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Li Q, Feng L, Sun J, Zhu H, Zeng G, Gao P, Yuan J, Zhao Y, Li S, Lan X, Chen X, Li Z, Chen S, Dong H, Li M, Li X, Yang Z, Li H, Xie G, Wang Z, Lin PH, Chen J, Wang Y, Wu Y. Effects of Chinese heart-healthy diet on blood lipids, glucose, and estimated 10-y cardiovascular disease risk among Chinese adults: results on secondary outcomes of a randomized controlled trial. Am J Clin Nutr 2024; 119:333-343. [PMID: 38110039 DOI: 10.1016/j.ajcnut.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Healthy diet is essential for cardiovascular disease risk management, but its effects among Chinese patients, whose diets differ from Western diets, remain largely unknown. METHODS In this multicenter, patient- and outcome assessor-blind, randomized controlled feeding trial, 265 Chinese adults with baseline systolic blood pressure 130 to 159 mmHg were randomly assigned into Chinese heart-healthy (CHH) diet or usual diet for a 28-d intervention after a 7-d run-in period on usual diet. Blood lipids and glucose were measured from overnight fasting blood samples before and after the intervention. Ten-year cardiovascular disease risk was estimated using models previously developed and validated in Chinese. The changes in secondary outcomes of serum total cholesterol (TC), blood glucose, and 10-y cardiovascular disease risk over the intervention period were compared between intervention groups, adjusting for center, among participants with baseline and follow-up blood samples available. Sensitivity analyses were done with further adjustment for baseline values and covariables; missing data imputed; and among per-protocol population. RESULTS Among 256 eligible participants (130 on CHH diet, 126 on control diet), 42% had hypercholesterolemia and 15% had diabetes at baseline. In the control group, TC and 10-y cardiovascular disease risk decreased after the intervention by 0.16 mmol/L and 0.91%, respectively, but blood glucose increased by 0.25 mmol/L. Compared with usual diet, the CHH diet lowered TC (-0.14 mmol/L, P = 0.017) and 10-y cardiovascular disease risk (-1.24%, P = 0.001) further. No effect on blood glucose was found. All sensitivity analyses confirmed the results on TC and 10-y cardiovascular disease risk, and analysis with multiple variables adjusted showed a borderline significant effect on blood glucose (-0.17 mmol/L, P = 0.051). The differences in intake of nutrients and food groups between intervention groups explained the results. CONCLUSIONS The CHH diet reduced TC and 10-y cardiovascular disease risk and was likely to reduce blood glucose among Chinese adults with mild hypertension. Further studies with longer terms are warranted. This trial was registered at clinicaltrials.gov as NCT03882645.
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Affiliation(s)
- Qianqian Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Lin Feng
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Jianqin Sun
- Department of Clinical Nutrition, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Huilian Zhu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Guo Zeng
- Department of Nutrition, School of Public Health, Sichuan University, Chengdu, China
| | - Pei Gao
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Jihong Yuan
- Department of Nutrition, People's Republic of China Army General Hospital, Beijing, China
| | - Yanfang Zhao
- Department of Clinical Nutrition, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Shuyi Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xi Lan
- Department of Nutrition, School of Public Health, Sichuan University, Chengdu, China
| | - Xiayan Chen
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Zhen Li
- Department of Clinical Nutrition, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Si Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hongli Dong
- Department of Nutrition, School of Public Health, Sichuan University, Chengdu, China
| | - Ming Li
- Chinese Health Management Association, Beijing, China
| | - Xiang Li
- Sichuan Tourism University Culinary College, Chengdu, China
| | - Zhenquan Yang
- Yangzhou University College of Tourism and Cuisine, School of Food Science and Engineering, Yangzhou, China
| | - Huijuan Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Gaoqiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Zhu Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Pao-Hwa Lin
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Junshi Chen
- China National Food Safety Risk Assessment Center, Beijing, China
| | - Yanfang Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China.
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Desjardins C, Cyrenne-Dussault M, Barbier O, Bélanger A, Gangloff A, Guénette L, Leclerc J, Lefebvre J, Zongo A, Drouin-Chartier JP. Are Lipid-Lowering and Antihypertensive Medications Used as Complements to Heart-Healthy Diets? A Scoping Review. Adv Nutr 2023; 14:870-884. [PMID: 37121468 PMCID: PMC10334141 DOI: 10.1016/j.advnut.2023.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/06/2023] [Accepted: 04/27/2023] [Indexed: 05/02/2023] Open
Abstract
In cardiovascular disease (CVD) prevention, whether antihypertensive and lipid-lowering medications are used as complements to heart-healthy diets has not been thoroughly assessed. This scoping review aimed to 1) analyze observational studies that assessed the relationship between diet and antihypertensive/lipid-lowering medication use and 2) evaluate whether medication was used as a complement to heart-healthy dietary intakes. We searched MEDLINE, Embase, Web of Science, and CINAHL through 14 January, 2023, for studies that assessed either 1) intraindividual changes in diet associated with lipid-lowering/antihypertensive medication initiation or use or 2) interindividual differences in diet between users and nonusers of these medications. A total of 17 studies were included. Of those, 3 prospectively assessed the intraindividual changes in diet associated with medication initiation or use, but none documented potential changes in diet prior to medication initiation. The 14 other studies compared dietary intakes of medication users and nonusers, most of which also relied on an incomplete assessment of the temporal dynamics between diet and medication use as they employed cross-sectional (n = 12) or repeated cross-sectional (n = 2) designs. Data from 8 studies, including 4 of the 5 studies from Europe, suggested that medication was used as a complement to heart-healthy diets, whereas data from the 9 other studies, including the 4 conducted in the United States, provided no such evidence, indicating potential between-country differences in this relationship. Finally, no studies investigated how the dynamics between diet and medication use influenced the long-term CVD risk. This scoping review suggests that the current literature on the relationship between lipid-lowering/antihypertensive medication use and diet provides an incomplete perspective on how medication may influence diet in CVD prevention. Prospective studies assessing intraindividual changes in diet associated with medication initiation and use and how these dynamics influence the CVD risk are thus needed.
