Fish Consumption and the Risk of Chronic Disease: An Umbrella Review of Meta-Analyses of Prospective Cohort Studies

Dietary Patterns and Cardiovascular Diseases in Asia: A Systematic Review and Meta-Analysis

With emerging Asian-derived diet quality indices and data-driven dietary patterns available, we aimed to synthesize the various dietary patterns and quantify its association with cardiovascular diseases (CVDs) among Asian populations. We systematically searched PubMed, Embase, Scopus, and Web of Science for observational studies in South, Southeast, and East Asia. Dietary patterns were grouped "high-quality," which included high intakes of three or more of the following food groups: 1) fruits and vegetables, 2) whole grains, 3) healthy protein sources (legumes and nuts, fish and seafood, low-fat dairy, and lean meat and poultry), and 4) liquid plant oils. High-quality patterns were further subcategorized based on their derivation methods: non-Asian indices, Asian indices, data-driven patterns, and plant-based indices. Dietary patterns were grouped "low-quality," which included high intakes of two or more of the following: 5) ultraprocessed food, 6) beverages and foods with added sugars, 7) foods high in salt, and 8) alcoholic beverages. Data-driven dietary patterns characterized by animal food sources were labeled "animal-based," and studies using dietary diversity scores were labeled "diet diversity indices." Dietary patterns that could not be meaningfully categorized were summarized narratively. Study-specific effect estimates were pooled using a random-effects model. Forty-one studies were included in this review. Higher adherence to high-quality dietary patterns in the top compared with bottom tertile defined by non-Asian indices (RR: 0.78; 95% CI: 0.69, 0.88; GRADE: moderate), Asian indices (RR: 0.84; 95% CI: 0.79, 0.90; GRADE: low), and data-driven patterns (RR: 0.81; 95% CI: 0.74, 0.89; GRADE: moderate) were associated with lower CVD risk. Plant-based, low-quality, animal-based, and diet diversity indices dietary patterns were not associated with CVD. Associations of Asian diet quality indices and CVD risk were weaker than those with non-Asian indices, highlighting the need for current Asian diet quality criteria to be updated to better capture the impact of diet on CVD. The systematic review and meta-analysis was registered at PROSPERO as CRD42021244318.

Plant-Based Diets and Risk of Multimorbidity: The Health and Retirement Study

BACKGROUND

Plant-based diets have gained attention due to their beneficial effects against major chronic diseases, although their association with multimorbidity is mostly unknown.

OBJECTIVES

We examined the association between the healthful (hPDI) and unhealthful plant-based diet indices (uPDI) with multimorbidity among middle-aged and older adults from the United States.

METHODS

Data on 4262 adults aged >50 y was obtained from the 2012-2020 Health and Retirement Study (HRS) and 2013 Health Care and Nutrition Study (HCNS). Food consumption was collected at baseline with a food frequency questionnaire and 2 PDIs were derived: the hPDI, with positive scores for healthy plant foods and reverse scores for less healthy plant foods and animal foods; and the uPDI, with only positive scoring for less healthy plant foods. Complex multimorbidity, defined as ≥3 coexistent conditions, was ascertained from 8 self-reported conditions: hypertension, diabetes, cancer, chronic lung disease, heart disease, stroke, arthritis, and depression. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

After a median follow-up of 7.8 y, we documented 1202 incident cases of multimorbidity. Compared with the lowest quartile, higher adherence to the hPDI was inversely associated with multimorbidity (HR for quartile 3: 0.77; 95% CI: 0.62, 0.96 and HR for quartile 4: 0.79; 95% CI, 0.63, 0.98; P-trend = 0.02). In addition, a 10-point increment in the hPDI was associated with a 11% lower incidence of multimorbidity (95% CI: 1, 20%). No significant associations were found for the uPDI after adjusting for sociodemographic and lifestyle factors.

CONCLUSIONS

Higher adherence to the hPDI was inversely associated with multimorbidity among middle-aged and older adults. Plant-based diets that emphasize consumption of high-quality plant foods may help prevent the development of complex multimorbidity.

Association between Fish Consumption during Pregnancy and Maternal and Neonatal Outcomes: A Statistical Study in Southern Italy

Background: This research aimed to evaluate the association between the monthly consumption of fish (differentiated by type) and both gestational and neonatal outcomes. Methods: Women who were admitted for delivery in the last 6 months of 2023 were prospectively included and divided according to type of fish consumed (based on DHA and mercury content) and frequency of consumption. Neonatal outcomes included weight, length, head circumference, and 1st and 5th minute Apgar scores. Maternal outcomes were threats of abortion, preterm birth, gestational diabetes and hypertension, cesarean section, and differential body mass index (BMI). Results: Small-size oily fish with high DHA and low mercury content (type B fish) consumption was positively associated with neonatal weight and head circumference, and less weight gain in pregnancy. It was also significantly associated with lower incidences of gestational diabetes and hypertension, and cesarean section. Correlation between differential BMI and monthly consumption of fish resulted in statistical significance, especially in type B fish consumers. Conclusions: The consumption of type B fish was significantly associated with increased neonatal weight and head circumference and better maternal outcomes.

P. Oliveira MB, Prieto MA. Health benefits of bluefin tuna consumption: (Thunnus thynnus) as a case study

Consumers are increasingly interested in food products with high nutritional value and health benefits. For instance, fish consumption is linked with diverse positive health benefits and the prevention of certain widespread disorders, such as obesity, metabolic syndrome, or cardiovascular diseases. These benefits have been attributed to its excellent nutritional value (large amounts of high-quality fatty acids, proteins, vitamins, and minerals) and bioactive compounds, while being relatively low-caloric. Atlantic bluefin tuna (Thunnus tynnus) is one of the most consumed species worldwide, motivated by its good nutritional and organoleptic characteristics. Recently, some organizations have proposed limitations on its consumption due to the presence of contaminants, mainly heavy metals such as mercury. However, several studies have reported that most specimens hold lower levels of contaminants than the established limits and that their richness in selenium effectively limits the contaminants' bioaccessibility in the human body. Considering this situation, this study aims to provide baseline data about the nutritional composition and the latest evidence regarding the beneficial effects of Atlantic bluefin tuna consumption. A review of the risk-benefit ratio was also conducted to evaluate the safety of its consumption, considering the current suggested limitations to this species' consumption.

Fish Oil Supplementation Modifies the Proteome, Lipidome, and Function of High-Density Lipoprotein: Findings from a Trial in Young Healthy Adults

BACKGROUND

Fish oil with the ω-3 fatty acids EPA and DHA is an FDA-approved treatment of patients with severe hypertriglyceridemia. Furthermore, EPA is an FDA-approved treatment of patients with high risk of cardiovascular disease (CVD); however, the cardioprotective mechanisms are unclear.

OBJECTIVES

We aimed to determine if fish oil supplementation is cardioprotective due to beneficial modifications in HDL particles.

METHODS

Seven fish oil naïve subjects without a history of CVD were recruited to take a regimen of fish oil (1125 mg EPA and 875 mg DHA daily) for 30 d, followed by a 30-d washout period wherein no fish oil supplements were taken. HDL isolated from fasting whole blood at each time point via 2-step ultracentrifugation (ucHDL) was assessed for proteome, lipidome, cholesterol efflux capacity (CEC), and anti-inflammatory capacity.

RESULTS

Following fish oil supplementation, the HDL-associated proteins immunoglobulin heavy constant γ1, immunoglobulin heavy constant α1, apolipoprotein D, and phospholipid transfer protein decreased compared to baseline (P < 0.05). The HDL-associated phospholipid families sphingomyelins, phosphatidylcholines, and phosphatidylserines increased after fish oil supplementation relative to baseline (P < 0.05). Compared to baseline, fish oil supplementation increased serum HDL's CEC (P = 0.002). Fish oil-induced changes (Post compared with Baseline) in serum HDL's CEC positively correlated with plasma EPA levels (R2 = 0.7256; P = 0.015). Similarly, fish oil-induced changes in ucHDL's CEC positively correlated with ucHDL's ability to reduce interleukin 10 (R2 = 0.7353; P = 0.014) and interleukin 6 mRNA expression (R2 = 0.6322; P =0.033) in a human macrophage cell line.

