Practical Guidance for Food Consumption to Prevent Cardiovascular Disease

Promoting Heart Health: Raising Screening Awareness at a Brisbane Medical Center

Background Atherosclerotic cardiovascular disease (CVD) is a largely preventable, chronic, and progressive medical condition. There appears to be a general lack of knowledge about CVD prevention in the community. This pilot study was carried out to investigate the level of knowledge of CVD prevention among patients visiting a general practitioner (GP) practice in Brisbane. Aim To investigate the level of knowledge of CVD prevention among people visiting a local medical clinic in Brisbane, and to identify the factors responsible for any knowledge deficits. Material and methods A cross-sectional survey was conducted among Brisbane residents aged 45 years and older visiting a local medical center. This study surveyed 105 Australian individuals via an online survey or a hard copy questionnaire for those without online access. A combination of closed-ended questions and multiple-choice questionnaires was utilized to collect the data. Questions were formulated to assess the level of knowledge of CVD prevention among this demographic, exploring the subjects' awareness of the screening program, their adherence, factors behind non-adherence, and understanding the influence of education level and occupation on adherence. Results A total of 105 Brisbane adults completed the survey, of which 56 (53.3%) were male. The study found that 61 (58.1%) of the participants were aware of the CVD prevention screening program, but only 22 (21.9%) were compliant with it. Twelve (11.4%) participants attended these preventive screenings less frequently than recommended, while the remaining 69 (66.6%) had never undergone cardiovascular health checks. Conclusion Analysis of data from this population suggests that there is a knowledge deficit among Brisbane residents regarding CVD prevention programs. Enhanced efforts by clinicians to make patients aware of these screening tools and to employ early intervention strategies, especially lifestyle choices at an earlier age, would help lower the burden of CVD.

Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.

Association between eating habits during adolescence and gestational diabetes: data from the Japan environment and children's study

Purpose

It is difficult to change pre-pregnancy eating habits, yet establishing healthy eating habits before pregnancy is important for preventing gestational diabetes mellitus (GDM). This study aimed to examine whether the weight-loss behavior of avoiding between-meal and midnight snacking in teenagers is associated with a reduction in the risk of subsequent GDM.

Methods

We used a dataset (jecs-an-20,180,131) from a nationwide, prospective birth cohort study, the Japan Environment and Children's Study (JECS). We included 89,227 (85.7% of the total) mother-infant pairs with live births. Participants in their second or third trimester were asked to report their weight-loss behavior during their teenage years. The prevalence of GDM was investigated. Differences in maternal characteristics were examined using chi-square tests. Crude and adjusted logistic regression models were constructed to assess the associations of various maternal characteristics with the weight-loss behavior of avoiding between-meal and midnight snacking during teenage years.

Results

A total of 2,066 (2.3%) participants had GDM. Weight-loss behavior in teenagers was associated with a decreased risk of GDM. Among participants with normal weight or overweight prior to pregnancy, the adjusted odds ratios were 0.79 (95% confidence interval, 0.70-0.89) and 0.82 (95% confidence interval, 0.69-0.98), respectively.

Conclusions

The results suggest that teenage weight-loss behaviors, such as avoiding between-meal and midnight snacking, are associated with a decreased risk of developing GDM.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01294-2.

The Effect of Base Theory Educational Intervention on Health-Promoting Lifestyle in Women Susceptible to Cardiovascular Diseases: Application of the Theory of Planned Behavior

Background

Cardiovascular diseases are the second leading cause of mortality, disability, and reduced productivity in women over 40 years and the first cause of mortality in women over 60 years. Therefore, the present study aimed to determine the effect of educational intervention based on theory of planned behavior (TPB) on health-promoting lifestyle in women susceptible to cardiovascular diseases.

Methods

This quasiexperimental study was conducted on 200 women susceptible to cardiovascular diseases referred to health centers in Fasa city, Fars province, Iran. The available sampling was performed on women who referred to the centers and had a family record. In this study, two health-promoting lifestyle questionnaires consisting of 49 questions and the theory of planned behavior questionnaire consisting of 50 questions were used. The obtained data were analyzed by using the SPSS software version 24 in two stages before and six months after the educational intervention through paired t-test, independent t-test, chi-square test, and McNemar test.

Results

The mean age of women in the experimental and control groups was 38.74 ± 9.22 and 39.14 ± 9.08 years, respectively. The results showed a significant increase in the experimental group after six months of intervention in terms of health-promoting lifestyle and constructs of the theory of planned behavior. Also, mean blood pressure, fasting blood sugar, and smoking of experimental group decreased six months after the educational intervention.

