Plant foods and the risk of cerebrovascular diseases: a potential protection of fruit consumption

Estimating effects of whole grain consumption on type 2 diabetes, colorectal cancer and cardiovascular disease: a burden of proof study

BACKGROUND

Previous studies on whole grain consumption had inconsistent findings and lacked quantitative assessments of evidence quality. Therefore, we aimed to summarize updated findings using the Burden of Proof analysis (BPRF) to investigate the relationship of whole grain consumption on type 2 diabetes (T2D), colorectal cancer (CRC), stroke, and ischemic heart disease (IHD).

METHODS

We conducted a literature search in the Medline and Web of Science up to June 12, 2023, to identify related cohort studies and systematic reviews. The mean RR (relative risk) curve and uncertainty intervals (UIs), BPRF function, risk-outcome score (ROS), and the theoretical minimum risk exposure level (TMREL) were estimated to evaluate the level of four risk-outcome pairs.

RESULTS

In total, 27 prospective cohorts were included in our analysis. Consuming whole grain at the range of TMREL (118.5-148.1 g per day) was associated with lower risks: T2D (declined by 37.3%, 95% UI: 5.8 to 59.5), CRC (declined by 17.3%, 6.5 to 27.7), stroke (declined by 21.8%, 7.3 to 35.1), and IHD (declined by 36.9%, 7.1 to 58.0). For all outcomes except stroke, we observed a non-linear, monotonic decrease as whole grain consumption increased; For stroke, it followed a J-shaped curve (the greatest decline in the risk of stroke at consuming 100 g whole grain for a day). The relationships between whole grain consumption and four diseases are all two-star pairs (ROS: 0.087, 0.068, 0.062, 0.095 for T2D, CRC, stroke, and IHD, respectively).

CONCLUSION

Consuming 100 g of whole grains per day offers broad protective benefits. However, exceeding this threshold may diminish the protective effects against stroke. Our findings endorse replacing refined grains with whole grains as the main source of daily carbohydrates. REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: We have registered our research in PROSPERO, and the identifier of our meta-analyses is CRD42023447345.

Refined grain intake and cardiovascular disease: Meta-analyses of prospective cohort studies

Refined grains are included as part of an unhealthy, or Western, dietary pattern, which has been shown to be associated with increased risk of cardiovascular disease (CVD). To clarify the association between refined grain intake and CVD risk, Pubmed and Scopus databases were searched for relevant cohort studies from database inception to June 30, 2022. Only studies that examined refined grains as a distinct consumption category and not as part of a dietary pattern, were included. Meta-analyses were performed using Cochrane's RevMan 5.4.1 software, applying inverse variance risk ratios in random effects models for each outcome of interest. Heterogeneity was assessed with Cochrane's Q (chi2) and I2 statistics. Meta-analyses of hazard ratios (HR) and 95% confidence intervals (CI) obtained from 17 prospective cohort studies (>875,000 participants) indicated that refined grain intake was not associated with risk of CVD (HR = 1.08, 95% CI, 0.99-1.18, I2 = 70%; 9 cohorts), stroke (HR = 1.06, 95% CI 0.92-1.23, I2 = 70%; 9 cohorts), or heart failure (HR = 0.95, 95% CI 0.77-1.16, I2 = 10%; 5 cohorts). White rice intake was also not associated with risk of CVD (HR = 0.93, 95% CI 0.86-1.00, I2 = 25%; 7 cohorts) or stroke (HR = 1.03, 95% CI 0.93-1.14, I2 = 22%; 7 cohorts). No significant publication bias was evident (Egger's test P values all > 0.05). The lack of association between refined grain intake and CVD risk was observed in meta-analyses of studies that restricted analyses to only staple grain foods (e.g., bread, cereal, pasta, white rice), as well as for meta-analyses of studies that included both staple and indulgent grain foods (e.g., cakes, cookies, doughnuts, brownies, muffins, pastries). Probable confounding from unmeasured variables in studies included in the meta-analyses diminishes the overall quality of evidence. Although refined grains are included as a component of the Western dietary pattern, the results of the meta-analyses suggest that refined grains do not contribute to the higher CVD risk associated with this unhealthy dietary pattern. This information should be considered in formulation of future dietary recommendations.

Legume consumption in adults and risk of cardiovascular disease and type 2 diabetes: a systematic review and meta-analysis

Objectives

This study aimed to systematically review the evidence for associations between consumption of legumes and cardiovascular disease (CVD), type 2 diabetes (T2D) and their risk factors among healthy adults.

Methods

We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus up to 16 May 2022 for ≥4 weeks long randomized (RCT) and non-randomized controlled trials and prospective cohort studies with follow-up ≥12 months, assessing legume intake (beans/lentils/peas/soybeans, excluding peanuts and legume-products/protein/powder/flour) as the intervention or exposure. Outcomes were CVD, coronary heart disease (CHD), stroke, T2D and in intervention trials only: changes in blood lipids, glycemic markers, and blood pressure. Risk of bias (RoB) was evaluated with Cochrane's RoB2, ROBINS-I, and US Department of Agriculture (USDA)'s RoB-NObS. Effect sizes were pooled using random-effects meta-analyses and expressed as relative risk or weighed mean differences with 95% confidence intervals, heterogeneity quantified as I2. The evidence was appraised according to World Cancer Research Fund's criteria.

Results

Of the 181 full-text articles assessed for eligibility, 47 were included: 31 cohort studies (2,081,432 participants with generally low legume consumption), 14 crossover RCTs (448 participants), one parallel RCT and one non-randomized trial. Meta-analyses of cohort studies were suggestive of null associations for CVD, CHD, stroke and T2D. Meta-analyses of RCTs suggested a protective effect on total cholesterol (mean difference -0.22 mmol/L), low density lipoprotein (LDL)-cholesterol (-0.19 mmol/L), fasting glucose (-0.19 mmol/L), and HOMA-IR (-0.30). Heterogeneity was high (I2 = 52% for LDL-cholesterol, >75% for others). The overall evidence for associations between consumption of legumes and risk of CVD and T2D was considered limited - no conclusion.

Conclusion

Legume consumption was not found to influence risk of CVD and T2D in healthy adult populations with generally low legume consumption. However, protective effects on risk factors, seen in RCTs, lend some support for recommending legume consumption as part of diverse and healthy dietary patterns for prevention of CVD and T2D.

The Relationship Between Major Food Sources of Fructose and Cardiovascular Outcomes: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies

There is emerging evidence of associations between intake of sugar-sweetened beverages (SSBs), those that include various forms of added sugar, and increased risk of cardiovascular disease (CVD) but whether consumption of other dietary sources of fructose affects CVD is unclear. In this study, we conducted a meta-analysis to examine potential dose-response relationships between such foods and CVD, coronary heart disease (CHD), and stroke morbidity and mortality. We systematically searched the literature indexed in PubMed, Embase, and the Cochrane Library from the inception of each database to February 10, 2022. We included prospective cohort studies analyzing the association between at least 1 dietary source of fructose and CVD, CHD, and stroke. Based on data from 64 included studies, summary HRs and 95% CIs were calculated for the highest intake category compared with the lowest, and dose-response analyses were performed. Of all fructose sources examined, only SSB intakes showed positive associations with CVD, giving summary HRs per 250 mL/d increase of 1.10 (95% CI: 1.02, 1.17) for CVD, 1.11 (95% CI: 1.05, 1.17) for CHD, 1.08 (95% CI: 1.02, 1.13) for stroke morbidity, and 1.06 (95% CI: 1.02, 1.10) for CVD mortality. Conversely, 3 dietary sources showed protective associations: between fruits and CVD morbidity (HR: 0.97; 95% CI: 0.96, 0.98), fruits and CVD mortality (HR: 0.94; 95% CI: 0.92, 0.97), yogurt and CVD mortality (HR: 0.96; 95% CI: 0.93, 0.99), and breakfast cereals and CVD mortality (HR: 0.80; 95% CI: 0.70, 0.90). All these relationships were linear except for fruit, which was J-shaped: CVD morbidity was the lowest at 200 g/d and there was no protective association above 400 g/d. These findings indicate that the adverse associations between SSBs and CVD, CHD, and stroke morbidity and mortality do not extend to other dietary sources of fructose. The food matrix seemed to modify the association between fructose and cardiovascular outcomes.

Consumption of whole grains and refined grains and associated risk of cardiovascular disease events and all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies

BACKGROUND

Although relationships between the intake of whole grains and refined grains and the incidence of cardiovascular disease (CVD) events and all-cause mortality have been investigated, the conclusions have been inconclusive.

OBJECTIVES

We aimed to comprehensively summarize the evidence about the correlation between consuming whole grains and refined grains and risks of CVD events and all-cause mortality and to evaluate the meta-evidence quality.

METHODS

We searched PubMed, Embase, and Web of Science until 15 March, 2022. Random-effects models were employed to calculate summary relative risks (RRs) and 95% confidence intervals (CIs). We explored potential linear or nonlinear relationships using restricted cubic splines. The NutriGrade tool was employed to rate meta-evidence quality.

