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Noronha JC, Nishi SK, Khan TA, Blanco Mejia S, Kendall CWC, Kahleová H, Rahelić D, Salas-Salvadó J, Leiter LA, Lean MEJ, Sievenpiper JL. Weight management using meal replacements and cardiometabolic risk reduction in individuals with pre-diabetes and features of metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Obes Rev 2024:e13751. [PMID: 38693302 DOI: 10.1111/obr.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/06/2024] [Accepted: 03/19/2024] [Indexed: 05/03/2024]
Abstract
This review synthesized the evidence from randomized controlled trials comparing the effect of meal replacements (MRs) as part of a weight loss intervention with conventional food-based weight loss diets on cardiometabolic risk in individuals with pre-diabetes and features of metabolic syndrome. MEDLINE, EMBASE, and Cochrane Library were searched through January 16, 2024. Data were pooled using the generic inverse variance method and expressed as mean difference [95% confidence intervals]. The overall certainty of the evidence was assessed using GRADE. Ten trials (n = 1254) met the eligibility criteria. MRs led to greater reductions in body weight (-1.38 kg [-1.81, -0.95]), body mass index (BMI, -0.56 kg/m2 [-0.78, -0.34]), waist circumference (-1.17 cm [-1.93, -0.41]), HbA1c (-0.11% [-0.22, 0.00]), LDL-c (-0.18 mmol/L [-0.28, -0.08]), non-HDL-c (-0.17 mmol/L [-0.33, -0.01]), and systolic blood pressure (-2.22 mmHg [-4.20, -0.23]). The overall certainty of the evidence was low to moderate owing to imprecision and/or inconsistency. The available evidence suggests that incorporating MRs into a weight loss intervention leads to small important reductions in body weight, BMI, LDL-c, non-HDL-c, and systolic blood pressure, and trivial reductions in waist circumference and HbA1c, beyond that seen with conventional food-based weight loss diets.
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Affiliation(s)
- Jarvis C Noronha
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Stephanie K Nishi
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- Alimentació, Nutrició, Desenvolupament i Salut Mental, Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de La Obesidad y La Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Tauseef A Khan
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hana Kahleová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- Alimentació, Nutrició, Desenvolupament i Salut Mental, Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de La Obesidad y La Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Lawrence A Leiter
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael E J Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Alvarado DA, Ibarra-Sánchez LA, Mysonhimer AR, Khan TA, Cao R, Miller MJ, Holscher HD. Honey Varietals Differentially Impact Bifidobacterium animalis ssp. lactis Survivability in Yogurt through Simulated In Vitro Digestion. J Nutr 2024; 154:866-874. [PMID: 38219862 PMCID: PMC10942848 DOI: 10.1016/j.tjnut.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Bifidobacterium animalis ssp. lactis DN-173 010/CNCM I-2494 (B. animalis) is a probiotic strain commonly added to yogurt. Yogurt and honey are a popular culinary pairing. Honey improves bifidobacteria survival in vitro. However, probiotic survival in yogurt with honey during in vitro digestion has not been investigated. OBJECTIVES The study aimed to evaluate the effects of different honey varietals and concentrations on B. animalis survivability in yogurt through in vitro digestion. METHODS Yogurt with honey or control-treated samples underwent in vitro simulated oral, gastric, and intestinal digestion. B. animalis cells were enumerated on de Man Rogosa and Sharpe (MRS) medium followed by an overlay with a modified selective MRS medium; all underwent anaerobic incubation. B. animalis were enumerated predigestion and after oral, gastric, and intestinal digestion. There were 2 study phases: Phase 1 tested 4 honey varietals at 20% wt/wt per 170 g yogurt, and Phase 2 tested 7 dosages of clover honey (20, 14, 10, 9, 8, 6, and 4% wt/wt) per 170 g yogurt. RESULTS Similar B. animalis counts were observed between all treatments after oral and gastric digestion (<1 Log colony forming units (CFU)/g probiotic reduction). Higher B. animalis survivability was observed in yogurt with clover honey after exposure to simulated intestinal fluids (∼3.5 Log CFU/g reduction; P < 0.05) compared to all control treatments (∼5.5 Log CFU/g reduction; P < 0.05). Yogurt with 10-20% wt/wt clover honey increased B. animalis survivability after simulated in vitro digestion (≤ ∼4.7 Log CFU/g survival; P < 0.05). CONCLUSIONS Yogurt with added honey improves probiotic survivability during in vitro digestion. The effective dose of clover honey in yogurt was 10-20% wt/wt per serving (1-2 tablespoons per 170 g yogurt) for increased probiotic survivability during in vitro digestion.
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Affiliation(s)
- David A Alvarado
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL, United States; Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States
| | | | - Annemarie R Mysonhimer
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL, United States
| | - Tauseef A Khan
- Division of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Rong Cao
- Guelph Research and Development Centre, Agriculture and Agri-Food Canada, Guelph, Canada
| | - Michael J Miller
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL, United States; Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States
| | - Hannah D Holscher
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL, United States; Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States.
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Nguyen M, Jarvis SE, Chiavaroli L, Mejia SB, Zurbau A, Khan TA, Tobias DK, Willett WC, Hu FB, Hanley AJ, Birken CS, Sievenpiper JL, Malik VS. Consumption of 100% Fruit Juice and Body Weight in Children and Adults: A Systematic Review and Meta-Analysis. JAMA Pediatr 2024; 178:237-246. [PMID: 38227336 PMCID: PMC10792499 DOI: 10.1001/jamapediatrics.2023.6124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 01/17/2024]
Abstract
Importance Concerns have been raised that frequent consumption of 100% fruit juice may promote weight gain. Current evidence on fruit juice and weight gain has yielded mixed findings from both observational studies and clinical trials. Objective To synthesize the available evidence on 100% fruit juice consumption and body weight in children and adults. Data Sources MEDLINE, Embase, and Cochrane databases were searched through May 18, 2023. Study Selection Prospective cohort studies of at least 6 months and randomized clinical trials (RCTs) of at least 2 weeks assessing the association of 100% fruit juice with body weight change in children and adults were included. In the trials, fruit juices were compared with noncaloric controls. Data Extraction and Synthesis Data were pooled using random-effects models and presented as β coefficients with 95% CIs for cohort studies and mean differences (MDs) with 95% CIs for RCTs. Main Outcomes and Measures Change in body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was assessed in children and change in body weight in adults. Results A total of 42 eligible studies were included in this analysis, including 17 among children (17 cohorts; 0 RCTs; 45 851 children; median [IQR] age, 8 [1-15] years) and 25 among adults (6 cohorts; 19 RCTs; 268 095 adults; median [IQR] age among cohort studies, 48 [41-61] years; median [IQR] age among RCTs, 42 [25-59]). Among cohort studies in children, each additional serving per day of 100% fruit juice was associated with a 0.03 (95% CI, 0.01-0.05) higher BMI change. Among cohort studies in adults, studies that did not adjust for energy showed greater body weight gain (0.21 kg; 95% CI, 0.15-0.27 kg) than studies that did adjust for energy intake (-0.08 kg; 95% CI, -0.11 to -0.05 kg; P for meta-regression <.001). RCTs in adults found no significant association of assignment to 100% fruit juice with body weight but the CI was wide (MD, -0.53 kg; 95% CI, -1.55 to 0.48 kg). Conclusion and Relevance Based on the available evidence from prospective cohort studies, in this systematic review and meta-analysis, 1 serving per day of 100% fruit juice was associated with BMI gain among children. Findings in adults found a significant association among studies unadjusted for total energy, suggesting potential mediation by calories. Further trials of 100% fruit juice and body weight are desirable. Our findings support guidance to limit consumption of fruit juice to prevent intake of excess calories and weight gain.
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Affiliation(s)
- Michelle Nguyen
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E. Jarvis
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Deirdre K. Tobias
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Walter C. Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Frank B. Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anthony J. Hanley
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Catherine S. Birken
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology & Metabolism, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vasanti S. Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
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Chen V, Khan TA, Chiavaroli L, Ahmed A, Lee D, Kendall CWC, Sievenpiper JL. Response to comment on "Relation of fruit juice with adiposity and diabetes depends on how fruit juice is defined: a re-analysis of the EFSA draft scientific opinion on the tolerable upper intake level for dietary sugars" by Chen et al. 2023. Eur J Clin Nutr 2023; 77:1178-1179. [PMID: 37853097 PMCID: PMC10686817 DOI: 10.1038/s41430-023-01323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Victoria Chen
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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5
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Khan TA, Lee JJ, Ayoub-Charette S, Noronha JC, McGlynn N, Chiavaroli L, Sievenpiper JL. WHO guideline on the use of non-sugar sweeteners: a need for reconsideration. Eur J Clin Nutr 2023; 77:1009-1013. [PMID: 37723261 PMCID: PMC10630128 DOI: 10.1038/s41430-023-01314-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/26/2023] [Accepted: 07/17/2023] [Indexed: 09/20/2023]
Grants
- 129920 CIHR
- JLS has received research support from the Canadian Foundation for Innovation, Ontario Research Fund, Province of Ontario Ministry of Research and Innovation and Science, Canadian Institutes of health Research (CIHR), Diabetes Canada, PSI Foundation, Banting and Best Diabetes Centre (BBDC).
- TAK was funded by a Toronto 3D Postdoctoral Fellowship Award.
- J.J.L. received research support from the Canadian Institutes of Health Research (CIHR) and has received research support from the Banting and Best Diabetes Centre at the University of Toronto.
- SA-C was funded by a CIHR Canadian Graduate Scholarships Master’s Award, the Loblaw Food as Medicine Graduate Award, the Ontario Graduate Scholarship (OGS), and the CIHR Canadian Graduate Scholarship Doctoral Award.
- JCN reports no sources of funding.
- NM reported receiving a Canadian Institutes of Health Research (CIHR)- Masters Award, a St. Michael’s Hospital Research Training Centre Scholarship and a Toronto 3D Internship during the conduct of the study.
- LC was funded by a Mitacs Elevate Postdoctoral Fellowship Award. CIHR Canada Graduate Scholarships Master’s Award. JLS was funded by a Diabetes Canada Clinician Scientist Award.
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Affiliation(s)
- Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Jennifer J Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sabrina Ayoub-Charette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Jarvis Clyde Noronha
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
- School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nema McGlynn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada.
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.
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Zurbau A, Khan TA, Wolever TM, Sievenpiper JL. Unveiling the optimal soluble dietary fiber for type 2 diabetes: galactomannans take the lead? Am J Clin Nutr 2023; 118:834-836. [PMID: 37793744 DOI: 10.1016/j.ajcnut.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; INQUIS Clinical Research Ltd., Toronto, Ontario, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Thomas Ms Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; INQUIS Clinical Research Ltd., Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
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7
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Liu Q, Chiavaroli L, Ayoub-Charette S, Ahmed A, Khan TA, Au-Yeung F, Lee D, Cheung A, Zurbau A, Choo VL, Mejia SB, de Souza RJ, Wolever TMS, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Fructose-containing food sources and blood pressure: A systematic review and meta-analysis of controlled feeding trials. PLoS One 2023; 18:e0264802. [PMID: 37582096 PMCID: PMC10427023 DOI: 10.1371/journal.pone.0264802] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/30/2023] [Indexed: 08/17/2023] Open
Abstract
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.
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Affiliation(s)
- Qi Liu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Sabrina Ayoub-Charette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Fei Au-Yeung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Vivian L. Choo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Russell J. de Souza
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Thomas M. S. Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Lawrence A. Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Cyril W. C. Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David J. A. Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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8
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Chen V, Khan TA, Chiavaroli L, Ahmed A, Lee D, Kendall CWC, Sievenpiper JL. Relation of fruit juice with adiposity and diabetes depends on how fruit juice is defined: a re-analysis of the EFSA draft scientific opinion on the tolerable upper intake level for dietary sugars. Eur J Clin Nutr 2023; 77:699-704. [PMID: 36737479 PMCID: PMC10335926 DOI: 10.1038/s41430-023-01258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Victoria Chen
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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9
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Khan TA, Zahoor ZU, Khan AS. Effect of Nystatin with and without DMAHDM on Antifungal and Mechanical Properties of Acrylic Resins. Eur J Prosthodont Restor Dent 2023; 31:152-160. [PMID: 36164988 DOI: 10.1922/ejprd_2439khan09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To investigate antifungal and mechanical properties after the impregnation of Dimethyl Amino-ethyl Hexa-decyl Di-methacrylate (DMAHDM) alone or in combination with Nystatin in polymethylmethacrylate. METHODOLOGY The control group was fabricated by mixing powder and liquid of PMMA at the ratio of 2.5:1 g/mL. The DMAHDM was added to PMMA liquid and were mixed with PMMA powder. The Nystatin (500,000 International Units (IU)) was mixed with PMMA powder, whereby the composite powder was mixed with the DMAHDM-based liquid. The prepared specimens were tested for fungal adhesion testing (at days 1 and 30), impact strength and flexural strength. Oneway ANOVA post-hoc Tukey's test were used for statistical analysis. RESULTS Statistical analysis for the adhesion assay revealed that the antifungal activities of unaged and aged specimens in experimental groups were statistically significant as compared to control group A. The groups containing DMAHDM with Nystatin have shown statistically reduced flexural strength. The impact strength test revealed that groups containing 20% DMAHDM alone and DMAHDM with Nystatin showed statistically reduced impact strength compared to the control group. CONCLUSION Antifungal activities of experimental PMMA resin was increased. The addition of DMAHDM alone in PMMA resin has no deleterious effects on impact and flexural strength, however, at higher concentration values were reduced.
