Effects of red meat, white meat, and nonmeat protein sources on atherogenic lipoprotein measures in the context of low compared with high saturated fat intake: a randomized controlled trial

Plant-Based Diets and Cardiovascular Disease in Older Adults: An Integrative Literature Review

Cardiovascular disease (CVD) is the leading cause of mortality globally, disproportionately impacting older adults. Plant-based diets (PBDs) have emerged as a dietary strategy to mitigate CVD risk, characterized by foods derived from plants and minimal to no animal-derived foods. This integrative review assesses the effectiveness of PBDs for improving CVD risk factors in older adults. A search was conducted in CINAHL, PubMed, and Medline databases for studies of PBDs and CVD risk factors in individuals aged 65 years and older. Quality assessment was performed using the Mixed Methods Appraisal Tool (MMAT). Seventeen publications were analyzed, 7 experimental and 10 non-experimental. All studies showed at least one positive association between PBDs and cardiovascular health in older adults. Findings highlighted significant associations between PBD adherence and reductions in key CVD risk factors, such as low-density lipoprotein cholesterol (LDL-C), blood pressure, and body mass index (BMI), alongside potential benefits in reducing coronary artery calcium and enhancing endothelial function and serum isoflavone concentrations. There is evidence for the potential of PBDs as an effective dietary strategy to prevent the onset and progression of CVD in older adults and reduce the risk of CVD mortality. This review indicates the need for further research. Larger randomized control trials focused on older adults may strengthen the evidence base and guide healthcare recommendations. PBDs should be considered as a part of holistic CVD prevention and management strategies for older adults, encouraging dietary patterns that are rich in fruits, vegetables, legumes, beans, nuts, seeds, and whole grains.

Dietary advanced glycation end-products and their associations with body weight on a Mediterranean diet and low-fat vegan diet: a randomized, cross-over trial

Objective

Evidence suggests that changes in dietary advanced glycation end-products (AGEs) may influence body weight, but the effects of different dietary patterns remain to be explored.The aim of this study was to compare the effects of a Mediterranean and a low-fat vegan diet on dietary AGEs and test their association with body weight.

Materials and methods

In this randomized cross-over trial, 62 overweight adults were assigned to a Mediterranean or a low-fat vegan diet for 16-week periods in random order, separated by a 4-week washout. Body weight was the primary outcome. Three-day diet records were analyzed using the Nutrition Data System for Research software and dietary AGEs were estimated, using an established database. Statistical approaches appropriate for crossover trials were implemented.

Results

Dietary AGEs decreased by 73%, that is, by 9,413 kilounits AGE/day (95% -10,869 to -7,957); p < 0.001, compared with no change on the Mediterranean diet (treatment effect -10,303 kilounits AGE/day [95% CI -13,090 to -7,516]; p < 0.001). The participants lost 6.0 kg on average on the vegan diet, compared with no change on the Mediterranean diet (treatment effect -6.0 kg [95% CI -7.5 to -4.5]; p < 0.001). Changes in dietary AGEs correlated with changes in body weight (r = +0.47; p < 0.001) and remained significant after adjustment for total energy intake (r = +0.39; p = 0.003).

Conclusion

Dietary AGEs did not change on the Mediterranean diet but decreased on a low-fat vegan diet, and this decrease was associated with changes in body weight, independent of energy intake.

Clinical trial registration

https://clinicaltrials.gov/, identifier NCT03698955.

Functional Lipids and Cardiovascular Disease Reduction: A Concise Review

Functional lipids are dietary substances that may have an impact on human health by lowering the risk of chronic illnesses and enhancing the quality of life. Numerous functional lipids have been reported to have potential health benefits in the prevention, management, and treatment of cardiovascular disease, the leading cause of death in the United States. However, there is still insufficient and contradictory information in the literature about their effectiveness and associated mechanisms of action. The objective of this review, therefore, is to evaluate available literature regarding these functional lipids and their health benefits. Various studies have been conducted to understand the links between functional lipids and the prevention and treatment of chronic diseases. Recent studies on phytosterols have reported that CLA, medium-chain triglycerides, and omega-3 and 6 fatty acids have positive effects on human health. Also, eicosanoids, which are the metabolites of these fatty acids, are produced in relation to the ratio of omega-3 to omega-6 polyunsaturated fatty acids and may modulate disease conditions. These functional lipids are available either in dietary or supplement forms and have been proven to be efficient, accessible, and inexpensive to be included in the diet. However, further research is required to properly elucidate the dosages, dietary intake, effectiveness, and their mechanisms of action in addition to the development of valid disease biomarkers and long-term effects in humans.

Animal vs Plant-Based Meat: A Hearty Debate

Plant-based meat alternatives (PBMAs) are highly processed food products that typically replace meat in the diet. In Canada, the growing demand for PBMAs coincides with public health recommendations to reduce ultra-processed food consumption, which prompts the need to investigate the long-term health implications of PBMAs. This review assesses the available literature on PBMAs and cardiovascular disease (CVD), including an evaluation of their nutritional profile and impact on CVD risk factors. Overall, the nutritional profiles of PBMAs vary considerably but generally align with recommendations for improving cardiovascular health; compared with meat, PBMAs are usually lower in saturated fat and higher in polyunsaturated fat and dietary fibre. Some dietary trials that have replaced meat with PBMAs have reported improvements in CVD risk factors, including total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B-100, and body weight. No currently available evidence suggests that the concerning aspects of PMBAs (eg, food processing and high sodium content) negate the potential cardiovascular benefits. We conclude that replacing meat with PBMAs may be cardioprotective; however, long-term randomised controlled trials and prospective cohort studies that evaluate CVD events (eg, myocardial infarction, stroke) are essential to draw more definitive conclusions.

Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial

The ketogenic diet (KD, also known as metabolic therapy) has been successful in the treatment of obesity, type 2 diabetes, and epilepsy. More recently, this treatment has shown promise in the treatment of psychiatric illness. We conducted a 4-month pilot study to investigate the effects of a KD on individuals with schizophrenia or bipolar disorder with existing metabolic abnormalities. Twenty-three participants were enrolled in a single-arm trial. Results showcased improvements in metabolic health, with no participants meeting metabolic syndrome criteria by study conclusion. Adherent individuals experienced significant reduction in weight (12 %), BMI (12 %), waist circumference (13 %), and visceral adipose tissue (36 %). Observed biomarker enhancements in this population include a 27 % decrease in HOMA-IR, and a 25 % drop in triglyceride levels. In psychiatric measurements, participants with schizophrenia showed a 32 % reduction in Brief Psychiatric Rating Scale scores. Overall Clinical Global Impression (CGI) severity improved by an average of 31 %, and the proportion of participants that started with elevated symptomatology improved at least 1-point on CGI (79 %). Psychiatric outcomes across the cohort encompassed increased life satisfaction (17 %) and enhanced sleep quality (19 %). This pilot trial underscores the potential advantages of adjunctive ketogenic dietary treatment in individuals grappling with serious mental illness.

Substitution of dietary monounsaturated fatty acids from olive oil for saturated fatty acids from lard increases low-density lipoprotein apolipoprotein B-100 fractional catabolic rate in subjects with dyslipidemia associated with insulin resistance: a randomized controlled trial

BACKGROUND

The substitution of monounsaturated acids (MUFAs) for saturated fatty acids (SFAs) is recommended for cardiovascular disease prevention but its impact on lipoprotein metabolism in subjects with dyslipidemia associated with insulin resistance (IR) remains largely unknown.

OBJECTIVES

This study aimed to evaluate the impact of substituting MUFAs for SFAs on the in vivo kinetics of apolipoprotein (apo)B-containing lipoproteins and on the plasma lipidomic profile in adults with IR-induced dyslipidemia.

METHODS

Males and females with dyslipidemia associated with IR (n = 18) were recruited for this crossover double-blind randomized controlled trial. Subjects consumed, in random order, a diet rich in SFAs (SFAs: 13.4%E; MUFAs: 14.4%E) and a diet rich in MUFAs (SFAs: 7.1%E; MUFAs: 20.7%E) in fully controlled feeding conditions for periods of 4 wk each, separated by a 4-wk washout. At the end of each diet, fasting plasma samples were taken together with measurements of the in vivo kinetics of apoB-containing lipoproteins.