CONCLUSIONS

Overall, fish oil supplementation improved HDL's sterol efflux capacity through comprehensive modifications to its proteome and lipidome.

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

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

Microbial Profile of Fresh and Semicooked Nile Tilapia (Oreochromis niloticus) and Hygienic Practice of Fish Handlers in Hawassa, Ethiopia

Despite its high nutritional quality, fish is a highly perishable food item. This study aimed at assessing the microbial quality and safety of fresh and semicooked Nile tilapia fish fillets and the food safety practices of fish handlers in Hawassa City. The microbial load of 40 for each of raw and semicooked fillet samples was estimated by the standard plate count method, and the dominant flora as well as common bacterial pathogens were identified following phenotypic procedures. Moreover, a survey was conducted to assess the hygienic conditions and food safety practices of 30 fish handlers. The mean microbial load of the raw fillet samples in log10CFUg-1 was 8.42 for aerobic mesophilic bacteria (AMBC), 2.52 for total coliforms (TCC), and 3.41 for a count of staphylococci (CS). On the other hand, the respective parameters for the semicooked fillets in log10CFUg-1 were 6.68 (AMBC), 2.52 (TCC), and 3.17 (CS). The mean AMBC of all the fresh raw fillet samples exceeded the recommended maximum permissible limits. The mean SC of raw fillets from three of the eight vendors and one semicooked fillet were at a potentially hazardous level (>4 log units). Moreover, Salmonella species were isolated from 30% to 25% of raw and semicooked samples, respectively. The mesophilic bacterial flora of both types of samples was dominated by Bacillus species, Salmonella species, E coli, and Staphylococcus species. Most fish handlers did not practice hygienic food handling and lacked basic sanitation amenities like clean water and soap for hand washing. Moreover, nearly all the fish handlers did not have any formal education. These findings call for public health intervention measures like the provision of training in good hygienic practices and certification for fish vendors in the chain.

An Update on Nutrition Guidance for Cardiovascular Health

PURPOSE OF REVIEW

The goal of this article is to summarize recent guidance on diet and cardiovascular health.

RECENT FINDINGS

Cardiovascular diseases are the leading cause of death in the USA, and diet significantly impacts cardiovascular disease risk. The focus of contemporary dietary recommendations has shifted from single nutrient replacements to dietary patterns such as the Mediterranean, healthy USA, Dietary Approaches to Stop Hypertension, and healthy plant-based patterns. Recommended dietary patterns emphasize whole grains, fruits, vegetables, nuts, seeds, legumes/pulses, seafood, lean meats, and fish/seafood. They also limit intakes of ultra-processed foods, processed meats, and alcohol, as well as foods high in salt and added sugars, particularly sugar-sweetened beverages.

Validation of "Life's Essential 8" Metrics With Cardiovascular Structural Status in Children: The PROC Study in China

Background Life's Essential 8 (LE8) metrics for cardiovascular health (CVH) aid primordial prevention in US populations. Methods and Results We conducted a child cohort study (PROC [Beijing Child Growth and Health Cohort]) with baseline (2018-2019) and follow-up (2020-2021) assessments, enrolling disease-free 6- to 10-year-old children from 6 elementary schools in Beijing. We collected LE8-assessed components via questionnaire surveys and 3 cardiovascular structural parameters by 2-dimensional M-mode echocardiography: left ventricular mass (LVM), LVM index, and carotid intima-media thickness. Compared with 1914 participants (mean age, 6.6 years) at baseline, we saw lower mean CVH scores at follow-up (n=1789; 8.5 years). Among LE8 components, diet presented the lowest perfect-score prevalence (5.1%). Only 18.6% of participants had physical activity ≥420 min/wk, 55.9% had nicotine exposure, and 25.2% had abnormal sleep duration. Prevalence of overweight/obesity was 26.8% at baseline and 38.2% at follow-up. We noted optimal blood lipid scores in 30.7%, while 12.9% of children had abnormal fasting glucose. Normal BP was 71.6% at baseline and 60.3% at follow-up. LVM (g), LVM index (g/m2.7), and carotid intima-media thickness (mm) were significantly lower in children with high (56.8, 33.2, 0.35) or moderate CVH scores (60.6, 34.6, 0.36), compared with children with low CVH scores (67.9, 37.1, 0.37). Adjusting for age/sex, LVM (β=11.8 [95% CI, 3.5-20.0]; P=0.005), LVM index (β=4.4 [95% CI, 0.5-8.3]; P=0.027), and carotid intima-media thickness (β=0.016 [95% CI, 0.002-0.030]; P=0.028) were higher in the low-CVH group. Conclusions CVH scores were suboptimal, declining with age. LE8 metrics indicated worse CVH in children with abnormal cardiovascular structural measurements, suggesting the validity of LE8 in assessing child CVH. Registration URL: https://www.chictr.org.cn/index.html; Unique identifier: ChiCTR2100044027.

Prevalence of Depression and Fish Consumption among First Year Spanish University Students: UniHcos Project

The World Health Organization estimates that one fifth of university students have experienced major depressive disorder at some point in their lives. Nutrition may be one of the modifiable factors that influence the development of depression. Specifically, low omega-3 fatty acid and vitamin D levels, both nutrients found in high quantities in fish, have been linked to depressive disorders. The main objective of this study was to evaluate the prevalence of depression among young Spanish university students, in addition to the pattern of fish consumption among students and the possible relationship between fish consumption and the presence of depression. Data were collected retrospectively from a nationally representative sample of 11,485 Spanish university students aged 18 years or older in 11 Spanish universities, from 2012 to 2022. The respondents were analyzed according to frequency of consumption and compliance with weekly recommendations for fish intake and the presence of depression. Regression models were also performed to determine students' odds of depression as a function of compliance with recommendations according to selected sociodemographic variables. The prevalence of depression was 10.5%; it was more prevalent in women, older students and in those with both high and low BMIs. In addition, it was also more prevalent in those that lived outside the family home, with roommates and those who were employed. Sixty-seven percent of the students met the fish intake recommendations. The most common frequency of fish consumption was 1-2 times/week (44.2%), and the least frequent was 2.3% daily fish consumption. Students from northern universities were more likely to consume fish (68.4%) than those from southern universities (66.4%). Non-consumption of fish was found to increase the risk of depression (ORa = 1.45 (1.28-1.64); AF = 31.0% (21.9-39.0)), but it was the student's own conditions that had the greatest influence on the development of the disorder. In summary, a lower consumption of fish seems to be associated with a higher incidence of depression in Spanish university students; however, other social factors of the student may influence the development of the disorder, and all of this should be taken into account for the development of prevention strategies.

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

AIMS

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

DATA SYNTHESIS

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

CONCLUSIONS

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

Living Alone: Associations with Diet and Health in the Spanish Young Adult Population

Eating together as a family has important health benefits, as the diet is more balanced and of a higher quality. Eating together is also a factor in the prevention of diet-related diseases. The promotion of family and shared meals is currently a public health strategy. The aim of this research was to study the eating habits of the Spanish young adult population and their impact on health. An observational, descriptive, cross-sectional study was carried out using surveys. A questionnaire was designed and validated to explore a set of variables related to food and health. The dissemination was carried out through social networks by means of an online form, using non-probabilistic snowball sampling to obtain a sample of 17,969 subjects aged between 18 and 45 years. We found statistically significant differences between people living in a family home compared to people living outside a family home in the healthy eating index for the Spanish population, fish consumption, and fried food consumption. This suggests that the nutrition of people living in a family home is healthier, although their BMI is higher. People living together have a statistically higher healthy eating index value than people living alone; consume fast food, fried food, and ultra-processed food less frequently; and eat fish more often. On the other hand, people who live in a family home or are accompanied are more likely to have a sedentary lifestyle and are less physically active. It was concluded that people living alone have a worse healthy eating index than those living with company, which seems to indicate that nutritional interventions should pay attention to people living alone as a variable to be taken into account in future analyses.

