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Nishi SK, Khoury N, Valle Hita C, Zurbau A, Salas-Salvadó J, Babio N. Vegetable and Fruit Intake Variety and Cardiovascular Health and Mortality: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients 2023; 15:4913. [PMID: 38068771 PMCID: PMC10707746 DOI: 10.3390/nu15234913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION A multitude of evidence supports the consumption of a higher quantity of vegetables and fruits for their cardiovascular benefits. Nonetheless, the extent to which variety is associated with cardiovascular health remains unclear. OBJECTIVE To conduct a systematic review and meta-analysis of observational studies (prospective cohort and cross-sectional studies) assessing the role of a variety of vegetable and fruit consumption in cardiovascular morbidity and mortality in adults. DATA SOURCES MEDLINE-PubMed, Cochrane databases, and reference lists were searched through March 2023. DATA EXTRACTION Two independent reviewers extracted data and assessed the risk of bias (National Heart, Lung, and Blood Institute Tool and Newcastle-Ottawa Scale). DATA ANALYSIS Data were pooled (fixed and random [DerSimonian and Laird] effects for <5 and ≥5 study comparisons, respectively), and heterogeneity was assessed using the Cochran Q statistic and quantified (I2 statistic). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the overall certainty of the evidence. Five cross-sectional (n = 45,761) and seven prospective studies (n = 253,422) met the eligibility criteria. Greater variety of vegetable and fruit consumption was prospectively related to decreased all-cause mortality (risk ratio, 0.89 [95% CI, 0.82-0.97], seven study comparisons, n = 196,925), while no significant associations were observed with assessed cardiovascular-related mortality or morbidity. For all outcomes, the certainty of the evidence was graded as "low" or "very low" owing to inconsistency and/or imprecision. CONCLUSIONS Overall, this study shows that greater variety in vegetable and fruit consumption may reduce all-cause mortality and highlights the need for additional studies with a higher degree of evidence to better understand its role in cardiovascular health.
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Affiliation(s)
- Stephanie K. Nishi
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada;
| | - Nadine Khoury
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
| | - Cristina Valle Hita
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
| | - Andreea Zurbau
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada;
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Nancy Babio
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup Alimentació, Nutrició, Desenvolupament i Salut Mental, 43201 Reus, Spain; (N.K.); (C.V.H.); (J.S.-S.)
- Institut d’Investigació Pere Virgili (IISPV), Carrer Dr. Mallafré Guasch, 4, 43007 Tarragona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
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Asher RC, Clarke ED, Bucher T, Shrewsbury VA, Roberts S, Collins CE. Impact and evaluation of an online culinary nutrition course for health, education and industry professionals to promote vegetable knowledge and consumption. J Hum Nutr Diet 2023; 36:967-980. [PMID: 36321462 PMCID: PMC10947242 DOI: 10.1111/jhn.13109] [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: 06/29/2022] [Accepted: 10/16/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Poor diet, including inadequate vegetable intake, is a leading risk factor for noncommunicable disease. Culinary and nutrition education provided to trainee and practising health and education professionals is an emerging strategy to promote improved dietary intake, including vegetable consumption. We evaluated the impact and feasibility of an online culinary medicine and nutrition (CM/CN) short course for health, education and vegetable industry professionals. The course aimed to improve participants' skills and confidence to prepare vegetables, knowledge of evidence-based nutrition information and recommendations for improving vegetable consumption and diet quality. METHODS A pre-post study consisting of two separate groups participating in two course rounds recruited practising professionals (n = 30) working in health; community, adult and/or culinary education; and the vegetable industry. Evaluation assessed diet quality, vegetable consumption barriers, cooking and food skill confidence, nutrition knowledge and process measures. RESULTS Seventeen participants (68%) completed the programme. Pre- to postintervention statistically significant increases in vegetables (M 1.3, SD 2.2), fruit (M 1.6, SD 3.1), and breads and cereal (M 1.1, SD 1.7) intakes were observed. Statistically significant increases and large effect sizes for mean food skill confidence scores (M 8.9, SD 15.4, Cohen's d 0.56) and nutrition knowledge scores (M 6.2, SD 15.4, Cohen's d 0.83) were also observed pre- to postintervention. CONCLUSIONS The short online course was feasible and improved diet quality, food skill confidence and nutrition knowledge. Online CM/CN education for practising professionals represents a promising area of research. Future research involving a larger study sample and a more rigorous study design such as a randomised control trial is warranted.
