Food intake patterns and 25-year mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study. The Seven Countries Study Research Group

The lipid-heart hypothesis from the Seven Countries Study of Cardiovascular Diseases

PURPOSE OF REVIEW

To summarize and comment recent analyses from the Seven Countries Study of Cardiovascular Diseases (SCS) on the role of Atherogenicity (ATI) and Thrombogenicity (THI) indexes (created by combining several types of dietary fatty acids) in predicting major cardiovascular disease (CVD) and mainly coronary heart disease (CHD) mortalities in a long follow-up observation of ecological procedures involving 16 cohorts of middle-aged men.

RECENT FINDINGS

In a chain of steps, a dietary score [Mediterranean Adequacy Index (MAI)] was inversely correlated with the ATI (R = -0.91). ATI directly correlated with serum cholesterol (R = +0.73) and serum cholesterol directly correlated with 50-year CHD mortality (R = +0.78). Moreover, MAI was inversely correlated (R = -0.91) and ATI was directly correlated with CHD mortality (R = +0.93). THI produced comparable results. In 10 cohorts reaching the extinction after 60 years of follow-up, results were similar. The same dietary and metabolic indicators were instead unrelated to other major types of CVD fatalities (heart diseases of uncertain etiology and stroke) or even inverse.

SUMMARY

ATI and THI indices assembled by pooling several types of dietary fatty acids are strongly associated with long-term CHD mortality but not with other major CVD types.

Ancel Keys, the Mediterranean Diet, and the Seven Countries Study: A Review

The identification of the "Mediterranean Diet" (MD) by Prof. Ancel Keys is described here, alongside its confirmation through the epidemiological study known as "The Seven Countries Study of Cardiovascular Diseases" (SCS). Prof. Keys' intuition on the possible dietary determinants of coronary heart disease (CHD) was derived from several pilot studies conducted in various countries. His impression was that the healthy diet was eaten along the Mediterranean shores of Italy, former Yugoslavia, and Greece, characterized by a large intake of bread, cereals, vegetables, fruit, and olive oil, with a small intake of meat, milk, dairy, and sugar products. The SCS was conducted across 16 cohorts of middle-aged men in seven countries (USA, Finland, the Netherlands, Italy, former Yugoslavia, Greece, and Japan), with assessments of usual eating habits, repeated medical examinations, and long-term follow-up. Analyses by Keys on the data from the first 15 years of follow-up indicated that low intake of saturated fatty acids (SAFA), usually derived from animal foods, was associated with the lower occurrence of and mortality from CHD, confirming the idea that a diet such as the Mediterranean Diet could be healthy. Further analyses by collaborators of the SCS, over a longer follow-up period, included the use of food groups and dietary scores of different types, confirming that cohorts with a Mediterranean Diet had a lower risk and death rate from CHD, whereas the reverse occurred in populations consuming an unhealthy diet.

Global burden of cardiovascular diseases attributable to diet low in seafood omega-3 fatty acids from 1990~2021 and forecasting the future trends: A population-based study

BACKGROUND

This research investigates the worldwide influence of cardiovascular diseases (CVD) associated with low intake of seafood omega-3 fatty acids, based on data from the 2021 Global Burden of Disease Study.

METHOD

The study evaluated the effects of insufficient seafood omega-3 fatty acid consumption on CVD at international, regional, and country levels. It analyzed variations across different demographics, including age and gender, and explored the relationship between disease burden and the Socio-Demographic Index (SDI). Additionally, it utilized an ARIMA model to predict the incidence of CVD connected to this dietary deficiency until 2050.

RESULT

In 2021, diets deficient in seafood omega-3 fatty acids contributed to roughly 737.88 thousand deaths and 17.87 million disability-adjusted life years (DALYs) from CVD, with a noted decrease in this health impact over the period studied. The most substantial effects were seen in the elderly, particularly those aged 75 and above, with males experiencing a higher disease impact. Future forecasts suggest probable declines in disease rates across all SDI areas. However, nations in North Africa and the Middle East are projected to encounter growing difficulties related to CVD stemming from low seafood omega-3 intake by 2030 and 2050.

CONCLUSION

These results highlight the critical need for preventive strategies against CVD and stress the significance of dietary management.

Population dietary-metabolic characteristics and mortality from major cardiovascular disease subtypes: the Seven Contries Study 60-year follow-up

BACKGROUND AND AIM

During the last few years, the Seven Countries Study of Cardiovascular Diseases (SCS) produced some new analyses dealing with the relationships of a dietary score, the pool of dietary fatty acids and serum cholesterol with major types of cardiovascular disease (CVD) mortality in 10 cohorts of 6 countries made of middle-aged men followed-up for 60 years until extinction. This sparse evidence is condensed here to provide a coherent view.

METHODS AND RESULTS

The Mediterranean Adequacy Index (MAI, a dietary score whose high levels depict the characteristics of the Mediterranean Diet), was highly and significantly associated in an inverse way, at country levels, with the Atherogenicity (ATI) and the Thrombogenicity (THI) indexes that included a series of dietary fatty acids. These indexes were highly and significantly associated in a direct way with country baseline serum cholesterol levels. Countries with high serum cholesterol had largely higher death rates from coronary heart disease (CHD) and lower rates from other heart diseases of uncertain etiology and stroke. The reverse was observed in countries with low serum cholesterol.

CONCLUSION

The chain of diet, dietary fatty acids and serum cholesterol seems to be responsible in various ways for the different distribution of major CVD mortality subtypes in extincted cohorts.

Dietary atherogenicity and thrombogenicity indexes predicting cardiovascular mortality: 50-year follow-up of the Seven Countries Study

BACKGROUND AND AIM

To study the relationships of an Atherogenicity Index (ATI) and a Thrombogenicity Index (THI), with 50-year mortality from coronary heart disease (CHD), other heart diseases of uncertain etiology (HDUE) and cerebrovascular disease or stroke (STR), in 16 international cohorts of middle-aged men.

METHODS AND RESULTS

Foods from a dietary survey in subsamples of men in each cohort of the Seven Countries Study (SCS) were chemically analyzed for several types of fatty acids that were converted into ATI and THI identifying each of 16 cohorts. Ecological correlations of the ATI and THI were calculated with the three fatal CVD conditions and with all-cause mortality at 25 and 50 years. Correlation coefficients (Rs) were positive and highly significant between ATI and THI versus CHD mortality, with levels ranging from 0.79 to 0.97, depending on the duration of follow-up and the choice of 10 or of 16 cohorts. This was not the case for HDUE and STR mortality for which Rs were variable and not significant. A strong direct association was also found with all-causes deaths at 25 and 50-years. ATI and THI were also directly related with dietary saturated fat and cholesterol levels and inversely with the Mediterranean Adequacy Index (a score identifying the Mediterranean diet).

CONCLUSION

These findings indicate that CHD has a different relationship with dietary lipids intake than HDUE and STR. This suggests that HDUE and STR have different underlying pathways or are different diseases.

Adequacy of usual intake of Japanese college athletes in various sports clubs

BACKGROUND

While many studies have been published on nutrient intake assessment for performance improvement and deficiency prevention in single-sport athletes, few studies have addressed nutrient intakes in athletes from a various sports.

AIM

The aim of this study was to determine whether Japanese college athletes meet the Dietary Reference Intakes (DRIs) and sports nutrition recommendations (SNRs).

METHODS

Dietary intake was assessed in 1049 Japanese college athletes from a variety of sports using a validated brief-type self-administered diet history questionnaire. The prevalence of inadequate intakes was estimated by comparing the DRIs and SNRs.

RESULTS

For protein, riboflavin, niacin, vitamins B-6, vitamins B-12, folate, magnesium, zinc, and copper, <10% of females and males consumed diets that fell below the estimated average requirement (EAR) in the DRIs. A large proportion of female and male college athletes demonstrated intakes that were below the EAR for vitamin A (7.8% and 19.0%, respectively), thiamin (10.4% and 23.9%, respectively), calcium (20.4% and 29.7%, respectively), and iron (24.2% and 2.5%, respectively). Regarding DG for chronic disease prevention in the DRIs, over half of both female and male athletes exceeded the DG for saturated fat acid and sodium, and fell below the DG for dietary fiber. Few of both female and male had intakes below the SNRs for protein and carbohydrates.

CONCLUSION

The results of the present study reveal the nutrient intake status of Japanese college athletes by comparing the DRIs and SNRs. Most meet the SNRs for optimal performance, but not the DRIs for health.

