Article

Plant-based Diet and Adiposity Over Time in a Middle-aged and Elderly Population: The Rotterdam Study

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Abstract

Background: We aimed to explore whether adhering to a more plant-based diet, beyond strict vegan or vegetarian diets, may help prevent adiposity in a middle-aged and elderly population. Methods: We included 9,633 participants from the Rotterdam Study, a prospective cohort in the Netherlands. Dietary data were collected using food-frequency questionnaires at baseline of three subcohorts of the Rotterdam Study (1989-1993, 2000-2001, 2006-2008). We created a plant-based diet index by giving plant-based foods positive scores and animal-based foods reverse scores. A higher score on the index reflected an overall more plant-based and less animal-based diet. Data on anthropometrics and body composition (using dual energy X-ray absorptiometry) were collected every 3-5 years from 1989 to 2016. We used multivariable linear mixed models to analyze the associations. Results: In the 9,633 participants, baseline plant-based diet score ranged from 21.0 to 73.0 with a mean ± SD of 49.0 ± 7.0. In multivariable-adjusted analyses, higher adherence to a plant-based diet was associated with lower BMI, waist circumference, fat mass index, and body fat percentage across a median follow-up period of 7.1 years (per 10 points higher score, BMI: β = -0.70 kg/m [95% CI = -0.81, -0.59]; waist circumference: -2.0 cm [-2.3, -1.7]; fat mass index: -0.66 kg/m [-0.80, -0.52]; body fat percentage: -1.1 points [-1.3, -0.84]). Conclusions: In this population-based cohort of middle-aged and elderly participants, a higher adherence to a more plant-based, less animal-based diet was associated with less adiposity over time, irrespective of general healthfulness of the specific plant- and animal-based foods.

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... It is well-established that diets higher in plant-based foods and with fewer animal source foods confer both health and environmental benefits [1][2][3]. Plant-based diets have been associated with a lower risk of various diseases [4][5][6][7][8][9][10][11], including a lower risk of obesity [12][13][14][15][16][17][18][19], which is among the greatest contributors to premature mortality [20][21][22]. Moreover, whereas strict vegan or vegetarian diets might not be easily embraced within the general population, provegetarian diets (i.e., preferentially but not exclusively consuming plant-derived foods) based on gradual dietary changes may be easier to adopt. ...
... The associations observed between a general preference for plant-derived foods and lower risk of overweight/obesity are consistent with previous research [12][13][14][15][16][17][18][19][20]. In particular, preference for less-healthy plant foods was associated with an increased risk of overweight/obesity compared with preferential selection of healthier plant foods, as could be expected. ...
... Therefore, it seems that healthy plant foods could apparently be driving the observed beneficial effect. The associations were also moderately attenuated by giving healthier animal foods positive scores [12]. Additionally, another study found that a greater consumption of sugar-sweetened beverages and ultra-processed food was associated with a higher risk of being overweight among vegetarians [50], which further supports our results. ...
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Provegetarian diets (i.e., preference for plant-derived foods but not exclusion of animal foods) have been associated with a reduced risk of long-term weight gain and could be more easily embraced than strict vegetarian diets. However, not all plant-derived foods are equally healthy. In the “Seguimiento Universidad de Navarra” (SUN) cohort, we prospectively evaluated the association between different provegetarian food patterns and the incidence of overweight/obesity in 11,554 participants with initial body mass index <25 kg/m2. A provegetarian food pattern (FP) was built by assigning positive scores to plant foods and reverse scores to animal foods. A healthful and an unhealthful provegetarian FP, which distinguished between healthy (fruits/vegetables/whole grains/nuts/legumes/olive oil/coffee) and less-healthy plant foods (fruit juices/potatoes/refined grains/pastries/sugary beverages), were also built. A total of 2320 new cases of overweight or obesity were identified after a median follow-up of 10.3 years. Higher baseline conformity with the overall provegetarian FP was inversely associated with overweight/obesity (HR comparing extreme quintiles: 0.85; 95% CI: 0.75 to 0.96; p-trend: 0.014). This association was stronger for the healthful FP (HR: 0.78; 95% CI: 0.67 to 0.90; p-trend: <0.001) and was not apparent for the unhealthful FP (HR: 1.07; 95% CI: 0.92 to 1.23; p-trend: 0.551). In a large prospective cohort of relatively young adults, better conformity with a healthy provegetarian diet was associated with a reduced long-term risk of overweight/obesity, whereas no consistent trend was found for a FP that emphasized less-healthy plant foods.
... After applying the eligibility criteria to 140 full papers, 7 publications including 9 cohorts were identified to be included in the review. We excluded a study that assessed changes in PDIs and body weight change in a duplicate cohort and included the publication with a greater number of anthropometric and adiposity measures (Chen et al. 2019). Table 2 summarizes study characteristics and Table 3 Table S4 summarizes the outcomes and variables included in the most adjusted model for each study. ...
... There were no significant associations between the PDI and fat mass or waist circumference. Chen et al. assessed the association between PDI and BMI, fat mass, waist circumference, and body fat percentage in the Rotterdam study (Chen et al. 2019). Comparing extreme quantiles, PDI was associated with 2.3 kg/m 2 lower BMI (95% CI: −1.6, −0.99, p trend <0.0001), 4.1 lower waist circumference (95% CI: −4.8, −3.3, p trend <0.0001), 1.5 lower fat mass index score (95% CI: −1.8, −1.2, p for trend <0.0001), and 2.9% lower body fat % (95% CI: ...
... Stratified analyses indicating a stronger association among normal weight groups compared to those with obesity suggest that combined weight group analyses present underestimated associations (Gómez-Donoso et al. 2019;Satija et al. 2019;Waterplas et al. 2020;Wang et al. 2021). Although Chen et al. found no difference when individuals with obesity were included or not, the dietary patterns may have been more homogeneous among the Dutch cohort (Chen et al. 2019). The lack of association among cohorts with overweight/obesity may be explained by lower quality dietary patterns in this group, and a narrow distribution of dietary quality to detect an association. ...
Article
The worldwide prevalence of obesity and its co-morbidities is staggering, and elevated body mass index represents a leading risk factor of death globally. Consistent evidence demonstrates a high-quality plant-based diet as an effective intervention for weight management, although it may be particularly challenging to adopt in its entirety for habitual meat consumers or individuals with especially poor-quality diets. Plant-based diets are increasingly studied using indices such as the overall plant-based diet index (PDI), healthful PDI, and unhealthful PDI, which offer more flexibility than a binary classification of vegetarianism and better facilitate translation into dietary recommendations. We summarized these recently accumulated studies to comprehensively evaluate plant-based diets in relation to obesity risk. We searched Medline, Embase, and CINAHL databases through January 2022 and identified 9 prospective adult cohorts. Reporting of results was consistent with PRISMA guidelines and certainty of the evidence was assessed using domains from GRADE. The PDI had a protective association with body weight gain and adiposity. Emphasis of healthful plant foods strengthened this association and emphasis of unhealthful plant foods demonstrated either a positive or null association. The certainty of the evidence was considered moderate. These findings have wide application to inform dietary interventions and sustainable policy recommendations. Prospero ID: CRD42020198143.
... A variety of eating patterns have been reported to be beneficial for weight loss and reduced cardiometabolic risk, including plant-based (13) , Mediterranean (14) , vegan/ vegetarian (15) , Paleo (16) , low-carb (17) or gluten-free (18) . Given the high prevalence of overweight and obesity associated with typical US dietary intake patterns (19,20) , studying individuals who report long-term adherence to diets lower in refined foods, higher in fibre and containing more fruits and vegetables can provide important examples of lifestyle choices that may support higher dietary quality or healthier weight. ...
... Emerging evidence from longitudinal studies shows that higher conformity to more plant-based diets is associated with less weight gain (13,34) , less gain in abdominal adiposity (13) and reduced risk of becoming overweight or obese (34) . Noteworthy is the observation that weight gain is not mitigated in followers of plant-based diets when these diets are considered 'less healthy', that is, diets high in sugary foods and beverages, refined gains and desserts (35) . ...
... Emerging evidence from longitudinal studies shows that higher conformity to more plant-based diets is associated with less weight gain (13,34) , less gain in abdominal adiposity (13) and reduced risk of becoming overweight or obese (34) . Noteworthy is the observation that weight gain is not mitigated in followers of plant-based diets when these diets are considered 'less healthy', that is, diets high in sugary foods and beverages, refined gains and desserts (35) . ...
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Objective To describe characteristics of self-identified popular diet followers and compare mean BMI across these diets, stratified by time following diet. Design Cross-sectional, web-based survey administered in 2015. Setting Non-localised, international survey. Participants Self-selected followers of popular diets ( n 9019) were recruited to the survey via social media and email announcements by diet community leaders, categorised into eight major diet groups. Results General linear models were used to compare mean BMI among (1) short-term (<1 year) and long-term (≥1 year) followers within diet groups and (2) those identifying as ‘try to eat healthy’ (TTEH) to all other diet groups, stratified by time following the specific diet. Participants were 82 % female, 93 % White and 96 % non-Hispanic. Geometric mean BMI was lower ( P < 0·05 for all) among longer-term followers (≥1 year) of whole food, plant-based (WFPB), vegan, whole food and low-carb diets compared with shorter-term followers. Among those following their diet for 1–5 years ( n 4067), geometric mean BMI (kg/m ² ) were lower ( P < 0·05 for all) for all groups compared with TTEH (26·4 kg/m ² ): WFPB (23·2 kg/m ² ), vegan (23·5 kg/m ² ), Paleo (24·6 kg/m ² ), vegetarian (25·0 kg/m ² ), whole food (24·6 kg/m ² ), Weston A. Price (23·5 kg/m ² ) and low-carb (24·7 kg/m ² ). Conclusion Our findings suggest that BMI is lower among individuals who made active decisions to adhere to a specific diet, particularly more plant-based diets and/or diets limiting highly processed foods, compared with those who simply TTEH. BMI is also lower among individuals who follow intentional eating plans for longer time periods.
... 17,18 Individuals adhering to vegetarian diets typically have lower BMI, and lower incidences of heart disease, type II diabetes, and hypertension. [19][20][21][22][23] One reason for these findings could be plant-based products are rich in polyphenols, antioxidants, and fiber that decrease inflammation and promote insulin sensitivity. 14,[24][25][26] Elderly populations benefit from daily physical activity. ...
... 33 Diets focused on plant-based whole foods not only decrease plaque formation but also obesity, cardiovascular morbidity, hypertension, CVD, and stroke, as well as mortality in the elderly. 5,14,21,34 These benefits are likely from protective nutrients such as antioxidants and antiinflammatory compounds in plantbased foods 35,36 that work through multiple mechanisms, such as folate which helps lower plasma homocysteine. 37 Improvements in cognition were discovered among elderly patients that follow Mediterranean diets, which may be the result of lowering inflammation, which otherwise can cause cerebral damage over time and lead to cognitive decline. ...
