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Hu F, Wang Z, Liu Y, Gao Y, Liu S, Xu C, Wang Y, Cai Y. Association between total cholesterol and all-cause mortality in oldest old: a national longitudinal study. Front Endocrinol (Lausanne) 2024; 15:1405283. [PMID: 38938514 PMCID: PMC11208679 DOI: 10.3389/fendo.2024.1405283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024] Open
Abstract
Background A common sense is that lower serum cholesterol levels are better. However, a growing number of researches have questioned this especially for the oldest old. The current study was to assess the association between total cholesterol and all-cause mortality in a group of people aged 85 years old and over. Methods We selected 903 Chinese old participants who aged ≥85 years from the Chinese Longitudinal Healthy Longevity Survey(CLHLS) at baseline in 2012. The participants were followed up until death or until December 31, 2014. The outcome was all-cause mortality. The univariate and multivariate Cox regression analyses were used to estimate risk levels of all-cause mortality. We stratified the participants into three groups (<3.40, 3.40-4.39, ≥4.39 mmol/L) based on the restricted cubic splines methods. The survival probability according to total cholesterol category was calculated using the Kaplan-Meier curves, and the log-rank test was performed to analyze differences between the groups. Results During the follow-up of three years, 282 participants died, 497 survived and 124 lost to follow-up. There was significant relationship between the total cholesterol and lower risk of all-cause mortality in the multivariable Cox regression analysis (HR=0.88, 95% CI: 0.78-1.00). Based on the restricted cubic splines methods, the total cholesterol was converted from a continuous variable to a categorical variable. The populations were divided into three groups (<3.40, 3.40-4.39, ≥4.39 mmol/L) according to the total cholesterol categorized by cutoff values. Compared to the total cholesterol level of <3.40 mmol/L, populations in the total cholesterol level of 3.40-4.39 mmol/L (HR = 0.72, 95% CI: 0.53-0.97) and ≥4.39 mmol/L (HR = 0.71, 95% CI: 0.52-0.96) groups had lower all-cause mortality in multivariate Cox regression analysis and higher survival probability in survival analysis. When two groups were divided, similar results were found among the populations in the total cholesterol level of ≥3.40 mmol/L compared to the populations in the total cholesterol level of <3.40 mmol/L groups. Conclusion In oldest old aged 85 and older, serum total cholesterol levels are inversely associated with all-cause mortality. This study suggested that total cholesterol should be maintained to acceptable levels (≥ 3.40 mmol/L) in oldest old to achieve longevity.
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Affiliation(s)
| | | | | | | | | | | | - Ying Wang
- Public Health Department, International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Cai
- Public Health Department, International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Morimoto N, Urayama KY, Tanaka A, Ai M. Relationship between dietary fiber to carbohydrate ratio and mortality risk in US adults: NHANES 2007-2018. Nutr Metab Cardiovasc Dis 2024; 34:661-671. [PMID: 38161116 DOI: 10.1016/j.numecd.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/04/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND AIMS The evidence is inconsistent regarding associations between relative proportions of macronutrient intake and disease risk, potentially due to limitations in accounting for differential effects of simple sugars and dietary fiber, grouped as "carbohydrates." We examined the association between the ratio of dietary fiber to carbohydrate intake (FC-R) measure, the relative proportion of macronutrients, and mortality risk in a nationally representative sample of U.S. adults. METHODS AND RESULTS We performed a retrospective cohort study, using data from the National Health and Nutrition Examination Survey in 2007-2018 and linked mortality data among 15,789 adults aged ≥40 years. We categorized participants into three groups by tertile cutpoints of FC-R, and by percent calories from carbohydrate (<45 %, 45-65 %, and >65 %). Cox proportional hazards regression was performed to estimate hazard ratios (HR) for all-cause mortality with 95 % confidence intervals (95 % CI), adjusting for demographic, health history, and lifestyle factors. During a median follow-up of 6.5 years, 2044 deaths were observed. Compared to the low FC-R group, higher FC-R groups showed a reduction in mortality risk after adjusting for potential confounders (high vs low: HR = 0.71, 95 % CI = 0.62-0.83). The association persisted in those consuming 45-65 % and >65 % of calories from carbohydrate, while the association was attenuated in those with <45 % of calories from carbohydrate. Percent calories from carbohydrate showed no association with mortality risk. CONCLUSION Higher FC-R was associated with lower all-cause mortality risk in adults with moderate to high levels of percent calories from carbohydrate. Mechanisms of the association warrant further investigation.
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Affiliation(s)
- Nobuhisa Morimoto
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan.
| | - Kevin Y Urayama
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan; Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Tanaka
- Nutrition Clinic, Kagawa Nutrition University, Tokyo, Japan
| | - Masumi Ai
- Department of Insured Medical Care Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Mirrafiei A, Jayedi A, Shab-Bidar S. Total and different dietary fiber subtypes and the risk of all-cause, cardiovascular, and cancer mortality: a dose-response meta-analysis of prospective cohort studies. Food Funct 2023; 14:10667-10680. [PMID: 37997693 DOI: 10.1039/d2fo04024g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
We aimed to conduct a comprehensive review of the association between dietary fiber and the risk of mortality. We did a systematic search in PubMed, Scopus, and Web of Science up to November 2022 to find prospective cohort studies of the relationship between total and subtypes of dietary fiber and the risk of all-cause, cardiovascular (CVD), and cancer mortality in the general population. The hazard ratios (HRs) and 95% CIs were calculated using a random-effects model. A total of 28 studies with 1 613 885 participants were included. Higher intake of total and subtypes of dietary fiber including cereal, vegetable, legume, soluble, and insoluble fiber, but not fruit fiber, was associated with a lower risk of all-cause mortality, with HRs ranging from 0.77 for insoluble fiber to 0.93 for legume fiber. Similar findings were observed for CVD mortality, where higher intake of total and all subtypes of dietary fiber was each associated with a lower risk. Higher intake of total, cereal, vegetable, and insoluble fiber was also associated with a lower risk of cancer mortality. No association was found between the intake of fruit, legume, and soluble fiber and cancer mortality. Dose-response meta-analyses suggested an inverse association between total fiber intake and the risk of all-cause, CVD, and cancer mortality. The certainty of evidence was rated moderate for the association of total fiber with all-cause, CVD, and cancer mortality. In conclusion, our findings highlight the potential advantages of consuming a wide range of dietary fiber subtypes against all-cause, CVD, and cancer mortality. Registry and registry number: PROSPERO (CRD42021226816).
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Affiliation(s)
- Amin Mirrafiei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No. 44, Hojjat-dost Alley, Naderi St, Keshavarz Blvd, P. O. Box 14155/6117, Tehran, Iran.
| | - Ahmad Jayedi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No. 44, Hojjat-dost Alley, Naderi St, Keshavarz Blvd, P. O. Box 14155/6117, Tehran, Iran.
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Ghorbani Z, Noormohammadi M, Kazemi A, Poustchi H, Pourshams A, Martami F, Hashemian M, Malekzadeh R, Hekmatdoost A. Higher intakes of fiber, total vegetables, and fruits may attenuate the risk of all-cause and cause-specific mortality: findings from a large prospective cohort study. Nutr J 2023; 22:60. [PMID: 37978495 PMCID: PMC10655472 DOI: 10.1186/s12937-023-00883-4] [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: 04/26/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Although studies have reported an inverse association between fruits, vegetables, and fiber consumption and all-cause and cause-specific mortality, the issue remains incompletely defined in the Middle Eastern population. AIMS The current study aimed to investigate the association between dietary fiber, fruit, and vegetable intake and all-cause and cause-specific mortality. METHODS A total of 48632 participants (mean age = 52years), 57.5% (n = 27974) women and 42.5% (n = 20658) men, were recruited from an ongoing large-scale prospective cohort study (the Golestan Cohort Study (GCS)), in the north of Iran. Using a validated semi-quantitative 116-item food questionnaire, dietary intakes were collected. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) of all-cause and cause-specific mortality were reported. RESULTS After approximately 14 years of follow-up, 10,774 deaths were recorded. In the fully adjusted model, compared to those in the lowest quintile of intake, those in the second and third quintiles of dietary fiber intake had a 7%-10% reduction in risk of all-cause mortality, and a 15%-17% reduction in the risk of mortality from other causes. Increasing consumption of fruits was also associated with a decreased risk of mortality for all-cause mortality by 9%-11%, and all cancer by 15-20%. Further, those in the third and fourth quintiles of vegetables intake had 11%-12% lower risk for CVD mortality. DISCUSSION The results from the GCS further support the current recommendations on following a healthy diet containing proper amounts of fiber, vegetables, and fruits, as health-protective dietary items. CONCLUSIONS Higher intake of dietary fiber, fruits, and vegetables has the potential to reduce both overall and cause-specific mortality rates. However, additional cohort studies with larger sample size and long-term follow-up durations are required to establish these findings.
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Affiliation(s)
- Zeinab Ghorbani
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Nutrition, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Morvarid Noormohammadi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Asma Kazemi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Poustchi
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Martami
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azita Hekmatdoost
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Neuenschwander M, Stadelmaier J, Eble J, Grummich K, Szczerba E, Kiesswetter E, Schlesinger S, Schwingshackl L. Substitution of animal-based with plant-based foods on cardiometabolic health and all-cause mortality: a systematic review and meta-analysis of prospective studies. BMC Med 2023; 21:404. [PMID: 37968628 PMCID: PMC10652524 DOI: 10.1186/s12916-023-03093-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/25/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND There is growing evidence that substituting animal-based with plant-based foods is associated with a lower risk of cardiovascular diseases (CVD), type 2 diabetes (T2D), and all-cause mortality. Our aim was to summarize and evaluate the evidence for the substitution of any animal-based foods with plant-based foods on cardiometabolic health and all-cause mortality in a systematic review and meta-analysis. METHODS We systematically searched MEDLINE, Embase, and Web of Science to March 2023 for prospective studies investigating the substitution of animal-based with plant-based foods on CVD, T2D, and all-cause mortality. We calculated summary hazard ratios (SHRs) and 95% confidence intervals (95% CI) using random-effects meta-analyses. We assessed the certainty of evidence (CoE) using the GRADE approach. RESULTS In total, 37 publications based on 24 cohorts were included. There was moderate CoE for a lower risk of CVD when substituting processed meat with nuts [SHR (95% CI): 0.73 (0.59, 0.91), n = 8 cohorts], legumes [0.77 (0.68, 0.87), n = 8], and whole grains [0.64 (0.54, 0.75), n = 7], as well as eggs with nuts [0.83 (0.78, 0.89), n = 8] and butter with olive oil [0.96 (0.95, 0.98), n = 3]. Furthermore, we found moderate CoE for an inverse association with T2D incidence when substituting red meat with whole grains/cereals [0.90 (0.84, 0.96), n = 6] and red meat or processed meat with nuts [0.92 (0.90, 0.94), n = 6 or 0.78 (0.69, 0.88), n = 6], as well as for replacing poultry with whole grains [0.87 (0.83, 0.90), n = 2] and eggs with nuts or whole grains [0.82 (0.79, 0.86), n = 2 or 0.79 (0.76, 0.83), n = 2]. Moreover, replacing red meat for nuts [0.93 (0.91, 0.95), n = 9] and whole grains [0.96 (0.95, 0.98), n = 3], processed meat with nuts [0.79 (0.71, 0.88), n = 9] and legumes [0.91 (0.85, 0.98), n = 9], dairy with nuts [0.94 (0.91, 0.97), n = 3], and eggs with nuts [0.85 (0.82, 0.89), n = 8] and legumes [0.90 (0.89, 0.91), n = 7] was associated with a reduced risk of all-cause mortality. CONCLUSIONS Our findings indicate that a shift from animal-based (e.g., red and processed meat, eggs, dairy, poultry, butter) to plant-based (e.g., nuts, legumes, whole grains, olive oil) foods is beneficially associated with cardiometabolic health and all-cause mortality.
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Affiliation(s)
- Manuela Neuenschwander
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julian Eble
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Grummich
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Edyta Szczerba
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Eva Kiesswetter
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sabrina Schlesinger
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany.
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Yao F, Ma J, Cui Y, Huang C, Lu R, Hu F, Zhu X, Qin P. Dietary intake of total vegetable, fruit, cereal, soluble and insoluble fiber and risk of all-cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies. Front Nutr 2023; 10:1153165. [PMID: 37854351 PMCID: PMC10579821 DOI: 10.3389/fnut.2023.1153165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
Objectives To conduct a systematic review and meta-analysis of prospective cohort studies to investigate the association between total, vegetable, fruit, cereal, soluble and insoluble fiber intake and risk of all causes, cardiovascular disease (CVD), and cancer mortality and quantitatively assess the dose-response relation. Methods Eligible studies were identified by searching PubMed, Embase and Web of science before August 2023. Random effects models were used to calculate summary relative risk (RR) and 95% confidence intervals (CI) and restricted cubic splines to model the linear/non-linear association. Results The summary RR for all-cause, CVD and cancer mortality of dietary fiber was 0.90 (95% CI: 0.86,0.93), 0.87 (0.84,0.91), 0.91 (0.88,0.93), respectively. Significant association was observed for all-cause and CVD mortality with fruit, vegetable cereal and soluble fiber intake and cancer mortality with cereal fiber intake. No significant association was found for insoluble fiber, vegetable or fruit fiber intake and cancer mortality. Dose-response analysis showed a significant non-linear relation of dietary fiber intake with all-cause mortality, and linear relation for others. Conclusions Higher dietary fiber including different type and food sources of fiber intake were associated with lower risk of mortality. Our findings provide more comprehensive evidence on dietary fiber intake with mortality. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier: CRD42022338837.