Association between the Japanese Diet and Coronary Artery Disease in Patients Undergoing Coronary Angiography

Several cohort studies have reported that the Japanese diet is associated with reduced cardiovascular disease mortality. However, the results were not always consistent, and most of those studies conducted dietary surveys around 1990. We investigated the association between the Japanese diet and coronary artery disease (CAD) in 802 patients undergoing coronary angiography. The Japanese diet score was defined as the sum of scores of the intakes of fish, soy products, vegetables, seaweed, fruits, and green tea. CAD was found in 511 patients, of whom 173 had myocardial infarction (MI). Intakes of fish, soy products, vegetables, seaweed, fruits, and green tea were lower in patients with CAD, especially in those with MI, than in those without CAD. As a result, the Japanese diet score was significantly lower in patients with CAD than in those without CAD (p < 0.001). To clarify the association between the Japanese diet and CAD, the 802 study patients were divided into three tertiles by the Japanese diet score. The proportion of CAD decreased with the Japanese diet score, reaching 72% in patients at T1 (lowest score), 63% at T2, and 55% at T3 (highest) (p < 0.05). The proportion of MI also decreased with the Japanese diet score, reaching 25% at T1, 24% at T2, and 15% at T3 (p < 0.05). In a multivariate analysis, compared with T1, the adjusted odds ratios for CAD and MI were 0.41 (95% confidence interval [CI]: 0.26-0.63) and 0.61 (95% CI: 0.38-0.99) for T3, respectively. Thus, the Japanese diet was found to be inversely associated with CAD in Japanese patients undergoing coronary angiography.

Trends in energy and macronutrient intake among Taiwanese older adults in 1999-2000, 2005-2008 and 2013-2016 periods

BACKGROUND

This study aimed to explore trends, in 3 periods, in the intake of energy and macronutrients among Taiwanese older adults.

METHODS

Study subjects were those aged ≥65 years in the Nutrition and Health Survey in Taiwan 1999-2000 as well as the surveys in 2005-2008 and 2013-2016. Twenty-four-hour dietary recall data were obtained. This study used the 3 nutrition survey datasets for 1999-2000, 2005-2008, and 2013-2016, including data on the questionnaire, physical examination, and dietary intakes. Each nutrition survey involved the face-to-face household interview, and individual's dietary intake of carbohydrate, fat, and protein (% of energy) was estimated. Subsequently, intake statuses of the three macronutrients were classified into below, meeting, and above intake categories.

RESULTS

In the 2013-2016 survey, approximately 40% of the older adults had a low intake of energy. The prevalence of older adults with a meeting intake of carbohydrate, fat, and protein have increased from the 1999-2000 to 2013-2016 periods. The prevalence of people having a low intake of carbohydrate declined from the 1999-2000 period to the 2013-2016 period. The prevalence of high fat intake in 2013-2016 was approximately 5% higher than that in 1999-2000. In the 2013-2016 period, the prevalence of low intake of carbohydrate, fat, and protein were 25.9, 24.5, and 4.9%, respectively; moreover, the prevalence of high intake of the aforementioned macronutrients were 38.7, 36.2, and 17.6%, respectively.

CONCLUSIONS

Our study provides important evidence on the dietary patterns, as well as their changes over time among Taiwanese older adults. Such information would be useful for health policy makers about the burden of unbalanced diet and for nutrition educators on planning nutrition promotion interventions about well-balanced dietary for the older persons.

Associations between fecal short-chain fatty acids, plasma inflammatory cytokines, and dietary markers with depression and anxiety: Post hoc analysis of the ENGAGE-2 pilot trial

BACKGROUND

The microbiome-gut-brain-axis (MGBA) is emerging as an important mechanistic link between diet and mental health. The role of significant modifiers of the MGBA, including gut microbial metabolites and systemic inflammation, in individuals comorbid with obesity and mental disorders, is under-investigated.

OBJECTIVES

This exploratory analysis examined associations among microbial metabolites-fecal SCFAs, plasma inflammatory cytokines, and diet with depression and anxiety scores in adults comorbid with obesity and depression.

METHODS

Stool and blood were obtained from a subsample (n = 34) of participants enrolled in an integrated behavioral intervention for weight loss and depression. Pearson partial correlation and multivariate analyses determined associations among changes in fecal SCFAs (propionic, butyric, acetic, and isovaleric acids), plasma cytokines [C-reactive protein, interleukin 1 beta, interleukin 1 receptor antagonist (IL-1RA), interleukin 6, and TNF-α], and 35 dietary markers over 2 mo, and changes in SCL-20 (Depression Symptom Checklist 20-item) and GAD-7 (Generalized Anxiety Disorder 7-Item) scores over 6 mo.

RESULTS

Changes in the SCFAs and TNF-α at 2 mo were positively associated (standardized coefficients: 0.06-0.40; 0.03-0.34) with changes in depression and anxiety scores at 6 mo, whereas changes in IL-1RA at 2 mo were inversely associated (standardized coefficients: -0.24; -0.05). After 2 mo, changes in 12 dietary markers, including animal protein, were associated with changes in SCFAs, TNF-α, or IL-1RA at 2 mo (standardized coefficients: -0.27 to 0.20). Changes in 11 dietary markers, including animal protein, at 2 mo were associated with changes in depression or anxiety symptom scores at 6 mo (standardized coefficients: -0.24 to 0.20; -0.16 to 0.15).

CONCLUSIONS

Gut microbial metabolites and systemic inflammation may be biomarkers of importance within the MGBA, linking dietary markers, such as animal protein intake, to depression and anxiety for individuals with comorbid obesity. These findings are exploratory and warrant replication.

Eicosapentaenoic acid vs. docosahexaenoic acid for the prevention of cardiovascular disease

PURPOSE OF REVIEW

Populations with greater fatty fish intake have lower risk of coronary heart disease. However, trials testing omega-3 fatty acids (FA) on cardiovascular outcomes have yielded inconsistent results. In this review, we summarize the major cardiovascular trials examining omega-3 FA supplementation, and compare differences with eicosapentaenoic acid (EPA) alone vs. docosahexaenoic acid (DHA) combined with EPA.

RECENT FINDINGS

The JELIS and REDUCE-IT trials both demonstrated significant reduction in cardiovascular events with high dose EPA in the form of icosapent ethyl (IPE), with a similar trend seen in the RESPECT-EPA trial. In contrast, the ASCEND, VITAL, STRENGTH, and OMEMI trials examining EPA+DPA combinations failed to demonstrate benefit. Beyond the difference in omega-3 FA formulations (IPE vs. omega-3 carboxylic acid), other differences between REDUCE-IT and STRENGTH include the achieved EPA levels, differing properties that EPA and DHA have on membrane stabilization, and the comparator oils tested in the trials.

SUMMARY

The totality of evidence suggests EPA alone, administered in a highly-purified, high-dose form, improves cardiovascular outcomes among patients with elevated triglycerides at high cardiovascular risk, but EPA and DHA together does not. Current guidelines endorse the use of IPE in statin-treated patients at high cardiovascular risk who have triglycerides >135 mg/dl.

Associations between diet and incidence risk of lung cancer: A Mendelian randomization study

Background

Observational studies have revealed associations between diet and lung cancer. However, it is unclear whether the association is disturbed by confounding factors. We used a two-sample Mendelian randomization (MR) method to characterize the associations between diet and the lung cancer risk (including 3 subtypes: lung adenocarcinoma (LA), squamous cell lung carcinoma (SqCLC), and small cell lung cancer (SCLC)).

Materials and methods

Data on 20 diets were screened from the UK Biobank. Lung cancer data came from a large meta-analysis of 85,716 individuals. The inverse-variance weighted method was used as the main analysis. Sensitivity analysis was also used to explain the different multiplicity patterns of the final model.

Results

Our results showed significant evidence that 3 diets were associated with lung cancer [odds ratio (OR): 0.271, 95% confidence interval (CI): 0.150–0.488, p = 1.46 × 10−4, dried fruit; OR: 3.010, 95% CI: 1.608–5.632, p = 5.70 × 10−4, beer] and SqCLC (OR: 0.135, 95% CI: 0.062–0.293, p = 2.33 × 10−5, dried fruit; OR: 0.485, 95% CI: 0.328–0.717, p = 2.9 × 10−4, cheese). There were also suggestive correlations between 5 dietary intakes and lung cancer (OR: 0.441, 95% CI: 0.250–0.778, p = 0.008, cereal; OR: 2.267, 95% CI: 1.126–4.564, p = 0.022, beef), LA (OR: 0.494, 95% CI: 0.285–0.858, p = 0.012, dried fruit; OR: 3.536, 95% CI: 1.546–8.085, p = 0.003, beer) and SCLC (OR: 0.006, 95% CI: 0.000–0.222, p = 0.039, non-oily fish; OR: 0.239, 95% CI: 0.086–0.664, p = 0.006, dried fruit). No other association between diet and lung cancer was observed.