Conclusion

Considering the irreplaceable role of education in adopting healthy behaviors and the role of women in strengthening the family foundation, quality educational programs should be designed and regularly implemented by health care providers for women.

Smartphone-Based Electrochemical Biosensor for On-Site Nutritional Quality Assessment of Coffee Blends

This work aimed to develop an easy-to-use smartphone-based electrochemical biosensor to quickly assess a coffee blend's total polyphenols (Phs) content at the industrial and individual levels. The device is based on a commercial carbon-based screen-printed electrode (SPE) modified with multi-walled carbon nanotubes (CNTs) and gold nanoparticles (GNPs). At the same time, the biological recognition element, Laccase from Trametes versicolor, TvLac, was immobilized on the sensor surface by using glutaraldehyde (GA) as a cross-linking agent. The platform was electrochemically characterized to ascertain the influence of the SPE surface modification on its performance. The working electrode (WE) surface morphology characterization was obtained by scanning electron microscopy (SEM) and Fourier-transform infrared (FT-IR) imaging. All the measurements were carried out with a micro-potentiostat, the Sensit Smart by PalmSens, connected to a smartphone. The developed biosensor provided a sensitivity of 0.12 μA/μM, a linear response ranging from 5 to 70 μM, and a lower detection limit (LOD) of 2.99 μM. Afterward, the biosensor was tested for quantifying the total Phs content in coffee blends, evaluating the influence of both the variety and the roasting degree. The smartphone-based electrochemical biosensor's performance was validated through the Folin-Ciocâlteu standard method.

Maximizing cardiovascular benefits of fish consumption within the One Health approach: Should current recommendations be revised?

AIMS

Current dietary recommendations on fish consumption for cardiovascular disease (CVD) prevention put somewhat vague emphasis on fatty fish, mainly driven by evidence on the cardioprotective effects of n-3 PUFAs. Recent data on the consumption of different types of fish in relation to hard cardiovascular endpoints suggests that fatty but not lean fish can contribute to CVD prevention. This considered, we aimed at evaluating, by an environmental perspective, fish consumption limited to the fatty type - in appropriate amounts for optimizing CVD prevention - within the European context.

DATA SYNTHESIS

Starting from the current average intake of total fish by the European population (i.e., 2 servings/week of fatty plus lean fish), we show that the shift towards the consumption of 2 servings/week of solely fatty fish - appropriate for optimizing CVD prevention - would allow a 32% saving of greenhouse gas (GHG) emissions related to fish consumption. This is due to the lower environmental impact of fatty fish globally considered, compared to lean fish. However, since the carbon footprint of different fatty fish species can vary significantly - with small blue fish (e.g., anchovies, sardines, herrings) in the lowest range, we estimated that GHG emissions due to fish consumption in Europe could be reduced by 82% by focusing on small blue fish consumption.

CONCLUSIONS

Consumption of 2 servings/week of small blue fish could represent a feasible and effective choice among the functional dietary strategies available to achieve the maximal benefits for human and environmental health.

A Review of Low-Density Lipoprotein-Lowering Diets in the Age of Anti-Sense Technology

This narrative review discusses an important issue, the primary role of diet in reducing low-density lipoprotein cholesterol (LDLc) concentrations in polygenic hypercholesterolemia. Two effective drugs, statins, and ezetimibe, that lower LDLc > 20% are relatively inexpensive and potential competitors to strict dieting. Biochemical and genomic studies have shown that proprotein convertase subtilisin kexin type 9 (PCSK9) plays an important role in low-density lipoprotein (LDL) and lipid metabolism. Clinical trials have demonstrated that inhibitory monoclonal antibodies of PCSK9 dose-dependently lower LDLc up to 60%, with evidence of both regression and stabilization of coronary atherosclerosis and a reduction in cardiovascular risk. Recent approaches using RNA interference to achieve PCSK9 inhibition are currently undergoing clinical evaluation. The latter presents an attractive option of twice-yearly injections. They are, however, currently expensive and unsuitable for moderate hypercholesterolemia, which is largely due to inappropriate patterns of eating. The best dietary approach, the substitution of saturated fatty acids by polyunsaturated fatty acids at 5% energy, yields > 10% lowering of LDLc. Foods such as nuts and brans, especially within a prudent, plant-based diet low in saturates complemented by supplements such as phytosterols, have the potential to reduce LDLc further. A combination of such foods has been shown to lower LDLc by 20%. A nutritional approach requires backing from industry to develop and market LDLc-lowering products before pharmacology replaces the diet option. Energetic support from health professionals is vital.

