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Ma Y, Zheng Z, Zhuang L, Wang H, Li A, Chen L, Liu L. Dietary Macronutrient Intake and Cardiovascular Disease Risk and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Nutrients 2024; 16:152. [PMID: 38201983 PMCID: PMC10780780 DOI: 10.3390/nu16010152] [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: 11/17/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Many epidemiological studies have evaluated the intake of macronutrients and the risk of mortality and cardiovascular disease (CVD). However, current evidence is conflicting and warrants further investigation. Therefore, we carried out an umbrella review to examine and quantify the potential dose-response association of dietary macronutrient intake with CVD morbidity and mortality. Prospective cohort studies from PubMed, Embase, and CENTRAL were reviewed, which reported associations of macronutrients (protein, fat, and carbohydrate) with all-cause, CVD, cancer mortality, or CVD events. Multivariable relative risks (RR) were pooled, and heterogeneity was assessed. The results of 124 prospective cohort studies were included in the systematic review and 101 in the meta-analysis. During the follow-up period from 2.2 to 30 years, 506,086 deaths and 79,585 CVD events occurred among 5,107,821 participants. High total protein intake was associated with low CVD morbidity (RR 0.88, 95% confidence interval 0.82-0.94), while high total carbohydrate intake was associated with high CVD morbidity (1.08, 1.02-1.13). For fats, a high intake of total fat was associated with a decreased all-cause mortality risk (0.92, 0.85-0.99). Saturated fatty acid intake was only associated with cancer mortality (1.10, 1.06-1.14); Both monounsaturated fatty acid (MUFA) and polyunsaturated fatty acids (PUFA) intake was associated with all-cause mortality (MUFA: 0.92, 0.86-0.98; PUFA: 0.91, 0.86-0.96). This meta-analysis supports that protein intake is associated with a decreased risk of CVD morbidity, while carbohydrate intake is associated with an increased risk of CVD morbidity. High total fat intake is associated with a low risk of all-cause mortality, and this effect was different in an analysis stratified by the type of fat.
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Affiliation(s)
- Yibin Ma
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.M.); (Z.Z.); (L.C.)
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Zekun Zheng
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.M.); (Z.Z.); (L.C.)
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Litao Zhuang
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Huiting Wang
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Anni Li
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.M.); (Z.Z.); (L.C.)
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
| | - Liegang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.M.); (Z.Z.); (L.C.)
- Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (L.Z.); (H.W.); (A.L.)
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The Impact of High Protein Diets on Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Nutrients 2023; 15:nu15061372. [PMID: 36986102 PMCID: PMC10058321 DOI: 10.3390/nu15061372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
High protein diets have gained increased popularity as a means of losing weight, increasing muscle mass and strength, and improving cardiometabolic parameters. Only a few meta-analyses have addressed their impact on cardiovascular morbidity and mortality and failed to show any significant associations without applying strict values to define high protein intake. Due to the conflicting research background, we conducted a meta-analysis to assess the impact of high protein diets compared to normal protein consumption on cardiovascular outcomes in adults without established cardiovascular disease. Fourteen prospective cohort studies were included. A total of 6 studies, including 221,583 participants, reported data about cardiovascular death, without showing a statistically significant difference in the random effect model (odds ratio: 0.94; confidence interval: 0.60–1.46; I2 = 98%; p = 0.77). Analysis of three studies, which included 90,231 participants showed that a high protein diet was not associated with a lower risk of stroke (odds ratio: 1.02; confidence interval: 0.94–1.10; I2 = 0%; p = 0.66). Regarding the secondary outcome of non-fatal myocardial infarction, stroke, or cardiovascular death, 13 studies that included 521,155 participants showed no statistically significant difference (odds ratio; 0.87; confidence interval: 0.70–1.07; I2 = 97%; p = 0.19). In conclusion, according to our study results, high protein consumption does not affect cardiovascular prognosis.
