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Bersch-Ferreira ÂC, Weschenfelder C, Vieira Machado RH, Nakagawa Santos RH, Riley TM, da Silva LR, Miyada DHK, Sady ERR, de Abreu-Silva EO, Laranjeira LN, de Quadros AS, Dos Santos JL, Souza GC, Parahiba SM, Fayh APT, Bezerra DS, Carvalho APPF, Machado MMA, Vasconcelos SML, Santos MVR, de Figueiredo Neto JA, Dias LPP, Zaina Nagano FE, de Almeida CCP, Moreira ASB, de Oliveira RD, Rogero MM, Sampaio GR, da Silva Torres EAF, Weber B, Cavalcanti AB, Marcadenti A. Effects of mixed nuts as part of a Brazilian Cardioprotective diet on LDL-cholesterol in adult patients after myocardial infarction: a multicenter randomized controlled clinical trial. Nutr J 2024; 23:118. [PMID: 39354558 PMCID: PMC11445998 DOI: 10.1186/s12937-024-01020-5] [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: 04/09/2024] [Accepted: 09/17/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Nuts consumption is related to cardioprotective effects on primary cardiovascular prevention, but studies conducted in secondary prevention are small, scarce and controversial. The objective of this trial was to evaluate the effects of a regional and sustainable cardioprotective diet added or not with an affordable mixed nuts on cardiometabolic features in patients with previous myocardial infarction. METHODS DICA-NUTS study is a national, multi-center, and superiority-parallel randomized clinical trial. Males and females over 40 years old diagnosed with previous myocardial infarction in the last 2 to 6 months were included. Patients were allocated into two groups: the Brazilian Cardioprotective diet (DICA Br) supplemented with 30 g/day of mixed nuts (10 g of peanuts; 10 g of cashew; 10 g of Brazil nuts) (intervention group, n = 193); or only DICA Br prescription (control group, n = 195). The primary outcome was low-density lipoprotein cholesterol means (in mg/dL) after 16 weeks. Secondary outcomes were other lipid biomarkers, glycemic and anthropometric data and diet quality. RESULTS After adjustment for baseline values, participating study site, time since myocardial infarction and statin treatment regimen (high potency, moderate and low potency/no statins), no significant difference was found between the groups in low-density lipoprotein cholesterol concentrations (intervention-control difference: 3.48 mg/dL [-3.45 to 10.41], P = 0.32). Both groups improved their overall diet quality at the end of the study without differences between them after 16 weeks (intervention-control difference: 1.05 (-0.9 to 2.99); P = 0.29). Other lipids, glycemic profile and anthropometrics were also not different between study groups at the end of the study. CONCLUSION Adding 30 g/day of mixed nuts to the DICA Br for 16 weeks did not change lipid, glycemic and anthropometric features in the post-myocardial infarction setting. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov website under number NCT03728127 and its World Health Organization Universal Trial Number (WHO-UTN) is U1111-1259-8105.
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Grants
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- NUPs: 25000.009770/2018-86 and 25000.184506/2020-45 Hcor as part of the "Hospitais de Excelência a Serviço do SUS", in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
- Hcor as part of the “Hospitais de Excelência a Serviço do SUS”, in partnership with the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) and Brazilian Ministry of Health. The sponsor had no role in study design; collection, management, analysis, and interpretation of data; and writing of the report.
