Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries

Dietary management of dyslipidemia

The rising burden of cardiovascular disease (CVD) has made the achievement of optimal lipoprotein levels a major public health priority. As nearly a fifth of global mortality is associated with dietary factors, and recommendations have been mired in controversy, a fresh look on the available data is attempted. Well established concepts regarding nutrition and cardiometabolic health, role of macronutrients, calories, and controversial foods are discussed followed by recommendations in the Indian context. A healthy dietary pattern rather than individual foods or nutrients is emphasized, and this is generally plant based with optional consumption of dairy, eggs, and meats within the suggested limits. Suggestions/recommendations are given for consumption of individual foods, remembering that choosing appropriate replacement foods is as important as restricting unhealthy foods.

Assessment of Nutritional Status in the Diagnostic Evaluation of the Child with Growth Failure

Current clinical guidelines provide information about the diagnostic workup of children with growth failure. This mini-review focuses on the nutritional assessment, which has received relatively little attention in such guidelines. The past medical history, in particular a low birth size and early feeding problems, can provide information that can increase the likelihood of nutritional deficits or several genetic causes. The current medical history should include a dietary history and can thereby reveal a poorly planned or severely restricted diet, which can be associated with nutritional deficiencies. Children on a vegan diet should receive various nutritional supplements, but insufficient compliance has been reported in one-third of cases. While proper use of nutritional supplements in children consuming a vegan diet appears to be associated with normal growth and development, insufficient intake of supplements may impede growth and bone formation. Physical examination and analysis of height and weight over time can help differentiating between endocrine causes, gastrointestinal disorders, psychosocial problems, or underlying genetic conditions that prevent adequate nutritional intake. Laboratory screening should be part of the workup in every child with short stature, and further laboratory tests can be indicated if warranted by the dietary history, especially in children on a poorly planned vegan diet.

Managing Menopausal Symptoms in Young Women With Breast Cancer: When Medicine Is Not All. The Take Care Project

In the last decade, endocrine therapy strategies in perimenopausal women with hormone-responsive early breast cancer (BC) have changed and now ovarian function suppression (OFS) is recommended for the majority of patients. Side effects of OFS mimic menopausal symptoms, including hot flushes, sweats, weight gain, and sexual dysfunction, which may negatively impact quality of life (QoL). Aims of the Take Care Project are the education of physicians and patients to have all the information (medical and nonmedical) they need to manage menopausal symptoms by distributing educational materials useful to face menopause. Four different areas have been identified by surveys conducted among physicians and young patients: for each area, interventions and tools have been elaborated by a doctor and nonphysician professionals of these identified areas, to offer the widest information available. Clinical and practical suggestions have been provided. Based on the evidence given, we strongly suggest setting up a multidisciplinary team for the treatment planning of young patients with BC, which could help patients to face and manage their new menopause condition. The reduction of side effects and the improvement in QoL should be the best ally to treat young patients with BC.

Nutritional and socio-economic predictors of adult height in 152 world populations

Height is one of the most sensitive indicators of well-being because it combines the external influences of nutrition, economic wealth, health care, social equality, and other important socio-economic factors. The aim of this ecological study was to compare actual values of male and female height from 152 populations (except sub-Saharan Africa) with the mean supply of 47 food items from the FAOSTAT database (1995-2013) and mean values of seven socio-economic indicators (1995-2013). This comparison shows that economic wealth at the country level is only a mediocre correlate of physical growth because it is only loosely associated with the quality of nutrition and it does not reflect the social distribution of wealth. In a multiple regression model, the best predictors of stature are protein sources of the best and worst quality, and total fertility (which critically influences the amount of resources expended per child). In summary, these findings indicate that irrespective of crude economic statistics, the choice of specific nutrient sources and small family size are crucial factors determining the optimal physical development of children. Based on our data, we also believe that current international dietary recommendations regarding protein intake and protein quality would deserve serious re-evaluation.