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Yuan Z, Yu Z, Zhang Y, Yang H. Analysis of the Clinical Diagnostic Value of GMFB in Cerebral Infarction. Curr Pharm Biotechnol 2020; 21:955-963. [PMID: 32039676 DOI: 10.2174/1389201021666200210102425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/12/2019] [Accepted: 01/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Glial Maturation Factor Beta (GMFB) is a highly conserved brain-enriched protein implicated in immunoregulation, neuroplasticity and apoptosis, processes central to neural injury and repair following cerebral ischaemia. Therefore, we examined if changes in neurocellular GMFB expression and release can be used to assess brain injury following ischaemia. METHODS AND RESULTS Immunofluorescence staining, Western blotting, immunohistochemistry and ELISA were used to measure GMFB in cultured neurons and astrocytes, rat brain tissues and plasma samples from stroke model rats and stroke patients, while cell viability assays, TTC staining and micro- PET were used to assess neural cell death and infarct severity. Immunofluorescence and immunohistochemistry revealed GMFB expression mainly in astrocyte and neuronal nuclei but also in neuronal axons and dendrites. Free GMFB concentration increased progressively in the culture medium during hypoxia-hypoglycaemia treatment. Plasma GMFB concentration increased in rats subjected to middle cerebral artery occlusion (MCAO, a model of stroke-reperfusion) and in stroke patients. Plasma GMFB in MCAO model rats was strongly correlated with infarct size (R2=0.9582). Plasma GMFB concentration was also markedly elevated in stroke patients within 24 h of onset and remained elevated for more than one week. Conversely, plasma GMFB elevations were not significant in myocardial infarct patients and stroke patients without infarction. CONCLUSION GMFB has the prerequisite stability, expression specificity and response dynamics to serve as a reliable indicator of ischaemic injury in animal models and stroke patients. Plasma GMFB may be a convenient non-invasive adjunct to neuroimaging for stroke diagnosis and prognosis.
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Affiliation(s)
- Zhaohu Yuan
- Department of Blood Transfusion, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China
| | - Zhiwu Yu
- Division of Laboratory Science, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong, China
| | - Yiyu Zhang
- Department of Blood Transfusion, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China
| | - Huikuan Yang
- Department of Blood Transfusion, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China
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Kurihara A, Okamura T, Sugiyama D, Higashiyama A, Watanabe M, Okuda N, Kadota A, Miyagawa N, Fujiyoshi A, Yoshita K, Ohkubo T, Okayama A, Miura K, Ueshima H. Vegetable Protein Intake was Inversely Associated with Cardiovascular Mortality in a 15-Year Follow-Up Study of the General Japanese Population. J Atheroscler Thromb 2019; 26:198-206. [PMID: 30089755 PMCID: PMC6365153 DOI: 10.5551/jat.44172] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/11/2018] [Indexed: 11/24/2022] Open
Abstract
AIM To examine the relationship between the intake of dietary vegetable protein and CVD mortality in a 15-year follow-up study of a representative sample of the Japanese population. METHODS A total of 7,744 participants aged 30 years or older (3,224 males and 4,520 females) who were free of CVD at baseline were included in this analysis. Vegetable protein intake (% energy) was assessed using a three-day semi-weighed dietary record at baseline. Multivariable-adjusted hazard ratios (HRs) were calculated using Cox's proportional hazards model after adjusting for confounding factors. RESULTS The total person-years studied were 107,988 with a mean follow-up period of 13.9 years. There were 1,213 deaths during the follow-up period, among which 354 (29.2%) were due to CVD. Vegetable protein intake was associated inversely with CVD and cerebral hemorrhage mortality, with the HRs for a 1% energy increment in vegetable protein intake being 0.86 (95% CI, 0.75-0.99) and 0.58 (95% CI, 0.35-0.95), respectively. In the subgroup analysis of participants with or without hypertension, the inverse association between vegetable protein intake and CVD mortality was more evident in the nonhypertensive group, with the HRs for CVD and stroke being 0.68 (95% CI, 0.50-0.94) and 0.50 (95% CI, 0.30-0.84), respectively. CONCLUSIONS Vegetable protein intake may prevent future CVD, particularly in nonhypertensive subjects in the Japanese population. However, further studies are necessary to examine the biological mechanisms of this effect.
