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Demark-Wahnefried W, Oster RA, Smith KP, Kaur H, Frugé AD, Cole WW, Locher JL, Rocque GB, Pisu M, Bail JR, Cohen HJ, Moellering DR, Blair CK. Vegetable Gardening and Health Outcomes in Older Cancer Survivors: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2417122. [PMID: 38900426 PMCID: PMC11190797 DOI: 10.1001/jamanetworkopen.2024.17122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/16/2024] [Indexed: 06/21/2024] Open
Abstract
Importance Cancer survivors experience accelerated functional decline that threatens independence and quality of life. Previous studies have suggested that vegetable gardening may improve diet, physical activity, and physical function in this vulnerable population, which comprises more than 5% of the US population. Objective To assess whether diet, physical activity and functioning, and other outcomes improved in older cancer survivors assigned to a vegetable gardening intervention compared with a waitlist. Design, Setting, and Participants From May 11, 2016, to May 2, 2022, a 2-arm, assessor-blinded, crossover-designed, intent-to-treat, randomized clinical trial was conducted at cancer survivors' homes across Alabama. Medicare-eligible survivors of cancers with 5-year survival of 60% or more were registry ascertained and screened for suboptimal vegetable and fruit consumption (<5 servings per day), physical activity (<150 moderate-to-vigorous minutes per week), and physical function (36-Item Short Form Health Survey [SF-36] subscale score ≤90). Consented participants underwent baseline assessments, were randomly assigned to intervention or waitlisted arms, and were reassessed at 1-year follow-up. Intervention One-year, home-based vegetable gardening intervention providing gardening supplies and mentorship by cooperative extension-certified master gardeners to plant and maintain spring, summer, and fall gardens. Waitlisted participants received the identical intervention after 12 months. Main Outcomes and Measures The main outcome was a composite index of improvements in self-reported vegetable and fruit consumption, physical activity, and physical function corroborated by plasma α-carotene levels, accelerometry, and physical performance assessments, respectively. Results Of 381 enrolled participants (mean [SD] age, 69.8 [6.4] years; range, 50-95 years; 263 [69.0%] female), 194 were assigned to the gardening intervention and 187 were waitlisted (attrition rates, 7.2% and 7.0%, respectively). Intent-to-treat analyses did not detect a significant improvement in the composite index of vegetable and fruit intake, moderate-vigorous physical activity, and physical function (intervention arm vs waitlisted arm, 4.5% vs 3.1%; P = .53) or between-arm differences in vegetable and fruit intake (mean difference, 0.3 [95% CI, -0.1 to 0.7] servings per day; P = .10). The intervention arm experienced a significant improvement in vegetable and fruit intake (mean increase, 0.3 [95% CI, 0.0-0.6] servings per day; P = .04). Significant improvements also were observed in the intervention arm vs waitlisted arm in physical performance (mean difference for 2-minute step test, 6.0 [95% CI, 0.8-11.2] steps; P = .03; for 30-second chair stand, 0.8 [95% CI, 0.1-1.5] repetitions; P = .02), perceived health (8.4 [95% CI, 3.0-13.9] points on a 100-point scale [higher scores indicate better health]; P = .003), and gut microbiome alpha diversity (84.1 [95% CI, 20.5-147.6] more observed species; P = .01). The COVID-19 pandemic significantly moderated effects (eg, odds of improvement in self-reported physical functioning were greater before vs during the pandemic: odds ratio, 2.17; 95% CI, 1.12-4.22; P = .02). Conclusions and Relevance In this randomized clinical trial including older cancer survivors, a vegetable gardening intervention did not significantly improve a composite index of diet, physical activity, and physical function; however, survivors assigned to the intervention had significantly increased vegetable and fruit consumption and, compared with waitlisted survivors, experienced significant improvements in perceived health and physical performance. Further study in broader populations and during pandemic-free periods is needed to determine definitive benefits. Trial Registration ClinicalTrials.gov Identifier: NCT02985411.
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Affiliation(s)
| | | | - Kerry P. Smith
- Alabama Cooperative Extension System, Auburn University, Auburn
| | - Harleen Kaur
- Department of Nutrition Sciences, University of Alabama at Birmingham
| | | | - W. Walker Cole
- Department of Health Behavior, University of Alabama at Birmingham
| | | | | | - Maria Pisu
- Department of Medicine, University of Alabama at Birmingham
| | | | - Harvey Jay Cohen
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque
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Zhang C, Li K, Xu SN, Zhang JK, Ma MH, Liu Y. Higher serum carotenoid concentrations were associated with the lower risk of cancer-related death: Evidence from the National Health and Nutrition Examination Survey. Nutr Res 2024; 126:88-98. [PMID: 38642420 DOI: 10.1016/j.nutres.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024]
Abstract
The study focuses on the association between serum carotenoids and cancer-related death. Using data from the National Health and Nutrition Examination Survey (2001-2006 and 2017-2018), the study encompasses 10,277 participants older than age 20 years, with recorded baseline characteristics and serum carotenoid concentrations (including α-carotene, trans-β-carotene, cis-β-carotene, β-cryptoxanthin, trans-lycopene, and lutein/zeaxanthin). We hypothesized that serum carotenoid concentrations were negatively associated with cancer-related death. The weighted chi-square analyses indicate significant negative correlations between higher serum concentrations of α-carotene, β-cryptoxanthin, trans-lycopene, and total carotenoids, and the risk of cancer-related deaths. Using weighted Cox regression analysis, this study confirms that α-carotene, β-cryptoxanthin, trans-lycopene, and total carotenoids, as continuous or categorical variables, are inversely related to cancer mortality (P < .0001). Furthermore, considering competitive risk events, lower concentrations of serum β-cryptoxanthin (Fine-Gray P = 1.12e-04), trans-lycopene (P = 5.68e-14), and total carotenoids (P = .03) are associated with an increased risk of cancer-related deaths. The research reveals a crucial inverse relationship between serum carotenoid concentrations and cancer-related death.
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Affiliation(s)
- Cheng Zhang
- Department of Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, PR China
| | - Ke Li
- Department of Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, PR China
| | - Shu-Ning Xu
- Department of Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, PR China
| | - Jia-Kui Zhang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, PR China
| | - Ming-Hui Ma
- Department of Gastrointestinal Surgery, Maoming People's Hospital, Maoming 525000, PR China
| | - Ying Liu
- Department of Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, PR China.
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Okekunle AP, Asowata OJ, Akpa OM, Fakunle AG, Bodunde I, Komolafe M, Arulogun O, Sarfo FS, Obiako R, Osaigbovo G, Ogbole G, Bello A, Adeniyi S, Calys-Tagoe B, Appiah L, Jenkins C, Oyinloye O, Dambatta H, Balogun O, Singh A, Olalere A, Mensah Y, Ogah OS, Ibinaiye P, Adebayo O, Adebajo O, Adebayo P, Chukwuonye I, Akinyemi R, Ovbiagele B, Owolabi M. Dietary patterns associated with hypertension among stroke-free indigenous Africans: insights from the Stroke Investigative Research and Educational Network study. J Hypertens 2024; 42:620-628. [PMID: 38230616 PMCID: PMC11126300 DOI: 10.1097/hjh.0000000000003662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND The dietary factors associated with the high burden of hypertension among indigenous Africans remain poorly understood. We assessed the relationship between dietary patterns and hypertension among indigenous Africans. METHOD In this study, 1550 participants with hypertension matched (for age: ± 5 years, sex and ethnicity) with 1550 participants without hypertension were identified from the stroke-free population in the Stroke Investigative Research and Educational Network study in Ghana and Nigeria. Food consumption was assessed using a food frequency questionnaire, and dietary information was summarized using principal component analysis to identify seven dietary patterns. Conditional logistic regression was applied to compute the odds ratio (OR) and 95% confidence interval (CI) for the risk of hypertension by tertiles of dietary patterns adjusting for age, education, income, smoking, alcohol use, physical inactivity, family history of cardiovascular diseases, obesity and salt intake at a two-sided P less than 0.05. RESULTS Multivariable-adjusted OR [95% confidence interval (CI)] for risk of hypertension by second and third tertiles [using the lowest (first) tertile as reference] of dietary patterns were 0.62 (0.48-0.80), 0.70 (0.54-0.90) for whole grains and fruit drinks; 0.87 (0.68-1.12), 0.83 (0.64-1.08) for fruits; 0.85 (0.65-1.10), 0.97 (0.75-1.26) for vegetables, legumes and potatoes; 0.78 (0.60-1.00), 0.84 (0.65-1.08) for fried foods and sweetened drinks; 1.13 (0.88-1.45), 0.80 (0.62-1.03) for poultry product and organ meat; 1.11 (0.86-1.43), 0.88 (0.68-1.14) for red meat; and 1.14 (0.88-1.48), 1.09 (0.84-1.43) for processed foods ( P < 0.05). CONCLUSION A higher adherence to dietary consumption of whole grains and fruits was inversely associated with low odds of hypertension in this population.
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Affiliation(s)
- Akinkunmi Paul Okekunle
- Department of Medicine, University of Ibadan, Nigeria
- Department of Food and Nutrition, Seoul National University, Koreay
| | | | - Onoja Matthew Akpa
- Department of Epidemiology and Medical Statistics
- Institute of Cardiovascular Diseases, University of Ibadan
| | - Adekunle Gregory Fakunle
- Department of Medicine, University of Ibadan, Nigeria
- Department of Public Health, Osun State University, Osogbo, Osun State
| | | | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, University of Ibadan, Nigeria
| | - Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Ghana
| | | | | | - Godwin Ogbole
- Department of Radiology, College of Medicine, University of Ibadan
| | - Abiodun Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Sunday Adeniyi
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Benedict Calys-Tagoe
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Ghana
| | - Lambert Appiah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Olalekan Oyinloye
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife
| | | | | | - Arti Singh
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | - Yaw Mensah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Ghana
| | | | | | | | | | | | | | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training College of Medicine
- Center for Genomic and Precision Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, University of California San Francisco, USA
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Nigeria
- Center for Genomic and Precision Medicine, University of Ibadan, Nigeria
- Lebanese American University of Beirut, Lebanon
- Blossom Specialist Medican Centre, Ibadan, Nigeria
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Zheng G, Ran S, Zhang J, Qian AM, Hua J, Wang C, Vaughn MG, Tabet M, Lin H. Fresh fruit, dried fruit, raw vegetables, and cooked vegetables consumption associated with progression trajectory of type 2 diabetes: a multi-state analysis of a prospective cohort. Eur J Nutr 2024:10.1007/s00394-024-03362-6. [PMID: 38520525 DOI: 10.1007/s00394-024-03362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To examine the effects of fresh fruit, dried fruit, raw vegetables, and cooked vegetables on type 2 diabetes (T2D) progression trajectory. METHODS We included 429,886 participants in the UK Biobank who were free of diabetes and diabetes complications at baseline. Food groups were determined using a validated food frequency questionnaire. Outcomes were T2D incidence, complications, and mortality. Multi-state model was used to analyze the effects of food groups on T2D progression. RESULTS During a follow-up of 12.6 years, 10,333 incident T2D cases were identified, of whom, 3961 (38.3%) developed T2D complications and 1169 (29.5%) died. We found that impacts of four food groups on T2D progression varied depending on disease stage. For example, compared to participants who ate less than one piece of dried fruit per day, the hazard ratios and 95% confidence intervals for those who ate ≥ 2 pieces of dried fruit per day were 0.82 (0.77, 0.87), 0.88 (0.85, 0.92), and 0.86 (0.78, 0.95) for transitions from diabetes-free state to incident T2D, from diabetes-free state to total death, and from incident T2D to T2D complications, respectively. Higher intake of fresh fruit was significantly associated with lower risk of disease progression from diabetes-free state to all-cause death. Higher intake of raw and cooked vegetables was significantly associated with lower risks of disease progression from diabetes-free state to incident T2D and to total death. CONCLUSIONS These findings indicate that higher intake of fresh fruit, dried fruit, raw vegetables, and cooked vegetables could be beneficial for primary and secondary prevention of T2D.
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Affiliation(s)
- Guzhengyue Zheng
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong, 510080, P. R. China
| | - Shanshan Ran
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong, 510080, P. R. China
| | - Jingyi Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong, 510080, P. R. China
| | - Aaron M Qian
- Department of Psychology, College of Arts and Sciences, Saint Louis University, United States of America, Tegeler Hall, 3700 Lindell Boulevard, Saint Louis, MO, 63103, USA
| | - Junjie Hua
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong, 510080, P. R. China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, P. R. China
| | - Michael G Vaughn
- School of Social Work, Saint Louis University, Tegeler Hall, 3550 Lindell Boulevard, Saint Louis, MO, 63103, USA
| | - Maya Tabet
- College of Global Population Health, University of Health Sciences and Pharmacy in Saint Louis, United States of America, 1 Pharmacy Place, Saint Louis, MO, 63110, USA
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, 2nd Yat-sen Road, Yuexiu District, Guangzhou, Guangdong, 510080, P. R. China.
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Ghorbani Z, Noormohammadi M, Kazemi A, Poustchi H, Pourshams A, Martami F, Hashemian M, Malekzadeh R, Hekmatdoost A. Higher intakes of fiber, total vegetables, and fruits may attenuate the risk of all-cause and cause-specific mortality: findings from a large prospective cohort study. Nutr J 2023; 22:60. [PMID: 37978495 PMCID: PMC10655472 DOI: 10.1186/s12937-023-00883-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Although studies have reported an inverse association between fruits, vegetables, and fiber consumption and all-cause and cause-specific mortality, the issue remains incompletely defined in the Middle Eastern population. AIMS The current study aimed to investigate the association between dietary fiber, fruit, and vegetable intake and all-cause and cause-specific mortality. METHODS A total of 48632 participants (mean age = 52years), 57.5% (n = 27974) women and 42.5% (n = 20658) men, were recruited from an ongoing large-scale prospective cohort study (the Golestan Cohort Study (GCS)), in the north of Iran. Using a validated semi-quantitative 116-item food questionnaire, dietary intakes were collected. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) of all-cause and cause-specific mortality were reported. RESULTS After approximately 14 years of follow-up, 10,774 deaths were recorded. In the fully adjusted model, compared to those in the lowest quintile of intake, those in the second and third quintiles of dietary fiber intake had a 7%-10% reduction in risk of all-cause mortality, and a 15%-17% reduction in the risk of mortality from other causes. Increasing consumption of fruits was also associated with a decreased risk of mortality for all-cause mortality by 9%-11%, and all cancer by 15-20%. Further, those in the third and fourth quintiles of vegetables intake had 11%-12% lower risk for CVD mortality. DISCUSSION The results from the GCS further support the current recommendations on following a healthy diet containing proper amounts of fiber, vegetables, and fruits, as health-protective dietary items. CONCLUSIONS Higher intake of dietary fiber, fruits, and vegetables has the potential to reduce both overall and cause-specific mortality rates. However, additional cohort studies with larger sample size and long-term follow-up durations are required to establish these findings.