Article
The Complete Health Improvement Program (CHIP) is an intensive therapeutic lifestyle modification program (ITLMP) with well-documented success in decreasing risk factors for cardiovascular disease (CVD). Plant-based diets and physical activity are components of the program that contribute to these improvements. Yet, there are few studies on how ITLMPs affect risk factors specifically for the geriatric population. The goal of this study was to examine results of CHIP participants with a focus on the older (greater than 65 years) population in Athens, Ohio. Retrospective data from 2011 to 2017 were analyzed for 26 CHIP classes. Recorded variables included body mass index (BMI), blood pressure (BP), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), blood glucose (BG), and exercise level. Among geriatric participants, significant changes were found in BMI, BP, TC, LDL, HDL, BG, and exercise level ( P < .001). As compared to the younger population, changes in variables were equivalent in the geriatric population in all variables ( P > .05). These improvements in CVD risk factors among the elderly support the hypothesis that CHIP should be considered for CVD prevention and treatment in the geriatric population.
... In women, an increased PDI was associated with an increase in BMI in the adjusted model only. Our results, concerning associations between the plant-based diet indices and anthropometrics, differ from the study of Chen et al., 14 demonstrating that a higher score on the PDI was associated with a lower BMI, waist circumference, fat mass index and body fat percentage. These conflicting results may be explained by the different methods used. ...
... These conflicting results may be explained by the different methods used. The sample size in the Chen et al. 14 study was larger and only baseline measurement of dietary intake were available, whereas in the present study food intake was measured at both test moments. ...
Article
Aim: Plant-based diets are recommended in the context of environmental sustainability and health. Since not all plant foods can be considered beneficial, a distinction needs to be made between healthful and unhealthful plant foods. The aim of this study was to investigate longitudinal associations between changes in an overall plant-based diet index, a healthful plant-based diet index and an unhealthful plant-based diet index, with changes in anthropometrics and blood lipids as indicators of morphological and metabolic fitness, respectively. Methods: A 3-day dietary record was completed by 650 Flemish adults (420 men, 230 women) in 2002-2004 and 2012-2014. Three plant-based diet indices were calculated based on quintile scores regarding the intake of animal- or plant-based food items. Associations between 10-year changes in diet indices and changes in anthropometrics and blood lipids were tested using multivariate linear regression. Results: Plant-based diet indices did not differ over time. Using the unadjusted model, few significant associations were found between changes in diet indices and changes in anthropometrics and blood lipids. However, these relationships disappeared after adjusting for confounding. In women, a positive association was found between changes in overall plant-based diet index and changes in body mass index in the adjusted model. Conclusions: Index values did not differ over time and few longitudinal associations were found.
... Plant-based diets, characterized by a reduction or elimination of animal product consumption, have been shown to exert beneficial effects with regard to the incidence and clinical course of different diseases including obesity, type 2 diabetes, cardiovascular diseases, cancer, and rheumatoid arthritis (9)(10)(11)(12). Furthermore, not only are the health benefits of plant-based or vegetarian diets increasingly promoting these alternate dietary habits but also in terms of animal welfare, ethical aspects, and food and environmental sustainability these dietary choices have become more popular during the last couple of decades (13)(14)(15). ...
... In 2 recent analyses of observational cohorts, higher adherence to overall or specifically healthy plant-based diets was related to decreased body weight, body fat percentage, fat mass index, waist circumference, and BMI (11,41). Furthermore, a higher intake of fruits and vegetables was inversely associated with MRI-determined hepatic triglyceride content and visceral fat in a Dutch study. ...
Article
Background: Better adherence to plant-based diets has been linked to lower risk of metabolic diseases but the effect on abdominal fat distribution and liver fat content is unclear. Objectives: We aimed to examine the association between different plant-based diet indices and measures of abdominal fat distribution and liver fat content. Methods: In a population-based sample of 578 individuals from Northern Germany (57% male, median age 62 y), diet was assessed with a validated FFQ and an overall, a healthy, and an unhealthy plant-based diet index were derived. Participants underwent MRI to assess volumes of visceral and subcutaneous abdominal adipose tissue and liver signal intensity (LSI), a measure of liver fat content. Fatty liver disease (FLD) was defined as log LSI ≥3.0. Cross-sectional associations of the plant-based diet indices with visceral and subcutaneous abdominal fat volumes, LSI, and FLD were assessed in linear and logistic regression analyses. The most comprehensive model adjusted for age, sex, education, smoking, alcohol, physical activity, energy intake, diabetes, hyperlipidemia, and BMI. Results Higher overall and healthy plant-based diet indices both revealed statistically significant associations with lower visceral and subcutaneous abdominal adipose tissue volumes and with lower odds of FLD in multivariable-adjusted models without BMI. Upon additional adjustment for BMI, only the association of the healthy plant-based diet with visceral adipose tissue remained statistically significant (per 10-point higher healthy plant-based diet index, percentage change in visceral adipose tissue: −4.9%, 95% CI: −8.6%, −2.0%). None of the plant-based diet indices was associated with LSI. The unhealthy plant-based diet index was unrelated to any of the abdominal or liver fat parameters. Conclusions: Adherence to healthy plant-based diets was associated with lower visceral adipose tissue. None of the other examined associations remained statistically significant after adjustment for BMI.
... The consumption of plant-based diets has been associated with a lower BMI. 58,59 For instance, results from a meta-analysis of 12 randomized controlled trials on vegetarian diets and weight loss demonstrated that participants randomized to vegetarian diets exhibited significantly more weight reduction than those randomized to nonvegetarian diets, with even greater reductions for vegan diets. 58 Similarly, another study in a cohort of older adults showed that higher adherence to a plant-based diet, regardless of food healthfulness, was associated with lower measures of ...
... adiposity over time. 59 Likewise, dietary components that increase DII scores, such as total energy, fats, and carbohydrates, contribute to, or are themselves, sources of calories. 24 Furthermore, BMI is associated with DII scores and inflammation, given that obesity increases inflammatory mediators while decreasing adiponectin, an anti-inflammatory biomarker. ...
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Background Saudi Arabian diets are transitioning to more Western dietary patterns that have been associated with higher levels of inflammation. Emerging evidence suggests plant-based diets are related to lower levels of inflammation; however, the definition of plant-based diets varies. Objective The purpose of this study was to identify the extent to which an overall Plant-Based Diet Index (PDI), Healthy-PDI (hPDI), and Unhealthy-PDI (uPDI) vs Energy-Adjusted Dietary Inflammatory Index correlate with high-sensitivity C-reactive protein (hs-CRP) level. Design This was a cross-sectional study carried out at King Saud University. Data on dietary intake, anthropometrics, and hs-CRP were collected. Participants/setting Female students aged 19 to 35 years (n = 401) were recruited from King Saud University, Riyadh, Saudi Arabia, between February and May 2019. Main outcome measures The main outcome was hs-CRP level. Statistical analyses performed Pearson correlation and multivariate linear regression analyses were used to examine the associations between hs-CRP, each PDI, and Energy-Adjusted Dietary Inflammatory Index (E-DII). Results E-DII and uPDI scores had a moderate and a small positive correlation with hs-CRP levels (r = 0.46 and 0.22, respectively), whereas PDI and hPDI scores had a small and a moderate inverse correlation with hs-CRP levels (r = –0.13 and –0.31, respectively). A 1-standard deviation higher E-DII score was directly associated with a 1.05 mg/L higher hs-CRP level (95% confidence interval 0.72 to 1.38; P < 0.0001) after adjusting for body mass index. Overall PDI score was not associated with hs-CRP levels. A 6-point higher hPDI and uPDI score were associated with a 0.13 mg/L lower hs-CRP (95% confidence interval −0.08 to −0.28) and a 0.15 mg/L higher hs-CRP (95% confidence interval 0.03 to 0.31), respectively, after adjusting for lifestyle and dietary factors; however, results attenuated and were no longer statistically significant after body mass index adjustment. Conclusions Although all indexes had a small or moderate correlation with hs-CRP, only E-DII score was positively associated with hs-CRP level. Future research can examine PDI-based interventions for lowering inflammation.
... A study investigated whether adhering to more PBD, beyond strict vegan or vegetarian diets could help prevent adiposity in a middle-aged and elderly population [203]. In this population-based cohort of middle-aged and elderly participants, a higher adherence to a more plant-based, less animal-based diet was associated with less adiposity over time, irrespective of the general healthfulness of the specific plant and animal-based foods [203]. ...
... A study investigated whether adhering to more PBD, beyond strict vegan or vegetarian diets could help prevent adiposity in a middle-aged and elderly population [203]. In this population-based cohort of middle-aged and elderly participants, a higher adherence to a more plant-based, less animal-based diet was associated with less adiposity over time, irrespective of the general healthfulness of the specific plant and animal-based foods [203]. Similarly, Ratjen et al. [204] found that adherence to PBDs was associated with lower VAT. ...
Article
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The prevalence of obesity continues to rise worldwide despite evidence-based public health recommendations. The promise to adopt a healthy lifestyle is increasingly important for tackling this global epidemic. Calorie restriction or regular exercise or a combination of the two is accepted as an effective strategy in preventing or treating obesity. Furthermore, the benefits conferred by regular exercise to overcome obesity are attributed not only to reduced adiposity or reduced levels of circulating lipids but also to the proteins, peptides, enzymes, and metabolites that are released from contracting skeletal muscle or other organs. The secretion of these molecules called cytokines in response to exercise induces browning of white adipose tissue by increasing the expression of brown adipocyte-specific genes within the white adipose tissue, suggesting that exercise-induced cytokines may play a significant role in preventing obesity. In this review, we present research-based evidence supporting the effects of exercise and various diet interventions on preventing obesity and adipose tissue health. We also discuss the interplay between adipose tissue and the cytokines secreted from skeletal muscle and other organs that are known to affect adipose tissue and metabolism.
... In contrast to our results, Waterplas et al reported that higher PDI scores were associated with an increase in BMI in adjusted analyses. 11 Chen et al found that higher PDI was associated with lower BMI, waist circumference, body fat percentage, and fat mass index 24 . In a cross-sectional study by Zamani et al, higher uPDI was associated with a higher risk of obesity, but PDI and hPDI were not 12 . ...
Article
Introduction: Given that some plant-based foods, such as potatoes, adversely affect cardiovascular disease (CVD) risk factors, this study was performed to assess the association between plant dietary patterns and these risk factors. Methods: This cross-sectional study was conducted among 371 healthy 18 to 50 year-old Iranian women. Participant dietary intake was assessed using a validated food frequency questionnaire. Nineteen food groups were ranked in deciles and received scores from 1 to 10. An overall plant-based dietary index (PDI), a healthy plant-based dietary index (hPDI), and an unhealthy plant-based dietary index (uPDI) were calculated. Results: Participants who scored in the top tertile of the PDI or uPDI consumed less fat and protein and more carbohydrates, compared to women in the lowest tertile (P < 0.05). There was no significant variation in macronutrient consumption between the highest and lowest tertiles of hPDI. Participants who scored in the highest tertile of PDI had lower low density cholesterol level (LDL) (79.61 ± 14.36 mg dL−1 vs. 83.01 ± 14.96 mg/dL−1, P = 0.021). In addition, higher adherence to uPDI was associated with higher triglyceride (TG) levels compared to participants with lower adherence (101.5 ± 56.55 mg/dL−1 vs. 97.70 ± 56.46 mg dL−1, P < 0.0001). Here was no significant association between PDI, hPDI and uPDI and CVD risk factors in regression model. Conclusion: We found no significant association between plant-based dietary indices and CVD risk factors in women, except for LDL-C and TG. Future cohort studies are needed to confirm these findings.