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Affiliation(s)
- T A Khan
- Sardar Begun Dental College, Gandhara University, Peshawar, Pakistan
| | - Z U Zahoor
- Department of Biochemistry, Peshawar Medical College, Peshawar, KPK, Pakistan
| | - A S Khan
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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10
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Khan TA, Field D, Chen V, Ahmad S, Mejia SB, Kahleová H, Rahelić D, Salas-Salvadó J, Leiter LA, Uusitupa M, Kendall CW, Sievenpiper JL. Combination of Multiple Low-Risk Lifestyle Behaviors and Incident Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies. Diabetes Care 2023; 46:643-656. [PMID: 36812419 PMCID: PMC10020027 DOI: 10.2337/dc22-1024] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/08/2022] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Combined low-risk lifestyle behaviors (LRLBs) have been associated with a reduction in type 2 diabetes risk. This relationship has not been systematically quantified. RESEARCH DESIGN AND METHODS A systematic review and meta-analysis was conducted to assess the association of combined LRLBs with type 2 diabetes. Databases were searched up to September 2022. Prospective cohort studies reporting the association between a minimum of three combined LRLBs (including healthy diet) with incident type 2 diabetes were included. Independent reviewers extracted data and assessed study quality. Risk estimates of extreme comparisons were pooled using a random-effects model. Global dose-response meta-analysis (DRM) for maximum adherence was estimated using a one-stage linear mixed model. The certainty of the evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). RESULTS Thirty cohort comparisons (n = 1,693,753) involving 75,669 incident type 2 diabetes cases were included. LRLBs, with author-defined ranges, were healthy body weight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption. LRLBs were associated with 80% lower risk of type 2 diabetes (relative risk [RR] 0.20; 95% CI 0.17-0.23), comparing the highest with lowest adherence. Global DRM for maximum adherence to all five LRLBs reached 85% protection (RR 0.15; 95% CI 0.12-0.18). The overall certainty of the evidence was graded as high. CONCLUSIONS There is a very good indication that a combination of LRLBs that includes maintaining a healthy bodyweight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption is associated with a lower risk of incident type 2 diabetes.
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Affiliation(s)
- Tauseef A. Khan
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Field
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Chen
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suleman Ahmad
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hana Kahleová
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- Catholic University of Croatia, School of Medicine, Zagreb, Croatia
- Josip Juraj Strossmayer University of Osijek, School of Medicine, Osijek, Croatia
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Human Nutrition Unit, Biochemistry and Biotechnology Department, Sant Joan University Hospital, Institut d’Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - Lawrence A. Leiter
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li KaShing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Cyril W.C. Kendall
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L. Sievenpiper
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li KaShing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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11
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Oguntala JO, Zurbau A, Kavanagh ME, Glenn A, Chiavaroli L, Khan TA, Blanco Meija S, Jenkins DJ, Kendall C, Sievenpiper JL. Abstract P521: Association Between Dietary Phytosterols and Risk of Cardiovascular Disease Mortality in US Adults: Findings From the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction:
Phytosterols (plant sterols) are naturally occurring components of plant food sources, including vegetable oils, nuts, cereals and legumes. Their chemical structure impedes intestinal cholesterol absorption and regular consumption has been related to lower serum low-density cholesterol (LDL-C), a causal risk factor for cardiovascular disease (CVD). The association between dietary plant sterol intake and CVD has yet to be determined.
Objective:
We aimed to examine the association of phytosterol consumption in the diet with cardiovascular mortality in US adults the National Health & Nutrition Examination Survey III (NHANES III), 1988-1994.
Methods:
We conducted a prospective cohort analysis on National Health and Nutrition Examination Survey (NHANES, 1988-1994 [III]), linked with the National Death Index mortality data (2015) to associate dietary phytosterol intake from 24h dietary recall data with CVD mortality. We included 13,004 adults aged ≥20 years who were non-pregnant, free of CVD at baseline and completed ≥1 24h dietary recall with plausible caloric intake data. We excluded individuals with death occurring within 1 year of baseline. We created a database quantifying the phytosterol content of foods in the 24h dietary recall data and estimated usual intake by quintiles using the NCI method. We determined the risk function by regression calibration and estimated CVD mortality risk between the 10
th
(Q1) and 90
th
(Q5) percentiles of usual intake. Data was adjusted for sex, age, smoking status and ethnicity.
Results:
Over a mean±SD follow-up period of 21.2±5.1y, 949 CVD deaths occurred in a population with a mean±SD age of 44.2±14.3y, BMI 26.7±4.7 kg/m
2
and mean dietary plant sterol usual intake of 272.3 mg/day. The top sources of dietary phytosterols were from potatoes 23%), wheat and other grains (21%) and beans, legumes and nuts (13%). Mean usual intake plant intake in the 10
th
(Q1) and 90
th
(Q5) percentiles of the population was 150.1 and 414.0 mg/day. The estimated relative risk for CVD mortality between Q1 (ref) and Q5 was 0.972 (p<0.05).
Conclusions:
Preliminary analyses suggest a CVD death risk reduction of 2.8% in the highest versus lowest intakes of dietary plant sterols in the US population. We plan to expand the multivariable model to include the Healthy Eating Index (diet quality) and assess stratification by healthful and unhealthful sources of phytosterols and linear and non-linear dose response analyses to determine the robustness of the association.
OSF Registration:
osf.io/da4sg
Funding:
Amgen Scholars Program, Canadian Institutes of Health Research (CIHR), Banting and Best Diabetes Centre (BBDC), Toronto 3D Knowledge Synthesis and Clinical Trials foundation
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Affiliation(s)
| | - Andreea Zurbau
- Univ of Toronto - Temerty Faculty of Medicine, Toronto, Canada
| | | | - Andrea Glenn
- Univ of Toronto - Temerty Faculty of Medicine, Toronto, Canada
| | | | - Tauseef A Khan
- Univ of Toronto - Temerty Faculty of Medicine, Toronto, Canada
| | | | - David J Jenkins
- Univ of Toronto - Temerty Faculty of Medicine, Toronto, Canada
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12
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Nasser SMT, Rana AA, Doffinger R, Kafizas A, Khan TA, Nasser S. Elevated free interleukin-18 associated with severity and mortality in prospective cohort study of 206 hospitalised COVID-19 patients. Intensive Care Med Exp 2023; 11:9. [PMID: 36823262 PMCID: PMC9949911 DOI: 10.1186/s40635-022-00488-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/19/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Divergence between deterioration to life-threatening COVID-19 or clinical improvement occurs for most within the first 14 days of symptoms. Life-threatening COVID-19 shares clinical similarities with Macrophage Activation Syndrome, which can be driven by elevated Free Interleukin-18 (IL-18) due to failure of negative-feedback release of IL-18 binding protein (IL-18bp). We, therefore, designed a prospective, longitudinal cohort study to examine IL-18 negative-feedback control in relation to COVID-19 severity and mortality from symptom day 15 onwards. METHODS 662 blood samples, matched to time from symptom onset, from 206 COVID-19 patients were analysed by enzyme-linked immunosorbent assay for IL-18 and IL-18bp, enabling calculation of free IL-18 (fIL-18) using the updated dissociation constant (Kd) of 0.05 nmol. Adjusted multivariate regression analysis was used to assess the relationship between highest fIL-18 and outcome measures of COVID-19 severity and mortality. Re-calculated fIL-18 values from a previously studied healthy cohort are also presented. RESULTS Range of fIL-18 in COVID-19 cohort was 10.05-1157.7 pg/ml. Up to symptom day 14, mean fIL-18 levels increased in all patients. Levels in survivors declined thereafter, but remained elevated in non-survivors. Adjusted regression analysis from symptom day 15 onwards showed a 100 mmHg decrease in PaO2/FiO2 (primary outcome) for each 37.7 pg/ml increase in highest fIL-18 (p < 0.03). Per 50 pg/ml increase in highest fIL-18, adjusted logistic regression gave an odds-ratio (OR) for crude 60-day mortality of 1.41 (1.1-2.0) (p < 0.03), and an OR for death with hypoxaemic respiratory failure of 1.90 [1.3-3.1] (p < 0.01). Highest fIL-18 was associated also with organ failure in patients with hypoxaemic respiratory failure, with an increase of 63.67 pg/ml for every additional organ supported (p < 0.01). CONCLUSIONS Elevated free IL-18 levels from symptom day 15 onwards are associated with COVID-19 severity and mortality. ISRCTN: #13450549; registration date: 30/12/2020.
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Affiliation(s)
- Syed M. T. Nasser
- grid.451052.70000 0004 0581 2008Intensive Care Department, Surrey and Sussex NHS Foundation Trust, Redhill, UK ,grid.416224.70000 0004 0417 0648Present Address: Intensive Care Department, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX UK
| | - Anas A. Rana
- grid.6572.60000 0004 1936 7486Centre for Computational Biology, Birmingham University, Birmingham, UK
| | - Rainer Doffinger
- grid.24029.3d0000 0004 0383 8386Department of Clinical Biochemistry and Immunology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Andreas Kafizas
- grid.7445.20000 0001 2113 8111The Grantham Institute for Climate Change and the Environment, Imperial College London, South Kensington, London, UK ,grid.7445.20000 0001 2113 8111Department of Chemistry, Molecular Science Research Hub, Imperial College London, White City, London, UK
| | - Tauseef A. Khan
- grid.17063.330000 0001 2157 2938Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shuaib Nasser
- grid.24029.3d0000 0004 0383 8386Department of Allergy, Cambridge University Hospitals NHS Trust, Cambridge, UK
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13
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Chiavaroli L, Cheung A, Ayoub-Charette S, Ahmed A, Lee D, Au-Yeung F, Qi X, Back S, McGlynn N, Ha V, Lai E, Khan TA, Blanco Mejia S, Zurbau A, Choo VL, de Souza RJ, Wolever TM, Leiter LA, Kendall CW, Jenkins DJ, Sievenpiper JL. Important food sources of fructose-containing sugars and adiposity: A systematic review and meta-analysis of controlled feeding trials. Am J Clin Nutr 2023; 117:741-765. [PMID: 36842451 DOI: 10.1016/j.ajcnut.2023.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/29/2022] [Accepted: 01/18/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Sugar-sweetened beverages (SSBs) providing excess energy increase adiposity. The effect of other food sources of sugars at different energy control levels is unclear. OBJECTIVES To determine the effect of food sources of fructose-containing sugars by energy control on adiposity. METHODS In this systematic review and meta-analysis, MEDLINE, Embase, and Cochrane Library were searched through April 2022 for controlled trials ≥2 wk. We prespecified 4 trial designs by energy control: substitution (energy-matched replacement of sugars), addition (energy from sugars added), subtraction (energy from sugars subtracted), and ad libitum (energy from sugars freely replaced). Independent authors extracted data. The primary outcome was body weight. Secondary outcomes included other adiposity measures. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. RESULTS We included 169 trials (255 trial comparisons, n = 10,357) assessing 14 food sources at 4 energy control levels over a median 12 wk. Total fructose-containing sugars increased body weight (MD: 0.28 kg; 95% CI: 0.06, 0.50 kg; PMD = 0.011) in addition trials and decreased body weight (MD: -0.96 kg; 95% CI: -1.78, -0.14 kg; PMD = 0.022) in subtraction trials with no effect in substitution or ad libitum trials. There was interaction/influence by food sources on body weight: substitution trials [fruits decreased; added nutritive sweeteners and mixed sources (with SSBs) increased]; addition trials [dried fruits, honey, fruits (≤10%E), and 100% fruit juice (≤10%E) decreased; SSBs, fruit drink, and mixed sources (with SSBs) increased]; subtraction trials [removal of mixed sources (with SSBs) decreased]; and ad libitum trials [mixed sources (with/without SSBs) increased]. GRADE scores were generally moderate. Results were similar across secondary outcomes. CONCLUSIONS Energy control and food sources mediate the effect of fructose-containing sugars on adiposity. The evidence provides a good indication that excess energy from sugars (particularly SSBs at high doses ≥20%E or 100 g/d) increase adiposity, whereas their removal decrease adiposity. Most other food sources had no effect, with some showing decreases (particularly fruits at lower doses ≤10%E or 50 g/d). This trial was registered at clinicaltrials.gov as NCT02558920 (https://clinicaltrials.gov/ct2/show/NCT02558920).
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Affiliation(s)
- Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sabrina Ayoub-Charette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fei Au-Yeung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - XinYe Qi
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Songhee Back
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Néma McGlynn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vanessa Ha
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ethan Lai
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Vivian L Choo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Russell J de Souza
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Thomas Ms Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril Wc Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David Ja Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
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14
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Nguyen M, Jarvis SE, Tinajero MG, Yu J, Chiavaroli L, Mejia SB, Khan TA, Tobias DK, Willett WC, Hu FB, Hanley AJ, Birken CS, Sievenpiper JL, Malik VS. Sugar-sweetened beverage consumption and weight gain in children and adults: a systematic review and meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr 2023; 117:160-174. [PMID: 36789935 DOI: 10.1016/j.ajcnut.2022.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sugar-sweetened beverages (SSBs) have been implicated in fueling the obesity epidemic. OBJECTIVES This study aimed to update a synthesis of the evidence on SSBs and weight gain in children and adults. METHODS MEDLINE, Embase, and Cochrane databases were searched through September 8, 2022, for prospective cohort studies and randomized controlled trials (RCTs) that evaluated intake of SSBs in relation to BMI and body weight in children and adults, respectively. Eligible interventions were compared against a noncaloric control. Study-level estimates were pooled using random-effects meta-analysis and presented as β-coefficients with 95% CIs for cohorts and weighted mean differences (MDs) with 95% CIs for RCTs. RESULTS We identified 85 articles including 48 in children (40 cohorts, n = 91,713; 8 RCTs, n = 2783) and 37 in adults (21 cohorts, n = 448,661; 16 RCTs, n = 1343). Among cohort studies, each serving/day increase in SSB intake was associated with a 0.07-kg/m2 (95% CI: 0.04 kg/m2, 0.10 kg/m2) higher BMI in children and a 0.42-kg (95% CI: 0.26 kg, 0.58 kg) higher body weight in adults. RCTs in children indicated less BMI gain with SSB reduction interventions compared with control (MD: -0.21 kg/m2; 95% CI: -0.40 kg/m2, -0.01 kg/m2). In adults, randomization to addition of SSBs to the diet led to greater body weight gain (MD: 0.83 kg; 95% CI: 0.47 kg, 1.19 kg), and subtraction of SSBs led to weight loss (MD: -0.49 kg; 95% CI: -0.66 kg, -0.32 kg) compared with the control groups. A positive linear dose-response association between SSB consumption and weight gain was found in all outcomes assessed. CONCLUSIONS Our updated systematic review and meta-analysis expands on prior evidence to confirm that SSB consumption promotes higher BMI and body weight in both children and adults, underscoring the importance of dietary guidance and public policy strategies to limit intake. This meta-analysis was registered at the International Prospective Register of Systematic Reviews as CRD42020209915.
