Ten-year incidence of coronary heart disease in the Honolulu Heart Program. Relationship to nutrient intake

Inverse Association between the Global Diet Quality Score and New-Onset Hypertension in Adults: A Nationwide Cohort Study

BACKGROUND

The Global Diet Quality Score (GDQS) is a simple and practical dietary metric associated with a number of chronic diseases. The GDQS included various foods related to blood pressure, especially diverse plant-based foods that have shown to lower blood pressure. However, studies on the role of the GDQS in reducing the risk of new-onset hypertension and whether its performance differs from that of other dietary metrics are lacking.

OBJECTIVE

We aimed to examine the association between the GDQS and new-onset hypertension and to compare its performance with that of other dietary patterns, including the Plant-based Diet Index (PDI), alternate Mediterranean diet (aMED) score, Alternative Healthy Eating Index-2010, and Dietary Approaches to Stop Hypertension (DASH) score in Chinese adults.

METHODS

We included a total of 12,002 participants (5644 males and 6358 females) aged >18 y from the China Health and Nutrition Survey (1997-2015). Dietary intake was estimated using average food intakes from 3 consecutive 24-h dietary recalls. Multivariable relative risks (RRs) were computed for hypertension using modified Poisson regression models.

RESULTS

With ≤18 y of follow-up (mean 8.7± 5.4 y), we ascertained 4232 incident cases of hypertension. Compared with participants with a low GDQS score (<15), the multivariable-adjusted RR of hypertension was 0.72 [95% confidence interval (CI): 0.62, 0.83] among participants with a high score (≥23). A 25% increment in the GDQS was associated with a 30% (RR, 0.70; 95% CI: 0.64, 0.76) lower risk of new-onset hypertension, which was comparable with the RRs of new-onset hypertension associated with every 25% increment in the PDI (RR, 0.84; 95% CI: 0.76, 0.93), DASH score (RR, 0.84; 95% CI: 0.78, 0.91), and aMED score (RR, 0.89; 95% CI: 0.84, 0.93).

CONCLUSION

A higher GDQS was associated with a lower risk of new-onset hypertension, with comparable associations of new-onset hypertension with PDI, DASH, and aMED scores in Chinese adults.

Dietary Macronutrient Intake and Cardiovascular Disease Risk and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Many epidemiological studies have evaluated the intake of macronutrients and the risk of mortality and cardiovascular disease (CVD). However, current evidence is conflicting and warrants further investigation. Therefore, we carried out an umbrella review to examine and quantify the potential dose-response association of dietary macronutrient intake with CVD morbidity and mortality. Prospective cohort studies from PubMed, Embase, and CENTRAL were reviewed, which reported associations of macronutrients (protein, fat, and carbohydrate) with all-cause, CVD, cancer mortality, or CVD events. Multivariable relative risks (RR) were pooled, and heterogeneity was assessed. The results of 124 prospective cohort studies were included in the systematic review and 101 in the meta-analysis. During the follow-up period from 2.2 to 30 years, 506,086 deaths and 79,585 CVD events occurred among 5,107,821 participants. High total protein intake was associated with low CVD morbidity (RR 0.88, 95% confidence interval 0.82-0.94), while high total carbohydrate intake was associated with high CVD morbidity (1.08, 1.02-1.13). For fats, a high intake of total fat was associated with a decreased all-cause mortality risk (0.92, 0.85-0.99). Saturated fatty acid intake was only associated with cancer mortality (1.10, 1.06-1.14); Both monounsaturated fatty acid (MUFA) and polyunsaturated fatty acids (PUFA) intake was associated with all-cause mortality (MUFA: 0.92, 0.86-0.98; PUFA: 0.91, 0.86-0.96). This meta-analysis supports that protein intake is associated with a decreased risk of CVD morbidity, while carbohydrate intake is associated with an increased risk of CVD morbidity. High total fat intake is associated with a low risk of all-cause mortality, and this effect was different in an analysis stratified by the type of fat.

Dietary intake, biomarkers and supplementation of fatty acids and risk of coronary events: a systematic review and dose-response meta-analysis of randomized controlled trials and prospective observational studies

We aimed to review the association of dietary fats and risk of coronary events in adults. We searched PubMed, Embase, CENTRAL, Scopus, and Web of Sciences to April 2022 for prospective cohorts and randomized trials investigating the association of dietary intake and biomarkers of fats and fatty acid interventions and the risk of coronary events. We performed random-effects meta-analyses to estimate relative risk (RR) for the top versus bottom tertiles of exposures. One-hundered sixty-five prospective cohorts and randomized trials were included. Dietary intake and biomarkers of total fat and saturated, monounsaturated, and polyunsaturated fatty acids were not associated with the risk of coronary events. Dietary intake of trans fatty acids, palmitic acid, stearic acid, and saturated fatty acids from meat and unprocessed meat was modestly associated with a higher risk and, in contrast, intake of alpha-linolenic acid, long-chain omega-3 fatty acids, and linoleic acid was modestly associated with a lower risk. Supplementation with long-chain omega-3 fatty acids and increasing the consumption of alpha-linolenic and linoleic acids in place of saturated fats reduced the risk of coronary events. Existing evidence, in its totality, provides a modest support in favor of current recommendations suggesting replacement of saturated fats with polyunsaturated fats.

Coconut oil consumption and bodyweight reduction: a systematic review and meta-analysis

INTRODUCTION

Due to the composition and biological properties of coconut oil, there is still considerable debate regarding potential benefits for the management of obesity, including the specific impact on body weight (BW) reduction. This systematic review and meta-analysis of clinical trials aims to assess the impact of coconut oil on BW reduction in comparison to other oils and fats.

EVIDENCE ACQUISITION

The databases, PubMed^®, Web of Science^®, EMBASE^®, and SciVerse Scopus^® were systematically searched. A combination of medical subject headings and words linked to coconut oil and obesity parameters were utilized. Any clinical trials comparing coconut oil to any other form of oil or fat, with more than one month feeding period among adults were considered.

EVIDENCE SYNTHESIS

From the 540 potentially relevant papers, 9 were included. The period of coconut oil intake varied from four to twelve weeks, apart from one long-term trial where coconut oil was consumed for two years. When compared to other oils and fats, coconut oil substantially decreased BW (N.=546), Body Mass Index (BMI) (N.=551), and percentage of fat mass (FM%) (N.=491) by 0.75 kg (P=0.04), 0.28 kg/m² (P=0.03), and 0.35% (P=0.008), respectively. Coconut oil consumption did not result in any significant alteration in waist circumference (WC) (N.=385) (-0.61 cm; P=0.30), waist-to-hip ratio (WHR) (N.=330) (-0.01; P=0.39) and FM (N.=86) (-0.25 kg; P=0.29).

CONCLUSIONS

Results indicate a small statistically significant reduction in BW, BMI, and FM% in the coconut oil group. In contrast, consumption of coconut oil had no statistically significant effect on WC, WHR, or FM.

Age-associated changes in circulatory fatty acids: new insights on adults and long-lived individuals

Long-lived individuals (LLIs) are considered an ideal model to study healthy human aging. Blood fatty acid (FA) profile of a cohort of LLIs (90-111 years old, n = 49) from Sicily was compared to adults (18-64 years old, n = 69) and older adults (65-89 years old, n = 54) from the same area. Genetic variants in key enzymes related to FA biosynthesis and metabolism were also genotyped to investigate a potential genetic predisposition in determining the FA profile. Gas chromatography was employed to determine the FA profile, and genotyping was performed using high-resolution melt (HRM) analysis. Blood levels of total polyunsaturated FA (PUFA) and total trans-FA decreased with age, while the levels of saturated FA (SFA) remained unchanged. Interestingly, distinctively higher circulatory levels of monounsaturated FA (MUFA) in LLIs compared to adults and older adults were observed. In addition, among LLIs, rs174537 in the FA desaturase 1/2 (FADS1/2) gene was associated with linoleic acid (LA, 18:2n-6) and docosatetraenoic acid (DTA, 22:4n-6) levels, and the rs953413 in the elongase of very long FA 2 (ELOVL2) was associated with DTA levels. We further observed that rs174579 and rs174626 genotypes in FADS1/2 significantly affect delta-6 desaturase (D6D) activity. In conclusion, our results suggest that the LLIs have a different FA profile characterized by high MUFA content, which indicates reduced peroxidation while maintaining membrane fluidity.