RESULTS

Substituting MUFAs for SFAs had no impact on triglyceride-rich lipoprotein apoB-48 fractional catabolic rate (FCR) (Δ = -8.9%, P = 0.4) and production rate (Δ = 0.0%, P = 0.9), although it decreased very low-density lipoprotein apoB-100 pool size (PS) (Δ = -22.5%; P = 0.01). This substitution also reduced low-density lipoprotein cholesterol (LDL-C) (Δ = -7.0%; P = 0.01), non-high-density lipoprotein cholesterol (Δ = -2.5%; P = 0.04), and LDL apoB-100 PS (Δ = -6.0%; P = 0.05). These differences were partially attributed to an increase in LDL apoB-100 FCR (Δ = +1.6%; P = 0.05). The MUFA diet showed reduced sphingolipid concentrations and elevated glycerophospholipid levels compared with the SFA diet.

CONCLUSIONS

This study demonstrated that substituting dietary MUFAs for SFAs decreases LDL-C levels and LDL PS by increasing LDL apoB-100 FCR and results in an overall improved plasma lipidomic profile in individuals with IR-induced lipidemia.

TRIAL REGISTRATION

This trial was registered as clinicaltrials.gov as NCT03872349.

Association between oral nutrition and inflammation after intestinal transplantation

Intestinal transplantation (Itx) can be a life-saving treatment for certain patient populations, including those patients with intestinal failure (IF) who develop life-threatening complications due to the use of parenteral nutrition (PN). Most patients who have undergone Itx are eventually able to tolerate a full oral diet. However, little guidance or consensus exists regarding optimizing the specific components of an oral diet for Itx patients, including macronutrients, micronutrients and dietary patterns. While oral dietary prescriptions have moved to the forefront of primary and preventive care, this movement has yet to occur across the field of organ transplantation. Evidence to date points to the role of systemic chronic inflammation (SCI) in a wide variety of chronic diseases as well as post-transplant graft dysfunction. This review will discuss current trends in oral nutrition for Itx patients and also offer novel insights into nutritional management techniques that may help to decrease SCI and chronic disease risk as well as optimize graft function.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

White meat consumption and risk of cardiovascular disease and type 2 diabetes: a systematic review and meta-analysis

Objectives

The aim was to systematically review the associations among white meat consumption, cardiovascular diseases (CVD), and type 2 diabetes (T2D).

Methods

Databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials and Scopus were searched (15th October 2021) for randomized intervention trials (RCTs, ≥ 4 weeks of duration) and prospective cohort studies (≥12 month of follow-up) assessing the consumption of white meat as the intervention/exposure. Eligible outcomes for RCTs were cardiometabolic risk factors and for cohorts, fatal and non-fatal CVD and incident T2D. Risk of bias was estimated using the Cochrane's RoB2 and Risk of Bias for Nutrition Observational Studies. Meta-analysis was conducted in case of ≥3 relevant intervention studies or ≥5 cohort studies using random-effects models. The strength of evidence was evaluated using the World Cancer Research Fund's criteria.

Results

The literature search yielded 5,795 scientific articles, and after screening 43 full-text articles, 23 cohort studies and three intervention studies were included. All included intervention studies matched fat content of intervention and control diets, and none of them showed any significant effects on the selected outcomes of white meat when compared to red meat. Findings from the cohort studies generally did not support any associations between white meat intake and outcomes. Meta-analyses were conducted for CVD mortality (RR: 0.95, 95% CI: 0.87-1.02, P = 0.23, I2 = 25%) and T2D incidence (RR: 0.98, 95% CI: 0.87-1.11, P = 0.81, I2 = 82%).

Conclusion

The currently available evidence does not indicate a role, beneficial or detrimental, of white meat consumption for CVD and T2D. Future studies investigating potentially different health effects of processed versus unprocessed white meat and substitution of red meat with white meat are warranted.Registration: Prospero registration CRD42022295915.

The effects of substituting red and processed meat for mycoprotein on biomarkers of cardiovascular risk in healthy volunteers: an analysis of secondary endpoints from Mycomeat

PURPOSE

Mycoprotein is a relatively novel food source produced from the biomass of Fusarium venenatum. It has previously been shown to improve CVD risk markers in intervention trials when it is compared against total meat. It has not hitherto been assessed specifically for benefits relative to red and processed meat.

METHODS

We leveraged samples from Mycomeat, an investigator-blind randomised crossover controlled trial in metabolically healthy male adults (n = 20), randomised to consume 240 g/day of red and processed meat for 14 days followed by mycoprotein, or vice versa. Blood biochemical indices were a priori defined secondary endpoints.

RESULTS

Mycoprotein consumption led to a 6.74% reduction in total cholesterol (P = 0.02) and 12.3% reduction in LDL cholesterol (P = 0.02) from baseline values. Change in fasted triglycerides was not significantly different between diets (+ 0.19 ± 0.11 mmol/l with mycoprotein, P = 0.09). There was a small but significant reduction in waist circumference for mycoprotein relative to meat (- 0.95 ± 0.42 cm, P = 0.04). Following the mycoprotein diet, mean systolic (- 2.41 ± 1.89 mmHg, P = 0.23) and diastolic blood pressure (- 0.80 ± 1.23 mmHg, P = 0.43) were reduced from baseline. There were no statistically significant effects of the intervention on urinary sodium, nitrite or TMAO; while urinary potassium (+ 126.12 ± 50.30 mmol/l, P = 0.02) and nitrate (+ 2.12 ± 0.90 mmol/l, P = 0.04) were both significantly higher with mycoprotein relative to meat. The study population comprised metabolically healthy adults, therefore, changes in plasma lipids had little effect on cardiovascular risk scores (- 0.34% FRS for mycoprotein P = 0.24).

CONCLUSIONS

These results confirm potential cardiovascular benefits when displacing red and processed meat with mycoprotein in the diet. Longer trials in higher risk study populations are needed to fully elucidate suggested benefits for blood pressure and body composition.

CLINICALTRIALS

gov Identifier: NCT03944421.

Moving towards more sustainable diets: Is there potential for a personalised approach in practice?

Discourse on the relationship between food production, healthy eating and sustainability has become increasingly prominent and controversial in recent years. Research groups often take one perspective when reporting on sustainable diets, and several often neglect considerations for the multiple aspects that make a diet truly sustainable, such as cultural acceptability, differences in nutritional requirements amongst the population and the efficiency of long-term dietary change. Plant-based diets are associated with lower greenhouse gas emissions (GHGEs) and have been linked with better health outcomes, including lower risk of diet-related chronic disease. However, foods associated with higher GHGE, such as lean red meat, fish and dairy, have beneficial nutritional profiles and contribute significantly to micronutrient intakes. Some research has shown that diets associated with lower GHGE can be less nutritionally adequate. Several countries now include sustainability recommendations in dietary guidelines but use vague language such as "increase" or "consume regularly" when referring to plant-based foods. General population-based nutrition advice has poor adherence and does not consider differences in nutritional needs. Although modelling studies show potential to significantly reduce environmental impact with dietary changes, personalising such dietary recommendations has not been studied. Adapting recommendations to the individual through reproducible methods of personalised nutrition has been shown to lead to more favourable and longer-lasting dietary changes compared to population-based nutrition advice. When considering sustainable healthy dietary guidelines, personalised feedback may increase the acceptability, effectiveness and nutritional adequacy of the diet. A personalised approach has the potential for delivering a new structure of more sustainable healthy food-based dietary guidelines. This review evaluates the potential to develop personalised sustainable healthy food-based dietary guidelines and discusses potential implications for policy and practice.

Dietary fatty acids intake and all-cause and cardiovascular mortality in patients on peritoneal dialysis

BACKGROUND & AIMS

The relationship between dietary fatty acids (FA) and clinical outcomes are relatively lacking in non-dialyzed and dialyzed chronic kidney disease (CKD) population, resulting in insufficient guide about the dietary FA intake in this population. In this study, we aimed to observe the association between the intake of total or different types of FA and all-cause and cardiovascular (CV) mortality in patients undergoing peritoneal dialysis (PD).

