Nutrition Metabolism and Cardiovascular Diseases最新文献

Aims: The Mediterranean diet (MedD) is associated with improved metabolic health and modulation of gut microbiota (GM), both relevant to preventing type 2 diabetes (T2D) and cardiovascular disease (CVD). This systematic review and meta-analysis evaluated the effects of MedD-based dietary interventions on metabolic outcomes and GM composition in individuals at increased risk of T2D and CVD.

Data synthesis: We searched PubMed, Embase, Web of Science, Cochrane CENTRAL, and Scopus up to October 11, 2024, for randomized controlled trials (RCTs) comparing MedD-based diets to control diets in adults. Studies reporting outcomes on glucose metabolism and GM composition were included. Random-effects meta-analyses were conducted on metabolic outcomes. GM findings were synthesized descriptively due to heterogeneity in sequencing methods and taxonomic reporting. Nine RCTs (n = 1337 participants) met the inclusion criteria. Compared with control diets, MedD interventions significantly reduced glycated hemoglobin (HbA1c) (mean difference -0.18, 95 % CI = -0.35, -0.01), LDL cholesterol (-0.10, 95 % CI = -0.19, -0.00), and triglycerides -0.20, 95 % CI = -0.28, -0.12). No significant effects were observed on fasting glucose, insulin, HOMA-IR, total cholesterol, or HDL cholesterol. A qualitative GM analysis showed increased α-diversity and enrichment of health-related taxa, including Akkermansia muciniphila and Roseburia spp.

Conclusions: Our findings suggest that MedD interventions improve HbA1c, LDL cholesterol, and triglycerides, and promote beneficial GM changes. These may contribute to the metabolic benefits of the MedD. Future research should focus on individualized approaches, longer intervention periods, and mechanistic insights using multi-omics data to better understand the diet-microbiota-host interaction.

Protocol registration: PROSPERO as CRD42023428016.

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).

Background and aims: The relationship between changes in the cardiovascular health (CVH) score over time and the risk of stroke in hypertensive patients remains unclear.

Methods and results: A total of 17,631 hypertensive participants in the Kailuan study who attended three consecutive health checks in 2006, 2008, and 2010 and had no history of stroke or cancer were included. Their mean age was 56.45 ± 11.07 years, including 14,585 males (82.72 %) and 3046 females (17.28 %). The CVH score is calculated by averaging eight key cardiovascular health indicators-blood pressure, plasma glucose, blood lipids, body mass index, smoking, sleep duration, physical activity, and diet-each scored from 0 (lowest) to 100 (highest). Latent mixed models were used to determine the trajectory of CVH score during the exposure period (2006-2010) to predict stroke risk from 2010 to 2021. The Bayesian information criterion (BIC) was used to fit the model, and the five patterns were determined as the best fit. In addition, Cox proportional hazards models were used to calculate the hazard ratio (HR) and 95 % confidence interval (CI) for stroke in different trajectory groups, as they are well-suited for analyzing time-to-event data and can effectively handle censored observations, which is essential for our longitudinal study design. Five trajectories of CVH score were identified: low-stable (n = 1190; range, 43.7-41.0), moderate-increasing (n = 1035; mean increase from 46.9 to 56.1), moderate-decreasing (n = 4520; mean decrease from 56.6 to 52.1), high-stable I (n = 8551; range, 62.3-63.0), and high-stable II (n = 2335; range, 68.7-71.5). During a median follow-up of 10.94 years, 1499 cases of incident stroke were identified. After adjustment for potential confounders, and compared to the low-stable group, the HRs (95 % CIs) for stroke in the moderate-increasing, moderate-decreasing, high-stable I, and high-stable II groups were as follows: 0.76 (0.59,0.97), 0.72 (0.60,0.87), 0.51 (0.42,0.61), and 0.32 (0.25,0.41), respectively.

Conclusions: In hypertensive patients, the long-term maintenance of a high CVH score or an improvement in CVH score is associated with a lower risk of stroke than a low-stable CVH score trajectory.

Background and aims: To investigate temporal variations in ethnic demography in those with versus without type 2 diabetes across age.

Methods and results: We used the Clinical Practice Research Datalink to identify adults with newly-diagnosed type 2 diabetes, matched to ∼5 individuals without diabetes. Between 2000 and 2021, we calculated the proportion of individuals with type 2 diabetes from each ethnic group (Black/South Asian/White/Other) across age groups (18-39/40-59/≥60 years) and compared them to proportions in individuals without type 2 diabetes. We included 2,679,348 individuals with type 2 diabetes and 9,019,351 without. In individuals aged 18-39 years, between 2000 and 2021, proportions of individuals with type 2 diabetes from South Asian, White and other ethnic groups remained stable relative to individuals without diabetes, whilst proportions from Black ethnic groups became more similar over time. In older individuals (40-59/>60 years) with type 2 diabetes, the proportion of individuals from each ethnic group became more similar to the proportions in those without diabetes over time.

Conclusion: Increases in early-onset type 2 diabetes between 2000 and 2021 are not related to disproportionately increasing risks across ethnicity. Excess risk of type 2 diabetes with ethnicity diminished apart from in individuals from South Asian and other ethnic groups aged 18-39 years.

Aims: Diet quality is a multidimensional concept linked to health outcomes, but its definition varies across studies and cultures. This perspective examines how diet quality is defined in scientific literature integrating evidence from dietary guidelines, diet quality indices, and recent research.