Barriers and facilitators to nutritional recommendations identified by participants of a cardiovascular rehabilitation program in a low resource context in Brazil

OBJECTIVES

Nutritional recommendations, a core component of cardiovascular rehabilitation, play a vital role in managing cardiovascular diseases. However, adherence to these recommendations is complex, particularly in low-resource settings. This study explored the barriers and facilitators influencing adherence to nutritional recommendations among participants in a low-resource cardiovascular rehabilitation program in Brazil.

METHODS

A mixed-methods approach was employed. Sociodemographic data, the Mediterranean diet score, scale for assessing nutrition, and open-ended questions on adherence were collected. Those who completed the questionnaires (phase 1) were invited to participate in one focus group session (phase 2). The participants were characterized according to the responses provided in phase 1 (Mediterranean diet score and scale for assessing nutrition) in low adherence or high adherence to dietary practice. Descriptive statistics and thematic content analysis within the context of the theory of planned behavior were employed.

RESULTS

Seventy-four participants completed phase 1, with 41.9% classified into low adherence and 27.0% in high adherence; of those, 17 participated in phase 2. Focus group findings revealed 9 themes/29 subthemes. Barriers included food prices, income, knowledge, routine, food access, family patterns, disease, work, anxiety, eating habits, and food planning. Facilitators included affordable food, health considerations, taste preferences, knowledge, family/professional support, government assistance, personal willpower, income stability, easy food access, media influence, and a quiet eating place.

CONCLUSIONS

The study findings underscore the need for targeted interventions, including individualized meal planning, community engagement, and enhanced access to healthcare professionals, to optimize dietary adherence and improve cardiovascular outcomes.

MicroRNAs and the Mediterranean diet: a nutri-omics perspective for lung cancer

Lung cancer is the deadliest cancer type worldwide with ~ 1.8 million deaths per-year. Smoking accounts for ~ 85% of all cases, with a described joint effect with unhealthy diet in lung cancer risk increase. Public health policies to prevent carcinogens exposure, promote smoking cessation and advocacy for healthy nutrition, are therefore highly recommended. Here we have examined the benefits of the Mediterranean Diet (MedDiet) in protecting against some non-communicable diseases including lung cancer, highlighting the epidemiological and biomolecular aspects of MedDiet anti-inflammatory effect and its interaction with smoking habits closely linked to risk of lung cancer. Considering the high incidence and mortality rates of lung cancer, we discussed also about the global impact that a Planeterranean extension of the benefits of MedDiet could have on controlling lung cancer risk. We also debated the impact of personalized nutrition on lung cancer prevention, considering individual heterogeneity in response to diet plans as well as recent advancements on nutri-omics in lung cancer research, with a specific focus on the role of microRNAs (miRNAs) as a promising nutritional molecular hub for lung cancer prevention. We strongly believe that a deep understanding of the molecular link between food components and genetic/epigenetics factors can expand effective intervention strategies.

The Lipid-Heart Hypothesis and the Keys Equation Defined the Dietary Guidelines but Ignored the Impact of Trans-Fat and High Linoleic Acid Consumption

In response to a perceived epidemic of coronary heart disease, Ancel Keys introduced the lipid-heart hypothesis in 1953 which asserted that high intakes of total fat, saturated fat, and cholesterol lead to atherosclerosis and that consuming less fat and cholesterol, and replacing saturated fat with polyunsaturated fat, would reduce serum cholesterol and consequently the risk of heart disease. Keys proposed an equation that would predict the concentration of serum cholesterol (ΔChol.) from the consumption of saturated fat (ΔS), polyunsaturated fat (ΔP), and cholesterol (ΔZ): ΔChol. = 1.2(2ΔS - ΔP) + 1.5ΔZ. However, the Keys equation conflated natural saturated fat and industrial trans-fat into a single parameter and considered only linoleic acid as the polyunsaturated fat. This ignored the widespread consumption of trans-fat and its effects on serum cholesterol and promoted an imbalance of omega-6 to omega-3 fatty acids in the diet. Numerous observational, epidemiological, interventional, and autopsy studies have failed to validate the Keys equation and the lipid-heart hypothesis. Nevertheless, these have been the cornerstone of national and international dietary guidelines which have focused disproportionately on heart disease and much less so on cancer and metabolic disorders, which have steadily increased since the adoption of this hypothesis.

Effects of dietary interventions on cardiovascular outcomes: a network meta-analysis

CONTEXT

Next to a large body of epidemiological observational studies showing that the Mediterranean diet (MD) is an important lifestyle determinant of cardiovascular risk, there is less relevant evidence from well-conducted randomized controlled trials (RCTs) with hard cardiovascular outcomes.

OBJECTIVE

The objective of the study was to identify the most effective dietary intervention for reducing cardiovascular morbidity and mortality.

DATA SOURCES

A systematic approach following PRISMA network meta-analyses reporting guidelines was applied to a search of electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Embase) without language restrictions, supplemented by scanning through bibliographies of studies and meetings' abstract material. Inclusion criteria were RCTs conducted in an adult population, investigating the effects of different type of diets or dietary patterns on all-cause mortality and cardiovascular outcomes of interest.

DATA EXTRACTION

Data extraction for each study was conducted by 2 independent reviewers.

DATA ANALYSIS

A frequentist network meta-analysis using a random-effects model was conducted. Death from any cardiovascular cause was defined as the primary outcome. A total of 17 trials incorporating 83 280 participants were included in the systematic review. Twelve articles (n = 80 550 participants) contributed to the network meta-analysis for the primary outcome. When compared with the control diet, only the MD showed a reduction in cardiovascular deaths (risk ratio = 0.59; 95% confidence interval, 0.42-0.82). Additionally, MD was the sole dietary strategy that decreased the risk of major cardiovascular events, myocardial infarction, angina, and all-cause mortality.

CONCLUSIONS

MD may play a protective role against cardiovascular disease and death for primary and also secondary prevention.

SYSTEMATIC REVIEW REGISTRATION

Center for Open Science, https://doi.org/10.17605/OSF.IO/5KX83.

Diet quality and cardiovascular outcomes: A systematic review and meta-analysis of cohort studies

AIMS

To evaluate relationships between diet quality and cardiovascular outcomes.

METHODS

Six databases were searched for studies published between January 2007 and October 2021. Eligible studies included cohort studies that assessed the relationship between a priori diet quality and cardiovascular disease mortality and morbidity in adults. The Academy of Nutrition and Dietetics Checklist was used to assess the risk of bias. Study characteristics and outcomes were extracted from eligible studies using standardised processes. Data were summarised using risk ratios for cardiovascular disease incidence and mortality with difference compared for highest versus lowest diet quality synthesised in meta-analyses using a random effects model.

RESULTS

Of the 4780 studies identified, 159 studies (n = 6 272 676 adults) were included. Meta-analyses identified a significantly lower cardiovascular disease incidence (n = 42 studies, relative risk 0.83, 95% CI 0.82-0.84, p < 0.001) and mortality risk (n = 49 studies, relative risk 0.83, 95% CI 0.82-0.84, p < 0.001) among those with highest versus lowest diet quality. In sensitivity analyses of a high number of pooled studies (≥13 studies) the Mediterranean style diet patterns and adherence to the heart healthy diet guidelines were significantly associated with a risk reduction of 15% and 14% for cardiovascular disease incidence and 17% and 20% for cardiovascular disease mortality respectively (p < 0.05).

CONCLUSIONS

Higher diet quality is associated with lower incidence and risk of mortality for cardiovascular disease however, significant study heterogeneity was identified for these relationships.

Dietary pattern and hepatic lipid metabolism

The liver is the leading site for lipid metabolism, involving not only fatty acid beta-oxidation but also de novo synthesis of endogenous triglycerides and ketogenesis. The liver maintains systemic lipid homeostasis by regulating lipid synthesis, catabolism, and transportation. Dysregulation of hepatic lipid metabolism precipitates disorders, such as non-alcoholic fatty liver disease (NAFLD), affecting the whole body. Thus, comprehending and studying hepatic lipid metabolism is crucial for preventing and treating metabolic liver diseases. Traditionally, researchers have investigated the impact of a single nutrient on hepatic lipid metabolism. However, real-life dietary patterns encompass diverse nutrients rather than single components. In recent years, there have been increased studies and notable progress regarding the effects of distinct dietary patterns on hepatic lipid metabolism. This review summarizes the influence of diverse dietary patterns on hepatic lipid metabolism, elucidating underlying molecular mechanisms and appraising the therapeutic potential of dietary patterns in managing hepatic steatosis.

Dietary Guidance for Cardiovascular Health: Consensus and Controversies

Healthy diet, regular exercise and smoking cessation comprise the 'golden triad' of primary prevention of cardiovascular disease (CVD) [...].