RESULTS

Twenty-four articles (68 studies; 46 for whole grains and 22 for refined grains) with 1,624,407 participants were included. Per 30-g increase in daily whole grain consumption, the RRs and 95% CIs of stroke, coronary heart disease (CHD), heart failure (HF), CVD, and all-cause mortality were 0.98 (0.96, 1.00), 0.94 (0.92, 0.97), 0.97 (0.89, 1.07), 0.92 (0.88, 0.96), and 0.94 (0.92, 0.97), respectively. Whole grain consumption was linearly associated with CHD (P_nonlinearity = 0.231) and nonlinearly associated with CVD (P_nonlinearity = 0.002) and all-cause mortality (P_nonlinearity = 0.001). Except for a positive correlation between refined grain consumption and all-cause mortality in the restricted cubic spline, no significant influence of refined grain intake on stroke, CHD, HF, and CVD was detected. The meta-evidence quality for the association of whole grain consumption with stroke, CHD, HF, CVD, and all-cause mortality was moderate, moderate, low, high, and high, respectively. For refined grains, all meta-evidence was of low quality.

CONCLUSIONS

Consuming whole grains, rather than refined grains, can assist in preventing CHD, CVD, and all-cause mortality. Relationships between consumption of refined grains and health outcomes should be interpreted cautiously because of the low quality of meta-evidence.

Intake of legumes and cardiovascular disease: A systematic review and dose-response meta-analysis

AIMS

To summarize the evidence on the association between the intake of legumes and the risk of cardiovascular disease (CVD) overall, coronary heart disease (CHD) and stroke, and to identify optimal intake levels for reduced disease risk through a systematic review and dose-response meta-analysis.

DATA SYNTHESIS

We have systematically searched PubMed, Scopus and Web of Science up to March, 2022 for the retrieval of intervention and observational studies (PROSPERO Reg. number: CRD42021247565). Pooled relative risks (RRs) comparing extreme categories of intake were computed using random-effects models. One-stage dose-response meta-analyses were also performed using random-effects models. 22 831 articles were screened resulting in 26 eligible observational studies (21 prospective cohort and 5 case-control studies). When comparing extreme categories of intake, the consumption of legumes was inversely associated with CVD (n = 25: RR = 0.94; 95%CI:0.89,0.99) and CHD (n = 16: RR = 0.90; 95%CI:0.85,0.96), but not with stroke (n = 9: RR = 1.00; 95%CI:0.93,1.08). We further found evidence for an inverse dose-response association with CHD, increasing in magnitude up to an intake of 400 g/week, after which the benefit seems to level-off.

CONCLUSIONS

The intake of legumes was associated with a reduced risk of CVD and CHD, but not with stroke, among individuals with the highest consumption levels. An intake level of 400 g/week seemed to provide the optimal cardiovascular benefit. Further research is needed to better understand the role of legumes in stroke subtypes.

Health effects associated with vegetable consumption: a Burden of Proof study

Previous research suggests a protective effect of vegetable consumption against chronic disease, but the quality of evidence underlying those findings remains uncertain. We applied a Bayesian meta-regression tool to estimate the mean risk function and quantify the quality of evidence for associations between vegetable consumption and ischemic heart disease (IHD), ischemic stroke, hemorrhagic stroke, type 2 diabetes and esophageal cancer. Increasing from no vegetable consumption to the theoretical minimum risk exposure level (306-372 g daily) was associated with a 23.2% decline (95% uncertainty interval, including between-study heterogeneity: 16.4-29.4) in ischemic stroke risk; a 22.9% (13.6-31.3) decline in IHD risk; a 15.9% (1.7-28.1) decline in hemorrhagic stroke risk; a 28.5% (-0.02-51.4) decline in esophageal cancer risk; and a 26.1% (-3.6-48.3) decline in type 2 diabetes risk. We found statistically significant protective effects of vegetable consumption for ischemic stroke (three stars), IHD (two stars), hemorrhagic stroke (two stars) and esophageal cancer (two stars). Including between-study heterogeneity, we did not detect a significant association with type 2 diabetes, corresponding to a one-star rating. Although current evidence supports increased efforts and policies to promote vegetable consumption, remaining uncertainties suggest the need for continued research.

Cruciferous vegetable consumption and multiple health outcomes: an umbrella review of 41 systematic reviews and meta-analyses of 303 observational studies

Background: Epidemiological studies evaluating the associations between the consumption of cruciferous vegetables (CV) and diverse health outcomes have generated inconsistent findings. Therefore, we carried out an umbrella review to systematically summarize existing evidence on this topic. Methods: This study had been registered at PROSPERO (no. CRD42021262011). Relevant systematic reviews and meta-analyses of observational studies were identified by searching PubMed, Web of science, and Embase databases from inception up to March 15, 2021. Observational studies investigating the association between CV intake and multiple health outcomes in humans were eligible for inclusion. The validated AMSTAR (A Measurement Tool to Assess Systematic Reviews) instrument was utilized for assessing the methodological quality of the included systematic reviews. For each meta-analysis, we assessed the summary effect size by using fixed and random effects models, 95% prediction intervals, heterogeneity, evidence of small-study effects, and excess significance bias. Results: Our umbrella review included 41 meta-analyses of 303 individual studies involving 13 394 722 participants. Twenty-four health outcomes including cancers (n = 23), cardiovascular disease (n = 12), mortality (n = 5), and metabolic diseases (n = 1) were evaluated. The summary random effects estimates were significant at P < 0.05 in 24 meta-analyses - all of which reported decreased risks of health outcomes. All were of moderate methodological quality in our study. Of the 41 meta-analyses, we observed suggestive evidence for beneficial associations between gastric cancer, lung cancer, endometrial cancer, and all-cause mortality. Moreover, 16 associations were supported by weak evidence, including breast cancer, lung cancer, renal cell carcinoma, bladder cancer, prostate cancer, ovarian cancer, endometrial cancer, colon cancer, colorectal adenoma, colorectal neoplasm, non-Hodgkin lymphoma, and total cancer. Conclusions: It revealed that CV intake might be associated with beneficial effects on several health-related outcomes (gastric cancer, lung cancer, endometrial cancer, and all-cause mortality). Other associations could be genuine, but substantial uncertainty remains. Additional studies are needed to evaluate the relationship between the consumption of CV and various health outcomes as well as robust randomized controlled trials in the future.

Coarse Grain Consumption and Risk of Cardiometabolic Diseases: A Prospective Cohort Study of Chinese Adults

BACKGROUND

Lower consumption of whole grains is associated with higher risks of diabetes and coronary heart disease in Western populations, but evidence is still limited for stroke. Moreover, little is known in China, where the rates of cardiometabolic diseases are high and the grain types consumed are different from those in Western countries.

OBJECTIVES

To examine the associations between coarse-grain (e.g., millet, corn, and sorghum) consumption and incident cardiometabolic diseases among Chinese adults.

METHODS

The prospective China Kadoorie Biobank enrolled >0.5 million adults aged 30-79 years from 10 urban and rural areas during 2004-2008. At baseline, consumption frequencies (in 5 categories from "never" to "daily") of 12 major food groups, including coarse grains, were collected using a validated FFQ. After a median of 11 years of follow-up, 17,149 cases of diabetes, 29,876 ischemic strokes, 6097 hemorrhagic strokes, and 6704 major coronary events were recorded among 461,047 participants without a prevalence of major chronic diseases at baseline. Cox regression analyses were used to yield adjusted HRs for each disease associated with coarse-grain consumption.

RESULTS

Overall, 13.8% of participants reported regularly consuming (i.e., ≥4 days/week, regular consumers) and 29.4% reported never or rarely consuming coarse grains (i.e., nonconsumers) at baseline. Compared with nonconsumers, regular consumers had lower risks of diabetes (adjusted HR, 0.88; 95% CI, 0.78-0.98) and ischemic stroke (adjusted HR, 0.86; 95% CI, 0.81-0.93), but not hemorrhagic stroke (adjusted HR, 0.96; 95% CI, 0.76-1.20) or major coronary events (adjusted HR, 0.95; 95% CI, 0.81-1.12). For diabetes and ischemic stroke, each 100 g/day increase in the usual intake of coarse grains was associated with 14% (adjusted HR, 0.86; 95% CI, 0.76-0.97) and 13% (adjusted HR, 0.87; 95% CI, 0.81-0.94) lower risks, respectively, with similar results in various subgroups.

CONCLUSIONS

In Chinese adults, higher coarse-grain consumption is associated with lower risks of diabetes and ischemic stroke, supporting the promotion of coarse-grain consumption in China.

Roles of Nutraceuticals and Functional Food in Prevention of Cardiovascular Disease

The chapter provides an overview of cardiovascular disease, a major cause of mortality worldwide. It relates economic and social impacts to the disease, especially in developing countries. One of the approaches to addressing this challenge is increasing awareness within society, through implementation of education programs. It is important for society to understand the types and roles of the risk factors leading to cardiovascular disease. Emphasis is on the role of functional food and nutraceuticals as dietary sources that could prevent development of cardiovascular disease. The chapter highlights roles of nutraceuticals and functional food sources from medical plants, seeds, berries, and tropical fruits in lowering risk factors. Key findings from trials conducted in Asia, China, Europe, and America provide supporting evidence for the importance of functional food to health, and its potential for modifying the level of risk factors related to cardiovascular diseases.

