Major dietary protein sources and risk of coronary heart disease in women

Dietary Patterns Are Associated with Metabolic Outcomes among Adult Samoans in a Cross-Sectional Study

Background: The Samoan population has been undergoing a nutrition transition toward more imported and processed foods and a more sedentary lifestyle.Objectives: We aimed to identify dietary patterns in Samoa and to evaluate their associations with metabolic outcomes.Methods: The sample of this cross-sectional study includes 2774 Samoan adults recruited in 2010 (1104 with metabolic syndrome compared with 1670 without). Principal component analysis on food items from a 104-item food-frequency questionnaire was used to identify dietary patterns. Adjusted least squares means of each component of metabolic syndrome were estimated by quintiles of factor scores for each dietary pattern. Metabolic syndrome status was regressed on quintiles of scores by using log-binomial models to obtain prevalence ratios.Results: We identified a modern pattern, a mixed-traditional pattern, and a mixed-modern pattern. The modern pattern included a high intake of imported and processed foods, including pizza, cheeseburgers, margarine, sugary drinks, desserts, snacks, egg products, noodles, nuts, breads, and cakes and a low intake of traditional agricultural products and fish. The mixed-traditional pattern had a high intake of neotraditional foods, including fruits, vegetables, soup, poultry, and fish, and imported and processed foods, including dairy products, breads, and cakes. The mixed-modern pattern was loaded with imported and processed foods, including pizza, cheeseburgers, red meat, egg products, noodles, and grains, but also with neotraditional foods, such as seafood and coconut. It also included a low intake of fish, tea, coffee, soup, and traditional agricultural staples. Higher adherence to the mixed-modern pattern was associated with lower abdominal circumference (P-trend < 0.0001), lower serum triglycerides (P-trend = 0.03), and higher serum HDL cholesterol (P-trend = 0.0003). The mixed-modern pattern was inversely associated with prevalence of metabolic syndrome (the highest quintile: prevalence ratio = 0.79; 95% CI: 0.69, 0.91; P-trend = 0.006).Conclusion: Mixed dietary patterns containing healthier foods, rather than a largely imported and processed modern diet, may help prevent metabolic syndrome in Samoa.

The effect of dairy consumption on the prevention of cardiovascular diseases: A meta-analysis of prospective studies

Introduction: There is no global consensus on the relationship of dairy products with cardiovascular diseases. This study was conducted to evaluate the effect of the consumption of dairy products on cardiovascular diseases, including stroke and coronary heart disease (CHD). Methods: Important electronic databases such as the Scopus, Science Direct, and PubMed were evaluated up to September 2014. All prospective cohort studies that evaluated the relationship between dairy products consumption and cardiovascular diseases were included regardless of their publication date and language. The study participants were evaluated regardless of age, sex, and ethnicity. The STROBE checklist was used to assess quality of the study. Two investigators separately selected the studies and extracted the data. The designated effects were risk ratio (RR) and hazard ratio (HR). The random effect model was used to combine the results. Results: Meta-analysis was performed on 27 studies. There were 8648 cases of cardiovascular diseases (CVD), 11806 cases of CHD, and 29300 cases of stroke. An inverse association was found between total dairy intake and CVD (RR=0.90, 95% CI: 0.81-0.99) and stroke (RR=0.88, 95% CI: 0.82-0.95) while no association was observed between total dairy intake and CHD. The total diary intake was associated with decreased mortality of stroke (RR=0.80, 95% CI: 0.76-0.83) although it had no association with its incidence (RR=0.96, 95% CI: 0.88-1.04). Conclusion: This is the first meta-analysis of the relationship of total dairy intake with CVD. This study showed an inverse relationship between total dairy intake and CVD while no relationship was found for CHD. Considering the limited number of studies in this regard, more studies are required to investigate the effect of different factors on the association of dairy intake and CVD.

Trends in Determinants of Hypercholesterolemia among Chinese Adults between 2002 and 2012: Results from theNational Nutrition Survey

Hypercholesterolemia is a known risk factor for cardiovascular diseases and affects a high proportion of the population. This study aimed to assess and compare the determinants of hypercholesterolemia among Chinese adults aged 18 years and above, from 2002 to 2012. The study used a stratified multistage cluster sampling method to select participants. Sociodemographic and lifestyle information was collected during face-to-face interviews. Dietary intake was calculated by 3-day, 24-h dietary records in combination with weighted edible oil and condiments. Hypercholesterolemia was defined as total cholesterol above 6.22 mmol/L (240 mg/dL) from fasting blood samples. The study included 47,701 (mean age 43.0 years) and 39,870 (mean age 51.0 years) participants in 2002 and 2010–2012 surveys respectively. The weighted prevalence of hypercholesterolemia increased from 1.6% (2.1% urban, 1.0% rural) in 2002 to 6.0% (6.4% urban, 5.1% rural) in 2012. The intake of plant-based food decreased but the intake of pork increased over the 10 years. A high intake of protein and pork, alcohol drinking and overweight/obesity were positively associated with hypercholesterolemia. Neither education nor fruit and vegetable intake were associated with hypercholesterolemia. In conclusion, the burden of hypercholesterolemia increased substantially between 2002 and 2012 in China. Unhealthy lifestyle factors and change in traditional dietary pattern were positively associated with hypercholesterolemia. Further research on the role of diet in the development and prevention of hypercholesterolemia is needed.

Influence of temperate, subtropical, and tropical fruit consumption on risk of type 2 diabetes in an Asian population

Background: Findings on the relation between fruit consumption and the risk of type 2 diabetes mellitus (T2DM) have been inconsistent.Objectives: We examined whether the consumption of total, temperate, subtropical, and tropical fruit is associated with T2DM risk and whether differences in the carbohydrate quality of fruit influence T2DM risk in Asians.Design: We included 45,411 participants in the Singapore Chinese Health Study who were 45-74 y old and had no diabetes, cancer, or cardiovascular disease at recruitment (1993-1998). Fruit intake was assessed with the use of a validated food-frequency questionnaire. Physician-diagnosed incident T2DM cases were reported at follow-up 1 (1999-2004) and follow-up 2 (2006-2010) interviews. Cox proportional hazards regression was used to estimate HRs and 95% CIs of diabetes risk.Results: In 494,741 person-years of follow-up, 5207 participants developed T2DM. After adjustment for lifestyle and dietary risk factors, high total fruit consumption was not consistently associated with lower T2DM risk [men: HR of 1.33 (95% CI: 1.04, 1.71) for ≥3 servings/d compared with <1 serving/wk (P-trend = 0.17); women: HR of 0.88 (95% CI: 0.71, 1.11) (P-trend = 0.008); P-interaction = 0.003]. The direct association in men was observed for higher-glycemic index (GI) fruit [HR: 1.51 (95% CI: 1.22, 1.86) for ≥1 serving/d compared with rarely consumed; P-trend = 0.001] but not for lower or moderate GI fruit. In women, the consumption of temperate fruit, but not of subtropical or tropical fruit, was associated with lower T2DM risk [HR: 0.79 (95% CI: 0.67, 0.92) for ≥1 serving/d compared with rarely; P-trend = 0.006].Conclusions: The consumption of temperate fruit, such as apples, was associated with a lower risk of T2DM in women, whereas the consumption of higher-GI fruit, such as bananas, was associated with higher risk in men. The impact of fruit consumption on the risk of diabetes may differ by the type of fruit, which may reflect differences in the glycemic impact or phytochemical content.

