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Bonekamp NE, Cruijsen E, Geleijnse JM, Winkels RM, Visseren FLJ, Morris PB, Koopal C. Diet in secondary prevention: the effect of dietary patterns on cardiovascular risk factors in patients with cardiovascular disease: a systematic review and network meta-analysis. Nutr J 2024; 23:18. [PMID: 38331867 PMCID: PMC10851459 DOI: 10.1186/s12937-024-00922-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Improving dietary habits is a first-line recommendation for patients with cardiovascular disease (CVD). It is unclear which dietary pattern most effectively lowers cardiovascular risk factors and what the short- and long-term effects are. Therefore, this network meta-analysis compared the effects of popular dietary patterns on cardiovascular risk factors in patients with established CVD. METHODS A systematic search of PubMed, Embase, the Cochrane library, SCOPUS and Web of Science was conducted up to 1 April 2023. Randomized controlled trials (RCTs) comparing the effect of popular dietary patterns (Mediterranean, moderate carbohydrate, low glycemic index, low-fat and minimal dietary intervention) on cardiovascular risk factors (body weight, systolic blood pressure, lipids) in CVD populations were selected. A random-effects network meta-analysis was performed. RESULTS Seventeen RCTs comprising 6,331 participants were included. The moderate carbohydrate diet had the most beneficial effect on body weight (-4.6 kg, 95%CrI -25.1; 15.8) and systolic blood pressure (-7.0 mmHg 95%CrI -16.8; 2.7) compared to minimal intervention. None of the included dietary patterns had a favorable effect on low-density lipoprotein cholesterol. After 12 months, the effects were attenuated compared to those at < 6 months. CONCLUSIONS In this network meta-analysis of 17 randomized trials, potentially clinically relevant effects of dietary interventions on CV risk factors were observed, but there was considerable uncertainty due to study heterogeneity, low adherence, or actual diminished effects in the medically treated CVD population. It was not possible to select optimal dietary patterns for secondary CVD prevention. Given recent clinical trials demonstrating the potential of dietary patterns to significantly reduce cardiovascular event risk, it is likely that these effects are effectuated through alternative physiological pathways.
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Affiliation(s)
- N E Bonekamp
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, the Netherlands
| | - E Cruijsen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - J M Geleijnse
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - R M Winkels
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - F L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, the Netherlands.
| | - P B Morris
- Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - C Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, Utrecht, 3508 GA, the Netherlands
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da Conceição AR, da Silva A, Juvanhol LL, Marcadenti A, Bersch-Ferreira ÂC, Weber B, Shivappa N, Bressan J. The Brazilian Cardioprotective Nutritional (BALANCE) Program improves diet quality in patients with established cardiovascular disease: Results from a multicenter randomized controlled trial. Nutr Res 2024; 121:82-94. [PMID: 38056033 DOI: 10.1016/j.nutres.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 12/08/2023]
Abstract
Dietary modifications are essential strategies for cardiovascular disease prevention. However, studies are needed to investigate the diet quality of individuals undergoing secondary prevention in cardiology and who received dietary intervention based on cardiovascular disease management. We prospectively evaluated the diet quality in the Brazilian Cardioprotective Nutritional Program Trial (BALANCE Program Trial). We hypothesized that the BALANCE Program could improve patients' dietary pattern according to different indices of diet quality such as the Dietary Inflammatory Index (DII); the dietary total antioxidant capacity; overall, healthful, and unhealthful Plant-Based Diet Index (PDI, hPDI, and uPDI, respectively); and modified Alternative Healthy Eating Index (mAHEI). This multicenter randomized, controlled trial included patients aged ≥45 years randomly assigned to either the experimental or control group. Data from 2185 participants at baseline and after 12, 24, 36, and 48 months showed that the intervention group (n = 1077) had lower mean values of DII and higher dietary total antioxidant capacity, PDI, hPDI, and mAHEI than the control group. The results also showed differences between the follow-up times for DII, hPDI, and uPDI (48 months vs baseline) and for PDI and mAHEI (24 months vs baseline), regardless of group. The interaction analysis demonstrated that the intervention group showed better results than the control group at 12, 24, 36, and 48 months for the DII and at months 12, 36, and 48 for the mAHEI. Our results provide prospective evidence that the BALANCE Program improved the diet quality in those in secondary cardiovascular prevention according to different indices, with the intervention group showing better results than the control group.
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Affiliation(s)
| | - Alessandra da Silva
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | | | - Aline Marcadenti
- Hcor Research Institute, HCor (IP-Hcor), São Paulo, SP, Brazil; Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul (IC/FUC), Porto Alegre, RS, Brazil
| | - Ângela Cristine Bersch-Ferreira
- Hcor Research Institute, HCor (IP-Hcor), São Paulo, SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, PROADI-SUS Office, São Paulo, SP, Brazil
| | | | - Nitin Shivappa
- Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, MG, Brazil
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Brito L, Sahade V, Weber B, Bersch-Ferreira ÂC, Marcadenti A, Torreglosa C, Kovacs C, Moreira ASB, Torres RDS, Marinho H, Matos C, Abib R, Souza GC, Shirmann GDS, Nagano FEZ, Ramos MEM, Poloni S, El Kik RM, Feres NH, Dutra ES, Ferreira Carvalho APP, David MM, Galvão I, Sousa ACS, Dantas CDF, Gonçalves A, Pinheiro JMF, Vasconcelos SML, Penafort A, de Oliveira Carlos DM, Luna A, Neto JADF, Dias L, Moriguchi EH, Bruscato N, Izar MC, Lopes S, Backes LM, Bressan J, Raimondi S, Kumbier M, Daltro C. Factors associated with diet quality among Brazilian individuals with cardiovascular diseases. J Hum Nutr Diet 2023; 36:1713-1726. [PMID: 37283442 DOI: 10.1111/jhn.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/04/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. METHODS This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. RESULTS In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence. CONCLUSIONS A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.
