Impact of dietary patterns and interventions on cardiovascular health

The Combined Effects of the Most Important Dietary Patterns on the Incidence and Prevalence of Chronic Renal Failure: Results from the US National Health and Nutrition Examination Survey and Mendelian Analyses

BACKGROUND

We aimed to comprehensively assess the relationship of specific dietary patterns and various nutrients with chronic kidney disease (CKD) and its progression.

METHODS

The observational study data were from the NHANES 2005-2020. We calculated four dietary pattern scores (healthy eating index 2020 (HEI-2020), dietary inflammatory index (DII), alternative mediterranean diet (aMed), and dietary approaches to stop hypertension (DASH)) and the intakes of various nutrients and defined CKD, CKD-very high risk, and kidney dialysis. Associations between dietary patterns and nutrients and disease were assessed by means of two logistic regression models. Two-sample MR was performed with various food and nutrients as the exposure and CKD, kidney dialysis as the outcome. Sensitivity analyses were conducted to verify the reliability of the results.

RESULTS

A total of 25,167 participants were included in the analyses, of whom 4161 had CKD. HEI-2020, aMed, and DASH were significantly negatively associated with CKD and CKD-very high risk at higher quartiles, while DII was significantly positively associated. A higher intake of vitamins and minerals may reduce the incidence and progression of CKD to varying degrees. The MR results, corrected for false discovery rates, showed that a higher sodium intake was associated with a higher prevalence of CKD (OR: 3.91, 95%CI: 2.55, 5.99).

CONCLUSIONS

Adhering to the three dietary patterns of HEI-2020, aMed, and DASH and supplementing with vitamins and minerals benefits kidney health.

Mortality pattern trends and disparities among Chinese from 2004 to 2016

BACKGROUND

With the changes in environmental, medical technique, population structure and national health projects, human mortality rates have undergone great changes all over the world. According to "World Health Statistics 2016: Monitoring Health for the SDGs (Sustainable Development Goals)", we can draw a globally vision about life expectancy and cause of death; also, significant inequality still persists within and among countries. This study was designed to research into the trend of mortality pattern in China, evaluate the disparities of age-specific and disease-specific mortality rates between male and female, and provides a scientific basis for further prevention strategies and policies design.

METHODS

Data from the Chinese Disease Surveillance Points system were used to calculate crude and age-adjusted death rates, annual percent changes (APC) for men and women during 2004 to 2016. Age-standardized mortality rates (ASMR) were performed through the direct method with the World Health Organization's World Standard Population. APC, according to log linear model, was adopted to describe the mortality rate trend. The χ2 test was used to compare differences between age-specific and cause-specific mortality rates of men and women. Data analysis and figures were completed by R software.

RESULTS

The mortality rates of men and women have decreased significantly (P < 0.05) during 2004-2016, and the APC were1.98 and 2.45%, respectively. In 2016, the crude mortality rate (CMR) and ASMR in all causes of death were 658.50 and 490.28 per 100,000 per year, respectively. The 5 leading causes of death were malignant neoplasm, cerebrovascular disease, heart disease, COPD, and accidental injury. The mortality rates of men were higher than that of women in all age groups.

CONCLUSIONS

There are severe health gaps and disparities between male and female, and the chronic non-communicable diseases continue to be a serious health threat to Chinese residents.

Pros & cons of some popular extreme weight-loss diets

Obesity has now become a huge public health issue not only in the developed world but also in developing countries. In view of the health hazards associated with obesity and more importantly for cosmetic reasons, many people, particularly the youth, have started resorting to 'extreme' weight-loss diets to achieve a rapid reduction in weight. These extreme diets are either very low in carbohydrate or very low in fat. Such extreme diets not only make the diet unbalanced but also have safety issues. Moreover, these are not sustainable in the long run. The weight that is lost is regained within a short period of time when people go off these extreme diets. This explains why the popularity of most extreme diets peaks as well as wanes rapidly. Instead of resorting to such extreme diets, correction of obesity is best achieved with balanced, healthy, nutritious diets which are low in calories, combined with adequate physical activity (exercise). Motivational counselling can also help people to initiate weight loss and sustain this weight loss over longer periods of time.

Effect of nutrient deprivation on the expression and the epigenetic signature of sirtuin genes

BACKGROUND AND AIM

Over the last decades advances in understanding the molecular bases of the close relationship between nutrition, metabolism, and diseases have been impressive. However, there are always novel frontiers coming up and epigenetics is one of these. Sirtuins, are pivotal factors in the control of metabolic pathways according to nutrient availability. In the present study we evaluated the effect of nutrient deprivation on expression, DNA methylation and chromatin status of the sirtuin genes.

METHODS AND RESULTS

We performed these studies in mouse hepatoma cells, that were grown in standard medium, or in media containing low glucose concentration, or no glucose, or no amino acids. We applied quantitative real-time PCR to cDNA, methylation-enriched DNA and nuclease-treated DNA in order to evaluate gene expression, DNA methylation, and chromatin condensation, respectively. This study shows that the expression of sirtuin genes varies following nutrient deprivation. Moreover, we observed that changes of DNA methylation and chromatin condensation occur at the transcription start site of sirtuin genes following nutrient deprivation.

CONCLUSIONS

Epigenetic mechanisms may have a role in the sirtuin response to nutrient deprivations in cultured hepatoma cells. Replicating these results in vivo to achieve a comprehensive understanding of the epigenetic control of sirtuin expression following nutrient deprivations might open up novel therapeutic possibilities to cure metabolic diseases and promote human health.

Dietary Patterns and Long-Term Survival: A Retrospective Study of Healthy Primary Care Patients

BACKGROUND

Dietary patterns are related to mortality in selected populations with comorbidities. We studied whether dietary patterns are associated with long-term survival in a middle-aged, healthy population.

METHODS

In this observational cohort study at the Cooper Clinic preventive medicine center (Dallas, Tex), a volunteer sample of 11,376 men and women with no history of myocardial infarction or stroke completed a baseline dietary assessment between 1987 and 1999 and were observed for an average of 18 years. Proportional hazard regressions, including a tree-augmented model, were used to assess the association of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, Mediterranean dietary pattern, and individual dietary components with mortality. The primary outcome was all-cause mortality. The secondary outcome was cardiovascular mortality.

RESULTS

Mean baseline age was 47 years. Each quintile increase in the DASH diet score was associated with a 6% lower adjusted risk for all-cause mortality (P < .02). The Mediterranean diet was not independently associated with all-cause or cardiovascular mortality. Solid fats and added sugars were the most predictive of mortality. Individuals who consumed >34% of their daily calories as solid fats had the highest risk for all-cause mortality.

CONCLUSIONS

The DASH dietary pattern was associated with significantly lower all-cause mortality over approximately 2 decades of follow-up in a middle-aged, generally healthy population. Added solid fat and added sugar intake were the most predictive of all-cause mortality. These results suggest that promotion of a healthy dietary pattern should begin in middle age, before the development of comorbid risk factors.

