Nutrition Metabolism and Cardiovascular Diseases最新文献

Background and aim: The combined role of the cardiometabolic index (CMI), a marker of visceral obesity and dyslipidemia, and high-sensitivity C-reactive protein (hsCRP), an inflammatory marker, in predicting cardiovascular disease (CVD) risk remains unexplored. This study investigates their synergistic effect on new-onset CVD.

Methods and results: In this prospective cohort of 7856 CVD-free adults from CHARLS study, participants were categorized by median CMI and hsCRP (cutoff: 2 mg/L). Over a median 7-year follow-up, 1502 CVD incidents occurred. Compared with the low CMI and low hsCRP reference group, individuals with both high CMI and high hsCRP showed the highest risks of CVD (HR 1.54, 95 % CI 1.33-1.78), stroke (HR 2.27, 95 % CI 1.74-2.97), and heart disease (HR 1.37, 95 % CI 1.15-1.63), although multiplicative and additive interaction tests were not statistically significant. Mediation analyses indicated that blood pressure measures, and fasting glucose for heart disease, partially mediated CMI's association with outcomes. A bidirectional mediation relationship was observed between CMI and hsCRP for stroke risk. These findings remained consistent in sensitivity analyses, including competing risk models, subgroup analyses across population strata, and analyses using multiple imputation or an alternative hsCRP cutoff (3 mg/L).

Conclusion: The joint elevation of CMI and hsCRP identifies individuals at the highest risk of CVD, stroke, and heart disease, underscoring the combined contribution of metabolic and inflammatory pathways to cardiovascular pathogenesis. This supports the integration of both markers for early risk stratification.

Background and aims: High blood pressure (BP), a key modifiable risk factor for cardiovascular disease, often begins in childhood. While adult meta-analyses have shown consistent associations between ultra-processed food (UPF) intake and elevated BP, findings in children remain inconsistent. Given that UPFs make up majority of Canadian children's diets, we examined associations between early childhood UPF intake and BP in mid-childhood, and assessed the impact of substituting UPFs with minimally processed foods (MPF).

Methods and results: In this study, among 1408 participants from the Canadian CHILD Cohort Study, UPF, defined based on the NOVA classification system, was assessed at three years of age. BP was measured at age eight. We examined associations using multivariable-adjusted mixed-effects linear regression, evaluated substitution models to estimate the effect of replacing UPFs with MPFs, and examined body mass index (BMI) as a potential mediator. At age three, UPFs contributed 44.3% of total daily energy intake. At age eight, mean systolic and diastolic BP were 104 (SD 9) and 59 (SD 6) mmHg, respectively. Each 10% increase in UPF intake was associated with 0.31 mmHg higher diastolic BP (95% CI: 0.01, 0.61), driven by "Breads and cereals" and "Ready-to-eat/heat mixed dishes" categories. Replacing 10% of energy from UPFs with MPFs, in simulated substitution analyses, was associated with 0.45 mmHg lower diastolic BP. The associations between UPF and diastolic BP were partially mediated (∼27%) by child BMI.

Conclusions: Higher UPF intake in early childhood was statistically associated with higher diastolic blood pressure at age eight, with simulated substitution models suggesting modest reductions in diastolic blood pressure when substituting energy contributed from UPFs with MPFs. While these effect sizes are small, these findings underscore the importance of early dietary guidance and UPF reduction in pediatric preventive care.

Background and aims: The Bariatric Surgery and LDL Cholesterol (BASALTO) randomized clinical trial reported differential LDL cholesterol responses after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). In this exploratory analysis of BASALTO we characterized lipidomic changes associated with both procedures and their relationship with LDL cholesterol response.

Methods and results: Plasma samples of 30 patients with obesity and high LDL cholesterol (15 RYGB, 15 SG) were analyzed using targeted mass spectrometry to quantify over 50 pre-defined lipid species at baseline, 3 months, and 12 months after surgery. At 12 months, RYGB induced consistent reductions in LDL cholesterol, whereas SG showed marked interindividual variability. Both procedures were associated with shared and procedure-specific lipidomic changes, including divergent patterns in cholesterol absorption. No significant associations between lipidomic changes and LDL cholesterol were observed after RYGB. In contrast, after SG, changes in monoacylglycerols (16:0, 20:4, 18:1) at 3 months and increases in cholestanol (pFDR = 0.039) and HexCer 18:0 (pFDR = 0.031) at 12 months were directly associated with LDL cholesterol response.

Conclusion: LDL cholesterol reduction after RYGB appears independent of shifts in selected lipids, whereas variability after SG may be partly driven by cholesterol absorption and ceramide-related pathways.

Clinical trial registration: NCT03975478.

Background and aims: Studies demonstrate that Low Density Lipoprotein (LDL) cholesterol targets are largely unreached in real-life, particularly in the higher cardiovascular (CV) risk classes. Our aim was to evaluate LDL target achievement in very high and extreme CV risk patients at the end of a Cardiac Rehabilitation (CR) program.