Effect of a Low-Carbohydrate High-Fat Diet and a Single Bout of Exercise on Glucose Tolerance, Lipid Profile and Endothelial Function in Normal Weight Young Healthy Females

Low-carbohydrate-high-fat (LCHF) diets are efficient for weight loss, and are also used by healthy people to maintain bodyweight. The main aim of this study was to investigate the effect of 3-week energy-balanced LCHF-diet, with >75 percentage energy (E%) from fat, on glucose tolerance and lipid profile in normal weight, young, healthy women. The second aim of the study was to investigate if a bout of exercise would prevent any negative effect of LCHF-diet on glucose tolerance. Seventeen females participated, age 23.5 ± 0.5 years; body mass index 21.0 ± 0.4 kg/m², with a mean dietary intake of 78 ± 1 E% fat, 19 ± 1 E% protein and 3 ± 0 E% carbohydrates. Measurements were performed at baseline and post-intervention. Fasting glucose decreased from 4.7 ± 0.1 to 4.4 mmol/L (p < 0.001) during the dietary intervention whereas fasting insulin was unaffected. Glucose area under the curve (AUC) and insulin AUC did not change during an OGTT after the intervention. Before the intervention, a bout of aerobic exercise reduced fasting glucose (4.4 ± 0.1 mmol/L, p < 0.001) and glucose AUC (739 ± 41 to 661 ± 25, p = 0.008) during OGTT the following morning. After the intervention, exercise did not reduce fasting glucose the following morning, and glucose AUC during an OGTT increased compared to the day before (789 ± 43 to 889 ± 40 mmol/L∙120min^–1, p = 0.001). AUC for insulin was unaffected. The dietary intervention increased total cholesterol (p < 0.001), low-density lipoprotein (p ≤ 0.001), high-density lipoprotein (p = 0.011), triglycerides (p = 0.035), and free fatty acids (p = 0.021). In conclusion, 3-week LCHF-diet reduced fasting glucose, while glucose tolerance was unaffected. A bout of exercise post-intervention did not decrease AUC glucose as it did at baseline. Total cholesterol increased, mainly due to increments in low-density lipoprotein. LCHF-diets should be further evaluated and carefully considered for healthy individuals.

Adherence to a snacking dietary pattern is decreasing in Colombia among the youngest and the wealthiest: results of two representative national surveys

Background

A common recommendation is to reduce the consumption of snack food and replace this consumption with nutrient-dense foods. The objective was to assess whether in Colombian children and adults there were changes in the consumption of the snack dietary pattern (SP) in the 5 years 2010–2015. In addition, this study aimed to establish the relationship between the SP and some biological, socioeconomic, and geographic variables in Colombia, South America.

Methods

Based on a Food Frequency Questionnaire (FFQ) applied both in 2010 and 2015 in the national nutritional situation surveys, the adherence to the snack consumption pattern was established through factor analysis. The change in the adherence of consumption to the SP was established for the five-year period [2015 minus 2010], using multiple linear regression models. Crude and adjusted differences were estimated by the following covariables: sex, age, marital status, food security, wealth index, ethnicity, education of the head of the household, area and region. In total, 37,981 subjects were analyzed. In 2010, 10,150 children (5 to 17 years old) and 5145 adults (18 to 64 years old) were included, and in 2015, 13,243 children and 9443 adults.

Results

In children, the adjusted difference in the adherence to SP was − 0.37 (95% CI: − 0.42, − 0.32). In adults, the adjusted difference in the adherence to SP was − 0.27 (95% CI: − 0.31, − 0.24). In all categories of covariables, consumption decreased, for all p < 0.0001. In children, the decrease in consumption was inversely associated with height-age. The decrease was smaller at the extremes of the BMI distribution, Z < -2 and Z > 2. The decrease in consumption was directly associated with the level of food security in the home and the wealth index. In adults, the decrease in consumption was inversely related to age and was directly related to the level of food security of the household, wealth index, and education level. The BMI decrease was greater in subjects with 18.5–24.9. In subjects with 30+, it was lower than in subjects with 25.0–29.9.

Conclusions

In the 5 years 2010–2015, snack consumption is decreasing. The region, the richest subjects, those with adequate BMI, and in households with more educated heads of household, achieved a greater decrease in SP.

A Low ω-6/ω-3 Ratio High-Fat Diet Improves Rat Metabolism via Purine and Tryptophan Metabolism in the Intestinal Tract, While Reversed by Inulin

A high-fat diet (HFD) is the main cause of metabolic diseases. However, HFD in previous studies consists of much lard, which contains a large amount of omega-6 (ω-6) polyunsaturated fatty acid (PUFA) and little omega-3 (ω-3) PUFA. The role of ω-6/ω-3 ratio of HFD in the development of metabolic diseases remains incompletely discussed. In this study, rats were fed with either a low or a high ω-6/ω-3 ratio HFD singly or combined with inulin. Metabolism state was valued and metabolomics of cecal content were detected. Results show that HFD with low ω-6/ω-3 ratio promotes the glucose utilization in rats. However, inulin had different effects on metabolism with different diets. Xanthosine and kynurenic acid in cecum were positively related to epididymal white adipose tissues (eWAT) mass. The present study indicates the beneficial effects of low ω-6/ω-3 ratio HFD (LRD) on the metabolic state of rats. Moreover, xanthosine and kynurenic acid were closely related to the development of metabolic diseases.