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Affiliation(s)
- Feifei Yao
- Clinical Public Health Center, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Jianping Ma
- Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Yong Cui
- Department of Oncology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Cuihong Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ruiqi Lu
- School of Public Health, Shantou University, Shantou, Guangdong, China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, Shenzhen University Health Science Center, School of Public Health, Shenzhen, Guangdong, China
| | - Xiaoming Zhu
- Department of Biostatistics and Epidemiology, School of Public Health, Xi'an Medical University, Xi'an, Shanxi, China
| | - Pei Qin
- Clinical Public Health Center, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
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Goldfarb G, Sela Y. The Ideal Diet for Humans to Sustainably Feed the Growing Population - Review, Meta-Analyses, and Policies for Change. F1000Res 2023; 10:1135. [PMID: 37928317 PMCID: PMC10623543 DOI: 10.12688/f1000research.73470.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION As of now, no study has combined research from different sciences to determine the most suitable diet for humans. This issue is urgent due to the predicted population growth, the effect of this on the environment, and the deterioration of human health and associated costs. METHODS A literature review determined whether an optimal diet for humans exists and what such a diet is, followed by six meta-analyses. The standard criteria for conducting meta-analyses of observational studies were followed. A review of literature reporting Hazard Ratios with a 95% confidence interval for red meat intake, dairy intake, plant-based diet, fiber intake, and serum IGF-1 levels were extracted to calculate effect sizes. RESULTS Results calculated using NCSS software show that high meat consumption increases mortality probability by 18% on average and increases diabetes risk by 50%. Plant-based and high-fiber diets decrease mortality by 15% and 20% respectively ( p < .001). Plant-based diets decreased diabetes risk by 27%, and dairy consumption (measured by increased IGF-1 levels) increased cancer probability by 48% ( p < 0.01). A vegetarian or Mediterranean diet was not found to decrease the probability of heart disease. A vegetarian diet can be healthy or not, depending on the foods consumed. A Mediterranean diet with high quantities of meat and dairy products will not produce the health effects desired. The main limitations of the study were that observational studies were heterogeneous and limited by potential confounders. DISCUSSION The literature and meta-analyses point to an optimal diet for humans that has followed our species from the beginnings of humankind. The optimal diet is a whole food, high fiber, low-fat, 90+% plant-based diet. This diet allowed humans to become the most developed species on Earth. To ensure people's nutritional needs are met healthily and sustainably, governmental dietary interventions are necessary.
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Affiliation(s)
- Galit Goldfarb
- Nutrition, OUS University, The Royal Academy of Economics and Technology, Zürich, Switzerland
| | - Yaron Sela
- Nutrition, OUS University, The Royal Academy of Economics and Technology, Zürich, Switzerland
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Sun T, Zhang Y, Ding L, Zhang Y, Li T, Li Q. The Relationship Between Major Food Sources of Fructose and Cardiovascular Outcomes: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Adv Nutr 2023; 14:256-269. [PMID: 36803836 DOI: 10.1016/j.advnut.2022.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
There is emerging evidence of associations between intake of sugar-sweetened beverages (SSBs), those that include various forms of added sugar, and increased risk of cardiovascular disease (CVD) but whether consumption of other dietary sources of fructose affects CVD is unclear. In this study, we conducted a meta-analysis to examine potential dose-response relationships between such foods and CVD, coronary heart disease (CHD), and stroke morbidity and mortality. We systematically searched the literature indexed in PubMed, Embase, and the Cochrane Library from the inception of each database to February 10, 2022. We included prospective cohort studies analyzing the association between at least 1 dietary source of fructose and CVD, CHD, and stroke. Based on data from 64 included studies, summary HRs and 95% CIs were calculated for the highest intake category compared with the lowest, and dose-response analyses were performed. Of all fructose sources examined, only SSB intakes showed positive associations with CVD, giving summary HRs per 250 mL/d increase of 1.10 (95% CI: 1.02, 1.17) for CVD, 1.11 (95% CI: 1.05, 1.17) for CHD, 1.08 (95% CI: 1.02, 1.13) for stroke morbidity, and 1.06 (95% CI: 1.02, 1.10) for CVD mortality. Conversely, 3 dietary sources showed protective associations: between fruits and CVD morbidity (HR: 0.97; 95% CI: 0.96, 0.98), fruits and CVD mortality (HR: 0.94; 95% CI: 0.92, 0.97), yogurt and CVD mortality (HR: 0.96; 95% CI: 0.93, 0.99), and breakfast cereals and CVD mortality (HR: 0.80; 95% CI: 0.70, 0.90). All these relationships were linear except for fruit, which was J-shaped: CVD morbidity was the lowest at 200 g/d and there was no protective association above 400 g/d. These findings indicate that the adverse associations between SSBs and CVD, CHD, and stroke morbidity and mortality do not extend to other dietary sources of fructose. The food matrix seemed to modify the association between fructose and cardiovascular outcomes.
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Affiliation(s)
- Tingting Sun
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yabing Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Ding
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yonggang Zhang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Mitochondria and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
| | - Qian Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
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Hu H, Zhao Y, Feng Y, Yang X, Li Y, Wu Y, Yuan L, Zhang J, Li T, Huang H, Li X, Zhang M, Sun L, Hu D. Consumption of whole grains and refined grains and associated risk of cardiovascular disease events and all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. Am J Clin Nutr 2023; 117:149-159. [PMID: 36789934 DOI: 10.1016/j.ajcnut.2022.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/10/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although relationships between the intake of whole grains and refined grains and the incidence of cardiovascular disease (CVD) events and all-cause mortality have been investigated, the conclusions have been inconclusive. OBJECTIVES We aimed to comprehensively summarize the evidence about the correlation between consuming whole grains and refined grains and risks of CVD events and all-cause mortality and to evaluate the meta-evidence quality. METHODS We searched PubMed, Embase, and Web of Science until 15 March, 2022. Random-effects models were employed to calculate summary relative risks (RRs) and 95% confidence intervals (CIs). We explored potential linear or nonlinear relationships using restricted cubic splines. The NutriGrade tool was employed to rate meta-evidence quality. RESULTS Twenty-four articles (68 studies; 46 for whole grains and 22 for refined grains) with 1,624,407 participants were included. Per 30-g increase in daily whole grain consumption, the RRs and 95% CIs of stroke, coronary heart disease (CHD), heart failure (HF), CVD, and all-cause mortality were 0.98 (0.96, 1.00), 0.94 (0.92, 0.97), 0.97 (0.89, 1.07), 0.92 (0.88, 0.96), and 0.94 (0.92, 0.97), respectively. Whole grain consumption was linearly associated with CHD (Pnonlinearity = 0.231) and nonlinearly associated with CVD (Pnonlinearity = 0.002) and all-cause mortality (Pnonlinearity = 0.001). Except for a positive correlation between refined grain consumption and all-cause mortality in the restricted cubic spline, no significant influence of refined grain intake on stroke, CHD, HF, and CVD was detected. The meta-evidence quality for the association of whole grain consumption with stroke, CHD, HF, CVD, and all-cause mortality was moderate, moderate, low, high, and high, respectively. For refined grains, all meta-evidence was of low quality. CONCLUSIONS Consuming whole grains, rather than refined grains, can assist in preventing CHD, CVD, and all-cause mortality. Relationships between consumption of refined grains and health outcomes should be interpreted cautiously because of the low quality of meta-evidence.
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Affiliation(s)
- Huifang Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yifei Feng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xingjin Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yang Li
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Yuying Wu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Lijun Yuan
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jinli Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Tianze Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hao Huang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Xi Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Liang Sun
- Department of Social Medicine and Health Service Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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10
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Jadhav A, Vadiveloo M, Laforge RG, Melanson KJ. Dietary contributors to fermentable carbohydrate intake in healthy American college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-11. [PMID: 36170454 DOI: 10.1080/07448481.2022.2119403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/04/2022] [Accepted: 08/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The study explored food items that contribute most toward increased fermentable carbohydrate (FC) intake and its association with diet quality in college students. METHOD This cross-sectional study included 571 consented college students (≥18 years) with reported energy intakes (500-3500 kcal/day for women; 800-4000 kcal/day for men). FC intake and healthy eating index-2015 (HEI-2015) scores were assessed by diet history questionnaire-II. Data were analyzed by unadjusted bivariate linear regression and Pearson correlation tests. RESULTS The mean intakes of total FC (β = 1.24; 95% Confidence Interval: 1.02, 1.47) significantly predicted HEI-2015 scores. Positive correlations were found between FC intake and red and orange vegetables (r = 0.62), whole fruits (r = 0.63), and dark green vegetables (r = 0.58). Conclusions: Higher FC intake was associated with higher diet quality; vegetables and fruits are primary contributors to FC content. Efforts are required to promote these food items to improve diet quality and FC intake to shape eating choices in college students.
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Affiliation(s)
- Ajita Jadhav
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Maya Vadiveloo
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Robert G Laforge
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Kathleen J Melanson
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, Rhode Island, USA
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11
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Kwon YJ, Lee HS, Park G, Kim HM, Lee JW. Association of Dietary Fiber Intake with All-Cause Mortality and Cardiovascular Disease Mortality: A 10-Year Prospective Cohort Study. Nutrients 2022; 14:nu14153089. [PMID: 35956265 PMCID: PMC9370192 DOI: 10.3390/nu14153089] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/25/2022] Open
Abstract
Although previous studies have established that dietary fiber (DF) intake reduces the total cardiovascular disease (CVD) mortality in general populations, limited studies have been conducted in individuals with pre-existing chronic conditions, especially in Asian countries. We aimed to investigate the association of DF intake with all-cause and CVD mortality in the general population and in the subpopulation with hypertension, diabetes, and dyslipidemia. We examined the relationship between DF intake and all-cause and CVD mortality using the Korean genome and epidemiology study. Diet was assessed using a food-frequency questionnaire at baseline. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) after adjusting for confounders. During the mean 10.1 years of follow-up, higher DF intake was significantly associated with a lower risk of all-cause mortality after adjusting for confounders (HR and 95% CIs for Q5 vs. Q1: 0.84 (0.76−0.93); p < 0.001). DF intake was inversely associated with a lower risk of CVD mortality after adjusting for the same confounders (HR and 95% CIs for Q5 vs. Q1: 0.61 (0.47−0.78); p < 0.001). Total DF intake was inversely associated with all-cause and CVD mortality in middle-aged and older adults.
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Affiliation(s)
- Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul 16995, Korea;
| | - Hye-Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul 03277, Korea;
| | - Goeun Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea;
| | - Hyung-Mi Kim
- Department of Food and Nutrition, Dongduck Women’s University, Seoul 02748, Korea;
| | - Ji-Won Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence:
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12
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Associations between Consumption of Dietary Fibers and the Risk of Type 2 Diabetes, Hypertension, Obesity, Cardiovascular Diseases, and Mortality in Chinese Adults: Longitudinal Analyses from the China Health and Nutrition Survey. Nutrients 2022; 14:nu14132650. [PMID: 35807831 PMCID: PMC9268526 DOI: 10.3390/nu14132650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 12/10/2022] Open
Abstract
Although many studies have explored the relationship between total dietary fiber intake and the risk of chronic non-communicable diseases, the results are mixed. There is also a lack of research on the association between dietary fiber intake from different food sources and disease. Using data from the China Nutrition and Health Database from 2004 to 2015, Cox proportional risk models were used to explore the associations between total dietary fiber and fiber intake from different food sources and the occurrence of type 2 diabetes, hypertension, obesity, cardiovascular disease, and all-cause mortality. After multi-factorial adjustment, the hazard ratios (95% confidence interval) of total dietary fiber intake (quartile 4 vs. quartile 1) in type 2 diabetes, hypertension, obesity, cardiovascular disease, and all-cause mortality cohorts were 1.20 (0.93, 1.55), 0.91 (0.75, 1.12), 0.93 (0.64, 1.35), 1.13 (0.60, 2.12), 1.13 (0.60, 2.12), and 1.13 (0.84, 1.52). Whole-grain fiber intake was positively associated with hypertension but not with the occurrence of other diseases. No association was observed between legume fibers, fruit fibers, and vegetable fibers in the cohorts of type 2 diabetes, hypertension, obesity, cardiovascular diseases and all-cause mortality. Our study did not find any association between total dietary fiber and dietary fiber intake from different food sources and type 2 diabetes, obesity, cardiovascular disease, and all-cause mortality in the Chinese population. The role of dietary fiber in the Chinese population may be overestimated. More extraordinary efforts are needed to further confirm the association between dietary fiber and these diseases in the Chinese population.