Dietary Transitions and Health Outcomes in Four Populations - Systematic Review

IMPORTANCE

Non-communicable chronic diseases (NCDs) such as obesity, type 2 diabetes, heart disease, and cancer were rare among non-western populations with traditional diets and lifestyles. As populations transitioned toward industrialized diets and lifestyles, NCDs developed.

OBJECTIVE

We performed a systematic literature review to examine the effects of diet and lifestyle transitions on NCDs.

EVIDENCE REVIEW

We identified 22 populations that underwent a nutrition transition, eleven of which had sufficient data. Of these, we chose four populations with diverse geographies, diets and lifestyles who underwent a dietary and lifestyle transition and explored the relationship between dietary changes and health outcomes. We excluded populations with features overlapping with selected populations or with complicating factors such as inadequate data, subgroups, and different study methodologies over different periods. The selected populations were Yemenite Jews, Tokelauans, Tanushimaru Japanese, and Maasai. We also review transition data from seven excluded populations (Pima, Navajo, Aboriginal Australians, South African Natal Indians and Zulu speakers, Inuit, and Hadza) to assess for bias.

FINDINGS

The three groups that replaced saturated fats (SFA) from animal (Yemenite Jews, Maasai) or plants (Tokelau) with refined carbohydrates had negative health outcomes (e.g., increased obesity, diabetes, heart disease). Yemenites reduced SFA consumption by >40% post-transition but men's BMI increased 19% and diabetes increased ~40-fold. Tokelauans reduced fat, dramatically reduced SFA, and increased sugar intake: obesity and diabetes rose. The Tanushimaruans transitioned to more fats and less carbohydrates and used more anti-hypertensive medications; stroke and breast cancer declined while heart disease was stable. The Maasai transitioned to lower fat, SFA and higher carbohydrates and had increased BMI and diabetes. Similar patterns were observed in the seven other populations.

CONCLUSION

The nutrient category most strongly associated with negative health outcomes - especially obesity and diabetes - was sugar (increased 600-650% in Yemenite Jews and Tokelauans) and refined carbohydrates (among Maasai, total carbohydrates increased 39% in men and 362% in women), while increased calories was less strongly associated with these disorders. Across 11 populations, NCDs were associated with increased refined carbohydrates more than increased calories, reduced activity or other factors, but cannot be attributed to SFA or total fat consumption.

Diversity in citations to a single study: A citation context network analysis of how evidence from a prospective cohort study was cited

Between its origin in the 1950s and its endorsement by a consensus conference in 1984, the diet–heart hypothesis was the subject of intense controversy. Paul et al. (1963) is a highly cited prospective cohort study that reported findings inconvenient for this hypothesis, reporting no association between diet and heart disease; however, many other findings were also reported. By citation context and network analysis of 343 citing papers, I show how Paul et al. was cited in the 20 years after its publication. Generally, different findings were cited by different communities focusing on different risk factors; these communities were established by either research foci title terms or via cluster membership as established via modularity maximization. The most frequently cited findings were the significant associations between heart disease and serum cholesterol (n = 85), blood pressure (n = 57), and coffee consumption (n = 54). The lack of association between diet and heart disease was cited in just 41 papers. Yet, no single empirical finding was referred to in more than 25% of the citing papers. This raises questions about the value of inferring impact from citation counts alone and raises problems for studies using such counts to measure citation bias.

The association of 14-year dietary cholesterol trajectories with the risk of cardio-metabolic diseases, all-cause mortality and serum lipids

OBJECTIVES

The effect of dietary cholesterol consumption on health effects and serum lipids remains controversial. This study aimed to examine the association of dietary cholesterol trajectories over 14 years in China with the risk of cardio-metabolic diseases and all-cause mortality and serum lipids.

METHODS

This study used weighted longitudinal data of 8952 adults from the China Health and Nutrition Survey, and subgroup analyses included 5466 adults who provided blood samples. Latent class trajectory modelling was performed to examine cholesterol trajectories. Cox regression models and general linear regressions were performed to examine the association between trajectories and outcomes.

RESULTS

Compared to the participants with persistently low dietary cholesterol intake, participants with gradually increasing cholesterol intake throughout adulthood were more likely to have hypertension (HR = 1.14, 95% CI: 1.03, 1.28) and to die due to all causes (HR = 2.19, 95% CI: 1.57, 3.05). Moreover, participants with persistently high cholesterol intake were more likely to die due to all causes (HR = 2.26, 95% CI 1.47, 3.47). The total cholesterol (TC):HDL-cholesterol (HDL-C) ratio and apolipoprotein B (ApoB) in these two groups were also significantly elevated compared to the group with persistently low dietary cholesterol intake (all P < 0.05). An association between trajectories of cholesterol and the incidence of diabetes was also observed; however, such an association became non significant after additional adjustment for other nutrients, food consumption and social environment.

CONCLUSIONS

Gradually increasing or persistently high cholesterol consumption throughout adulthood was significantly associated with an increased risk of hypertension and all-cause mortality with elevated serum lipids.

Controversies and discrepancies in the effect of dietary fat and cholesterol on cardiovascular risk

Cardiovascular disease (CVD) is the leading cause of death worldwide. The top ten causes of death in Singapore include many cardiovascular-related diseases such as ischaemic heart disease. The increasing prevalence of CVD poses a burden to both the economy and healthcare system of a country. Dietary habits, in particular dietary fats and cholesterol intake, have been shown to greatly influence CVD risks. Therefore, reference and adherence to relevant dietary guidelines could be crucial in CVD prevention. Recent research findings have provided novel insights into the relationship between certain dietary fats or cholesterol intake and CVD risks, challenging or reinforcing previous guidelines. These findings may, however, be conflicting, and there are still controversies over the effects of dietary fats and cholesterol as well as their association with cardiovascular risk. This review paper aims to evaluate common controversies, identify gaps in relevant research areas and summarise evidence-based dietary recommendations.

Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association

The elimination of specific dietary cholesterol target recommendations in recent guidelines has raised questions about its role with respect to cardiovascular disease. This advisory was developed after a review of human studies on the relationship of dietary cholesterol with blood lipids, lipoproteins, and cardiovascular disease risk to address questions about the relevance of dietary cholesterol guidance for heart health. Evidence from observational studies conducted in several countries generally does not indicate a significant association with cardiovascular disease risk. Although meta-analyses of intervention studies differ in their findings, most associate intakes of cholesterol that exceed current average levels with elevated total or low-density lipoprotein cholesterol concentrations. Dietary guidance should focus on healthy dietary patterns (eg, Mediterranean-style and DASH [Dietary Approaches to Stop Hypertension]–style diets) that are inherently relatively low in cholesterol with typical levels similar to the current US intake. These patterns emphasize fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds, and liquid vegetable oils. A recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health.

A Positive Association Between Dietary Intake of Higher Cow's Milk-Fat Percentage and Non-High-Density Lipoprotein Cholesterol in Young Children

OBJECTIVES

To determine the association between cow's milk-fat and non-high-density lipoprotein (non-HDL) cholesterol, a marker of cardiovascular disease (CVD) risk in young children, and whether this association is mediated by the typical volume of cow's milk consumed.

STUDY DESIGN

A longitudinal study in 2- to 8-year-old children (n = 2890) was conducted through The Applied Research Group for Kids (TARGet Kids!), a practice-based research network in Toronto, Canada. Generalized estimating equations were used to examine the relationship between parent-reported cow's milk-fat percentage intake and serum non-HDL cholesterol concentrations as well as having high non-HDL cholesterol (≥3.75 mmol/L [145 mg/dL]), adjusting for covariates including age, sex, body mass index z score, breastfeeding duration, mother's ethnicity, and parental history of CVD. Bootstrap resampling (10 000 repetitions) was used to assess whether typical volume consumed mediated the association between cow's milk-fat percentage and non-HDL cholesterol.

RESULTS

In total, 156 (5.4%) had high non-HDL cholesterol. Each percent increase in cow's milk-fat was associated with a 0.035 mmol/L (1.35 mg/dL) (P < .001) and 0.024 mmol/L (0.92 mg/dL) (P = .01) increase in non-HDL cholesterol, unadjusted and adjusted for covariates respectively. Cow's milk-fat percentage was not associated with greater odds of having high non-HDL cholesterol. Volume of cow's milk partially mediated the association between cow's milk-fat percentage and non-HDL cholesterol, accounting for 28% of the relationship (P < .001).

CONCLUSIONS

Consumption of higher-fat cow's milk was associated with a small increase in non-HDL cholesterol but not greater odds of having high non-HDL cholesterol. Further research is needed to assess this relationship with other CVD risk factors in young children.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01869530.