... Findings from Ratjen et al. showed that adherence to a healthy plant-based diet remained associated with lower VAT, even after adjusting for several potential confounders including body mass index (BMI) (4). These cross-sectional results are somehow in line with other longitudinal studies reporting in middle-aged and elderly populations inverse associations over time between adherence to overall or specifically healthy plant-based diet and measures of adiposity such as BMI, waist circumference, fat mass index, and body fat percentage (3,5). Such associations may be partly explained by the abundant intake of certain components of plant-based foods. ...
... These results are in line with previous studies that specifically focused on abdominal adiposity. In prospective studies, greater adherence to plant-based diets decreased WC by 2.0 cm over 7 years [29], and individuals with higher uPDI scores had a 1.46 times greater risk of abdominal obesity when using WC as a Values are presented as hazard ratio (95% confidence interval). Q, quintile; PDI, plant-based diet index; hPDI, healthy plant-based diet index; uPDI, unhealthy plant-based diet index; MET, metabolic equivalent of task. 1 The multivariable-adjusted model was adjusted for age (years), gender (men or women), total energy intake (kcal/day), high school graduate (yes or no), physical activity level (METs), current smoking (yes or no), alcohol intake (g/day), and body mass index at baseline. 2 Treating the median value of each group as a continuous variable using a Cox proportional-hazard model. ...
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Objectives: Different approaches using repeated dietary measurements may yield differences in the magnitude and interpretation of findings. We aimed to compare three dietary measurements (baseline, most recent, and cumulative average) in the association between plant-based diet indices (PDIs) and incident abdominal obesity in Korean adults aged 40-69 years. Methods: This study included 6054 participants (women, 54%) free of abdominal obesity at baseline, defined as waist circumference ≥ 90 cm for men and ≥ 85 cm for women. As exposures, baseline, most recent, and cumulative average for PDI, healthy-PDI (hPDI), and unhealthy-PDI (uPDI) were created. A Cox proportional hazard model was used to estimate the hazard ratios (HRs) for abdominal obesity. Results: During 45,818 person-years of follow-up (median 9 years), we identified 1778 incident cases of abdominal obesity. In multivariable-adjusted analysis, a higher uPDI was associated with an increased risk of abdominal obesity in both total and stratified analyses. The findings were consistent across all approaches (Q5 vs. Q1, HR baseline=1.70, 95% CI 1.46, 1.98; HR most recent=1.52, 95% CI 1.30, 1.78; HR cumulative average=1.76, 95% CI 1.51, 2.06 in total set). PDI showed no meaningful association with abdominal obesity risk in all analyses. hPDI average had a suggestive inverse association with abdominal obesity risk in men and hPDI baseline had a positive association with abdominal obesity risk in women. Conclusion: Greater adherence to unhealthy plant-based diets may increase the risk of developing abdominal obesity in Korean adults. The findings were generally consistent across all approaches.
... For the current analysis within the Rotterdam Study, of the 14,926 participants who participated at baseline, we had dietary data available for 9701. Main reasons for absence of valid dietary data among the 5225 participants were: no dietary data available (n = 4890) including not having received dietary assessment because of logistic reasons, living in a resident home for elderly or suspected dementia, and not having completed the dietary assessment; or excluded as invalid dietary data (n = 335) defined as an estimated energy intake of < 500 or > 5000 kcal/day) [18,19]. From these 9701 participants, we further excluded 1914 participants with CVD, diabetes, or cancer at baseline, and 1 participant without follow-up data on mortality, leaving 7786 participants for the main analyses (Supplemental Figure 1). ...
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Evidence for associations between long-term protein intake with mortality is not consistent. We aimed to examine associations of dietary protein from different sources with all-cause and cause-specific mortality. We followed 7786 participants from three sub-cohorts of the Rotterdam Study, a population-based cohort in the Netherlands. Dietary data were collected using food-frequency questionnaires at baseline (1989–1993, 2000–2001, 2006–2008). Deaths were followed until 2018. Associations were examined using Cox regression. Additionally, we performed a highest versus lowest meta-analysis and a dose–response meta-analysis to summarize results from the Rotterdam Study and previous prospective cohorts. During a median follow-up of 13.0 years, 3589 deaths were documented in the Rotterdam Study. In this cohort, after multivariable adjustment, higher total protein intake was associated with higher all-cause mortality [e.g. highest versus lowest quartile of total protein intake as percentage of energy (Q4 versus Q1), HR = 1.12 (1.01, 1.25)]; mainly explained by higher animal protein intake and CVD mortality [Q4 versus Q1, CVD mortality: 1.28 (1.03, 1.60)]. The association of animal protein intake and CVD was mainly contributed to by protein from meat and dairy. Total plant protein intake was not associated with all-cause or cause-specific mortality, mainly explained by null associations for protein from grains and potatoes; but higher intake of protein from legumes, nuts, vegetables, and fruits was associated with lower risk of all-cause and cause-specific mortality. Findings for total and animal protein intake were corroborated in a meta-analysis of eleven prospective cohort studies including the Rotterdam Study (total 64,306 deaths among 350,452 participants): higher total protein intake was associated with higher all-cause mortality [pooled RR for highest versus lowest quantile 1.05 (1.01, 1.10)]; and for dose–response per 5 energy percent (E%) increment, 1.02 (1.004, 1.04); again mainly driven by an association between animal protein and CVD mortality [highest versus lowest, 1.09 (1.01, 1.18); per 5 E% increment, 1.05 (1.02, 1.09)]. Furthermore, in the meta-analysis a higher plant protein intake was associated with lower all-cause and CVD mortality [e.g. for all-cause mortality, highest versus lowest, 0.93 (0.87, 0.99); per 5 E% increment, 0.87 (0.78, 0.98), for CVD mortality, highest versus lowest 0.86 (0.73, 1.00)]. Evidence from prospective cohort studies to date suggests that total protein intake is positively associated with all-cause mortality, mainly driven by a harmful association of animal protein with CVD mortality. Plant protein intake is inversely associated with all-cause and CVD mortality. Our findings support current dietary recommendations to increase intake of plant protein in place of animal protein.Clinical trial registry number and website NTR6831, https://www.trialregister.nl/trial/6645
... We observed that a more plant-based diet and a lower intake of animal protein are associated with lower insulin resistance over time and lower risk of diabetes, independent of other lifestyle and dietary factors [205,389]. In other analyses we studied several pathways that may link nutrition or physical activity to diabetes risk and metabolic health, such as adiposity [390], inflammatory pathways [391,199] or DNA methylation [392][393][394][395]. ...
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The Rotterdam Study is an ongoing prospective cohort study that started in 1990 in the city of Rotterdam, The Netherlands. The study aims to unravel etiology, preclinical course, natural history and potential targets for intervention for chronic diseases in mid-life and late-life. The study focuses on cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1700 research articles and reports. This article provides an update on the rationale and design of the study. It also presents a summary of the major findings from the preceding 3 years and outlines developments for the coming period.
... Nutrition is one of the most important factors that affects body composition. Previous studies have suggested that a plantbased diet, defined as a high intake of plant foods and a low intake of animal foods in an omnivorous diet, might contribute to improved body composition in adults (5)(6)(7). These findings are in agreement with those of studies that have investigated healthy dietary patterns, such as the Mediterranean diet (8) and the DASH diet (9), in adults. ...
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Evidence suggests that plant-based diets are beneficial for alleviating metabolic diseases. Childhood is a crucial period for body growth and development. However, it is unknown whether adherence to a plant-based diet is related to a healthy body composition in children. We aimed to assess the relationship between a plant-based diet and body composition in children. A total of 452 Chinese children aged 6–9 years old participated in this cross-sectional study. Lean mass (LM), fat mass, and fat mass percentage (FMP) were assessed via dual-energy X-ray absorptiometry. An age- and sex-specific abdominal FMP ≥85th percentile was defined as abdominal obesity. Handgrip strength was measured using a hydraulic hand dynamometer. A validated 79-item food frequency questionnaire was used to collect dietary information. Overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) scores were calculated. After adjusting for potential covariates, a higher hPDI score (per 10-score increment) was associated with a higher LM in the android area (0.038 kg, 3.2%), gynoid area (0.048 kg, 1.9%), and trunk (0.102 kg, 1.2%) and with a lower FMP (1.18%) in the android area. In contrast, a higher uPDI score (per 10-score increment) was associated with a lower LM in the trunk (0.091 kg, 1.1%) and android area (0.023 kg, 1.9%) and with a higher FMP (0.74%) in the android area. No significant associations were observed between the overall PDI and body composition or abdominal obesity. After stratifying by sex, higher (vs. lower) hPDI scores was associated with lower abdominal obesity risk in girls and higher handgrip strength in boys. In conclusion, in this cross-sectional study, we found that stronger adherence to a healthful plant-based diet, and less adherence to an unhealthful plant-based diet was associated with better body composition in Chinese omnivorous children aged 6–9 years old. Our results highlight the need to distinguish between healthy and unhealthy plant foods within investigating how to obtain a healthy body composition in children.
... For the current study, we excluded participants with type 2 diabetes (n = 1231), insulin resistance (n = 1995), cancer (n = 168), or renal diseases (n = 296) at baseline examination ( Fig. 1). Of the remaining 6340 participants, those with incomplete data were further excluded: missing biochemical (n = 38) or dietary (n = 204) data values, implausible energy intakes (< 500 kcal/day or > 5000 kcal/day) [17][18][19] (n = 58), no follow-up visits after baseline examination (n = 535), and missing covariate information (n = 99). The final analytic sample was 5406 participants (2707 men and 2699 women), and data were obtained from follow-up examinations until 2016. ...
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Background Acid-base homeostasis is increasingly being recognized to play an important role in normal metabolic function. However, prospective studies on the relationship between diet-induced acid-base imbalance and insulin resistance among Asian populations have been limited. Thus, we investigated whether diet-induced metabolic acidosis was prospectively associated with insulin resistance risk in middle-aged and older Korean adults. Methods In total, 5406 participants from the Korean Genome and Epidemiology Study without type 2 diabetes, insulin resistance, cancer, or renal diseases at baseline examination were included in this study. To estimate diet-induced metabolic acidosis, we used potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores calculated from the usual dietary intake assessed by a validated 103-item food frequency questionnaire at baseline. Multivariable Cox proportional hazard models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of insulin resistance incidence. Results During a mean follow-up period of 7.4 years, we documented 3449 insulin resistance cases. In the fully adjusted model, the future insulin resistance risk was significantly higher among participants in the highest quartiles of PRAL (HR: 1.30, 95% CI: 1.13–1.48, Ptrend = 0.0002) and NEAP (HR: 1.30, 95% CI: 1.14–1.49, Ptrend = 0.0008) than among those in the lowest quartiles. Associations were slightly strengthened among men, adults < 50 years old, obese participants, or those with low physical activity levels. Conclusions Our findings suggested that diet-dependent acid load was positively associated with the future development of insulin resistance, suggesting effect modification by sex, age, the presence of obesity, and physical activity levels.
... To test the robustness of our findings, we conducted several sensitivity analyses based on our fully adjusted model (model 2). First, because change in body weight may be a potential mediator of the association between changes in plant-based diets and risk of type 2 diabetes, we further adjusted for concurrent 4-year changes in body weight (quintiles) (25,26). We also estimated the percentage of the association between changes in plant-based diets and diabetes risk that was mediated by concurrent changes in body weight. ...
