been proven to significantly lower blood pressure in hypertensive individuals in the United States [15]. Additionally, some investigations showed that incorporating certain foods into one's diet can be highly beneficial for cardiovascular health. ...
Background
Dietary choices are inextricably linked to the incidence of cardiovascular disease (CVD), whereas an optimal dietary pattern to minimize CVD morbidity in high-risk subjects remains challenging.
Methods
We comprehensively assessed the relationship between food consumption frequencies and CVD in 28,979 high-risk subjects. The outcome was defined as the composite of the incidence of major CVD events, including coronary heart disease and stroke. Risk factors associated with CVD were screened through a shrinkage approach, specifically least absolute shrinkage and selection operator (LASSO) regression. Hazard ratios (HRs) for various dietary consumption frequencies were assessed using multivariable Cox frailty models with random intercepts.
Results
Increased egg and seafood consumption were associated with a lower risk of CVD (daily vs little, HR 1.70, 95% confidence interval, CI: 0.79–3.64, ptrend = 0.0073 and HR 1.86, 95% CI: 1.24–2.81, ptrend = 0.024, respectively). 6 non-food (age, sex, smoke, location, heart ratio, and systolic blood pressure) and 3 food (fruit, egg, and seafood) related risk factors were included in the nomogram to predict 3 and 5-year incidence of CVD. The concordance indexes of the training and validation cohorts were 0.733 (95% CI: 0.725–0.741) and 0.705 (95% CI: 0.693–0.717), respectively. The nomogram was validated using the calibration and time-dependent receiver operating characteristic curves, demonstrating respectable accuracy and discrimination.
Conclusions
Guided by the concept of “food as medicine”, this nomogram could provide dietary guidance and prognostic prediction for high cardiac risk subjects in CVD prevention.
... The vegetarian diet includes a variety of eating patterns: from diets that omit all animal meats and products (vegan) to diets that contain eggs, milk, and milk products (lacto-ovo vegetarian) or even fish, in addition to eggs, milk, and milk products (pesco-vegetarian) [46]. Recent studies have shown the benefits of adhering to this diet, such as weight loss and reducing the risk of metabolic diseases such as CVD and T2DM [46][47][48]. The results of a systematic review of several clinical trials showed that adherence to this diet can improve the lipid profile by reducing TC and LDL-C levels. ...
Dyslipidemia is defined as an imbalance in the blood lipid profile that can cause many metabolic diseases. Several clinical studies in the past have proven the importance of a proper diet in the prevention and treatment of dyslipidemia. However, the relationship between consumption of a single food like red meat or whole grain with the occurrence of dyslipidemia has been well investigated. But considering the cumulative effect of food patterns can indicate a better image of the relationship between daily food intake and dyslipidemia. It has been proven that following diets like the dietary approach to stop hypertension (DASH) diet and the Mediterranean diet (MD) have been associated with a reduction in inflammatory and lipid markers. In recent years, a new diet based on observing the food pattern of the ancestors and early humans, called the Paleolithic diet (PD), has been researched. The PD is categorized as low-carbohydrate and high-fat diet. It is thought that through increasing ketone bodies and suppressing appetite, it reduces the incidence of metabolic diseases. Studies have also been conducted to find out the relationship between PD and dyslipidemia. Therefore, we decided to collect the results of some of them in this chapter.
... However, it should be noted that five interventional studies (Portfolio diet) were relatively short in duration (one month), so the longer-term effects of this dietary pattern and others need to be established in future trials that also include other populations. As shown in Figure 3, other diets, including the vegetarian diet (Kahleova, Levin, and Barnard 2018) and the Nordic diet (Massara et al. 2022), have also been described as having beneficial effects on lowering blood lipids a meta-analysis of 11 trials 832 participants aged 28.0-56.2 years the effectiveness of vegetarian diets on blood lipids (total cholesterol, ldl-C, Hdl-C, and tG). ...
Cardiovascular disease (CVD) is one of the leading causes of death globally, and vascular calcification (VC) has been recognized as an independent and strong predictor of global CVD and mortality. Chronic inflammation has been demonstrated to play a significant role in the progression of VC. This review aims to summarize the literature that aimed to elucidate the associations between dietary inflammation (DI) and VC as well as to explore the mechanisms underlying the association and discuss strategies (including dietary interventions) to prevent VC. Notably, diets rich in processed foods, carbohydrates with high glycemic index/load, saturated fatty acids, trans-fatty acids, cholesterol, and phosphorus were found to induce inflammatory responses and accelerate the progression of VC, indicating a close relationship between DI and VC. Moreover, we demonstrate that an imbalance in the composition of the gut microbiota caused by the intake of specific dietary choices favored the production of certain metabolites that may contribute to the progression of VC. The release of inflammatory and adhesion cytokines, activation of inflammatory pathways, oxidative stress, and metabolic disorders were noted to be the main mechanisms through which DI induced VC. To reduce and slow the progression of VC, emphasis should be placed on the intake of diets rich in omega-3 fatty acids, dietary fiber, Mg, Zn, and polyphenols, as well as the adjustment of dietary pattern to reduce the risk of VC. This review is expected to be useful for guiding future research on the interplay between DI and VC.
... As EC survivors are more likely to die from CVD than EC, it is of high importance that survivorship is optimised through identification and management of chronic disease risk factors such as hyperlipidaemia, high weight, and hyperglycaemia. 9 Nutrition care and dietary modification are the cornerstones of CVD prevention and management.24 Increasing access to consistently available and relevant (ie, EC and CVD focused) nutrition and wellbeing advice is needed to support the management of chronic disease risk factors for people who have survived EC. ...
Aims
The aim was to explore Endometrial cancer (EC) survivors' experiences of being offered nutrition and well‐being advice.
Methods
This qualitative study was conducted at two tertiary centres in Aotearoa New Zealand. Semi‐structured conversations with people who had completed treatment for EC in the past 12 months were undertaken to explore how they were offered nutrition and well‐being advice as part of standard follow‐up care. Interviews were analysed using reflexive thematic analysis.
Results
Fifteen people of Pacific, Māori and European ethnicity participated. Five themes were derived: (i) isolation and vulnerability, (ii) importance of language, (iii) inconsistent availability and relevance of nutrition and well‐being information, (iv) competing priorities and influences and (v) holistic and culturally responsive support. People often experienced judgement associated with their weight as part of their care, with limited understanding of their lived realities. Nutrition and well‐being advice was not widely available or accessible, and people had to explicitly ask for it. Social and environmental factors were barriers to making changes to health behaviours. A need for culturally safe holistic care was identified.
Conclusion
Enhancing survivorship after EC is ultimately premised on providing culturally safe and responsive care. Expanding workforce training in communication around high weight as well as education and self‐assessment of cultural safety could enable aspects of this. A holistic care program could facilitate wider access to nutrition and well‐being advice and better meet the needs of this population.
... Nutritionally, black-eyed peas are laden with both soluble and insoluble dietary fibres, essential minerals, vitamins, particularly those of the B group, and other beneficial compounds such as phenolic acids that are known for their antioxidant properties [21]. These components are crucial not only for general health but also offer preventive benefits against chronic diseases such as cardiovascular diseases, hypercholesterolemia, obesity, diabetes, and various cancers due to their bioactive compounds [22][23][24][25][26][27]. ...
Incorporating plant-based ingredients as meat substitutes can be a strategy to reformulate healthier and more environmentally sustainable meat products. However, meat species variations could lead to different physicochemical and sensory characteristics of the final products. This study aimed to evaluate the physicochemical, sensory, and microstructural properties of patties made from different meat species [chicken (CB), beef (BEB), mutton (MB), and buffalo (BFB)] and substituted with 50% black-eyed peas compared to 100% black-eyed peas (BEP) as the control. An array of physicochemical properties was evaluated, encompassing cooking yield, shrinkage, water holding capacity (WHC), pH, proximate composition, texture, gel strength, and colour. Furthermore, scanning electron microscopy and sensory evaluation were employed to elucidate the microstructural modifications and sensory attributes of the samples. The results reveal significant differences in proximate composition, WHC, and textural properties across the meat species. CB exhibited a higher lightness, cooking yield and softer texture than other samples, which displayed better water retention. Whereas BEB and BFP were harder and chewier. The BEB resulted in lower gel strength and less intact structure, as evidenced by microstructure images and texture profile analysis (TPA) results. No significant difference in sensory traits exists between different meat species. Despite the overall acceptability of BEB being the highest, the MB was the lowest. The composition, texture, and sensory features of chicken and beef with the incorporation of BEP make them viable candidates for use in the development of healthy patties.
... While in low-income countries food access is often limited due to disadvantageous socio-economic conditions, high-income countries are nowadays frequently characterized by an excess supply of low-quality, energy-dense foods. The use of highly processed foodstuffs and poor dietary habits favor the onset of non-communicable chronic diseases, which could be largely prevented by adopting a plant-based diet (2,3). At the same time, countries with a rapid urbanization trend are adopting an increasingly Westernized diet with a prevalence of meat-based food options which poses strong health risks and an ecological impact that is not sustainable (4,5). ...
... Известни са няколко варианта на вегетарианство, като всички те консумират предимно продукти на растителна основа. Кохортните данни показват, че диетите с ниско съдържание на мазнини, обогатени с плодове, зеленчуци и фибри, могат да доведат до намаляване на рисковите фактори за коронарни сърдечни заболявания, по-добър липиден профил и понижаване на кръвното налягане (Berkow&Barnard, 2005; Kahleova et al., 2018). Освен това изглежда, че вегетарианските диети предотвратяват развитието на рак и диабет тип 2 (Lee& Park, 2017). ...
... While light exposure is the predominant zeitgeber, food intake also entrains the circadian system, and research shows that metabolic health is influenced not just by the quantity and quality of dietary intake, but also by the timing, regularity, and energy distribution of eating occasions in the 24 h day and across days [3,4]. Indeed, aspects of chrononutrition, stemming from environmental, cultural, and physiological factors as well as personal preference and lifestyle choices that alter eating behaviors, have been linked to the etiology of CVD, type 2 diabetes, metabolic syndrome, hypertension, and obesity [5]. ...
Chrononutrition is a rapidly evolving field of nutritional epidemiology that addresses the complex relationship between temporal eating patterns, circadian rhythms, and metabolic health, but most prior research has focused on the cardiometabolic consequences of time-restricted feeding and intermittent fasting. The purpose of this topical review is to summarize epidemiological evidence from observational and intervention studies regarding the role of chrononutrition metrics related to eating timing and regularity in cardiometabolic health preservation and cardiovascular disease prevention. Observational studies are limited due to the lack of time-stamped diet data in most population-based studies. Findings from cohort studies generally indicate that breakfast skipping or the later timing of the first eating occasion, a later lunch and dinner, and a greater proportion of caloric intake consumed in the evening are associated with adverse cardiometabolic outcomes, including higher risk for coronary heart disease, hypertension, type 2 diabetes, obesity, dyslipidemia, and systemic inflammation. Randomized controlled trials are also limited, as most in the field of chrononutrition focus on the cardiometabolic consequences of time-restricted feeding. Overall, interventions that shift eating timing patterns to earlier in the day and that restrict evening caloric intake tend to have protective effects on cardiometabolic health, but small sample sizes and short follow-up are notable limitations. Innovation in dietary assessment approaches, to develop low-cost validated tools with acceptable participant burden that reliably capture chrononutrition metrics, is needed for advancing observational evidence. Culturally responsive pragmatic intervention studies with sufficiently large and representative samples are needed to understand the impact of fixed and earlier eating timing schedules on cardiometabolic health. Additional research is warranted to understand the modifiable determinants of temporal eating patterns, to investigate the role of chrononutrition in the context of other dimensions of diet (quantity, quality, and food and nutrition security) in achieving cardiometabolic health equity, and to elucidate underlying physiological mechanisms.