Omega-6 fats for the primary and secondary prevention of cardiovascular disease

BACKGROUND

Omega-6 fats are polyunsaturated fats vital for many physiological functions, but their effect on cardiovascular disease (CVD) risk is debated.

OBJECTIVES

To assess effects of increasing omega-6 fats (linoleic acid (LA), gamma-linolenic acid (GLA), dihomo-gamma-linolenic acid (DGLA) and arachidonic acid (AA)) on CVD and all-cause mortality.

SEARCH METHODS

We searched CENTRAL, MEDLINE and Embase to May 2017 and clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform to September 2016, without language restrictions. We checked trials included in relevant systematic reviews.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing higher versus lower omega-6 fat intake in adults with or without CVD, assessing effects over at least 12 months. We included full texts, abstracts, trials registry entries and unpublished studies. Outcomes were all-cause mortality, CVD mortality, CVD events, risk factors (blood lipids, adiposity, blood pressure), and potential adverse events. We excluded trials where we could not separate omega-6 fat effects from those of other dietary, lifestyle or medication interventions.

DATA COLLECTION AND ANALYSIS

Two authors independently screened titles/abstracts, assessed trials for inclusion, extracted data, and assessed risk of bias of included trials. We wrote to authors of included studies. Meta-analyses used random-effects analysis, while sensitivity analyses used fixed-effects and limited analyses to trials at low summary risk of bias. We assessed GRADE quality of evidence for 'Summary of findings' tables.

MAIN RESULTS

We included 19 RCTs in 6461 participants who were followed for one to eight years. Seven trials assessed the effects of supplemental GLA and 12 of LA, none DGLA or AA; the omega-6 fats usually displaced dietary saturated or monounsaturated fats. We assessed three RCTs as being at low summary risk of bias.Primary outcomes: we found low-quality evidence that increased intake of omega-6 fats may make little or no difference to all-cause mortality (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.88 to 1.12, 740 deaths, 4506 randomised, 10 trials) or CVD events (RR 0.97, 95% CI 0.81 to 1.15, 1404 people experienced events of 4962 randomised, 7 trials). We are uncertain whether increasing omega-6 fats affects CVD mortality (RR 1.09, 95% CI 0.76 to 1.55, 472 deaths, 4019 randomised, 7 trials), coronary heart disease events (RR 0.88, 95% CI 0.66 to 1.17, 1059 people with events of 3997 randomised, 7 trials), major adverse cardiac and cerebrovascular events (RR 0.84, 95% CI 0.59 to 1.20, 817 events, 2879 participants, 2 trials) or stroke (RR 1.36, 95% CI 0.45 to 4.11, 54 events, 3730 participants, 4 trials), as we assessed the evidence as being of very low quality. We found no evidence of dose-response or duration effects for any primary outcome, but there was a suggestion of greater protection in participants with lower baseline omega-6 intake across outcomes.Additional key outcomes: we found increased intake of omega-6 fats may reduce myocardial infarction (MI) risk (RR 0.88, 95% CI 0.76 to 1.02, 609 events, 4606 participants, 7 trials, low-quality evidence). High-quality evidence suggests increasing omega-6 fats reduces total serum cholesterol a little in the long term (mean difference (MD) -0.33 mmol/L, 95% CI -0.50 to -0.16, I² = 81%; heterogeneity partially explained by dose, 4280 participants, 10 trials). Increasing omega-6 fats probably has little or no effect on adiposity (body mass index (BMI) MD -0.20 kg/m², 95% CI -0.56 to 0.16, 371 participants, 1 trial, moderate-quality evidence). It may make little or no difference to serum triglycerides (MD -0.01 mmol/L, 95% CI -0.23 to 0.21, 834 participants, 5 trials), HDL (MD -0.01 mmol/L, 95% CI -0.03 to 0.02, 1995 participants, 4 trials) or low-density lipoprotein (MD -0.04 mmol/L, 95% CI -0.21 to 0.14, 244 participants, 2 trials, low-quality evidence).

AUTHORS' CONCLUSIONS

This is the most extensive systematic assessment of effects of omega-6 fats on cardiovascular health, mortality, lipids and adiposity to date, using previously unpublished data. We found no evidence that increasing omega-6 fats reduces cardiovascular outcomes other than MI, where 53 people may need to increase omega-6 fat intake to prevent 1 person from experiencing MI. Although benefits of omega-6 fats remain to be proven, increasing omega-6 fats may be of benefit in people at high risk of MI. Increased omega-6 fats reduce serum total cholesterol but not other blood fat fractions or adiposity.

Omega-6 fats for the primary and secondary prevention of cardiovascular disease

BACKGROUND

Omega-6 fats are polyunsaturated fats vital for many physiological functions, but their effect on cardiovascular disease (CVD) risk is debated.

OBJECTIVES

To assess effects of increasing omega-6 fats (linoleic acid (LA), gamma-linolenic acid (GLA), dihomo-gamma-linolenic acid (DGLA) and arachidonic acid (AA)) on CVD and all-cause mortality.

SEARCH METHODS

We searched CENTRAL, MEDLINE and Embase to May 2017 and clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform to September 2016, without language restrictions. We checked trials included in relevant systematic reviews.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing higher versus lower omega-6 fat intake in adults with or without CVD, assessing effects over at least 12 months. We included full texts, abstracts, trials registry entries and unpublished studies. Outcomes were all-cause mortality, CVD mortality, CVD events, risk factors (blood lipids, adiposity, blood pressure), and potential adverse events. We excluded trials where we could not separate omega-6 fat effects from those of other dietary, lifestyle or medication interventions.

DATA COLLECTION AND ANALYSIS

Two authors independently screened titles/abstracts, assessed trials for inclusion, extracted data, and assessed risk of bias of included trials. We wrote to authors of included studies. Meta-analyses used random-effects analysis, while sensitivity analyses used fixed-effects and limited analyses to trials at low summary risk of bias. We assessed GRADE quality of evidence for 'Summary of findings' tables.

MAIN RESULTS

We included 19 RCTs in 6461 participants who were followed for one to eight years. Seven trials assessed the effects of supplemental GLA and 12 of LA, none DGLA or AA; the omega-6 fats usually displaced dietary saturated or monounsaturated fats. We assessed three RCTs as being at low summary risk of bias.Primary outcomes: we found low-quality evidence that increased intake of omega-6 fats may make little or no difference to all-cause mortality (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.88 to 1.12, 740 deaths, 4506 randomised, 10 trials) or CVD events (RR 0.97, 95% CI 0.81 to 1.15, 1404 people experienced events of 4962 randomised, 7 trials). We are uncertain whether increasing omega-6 fats affects CVD mortality (RR 1.09, 95% CI 0.76 to 1.55, 472 deaths, 4019 randomised, 7 trials), coronary heart disease events (RR 0.88, 95% CI 0.66 to 1.17, 1059 people with events of 3997 randomised, 7 trials), major adverse cardiac and cerebrovascular events (RR 0.84, 95% CI 0.59 to 1.20, 817 events, 2879 participants, 2 trials) or stroke (RR 1.36, 95% CI 0.45 to 4.11, 54 events, 3730 participants, 4 trials), as we assessed the evidence as being of very low quality. We found no evidence of dose-response or duration effects for any primary outcome, but there was a suggestion of greater protection in participants with lower baseline omega-6 intake across outcomes.Additional key outcomes: we found increased intake of omega-6 fats may reduce myocardial infarction (MI) risk (RR 0.88, 95% CI 0.76 to 1.02, 609 events, 4606 participants, 7 trials, low-quality evidence). High-quality evidence suggests increasing omega-6 fats reduces total serum cholesterol a little in the long term (mean difference (MD) -0.33 mmol/L, 95% CI -0.50 to -0.16, I2 = 81%; heterogeneity partially explained by dose, 4280 participants, 10 trials). Increasing omega-6 fats probably has little or no effect on adiposity (body mass index (BMI) MD -0.20 kg/m2, 95% CI -0.56 to 0.16, 371 participants, 1 trial, moderate-quality evidence). It may make little or no difference to serum triglycerides (MD -0.01 mmol/L, 95% CI -0.23 to 0.21, 834 participants, 5 trials), HDL (MD -0.01 mmol/L, 95% CI -0.03 to 0.02, 1995 participants, 4 trials) or low-density lipoprotein (MD -0.04 mmol/L, 95% CI -0.21 to 0.14, 244 participants, 2 trials, low-quality evidence).