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Affiliation(s)
- Michelle Nguyen
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E Jarvis
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Maria G Tinajero
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jiayue Yu
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Deirdre K Tobias
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Anthony J Hanley
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Endocrinology, University of Toronto, Toronto, ON, Canada; Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada
| | - Catherine S Birken
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis & Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology & Metabolism, St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Vasanti S Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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15
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Massara P, Zurbau A, Glenn AJ, Chiavaroli L, Khan TA, Viguiliouk E, Mejia SB, Comelli EM, Chen V, Schwab U, Risérus U, Uusitupa M, Aas AM, Hermansen K, Thorsdottir I, Rahelić D, Kahleová H, Salas-Salvadó J, Kendall CWC, Sievenpiper JL. Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials. Diabetologia 2022; 65:2011-2031. [PMID: 36008559 PMCID: PMC9630197 DOI: 10.1007/s00125-022-05760-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/24/2022] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Nordic dietary patterns that are high in healthy traditional Nordic foods may have a role in the prevention and management of diabetes. To inform the update of the EASD clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of Nordic dietary patterns and cardiometabolic outcomes. METHODS We searched MEDLINE, EMBASE and The Cochrane Library from inception to 9 March 2021. We included prospective cohort studies and RCTs with a follow-up of ≥1 year and ≥3 weeks, respectively. Two independent reviewers extracted relevant data and assessed the risk of bias (Newcastle-Ottawa Scale and Cochrane risk of bias tool). The primary outcome was total CVD incidence in the prospective cohort studies and LDL-cholesterol in the RCTs. Secondary outcomes in the prospective cohort studies were CVD mortality, CHD incidence and mortality, stroke incidence and mortality, and type 2 diabetes incidence; in the RCTs, secondary outcomes were other established lipid targets (non-HDL-cholesterol, apolipoprotein B, HDL-cholesterol, triglycerides), markers of glycaemic control (HbA1c, fasting glucose, fasting insulin), adiposity (body weight, BMI, waist circumference) and inflammation (C-reactive protein), and blood pressure (systolic and diastolic blood pressure). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence. RESULTS We included 15 unique prospective cohort studies (n=1,057,176, with 41,708 cardiovascular events and 13,121 diabetes cases) of people with diabetes for the assessment of cardiovascular outcomes or people without diabetes for the assessment of diabetes incidence, and six RCTs (n=717) in people with one or more risk factor for diabetes. In the prospective cohort studies, higher adherence to Nordic dietary patterns was associated with 'small important' reductions in the primary outcome, total CVD incidence (RR for highest vs lowest adherence: 0.93 [95% CI 0.88, 0.99], p=0.01; substantial heterogeneity: I2=88%, pQ<0.001), and similar or greater reductions in the secondary outcomes of CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). Inverse dose-response gradients were seen for total CVD incidence, CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). No studies assessed CHD or stroke mortality. In the RCTs, there were small important reductions in LDL-cholesterol (mean difference [MD] -0.26 mmol/l [95% CI -0.52, -0.00], pMD=0.05; substantial heterogeneity: I2=89%, pQ<0.01), and 'small important' or greater reductions in the secondary outcomes of non-HDL-cholesterol, apolipoprotein B, insulin, body weight, BMI and systolic blood pressure (p<0.05). For the other outcomes there were 'trivial' reductions or no effect. The certainty of the evidence was low for total CVD incidence and LDL-cholesterol; moderate to high for CVD mortality, established lipid targets, adiposity markers, glycaemic control, blood pressure and inflammation; and low for all other outcomes, with evidence being downgraded mainly because of imprecision and inconsistency. CONCLUSIONS/INTERPRETATION Adherence to Nordic dietary patterns is associated with generally small important reductions in the risk of major CVD outcomes and diabetes, which are supported by similar reductions in LDL-cholesterol and other intermediate cardiometabolic risk factors. The available evidence provides a generally good indication of the likely benefits of Nordic dietary patterns in people with or at risk for diabetes. REGISTRATION ClinicalTrials.gov NCT04094194. FUNDING Diabetes and Nutrition Study Group of the EASD Clinical Practice.
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Affiliation(s)
- Paraskevi Massara
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Andrea J Glenn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Effie Viguiliouk
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Elena M Comelli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Victoria Chen
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland.
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anne-Marie Aas
- Division of Medicine, Department of Clinical Service, Section of Nutrition and Dietetics, Oslo University Hospital, Oslo, Norway
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Inga Thorsdottir
- Unit for Nutrition Research, Health Science Institute, University of Iceland, Reykjavík, Iceland
- Landspitali - University Hospital of Iceland, Reykjavík, Iceland
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- Croatian Catholic University School of Medicine, Zagreb, Croatia
- Josip Juraj Strossmayer University School of Medicine, Osijek, Croatia
| | - Hana Kahleová
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Jordi Salas-Salvadó
- Centro de Investigacion Biomedica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Human Nutrition Department, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada.
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada.
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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16
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Ahmed A, Tul-Noor Z, Lee D, Bajwah S, Ahmed Z, Zafar S, Syeda M, Jamil F, Qureshi F, Zia F, Baig R, Ahmed S, Tayyiba M, Ahmad S, Ramdath D, Tsao R, Cui S, Kendall CWC, de Souza RJ, Khan TA, Sievenpiper JL. Effect of honey on cardiometabolic risk factors: a systematic review and meta-analysis. Nutr Rev 2022:6827512. [DOI: 10.1093/nutrit/nuac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Context
Excess calories from free sugars are implicated in the epidemics of obesity and type 2 diabetes. Honey is a free sugar but is generally regarded as healthy.
Objective
The effect of honey on cardiometabolic risk factors was assessed via a systematic review and meta-analysis of controlled trials using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.
Data Sources
MEDLINE, Embase, and the Cochrane Library databases were searched up to January 4, 2021, for controlled trials ≥1 week in duration that assessed the effect of oral honey intake on adiposity, glycemic control, lipids, blood pressure, uric acid, inflammatory markers, and markers of nonalcoholic fatty liver disease.
Data Extraction
Independent reviewers extracted data and assessed risk of bias. Data were pooled using the inverse variance method and expressed as mean differences (MDs) with 95%CIs. Certainty of evidence was assessed using GRADE.
Data Analysis
A total of 18 controlled trials (33 trial comparisons, N = 1105 participants) were included. Overall, honey reduced fasting glucose (MD = −0.20 mmol/L, 95%CI, −0.37 to −0.04 mmol/L; low certainty of evidence), total cholesterol (MD = −0.18 mmol/L, 95%CI, −0.33 to −0.04 mmol/L; low certainty), low-density lipoprotein cholesterol (MD = −0.16 mmol/L, 95%CI, −0.30 to −0.02 mmol/L; low certainty), fasting triglycerides (MD = −0.13 mmol/L, 95%CI, −0.20 to −0.07 mmol/L; low certainty), and alanine aminotransferase (MD = −9.75 U/L, 95%CI, −18.29 to −1.21 U/L; low certainty) and increased high-density lipoprotein cholesterol (MD = 0.07 mmol/L, 95%CI, 0.04–0.10 mmol/L; high certainty). There were significant subgroup differences by floral source and by honey processing, with robinia honey, clover honey, and raw honey showing beneficial effects on fasting glucose and total cholesterol.
Conclusion
Honey, especially robinia, clover, and unprocessed raw honey, may improve glycemic control and lipid levels when consumed within a healthy dietary pattern. More studies focusing on the floral source and the processing of honey are required to increase certainty of the evidence.
Systematic Review Registration
PROSPERO registration number CRD42015023580.
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Affiliation(s)
- Amna Ahmed
- University of Toronto Department of Nutritional Sciences, Temerty Faculty of Medicine, , Toronto, Ontario, Canada
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Zujaja Tul-Noor
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Danielle Lee
- University of Toronto Department of Nutritional Sciences, Temerty Faculty of Medicine, , Toronto, Ontario, Canada
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Shamaila Bajwah
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Zara Ahmed
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Shanza Zafar
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Maliha Syeda
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Fakeha Jamil
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Faizaan Qureshi
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
- York University Faculty of Science, , Toronto, Ontario, Canada
| | - Fatima Zia
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Rumsha Baig
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Saniya Ahmed
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Mobushra Tayyiba
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Suleman Ahmad
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Dan Ramdath
- Agriculture and Agri-Food Canada Guelph Research & Development Centre, , Guelph, Ontario, Canada
| | - Rong Tsao
- Agriculture and Agri-Food Canada Guelph Research & Development Centre, , Guelph, Ontario, Canada
| | - Steve Cui
- Agriculture and Agri-Food Canada Guelph Research & Development Centre, , Guelph, Ontario, Canada
| | - Cyril W C Kendall
- University of Toronto Department of Nutritional Sciences, Temerty Faculty of Medicine, , Toronto, Ontario, Canada
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
- University of Saskatchewan College of Pharmacy and Nutrition, , Saskatoon, Saskatchewan, Canada
| | - Russell J de Souza
- McMaster University Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, , Hamilton, Ontario, Canada, and the Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Tauseef A Khan
- University of Toronto Department of Nutritional Sciences, Temerty Faculty of Medicine, , Toronto, Ontario, Canada
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - John L Sievenpiper
- University of Toronto Department of Nutritional Sciences, Temerty Faculty of Medicine, , Toronto, Ontario, Canada
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
- St Michael's Hospital Division of Endocrinology and Metabolism, , Toronto, Ontario, Canada
- St Michael's Hospital Li Ka Shing Knowledge Institute, , Toronto, Ontario, Canada
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17
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Almaatani D, Zurbau A, Khoshnevisan F, Bandsma RHJ, Khan TA, Sievenpiper JL, Van Den Heuvel M. The association between parents' stress and parental feeding practices and feeding styles: Systematic review and meta-analysis of observational studies. Matern Child Nutr 2022; 19:e13448. [PMID: 36284502 PMCID: PMC9749598 DOI: 10.1111/mcn.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/31/2022] [Accepted: 09/24/2022] [Indexed: 12/15/2022]
Abstract
In the extended UNICEF framework of early childhood nutrition, parents' stress is associated with parental feeding style. However, no comprehensive review has examined the association between parents' stress and feeding styles and practices. The objective of our review was to synthesise the current literature examining the association between parents' stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. We searched; MEDLINE, EMBASE, PSYCHINFO and CINAHL from 2019 to 2021. Two investigators independently extracted relevant data and assessed the study quality and the certainty of evidence. Data were pooled using generic inverse variance with fixed effects (<5 comparisons) or random effects (≥5 comparisons) and expressed as correlation coefficients with 95% confidence intervals (CI). Between study heterogeneity was assessed using Cochran's Q and quantified with I2 . We identified 6 longitudinal and 11 cross-sectional studies, of which 4 studies provided sufficient data to be pooled. A very small correlation between general stress and restrictive feeding practices was observed (r = 0.06 [95% CI: 0.01-0.12]; no substantial heterogeneity (I2 = 0.00%, PQ < 0.85, very low certainty). No correlation between general stress and feeding pressure was identified (r = 0.06 [95% CI: -0.02 to 0.15]). Results showed that both general and parenting stress were associated with suboptimal breastfeeding practices and unresponsive feeding styles. Conclusion: This study demonstrated a low-to-moderate quality of literature for the inclusion of parents' stress in the extended UNICEF care model of child nutrition. Future research needs to explore this relationship longitudinally and in ethnic diverse populations to inform tailored interventions that promote responsive feeding practices.
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Affiliation(s)
- Dina Almaatani
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
| | - Farnaz Khoshnevisan
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Robert H. J. Bandsma
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada,Department of PaediatricsUniversity of TorontoTorontoCanada,Division of Gastroenterology, Hepatology and NutritionHospital for Sick ChildrenTorontoCanada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada,Department of Medicine, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Department of Medicine, Division of Endocrinology and MetabolismSt. Michael's HospitalTorontoOntarioCanada,Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
| | - Meta Van Den Heuvel
- Department of PaediatricsUniversity of TorontoTorontoCanada,Division of Paediatric MedicineHospital for Sick ChildrenTorontoCanada
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18
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Morshed MR, Ashraf I, Hussain MZ, Khan TA, Anwar MI, Imtiaz MN, Alam MA, Siddiqui NA, Ahmed AS. Evaluation of Early Renal Involvement in Essential Hypertension by Measuring Urinary Biomarkers. Mymensingh Med J 2022; 31:1183-1191. [PMID: 36189570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Hypertensive kidney damage results in glomerular as well as tubular dysfunction. Albuminuria is a well-known marker of glomerular damage. On the other hand, urinary uromodulin is increasingly considered as a potential biomarker of early tubular dysfunction. The aim of the study was to assess glomerular and tubular function of the kidney by measuring urinary albumin and uromodulin excretion in hypertensive subjects. This cross-sectional study was conducted from July 2018 to June 2019 in Hypertension Clinic of Dhaka Medical College Hospital, Dhaka and Kidney Care and Research Centre, Sonargaon, Narayanganj, Bangladesh. In this study 122 hypertensive subjects with age >30 years, duration of hypertension <5 years, without accelerated or malignant BP, absence of dipstick proteinuria and eGFR >60ml/min were included. There were also 33 normotensive individuals included as healthy controls. Albumin-creatinine ratio (uACR mg/g), urine uromodulin-creatinine ratio (uUMODμg/g), urinary sodium-creatinine ratio (mEq/g) and potassium-creatinine ratio (mEq/g) were measured from single morning spot urine sample. Urinary uromodulin levels were measured by ELISA method. The hypertensive and normotensive subjects were age matched 49.0±12.0 vs. 48.0±11.0, years (p=NS). The mean uACR was 29.0±65.0 versus 5.6±2.7mg/g, (p<0.001) respectively. The median uUMOD in hypertensive subjects was 3.38 (1.73-9.06) and in normotensives 3.85(2.28-5.69) μg/g (p=non significant). Multivariate analysis showed significant inverse association between diastolic blood pressure and urinary uromodulin excretion. A uUMOD cut-off of 2.9 (25th percentile) showed eGFR, urinary sodium and potassium excretions were significantly lower at low uromodulin group. The glomerular involvement was found in 21.0% of hypertensive subjects as evidenced by albuminuria. No difference was observed in urinary uromodulin level between hypertensive and normotensive subjects. Low urinary uromodulin level was associated with lower eGFR, Na+ and K+ excretion which indicate simultaneous tubular and glomerular involvement.
