Food Groups and Risk of Hypertension: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies

Aligning front-of-pack labelling with dietary guidelines: including whole grains in the health star rating

PURPOSE

Front-of-pack labelling systems, such as the Health Star Rating (HSR), aim to aid healthy consumer dietary choices and complement national dietary guidelines. Dietary guidelines aim to be holistic by extending beyond the individual nutrients of food, including other food components that indicate diet quality, including whole grains. We aimed to test the feasibility of including whole grains in the HSR algorithm, to better inform dietary guidance in Australia coherent with existing dietary guidelines.

METHODS

We assigned whole-grain points as a favourable component of the HSR based on the whole-grain content of foods. We compared the original, and three modified HSR algorithms (including altered thresholds for star ratings) using independent-samples median tests. Finally, we used Spearman's correlation to measure the strength of association between an item's nutritional composition (all components of the HSR algorithm including all favourable and unfavourable components) and their HSR using each algorithm.

RESULTS

Up to 10 points were added for products with ≥ 50% whole-grain content, with no points for products with < 25%. Adjusting the HSR score cut-off by 3 points for grain products created the greatest difference in median HSR between refined and whole-grain items (up to 2 stars difference), compared to the original algorithm (a maximum of 1 star).

CONCLUSIONS

The addition of whole grains to the HSR algorithm improved the differentiation of refined and whole-grain items, and therefore better aligned with dietary guidelines. Holistic approaches to food guidance systems are required to provide consistent messaging and inform positive food choices.

Development and Validation of the Meiji Nutritional Profiling System per Serving Size

Serving size may be the appropriate reference for calculating food nutritional value. We aimed to assess the nutritional values of Japanese foods based on serving sizes rather than per 100 g by adapting the Meiji Nutritional Profiling System (Meiji NPS). Given the variability in serving sizes across countries, we used Japanese serving sizes to calculate the Meiji NPS scores. We confirmed the convergent validity of the Meiji NPS scores per serving size with the Nutrient-Rich Food Index 9.3 using Spearman's correlation coefficients (r = 0.51, p < 0.001). Food groups recommended by official guidelines, such as pulses, nuts and seeds, fish and seafood, fruits, vegetables, and milk and milk products, scored relatively high. Furthermore, the nutrient density scores of food items with small serving sizes, such as mushrooms, algae, seasonings, and fats and oils, were moderated when calculated by per serving size, despite having considerably higher or lower scores per 100 g. These results indicate that calculating NPS per serving size allows for the assessment of the nutritional value of food items in accordance with actual consumption quantities. Therefore, the Meiji NPS calculated per serving size, alongside the per 100 g version, may be useful for dietary management depending on specific purposes.

Association of conventional cigarette smoking, heated tobacco product use and dual use with hypertension

BACKGROUND

Heated tobacco products (HTPs) have emerged as alternatives to conventional cigarettes. However, their health effects remain largely unknown. This study aimed to prospectively explore the association between the use of cigarettes and HTPs and the risk of hypertension.

METHODS

This cohort study analysed data from 30 152 workers (82.0% men, mean age 42.9 ± 11.0 years) who were initially free of hypertension, participating in the Japan Epidemiology Collaboration on Occupational Health Study. Participants were categorized into five groups based on their self-reported tobacco product use: never smokers, past smokers, exclusive cigarette smokers, exclusive HTP users and dual users of cigarettes and HTPs. Hypertension cases were identified using three data points from annual health checkup data collected between 2019 and 2021. Cox proportional hazards regression models were used to investigate the association between tobacco product use and hypertension.

RESULTS

During a mean follow-up of 2.6 years (range: 0.1-4.0 years), 3656 new cases of hypertension were identified. Compared with never smokers, the risk of hypertension was higher among exclusive cigarette smokers [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.13-1.41] and exclusive HTP users (HR 1.19, 95% CI 1.06-1.34). There was also a suggestion of increased risk of hypertension among dual users (HR 1.16, 95% CI 0.98-1.38). Furthermore, the risk of hypertension increased with the intensity of cigarette/HTP use in all tobacco product users.

CONCLUSIONS

Similarly, both cigarette smoking and HTP use elevate the risk of hypertension. HTPs should not be regarded as less harmful alternatives to traditional cigarettes for preventing hypertension.

Dairy products and hypertension: Cross-sectional and prospective associations

BACKGROUND

The association between dairy intake and prevalence or incidence of hypertension remains controversial. We aimed to investigate the association between intake of different dairy products and prevalence and incidence of hypertension in a community-dwelling sample.

METHODS

Three cross-sectional studies (2009-12, 2014-17 and 2018-21) and one prospective study (2009-12 to 2018-21) were conducted in Lausanne, Switzerland. Dietary intake was assessed via a validated food frequency questionnaire. Dairy consumption was compared between participants with and without prevalent or incident hypertension.

RESULTS

For the cross-sectional analyses, data from 4437 (2009-12, 54.0% women, 57.7 ± 10.5 years), 2925 (2014-17, 53.4% women, 62.5 ± 10.0 years), and 2144 (2018-21; 53.3% women, 65.5 ± 9.6 years) participants were used. No consistent differences between participants with and without hypertension were found for all dairy products (total dairy, milk, yogurt, cheese, low-fat dairy, and full-fat dairy) although participants with hypertension tended to consume less cheese (51 ± 1 vs. 55 ± 1, p = 0.014, 52 ± 1 vs. 56 ± 1, p = 0.053, and 54 ± 1 vs. 56 ± 1 g/day for 2009-12, 2014-17 and 2018-21, respectively). For the prospective study, data from 2303 participants (60.8% women, 53.9 ± 9.0 years) were used. Irrespective of the dairy product considered, no association was found between quartiles of dairy consumption and development of hypertension. Similar findings were obtained after stratifying on dietary quality.

CONCLUSION

In this population-based study, no association was found between the consumption of different dairy products and the prevalence or incidence of hypertension.

Low-fat yogurt consumption maintains biomarkers of immune function relative to nondairy control food in women with elevated BMI: A randomized controlled crossover trial

Yogurt consumption may help reduce chronic inflammation associated with obesity. However, the underlying mechanism(s) by which yogurt consumption modulates the immune system have not been validated in human intervention studies. We hypothesized that 4-week yogurt consumption (12 oz/day) attenuates systemic inflammation by modulating the proportion of circulating T helper (Th) 17 and regulatory T (Treg) cells in adult women with elevated body mass index (BMI). To test the hypothesis, we conducted a randomized crossover dietary intervention study consisted of a 4-week dietary intervention in which participants consumed 12 oz of either low-fat dairy yogurt or a soy pudding control snack per day, with a 4-week washout between treatments. Thirty-nine healthy adult women with a BMI between 25 and 40 kg/m2 were enrolled and 20 completed the study. Changes in the biometrics, circulating T cells, and markers of systemic and colonic inflammation were assessed between the 2 treatment groups, as well as 24-hour diet recalls were conducted at baseline and following each treatment. The primary study outcome, the change in the proportion of circulating Th17 cells, was unaffected by the treatments. Secondary outcome measures, circulating Treg, Th17, and markers of chronic inflammation, were maintained by yogurt treatment, whereas circulating Treg was increased and interleukin-10 was reduced by control snack treatment. However, circulating Treg changes were not associated with changes to other biomarkers of inflammation, implying other immune cells and/or tissues may mediate circulating biomarkers of chronic inflammation. This study was approved by the University of Wisconsin-Madison institutional review board and registered at ClinicalTrials.gov NCT04149418.

Animal board invited review: Dietary transition from animal to plant-derived foods: Are there risks to health?

Animal-derived foods (ADFs) are a very varied group of foods, but many are nutrient rich and contain higher quality protein than provided by plant-derived foods such that a simple replacement of ADF protein is likely to lead to a reduction in overall protein quality. In addition, many ADFs are richer in some nutrients than plant-based foods (e.g. Fe, Ca) and these often have a higher bioavailability. ADFs also provide nutrients that plants cannot supply (e.g. vitamin B12) and some provide beneficial health functionality (e.g. hypotensive) which is not explained by traditional nutrition. However, there remains a good health reason to increase the proportion of plant-derived food in many diets to increase the intake of dietary fibre which is often consumed at very sub-optimal levels. It seems logical that the increased plant-derived foods should replace the ADFs that have the least benefit, the greatest risk to health and the highest environmental impact. Processed meat fits these characteristics and should be an initial target for replacement with plant-based based protein-rich foods that additionally provide the necessary nutrients and have high-quality dietary fibre. Processed meat covers a wide range of products including several traditional foods (e.g. sausages) which will make decisions on food replacement challenging. There is therefore an urgent need for research to better define the relative health risks associated with the range of processed meat-based foods. The aim of this review is to examine the evidence on the benefits and risks of this dietary transition including the absolute necessity to consider initial nutrient status before the replacement of ADFs is considered.

Consumption of processed meat but not red meat is associated with the incidence of hypertension: ELSA-Brasil cohort

OBJECTIVES

To verify the association between the consumption of red and processed meats and the incidence of hypertension in participants of the Longitudinal Study of Adult Health.

METHODS

This was a cohort with data from the baseline (2008-2010) and second wave (2012-2014) with 8,089 public workers of both sexes and different racial groups, with mean age of 49 ± 8 years (35-74 years old). Meat consumption (g/d) was estimated using a food frequency questionnaire and was divided into consumption tertiles. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic ≥90 mm Hg and/or antihypertensive medication. Cox proportional hazards models were used to estimate adjusted Hazard Ration (HRs) and 95% confidence interval (CI) for incident hypertension.

RESULTS

A total of 1186 incident cases of hypertension were identified. Even adjusting for confounders, such as urinary Na/K (sodium/potassium) ratio and BMI (body mass index), participants in the second (HR:1.19; 95% CI 1.03-1.30) and third (HR:1.30; 95% CI:1.11-1.53) tertile of processed meat consumption had a higher risk of developing hypertension than those in the first tertile. We did not find a significant association between red meat consumption and hypertension.

