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Lima do Vale MR, Buckner L, Mitrofan CG, Tramontt CR, Kargbo SK, Khalid A, Ashraf S, Mouti S, Dai X, Unwin D, Bohn J, Goldberg L, Golubic R, Ray S. A synthesis of pathways linking diet, metabolic risk and cardiovascular disease: a framework to guide further research and approaches to evidence-based practice. Nutr Res Rev 2023; 36:232-258. [PMID: 34839838 DOI: 10.1017/s0954422421000378] [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] [Indexed: 11/07/2022]
Abstract
Cardiovascular disease (CVD) is the most common non-communicable disease occurring globally. Although previous literature has provided useful insights into the important role that diet plays in CVD prevention and treatment, understanding the causal role of diets is a difficult task considering inherent and introduced weaknesses of observational (e.g. not properly addressing confounders and mediators) and experimental research designs (e.g. not appropriate or well designed). In this narrative review, we organised current evidence linking diet, as well as conventional and emerging physiological risk factors, with CVD risk, incidence and mortality in a series of diagrams. The diagrams presented can aid causal inference studies as they provide a visual representation of the types of studies underlying the associations between potential risk markers/factors for CVD. This may facilitate the selection of variables to be considered and the creation of analytical models. Evidence depicted in the diagrams was systematically collected from studies included in the British Nutrition Task Force report on diet and CVD and database searches, including Medline and Embase. Although several markers and disorders linked to conventional and emerging risk factors for CVD were identified, the causal link between many remains unknown. There is a need to address the multifactorial nature of CVD and the complex interplay between conventional and emerging risk factors with natural and built environments, while bringing the life course into the spotlight.
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Affiliation(s)
| | - Luke Buckner
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | | | | | | | - Ali Khalid
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Sammyia Ashraf
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Saad Mouti
- University of California Berkeley, Consortium for Data Analytics in Risk, Berkeley, CA, USA
| | - Xiaowu Dai
- University of California Berkeley, Consortium for Data Analytics in Risk, Berkeley, CA, USA
| | | | - Jeffrey Bohn
- University of California Berkeley, Consortium for Data Analytics in Risk, Berkeley, CA, USA
- Swiss Re Institute, Zürich, Switzerland
| | - Lisa Goldberg
- University of California Berkeley, Consortium for Data Analytics in Risk, Berkeley, CA, USA
| | - Rajna Golubic
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Diabetes Trials Unit, University of Oxford, Oxford, UK
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
- University of Ulster, School of Biomedical Sciences, Coleraine, UK
- University of Cambridge, School of the Humanities and Social Sciences, Cambridge, UK
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Zhao Y, Zhang J, Chen C, Qin P, Zhang M, Shi X, Yang Y, Lu J, Sun L, Hu D. Comparison of six surrogate insulin resistance indexes for predicting the risk of incident stroke: The Rural Chinese Cohort Study. Diabetes Metab Res Rev 2022; 38:e3567. [PMID: 35929532 DOI: 10.1002/dmrr.3567] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 07/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Some cheap and easily used operated indexes of insulin resistance (IR) were currently available. We aimed to evaluate the association of six surrogate indexes of IR with incident stroke and to compare their predictive capacity. METHODS We analysed data from 14,595 eligible study participants from the Rural Chinese Cohort Study. Modified Poisson regression models were used to estimate relative risks (RRs) and 95% confidence intervals (95% CIs) of incident stroke associated with the visceral adiposity index (VAI), the Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP), triglyceride-glucose (TyG), TyG-body mass index, and TyG-waist circumference. The receiver operator characteristic curve was used to compare the ability of the abovementioned IR indexes to predict stroke. RESULTS During a median follow-up of 6 years, 786 newly diagnosed stroke cases were identified. The levels of six surrogate indexes of IR were all significantly higher in the stroke population than in the non-stroke population (p < 0.001). Compared with quartile 1, the multivariable adjusted RRs (95% CIs) of incident stroke for quartile 4 were 2.01 (1.47-2.76), 1.62 (1.28, 2.04), 1.64 (1.28-2.09), and 1.92 (1.50-2.45) for CVAI, VAI, LAP, and TyG, respectively. Significant dose-response associations were also found between surrogate IR indexes and risk of stroke. The area under the curves|areas under the curves for CVAI (0.674) was significantly greater than for other indexes (TyG-WC:0.622, TyG:0.614, LAP:0.606, TyG-BMI:0.598, and VAI:0.577) (p < 0.001). CONCLUSIONS Six surrogate indexes of IR were independently associated with incident stroke. The CVAI may be the most suitable index for stroke prediction.