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Affiliation(s)
- Zeinab Ghorbani
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Nutrition, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Morvarid Noormohammadi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Asma Kazemi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Poustchi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Martami
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azita Hekmatdoost
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Feng Q, Grant AJ, Yang Q, Burgess S, Bešević J, Conroy M, Omiyale W, Sun Y, Allen N, Lacey B. Genetically Predicted Vegetable Intake and Cardiovascular Diseases and Risk Factors: An Investigation with Mendelian Randomization. Nutrients 2023; 15:3682. [PMID: 37686714 PMCID: PMC10490460 DOI: 10.3390/nu15173682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The associations between vegetable intake and cardiovascular diseases have been demonstrated in observational studies, but less sufficiently in randomized trials. Mendelian randomization has been considered a promising alternative in causal inference. The separate effects of cooked and raw vegetable intake remain unclear. This study aimed to investigate the associations between cooked and raw vegetable intake with cardiovascular outcomes using MR. METHODS We identified 15 and 28 genetic variants statistically and biologically associated with cooked and raw vegetable intake, respectively, from previous genome-wide association studies, which were used as instrumental variables to estimate associations with coronary heart disease (CHD), stroke, heart failure (HF), and atrial fibrillation (AF). The independent effects of genetically predicted cooked and raw vegetable intake were examined using multivariable MR analysis. We performed one-sample and two-sample MR analyses and combined their results using meta-analysis. Bonferroni correction was applied for multiple comparisons. We performed two-sample MR analysis for cardiometabolic risk factors (serum lipids, blood pressure, body mass index, and glycemic traits) to explore the potential mechanisms. RESULTS In the MR meta-analysis of 1.2 million participants, we found null evidence for associations between genetically predicted cooked and raw vegetable intake with CHD, HF, or AF. Raw vegetable intake was nominally associated with stroke (odds ratio [95% confidence interval] 0.82 [0.69-0.98] per 1 daily serving increase, p = 0.03), but this association did not pass the corrected significance level. We found consistently null evidence for associations with serum lipids, blood pressure, body mass index, or glycemic traits. CONCLUSIONS We found null evidence for associations between genetically predicted vegetable intake with CHD, AF, HF, or cardiometabolic risk factors in this MR study. Raw vegetable intake may reduce risk of stroke, but this warrants more research. True associations between vegetable intake and CVDs cannot be completely ruled out, and future investigations are required for causal inference in nutritional research.
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Affiliation(s)
- Qi Feng
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Andrew J. Grant
- MRC Biostatistics Unit, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Qian Yang
- MRC Integrative Epidemiology, University of Bristol, Bristol BS1 3NY, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS1 3NY, UK
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Jelena Bešević
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Megan Conroy
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Wemimo Omiyale
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Yangbo Sun
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Naomi Allen
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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Huang J, He Z, Xu M, Du J, Zhao YT. Socioeconomic status may affect association of vegetable intake with risk of ischemic cardio-cerebral vascular disease: a Mendelian randomization study. Front Nutr 2023; 10:1161175. [PMID: 37599701 PMCID: PMC10436213 DOI: 10.3389/fnut.2023.1161175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/23/2023] [Indexed: 08/22/2023] Open
Abstract
Background Previous studies found that increasing vegetable intake benefits are reduced after adjustment for socioeconomic factors. Using genetic variation as an instrumental variable for vegetable intake and socioeconomic status, we investigated the relationship between vegetable intake and ischemic cardio-cerebral vascular diseases and focused on whether socioeconomic status was a possible confounder. Methods From three independent genome-wide association studies, we extracted instrumental variables reflecting raw and cooked vegetable intake, which were used to perform Mendelian randomization analysis. To evaluate the effects of socioeconomic factors on vegetable intake, univariate and multivariate Mendelian randomization analyses were performed using single nucleotide polymorphisms representing education attainment and household income reported in the literature. We also performed outlier assessment and a series of sensitivity analyses to confirm the results. Results Genetically predicted raw and cooked vegetable intake were not associated with any ischemic cardio-cerebral vascular diseases and lipid components after Bonferroni correction. Univariate Mendelian randomized analysis revealed that raw vegetable intake was positively correlated with education attainment (β = 0.04, p = 0.029) and household income (β = 0.07, p < 0.001). Multivariate Mendelian randomized model showed a positive correlation between household income and raw vegetable intake (β = 0.06, p = 0.004). Socioeconomic status was closely associated with eating habits and lifestyle related to the risk of cardiovascular diseases. Conclusion Genetically determined raw and cooked vegetable intake was not associated with significant benefits in terms of ischemic cardio-cerebral vascular diseases while genetically determined socioeconomic status may have an impact on vegetable intake. Socioeconomic status, which was closely associated with other eating habits and lifestyle, may affect the association between vegetable intake and ischemic cardio-cerebral vascular diseases.
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Affiliation(s)
- Jiutian Huang
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Ziyi He
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Minhui Xu
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Jianing Du
- Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yun-tao Zhao
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
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Luetic S, Knezovic Z, Jurcic K, Majic Z, Tripkovic K, Sutlovic D. Leafy Vegetable Nitrite and Nitrate Content: Potential Health Effects. Foods 2023; 12:foods12081655. [PMID: 37107450 PMCID: PMC10137473 DOI: 10.3390/foods12081655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
The aim of this research was to determine the concentrations of nitrates and nitrites in different types of vegetables that are commonly represented in the diet of the inhabitants of Split and Dalmatian County. Therefore, using the method of random selection, there were 96 samples of different vegetables. The determination of the nitrate and nitrite concentrations was carried out by high-pressure liquid chromatography (HPLC) with a diode array detector (DAD). The nitrate concentrations in the range 2.1-4526.3 mg kg-1 were found in 92.7% of the analyzed samples. The highest nitrate values were found in rucola (Eruca sativa L.) followed by Swiss chard (Beta vulgaris L.). In 36.5% of the leafy vegetables intended for consumption without prior heat treatment, nitrite was found in the range of 3.3-537.9 mg kg-1. The high levels of nitrite in the vegetables intended for fresh consumption and the high nitrate values in Swiss chard indicate the need to establish maximum nitrite limits in vegetables, as well as the broadening of legal nitrate limits to wide varieties of vegetables.
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Affiliation(s)
- Sanja Luetic
- Teaching Institute for Public Health, Split-Dalmatia County, 21000 Split, Croatia
| | - Zlatka Knezovic
- Teaching Institute for Public Health, Split-Dalmatia County, 21000 Split, Croatia
- Department of Health Studies, University of Split, 21000 Split, Croatia
| | - Katarina Jurcic
- Teaching Institute for Public Health, Split-Dalmatia County, 21000 Split, Croatia
| | - Zrinka Majic
- Teaching Institute for Public Health, Split-Dalmatia County, 21000 Split, Croatia
| | - Ksenija Tripkovic
- Teaching Institute for Public Health, Split-Dalmatia County, 21000 Split, Croatia
| | - Davorka Sutlovic
- Department of Health Studies, University of Split, 21000 Split, Croatia
- Department of Toxicology and Pharmacogenetics, School of Medicine, University of Split, 21000 Split, Croatia
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Sun T, Zhang Y, Ding L, Zhang Y, Li T, Li Q. The Relationship Between Major Food Sources of Fructose and Cardiovascular Outcomes: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Adv Nutr 2023; 14:256-269. [PMID: 36803836 DOI: 10.1016/j.advnut.2022.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
There is emerging evidence of associations between intake of sugar-sweetened beverages (SSBs), those that include various forms of added sugar, and increased risk of cardiovascular disease (CVD) but whether consumption of other dietary sources of fructose affects CVD is unclear. In this study, we conducted a meta-analysis to examine potential dose-response relationships between such foods and CVD, coronary heart disease (CHD), and stroke morbidity and mortality. We systematically searched the literature indexed in PubMed, Embase, and the Cochrane Library from the inception of each database to February 10, 2022. We included prospective cohort studies analyzing the association between at least 1 dietary source of fructose and CVD, CHD, and stroke. Based on data from 64 included studies, summary HRs and 95% CIs were calculated for the highest intake category compared with the lowest, and dose-response analyses were performed. Of all fructose sources examined, only SSB intakes showed positive associations with CVD, giving summary HRs per 250 mL/d increase of 1.10 (95% CI: 1.02, 1.17) for CVD, 1.11 (95% CI: 1.05, 1.17) for CHD, 1.08 (95% CI: 1.02, 1.13) for stroke morbidity, and 1.06 (95% CI: 1.02, 1.10) for CVD mortality. Conversely, 3 dietary sources showed protective associations: between fruits and CVD morbidity (HR: 0.97; 95% CI: 0.96, 0.98), fruits and CVD mortality (HR: 0.94; 95% CI: 0.92, 0.97), yogurt and CVD mortality (HR: 0.96; 95% CI: 0.93, 0.99), and breakfast cereals and CVD mortality (HR: 0.80; 95% CI: 0.70, 0.90). All these relationships were linear except for fruit, which was J-shaped: CVD morbidity was the lowest at 200 g/d and there was no protective association above 400 g/d. These findings indicate that the adverse associations between SSBs and CVD, CHD, and stroke morbidity and mortality do not extend to other dietary sources of fructose. The food matrix seemed to modify the association between fructose and cardiovascular outcomes.
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Affiliation(s)
- Tingting Sun
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yabing Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Ding
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yonggang Zhang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Mitochondria and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
| | - Qian Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
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Aekplakorn W, Neelapaichit N, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Sangwatanaroj S, Laohavinij W, Nonthaluck J. Ideal cardiovascular health and all-cause or cardiovascular mortality in a longitudinal study of the Thai National Health Examination Survey IV and V. Sci Rep 2023; 13:2781. [PMID: 36797348 PMCID: PMC9935621 DOI: 10.1038/s41598-023-29959-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
The relationship of ideal cardiovascular health (CVH) and health outcomes has been rarely assessed in middle-income countries. We determined the ideal CVH metrics and association with all-cause and cardiovascular (CVD) mortality in the Thai population. We used baseline data from two rounds of the National Health Examination survey (15,219 participants in 2009 and 14,499 in 2014), and assessed all-cause and CVD deaths until 2020. The prevalence of 5-7 ideal CVH metrics in 2009 was 10.4% versus 9.5% in 2014. During a median follow-up of 7.1 years, the all-cause and CVD mortality rates were 19.4 and 4.6 per 1000 person-years for 0-1 ideal CVH metrics, and 13.0 and 2.1, 9.6 and 1.5, 6.0 and 1.0, and 2.9 and 0.4 per 1000 person-years for 2, 3, 4, and 5-7 ideal CVH metrics, respectively. Participants with 2, 3, 4, or 5-7 ideal metrics had a significantly lower risk of mortality than those with 0-1 ideal CVH metrics (adjusted hazard ratios: 0.75, 0.70, 0.60, and 0.47 for all-cause, and 0.54, 0.52, 0.50, and 0.31 for CVD, respectively). Individuals with a higher number of the modified ideal CVH metrics have a lower risk of all-cause and CVD mortality.
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Affiliation(s)
- Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Rd., Ratchathewi, Bangkok, Thailand.
| | - Nareemarn Neelapaichit
- grid.10223.320000 0004 1937 0490Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwat Chariyalertsak
- grid.7132.70000 0000 9039 7662Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | - Pattapong Kessomboon
- grid.9786.00000 0004 0470 0856Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sawitri Assanangkornchai
- grid.7130.50000 0004 0470 1162Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Surasak Taneepanichskul
- grid.7922.e0000 0001 0244 7875College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Somkiat Sangwatanaroj
- grid.7922.e0000 0001 0244 7875Department of Internal Medicine, Faculty of Medicine Chulalongkorn Hospital, Chulalongkorn University, Rama VI Rd., Pathumwan, Bangkok, Thailand
| | - Wasin Laohavinij
- grid.7922.e0000 0001 0244 7875Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jiraluck Nonthaluck
- grid.10223.320000 0004 1937 0490Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
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11
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Akpa OM, Okekunle AP, Asowata OJ, Chikowore T, Mohamed SF, Sarfo F, Akinyemi R, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Ogbole G, Tiwari HK, Akinyemi J, Fakunle A, Uvere E, Adeoye AM, Lackland D, Arnett DK, Ovbiagele B, Ramsay M, Owolabi M. Frequent vegetable consumption is inversely associated with hypertension among indigenous Africans. Eur J Prev Cardiol 2022; 29:2359-2371. [PMID: 36098047 PMCID: PMC9977189 DOI: 10.1093/eurjpc/zwac208] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/29/2022] [Accepted: 09/09/2022] [Indexed: 01/30/2023]
Abstract
AIMS The relationship between vegetable consumption and hypertension occurrence remains poorly characterized in sub-Saharan Africa. This study assessed the association of vegetable consumption with odds of hypertension among indigenous Africans. METHODS AND RESULTS We harmonized data on prior vegetable consumption and hypertension occurrence (defined as one of the following conditions; systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg or previous diagnosis or use of antihypertensive medications) from 16 445 participants across five African countries (Nigeria, South Africa, Kenya, Ghana and Burkina Faso) in the Stroke Investigative Research and Educational Network and Africa Wits-INDEPTH partnership for Genomic studies. Vegetable consumption (in servings/week) was classified as 'low' (<6). 'moderate' (6-11), 'sufficient' (12-29), and 'high' (≥30). Odds ratios (ORs) and 95% confidence interval (CI) of hypertension were estimated by categories of vegetable consumption (using 'low' consumption as reference), adjusting for sex, age in years, family history of cardiovascular diseases, education, smoking, alcohol use, physical inactivity, body mass index, diabetes mellitus and dyslipidaemia using logistic regressions at P < 0.05. The mean age of participants was 53.0 ( ± 10.7) years, and 7552 (45.9%) were males, whereas 7070 (42.9%) had hypertension. In addition, 6672(40.6%) participants had 'low' vegetable consumption, and 1758(10.7%) had 'high' vegetable consumption. Multivariable-adjusted OR for hypertension by distribution of vegetable consumption (using 'low' consumption as reference) were 1.03 (95% CI: 0.95, 1.12) for 'moderate' consumption; 0.80 (0.73, 0.88) for 'sufficient', and 0.81 (0.72, 0.92) for 'high' consumption, P-for-trend <0.0001. CONCLUSION Indigenous Africans who consumed at least 12 servings of vegetables per week were less likely to be found hypertensive, particularly among males and young adults.
