Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women

The Effect of a High-Fat Diet on the Fatty Acid Composition in the Hearts of Mice

The Western diet can lead to alterations in cardiac function and increase cardiovascular risk, which can be reproduced in animal models by implementing a high-fat diet (HFD). However, the mechanism of these alterations is not fully understood and may be dependent on alterations in heart lipid composition. The aim of this study was to evaluate the effect of an HFD on the fatty acid (FA) composition of total lipids, as well as of various lipid fractions in the heart, and on heart function. C57BL/6 mice were fed an HFD or standard laboratory diet. The FA composition of chow, serum, heart and skeletal muscle tissues was measured by gas chromatography–mass spectrometry. Cardiac function was evaluated by ultrasonography. Our results showed an unexpected increase in polyunsaturated FAs (PUFAs) and a significant decrease in monounsaturated FAs (MUFAs) in the heart tissue of mice fed the HFD. For comparison, no such effects were observed in skeletal muscle or serum samples. Furthermore, we found that the largest increase in PUFAs was in the sphingolipid fraction, whereas the largest decrease in MUFAs was in the phospholipid and sphingomyelin fractions. The hearts of mice fed an HFD had an increased content of triacylglycerols. Moreover, the HFD treatment altered aortic flow pattern. We did not find significant changes in heart mass or oxidative stress markers between mice fed the HFD and standard diet. The above results suggest that alterations in FA composition in the heart may contribute to deterioration of heart function. A possible mechanism of this phenomenon is the alteration of sphingolipids and phospholipids in the fatty acid profile, which may change the physical properties of these lipids. Since phospho- and sphingolipids are the major components of cell membranes, alterations in their structures in heart cells can result in changes in cell membrane properties.

The role of the microbiota in sedentary lifestyle disorders and ageing: lessons from the animal kingdom

A paradox of so-called developed countries is that, as the major historical causes of human mortality are eliminated or mitigated by medical progress, lifestyle-related diseases have become major killers. Furthermore, as lifespan is extended by the combined effects of modern medicine, health span is struggling to keep apace because of the burden of noncommunicable diseases linked to diet and sedentary lifestyle. The gut microbiome is now recognized as a plastic environmental risk factor for many of these diseases, the microbiome being defined as the complex community of co-evolved commensal microbes that breaks down components of a complex diet, modulates innate immunity, and produces signalling molecules and metabolites that can impact on diverse regulatory systems in mammals. Aspects of the so-called 'Western' lifestyle linked to disease risk such as energy dense diet and antibiotic treatment are known to affect the composition and function of the microbiome. Here, we review the detailed mechanisms whereby the gut microbiome may modulate risk of diseases linked to sedentary lifestyle and ageing-related health loss. We focus on the comparative value of natural animal models such as hibernation for studying metabolic regulation and the challenge of extrapolating from animal models to processes that occur in human ageing.

Dietary patterns and cardiovascular disease in Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS)

BACKGROUND AND AIMS

Empirically-derived dietary patterns have been shown to have both positive and adverse associations with cardiovascular disease (CVD). Yet, such associations remain unclear in the Greek population. The aim of this study was to investigate the association between empirically-derived dietary patterns and the presence of CVD and CVD-related medical conditions in a nationally representative sample of Greek adults.

METHODS AND RESULTS

Adult participants (≥20 years old) of the Hellenic National Nutrition and Health Survey (HNNHS) were included (N = 3552; 41.2% men; 43.7 years, SD: 18.1). Dietary patterns were derived by principal component analysis using 24-h recall data. The presence of dyslipidemia (elevated cholesterol and/or triglycerides), hypertension, coronary heart disease, and total CVD, was defined according to the International Clinical Diagnosis (ICD)-10 codes. Odds ratios of CVD outcomes were estimated across dietary patterns using multivariable logistic regression analysis. Three dietary patterns -Traditional (proxy Mediterranean), Western, and Prudent-were identified explaining 16.5% of the total variance in consumption. Logistic regression analysis, adjusted for age, sex, total caloric intake, sociodemographic characteristics, and other CVD risk factors, showed an inverse association between the Traditional dietary pattern and CVD presence (OR: 0.53; 95% CI: 0.30-0.95), and a positive association between the Western pattern and dyslipidemia (1.52; 1.02-2.26). No association was found between the Prudent pattern and CVD outcomes.

CONCLUSION

The variability of food intake combinations in the Greek population seem to be associated with the presence of CVD and CVD related conditions. Such findings are imperative for national monitoring and informed priority setting.

Diet in Chronic Kidney Disease: an integrated approach to nutritional therapy

A healthy diet is an essential requirement to promote and preserve health, even in the presence of diseases, such as chronic kidney disease (CKD). In this review, nutritional therapy for CKD will be addressed considering not only the main nutrients such as protein, phosphorus, potassium, and sodium, which require adjustments as a result of changes that accompany the reduction of renal functions, but also the benefits of adopting dietary patterns associated with better outcomes for both preventing and treating CKD. We will also emphasize that these aspects should also be combined with a process of giving new meaning to a healthy diet so that it can be promoted. Finally, we will present the perspective of an integrated approach to the individual with CKD, exploring the importance of considering biological, psychological, social, cultural, and economic aspects. This approach has the potential to contribute to better adherence to treatment, thus improving the patient's quality of life.

Dietary patterns and risk of systemic lupus erythematosus in women

OBJECTIVE

Dietary intake is a complex exposure and a potential risk factor for systemic lupus erythematosus (SLE) due to its impact on lipid and glucose metabolism, oxidative stress, and the intestinal microbiome. We aimed to test whether a prudent dietary pattern is associated with a lower risk of SLE, and whether a Western dietary pattern is associated with a higher risk of SLE.

METHODS

We prospectively investigated two dietary patterns and SLE risk among women in the Nurses' Health Study (NHS, 1984-2014) and Nurses' Health Study II (NHSII, 1991-2015). Food frequency questionnaires were completed every four years. Congruent with prior work in NHS and NHSII, we derived two separate dietary patterns (prudent and Western) using principal component analysis within each cohort. Incident SLE was confirmed by the American College of Rheumatology's 1997 criteria. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for SLE by dietary pattern quartiles using Cox models adjusted for time-varying covariates. Models were performed separately in each cohort and results were meta-analyzed. Stratified analyses tested the association of dietary patterns with anti-dsDNA positive SLE and anti-dsDNA negative SLE.

RESULTS

We confirmed 82 NHS incident SLE cases and 98 NHSII SLE cases during 3,833,054 person-years of follow-up. A higher (healthier) prudent dietary pattern score was not associated with SLE risk (meta-analyzed HRQ4 versus Q1 0.84 [95% CI 0.51, 1.38]). Women with higher (less healthy) Western dietary pattern scores did not have a significantly increased risk for SLE (meta-analyzed HRQ4 versus Q1 1.35 [95% CI 0.77, 2.35]). Results were similar after further adjustment for body mass index. Incident anti-dsDNA positive SLE and anti-dsDNA negative SLE were not associated with either dietary pattern.

CONCLUSION

We did not observe a relationship between prudent or Western dietary pattern score and risk of SLE.

Cardiovascular Disease Risk in Survivors of Breast Cancer

PURPOSE OF REVIEW

Early detection and improved treatment in breast cancer have resulted in an increased number of survivors. Cardiovascular disease now remains an important cause for morbidity and mortality in this population. There is a growing gap in the knowledge about the optimal long-term cardiovascular management of this population.

FINDINGS

Breast cancer and cardiovascular disease share a number of common risk factors. Different breast cancer treatment modalities, including anthracyclines, radiation, and hormonal therapy, can act in synergy with preexisting and/or new cardiovascular risk factors to result in significant cardiovascular disease. We summarize the recent evidence about cardiovascular effects of breast cancer therapy and recommendations for their diagnosis and management during the cancer treatment continuum into survivorship. We also present current research initiatives and how they inform clinical care.

