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Vegetarian diets and incidence of diabetes in the Adventist Health Study-2

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Vegetarian diets and incidence of diabetes in the Adventist Health Study-2

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Aim: To evaluate the relationship of diet to incident diabetes among non-Black and Black participants in the Adventist Health Study-2. Methods and results: Participants were 15,200 men and 26,187 women (17.3% Blacks) across the U.S. and Canada who were free of diabetes and who provided demographic, anthropometric, lifestyle and dietary data. Participants were grouped as vegan, lacto ovo vegetarian, pesco vegetarian, semi-vegetarian or non-vegetarian (reference group). A follow-up questionnaire after two years elicited information on the development of diabetes. Cases of diabetes developed in 0.54% of vegans, 1.08% of lacto ovo vegetarians, 1.29% of pesco vegetarians, 0.92% of semi-vegetarians and 2.12% of non-vegetarians. Blacks had an increased risk compared to non-Blacks (odds ratio [OR] 1.364; 95% confidence interval [CI], 1.093-1.702). In multiple logistic regression analysis controlling for age, gender, education, income, television watching, physical activity, sleep, alcohol use, smoking and BMI, vegans (OR 0.381; 95% CI 0.236-0.617), lacto ovo vegetarians (OR 0.618; 95% CI 0.503-0.760) and semi-vegetarians (OR 0.486, 95% CI 0.312-0.755) had a lower risk of diabetes than non-vegetarians. In non-Blacks vegan, lacto ovo and semi-vegetarian diets were protective against diabetes (OR 0.429, 95% CI 0.249-0.740; OR 0.684, 95% CI 0.542-0.862; OR 0.501, 95% CI 0.303-0.827); among Blacks vegan and lacto ovo vegetarian diets were protective (OR 0.304, 95% CI 0.110-0.842; OR 0.472, 95% CI 0.270-0.825). These associations were strengthened when BMI was removed from the analyses. Conclusion: Vegetarian diets (vegan, lacto ovo, semi-) were associated with a substantial and independent reduction in diabetes incidence. In Blacks the dimension of the protection associated with vegetarian diets was as great as the excess risk associated with Black ethnicity.

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... Findings from the Adventist Health Study-2 Cohort have demonstrated that vegetarian dietary patterns have been associated with many positive health outcomes, including lower risk of metabolic syndrome (56%) [1], lower incidence of diabetes (39-62%) [2], lower overall mortality (hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.80-0.97), and cardiovascular disease mortality (HR: 0.71, 95% CI: 0.57-0.90) ...
... Additionally, compared to non-vegetarians, they have more favorable fatty acid profiles, including lower saturated fatty acids, and higher total omega-3, along with higher levels of phytochemicals such as carotenoids, enterolactone, and isoflavones in plasma or urine [15], but lower inflammatory cytokines [79]. Importantly, vegetarians have shown significantly reduced risks of diabetes, hypertension, cardiovascular disease, select cancers, and all-cause mortality relative to non-vegetarians [1][2][3]80]. These differences in disease and biomarker profiles between vegetarians and non-vegetarians coincide with the differences in plasma metabolites identified in the present study. ...
... Values presented as n (%) or mean (SD).2 Dietary variables adjusted for kcal/day.3 ...
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It is unclear how vegetarian dietary patterns influence plasma metabolites involved in biological processes regulating chronic diseases. We sought to identify plasma metabolic profiles distinguishing vegans (avoiding meat, eggs, dairy) from non-vegetarians (consuming ≥28 g/day red meat) of the Adventist Health Study-2 cohort using global metabolomics profiling with ultra-performance liquid chromatography mass spectrometry (UPLC-MS/MS). Differences in abundance of metabolites or biochemical subclasses were analyzed using linear regression models, adjusting for surrogate and confounding variables, with cross-validation to simulate results from an independent sample. Random forest was used as a learning tool for classification, and principal component analysis was used to identify clusters of related metabolites. Differences in covariate-adjusted metabolite abundance were identified in over 60% of metabolites (586/930), after adjustment for false discovery. The vast majority of differentially abundant metabolites or metabolite subclasses showed lower abundance in vegans, including xanthine, histidine, branched fatty acids, acetylated peptides, ceramides, and long-chain acylcarnitines, among others. Many of these metabolite subclasses have roles in insulin dysregulation, cardiometabolic phenotypes, and inflammation. Analysis of metabolic profiles in vegans and non-vegetarians revealed vast differences in these two dietary groups, reflecting differences in consumption of animal and plant products. These metabolites serve as biomarkers of food intake, many with potential pathophysiological consequences for cardiometabolic diseases.
... The main characteristics of the included observational studies reporting the effects of vegan or plant-based dietary patterns on risk for T2D (prevalence or incidence) are summarized in Table 1. Of the seven studies, five were classified as prospective cohort studies [7][8][9][10][11] and two as cross-sectional studies [12,13]. The study quality assessment for each observational study reported a good quality in four studies [9][10][11]13] and a fair quality in three studies [7,8,12]. ...
... Of the seven studies, five were classified as prospective cohort studies [7][8][9][10][11] and two as cross-sectional studies [12,13]. The study quality assessment for each observational study reported a good quality in four studies [9][10][11]13] and a fair quality in three studies [7,8,12]. No study was rated of poor quality. ...
... From the seven observational studies, five prospective cohort studies evaluated the incidence rate of T2D among vegans [7,11] or people that consumed a PBD [8][9][10]. ...
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A protective effect of vegan diets on health outcomes has been observed in previous studies, but its impact on diabetes is still debated. The aim of this review is to assess the relationship between vegan diets and the risk for type 2 diabetes (T2D) along with its effect on glycemic control and diabetes-related complications. In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta–Analyses) guidelines, Pubmed and Cochrane library databases were systematically searched for all relevant studies. Seven observational and eight randomized controlled (RCTs) studies were included. The methodological quality of studies was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies and the Cochrane Risk of Bias Tool for RCTs. We found that a vegan diet is associated with lower T2D prevalence or incidence and in T2D patients decreases high glucose values and improves glucose homeostasis, as reported from the majority of included studies. This approach seems to be comparable to other recommended healthful eating models, but as it may have potential adverse effects associated with the long-term exclusion of some nutrients, appropriate nutritional planning and surveillance are recommended, particularly in specific groups of diabetic patients such as frail elderly, adolescents, and pregnant or breastfeeding women.
... En qua voeding, hoe lager de inname van dierlijk vet [20] en hoe meer plantaardige eiwitbronnen de deelnemers in de eerste studie aten, des te beter het dieet leek te werken [21], hetgeen zou kunnen verklaren waarom vegetarische diëten nog beter lijken te werken, en des te meer plantaardig, des te lager de prevalentie van hypertensie [22]. Op het DASH-dieet minderden de studieparticipanten in het consumeren van vlees, maar ze eten het nog steeds elke dag, dus zouden ze kwalificeren als niet- Dezelfde soort stapsgewijze dalingen in diabetes mellitus-percentages zijn zichtbaar als het dieet meer en meer plantaardig wordt en een daling van het overtollige lichaamsgewicht is hiervan ook een resultaat zodat alleen degenen die volledig plantaardig eten in de ideale lichaamsgewichtscategorie vallen [23]. Maar men zou zich kunnen afvragen of het kan zijn dat degenen die plantaardig eten enkel omdat ze gemiddeld zo mager zijn zo'n lagere bloeddruk hebben, maar dit is zeker niet het geval aangezien degenen die plantaardig eten slechts een fractie van het diabetesrisico hebben, zelfs bij dezelfde lichaamsmassa en zelfs na controle voor de lichaamsmassaindex (ook wel "body mass index BMI" genoemd) [23]. ...
... Op het DASH-dieet minderden de studieparticipanten in het consumeren van vlees, maar ze eten het nog steeds elke dag, dus zouden ze kwalificeren als niet- Dezelfde soort stapsgewijze dalingen in diabetes mellitus-percentages zijn zichtbaar als het dieet meer en meer plantaardig wordt en een daling van het overtollige lichaamsgewicht is hiervan ook een resultaat zodat alleen degenen die volledig plantaardig eten in de ideale lichaamsgewichtscategorie vallen [23]. Maar men zou zich kunnen afvragen of het kan zijn dat degenen die plantaardig eten enkel omdat ze gemiddeld zo mager zijn zo'n lagere bloeddruk hebben, maar dit is zeker niet het geval aangezien degenen die plantaardig eten slechts een fractie van het diabetesrisico hebben, zelfs bij dezelfde lichaamsmassa en zelfs na controle voor de lichaamsmassaindex (ook wel "body mass index BMI" genoemd) [23]. Kijken naar hypertensie heeft de gemiddelde Amerikaan een aandoening welke prehypertensie wordt genoemd, hetgeen betekent dat het hoogste getal van de bloeddruk tussen 120 en 139 ligt en dus nog geen hypertensie welke operationeel gedefinieerd begint bij 140, maar het betekent dat die mensen mogelijk op weg zijn om hypertensie te ontwikkelen. ...
... Vergeleken met de bloeddruk van degenen die volwaardige plantaardige diëten aten was de gemiddelde bloeddruk niet 3 (drie) punten lager, niet 4 (vier) punten lager en zelfs niet 7 (zeven) punten lager, maar lag deze zelfs 28 punten lager. Het is ook zo dat de groep die in deze studie het standaard Amerikaanse dieet at gemiddeld overgewicht had met een BMI van meer dan 26, hetgeen nog steeds beter was dan de meeste Amerikanen in die tijd op dat moment, terwijl de veganisten gemiddeld een BMI van 21 hadden, hetgeen ongeveer 36 pond (dat is ongeveer 16 [kg]) lichter in massa is [23]. Dus het kan ook zo zijn, en dit is ongeveer de enige reden die nog over is, dat degenen die vlees, eieren, zuivelproducten en relatief meer bewerkte rommel aten, zo'n hogere bloeddruk hadden omdat ze te zwaar waren, en dus dat het dieet op zichzelf er misschien niets mee te maken heeft. ...
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The dried petals of the hibiscus flower may help as nutrition for the cardiovascular system, potentially as nutrition against cancer and may help as nutrition for the immune system. Article: Hibiscus [Sources below] The relatively often reddish colored dried petals of the flowers of the in the relatively warm temperate mediterranean, subtropical and tropical areas of the world growing hibiscus shrub plant genus (also called "flor de Jamaica" in the country Mexico, "sorrel" in the Caribbean areas, "roselle" in many parts of the world, also "rose mallow", "hardy hibiscus", "rose of Sharon" which name is more specifically used to describe the not in the same family related hypericum calycinum, "ibískos", "ἰβίσκος", "rose of Althea" more specifically used for the garden hibiscus hibiscus syriacus and "tropical hibiscus") containing about 200 plant species, e.g., the hibiscus blossom sabdariffa Sudan, which genus is categorizable in the mallow malvaceae plant family (also called "kaasjeskruidfamilie", "malvaceae sensu lato" and "malvaceae sensu") often used in tea (e.g. hibiscus tea also called "sour tea" because it has acids in it like citric acid [2] or (inclusive or) as the zing in red zinger tea) or (inclusive or) even higher in nutrients using the whole flower parts as high antioxidant smoothie fruit punches (as you can in the following proportions soak 1 (one) handful of bulk dried organic hibiscus flowers cold brewing overnight and then blend with 1 (one) knuckle of fresh ginger, 1 (one) teaspoon of amla powder, 3 (three) tablespoons of date syrup or (exclusive or) blend in some dates, 1 (one) handful of fresh dark leavy green mint leaves and some lemon juice to make a drink just to drink throughout the day which is cold storable in the fridge) are possible usable as: >it may be useful as nutrition for the immune system since a study showed that consumption of an aqueous hibiscus extract like tea has impact on systemic antioxidant potential in relatively healthy human animal being subjects thus shown that the antioxidant phytonutrients in hibiscus are effectively absorbed in human animal bodies having bioavailable in the bloodstream. If you take people and have
... An extensive body of population studies and clinical trials supports the implementation of PBDs for the prevention of obesity and obesity-related diseases. Observational data from the Adventist Health Study-2 (AHS-2) involving 41,387 participants, showed that body mass index (BMI) was positively correlated with the amount of animal-based foods consumed, such that non-vegetarians had the highest BMI, followed by semi-vegetarians, pescatarians, vegetarians, and vegans [29]. In addition, findings from the EPIC-Oxford cohort, containing 21,966 men and women, have shown that vegans and pescatarian women gain significantly less weight annually compared with meat-eaters [30]. ...
... After adjusting for BMI and other confounding variables, vegans had half the risk of T2D than non-vegetarians (Odds Ratio (OR)) 0.51 (95% CI: 0.40, 0.66)) and semi-vegetarians had an intermediate risk (0.76 (0.65, 0.90)). In a 2-year prospective study of the AHS-2 cohort, vegans had less than half the risk of T2D than non-vegetarians (OR 0.38 (0.24, 0.62)) even when adjustments were made for BMI and other confounders [29]. In a 17-year prospective study with 8401 participants, long-term weekly dietary inclusion of meat was associated with 74% increased (OR 1.74 (1.36, 2.22)) odds of T2D compared with long-term adherence to a vegetarian dietary pattern [44]. ...
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The coronavirus pandemic has acted as a reset on global economies, providing us with the opportunity to build back greener and ensure global warming does not surpass 1.5 °C. It is time for developed nations to commit to red meat reduction targets and shift to plant-based dietary patterns. Transitioning to plant-based diets (PBDs) has the potential to reduce diet-related land use by 76%, diet-related greenhouse gas emissions by 49%, eutrophication by 49%, and green and blue water use by 21% and 14%, respectively, whilst garnering substantial health co-benefits. An extensive body of data from prospective cohort studies and controlled trials supports the implementation of PBDs for obesity and chronic disease prevention. The consumption of diets high in fruits, vegetables, legumes, whole grains, nuts, fish, and unsaturated vegetable oils, and low in animal products, refined grains, and added sugars are associated with a lower risk of all-cause mortality. Meat appreciation, health concerns, convenience, and expense are prominent barriers to PBDs. Strategic policy action is required to overcome these barriers and promote the implementation of healthy and sustainable PBDs.
... [4] In a prospective Adventist health study with over 41,000 people, those who rigorously adhered to more whole plant foods had a much lower chance of acquiring diabetes, but those who consumed omnivorous diets of various kinds had a higher risk. [5] A plethora of comorbidities are exacerbated by the diabetes epidemic. Hypertension is one of the most common consequences of diabetes mellitus. ...
... [19] According to the Adventist Health Study 2, which enrolled over 61,000 people, the risk of T2DM increased in direct proportion to the amount of animalbased nutrition consumed. [5] Despite the fact that male T1DM patients outnumbered females in this study, T2DM was more common among females. This finding is consistent with current evidence from population-based research indicating that T2DM is more common in women than in men. ...