Cytotoxic, Antimitotic, and Antiproliferation Studies on Rasam: A South Indian Traditional Functional Food

Background

Rasam is a traditional South Indian food, prepared using tamarind juice as a base, with a variety of spices. Rasam, with all its ingredients medicinally claimed for various ailments, is a functional food. Systematic consumption of traditional functional food provides an excellent preventive measure to ward off many diseases.

Objective

To study rasam for cytotoxic, antimitotic, and antiproliferation potential beyond its culinary and nutritional effect.

Materials and Methods

Brine shrimp lethality assay, onion root tip inhibition assay, and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay in Calu-6, HeLa, MCF-7 cell lines for four stage-wise samples in the preparation of rasam (RS1, RS2, RS3, and RS4) were studied.

Results

RS4, the end product of rasam showed high lethality with an LC₅₀ value of 38.7 μL/mL. It showed maximum antimitotic activity in a dose-dependent manner compared to other samples with an IC₅₀ value of 189.86 μL/mL. RS4 also showed an IC₅₀ value of 350.22 and 410.15 μL/mL in MCF-7 and Calu-6 cell lines, respectively.

Conclusion

From this study, we suggest that rasam is a classic example of traditional functional food and it can treat breast and lung cancer on chronic use.

SUMMARY

Rasam, a South Indian traditional functional food, showed high lethality (LC₅₀ = 38.7 mL/mL) against brine shrimpsRasam also showed potential antimitotic activity (IC₅₀ = 189.86 mL/mL) by inhibiting the onion root tipsRasam showed an IC₅₀ value of 350.22 and 410.15 mL/mL against MCF-7 and Calu-6 cell lines respectivelyRasam, when consumed on daily dietary basis, can treat breast and lung cancer. Abbreviations used: SS 316: Stainless Steel 316 grade; MTT: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide; DMEM: Dulbecco's modified Eagle medium; FBS: Fetal bovine serum media; TPVG: Trypsin phosphate versene glucose; EDTA: Ethylene diamine tetra acetic acid; PBS: Phosphate buffered saline; DMSO: Dimethyl sulfoxide.

Factors Affecting Dietary Practices in a Mississippi African American Community

This study examined the practices, personal motivation, and barriers of African American communities in Mississippi regarding their dietary practices. We selected the Metro Jackson Area comprised of Hinds, Madison and Rankin Counties because it is a combination of urban and rural communities. The sample consisted of 70 participants from seven sites. A total of seven focus groups responded to six questions to assess practices, personal motivation, and barriers to dietary practices: (1) Where in your community can you access fresh fruits and vegetables? (2) How many meals a day should a person eat? (3) What would you consider to be a healthy breakfast, lunch and dinner? (4) What would you consider to be a healthy snack? (5) What do you consider to be your motivations for eating healthy? (6) What do you consider to be your barriers to eating healthy? Each of the seven focus groups consisted of 6 to 12 participants and provided details of their dietary practices. The focus group interviews were digitally-recorded. The recorded interviews were transcribed. The majority of the participants stated that there is a limited availability of fresh fruits/vegetables in rural areas because of a shortage of grocery stores. When they do find fruits, they are priced very high and are unaffordable. Even though health conditions dictate food frequency and portion size, community members feel that individuals should eat three good balanced meals per day with snacks, and they should adhere to small portion sizes. While the desire to attain overall good health and eliminate associative risks for heart disease (e.g., diabetes, obesity) are personal motivations, the cost of food, transportation, age, and time required for food preparation were seen as barriers to healthy eating. Decisions regarding meal choice and meal frequency can have an impact on long-term health outcomes. Health promotion programs should become an integral part of academic- community collaborative agreements.

Genome-Wide Association Study of Dietary Pattern Scores

Dietary patterns, representing global food supplies rather than specific nutrients or food intakes, have been associated with cardiovascular disease (CVD) incidence and mortality. The contribution of genetic factors in the determination of food intakes, preferences and dietary patterns has been previously established. The current study aimed to identify novel genetic factors associated with reported dietary pattern scores. Reported dietary patterns scores were derived from reported dietary intakes for the preceding month and were obtained through a food frequency questionnaire and genome-wide association study (GWAS) conducted in a study sample of 141 individuals. Reported Prudent and Western dietary patterns demonstrated nominal associations (p < 1 × 10-5) with 78 and 27 single nucleotide polymorphisms (SNPs), respectively. Among these, SNPs annotated to genes previously associated with neurological disorders, CVD risk factors and obesity were identified. Further assessment of SNPs demonstrated an impact on gene expression levels in blood for SNPs located within/near BCKDHB (p = 0.02) and the hypothalamic glucosensor PFKFB3 (p = 0.0004) genes, potentially mediated through an impact on the binding of transcription factors (TFs). Overrepresentations of glucose/energy homeostasis and hormone response TFs were also observed from SNP-surrounding sequences. Results from the current GWAS study suggest an interplay of genes involved in the metabolic response to dietary patterns on obesity, glucose metabolism and food-induced response in the brain in the adoption of dietary patterns.

The Effect of Diet on the Survival of Patients with Chronic Kidney Disease

The prevalence of chronic kidney disease (CKD) is high and it is gradually increasing. Individuals with CKD should introduce appropriate measures to hamper the progression of kidney function deterioration as well as prevent the development or progression of CKD-related diseases. A kidney-friendly diet may help to protect kidneys from further damage. Patients with kidney damage should limit the intake of certain foods to reduce the accumulation of unexcreted metabolic products and also to protect against hypertension, proteinuria and other heart and bone health problems. Despite the fact that the influence of certain types of nutrients has been widely studied in relation to kidney function and overall health in CKD patients, there are few studies on the impact of a specific diet on their survival. Animal studies demonstrated prolonged survival of rats with CKD fed with protein-restricted diets. In humans, the results of studies are conflicting. Some of them indicate slowing down of the progression of kidney disease and reduction in proteinuria, but other underline significant worsening of patients' nutritional state, which can be dangerous. A recent systemic study revealed that a healthy diet comprising many fruits and vegetables, fish, legumes, whole grains, and fibers and also the cutting down on red meat, sodium, and refined sugar intake was associated with lower mortality in people with kidney disease. The aim of this paper is to review the results of studies concerning the impact of diet on the survival of CKD patients.

A Comprehensive Review on Rasam: A South Indian Traditional Functional Food

The view that food can have an expanded role that goes well beyond providing a source of nutrients truly applies to traditional functional foods. The systematic consumption of such traditional functional food provides an excellent preventive measure to ward off many diseases. Rasam, a soup of spices, is a traditional South Indian food. It is traditionally prepared using tamarind juice as a base, with the addition of Indian sesame oil, turmeric, tomato, chili pepper, pepper, garlic, cumin, curry leaves, mustard, coriander, asafoetida, sea salt, and water. Rasam is a classic example of traditional functional food with all its ingredients medicinally claimed for various ailments. The preclinical and clinical studies on rasam and its ingredients support their traditional claim. This review is an attempt to compile the literatures on rasam, its ingredients, and to highlight its medicinal potential that has been underestimated.