CONCLUSIONS

The increased risk of developing hypertension is associated with moderate and high consumption of processed meats but not with consumption of red meat.

Association between watching eating shows and unhealthy food consumption in Korean adolescents

BACKGROUND

Eating habits formed during adolescence greatly influence the maintenance of health in adulthood. With the recent development of social media and easy access to the Internet, adolescents watch plenty of food videos, particularly Mukbang and Cookbnag(eating show)content. This media genre's impact on food choices has been covered in several studies; however, studies on unhealthy eating habits directly related to adolescents' exposure to eating shows are insufficient.

METHODS

For this study, we used data from the 18th Korea Youth Risk Behavior Survey conducted in 2022 and finalized 50,451 participants. The extent of exposure to eating show media over the course of a week, as well as the consumption of fast food, sugar-sweetened beverages (SSBs), and high caffeinated beverages within that week were measured through self-reporting questionnaires. We classified the participants into two groups based on their frequency of watching eating shows. A multiple logistic regression analysis was performed to investigate the association between eating show and unhealthy food consumption.

RESULTS

For both males and females, eating show exposure was strongly associated with the consumption of fast food (male: OR:1.37, 95% CI:1.26-1.49; female: OR:1.46, 95% CI:1.36-1.57), SSB (male: OR:1.42, 95% CI:1.26-1.60; female: OR:1.51, 95% CI:1.35-1.70), and high caffeinated beverage (male: OR:1.30, 95% CI:1.23-1.37; female: OR:1.24, 95% CI:1.18-1.31). It was observed that both sexes were more likely to frequently eat unhealthy food than students who did not watch eating shows.

CONCLUSION

Among Korean adolescents, students exposed to eating shows, which primarily aim to entertain, were more likely to consume fast food, SSBs, and high caffeinated beverages. Therefore, this study's findings suggest that eating show could influence adolescents' food choices, highlighting the need for interest in emerging cultures and corresponding health policies.

Associations between whole grains intake and new-onset hypertension: a prospective cohort study

IMPORTANCE

Epidemiological evidences regarding the association between whole grain intake and the risk of new-onset hypertension are still controversial.

OBJECTIVE

We aimed to investigate the relationship between whole grain intake and new-onset hypertension and examine possible effect modifiers in the general population.

METHODS

A total of 10,973 participants without hypertension from the China Health and Nutrition Survey were enrolled, with follow-up beginning in 1997 and ending in 2015. Whole grain intake was assessed by 3 consecutive 24-h dietary recalls combined with a household food inventory. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression model after adjusting for potential risk factors.

RESULTS

During a median follow-up of 7.0 years, 3,733 participants developed new-onset hypertension. The adjusted HRs (95% CIs) were as follows: for quartile 2 (HR: 0.52; 95% CI: 0.47-0.57), quartile 3 (HR: 0.46; 95% CI: 0.42-0.51), and quartile 4 (HR: 0.35; 95% CI: 0.31-0.38), compared with quartile 1. Different types of whole grain types, including wheat (adjusted HR, 0.35; 95% CI, 0.32-0.39), maize (adjusted HR, 0.50; 95% CI, 0.42-0.59), and millet (adjusted HR, 0.38; 95% CI, 0.30-0.48), showed significant associations with a reduced risk of hypertension. The association between whole grain intake and new-onset hypertension was stronger in individuals with older age (P for interaction < 0.001) and higher BMI (P for interaction < 0.001).

CONCLUSION

Higher consumption of whole grains was significantly associated with a lower risk of new-onset hypertension. This study provides further evidence supporting the importance of increasing whole grain intake for hypertension prevention among Chinese adults.

The effect of increased fruit and vegetable consumption on blood pressure and lipids: a pooled analysis of six randomised controlled fruit and vegetable intervention trials

BACKGROUND

Increasing fruit and vegetable (FV) consumption is associated with reduced cardiovascular disease risk in observational studies but with little evidence from randomised controlled trials (RCTs). The impact of concurrent pharmacological therapy is unknown.

OBJECTIVE

To pool data from six RCTs to examine the effect of increasing FV intake on blood pressure (BP) and lipid profile, also exploring whether effects differed by medication use.

DESIGN

Across trials, dietary intake was assessed by diet diaries or histories, lipids by routine biochemical methods and BP by automated monitors. Linear regression provided an estimate of the change in lipid profile or BP associated with a one portion increase in self-reported daily FV intake, with interaction terms fitted for medication use.

RESULTS

The pooled sample included a total of 554 participants (308 males and 246 females). Meta-analysis of regression coefficients revealed no significant change in either systolic or diastolic BP per portion FV increase, although there was significant heterogeneity across trials for systolic BP (I2 = 73%). Neither adjusting for change in body mass index, nor analysis according to use of anti-hypertensive medication altered the relationship. There was no significant change in lipid profile per portion FV increase, although there was a significant reduction in total cholesterol among those not on lipid-lowering therapy (P < 0.05 after Bonferroni correction).

CONCLUSION

Pooled analysis of six individual FV trials showed no impact of increasing intake on BP or lipids, but there was a total cholesterol-lowering effect in those not on lipid-lowering therapy.

Substitution of Dairy Products and Risk of Death and Cardiometabolic Diseases: A Systematic Review and Meta-Analysis of Prospective Studies

Substitution models in epidemiologic studies specifying both substitute and substituted food in relation to disease risk may be useful to inform dietary guidelines. A systematic review of prospective observational studies was performed to quantify the risks of all-cause mortality, cardiovascular disease, and type 2 diabetes (T2D) associated with the substitution of dairy products with other foods and between different dairy products. We systematically searched MEDLINE, Embase, and Web of Science until 28th June, 2023. We calculated summary relative risks (SRRs) and 95% confidence intervals (95% CI) in random-effects meta-analyses. We assessed the risk of bias with the Risk Of Bias In Non-randomized Studies - of Exposure (ROBINS-E) tool and certainty of evidence (CoE) using the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) approach. Fifteen studies (with 34 publications) were included. There was moderate CoE that the substitution of low-fat dairy with red meat was associated with a higher risk of mortality, coronary artery disease, and T2D [SRR (95% CI): 1.11 (1.06, 1.16), 1.13 (1.08, 1.18), and 1.20 (1.16, 1.25)]. A higher risk of mortality and T2D was also observed when substituting low-fat dairy with processed meat [SRR (95% CI): 1.19 (1.11, 1.28) and 1.41 (1.33, 1.49); moderate CoE]. A lower mortality risk was associated with the substitution of dairy and yogurt with whole grains [SRR (95% CI): 0.89 (0.84, 0.93) and 0.91 (0.85, 0.97)], and butter with olive oil [SRR (95% CI): 0.94 (0.92, 0.97); all moderate CoE]. Mainly no associations were observed when substituting dairy products against each other on disease and mortality risk. Our findings indicate associations between substituting dairy with red or processed meat and higher disease risk, whereas its substitution with whole grains was associated with a lower risk. However, there is little robust evidence that substituting whole-fat with low-fat dairy is associated with disease risk. (CRD42022303198).

Observational Dose-Response Meta-Analysis Methods May Bias Risk Estimates at Low Consumption Levels: The Case of Meat and Colorectal Cancer

Observational studies of foods and health are susceptible to bias, particularly from confounding between diet and other lifestyle factors. Common methods for deriving dose-response meta-analysis (DRMA) may contribute to biased or overly certain risk estimates. We used DRMA models to evaluate the empirical evidence for colorectal cancer (CRC) association with unprocessed red meat (RM) and processed meats (PM), and the consistency of this association for low and high consumers under different modeling assumptions. Using the Global Burden of Disease project's systematic reviews as a start, we compiled a data set of studies of PM with 29 cohorts contributing 23,522,676 person-years and of 23 cohorts for RM totaling 17,259,839 person-years. We fitted DRMA models to lower consumers only [consumption < United States median of PM (21 g/d) or RM (56 g/d)] and compared them with DRMA models using all consumers. To investigate impacts of model selection, we compared classical DRMA models against an empirical model for both lower consumers only and for all consumers. Finally, we assessed if the type of reference consumer (nonconsumer or mixed consumer/nonconsumer) influenced a meta-analysis of the lowest consumption arm. We found no significant association with consumption of 50 g/d RM using an empirical fit with lower consumption (relative risk [RR] 0.93 (0.8-1.02) or all consumption levels (1.04 (0.99-1.10)), while classical models showed RRs as high as 1.09 (1.00-1.18) at 50g/day. PM consumption of 20 g/d was not associated with CRC (1.01 (0.87-1.18)) when using lower consumer data, regardless of model choice. Using all consumption data resulted in association with CRC at 20g/day of PM for the empirical models (1.07 (1.02-1.12)) and with as little as 1g/day for classical models. The empirical DRMA showed nonlinear, nonmonotonic relationships for PM and RM. Nonconsumer reference groups did not affect RM (P = 0.056) or PM (P = 0.937) association with CRC in lowest consumption arms. In conclusion, classical DRMA model assumptions and inclusion of higher consumption levels influence the association between CRC and low RM and PM consumption. Furthermore, a no-risk limit of 0 g/d consumption of RM and PM is inconsistent with the evidence.

Dietary approach for the treatment of arterial hypertension in patients with diabetes mellitus

The association of hypertension and diabetes mellitus is extremely common, increasing the mortality risk of patients, mainly by cardiovascular causes. Regarding the blood pressure (BP) targets to be achieved, most guidelines suggest levels of 130 mmHg for SBP and of 80 mmHg for DBP. Dietary modifications are quite effective, and many studies suggest that decreasing sodium intake and increasing potassium ingestion are both valuable practices for reducing BP. This can be achieved by stimulating the ingestion of lacteous products, vegetables, and nuts. As for the ideal pharmacologic treatment for hypertension, either calcium channel blockers, diuretics or angiotensin-system blockers can be the first class of drug to be used. In this review, we summarize the evaluation of patients with diabetes mellitus and hypertension, and discuss the available therapeutic approaches, with emphasis on evidence-based dietary recommendations.