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Affiliation(s)
- M R Morshed
- Dr Md Raquib Morshed, Registrar, Department of Nephrology, National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, Bangladesh; E-mail:
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Lee JJ, Khan TA, McGlynn N, Malik VS, Hill JO, Leiter LA, Jeppesen PB, Rahelić D, Kahleová H, Salas-Salvadó J, Kendall CW, Sievenpiper JL. Relation of Change or Substitution of Low- and No-Calorie Sweetened Beverages With Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Prospective Cohort Studies. Diabetes Care 2022; 45:1917-1930. [PMID: 35901272 PMCID: PMC9346984 DOI: 10.2337/dc21-2130] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/21/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Adverse associations of low- and no-calorie sweetened beverages (LNCSB) with cardiometabolic outcomes in observational studies may be explained by reverse causality and residual confounding. PURPOSE To address these limitations we used change analyses of repeated measures of intake and substitution analyses to synthesize the association of LNCSB with cardiometabolic outcomes. DATA SOURCES MEDLINE, Embase, and the Cochrane Library were searched up to 10 June 2021 for prospective cohort studies with ≥1 year of follow-up duration in adults. STUDY SELECTION Outcomes included changes in clinical measures of adiposity, risk of overweight/obesity, metabolic syndrome, type 2 diabetes (T2D), cardiovascular disease, and total mortality. DATA EXTRACTION Two independent reviewers extracted data, assessed study quality, and assessed certainty of evidence using GRADE. Data were pooled with a random-effects model and expressed as mean difference (MD) or risk ratio (RR) and 95% CI. DATA SYNTHESIS A total of 14 cohorts (416,830 participants) met the eligibility criteria. Increase in LNCSB intake was associated with lower weight (5 cohorts, 130,020 participants; MD -0.008 kg/year [95% CI -0.014, -0.002]). Substitution of LNCSB for sugar-sweetened beverages (SSB) was associated with lower weight (three cohorts, 165,579 participants; MD, -0.12 [-0.14, -0.10,] kg/y) and lower incidence of obesity (OB) (one cohort, 15,765 participants; RR 0.88 [95% CI 0.88, 0.89]), coronary heart disease (six cohorts, 233,676 participants; 0.89 [0.81, 0.98]), cardiovascular disease mortality (one cohort, 118,363 participants; 0.95 [0.90, 0.99]), and total mortality (one cohort, 118,363 participants; 0.96 [0.94, 0.98]) with no adverse associations across other outcomes. Substitution of water for SSB showed lower weight (three cohorts, 165,579 participants; MD -0.10 kg/year [-0.13, -0.06]), lower waist circumference (one cohort, 173 participants; -2.71 cm/year [-4.27, -1.15]) and percent body fat (one cohort, 173 participants; -1.51% per year [-2.61, -0.42]), and lower incidence of OB (one cohort, 15,765 participants; RR 0.85 [0.75, 0.97]) and T2D (three cohorts, 281,855 participants; 0.96 [0.94, 0.98]). Substitution of LNCSB for water showed no adverse associations. LIMITATIONS The evidence was low to very low certainty owing to downgrades for imprecision, indirectness, and/or inconsistency. CONCLUSIONS LNCSB were not associated with cardiometabolic harm in analyses that model the exposure as change or substitutions. The available evidence provides some indication that LNCSB in their intended substitution for SSB may be associated with cardiometabolic benefit, comparable with the standard of care, water.
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Affiliation(s)
- Jennifer J. Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Nema McGlynn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Vasanti S. Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - James O. Hill
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL
| | - Lawrence A. Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Per Bendix Jeppesen
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- Catholic University of Croatia School of Medicine, Zagreb, Croatia
- Josip Juraj Strossmayer University of Osijek School of Medicine, Osijek, Croatia
| | - Hana Kahleová
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Human Nutrition Department, Pere Virgili Biomedical Research Institute (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - Cyril W.C. Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Qamar Z, Abdul NS, Khan TA, Zeeshan T, Helal Uddin ABM, Albaqawi AH, Almejlad NK. The effect of selected commercially available mouth-rinses vs. curcumin photosensitizers in an artificial mouth model mimicking their use before meals on early colonizers single species biofilm. Eur Rev Med Pharmacol Sci 2022; 26:5466-5475. [PMID: 35993642 DOI: 10.26355/eurrev_202208_29415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of the study was to determine the bacterial-adherence to the experimental pellicle pretreated with commercially available oral-rinse/ photosensitizer (mimicking use of oral-rinse/ photosensitizer before meals). MATERIALS AND METHODS An artificial mouth (NAM) system was used for the development of single-species biofilm (Actinomyces viscosus, Streptococcus mitis and Streptococcus sanguinis respectively). Two commercially available oral-rinses containing active ingredients [Essential oils (EO) and Chlorhexidine gluconate (CHX) were used. Curcumin photosensitizer (PS) was used as a photosensitizer against the microbes. For the adherence study, the experimental pellicle on the beads (in the capillary tubes of the NAM system) was pretreated with the oral-rinse and photosensitizer before the inoculation of bacteria; this would resemble the use of rinse/ photosensitizer before meal. The bacterial population of the biofilm was determined using serial dilution assay and expressed as colony forming unit per ml. Deionized distilled water was used in place of oral-rinse/photosensitizer and served as a negative-control. For the qualitative study, bacterial population viewing was carried out using Scanning Electron Microscope (SEM). RESULTS It was observed that on treatment with the oral-rinses the bacterial population of S.mitis, S.sanguinis and A.viscosus (adherence) was significantly reduced where the reduction was less for EO-based oral-rinse compared with that of CHX and curcumin PS in the following sequence EO<CHX<PS (p<0.05). CONCLUSIONS From the results, it appears that curcumin photosensitizer and oral-rinses contain CHX to be preferably used before-meal and EO after-meal.
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Affiliation(s)
- Z Qamar
- Department of O&MFS and Diagnostic Sciences, Faculty of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia.
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Lee D, Chiavaroli L, Ayoub-Charette S, Khan TA, Zurbau A, Au-Yeung F, Cheung A, Liu Q, Qi X, Ahmed A, Choo VL, Blanco Mejia S, Malik VS, El-Sohemy A, de Souza RJ, Wolever TMS, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Important Food Sources of Fructose-Containing Sugars and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Controlled Trials. Nutrients 2022; 14:nu14142846. [PMID: 35889803 PMCID: PMC9325155 DOI: 10.3390/nu14142846] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Fructose providing excess calories in the form of sugar sweetened beverages (SSBs) increases markers of non-alcoholic fatty liver disease (NAFLD). Whether this effect holds for other important food sources of fructose-containing sugars is unclear. To investigate the role of food source and energy, we conducted a systematic review and meta-analysis of controlled trials of the effect of fructose-containing sugars by food source at different levels of energy control on non-alcoholic fatty liver disease (NAFLD) markers. Methods and Findings: MEDLINE, Embase, and the Cochrane Library were searched through 7 January 2022 for controlled trials ≥7-days. Four trial designs were prespecified: substitution (energy-matched substitution of sugars for other macronutrients); addition (excess energy from sugars added to diets); subtraction (excess energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients). The primary outcome was intrahepatocellular lipid (IHCL). Secondary outcomes were alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Independent reviewers extracted data and assessed risk of bias. The certainty of evidence was assessed using GRADE. We included 51 trials (75 trial comparisons, n = 2059) of 10 food sources (sugar-sweetened beverages (SSBs); sweetened dairy alternative; 100% fruit juice; fruit; dried fruit; mixed fruit sources; sweets and desserts; added nutritive sweetener; honey; and mixed sources (with SSBs)) in predominantly healthy mixed weight or overweight/obese younger adults. Total fructose-containing sugars increased IHCL (standardized mean difference = 1.72 [95% CI, 1.08 to 2.36], p < 0.001) in addition trials and decreased AST in subtraction trials with no effect on any outcome in substitution or ad libitum trials. There was evidence of influence by food source with SSBs increasing IHCL and ALT in addition trials and mixed sources (with SSBs) decreasing AST in subtraction trials. The certainty of evidence was high for the effect on IHCL and moderate for the effect on ALT for SSBs in addition trials, low for the effect on AST for the removal of energy from mixed sources (with SSBs) in subtraction trials, and generally low to moderate for all other comparisons. Conclusions: Energy control and food source appear to mediate the effect of fructose-containing sugars on NAFLD markers. The evidence provides a good indication that the addition of excess energy from SSBs leads to large increases in liver fat and small important increases in ALT while there is less of an indication that the removal of energy from mixed sources (with SSBs) leads to moderate reductions in AST. Varying uncertainty remains for the lack of effect of other important food sources of fructose-containing sugars at different levels of energy control.
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Affiliation(s)
- Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Sabrina Ayoub-Charette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- INQUIS Clinical Research Ltd. (Formerly GI Labs), Toronto, ON M5C 2N8, Canada
| | - Fei Au-Yeung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- INQUIS Clinical Research Ltd. (Formerly GI Labs), Toronto, ON M5C 2N8, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Qi Liu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Xinye Qi
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Vivian L. Choo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Vasanti S. Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
| | - Russell J. de Souza
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada
| | - Thomas M. S. Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- INQUIS Clinical Research Ltd. (Formerly GI Labs), Toronto, ON M5C 2N8, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Lawrence A. Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
| | - Cyril W. C. Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - David J. A. Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
- Correspondence: ; Tel.: +1-416-867-3732
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22
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Koppolu P, Khan TA, A Almarshad AA, Lingam AS, Afroz MM, Alanazi HF. Management of a 20-year-old longstanding oroantral fistula: A case report and review of literature. Niger J Clin Pract 2022; 25:731-736. [PMID: 35593621 DOI: 10.4103/njcp.njcp_1911_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A systematic treatment plan and an appropriate selection of surgical technique are the critical requirements for an effective closure of oroantral fistula (OAF). A 45-year-old female patient had sinus opening after she underwent a surgical tooth extraction 20 years back. On her frequent visits to the dentists some attempts were made for closure including surgical intervention, only for the lesion to return back. Computerized tomography (CT) scan was taken to rule out any bony extension of a lesion, the CT revealed a 1 × 1 cm radiolucency with a through - through communication from the alveolar bone to the right maxillary sinus because of the bony defect in the floor of maxillary sinus along with thickening of the maxillary sinus lining. The closure of the defect was done by a lateral pedicle flap raised from the right side was elevated and laterally slid to cover the defect without tension and was sutured with 4-0 resorbable interrupted suture while maintaining a bare surgical bed covered by the periosteum and a thin layer of connective tissue. This technique provides immediate repair of the defect to the patient, and also maintains comparatively normal anatomic architecture to the oral cavity. Eight months postoperative follow-up revealed a complete closure of OAF without any complications. The findings of this case suggest that lateral sliding pedicle flap can be a conservative approach in managing a long-standing OAF.
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Affiliation(s)
- P Koppolu
- Department of Preventive, Dental Sciences, Dar Al Uloom University, Riyadh, KSA
| | - T A Khan
- Departmen of Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, KSA
| | - A A A Almarshad
- Departmen of Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, KSA
| | - A S Lingam
- Departmen of Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, KSA
| | - M M Afroz
- Departmen of Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, KSA
| | - H F Alanazi
- Department of Dentistry, Dr. Sulaiman Al Habib Medical Group, Riyadh, KSA
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23
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Huq FN, Momenuzzaman NAM, Chowdhury AW, Hoque MM, Khan KN, Begum F, Shafique AM, Anis R, Rahman MA, Nahar S, Chakraborty S, Ahmad T, Khan TA, Ullah R, Rahman MM. Effect of telephone-monitored home-based cardiac rehabilitation exercise on functional capacity and quality of life in heart failure patients in a lower-middle-income country. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Chronic heart failure (CHF) prevails as one of the major cardiovascular diseases in lower-middle-income countries (LMICs) like Bangladesh. Home-Based Cardiac Rehabilitation (HBCR) is a cost-effective method of secondary prevention of chronic heart failure which, if provided, might not only improve the health status of the patients but might also reduce the financial and hospitalization burden on the health care system of these countries. The study aims to assess the scope and benefits of HBCR in such low resource settings.
Purpose
The study evaluates the effect of telephone-monitored HBCR exercise programme in improving the functional capacity and quality of life (QoL) in patients of CHF with reduced ejection fraction due to ischemic heart disease (IHD).
Method
This self-controlled interventional study was conducted from August 2019 to July 2020 at a heart failure clinic, a tertiary healthcare centre in Bangladesh. A total of 115 patients of CHF with ejection fraction <40% and in NYHA class II and III were included in the study according to selection criteria. The functional capacity of the patients was evaluated by NYHA classification and 6-minute walk test. The quality of life of the patients was evaluated by Minnesota Living with Heart Failure Questionnaire (MLHFQ). All patients were advised to perform HBCR exercise as per recommended guideline and were telephone-monitored 2-weekly. After the 3-months study period, the participants were divided into compliant and partial compliant groups based on their adherence to the guideline. Repeat evaluation of patients' condition was carried out. Results were then compared within the groups and data was analyzed through appropriate statistical methods.