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Affiliation(s)
- Luciana Brito
- Programa de Pós-Graduação em Medicina e Saúde da UFBA, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Empresa Brasileira de Serviços Hospitalares (EBSERH), Salvador, Bahia, Brazil
| | - Viviane Sahade
- Departamento de Nutrição da Escola de Nutrição da UFBA, Salvador, Bahia, Brazil
| | | | | | | | | | | | - Annie Seixas Bello Moreira
- Instituto Nacional de Cardiologia (INC), Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | | | - Helyde Marinho
- Instituto Nacional de Pesquisas da Amazônia, Hospital Universitário Francisca Mendes, Manaus, Amazonas, Brazil
| | - Cristina Matos
- Universidade do Vale do Itajaí (UNIVALI), Itajaí, Santa Catarina, Brazil
| | - Renata Abib
- Hospital Escola da Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | | | | | | | | | - Soraia Poloni
- Instituto de Cardiologia-Fundação Universitária de Cardiologia (IC-FUC), Porto Alegre, Rio Grande do Sul, Brazil
| | - Raquel Milani El Kik
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Eliane Said Dutra
- Hospital Universitário de Brasília, Brasília, Distrito Federal, Brazil
| | | | - Marta Marques David
- Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Isa Galvão
- Pronto Socorro Cardiológico Universitário de Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Amanda Gonçalves
- Hospital Universitário Alcides Carneiro, Campina Grande, Paraíba, Brazil
| | | | | | - Andreza Penafort
- Universidade de Fortaleza (UNIFOR) and Núcleo de Atenção Médica Integrada (NAMI) da Fundação Edson Queiroz, Fortaleza, Ceará, Brazil
| | | | - Adriana Luna
- Hospital Universitário da Fundação da Universidade Federal de Sergipe (FUFSE), Aracaju, Sergipe, Brazil
| | | | - Luciana Dias
- Hospital Universitário Presidente Dutra do Maranhão, Universidade Federal, São Luiz, Maranhão, Brazil
| | | | - Neide Bruscato
- Associação Veranense de Assistência em Saúde, Veranópolis, Rio Grande do Sul, Brazil
| | - Maria Cristina Izar
- Ambulatório de Lípides, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sonia Lopes
- Universidade Federal Tocantins, Palmas, Tocantins, Brazil
| | | | | | - Simone Raimondi
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, Brazil
| | | | - Carla Daltro
- Programa de Pós-Graduação em Medicina e Saúde da UFBA, Departamento de Nutrição da Escola de Nutrição da UFBA, Salvador, Bahia, Brazil
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Karam G, Agarwal A, Sadeghirad B, Jalink M, Hitchcock CL, Ge L, Kiflen R, Ahmed W, Zea AM, Milenkovic J, Chedrawe MA, Rabassa M, El Dib R, Goldenberg JZ, Guyatt GH, Boyce E, Johnston BC. Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis. BMJ 2023; 380:e072003. [PMID: 36990505 PMCID: PMC10053756 DOI: 10.1136/bmj-2022-072003] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To determine the relative efficacy of structured named diet and health behaviour programmes (dietary programmes) for prevention of mortality and major cardiovascular events in patients at increased risk of cardiovascular disease. DESIGN Systematic review and network meta-analysis of randomised controlled trials. DATA SOURCES AMED (Allied and Complementary Medicine Database), CENTRAL (Cochrane Central Register of Controlled Trials), Embase, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and ClinicalTrials.gov were searched up to September 2021. STUDY SELECTION Randomised trials of patients at increased risk of cardiovascular disease that compared dietary programmes with minimal intervention (eg, healthy diet brochure) or alternative programmes with at least nine months of follow-up and reporting on mortality or major cardiovascular events (such as stroke or non-fatal myocardial infarction). In addition to dietary intervention, dietary programmes could also include exercise, behavioural support, and other secondary interventions such as drug treatment. OUTCOMES AND MEASURES All cause mortality, cardiovascular mortality, and individual cardiovascular events (stroke, non-fatal myocardial infarction, and unplanned cardiovascular interventions). REVIEW METHODS Pairs of reviewers independently extracted data and assessed risk of bias. A random effects network meta-analysis was performed using a frequentist approach and grading of recommendations assessment, development and evaluation (GRADE) methods to determine the certainty of evidence for each outcome. RESULTS 40 eligible trials were identified with 35 548 participants across seven named dietary programmes (low fat, 18 studies; Mediterranean, 12; very low fat, 6; modified fat, 4; combined low fat and low sodium, 3; Ornish, 3; Pritikin, 1). At last reported follow-up, based on moderate certainty evidence, Mediterranean dietary programmes proved superior to minimal intervention for the prevention of all cause mortality (odds ratio 0.72, 95% confidence interval 0.56 to 0.92; patients at intermediate risk: risk difference 17 fewer per 1000 followed over five years), cardiovascular mortality (0.55, 0.39 to 0.78; 13 fewer per 1000), stroke (0.65, 0.46 to 0.93; 7 fewer per 1000), and non-fatal myocardial infarction (0.48, 0.36 to 0.65; 17 fewer per 1000). Based on moderate certainty evidence, low fat programmes proved superior to minimal intervention for prevention of all cause mortality (0.84, 0.74 to 0.95; 9 fewer per 1000) and non-fatal myocardial infarction (0.77, 0.61 to 0.96; 7 fewer per 1000). The absolute effects for both dietary programmes were more pronounced for patients at high risk. There were no convincing differences between Mediterranean and low fat programmes for mortality or non-fatal myocardial infarction. The five remaining dietary programmes generally had little or no benefit compared with minimal intervention typically based on low to moderate certainty evidence. CONCLUSIONS Moderate certainty evidence shows that programmes promoting Mediterranean and low fat diets, with or without physical activity or other interventions, reduce all cause mortality and non-fatal myocardial infarction in patients with increased cardiovascular risk. Mediterranean programmes are also likely to reduce stroke risk. Generally, other named dietary programmes were not superior to minimal intervention. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016047939.