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Affiliation(s)
- Onoja Matthew Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
| | - Akinkunmi Paul Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
- Department of Food and Nutrition, Seoul National University, 08826, Seoul, Korea
| | - Osahon Jeffery Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
| | - Tinashe Chikowore
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2000, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2000, South Africa
| | - Shukri F. Mohamed
- Health and Well-Being Program, African Population and Health Research Center, 00100, Nairobi, Kenya
| | - Fred Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, 00000, Kumasi, Ghana
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, P.O. Box LG 1181, Legon, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin, 240003, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, 810107, Zaria, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, 700233, Kano, Nigeria
| | - Godwin O. Osaigbovo
- Department of Internal Medicine, Jos University Teaching Hospital Jos, 930241, Jos, Nigeria
| | - Godwin Ogbole
- Department of Radiology, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
| | - Hemant K. Tiwari
- Department of Biostatistics, School of Public Health, the University of Alabama at Birmingham, Birmingham, 35233 AL, USA
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
| | - Adekunle Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
- Department of Public Health, College of Health Sciences, Osun State University, 210001, Osogbo, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
| | - Abiodun M. Adeoye
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
| | - Daniel Lackland
- Department of Neurology, Medical University of South Carolina, Charleston, 29425 SC, USA
| | - Donna K. Arnett
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, 40536 KY, USA
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, San-Francisco, 94143 CA, USA
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2000, South Africa
- Division of Human Genetics, National Health Laboratory Service, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2000, South Africa
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
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12
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Exposure to (Poly)phenol Metabolites after a Fruit and Vegetable Supplement Intake: A Double-Blind, Cross-Over, Randomized Trial. Nutrients 2022; 14:nu14224913. [PMID: 36432599 PMCID: PMC9692523 DOI: 10.3390/nu14224913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Dietary (poly)phenol intake derived from the daily consumption of five portions of fruits and vegetables could protect against the development of non-communicable diseases. However, the general population does not meet the recommended intake. Supplementation with (poly)phenol-rich ingredients, within a varied and balanced diet, could help in filling this nutritional gap. This study aimed to validate the proof-of-concept of a (poly)phenolic supplementation developed to enhance the daily consumption of potentially bioactive compounds. Oxxynea® is a (poly)phenol-rich ingredient developed to provide the quantity and the variety corresponding to five-a-day fruit and vegetable consumption. In this double-blind, randomized cross-over study, 10 participants were supplemented with 450 mg of a (poly)phenol-based supplement or a placebo. Pharmacokinetics and urinary excretion profiles were measured for 24 and 48 h, respectively, using UPHLC-MS/MS analysis. The pharmacokinetic profile displayed a triphasic absorption, indicating peaks of circulating metabolites at 1.75 ± 0.25 h, 4.50 ± 0.34 h, 9.50 ± 0.33 h and an average Tmax (time of maximal plasma concentration) of 6.90 ± 0.96 h. Similarly, the urinary profile showed maximum metabolite excretion at 3-6 h, 6-10 h and 14-24 h after supplement consumption. Compared to individual metabolites belonging to different (poly)phenolic subfamilies, the total circulating and excreted metabolites showed a reduced coefficient of variation (CV 38%). The overall bioavailability estimated was 27.4 ± 3.4%. Oxxynea® supplementation may provide a sustained exposure to several (poly)phenolic metabolites and catabolites and reduces the inter-individual variation that could arise from supplementing only one class of (poly)phenol.
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13
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Shen J, He M, Lv R, Huang L, Yang J, Wu Y, Gu Y, Rong S, Yang M, Yuan C, Zhang R. Association of Mushrooms and Algae Consumption with Mortality among Chinese Older Adults: A Prospective Cohort Study. Nutrients 2022; 14:nu14193891. [PMID: 36235543 PMCID: PMC9571415 DOI: 10.3390/nu14193891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 11/18/2022] Open
Abstract
Mushrooms and algae are important sources of dietary bioactive compounds, but their associations with mortality remain unclear. We examined the association of mushrooms and algae consumption with subsequent risk of all-cause mortality among older adults. This study included 13,156 older adults aged 65 years and above in the Chinese Longitudinal Healthy Longevity Survey (2008–2018). Consumption of mushrooms and algae at baseline and age of 60 were assessed using a simplified food frequency questionnaire (FFQ). We used Cox proportional hazards models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). During 74,976 person-years of follow-up, a total of 8937 death cases were documented. After adjustment for demographic, lifestyle, and other dietary factors, participants who consumed mushrooms and algae at least once per week had a lower risk of all-cause mortality than rare consumers (0–1 time per year) (HR = 0.86; 95% CI: 0.80–0.93). Compared to participants with rare intake at both age 60 and the study baseline (average age of 87), those who maintained regular consumptions over time had the lowest hazard of mortality (HR = 0.86; 95% CI: 0.76–0.98). Our findings supported the potential beneficial role of long-term consumption of mushrooms and algae in reducing all-cause mortality among older adults. Further studies are warranted to evaluate the health benefit for longevity of specific types of mushrooms and algae.
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Affiliation(s)
- Jie Shen
- School of Public Health, The Children’s Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Mengjie He
- Institute of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Rongxia Lv
- School of Public Health, The Children’s Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Liyan Huang
- School of Public Health, The Children’s Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jiaxi Yang
- Global Center for Asian Women’s Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore
| | - You Wu
- Institute for Hospital Management, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Yuxuan Gu
- Center for Gerontology Research, Department of Social Security, Nanjing Normal University, Nanjing 211102, China
| | - Shuang Rong
- Department of Public Health School, Wuhan University of Science & Technology, Wuhan 430065, China
| | - Min Yang
- School of Public Health, The Children’s Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Changzheng Yuan
- School of Public Health, The Children’s Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310058, China
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Correspondence: (C.Y.); (R.Z.)
| | - Ronghua Zhang
- Institute of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
- Correspondence: (C.Y.); (R.Z.)
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14
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Different dietary assessment methods, similar conclusions? Comparison of a country's adherence to food-based dietary guidelines as depicted in two population-based surveys using different dietary assessment methods. Public Health Nutr 2022; 25:2395-2402. [PMID: 35307049 PMCID: PMC9991603 DOI: 10.1017/s1368980022000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Different methods of dietary intake assessment are frequently used to assess a population's diet. In this study, we aimed to compare the adherence to Swiss food-based dietary guidelines as depicted in two Swiss population-based surveys using different methods of dietary assessment. DESIGN Two population-based, cross-sectional surveys were compared. In the Swiss Health Survey (SHS), diet was assessed via a short set of questions on specific food groups, while in menuCH by two non-consecutive 24-h dietary recall interviews. SETTING To compare the diet depicted in these surveys, we used the Swiss food-based dietary guidelines on vegetable, fruit, dairy product, meat and meat product, fish and alcohol. The weighted proportion of responders meeting these guidelines was calculated for both surveys and was compared overall and by selected characteristics. PARTICIPANTS Residents of Switzerland, selected from a stratified random sample of the non-institutionalised residents, who agreed to participate in the respective survey. To ensure comparability between the surveys, the age of the study populations was restricted to 18-75 years. RESULTS In menuCH, approximately 2 % of responders met ≥4 of the selected Swiss food-based dietary guidelines. In the SHS, using a cruder dietary assessment, the corresponding percentage was 20 %. In both surveys, more women and never smokers were meeting ≥4 food-based dietary guidelines compared to men and current or former smokers, respectively. CONCLUSIONS Our study comparing the diet in two population-based, representative surveys detected large variations in guideline adherence depending on the dietary assessment method used.
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15
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Fujii R, Suzuki K, Yamada H, Kawado M, Hashimoto S, Tsuboi Y, Wakai K, Iso H, Watanabe Y, Fujino Y, Tamakoshi A. Association between serum carotenoids and premature mortality in a population-based case-control study. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:607-620. [PMID: 36237882 PMCID: PMC9529633 DOI: 10.18999/nagjms.84.3.607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022]
Abstract
Carotenoids are abundant pigments mainly contained in vegetables and fruits, and show antioxidant properties by quenching free radicals in human body. Few studies have investigated associations between serum carotenoid levels and premature mortality. The objective of this study was to investigate the association between serum carotenoid level and premature mortality in a Japanese population. This study included 446 Japanese adults (174 men, aged of 40-64) recruited as participants in the Japan Collaborative Cohort (JACC) Study. Serum carotenoid level was measured by high-performance liquid chromatography. Premature mortality was defined as death before 65 years old during the follow-up period. Premature mortality was ascertained in 60 men (34.5%) and 65 women (23.9%). In men, compared to the 1st tertile of serum β-cryptoxanthin and provitamin A, those who were in the 3rd tertile had lower risks of premature all-cause mortality (OR, 95% CI: 0.19, 0.07-0.47 for β-cryptoxanthin, and 0.24, 0.09-0.61 for provitamin A). In women, compared to the 1st tertile of serum β-cryptoxanthin, those who were in the 3rd tertile had higher risks of premature all-cause mortality (OR, 95% CI: 1.94, 1.00-4.03). These significant associations were observed in analyses for premature cancer mortality. We found significant associations between higher levels of serum β-cryptoxanthin and provitamin A and lower risks of premature mortality among Japanese men, while a different directional association was found in women. Although these findings suggest roles of serum carotenoids on premature mortality, further studies are needed to validate this association in other populations.
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Affiliation(s)
- Ryosuke Fujii
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, Toyoake, Japan
| | - Koji Suzuki
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, Toyoake, Japan
| | - Hiroya Yamada
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, Japan
| | - Miyuki Kawado
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shuji Hashimoto
- Department of Hygiene, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshiki Tsuboi
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, Toyoake, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiyuki Watanabe
- Department of Nursing, Faculty of Health and Medical Sciences, Kyoto University of Advanced Science, Kyoto, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
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Mapping and determinants of consumption of egg and/or flesh foods and zero vegetables or fruits among young children in SSA. Sci Rep 2022; 12:11924. [PMID: 35831382 PMCID: PMC9279389 DOI: 10.1038/s41598-022-15102-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 06/17/2022] [Indexed: 11/09/2022] Open
Abstract
Zero vegetable or fruit and egg and/or flesh foods are the latest indicators for assessing infant and young child feeding practices. Understanding national and subnational heterogeneity and regional clustering in children with SSA is becoming increasingly essential for geographic targeting and policy prioritization. Geographical case identification, determinants, and impacts were all investigated. SSA children's consumption of vegetable or fruit, egg and/or flesh food, and both were low. In SSA, some portions of the Southern, South direction of the Western and Central regions have a lower weight of all bad conditions than others, although children continue to suffer in considerable numbers in all disadvantage circumstances. Children under the age of 1 year, from rural areas, uneducated families, and low income were all disadvantaged by both feeding techniques. To improve child nutrition status, multisectoral collaboration is essential. This framework allows for the tracking, planning, and implementation of nutritional treatments.
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A Produce Prescription Program in Eastern North Carolina Results in Increased Voucher Redemption Rates and Increased Fruit and Vegetable Intake among Participants. Nutrients 2022; 14:nu14122431. [PMID: 35745161 PMCID: PMC9229115 DOI: 10.3390/nu14122431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
Few produce prescription programs have taken place in rural areas, in the context of existing public health programs. Thus, the purpose of this mixed-methods study was to examine voucher redemption rates, change in fruit and vegetable intake, and suggestions for improvement among participants enrolled in a produce prescription program occurring in existing public health programs throughout rural eastern North Carolina. We examined voucher redemption rates and conducted pre- (n = 125) and post-intervention surveys assessing fruit and vegetable intake. t-tests were used to examine changes in intake pre- versus post-intervention among 50 participants. Participants (n = 32) also completed a semi-structured, telephone interview. Qualitative data were thematically analyzed to determine potential improvements. The overall voucher redemption rate was 52%. There was a 0.29 (standard deviation = 0.91, p = 0.031) cup increase in self-reported fruit intake comparing post- to pre-intervention data. Qualitative analyses indicated that participants enjoyed the financial benefits of the program and wanted it to continue. The produce prescription program was successful in increasing self-reported fruit intake among participants. More research is needed to determine if changes in intake persist when measured objectively, and on best methods for the program’s financial sustainability.
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18
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Feng Q, Kim JH, Omiyale W, Bešević J, Conroy M, May M, Yang Z, Wong SYS, Tsoi KKF, Allen N, Lacey B. Raw and Cooked Vegetable Consumption and Risk of Cardiovascular Disease: A Study of 400,000 Adults in UK Biobank. Front Nutr 2022; 9:831470. [PMID: 35265657 PMCID: PMC8901125 DOI: 10.3389/fnut.2022.831470] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Higher levels of vegetable consumption have been associated with a lower risk of cardiovascular disease (CVD), but the independent effect of raw and cooked vegetable consumption remains unclear. Methods From the UK Biobank cohort, 399,586 participants without prior CVD were included in the analysis. Raw and cooked vegetable intakes were measured with a validated dietary questionnaire at baseline. Multivariable Cox regression was used to estimate the associations between vegetable intake and CVD incidence and mortality, adjusted for socioeconomic status, health status, and lifestyle factors. The potential effect of residual confounding was assessed by calculating the percentage reduction in the likelihood ratio (LR) statistics after adjustment for the confounders. Results The mean age was 56 years and 55% were women. Mean intakes of raw and cooked vegetables were 2.3 and 2.8 tablespoons/day, respectively. During 12 years of follow-up, 18,052 major CVD events and 4,406 CVD deaths occurred. Raw vegetable intake was inversely associated with both CVD incidence (adjusted hazard ratio (HR) [95% CI] for the highest vs. lowest intake: 0.89 [0.83–0.95]) and CVD mortality (0.85 [0.74–0.97]), while cooked vegetable intake was not (1.00 [0.91–1.09] and 0.96 [0.80–1.13], respectively). Adjustment for potential confounders reduced the LR statistics for the associations of raw vegetables with CVD incidence and mortality by 82 and 87%, respectively. Conclusions Higher intakes of raw, but not cooked, vegetables were associated with lower CVD risk. Residual confounding is likely to account for much, if not all, of the observed associations. This study suggests the need to reappraise the evidence on the burden of CVD disease attributable to low vegetable intake in the high-income populations.