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Affiliation(s)
- Ayako Kurihara
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Sugiyama
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Aya Higashiyama
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Makoto Watanabe
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Katsushi Yoshita
- Department of Food and Nutrition, Osaka City University, Osaka, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University, Tokyo, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - for the NIPPON DATA90 Research Group
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan
- Research Institute of Strategy for Prevention, Tokyo, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
- Department of Food and Nutrition, Osaka City University, Osaka, Japan
- Department of Hygiene and Public Health, Teikyo University, Tokyo, Japan
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Ozawa M, Yoshida D, Hata J, Ohara T, Mukai N, Shibata M, Uchida K, Nagata M, Kitazono T, Kiyohara Y, Ninomiya T. Dietary Protein Intake and Stroke Risk in a General Japanese Population: The Hisayama Study. Stroke 2017; 48:1478-1486. [PMID: 28487340 DOI: 10.1161/strokeaha.116.016059] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/18/2017] [Accepted: 03/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The influence of dietary protein intake on stroke risk is an area of interest. We investigated the association between dietary protein intake and stroke risk in Japanese, considering sources of protein. METHODS A total of 2400 subjects aged 40 to 79 years were followed up for 19 years. Dietary protein intake was estimated using a 70-item semiquantitative food frequency questionnaire. The risk estimates for incident stroke and its subtypes were calculated using a Cox proportional hazards model. RESULTS During the follow-up, 254 participants experienced stroke events; of these, 172 had ischemic stroke, and 58 had intracerebral hemorrhage. Higher total protein intake was significantly associated with lower risks of stroke and intracerebral hemorrhage (both P for trend <0.05). With regard to sources of protein, the risks of total stroke and ischemic stroke significantly decreased by 40% (95% confidence interval, 12%-59%) and 40% (5%-62%), respectively, in subjects with the highest quartile of vegetable protein intake compared with those with the lowest one. In contrast, subjects with the highest quartile of animal protein intake had a 53% (4%-77%) lower risk of intracerebral hemorrhage. Vegetable protein intake was positively correlated with intakes of soybean products, vegetable, and algae, whereas animal protein intake was positively correlated with intakes of fish, meat, eggs, and milk/dairy products. Both types of protein intakes were negatively correlated with intakes of rice and alcohol. CONCLUSIONS Our findings suggest that higher dietary protein intake is associated with a reduced risk of stroke in the general Japanese population.
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Affiliation(s)
- Mio Ozawa
- From the Department of Epidemiology and Public Health (M.O., D.Y., J.H., T.O., N.M., M.S., T.N.), Center for Cohort Studies (D.Y., J.H., N.M., M.S., T.N.), Department of Medicine and Clinical Science (J.H., N.M., T.K.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan (K.U.); Food Science Research Laboratories, Division of Research and Development, Meiji Co, Ltd, Odawara, Japan (M.N.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Daigo Yoshida
- From the Department of Epidemiology and Public Health (M.O., D.Y., J.H., T.O., N.M., M.S., T.N.), Center for Cohort Studies (D.Y., J.H., N.M., M.S., T.N.), Department of Medicine and Clinical Science (J.H., N.M., T.K.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan (K.U.); Food Science Research Laboratories, Division of Research and Development, Meiji Co, Ltd, Odawara, Japan (M.N.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Jun Hata
- From the Department of Epidemiology and Public Health (M.O., D.Y., J.H., T.O., N.M., M.S., T.N.), Center for Cohort Studies (D.Y., J.H., N.M., M.S., T.N.), Department of Medicine and Clinical Science (J.H., N.M., T.K.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan (K.U.); Food Science Research Laboratories, Division of Research and Development, Meiji Co, Ltd, Odawara, Japan (M.N.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Tomoyuki Ohara
- From the Department of Epidemiology and Public Health (M.O., D.Y., J.H., T.O., N.M., M.S., T.N.), Center for Cohort Studies (D.Y., J.H., N.M., M.S., T.N.), Department of Medicine and Clinical Science (J.H., N.M., T.K.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan (K.U.); Food Science Research Laboratories, Division of Research and Development, Meiji Co, Ltd, Odawara, Japan (M.N.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Naoko Mukai
- From the Department of Epidemiology and Public Health (M.O., D.Y., J.H., T.O., N.M., M.S., T.N.), Center for Cohort Studies (D.Y., J.H., N.M., M.S., T.N.), Department of Medicine and Clinical Science (J.H., N.M., T.K.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan (K.U.); Food Science Research Laboratories, Division of Research and Development, Meiji Co, Ltd, Odawara, Japan (M.N.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Mao Shibata
- From the Department of Epidemiology and Public Health (M.O., D.Y., J.H., T.O., N.M., M.S., T.N.), Center for Cohort Studies (D.Y., J.H., N.M., M.S., T.N.), Department of Medicine and Clinical Science (J.H., N.M., T.K.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan (K.U.); Food Science Research Laboratories, Division of Research and Development, Meiji Co, Ltd, Odawara, Japan (M.N.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Kazuhiro Uchida