... Notably, ASS1 and DDAH1 also contribute to the regulation of vascular NO production to prevent inflammatory processes such as atherosclerosis (Goodwin et al., 2004;Liu et al., 2016). With long-term consumption of plant foods reducing the incidence of cardiovascular disease, giant pandas dieted on highfiber, low-fat bamboo and the aforementioned genes that reduce atherosclerosis show a hypomethylation and high expression pattern that seems to contradict their dietary habits (Kahleova et al., 2018). ...
Epigenetic regulation plays an important role in the evolution of species adaptations, yet little information is available on the epigenetic mechanisms underlying the adaptive evolution of bamboo‐eating in both giant pandas (Ailuropoda melanoleuca) and red pandas (Ailurus fulgens). To investigate the potential contribution of epigenetic to the adaptive evolution of bamboo‐eating in giant and red pandas, we performed hepatic comparative transcriptome and methylome analyses between bamboo‐eating pandas and carnivorous polar bears (Ursus maritimus). We found that genes involved in carbohydrate, lipid, amino acid, and protein metabolism showed significant differences in methylation and expression levels between the two panda species and polar bears. Clustering analysis of gene expression revealed that giant pandas did not form a sister group with the more closely related polar bears, suggesting that the expression pattern of genes in livers of giant pandas and red pandas have evolved convergently driven by their similar diets. Compared to polar bears, some key genes involved in carbohydrate metabolism and biological oxidation and cholesterol synthesis showed hypomethylation and higher expression in giant and red pandas, while genes involved in fat digestion and absorption, fatty acid metabolism, lysine degradation, resistance to lipid peroxidation and detoxification showed hypermethylation and low expression. Our study elucidates the special nutrient utilization mechanism of giant pandas and red pandas and provides some insights into the molecular mechanism of their adaptive evolution of bamboo feeding. This has important implications for the breeding and conservation of giant pandas and red pandas.
... Beyond focusing on individual foods or nutrients, the complexity of daily diets encompasses combinations of multiple foods and nutrients. In recent years, the significance of diet quality scores and overall dietary patterns, including Healthy Eating Index (HEI), DII, Mediterranean diet (MedDiet), Dietary Approaches to Stop Hypertension (DASH) diet, and vegetarian diets, have been increasingly recognized [26][27][28][29]. While previous research on dietary patterns in the context of HF prevention and treatment has primarily focused on the MedDiet and DASH diet [30,31], the role of chronic inflammation in CVD progression has been emphasized [32][33][34]. ...
Background
With cardiovascular diseases standing as a leading cause of mortality worldwide, the interplay between diet-induced inflammation, as quantified by the Dietary Inflammatory Index (DII), and heart failure biomarker NT-proBNP has not been investigated in the general population.
Methods
This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999–2004, encompassing 10,766 individuals. The relationship between the DII and NT-proBNP levels was evaluated through multivariable-adjusted regression models. To pinpoint crucial dietary components influencing NT-proBNP levels, the LASSO regression model was utilized. Stratified analyses were then conducted to examine the associations within specific subgroups to identify differential effects of the DII on NT-proBNP levels across diverse populations.
Results
In individuals without heart failure, a unit increase in the DII was significantly associated with an increase in NT-proBNP levels. Specifically, NT-proBNP levels rose by 9.69 pg/mL (95% CI: 6.47, 12.91; p < 0.001) without adjustments, 8.57 pg/mL (95% CI: 4.97, 12.17; p < 0.001) after adjusting for demographic factors, and 5.54 pg/mL (95% CI: 1.75, 9.32; p = 0.001) with further adjustments for health variables. In participants with a history of heart failure, those in the second and third DII quartile showed a trend towards higher NT-proBNP levels compared to those in the lowest quartile, with increases of 717.06 pg/mL (95% CI: 76.49–1357.63, p = 0.030) and 855.49 pg/mL (95% CI: 156.57–1554.41, p = 0.018). Significant interactions were observed in subgroup analyses by age (<50: β = 3.63, p = 0.141; 50–75: β = 18.4, p<0.001; >75: β = 56.09, p<0.001), gender (men: β = 17.82, p<0.001; women: β = 7.43, p = 0.061),hypertension (β = 25.73, p<0.001) and diabetes (β = 38.94, p<0.001).
Conclusion
This study identified a positive correlation between the DII and NT-proBNP levels, suggesting a robust link between pro-inflammatory diets and increased heart failure biomarkers, with implications for dietary modifications in cardiovascular risk management.
... Meat eaters were people who ate a lot of meat and fish (three meals a day, every meal) and very little vegetarian food (less than one meal a day); vegetarians included people that did not eat meat and fish (less than one meal a day) and lots of vegetarian food (three meals a day, every meal); and balanced eaters for those who ate a balanced and reasonable amount of meat, fish, and vegetarian food (three meals a day, every meal). [19][20][21] According to the 11th Revision of the International Classification of Diseases (ICD-11), the history of smoking and alcohol consumption was classified as never had, currently have, and quit. 22 Never smokers were those who had never smoked; smokers were those who had smoked for six months or more in their lifetime and were currently smoking at the time of the survey; quitters included those who had smoked in the past but did not smoke anymore at the moment of the survey. ...
Background
Primary liver cancer (PLC) is a fatal malignancy, sleep quality and gut microbiota were shown to be associated with PLC. However, the mechanism of how sleep quality affects PLC is unclear. This study aims to investigate the mediation/moderation effects of gut microbiota on sleep quality and the occurrence of PLC.
Methods
The causality of sleep quality and the occurrence of PLC was detected through the Mendelian randomization (MR) analysis based on the data including 305,359 individuals (Finland Database) and 456,348 participants (UK Biobank). The primary method used for MR analysis was inverse-variance weighted analysis. Gut microbiota’ mediation/moderation effects were uncovered in the case–control study including 254 patients with PLC and 193 people with benign liver diseases through the mediation/moderation effect analyses. People’s sleep quality was evaluated through the Pittsburgh sleep quality index (PSQI).
Results
Poor sleep quality could lead to PLC through the MR analysis (P = 0.026). The case–control study uncovered that Actinobacteria had mediation effects on the relationship between PSQI score, self-sleep quality, and the occurrence of PLC (P = 0.048, P = 0.046). Actinobacteria and Bifidobacterium could inhibit the development of PLC caused by short night sleep duration (P = 0.021, P = 0.022). Erysipelotrichales could weaken the influence of daytime dysfunction on PLC (P = 0.033). Roseburia modulated the contribution of nocturnal insomnia and poor sleep quality to PLC (P = 0.009, P = 0.017).
Conclusion
Poor sleep quality was associated with PLC. Gut microbiota’ mediation/moderation effects on poor sleep quality and the occurrence of PLC prompted an insightful idea for the prevention of PLC.
... For instance, plantbased diets have been associated with favorable outcomes such as reduced blood pressure, lower blood lipid levels, and decreased platelet aggregation compared to non-vegetarian diets. Additionally, they have demonstrated benefits in weight management, as well as a decreased risk of developing metabolic syndrome and type-2 diabetes [8]; however, strict adherence to such diets may entail potential risks, including hyperhomocysteinemia, protein deficiency, anemia, and decreased creatinine content in muscles [9]. Also, the ketogenic diet has been noted for inducing rapid and significant weight loss, alongside positive biomarker changes, such as reduced serum hemoglobin A1c levels in individuals with type-2 diabetes. ...
The Mediterranean diet (MD), rich in minimally processed plant foods and in monounsaturated fats but low in saturated fats, meat, and dairy products, represents one of the most studied diets for cardiovascular health. It has been shown, from both observational and randomized controlled trials, that MD reduces body weight, improves cardiovascular disease surrogates such as waist-to-hip ratios, lipids, and inflammation markers, and even prevents the development of fatal and nonfatal cardiovascular disease, diabetes, obesity, and other diseases. However, it is unclear whether it offers cardiovascular benefits from its individual components or as a whole. Furthermore, limitations in the methodology of studies and meta-analyses have raised some concerns over its potential cardiovascular benefits. MD is also associated with characteristic changes in the intestinal microbiota, mediated through its constituents. These include increased growth of species producing short-chain fatty acids, such as Clostridium leptum and Eubacterium rectale, increased growth of Bifidobacteria, Bacteroides, and Faecalibacterium prausnitzii species, and reduced growth of Firmicutes and Blautia species. Such changes are known to be favorably associated with inflammation, oxidative status, and overall metabolic health. This review will focus on the effects of MD on cardiovascular health through its action on gut microbiota.
... Coronary heart disease (CHD) is a serious condition resulting from atherosclerotic coronary artery stenosis that can lead to myocardial ischemia, myocardial infarction (MI), and death (Kahleova et al., 2018;Zhou et al., 2018;Fuchs et al., 2019;Lu et al., 2020). CHD and MI are the leading causes of mortality in industrialized nations, and rates of these morbidities are steadily rising throughout the world (Sagar et al., 2012;Cao et al., 2015). ...
Background: ZhuRiHeng Drop Pill (ZRH) is a traditional Mongolian medicinal preparation. Despite its long history of use for the treatment of coronary heart disease, there have been few toxicological studies of the safety profile of ZRH.
Purpose: In order to comprehensively elucidate the underlying mechanisms behind the observed toxicity of ZRH on rat livers in the 180-day repeated oral toxicity study, we conducted a comprehensive analysis by integrating transcriptomic and metabolomic data.
Methods: High-resolution mass spectrometry was conducted to evaluate the constituents of ZRH. For the acute oral toxicity study, mice were administered a dose of 32 g/(kg·d) of ZRH, while rats were instead orally administered 0.934, 1.868, or 3.736 g/(kg·d) of ZRH over a 180-day period in a 180-day repeated oral toxicity study. Conventional index and organ weights/histology were then monitored to detect any potential ZRH treatment-related toxicity. To identify key genes and metabolites involved in ZRH toxicological processes, we performed transcriptomic and metabolomic analyses of liver tissue upon ZRH treatment using RNA-seq techniques, qPCR and liquid chromatography-mass spectrometry analyses.
Results: A total of 60 compounds in ZRH were identified and speculated in positive and negative ion modes. Mice in the acute toxicity study exhibited no signs of ZRH-related toxicity. In a protracted oral toxicity investigation spanning 180 days, discernible elevations in liver ratios were noted in both male and female rats across all three dose cohorts, relative to the control group ( p < 0.05 or p < 0.01). Upon subjecting to ZRH treatment, our transcriptomic and qPCR analyses unveiled notable upregulation of crucial genes, exemplified by Abcb1b and Cyp2b2 , known for theirs involvement in liver drug transport and metabolism function. Furthermore, our untargeted metabolomic analysis provided supplementary insights, revealing significant regulation in pyrimidine metabolism, as well as alanine, aspartate, and glutamate metabolism pathways.
Conclusion: Our study unveils a panoramic understanding of the temporal, dosage-specific, and gene dimensions surrounding the metabolic and transcriptional shifts induced by ZRH exposure. As we peer into the future, recommendations emerge for further exploration, encompassing aspects such as time dynamics, dosage considerations, and gene-centric avenues to enhance therapeutic efficacy.
... This nutritional imbalance contributes to the increasing incidence of obesity, type 2 diabetes, hypertension, hyperlipidemia, and coronary artery disease [29][30][31]. The abundance of fiber, antioxidants, and phytochemicals in plant-based and healthy plant-based diets may contribute to decreased blood pressure, improved lipid profiles, and reduced risk of CVDs [32][33][34][35]. ...