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Hajipour A, Afsharfar M, Jonoush M, Ahmadzadeh M, Gholamalizadeh M, Hassanpour Ardekanizadeh N, Doaei S, Mohammadi‐Nasrabadi F. The effects of dietary fiber on common complications in critically ill patients; with a special focus on viral infections; a systematic reveiw. Immun Inflamm Dis 2022; 10:e613. [PMID: 35478440 PMCID: PMC9017620 DOI: 10.1002/iid3.613] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 12/17/2022] Open
Abstract
Background Viral infections are mostly highly contagious and may cause widespread health problems. Some studies reported that the dietary fiber (DF) may be effective in reducing the complications of viral infections in intensive care unit (ICU) patients. The present review study aimed to investigate the effect of DF on common complications in critically ill patients with viral infections. Methods A literature review was conducted for the published papers in English from January 2001 to July 2021 using related keywords. Studies with clinical trial or case‐control design described the effects of fiber intake on the complications of viral infections in patients admitted to the ICU were collected. Results DF may reduce the mortality rate of viral infections through modulating inflammatory processes. A higher intake of DF intake may improve hyperglycemia and impaired glucose tolerance in patients with viral infections. A high‐fiber formula in enteral nutrition was reported to reduce the risk of diarrhea in patients with viral infections. Conclusion DF may reduce the complications of viral infections such as inflammation, diarrhea, hyperglycemia, and mortality in critically ill patients. Future longitudinal studies on the amount and type of DF are warranted.
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Affiliation(s)
- Azadeh Hajipour
- Department of Nutrition, School of Health Qazvin University of Medical Sciences Qazvin Iran
| | - Maryam Afsharfar
- Department of Nutrition, School of Medicine Zahedan University of Medical Sciences Zahedan Iran
| | - Mona Jonoush
- Department of Nutrition, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Mina Ahmadzadeh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Maryam Gholamalizadeh
- School of Medicine, Cancer Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Naeemeh Hassanpour Ardekanizadeh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Saeid Doaei
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, School of Medicine, Al‐Zahra Hospital Guilan University of Medical Sciences Rasht Iran
| | - Fatemeh Mohammadi‐Nasrabadi
- Department of Food and Nutrition Policy and Planning Research, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute Shahid Beheshti University of Medical Sciences Tehran Iran
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14
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Kwon YJ, Lee HS, Park GE, Lee JW. Association Between Dietary Fiber Intake and All-Cause and Cardiovascular Mortality in Middle Aged and Elderly Adults With Chronic Kidney Disease. Front Nutr 2022; 9:863391. [PMID: 35520287 PMCID: PMC9062480 DOI: 10.3389/fnut.2022.863391] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimsDespite accumulating evidence on the benefits of dietary fiber in the general population, there is a lack of representative data on mortality in patients with chronic kidney disease (CKD). This study examined the role of dietary fiber intake on all-cause and cardiovascular mortality in patients with CKD using representative Korean cohort data.MethodsThe study included 3,892 participants with estimated glomerular filtration rates <60 mL/min/1.73 m2 from the Korean Genome and Epidemiology Study. Mortality status was followed by data linkage with national data sources. Nutritional status was assessed using a validated food frequency questionnaire. Dietary fiber was categorized into quintiles (Q). A multivariable Cox proportional hazards regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cardiovascular mortality.ResultsThe average daily fiber intake of patients with CKD was 5.1 g/day. During the 10.1-year follow-up period, 602 (149 cardiovascular) deaths were documented. The HR (95% CI) for all-cause mortality in the highest quintile compared with that in the lowest quintile was 0.63 (0.46–0.87) after adjusting for age, sex, BMI, smoking, alcohol intake, exercise, total calorie intake, hypertension, diabetes, and dyslipidemia (P = 0.005). The HR (95% CI) for cardiovascular mortality in the highest quintile compared with that in the lowest quintile was 0.56 (0.29–1.08) after adjusting for same confounders (P = 0.082).ConclusionIn conclusion, we observed an inverse association between dietary fiber intake and all-cause mortality in CKD patients. Small increments in fiber intake reduced the risk of all-cause mortality by 37%. This finding highlights the need for inexpensive but important dietary modification strategies for encouraging fiber intake in the Korean CKD population.
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Affiliation(s)
- Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea
| | - Go Eun Park
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji-Won Lee
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Ji-Won Lee
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15
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Current Research on the Effects of Non-Digestible Carbohydrates on Metabolic Disease. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12083768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Metabolic diseases (MDs), including cardiovascular diseases (CVDs) and diabetes, occur when the body’s normal metabolic processes are disrupted. Behavioral risk factors such as obesity, physical inactivity, and dietary habits are strongly associated with a higher risk of MD. However, scientific evidence strongly suggests that balanced, healthy diets containing non-digestible carbohydrates (NDCs), such as dietary fiber and resistant starch, can reduce the risk of developing MD. In particular, major properties of NDCs, such as water retention, fecal bulking, viscosity, and fermentation in the gut, have been found to be important for reducing the risk of MD by decreasing blood glucose and lipid levels, increasing satiety and insulin sensitivity, and modifying the gut microbiome. Short chain fatty acids produced during the fermentation of NDCs in the gut are mainly responsible for improvement in MD. However, the effects of NDCs are dependent on the type, source, dose, and duration of NDC intake, and some of the mechanisms underlying the efficacy of NDCs on MD remain unclear. In this review, we briefly summarize current studies on the effects of NDCs on MD and discuss potential mechanisms that might contribute to further understanding these effects.
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16
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Nutritional and health beneficts of whole grains cereals. NUTR HOSP 2022; 39:3-7. [DOI: 10.20960/nh.04301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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17
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Changes in Quantity and Sources of Dietary Fiber from Adopting Healthy Low-Fat vs. Healthy Low-Carb Weight Loss Diets: Secondary Analysis of DIETFITS Weight Loss Diet Study. Nutrients 2021; 13:nu13103625. [PMID: 34684626 PMCID: PMC8539701 DOI: 10.3390/nu13103625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023] Open
Abstract
The daily intake of dietary fiber is well below the recommended levels in the US. The effect of adopting a low-fat vs. a low-carbohydrate weight loss diet on fiber intake is of interest but not well-documented, especially when both approaches promote high-quality food choices. The objective of this paper is to compare the quantity and sources of dietary fiber between a healthy low-fat (HLF) vs. healthy low-carbohydrate (HLC) diet group when consumed over 12 months in a weight loss diet study. In this secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) study, the amount and sources of dietary fiber were examined in generally healthy adults, 18-50 years of age, Body Mass Index (BMI) 28-40 kg/m2, randomized to HLF or HLC for 12 months, who had available 24-h recalls at 0 (n = 609), 3 (n = 549), 6 (n = 491), and 12 (n = 449) months. The dietary intake was estimated by the Nutrition Data System for Research (NDS-R). The sources of fiber were determined for the major food groups. Significantly more total dietary fiber was consumed by HLF at every post-randomization time point, and, at 12 m, was 23.04 ± 9.43 g vs. 18.61 ± 8.12 g for HLF vs. HLC, respectively, p < 0.0001. In both diet groups at 12 months, the highest amount of dietary fiber came from non-starchy vegetables (4.13 ± 3.05 g and 5.13 ± 3.59 g). The other primary sources of fiber at 12 months for the HLF group were from whole grains (3.90 ± 3.13 g) and fruits (3.40 ± 2.87 g), and, for the HLC group, were from plant protein and fat sources, such as nuts and seeds, their butters, and avocados (2.64 ± 2.64 g). In the DIETFITS study, the difference in the total fiber intake for the HLF vs. HLC groups was more modest than expected. The HLC group consumed reasonably high amounts of fiber from high-protein and high fat plant-based sources.
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18
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Wang DD, Li Y, Bhupathiraju SN, Rosner BA, Sun Q, Giovannucci EL, Rimm EB, Manson JE, Willett WC, Stampfer MJ, Hu FB. Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation 2021; 143:1642-1654. [PMID: 33641343 DOI: 10.1161/circulationaha.120.048996] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The optimal intake levels of fruit and vegetables for maintaining long-term health are uncertain. METHODS We followed 66 719 women from the Nurses' Health Study (1984-2014) and 42 016 men from the Health Professionals Follow-up Study (1986-2014) who were free from cardiovascular disease (CVD), cancer, and diabetes at baseline. Diet was assessed using a validated semiquantitative food frequency questionnaire at baseline and updated every 2 to 4 years. We also conducted a dose-response meta-analysis, including results from our 2 cohorts and 24 other prospective cohort studies. RESULTS We documented 33 898 deaths during the follow-up. After adjustment for known and suspected confounding variables and risk factors, we observed nonlinear inverse associations of fruit and vegetable intake with total mortality and cause-specific mortality attributable to cancer, CVD, and respiratory disease (all Pnonlinear<0.001). Intake of ≈5 servings per day of fruit and vegetables, or 2 servings of fruit and 3 servings of vegetables, was associated with the lowest mortality, and above that level, higher intake was not associated with additional risk reduction. In comparison with the reference level (2 servings/d), daily intake of 5 servings of fruit and vegetables was associated with hazard ratios (95% CI) of 0.87 (0.85-0.90) for total mortality, 0.88 (0.83-0.94) for CVD mortality, 0.90 (0.86-0.95) for cancer mortality, and 0.65 (0.59-0.72) for respiratory disease mortality. The dose-response meta-analysis that included 145 015 deaths accrued in 1 892 885 participants yielded similar results (summary risk ratio of mortality for 5 servings/d=0.87 [95% CI, 0.85-0.88]; Pnonlinear<0.001). Higher intakes of most subgroups of fruits and vegetables were associated with lower mortality, with the exception of starchy vegetables such as peas and corn. Intakes of fruit juices and potatoes were not associated with total and cause-specific mortality. CONCLUSIONS Higher intakes of fruit and vegetables were associated with lower mortality; the risk reduction plateaued at ≈5 servings of fruit and vegetables per day. These findings support current dietary recommendations to increase intake of fruits and vegetables, but not fruit juices and potatoes.
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Affiliation(s)
- Dong D Wang
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Yanping Li
- Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Shilpa N Bhupathiraju
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Bernard A Rosner
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Biostatistics (B.A.R.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Qi Sun
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Edward L Giovannucci
- Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Eric B Rimm
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - JoAnn E Manson
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Division of Preventive Medicine, Department of Medicine (J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Walter C Willett
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Meir J Stampfer
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
| | - Frank B Hu
- Channing Division for Network Medicine (D.D.W., S.N.B., B.A.R., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition (D.D.W., Y.L., S.N.B., Q.S., E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology (E.L.G., E.B.R., J.E.M., W.C.W., M.J.S., F.B.H.), Harvard T. H. Chan School of Public Health, Boston, MA
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Zawada A, Rychter AM, Ratajczak AE, Lisiecka-Masian A, Dobrowolska A, Krela-Kaźmierczak I. Does Gut-Microbiome Interaction Protect against Obesity and Obesity-Associated Metabolic Disorders? Microorganisms 2020; 9:microorganisms9010018. [PMID: 33374597 PMCID: PMC7822472 DOI: 10.3390/microorganisms9010018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023] Open
Abstract
More research has recently focused on the role of the gut microbiota in the development or course of numerous diseases, including non-communicable diseases. As obesity remains prevalent, the question arises as to what microbial changes are associated with increased obesity prevalence and what kind of prevention and treatment approaches it could provide. Moreover, the influence of the gut-brain axis on obesity is also crucial, since it can affect metabolism and food intake. The quantitative and qualitative changes in the microbiota composition are called dysbiosis; however, in view of the current knowledge, it is difficult to conclude which microbial imbalances are adverse or beneficial. Increased numbers of pathological microorganisms were observed among patients with obesity and comorbidities associated with it, such as diabetes, cardiovascular disease, and insulin resistance. Our review provides current knowledge regarding changes in the intestinal microbiota associated with obesity and obesity-associated comorbidities. Nevertheless, given that dietary patterns and nutrients are two of the factors affecting the intestinal microbiota, we also discuss the role of different dietary approaches, vitamins, and minerals in the shaping of the intestinal microbiota.
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Whole Grains, Refined Grains, and Cancer Risk: A Systematic Review of Meta-Analyses of Observational Studies. Nutrients 2020; 12:nu12123756. [PMID: 33297391 PMCID: PMC7762239 DOI: 10.3390/nu12123756] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/21/2022] Open
Abstract
PubMed, Web of Science, and the Cochrane Database of Systematic Reviews were searched for meta-analyses that provided risk estimates (±95% confidence intervals) for associations between intakes of whole and refined grains and risk of total and site-specific cancer. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Only meta-analyses that included whole grains and refined grains as separate food groups, and not as part of dietary patterns, were included. A total of 17 publications were identified that met inclusion criteria. Within these, results from a total of 54 distinct meta-analyses were reported for whole grains and 5 meta-analyses for refined grains. For total cancer mortality, 7 meta-analyses of cohort studies indicated that whole grain intake was associated with 6% to 12% lower risk in comparison of highest vs. lowest intake groups, and 3% to 20% lower risk for doses ranging from 15 to 90 g/day. For site-specific cancers, meta-analyses indicated that whole grain intake was consistently associated with lower risks of colorectal, colon, gastric, pancreatic, and esophageal cancers. Limited data were available for refined grains, with only 4 publications providing risk estimates, and only 1 of the meta-analyses included more than 3 studies. High intake of refined grains was associated with increased risk of colon and gastric cancer. By contrast, in the only dose-response meta-analysis, each 90 g/day consumption of refined grains was associated with a 6% lower risk of total cancer. In addition to the limited number of published meta-analyses on refined grains, results were also weakened due to the fact that refined grains were frequently defined to include both staple grain foods and indulgent grain foods, and the majority of studies included in the meta-analyses provided no specific definition of refined grains. Overall, meta-analyses of cohort and case-control studies consistently demonstrate that whole grain intake is associated with lower risk of total and site-specific cancer, and support current dietary recommendations to increase whole grain consumption. By contrast, the relationship between refined grain intake and cancer risk is inconclusive.
