Nutrition Metabolism and Cardiovascular Diseases最新文献

Background and aims: Combined therapy, sodium-glucose cotransporter 2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP1ra) reduce all-cause mortality in patients with diabetes. We aimed to analyse the differential behaviour of combined therapy between women and men regarding all-cause mortality.

Methods and results: This is a retrospective observational cohort study. Using "Big data" according to electronic medical records in the Santiago-Barbanza health area, which covers 450,000 patients. Out of 15,118 patients, 41 % were women. The median follow-up was 33 months. Women were older (71 [62-78] vs. 67 [59-75], p: <0.001) and with a higher incidence of obesity (53 % vs. 41 %, p: <0.001), meanwhile, men presented more coronary artery disease (CAD) (19 % vs. 9 %, p: <0.001). The multinomial propensity score and multivariate Cox regression were used for statistical analysis. All-cause mortality was compared between combined vs. monotherapy in women or men. Men had a higher risk of all-cause mortality than women in this population (HR [95 % CI] 1.50 [1.28-1.75]). Combined regarding monotherapy (GLP1ra (HR [95 % CI] 0.19 [0.14-0.27]), or SGLT2i (HR [95 % CI] 0.30 [0.23-0.40]), and treatment duration (HR [95 % CI] 0.95 [0.94-0.96] were associated with lower risk of all-cause mortality; with higher benefit in women (GLP1ra (HR [95 % CI] 0.14 [0.08-0.27]), or SGLT2i (HR [95 % CI] 0.18 [0.11-0.30]) regarding men (HR [95 % CI] 0.25 [0.16-0.40] for GLP1ra, and HR [95 % CI] 0.41 [0.29-0.58] for SGLT2i).

Conclusions: Combined therapy vs. monotherapy was associated with a lower risk of all-cause mortality in patients regardless of sex. Nevertheless, a higher benefit was observed in women regarding men.

Background and aim: The atherogenic index of plasma (AIP), calculated as log10 (triglyceride/high-density lipoprotein cholesterol, TG/HDL-C), has been proposed as a reliable marker for evaluating lipid-related atherosclerotic risk. However, the association between AIP and new-onset hypertension (HTN) remains controversial. This study aimed to investigate the relationship between AIP and new-onset HTN and to explore the potential mediating role of body mass index (BMI).

Methods and results: This prospective cohort study included adult participants without HTN at baseline who were enrolled from a large community-based health screening program between 2014 and 2023. Baseline clinical characteristics, anthropometric parameters, and biochemical indices were collected. Restricted cubic spline (RCS) analysis was used to determine the inflection point of AIP for grouping participants into low- and high-AIP categories. Propensity score matching (PSM) was applied to balance baseline confounders between groups. The cumulative incidence of HTN was compared using cumulative risk curves and log-rank tests. Multivariate Cox proportional hazards models were employed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). Mediation analysis was performed to assess whether BMI mediated the relationship between AIP and new-onset HTN. The results showed participants with higher baseline or cumulative AIP values had a significantly higher risk of developing HTN (log-rank p < 0.001). After multivariable adjustment, individuals in the high-AIP group exhibited an elevated risk of new-onset HTN (HR = 1.42, 95 % CI 1.25-1.61, p < 0.001) compared with those in the low-AIP group. BMI partially mediated the association between AIP and HTN, accounting for approximately 5.76 % of the total effect (p < 0.001).

Conclusions: A high AIP increased the risk of new HTN. BMI potentially mediated the association between the AIP and new-onset HTN.

Background and aim: Cardiorespiratory fitness, measured as peak oxygen uptake (VO₂peak), is a key marker of metabolic health in youth, but age- and sex-specific diagnostic thresholds for identifying elevated cardiometabolic risk (CMR) remain undefined. This study aimed to establish age- and sex-specific VO₂peak cut-points for elevated CMR by (i) conducting a cross-sectional diagnostic analysis that compared the diagnostic accuracy of commonly used VO₂peak estimation equations (Barnett, Léger, Matsuzaka) to select the best-performing index, and (ii) performing a systematic review and meta-analysis to synthesize and validate findings.