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Affiliation(s)
- Roberta C. Asher
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
| | - Erin D. Clarke
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
| | - Tamara Bucher
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
- School of Environmental and Life Sciences, College of EngineeringScience and EnvironmentCallaghanAustralia
| | - Vanessa A. Shrewsbury
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
| | | | - Clare E. Collins
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
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Asher RC, Bucher T, Shrewsbury VA, Clarke ED, Herbert J, Roberts S, Meeder A, Collins CE. Facilitators and barriers to providing culinary nutrition, culinary medicine and behaviour change support: An online cross-sectional survey of Australian health and education professionals. J Hum Nutr Diet 2023; 36:252-265. [PMID: 35651300 PMCID: PMC10084112 DOI: 10.1111/jhn.13044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/04/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND An Australia wide cross-sectional online survey examined facilitators and barriers of health and education professionals to providing culinary nutrition (CN) and culinary medicine (CM) education and behaviour change support in usual practice, in addition to identifying continuing professional development (CPD) needs in this domain. METHODS Survey items included socio-demographic characteristics, cooking and food skills confidence, nutrition knowledge (PKB-7), fruit and vegetable intake (FAVVA) and CPD needs. Data were summarised descriptively. RESULTS Of 277 participants, 65% were likely/somewhat likely to participate in CN CPD. Mean (SD) cooking and food skill confidence scores were 73 (17.5) and 107.2 (24), out of 98 and 147, respectively. Mean PKB-7 score was 3.7 (1.4), out of 7. Mean FAVVA score was 98 (29), out of 190. CONCLUSIONS Gaps in knowledge and limited time were the greatest modifiable barriers to providing CM/CN education and behaviour change support in practice. Health and education professionals are interested in CPD conducted by dietitians and culinary professionals to enhance their knowledge of CM/CN and behaviour change support.
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Affiliation(s)
- Roberta C Asher
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia
| | - Tamara Bucher
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,School of Environmental and Life Sciences, College of Engineering, Science and Environment, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
| | - Vanessa A Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
| | - Erin D Clarke
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
| | - Jaimee Herbert
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia
| | - Steven Roberts
- Rijk Zwaan Australia Pty. Ltd., Daylesford, VIC, Australia
| | - Annette Meeder
- Rijk Zwaan Zaadteelt en Zaadhandel B.V., De Lier, The Netherlands
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, Rankin Park, NSW, Australia
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Reay WR, Haslam R, Cairns MJ, Moschonis G, Clarke E, Attia J, Collins CE. Variation in cardiovascular disease risk factors among older adults in the Hunter Community Study cohort; a comparison of diet quality versus polygenic risk score. J Hum Nutr Diet 2022; 35:675-688. [PMID: 35560851 PMCID: PMC9542949 DOI: 10.1111/jhn.13031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
Background The interplay between cardiovascular disease (CVD) genetic risk indexed by a polygenic risk score (PRS) and diet quality still requires further investigation amongst older adults or those with established or treated CVD. The present study aimed to evaluate the relative contribution of diet quality, measured using the Australian Recommended Food Score (ARFS) and PRS, with respect to explaining variation in plasma lipids CVD outcomes in the Hunter Cohort. Methods The study comprised a secondary analysis of cross‐sectional data from the Hunter Cohort study. Single‐nucleotide polymorphisms from previously derived polygenic scores (PGSs) for three lipid classes were obtained: low‐density lipoprotein, high‐density lipoprotein and triglycerides, as well as PRS for coronary artery disease (CAD) from the PGS catalogue. Regression modelling and odds ratios were used to determine associations between PRS, ARFS and CVD risk. Results In total, 1703 participants were included: mean ± SD age 66 ± 7.4 years, 51% female, mean ± SD total ARFS 28.1 ± 8 (out of 74). Total diet quality and vegetable subscale were not