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Affiliation(s)
- Ângela Cristine Bersch-Ferreira
- Department of Education and Research, BP - Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
- Hcor Research Institute, 200 Desembargador Eliseu Guilherme, 8th Floor, São Paulo, SP, Zip Code 04004-030, Brazil
| | - Camila Weschenfelder
- Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia/Fundação Universitária de Cardiologia Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Rachel Helena Vieira Machado
- Hcor Research Institute, 200 Desembargador Eliseu Guilherme, 8th Floor, São Paulo, SP, Zip Code 04004-030, Brazil
| | - Renato Hideo Nakagawa Santos
- Hcor Research Institute, 200 Desembargador Eliseu Guilherme, 8th Floor, São Paulo, SP, Zip Code 04004-030, Brazil
| | - Terrence M Riley
- Pennington Biomedical Research Center, Baton Rouge, LA, United States of America
| | - Lucas Ribeiro da Silva
- Hcor Research Institute, 200 Desembargador Eliseu Guilherme, 8th Floor, São Paulo, SP, Zip Code 04004-030, Brazil
| | - Debora Harumi Kodama Miyada
- Hcor Research Institute, 200 Desembargador Eliseu Guilherme, 8th Floor, São Paulo, SP, Zip Code 04004-030, Brazil
| | - Erica Regina Ribeiro Sady
- Hcor Research Institute, 200 Desembargador Eliseu Guilherme, 8th Floor, São Paulo, SP, Zip Code 04004-030, Brazil
| | - Erlon Oliveira de Abreu-Silva
- Hcor Research Institute, 200 Desembargador Eliseu Guilherme, 8th Floor, São Paulo, SP, Zip Code 04004-030, Brazil
- Master`S Program in Clinical Research, Dresden International University, Dresden, Germany
| | - Ligia Nasi Laranjeira
- Hcor Research Institute, 200 Desembargador Eliseu Guilherme, 8th Floor, São Paulo, SP, Zip Code 04004-030, Brazil
| | - Alexandre Schaan de Quadros
- Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia/Fundação Universitária de Cardiologia Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Júlia Lorenzon Dos Santos
- Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia/Fundação Universitária de Cardiologia Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Gabriela Corrêa Souza
- Graduation Program in Food, Nutrition and Health, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Suena Medeiros Parahiba
- Graduation Program in Food, Nutrition and Health, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ana Paula Trussardi Fayh
- PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Universidade Federal Do Rio Grande Do Norte, Natal, RN, Brazil
| | - Danielle Soares Bezerra
- Faculty of Health Science of Trairi, Universidade Federal Do Rio Grande Do Norte (FACISA-UFRN), Santa Cruz, RN, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Marcelo Macedo Rogero
- Department of Nutrition, School of Public Health, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Geni Rodrigues Sampaio
- Department of Nutrition, School of Public Health, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Bernardete Weber
- PROADI-SUS Office, Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, SP, Brazil
| | - Alexandre Biasi Cavalcanti
- Hcor Research Institute, 200 Desembargador Eliseu Guilherme, 8th Floor, São Paulo, SP, Zip Code 04004-030, Brazil
| | - Aline Marcadenti
- Hcor Research Institute, 200 Desembargador Eliseu Guilherme, 8th Floor, São Paulo, SP, Zip Code 04004-030, Brazil.
- Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia/Fundação Universitária de Cardiologia Do Rio Grande Do Sul, Porto Alegre, RS, Brazil.
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Zhao D, Tian Z, Kuang H, Xu Y, Zheng Y, Zhong Z, Liang L, Yang Y. Associations between Long-Term Dietary Coenzyme Q10 Intake and New-Onset Hypertension in Adults: Insights from a Nationwide Prospective Cohort Study. Nutrients 2024; 16:2478. [PMID: 39125357 PMCID: PMC11313835 DOI: 10.3390/nu16152478] [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: 06/28/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Coenzyme Q10 (CoQ10) supplementation appears to be associated with a lower blood pressure. Nevertheless, it remains unclear whether food-sourced CoQ10 will affect new-onset hypertension in general adults. This study investigated the relationship between dietary CoQ10 intake and new-onset hypertension among the general population. Participants without hypertension at baseline from the China Health and Nutrition Survey (CHNS) prospective cohort study were included (n = 11,428). Dietary CoQ10 intake was collected by validated dietary recalls and the food weighing method. Linear and non-linear relationships between dietary CoQ10 intake and new-onset hypertension were analyzed using multivariable Cox proportional hazards models and restricted cubic splines. During follow-up (median: 6 years), 4006 new-onset hypertension cases were documented. Compared with non-consumers, the hazard ratio (HR) and 95% confidence interval (CI) from quintile 2 to 4 total dietary CoQ10 were 0.83 (0.76, 0.91), 0.86 (0.78, 0.94) and 1.01 (0.92, 1.11); total plant-derived CoQ10 were 0.80 (0.73, 0.88), 1.00 (0.91, 1.09) and 1.10 (1.00, 1.20); and animal-derived CoQ10 were 0.65 (0.59, 0.71), 0.58 (0.53, 0.64) and 0.68 (0.62, 0.75). The lowest risk was found at moderate intake, with a non-linear relationship (P nonlinearity < 0.05). Furthermore, the overall inverse association was stronger among individuals without alcohol consumption or eating a low-fat diet. Moderate long-term dietary CoQ10 intake might be protective against new-onset hypertension. However, it follows a non-linear relationship and excessive intake may increase the risk of new-onset hypertension in the Chinese population.