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Introduction: Diabetes is a lifestyle disorder that is of global public health concern. The comorbidities associated with diabetes often predispose to early mortality. Available conventional medications often elicit limited therapeutic activity, except when combined with ideal lifestyle modifications. This study aimed at investigating how diabetes patients responded to intensive lifestyle changes including diet and exercise. fiveyear retrospective study of diabetic subjects who under went ten days of intense lifestyle changes. The patient's hospital record was retrieved. Data were analysed using paired tThe most common comorbidity among diabetic patients was hypertension, affecting 86 (5 At the onset of admission to the lifestyle ward, there were 12 (7.6%), 19 (12.1%), 42 (26.8%), and 13 (8.3%) diabetic patients with elevated blood pressure, stage 1, 2, and 3 hypertension, respectively. On discharge, 85 (54.1%) of the patie plantMethod : This was a test on graph pad prism (version 5.0). Results: 4.8%) of them. nts had normal blood pressure, while 42 (26.8%), 27 (17.2%), and 42 (26.8%) had elevated, stage 1 and 2 hypertension, respectively. The mean fasting blood glucose (FBG) obtained was 13.24 mol/L, body mass index (BMI) was 27.10, systolic blood pressure (SBP ) was 193.3mmHg, while mean diastolic blood pressure (DBP) was 120.34mmHg. After the lifestyle intervention mean FBG (6.23 mmol/L), BMI (21.73), SBP (118.3 mmHg), and DBP (95.57 mmHg) were all significantly (p < 0.05) lower. Conclusion: The implementation of a whole food based diet and exercise resulted in a considerable remission of diabetes mellitus and its most common comorbidity, hypertension, according to this study
... Considering the effects of macronutrients on cardiometabolic health, dietary protein has received little attention compared with dietary fats and carbohydrates. Among various dietary patterns, adherence to vegetarian dietary patterns has been associated with a lower risk of developing metabolic syndrome abnormalities [6][7][8][9][10][11], diabetes [12][13][14] and CVD mortality [15]. However, the benefits of plant protein intake cannot be inferred from studies on vegetarians because other components of their diets such as other macronutrients, vitamins, minerals, phytochemicals, and fiber individually or in combination can influence cardiometabolic health outcomes [10]. ...
... A meta-analysis of RCT trials showed that substitution of plant protein for animal protein decreased LDL, non-HDL, and apolipoprotein B [45,46]. It is unclear why in our study dietary plant protein intake did not show an inverse association with the lipid biomarkers when much evidence exits on the beneficial effect of vegetarian diets on blood lipid [6,11,12]. A possible explanation could be related to the combined effect from several components found in vegetarian diets in addition to plant protein such as soluble fiber, saponins, steroids, polyphenols, and phytates which have lipid modifying properties. ...
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Background: Few research studies have focused on the effects of dietary protein on metabolic syndrome and its components. Our objective was to determine the relationship between the type of dietary protein intake and animal to plant (AP) protein ratio with metabolic syndrome and its components. Methods: This population-based study had a cross sectional design and conducted on 518 participants of the Adventist Health Study 2 (AHS-2) Calibration Study. Two sets of three dietary 24-h recalls were obtained six months apart. Anthropometric measures and biochemical tests were performed in clinics. Regression calibration models were used to determine the association of type of dietary protein with metabolic syndrome and its components (raised triglyceride, raised blood pressure, reduced high-density lipoprotein cholesterol (HDL), raised fasting blood glucose and increased waist circumference). Results: The likelihood of metabolic syndrome was lower in those with higher total dietary protein and animal protein intake (p = 0.02).Total protein (β = 0.004, [95%CI: 0.002, 0.007]), animal protein intake (β = 0.004, [95%CI: 0.001, 0.007]) and AP protein intake ratio (β = 0.034, [95%CI: 0.021, 0.047]) were positively associated with waist circumference. Higher AP protein ratio was related to higher fasting blood glucose (β = 0.023, [95%CI: 0.005, 0.041]). Conclusion: Our study suggests that considering a significant amount of plant protein as a part of total dietary protein has beneficial effects on cardiometabolic risk factors.
... 108 The religious group Seventh-day Adventists promotes vegetarianism, which may be advantageous as several studies have shown that vegetarianism is associated with lower prevalence of type 2 diabetes. 109 However, the diet of Seventhday Adventists is characterized by a large intake of carbohydrates in the form of fruits and vegetables, as well as high content of fatty acids, dietary fiber, folic acid, vitamin C, vitamin E and Mg 110 Vegetarianism is also practiced in Hinduism and Buddhism. 111 carbohydrates as a staple, usually rice and or chapatis (form of bread). ...
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Evidence suggests that low carbohydrate (<130 g/day of carbohydrate) (LCD) and very low carbohydrate, ketogenic diets (typically <50 g/day of carbohydrate) (VLCKD) can be effective tools for managing diabetes given their beneficial effects on weight loss and glycemic control. VLCKD also result in favorable lipid profile changes. However, these beneficial effects can be limited by poor dietary adherence. Cultural, religious, and economic barriers pose unique challenges to achieving nutritional compliance with LCD and VLCKD. We review the various methods for assessing adherence in clinical studies and obstacles posed, as well as potential solutions to these challenges.
... Diets with greater proportions of fruits, vegetables, nuts grains, and reduced proportions of red meat, such as the Mediterranean, pescatarian, and vegetarian diets, significantly lower the risks of chronic diseases such as type 2 diabetes, cancer, and coronary and all-cause mortality [42,46,49]. Predominantly plant-based diets also appear associated with decreased weights and a lower prevalence of obesity [50,51]. Furthermore, diets with reduced quantities of meat, such as vegetarian and the Mediterranean diet, have a lower environmental impact and are more sustainable than the usual western diet [52]. ...
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Purpose of Review The goal of this manuscript is to identify dietary and active transport strategies that reduce greenhouse gases and obesity, and thereby mitigate the effects of climate change on crop yields and micronutrient content. Recent Findings This report builds on our earlier publication that described the Global Syndemic of Obesity, Undernutrition, and Climate Change. We focus here on the contributions that the USA makes to the Global Syndemic and the policy solutions necessary to reduce the effects of the transport and food and agriculture systems on greenhouse gas emissions and environmental degradation. Summary A recent study suggests that people are interested and ready to address local solutions to climate change. Changing the individual behaviors that sustain the US transport and food and agriculture systems is the first step to the broader engagement necessary to build the political will that to achieve institutional, municipal, state, and federal policy.
... Además, se reportó una reducción significativa de la glucosa en ayunas, LDL, IMC y circunferencia de cintura. El estudio epidemiológico longitudinal Adventist Health-2 evalúo la incidencia de DM2, demostrándose que dietas veganas (OR= 0.38), ovo-lacto-vegetariana (OR= 0.62), y semi vegetariana (OR= 0.49) se asociaron significativamente con menor riesgo de DM2 en comparación con los no vegetarianos 32 . Otros estudios epidemiológicos han asociado patrones de DBP, como el tipo mediterráneo, vegetariano y DASH con un menor riesgo de DM2 33 . ...
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Plant-based diets (PBD) are characterized by a high intake of foods of plant origin and the partial or total avoidance of animal products. The objective of the current study was to compile the evidence on types of PBD and its effect on the main modifiable cardio-metabolic risk factors (CMRF). Healthy and unhealthy PBD were found to exist. Some healthy PBDs were: vegetarian, mediterranean and DASH (Dietary Approaches to Stop Hypertension). These promote the intake of “healthy” plant-based foods (fruits, vegetables, legumes, seeds, nuts, whole grains, avocado, olive oil and / or canola) and a gradual reduction of all foods of animal origin, especially red and processed meats; avoiding “less healthy” plant-based foods (refined, fried cereals, pastry products, foods with added sugar). Unhealthy PBDs were characterized by a high intake of these “less healthy” foods, and are associated with greater cardiovascular risk, due to the low contribution of antioxidants, micronutrients, dietary fiber and unsaturated fats. Healthy PBDs can lower the risk of type 2 diabetes, high blood pressure, being overweight, and obesity. They have shown greater cardiovascular benefits compared to traditional diets, significantly reducing: HbA1c and fasting glycemia in diabetics; systolic and diastolic blood pressure in hypertensive and prehypertensive patients; body mass index in overweight / obese subjects and improves lipid profile in subjects with dyslipidemia. Healthy PBD patterns, such as vegetarian, Mediterranean, and DASH are recommended to prevent and treat CMRF. Key words: Cardiovascular disease; Epidemiology; Nutrition; Plant-based diet; Pro-vegetarian; Risk factors
... It is supported by a previous meta-analysis that showed that a vegetarian diet could prevent the development of T2DM [32]. Such a relationship is independent of BMI [50][51][52]. Vegans also have low levels of intramyocellular lipids related to improved insulin sensitivity [53]. In addition, low consumption of saturated lipids [54,55] and low liver fat content [56] participate in a better β-cell function. ...
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Background A vegan diet has benefits on weight reduction and on the parameters of glucose and lipid metabolism. This meta-analysis aimed to investigate the efficacy of plant-based diets on insulin resistance and blood lipids in patients with obesity. Methods PubMed, Embase, and the Cochrane Library were searched for available papers published up to March 2021. The primary outcome was insulin resistance which was assessed by Homeostasis Model Assessment Insulin Resistance (HOMA-IR), other metabolic parameters measures including the pre/post-diet changes in triglycerides, HDL-cholesterol, total cholesterol, LDL-cholesterol. All analyses were performed using the random-effects model. Results Six studies (seven datasets) were included. Compared with baseline, the plant-based diet improved the HOMA-IR (SMD = 1.64, 95%CI 0.95, 2.33; I ² = 91.8%, P heterogeneity < 0.001), total cholesterol (SMD = 2.51, 95% CI 0.88, 4.13; I ² = 98.0%, P heterogeneity < 0.001), HDL-cholesterol (SMD = 1.55, 95% CI 0.66, 2.44; I ² = 92.0%, P heterogeneity < 0.001), and LDL-cholesterol (SMD = 2.50, 95% CI 1.30, 3.70; I ² = 94.4%, P heterogeneity < 0.001), but not the triglycerides (SMD = − 0.62, 95% CI − 1.92, 0.68; I ² = 97.8%, P heterogeneity < 0.001). The sensitivity analyses showed that the results were robust. Conclusions In obese individuals with insulin resistance, a vegan diet improves insulin resistance and dyslipidemia, except for triglycerides.
... Have a lower BMI and less risk of obesity [22] Lower risk of insulin resistance, prediabetes, and type 2 diabetes mellitus [23] Favorable lipid profile [24,25] Benefits for people with hypertension [24,25] Lower risk of cardiovascular diseases (heart disease and stroke) [24,25] Lowers the risk for colorectal cancers [26] Vegan diets generally contain a variety of cancer-protective dietary factors [27] Various phytochemicals in a vegan diet possess potent antioxidant and antiproliferative activities [27,28] Increased consumption of tofu and other isoflavone-containing soy products has some protective effects against breast cancer in females [29] Vegetarian diets are associated with a higher life expectancy compared with diets containing meat [30] BMI: Body mass index Decreasing production of meat and the promotion of plant-based food would also help reduce the GHG output and help control the crisis of climate change. Plant-based diet being healthier, would enhance overall health and well-being. ...
... Vegetarian diets have been shown to lower blood pressures in a meta-analysis of randomized, controlled trials (systolic blood pressure (SBP): -4.8 mmHg and diastolic blood pressure (DBP): -2.2 mmHg) [142] and in a prospective cohort study (odds ratio: 0.66, 95% CI: 0.50, 0.87) [143]. Vegetarian diets have been shown to reduce gout-associated comorbidities, such as hypertension [142,143], diabetes mellitus [144,145], and cardiovascular diseases (CVD) [146]. ...
... Prevalensi diabetes mellitus (DM) tipe 2 banyak terjadi pada individu yang menerapkan pola diet omnivora (20,21). Hasil penelitian kohort menyatakan bawah konsumsi daging berkaitan dengan risiko DM tipe 2 (22,23). ...
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Health status and micronutrient intake among vegetarian and non-vegetarian in Bali Background: Several studies have reported that vegetarian diets have health benefits for those adopting the diets. Objective: This study aimed to compare anemia status and micronutrient intake between vegetarians and non-vegetarians in Bali. Methods: This cross-sectional study was conducted in Bali. A total of 240 samples consisting of 160 vegetarians and 80 non-vegetarians were randomly selected. Hemoglobin (Hb) and fasting blood sugar levels were measured using the cyanmethemoglobin method and enzymatic colorimetric, respectively. Meanwhile, the data on micronutrient intakes were collected by interviews using the semi-quantitative food frequency questionnaire (SQFFQ). The data were analyzed using descriptive statistics, and the Mann-Whitney test was performed to analyze the differences. Results: The study’s results showed that the mean Hb levels in the vegetarian group were significantly lower than non-vegetarians (p=0.002; p
... Some observational cohort studies [23,24] and systematic reviews indicated that increasing daily physical activity could decrease the progression and incidence of T2DM [25]. In contrast, few studies have reported no significant association between physical activity and T2DM [26,27]. Most previous studies assessed physical activity at baseline, and further studies are required to investigate the timevarying effect of physical activity on the incidence of T2DM. ...
Article
Background The time-varying association between physical activity (PA) and incidence of type 2 diabetes (T2DM) is still unclear. The present study aimed to investigate this association in the early- and late-adulthood during a 9-year follow-up. Methods This study was conducted on 3905 participants in early and late adulthood, using the Tehran Lipid and Glucose Study (TLGS) dataset. PA was assessed via the Iranian version of Modified Activity Questionnaire (MAQ). The association between trend of PA and incident T2DM was investigated using time-varying Cox’s proportional hazard model. Variables including job, education, smoking and body mass index (BMI) were adjusted in the final model. Results The distribution of sex- and age-specific levels of PA changed significantly over time. Compared with physically inactive women, for older women with high level of PA, the risk of T2DM was 0.64 (95% CI: 0.43−0.95, P = 0.02) in adjusted model. Moreover, hazard for low PA group was significantly higher than the moderate group, and for these two groups were significantly higher than high PA level (P < 0.05). Conclusion High PA level can postpone the incident T2DM in early-aged and elderly women, over time. Therefore, gender and age are of great importance in designing the PA modifying programs to prevent T2DM.
... In contrast, a positive relationship was reported between dietary inflammatory index and risk of glioma in earlier studies 15 . Plant-based diets, which encompass a diverse family of eating patterns, include plant foods such as legumes, whole grains, vegetables, fruits, nuts, seeds, and lack some or all animal foods in their context 16 . Plantbased diets emphasize on the quality of plant foods, which is lacking in the previous healthy dietary patterns 17 www.nature.com/scientificreports/ ...