Data synthesis: Core principles consistently defining diet quality are adequacy, diversity, balance, and moderation. These translate into diets that meet nutrient requirements, include a variety of foods across food groups, ensure appropriate macronutrient distribution, and limit added sugars, salt, and unhealthy fats. Nutrient density and macronutrient quality further refine the concept, with emphasis on unsaturated fats and high-fiber carbohydrates. High-quality diets generally prioritize plant-based foods over animal products. Emerging dimensions extend diet quality beyond health to include environmental sustainability, degree of food processing, and socio-cultural factors such as cultural acceptability, affordability, and equitable access to food.

Conclusions: Diet quality is a holistic construct integrating nutritional health, sustainability, safety, and cultural relevance. It is not limited to a single dietary model, as multiple patterns can achieve high quality when these criteria are met, with the Mediterranean diet as a well-established example. Future evaluations should integrate nutritional, environmental, food security, food processing and cultural indicators.

Background and aim: Evidence has linked long-term outdoor air pollution with cardiovascular disease (CVD), while potential causal relationships of air pollutant exposure with CVD and mediation roles of metabolic risk factors remain under-explored.

Methods and results: We evaluated time-weighted exposure to fine particulate matter (PM_2.5), ozone (O₃), and PM_2.5 components among 21,102 participants from the CHCN-BTH cohort. Well-validated online databases, participants' outdoor activity durations, and pollutant infiltration factors were used to assess time-weighted exposure. We employed the targeted maximum likelihood estimation (TMLE) approach to estimate potential causal relationships between air pollutants and incident CVD. High-dimensional mediation analyses were used to further investigate the mediating roles of metabolic risk factors. Compared with exposures at first quartile concentration (Q1), participants in highest quartile of exposure (Q4) to air pollutants exhibited significantly increased risk of CVD incidence: PM_2.5 (RR: 3.453, 95%CI: 2.674-4.460), warm-season O₃ (1.332, 1.016-1.746), black carbon (BC) (4.885, 2.866-8.327), ammonium (NH₄⁺) (1.959, 1.378-2.785), nitrate (NO₃^-) (1.679, 1.117-2.525), sulfate (SO₄^2-) (2.860, 2.211-3.701), and organic matter (OM) (4.070, 2.283-7.253). High-dimensional mediation analysis indicates that high-density lipoprotein-cholesterol (HDL-C) played a mediating role in the total effects, accounting for 10.46%, 24.96%, 39.35%, and 24.74% of PM_2.5, BC, SO₄^2-, and OM, respectively. Systolic blood pressure (SBP) mediated 13.41% of the total effect attributable to warm-season O₃.

Conclusions: This study provides potential causal linkage between air pollutants and CVD risk. Notably, our findings reveal roles of HDL-C and SBP in mediating the effects of CVD induced by air pollutant exposures.

Background and aim: To explore food group intake and adherence to the Mediterranean Diet (MD) in a representative sample of 2833 middle-aged and older adults from the HERMEX study.

Methods and results: This cross-sectional study utilized a food frequency questionnaire to assess food group intake and measured MD adherence using the MD Score. Sociodemographic, anthropometric, and clinical characteristics were also analyzed. Among participants, 74 % were living with overweight or obesity, 69.9 % were non-smokers, and 88 % showed medium-high adherence to the MD. Compared to the national dietary recommendations issued by the Spanish Agency for Food Safety and Nutrition (AESAN), 76 % had carbohydrate intake below recommended levels (average intake: 35.4 %), whereas 73.5 % consumed protein at 16.6 % of total energy intake. Only 2 % of participants adhered to the fat intake recommendation (<35 % of total energy). Consumption of fruits, vegetables, cereals, potatoes, and eggs was below recommendations, while intake of legumes, nuts, fish, seafood, and dairy met or nearly met the recommendations. Meat consumption exceeded recommendations. Macronutrient intake (carbohydrates, protein, fat, and fiber) was similar across BMI groups. However, participants with obesity consumed fewer nuts, whereas those with normal weight had a higher intake of red wine compared to individuals with overweight (p < 0.05). MD adherence was similar across BMI groups (34 points on a 0-55 scale).

Conclusions: Prevalence of overweight and obesity was high despite medium-high adherence to the MD. Overall, caloric intake and food consumption patterns were consistent across BMI groups, with notable differences in nut and red wine intake.

Aims: During the past four decades, the relationship between black tea consumption and coronary heart disease (CHD) risk has been assessed in numerous studies, with conflicting results. We aimed to perform a meta-analysis to systematically examine the data published on the association in cohort studies.

Data synthesis: We searched the PubMed and EMBASE databases for studies conducted from 1966 to August 2024. Study-specific risk estimates were combined by using a random-effects model. Dose-response relationship was assessed by a 2-stage random-effects dose-response meta-analysis. A total of 14 studies, with 16,990 CHD cases among 958,477 participants, were included. The overall results showed a significant 11 % reduction in CHD risk with the highest black tea consumption [summary relative risk (RR): 0.89; 95 % confidence interval (CI): 0.79, 0.99]; there was a significant heterogeneity (P = 0.007, I² = 50.6 %). In the subgroup analysis by region, the protective effect was observed in the European, but not in the USA. We observed a nonlinear association between black tea consumption and CHD risk (P for nonlinearity = 0.0011). Compared with non-consumers, the RRs (95 % CI) of CHD across levels of black tea consumption were 0.95 (0.91, 0.99) for 2 cups/day, 0.91 (0.86, 0.96) for 4 cups/day, 0.89 (0.83, 0.95) for 6 cups/day, 0.86 (0.78, 0.96) for 8 cups/day, and 0.84 (0.72, 0.98) for 10 cups/day.

Conclusions: This meta-analysis demonstrates that black tea consumption was associated with a reduced CHD risk. Our results support recommendations for black tea consumption to the primary prevention of CHD.

Systematic review registration: PROSPERO CRD42023395469.

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.