Potential health hazards of eating red meat

Red meat (beef, veal, pork, lamb and mutton) consumption contributes several important nutrients to the diet, for example essential amino acids, vitamins (including B12) and minerals (including iron and zinc). Processed red meat (ham, sausages, bacon, frankfurters, salami, etc.) undergoes treatment (curing, smoking, salting or the use of chemical preservatives and additives) to improve its shelf life and/or taste. During recent decades, consumption of red meat has been increasing globally, especially in developing countries. At the same time, there has been growing evidence that high consumption of red meat, especially of processed meat, may be associated with an increased risk of several major chronic diseases. Here, a comprehensive summary is provided of the accumulated evidence based on prospective cohort studies regarding the potential adverse health effects of red meat consumption on major chronic diseases, such as diabetes, coronary heart disease, heart failure, stroke and cancer at several sites, and mortality. Risk estimates from pooled analyses and meta-analyses are presented together with recently published findings. Based on at least six cohorts, summary results for the consumption of unprocessed red meat of 100 g day^-1 varied from nonsignificant to statistically significantly increased risk (11% for stroke and for breast cancer, 15% for cardiovascular mortality, 17% for colorectal and 19% for advanced prostate cancer); for the consumption of 50 g day^-1 processed meat, the risks were statistically significantly increased for most of the studied diseases (4% for total prostate cancer, 8% for cancer mortality, 9% for breast, 18% for colorectal and 19% for pancreatic cancer, 13% for stroke, 22% for total and 24% for cardiovascular mortality and 32% for diabetes). Potential biological mechanisms underlying the observed risks and the environmental impact of red meat production are also discussed. The evidence-based integrated message is that it is plausible to conclude that high consumption of red meat, and especially processed meat, is associated with an increased risk of several major chronic diseases and preterm mortality. Production of red meat involves an environmental burden. Therefore, some European countries have already integrated these two issues, human health and the 'health of the planet', into new dietary guidelines and recommended limiting consumption of red meat.

Red Meat and Health

Despite its nutritional benefits, there is an increasing body of evidence to suggest that regular consumption of red meat may negatively impact health and disease risk, including the risk of most common chronic diseases. This chapter reviews the current evidence linking red and processed meat intakes with chronic disease, obesity and mortality risks and discusses possible mechanisms to explain these associations. Research on the health benefits of diets low in red meat, including vegetarian, vegan, Mediterranean and other plant-based diets, is also reviewed.

Dietary strategies for cardiovascular health

Cardiovascular disease is developed across a lifetime accumulation of risk. Numerous independent and synergistic cardiovascular risk factors can be induced by unhealthy dietary patterns. Epidemiological, mechanistic, clinical, and translational research point to refined sugars, processed and fatty meats, synthetic oils, and sodium as major dietary risk factors. The purpose of this review is to integrate these learnings into key principles for dietary frameworks aimed at improving overall cardiovascular health.

Nut consumption and risk of cardiovascular disease, total cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies

BACKGROUND

Although nut consumption has been associated with a reduced risk of cardiovascular disease and all-cause mortality, data on less common causes of death has not been systematically assessed. Previous reviews missed several studies and additional studies have since been published. We therefore conducted a systematic review and meta-analysis of nut consumption and risk of cardiovascular disease, total cancer, and all-cause and cause-specific mortality.

METHODS

PubMed and Embase were searched for prospective studies of nut consumption and risk of cardiovascular disease, total cancer, and all-cause and cause-specific mortality in adult populations published up to July 19, 2016. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. The burden of mortality attributable to low nut consumption was calculated for selected regions.

RESULTS

Twenty studies (29 publications) were included in the meta-analysis. The summary RRs per 28 grams/day increase in nut intake was for coronary heart disease, 0.71 (95% CI: 0.63-0.80, I2 = 47%, n = 11), stroke, 0.93 (95% CI: 0.83-1.05, I2 = 14%, n = 11), cardiovascular disease, 0.79 (95% CI: 0.70-0.88, I2 = 60%, n = 12), total cancer, 0.85 (95% CI: 0.76-0.94, I2 = 42%, n = 8), all-cause mortality, 0.78 (95% CI: 0.72-0.84, I2 = 66%, n = 15), and for mortality from respiratory disease, 0.48 (95% CI: 0.26-0.89, I2 = 61%, n = 3), diabetes, 0.61 (95% CI: 0.43-0.88, I2 = 0%, n = 4), neurodegenerative disease, 0.65 (95% CI: 0.40-1.08, I2 = 5.9%, n = 3), infectious disease, 0.25 (95% CI: 0.07-0.85, I2 = 54%, n = 2), and kidney disease, 0.27 (95% CI: 0.04-1.91, I2 = 61%, n = 2). The results were similar for tree nuts and peanuts. If the associations are causal, an estimated 4.4 million premature deaths in the America, Europe, Southeast Asia, and Western Pacific would be attributable to a nut intake below 20 grams per day in 2013.

CONCLUSIONS

Higher nut intake is associated with reduced risk of cardiovascular disease, total cancer and all-cause mortality, and mortality from respiratory disease, diabetes, and infections.

Consumption of Unprocessed and Processed Red Meat and the Risk of Chronic Obstructive Pulmonary Disease: A Prospective Cohort Study of Men

Consumption of both processed and unprocessed red meat has been associated with a higher risk of major chronic diseases. However, only processed meat consumption has been studied in relation to chronic obstructive pulmonary disease (COPD). Therefore, we endeavored to determine the association between the risk of COPD and consumption of processed and unprocessed red meat while taking into account smoking status. The population-based prospective Cohort of Swedish Men included 43,848 men who were 45-79 years of age and had no history of COPD or cancer at baseline. Meat consumption was assessed using a self-administered questionnaire in 1997. During 13.2 years of follow-up, 1,909 COPD cases were ascertained. Consumption of processed meat was associated with risk of COPD: Compared with men who consumed less than 25 g/day of processed meat, men who consumed 75 g/day or more had a multivariable-adjusted hazard ratio of 1.21 (95% confidence interval: 1.02, 1.44; P for trend = 0.03). The positive association was confined to current smokers (P for interaction = 0.003); among smokers who consumed 75 g/day or more of processed red meat, the hazard ratio was 1.26 (95% confidence interval: 1.00, 1.60) when compared with persons who consumed less than 25 g/day. Consumption of unprocessed red meat was not associated with COPD incidence. Findings from this prospective study indicate that high consumption of processed red meat is associated with an increased COPD risk among smokers.

Preclinical and Clinical Studies on Antioxidative, Antihypertensive and Cardioprotective Effect of Marine Proteins and Peptides-A Review

High seafood consumption has traditionally been linked to a reduced risk of cardiovascular diseases, mainly due to the lipid lowering effects of the long chained omega 3 fatty acids. However, fish and seafood are also excellent sources of good quality proteins and emerging documentation show that, upon digestion, these proteins are sources for bioactive peptides with documented favorable physiological effects such as antioxidative, antihypertensive and other cardioprotective effects. This documentation is mainly from in vitro studies, but also animal studies are arising. Evidence from human studies evaluating the positive health effects of marine proteins and peptides are scarce. In one study, a reduction in oxidative stress after intake of cod has been documented and a few human clinical trials have been performed evaluating the effect on blood pressure. The results are, however, inconclusive. The majority of the human clinical trials performed to investigate positive health effects of marine protein and lean fish intake, has focused on blood lipids. While some studies have documented a reduction in triglycerides after intake of lean fish, others have documented no effects.