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Available evidence suggests a favorable association between adherence to a plant-based diet and disease prevention, but data on the link between such dietary intakes and cancer are scarce. We examined the association between the overall plant-based diet (PDI), healthy plant-based diet (hPDI), and unhealthy plant-based diet (uPDI) and risk of glioma. This case–control study was conducted on 128 newly diagnosed glioma patients, and 256 hospital-based controls. Cases were diagnosed by pathological test and controls were selected from hospitalized people in orthopedic and surgical wards. Dietary intakes were assessed using a validated Block-format 123-items food frequency questionnaire. Scores of plant-based dietary patterns were calculated using the method suggested by Satija et al. After controlling for potential confounders, individuals with higher scores of PDI (OR: 0.54, 95% CI: 0.32–0.91, P-trend < 0.001) and hPDI (OR: 0.32, 95% CI: 0.18–0.57, P-trend < 0.001) had significantly lower odds of glioma compared with those with the lowest scores. This association did not change in the fully adjusted model; such that subjects in the highest tertile of PDI and hPDI were 69% and 71% less likely to have glioma compared with those in the lowest tertile. In contrast, higher scores of uPDI was significantly associated with a greater odds of glioma (OR: 2.85, 95% CI: 1.26–6.47, P-trend = 0.02). Adherence to PDI and hPDI was associated with a lower odds of glioma, while greater adherence to uPDI was directly associated with the likelihood of glioma. Further prospective cohort studies are needed to examine our findings.
... The results were consistent with our research. Furthermore, eating habits [35], dietary inflammatory index [36], income status [37], education level [38], and significant heterogeneity in critical metabolic factors [34] might modify the relationship between BMI and DM. ...
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Objectives: Previous studies reported that overweight older adults had a lower mortality after cardiovascular diseases attack, indicating being thinner might not always be better. However, there is an ongoing debate about what is the optimal range of body mass index (BMI) for the aged population. We aimed to evaluate the value of BMI for the prediction of incident diabetes mellitus (DM) in the Chinese elderly population. Methods: A total number of 6,911 Chinese elderly people (4,110 men and 2,801 women, aged 71 ± 6.0 years) were included in this cohort study. BMI was measured at baseline (Jan 1, 2014, to Dec 31, 2014). All the participants were further classified into six groups: <18.5 kg/m2, 18.5 to <22.5 kg/m2, 22.5 to <25.0 kg/m2, 25.0 to <27.5 kg/m2, 27.5 to <30.0 kg/m2, and ≥30.0 kg/m2. Fasting blood glucose (FBG) and glycated hemoglobin A1c (HbA1c) were annually measured during follow-up (Jan 1, 2015-May 31, 2019). DM was confirmed if either FBG ≥ 7.0 mmol/L or HbA1c ≥ 6.5%. We used the Cox proportional hazard regression model to evaluate the association between BMI and the prediction of incident DM. Results: Comparing individuals with a BMI range of 18.5 to <22.5 kg/m2 (reference), the hazard ratio for incident DM was 2.13 (95% CI: 1.54~2.95), 2.14 (95% CI: 1.53~3.00), 3.17 (95% CI: 2.19~4.59), 3.15 (95% CI: 1.94~5.09), and 3.14 (95% CI: 1.94~5.09) for the group with a BMI range of 22.5 to <25.0 kg/m2, 25.0 to <27.5 kg/m2, 27.5 to <30.0 kg/m2, and ≥30.0 kg/m2 after adjusting for baseline age, sex, blood pressure, lipid profiles, and eGFR (P trend < 0.001), after adjusting for the abovementioned confounders. The association tended to be closer in men and young participants, compared with their counterparts. Conclusions: High BMI was associated with a high risk of developing DM in the Chinese aged population. Thus, it is optimal for the aged population to maintain their body weight within a reasonable range to prevent chronic diseases.
... McMacken & Shah [67] reviewed the prevention of T2D by means of consuming plant-based eating patterns. In the latter review they utilized data from observational cohort studies, which were conducted in high income countries in North America [27,[68][69][70] and East Asia [71] to examine the health benefits of a PBD in relation to T2D. The lack of evidence on this research topic from SSA amongst other low-tomiddle income countries, remain a concern and greater efforts are needed to address this gap in the literature. ...
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Background Studies have investigated dietary attributes associated with cardiovascular disease (CVD) risk in Africa. However, there has been no effort to critically assess the existing evidence. This systematic review examined available evidence on the association between plant-based dietary exposures and CVD risk profile in Africa. PROSPERO registration number: CRD42020159862. Methods We conducted a literature search for observational studies reporting on plant-based dietary exposures in relation to CVD risk profile in African populations. PubMed-Medline, Scopus, EBSCOhost, and African Journals Online platforms were searched up to 19 March 2021. Titles and abstracts of the identified records were screened independently by two investigators. The quality of the studies was also assessed independently. Results Of 458 entries identified, 15 studies published between 2002 and 2020 were included in this review. These studies originated from 12 sub-Saharan Africa (SSA) countries. Sample sizes ranged from 110 to 2362, age from 18 to 80 years; and majority of participants were females (66.0%). In all, four plant-based dietary exposures were identified across SSA. Sixty percent of the studies reported a significant association between a plant-based dietary exposure with at least one CVD risk factor such as hypertension, diabetes mellitus, dyslipidaemia, overweight/obesity, and metabolic syndrome. Conclusions The few available studies suggest that there may be a protective effect of plant-based dietary exposures on CVD risk profile in the African setting. Nonetheless, more elaborated studies are still needed to address plant-based diet (PBD) adherence in relation with CVD risk in African populations.
... Recent studies show that FGF21 levels are markedly elevated in people who habitually consume plant-based (vegan) diets of modest protein content-likely reflecting hepatic activation of GCN2, which detects a relative deficiency of essential amino acids [102][103][104]. An epidemiological study in Loma Linda, which has a high population of vegetarians, found that, after multivariate adjustment including BMI, long-term vegans, as opposed to omnivores, were 62% less likely to develop type 2 diabetes, without adjustment for BMI (which tends to be low in vegans), and 77% protection was observed [105]. The low proportion of total dietary fat provided as saturated fat in most vegan diets may also provide protection in this regard by improving peripheral insulin sensitivity and hence lessening glucose/lipid overexposure [106]. ...
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In people with metabolic syndrome, episodic exposure of pancreatic beta cells to elevated levels of both glucose and free fatty acids (FFAs)—or glucolipotoxicity—can induce a loss of glucose-stimulated insulin secretion (GSIS). This in turn can lead to a chronic state of glucolipotoxicity and a sustained loss of GSIS, ushering in type 2 diabetes. Loss of GSIS reflects a decline in beta cell glucokinase (GK) expression associated with decreased nuclear levels of the pancreatic and duodenal homeobox 1 (PDX1) factor that drives its transcription, along with that of Glut2 and insulin. Glucolipotoxicity-induced production of reactive oxygen species (ROS), stemming from both mitochondria and the NOX2 isoform of NADPH oxidase, drives an increase in c-Jun N-terminal kinase (JNK) activity that promotes nuclear export of PDX1, and impairs autocrine insulin signaling; the latter effect decreases PDX1 expression at the transcriptional level and up-regulates beta cell apoptosis. Conversely, the incretin hormone glucagon-like peptide-1 (GLP-1) promotes nuclear import of PDX1 via cAMP signaling. Nutraceuticals that quell an increase in beta cell ROS production, that amplify or mimic autocrine insulin signaling, or that boost GLP-1 production, should help to maintain GSIS and suppress beta cell apoptosis in the face of glucolipotoxicity, postponing or preventing onset of type 2 diabetes. Nutraceuticals with potential in this regard include the following: phycocyanobilin—an inhibitor of NOX2; agents promoting mitophagy and mitochondrial biogenesis, such as ferulic acid, lipoic acid, melatonin, berberine, and astaxanthin; myo-inositol and high-dose biotin, which promote phosphatidylinositol 3-kinase (PI3K)/Akt activation; and prebiotics/probiotics capable of boosting GLP-1 secretion. Complex supplements or functional foods providing a selection of these agents might be useful for diabetes prevention.
... A study that explored the effect of a plant-based diet, especially the high fibre content associated with it, revealed that a plant-based diet can be healthy and nutritious and can reduce the risk of chronic diseases such as type 2 diabetes, cancer, and cardiovascular diseases. An omnivore diet leads to the consumption of unhealthy fats and, thus, can have a negative effect on health [26]. A randomized controlled trial in New Zealand (controls n = 32, intervention n = 33) found that following a plant-based diet reduced BMI and cholesterol levels [27]. ...
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Introduction One of the most essential risk factors for chronic medical conditions is dietary intake. The dietary habits in Saudi Arabia shifted towards the Western diet, which is high in fat, salt and sugar. Plant-based diets like vegetarianism and veganism have gained popularity in the last few years. Individuals commit to a plant-based diet for many reasons. Plant-based diets are associated with various health benefits but can still cause nutrition deficiencies. Purpose The aim of the study is to examine the proportion of vegan, vegetarian and omnivore diets in Saudi Arabia. To compare between plant-eaters and meat-eaters in health, lifestyle factors and nutritional status. Methods A cross-sectional study was conducted. A previously validated online questionnaire was distributed via social media platforms. The authors used convenience sampling to collect the data. Results A total of 1018 respondents answered the survey. Most respondents 885 (87%) were omnivores, 52 were vegetarians (5%) and 81 (8%) were vegans. Moreover, 61% of the total respondents never consumed vitamin B12 supplements, and 10% consumed vitamin B12 daily. The majority of respondents 548 (54%) used no other dietary supplements, and 470 (46%) used unspecified dietary supplements. Vegan respondents were more likely than other diet categories to have healthier lifestyle features, including >3 times/week exercise (standardized residual = 3.55) and >7 hours of sleep (standardized residual = 2.44). Conclusion Majority of Saudis follow omnivore diets and the frequency of those who follow plant-based diets is very low. Those who follow a vegan diet seem to have better health rating and lifestyle compared to the omnivores. Public health officials and healthcare providers are encouraged to increase awareness among the Saudi population about the health benefits of a plant-based diet.
... Plusieurs auteurs rapportent les effets bénéfiques d'autres types de régimes et modes alimentaires sur le contrôle glycémique (HbA1c, glycémie à jeun, en postprandiale…), la tension artérielle, la prise de poids, la sensibilité à l'insuline ou les risques de développement de DT2 ou de complications associées. Parmi ces régimes et modes alimentaires, on retrouve le mode alimentaire méditerranéen [215][216][217][218][219][220][221], le régime DASH (Dietary Approach to Stop Hypertension) [220,[222][223][224][225][226][227][228][229][230], le régime végétarien [221,[231][232][233] ou encore le régime nordique [234][235][236][237]. Les effets bénéfiques pour la santé apportés par ces types de régimes reposent davantage sur la complémentarité de plusieurs aliments et nutriments que dans un aliment en lui-même [238]. Les études citées précédemment ont démontré qu'une pléiade de régimes alimentaires, dont la composition en macronutriments varie, peuvent-être utilisés de [167]. ...
Thesis
L’hyperglycémie chronique est impliquée dans le développement de complications associées au DT2 et la variabilité glycémique (VG) apparait comme une composante à part entière de l'homéostasie du glucose. Les mesures hygiéno-diététiques, en première ligne dans la prise en charge du DT2, passent entre autres par une modification de l’alimentation, dans laquelle les glucides occupent une place prépondérante. Au-delà de la quantité, la qualité des glucides a été mise en avant comme ayant un impact déterminant sur les excursions glycémiques. Notamment, la digestibilité des produits à base d’amidon pourrait alors avoir un impact sur le contrôle glycémique chez les patients atteints de DT2. Mais il y a aujourd’hui un réel besoin d’apporter une caractérisation des produits plus complète sur cet aspect et de mener des études de faisabilité et d’efficacité de tels régimes modulant la digestibilité de l’amidon. Mes travaux de thèse montrent qu’il est possible de concevoir un régime riche en amidon lentement digestible (SDS), grâce à des choix de produits amylacés disponibles dans le commerce, des conseils de cuisson et des recommandations adaptées. Pour la première fois, nous avons montré que le contrôle de la digestibilité de l'amidon de produits amylacés avec des instructions de cuisson appropriées dans une population atteinte de DT2 augmentait la consommation de contenu en SDS dans un contexte de vie réelle et que ce type de régime était bien accepté dans telle population. De plus, nous avons montré que l’augmentation du rapport SDS/glucides était associée à une amélioration du contrôle glycémique postprandial et qu’il existait une corrélation linéaire inverse entre les paramètres de VG et la teneur en SDS. La mise en œuvre d’un régime riche en amidon lentement digestible dans une population atteinte de DT2, a montré une différence significative sur le profil de variabilité glycémique, mais également sur les excursions glycémiques postprandiales, évalués par le CGMS, en comparaison avec un régime pauvre en amidon lentement digestible. Ce type de régime a également permis aux patients d’atteindre des cibles glycémiques postprandiales plus appropriées. Grâce à un travail de revue de la littérature, nous avons mis en évidence que la déviation standard (SD), le coefficient de variation (CV), l’amplitude moyenne des excursions glycémiques (MAGE) et la moyenne glycémique (MBG) étaient les paramètres de VG les plus étudiés en termes de relation avec les paramètres de diagnostic du DT2 et les complications liées au DT2 et qu’ils montraient des relations fortes, en particulier avec l’HbA1c. Dans les études interventionnelles, nous avons pu voir que la SD, le MAGE et le temps dans la cible (TIR) étaient les paramètres les plus utilisés comme critères d’évaluation, montrant des améliorations significatives suite aux interventions pharmacologiques ou nutritionnelles, souvent en lien avec des paramètres de contrôle glycémique comme l’HbA1c, la glycémie à jeun ou en postprandial. La VG apparaît donc comme une composante clé de la dysglycémie du DT2. Au-delà de son utilisation par le patient comme support du contrôle glycémique, le CGMS apparait comme un outil pertinent en recherche clinique pour évaluer l’efficacité des interventions même si à ce jour, il reste encore très peu utilisé pour les interventions nutritionnelles. Des études plus approfondies seront cependant nécessaires pour confirmer l'impact bénéfique de telles interventions alimentaires à long terme. Nous avons conçu une étude à plus grande échelle pour étudier l'impact à long terme d’un régime riche en SDS sur la variabilité et le contrôle glycémiques (CGMS) et les complications et comorbidités associées chez le patient atteint de DT2. La modulation de la digestibilité de l'amidon dans l'alimentation pourrait alors être utilisée comme un outil nutritionnel simple et approprié pour améliorer l'homéostasie glucidique au quotidien dans le DT2.
... The Adventist Health adjusting for a similar set of confounders to those included in this study. 34 In addition, a study that excluded participants who had type 2 diabetes, fasting blood glucose of 7.0 mmol/L or higher, cancer, coronary heart disease and stroke at baseline, reported that vegetarians and converted vegetarians (individuals who became vegetarians within 5 years) had a 35% and 53% lower risk of type 2 diabetes, respectively, compared with non-vegetarians, after adjusting for gender, age, education, family history of diabetes, PA, use of lipidlowering medications, follow-up methods and baseline BMI. 35 The inconsistent results pertaining to vegetarian diets could be related to the TE intake, and macronutrient and micronutrient patterns of the participants, which warrants further study. ...