Conclusion

Our study preliminary found that cheese, dried fruit, and beer intake were significantly associated with the risk of lung cancer or its subtypes, while cereal, beef, and non-oily fish intake were suggestively associated with the risk of lung cancer or its subtypes. Well-designed prospective studies are still needed to confirm our findings in the future.

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.

Determination of the level of evidence for the association between different food groups/items and dietary fiber intake and the risk of cardiovascular diseases and hypertension: An umbrella review

Evidence has suggested that nutrition is a preventive factor against cardiovascular disease (CVD) risk. Because of a sharp growth in published meta-analyses and pooled analyses in recent years, a reassessment of old evidence is needed. We aimed to determine the level of evidence for the association between the consumption of different food groups/items and dietary fiber and the incidence risk of CVDs, hypertension, and atrial fibrillation from meta-analyses and pooled analyses of observational studies. Databases Scopus, PubMed/Medline, and Web of Science were searched for related studies. Fifty-eight articles met the inclusion criteria for evidence grading. In summary, grading the level of evidence showed a suggestive inverse association between the higher consumption of fruits, whole grains, fish, legumes, nuts, and dietary fibers with the incidence risk of hypertension and different types of CVD. Also, there was a probable inverse association between the higher consumption of total and low-fat dairy products and the risk of hypertension. Higher red meat consumption had a probable association with the increased risk of ischemic stroke. Higher consumption of processed meat and poultry also had a suggestive direct association with the incidence risk of stroke and hypertension. We have tried to present a comprehensive and useful overview of the level of evidence based on the most updated findings. The summary of results in the current umbrella review can be a helpful tool for nutritionists, dietitians, and researchers to establish new studies and identify research gaps in related issues.

Association between regional dietary patterns and cardiovascular health status among elderly in China

Objectives

To evaluate the cardiovascular health (CVH) status of the elderly and analyze the effects of dietary patterns and demographic characteristics on CVH.

Methods

A total of 4299 individuals aged 60 years and above from the China Health and Nutrition Survey in 2018 were selected as the research objects. Cluster analysis was used to analyze the dietary patterns. The definition of "Life's Essential 8" of CVH released by American Heart Association (AHA)in 2022 was used to evaluate CVH status. Finally, multinomial logit model was used to analyze the impact of demographic economic characteristics on CVH.

Results

Three dietary patterns were obtained by cluster analysis. In pattern 1, the intake of wheat, other grains, tubers and legumes was higher. Pattern 2 was dominated by high intake of aquatic products, vegetables and fruits; Pattern 3 was dominated by higher intake of rice and livestock meat. The total CVH score was 68.50, and sleep and blood pressure had the highest and lowest scores (85.85 and 37.64). Pattern 1 and Pattern 2 have slightly higher CVH scores. There were 16%-18% of the elderly with high CVH, and there was no significant difference in the distribution of high, moderate and low CVH among the three patterns (p=0.29). More than 50% of the elderly have 3-4 ideal metrics, 0.2% of the elderly have all 8 metrics reached the ideal state only in pattern 1. Multinomial logit analysis showed that the elderly in pattern 2 had 6-8 ideal metrics, which was 1.81 times higher than that in pattern 1; The presence of 6-8 ideal metrics in female was 3.42 times higher than that in male; Those with a college degree and above have 6-8 ideal metrics, which was 1.99 times of those with a primary school degree and below. Compared with 60-69 years, the presence of 6-8 ideal metrics in 70 years and above was 35% lower (OR=0.65,95%=0.49-0.87). The presence of 6-8 ideal metrics in high income group were 31% lower than those in low income group (OR=0.69,95%=0.47-1.00).

Conclusions

The elderly in China were in moderate CVH. Dietary pattern characterized by higher intake of aquatic products, vegetables and fruits were more likely to have more ideal CVH metrics. It is necessary to take targeted intervention measures for the elderly and health factors with low scores to promote the improvement of CVH status.

Fish Consumption and Risk of Stroke in Chinese Adults: A Prospective Cohort Study in Shanghai, China

Present studies on the association of fish consumption with risk of stroke have shown controversial results, and this association within the Chinese population remains unknown. We aimed to investigate the association between fish consumption and incidence of total stroke, ischemic stroke and hemorrhagic stroke among adults in China. We analyzed the data of 57,701 adults aged 20–74 years, with no history of stroke, in a prospective cohort study in Shanghai. Fish consumption was calculated from a food frequency questionnaire at baseline and divided into four categories (less than 300, 300–450, 450–600 and more than 600 g/week). Participant information was linked to health information systems in which stroke event information was collected up until 31 December 2021. The hazard ratios (HR) and 95% confidence intervals (CI) of the associations of fish consumption with risk of total stroke, ischemic stroke and hemorrhagic stroke were estimated using cox proportional hazards regression models. Dose–response relationships were estimated using restricted cubic spline analyses. During a median follow-up of 4.56 years, 807 newly developed stroke events were ascertained, including 664 ischemic stroke events and 113 hemorrhagic stroke events. Fish consumption of 300–450 g/week was associated with a reduced risk of total stroke (HR: 0.78, 95% CI: 0.64–0.94) and ischemic stroke (0.70 (0.57–0.88)) compared with fish consumption of less than 300 g/week, after adjustment for comprehensive covariates including sociodemographic characteristics, lifestyle, dietary patterns and disease histories. No significant association was found between fish consumption and hemorrhagic stroke. The findings of our study support the consumption level of fish recommended in the dietary guidelines.

Clinical significance of polyunsaturated fatty acids in the prevention of cardiovascular diseases

Cardiovascular diseases are one of the most important problems of modern medicine. They are associated with a large number of health care visits, hospitalizations and mortality. Prevention of atherosclerosis is one of the most effective strategies and should start as early as possible. Correction of lipid metabolism disorders is associated with definite clinical successes, both in primary prevention and in the prevention of complications of many cardiovascular diseases. A growing body of evidence suggests a multifaceted role for polyunsaturated fatty acids. They demonstrate a variety of functions in inflammation, both participating directly in a number of cellular processes and acting as a precursor for subsequent biosynthesis of lipid mediators. Extensive clinical data also support the importance of polyunsaturated fatty acids, but all questions have not been answered to date, indicating the need for further research.

The Impact of Foods, Nutrients, or Dietary Patterns on Telomere Length in Childhood and Adolescence: A Systematic Review

Environmental factors such as diet can affect telomere length (TL) dynamics. However, the role that children’s and adolescents’ diets play in maintaining TL is not well understood. Thus, we conducted a systematic review to examine the association between the intake of nutrients, foods, food groups, and/or dietary patterns and TL in childhood and adolescence. Following the PRISMA guidelines, we searched MEDLINE via PubMed, Embase, and Cochrane databases and additional registers and methods. The five selected studies were cross-sectional and conducted in children and adolescents aged 2 to 18 years. The main results suggest that a higher consumption of fish, nuts and seeds, fruits and vegetables, green leafy and cruciferous vegetables, olives, legumes, polyunsaturated fatty acids, and an antioxidant-rich diet might positively affect TL. On the contrary, a higher intake of dairy products, simple sugar, sugar-sweetened beverages, cereals, especially white bread, and a diet high in glycaemic load were factors associated with TL shortening. To our knowledge, this is the first systematic review examining the impact of dietary intake factors on TL in childhood and adolescence. Although limited, these results are consistent with previous studies in different adult populations. Further research is needed to ascertain potential nutritional determinants of TL in childhood and adolescence.

Big Fish or No Fish; Eicosapentaenoic Acid and Cardiovascular Disease

Benefits of omega 3 fatty acids for cardiovascular and other diseases have been touted for more than 50 years. The one clear clinical benefit of these lipids is the reduction of circulating levels of triglycerides, making them a useful approach for the prevention of pancreatitis in severely hypertriglyceridemic patients. After a series of spectacularly failed clinical trials that were criticized for the choice of subjects and doses of omega 3 fatty acids used, Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) using a high dose of icosapent ethyl (IPE) reported a reduction in cardiovascular disease (CVD) events. However, this trial has generated controversy due to the use of mineral oil in the control group and the associated side effects of the IPA. This review will focus on the following topics: What are the epidemiologic data suggesting a benefit of omega 3 fatty acids? What might be the mechanisms for these benefits? Why have the clinical trials failed to resolve whether these fatty acids provide benefit? What choices should a clinician consider?