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Affiliation(s)
- Qi Feng
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Qi Feng
| | - Jean H. Kim
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wemimo Omiyale
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Jelena Bešević
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Megan Conroy
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Margaret May
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Zuyao Yang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Samuel Yeung-shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kelvin Kam-fai Tsoi
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- SH Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Naomi Allen
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
| | - Ben Lacey
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, United Kingdom
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Jia SS, Liu Q, Allman-Farinelli M, Partridge SR, Pratten A, Yates L, Stevens M, McGill B. The Use of Portion Control Plates to Promote Healthy Eating and Diet-Related Outcomes: A Scoping Review. Nutrients 2022; 14:nu14040892. [PMID: 35215542 PMCID: PMC8874720 DOI: 10.3390/nu14040892] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 01/17/2023] Open
Abstract
The role of portion control plates in achieving healthy diets is unclear. The aim of this scoping review was to systematically map findings from peer reviewed and grey literature to provide evidence for the use of portion control plates to promote healthy eating and nutrition-related knowledge in children and adults. A secondary aim was to review the design characteristics of portion control plates. The search was conducted in four databases, including Medline, CINAHL, Embase, and PsycInfo, and grey literature sources following the PRISMA scoping review guidelines. A total of 22 articles comprising 23 intervention studies and 8 from grey literature were included. It was found that the various two-dimensional and three-dimensional portion control plates examined were effective tools for better portion size selection in healthy children and adults. Most portion control plates dedicated half the plate to vegetables, a quarter to protein, and a quarter to carbohydrates. The use of portion control plates in nutrition interventions appears to promote weight loss among those with overweight and obesity and/or type 2 diabetes. However, portion control plates were mostly used as part of multicomponent interventions and the effectiveness of the portion control plate as a stand-alone educational resource or portion control tool alone was uncertain. Further interventional research is indicated to investigate portion plates as tools to improve dietary behaviours and food consumption at the population level.
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Affiliation(s)
- Si Si Jia
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia;
- Correspondence: ; Tel.: +61-2-8627-1697
| | - Qingzhou Liu
- Charles Perkins Centre, School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Sydney 2006, Australia;
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia;
| | - Stephanie R. Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia;
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia;
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia;
| | - Amy Pratten
- New South Wales Ministry of Health, Centre for Population Health, St Leonards, Sydney 2065, Australia; (A.P.); (L.Y.); (M.S.)
| | - Lisa Yates
- New South Wales Ministry of Health, Centre for Population Health, St Leonards, Sydney 2065, Australia; (A.P.); (L.Y.); (M.S.)
| | - Matthew Stevens
- New South Wales Ministry of Health, Centre for Population Health, St Leonards, Sydney 2065, Australia; (A.P.); (L.Y.); (M.S.)
| | - Bronwyn McGill
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia;
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20
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Halvorsen RE, Elvestad M, Molin M, Aune D. Fruit and vegetable consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of prospective studies. BMJ Nutr Prev Health 2022; 4:519-531. [PMID: 35028521 PMCID: PMC8718861 DOI: 10.1136/bmjnph-2020-000218] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/28/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The association between intake of fruit and vegetables and their subtypes, and the risk of type 2 diabetes has been investigated in several studies, but the results have been inconsistent. OBJECTIVE We conducted an updated systematic review and dose-response meta-analysis of prospective studies on intakes of fruit and vegetables and fruit and vegetable subtypes and the risk of type 2 diabetes. DESIGN PubMed and Embase databases were searched up to 20 October 2020. Prospective cohort studies of fruit and vegetable consumption and type 2 diabetes mellitus were included. Summary relative risks (RRs) and 95% CIs were estimated using a random effects model. RESULTS We included 23 cohort studies. The summary RR for high versus low intake and per 200 g/day were 0.93 (95% CI: 0.89 to 0.98, I2=0%, n=10 studies) and 0.98 (95% CI: 0.95 to 1.01, I2=37.8%, n=7) for fruit and vegetables combined, 0.93 (95% CI: 0.90 to 0.97, I2=9.3%, n=20) and 0.96 (95% CI: 0.92 to 1.00, I2=68.4%, n=19) for fruits and 0.95 (95% CI: 0.88 to 1.02, I2=60.4%, n=17) and 0.97 (95% CI: 0.94 to 1.01, I2=39.2%, n=16) for vegetables, respectively. Inverse associations were observed for apples, apples and pears, blueberries, grapefruit and grapes and raisins, while positive associations were observed for intakes of cantaloupe, fruit drinks, fruit juice, brussels sprouts, cauliflower and potatoes, however, most of these associations were based on few studies and need further investigation in additional studies. CONCLUSIONS This meta-analysis found a weak inverse association between fruit and vegetable intake and type 2 diabetes risk. There is indication of both inverse and positive associations between intake of several fruit and vegetables subtypes and type 2 diabetes risk, however, further studies are needed before firm conclusions can be made.
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Affiliation(s)
- Rine Elise Halvorsen
- Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Mathilde Elvestad
- Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Marianne Molin
- Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway.,Department of Nutrition, Bjørknes University College, Oslo, Norway
| | - Dagfinn Aune
- Department of Nutrition, Bjørknes University College, Oslo, Norway.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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21
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Adeva-Andany MM, Fernández-Fernández C, Carneiro-Freire N, Vila-Altesor M, Ameneiros-Rodríguez E. The differential effect of animal versus vegetable dietary protein on the clinical manifestations of diabetic kidney disease in humans. Clin Nutr ESPEN 2022; 48:21-35. [DOI: 10.1016/j.clnesp.2022.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
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22
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The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality: Summary Findings of the EPIC Study. Nutrients 2021; 13:nu13124293. [PMID: 34959845 PMCID: PMC8709081 DOI: 10.3390/nu13124293] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023] Open
Abstract
Evidence on the impact of diet, alcohol, body-mass index (BMI), and physical activity on mortality due to cancer and other cancer-related outcomes is still scarce. Herein, we reviewed the contribution of the European Prospective Investigation into Cancer and Nutrition (EPIC) study to the current state of the art on the role of these factors in cancer mortality. We identified 45 studies using a rapid systematic review methodology. Dietary factors associated with reduced cancer mortality included raw vegetable intake; dietary fiber intake; the Mediterranean diet; other dietary scores; other diet patterns including low meat eaters, vegetarians/vegans, or fish eaters; dietary intake (or biomarkers) of some vitamins (e.g., vitamin D, vitamin K2, or Vitamin C); and intake of lignans. Physical activity and following healthy lifestyle recommendations also reduced cancer mortality risk. In contrast, dietary factors associated with higher cancer mortality risk included poor diet quality, consumption of alcohol and soft drinks including juice, and, to a lesser extent, intake of some fatty acids. Excess weight and obesity also increased the risk of cancer mortality. The EPIC study holds valuable information on diet and lifestyle factors and offers a unique opportunity to identify key diet-related factors for cancer mortality prevention.
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23
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Ba DM, Gao X, Al-Shaar L, Muscat J, Chinchilli VM, Ssentongo P, Zhang X, Liu G, Beelman RB, Richie JP. Prospective study of dietary mushroom intake and risk of mortality: results from continuous National Health and Nutrition Examination Survey (NHANES) 2003-2014 and a meta-analysis. Nutr J 2021; 20:80. [PMID: 34548082 PMCID: PMC8454070 DOI: 10.1186/s12937-021-00738-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Whether mushroom consumption, which is a rich source of potent antioxidants ergothioneine and glutathione, vitamins, and minerals (e.g., selenium & copper), is associated with a lower mortality risk is not well understood. This study aimed to examine the association between mushroom consumption and risk of mortality in a prospective cohort study and a meta-analysis of prospective cohort studies. Methods We followed 30,378 participants from the continuous National Health and Nutrition Examination Survey (NHANES) extant data (2003-2014). Dietary mushroom intake was assessed using up to two 24-h recalls. Mortality was evaluated in all participants linked to the National Death Index mortality data through December 31, 2015. We used Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs). We also conducted a meta-analysis, including results from our present study and 4 other cohort studies. Results During a mean (SD) of 6.7 (3.4) years of follow-up, a total of 2855 death cases were documented among NHANES participants. In our analysis of continuous NHANES, we found a non-significant association between mushroom consumption and all-cause mortality (adjusted hazard ratio (HR) = 0.84; 95% CI: 0.67-1.06) after adjusting for demographic, major lifestyle factors, overall diet quality, and other dietary factors, including total energy. The meta-analysis of prospective cohort studies, including 601,893 individuals, showed that mushroom consumption was associated with a lower risk of all-cause mortality (pooled risk ratio: 0.94; 95% CI: 0.91, 0.98). Conclusion In a meta-analysis of prospective cohort studies, mushroom consumption was associated with a lower risk of all-cause mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00738-w.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Laila Al-Shaar
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Joshua Muscat
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Xinyuan Zhang
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Robert B Beelman
- Department of Food Science and Center for Plant and Mushroom Foods for Health, College of Agricultural Sciences, Pennsylvania State University, University Park, PA, USA
| | - John P Richie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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Zhu J, Ling Y, Tse LA, Kinra S, Li Y. Circulating vitamin C and the risk of cardiovascular diseases: A Mendelian randomization study. Nutr Metab Cardiovasc Dis 2021; 31:2398-2406. [PMID: 34088583 DOI: 10.1016/j.numecd.2021.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS The impact of vitamin C supplementation on the risk of cardiovascular diseases (CVDs) remains uncertain with inconsistent evidence obtained from observational studies and randomized clinical trials (RCTs). We aimed to assess possible causal associations of vitamin C with major CVD events as well as their risk factors using Mendelian randomization (MR) design. METHODS AND RESULTS Nine genetic variants associated with vitamin C at genome-wide significance (p < 5 × 10-8) were used as instrumental variables to predict plasma vitamin C levels. The primary outcomes were coronary artery disease (Ncase = 122,733 and Ncontrol = 424,528), atrial fibrillation (Ncase = 60,620 and Ncontrol = 970,216), heart failure (Ncase = 47,309 and Ncontrol = 930,014), and ischemic stroke (Ncase = 40,585 and Ncontrol = 406,111). Several CVD risk factors were also evaluated in secondary analyses. Two-sample MR analyses were performed using the inverse variance weighted method, with several sensitivity analyses. Genetically determined higher levels of plasma vitamin C were not significantly associated with any of the four examined CVD events. Likewise, there is no convincing evidence for the associations between genetically determined vitamin C and CVD risk factors, including higher blood lipids, higher blood pressure, and abnormal body composition. Sensitivity analyses using different analytical approaches yielded consistent results. Additionally, MR assumptions did not seem to be violated. CONCLUSION This MR study does not support a causal protective role to circulate vitamin C levels on various types of CVD events. In combination with previous RCT results, our findings suggest that vitamin C supplementation to increase circulating vitamin C levels may not help in CVD prevention.
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Affiliation(s)
- Jiahao Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou 310053, China
| | - Yuxiao Ling
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou 310053, China
| | - Lap A Tse
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories 999077, Hong Kong
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Yingjun Li
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou 310053, China.
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Fujii R, Tsuboi Y, Maeda K, Ishihara Y, Suzuki K. Analysis of Repeated Measurements of Serum Carotenoid Levels and All-Cause and Cause-Specific Mortality in Japan. JAMA Netw Open 2021; 4:e2113369. [PMID: 34115126 PMCID: PMC8196342 DOI: 10.1001/jamanetworkopen.2021.13369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE The associations of levels of diverse serum carotenoids ascertained via repeated measurements with all-cause, cancer, and cardiovascular disease (CVD) mortality risk have not been considered in previous prospective studies. OBJECTIVE To investigate the association between repeated measurement of serum carotenoid levels and all-cause and cause-specific mortality risk. DESIGN, SETTING, AND PARTICIPANTS This cohort study's baseline data were collected using information from physical examinations from 1990 to 1999. Eligible participants were followed up until December 2017, with a median (interquartile range) follow-up period of 22.3 (15.5-25.3) years. Included individuals were age 40 years or older at the baseline data collection, were residents of the study site in the town of Yakumo, Hokkaido, Japan, and participated in a physical examination at least once from 1990 to 1999. Among eligible participants, after excluding 332 individuals, 3116 individuals were included in the analysis. Data analysis was conducted in April 2020. EXPOSURES Repeated measurements of 6 serum carotenoid levels and 4 associated indices. MAIN OUTCOMES AND MEASURES All-cause, cancer, and CVD mortality, categorized by International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes, were recorded. A time-dependent Cox regression model was performed to examine associations between time-varying serum carotenoid levels and mortality. RESULTS Among 3116 individuals who received physical examinations, the mean (SD) age was 54.7 (10.6) years and 1883 (60.4%) were women. During the follow-up period, 762 deaths from all causes, 253 deaths from cancer, and 210 deaths from CVD were ascertained. In a time-dependent Cox regression analysis, for every 25% higher serum levels of total carotenoids, risks were statistically significantly lower for all-cause mortality (hazard ratio [HR], 0.85; 95% CI, 0.82-0.87; P < .001), cancer mortality (HR, 0.82; 95% CI, 0.78-0.87; P < .001), and CVD mortality (HR, 0.86; 95% CI, 0.81-0.91; P < .001). Using only baseline measures, for every 25% higher serum levels of total carotenoids, risks were also statistically significantly lower for all-cause mortality (HR, 0.92; 95% CI, 0.89-0.95; P < .001), cancer mortality (HR, 0.87; 95% CI, 0.83-0.93; P < .001), and CVD mortality (HR, 0.93; 95% CI, 0.88-0.99; P = .03) but with larger HRs than those associated with repeated measurements. CONCLUSIONS AND RELEVANCE This study found that higher levels of serum carotenoids in analysis using repeated measurements were associated with significantly lower all-cause and cause-specific mortality over a follow-up period of 25 years.