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Aims: Current evidence on the associations between alternative (e.g. fish and vegetarian) diets and incident type 2 diabetes is elusive. This study aimed to investigate the associations between types of diet and incident type 2 diabetes and whether adiposity mediated these associations. Materials and methods: 203,790 participants from UK Biobank (mean age 55.2 years; 55.8% women) without diabetes at baseline were included in this prospective study. Using the dietary intake data self-reported at baseline, participants were categorized as vegetarians (n=3,237), fish eaters (n=4,405), fish & poultry eaters (n=2,217), meat eaters (n=178,004) and varied diet (n=15,927). The association between type of diet and incident type 2 diabetes was investigated using Cox-proportional hazards models with a 2-years landmark analysis. The mediation role of adiposity was tested under a counterfactual framework. Results: After excluding the first two years of follow-up, the median follow-up was 5.4 (IQR: 4.8-6.3) years, during which 5,067 (2.5%) participants were diagnosed with type 2 diabetes. After adjusting for lifestyle factors, fish eaters (HR 0.52 [95% CI: 0.39-0.69]) and fish & poultry eaters (HR 0.62 [95% CI: 0.45-0.88]) had lower risk of incident type 2 diabetes compared with meat eaters. The association for vegetarians was not significant. Varied diet had a higher risk of type 2 diabetes. Obesity partially mediated the association of fish (30.6%), fish & poultry (49.8%) and varied (55.2%) diets. Conclusions: Fish and fish & poultry eaters were at a lower risk of incident type 2 diabetes than meat eaters, partially attributable to lower obesity risk. This article is protected by copyright. All rights reserved.
... The major drivers of the global diabetes epidemic are unhealthy diet, overweight/obesity, genetic predisposition and other lifestyle factors [3]. Plant-based diets, especially healthy plant-based diets rich in high-quality plant foods, such as whole grains, fruits and vegetables, have been associated with a lower risk of type 2 diabetes [4,5]. However, the underlying mechanisms are not fully understood. ...
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Aims/hypothesis Plant-based diets, especially when rich in healthy plant foods, have been associated with a lower risk of type 2 diabetes. However, whether plasma metabolite profiles related to plant-based diets reflect this association was unknown. The aim of this study was to identify the plasma metabolite profiles related to plant-based diets, and to evaluate the associations between the identified metabolite profiles and the risk of type 2 diabetes. Methods Within three prospective cohorts (Nurses’ Health Study, Nurses’ Health Study II and Health Professionals Follow-up Study), we measured plasma metabolites from 10,684 participants using high-throughput LC MS. Adherence to plant-based diets was assessed by three indices derived from the food frequency questionnaire: an overall Plant-based Diet Index (PDI), a Healthy Plant-based Diet Index (hPDI), and an Unhealthy Plant-based Diet Index (uPDI). Multi-metabolite profiles related to plant-based diet were identified using elastic net regression with a training/testing approach. The prospective associations between metabolite profiles and incident type 2 diabetes were evaluated using multivariable Cox proportional hazards regression. Metabolites potentially mediating the association between plant-based diets and type 2 diabetes risk were further identified. Results We identified multi-metabolite profiles comprising 55 metabolites for PDI, 93 metabolites for hPDI and 75 metabolites for uPDI. Metabolite profile scores based on the identified metabolite profiles were correlated with the corresponding diet index (Pearson r = 0.33–0.35 for PDI, 0.41–0.45 for hPDI, and 0.37–0.38 for uPDI, all p<0.001). Metabolite profile scores of PDI (HR per 1 SD higher = 0.81 [95% CI 0.75, 0.88]) and hPDI (HR per 1 SD higher = 0.77 [95% CI 0.71, 0.84]) showed an inverse association with incident type 2 diabetes, whereas the metabolite profile score for uPDI was not associated with the risk. Mutual adjustment for metabolites selected in the metabolite profiles, including trigonelline, hippurate, isoleucine and a subset of triacylglycerols, attenuated the associations of diet indices PDI and hPDI with lower type 2 diabetes risk. The explainable proportion of PDI/hPDI-related diabetes risk by these metabolites ranged between 8.5% and 37.2% (all p<0.05). Conclusions/interpretation Plasma metabolite profiles related to plant-based diets, especially a healthy plant-based diet, were associated with a lower risk of type 2 diabetes among a generally healthy population. Our findings support the beneficial role of healthy plant-based diets in diabetes prevention and provide new insights for future investigation. Graphical abstract
... In this sense, the term of flexitarian diets (primary but not strictly vegetarian diet, occasionally eating meat or fish) could result in a better option for reducing the environmental impact of diets by means of reducing meat consumption and regulating obesity at the same time [92,93]. Although there is variability between the definition of this dietary pattern, it has been referred that reducing meat consumption, especially red meat, at maximum once a week or better a month, could significantly decrease the environmental impact of current diets [93,94]. Although the identification of the impact of meat consumption on WF to determine recommendations of consumption was not the objective of the present study, as an extra and complementary analysis we identified the WF of beef consumption by frequency of consumption (data shown in Supplementary Table 6 in Electronic supplementary material 6). ...
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Purpose Nutrition transition (NT) has modified the way that the Mexican population eats, while their body composition has also been modified. These changes have been linked with environmental impacts; however, little is known regarding water footprint (WF). The objective of this paper was to analyze the NT process in Mexico and evaluate its impact on WF using principal component analysis (PCA). Methods A validated Food Consumption Frequency Questionnaire (FCFQ) was modified and applied to 400 adults from the Metropolitan Zone of Guadalajara, Mexico. The WF was calculated according to the WF Assessment Method. PCA and tertiles analysis was carried out to define dietary patterns WFs (DPWF). Questions covering sociodemographic and socioeconomic factors, as well as body composition data and physical activity levels were measured. Results The average DPWF was 6619.58 ± 3182.62 L per person per day (L p⁻¹d⁻¹). We found three DPWF by PCA: Medium NT (55% from the total sample), Healthy plant-based (28%), and High in animal protein (17%). The highest energy consumption, western and Mexican foods intake, and dietary WF were found in Medium NT DPWF, as well as obesity prevalence. Fruits and vegetable consumption was higher in Healthy plant-based DPWF. Muscle mass percentage was higher in the High in animal protein DPWF. Conclusions Although most of the population is currently on Medium NT, new dietary patterns have emerged, where there was found a trend to plant-based diets but also diets high in animal food sources that can influence nutritional status.
... This is in part due to the environmental benefits of PBDs, as plant foods use substantially fewer natural resources (including water, fossil energy, fertilizer, and pesticides) than animal foods [2]. PBDs have also demonstrated a variety of health benefits, including a reduced risk of chronic diseases such as ischemic heart disease, cancer, high blood pressure, and type 2 diabetes (T2D) [3][4][5]. These environmental and health benefits provide strong rationale for shifting to a more plant-focused eating pattern. ...
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Background Diet plays a critical role in the prevention and treatment of metabolic syndrome (MetS). In addition to being environmentally sustainable, plant-based diets (PBD) have demonstrated a range of health benefits, including a protective effect against MetS. Most research on this topic has focused on PBDs as a whole, without considering the influence of diet quality. Methods Data were obtained from 29 individuals with MetS. Subjects were asked to follow a PBD for 13 weeks. PBD quality was assessed using healthful PBD index (hPDI) and unhealthful PBD index (uPDI). Higher hPDI represented greater consumption of healthy plant foods and lower consumption of less-healthy plant foods. Higher uPDI represented greater consumption of less-healthy plant foods and lower consumption of healthy plant foods. For each participant, hPDI and uPDI scores were calculated at baseline and 9-weeks follow-up. Participants were divided into quintiles according to hPDI and uPDI scores. Statistical analyses were performed to determine the association between biomarker measures and PBD quality scores. Results After 2 weeks, mean weight was lower in hPDI quintile 5 compared to hPDI quintile 1, and higher in uPDI quintile 5 compared to uPDI quintile 1 (p < .05). At baseline, hPDI was inversely associated with weight (r = −0.445, p < .05), and uPDI positively associated with weight (r = 0.437, p < .05). Using follow-up data, HDL-C was positively associated with hPDI (r = .411, p < .05) and negatively associated with uPDI (r = −0.411, p < .05). Conclusions In individuals with MetS, adherence to a healthful plant-based diet was associated with lower weight and higher HDL cholesterol, highlighting the influence of diet quality on the health effects associated with PBDs.
... In our cohort, 52% were vegetarian, and hence, the effect of a vegetarian diet on reducing the carotid plaque burden became significant. Compared with nonvegetarians, vegetarians typically have lower BMI, blood pressure, prevalence of hypertension, and incidence of diabetes [8,[42][43][44]. Long-term consumption of a vegetarian diet is associated with a decrease in multiple cardiovascular risk factors and an improvement in lipid profile, thereby benefitting CIMT and CPS. ...
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Carotid atherosclerosis is associated with cardiovascular and cerebrovascular events. We explored an appropriate method for selecting participants without ischemic cerebrovascular disease but with various comorbidities eligible for a carotid ultrasound. This was a retrospective subgroup analysis of the carotid plaque burden from a previous study involving a vascular and cognitive survey of 956 elderly recycling volunteers (778 women and 178 men; mean age: 70.8 years). We used carotid ultrasound to detect the carotid plaque and computed the carotid plaque score (CPS). A moderate or high degree of carotid atherosclerosis (MHCA) was defined as CPS > 5 and was observed in 22% of the participants. The CPS had positive linear correlations with age, systolic blood pressure, and fasting glucose. We stratified the participants into four age groups: 60–69, 70–74, 75–79, and ≥80 years. Multivariable analysis revealed that significant predictors for MHCA were age, male sex, hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, and a nonvegetarian diet. Coronary artery disease and advanced age were the two strongest predictors. We chose the aforementioned seven significant predictors to establish a nomogram for MHCA prediction. The area under the receiver operating characteristic curve in internal validation with 10-fold cross-validation and the classification accuracy of the nomogram were 0.785 and 0.797, respectively. We presumed people who have a ≥50% probability of MHCA warranted a carotid ultrasound. A flowchart table derived from the nomogram addressing the probabilities of all models of combinations of comorbidities was established to identify participants who had a probability of MHCA ≥ 50% (corresponding to a total nomogram score of ≥15 points). We further established a carotid risk score range from 0 to 17 comprising the seven predictors. A carotid risk score ≥ 7 was the most optimal cutoff value associated with a probability of MHCA ≥ 50%. Both total nomogram score ≥ 15 points and carotid risk score ≥ 7 can help in the rapid identification of individuals without stroke but who have a ≥50% probability of MHCA—these individuals should schedule a carotid ultrasound.
... Prior epidemiologic studies have reported a lower risk of diabetes in vegetarians than nonvegetarians, at least partly explained by differences in BMI (2,48,49). In our current study, differences in glucose concentrations by diet group disappeared upon adjustment for BMI, whereas differences in HbA1c concentrations were attenuated but remained statistically significant. ...
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Background Prospective studies have shown differences in some disease risks between vegetarians and nonvegetarians, but the potential biological pathways are not well understood. Objectives We aimed to assess differences in concentrations of biomarkers related to disease pathways in people with varying degrees of animal foods exclusion. Methods The UK Biobank recruited 500,000 participants aged 40–69 y (54.4% women) throughout the United Kingdom in 2006–2010. Blood and urine were collected at recruitment and assayed for more than 30 biomarkers related to cardiovascular diseases, bone and joint health, cancer, diabetes, renal disease, and liver health. In cross-sectional analyses, we estimated adjusted geometric means of these biomarkers by 6 diet groups (regular meat eaters, low meat eaters, poultry eaters, fish eaters, vegetarians, vegans) in 466,058 white British participants and 2 diet groups (meat eaters, vegetarians) in 5535 British Indian participants. Results We observed differences in the concentrations of most biomarkers, with many biomarkers showing a gradient effect from meat eaters to vegetarians/vegans. Of the largest differences, compared with white British regular meat eaters, white British vegans had lower C-reactive protein [adjusted geometric mean (95% CI): 1.13 (1.03, 1.25) compared with 1.43 (1.42, 1.43) mg/L], lower low-density lipoprotein cholesterol [3.13 (3.07, 3.20) compared with 3.65 (3.65, 3.65) mmol/L], lower vitamin D [34.4 (33.1, 35.9) compared with 44.5 (44.4, 44.5) nmol/L], lower serum urea [4.21 (4.11, 4.30) compared with 5.36 (5.36, 5.37) mmol/L], lower urinary creatinine [5440 (5120, 5770) compared with 7280 (7260, 7300) μmol/L], and lower γ-glutamyltransferase [23.5 (22.2, 24.8) compared with 29.6 (29.6, 29.7) U/L]. Patterns were mostly similar in British Indians, and results were consistent between women and men. Conclusions The observed differences in biomarker concentrations, including lower C-reactive protein, lower LDL cholesterol, lower vitamin D, lower creatinine, and lower γ-glutamyltransferase, in vegetarians and vegans may relate to differences in future disease risk.
... One of the most common reasons for western consumers to reduce or eliminate meat from their diet is the perceived health benefits of plant-based eating, surpassing animal welfare and environmental concerns (Mullee et al., 2017;Jones, 2020). A growing body of research suggests that high-level meat consumption is associated with non-communicable diseases (NCDs) such as diabetes (Tonstad et al., 2013), heart disease (Tong et al., 2019) and diverticular disease (Crowe et al., 2011), while following a low or no meat diet can help reduce the risk (Satija and Hu, 2018;Knuppel et al., 2019;Qian et al., 2019). This is particularly true of red and processed meat. ...
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Mainstream media play a central role in shaping the ways diet and nutrition are discussed in the public sphere, yet few studies have explored its depictions of the meat-health nexus. Focusing on eight of the most popular news online sites consumed by lower-income groups in the UK-the demographic most likely to eat meat, according to a survey conducted for this study-we carried out content analysis of 128 articles. We found, first, a multiplicity of pro- and anti-meat narratives across all news outlets; second, that the dominant recommendation, found in 40% of our sample, was to eat less or no red meat; and third, that a balanced or neutral sentiment was present in over half of our sample, with a ratio of 3:2 (anti-versus pro-meat) in remaining articles. We found that the editorial leaning of a news outlet was not closely correlated with its overall sentiment towards meat consumption; all were neutral or slightly anti-meat, with the exception of LAD Bible, the only clearly pro-meat outlet. Qualitative analysis uncovered three key themes: the risk of red meat on colorectal cancer, uncertainty around plant-based options, and individual dietary choice. We use case studies guided by these themes to highlight some of the shortcomings of health communication and provide recommendations, with a focus on improved dialogue between journalists and researchers.
... Diabetes prevalence has increased in recent decades in the context of significant diet changes, including reduced consumption of vegetables, fruits, and legumes, coupled with increased consumption of animal-derived and processed food products (3). A plant-based eating pattern is associated with a significantly lower prevalence of type 2 diabetes, compared with nonvegetarian diets (4), and there is strong evidence supporting the use of a plant-based eating pattern in clinical practice for individuals with type 2 diabetes. The American Association of Clinical Endocrinologists and the American College of Endocrinology, as well as the American College of Lifestyle Medicine, recommend a plant-based eating pattern as a key component of lifestyle therapy for patients with type 2 diabetes (5,6). ...