Obesity Management in the Primary Prevention of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most frequent primary hepatic malignancy and a leading cause of cancer-related death globally. HCC is associated with an indolent clinical presentation, resulting in frequent advanced stage diagnoses where surgical resection or transplant therapies are not an option and medical therapies are largely ineffective at improving survival. As such, there is a critical need to identify and enhance primary prevention strategies to mitigate HCC-related morbidity and mortality. Obesity is an independent risk factor for the onset and progression of HCC. Furthermore, obesity is a leading cause of nonalcoholic steatohepatitis (NASH), the fasting growing etiological factor of HCC. Herein, we review evolving clinical and mechanistic associations between obesity and hepatocarcinogenesis with an emphasis on the therapeutic efficacy of prevailing lifestyle/behavioral, medical, and surgical treatment strategies for weight reduction and NASH reversal.

Profiling of Croatian Consumers Based on Their Intention to Consume Farmed Fish

Today’s increased demand and consumption of fish would be impossible to ensure without aquaculture. Farmed fish, however, is often considered inferior among consumers in comparison to its wild counterparts. The aim of this study was to profile Croatian fishery consumers based on their intention to consume farmed fish. The participants in this study were a nationally representative sample of people responsible for food purchasing within the household (n = 977), whose responses were collected by the CAWI (computer-aided web interviewing) method. Four clusters were identified and described: farmed fish enthusiasts (21.1%), farmed fish supporters (17.4%), indifferents (44.7%), and farmed fish sceptics (16.8%). Results showed that consumer segments differed significantly with respect to age, income, employment status, living region, and physical activity. Furthermore, intention to consume farmed fish is related to fish consumption in general (those with higher intention are more frequent fish consumers). Interestingly, prejudices against farmed fish are present in all clusters; however, these prejudices are more pronounced among those with the weakest intention to consume farmed fish. Differences between clusters were observed also in respect to product information and preferences, knowledge about fish, places of usual purchase, and source of information about fishery products. The obtained results could be used in designing marketing strategies to promote farmed fish consumption.

Role of Oxidative Stress in the Pathogenesis of Atherothrombotic Diseases

Oxidative stress is generated by the imbalance between reactive oxygen species (ROS) formation and antioxidant scavenger system’s activity. Increased ROS, such as superoxide anion, hydrogen peroxide, hydroxyl radical and peroxynitrite, likely contribute to the development and complications of atherosclerotic cardiovascular diseases (ASCVD). In genetically modified mouse models of atherosclerosis, the overexpression of ROS-generating enzymes and uncontrolled ROS formation appear to be associated with accelerated atherosclerosis. Conversely, the overexpression of ROS scavenger systems reduces or stabilizes atherosclerotic lesions, depending on the genetic background of the mouse model. In humans, higher levels of circulating biomarkers derived from the oxidation of lipids (8-epi-prostaglandin F_2α, and malondialdehyde), as well as proteins (oxidized low-density lipoprotein, nitrotyrosine, protein carbonyls, advanced glycation end-products), are increased in conditions of high cardiovascular risk or overt ASCVD, and some oxidation biomarkers have been reported as independent predictors of ASCVD in large observational cohorts. In animal models, antioxidant supplementation with melatonin, resveratrol, Vitamin E, stevioside, acacetin and n-polyunsaturated fatty acids reduced ROS and attenuated atherosclerotic lesions. However, in humans, evidence from large, placebo-controlled, randomized trials or prospective studies failed to show any athero-protective effect of antioxidant supplementation with different compounds in different CV settings. However, the chronic consumption of diets known to be rich in antioxidant compounds (e.g., Mediterranean and high-fish diet), has shown to reduce ASCVD over decades. Future studies are needed to fill the gap between the data and targets derived from studies in animals and their pathogenetic and therapeutic significance in human ASCVD.

N-3 polyunsaturated fatty acids for cardiovascular risk

PURPOSE OF REVIEW

Use of omega-3 fatty acid (OM3FA) supplements to reduce risk of cardiovascular events has been investigated, largely without evidence of meaningful benefit, over the last 4 decades.

RECENT FINDINGS

The first contemporary clinical trial to show benefit of OM3FA use was the REDUCE-IT trial (2018), showing a remarkable 25% relative risk reduction in the intervention group that received icosapent ethyl 4 g daily compared to a mineral oil placebo group. The STRENGTH trial (2020), which was similar in design to the REDUCE-IT trial but compared 4 g daily dose of combined OM3FA with a corn oil placebo, was terminated early due to futility.

SUMMARY

This article provides a review of the data surrounding these trials and discusses the differing results of the two trials. There are key differences in the design of the two trials, the most notable is the use of mineral oil in the REDUCE-IT trial, which was potentially a nonneutral comparator. Additionally, both trials showed an increase in the incidence of atrial fibrillation. With the unclear benefit of OM3FA supplementation and possibility of harm, the current data suggest that the risk of routine use of OM3FA outweighs the possibility of reduction in risk of cardiovascular events.

Fish Consumption: Influence of Knowledge, Product Information, and Satisfaction with Product Attributes

Due to its numerous health benefits, fish consumption should be strongly encouraged. Fish consumption, however, is a complex phenomenon influenced by various factors. The aim of this research is to examine the influence of knowledge, product information, and satisfaction with product attributes on fish consumption in a nationally representative sample of people responsible for food purchasing within households in Croatia (n = 977) and Italy (n = 967). Fish consumption was well predicted (R2 = 15%) by the proposed structural model, using the partial least squares structural equation modelling method (PLS-SEM). The obtained results confirm that subjective knowledge (β = 0.277, p < 0.001) and satisfaction with product attributes (β = 0.197, p < 0.001) are predictors of fish consumption. Subjective knowledge was influenced by product information (β = 0.161, p < 0.001), as well as by satisfaction with product attributes (β = 0.282, p < 0.001), while objective knowledge had an influence on product information (β = 0.194, p < 0.001). Although satisfaction with product attributes was the strongest predictor of subjective knowledge in both countries (βCRO = 0.244, βIT = 0.398), it had a greater effect among Italians (p = 0.001), while the impact of product information (βCRO = 0.210, βIT = 0.086) was more pronounced among Croatians (p = 0.010). Since the mediating role of subjective knowledge in all models was confirmed, action focused on enhancing subjective knowledge should be taken to increase fish consumption.

Exposure to Toxic Metals and Health Risk Assessment through Ingestion of Canned Sardines Sold in Brazil

The presence of heavy metals in the environment is increasing, which can be a danger to public health. Fish exposed to contaminated environments tend to have higher concentrations of some metals in their tissues. Monitoring these elements remains urgent as it is a matter of global concern. Canned sardines from the Brazilian market were analyzed for elements (Al, As, Ba, Cd, Co, Cr, Cu, Fe, Ni, Pb, Se, and Zn) of metals and metalloids, including some toxic, using inductively coupled plasma optical spectrometry (ICP OES) in two types of sardines (preserved in oil and tomato sauce) from five different brands. The results were compared to limit levels for consumption set by FAO/WHO. Moreover, we assessed the associated risk regarding the elemental intake of these elements through the samples, using the hazard quotient (HQ), hazard index (HI), and carcinogenic risk (CR). All samples had unfavorable HQ and HI, primarily due to arsenic content. In the same manner, CR for arsenic was above the proposed limit of 10⁻⁴, and cadmium and chromium, which were within the acceptable limit (10⁻⁶ to 10⁻⁴), require attention. These results show that chronic consumption of canned sardines sold in Brazil is unsafe, and quality surveillance is needed to ensure there is no risk to the population that ingests these products.

Evaluation of the Quality of Evidence of the Association of Foods and Nutrients With Cardiovascular Disease and Diabetes: A Systematic Review

IMPORTANCE

Poor diet is a leading global factor associated with cardiometabolic disease (CMD). Understanding the quality of evidence of the associations between specific dietary factors and CMD, including effect size (relative risk [RR]) and uncertainty, is essential to guide policy and consumer actions to achieve healthy diet and public health goals.