Future prospects for dissecting inter-individual variability in the absorption, distribution and elimination of plant bioactives of relevance for cardiometabolic endpoints

PURPOSE

The health-promoting potential of food-derived plant bioactive compounds is evident but not always consistent across studies. Large inter-individual variability may originate from differences in digestion, absorption, distribution, metabolism and excretion (ADME). ADME can be modulated by age, sex, dietary habits, microbiome composition, genetic variation, drug exposure and many other factors. Within the recent COST Action POSITIVe, large-scale literature surveys were undertaken to identify the reasons and extent of inter-individual variability in ADME of selected plant bioactive compounds of importance to cardiometabolic health. The aim of the present review is to summarize the findings and suggest a framework for future studies designed to investigate the etiology of inter-individual variability in plant bioactive ADME and bioefficacy.

RESULTS

Few studies have reported individual data on the ADME of bioactive compounds and on determinants such as age, diet, lifestyle, health status and medication, thereby limiting a mechanistic understanding of the main drivers of variation in ADME processes observed across individuals. Metabolomics represent crucial techniques to decipher inter-individual variability and to stratify individuals according to metabotypes reflecting the intrinsic capacity to absorb and metabolize bioactive compounds.

CONCLUSION

A methodological framework was developed to decipher how the contribution from genetic variants or microbiome variants to ADME of bioactive compounds can be predicted. Future study design should include (1) a larger number of study participants, (2) individual and full profiling of all possible determinants of internal exposure, (3) the presentation of individual ADME data and (4) incorporation of omics platforms, such as genomics, microbiomics and metabolomics in ADME and efficacy studies.

Barriers and Facilitators of Fruit and Vegetable Consumption in Renal Transplant Recipients, Family Members and Healthcare Professionals-A Focus Group Study

Low fruit and vegetable consumption is associated with poor outcomes after renal transplantation. Insufficient fruit and vegetable consumption is reported in the majority of renal transplant recipients (RTR). The aim of this study was to identify barriers and facilitators of fruit and vegetable consumption after renal transplantation and explore if certain barriers and facilitators were transplant-related. After purposive sampling, RTR (n = 19), their family members (n = 15) and healthcare professionals (n = 5) from a Dutch transplant center participated in seven focus group discussions (three each for RTR and family members, one with healthcare professionals). Transcripts were analyzed using social cognitive theory as conceptual framework and content analysis was used for identification of themes. Transplant-related barriers and facilitators were described separately. In categorizing barriers and facilitators, four transplant-related themes were identified: transition in diet (accompanied by, e.g., fear or difficulties with new routine), physical health (e.g., recovery of uremic symptoms), medication (e.g., cravings by prednisolone) and competing priorities after transplantation (e.g., social participation activities). Among the generic personal and environmental barriers and facilitators, food literacy and social support were most relevant. In conclusion, transplant-related and generic barriers and facilitators were identified for fruit and vegetable consumption in RTR. The barriers that accompany the dietary transition after renal transplantation may contribute to the generally poorer fruit and vegetable consumption of RTR. These findings can be used for the development of additional nutritional counseling strategies in renal transplant care.

Effect of dietary fat and sucrose consumption on cardiac fibrosis in mice and rhesus monkeys

Calorie restriction (CR) improved health span in 2 longitudinal studies in nonhuman primates (NHPs), yet only the University of Wisconsin (UW) study demonstrated an increase in survival in CR monkeys relative to controls; the National Institute on Aging (NIA) study did not. Here, analysis of left ventricle samples showed that CR did not reduce cardiac fibrosis relative to controls. However, there was a 5.9-fold increase of total fibrosis in UW hearts, compared with NIA hearts. Diet composition was a prominent difference between the studies; therefore, we used the NHP diets to characterize diet-associated molecular and functional changes in the hearts of mice. Consistent with the findings from the NHP samples, mice fed a UW or a modified NIA diet with increased sucrose and fat developed greater cardiac fibrosis compared with mice fed the NIA diet, and transcriptomics analysis revealed diet-induced activation of myocardial oxidative phosphorylation and cardiac muscle contraction pathways.

Skeletal Muscle Mitochondrial Respiration Is Elevated in Female Cynomolgus Macaques Fed a Western Compared with a Mediterranean Diet

BACKGROUND

Western diets are associated with increased incidences of obesity, hypertension, diabetes, and hypercholesterolemia, whereas Mediterranean diets, richer in polyphenols, monounsaturated fats, fruits, vegetables, poultry, and fish, appear to have cardiometabolic health benefits. Previous work has included population-based studies with limited evidence for causation or animal studies focused on single macro- or micronutrients; therefore, primate animal models provide an opportunity to determine potential mechanisms underlying the effects of dietary patterns on health and disease.

OBJECTIVE

The aim of this study was to determine the effects of whole dietary patterns, either a Western or Mediterranean diet, on skeletal muscle mitochondrial bioenergetics in cynomolgus macaques.

METHODS

In this study, 22 adult female cynomolgus macaques (∼11-14 y by dentition) were fed either a Western or Mediterranean diet for 30 mo. The Western diet was designed to mimic the diet of a middle-aged American woman and the Mediterranean diet included key aspects of Mediterranean diets studied in humans, such as plant-based proteins and fat, complex carbohydrates, and fiber. Diets were matched on macronutrient composition (16% protein, 54% carbohydrate, and 31% fat) and cholesterol content. Skeletal muscle was collected for high-resolution respirometry, citrate synthase activity, and western blot measurements. Pearson correlation analysis between respirometry measures and measures of carbohydrate metabolism was also performed.

RESULTS

We found that consumption of a Western diet resulted in significantly higher mitochondrial respiration with fatty acid oxidation (FAO) (53%), FAO + complex I (52%), complex I + II (31%), max electron transport system (ETS) (31%), and ETS rotenone sensitive (31%) than did consumption of a Mediterranean diet. In addition, measures of respiration in response to fatty acids were significantly and positively correlated with both insulin resistance and plasma insulin concentrations.

CONCLUSIONS

This study highlights the importance of dietary composition in mitochondrial bioenergetics and that diet can influence skeletal muscle mitochondrial respiration independently of other factors such as macronutrient composition.

Analysis of dietary patterns and cross-sectional and longitudinal associations with hypertension, high BMI and type 2 diabetes in Peru

OBJECTIVE

To determine if specific dietary patterns are associated with risk of hypertension, type 2 diabetes mellitus (T2DM) and high BMI in four sites in Peru.

DESIGN

We analysed dietary patterns from a cohort of Peruvian adults in four geographical settings using latent class analysis. Associations with prevalence and incidence of hypertension, T2DM and high BMI were assessed using Poisson regression and generalised linear models, adjusted for potential confounders.

SETTING

Four sites in Peru varying in degree of urbanisation.

PARTICIPANTS

Adults aged ≥35 years (n 3280).

RESULTS

We identified four distinct dietary patterns corresponding to different stages of the Peruvian nutrition transition, reflected by the foods frequently consumed in each pattern. Participants consuming the 'stage 3' diet, characterised by high proportional consumption of processed foods, animal products and low consumption of vegetables, mostly consumed in the semi-urban setting, showed the highest prevalence of all health outcomes (hypertension 32·1 %; T2DM 10·7 %; high BMI 75·1 %). Those with a more traditional 'stage 1' diet characterised by potato and vegetables, mostly consumed in the rural setting, had lower prevalence of hypertension (prevalence ratio; 95 CI: 0·57; 0·43, 0·75), T2DM (0·36; 0·16, 0·86) and high BMI (0·55; 0·48, 0·63) compared with the 'stage 3' diet. Incidence of hypertension was highest among individuals consuming the 'stage 3' diet (63·75 per 1000 person-years; 95 % CI 52·40, 77·55).