AUTHORS' CONCLUSIONS

This is the most extensive systematic assessment of effects of omega-6 fats on cardiovascular health, mortality, lipids and adiposity to date, using previously unpublished data. We found no evidence that increasing omega-6 fats reduces cardiovascular outcomes other than MI, where 53 people may need to increase omega-6 fat intake to prevent 1 person from experiencing MI. Although benefits of omega-6 fats remain to be proven, increasing omega-6 fats may be of benefit in people at high risk of MI. Increased omega-6 fats reduce serum total cholesterol but not other blood fat fractions or adiposity.

Nutrition and Cardiovascular Disease-an Update

PURPOSE OF REVIEW

This review summarizes recent developments in nutrition and cardiovascular disease (CVD) prevention.

RECENT FINDINGS

Contemporary dietary guidance recommends healthy dietary patterns with emphasis on food-based recommendations because the totality of the diet (i.e., the combinations and quantities of foods and nutrients consumed) is an important determinant of health. In many guidelines, recommendations are still made for saturated fat, added sugar, sodium, and dietary cholesterol because these are over-consumed by many people and are related to chronic disease development. Epidemiological research illustrates the importance of considering the total diet and the interrelatedness of nutrients in a dietary pattern. Traditionally, epidemiological research focused on individual nutrients in isolation, which can result in erroneous conclusions. An example of this, which has led to substantial controversy, is the evidence from studies evaluating the association between saturated fat and CVD without considering the replacement nutrient. Another controversial topic is the relationship between dietary cholesterol and CVD, which is confounded by saturated fat intake. Finally, the totality of evidence shows that high sodium intake is associated with greater CVD risk; however, some epidemiological research has suggested that a low-sodium intake is detrimental, which has caused some controversy. Overall, this reductionist approach has led to a debate about recommendations for saturated fat, cholesterol, and sodium. However, if approaches that accounted for the interrelatedness of nutrients had been taken, it is likely that there would be less controversy about these nutrients. To encourage dietary pattern-based approaches and consideration of total intake, dietary guidelines should emphasize food-based recommendations that meet nutrient targets. Thus, nutrient targets should underpin food-based dietary guidelines, and recommended dietary patterns should comply with nutrient-based targets. The evidence reviewed shows that it is imperative to consider total dietary patterns for CVD prevention. Dietary guidance should be aligned with nutrient targets and recommendations should be food and dietary pattern based.

High Dietary Saturated Fat is Associated with a Low Risk of Intracerebral Hemorrhage and Ischemic Stroke in Japanese but not in Non-Japanese: A Review and Meta-Analysis of Prospective Cohort Studies

AIM

The associations between dietary saturated fatty acids and the risks of stroke subtypes in cohort studies were examined by a meta-analysis of separate ethnic Japanese and non-Japanese cohorts, and causes of their difference were elucidated.

METHOD

Log hazard ratio (HR) with 95% confidence interval (CI) of the highest versus the lowest saturated fat intake from cohort studies were weighed by an inverse variance method to combine HRs.

RESULTS

Five studies of intracerebral hemorrhage and 11 studies/comparisons of ischemic stroke were selected. A meta-analysis of intracerebral hemorrhage excluding subarachnoid hemorrhage showed a strong inverse association in Japanese (n=3, HR=0.55, 95% CI 0.32-0.94) but not in non-Japanese (n=2, HR=0.98, 95% CI 0.62-1.53). A meta-analysis of ischemic stroke showed a mild inverse association in Japanese (n=4, HR=0.82, 95% CI 0.71-0.93) but not in non-Japanese (n=7, HR= 0.93, 95% CI 0.84-1.03). The effect size of saturated fat in reducing the risk of stroke in Japanese was stronger for intracerebral hemorrhage (45% reduction) than for ischemic stroke (18% reduction).

CONCLUSIONS

In Japanese but not in non-Japanese, a diet high in saturated fat is associated with a low risk of intracerebral hemorrhage and ischemic stroke. This may be due to differences in the range of intake of saturated fat, genetic susceptibility, incidence of lacunar infarction, and/or confounding factors such as dietary proteins. An intervention study targeting Japanese will be required to verify the causality.

Setting the Lipid Component of the Diet: A Work in Process

Some of the most relevant yet controversial issues in nutrition are those surrounding the guidelines on quality and quantity of dietary fat in the prevention and treatment of cardiovascular diseases and coronary heart diseases. Conflicting evidence questions the credibility of the previous dietary guidelines, particularly the quality of the evidence on which these recommendations were based. It is therefore important to explore the changes that have occurred in these guidelines and their influence on the adoption of different dietary patterns over time. In this review, we summarize the evolution of the fat component of the dietary guidelines, discuss controversial aspects, and highlight the areas in which additional evidence is still needed. Over the years, the scientific community has shown an obsession for calories in a diet instead of focusing on the quality of the food that makes up the diet. This is why certain authors have identified the importance of evaluating a diet focusing on diet patterns, rather than single isolated nutrients. This approach has been proposed in the most recent Dietary Guidelines for Americans.

The Association of Bread and Rice with Metabolic Factors in Type 2 Diabetic Patients

Purpose

Carbohydrates are shown to have an important role in blood glucose control, type 2 diabetes and cardiovascular diseases risk. This is even more challenging when considering populations consuming refined grains diets. Bread and rice are staple foods which supply main proportion of Iranian calorie intake. This study was designed to investigate the effect of bread and rice intake on blood glucose control, lipid profile and anthropometric measurements in Iranian type 2 diabetic patients.

Methods

426 patients with type 2 diabetes were included in this study. Anthropometric measurements were done using standard methods. Dietary information was assessed by a valid and reliable food frequency questionnaire (FFQ). Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), serum triglycride (TG), total cholesterol (TC), low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol were examined after 12-hour fasting.

Results

The results represented that people in the highest tertile compared to the lowest tertile of calorie adjusted total bread intake have higher FBG. FBG in the highest tertile of calorie adjusted total bread-rice intake was also significantly higher than the lowest. The association remained significant after adjusting for potential confounders. Rice intake showed no association with cardio-metabolic risk factors.

Conclusion

We founded that higher total bread intake and total bread-rice intake were associated with FBG in type 2 diabetic patients whereas rice intake was not associated with glucose and lipid profile. This result should be confirmed in prospective studies, considering varieties, glycemic index (GI), glycemic load (GL) and cooking method of bread and rice.

Can wheat germ have a beneficial effect on human health? A study protocol for a randomised crossover controlled trial to evaluate its health effects

INTRODUCTION

Cardiovascular diseases (CVD) are the leading cause of mortality worldwide and diet is an important contributor to CVD risk. Thus, several food derivatives are being investigated for their beneficial impact on reducing cardiometabolic risk factors, either in risk groups or in healthy population as a preventive measure. Wheat germ is a food by-product with high nutritional value, especially as a concentrated source of dietary fibre and essential fatty acids, but its incorporation into the diet has been rare up to now. Previous studies do not clarify the hypothesised potential causal relationship between the consumption of wheat germ and benefits for human health.

METHODS AND ANALYSIS

We are conducting a randomised, double-blinded, crossover, placebo-controlled clinical trial designed to assess the physiological effects of daily consumption of wheat germ-enriched bread (containing 6 g of wheat germ) compared with non-enriched bread, over a 4-week period with a 15-week follow-up, in a healthy human population. A total of 55 participants (healthy volunteers, aged 18-60) have been recruited from the Porto metropolitan area in northern Portugal. Our aim is to evaluate the health effects of wheat germ on blood cholesterol and triglycerides, postprandial glycaemic response, gastrointestinal function and discomfort, and changes in intestinal microbiota and insulin resistance as secondary outcomes. The study follows the best practices for evaluating health claims in food according to the European Food Safety Authority (EFSA) scientific opinion, namely random allocation, double blinding, reporting methods to measure and maximise compliance, and validated outcomes with beneficial physiological effects as recommended by EFSA.

ETHICS AND DISSEMINATION

The study has been approved by the Health Ethics Committee of São João Hospital Centre (156-15) and the Ethics Committee of Faculty of Medicine of the University of Porto (PCEDCSS-FMUP07/2015). Results will be disseminated through peer-reviewed publications and presentations at international scientific meetings.

TRIAL REGISTRATION NUMBER

NCT02405507; pre-results.