OBJECTIVE

To assess the quality of evidence of the associations between specific dietary factors and CMD as well as the quantitative evidence for RRs and the uncertainty of these risk estimates.

EVIDENCE REVIEW

PubMed and the reference lists of eligible articles were searched between May 1, 2015, and February 26, 2021, for systematic reviews with meta-analyses of randomized clinical trials and prospective cohort studies that analyzed the consumption of 1 or more of the dietary factors of interest; reported dose-response meta-analyses; included healthy adults; and assessed 1 or more of the outcomes of interest. Study characteristics and RR estimates were extracted in duplicate. For identified associations, quality of evidence was assessed using the Bradford-Hill criteria for causation.

FINDINGS

A total of 2058 potentially relevant reports were identified, from which 285 full-text articles were assessed for eligibility. The final selection of articles included 28 meta-analyses representing 62 associations between diet and CMD. Among these associations, 10 foods, 3 beverages, and 12 nutrients had at least probable evidence of associations with coronary heart disease, stroke, and/or diabetes. Most RRs ranged from 0.87 to 0.96 per daily serving change for protective associations and from 1.06 to 1.15 per daily serving change for harmful associations. Most identified associations were protective (n = 38) and a smaller number were harmful (n = 24), with a higher risk associated with higher intake.

CONCLUSIONS AND RELEVANCE

This systematic review summarized the current quality of evidence of the associations of specific dietary factors with coronary heart disease, stroke, and diabetes. These findings may inform dietary guidance, the assessment of disease burden in specific populations, policy setting, and future research.

Omega 3 Fatty Acids and Health: The Little We Know after All These Years

Elagizi et al. [1] provide an update on the effects of long-chain omega 3 fatty acids on the cardiovascular system [...].

Lifestyle and Hepatocellular Carcinoma What Is the Evidence and Prevention Recommendations

Simple Summary

The increasing public health burden of Hepatocellular carcinoma (HCC) emphasizes the importance of defining important modifiable risk factors. In the following review, we will discuss the evidence for the relation of major lifestyle risk factors, mostly from large population-based studies. Generally, it is has been shown that healthy lifestyle habits, including minimizing obesity, eating a healthy diet, avoidance of smoking and alcohol, and increasing physical activity, have the potential to prevent HCC. Dietary composition is important beyond obesity. Consumption of n-3 polyunsaturated fatty acids, as well as fish and poultry, vegetables and fiber, are inversely associated with HCC, while red meat, saturated fat, cholesterol and sugar are related to increased risk. Data from multiple studies clearly show a beneficial effect for physical activity in reducing the risk of HCC. Smoking and alcohol can lead to liver fibrosis and liver cancer and jointly lead to an even greater risk.

Abstract

The increasing burden of hepatocellular carcinoma (HCC) emphasizes the unmet need for primary prevention. Lifestyle measures appear to be important modifiable risk factors for HCC regardless of its etiology. Lifestyle patterns, as a whole and each component separately, are related to HCC risk. Dietary composition is important beyond obesity. Consumption of n-3 polyunsaturated fatty acids, as well as fish and poultry, are inversely associated with HCC, while red meat, saturated fat, and cholesterol are related to increased risk. Sugar consumption is associated with HCC risk, while fiber and vegetable intake is protective. Data from multiple studies clearly show a beneficial effect for physical activity in reducing the risk of HCC. However, the duration, mode and intensity of physical activity needed are yet to be determined. There is evidence that smoking can lead to liver fibrosis and liver cancer and has a synergistic effect with alcohol drinking. On the other hand, an excessive amount of alcohol by itself has been associated with increased risk of HCC directly (carcinogenic effect) or indirectly (liver fibrosis and cirrhosis progression. Large-scale intervention studies testing the effect of comprehensive lifestyle interventions on HCC prevention among diverse cohorts of liver disease patients are greatly warranted.

2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association

Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.

Chia seeds oil enriched with phytosterols and mucilage as a cardioprotective dietary supplement towards inflammation, oxidative stress, and dyslipidemia

Introduction: Non-communicable diseases are a cluster of metabolic diseases, which include type-2 diabetes, cancer, and cardiovascular diseases (CVDs). The aim of the current research was to incorporate dietary fibers (mucilage) and phytosterol for enriching chia seeds oil for producing new dietary supplements for cardio-protection from oxidative stress, inflammation, and dyslipidemia. Methods: Fatty acids profile, phytosterols, and phenolic compounds content of the prepared dietary supplement were assessed. The cardioprotective potency of the dietary supplement was evaluated in rats fed on a high-fat diet for a month. Biochemical parameters related to inflammation, oxidative stress, lipid profile, cardiac enzymes, and kidney function were determined in all rats. Results: The results revealed that dietary supplement was rich in omega-3 fatty acids. Beta-sitosterol and campesterol were the major phytosterols in chia seeds oil dietary supplement. Phenolic compounds were present by 25.9 ± 1.202 mg gallic acid equivalent (GAE)/g dietary supplements. Rats fed on the high-fat diet showed significant elevation (P < 0.05) in inflammatory markers, oxidative stress, dyslipidemia, and cardiac enzymes in association with the elevation of kidney function compared with normal rats. Administration of both doses of dietary supplement significantly (P < 0.05) improved all the studied biochemical parameters. The high dose of the dietary supplement was promising in the reduction of inflammatory markers, oxidative stress, and improved dyslipidemia in accordance with the reduction of all cardiac enzymes and kidney function. Conclusion: Dietary supplements investigated in the current research showed cardioprotective potency through its anti-inflammatory and dyslipidemic activities, which may be attributed to the presence of phenolic compounds, omega-3 fatty acids, phytosterols, and soluble dietary fibers.

Macro- and microelements in some species of marine life from the Sea of Okhotsk

Introduction. Residents of northern regions have a diet low in essential macro- and microelements. The Sea of Okhotsk is an enormous source of fish and non-fish products. We aimed to determine mineral contents in marine fish, shellfish, and algae in order to assess if they could satisfy the daily requirement for these elements through fish and non-fish consumption. Study objects and methods. Our study objects were saffron cod (Eleginus gracilis L.), blue-headed halibut (Reinhardtius hippoglossoides L.), commander squid (Berryteuthis magister L.), northern shrimp (Pandalus borealis L.), salted pink salmon caviar (Oncorhynchus gorbuscham L.), and kelp (Laminaria L.). The contents of 25 macro- and microelements were determined by atomic emission spectrometry and mass spectrometry with inductively coupled argon plasma. Results and discussion. The absolute contents of macro- and microelements in the marine species were used to assess the proportion of the recommended daily requirement that they account for. Also, we performed a thorough comparative analysis of mineral quantities in the studied species of marine fish, pink salmon caviar, shellfish, and algae from the Sea of Okhotsk. Finally, we examined the elemental status of the coastal residents belonging to the “northern type” and identified their deficiencies of vital chemical elements. Conclusion. Some chemical elements in the studied marine species from the Sea of Okhotsk (Magadan Region) satisfy over 100% of the daily human requirement for these minerals. Therefore, their products can be recommended as part of a northern diet in order to compensate for the deficiencies of certain minerals.

The Mediterranean diet and dietary approach to stop hypertension (DASH)-style diet are differently associated with lipid profile in a large sample of Iranian adults: a cross-sectional study of Shahedieh cohort

BACKGROUND

The association between the Mediterranean diet (MED) or dietary approach to stop hypertension (DASH) and cardiovascular disease (CVD) risk factors is well-documented. Nevertheless, a consistent relationship with the Middle East population has yet to be known. Thus, we aimed to investigate the association between DASH/MED and blood lipids in Iranian adults.

METHODS

Four thousand seven hundred forty participants, aged 35-70 years (mean: 50.0) participated in the Shahedieh cohort study in Yazd, Iran, were followed from 2016 until now. Participants provided dietary and blood lipid data through a validated semi-quantitative food frequency questionnaire, and blood samples were taken after a fasted state. We used binary logistic regression to examine the association between DASH/MED scores and blood lipids.