A plant-based diet rich in whole foods and fiber is beneficial for cardiovascular (CV) health. This impact is often linked to specific food groups and their preparation methods, reflecting the overall dietary pattern. However, research on the long-term effects of a carefully designed plant-based diet on adults transitioning from a typical Western lifestyle is limited. Notably, studies on people managing CV risk factors effectively are scarce. As part of a cross-sectional study, we examined 151 individuals committed to a long-term, well-designed plant-based diet and active lifestyle. We investigated how specific food groups and macronutrient intake are related to various CV health markers. In this secondary analysis, our comprehensive approach encompassed several methods: 3-day weighted dietary records, fasting blood lipid and blood pressure measurements, body composition assessments, and evaluations of lifestyle status. We adjusted our analysis for multiple variables, such as age, sex, current body mass index, smoking status, physical activity, and time (years) following the plant-based diet. Our findings revealed several associations between macronutrient intake (per 50 g) and CV risk markers, although these associations were generally weak. Individuals who consumed more whole grains and fruits had lower levels of total, low-density lipoprotein (LDL-C), and high-density lipoprotein (HDL-C) cholesterol. We also found associations between the intake of legumes and nuts/seeds and reduced HDL-C levels. These findings suggested that these food groups might influence the lipid profile, contributing to CV health in a plant-based diet. A greater intake of spices/herbs was associated with lower uric acid levels, while diets rich in plant-based fast food and pasta (made from white flour) were associated with higher uric acid levels. A greater intake of various macronutrients, such as fiber, carbohydrates (from whole-food sources), proteins, and different types of fats (saturated fatty acids [SFAs], monounsaturated fatty acids [MUFAs], and polyunsaturated fatty acids [PUFAs]), was associated with lower levels of total cholesterol, LDL-C (only for carbohydrates), and HDL-C. We found a unique negative correlation between PUFA intake and LDL-C, suggesting that PUFAs might significantly affect LDL-C levels. In contrast, increased fiber, protein and SFA consumption were associated with increased uric acid levels. These findings support the impact of dietary patterns on CV risk factors, highlighting that even small amounts of unhealthy food groups can significantly influence specific CV risk markers, regardless of the overall diet.
Background: Plant-based diets are increasingly being recognized for their role in disease management. Recent research has focused on evaluating the health benefits and potential risks associated with vegan and more inclusive plant-based diets, which include limited animal products. Objective: The objective of this study was to investigate the effects of a strictly vegan diet compared to a more flexible plant-based diet with occasional animal products on various health markers over a six-month period. Methods: In this randomized controlled trial, 64 participants were assigned to either a vegan group (Group 1) or a more plant-based group with limited animal products (Group 2), each containing 32 participants. Dietary adherence was assessed biweekly via 24-hour dietary recalls. Health outcomes measured included BMI, blood lipid profiles, LDL cholesterol, and HDL cholesterol. Data were analyzed using independent t-tests and chi-square tests for categorical variables. Results: After six months, Group 2 showed greater improvements in health metrics compared to Group 1. Group 2's BMI decreased from 23.1 ± 2.0 to 21.8 ± 1.7, LDL cholesterol from 115 ± 10 mg/dL to 95 ± 11 mg/dL, and HDL cholesterol increased from 40 ± 4 mg/dL to 50 ± 5 mg/dL. Group 1 also showed improvements, though to a lesser extent, with BMI reducing from 22.4 ± 1.8 to 21.9 ± 1.6 and LDL cholesterol from 110 ± 15 mg/dL to 104 ± 12 mg/dL. Conclusion: The inclusion of limited animal products in a plant-based diet was associated with more significant improvements in cardiovascular and metabolic health markers than a strictly vegan diet. These findings suggest that a more flexible plant-based diet may offer an optimal balance of benefits for disease management.
Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide, with dietary phytosterols intake showing the cardioprotective effects.
Cardiovascular diseases (CVD) represent a primary global health challenge. Poor dietary choices and lifestyle factors significantly increase the risk of developing CVD. Legumes, recognized as functional foods, contain various bioactive components such as active peptides, protease inhibitors, saponins, isoflavones, lectins, phytates, and tannins. Studies have demonstrated that several of these compounds are associated with the prevention and treatment of cardiovascular diseases, notably active peptides, saponins, isoflavones, and tannins. This review aims to analyze and summarize the relationship between bioactive compounds in legumes and cardiovascular health. It elaborates on the mechanisms through which active ingredients in legumes interact with risk factors for cardiovascular diseases, such as hypertension, hypercholesterolemia, endothelial dysfunction, and atherosclerosis. These mechanisms include, but are not limited to, lowering blood pressure, regulating lipid levels, promoting anticoagulation, enhancing endothelial function, and modulating TLR4 and NF-κB signaling pathways. Together, these mechanisms emphasize the potential of legumes in improving cardiovascular health. Additionally, the limitations of bioactive components in legumes and their practical applications, with the goal of fostering further advancements in this area were discussed.
Objetivo: Avaliar a relação entre dieta vegetariana, comer transtornado e imagem corporal em adolescentes. Métodos: Estudo transversal realizado em duas escolas privadas, localizadas no município de São Paulo, com 204 adolescentes, idade entre 15 anos e 18 anos e 11 meses. A avaliação da imagem corporal em meninos foi realizada pelo Male Body Dissatisfaction Scale versão curta, enquanto que nas meninas utilizou-se o Body Shape Questionnaire. Avaliou-se o comportamento alimentar transtornado pela Escala de Atitudes Alimentares Transtornadas para Adolescentes versão curta em ambos os sexos. Os indivíduos que indicaram não aderir a uma dieta vegetariana compuseram o grupo controle. Realizou-se análise estatística de acordo com comportamento das variáveis. Resultados: 92,2% da população estudada foi composta por onívoros, sendo apenas 7,8% da amostra vegetariana. Na análise dos escores médios de insatisfação corporal e comer transtornado, não houve diferença entre os tipos de dieta, embora o comer transtornado tenha sido significativamente maior entre meninas. Observou-se correlação moderada entre o comer transtornado e a insatisfação com a imagem corporal em toda a população feminina e entre vegetarianas; já nos meninos, a correlação foi fraca entre essas variáveis e apenas presente quando considerada toda a população masculina. Conclusões: A frequência de vegetarianismo e de comportamentos do comer transtornado não diferiu entre vegetarianos e onívoros. Observou-se, no entanto, relação entre o comer transtornado e insatisfação com a imagem corporal em meninas, sobretudo entre as vegetarianas, reforçando a importância de mais investigações nesta população.
Background
Although national food guides are designed, ostensibly, to translate scientific evidence with respect to food, dietary patterns, and health, their development has increasingly become a corporate/political process as well as scientific one; often with corporate/political influences overriding science. Our aim was to construct an unbiased, sustainable, evidence-informed Universal Food Guide to serve as a template for countries to develop their unique guides, thereby, provide a valid resource for health professionals, health authorities, and the public.
Methods
To address our aim, we conducted an integrative review of multiple evidence-informed sources (e.g., established databases, evidence syntheses, scholarly treatises, and policy documents) related to four areas: 1. Food guides’ utility and conflicts of interest; 2. The evidence-based healthiest diet; 3. Constituents of the Universal Food Guide template; and 4. Implications for population health; regulation/governance; environment/climate/planetary health; and ethics.
Results
The eating pattern that is healthiest for humans (i.e., most natural, and associated with maximal health across the life cycle; reduced non-communicable disease (NCD) risk; and minimal end-of-life illness) is whole food, low fat, plant-based, especially vegan, with the absence of ultra-processed food. Disparities in national food guide recommendations can be explained by factors other than science, specifically, corporate/political interests reflected in heavily government-subsidized, animal-sourced products; and trends toward dominance of daily consumption of processed/ultra-processed foods. Both trends have well-documented adverse consequences, i.e., NCDs and endangered environmental/planetary health. Commitment to an evidence-informed plant-based eating pattern, particularly vegan, will reduce risks/manifestations of NCDs; inform healthy food and nutrition policy regulation/governance; support sustainable environment/climate and planetary health; and is ethical with respect to ‘best’ evidence-based practice, and human and animal welfare.
Conclusion
The Universal Food Guide that serves as a template for national food guides is both urgent and timely given the well-documented health-harming influences that corporate stakeholders/politicians and advisory committees with conflicts of interest, exert on national food guides. Such influence contributes to the largely-preventable NCDs and environmental issues. Policy makers, health professionals, and the public need unbiased, scientific evidence as informed by the Universal Food Guide, to inform their recommendations and choices.
Vitamin B 12 , cobalamin, is indispensable for humans owing to its participation in two biochemical reactions: the conversion of l -methylmalonyl coenzyme A to succinyl coenzyme A, and the formation of methionine by methylation of homocysteine. Eukaryotes, encompassing plants, fungi, animals and humans, do not synthesise vitamin B 12 , in contrast to prokaryotes. Humans must consume it in their diet. The most important sources include meat, milk and dairy products, fish, shellfish and eggs. Due to this, vegetarians are at risk to develop a vitamin B 12 deficiency and it is recommended that they consume fortified food. Vitamin B 12 behaves differently to most vitamins of the B complex in several aspects, e.g. it is more stable, has a very specific mechanism of absorption and is stored in large amounts in the organism. This review summarises all its biological aspects (including its structure and natural sources as well as its stability in food, pharmacokinetics and physiological function) as well as causes, symptoms, diagnosis (with a summary of analytical methods for its measurement), prevention and treatment of its deficiency, and its pharmacological use and potential toxicity.
Adopting a healthy dietary pattern may be an initial step in combating inflammation-related chronic diseases; however, a comprehensive synthesis evaluating current evidence is lacking. This umbrella review aimed to summarise the current evidence on the effects of dietary patterns on circulating C-reactive protein (CRP) levels in adults. We conducted an exhaustive search of the Pubmed, Scopus and Epistemonikos databases, spanning from their inception to November 2023, to identify systematic reviews and meta-analyses across all study designs. Subsequently, we employed a random-effects model to recompute the pooled mean difference. Methodological quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) checklist, and evidence certainty was categorised as non-significant, weak, suggestive, highly suggestive or convincing (PROSPERO: CRD42023484917). We included twenty-seven articles with thirty meta-analyses of seven dietary patterns, fifteen of which (50 %) exhibited high methodological quality. The summary effects of randomised controlled trials (RCT) found that the Mediterranean diet was the most effective in reducing circulating CRP levels, followed by Vegetarian/Vegan and Energy-restricted diets, though the evidence was of weak quality. In contrast, Intermittent Fasting, Ketogenic, Nordic and Paleolithic diets did not show an inverse correlation with circulating CRP levels. Some results from combined interventional and observational studies, as well as solely observational studies, also agreed with these findings. These dietary patterns show the potential in reducing CRP levels in adults, yet the lack of high-quality evidence suggests future studies may alter the summary estimates. Therefore, further well-conducted studies are warranted.
Cardiovascular disease (CVD) is related to many risk factors like unhealthy dietary pattern and physical inactivity. Dietary modification has been involved in managing and reducing the risk of CVD. The current study aimed to investigate the association of obesity and nutritional status with clinical characteristics, echocardiographic changes, and clinical outcomes in a random sample of 54 individuals aged between 30-60 years enrolled from the outpatient cardiology clinic in Ain Shams University hospital. Study participants were classified into five groups according to heart disease status (normal control, metabolic syndrome, risk factor, compensated CVD, decompensated CVD). A standardized 24-four-hour questionnaire was used to determine dietary intake. Anthropometric measurements, biochemical analysis and echocardiography examination were done for all study subjects. Overall and central obesity was highly prevalent among the metabolic syndrome, risk factor and decompensated CVD groups compared to the other groups. We found that obese individuals with poor nutritional status have the highest comorbidity burden, the most adverse cardiac remodeling, and the least favorable composite outcome. Therefore, increasing public awareness of healthy lifestyle and dietary patterns to enhance the prevention of CVD and associated risk factors.