Behavioral Medicine in Primary Prevention

This article is a selective overview of behavioral medicine approaches to primary prevention. The main areas of discussion concern addictive behaviors and dietary factors. Overall, traditional educational approaches appear to succeed in altering understanding of these problems, but are less effective in actual prevention. More recently, behavioral medicine efforts, which focus on psychological and social influences, have demonstrated encouraging results. However, further systematic research is needed on these promising approaches before definitive conclusions can be drawn. Suggestions are provided for future primary prevention efforts as well as discernment of important mediating variables.

Genome-wide meta-analyses identify novel loci associated with n-3 and n-6 polyunsaturated fatty acid levels in Chinese and European-ancestry populations

Epidemiological studies suggest that levels of n-3 and n-6 long-chain polyunsaturated fatty acids are associated with risk of cardio-metabolic outcomes across different ethnic groups. Recent genome-wide association studies in populations of European ancestry have identified several loci associated with plasma and/or erythrocyte polyunsaturated fatty acids. To identify additional novel loci, we carried out a genome-wide association study in two population-based cohorts consisting of 3521 Chinese participants, followed by a trans-ethnic meta-analysis with meta-analysis results from 8962 participants of European ancestry. Four novel loci (MYB, AGPAT4, DGAT2 and PPT2) reached genome-wide significance in the trans-ethnic meta-analysis (log10(Bayes Factor) ≥ 6). Of them, associations of MYB and AGPAT4 with docosatetraenoic acid (log10(Bayes Factor) = 11.5 and 8.69, respectively) also reached genome-wide significance in the Chinese-specific genome-wide association analyses (P = 4.15 × 10(-14) and 4.30 × 10(-12), respectively), while associations of DGAT2 with gamma-linolenic acid (log10(Bayes Factor) = 6.16) and of PPT2 with docosapentaenoic acid (log10(Bayes Factor) = 6.24) were nominally significant in both Chinese- and European-specific genome-wide association analyses (P ≤ 0.003). We also confirmed previously reported loci including FADS1, NTAN1, NRBF2, ELOVL2 and GCKR. Different effect sizes in FADS1 and independent association signals in ELOVL2 were observed. These results provide novel insight into the genetic background of polyunsaturated fatty acids and their differences between Chinese and European populations.

Revisiting Human Cholesterol Synthesis and Absorption: The Reciprocity Paradigm and its Key Regulators

Hypercholesterolemia is a major risk factor for cardiovascular disease. Cholesterol homeostasis in the body is governed by the interplay between absorption, synthesis, and excretion or conversion of cholesterol into bile acids. A reciprocal relationship between cholesterol synthesis and absorption is known to regulate circulating cholesterol in response to dietary or therapeutic interventions. However, the degree to which these factors affect synthesis and absorption and the extent to which one vector shifts in response to the other are not thoroughly understood. Also, huge inter-individual variability exists in the manner in which the two systems act in response to any cholesterol-lowering treatment. Various factors are known to account for this variability and in light of recent experimental advances new players such as gene-gene interactions, gene-environmental effects, and gut microbiome hold immense potential in offering an explanation to the complex traits of inter-individual variability in human cholesterol metabolism. In this context, the objective of the present review is to provide an overview on cholesterol metabolism and discuss the role of potential factors such as genetics, epigenetics, epistasis, and gut microbiome, as well as other regulators in modulating cholesterol metabolism, especially emphasizing the reciprocal relationship between cholesterol synthesis and absorption. Furthermore, an evaluation of the implications of this push-pull mechanism on cholesterol-lowering strategies is presented.

Revisiting Human Cholesterol Synthesis and Absorption: The Reciprocity Paradigm and its Key Regulators

Hypercholesterolemia is a major risk factor for cardiovascular disease. Cholesterol homeostasis in the body is governed by the interplay between absorption, synthesis, and excretion or conversion of cholesterol into bile acids. A reciprocal relationship between cholesterol synthesis and absorption is known to regulate circulating cholesterol in response to dietary or therapeutic interventions. However, the degree to which these factors affect synthesis and absorption and the extent to which one vector shifts in response to the other are not thoroughly understood. Also, huge inter-individual variability exists in the manner in which the two systems act in response to any cholesterol-lowering treatment. Various factors are known to account for this variability and in light of recent experimental advances new players such as gene-gene interactions, gene-environmental effects, and gut microbiome hold immense potential in offering an explanation to the complex traits of inter-individual variability in human cholesterol metabolism. In this context, the objective of the present review is to provide an overview on cholesterol metabolism and discuss the role of potential factors such as genetics, epigenetics, epistasis, and gut microbiome, as well as other regulators in modulating cholesterol metabolism, especially emphasizing the reciprocal relationship between cholesterol synthesis and absorption. Furthermore, an evaluation of the implications of this push-pull mechanism on cholesterol-lowering strategies is presented.

Omega 6 fatty acids for the primary prevention of cardiovascular disease

BACKGROUND

Omega 6 plays a vital role in many physiological functions but there is controversy concerning its effect on cardiovascular disease (CVD) risk. There is conflicting evidence whether increasing or decreasing omega 6 intake results in beneficial effects.

OBJECTIVES

The two primary objectives of this Cochrane review were to determine the effectiveness of:1. Increasing omega 6 (Linoleic acid (LA), Gamma-linolenic acid (GLA), Dihomo-gamma-linolenic acid (DGLA), Arachidonic acid (AA), or any combination) intake in place of saturated or monounsaturated fats or carbohydrates for the primary prevention of CVD.2. Decreasing omega 6 (LA, GLA, DGLA, AA, or any combination) intake in place of carbohydrates or protein (or both) for the primary prevention of CVD.

SEARCH METHODS

We searched the following electronic databases up to 23 September 2014: the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library (Issue 8 of 12, 2014); MEDLINE (Ovid) (1946 to September week 2, 2014); EMBASE Classic and EMBASE (Ovid) (1947 to September 2014); Web of Science Core Collection (Thomson Reuters) (1990 to September 2014); Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database, and Health Economics Evaluations Database on the Cochrane Library (Issue 3 of 4, 2014). We searched trial registers and reference lists of reviews for further studies. We applied no language restrictions.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of interventions stating an intention to increase or decrease omega 6 fatty acids, lasting at least six months, and including healthy adults or adults at high risk of CVD. The comparison group was given no advice, no supplementation, a placebo, a control diet, or continued with their usual diet. The outcomes of interest were CVD clinical events (all-cause mortality, cardiovascular mortality, non-fatal end points) and CVD risk factors (changes in blood pressure, changes in blood lipids, occurrence of type 2 diabetes). We excluded trials involving exercise or multifactorial interventions to avoid confounding.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion, extracted the data, and assessed the risk of bias in the included trials.

MAIN RESULTS

We included four RCTs (five papers) that randomised 660 participants. No ongoing trials were identified. All included trials had at least one domain with an unclear risk of bias. There were no RCTs of omega 6 intake reporting CVD clinical events. Three trials investigated the effect of increased omega 6 intake on lipid levels (total cholesterol, low density lipoprotein (LDL-cholesterol), and high density lipoprotein (HDL-cholesterol)), two trials reported triglycerides, and two trials reported blood pressure (diastolic and systolic blood pressure). Two trials, one with two relevant intervention arms, investigated the effect of decreased omega 6 intake on blood pressure parameters and lipid levels (total cholesterol, LDL-cholesterol, and HDL-cholesterol) and one trial reported triglycerides. Our analyses found no statistically significant effects of either increased or decreased omega 6 intake on CVD risk factors.Two studies were supported by funding from the UK Food Standards Agency and Medical Research Council. One study was supported by Lipid Nutrition, a commercial company in the Netherlands and the Dutch Ministry of Economic Affairs. The final study was supported by grants from the Finnish Food Research Foundation, Finnish Heart Research Foundation, Aarne and Aili Turnen Foundation, and the Research Council for Health, Academy of Finland.

AUTHORS' CONCLUSIONS

We found no studies examining the effects of either increased or decreased omega 6 on our primary outcome CVD clinical endpoints and insufficient evidence to show an effect of increased or decreased omega 6 intake on CVD risk factors such as blood lipids and blood pressure. Very few trials were identified with a relatively small number of participants randomised. There is a need for larger well conducted RCTs assessing cardiovascular events as well as cardiovascular risk factors.