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Affiliation(s)
- Giorgio Karam
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arnav Agarwal
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Jalink
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Long Ge
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ruhi Kiflen
- Ontario Hospital Association, Toronto, Ontario, Canada
| | - Waleed Ahmed
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adriana M Zea
- School of Nutrition and Dietetics, Universidad de Antioquia, Medellin, Colombia
| | - Jovana Milenkovic
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Aj Chedrawe
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Regina El Dib
- Institute of Science and Technology, University Estadual Paulista, São José dos Campos, São Paulo, Brazil
| | - Joshua Z Goldenberg
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, USA
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Bradley C Johnston
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, USA
- Department of Epidemiology and Biostatistics, School of Public Health, College Station, TX, USA
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Coura AGL, de Arruda Neta ADCP, de Lima RLFC, Bersch-Ferreira ÂC, Weber B, Vianna RPDT. Tracking of Dietary Patterns in the Secondary Prevention of Cardiovascular Disease after a Nutritional Intervention Program-A Randomized Clinical Trial. Nutrients 2022; 14:nu14224716. [PMID: 36432401 PMCID: PMC9695891 DOI: 10.3390/nu14224716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/24/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
Individuals with a history of previous cardiovascular events have an increased risk of mortality and morbidity, so adherence to a healthy dietary pattern is essential. We aimed to evaluate and compare dietary patterns between the control and the experimental group from the BALANCE Program. A total of 2360 individuals aged 45 years or older with previous cardiovascular disease were included. The individuals were randomized into two groups: intervention (dietary prescription with nutritional recommendations, nutritional education program based on playful strategies, suggestions of typical and accessible Brazilian foods and intensive monitoring) and control (conventional nutritional counseling). The dietary patterns were identified using factor analysis with the principal component extraction method, and the t-Student tests and ANOVA test were performed to evaluate the associated factors. Four dietary patterns were identified for both groups: "Traditional", "Snack", "Western", "Cardioprotective". There was an increase in the variances of the "Cardioprotective" pattern in both groups. Regarding the "Western" pattern, there was a significant reduction in the variances of the experimental group (10.63% vs. 8.14%). Both groups had improvements in eating habits, especially in the first year of follow-up. The greater increase in adherence to the traditional and cardioprotective pattern in the experimental group justifies the initiative of the BALANCE program.
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Affiliation(s)
- Amanda Gonçalves Lopes Coura
- Postgraduate Program in Nutrition Sciences, Federal University of Paraíba, João Pessoa 58059-900, Brazil
- Correspondence:
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Chhabra JS, Juneja A, Etkin Y, Landis G, Gardener H, Garuthara M, Hoffstaetter T, Oropallo A. The effect of nutrition on stroke risk: A systematic review. Nutr Health 2022; 29:255-267. [PMID: 36040714 DOI: 10.1177/02601060221122218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: An estimated 33% reduction in cardiovascular events can be achieved when incorporating whole grains, fruits, vegetables, poultry, nuts, and vegetable oils in the diet along with reduced consumption of refined carbohydrates, processed meats, and sugar sweetened beverages. We performed a systematic review to analyze the impact of nutritional intervention on stroke risk, as there is no current consensus concerning dietary recommendation for primary and secondary stroke prevention. Methods: A literature search of the PubMed database from January 2010 to June 2020 was performed using combinations of the following search terms: carotid disease, carotid artery disease, carotid stenosis, carotid intima-media thickness (CIMT), diet, nutrition, micronutrition, embolic stroke, and stroke. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist. Results: 28 studies met our inclusion criteria. Multiple studies showed an inverse relationship between consumption of vegetables and fruits and stroke risk. Vitamin B12 or a combination of B Vitamins was the most common supplement studied in stroke prevention. Only one RCT showed the use of B12 (500 micrograms/day) correlated with lower CIMT at follow up in healthy vegetarians. Discussion: The key findings from this systematic review indicate that adopting a diet rich in fruits and vegetables earlier in life may lower stroke risk compared with meats and fat intake. B vitamins also appear to confer some protection against stroke. However, not enough data exists to support the use of multivitamins, calcium, soy products and other supplements for primary or secondary stroke prevention.
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Affiliation(s)
| | | | - Yana Etkin
- Northwell Health, New Hyde Park, NY, USA
| | | | - Hannah Gardener
- University of Miami Miller School of Medicine, Miami, FL, USA
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Costa JO, Aidar FJ, Barbosa JS, Alves LVS, Oliveira VB, de Oliveira LMSM, Rocha RMS, Vieira DADS, Costa IMNBDC, de Souza MFC, Oliveira JLM, Baumworcel L, Neves EB, Díaz-de-Durana AL, Almeida-Santos MA, Sousa ACS. BALANCE Dietary Index in Patients with Heart Failure, and Its Adherence in Sergipe, Brazil. Clin Pract 2022; 12:383-395. [PMID: 35735662 PMCID: PMC9221597 DOI: 10.3390/clinpract12030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: “The effective treatment of Heart Failure (HF) involves care with food intake. Recently, the Ministry of Health created the Brazilian Cardioprotective Diet and its dietary index, BALANCE, which assesses adherence to the standard’s recommendations”. Methods: This observational prospective study is part of the Congestive Heart Failure Registry (VICTIM-CHF) of Aracaju/SE. Observations and data collection took place from April 2018 to February 2021. Sociodemographic and clinical aspects and food consumption were evaluated. Food intake was determined using the food frequency questionnaire. Foods were categorized using the BALANCE dietary index into green, yellow, blue and red food groups. The BALANCE dietary index was obtained using median and interquartile ranges, scores of the Mann–Whitney U test, and associations between clinical variables and the index, through linear regression. Results: Participants included 240 patients with HF (61.12 ± 1.06 years), who were assisted by the Unified Health System (67.5%). Individuals with a partner showed greater adherence to the green food group recommendations (0.09; 0.00–0.17). The lowest adherence to recommendations regarding the blue food group was observed in individuals with excess weight, who had a higher consumption of foods rich in animal protein (0.54; 0.38–0.78). As for the red food group (ultra-processed foods) the highest adherence was observed by patients with diabetes mellitus (0.41; 0.05–0.77). The greatest adherence to the yellow food group, and a higher score, was observed in patients with the smallest left ventricular systolic diameter (LVSD). Conclusions: Being married was directly associated with the consumption of foods in the green group, while being overweight and having diabetes were inversely associated with adherence to the blue and red food groups, respectively. Greater adherence to the yellow food group recommendations was inversely associated with less change in the DSFVE.