Consumption of flavonoid-rich fruits, flavonoids from fruits and stroke risk: a prospective cohort study

We sought to examine the prospective associations of specific fruit consumption, in particular flavonoid-rich fruit (FRF) consumption, with the risk of stroke and subtypes of stroke in a Japanese population. A study followed a total of 39 843 men and 47 334 women aged 44-76 years, and free of CVD, diabetes and cancer at baseline since 1995 and 1998 to the end of 2009 and 2012, respectively. Data on total and specific FRF consumption for each participant were obtained using a self-administrated FFQ. The hazard ratios (HR) of stroke in relation to total and specific FRF consumption were estimated through Cox proportional hazards regression models. During a median follow-up of 13·1 years, 4091 incident stroke cases (2557 cerebral infarctions and 1516 haemorrhagic strokes) were documented. After adjustment for age, BMI, study area, lifestyles, dietary factors and other risk factors, it was found that total FRF consumption was associated with a significantly lower risk of stroke in women (HR = 0·70; 95 % CI 0·58, 0·84), while the association in men was not significant (HR = 0·93; 95 % CI 0·79, 1·09). As for specific FRF, consumptions of citrus fruits, strawberries and grapes were found associated with a lower stroke risk in women. Higher consumptions of FRF, in particular citrus fruits, strawberries and grapes, were associated with a lower risk of developing stroke in Japanese women.

Evaluating the role of orange juice, HESPERidin in vascular HEALTH benefits (HESPER-HEALTH study): protocol for a randomised controlled trial

INTRODUCTION

Although epidemiological studies associate the consumption of sugary beverages with adverse health effects, human experimental studies have demonstrated substantially different metabolic responses when 100% fruit juices are compared with artificial beverages. Fruit juices do not just provide sugars and associated calories, but they are also rich in bioactive compounds. Flavanones are bioactives specifically and abundantly found in citrus foods, with hesperidin as the major representative in sweet oranges. Flavanone intake has been associated with a lower incidence of mortality from cardiovascular disease (CVD). However, clinical evidence are too scarce to confirm the vasculoprotective effects of 100% orange juice (OJ) presumably mediated by flavanones and thereby do not allow firm conclusions to be drawn about their efficacy.

METHODS AND ANALYSIS

The HESPER-HEALTH study aims to assess the efficacy of OJ in improving vascular function and the contribution of hesperidin to these effects. This double-blind, randomised, controlled, crossover study will be carried out in 42 volunteers predisposed to CVD, based on age and on overweight. It includes three 6-week periods of consumption of 330 mL/d of OJ versus control drinks with and without hesperidin at a dose in agreement with a daily OJ serving (approx. 200-215 mg). The primary outcome is endothelial function, assessed by flow mediated dilation, with measurements performed at fasting and postprandially in response to a challenge meal. The secondary outcomes include bioavailability and metabolism of flavanones, changes in other markers of vascular function, systemic biomarkers of cardiovascular risk, endothelial dysfunction and inflammation, vitamin C and carotenoids status, anthropometry and body composition, gut microbiota composition, nutrigenomic response and in oxylipin profiling.

ETHICS AND DISSEMINATION

This ongoing study was approved by the Ethics committee Sud-Est III, Bron, France on 17 November 2020. The trial is registered on ClinicalTrials.gov. The results will be disseminated in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT04731987; Pre-results.

High Hydrostatic Pressure vs. Thermal Pasteurization: The Effect on the Bioactive Compound Profile of a Citrus Maqui Beverage

The effects of high hydrostatic pressure (HHP) compared to thermal pasteurization (TP) were studied in healthy citrus-maqui beverages. The impact of the processing technologies on the microbiological and phytochemical profile was assessed by applying two HHP treatments at 450 and 600 MPa for 180 s and TP at 85 °C for 15 s. The shelf life under refrigeration (4 °C) and room temperature (20 °C) was monitored for 90 days. All treatments ensured microbiological stability at both storage temperatures. Aside from that, the physicochemical parameters were not significantly different after processing or throughout the storage period. Regarding color parameters, an increase in the reddish coloration was observed during storage for those beverages treated by HHP. In general, phenolic compounds were little affected by the processing technique, even when treatment under HHP was more stable than by TP during storage. On the other hand, vitamin C showed great degradation after processing under any condition. It can be concluded that HHP is an effective alternative to thermal treatments, achieving effective microbial inactivation and extending the shelf life of the juices by contributing to a better preservation of color and bioactive compounds.

Relation of Different Fruit and Vegetable Sources With Incident Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Background Public health policies reflect concerns that certain fruit sources may not have the intended benefits and that vegetables should be preferred to fruit. We assessed the relation of fruit and vegetable sources with cardiovascular outcomes using a systematic review and meta-analysis of prospective cohort studies. Methods and Results MEDLINE, EMBASE, and Cochrane were searched through June 3, 2019. Two independent reviewers extracted data and assessed study quality (Newcastle-Ottawa Scale). Data were pooled (fixed effects), and heterogeneity (Cochrane-Q and I2) and certainty of the evidence (Grading of Recommendations Assessment, Development, and Evaluation) were assessed. Eighty-one cohorts involving 4 031 896 individuals and 125 112 cardiovascular events were included. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (risk ratio, 0.93 [95% CI, 0.89-0.96]; 0.91 [0.88-0.95]; and 0.94 [0.90-0.97], respectively), coronary heart disease (0.88 [0.83-0.92]; 0.88 [0.84-0.92]; and 0.92 [0.87-0.96], respectively), and stroke (0.82 [0.77-0.88], 0.82 [0.79-0.85]; and 0.88 [0.83-0.93], respectively) incidence. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (0.89 [0.85-0.93]; 0.88 [0.86-0.91]; and 0.87 [0.85-0.90], respectively), coronary heart disease (0.81 [0.72-0.92]; 0.86 [0.82-0.90]; and 0.86 [0.83-0.89], respectively), and stroke (0.73 [0.65-0.81]; 0.87 [0.84-0.91]; and 0.94 [0.90-0.99], respectively) mortality. There were greater benefits for citrus, 100% fruit juice, and pommes among fruit sources and allium, carrots, cruciferous, and green leafy among vegetable sources. No sources showed an adverse association. The certainty of the evidence was "very low" to "moderate," with the highest for total fruit and/or vegetables, pommes fruit, and green leafy vegetables. Conclusions Fruits and vegetables are associated with cardiovascular benefit, with some sources associated with greater benefit and none showing an adverse association. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT03394339.

Nutrition, Thrombosis, and Cardiovascular Disease

Previous studies reported an inverse association between healthy dietary patterns (such as Mediterranean diet) and the incidence of cardiovascular events. As the mechanism accounting for cardiovascular disease is prevalently due to the atherothrombosis, where a pivotal role is played by platelet activation, it would be arguable that diets with protective effects against cardiovascular disease exert an anti-atherothrombotic effect via inhibition of platelet activation. There are several and sparse typologies of studies, which investigated if single nutrients by diets recognized as having cardiovascular protection may exert an antithrombotic effect. The most investigated nutrients are key components of the Mediterranean diets such as fruits and vegetables, fish, olive oil, and wine; other diets with protective effects include nuts and cocoa. Here we summarize experimental and human interventional studies which investigated the antithrombotic effects of such nutrients in experimental models of thrombosis or analyzed biomarkers of clotting, platelet, and fibrinolysis activation in human; furthermore in vitro studies explored the underlying mechanism at level of several cell lines such as platelets or endothelial cells. In this context, we analyzed if nutrients affect simultaneously or separately clotting, platelet, and fibrinolysis pathways giving special attention to the relationship between oxidative stress and thrombosis as most nutrients are believed to possess antioxidant properties.

Effect of Heat Treatment on the Anticancer Activity of Houttuynia cordata Thunb Aerial Stem Extract in Human Gastric Cancer SGC-7901 Cells

Gastric cancer is one of the most common malignant tumors in the world, and prevention through diet is one of the ways to control. Houttuynia cordata thunb.(HCT) is a plant having medicine and food function, has many biological properties. However, the effect of food style on the anticancer activity of HCT is not clear. So, we investigate the effect of heat treatment on anticancer activity of HCT. HCT extracts (heated aerial stem, heated subterraneous stem, heated leaves defined as HAS, HSS, HL, respectively, and not heated defined as NAS, NSS, NL, respectively) were obtained, and their inhibited activity were detected by alamar blue assay. The cell apoptosis was detected by DAPI staining and flow cytometry analysis. Western blot was performed to test the expression of apoptotic related protein. HCT showed the anticancer activity in four human tumor cell lines. Interestingly, heat treatment could increase the anticancer activity. In SCG-7901 cells, heat treatment increased anticancer activity of AS by 2-14 folds and induced apoptosis through regulating the intrinsic signaling pathways. Intriguingly, the caspase nine specific inhibitor blocked AS-reduced cell viability. Heat treatment increased the anticancer activity of HCT, and can be used as a dietary style for prevention of gastric cancer.

