Nutrition Metabolism and Cardiovascular Diseases最新文献

Background and aims: The American Heart Association released the Life's Essential 8 (LE8) metrics for cardiovascular health (CVH) promotion. This study aims to identify the association between LE8 and the risk of total, ischemic, and hemorrhagic stroke.

Methods and results: We included 37,358 participants from the European Prospective Investigation into Cancer and Nutrition- Netherlands (EPIC-NL) population-based cohort. CVH was defined using the LE8 score based on diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood pressure, and blood glucose. The overall LE8 score was categorized as low (0-49), moderate (50-79), and high (80-100). Incident (non) fatal stroke events were ascertained via record linkage. Cox regression analyses were used to assess the association between LE8 and risk of stroke. The mean age of participants was 49 years ± 12 and 75 % of participants were female. The mean LE8 score of the participants was 72.3 ± 11.2. During median follow-up of 15.3 years (interquartile range: 14.1-16.5 years), 1323 (3.5 %) total stroke, 873 (2.3 %) ischemic stroke, and 247 (0.7 %) hemorrhagic stroke cases occurred. In the adjusted models, compared to low CVH score, moderate and high CVH scores were associated with a lower risk of total stroke (hazard ratio (HR): 0.52; 95 % confidence interval (CI): 0.41-0.65 for moderate CVH and HR: 0.33; 95 %CI: 0.25-0.43 for high CVH).

Conclusions: Our data suggest a strong inverse relationship between LE8 and total, ischemic and hemorrhagic stroke among Dutch adults. Improving the LE8 score could be a valuable tool to aid in stroke prevention.

Background and aim: Increased grip strength was related to reduced risks of metabolic diseases. However, no studies have assessed whether grip strength is associated with the risk of metabolic multimorbidity. This study aimed to address this issue in Chinese adults.

Methods and results: We included 4352 participants without metabolic multimorbidity at baseline from the China Health and Retirement Longitudinal Study, who were followed up for 4 years. Metabolic multimorbidity was defined as the coexistence of two or more metabolic diseases, including diabetes, hypertension, dyslipidemia, and hyperuricaemia. Grip strength was measured and normalized by body weight. Cox regression analysis was performed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). During follow-up, 791 participants (18 %) developed metabolic multimorbidity. Grip strength was lower in individuals with metabolic multimorbidity than those without (p < 0.001). After multivariate-adjustment, each one standard deviation increase in grip strength was associated with a 10 % reduction in the risk of metabolic multimorbidity (HR: 0.90, 95 % CI: 0.83-0.97), with enhanced associations observed in females and non-drinkers. Stratified analyses showed the HRs for two, three, and four combined metabolic diseases in relation to one standard deviation increase in grip strength were 0.88 (95 % CI: 0.82-0.94), 0.74 (95 % CI: 0.61-0.89), and 0.87 (95 % CI: 0.49-1.52), respectively. Further analysis showed the pronounced association in relation to grip strength was observed for the following types (of metabolic multimorbidity): hypertension-diabetes, diabetes-hyperlipidemia, and hypertension-diabetes-hyperlipidemia.

Conclusions: Higher grip strength is associated with a lower risk of metabolic multimorbidity in middle-aged and older Chinese adults.

Background and aim: Recent studies have identified the weight-adjusted waist index (WWI) as a novel anthropometric measure strongly associated with metabolic diseases and mortality. However, it remains unclear whether cumulative exposure to WWI influences the risk of all-cause mortality among patients with type 2 diabetes mellitus (T2DM).This study aims to assess how baseline WWI and cumulative WWI are linked to all-cause mortality in patients with T2DM and their predictive value.

Methods and results: This study used data from the ACCORD/ACCORDION clinical trial. Baseline WWI and cumulative WWI were calculated for the first three follow-up visits. The Kaplan-Meier survival curve and the Cox proportional hazards regression model were employed to investigate the relationship between WWI and all-cause mortality. RCS and smooth curve fitting techniques were employed to find possible nonlinear associations. Predictive ability was assessed via AUC, NRI, and IDI. Over 6.61 median follow-up years, 1274 deaths occurred. Each 1-unit increase in baseline and cumulative WWI raised mortality risk by 15 % (HR = 1.15, 95 % CI: 1.06-1.24) and 8 % (HR = 1.08, 95 % CI: 1.05-1.11), respectively. Highest WWI quartiles had 1.29-fold (baseline) and 1.49-fold (cumulative) higher mortality risks. Cumulative WWI showed a linear association with mortality risk, while baseline WWI exhibited a U-shaped relationship (inflection point: 10.236). Cumulative WWI had superior predictive ability.