Fatty acids linked to cardiovascular mortality are associated with risk factors

Background

Although saturated fatty acids (FAs) have been linked to cardiovascular mortality, it is not clear whether this outcome is attributable solely to their effects on low-density lipoprotein cholesterol (LDL-C) or whether other risk factors are also associated with FAs. The Western Alaskan Native population, with its rapidly changing lifestyles, shift in diet from unsaturated to saturated fatty acids and dramatic increase in cardiovascular disease (CVD), presents an opportunity to elucidate any associations between specific FAs and known CVD risk factors.

Objective

We tested the hypothesis that the specific FAs previously identified as related to CVD mortality are also associated with individual CVD risk factors.

Methods

In this community-based, cross-sectional study, relative proportions of FAs in plasma and red blood cell membranes were compared with CVD risk factors in a sample of 758 men and women aged ≥35 years. Linear regression analyses were used to analyze relations between specific FAs and CVD risk factors (LDL-C, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, systolic blood pressure, diastolic blood pressure, heart rate, body mass index, fasting glucose and fasting insulin, 2-hour glucose and 2-hour insulin).

Results

The specific saturated FAs previously identified as related to CVD mortality, the palmitic and myristic acids, were adversely associated with most CVD risk factors, whereas unsaturated linoleic acid (18:2n-6) and the marine n-3 FAs were not associated or were beneficially associated with CVD risk factors.

Conclusions

The results suggest that CVD risk factors are more extensively affected by individual FAs than hitherto recognized, and that risk for CVD, MI and stroke can be reduced by reducing the intake of palmitate, myristic acid and simple carbohydrates and improved by greater intake of linoleic acid and marine n-3 FAs.

Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis

BACKGROUND

Dietary cholesterol has been suggested to increase the risk of cardiovascular disease (CVD), which has led to US recommendations to reduce cholesterol intake.

OBJECTIVE

The authors examine the effects of dietary cholesterol on CVD risk in healthy adults by using systematic review and meta-analysis.

DESIGN

MEDLINE, Cochrane Central, and Commonwealth Agricultural Bureau Abstracts databases were searched through December 2013 for prospective studies that quantified dietary cholesterol. Investigators independently screened citations and verified extracted data on study and participant characteristics, outcomes, and quality. Random-effect models meta-analysis was used when at least 3 studies reported the same CVD outcome.

RESULTS

Forty studies (17 cohorts in 19 publications with 361,923 subjects and 19 trials in 21 publications with 632 subjects) published between 1979 and 2013 were eligible for review. Dietary cholesterol was not statistically significantly associated with any coronary artery disease (4 cohorts; no summary RR), ischemic stroke (4 cohorts; summary RR: 1.13; 95% CI: 0.99, 1.28), or hemorrhagic stroke (3 cohorts; summary RR: 1.09; 95% CI: 0.79, 1.50). Dietary cholesterol statistically significantly increased both serum total cholesterol (17 trials; net change: 11.2 mg/dL; 95% CI: 6.4, 15.9) and low-density lipoprotein (LDL) cholesterol (14 trials; net change: 6.7 mg/dL; 95% CI: 1.7, 11.7 mg/dL). Increases in LDL cholesterol were no longer statistically significant when intervention doses exceeded 900 mg/d. Dietary cholesterol also statistically significantly increased serum high-density lipoprotein cholesterol (13 trials; net change: 3.2 mg/dL; 95% CI: 0.9, 9.7 mg/dL) and the LDL to high-density lipoprotein ratio (5 trials; net change: 0.2; 95% CI: 0.0, 0.3). Dietary cholesterol did not statistically significantly change serum triglycerides or very-low-density lipoprotein concentrations.

CONCLUSION

Reviewed studies were heterogeneous and lacked the methodologic rigor to draw any conclusions regarding the effects of dietary cholesterol on CVD risk. Carefully adjusted and well-conducted cohort studies would be useful to identify the relative effects of dietary cholesterol on CVD risk.

Dietary approaches for management of cardio-vascular health- a review

Dietary patterns of consumers have changed and the importance of diet as a therapeutic adjunct in the form of nutraceuticals has become the trend of the millennium. Major contributory factor behind this trend is the idea of improving health by modifying the diet that is more attractive to the health conscious consumer as compared to drugs. According to a recent report of WHO, prevalence of cardio vascular disease has increased progressively in the past few years. It has been estimated that one-fifth of deaths in India are due to coronary heart disease that is inflicting at a much younger age in Indians than in the West. Such an insight suggests that cardiac health needs protection. Food products containing functional ingredients that are useful in controlling various different diseases are expected to provide health benefits. Recent research indicates that foods rich in omega-3 fatty acids, antioxidant vitamins and fibres may be beneficial for cardio-vascular health.

Rice consumption is not associated with risk of cardiovascular disease morbidity or mortality in Japanese men and women: a large population-based, prospective cohort study

BACKGROUND

Rice consumption has been associated with risk of type 2 diabetes, but its relation with cardiovascular disease (CVD) is limited.

OBJECTIVE

We examined the association between rice consumption and risk of CVD incidence and mortality in a Japanese population.

DESIGN

This was a prospective study in 91,223 Japanese men and women aged 40-69 y in whom rice consumption was determined and updated from 3 self-administered food-frequency questionnaires, each 5 y apart. Follow-up for incidence was from 1990 to 2009 in cohort I and 1993 to 2007 in cohort II and for mortality was from 1990 to 2009 in cohort I and 1993 to 2009 in cohort II. HRs and 95% CIs of CVD incidence and mortality were calculated according to quintiles of cumulative average rice consumption.

RESULTS

In 15-18 y of follow-up, we ascertained 4395 incident cases of stroke, 1088 incident cases of ischemic heart disease (IHD), and 2705 deaths from CVD. Rice consumption was not associated with risk of incident stroke or IHD; the multivariable HR (95% CI) in the highest compared with lowest rice consumption quintiles was 1.01 (0.90, 1.14) for total stroke and 1.08 (0.84, 1.38) for IHD. Similarly, there was no association between rice consumption and risk of mortality from CVD; the HR (95% CI) for mortality from total CVD was 0.97 (0.84, 1.13). There were no interactions with sex or effect modifications by body mass index for any endpoint.

CONCLUSION

Rice consumption is not associated with risk of CVD morbidity or mortality.

Genome-wide association study of plasma N6 polyunsaturated fatty acids within the cohorts for heart and aging research in genomic epidemiology consortium

BACKGROUND

Omega6 (n6) polyunsaturated fatty acids (PUFAs) and their metabolites are involved in cell signaling, inflammation, clot formation, and other crucial biological processes. Genetic components, such as variants of fatty acid desaturase (FADS) genes, determine the composition of n6 PUFAs.

METHODS AND RESULTS

To elucidate undiscovered biological pathways that may influence n6 PUFA composition, we conducted genome-wide association studies and meta-analyses of associations of common genetic variants with 6 plasma n6 PUFAs in 8631 white adults (55% women) across 5 prospective studies. Plasma phospholipid or total plasma fatty acids were analyzed by similar gas chromatography techniques. The n6 fatty acids linoleic acid (LA), γ-linolenic acid (GLA), dihomo-GLA, arachidonic acid, and adrenic acid were expressed as percentage of total fatty acids. We performed linear regression with robust SEs to test for single-nucleotide polymorphism-fatty acid associations, with pooling using inverse-variance-weighted meta-analysis. Novel regions were identified on chromosome 10 associated with LA (rs10740118; P=8.1×10(-9); near NRBF2), on chromosome 16 with LA, GLA, dihomo-GLA, and arachidonic acid (rs16966952; P=1.2×10(-15), 5.0×10(-11), 7.6×10(-65), and 2.4×10(-10), respectively; NTAN1), and on chromosome 6 with adrenic acid after adjustment for arachidonic acid (rs3134950; P=2.1×10(-10); AGPAT1). We confirmed previous findings of the FADS cluster on chromosome 11 with LA and arachidonic acid, and further observed novel genome-wide significant association of this cluster with GLA, dihomo-GLA, and adrenic acid (P=2.3×10(-72), 2.6×10(-151), and 6.3×10(-140), respectively).

CONCLUSIONS

Our findings suggest that along with the FADS gene cluster, additional genes may influence n6 PUFA composition.

Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis

BACKGROUND

The associations of egg consumption with cardiovascular disease (CVD) and diabetes are still unclear.

OBJECTIVE

We aimed to quantitatively summarize the literature on egg consumption and risk of CVD, cardiac mortality, and type 2 diabetes by conducting a meta-analysis of prospective cohort studies.