Consumption of Dairy Foods and Cardiovascular Disease: A Systematic Review

Limited consumption of dairy foods and use of low-fat products is recommended for cardiovascular (CV) prevention; however, other features besides fat content modulate their metabolic effects. We analyze updated evidence on the relationship of different dairy products (low/full-fat dairy, milk, cheese, yogurt) with CVD by reviewing meta-analyses of cohort studies and individual prospective cohort studies with CV hard endpoints (CVD/CHD incidence/mortality), together with meta-analyses of randomized controlled trials exploring the effect of dairy on major CV risk factors. The analyses provide evidence that moderate dairy consumption (up to 200 g/day, globally) has no detrimental effects on CV health and that their effect depends more on the food type (cheese, yogurt, milk) than on the fat content. These data expand current knowledge and may inform revision of current guidelines for CVD prevention.

Clinical Practice Guidelines Using GRADE and AGREE II for the Impact of Genetic Variants on Plasma Lipid/Lipoprotein/Apolipoprotein Responsiveness to Omega-3 Fatty Acids

Background

A recent systematic review, which used the GRADE methodology, concluded that there is strong evidence for two gene-diet associations related to omega-3 and plasma triglyceride (TG) responses. Systematic reviews can be used to inform the development of clinical practice guidelines (CPGs).

Objective

To provide guidance for clinical practice related to genetic testing for evaluating responsiveness to dietary/supplemental omega-3s and their impact on plasma lipids/lipoproteins/apolipoproteins.

Design

Using the results of the abovementioned systematic review, the first CPGs in nutrigenetics were developed using the established GRADE methodology and AGREE II approach.

Results

Three clinical practice recommendations were developed. Most gene-diet associations identified in the literature lack adequate scientific and clinical validity to warrant consideration for implementing in a practice setting. However, two gene-diet associations with strong evidence (GRADE quality: moderate and high) can be considered for implementation into clinical practice in certain cases: male APOE-E4 carriers (rs429358, rs7412) and TG changes in response to the omega-3 fatty acids eicosapentaenoic acid (EPA) and/or docosahexaenoic acid (DHA) as well as a 31-SNP nutrigenetic risk score and TG changes in response to EPA+DHA among adults with overweight/obesity. Ethical and regulatory implications must be considered when providing APOE nutrigenetic tests given the well-established link between APOE genetic variation and Alzheimer's Disease.

Conclusion

Most of the evidence in this area is not ready for implementation into clinical practice primarily due to low scientific validity (low quality of evidence). However, the first CPGs in nutrigenetics have been developed for two nutrigenetic associations with strong scientific validity, related to dietary/supplemental omega-3 and TG responses.

Macronutrient quality index and cardiovascular disease risk in the Seguimiento Universidad de Navarra (SUN) cohort

PURPOSE

To assess the association between a multi-dimensional Macronutrient Quality Index (MQI) and the risk of cardiovascular disease (CVD) in a Mediterranean cohort.

METHODS

Prospective analyses among 18,418 participants (mean age 36 years, 60.8% women) of the Seguimiento Universidad de Navarra (SUN) cohort. Dietary intake information was obtained through a validated semi-quantitative food-frequency questionnaire (FFQ). The MQI (expressing high-quality macronutrient intake) was calculated based on three previously reported quality indices: the Carbohydrate Quality Index (CQI), the Fat Quality Index (FQI), and the Healthy Plate Protein source Quality Index (HPPQI). Adherence to the Mediterranean diet (MedDiet) and Provegetarian Diet was evaluated using the Trichopoulou index and the score proposed by Martínez-González, respectively. CVD was defined as new-onset stroke, myocardial infarction, or CVD death.

RESULTS

After a median follow-up time of 14 years (211,744 person-years), 171 cases of CVD were identified. A significant inverse association was found between the MQI and CVD risk with multivariable-adjusted HR for the highest vs. the lowest quartile of 0.60 (95% IC, 0.38-0.96; P_trend = 0.024).

CONCLUSION

In this Mediterranean cohort, we found a significant inverse relationship between a multidimensional MQI (expressing high-quality macronutrient intake) and a lower risk of CVD.

A non-traditional dietary pattern increases risk of coronary artery disease in the Nepalese population

OBJECTIVES

Several dietary patterns are associated with cardiovascular diseases. Traditional, Western, Mediterranean, and vegetarian are common dietary patterns, derived from principal component analysis (PCA) of dietary food intakes associated with cardiovascular diseases; however, these patterns were derived mostly from the diet habits of people in Western and European countries. Therefore, the present study aimed to determine dietary patterns linked with coronary artery disease (CAD) in the Nepalese population.