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Affiliation(s)
- Dan Zhao
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China (L.L.)
- Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Shenzhen 518107, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Zezhong Tian
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China (L.L.)
- Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Shenzhen 518107, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Huiying Kuang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China (L.L.)
- Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Shenzhen 518107, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yixuan Xu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China (L.L.)
- Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Shenzhen 518107, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yiqi Zheng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Zepei Zhong
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China (L.L.)
- Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Shenzhen 518107, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Lihan Liang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China (L.L.)
- Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Shenzhen 518107, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yan Yang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China (L.L.)
- Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Shenzhen 518107, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou 510080, China
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Brown AGM, Adas S, de Jesus J, Farmer N, Fisher R, Pratt CA. Bridging the Gap: The Need to Implement Dietary Guidance to Address Cardiovascular Health. Nutrients 2024; 16:2125. [PMID: 38999873 PMCID: PMC11243232 DOI: 10.3390/nu16132125] [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: 05/28/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the U.S. and globally. Research demonstrates that diet is a leading contributor to the development of CVD, its prevention and management, and the overall promotion of cardiovascular health. This article describes the current state of the evidence, including research on the DASH and Mediterranean diets to promote cardiovascular health and prevent CVD. The article suggests approaches to implement evidence-based diets and federal dietary guidance to promote the adoption and integration of these interventions in both community and clinical settings. It highlights the current U.S. federal interest in "Food is Medicine" and its importance in addressing diet-related chronic diseases and promoting cardiovascular health.
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Affiliation(s)
- Alison G M Brown
- National Heart Lung and Blood Institute, Division of Cardiovascular Sciences, U.S. Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Samantha Adas
- Office of Nutrition Research, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Rockville, MD 20852, USA
| | - Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, U.S. Department of Health and Human Services, Bethesda, MD 20892, USA
| | - Rachel Fisher
- Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Rockville, MD 20852, USA
| | - Charlotte A Pratt
- National Heart Lung and Blood Institute, Division of Cardiovascular Sciences, U.S. Department of Health and Human Services, Bethesda, MD 20892, USA
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4
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Senkus KE, Dudzik JM, Lennon SL, DellaValle DM, Moloney LM, Handu D, Rozga M. Medical nutrition therapy provided by a dietitian improves outcomes in adults with prehypertension or hypertension: a systematic review and meta-analysis. Am J Clin Nutr 2024; 119:1417-1442. [PMID: 38641320 DOI: 10.1016/j.ajcnut.2024.04.012] [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: 12/19/2023] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Hypertension is an important risk factor for cardiovascular disease (CVD). Interventions with dietitians can help modify dietary intake and reduce hypertension risk. OBJECTIVES We aimed to examine the following research question: In adults with prehypertension or hypertension, what is the effect of medical nutrition therapy (MNT) provided by a dietitian on blood pressure (BP), CVD risk and events, and anthropometrics compared with standard care or no intervention? METHODS MEDLINE, CINAHL, and Cochrane Central databases were searched for randomized controlled trials (RCTs) published in peer-reviewed journals from 1985-2022. Risk of bias was assessed using version 2 of the Cochrane tool for RCTs. Meta-analyses were conducted using the DerSimonian-Laird random-effects model. Certainty of evidence (COE) was assessed for each outcome using the Grading of Recommendations, Assessment and Evaluation method. RESULTS Forty articles representing 31 RCTs were included and analyzed. MNT provided by a dietitian may reduce systolic [mean difference (MD): -3.63 mmHg; 95% confidence interval (CI): -4.35, -2.91 mmHg] and diastolic (MD: -2.02 mmHg; 95% CI: -2.56, -1.49 mmHg) BP (P < 0.001) and body weight (MD: -1.84 kg; 95% CI: -2.72, -0.96 kg; P < 0.001) and improve antihypertensive medication usage, relative risk of stroke (MD: 0.34; 95% CI: 0.14, 0.81; P = 0.02), and CVD risk score [standardized mean difference (SMD): -0.20; 95% CI: -0.30, -0.09; P < 0.001] compared with control participants, and COE was moderate. Additionally, MNT may reduce arterial stiffness (SMD: -0.45; 95% CI: -0.71, -0.19; P = 0.008) and waist circumference (SMD: -1.18 cm; 95% CI: -2.00, -0.36; P = 0.04), and COE was low. There was no significant difference in risk of myocardial infarction between groups. Dietitian interventions reduced BP and related cardiovascular outcomes for adults with prehypertension or hypertension. CONCLUSIONS Dietitians play a critical role in improving cardiometabolic risk factors for adults with elevated BP; thus, improved payment for and access to MNT services has the potential to significantly impact public health. This review was registered at PROSPERO as CRD42022351693.