- From the Department of Epidemiology and Public Health (M.O., D.Y., J.H., T.O., N.M., M.S., T.N.), Center for Cohort Studies (D.Y., J.H., N.M., M.S., T.N.), Department of Medicine and Clinical Science (J.H., N.M., T.K.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan (K.U.); Food Science Research Laboratories, Division of Research and Development, Meiji Co, Ltd, Odawara, Japan (M.N.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Masashi Nagata
- From the Department of Epidemiology and Public Health (M.O., D.Y., J.H., T.O., N.M., M.S., T.N.), Center for Cohort Studies (D.Y., J.H., N.M., M.S., T.N.), Department of Medicine and Clinical Science (J.H., N.M., T.K.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan (K.U.); Food Science Research Laboratories, Division of Research and Development, Meiji Co, Ltd, Odawara, Japan (M.N.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Takanari Kitazono
- From the Department of Epidemiology and Public Health (M.O., D.Y., J.H., T.O., N.M., M.S., T.N.), Center for Cohort Studies (D.Y., J.H., N.M., M.S., T.N.), Department of Medicine and Clinical Science (J.H., N.M., T.K.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan (K.U.); Food Science Research Laboratories, Division of Research and Development, Meiji Co, Ltd, Odawara, Japan (M.N.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Yutaka Kiyohara
- From the Department of Epidemiology and Public Health (M.O., D.Y., J.H., T.O., N.M., M.S., T.N.), Center for Cohort Studies (D.Y., J.H., N.M., M.S., T.N.), Department of Medicine and Clinical Science (J.H., N.M., T.K.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan (K.U.); Food Science Research Laboratories, Division of Research and Development, Meiji Co, Ltd, Odawara, Japan (M.N.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.)
| | - Toshiharu Ninomiya
- From the Department of Epidemiology and Public Health (M.O., D.Y., J.H., T.O., N.M., M.S., T.N.), Center for Cohort Studies (D.Y., J.H., N.M., M.S., T.N.), Department of Medicine and Clinical Science (J.H., N.M., T.K.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Promotion, School of Health and Nutrition Sciences, Nakamura-Gakuen University, Fukuoka, Japan (K.U.); Food Science Research Laboratories, Division of Research and Development, Meiji Co, Ltd, Odawara, Japan (M.N.); and Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan (Y.K.).
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Abstract
Adequate protein intake is critical for health and development. Generally, protein of animal origin is of higher quality for humans owing to its amino acid pattern and good digestibility. When administered in mixtures it can enhance the quality of plant proteins, but its availability is often low in low-income communities, especially in young children, the elderly, and pregnant and lactating women, who have increased requirements and in whom high-quality protein also stimulates (bone) growth and maintenance. Although high protein intake was associated with increased type 2 diabetes mellitus risk, milk and seafood are good sources of branched chain amino acids and taurine, which act beneficially on glucose metabolism and blood pressure. However, high consumption of protein-rich animal food is also associated with adverse health effects and higher risk for noncommunicable diseases, partly related to other components of these foods, like saturated fatty acids and potential carcinogens in processed meat but also the atherogenic methionine metabolite homocysteine. In moderation, however, animal proteins are especially important for health maintenance in vulnerable persons.
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Affiliation(s)
- Ibrahim Elmadfa
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Vienna 1010, Austria;,
| | - Alexa L. Meyer
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Vienna 1010, Austria;,
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Salari A, Mahdavi-Roshan M, Hasandokht T, Gholipour M, Soltanipour S, Nagshbandi M, Javadzadeh A. Nutritional intake, depressive symptoms and vitamin D status in hypertensive patients in the north of Iran: A case-control study. HIPERTENSION Y RIESGO VASCULAR 2016; 34:65-71. [PMID: 28039036 DOI: 10.1016/j.hipert.2016.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We investigated vitamin D status, body size, nutritional intake and depression status in hypertensive patients in the north of Iran that have special dietary habit and lifestyle according to their culture and geographical situation. MATERIALS AND METHODS This study was conducted on 127 patients with newly recognized hypertension and the 120 normal participants, in the north of Iran. Anthropometric data was measured and demographic characteristics, dietary intake, depression and medical status were collected by valid questionnaires. Blood samples were measured for 25-hydroxyvitamin D. RESULTS Hypertensive patients had significantly lower serum 25-hydroxyvitamin D than control group (16±8.7ng/mL vs. 19.8±8.4ng/mL; P=0.04). In adjusted model, serum 25-hydroxyvitamin D of less than 30ng/mL was associated with an almost 4-fold odds of hypertension. The odds of hypertension in depressed patients was 1.2 times higher than in those without depression (p=0.002). After adjusted logistic regression analysis for energy intake, significant association was observed between hypertension and some dietary nutrients, including cholesterol, fiber and vitamin D intake. There was no significant association between hypertension and body weight, waist circumference as well as BMI. CONCLUSION The vitamin D status was lower in the most individuals and it causes a considerable increase in the risk of hypertension. Undesirable intake of some nutrients and depression also increase the risk of developing hypertension. Health training about suitable dietary habits, easier access to vitamin D supplementation and screening for depression in patients with hypertension are cost-effective tools to improve outcomes in Iran.