Conclusions: WWI independently predicts mortality in T2DM patients, with cumulative WWI being more stable and predictive. WWI may serve as an additional factor to be considered for long-term risk stratification and personalized management in T2DM.

Aims: Variability in sleep patterns between weekdays and weekends, along with day-to-day fluctuations, is prevalent among children and adolescents. These inconsistencies have been hypothesized to contribute to obesity within this demographic. However, a comprehensive synthesis of evidence remains lacking.

Data synthesis: This systematic review and meta-analysis focused on observational studies investigating the associations between weekday-to-weekend and day-to-day sleep differences and adiposity-related measures. Five major databases were searched from their inception to April 2024. The effect sizes and corresponding 95 % confidence intervals were pooled using the profile likelihood model and the quality effect model. Thirty-seven studies, comprising 197873 participants, met the inclusion criteria for our meta-analysis. The profile likelihood model indicated that, compared to the lowest group, individuals in the highest group of social jetlag, defined as the difference in sleep-wake timing between weekdays and weekends, showed increased BMI (body mass index)-z score (β: 0.06, 95 % CI: 0.05, 0.07), percentage fat mass (β: 0.10, 95 % CI: 0.01, 0.39), and odds of overweight/obesity (odds ratio: 1.25, 95 % CI: 1.01, 1.53). However, after adjusting for study quality, these associations became non-significant. Additionally, weekday-to-weekend bedtime difference was significantly and positively associated with BMI-z (β: 0.07, 95 % CI: 0.01, 0.10). Elevated intradaily variability was linked to the prevalence of overweight/obesity, whereas bedtime standard deviation was related to higher BMI-z, waist circumference and percentage fat mass, with limited data available.

Conclusion: Social jetlag and weekday-to-weekend bedtime differences may play a role in the development of obesity in children and adolescents. However, further studies with higher quality are needed to clarify these relationships.

Background and aim: Obesity has been considered as a risk factor for peripheral artery disease (PAD), but the impact of obesity combined with or without metabolic abnormality on risk of PAD remains unclear. This study aimed to explore the association between different metabolic phenotypes of obesity and PAD risk.

Methods and results: This study included 5440 participants without PAD at baseline. Metabolically healthy obesity (MHO) definition 1 was defined as body mass index (BMI)≥30 kg/m² without any metabolic syndrome (MetS) components, and MHO definition 2-3 were conducted for other conditions characterizing metabolic phenotypes. Cox proportional hazards regression model was established to investigate the associations between obesity with different metabolic parameters and PAD risk. During a mean follow-up of 15.6 years, 543 participants had incident PAD. Compared with participants with metabolic healthy normal weight, MHO participants did not show significantly higher risk of incident PAD without or with chronic limb ischemia, and obesity with unhealthy metabolic profile had the highest significant risk of incident PAD, with hazard ratios ranging from 1.702 (1.273-2.276) to 1.740 (1.316-2.301) (depend on MHO definition 1-3). Additionally, per 1 kg/m² increase of BMI was associated with a higher risk of PAD in metabolic unhealthy groups, and increasing of MetS components had an elevated risk of PAD, regardless of BMI status.

Conclusions: While MHO did not demonstrate a significant association with increased PAD risk, metabolically unhealthy obesity was associated with a markedly elevated risk of PAD events.

Background and aim: The gut microbiota is intricately linked to the pathogenesis of type 2 diabetes mellitus (T2DM). This review aims to explore the bidirectional interaction between antidiabetic drugs and the gut microbiota, focusing on how drugs modulate the microbiome to exert therapeutic effects and how this interaction influences common drug side effects, thereby outlining the role of pharmacomicrobiomics in personalizing T2DM treatment.