Article
Objective: We evaluated the associations between changes in plant-based diets and subsequent risk of type 2 diabetes. Research design and methods: We prospectively followed 76,530 women in the Nurses' Health Study (NHS) (1986-2012), 81,569 women in NHS II (1991-2017), and 34,468 men in the Health Professionals Follow-up Study (1986-2016). Adherence to plant-based diets was assessed every 4 years with the overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). We used multivariable Cox proportional hazards models to estimate hazard ratios (HRs). We pooled results of the three cohorts using meta-analysis. Results: We documented 12,627 cases of type 2 diabetes during 2,955,350 person-years of follow-up. After adjustment for initial BMI and initial and 4-year changes in alcohol intake, smoking, physical activity, and other factors, compared with participants whose indices remained relatively stable (±3%), participants with the largest decrease (>10%) in PDI and hPDI over 4 years had a 12-23% higher diabetes risk in the subsequent 4 years (pooled HR, PDI 1.12 [95% CI 1.05, 1.20], hPDI 1.23 [1.16, 1.31]). Each 10% increment in PDI and hPDI over 4 years was associated with a 7-9% lower risk (PDI 0.93 [0.91, 0.95], hPDI 0.91 [0.87, 0.95]). Changes in uPDI were not associated with diabetes risk. Weight changes accounted for 6.0-35.6% of the associations between changes in PDI and hPDI and diabetes risk. Conclusions: Improving adherence to overall and healthful plant-based diets was associated with a lower risk of type 2 diabetes, whereas decreased adherence to such diets was associated with a higher risk.
... A study by Chen et al. [155], with a seven years follow-up, evaluated whether a "strict" vegan diet was able to prevent abdominal fat accumulation in aged subjects. The results demonstrated that a higher adherence to vegan diet allowed a lower BMI, waisthip circumference, and fat mass (in percentage terms), confirming that this diet is associated with a better body composition compared to a free diet. ...
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Plant-based diets (PBDs) are increasingly consumed by the Italian population and around the world. In particular, among PBDs, the vegan diet is a food pattern characterized by the exclusion of all animal-origin foods. What drives people to adopt this model are mainly ethical, health and environmental reasons. A vegan diet, if well-balanced and varied, can help in achieving and maintaining an optimal state of health. However, this nutritional approach, if not well-balanced, can cause deficiencies in proteins, ω-3 fatty acids, iron, vitamin D and calcium, zinc, iodine and, above all, vitamin B12. Oral food supplements especially fortified foods are recommended in these cases to restore the nutritional deficiencies. A vegan diet generally reduces the risk of developing chronic non-communicable degenerative diseases, such as metabolic syndrome (MetS) and, in addition, requires fewer natural resources for food production than an omnivorous diet. The aim of this review is to analyze the possible impact of the vegan diet on MetS onset and its treatment.
... [15][16][17] Whilst it is explored the effects of a strict VD in some randomized controlled trials, it is also found that substituting a portion of animal and animal-based products with that plant-based foods in many epidemiological studies. [18] These strategies have exhibited benefits related to morbidity, mortality, and prevention which are linked to many chronic diseases. [19] Although, it is suggested in much research related to clinical conditions that there should be included more vegetables, fruits, and whole grains in the meal without abandoning animal and animal-based products. ...
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Sportsmen may choose to include vegetarian diet in their dietary regime for a variety of ways like its beneficial health impact, due to religious restrictions or to protect animals for environmental integrity. These diets are loaded with a wide variety of phytochemicals with superior health benefits safeguarding against chronic diseases. Besides their role in health management these foods also play a key role in enhancing different sports performances owing to contained with instant energy providing carbohydrates that are crucial for competitive sports performance. Furthermore, they are also richly enriched with antioxidants that are essential for high-end sports performance. However, few vegetarian diets are the source of anti-nutritional entities like high fiber content, chelating agents, phytates, and tannic acid. These interfere with the bio-availability of crucial dietary components like iron, zinc, proteins. Therefore, a sound nutritional approach is required while planning plant-based dietary regimes for sports performance. This review will systematically focus on the impact of vegetarian diets on sports performance in the light of currently available research findings in this field to provide a guiding hand to sports specialists and nutritional experts in planning the vegetarian dietary plans for optimizing the sports performance. In addition, this review explains the bio-availability and enhancement strategies of different vegetarian diet-based nutrients through different energy metabolism pathways.
... Findings from the population-based Rotterdam study indicate that a diet rich in plant-based foods, but not necessarily a vegetarian or vegan pattern, is associated with reduced adiposity and improved insulin sensitivity, even after adjusting for BMI [34,35]. Like previous intervention trials [36e38], our results are in line with these observations. ...
Article
Background & aims Growing evidence suggests that biomarker-guided dietary interventions can optimize response to treatment. In this study, we evaluated the efficacy of the PREVENTOMCIS platform—which uses metabolomic and genetic information to classify individuals into different ‘metabolic clusters’ and create personalized dietary plans—for improving health outcomes in subjects with overweight or obesity. Methods A 10-week parallel, double-blinded, randomized intervention was conducted in 100 adults (82 completers) aged 18–65 years, with body mass index ≥27 but <40 kg/m², who were allocated into either a personalized diet group (n = 49) or a control diet group (n = 51). About 60% of all food was provided free-of-charge. No specific instruction to restrict energy intake was given. The primary outcome was change in fat mass from baseline, evaluated by dual energy X-ray absorptiometry. Other endpoints included body weight, waist circumference, lipid profile, glucose homeostasis markers, inflammatory markers, blood pressure, physical activity, stress and eating behavior. Results There were significant main effects of time (P < 0.01), but no group main effects, or time-by-group interactions, for the change in fat mass (personalized: −2.1 [95% CI -2.9, −1.4] kg; control: −2.0 [95% CI -2.7, −1.3] kg) and body weight (personalized: −3.1 [95% CI -4.1, −2.1] kg; control: −3.3 [95% CI −4.2, −2.4] kg). The difference between groups in fat mass change was −0.1 kg (95% CI −1.2, 0.9 kg, P = 0.77). Both diets resulted in significant improvements in insulin resistance and lipid profile, but there were no significant differences between groups. Conclusion Personalized dietary plans did not result in greater benefits over a generic, but generally healthy diet, in this 10-week clinical trial. Further studies are required to establish the soundness of different precision nutrition approaches, and translate this science into clinically relevant dietary advice to reduce the burden of obesity and its comorbidities. Clinical trial registry ClinicalTrials.govregistry (NCT04590989).
... Given that BMI represents a pathway through which plantbased diets may affect GDM risk (45,46), controlling for it might have resulted in an underestimation of the overall associations of PDIs with GDM risk. At the same time, BMI could also be a confounder, for which statistical adjustment gives a more accurate estimate of the independent association between plant-based diets and GDM. ...
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Background Emerging evidence suggests beneficial impacts of plant-based diets on glucose metabolism among generally healthy individuals. Whether adherence to these diets is related to risk of gestational diabetes mellitus (GDM) is unknown. Objectives We aimed to examine associations between plant-based diets and GDM in a large prospective study. Methods We included 14,926 women from the Nurses’ Health Study II (1991–2001), who reported ≥1 singleton pregnancy and without previous GDM before the index pregnancy. Prepregnancy adherence to plant-based diets was measured by an overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) as assessed by FFQs every 4 y. Incident first-time GDM was ascertained from a self-reported physician diagnosis, which was previously validated by review of medical records. We used log-binomial models with generalized estimating equations to calculate RRs and 95% CIs for associations of PDIs with GDM. Results We documented 846 incident GDM cases over the 10-y follow-up among 20,707 pregnancies. Greater adherence to the PDI and hPDI was associated with lower GDM risk. For the PDI, the multivariable-adjusted RR (95% CI) comparing the highest and lowest quintiles (Q5 compared with Q1) was 0.70 (0.56, 0.87) (Ptrend = 0.0004), and for each 10-point increment was 0.80 (0.71, 0.90). For the hPDI, the RR (95% CI) of Q5 compared with Q1 was 0.75 (0.59, 0.94) (Ptrend = 0.009) and for each 10-point increment was 0.86 (0.77, 0.95). After further adjustment for prepregnancy BMI, the associations were attenuated but remained significant: for the PDI, the RR (95% CI) for each 10-point increment was 0.89 (0.79, 1.00) and the corresponding RR (95% CI) was 0.89 (0.80, 0.99) for the hPDI. The uPDI was not associated with GDM. Conclusions Our study suggests that greater prepregnancy adherence to a healthful plant-based diet was associated with lower risk of GDM, whereas an unhealthful plant-based diet was not related to GDM risk.
... An abundance of evidence exists in support of a PB diet for leaner body composition and decreased body mass (Chen et al. 2019;Yadav et al. 2016;Sabaté and Wien 2010), characteristics that athletes may strive for, especially if they compete in weight class or esthetic sports or sports where weight has a direct impact on performance (i.e., cycling). Phillips et al. (2004) found that adherence to a PB diet decreased skinfold thickness and waist-to-height ratio, independent of weight loss. ...
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Individuals may opt to follow a plant-based diet for a variety of reasons, such as religious practices, health benefits or concerns for animal or environmental welfare. Such diets offer a broad spectrum of health benefits including aiding in the prevention and management of chronic diseases. In addition to health benefits, a plant-based diet may provide performance-enhancing effects for various types of exercise due to high carbohydrate levels and the high concentration of antioxidants and phytochemicals found in a plant-based diet. However, some plant-based foods also contain anti-nutrional factors, such as phytate and tannins, which decrease the bioavailability of key nutrients, such as iron, zinc, and protein. Thus, plant-based diets must be carefully planned to ensure adequate intake and absorption of energy and all essential nutrients. The current narrative review summarizes the current state of the research concerning the implications of a plant-based diet for health and exercise performance. It also outlines strategies to enhance the bioavailability of nutrients, sources of hard-to-get nutrients, and sport supplements that could interest plant-based athletes.
... There are some common features of healthy dietary patterns, including the consumption of wholegrain cereals, fruits, and vegetables, that are recommended by the World Health Organization Global Strategy on Diet, Physical Activity, and Health [3], and cholesterol-lowering foods, namely oats, barley, nuts, and plant protein foods (e.g., soy and other legumes) [4]. In addition, a higher adherence to plant-based diets, especially those rich in a variety of plant foods (whole grains, fruits, vegetables, nuts, legumes, and vegetable oils), may be associated with decreased weight gain and lower adiposity in prospective cohorts among the general population [5,6]. ...