The spectrum of epidemiology underlying sudden cardiac death

Sudden cardiac death (SCD) from cardiac arrest is a major international public health problem accounting for an estimated 15%-20% of all deaths. Although resuscitation rates are generally improving throughout the world, the majority of individuals who experience a sudden cardiac arrest will not survive. SCD most often develops in older adults with acquired structural heart disease, but it also rarely occurs in the young, where it is more commonly because of inherited disorders. Coronary heart disease is known to be the most common pathology underlying SCD, followed by cardiomyopathies, inherited arrhythmia syndromes, and valvular heart disease. During the past 3 decades, declines in SCD rates have not been as steep as for other causes of coronary heart disease deaths, and there is a growing fraction of SCDs not due to coronary heart disease and ventricular arrhythmias, particularly among certain subsets of the population. The growing heterogeneity of the pathologies and mechanisms underlying SCD present major challenges for SCD prevention, which are magnified further by a frequent lack of recognition of the underlying cardiac condition before death. Multifaceted preventative approaches, which address risk factors in seemingly low-risk and known high-risk populations, will be required to decrease the burden of SCD. In this Compendium, we review the wide-ranging spectrum of epidemiology underlying SCD within both the general population and in high-risk subsets with established cardiac disease placing an emphasis on recent global trends, remaining uncertainties, and potential targeted preventive strategies.

Association between dietary pattern and risk of cardiovascular disease among adults in the Middle East and North Africa region: a systematic review

OBJECTIVE

This paper reviews the evidence related to the association of dietary pattern with coronary heart disease (CHD), strokes, and the associated risk factors among adults in the Middle East and North Africa (MENA) region.

METHODS

A systematic review of published articles between January 1990 and March 2015 was conducted using Pro-Quest Public Health, MEDLINE, and Google Scholar. The term 'dietary pattern' refers to data derived from dietary pattern analyses and individual food component analyses.

RESULTS

The search identified 15 studies. The available data in the MENA region showed that Western dietary pattern has been predominant among adults with fewer adherences to the traditional diet, such as the Mediterranean diet. The Western dietary pattern was found to be associated with an increased risk of dyslipidaemia, diabetes, metabolic syndrome (MetS), body mass index (BMI), and hypertension. The Mediterranean diet, labelled in two studies as 'the traditional Lebanese diet', was negatively associated with BMI, waist circumference (WC), and the risk of diabetes, while one study found no association between the Mediterranean diet and MetS. Two randomised controlled trials conducted in Iran demonstrated the effect of the dietary approach to stop hypertension (DASH) in reducing metabolic risk among patients with diabetes and MetS. Likewise, the consumption of dairy products was associated with decreased blood pressure and WC, while the intake of whole grains was associated with reduced WC. In addition, the high consumption of black tea was found to be associated with decreased serum lipids. The intake of fish, vegetable oils, and tea had a protective effect on CHD, whereas the intake of full-fat yoghurt and hydrogenated fats was associated with an increased risk of CHD.

CONCLUSION

There appears to be a significant association of Western dietary pattern with the increased risk of CHD, strokes, and associated risk factors among adults in the MENA region. Conversely, increased adherence to Mediterranean and/or DASH dietary patterns or their individual food components is associated with a decreased risk of CHD and the associated risk factors. Therefore, increasing awareness of the high burden of CHD and the associated risk factors is crucial, as well as the need for nutrition education programs to improve the knowledge among the MENA population regarding healthy diets and diet-related diseases.

Clinical Strategies for Managing Dyslipidemias

Dyslipidemia is defined as elevated fasting blood levels of total cholesterol (TC), and its primary lipoprotein carrier—low-density lipoprotein (LDL), triglycerides (TG), or reduced high-density lipoprotein (HDL), alone, or in combination (mixed dyslipidemia). Dyslipidemia is well known to be associated with cardiovascular disease (CVD) risk. All patients with dyslipidemia should initiate therapeutic lifestyle changes to target lifestyle-related factors such as physical inactivity, dietary habits, and obesity. The combination of a proper dietary plan and regular aerobic exercise has been reported to lower TC, LDL-C, and TG by 7% to 18%, while increasing HDL-C by 2% to 18%. Numerous pharmacological therapies are available and aggressive therapy using a HMG-CoA reductase (3-hydroxy-3-methyl-glutaryl coenzyme A reductase) inhibitor (statins) should be initiated if lifestyle therapy is not enough to achieve optimal lipid levels with a primary target of lowering LDL-C levels. Aggressive treatment of dyslipidemia with maximal dosage of statin drugs have been reported to reduce LDL-C by 30% to 60%. If mixed dyslipidemia is present, a combination therapy with statin, niacin, cholestyramine, or fibrates should be initiated to reduce the risk of CVD events. These strategies have been shown to reduce CVD risk and optimize LDL-C levels in primary and secondary prevention of CVD.

LC-MS/MS coupled with QSAR modeling in characterising of angiotensin I-converting enzyme inhibitory peptides from soybean proteins

The importance of soy products in reducing the risk of cardiovascular disease is well documented. Our previous computation study has indicated the presence of several potent ACE inhibitory peptides within soybean proteins which needs to be identified. The aim of the study was to identify ACE inhibitory peptides from soy proteins using LC-MS/MS coupled with quantitative structure-activity relationship (QSAR) model. Soybean protein hydrolysate digested by thermolysin showed an IC50 value of 53.6 μg/mL, decreased slightly to 51.8 μg/mL after adding pepsin, and increased to 115.6 μg/mL after adding trypsin. A total of 34 peptides were characterised from LC-MS/MS. Five novel tripeptides, IVF, LLF, LNF, LSW and LEF, with predicted IC50 values lower than 10 μM were synthesized and validated. The results showed that soybean is an excellent source of ACE inhibitory peptides.

Developmental origins of chronic renal disease: an integrative hypothesis

Cardiovascular diseases are one of the leading causes of mortality. Hypertension (HT) is one of the principal risk factors associated with death. Chronic kidney disease (CKD), which is probably underestimated, increases the risk and the severity of adverse cardiovascular events. It is now recognized that low birth weight is a risk factor for these diseases, and this relationship is amplified by a rapid catch-up growth or overfeeding during infancy or childhood. The pathophysiological and molecular mechanisms involved in the “early programming” of CKD are multiple and partially understood. It has been proposed that the developmental programming of arterial hypertension and chronic kidney disease is related to a reduced nephron endowment. However, this mechanism is still discussed. This review discusses the complex relationship between birth weight and nephron endowment and how early growth and nutrition influence long term HT and CKD. We hypothesize that fetal environment reduces moderately the nephron number which appears insufficient by itself to induce long term diseases. Reduced nephron number constitutes a “factor of vulnerability” when additional factors, in particular a rapid postnatal growth or overfeeding, promote the early onset of diseases through a complex combination of various pathophysiological pathways.