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Affiliation(s)
- Jamille Oliveira Costa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
- Correspondence:
| | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil;
- Graduate Program in Physical Education, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Graduate Program in Physiological Science, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
| | - Juliana Santos Barbosa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Luciana Vieira Sousa Alves
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Victor Batista Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Larissa Marina Santana Mendonça de Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Raysa Manuelle Santos Rocha
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Diva Aliete dos Santos Vieira
- Department of Nutrition, Campus Prof. Antônio Garcia Filho, Federal University of Sergipe (UFS), Lagarto 49400-000, SE, Brazil;
| | | | - Márcia Ferreira Cândido de Souza
- Graduate Program Professional in Management and Technological Innovation in Health, Federal University of Sergipe, Aracaju 49100-000, SE, Brazil;
| | - Joselina Luzia Menezes Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
| | - Leonardo Baumworcel
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
| | - Eduardo Borba Neves
- Graduate Program in Biomedical Engineering, Federal Technological University of Paraná (UTFPR), Curitiba 80230-901, PR, Brazil;
| | - Alfonso López Díaz-de-Durana
- Sports Department, Physical Activity and Sports Faculty-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Marcos Antonio Almeida-Santos
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
- Graduate Program in Health and Environment, Tiradentes University (UNIT), Aracaju 49010-390, SE, Brazil
| | - Antônio Carlos Sobral Sousa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
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Cacau LT, Marcadenti A, Bersch-Ferreira AC, Weber B, de Almeida JC, Rodrigues CCR, Lotufo PA, Bensenor IM, Marchioni DM. The AHA Recommendations for a Healthy Diet and Ultra-Processed Foods: Building a New Diet Quality Index. Front Nutr 2022; 9:804121. [PMID: 35479734 PMCID: PMC9036106 DOI: 10.3389/fnut.2022.804121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
The American Heart Association (AHA) has developed the concept of “ideal cardiovascular health” (ICH), a seven-component score, which includes health dietary metrics. Higher ultra-processed foods intake is related with several cardiometabolic and cardiovascular diseases. We propose to develop and validate the Cardiovascular Health Diet Index (CHDI), a diet quality index that combines the AHA's recommendations of a healthy diet for cardiovascular health and ultra-processed foods. We used dietary data obtained through a 114-item FFQ from 14,779 participants of the Brazilian Longitudinal Study of Adults Health (ELSA-Brasil). The CHDI had 11 components and a total score ranging from 0 to 110 points. Validation and reliability analyses were performed, including principal component analyses, association with selected nutrients, means differences between groups (for example, smokers vs. non-smokers), Cronbach's alpha, and linear regression analyses between CHDI and overall dietary quality. The mean CHDI was 57.1 points (95% CI 47.9:66.0). The CHDI had four dimensions; in addition, it was associated with nutrients related to cardiovascular health, and the points were significantly (p < 0.001) lower in smokers (52.1) than in non-smokers (57.8). Cronbach's alpha value was 0.50. After age and sex adjustment, the CHDI score remained associated with a higher overall dietary quality (β 0.87, 95%CI 0.84:0.89, p < 0.001). The CHDI proved to be valid and reliable for use, in addition to being associated with higher overall dietary quality. The use of CHDI is expected to assess the population's compliance with dietary recommendations for promoting cardiovascular health and preventing cardiovascular disease.
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Affiliation(s)
- Leandro Teixeira Cacau
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Aline Marcadenti
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
- Instituto de Pesquisa, Hospital do Coração, São Paulo, Brazil
- Programa de Pós-Graduação em Ciências da Saúde (Cardiologia), Intituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Jussara Carnevale de Almeida
- Departamento de Nutrição, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cíntia Corte Real Rodrigues
- Departamento de Nutrição, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Nutrição e Dietética, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Paulo Andrade Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Isabela Martins Bensenor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Dirce Maria Marchioni
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
- *Correspondence: Dirce Maria Marchioni
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Absolute and Relative Agreement between the Current and Modified Brazilian Cardioprotective Nutritional Program Dietary Index (BALANCE DI) and the American Heart Association Healthy Diet Score (AHA-DS) in Post Myocardial Infarction Patients. Nutrients 2022; 14:nu14071378. [PMID: 35405989 PMCID: PMC9002536 DOI: 10.3390/nu14071378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 12/10/2022] Open
Abstract
The American Heart Association Diet Score (AHA-DS) defines the cardiovascular health, and the Brazilian Cardioprotective Nutritional Program Dietary Index (BALANCE DI) was designed to evaluate diet quality in secondary cardiovascular prevention settings. Our aim was to assess the absolute and relative agreement between both tools in Brazilian adults after a myocardial infarction (MI). In this cross-sectional study, 473 individuals were included and had their diet assessed by a 24 h food recall and a semi-quantitative Food Frequency Questionnaire. The weighted Kappa between BALANCE DI and primary AHA-DS was 0.66 (95% CI: 0.08-0.21), and between BALANCE DI and total AHA-DS was 0.70 (95% CI: 0.20-0.32). To improve the agreement between the tools, modifications were made to the BALANCE DI scoring system. The weighted Kappa between New BALANCE DI and primary AHA-DS was 0.77 (95% CI: 0.36-0.48), and between BALANCE DI and total AHA-DS was 0.76 (95% CI: 0.34-0.46). The mean bias observed between the New BALANCE DI as compared to the primary and total AHA-DS was -16% (-51 to 19) and -8% (-41 to 24), respectively. Our results suggest that the New BALANCE DI may be a useful tool to evaluate diet quality in post MI patients.