The rise and fall of tobacco smoking and associated rise and fall of coronary atherosclerosis the lethal role of tobacco

In this review two new hypotheses are explored, one, that the decline in coronary heart disease is mainly due to a dramatic decline in the prevalence of underlying atherosclerosis and two, that tobacco smoking has been a much greater influence on atherosclerosis than previously estimated. The major outcome of coronary atherosclerosis is myocardial infarction. Between 1900 and 1960 the prevalence of coronary atherosclerosis dramatically rose in young male soldiers. Between 1960 and 2010 the prevalence of coronary atherosclerosis in young US soldiers equally dramatically fell. Understanding the reasons for this rise and fall offers important insights into the causes of atherosclerosis. In 1960 over 50% of US military personnel were tobacco smokers but by 1988 the rate had reduced to 30%. The increased prevalence of coronary atherosclerosis in young soldiers between 1900 and 1960 was mainly due to increased tobacco smoking. An additional influence was an increase in food and sugar consumption. The fall in atherosclerosis between 1960 and 2010 was probably due to a reduction in tobacco smoking and to a lesser extent, control of hypertension and lowering of high serum total cholesterol. In Western populations up to two thirds of the fall in deaths due to myocardial infarction has been shown to be due to declines in the incidence of heart attacks. Based on the data included in this review it is arguable that the main reason for the fall in the incidence of heart attacks is the fall in the prevalence of underlying coronary atherosclerosis. The adverse influences of tobacco have been well documented. However the enormity of these adverse influences has not been recognised. Over 50% of men continue to smoke tobacco in China, Indonesia, Russia and middle eastern countries. Based on the experience of Western countries over half of these men will die of smoking related conditions.

Dietary nutrient intake and cognitive function in the Age-Related Eye Disease Studies 1 and 2

INTRODUCTION

The objective was to analyze associations between dietary intake of multiple nutrients and altered cognitive function and/or decline.

METHODS

Observational analyses of participants (n = 6334) in two randomized trials of nutritional supplements for age-related macular degeneration: Age-Related Eye Disease Study (AREDS) and AREDS2.

RESULTS

In AREDS, for 4 of 38 nutrients examined, higher intake quintiles were significantly associated with decreased risk of cognitive impairment on the Modified Mini-Mental State test (<80): β-carotene, copper, docosahexaenoic acid, and insoluble fiber. In AREDS2, for 13 of 44 nutrients, higher intake quintiles were associated with decreased risk on the Telephone Interview Cognitive Status-Modified (<30). Rate of cognitive decline over up to 10 years was not significantly different with higher intake of any nutrient.

DISCUSSION

Higher dietary intake of multiple nutrients, including specific vitamins, minerals, carotenoids, fatty acids, and fiber, was associated with lower risk of cognitive impairment but not slower decline in cognitive function.

Popular Dietary Trends' Impact on Athletic Performance: A Critical Analysis Review

BACKGROUND

Nutrition fuels optimal performance for athletes. With increased research developments, numerous diets available, and publicity from professional athletes, a review of dietary patterns impact on athletic performance is warranted.

RESULTS

The Mediterranean diet is a low inflammatory diet linked to improved power and muscle endurance and body composition. Ketogenic diets are restrictive of carbohydrates and proteins. Though both show no decrements in weight loss, ketogenic diets, which is a more restrictive form of low-carbohydrate diets, can be more difficult to follow. High-protein and protein-paced versions of low-carbohydrate diets have also shown to benefit athletic performance. Plant-based diets have many variations. Vegans are at risk of micronutrient deficiencies and decreased leucine content, and therefore, decreased muscle protein synthesis. However, the literature has not shown decreases in performance compared to omnivores. Intermittent fasting has many different versions, which may not suit those with comorbidities or specific needs as well as lead to decreases in sprint speed and worsening time to exhaustion.

CONCLUSIONS

This paper critically evaluates the research on diets in relation to athletic performance and details some of the potential risks that should be monitored. No one diet is universally recommend for athletes; however, this article provides the information for athletes to analyze, in conjunction with medical professional counsel, their own diet and consider sustainable changes that can help achieve performance and body habitus goals.

Association of dietary patterns and health outcomes by spatial regression analysis of nationally representative survey data from India

Background

Our aim was to study the regional differences in dietary patterns in India and their association with population-level nutrition-related health indicators such as the prevalence of anemia, overweight, undernutrition, and hyperglycemia.

Objectives

To identify and characterize the dietary patterns from publicly available nationally representative survey data on food consumption conducted by the National Sample Survey Office (NSSO) to study the regional differences in dietary patterns.

Methods

Dietary patterns were identified by factor analysis of per capita food consumption data from the household consumer expenditure survey (2011). Mean factor scores of dietary patterns were calculated for each district separately for urban and rural regions. Ecological association of factor scores with the district-level percentage prevalence of health indicators from the National Family Health Survey-4 (2015-2016) data was done by the Spatial Durbin Model of spatial regression analysis.

Results

Factor analyses revealed four dietary patterns which were similar in terms of the food items that characterized the factors for both rural and urban regions. Direct effects of dietary patterns by spatial regression analyses were observed with several health outcomes after adjusting for differences in socioeconomic development. Prevalence of anemia was positively associated with "Milk and wheat-rich diet" among men in the rural regions but negatively associated with other dietary patterns. Prevalence of overweight and high blood glucose was positively associated with "Rice and meat-rich diet" and "Coconut and seafood rich diet" in the rural regions. "Refined oil and tur dal-rich diet" was positively associated with the prevalence of overweight and hypertension in urban regions and negatively associated with underweight and anemia in men in rural and urban regions.

Conclusions

Spatial regression analyses revealed several important associations between dietary patterns and health outcomes, mostly in rural regions and some in urban regions. These results suggest the role of the major food items consumed in different regions and their impact on health outcomes in India and may have implications in tailoring dietary modifications accordingly.

High fish intake rich in n-3 polyunsaturated fatty acids reduces cardiovascular disease incidence in healthy adults: The ATTICA cohort study (2002-2022)

Background: The long-term effects of high fish intake rich in n-3 fatty acids for deterring cardiovascular disease (CVD) and related adverse outcomes in healthy individuals have not been yet elucidated.

Purpose: To evaluate the association between total seafood, as well as small fish, intake on 10- and 20-year CVD incidence and mortality in healthy adults.

Methods: A prospective cohort study (n = 2,020) was conducted in healthy community dwelling adults in Athens, Greece, selected following age- and sex-based random multistage sampling (mean ± SD age at baseline: 45.2 ± 14.0 years). Seafood (high (&gt;2 servings/week) vs. low (≤2 servings/week) intake), including small fish rich in n-3 fatty acids (high (&gt;1 serving/week) vs. low (≤1 serving/week) intake), consumption was evaluated by semi-quantitative food frequency questionnaire at baseline. The occurrence of non-fatal and/or fatal CVD events (ICD-10) was assessed during 10- and 20-year follow-up periods.

Results: Only 32.7% and 9.6% of participants had high seafood and small fish intakes, respectively. Participants with high seafood intake had 27% decreased 10-year CVD risk (adj. HR:0.73; 95% CI:0.55-0.98) and 74% lower attributable mortality (adj. HR:0.26; 95% CI:0.11-0.58). Participants with high seafood intake also sustained a 24% lower 20-year risk of CVD mortality (adj. HR: 0.76; 95% CI: 0.55-0.98). Moreover, participants with high small fish intake had a lower 10-year CVD risk and 76% decreased risk of 10-year CVD mortality (adj. HR:0.24; 95% CI:0.06-0.99), even among normotensive individuals (adj. HR:0.31; 95% CI:0.13-0.73). When analogous analyses focused on 20-year CVD incidence and mortality, similar but not significant associations were observed (all p-values &gt;0.10).

Conclusion: High intake of seafood, and particularly small fish rich in n-3 fatty acids, was associated with a lower risk of 10-year fatal and non-fatal CVD. Thus, public health interventions aimed at enhancing small fish consumption may most effectively deter long-term CVD outcomes, particularly among low risk normotensive individuals.