Results
Significant improvement of NYHA class (p<0.05), and 6-minute walk test distance (6MWTD) (1102.01±215.90 feet vs 1243.30±217.86 feet; p<0.001) were noticed after the rehabilitation programme. Improvement of total MLHFQ score was also observed (35.53±14 vs 28.22±12.84; p<0.001) at 3-months follow up. The functional capacity and quality of life of the patients in both the compliant and partially compliant groups showed significant improvement after the rehabilitation programme (p<0.001); though no difference was found in the indicators when compared between compliant vs partially compliant groups after rehabilitation except for 6MWTD (1302.86±219.61 feet vs 1230.71±212.284 feet, p<0.001).
Conclusion
From the results, it can be concluded that any amount of routine exercise tends to improve quality of life and symptoms in patients of chronic heart failure with reduced ejection fraction. However, to achieve the best effect in functional capacity and overall health status, the addition of a structured exercise programme like HBCR can be beneficial for proper rehabilitation in low resource settings. Further validation of the results is recommended through randomized control trials in larger study groups.
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Affiliation(s)
- FN Huq
- United Hospital Ltd, Cardiology, Dhaka, Bangladesh
| | | | - AW Chowdhury
- Dhaka Medical College Hospital, Cardiology, Dhaka, Bangladesh
| | - MM Hoque
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Biochemistry, Dhaka, Bangladesh
| | - KN Khan
- United Hospital Ltd, Cardiology, Dhaka, Bangladesh
| | - F Begum
- United Hospital Ltd, Cardiology, Dhaka, Bangladesh
| | - AM Shafique
- United Hospital Ltd, Cardiology, Dhaka, Bangladesh
| | - R Anis
- United Hospital Ltd, Cardiology, Dhaka, Bangladesh
| | - MA Rahman
- Sorkari Karmachari Hospital, Cardiology, Dhaka, Bangladesh
| | - S Nahar
- United Hospital Ltd, Cardiology, Dhaka, Bangladesh
| | | | - T Ahmad
- United Hospital Ltd, Cardiology, Dhaka, Bangladesh
| | - TA Khan
- United Hospital Ltd, Cardiology, Dhaka, Bangladesh
| | - R Ullah
- United Hospital Ltd, Cardiology, Dhaka, Bangladesh
| | - MM Rahman
- Keraniganj Upazila Health Complex, Dhaka, Bangladesh
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24
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Shahinfar H, Jayedi A, Khan TA, Shab-Bidar S. Coffee consumption and cardiovascular diseases and mortality in patients with type 2 diabetes: A systematic review and dose-response meta-analysis of cohort studies. Nutr Metab Cardiovasc Dis 2021; 31:2526-2538. [PMID: 34112583 DOI: 10.1016/j.numecd.2021.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023]
Abstract
AIMS To evaluate the long-term consequences of coffee drinking in patients with type 2 diabetes. DATA SYNTHESIS PubMed, Scopus, and Web of Sciences were searched to November 2020 for prospective cohort studies evaluating the association of coffee drinking with risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes. Two reviewers extracted data and rated the certainty of evidence using GRADE approach. Random-effects models were used to estimate the hazard ratios (HRs) and 95% CIs. Dose-response associations were modeled by a one-stage mixed-effects meta-analysis. Ten prospective cohort studies with 82,270 cases were included. Compared to those with no coffee consumption, the HRs for consumption of 4 cups/d were 0.79 (95%CI: 0.72, 0.87; n = 10 studies) for all-cause mortality, 0.60 (95%CI: 0.46, 0.79; n = 4) for CVD mortality, 0.68 (95%CI: 0.51, 0.91; n = 3) for coronary heart disease (CHD) mortality, 0.72 (95%CI: 0.54, 0.98; n = 2) for CHD, and 0.77 (95%CI: 0.61, 0.98; n = 2) for total CVD events. There was no significant association for cancer mortality and stroke. There was an inverse monotonic association between coffee drinking and all-cause and CVD mortality, and inverse linear association for CHD and total CVD events. The certainty of evidence was graded moderate for all-cause mortality, and low or very low for other outcomes. CONCLUSIONS Drinking coffee may be inversely associated with the risk of mortality in patients with type 2 diabetes. However, more research is needed considering type of coffee, sugar and cream added to coffee, and history of CVD to present more confident results. REGISTRY AND REGISTRY NUMBER The protocol of this systematic review was registered at Open Science Framework (https://osf.io/8uaf3, registered form: osf.io/xur76, registration DOI: 10.17605/OSF.IO/8UAF3).
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Affiliation(s)
- Hossein Shahinfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jayedi
- Food Safety Research Center (salt), Semnan University of Medical Siences, Semnan, Iran
| | - Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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25
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Glenn AJ, Boucher BA, Kavcic CC, Khan TA, Paquette M, Kendall CWC, Hanley AJ, Jenkins DJA, Sievenpiper JL. Development of a Portfolio Diet Score and Its Concurrent and Predictive Validity Assessed by a Food Frequency Questionnaire. Nutrients 2021; 13:nu13082850. [PMID: 34445009 PMCID: PMC8398786 DOI: 10.3390/nu13082850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022] Open
Abstract
The Portfolio Diet, a plant-based portfolio of cholesterol-lowering foods, has been shown to reduce low-density lipoprotein cholesterol (LDL-C), and other cardiovascular risk factors, in randomized controlled trials (RCTs). It is not known if these beneficial effects translate to a lower incidence OF cardiovascular disease (CVD). To support examinations between Portfolio Diet adherence and disease, a Portfolio Diet score (PDS) was developed and its predictive and concurrent validity was assessed within the Toronto Healthy Diet Study, a six-month RCT in overweight adults. Predictive validity was assessed using change in the PDS measured by food frequency questionnaire (FFQ) and concomitant change in LDL-C from baseline to six months using multiple linear regression, adjusted for potential confounders (n = 652). Concurrent validity was assessed in a subset of participants (n = 50) who completed the FFQ and a 7-day diet record (7DDR) at baseline. The PDS determined from each diet assessment method was used to derive correlation coefficients and Bland–Altman plots to assess the between-method agreement. The change in PDS was inversely associated with change in LDL-C (β coefficients: −0.01 mmol/L (95% confidence intervals (CIs): −0.02, −0.002; p = 0.02). The correlation between the PDS from the FFQ and 7DDR was 0.69 (95% CIs: 0.48, 0.85). The Bland–Altman plot showed reasonable agreement between the score from the FFQ and 7DDR. These findings indicate predictive validity of the PDS with lower LDL-C, and reasonable concurrent validity of the PDS as assessed by an FFQ against a 7DDR.
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Affiliation(s)
- Andrea J. Glenn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Beatrice A. Boucher
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
| | - Chloe C. Kavcic
- School of Nutrition, Ryerson University, Toronto, ON M5B 2K3, Canada;
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Melanie Paquette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Cyril W. C. Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Anthony J. Hanley
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - David J. A. Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1A6, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1A6, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Correspondence: ; Tel.: +1-416-867-3732
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26
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Chiavaroli L, Lee D, Ahmed A, Cheung A, Khan TA, Blanco S, Mejia, Mirrahimi A, Jenkins DJA, Livesey G, Wolever TMS, Rahelić D, Kahleová H, Salas-Salvadó J, Kendall CWC, Sievenpiper JL. Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials. BMJ 2021; 374:n1651. [PMID: 34348965 PMCID: PMC8336013 DOI: 10.1136/bmj.n1651] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To inform the update of the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase, and the Cochrane Library searched up to 13 May 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials of three or more weeks investigating the effect of diets with low glycaemic index (GI)/glycaemic load (GL) in diabetes. OUTCOME AND MEASURES The primary outcome was glycated haemoglobin (HbA1c). Secondary outcomes included other markers of glycaemic control (fasting glucose, fasting insulin); blood lipids (low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, apo B, triglycerides); adiposity (body weight, BMI (body mass index), waist circumference), blood pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP)), and inflammation (C reactive protein (CRP)). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Data were pooled by random effects models. GRADE (grading of recommendations assessment, development, and evaluation) was used to assess the certainty of evidence. RESULTS 29 trial comparisons were identified in 1617 participants with type 1 and 2 diabetes who were predominantly middle aged, overweight, or obese with moderately controlled type 2 diabetes treated by hyperglycaemia drugs or insulin. Low GI/GL dietary patterns reduced HbA1c in comparison with higher GI/GL control diets (mean difference −0.31% (95% confidence interval −0.42 to −0.19%), P<0.001; substantial heterogeneity, I2=75%, P<0.001). Reductions occurred also in fasting glucose, LDL-C, non-HDL-C, apo B, triglycerides, body weight, BMI, systolic blood pressure (dose-response), and CRP (P<0.05), but not blood insulin, HDL-C, waist circumference, or diastolic blood pressure. A positive dose-response gradient was seen for the difference in GL and HbA1c and for absolute dietary GI and SBP (P<0.05). The certainty of evidence was high for the reduction in HbA1c and moderate for most secondary outcomes, with downgrades due mainly to imprecision. CONCLUSIONS This synthesis suggests that low GI/GL dietary patterns result in small important improvements in established targets of glycaemic control, blood lipids, adiposity, blood pressure, and inflammation beyond concurrent treatment with hyperglycaemia drugs or insulin, predominantly in adults with moderately controlled type 1 and type 2 diabetes. The available evidence provides a good indication of the likely benefit in this population. STUDY REGISTRATION ClinicalTrials.gov NCT04045938.
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Affiliation(s)
- Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Sonia Blanco
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
- Independent Nutrition Logic, Wymondham, UK
- INQUIS Clinical Research, Toronto, ON, Canada
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC, USA
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari San Joan de Reus, Reus, Spain
- Consorcio CIBER, MP Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- College of Pharmacy and Nutrition, University of Saskatchewan, SK, Canada
| | - Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
| | - Arash Mirrahimi
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
| | | | - Thomas M S Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- INQUIS Clinical Research, Toronto, ON, Canada
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Hana Kahleová
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili, Hospital Universitari San Joan de Reus, Reus, Spain
- Consorcio CIBER, MP Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael’s Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
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27
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Ahmed A, Khan TA, Dan Ramdath D, Kendall CWC, Sievenpiper JL. Rare sugars and their health effects in humans: a systematic review and narrative synthesis of the evidence from human trials. Nutr Rev 2021; 80:255-270. [PMID: 34339507 PMCID: PMC8754252 DOI: 10.1093/nutrit/nuab012] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/22/2021] [Accepted: 02/25/2021] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Rare sugars are monosaccharides and disaccharides (found in small quantities in nature) that have slight differences in their chemical structure compared with traditional sugars. Little is known about their unique physiological and cardiometabolic effects in humans. OBJECTIVE The objective of this study was to conduct a systematic review and synthesis of controlled intervention studies of rare sugars in humans, using PRISMA guidelines. DATA SOURCES MEDLINE and EMBASE were searched through October 1, 2020. Studies included both post-prandial (acute) and longer-term (≥1 week duration) human feeding studies that examined the effect of rare sugars (including allulose, arabinose, tagatose, trehalose, and isomaltulose) on cardiometabolic and physiological risk factors. DATA EXTRACTION In all, 50 studies in humans focusing on the 5 selected rare sugars were found. A narrative synthesis of the selected literature was conducted, without formal quality assessment or quantitative synthesis. DATA SYNTHESIS The narrative summary included the food source of each rare sugar, its effect in humans, and the possible mechanism of effect. Overall, these rare sugars were found to offer both short- and long-term benefits for glycemic control and weight loss, with effects differing between healthy individuals, overweight/obese individuals, and those with type 2 diabetes. Most studies were of small size and there was a lack of large randomized controlled trials that could confirm the beneficial effects of these rare sugars. CONCLUSION Rare sugars could offer an opportunity for commercialization as an alternative sweetener, especially for those who are at high cardiometabolic risk. SYSTEMATIC REVIEW REGISTRATION OSF registration no. 10.17605/OSF.IO/FW43D.
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Affiliation(s)
- Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto , Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto , Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - D Dan Ramdath
- Guelph Research & Development Centre, Agriculture and Agri-Food Canada (AAFC), Guelph, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto , Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto , Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Endocrinology and Metabolism, Department of Medicine St. Michael's Hospital, Toronto, ON, Canada; and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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Zeraatkar D, Bhasin A, Morassut RE, Churchill I, Gupta A, Lawson DO, Miroshnychenko A, Sirotich E, Aryal K, Mikhail D, Khan TA, Ha V, Sievenpiper JL, Hanna SE, Beyene J, de Souza RJ. Characteristics and quality of systematic reviews and meta-analyses of observational nutritional epidemiology: a cross-sectional study. Am J Clin Nutr 2021; 113:1578-1592. [PMID: 33740039 PMCID: PMC8243916 DOI: 10.1093/ajcn/nqab002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Dietary recommendations and policies should be guided by rigorous systematic reviews. Reviews that are of poor methodological quality may be ineffective or misleading. Most of the evidence in nutrition comes from nonrandomized studies of nutritional exposures (usually referred to as nutritional epidemiology studies), but to date methodological evaluations of the quality of systematic reviews of such studies have been sparse and inconsistent. OBJECTIVES We aimed to investigate the quality of recently published systematic reviews and meta-analyses of nutritional epidemiology studies and to propose guidance addressing major limitations. METHODS We searched MEDLINE (January 2018-August 2019), EMBASE (January 2018-August 2019), and the Cochrane Database of Systematic Reviews (January 2018-February 2019) for systematic reviews of nutritional epidemiology studies. We included a random sample of 150 reviews. RESULTS Most reviews were published by authors from Asia (n = 49; 32.7%) or Europe (n = 43; 28.7%) and investigated foods or beverages (n = 60; 40.0%) and cancer morbidity and mortality (n = 54; 36%). Reviews often had important limitations: less than one-quarter (n = 30; 20.0%) reported preregistration of a protocol and almost one-third (n = 42; 28.0%) did not report a replicable search strategy. Suboptimal practices and errors in the synthesis of results were common: one-quarter of meta-analyses (n = 30; 26.1%) selected the meta-analytic model based on statistical indicators of heterogeneity and almost half of meta-analyses (n = 50; 43.5%) did not consider dose-response associations even when it was appropriate to do so. Only 16 (10.7%) reviews used an established system to evaluate the certainty of evidence. CONCLUSIONS Systematic reviews of nutritional epidemiology studies often have serious limitations. Authors can improve future reviews by involving statisticians, methodologists, and researchers with substantive knowledge in the specific area of nutrition being studied and using a rigorous and transparent system to evaluate the certainty of evidence.