While there are data regarding the glycaemic index (GI) and glycaemic load (GL) of many foods in the literature, the values for packaged vegan analogue foods have not been previously published, although processed vegan foods usually contain more carbohydrates than their animal‐based counterparts. This study was carried out to determine the GI and GL values of a selection of packaged vegan foods popular in Türkiye. To determine the GI and GL of test foods, 12 healthy volunteer females participated in the study. Participants randomly consumed test and reference foods (glucose and white bread) on each trial day, and capillary blood glucose was measured at baseline, 15, 30, 45, 60, 90 and 120 mins in duplicate. The GIs of vegan schnitzel, vegan chickpea burger, vegan mince pita, vegan chocolate, vegan snack bar and vegan cheese were 26.1 ± 19.61 (low), 27.1 ± 17.21 (low), 65.1 ± 28.60 (moderate), 42.7 ± 22.32 (low), 63.6 ± 45.86 (moderate), 36.4 ± 16.85 (low), respectively, according to the glucose reference, and were 28.2 ± 16.17 (low), 34.7 ± 18.26 (low), 81.2 ± 31.96 (high), 48.8 ± 12.87 (low), 82.0 ± 54.05 (high), 46.7 ± 28.66 (low), respectively, according to the white bread reference. GLs were 3.5 ± 2.66 (low), 8.6 ± 5.46 (low), 26.6 ± 11.67 (high), 6.1 ± 3.19 (low), 14.2 ± 10.28 (moderate), 5.7 ± 2.63 (low), respectively, according to the glucose reference, and were 3.8 ± 2.19 (low), 11.0 ± 5.80 (moderate), 33.1 ± 13.04 (high), 7.0 ± 1.84 (low), 18.4 ± 12.12 (moderate), 7.3 ± 4.47 (low), respectively, according to the white bread reference. The data from this study provide preliminary data for the GIs and GLs of packaged and processed vegan foods and show that the GIs and GLs of meat and cheese vegan analogues, while still low or moderate, tend to be higher than their animal‐based counterparts which have lower or no glycaemic responses. Further research on the GIs and GLs of more vegan foods is needed.
Nutrition and heart healthy quality diets are essential components of prevention and management of cardiovascular disease. In this chapter, the evidence for specific diets, nutrients and dietary patterns is reviewed, and best practices for preventive cardiovascular care around nutrition and across the life course is presented. Aspects of nutrition that contribute to healthy weight and weight management including current understandings of the microbiome are reviewed. Factors associated with quality nutrition and cardiovascular outcomes, including social determinants, and policy to mitigate adverse influences on diet access and costs are explored.
Social determinants of health (SDoH), the conditions in which people live, work, play, and pray, are recognized as the key contributors to disparities in cardiovascular health. These conditions contribute to the adoption and maintenance of health behaviors and cardiovascular disease (CVD). This chapter reviews the epidemiological evidence demonstrating associations between SDoH and cardiovascular health. Additionally, the assessment of social determinants and their influence on prevention of cardiovascular conditions and interventions that mitigate the effects of adverse SDoH are outlined.
Introduction: The purpose of this study was to assess the structural characteristics of the styloid process (SP) using cone-beam computed tomography (CBCT) examination in patients with orofacial pain. Additionally, the study aimed to determine the prevalence of elongated SP and its relationship to gender in the study population.
Methods: A retrospective evaluation was conducted on the clinical and radiographic records of 208 patients. Radiological examinations were performed on CBCT images to measure the structure, length, and medial angulations of the SP.
Results: Out of 208 patients, the distribution of SP elongation was as follows: 96 (46%) had non-elongated SP, 28 (13%) had elongation on the left side, 16 (8%) had elongation on the right side, and 68 (33%) had bilateral elongation of SP. The patients with elongated SP had significantly decreased angle values. However, there were no statistically significant differences in the length values of SP between males and females in both groups. Additionally, a significantly increased prevalence of symptoms, except for headaches, was observed in patients with elongated SP.
Conclusions: This study introduces cone beam computed tomography (CBCT) as a substitute approach for CT or panoramic radiographs in gauging and evaluating the styloid process (SP). Individuals experiencing orofacial pain, along with elongated SP, exhibited a higher incidence of associated neurological symptoms relative to those without elongation.
Background
Healthy behavioral lifestyles, especially healthy dietary patterns, have beneficial effects on chronic diseases, but the evidence of relationship between the main dietary patterns (DP) and the risk of chronic diseases in high altitude area is still limited.
Methods
The eligible high altitude residents were enrolled in the cross-sectional study. The food frequency questionnaires were used to collect information about the dietary intake of the participants. The dietary patterns were extracted by principal component analysis (PCA), and the scores for each dietary pattern were farther categorized into tertiles as low(T1), middle(T2) and high(T3). Logistic regression was used to evaluate the association between independent variables (dietary patterns, smoking, alcohol drinking, tea drinking and physical exercise) and chronic diseases in the year 2021.
Results
A total of 606 eligible participants involved in the survey with an average age of 40.7 ± 16.4 year old. 242 (39.9%) participants suffered from at least one chronic disease. Five dietary patterns were identified: dry nuts and beverage, traditional Tibetan, three-high (high-salt, high-carbonhydrate, high-fat), animal-predominant high protein and high dietary fiber pattern. After adjusting for the potential confounders, people in the three-high pattern (T2: OR = 1.81, 95%CI:1.10–2.99, P = 0.020, T3: OR = 1.90, 95%CI:1.09–3.33, P = 0.024), animal-predominant high protein pattern (T2: OR = 2.37, 95%CI:1.42–3.94, P = 0.001), smoking (OR = 1.88, 95%CI:1.06–3.35, P = 0.031) and tea drinking (OR = 1.85, 95%CI:1.13–3.02, P = 0.015) had higher odds of chronic diseases than those in the lowest tertile (T1) or reference group, while people in the traditional Tibetan pattern (T2: OR = 0.47, 95%CI:0.28–0.80, P = 0.006) and participation in physical exercise (OR = 0.62, 95%CI:0.39–0.99, P = 0.044) had lower odds of chronic diseases.
Conclusion
The traditional Tibetan pattern has a positive effect on decreased risk of chronic diseases among high altitude residents. Furthermore, adhering to a healthy lifestyle, including quitting smoking and enhancing physical activity, can aid in mitigating the risk of chronic diseases in high altitude residents.
Este documento está dedicado a la alimentación vegetariana y vegana basada en plantas. Asumir la alimentación en toda su complejidad implica comprender las elecciones alimentarias desde una mirada individual y a la vez colectiva, entendiendo que las razones por las cuales una persona adopta hábitos o conductas en su práctica alimentaria son múltiples y diversas. Siguiendo esta línea, en los últimos años ha crecido en forma notable el número de personas que eligen llevar adelante una alimentación vegetariana, vegana y basada en plantas, cuyo derecho a una alimentación adecuada también debe ser garantizado. Esta revisión no surge como una recomendación del Ministerio de Salud de adoptar una alimentación vegetariana o vegana, sino que busca reconocer a las personas que la eligen, brindando al equipo de salud herramientas para acompañarlas a que puedan hacerlo de una manera saludable.
Health problems have always received significant attention. According to previous research, different food types are highly related to multiple chronic diseases. However, few studies have been conducted to comprehensively assess the future development of people’s health in terms of food structure or food preferences. This paper uses transfer learning-based image recognition method to analyze the food preferences of the United States people for 101 kinds of food based on online rating information. According to the analysis results, the overall food preferences of the Americans tend to be healthy, although foods with high sugar content are still one of the top-rated categories among the public. In addition, compared to domestic foods, foreign foods are widely popular among American residents. Our study can be useful for the research perspective that food preference reflects people’s tendency of future food structure and, based on which, predicts their future health.
Background:
Plant-based diets are becoming more and more widespread among the Spanish population, progressively replacing the Mediterranean dietary pattern. Different studies have shown the motivations for adherence to these diets, and others have highlighted some health advantages and disadvantages.
Purpose of the study:
Further studies are needed to define the socio-demographic determinants that influence the choice of a plant-based diet and to study the relationship that the choice of dietary pattern has on the health and lifestyle habits of the population.
Methods:
A descriptive, cross-sectional study was conducted on the Spanish population. The NutSo-HH questionnaire, developed and validated by the research team, was used to gather socio-demographic, nutritional, social, and lifestyle information through non-probabilistic snowball sampling.
Results:
The questionnaire was completed by 22,181 Spanish citizens, of whom only 19,211 were of interest to the study. The socio-demographic variables gender, age, educational level, income level, and place of residence do not seem to influence the prevalence of a plant-based diet (n = 1638) compared to a Mediterranean diet (n = 17,573). People following a vegetarian or vegan diet have a lower BMI, and they consume less fried food, fast food, and ultra-processed dishes and fewer energy drinks or sugary beverages. They also do more exercise and sleep longer hours, smoke less, and consume alcohol less frequently. However, there seem to be more diagnosed eating disorders among people who follow a plant-based diet than those who follow a Mediterranean diet.
Conclusions:
People who adopt a plant-based diet tend to exhibit healthier lifestyle patterns and consume fewer foods that are detrimental to their health. However, it is essential for such dietary choices to be supervised by healthcare professionals to mitigate the risk of maladaptive behaviors evolving into eating disorders.
Metabolic factors are major and controllable risk factors for cardiovascular diseases (CVD), and few studies have described this burden. We aim to assess it from 1990 to 2019 and predict the trends through 2034. Global Burden of Disease (GBD) provides data on sex, age, and socio-demographic index (SDI) levels. Numbers, age-standardized death rates (ASDR) and estimated annual percentage change (EAPC) were used. Future trends were estimated by NORDPRED model. The deaths cases of metabolic-related CVD increased from 8.61 million (95% UI: 7.91–9.29) to 13.71 million (95% UI: 12.24–14.94) globally. The ASDR continued to decline globally (EAPC = −1.36). The burden was heavier in male and middle-aged people and elderly people. CVD-related ASDR caused by high systolic blood pressure (SBP) had a downward trend globally (EAPC = −1.45), while trends of high body mass index (BMI) (EAPC = 1.29, 1.97, 0.92) and fasting plasma glucose (FPG) (EAPC = 0.95, 1.08, 0.46) were increasing in the middle, low-middle, and low SDI regions, respectively. Compared to 2015–2019, cumulative deaths will increase by 27.85% from 2030 to 2034, while ASDR will decrease 10.47%. The metabolic-related CVD burden remained high globally and deaths will continue to rise in the future. Men, middle-aged and elderly people were focus of concern. High SBP was globally well-managed over the past 30 years, but the CVD burden due to high BMI and FPG remained high. Exceptional initiatives are needed to regarding interventions targeting high BMI and FPG in middle and lower SDI regions.
Objective:
Nutrition plays a significant role in preserving the balance of the human body. Considering each person's particular characteristics, diet can directly and indirectly alter the body's immune response. The purpose of this study is to draw attention to the connection between a vegetarian diet and its impact on oral health.
Materials and methods:
To determine the connection between a vegetarian diet and dental health, a search of the literature was conducted on the PubMed, Scopus, and Web of Science databases. English language and a publication year between January 1, 2013, and March 1, 2023, were the inclusion criteria for the search.
Results:
There were 167 articles in total that addressed the subject of interest, and 18 of them were chosen for qualitative analysis.
Conclusions:
This study suggests that a vegetarian diet may alter oral health, namely periodontal health, tooth erosion, and oral microbiome. Even if the data collected prevents the effect of a vegetarian diet on oral health from being confirmed, this study acts as a starting point for future, more focused research.