Dairy fat and risk of cardiovascular disease in 3 cohorts of US adults

BACKGROUND

Few prospective studies have examined dairy fat in relation to cardiovascular disease (CVD).

OBJECTIVE

We aimed to evaluate the association between dairy fat and incident CVD in US adults.

DESIGN

We followed 43,652 men in the Health Professionals Follow-Up Study (1986-2010), 87,907 women in the Nurses' Health Study (1980-2012), and 90,675 women in the Nurses' Health Study II (1991-2011). Dairy fat and other fat intakes were assessed every 4 y with the use of validated food-frequency questionnaires.

RESULTS

During 5,158,337 person-years of follow-up, we documented 14,815 incident CVD cases including 8974 coronary heart disease cases (nonfatal myocardial infarction or fatal coronary disease) and 5841 stroke cases. In multivariate analyses, compared with an equivalent amount of energy from carbohydrates (excluding fruit and vegetables), dairy fat intake was not significantly related to risk of total CVD (for a 5% increase in energy from dairy fat, the RR was 1.02; 95% CI: 0.98, 1.05), coronary heart disease (RR: 1.03; 95% CI: 0.98, 1.09), or stroke (RR: 0.99; 95% CI: 0.93, 1.05) (P > 0.05 for all). In models in which we estimated the effects of exchanging different fat sources, the replacement of 5% of energy intake from dairy fat with equivalent energy intake from polyunsaturated fatty acid (PUFA) or vegetable fat was associated with 24% (RR: 0.76; 95% CI: 0.71, 0.81) and 10% (RR: 0.90; 95% CI: 0.87, 0.93) lower risk of CVD, respectively, whereas the 5% energy intake substitution of other animal fat with dairy fat was associated with 6% increased CVD risk (RR: 1.06; 95% CI: 1.02, 1.09).

CONCLUSIONS

The replacement of animal fats, including dairy fat, with vegetable sources of fats and PUFAs may reduce risk of CVD. Whether the food matrix may modify the effect of dairy fat on health outcomes warrants further investigation.

Substitution of meat and fish with vegetables or potatoes and risk of myocardial infarction

Red meat has been suggested to be adversely associated with risk of myocardial infarction (MI), whereas vegetable consumption has been found to be protective. The aim of this study was to investigate substitutions of red meat, poultry and fish with vegetables or potatoes for MI prevention. We followed up 29 142 women and 26 029 men in the Danish Diet, Cancer and Health study aged 50-64 years with no known history of MI at baseline. Diet was assessed by a validated 192-item FFQ at baseline. Adjusted Cox proportional hazard models were used to calculate hazard ratios (HR) and 95 % CI for MI associated with specified food substitutions of 150 g/week. During a median follow-up of 13·6 years, we identified 656 female and 1694 male cases. Among women, the HR for MI when replacing red meat with vegetables was 0·94 (95 % CI 0·90, 0·98). Replacing fatty fish with vegetables was associated with a higher risk of MI (HR 1·23; 95 % CI 1·05, 1·45), whereas an inverse, statistically non-significant association was found for lean fish (HR 0·93; 95 % CI 0·83, 1·05). Substituting poultry with vegetables was not associated with risk of MI (HR 1·00; 95 % CI 0·90, 1·11). Findings for substitution with potatoes were similar to findings for vegetables. Among men, a similar pattern was observed, but the associations were weak and mostly statistically non-significant. This study suggests that replacing red meat with vegetables or potatoes is associated with a lower risk of MI, whereas replacing fatty fish with vegetables or potatoes is associated with a higher risk of MI.

Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality

IMPORTANCE

Defining what represents a macronutritionally balanced diet remains an open question and a high priority in nutrition research. Although the amount of protein may have specific effects, from a broader dietary perspective, the choice of protein sources will inevitably influence other components of diet and may be a critical determinant for the health outcome.

OBJECTIVE

To examine the associations of animal and plant protein intake with the risk for mortality.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study of US health care professionals included 131 342 participants from the Nurses' Health Study (1980 to end of follow-up on June 1, 2012) and Health Professionals Follow-up Study (1986 to end of follow-up on January 31, 2012). Animal and plant protein intake was assessed by regularly updated validated food frequency questionnaires. Data were analyzed from June 20, 2014, to January 18, 2016.

MAIN OUTCOMES AND MEASURES

Hazard ratios (HRs) for all-cause and cause-specific mortality.

RESULTS

Of the 131 342 participants, 85 013 were women (64.7%) and 46 329 were men (35.3%) (mean [SD] age, 49 [9] years). The median protein intake, as assessed by percentage of energy, was 14% for animal protein (5th-95th percentile, 9%-22%) and 4% for plant protein (5th-95th percentile, 2%-6%). After adjusting for major lifestyle and dietary risk factors, animal protein intake was not associated with all-cause mortality (HR, 1.02 per 10% energy increment; 95% CI, 0.98-1.05; P for trend = .33) but was associated with higher cardiovascular mortality (HR, 1.08 per 10% energy increment; 95% CI, 1.01-1.16; P for trend = .04). Plant protein was associated with lower all-cause mortality (HR, 0.90 per 3% energy increment; 95% CI, 0.86-0.95; P for trend < .001) and cardiovascular mortality (HR, 0.88 per 3% energy increment; 95% CI, 0.80-0.97; P for trend = .007). These associations were confined to participants with at least 1 unhealthy lifestyle factor based on smoking, heavy alcohol intake, overweight or obesity, and physical inactivity, but not evident among those without any of these risk factors. Replacing animal protein of various origins with plant protein was associated with lower mortality. In particular, the HRs for all-cause mortality were 0.66 (95% CI, 0.59-0.75) when 3% of energy from plant protein was substituted for an equivalent amount of protein from processed red meat, 0.88 (95% CI, 0.84-0.92) from unprocessed red meat, and 0.81 (95% CI, 0.75-0.88) from egg.

CONCLUSIONS AND RELEVANCE

High animal protein intake was positively associated with cardiovascular mortality and high plant protein intake was inversely associated with all-cause and cardiovascular mortality, especially among individuals with at least 1 lifestyle risk factor. Substitution of plant protein for animal protein, especially that from processed red meat, was associated with lower mortality, suggesting the importance of protein source.

Pre- and postdiagnostic diet in relation to mortality among breast cancer survivors in the CPS-II Nutrition Cohort

PURPOSE

Due to the limited evidence on the role of diet and cause-specific mortality among breast cancer survivors, current nutrition guidelines for this population are consistent with those for cancer prevention. We evaluated whether diets consistent with the American Cancer Society recommendations for cancer prevention were associated with risk of death in breast cancer survivors.

METHODS

Participants reported information on diet and other factors at baseline in 1992-1993 and twice during follow-up. A nine-point score reflecting concordance with diet recommendations was calculated. Multivariable-adjusted relative risks (RR) and 95 % confidence intervals (CI) for diet score in relation to overall and cause-specific mortality were computed using Cox proportional hazards regression methods.

RESULTS

Among 4,452 women diagnosed with locally and regionally staged breast cancer after baseline and until 2011, 1,204 died during follow-up through 2012 (398 from breast cancer). Prediagnostic diet score was not associated with mortality from any cause. Postdiagnostic diet score was associated with neither breast cancer-specific mortality (RR 1.44, 95 % CI 0.90-2.30 for scores 6-9 vs 0-2) nor cardiovascular disease mortality (RR 0.81, 95 % CI 0.47-1.39), but compared to a score of 0-2, a score of 6-9 was associated with a borderline lower risk of other causes of death (RR 0.78, 95 % CI 0.56-1.07, p _trend = 0.03; per two-point increase in score RR 0.88, 95 % CI 0.79-0.99). Of diet score components, only limiting red and processed meat consumption was associated with statistically significantly lower risk of total, CVD, and other non-breast cancer mortality.