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Affiliation(s)
- Katelyn E Senkus
- Department of Human Nutrition and Hospitality Management, College of Human Environmental Sciences, University of Alabama, Tuscaloosa, AL, United States
| | - Josephine M Dudzik
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, United States
| | - Shannon L Lennon
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Diane M DellaValle
- Health and Human Performance Department, King's College, Wilkes-Barre, PA, United States
| | - Lisa M Moloney
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Deepa Handu
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Mary Rozga
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL, United States.
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5
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Filippou CD, Thomopoulos CG, Konstantinidis DG, Dimitriadis KS, Chrysochoou CA, Tatakis FA, Siafi EP, Tousoulis DM, Nihoyannopoulos PI, Panagiotakos DB, Tsioufis KP. Effect of DASH vs. mediterranean diet accompanied by a salt restriction on metabolic syndrome and cardiometabolic risk factors in adults with high normal blood pressure or grade 1 hypertension: secondary analyses of a randomized controlled trial. Hellenic J Cardiol 2024:S1109-9666(24)00110-6. [PMID: 38777087 DOI: 10.1016/j.hjc.2024.05.006] [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: 02/02/2024] [Revised: 03/29/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE Lifestyle interventions are recommended as the first-line treatment to control metabolic syndrome components and improve cardiometabolic risk factors. However, studies directly comparing the cardiometabolic effects of the Dietary Approaches to Stop Hypertension (DASH) vs. the Mediterranean diet (MedDiet) accompanied by salt restriction are currently lacking. Thus, with the present secondary analyses of a randomized trial, we aimed to assess the cardiometabolic effects of a 3-month intensive dietary intervention implementing salt restriction alone or on top of the DASH and MedDiet compared to no/minimal intervention in never drug-treated adults with high normal blood pressure (BP) or grade 1 hypertension. METHODS We randomly assigned individuals to the control group (CG, n = 60), salt restriction group (SRG, n = 60), DASH diet with salt restriction group (DDG, n = 60), or MedDiet with salt restriction group (MDG, n = 60). RESULTS According to the intention-to-treat analysis, the DDG and the MDG had lower odds ratio (OR) (95% CI) of metabolic syndrome [0.29 (0.12, 0.72), and 0.15 (0.06, 0.41), respectively] compared to the CG. Moreover, the MDG had lower odds of metabolic syndrome compared to the SRG and lower odds of elevated BP levels than the DDG and the SRG. Moreover, total and LDL-cholesterol, fasting glucose, HbA1c, and systolic/diastolic BP were reduced in all three intervention groups compared to the CG. CONCLUSION On a background of salt restriction, the MedDiet was superior in BP reduction, but the DASH and MedDiet reduced the prevalence of metabolic syndrome to the same extent.