Positive Association of Dietary Inflammatory Index with Incidence of Cardiovascular Disease: Findings from a Korean Population-Based Prospective Study

Recently, diets with higher inflammatory potentials based on the dietary inflammatory index (DII^®) have been shown to be associated with increased cardiovascular disease (CVD) risk in the general population. We aimed to prospectively investigate the association between the DII and CVD risk in the large Korean Genome and Epidemiology Study_Health Examination (KoGES_HEXA) cohort comprised of 162,773 participants (men 55,070; women 107,703). A validated semi-quantitative food frequency questionnaire (SQ-FFQ) was used to calculate the DII score. Statistical analyses were performed by using a multivariable Cox proportional hazard model. During the mean follow-up of 7.4 years, 1111 cases of CVD were diagnosed. Higher DII score was associated with increased risk of CVD in men (hazard ratio [HR]_{Quintile 5 vs. 1} 1.43; 95% CI 1.04–1.96) and in women (HR_{Quintile 5 vs. 1} 1.19; 95% CI 0.85–1.67), although not significant for women. The risk of CVD was significantly higher in physically inactive men (HR_{Quintile 5 vs. 1} 1.80; 95% CI 1.03–3.12), obese men (HR_{Quintile 5 vs. 1} 1.77; 95% CI 1.13–2.76) and men who smoked (HR_{Quintile 5 vs. 1} 1.60; 95% CI 1.10–2.33), respectively. The risk of developing stroke was significantly higher for men (HR_{Quintile 5 vs. 1} 2.06; 95% CI 1.07–3.98; p = 0.003), but not for women. A pro-inflammatory diet, as indicated by higher DII scores, was associated with increased risk of CVD and stroke among men.

Effects of Dietary Blueberry (Vaccinium ashei Reade) Leaves on Mildly Postprandial Hypertriglyceridemia

Prevention of postprandial hypertriglyceridemia is an important consideration for reducing the risk of developing cardiovascular disease. While blueberry fruits have been reported to ameliorate lipid metabolism in humans, there are only few research reports on the effects of blueberry leaves (BL). Here, we investigated the efficacy of BL on postprandial hyperlipidemia in subjects with high fasting triacylglycerol (TG) concentrations. Randomized, double-blind, cross-over design study was conducted. The subjects consumed a BL containing beverage or a placebo beverage before a fat-enriched test meal. Blood samples were collected prior to and 1, 2, 3, 4, and 5 hours after consuming the test beverage. The postprandial serum TG and remnant-like particle cholesterol (RLP-C) concentrations were significantly lower in the BL beverage compared with those in the placebo beverage. Additionally, BL was more effective in subjects with high fasting ghrelin with gastric emptying function. In current study, fasting ghrelin correlated with the increase in postprandial serum TG, suggesting that BL ameliorates hypertriglyceridemia through delayed gastric emptying. In conclusion, this pilot study suggests that BL may be useful as an early dietary therapy for treating postprandial hyperlipidemia.

Legume Consumption and Cardiometabolic Health

Legumes are key components of several plant-based diets and are recognized as having a wide range of potential health benefits. Previous systematic reviews and meta-analyses have summarized the evidence regarding different cardiometabolic outcomes, such as cardiovascular disease (CVD) and type 2 diabetes (T2D), and legume consumption. However, those studies did not differentiate between nonsoy and soy legumes, which have different nutritional profiles. The aim of the present updated review, therefore, was to summarize and meta-analyze the published evidence regarding legume consumption (making a distinction between nonsoy and soy legumes) and cardiometabolic diseases. In addition, we reviewed randomized clinical trials assessing the effect of legume consumption on CVD risk factors in order to understand their associations. The results revealed a prospective, significant inverse association between total legume consumption and CVD and coronary heart disease risk, whereas a nonsignificant association was observed with T2D and stroke. In the stratified analysis by legume subtypes, only nonsoy legumes were associated with lower risk of T2D. Unfortunately, owing to the paucity of studies analyzing legumes and CVD, it was not possible to stratify the analysis for these outcomes. Because of the high degree of heterogeneity observed for most of the outcomes and the few studies included in some analyses, further prospective studies are warranted to determine the potential role of legume consumption on CVD and T2D.

Associations between Dietary Pulses Alone or with Other Legumes and Cardiometabolic Disease Outcomes: An Umbrella Review and Updated Systematic Review and Meta-analysis of Prospective Cohort Studies

To update the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy, we conducted an umbrella review and updated systematic review and meta-analysis (SRMA) of prospective cohort studies of the association between dietary pulses with or without other legumes and cardiometabolic disease outcomes. We searched the PubMed, MEDLINE, EMBASE, and Cochrane databases through March 2019. We included the most recent SRMAs of prospective cohort studies and new prospective cohort studies published after the census dates of the included SRMAs assessing the relation between dietary pulses with or without other legumes and incidence and mortality of cardiovascular diseases (CVDs) [including coronary heart disease (CHD), myocardial infarction (MI), and stroke], diabetes, hypertension, and/or obesity. Two independent reviewers extracted data and assessed risk of bias. Risk estimates were pooled using the generic inverse variance method and expressed as risk ratios (RRs) with 95% CIs. The overall certainty of the evidence was assessed using the GRADE approach. Six SRMAs were identified and updated to include 28 unique prospective cohort studies with the following number of cases for each outcome: CVD incidence, 10,261; CVD mortality, 16,168; CHD incidence, 7786; CHD mortality, 3331; MI incidence, 2585; stroke incidence, 8570; stroke mortality, 2384; diabetes incidence, 10,457; hypertension incidence, 83,284; obesity incidence, 8125. Comparing the highest with the lowest level of intake, dietary pulses with or without other legumes were associated with significant decreases in CVD (RR: 0.92; 95% CI: 0.85, 0.99), CHD (RR: 0.90; 95% CI: 0.83, 0.99), hypertension (RR: 0.91; 95% CI: 0.86, 0.97), and obesity (RR: 0.87; 95% CI: 0.81, 0.94) incidence. There was no association with MI, stroke, and diabetes incidence or CVD, CHD, and stroke mortality. The overall certainty of the evidence was graded as "low" for CVD incidence and "very low" for all other outcomes. Current evidence shows that dietary pulses with or without other legumes are associated with reduced CVD incidence with low certainty and reduced CHD, hypertension, and obesity incidence with very low certainty. More research is needed to improve our estimates. This trial was registered at clinicaltrials.gov as NCT03555734.

Potatoes and risk of chronic disease: a systematic review and dose-response meta-analysis

PURPOSE

We aimed to synthesize the evidence on the relation between different types of potato consumption with risk of all-cause mortality, coronary heart disease (CHD), stroke, type 2 diabetes (T2D), colorectal cancer (CRC), and hypertension.

METHODS

Systematic searches until May 2018 were conducted in PubMed, Scopus, and Web of Science. Random effects meta-analyses comparing extreme categories, linear and non-linear dose-response analyses were conducted.

RESULTS

Twenty-eight reports were identified. Only total potato consumption was available for some endpoints which showed no associations with all-cause mortality (RR: 0.88, 95% CI 0.69-1.12), CHD (RR: 1.03, 95% CI 0.96-1.09), stroke (RR: 0.98, 95% CI 0.93-1.03), and CRC (RR: 1.05, 95% CI 0.92-1.20) per one daily/serving (150 g/day) increase. Consumption of one daily serving of boiled/baked/mashed-potatoes was not associated with risk of hypertension (RR: 1.08, 95% CI 0.96-1.21), but slightly with the risk of T2D (RR: 1.09, 95% 1.01-1.18). Positive associations for the risk of T2D (RR: 1.66, 95% CI 1.43-1.94) and hypertension (RR: 1.37, 95% CI 1.15-1.63) were observed for each 150 g/day increase in French-fries consumption. The quality of evidence was rated mostly low (moderate quality of evidence for the risk-associations of French-fries).

CONCLUSION

Total potato consumption is not related to risk for many chronic diseases but could pose a small increase in risk for T2D if consumed boiled. A clear risk relation was found between French-fries consumption and risk of T2D and hypertension. For several outcomes, the impact of different preparation procedures could not be assessed.

Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association?

Refined grain intake is widely assumed to be associated with adverse health outcomes, including increased risk for cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity. The 2015 Dietary Guidelines Advisory Committee recommended that to improve dietary quality, the US population should replace most refined grains with whole grains. This recommendation was based largely on results from studies that examined dietary patterns, not separate food groups. A Western dietary pattern typically includes red and processed meat, sugar-sweetened foods and beverages, French fries, and high-fat dairy products, as well as refined grains, and has been linked to increased risk of many chronic diseases. However, when evaluated as a distinct food category, 11 meta-analyses of prospective cohort studies, which included a total of 32 publications with data from 24 distinct cohorts, demonstrated that refined grain intake was not associated with all-cause mortality, T2D, CVD, coronary heart disease (CHD), stroke, hypertension, or cancer. By contrast, consumption of red and processed meat was consistently associated with increased risk of these same health outcomes. Refined grain consumption up to 6-7 servings/d (1 serving = 30 g) was not associated with higher risk of CHD, T2D, hypertension, or all-cause mortality. Moreover, total grain intake was not associated with risk of CVD, CHD, stroke, or cancer, but was associated with lower risk of all-cause mortality. Consequently, the recommendation to reduce refined grain intake based on results from studies linking a Western dietary pattern to numerous adverse health outcomes is contrary to a substantial body of published scientific evidence. Future research needs to better define refined grain intake to distinguish between staple grain foods and indulgent grain foods, and to better design randomized controlled trials to resolve discrepancies between results from observational studies and such trials with regard to determining the benefits of whole grains compared with refined grains.