METHODS

This is a prospective cohort study with data retrospectively analyzed in 881 patients undergoing PD. Dietary FA intake measured by 3-day dietary records. The outcomes were defined as all-cause and CV death. Baseline FA intake and time-averaged FA intake were categorized by tertiles based on the distribution among the study population. We used univariate and multivariate Cox proportional regression models to determine the association between amounts and types of FA and all-cause and CV mortality.

RESULTS

During a median follow up of 45 months, 93 patients were still being maintained on PD, 467 had died, including 189 (40.5%) attributable to CV death. Compared to patients in the low tertile of total FA (TFA) intake at baseline group, the middle or/and high tertile groups were more likely to be male, younger, well-educated and better nutritional status (P < 0.05). At the baseline, no association was found between all-cause and CV death in either total or different types of FA after adjusting for nutritional variables. As for time-averaged analyses, the associations of TFA, saturated FA (SFA), monounsaturated FA (MUFA), ω-3 and ω-6 polyunsaturated FA (PUFA) and all-cause mortality were weakened after adjustment for laboratory and nutrients variables. However, PUFA independently reduced 5% of mortality even after adjustment for laboratory and nutrients variables [HR 0.95 (0.91, 0.99), P = 0.023], and the ratio of MUFA/PUFA was positively associated with the risk for all-cause mortality [HR 1.05 (1.01, 1.09), P = 0.008]. Furthermore, each 10% increase of the ratio of ω-6/ω-3 was only weakly associated with the risk for all-cause mortality [HR 1.02 (1.00, 1.04), P = 0.034]. As for CVD mortality, the impacts of total and each type of FA disappeared after adjustment for laboratory or nutrients variables.

CONCLUSIONS

Time-averaged PUFA intake was independently associated with a lower risk for all-cause mortality in our PD cohort, while the higher ratio of MUFA/PUFA and ω-6/ω-3 increased all-cause mortality. More observational and interventional researches are needed to determine these associations.

Bacterial microbiota in different types of processed meat products: diversity, adaptation, and co-occurrence

As a double-edged sword, some bacterial microbes can improve the quality and shelf life of meat products, but others mainly responsible for deterioration of the safety and quality of meat products. This review aims to present a landscape of the bacterial microbiota in different types of processed meat products. After demonstrating a panoramic view of the bacterial genera in meat products, the diversity of bacterial microbiota was evaluated in two dimensions, namely different types of processed meat products and different meats. Then, the influence of environmental factors on bacterial communities was evaluated according to the storage temperature, packaging conditions, and sterilization methods. Furthermore, microbes are not independent. To explore interactions among those genera, co-occurrence patterns were examined. In these respects, this review highlighted the recent advances in fundamental principles that underlie the environmental adaption tricks and why some species tend to occur together frequently, such as metabolic cross-feeding, co-aggregate at microscale, and the intercellular signaling system. Further investigations are required to unveil the underlying molecular mechanisms that govern microbial community systems, ultimately contributing to developing new strategies to harness beneficial microorganisms and control harmful microorganisms.

Variations in the Relative Abundance of Gut Bacteria Correlate with Lipid Profiles in Healthy Adults

The gut microbiome is a versatile system regulating numerous aspects of host metabolism. Among other traits, variations in the composition of gut microbial communities are related to blood lipid patterns and hyperlipidaemia, yet inconsistent association patterns exist. This study aims to assess the relationships between the composition of the gut microbiome and variations in lipid profiles among healthy adults. This study used data and samples from 23 adult participants of a previously conducted dietary intervention study. Circulating lipid measurements and whole-metagenome sequences of the gut microbiome were derived from 180 blood and faecal samples collected from eight visits distributed across an 11-week study. Lipid-related variables explained approximately 4.5% of the variation in gut microbiome compositions, with higher effects observed for total cholesterol and high-density lipoproteins. Species from the genera Odoribacter, Anaerostipes, and Parabacteroides correlated with increased serum lipid levels, whereas probiotic species like Akkermansia muciniphila were more abundant among participants with healthier blood lipid profiles. An inverse correlation with serum cholesterol was also observed for Massilistercora timonensis, a player in regulating lipid turnover. The observed correlation patterns add to the growing evidence supporting the role of the gut microbiome as an essential regulator of host lipid metabolism.

Nutritional and health benefits and risks of plant-based substitute foods

Plant-based substitutes (PBS) are seen as a convenient way to transition to a more plant-based diet, but their potential health benefits and nutritional concerns remain debated. Based on a review of the literature, it is concluded here that the primary risk of insufficient nutrient intake with PBS concerns iron and calcium, which are critical to the nutritional value of PBS. Other risks were identified but these would depend on the characteristics of the overall diet, as is the case for iodine in a diet containing no seafood or dairy, and vitamin B12 in a vegetarian/vegan diet. Conversely, the use of PBS is also expected to confer some benefits for long-term health because it would result in higher fibre intakes (in the case of meat PBS) and lower SFA intakes (but higher PUFA/MUFA intakes), but attention should be paid to a potential increase in sodium intake with PBS of meat products. In fact, a recurring finding in this review was that PBS is a very heterogeneous food category involving considerable variations in ingredient and nutrient composition, and whose design could be improved in order to foster nutritional and health benefits. The latter also depend on the animal food that is being replaced and are only deemed likely when PBS replace red meat. The fortification of PBS with key nutrients such as iron and calcium may constitute an actionable public health solution to further shift the balance in favour of PBS in the context of the current dietary transition in western countries.

Small Dense Low-Density Lipoprotein Cholesterol Levels in Breakfast Skippers and Staple Foods Skippers

AIMS

Skipping breakfast is known as a cardiovascular disease (CVD) risk. Recently, eating and dietary patterns have been varied in many countries, however, the mechanisms of promoting CVD are still unclear. Our goal was to assess the effects of eating and dietary patterns on CVD risk factors, with a focus on lipid parameters including serum concentration of small dense low-density lipoprotein cholesterol (sdLDL-C).

METHODS

Subjects consisted of 27,997 Japanese men and women, who had medical check-up. Lipid parameters including sdLDL-C levels in breakfast skippers were compared with those in breakfast eaters. Lipid parameters in staple foods skippers were also compared with those in staple foods eaters.

RESULTS

Breakfast skippers had significantly (p＜0.01) higher serum levels of median sdLDL-C than breakfast eaters in both genders (34.7 versus 32.0 mg/dL in men, 25.4 versus 24.9 mg/dL in women, respectively), and the same was true for sdLDL-C/LDL-C ratio (0.276 versus 0.260 in men, 0.218 versus 0.209 in women, respectively). Similarly, staple foods skippers had significantly higher sdLDL-C level than staple foods eaters in both genders (34.1 versus 31.6 mg/dL in men, 25.8 versus 24.7 mg/dL in women), and the same went for sdLDL-C/LDL-C ratio (0.278 versus 0.256 in men, 0.215 versus 0.208 mg/dL in women, respectively).

CONCLUSION

Our data indicate that both skipping breakfast and having meals without staple foods increase serum sdLDL-C concentration and cause unfavorable lipid profiles, and then may promote CVD. These finding provide evidence for the importance of having breakfast and meals with staple foods for preventing CVD.

Dietary saturated fat and cholesterol: cracking the myths around eggs and cardiovascular disease

Whilst dietary cholesterol guidelines have waivered through the years with historic restrictions lifted for the majority of the general population, recommendations to reduce saturated fat intake have been the mainstay of dietary guidelines since the 1980s and were recently reinforced by the Scientific Advisory Committee on Nutrition (SACN). Cholesterol metabolism is complex, with saturated fat known to have a more significant contribution at raising levels of low-density lipoprotein (LDL) cholesterol, a well-established risk factor for cardiovascular disease (CVD). However, it is clear from metabolic research that hyper-responsiveness to both dietary cholesterol and saturated fat exists; hence, for specific subsets of the population, reductions in both nutrients may be indicated. With this in mind, the current article aims to provide an overview of the mechanisms underlying biological variation in responsiveness and introduces research currently underway which will hopefully identify simple biomarkers that can be used to predict responsiveness and permit tailored, personalised, dietary advice. Eggs are a well-known source of dietary cholesterol whilst being low in saturated fat. A common question encountered in clinical practice is must individuals limit intake to manage blood cholesterol levels. This article summarises key recent papers which confirm that eggs can be enjoyed as part of a healthy balanced diet, whilst highlighting the need for further research in certain population groups, e.g. in individuals with diabetes.