CONCLUSIONS

Diets consistent with guidelines for cancer prevention were not associated with breast cancer-specific mortality. However, their association with other causes of mortality underscores the importance of consuming a healthy diet in this population.

Diets higher in animal and plant protein are associated with lower adiposity and do not impair kidney function in US adults

BACKGROUND

Higher-protein diets are associated with decreased adiposity and greater HDL cholesterol than lower protein diets. Whether these benefits can be attributed to a specific protein source (i.e., nondairy animal, dairy, or plant) is unknown, and concerns remain regarding the impact of higher-protein diets on kidney function.

OBJECTIVE

The objective of this study was to evaluate trends of protein source on markers of cardiometabolic disease risk and kidney function in US adults.

DESIGN

Total, nondairy animal, dairy, and plant protein intake were estimated with the use of 24-h recall data from NHANES 2007-2010 (n = 11,111; ≥19 y). Associations between source-specific protein intake and health outcomes were determined with the use of models that adjusted for sex, race and ethnicity, age, physical activity, poverty-to-income ratio, individual intake (grams per kilogram) for each of the other 2 protein sources, body mass index (BMI) (except for weight-related variables), and macronutrient (carbohydrate, fiber, and total and saturated fat) intake.

RESULTS

Mean ± SE total protein intake was 82.3 ± 0.8 g/d (animal: 37.4 ± 0.5 g/d; plant: 24.7 ± 0.3 g/d; and dairy: 13.4 ± 0.3 g/d). Both BMI and waist circumference were inversely associated [regression coefficient (95% CI)] with animal [-0.199 (-0.265, -0.134), P < 0.0001; -0.505 (-0.641, -0.370), P < 0.0001] and plant [-0.346 (-0.455, -0.237), P < 0.0001; -0.826 (-1.114, -0.538), P < 0.0001] protein intake. Blood urea nitrogen concentrations increased across deciles for animal [0.313 (0.248, 0.379), P < 0.0001; decile 1-10: 11.6 ± 0.2 to 14.9 ± 0.3 mg/dL] and dairy [0.195 (0.139, 0.251), P < 0.0001; decile 1-10: 12.7 ± 0.2 to 13.9 ± 0.2 mg/dL] but not plant protein intake. Glomerular filtration rate and blood creatinine were not associated with intake of any protein source.

CONCLUSIONS

Diets higher in plant and animal protein, independent of other dietary factors, are associated with cardiometabolic benefits, particularly improved central adiposity, with no apparent impairment of kidney function.

Legume consumption and CVD risk: a systematic review and meta-analysis

Objective

The aim of the present study was to systematically review and perform a meta-analysis of prospective cohort studies exploring the association between dietary legume consumption and CVD risk, including CHD and stroke.

Design

The PubMed and EMBASE databases were searched up to December 2015. A meta-analysis of the highestv.lowest (reference) category of dietary legume consumption was performed through random-effects models.

Results

Fourteen studies conducted on eleven cohorts and accounting for a total of 367 000 individuals and 18 475 cases of CVD (7451 CHD and 6336 stroke cases) were considered for the analyses. Compared with lower legume consumption, the highest category of exposure was associated with a decreased risk of 10 % in both CVD and CHD (relative risk=0·90; 95 % CI 0·84, 0·97) with no or little evidence of heterogeneity and no publication bias. Null results were found regarding legume consumption and stroke risk. No substantial confounding factors were evident in stratified analyses.

Conclusions

Legume consumption was associated with lower risk of CVD. Legumes’ intrinsic characteristics, because they are often part of an overall healthy diet, or because they are a substitute for unhealthy sources of protein may potentially explain the current findings.

Diet, lipids, and cardiovascular disease

PURPOSE OF REVIEW

Modulation of diet is the primary lifestyle approach for reducing cardiovascular disease (CVD) risk, with a major focus of current guidelines being to lower LDL cholesterol by reducing intake of saturated fatty acids. However, dietary effects on lipid-related CVD risk factors extend beyond LDL cholesterol, with growing emphasis on the prevention and management of atherogenic dyslipidemia, which includes elevated triglyceride, small dense LDL, and reduced HDL cholesterol, and which is associated with excess adiposity and insulin resistance. We here review recent studies of dietary macronutrient effects on CVD risk that may act through effects on plasma lipid and lipoprotein metabolism.

RECENT FINDINGS

Effects of reducing saturated fatty acids on CVD risk have been evaluated both in terms of the replacement macronutrient(s) and the food and dietary context in which the macronutrients are consumed. Although weight loss remains the most important goal for reducing cardiometabolic risk among overweight and obese individuals, a variety of lines of evidence support limitation of added sugars and processed starches for improving features of atherogenic dyslipidemia.

SUMMARY

Increasing understanding of the complexity of nutrient-disease relationships has shifted the framework for CVD prevention from a focus on macronutrient content of diets to foods and dietary patterns.

Diet, Lifestyle, Biomarkers, Genetic Factors, and Risk of Cardiovascular Disease in the Nurses' Health Studies

OBJECTIVES

To review the contributions of the Nurses' Health Studies (NHSs) to the understanding of cardiovascular disease etiology in women.

METHODS

We performed a narrative review of the publications of the NHS and NHS II between 1976 and 2016.

RESULTS

Diets low in trans fat, saturated fat, refined carbohydrates, and sugar-sweetened beverages and rich in fruits and vegetables, whole grains, and sources of unsaturated fats are associated with reduced risk of cardiovascular disease. Healthy lifestyle choices include smoking avoidance, regular physical activity, maintaining a normal body mass index, and moderate alcohol consumption. Adherence to a combination of these healthy diet and lifestyle behaviors may prevent most vascular events. Studies also covered oral contraceptive use, postmenopausal hormone therapy, shift work, sleep duration, psychosocial factors, and various biomarkers and genetic factors. Findings, such as the association of trans fat with cardiovascular disease, have helped shaped medical guidelines and government policies.

CONCLUSIONS

The NHS has provided compelling evidence that the majority of vascular events may be prevented by avoiding smoking, participating in regular physical activity, maintaining normal body mass index, and eating a healthy diet.

Red Meat Intake and Risk of ESRD

Randomized controlled trials suggest that protein restriction may retard the progression of CKD toward ESRD. However, the effects of dietary protein intake level and the food sources of dietary protein on the risk of ESRD in the general population remain unclear. We investigated these effects in the Singapore Chinese Health Study, a prospective population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998. We collected habitual diet information via a validated semiquantitative food frequency questionnaire and identified ESRD via record linkage with a nationwide registry. In all, 951 cases of ESRD occurred over a mean follow-up of 15.5 years. Regarding total protein intake, compared with the lowest quartile, the three higher quartiles combined had a hazard ratio for ESRD of 1.24 (95% confidence interval [95% CI], 1.05 to 1.46), but the dose-dependent association across the quartiles was not statistically significant (P_trend=0.16). Red meat intake strongly associated with ESRD risk in a dose-dependent manner (hazard ratio for highest quartile versus lowest quartile,1.40 [95% CI, 1.15 to 1.71; P_trend<0.001]). Intake of poultry, fish, eggs, or dairy products did not associate with risk of ESRD. In substitution analysis, replacing one serving of red meat with other food sources of protein associated with a maximum relative risk reduction of 62.4% (95% CI, 33.1 to 78.9; P<0.01). Our study shows that red meat intake may increase the risk of ESRD in the general population and substituting alternative sources of protein may reduce the incidence of ESRD.