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Katagiri R, Goto A, Sawada N, Yamaji T, Iwasaki M, Noda M, Iso H, Tsugane S. Dietary fiber intake and total and cause-specific mortality: the Japan Public Health Center-based prospective study. Am J Clin Nutr 2020; 111:1027-1035. [PMID: 31990973 DOI: 10.1093/ajcn/nqaa002] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An inverse association has been shown between dietary fiber intake and several noncommunicable diseases. However, evidence of this effect remains unclear in the Asian population. OBJECTIVE We examined the association between dietary fiber intake and all-cause and cause-specific mortality, as well as the association between fiber intake from dietary sources and all-cause mortality. METHODS We conducted a large-scale population-based cohort study (Japan Public Health Center-based prospective study). A validated questionnaire with 138 food items was completed by 92,924 participants (42,754 men and 50,170 women) aged 45-74 y. Dietary fiber intake was calculated and divided into quintiles. HR and 95% CI of total and cause-specific mortality were reported. RESULTS During the mean follow-up of 16.8 y, 19,400 deaths were identified. In multivariable adjusted models, total, soluble, and insoluble fiber intakes were inversely associated with all-cause mortality. The HRs of total mortality in the highest quintile of total fiber intake compared with the lowest quintile were 0.77 (95% CI: 0.72, 0.82; Ptrend <0.0001) in men and 0.82 (95% CI: 0.76, 0.89; Ptrend <0.0001) in women. Increased quintiles of dietary fiber intake were significantly associated with decreased mortality due to total cardiovascular disease (CVD), respiratory disease, and injury in both men and women, whereas dietary fiber intake was inversely associated with cancer mortality in men but not women. Fiber from fruits, beans, and vegetables, but not from cereals, was inversely associated with total mortality. CONCLUSION In this large-scale prospective study with a long follow-up period, dietary fiber was inversely associated with all-cause mortality. Since intakes of dietary fiber, mainly from fruits, vegetables, and beans were associated with lower all-cause mortality, these food sources may be good options for people aiming to consume more fiber.
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Affiliation(s)
- Ryoko Katagiri
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Atsushi Goto
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Diabetes, Metabolism, and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, Kounodai, Ichikawa, Chiba, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Yamadaoka, Suita-shi, Osaka, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan
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Martínez-González MA, Fernandez-Lazaro CI, Toledo E, Díaz-López A, Corella D, Goday A, Romaguera D, Vioque J, Alonso-Gómez ÁM, Wärnberg J, Martínez JA, Serra-Majem L, Estruch R, Tinahones FJ, Lapetra J, Pintó X, Tur JA, López-Miranda J, Cano-Ibáñez N, Delgado-Rodríguez M, Matía-Martín P, Daimiel L, Sánchez VM, Vidal J, Vázquez C, Ros E, Buil-Cosiales P, Portoles O, Soria-Florido M, Konieczna J, Navarrete-Muñoz EM, Tojal-Sierra L, Fernández-García JC, Abete I, Henríquez-Sánchez P, Muñoz-Garach A, Santos-Lozano JM, Corbella E, Bibiloni MDM, Becerra-Tomás N, Barragán R, Castañer O, Fiol M, García de la Hera M, Belló-Mora MC, Gea A, Babio N, Fitó M, Ruiz-Canela M, Zazpe I, Salas-Salvadó J. Carbohydrate quality changes and concurrent changes in cardiovascular risk factors: a longitudinal analysis in the PREDIMED-Plus randomized trial. Am J Clin Nutr 2020; 111:291-306. [PMID: 31868210 DOI: 10.1093/ajcn/nqz298] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Overall quality of dietary carbohydrate intake rather than total carbohydrate intake may determine the risk of cardiovascular disease (CVD). OBJECTIVE We examined 6- and 12-mo changes in carbohydrate quality index (CQI) and concurrent changes in several CVD risk factors in a multicenter, randomized, primary-prevention trial (PREDIMED-Plus) based on an intensive weight-loss lifestyle intervention program. METHODS Prospective analysis of 5373 overweight/obese Spanish adults (aged 55-75 y) with metabolic syndrome (MetS). Dietary intake information obtained from a validated 143-item semiquantitative food-frequency questionnaire was used to calculate 6- and 12-mo changes in CQI (categorized in quintiles), based on 4 criteria (total dietary fiber intake, glycemic index, whole grain/total grain ratio, and solid carbohydrate/total carbohydrate ratio). The outcomes were changes in intermediate markers of CVD. RESULTS During the 12-mo follow-up, the majority of participants improved their CQI by increasing their consumption of fruits, vegetables, legumes, fish, and nuts and decreasing their consumption of refined cereals, added sugars, and sugar-sweetened beverages. After 6 mo, body weight, waist circumference (WC), systolic and diastolic blood pressure (BP), fasting blood glucose, glycated hemoglobin (HbA1c), triglyceride levels, triglycerides and glucose (TyG) index, and TyG-WC decreased across successive quintiles of improvement in the CQI. After 12 mo, improvements were additionally observed for HDL cholesterol and for the ratio of total to HDL cholesterol. Favorable improvements (expressed in common units of SD and 95% CI) for quintile 5 compared with quintile 1 of CQI change were observed for most risk factors, including TyG-WC (SD -0.20; 95% CI -0.26, -0.15), HbA1c (SD -0.16; 95% CI -0.23, -0.10), weight (SD -0.12; 95% CI -0.14, -0.09), systolic BP (SD -0.11; 95% CI -0.19, -0.02) and diastolic BP (SD -0.11; 95% CI -0.19, -0.04). CONCLUSIONS Improvements in CQI were strongly associated with concurrent favorable CVD risk factor changes maintained over time in overweight/obese adults with MetS. This trial was registered as ISRCTN 89898870.
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Affiliation(s)
- Miguel A Martínez-González
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, IdiSNA, Pamplona, Spain.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Cesar I Fernandez-Lazaro
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, IdiSNA, Pamplona, Spain
| | - Estefanía Toledo
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, IdiSNA, Pamplona, Spain
| | - Andrés Díaz-López
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain.,Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | - Dolores Corella
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Albert Goday
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d'Investigació Médica, Barcelona, Spain
| | - Dora Romaguera
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Jesús Vioque
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.,Miguel Hernandez University, ISABIAL-FISABIO, Alicante, Spain
| | - Ángel M Alonso-Gómez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Julia Wärnberg
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Department of Nursing, School of Health Sciences, University of Málaga Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain
| | - J Alfredo Martínez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, Pamplona, Spain.,Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, Madrid, Spain
| | - Luís Serra-Majem
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Nutrition Research Group, Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ramon Estruch
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Department of Internal Medicine, Institut d'Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francisco J Tinahones
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Virgen de la Victoria Hospital, Department of Endocrinology, IBIMA, University of Málaga, Málaga, Spain
| | - José Lapetra
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | - Xavier Pintó
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona Spain
| | - Josep A Tur
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain.,Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain
| | - José López-Miranda
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Naomi Cano-Ibáñez
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Miguel Delgado-Rodríguez
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.,Division of Preventive Medicine, University of Jaén, Jaén, Spain
| | - Pilar Matía-Martín
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Lidia Daimiel
- Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, Madrid, Spain
| | - Vicente Martín Sánchez
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d'Investigació Médica, Barcelona, Spain.,Institute of Biomedicine, University of León, León, Spain
| | - Josep Vidal
- CIBER Diabetes y Enfermedades Metabólicas, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Endocrinology, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Clotilde Vázquez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Department of Endocrinology and Nutrition, Hospital Fundación Jiménez Díaz, Instituto de Investigaciones Biomédicas IISFJD, University Autonoma, Madrid, Spain
| | - Emilio Ros
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Lipid Clinic, Department of Endocrinology and Nutrition, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Pilar Buil-Cosiales
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, IdiSNA, Pamplona, Spain.,Atención Primaria, Servicio Navarro de Salud, Pamplona, Navarra, Spain
| | - Olga Portoles
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - María Soria-Florido
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d'Investigació Médica, Barcelona, Spain.,Department of Nutrition, Food Sciences and Gastronomy, University of Barcelona, Barcelona, Spain
| | - Jadwiga Konieczna
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Eva M Navarrete-Muñoz
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.,Miguel Hernandez University, ISABIAL-FISABIO, Alicante, Spain
| | - Lucas Tojal-Sierra
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - José C Fernández-García
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Virgen de la Victoria Hospital, Department of Endocrinology, IBIMA, University of Málaga, Málaga, Spain
| | - Itziar Abete
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, Pamplona, Spain
| | - Patricia Henríquez-Sánchez
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Nutrition Research Group, Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Araceli Muñoz-Garach
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Virgen de la Victoria Hospital, Department of Endocrinology, IBIMA, University of Málaga, Málaga, Spain
| | - José M Santos-Lozano
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | - Emili Corbella
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona Spain
| | - Maria Del Mar Bibiloni
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain.,Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain
| | - Nerea Becerra-Tomás
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain.,Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | - Rocío Barragán
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Olga Castañer
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d'Investigació Médica, Barcelona, Spain
| | - Miquel Fiol
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Manoli García de la Hera
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.,Miguel Hernandez University, ISABIAL-FISABIO, Alicante, Spain
| | - María C Belló-Mora
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Alfredo Gea
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, IdiSNA, Pamplona, Spain
| | - Nancy Babio
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain.,Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | - Montse Fitó
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d'Investigació Médica, Barcelona, Spain
| | - Miguel Ruiz-Canela
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, IdiSNA, Pamplona, Spain
| | - Itziar Zazpe
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, IdiSNA, Pamplona, Spain.,Department of Nutrition and Food Sciences and Physiology, School of Pharmacy and Nutrition, University of Navarra
| | - Jordi Salas-Salvadó
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain.,Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain.,Institut d'Investigació Sanitària Pere Virgili, Reus, Spain.,University Hospital of Sant Joan de Reus, Nutrition Unit, Reus, Spain
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Dominguez LJ, Barbagallo M. Dietary fiber intake and the Mediterranean population. THE MEDITERRANEAN DIET 2020:257-265. [DOI: 10.1016/b978-0-12-818649-7.00023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Ortega-Santos CP, Whisner CM. The Key to Successful Weight Loss on a High-Fiber Diet May Be in Gut Microbiome Prevotella Abundance. J Nutr 2019; 149:2083-2084. [PMID: 31584088 DOI: 10.1093/jn/nxz248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - Corrie M Whisner
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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25
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Fruit and Vegetable Consumption and Potential Moderators Associated with All-Cause Mortality in a Representative Sample of Spanish Older Adults. Nutrients 2019; 11:nu11081794. [PMID: 31382535 PMCID: PMC6723290 DOI: 10.3390/nu11081794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 02/06/2023] Open
Abstract
This study sought to determine the association between levels of fruit and vegetable consumption and time to death, and to explore potential moderators. We analyzed a nationally-representative sample of 1699 older adults aged 65+ who were followed up for a period of 6 years. Participants were classified into low (≤3 servings day), medium (4), or high (≥5) consumption using tertiles. Unadjusted and adjusted cox proportional hazard regression models (by age, gender, cohabiting, education, multimorbidity, smoking, physical activity, alcohol consumption, and obesity) were calculated. The majority of participants (65.7%) did not meet the recommendation of five servings per day. High fruit and vegetable intake increased by 27% the probability of surviving among older adults with two chronic conditions, compared to those who consumed ≤3 servings per day (HR = 0.38, 95%CI = 0.21–0.69). However, this beneficial effect was not found for people with none, one chronic condition or three or more, indicating that this protective effect might not be sufficient for more severe cases of multimorbidity. Given a common co-occurrence of two non-communicable diseases in the elderly and the low frequency of fruit and vegetable consumption in this population, interventions to promote consuming five or more servings per day could have a significant positive impact on reducing mortality.
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26
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Aoun C, Papazian T, Helou K, El Osta N, Khabbaz LR. Comparison of five international indices of adherence to the Mediterranean diet among healthy adults: similarities and differences. Nutr Res Pract 2019; 13:333-343. [PMID: 31388410 PMCID: PMC6669066 DOI: 10.4162/nrp.2019.13.4.333] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/13/2019] [Accepted: 07/03/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/OBJECTIVES To compare five indices of adherence to the Mediterranean Diet (MD) among adults living in the Mediterranean region. SUBJECTS/METHODS A total of 100 healthy Lebanese adults aged between 18 and 65 years. Face-to-face interviews to collect sociodemographic and medical information, to take anthropometric measurements, and to fill a validated, culturally adapted, food frequency questionnaire (FFQ). The score for each item was calculated following the recommendations for each corresponding index. The five MD indices were Mediterranean Diet Scale (MDScale), Mediterranean Food Pattern (MFP), MD Score (MDS), Short Mediterranean Diet Questionnaire (SMDQ), and the MedDiet score. RESULTS Significant correlations were detected between items with P-values < 0.001. Minimal agreement was seen between MDScale and MedDiet score and maximal agreement between MDS and MedDiet score. Univariate and multivariate analyses showed that MDS and MedDiet scores had significant correlations with fiber and olive oil intake, main components of the MD. MDScale showed a significant correlation with waist-to-hip ratio and with total energy intake but none of the five indices was correlated to body mass index (BMI). CONCLUSIONS The indices that showed the highest correlation with variables related to the MD are the MDScale and the MedDiet score; therefore, they can be used to assess our future study populations. Based on the current results, more than half of the study population was non-adherent to the MD and adherence to this diet did not appear to protect against being overweight (BMI ≥ 30).