Soy Consumption and the Risk of Type 2 Diabetes and Cardiovascular Diseases: A Systematic Review and Meta-Analysis

Soy is rich in plant protein, isoflavones, and polyunsaturated fatty acids. To clarify the associations between soy intake and type 2 diabetes (T2D) and cardiovascular diseases (CVDs) events, we performed a meta-analysis and review. A total of 1963 studies met the inclusion criteria, and 29 articles with 16,521 T2D and 54,213 CVDs events were identified by the eligibility criteria. During a follow-up of 2.5–24 years, the risk of T2D, CVDs, coronary heart disease, and stroke in participants with the highest soy consumption decreased by 17% (total relative risk (TRR) = 0.83, 95% CI: 0.74–0.93), 13% (TRR = 0.87, 95% CI: 0.81–0.94), 21% (TRR = 0.79, 95% CI: 0.71–0.88), and 12% (TRR = 0.88, 95% CI: 0.79–0.99), respectively, compared to the lowest sot consumption. A daily intake of 26.7 g of tofu reduced CVDs risk by 18% (TRR = 0.82, 95% CI: 0.74–0.92) and 11.1 g of natto lowered the risk of CVDs by 17% (TRR = 0.83, 95% CI: 0.78–0.89), especially stroke. This meta-analysis demonstrated that soy consumption was negatively associated with the risks of T2D and CVDs and a specific quantity of soy products was the most beneficial for the prevention of T2D and CVDs. This study has been registered on PROSPERO (registration number: CRD42022360504).

A short history of saturated fat: the making and unmaking of a scientific consensus

PURPOSE OF REVIEW

This article recounts the history of the diet-heart hypothesis from the late 1950s up to the current day, with revelations that have never before been published in the scientific literature. Insights include the role of authorities in launching the diet-hypothesis, including a potential conflict of interest for the American Heart Association; a number of crucial details regarding studies considered influential to the hypothesis; irregularities in the scientific reviews on saturated fats, for both the 2015 and 2020 Dietary Guidelines for Americans; and possible conflicts of interest on the relevant subcommittee reviewing saturated fats for the 2020 Dietary Guidelines Advisory Committee. Information obtained via the Freedom of Information Act (FOIA) on emails from the 2015 process is published here for the first time. These findings are highly relevant to the 2025-2030 Dietary Guidelines process, now underway, which has plans for a new review on saturated fats.

RECENT FINDINGS

Recent findings include shortcomings in the scientific review processes on saturated fats, for both the current 2020-2025 Dietary Guidelines for Americans and the previous edition (2015-2020). Revelations include the fact the 2015 Advisory Committee acknowledged, in an e-mail, the lack of scientific justification for any specific numeric cap on these fats. Other, previously unpublished findings include significant potential financial conflicts on the relevant 2020 guidelines subcommittee, including the participation of plant-based advocates, an expert who promotes a plant-based diet for religious reasons, experts who had received extensive funding from industries, such as tree nuts and soy, whose products benefit from continued policy recommendations favoring polyunsaturated fats, and one expert who had spent more than 50 years of her career dedicated to 'proving' the diet-heart hypothesis.

SUMMARY

The idea that saturated fats cause heart disease, called the diet-heart hypothesis, was introduced in the 1950s, based on weak, associational evidence. Subsequent clinical trials attempting to substantiate this hypothesis could never establish a causal link. However, these clinical-trial data were largely ignored for decades, until journalists brought them to light about a decade ago. Subsequent reexaminations of this evidence by nutrition experts have now been published in >20 review papers, which have largely concluded that saturated fats have no effect on cardiovascular disease, cardiovascular mortality or total mortality. The current challenge is for this new consensus on saturated fats to be recognized by policy makers, who, in the United States, have shown marked resistance to the introduction of the new evidence. In the case of the 2020 Dietary Guidelines, experts have been found even to deny their own evidence. The global re-evaluation of saturated fats that has occurred over the past decade implies that caps on these fats are not warranted and should no longer be part of national dietary guidelines. Conflicts of interest and longstanding biases stand in the way of updating dietary policy to reflect the current evidence.

Effects of Lockdown for COVID-19 Pandemic on Chronic Kidney Disease Progression in Children with Congenital Anomalies of the Kidney and Urinary Tract: A Retrospective Pilot Study

The coronavirus disease 2019 (COVID-19) pandemic changed adults and children's lifestyle. We focused our attention on children affected by chronic kidney disease (CKD) due to congenital abnormalities of kidney and urinary tract (CAKUT) and their behavior during the lockdown. Our aims were to evaluate the incidence of CKD progression within 6 months after the end of the first Italian lockdown and the factors associated to it. CKD progression was defined by the transition to higher CKD stage or by the drop in estimated glomerular filtration rate by a 25% or more for patients belonging to CKD stages 1 and 2. We retrospectively selected 21 children with CAKUT and CKD ≥ stage 1 observed within 3 months before and 6 months after the first Italian lockdown. We called them by phone and asked them about their lifestyle before and during lockdown focusing on physical activity, screen time, sweet/candies/sugar-sweetened beverages eaten/drunk and adherence to the Mediterranean diet (MD) (through KIDMED questionnaire). We calculated and analyzed the delta between the pre- and post- lockdown observation of all collected parameters (clinical and biochemical parameters and questionnaires scores). Analyzing the overall cohort, we found significantly increased mean BMI and mean screen time and significantly lower mean physical activity time in post- compared with pre-lockdown observations. Eleven out of twenty-one patients (52.4%) had a worsening of CKD. These patients presented higher delta of levels of uric acid and microalbuminuria and showed minor adherence to the MD and declared to have consumed more sweets or candies or sugar-sweetened beverages/week during the lockdown with a tendentially major increment of BMI compared with patients not presenting CKD progression. In conclusion, the lockdown for COVID-19 pandemic determined increase of BMI in all enrolled patients due to a "forced" negative lifestyle. About half of these patients presented CKD progression. This progression was associated to less adherence to the MD and major consumption of sweets or candies or sugar-sweetened beverages.

Diverse selection pressures shaping the genetic architecture of behçet disease susceptibility

Behçet disease (BD) is a polygenic, multifactorial, multisystem inflammatory condition with unknown etiology. Global distribution of BD is geographically structured, highest prevalence observed among East Asian, Middle Eastern, and Mediterranean populations. Although adaptive selection on a few BD susceptibility loci is speculated, a thorough evolutionary analysis on the genetic architecture of BD is lacking. We aimed to understand whether increased BD risk in the human populations with high prevalence is due to past selection on BD associated genes. We performed population genetics analyses with East Asian (high BD prevalence), European (low/very low BD prevalence), and African (very low/no BD prevalence) populations. Comparison of ancestral and derived alleles' frequencies versus their reported susceptible or protective effect on BD showed both derived and ancestral alleles are associated with increased BD risk. Variants showing higher risk to and more significant association with BD had smaller allele frequency differences, and showed less population differentiation compared to variants that showed smaller risk and less significant association with BD. Results suggest BD alleles are not unique to East Asians but are also found in other world populations at appreciable frequencies, and argue against selection favoring these variants only in populations with high BD prevalence. BD associated gene analyses showed similar evolutionary histories driven by neutral processes for many genes or balancing selection for HLA (Human Leukocyte Antigen) genes in all three populations studied. However, nucleotide diversity in several HLA region genes was much higher in East Asians suggesting selection for high nucleotide and haplotype diversity in East Asians. Recent selective sweep for genes involved in antigen recognition, peptide processing, immune and cellular differentiation regulation was observed only in East Asians. We conclude that the evolutionary processes shaping the genetic diversity in BD risk genes are diverse, and elucidating the underlying specific selection mechanisms is complex. Several of the genes examined in this study are risk factors (such as ERAP1, IL23R, HLA-G) for other inflammatory diseases. Thus, our conclusions are not only limited to BD but may have broader implications for other inflammatory diseases.

Adherence to a Mediterranean Diet and Geographic Atrophy Enlargement Rate: Age-Related Eye Disease Study 2 Report 29

PURPOSE

To determine whether closer adherence to a Mediterranean diet was associated with altered speed of geographic atrophy (GA) enlargement.

DESIGN

Post hoc analysis of a cohort within the Age-Related Eye Disease Study 2.

PARTICIPANTS

The study included 1155 eyes (850 participants; mean age, 74.9 years) with GA at 2 or more visits.

METHODS

Geographic atrophy area was measured from color fundus photographs at annual visits. An alternative Mediterranean Diet index (aMedi) was calculated for each participant by food frequency questionnaire. Mixed-model regression of square root GA area was performed by aMedi.

MAIN OUTCOME MEASURES

Change in square root of GA area over time.

RESULTS

Over a mean follow-up of 3.1 years, the mean GA enlargement rate was 0.282 mm/year (95% confidence interval, 0.270-0.293). Enlargement was significantly slower in those with higher aMedi at 0.256 mm/year (0.236-0.276), 0.290 (0.268-0.311), and 0.298 (0.280-0.317; P = 0.008) for aMedi tertiles 3, 2, and 1, respectively. Of the 9 aMedi components considered separately, significant differences in enlargement rate were observed for 4 (whole fruit [P = 0.0004], red meat [P = 0.0002], alcohol [P = 0.006], and monounsaturated fatty acid to saturated fatty acid ratio ([MUFA:SFA] [P = 0.040]) but not for fish (P = 0.14). Enlargement was slower in those with higher whole fruit, lower red meat, moderate alcohol, and higher MUFA:SFA intake. In the 768 eyes with noncentral GA, aMedi was not associated with slower progression to central involvement: hazard ratios were 1.11 (0.83-1.48) and 0.95 (0.71-1.26) for tertiles 2 and 3, respectively.