Vegetarian diets and gut microbiota: important shifts in markers of metabolism and cardiovascular disease

Vegetarian diets have been associated with a lower incidence of several chronic diseases. The benefits of plant-based diets are related mainly to the improvement of metabolic parameters that can indicate risk for such diseases. Some metabolic factors, such as oxidative balance, lipid profile, and glucose homeostasis, can be improved directly by diet, but paradoxically, some characteristics of vegetarian diets may promote a negative scenario that increases the risk of certain chronic diseases. Additionally, many benefits of a vegetarian diet are mediated by the gut microbiota, members of which not only have taxonomic and functional differences but also produce diverse, specific metabolites that vary according to whether the host consumes an omnivorous or a vegetarian diet. This review examines the modulation of human metabolism and gut microbiota by vegetarian and omnivorous dietary patterns and explores how this modulation may affect the risk of cardiovascular disease.

Dietary Interventions, Cardiovascular Aging, and Disease

Recent studies indicate that dietary interventions have the potential to prevent and even treat cardiovascular disease, which is the leading cause of death. Many of these studies have focused on various animal models that are able to recreate one or more conditions or elevate risk factors that characterize the disease. Here, we highlight macronutrient-focused interventions in both mammalian model organisms and humans with emphasis on some of the most relevant and well-established diets known to be associated with cardiovascular disease prevention and treatment. We also discuss more recent dietary interventions in rodents, monkeys, and humans, which affect atherosclerosis and cardiovascular diseases with focus on those that also delay aging.

Dietary Protein Intake and Risk of Type 2 Diabetes in US Men and Women

Dietary proteins are important modulators of glucose metabolism. However, few longitudinal studies have evaluated the associations between intake of protein and protein type and risk of type 2 diabetes (T2D). We investigated the associations between total, animal, and vegetable protein and incident T2D in 72,992 women from the Nurses' Health Study (1984-2008), 92,088 women from Nurses' Health Study II (1991-2009) and 40,722 men from the Health Professionals Follow-up Study (1986-2008). During 4,146,216 person-years of follow-up, we documented 15,580 cases of T2D. In pooled multivariate models including body mass index, participants in the highest quintiles of percentage of energy derived from total protein and animal protein had 7% (95% confidence interval (CI): 1, 17) and 13% (95% CI: 6, 21) increased risks of T2D compared with those in the lowest quintiles, respectively. Percentage of energy intake from vegetable protein was associated with a moderately decreased risk of T2D (comparing extreme quintiles, hazard ratio =0.91, 95% CI: 0.84, 0.98). Substituting 5% of energy intake from vegetable protein for animal protein was associated with a 23% (95% CI: 16, 30) reduced risk of T2D. In conclusion, higher intake of animal protein was associated with an increased risk of T2D, while higher intake of vegetable protein was associated with a modestly reduced risk.

Red and processed meat consumption and mortality: dose-response meta-analysis of prospective cohort studies

OBJECTIVE

To examine and quantify the potential dose-response relationship between red and processed meat consumption and risk of all-cause, cardiovascular and cancer mortality.

DESIGN

We searched MEDLINE, Embase, ISI Web of Knowledge, CINHAL, Scopus, the Cochrane library and reference lists of retrieved articles up to 30 November 2014 without language restrictions. We retrieved prospective cohort studies that reported risk estimates for all-cause, cardiovascular and cancer mortality by red and/or processed meat intake levels. The dose-response relationships were estimated using data from red and processed meat intake categories in each study. Random-effects models were used to calculate pooled relative risks and 95 % confidence intervals and to incorporate between-study variations.

RESULTS

Nine articles with seventeen prospective cohorts were eligible in this meta-analysis, including a total of 150 328 deaths. There was evidence of a non-linear association between processed meat consumption and risk of all-cause and cardiovascular mortality, but not for cancer mortality. For processed meat, the pooled relative risk with an increase of one serving per day was 1·15 (95 % CI 1·11, 1·19) for all-cause mortality (five studies; P<0·001 for linear trend), 1·15 (95 % CI 1·07, 1·24) for cardiovascular mortality (six studies; P<0·001) and 1·08 (95 % CI 1·06, 1·11) for cancer mortality (five studies; P<0·001). Similar associations were found with total meat intake. The association between unprocessed red meat consumption and mortality risk was found in the US populations, but not in European or Asian populations.

CONCLUSIONS

The present meta-analysis indicates that higher consumption of total red meat and processed meat is associated with an increased risk of total, cardiovascular and cancer mortality.

Substitutions of red meat, poultry and fish and risk of myocardial infarction

Red meat has been suggested to be adversely associated with risk of myocardial infarction (MI), but previous studies have rarely taken replacement foods into consideration. We aimed to investigate optimal substitutions between and within the food groups of red meat, poultry and fish for MI prevention. We followed up 55 171 women and men aged 50-64 years with no known history of MI at recruitment. Diet was assessed by a validated 192-item FFQ at baseline. Adjusted Cox proportional hazard models were used to calculate hazard ratios (HR) and 95 % CI for specified food substitutions of 150 g/week. During a median follow-up time of 13·6 years, we identified 656 female and 1694 male cases. Among women, the HR for replacing red meat with fatty fish was 0·76 (95 % CI 0·64, 0·89), whereas the HR for replacing red meat with lean fish was 1·00 (95 % CI 0·89, 1·14). Similarly, replacing poultry with fatty but not lean fish was inversely associated with MI: the HR was 0·81 (95 % CI 0·67, 0·98) for fatty fish and was 1·08 (95 % CI 0·92, 1·27) for lean fish. The HR for replacing lean with fatty fish was 0·75 (95 % CI 0·60, 0·94). Replacing processed with unprocessed red meat was not associated with MI. Among men, a similar pattern was found, although the associations were not statistically significant. This study suggests that replacing red meat, poultry or lean fish with fatty fish is associated with a lower risk of MI.

Potato Consumption and Risk of Type 2 Diabetes: Results From Three Prospective Cohort Studies

OBJECTIVE

We aimed to elucidate whether potato consumption is associated with a higher risk of type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS

We analyzed data in three cohorts consisting of U.S. male and female health professionals without diabetes, cardiovascular disease, and cancer at baseline: 70,773 women from the Nurses' Health Study (1984-2010), 87,739 women from Nurses' Health Study II (1991-2011), and 40,669 men from the Health Professionals Follow-up Study (1986-2010). Potato consumption was assessed quadrennially using validated food frequency questionnaires (FFQs), and we calculated 4-year change in potato consumption from consecutive FFQs. Self-reported T2D diagnosis was confirmed using a validated supplementary questionnaire.

RESULTS

During 3,988,007 person-years of follow-up, 15,362 new cases of T2D were identified. Higher consumption of total potatoes (including baked, boiled, or mashed potatoes and french fries) was significantly associated with an elevated risk for T2D: the pooled hazard ratio (HR) of T2D compared with <1 serving/week was 1.07 (95% CI 0.97-1.18) for 2-4 servings/week and 1.33 (95% CI 1.17-1.52) for ≥7 servings/week after adjustment for demographic, lifestyle, and dietary factors. In addition, the pooled HRs of T2D for every 3 servings/week were 1.04 (95% CI 1.01-1.08) for baked, boiled, or mashed potatoes, and 1.19 (95% CI 1.13-1.25) for french fries. We further estimated that the HR of T2D was 0.88 (95% CI 0.84-0.91) for replacing 3 servings/week of total potatoes with the same amount of whole grains. Last, in comparison with stable potato consumption, every 3-servings/week increment of potato consumption in 4 years was associated with a 4% (95% CI 0-8%) higher T2D risk.