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Affiliation(s)
- Carla Aoun
- Laboratoire de pharmacologie, pharmacie clinique et contrôle de qualité des médicaments, Faculty of pharmacy, Saint-Joseph University of Beirut, Beirut, 1107 2180, Lebanon.,Department of nutrition, Faculty of pharmacy, Saint-Joseph University of Beirut, Beirut, 1107 2180, Lebanon
| | - Tatiana Papazian
- Laboratoire de pharmacologie, pharmacie clinique et contrôle de qualité des médicaments, Faculty of pharmacy, Saint-Joseph University of Beirut, Beirut, 1107 2180, Lebanon.,Department of nutrition, Faculty of pharmacy, Saint-Joseph University of Beirut, Beirut, 1107 2180, Lebanon
| | - Khalil Helou
- Department of nutrition, Faculty of pharmacy, Saint-Joseph University of Beirut, Beirut, 1107 2180, Lebanon
| | - Nada El Osta
- Department of Public Health, Faculty of Medicine, Saint-Joseph University, Beirut, 1107 2180, Lebanon.,Department of Prosthodontics, Faculty of Dental Medicine, Saint-Joseph University, 1107 2180, Beirut, Lebanon.,Centre de Recherche en Odontologie Clinique, EA 4847, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Lydia Rabbaa Khabbaz
- Laboratoire de pharmacologie, pharmacie clinique et contrôle de qualité des médicaments, Faculty of pharmacy, Saint-Joseph University of Beirut, Beirut, 1107 2180, Lebanon
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Garcia-Arellano A, Martínez-González MA, Ramallal R, Salas-Salvadó J, Hébert JR, Corella D, Shivappa N, Forga L, Schröder H, Muñoz-Bravo C, Estruch R, Fiol M, Lapetra J, Serra-Majem L, Ros E, Rekondo J, Toledo E, Razquin C, Ruiz-Canela M, Alonso A, Barrio Lopez M, Basterra-Gortari F, Benito Corchon S, Bes-Rastrollo M, Beunza J, Carlos S, Cervantes S, de Irala J, de la Rosa P, de la Fuente C, Donat-Vargas C, Donazar M, Fernandez Montero A, Gea A, Goni-Ochandorena E, Guillen-Grima F, Lahortiga F, Llorca J, Lopez del Burgo C, Mari-Sanchıs A, Marti A, Mendonça R, Nuñez-Cordoba J, Pimenta A, Rico A, Ruiz Zambrana A, Sayon-Orea C, Toledo-Atucha J, Vazquez Ruiz Z, Zazpe Garcıa I, Sánchez- Tainta A, Buil-Cosiales P, Díez-Espino J, Sanjulian B, Martínez J, Marti A, Serrano-Martínez M, Basterra-Gortari F, Extremera-Urabayen J, Garcia-Pérez L, Arroyo-Azpa C, Barcena A, Oreja-Arrayago C, Lasanta-Sáez M, Cia-Lecumberri P, Elcarte-Lopez T, Artal-Moneva F, Esparza-López J, Figuerido-Garmendia E, Tabar-Sarrias J, Fernández- Urzainqui L, Ariz-Arnedo M, Cabeza-Beunza J, Pascual-Pascual P, Martínez-Mazo M, Arina-Vergara E, Macua-Martínez T, Pascual Pascual P, Garcés Ducar M, Martí Massó R, Villanueva Moreno R, Parra-Osés A, Serra-Mir M, Pérez-Heras A, Viñas C, Casas R, Medina-Remon A, Villanueva P, Baena J, García M, Oller M, Amat J, Duaso I, García Y, Iglesias C, Simón C, Quinzavos L, Parra L, Liroz M, Benavent J, Clos J, Pla I, Amorós M, Bonet M, Martín M, Sánchez M, Altirriba J, Manzano E, Altés A, Cofán M, Valls-Pedret C, Sala-Vila A, Doménech M, Bulló M, Basora-Gallisa J, González R, Molina C, Mena G, Martínez P, Ibarrola N, Sorlí J, García Roselló J, Martin F, Tort N, Isach A, Babio N, Salas-Huetos A, Becerra-Tomás N, Rosique- Esteban N, Hernandez P, Canudas S, Papandreou C, Ferreira C, Cabre M, Mestres G, Paris F, Llauradó M, Pedret R, Basells J, Vizcaino J, Segarra R, Giardina S, Guasch-Ferré M, Díaz-López A, Fernández-Ballart J, Balanza R, Tello S, Vila J, de la Torre R, Muñoz-Aguayo D, Elosua R, Marrugat J, Schröder H, Molina N, Maestre E, Rovira A, Castañer O, Farré M, Sorli J, Carrasco P, Ortega-Azorín C, Asensio E, Osma R, Barragán R, Francés F, Guillén M, González J, Sáiz C, Portolés O, Giménez F, Coltell O, Fernández-Carrión R, Guillem-Sáiz P, González-Monje I, Quiles L, Pascual V, Riera C, Pages M, Godoy D, Carratalá-Calvo A, Sánchez-Navarro S, Valero-Barceló C, Salaverria I, Hierro TD, Algorta J, Francisco S, Alonso A, San Vicente J, Casi A, Sanz E, Felipe I, Rekondo J, Loma-Osorio A, Fernandez-Crehuet J, Garcia-Rodriguez A, Wärnberg J, Benitez Pont R, Bianchi Alba M, Navajas R, Gómez-Huelgas R, Martínez-González J, Velasco García V, de Diego Salas J, Baca Osorio A, Gil Zarzosa J, Sánchez Luque J, Vargas López E, Romaguera D, García-Valdueza M, Proenza A, Prieto R, Frontera G, Munuera S, Vivó M, Bestard F, Munar J, Coll L, Fiol F, Ginard M, Jover A, García J, Santos-Lozano J, Ortega-Calvo M, Leal M, Martínez E, Mellado L, Miró-Moriano L, Domínguez-Espinaco C, Vaquero- Diaz S, Iglesias P, Román P, Corchado Y, Lozano-Rodríguez J, Lamuela-Raventós R, López- Sabater M, Castellote-Bargalló A, Quifer-Rada P, Tresserra-Rimbau A, Alvarez-Pérez J, Díez Benítez E, Bautista Castaño I, Maldonado Díaz I, Sanchez-Villegas A, Férnandez- Rodríguez M, Sarmiendo de la Fe F, Simón García C, Falcón Sanabria I, Macías Gutiérrez B, Santana Santana A, de la Cruz E, Galera A, Pintó-Salas X, Trias F, Sarasa I, Rodríguez M, Corbella X, Corbella E, Goday A, Muñoz M, Cabezas C, Vinyoles E, Rovira M, Garcia L, Baby P, Ramos A, Mengual L, Roura P, Yuste M, Guarner A, Rovira A, Santamaria M, Mata M, de Juan C, Brau A, Fernandez M, Gutierrez E, Murillo C, Garcia J, Tafalla M, Bobe I, Díaz A, Araque M, Solis E, Cervello T, Montull I, Tur J, Portillo M, Sáez G. Dietary inflammatory index and all-cause mortality in large cohorts: The SUN and PREDIMED studies. Clin Nutr 2019; 38:1221-1231. [PMID: 30651193 DOI: 10.1016/j.clnu.2018.05.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/24/2018] [Accepted: 05/02/2018] [Indexed: 12/22/2022]
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Dietary Fiber, Atherosclerosis, and Cardiovascular Disease. Nutrients 2019; 11:nu11051155. [PMID: 31126110 PMCID: PMC6566984 DOI: 10.3390/nu11051155] [Citation(s) in RCA: 248] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022] Open
Abstract
Observational studies have shown that dietary fiber intake is associated with decreased risk of cardiovascular disease. Dietary fiber is a non-digestible form of carbohydrates, due to the lack of the digestive enzyme in humans required to digest fiber. Dietary fibers and lignin are intrinsic to plants and are classified according to their water solubility properties as either soluble or insoluble fibers. Water-soluble fibers include pectin, gums, mucilage, fructans, and some resistant starches. They are present in some fruits, vegetables, oats, and barley. Soluble fibers have been shown to lower blood cholesterol by several mechanisms. On the other hand, water-insoluble fibers mainly include lignin, cellulose, and hemicellulose; whole-grain foods, bran, nuts, and seeds are rich in these fibers. Water-insoluble fibers have rapid gastric emptying, and as such may decrease the intestinal transit time and increase fecal bulk, thus promoting digestive regularity. In addition to dietary fiber, isolated and extracted fibers are known as functional fiber and have been shown to induce beneficial health effects when added to food during processing. The recommended daily allowances (RDAs) for total fiber intake for men and women aged 19–50 are 38 gram/day and 25 gram/day, respectively. It is worth noting that the RDA recommendations are for healthy people and do not apply to individuals with some chronic diseases. Studies have shown that most Americans do not consume the recommended intake of fiber. This review will summarize the current knowledge regarding dietary fiber, sources of food containing fiber, atherosclerosis, and heart disease risk reduction.
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Offringa LC, Stanton MV, Hauser ME, Gardner CD. Fruits and Vegetables Versus Vegetables and Fruits: Rhyme and Reason for Word Order in Health Messages. Am J Lifestyle Med 2019; 13:224-234. [PMID: 31105482 PMCID: PMC6506980 DOI: 10.1177/1559827618769605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/06/2018] [Indexed: 11/16/2022] Open
Abstract
Both vegetable and fruit consumption contribute to wellness and disease prevention. Most dietary health messages promote both together and position the word "fruits" before "vegetables." We examined the word order of the commonly used phrase "fruits and vegetables" through linguistics, psychology, botany, nutrition, health outcomes, and current US intake to determine if the common word order best presents these two foods in health messaging. By comparing the 10 most commonly consumed vegetables versus fruits, we found that vegetables scored higher on the Aggregate Nutrient Density Index and contained fewer calories and more fiber than fruits. Among the "nutrients of public concern" listed in the 2015 Dietary Guidelines for Americans, we determined that vegetables are better sources of these nutrients than fruits, although fruits scored higher in antioxidant content. In observational cohort studies, vegetable and fruit consumption was found to be associated with decreased mortality. Finally, daily intakes of both vegetables and fruits are lower than recommended, but the discrepancy is larger for vegetables-especially among children-suggesting a greater imperative to promote vegetables. For these reasons, future health messages promoting both together should intentionally put "vegetables" first to promote intake and emphasize their importance regarding contribution to health.
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Affiliation(s)
- Lisa C. Offringa
- Stanford Prevention Research Center, Stanford
University School of Medicine, Palo Alto, California (LCO, MEH, CDG)
- Department of Nursing and Health Sciences,
California State University, East Bay, Hayward, California (MVS)
| | - Michael V. Stanton
- Stanford Prevention Research Center, Stanford
University School of Medicine, Palo Alto, California (LCO, MEH, CDG)
- Department of Nursing and Health Sciences,
California State University, East Bay, Hayward, California (MVS)
| | - Michelle E. Hauser
- Stanford Prevention Research Center, Stanford
University School of Medicine, Palo Alto, California (LCO, MEH, CDG)
- Department of Nursing and Health Sciences,
California State University, East Bay, Hayward, California (MVS)
| | - Christopher D. Gardner
- Christopher D. Gardner, PhD, Stanford
Prevention Research Center, Stanford University School of Medicine, 1265 Welch
Road, Stanford, CA 94305-5411; e-mail:
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Dreher ML. Whole Fruits and Fruit Fiber Emerging Health Effects. Nutrients 2018; 10:E1833. [PMID: 30487459 PMCID: PMC6315720 DOI: 10.3390/nu10121833] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
Less than 10% of most Western populations consume adequate levels of whole fruits and dietary fiber with typical intake being about half of the recommended levels. Evidence of the beneficial health effects of consuming adequate levels of whole fruits has been steadily growing, especially regarding their bioactive fiber prebiotic effects and role in improved weight control, wellness and healthy aging. The primary aim of this narrative review article is to examine the increasing number of health benefits which are associated with the adequate intake of whole fruits, especially fruit fiber, throughout the human lifecycle. These potential health benefits include: protecting colonic gastrointestinal health (e.g., constipation, irritable bowel syndrome, inflammatory bowel diseases, and diverticular disease); promoting long-term weight management; reducing risk of cardiovascular disease, type 2 diabetes and metabolic syndrome; defending against colorectal and lung cancers; improving odds of successful aging; reducing the severity of asthma and chronic obstructive pulmonary disease; enhancing psychological well-being and lowering the risk of depression; contributing to higher bone mineral density in children and adults; reducing risk of seborrheic dermatitis; and helping to attenuate autism spectrum disorder severity. Low whole fruit intake represents a potentially more serious global population health threat than previously recognized, especially in light of the emerging research on whole fruit and fruit fiber health benefits.
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Affiliation(s)
- Mark L Dreher
- Nutrition Science Solutions, LLC, Wimberley, 78676 TX, USA.