CONCLUSIONS

A Mediterranean-type diet was associated with slower GA enlargement. Diet patterns like this may therefore lead to clinically meaningful delays in vision loss. Several components seemed to contribute most to this association in a pattern that differed from those most associated with decreased progression to GA. Hence, the Mediterranean diet is associated with protection against both faster progression to GA and faster enlargement of GA but for partially distinct reasons. These findings may help inform evidence-based dietary recommendations. Understanding the mechanisms responsible may provide insights into the underlying biology and lead to the development of nutritional supplements.

A Generation Shift in Mediterranean Diet Adherence and Its Association with Biological Markers and Health in Dalmatia, Croatia

Previous studies have confirmed the beneficial effect of a Mediterranean diet in mitigating health issues related to cardiovascular disease, diabetes and obesity. However, rapid changes in the traditional way of life and the “westernization” of the diet in Mediterranean populations, especially in younger generations, has led to progressive abandonment of healthy dietary patterns. In order to investigate the generation shift in dietary patterns and lifestyle habits in the Mediterranean part of Croatia, we compared two cohorts of 610 women (266 pregnant and 344 non-pregnant) from the same region, but from different age groups. The MDSS score was derived from food frequency questionnaires. The results showed that the young, reproductively active generation (pregnant women) in Dalmatia, Croatia, although having a higher education and socioeconomic status, exhibits a more adverse eating behaviour (lower adherence to the Mediterranean diet) and lifestyle (excessive smoking in pregnancy) than the older population from the same region. Lower MDSS scores across aggregated age groups in both cohorts showed significant association with higher blood lipid levels and higher smoking frequency. In conclusion, Mediterranean diet adherence is associated with biological markers (age, lipid profile) and lifestyle (smoking) in our study, with a more adverse trend observed in the younger generation.

Interplay Between Adherence to the Mediterranean Diet and Lipid Profile: A Comparative Survey Between Day-Time Healthcare and Non-healthcare Female Workers

Introduction: Occupational physicians, as an aspect of the periodic health surveillance of workers prescribed by law, must develop preventive programs against adverse health-related occurrences (Legislative Decree 81/2008, art.25) to reduce major risk factors for non-communicable/chronic diseases. Eating habits play an important role in defining risk trajectories in the workplace. Methods: We randomly and cross-sectionally evaluated 147 females, of which 59 were healthcare workers (HCWs) and 88 were non-HCWs. The assessment included a dietary screening for adherence to the Mediterranean diet (MD) and a clinical baseline collection of major fluid biomarkers and anthropometric indicators for cardiovascular and metabolic risk. Results: The HCW group exhibited greater adherence to the MD than the non-HCW group. Nevertheless, they showed higher serum levels of triglycerides and total cholesterol. Menopause and type of work significantly and unfavorably affected triglyceride serum levels among HCWs. Conclusion: Greater preventive efforts are needed in the context of periodic health surveillance by occupational physicians. Disseminating additional information on a healthier lifestyle, particularly among female workers of perimenopausal age, is a key issue.

Infection and food combine to cause atherosclerotic coronary heart disease - Review and hypothesis

HYPOTHESIS

It is hypothesised that a combination of childhood and later life infections and excess food consumption, particularly of Western style food, initiates and contributes to atherosclerotic coronary heart disease. To consider this hypothesis we have conducted a brief review of the role of childhood infections, food, and their combined influence on atherosclerosis.

EVIDENCE

(i) Studies of populations with high prevalence of infections and low "hunter gather" like food consumption, have extremely low prevalence of atherosclerosis, (ii) there are consistent associations between infections in childhood and adult atherosclerotic coronary heart disease, (iii) there is an association between increased body weight, (an indication of excess eating), and atherosclerotic heart disease, and (iv) there is evidence that a combination of increased body weight and infections influences the development of atherosclerotic coronary heart disease.Infections do not appear to act independently to cause atherosclerosis. A combination of both food and infection appears to be required to cause atheroma.

CONCLUSION

The hypothesis that infections when combined with excess eating initiates atherosclerosis, is plausible.

ACTION

Action aimed at prevention of atherosclerotic heart disease is possible. There are three safe approaches to prevention (i) encouragement of Mediterranean like diets, (ii) avoidance of overeating and (iii) vigorous control of infections among all age groups. There is a need to monitor patients with a history of serious childhood infections and poor nutrition. In addition, for high risk subjects, cholesterol lowering statins are of proven and safe value.

Tissue distribution and seasonal accumulation of carotenoids in Yesso scallop (Mizuhopecten yessoensis) with orange adductor muscle

Carotenoids are colored compounds with important physiological functions. The Haida golden scallop, which has an orange adductor muscle, is a carotenoid-enriched variety of scallop Mizuhopecten yessoensis, an important aquaculture shellfish. In this study, we investigated the tissue distribution of the carotenoids, pectenolone and pectenoxanthin, in both Haida golden scallop and normal Yesso scallop. Both carotenoids were detected in all the sampled tissues of the two scallops, except in the adductor muscle of normal scallop. There were significantly more carotenoids in Haida golden scallop than in normal scallop, in the tissues of the mantle, female gonad, kidney, and adductor muscle. Increased carotenoid concentrations were detected in Haida golden scallop adductor muscle during the spring spawning season, indicating the effects of reproduction on muscle carotenoids accumulation. This study was the first systematic investigation of carotenoid distribution in Yesso scallop tissues and will benefit future research on carotenoid accumulation and function in scallops.

Cardiovascular Aging and Longevity: JACC State-of-the-Art Review

Cardiovascular aging and longevity are interrelated through many pathophysiological mechanisms. Many factors that promote atherosclerotic cardiovascular disease are also implicated in the aging process and vice versa. Indeed, cardiometabolic disorders such as hyperglycemia, insulin resistance, dyslipidemia, and arterial hypertension share common pathophysiological mechanisms with aging and longevity. Moreover, genetic modulators of longevity have a significant impact on cardiovascular aging. The current knowledge of genetic, molecular, and biochemical pathways of aging may serve as a substrate to introduce interventions that might delay cardiovascular aging, thus approaching the goal of longevity. In the present review, the authors describe pathophysiological links between cardiovascular aging and longevity and translate these mechanisms into clinical data by reporting genetic, dietary, and environmental characteristics from long-living populations.

Simple versus complex carbohydrates and health: A frequently neglected problem

AIMS

For several decades, there has been a notion that dietary fat is made of different components (at least SAFA, MUFA, and PUFA) that exhibit different and sometimes contrasting effects when associated with health and diseases: coronary heart disease (CHD) and cardiovascular diseases (CVD) in general. A similar fact is not noticed in carbohydrates and their components considering that even some major recent studies on the issue did not segregate simple carbohydrates from complex carbohydrates. In this study, we aimed to stress this need.

DATA SYNTHESIS

A small number of selected studies are presented and commented where segregation of simple from complex carbohydrates was either performed or disregarded to address the inconsistency of not disentangling them.

CONCLUSIONS

If only total fats were considered in investigations where fat was studied, the present notion and attitude toward different roles of the various classes of fats, at least SAFA versus unsaturated (MUFA and PUFA) would be missing. Therefore, there is a need to disentangle simple from complex carbohydrates, and this should be systematically applied when addressing CHD or CVD mortality risks and their preventive measures.

Metabo-tip: a metabolomics platform for lifestyle monitoring supporting the development of novel strategies in predictive, preventive and personalised medicine

BACKGROUND/AIMS

Exposure to bioactive compounds from nutrition, pharmaceuticals, environmental contaminants or other lifestyle habits may affect the human organism. To gain insight into the effects of these influences, as well as the fundamental biochemical mechanisms behind them, individual molecular profiling seems to be a promising tool and may support the further development of predictive, preventive and personalised medicine.

METHODS

We developed an assay, called metabo-tip for the analysis of sweat, collected from fingertips, using mass spectrometry-by far the most comprehensive and sensitive method for such analyses. To evaluate this assay, we exposed volunteers to various xenobiotics using standardised protocols and investigated their metabolic response.