CONCLUSIONS

Greater consumption of potatoes, especially french fries, was associated with a higher T2D risk, independent of BMI and other risk factors. Replacement of potatoes with whole grains was associated with a lower T2D risk.

Probiotics and blood pressure: current insights

Gut microbiota play a significant role in host metabolic processes, and recent metagenomic surveys have revealed that they are involved in host immune modulation and influence host development and physiology (organ development). Initially, probiotics are identified as potential therapeutics to treat gastrointestinal disorders and to revitalize the disturbed gut ecosystem. Currently, studies are exploring the potential for expanded uses of probiotics for improving the health conditions in metabolic disorders that increase the risk of developing cardiovascular diseases such as hypertension. Further investigations are required to evaluate targeted and effective use of the wide variety of probiotic strains in various metabolic disorders to improve the overall health status of the host. This review addresses the causes of hypertension and the hypotensive effect of probiotics, with a focus on their mechanistic action.

Mediterranean nutraceutical foods: Strategy to improve vascular ageing

Ageing is characterized by a decline in all systemic functions. A greater susceptibility to apoptosis and senescence may contribute to proliferative and functional impairment of endothelial progenitor cells. They play an important role in neo-angiogenesis and endothelial repair. Vascular ageing is associated with changes in the structure and functions of vessels' wall. There are many possible causes of this damage. For sure, inflammation and oxidative stress play a fundamental role in the pathogenesis of endothelial dysfunction, commonly attributed to a reduced availability of nitric oxide. Inflammageing, the chronic low-grade inflammation that characterizes elderly people, aggravates vascular pathology and provokes atherosclerosis, the major cardiovascular disease. Nutraceutical and molecular biology represent new insights in this field. In fact, the first could represent a possible treatment in the prevention or delay of vascular ageing; the second could offer new possible targets for potential therapeutic interventions. In this review, we pay attention on the causes of vascular ageing and on the effects of nutraceuticals on it.

Dietary intake of cod and scallop reduces atherosclerotic burden in female apolipoprotein E-deficient mice fed a Western-type high fat diet for 13 weeks

Background

It is now increasingly recognized that the beneficial effects of seafood consumption is not limited to lipids and fatty acid, but that the protein part, i.e., peptides and amino acids, together with vitamins and even unknown bioactive constituents also are important for disease prevention. This study was designed to evaluate the putative anti-atherogenic effects of different protein sources (a lean seafood and a nonseafood) in apolipoprotein E-deficient (apoE^−/−) mice.

Methods

Twenty-four 5-week-old female apoE^−/− mice were fed Western type diets containing chicken or a combination of cod and scallops as dietary protein sources for 13 weeks. Atherosclerotic plaque burden, weight, serum levels of leptin, glucose and LDL cholesterol as well as gene expressions from liver and heart were evaluated. Statistical analyses were performed using SPSS. Differences between the variables were evaluated using independent t-test or Mann–Whitney U test for normally and non-normally distributed variables, respectively. Normality was defined by the Shapiro-Wilk test.

Results

The mice fed cod-scallop had a 24 % (p < 0.05) reduced total aorta atherosclerotic plaque burden compared to the chicken fed group, whereas the reduction in plaque in the less lesion prone thoracic and abdominal parts of the descending aorta were 46 % (p < 0.05) and 56 % (p < 0.05), respectively. In addition, mice fed cod-scallop gained less weight, and had lower serum levels of leptin, glucose and LDL cholesterol, compared to those fed chicken. Analysis of expression of the genes from liver and heart showed that hepatic endogenous antioxidant paraoxonase 2 (Pon2 gene) and the vascular cell adhesion molecule VCAM-1 (Vcam1 gene) were down regulated in mice fed cod-scallop compared to mice fed chicken.

Conclusion

The present study revealed a metabolic beneficial effect of lean seafood compared to chicken, as atherosclerotic plaque burden, serum glucose, leptin and LDL cholesterol levels were reduced in mice fed cod-scallop.

Electronic supplementary material

The online version of this article (doi:10.1186/s12986-016-0068-z) contains supplementary material, which is available to authorized users.

Energy-restricted, high-protein diets more effectively impact cardiometabolic profile in overweight and obese women than lower-protein diets

BACKGROUND & AIMS

High-protein energy-restricted diets have demonstrated efficacy in promoting weight loss in overweight and obesity. However, the protein percentage that achieves optimal efficacy and acceptability remains unknown. We sought to assess the effects of three energy-reduced diets with different percentages of calories from protein (20%, 27%, and 35%) on weight loss and lipids. Secondary outcomes included diet acceptability and compliance.

METHODS

Six-month, randomized study included women aged 18-80 years with BMI of 27.5-45 kg/m² and who were not taking lipid-lowering drugs. We randomly assigned 91 women to one of three calorie-reduced diets with: protein, 20%, 27%, or 35% (80% from animal protein); carbohydrates, 50%, 43%, or 35%; fat, 30%. Dietary intervention involved individual visits with a nutritionist every 2 weeks during the first 3 months. We performed a follow-up visit at 6 months.

RESULTS

Eighty women aged 44.0 ± 9.08 years with BMI of 37.7 ± 3.39 kg/m² completed the study. At 3 months, weight loss was -8.16 ± 4.18 kg, -9.66 ± 5.28 kg, and -10.7 ± 4.28 kg in the 20%, 27%, and 35%-protein groups, respectively (P = 0.16). These figures slightly and homogeneously increased at 6 months. Around 65% of women following 35%-protein diet lost ≥10% of body weight vs. ∼33% in 20%-protein group (P = 0.023). Significant decreases occurred in fat mass, lipids and insulin resistance, especially in the 35%-protein group (P < 0.05 vs. 20% protein). This improvement was not fully explained by weight loss. Triglyceride change was negatively correlated with animal-protein intake. All groups provided similar responses to an acceptance, palatability, and satisfaction questionnaire.

CONCLUSIONS

An energy-restricted diet with 35% protein, mostly of animal origin, more effectively impacts cardiometabolic profile than an energy-restricted diet with lower protein content although no clear benefit between diets in terms of overall weight loss was observed. The high-protein diet displayed an excellent safety profile and acceptability. This trial was registered in ClinicalTrials.gov as NCT02160496.

CLINICAL TRIAL REGISTRATION

The clinical trial has been registered in ClinicalTrials.gov (Identifier: NCT02160496).