CONCLUSIONS

The study found more traditional diets were associated with a lower prevalence of three common chronic diseases, while prevalence of these diseases was higher with a diet high in processed foods and low in vegetables.

Lipid findings from the Diabetes Education to Lower Insulin, Sugars, and Hunger (DELISH) Study

Background

A carbohydrate-restricted (CR) diet can improve glycemic control in people with type 2 diabetes mellitus (T2DM). There are concerns, however, that the high dietary fat content of CR diets can increase low-density lipoprotein cholesterol (LDL-C), thus increasing cardiovascular disease (CVD) risk. Quantifying CVD risk associated with changes in LDL-C in the context of CR diets is complicated by the fact that LDL-C reflects heterogeneous lipids. For example, small LDL particle number (sLDL-P) is more closely associated with CVD risk than is total LDL-C, and CR diets tend to decrease the proportion of sLDL-C in LDL-C, which standard lipid measures do not indicate. Advanced lipoprotein assays, such as nuclear magnetic resonance (NMR) testing, can subfractionate lipoproteins by size and density and may better depict the effects of CR diets on CVD risk.

Methods

Adults (N = 58) with T2DM (n = 37 women; baseline HbA1c ≥ 6.5%) completed a 6-month group-based CR diet intervention. We obtained a standard lipid panel, advanced lipoprotein assays (NMR testing), and two 24-h diet recalls at baseline and post-intervention (6 months). Participants also completed home-based blood ketone testing (a biological index of dietary adherence) during the final five weeks of the intervention.

Results

From baseline to post-intervention, participants had increased mean HDL-C, decreased triglycerides and triglyceride/HDL ratio, decreased mean sLDL-P, and increased LDL size, which reflect reductions in CVD risk (ps < 0.05). Participants did not have statistically significant changes in total cholesterol, non-HDL-C cholesterol, LDL-P, or HDL-P. Twelve participants (23.1%) had a ≥ 5% increase in sLDL-P. Exploratory analyses revealed that participants with sLDL-P increases of ≥ 5% reported larger increases in servings of red meat than participants without sLDL-P increases of ≥ 5% (+ 0.69 vs − 0.29 servings; p = 0.033). Changes in saturated fat intake were not associated with changes in sLDL-P.

Conclusions

Among most participants, we observed changes in several lipid measures consistent with decreased CVD risk. Approximately one in four participants evidenced increases in sLDL-P. Further research should clarify whether individuals with increased sLDL-P after implementing a CR diet can reverse observed increases by limiting red meat consumption.

Trial registration

ClinicalTrials.gov, NCT03207711, Registered 6/11/2017. Retrospectively registered.

Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease: Mechanisms and Therapeutic Implications

New evidence suggests that non-alcoholic fatty liver disease (NAFLD) has a strong multifaceted relationship with diabetes and metabolic syndrome, and is associated with increased risk of cardiovascular events, regardless of traditional risk factors, such as hypertension, diabetes, dyslipidemia, and obesity. Given the pandemic-level rise of NAFLD—in parallel with the increasing prevalence of obesity and other components of the metabolic syndrome—and its association with poor cardiovascular outcomes, the question of how to manage NAFLD properly, in order to reduce the burden of associated incident cardiovascular events, is both timely and highly relevant. This review aims to summarize the current knowledge of the association between NAFLD and cardiovascular disease, and also to discuss possible clinical strategies for cardiovascular risk assessment, as well as the spectrum of available therapeutic strategies for the prevention and treatment of NAFLD and its downstream events.

Association of dietary patterns and risk of cardiovascular disease events in the MASHAD cohort study

BACKGROUND

Cardiovascular disease (CVD) is the principal cause of mortality and disability in Iranian adults. We aimed to evaluate the relationship between dietary patterns and CVD incidence in a large sample of adults in northeastern Iran.

METHODS

The present study comprised a prospective study of 5706 CVD-free men and women aged 35-65 years who participated in a cohort study. All of the participants were followed up for a 6-year period. Dietary patterns were derived from a 65-item validated food frequency questionnaire and the factor analysis method was used to determine dietary patterns.

RESULTS

We identified two major dietary patterns: (i) a Balanced dietary pattern (a high intake of green leafy vegetables, other vegetables, fruits, dairy products, red meats, poultry, seafoods, legumes and nuts, as well as a low intake of sugar) and (ii) a Western dietary pattern (a high intake of sugar, tea, egg, snacks, fast foods, potato, carbonated beverages, pickled foods, organs meat and butter) by factor analysis. The hazard ratio (HR) and 95% confidence intervals (CIs) of total CVD in the highest versus lowest tertiles of the Balanced pattern were 1.29 (95% CI = 0.67-2.47; P = 0.44). The HR and 95% CIs of CVD in the highest versus lowest tertiles of Western pattern were 2.21 (95% CI = 1.08-4.45; P = 0.03).

CONCLUSIONS

During the 6-year follow-up, we found that adherence to a Balanced dietary pattern was not significantly associated with CVD events. However, adherence to a Western dietary pattern was associated with a significantly increased risk of CVD events and its associated risk.

Pretreatment Dietary Patterns Are Associated with the Presence of Nutrition Impact Symptoms 1 Year after Diagnosis in Patients with Head and Neck Cancer

BACKGROUND

Dietary inflammatory potential could impact the presence and severity of chronic adverse treatment effects among patients with head and neck cancer. The objective of this study was to determine whether pretreatment dietary patterns are associated with nutrition impact symptoms (NIS) as self-reported 1 year after diagnosis.

METHODS

This was a longitudinal study of 336 patients with newly diagnosed head and neck cancer enrolled in the University of Michigan Head and Neck Specialized Program of Research Excellence. Principal component analysis was utilized to derive pretreatment dietary patterns from food frequency questionnaire data. Burden of seven NIS was self-reported 1 year after diagnosis. Associations between pretreatment dietary patterns and individual symptoms and a composite NIS summary score were examined with multivariable logistic regression models.

RESULTS

The two dietary patterns that emerged were prudent and Western. After adjusting for age, smoking status, body mass index, tumor site, cancer stage, calories, and human papillomavirus status, significant inverse associations were observed between the prudent pattern and difficulty chewing [OR 0.44; 95% confidence interval (CI), 0.21-0.93; P = 0.03], dysphagia of liquids (OR 0.38; 95% CI, 0.18-0.79; P = 0.009), dysphagia of solid foods (OR 0.46; 95% CI, 0.22-0.96; P = 0.03), mucositis (OR 0.48; 95% CI, 0.24-0.96; P = 0.03), and the NIS summary score (OR 0.45; 95% CI, 0.22-0.94; P = 0.03). No significant associations were observed between the Western pattern and NIS.

CONCLUSIONS

Consumption of a prudent diet before treatment may help reduce the risk of chronic NIS burden among head and neck cancer survivors.

IMPACT

Dietary interventions are needed to test whether consumption of a prudent dietary pattern before and during head and neck cancer treatment results in reduced NIS burden.

Visceral fat reduction is positively associated with blood pressure reduction in overweight or obese males but not females: an observational study

BACKGROUND

Visceral adiposity has been reported to play a key role in hypertension compared with other measurements of regional or general obesity. The aim of current study was to evaluate the relationship between visceral fat reduction and changes in blood pressure in a group of overweight or obese Chinese individuals.