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Affiliation(s)
- Clémence Desjardins
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Canada; Faculty of Pharmacy, Laval University, Québec City, Canada
| | - Marie Cyrenne-Dussault
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Canada; Faculty of Pharmacy, Laval University, Québec City, Canada
| | - Olivier Barbier
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Canada; Faculty of Pharmacy, Laval University, Québec City, Canada; CHU de Québec-Université Laval Research Center, Québec City, Canada
| | - Amélie Bélanger
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Canada; Faculty of Pharmacy, Laval University, Québec City, Canada
| | - Anne Gangloff
- CHU de Québec-Université Laval Research Center, Québec City, Canada; Faculty of Medicine, Laval University, Québec City, Canada
| | - Line Guénette
- Faculty of Pharmacy, Laval University, Québec City, Canada; CHU de Québec-Université Laval Research Center, Québec City, Canada
| | - Jacinthe Leclerc
- Faculty of Pharmacy, Laval University, Québec City, Canada; Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Canada
| | - Jean Lefebvre
- Faculty of Pharmacy, Laval University, Québec City, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, Laval University, Québec City, Canada; CHU de Québec-Université Laval Research Center, Québec City, Canada
| | - Jean-Philippe Drouin-Chartier
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Canada; Faculty of Pharmacy, Laval University, Québec City, Canada.
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Marques-Vidal P, Jankowski P, Reiner Ž, De Bacquer D, Kotseva K. Dietary management of patients at high risk for cardiovascular disease; EUROASPIRE V. Clin Nutr ESPEN 2023; 55:144-150. [DOI: 10.1016/j.clnesp.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/01/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
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Gebremedhin AF, Dawson A, Hayen A. Determinants of continuum of care for maternal, newborn, and child health services in Ethiopia: Analysis of the modified composite coverage index using a quantile regression approach. PLoS One 2023; 18:e0280629. [PMID: 36662768 PMCID: PMC9858465 DOI: 10.1371/journal.pone.0280629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
Maternal and child mortality remain unacceptably high in the Sustainable Development Goals era. Continuum of care has become a key strategy for improving the health of mothers and newborns. Previous research on the continuum of care in Ethiopia is often limited to maternal health services. Maternal and child health services are inseparably linked, and an integrated approach to care is essential. This study assessed the continuum of maternal, newborn, and child health care and associated factors in Ethiopia. The analysis was based on the 2016 Ethiopian Demographic and Health Survey data. We restricted our analysis to women with their most recent children-alive and living with their mother- aged 12-23 months at the time of the survey (n = 1891). The modified composite coverage index, constructed from twelve maternal and child health services, was calculated as an indicator of the continuum of care. Bivariable and multivariable quantile regression were used to analyse the relationship between the predictors and specific quantiles of the composite coverage index. The effect of each variable was examined at the 10th, 25th, 50th, 75th, and 95th quantiles. The results showed that the average composite coverage index value was 39%. The overall completion rate of the continuum of care was low (2%). Four % of the women did not receive any of the services along the continuum of care. Postnatal care for newborns had the lowest coverage (12%). This study provides evidence that factors such as the educational status of women, region, residence, socio-economic status, perceived distance to a health facility, pregnancy intention, mode of delivery, parity, and early antenatal care initiation influence the continuum of care differently across levels of the composite coverage index. The findings call for integrated and targeted strategies that aim to improve the continuum of care considering the determinants.
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Affiliation(s)
- Aster Ferede Gebremedhin
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 154] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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Zhao Y, Liu X, Mao Z, Hou J, Huo W, Wang C, Wei S. Relationship between multiple healthy lifestyles and serum lipids among adults in rural China: A population-based cross-sectional study. Prev Med 2020; 138:106158. [PMID: 32473269 DOI: 10.1016/j.ypmed.2020.106158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/30/2020] [Accepted: 05/24/2020] [Indexed: 12/12/2022]
Abstract
Although several single lifestyles have been reported to meliorate serum lipid levels, there is little evidence of the relationship between multiple healthy lifestyles and lipid levels in Chinese adults. Cross-sectional data of 35,150 participants aged 18-79 years without dyslipidemia at baseline in the Henan Rural Cohort were collected from 2015 to 2017, to investigate the associations between individual and combinations of 6 healthy lifestyle factors and lipid levels. In multivariate linear regression analyses, non-current smoking, non-current alcohol consumption, regular physical exercise, healthy diet, lower body mass index, and lower waist-to-hip ratio were significantly associated with lower concentration of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) and higher concentrations of high-density lipoprotein cholesterol (HDL-C) (all P < .001). There were positive quantitative correlations between the number of healthy lifestyle factors and the low levels of lipids (all P for linear trend <0.001). People with 6 healthy lifestyle factors had 0.72-mmol/L (95% confidence interval [CI]: 0.64 to 0.81) lower TC, 1.02-mmol/L (95% CI: 0.93 to 1.11) lower TG, 0.54-mmol/L (95% CI: 0.47 to 0.61) lower LDL-C, and 0.32-mmol/L (95% CI: 0.29 to 0.34) higher HDL-C, than people who had 0-1 healthy lifestyle factors. In this study, we found an association between an increased number of healthy lifestyle factors and better serum lipid profiles. The causality and temporality between maintenance of a healthy lifestyle and optimal lipid levels merit further investigations.
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Affiliation(s)
- Yanting Zhao
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Wenqian Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China.
| | - Sheng Wei
- Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China.
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