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Affiliation(s)
- Yang Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jinli Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Chuanqi Chen
- Department of Endocrinology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Pei Qin
- Department of Medical Record Management, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Xuezhong Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yongli Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jie Lu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Liang Sun
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Dongsheng Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
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Wu A, Li Y, Liu R, Qi D, Yu G, Yan X, Mao D, Li X, Zhou R, Dai W. Predictive Value of Insulin Resistance as Determined by Homeostasis Model Assessment in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis. Horm Metab Res 2021; 53:746-751. [PMID: 34740276 DOI: 10.1055/a-1648-7767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Studies on association between homeostasis model assessment of insulin resistance (HOMA-IR) and adverse outcomes have yielded conflicting results in patients with acute ischemic stroke (AIS). This meta-analysis aimed to assess the predictive value of HOMA-IR in AIS patients. Two authors comprehensively searched PubMed and Embase databases until February 28, 2021. All observational studies investigating the association between HOMA-IR and adverse outcomes in AIS patients were included. Outcome measures were poor functional outcome (Modified Rankin Scale≥3), all-cause mortality, stroke recurrence, and neurologic worsening. Seven studies (eight articles) involving 8330 AIS patients were identified. For the highest versus lowest HOMA-IR, the pooled risk ratio (RR) of poor functional outcome was 2.55 (95% CI 1.76-3.70) after adjustment of conventional confounding factors. In addition, elevated HOMA-IR was associated with higher risk of neurologic worsening (RR 1.93; 95% CI 1.15-3.26). However, there were conflicting findings on the association of HOMA-IR with stroke recurrence and all-cause mortality. This meta-analysis confirms that HOMA-IR is significantly associated with an increased risk of poor functional outcome in patients with AIS. However, interpretation of the results of mortality, stroke recurrence, and neurologic worsening should be done with caution due to small number of studies available.
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Affiliation(s)
- An Wu
- Department of Neurosurgery, Quzhou Hospital Affiliated to Wenzhou University, Quzhou, China
| | - Yunping Li
- Department of Neurosurgery, Quzhou Hospital Affiliated to Wenzhou University, Quzhou, China
| | - Rongcai Liu
- Department of Neurosurgery, Quzhou Hospital Affiliated to Wenzhou University, Quzhou, China
| | - Dongjing Qi
- Department of Neurosurgery, Quzhou Hospital Affiliated to Wenzhou University, Quzhou, China
| | - Guofeng Yu
- Department of Neurosurgery, Quzhou Hospital Affiliated to Wenzhou University, Quzhou, China
| | - Xinjiang Yan
- Department of Neurosurgery, Quzhou Hospital Affiliated to Wenzhou University, Quzhou, China
| | - Dandan Mao
- Department of Neurosurgery, Quzhou Hospital Affiliated to Wenzhou University, Quzhou, China
| | - Xiang Li
- Department of Neurosurgery, Quzhou Hospital Affiliated to Wenzhou University, Quzhou, China
| | - Richeng Zhou
- Department of Neurosurgery, Quzhou Hospital Affiliated to Wenzhou University, Quzhou, China
| | - Weimin Dai
- Department of Neurosurgery, Quzhou Hospital Affiliated to Wenzhou University, Quzhou, China
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Zhao Y, Sun H, Zhang W, Xi Y, Shi X, Yang Y, Lu J, Zhang M, Sun L, Hu D. Elevated triglyceride-glucose index predicts risk of incident ischaemic stroke: The Rural Chinese cohort study. DIABETES & METABOLISM 2021; 47:101246. [PMID: 33722769 DOI: 10.1016/j.diabet.2021.101246] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 01/23/2023]
Abstract
AIM As the association between insulin resistance and ischaemic stroke is conflicting, our study aimed to examine the association between triglyceride-glucose (TyG), a surrogate marker of insulin resistance, and incident ischaemic stroke, and also to further assess the potential effect of modification by several known risk factors of stroke. METHODS The Rural Chinese Cohort Study enrolled 11,777 participants, aged ≥40 years, who were free of stroke and cardiovascular disease at baseline during 2007-2008, and who were then followed during 2013-2014. TyG was determined using the following formula: Ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The relative risk (RR) and 95% confidence interval (CI) of incident ischaemic stroke associated with TyG were estimated using modified Poisson regression models. RESULTS During a median follow-up duration of 6 years, 677 new ischaemic stroke cases were identified. After multivariate adjustment, RR (95% CI) values for ischaemic stroke were 1.33 (1.01-1.75), 1.57 (1.17-2.10) and 1.95 (1.34-2.82) in TyG quartile (Q) 2, 3 and 4 groups, respectively, compared with Q1. A significant interaction between TyG index and age for risk of ischaemic stroke (Pinteraction < 0.001) was also observed. However, no significant interaction was found between TyG index and other potential risk factors of risk for ischaemic stroke, although there were significant positive associations with female, non-smoker, non-drinker, low or moderate physical activity, non-obese and non-type 2 diabetes mellitus groups. CONCLUSION Elevated TyG index is an independent predictor of ischaemic stroke in the general population, and insulin resistance may be positively associated with future stroke risk.
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Affiliation(s)
- Yang Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Haohang Sun
- Cardiovascular Department, Zhengzhou Yihe Hospital Affiliated to Henan University, Zhengzhou, Henan, People's Republic of China
| | - Weidong Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuanlin Xi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xuezhong Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yongli Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jie Lu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Liang Sun
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China; Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.
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