Lunch energy density and the metabolic syndrome in patients with type 2 diabetes mellitus

The aim of the present study was to investigate the possible associations between dietary energy density (ED) and the metabolic syndrome (MetS) in patients with type 2 diabetes. In the present case-control study, the dietary ED of 125 patients with type 2 diabetes (seventy-eight with (cases) the MetS and forty-seven without (controls) the MetS; mean age 62·0 (SD 9·4) years, mean diabetes duration 12·5 (SD 8·4) years and mean glycated Hb 7·2 (SD 1·3) %) was assessed by weighed diet records. The MetS was defined according to the 2009 Joint Interim Statement and ED by the amount of energy (kJ) in a given weight of food. Data are expressed as means (standard deviations) or medians (interquartile ranges). Patients with the MetS reported lower intakes of total energy and fibre, and a higher total food amount than the controls; the total ED did not differ, but the cases had a higher ED at lunch (mean 6·3 (SD 1·3) v. 5·9 (SD 0·8) kJ/g; P= 0·017). In this meal, patients with the MetS had lower intakes of beans (median 0·7 (interquartile range 0·4-1·1) v. 1·1 (interquartile range 0·6-1·6) g/kg; P= 0·020), vegetables (median 1·2 (interquartile range 0·6-1·7) v. 1·4 (interquartile range 1·0-2·0) g/kg; P= 0·046) and total meat (median 1·3 (interquartile range 1·0-1·6) v. 1·4 (interquartile range 1·2-1·8) g/kg; P= 0·034) than patients without the MetS. The associations between lunch ED (kJ/g) and food groups (g/kg) were confirmed for vegetables (r - 0·584; P< 0·001), fruits (r - 0·233; P= 0·070), beans (r - 0·189; P= 0·037) and oils (r 0·323; P< 0·001). In a multivariate logistic regression model, a high lunch ED was associated with the MetS (OR 6·89, 95 % CI 1·35, 35·15; P =0·020) after adjusting for confounders. In conclusion, a high ED at lunch increased the odds of the presence of the MetS in patients with type 2 diabetes. Beans and vegetables may be the major contributors to this association and their consumption might be considered to decrease ED.

Mediterranean style diet and 12-year incidence of cardiovascular diseases: the EPIC-NL cohort study

Background

A recent meta-analysis showed that a Mediterranean style diet may protect against cardiovascular diseases (CVD). Studies on disease-specific associations are limited. We evaluated the Mediterranean Diet Score (MDS) in relation to incidence of total and specific CVDs.

Methods

The EPIC-NL Study is a cohort of 40,011 men and women aged 20–70 years, examined between 1993 and 1997, with 10–15 years of follow-up. Diet was assessed with a validated food frequency questionnaire and the MDS was based on the daily intakes of vegetables, fruits, legumes and nuts, grains, fish, fatty acids, meat, dairy, and alcohol. Cardiovascular morbidity and mortality were ascertained through linkage with national registries. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) adjusted for age, sex, cohort, smoking, physical activity, total energy intake, and educational level.

Results

In 34,708 participants free of CVD at baseline, 4881 CVD events occurred, and 487 persons died from CVD. A two unit increment in MDS (range 0–9) was inversely associated with fatal CVD (HR: 0.78; 95%CI: 0.69–0.88), total CVD (HR: 0.95 (0.91–0.98)), myocardial infarction (HR: 0.86 (0.79–0.93)), stroke (HR: 0.88 (0.78–1.00)), and pulmonary embolism (HR: 0.74 (0.59–0.92)). The MDS was not related to incident angina pectoris, transient ischemic attack and peripheral arterial disease.

Conclusion

Better adherence to a Mediterranean style diet was more strongly associated with fatal CVD than with total CVD. Disease specific associations were strongest for incident myocardial infarction, stroke and pulmonary embolism.

Effects of two different types of fast food on postprandial metabolism in normal and overweight subjects

BACKGROUND/OBJECTIVES

The aim was to investigate the effects of a conventional and an unconventional fast-food meal on postprandial metabolism in normal and in overweight subjects.

SUBJECTS/METHODS

Twenty-five healthy normal (n = 12) and overweight (n = 13) volunteers (21-39 years) participated in this randomized, dietary cross-over study and received two test meals (matched in energy and energy giving nutrients) after an overnight fast with 1 week between test days. The conventional fast-food meal was a hamburger meal (hamburger, bacon, cola drink, calculated glycemic load = 48.7), the unconventional fast food was a salmonburger meal (fiber-rich sourdough rye bread, salad with vinegar, orange juice, glycemic load = 46.0). Blood samples were taken before and after the meal and analyzed for glucose (before 20, 40, 60 and 80 min) and insulin (before 1, 2 and 3 h).

RESULTS

Postprandial increases in glucose and insulin were 44% lower after the unconventional meal (P<0.001 and P = 0.003, respectively). The difference between meals in insulin response (that is, conventional meal higher than unconventional) correlated with body mass index (BMI) (r = 0.538, P = 0.006).

CONCLUSIONS

Unconventional fast food can have less effect on blood insulin and glucose postprandially compared with conventional fast food matched in energy and energy giving nutrients. The difference between meals in insulin response is associated with higher BMI. Thus, improvement in food quality might help to control postprandial increases in blood glucose and blood insulin.

Diet modulates endogenous thrombin generation, a biological estimate of thrombosis risk, independently of the metabolic status

OBJECTIVE

High endogenous thrombin potential (ETP) is associated with venous and arterial thrombosis. Better knowledge of environmental influences on ETP may help to prevent thrombosis.

METHODS AND RESULTS

Weaning rats exhibited high ETP values that decreased in low-fat diet and remained elevated on high-fat diet. In adult rats, high-fat diet-induced ETP increase was independent of coagulation factors, obesity, and insulin resistance and negatively associated with polyunsaturated fatty acid levels. Switching from high-fat diet to low-fat diet reversed the procoagulant phenotype with a slower kinetic than the normalization of hyperinsulinemia. In humans, ETP was independent of body weight whereas it was negatively associated with nutritional markers such as the percentage of energy provided by proteins, the protein:fat ratio, circulating phenolic compounds, and omega-3 polyunsaturated fatty acid. A recommended 3-month healthy diet with reduced energy density, including lipids, decreased ETP (-21%; P<0.0001). Changes in ETP were not associated with body weight, insulin sensitivity, or coagulation factor variations, but correlated negatively with plasma docosahexaenoic acid, a nutritional status sensitive fatty acid, and compounds reflecting vegetable intake.

CONCLUSIONS

Diet plays a pivotal role in regulating ETP, independently of obesity and insulin resistance. Global nutritional recommendations could be useful in primary prevention of venous thrombosis.

The Western-style diet: a major risk factor for impaired kidney function and chronic kidney disease

The Western-style diet is characterized by its highly processed and refined foods and high contents of sugars, salt, and fat and protein from red meat. It has been recognized as the major contributor to metabolic disturbances and the development of obesity-related diseases including type 2 diabetes, hypertension, and cardiovascular disease. Also, the Western-style diet has been associated with an increased incidence of chronic kidney disease (CKD). A combination of dietary factors contributes to the impairment of renal vascularization, steatosis and inflammation, hypertension, and impaired renal hormonal regulation. This review addresses recent progress in the understanding of the association of the Western-style diet with the induction of dyslipidemia, oxidative stress, inflammation, and disturbances of corticosteroid regulation in the development of CKD. Future research needs to distinguish between acute and chronic effects of diets with high contents of sugars, salt, and fat and protein from red meat, and to uncover the contribution of each component. Improved therapeutic interventions should consider potentially altered drug metabolism and pharmacokinetics and be combined with lifestyle changes. A clinical assessment of the long-term risks of whole-body disturbances is strongly recommended to reduce metabolic complications and cardiovascular risk in kidney donors and patients with CKD.