Cardiovascular disease (CVD) risk factors, incidence and death increases from around the time of menopause comparing to women in reproductive age. A healthy lifestyle can prevent CVD, but it is unclear which lifestyle factors may help maintain and improve cardiovascular health for women after menopausal transition. We conducted a systematic review and meta-analysis of prospective cohort studies to evaluate the association between modifiable lifestyle factors (specifically smoking, physical activity, alcohol intake, and obesity), with CVD and mortality in middle-aged and elderly women. Pubmed, Embase, among other databases and reference lists were searched until February 29th, 2016. Study specific relative risks (RR) were meta-analyzed using random effect models. We included 59 studies involving 5,358,902 women. Comparing current versus never smokers, pooled RR were 3.12 (95% CI 2.15–4.52) for CHD incidence, 2.09 (95% CI 1.51–2.89) for stroke incidence, 2.76 (95% CI 1.62–4.71) for CVD mortality and 2.22 (95% CI 1.92–2.57) for all-cause mortality. Physical activity was associated with a decreased risk of 0.74 (95% CI 0.67–0.80) for overall CVD, 0.71 (95% CI 0.67–0.75) for CHD, 0.77 (95% CI 0.70–0.85) for stroke, 0.70 (95% CI 0.58–0.84) for CVD mortality and 0.71 (95% CI 0.65–0.78) for all-cause mortality. Comparing moderate drinkers versus non-drinkers, the RR was 0.72 (95% CI 0.56–0.91) for CHD, 0.63 (95% CI 0.57–0.71) for CVD mortality and 0.80 (95% CI 0.76–0.84) for all-cause mortality. For women with BMI 30–35 kg/m2 the risk was 1.67 (95% CI 1.24–2.25) for CHD and 2.3 (95% CI 1.56–3.40) for CVD mortality, compared to normal weight. Each 5 kg/m2 increase in BMI was associated with 24% (95% CI 16–33%) higher risk for all-cause mortality. This meta-analysis suggests that physical activity and moderate alcohol intake were associated with a reduced risk for CVD and mortality. Smoking and higher BMI were associated with an increased risk of these endpoints. Adherence to a healthy lifestyle may substantially lower the burden of CVD and reduce the risk of mortality among middle-aged and elderly women. However, this review highlights important gaps, as lack of standardized methods in assessing lifestyle factors and lack of accurate information on menopause status, which should be addressed by future studies in order to understand the role of menopause on the association between lifestyle factors and cardiovascular events.
Prehypertension (pHTN) and metabolic syndrome (MetS) are both lifestyle diseases that are potentiated by increased adiposity, as both disease processes are closely related to weight. In the case of pHTN, increased adiposity causes dysregulation of the renin-angiotensin-aldosterone-system (RAAS) as well as adipokine- and leptin-associated increases in adrenergic tone. In MetS, excess weight potentiates hyperglycemia and insulin resistance which causes positive feedback into the RAAS system, activates an inflammatory cascade that potentiates atherosclerosis, and causes lipid dysregulation which together contribute to cardiovascular disease, especially coronary heart disease (CHD) and heart failure (HF). The relationship with all-cause mortality is not as clear-cut in part because of some protective effects associated with the obesity paradox in chronic diseases such as CHD and HF. However, in healthy populations, the absence of excess weight and its associated effects on prehypertension and MetS are associated with a longer absolute and disease-free lifespan.
Metabolic syndrome, variously known also as syndrome X, insulin resistance, etc., is defined by WHO as a pathologic condition characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia. Though there is some variation in the definition by other health care organization, the differences are minor. With the successful conquest of communicable infectious diseases in most of the world, this new non-communicable disease (NCD) has become the major health hazard of modern world. Though it started in the Western world, with the spread of the Western lifestyle across the globe, it has become now a truly global problem. The prevalence of the metabolic syndrome is often more in the urban population of some developing countries than in its Western counterparts. The two basic forces spreading this malady are the increase in consumption of high calorie-low fiber fast food and the decrease in physical activity due to mechanized transportations and sedentary form of leisure time activities. The syndrome feeds into the spread of the diseases like type 2 diabetes, coronary diseases, stroke, and other disabilities. The total cost of the malady including the cost of health care and loss of potential economic activity is in trillions. The present trend is not sustainable unless a magic cure is found (unlikely) or concerted global/governmental/societal efforts are made to change the lifestyle that is promoting it. There are certainly some elements in the causation of the metabolic syndrome that cannot be changed but many are amenable for corrections and curtailments. For example, better urban planning to encourage active lifestyle, subsidizing consumption of whole grains and possible taxing high calorie snacks, restricting media advertisement of unhealthy food, etc. Revitalizing old fashion healthier lifestyle, promoting old-fashioned foods using healthy herbs rather than oil and sugar, and educating people about choosing healthy/wholesome food over junks are among the steps that can be considered.
The aim of this study was to test the effect of a plant-based dietary intervention on beta-cell function in overweight adults with no history of diabetes. Participants (n = 75) were randomized to follow a low-fat plant-based diet (n = 38) or to make no diet changes (n = 37) for 16 weeks. At baseline and 16 weeks, beta-cell function was quantified with a mathematical model. Using a standard meal test, insulin secretory rate was calculated by C-peptide deconvolution. The Homeostasis Model Assessment (HOMA-IR) index was used to assess insulin resistance while fasting. A marked increase in meal-stimulated insulin secretion was observed in the intervention group compared with controls (interaction between group and time, Gxt, p < 0.001). HOMA-IR index fell significantly (p < 0.001) in the intervention group (treatment effect -1.0 (95% CI, -1.2 to -0.8); Gxt, p = 0.004). Changes in HOMA-IR correlated positively with changes in body mass index (BMI) and visceral fat volume (r = 0.34; p = 0.009 and r = 0.42; p = 0.001, respectively). The latter remained significant after adjustment for changes in BMI (r = 0.41; p = 0.002). Changes in glucose-induced insulin secretion correlated negatively with BMI changes (r = -0.25; p = 0.04), but not with changes in visceral fat. Beta-cell function and insulin sensitivity were significantly improved through a low-fat plant-based diet in overweight adults.
Background:
Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up.
Methods:
Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4-14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5-<25·0 kg/m(2).
Findings:
All-cause mortality was minimal at 20·0-25·0 kg/m(2) (HR 1·00, 95% CI 0·98-1·02 for BMI 20·0-<22·5 kg/m(2); 1·00, 0·99-1·01 for BMI 22·5-<25·0 kg/m(2)), and increased significantly both just below this range (1·13, 1·09-1·17 for BMI 18·5-<20·0 kg/m(2); 1·51, 1·43-1·59 for BMI 15·0-<18·5) and throughout the overweight range (1·07, 1·07-1·08 for BMI 25·0-<27·5 kg/m(2); 1·20, 1·18-1·22 for BMI 27·5-<30·0 kg/m(2)). The HR for obesity grade 1 (BMI 30·0-<35·0 kg/m(2)) was 1·45, 95% CI 1·41-1·48; the HR for obesity grade 2 (35·0-<40·0 kg/m(2)) was 1·94, 1·87-2·01; and the HR for obesity grade 3 (40·0-<60·0 kg/m(2)) was 2·76, 2·60-2·92. For BMI over 25·0 kg/m(2), mortality increased approximately log-linearly with BMI; the HR per 5 kg/m(2) units higher BMI was 1·39 (1·34-1·43) in Europe, 1·29 (1·26-1·32) in North America, 1·39 (1·34-1·44) in east Asia, and 1·31 (1·27-1·35) in Australia and New Zealand. This HR per 5 kg/m(2) units higher BMI (for BMI over 25 kg/m(2)) was greater in younger than older people (1·52, 95% CI 1·47-1·56, for BMI measured at 35-49 years vs 1·21, 1·17-1·25, for BMI measured at 70-89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46-1·56, vs 1·30, 1·26-1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI.
Interpretation:
The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations.
Funding:
UK Medical Research Council, British Heart Foundation, National Institute for Health Research, US National Institutes of Health.
Context:
Although a recent meta-analysis of randomized controlled trials showed that adoption of a vegetarian diet reduces plasma lipids, the association between vegetarian diets and long-term effects on plasma lipids has not been subjected to meta-analysis.
Objective:
The aim was to conduct a systematic review and meta-analysis of observational studies and clinical trials that have examined associations between plant-based diets and plasma lipids.
Data sources:
MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for articles published in English until June 2015.
Study selection:
The literature was searched for controlled trials and observational studies that investigated the effects of at least 4 weeks of a vegetarian diet on plasma lipids.
Data extraction:
Two reviewers independently extracted the study methodology and sample size, the baseline characteristics of the study population, and the concentrations and variance measures of plasma lipids. Mean differences in concentrations of plasma lipids between vegetarian and comparison diet groups were calculated. Data were pooled using a random-effects model.
Results:
Of the 8385 studies identified, 30 observational studies and 19 clinical trials met the inclusion criteria (N = 1484; mean age, 48.6 years). Consumption of vegetarian diets was associated with lower mean concentrations of total cholesterol (-29.2 and -12.5 mg/dL, P < 0.001), low-density lipoprotein cholesterol (-22.9 and -12.2 mg/dL, P < 0.001), and high-density lipoprotein cholesterol (-3.6 and -3.4 mg/dL, P < 0.001), compared with consumption of omnivorous diets in observational studies and clinical trials, respectively. Triglyceride differences were -6.5 (P = 0.092) in observational studies and 5.8 mg/dL (P = 0.090) in intervention trials.
Conclusions:
Plant-based diets are associated with decreased total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, but not with decreased triglycerides.
Systematic review registration:
PROSPERO number CRD42015023783. Available at: https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015023783.
Background: Despite growing evidence for food-based dietary patterns’ potential to reduce cardiovascular disease risk, knowledge about the amounts of food associated with the greatest change in risk of specific cardiovascular outcomes and about the quality of meta-evidence is limited.Therefore, the aim of this meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups (whole grains, refined grains, vegetables, fruit, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages [SSB]) and the risk of coronary heart disease (CHD), stroke and heart failure (HF).
Methods: We conducted a systematic search in PubMed and Embase up to March 2017 for prospective studies. Summary risk ratios (RRs) and 95% confidence intervals (95% CI) were estimated using a random effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships.
Results: Overall, 123 reports were included in the meta-analyses. An inverse association was present for whole grains (RRCHD: 0.95 (95% CI: 0.92-0.98), RRHF: 0.96 (0.95-0.97)), vegetables and fruits (RRCHD: 0.97 (0.96-0.99), and 0.94 (0.90-0.97); RRstroke: 0.92 (0.86-0.98), and 0.90 (0.84-0.97)), nuts (RRCHD: 0.67 (0.43-1.05)), and fish consumption (RRCHD: 0.88 (0.79-0.99), RRstroke: 0.86 (0.75-0.99), and RRHF: 0.80 (0.67-0.95)), while a positive association was present for egg (RRHF: 1.16 (1.03-1.31)), red meat (RRCHD: 1.15 (1.08-1.23), RRstroke: 1.12 (1.06-1.17), RRHF: 1.08 (1.02-1.14)), processed meat (RRCHD: 1.27 (1.09-1.49), RRstroke: 1.17 (1.02-1.34), RRHF: 1.12 (1.05-1.19)), and SSB consumption (RRCHD: 1.17 (1.11-1.23), RRstroke: 1.07 (1.02-1.12), RRHF: 1.08 (1.05-1.12)) in the linear dose-response meta-analysis. There were clear indications for non-linear dose-response relationships between whole grains, fruit, nuts, dairy, and red meat and CHD.
Conclusion: An optimal intake of whole grains, vegetables, fruit, nuts, legumes, dairy, fish, red and processed meat, eggs and SSB showed an important lower risk of CVD.
The importance of metabolic syndrome (MetS) lies in its associated risk of cardiovascular disease and type 2 diabetes, as well as other harmful conditions such as nonalcoholic fatty liver disease. In this report, the available scientific evidence on the associations between lifestyle changes and MetS and its components is reviewed to derive recommendations for MetS prevention and management. Weight loss through an energy-restricted diet together with increased energy expenditure. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute.
IMPORTANCE: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. OBJECTIVE: To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. DESIGN: A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. MAIN OUTCOMES AND MEASURES: Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year. RESULTS: Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115 mm Hg increased from 148 million (95% UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140 mm Hg or higher, the loss increased from 95.9 million (95% UI, 87.0-104.9 million) to 143.0 million (95% UI, 130.2-157.0 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0 million [95% UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg. CONCLUSIONS AND RELEVANCE: In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher.
