Nutrition Metabolism and Cardiovascular Diseases最新文献

Background and aim: Blood pressure variability (BPV) is an emerging risk factor for cardiovascular disease (CVD). However, the association between the magnitude of systolic blood pressure (SBP) fluctuations per unit time (utBPV) and CVD remains unclear. This study aimed to investigate the relationship between utBPV and incident CVD in a middle-aged and elderly population.

Methods and results: Using data from the China Health and Retirement Longitudinal Study (CHARLS), we enrolled 6134 participants aged ≥45 years without baseline CVD between 2011 and 2015. utBPV was defined as the sum of the absolute differences between consecutive SBP measurements divided by the time interval (mmHg/min). Multivariable logistic regression and restricted cubic spline analyses were employed to examine the association between utBPV and incident CVD, with subgroup analyses stratified by baseline hypertension status.During a median follow-up of 4 years, 657 incident CVD cases were observed. The results demonstrated that utBPV was a risk factor for CVD (OR: 1.018, 95 % CI: 1.005-1.031). In the non-hypertensive population, each 1-unit increase in utBPV was associated with a 2.8 % higher risk (P = 0.002). When analyzed by quartiles, the Q4 group had a 29.5 % increased risk compared to the Q1 group (95 % CI: 0.919-1.825), though the trend was not statistically significant (P = 0.166). No significant association was observed in hypertensive individuals.

Conclusions: utBPV is an independent risk factor for incident CVD in non-hypertensive adults aged 45 years and older. Given its convenience for clinical measurement, utBPV may serve as a practical tool for early CVD risk assessment.

Background and aims: To evaluate the effectiveness and metabolic effects of restricting UPF consumption in individuals with obesity undergoing energy restriction.

Methods and results: Randomized, parallel clinical trial, lasting 12 months. Participants were randomly allocated into two groups: (a) generic energy restriction (ER-G) and (b) energy restriction associated with UPF restriction (ER-UPF). Energy requirements were determined using calorimetry and accelerometry data. Anthropometric, dietary, body composition, metabolic, and biochemical data were collected. 148 individuals were included. The baseline intake of UPF was 21.16 [18.42; 23.90]% in the ER-UPF group and 23.70 [20.92; 26.48]% in the ER-G group, and, at 12 months, decreased to 13.86 % in the ER-UPF and to 20.02 % in the ER-G (p = 0.08). The ER-UPF group reduced the NOVA-UPF Score (from 2.74 [2.28; 3.20] to 1.86 [1.18; 2.53] at 12 months) compared to the ER-G (from 2.62 [2.15; 3.09] to 2.47 [1.76; 3.17]; p = 0.03). The monthly bodyweight data analysis showed that the ER-UPF group lost more weight compared to the ER-G group (final values: 82.9 [79.6; 86.2] kg vs. 86.3 [83.0; 89.7] kg; p = 0.01). Despite these findings, no changes were observed in the other outcomes.

Conclusion: The proposed intervention resulted in significantly smaller decreases in UPF intake than expected and induced only a statistically, but non-clinically significant, greater weight loss compared to the ER-G. These findings may be partially explained by the fact that individuals had low UPF intake in the baseline. Future studies should focus on populations with higher basal UPF intake.

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.

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: Cardiovascular mortality is the leading cause of death among elderly hypertensive patients. However, the reference indicators for nutritional management in this population remain a subject of debate. The aim of this study is to explore and compare the predictive value of three commonly used nutritional assessment indicators for cardiovascular mortality in elderly hypertensive patients.

Methods and results: This study included 3611 elderly hypertensive patients aged 60 and above from seven cycles of NHANES (2005-2018). The population was categorized into two groups (malnourished vs. non-malnourished) using reference cutoff values for three nutritional assessment indicators: PNI, GNRI, and CONUT score. Multivariate Cox regression and competing risk analysis were employed to compare the predictive abilities of these three indicators for cardiovascular mortality risk. Subgroup analyses were also conducted to explore whether kidney dysfunction, cardiovascular disease, or gender interacted with the three nutritional indicators. Additionally, restricted cubic splines (RCS) curves were used to explore the dose-response relationship. Decision curve analysis was applied to assess the clinical value of these three indicators in predicting cardiovascular mortality risk. Time-dependent receiver operating characteristic (ROC) curves were used to calculate the area under the curve (AUC) for each indicator's prediction of cardiovascular mortality risk at different follow-up times. Furthermore, Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) were calculated based on multivariate Cox regression models to compare the predictive ability of these models over different follow-up durations. Malnourished patients diagnosed by PNI had a 2.70 times higher risk of cardiovascular death compared to non-malnourished patients (HR: 3.70, 95 % CI: 2.54-5.38), representing the highest cardiovascular mortality risk among the three groups. Patients diagnosed with malnutrition using GNRI and CONUT score had cardiovascular mortality risks increased by 1.39 times (HR: 2.39, 95 % CI: 1.58-3.63) and 0.84 times (HR: 1.84, 95 % CI: 1.33-2.55), respectively. In the multivariate competing risks model, the results were similar to those from the Cox regression analysis. The non-restricted cubic spline plot demonstrates an L-shaped association between GNRI and PNI with cardiovascular mortality, while the COUNT score shows an inverse L-shaped association. In addition, both the Time-ROC curve's AUC and NRI support that PNI's predictive advantage for cardiovascular mortality risk gradually increases with longer follow-up time.

Conclusion: PNI has superior predictive value for cardiovascular mortality risk compared to GNRI and COUNT score, especially for long-term prognosis.