Inverse Association between the Global Diet Quality Score and New-Onset Hypertension in Adults: A Nationwide Cohort Study

BACKGROUND

The Global Diet Quality Score (GDQS) is a simple and practical dietary metric associated with a number of chronic diseases. The GDQS included various foods related to blood pressure, especially diverse plant-based foods that have shown to lower blood pressure. However, studies on the role of the GDQS in reducing the risk of new-onset hypertension and whether its performance differs from that of other dietary metrics are lacking.

OBJECTIVE

We aimed to examine the association between the GDQS and new-onset hypertension and to compare its performance with that of other dietary patterns, including the Plant-based Diet Index (PDI), alternate Mediterranean diet (aMED) score, Alternative Healthy Eating Index-2010, and Dietary Approaches to Stop Hypertension (DASH) score in Chinese adults.

METHODS

We included a total of 12,002 participants (5644 males and 6358 females) aged >18 y from the China Health and Nutrition Survey (1997-2015). Dietary intake was estimated using average food intakes from 3 consecutive 24-h dietary recalls. Multivariable relative risks (RRs) were computed for hypertension using modified Poisson regression models.

RESULTS

With ≤18 y of follow-up (mean 8.7± 5.4 y), we ascertained 4232 incident cases of hypertension. Compared with participants with a low GDQS score (<15), the multivariable-adjusted RR of hypertension was 0.72 [95% confidence interval (CI): 0.62, 0.83] among participants with a high score (≥23). A 25% increment in the GDQS was associated with a 30% (RR, 0.70; 95% CI: 0.64, 0.76) lower risk of new-onset hypertension, which was comparable with the RRs of new-onset hypertension associated with every 25% increment in the PDI (RR, 0.84; 95% CI: 0.76, 0.93), DASH score (RR, 0.84; 95% CI: 0.78, 0.91), and aMED score (RR, 0.89; 95% CI: 0.84, 0.93).

CONCLUSION

A higher GDQS was associated with a lower risk of new-onset hypertension, with comparable associations of new-onset hypertension with PDI, DASH, and aMED scores in Chinese adults.

The Association between the Diversity of Coenzyme Q10 Intake from Dietary Sources and the Risk of New-Onset Hypertension: A Nationwide Cohort Study

Coenzyme Q10 (CoQ10) is a food active component with blood-pressure-improving properties. However, the association between the variety and quantity of different sources of dietary CoQ10 and new-onset hypertension remains uncertain. We aimed to investigate the associations between the diversity and quantity of CoQ10 intake from eight major food sources and new-onset hypertension risk. A total of 11,489 participants were included. Dietary intake was evaluated via three consecutive 24 h recalls and household food inventory. The diversity score of CoQ10 sources was calculated by the sum of food groups consumed in the ideal range. Cox proportional hazard models were used for evaluating their associations with hypertension. Model performance was assessed by ROC analyses and 200-times ten-fold cross-validation. The relationships between CoQ10 and hypertension were U-shaped for meat, egg, vegetable, and fruit sources, inverse J-shaped for fish, and nut sources, and L-shaped for dairy products sources (all p-values < 0.001). A higher diversity score was associated with lower hypertension risk (HR (95% CI): 0.66 (0.64, 0.69)). The mean areas under the ROC curves for 6, 12 and 18 years were 0.81, 0.80 and 0.78, respectively. There is a negative correlation between the diversity of CoQ10 with moderate intake from different sources and new-onset hypertension. One diversity score based on CoQ10 was developed.

Development and Validation of the Meiji Nutritional Profiling System (Meiji NPS) to Address Dietary Needs of Adults and Older Adults in Japan

This study introduces the Meiji Nutritional Profiling System (Meiji NPS), which was specifically designed to respond to age-related shifts in nutrient requirements among Japanese adults (<65 years old) and older adults (≥65 years old). Japan has one of the most aged societies in the world. The health issues of interest are malnutrition and lifestyle-related diseases among adults and frailty among older adults. Two versions of the NPS were developed based on nutrients to encourage (protein, dietary fibers, calcium, iron, and vitamin D), food groups to encourage (fruits, vegetables, nuts, legumes, and dairy), and nutrients to limit (energy, saturated fatty acids, sugars, and salt equivalents). The Meiji NPS for older adults did not include iron or saturated fatty acids. The algorithms were based on the Nutrient-Rich Foods Index (NRF). The convergent validity between the Meiji NPS and the existing NPSs for the same foods was confirmed using Spearman's correlation coefficients (NRF: r = 0.67 for adults and r = 0.60 for older adults; Health Star Rating: r = 0.64 for adults and r = 0.61 for older adults). The Meiji NPS may be useful for nutritional evaluation and reformulation of food products, tailored to adults and older adults to ameliorate health issues in Japan.

Association between joint physical activity and healthy dietary patterns and hypertension in US adults: cross-sectional NHANES study

BACKGROUND

Lack of physical activity (PA), poor dietary habits, or other unhealthy lifestyle behaviors are potential modifiable risk factors for hypertension. It has been sufficiently demonstrated in previous studies that physical activity or healthy dietary patterns can reduce the risk of hypertension. However, no research focused on the joint effects of PA and healthy dietary patterns on hypertension in a representative sample of adults.

METHODS

We used data collected from the 2007-2018 National Health and Nutrition Examination Survey. Healthy dietary patterns were assessed with the Healthy Eating Index 2015 (HEI-2015), and PA was measured using the metabolic equivalent minutes per week reported in questionnaires. We created four lifestyle categories based on the HEI-2015 and PA: (1) unhealthy diet and physically inactive (less than recommended PA), (2) healthy diet but physically inactive, (3) unhealthy diet but physically active (recommended PA), (4) healthy diet and physically active. Logistic regression was used to evaluate the association between joint PA and HEI-2015 and hypertension.

RESULTS

A total of 24,453 participants were enrolled in the study. Compared with unhealthy diet and physically inactive individuals, only healthy diet and physically active participants (adjusted odds ratio [AOR]: 0.77, 95% CI 0.65-0.9) were negatively associated with hypertension, while healthy diet but physically inactive participants (AOR: 0.89, 95% CI 0.76-1.03) and unhealthy diet but physically active participants (AOR: 0.9, 95% CI 0.76-1.06) were not associated with hypertension.

CONCLUSION

In a representative sample of US adults, our findings suggest that individuals with recommended PA and healthy dietary patterns have a lower risk of hypertension than those with an unhealthy diet or less than recommended PA. Healthy eating habits and regular PA are potential preventive precautions against hypertension.

The association between dairy intake in adolescents on inflammation and risk markers of type 2 diabetes during young adulthood: results of the DONALD study

OBJECTIVE

The aim of this analysis was to investigate whether habitual intake of total dairy (TD) or different dairy types (liquid, solid, fermented, non-fermented, low-fat, high-fat, low-sugar and high-sugar dairy) during adolescence is associated with biomarkers of low-grade inflammation as well as risk factors of type 2 diabetes in young adulthood.

DESIGN

Multivariable linear regression analyses were used to investigate prospective associations between estimated TD intake as well as intake of different types of dairy and a pro-inflammatory score, based on high-sensitivity C-reactive protein, IL-6, IL-18, leptin and adiponectin, and insulin resistance assessed as Homeostasis Model Assessment Insulin Resistance in an open-cohort study.

SETTING

Dortmund, Germany.

PARTICIPANTS

Data from participants (n 375) of the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were included, for whom at least two 3-d weighed dietary records during adolescence (median age: 11 years) and one blood sample in young adulthood (>18 years) were available.

RESULTS

There was no statistically significant association between TD intake or intake of any dairy type and the pro-inflammatory score (all P > 0·05). TD intake as well as each dairy type intake and insulin resistance also showed no association (all P > 0·05).

CONCLUSIONS

The habitual intake of dairy or individual types of dairy during adolescence does not seem to have a major impact on low-grade systemic inflammation and insulin resistance in the long term. There was no indication regarding a restriction of dairy intake for healthy children and adolescents in terms of diabetes risk reduction.

Dietary branched-chain amino acids intake and new-onset hypertension: a nationwide prospective cohort study in China

OBJECTIVE

This study aimed to investigate the relationship between dietary branched-chain amino acids (BCAAs) and the risk of developing hypertension.

METHODS

A cohort study of 14,883 Chinese adults without hypertension at baseline with were followed for an average of 8.9 years. Dietary intakes of BCAAs, including Ile, Leu, and Val, were collected using 3-day 24-h meal recall and household condiment weighing. Cox proportional hazards regression, restricted cubic splines, interaction analysis, and sensitivity analysis were used to assess the relationship between dietary BCAAs and risk of developing self-reported hypertension, adjusting for age, gender, region, body mass index (BMI), smoking and drinking status, physical activity, energy intake, salt intake.

RESULTS

Among 14,883 study subjects, 6386(42.9%) subjects aged ≥ 45 years at baseline, 2692 (18.1%) had new-onset hypertension during the study period, with a median age of 56 years. High levels of dietary BCAAs were associated with an increased risk of new-onset hypertension. Compared with the 41st-60th percentile, multivariable adjusted hazard ratio (HR) for new-onset hypertension was 1.16 (95% CI 1.01-1.32) for dietary BCAAs 61st-80th percentiles, 1.30 (1.13-1.50) for 81st-95th, 1.60 (1.32-1.95) for 96th-100th. The cut-off value of new-onset hypertension risk, total BCAAs, Ile, Leu, and Val were 15.7 g/day, 4.1 g/day, 6.9 g/day, 4.6 g/day, respectively, and the proportion of the population above these intake values were 13.9%, 13.1%, 15.4%, and 14.4%, respectively. Age, BMI, and salt intake had an interactive effect on this relationship (P < 0.001).