Methods and results: To establish diagnostic thresholds of VO₂peak for identifying CMR in youth, we conducted a two-part study. First, a cross-sectional analysis was performed using data from 1059 children aged 8-11 years. Second, a systematic review and meta-analysis were conducted to synthesize evidence from existing observational studies. The literature search included four databases. Eligible studies included cross-sectional or cohort designs with participants aged 3-18 years, and reported cardiorespiratory fitness as VO₂peak along with composite measures of CMR. We included 14 studies comprising a total of 20,780 children and adolescents. Optimal VO₂peak thresholds for identifying elevated CMR were 43.2 mL/kg/min for boys and 41.9 mL/kg/min for girls aged <13 years, and 40.0 mL/kg/min for boys and 38.5 mL/kg/min for girls aged ≥13. These thresholds demonstrated moderate-to-strong diagnostic performance, and corresponded to the 20th-40th percentiles of international normative data.

Conclusion: We report novel age- and sex-specific VO₂peak thresholds for elevated CMR in youth, with good diagnostic performance, to aid early identification and prevention.

Background and aims: The Mediterranean diet (MD) has been associated with better glycaemic control in children with type 1 diabetes mellitus (T1DM) and favourable microbiome profiles in healthy individuals. However, it remains unclear whether MD adherence is associated with glycaemic control via microbiome. This study examined the relationships among MD adherence, gut microbiome, and glycaemic control in adults with T1DM and assessed the microbiome's ability to predict clinical and dietary outcomes.

Methods and results: In a cross-sectional study of 253 adults with T1DM, dietary intake was assessed using the EPIC food frequency questionnaire, and MD adherence was measured using the rMED score. Participants were stratified by adherence level (low, medium, high). Glycaemic control was evaluated using HbA1c and CGM metrics. Shotgun metagenomic sequencing of stool samples (n = 103) assessed the gut microbiome. Statistical analyses included ANOVA, PERMANOVA, LEfSe, and machine learning modeling. Higher MD adherence was associated with lower HbA1c levels (7.1 % vs 7.7 %; p < 0.001), greater time in range (67.0 % vs 59.4 %; p-trend = 0.03), and higher HDL cholesterol (1.62 vs 1.39 mmol/L; p = 0.01). High MD adherence was linked to a greater abundance of bacterial species such as Faecalibacterium prausnitzii. Both high MD adherence and lower HbA1c were associated with distinct microbiome functional pathways. Microbiome-based machine learning models predicted dietary patterns and clinical metrics.

Conclusions: In adults with T1DM, greater MD adherence is associated with better glycaemic control and a favourable gut microbiome. Specific microbial pathways may underlie these associations. Integrating diet and microbiome data supports personalized care. The study was registered at ClinicalTrials.gov with the identifier NCT05936242.

The integrity of the vascular endothelium is fundamental to regulating cardio-metabolic and neurological functions. Endothelial dysfunction (ED) is a key driver of atherosclerosis and is strongly linked to the pathogenesis of heart disease, peripheral arterial disease, and stroke. This review describes the relationship between dietary patterns and endothelial health, focusing on observational and experimental studies that investigate the protective effects of healthy dietary patterns in the maintenance of endothelial integrity and prevention of ED. Plant-based diets, including Mediterranean and Dietary Approaches to Stop Hypertension (DASH) dietary patterns, have been linked to improvement of endothelial function through multiple mechanisms such as increased nitric oxide bioavailability, reduced oxidative stress and inflammation, and fostering a healthy gut microbiome. Traditional Japanese, Nordic, and Palaeolithic dietary patterns also show potential cardiovascular benefits through improved vascular biomarkers and significant anti-inflammatory effects, though evidence on effects on endothelial function remains less established. The consequences of poor endothelial health extend to all systems, and the brain is one of the organs crucially affected by ED. ED has been increasingly recognised as a critical contributor to cognitive decline, dementia, and stroke, largely accounted and explained by mechanisms impairing cerebral blood flow, neuronal metabolism, neuro-vascular coupling and compromised integrity of the blood-brain barrier. This review highlights the importance of maintaining endothelial health as a protective strategy for cognitive function and reduction of dementia risk. Adherence to dietary patterns with protective effects on endothelial integrity may represent an effective strategy to promote lifelong health for both the heart and brain.