Dairy consumption and CVD: a systematic review and meta-analysis

Inverse associations between dairy consumption and CVD have been reported in several epidemiological studies. Our objective was to conduct a meta-analysis of prospective cohort studies of dairy intake and CVD. A comprehensive literature search was conducted to identify studies that reported risk estimates for total dairy intake, individual dairy products, low/full-fat dairy intake, Ca from dairy sources and CVD, CHD and stroke. Random-effects meta-analyses were used to generate summary relative risk estimates (SRRE) for high v. low intake and stratified intake dose-response analyses. Additional dose-response analyses were performed. Heterogeneity was examined in sub-group and sensitivity analyses. In total, thirty-one unique cohort studies were identified and included in the meta-analysis. Several statistically significant SRRE below 1.0 were observed, namely for total dairy intake and stroke (SRRE=0·91; 95% CI 0·83, 0·99), cheese intake and CHD (SRRE=0·82; 95% CI 0·72, 0·93) and stroke (SRRE=0·87; 95% CI 0·77, 0·99), and Ca from dairy sources and stroke (SRRE=0·69; 95% CI 0·60, 0·81). However, there was little evidence for inverse dose-response relationships between the dairy variables and CHD and stroke after adjusting for within-study covariance. The results of this meta-analysis of prospective cohort studies have shown that dairy consumption may be associated with reduced risks of CVD, although additional data are needed to more comprehensively examine potential dose-response patterns.

Does Milk Consumption Contribute to Cardiometabolic Health and Overall Diet Quality?

Although milk consumption is recommended in most dietary guidelines around the world, its contribution to overall diet quality remains a matter of debate in the scientific community as well as in the public domain. This article summarizes the discussion among experts in the field on the place of milk in a balanced healthy diet. The evidence to date suggests at least a neutral effect of milk intake on health outcomes. The possibility that milk intake is simply a marker of diets higher in nutritional quality cannot be ruled out. This review also identifies a number of key research gaps pertaining to the impact of milk consumption on health. These need to be addressed to better inform future dietary guidelines.

Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review

Suboptimal nutrition is a leading cause of poor health. Nutrition and policy science have advanced rapidly, creating confusion yet also providing powerful opportunities to reduce the adverse health and economic impacts of poor diets. This review considers the history, new evidence, controversies, and corresponding lessons for modern dietary and policy priorities for cardiovascular diseases, obesity, and diabetes mellitus. Major identified themes include the importance of evaluating the full diversity of diet-related risk pathways, not only blood lipids or obesity; focusing on foods and overall diet patterns, rather than single isolated nutrients; recognizing the complex influences of different foods on long-term weight regulation, rather than simply counting calories; and characterizing and implementing evidence-based strategies, including policy approaches, for lifestyle change. Evidence-informed dietary priorities include increased fruits, nonstarchy vegetables, nuts, legumes, fish, vegetable oils, yogurt, and minimally processed whole grains; and fewer red meats, processed (eg, sodium-preserved) meats, and foods rich in refined grains, starch, added sugars, salt, and trans fat. More investigation is needed on the cardiometabolic effects of phenolics, dairy fat, probiotics, fermentation, coffee, tea, cocoa, eggs, specific vegetable and tropical oils, vitamin D, individual fatty acids, and diet-microbiome interactions. Little evidence to date supports the cardiometabolic relevance of other popular priorities: eg, local, organic, grass-fed, farmed/wild, or non-genetically modified. Evidence-based personalized nutrition appears to depend more on nongenetic characteristics (eg, physical activity, abdominal adiposity, gender, socioeconomic status, culture) than genetic factors. Food choices must be strongly supported by clinical behavior change efforts, health systems reforms, novel technologies, and robust policy strategies targeting economic incentives, schools and workplaces, neighborhood environments, and the food system. Scientific advances provide crucial new insights on optimal targets and best practices to reduce the burdens of diet-related cardiometabolic diseases.

The conserved role of protein restriction in aging and disease

PURPOSE OF REVIEW

Dietary interventions are effective strategies for preventing disease and promoting health span. Many of the effects of dietary restriction are linked to amino acid and protein levels and their regulation of nutrient-signaling pathways. Thus, protein restriction is a promising therapeutic strategy for preventing aging-related diseases and extending life span.

RECENT FINDINGS

Studies in yeast and flies have shown that amino acid restriction promotes longevity and protection. In rodents, protein restriction extends life span and alleviates detrimental aging phenotypes. Finally, clinical trials in middle-aged adults have demonstrated the role of a protein-restricted diet in promoting health span. Interestingly, the population over the age of 65 may not benefit from severe protein restriction potentially because of the increased physiological decline that leads to decreased amino acid absorption and altered protein synthesis.

SUMMARY

Protein restriction can have profound effects on health and longevity, but excessive restriction is detrimental, particularly in the very old. The investigation of the mechanisms that modulate nutrient-sensing pathways is important to understand how regulation of protein intake can optimize health span and longevity.

Red Meat and Health

Despite its nutritional benefits, there is an increasing body of evidence to suggest that regular consumption of red meat may negatively impact health and disease risk, including the risk of most common chronic diseases. This chapter reviews the current evidence linking red and processed meat intakes with chronic disease, obesity and mortality risks and discusses possible mechanisms to explain these associations. Research on the health benefits of diets low in red meat, including vegetarian, vegan, Mediterranean and other plant-based diets, is also reviewed.

Chemical Components and Meat Quality Traits Related to Palatability of Ten Primal Cuts from Hanwoo Carcasses

To determine chemical components and meat quality traits related to palatability of 10 primal cuts, 25 Hanwoo carcasses were selected from 5 carcasses × 5 quality grades and used to obtain proximate data and meat quality characteristics. Significant differences (p<0.05) in chemical component and meat quality were found among the 10 primal cuts. The highest fat content was found in the kalbi, followed by dungsim, yangjee, chaekeut, ansim, abdari, suldo, moksim, udun, and satae. Protein and moisture contents in the 10 primal cuts were in reverse order of fat content. Moksim had the highest drip loss % and cooking loss % than all other primal cuts while kalbi showed the lowest (p<0.05) percentage of drip and cooking loss. Ansim had the longest sarcomere length but the lowest shear force values than all other cuts (p<0.05). The highest (p<0.05) score for overall acceptability was observed in ansim. Moksim, udun, abdari, and satae were rated the lowest (p<0.05) in overall acceptability among the 10 primal cuts from Hanwoo carcasses. In conclusion, ansim, dungsim, chaekeut, and kalbi had the highest overall acceptability due to their higher fat contents and lower shear force values.

Probiotic supplementation and trimethylamine-N-oxide production following a high-fat diet

OBJECTIVE

The objective of this study was to test the hypothesis that the multi-strain probiotic VSL#3 would attenuate the increase in fasting plasma concentrations of trimethylamine-N-oxide (TMAO) following a high-fat diet.

METHODS

Nineteen healthy, non-obese males (18-30 years) participated in the present study. Following a 2-week eucaloric control diet, subjects were randomized to either VSL#3 (900 billion live bacteria) or placebo (cornstarch) during the consumption of a hypercaloric (+1,000 kcal day(-1) ), high-fat diet (55% fat) for 4 weeks. Plasma TMAO, L-carnitine, choline, and betaine (UPLC-MS/MS) were measured at baseline and following a high-fat diet.

RESULTS

Plasma TMAO significantly increased 89% ± 66% vs. 115% ± 61% in both the VSL#3 and placebo groups, respectively; however, the magnitude of change in plasma TMAO was not different (P > 0.05) between them. Plasma L-carnitine, choline, and betaine concentrations did not increase following the high-fat diet in either group.

CONCLUSIONS

A high-fat diet increases plasma TMAO in healthy, normal-weight, young males. However, VSL#3 treatment does not appear to influence plasma TMAO concentrations following a high-fat diet. Future studies are needed to determine whether other therapeutic strategies can attenuate the production of TMAO.

Plant protein and animal proteins: do they differentially affect cardiovascular disease risk?