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Affiliation(s)
- Christina D Filippou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Dimitrios G Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Kyriakos S Dimitriadis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Christina A Chrysochoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Fotis A Tatakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Eirini P Siafi
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios M Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Petros I Nihoyannopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Konstantinos P Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Zambrano AK, Cadena-Ullauri S, Ruiz-Pozo VA, Tamayo-Trujillo R, Paz-Cruz E, Guevara-Ramírez P, Frias-Toral E, Simancas-Racines D. Impact of fundamental components of the Mediterranean diet on the microbiota composition in blood pressure regulation. J Transl Med 2024; 22:417. [PMID: 38702795 PMCID: PMC11067105 DOI: 10.1186/s12967-024-05175-x] [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: 01/31/2024] [Accepted: 04/05/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The Mediterranean diet (MedDiet) is a widely studied dietary pattern reflecting the culinary traditions of Mediterranean regions. High adherence to MedDiet correlates with reduced blood pressure and lower cardiovascular disease (CVD) incidence and mortality. Furthermore, microbiota, influenced by diet, plays a crucial role in cardiovascular health, and dysbiosis in CVD patients suggests the possible beneficial effects of microbiota modulation on blood pressure. The MedDiet, rich in fiber and polyphenols, shapes a distinct microbiota, associated with higher biodiversity and positive health effects. The review aims to describe how various Mediterranean diet components impact gut microbiota, influencing blood pressure dynamics. MAIN BODY The MedDiet promotes gut health and blood pressure regulation through its various components. For instance, whole grains promote a healthy gut microbiota given that they act as substrates leading to the production of short-chain fatty acids (SCFAs) that can modulate the immune response, preserve gut barrier integrity, and regulate energy metabolism. Other components of the MedDiet, including olive oil, fuits, vegetables, red wine, fish, and lean proteins, have also been associated with blood pressure and gut microbiota regulation. CONCLUSION The MedDiet is a dietary approach that offers several health benefits in terms of cardiovascular disease management and its associated risk factors, including hypertension. Furthermore, the intake of MedDiet components promote a favorable gut microbiota environment, which, in turn, has been shown that aids in other physiological processes like blood pressure regulation.
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Affiliation(s)
- Ana Karina Zambrano
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador.
| | - Santiago Cadena-Ullauri
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador
| | - Viviana A Ruiz-Pozo
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador
| | - Rafael Tamayo-Trujillo
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador
| | - Elius Paz-Cruz
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador
| | - Patricia Guevara-Ramírez
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador
| | - Evelyn Frias-Toral
- Escuela de Medicina, Universidad Espíritu Santo, Samborondón, 0901952, Ecuador
| | - Daniel Simancas-Racines
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Quito, 170527, Ecuador
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7
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Ramírez Gallegos I, Marina Arroyo M, López-González ÁA, Vicente-Herrero MT, Vallejos D, Sastre-Alzamora T, Ramírez-Manent JI. The Effect of a Program to Improve Adherence to the Mediterranean Diet on Cardiometabolic Parameters in 7034 Spanish Workers. Nutrients 2024; 16:1082. [PMID: 38613115 PMCID: PMC11013770 DOI: 10.3390/nu16071082] [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: 03/14/2024] [Revised: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Cardiovascular and metabolic diseases include a large group of pathologies and constitute one of the most serious chronic health problems facing the 21st century, with high rates of morbidity and mortality worldwide. Unhealthy diets influence the development of these pathologies. The Mediterranean diet can be an important part in the treatment of these diseases. The objective of this study was to assess the effect of a program that aims to increase adherence to the Mediterranean diet on the improvement of different cardiometabolic risk parameters. METHODS A prospective intervention study was carried out on 7034 Spanish workers. Prior to the intervention, 22 cardiometabolic risk scales were evaluated. Participants in this study were informed both orally and in writing of the characteristics and benefits of the Mediterranean diet and were given the website of the Ministry of Health, Consumption and Social Welfare of Spain, which provides advice on nutrition. Adherence to the Mediterranean diet was reinforced by sending a monthly SMS to their mobile phones. After six months of follow-up, the 22 risk scales were re-evaluated to assess changes. Means and standard deviations were calculated using Student's t test to analyse quantitative variables. Prevalence was calculated using the Chi-square test when the variables were qualitative. RESULTS All the cardiometabolic risk scales studied decreased after implementing a program to improve and enhance adherence to the Mediterranean diet. The number of losses in the sample was very low, standing at 4.31%. CONCLUSIONS The Mediterranean diet is effective in reducing all cardiovascular risk scales evaluated. The mean values and prevalence of high values of the different cardiometabolic risk scales analysed led to lower values after the implementation of the program to increase adherence to the Mediterranean diet. We observed a significant positive difference in metabolic age in both sexes. We have obtained a significant improvement in the insulin resistance index, especially in the SPISE-IR index, data that we have not found in previous publications. Easy access to the Internet and new information and communication technologies facilitate adherence to a diet and can reduce the number of losses.