Insulin resistance often refers to a pathological condition in which cells fail to respond to the normal actions of insulin. Increasing literature has noted a critical role of insulin resistance in the pathogenesis of ischemic stroke. Insulin resistance plays an important role in the pathogenesis of ischemic stroke via enhancing advanced changes of atherosclerosis. A variety of literature indicates that insulin resistance enhances platelet adhesion, activation and aggregation which are conducive to the occurrence of ischemic stroke. Insulin resistance also induces hemodynamic disturbances and contributes to the onset of ischemic stroke. In addition, insulin resistance may augment the role of the modifiable risk factors in ischemic stroke and induce the occurrence of ischemic stroke. Preclinical and clinical studies have supported that improving insulin resistance may be an effective measure to prevent or delay ischemic stroke.
Background/Objective
There is little randomised evidence using a whole food plant-based (WFPB) diet as intervention for elevated body mass index (BMI) or dyslipidaemia. We investigated the effectiveness of a community-based dietary programme. Primary end points: BMI and cholesterol at 6 months (subsequently extended).
Subjects
Ages 35–70, from one general practice in Gisborne, New Zealand. Diagnosed with obesity or overweight and at least one of type 2 diabetes, ischaemic heart disease, hypertension or hypercholesterolaemia. Of 65 subjects randomised (control n=32, intervention n=33), 49 (75.4%) completed the study to 6 months. Twenty-three (70%) intervention participants were followed up at 12 months.
Methods
All participants received normal care. Intervention participants attended facilitated meetings twice-weekly for 12 weeks, and followed a non-energy-restricted WFPB diet with vitamin B12 supplementation.
Results
At 6 months, mean BMI reduction was greater with the WFPB diet compared with normal care (4.4 vs 0.4, difference: 3.9 kg m⁻² (95% confidence interval (CI)±1), P<0.0001). Mean cholesterol reduction was greater with the WFPB diet, but the difference was not significant compared with normal care (0.71 vs 0.26, difference: 0.45 mmol l⁻¹ (95% CI±0.54), P=0.1), unless dropouts were excluded (difference: 0.56 mmol l⁻¹ (95% CI±0.54), P=0.05). Twelve-month mean reductions for the WFPB diet group were 4.2 (±0.8) kg m⁻² BMI points and 0.55 (±0.54, P=0.05) mmol l⁻¹ total cholesterol. No serious harms were reported.
Conclusions
This programme led to significant improvements in BMI, cholesterol and other risk factors. To the best of our knowledge, this research has achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy intake or mandate regular exercise.
Calorie restriction or changes in dietary composition can enhance healthy aging, but the inability of most subjects to adhere to chronic and extreme diets, as well as potentially adverse effects, limits their application. We randomized 100 generally healthy participants from the United States into two study arms and tested the effects of a fasting-mimicking diet (FMD)—low in calories, sugars, and protein but high in unsaturated fats—on markers/risk factors associated with aging and age-related diseases. We compared subjects who followed 3 months of an unrestricted diet to subjects who consumed the FMD for 5 consecutive days per month for 3 months. Three FMD cycles reduced body weight, trunk, and total body fat; lowered blood pressure; and decreased insulin-like growth factor 1 (IGF-1). No serious adverse effects were reported. After 3 months, control diet subjects were crossed over to the FMD program, resulting in a total of 71 subjects completing three FMD cycles. A post hoc analysis of subjects from both FMD arms showed that body mass index, blood pressure, fasting glucose, IGF-1, triglycerides, total and low-density lipoprotein cholesterol, and C-reactive protein were more beneficially affected in participants at risk for disease than in subjects who were not at risk. Thus, cycles of a 5-day FMD are safe, feasible, and effective in reducing markers/risk factors for aging and age-related diseases. Larger studies in patients with diagnosed diseases or selected on the basis of risk factors are warranted to confirm the effect of the FMD on disease prevention and treatment.
Importance: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions.
Objective: To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015.
Design: A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis.
Main Outcomes and Measures: Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year.
Results: Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115 mm Hg increased from 148 million (95% UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140 mm Hg or higher, the loss increased from 5.2 million (95% UI, 4.6-5.7 million) to 7.8 million (95% UI, 7.0-8.7 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0 million [95% UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg.
Conclusions and Relevance: In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher.
We investigated the association of the Finnish Diabetes Risk Score (FINDRISC) with insulin secretion, insulin sensitivity, and risk of type 2 diabetes, drug-treated hypertension, cardiovascular (CVD) events and total mortality in a follow-up study of the Metabolic Syndrome in Men (METSIM) cohort. The METSIM study includes 10,197 Finnish men, aged 45–73 years, and examined in 2005–2010. Of 8,749 non-diabetic participants of the METSIM study 693 developed incident type 2 diabetes, 225 started antihypertensive medication, 351 had a CVD event, and 392 died during a 8.2-year follow-up. The FINDRISC was significantly associated with decreases in insulin secretion and insulin sensitivity (P<0.0001), and with a 4.14-fold increased risk of incident type 2 diabetes, 2.43-fold increased risk of drug-treated hypertension, 1.61-fold increased risk of CVD, and 1.55-increased risk of total mortality (the FINDRISC ≥12 vs. < 12 points). In conclusion, the FINDRISC predicts impairment in insulin secretion and insulin sensitivity, the conversion to type 2 diabetes, drug-treated hypertension, CVD events and total mortality.
Objectives:
A vegetarian diet may prevent elevation of blood pressures and lower the risk for hypertension through lower degrees of obesity, inflammation, and insulin resistance. This study investigated the association between a vegetarian diet and hypertension incidence in a cohort of Taiwanese adult nonsmokers and examined whether this association was mediated through inflammation, abdominal obesity, or insulin resistance (using fasting glucose as a proxy).
Methods:
This matched cohort study was from the 1994-2008 MJ Health Screening Database. Each vegetarian was matched with five nonvegetarians by age, sex, and study site. The analysis included 4109 nonsmokers (3423 nonvegetarians and 686 vegetarians), followed for a median of 1.61 years. The outcome includes hypertension incidence, as well as SBP and DBP levels. Regression analysis was performed to assess the association between vegetarian diet and hypertension incidence or future blood pressure levels in the presence/absence of potential mediators.
Results:
Vegetarians had a 34% lower risk for hypertension, adjusting for age and sex (odds ratio: 0.66, 95% confidence interval: 0.50-0.87; SBP: -3.3 mmHg, P < 0.001; DBP: -1.5 mmHg, P < 0.001). The results stay statistically significant after further adjustment for C-reactive protein, waist circumference, and fasting glucose (odds ratio: 0.72, 95% confidence interval: 0.55-0.86; SBP: -2.4 mmHg, P < 0.05; DBP: -1.1 mmHg, P < 0.05). The protective association between vegetarian diet and hypertension appeared to be consistent across age groups.
Conclusion:
Taiwanese vegetarians had lower incidence of hypertension than nonvegetarians. Vegetarian diets may protect against hypertension beyond lower abdominal obesity, inflammation, and insulin resistance.
Summary
Background
Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries.
Methods
We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue.
Findings
We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6–17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9–29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world's men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m2). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women.
Interpretation
If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia.
Funding
Wellcome Trust, Grand Challenges Canada
Objective:
To examine the association of BMI percentile and change in BMI percentile to change in blood pressure (BP) percentile and development of hypertension (HTN).
Methods:
This retrospective cohort included 101 606 subjects age 3 to 17 years from 3 health systems across the United States. Height, weight, and BPs were extracted from electronic health records, and BMI and BP percentiles were computed with the appropriate age, gender, and height charts. Mixed linear regression estimated change in BP percentile, and proportional hazards regression was used to estimate risk of incident HTN associated with BMI percentile and change in BMI percentile.
Results:
The largest increases in BP percentile were observed among children and adolescents who became obese or maintained obesity. Over a median 3.1 years of follow-up, 0.3% of subjects developed HTN. Obese children ages 3 to 11 had twofold increased risk of developing HTN compared with healthy weight children. Obese children and adolescents had a twofold increased risk of developing HTN, and severely obese children had a more than fourfold increased risk. Compared with those who maintained a healthy weight, children and adolescents who became obese or maintained obesity had a more than threefold increased risk of incident HTN.
Conclusions:
We observed a strong, statistically significant association between increasing BMI percentile and increases in BP percentile, with risk of incident HTN associated primarily with obesity. The adverse impact of weight gain and obesity in this cohort over a short period underscores the early need for effective strategies for prevention of overweight and obesity.
Background:
Beneficial effects of vegetarian and vegan diets on health outcomes have been supposed in previous studies.
Objectives:
Aim of this study was to clarify the association between vegetarian, vegan diets, risk factors for chronic diseases, risk of all-cause mortality, incidence and mortality from cardio-cerebrovascular diseases, total cancer and specific type of cancer (colorectal, breast, prostate and lung), through meta-analysis.
Methods:
A comprehensive search of Medline, EMBASE, Scopus, The Cochrane Library and Google Scholar was conducted.
Results:
Eighty-six cross-sectional and 10 cohort prospective studies were included. The overall analysis among cross-sectional studies reported significant reduced levels of body mass index, total cholesterol, LDL-cholesterol, and glucose levels in vegetarians and vegans versus omnivores. With regard to prospective cohort studies, the analysis showed a significant reduced risk of incidence and/or mortality from ischemic heart disease (RR 0.75; 95% CI, 0.68 to 0.82) and incidence of total cancer (RR 0.92; 95% CI 0.87 to 0.98) but not of total cardiovascular and cerebrovascular diseases, all-cause mortality and mortality from cancer. No significant association was evidenced when specific types of cancer were analyzed. The analysis conducted among vegans reported significant association with the risk of incidence from total cancer (RR 0.85; 95% CI, 0.75 to 0.95), despite obtained only in a limited number of studies.
Conclusions:
This comprehensive meta-analysis reports a significant protective effect of a vegetarian diet versus the incidence and/or mortality from ischemic heart disease (-25%) and incidence from total cancer (-8%). Vegan diet conferred a significant reduced risk (-15%) of incidence from total cancer.
A high blood level of low-density lipoprotein cholesterol (LDL-C) remains a major risk factor for atherosclerotic cardiovascular disease (ASCVD) (1), although data from 2005 through 2012 has shown a decline in high cholesterol (total and LDL cholesterol) along with an increase in the use of cholesterol-lowering medications (2-4). The most recent national guidelines (published in 2013) from the American College of Cardiology and the American Heart Association (ACC/AHA) expand previous recommendations for reducing cholesterol to include lifestyle modifications and medication use as part of complete cholesterol management and to lower risk for ASCVD (5-8). Because changes in cholesterol treatment guidelines might magnify existing disparities in care and medication use, it is important to describe persons currently eligible for treatment and medication use, particularly as more providers implement the 2013 ACC/AHA guidelines. To understand baseline estimates of U.S. adults on or eligible for cholesterol treatment, as well as to identify sex and racial/ethnic disparities, CDC analyzed data from the 2005-2012 National Health and Nutrition Examination Surveys (NHANES). Because the 2013 ACC/AHA guidelines focus on initiation or continuation of cholesterol treatment, adults meeting the guidelines' eligibility criteria as well as adults who were currently taking cholesterol-lowering medication were assessed as a group. Overall, 36.7% of U.S. adults or 78.1 million persons aged ≥21 years were on or eligible for cholesterol treatment. Within this group, 55.5% were currently taking cholesterol-lowering medication, and 46.6% reported making lifestyle modifications, such as exercising, dietary changes, or controlling their weight, to lower cholesterol; 37.1% reported making lifestyle modifications and taking medication, and 35.5% reported doing neither. Among adults on or eligible for cholesterol-lowering medication, the proportion taking cholesterol-lowering medication was higher for women than men and for non-Hispanic whites (whites) than Mexican-Americans and non-Hispanic blacks (blacks). Further efforts by clinicians and public health practitioners are needed to implement complementary and targeted patient education and disease management programs to reduce sex and racial/ethnic disparities among adults eligible for treatment of cholesterol.