CONCLUSION

There was a significant positive association between total dietary BCAAs, Ile, Leu, Val intake and the risk of developing hypertension, after adjustment for confounders. This relationship was influenced by age, BMI, and salt intake. Further research is needed to clarify the mechanism and potential role of BCAAs in the pathogenesis of hypertension.

Fish - a scoping review for Nordic Nutrition Recommendations 2023

The aim of this scoping review was to conduct evidence-based documentation between fish intake and health outcomes for food-based dietary guidelines (FBDGs) in the Nordic Nutrition Recommendations (NNR) 2023. For most health outcomes, the evidence for fish oil and n-3 long chain (LC) polyunsaturated fatty acids (PUFA) supplementation was included when examining evidence between fish intake and health. In this review, conclusions from qualified systematic reviews (qSR) approved by NNR2023 are included. In addition, conclusions of a de novo systematic reviews on the topic of n-3 LC-PUFA, asthma, and allergy are included. Finally, a systematic literature search was performed limited to systematic reviews and meta-analysis published between 2011 and September 2021. In total, 21 papers from the systematic literature search, four qSR, and eight reports were included addressing the association between fish intake, fish oil, and n-3 LC-PUFA supplementation on several health outcomes. These included cardiovascular disease (CVD), type 2 diabetes, cancers (colorectal, breast, and prostate), metabolic syndrome, obesity, mortality, cognition and mental health, pregnancy-related outcomes (preterm birth and birth weight), and outcomes specific for children (neurodevelopment, and risk of food allergies, and asthma). In addition, intermediate risk factors such as blood lipids, glucose, C-reactive protein, and blood pressure were reviewed. Based on current evidence, fish consumption can have beneficial effects to prevent coronary heart disease (CHD) and stroke incidence, and lower mortality from CVD, CHD, myocardial infarction (MI), and stroke, as well as total mortality risk. In addition, fish consumption is beneficial for preventing cognitive decline in adults (e.g. dementia and Alzheimer's disease). Fish intake may also prevent metabolic syndrome, supported by an observed association between fish intake and reduction in plasma triglycerides and increase in high-density lipoprotein (HDL) cholesterol levels. Data from fish oil and n-3 LC-PUFA supplementation studies supports the conclusions on the effects of fish consumption on most of the health outcomes.

Planting the Seed for Blood Pressure Control: The Role of Plant-Based Nutrition in the Management of Hypertension

PURPOSE OF REVIEW

Hypertension results in significant morbidity, mortality, and healthcare expenditures. Fortunately, it is largely preventable and treatable by implementing dietary interventions, though these remain underutilized. Here, we aim to explore the role of healthy dietary patterns in hypertension management and describe approaches for busy clinicians to address nutrition effectively and efficiently with patients.

RECENT FINDINGS

DASH, Mediterranean, vegetarian, and vegan diets that include minimally processed, plant-based foods as core elements have consistently shown positive effects on hypertension. Recommendations that distill the most healthful components of these diets can significantly impact patient outcomes. Clinicians can harness evidence-based dietary assessment and counseling tools to implement and support behavioral changes, even during brief office visits. Healthful plant-based dietary patterns can often effectively prevent and treat hypertension. Clinicians may help improve patient outcomes by discussing evidence-based nutrition with their patients. Future work to promote infrastructural change that supports incorporating evidence-based nutrition into medical education, clinical care, and society at large can support these efforts.

Association of consumption of sugar-sweetened beverages with elevated blood pressure among college students in Yunnan Province, China

OBJECTIVE

Although some studies have examined the association between eating behaviour and elevated blood pressure (EBP) in adolescents, current data on the association between sugar-sweetened beverages (SSB) and EBP in adolescents in Yunnan Province, China, are lacking.

SETTING

Cluster sampling was used to survey freshmen at a college in Kunming, Yunnan Province, from November to December. Data on SSB consumption were collected using an FFQ measuring height, weight and blood pressure. A logistic regression model was used to analyse the association between SSB consumption and EBP, encompassing prehypertension and hypertension with sex-specific analyses.

PARTICIPANTS

The analysis included 4781 college students.

RESULTS

Elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP) were detected in 35·10 % (1678/4781) and 39·34 % (1881/4781) of patients, respectively. After adjusting for confounding variables, tea beverage consumption was associated with elevated SBP (OR = 1·24, 95 % CI: 1·03, 1·49, P = 0·024), and carbonated beverage (OR = 1·23, 95 % CI: 1·04, 1·45, P = 0·019) and milk beverage (OR = 0·81, 95 % CI: 0·69, 0·95, P = 0·010) consumption was associated with elevated DBP in college students. Moreover, fruit beverage (OR = 1·32, 95 % CI: 1·00, 1·75, P = 0·048) and milk beverage consumption (OR = 0·69, 95 % CI: 0·52, 0·93, P = 0·014) was associated with elevated DBP in males.

CONCLUSION

Our findings indicated that fruit and milk beverage consumption was associated with elevated DBP in males, and no association was observed with EBP in females.

Meat and meat products - a scoping review for Nordic Nutrition Recommendations 2023

Meat is not only a source of several nutrients but also a proposed risk factor for several non-communicable diseases. Here, we describe the totality of evidence for the role of meat intake for chronic disease outcomes, discuss potential mechanistic pathways, knowledge gaps, and limitations of the literature. Use of the scoping review is based on a de novo systematic review (SR) and meta-analysis on the association between poultry intake and cardiovascular disease (CVD) and type 2 diabetes (T2D), qualified SRs (as defined in the Nordic Nutrition Recommendations 2023 project) on meat intake and cancer by the World Cancer Research Fund (WCRF), the International Agency for Research on Cancer (IARC), and a systematic literature search of SRs and meta-analyses. The quality of the SRs was evaluated using a modified AMSTAR 2 tool, and the strength of evidence was evaluated based on a predefined criteria developed by the WCRF. The quality of the SRs was on average critically low. Our findings indicate that the evidence is too limited for conclusions for most of the chronic disease outcomes. However, findings from qualified SRs indicate strong evidence that processed meat increases the risk of colorectal cancer and probable evidence that red meat (unprocessed, processed, or both) increases the risk. The evidence suggests that both unprocessed red meat and processed meat (also including processed poultry meat) are probable risk factors for CVD mortality and stroke, and that total red meat and processed meat are risk factors for CHD. We found no sufficient evidence suggesting that unprocessed red meat, processed red meat, total red meat, or processed meat (including red and white meat) would be protective of any chronic disease. There was also no sufficient evidence to conclude on protective effect of poultry on any chronic diseases; effects on the risk of CVD, stroke, and T2D, to any direction, were regarded as unlikely.

Cereals and cereal products - a scoping review for Nordic Nutrition Recommendations 2023

Cereals and cereal products have traditionally been staple foods in many countries including in the Nordics and Baltics. Cereals can be consumed with their entire grain kernel and are then referred to as whole grains or can be consumed after removal of the bran or germ and are then referred to as refined grains. The terms cereals and grains are often used interchangeably. In this scoping review, we examine the associations between intake of cereals and cereal products and major health outcomes to contribute to up-to-date food-based dietary guidelines for the Nordic and Baltic countries in the Nordic Nutrition Recommendations 2023 project. Five qualified systematic reviews that covered non-communicable diseases, mortality, and risk factors were identified, and a supplementary literature search was performed in the MEDLINE and Cochrane databases for more recent studies and other endpoints. Compared to other high-income countries, the Nordic populations have a high consumption of whole grain foods. In some of the countries, rye constitutes a substantial fraction of the cereal consumption. However, few studies are available for specific cereals, and most of the research has been performed in predominantly wheat-consuming populations. The evidence suggests clear dose-response associations between a high intake of whole grains and lower risks of cardiovascular disease, colorectal cancer, type 2 diabetes, and premature mortality. The lowest risks of morbidity and mortality were observed for 3-7 servings of whole grains per day, equivalent of 90-210 g/day (fresh weight or ready-to-eat whole grain products, such as oatmeal or whole grain rye bread). Evidence from randomized trials indicates that a high intake of whole grains is beneficial for reducing weight gain. There is less evidence for refined grains, but the available evidence does not seem to indicate similar beneficial associations as for whole grains. It is suggested that replacing refined grains with whole grains would improve several important health outcomes. Cereals are plant foods that can be grown in most of the Nordic and Baltic regions.

Nuts and seeds - a scoping review for Nordic Nutrition Recommendations 2023

Background

Nuts and seeds have been part of diets in most of the world for millenniums, and they have also been consumed in the Nordic and Baltic countries for centuries. Consumption of nuts and seeds is linked with various health outcomes. Therefore, when updating the Nordic Nutrition Recommendations (NNR), summarizing the best evidence on key health outcomes from the consumption of nuts and seeds is essential.

Objectives

This study aims to evaluate the updated evidence on the consumption of nuts and seeds and health outcomes regarded relevant for the Nordic and Baltic countries, as well as their dose-response relationship presented in updated systematic reviews and meta-analyses.

Method

The scoping review is built on a de novo systematic review and an umbrella review published in 2022 on the consumption of nuts and seeds and its various health outcomes, including cardiovascular disease and diabetes.

Results

Intake of nuts and seeds is associated with a lower risk of cardiovascular diseases, with evidence assessed as probable. This conclusion is mirrored by evidence from trials on biomarkers for chronic diseases. An intake of a serving of nuts of 28-30 g/day compared to not eating nuts is estimated to translate into approximately 20% relative reduction in the risks of cardiovascular disease and premature deaths. For cancers, consumption of a serving of nuts is inversely associated with cancer mortality. However, for type 2 diabetes, there are mixed and inconclusive results. Additionally, there are inverse associations between nut consumption and respiratory and infectious disease mortality. Allergies for nuts are seen among 1-2% of the population.

Conclusion

Overall, the current evidence supports dietary recommendations to increase nut consumption to a serving of nuts and seeds per day for people without allergies to these foods.