METHODS

Food frequency questionnaires were used to estimate dietary intakes in 306 people with CAD and 306 people in a control group matched for age and sex. PCA was performed to deduce the dietary patterns, and conditional logistic regression was executed to determine the association of the dietary patterns with CAD.

RESULTS

The component of PCA with higher loadings of refined grain, sugar, and meat and lower loadings of milk, whole grain, and fruit was named the non-traditional dietary pattern in the present study. We found a 34% increased risk of CAD (odds ratio, 1.34; 95% confidence interval, 1.14-1.58; P < 0.001) associated with this dietary pattern after adjusting for smoking, physical activity, and cardiometabolic risk factors. Dietary-pattern scores were further categorized into tertiles, and the third tertile was observed with significanly higher odds of CAD than the first tertile (odds ratio, 2.32; 95% confidence interval, 1.3-4.14; P for trend = 0.004).

CONCLUSIONS

PCA-derived non-traditional dietary patterns can be a risk for developing CAD in Nepalese people. However, further cohort studies or randomized community trials are suggested to confirm our findings.

Whole-fat dairy products do not adversely affect adiposity or cardiometabolic risk factors in children in the Milky Way Study: a double-blind randomized controlled pilot study

BACKGROUND

Limited evidence supports the common public health guideline that children >2 y of age should consume dairy with reduced fat content.

OBJECTIVES

We aimed to investigate the effects of whole-fat compared with reduced-fat dairy intake on measures of adiposity and biomarkers of cardiometabolic risk in healthy 4- to 6-y-old children.

METHODS

The Milky Way Study enrolled 49 children (mean ± SD age: 5.2 ± 0.9 y; 47% girls) who were habitual consumers of whole-fat dairy, then randomly assigned them in a double-blind fashion to remain on whole-fat dairy or switch their dairy consumption to reduced-fat products for 3 mo. Primary endpoints included measures of adiposity, body composition, blood pressure, fasting serum lipids, blood glucose, glycated hemoglobin (HbA1c), and C-reactive protein (CRP) and were assessed at baseline and study end. Pre- and postintervention results were compared using linear mixed models, adjusted for growth, age, and sex.

RESULTS

Dairy fat intake was reduced by an adjusted (mean ± SEM) 12.9 ± 4.1 g/d in the reduced-fat compared with the whole-fat dairy group (95% CI: -21.2, -4.6 g/d; P = 0.003), whereas dietary energy intakes remained similar (P = 0.936). We found no significant differential changes between dairy groups in any measure of adiposity, body composition, blood pressure, or fasting serum lipids, glucose, HbA1c, and CRP.

CONCLUSIONS

Our results suggest that although changing from whole-fat to reduced-fat dairy products does reduce dairy fat intake, it does not result in changes to markers of adiposity or cardiometabolic disease risk in healthy children.This trial was registered at www.anzctr.org.au as ACTRN12616001642471.

Role of Food Antioxidants in Modulating Gut Microbial Communities: Novel Understandings in Intestinal Oxidative Stress Damage and Their Impact on Host Health

Dietary components have an important role on the structure and function of host gut microbial communities. Even though, various dietary components, such as carbohydrates, fats, proteins, fibers, and vitamins, have been studied in depth for their effect on gut microbiomes, little attention has been paid regarding the impact of several food antioxidants on the gut microbiome. The long-term exposure to reactive oxygen species (ROS) can cause microbial dysbiosis which leads to numerous intestinal diseases such as microbiota dysbiosis, intestinal injury, colorectal cancers, enteric infections, and inflammatory bowel diseases. Recently, it has been shown that the food derived antioxidant compounds might protect the host from intestinal oxidative stress via modulating the composition of beneficial microbial species in the gut. The present review summarizes the impact of food antioxidants including antioxidant vitamins, dietary polyphenols, carotenoids, and bioactive peptides on the structure as well as function of host gut microbial communities. Several in vitro, animal model, and clinical studies indicates that food antioxidants might modify the host gut microbial communities and their health status. However, still further clarification is needed as to whether changes in certain microbial species caused by food additives may lead to changes in metabolism and immune function.