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Affiliation(s)
- Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada,Department of Biomedical Informatics, Harvard Medical
School, Boston, MA, USA
| | - Arrti Bhasin
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Rita E Morassut
- Schulich School of Medicine and Dentistry, Western
University, London, Ontario, Canada
| | - Isabella Churchill
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Arnav Gupta
- Department of Medicine, University of Ottawa,
Ottawa, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Anna Miroshnychenko
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Komal Aryal
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - David Mikhail
- Faculty of Science, McMaster University,
Hamilton, Ontario, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Department of Medicine,
Temerty Faculty of Medicine, University of Toronto,
Toronto, Ontario, Canada,3D Knowledge Synthesis and Clinical Trials Unit, Clinical
Nutrition and Risk Factor Modification Centre, Division of Endocrinology
& Metabolism, St. Michael's Hospital,
Toronto, Ontario, Canada
| | - Vanessa Ha
- School of Medicine, Queen's University,
Kingston, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Department of Medicine,
Temerty Faculty of Medicine, University of Toronto,
Toronto, Ontario, Canada,3D Knowledge Synthesis and Clinical Trials Unit, Clinical
Nutrition and Risk Factor Modification Centre, Division of Endocrinology
& Metabolism, St. Michael's Hospital,
Toronto, Ontario, Canada
| | - Steven E Hanna
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
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Khan TA, Al Nasr IS, Mujawah AH, Koko WS. Assessment of Euphorbia retusa and Pulicaria undulata activity against Leishmania major and Toxoplasma gondii. Trop Biomed 2021; 38:135-141. [PMID: 33797536 DOI: 10.47665/tb.38.1.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Leishmaniasis and toxoplasmosis are parasitic protozoal diseases that pose serious health concerns, especially for immunocompromised people. Leishmania major and Toxoplasma gondii are endemic in Saudi Arabia and are particularly common in the Qassim Region. The present work was conducted to evaluate the in vitro antileishmanial and antitoxoplasmal activity of methanolic extracts and phytochemical fractions from two plants, Euphorpia retusa and Pulicaria undulata, which are ethnobotanical agents used to treat parasitic infection. Whole E. retusa and P. undulata plants were extracted with methanol and fractionated using petroleum ether, chloroform, ethyl acetate, n-butanol, and water and then were tested in vitro against L. major promastigote and the amastigote stages of T. gondii; the cytotoxicity of the extracts was tested against Vero cell line. The methanolic extracts of E. retusa and P. undulata exhibited promising antitoxoplasmal activity against T. gondii with EC50 values 5.6 and 12.7 μg mL-1, respectively. The chloroform fraction of P. undulata was the most potent, exhibiting an EC50 of 1.4 μg mL-1 and SI value of 12.1. It was also the most active fraction against both L. major promastigotes and amastigotes, exhibiting an EC50 of 3.9 and 3.8 μg mL-1 and SI values 4.4 and 4.5, respectively. The chloroform fraction from P. undulata is a very good candidate for the isolation of active antitoxoplasmal and antileishmanial ingredients; therefore, further phytochemical analysis for active compound isolation is highly recommended.
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Affiliation(s)
- T A Khan
- Department of Biomedical Instrumentation, College of Applied Health Sciences, Qassim University, Ar Rass, Saudi Arabia
| | - I S Al Nasr
- Department of Biology, College of Science and Arts, Qassim University, Unaizah, Saudi Arabia
- Department of Science Laboratories, College of Science and Arts, Qassim University, Ar Rass, Saudi Arabia
| | - A H Mujawah
- Department of Chemistry, College of Science and Arts, Qassim University, Ar Rass, Saudi Arabia
| | - W S Koko
- Department of Science Laboratories, College of Science and Arts, Qassim University, Ar Rass, Saudi Arabia
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30
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Zurbau A, Noronha JC, Khan TA, Sievenpiper JL, Wolever TMS. The effect of oat β-glucan on postprandial blood glucose and insulin responses: a systematic review and meta-analysis. Eur J Clin Nutr 2021; 75:1540-1554. [PMID: 33608654 PMCID: PMC8563417 DOI: 10.1038/s41430-021-00875-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 12/26/2022]
Abstract
To determine the effect of oat β‑glucan (OBG) on acute glucose and insulin responses and identify significant effect modifiers we searched the MEDLINE, EMBASE, and Cochrane databases through October 27, 2020 for acute, crossover, controlled feeding trials investigating the effect of adding OBG (concentrate or oat-bran) to carbohydrate-containing test-meals compared to comparable or different carbohydrate-matched control-meals in humans regardless of health status. The primary outcome was glucose incremental area-under-the-curve (iAUC). Secondary outcomes were insulin iAUC, and glucose and insulin incremental peak-rise (iPeak). Two reviewers extracted the data and assessed risk-of-bias and certainty-of-evidence (GRADE). Data were pooled using generic inverse-variance with random-effects model and expressed as ratio-of-means with [95% CIs]. We included 103 trial comparisons (N = 538). OBG reduced glucose iAUC and iPeak by 23% (0.77 [0.74, 0.81]) and 28% (0.72 [0.64, 0.76]) and insulin by 22% (0.78 [0.72, 0.85]) and 24% (0.76 [0.65, 0.88]), respectively. Dose, molecular-weight, and comparator were significant effect modifiers of glucose iAUC and iPeak. Significant linear dose-response relationships were observed for all outcomes. OBG molecular-weight >300 kg/mol significantly reduced glucose iAUC and iPeak, whereas molecular-weight <300 kg/mol did not. Reductions in glucose iAUC (27 vs 20%, p = 0.03) and iPeak (39 vs 25%, p < 0.01) were significantly larger with different vs comparable control-meals. Outcomes were similar in participants with and without diabetes. All outcomes had high certainty-of-evidence. In conclusion, current evidence indicates that adding OBG to carbohydrate-containing meals reduces glycaemic and insulinaemic responses. However, the magnitude of glucose reduction depends on OBG dose, molecular-weight, and the comparator.
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Affiliation(s)
- Andreea Zurbau
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jarvis C Noronha
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, ON, Canada
| | - Tauseef A Khan
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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Vors C, Allaire J, Blanco Mejia S, Khan TA, Sievenpiper JL, Lamarche B. Reply to J Morze and L Schwingshackl. Adv Nutr 2021; 12:278-279. [PMID: 33517407 PMCID: PMC7850077 DOI: 10.1093/advances/nmaa131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Cécile Vors
- From the Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Laval University, Quebec City, Canada
| | - Janie Allaire
- From the Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Laval University, Quebec City, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
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Khan TA, Sievenpiper JL, Fernstrom JD. Commentary: Dietary Glutamic Acid, Obesity, and Depressive Symptoms in Patients With Schizophrenia. Front Psychiatry 2021; 12:725786. [PMID: 34721103 PMCID: PMC8551475 DOI: 10.3389/fpsyt.2021.725786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.,Division of Endocrinology & Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Scientist, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - John D Fernstrom
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Braunstein CR, Noronha JC, Khan TA, Mejia SB, Wolever TMS, Josse RG, Kendall CWC, Sievenpiper JL. Effect of fructose and its epimers on postprandial carbohydrate metabolism: A systematic review and meta-analysis. Clin Nutr 2020; 39:3308-3318. [DOI: 10.1016/j.clnu.2020.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/25/2020] [Accepted: 03/01/2020] [Indexed: 12/14/2022]
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Zurbau A, Au‐Yeung F, Blanco Mejia S, Khan TA, Vuksan V, Jovanovski E, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Relation of Different Fruit and Vegetable Sources With Incident Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc 2020; 9:e017728. [PMID: 33000670 PMCID: PMC7792377 DOI: 10.1161/jaha.120.017728] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022]
Abstract
Background Public health policies reflect concerns that certain fruit sources may not have the intended benefits and that vegetables should be preferred to fruit. We assessed the relation of fruit and vegetable sources with cardiovascular outcomes using a systematic review and meta-analysis of prospective cohort studies. Methods and Results MEDLINE, EMBASE, and Cochrane were searched through June 3, 2019. Two independent reviewers extracted data and assessed study quality (Newcastle-Ottawa Scale). Data were pooled (fixed effects), and heterogeneity (Cochrane-Q and I2) and certainty of the evidence (Grading of Recommendations Assessment, Development, and Evaluation) were assessed. Eighty-one cohorts involving 4 031 896 individuals and 125 112 cardiovascular events were included. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (risk ratio, 0.93 [95% CI, 0.89-0.96]; 0.91 [0.88-0.95]; and 0.94 [0.90-0.97], respectively), coronary heart disease (0.88 [0.83-0.92]; 0.88 [0.84-0.92]; and 0.92 [0.87-0.96], respectively), and stroke (0.82 [0.77-0.88], 0.82 [0.79-0.85]; and 0.88 [0.83-0.93], respectively) incidence. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (0.89 [0.85-0.93]; 0.88 [0.86-0.91]; and 0.87 [0.85-0.90], respectively), coronary heart disease (0.81 [0.72-0.92]; 0.86 [0.82-0.90]; and 0.86 [0.83-0.89], respectively), and stroke (0.73 [0.65-0.81]; 0.87 [0.84-0.91]; and 0.94 [0.90-0.99], respectively) mortality. There were greater benefits for citrus, 100% fruit juice, and pommes among fruit sources and allium, carrots, cruciferous, and green leafy among vegetable sources. No sources showed an adverse association. The certainty of the evidence was "very low" to "moderate," with the highest for total fruit and/or vegetables, pommes fruit, and green leafy vegetables. Conclusions Fruits and vegetables are associated with cardiovascular benefit, with some sources associated with greater benefit and none showing an adverse association. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03394339.
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Affiliation(s)
- Andreea Zurbau
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
| | - Fei Au‐Yeung
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
| | - Sonia Blanco Mejia
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
| | - Tauseef A. Khan
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
| | - Vladimir Vuksan
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoOntarioCanada
- Division of Endocrinology and MetabolismSt. Michael’s HospitalTorontoOntarioCanada
| | - Elena Jovanovski
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
| | - Lawrence A. Leiter
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoOntarioCanada
- Division of Endocrinology and MetabolismSt. Michael’s HospitalTorontoOntarioCanada
- Department of Medicine, Faculty of MedicineUniversity of TorontoOntarioCanada
| | - Cyril W. C. Kendall
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
- College of Pharmacy and NutritionUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - David J. A. Jenkins
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoOntarioCanada
- Division of Endocrinology and MetabolismSt. Michael’s HospitalTorontoOntarioCanada
| | - John L. Sievenpiper
- Department of Nutritional SciencesFaculty of MedicineUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael’s HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trial UnitTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoOntarioCanada
- Division of Endocrinology and MetabolismSt. Michael’s HospitalTorontoOntarioCanada
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Affiliation(s)
- Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Jayedi A, Emadi A, Khan TA, Abdolshahi A, Shab-Bidar S. Dietary Fiber and Survival in Women with Breast Cancer: A Dose-Response Meta-Analysis of Prospective Cohort Studies. Nutr Cancer 2020; 73:1570-1580. [PMID: 32795218 DOI: 10.1080/01635581.2020.1803928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We aimed to investigate the association of dietary fiber consumption with mortality risk in women with breast cancer. A systematic search was undertaken in PubMed, Scopus, and ISI Web of Science till March 2020 to find cohort studies investigating the association of dietary fiber consumption with mortality risk in women with breast cancer. A random-effects model was used to combine study-specific results. The quality of evidence was rated by NutriGrade score. Seven prospective cohort studies with 1,426 cases of all-cause mortality and 679 cases of breast cancer-specific mortality among 11,295 patients with breast cancer were included. The relative risks for the highest compared to the lowest category of dietary fiber consumption were 0.63 (95%CI: 0.52, 0.77; I2 = 0%, n = 5) for all-cause mortality, and 0.72 (95%CI: 0.54, 0.96; I2 = 0%, n = 5) for breast cancer-specific mortality. There was a strong linear association between fiber intake and all-cause mortality risk. The quality of evidence was rated moderate for all-cause mortality, and low for breast cancer-specific mortality. Higher dietary fiber consumption may improve survival in patients with breast cancer. More research is needed to confirm the present results, considering types of fiber consumed and tumor estrogen receptor status.
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Affiliation(s)
- Ahmad Jayedi
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran.,Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Emadi
- Deputy of Research and Technology, Semnan University of Medical Sciences, Semnan, Iran
| | - Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Anna Abdolshahi
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Vors C, Allaire J, Mejia SB, Khan TA, Sievenpiper JL, Lamarche B. Comparing the Effects of Docosahexaenoic and Eicosapentaenoic Acids on Inflammation Markers Using Pairwise and Network Meta-Analyses of Randomized Controlled Trials. Adv Nutr 2020; 12:128-140. [PMID: 32790827 PMCID: PMC7850108 DOI: 10.1093/advances/nmaa086] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/14/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022] Open
Abstract
Recent data from randomized clinical trials (RCTs) suggest that DHA may have stronger anti-inflammatory effects than EPA. This body of evidence has not yet been quantitatively reviewed. The aim of this study was to compare the effect of DHA and EPA on several markers of systemic inflammation by pairwise and network meta-analyses of RCTs. MEDLINE, EMBASE, and The Cochrane Library were searched through to September 2019. We included RCTs of ≥7 d on adults regardless of health status that directly compared the effects of DHA with EPA and RCTs of indirect comparisons, in which the effects of DHA or EPA were compared individually to a control fatty acid. Differences in circulating concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and adiponectin were the primary outcome measures. Data were pooled by pairwise and network meta-analysis and expressed as mean differences (MDs) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic) in the pairwise meta-analysis. Inconsistency and transitivity were evaluated in the network meta-analysis. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Eligibility criteria were met by 5 RCTs (N = 411) for the pairwise meta-analysis and 20 RCTs (N = 1231) for the network meta-analysis. In the pairwise meta-analysis, DHA and EPA had similar effects on plasma CRP [MDDHA versus EPA = 0.14 mg/L (95% CI: -0.57, 0.85); I2 = 61%], IL-6 [MDDHA versus EPA = 0.10 pg/mL (-0.15, 0.34); I2 = 40%], and TNF-α [MDDHA versus EPA = -0.10 pg/mL (-0.37, 0.18); I2 = 40%]. In the network meta-analysis, the effects of DHA and EPA on plasma CRP [MDDHA versus EPA = -0.33 mg/L (-0.75, 0.10)], IL-6 [MDDHA versus EPA = 0.09 pg/mL (-0.12, 0.30)], and TNF-α [MDDHA versus EPA = -0.02 pg/mL (-0.25, 0.20)] were also similar. DHA and EPA had similar effects on plasma adiponectin in the network meta-analysis. Results from pairwise and network meta-analyses suggest that supplementation with either DHA or EPA does not differentially modify systemic markers of subclinical inflammation.