Background and aim: Reduction in liver fibrosis, as assessed by liver stiffness measurement (LSM) on serial vibration-controlled transient elastography (VCTE) examinations, may have beneficial effects on development of liver-related and cardiovascular outcomes in individuals with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods and results: A prospective cohort of 288 individuals with type 2 diabetes and MASLD performed 2 VCTE exams at least two years apart, and significant LSM reduction was defined as >20 % decrease. Logistic regression assessed the independent correlates of having LSM reduction and multivariable Cox analyses assessed associations between LSM reduction and liver-related and cardiovascular outcomes. Eighty-six individuals (30 %) had a reduction in LSM >20 %; its independent correlates were a lower aspartate aminotransferase (AST ≤20 U/L) and HbA_1c (≤7 %) levels closest to the 2nd VCTE exam, the use of statins and having the wild CC genotype of the PNPLA3 gene. Over a median follow-up of 6 years, there were 22 liver-related and 28 cardiovascular events. Reduction in LSM was associated with a significant 78 % lower risk of liver events and 62 % lower cardiovascular risk.

Conclusions: Using statins and achieving good glycemic control are associated with higher chances of having liver fibrosis reduction, and serum AST reduction may be a biomarker of such improvement. Having LSM reduction on serial VCTE examinations is associated with lower risks of adverse cardiovascular and liver-related events and, if further confirmed, it might be a treatment goal in individuals with type 2 diabetes and MASLD.

Background and aims: Inflammation is an established cardiovascular disease risk factor, but its role in the link between food environments and cardiovascular risk remains unexplored. We aimed to study longitudinal associations between residential fast food outlets (FFOs) and inflammatory markers in US females from the Nurses' Health Study II with stored blood and residential addresses.

Methods and results: We counted FFOs within 1500-m buffers around each address in 1998 and 2010. In samples collected at two time points (1999, 2011), we measured C-reactive protein (CRP, N = 1350), Interleukin-6 (IL-6, N = 809), and adiponectin (N = 836). We performed multivariable linear regression with repeated measures to study changes in FFOs and inflammatory markers and multivariable linear regression analyses to study FFOs count in 1998 and changes in inflammatory markers between 1999 and 2011. Models were adjusted for age, race/ethnicity, partners' education, smoking, neighborhood socioeconomic status (nSES), and population density. We explored effect modification by nSES and population density. No associations were observed in linear mixed models (e.g., CRP (β: 0.00, 95 %CI: 0.01,0.01) or in linear models including changes in inflammatory outcomes (e.g., CRP (β:0.00, 95 %CI: 0.01, 0.02). We also observed no effect modification for nSES or population density.

Conclusion: In conclusion, we found no evidence for longitudinal associations between FFOs count and inflammatory markers in this study.

Background and aims: Evidence on the association of Body Roundness Index (BRI), an anthropometric indicator of body fat and visceral adiposity, with cardiometabolic multimorbidity (CMM) remains limited. This study aimed to compare the associations and predictive utilities of BRI and body mass index (BMI) for CMM.

Methods and results: We analyzed data from 3348 adults (mean age 63 years; 45.1 % male) in the English Longitudinal Study of Ageing, free of major cardiometabolic conditions at baseline (2008-2009). BRI was derived from height and waist circumference. CMM was defined as having ≥2 of the following by 2021-2023: hypertension, cardiovascular disease, diabetes, or stroke. Multivariable odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated. During 12-15 years of follow-up, 197 participants (5.9 %) developed CMM. Both BRI and BMI showed linear dose-response relationships with CMM risk (p for nonlinearity >0.05). Higher BRI was associated with increased odds of CMM (per 1-SD: OR 1.33, 95 % CI 1.17-1.53; top vs bottom tertile: OR 1.89, 95 % CI 1.23-2.90), with similar findings for BMI. Adding BRI to conventional risk models modestly improved discrimination (ΔC-index = 0.0082, p = .26) and significantly improved model fit (p < .001). Gains for BMI were smaller (ΔC-index = 0.0049, p = .46), with BRI offering a slightly greater improvement in predictive performance (Δ = 0.0033, p = .40).

Conclusion: Both BRI and BMI were independently and linearly associated with an increased risk of CMM. BRI showed slightly stronger predictive performance than BMI.