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Barbarash OL, Sedykh DY, Petrova TS, Kashtalap VV, Tsygankova DP. Healthy nutrition in secondary prevention after myocardial infarction. What to focus on? КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-2918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Rationalization of dietary behavior in patients after myocardial infarction is the subject of numerous discussions. Despite the proven preventive effect of a healthy diet and the benefits of certain foods in cardiovascular diseases, this type of intervention is still underused. The aim of this review was to analyze current approaches to modifying the nutrition of patients within the secondary prevention of myocardial infarction. For this, 903 publications from PubMed/MEDLINE database over the past 5 years were studied. The Mediterranean diet demonstrated the highest efficacy and safety in preventing athero-thrombotic events among existing dietary patterns. However, its wide reproducibility in different regions is associated with a number of limitations. Government programs to modify and support a healthy diet beyond the conventional low-cholesterol diet may be promising in secondary prevention, especially if patients are properly monitored and motivated.
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Affiliation(s)
- O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - D. Yu. Sedykh
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - T. S. Petrova
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - V. V. Kashtalap
- Research Institute for Complex Issues of Cardiovascular Diseases
| | - D. P. Tsygankova
- Research Institute for Complex Issues of Cardiovascular Diseases
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Effects of Supervised Cardiac Rehabilitation Programmes on Quality of Life among Myocardial Infarction Patients: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2021; 8:jcdd8120166. [PMID: 34940521 PMCID: PMC8703932 DOI: 10.3390/jcdd8120166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/11/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022] Open
Abstract
Coronary heart disease is the leading cause of death and disability worldwide. Traditionally, cardiac rehabilitation programmes are offered after cardiac events to aid recovery, improve quality of life, and reduce adverse events. The objective of this review was to assess the health-related quality of life, after a supervised cardiac rehabilitation programme, of patients who suffered a myocardial infarction. A systematic review was carried out in the CINAHL, Cochrane, LILACS, Medline, Scopus, and SciELO databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Randomised controlled trials were selected. Meta-analyses were performed for the Short Form Health Survey SF-36, Myocardial Infarction Dimensional Assessment Scale (MIDAS), MacNew Heart Disease-Health-Related Quality of Life (HRQL) questionnaire, and European Quality of Life-Visual Analogue Scale (EuroQol-VAS) with the software Cochrane RevMan Web. Ten articles were found covering a total of 3577 patients. In the meta-analysis, the effect size of the cardiac rehabilitation programme was statistically significant in the intervention group for physical activity, emotional reaction, and dependency dimensions of the MIDAS questionnaire. For the control group, the score improved for SF-36 physical functioning, and body pain dimensions. The mean difference between the control and intervention group was not significant for the remaining dimensions, and neither for the MacNew Heart Disease-HRQL and EuroQol-VAS questionnaires. Supervised cardiac rehabilitation programmes were effective in improving health-related quality of life, however, there was a potential variability in the interventions; therefore, the results should be interpreted with caution. This study supports the importance of providing care and evaluating interventions via the supervision of trained health professionals, and further randomised clinical trials are needed to analyse the positive changes in mental and physical health outcomes.
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Effect of pecan nuts and extra-virgin olive oil on glycemic profile and nontraditional anthropometric indexes in patients with coronary artery disease: a randomized clinical trial. Eur J Clin Nutr 2021; 76:827-834. [PMID: 34811509 DOI: 10.1038/s41430-021-01045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES The influence of cardioprotective foods on nontraditional indexes related to dysglycemia and body fat distribution is unknown in individuals with coronary artery disease (CAD). This study aimed to evaluate the effect of a healthy diet supplemented with pecan nuts or extra-virgin olive oil on glycemic profile and adipose tissue dysfunction assessed by anthropometric indexes in patients with stable CAD. SUBJECTS/METHODS In a randomized, pragmatic, parallel clinical trial lasting 12 weeks, 204 individuals were allocated to three interventions: a healthy diet (control group [CG], n = 67), a healthy diet plus 30 g/day of pecan nuts (pecan nut group [PNG], n = 68), or a healthy diet plus 30 mL/day of extra-virgin olive oil (olive oil group [OOG], n = 69). Triglyceride-glucose (TyG) index (primary outcome) and other markers of glycemic profile were evaluated, and nontraditional anthropometric indexes as well. Diet quality was assessed according to the Alternate Healthy Eating Index (mAHEI). RESULTS After adjustment for baseline values, use of antidiabetic drugs and insulin, there were no differences in both glycemic and anthropometric profiles according to groups at the end of the study. PNG improved the quality of the diet in comparison to other groups (final mAHEI scores: CG: 19 ± 7.5; PNG: 26 ± 8; OOG: 18.9 ± 6; P < 0.001). CONCLUSIONS There was no difference regarding glycemic and anthropometric parameters according to interventions in patients with stable CAD. However, adding pecan nuts to a healthy diet may improve its quality. Further studies must be conducted considering dietary interventions on secondary cardiovascular prevention setting. CLINICAL TRIALS IDENTIFIER NUMBER NCT02202265. First Posted: July 2014; Last Update: September 2020.