Background
Vegetarian diets exclude all animal flesh and are being widely adopted by an increasing number of people; however, effects on blood lipid concentrations remain unclear. This meta‐analysis aimed to quantitatively assess the overall effects of vegetarian diets on blood lipids.
Methods and Results
We searched PubMed, Scopus, Embase, ISI Web of Knowledge, and the Cochrane Library through March 2015. Studies were included if they described the effectiveness of vegetarian diets on blood lipids (total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, and triglyceride). Weighted mean effect sizes were calculated for net changes by using a random‐effects model. We performed subgroup and univariate meta‐regression analyses to explore sources of heterogeneity. Eleven trials were included in the meta‐analysis. Vegetarian diets significantly lowered blood concentrations of total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, and non–high‐density lipoprotein cholesterol, and the pooled estimated changes were −0.36 mmol/L (95% CI −0.55 to −0.17; P<0.001), −0.34 mmol/L (95% CI −0.57 to −0.11; P<0.001), −0.10 mmol/L (95% CI −0.14 to −0.06; P<0.001), and −0.30 mmol/L (95% CI −0.50 to −0.10; P=0.04), respectively. Vegetarian diets did not significantly affect blood triglyceride concentrations, with a pooled estimated mean difference of 0.04 mmol/L (95% CI −0.05 to 0.13; P=0.40).
Conclusions
This systematic review and meta‐analysis provides evidence that vegetarian diets effectively lower blood concentrations of total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, and non–high‐density lipoprotein cholesterol. Such diets could be a useful nonpharmaceutical means of managing dyslipidemia, especially hypercholesterolemia.
BACKGROUND:
Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitate organization and planning of evidence-based stroke care.
OBJECTIVES:
This study aims to estimate incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke (IS) and hemorrhagic stroke (HS) for 188 countries from 1990 to 2013.
METHODOLOGY:
Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated using all available data on mortality and stroke incidence, prevalence and excess mortality. Statistical models and country-level covariate data were employed, and all rates were age-standardized to a global population. All estimates were produced with 95% uncertainty intervals (UIs).
RESULTS:
In 2013, there were globally almost 25.7 million stroke survivors (71% with IS), 6.5 million deaths from stroke (51% died from IS), 113 million DALYs due to stroke (58% due to IS) and 10.3 million new strokes (67% IS). Over the 1990-2013 period, there was a significant increase in the absolute number of DALYs due to IS, and of deaths from IS and HS, survivors and incident events for both IS and HS. The preponderance of the burden of stroke continued to reside in developing countries, comprising 75.2% of deaths from stroke and 81.0% of stroke-related DALYs. Globally, the proportional contribution of stroke-related DALYs and deaths due to stroke compared to all diseases increased from 1990 (3.54% (95% UI 3.11-4.00) and 9.66% (95% UI 8.47-10.70), respectively) to 2013 (4.62% (95% UI 4.01-5.30) and 11.75% (95% UI 10.45-13.31), respectively), but there was a diverging trend in developed and developing countries with a significant increase in DALYs and deaths in developing countries, and no measurable change in the proportional contribution of DALYs and deaths from stroke in developed countries.
CONCLUSION:
Global stroke burden continues to increase globally. More efficient stroke prevention and management strategies are urgently needed to halt and eventually reverse the stroke pandemic, while universal access to organized stroke services should be a priority.
Several previous cross-sectional studies have shown that vegetarians have a better metabolic profile than non-vegetarians, suggesting that a vegetarian dietary pattern may help prevent chronic degenerative diseases. However, longitudinal studies on the impact of vegetarian diets on metabolic traits are scarce. We studied how several sub-types of vegetarian diets affect metabolic traits, including waist circumference, BMI, systolic blood pressure (SBP), diastolic blood pressure, fasting blood glucose, total cholesterol (TC), HDL, LDL, TAG and TC:HDL ratio, through both cross-sectional and longitudinal study designs. The study used the MJ Health Screening database, with data collected from 1994 to 2008 in Taiwan, which included 4415 lacto-ovo-vegetarians, 1855 lacto-vegetarians and 1913 vegans; each vegetarian was matched with five non-vegetarians based on age, sex and study site. In the longitudinal follow-up, each additional year of vegan diet lowered the risk of obesity by 7 % (95 % CI 0·88, 0·99), whereas each additional year of lacto-vegetarian diet lowered the risk of elevated SBP by 8 % (95 % CI 0·85, 0·99) and elevated glucose by 7 % (95 % CI 0·87, 0·99), and each additional year of ovo-lacto-vegetarian diet increased abnormal HDL by 7 % (95 % CI 1·03, 1·12), compared with non-vegetarians. In the cross-sectional comparisons, all sub-types of vegetarians had lower likelihoods of abnormalities compared with non-vegetarians on all metabolic traits (
P
<0·001 for all comparisons), except for HDL and TAG. The better metabolic profile in vegetarians is partially attributable to lower BMI. With proper management of TAG and HDL, along with caution about the intake of refined carbohydrates and fructose, a plant-based diet may benefit all aspects of the metabolic profile.
It has been demonstrated that a vegetarian diet may be effective in reducing body weight, however, the underlying mechanisms are not entirely clear. We investigated whether there is a difference in resting energy expenditure between 26 vegetarians and 26 non-vegetarians and the correlation between some nutritional factors and inflammatory markers with resting energy expenditure. In this cross-sectional study, vegetarians and non-vegetarians were matched by age, body mass index and gender. All underwent instrumental examinations to assess the difference in body composition, nutrient intake and resting energy expenditure. Biochemical analyses and 12 different cytokines and growth factors were measured as an index of inflammatory state. A higher resting energy expenditure was found in vegetarians than in non-vegetarians (p = 0.008). Furthermore, a higher energy from diet, fibre, vegetable fats intake and interleukin-β (IL-1β) was found between the groups. In the univariate and multivariable analysis, resting energy expenditure was associated with vegetarian diet, free-fat mass and vegetable fats (p < 0.001; Slope in statistic (B) = 4.8; β = 0.42). After adjustment for cytokines, log10 interleukin-10 (IL-10) still correlated with resting energy expenditure (p = 0.02). Resting energy expenditure was positively correlated with a specific component of the vegetarian's diet, i.e., vegetable fats. Furthermore, we showed that IL-10 was positively associated with resting energy expenditure in this population
Background:
Recent trends in the prevalence of metabolic syndrome (MetS) and its components among U.S. adults are not known.
Methods:
We performed an updated analysis using the National Health and Nutrition Examination Survey 2007-2014 data to investigate the latest trends of prevalence of MetS and its components. MetS was defined based on the modified National Cholesterol Education Program-Adult Treatment Panel III criteria. Multiple regression models were used to assess linear trends over the years, after adjusting for sex, age, and race/ethnicity, as appropriate. Sampling weights were considered to account for complex sampling design, and all estimates were adjusted by age by a direct method.
Results:
During 2007-2014, the age-adjusted weighted prevalence (±standard error) of MetS among U.S. adults was 34.3 ± 0.8%. In age-stratified analysis, 54.9 ± 1.7% of elderly population aged 60 and over had MetS. When evaluating trends from 2007 to 2014, the prevalence of MetS remained stable in all sex, age, and race/ethnicity groups (P-trends > 0.100 for all). Among the components of MetS, the prevalence of hypertriglyceridemia and fasting hyperglycemia decreased (P-trend <0.050). However, the prevalence of abdominal obesity significantly increased, especially in women (P-trend = 0.009). The prevalence of elevated blood pressure and low high-density lipoprotein cholesterol level remained stable.
Conclusions:
The prevalence of MetS remained stable during 2007-2014. However, it was still prevalent in the U.S., especially among the elderly population. The prevalence of abdominal obesity continued to increase in women for which more efforts should be made.
Men's mental health and how they think about their health are critical to the future of men's health. Poor health choice patterns are established under age 50, when men are twice as likely to die than women. As the future of medicine focuses on quality and value, a better understanding of the social determinants of men's health will identify areas for improvement. The presentation of a man to a clinician's office with a sexual health complaint presents an opportunity for more complete evaluation. The future of men's health will be well served by integrated men's health centers that focus on the entire man.
Background: Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods: We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings: We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6–17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9–29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world's men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m2). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women. Interpretation: If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia.
Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.
Although there is measurable global progress in prevention of cardiovascular disease (CVD), it has been highly uneven and inadequate, particularly in low- and middle-income countries. Voluntary global targets have helped to galvanize attention, resources and accountability on tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity which are the major behavioural drivers of CVD. Many obstacles and challenges continue to impede the progress of cardiovascular prevention. The inclusion of noncommunicable diseases (NCDs) in the sustainable development agenda as a specific target, offers an unprecedented opportunity to further advance the global progress of cardiovascular prevention. In order to seize this opportunity, a paradigm shift is required in the way key challenges to cardiovascular prevention are addressed. Such an approach must provide leadership for intersectoral policy coherence, identify effective means of tackling commercial determinants of behavioural risk factors, use rights based arguments, enhance public engagement and ensure accountability.
Importance
In the United States, national associations of individual dietary factors with specific cardiometabolic diseases are not well established.
Objective
To estimate associations of intake of 10 specific dietary factors with mortality due to heart disease, stroke, and type 2 diabetes (cardiometabolic mortality) among US adults.
Design, Setting, and Participants
A comparative risk assessment model incorporated data and corresponding uncertainty on population demographics and dietary habits from National Health and Nutrition Examination Surveys (1999-2002: n = 8104; 2009-2012: n = 8516); estimated associations of diet and disease from meta-analyses of prospective studies and clinical trials with validity analyses to assess potential bias; and estimated disease-specific national mortality from the National Center for Health Statistics.
Exposures
Consumption of 10 foods/nutrients associated with cardiometabolic diseases: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium.
Main Outcomes and Measures
Estimated absolute and percentage mortality due to heart disease, stroke, and type 2 diabetes in 2012. Disease-specific and demographic-specific (age, sex, race, and education) mortality and trends between 2002 and 2012 were also evaluated.
Results
In 2012, 702 308 cardiometabolic deaths occurred in US adults, including 506 100 from heart disease (371 266 coronary heart disease, 35 019 hypertensive heart disease, and 99 815 other cardiovascular disease), 128 294 from stroke (16 125 ischemic, 32 591 hemorrhagic, and 79 578 other), and 67 914 from type 2 diabetes. Of these, an estimated 318 656 (95% uncertainty interval [UI], 306 064-329 755; 45.4%) cardiometabolic deaths per year were associated with suboptimal intakes—48.6% (95% UI, 46.2%-50.9%) of cardiometabolic deaths in men and 41.8% (95% UI, 39.3%-44.2%) in women; 64.2% (95% UI, 60.6%-67.9%) at younger ages (25-34 years) and 35.7% (95% UI, 33.1%-38.1%) at older ages (≥75 years); 53.1% (95% UI, 51.6%-54.8%) among blacks, 50.0% (95% UI, 48.2%-51.8%) among Hispanics, and 42.8% (95% UI, 40.9%-44.5%) among whites; and 46.8% (95% UI, 44.9%-48.7%) among lower-, 45.7% (95% UI, 44.2%-47.4%) among medium-, and 39.1% (95% UI, 37.2%-41.2%) among higher-educated individuals. The largest numbers of estimated diet-related cardiometabolic deaths were related to high sodium (66 508 deaths in 2012; 9.5% of all cardiometabolic deaths), low nuts/seeds (59 374; 8.5%), high processed meats (57 766; 8.2%), low seafood omega-3 fats (54 626; 7.8%), low vegetables (53 410; 7.6%), low fruits (52 547; 7.5%), and high SSBs (51 694; 7.4%). Between 2002 and 2012, population-adjusted US cardiometabolic deaths per year decreased by 26.5%. The greatest decline was associated with insufficient polyunsaturated fats (−20.8% relative change [95% UI, −18.5% to −22.8%]), nuts/seeds (−18.0% [95% UI, −14.6% to −21.0%]), and excess SSBs (−14.5% [95% UI, −12.0% to −16.9%]). The greatest increase was associated with unprocessed red meats (+14.4% [95% UI, 9.1%-19.5%]).