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Affiliation(s)
- Ryosuke Fujii
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, Toyoake, Japan
| | - Yoshiki Tsuboi
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, Toyoake, Japan
| | - Keisuke Maeda
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, Toyoake, Japan
| | - Yuya Ishihara
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, Toyoake, Japan
| | - Koji Suzuki
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, Toyoake, Japan
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26
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Banerjee T, Carrero JJ, McCulloch C, Burrows NR, Siegel KR, Morgenstern H, Saran R, Powe NR. Dietary Factors and Prevention: Risk of End-Stage Kidney Disease by Fruit and Vegetable Consumption. Am J Nephrol 2021; 52:356-367. [PMID: 34044392 PMCID: PMC8263504 DOI: 10.1159/000514754] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association between fruit and vegetable (FV) intake and the risk of end-stage kidney disease (ESKD) has not been examined in the general population and fully explored in chronic kidney disease (CKD). We prospectively evaluated this relationship in US representative sample of adults and evaluated consistency by the presence or absence, and severity, of CKD. METHODS We used data from the Third National Health and Nutrition Examination Survey (1988-1994) linked with the US Renal Data System, including 14,725 adults aged ≥20 years and with follow-up for ESKD through 2008. Daily FV intake was ascertained using a food frequency questionnaire. We examined the association between selected categories of FV intake and ESKD using a Fine Gray competing risk model adjusting for sociodemographics, lifestyle, clinical and nutritional factors, estimated glomerular filtration rate, and albuminuria. We evaluated whether risk varied in individuals with severe versus any CKD. RESULTS 230 participants (1.5%) developed ESKD during follow-up. In the adjusted model, compared to highest intake, those in lowest categories of FV intake had a higher risk of ESKD, for <2 times/day (1.45 [1.24-1.68], 2 to <3 times/day (1.40 [1.18-1.61]), 3 to <4 times/day (1.25 [1.04-1.46]), and 4 to <6 times/day (1.14 [0.97-1.31]). There was suggestion of heterogeneity (p for interaction = 0.03) with possible stronger inverse association in patients with CKD than those without CKD. After stratification, we obtained similar strong inverse association when we examined ESKD incidence across intake of FVs in participants with CKD stages 1-4 (n = 5,346) and specifically in those with CKD stages 3-4 (n = 1,084). CONCLUSIONS Low intake of FVs was associated with higher risk of ESKD in US adults with and without CKD, supporting an emerging body of literature on the potential benefits of plant-rich diets for prevention of ESKD.
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Affiliation(s)
- Tanushree Banerjee
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Charles McCulloch
- Department of Biostatistics, University of California, San Francisco, California, USA
| | - Nilka Rios Burrows
- Division of Diabetes Translation, Centers for Disease and Control and Prevention, Atlanta, Georgia, USA
| | - Karen R Siegel
- Division of Diabetes Translation, Centers for Disease and Control and Prevention, Atlanta, Georgia, USA
| | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Urology, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Rajiv Saran
- Kidney Epidemiology & Cost Center, University of Michigan, Ann Arbor, Michigan, USA
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Neil R Powe
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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Abstract
Cigarette smoke (CS) is likely the most common preventable cause of human morbidity and mortality worldwide. Consequently, inexpensive interventional strategies for preventing CS-related diseases would positively impact health systems. Inhaled CS is a powerful inflammatory stimulus and produces a shift in the normal balance between antioxidants and oxidants, inducing oxidative stress in both the respiratory system and throughout the body. This enduring and systemic pro-oxidative state within the body is reflected by increased levels of oxidative stress and inflammation biomarkers seen in smokers. Smokers might benefit from consuming antioxidant supplements, or a diet rich in fruit and vegetables, which can reduce the CS-related oxidative stress. This review provides an overview of the plasma profile of antioxidants observable in smokers and examines the heterogeneous literature to elucidate and discuss the effectiveness of interventional strategies based on antioxidant supplements or an antioxidant-rich diet to improve the health of smokers. An antioxidant-rich diet can provide an easy-to-implement and cost-effective preventative strategy to reduce the risk of CS-related diseases, thus being one of the simplest ways for smokers to stay in good health for as long as possible. The health benefits attributable to the intake of antioxidants have been observed predominantly when these have been consumed within their natural food matrices in an optimal antioxidant-rich diet, while these preventive effects are rarely achieved with the intake of individual antioxidants, even at high doses.
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Ba DM, Gao X, Muscat J, Al-Shaar L, Chinchilli V, Zhang X, Ssentongo P, Beelman RB, Richie JP. Association of mushroom consumption with all-cause and cause-specific mortality among American adults: prospective cohort study findings from NHANES III. Nutr J 2021; 20:38. [PMID: 33888143 PMCID: PMC8061446 DOI: 10.1186/s12937-021-00691-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/01/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Whether mushroom consumption, which is rich in several bioactive compounds, including the crucial antioxidants ergothioneine and glutathione, is inversely associated with low all-cause and cause-specific mortality remains uncertain. This study aimed to prospectively investigate the association between mushroom consumption and all-cause and cause-specific mortality risk. METHODS Longitudinal analyses of participants from the Third National Health and Nutrition Examination Survey (NHANES III) extant data (1988-1994). Mushroom intake was assessed by a single 24-h dietary recall using the US Department of Agriculture food codes for recipe foods. All-cause and cause-specific mortality were assessed in all participants linked to the National Death Index mortality data (1988-2015). We used Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause and cause-specific mortality. RESULTS Among 15,546 participants included in the current analysis, the mean (SE) age was 44.3 (0.5) years. During a mean (SD) follow-up duration of 19.5 (7.4) years , a total of 5826 deaths were documented. Participants who reported consuming mushrooms had lower risk of all-cause mortality compared with those without mushroom intake (adjusted hazard ratio (HR) = 0.84; 95% CI: 0.73-0.98) after adjusting for demographic, major lifestyle factors, overall diet quality, and other dietary factors including total energy. When cause-specific mortality was examined, we did not observe any statistically significant associations with mushroom consumption. Consuming 1-serving of mushrooms per day instead of 1-serving of processed or red meats was associated with lower risk of all-cause mortality (adjusted HR = 0.65; 95% CI: 0.50-0.84). We also observed a dose-response relationship between higher mushroom consumption and lower risk of all-cause mortality (P-trend = 0.03). CONCLUSION Mushroom consumption was associated with a lower risk of total mortality in this nationally representative sample of US adults.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Joshua Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Vernon Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Xinyuan Zhang
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Robert B Beelman
- Department of Food Science and Center for Plant and Mushroom Foods for Health, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, USA
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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Mendonça N, Hengeveld LM, Visser M, Presse N, Canhão H, Simonsick EM, Kritchevsky SB, Newman AB, Gaudreau P, Jagger C. Low protein intake, physical activity, and physical function in European and North American community-dwelling older adults: a pooled analysis of four longitudinal aging cohorts. Am J Clin Nutr 2021; 114:29-41. [PMID: 33829238 PMCID: PMC8246618 DOI: 10.1093/ajcn/nqab051] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/09/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Dietary protein may slow the decline in muscle mass and function with aging, making it a sensible candidate to prevent or modulate disability progression. At present, studies providing reliable estimates of the association between protein intake and physical function, and its interaction with physical activity (PA), in community-dwelling older adults are lacking. OBJECTIVES We investigated the longitudinal relation between protein intake and physical function, and the interaction with PA. METHODS We undertook a pooled analysis of individual participant data from cohorts in the PROMISS (PRevention Of Malnutrition In Senior Subjects in the European Union) consortium (the Health Aging and Body Composition Study, Quebec Longitudinal Study on Nutrition and Successful Aging, Longitudinal Aging Study Amsterdam, and Newcastle 85+) in which 5725 community-dwelling older adults were followed up to 8.5 y. The relation between protein intake and walking speed was determined using joint models (linear mixed-effects and Cox proportional hazards models) and the relation with mobility limitation was investigated using multistate models. RESULTS Higher protein intake was modestly protective of decline in walking speed in a dose-dependent manner [e.g., protein intake ≥1.2 compared with 0.8 g/kg adjusted body weight (aBW)/d: β = 0.024, 95% CI: 0.009, 0.032 SD/y], with no clear indication of interaction with PA. Participants with protein intake ≥0.8 g/kg aBW/d had also a lower likelihood of incident mobility limitation, which was observed for each level of PA. This association seemed to be dose-dependent for difficulty walking but not for difficulty climbing stairs. No associations between protein intake and other mobility limitations transitions were observed. CONCLUSIONS Higher daily protein intake can reduce physical function decline not only in older adults with protein intake below the current RDA of 0.8 g/kg BW/d, but also in those with a protein intake that is already considered sufficient. This dose-dependent association was observed for each level of PA, suggesting no clear synergistic association between protein intake and PA in relation to physical function.
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Affiliation(s)
| | - Linda M Hengeveld
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nancy Presse
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada,Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada,Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, Quebec, Canada
| | - Helena Canhão
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (UNL), Lisbon, Portugal,Comprehensive Health Research Centre (CHRC), NOVA Medical School, Lisbon, Portugal
| | | | | | - Anne B Newman
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, PA, USA
| | - Pierrette Gaudreau
- Department of Medicine, University of Montréal, H3T 1J4, Montréal, Quebec, Canada,Research Centre of the Centre hospitalier de l'Université de Montréal (CHUM), H2X 0A9, Montréal, Quebec, Canada
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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30
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Wang DD, Li Y, Bhupathiraju SN, Rosner BA, Sun Q, Giovannucci EL, Rimm EB, Manson JE, Willett WC, Stampfer MJ, Hu FB. Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation 2021; 143:1642-1654. [PMID: 33641343 DOI: 10.1161/circulationaha.120.048996] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The optimal intake levels of fruit and vegetables for maintaining long-term health are uncertain. METHODS We followed 66 719 women from the Nurses' Health Study (1984-2014) and 42 016 men from the Health Professionals Follow-up Study (1986-2014) who were free from cardiovascular disease (CVD), cancer, and diabetes at baseline. Diet was assessed using a validated semiquantitative food frequency questionnaire at baseline and updated every 2 to 4 years. We also conducted a dose-response meta-analysis, including results from our 2 cohorts and 24 other prospective cohort studies. RESULTS We documented 33 898 deaths during the follow-up. After adjustment for known and suspected confounding variables and risk factors, we observed nonlinear inverse associations of fruit and vegetable intake with total mortality and cause-specific mortality attributable to cancer, CVD, and respiratory disease (all Pnonlinear<0.001). Intake of ≈5 servings per day of fruit and vegetables, or 2 servings of fruit and 3 servings of vegetables, was associated with the lowest mortality, and above that level, higher intake was not associated with additional risk reduction. In comparison with the reference level (2 servings/d), daily intake of 5 servings of fruit and vegetables was associated with hazard ratios (95% CI) of 0.87 (0.85-0.90) for total mortality, 0.88 (0.83-0.94) for CVD mortality, 0.90 (0.86-0.95) for cancer mortality, and 0.65 (0.59-0.72) for respiratory disease mortality. The dose-response meta-analysis that included 145 015 deaths accrued in 1 892 885 participants yielded similar results (summary risk ratio of mortality for 5 servings/d=0.87 [95% CI, 0.85-0.88]; Pnonlinear<0.001). Higher intakes of most subgroups of fruits and vegetables were associated with lower mortality, with the exception of starchy vegetables such as peas and corn. Intakes of fruit juices and potatoes were not associated with total and cause-specific mortality. CONCLUSIONS Higher intakes of fruit and vegetables were associated with lower mortality; the risk reduction plateaued at ≈5 servings of fruit and vegetables per day. These findings support current dietary recommendations to increase intake of fruits and vegetables, but not fruit juices and potatoes.
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Affiliation(s)
- Dong D Wang
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Yanping Li
- Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Shilpa N Bhupathiraju
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Bernard A Rosner
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Biostatistics (B.A.R.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Qi Sun
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Edward L Giovannucci
- Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Eric B Rimm
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - JoAnn E Manson
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Division of Preventive Medicine, Department of Medicine (J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Walter C Willett
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Meir J Stampfer
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Frank B Hu
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
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31
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Boakye D, Walter V, Jansen L, Martens UM, Chang-Claude J, Hoffmeister M, Brenner H. Magnitude of the Age-Advancement Effect of Comorbidities in Colorectal Cancer Prognosis. J Natl Compr Canc Netw 2021; 18:59-68. [PMID: 31910379 DOI: 10.6004/jnccn.2019.7346] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 08/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Comorbidities and old age independently compromise prognosis of patients with colorectal cancer (CRC). The impact of comorbidities could thus be considered as conveying worse prognosis already at younger ages, but evidence is lacking on how much worsening of prognosis with age is advanced to younger ages in comorbid versus noncomorbid patients. We aimed to quantify, for the first time, the impact of comorbidities on CRC prognosis in "age advancement" of worse prognosis. METHODS A total of 4,602 patients aged ≥30 years who were diagnosed with CRC in 2003 through 2014 were recruited into a population-based study in the Rhine-Neckar region of Germany and observed over a median period of 5.1 years. Overall comorbidity was quantified using the Charlson comorbidity index (CCI). Hazard ratios and age advancement periods (AAPs) for comorbidities were calculated from multivariable Cox proportional hazards models for relevant survival outcomes. RESULTS Hazard ratios for CCI scores 1, 2, and ≥3 compared with CCI 0 were 1.25, 1.53, and 2.30 (P<.001) for overall survival and 1.20, 1.48, and 2.03 (P<.001) for disease-free survival, respectively. Corresponding AAP estimates for CCI scores 1, 2, and ≥3 were 5.0 (95% CI, 1.9-8.1), 9.7 (95% CI, 6.1-13.3), and 18.9 years (95% CI, 14.4-23.3) for overall survival and 5.5 (95% CI, 1.5-9.5), 11.7 (95% CI, 7.0-16.4), and 21.0 years (95% CI, 15.1-26.9) for disease-free survival. Particularly pronounced effects of comorbidity on CRC prognosis were observed in patients with stage I-III CRC. CONCLUSIONS Comorbidities advance the commonly observed deterioration of prognosis with age by many years, meaning that at substantially younger ages, comorbid patients with CRC experience survival rates comparable to those of older patients without comorbidity. This first derivation of AAPs may enhance the empirical basis for treatment decisions in patients with comorbidities and highlight the need to incorporate comorbidities into prognostic nomograms for CRC.
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Affiliation(s)
- Daniel Boakye
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), and.,Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Viola Walter
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), and
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), and
| | - Uwe M Martens
- SLK-Clinics, Cancer Center Heilbronn-Franken, Heilbronn, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), and
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), and.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; and.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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32
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Gu Y, He Y, Ali SH, Harper K, Dong H, Gittelsohn J. Fruit and Vegetable Intake and All-Cause Mortality in a Chinese Population: The China Health and Nutrition Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E342. [PMID: 33466375 PMCID: PMC7794965 DOI: 10.3390/ijerph18010342] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 11/18/2022]
Abstract
This study was to investigate the association of long-term fruit and vegetable (FV) intake with all-cause mortality. We utilized data from the China Health and Nutrition Survey (CHNS), a prospective cohort study conducted in China. The sample population included 19,542 adult respondents with complete mortality data up to 31 December 2011. Cumulative FV intake was assessed by 3 day 24 h dietary recalls. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality. Covariates included sociodemographic characteristics, lifestyle factors, health-related factors, and urban index. A total of 1409 deaths were observed during follow-up (median: 14 years). In the fully adjusted model, vegetable intake of the fourth quintile (327~408 g/day) had the greatest negative association with death compared to the lowest quintile (HR = 0.63, 95% CI: 0.53-0.76). Fruit intake of the fifth quintile (more than 126 g/day) had the highest negative association (HR = 0.24, 95% CI: 0.15-0.40) and increasing general FV intake were also negatively associated with all-cause mortality which demonstrated the greatest negative association in the amount of fourth quintile (HR = 0.59, 95% CI: 0.49-0.70) compared to the lowest quintile. To conclude, greater FV intake is associated with a reduced risk of total mortality for Chinese adults. High intake of fruit has a stronger negative association with mortality than differences in intake of vegetables. Our findings support recommendations to increase the intake of FV to promote overall longevity.