Dairy, Meat, Seafood, and Plant Sources of Saturated Fat: United States, Ages Two Years and Over, 2017-2020

BACKGROUND

Research suggests that the effects of saturated fat (SF) on health differ depending on its food source. Dairy SF has been associated with lower cardiovascular disease (CVD) risk, whereas meat SF is linked to a higher CVD risk.

OBJECTIVES

To estimate the contribution to the total intake of SF of 1) 5 food groups - dairy, meats, seafood, plants, and "other," and 2) the top 10 specific food category sources in the United States population overall and by sociodemographic subgroup.

METHODS

The analysis included data from 11,798 participants in the 2017-March 2020 National Health and Nutrition Examination Survey aged 2+ y. Grams of SF from the food sources expressed as a percentage of the total grams of SF consumed, were estimated using the population ratio method.

RESULTS

Mean daily intake of SF was 28.1 g [95% confidence interval (CI): 27.6-28.6 g], comprising 11.9% (95% CI: 11.7-12.1%) of total energy intake. Dairy contributed 28.4% of SF, followed by meats (22.1%), plant sources (7.5%), fish and seafood (1.2%), and the remaining foods (41.6%). Youth had higher SF intake from dairy than adults (P < 0.001), whereas non-Hispanic Whites had higher intake than non-Hispanic Blacks (P < 0.001) and Hispanics (P = 0.016). Adults had higher SF intake from meats than youth (P = 0.002), males more than females (P < 0.001), and non-Hispanic Blacks more than non-Hispanic Asians (P = 0.016) and Hispanics (P < 0.001). The top 10 specific sources of SF were unprocessed red meats, sweet bakery products, cured meats, milk, cheese, pizza, unprocessed poultry, Mexican mixed dishes, eggs, and combined fruits and vegetables.

CONCLUSIONS

Although dairy contributed ∼30% of SF compared to ∼20% for total meat, the top specific food category source of SF was unprocessed red meats, which ranked in the top 2 food category sources of SF for most subgroups. These findings may be useful for further research to examine the relationship between the different sources of SF and health outcomes.

Recent strategies for improving the quality of meat products

Processed meat products play a vital role in our daily dietary intake due to their rich protein content and the inherent convenience they offer. However, they often contain synthetic additives and ingredients that may pose health risks when taken excessively. This review explores strategies to improve meat product quality, focusing on three key approaches: substituting synthetic additives, reducing the ingredients potentially harmful when overconsumed like salt and animal fat, and boosting nutritional value. To replace synthetic additives, natural sources like celery and beet powders, as well as atmospheric cold plasma treatment, have been considered. However, for phosphates, the use of organic alternatives is limited due to the low phosphate content in natural substances. Thus, dietary fiber has been used to replicate phosphate functions by enhancing water retention and emulsion stability in meat products. Reducing the excessive salt and animal fat has garnered attention. Plant polysaccharides interact with water, fat, and proteins, improving gel formation and water retention, and enabling the development of low-salt and low-fat products. Replacing saturated fats with vegetable oils is also an option, but it requires techniques like Pickering emulsion or encapsulation to maintain product quality. These strategies aim to reduce or replace synthetic additives and ingredients that can potentially harm health. Dietary fiber offers numerous health benefits, including gut health improvement, calorie reduction, and blood glucose and lipid level regulation. Natural plant extracts not only enhance oxidative stability but also reduce potential carcinogens as antioxidants. Controlling protein and lipid bioavailability is also considered, especially for specific consumer groups like infants, the elderly, and individuals engaged in physical training with dietary management. Future research should explore the full potential of dietary fiber, encompassing synthetic additive substitution, salt and animal fat reduction, and nutritional enhancement. Additionally, optimal sources and dosages of polysaccharides should be determined, considering their distinct properties in interactions with water, proteins, and fats. This holistic approach holds promise for improving meat product quality with minimal processing.

Dairy foods and cardiometabolic diseases: an update and a reassessment of the impact of SFA

Type 2 diabetes (T2D) and CVD are major causes of mortality and chronic morbidity. Whilst mortality from CVD has decreased they remain the largest cause of death in Europe and the prevalence of T2D is increasing rapidly. A consistent component of public health advice is to reduce intake of SFA to reduce CVD in particular, which implies limiting dairy food consumption. The prospective studies and randomised controlled trials included in this review show that for dairy foods at least, SFA are not consistently associated with CVD or T2D risk. For CVD the association with dairy foods is generally neutral despite dairy foods being the major source of SFA in many diets. This creates considerable doubt, at least for dairy foods, concerning the validity of the traditional diet-heart hypothesis which positively relates SFA intake to increased serum LDL-cholesterol and subsequent increased CVD. There is now emerging evidence to explain this which is highly relevant to dairy foods. These include the potentially counterbalancing effect of SFA-stimulated HDL-cholesterol and specific food matrix factors. In addition, SFA are associated with the less atherogenic large buoyant LDL particles and possible counterbalancing hypotensive effects of dairy proteins. Overall, dairy foods have either a neutral or beneficial association with CVD and T2D. Beneficial associations are seen for blood pressure and the reduced T2D risk linked to yoghurt consumption, a subject that needs urgent attention given the sharp rise in T2D prevalence in many countries.

Poultry Consumption and Human Cardiometabolic Health-Related Outcomes: A Narrative Review

Poultry meats, in particular chicken, have high rates of consumption globally. Poultry is the most consumed type of meat in the United States (US), with chicken being the most common type of poultry consumed. The amounts of chicken and total poultry consumed in the US have more than tripled over the last six decades. This narrative review describes nutritional profiles of commonly consumed chicken/poultry products, consumption trends, and dietary recommendations in the US. Overviews of the scientific literature pertaining to associations between, and effects of consuming chicken/poultry on, body weight and body composition, cardiovascular disease (CVD), and type II diabetes mellitus (T2DM) are provided. Limited evidence from randomized controlled trials indicates the consumption of lean unprocessed chicken as a primary dietary protein source has either beneficial or neutral effects on body weight and body composition and risk factors for CVD and T2DM. Apparently, zero randomized controlled feeding trials have specifically assessed the effects of consuming processed chicken/poultry on these health outcomes. Evidence from observational studies is less consistent, likely due to confounding factors such as a lack of a description of and distinctions among types of chicken/poultry products, amounts consumed, and cooking and preservation methods. New experimental and observational research on the impacts of consuming chicken/poultry, especially processed versions, on cardiometabolic health is sorely needed.

Red meat consumption, cardiovascular diseases, and diabetes: a systematic review and meta-analysis

AIMS

Observational studies show inconsistent associations of red meat consumption with cardiovascular disease (CVD) and diabetes. Moreover, red meat consumption varies by sex and setting, however, whether the associations vary by sex and setting remains unclear.

METHODS AND RESULTS

This systematic review and meta-analysis was conducted to summarize the evidence concerning the associations of unprocessed and processed red meat consumption with CVD and its subtypes [coronary heart disease (CHD), stroke, and heart failure], type two diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM) and to assess differences by sex and setting (western vs. eastern, categorized based on dietary pattern and geographic region). Two researchers independently screened studies from PubMed, Web of Science, Embase, and the Cochrane Library for observational studies and randomized controlled trials (RCTs) published by 30 June 2022. Forty-three observational studies (N = 4 462 810, 61.7% women) for CVD and 27 observational studies (N = 1 760 774, 64.4% women) for diabetes were included. Red meat consumption was positively associated with CVD [hazard ratio (HR) 1.11, 95% confidence interval (CI) 1.05 to 1.16 for unprocessed red meat (per 100 g/day increment); 1.26, 95% CI 1.18 to 1.35 for processed red meat (per 50 g/day increment)], CVD subtypes, T2DM, and GDM. The associations with stroke and T2DM were higher in western settings, with no difference by sex.