Roles of Nutraceuticals and Functional Food in Prevention of Cardiovascular Disease

The chapter provides an overview of cardiovascular disease, a major cause of mortality worldwide. It relates economic and social impacts to the disease, especially in developing countries. One of the approaches to addressing this challenge is increasing awareness within society, through implementation of education programs. It is important for society to understand the types and roles of the risk factors leading to cardiovascular disease. Emphasis is on the role of functional food and nutraceuticals as dietary sources that could prevent development of cardiovascular disease. The chapter highlights roles of nutraceuticals and functional food sources from medical plants, seeds, berries, and tropical fruits in lowering risk factors. Key findings from trials conducted in Asia, China, Europe, and America provide supporting evidence for the importance of functional food to health, and its potential for modifying the level of risk factors related to cardiovascular diseases.

Dietary intake of anthocyanins and risk of cardiovascular disease: A systematic review and meta-analysis of prospective cohort studies

Accumulating evidence suggests flavonoid intake is associated with reduced risk of non-communicable diseases. We aimed to systematically determine and quantify the potential association between dietary anthocyanin intake and risk of cardiovascular diseases (CVD). A systematic literature search of studies reporting anthocyanin intake and risk of fatal or nonfatal CVD was performed using SCOPUS, MEDLINE, CINAHL and Cochrane Library. The relative risk (RR) or hazard ratio (HR) of highest category of anthocyanin foods were pooled in a random-effects meta-analysis. Subgroup analysis were conducted to determine possible sources of heterogeneity. The meta-analysis suggested intake of dietary anthocyanins and reduced risk of CHD (RR = 0.91, 95% CI: 0.83, 0.99; I² = 12.0, P_h = 0.337) and CVD mortality (RR = 0.92, 95% CI: 0.87, 0.97; I² = 0.0, P_h = 0.584). However, there was no relationship between the intake of these compounds and reduced risk of MI, stroke or total CVD. Subgroup analysis determined reduced risk of CHD and CVD mortality was more prominent for anthocyanidin intake, as opposed to anthocyanin or berries. Our systematic review and meta-analysis provides evidence that anthocyanins, specifically anthocyanidins, reduce the risk of CHD and CVD mortality. Further randomized controlled trials on anthocyanin intake and CVD risk factors are needed to support these findings.

Stroke medicine in antiquity: The Greek and Muslim contribution

The collective human effort to understand the brain and its common disease, stroke, has spanned many centuries, cultures, and societies. The ancient Greek and Muslim physicians made important contributions to the understanding and management of stroke in their time. The Muslim physicians, from 800 to 1200 AD, played an outstanding role, by conserving and refining Greco-Roman philosophies, formulating their own theories and reaching conclusions, some of which match our modern stroke models. They recognized the importance of the brain as a source of stroke symptoms, proposed the vascular nature of stroke etiology, and had some thoughts about intra-ventricular hemorrhage, and the process of atherosclerosis with the help of ancient philosophies. Their management strategies have now been discarded, but some of the herbal medicines they used, may be useful in stroke management today. Therefore, more research is required into the ancient texts to evaluate the efficacy of their management strategies.

Effect of increasing fruit and vegetable intake by dietary intervention on nutritional biomarkers and attitudes to dietary change: a randomised trial

PURPOSE

Low fruit and vegetable consumption is linked with an increased risk of death from vascular disease and cancer. The benefit of eating fruits and vegetables is attributed in part to antioxidants, vitamins and phytochemicals. Whether increasing intake impacts on markers of disease remains to be established. This study investigates whether increasing daily intake of fruits, vegetables and juices from low (approx. 3 portions), to high intakes (approx. 8 portions) impacts on nutritional and clinical biomarkers. Barriers to achieving the recommended fruit and vegetable intakes are also investigated.

METHOD

In a randomised clinical trial, the participants [19 men and 26 women (39-58 years)] with low reported fruit, juice and vegetable intake (<3 portions/day) were randomised to consume either their usual diet or a diet supplemented with an additional 480 g of fruit and vegetables and fruit juice (300 ml) daily for 12 weeks. Nutritional biomarkers (vitamin C, carotenoids, B vitamins), antioxidant capacity and genomic stability were measured pre-intervention, at 4-, 8- and 12 weeks throughout the intervention. Samples were also taken post-intervention after a 6-week washout period. Glucose, homocysteine, lipids, blood pressure, weight and arterial stiffness were also measured. Intake of fruit, fruit juice and vegetables was reassessed 12 months after conducting the study and a questionnaire was developed to identify barriers to healthy eating.

RESULTS

Intake increased significantly in the intervention group compared to controls, achieving 8.4 portions/day after 12 weeks. Plasma vitamin C (35%), folate (15%) and certain carotenoids [α-carotene (50%) and β-carotene (70%) and lutein/zeaxanthin (70%)] were significantly increased (P < 0.05) in the intervention group. There were no significant changes in antioxidant capacity, DNA damage and markers of vascular health. Barriers to achieving recommended intakes of fruits and vegetables measured 12 months after the intervention period were amount, inconvenience and cost.

CONCLUSION

While increasing fruit, juice and vegetable consumption increases circulating level of beneficial nutrients in healthy subjects, a 12-week intervention was not associated with effects on antioxidant status or lymphocyte DNA damage.

TRIAL REGISTRATION

This trial was registered at Controlled-Trials.com; registration ISRCTN71368072.

Cardiovascular Health Benefits of Specific Vegetable Types: A Narrative Review

Adequate vegetable consumption is one of the cornerstones of a healthy diet. The recommendation to increase vegetable intake is part of most dietary guidelines. Despite widespread and long-running public health messages to increase vegetable intake, similar to other countries worldwide, less than 1 in 10 adult Australians manage to meet target advice. Dietary guidelines are predominantly based on studies linking diets high in vegetables with lower risk of chronic diseases. Identifying vegetables with the strongest health benefits and incorporating these into dietary recommendations may enhance public health initiatives around vegetable intake. These enhanced public health initiatives would be targeted at reducing the risk of chronic diseases, such as cardiovascular diseases (CVD). Specific vegetable types contain high levels of particular nutrients and phytochemicals linked with cardiovascular health benefits. However, it is not clear if increasing intake of these specific vegetable types will result in larger benefits on risk of chronic diseases. This review presents an overview of the evidence for the relationships of specific types of vegetables, including leafy green, cruciferous, allium, yellow-orange-red and legumes, with subclinical and clinical CVD outcomes in observational epidemiological studies.

Food groups and risk of coronary heart disease, stroke and heart failure: A systematic review and dose-response meta-analysis of prospective studies

BACKGROUND

Despite growing evidence for food-based dietary patterns' potential to reduce cardiovascular disease risk, knowledge about the amounts of food associated with the greatest change in risk of specific cardiovascular outcomes and about the quality of meta-evidence is limited. Therefore, the aim of this meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups (whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages [SSB]) and the risk of coronary heart disease (CHD), stroke and heart failure (HF).

METHODS

We conducted a systematic search in PubMed and Embase up to March 2017 for prospective studies. Summary risk ratios (RRs) and 95% confidence intervals (95% CI) were estimated using a random effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships.

RESULTS

Overall, 123 reports were included in the meta-analyses. An inverse association was present for whole grains (RRCHD: 0.95 (95% CI: 0.92-0.98), RRHF: 0.96 (0.95-0.97)), vegetables and fruits (RRCHD: 0.97 (0.96-0.99), and 0.94 (0.90-0.97); RRstroke: 0.92 (0.86-0.98), and 0.90 (0.84-0.97)), nuts (RRCHD: 0.67 (0.43-1.05)), and fish consumption (RRCHD: 0.88 (0.79-0.99), RRstroke: 0.86 (0.75-0.99), and RRHF: 0.80 (0.67-0.95)), while a positive association was present for egg (RRHF: 1.16 (1.03-1.31)), red meat (RRCHD: 1.15 (1.08-1.23), RRstroke: 1.12 (1.06-1.17), RRHF: 1.08 (1.02-1.14)), processed meat (RRCHD: 1.27 (1.09-1.49), RRstroke: 1.17 (1.02-1.34), RRHF: 1.12 (1.05-1.19)), and SSB consumption (RRCHD: 1.17 (1.11-1.23), RRstroke: 1.07 (1.02-1.12), RRHF: 1.08 (1.05-1.12)) in the linear dose-response meta-analysis. There were clear indications for non-linear dose-response relationships between whole grains, fruits, nuts, dairy, and red meat and CHD.

CONCLUSION

An optimal intake of whole grains, vegetables, fruits, nuts, legumes, dairy, fish, red and processed meat, eggs and SSB showed an important lower risk of CHD, stroke, and HF.

Fresh fruit consumption and all-cause and cause-specific mortality: findings from the China Kadoorie Biobank

Background

Higher fruit consumption is associated with lower risk of cardiovascular disease (CVD). Substantial uncertainties remain, however, about the associations of fruit consumption with all-cause mortality and mortality from subtypes of CVD and major non-vascular diseases, especially in China.

Methods

In 2004-08, the nationwide China Kadoorie Biobank Study recruited > 0.5 million adults aged 30-79 years from 10 diverse localities in China. Fresh fruit consumption was estimated using an interviewer-administered electronic questionnaire, and mortality data were collected from death registries. Among the 462 342 participants who were free of major chronic diseases at baseline, 17 894 deaths were recorded during ∼ 7 years of follow-up. Cox regression yielded adjusted rate ratios (RRs) for all-cause and cause-specific mortality associated with fruit consumption.