Association between nutrient patterns and serum lipids in Chinese adult women: A cross-sectional study

AIM

To investigate the association between patterns of nutrient intake and serum lipids in Chinese women aged 18-80 years.

METHODS

In the present study, cross-sectional data were analysed from 2886 female participants aged 18-80 years from the China Health and Nutrition Survey wave 2009. Nutrient patterns were identified using factor analysis combined with cluster analysis based on the data of nutrient intake for three consecutive days. Multivariate linear regression models were used to estimate the association of nutrient patterns with serum lipids.

RESULTS

Four nutrient patterns were identified in Chinese adult women, which were the plant-based pattern, carbohydrate and animal fat pattern, plant fat and sodium pattern, and the animal-based pattern. Participants following different patterns varied significantly in sociodemographic characteristics, lifestyle behaviours and food consumption. Compared with the plant-based pattern, the carbohydrate and animal fat pattern was positively associated with low-density lipoprotein cholesterol (β = 4.57, 95% CI: 0.29-8.85, P = 0.036) and total cholesterol (β = 4.89, 95% CI: 0.34-9.44, P = 0.035). The corresponding rises for the animal-based pattern were 4.91 (95% CI: 0.99-8.82, P = 0.014) and 4.98 (95% CI: 0.82-9.15, P = 0.019), respectively.

CONCLUSIONS

Nutrient patterns with a high intake of animal fat and a low intake dietary fibre and with high intakes of animal fat, animal protein and cholesterol may increase the serum cholesterol in Chinese women.

Dietary diversity and healthy life expectancy-an international comparative study

BACKGROUND/OBJECTIVES

The prolongation of healthy life expectancy (HALE) is a core issue of health policy in many countries. The purpose of this study is to clarify the relationship between dietary diversity and HALE using international databases.

MATERIALS/METHODS

HALE data by country were derived from the Global Burden of Disease (GBD) 2015 database. Average food supply (g/day/capita) and energy supply (kcal/day/capita) by country, excluding loss between production and household, were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. Each food was sorted across 12 food groups, and dietary diversity was obtained from food groups using the Quantitative Index for Dietary Diversity (QUANTIDD). The cross-sectional and longitudinal associations between QUANTIDD and HALE were examined in the countries with populations of one million or greater.

RESULTS

Cross-sectional analysis showed that HALE was significantly associated with QUANTIDD (β = 99.9 ± 11.4, p < 0.001) in the single regression model and in the multiple regression model controlled for covariates (β = 36.4 ± 11.3, p = 0.002). Longitudinal analysis showed that HALE increased with QUANTIDD during the 15-year study period (β = 46.4 ± 5.1, p < 0.001), and this association was also significant when controlled for covariates (β = 39.7 ± 5.1, p < 0.001). Longitudinal association of QUANTIDD with the percentage difference between life expectancy and HALE controlled for covariates was significantly negative (β = - 1.3 ± 0.5, p = 0.011).

CONCLUSIONS

After controlling for socioeconomic indicators, longer healthy life is enjoyed by populations of countries with greater dietary diversity.

Cancer Incidence in Europe: An Ecological Analysis of Nutritional and Other Environmental Factors

The aim of this work was to offer an ecological alternative to conventional observational studies and identify factors potentially associated with cancer incidence in Europe. The incidence of 24 types of cancer in 39 European countries (2012) was compared with a long-term mean supply of 68 food items from the FAOSTAT database (1993-2011) and some other variables such as smoking, body mass index, raised cholesterol, and socioeconomic indicators. In addition to simple Pearson linear correlations, the data were analyzed via factor analyses and penalized regression methods. This comparison identified two main groups of cancers that are characteristically associated with the same variables. The first group consists of cancers of the prostate, breast, white blood cells, and melanoma. Their incidence increases with rising gross domestic product (GDP) per capita, a prevalence of raised cholesterol and a high intake of animal products. The second group includes primarily cancers of the digestive tract and is most consistently correlated with alcoholic beverages, lard, and eggs. In addition, we found specific correlations between certain variables and some other types of cancer (smoking-lung and larynx cancer; low GDP per capita and high carbohydrate consumption-stomach and cervical cancer; tea drinking-esophageal cancer; maize consumption and wine drinking-liver cancer). The documented findings often remarkably agree with the current scientific consensus, and when combined with evidence based on different methodologies, they can further extend our knowledge of the etiology of cancer. In addition, our study also identifies several foods with possible preventive effects and indicates that various dairy products may markedly differ in their relationship to cancer incidence. All these data can potentially be of fundamental importance for clinical practice and the survival of cancer patients.