Effects of linseed consumption for a short period of time on lipid profile and atherosclerotic lesions in rabbits fed a hypercholesterolaemic diet

Linseed contains biologically active substances, such as lignans, fibres and linoleic acid, which are believed to provide cardioprotective effects. The objective of the present study was to assess the potential hypolipaemic, anti-atherogenic and anti-inflammatory effects of linseed consumption using an experimental animal model, with rabbits fed a hypercholesterolaemic diet (1 % cholesterol extracted from lyophilised egg). A total of twenty white male rabbits were selected and divided into two groups: group I (GI), control group, ten rabbits; group II (GII), ten rabbits. The animals were fed a hypercholesterolaemic diet for 56 d. For the GII diet, ground linseed was added from day 29 through to day 56. Animals underwent aortic arch and descending aorta dissection on day 56 for histological, morphometric and immunohistochemical analysis. At the end of the experiment, GII animals presented with lower levels of total cholesterol (TC, 10 068·3 v. 16 767·0 mg/l; P < 0·05) and lower levels of LDL-cholesterol (LDL-C; 10 743·2 v. 15 961·2 mg/l; P < 0·05) when compared with the GI control group. There was no significant difference in serum HDL-cholesterol and TAG between the two groups. Almost all animals exhibited type III atherosclerotic lesions in the descending aorta. There was no statistically significant difference between the intima area and the intima:media layer area ratio in both groups. There was no difference between the positive areas for vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 molecules between the groups. Linseed consumption showed hypolipaemic action by reducing LDL-C and TC levels; however, this cholesterol-lowering effect did not reduce the atherosclerotic lesions induced by a hypercholesterolaemic diet (1 % cholesterol) for a short period of time.

Invited commentary: dietary pattern analysis

The analytic approaches used in nutritional epidemiology for dietary pattern analyses share common characteristics with those of genetic epidemiology. In this issue of the Journal, Gorst-Rasmussen et al. (Am J Epidemiol. 2011;173(10):1097-1104) discuss one such approach. Application of methods used in genetic pattern analyses to nutritional epidemiology could prove valuable but raises important issues that need to be considered because dietary and genetic studies often address different types of questions in analyzing interrelated variables. These different aims require statistical methods that assume different characteristics of the underlying patterns. The authors briefly describe such differences to facilitate interpretation and applications of previous and future pattern studies.

Weight loss and lifetime medical expenditures: a case study with TRICARE prime beneficiaries

BACKGROUND

TRICARE's Prime (managed care) plan spends more than $1 billion annually in medical expenditures attributed to overweight and obesity.

PURPOSE

This study estimates change in lifetime disease prevalence and medical expenditures associated with weight loss for beneficiaries in TRICARE's Prime plan.

METHODS

This 2010 analysis uses Markov Chain Monte Carlo simulation with demographics, biometrics, health behavior, and disease presence for 857,200 overweight and 521,800 obese beneficiaries aged 18-64 years in 2008 to model future onset of diseases linked to excess weight. Prediction equations in the simulation come from multiple sources: (1) regression analysis with longitudinal (2007-2008) TRICARE medical claims and electronic health records for 2.1 million beneficiaries; (2) regression analysis with Medical Expenditure Panel Survey (2002-2007) and National Health and Nutrition Examination Survey (1999-2008) data; (3) cancer and mortality risk from Surveillance, Epidemiology, and End Results data; and (4) published findings from clinical trials.

RESULTS

Among overweight and obese beneficiaries, lifetime medical expenditures declined $440 (3% discount rate) for each permanent 1% reduction in body weight. This includes $590 in savings from improved health, offset by $150 in additional expenditures from prolonged life. Estimates range from $660 reduction for grossly obese adults aged <45 years to $40 gain from grossly obese adults aged 55-64 years (where expenditures from increased longevity exceed savings from improved health). If weight loss is temporary and regained after 24 months, lifetime expenditures decline by $40 per 1% reduction in body weight.

CONCLUSIONS

Long-term benefits from weight loss are substantially greater than short-term benefits, underscoring the need for a societal perspective to combat obesity.

[Critical analysis of the American Diabetes Association dietary recommendations for cardiovascular disease in diabetes mellitus]

Cardiovascular disease (CVD) is the main cause of mortality among patients with diabetes mellitus (DM), and dietary intervention is an essential measure to prevent and treat this complication. The aim of this manuscript was to review scientific evidence that underlies the dietetic recommendations of the American Diabetes Association (ADA) for prevention and treatment of CVD in patients with DM. The ADA guidelines are mostly based on studies performed on patients with CVD and without DM. The evidence-based dietary recommendations for patients with DM are to increase the intake of fish and soluble fibers. Although DM has been considered as an equivalent of established CVD, the adoption of the same dietary recommendations for patients without DM and with CVD for all patients with DM is still questionable -- especially considering the peculiarities of CVD in DM. Randomized clinical trials including patients with DM should provide further information regarding the benefits of these dietary interventions for CVD.

Altered dietary salt intake for preventing and treating diabetic kidney disease

BACKGROUND

There is strong evidence that our current consumption of salt is a major factor for increased blood pressure (BP) and a modest reduction in salt intake lowers BP whether BP levels are normal or raised. Tight control of BP in diabetics lowers the risk of strokes, heart attacks and heart failure and slows the progression of diabetic kidney disease (DKD). Currently there is no consensus in restricting salt intake in diabetic patients.

OBJECTIVES

To evaluate the effect of altered salt intake on BP and markers of cardiovascular disease and DKD.

SEARCH STRATEGY

In January 2010, we searched the Cochrane Renal Group's Specialised Register, CENTRAL (in The Cochrane Library), MEDLINE (from 1966) and EMBASE (from 1980) to identify appropriate articles.

SELECTION CRITERIA

We included all randomised controlled trials of salt reduction in individuals with type 1 and type 2 diabetes.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed studies and resolved differences by discussion with a third independent author. We calculated mean effect sizes using both the fixed-effect and random-effects models.

MAIN RESULTS

Thirteen studies (254 individuals) met our inclusion criteria. These included 75 individuals with type 1 diabetes and 158 individuals with type 2 diabetes. The median reduction in urinary sodium was 203 mmol/24 h (11.9 g/day) in type 1 diabetes and 125 mmol/24 h (7.3 g/day) in type 2 diabetes. The median duration of salt restriction was one week in both type 1 and type 2 diabetes. BP was reduced in both type 1 and type 2 diabetes. In type 1 diabetes (56 individuals), salt restriction reduced BP by -7.11/-3.13 mm Hg (systolic/diastolic); 95% CI: systolic BP (SBP) -9.13 to -5.10; diastolic BP (DBP) -4.28 to -1.98). In type 2 diabetes (56 individuals), salt restriction reduced BP by -6.90/-2.87 mm Hg (95% CI: SBP -9.84 to -3.95; DBP -4.39 to -1.35). There was a greater reduction in BP in normotensive patients, possibly due to a larger decrease in salt intake in this group.