Results

At baseline, 28% of participants reported consuming fruit ≥ 4 days/week (regular consumers) and 6% reported never/rarely consuming fruit (non-consumers). Compared with non-consumers, regular consumers had 27% [RR = 0.73, 95% confidence interval (CI) 0.70-0.76] lower all-cause mortality, 34% lower CVD mortality (n = 6166; RR = 0.66, 0.61-0.71), 17% lower cancer mortality (n = 6796; RR = 0.83, 0.78-0.89) and 42% lower mortality from chronic obstructive pulmonary disease (COPD) (n = 1119; RR = 0.58, 0.47-0.71). For each of the above, there was an approximately log-linear dose-response relationship with amount consumed. For mortality from site-specific cancers, fruit consumption was inversely associated with digestive tract cancer (n = 2265; RR = 0.72, 0.64-0.81), particularly oesophageal cancer (n = 801; RR = 0.65, 0.50-0.83), but not with cancer of lung or liver.

Conclusions

Among Chinese adults, higher fresh fruit consumption was associated with significantly lower mortality from several major vascular and non-vascular diseases. Given the current low population level of fruit consumption, substantial health benefits could be gained from increased fruit consumption in China.

Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies

Background

Questions remain about the strength and shape of the dose-response relationship between fruit and vegetable intake and risk of cardiovascular disease, cancer and mortality, and the effects of specific types of fruit and vegetables. We conducted a systematic review and meta-analysis to clarify these associations.

Methods

PubMed and Embase were searched up to 29 September 2016. Prospective studies of fruit and vegetable intake and cardiovascular disease, total cancer and all-cause mortality were included. Summary relative risks (RRs) were calculated using a random effects model, and the mortality burden globally was estimated; 95 studies (142 publications) were included.

Results

For fruits and vegetables combined, the summary RR per 200 g/day was 0.92 [95% confidence interval (CI): 0.90-0.94, I 2  = 0%, n  = 15] for coronary heart disease, 0.84 (95% CI: 0.76-0.92, I 2  = 73%, n  = 10) for stroke, 0.92 (95% CI: 0.90-0.95, I 2  = 31%, n  = 13) for cardiovascular disease, 0.97 (95% CI: 0.95-0.99, I 2  = 49%, n  = 12) for total cancer and 0.90 (95% CI: 0.87-0.93, I 2  = 83%, n  = 15) for all-cause mortality. Similar associations were observed for fruits and vegetables separately. Reductions in risk were observed up to 800 g/day for all outcomes except cancer (600 g/day). Inverse associations were observed between the intake of apples and pears, citrus fruits, green leafy vegetables, cruciferous vegetables, and salads and cardiovascular disease and all-cause mortality, and between the intake of green-yellow vegetables and cruciferous vegetables and total cancer risk. An estimated 5.6 and 7.8 million premature deaths worldwide in 2013 may be attributable to a fruit and vegetable intake below 500 and 800 g/day, respectively, if the observed associations are causal.

Conclusions

Fruit and vegetable intakes were associated with reduced risk of cardiovascular disease, cancer and all-cause mortality. These results support public health recommendations to increase fruit and vegetable intake for the prevention of cardiovascular disease, cancer, and premature mortality.

Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: Systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE)

BACKGROUND

Dietary habits are major contributors to coronary heart disease, stroke, and diabetes. However, comprehensive evaluation of etiologic effects of dietary factors on cardiometabolic outcomes, their quantitative effects, and corresponding optimal intakes are not well-established.

OBJECTIVE

To systematically review the evidence for effects of dietary factors on cardiometabolic diseases, including comprehensively assess evidence for causality; estimate magnitudes of etiologic effects; evaluate heterogeneity and potential for bias in these etiologic effects; and determine optimal population intake levels.

METHODS

We utilized Bradford-Hill criteria to assess probable or convincing evidence for causal effects of multiple diet-cardiometabolic disease relationships. Etiologic effects were quantified from published or de novo meta-analyses of prospective studies or randomized clinical trials, incorporating standardized units, dose-response estimates, and heterogeneity by age and other characteristics. Potential for bias was assessed in validity analyses. Optimal intakes were determined by levels associated with lowest disease risk.

RESULTS

We identified 10 foods and 7 nutrients with evidence for causal cardiometabolic effects, including protective effects of fruits, vegetables, beans/legumes, nuts/seeds, whole grains, fish, yogurt, fiber, seafood omega-3s, polyunsaturated fats, and potassium; and harms of unprocessed red meats, processed meats, sugar-sweetened beverages, glycemic load, trans-fats, and sodium. Proportional etiologic effects declined with age, but did not generally vary by sex. Established optimal population intakes were generally consistent with observed national intakes and major dietary guidelines. In validity analyses, the identified effects of individual dietary components were similar to quantified effects of dietary patterns on cardiovascular risk factors and hard endpoints.

CONCLUSIONS

These novel findings provide a comprehensive summary of causal evidence, quantitative etiologic effects, heterogeneity, and optimal intakes of major dietary factors for cardiometabolic diseases, informing disease impact estimation and policy planning and priorities.

Flavanone Intake Is Inversely Associated with Risk of Incident Ischemic Stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

BACKGROUND

Flavonoids may have beneficial cerebrovascular effects, but evidence from racially and geographically representative cohorts in comprehensive flavonoid databases is lacking. Given racial and geographic disparities in stroke incidence, representative cohort studies are needed.

OBJECTIVES

We evaluated the association between flavonoid intake and incident ischemic stroke in a biracial, national cohort using updated flavonoid composition tables and assessed differences in flavonoid intake by sex, race, and region of residence.

METHODS

We evaluated 20,024 participants in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a biracial prospective study. Participants with stroke history or missing dietary data were excluded. Flavonoid intake was estimated by using a Block98 food frequency questionnaire and the USDA's Provisional Flavonoid Addendum and Proanthocyanidin Database. Associations between quintiles of flavonoid intake and incident ischemic stroke were evaluated by using Cox proportional hazards models, adjusting for confounders.

RESULTS

Over 6.5 y, 524 acute ischemic strokes occurred. Flavanone intake was lower in the Southeastern United States but higher in blacks than in whites. After multivariable adjustment, flavanone intake was inversely associated with incident ischemic stroke (HR: 0.72; 95% CI: 0.55, 0.95; P-trend = 0.03). Consumption of citrus fruits and juices was inversely associated with incident ischemic stroke (HR: 0.69; 95% CI: 0.53, 0.91; P-trend = 0.02). Total flavonoids and other flavonoid subclasses were not associated with incident ischemic stroke. There was no statistical interaction with sex, race, or region for any flavonoid measure.

CONCLUSIONS

Greater consumption of flavanones, but not total or other flavonoid subclasses, was inversely associated with incident ischemic stroke. Associations did not differ by sex, race, or region for the association; however, regional differences in flavanone intake may contribute to regional disparities in ischemic stroke incidence. Higher flavanone intake in blacks suggests that flavanone intake is not implicated in racial disparities in ischemic stroke incidence.

Legume consumption and CVD risk: a systematic review and meta-analysis

Objective

The aim of the present study was to systematically review and perform a meta-analysis of prospective cohort studies exploring the association between dietary legume consumption and CVD risk, including CHD and stroke.

Design

The PubMed and EMBASE databases were searched up to December 2015. A meta-analysis of the highestv.lowest (reference) category of dietary legume consumption was performed through random-effects models.

Results

Fourteen studies conducted on eleven cohorts and accounting for a total of 367 000 individuals and 18 475 cases of CVD (7451 CHD and 6336 stroke cases) were considered for the analyses. Compared with lower legume consumption, the highest category of exposure was associated with a decreased risk of 10 % in both CVD and CHD (relative risk=0·90; 95 % CI 0·84, 0·97) with no or little evidence of heterogeneity and no publication bias. Null results were found regarding legume consumption and stroke risk. No substantial confounding factors were evident in stratified analyses.

Conclusions

Legume consumption was associated with lower risk of CVD. Legumes’ intrinsic characteristics, because they are often part of an overall healthy diet, or because they are a substitute for unhealthy sources of protein may potentially explain the current findings.

The effect of green leafy and cruciferous vegetable intake on the incidence of cardiovascular disease: A meta-analysis

Does the consumption of green leafy vegetables including cruciferous vegetables significantly reduce the incidence of cardiovascular disease? This research question was answered via employing the statistical methods of meta-analysis by synthesizing relevant worldwide studies that address the association between the consumption of green leafy vegetables and risk of incidence of said diseases. All meta-analysis calculations included determination of effect sizes of relative risk, and their respective 95% confidence intervals, heterogeneity of the studies, relative weights for each study, and significance (p) for each study. Eight studies met the inclusion criteria, which investigated the relationship between the incidences of total cardiovascular disease with the intake of green leafy vegetables. The overall effect size (random effect model) was: RR = 0.842 (95% CI = 0.753 to 0.941), p = 0.002, which indicates a significant 15.8% reduced incidence of cardiovascular disease.