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Adegbola A, Behrendt CA, Zyriax BC, Windler E, Kreutzburg T. The impact of nutrition on the development and progression of peripheral artery disease: A systematic review. Clin Nutr 2021; 41:49-70. [PMID: 34864455 DOI: 10.1016/j.clnu.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/16/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS This systematic review sought to identify and summarize existing evidence for the impact of nutrition on the development, progression, and outcomes of peripheral artery disease (PAD). METHODS We performed a systematic literature search of available studies published between January 1974 and December 2019. Randomized controlled trials (RCT), observational studies, and cross-sectional studies reporting either the primary or secondary prevention of PAD with nutritional intake were included. The quality assessment was performed for the RCTs, without pooling a meta-risk estimate. RESULTS Among a total of 8502 records screened, 186 full texts were assessed for eligibility, and 82 studies (30% RCT) were analyzed. The nutrients were structured in fruits, vegetables and antioxidants, fats and oils, dietary fiber, meat, proteins, vitamins and trace elements, and diets and lifestyle. The findings of the current systematic review indicate that the Mediterranean diet, nuts, and polyunsaturated fat are associated with a lower incidence of PAD and saturated fat, cholesterol, and processed meat were associated with higher rates of cardiovascular events in patients suffering from PAD. CONCLUSIONS The current review found evidence of a beneficial impact of the Mediterranean diet including nuts in this target population. More RCTs and high-quality registries are needed that focus on nutritional habits among patients with PAD to design appropriate preventive programs.
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Affiliation(s)
- Abiodun Adegbola
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Birgit-Christiane Zyriax
- University Professorship for Midwifery Science - Health Care Research and Prevention, IVDP, University Medical Center Hamburg-Eppendorf, Germany.
| | - Eberhard Windler
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Thea Kreutzburg
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Guerra TDRB. The Present and Future of the Cardioprotective Food Model for the Brazilian Population. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20210254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Effects of a Brazilian cardioprotective diet and nuts on cardiometabolic parameters after myocardial infarction: study protocol for a randomized controlled clinical trial. Trials 2021; 22:582. [PMID: 34470656 PMCID: PMC8411551 DOI: 10.1186/s13063-021-05494-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Nut consumption has been related to improvements on cardiometabolic parameters and reduction in the severity of atherosclerosis mainly in primary cardiovascular prevention. The objective of this trial is to evaluate the effects of the Brazilian Cardioprotective Diet (DIetaCArdioprotetoraBrasileira, DICA Br) based on consumption of inexpensive locally accessible foods supplemented or not with mixed nuts on cardiometabolic features in patients with previous myocardial infarction (MI). Methods DICA-NUTS study is a national, multicenter, randomized 16-week follow-up clinical trial. Patients over 40 years old with diagnosis of previous MI in the last 2 to 6 months will be recruited (n = 388). A standardized questionnaire will be applied to data collection and blood samples will be obtained. Patients will be allocated in two groups: Group 1: DICA Br supplemented with 30 g/day of mixed nuts (10 g of peanuts, 10 g of cashew, 10 g of Brazil nuts); and Group 2: only DICA Br. The primary outcome will consist of LDL cholesterol means (in mg/dL) after 16 weeks of intervention. Secondary outcomes will consist of other markers of lipid profile, glycemic profile, and anthropometric data. Discussion It is expected that DICA Br supplemented with mixed nuts have superior beneficial effects on cardiometabolic parameters in patients after a MI, when compared to DICA Br. Trial registration ClinicalTrials.gov Identifier NCT03728127. First register: November 1, 2018; Last update: June 16, 2021. World Health Organization Universal Trial Number (WHO-UTN): U1111-1259-8105. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05494-0.
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Martins PRT, Moreira ASB, Santos EMD, Rodrigues LF, Weber B. Effect of the Brazilian Cardioprotective Nutritional Program on the Quality of Life of Atherosclerotic Disease Patients. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Bersch-Ferreira AC, Hall WL, Santos RHN, Torreglosa CR, Sampaio G, Tereza da Silva J, Alves R, Ross MB, Gehringer MO, Kovacs C, Marcadenti A, Magnoni D, Weber B, Rogero MM. The effect of the a regional cardioprotective nutritional program on inflammatory biomarkers and metabolic risk factors in secondary prevention for cardiovascular disease, a randomised trial. Clin Nutr 2021; 40:3828-3835. [PMID: 34130029 DOI: 10.1016/j.clnu.2021.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/28/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS To evaluate the effect of the Brazilian Cardioprotective Diet Program (BALANCE Program) on inflammatory biomarkers, involved in the pathophysiology of the atherosclerosis, on inflammatory biomarkers, cardiovascular risk factors, and on plasma fatty acids in cardiovascular disease secondary prevention patients. METHODS In this substudy of the BALANCE Program randomized clinical trial, a total of 369 patients aged 45 years or older, who have experienced cardiovascular disease in the previous 10 years, were included. These patients were randomized into two groups and followed up for six months: BALANCE Program group and control group (conventional nutrition advice). In the initial and six-month final visits, anthropometry (body weight, height and waist circumference), food intake evaluation by 24-h dietary recall, plasma inflammatory biomarkers (IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-α, adiponectin, and C-reactive protein levels), blood pressure, glycemia, insulinemia, lipid profile, and plasma fatty acids levels were evaluated. RESULTS The BALANCE Program group showed increased plasma alpha-linolenic acid levels (P = 0.008), reduction in waist circumference (P = 0.049) and BMI (P = 0.032). No difference was observed among plasma inflammatory biomarkers and clinical data. CONCLUSION After six months of follow-up, BALANCE Program led to a significant reduction on BMI and waist circumference in individuals in secondary prevention for cardiovascular disease. Although plasmatic alpha-linolenic acid has increased, there was no impact on plasma inflammatory biomarkers. CLINICAL TRIAL REGISTRATION NCT01620398.