METHODS

An observational study was conducted with 168 participants (ChiCTR-OOC-17012000). Body composition, blood parameters and blood pressure were assessed at the beginning and end of the intervention. Males and females were categorized separately into quartiles according to changes in visceral fat during the intervention. Multiple linear regression models were used to assess the associations of changes in systolic and diastolic blood pressure with changes of visceral fat area, adjusted for potential confounders.

RESULTS

Changes in visceral fat was significantly associated with systolic and diastolic blood pressure in men for systolic (β = 0.234, 95% CI: 0.103, 0.365; p = 0.001) and diastolic blood pressure (β = 0.237; 95% CI: 0.127, 0.346; p <0.001), but not in women after adjustment for the same potential confounders for systolic blood (β = - 0.003, 95% CI: - 0.260, 0.255; p = 0.984) and diastolic blood pressure (β = 0.101, 95% CI: - 0.072, 0.273; p = 0.249).

CONCLUSIONS

A positive association was observed between reduction in visceral fat and improvements in both systolic blood and diastolic blood pressures in males but not females in a 12-week meal replacement intervention.

TRIAL REGISTRATION

The Ethics Committee of Peking University Health Science Center approved the study protocol on 6 July 2017. The authors confirm that all ongoing and related trials for this intervention were carried out following the rules of the Declaration of Helsinki of 1975 and registered (ChiCTR-OOC-17012000). http://www.chictr.org.cn/showprojen.aspx?proj=20426.

Healthy dietary patterns and risk and survival of breast cancer: a meta-analysis of cohort studies

PURPOSES

Dietary patterns have been found to be associated with the overall cancer risk and survival. However, the associations of healthy dietary patterns and breast cancer remain unclear. We aimed to conduct a meta-analysis of prospective cohort studies to estimate the pooled results of the association of healthy dietary patterns with breast cancer risk and survival.

METHODS

PubMed, EMBASE, and Web of Science were searched for literature published until June 24th, 2018 that examined the associations between healthy dietary patterns and breast cancer risk and survival. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated by using a random-effects model for meta-analysis.

RESULTS

There were 32 articles retrieved for the meta-analysis, with 27 for breast cancer risk and five for breast cancer survival. There was a statistically significant lower risk of breast cancer associated with healthy dietary patterns (RR = 0.93, 95% CI: 0.88, 0.98). Subgroup analysis results suggested that there was an inverse association between breast cancer risk and posterori-derived healthy patterns, but no statistically significant associations were found in other stratified subgroups (a priori-derived diet, study region, menopausal status, or breast cancer subtypes). Healthy dietary patterns were associated inversely with all-cause mortality (RR = 0.76, 95% CI: 0.63, 0.92); however, no association was found for breast cancer-specific mortality.

CONCLUSIONS

The results suggested that healthy dietary patterns might be associated with a reduced risk of breast cancer and all-cause mortality among breast cancer patients. It could be clinically relevant to promote healthy dietary patterns for breast cancer prevention and improve survival among breast cancer patients.

The influence of maternal and infant nutrition on cardiometabolic traits: novel findings and future research directions from four Canadian birth cohort studies

A mother's nutritional choices while pregnant may have a great influence on her baby's development in the womb and during infancy. There is evidence that what a mother eats during pregnancy interacts with her genes to affect her child's susceptibility to poor health outcomes including childhood obesity, pre-diabetes, allergy and asthma. Furthermore, after what an infant eats can change his or her intestinal bacteria, which can further influence the development of these poor outcomes. In the present paper, we review the importance of birth cohorts, the formation and early findings from a multi-ethnic birth cohort alliance in Canada and summarise our future research directions for this birth cohort alliance. We summarise a method for harmonising collection and analysis of self-reported dietary data across multiple cohorts and provide examples of how this birth cohort alliance has contributed to our understanding of gestational diabetes risk; ethnic and diet-influences differences in the healthy infant microbiome; and the interplay between diet, ethnicity and birth weight. Ongoing work in this birth cohort alliance will focus on the use of metabolomic profiling to measure dietary intake, discovery of unique diet-gene and diet-epigenome interactions, and qualitative interviews with families of children at risk of metabolic syndrome. Our findings to-date and future areas of research will advance the evidence base that informs dietary guidelines in pregnancy, infancy and childhood, and will be relevant to diverse and high-risk populations of Canada and other high-income countries.

Plasma marine n-3 polyunsaturated fatty acids and cardiovascular risk factors: data from the ACE 1950 study

PURPOSE

A high intake of marine n-3 polyunsaturated fatty acids (PUFAs) might improve cardiovascular (CV) health. We conducted a cross-sectional study to investigate associations between plasma phospholipid levels of marine n-3 PUFAs and CV risk factors, educational level, physical activity and smoking habits.

METHODS

A total of 3706 individuals from a general population, all born in 1950 and residing in Akershus County, Norway, were included in this study. The main statistical approach was multivariable adjusted linear regression.

RESULTS

Plasma marine n-3 PUFA levels ranged from 2.7 to 20.3 wt%, with a median level of 7.7 wt% (interquartile range 4.3-11.1 wt%). High levels of plasma marine n-3 PUFAs were associated with lower serum triglycerides [Standardized regression coefficient (Std.β-coeff.) - 0.14, p < 0.001], body mass index (Std. β-coeff. -0.08, p < 0.001), serum creatinine (Std. β-coeff. -0.03, p = 0.05), C-reactive protein levels (Std. β-coeff. - 0.03, p = 0.04), higher levels of serum high-density lipoprotein cholesterol (Std. β-coeff. 0.08, p < 0.001) and low-density lipoprotein cholesterol (Std. β-coeff. 0.04, p = 0.003). High levels of plasma marine n-3 PUFAs were also associated with lower glycated hemoglobin (Std. β-coeff. - 0.04, p = 0.01), however, only in individuals without diabetes. We found no associations between plasma marine n-3 PUFA levels and fasting plasma glucose or carotid intima-media thickness. High levels of plasma marine n-3 PUFAs were associated with higher educational level, more physical activity and lower prevalence of smoking.

CONCLUSION

In this cross-sectional study of Norwegian individuals born in 1950, high levels of plasma marine n-3 PUFAs were favourably associated with several CV risk factors, suggesting that fish consumption might improve CV health.

Global sustainability (health, environment and monetary costs) of three dietary patterns: results from a Spanish cohort (the SUN project)

OBJECTIVE

To evaluate the sustainability of the dietary patterns, according to their effects on health and environment and their affordability.

DESIGN

Prospective, ongoing cohort study of university graduates.

SETTINGS

The Spanish SUN project (Seguimiento Universidad de Navarra, University of Navarra Follow-up), starting from 1999.

PARTICIPANTS

A total of 18 429 participants.

METHODS

Information from participants is collected every 2 years by validated questionnaires. We assessed three dietary patterns (the Mediterranean, the Western and the Provegetarian dietary patterns). The rate advancement period (RAP) was used to assess the healthiness of each pattern (considering the composite endpoint of all-cause mortality, cardiovascular disease, breast cancer or type 2 diabetes). We also assessed environmental footprints and monetary costs of each dietary pattern.

RESULTS

After a median follow-up of 10.1 years, we identified 469 incident cases of the composite endpoint. The Mediterranean dietary pattern exhibited the best RAP (3.10 years gained [95% CI 4.35 to 1.85] for the highest vs the lowest quartile), while the Western pattern was the unhealthiest pattern (1.33 years lost when comparing extreme quartiles). In a scale between 4 and 16 of harmful environmental effects (the lower, the more environmentally friendly), the Provegetarian pattern scored best (8.82 [95% CI 8.75 to 8.88] when comparing extreme quartiles), whereas the Western pattern was the most detrimental pattern (10.80 [95% CI 10.72 to 10.87]). Regarding monetary costs, the Western pattern was the most affordable pattern (€5.87/day [95% CI 5.82 to 5.93], for the upper quartile), while the Mediterranean pattern was the most expensive pattern (€7.52/day [95% CI 7.47 to 7.56]). The Mediterranean dietary pattern was the most overall sustainable option, closely followed by the Provegetarian pattern. The least overall sustainable pattern was the Western dietary pattern.