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Affiliation(s)
- Yuxuan Gu
- Department of Social Medicine, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou 310058, China;
| | - Yansu He
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
| | - Shahmir H. Ali
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 11201, USA;
| | - Kaitlyn Harper
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (K.H.); (J.G.)
| | - Hengjin Dong
- Department of Social Medicine, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou 310058, China;
| | - Joel Gittelsohn
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (K.H.); (J.G.)
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Health Effects of Grape Seed and Skin Extracts and Their Influence on Biochemical Markers. Molecules 2020; 25:molecules25225311. [PMID: 33202575 PMCID: PMC7696942 DOI: 10.3390/molecules25225311] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Abstract
This review is focused on the study of the effects of grape seed and skin extract (GSSE) on human health. GSSE contains high concentrations of important polyphenolic substances with high biological activity. This review is a summary of studies that investigate the effects of GSSE on diabetes mellitus, cardiovascular disease and cancer, its neuroprotective effect, and its effects on the gastrointestinal tract and other health complications related to these diseases. The results of the studies confirm that the anti-inflammatory, antiapoptotic, and pro-proliferative effects of “Vitis vinifera L.” seed extract reduce the level of oxidative stress and improve the overall lipid metabolism.
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Zurbau A, Au‐Yeung F, Blanco Mejia S, Khan TA, Vuksan V, Jovanovski E, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Relation of Different Fruit and Vegetable Sources With Incident Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc 2020; 9:e017728. [PMID: 33000670 PMCID: PMC7792377 DOI: 10.1161/jaha.120.017728] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022]
Abstract
Background Public health policies reflect concerns that certain fruit sources may not have the intended benefits and that vegetables should be preferred to fruit. We assessed the relation of fruit and vegetable sources with cardiovascular outcomes using a systematic review and meta-analysis of prospective cohort studies. Methods and Results MEDLINE, EMBASE, and Cochrane were searched through June 3, 2019. Two independent reviewers extracted data and assessed study quality (Newcastle-Ottawa Scale). Data were pooled (fixed effects), and heterogeneity (Cochrane-Q and I2) and certainty of the evidence (Grading of Recommendations Assessment, Development, and Evaluation) were assessed. Eighty-one cohorts involving 4 031 896 individuals and 125 112 cardiovascular events were included. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (risk ratio, 0.93 [95% CI, 0.89-0.96]; 0.91 [0.88-0.95]; and 0.94 [0.90-0.97], respectively), coronary heart disease (0.88 [0.83-0.92]; 0.88 [0.84-0.92]; and 0.92 [0.87-0.96], respectively), and stroke (0.82 [0.77-0.88], 0.82 [0.79-0.85]; and 0.88 [0.83-0.93], respectively) incidence. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (0.89 [0.85-0.93]; 0.88 [0.86-0.91]; and 0.87 [0.85-0.90], respectively), coronary heart disease (0.81 [0.72-0.92]; 0.86 [0.82-0.90]; and 0.86 [0.83-0.89], respectively), and stroke (0.73 [0.65-0.81]; 0.87 [0.84-0.91]; and 0.94 [0.90-0.99], respectively) mortality. There were greater benefits for citrus, 100% fruit juice, and pommes among fruit sources and allium, carrots, cruciferous, and green leafy among vegetable sources. No sources showed an adverse association. The certainty of the evidence was "very low" to "moderate," with the highest for total fruit and/or vegetables, pommes fruit, and green leafy vegetables. Conclusions Fruits and vegetables are associated with cardiovascular benefit, with some sources associated with greater benefit and none showing an adverse association. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03394339.
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Affiliation(s)
- Andreea Zurbau
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
| | - Fei Au‐Yeung
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
| | - Sonia Blanco Mejia
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
| | - Tauseef A. Khan
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
| | - Vladimir Vuksan
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoOntarioCanada
- Division of Endocrinology and MetabolismSt. Michael’s HospitalTorontoOntarioCanada
| | - Elena Jovanovski
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
| | - Lawrence A. Leiter
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoOntarioCanada
- Division of Endocrinology and MetabolismSt. Michael’s HospitalTorontoOntarioCanada
- Department of Medicine, Faculty of MedicineUniversity of TorontoOntarioCanada
| | - Cyril W. C. Kendall
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
- College of Pharmacy and NutritionUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - David J. A. Jenkins
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoOntarioCanada
- Division of Endocrinology and MetabolismSt. Michael’s HospitalTorontoOntarioCanada
| | - John L. Sievenpiper
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoOntarioCanada
- Division of Endocrinology and MetabolismSt. Michael’s HospitalTorontoOntarioCanada
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Keck MM, Vivier H, Cassisi JE, Dvorak RD, Dunn ME, Neer SM, Ross EJ. Examining the Role of Anxiety and Depression in Dietary Choices among College Students. Nutrients 2020; 12:nu12072061. [PMID: 32664465 PMCID: PMC7400947 DOI: 10.3390/nu12072061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 01/14/2023] Open
Abstract
This study examines the role of anxiety and depression symptoms in predicting dietary choices in emerging adults while accounting for sex differences in these relationships. Participants were 225 English speaking undergraduates enrolled in a university in southeastern United States. Participants were recruited through an online research recruitment application utilized by the university. Participants volunteered for a two-phased anonymous survey monitoring the effects of eating habits and gastrointestinal health in young adults. As part of this effort, participants completed self-reporting measures related to anxiety and depression, as well as an automated, self-administered 24-h diet recall. Multigroup path analysis was used to test primary hypotheses. Overall, a decrease in total caloric intake and an increase in sugar consumption were found as self-reported symptoms of anxiety and depression increased. In addition, there were sex differences in the relationship between depression and food choices. Men consumed more saturated fat as well as less fruits and vegetables as self-reported symptoms of depression increased. Results suggest symptoms of depression are a greater risk factor for poor nutrition in male college students than females. The findings provide another justification to screen for psychological distress in student health services given the implications on behavioral lifestyle and health.
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Affiliation(s)
- Michelle M. Keck
- Department of Psychology, College of Sciences, University of Central Florida, Orlando, FL 32816, USA; (J.E.C.); (R.D.D.); (M.E.D.); (S.M.N.); (E.J.R.)
- Correspondence:
| | | | - Jeffrey E. Cassisi
- Department of Psychology, College of Sciences, University of Central Florida, Orlando, FL 32816, USA; (J.E.C.); (R.D.D.); (M.E.D.); (S.M.N.); (E.J.R.)
| | - Robert D. Dvorak
- Department of Psychology, College of Sciences, University of Central Florida, Orlando, FL 32816, USA; (J.E.C.); (R.D.D.); (M.E.D.); (S.M.N.); (E.J.R.)
| | - Michael E. Dunn
- Department of Psychology, College of Sciences, University of Central Florida, Orlando, FL 32816, USA; (J.E.C.); (R.D.D.); (M.E.D.); (S.M.N.); (E.J.R.)
| | - Sandra M. Neer
- Department of Psychology, College of Sciences, University of Central Florida, Orlando, FL 32816, USA; (J.E.C.); (R.D.D.); (M.E.D.); (S.M.N.); (E.J.R.)
| | - Emily J. Ross
- Department of Psychology, College of Sciences, University of Central Florida, Orlando, FL 32816, USA; (J.E.C.); (R.D.D.); (M.E.D.); (S.M.N.); (E.J.R.)
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Poor Dietary Polyphenol Intake in Childhood Cancer Patients. Nutrients 2019; 11:nu11112835. [PMID: 31752350 PMCID: PMC6893556 DOI: 10.3390/nu11112835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022] Open
Abstract
Emerging research demonstrates polyphenol-rich diets like the Mediterranean diet may play a role in improving the outcomes of adult cancer therapy. To date, there are no trials assessing the intake or efficacy of polyphenol-rich diets in childhood cancer patients. In this study we collected dietary data on 59 childhood cancer patients on treatment using a three-pass 24-h dietary recall (24-HDR), which is based on a validated and structured three-part methodology. Polyphenol consumption was calculated by matching the food consumption data with polyphenol content extracted from the most updated Phenol-Explorer database. The mean total polyphenol intake was 173.31 ± 141.02 mg/day. The major food sources of polyphenols were fruits, beverages, and cereals. There were no significant associations with time since diagnosis, body mass index (BMI) z-score, types of cancer, treatment intensity, food-related symptoms, relapse, and total daily polyphenol intake. Further investigation with larger studies will facilitate the steps in assessing the value of polyphenol-rich dietary patterns in future nutritional interventions for childhood cancer patients.
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Aune D. Plant Foods, Antioxidant Biomarkers, and the Risk of Cardiovascular Disease, Cancer, and Mortality: A Review of the Evidence. Adv Nutr 2019; 10:S404-S421. [PMID: 31728499 PMCID: PMC6855972 DOI: 10.1093/advances/nmz042] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/15/2019] [Accepted: 03/28/2019] [Indexed: 12/14/2022] Open
Abstract
Although a high intake of plant foods such as fruits, vegetables, whole grains, nuts, and legumes has been recommended for chronic disease prevention, it has been unclear what is the optimal amount of intake of these foods and whether specific subtypes are particularly beneficial. The evidence from several recently published meta-analyses on plant foods and antioxidants and various health outcomes is reviewed as well as more recently published studies. In meta-analyses of prospective studies, inverse associations were observed between intake of fruits, vegetables, whole grains, and nuts and the risk of coronary artery disease, stroke, cardiovascular disease overall, total cancer, and all-cause mortality. The strongest reductions in risk were observed at an intake of 800 g/d for fruits and vegetables, 225 g/d for whole grains, and 15-20 g/d for nuts, respectively. Whole-grain and nut consumption was also inversely associated with mortality from respiratory disease, infections, and diabetes. Stronger and more linear inverse associations were observed between blood concentrations of antioxidants (vitamin C, carotenoids, vitamin E) and cardiovascular disease, cancer, and all-cause mortality than for dietary intake. Most studies that have since been published have been consistent with these results; however, further studies are needed on subtypes of plant foods and less common causes of death. These results strongly support dietary recommendations to increase intake of plant foods, and suggest optimal intakes for chronic disease prevention may be ∼800 g/d for intakes of fruits and vegetables, 225 g/d for whole grains, and 15-20 g/d for nuts. Diets high in plant foods could potentially prevent several million premature deaths each year if adopted globally.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Schwingshackl L, Schwedhelm C, Hoffmann G, Boeing H. Potatoes and risk of chronic disease: a systematic review and dose-response meta-analysis. Eur J Nutr 2019; 58:2243-2251. [PMID: 29987352 PMCID: PMC6689281 DOI: 10.1007/s00394-018-1774-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/06/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE We aimed to synthesize the evidence on the relation between different types of potato consumption with risk of all-cause mortality, coronary heart disease (CHD), stroke, type 2 diabetes (T2D), colorectal cancer (CRC), and hypertension. METHODS Systematic searches until May 2018 were conducted in PubMed, Scopus, and Web of Science. Random effects meta-analyses comparing extreme categories, linear and non-linear dose-response analyses were conducted. RESULTS Twenty-eight reports were identified. Only total potato consumption was available for some endpoints which showed no associations with all-cause mortality (RR: 0.88, 95% CI 0.69-1.12), CHD (RR: 1.03, 95% CI 0.96-1.09), stroke (RR: 0.98, 95% CI 0.93-1.03), and CRC (RR: 1.05, 95% CI 0.92-1.20) per one daily/serving (150 g/day) increase. Consumption of one daily serving of boiled/baked/mashed-potatoes was not associated with risk of hypertension (RR: 1.08, 95% CI 0.96-1.21), but slightly with the risk of T2D (RR: 1.09, 95% 1.01-1.18). Positive associations for the risk of T2D (RR: 1.66, 95% CI 1.43-1.94) and hypertension (RR: 1.37, 95% CI 1.15-1.63) were observed for each 150 g/day increase in French-fries consumption. The quality of evidence was rated mostly low (moderate quality of evidence for the risk-associations of French-fries). CONCLUSION Total potato consumption is not related to risk for many chronic diseases but could pose a small increase in risk for T2D if consumed boiled. A clear risk relation was found between French-fries consumption and risk of T2D and hypertension. For several outcomes, the impact of different preparation procedures could not be assessed.
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Affiliation(s)
- Lukas Schwingshackl
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Berlin, Germany.
| | - Carolina Schwedhelm
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Berlin, Germany
| | - Georg Hoffmann
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, UZA II, 1090, Vienna, Austria
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Berlin, Germany
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Fruit and vegetable consumption and its contribution to inequalities in life expectancy and disability-free life expectancy in ten European countries. Int J Public Health 2019; 64:861-872. [PMID: 31183533 PMCID: PMC6614160 DOI: 10.1007/s00038-019-01253-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/04/2019] [Accepted: 05/14/2019] [Indexed: 01/09/2023] Open
Abstract
Objectives To assess to what extent educational differences in total life expectancy (TLE) and disability-free life expectancy (DFLE) could be reduced by improving fruit and vegetable consumption in ten European countries. Methods Data from national census or registries with mortality follow-up, EU-SILC, and ESS were used in two scenarios to calculate the impact: the upward levelling scenario (exposure in low educated equals exposure in high educated) and the elimination scenario (no exposure in both groups). Results are estimated for men and women between ages 35 and 79 years. Results Varying by country, upward levelling reduced inequalities in DFLE by 0.1–1.1 years (1–10%) in males, and by 0.0–1.3 years (0–18%) in females. Eliminating exposure reduced inequalities in DFLE between 0.6 and 1.7 years for males (6–15%), and between 0.1 years and 1.8 years for females (3–20%). Conclusions Upward levelling of fruit and vegetable consumption would have a small, positive effect on both TLE and DFLE, and could potentially reduce inequalities in TLE and DFLE. Electronic supplementary material The online version of this article (10.1007/s00038-019-01253-w) contains supplementary material, which is available to authorized users.