AUTHORS' CONCLUSIONS

Although the studies are not extensive, this meta-analysis shows a large fall in BP with salt restriction, similar to that of single drug therapy. All diabetics should consider reducing salt intake at least to less than 5-6 g/day in keeping with current recommendations for the general population and may consider lowering salt intake to lower levels, although further studies are needed.

Dietary patterns and their associations with health behaviours in Korea

OBJECTIVE

Dietary habits, including dietary patterns, have been associated with the risk of chronic diseases, including cancer. The objective of the present study was to evaluate Korean dietary patterns as assessed by using an FFQ and associations of dietary patterns with lifestyle risk factors.

DESIGN

Dietary patterns were analysed by factor analysis using a sixteen-group FFQ. The associations between dietary patterns and lifestyle risk factors were investigated by logistic regression analysis.

SETTING

The National Cancer Center in South Korea.

SUBJECTS

The study population included 11 440 participants aged ≥ 30 years who were recruited between 2002 and 2007.

RESULTS

Compared with the lowest quartile intake of each dietary pattern, current smoking was positively associated with the Western pattern (OR = 1·55 for the highest quartile, 95 % CI 1·27, 1·88; P < 0·001) and the traditional pattern (OR = 1·34, 95 % CI 1·11, 1·62; P = 0·002) in men, but was inversely associated with the healthy pattern in both genders (P < 0·001) and the traditional pattern (OR = 0·52, 95 % CI 0·36, 0·75; P = 0·001) in women. Alcohol consumption was positively associated with all patterns in both genders, while no association was observed with the healthy pattern in women. Physical activity and dietary supplement use were positively associated with all patterns in both genders, with the exception of physical activity in women, which showed an inverse association with the traditional pattern.

CONCLUSIONS

Dietary patterns are strongly associated with health behaviours. The possible confounding effect of other risk behaviours should be appropriately considered when conducting nutritional epidemiological studies.

The tsim tsoum approaches for prevention of cardiovascular disease

The Tsim Tsoum Concept means that humans evolved on a diet in which nature recommends to ingest fatty acids in a balanced ratio (polyunsaturated(P) : saturated(S) =w-6 : w-3 = 1 : 1)as part of dietary lipid pattern where monounsaturated fatty acids(MUFA) is the major fatty acid(P : M : S = 1 : 6 : 1) in the background of other dietary factors; antioxidants, vitamins, minerals and fiber as well as physical activity and low mental stress. Several hundred years ago, our diet included natural foods; fruits, vegetables, green vegetables, seeds, eggs and honey. Fish, and wild meat were also available to pre-agricultural humans which shaped modern human genetic nutritional requirement. Cereal grains (refined), and vegetable oils that are rich in w-6 fatty acids are relatively recent addition to the human diet that represent dramatic departure from those foods to which we are adapted. Excess of linoleic acid, trans fatty acids (TFA), saturated and total fat as well as refined starches and sugar are proinflammatory. Low dietary MUFA and n-3 fatty acids and other long chain polyunsarurated fatty acids (LCPUFA) are important in the pathogenesis of metabolic syndrome. Increased sympathetic activity with greater secretion of neurotransmitters in conjunction of underlying long chain PUFA deficiency, and excess of proinflammatory nutrients, may damage the neurons via proinflammatory cytokines, in the ventromedial hypothalamus and insulin receptors in the brain.Since, 30–50% of the fatty acids in the brain are LCPUFA, especially omega-3 fatty acids, which are incorporated in the cell membrane phospholipids, it is possible that their supplementation may be protective.Blood lipid composition does reflect one's health status: (a) circulating serum lipoproteins and their ratio provide information on their atherogenicity to blood vessels and (b) circulating plasma fatty acids, such as w-6/w-3 fatty acid ratio, give indication on proinflammatory status of blood vessels, cardiomyocytes, liver cells and neurones; (a) and (b) are phenotype-related and depend on genetic, environmental and developmental factors. As such, they appear as universal markers for holistic health and these may be important in the pathogenesis of cardiovascular diseases and cancer, which is the main consideration of Tsim Tsoum concept.

Acute cellular transplant rejection following laparoscopic adjustable gastric banding in a morbidly obese patient post heart transplantation

BACKGROUND

Obesity is a worldwide health problem that is often worsened after organ transplantation. As obesity is associated with increased incidence of metabolic syndrome, cardiovascular events and death, it is essential to control weight and avoid weight gain in patients especially following cardiac transplantation. Of the various strategies that are available for weight reduction, bariatric surgery seems to be the most effective in achieving weight loss and in maintaining the reduced body weight. However, this has not been frequently performed in organ-transplant recipients.

CASE REPORT

We are reporting a unique case of a bariatric surgery procedure performed in a patient after cardiac transplantation. A 30-year-old African-American man with a history of end-stage heart failure due to idiopathic dilated cardiomyopathy underwent orthotopic cardiac transplantation. Three years after transplantation, the patient underwent laparoscopic adjustable gastric banding surgery for morbid obesity. Two months later, the patient presented with severe heart failure and was diagnosed with acute cellular rejection as evidenced by endomyocardial biopsy results despite continued combined immunosuppressive therapy that had not been changed but with significantly reduced blood levels of calcineurin inhibitors.

CONCLUSION

We hypothesize that the altered gastro-intestinal motility and delayed gastric emptying due to laparoscopic adjustable gastric banding may have caused incomplete absorption of the administered immunosuppressant drugs in this particular case, as evidenced by the low tacrolimus level, resulting in acute cellular rejection of the transplanted heart, which has never been described before.

Potential health benefits and medical cost savings from calorie, sodium, and saturated fat reductions in the American diet

PURPOSE

Model the potential national health benefits and medical savings from reduced daily intake of calories, sodium, and saturated fat among the U.S. adult population.

DESIGN

Simulation based on secondary data analysis; quantitative research. Measures include the prevalence of overweight/obesity, uncontrolled hypertension, elevated cholesterol, and related chronic conditions under various hypothetical dietary changes.

SETTING

United States.

SUBJECTS

Two hundred twenty-four million adults.

MEASURES

Findings come from a Nutrition Impact Model that combines information from national surveys, peer-reviewed studies, and government reports.

ANALYSIS

The simulation model predicts disease prevalence and medical expenditures under hypothetical dietary change scenarios.

RESULTS

We estimate that permanent 100-kcal reductions in daily intake would eliminate approximately 71.2 million cases of overweight/obesity and save $58 billion annually. Long-term sodium intake reductions of 400 mg/d in those with uncontrolled hypertension would eliminate about 1.5 million cases, saving $2.3 billion annually. Decreasing 5 g/d of saturated fat intake in those with elevated cholesterol would eliminate 3.9 million cases, saving $2.0 billion annually.