RESULTS

As early as 15 min after the consumption of a cup of coffee, 50 g of dark chocolate or a serving of citrus fruits, significant changes in the sweat composition of the fingertips were observed, providing relevant information in regard to the ingested substances. This included not only health-promoting bioactive compounds but also potential hazardous substances. Furthermore, the identification of metabolites from orally ingested medications such as metamizole indicated the applicability of this assay to observe specific enzymatic processes in a personalised fashion. Remarkably, we found that the sweat composition fluctuated in a diurnal rhythm, supporting the hypothesis that the composition of sweat can be influenced by endogenous metabolic activities. This was further corroborated by the finding that histamine was significantly increased in the metabo-tip assay in individuals with allergic reactions.

CONCLUSION

Metabo-tip analysis may have a large number of practical applications due to its analytical power, non-invasive character and the potential of frequent sampling, especially regarding the individualised monitoring of specific lifestyle and influencing factors. The extraordinarily rich individualised metabolomics data provided by metabo-tip offer direct access to individual metabolic activities and will thus support predictive preventive personalised medicine.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13167-021-00241-6.

[Diet and asthma: Better eating for better breathing?]

Inhaled therapies are the cornerstone of asthma treatment. However, according to national and international guidelines, non-pharmacological interventions should not be neglected in asthma. It has been demonstrated that a healthy diet is beneficial to general health. Recently, the effect of diet on asthma has been highlighted in many studies. Two diets have been particularly studied: the Mediterranean diet (high in fruits and vegetables and low in fat) and the Western diet (high in saturated fat and low in fruits and vegetables). A beneficial effect of the Mediterranean diet and deleterious effect of the Western diet on the development or control of asthma has been shown in some studies even after adjustment for overweight. Study findings have not been unanimous, probably related to the complexity of conducting studies on a diet that may change from day to day for any individual subject. In addition, the effect of physical exercise, which is known to be beneficial in asthma, is rarely taken into account in these studies. However, studies on diet are becoming more complex with the use of specific dietary indices, which should bring interesting data in the future.

Ancel Keys: The legacy of a giant in physiology, nutrition, and public health

Ancel Keys, whose life spanned over 100 years (1904-2004), made a wealth of seminal scientific and public health contributions. As a physiologist, nutritionist, and public health scientist, he has left his mark on the 20th century by exploring different areas of physiology and nutrition, as well as by contributing to the understanding of basic public health issues. Among his major achievements one can mention in chronological order: studying adaptation to very high altitude, developing the K ration to enable the US military to survive with light but dense food, dissecting the physiology of starvation and nutritional rehabilitation to optimize recovery of functions, uncovering the link between serum cholesterol and heart disease, coordinating the first multi-country epidemiological longitudinal study in nutrition and health, coining the word "body mass index" (BMI), which he showed to be the best body weight index to predict body fat, and promoting the Mediterranean diet for a healthy life style. This review examines the historical events and scientific intrigues that have surrounded Ancel Keys's major classical studies that have ensured him a central place in the history of medical science.

Effects of Nutrition Education Program for the Japan Diet on Serum LDL-Cholesterol Concentration in Patients with Dyslipidemia: A Randomized Controlled Trial

Aim: The Japan Diet (JD) recommended by the Japan Atherosclerosis Society based on the traditional Japanese diet is presumably favorable for preventing atherosclerotic cardiovascular diseases, but few high-quality controlled clinical trials have examined its benefits as compared with other diets. We studied effects of nutrition education for JD intake as compared with partial JD (PJD) intake on serum lipids and inflammatory parameters in subjects with dyslipidemia.

Methods: A randomized parallel controlled clinical trial was conducted on outpatients with dyslipidemia. Participants were randomly divided into the JD or the PJD group. Face-to-face nutrition education based on each diet at baseline and at 3 months, as well as monthly counseling by mail during the intervening 3-month period, were provided and participants practiced up to 6 months. Both groups were advised to reduce consumptions of animal fat/ fatty meat/poultry, confections, and alcoholic drinks. Additionally, the JD group participants were recommended to consume more fish, soybean products especially natto, vegetables, and seaweed/mushrooms/konjak, and to switch from refined to unrefined cereals or barley.

Results: Mean LDL-cholesterol was 125 +/- 29 mg/dL at baseline, and the JD group ( n =49) showed a greater mean LDL-cholesterol decrease than the PJD group ( n =49) [- 8 mg/dL in JD vs 1 mg/dL in PJD, difference, -9 mg/dL (95%CI, -17 to 0) p =0.043)], and triglyceride ( p =0.023) and insulin ( p =0.033) reductions were larger in the JD group than in the PJD group at 6 months.

Conclusion: Nutrition education for JD intake was suggested to improve serum lipid and metabolic parameters in patients with dyslipidemia.

Dietary fatty acids and CHD: from specific recommendations to dietary patterns

Several countries have issued dietary recommendations about total and specific fatty acid (FA) intake for the prevention of CHD. For many years until today, controversies have existed especially about the deleterious effect or not of SFA, and the protective effect or not of n-3 PUFA, so that some authors have criticised these recommendations. There are many reasons for these controversies, including the different conclusions of prospective cohort studies compared with randomised clinical trials (RCT), and the contradictory conclusions of meta-analyses depending on the quality, number and type of studies included. The interrelationships between different FA in the diet make it difficult to analyse the specific effect of a particular class of FA on CHD. Furthermore, based on clinical practice and effectiveness of population-based prevention, it is very difficult at the individual level to assess in personal dietary intake the actual percentage and/or amount of SFA contained in each meal or consumed daily/weekly. In this critical narrative review, we try to answer the question of whether it would not be more relevant, in 2020, to promote dietary patterns, rather than FA intake recommendations. We critically analyse past and recent data on the association of FA with CHD, then propose that the Mediterranean diet and Japanese diet should be revitalised for Westerners and Asian populations, respectively. This does not exclude the usefulness of continuing research about effects of FA towards CHD, and accepting that what seems true today might be revised, at least partially tomorrow.

Nutritional Approaches for the Management of Nonalcoholic Fatty Liver Disease: An Evidence-Based Review

Nonalcoholic fatty liver disease (NAFLD) is on the rise worldwide representing a public health issue. Its coexistence with obesity and other metabolic alterations is highly frequent. Therefore, current therapy interventions for NAFLD are mainly focused on progressive weight loss through modulation of overall calorie intake with or without specific macronutrient adjustments. Furthermore, other relevant nutritional interventions are built on food selection and time-restricted eating. Since every strategy might bring different results, choosing the optimal diet therapy for a patient is a complicated task, because NAFLD is a multifactorial complex disease. Importantly, some factors need to be considered, such as nutrition-based evidence in terms of hepatic morphophysiological improvements as well as adherence of the patient to the meal plan and adaptability in their cultural context. Thus, the purpose of this review is to explore and compare the subtleties and nuances of the most relevant clinical practice guidelines and the nutritional approaches for the management of NAFLD with a special attention to tangible outcomes and long-term adherence.

What Model of Nutrition Can Be Recommended to People Ending Their Professional Sports Career? An Analysis of the Mediterranean Diet and the CRON Diet in the Context of Former Athletes

Athletes who retire from their sporting career face an increase in body weight, leading to overweight or obesity. Simultaneously, a significant number of these athletes meet the criteria of metabolic syndrome. The available literature does not offer clearly defined standards of nutrition for the discussed group of people. In this situation, it seems advisable to develop different standards of dietary behavior typical of athletes finishing their sports careers. For this purpose, the study analyzed two types of diets: the Mediterranean diet and the Calorie Restriction with Optimal Nutrition (CRON) diet based on significant calorie restrictions. Both diets seem to meet the requirements of this group of people.

Adherence to a Mediterranean Diet and Thyroid Function in Obesity: A Cross-Sectional Apulian Survey

Much research suggests that Mediterranean eating habits and lifestyle contribute to counteract the risk of chronic diseases while promoting longevity, but little information is available on the effects of the Mediterranean diet (Med-Diet) on thyroid function, particularly among overweight/obese subjects. Nevertheless, consistent data reported a slight increase in serum levels of the thyroid-stimulating hormone (TSH) and a higher rate of conversion of thyroxine (T4) to triiodothyronine (T3) in obesity. This cross-sectional study was aimed at investigating the relationship between adherence to the Med-Diet and circulating thyroid hormones in a cohort of overweight/obese subjects from Apulia (Southern Italy). Methods: We studied 324 consecutive outpatient subjects (228 women and 96 men, age range 14-72 years) taking no drug therapy and showing normal levels of thyroid hormones, but complicated by overweight and obesity (body mass index (BMI) ≥ 25 Kg/m2). The PREDIMED (PREvención con DIeta MEDiterránea) questionnaire was cross-sectionally administered to assess the adherence to the Med-Diet, and hormonal, metabolic, and routine laboratory parameters were collected. Results: Higher adherence to Med-Diet was found to be inversely related to free T3 (p < 0.01) and T4 (p < 0.01) serum levels. Considering each item in the PREDIMED questionnaire, people consuming at least four spoonfuls of extra-virgin olive oil (EVOO) per day, as well as those consuming at least two servings of vegetables per day, had lower free T3 levels (p 0.033 and p 0.021, respectively). Furthermore, consuming at least four spoonfuls of EVOO per day was found to be associated to lower free T4 serum concentrations (p 0.011). Multinomial logistic regression models, performed on tertiles of thyroid hormones to further investigate the relationship with Med-Diet, corroborated the significance only for free T4. Conclusion: Increased adherence to the Med-Diet was independently associated to a slightly reduced thyroid function, but still within the reference range for free T3 and T4 serum levels. This first finding in this field opens up a research line on any underlying biological interplay.