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Despite continuous growth in dietary pattern research, the relative importance of each dietary component in the overall pattern and their joint effects on mortality risk have not been examined adequately. We explored the individual and joint associations of multiple food groups with all-cause and cause-specific mortality (cardiovascular disease (CVD) or cancer), by analyzing data from a cohort of 3995 Hong Kong Chinese older adults in the Mr. Osteoporosis (OS) and Ms. OS Study. Cox proportional hazards models were used to examine the associations of food groups with mortality risk. The individual and joint contribution of food groups to mortality risk has been quantified by a machine learning approach, i.e., the Quantile G-Computation. When comparing the highest with the lowest quartile of intake, dark green and leafy vegetables (hazard ratio (HR) = 0.82, 95% confidence interval (CI) = 0.70 to 0.96, Ptrend = 0.049), fruit (HR = 0.79, 95% CI = 0.68 to 0.93, Ptrend = 0.006), legumes (HR = 0.75, 95% CI = 0.63 to 0.87, Ptrend = 0.052), mushroom and fungi (HR = 0.76, 95% CI = 0.65 to 0.88, Ptrend = 0.023), soy and soy products (HR = 0.77, 95% CI = 0.66 to 0.90, Ptrend = 0.143), and whole grains (HR = 0.76, 95% CI = 0.65 to 0.89, Ptrend = 0.008) were inversely associated with all-cause mortality. Legume intake was associated with a lower risk of CVD mortality, while fruit, nuts, soy and soy products were associated with a lower risk of cancer mortality. From the Quantile G-Computation, whole grains, legumes, fruits, mushroom and fungi, soy and soy products had a higher relative weighting on mortality risk, and the joint effect of food groups was inversely associated with the mortality risk due to all-causes (HR = 0.39, 95% CI = 0.27 to 0.55), CVD (HR = 0.78, 95% CI = 0.67 to 0.91), and cancer (HR = 0.31, 95% CI = 0.15 to 0.65). From a sex-stratified analysis, most associations between food groups (whole grains, legumes, fruits, mushroom and fungi, soy and soy products) and mortality risk remained significant among men. In conclusion, whole grains, legumes, fruits, mushroom and fungi, soy and soy products were the main contributors to a reduction in mortality risk, and their joint effects were stronger than individual food groups. Moreover, the sex-specific association of sweets and desserts with cancer mortality may be worth further investigation.
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During the last half of the twentieth century, age-adjusted mortality from pancreatic cancer in Japan rose about nine-fold in both sexes. Well-characterized risk factors such as smoking, obesity/metabolic syndrome, and heavy alcohol use appear to explain only a modest part of this rise. It is proposed that a diet relatively low in protein, and particularly low in animal protein, was a key determinant of the low risk for pancreatic cancer in mid-century Japan. It is further proposed that pancreatic acinar cells, owing to their extraordinarily high rate of protein synthesis, are at high risk for ER stress; that such stress plays a fundamental role in the induction of most pancreatic cancers; and that low-protein diets help to offset such stress by modulating activities of the kinases GCN2 and mTORC1 while increasing autocrine and systemic production of fibroblast growth factor 21. This model appears to clarify the role of various risk factors and protective factors in pancreatic cancer induction. A vegan or quasi-vegan low-protein diet may have broader potential for decreasing risk for a range of common “Western” cancers.
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Background Little is known about the role of emerging plant-based dietary patterns in cardiovascular disease (CVD) at the national population level. Objectives The objectives of this research were to assess the validity and reliability of newly-established plant-based dietary indices, and to evaluate their associations with CVD risk among Canadian adults. Design Data were obtained from repeated 24-hour dietary recalls of adult participants in the cross-sectional, nationally representative Canadian Community Health Survey cycle 2004 linked to vital statistics (n=12,323) and cycle 2015 (n=14,026). Plant-based diet quality was assessed with a revised Plant-based Dietary Index (PDI), EAT-Lancet Reference Diet (ERD) score and the latest Dietary Guidelines for Americans Adherence Index (DGAI) 2020. Weighted multivariate analyses were used for testing associations between diet quality and lifestyle characteristics, and weighted multivariable-adjusted Cox proportional-hazards models for associations with CVD risk. Results Construct validity was confirmed for the revised PDI and DGAI 2020 (but not ERD) as participants in the highest (healthiest) quartile, compared to those in the lowest (least healthy), were more likely to be female (52.63±1.27% compared to 44.8±1.65% for revised PDI; 59.37±2.01% compared to 40.84±1.71% for DGAI 2020), older (50.55±0.39 compared to 45.56±0.43 for revised PDI; 51.57±0.39 compared to 46.35±0.54 for DGAI 2020), to have post-secondary education (32.36±1.55% compared to 21.12±1.31% for revised PDI; 34.17±2.69% compared to 17.87±0.98% for DGAI 2020), and less likely to be daily smokers (8.21±1% compared to 17.06±1.45% for revised PDI; 7.36±1.71% compared to 21.53±1.58% for DGAI 2020) (P-trend<0.0001). No significant associations were observed between dietary index scores and CVD risk. Conclusions Revised PDI and DGAI 2020 provided valid and meaningful measures of plant-based eating among Canadians, while validity of ERD was not directly confirmed. Adherence to the plant-based dietary patterns was not associated with CVD risk. Future large-scale analyses are necessary to further evaluate the role of plant-based eating in CVD prevention.
Article
Background We sought to investigate whether adherence to a more plant-based, and less animal-based, diet is associated with visceral adiposity, lipid accumulation product (LAP), and triglyceride-glucose index (TyG) in Iranian adults. Methods This cross-sectional study was conducted on 270 adults aged between 18–75 years old. We created three plant-based diets. including an overall plant-based diet index (PDI), hPDI, and uPDI based on tertiles regarding the intake of animal- or plant-based food items obtained from a semi quantitative food-frequency questionnaire. Results Higher hPDI was significantly associated with lower body mass index (BMI) (P-value = 0.01), lower waist circumference (P-value<0.001), and lower waist-hip ratio (P-value<0.001). A significant increase was found for high density lipoproteins (HDL) (P-trend <0.001) with a significant decrease for LAP (P-value = 0.03) in those with higher adherence to hPDI. Moreover, greater adherence to PDI was associated with a significant increase in diastolic blood pressure (DBP) (p-value = 0.01) and fat free mass (FFM) (p-value = 0.01). There were no significant associations between PDIs and TyG and VFA. Conclusion We found that a higher hPDI score was significantly associated with better anthropometric measurements. A significant increase was found for HDL and a significant decrease was found for LAP on hPDI. However, a higher PDI score was significantly associated with higher DBP and higher FFM.
Chapter
Studies have shown that food consumption increases when more food is available. Over the past decades, per capita, US food availability has increased by three-fold; however, the way our diet affects our energy balance is complex. Daily energy expenditure depends on total energy intake (kilocalories consumed), macronutrient composition (fat, protein, and carbohydrates), the energy density of the food (kilocalories per gram of food), and the timing of the food intake. Besides, economic and policy influences to maximize food production have to build industrialized systems that produce and market highly processed foods rich in corn, soy, sugars, etc. The unnaturally high amounts of salt, sugar, fat, and flavor additives increase consumption. Also, changes in behavior and lifestyle with snacking between meals and more people eating in restaurants likely lead to increased calorie intake, thereby causing obesity.
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Vegetarians are reported to have lower body weight, blood pressure (BP) and cardiovascular disease (CVD) risk compared to omnivores, yet the mechanisms remain unclear. A vegetarian diet may protect the vascular endothelium, reducing the risk of atherosclerosis and CVD. This cross-sectional study compared vascular function between omnivores (OMN) and vegetarians (VEG). We hypothesized that VEG would have greater vascular function compared to OMN. Fifty-eight normotensive young healthy adults participated (40W/18M; 28 OMN (15W/13M) and 30 VEG (25W/5M); 26±7 yr; BP: 112±11 / 67±8 mm Hg). Arterial stiffness, assessed by carotid-to-femoral pulse wave velocity (OMN: 5.6±0.8 m/s, VEG: 5.3±0.8 m/s; P=0.17) and wave reflection assessed by aortic augmentation index (OMN: 6.9±12.3%, VEG: 8.8±13.5%; P=0.57) were not different between groups. However, central pulse pressure (OMN: 32±5; VEG: 29±5 mmHg; P=0.048) and forward wave reflection were greater in omnivores (O: 26±3; V: 24±3 mmHg P=0.048). Endothelial-dependent dilation measured by brachial artery flow-mediated dilation was not different between groups (OMN: 6.0±2.9 %, VEG: 6.9±3.3 %; P=0.29). Percent change in femoral blood flow from baseline during passive leg movement, another assessment of nitric oxide-mediated endothelial dilation, was similar between groups (OMN: 203±88 mL/min, VEG: 253±192 mL/min; P=0.50). These data suggest that healthy young adults, normotensive vegetarians do not have significantly improved vascular function compared to omnivores however, they have a lower central pulse pressure and forward wave amplitude which may lower the risk of future CVD.
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We hypothesised that a plant-based diet, without excluding any specific animal food, may be beneficial for body composition. This study aims to evaluate if the consumption of a plant-based diet impacts body composition of adults, through a systematic review of the literature. The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature search was conducted in EMBASE, PubMed, Scopus and Web of Science in February 2021. Cross-sectionals, interventional trials, and cohort studies were included if changes in the body composition, were associated with olant-based index (PDI). Meta-analyses were performed using DerSimonian and Laird random effects model with 95% confidence intervals even in the absence of statistical heterogeneity. A total of 6680 citations were found in the systematic search and after the screening process, 12 studies were included. Out of the 11 studies evaluating body mass index, 8 provided data of BMI from a total of 134,128 participants among the quantiles of PDI and a meta-analysis was performed (SMD = 0.17 kg/m², 95% CI = [0.02; 0.32]). Out of the 7 studies that evaluated waist circumference (WC), 4 provided data of WC among the quantiles of PDI from a total of 12.968 participants. Like BMI, the pooled analysis indicated an increase (SMD = 0.50 kg/m², 95% CI = [0.01; 1.00]) of WC as greater was the PDI. Both analyses were influenced by a large study, and in the sensitive analysis the significance was lost.Our findings did not observe an association between a higher PDI and body composition. Also, most studies evaluating total and central adiposity did not find any association with the PDI. Probably, PDI must be considered in the context of food processing, considering that not all vegetable foods are healthy.
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Covering: up to 2020 Chronic, low-grade inflammation is linked to aging and has been termed “inflammaging”. Inflammaging is considered a key contributor to the development of metabolic dysfunction and a broad spectrum of diseases or disorders including declines in brain and heart function. Genome-wide association studies (GWAS) coupled with epigenome-wide association studies (EWAS) have shown the importance of diet in the development of chronic and age-related diseases. Moreover, dietary interventions e.g. caloric restriction can attenuate inflammation to delay and/or prevent these diseases. Common themes in these studies entail the use of phytochemicals (plant-derived compounds) or the production of short chain fatty acids (SCFAs) as epigenetic modifiers of DNA and histone proteins. Epigenetic modifications are dynamically regulated and as such, serve as potential therapeutic targets for the treatment or prevention of age-related disease. In this review, we will focus on the role for natural products that include phytochemicals and short chain fatty acids (SCFAs) as regulators of these epigenetic adaptations. Specifically, we discuss regulators of methylation, acetylation and acylation, in the protection from chronic inflammation driven metabolic dysfunction and deterioration of neurocognitive and cardiac function.