Meta-Analysis of the Association Between Whole and Refined Grain Consumption and Stroke Risk Based on Prospective Cohort Studies

The association between whole and refined grain consumption and stroke risk remains unclear. A search using MEDLINE and EMBASE databases was performed through February 29, 2016. Seven prospective studies with a total of 446 451 subjects and 5892 stroke events were included. The summary relative risk (SRR) of stroke for the high versus low consumption was 0.95 (95% confidence interval [CI] = 0.83-1.14) for total grains, 0.92 (95% CI = 0.72-1.17) for whole grains, and 0.99 (95% CI = 0.84-1.16) for refined grains. Diets rich in whole grains were inversely associated with ischemic stroke risk (SRR = 0.75, 95% CI = 0.60-0.95). Our meta-analysis revealed that whole and refined grain consumption is not associated with total stroke risk; however, whole grain consumption is associated with reduced ischemic stroke risk.

Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies

OBJECTIVE

 To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality.

DATA SOURCES

 PubMed and Embase searched up to 3 April 2016.

STUDY SELECTION

 Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality.

DATA SYNTHESIS

 Summary relative risks and 95% confidence intervals calculated with a random effects model.

RESULTS

 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings-for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I(2)=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I(2)=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I(2)=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I(2)=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I(2)=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I(2)=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I(2)=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I(2)=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I(2)=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I(2)=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular disease and/or all cause mortality, but there was little evidence of an association with refined grains, white rice, total rice, or total grains.

CONCLUSIONS

 This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes. These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality.

Synergistic neuroprotection by epicatechin and quercetin: Activation of convergent mitochondrial signaling pathways

In view of evidence that increased consumption of epicatechin (E) and quercetin (Q) may reduce the risk of stroke, we have measured the effects of combining E and Q on mitochondrial function and neuronal survival following oxygen-glucose deprivation (OGD). Relative to mouse cortical neuron cultures pretreated (24h) with either E or Q (0.1-10μM), E+Q synergistically attenuated OGD-induced neuronal cell death. E, Q and E+Q (0.3μM) increased spare respiratory capacity but only E+Q (0.3μM) preserved this crucial parameter of neuronal mitochondrial function after OGD. These improvements were accompanied by corresponding increases in cyclic AMP response element binding protein (CREB) phosphorylation and the expression of CREB-target genes that promote neuronal survival (Bcl-2) and mitochondrial biogenesis (PGC-1α). Consistent with these findings, E+Q (0.1 and 1.0μM) elevated mitochondrial gene expression (MT-ND2 and MT-ATP6) to a greater extent than E or Q after OGD. Q (0.3-3.0μM), but not E (3.0μM), elevated cytosolic calcium (Ca(2+)) spikes and the mitochondrial membrane potential. Conversely, E and E+Q (0.1 and 0.3μM), but not Q (0.1 and 0.3μM), activated protein kinase B (Akt). Nitric oxide synthase (NOS) inhibition with L-N(G)-nitroarginine methyl ester (1.0μM) blocked neuroprotection by E (0.3μM) or Q (1.0μM). Oral administration of E+Q (75mg/kg; once daily for 5days) reduced hypoxic-ischemic brain injury. These findings suggest E and Q activate Akt- and Ca(2+)-mediated signaling pathways that converge on NOS and CREB resulting in synergistic improvements in neuronal mitochondrial performance which confer profound protection against ischemic injury.

Orange juice-derived flavanone and phenolic metabolites do not acutely affect cardiovascular risk biomarkers: a randomized, placebo-controlled, crossover trial in men at moderate risk of cardiovascular disease

BACKGROUND

Epidemiologic data suggest inverse associations between citrus flavanone intake and cardiovascular disease (CVD) risk. However, insufficient randomized controlled trial data limit our understanding of the mechanisms by which flavanones and their metabolites potentially reduce cardiovascular risk factors.

OBJECTIVE

We examined the effects of orange juice or a dose-matched hesperidin supplement on plasma concentrations of established and novel flavanone metabolites and their effects on cardiovascular risk biomarkers in men at moderate CVD risk.

DESIGN

In an acute, randomized, placebo-controlled crossover trial, 16 fasted participants (aged 51-69 y) received orange juice or a hesperidin supplement (both providing 320 mg hesperidin) or control (all matched for sugar and vitamin C content). At baseline and 5 h postintake, endothelial function (primary outcome), blood pressure, arterial stiffness, cardiac autonomic function, platelet activation, and NADPH oxidase gene expression and plasma flavanone metabolites were assessed. Before each intervention, a diet low in flavonoids, nitrate/nitrite, alcohol, and caffeine was followed, and a standardized low-flavonoid evening meal was consumed.

RESULTS

Orange juice intake significantly elevated mean ± SEM plasma concentrations of 8 flavanone (1.75 ± 0.35 μmol/L, P < 0.0001) and 15 phenolic (13.27 ± 2.22 μmol/L, P < 0.0001) metabolites compared with control at 5 h postconsumption. Despite increased plasma flavanone and phenolic metabolite concentrations, cardiovascular risk biomarkers were unaltered. After hesperidin supplement intake, flavanone metabolites were not different from the control, suggesting altered absorption/metabolism compared with the orange juice matrix.

CONCLUSIONS

After single-dose flavanone intake within orange juice, circulating flavanone and phenolic metabolites collectively reached a concentration of 15.20 ± 2.15 μmol/L, but no effects were observed on cardiovascular risk biomarkers. Longer-duration randomized controlled trials are required to examine previous associations between higher flavanone intakes and improved cardiovascular health and to ascertain the relative importance of food matrix and flavanone-derived phenolic metabolites. This trial was registered at clinicaltrials.gov as NCT01530893.

Associations between low consumption of fruits and vegetables and nutritional deficiencies in Brazilian schoolchildren

OBJECTIVE

We examined associations between the frequency of fruit and vegetable (F&V) consumption and nutritional deficiencies among Brazilian schoolchildren.

DESIGN

A cross-sectional, population-based study was performed. A short FFQ was used to assess consumption of fruits and vegetables (F&V) over the past month. The prevalence ratios (PR) and 95 % confidence intervals for stunting, obesity, anaemia, vitamin A and folate deficiencies, vitamin E and vitamin D insufficiencies were estimated for low F&V consumption frequency (vegetables ≤ 3 times/month and fruits ≤ 3 times/week) and compared with children with usual F&V consumption frequency (vegetables ≥ 1 time/week and fruits ≥ 4 times/week).

SETTING

Acrelândia, Western Brazilian Amazon.

SUBJECTS

A total of 702 children aged 4-10 years.

RESULTS

Only 5 % of children consumed F&V ≥ 5 times/d. Prevalence of deficiency was 31 %, 15 %, 9 % and 2 % for vitamins D, A, E and folate, respectively. Overall, 6.3% of children were anaemic, 3.3% were stunted, 2.7% were obese and 33 % had multiple nutritional deficiencies. Low frequency of F&V consumption was associated with lower plasma concentrations of carotenoids and vitamin E. Nutritional deficiencies were higher among non-consumers of F&V when compared with usual consumers: anaemia (PR=1.9; 95 % CI 1.0, 3.7), vitamin E insufficiency (PR=2.5; 95% CI 1.5, 4.2), vitamin D insufficiency (PR=1.5; 95% CI 1.1, 1.9) and stunting (PR=2.6; 95% CI 1.1, 6.1).

CONCLUSIONS

In our study, the occurrence of nutritional deficiencies in children with low F&V consumption was twice as high as in children with usual F&V consumption, reinforcing the importance of effective actions to promote the consumption of F&V.

The case for diet: a safe and efficacious strategy for secondary stroke prevention

Diet is strongly associated with risk for first stroke. In particular, observational and experimental research suggests that a Mediterranean-type diet may reduce risk for first ischemic stroke with an effect size comparable to statin therapy. These data for first ischemic stroke suggest that diet may also be associated with risk for recurrent stroke and that diet modification might represent an effective intervention for secondary prevention. However, research on dietary pattern after stroke is limited and direct experimental evidence for a therapeutic effect in secondary prevention does not exist. The uncertain state of science in this area is reflected in recent guidelines on secondary stroke prevention from the American Heart Association, in which the Mediterranean-type diet is listed with only a class IIa recommendation (level of evidence C). To change guidelines and practice, research is needed, starting with efforts to better define current nutritional practices of stroke patients. Food frequency questionnaires and mobile applications for real-time recording of intake are available for this purpose. Dietary strategies for secondary stroke prevention are low risk, high potential, and warrant further evaluation.

Weighing the Evidence of Common Beliefs in Obesity Research

Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.

Consumption of nuts and legumes and risk of stroke: a meta-analysis of prospective cohort studies

BACKGROUND AND AIM

The relationships between dietary nuts and legume intake and risk of stroke are inconsistent. We summarized the evidence by a meta-analysis of prospective cohort studies.

METHODS AND RESULTS

We systematically searched the MEDLINE and EMBASE databases up to 31 January 2014. Random-effects models were used to calculate summary relative risks (SRRs) and 95% confidence intervals (CIs). Between-study heterogeneity was assessed using the Cochran's Q and I(2) statistics. Eight prospective studies with a total of 468,887 subjects and 10,493 stroke events were included in the meta-analysis. Overall, a diet containing greater amounts of legumes may be not associated with a lower risk of stroke (SRR = 0.95, 95% CI: 0.84-1.08; P(heterogeneity) = 0.091, I(2) = 43.2%); however, a diet containing greater amounts of nuts may be associated with a lower risk of stroke (SRR = 0.90, 95% CI: 0.81-0.99; P(heterogeneity) = 0.527, I(2) = 0). Gender significantly modified the effects of nut consumption on stroke risk, and high nut intake was associated with reduced risk of stroke in women (SRR = 0.85, 95% CI: 0.75-0.97) other than in men (SRR = 0.95, 95% CI: 0.82-1.11).