Ancel Benjamin Keys (1904-2004): His early works and the legacy of the modern Mediterranean diet

Culturally congruent dietary patterns have evolved with geographic and societal traditions and can be traced as far back as pre-Hellenistic Greece. Today, the modern Mediterranean diet (MDiet) is recognized internationally as an anti-obesogenic cardioprotective dietary model consisting of plant-based foods native to the Mediterranean basin, fish, olive oil, and an active lifestyle. With the assumption that obesity and heart disease rates adversely affected life expectancy, the MDiet was identified by Dr Ancel Keys as a primary characteristic among people-groups largely immune to these trends. Following extensive research on how food quality affected human performance, Keys engineered the largest ecologic investigation of dietary habits and their effects on heart disease and longevity known as the Seven Countries Study. A new understanding of how regionally and culturally specific diets affected entire populations led to the introduction of the MDiet to the global public health community. This historiographic portrait of Dr Keys describes his humble beginnings, highlights critical points in his career, discusses his seminal research into diet and culture as protective agents, and details his legacy as the pioneer of the modern MDiet.

Comparison of Food and Nutrient Intakes between Japanese Dyslipidemic Patients with and without Low-Density Lipoprotein Cholesterol Lowering Drug Therapy: A Cross-Sectional Study

Aim: We aimed to clarify actual food and nutrient intakes in Japanese patients with dyslipidemia. We also compared food and nutrient intakes between patients with and without low-density lipoprotein cholesterol (LDL-C) lowering drug therapy.

Methods: Food and nutrient intakes were assessed employing 3-day weighted dietary records in this cross-sectional study of 104 Japanese outpatients with dyslipidemia, age 30–65 years, not given dietary counseling. Anthropometric and biochemical parameters were measured after an overnight fast. Food and nutrient intakes were compared between patients with versus without LDL-C lowering drug prescriptions. Stepwise multiple regression analysis was performed to identify relationships between the serum LDL-C concentrations and food intakes.

Results: Of the 104 patients, 43.3% were prescribed LDL-C lowering drugs, primarily statins. Of the total patients, 83% had lipid intakes over 25% of total energy consumption (%E), exceeding the recommendation for dyslipidemia by the Japan Atherosclerosis Society. Similarly, 77% had saturated fatty acid intakes over 7%E, and 88% had cholesterol intakes over 200 mg per day. Dietary fiber consumption was low (< 25 g) in 97% of patients. Those taking LDL-C lowering drugs consumed less “meat, poultry and processed meat products” and “cereals”, and more “fish”, “fruits” and “nuts”, than patients not taking these drugs (p < 0.05). Food intakes correlating with LDL-C concentrations independently of drug therapy differed between patients taking versus not taking these medications.

Conclusion: Our results support the necessity of diet therapy for patients with dyslipidemia regardless of whether LDL-C lowering drugs are prescribed.

The clinical trial registration number: UMIN000022955

Adherence to the Mediterranean Diet and Progression to Late Age-Related Macular Degeneration in the Age-Related Eye Disease Studies 1 and 2

PURPOSE

To determine whether closer adherence to a Mediterranean diet (and its individual components) was associated with altered risk of progression to late age-related macular degeneration (AMD) and large drusen. Additional objectives were to assess interactions with AMD genotype.

DESIGN

Retrospective analysis of 2 controlled clinical trial cohorts: Age-Related Eye Disease Study (AREDS) and AREDS2.

PARTICIPANTS

Eyes with no late AMD at baseline in AREDS participants (n = 4255) and AREDS2 participants (n = 3611): total of 13 204 eyes (7756 participants). Mean age was 71 years (standard deviation, 6.6); 56.5% were female.

METHODS

Color fundus photographs were collected at annual study visits and graded centrally for late AMD. The modified Alternative Mediterranean Diet Index (aMedi) score was calculated for each participant from food frequency questionnaires.

MAIN OUTCOME MEASURES

Progression to late AMD, geographic atrophy (GA), and neovascular AMD; progression to large drusen.

RESULTS

Over a median follow-up of 10.2 years, of the 13 204 eyes, 34.0% progressed to late AMD. Hazard ratios (HRs) for progression in aMedi tertile 3 versus 1 were 0.78 (95% confidence interval [CI], 0.71-0.85, P < 0.0001) for late AMD, 0.71 (0.63-0.80, P < 0.0001) for GA, and 0.84 (0.75-0.95, P = 0.005) for neovascular AMD. For fish consumption, HRs for late AMD in quartile 4 versus 1 were 0.69 (0.58-0.82, P < 0.0001; AREDS) and 0.92 (0.78-1.07, P = 0.28; AREDS2). In AREDS, both aMedi and its fish component interacted with CFH rs10922109 for late AMD (P = 0.01 and P = 0.0005, respectively); higher aMedi and fish intake were each associated with decreased risk only in participants with protective alleles. In separate analyses (n = 5029 eyes of 3026 AREDS participants), the HR for progression to large drusen in aMedi tertile 3 versus 1 was 0.79 (0.68-0.93, P = 0.004).

CONCLUSIONS

Closer adherence to a Mediterranean-type diet was associated with lower risk of progression to late AMD and to large drusen. The signal was greater for GA than neovascular AMD. Fish intake contributed to this protective association. CFH genotype strongly influenced these relationships. These findings may help inform evidence-based dietary recommendations.

Science dialogue mapping of knowledge and knowledge gaps related to the effects of dairy intake on human cardiovascular health and disease

Dairy has been described as everything from a superfood to a poison; yet, arguments, assumptions, and data justifying these labels are not always clear. We used an issue-based information system, "dialogue mapping™," to summarize scientific points of a live panel discussion on the putative effects of dairy on cardiovascular diseases (CVD) from a day-long session among experts in nutrition and CVD. Dialogue mapping captures relations among ideas to explicitly, logically, and visually connect issues/questions, ideas, pro/con arguments, and agreements, even if discussed at different times. Experts discussed two propositions: for CVD risk, consumption of full-fat dairy products 1) should be minimized, in part because of their saturated fat content, or 2) need not be minimized, despite their saturated fat content. The panel discussed the dairy-CVD relation through blood lipids, diabetes, obesity, energy balance, blood pressure, dairy bioactives, biobehavioral components, and other putative causal pathways. Associations and effects reported in the literature have varied by fat content of dairy elements considered, study design, intake methods, and biomarker versus disease outcomes. Two conceptual topics emerged from the discussion: 1) individual variability: whether recommendations should be targeted only to those at high CVD risk; 2) quality of evidence: whether data on dairy-CVD relations are strong enough for reliable conclusions-positive, negative, or null. Future procedural improvements for science dialog mapping include using singular rather than competing propositions for discussion.

Associations between dietary patterns and blood pressure in a sample of Australian adults

BACKGROUND

Investigating effects of whole diets on blood pressure (BP) can contribute to development of diet-based recommendations for health. Our aim was to assess the relationship between dietary patterns and BP in a sample of free-living Australian adults.

METHODS

Usual dietary patterns of participants recruited to dietary intervention studies were assessed using factor analysis (two 24-h recalls). The mean of seven days of daily, seated BP measurements were used.

RESULTS

Complete data from 251 participants (112 males; mean age 55.1(9.1) (SD) years; body mass index (BMI) 29.5(3.9) kg/m²) was included. Three dietary patterns were identified. Only Dietary Pattern 2 was positively associated with home systolic BP (β = 1.88, 95% CI 0.16, 3.60) after adjusting for age, sex, BMI, anti-hypertensive medication, smoking, education, physical activity and energy intake. This dietary pattern was characterised by high consumption of low-fibre bread, pasta, noodles and rice, meat dishes, poultry dishes and egg dishes, mixed cereal dishes, salted nuts and low consumption of milk and yoghurt (low-fat), vegetable juice, vegetables and high-fibre bread. Dietary Pattern 2 was also positively associated with intakes of energy (P = 0.002) and sodium (P = 0.005) and inversely associated with potassium intake (P = 0.002). After adjustment for energy, only the inverse association with potassium remained (P <  0.001).