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A plant-based eating pattern is associated with a reduced risk of developing type 2 diabetes and is highly effective in its treatment. Diets that emphasize whole grains, vegetables, fruits, and legumes and exclude animal products improve blood glucose concentrations, body weight, plasma lipid concentrations, and blood pressure and play an important role in reducing the risk of cardiovascular and microvascular complications. This article reviews scientific evidence on the effects of plant-based diets for the prevention and treatment of type 2 diabetes. The mechanisms by which plant-based diets improve body weight, insulin sensitivity, and β-cell function are described. Practical considerations including education, nutrition adequacy, and adjusting medications will enhance the success of patients who have diabetes.
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Objective: The objective of this review is to chart the evidence relating to food security among African Canadian communities to inform future research and offer insight related to food security in African Canadian communities. Introduction: Achieving food security is of global importance in the attainment of the United Nations Sustainable Development Goals. As a social determinant of health, food security, which refers to the unrestricted physical, economic, and timely access to safe and nutritious foods, impacts over four million Canadians. Yet, little is known about food security and the differential impacts of food insecurity among African Canadians. This scoping review sought to describe the current state of food security among African Canadians. Inclusion criteria: Sources were considered for inclusion if they met the eligibility criteria outlined in the a priori protocol. Specifically, sources were considered if they: i) focused on Canada, ii) involved African Canadians, and iii) examined food security. No restrictions were placed on date of publication and language restrictions were limited to English and French. Methods: This scoping review was conducted in accordance with JBI methodology and comprised a search of published and unpublished sources. Data were extracted independently in Excel by two team members according to data items outlined in the extraction tool. In instances where articles were unavailable, authors of potential sources were contacted at the full-text review phase to request access to the full text of their article. Databases and relevant websites containing peer-reviewed, unpublished, and gray literature were searched. Ancestry searching and forward citation tracing were completed. Results: The search of databases yielded a total of 1183 records. Ancestry tracing yielded 287 records. After removing duplicates, 1075 titles and abstracts were screened for eligibility and 80 advanced to full-text screening. Seventy-five full-text articles were excluded based on inclusion criteria, leaving five articles that underwent data extraction. All included studies involved African Canadian participants in Canada (n = 5). All studies focused on adults (n = 5); one study included women and men participants (n = 1), while four focused exclusively on women (n = 4). Importantly, one study involving women participants included cis- and trans women as well as those identifying as queer (n = 1). Study designs reflected qualitative (n = 2), quantitative (n = 1), and mixed methods (n = 2) designs. Conclusions: This review begins to fill a gap in understanding the current evidence available on food security as it impacts African Canadians. The findings of this review represent existing research, describing the type of evidence available and methodologies used, before suggesting implications for research and practice. The inclusion of only five studies reveals the limited evidence regarding the current state of food security among African Canadians. Further, included studies were exclusively conducted in urban settings; predominantly in one province. There is a need for further research in rural communities, in other provinces and territories, as well as with younger and older participants. Lastly, the urgent need to collect race-disaggregated data in Canada is evident.
Article
Background: Plant-based diets have been associated with lower risk of various diseases, including type 2 diabetes, cardiovascular disease, and other cardiometabolic risk factors. However, the association between plant-based diet quality and breast cancer remains unclear. Methods: We prospectively followed 76,690 women from the Nurses' Health Study (NHS, 1984-2016) and 93,295 women from the NHSII (1991-2017). Adherence to an overall plant-based diet index (PDI), a healthful PDI (hPDI), and an unhealthful PDI (uPDI) was assessed using previously developed indices. Cox proportional hazards models were used to estimate HR and 95% confidence intervals (CI) for incident invasive breast cancer. Results: Over 4,841,083 person-years of follow-up, we documented 12,482 incident invasive breast cancer cases. Women with greater adherence to PDI and hPDI were at modestly lower risk of breast cancer [(HRQ5 vs. Q1, 0.89; 95% CI, 0.84-0.95); (HRQ5 vs. Q1, 0.89; 95% CI, 0.83-0.94)]. We observed significant heterogeneity by estrogen receptor (ER) status, with the strongest inverse association between hPDI and breast cancer observed with ER-negative tumors [HRQ5 vs. Q1, 0.77; 95% CI, 0.65-0.90; P trend < 0.01]. We also found an inverse association between extreme quintiles of healthy plant foods and ER-negative breast cancer [HR, 0.74; 95% CI, 0.61-0.88; P trend < 0.01]. Conclusions: This study provides evidence that adherence to a healthful plant-based diet may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors. Impact: This is the first prospective study investigating the relation between healthful and unhealthful plant-based dietary indices and risk of total and subtype-specific breast cancer.
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Objectif : Refaire le point sur les évidences concernant les effets des régimes végétariens et végétaliens chez les adultes, et d'ainsi pouvoir conseiller de manière la plus correcte possible les patients se posant des questions à propos de cela, en fonction de leurs comorbidités, de leurs maladies. Méthode : Suite à une recherche dans les bases de données PubMed, SciencesDirect et Cochrane, les études retenues ont été soumises à une sélection. La question de recherche utilisée était la suivante : « Quels sont les réels effets d'un régime végétarien et végétalien ? Et que retenir comme informations pertinentes afin de pouvoir conseiller les patients par rapport à leur alimentation en fonction de leur pathologie ? ». Résultats : La sélection d'articles a permis de retenir 10 articles à travers les différentes bases de données. Suite au premier tri d'articles, seules les revues systématiques et les méta-analyses ont été retenues. Les études ont été regroupées en sous-groupe : les effets sur les maladies graves, les effets sur les maladies tel que le diabète et l'hypertension artérielle, ainsi que les effets sur l'ostéoporose. Conclusion : De manière générale, les régimes végétariens/végétaliens semblent être une bonne alternative pour la santé. En effet il a été démontré qu'ils auraient des effets protecteurs sur les facteurs de risques des maladies cardio-vasculaire ainsi que sur l'incidence et la mortalité des maladies coronariennes. Ils joueraient également un rôle protecteur dans les pa...
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A healthy plant-based diet (PBD), which consists of mostly plant-derived foods and abstains from animal products, has been shown to be effective in managing risk factors for cardiovascular disease (CVD) and in reducing adverse CVD outcomes. PBDs have been shown to have beneficial effects in the prevention of coronary artery disease, hypertension, cerebrovascular accident, type 2 diabetes mellitus, and heart failure and may also reduce cardiovascular mortality. Potential mechanisms for these benefits include reduction in atherogenic lipid levels (LDL-C and non-HDL-C), presence of anti-atherogenic compounds such as polyphenols and fibers, and avoidance of pro-atherogenic compounds found in animal products. Structured PBD/lifestyle programs have been developed, and while each varies in composition, all programs attempt to provide comprehensive recommendations for implementing a PBD to reduce CVD risk. Further research is needed to better understand the full range of benefits, and potential limitations, of a PBD and related structured diet/lifestyle programs. In clinical practice, recommendations for a healthy PBD should align with preferences of the individual patient in order to maximize both quality of life and cardiovascular benefit.
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Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We comprehensively reviewed the role of well-studied diets (Mediterranean, vegetarian/vegan, low-carbohydrate ketogenic and intermittent fasting diet) and prevalent eating behaviors (emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking and fast/ultra-processed food consumption) on the traditional risk factors of PAD. Moreover, we analyzed the interplay between PAD and nutritional status, nutrients, dietary patterns and eating habits. Dietary patterns and eating disorders affect the development and progression of PAD, as well as its disabling complications including major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Nutrition and dietary risk factor modification are important targets to reduce the risk of PAD as well as the subsequent development of MACE and MALE.
Article
Context The obesity epidemic is a main driver of the chronic disease epidemic; however, present treatment approaches have suboptimal efficacy. Objectives To assess the efficacy of plant-predominant (vegan, vegetarian, plant-based whole foods [PBWFs]) diets in treating obesity and its main cardiometabolic sequelae: hyperlipidemia (HLD); indices of insulin resistance, glycemic control, and diabetes mellitus type 2 (DM2); and cardiovascular disease (CVD), including hypertension (HTN). Data Sources A systematic search of multiple databases was conducted for articles published between November 2019 and February 2020; databases searched included: PubMed, Medline (Ovid), Cochrane, CENTRAL, and CINAHL. Data Extraction and Analysis All interventional trials (randomized controlled trials [RCTs] and trials of non-randomized experimental design) that met the inclusion criteria (English language, duration of at least 4 weeks, primary end point congruent with above objectives, no major flaws in research design that would prevent interpretation) were included in the review. A total of 3135 articles were scanned and 84 were selected. The articles were collated and summarized in 2 evidence tables. Risk of bias for RCTs was assessed using the Cochrane Risk-of-Bias tool 2 as a guide. For non-randomized trials, higher risk of bias was assumed, and the JBI Critical Appraisal tool was used as a guide to determine inclusion. Results Plant-based diets, in general, demonstrated improved weight control and cardiometabolic outcomes related to lipids, cardiovascular end points, blood pressure, insulin sensitivity, A1C, and fasting glucose, and a lower risk of diabetes compared with usual diets and in some cases standard health-oriented diets such as the American Heart Association (AHA), American Diabetic Association (ADA), and Mediterranean diets. Preliminary studies suggest plant-predominant diets practiced as part of healthy lifestyle interventions may stabilize or even reverse DM 2 and CVD. The acceptability and sustainability of plant-predominant diets where measured were generally similar to other health-oriented diets. Conclusion Plant-predominant diets can play a major role in reversing the obesity and chronic disease epidemics. In the setting of sustained lifestyle intervention programs, they may arrest or even reverse DM2 and CVD. Further higher-level RCTs are needed to confirm and expand on these findings.
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Background: The association between plant-based diets and cardiovascular disease (CVD) remains poorly characterized. Given that diet represents an important and a modifiable risk factor, this study aimed to assess (1) the relationships between the impact of adherence to plant-based diets on cardiovascular mortality, incident CVD, and stroke; (2) if associations differed by adherence to healthful and less healthful plant-based diets. Methods and Findings: MEDLINE and EMBASE databases were searched up to May 2021. Studies assessing CVD outcomes with relation to plant-based dietary patterns or according to plant-based dietary indices (PDI) were included. A meta-analysis of hazard ratios (HR) was conducted using DerSimonian and Laird random effects model. Thirteen studies involving 410,085 participants were included. Greater adherence to an overall plant-based dietary pattern was significantly associated with a lower risk of cardiovascular mortality (pooled HR: 0.92, 95% CI: 0.86–0.99 p = 0.0193, I2 = 88.5%, N = 124,501) and a lower risk of CVD incidence (pooled HR: 0.90, 95% CI: 0.82–0.98, p = 0.0173, I2 = 87.2%, N = 323,854). Among the studies that used PDI, unhealthful plant-based diets were associated with increased risk of cardiovascular mortality (pooled HR: 1.05, 95% CI: 1.01–1.09, p = 0.0123, I2 = 0.00%, N = 18,966), but not CVD incidence. Conversely, healthful plant-based diets were associated with decreased CVD incidence (pooled HR: 0.87, 95% CI: 0.80–0.95, p = 0.0011, I2 = 57.5%, N = 71,301), but not mortality. Vegetarians also had significantly lower CVD incidence (HR: 0.81, 95% CI: 0.72–0.91, p = 0.0004, I2 = 22.2%, N = 16,254), but similar CVD mortality or stroke risk when compared to the meat-eaters. Conclusion: To date, this comprehensive study examines the effects of a plant-based diet on major clinical endpoints using more holistic PDIs. These findings highlight the favorable role of healthful plant-based foods in reducing cardiovascular mortality and CVD.
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A plant‐based diet can lower the incidence of type 2 diabetes in an average risk population. Type 2 diabetes affects populations at all levels of the socio‐economic strata worldwide and in fact disproportionately affects populations in lower‐income countries. Several mechanisms have been proposed to explain the benefit of a plant‐based diet in the risk reduction of type 2 diabetes. The Mediterranean diet plan has been studied in the management of early type 2 diabetes. The American Diabetes Association in its most recent statement on medical nutrition therapy in the management of type 2 diabetes, emphasizes that there are no comparison studies between eating patterns. Regular dietary fiber intake is associated with lower all‐ cause mortality in people with type 2 diabetes. The American Diabetes Association recommends that fiber be incorporated through foods that are naturally high in fiber, as opposed to supplements, to reap other benefits such as micronutrients and phytochemicals naturally found in foods.
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Plant-based diets, defined here as including both vegan and lacto-ovo-vegetarian diets, are growing in popularity throughout the Western world for various reasons, including concerns for human health and the health of the planet. Plant-based diets are more environmentally sustainable than meat-based diets and have a reduced environmental impact, including producing lower levels of greenhouse gas emissions. Dietary guidelines are normally formulated to enhance the health of society, reduce the risk of chronic diseases, and prevent nutritional deficiencies. We reviewed the scientific data on plant-based diets to summarize their preventative and therapeutic role in cardiovascular disease, cancer, diabetes, obesity, and osteoporosis. Consuming plant-based diets is safe and effective for all stages of the life cycle, from pregnancy and lactation, to childhood, to old age. Plant-based diets, which are high in fiber and polyphenolics, are also associated with a diverse gut microbiota, producing metabolites that have anti-inflammatory functions that may help manage disease processes. Concerns about the adequate intake of a number of nutrients, including vitamin B12, calcium, vitamin D, iron, zinc, and omega-3 fats, are discussed. The use of fortified foods and/or supplements as well as appropriate food choices are outlined for each nutrient. Finally, guidelines are suggested for health professionals working with clients consuming plant-based diets.
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The global adoption of predominantly plant-based sustainable healthy diets will help reduce the risk of obesity- and malnutrition-related non-communicable diseases while protecting the future health of our planet. This review examines the benefits and limitations of different types of plant-based diets in terms of health and nutrition, affordability and accessibility, cultural (ethical and religious) acceptability, and the environment (i.e., the four pillars underlying sustainable healthy diets). Results suggest that, without professional supervision, traditional plant-based diets (vegan, vegetarian and pescatarian diets) can increase the risk of nutritional deficiencies among infants, children/adolescents, adult females, pregnant/lactating women and the elderly. In contrast, flexitarian diets and territorial diversified diets (TDDs, e.g., Mediterranean and New Nordic diets) that include large quantities of plant-sourced foods, low levels of red meat and moderate amounts of poultry, fish, eggs and dairy can meet the energy and nutrition needs of different populations without the need for dietary education or supplementation. Compared to vegan, vegetarian and pescatarian diets, more diverse flexitarian diets and TDDs are associated with reduced volumes of food waste and may be more acceptable and easier to maintain for people who previously followed western diets. Although flexitarian diets and TDDs have a greater impact on the environment than vegan, vegetarian and pescatarian diets, the negative effects are considerably reduced compared to western diets, especially if diets include locally-sourced seasonal foods. Further studies are required to define more precisely optimal sustainable healthy diets for different populations and to ensure that diets are affordable and accessible to people in all countries.