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Affiliation(s)
- Ignacio Ramírez Gallegos
- Investigation Group ADEMA SALUD, University Institute for Research in Health Sciences (IUNICS), 07010 Palma, Balearic Islands, Spain; (I.R.G.); (M.M.A.); (M.T.V.-H.); (D.V.); (T.S.-A.); (J.I.R.-M.)
| | - Marta Marina Arroyo
- Investigation Group ADEMA SALUD, University Institute for Research in Health Sciences (IUNICS), 07010 Palma, Balearic Islands, Spain; (I.R.G.); (M.M.A.); (M.T.V.-H.); (D.V.); (T.S.-A.); (J.I.R.-M.)
| | - Ángel Arturo López-González
- Investigation Group ADEMA SALUD, University Institute for Research in Health Sciences (IUNICS), 07010 Palma, Balearic Islands, Spain; (I.R.G.); (M.M.A.); (M.T.V.-H.); (D.V.); (T.S.-A.); (J.I.R.-M.)
- Faculty of Dentistry, University School ADEMA, 07010 Palma, Balearic Islands, Spain
- Institut d’Investigació Sanitària de les Illes Balears (IDISBA), Balearic Islands Health Research Institute Foundation, 07010 Palma, Balearic Islands, Spain
- Balearic Islands Health Service, 07010 Palma, Balearic Islands, Spain
| | - Maria Teófila Vicente-Herrero
- Investigation Group ADEMA SALUD, University Institute for Research in Health Sciences (IUNICS), 07010 Palma, Balearic Islands, Spain; (I.R.G.); (M.M.A.); (M.T.V.-H.); (D.V.); (T.S.-A.); (J.I.R.-M.)
| | - Daniela Vallejos
- Investigation Group ADEMA SALUD, University Institute for Research in Health Sciences (IUNICS), 07010 Palma, Balearic Islands, Spain; (I.R.G.); (M.M.A.); (M.T.V.-H.); (D.V.); (T.S.-A.); (J.I.R.-M.)
| | - Tomás Sastre-Alzamora
- Investigation Group ADEMA SALUD, University Institute for Research in Health Sciences (IUNICS), 07010 Palma, Balearic Islands, Spain; (I.R.G.); (M.M.A.); (M.T.V.-H.); (D.V.); (T.S.-A.); (J.I.R.-M.)
| | - José Ignacio Ramírez-Manent
- Investigation Group ADEMA SALUD, University Institute for Research in Health Sciences (IUNICS), 07010 Palma, Balearic Islands, Spain; (I.R.G.); (M.M.A.); (M.T.V.-H.); (D.V.); (T.S.-A.); (J.I.R.-M.)
- Institut d’Investigació Sanitària de les Illes Balears (IDISBA), Balearic Islands Health Research Institute Foundation, 07010 Palma, Balearic Islands, Spain
- Balearic Islands Health Service, 07010 Palma, Balearic Islands, Spain
- Faculty of Medicine, University of the Balearic Islands, 07010 Palma, Balearic Islands, Spain
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8
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Gupta DK, Lewis CE, Allen NB. Dietary Sodium and Blood Pressure-Reply. JAMA 2024; 331:1155-1156. [PMID: 38563837 DOI: 10.1001/jama.2024.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Deepak K Gupta
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
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9
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D’Elia L, Strazzullo P. Dietary Salt Restriction and Adherence to the Mediterranean Diet: A Single Way to Reduce Cardiovascular Risk? J Clin Med 2024; 13:486. [PMID: 38256620 PMCID: PMC10816989 DOI: 10.3390/jcm13020486] [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: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
The dietary restriction of salt intake and the adhesion to Mediterranean dietary patterns are among the most recommended lifestyle modifications for the prevention of cardiovascular diseases. A large amount of evidence supports these recommendations; indeed, several studies show that a higher adherence to Mediterranean dietary patterns is associated with a reduced risk of cardiovascular disease. Likewise, findings from observational and clinical studies suggest a causal role of excess salt intake in blood pressure increase, cardiovascular organ damage, and the incidence of cardiovascular diseases. In this context, it is also conceivable that the beneficial effects of these two dietary patterns overlap because Mediterranean dietary patterns are typically characterized by a large consumption of plant-based foods with low sodium content. However, there is little data on this issue, and heterogeneous results are available on the relationship between adherence to salt restriction and to Mediterranean dietary patterns. Thus, this short review focuses on the epidemiological and clinical evidence of the relationship between the adherence to Mediterranean dietary patterns and dietary salt restriction in the context of cardiovascular risk.
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Affiliation(s)
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy;
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