CONCLUSIONS

In this sample of Australian adults, Dietary Pattern 2 was associated with higher BP and thus chronic disease risk, supporting the evidence that diets high in energy and sodium, and low in potassium from vegetables and dairy, are detrimental to cardiovascular health.

Impact of different types of olive oil on cardiovascular risk factors: A systematic review and network meta-analysis

BACKGROUND AND AIM

This network meta-analysis (NMA) compares the effects of different types of olive oil (OO) on cardiovascular risk factors.

METHODS AND RESULTS

Literature search was conducted on three electronic databases (Medline, Web of Science, and Cochrane Central).

INCLUSION CRITERIA

Randomized controlled trials (RCTs) (≥3 weeks duration of intervention) comparing at least two of the following types of OO: refined OO (ROO), mixed OO (MOO), low phenolic (extra) virgin OO (LP(E)VOO), and high phenolic (extra) virgin OO (HP(E)VOO). Random-effects NMA was performed for seven outcomes; and surface under the cumulative ranking curve (SUCRA) was estimated, using an analytical approach (P-score). Thirteen RCTs (16 reports) with 611 mainly healthy participants (mean age: 26-70 years) were identified. No differences for total cholesterol, HDL-cholesterol, triacylglycerols, and diastolic blood pressure were observed comparing ROO, MOO, LP(E)VOO and HP(E)VOO. HP(E)VOO slightly reduce LDL-cholesterol (LDL-C) compared to LP(E)VOO (mean difference [MD]: -0.14 mmol/L, 95%-CI: -0.28, -0.01). Both, HP(E)VOO and LP(E)VOO reduces SBP compared to ROO (range of MD: -2.99 to -2.87 mmHg), and HP(E)VOO may improve oxidized LDL-cholesterol (oxLDL-C) compared to ROO (standardized MD: -0.68, 95%-CI: -1.31, -0.04). In secondary analyses, EVOO may reduce oxLDL-C compared to ROO, and a dose-response relationship between higher intakes of phenolic compounds from OO and lower SBP and oxLDL-C values was detected. HP(E)VOO was ranked as best treatment for LDL-C (P-score: 0.83), oxLDL-C (0.88), and SBP (0.75).

CONCLUSIONS

HP(E)VOO may improve some cardiovascular risk factors, however, public health implications are limited by overall low or moderate certainty of evidence.

Mediterranean diet: The role of long-chain ω-3 fatty acids in fish; polyphenols in fruits, vegetables, cereals, coffee, tea, cacao and wine; probiotics and vitamins in prevention of stroke, age-related cognitive decline, and Alzheimer disease

The mechanisms of action of the dietary components of the Mediterranean diet are reviewed in prevention of cardiovascular disease, stroke, age-associated cognitive decline and Alzheimer disease. A companion article provides a comprehensive review of extra-virgin olive oil. The benefits of consumption of long-chain ω-3 fatty acids are described. Fresh fish provides eicosapentaenoic acid while α-linolenic acid is found in canola and soybean oils, purslane and nuts. These ω-3 fatty acids interact metabolically with ω-6 fatty acids mainly linoleic acid from corn oil, sunflower oil and peanut oil. Diets rich in ω-6 fatty acids inhibit the formation of healthier ω-3 fatty acids. The deleterious effects on lipid metabolism of excessive intake of carbohydrates, in particular high-fructose corn syrup and artificial sweeteners, are explained. The critical role of the ω-3 fatty acid docosahexaenoic acid in the developing and aging brain and in Alzheimer disease is addressed. Nutritional epidemiology studies, prospective population-based surveys, and clinical trials confirm the salutary effects of fish consumption on prevention of coronary artery disease, stroke and dementia. Recent recommendations on fish consumption by pregnant women and potential mercury toxicity are reviewed. The polyphenols and flavonoids of plant origin play a critical role in the Mediterranean diet, because of their antioxidant and anti-inflammatory properties of benefit in type-2 diabetes mellitus, cardiovascular disease, stroke and cancer prevention. Polyphenols from fruits and vegetables modulate tau hyperphosphorylation and beta amyloid aggregation in animal models of Alzheimer disease. From the public health viewpoint worldwide the daily consumption of fruits and vegetables has become the main tool for prevention of cardiovascular disease and stroke. We review the important dietary role of cereal grains in prevention of coronary disease and stroke. Polyphenols from grapes, wine and alcoholic beverages are discussed, in particular their effects on coagulation. The mechanisms of action of probiotics and vitamins are also included.

Fad Diets: Hype or Hope?

PURPOSE OF REVIEW

Obesity continues to be a growing concern globally due to association with a number of comorbidities and contributing significantly to increase in health care expenditures. Despite availability of a number of treatment modalities, lifestyle modification with dietary modification and exercise continues to be the foundation. However, the standard model of lifestyle modification is not efficacious or sustainable for many patients leading them to seek alternative approaches. We conducted a comprehensive literature review to present the data regarding efficacy and sustainability of many common dietary approaches.

RECENT FINDINGS

Building upon previous work, recent randomized controlled trials have compared many popular diets head to head in varying patient populations. Along with the weight changes, studies have investigated the changes in metabolic parameters, inflammatory markers, and cardiac risk factor reduction. Though the studies do not show superiority of one diet compared to the other, the preventive benefits and other favorable metabolic changes of the diets make them worthy of consideration.

Mediterranean Diet Pyramid: A Proposal for Italian People. A Systematic Review of Prospective Studies to Derive Serving Sizes

In the last decade, a number of meta-analyses of mostly observational studies evaluated the relation between the intake of food groups and the risk of noncommunicable diseases (NCDs). In this study, we systematically reviewed dose-response meta-analyses of prospective studies with the aim to derive the quantities of food to consume to attain a protective (Mediterranean food) or a non-adverse (non-Mediterranean food) effect toward selected NCDs such as cardiovascular disease (CVD) including coronary heart disease (CHD) and stroke, type 2 diabetes (T2DM), colorectal (CRC) and breast cancer. These derived quantities, wherever possible, were suggested for a quantification of food servings of the Mediterranean Diet Pyramid proposed for Italian People (MDPPI). This pyramid came from the Modern Mediterranean Diet Pyramid developed in 2009 for Italian people. A weekly menu plan was built on the advice about frequency of intakes and serving sizes of such pyramid and the nutritional composition of this diet was compared with the Reference Italian Mediterranean Diet followed in 1960 in Nicotera. The diet built according the advice of MDPPI was very similar to that of Nicotera in the late 1950s that has been chosen as Italian Reference Mediterranean Diet with the exception of percentage of energy provided by cereals that was lower and of fruits and vegetables that was higher. Saturated fatty acids were only the 6% of daily energy intake. Also the Mediterranean Adequacy Index (MAI) was very similar to that of the aforementioned diet.

Evidence for Recent Polygenic Selection on Educational Attainment and Intelligence Inferred from Gwas Hits: A Replication of Previous Findings Using Recent Data

Genetic variants identified by three large genome-wide association studies (GWAS) of educational attainment (EA) were used to test a polygenic selection model. Weighted and unweighted polygenic scores (PGS) were calculated and compared across populations using data from the 1000 Genomes (n = 26), HGDP-CEPH (n = 52) and gnomAD (n = 8) datasets. The PGS from the largest EA GWAS was highly correlated to two previously published PGSs (r = 0.96–0.97, N = 26). These factors are both highly predictive of average population IQ (r = 0.9, N = 23) and Learning index (r = 0.8, N = 22) and are robust to tests of spatial autocorrelation. Monte Carlo simulations yielded highly significant p values. In the gnomAD samples, the correlation between PGS and IQ was almost perfect (r = 0.98, N = 8), and ANOVA showed significant population differences in allele frequencies with positive effect. Socioeconomic variables slightly improved the prediction accuracy of the model (from 78–80% to 85–89%), but the PGS explained twice as much of the variance in IQ compared to socioeconomic variables. In both 1000 Genomes and gnomAD, there was a weak trend for lower GWAS significance SNPs to be less predictive of population IQ. Additionally, a subset of SNPs were found in the HGDP-CEPH sample (N = 127). The analysis of this sample yielded a positive correlation with latitude and a low negative correlation with distance from East Africa. This study provides robust results after accounting for spatial autocorrelation with Fst distances and random noise via an empirical Monte Carlo simulation using null SNPs.