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Affiliation(s)
- Angela C Bersch-Ferreira
- Research Institute-HCor, São Paulo, Brazil; Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Wendy L Hall
- Department of Nutritional Sciences, Faculty of Life Sciences & Medicine, Kings College, London, England
| | | | - Camila R Torreglosa
- Research Institute-HCor, São Paulo, Brazil; Program in Global Health and Sustainability, University of São Paulo, São Paulo, SP, Brazil
| | - Geni Sampaio
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Renata Alves
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Department of Clinical Nutrition at Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Maria Beatriz Ross
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Cristiane Kovacs
- Department of Clinical Nutrition at Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Aline Marcadenti
- Research Institute-HCor, São Paulo, Brazil; Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Daniel Magnoni
- Department of Clinical Nutrition at Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Marcelo Macedo Rogero
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
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Oliveira MGD, Silva AFDAD, Santos TLD, Cunha ML, Taveira BRF, Muxfeldt ES. Potential Impact of the New American High Blood Pressure Guidelines on Hypertension Prevalence in a Primary Health Care Unit in Rio de Janeiro – the LapARC Study. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20190205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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de Brito Gonçalves Nascimento L, Sahade V, Weber B, Pinheiro JMF, Dias LPP, Figueiredo Neto JA, Carlos Sobral Sousa A, Pinho CPS, Luna AB, Vasconcelos SML, Dantas CDF, Penafort ADM, Carlos DMDO, Daltro C. Diabetic Patients with Cardiovascular Disease Show More Metabolic Syndrome than Nondiabetic Patients: Multicentric Study in the Northeast of Brazil. Metab Syndr Relat Disord 2021; 19:233-239. [PMID: 33523760 DOI: 10.1089/met.2020.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Diabetes mellitus (DM) is associated with a higher prevalence of metabolic syndrome (MS) and cardiovascular mortality. However, few Brazilian studies evaluated MS in diabetic individuals with cardiovascular disease (CVD). Nevertheless, the objective of this study was to compare the prevalence of MS in cardiac patients with and without DM. Methods: Cross-sectional study of BALANCE Program Trial with patients with CVD, ≥45 years old, who had been attending specialized ambulatories on cardiovascular health, in eight states in the Northeast of Brazil. The components of MS were evaluated by following the criteria of National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP III) and Joint Interim Statement (JIS). In addition, there were investigated different indexes of abdominal obesity, variables related to lifestyle, and food intake. The statistical analysis included descriptive statistics and the Student's t-test, Mann-Whitney, and chi-squared tests for the comparison of groups. There were significant values of P < 0.05. Results: Six hundred forty-seven individuals were evaluated with average (standard deviation) age of 63.1 (9.3) years, being 50.5% females and 40.3% diabetic patients. When the groups of patients who were diabetic and the nondiabetic ones, the first showed higher percentage of obesity (38.5% vs. 23.2%, P < 0.001), of high waist circumference (84.8% vs. 71.9%; P < 0.001), higher waist-height ratio [0.6 (0.6-0.7) vs. 0.6 (0.5-0.6); P < 0.001], conicity index [1.35 (1.29-1.39) vs. 1.32 (1.27-1.38); P = 0.004], and prevalence of MS, because of the criteria of NCEP ATP III (98.8% vs. 80.4%; P < 0.001), as well as the criteria of JIS (99.2% vs. 89.3%; P < 0.001). The component of higher frequency was high blood pressure and/or hypertension (95.0%), followed by hypertriglyceridemia (93.0%). There were no differences regarding age, lifestyle, and food intake. Conclusions: Diabetic individuals with CVD showed more prevalence of MS and more abdominal obesity than nondiabetic individuals. ClinicalTrials.gov ID: NCT01620398.
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Affiliation(s)
- Luciana de Brito Gonçalves Nascimento
- University Hospital Complex Professor Edgard Santos, Federal University of Bahia, and Medicine and Health Postgraduate Program University Federal of Bahia, Salvador, Brazil
| | - Viviane Sahade
- Department of Nutrition, Nutrition School of Federal University of Bahia, Salvador, Brazil
| | | | | | | | | | | | | | | | | | - Clenise de Farias Dantas
- University Hospital Alcides Carneiro, Federal University of Campina Grande, Campina Grande, Brazil
| | | | | | - Carla Daltro
- Medicine and Health Postgraduate Program University Federal of Bahia and Department of Nutrition, Nutrition School of University Federal of Bahia, Salvador, Brazil
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Alves da Silva R, Bersch-Ferreira ÂC, Gehringer MO, Ross-Fernandes MB, Kovacs do Amaral C, Lin Wang HT, Lima PH, de Lima PA, França JÍ, Weber B, Magnoni CD, Rogero MM. Effect of qualitative and quantitative nutritional plan on gene expression in obese patients in secondary prevention for cardiovascular disease. Clin Nutr ESPEN 2021; 41:351-359. [PMID: 33487289 DOI: 10.1016/j.clnesp.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND & AIMS Diet is a modifiable risk factor, which may influence the gene expression and the concentration of inflammatory biomarkers related to obesity and atherosclerosis. In this substudy from Brazilian Cardioprotective Nutritional (BALANCE) Program, we hypothesized that a nutritional intervention based on the usual Brazilian diet modulates the expression of genes involved with atherosclerosis and inflammatory biomarkers in male patients, in the secondary prevention for cardiovascular disease. METHODS Six male patients, aged 45 years or older, obese, were selected to follow a qualitative-quantitative food plan for 6 months. Glycemia, insulinemia, lipid profile, plasma concentration of inflammatory biomarkers (interleukin (IL) -1β), IL-6, IL-8, IL-10, IL-12, tumor necrosis factor alpha, C-reactive protein and adiponectin, and expression of 84 atherosclerosis-related genes in total peripheral blood cells, were measured. RESULTS After nutritional intervention, the participants reduced weight (p < 0.04), waist circumference (p < 0.04), Homeostasis Model Assessment index for insulin resistance (p = 0.046) and overall leukocyte count (p = 0.046) and neutrophils (p = 0.028). There was no significant modification in the plasma concentration of the inflammatory biomarkers, however, there was a significant increase in the expression of Apo A1 (p = 0.011), ELN (p = 0.017) and IL4 (p = 0.037) genes. CONCLUSIONS The BALANCE Program, the qualitative-quantitative food plan composed of Brazilian usual foods, did not reduce the concentration of inflammatory biomarkers, but increased in total peripheral blood cells the expression of genes involved in reducing the risk of cardiometabolic in obese patients, in secondary prevention for cardiovascular disease. The clinical trial is registered at https://clinicaltrials.gov/ and the unique identifier is NCT01620398.