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Bozzetto L, Costabile G, Della Pepa G, Ciciola P, Vetrani C, Vitale M, Rivellese AA, Annuzzi G. Dietary Fibre as a Unifying Remedy for the Whole Spectrum of Obesity-Associated Cardiovascular Risk. Nutrients 2018; 10:E943. [PMID: 30037123 PMCID: PMC6073249 DOI: 10.3390/nu10070943] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/15/2018] [Accepted: 07/18/2018] [Indexed: 02/07/2023] Open
Abstract
Obesity is a pandemic carrying the heavy burden of multiple and serious co-morbidities including metabolic syndrome, type 2 diabetes and cardiovascular diseases. The pathophysiological processes leading to the accumulation of body fat slowly evolve to fat accumulation in other body compartments than subcutaneous tissue. This abnormal fat deposition determines insulin resistance which in turn causes blood glucose and lipid metabolism derangement, non-alcoholic fatty liver disease, hypertension, and metabolic syndrome. All these conditions contribute to increase the cardiovascular risk of obese people. Several randomized clinical trials demonstrated that moderate weight loss (5⁻10%) in obese patients improves obesity-related metabolic risk factors and coexisting disorders. Therefore, nutritional strategies able to facilitate weight management, and in the meantime positively influence obesity-associated cardiovascular risk factors, should be implemented. To this aim, a suitable option could be dietary fibres that may also act independently of weight loss. The present narrative review summarizes the current evidence about the effects of dietary fibres on weight management in obese people. Moreover, all of the different cardiovascular risk factors are individually considered and evidence on cardiovascular outcomes is summarized. We also describe the plausible mechanisms by which different dietary fibres could modulate cardio-metabolic risk factors. Overall, despite both epidemiological and intervention studies on weight loss that show statistically significant but negligible clinical effects, dietary fibres seem to have a beneficial impact on main pathophysiological pathways involved in cardiovascular risk (i.e., insulin resistance, renin-angiotensin, and sympathetic nervous systems). Although the evidence is not conclusive, this suggests that fibre would be a suitable option to counteract obesity-related cardio-metabolic diseases also independently of weight loss. However, evidence is not consistent for the different risk factors, with clear beneficial effects shown on blood glucose metabolism and Low Density Lipoprotein (LDL) cholesterol while there is fewer, and less consistent data shown on plasma triglyceride and blood pressure. Ascribing the beneficial effect of some foods (i.e., fruits and vegetables) solely to their fibre content requires more investigation on the pathophysiological role of other dietary components, such as polyphenols.
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Affiliation(s)
- Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Giuseppina Costabile
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Paola Ciciola
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Claudia Vetrani
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
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Ma X, Tang WG, Yang Y, Zhang QL, Zheng JL, Xiang YB. Association between whole grain intake and all-cause mortality: a meta-analysis of cohort studies. Oncotarget 2018; 7:61996-62005. [PMID: 27566558 PMCID: PMC5308706 DOI: 10.18632/oncotarget.11491] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/09/2016] [Indexed: 12/26/2022] Open
Abstract
Some observational studies have examined the association between dietary whole grain intake and all-cause mortality, but the results were inconclusive. We therefore conducted a meta-analysis to summarize the evidence from cohort studies regarding the association between whole grain intake and all-cause mortality. Pertinent studies were identified by searching PubMed, Embase and Web of Knowledge, up to February 28, 2016. Study-specific estimates were combined using random-effects models. Eleven prospective cohort studies involving 101,282 deaths and 843,749 participants were included in this meta-analysis. The pooled relative risk of all-cause mortality for the highest category of whole grain intake versus lowest category was 0.82 (95% confidence interval: 0.78, 0.87). There was a 7% reduction in risk associated with each 1 serving/day increase in whole grain intake (relative risk = 0.93; 95% confidence interval: 0.89, 0.97). No publication bias was found. This analysis indicates that higher intake of whole grain is associated with a reduced risk of all-cause mortality. The findings support current recommendations for increasing whole grain consumption to promote health and overall longevity.
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Affiliation(s)
- Xiao Ma
- State Key Laboratory of Oncogenes and Related Genes and Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei-Guo Tang
- State Key Laboratory of Oncogenes and Related Genes and Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yang Yang
- State Key Laboratory of Oncogenes and Related Genes and Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qing-Li Zhang
- State Key Laboratory of Oncogenes and Related Genes and Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia-Li Zheng
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Yong-Bing Xiang
- State Key Laboratory of Oncogenes and Related Genes and Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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White J, Greene G, Kivimaki M, Batty GD. Association between changes in lifestyle and all-cause mortality: the Health and Lifestyle Survey. J Epidemiol Community Health 2018; 72:711-714. [PMID: 29602792 DOI: 10.1136/jech-2017-210363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND To examine the combined influence of changes in physical activity, diet, smoking and alcohol consumption on all-cause mortality. METHODS Health behaviours were assessed in 1984/1985 and 1991/1992 in 8123 adults from the UK (4666 women, median age 41.0 years). An unhealthy lifestyle score was calculated, allocating one point for smoking, fruits and vegetables <3 times a day, physical activity <2 hours a week and >14 units (women) or >21 units of alcohol (men) per week. RESULTS There were 2003 deaths over a median follow-up of 6.6 years (IQR 5.9-7.2) following the resurvey. The modal change in the unhealthy lifestyle score was zero, 41.8% had the same score, 35.5% decreased and 22.7% increased score between surveys. A one unit decrease in the unhealthy lifestyle score was not associated with a beneficial effect on mortality (HR 0.93; 95% CI 0.83 to 1.04). A one unit increase in the unhealthy lifestyle score increased the risk of mortality (adjusted HR 1.09; 95% CI 1.01 to 1.18). CONCLUSIONS In this general population sample, the adoption of an unhealthy lifestyle was associated with an increased risk of mortality.
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Affiliation(s)
- James White
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.,Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Giles Greene
- Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Cardiff University, Cardiff, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
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Korre M, Sotos-Prieto M, Kales SN. Survival Mediterranean Style: Lifestyle Changes to Improve the Health of the US Fire Service. Front Public Health 2017; 5:331. [PMID: 29326915 PMCID: PMC5741604 DOI: 10.3389/fpubh.2017.00331] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular disease (CVD) causes almost half of all on-duty deaths in US firefighters and is an important and costly cause of morbidity. In addition, cancer is a growing health concern in this population. Obesity and obesity-associated, cardiometabolic risk clustering are major, modifiable risk factors for fire service CVD and cancer risk. The Mediterranean diet (MedDiet) is proven effective in primary and secondary CVD prevention. It is also associated with a decreased risk of cancer and other chronic diseases. Moreover, it can be adapted into successful workplace interventions. Emerging data from our group regarding the US Fire Service show that greater compliance with the MedDiet is associated with improved CVD risk profiles and less weight gain among career firefighters. Moreover, the fact that career firefighters take a considerable number of meals communally on the job also represents an excellent opportunity for a workplace Mediterranean Diet Nutritional Intervention (MDNI). The devastating effects of obesity, CVD, and cancer on the US fire service are recognized, but currently few effective preventive programs exist. The consistently positive health benefits from following a MedDiet and promising preliminary data in the fire service justify translational research to determine the most effective means of delivering MDNIs to US firefighters. Therefore, a high priority should be assigned to efforts, which can help further disseminate and implement our program of novel behavior change strategies, "Survival Mediterranean Style," throughout the US fire service and eventually to other occupations.
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Affiliation(s)
- Maria Korre
- Environmental & Occupational Medicine & Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Mercedes Sotos-Prieto
- Environmental & Occupational Medicine & Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- The Diabetes Institute, Ohio University, Athens, OH, United States
- Department of Food Sciences and Nutrition, School of Applied Heath Sciences and Wellness, Ohio University, Athens, OH, United States
| | - Stefanos N. Kales
- Environmental & Occupational Medicine & Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
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Association of whole grain intake with all-cause, cardiovascular, and cancer mortality: a systematic review and dose-response meta-analysis from prospective cohort studies. Eur J Clin Nutr 2017; 72:57-65. [PMID: 29091078 DOI: 10.1038/ejcn.2017.149] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/04/2017] [Accepted: 08/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Whole grains are rich source of nutrients and have shown beneficial effects on human health. This study was designed to systematically review the existing results and quantitatively assess the dose-response relationship of whole grain intake with all-cause and cause-specific mortality. SUBJECTS/METHODS We searched 'whole grain' or 'whole grains' in combination with 'mortality'' or 'cardiovascular disease' or 'cancer' through the Web of Science and PubMed databases till 20 January 2016. To be eligible for inclusion, publications should be prospective cohort studies and reported the influence of whole grain intake on human mortality. Relative risks (RRs) and 95% confidence intervals (CIs) from the included studies were pooled by a random effects model or fixed effect model. RESULTS We included 19 cohort studies from 17 articles, with 1 041 692 participants and 96 710 deaths in total, in the analyses. We observed an inverse relationship of whole grain intake with risk of total, cardiovascular disease and cancer mortality. The pooled RR was 0.84 (95% CI 0.81-0.88, n=9) for total mortality, 0.83 (95% CI 0.79-0.86, n=8) for CVD mortality and 0.94 (95% CI 0.87-1.01, n=14) for cancer mortality, comparing the highest intake of whole grain with the lowest category. For dose-response analysis, we found a nonlinear relationship of whole grain intake with risk of total, cardiovascular and cancer mortality. Each 28 g/d intake of whole grains was associated with a 9% (pooled RR: 0.91 (0.90-0.93)) lower risk for total mortality, 14% (pooled RR: 0.86 (0.83-0.89)) lower risk for CVD mortality and 3% (pooled RR: 0.97 (0.95-0.99)) lower risk for cancer mortality. CONCLUSIONS Our study shows that whole grain intake was inversely associated with risk of total, CVD and cancer mortality. Our results support current dietary guidelines to increase the intake of whole grains. Government officials, scientists and medical staff should take actions to promote whole grains intake.
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McRae MP. Dietary Fiber Is Beneficial for the Prevention of Cardiovascular Disease: An Umbrella Review of Meta-analyses. J Chiropr Med 2017; 16:289-299. [PMID: 29276461 DOI: 10.1016/j.jcm.2017.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/02/2017] [Accepted: 05/23/2017] [Indexed: 02/07/2023] Open
Abstract
Objective The purpose of this study was to review previously published meta-analyses on the effectiveness of dietary fiber on cardiovascular disease. Methods An umbrella review of all published meta-analyses was performed. A PubMed search from January 1, 1980, to January 31, 2017, was conducted using the following search strategy: (fiber OR glucan OR psyllium OR fructans) AND (meta-analysis OR systematic review). Only English-language publications that provided quantitative statistical analysis on cardiovascular disease, lipid concentrations, or blood pressure were retrieved. Results Thirty-one meta-analyses were retrieved for inclusion in this umbrella review, and all meta-analyses comparing highest versus lowest dietary fiber intake reported statistically significant reductions in the relative risk (RR) of cardiovascular disease mortality (RR = 0.77-0.83), as well as the incidences of cardiovascular disease (RR = 0.72-0.91), coronary heart disease (RR = 0.76-0.93), and stroke (RR = 0.83-0.93). Meta-analyses on supplementation studies using β-glucan or psyllium fibers also reported statistically significant reductions in both total serum and low-density lipoprotein cholesterol concentrations. Conclusion This review suggests that individuals consuming the highest amounts of dietary fiber intake can significantly reduce their incidence and mortality from cardiovascular disease. Mechanistically, these beneficial effects may be due to dietary fibers' actions on reducing total serum and low-density lipoprotein cholesterol concentrations between 9.3 to 14.7 mg/dL and 10.8 to 13.5 mg/dL, respectively.
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Affiliation(s)
- Marc P McRae
- Department of Basic Sciences, National University of Health Sciences, Lombard, Illinois
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García-Meseguer MJ, Delicado-Soria A, Serrano-Urrea R. Fiber Patterns in Young Adults Living in Different Environments (USA, Spain, and Tunisia). Anthropometric and Lifestyle Characteristics. Nutrients 2017; 9:nu9091030. [PMID: 28927012 PMCID: PMC5622790 DOI: 10.3390/nu9091030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/14/2017] [Accepted: 09/13/2017] [Indexed: 12/17/2022] Open
Abstract
Benefits of dietary fiber go beyond its effect on chronic diseases associated with development. Consequently, the pattern of fiber intake has been considered an indicator for diet quality. Young adults are especially vulnerable to a food environment that drives an increase in chronic diseases linked to economic development. The aim of this work was to characterize patterns of fiber intake among university students. A cross-sectional study was conducted on a sample of 730 students enrolled at the University of Castilla-La Mancha (Spain), the University of Carthage (Tunisia), and Florida International University (USA). Mean age was 21.2. Food consumption was self-reported in two 24-h recalls. Mean dietary fiber intake was 17.8 g, not reaching the adequate intake. Contrary to expectations, American participants were the highest consumers (p < 0.001), and also exhibited the highest BMI. Cereals, legumes, vegetables and fruit were the main food sources of fiber. Fiber from appetizers, prepared and precooked meals, sauces, spices and condiments accounted for 16.7% in American participants, 7.4% in Spanish participants and 2.6% in Tunisian participants. Total fiber intake increased with energy intake but did not depend on smoking habits and physical activity in any country. It is essential to improve consumers’ interpretation of guidelines on fiber intake.
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Affiliation(s)
- María José García-Meseguer
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Avda. de España, s/n, 02071 Albacete, Spain.
| | - Amalia Delicado-Soria
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla-La Mancha, Avda. de España, s/n, 02071 Albacete, Spain.
| | - Ramón Serrano-Urrea
- Department of Mathematics, Faculty of Computer Science Engineering, University of Castilla-La Mancha, Avda. de España, s/n, 02071 Albacete, Spain.