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Affiliation(s)
- A Salari
- Guilan Interventional Cardiovascular Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - M Mahdavi-Roshan
- Guilan Interventional Cardiovascular Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran; Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - T Hasandokht
- Guilan Interventional Cardiovascular Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran; Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - M Gholipour
- Guilan Interventional Cardiovascular Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - S Soltanipour
- Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - M Nagshbandi
- Guilan Interventional Cardiovascular Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - A Javadzadeh
- Guilan Interventional Cardiovascular Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Zhang XW, Yang Z, Li M, Li K, Deng YQ, Tang ZY. Association between dietary protein intake and risk of stroke: A meta-analysis of prospective studies. Int J Cardiol 2016; 223:548-551. [DOI: 10.1016/j.ijcard.2016.08.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 08/05/2016] [Indexed: 11/27/2022]
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Courand PY, Lesiuk C, Milon H, Defforges A, Fouque D, Harbaoui B, Lantelme P. Association Between Protein Intake and Mortality in Hypertensive Patients Without Chronic Kidney Disease in the OLD-HTA Cohort. Hypertension 2016; 67:1142-9. [PMID: 27091898 DOI: 10.1161/hypertensionaha.116.07409] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/12/2016] [Indexed: 02/05/2023]
Abstract
Protein intake may have some benefits on reducing blood pressure and cardiovascular events, but their effects are still debated. The objective of this study was to test the prognostic value of protein intake assessed by 24-hour urinary urea in a cohort of hypertensive patients with preserved renal function. A total of 1128 hypertensive patients were followed according to tertile of protein intake adjusted for ideal body weight: <0.70, 0.70 to 0.93, and >0.93 g/kg. Baseline characteristics (mean±standard deviation) were age 45.1±13.2 years, systolic/diastolic blood pressure 185±32/107±20 mm Hg, and estimated glomerular filtration rate 82±32 mL/min. After 10 years of follow-up, 289 deaths occurred, 202 of which were of cardiovascular cause. After adjustment for major cardiovascular risk factors, patients in the second and third tertiles of protein intake had a decreased risk of all-cause death (hazard ratio [95% confidence interval], 0.71 [0.56-0.91]) and cardiovascular death (0.72 [0.54-0.96]), but not of stroke death (0.72 [0.41-1.28]) in comparison to patients in the low protein intake tertile. Normal-high protein intake was associated with a better outcome in a subset of the population: younger patients, low salt intake, without aortic atherosclerosis, or previous cardiovascular events (Pinteraction<0.10 for all). Hypertensive patients having a protein intake >0.7 g/kg ideal body weight, particularly those at low risk, had lower all-cause and cardiovascular mortality rates. Physicians may encourage hyper tensive patients to have normal or high protein diet in addition to low salt consumption, moderate alcohol consumption, and regular physical activity.
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Affiliation(s)
- Pierre-Yves Courand
- From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.).
| | - Chloé Lesiuk
- From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.)
| | - Hugues Milon
- From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.)
| | - Alice Defforges
- From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.)
| | - Denis Fouque
- From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.)
| | - Brahim Harbaoui
- From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.)
| | - Pierre Lantelme
- From the Cardiology Department, European Society of Hypertension Excellence center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France (P.-Y.C., C.L., H.M., A.D., B.H., P.L.); Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France (P.-Y.C., B.H., P.L.); and Department of Nephrology and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, CARMEN, CENS, Université Claude Bernard Lyon 1, F-69310, Pierre-Bénite, France (D.F.)