CONCLUSION

Unprocessed and processed red meat consumption are both associated with higher risk of CVD, CVD subtypes, and diabetes, with a stronger association in western settings but no sex difference. Better understanding of the mechanisms is needed to facilitate improving cardiometabolic and planetary health.

Dietary Heat-Treatment Contaminants Exposure and Cancer: A Case Study from Turkey

In this study, the 10-year dietary habits of patients diagnosed with cancer (n = 1155) were retrospectively analyzed, and the relationships between dietary (red meat, white meat, fish meat, French fries, bread, instant coffee, ready-to-drink coffee, Turkish coffee, and black tea) heterocyclic amines, polycyclic aromatic hydrocarbons, acrylamide, and N-nitrosamine-based risk scores and cancer types were statistically evaluated. The foods with the highest and lowest mean dietary heat-treatment contaminant risk scores were red meat and ready-to-drink coffee, respectively. There were statistically significant differences in the dietary heat-treatment contamination risk scores based on the cancer patients' demographic characteristics (sex, age, smoking, and body mass index) (p < 0.05). According to the cancer types, the systems with the highest and lowest dietary heat-treatment contaminant risk scores were determined as other (brain, thyroid, lymphatic malignancies, skin, oro- and hypopharynx, and hematology) and the reproductive (breast, uterus, and ovary) system, respectively. The relationship between instant coffee consumption and respiratory system cancer types, the frequency of consumption of French fries and urinary system cancer types and the consumption of meat products and gastrointestinal system cancer types were determined. It is thought that this study contains important findings regarding the relationship between dietary habits and cancer and will be a good source for other studies to be conducted in this context.

Total meat (flesh) supply may be a significant risk factor for cardiovascular diseases worldwide

Consumption of red meat instead of white meat has typically been associated with cardiovascular diseases (CVDs). Reflecting actual diet patterns, this study explored the role of total meat (red + white) in predicting CVD incidence. Data from 217 countries were extracted from United Nations agencies for the analyses in five steps. Bivariate correlations were applied to examine the relationship between total meat and CVD incidence globally and regionally. Partial correlation was applied to identify that total meat was an independent predictor of CVD incidence while socioeconomic status, obesity, and urbanization were statistically constant. Stepwise linear regression was conducted for selecting the significant predictor of CVD incidence. SPSS 28 and Microsoft Excel were used for correlation analyses. Globally, total meat correlated to CVD incidence strongly and significantly in bivariate correlation models. This relationship remained significant in partial correlation when socioeconomic status, obesity, and urbanization were statistically kept constant. Stepwise multiple regression identified that, second to socioeconomic status, total meat was a significant predictor of CVD incidence. Total meat correlated to CVD incidence in different country groupings. However, the correlations between total meat and CVD incidence were significantly stronger in developing countries than in developed countries. Worldwide, total meat (flesh) consumption correlated to CVD incidence independently, but significantly stronger in developing countries than in developed countries. This correlation is worth exploring further in longitudinal cohort studies.

Dietary advanced glycation products and their associations with insulin sensitivity and body weight: A 16-week randomized clinical trial

Background

Evidence suggests that changes in advanced glycation end-products (AGEs) may influence body weight. Previous studies have focused on cooking methods as the primary way how to reduce the dietary AGEs but little is known about the effects of a change in diet composition.

Objective

The aim of this study was to assess the effects of a low-fat plant-based diet on dietary AGEs and test the association with body weight, body composition, and insulin sensitivity.

Methods

Participants who were overweight (n = 244) were randomly assigned to an intervention (low-fat plant-based) (n = 122) or control group (n = 122) for 16 weeks. Before and after the intervention period, body composition was measured by dual X-ray absorptiometry. Insulin sensitivity was assessed with the predicted insulin sensitivity index (PREDIM). Three-day diet records were analyzed using the Nutrition Data System for Research software and dietary AGEs were estimated, using a database. Repeated measure ANOVA was used for statistical analysis.

Results

Dietary AGEs decreased in the intervention group by 8768 ku/day on average (95% -9611 to -7925; p < 0.001), compared with the control group (-1608; 95% CI -2709 to -506; p = 0.005; treatment effect -7161 ku/day [95% CI -8540 to -5781]; Gxt, p < 0.001). Body weight decreased by 6.4 kg in the intervention group, compared with 0.5 kg in the control group (treatment effect -5.9 kg [95% CI -6.8 to -5.0]; Gxt, p < 0.001), largely due to a reduction in fat mass, notably visceral fat. PREDIM increased in the intervention group (treatment effect +0.9 [95% CI + 0.5 to +1.2]; p < 0.001). Changes in dietary AGEs correlated with changes in body weight (r = +0.41; p < 0.001), fat mass (r = +0.38; p < 0.001), visceral fat (r = +0.23; p < 0.001), and PREDIM (r = -0.28; p < 0.001), and remained significant even after adjustment for changes in energy intake (r = +0.35; p < 0.001 for body weight; r = +0.34; p < 0.001 for fat mass; r = +0.15; p = 0.03 for visceral fat; and r = -0.24; p < 0.001 for PREDIM).

Conclusions

Dietary AGEs decreased on a low-fat plant-based diet, and this decrease was associated with changes in body weight, body composition, and insulin sensitivity, independent of energy intake. These findings demonstrate positive effects of qualitative dietary changes on dietary AGEs and cardiometabolic outcomes.

Clinical Trial Registry Number

NCT02939638.

Current dietary intake of the Japanese population in reference to the planetary health diet-preliminary assessment

Introduction

We sought to assess the Japanese diet by examining the current dietary intake in Japan using the global reference diet from the EAT-Lancet Commission (Planetary Health Diet; PHD), from the perspective of protein intake in different age groups.

Methods

Average dietary intake by food group in the Japan National Health and Nutrition Survey 2019 (NHNS 2019) was converted to the PHD food groups, and the diet gap (DG) (%) of the global reference of the PHD was calculated by age group.

Results

Although the DG of the intake was excessive compared with the global reference of the PHD in most food groups in all age groups (7.1-416%), the intake exceeded the upper limit of the range only for red meat (640%). Red meat had the highest DG among subjects in their 40s, although the DG decreased with increasing age. Protein intake was within the possible range and did not greatly exceed the recommended dietary intake in the Japanese standard.

Discussion

The current Japanese diet contains an excessive intake of red meat in terms of the global reference of the PHD. This trend is similar to that previously reported in various western regions and countries. However, the Japanese diet does not significantly exceed the recommended protein intake for Japanese people, suggesting that the PHD is an environmentally friendly and healthy choice for younger and older age groups in an aging Japanese society. Policy makers need to develop sustainable and healthy food-based dietary guidelines in addition to providing food and nutrition education and developing a food environment that encourages sustainable and healthy choices to support dietary change.

Classification of Common Food Lipid Sources Regarding Healthiness Using Advanced Lipidomics: A Four-Arm Crossover Study

Prospective studies have failed to establish a causal relationship between animal fat intake and cardiovascular diseases in humans. Furthermore, the metabolic effects of different dietary sources remain unknown. In this four-arm crossover study, we investigated the impact of consuming cheese, beef, and pork meat on classic and new cardiovascular risk markers (obtained from lipidomics) in the context of a healthy diet. A total of 33 young healthy volunteers (23 women/10 men) were assigned to one out of four test diets in a Latin square design. Each test diet was consumed for 14 days, with a 2-week washout. Participants received a healthy diet plus Gouda- or Goutaler-type cheeses, pork, or beef meats. Before and after each diet, fasting blood samples were withdrawn. A reduction in total cholesterol and an increase in high density lipoprotein particle size were detected after all diets. Only the pork diet upregulated plasma unsaturated fatty acids and downregulated triglycerides species. Improvements in the lipoprotein profile and upregulation of circulating plasmalogen species were also observed after the pork diet. Our study suggests that, within the context of a healthy diet rich in micronutrients and fiber, the consumption of animal products, in particular pork meat, may not induce deleterious effects, and reducing the intake of animal products should not be regarded as a way of reducing cardiovascular risk in young individuals.