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Affiliation(s)
- Cécile Vors
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Laval University, Quebec City, Canada
| | - Janie Allaire
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Laval University, Quebec City, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
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Semnani-Azad Z, Khan TA, Blanco Mejia S, de Souza RJ, Leiter LA, Kendall CWC, Hanley AJ, Sievenpiper JL. Association of Major Food Sources of Fructose-Containing Sugars With Incident Metabolic Syndrome: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e209993. [PMID: 32644139 PMCID: PMC7348689 DOI: 10.1001/jamanetworkopen.2020.9993] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Sugar-sweetened beverages (SSBs) are associated with increased risk of metabolic syndrome (MetS). However, the role of other important food sources of fructose-containing sugars in the development of MetS remains unclear. OBJECTIVE To examine the association of major food sources of fructose-containing sugars with incident MetS. DATA SOURCES MEDLINE, Embase, and Cochrane Library were searched from database inception to March 24, 2020, in addition to manual searches of reference lists from included studies using the following search terms: sugar-sweetened beverages, fruit drink, yogurt, metabolic syndrome, and prospective study. STUDY SELECTION Inclusion criteria included prospective cohort studies of 1 year or longer that investigated the association of important food sources of fructose-containing sugars with incident MetS in participants free of MetS at the start of the study. DATA EXTRACTION AND SYNTHESIS Study quality was assessed using the Newcastle-Ottawa Scale. Extreme quantile risk estimates for each food source with MetS incidence were pooled using a random-effects meta-analysis. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). Dose-response analyses were performed using a 1-stage linear mixed-effects model. The certainty of the evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Results were reported according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. MAIN OUTCOMES AND MEASURES Pooled risk ratio (RR) of incident MetS (pairwise and dose response). RESULTS Thirteen prospective cohort studies (49 591 participants [median age, 51 years; range, 6-90 years]; 14 205 with MetS) that assessed 8 fructose-containing foods and MetS were included. An adverse linear dose-response association for SSBs (RR for 355 mL/d, 1.14; 95% CI, 1.05-1.23) and an L-shaped protective dose-response association for yogurt (RR for 85 g/d, 0.66; 95% CI, 0.58-0.76) and fruit (RR for 80 g/d, 0.82; 95% CI, 0.78-0.86) was found. Fruit juices (mixed and 100%) had a U-shaped dose-response association with protection at moderate doses (mixed fruit juice: RR for 125 mL/d, 0.58; 95% CI, 0.42-0.79; 100% fruit juice: RR for 125 mL/d, 0.77; 95% CI, 0.61-0.97). Honey, ice cream, and confectionary had no association with MetS incidence. The certainty of the evidence was moderate for SSBs, yogurt, fruit, mixed fruit juice, and 100% fruit juice and very low for all other food sources. CONCLUSIONS AND RELEVANCE The findings of this meta-analysis suggest that the adverse association of SSBs with MetS does not extend to other food sources of fructose-containing sugars, with a protective association for yogurt and fruit throughout the dose range and for 100% fruit juice and mixed fruit juices at moderate doses. Therefore, current policies and guidelines on the need to limit sources of free sugars may need to be reexamined.
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Affiliation(s)
- Zhila Semnani-Azad
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Russell J. de Souza
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Lawrence A. Leiter
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Cyril W. C. Kendall
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Nutrition and Dietetics, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Anthony J. Hanley
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
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Affiliation(s)
- Tauseef A Khan
- From the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Laura Chiavaroli
- From the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Richard P Bazinet
- From the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John L Sievenpiper
- From the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Khan TA, Tayyiba M, Agarwal A, Mejia SB, de Souza RJ, Wolever TMS, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Relation of Total Sugars, Sucrose, Fructose, and Added Sugars With the Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies. Mayo Clin Proc 2019; 94:2399-2414. [PMID: 31806098 DOI: 10.1016/j.mayocp.2019.05.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/27/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the association of total and added fructose-containing sugars on cardiovascular (CVD) incidence and mortality. METHODS MEDLINE, EMBASE and Cochrane Library were searched from January 1, 1980, to July 31, 2018. Prospective cohort studies assessing the association of reported intakes of total, sucrose, fructose and added sugars with CVD incidence and mortality in individuals free from disease at baseline were included. Risk estimates were pooled using the inverse variance method, and dose-response analysis was modeled. RESULTS Eligibility criteria were met by 24 prospective cohort comparisons (624,128 unique individuals; 11,856 CVD incidence cases and 12,224 CVD mortality cases). Total sugars, sucrose, and fructose were not associated with CVD incidence. Total sugars (risk ratio, 1.09 [95% confidence interval, 1.02 to 1.17]) and fructose (1.08 [1.01 to 1.15]) showed a harmful association for CVD mortality, there was no association for added sugars and a beneficial association for sucrose (0.94 [0.89 to 0.99]). Dose-response analyses showed a beneficial linear dose-response gradient for sucrose and nonlinear dose-response thresholds for harm for total sugars (133 grams, 26% energy), fructose (58 grams, 11% energy) and added sugars (65 grams, 13% energy) in relation to CVD mortality (P<.05). The certainty of the evidence using GRADE was very low for CVD incidence and low for CVD mortality for all sugar types. CONCLUSION Current evidence supports a threshold of harm for intakes of total sugars, added sugars, and fructose at higher exposures and lack of harm for sucrose independent of food form for CVD mortality. Further research of different food sources of sugars is needed to define better the relationship between sugars and CVD. REGISTRATION: clinicaltrials.gov, NCT01608620.
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Affiliation(s)
- Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mobushra Tayyiba
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arnav Agarwal
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Russell J de Souza
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Thomas M S Wolever
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.
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Khan TA, Chiavaroli L, Zurbau A, Sievenpiper JL. A lack of consideration of a dose-response relationship can lead to erroneous conclusions regarding 100% fruit juice and the risk of cardiometabolic disease. Eur J Clin Nutr 2019; 73:1556-1560. [PMID: 31636410 PMCID: PMC6954109 DOI: 10.1038/s41430-019-0514-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/10/2019] [Accepted: 09/27/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada. .,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. .,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Glenn AJ, Viguiliouk E, Seider M, Boucher BA, Khan TA, Blanco Mejia S, Jenkins DJA, Kahleová H, Rahelić D, Salas-Salvadó J, Kendall CWC, Sievenpiper JL. Relation of Vegetarian Dietary Patterns With Major Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Front Nutr 2019; 6:80. [PMID: 31263700 PMCID: PMC6585466 DOI: 10.3389/fnut.2019.00080] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Vegetarian dietary patterns are recommended for cardiovascular disease (CVD) prevention and management due to their favorable effects on cardiometabolic risk factors, however, the role of vegetarian dietary patterns in CVD incidence and mortality remains unclear. Objective: To update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we undertook a systematic review and meta-analysis of the association of vegetarian dietary patterns with major cardiovascular outcomes in prospective cohort studies that included individuals with and without diabetes using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Methods: MEDLINE, EMBASE, and Cochrane databases were searched through September 6th, 2018. We included prospective cohort studies ≥1 year of follow-up including individuals with or without diabetes reporting the relation of vegetarian and non-vegetarian dietary patterns with at least one cardiovascular outcome. Two independent reviewers extracted data and assessed study quality (Newcastle-Ottawa Scale). The pre-specified outcomes included CVD incidence and mortality (total CVD, coronary heart disease (CHD) and stroke). Risk ratios for associations were pooled using inverse variance random effects model and expressed as risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2-statistic). The overall certainty of the evidence was assessed using GRADE. Results: Seven prospective cohort studies (197,737 participants, 8,430 events) were included. A vegetarian dietary pattern was associated with reduced CHD mortality [RR, 0.78 (CI, 0.69, 0.88)] and incidence [0.72 (0.61, 0.85)] but were not associated with CVD mortality [0.92 (0.84, 1.02)] and stroke mortality [0.92 (0.77, 1.10)]. The overall certainty of the evidence was graded as “very low” for all outcomes, owing to downgrades for indirectness and imprecision. Conclusions: Very low-quality evidence indicates that vegetarian dietary patterns are associated with reductions in CHD mortality and incidence but not with CVD and stroke mortality in individuals with and without diabetes. More research, particularly in different populations, is needed to improve the certainty in our estimates. Clinical Trial Registration:Clinicaltrials.gov, identifier: NCT03610828.
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Affiliation(s)
- Andrea J Glenn
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada
| | - Effie Viguiliouk
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada
| | - Maxine Seider
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada
| | - Beatrice A Boucher
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hana Kahleová
- Physicians Committee for Responsible Medicine, Washington, DC, United States.,Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBER Obn), Instituto de Salud Carlos III, Madrid, Spain.,Human Nutrition Department, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Cyril W C Kendall
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada.,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
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Blanco Mejia S, Messina M, Li SS, Viguiliouk E, Chiavaroli L, Khan TA, Srichaikul K, Mirrahimi A, Sievenpiper JL, Kris-Etherton P, Jenkins DJA. A Meta-Analysis of 46 Studies Identified by the FDA Demonstrates that Soy Protein Decreases Circulating LDL and Total Cholesterol Concentrations in Adults. J Nutr 2019; 149:968-981. [PMID: 31006811 PMCID: PMC6543199 DOI: 10.1093/jn/nxz020] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/05/2018] [Accepted: 01/25/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Certain plant foods (nuts and soy protein) and food components (viscous fibers and plant sterols) have been permitted by the FDA to carry a heart health claim based on their cholesterol-lowering ability. The FDA is currently considering revoking the heart health claim for soy protein due to a perceived lack of consistent LDL cholesterol reduction in randomized controlled trials. OBJECTIVE We performed a meta-analysis of the 46 controlled trials on which the FDA will base its decision to revoke the heart health claim for soy protein. METHODS We included the 46 trials on adult men and women, with baseline circulating LDL cholesterol concentrations ranging from 110 to 201 mg/dL, as identified by the FDA, that studied the effects of soy protein on LDL cholesterol and total cholesterol (TC) compared with non-soy protein. Two independent reviewers extracted relevant data. Data were pooled by the generic inverse variance method with a random effects model and expressed as mean differences with 95% CI. Heterogeneity was assessed and quantified. RESULTS Of the 46 trials identified by the FDA, 43 provided data for meta-analyses. Of these, 41 provided data for LDL cholesterol, and all 43 provided data for TC. Soy protein at a median dose of 25 g/d during a median follow-up of 6 wk decreased LDL cholesterol by 4.76 mg/dL (95% CI: -6.71, -2.80 mg/dL, P < 0.0001; I2 = 55%, P < 0.0001) and decreased TC by 6.41 mg/dL (95% CI: -9.30, -3.52 mg/dL, P < 0.0001; I2 = 74%, P < 0.0001) compared with non-soy protein controls. There was no dose-response effect or evidence of publication bias for either outcome. Inspection of the individual trial estimates indicated most trials (∼75%) showed a reduction in LDL cholesterol (range: -0.77 to -58.60 mg/dL), although only a minority of these were individually statistically significant. CONCLUSIONS Soy protein significantly reduced LDL cholesterol by approximately 3-4% in adults. Our data support the advice given to the general public internationally to increase plant protein intake. This trial was registered at clinicaltrials.gov as NCT03468127.
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Affiliation(s)
- Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | | | - Siying S Li
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Effie Viguiliouk
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | - Korbua Srichaikul
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Arash Mirrahimi
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Penny Kris-Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Address correspondence to DJAJ (e-mail: )
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Khan TA, Malik VS, Sievenpiper JL. Letter by Khan et al Regarding Article, "Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women's Health Initiative". Stroke 2019; 50:e167-e168. [PMID: 31092156 DOI: 10.1161/strokeaha.119.025571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, ON, Canada
| | - Vasanti S Malik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, ON, Canada
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Ayoub-Charette S, Liu Q, Khan TA, Au-Yeung F, Blanco Mejia S, de Souza RJ, Wolever TM, Leiter LA, Kendall C, Sievenpiper JL. Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies. BMJ Open 2019; 9:e024171. [PMID: 31061018 PMCID: PMC6502023 DOI: 10.1136/bmjopen-2018-024171] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Sugar-sweetened beverages (SSBs) are associated with hyperuricaemia and gout. Whether other important food sources of fructose-containing sugars share this association is unclear. DESIGN To assess the relation of important food sources of fructose-containing sugars with incident gout and hyperuricaemia, we conducted a systematic review and meta-analysis of prospective cohort studies. METHODS We searched MEDLINE, Embase and the Cochrane Library (through 13 September 2017). We included prospective cohort studies that investigated the relationship between food sources of sugar and incident gout or hyperuricaemia. Two independent reviewers extracted relevant data and assessed the risk of bias. We pooled natural-log transformed risk ratios (RRs) using the generic inverse variance method with random effects model and expressed as RR with 95% confidence intervals (CIs). The overall certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS We identified three studies (1 54 289 participants, 1761 cases of gout), comparing the highest with the lowest level of exposure for SSBs, fruit juices and fruits. No reports were found reporting incident hyperuricaemia. Fruit juice and SSB intake showed an adverse association (fruit juice: RR=1.77, 95% CI 1.20 to 2.61; SSB: RR=2.08, 95% CI 1.40 to 3.08), when comparing the highest to lowest intake of the most adjusted models. There was no significant association between fruit intake and gout (RR 0.85, 95% CI 0.63 to 1.14). The strongest evidence was for the adverse association with SSB intake (moderate certainty), and the weakest evidence was for the adverse association with fruit juice intake (very low certainty) and lack of association with fruit intake (very low certainty). CONCLUSION There is an adverse association of SSB and fruit juice intake with incident gout, which does not appear to extend to fruit intake. Further research is needed to improve our estimates. TRIAL REGISTRATION NUMBER NCT02702375; Results.