CONCLUSIONS

Modest to aggressive changes in diet can improve health and reduce annual national medical expenditures by $60 billion to $120 billion. One use of the model is to estimate the impact of dietary change related to setting public health priorities for dietary guidance. The findings here argue that emphasis on reduction in caloric intake should be the highest priority.

Adherence to 2005 Dietary Guidelines for Americans is associated with a reduced progression of coronary artery atherosclerosis in women with established coronary artery disease

BACKGROUND

A premise of the 2005 Dietary Guidelines for Americans (DGA) is chronic disease prevention.

OBJECTIVE

The goal was to determine whether a diet meeting the DGA is associated with less atherosclerotic lesion progression.

DESIGN

We used the data from 224 postmenopausal women with established coronary artery disease enrolled in the Estrogen Replacement and Atherosclerosis Study. Atherosclerosis progression was defined by repeated measures of quantitative angiography over a 3-y period. Adherence to the key DGA recommendations was measured by using the DGA Adherence Index (DGAI; possible range: 0-20), with each component weighted equally, and the modified DGAI score (wDGAI; possible range: -0.19-0.51), with each component weighted based on its relation to atherosclerosis progression. Mixed-model regression analyses were performed to assess the association between diet and atherosclerosis progression.

RESULTS

No women consumed a diet meeting all of the DGA recommendations. The mean (range) of the DGAI score was 14.1 (8.0-19.0). DGAI was not associated with atherosclerosis progression (P = 0.44), whereas wDGAI was inversely associated; a 1-SD difference in wDGAI was related to 0.049-mm less narrowing of the coronary arteries (SE = 0.017, P = 0.004).

CONCLUSIONS

In postmenopausal women with established heart disease, under the assumption that all DGA recommendations are similarly effective, overall adherence was not associated with atherosclerosis progression. However, assigning differential weights to the DGA recommendations, the adherence was significantly associated with slower atherosclerosis progression. Assuming equity of associations between all dietary recommendations and disease outcomes is a limitation in accurately examining the effectiveness of the DGA.

Dyslipidemia and Risk of Coronary Heart Disease: Role of Lifestyle Approaches for Its Management

Multiple risk factors have a causative relationship to the etiology of coronary heart disease (CHD). However, it is clear that dyslipidemia plays a central role. The chain of evidence is strongest for elevated levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). An inverse association has also been demonstrated between levels of high-density lipoprotein cholesterol (HDL-C) and its principal apolipoprotein, A-1, and risk of CHD. Elevated levels of fasting triglyceride (TG) also are a predictor of CHD, but the independent contribution of TG is difficult to prove because of its usual association with reduced levels of HDL-C; elevated levels of small, dense, highly-atherogenic LDL particles; and the metabolic syndrome. Elevated fasting levels of non—HDL-C (TC — LDL-C) and apolipoprotein B also are strongly predictive of the risk of CHD. Therapeutic lifestyle changes are important adjuncts to pharmacologic management of dyslipidemia. The purpose of this article is to review these contributions with an emphasis on dietary habits (particularly lipid intake), weight management, and aerobic exercise.

Reduced factor VII and factor VIII levels and prolonged thrombin-generation times during a healthy diet in middle-aged women with mild to moderate cardiovascular disease risk

BACKGROUND

No experimental study has investigated the effect of whole-diet therapies on a wide range of hemostatic parameters, and their relationship with metabolic and inflammatory markers. Such information was sought in middle-aged women with moderate cardiovascular disease (CVD) risk subjected to an integrated healthy diet.

METHODS

Forty-nine premenopausal women were screened for C-reactive protein levels > or =1 mg L(-1) and at least one additional CVD risk factor. Sixteen women (age: 43-54 years) were selected and received a 12-week diet (four phases) integrating National Cholesterol Education Program-Adult Treatment Panel-III recommendations with components of a Mediterranean-style diet.

RESULTS

We observed a reduction in body mass index (BMI) (P = 0.001), waist circumference (P = 0.005), total (P = 0.011) and low-density lipoprotein (LDL) cholesterol levels (P = 0.035). Antigen levels of coagulation factor (F)VII (P = 0.003) and FVIII (P = 0.005) were clearly reduced by dietary intervention, which also appeared to decrease circulating tissue factor but not fibrinogen and von Willebrand factor (VWF) antigen levels. Levels of FVIII and tumor necrosis factor-alpha, among the inflammation markers, showed the highest correlation, particularly before the intervention (r = 0.55, P = 0.032). Only this cytokine influenced FVIII variation over time, thus highlighting new relations between coagulation and cellular components of inflammation. The functional effect of diet on coagulation was indicated by markedly prolonged thrombin generation initiation and propagation times (lag time, P = 0.002; time to peak, P = 0.005).

CONCLUSIONS

The changes observed in coagulation initiation and amplification phases, body composition and lipid profile could translate into a remarkable decrease in the risk for cardiovascular disease. Our observations suggest novel relationships between coagulation and inflammatory components.

Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women

BACKGROUND

The impact of overall dietary patterns that reflect actual eating behaviors on mortality caused by cardiovascular or other chronic diseases is largely unknown.

METHODS AND RESULTS

We prospectively evaluated the relation between dietary patterns and risk of cardiovascular, cancer, and all-cause mortality among 72,113 women who were free of myocardial infarction, angina, coronary artery surgery, stroke, diabetes mellitus, or cancer and were followed up from 1984 to 2002. Dietary patterns were derived by factor analysis based on validated food frequency questionnaires administered every 2 to 4 years. Two major dietary patterns were identified: High prudent pattern scores represented high intakes of vegetables, fruit, legumes, fish, poultry, and whole grains, whereas high Western pattern scores reflected high intakes of red meat, processed meat, refined grains, french fries, and sweets/desserts. During 18 years of follow-up, 6011 deaths occurred, including 1154 cardiovascular deaths and 3139 cancer deaths. After multivariable adjustment, the prudent diet was associated with a 28% lower risk of cardiovascular mortality (95% confidence interval [CI], 13 to 40) and a 17% lower risk of all-cause mortality (95% CI, 10 to 24) when the highest quintile was compared with the lowest quintile. In contrast, the Western pattern was associated with a higher risk of mortality from cardiovascular disease (22%; 95% CI, 1 to 48), cancer (16%; 95% CI, 3 to 30), and all causes (21%; 95% CI, 12 to 32).

CONCLUSIONS

Greater adherence to the prudent pattern may reduce the risk of cardiovascular and total mortality, whereas greater adherence to the Western pattern may increase the risk among initially healthy women.

The effects of a Mediterranean-style dietary pattern on cardiovascular disease risk

Dietary patterns influence cardiovascular disease by inhibiting or promoting atherogenesis. Certain nutrients play key roles at different stages of this process, and the combined nutrients of a Mediterranean-style diet offer a significant source of primary and secondary disease prevention. Although current evidence does not support recommendations for or against single-nutrient supplementation, a Mediterranean-style diet should be recommended to reduce the risk of cardiovascular disease. Current nutrition recommendations and mechanisms by which a Mediterranean-style diet impacts cardiovascular risk are described in this article.