Dietary advanced glycation end-products and postmenopausal hot flashes: A post-hoc analysis of a 12-week randomized clinical trial

OBJECTIVE

Postmenopausal hot flashes are associated with an increased risk of cardiovascular disease and diabetes. Because dietary advanced glycation end-products (AGEs) may act as endocrine disruptors, this study examined the potential association of modifications to the intake of dietary AGEs with the frequency and severity of postmenopausal hot flashes.

METHODS

Postmenopausal women (n = 84) reporting ≥2 moderate-to-severe hot flashes daily were randomly assigned to either the intervention group or the control group. The former were asked to follow a low-fat, vegan diet, including cooked soybeans (1/2 cup [86 g]/day) for 12 weeks, and the latter continued their usual diets for 12 weeks. Frequency and severity of hot flashes were recorded with a mobile application. Three-day diet records were analyzed using the Nutrition Data System for Research software and dietary AGEs were estimated, using a database. Seventy-one participants completed the whole study and 63 provided complete hot flash and dietary data for the AGEs analysis (n = 31 in the intervention and n = 24 in the control group). Pearson correlations were used to assess the association between changes in hot flashes and dietary AGEs.

RESULTS

Dietary AGEs decreased in the intervention group by 73 %, that is by 5509 ku/day on average (95 % -7009 to -4009; p < 0.001), compared with the control group (+458; 95 % CI -835 to +1751; p = 0.47; treatment effect -5968 ku/day [95 % CI -7945 to -3991]; Gxt, p < 0.001). Severe hot flashes decreased by 92 % (p < 0.001) and moderate-to-severe hot flashes decreased by 88 % in the intervention group (p < 0.001). Changes in dietary AGEs correlated with changes in severe (r = +0.39; p = 0.002) and moderate hot flashes (r = +0.34; p = 0.009) and remained significant after adjustment for changes in energy intake (r = +0.45; p < 0.001; and r = +0.37; p = 0.004, respectively) and changes in body mass index (r = +0.37; p = 0.004; and r = +0.27; p = 0.04, respectively). The reduction in dietary AGEs required to achieve a predicted reduction in hot flashes by 1/day was 6933 ku/day for severe and 4366 ku/day for moderate-to-severe hot flashes.

CONCLUSIONS

The reduction in dietary AGEs with a low-fat plant-based diet was associated with a significant reduction in the frequency of severe and moderate-to-severe postmenopausal hot flashes, independent of changes in energy intake and weight loss. Plant-based diets could be used not only to alleviate vasomotor symptoms in postmenopausal women, but also to reduce other health risks associated with AGEs.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04587154.

Popular fad diets: An evidence-based perspective

Despite the emergence of stronger nutritional science over the past two decades, fad diets remain highly popular. However, growing medical evidence has led to the endorsement of healthy eating patterns by medical societies. This thus allows fad diets to be compared to the emerging scientific evidence as to which diets promote or damage health. In this narrative review, the most popular current fad diets are critically analyzed, including low-fat diets, vegan and vegetarian diets, low-carbohydrate diets, ketogenic diets, Paleolithic diets, and intermittent fasting. Each of these diets has some scientific merit, but each has potential deficiencies relative to the findings of nutritional science. This article also presents the common themes that emerge among the dietary guidance of leading health organizations, such as the American Heart Association and the American College of Lifestyle Medicine. While there are important distinctions between dietary recommendations emanating from various medical societies, each recommends eating more unrefined, plant-based foods, while eating fewer highly processed foods and added sugars, and avoiding excessive calorie consumption as an important nutritional strategy for the prevention and management of chronic conditions and promotion of overall health.

A FOUR-YEAR CYCLE COMPARISON OF THE NUTRITIONAL AND CARDIOVASCULAR HEALTH STATUS OF AN ELITE-LEVEL FEMALE ARTISTIC GYMNAST: CASE STUDY REPORT FROM SLOVENIA

Regular monitoring of body composition, nutrition, health, and motor skills are crucial for further training process planning and performance progress. With the same protocol and methods, we evaluated a four-year change (2018 vs. 2022) in the nutritional and cardiovascular health status of the currently most successful elite-level adult female artistic gymnast in Slovenia. Detailed body composition and dietary intake were assessed using dual-energy X-ray absorptiometry and a standardized food questionnaire FFQ. The blood lipids and safety factors, blood pressure, and serum micronutrients (e.g., B12, 25-hydroxyvitamin D (25(OH)D), potassium, calcium, phosphorus, magnesium, and iron) status were measured. The four-year comparison showed an improved body composition status: decreased body fat mass/percentage, android fat percentage, and android/gynoid ratio, while other anthropometrical and body composition parameters remained essentially unchanged. We also measured an improvement of some and worsening of other cardiovascular health serum variables (i.e., decreased total cholesterol but increased low-density lipoprotein cholesterol and S-glucose), most likely due to the differences in assessed dietary intake (i.e., lower total fat, mono- and polyunsaturated fatty acid intake but higher cholesterol intake and still high free sugar and saturated fat intake, despite higher fiber). Notably, nutrient intakes that are generally of concern (fiber (borderline low intake), eicosapentaenoic omega-3 fatty acids and docosahexaenoic omega-3 fatty acids, vitamin B12 and D, calcium (borderline low intake), iron, and zinc) were within recommended ranges. However, the athlete’s vitamin E and potassium intakes were not adequate. Furthermore, in 2018, the athlete did not consume dietary supplements, while she now regularly uses several dietary supplements, including enriched plant-based protein powder, isolated vitamin B12, C, D, and iron. Moreover, the athlete had significantly lower than recommended serum levels of 25(OH)D, probably due to insufficient regular intake of vitamin D in the form of a dietary supplement (1000 IU/d). Moreover, from the micronutrient serum, phosphorus, and iron levels that deviated from the reference values in the 2018 study, in the current study, they were found to be within referenced ranges (i.e., iron status was markedly improved). This kind of screening toolbox, using valid, sensitive, and affordable methods and with rapid organizational implementation, may be a viable format for regular monitoring.

Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Severe Dyslipidemia Mimicking Familial Hypercholesterolemia Induced by High-Fat, Low-Carbohydrate Diets: A Critical Review

Emerging studies in the literature describe an association between high-fat, low-carbohydrate diets and severe hypercholesterolemia consistent with the levels observed in patients with (homozygous) familial hypercholesterolemia (FH). High levels of low-density lipoprotein cholesterol (LDL-C) may result from the reduced clearance of LDL particles from the circulation, the increased production of their precursor, or a combination of both. The increased intake of (saturated) fat and cholesterol, combined with limited to no intake of carbohydrates and fiber, are the main features of diets linked to hypercholesterolemia. However, several observations in previous studies, together with our observations from our lipid clinic, do not provide a definitive pathophysiological explanation for severe hypercholesterolemia. Therefore, we review these findings and possible pathophysiological explanations as well as opportunities for future research. Altogether, clinicians should rule out high-fat, low-carbohydrate diets as a possible cause for hypercholesterolemia in patients presenting with clinical FH in whom no mutation is found and discuss dietary modifications to durably reduce LDL-C levels and cardiovascular disease risk.

Fresh Beef and Lamb Consumption in Relation to Nutrient Intakes and Markers of Nutrition and Health Status among the Population Aged 5-90 Years in Ireland

The dietary role of meat is under scrutiny for health and environmental reasons, yet a growing body of evidence proposes that advice to limit red meat consumption is unnecessarily restrictive. The aim of this study was to investigate the role of 'fresh beef and lamb' in the diet of the population (5-90 years) in Ireland and its association with markers of nutrition and health status. Analyses are based on data from three nationally representative dietary surveys in the Republic of Ireland. Dietary intake data were estimated using food records, and nutrient intakes were estimated based on UK and Irish food composition tables. Biochemical samples were collected and analysed using standard procedures. 'Fresh beef and lamb' (defined as beef/lamb that had not undergone any preserving process other than chilling/freezing/quick-freezing) was consumed by 68-84% of the population and intakes ranged from 19 to 43 g/d across age groups. It made important contributions to intakes of protein, monounsaturated fat, vitamins D, B12, niacin, iron and zinc while also contributing relatively small proportions of total fat, saturated fat and salt. Higher consumption of 'fresh beef and lamb' was associated with higher intakes of protein, niacin, vitamins B6, B12, zinc and potassium (but also total fat) and lower intakes of carbohydrate and total sugars (but also dietary fibre). In adults, older adults and WCBA, higher consumption of 'fresh beef and lamb' was not associated with increased risk factors of cardio-metabolic diseases nor was it associated with better or poorer nutritional status for vitamins D, B12 or iron. This study adds to the evidence base on the contribution of 'fresh beef and lamb' in the diet and may be useful to policymakers updating guidance for healthy diets from sustainable food systems.