CONCLUSION

Following plant-based diets, like the Mediterranean or Provegetarian dietary patterns, could be a good option in order to achieve an overall sustainable diet.

TRIAL REGISTRATION NUMBER

NCT02669602; Results.

Comparison of the gut microbiota of obese individuals from different geographic origins

Few studies have examined the interaction of human geography, microbial community structure and obesity. We tested obese adult volunteers from France, Saudi Arabia, French Polynesia and from a traditional population in the village of Trois-Sauts in French Guiana by sequencing the V3-V4 region. We also sequenced homemade fermented cachiri beers that were obtained from the traditional Amazonian population and are highly consumed by this population. We found that French and Saudis had significantly less richness and biodiversity in their gut microbiota than Amazonians and Polynesians (p <0.05). Principle coordinate analysis of the overall composition of the genera communities revealed that the microbiomes of Amazonians clustered independently from the other obese individuals. Moreover, we found that Amazonians presented significantly stricter anaerobic genera than the Saudis, French and Polynesians (p < 0.001). Polynesians presented significantly lower relative abundance of Lactobacillus sp. than French (p 0.01) and Saudis (p 0.05). Treponema berlinense and Treponema succinifaciens were only present in the gut microbiome of Amazonians. The cachiri beers presented significantly more bacterial species in common with the gut microbiome of Amazonians (p < 0.005). Obese individuals with different origins present modifications in their gut microbiota, and we provide evidence that the cachiri beers influenced the gut microbiome of Amazonians.

DIETARY PATTERNS AND THEIR ASSOCIATION WITH OBESITY: A CROSS-SECTIONAL STUDY

Context

Scarce data on dietary habits in Eastern European countries is available and reports investigated individual food items and not dietary patterns in these populations.

Objective

To identify dietary patterns and to explore their association with obesity in a sample from Romanian population.

Design

Cross-sectional.

Subjects and Methods

This was an analysis of data collected from 1398 adult participants in ORO study. Data on lifestyle, eating habits and food frequency consumption were collected.

Results

By principal component analysis we identified 3 dietary patterns explaining 31.4% of the diet variation: High meat/High fat pattern, Western pattern and Prudent pattern. High meat/High fat pattern was associated with male gender, lower educational level, living in a rural, smoking and a higher probability for the presence of obesity (OR 1.2 [95%CI: 1.1-1.4]). Western pattern was associated with younger age, a higher level of physical activity and smoking. Prudent pattern was associated with older age, female gender, a higher level of physical activity, not smoking status and a lower probability for the presence of obesity (OR 0.8 [95%CI: 0.7-0.9]).

Conclusions

This study provides for the first-time information on the association between dietary patterns in adults from an Eastern European country and the presence of obesity.

Development of the Metabolic Syndrome: Study Design and Baseline Data of the Lufthansa Prevention Study (LUPS), A Prospective Observational Cohort Survey

The Lufthansa Prevention Study (LUPS) study is a prospective observation of a healthy worker cohort to identify early changes in metabolism leading to the Metabolic Syndrome (MetS) and to analyze their relation to behavioral factors like nutrition, physical activity, psychological status, and to underlying genetic conditions. The LUPS study recruited a sample of 1.962 non-diabetic healthy adults between 25-60 years, employed at a flight base of Lufthansa Technik GmbH in Hamburg, Germany. Baseline assessments included anthropometric measures, blood and urine samples and medical history. Psychosocial variables, dietary habits and life-style risk factors were assessed via self-reported questionnaires.In this report we describe the study design and present baseline parameters including the prevalence of the MetS using different classification criteria. The MetS was present in 20% of male and 12% of female subjects according to the 'Harmonizing the metabolic syndrome' definition. The prevalence varies between 2.6% in male and 2.3% in female subjects up to 48% in male and 41% in female subjects according to different classification criteria of MetS.In conclusion, this first cross-sectional view on the LUPS data confirms the expectation that this cohort is rather healthy and thus provides the opportunity to analyze early changes associated with the development of the MetS. The LUPS study is registered as a clinical trial NCT01313156.

Capsaicin is beneficial to hyperlipidemia, oxidative stress, endothelial dysfunction, and atherosclerosis in Guinea pigs fed on a high-fat diet

Capsaicin has anti-inflammatory and antioxidant effects, as well as some benefits on the cardiovascular system. The exact effects of capsaicin on atherosclerosis are poorly understood. To investigate the effects of capsaicin on hyperlipidemia and atherosclerosis in guinea pigs fed on a high-fat diet, as well as its potential mechanisms. Guinea pigs (n = 48) were randomly divided into six groups (n = 8/group): normal diet (control); high fat diet (model); model + low-dose capsaicin (2.5 mg/kg); model + moderate-dose capsaicin (5 mg/kg); model + high-dose capsaicin (10 mg/kg), and model + simvastatin (1.5 mg/kg) (positive control). After 14 weeks, serum lipids, apolipoprotein B100, malondialdehyde (MDA), superoxide dismutase (SOD), nitric oxide (NO), and endothelin-1 were measured. Aortic atherosclerotic lesions were histologically examined. eNOS and iNOS were assessed by immunohistochemistry. The model group developed severe dyslipidemia and associated histologic changes and endothelial dysfunction. All doses of capsaicin decreased total cholesterol, triglycerides, low-density lipoprotein cholesterol, and apolipoprotein B-100, and increased high-density lipoprotein cholesterol (all P < 0.05). Capsaicin alleviated the plaque area (-17.9-70.5%), plaque area to intima ratio (-18.0-73.6%), and intima thickness (-20.5-83.6%) (all P < 0.05). Capsaicin decreased MDA (-45.5-76.1%), ET-1 (-19.6-51.6%), and average gray value (AGV) of eNOS (-10.9-48.8%), and increased SOD activity (+31.7-76.1%), NO (+11.2-36.8%), and AGV of iNOS (+6.8-+93.0%) (all P < 0.05). Similar changes were observed with simvastatin. Capsaicin is beneficial to hyperlipidemia and atherosclerosis in guinea pigs fed on a high-fat diet. Reduced oxidative stress and endothelial dysfunction were involved in these benefits. This could represent a novel approach to prevent cardiovascular diseases.

Family History of Premature Coronary Artery Disease (P-CAD)-A Non-Modifiable Risk Factor? Dietary Patterns of Young Healthy Offspring of P-CAD Patients: A Case-Control Study (MAGNETIC Project)

Dietary habits of healthy offspring with a positive family history of premature coronary artery disease (P-CAD) have not been studied so far. The aim of this study was twofold: (1) to identify dietary patterns in a sample of young healthy adults with (cases) and without (controls) family history of P-CAD, and (2) to study the association between dietary patterns and family history of P-CAD. The data came from the MAGNETIC case-control study. The participants were healthy adults aged 18⁻35 years old, with (n = 351) and without a family history of P-CAD (n = 338). Dietary data were collected with food frequency questionnaire FFQ-6. Dietary patterns (DP) were derived using principal component analysis (PCA). The associations between the adherence to DPs and family history of P-CAD were investigated using logistic regression. Two models were created: crude and adjusted for age, sex, smoking status, place of residence, financial situation, education, and physical activity at leisure time. Three DPs were identified: 'prudent', 'westernized traditional' and 'dairy, breakfast cereals, and treats'. In both crude and adjusted models, subjects with family history of P-CAD showed higher adherence by 31% and 25% to 'westernized traditional' DP (odds ratio (OR) 1.31, 95% confidence interval (95% CI): 1.12⁻1.53; p < 0.005; per 1 unit of standard deviation (SD) of DP score and adjOR 1.25, 95% CI: 1.06⁻1.48; p = 0.007; per 1 unit of SD of DP score, respectively). Young healthy adults with family history of P-CAD present unfavorable dietary patterns and are potentially a target group for CAD primary prevention programs.