Vegetables, fruits, and berries - a scoping review for Nordic Nutrition Recommendations 2023

Vegetables, fruits, and berries comprise a large variety of foods and are recognised to play an important role in preventing chronic diseases. Many observational studies have been published during the last decade, and the aim of this scoping review is to describe the overall evidence for the role of vegetables, fruits, and berries for health-related outcomes as a basis for setting and updating food-based dietary guidelines. A scoping review was conducted according to the protocol developed within the Nordic Nutrition Recommendations 2023 project. Current available evidence strengthens the role of consuming vegetables, fruits, and berries in preventing chronic diseases. The most robust evidence is found for cancer in the gastric system and lung cancer, cardiovascular disease, and all-cause mortality. Steeper risk reductions are generally seen at the lower intake ranges, but further reductions have been seen for higher intakes for cardiovascular disease. Weaker associations are seen for type 2 diabetes. There is evidence that suggests a beneficial role also for outcomes such as osteoporosis, depression, cognitive disorders, and frailty in the elderly. The observed associations are supported by several mechanisms, indicting causal effects. Some subgroups of vegetables, fruits, and berries may have greater benefits than other subgroups, supporting a recommendation to consume a variety of these foods.

The Cardioprotective Properties of Selected Nuts: Their Functional Ingredients and Molecular Mechanisms

Nuts have been known as a nutritious food since ancient times and can be considered part of our original diet: they are one of the few foods that have been eaten in the same form for thousands of years. They consist of various dry fruits and seeds, with the most common species being almonds (Prunus dulcis), hazelnuts (Corylus avellana), cashews (cashew nuts, Anacardium occidentale), pistachios (Pistacia vera), walnuts (Italian nuts, Juglans regia), peanuts (Arachia hypogaca), Brazil nuts (Bartholletia excels), pecans (Corya illinoinensis), macadamia nuts (Macademia ternifolia) and pine nuts. Both in vitro and in vivo studies have found nuts to possess a range of bioactive compounds with cardioprotective properties, and hence, their consumption may play a role in preventing and treating cardiovascular diseases (CVDs). The present work reviews the current state of knowledge regarding the functional ingredients of various nuts (almonds, Brazil nuts, cashew nuts, hazelnuts, macadamia nuts, peanuts, pecan nuts, pine nuts, pistachios, and walnuts) and the molecular mechanisms of their cardioprotective action. The data indicate that almonds, walnuts and pistachios are the best nut sources of bioactive ingredients with cardioprotective properties.

Refined grain intake and cardiovascular disease: Meta-analyses of prospective cohort studies

Refined grains are included as part of an unhealthy, or Western, dietary pattern, which has been shown to be associated with increased risk of cardiovascular disease (CVD). To clarify the association between refined grain intake and CVD risk, Pubmed and Scopus databases were searched for relevant cohort studies from database inception to June 30, 2022. Only studies that examined refined grains as a distinct consumption category and not as part of a dietary pattern, were included. Meta-analyses were performed using Cochrane's RevMan 5.4.1 software, applying inverse variance risk ratios in random effects models for each outcome of interest. Heterogeneity was assessed with Cochrane's Q (chi2) and I2 statistics. Meta-analyses of hazard ratios (HR) and 95% confidence intervals (CI) obtained from 17 prospective cohort studies (>875,000 participants) indicated that refined grain intake was not associated with risk of CVD (HR = 1.08, 95% CI, 0.99-1.18, I2 = 70%; 9 cohorts), stroke (HR = 1.06, 95% CI 0.92-1.23, I2 = 70%; 9 cohorts), or heart failure (HR = 0.95, 95% CI 0.77-1.16, I2 = 10%; 5 cohorts). White rice intake was also not associated with risk of CVD (HR = 0.93, 95% CI 0.86-1.00, I2 = 25%; 7 cohorts) or stroke (HR = 1.03, 95% CI 0.93-1.14, I2 = 22%; 7 cohorts). No significant publication bias was evident (Egger's test P values all > 0.05). The lack of association between refined grain intake and CVD risk was observed in meta-analyses of studies that restricted analyses to only staple grain foods (e.g., bread, cereal, pasta, white rice), as well as for meta-analyses of studies that included both staple and indulgent grain foods (e.g., cakes, cookies, doughnuts, brownies, muffins, pastries). Probable confounding from unmeasured variables in studies included in the meta-analyses diminishes the overall quality of evidence. Although refined grains are included as a component of the Western dietary pattern, the results of the meta-analyses suggest that refined grains do not contribute to the higher CVD risk associated with this unhealthy dietary pattern. This information should be considered in formulation of future dietary recommendations.

The Role of Diet in the Prevention of Hypertension and Management of Blood Pressure: An Umbrella Review of Meta-Analyses of Interventional and Observational Studies

High blood pressure (BP) is a major pathological risk factor for the development of several cardiovascular diseases. Diet is a key modifier of BP, but the underlying relationships are not clearly demonstrated. This is an umbrella review of published meta-analyses to critically evaluate the wide range of dietary evidence from bioactive compounds to dietary patterns on BP and risk of hypertension. PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception until October 31, 2021, for relevant meta-analyses of randomized controlled trials or meta-analyses of observational studies. A total of 175 publications reporting 341 meta-analyses of randomized controlled trials (145 publications) and 70 meta-analyses of observational studies (30 publications) were included in the review. The methodological quality of the included publications was assessed using Assessment of Multiple Systematic Reviews 2 and the evidence quality of each selected meta-analysis was assessed using NutriGrade. This umbrella review supports recommended public health guidelines for prevention and control of hypertension. Dietary patterns including the Dietary Approaches to Stop Hypertension and the Mediterranean-type diets that further restrict sodium, and moderate alcohol intake are advised. To produce high-quality evidence and substantiate strong recommendations, future research should address areas where the low quality of evidence was observed (for example, intake of dietary fiber, fish, egg, meat, dairy products, fruit juice, and nuts) and emphasize focus on dietary factors not yet conclusively investigated.

Personal health behaviors and physical activity and nutrition counseling by nurse practitioners: An online survey

BACKGROUND

Healthy lifestyle counseling improves nutritional intake and participation in exercise, yet the rate of patient counseling varies and clinicians' personal behaviors can influence counseling practices.

PURPOSE

This cross-sectional study evaluated lifestyle counseling by nurse practitioners (NPs) and the relationship between their personal behaviors and patient counseling.

METHODOLOGY

Practicing NPs ( N = 1,220) completed an online survey regarding personal behaviors and counseling for healthy body weight, moderate-vigorous physical activity, muscle strengthening, fruit and vegetable consumption, and dietary protein.

RESULTS

The majority reported counseling "usually" or "often" for healthy weight (54%), moderate-vigorous physical activity (53%), and fruits/vegetables (57%), whereas only 44% and 17% reported "usually" or "often" counseling for dietary protein and muscle strengthening. When NPs did not personally engage in the behavior, the odds for counseling were significantly reduced: NPs were 21% less likely to counsel for moderate-vigorous physical activity (odds ratio [OR] = 0.79 [0.65-0.97], p = .026), 27% less likely to counsel for muscle strengthening (OR = 0.73 [0.60-0.90], p = .004), 57% less likely to counsel for fruit/vegetable consumption (OR = 0.43 [0.35-0.54], p < .001), and 72% less likely to counsel for dietary protein (OR = 0.28 [0.18-0.45], p < .001). Personal body mass index did not predict counseling for a healthy weight.

CONCLUSION

Although NPs report regular patient counseling regarding healthy lifestyle behaviors, the odds for counseling are increased approximately 20-75% when they engage in the behaviors themselves.

IMPLICATIONS

Promotion of healthy behaviors during professional education may have long-term implications for preventive health counseling.

Dietary patterns and associations with metabolic risk factors for non-communicable disease

Unhealthy dietary habit is a major contributor to the burden of non-communicable diseases such as cardiovascular diseases, diabetes, and hypertension, especially the increased burden in low- and middle-income countries. Evidence of the association between specific dietary patterns and health outcomes is scarce in sub-Saharan African countries. This study aimed to identify principal dietary patterns and evaluate associations with metabolic risk factors including hypertension, overweight/obesity, and abdominal obesity in Northwest Ethiopia. A community-based cross-sectional survey was conducted among adults in Bahir Dar, Northwest Ethiopia, from 10 May 2021 to 20 June 2021. Dietary intake was collected using a validated food frequency questionnaire. Anthropometric (weight, height, hip/waist circumference) and blood pressure measurements were performed using standardized tools. Principal component analysis was conducted to derive dietary patterns. Chi-square and logistic regression analyses were used to examine the association between dietary patterns and metabolic risk factors and with sociodemographic and individual risk factors. This study derives two types of dietary patterns: 'westernized' dietary pattern, which is positively correlated with consumption of meat, dairy, fast foods, alcohol, fish, sweet/sugary foods, and fruits, and 'traditional' dietary pattern, which is positively correlated with intake of cereals, vegetables, legumes, roots/tubers, coffee, and oils. The prevalence of hypertension was significantly lower in adults with higher quantiles of westernized dietary pattern (AOR = 0.28, 95% CI 0.13 to 0.60; p < 0.01; quantile three); and (AOR = 0.35, 95% CI 0.17, 0.75; p < 0.01; quantile four). Younger, married, and middle-income adults were associated with the highest quantile of the westernized pattern. Being females and having middle income associated with the highest quantile of traditional dietary patterns (p < 0.05). This study suggested two types of dietary patterns, westernized and traditional, among adults in Northwest Ethiopia and revealed a significant association with metabolic risk factors like hypertension. Identifying the main dietary patterns in the population could be informative to consider local-based dietary recommendations and interventions to reduce metabolic risk factors.

Association of Whole Grain Consumption and Cognitive Decline: An Investigation From a Community-Based Biracial Cohort of Older Adults

BACKGROUND AND OBJECTIVES

To examine the association of whole grain consumption and longitudinal change in global cognition, perceptual speed, and episodic memory by different race/ethnicity.