Proteins from plant-based compared with animal-based food sources may have different effects on cardiovascular disease (CVD) risk factors. Numerous epidemiologic and intervention studies have evaluated their respective health benefits; however, it is difficult to isolate the role of plant or animal protein on CVD risk. This review evaluates the current evidence from observational and intervention studies, focusing on the specific protein-providing foods and populations studied. Dietary protein is derived from many food sources, and each provides a different composite of nonprotein compounds that can also affect CVD risk factors. Increasing the consumption of protein-rich foods also typically results in lower intakes of other nutrients, which may simultaneously influence outcomes. Given these complexities, blanket statements about plant or animal protein may be too general, and greater consideration of the specific protein food sources and the background diet is required. The potential mechanisms responsible for any specific effects of plant and animal protein are similarly multifaceted and include the amino acid content of particular foods, contributions from other nonprotein compounds provided concomitantly by the whole food, and interactions with the gut microbiome. Evidence to date is inconclusive, and additional studies are needed to further advance our understanding of the complexity of plant protein vs. animal protein comparisons. Nonetheless, current evidence supports the idea that CVD risk can be reduced by a dietary pattern that provides more plant sources of protein compared with the typical American diet and also includes animal-based protein foods that are unprocessed and low in saturated fat.

A systematic review and meta-analysis of nut consumption and incident risk of CVD and all-cause mortality

Dietary patterns containing nuts are associated with a lower risk of CVD mortality, and increased nut consumption has been shown to have beneficial effects on CVD risk factors including serum lipid levels. Recent studies have reported on the relationship between nut intake and CVD outcomes and mortality. Our objective was to systematically review the literature and quantify associations between nut consumption and CVD outcomes and all-cause mortality. Five electronic databases (through July 2015), previous reviews and bibliographies of qualifying articles were searched. In the twenty included prospective cohort studies (n 467 389), nut consumption was significantly associated with a lower risk of all-cause mortality (ten studies; risk ratio (RR) 0·81; 95 % CI 0·77, 0·85 for highest v. lowest quantile of intake, Phet=0·04, I2=43 %), CVD mortality (five studies; RR 0·73; 95 % CI 0·68, 0·78; Phet=0·31, I2=16 %), all CHD (three studies; RR 0·66; 95 % CI 0·48, 0·91; Phet=0·0002, I2=88 %) and CHD mortality (seven studies; RR 0·70; 95 % CI 0·64, 0·76; Phet=0·65, I2=0 %), as well as a statistically non-significant reduction in the risk of non-fatal CHD (three studies; RR 0·71; 95 % CI 0·49, 1·03; Phet=0·03, I2=72 %) and stroke mortality (three studies; RR 0·83; 95 % CI 0·69, 1·00; Phet=0·54, I2=0 %). No evidence of association was found for total stroke (two studies; RR 1·05; 95 % CI 0·69, 1·61; Phet=0·04, I2=77 %). Data on total CVD and sudden cardiac death were available from one cohort study, and they were significantly inversely associated with nut consumption. In conclusion, we found that higher nut consumption is associated with a lower risk of all-cause mortality, total CVD, CVD mortality, total CHD, CHD mortality and sudden cardiac death.

Association of Processed Meat Intake with Hypertension Risk in Hemodialysis Patients: A Cross-Sectional Study

In this cross-sectional study, we hypothesized that hemodialysis patients consuming greater processed meat is associated with hypertension risk, which can be partly explained by the high sodium content in processed meat. From September 2013 to May 2014, one hundred and four patients requiring chronic hemodialysis treatment were recruited from hemodialysis centers. Data on systolic blood pressure and diastolic blood pressure before receiving dialysis, and 3-day dietary records of the recruited patients were collected. HD patients with systolic and diastolic blood pressures greater than140 mmHg and higher than 90 mmHg, respectively, were considered hypertension risk. Protein foods were divided into 4 categories: red meat, white meat, soybeans, and processed meat (e.g., sausage and ham). In a model adjusted for energy intake and hypertension history, additional servings of processed meats was positively associated to systolic blood pressure >140 mmHg (odds ratio [95% confidence interval]: 2.1 [1.0–4.3]), and diastolic blood pressure > 90 mmHg (odds ratio: 2.5 [1.2–5.5]). After adjustment for dietary sodium contents or body mass index (BMI), most associations were substantially attenuated and were no longer significant. In systolic blood pressure greater than140 mmHg, one serving per day of red meats (β = -1.22, P < .05) and white meats (β = -0. 75, P = .05) was associated with a reduced risk compared with one serving per day of processed meats. Similarly, compared with one serving per day of processed meat, a reduced risk of diastolic blood pressure higher than 90 mmHg was associated with one serving per day of red meat (β = -1. 59, P < .05), white meat (β = -0. 62, P < .05). Thus, in these hemodialysis patients, intake of processed meat is significantly positively associated with higher blood pressure risk, and both sodium contents in processed meat and BMI significantly contributes to this association.

Association of Dietary Protein Consumption With Incident Silent Cerebral Infarcts and Stroke: The Atherosclerosis Risk in Communities (ARIC) Study

BACKGROUND AND PURPOSE

The effect of dietary protein on the risk of stroke has shown inconsistent results. We aimed to evaluate the relationship of dietary protein sources with the risk of stroke and silent cerebral infarcts in a large community-based cohort.

METHODS

We studied 11601 adults (age, 45-64 years at baseline in 1987-1989) enrolled in the Atherosclerosis Risk in Communities (ARIC) Study, free of diabetes mellitus and cardiovascular disease. Dietary protein intake was assessed with validated food frequency questionnaires at baseline and after 6 years of follow-up. Incident stroke events were identified through hospital discharge codes and stroke deaths and physician-adjudicated through December 31, 2011. A subset of participants (n=653) underwent brain magnetic resonance imaging in 1993 to 1995 and in 2004 to 2006. Cox proportional hazard models and logistic regression were used for statistical analyses.

RESULTS

During a median follow-up of 22.7 years, there were 699 stroke events. In multivariable analyses, total, animal, and vegetable protein consumption was not associated with risk of stroke. Red meat consumption was associated with increased stroke risk, particularly ischemic events. The hazard ratios (95% confidence interval) for risk of ischemic stroke across ascending quintiles of red meat consumption were 1 (ref), 1.13 (0.85-1.49), 1.44 (1.09-1.90), 1.33 (0.99-1.79), and 1.47 (1.06-2.05); Ptrend=0.01. No association of major dietary protein sources with silent cerebral infarcts was detected.

CONCLUSIONS

This study supports the notion that consumption of red meat may increase the risk of ischemic stroke. No association between dietary protein intake and silent cerebral infarcts was found.

Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System: A Report From the Workshop Convened by the World Heart Federation

Major scholars in the field, on the basis of a 3-day consensus, created an in-depth review of current knowledge on the role of diet in cardiovascular disease (CVD), the changing global food system and global dietary patterns, and potential policy solutions. Evidence from different countries and age/race/ethnicity/socioeconomic groups suggesting the health effects studies of foods, macronutrients, and dietary patterns on CVD appear to be far more consistent though regional knowledge gaps is highlighted. Large gaps in knowledge about the association of macronutrients to CVD in low- and middle-income countries particularly linked with dietary patterns are reviewed. Our understanding of foods and macronutrients in relationship to CVD is broadly clear; however, major gaps exist both in dietary pattern research and ways to change diets and food systems. On the basis of the current evidence, the traditional Mediterranean-type diet, including plant foods and emphasis on plant protein sources provides a well-tested healthy dietary pattern to reduce CVD.