Relative validity and reproducibility of dietary quality scores from a short diet screener in a multi-ethnic Asian population

Objective

Short screeners for assessing dietary quality are lacking in Asia. We recently developed a short thirty-seven-item diet screener (DS). The present study aimed to evaluate reproducibility and relative validity of the DS in assessing a priori dietary quality indices (DQI; i.e. the Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean Diet (aMed) and Dietary Approaches to Stop Hypertension (DASH) diet) and intakes of selected foods.

Design

DS administration and biomarker measurement took place twice within a 4-month interval. A 163-item FFQ was administered one month after the second DS administration.

Setting

Singapore, a multi-ethnic urban Asian country.

Subjects

Singapore residents (n 161) aged 18–79 years, of Chinese, Malay and Indian ethnicity.

Results

Reproducibility coefficients for the two DS were 0·71 (DQI) and 0·65 (food groups). Correlations (ρ) between mean DS and FFQ DQI scores were 0·51 (AHEI-2010), 0·50 (aMed) and 0·61 (DASH; all P<0·05). Cohen’s weighted kappa indicated moderate agreement between the two measures (κw=0·48–0·58). DS DQI scores were associated with concentrations of β-cryptoxanthin (AHEI-2010, ρ=0·26; P<0·05), odd-chain SFA (aMed, ρ=0·24; DASH, ρ=0·25; both P<0·05), and enterolactone, total carotenoids, PUFA and α-linolenic acid (all scores, ρ=0·17–0·30; all P<0·05). Scores were not associated with isoflavone or long-chain n-3 PUFA concentrations.

Conclusions

A short screener can be used to assess DQI with good reproducibility and relative validity compared with a longer FFQ in an Asian population.

Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All-Cause Mortality in the REGARDS Study

BACKGROUND

Previously, we reported on associations between dietary patterns and incident acute coronary heart disease (CHD) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Here, we investigated the associations of dietary patterns and a dietary index with recurrent CHD events and all-cause mortality in REGARDS participants with existing CHD.

METHODS AND RESULTS

We included data from 3562 participants with existing CHD in REGARDS. We used Cox proportional hazards regression to examine the hazard of first recurrence of CHD events-definite or probable MI or acute CHD death-and all-cause mortality associated with quartiles of empirically derived dietary patterns (convenience, plant-based, sweets, Southern, and alcohol and salads) and the Mediterranean diet score. Over a median 7.1 years (interquartile range, 4.4, 8.9 years) follow-up, there were 581 recurrent CHD events and 1098 deaths. In multivariable-adjusted models, the Mediterranean diet score was inversely associated with the hazard of recurrent CHD events (hazard ratio for highest score versus lowest score, 0.78; 95% confidence interval, 0.62-0.98; PTrend=0.036). The Southern dietary pattern was adversely associated with the hazard of all-cause mortality (hazard ratio for Q4 versus Q1, 1.57; 95% confidence interval, 1.28-1.91; PTrend<0.001). The Mediterranean diet score was inversely associated with the hazard of all-cause mortality (hazard ratio for highest score versus lowest score, 0.80; 95% confidence interval, 0.67-0.95; PTrend=0.014).

CONCLUSIONS

The Southern dietary pattern was associated with a greater hazard of all-cause mortality in REGARDS participants. Greater adherence to the Mediterranean diet was associated with both a lower hazard of recurrent CHD events and all-cause mortality.

Breakfast patterns and their association with body mass index in Brazilian adults

The objective was to investigate the relationships between body mass index (BMI), skipping breakfast, and breakfast patterns in Brazilian adults. We analyzed data of 21,003 individuals aged between 20 to 59 from the Brazilian National Dietary Survey 2008-2009. Breakfast was defined as the eating occasion between 5 and 10a.m. with the highest usual food consumption (exceeding 50Kcal/209.2kJ). Dietary patterns were derived by the factor analysis of 18 food groups (usual intake). Controlling for confounders linear regressions of BMI were used to verify the associations considering the survey design. Skipping breakfast was not associated with BMI. Three breakfast patterns were observed (48% variability): Brazilian Northern (positive loading for meats, preparations with corn, eggs, tubers/roots/potatoes, dairy products, savory snacks/crackers, fruit juices/fruit drinks/soy-based drinks); Western (positive for fruit juices/fruit drinks/soy-based drinks, sandwiches/pizza, baked/deep-fried snacks, chocolate/desserts, cakes/cookies) and Brazilian Southeastern (cold cut meat, milk, cheese, coffee/tea, bread). The Brazilian Southeastern pattern was inversely associated with BMI, while the Brazilian Northern pattern was directly associated with it. Therefore, the results suggest a role for breakfast quality in the association with BMI. Thus, a Brazilian Southeastern breakfast usual intake may be inversely associated with BMI.

Regard sur l'expérience de vivre avec le cancer : Le cancer comme occasion de changement chez des personnes âgées de 60 à 73 ans

ABSTRACTIt is possible for individuals with a diagnosis of cancer to see the illness as an opportunity to change and to make certain decisions that could improve their chances of recovery. We aimed, through qualitative research, to understand the experience of cancer in older adults through new behaviors and habits, intentions to change and maintenance of old behaviors and habits in the context of the disease. Our participants were 10 people aged 60 to 73 with a diagnosis of cancer. The majority of participants expressed intentions to change or adopted new behaviors or habits. Relatives had very little influence on participant's choices and participants did not seek information on cancer or ways to contribute to healing. However, they were very receptive to the recommendations made by physicians.

A high omega-3 fatty acid diet rapidly changes the lipid composition of cardiac tissue and results in cardioprotection

The present study was designed to ascertain the effects of 3 diets with different omega-3/6 fatty acid ratios on infarct size and the modifications that these diets induce in the lipid composition of cardiac tissue. Sprague-Dawley rats were fed omega-3/6 fatty acid diets with 1:1, 1:5, or 1:20 ratios for at least 10 days, followed by occlusion of the left anterior descending artery for 40 min and 24 h of reperfusion. Infarct size was significantly smaller in the 1:1 group than in the other groups. Significantly higher concentrations of the omega-3 fatty acids eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid were found in the 1:1 group than in the other groups. Omega-6 polyunsaturated fatty acid levels were similar between groups, although they were higher in the 1:5 and 1:20 groups than in the 1:1 group. Margaric acid concentrations were higher in the 1:1 group than in the other groups. Docosahexaenoic acid levels in cardiac tissue and infarct size were significantly correlated with no other significant links being apparent. The present study indicated that a 1:1 omega-3/6 fatty acid ratio protected against ischemia and was associated with increased omega-3 fatty acid composition of cardiac tissue.