Methods and results: A total of 940 patients with recent acute or chronic coronary syndrome participating in a CR program were enrolled between January 2012 and December 2023. LDL targets were <70 mg/dL for patients treated before August 2019, <55 mg/dL after this date and <40 mg/dL for extreme CV risk subjects. Mean age was 66.9 ± 10.6 years, 82.9 % of the subjects were males and LDL cholesterol decreased from 107.3 ± 39.3 to 64.5 ± 24.6. 88.0 % of the subjects were taking high-intensity statins, 38.1 % ezetimibe while only 4.6 % PCSK9-inhibitors and 0.9 % bempedoic acid. 53.1 % of the patients reached the LDL target with particularly positive peaks in 2018 (72.8 %), 2022 (78.8 %) and 2023 (75.7 %). 29.8 % of the patients had extreme CV risk and they achieved the target of LDL <40 mg/dL only in 16.4 %, with a higher prevalence in the latest years (32 % in 2022 and 22.7 % in 2023).

Conclusions: Our results are highly encouraging compared to those reported in previous observational studies. The further we move from guideline publication, the higher the proportion of patients achieving LDL targets, supported by increased clinical awareness and new pharmacological options. However, more attention should be paid to extreme CV risk patients, both in term of correct dentification and treatment.

Background and aims: The global incidence of type 2 diabetes (T2D) is increasing, primarily due to poor diet and sedentary lifestyles. This study evaluated the association between the consumption of minimally processed foods and the risk of developing T2D.

Methods and results: This prospective cohort study was part of the Cohort of Universities of Minas Gerais, which tracked the health outcomes of Brazilian adults without T2D at baseline over six years. Baseline consumption of in natura or minimally processed foods and culinary ingredients was evaluated using the NOVA food classification system and a validated 144-item semiquantitative food frequency questionnaire. Directed acyclic graphs were constructed to identify the minimum set of adjustment variables required to control confounding factors. Relationships between the incidence rate ratio (IRR) of T2D and consumption of in natura/minimally processed foods and culinary ingredients were assessed using Cox regression analysis. Among 3808 participants (mean age: 34 years; 65.1 % female; 55.8 % physically active), 103 (2.7 %) developed T2D within six years. On average, in natura foods accounted for 60 % of daily energy intake (DEI), whereas processed culinary ingredients contributed 6 %. After adjusting for potential confounders, individuals in the highest tertile of in natura/minimally processed foods and culinary ingredients consumption (81 % of DEI) had a reduced risk of T2D (IRR = 0.59, 95 % confidence interval: 0.35-0.98) compared with those in the lowest tertile of consumption (53 % of DEI).

Conclusion: Among Brazilian adults, higher consumption of minimally processed foods is associated with a reduced risk of developing T2D.

Aims: Among the risk factors leading to cardiovascular disease (CVD), hypercholesterolemia stands out as a key driver of vascular dysfunction and the development of atherosclerotic CVD. This review is aimed to highlight the emergent evidence showing that maternal supraphysiological hypercholesterolemia (MSPH) is a key risk factor for transgenerational CVD risk and to advocate for the development of strategies for the early prediction and prevention of MSPH.

Data synthesis: Increasing evidence suggests that an individual's lifetime CVD risk may be modified by in utero exposure. However, the contribution of maternal lipid levels to pregnancy has been neglected. In women, chronic hypercholesterolemia occurs during pregnancy, during which total cholesterol (TC) and low-density lipoprotein cholesterol (LDL) levels rise to meet fetal growth demands. Two patterns of increased pregnancy cholesterol levels have been described in the literature: i) those with maternal physiological hypercholesterolemia (MPH), characterized by increased TC levels at the end of gestation up to 280 mg/dl, and ii) those with MSPH, characterized by TC levels at the end of pregnancy above 280 mg/dl in combination with elevated LDL levels. This overlooked distinction is crucial considering the increased evidence linking MSPH to elevated cardiovascular risk in both mothers and offspring.

Conclusion: Available data suggest that MSPH is associated with increased CVD risk in mothers in addition to fetal atherogenesis and increased lifetime risk of CVD in offspring. The implementation of early detection and interventions to mitigate MSPH could potentially improve acute and long-term health outcomes for both mothers and babies.

Background and aim: Sarcopenia, characterized by decreased muscle mass or muscle dysfunction, is associated with cardiovascular disease and mortality. However, the mediating effect of sarcopenia on the relationship between aging or obesity (especially central obesity) and adverse outcomes remains unclear.

Methods and results: Sarcopenia was defined using functional criteria in the China Health and Retirement Longitudinal Study (CHARLS) and the English Longitudinal Study of Ageing (ELSA). In the National Health and Nutrition Examination Survey (NHANES) sarcopenia was determined using the skeletal muscle index (SMI) derived from appendicular skeletal muscle mass. A causal mediation analysis using counterfactual framework was conducted to estimate the mediating effect of sarcopenia on mortality associated with aging, obesity or central obesity. Sarcopenia was consistently associated with increased all-cause mortality, particularly among older adults. The combination of aging and sarcopenia amplified both mortality and cardiovascular disease (CVD) risks across cohorts. Sarcopenia partially meditated age-related all-cause mortality and cardiovascular outcomes by 8.67 % and 8.5 % in CHARLS (n = 9433), 8.56 % and 7.48 % in ELSA (n = 4389), 4.36 % and 3.95 % in NHANES (n = 16511), respectively. In NHANES but not other two cohorts, sarcopenia attenuated the adverse effects of obesity on mortality, and mediated the impact of central obesity on all-cause mortality. Subgroup and sensitivity analyses confirmed the robustness of these findings, showing similar mediation patterns across BMI categories or continuous exposure variables.