Global Correlates of Cardiovascular Risk: A Comparison of 158 Countries

The aim of this study was a large-scale ecological analysis of nutritional and other environmental factors potentially associated with the incidence of cardiovascular diseases (CVDs) in the global context. Indicators of CVDs from 158 countries were compared with the statistics of mean intake (supply) of 60 food items between 1993 and 2011, obesity rates, health expenditure and life expectancy. This comparison shows that the relationship between CVD indicators (raised blood pressure, CVD mortality, raised blood glucose) and independent variables in the global context is influenced by various factors, such as short life expectancy, religiously conditioned dietary customs, the imprecision of some statistics and undernutrition. However, regardless of the statistical method used, the results always show very similar trends and identify high carbohydrate consumption (mainly in the form of cereals and wheat, in particular) as the dietary factor most consistently associated with the risk of CVDs. These findings are in line with the changing view of the causes of CVDs. Because only the statistics of raised blood glucose include people using medications and reflect true prevalence that is independent of healthcare, more objective data on the prevalence of CVDs are needed to confirm these observed trends.

Dietary Patterns Associated with Lower 10-Year Atherosclerotic Cardiovascular Disease Risk among Urban African-American and White Adults Consuming Western Diets

The study's objective was to determine whether variations in the 2013 American College of Cardiology/American Heart Association 10-year risk for atherosclerotic cardiovascular disease (ASCVD) were associated with differences in food consumption and diet quality. Findings from the baseline wave of Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study 2004-2009, revealed participants consumed a Western diet. Diet quality measures, specifically the Healthy Eating Index (HEI)-2010, Dietary Approaches to Stop Hypertension (DASH) diet and the Mean Adequacy Ratio (MAR), based on two 24-h recalls collected during follow-up HANDLS studies from 2009-2013, were used. Reported foods were assigned to 27 groups. In this cross-sectional analysis, the participants (n = 2140) were categorized into tertiles based on their 10-year ASCVD risk. Lower and upper tertiles were used to determine significantly different consumption rates among the food groups. Ten groups were used in hierarchical case clustering to generate four dietary patterns (DPs) based on group energy contribution. The DP with the highest HEI-2010 score included sandwiches along with vegetables and cheese/yogurt. This DP, along with the pizza/sandwiches DP, had significantly higher DASH and MAR scores and a lower 10-year ASCVD risk, compared to the remaining two DPs-meats/sandwiches and sandwiches/bakery products; thus, Western dietary patterns were associated with different levels of ASCVD 10-year risk.

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study

BACKGROUND

The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear.

METHODS

The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering.

FINDINGS

During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12-1·46], p_trend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67-0·87], p_trend<0·0001; saturated fat, HR 0·86 [0·76-0·99], p_trend=0·0088; monounsaturated fat: HR 0·81 [0·71-0·92], p_trend<0·0001; and polyunsaturated fat: HR 0·80 [0·71-0·89], p_trend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64-0·98], p_trend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.

INTERPRETATION

High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

FUNDING

Full funding sources listed at the end of the paper (see Acknowledgments).

A simple method for calculation of basic molecular properties of nutrients and their use as a criterion for a healthy diet

Background: Healthy nutrition is vital for good health and well-being. Despite the important role of a healthy nutritional diet, recommendations for healthy eating remain elusive and are mainly based on general properties of nutrients. The present study proposes an improved characterization of the molecular characteristics of nutrients, which are important for biological functions and can be useful in describing a healthy diet. Methods: We investigated the electronic properties of some known nutrient ingredients. In this analysis, we used the average quasi valence number (AQVN) and the electron-ion interaction potential (EIIP), which are molecular descriptors that represent the basic electronic properties of organic molecules.   Results: Our results show that most nutrients can be represented by specific groups of organic compounds according to their basic electronic properties, and these differ from the vast majority of known chemicals. Based on this finding, we have proposed a simple criterion for the selection of food components for healthy nutrition. Discussion: Further studies on the electronic properties of nutrients could serve as a basis for better understanding of their biological functions.