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Aune D, Giovannucci E, Boffetta P, Fadnes LT, Keum N, Norat T, Greenwood DC, Riboli E, Vatten LJ, Tonstad S. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol 2017; 46:1029-1056. [PMID: 28338764 PMCID: PMC5837313 DOI: 10.1093/ije/dyw319] [Citation(s) in RCA: 1128] [Impact Index Per Article: 161.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2016] [Indexed: 12/23/2022] Open
Abstract
Background Questions remain about the strength and shape of the dose-response relationship between fruit and vegetable intake and risk of cardiovascular disease, cancer and mortality, and the effects of specific types of fruit and vegetables. We conducted a systematic review and meta-analysis to clarify these associations. Methods PubMed and Embase were searched up to 29 September 2016. Prospective studies of fruit and vegetable intake and cardiovascular disease, total cancer and all-cause mortality were included. Summary relative risks (RRs) were calculated using a random effects model, and the mortality burden globally was estimated; 95 studies (142 publications) were included. Results For fruits and vegetables combined, the summary RR per 200 g/day was 0.92 [95% confidence interval (CI): 0.90-0.94, I 2 = 0%, n = 15] for coronary heart disease, 0.84 (95% CI: 0.76-0.92, I 2 = 73%, n = 10) for stroke, 0.92 (95% CI: 0.90-0.95, I 2 = 31%, n = 13) for cardiovascular disease, 0.97 (95% CI: 0.95-0.99, I 2 = 49%, n = 12) for total cancer and 0.90 (95% CI: 0.87-0.93, I 2 = 83%, n = 15) for all-cause mortality. Similar associations were observed for fruits and vegetables separately. Reductions in risk were observed up to 800 g/day for all outcomes except cancer (600 g/day). Inverse associations were observed between the intake of apples and pears, citrus fruits, green leafy vegetables, cruciferous vegetables, and salads and cardiovascular disease and all-cause mortality, and between the intake of green-yellow vegetables and cruciferous vegetables and total cancer risk. An estimated 5.6 and 7.8 million premature deaths worldwide in 2013 may be attributable to a fruit and vegetable intake below 500 and 800 g/day, respectively, if the observed associations are causal. Conclusions Fruit and vegetable intakes were associated with reduced risk of cardiovascular disease, cancer and all-cause mortality. These results support public health recommendations to increase fruit and vegetable intake for the prevention of cardiovascular disease, cancer, and premature mortality.
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Affiliation(s)
- Dagfinn Aune
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Bjørknes University College, Oslo, Norway
| | - Edward Giovannucci
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology
- Department of Nutrition, Harvard T. Chan School of Public Health, Boston, MA, USA
| | - Paolo Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lars T Fadnes
- Department of Global Public Health and Primary Care & Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - NaNa Keum
- Department of Epidemiology
- Department of Nutrition, Harvard T. Chan School of Public Health, Boston, MA, USA
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | | | - Elio Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Lars J Vatten
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
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Schwingshackl L, Schwedhelm C, Hoffmann G, Lampousi AM, Knüppel S, Iqbal K, Bechthold A, Schlesinger S, Boeing H. Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr 2017; 105:1462-1473. [PMID: 28446499 DOI: 10.3945/ajcn.117.153148] [Citation(s) in RCA: 251] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/28/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Suboptimal diet is one of the most important factors in preventing early death and disability worldwide.Objective: The aim of this meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups, including whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages, with risk of all-cause mortality.Design: We conducted a systematic search in PubMed, Embase, and Google Scholar for prospective studies investigating the association between these 12 food groups and risk of all-cause mortality. Summary RRs and 95% CIs were estimated with the use of a random effects model for high-intake compared with low-intake categories, as well as for linear and nonlinear relations. Moreover, the risk reduction potential of foods was calculated by multiplying the RR by optimal intake values (serving category with the strongest association) for risk-reducing foods or risk-increasing foods, respectively.Results: With increasing intake (for each daily serving) of whole grains (RR: 0.92; 95% CI: 0.89, 0.95), vegetables (RR: 0.96; 95% CI: 0.95, 0.98), fruits (RR: 0.94; 95% CI: 0.92, 0.97), nuts (RR: 0.76; 95% CI: 0.69, 0.84), and fish (RR: 0.93; 95% CI: 0.88, 0.98), the risk of all-cause mortality decreased; higher intake of red meat (RR: 1.10; 95% CI: 1.04, 1.18) and processed meat (RR: 1.23; 95% CI: 1.12, 1.36) was associated with an increased risk of all-cause mortality in a linear dose-response meta-analysis. A clear indication of nonlinearity was seen for the relations between vegetables, fruits, nuts, and dairy and all-cause mortality. Optimal consumption of risk-decreasing foods results in a 56% reduction of all-cause mortality, whereas consumption of risk-increasing foods is associated with a 2-fold increased risk of all-cause mortality.Conclusion: Selecting specific optimal intakes of the investigated food groups can lead to a considerable change in the risk of premature death.
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Affiliation(s)
- Lukas Schwingshackl
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany;
| | - Carolina Schwedhelm
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Georg Hoffmann
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - Anna-Maria Lampousi
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Sven Knüppel
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Khalid Iqbal
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | | | - Sabrina Schlesinger
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; and.,Institute for Biometry and Epidemiology, Leibniz Institute for Diabetes Research, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Heiner Boeing
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
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Consumption of Fruit or Fiber-Fruit Decreases the Risk of Cardiovascular Disease in a Mediterranean Young Cohort. Nutrients 2017; 9:nu9030295. [PMID: 28304346 PMCID: PMC5372958 DOI: 10.3390/nu9030295] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/27/2017] [Accepted: 03/10/2017] [Indexed: 12/11/2022] Open
Abstract
Fiber and fiber-rich foods have been inversely associated with cardiovascular disease (CVD), but the evidence is scarce in young and Mediterranean cohorts. We used Cox regression models to assess the association between quintiles of total fiber and fiber from different sources, and the risk of CVD adjusted for the principal confounding factors in a Mediterranean cohort of young adults, the SUN (Seguimiento Universidad de Navarra, Follow-up) cohort. After a median follow-up of 10.3 years, we observed 112 cases of CVD among 17,007 participants (61% female, mean age 38 years). We observed an inverse association between fiber intake and CVD events (p for trend = 0.024) and also between the highest quintile of fruit consumption (hazard ratio (HR) 0.51, 95% confidence interval (CI) 0.27–0.95) or whole grains consumption (HR 0.43 95% CI 0.20–0.93) and CVD compared to the lowest quintile, and also a HR of 0.58 (95% CI 0.37–0.90) for the participants who ate at least 175 g/day of fruit. Only the participants in the highest quintile of fruit-derived fiber intake had a significantly lower risk of CVD (HR 0.52, 95% CI 0.28–0.97). The participants who ate at least one serving per week of cruciferous vegetables had a lower risk than those who did not (HR 0.52, 95% CI 0.30–0.89). In conclusion, high fruit consumption, whole grain consumption, or consumption of at least one serving/week of cruciferous vegetables may be protective against CVD in young Mediterranean populations.
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Chan M, Kelly J, Tapsell L. Dietary Modeling of Foods for Advanced CKD Based on General Healthy Eating Guidelines: What Should Be on the Plate? Am J Kidney Dis 2017; 69:436-450. [PMID: 28129911 DOI: 10.1053/j.ajkd.2016.09.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/19/2016] [Indexed: 12/30/2022]
Abstract
Chronic kidney disease (CKD) is a major public health problem with significant clinical, societal, and psychosocial burdens. Nutrition therapy has been an integral part of the medical management of patients with CKD for more than a century, with the main goals of preserving kidney function and preventing complications. Nutrition abnormalities may emerge well before dialysis therapy is initiated and are associated with poor outcomes. It is therefore important to revisit nutrition management in the advanced stages of CKD to gain a broader insight into its role and effect on patient outcomes. Traditionally, nutrition recommendations have focused on the prescription of energy (calories) and macro- and micronutrients. Today, dietary modeling also focuses on the evidence for food consumption on health. This review argues that advanced non-dialysis-dependent CKD nutrition requirements to a large extent align with healthy eating guidelines for the general population and should not be based on deprivation or be unusually restrictive. The best currently available evidence for the CKD diet is likely to be derived from CKD nutrition prescriptions in conjunction with evidence underpinning national dietary guidelines and evidence of healthy dietary patterns, such as Mediterranean-style and Dietary Approaches to Stop Hypertension (DASH)-style eating. Positive messages from these dietary patterns should improve acceptance of CKD dietary interventions among patients.
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Affiliation(s)
- Maria Chan
- Department of Nutrition and Dietetics, The St. George Hospital, Kogarah, NSW, Australia; Department of Nutrition and Dietetics, School of Medicine, University of Wollongong, Wollongong, NSW, Australia; Department of Renal Medicine, The St. George Hospital, Kogarah, NSW, Australia; St. George Clinical School, School of Medicine, The University of New South Wales, NSW, Australia.
| | - John Kelly
- Department of Renal Medicine, The St. George Hospital, Kogarah, NSW, Australia; St. George Clinical School, School of Medicine, The University of New South Wales, NSW, Australia
| | - Linda Tapsell
- Department of Nutrition and Dietetics, School of Medicine, University of Wollongong, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Benisi-Kohansal S, Saneei P, Salehi-Marzijarani M, Larijani B, Esmaillzadeh A. Whole-Grain Intake and Mortality from All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Adv Nutr 2016; 7:1052-1065. [PMID: 28140323 PMCID: PMC5105035 DOI: 10.3945/an.115.011635] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
No conclusive information is available about the relation between the consumption of whole grains and the risk of mortality. We aimed to conduct a meta-analysis of prospective cohort studies to summarize the relation between whole-grain intake and risk of mortality from all causes, cardiovascular disease, and total and specific cancers. A systematic search of the literature published earlier than March 2015 was conducted in Medline and PubMed, SCOPUS, EMBASE, and Cochrane Library to identify relevant articles. Prospective cohort studies that examined the association of total whole-grain intake or specific whole-grain foods with risk of mortality from all causes, cardiovascular disease, and total and specific cancers were considered. Twenty prospective cohort studies were included in the systematic review: 9 studies reported total whole-grain intake and 11 others reported specific whole-grain food intake. In a follow-up period of 5.5 to 26 y, there were 191,979 deaths (25,595 from cardiovascular disease, 32,746 from total cancers, and 2671 from specific cancers) in 2,282,603 participants. A greater intake of both total whole grains and specific whole-grain foods was significantly associated with a lower risk of all-cause mortality in the meta-analysis. The pooled RR for all-cause mortality for an increase of 3 servings total whole grains/d (90 g/d) was 0.83 (95% CI: 0.79, 0.88). Total whole-grain intake (0.84; 95% CI: 0.76, 0.93) and specific whole-grain foods (0.82; 95% CI: 0.75, 0.90) were also associated with a reduced risk of mortality from cardiovascular disease. Each additional 3 servings total whole grains/d was associated with a 25% lower risk of mortality from cardiovascular disease. An inverse association was observed between whole-grain intake and risk of mortality from total cancers (0.94; 95% CI: 0.91, 0.98). We found an inverse association between whole-grain intake and mortality from all causes, cardiovascular disease, and total cancers.
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Affiliation(s)
- Sanaz Benisi-Kohansal
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvane Saneei
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Ahmad Esmaillzadeh
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, and .,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Zhu Y, Wang P, Sha W, Sang S. Urinary Biomarkers of Whole Grain Wheat Intake Identified by Non-targeted and Targeted Metabolomics Approaches. Sci Rep 2016; 6:36278. [PMID: 27805021 PMCID: PMC5090248 DOI: 10.1038/srep36278] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/13/2016] [Indexed: 01/08/2023] Open
Abstract
Mounting evidence suggests that whole grain (WG) intake plays an important role in chronic disease prevention. However, numerous human studies have failed to produce clear-cut conclusions on this topic. Here, a combination of non-targeted and targeted metabolomics approaches, together with kinetic studies, was used to investigate biomarkers of WG wheat intake and further explore the diet-disease associations. Via these integrated approaches, forty-one compounds were identified as the most discriminating endogenous metabolites after WG versus refined grain (RG) wheat bread consumption. The corresponding biological assessment of these endogenous changes suggests that, in contrast to RG consumption, WG wheat consumption may facilitate antioxidant defense systems and moderate the risk factors of cancer, cardiovascular diseases, and other chronic diseases. A panel of urinary markers consisting of seven alkylresorcinol metabolites and five benzoxazinoid derivatives as specific biomarkers, as well as five phenolic acid derivatives, was also established to cover multiple time points and longer time periods for correctly and objectively monitoring WG wheat intake. Through these findings, we have established a comprehensive biomarker pool to better assess WG wheat consumption, and to monitor the endogenous changes that are linked to health effects of WG wheat consumption.