Conclusions: Sarcopenia partially mediates age-related mortality and cardiovascular risk, and modulates obesity-related outcomes variably across cohorts. Evidence-based sarcopenia prevention strategies may offer a promising strategy to reduce age- and obesity-associated health risks.

Advanced Glycation End Products (AGEs), formed through the non-enzymatic Maillard reaction, are pivotal molecular culprits linking metabolic dysfunction, chronic disease, and the acceleration of biological aging. While AGEs are synthesized endogenously, modern Western diets, defined by thermal food processing, introduce a substantial and increasing pool of exogenous dietary AGEs (dAGEs). This viewpoint critically assesses the evidence supporting the outdated theory that AGEs are not inert biomarkers but active, etiological factors driving pathology. The impact of AGEs is characterized by a dual mechanism: the direct impairment of structural integrity via irreversible protein cross-linking, and the systemic induction of oxidative stress and chronic inflammation ("inflammaging") through binding and activation of the Receptor for AGEs (RAGE). This persistent systemic load-heavily contributed by high-fat, high-protein foods cooked at dry, high heat-is implicated in accelerating insulin resistance, cardiovascular complications, and neurodegeneration. Nutritional strategies have focused on mitigating this exogenous burden through simple culinary modifications, such as utilizing moist heat and acidic ingredients, which significantly curb dAGE formation in the kitchen. However, a critical gap remains: while short-term mechanistic studies are compelling, definitive, long-term human intervention trials are lacking. We argue that future research must rigorously quantify the independent contribution of dAGE restriction to health span and longevity to fully legitimize its role as a primary, evidence-based nutritional intervention for preventative health.

Background and aims: Sustainable diets are increasingly recognized as a key strategy to promote human health while reducing environmental impacts. The Planetary Health Diet (PHD) provides a global framework for sustainable and healthy eating patterns, but evidence on its adherence and implications in specific populations is still limited. The aim of this study was to test the level of adherence, the environmental impact, and the nutritional quality of several scores assessing the level of adherence to the PHD in a cohort of Italian individuals.

Methods and results: Dietary habits were assessed through validated food frequency questionnaires while various scores have been applied to evaluate the level of adherence to PHD (ELD-I, EAT, PHDI-Cacau, NB-EAT, PHDI-Bui) in 1936 Italian adults, using the Mediterranean diet (MEDI-LITE) as reference. The environmental impact was quantified as carbon and water footprints (CF and WF) using the SU-EATABLE LIFE database. Higher adherence to PHD-related indices generally corresponded to healthier nutrient profiles, higher fiber intake, and better concordance with Italian dietary recommendations, although some indices predicted lower intake of certain nutrients (e.g., vitamin B12, calcium). The MEDI-LITE index consistently predicted higher adequacy across dietary and nutrient recommendations. Absolute CF and WF showed mixed trends across indices, while energy-standardized values (per 1000 kcal) indicated lower impacts for all PHD-related scores, apart from the ELD-I. Adherence to the Mediterranean diet was also associated with favorable energy-adjusted environmental outcomes.

Conclusion: These findings reinforce the existing alignment between the intrinsic characteristics of the Mediterranean diet with both nutrition and sustainability objectives.

Background and aim: Provision of dietary counselling has been shown to improve dietary quality, cardiometabolic risk factors (CMRF) and mental health, but these beneficial effects are not well studied in Asian older women. Thus, this study aimed to assess the impact of dietary counselling on CMRF, mental health parameters and dietary quality in Singapore older women.

Methods and results: This was a 12-week, parallel design, randomized controlled trial and 39 older women (mean age of 67.5 years old) recruited from a senior activity center in Singapore were randomized to the control group (n = 19) or the intervention group (n = 20). Only subjects in the intervention group received high intensity dietary counselling for 12 weeks while the control group maintained their lifestyle. Dietary quality based on the alternate healthy eating index (AHEI)-2010 score, anthropometric measurement, CMRF and mental health parameters were measured at Week 0 and Week 12. Albeit no major changes in CMRF observed; the control group showed increase in blood N^ε-(1-carboxymethyl)-l-lysine (CML) levels, which is a well-characterized advanced glycation end product (AGE), while intervention group showed a decrease, and net changes were significantly different between groups. Additionally, the intervention group also showed decrease in depressive symptoms. Overall, no changes in dietary quality was observed.

Conclusion: The provision of dietary counselling may be a viable nutritional strategy in regulating AGE levels and potentially reducing cardiometabolic disease risk with improving mental health in Singapore older women.

Registration number of clinical trial: Registered in clinicaltrials.gov as NCT03702335 and approved by the National University of Singapore Institutional Review Board (IRB H-18-040).