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Effect of diet composition on insulin sensitivity in humans. Clin Nutr ESPEN 2019; 33:29-38. [PMID: 31451269 DOI: 10.1016/j.clnesp.2019.05.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/21/2019] [Indexed: 12/27/2022]
Abstract
Diet composition has a marked impact on the risk of developing type 2 diabetes and cardiovascular disease. Prospective studies show that dietary patterns with elevated amount of animal products and low quantity of vegetable food items raise the risk of these diseases. In healthy subjects, animal protein intake intensifies insulin resistance whereas plant-based foods enhance insulin sensitivity. Similar effects have been documented in patients with diabetes. Accordingly, pre-pregnancy intake of meat (processed and unprocessed) has been strongly associated with a higher risk of gestational diabetes whereas greater pre-pregnancy vegetable protein consumption is associated with a lower risk of gestational diabetes. Population groups that modify their traditional dietary habit increasing the amount of animal products while reducing plant-based foods experience a remarkable rise in the frequency of type 2 diabetes. The association of animal protein intake with insulin resistance is independent of body mass index. In obese individuals that consume high animal protein diets, insulin sensitivity does not improve following weight loss. Diets aimed to lose weight that encourage restriction of carbohydrates and elevated consumption of animal protein intensify insulin resistance increasing the risk of developing type 2 diabetes and cardiovascular disease. The effect of dietary components on insulin sensitivity may contribute to explain the striking impact of eating habits on the risk of type 2 diabetes and cardiovascular disease. Insulin resistance predisposes to type 2 diabetes in healthy subjects and deteriorates metabolic control in patients with diabetes. In nondiabetic and diabetic individuals, insulin resistance is a major cardiovascular risk factor.
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Adeva-Andany MM, Funcasta-Calderón R, Fernández-Fernández C, Castro-Quintela E, Carneiro-Freire N. Metabolic effects of glucagon in humans. J Clin Transl Endocrinol 2019; 15:45-53. [PMID: 30619718 PMCID: PMC6312800 DOI: 10.1016/j.jcte.2018.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 01/09/2023] Open
Abstract
Diabetes is a common metabolic disorder that involves glucose, amino acids, and fatty acids. Either insulin deficiency or insulin resistance may cause diabetes. Insulin deficiency causes type 1 diabetes and diabetes associated with total pancreatectomy. Glucagon produces insulin resistance. Glucagon-induced insulin resistance promotes type 2 diabetes and diabetes associated with glucagonoma. Further, glucagon-induced insulin resistance aggravates the metabolic consequences of the insulin-deficient state. A major metabolic effect of insulin is the accumulation of glucose as glycogen in the liver. Glucagon opposes hepatic insulin action and enhances the rate of gluconeogenesis, increasing hepatic glucose output. In order to support gluconeogenesis, glucagon promotes skeletal muscle wasting to supply amino acids as gluconeogenic precursors. Glucagon promotes hepatic fatty acid oxidation to supply energy required to sustain gluconeogenesis. Hepatic fatty acid oxidation generates β-hydroxybutyrate and acetoacetate (ketogenesis). Prospective studies reveal that elevated glucagon secretion at baseline occurs in healthy subjects who develop impaired glucose tolerance at follow-up compared with subjects who maintain normal glucose tolerance, suggesting a relationship between elevated glucagon secretion and development of impaired glucose tolerance. Prospective studies have identified animal protein consumption as an independent risk factor for type 2 diabetes and cardiovascular disease. Animal protein intake activates glucagon secretion inducing sustained elevations in plasma glucagon. Glucagon is a major hormone that causes insulin resistance. Insulin resistance is an established cardiovascular risk factor additionally to its pathogenic role in diabetes. Glucagon may be a potential link between animal protein intake and the risk of developing type 2 diabetes and cardiovascular disease.
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Affiliation(s)
- María M. Adeva-Andany
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
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Kim Y, Keogh J, Clifton PM. Nuts and Cardio-Metabolic Disease: A Review of Meta-Analyses. Nutrients 2018; 10:E1935. [PMID: 30563231 PMCID: PMC6316378 DOI: 10.3390/nu10121935] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Accumulating epidemiological and intervention evidence suggest that nut consumption is associated with reduced incidence of some cardiometabolic diseases. However, to date no review of meta-analyses of epidemiological and intervention studies has evaluated the effects of nut consumption on cardiometabolic disease. Design/Results: Electronic searches for meta-analyses of epidemiological and intervention studies were undertaken in PubMed®/MEDLINE®. Meta-analyses of prospective studies show that nut consumption appears to be associated with reduced all-cause mortality by 19⁻20% (n = 6), cardiovascular disease (CVD) incidence (19%; n = 3) and mortality (25%; n = 3), coronary heart disease (CHD) incidence (20⁻34%; n = 2) and mortality (27⁻30%; n = 2) and stroke incidence (10⁻11%; n = 7) and mortality (18%; n = 2). No association between nut consumption and the risk of type 2 diabetes mellitus (T2DM) was observed in meta-analyses of prospective studies, whereas a decrease in fasting blood glucose ranging from 0.08 to 0.15 mmol/L was observed in 3 meta-analyses of intervention studies. In the interventions, nut consumption also had favorable effects on total cholesterol (0.021 to 0.28 mmol/L reduction from 8 meta-analyses of interventions) and low-density lipoprotein cholesterol (0.017 to 0.26 mmol/L reduction from 8 meta-analyses of interventions) and endothelial function (0.79 to 1.03% increase in flow-mediated dilation from 4 meta-analyses of interventions). Nut consumption did not significantly affect body weight. Nut consumption had no effect on inflammatory markers in intervention studies. The effect on blood pressure was inconsistent. A higher nut consumption was associated with a lower incidence of hypertension in prospective studies, while nut consumption did not improve blood pressure in intervention studies. CONCLUSIONS Nut consumption appeared to be associated with lower all-cause mortality and CVD and CHD mortality. There was no association between nut consumption and the incidence of T2DM although fasting blood glucose is decreased in intervention studies. In intervention studies nuts lower total cholesterol and low-density lipoprotein cholesterol (LDL-C).
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Affiliation(s)
- Yoona Kim
- Department of Food and Nutrition/Institute of Agriculture and Life Science, Gyeongsang National University, Jinju 52828, Korea.
| | - Jennifer Keogh
- School of Pharmacy and Medical Sciences, University of South Australia, General Post Office Box 2471, Adelaide, SA 5001, Australia.
| | - Peter M Clifton
- School of Pharmacy and Medical Sciences, University of South Australia, General Post Office Box 2471, Adelaide, SA 5001, Australia.
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Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC, Tonstad S, Vatten LJ, Riboli E, Norat T. Dietary intake and blood concentrations of antioxidants and the risk of cardiovascular disease, total cancer, and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies. Am J Clin Nutr 2018; 108:1069-1091. [PMID: 30475962 PMCID: PMC6250988 DOI: 10.1093/ajcn/nqy097] [Citation(s) in RCA: 206] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/27/2018] [Indexed: 12/14/2022] Open
Abstract
Background High dietary intake or blood concentrations (as biomarkers of dietary intake) of vitamin C, carotenoids, and vitamin E have been associated with reduced risk of cardiovascular disease, cancer, and mortality, but these associations have not been systematically assessed. Objective We conducted a systematic review and meta-analysis of prospective studies of dietary intake and blood concentrations of vitamin C, carotenoids, and vitamin E in relation to these outcomes. Design We searched PubMed and Embase up to 14 February 2018. Summary RRs and 95% CIs were calculated with the use of random-effects models. Results Sixty-nine prospective studies (99 publications) were included. The summary RR per 100-mg/d increment of dietary vitamin C intake was 0.88 (95% CI: 0.79, 0.98, I2 = 65%, n = 11) for coronary heart disease, 0.92 (95% CI: 0.87, 0.98, I2 = 68%, n = 12) for stroke, 0.89 (95% CI: 0.85, 0.94, I2 = 27%, n = 10) for cardiovascular disease, 0.93 (95% CI: 0.87, 0.99, I2 = 46%, n = 8) for total cancer, and 0.89 (95% CI: 0.85, 0.94, I2 = 80%, n = 14) for all-cause mortality. Corresponding RRs per 50-μmol/L increase in blood concentrations of vitamin C were 0.74 (95% CI: 0.65, 0.83, I2 = 0%, n = 4), 0.70 (95% CI: 0.61, 0.81, I2 = 0%, n = 4), 0.76 (95% CI: 0.65, 0.87, I2 = 56%, n = 6), 0.74 (95% CI: 0.66, 0.82, I2 = 0%, n = 5), and 0.72 (95% CI: 0.66, 0.79, I2 = 0%, n = 8). Dietary intake and/or blood concentrations of carotenoids (total, β-carotene, α-carotene, β-cryptoxanthin, lycopene) and α-tocopherol, but not dietary vitamin E, were similarly inversely associated with coronary heart disease, stroke, cardiovascular disease, cancer, and/or all-cause mortality. Conclusions Higher dietary intake and/or blood concentrations of vitamin C, carotenoids, and α-tocopherol (as markers of fruit and vegetable intake) were associated with reduced risk of cardiovascular disease, total cancer, and all-cause mortality. These results support recommendations to increase fruit and vegetable intake, but not antioxidant supplement use, for chronic disease prevention.
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Affiliation(s)
- Dagfinn Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - NaNa Keum
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Edward Giovannucci
- Departments of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Lars T Fadnes
- Bergen Addiction Research Group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Darren C Greenwood
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Lars J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
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Mazzocca A, Ferraro G, Misciagna G, Fais S. Moving the systemic evolutionary approach to cancer forward: Therapeutic implications. Med Hypotheses 2018; 121:80-87. [PMID: 30396500 DOI: 10.1016/j.mehy.2018.09.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/26/2018] [Accepted: 09/18/2018] [Indexed: 12/31/2022]
Abstract
We have previously presented a new Systemic Evolutionary Theory of Cancer (SETOC) based on the failure of proper endosymbiosis in eukaryotic cells. Here, we propose that the progressive uncoupling of two endosymbiotic subsystems (information and energy) inside the cell, as a consequence of long-term injuries, gives rise to alterations (i) in tissue interactions and (ii) in cell organization. In the first case, we argue that the impairment of both the coherent state and the synergy between intercellular communications underpins the onset of tissue dysplasia, that usually evolves towards cancer development. In the second case, we suggest that the rupture of endosymbiosis drives a sort of cell regression towards a protist-like entity represented by the concept of "de-emergence" postulated in our systemic evolutionary approach to carcinogenesis. This conceptual association of the cancer cell with a protist-like organism could support the development of novel cancer therapeutic approaches. To this end, we propose a paradigm shift in cancer pharmacology since: i) our knowledge of cancer pathophysiology as a complex system is insufficient, despite a vast knowledge of molecular mechanisms underlying cancer; ii) current cancer pharmacology deals only with microvariables (e.g. gene or protein targets), which do not account for the integrated pathophysiology of cancer, rather than with macrovariables (e.g. pH, membrane potential, electromagnetic fields, cell communications and so on) and mesovariables (between micro and macro), such as the interaction between various cellular components including cellular organelles. This paradigm shift should allow cancer pharmacology to move forward from molecular treatments (focusing on single targets) to modular treatments that consider cancer-related processes (i.e. inflammation, coagulation, etc.) or even to a sort of ecosystemic treatment addressing the whole functioning of the "cancer ecosystem". Examples of ecosystems treatment may be natural plant derivatives that act synergistically or pulsed electromagnetic fields which can act on particular biological processes in cancer cells. In addition, we need different working theoretical models on which to base new anticancer pharmacological approaches. Finally, we examine what value our systemic evolutionary approach could add to cancer treatments, in particular in liver cancer as a paradigm for developing potential applications.
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Affiliation(s)
- Antonio Mazzocca
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare, 11, 70124 Bari, Italy.
| | - Giovanni Ferraro
- Interuniversity Department of Physics, Polytechnic of Bari, Via Orabona, 4, 70126 Bari, Italy
| | - Giovanni Misciagna
- Scientific and Ethical Committee, University Hospital Policlinico, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Stefano Fais
- Department of Oncology and Molecular Medicine (OMM), National Institute of Health, Viale Regina Elena, 299, 00161 Rome, Italy
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Gans KM, Risica PM, Keita AD, Dionne L, Mello J, Stowers KC, Papandonatos G, Whittaker S, Gorham G. Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the 'Live Well, Viva Bien' cluster-randomized trial. Int J Behav Nutr Phys Act 2018; 15:80. [PMID: 30126463 PMCID: PMC6102886 DOI: 10.1186/s12966-018-0704-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 07/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Fruit and vegetable (F&V) intake can reduce risks for chronic disease, but is much lower than recommended amounts in most Western populations, especially for those with low income levels. Rigorous research is needed on practical, cost-effective interventions that address environmental as well as personal determinants of F&V intake. This paper presents the results of a cluster randomized controlled trial evaluating the efficacy of 'Live Well, Viva Bien' (LWVB), a multicomponent intervention that included discount, mobile fresh F&V markets in conjunction with nutrition education. METHODS Fifteen subsidized housing sites in Providence County, Rhode Island (8 intervention and 7 control sites) were randomized using a random number generator. Of these, nine housed elderly and/or disabled residents and six housed families. A total of 1597 adult housing site residents (treatment n = 837; control n = 760) were enrolled (73% women, 54% Hispanic, 17% black, Mean age 54 years). A year-long multicomponent intervention including mobile F&V markets plus nutrition education (e.g. campaigns, DVDs, newsletters, recipes, and chef demonstrations) was implemented at intervention sites. Physical activity and stress interventions were implemented at control sites. Follow-up occurred at 6 and 12 months. The main outcome measure was F&V consumption measured by National Cancer Institute's 'Eating at America's Table All Day Screener'. RESULTS From baseline to 12 months, the intervention group increased total F&V intake by 0.44 cups with the control group decreasing intake by 0.08 cups (p < .02). Results also showed an increased frequency of F&V eating behaviors compared to the control group (p < .01). There was a clear dose response effect of the F&V markets with participants who reported attending all or most of the markets increasing F&V intake by 2.1 cups and 0.86 cups, respectively compared with less than half cup increases for lower levels of market attendance (p < .05). Use of the DVDs, recipes and taste-testings was also associated with greater increases in F&V intake; however, use of other educational components was not. CONCLUSIONS LWVB is the first cluster, randomized controlled trial to demonstrate the efficacy of year-round F&V markets on improving F&V intake for low-income adults, which provides an evidence-base to bolster the mission of mobile produce markets. Further, the results more broadly support investment in environmental changes to alleviate disparities in F&V consumption and diet-related health inequities. TRIAL REGISTRATION NUMBER Clinicatrials.gov registration number: NCT02669472.