RESULTS

In the participants who ingested a DASH-like diet the third vs. the first tertile of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) levels, and LDL/HDL (high-density lipoprotein) ratio reduced significantly (P < 0.01). While in the participants who ingested the MED-like diet the HDL level increased significantly( 52.8 ± 12. 3 vs. 51.6 ± 11.6, P < 0.01). In Binary logistic regression, higher adherence to the DASH diet showed 19 % lower odds of high TC level (OR: 0.81; 95 %CI: 0.69-0.95) and 18 % lower odds of high LDL/HDL ratio (OR: 0.82; 95 %CI: 0.70-0.96). Besides, high adherence to the MED diet was associated with lower odds of LDL/HDL ratio (OR: 0.85; 95 %CI: 0.72-0.99).

CONCLUSIONS

Our findings suggest that TC, TG, LDL, LDL/HDL ratio, and HDL improved in participants who ingested a DASH-like diet and the LDL/HDL ratio improved in participants who ingested MED-like diet and, subsequently they might have a protective effect on CVDs risk. Further epidemiological studies are needed to confirm our findings.

PUFA Supplementation and Heart Failure: Effects on Fibrosis and Cardiac Remodeling

Heart failure (HF) characterized by cardiac remodeling is a condition in which inflammation and fibrosis play a key role. Dietary supplementation with n-3 polyunsaturated fatty acids (PUFAs) seems to produce good results. In fact, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have anti-inflammatory and antioxidant properties and different cardioprotective mechanisms. In particular, following their interaction with the nuclear factor erythropoietin 2 related factor 2 (NRF2), the free fatty acid receptor 4 (Ffar4) receptor, or the G-protein coupled receptor 120 (GPR120) fibroblast receptors, they inhibit cardiac fibrosis and protect the heart from HF onset. Furthermore, n-3 PUFAs increase the left ventricular ejection fraction (LVEF), reduce global longitudinal deformation, E/e ratio (early ventricular filling and early mitral annulus velocity), soluble interleukin-1 receptor-like 1 (sST2) and high-sensitive C Reactive protein (hsCRP) levels, and increase flow-mediated dilation. Moreover, lower levels of brain natriuretic peptide (BNP) and serum norepinephrine (sNE) are reported and have a positive effect on cardiac hemodynamics. In addition, they reduce cardiac remodeling and inflammation by protecting patients from HF onset after myocardial infarction (MI). The positive effects of PUFA supplementation are associated with treatment duration and a daily dosage of 1–2 g. Therefore, both the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA) define dietary supplementation with n-3 PUFAs as an effective therapy for reducing the risk of hospitalization and death in HF patients. In this review, we seek to highlight the most recent studies related to the effect of PUFA supplementation in HF. For that purpose, a PubMed literature survey was conducted with a focus on various in vitro and in vivo studies and clinical trials from 2015 to 2021.

Gut Microbiota-Derived Trimethylamine N-Oxide and Kidney Function: A Systematic Review and Meta-Analysis

Elevated circulating trimethylamine N-oxide (TMAO) concentrations have been observed in patients with chronic kidney disease (CKD). We aimed to systematically estimate and quantify the association between TMAO concentrations and kidney function. The PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science databases were systematically searched from 1995 to 1 June, 2020, for clinical studies on circulating TMAO concentrations and kidney function indicators. We used R software to conduct meta-analyses of the extracted data. A cumulative meta-analysis was applied to test whether health status affected the pooled effect value. Meta-regression and subgroup analyses were performed to identify possible sources of heterogeneity. Ultimately, we included a total of 32 eligible clinical studies involving 42,062 participants. In meta-analyses of continuous-outcome variables, advanced CKD was associated with a 67.9 μmol/L (95% CI: 52.7, 83.2; P < 0.01) increase in TMAO concentration, and subjects with high concentrations of TMAO had a 12.9 mL/(min·1.73 m2) (95% CI: -16.6, -9.14; P < 0.01) decrease in glomerular filtration rate (GFR). In meta-analyses of the correlations, TMAO was strongly inversely correlated with GFR [Fisher's z-transformed correlation coefficient (ZCOR): -0.45; 95% CI: -0.58, -0.32; P < 0.01] and positively associated with the urine albumin-to-creatinine ratio (UACR; ZCOR: 0.26; 95% CI: 0.08, 0.43; P < 0.01), serum creatinine (sCr; ZCOR: 0.43; 95% CI: 0.28, 0.58; P < 0.01), urine albumin excretion rate (UAER; ZCOR: 0.06; 95% CI: 0.04, 0.09; P < 0.01), blood urea (ZCOR: 0.50; 95% CI: 0.29, 0.72; P < 0.01), blood uric acid (ZCOR: 0.32; 95% CI: 0.25, 0.38; P < 0.01), and serum cystatin C (CysC; ZCOR: 0.47, 95% CI: 0.44, 0.51; P < 0.01). This is the first systematic review and meta-analysis to reveal a negative association between circulating TMAO concentrations and kidney function.

Intake of Fish and Marine n-3 Polyunsaturated Fatty Acids and Risk of Cardiovascular Disease Mortality: A Meta-Analysis of Prospective Cohort Studies

Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease (CVD) mortality risk. However, the results were inconsistent. The purpose of this meta-analysis is to quantitatively evaluate the association between marine n-3 PUFA, fish and CVD mortality risk with prospective cohort studies. A systematic search was performed on PubMed, Web of Science, Embase and MEDLINE databases from the establishment of the database to May 2021. A total of 25 cohort studies were included with 2,027,512 participants and 103,734 CVD deaths. The results indicated that the fish consumption was inversely associated with the CVD mortality risk [relevant risk (RR) = 0.91; 95% confidence intervals (CI) 0.85−0.98]. The higher marine n-3 PUFA intake was associated with the reduced risk of CVD mortality (RR = 0.87; 95% CI: 0.85–0.89). Dose-response analysis suggested that the risk of CVD mortality was decreased by 4% with an increase of 20 g of fish intake (RR = 0.96; 95% CI: 0.94–0.99) or 80 milligrams of marine n-3 PUFA intake (RR = 0.96; 95% CI: 0.94–0.98) per day. The current work provides evidence that the intake of fish and marine n-3 PUFA are inversely associated with the risk of CVD mortality.

Time-restricted feeding is associated with mental health in elderly Italian adults

In recent years, mental disorders have represented a relevant public health problem due to their deleterious effect on quality of life and the difficulty of timely diagnosis. The growing trends have been shown to be highly influenced by modern society, unhealthy lifestyle and harmful dietary habits. Not only the specific foods or dietary patterns have been hypothesized to play a role on mental health; also, temporal regulation of feeding and fasting has emerged as an innovative strategy to prevent and treat mental health disease. The aim of this cross-sectional study was to investigate the association between time-restricted feeding (TRF) and mental health outcomes including perceived stress, depressive symptoms, and sleep quality assessed in a cohort of southern Italian adults. Demographic and dietary characteristics of 1,572 adults living in southern Italy were analyzed. Food frequency questionnaires were used to calculate dietary intakes; participants were also asked what time, on average, they consumed their meals to calculate the eating window of time and identify those eating within 8 hours or less. Logistic regression analyses were performed to test the association between mental health outcomes. After adjusting for potential confounding factors, including adherence to the Mediterranean diet and having breakfast/dinner, no associations were found between TRF and mental health outcomes; however, when performing the analyses by age groups, individuals older than 70 years having a feeding time window of 8 hours were less likely to have signs of mental health distress [odds ratio (OR) = 0.14, 95% confidence interval (CI): 0.03-0.65] compared to those having no feeding time restriction independently of diet quality; notably, adjusting for having breakfast nullified the association (OR = 0.13, 95% CI: 0.02-1.18), while adjusting for having dinner did not change it (OR = 0.14, 95% CI: 0.03-0.67). No further associations were found for specific mental health outcomes explored separately. In conclusion, restricting the daily time feeding window is associated with lower signs of mental health distress in individuals older than 70 years. Albeit preliminary, these findings on elderly individuals require further investigation using prospective design and an amended approach to control for fasting.

Associations of Fish Consumption With Risk of Cardiovascular Disease and Mortality Among Individuals With or Without Vascular Disease From 58 Countries

IMPORTANCE

Cohort studies report inconsistent associations between fish consumption, a major source of long-chain ω-3 fatty acids, and risk of cardiovascular disease (CVD) and mortality. Whether the associations vary between those with and those without vascular disease is unknown.