A comparison of statistical and machine-learning techniques in evaluating the association between dietary patterns and 10-year cardiometabolic risk (2002-2012): the ATTICA study

Statistical methods are usually applied in examining diet-disease associations, whereas factor analysis is commonly used for dietary pattern recognition. Recently, machine learning (ML) has been also proposed as an alternative technique in health classification. In this work, the predictive accuracy of statistical v. ML methodologies as regards the association of dietary patterns on CVD risk was tested. During 2001-2002, 3042 men and women (45 (sd 14) years) were enrolled in the ATTICA study. In 2011-2012, the 10-year CVD follow-up was performed among 2020 participants. Item Response Theory was applied to create a metric of combined 10-year cardiometabolic risk, the 'Cardiometabolic Health Score', that incorporated incidence of CVD, diabetes, hypertension and hypercholesterolaemia. Factor analysis was performed to extract dietary patterns, on the basis of either foods or nutrients consumed; linear regression analysis was used to assess their association with the cardiometabolic score. Two ML techniques (k-nearest-neighbor's algorithm and random-forests decision tree) were applied to evaluate participants' health based on dietary information. Factor analysis revealed five and three factors from foods and nutrients, respectively, explaining 54 and 65 % of the total variation in intake. Nutrient and food pattern regression models showed similar accuracy in correctly classifying an individual according to the cardiometabolic risk (R 2=9·6 % and R 2=8·3 %, respectively). ML techniques were superior compared with linear regression in correct classification of the individuals according to the Health Score (accuracy approximately 38 v. 6 %, respectively), whereas the two ML methods showed equal classification ability. Conclusively, ML methods could be a valuable tool in the field of nutritional epidemiology, leading to more accurate disease-risk evaluation.

Mediators of two selective prevention interventions targeting both obesity and eating disorders

The present study tested hypothesized mechanisms underlying the effects of two selective prevention interventions targeting both obesity and eating disorders (Healthy Weight and the newly developed Project Health), relative to video control. Tests examined mediation for the significant weight gain prevention and eating disorder symptom prevention effects previously reported. College students (N = 364; 72% women) with weight concerns were randomized to condition and assessed for 2-years post-intervention. Project Health participants had significant improvements in 2 of the 7 proposed mediators relative to comparisons (i.e., cognitive dissonance, the unhealthy Western dietary pattern) but change in these variables did not mediate its effect on long-term BMI change. Two variables emerged as full mediators of the eating disorder prevention effects for both experimental interventions: body dissatisfaction and negative affect. Analyses failed to support the exploratory hypothesis that change in eating disorder symptoms mediated the effects of condition on BMI gain. This report is the among the first to examine mediation for programs aimed at preventing both weight gain and eating disorders, particularly in mixed-gender groups. Mediational analyses are essential in identifying the mechanism of intervention action, which can inform improvements to prevention programs.

Healthy Plant-Based Diets Are Associated with Lower Risk of All-Cause Mortality in US Adults

Background

Plant-based diets, often referred to as vegetarian diets, are associated with health benefits. However, the association with mortality is less clear.

Objective

We investigated associations between plant-based diet indexes and all-cause and cardiovascular disease mortality in a nationally representative sample of US adults.

Methods

Analyses were based on 11,879 participants (20-80 y of age) from NHANES III (1988-1994) linked to data on all-cause and cardiovascular disease mortality through 2011. We constructed an overall plant-based diet index (PDI), which assigns positive scores for plant foods and negative scores for animal foods, on the basis of a food-frequency questionnaire administered at baseline. We also constructed a healthful PDI (hPDI), in which only healthy plant foods received positive scores, and a less-healthful (unhealthy) PDI (uPDI), in which only less-healthful plant foods received positive scores. Cox proportional hazards models were used to estimate the association between plant-based diet consumption in 1988-1994 and subsequent mortality. We tested for effect modification by sex.

Results

In the overall sample, PDI and uPDI were not associated with all-cause or cardiovascular disease mortality after controlling for demographic characteristics, socioeconomic factors, and health behaviors. However, among those with an hPDI score above the median, a 10-unit increase in hPDI was associated with a 5% lower risk in all-cause mortality in the overall study population (HR: 0.95; 95% CI: 0.91, 0.98) and among women (HR: 0.94; 95% CI: 0.88, 0.99), but not among men (HR: 0.95; 95% CI: 0.90, 1.01). There was no effect modification by sex (P-interaction > 0.10).

Conclusions

A nonlinear association between hPDI and all-cause mortality was observed. Healthy plant-based diet scores above the median were associated with a lower risk of all-cause mortality in US adults. Future research exploring the impact of quality of plant-based diets on long-term health outcomes is necessary.

Can Nutrition Lower the Risk of Recurrence in Breast Cancer?

BACKGROUND

The impact of diet on breast cancer prognosis is poorly understood. Therefore, we conducted a literature search summarizing the current evidence on the effect of diet on breast cancer recurrence and mortality.

METHODS

The PubMed database was searched for original studies, reviews, and meta-analyses published between 2010 and 2017. Studies related to diet, dietary patterns, special diets or specific dietary factors, and breast cancer recurrence or mortality were included.

RESULTS

Adherence to high diet quality indices (relative risk (RR) 0.74, 95% confidence interval (CI) 0.60-0.90) and a prudent/healthy dietary pattern (RR 0.76, 95% CI 0.60-0.95) may have a beneficial effect on breast cancer prognosis, whereas a Western/unhealthy diet is associated with poorer overall mortality (RR 1.44, 95% CI 1.17-1.77). For low-fat diets, the findings are inconsistent. A positive effect of the Mediterranean Diet was found for all-cause mortality, but no beneficial effect from other diets such as low-carbohydrate, ketogenic or vegetarian/vegan diets was observed. Alcohol consumption was associated with an increased risk for breast cancer recurrence. No general recommendation for soy exists, but occasional intake seems to be acceptable, whereas the use of other supplements is not justified.

CONCLUSION

Adherence to high-quality diets and a prudent/healthy dietary pattern seem to be beneficial for breast cancer prognosis. No clear evidence for a benefit from special diets, soy products, or other supplements was found.

Health- and Taste-Related Attitudes Associated with Dietary Patterns in a Representative Sample of Polish Girls and Young Women: A Cross-Sectional Study (GEBaHealth Project)

Attitudes can be predictors of certain health-related behaviours. The attitudes of young females towards health and taste have not been yet fully examined and their associations with dietary behaviours remain unclear. The aim of the study was to investigate if attitudes are associated with dietary patterns in a representative sample of Polish girls. The study population consisted of 1107 girls, aged 13-21 and living in Poland. Attitudes were assessed using the Health and Taste Attitudes Scale (HTAS) and categorised as negative, neutral or positive. Dietary data was obtained using a Food Frequency Questionnaire. Dietary patterns (DPs), derived previously with a Principal Component Analysis (PCA), were 'Traditional Polish', 'Fruit and vegetables', 'Fast food and sweets' and 'Dairy and fats'. The associations between attitudes and DPs were assessed using Spearman's correlation coefficients and logistic regression. The reference group were girls with neutral attitudes. Odds ratios (ORs) were adjusted for age, socioeconomic status (SES), and body mass index (BMI). The correlations between attitudes and DPs ranged from -0.28 for attitudes towards health and 'Fast food and sweets' and 'Traditional Polish' DPs to 0.33 for attitudes towards health and the 'Fruit and vegetables' DP (p < 0.05). In the logistic regression analysis, the strongest associations within health-related HTAS subscales were observed between negative attitudes towards natural products and the 'Fast food and sweets' DP (OR: 10.93; 95% CI: 3.32-36.01) and between positive attitudes towards health and the 'Fruit and vegetables' DP (OR: 5.10; 3.11-8.37). The strongest associations within taste-related HTAS subscales were observed between positive attitudes towards craving for sweet foods and the 'Traditional Polish' DP (OR: 1.93; 1.43-2.61) and between positive attitudes towards using food as a reward and the 'Dairy and fats' DP (OR: 2.08; 1.22-3.55) as well as the 'Fast food and sweets' DP (OR: 2.07; 1.14-3.74). Positive attitudes towards health were associated with a pro-healthy dietary pattern characterised by the consumption of fruit and vegetables, while negative attitudes towards natural products as well as a strong craving for sweets and using food as a reward were associated with less healthy dietary patterns. To improve the dietary habits of girls and young women, positive attitudes towards health should be strengthened and supported by emphasizing the sensory values of pro-healthy foods.

Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association

Cardiovascular disease (CVD) remains the leading cause of mortality in women, yet many people perceive breast cancer to be the number one threat to women's health. CVD and breast cancer have several overlapping risk factors, such as obesity and smoking. Additionally, current breast cancer treatments can have a negative impact on cardiovascular health (eg, left ventricular dysfunction, accelerated CVD), and for women with pre-existing CVD, this might influence cancer treatment decisions by both the patient and the provider. Improvements in early detection and treatment of breast cancer have led to an increasing number of breast cancer survivors who are at risk of long-term cardiac complications from cancer treatments. For older women, CVD poses a greater mortality threat than breast cancer itself. This is the first scientific statement from the American Heart Association on CVD and breast cancer. This document will provide a comprehensive overview of the prevalence of these diseases, shared risk factors, the cardiotoxic effects of therapy, and the prevention and treatment of CVD in breast cancer patients.

Overall Dietary Intake and Prognosis after Breast Cancer: A Systematic Review

Breast cancer survivors often seek information about how lifestyle factors, such as diet, may influence their prognosis. Previous studies have reviewed evidence around single nutrients, individual foods or food groups. We reviewed studies examining relationships between overall dietary intake and prognosis in breast cancer survivors. A systematic search was conducted to identify studies, published until June 2016, which assessed associations between overall dietary intake (i.e., quality; score; pattern) and mortality and/or recurrence in breast cancer survivors. We identified seven eligible studies. Studies were heterogeneous regarding diet assessment timing (before/after diagnosis); mean age and menopausal status; and dietary intake measure (statistically derived/a priori defined indices). Better overall dietary intake (i.e., better quality; healthy/prudent pattern; less inflammatory diet) was associated with decreased risk of overall and non-breast cancer mortality, in most studies. Insufficient evidence is available to draw conclusions regarding breast cancer-specific survival and disease recurrence. Following breast cancer diagnosis, better overall dietary intake may independently improve overall and non-breast cancer survival. Survivors may improve prognosis by adopting more healthful dietary patterns consistent with dietary guidelines and/or prudent diet. Future adequately powered studies should consider measuring dietary intake consistently to better understand the role of diet in disease-specific outcomes.

Dietary patterns and primary liver cancer in Chinese adults: a case-control study

Introduction

Healthy dietary patterns may prevent many chronic diseases, and is emphasized by 2015 US dietary guideline, but it remains unclear which dietary patterns may be benefit to prevention of primary liver cancer (PLC).

Materials and Methods

We recruited 782 PLC cases and 1:1 age- and sex-matched controls in Guangzhou, China. Habitual dietary intake was assessed by face-to-face interview using a 79-item food frequency questionnaire, and used to explore dietary patterns by factor analysis.

Results

Three dietary patterns were identified: 1) an urban prudent dietary pattern (UPDP) characterized by high in dairy products, eggs, mushrooms, nuts and soy foods, but low in refined grains; 2) a traditional Cantonese dietary pattern (TCDP) consisting of a high intake of fruit and vegetables, fish, Cantonese soup, and Chinese herb tea; and 3) a high meat and preserved food pattern (MPFP). Multivariable analyses showed favorable associations for the first two dietary patterns, but unfavorable association for the last one (all p-trend < 0.01). Odds ratios (95% CI) of PLC for the highest (vs. lowest) quartile of pattern scores of the three patterns were 0.25 (0.18–0.35), 0.61 (0.46–0.82), and 1.98 (1.46–2.69), respectively.

Conclusions

Our findings suggest that the UPDP and TCDP were associated with lower, whereas the MPFP with higher, risk of PLC.

Dietary Patterns and Retinal Vessel Caliber in the Irish Nun Eye Study

BACKGROUND

Retinal vessel abnormalities are associated with cardiovascular disease risk. Widening of retinal venules is associated with increased risk of stroke while narrowing of retinal arterioles independently predicts incident hypertension, coronary heart disease and diabetes. Dietary factors are known to play an important role in cardiovascular health. However, few studies have examined the association between dietary patterns (DPs) and retinal microvascular health.

OBJECTIVE

To examine the association between 'a posteriori'-derived DPs and retinal vascular caliber (RVC) in older women with a restricted lifestyle.

METHODS

This was a cross-sectional study of 1233 participants (mean age: 76.3 years) from the Irish Nun Eye Study (INES). Computer-assisted software was used to measure RVC from digital eye images using standardized protocols. Dietary intake was assessed using a food frequency questionnaire (FFQ). DP analysis was performed using principal component analysis from completed FFQs. Regression models were used to assess associations between DPs and retinal vessel diameters, adjusting for age, body mass index, refraction, hypertension, diabetes mellitus, ischemic heart disease, cerebrovascular accident and fellow eye RVC.

RESULTS

Two DPs were identified: a 'healthy' pattern with high factor loadings for fruit, vegetables, wholegrains and oily fish and an 'unhealthy' pattern with high factor loadings for sugar and sweets, chips, high fat dairy products and French fries. Adjusted linear regression analysis revealed that those who adhered most closely to the unhealthy DP had wider central retinal venular equivalent (CRVE) (p=0.03) and narrower central retinal arteriolar equivalent (CRAE) (p=0.01) compared to the least unhealthy DP. No independent relationship was observed between the healthy DP and RVC.

CONCLUSION

In this cohort of older women with a restricted lifestyle, an unhealthy DP was independently associated with an unfavorable retinal profile, namely a widening of retinal venules and narrowing of retinal arterioles.

Healthy Dietary Patterns for Preventing Cardiometabolic Disease: The Role of Plant-Based Foods and Animal Products

Diets rich in plant foods are increasingly recommended to lower the risk of cardiometabolic diseases because of strong evidence that fruit, vegetables, legumes, whole grains, nuts, and seeds are protective. Although some animal products, such as unprocessed lean red meat, poultry, eggs, and dairy products, are recommended in dietary patterns to prevent cardiometabolic diseases, many health professionals advocate for exclusively plant-based dietary patterns. The aim of this article was to review recent evidence on the relative contributions of plant-based foods and animal products to a healthy dietary pattern. Secondary aims were to discuss current consumption patterns and adherence to dietary recommendations. Epidemiologic evidence suggests that a higher intake of plant-based foods is associated with a lower risk of cardiometabolic disease, whereas a higher meat intake increases the risk of cardiometabolic disease and the replacement of small quantities of animal protein with plant protein is associated with lower risk. Randomized controlled studies show that nutrient-dense diets containing animal protein, including some unprocessed lean meats, improve cardiovascular disease risk factors. Therefore, it is likely that the consumption of animal products, at recommended amounts, in the context of a dietary pattern that meets recommendations for fruit, vegetables, whole grains, nuts, seeds, and legumes, and does not exceed recommendations for added sugar, sodium, and saturated fat, may not increase cardiometabolic risk. Currently, adherence to these recommendations is suboptimal. Therefore, rather than debating the merits of healthy dietary patterns that are exclusively plant-based or that include animal sources in recommended amounts, the focus should be on improving overall eating patterns to align with dietary guidelines. Registered Dietitian/Nutritionists (RDNs) have the requisite nutrition expertise to facilitate change at the individual and population levels to promote adherence to healthy dietary patterns. Importantly, advocacy activities are urgently needed to create a healthier food environment, and all health professionals, including RDNs, must play a role.