Protein Intake from Various Foods Sources Is Negatively Associated with Cardiometabolic Risk Markers in Italian Older Adults

OBJECTIVES

To examine the relationships between protein intake from various food sources and cardiometabolic risk markers in Italian older adults.

DESIGN

Cross-sectional study.

SETTING

Unconventional settings across Italy (e.g., exhibitions, health promotion campaigns).

PARTICIPANTS

People 65+ years who provided a written informed consent.

MEASUREMENTS

Blood pressure (BP), blood glucose, total blood cholesterol, and anthropometric indices were assessed. Daily protein intake was estimated for 12 food items listed in a food frequency questionnaire.

RESULTS

Three-thousand four-hundred twenty-four older adults (mean age: 72.7 ± 5.7 years; 55% women) were included in the study. Results of linear regression analysis indicated that protein intake from several food sources was negatively associated with BP, waist and hip circumferences, and waist-to-hip ratio in both sexes. Blood glucose levels were inversely associated with many protein sources in women. Positive associations were observed between some protein sources and total blood cholesterol in both men and women.

CONCLUSION

Our findings suggest that dietary protein is differentially associated with cardiometabolic risk factors depending on sex and food sources.

[Nutrition for diabetic patients (Update 2023)]

All patients with diabetes require individual and personalized nutritional consultation with professionals. The patient's needs should be the primary focus of the dietary therapy, taking their lifestyle and the type of diabetes into consideration. With the recommendations to the patient's diet, there need to be specific metabolic goals to reduce the disease's progression and to avoid long term health effects. Therefore, practical guidelines such as portion size and meal planning tips should be the main focus.According to the latest national and international standards, patients suffering from diabetes should have access to nutrition consulting and nutritional training. During consultation they can be supported on- how to manage their health condition and choosing food and beverage to improve their health.These practical recommendations sum up the latest literature on nutritional aspects of diabetes treatment.

Effect of Lean Red Meat from Beef (Pirenaica Breed) Versus Lean White Meat Consumption on Diet Quality: A Randomized-Controlled Crossover Study in Healthy Young Adults

A randomized crossover study was carried out in three University accommodation halls. Participants consumed either beef (Pirenaica breed) (PB) or conventional chicken (CC) three times per week for an 8-week periods with their usual diet, each one separated by a 5-week wash out period. Dietary variables were recollected by the Food Frequency Questionnaire (FFQ), and the Diet Quality Index (DQI) was calculated. Forty-seven healthy adults were included (19.9 ± 1.75 years). The inclusion of both types of diets did not modify the components of the DQI, such as the diversity, equilibrium, adequacy and excess. However, when only the first period was analyzed, a significant decrease in the consumption of fruits and vegetables was observed in those participants who received the PB diet (intervention group). The CC diet (control group) significantly reduced the consumption of fish and eggs, total DQI, and DQI quality component. The expected effect was observed in the significant increment of consumption of red meat after the intervention period.

Saturated fats, dairy foods and cardiovascular health: No longer a curious paradox?

Cardiovascular diseases (CVDs) are a major cause of death and morbidity in many parts of the world, and many dietary guidelines limit the intake of saturated fatty acids (SFA) as they are regarded as an important risk factor for CVDs due to their association with increased blood cholesterol. Dairy foods are often a major contributor to dietary intake of SFA, and since many dietary guidelines contain restrictions on SFA intake, this can lead to a moderation of dairy food intake despite meta-analyses generally showing dairy to have a neutral or negative association with CVDs. Many prospective studies and randomised controlled trials do not support a simple positive association between SFA intake and the risk of atherosclerotic CVD and its components although some early studies had a number of methodological weakness. Studies that included blood cholesterol data do broadly support the positive relationship between SFA and blood low-density lipoprotein cholesterol (LDL-C) but without increased CVD risk resulting, despite LDL being a causal factor in atherosclerotic CVD. These data suggest that LDL-C alone is not a consistently good predictor or cause of CVD risk, perhaps particularly in relation to dairy food consumption although some non-dairy food studies have also shown LDL-C reduction was not reflected in reduced CVD risk. This narrative review examines some reasons for these findings. Overall, restrictions on dairy food intake do not seem warranted, although there remains a need to further understand the association of different dairy food types with chronic diseases, perhaps particularly for type 2 diabetes.

The Interplay between Cardiovascular Disease, Exercise, and the Gut Microbiome

Cardiovascular disease (CVD) is the leading cause of death worldwide, with physical inactivity being a known contributor to the global rates of CVD incidence. The gut microbiota has been associated with many diseases including CVD and other comorbidities such at type 2 diabetes and obesity. Researchers have begun to examine the gut microbiome as a predictor of early disease states by detecting disruptions, or dysbiosis, in the microbiota. Evidence is lacking to investigate the potential link between the gut microbiota, exercise, and CVD risk and development. Research supports that diets with whole food have reduced instances of CVD and associated diseases, increased abundances of beneficial gut bacteria, and altered gut-derived metabolite production. Further, exercise and lifestyle changes to increase physical activity demonstrate improved health outcomes related to CVD risk and comorbidities and gut microbial diversity. It is difficult to study an outcome such as CVD when including multiple factors; however, it is evident that exercise, lifestyle, and the gut microbiota contribute to improved health in their own ways. This review will highlight current research findings and what potential treatments of CVD may be generated by manipulation of the gut microbiota and/or exercise.

Effect of the interaction between alcohol and meat consumption on the hyperlipidaemia risk among elderly individuals: Evidence from Shanghai, China

Background

Diet and other lifestyle habits may have an increased effect on blood lipids in older people. This study aimed to examine the associations between diet (meat, fish, and egg), alcohol consumption and blood lipids.

Methods

Surveillance data on chronic diseases and their risk factors were collected from Shanghai during 2017–2018. A Kish table was used for sampling 438 older adults, of whom 71 consumed alcohol. Logistic regression was used to test the relationships between diet, alcohol consumption and blood lipid levels in elderly individuals, and the marginal effects (MEs) were estimated.

Results

Dyslipidaemia was more common among drinkers than among nondrinkers (P < 0.01). Alcohol consumption was associated with dyslipidaemia (OR = 2.667, P < 0.01 for TC; OR = 1.919, P < 0.05 for LDL; OR = 3.412, P < 0.01 for TG), and consumption of more than 50 g of meat per day showed similar associations (OR = 3.227, P < 0.01 for TC; OR = 3.263, P < 0.01, for LDL; OR = 2.329, P < 0.01 for TG). The MEs of alcohol drinking and excessive meat consumption on the rate of dyslipidaemia were 0.324 for TC (P < 0.01), 0.255 for LDL (P < 0.05), and 0.174 for TG (P < 0.01).

Discussion

The risk of hyperlipidaemia was increased among elderly individuals with excessive meat and alcohol consumption, which also had an interactive effect.

What do Consumers Read About Meat? An Analysis of Media Representations of the Meat-environment Relationship Found in Popular Online News Sites in the UK

Previous scholarship suggests that elite media have tended to pay little attention to the adverse environmental impacts associated with meat consumption and production. Through content analysis of 116 articles from 2019, published on eight popular online news sites consumed by a wide range of demographics in the UK, including lower-income groups (the sector most likely to eat meat), we identify common anti-meat and pro-meat environmental narratives, solutions and recommendations, and the dominant sentiment towards both meat consumption and production. We observed a significantly greater presence of anti-meat consumption and/or production narratives than pro-meat. Over half the articles showed anti-meat consumption sentiment, with only 5% predominately in favour. 10% were against unspecified or industrial production practices, 28% were against industrial-scale farming but supported sustainable methods; and none were entirely in favour of the meat industry. These findings are reflected in the dominant recommendation, present in over 60% of articles, to eat less meat. Our results add substantially to previous media research, particularly showing the increased volume of coverage of the meat-environment nexus, varying levels of contestation around meat eating, and the division of responsibility between consumers and industry.