significantly associated with measured lipids. By contrast, PGS for each lipid demonstrated a markedly strong, statistically significant correlation with its respective measured lipid. There was a significant association between CAD PRS and 5/6 CVD phenotypes (all except atrial fibrillation), with the largest effect size shown with coronary bypass. Adding dietary intake as a covariate did not change this relationship. Conclusions Lipid PGS explained more variance in measured lipids than diet quality. However, the poor diet quality observed in the current cohort may have limited the ability to observe any beneficial effects. Future research should investigate whether the diet quality of older adults can be improved and also the effect of these improvements on changes in polygenic risk. The Australian Recommended Food Score (ARFS) had little association with lipid and cardiovascular disease (CVD) endpoints. Lipid polygenic score (PGS) explained more variance in measured lipids than diet quality. The lipid PGS was associated with all three lipid parameters and some CVD endpoints, especially high cholesterol. Coronary artery disease polygenic risk score was associated with CVD endpoints angina, coronary bypass, heart attack, high cholesterol and hypertension and some lipid parameters (high‐density lipoprotein cholesterol).
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Affiliation(s)
- William R Reay
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Rebecca Haslam
- Hunter Medical Research Institute, New Lambton, NSW, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle Callaghan, NSW, Australia
| | - Murray J Cairns
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - George Moschonis
- Department of Dietetics, Nutrition and Sport, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Erin Clarke
- Hunter Medical Research Institute, New Lambton, NSW, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle Callaghan, NSW, Australia
| | - John Attia
- Hunter Medical Research Institute, New Lambton, NSW, Australia.,School of Population Health and Medical Practice, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Clare Elizabeth Collins
- Hunter Medical Research Institute, New Lambton, NSW, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle Callaghan, NSW, Australia
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Ridoutt B, Baird D, Hendrie GA. Diets with Higher Vegetable Intake and Lower Environmental Impact: Evidence from a Large Australian Population Health Survey. Nutrients 2022; 14:nu14071517. [PMID: 35406130 PMCID: PMC9002518 DOI: 10.3390/nu14071517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 12/21/2022] Open
Abstract
Increasing the consumption of vegetables is a public health nutrition priority in Australia. This must be achieved in the context of lowering dietary environmental impacts. In this study, a subgroup of 1700 Australian adult daily diets having a higher diet-quality score and a lower environmental impact score was isolated from Australian Health Survey data. These diets were primarily distinguished by their lower content of energy-dense/nutrient-poor discretionary foods. Among these diets, those with higher levels of vegetable intake were characterized by greater variety of vegetables eaten, lower intake of bread and cereal foods, and higher intake of red meat. These diets also had a greater likelihood of achieving recommended intakes for a range of vitamins and minerals. These findings highlighted the importance of considering the total diet in developing strategies to promote healthy and sustainable food consumption, as well as the need to understand the interrelationships between foods that exist in a local cultural context. As vegetables are usually eaten with other foods, higher vegetable consumption in Australia could be supported by encouraging more regular consumption of the types of meals that include larger quantities of vegetables. Our results showed that this was possible while also substantially lowering total dietary environmental impacts.
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Affiliation(s)
- Bradley Ridoutt
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Agriculture and Food, Clayton, VIC 3169, Australia
- Department of Agricultural Economics, University of the Free State, Bloemfontein 9300, South Africa
- Correspondence: ; Tel.: +61-3-9545-2159
| | - Danielle Baird
- CSIRO Health and Biosecurity, Adelaide, SA 5000, Australia; (D.B.); (G.A.H.)
| | - Gilly A. Hendrie
- CSIRO Health and Biosecurity, Adelaide, SA 5000, Australia; (D.B.); (G.A.H.)
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