DESIGN

A systematic literature review was conducted for published studies in PubMed and EMBASE through March 2012. Additional information was retrieved through Google or a hand review of the reference from relevant articles. Studies were included if they had a prospective study design, were published in English-language journals, and provided HRs and 95% CIs for the associations of interest. Data were independently extracted by 2 investigators, and the weighted HRs and 95% CIs for the associations of interest were estimated by using a random-effects model.

RESULTS

A total of 22 independent cohorts from 16 studies were identified, including participants ranging in number from 1600 to 90,735 and in follow-up time from 5.8 to 20.0 y. Comparison of the highest category (≥1 egg/d) of egg consumption with the lowest (<1 egg/wk or never) resulted in a pooled HR (95% CI) of 0.96 (0.88, 1.05) for overall CVD, 0.97 (0.86, 1.09) for ischemic heart disease, 0.93 (0.81, 1.07) for stroke, 0.98 (0.77, 1.24) for ischemic heart disease mortality, 0.92 (0.56, 1.50) for stroke mortality, and 1.42 (1.09, 1.86) for type 2 diabetes. Of the studies conducted in diabetic patients, the pooled HR (95% CI) was 1.69 (1.09, 2.62) for overall CVD.

CONCLUSIONS

This meta-analysis suggests that egg consumption is not associated with the risk of CVD and cardiac mortality in the general population. However, egg consumption may be associated with an increased incidence of type 2 diabetes among the general population and CVD comorbidity among diabetic patients.

[Assessment of the risk of ischemic heart disease and its relevant factors among Japanese police officers]

OBJECTIVES

Compared to other public employees, police officers have higher absence rates due to heart diseases, and ischemic heart disease (IHD) is one of the most frequent causes of death in their occupational life. The aim of this study was to investigate the prevalence of the risk factors for IHD among police officers and to examine its association with working conditions and lifestyles.

METHODS

First, 58 male police officers who developed IHD from 1996 to 2011 and 116 age- and rank-matched controls who were free from cerebro- and cardiovascular diseases were compared with respect to the prevalence of traditional risk factors five years before the onset of IHD. Then, the prevalence of IHD risk factors, and the frequency of metabolic syndrome (MetS) by age group, working condition and lifestyle were investigated in a cross-sectional survey of data of 1,539 male police officers and 153 male office workers in a prefectural police force.

RESULTS

In the case control study, the IHD cases had significantly higher prevalences of hypertension (p<0.001), hyper-LDL-cholesterolemia (p<0.05), glucose intolerance (p<0.05), and hyperuricemia (p<0.05) before the onset of IHD. Multiple logistic regression analysis revealed that hypertension (odds ratio [95% confidence interval] : 3.96 [1.82-8.59]), glucose intolerance (3.28 [1.34-8.03]), hypo-HDL-cholesterolemia (2.26 [1.03-4.97]), and hyper-LDL-cholesterolemia (2.18 [1.03-4.61]) were independently associated with the development of IHD (model chi-square, p<0.001; correct classification rate, 77.0%). In the cross sectional analyses, among the police officers, abdominal obesity (waist circumference of ≥ 85 cm) was significantly more frequent (57.3% vs. 35.3%, p<0.001) and the prevalence of dyslipidemia and glucose intolerance increased with age more remarkably than in the general office workers. In the age-group of 45-59 years, the clustering number of risk factors in individuals (1.8 vs. 1.4, p<0.01) and the frequency of MetS (25.0 vs. 15.5, p<0.1) were greater in the police officers than the office workers. Among the police officers, subjects with MetS had significantly higher rates of shift work (33.6% vs. 25.4%, p<0.01), lack of sound sleep (42.5% vs. 33.7%, p<0.01), and heavy drinking (12.8 vs. 6.3%, p<0.01) than those without MetS.

CONCLUSIONS

In this study, the development of IHD in police officers was significantly associated with traditional risk factors, especially with hypertension, dyslipidemia and glucose intolerance. The increase with age of the prevalence of IHD risk factors and the frequency of MetS were greater in police officers than office workers. Irregular working conditions, such as shift work, long working time, and unfavorable lifestyles, e.g. alcohol drinking and poor sleeping conditions, may influence the higher prevalence of risk factors for IHD in police officers.

Fiber-free white flour with fructose offers a better model of metabolic syndrome

Background

The metabolic syndrome (MS) is a combination of metabolic abnormalities that lead to an increased risk of cardiovascular diseases. Due to its rising incidence and demanding life-long use of multiple drugs, there is a growing interest in testing and developing new allopathic, complementary and alternative therapies for controlling or curing disorders of MS. The discovery of new therapeutic modalities requires animal models of disease and currently available models have limitations. Developing an appropriate animal model for MS to achieve various therapeutic targets remains a challenge and this study aims to develop a rat model which closely depicts MS in humans.

Methodology

Rat model of MS was developed by replacing 60% of diet with fructose. Four groups of Sprague–Dawley rats were either given whole wheat or refined flour with and without fructose for 8 weeks. Data were analyzed on SPSS and Graphpad Prism using ANOVA with Tukey’s and Bonferonni tests for multiple group comparison. A p-value of less than 0.05 was considered significant for differences between groups.

Results

Replacing whole wheat with refined wheat flour in rat chow in 60% fructose-fed Sprague–Dawley rats resulted in hypertension (p 0.01), hyper-insulinemia (p < 0.001), hyperglycemia (p 0.03) and a reduction in HDL levels (p 0.002) at 4 weeks while hyper-triglyceridemia (p 0.001) with endothelial dysfunction was observed at 8 weeks.

Conclusion

It is concluded that the refined wheat flour with 60% fructose in diet hastens the development of metabolic syndrome in 4 weeks and replacing whole wheat flour with refined flour in diet induces a more effective abnormality including a low HDL. Further studies may be directed to assess the associated pathological changes, which can be used to study the effect of different therapeutic modalities on an animal model of MS with low HDL.

Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies

Objective

Low-carbohydrate diets and their combination with high-protein diets have been gaining widespread popularity to control weight. In addition to weight loss, they may have favorable short-term effects on the risk factors of cardiovascular disease (CVD). Our objective was to elucidate their long-term effects on mortality and CVD incidence.

Data sources

MEDLINE, EMBASE, ISI Web of Science, Cochrane Library, and ClinicalTrials.gov for relevant articles published as of September 2012. Cohort studies of at least one year’s follow-up period were included.

Review methods

Identified articles were systematically reviewed and those with pertinent data were selected for meta-analysis. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for all-cause mortality, CVD mortality and CVD incidence were calculated using the random-effects model with inverse-variance weighting.

Results

We included 17 studies for a systematic review, followed by a meta-analysis using pertinent data. Of the 272,216 people in 4 cohort studies using the low-carbohydrate score, 15,981 (5.9%) cases of death from all-cause were reported. The risk of all-cause mortality among those with high low-carbohydrate score was significantly elevated: the pooled RR (95% CI) was 1.31 (1.07–1.59). A total of 3,214 (1.3%) cases of CVD death among 249,272 subjects in 3 cohort studies and 5,081 (2.3%) incident CVD cases among 220,691 people in different 4 cohort studies were reported. The risks of CVD mortality and incidence were not statistically increased: the pooled RRs (95% CIs) were 1.10 (0.98–1.24) and 0.98 (0.78–1.24), respectively. Analyses using low-carbohydrate/high-protein score yielded similar results.

Conclusion

Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not significantly associated with a risk of CVD mortality and incidence. However, this analysis is based on limited observational studies and large-scale trials on the complex interactions between low-carbohydrate diets and long-term outcomes are needed.

Missed opportunities for providing low-fat dietary advice to people with diabetes

Introduction

Because cardiovascular disease is closely linked to diabetes, national guidelines recommend low-fat dietary advice for patients who have cardiovascular disease or are at risk for diabetes. The prevalence of receiving such advice is not known. We assessed the lifetime prevalence rates of receiving low-fat dietary advice from a health professional and the relationship between having diabetes or risk factors for diabetes and receiving low-fat dietary advice.

Methods

From 2002 through 2009, 188,006 adults answered the following question in the Medical Expenditure Panel Survey: “Has a doctor or other health professional ever advised you to eat fewer high-fat or high-cholesterol foods?” We assessed the association between receiving advice and the following predictors: a diabetes diagnosis, 7 single risk factors for type 2 diabetes, and total number of risk factors.