Red meat consumption and risk for dyslipidaemia and inflammation: A systematic review and meta-analysis

Aim

The study (PROSPERO: CRD42021240905) aims to reveal the relationships among red meat, serum lipids and inflammatory biomarkers.

Methods and results

PubMed, EMBASE and the Cochrane databases were explored through December 2021 to identify 574 studies about red meat and serum lipids markers including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP) or hypersensitive-CRP (hs-CRP). Finally, 20 randomized controlled trials (RCTs) involving 1001 people were included, red meat and serum lipid markers and their relevant information was extracted. The pooled standard mean difference (SMD) was obtained by applying a random-effects model, and subgroup analyses and meta-regression were employed to explain the heterogeneity. Compared with white meat or grain diets, the gross results showed that the consumption of red meat increased serum lipid concentrations like TG (0.29 mmol/L, 95% CI 0.14, 0.44,P<0.001), but did not significantly influence the TC (0.13 mmol/L, 95% CI −0.07, 0.33, P = 0.21), LDL-C (0.11 mmol/L, 95% CI −0.23, 0.45, P = 0.53), HDL-C (−0.07 mmol/L, 95% CI −0.31, 0.17, P = 0.57),CRP or hs-CRP (0.13 mmol/L, 95% CI −0.10, 0.37,P = 0.273).

Conclusion

Our study provided evidence to the fact that red meat consumption affected serum lipids levels like TG, but almost had no effect on TC, LDL-C, HDL-C and CRP or hs-CRP. Such diets with red meat should be taken seriously to avoid the problem of high lipid profiles.

Systematic review registration

[https://www.crd.york.ac.uk/PROSPERO], identifier [CRD42021240905].

Red and processed meat intakes and cardiovascular disease and type 2 diabetes mellitus: An umbrella systematic review and assessment of causal relations using Bradford Hill's criteria

Observational research suggests higher red and processed meat intakes predict greater risks of developing or dying from cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM), but this research limits causal inference. This systematic review of reviews utilizes both observational and experimental research findings to infer causality of these relations. Reviews from four databases were screened by two researchers. Reviews included unprocessed red meat (URM), processed meat (PM), or mixed URM + PM intake, and reported CVD or T2DM outcomes. Twenty-nine reviews were included, and causality was inferred using Bradford Hill's Criteria. Observational assessments of CVD outcomes and all meat types consistently reported weak associations while, T2DM outcomes and PM and Mixed URM + PM assessments consistently reported strong associations. Experimental assessments of Mixed URM + PM on CVD and T2DM risk factors were predominately not significant which lacked coherence with observational findings. For all meat types and outcomes, temporality and plausible mechanisms were established, but specificity and analogous relationships do not support causality. Evidence was insufficient for URM and T2DM. More experimental research is needed to strengthen these inferences. These results suggest that red and processed meat intakes are not likely causally related to CVD but there is potential for a causal relationship with T2DM.

Effect of the Intake of Lean Red-Meat from Beef-(Pirenaica Breed) versus Lean White-Meat on Body Composition, Fatty Acids Profile and Cardiovascular Risk Indicators: A Randomized Cross-Over Study in Healthy Young Adults

The main dietary guidelines recommended a restriction of total and saturated fat intake in the management of cardiovascular risk. These recommendations are overgeneralized, and all red meats should be limited and replaced by white meat. The aim is to assess the effect of the consumption of beef (from the Pirenaica breed) or chicken-based diets on body composition, fatty acid profile and cardiovascular (CV) risk indicators in healthy adults. A randomized cross-over study was carried out in three University accommodation halls. Participants consumed either the Pirenaica breed beef or chicken three times per week for 8-week periods with their usual diet. Body composition, clinical, biochemical and dietary variables were evaluated at baseline and at the end of each period. A validated diet questionnaire was used to assess nutrient intake and monitor compliance. Intervention and control group comparisons were done with the general linear regression model for repeated measures. Forty-seven healthy adults were included (51.6% males, mean age 19.9 ± 1.75 years). No significant differences were found in body composition, fatty acid profile or CV risk indicators from baseline in either diet group. Consumption of lean red meat (Pirenaica breed) or lean white meat (chicken) as part of the usual diet is associated with a similar response. Clinical Trial Registration: NCT 04832217 (accessed on 6 September 2022).

State-of-the-Art Review: Evidence on Red Meat Consumption and Hypertension Outcomes

Hypertension (HTN) is a well-established risk factor for cardiovascular diseases (CVDs), including ischemic heart disease, stroke, heart failure, and atrial fibrillation. The prevalence of HTN, as well as mortality rates attributable to HTN, continue to increase, particularly in the United States and among Black populations. The risk of HTN involves a complex interaction of genetics and modifiable risk factors, including dietary patterns. In this regard, there is accumulating evidence that links dietary intake of red meat with a higher risk of poorly controlled blood pressure and HTN. However, research on this topic contains significant methodological limitations, which are described in the review. The report provided below also summarizes the available research reports, with an emphasis on processed red meat consumption and how different dietary patterns among certain populations may contribute to HTN-related health disparities. Finally, this review outlines potential mechanisms and provides recommendations for providers to counsel patients with evidence-based nutritional approaches regarding red meat and the risk of HTN, as well as CVD morbidity and mortality.

Nutritional Risk Factors Associated with Vasomotor Symptoms in Women Aged 40-65 Years

Vasomotor symptoms (VMS) are the most common symptoms among menopausal women; these include hot flashes and night sweats, and palpitations often occur along with hot flashes. Some studies in Mexico reported that around 50% of women presented with VMS mainly in the menopausal transition. It has been proven that VMS are not only triggered by an estrogen deficiency, but also by nutritional risk factors. Evidence of an association between nutritional risk factors and VMS is limited in Mexican women. The aim of this study is to identify nutritional risk factors associated with VMS in women aged 40−65 years. This is a comparative cross-sectional study, undertaken in a retrospective way. A sample group (n = 406 women) was divided into four stages according to STRAW+10 (Stages of Reproductive Aging Workshop): late reproductive, menopausal transition, early postmenopause, and late postmenopause. Hot flashes were present mainly in the early postmenopause stage (38.1%, p ≤ 0.001). Two or more VMS were reported in 23.2% of women in the menopausal transition stage and 29.3% in the early postmenopause stage (p < 0.001). The presence of VMS was associated with different nutritional risk factors (weight, fasting glucose levels, cardiorespiratory fitness, and tobacco use) in women living in the northeast of Mexico.

Controversial Dietary Patterns: A High Yield Primer for Clinicians

In cardiology clinic visits, the discussion of optimal dietary patterns for prevention and management of cardiovascular disease is usually very limited. Herein, we explore the benefits and risks of various dietary patterns, including intermittent fasting, low carbohydrate, Paleolithic, whole food plant-based diet, and Mediterranean dietary patterns within the context of cardiovascular disease to empower clinicians with the evidence and information they need to maximally benefit their patients.

One person's meat is another's poison: representations of the meat-health nexus in UK news media

Mainstream media play a central role in shaping the ways diet and nutrition are discussed in the public sphere, yet few studies have explored its depictions of the meat-health nexus. Focusing on eight of the most popular news online sites consumed by lower-income groups in the UK-the demographic most likely to eat meat, according to a survey conducted for this study-we carried out content analysis of 128 articles. We found, first, a multiplicity of pro- and anti-meat narratives across all news outlets; second, that the dominant recommendation, found in 40% of our sample, was to eat less or no red meat; and third, that a balanced or neutral sentiment was present in over half of our sample, with a ratio of 3:2 (anti-versus pro-meat) in remaining articles. We found that the editorial leaning of a news outlet was not closely correlated with its overall sentiment towards meat consumption; all were neutral or slightly anti-meat, with the exception of LAD Bible, the only clearly pro-meat outlet. Qualitative analysis uncovered three key themes: the risk of red meat on colorectal cancer, uncertainty around plant-based options, and individual dietary choice. We use case studies guided by these themes to highlight some of the shortcomings of health communication and provide recommendations, with a focus on improved dialogue between journalists and researchers.