METHODS

We included 3,326 participants from the Chicago Health and Aging Project who responded to a Food Frequency Questionnaire (FFQ), with 2 or more cognitive assessments. Global cognition was assessed using a composite score of episodic memory, perceptual speed, and the Mini Mental State Examination (MMSE). Diet was assessed by a 144-item FFQ. Linear mixed-effects models were used to estimate the association of intakes of whole grains and cognitive decline.

RESULTS

This study involved 3,326 participants (60.1% African American [AA], 63.7% female) with a mean age of 75 years at baseline and a mean follow-up of 6.1 years. Higher consumption of whole grains was associated with a slower rate of global cognitive decline. Among AA participants, those in the highest quintile of whole grain consumption had a slower rate of decline in global cognition (β = 0.024, 95% CI [0.008-0.039], p = 0.004), perceptual speed (β = 0.023, 95% CI [0.007-0.040], p = 0.005), and episodic memory (β = 0.028, 95% CI [0.005-0.050], p = 0.01) compared with those on the lowest quintile. Regarding the amount consumed, in AA participants, those who consumed >3 servings/d vs those who consumed <1 serving/d had a slower rate of decline in global cognition (β = 0.021, 95% CI [0.005-0.036], p = 0.0093). In White participants, with >3 servings/d, we found a suggestive association of whole grains with global cognitive decline when compared with those who consumed <1 serving/d (β = 0.025, 95% CI [-0.003 to 0.053], p = 0.08).

DISCUSSION

Among AA participants, individuals with higher consumption of whole grains and more frequent consumption of whole grain had slower decline in global cognition, perceptual speed, and episodic memory. We did not see a similar trend in White adults.

Psychosocial and environmental risk factors of obesity and hypertension in children and adolescents-a literature overview

Childhood obesity has become a worldwide epidemic in the 21st century. Its treatment is challenging and often ineffective, among others due to complex, often not obvious causes. Awareness of the existence and meaning of psychosocial and environmental risk factors seems to be an essential element in the prevention and treatment of obesity and its complications, especially arterial hypertension. In this review, we will discuss the role of that risk factors linking obesity and increased cardiovascular disorders including the role of nutritional factors (including the role of unhealthy diet, inadequate hydration), unhealthy behaviors (e.g. smoking, alcohol and drugs, sedentary behavior, low physical activity, disrupted circadian rhythms, sleep disorders, screen exposure), unfavorable social factors (such as dysfunctional family, bullying, chronic stress, mood disorders, depression, urbanization, noise, and environmental pollution), and finally differences in cardiovascular risk in girls and boys.

Sugar-sweetened beverages consumption increases the risk of metabolic syndrome and its components in adults: Consistent and robust evidence from an umbrella review

BACKGROUND & AIMS

Sugar-sweetened beverages (SSBs) are potential modifiable risk factors for reducing the risk of metabolic syndrome (MetS); however, there is a lack of an umbrella review that robustly synthesizes the evidence. This review aims to synthesize the evidence linking habitual SSBs intake with MetS in adults, emphasizing the need for policy and regulatory actions.

METHODS

Four databases were comprehensively searched for relevant meta-analyses of prospective studies up to July 2023. Two authors independently conducted the screening for eligibility, data extraction, and quality assessment. The outcome of interest was MetS in adults, encompassing its component conditions. The present review was registered with PROSPERO (CRD42023402549).

RESULTS

Of the 16 eligible meta-analyses identified, 30 summary estimates were obtained for the impact of SSBs consumption on obesity, type 2 diabetes, hypertension, and MetS. Seven were rated as 'High' methodological quality, with the rest classified as 'Moderate' and 'Low' quality, consisting of three and six references, respectively. A comparison of the highest and lowest levels of SSBs consumption revealed an increased risk of 18% (95% CI: 13%-24%), 12% (95% CI: 11%-14%), 29% (95% CI: 25%-32%), and 29% (95% CI: 7%-52%) for obesity, hypertension, type 2 diabetes, and MetS, respectively. Consistently, the findings from dose-response analyses are in agreement with and corroborate the existing evidence that SSBs are a significant risk factor for the development of MetS and its related conditions. Noticeably, the quality of evidence was predominantly deemed as highly suggestive and convincing. Moreover, consensus on specific criteria to identify studies related to SSBs in literature searching was lacking, and most primary studies were conducted in developed countries and Europe.

CONCLUSIONS

Our findings suggest that more rigorous and targeted policy interventions are warranted to curtail SSBs consumption, in order to alleviate the global burden of MetS.

Longitudinal study of dietary patterns and hypertension in adults: China Health and Nutrition Survey 1991-2018

China is undergoing the nutrition transition that may explain partly the high prevalence of hypertension. We aimed to investigate the longitudinal association between dietary patterns and hypertension in Chinese adults over 28 years of follow-up. We used data collected in the China Health and Nutrition Survey from 1991 to 2018. Adults aged 18 years and above (n = 15,929) were included in the analysis, for whom questionnaires and anthropometric data were collected during at least two waves. Factor analysis was conducted to derive food patterns based on 18 foods or food groups. We constructed three-level mixed-effect linear regression models to estimate systolic blood pressure (SBP) and diastolic blood pressure (DBP) in relation to quartiles of dietary pattern score and performed three-level mixed-effect logistic regression models to assess the risk of hypertension. Participants in the top quartile of the modern pattern had a decrease in SBP (β = - 0.51; 95% CI -0.86, -0.16; P < 0.01) when adjusted for all potential confounders, whereas participants in the top quartile of the meat pattern had an increase in DBP (β = 0.31; 95% CI 0.08, 0.53; P < 0.01). Participants in the highest quartile of the meat pattern were more likely to have hypertension (OR = 1.14; 95% CI 1.03, 1.24; P < 0.01). Adherence to the modern pattern characterized by high intake of fruits and dairy products was inversely associated with SBP, whereas the meat pattern was positively associated with DBP and the risk of hypertension. These findings may well have important public health implications.

An Unhealthy Plant-Based Diet Increases Risk of Hypertension but not Framingham Risk Score in Adults

Backgrounds

We investigated the relation of plant-based diets (PDs) with hypertension (HTN) and Framingham risk score (FRS) in Iranian adults.

Objectives

We hypothesized that healthy PDs might have positive effects on blood pressure (BP) and FRS, whereas less-healthy plant-based foods might have negative effects.

Methods

The current cross-sectional study was performed on 527 middle-aged adults (45.7% women), who were selected through a multistage cluster random-sampling method. The assessment of dietary intakes was performed by using a validated food-frequency questionnaire. Twelve-hour fasting blood samples were collected to evaluate total cholesterol and high-density lipoprotein concentrations. BP was measured through the standard method and HTN was defined as BP ≥130/80 mmHg. FRS was used to predict the 10-y risk for development of cardiovascular disease (CVD).

Results

The prevalence of HTN and high FRS among study participants were, respectively, 62% and 15.6%. After adjustment for potential confounders, plant-based diet index (PDI) and healthy plant-based diet index (hPDI) were not significantly associated with HTN [odds ratio (OR): 0.99; 95% confidence interval (CI): 0.55, 1.79 and OR: 0.83; 95% CI: 0.45, 1.53, respectively)]. However, those in the highest tertile of unhealthy plant-based diet index (uPDI) in comparison with those in the bottom tertile had a 100% increased odds of HTN (OR: 2.00; 95% CI: 1.04, 3.88). Greater adherence to PDI, hPDI, and uPDI was not related to high FRS chance, in fully adjusted model (OR: 0.50; 95% CI: 0.15, 1.65; OR: 1.03; 95% CI: 0.26, 4.04; and OR: 2.05; 95% CI: 0.56, 7.52, respectively).

Conclusions

This study demonstrated that less-healthy PDs would enhance the chance of HTN in Iranian adults, although PDIs were not significantly related to the 10-y risk of developing CVD.

Saturated fat, the estimated absolute risk and certainty of risk for mortality and major cancer and cardiometabolic outcomes: an overview of systematic reviews

OBJECTIVE

To assess the impact of reducing saturated fat or fatty foods, or replacing saturated fat with unsaturated fat, carbohydrate or protein, on the risk of mortality and major cancer and cardiometabolic outcomes in adults.

METHODS

We searched MEDLINE, EMBASE, CINAHL, and references of included studies for systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) and observational studies in adults published in the past 10 years. Eligible reviews investigated reducing saturated fat or fatty foods or replacing saturated fat with unsaturated fat, carbohydrate or protein, on the risk of cancer and cardiometabolic outcomes and assessed the certainty of evidence for each outcome using, for example, the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. We assessed the quality of SRMAs using a modified version of AMSTAR-2. Results were summarized as absolute estimates of effect together with the certainty of effects using a narrative synthesis approach.

RESULTS

We included 17 SRMAs (13 reviews of observational studies with follow-up 1 to 34 years; 4 reviews of RCTs with follow-up 1 to 17 years). The quality of two-thirds of the SRMAs was critically low to moderate; the main limitations included deficient reporting of study selection, absolute effect estimates, sources of funding, and a priori subgroups to explore heterogeneity. Our included reviews reported > 100 estimates of effect across 11 critically important cancer and cardiometabolic outcomes. High quality SRMAs consistently and predominantly reported low to very low certainty evidence that reducing or replacing saturated fat was associated with a very small risk reduction in cancer and cardiometabolic endpoints. The risk reductions where approximately divided, some being statistically significant and some being not statistically significant. However, based on 2 moderate to high quality reviews, we found moderate certainty evidence for a small but important effect that was statistically significant for two outcomes (total mortality events [20 fewer events per 1000 followed] and combined cardiovascular events [16 fewer per 1000 followed]). Conversely, 4 moderate to high quality reviews showed very small effects on total mortality, with 3 of these reviews showing non-statistically significant mortality effects.

CONCLUSION

Systematic reviews investigating the impact of SFA on mortality and major cancer and cardiometabolic outcomes almost universally suggest very small absolute changes in risk, and the data is based primarily on low and very low certainty evidence.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020172141.