Results

Among respondents without diabetes or risk factors for diabetes, 7.4% received low-fat dietary advice; 70.6% of respondents with diabetes received advice. Respondents with diabetes were almost twice as likely to receive advice as respondents without diabetes or its risk factors. As the number of risk factors increased, the likelihood of receiving low-fat dietary advice increased. Although unadjusted advice rates increased during the study period, the likelihood of receiving advice decreased.

Conclusion

Although most participants with diabetes received low-fat dietary advice, almost one-third did not. Low-fat dietary advice was more closely associated with the total number of diabetes risk factors than the presence of diabetes. Increasing rates of diabetes and diabetes risk factors are outpacing increases in provision of low-fat dietary advice.

Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases

The relative contribution of nutrition-related chronic diseases to the total disease burden of the society and the health care costs has risen continuously over the last decades. Thus, there is an urgent necessity to better exploit the potential of dietary prevention of diseases. Carbohydrates play a major role in human nutrition - next to fat, carbohydrates are the second biggest group of energy-yielding nutrients. Obesity, type 2 diabetes mellitus, dyslipoproteinaemia, hypertension, metabolic syndrome, coronary heart disease and cancer are wide-spread diseases, in which carbohydrates could have a pathophysiologic relevance. Correspondingly, modification of carbohydrate intake could have a preventive potential. In the present evidence-based guideline of the German Nutrition Society, the potential role of carbohydrates in the primary prevention of the named diseases was judged systematically. The major findings were: a high carbohydrate intake at the expense of total fat and saturated fatty acids reduces the concentrations of total, LDL and HDL cholesterol. A high carbohydrate consumption at the expense of polyunsaturated fatty acids increases total and LDL cholesterol, but reduces HDL cholesterol. Regardless of the type of fat being replaced, a high carbohydrate intake promotes an increase in the triglyceride concentration. Furthermore, a high consumption of sugar-sweetened beverages increases the risk of obesity and type 2 diabetes mellitus, whereas a high dietary fibre intake, mainly from whole-grain products, reduces the risk of obesity, type 2 diabetes mellitus, dyslipoproteinaemia, cardiovascular disease and colorectal cancer at varying evidence levels. The practical consequences for current dietary recommendations are presented.

Alterations in circulating fatty acid composition in patients with systemic lupus erythematosus: a pilot study

INTRODUCTION

Circulating fatty acids (FAs) may play a role in the disease pathogenesis of patients with systemic lupus erythematosus (SLE).

OBJECTIVES

To compare red blood cell (RBC) and plasma FA composition: (1) between female SLE patients and age-matched healthy female (HF) controls and in SLE with history of cardiovascular disease (CVD) and those with no history (SLE+CVD vs SLE-CVD); and (2) between SLE patients who were or were not receiving prednisone treatment at the time of blood sampling.

METHODS

This cross-sectional study consisted of 33 female patients with SLE (11 SLE+CVD, 22 SLE-CVD) and 20 HF controls. Demographics, CVD risk, medication profile, blood biochemistry, and FA composition of RBC and plasma total lipids were determined.

RESULTS

Waist circumference and body mass index were higher in SLE patients than in HF controls. These variables along with serum triglycerides, blood glucose, and systolic blood pressure were higher in SLE+CVD than SLE-CVD patients. RBC FA composition showed lower eicosapentaenoic acid (EPA, ω-3 active metabolite) and ω-3 index (EPA+ docosahexaenoic acid) in SLE patients compared with HF controls. The ratio of the RBC inflammatory metabolite, arachidonic acid, to the anti-inflammatory metabolite EPA was also significantly higher in SLE patients than in HF controls. No differences were seen in plasma FA between SLE and HF groups. However, SLE-CVD patients had a more favorable lipid profile than SLE+CVD patients. In SLE patients, the use of prednisone resulted in alteration of both RBC and plasma FA composition.

CONCLUSION

SLE patients, regardless of their history of CVD, have altered plasma and RBC FA composition favoring inflammation. The use of prednisone was associated with differences in FA profile.

The role of meat fat in the human diet

Food fat plays an important role in the human diet. On the one hand, fats provide the body with energy, contribute to the absorption of fat-soluble vitamins, and act as structural elements of cell walls. On the other hand, a high fat intake is associated with obesity, type 2 diabetes, cancer, and coronary heart disease. Animal fats, which contain a high proportion of saturated fatty acids, are often the focus of attention when it comes to reducing the share of fat in the diet. The present overview of the literature describes the amount of total fat and the percentage of individual fatty acid groups in meat and meat products, documents the contribution of meat and meat products to fat intake, and investigates the connection between meat fat and various diseases. The information given is based mainly on data material from Switzerland; data from other countries have been included for comparison.

Rice intake is associated with reduced risk of mortality from cardiovascular disease in Japanese men but not women

Rice is a staple food in Japan and provides 43% of carbohydrate and 29% of energy intake in the Japanese population. In a prospective study encompassing 83,752 Japanese men and women aged 40-79 y, rice intake was determined by self-administered FFQ. Median follow-up time was 14.1 y from 1988-1990 to the end of 2003, and HR and 95% CI of mortality were calculated according to quintiles of energy-adjusted rice intake. A total of 3514 cardiovascular deaths [1640 strokes, 707 coronary heart disease (CHD), and 560 heart failure] were documented. There was a gender difference on the effect of rice intake on the risk of cardiovascular disease (CVD). Overall, rice intake was inversely associated with CHD, heart failure, and total CVD in men but not in women. Rice intake was not associated with risk of stroke in either gender. The multivariable HR (95% CI) for the extreme quintiles of rice intake in men were 0.70 [(0.49-0.99); P-trend = 0.02] for CHD, 0.70 [(0.46-1.05); P-trend = 0.05] for heart failure, and 0.82 [(0.70-0.97); P-trend = 0.006] for total CVD. For women, rice was not associated with reduced risk of mortality from CVD after adjusting for lifestyle and dietary variables. In conclusion, the consumption of steamed rice was associated with reduced risk of mortality from CVD in Japanese men but not women. This finding necessitates further investigations on the mechanisms leading to this gender difference.

Association between meat consumption and carotid intima-media thickness in Korean adults with metabolic syndrome

OBJECTIVES

The effect of meat consumption on cardiometabolic risk has been continuously studied, but their associations are not conclusive. The aim of this study is to examine the association between the consumption of meat or red meat and carotid intima-media thickness (IMT) in healthy Korean adults.

METHODS

This study evaluated 2374 community-dwelling adults (933 men and 1441 women) who were free of cardiovascular disease or cancer, living in a rural area in Korea. Total meat and red meat intakes were assessed with a validated 103 item-food frequency questionnaire. Carotid IMT was evaluated ultrasonographically, IMTmax was defined as the highest value among IMT of bilateral common carotid arteries.

RESULTS

After adjustment for potential confounding factors, the mean IMTmax tended to increase in higher meat consumption groups in both men and women with metabolic syndrome (p for trend= 0.027 and 0.049, respectively), but not in participants without metabolic syndrome. Frequent meat consumption (≥5 servings/week) was significantly associated with higher IMTmax in men with metabolic syndrome (by 0.08 mm, p=0.015). Whereas, the association was not significant in women (by 0.05 mm, p=0.115). Similar but attenuated findings were shown with red meat intake.

CONCLUSIONS

Our findings suggest that a higher meat consumption may be associated with a higher carotid IMT in Korean adults with metabolic syndrome. The frequent meat consumption (≥5 servings/week), compared with the others, was associated with a higher carotid IMTmax only in men with metabolic syndrome. Further research is required to explore optimal meat consumption in people with specific medical conditions.

Dietary cholesterol: from physiology to cardiovascular risk

Dietary cholesterol comes exclusively from animal sources, thus it is naturally present in our diet and tissues. It is an important component of cell membranes and a precursor of bile acids, steroid hormones and vitamin D. Contrary to phytosterols (originated from plants), cholesterol is synthesised in the human body in order to maintain a stable pool when dietary intake is low. Given the necessity for cholesterol, very effective intestinal uptake mechanisms and enterohepatic bile acid and cholesterol reabsorption cycles exist; conversely, phytosterols are poorly absorbed and, indeed, rapidly excreted. Dietary cholesterol content does not significantly influence plasma cholesterol values, which are regulated by different genetic and nutritional factors that influence cholesterol absorption or synthesis. Some subjects are hyper-absorbers and others are hyper-responders, which implies new therapeutic issues. Epidemiological data do not support a link between dietary cholesterol and CVD. Recent biological data concerning the effect of dietary cholesterol on LDL receptor-related protein may explain the complexity of the effect of cholesterol on CVD risk.