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Proteins are essential components of the human diet. Dietary proteins could be derived from animals and plants. Animal protein, although higher in demand, is generally considered less environmentally sustainable. Therefore, a gradual transition from animal-to plant-based protein food may be desirable to maintain environmental stability, ethical reasons, food affordability, greater food safety, fulfilling higher consumer demand, and combating of protein-energy malnutrition. Due to these reasons, plant-based proteins are steadily gaining popularity, and this upward trend is expected to continue for the next few decades. Plant proteins are a good source of many essential amino acids, vital macronutrients, and are sufficient to achieve complete protein nutrition. The main goal of this review is to provide an overview of plant-based protein that helps sustain a better life for humans and the nutritional quality of plant proteins. Therefore, the present review comprehensively explores the nutritional quality of the plant proteins, their cost-effective extraction and processing technologies, impacts on nutrition, different food wastes as an alternative source of plant protein, and their environmental impact. Furthermore, it focuses on the emerging technologies for improving plant proteins' bioavailability, digestibility, and organoleptic properties, and highlights the aforementioned technological challenges for future research work.
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Atrial fibrillation (AF) is the most common cardiac arrhythmia despite substantial efforts to understand the pathophysiology of the condition and develop improved treatments. Identifying the underlying causative mechanisms of AF in individual patients is difficult and the efficacy of current therapies is suboptimal. Consequently, the incidence of AF is steadily rising and there is a pressing need for novel therapies. Research has revealed that defects in specific molecular pathways underlie AF pathogenesis, resulting in electrical conduction disorders that drive AF. The severity of this so-called electropathology correlates with the stage of AF disease progression and determines the response to AF treatment. Therefore, unravelling the molecular mechanisms underlying electropathology is expected to fuel the development of innovative personalized diagnostic tools and mechanism-based therapies. Moreover, the co-creation of AF studies with patients to implement novel diagnostic tools and therapies is a prerequisite for successful personalized AF management. Currently, various treatment modalities targeting AF-related electropathology, including lifestyle changes, pharmaceutical and nutraceutical therapy, substrate-based ablative therapy, and neuromodulation, are available to maintain sinus rhythm and might offer a novel holistic strategy to treat AF. Atrial fibrillation (AF) is the most common cardiac arrhythmia and is increasing in prevalence as populations age. This Primer provides an overview of AF epidemiology, the mechanisms underlying electropathology in AF, and the diagnostic approaches and treatments, and highlights important directions to improve understanding and management of AF in co-creation with patients.
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Purpose To gain a better and more comprehensive understanding, this study aims to investigate the literature to explore the two popular diets’ health benefits and concerns. Google Scholar and PubMed were used to search for available and relevant nutrition and health articles that pertain to the benefits and concerns of plantogenic and ketogenic diets. Search terms like low carbohydrate, diet, ketogenic, vegetarian and chronic diseases were used. Information was obtained from review articles and original research articles and checked for accuracy. Ketogenic diets have been used for a long time for convulsion in children and now reappeared for weight loss purposes. Design/methodology/approach Ketogenic and plantogenic (plant-based) diets have been adopted today by many professionals and the public. Findings Ketogenic diets have been used for a long time for convulsion in children and now reappeared for weight loss purposes. Plantogenic diets also have been practiced for many years for religious, health and environmental reasons. Compared to plantogenic diets, ketogenic diets lack long-term evidence of its potential benefits and harm. Research limitations/implications Maybe Lacto-ovo vegetarian and pesco-vegetarian (eat fish but not meats) diets are OK. However, for strict plantogenic diets (total plantogenic/vegan diet), the risk of mineral or vitamin deficiency is present (Melina et al. , 2016). Of particular concern is dietary vitamin B12, which is obtained mostly from animal sources (Melina et al. , 2016). A long-term deficiency of vitamin B12 can lead to macrocytic anemia and cause neuro and psychological effects (Obeid et al. , 2019). Also, omega-3 fatty acids may be deficient in such a diet and probably need to be supplemented on those who follow the total plantogenic diet (Melina et al. , 2016). Other deficiencies of concern would be zinc, iron, calcium, vitamin D and iodine (Melina et al. , 2016). Another disadvantage is that many junk foods could be easily classified within the plantogenic diet, such as sugar, cakes, French fries, white bread and rice, sugar-sweetened beverages and sweets in general. These items are related to higher weight gain and, consequently, to a higher incidence of diabetes and other chronic diseases (Schulze et al. , 2004; Malik et al. , 2006; Fung et al. , 2009). Originality/value Plantogenic diets were concluded to have sustainable health benefits for humans and the environment over ketogenic diets, which could be used but under professional follow-up only.
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Physical inactivity, a prolonged sedentary lifestyle and unhealthy nutrition were identified a long time ago as the risk factors of excessive body weight and clinical obesity (hereinafter: obesity and the obese) as well as of a number of chronic diseases. How a modern person finds their way through this changed environment depends on a range of factors, mainly on the level of awareness about the many challenges that give rise to a need for an adjustment, the authenticity of the sources of information and the emerging possibilities and, eventually, the decisions to be made. The aim of the contribution is to provide accurate information about specific obsolete dogmas and to encourage the reader to take decisions that benefit their health.
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Cardiovascular diseases (CVD) are the leading cause of death globally, with over 17.9 million attributed deaths in 2019. Unhealthy diet is an often-overlooked major modifiable risk factor for CVD. Global Burden of Disease (GBD) estimates suggest that unhealthy diets account for nearly 26% of all deaths, of which 84% were attributed to CVD. Plant-based diets (PBDs), which are a diverse group of dietary patterns focused on plant produce, with flexibility for varying levels of vegetarianism, have been suggested to decrease the incidence of various cardiovascular and cardiometabolic diseases. In this review, we aim to delve into the spectrum of PBDs, revisit objective definitions and classifications, and compare them with standard non-vegetarian diets. We examine plausible mechanisms underlying the cardiovascular benefits of PBDs with a particular focus on the dietary manipulation of gut microbiota-host interaction and its effect on energy metabolism, and local and systemic inflammation. In addition, we explore the evidence on the impact of PBDs on cardiovascular disease, examine the challenges and limitations associated with dietary intervention studies, and devise strategies to draw valid conclusions. Dietary interventions, such as PBDs are one of the most powerful, attainable, cost-effective tools for health and environmental protection at the population level. We conclude with a clear appreciation for PBDs in environmental sustainability, climate change, and animal welfare.
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Currently, food industries largely based on animal products including egg, meat, and fish are facing a burning challenge to meet the continuously increasing consumer demand. The greater availability of plant-based foods has aided the transition from animal foods to plant foods due to its sustainable, convenient, and affordable nature. Different plant derived ingredients like globular proteins, oligosaccharides, dietary fibres, starch, amylopectin, short and long chain unsaturated fatty acids are used to develop plant based foods, however, selection of most important ones being critical for creating a successful end product. Most notably, when the use of bioactive ingredients is targeted, some challenges like instability and reaction with other food matrices persist in development of plant based foods. In this context, nanoencapsulation of food components is an emerging and innovative field for controlled and targeted delivery with various prophylactic activities. The technology encompassing nanoencapsulation facilitates the release of food components, improvement in bioaccessibility, and digestion in the human body. Moreover, the plant-based foods are gaining cumulative attention in the scientific community due to development of various analogues of meat, egg, and milk. This review describes the recent updates in scientific understanding of plant based foods highlighting their prophylactic measures, market demand, and plant based ingredients with physical, functional, and molecular properties, and encapsulation strategies for elimination of various hurdles, maintenance of food quality, and insurances of safety as well as bioavailability of beneficial nutrients.
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Fasting has been a practice among followers of different religions for many years. Christian Orthodox Church (COC) fasting is a periodic vegetarian-type diet while seafood and snails are allowed on most fasting days. The present scoping review aimed to present available data regarding the benefits of COC fasting on metabolic syndrome (MetS) risk factors. Databases were searched for available studies. Twenty publications, with a total of 1226 fasting participants, provided data on the effects on different variables of the MetS, including blood pressure, blood lipids and anthropometric measurements. Fasters’ diet is characterized by low saturated and trans fat intake, high complex carbohydrate and fiber consumption, due to foods allowed to consume. COC fasting has no deficiency in essential amino acids intake since seafood and snails allowed on fasting days. Fasters have healthier blood lipid profiles during and after COC fasting periods, total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, body weight and body mass index are reduced after a fasting period. Due to restricted or forbidden intake of specific foods during the COC fasting periods, one might expect that fasters may have reduced intake of macro- and micro-nutrients, but as showed in the available literature there are no deficiencies. Future research on COC fasting is needed in areas not investigated at all, like MetS, before reaching definite conclusions.
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Diet is thought to play an important role in the aetiology of type 2 diabetes. Previous studies have found positive associations between meat consumption and the risk of type 2 diabetes, but the results have been inconsistent. We conducted a systematic review and meta-analysis of cohort studies of meat consumption and type 2 diabetes risk. We searched several databases for cohort studies on meat consumption and type 2 diabetes risk, up to December 2008. Summary relative risks were estimated by use of a random-effects model. We identified 12 cohort studies. The estimated summary RR and 95% confidence interval of type 2 diabetes comparing high vs low intake was 1.17 (95% CI 0.92-1.48) for total meat, 1.21 (95% CI 1.07-1.38) for red meat and 1.41 (95% CI 1.25-1.60) for processed meat. There was heterogeneity amongst the studies of total, red and processed meat which, to some degree, was explained by the study characteristics. These results suggest that meat consumption increases the risk of type 2 diabetes. However, the possibility that residual confounding could explain this association cannot be excluded.
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To investigate the association between fish and seafood intake and new-onset type 2 diabetes. This was a population-based prospective cohort (European Prospective Investigation of Cancer [EPIC]-Norfolk) study of men and women aged 40-79 years at baseline (1993-1997). Habitual fish and seafood intake (white fish, oily fish, fried fish, and shellfish) was assessed using a semiquantitative food frequency questionnaire and categorized as less than one or one or more portions/week. During a median (interquartile range) follow-up of 10.2 (9.1-11.2) years, there were 725 incident diabetes cases among 21,984 eligible participants. Higher total fish intake (one or more versus less than one portions/week) was associated with a significantly lower risk of diabetes (odds ratio [OR] 0.75 [95% CI 0.58-0.96]), in analyses adjusted for age, sex, family history of diabetes, education, smoking, physical activity, dietary factors (total energy intake, alcohol intake, and plasma vitamin C) and obesity (BMI and waist circumference). White fish and oily fish intakes were similarly inversely associated with diabetes risk, but the associations were not significant after adjustment for dietary factors (oily fish) or obesity (white fish). Fried fish was not significantly associated with diabetes risk. Consuming one or more portions/week of shellfish was associated with an increased risk of diabetes (OR 1.36 [1.02-1.81]) in adjusted analyses. Total, white, and oily fish consumption may be beneficial for reducing risk of diabetes, reinforcing the public health message to consume fish regularly. Greater shellfish intake seems to be associated with an increased risk of diabetes, warranting further investigation into cooking methods and mechanisms.
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To examine whether socioeconomic status (SES) explains differences in the prevalence of type 2 diabetes between African-American and non-Hispanic white women and men. Cross sectional study of diabetes prevalence, SES, and other risk factors ascertained by physical examination and interview. Interviews were conducted in subjects' homes; physical examinations were conducted in mobile examination centres. 961 African-American women, 1641 non-Hispanic white women, 839 African-American men and 1537 non-Hispanic white men, aged 40 to 74 years, examined in the Third National Health and Nutrition Examination Survey (NHANES III), a representative sample of the non-institutionalised civilian population of the United States, 1988-1994. Among women, African-American race/ethnicity was associated with an age adjusted odds ratio of 1.76 (95% confidence intervals 1.21, 2.57), which was reduced to 1.42 (95% confidence intervals 0.95, 2.13) when poverty income ratio was controlled. Controlling for education or occupational status had minimal effects on this association. When other risk factors were controlled, race/ethnicity was not significantly associated with type 2 diabetes prevalence. Among men, the age adjusted odds ratio associated with African-American race/ethnicity was 1.43 (95% confidence intervals 1.03, 1.99). Controlling for SES variables only modestly affected the odds ratio for African/American race/ethnicity among men, while adjusting for other risk factors increased the racial/ethnic differences. Economic disadvantage may explain much of the excess prevalence of type 2 diabetes among African-American women, but not among men.
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Based on what is known of the components of plant-based diets and their effects from cohort studies, there is reason to believe that vegetarian diets would have advantages in the treatment of type 2 diabetes. At present there are few data on vegetarian diets in diabetes that do not in addition have weight loss or exercise components. Nevertheless, the use of whole-grain or traditionally processed cereals and legumes has been associated with improved glycemic control in both diabetic and insulin-resistant individuals. Long-term cohort studies have indicated that whole-grain consumption reduces the risk of both type 2 diabetes and cardiovascular disease. In addition, nuts (eg, almonds), viscous fibers (eg, fibers from oats and barley), soy proteins, and plant sterols, which may be part of the vegetarian diet, reduce serum lipids. In combination, these plant food components may have a very significant impact on cardiovascular disease, one of the major complications of diabetes. Furthermore, substituting soy or other vegetable proteins for animal protein may also decrease renal hyperfiltration, proteinuria, and renal acid load and in the long term reduce the risk of developing renal disease in type 2 diabetes. The vegetarian diet, therefore, contains a portfolio of natural products and food forms of benefit for both the carbohydrate and lipid abnormalities in diabetes. It is anticipated that their combined use in vegetarian diets will produce very significant metabolic advantages for the prevention and treatment of diabetes and its complications.
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This paper presents findings from formative research exploring Black Seventh-day Adventist church members' attitudes about Black non-participation in past studies, and suggestions for recruiting 45,000 Blacks to an upcoming longitudinal cohort study. Data were collected in California and Pennsylvania, using 15 key informant interviews and 6 focus groups. Key findings supported and elucidated existing literature on the barriers to minority recruitment, and included: a general mistrust of the medical/scientific community; a perception that providing informed consent relinquishes, rather than protects, an individual's rights; a perception of being "studied" rather than "studying," due to the paucity of Black investigators; and a perceived lack of cultural sensitivity in the recruitment of Blacks, and in the conduct of the research itself. Building trust throughout the process, from clearly demonstrating the benefits of participation, at the individual and community level, to including Blacks in the study design from conceptualization to data analysis and presentation, emerged as a critical component in garnering Black participation in future studies.
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The aim of this study was to prospectively assess the relation between red meat intake and incidence of type 2 diabetes. Over an average of 8.8 years, we evaluated 37,309 participants in the Women's Health Study aged >/=45 years who were free of cardiovascular disease, cancer, and type 2 diabetes and completed validated semiquantitative food frequency questionnaires in 1993. During 326,876 person-years of follow-up, we documented 1,558 incident cases of type 2 diabetes. After adjusting for age, BMI, total energy intake, exercise, alcohol intake, cigarette smoking, and family history of diabetes, we found positive associations between intakes of red meat and processed meat and risk of type 2 diabetes. Comparing women in the highest quintile with those in the lowest quintile, the multivariate-adjusted relative risks (RRs) of type 2 diabetes were 1.28 for red meat (95% CI 1.07-1.53, P < 0.001 for trend) and 1.23 for processed meat intake (1.05-1.45, P = 0.001 for trend). Furthermore, the significantly increased diabetes risk appeared to be most pronounced for frequent consumption of total processed meat (RR 1.43, 95% CI 1.17-1.75 for >/=5/week vs. <1/month, P < 0.001 for trend) and two major subtypes, which were bacon (1.21, 1.06-1.39 for >/=2/week vs. <1/week, P = 0.004 for trend) and hot dogs (1.28, 1.09-1.50 for >/=2/week vs. <1/week, P = 0.003 for trend). These results remained significant after further adjustment for intakes of dietary fiber, magnesium, glycemic load, and total fat. Intakes of total cholesterol, animal protein, and heme iron were also significantly associated with a higher risk of type 2 diabetes. Our data indicate that higher consumption of total red meat, especially various processed meats, may increase risk of developing type 2 diabetes in women.