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Protein intake in early childhood and cardiometabolic health at school age: the Generation R Study. Eur J Nutr 2015; 55:2117-27. [PMID: 26329684 PMCID: PMC5009172 DOI: 10.1007/s00394-015-1026-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 08/19/2015] [Indexed: 01/06/2023]
Abstract
Purpose High protein intake in infancy has been linked to obesity. We aimed to examine the associations of protein intake in early childhood with cardiovascular and metabolic outcomes at school age. Methods This study was performed in 2965 children participating in a population-based prospective cohort study. Protein intake at 1 year was assessed with a food frequency questionnaire and was adjusted for energy intake. At the children’s age of 6 years, we measured their body fat percentage (BF%), blood pressure (BP), and insulin, HDL cholesterol, and triglyceride serum levels. These measures were incorporated into a cardiometabolic risk factor score, using age- and sex-specific SD scores. Results In covariate-adjusted models, higher protein intake was associated with a higher BF%, lower diastolic BP, and lower triglyceride levels. We observed a significant interaction of protein intake with child sex on metabolic outcomes. Stratified analyses showed that protein intake was positively associated with BF% [0.07 SD (95 % CI 0.02; 0.13) per 10 g/day] and insulin levels in girls, but not in boys. In boys, but not in girls, higher protein intake was associated with lower triglyceride levels [−0.12 SD (95 % CI −0.20; −0.04) per 10 g/day] and a lower cardiometabolic risk factor score. Protein intake was not consistently associated with systolic BP or HDL cholesterol levels. Conclusion Protein intake in early childhood was associated with a higher BF% and higher insulin levels at 6 years in girls and with lower triglyceride levels in boys. Further studies are needed to explore these sex differences and to investigate whether the observed changes persist into adulthood. Electronic supplementary material The online version of this article (doi:10.1007/s00394-015-1026-7) contains supplementary material, which is available to authorized users.
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11
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Kris-Etherton PM, Fleming JA. Emerging nutrition science on fatty acids and cardiovascular disease: nutritionists' perspectives. Adv Nutr 2015; 6:326S-37S. [PMID: 25979506 PMCID: PMC4424771 DOI: 10.3945/an.114.006981] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Recent dietary guidance for heart health recommends a reduction (by ∼50%) in saturated fatty acid (SFA) intake to reduce LDL cholesterol and to decrease risk of cardiovascular disease (CVD). The 2010 Dietary Guidelines for Americans recommends substituting unsaturated fat [both polyunsaturated and monounsaturated fatty acids (PUFAs and MUFAs, respectively)] for SFAs. There are many dietary options that can be implemented to replace SFAs, given the different sources of unsaturated fats in the food supply. Compelling evidence exists for the cardioprotective benefits of n-3 (ω-3) PUFAs, both marine- and plant-derived. In addition, the evidence of cardioprotective benefits of n-6 (ω-6) PUFAs is strong, whereas that for MUFAs is mixed, although there is emerging evidence of benefits. Quantitatively, lowering SFAs by 50% will require, in part, substituting food sources of n-6 and n-3 PUFAs and MUFAs for food sources of SFAs. The use of n-3 PUFAs as a replacement for SFAs will result in a shortfall in reaching the SFA goal because of the relatively low amounts that can be incorporated in the diet, even with very high n-3 PUFA substitution. SFAs also can be replaced with dietary carbohydrate and/or protein. Replacing SFAs with carbohydrate, specifically refined sources, however, has little impact on reducing CVD risk. There is evidence about the health benefits of dietary protein on CVD risk, which merits study. Dietary guidelines have advanced considerably with the "replacement of SFA with unsaturated fat message" instead of recommending decreasing SFAs alone. A key question that remains is what is the optimal mix of macronutrients to maximally reduce CVD risk.