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Vegan or vegetarian diets have been suggested to reduce type 2 diabetes (T2D) risk. However, not much is known on whether variation in the degree of having a plant-based versus animal-based diet may be beneficial for prevention of T2D. We aimed to investigate whether level of adherence to a diet high in plant-based foods and low in animal-based foods is associated with insulin resistance, prediabetes, and T2D. Our analysis included 6798 participants (62.7 ± 7.8 years) from the Rotterdam Study (RS), a prospective population-based cohort in the Netherlands. Dietary intake data were collected with food-frequency questionnaires at baseline of three sub-cohorts of RS (RS-I-1: 1989–1993, RS-II-1: 2000–2001, RS-III-1: 2006–2008). We constructed a continuous plant-based dietary index (range 0–92) assessing adherence to a plant-based versus animal-based diet. Insulin resistance at baseline and follow-up was assessed using homeostasis model assessment of insulin resistance (HOMA-IR). Prediabetes and T2D were collected from general practitioners’ records, pharmacies’ databases, and follow-up examinations in our research center until 2012. We used multivariable linear mixed models to examine association of the index with longitudinal HOMA-IR, and multivariable Cox proportional-hazards regression models to examine associations of the index with risk of prediabetes and T2D. During median 5.7, and 7.3 years of follow-up, we documented 928 prediabetes cases and 642 T2D cases. After adjusting for sociodemographic and lifestyle factors, a higher score on the plant-based dietary index was associated with lower insulin resistance (per 10 units higher score: β = −0.09; 95% CI: − 0.10; − 0.08), lower prediabetes risk (HR = 0.89; 95% CI: 0.81; 0.98), and lower T2D risk [HR = 0.82 (0.73; 0.92)]. After additional adjustment for BMI, associations attenuated and remained statistically significant for longitudinal insulin resistance [β = −0.05 (− 0.06; − 0.04)] and T2D risk [HR = 0.87 (0.79; 0.99)], but no longer for prediabetes risk [HR = 0.93 (0.85; 1.03)]. In conclusion, a more plant-based and less animal-based diet may lower risk of insulin resistance, prediabetes and T2D. These findings strengthen recent dietary recommendations to adopt a more plant-based diet. Clinical Trial Registry number and website NTR6831, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6831. Electronic supplementary material The online version of this article (10.1007/s10654-018-0414-8) contains supplementary material, which is available to authorized users.
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The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1500 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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We aimed to evaluate the criterion validity of the 2015 food-based Dutch dietary guidelines, which were formulated based on evidence on the relation between diet and major chronic diseases. We studied 9701 participants of the Rotterdam Study, a population-based prospective cohort in individuals aged 45 years and over [median 64.1 years (95%-range 49.0–82.8)]. Dietary intake was assessed at baseline with a food-frequency questionnaire. For all participants, we examined adherence (yes/no) to fourteen items of the guidelines: vegetables (≥200 g/day), fruit (≥200 g/day), whole-grains (≥90 g/day), legumes (≥135 g/week), nuts (≥15 g/day), dairy (≥350 g/day), fish (≥100 g/week), tea (≥450 mL/day), ratio whole-grains:total grains (≥50%), ratio unsaturated fats and oils:total fats (≥50%), red and processed meat (<300 g/week), sugar-containing beverages (≤150 mL/day), alcohol (≤10 g/day) and salt (≤6 g/day). Total adherence was calculated as sum-score of the adherence to the individual items (0–14). Information on disease incidence and all-cause mortality during a median follow-up period of 13.5 years (range 0–27.0) was obtained from data collected at our research center and from medical records. Using Cox proportional-hazards models adjusted for confounders, we observed every additional component adhered to was associated with a 3% lower mortality risk (HR 0.97, 95% CI 0.95; 0.98), lower risk of stroke (HR 0.95, 95% CI 0.92; 0.99), chronic obstructive pulmonary disease (HR 0.94, 95% CI 0.91; 0.98), colorectal cancer (HR 0.90, 95% CI 0.84; 0.96), and depression (HR 0.97, 95% CI 0.95; 0.999), but not with incidence of coronary heart disease, type 2 diabetes, heart failure, lung cancer, breast cancer, or dementia. These associations were not driven by any of the individual dietary components. To conclude, adherence to the Dutch dietary guidelines was associated with a lower mortality risk and a lower risk of developing some but not all of the chronic diseases on which the guidelines were based. Electronic supplementary material The online version of this article (doi:10.1007/s10654-017-0295-2) contains supplementary material, which is available to authorized users.
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The goal of this paper is to review the evidence related to the effect of plant-based dietary patterns on obesity and weight loss, including both observational and intervention trials. Literature from plant-based diets (PBDs) epidemiological and clinical trial research was used to inform this review. In addition, data on dietary quality, adherence, and acceptability were evaluated and are presented. Both clinical trials and observational research indicate an advantage to adoption of PBDs for preventing overweight and obesity and promoting weight loss. PBDs may also confer higher levels of diet quality than are observed with other therapeutic diet approaches, with similar levels of adherence and acceptability. Future studies should utilize health behavior theory to inform intervention development and delivery of PBDs studies and new technologies to bring interventions to scale for greater public health impact. Research examining PBDs and weight loss is also needed with more diverse populations, including older adults. Based on the available evidence, PBDs should be considered a viable option for the treatment and prevention of overweight and obesity.
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Background: Plant-based diets have been recommended to reduce the risk of type 2 diabetes (T2D). However, not all plant foods are necessarily beneficial. We examined the association of an overall plant-based diet and hypothesized healthful and unhealthful versions of a plant-based diet with T2D incidence in three prospective cohort studies in the US. Methods and findings: We included 69,949 women from the Nurses' Health Study (1984-2012), 90,239 women from the Nurses' Health Study 2 (1991-2011), and 40,539 men from the Health Professionals Follow-Up Study (1986-2010), free of chronic diseases at baseline. Dietary data were collected every 2-4 y using a semi-quantitative food frequency questionnaire. Using these data, we created an overall plant-based diet index (PDI), where plant foods received positive scores, while animal foods (animal fats, dairy, eggs, fish/seafood, poultry/red meat, miscellaneous animal-based foods) received reverse scores. We also created a healthful plant-based diet index (hPDI), where healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea/coffee) received positive scores, while less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, sweets/desserts) and animal foods received reverse scores. Lastly, we created an unhealthful plant-based diet index (uPDI) by assigning positive scores to less healthy plant foods and reverse scores to healthy plant foods and animal foods. We documented 16,162 incident T2D cases during 4,102,369 person-years of follow-up. In pooled multivariable-adjusted analysis, both PDI and hPDI were inversely associated with T2D (PDI: hazard ratio [HR] for extreme deciles 0.51, 95% CI 0.47-0.55, p trend < 0.001; hPDI: HR for extreme deciles 0.55, 95% CI 0.51-0.59, p trend < 0.001). The association of T2D with PDI was considerably attenuated when we additionally adjusted for body mass index (BMI) categories (HR 0.80, 95% CI 0.74-0.87, p trend < 0.001), while that with hPDI remained largely unchanged (HR 0.66, 95% CI 0.61-0.72, p trend < 0.001). uPDI was positively associated with T2D even after BMI adjustment (HR for extreme deciles 1.16, 95% CI 1.08-1.25, p trend < 0.001). Limitations of the study include self-reported diet assessment, with the possibility of measurement error, and the potential for residual or unmeasured confounding given the observational nature of the study design. Conclusions: Our study suggests that plant-based diets, especially when rich in high-quality plant foods, are associated with substantially lower risk of developing T2D. This supports current recommendations to shift to diets rich in healthy plant foods, with lower intake of less healthy plant and animal foods.
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Chlorogenic acids (CGAs) are esters formed between caffeic and quinic acids, and represent an abundant group of plant polyphenols present in the human diet. CGAs have different subgroups that include caffeoylquinic, p-coumaroylquinic, and feruloyquinic acids. Results of epidemiological studies suggest that the consumption of beverages such as coffee, tea, wine, different herbal infusions, and also some fruit juices is linked to reduced risks of developing different chronic diseases. These beverages contain CGAs present in different concentrations and isomeric mixtures. The underlying mechanism(s) for specific health benefits attributed to CGAs involves mitigating oxidative stress, and hence the related adverse effects associated with an unbalanced intracellular redox state. There is also evidence to show that CGAs exhibit anti-inflammatory activities by modulating a number of important metabolic pathways. This review will focus on three specific aspects of the relevance of CGAs in coffee beverages; namely: (1) the relative composition of different CGA isomers present in coffee beverages; (2) analysis of in vitro and in vivo evidence that CGAs and individual isomers can mitigate oxidative and inflammatory stresses; and (3) description of the molecular mechanisms that have a key role in the cell signaling activity that underlines important functions.
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Background: Data are scarce for the lifetime risk of developing impaired glucose metabolism, including prediabetes, as are data for the risk of eventual progression from prediabetes to diabetes and for initiation of insulin treatment in previously untreated patients with diabetes. We aimed to calculate the lifetime risk of the full range of glucose impairments, from normoglycaemia to prediabetes, type 2 diabetes, and eventual insulin use. Methods: In this prospective population-based cohort analysis, we used data from the population-based Rotterdam Study. We identified diagnostic events by use of general practitioners' records, hospital discharge letters, pharmacy dispensing data, and serum fasting glucose measurements taken at the study centre (Rotterdam, Netherlands) visits. Normoglycaemia, prediabetes, and diabetes were defined on the basis of WHO criteria for fasting glucose (normoglycaemia: ≤6·0 mmol/L; prediabetes: >6·0 mmol/L and <7·0 mmol/L; and diabetes ≥7·0 mmol/L or use of glucose-lowering drug). We calculated lifetime risk using a modified version of survival analysis adjusted for the competing risk of death. We also estimated the lifetime risk of progression from prediabetes to overt diabetes and from diabetes free of insulin treatment to insulin use. Additionally, we calculated years lived with healthy glucose metabolism. Findings: We used data from 10 050 participants from the Rotterdam Study. During a follow-up of up to 14·7 years (between April 1, 1997, and Jan 1, 2012), 1148 participants developed prediabetes, 828 developed diabetes, and 237 started insulin treatment. At age 45 years, the remaining lifetime risk was 48·7% (95% CI 46·2-51·3) for prediabetes, 31·3% (29·3-33·3) for diabetes, and 9·1% (7·8-10·3) for insulin use. In individuals aged 45 years, the lifetime risk to progress from prediabetes to diabetes was 74·0% (95% CI 67·6-80·5), and 49·1% (38·2-60·0) of the individuals with overt diabetes at this age started insulin treatment. The lifetime risks attenuated with advancing age, but increased with increasing BMI and waist circumference. On average, individuals with severe obesity lived 10 fewer years without glucose impairment compared with normal-weight individuals. Interpretation: Impaired glucose metabolism is a substantial burden on population health, and our findings emphasise the need for more effective prevention strategies, which should be implemented as soon in a person's life as possible. The substantial lifetime risk of prediabetes and diabetes in lean individuals also supports risk factor control in non-obese individuals. Funding: Erasmus MC and Erasmus University Rotterdam; Netherlands Organisation for Scientific Research; Netherlands Organisation for Health Research and Development; Research Institute for Diseases in the Elderly; Netherlands Genomics Initiative; Netherlands Ministry of Education, Culture and Science; Netherlands Ministry of Health, Welfare and Sports; European Commission; and Municipality of Rotterdam.