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Major dietary patterns were studied for the ability to predict type 2 diabetes mellitus in a cohort of 4,304 Finnish men and women aged 40-69 years and free of diabetes at baseline in 1967-1972. Factor analysis was used to identify dietary patterns from dietary data that were collected using a 1-year dietary history interview. A total of 383 incident cases of type 2 diabetes occurred during a 23-year follow-up. Two major dietary patterns were identified. The pattern labeled "prudent" was characterized by higher consumption of fruits and vegetables, and the pattern labeled "conservative" was characterized by consumption of butter, potatoes, and whole milk. The relative risks (adjusted for nondietary confounders) between the extreme quartiles of the pattern scores were 0.72 (95% confidence interval: 0.53, 0.97; p(trend) = 0.03) for the prudent pattern and 1.49 (95% confidence interval: 1.11, 2.00; p(trend) = 0.01) for the conservative pattern. Thus, the prudent dietary pattern score was associated with a reduced risk and the conservative pattern score was associated with an increased risk of type 2 diabetes. In light of these results, it appears conceivable that the risk of developing type 2 diabetes can be reduced by changing dietary patterns.
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The aim of this study was to identify a dietary pattern associated with diabetes-related biomarkers and to investigate whether this pattern is associated with the incidence of type 2 diabetes. A nested case-control study of 192 cases of incident type 2 diabetes and 382 control subjects matched for sex and age was conducted. All subjects were participants in the population-based European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Dietary pattern score was derived using intake data on 48 food groups as exposure variables and the biomarkers HbA1c, HDL cholesterol, C-reactive protein and adiponectin as response variables in reduced rank regression. The association of the score with diabetes risk was estimated by conditional logistic regression analysis. A high score for the identified dietary pattern was characterised by a high intake of fresh fruit and a low intake of high-caloric soft drinks, beer, red meat, poultry, processed meat, legumes and bread (excluding wholegrain bread). Subjects with high scores had high plasma concentrations of HDL cholesterol and adiponectin and low plasma concentrations of HbA1c and C-reactive protein. After multivariate adjustment, the odds ratios for type 2 diabetes across increasing quintiles of the dietary pattern score were 1.0, 0.59, 0.51, 0.26 and 0.27, respectively (p = 0.0006 for trend). A high score for the identified dietary pattern is associated with a more favourable biomarker profile and a substantially reduced incidence of type 2 diabetes.
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The authors investigated the association of dietary patterns and type 2 diabetes in a 4-year prospective study of 36,787 adults in the Melbourne Collaborative Cohort Study (1990–1994). A total of 31,641 (86%) participants completed follow-up, and 365 cases were identified. Four factors with eigenvalues of greater than 2 were identified using the principal factor method with 124 foods/beverages, followed by orthogonal rotation. Variables with factor loadings having absolute values of 0.3 or greater were used in interpreting the factors. Odds ratios for diabetes incidence across quintiles of factor scores were computed by use of logistic regression, adjusting for age, energy intake, family history of diabetes, country of birth, and other factor scores. Factor 1, characterized by olive oil, salad vegetables, and legumes and by avoidance of sweet bakery items, margarine, and tea, was associated with country of birth but not with diabetes. Factor 2, characterized by salad and cooked vegetables, was inversely associated with diabetes. Factor 3, characterized by meats and fatty foods, was associated with increased diabetes risk. A range of fruits loaded strongly on factor 4, which showed little association with diabetes. Avoidance of a dietary pattern including meats and fatty foods, as well as adherence to a pattern including salad and cooked vegetables, is recommended.
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Few epidemiologic cohort studies on the etiology of chronic disease are powerful enough to distinguish racial and ethnic determinants from socioeconomic determinants of health behaviors and observed disease patterns. The Adventist Health Study-2 (AHS-2), with its large number of respondents and the variation in lifestyles of its target populations, promises to shed light on these issues. This paper focuses on some preliminary baseline analyses of responses from the first group of participants recruited for AHS-2. We administered a validated and pilot-tested questionnaire on various lifestyle practices and health outcomes to 56,754 respondents to AHS-2, comprising 14,376 non-Hispanic blacks and 42,378 non-Hispanic whites. We analyzed cross-sectional baseline data adjusted for age and sex and performed logistic regressions to test differences between responses from the two racial groups. In this Seventh-day Adventist (Adventist) cohort, blacks were less likely than whites to be lifelong vegetarians and more likely to be overweight or obese. Exercise levels were lower for blacks than for whites, but blacks were as likely as whites not to currently smoke or drink. Blacks reported higher rates of hypertension and diabetes than did whites but lower rates of high serum cholesterol, myocardial infarction, emphysema, and all cancers. After we eliminated skin cancer from the analysis, the age-adjusted prevalence of cancer remained significantly lower for black than for white women. The prevalence of prostate cancer was 47% higher for black men than for white men. The profile of health habits for black Adventists is better than that for blacks nationally. Given the intractable nature of many other contributors to health disparities, including racism, housing segregation, employment discrimination, limited educational opportunity, and poorer health care, the relative advantage for blacks of the Adventist lifestyle may hold promise for helping to close the gap in health status between blacks and whites nationally.
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Background: Control of body weight by balancing energy intake and energy expenditure is of major importance for the prevention of type 2 diabetes, but the role of specific dietary factors in the etiology of type 2 diabetes is less well established. We evaluated intakes of whole grain, bran, and germ in relation to risk of type 2 diabetes in prospective cohort studies. Methods and findings: We followed 161,737 US women of the Nurses' Health Studies (NHSs) I and II, without history of diabetes, cardiovascular disease, or cancer at baseline. The age at baseline was 37-65 y for NHSI and 26-46 y for NHSII. Dietary intakes and potential confounders were assessed with regularly administered questionnaires. We documented 6,486 cases of type 2 diabetes during 12-18 y of follow-up. Other prospective cohort studies on whole grain intake and risk of type 2 diabetes were identified in searches of MEDLINE and EMBASE up to January 2007, and data were independently extracted by two reviewers. The median whole grain intake in the lowest and highest quintile of intake was, respectively, 3.7 and 31.2 g/d for NHSI and 6.2 and 39.9 g/d for NHSII. After adjustment for potential confounders, the relative risks (RRs) for the highest as compared with the lowest quintile of whole grain intake was 0.63 (95% confidence interval [CI] 0.57-0.69) for NHSI and 0.68 (95% CI 0.57-0.81) for NHSII (both: p-value, test for trend <0.001). After further adjustment for body mass index (BMI), these RRs were 0.75 (95% CI 0.68-0.83; p-value, test for trend <0.001) and 0.86 (95% CI 0.72-1.02; p-value, test for trend 0.03) respectively. Associations for bran intake were similar to those for total whole grain intake, whereas no significant association was observed for germ intake after adjustment for bran. Based on pooled data for six cohort studies including 286,125 participants and 10,944 cases of type 2 diabetes, a two-serving-per-day increment in whole grain consumption was associated with a 21% (95% CI 13%-28%) decrease in risk of type 2 diabetes after adjustment for potential confounders and BMI. Conclusions: Whole grain intake is inversely associated with risk of type 2 diabetes, and this association is stronger for bran than for germ. Findings from prospective cohort studies consistently support increasing whole grain consumption for the prevention of type 2 diabetes.
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It has been postulated that a diet high in legumes may be beneficial for the prevention of type 2 diabetes mellitus (type 2 DM). However, data linking type 2 DM risk and legume intake are limited. The objective of the study was to examine the association between legume and soy food consumption and self-reported type 2 DM. The study was conducted in a population-based prospective cohort of middle-aged Chinese women. We followed 64,227 women with no history of type 2 DM, cancer, or cardiovascular disease at study recruitment for an average of 4.6 y. Participants completed in-person interviews that collected information on diabetes risk factors, including dietary intake and physical activity in adulthood. Anthropometric measurements were taken. Dietary intake was assessed with a validated food-frequency questionnaire at the baseline survey and at the first follow-up survey administered 2-3 y after study recruitment. We observed an inverse association between quintiles of total legume intake and 3 mutually exclusive legume groups (peanuts, soybeans, and other legumes) and type 2 DM incidence. The multivariate-adjusted relative risk of type 2 DM for the upper quintile compared with the lower quintile was 0.62 (95% CI: 0.51, 0.74) for total legumes and 0.53 (95% CI: 0.45, 0.62) for soybeans. The association between soy products (other than soy milk) and soy protein consumption (protein derived from soy beans and their products) with type 2 DM was not significant. Consumption of legumes, soybeans in particular, was inversely associated with the risk type 2 DM.
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We examined associations between fruit and vegetable intake and the incidence of type 2 diabetes (T2D) in a population-based prospective study of 64,191 women with no history of T2D or other chronic diseases at study recruitment and with valid dietary information. Dietary intake was assessed by in-person interviews using a validated FFQ. During 297,755 person-years of follow-up, 1608 new cases of T2D were documented. We used a Cox regression model to evaluate the association of fruit and vegetable intake (g/d) with the risk of T2D. Quintiles of vegetable intake and T2D were inversely associated. The relative risk for T2D for the upper quintile relative to the lower quintile of vegetable intake was 0.72 (95%CI: 0.61-0.85; P < 0.01) in multivariate analysis. Individual vegetable groups were all inversely and significantly associated with the risk of T2D. Fruit intake was not associated with the incidence of diabetes in this population. Our data suggest that vegetable consumption may protect against the development of T2D.
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Few studies have examined the long-term effect of habitual diet on risks of incident diabetes, coronary heart disease, and mortality. We analyzed the prospective relation of dietary patterns with incident chronic disease and mortality during 15 y of follow-up in the Whitehall II study. We conducted a prospective analysis (106,633 person-years at risk) among men and women (n = 7731) with a mean age of 50 y at the time of dietary assessment (127-item food-frequency questionnaire). Coronary death or nonfatal myocardial infarction and incident diabetes were verified by record tracing and oral-glucose-tolerance tests. Cluster analysis identified 4 dietary patterns at baseline. The patterns were termed unhealthy (white bread, processed meat, fries, and full-cream milk; n = 2665), sweet (white bread, biscuits, cakes, processed meat, and high-fat dairy products; n = 1042), Mediterranean-like (fruit, vegetables, rice, pasta, and wine; n = 1361), and healthy (fruit, vegetables, whole-meal bread, low-fat dairy, and little alcohol; n = 2663). Compared with the unhealthy pattern, the healthy pattern reduced the risk of coronary death or nonfatal myocardial infarction and diabetes; hazard ratios (95% CI) were 0.71 (0.51, 0.98) and 0.74 (0.58, 0.94), respectively, after adjustment for age, sex, ethnicity, dietary energy misreporting, social position, smoking status, and leisure-time physical activity. Dietary pattern was not associated with all-cause mortality. Residual confounding by socioeconomic factors was unlikely to account for the observed dietary effects. The healthy eating pattern reduced risks of diabetes and major coronary events. Such dietary patterns offer considerable health benefits to individuals and contribute to public health.
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Background: Cigarette smoking is an established predictor of incident type 2 diabetes mellitus, but the effects of smoking cessation on diabetes risk are unknown. Objective: To test the hypothesis that smoking cessation increases diabetes risk in the short term, possibly owing to cessation-related weight gain. Design: Prospective cohort study. Setting: The ARIC (Atherosclerosis Risk in Communities) Study. Patients: 10,892 middle-aged adults who initially did not have diabetes in 1987 to 1989. Measurements: Smoking was assessed by interview at baseline and at subsequent follow-up. Incident diabetes was ascertained by fasting glucose assays through 1998 and self-report of physician diagnosis or use of diabetes medications through 2004. Results: During 9 years of follow-up, 1254 adults developed type 2 diabetes. Compared with adults who never smoked, the adjusted hazard ratio of incident diabetes in the highest tertile of pack-years was 1.42 (95% CI, 1.20 to 1.67). In the first 3 years of follow-up, 380 adults quit smoking. After adjustment for age, race, sex, education, adiposity, physical activity, lipid levels, blood pressure, and ARIC Study center, compared with adults who never smoked, the hazard ratios of diabetes among former smokers, new quitters, and continuing smokers were 1.22 (CI, 0.99 to 1.50), 1.73 (CI, 1.19 to 2.53), and 1.31 (CI, 1.04 to 1.65), respectively. Further adjustment for weight change and leukocyte count attenuated these risks substantially. In an analysis of long-term risk after quitting, the highest risk occurred in the first 3 years (hazard ratio, 1.91 [CI, 1.19 to 3.05]), then gradually decreased to 0 at 12 years. Limitation: Residual confounding is possible even with meticulous adjustment for established diabetes risk factors. Conclusion: Cigarette smoking predicts incident type 2 diabetes, but smoking cessation leads to higher short-term risk. For smokers at risk for diabetes, smoking cessation should be coupled with strategies for diabetes prevention and early detection.
Article
The aim of this study was to investigate the association between processed and other meat intake and incidence of Type 2 diabetes in a large cohort of women. Incident cases of Type 2 diabetes were identified during 8 years of follow-up in a prospective cohort study of 91246 U.S. women aged 26 to 46 years and being free of diabetes and other major chronic diseases at baseline in 1991. We identified 741 incident cases of confirmed Type 2 diabetes during 716276 person-years of follow-up. The relative risk adjusted for potential non-dietary confounders was 1.91 (95% CI: 1.42-2.57) in women consuming processed meat five times or more a week compared with those consuming processed meat less than once a week ( p<0.001 for trend). Further adjustment for intakes of magnesium, cereal fibre, glycaemic index, and caffeine or for a Western dietary pattern did not appreciably change the results and associations remained strong after further adjustment for fatty acid and cholesterol intake. Frequent consumption of bacon, hot dogs, and sausage was each associated with an increased risk of diabetes. While total red meat (beef or lamb as main dish, pork as main dish, hamburger, beef, pork or lamb as sandwich or mixed dish) intake was associated with an increased risk of diabetes, this association was attenuated after adjustment for magnesium, cereal fiber, glycaemic index, and caffeine (relative risk: 1.44; 95% CI: 0.92-2.24). Our data suggest that diets high in processed meats could increase the risk for developing Type 2 diabetes.