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Affiliation(s)
- Kim M. Gans
- Department of Human Development and Family Studies, University of Connecticut, Storrs, USA
- University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Akilah Dulin Keita
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Jennifer Mello
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Kristen Cooksey Stowers
- University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA
- University of Connecticut Rudd Center for Food Policy and Obesity, Hartford, USA
| | - George Papandonatos
- Department of Statistical Scieces, Brown University School of Public Health, Providence, USA
| | | | - Gemma Gorham
- Department of Human Development and Family Studies, University of Connecticut, Storrs, USA
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Pluschke AM, Williams BA, Zhang D, Gidley MJ. Dietary pectin and mango pulp effects on small intestinal enzyme activity levels and macronutrient digestion in grower pigs. Food Funct 2018; 9:991-999. [PMID: 29340436 DOI: 10.1039/c7fo00602k] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The effects of refined pectin and mango pulp on macronutrient digestion and small intestinal enzyme activity were studied in grower pigs. Diets based on wheat starch with and without apple pectin or dried mango fruit pulp were fed to 30 grower pigs for 21 days. Pigs were euthanized two hours postprandially, and their gastrointestinal contents recovered. Starch and protein digestion as well as α-amylase activity were all increased in pigs fed pectin. In contrast, fat digestion, lipase and protease (trypsin) activities were all significantly reduced in these pigs. Pigs fed the mango fruit pulp diet had intermediate effects compared with pigs fed refined pectin and control diets. The data suggests that pectin has a significant effect on digestive enzyme activity and subsequent influence on macronutrient digestion. The fact that pectin caused either an increase (α-amylase) or decrease (lipase, protease) in enzyme activity in digesta, which either did (starch, lipid) or did not (protein) associate with residual nutrient differences illustrates the complexity of small intestinal responses to added fibre in diets.
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Affiliation(s)
- Anton M Pluschke
- ARC Centre of Excellence in Plant Cell Walls, Queensland Alliance for Agriculture and Food Innovation, Centre for Nutrition and Food Sciences, The University of Queensland, St Lucia Brisbane, 4072, Australia.
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Melaku YA, Renzaho A, Gill TK, Taylor AW, Dal Grande E, de Courten B, Baye E, Gonzalez-Chica D, Hyppӧnen E, Shi Z, Riley M, Adams R, Kinfu Y. Burden and trend of diet-related non-communicable diseases in Australia and comparison with 34 OECD countries, 1990-2015: findings from the Global Burden of Disease Study 2015. Eur J Nutr 2018. [PMID: 29516222 DOI: 10.1007/s00394-018-1656-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Diet is a major determining factor for many non-communicable chronic diseases (NCDs). However, evidence on diet-related NCD burden remains limited. We assessed the trends in diet-related NCDs in Australia from 1990 to 2015 and compared the results with other countries of the Organization for Economic Co-operation and Development (OECD). METHODS We used data and methods from the Global Burden of Disease (GBD) 2015 study to estimate the NCD mortality and disability-adjusted life years (DALYs) attributable to 14 dietary risk factors in Australia and 34 OECD nations. Countries were further ranked from the lowest (first) to highest (35th) burden using an age-standardized population attributable fraction (PAF). RESULTS In 2015, the estimated number of deaths attributable to dietary risks was 29,414 deaths [95% uncertainty interval (UI) 24,697 - 34,058 or 19.7% of NCD deaths] and 443,385 DALYs (95% UI 377,680-511,388 or 9.5% of NCD DALYs) in Australia. Young (25-49 years) and middle-age (50-69 years) male adults had a higher PAF of diet-related NCD deaths and DALYs than their female counterparts. Diets low in fruits, vegetables, nuts and seeds and whole grains, but high in sodium, were the major contributors to both NCD deaths and DALYs. Overall, 42.3% of cardiovascular deaths were attributable to dietary risk factors. The age-standardized PAF of diet-related NCD mortality and DALYs decreased over the study period by 28.2% (from 27.0% in 1990 to 19.4% in 2015) and 41.0% (from 14.3% in 1990 to 8.4% in 2015), respectively. In 2015, Australia ranked 12th of 35 examined countries in diet-related mortality. A small improvement of rank was recorded compared to the previous 25 years. CONCLUSIONS Despite a reduction in diet-related NCD burden over 25 years, dietary risks are still the major contributors to a high burden of NCDs in Australia. Interventions targeting NCDs should focus on dietary behaviours of individuals and population groups.
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Affiliation(s)
- Yohannes Adama Melaku
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
- Department of Human Nutrition, Institute of Public Health, The University of Gondar, Gondar, Ethiopia.
| | - Andre Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Anne W Taylor
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | | | - Barbora de Courten
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Estifanos Baye
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | | | - Elina Hyppӧnen
- Centre for Population Health Research, Sansom Institute, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Population, Policy and Practice, UCL Institute of Child Health, London, UK
| | - Zumin Shi
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar
| | - Malcolm Riley
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, SA, Australia
| | - Robert Adams
- Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, The University of Adelaide, Adelaide, Australia
| | - Yohannes Kinfu
- Faculty of Health, University of Canberra, Canberra, Australia
- School of Demography, Australian National University, Canberra, Australia
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48
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Jochems SHJ, Van Osch FHM, Bryan RT, Wesselius A, van Schooten FJ, Cheng KK, Zeegers MP. Impact of dietary patterns and the main food groups on mortality and recurrence in cancer survivors: a systematic review of current epidemiological literature. BMJ Open 2018; 8:e014530. [PMID: 29459359 PMCID: PMC5857700 DOI: 10.1136/bmjopen-2016-014530] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To determine whether there is an association between dietary patterns/indices and foods from the main food groups (highest vs lowest intakes) prior to or after cancer diagnosis and mortality and cancer recurrence in cancer survivors. PARTICIPANTS Survivors of common cancers with a 10-year survival rate of ≥50%: bladder, bowel, breast, cervical, kidney, laryngeal, prostate, testicular, uterine cancer, malignant melanoma and (non-)Hodgkin's lymphoma. OUTCOME MEASURES Mortality (overall, cancer-specific, from other causes) and cancer recurrence. INFORMATION SOURCES PubMed, Embase and the Cochrane Library were searched from inception to April 2017. Additional studies were identified by searching reference lists. Two authors independently screened titles and abstracts, assessed study quality and extracted the data. RESULTS A total of 38 studies were included. The risk of bias was rated low for the included randomised controlled trials (RCTs) and moderate for the cohort studies. The quality of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach and was rated moderate (RCTs), and (very)low (cohort studies). Reducing the amount of fat after diagnosis appears to decrease the risk of breast cancer recurrence. Adherence to a high-quality diet and prudent diet after diagnosis appears to decrease the risk of death from other causes (and overall mortality for high-quality diet) in breast cancer survivors. Adherence to a Western diet, before and after diagnosis, appears to increase the risk of overall mortality and death from other causes among breast cancer survivors. Evidence from studies among other cancer survivors was too limited or could not be identified. CONCLUSION For many cancer survivors, there is little evidence to date to indicate that particular dietary behaviours influence outcomes with regard to recurrence and mortality. Notwithstanding, limited evidence suggests that a low-fat diet, a high-quality diet and a prudent diet are beneficial for breast cancer survivors, while a Western diet is detrimental for breast cancer survivors.
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Affiliation(s)
- Sylvia H J Jochems
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Frits H M Van Osch
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Anke Wesselius
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Frederik J van Schooten
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Kar Keung Cheng
- Institute of Applied Health Research, Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Maurice P Zeegers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Miller V, Mente A, Dehghan M, Rangarajan S, Zhang X, Swaminathan S, Dagenais G, Gupta R, Mohan V, Lear S, Bangdiwala SI, Schutte AE, Wentzel-Viljoen E, Avezum A, Altuntas Y, Yusoff K, Ismail N, Peer N, Chifamba J, Diaz R, Rahman O, Mohammadifard N, Lana F, Zatonska K, Wielgosz A, Yusufali A, Iqbal R, Lopez-Jaramillo P, Khatib R, Rosengren A, Kutty VR, Li W, Liu J, Liu X, Yin L, Teo K, Anand S, Yusuf S. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet 2017; 390:2037-2049. [PMID: 28864331 DOI: 10.1016/s0140-6736(17)32253-5] [Citation(s) in RCA: 349] [Impact Index Per Article: 49.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/25/2017] [Accepted: 08/01/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia. METHODS We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE] in 135 335 individuals aged 35 to 70 years without cardiovascular disease from 613 communities in 18 low-income, middle-income, and high-income countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease. The follow-up period varied based on the date when recruitment began at each site or country. The main clinical outcomes were major cardiovascular disease (defined as death from cardiovascular causes and non-fatal myocardial infarction, stroke, and heart failure), fatal and non-fatal myocardial infarction, fatal and non-fatal strokes, cardiovascular mortality, non-cardiovascular mortality, and total mortality. Cox frailty models with random effects were used to assess associations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality. FINDINGS Participants were enrolled into the study between Jan 1, 2003, and March 31, 2013. For the current analysis, we included all unrefuted outcome events in the PURE study database through March 31, 2017. Overall, combined mean fruit, vegetable and legume intake was 3·91 (SD 2·77) servings per day. During a median 7·4 years (5·5-9·3) of follow-up, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented. Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex, and centre (random effect). The estimates were substantially attenuated in the multivariable adjusted models for major cardiovascular disease (hazard ratio [HR] 0·90, 95% CI 0·74-1·10, ptrend=0·1301), myocardial infarction (0·99, 0·74-1·31; ptrend=0·2033), stroke (0·92, 0·67-1·25; ptrend=0·7092), cardiovascular mortality (0·73, 0·53-1·02; ptrend=0·0568), non-cardiovascular mortality (0·84, 0·68-1·04; ptrend =0·0038), and total mortality (0·81, 0·68-0·96; ptrend<0·0001). The HR for total mortality was lowest for three to four servings per day (0·78, 95% CI 0·69-0·88) compared with the reference group, with no further apparent decrease in HR with higher consumption. When examined separately, fruit intake was associated with lower risk of cardiovascular, non-cardiovascular, and total mortality, while legume intake was inversely associated with non-cardiovascular death and total mortality (in fully adjusted models). For vegetables, raw vegetable intake was strongly associated with a lower risk of total mortality, whereas cooked vegetable intake showed a modest benefit against mortality. INTERPRETATION Higher fruit, vegetable, and legume consumption was associated with a lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375-500 g/day). FUNDING Full funding sources listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Victoria Miller
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
| | - Andrew Mente
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Xiaohe Zhang
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Gilles Dagenais
- Institut universitaire de cardiologie et pneumologie de Quebec, Université Laval, QC, Canada
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Scott Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | | | - Aletta E Schutte
- South African Medical Research Council/North-West University, Potchefstroom, South Africa
| | | | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, University Santo Amaro, São Paulo, Brazil
| | - Yuksel Altuntas
- Istanbul Sisli Hamidiye Etfal Health Training and Research Center, Istanbul, Turkey
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selayang, Selangor, Malaysia; UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Noorhassim Ismail
- Department of Community Health, Faculty of Medicine, University of Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Jephat Chifamba
- Physiology Department, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica ECLA, Rosaria, Argentina
| | | | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Katarzyna Zatonska
- Department of Social Medicine, Medical University of Wroclaw, Wroclaw, Poland
| | | | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Health Authority and Dubai Medical College, Dubai, United Arab Emirates
| | | | | | - Rasha Khatib
- Public Health Sciences, Stritch School of Medicine, IL, USA
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital/Őstra, Gőteborg, Sweden
| | | | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Jiankang Liu
- Jianshe Road Community Health Center, Chengdu, Sichuan Province, China
| | - Xiaoyun Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Sonia Anand
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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50
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Du H, Li L, Bennett D, Yang L, Guo Y, Key TJ, Bian Z, Chen Y, Walters RG, Millwood IY, Chen J, Wang J, Zhou X, Fang L, Li Y, Li X, Collins R, Peto R, Chen Z. Fresh fruit consumption and all-cause and cause-specific mortality: findings from the China Kadoorie Biobank. Int J Epidemiol 2017; 46:1444-1455. [PMID: 28449053 PMCID: PMC5837264 DOI: 10.1093/ije/dyx042] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 12/27/2022] Open
Abstract
Background Higher fruit consumption is associated with lower risk of cardiovascular disease (CVD). Substantial uncertainties remain, however, about the associations of fruit consumption with all-cause mortality and mortality from subtypes of CVD and major non-vascular diseases, especially in China. Methods In 2004-08, the nationwide China Kadoorie Biobank Study recruited > 0.5 million adults aged 30-79 years from 10 diverse localities in China. Fresh fruit consumption was estimated using an interviewer-administered electronic questionnaire, and mortality data were collected from death registries. Among the 462 342 participants who were free of major chronic diseases at baseline, 17 894 deaths were recorded during ∼ 7 years of follow-up. Cox regression yielded adjusted rate ratios (RRs) for all-cause and cause-specific mortality associated with fruit consumption. Results At baseline, 28% of participants reported consuming fruit ≥ 4 days/week (regular consumers) and 6% reported never/rarely consuming fruit (non-consumers). Compared with non-consumers, regular consumers had 27% [RR = 0.73, 95% confidence interval (CI) 0.70-0.76] lower all-cause mortality, 34% lower CVD mortality (n = 6166; RR = 0.66, 0.61-0.71), 17% lower cancer mortality (n = 6796; RR = 0.83, 0.78-0.89) and 42% lower mortality from chronic obstructive pulmonary disease (COPD) (n = 1119; RR = 0.58, 0.47-0.71). For each of the above, there was an approximately log-linear dose-response relationship with amount consumed. For mortality from site-specific cancers, fruit consumption was inversely associated with digestive tract cancer (n = 2265; RR = 0.72, 0.64-0.81), particularly oesophageal cancer (n = 801; RR = 0.65, 0.50-0.83), but not with cancer of lung or liver. Conclusions Among Chinese adults, higher fresh fruit consumption was associated with significantly lower mortality from several major vascular and non-vascular diseases. Given the current low population level of fruit consumption, substantial health benefits could be gained from increased fruit consumption in China.
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Affiliation(s)
- Huaidong Du
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Derrick Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Yiping Chen
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robin G Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iona Y Millwood
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Junshi Chen
- China National Center For Food Safety Risk Assessment, Beijing, China
| | | | - Xue Zhou
- Heilongjiang CDC, Harbin, Heilongjiang Province, China
| | - Le Fang
- Zhejiang CDC, Hangzhou, Zhejiang Province, China
| | - Yijun Li
- Meilan CDC, Haikou, Hainan Province, China
| | - Xianzhi Li
- Liuyang CDC, Liuyang, Hunan Province, China
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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