Essentials of a new clinical practice guidance on familial hypercholesterolaemia for physicians

Familial hypercholesterolaemia (FH) is a common, heritable and preventable cause of premature coronary artery disease. New clinical practice recommendations are presented to assist practitioners in enhancing the care of all patients with FH. Core recommendations are made on the detection, diagnosis, assessment and management of adults, children and adolescents with FH. Management is under-pinned by the precepts of risk stratification, adherence to healthy lifestyles, treatment of non-cholesterol risk factors and appropriate use of low-density lipoprotein (LDL)-cholesterol-lowering therapies including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. The recommendations need to be utilised using judicious clinical judgement and shared decision-making with patients and families. New government-funded schemes for genetic testing and use of PCSK9 inhibitors, as well as the National Health Genomics Policy Framework, will enable adoption of the recommendations. However, a comprehensive implementation science and practice strategy is required to ensure that the guidance translates into benefit for all families with FH.

Diet-Derived Antioxidants and Their Role in Inflammation, Obesity and Gut Microbiota Modulation

It is generally accepted that gut microbiota, inflammation and obesity are linked to the development of cardiovascular diseases and other chronic/non-communicable pathological conditions, including cancer, neurodegenerative diseases and ageing-related disorders. In this scenario, oxidative stress plays a pivotal role. Evidence suggests that the global dietary patterns may represent a tool in counteracting oxidative stress, thus preventing the onset of diseases related to oxidative stress. More specifically, dietary patterns based on the regular consumption of fruits and vegetables (i.e., Mediterranean diet) have been licensed by various national nutritional guidelines in many countries for their health-promoting effects. Such patterns, indeed, result in being rich in specific components, such as fiber, minerals, vitamins and antioxidants, whose beneficial effects on human health have been widely reported. This suggests a potential nutraceutical power of specific dietary components. In this manuscript, we summarize the most relevant evidence reporting the impact of dietary antioxidants on gut microbiota composition, inflammation and obesity, and we underline that antioxidants are implicated in a complex interplay between gut microbiota, inflammation and obesity, thus suggesting their possible role in the development and modulation of chronic diseases related to oxidative stress and in the maintenance of wellness. Do all roads lead to Rome?

Breast Cancer Survivors Undergoing Endocrine Therapy Have a Worrying Risk Factor Profile for Cardiovascular Diseases

The increased risk for cardiovascular diseases (CVDs) in breast cancer survivors has been widely discussed in the literature and occurs due to the cardiotoxicity of antineoplastic treatments, and also to the common risk factors between these diseases. Thus, the objective of our study was to evaluate, prospectively, the number of risk factors (NRF) for CVDs in women during endocrine therapy, and to associate the NRF with C reactive protein (CRP) and phase angle (PhA). The following risk factors for CVD were evaluated at three times: anthracycline chemotherapy, radiotherapy, comorbidities, inadequate diet, overweight, abdominal adiposity, alcoholism, smoking, physical inactivity and altered lipid profile. There was inadequacy in the most components of the Brazilian Healthy Eating Index—Revised and inadequate consumption of various types of fats and fibers. Most women in this study presented excessive abdominal fat and overweight, but these parameters have not changed over time (p < 0.005). Moreover, a high frequency of systemic arterial hypertension and physical inactivity was observed. The average NRF for CVDs was above ten, at the three evaluation times. Women with higher NRF had higher levels of CRP (p = 0.003), a predictor of cardiovascular risk, however, there was no significance with PhA (p = 0.256). Thus, intervention is needed to improve lifestyle.

Synopsis of an integrated guidance for enhancing the care of familial hypercholesterolaemia: an Australian perspective

Introduction

Familial hypercholesterolaemia (FH) is a common, heritable and preventable cause of premature coronary artery disease, with significant potential for positive impact on public health and healthcare savings. New clinical practice recommendations are presented in an abridged guidance to assist practitioners in enhancing the care of all patients with FH.

Main recommendations

Core recommendations are made on the detection, diagnosis, assessment and management of adults, children and adolescents with FH. There is a key role for general practitioners (GPs) working in collaboration with specialists with expertise in lipidology. Advice is given on genetic and cholesterol testing and risk notification of biological relatives undergoing cascade testing for FH; all healthcare professionals should develop skills in genomic medicine. Management is under-pinned by the precepts of risk stratification, adherence to healthy lifestyles, treatment of non-cholesterol risk factors, and appropriate use of low-density lipoprotein (LDL)-cholesterol lowering therapies, including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Recommendations on service design are provided in the full guidance.

Potential impact on care of FH

These recommendations need to be utilised using judicious clinical judgement and shared decision making with patients and families. Models of care need to be adapted to both local and regional needs and resources. In Australia new government funded schemes for genetic testing and use of PCSK9 inhibitors, as well as the National Health Genomics Policy Framework, will enable adoption of these recommendations. A broad implementation science strategy is, however, required to ensure that the guidance translates into benefit for all families with FH.