Dietary modification for prevention and control of high blood pressure

Hypertension (HT) remains the leading cause of cardiovascular and premature death around the world. Diet is one of the important factors that contributes to the development of HT. We review the current evidence of how different dietary factors may influence blood pressure (BP) and consequent development of HT. There is evidence that BP is positively associated with higher consumption of sodium, alcohol, animal-based protein such as red meat, low-quality carbohydrates such as sugar-sweetened beverages, and saturated fatty acids. On the contrary, other dietary constituents have BP-lowering effects. These include potassium, calcium, magnesium, yogurt, eggs, plant-based proteins such as soy and legumes, mono- and polyunsaturated fatty acids, and high-quality carbohydrates such as whole grain and fruits. Dietary fibre is unrelated to BP lowering, possibly due to the different mechanisms of various types of fibre. The effects of caffeine, hibiscus tea, pomegranate, and sesame on BP are also unclear as evidence is hard to assess due to the varying concentrations and different types of drinks used in studies. Implementing dietary changes such as the Dietary Approaches to Stop Hypertension (DASH diet) or adopting a Mediterranean diet has been shown to reduce and control BP. Although the effect of diet on BP control has been established, the optimal amount of each dietary component and consequent ability to devise a personalized diet for HT prevention and BP control for different populations still require further investigation.

Anthocyanin Effects on Vascular and Endothelial Health: Evidence from Clinical Trials and Role of Gut Microbiota Metabolites

Hypertension and derived cardiovascular disease (CVD) are among the leading causes of death worldwide. Increased oxidative stress and inflammatory state are involved in different alterations in endothelial functions that contribute to the onset of CVD. Polyphenols, and in particular anthocyanins, have aroused great interest for their antioxidant effects and their cardioprotective role. However, anthocyanins are rarely detected in blood serum because they are primarily metabolized by the gut microbiota. This review presents studies published to date that report the main results from clinical studies on the cardioprotective effects of anthocyanins and the role of the gut microbiota in the metabolism and bioavailability of anthocyanins and their influence on the composition of the microbiota. Even if it seems that anthocyanins have a significant effect on vascular health, more studies are required to better clarify which molecules and doses show vascular benefits without forgetting the crucial role of the microbiota.

Ultra-processed food consumption in Argentina according to income level and its association with the intake of healthy foods

Ultra-processed foods (UPFs) are associated with unhealthy diets and chronic diseases. Hence, knowing the consumption pattern of UPFs in the general population is crucial to design policies to improve public health, such as the recently approved law for the Promotion of Healthy Eating in Argentina (Law N° 27.642). The aim of the study was to characterise the consumption of UPFs according to income level and to assess their association with the intake of healthy foods in the Argentinian population. Healthy foods were defined in this study as those non-UPF groups that have been shown to reduce the risk of non-communicable diseases and excluded certain natural or minimally processed foods such as red meat, poultry and eggs. We retrieved data from the 2018-2019 National Nutrition and Health Survey (ENNyS 2), a cross-sectional, nationally representative survey performed in Argentina, including 15 595 inhabitants. We classified the 1040 food items recorded by the degree of processing using the NOVA system. UPFs represented nearly 26% of daily energy. The intake of UPFs increased with income, with a difference of up to 5 percentage points between the lowest (24%) and the highest (29%) income levels (p < 0.001). Cookies, industrial pastries, cakes and sugar-sweetened beverages were the most consumed UPF items, accounting for 10% of daily energy intake. We found that UPF intake was associated with a decrease in consumption of healthy food groups, mainly fruits and vegetables, where a difference of -28.3 g/2000 kcal and -62.3 g/2000 kcal between tertile 1 and tertile 3 was estimated, respectively. Therefore, Argentina still maintains a UPF consumption pattern of a low- and middle-income country, where UPF intake increases with income, but these foods also compete with the intake of healthy foods.

Dietary factors and hypertension risk in West Africa: a systematic review and meta-analysis of observational studies

BACKGROUND

Contrary to North America and Europe, the prevalence of hypertension is rising in West Africa. Although diet is implicated as a contributor to this trend, nutritional guidelines in West Africa are not tailored to address this concern. This study aimed to address this limitation by investigating dietary factors common to West Africa and evaluating their association with hypertension.

METHODS

PubMed, Scopus, Web of Science, and Medline were searched to identify studies that investigated diet and hypertension in West African adults. All meta-analyses used a generic inverse-variance random effects model, with subgroup analyses by age, BMI, and study location, and were performed in R.

RESULTS

Three thousand, two hundred ninety-eight studies were identified, of which 31 ( n  = 48 809 participants) satisfied inclusion criteria - all cross-sectional. Meta-analyses of the association between dietary factors and hypertension included dietary fat [odds ratio (OR) = 1.76; 95% confidence interval (95% CI) 1.44-2.14; P  < 0.0001], red meat (OR = 1.51; 95% CI: 1.04-2.18; P  = 0.03), junk-food (OR = 1.41; 95% CI: 1.19-1.67; P  < 0.0001), dietary salt (OR = 1.25; 95% CI: 1.12-1.40; P  < 0.0001), alcohol (OR = 1.17; 95% CI: 1.03-1.32; P  = 0.013), and 'fruits and vegetables' (OR = 0.80; 95% CI: 0.24-1.17; P  < 0.0001). Subgroup analyses suggested that 'fruit and vegetable' consumption is less protective in the elderly.

CONCLUSION

High consumption of dietary salt, red meat, dietary fat, junk food, and alcohol are associated with increased odds of hypertension, whereas high fruit and vegetable appear protective. This region-specific evidence will support the development of nutritional assessment tools for clinicians, patients, and researchers aiming to reduce hypertension in West Africa.

Health benefits of legume seeds

Pulses have been part of human nutrition for centuries. They are also used in folk medicine as products with multidirectional medicinal effects. They are annual plants representing the Fabaceae family. Their edible part is the fruit, i.e. the so-called pods. Whole pods or their parts can be eaten, depending on the species and fruit ripeness. Beans, peas, peanuts, chickpeas, lentils, broad beans and soybeans are edible legume species. Legume seeds are characterized by high nutritional value. Compared to seeds from other plants, they have high protein content ranging, on average, from 20% to 35%, depending on the type, growing conditions and maturity of the fruit. This review focuses on various health-promoting properties of legumes and presents their nutritional value and compounds exerting health-promoting effects. Many pulses have a low glycemic index, which is important for prevention and treatment of diabetes. In addition to their low glycemic index and high fiber content, pulses have α-amylase and α-glucosidase inhibitors, which reduce the absorption of glucose from the gastrointestinal tract. These compounds have antidiabetic and anti-inflammatory effects. Pulses have been shown to contain bioactive peptides with angiotensin-converting enzyme inhibitory properties; hence, they are useful in the treatment of cardiovascular diseases. Pulses used in the nutrition of obese individuals provide compounds with pancreatic lipase inhibitory properties, thus promoting weight reduction and control. © 2023 Society of Chemical Industry.

The relationship between the intake of fruits, vegetables, and dairy products with hypertension: findings from the STEPS study

BACKGROUND

The current research aimed to evaluate the relationship between fruit, vegetable (FV), and dairy consumption with the odds of developing hypertension based on nationwide Stepwise approach to surveillance (STEPS) data in Iran.

METHODS

This cross-sectional study was accomplished by the research center of non-communicable diseases (NCDs) in Tehran. In total, 29,378 individuals' data were analyzed. Participants were classified into normal, elevated BP, stage I, and stage II hypertension according to systolic blood pressure (SBP) and diastolic blood pressure (DBP) examinations. Based on the STEPS questionnaire, the consumption of FVs and dairy products was evaluated. Multinomial logistic regression was applied to assess the relationship between the consumption of FVs and dairy products with hypertension.

RESULTS

The findings revealed that only fruit consumption (≥ 2 servings/day) was negatively related to stage I hypertension (odds ratio (OR) = 0.81; 95% confidence interval (CI): 0.69-0.95) in two servings per day and OR = 0.81; 95% CI: 0.68-0.96 in > two servings per day) in the adjusted model. There was no significant relationship between consuming vegetables and dairy products with elevated BP and hypertension.

CONCLUSION

Our study showed that increasing fruit consumption was related to reducing hypertension odds. Regarding the consumption of dairy products and vegetables, no significant relationship was found with the odds of hypertension. More studies, especially cohorts, are needed to evaluate the impacts of FV and dairy products on the risk of hypertension.

Concordance between Dash Diet and Hypertension: Results from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

High blood pressure is an important predictor of atherosclerotic cardiovascular disease (ASCVD), particularly among South Asians, who are at higher risk for ASCVD when compared to other population groups. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is established as the best proven nonpharmacological approach to preventing hypertension in adults. Using data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort, we calculated a DASH dietary score to examine the association between adherence to the DASH diet and its components, and prevalent and incident hypertension and systolic and diastolic blood pressure, after five years of follow-up. We found that the relative risk ratio (RRR) of incident hypertension was 67% lower among participants in the highest DASH diet score category (aRRR: 0.33; 95% CI: 0.13, 0.82; ptrend = 0.02) compared with those in the lowest DASH diet score category in fully adjusted models. These findings are consistent with previous clinical trials and large prospective cohort studies, adding to evidence that supports the diet-disease relationship established between DASH diet and hypertension. This study is the first to examine DASH diet adherence and hypertension among South Asian adults in the U.S.