OBJECTIVE

To examine whether the associations of fish consumption with risk of CVD or of mortality differ between individuals with and individuals without vascular disease.

DESIGN, SETTING, AND PARTICIPANTS

This pooled analysis of individual participant data involved 191 558 individuals from 4 cohort studies-147 645 individuals (139 827 without CVD and 7818 with CVD) from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study and 43 413 patients with vascular disease in 3 prospective studies from 40 countries. Adjusted hazard ratios (HRs) were calculated by multilevel Cox regression separately within each study and then pooled using random-effects meta-analysis. This analysis was conducted from January to June 2020.

EXPOSURES

Fish consumption was recorded using validated food frequency questionnaires. In 1 of the cohorts with vascular disease, a separate qualitative food frequency questionnaire was used to assess intake of individual types of fish.

MAIN OUTCOMES AND MEASURES

Mortality and major CVD events (including myocardial infarction, stroke, congestive heart failure, or sudden death).

RESULTS

Overall, 191 558 participants with a mean (SD) age of 54.1 (8.0) years (91 666 [47.9%] male) were included in the present analysis. During 9.1 years of follow-up in PURE, compared with little or no fish intake (≤50 g/mo), an intake of 350 g/wk or more was not associated with risk of major CVD (HR, 0.95; 95% CI, 0.86-1.04) or total mortality (HR, 0.96; 0.88-1.05). By contrast, in the 3 cohorts of patients with vascular disease, the HR for risk of major CVD (HR, 0.84; 95% CI, 0.73-0.96) and total mortality (HR, 0.82; 95% CI, 0.74-0.91) was lowest with intakes of at least 175 g/wk (or approximately 2 servings/wk) compared with 50 g/mo or lower, with no further apparent decrease in HR with consumption of 350 g/wk or higher. Fish with higher amounts of ω-3 fatty acids were strongly associated with a lower risk of CVD (HR, 0.94; 95% CI, 0.92-0.97 per 5-g increment of intake), whereas other fish were neutral (collected in 1 cohort of patients with vascular disease). The association between fish intake and each outcome varied by CVD status, with a lower risk found among patients with vascular disease but not in general populations (for major CVD, I2 = 82.6 [P = .02]; for death, I2 = 90.8 [P = .001]).

CONCLUSIONS AND RELEVANCE

Findings of this pooled analysis of 4 cohort studies indicated that a minimal fish intake of 175 g (approximately 2 servings) weekly is associated with lower risk of major CVD and mortality among patients with prior CVD but not in general populations. The consumption of fish (especially oily fish) should be evaluated in randomized trials of clinical outcomes among people with vascular disease.

Seafood Intake as a Method of Non-Communicable Diseases (NCD) Prevention in Adults

Seafood (fish in particular) is one of the main food groups in nutrition models with proven health benefits. Seafood has long been considered a very valuable dietary component, mainly due to presence of n-3 polyunsaturated fatty acids (n-3 PUFA) but it is also an important source of protein (including collagen), anserine, taurine, iodine, selenium, vitamin A, vitamin K, vitamin D, tocopherols, B vitamins and astaxanthin. Considering the beneficial effects of these ingredients on blood pressure, lipid profile and the inflammatory process, seafood should be an essential component of the diet. Non-communicable diseases (NCD) such as cardiovascular diseases, cancer, diabetes and mental disorder, chronic respiratory diseases are common diseases associated with advanced age. Promotion of a healthy lifestyle (including proper nutritional behavior) and prevention of diseases are the most effective and efficient ways to decrease premature mortality from NCD and to maintain mental health and well-being. This review article shows the potential preventive and therapeutic effects of seafood with an emphasis on fish. Our narrative review presents the results of systematic reviews and meta-analysis.

Dietary management of cardiovascular risk including type 2 diabetes

PURPOSE OF REVIEW

Recent changes or confirmations linking patterns of eating and specific dietary interventions in the management of cardiovascular risk factors including associations with prevalent and incident type 2 diabetes.

RECENT FINDINGS

Recently published guidance for dietary management of cardiovascular risk and type 2 diabetes have mostly common features. Major findings include a trend to replace strict quantitative advice on nutrients with qualitative advice on food consumption with exceptions for diabetes, global advice to increase intake of plant foods, confirmation to substitute mono and polyunsaturated oils for saturated and trans fats, new advisory on supplemental omega-3 intake, less limitation on dairy foods and fermented dairy foods encouraged, reduced emphasis on specific cholesterol-rich foods allowing greater consumption of eggs except for people with diabetes, processed meat consumption limited allowing modest intake of lean red meat, distinguishing between 'healthy' and 'unhealthy' carbohydrates including sugars, and maintaining advice on healthy bodyweight, reducing salt intake and encouraging water as preferred beverage.

SUMMARY

The new guidance for healthier patterns of food consumption supported by evidence is more readily understood by health practitioners and translatable to consumers and patients.

Fatty Acid-Related Health Lipid Index of Raw and Fried Nile Tilapia (Oreochromis niloticus) Fish Muscle

Fried food consumption is popular in most parts of the world including Ethiopia. Among many fried products available in Ethiopia, fried fish is most commonly consumed in Hawassa Town due to the easy access to the fish from the lake. Recently, there is growing concern among fryers to recycle the oil while frying fish. However, there is limited evidence about the frying effect on the fatty-acid-related health lipid index of fried fish. Thus, the study was aimed to determine the fatty acid profile and the fatty-acid-related health lipid of raw and fried fish. Raw and fried fish were taken from the Hawassa open fish market. Fatty acid profiles were analyzed using a gas chromatography-mass spectrophotometer (GCMS), and the health lipid index was determined by calculation using the recommended formula. JMP pro 13 version software was used for data analysis. Our result showed that raw fish had a high amount of essential fatty acid, nutritive value index, hypocholesterolemic ratio, and peroxidizability index. In contrary to this, the fried fish had a high amount of trans-fatty acids, nonessential fatty acids, atherogenic index, and thrombogenic index. In conclusion, the fried fish loses its fatty-acid-related nutritional quality in uncontrolled frying conditions. Therefore, frying needs to be controlled, as it risks human health otherwise.

Greater Scores for Dietary Fat and Grain Quality Components Underlie Higher Total Healthy Eating Index-2015 Scores, While Whole Fruits, Seafood, and Plant Proteins Are Most Favorably Associated with Cardiometabolic Health in US Adults

BACKGROUND

High-quality diets reduce the risk of cardiometabolic and other chronic diseases. The dietary components that distinguish higher from lower quality diets, and their associations with health, have not been fully investigated.

OBJECTIVES

This study aimed to assess the component scores that underlie differences in total Healthy Eating Index (HEI)-2015 scores, quantify fatty acid (saturated, monounsaturated, polyunsaturated) intakes that comprise Fatty Acids component scores, and assess associations between component scores and cardiometabolic risk factors.

METHODS

A cross-sectional analysis of data from the NHANES (2001-2016) was conducted. Total and component HEI-2015 scores were assessed in adult (≥19 y) participants who provided one 24-h dietary recall (n = 39,799). Survey-weighted mean component scores by quartile of total HEI-2015 score were determined. Regression analyses were conducted to assess fatty acid intakes across quartiles of Fatty Acids component scores. Separate regression analyses were conducted to assess associations between component scores and cardiometabolic risk factors, after adjusting for demographic characteristics and health behaviors.

RESULTS

Scores for components related to dietary fat (Fatty Acids, Saturated Fats) and grain quality (Whole Grains, Refined Grains) accounted for the greatest differences in HEI-2015 scores. Higher Fatty Acids scores were primarily composed of lower saturated and greater polyunsaturated fat intakes. Whole Fruits, and Seafood and Plant Proteins, were most favorably associated with cardiometabolic risk factors including anthropometric measures (P < 0.001), systolic blood pressure (P < 0.01), glycemic markers (Whole Fruits only, P < 0.01), and HDL cholesterol and triglycerides (Seafood and Plant Proteins only, P < 0.001).

CONCLUSIONS

Average diet quality in US adults is suboptimal. Higher quality diets are primarily distinguished by the types of fats and grain-based foods that are consumed. Interventions targeting dietary components that are most favorably associated with cardiometabolic risk factors-whole fruits, seafood, and plant proteins-may have the greatest impact on disease risk.