Conclusions and Relevance
Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.
Aims:
Systemic levels of trimethylamine N-oxide (TMAO), a pro-atherogenic and pro-thrombotic metabolite produced from gut microbiota metabolism of dietary trimethylamine (TMA)-containing nutrients such as choline or carnitine, predict incident cardiovascular event risks in stable primary and secondary prevention subjects. However, the prognostic value of TMAO in the setting of acute coronary syndromes (ACS) remains unknown.
Methods and results:
We investigated the relationship of TMAO levels with incident cardiovascular risks among sequential patients presenting with ACS in two independent cohorts. In the Cleveland Cohort, comprised of sequential subjects (n = 530) presenting to the Emergency Department (ED) with chest pain of suspected cardiac origin, an elevated plasma TMAO level at presentation was independently associated with risk of major adverse cardiac events (MACE, including myocardial infarction, stroke, need for revascularization, or death) over the ensuing 30-day (4th quartile (Q4) adjusted odds ratio (OR) 6.30, 95% confidence interval (CI), 1.89-21.0, P < 0.01) and 6-month (Q4 adjusted OR 5.65, 95%CI, 1.91-16.7; P < 0.01) intervals. TMAO levels were also a significant predictor of the long term (7-year) mortality (Q4 adjusted HR 1.81, 95%CI, 1.04-3.15; P < 0.05). Interestingly, TMAO level at initial presentation predicted risk of incident MACE over the near-term (30 days and 6 months) even among subjects who were initially negative for troponin T (< 0.1 ng/mL) (30 days, Q4 adjusted OR 5.83, 95%CI, 1.79-19.03; P < 0.01). The prognostic value of TMAO was also assessed in an independent multicentre Swiss Cohort of ACS patients (n = 1683) who underwent coronary angiography. Trimethylamine N-oxide again predicted enhanced MACE risk (1-year) (adjusted Q4 hazard ratios: 1.57, 95% CI, 1.03-2.41; P <0.05).
Conclusion:
Plasma TMAO levels among patients presenting with chest pain predict both near- and long-term risks of incident cardiovascular events, and may thus provide clinical utility in risk stratification among subjects presenting with suspected ACS.
It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage. Vegetarians and vegans are at reduced risk of certain health conditions, including ischemic heart disease, type 2 diabetes, hypertension, certain types of cancer, and obesity. Low intake of saturated fat and high intakes of vegetables, fruits, whole grains, legumes, soy products, nuts, and seeds (all rich in fiber and phytochemicals) are characteristics of vegetarian and vegan diets that produce lower total and low-density lipoprotein cholesterol levels and better serum glucose control. These factors contribute to reduction of chronic disease. Vegans need reliable sources of vitamin B-12, such as fortified foods or supplements.
Recent findings from meta-analyses, European cohorts and randomised controlled trials (RCTs) evaluating the relationship between plant-based dietary regimes (i.e. those with an emphasis on plant foods, such as vegetarian, vegan, Mediterranean or combination diets), and the incidence of, or risk factors for, cardiovascular disease (CVD), type 2 diabetes (T2D) and obesity are considered in this review. Evidence from meta-analyses of epidemiological studies indicates that those following plant-based dietary regimes have around 20–25% lower risk of developing CVD and a similar reduced risk of developing T2D. Evidence from RCTs indicates that those following plant-based dietary regimes have lower total cholesterol, low-density lipoprotein-cholesterol and blood pressure, and modest reductions in inflammatory and endothelial markers. Higher intake of plant foods has been associated with lower incidence of obesity, lower BMI and smaller waist circumference. For weight loss, it seems that following a plant-based dietary regime results in weight loss comparable to that achieved on conventional reduced calorie diets, but with better overall weight management. The totality of evidence indicates there are benefits for cardiovascular health, risk of developing T2D and weight management from following a plant-based dietary regime. From a nutritional perspective, plant-based diets tend to be lower in saturated fatty acids, higher in unsaturated fatty acids and fibre, and lower in energy density than typical ‘Western’ diets. These qualities may be at the core of the health benefits reported and/or it may be simply a greater proportion of plant foods in the diet that is beneficial in its own right.
In 2013, the American Heart Association and American College of Cardiology published the "Guideline on Lifestyle Management to Reduce Cardiovascular Risk," which was based on a systematic review originally initiated by the National Heart, Lung, and Blood Institute. The guideline supports the American Heart Association's 2020 Strategic Impact Goals for cardiovascular health promotion and disease reduction by providing more specific details for adopting evidence-based diet and lifestyle behaviors to achieve those goals. In addition, the 2015-2020 Dietary Guidelines for Americans issued updated evidence relevant to reducing cardiovascular risk and provided additional recommendations for adopting healthy diet and lifestyle approaches. This scientific statement, intended for healthcare providers, summarizes relevant scientific and translational evidence and offers practical tips, tools, and dietary approaches to help patients/clients adapt these guidelines according to their sociocultural, economic, and taste preferences.
Plant-based dietary interventions have been proposed to reduce obesity induced chronic low-grade inflammation and hence prevent chronic disease risk; however, human evidence remains unclear. This systematic review and meta-analysis of intervention trials aimed to assess the effect of plant-based diets on obesity-related inflammatory biomarker profiles. Medline, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for articles published until January 2016 and mean differences in biomarkers of inflammatory status were assessed for: C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-ɑ), soluble intercellular adhesion molecule 1 (sICAM), leptin, adiponectin and resistin. Of initially identified 2,583 publications, 29 met the meta-analysis inclusion criteria [a total of 2,689 participants]. Consumption of plant-based diets was associated with a reduction in the mean concentrations of the following biomarkers: CRP [effect size, -0.55 mg/l, 95% confidence intervals (CI): -0.78; -0.32, I(2) = 94.4%], IL-6 [effect size, -0.25 ng/l, 95% CI: -0.56; 0.06, I(2) = 74%], and, to some degree, sICAM (-25.07 ng/ml [95% CI: -52.32; 2.17, I(2) = 93.2%]). No substantial effects were revealed for TNF-ɑ, resistin, adiponectin and leptin. Plant-based diets are associated with an improvement in obesity-related inflammatory profiles and could provide means for therapy and prevention of chronic disease risk. © 2016 World Obesity.
and Purpose—Fiber intake is associated with reduced stroke risk in prospective studies, but no meta-analysis has been published to date. Methods—Multiple electronic databases were searched for healthy participant studies reporting fiber intake and incidence of first hemorrhagic or ischemic stroke, published between January 1990 and May 2012. Results—Eight cohort studies from the United States, northern Europe, Australia, and Japan met inclusion criteria. Total dietary fiber intake was inversely associated with risk of hemorrhagic plus ischemic stroke, with some evidence of heterogeneity between studies (I2; relative risk per 7 g/day, 0.93; 95% confidence interval, 0.88–0.98; I2=59%). Soluble fiber intake, per 4 g/day, was not associated with stroke risk reduction with evidence of low heterogeneity between studies, relative risk 0.94 (95% confidence interval, 0.88–1.01; I2=21%). There were few studies reporting stroke risk in relation to insoluble fiber or fiber from cereals, fruit, or vegetables. Conclusions—Greater dietary fiber intake is significantly associated with lower risk of first stroke. Overall, findings support dietary recommendations to increase intake of total dietary fiber. However, a paucity of data on fiber from different foods precludes conclusions regarding the association between fiber type and stroke. There is a need for future studies to focus on fiber type and to examine risk for ischemic and hemorrhagic strokes separately.
ACC/AHA
: American College of Cardiology/American Heart Association
ACCF/AHA
: American College of Cardiology Foundation/American Heart Association
ACE
: angiotensin-converting enzyme
ACEI
: angiotensin-converting enzyme inhibitor
ACS
: acute coronary syndrome
AF
: atrial fibrillation
BACKGROUND:
Prospective studies of red meat consumption and risk of stroke have provided inconsistent results. We aimed to assess this association by conducting a meta-analysis of prospective cohort studies.
METHODS:
Relevant studies were identified by searching PubMed and EMBASE through April 1, 2013. Summary relative risks (RR) and the corresponding 95% confidence intervals (CIs) were estimated by random-effect or fixed-effect models.
RESULTS:
Seven prospective cohort studies were included in the analyses, involving 2,079,236 subjects and 21,730 strokes cases. Total red meat consumption was associated with total stroke (RR = 1.14, 95% CI 1.05-1.24), cerebral infarction (RR = 1.13, 95% CI 1.0-1.28), and ischemic stroke (RR = 1.22, 95% CI 1.01-1.46). A significant association was found between consumption of processed red meat and total stroke (RR = 1.17, 95% CI 1.09-1.27). Consumption of fresh red meat was significantly associated with total stroke (RR = 1.13, 95% CI 1.04-1.22) and ischemic stroke (RR = 1.15, 95% CI 1.03-1.29). However, no evidence suggests that any type of meat was associated with hemorrhagic stroke. Also, no association was found between consumption of processed red meat and ischemic stroke (RR = 1.15, 95% CI .98-1.36) and between consumption of fresh red meat and cerebral infarction (RR = 1.06, 95% CI [.94, 1.20]). A significant risk for total stroke could be observed when the consumption of total red meat was above 50 g/day, processed red meat was just above 0 g/day, and fresh red meat was above 70 g/day.
CONCLUSION:
Our findings indicate that high consumption of red meat, especially processed red meat, will increase the risk of stroke.
1 From the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom (A-CV, TN, DR, TM, PV, ER, and PHMP); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht,
The age-specific relevance of blood pressure to cause-specific mortality is best assessed by collaborative meta-analysis of individual participant data from the separate prospective studies. Methods Information was obtained on each of one million adults with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality. During 12.7 million person-years at risk, there were about 56 000 vascular deaths (12 000 stroke, 34000 ischaemic heart disease [IHD], 10000 other vascular) and 66 000 other deaths at ages 40-89 years. Meta-analyses, involving "time-dependent" correction for regression dilution, related mortality during each decade of age at death to the estimated usual blood pressure at the start of that decade. Findings Within each decade of age at death, the proportional difference in the risk of vascular death associated with a given absolute difference in usual blood pressure is about the same down to at least 115 mm Hg usual systolic blood pressure (SBP) and 75 mm Hg usual diastolic blood pressure (DBP), below which there is little evidence. At ages 40-69 years, each difference of 20 mm Hg usual SBP (or, approximately equivalently, 10 mm Hg usual DBP) is associated with more than a twofold difference in the stroke death rate, and with twofold differences in the death rates from IHD and from other vascular causes. All of these proportional differences in vascular mortality are about half as extreme at ages 80-89 years as at,ages 40-49 years, but the annual absolute differences in risk are greater in old age. The age-specific associations are similar for men and women, and for cerebral haemorrhage and cerebral ischaemia. For predicting vascular mortality from a single blood pressure measurement, the average of SBP and DBP is slightly more informative than either alone, and pulse pressure is much less informative. Interpretation Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.
Cardiovascular disease (CVD) is a leading cause of death among adults in the United States. To improve the cardiovascular health of the U.S. population, clinical practice guidelines recommend screening children and adolescents for risk factors associated with CVD, including abnormal blood cholesterol levels. This report provides 2011-2014 estimates from the National Health and Nutrition Examination Survey (NHANES) on the prevalence of high total cholesterol, low high-density lipoprotein (HDL) cholesterol, and high non-HDL cholesterol among children and adolescents aged 6-19. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.