Fructose-containing food sources and blood pressure: A systematic review and meta-analysis of controlled feeding trials

Whether food source or energy mediates the effect of fructose-containing sugars on blood pressure (BP) is unclear. We conducted a systematic review and meta-analysis of the effect of different food sources of fructose-containing sugars at different levels of energy control on BP. We searched MEDLINE, Embase and the Cochrane Library through June 2021 for controlled trials ≥7-days. We prespecified 4 trial designs: substitution (energy matched substitution of sugars); addition (excess energy from sugars added); subtraction (excess energy from sugars subtracted); and ad libitum (energy from sugars freely replaced). Outcomes were systolic and diastolic BP. Independent reviewers extracted data. GRADE assessed the certainty of evidence. We included 93 reports (147 trial comparisons, N = 5,213) assessing 12 different food sources across 4 energy control levels in adults with and without hypertension or at risk for hypertension. Total fructose-containing sugars had no effect in substitution, subtraction, or ad libitum trials but decreased systolic and diastolic BP in addition trials (P<0.05). There was evidence of interaction/influence by food source: fruit and 100% fruit juice decreased and mixed sources (with sugar-sweetened beverages [SSBs]) increased BP in addition trials and the removal of SSBs (linear dose response gradient) and mixed sources (with SSBs) decreased BP in subtraction trials. The certainty of evidence was generally moderate. Food source and energy control appear to mediate the effect of fructose-containing sugars on BP. The evidence provides a good indication that fruit and 100% fruit juice at low doses (up to or less than the public health threshold of ~10% E) lead to small, but important reductions in BP, while the addition of excess energy of mixed sources (with SSBs) at high doses (up to 23%) leads to moderate increases and their removal or the removal of SSBs alone (up to ~20% E) leads to small, but important decreases in BP in adults with and without hypertension or at risk for hypertension. Trial registration: Clinicaltrials.gov: NCT02716870.

Adherence to a healthy diet and odds of metabolic syndrome: A cross-sectional study

INTRODUCTION

Metabolic syndrome (MetS) is a major health concern around the world. Dietary factors, including diet quality, play a significant role in its pathophysiology. Healthy Eating Index (HEI) is a tool used as a valid measurement of the individual's diet quality. We aimed at investigating the relationship between diet quality as assessed by HEI-2015 and the risk of MetS and its components in a cross-sectional sample of suburban individuals from PERSIAN Kavar cohort study (PKCS), Fars province, Iran.

METHODS

2225 individuals meeting the eligibility criteria participated in the study. The relevant data were obtained from the baseline phase of PKCS. MetS was defined according to cut-offs presented by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). HEI-2015 was calculated for the included individuals. Odds ratios were estimated. P-values <0.05 were considered as significant.

RESULTS

The overall prevalence of MetS was 27.3%. Individuals with lower HEI-2015 scores had higher odds for MetS and its components. We observed that those who were categorized as the top HEI-2015 tertile had 42% (OR: 0.58; 95% CI: 0.38-0.90) lower odds of high blood pressure in the overall population. Also, the odds of high serum triacylglycerol was lower (OR: 0.72; 95% CI: 0.57-0.90) in those with the highest HEI-2015 scores.

CONCLUSION

We found that higher dietary quality measured by HEI will decrease the risk of developing MetS, hypertension, and hypertriglyceridemia among Iranian adults. However, future interventional studies are required to further elucidate the issue.

Diet and physical activity and metabolic disorders in patients with schizophrenia and bipolar affective disorder in the Polish population

Introduction

There are numerous reports of a higher prevalence of metabolic disorders in patients with schizophrenia and bipolar disorder (BD), yet its connections to diet and physical activity remain not fully explained. This article aimed to evaluate diet, physical activity and selected biochemical and anthropometric parameters associated with metabolism in patients with schizophrenia and BD and to analyse the relationships between these variables in the subjects.

Materials and Methods

A total of 126 adults participated in the study: 47 patients with schizophrenia, 54 patients with BD and 25 patients in mental illness remission (reference group). Data were collected on the underlying illness and concomitant illnesses, and the severity of symptoms of the current episode was assessed using the following scales: PANSS, MADRS and YMRS. An assessment of the subjects' diet (KomPAN questionnaire) and their physical activity (International Physical Activity Questionnaire) was carried out. Anthropometric and blood pressure measurements were taken and BMI and WHR were calculated. Serum concentrations of fasting glucose, TSH, total cholesterol, LDL and HDL fractions, triglycerides and leptin, ghrelin and resistin were determined. For statistical analysis, the significance level was set at 0.05. For multiple comparisons one way ANOVA or Kruskal Wallis were used with post hoc Tukey and Dunn tests, respectively. To determine correlation of variables, Pearson's linear correlation coefficient or Spearman's rank correlation coefficient were used.

Results

A total of 50.8% of the subjects had at least one metabolic disorder-most commonly excessive body weight (66.7%) and abdominal obesity (64.3%). Patients did not differ significantly in terms of physical activity, but they did differ in mean time spent sitting-with this being significantly longer for all groups than in the general population. The subjects differed in diet: patients with BD consumed less unhealthy foods than patients with schizophrenia. The highest correlations between physical activity, diet and variables defining metabolic disorders were found in patients with BD. Only in patients with schizophrenia were there significant correlations between the course of the disease and physical activity.

Discussion

The results suggest the existence of associations between diet, physical activity, and metabolic disorders in both BD and schizophrenia patients. They also suggest a tendency among those patients to spend long periods of time sitting.

Coffee Consumption and Risk of Hypertension in Adults: Systematic Review and Meta-Analysis

OBJECTIVES

The association between coffee intake and hypertension (HTN) risk is controversial. Therefore, this systematic review and meta-analysis aimed at summarizing the current evidence on the association of coffee with hypertension risk in observational studies.

METHODS

PubMed/Medline and Web of Science were searched for observational studies up to February 2023. Observational studies which assessed the risk of HTN in the highest category of coffee consumption in comparison with the lowest intake were included in the current meta-analysis (registration number: CRD42022371494). The pooled effect of coffee on HTN was evaluated using a random-effects model.

RESULTS

Twenty-five studies i.e., thirteen cross-sectional studies and twelve cohorts were identified to be eligible. Combining 13 extracted effect sizes from cohort studies showed that higher coffee consumption was associated with 7% reduction in the risk of HTN (95% CI: 0.88, 0.97; I²: 22.3%), whereas combining 16 effect sizes from cross-sectional studies illustrated a greater reduction in HTN risk (RR = 0.79, 95% CI: 0.72, 0.87; I² = 63.2%). These results varied by studies characteristics, such as the region of study, participants' sex, study quality, and sample size.

CONCLUSIONS

An inverse association was found between coffee consumption and hypertension risk in both cross-sectional and cohort studies. However, this association was dependent on studies characteristics. Further studies considering such factors are required to confirm the results of this study.

Food consumption by degree of processing is associated with nocturnal dipping and blood pressure variability: The ELSA-Brasil study

BACKGROUND AND AIMS

Ambulatory blood pressure monitoring (ABPM) allows the assessment of cardiovascular risk markers that cannot be obtained by casual measurements; however, the evidence on the association between food consumption and blood pressure (BP) assessed by ABPM is scarce. We aimed to evaluate the association between food consumption by degree of processing and ambulatory BP.

METHODS AND RESULTS

Cross-sectional analysis (2012-2014) of data from a subsample (n = 815) of ELSA-Brasil cohort participants who performed 24-h ABPM was conducted. Systolic (SBP) and diastolic (DBP) BP means and variability during the 24 h and subperiods (sleep and wake), nocturnal dipping, and morning surge were evaluated. Food consumption was classified according to NOVA. Associations were tested by generalized linear models. The consumption of unprocessed, minimally processed foods, and culinary ingredients (U/MPF&CI) was 63.1% of daily caloric intake, 10.8% of processed (PF), and 24.8% of ultraprocessed (UPF). A negative association was found between U/MPF&CI consumption and extreme dipping (T2: odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.55-0.58; T3: OR = 0.55; 95% CI = 0.54-0.57); and between UPF consumption and nondipping (T2: OR = 0.68, 95% CI = 0.55-0.85) and extreme dipping (T2: OR = 0.63, 95% CI = 0.61-0.65; T3: OR = 0.95, 95% CI = 0.91-0.99). There was a positive association between PF consumption and extreme dipping (T2: OR = 1.22, 95% CI = 1.18-1.27; T3: OR = 1.34, 95% CI = 1.29-1.39) and sleep SBP variability (T3: Coef = 0.56, 95% CI = 0.03-1.10).

CONCLUSIONS

The high consumption of PF was associated with greater BP variability and extreme dipping, while the U/MPF&CI and UPF consumption were negatively associated with alterations in nocturnal dipping.

The Effect of Non-Oil Seed Legume Intake on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Hypertension is a primary modifiable risk factor for CVD, whereby even small reductions in blood pressure (BP) can decrease risk for CVD events. Modification of dietary patterns is an established, nonpharmacologic approach for the prevention and management of hypertension. Legumes are a prevailing component of dietary patterns associated with lower BP in observational research, but there is a need to understand the effects of legume consumption on BP. This study aimed to synthesize evidence from randomized controlled trials (RCTs) for the effects of non-oil seed legume consumption on systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PROSPERO registration: CRD42021237732). We searched CINAHL, Cochrane, Medline, and PubMed scientific databases from inception through November 2022. A random-effects meta-analysis was conducted to assess the mean differences (MDs) for each outcome variable between legume-based and comparator diets. This review included 16 RCTs and 1092 participants. Studies ranged in duration (4-52 wk), participant age (17-75 y), and weekly legume dose (450-3150 g) in whole or powdered form. No significant overall effect between legume consumption and BP amelioration was observed in the meta-analysis (SBP-MD: -1.06 mm Hg; 95% CI: -2.57, 0.4410 mm Hg; I2 = 45%; DBP-MD: -0.48 mm Hg; 95% CI: -1.06, 0.10 mm Hg; I2 = 0%). The certainty of evidence was determined as low for SBP and DBP. Significant subgroup differences in SBP were found when studies were grouped according to participant BMI, with SBP reduction found for participants with overweight/obese BMI (MD -2.79 mm Hg, 95% CI: -4.68, -0.90 mm Hg). There is a need for large, high-quality trials to clearly define the benefits and mechanisms of legume consumption in BP management. Consideration of the relevance in individuals with obesity, overweight, and hypertension may also be warranted. This trial was registered at PROSPERO as CRD42021237732.