Methods and results: We comprehensively reviewed literature from PubMed, Scopus, and Embase on gut microbiota, T2DM, and antidiabetic drugs. Evidence indicates that various drug classes (e.g., metformin, sodium glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists (RAs), α-glucosidase inhibitors (AGIs)) significantly alter gut microbial composition (e.g., Bacteroidetes - to -Firmicutes ratio), functionality, and metabolite production (e.g., SCFAs, bile acids). These changes contribute not only to glycemic control but also to the drugs' cardiorenal benefits. Conversely, the microbiota influences drug metabolism and is implicated in the manifestation of typical side effects, such as gastrointestinal disturbances from metformin and acarbose.

Conclusions: The gut microbiota is a crucial mediator of both the efficacy and toxicity of antidiabetic drugs. Understanding pharmacomicrobiomics provides a novel framework for developing personalized therapeutic strategies in T2DM, potentially using an individual's microbiome as a biomarker for drug selection and side effect prediction.

Background and aims: InForma is a randomized controlled trial designed to promote weight loss in overweight or obese breast cancer survivors by encouraging adherence to a healthy diet and/or increased physical activity. This secondary analysis evaluated its effects on dietary patterns, nutrients and food groups intake, over a two-year period.

Methods and results: 260 breast cancer survivors with a BMI ≥25 kg/m² were randomized into four arms: Dietary Intervention (DI), Physical Activity Intervention (PAI), Physical Activity and Dietary Intervention (PADI), and Minimal Intervention (MI). Participants were followed for 24 months and dietary intake and adherence to the Mediterranean diet were assessed throughout validated questionnaires (EPIC-FFQ, QueMD). Principal component analysis identified three baseline dietary patterns explaining 33.6 % of the variance: MEDITERRANEAN loaded heavily on "olive oil" and "vegetables"; SWEET on "cake, sweets"; and WESTERN on "red, processed meat". Dietary factors contributing predominantly to each pattern decreased over follow-up visits, indicating an overall reduction in food consumption. Enrollment in DI and PADI arms compared to MI arm and being ≥60 years compared to <50 years, significantly predicted weight loss >5 %. Significant nutrient and energy intake reductions were observed, particularly at 6 months. Adherence to the Mediterranean diet improved in the whole study population, with no differences between intervention arms.

Conclusion: A lifestyle intervention can promote significant reductions in energy and nutrient intake, and modifications in dietary patterns. This study provides new insights into the effectiveness of personalized lifestyle interventions in promoting long-term dietary changes among breast cancer survivors.

Trial registration: ISRCTN53325751; ClinicalTrials.gov NCT02622711.

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.

Background and aims: Cardiovascular disease continues to be the leading cause of death worldwide, with atherosclerotic cardiovascular disease (ASCVD) being a major contributor. Elevated low-density lipoprotein cholesterol (LDL-C) levels are an important risk factor, which led to updated guidelines from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) in 2019 recommending lower LDL-C goals for patients at high- and very high-risk. However, many patients do not achieve the recommended LDL-C levels. The SANTORINI study was initiated to evaluate lipid management across Europe. This report presents the results of the 1-year follow-up of the Italian cohort.

Methods and results: The study included 2095 patients, with 1993 having 1-year follow-up data. At baseline, 32 % of patients were not receiving lipid-lowering therapy (LLT), decreasing to 2.1 % at follow-up. Monotherapy use increased from 34.2 % to 41.0 %, while combination therapy use increased from 33.8 % to 55.5 %, particularly with high-intensity statin and ezetimibe combinations. LDL-C levels decreased from 2.5 to 1.9 mmol/L overall, with a greater reduction in very high-risk patients. The proportion of patients achieving LDL-C goals increased from 20.8 % to 35.0 %. Cardiovascular events were more frequent in very high-risk patients, with 11 cardiovascular deaths and 80 major adverse cardiovascular events (MACE).

Conclusion: The Italian cohort of the SANTORINI study demonstrated improved LLT usage and LDL-C management, with a shift towards combination therapy. Despite these improvements, only one-third of patients achieved guideline-recommended LDL-C goals, highlighting the need to further optimise lipid-lowering strategies to reduce cardiovascular risk.

Trial registration: ClinicalTrials.gov Identifier: NCT04271280.