Background and aim: The formation of subendothelial macrophage-derived foam cells is a key driver of atherogenesis and contributes to the onset and progression of atherosclerosis (AS). The METTL3 gene, a central mediator of N6-methyladenosine (m6A) RNA methylation, serves as a critical regulatory node at the inflammation-metabolism nexus in immune pathophysiology.

Methods and result: This study aimed to investigate the METTL3-mediated regulatory mechanisms in subendothelial macrophage-derived foam cells formation and their association with necrosis and the pro-inflammatory properties of AS lesions. METTL3 expression was significantly higher in human carotid artery plaques compared to non-plaques. Macrophages treated with ox-LDL had an upregulated METTL3 expression, while its knockdown reduced lipid accumulation, foam cell formation, and inflammatory responses in macrophages. Myeloid Mettl3 knockout AS mice exhibited attenuated AS lesions. METTL3 knockdown elevated ABCA1, LXR-α, and ZNF771 expression. Gain- and loss-of-function studies demonstrated that METTL3 modulates lipid accumulation and inflammation partly through the ZNF771/LXR-α/ABCA1 axis. YTHDF2 knockdown increased ZNF771 levels, indicating that METTL3 cooperates with YTHDF2 to suppress ZNF771 expression, thereby inhibiting LXR-α transcription. Macrophage METTL3 exacerbates AS by suppressing cholesterol efflux and amplifying inflammation through YTHDF2-mediated downregulation of ZNF771, which attenuates the LXR-α/ABCA1 axis.

Conclusions: Our study identifies a novel METTL3-dependent mechanistic link between foam cell pathology and plaque destabilization.

Background and aims: No randomized clinical trial (RCT) using a factorial design has yet tested the hypothesis that a healthy diet and regular physical activity (PA) have synergistic effects on cardiometabolic risk.

Objective: to assess the synergy between a Mediterranean diet (MedDiet) and regular PA on postprandial triglyceridemia (TG) and other lipid risk factors.

Methods and results: In this 2x2 factorial 16-week RCT, two hundred men and women with abdominal obesity and moderate hypertriglyceridemia (TG ≥ 1.5 mmol/L) were randomly assigned to one of four groups: 1-control, 2-MedDiet only, 3-PA only and 4-MedDiet + PA. MedDiet groups were counseled to adhere to a MedDiet and received key MedDiet foods. The PA intervention targeted 150 min/week of moderate intensity exercise (65 % of measured VO₂peak). Controls were asked to maintain their usual dietary and PA habits. Postprandial serum TG was measured 4h after consumption of 35.1g fat/m² of body surface area. The dropout rate among participants (mean [SD] age, 53.8 [10.6] years; 75.5 % women) was 2.5 %. There was a small synergistic effect of the MedDiet and PA on 4h postprandial TG (P_interaction = 0.025), the MedDiet + PA group exhibiting the lowest post-intervention 4h TG concentrations of all groups. There was also evidence of a small synergistic effect between treatments in reducing apolipoprotein B concentrations (P_interaction = 0.077) measured on the last day of intervention, which was no longer observed when measured 48 h after the end of intervention.

Conclusion: The combination of a MedDiet and regular PA may have small, short-lived synergistic effects on postprandial TG concentrations and other cardiometabolic risk factors.

Background and aims: The development of carotid artery atherosclerosis differs between men and women. We examined the role of the metabolome in these sex differences in Australian adults.

Methods and results: Data is from the Australian Childhood Determinants of Adult Health (CDAH) study where 73 metabolomic biomarkers were measured at ages 26-36 years (2004-06) and carotid artery plaques were measured at ages 36-46 years (2014-19). We identified metabolites that modified the effect of sex on plaques in log-binomial regression models. Sex-specific regressions were performed for metabolic biomarkers that had a sex-specific association with plaques. There were 638 participants (53 % women, mean [SD] age 31.2 [2.6] years) in the analysis. Interactions were significant for sex with omega-3 fatty acid, docosahexaenoic acid (DHA), saturated fat percentage, and albumin on their association with plaques. Inverse associations with plaques in women, but not men, were found for saturated fat percentage in adjusted analysis (RR/SD increase 0.52 95 % CI 0.36-0.79; p < 0.001). Albumin signal area was positively associated with plaques in women in adjusted analysis (RR/SD increase 1.56 95 % CI 1.33-2.15; p = 0.006).

Conclusion: Associations between metabolic biomarkers and plaques were different in women compared with men, which may reveal sex-specific factors for atherosclerosis in women.

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.

In August 2025, the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) released an update of the dyslipidaemia management guidelines, including a brief statement on lipid-lowering dietary supplements. The document states that dietary supplements or vitamins lacking documented safety and significant LDL-cholesterol-lowering efficacy are not recommended to reduce ASCVD risk. This sentence has been interpreted by some as a broad discouragement against the use of nutraceuticals; however, the corresponding class of recommendation is "C", indicating reliance on expert opinion and routine practice rather than robust randomized evidence. The negative interpretation is further influenced by the recent EFSA opinion on red yeast rice, which raised safety concerns but does not extend to other nutraceuticals. Concerns regarding efficacy have also been shaped disproportionately by the SPORT trial, a short, single-blinded, underpowered study that compared a low-dose statin with a heterogeneous group of supplements, including some with no proven lipid-lowering effects. Notably, the guideline update does not address several nutraceuticals supported by meta-analyses-such as plant sterols, soluble fibers, berberine, artichoke extract, and bergamot-whose efficacy and safety are well documented. A more constructive reading of the update suggests encouraging clinicians to recommend only evidence-based nutraceuticals and motivating further research. These agents should be considered as adjuncts to lifestyle interventions in low-risk individuals, not as substitutes for pharmacologic therapy when indicated.