CONCLUSION

The current meta-analysis provides some evidences for the hypothesis that high intake of dietary nut was inversely associated with stroke risk, whereas dietary legumes intake was not associated with stroke risk.

Evaluation of fruit intake and its relation to body mass index of adolescents

Diets high in fruits and vegetables are recommended to maintain health. However, accurate fruit intake evaluation is hard and high sugar content in most of the fruits suggest possible negative relationships with health indices. The purpose of the present study was to evaluate the fruit intake status of adolescents and to examine the relationship between fruit intake and body mass index (BMI). For this, 400 middle and high school students were surveyed for their fruit eating attitude, preference, and intake level for fruit along with the evaluation of their relationship with anthropometric measures. As for fruit preference, the most frequent answer was 'like very much' (60.0%) and the preference of fruit was significantly higher in females than in males (p < 0.01). The highest answer to the reason to like fruits was 'delicious' (67.0%). The highest proportion of subjects replied that the amount of fruit intake was similar in both school meals and at home (39.3%) and unlikable feeling of fruits was 'sour' (47.0%). The favorite fruit was the apple followed by oriental melon, grape, Korean cherry, cherry, tangerine/orange, hallabong, plum, mango, persimmon, peach, pear/kiwi, apricot, Japanese apricot, and fig in order. As for the number of serving sizes per person were 2.9 times/day for male students and 3.0 times/day for female students showing no significant difference. The frequency of eating fruits in the evening showed a significant positive correlation with body weight (p < 0.05) and BMI (p < 0.01), respectively. In summary of these study findings, it was found that the fruit preference of adolescents was relatively high and their fruit intake level satisfied the recommended number of intake. The number of evening fruit intake had a significantly positive correlation with body weight and BMI. Further studies are required to examine the relationship between fruit intake and health indicators.

Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis

BACKGROUND

Relations between the consumption of nuts and legumes and risk of ischemic heart disease (IHD), stroke, and diabetes have not been well established.

OBJECTIVE

We systematically investigated and quantified associations of nut and legume consumption with incident IHD, stroke, and diabetes.

DESIGN

We systematically searched multiple databases to identify randomized controlled trials or observational studies that examined the relations. Studies were excluded if they reported only intermediate physiologic measures, soft cardiovascular outcomes, or crude risk estimates. Data were extracted independently and in duplicate. We assessed pooled dose-response relations by using a generalized least-squares trend estimation, and prespecified sources of heterogeneity were assessed by using metaregression. The potential for publication bias was explored by using funnel plots, Begg's and Egger's tests, and Duval and Tweedie trim-and-fill methods.

RESULTS

Of 3851 abstracts, 25 observational studies (23 prospective and 2 retrospective studies) and 2 trial reports met inclusion criteria and comprised 501,791 unique individuals and 11,869 IHD, 8244 stroke, and 14,449 diabetes events. The consumption of nuts was inversely associated with fatal IHD (6 studies; 6749 events; RR per 4 weekly 28.4-g servings: 0.76; 95% CI: 0.69, 0.84; I(2) = 28%), nonfatal IHD (4 studies; 2101 events; RR: 0.78; 0.67, 0.92; I(2) = 0%), and diabetes (6 studies; 13,308 events; RR: 0.87; 0.81,0.94; I(2) = 22%) but not stroke (4 studies; 5544 events). Legume consumption was inversely associated with total IHD (5 studies; 6514 events; RR per 4 weekly 100-g servings: 0.86; 0.78, 0.94; I(2) = 0%) but not significantly associated with stroke (6 studies; 6690 events) or diabetes (2 studies; 2746 events). A meta-regression did not identify the effect modification by age, duration of follow-up, study location, or study quality. Mixed evidence was seen for publication bias, but analyses by using the Duval and Tweedie trim-and-fill method did not appreciably alter results.

CONCLUSION

This systematic review supports inverse associations between eating nuts and incident IHD and diabetes and eating legumes and incident IHD.

Association between the intake of α-linolenic acid and the risk of CHD

The intake of the mainly plant-derived n-3 PUFA α-linolenic acid (ALA) has been reported to be associated with a lower risk of CHD. However, the results have been inconsistent. Therefore, the objective of the present study was to examine the association between the intake of ALA and the risk of CHD. Potential effect modification by the intake of long-chain n-3 PUFA (n-3 LCPUFA) was also investigated. Data from eight American and European prospective cohort studies including 148 675 women and 80 368 men were used. The outcome measure was incident CHD (CHD event and death). During 4-10 years of follow-up, 4493 CHD events and 1751 CHD deaths occurred. Among men, an inverse association (not significant) between the intake of ALA and the risk of CHD events and deaths was observed. For each additional gram of ALA consumed, a 15 % lower risk of CHD events (hazard ratios (HR) 0·85, 95 % CI 0·72, 1·01) and a 23 % lower risk of CHD deaths (HR 0·77, 95 % CI 0·58, 1·01) were observed. No consistent association was observed among women. No effect modification by the intake of n-3 LCPUFA was observed.

Fruits and Vegetables Consumption and Risk of Stroke

Background and Purpose—

We conducted a meta-analysis to summarize evidence from prospective cohort studies about the association of fruits and vegetables consumption with the risk of stroke.

Methods—

Pertinent studies were identified by a search of Embase and PubMed databases to January 2014. Study-specific relative risks with 95% confidence intervals were pooled using a random-effects model. Dose–response relationship was assessed by restricted cubic spline.

Results—

Twenty prospective cohort studies were included, involving 16 981 stroke events among 760 629 participants. The multivariable relative risk (95% confidence intervals) of stroke for the highest versus lowest category of total fruits and vegetables consumption was 0.79 (0.75–0.84), and the effect was 0.77 (0.71–0.84) for fruits consumption and 0.86 (0.79–0.93) for vegetables consumption. Subgroup and meta-regression showed that the inverse association of total fruits and vegetables consumption with the risk of stroke was consistent in subgroup analysis. Citrus fruits, apples/pears, and leafy vegetables might contribute to the protection. The linear dose–response relationship showed that the risk of stroke decreased by 32% (0.68 [0.56–0.82]) and 11% (0.89 [0.81–0.98]) for every 200 g per day increment in fruits consumption ( P for nonlinearity=0.77) and vegetables consumption ( P for nonlinearity=0.62), respectively.

Conclusions—

Fruits and vegetables consumption are inversely associated with the risk of stroke.

Neurite outgrowth of PC12 cells by 4'-O-β-D-glucopyranosyl-3',4-dimethoxychalcone from Brassica rapa L. 'hidabeni' was enhanced by pretreatment with p38MAPK inhibitor

The cellular effects of eleven compounds including chalcone glycosides isolated from Brassica rapa L. 'hidabeni' and their synthetic derivatives were studied in rat pheochromocytoma PC12 cells. Of the compounds tested, 4'-O-β-D-glucopyranosyl-3',4-dimethoxychalcone (A2) significantly increased the levels of the phosphorylated forms of extracellular signal-regulated kinases 1/2 (ERK 1/2), p38 mitogen-activated protein kinase (p38MAPK), and stress-activated protein kinases/Jun amino-terminal kinases (JNK/SAPK), but it did not affect Akt. Nerve growth factor (NGF), a well-known neurotrophic factor, increased the levels of phosphorylated ERK1/2, JNK/SAPK, and Akt but not p38MAPK, which may mediate marked neurite outgrowth. Signals evoked by A2 shared common characteristics with those induced by NGF; therefore, we evaluated the neuritogenic activity of A2 and found it induced only weak neurite outgrowth. However, this effect was enhanced by pre-treatment with a p38MAPK inhibitor, suggesting that the phosphorylation of p38MAPK down-regulated neurite outgrowth. From the results of this study, it was found that A2 in combination with a p38MAPK inhibitor can induce NGF-like effects. Hence, a combination of chalcone glycosides containing A2 and a p38MAPK inhibitor increases the likelihood that chalcone glycosides could be put to practical use in the form of drugs or alternative medicines to maintain neural health.

Sweet chestnut (Castanea sativa Mill.) bark extract: cardiovascular activity and myocyte protection against oxidative damage

This work was aimed at evaluating the cardioprotective effects of Castanea sativa Mill. (CSM) bark extract characterized in its phenolic composition by HPLC-DAD-MS analysis. The study was performed using primary cultures of neonatal rat cardiomyocytes to investigate the antioxidant and cytoprotective effects of CSM bark extract and isolated guinea pig left and right atria, left papillary muscle, and aorta to evaluate its direct effect on cholinergic and adrenergic response. In cultured cardiomyocytes the CSM bark extract reduced intracellular reactive oxygen species formation and improved cell viability following oxidative stress in dose-dependent manner. Moreover, the extract decreased the contraction induced by noradrenaline (1  μ M) in guinea pig aortic strips and induced transient negative chronotropic and positive inotropic effects without involvement of cholinergic or adrenergic receptors in the guinea pig atria. Our results indicate that CSM bark extract exhibits antioxidant activity and might induce cardioprotective effect.