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Affiliation(s)
- Penny M Kris-Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | - Jennifer A Fleming
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
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NADPH Oxidase Activity in Cerebral Arterioles Is a Key Mediator of Cerebral Small Vessel Disease-Implications for Prevention. Healthcare (Basel) 2015; 3:233-51. [PMID: 27417759 PMCID: PMC4939544 DOI: 10.3390/healthcare3020233] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/21/2015] [Accepted: 04/08/2015] [Indexed: 02/05/2023] Open
Abstract
Cerebral small vessel disease (SVD), a common feature of brain aging, is characterized by lacunar infarcts, microbleeds, leukoaraiosis, and a leaky blood-brain barrier. Functionally, it is associated with cognitive decline, dementia, depression, gait abnormalities, and increased risk for stroke. Cerebral arterioles in this syndrome tend to hypertrophy and lose their capacity for adaptive vasodilation. Rodent studies strongly suggest that activation of Nox2-dependent NADPH oxidase activity is a crucial driver of these structural and functional derangements of cerebral arterioles, in part owing to impairment of endothelial nitric oxide synthase (eNOS) activity. This oxidative stress may also contribute to the breakdown of the blood-brain barrier seen in SVD. Hypertension, aging, metabolic syndrome, smoking, hyperglycemia, and elevated homocysteine may promote activation of NADPH oxidase in cerebral arterioles. Inhibition of NADPH oxidase with phycocyanobilin from spirulina, as well as high-dose statin therapy, may have potential for prevention and control of SVD, and high-potassium diets merit study in this regard. Measures which support effective eNOS activity in other ways-exercise training, supplemental citrulline, certain dietary flavonoids (as in cocoa and green tea), and capsaicin, may also improve the function of cerebral arterioles. Asian epidemiology suggests that increased protein intakes may decrease risk for SVD; conceivably, arginine and/or cysteine-which boosts tissue glutathione synthesis, and can be administered as N-acetylcysteine-mediate this benefit. Ameliorating the risk factors for SVD-including hypertension, metabolic syndrome, hyperglycemia, smoking, and elevated homocysteine-also may help to prevent and control this syndrome, although few clinical trials have addressed this issue to date.
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Nagata C, Wada K, Tamura T, Kawachi T, Konishi K, Tsuji M, Nakamura K. Dietary intakes of glutamic acid and glycine are associated with stroke mortality in Japanese adults. J Nutr 2015; 145:720-8. [PMID: 25833775 DOI: 10.3945/jn.114.201293] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/23/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dietary intakes of glutamic acid and glycine have been reported to be associated with blood pressure. However, the link between intakes of these amino acids and stroke has not been studied. OBJECTIVE We aimed to examine the association between glutamic acid and glycine intakes and the risk of mortality from stroke in a population-based cohort study in Japan. METHODS The analyses included 29,079 residents (13,355 men and 15,724 women) of Takayama City, Japan, who were aged 35-101 y and enrolled in 1992. Their body mass index ranged from 9.9 to 57.4 kg/m(2). Their diets were assessed by a validated food frequency questionnaire. Deaths from stroke were ascertained over 16 y. RESULTS During follow-up, 677 deaths from stroke (328 men and 349 women) were identified. A high intake of glutamic acid in terms of a percentage of total protein was significantly associated with a decreased risk of mortality from total stroke in women after controlling for covariates; the HR (95% CI) for the highest vs. lowest quartile was 0.72 (0.53, 0.98; P-trend: 0.03). Glycine intake was significantly associated with an increased risk of mortality from total and ischemic stroke in men without history of hypertension at baseline; the HRs (95% CIs) for the highest vs. lowest tertile were 1.60 (0.97, 2.51; P-trend: 0.03) and 1.88 (1.01, 3.52; P-trend: 0.02), respectively. There was no association between animal or vegetable protein intake and mortality from total and any subtype of stroke. CONCLUSION The data suggest that glutamic acid and glycine intakes may be associated with risk of stroke mortality. Given that this is an initial observation, our results need to be confirmed.