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Affiliation(s)
- Yingdong Zhu
- Laboratory for Functional Foods and Human Health, Center for Excellence in Post-Harvest Technologies, North Carolina Agricultural and Technical State University, North Carolina Research Campus, Kannapolis, NC, USA
| | - Pei Wang
- Laboratory for Functional Foods and Human Health, Center for Excellence in Post-Harvest Technologies, North Carolina Agricultural and Technical State University, North Carolina Research Campus, Kannapolis, NC, USA
| | - Wei Sha
- Bioinformatics Services Division, University of North Carolina at Charlotte, North Carolina Research Campus, Kannapolis, NC, USA
| | - Shengmin Sang
- Laboratory for Functional Foods and Human Health, Center for Excellence in Post-Harvest Technologies, North Carolina Agricultural and Technical State University, North Carolina Research Campus, Kannapolis, NC, USA
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Healey G, Brough L, Murphy R, Hedderley D, Butts C, Coad J. Validity and Reproducibility of a Habitual Dietary Fibre Intake Short Food Frequency Questionnaire. Nutrients 2016; 8:nu8090558. [PMID: 27626442 PMCID: PMC5037543 DOI: 10.3390/nu8090558] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/24/2016] [Accepted: 09/05/2016] [Indexed: 11/16/2022] Open
Abstract
Low dietary fibre intake has been associated with poorer health outcomes, therefore having the ability to be able to quickly assess an individual's dietary fibre intake would prove useful in clinical practice and for research purposes. Current dietary assessment methods such as food records and food frequency questionnaires are time-consuming and burdensome, and there are presently no published short dietary fibre intake questionnaires that can quantify an individual's total habitual dietary fibre intake and classify individuals as low, moderate or high habitual dietary fibre consumers. Therefore, we aimed to develop and validate a habitual dietary fibre intake short food frequency questionnaire (DFI-FFQ) which can quickly and accurately classify individuals based on their habitual dietary fibre intake. In this study the DFI-FFQ was validated against the Monash University comprehensive nutrition assessment questionnaire (CNAQ). Fifty-two healthy, normal weight male (n = 17) and female (n = 35) participants, aged between 21 and 61 years, completed the DFI-FFQ twice and the CNAQ once. All eligible participants completed the study, however the data from 46% of the participants were excluded from analysis secondary to misreporting. The DFI-FFQ cannot accurately quantify total habitual dietary fibre intakes, however, it is a quick, valid and reproducible tool in classifying individuals based on their habitual dietary fibre intakes.
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Affiliation(s)
- Genelle Healey
- Massey Institute of Food Science and Technology, School of Food and Nutrition, Massey University, Palmerston North 4442, New Zealand.
- Food, Nutrition and Health, The New Zealand Institute for Plant & Food Research Limited, Palmerston North 4442, New Zealand.
| | - Louise Brough
- Massey Institute of Food Science and Technology, School of Food and Nutrition, Massey University, Palmerston North 4442, New Zealand.
| | - Rinki Murphy
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand.
| | - Duncan Hedderley
- Food, Nutrition and Health, The New Zealand Institute for Plant & Food Research Limited, Palmerston North 4442, New Zealand.
| | - Chrissie Butts
- Food, Nutrition and Health, The New Zealand Institute for Plant & Food Research Limited, Palmerston North 4442, New Zealand.
| | - Jane Coad
- Massey Institute of Food Science and Technology, School of Food and Nutrition, Massey University, Palmerston North 4442, New Zealand.
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Li B, Zhang G, Tan M, Zhao L, Jin L, Tang X, Jiang G, Zhong K. Consumption of whole grains in relation to mortality from all causes, cardiovascular disease, and diabetes: Dose-response meta-analysis of prospective cohort studies. Medicine (Baltimore) 2016; 95:e4229. [PMID: 27537552 PMCID: PMC5370779 DOI: 10.1097/md.0000000000004229] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To investigate the correlation between consumption of whole grains and the risk of all-cause, cardiovascular disease (CVD), and diabetes-specific mortality according to a dose-response meta-analysis of prospective cohort studies. METHODS Observational cohort studies, which reported associations between whole grains and the risk of death outcomes, were identified by searching articles in the MEDLINE, EMBASE, and the reference lists of relevant articles. The search was up to November 30, 2015. Data extraction was performed by 2 independent investigators, and a consensus was reached with involvement of a third. RESULTS Ten prospective cohort studies (9 publications) were eligible in this meta-analysis. During follow-up periods ranging from 5.5 to 26 years, there were 92,647 deaths among 782,751 participants. Overall, a diet containing greater amounts of whole grains may be associated with a lower risk of all-cause, CVD-, and coronary heart disease (CHD)-specific mortality. The summary relative risks (RRs) were 0.93 (95% confidence intervals [CIs]: 0.91-0.95; Pheterogeneity < 0.001) for all-cause mortality, 0.95 (95% CIs: 0.92-0.98; Pheterogeneity < 0.001) for CVD-specific mortality, and 0.92 (95% CIs: 0.88-0.97; Pheterogeneity < 0.001) for CHD-specific mortality for an increment of 1 serving (30 g) a day of whole grain intake. The combined estimates were robust across subgroup and sensitivity analyses. Higher consumption of whole grains was not appreciably associated with risk of mortality from stroke and diabetes. CONCLUSION Evidence from observational cohort studies indicates inverse associations of intake of whole grains with risk of mortality from all-cause, CVD, and CHD. However, no associations with risk of deaths from stroke and diabetes were observed.
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Affiliation(s)
| | | | | | | | | | | | - Gengxi Jiang
- Department of Cardiothoracic Surgery, Changhai Hospital of Second Military Medical University, Shanghai, China
- Correspondence: Keng Zhong, Gengxi Jiang, Department of Cardiothoracic Surgery, Changhai Hospital of Second Military Medical University, 168 Changhai Road, Shanghai 200433, China (e-mail: , )
| | - Keng Zhong
- Department of Cardiothoracic Surgery, Changhai Hospital of Second Military Medical University, Shanghai, China
- Correspondence: Keng Zhong, Gengxi Jiang, Department of Cardiothoracic Surgery, Changhai Hospital of Second Military Medical University, 168 Changhai Road, Shanghai 200433, China (e-mail: , )
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Abstract
In the last 20 years, many prospective cohort studies have assessed the relationships between food consumption and mortality. Result interpretation is mainly hindered by the limited adjustment for confounders and, to a lesser extent, the small sample sizes. The aim of this study was to investigate the association between dietary habits and all-cause mortality in a multicentre prospective cohort that included non-institutionalised, community-based elderly individuals (Three-City Study). A brief FFQ was administered at baseline. Hazard ratios (HR) and 95 % CI for all-cause mortality were estimated relative to the consumption frequency of several food groups, using Cox proportional hazards models adjusted for sex, centre, socio-demographic characteristics and health status indicators. Among the 8937 participants (mean age: 74·2 years, 60·7 % women), 2016 deaths were recorded during an average follow-up of 9 years. The risk of death was significantly lower among subjects with the highest fruit and vegetable consumption (HR 0·90; 95 % CI 0·82, 0·99, P=0·03) and with regular fish consumption (HR 0·89; 95 % CI 0·81, 0·97, P=0·01). The benefit of olive oil use was found only in women (moderate olive oil use: HR 0·80; 95 % CI 0·68, 0·94, P=0·007; intensive use: HR 0·72; 95 % CI 0·60, 0·85, P=0·0002). Conversely, daily meat consumption increased the mortality risk (HR 1·12; 95 % CI, 1·01, 1·24, P=0·03). No association was found between risk of death and diet diversity and use of various fats. These findings suggest that fruits/vegetables, olive oil and regular fish consumptions have a beneficial effect on the risk of death, independently of the socio-demographic features and the number of medical conditions.
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Xu H, Rossi M, Campbell KL, Sencion GL, Ärnlöv J, Cederholm T, Sjögren P, Risérus U, Lindholm B, Carrero JJ. Excess protein intake relative to fiber and cardiovascular events in elderly men with chronic kidney disease. Nutr Metab Cardiovasc Dis 2016; 26:597-602. [PMID: 27089977 DOI: 10.1016/j.numecd.2016.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/23/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS The elevated cardiovascular (CVD) risk observed in chronic kidney disease (CKD) may be partially alleviated through diet. While protein intake may link to CVD events in this patient population, dietary fiber has shown cardioprotective associations. Nutrients are not consumed in isolation; we hypothesize that CVD events in CKD may be associated with dietary patterns aligned with an excess of dietary protein relative to fiber. METHODS AND RESULTS Prospective cohort study from the Uppsala Longitudinal Study of Adult Men. Included were 390 elderly men aged 70-71 years with CKD and without clinical history of CVD. Protein and fiber intake, as well as its ratio, were calculated from 7-day dietary records. Cardiovascular events were registered prospectively during a median follow-up of 9.1 (inter-quartile range, 4.5-10.7) years. The median dietary intake of protein and fiber was 66.7 (60.7-71.1) and 16.6 (14.5-19.1) g/day respectively and the protein-to-fiber intake ratio was 4.0 (3.5-4.7). Protein-to-fiber intake ratio was directly associated with serum C-reactive protein levels. During follow-up, 164 first-time CVD events occurred (incidence rate 54.5/1000 per year). Protein-fiber intake ratio was an independent risk factor for CVD events [adjusted hazard ratio, HR per standard deviation increase (95% confidence interval, CI) 1.33 (1.08, 1.64)]. Although in opposing directions, dietary protein [1.18 (0.97, 1.44)], dietary fiber alone [0.81 (0.64, 1.02)], were not significantly associated with CVD events. CONCLUSIONS An excess of dietary protein relative to fiber intake was associated with the incidence of cardiovascular events in a homogeneous population of older men with CKD.
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Affiliation(s)
- H Xu
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - M Rossi
- Centre for Kidney Disease Research, Princess Alexandra Hospital, Brisbane, Australia; Division of Diabetes and Nutritional Sciences, King's College, London, United Kingdom
| | - K L Campbell
- Centre for Kidney Disease Research, Princess Alexandra Hospital, Brisbane, Australia; Bond University, Faculty of Health Sciences and Medicine, Robina, Australia
| | - G L Sencion
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - J Ärnlöv
- Department of Medical Sciences, Molecular epidemiology, Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - T Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - P Sjögren
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - U Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - B Lindholm
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - J J Carrero
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
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49
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Chen GC, Tong X, Xu JY, Han SF, Wan ZX, Qin JB, Qin LQ. Whole-grain intake and total, cardiovascular, and cancer mortality: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr 2016; 104:164-72. [PMID: 27225432 DOI: 10.3945/ajcn.115.122432] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 04/25/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The potential role of whole grain in preventing various mortality outcomes has been inconsistently reported in a wealth of prospective observational studies. OBJECTIVE We evaluated the relations between whole-grain intake and risks of dying from any cause, cardiovascular disease (CVD), and cancer through a meta-analytic approach. DESIGN Relevant studies were identified by searching PubMed and EMBASE databases and bibliographies of retrieved full publications. Summary RRs with 95% CIs were calculated with a random-effects model. RESULTS Thirteen studies on total mortality (104,061 deaths), 12 on CVD mortality (26,352 deaths), and 8 on cancer mortality (34,797 deaths) were included. Three studies reported whole-grain intake, and the remaining studies reported whole-grain product intake. In the dose-response analysis in which the intake of whole-grain products was converted to the amount of whole grain, the summary RRs for an increment in whole-grain intake of 50 g/d were 0.78 (95% CI: 0.67, 0.91) for total mortality, 0.70 (95% CI: 0.61, 0.79) for CVD mortality, and 0.82 (95% CI: 0.69, 0.96) for cancer mortality. A similar reduction was observed for the mortality from ischemic heart disease (RR: 0.68; 95% CI: 0.55, 0.84) but not from stroke (RR: 0.93; 95% CI: 0.54, 1.62). There was evidence of nonlinear associations of whole-grain intake with total (P-nonlinearity < 0.001) and CVD mortality (P-nonlinearity <0.001), but not with cancer mortality (P-nonlinearity = 0.12), with the curves for the associations appearing slightly steeper at lower ranges (<35 g/d) of the intake than at higher ranges. CONCLUSIONS Our findings suggest significant inverse relations between whole-grain intake and mortality due to any cause, CVD, or cancer. The findings support the recommendation of increasing whole-grain intake to improve public health.
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Affiliation(s)
- Guo-Chong Chen
- Department of Nutrition and Food Hygiene, School of Public Health
| | - Xing Tong
- Department of Nutrition and Food Hygiene, School of Public Health
| | - Jia-Ying Xu
- Key Laboratory of Radiation Biology, School of Radiation Medicine and Protection, and
| | - Shu-Fen Han
- Department of Nutrition and Food Hygiene, School of Public Health
| | - Zhong-Xiao Wan
- Department of Nutrition and Food Hygiene, School of Public Health
| | - Jia-Bi Qin
- Division of Medical Genetics, Maternal and Child Health Hospital of Hunan Province, Changsha, China
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Disease, Soochow University, Suzhou, China; and
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50
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Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC, Tonstad S, Vatten LJ, Riboli E, Norat T. Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ 2016; 353:i2716. [PMID: 27301975 PMCID: PMC4908315 DOI: 10.1136/bmj.i2716] [Citation(s) in RCA: 532] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality. DATA SOURCES PubMed and Embase searched up to 3 April 2016. STUDY SELECTION Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality. DATA SYNTHESIS Summary relative risks and 95% confidence intervals calculated with a random effects model. RESULTS 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings-for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I(2)=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I(2)=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I(2)=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I(2)=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I(2)=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I(2)=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I(2)=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I(2)=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I(2)=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I(2)=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular disease and/or all cause mortality, but there was little evidence of an association with refined grains, white rice, total rice, or total grains. CONCLUSIONS This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes. These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality.
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Affiliation(s)
- Dagfinn Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - NaNa Keum
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Edward Giovannucci
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lars T Fadnes
- Centre for International Health, Department of Global Public Health and Primary Care and Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Darren C Greenwood
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - Serena Tonstad
- Section of Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Lars J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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