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Vegetarian diets may promote weight loss, but evidence remains inconclusive. PubMed, EMBASE and UpToDate databases were searched through September 22, 2014, and investigators extracted data regarding study characteristics and assessed study quality among selected randomized clinical trials. Population size, demographic (i.e., gender and age) and anthropometric (i.e., body mass index) characteristics, types of interventions, follow-up periods, and trial quality (Jadad score) were recorded. The net changes in body weight of subjects were analyzed and pooled after assessing heterogeneity with a random effects model. Subgroup analysis was performed based on type of vegetarian diet, type of energy restriction, study population, and follow-up period. Twelve randomized controlled trials were included, involving a total of 1151 subjects who received the intervention over a median duration of 18 weeks. Overall, individuals assigned to the vegetarian diet groups lost significantly more weight than those assigned to the non-vegetarian diet groups (weighted mean difference, -2.02 kg; 95 % confidence interval [CI]: -2.80 to -1.23). Subgroup analysis detected significant weight reduction in subjects consuming a vegan diet (-2.52 kg; 95 % CI: -3.02 to -1.98) and, to a lesser extent, in those given lacto-ovo-vegetarian diets (-1.48 kg; 95 % CI: -3.43 to 0.47). Studies on subjects consuming vegetarian diets with energy restriction (ER) revealed a significantly greater weight reduction (-2.21 kg; 95 % CI: -3.31 to -1.12) than those without ER (-1.66 kg; 95 % CI: -2.85 to -0.48). The weight loss for subjects with follow-up of <1 year was greater (-2.05 kg; 95 % CI: -2.85 to -1.25) than those with follow-up of ≥1 year (-1.13 kg; 95 % CI: -2.04 to -0.21). Vegetarian diets appeared to have significant benefits on weight reduction compared to non-vegetarian diets. Further long-term trials are needed to investigate the effects of vegetarian diets on body weight control.
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In our published randomized, double-blind, placebo-controlled, 3-period crossover trial, healthy adult men (n = 21) consumed bars containing no supplemental fiber (placebo; NFC), polydextrose (21 g/d), and soluble corn fiber (SCF; 21 g/d) for 21 d each. Fecal specimens were collected between days 16 and 21 for fermentative end-product analysis and 16S ribosomal RNA bacterial gene amplification for bacterial taxa identification. Fiber supplementation decreased fecal putrefaction compounds and shifted abundances of several bacterial taxa. The objective was to perform whole-genome shotgun 454 pyrosequencing on the same fecal specimens collected in that clinical trial to obtain comprehensive fecal bacterial genome sequencing coverage and explore the full range of bacterial genetic information in the fecal microbiome, thereby using a systematic approach to study the impact of dietary fiber supplementation on fecal metabolites, bacterial taxa, and bacterial metagenomes. Fecal samples were subjected to whole-genome shotgun 454 pyrosequencing to identify both fecal bacterial populations present and their functional genetic capacity. Whole-genome shotgun sequencing results revealed that fiber consumption shifted the Bacteroidetes:Firmicutes ratio, increasing the relative abundance of Bacteroidetes 12 ± 2% and 13 ± 2% with polydextrose and SCF, respectively, compared with NFC. Bivariate correlations showed a positive correlation between the Bacteroidetes:Firmicutes ratio and total dietary fiber intake but not body mass index. Principal coordinates analysis of Bray-Curtis distances indicated that bacterial gene composition was more similar in participants consuming fibers (polydextrose and SCF combined) in comparison with NFC. Shifts in bacterial gene abundances after polydextrose and SCF supplementation included genes associated with carbohydrate, amino acid, and lipid metabolism, as well as metabolism of cofactors and vitamins. This study conveys novel information about the impact of dietary fiber supplementation on the phylogenetic structure and functional capacity of the fecal microbiome of healthy adults. This trial was registered at clinicaltrials.gov as NCT02091349. © 2015 American Society for Nutrition.
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Background: Vegetarian diets have been associated with reduced mortality. Because a pure vegetarian diet might not easily be embraced by many individuals, consuming preferentially plant-derived foods would be a more easily understood message. A provegetarian food pattern (FP) emphasizing preference for plant-derived foods might reduce all-cause mortality. Objective: The objective was to identify the association between an a priori-defined provegetarian FP and all-cause mortality. Design: We followed 7216 participants (57% women; mean age: 67 y) at high cardiovascular risk for a median of 4.8 y. A validated 137-item semiquantitative food-frequency questionnaire was administered at baseline and yearly thereafter. Fruit, vegetables, nuts, cereals, legumes, olive oil, and potatoes were positively weighted. Added animal fats, eggs, fish, dairy products, and meats or meat products were negatively weighted. Energy-adjusted quintiles were used to assign points to build the provegetarian FP (range: 12-60 points). Deaths were confirmed by review of medical records and the National Death Index. Results: There were 323 deaths during the follow-up period (76 from cardiovascular causes, 130 from cancer, 117 for noncancer, noncardiovascular causes). Higher baseline conformity with the provegetarian FP was associated with lower mortality (multivariable-adjusted HR for ≥ 40 compared with <30 points: 0.59; 95% CI: 0.40, 0.88). Similar results were found with the use of updated information on diet (RR: 0.59; 95% CI: 0.39, 0.89). Conclusions: Among omnivorous subjects at high cardiovascular risk, better conformity with an FP that emphasized plant-derived foods was associated with a reduced risk of all-cause mortality. This trial was registered at www.controlled-trials.com as ISRCTN35739639.
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The prevalence of cardiovascular diseases is rising. Therefore, adequate risk prediction and identification of its determinants is increasingly important. The Rotterdam Study is a prospective population-based cohort study ongoing since 1990 in the city of Rotterdam, The Netherlands. One of the main targets of the Rotterdam Study is to identify the determinants and prognosis of cardiovascular diseases. Case finding in epidemiological studies is strongly depending on various sources of follow-up and clear outcome definitions. The sources used for collection of data in the Rotterdam Study are diverse and the definitions of outcomes in the Rotterdam Study have changed due to the introduction of novel diagnostics and therapeutic interventions. This article gives the methods for data collection and the up-to-date definitions of the cardiac outcomes based on international guidelines, including the recently adopted cardiovascular disease mortality definitions. In all, detailed description of cardiac outcome definitions enhances the possibility to make comparisons with other studies in the field of cardiovascular research and may increase the strength of collaborations.
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We assessed the prevalence of type 2 diabetes in people following different types of vegetarian diets compared with that in nonvegetarians. The study population comprised 22,434 men and 38,469 women who participated in the Adventist Health Study-2 conducted in 2002-2006. We collected self-reported demographic, anthropometric, medical history, and lifestyle data from Seventh-Day Adventist church members across North America. The type of vegetarian diet was categorized based on a food-frequency questionnaire. We calculated odds ratios (ORs) and 95% CIs using multivariate-adjusted logistic regression. Mean BMI was lowest in vegans (23.6 kg/m(2)) and incrementally higher in lacto-ovo vegetarians (25.7 kg/m(2)), pesco-vegetarians (26.3 kg/m(2)), semi-vegetarians (27.3 kg/m(2)), and nonvegetarians (28.8 kg/m(2)). Prevalence of type 2 diabetes increased from 2.9% in vegans to 7.6% in nonvegetarians; the prevalence was intermediate in participants consuming lacto-ovo (3.2%), pesco (4.8%), or semi-vegetarian (6.1%) diets. After adjustment for age, sex, ethnicity, education, income, physical activity, television watching, sleep habits, alcohol use, and BMI, vegans (OR 0.51 [95% CI 0.40-0.66]), lacto-ovo vegetarians (0.54 [0.49-0.60]), pesco-vegetarians (0.70 [0.61-0.80]), and semi-vegetarians (0.76 [0.65-0.90]) had a lower risk of type 2 diabetes than nonvegetarians. The 5-unit BMI difference between vegans and nonvegetarians indicates a substantial potential of vegetarianism to protect against obesity. Increased conformity to vegetarian diets protected against risk of type 2 diabetes after lifestyle characteristics and BMI were taken into account. Pesco- and semi-vegetarian diets afforded intermediate protection.
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The study was conducted to assess the relative validity of a 170-item semiquantitative food frequency questionnaire (SFFQ) adapted for use in the elderly. The study was carried out in a sample of 80 men and women aged 55-75 y participating in a community based prospective cohort study in Rotterdam, The Netherlands. The two-step dietary assessment comprised a simple self-administered questionnaire (20 min) followed by a structured interview with trained dietitians (20 min) based on the completed questionnaire. Multiple food records (FR) collected over a one year period served as reference method. 24 h urine urea was used as indirect marker for protein intake. Compared with FR, the SFFQ generally overestimated nutrient intake as reflected by difference in means and the ratio of SFFQ to FR. Energy adjustment reduced the observed overestimation. Pearson's correlation coefficients varied from close to 0.5 to about 0.9 for crude data, and after adjustment for age, sex, total energy intake, and for within-person variability in daily intake for 0.4-0.8. Cross-classification into quintiles resulted in correct classification into the same or adjacent quintile of 75.8% for crude and 76.8% for energy-adjusted data. Validation of protein intake estimated by SFFQ with protein excretion from 24h urine urea indicated overestimation of protein intake by SFFQ. Spearman correlation coefficient between protein intake estimated from urea excretion and SFFQ was 0.67. Adaptation of a SFFQ for use in the elderly resulted in a valid and time-efficient dietary assessment instrument. Its ability to adequately rank study subjects according to their dietary intake support its application in epidemiological studies in the elderly.
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Dietary fat and its relation to obesity has been a controversial issue for several years. In this review, several kinds of data relating to this issue are presented. There are epidemiological cross-country data and data within countries showing an effect. However, in the United States, the intake of fat appears to be declining, whereas the prevalence of obesity rises-the American Paradox. Clinical studies show that trans fatty acids can increase insulin resistance and that exercise can enhance the rate of adaptation to a high fat diet by increasing the rate of fat oxidation. The differences in response of inflammatory signals and of insulin resistance to different fatty acids indicate that not all fatty acids are the same. There are also experimental data showing that most, but not all, animals consuming a high fat diet will become obese. A number of mechanisms have been postulated for this difference, including differential sensitivities to neurotransmitters, to the intestinal peptide, enterostatin, and to individual fatty acids. One important conclusion from this review is that both total fat and individual fatty acids have to be considered when reaching conclusions about dietary fat and obesity.
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Observational studies suggest that a plant-based diet is inversely related to body mass index (BMI), overweight, and obesity. Our objective was to examine the BMI (kg/m(2)) and risk of overweight and obesity of self-defined semivegetarian, lactovegetarian, and vegan women. Data analyzed in this cross-sectional study were from 55459 healthy women participating in the Swedish Mammography Cohort. Women were asked whether they considered themselves to be omnivores (n = 54257), semivegetarians (n = 960), lactovegetarians (n = 159), or vegans (n = 83), and this question was the main exposure variable in this study. In secondary analyses, we reclassified women as lactovegetarians on the basis of food intakes reported on the food-frequency questionnaire. The prevalence of overweight or obesity (BMI >/= 25) was 40% among omnivores, 29% among both semivegetarians and vegans, and 25% among lactovegetarians. In multivariate, adjusted logistic regression analyses, self-identified vegans had a significantly lower risk of overweight or obesity [odds ratio (OR) = 0.35; 95% CI: 0.18, 0.69] than did omnivores, as did lactovegetarians (OR = 0.54; 95% CI: 0.35, 0.85) and semivegetarians (OR = 0.52; 95% CI: 0.43, 0.62). Risk of overweight or obesity remained significantly lower among lactovegetarians classified on the basis of the food-frequency questionnaire (OR = 0.48; 95% CI: 0.30, 0.78). Even if vegetarians consume some animal products, our results suggest that self-identified semivegetarian, lactovegetarian, and vegan women have a lower risk of overweight and obesity than do omnivorous women. The advice to consume more plant foods and less animal products may help individuals control their weight.