Article
Key findings: Forty-five percent of adults had at least one of three diagnosed or undiagnosed chronic conditions—hypertension, hypercholesterolemia, or diabetes; one in eight adults (13%) had two of these conditions; and 3% of adults had all three chronic conditions. Nearly one in seven U.S. adults (15%) had one or more of these conditions undiagnosed. Non-Hispanic black persons were more likely than non-Hispanic white and Mexican-American persons to have at least one of the three conditions (diagnosed or undiagnosed). Non-Hispanic black and non-Hispanic white persons were more likely than Mexican-American persons to have both diagnosed or undiagnosed hypertension and hyper-cholesterolemia. Non-Hispanic black and Mexican-American persons were more likely than non-Hispanic white persons to have both diagnosed or undiagnosed hypertension and diabetes.
Article
Cigarette smoking is an established predictor of incident type 2 diabetes mellitus, but the effects of smoking cessation on diabetes risk are unknown. To test the hypothesis that smoking cessation increases diabetes risk in the short term, possibly owing to cessation-related weight gain. Prospective cohort study. The ARIC (Atherosclerosis Risk in Communities) Study. 10,892 middle-aged adults who initially did not have diabetes in 1987 to 1989. Smoking was assessed by interview at baseline and at subsequent follow-up. Incident diabetes was ascertained by fasting glucose assays through 1998 and self-report of physician diagnosis or use of diabetes medications through 2004. During 9 years of follow-up, 1254 adults developed type 2 diabetes. Compared with adults who never smoked, the adjusted hazard ratio of incident diabetes in the highest tertile of pack-years was 1.42 (95% CI, 1.20 to 1.67). In the first 3 years of follow-up, 380 adults quit smoking. After adjustment for age, race, sex, education, adiposity, physical activity, lipid levels, blood pressure, and ARIC Study center, compared with adults who never smoked, the hazard ratios of diabetes among former smokers, new quitters, and continuing smokers were 1.22 (CI, 0.99 to 1.50), 1.73 (CI, 1.19 to 2.53), and 1.31 (CI, 1.04 to 1.65), respectively. Further adjustment for weight change and leukocyte count attenuated these risks substantially. In an analysis of long-term risk after quitting, the highest risk occurred in the first 3 years (hazard ratio, 1.91 [CI, 1.19 to 3.05]), then gradually decreased to 0 at 12 years. Residual confounding is possible even with meticulous adjustment for established diabetes risk factors. Cigarette smoking predicts incident type 2 diabetes, but smoking cessation leads to higher short-term risk. For smokers at risk for diabetes, smoking cessation should be coupled with strategies for diabetes prevention and early detection.
Article
To investigate the relation between total fish, type of fish (lean and fatty), and eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake and risk of type 2 diabetes in a population-based cohort. The analysis included 4,472 Dutch participants aged >or=55 years without diabetes at baseline. Dietary intake was assessed with a semiquantitative food frequency questionnaire. Hazard ratios (relative risk [RR]) with 95% CIs were used to examine risk associations adjusted for age, sex, lifestyle, and nutritional factors. After 15 years of follow-up, 463 participants developed type 2 diabetes. Median fish intake, mainly lean fish (81%), was 10 g/day. Total fish intake was associated positively with risk of type 2 diabetes; the RR was 1.32 (95% CI 1.02-1.70) in the highest total fish group (>or=28 g/day) compared with that for non-fish eaters (P(trend) = 0.04). Correspondingly, lean fish intake tended to be associated positively with type 2 diabetes (RR highest group [>or=23 g/day] 1.30 [95% CI 1.01-1.68]; P(trend) = 0.06), but fatty fish was not. No association was observed between EPA and DHA intake and type 2 diabetes (RR highest group [>or=149.4 mg/day] 1.22 [0.97-1.53]). With additional adjustment for intake of selenium, cholesterol, and vitamin D, this RR decreased to 1.05 (0.80-1.38; P(trend) = 0.77). The findings do not support a beneficial effect of total fish, type of fish, or EPA and DHA intake on the risk of type 2 diabetes. Alternatively, other dietary components, such as selenium, and unmeasured contaminants present in fish might explain our results.
Article
Diet is a key component of a healthy lifestyle in the prevention of type 2 diabetes mellitus (T2DM). The role of long-chain omega-3 (n-3) fatty acids (LCFAs) in the development of T2DM remains unresolved. Objective: We examined the association between dietary LCFAs and incidence of T2DM in 3 prospective cohorts of women and men. We followed 195,204 US adults (152,700 women and 42,504 men) without preexisting chronic disease at baseline for 14 to 18 y. Fish and LCFA intakes were assessed at baseline and updated at 4-y intervals by using a validated food-frequency questionnaire. During nearly 3 million person-years of follow-up, 9380 new cases of T2DM were documented. After adjustment for other dietary and lifestyle risk factors, LCFA intake was positively related to incidence of T2DM. The pooled multivariate relative risks in 3 cohorts across increasing quintiles of LCFAs were as follows: 1 (reference), 1.00 (95% CI: 0.91, 1.09), 1.05 (95% CI: 0.97, 1.13), 1.17 (95% CI: 1.07, 1.28), and 1.24 (95% CI: 1.09, 1.40) (P for trend < 0.001). Compared with those who consumed fish less than once per month, the relative risk of T2DM was 1.22 (95% CI: 1.08, 1.39) for women who consumed > or =5 servings fish/wk (P for trend <0.001). We found no evidence that higher consumption of LCFAs and fish reduces the risk of T2DM. Instead, higher intakes may modestly increase the incidence of this disease. Given the beneficial effects of LCFA intake on many cardiovascular disease risk factors, the clinical relevance of this relation and its possible mechanisms require further investigation.
Article
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.
Article
We propose the hypothesis that a vegetarian diet reduces the risk of developing diabetes. Findings that have generated this hypothesis are from a population of 25,698 adult White Seventh-day Adventists identified in 1960. During 21 years of follow-up, the risk of diabetes as an underlying cause of death in Adventists was approximately one-half the risk for all US Whites. Within the male Adventist population, vegetarians had a substantially lower risk than non-vegetarians of diabetes as an underlying or contributing cause of death. Within both the male and female Adventist populations, the prevalence of self-reported diabetes also was lower in vegetarians than in non-vegetarians. The associations observed between diabetes and meat consumption were apparently not due to confounding by over- or under-weight, other selected dietary factors, or physical activity. All of the associations between meat consumption and diabetes were stronger in males than in females.
Article
To identify factors associated with diabetes mellitus and to determine whether racial differences in these factors, especially socioeconomic status, explain the high prevalence of diabetes among African-Americans, we performed a cross-sectional study using a population-based, representative sample from three US communities. The participants comprised 975 white and 418 African-American adults, aged 35 to 54 years. The main outcome variable was the presence of diabetes defined by either self-report or abnormal results on the oral glucose tolerance test (serum glucose level > 10.0 mmol/L (180 mg/dL) 1 hour after 50-g oral glucose dose). Compared to their white counterparts, African-American participants were more overweight, displayed greater central adiposity, and had lower socioeconomic status. Diabetes was over twice as prevalent among African-Americans (10.3%) as compared to whites (4.6%; odds ratio (OR) = 2.38; 95% confidence interval (95% CI): 1.50, 3.75; P = 0.0001). After adjustments for racial differences in age, socioeconomic status, overweight, and central adiposity, African-Americans remained over twice as likely to have diabetes compared to whites (OR = 2.35; 95% CI: 1.49, 3.73; P = 0.0003). The excess prevalence of diabetes in African-Americans was greatest in individuals of low socioeconomic status (OR = 4.09) and least among individuals of high socioeconomic status (OR = 1.90; P < 0.001 for trend). Racial differences in obesity and socioeconomic status do not appear to explain fully the higher prevalence of diabetes among African-Americans. African-American race seems to be a strong, independent risk factor for diabetes, especially among individuals of low socioeconomic status.
Article
The validity and reliability of selected physical activity questions were assessed in both Seventh-day Adventist (N = 131) and non-Adventist (N = 101) study groups. Vigorous activity questions similar to those used by others and new questions that measured moderate and light activities were included. Validation was external, comparing questionnaire data with treadmill exercise time, resting heart rate, and body mass index (kg.m-2), and internal, comparing data with other similar questions. Both Adventist and non-Adventist males showed significant age-adjusted correlations between treadmill time and a "Run-Walk-Jog Index" (R = 0.28, R = 0.48, respectively). These correlations increased substantially when restricting analysis to exercise speeds exceeding 3 mph (R = 0.39, R = 0.71, respectively). Frequency of sweating and a vigorous physical activity index also correlated significantly with treadmill time in males. Correlations were generally weaker in females. Moderate- and light-intensity questions were not correlated with physical fitness. Internal correlations R = 0.50-0.78) between the above three vigorous activity questions were significant in all groups, and correlations (R = 0.14-0.60) for light and moderate activity questions were also documented. Test-retest reliability coefficients were high for vigorous activity questions (R = 0.48-0.85) and for one set of moderate activity questions (R = 0.43-0.75). No important differences in validity and reliability were found between Adventist and non-Adventists, but the validity of vigorous activity measures was generally weaker in females.
Article
Physical activity has been identified as an important predictor of chronic disease risk in numerous studies in which activity levels were measured by questionnaire. Although the validity of physical activity questionnaires has been documented in a number of studies of U.S. adults, few have included a validation analysis among blacks. We have examined the validity and reliability of a physical activity questionnaire that was administered to 165 black Seventh-day Adventists from Southern California. Subjects completed a self-administered physical activity questionnaire and then "reference" measures of activity (7-d activity recalls, pedometer readings) and fitness (treadmill test) were completed in subsets of this population. The authors found that 7-d recall activity levels correlated well with the corresponding questionnaire indices among women (total activity, r = 0.65; vigorous, r = 0.85; moderate, r = 0.44; inactivity, r = 0.59; sleep duration, r = 0.52) and men (total activity, r = 0.51; vigorous, r = 0.65; moderate, r = 0.53; inactivity, r = 0.69; sleep duration, r = 0.39). Vigorous activity from 7-d recalls was best measured by gender-specific indices that included only recreational activities among men and emphasized nonrecreational activities among women. Correlations between questionnaire data and the other "reference" measures were lower. Test-retest correlations of questionnaire items over a 6-wk interval were high (r = 0.4-0.9). Simple questions can measure activities of different intensity with good validity and reliability among black Adventist men and women.
Article
To assess intake of several vitamins in preparation for a large cohort study investigating the effect of diet on risk of colon and prostate cancer. The dietary intake of several vitamins were assessed using eight different 24-hour recalls and a 200-item food frequency questionnaire (FFQ) from each subject. Participants also attended a clinic where blood was drawn and body composition, weight, height, and blood pressure were measured. A total of 97 black and 96 nonhispanic white subjects participated. The levels of alpha-tocopherol, carotene, folate, and vitamin C in the blood were correlated with the dietary intakes as measured by both 24-hour recalls and FFQ. Correlations between blood levels and energy-adjusted dietary intake assessed by 24-hour recalls (with supplements) were as follows: carotene (adjusted for serum cholesterol): 0.47 and 0.55 in black and white subjects, respectively; alpha-tocopherol (adjusted for serum cholesterol): 0.61 (blacks) and 0.50 (whites); vitamin C: 0.22 (blacks) and 0.17 (whites); folate: 0.54 (blacks) and 0.55 (whites). Correlations between blood levels and FFQ indices were smaller in magnitude: 0.34 and 0.28 for carotene in black and white subjects, respectively, 0.37 and 0.56 for alpha-tocopherol (adjusted for serum cholesterol), 0.20 and 0.03 for vitamin C and 0.24 and 0.32 for folate. The correlations observed were generally of modest to moderate size and were similar to or larger than those reported by others. This is despite variations in absorption, metabolism, and excretion of the vitamins and suggests that both the 24-hour recalls and the FFQ contain valid information.
Article
The role of diet in the development of type 2 diabetes mellitus remains unsettled. To examine the association between major dietary patterns and risk for type 2 diabetes mellitus. Prospective cohort study. United States. 42 504 male health professionals, 40 to 75 years of age, without diagnosed diabetes, cardiovascular disease, or cancer at baseline. Using factor analysis based on data from food-frequency questionnaires, we identified and validated two major dietary patterns that we labeled "prudent" (characterized by higher consumption of vegetables, fruit, fish, poultry and whole grains) and "western" (characterized by higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, and sweets and desserts). Relative risks and 95% CIs were adjusted for potential confounders, including body mass index (BMI), physical activity, and cigarette smoking. During 12 years of follow-up (466 508 person-years), we documented 1321 cases of type 2 diabetes. The prudent dietary pattern score was associated with a modestly lower risk for type 2 diabetes (relative risk for extreme quintiles, 0.84 [CI, 0.70 to 1.00]). In contrast, the western dietary pattern score was associated with an increased risk for type 2 diabetes (relative risk, 1.59 [CI, 1.32 to 1.93]; P < 0.001 for trend). A high score for the western dietary pattern combined with low physical activity (relative risk comparing extreme quintiles of dietary pattern score and physical activity, 1.96 [CI, 1.35 to 2.84]) or obesity (relative risk for BMI > or = 30 kg/m2 vs. <25 kg/m2, 11.2 [CI, 8.07 to 15.6]) was associated with a particularly high risk for type 2 diabetes. Our findings suggest that a western dietary pattern is associated with a substantially increased risk for type 2 diabetes in men.
Article
To calibrate and compare intake of different fats and individual fatty acids as assessed with a food frequency questionnaire (FFQ) against that estimated with (i) a series of dietary recalls and; (ii) the relative fat concentration in an adipose tissue biopsy. The FFQ was specially designed for use in a cohort of Seventh-day Adventists. In preparation for a large cohort study investigating the effect of diet on risk of colon, prostate and breast cancer. The association of adipose tissue fatty acids and dietary fat intake was assessed in 49 black and 72 white Seventh-day Adventists subjects using 8 different 24-hour recalls, a 200-item food frequency questionnaire (FFQ) and adipose tissue biopsies from each subject. Pearson correlation between fatty acids in adipose tissue and dietary intake as assessed by multiple 24-hour recalls were as follows: Linoleic acid: 0.77 in black and 0.71 in white subjects, respectively; Linolenic acid: 0.68 (blacks) and 0.62 (whites); Total Polyunsaturated fat (PUFA): 0.78 (blacks) and 0.70 (whites); Total Monounsaturated fat (MUFA): 0.35 (blacks) and 0.03 (whites); Total Saturated fat (SFA): 0.46 (blacks) and 0.56 (whites). Correlations between fatty acids in adipose tissue and dietary intake as assessed by FFQ were: Linoleic acid: 0.61 (blacks) and 0.52 (whites), respectively; Linolenic acid: 0.29 (blacks) and 0.49 (whites); PUFA: 0.62 (blacks) and 0.53 (whites); MUFA: 0.07 (blacks) and 0.31 (whites), SFA: 0.21 (blacks) and 0.31 (whites). Our study confirms findings of others that 24-hour recalls are valid for assessing dietary intake of different types of fat. The FFQ we developed and used in this study gave reasonably valid measures of fatty acid intake in our population and is thus suitable for use in large cohort studies. It had validity comparable to that observed for other FFQs.