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Affiliation(s)
- Renata Alves da Silva
- Department of Clinical Nutrition, Instituto Dante Pazzanese de Cardiologia, 04012-090, São Paulo, SP, Brazil.
| | | | - Marcella Omena Gehringer
- Nutritional Genomics and Inflammation Laboratory, Department of Nutrition, School of Public Health, University of São Paulo, 01246-904, São Paulo, Brazil.
| | - Maria Beatriz Ross-Fernandes
- Nutritional Genomics and Inflammation Laboratory, Department of Nutrition, School of Public Health, University of São Paulo, 01246-904, São Paulo, Brazil.
| | - Cristiane Kovacs do Amaral
- Department of Clinical Nutrition, Instituto Dante Pazzanese de Cardiologia, 04012-090, São Paulo, SP, Brazil.
| | - Hui-Tzu Lin Wang
- Department of Clinical Nutrition, Instituto Dante Pazzanese de Cardiologia, 04012-090, São Paulo, SP, Brazil.
| | - Paula Helena Lima
- Department of Clinical Nutrition, Instituto Dante Pazzanese de Cardiologia, 04012-090, São Paulo, SP, Brazil.
| | - Patrícia Azevedo de Lima
- Nutritional Genomics and Inflammation Laboratory, Department of Nutrition, School of Public Health, University of São Paulo, 01246-904, São Paulo, Brazil.
| | - João Ítalo França
- Department of Clinical Nutrition, Instituto Dante Pazzanese de Cardiologia, 04012-090, São Paulo, SP, Brazil.
| | - Bernardete Weber
- Research Institute - Hospital do Coração, 04005-000, São Paulo, SP, Brazil.
| | - Carlos Daniel Magnoni
- Department of Clinical Nutrition, Instituto Dante Pazzanese de Cardiologia, 04012-090, São Paulo, SP, Brazil.
| | - Marcelo Macedo Rogero
- Nutritional Genomics and Inflammation Laboratory, Department of Nutrition, School of Public Health, University of São Paulo, 01246-904, São Paulo, Brazil.
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Torreglosa CR, Sarti FM, Bersch-Ferreira ÂC, Weber B, Santos RHN, Chiavegatto Filho ADP. [Quality of diet and daily spending on food by adults with cardiovascular disease in Brazil]. CAD SAUDE PUBLICA 2020; 36:e00225019. [PMID: 33027431 DOI: 10.1590/0102-311x00225019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 03/31/2020] [Indexed: 12/27/2022] Open
Abstract
Adherence to a healthy diet depends on factors such as food prices, while studies in developed countries have identified higher costs of more nutritional foods. The current study aimed to assess the direct food expenditures by adults with cardiovascular disease in Brazil, investigating the relationship between cost and quality of diet. The study used data from a randomized clinical trial, the BALANCE Program. The current study is a cross-sectional baseline analysis of participants with high adherence to the trial, conducted in 35 sites in all five major geographic regions of Brazil. Food consumption by 1,160 individuals was collected with a 24-hour dietary recall (24HR), quality of diet was measured with the Diet Quality Index Revised (DQI-R), and direct food costs were estimated from market prices. No significant differences were observed between tertiles of adherence in the direct costs of food or individual characteristics. When all the 24HR were analyzed, there was no correlation between cost and quality of diet (r = 0.38; p = 0.17), while analysis by tertiles showed a weak correlation in the lowest tertile of adherence (r = -0.112; p = 0.03). The study showed absence of differences between direct costs of healthy versus unhealthy foods, a finding that can serve as an incentive for adherence to food recommendations in Brazil, thereby minimizing barriers to the adoption of healthy lifestyles.
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Parks K, Polak R. Culinary Medicine: Paving the Way to Health Through Our Forks. Am J Lifestyle Med 2020; 14:51-53. [PMID: 31903082 DOI: 10.1177/1559827619871922] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 02/04/2023] Open
Abstract
Recent findings reveal that suboptimal diet is responsible for more deaths than any other risk factor nationally and globally. It is estimated that with improving eating behaviors, 1 in 5 deaths can be prevented, underscoring the urgent need for effective dietary interventions.
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Affiliation(s)
- Kimberly Parks
- Division of Cardiology, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, Massachusetts (KP).,CHEF Coaching Program, Institute of Lifestyle Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, and Lifestyle Medicine Center, Sheba Medical Center, Tel Hashomer, Israel (RP)
| | - Rani Polak
- Division of Cardiology, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, Massachusetts (KP).,CHEF Coaching Program, Institute of Lifestyle Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, and Lifestyle Medicine Center, Sheba Medical Center, Tel Hashomer, Israel (RP)
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