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Whether different intakes of vegetables and fruit modulate immunologic markers is currently not known. We investigated the effects of low, medium, and high intakes of vegetables and fruit on markers of immune functions, including nonspecific markers of inflammation. In a randomized controlled trial, nonsmoking men consumed a diet that included < or = 2 servings/d of vegetables and fruit for 4 wk. The subjects were then randomly assigned to 1 of 3 groups to consume 2 servings/d, 5 servings/d, or 8 servings/d of carotenoid-rich vegetables and fruit for another 4-wk period. Plasma concentrations of vitamins C and E and carotenoids were measured. The assessment of immunologic and inflammatory markers included the number and activity of natural killer cells, secretion of cytokines, lymphocyte proliferation, and plasma C-reactive protein concentrations. The high intake (8 servings/d) of vegetables and fruit significantly increased total carotenoid concentrations in plasma compared with the low intake (2 servings/d; week 4 compared with week 8), whereas concentrations of vitamins C and E did not differ between week 4 and week 8. Immunologic markers were not significantly modulated. In contrast, C-reactive protein was significantly reduced at week 8 in the subjects who consumed 8 servings/d of vegetables and fruit compared with those who consumed 2 servings/d. In healthy, well-nourished, nonsmoking men, 4 wk of low or high intakes of carotenoid-rich vegetables and fruit did not affect markers of immune function. However, a high intake of vegetables and fruit may reduce inflammatory processes, as indicated by the reduction of plasma C-reactive protein.
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Cross-sectional studies have shown that vegetarians and vegans are leaner than omnivores. Longitudinal data on weight gain in these groups are sparse. We investigated changes in weight and body mass index (BMI) over a 5-year period in meat-eating, fish-eating, vegetarian, and vegan men and women in the UK. Self-reported anthropometric, dietary and lifestyle data were collected at baseline in 1994-1999 and at follow-up in 2000-2003; the median duration of follow-up was 5.3 years. A total of 21,966 men and women participating in Oxford arm of the European Prospective Investigation into Cancer and Nutrition aged 20-69 years at baseline. The mean annual weight gain was 389 (SD 884) g in men and 398 (SD 892) g in women. The differences between meat-eaters, fish-eaters, vegetarians and vegans in age-adjusted mean BMI at follow-up were similar to those seen at baseline. Multivariable-adjusted mean weight gain was somewhat smaller in vegans (284 g in men and 303 g in women, P<0.05 for both sexes) and fish-eaters (338 g, women only, P<0.001) compared with meat-eaters. Men and women who changed their diet in one or several steps in the direction meat-eater --> fish-eater --> vegetarian --> vegan showed the smallest mean annual weight gain of 242 (95% CI 133-351) and 301 (95% CI 238-365) g, respectively. During 5 years follow-up, the mean annual weight gain in a health-conscious cohort in the UK was approximately 400 g. Small differences in weight gain were observed between meat-eaters, fish-eaters, vegetarians and vegans. Lowest weight gain was seen among those who, during follow-up, had changed to a diet containing fewer animal food.
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Plant-based diets, defined in terms of low frequency of animal food consumption, have been increasingly recommended for their health benefits. Numerous studies have found plant-based diets, especially when rich in high quality plant foods such as whole grains, fruits, vegetables, and nuts, to be associated with lower risk of cardiovascular outcomes and intermediate risk factors. This review summarizes the current evidence base examining the associations of plant-based diets with cardiovascular endpoints, and discusses the potential biological mechanisms underlying their health effects, practical recommendations and applications of this research, and directions for future research. Healthful plant-based diets should be recommended as an environmentally sustainable dietary option for improved cardiovascular health.
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Background Being overweight or obese is associated with an increased risk of cardiovascular disease (CVD). Physical activity might reduce the risk associated with overweight and obesity. We examined the association between overweight and obesity and CVD risk as a function of physical activity levels in a middle-aged and elderly population. Design The study was a prospective cohort study. Methods The study included 5344 participants aged 55 years or older from the population-based Rotterdam Study. Participants were classified as having high or low physical activity based on the median of the population. Normal weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²) and obese participants (≥30 kg/m²) were categorized as having high or low physical activity to form six categories. We assessed the association of the six categories with CVD risk using Cox proportional hazard models adjusted for confounders. High physical activity and normal weight was used as the reference group. Results During 15 years of follow-up (median 10.3 years, interquartile range 8.2–11.7 years), 866 (16.2%) participants experienced a CVD event. Overweight and obese participants with low physical activity had a higher CVD risk than normal weight participants with high physical activity. The HRs and 95% confidence intervals (CIs) were 1.33 (1.07–1.66) and 1.35 (1.04–1.75), respectively. Overweight and obese participants with high physical activity did not show a higher CVD risk (HRs (95%CIs) 1.03 (0.82–1.29) and 1.12 (0.83–1.52), respectively). Conclusions Our findings suggest that the beneficial impact of physical activity on CVD might outweigh the negative impact of body mass index among middle-aged and elderly people. This emphasizes the importance of physical activity for everyone across all body mass index strata, while highlighting the risk associated with inactivity even among normal weight people.
Article
Context: In vitro and in vivo experiments have assigned both oncosuppressive and oncogenic properties to thyroid hormones. Population-based studies found inconclusive results. Objective: We aimed to prospectively assess the relation between thyroid function and incident cancer in a population based setting. Design, setting and participants: The current study is a prospective population-based cohort study including 10,318 participants for whom baseline measurements of free thyroxine (FT4) and/or thyrotropin (TSH) were available. Main outcome measures: Cox proportional hazards models were used to assess hazard ratios (HRs) of any solid non-skin cancer, as well as lung, breast, prostate and gastrointestinal cancer specifically. Results: Higher FT4 levels were associated with a higher risk of any solid cancer (HR: 1.42; 95% confidence interval (CI): 1.12-1.79), lung cancer (HR: 2.33; 95% CI: 1.39-3.92) and breast (HR: 1.77; 95% CI: 1.10-2.84) cancer. The risk estimates were similar after exclusion of thyroid-altering medication, but the association lost significance for breast cancer. Compared to the lowest FT4 tertile, the highest tertile was associated with a 1.13 fold increased risk of any solid, 1.79 fold increased risk of lung and 1.14 fold increased risk of breast cancer (p for trend < 0.05 for all). For TSH levels we found no associations with cancer risk. There was no differential effect of sex or age on the association between thyroid function and cancer risk. Conclusions: Higher FT4 levels are significantly associated with an increased risk of any solid, lung and breast cancer. Further research should elucidate the underlying pathophysiological mechanisms.
Article
To determine if increased dietary or supplemental intake of fiber slows or prevents inflammation as evidenced by high-sensitivity C-reactive protein (hs-CRP) values. CINAHL, Medline, Health Source, Nursing/Academic Edition, and the Cochrane Library. Evidence from this review suggested significant associations between fiber consumption and decreased risk for cardiovascular (CV) disease as evidenced by a decrease in hs-CRP levels. Six of the seven articles reviewed showed statistically significant decreases in hs-CRP levels as dietary fiber was increased. Fiber in the diet may play a strong role in CV health as evidenced by six clinical trials completed using amount of fiber intake in relation to inflammation, particularly hs-CRP levels. Patients need to be educated to adhere to a high fiber diet, either by dietary or supplemental means, using the recommended 25-30 g of fiber per day.
Article
The relative validity of a 104-item food-frequency method to assess intakes of fats and cholesterol was tested against the dietary history of 191 men and women. Pearson correlation coefficients ranged from 0.38 for linoleic acid (% of energy) to 0.83 for energy intake, with 0.78 and 0.75 for the intakes of total fat and saturated fatty acids, respectively. Mean intakes were overestimated by the food-frequency questionnaire relative to the dietary history by 5% for energy and monounsaturated fatty acids (% of energy) and up to 30% for linoleic acid intake. Linoleic acid concentrations in erythrocytes and adipose tissue were used as biomarkers of intake. The correlation of the linoleic acid intake according to the food-frequency questionnaire with linoleic acid in erythrocytes and adipose tissue was 0.44 and 0.28, respectively, and the dietary history gave similar values. The food-frequency questionnaire gives results similar to those from the dietary history and is thus considered appropriate for classifying subjects according to their fat intake.
Article
The role of dietary protein in weight loss and weight maintenance encompasses influences on crucial targets for body weight regulation, namely satiety, thermogenesis, energy efficiency, and body composition. Protein-induced satiety may be mainly due to oxidation of amino acids fed in excess, especially in diets with "incomplete" proteins. Protein-induced energy expenditure may be due to protein and urea synthesis and to gluconeogenesis; "complete" proteins having all essential amino acids show larger increases in energy expenditure than do lower-quality proteins. With respect to adverse effects, no protein-induced effects are observed on net bone balance or on calcium balance in young adults and elderly persons. Dietary protein even increases bone mineral mass and reduces incidence of osteoporotic fracture. During weight loss, nitrogen intake positively affects calcium balance and consequent preservation of bone mineral content. Sulphur-containing amino acids cause a blood pressure-raising effect by loss of nephron mass. Subjects with obesity, metabolic syndrome, and type 2 diabetes are particularly susceptible groups. This review provides an overview of how sustaining absolute protein intake affects metabolic targets for weight loss and weight maintenance during negative energy balance, i.e., sustaining satiety and energy expenditure and sparing fat-free mass, resulting in energy inefficiency. However, the long-term relationship between net protein synthesis and sparing fat-free mass remains to be elucidated.
Article
To examine dietary fat and meat intake in relation to risk of type 2 diabetes. We prospectively followed 42,504 male participants of the Health Professionals Follow-Up Study who were aged 40-75 years and free of diagnosed diabetes, cardiovascular disease, and cancer in 1986. Diet was assessed by a validated food frequency questionnaire and updated in 1990 and 1994. During 12 years of follow-up, we ascertained 1,321 incident cases of type 2 diabetes. Intakes of total fat (multivariate RR for extreme quintiles 1.27, CI 1.04-1.55, P for trend=0.02) and saturated fat (1.34, 1.09-1.66, P for trend=0.01) were associated with a higher risk of type 2 diabetes. However, these associations disappeared after additional adjustment for BMI (total fat RR 0.97, CI 0.79-1.18; saturated fat 0.97, 0.79-1.20). Intakes of oleic acid, trans-fat, long-chain n-3 fat, and alpha-linolenic acid were not associated with diabetes risk after multivariate adjustment. Linoleic acid was associated with a lower risk of type 2 diabetes in men <65 years of age (RR 0.74, CI 0.60-0.92, P for trend=0.01) and in men with a BMI <25 kg/m(2) (0.53, 0.33-0.85, P for trend=0.006) but not in older and obese men. Frequent consumption of processed meat was associated with a higher risk for type 2 diabetes (RR 1.46, CI 1.14-1.86 for > or = 5/week vs. <1/month, P for trend <0.0001). Total and saturated fat intake were associated with a higher risk of type 2 diabetes, but these associations were not independent of BMI. Frequent consumption of processed meats may increase risk of type 2 diabetes.
  • E Ravussin
  • B A Swinburn
Ravussin E, Swinburn BA. Pathophysiology of obesity. Lancet. 1992;340:404-408.