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Affiliation(s)
- Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan;
| | - Keiko Wada
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takashi Tamura
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Toshiaki Kawachi
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kie Konishi
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Michiko Tsuji
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan; Department of Food and Nutrition, Japan Women's University, Tokyo, Japan; and
| | - Kozue Nakamura
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan; Department of Food and Nutrition, Gifu City Women's College, Gifu, Japan
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Larsson SC, Håkansson N, Wolk A. Dietary Cysteine and Other Amino Acids and Stroke Incidence in Women. Stroke 2015; 46:922-6. [DOI: 10.1161/strokeaha.114.008022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Susanna C. Larsson
- From the Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niclas Håkansson
- From the Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- From the Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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15
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Effects of protein intake on blood pressure, insulin sensitivity and blood lipids in children: a systematic review. Br J Nutr 2015; 113:383-402. [PMID: 25622044 DOI: 10.1017/s0007114514003699] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
High protein intake in early childhood is associated with obesity, suggesting possible adverse effects on other cardiometabolic outcomes. However, studies in adults have suggested beneficial effects of protein intake on blood pressure (BP) and lipid profile. Whether dietary protein intake is associated with cardiovascular and metabolic health in children is unclear. Therefore, we aimed to systematically review the evidence on the associations of protein intake with BP, insulin sensitivity and blood lipids in children. We searched the databases Medline, Embase, Cochrane Central and PubMed for interventional and observational studies in healthy children up to the age of 18 years, in which associations of total, animal and/or vegetable protein intake with one or more of the following outcomes were reported: BP; measures of insulin sensitivity; cholesterol levels; or TAG levels. In the search, we identified 6636 abstracts, of which fifty-six studies met all selection criteria. In general, the quality of the included studies was low. Most studies were cross-sectional, and many did not control for potential confounders. No overall associations were observed between protein intake and insulin sensitivity or blood lipids. A few studies suggested an inverse association between dietary protein intake and BP, but evidence was inconclusive. Only four studies examined the effects of vegetable or animal protein intake, but with inconsistent results. In conclusion, the literature, to date provides insufficient evidence for effects of protein intake on BP, insulin sensitivity or blood lipids in children. Future studies could be improved by adequately adjusting for key confounders such as energy intake and obesity.
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Flock MR, Fleming JA, Kris-Etherton PM. Macronutrient replacement options for saturated fat: effects on cardiovascular health. Curr Opin Lipidol 2014; 25:67-74. [PMID: 24345985 DOI: 10.1097/mol.0000000000000039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss macronutrient replacement options for saturated fatty acids (SFAs) to optimize cardiovascular disease (CVD) risk reduction. RECENT FINDINGS Dietary recommendations advise decreasing SFAs. There is convincing evidence that replacing SFAs with unsaturated fat, both omega-6 and omega-3 polyunsaturated fatty acids, reduces CVD risk. Monounsaturated fatty acid substitution for SFAs also decreases CVD risk. Replacing SFAs with refined carbohydrate does little to alter CVD risk, whereas whole-grain CHO or lean protein substitutions beneficially affect CVD risk. SUMMARY Modifying the macronutrient composition of the diet by replacing SFAs with unsaturated fatty acids, as well as lean protein and carbohydrate from whole grains, all lower CVD risk. Research is needed to identify food sources of macronutrients that optimize CVD risk reduction.
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Affiliation(s)
- Michael R Flock
- Department of Nutritional Sciences, The Pennsylvania State University, Pennsylvania, USA
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Larsson SC, Orsini N, Wolk A. Dietary calcium intake and risk of stroke: a dose-response meta-analysis. Am J Clin Nutr 2013; 97:951-7. [PMID: 23553167 DOI: 10.3945/ajcn.112.052449] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The findings from epidemiologic studies of calcium intake and risk of stroke have been conflicting. OBJECTIVE The objective was to conduct a dose-response meta-analysis of prospective studies to assess the association between dietary calcium intake and stroke risk. DESIGN Relevant studies were identified by searching PubMed and EMBASE databases until 11 December 2012 and by reviewing the reference lists of relevant articles. Observational prospective studies that reported RRs and 95% CIs for the association of calcium intake with stroke incidence or mortality were eligible. Study-specific RRs were combined by using a random-effects model. RESULTS Eleven prospective studies, including 9095 cases of stroke, were included in the meta-analysis. Evidence of a nonlinear association between dietary calcium intake and risk of stroke was found. In a stratified analysis, calcium intake was inversely associated with risk of stroke in populations with a low to moderate average calcium intake (<700 mg/d; RR for a 300-mg/d increase in calcium intake: 0.82; 95% CI: 0.76, 0.88) but was weakly positively associated with risk in populations with a high calcium intake (≥700 mg/d; corresponding RR: 1.03; 95% CI: 1.01, 1.06). An inverse association between calcium intake and risk of stroke was observed only in Asian populations (n = 4; RR for a 300-mg/d increase in calcium intake: 0.78; 95% CI: 0.71, 0.87). CONCLUSION These findings suggest that dietary calcium intake may be inversely associated with stroke in populations with low to moderate calcium intakes and in Asian populations.
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Affiliation(s)
- Susanna C Larsson
- Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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