Traditional management of chronic stable angina

The clinical syndrome of chronic stable angina is an age-related condition that is one common manifestation of coronary artery disease (CAD). The presence of angina significantly affects quality of life when patients must limit their activities of daily living in an effort to prevent the occurrence of anginal attacks. In addition, patients are at risk for significant complications of CAD such as myocardial infarction, heart failure, stroke, and death. Therefore, treatment should focus not only on relief of symptoms and improvements in quality of life, but also on preventing disease progression and reducing the risk of complications from CAD. All patients should be instructed on the appropriate use of sublingual nitroglycerin for the immediate treatment of anginal episodes. Beta-blockers, calcium channel blockers, long-acting nitrate therapy, and ranolazine can prevent anginal symptoms. In addition, aggressive risk factor management, healthy lifestyle changes, antiplatelet agents such as aspirin, and angiotensin-converting enzyme inhibitors all should be used to prevent disease progression and occurrence of myocardial infarction or death. Many patients will be candidates for revascularization of the myocardium with either percutaneous coronary intervention or coronary artery bypass grafting for relief of symptoms as well as improvement in prognosis. Even after revascularization, patients may still require antianginal drug therapy. All patients undergoing revascularization should be guided to make appropriate lifestyle changes and to make concerted efforts to manage risk factors for CAD.

Influenza viruses in animal wildlife populations

Influenza viruses belong to the family Orthomyxoviridae. Genus Influenza A viruses are true zoonotic agents with many animal reservoirs, whereas genus Influenza B viruses are generally considered to be a virus of humans. The genome of influenza A viruses consists of eight unique segments of single-stranded RNA of negative polarity; they are typed according to their surface proteins, hemagglutinin (HA) and neuraminidase (NA). HA and NA, the major antigenic determinants of influenza A viruses, are present in 16 and nine serologic subtypes, respectively. Annual epidemics and occasional pandemics of influenza in humans depend on the continued evolution of influenza viruses. Although they have numerous potential host populations, most of our genetic and biologic data are obtained from studies of domestic populations of species such as chickens, turkeys, swine, and horses. Concerning wildlife populations, including wild populations of these domesticated species, much less is known. The purpose of this review is to establish what role wildlife populations play in the continued evolution of influenza viruses. Future work needs to determine what chain of events makes it possible for an influenza virus to be successfully transmitted to, and more importantly within, an alternative host population. Even questions as fundamental as which hosts can transmit viruses to humans remain unanswered so far.

Dietary patterns and cardiovascular mortality in the Melbourne Collaborative Cohort Study

BACKGROUND

Despite increased cardiovascular disease risk factors, migrants to Australia from Mediterranean countries have lower mortality than do native-born Australians. Dietary patterns may contribute to this.

OBJECTIVE

The objective was to investigate the relation between dietary patterns and mortality from cardiovascular (CVD) and ischemic heart disease (IHD) in an ethnically diverse population.

DESIGN

This was a prospective cohort study (mean follow-up: 10.4 y) of 40 653 volunteers (23 980 women) aged 40-69 y in the Melbourne Collaborative Cohort Study (1990-1994); 24% of the subjects were Mediterranean born.

RESULTS

Four dietary factors were identified from a food-frequency questionnaire with the use of principal components analysis. They explained 69% of intake variance and reflected frequent intakes of Mediterranean foods, vegetables, meat, and fresh fruit. The Mediterranean factor was inversely associated with CVD and IHD mortality in models adjusting for diabetes, waist-to-hip ratio, body mass index, and hypertension. For IHD, the hazard ratio (HR) for the highest compared with the lowest quartile of consumption was 0.59 (95% CI: 0.39, 0.89; P for trend = 0.03). Associations persisted in analyses excluding people with prior CVD (HR: 0.51; 95% CI: 0.30, 0.88; P for trend = 0.03). Vegetable and fresh fruit factors were inversely associated with CVD mortality but only among those without prior CVD. HRs (highest compared with lowest quartile) were 0.66 (95% CI: 0.48, 0.92; P for trend = 0.02) for vegetables and 0.69 (95% CI: 0.52, 0.93; P for trend = 0.04) for fresh fruit. The meat factor was not associated with CVD or IHD mortality.

CONCLUSION

Our findings suggest that frequent consumption of traditional Mediterranean foods is associated with reduced cardiovascular mortality after controlling for important risk factors and country of birth.

Exposure to secondhand smoke and biomarkers of cardiovascular disease risk in never-smoking adults

BACKGROUND

Exposure to secondhand smoke has been associated with a disproportionately high risk of coronary heart disease, thought to be mediated through inflammation, platelet aggregation, and/or endothelial dysfunction. The epidemiological association between objectively measured exposure to secondhand smoke and biomarkers of heart disease risk has not been investigated, however.

METHODS AND RESULTS

We have investigated the cross-sectional relation between secondhand smoke exposure, measured objectively as cotinine, and recognized biomarkers of heart disease risk, namely C-reactive protein, homocysteine, fibrinogen, and white blood cell count, in 7599 never-smoking adults from the Third National Health and Nutrition Examination Survey. Compared with subjects with no detectable cotinine, those with detectable but low-level cotinine (range, 0.05 to 0.215 ng/mL) had significantly higher levels of both fibrinogen (adjusted mean difference, 8.9 mg/dL; 95% CI, 0.9 to 17.0; P=0.03) and homocysteine (0.8 micromol/L; 95% CI, 0.4 to 1.1; P<0.001) but not C-reactive protein or white blood cell count. Effect estimates of similar magnitude and significance were seen in subjects in the high category of cotinine exposure (>0.215 ng/mL). The increased levels of fibrinogen and homocysteine seen in relation to secondhand smoke exposure were equivalent to approximately 30% to 45% of those seen for active smoking.

CONCLUSIONS

Passive smokers appear to have disproportionately increased levels of 2 biomarkers of cardiovascular disease risk, fibrinogen and homocysteine. This finding provides further evidence to suggest that low-level exposure to secondhand smoke has a clinically important effect on susceptibility to cardiovascular disease.

Overviews of pathogen emergence: which pathogens emerge, when and why?

An emerging pathogen has been defined as the causative agent of an infectious disease whose incidence is increasing following its appearance in a new host population or whose incidence is increasing in an existing population as a result of long-term changes in its underlying epidemiology (Woolhouse and Dye 2001). Although we appear to be in a period where novel diseases are appearing and old diseases are spreading at an unprecedented rate, disease emergence per se is not a new phenomenon. It is almost certain that disease emergence is a routine event in the evolutionary ecology of pathogens, and part of a ubiquitous response of pathogen populations to shifting arrays of host species. While our knowledge of emerging diseases is, for the most part, limited to the time span of the human lineage, this history provides us with a modern reflection of these deeper evolutionary processes, and it is clear from this record that at many times throughout human history, demographic and behavioural changes in society have provided opportunities for pathogens to emerge.