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Affiliation(s)
- Sabrina Ayoub-Charette
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Qi Liu
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tauseef A Khan
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fei Au-Yeung
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Russell J de Souza
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Toronto, Ontario, Canada
| | - Thomas Ms Wolever
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril Kendall
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Noronha JC, Nishi SK, Braunstein CR, Khan TA, Blanco Mejia S, Kendall CWC, Kahleová H, Rahelić D, Salas-Salvadó J, Leiter LA, Sievenpiper JL. The Effect of Liquid Meal Replacements on Cardiometabolic Risk Factors in Overweight/Obese Individuals With Type 2 Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care 2019; 42:767-776. [PMID: 30923163 DOI: 10.2337/dc18-2270] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/14/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The evidence for liquid meal replacements in diabetes has not been summarized. Our objective was to synthesize the evidence of the effect of liquid meal replacements on cardiometabolic risk factors in overweight/obese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS Data sources included MEDLINE, EMBASE, and the Cochrane Library through 10 December 2018. We included randomized trials of ≥2 weeks assessing the effect of liquid meal replacements in weight loss diets compared with traditional weight loss diets on cardiometabolic risk factors in overweight/obese subjects with type 2 diabetes. Two independent reviewers extracted relevant data and assessed risk of bias. Data were pooled using the inverse variance method. The overall certainty of the evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS Nine trial comparisons (N = 961 [median follow-up 24 weeks]) met eligibility criteria. Mean differences were for body weight -2.37 kg (95% CI -3.30 to -1.44), BMI -0.87 kg/m2 (-1.31 to -0.42), body fat -1.66% (-2.17 to -1.15), waist circumference -2.24 cm (-3.72 to -0.77), HbA1c -0.43% (-0.66 to -0.19) (-4.7 mmol/mol [-7.2 to -2.1]), fasting glucose -0.63 mmol/L (-0.99 to -0.27), fasting insulin -11.83 pmol/L (-23.11 to -0.54), systolic blood pressure -4.97mmHg (-7.32 to -2.62), and diastolic blood pressure -1.98 mmHg (-3.05 to -0.91). There was no effect on blood lipids. The overall certainty of the evidence was low to moderate owing to imprecision and/or inconsistency. CONCLUSIONS Liquid meal replacements in weight loss diets lead to modest reductions in body weight, BMI, and systolic blood pressure, and reductions of marginal clinical significance in body fat, waist circumference, HbA1c, fasting glucose, fasting insulin, and diastolic blood pressure. More high-quality trials are needed to improve the certainty in our estimates.
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Affiliation(s)
- Jarvis C Noronha
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Stephanie K Nishi
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Catherine R Braunstein
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tauseef A Khan
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sonia Blanco Mejia
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cyril W C Kendall
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Hana Kahleová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Physicians Committee for Responsible Medicine, Washington, DC
| | - Dario Rahelić
- Department of Endocrinology, Diabetes and Clinical Pharmacology, Dubrava University Hospital, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,Human Nutrition Unit, Institut d'Investigació Sanitària Pere i Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Lawrence A Leiter
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - John L Sievenpiper
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada .,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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Choo VL, Viguiliouk E, Blanco Mejia S, Cozma AI, Khan TA, Ha V, Wolever TMS, Leiter LA, Vuksan V, Kendall CWC, de Souza RJ, Jenkins DJA, Sievenpiper JL. Food sources of fructose-containing sugars and glycaemic control: systematic review and meta-analysis of controlled intervention studies. BMJ 2018; 363:k4644. [PMID: 30463844 PMCID: PMC6247175 DOI: 10.1136/bmj.k4644] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the effect of different food sources of fructose-containing sugars on glycaemic control at different levels of energy control. DESIGN Systematic review and meta-analysis of controlled intervention studies. DATA SOURCES Medine, Embase, and the Cochrane Library up to 25 April 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Controlled intervention studies of at least seven days' duration and assessing the effect of different food sources of fructose-containing sugars on glycaemic control in people with and without diabetes were included. Four study designs were prespecified on the basis of energy control: substitution studies (sugars in energy matched comparisons with other macronutrients), addition studies (excess energy from sugars added to diets), subtraction studies (energy from sugars subtracted from diets), and ad libitum studies (sugars freely replaced by other macronutrients without control for energy). Outcomes were glycated haemoglobin (HbA1c), fasting blood glucose, and fasting blood glucose insulin. DATA EXTRACTION AND SYNTHESIS Four independent reviewers extracted relevant data and assessed risk of bias. Data were pooled by random effects models and overall certainty of the evidence assessed by the GRADE approach (grading of recommendations assessment, development, and evaluation). RESULTS 155 study comparisons (n=5086) were included. Total fructose-containing sugars had no harmful effect on any outcome in substitution or subtraction studies, with a decrease seen in HbA1c in substitution studies (mean difference -0.22% (95% confidence interval to -0.35% to -0.08%), -25.9 mmol/mol (-27.3 to -24.4)), but a harmful effect was seen on fasting insulin in addition studies (4.68 pmol/L (1.40 to 7.96)) and ad libitum studies (7.24 pmol/L (0.47 to 14.00)). There was interaction by food source, with specific food sources showing beneficial effects (fruit and fruit juice) or harmful effects (sweetened milk and mixed sources) in substitution studies and harmful effects (sugars-sweetened beverages and fruit juice) in addition studies on at least one outcome. Most of the evidence was low quality. CONCLUSIONS Energy control and food source appear to mediate the effect of fructose-containing sugars on glycaemic control. Although most food sources of these sugars (especially fruit) do not have a harmful effect in energy matched substitutions with other macronutrients, several food sources of fructose-containing sugars (especially sugars-sweetened beverages) adding excess energy to diets have harmful effects. However, certainty in these estimates is low, and more high quality randomised controlled trials are needed. STUDY REGISTRATION Clinicaltrials.gov (NCT02716870).
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Affiliation(s)
- Vivian L Choo
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Effie Viguiliouk
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sonia Blanco Mejia
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Adrian I Cozma
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tauseef A Khan
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vanessa Ha
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Undergraduate Medical Education, School of Medicine, Queen's University, Kingston, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Thomas M S Wolever
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Lawrence A Leiter
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Vladimir Vuksan
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Cyril W C Kendall
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Russell J de Souza
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - David J A Jenkins
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - John L Sievenpiper
- Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
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Noronha JC, Braunstein CR, Glenn AJ, Khan TA, Viguiliouk E, Noseworthy R, Blanco Mejia S, Kendall CWC, Wolever TMS, Leiter LA, Sievenpiper JL. The effect of small doses of fructose and allulose on postprandial glucose metabolism in type 2 diabetes: A double-blind, randomized, controlled, acute feeding, equivalence trial. Diabetes Obes Metab 2018; 20:2361-2370. [PMID: 29797503 PMCID: PMC6175314 DOI: 10.1111/dom.13374] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 01/19/2023]
Abstract
AIM To assess and compare the effect of small doses of fructose and allulose on postprandial blood glucose regulation in type 2 diabetes. METHODS A double-blind, multiple-crossover, randomized, controlled, acute feeding, equivalence trial in 24 participants with type 2 diabetes was conducted. Each participant was randomly assigned six treatments separated by >1-week washouts. Treatments consisted of fructose or allulose at 0 g (control), 5 g or 10 g added to a 75-g glucose solution. A standard 75-g oral glucose tolerance test protocol was followed with blood samples at -30, 0, 30, 60, 90 and 120 minutes. The primary outcome measure was plasma glucose incremental area under the curve (iAUC). RESULTS Allulose significantly reduced plasma glucose iAUC by 8% at 10 g compared with 0 g (717.4 ± 38.3 vs. 777.5 ± 39.9 mmol × min/L, P = 0.015) with a linear dose response gradient between the reduction in plasma glucose iAUC and dose (P = 0.016). Allulose also significantly reduced several related secondary and exploratory outcome measures at 5 g (plasma glucose absolute mean and total AUC) and 10 g (plasma glucose absolute mean, absolute and incremental maximum concentration [Cmax ], and total AUC) (P < .0125). There was no effect of fructose at any dose. Although allulose showed statistically significant reductions in plasma glucose iAUC compared with fructose at 5 g, 10 g and pooled doses, these reductions were within the pre-specified equivalence margins of ±20%. CONCLUSION Allulose, but not fructose, led to modest reductions in the postprandial blood glucose response to oral glucose in individuals with type 2 diabetes. There is a need for long-term randomized trials to confirm the sustainability of these improvements.
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Affiliation(s)
- Jarvis C. Noronha
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Catherine R. Braunstein
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Andrea J. Glenn
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Tauseef A. Khan
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Effie Viguiliouk
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Rebecca Noseworthy
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Sonia Blanco Mejia
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Cyril W. C. Kendall
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- College of Pharmacy and NutritionUniversity of SaskatchewanSaskatoonCanada
| | - Thomas M. S. Wolever
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
- Division of EndocrinologySt. Michael's HospitalTorontoCanada
| | - Lawrence A. Leiter
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
- Division of EndocrinologySt. Michael's HospitalTorontoCanada
| | - John L. Sievenpiper
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
- Division of EndocrinologySt. Michael's HospitalTorontoCanada
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Habib MA, Taher MA, Sumi SN, Nahar K, Khan TA, Mia GM, Islam MS, Dey BP. Extra Skeletal Ewing's Sarcoma Involving Perineum of a Young Male Patient. Mymensingh Med J 2018; 27:879-882. [PMID: 30487509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Ewing's Sarcoma is the second most common primary malignant bone tumor in children and young adults after osteosarcoma but exceptionally it can arise from extra skeletal sites also. Extra skeletal Ewing's sarcoma is of neuroectodermal origin and usually involves extremities, retroperitoneum and paravertebral regions. No case of extra skeletal Ewing's sarcoma involving perineum is yet reported. A 16 years old male patient admitted to colorectal surgery department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh in July 2015 having swellings in perineum as well as both inguinal regions. The swelling was near to anal verge. FNAC from perineal swelling and inguinal lymph node demonstrate small blue round cell tumor. After operation the tumor size was 5cm×4cm, cell type was malignant round cell arranged in sheet and perivascular forming rosette. Extra skeletal Ewing's sarcoma can be a differential diagnosis of soft tissue tumor arising in perineum.
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Affiliation(s)
- M A Habib
- Dr Md Ahsan Habib, Assistant Professor Department of Oncosurgery, National Institute of Cancer Research & Hospital, Mohakhali, Dhaka, Bangladesh; E-mail: drahsanhabib1306 @gmail.com
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Chiavaroli L, Nishi SK, Khan TA, Braunstein CR, Glenn AJ, Mejia SB, Rahelić D, Kahleová H, Salas-Salvadó J, Jenkins DJA, Kendall CWC, Sievenpiper JL. Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Prog Cardiovasc Dis 2018; 61:43-53. [PMID: 29807048 DOI: 10.1016/j.pcad.2018.05.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The evidence for the Portfolio dietary pattern, a plant-based dietary pattern that combines recognized cholesterol-lowering foods (nuts, plant protein, viscous fibre, plant sterols), has not been summarized. OBJECTIVE To update the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of controlled trials using GRADE of the effect of the Portfolio dietary pattern on the primary therapeutic lipid target for cardiovascular disease prevention, low-density lipoprotein cholesterol (LDL-C), and other established cardiometabolic risk factors. METHODS We searched MEDLINE, EMBASE, and The Cochrane Library through April 19, 2018. We included controlled trials ≥ 3-weeks assessing the effect of the Portfolio dietary pattern on cardiometabolic risk factors compared with an energy-matched control diet free of Portfolio dietary pattern components. Two independent reviewers extracted data and assessed risk of bias. The primary outcome was LDL-C. Data were pooled using the generic inverse-variance method and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q statistic) and quantified (I2-statistic). GRADE assessed the certainty of the evidence. RESULTS Eligibility criteria were met by 7 trial comparisons in 439 participants with hyperlipidemia, in which the Portfolio dietary pattern was given on a background of a National Cholesterol Education Program (NCEP) Step II diet. The combination of a portfolio dietary pattern and NCEP Step II diet significantly reduced the primary outcome LDL-C by ~17% (MD, -0.73 mmol/L, [95% CI, -0.89 to -0.56 mmol/L]) as well as non-high-density lipoprotein cholesterol, apolipoprotein B, total cholesterol, triglycerides, systolic and diastolic blood pressure, C-reactive protein, and estimated 10-year coronary heart disease (CHD) risk, compared with an NCEP Step 2 diet alone (p < 0.05). There was no effect on high-density lipoprotein cholesterol or body weight. The certainty of the evidence was high for LDL-cholesterol and most lipid outcomes and moderate for all others outcomes. CONCLUSIONS Current evidence demonstrates that the Portfolio dietary pattern leads to clinically meaningful improvements in LDL-C as well as other established cardiometabolic risk factors and estimated 10-year CHD risk.
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Affiliation(s)
- Laura Chiavaroli
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie K Nishi
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tauseef A Khan
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Catherine R Braunstein
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea J Glenn
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sonia Blanco Mejia
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dario Rahelić
- Department of Endocrinology, Diabetes and Clinical Pharmacology, Dubrava University Hospital, Zagreb, Croatia
| | - Hana Kahleová
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic; Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Human Nutrition Department, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - David J A Jenkins
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - Cyril W C Kendall
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada.
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