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LeBlanc KE, Baer-Sinnott S, Lancaster KJ, Campos H, Lau KHK, Tucker KL, Kushi LH, Willett WC. Perspective: Beyond the Mediterranean Diet-Exploring Latin American, Asian, and African Heritage Diets as Cultural Models of Healthy Eating. Adv Nutr 2024; 15:100221. [PMID: 38604411 PMCID: PMC11087705 DOI: 10.1016/j.advnut.2024.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
The Mediterranean diet is a well-studied cultural model of healthy eating, yet research on healthy models from other cultures and cuisines has been limited. This perspective article summarizes the components of traditional Latin American, Asian, and African heritage diets, their association with diet quality and markers of health, and implications for nutrition programs and policy. Though these diets differ in specific foods and flavors, we present a common thread that emphasizes healthful plant foods and that is consistent with high dietary quality and low rates of major causes of disability and deaths. In this perspective, we propose that nutrition interventions that incorporate these cultural models of healthy eating show promise, though further research is needed to determine health outcomes and best practices for implementation.
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Affiliation(s)
| | | | - Kristie J Lancaster
- Department of Nutrition and Food Studies, New York University, New York, NY, United States
| | - Hannia Campos
- Department of Nutrition, Harvard University T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Katherine L Tucker
- Department of Biomedical & Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, United States
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Walter C Willett
- Department of Nutrition, Harvard University T.H. Chan School of Public Health, Boston, MA, United States
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Mozaffarian D. Plant-Based Diets and Diabetes Risk: Which Foods, What Mechanisms? Diabetes Care 2024; 47:787-789. [PMID: 38640411 DOI: 10.2337/dci24-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Affiliation(s)
- Dariush Mozaffarian
- Food Is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Fontanelli MDM, Batista LD, Martinez-Arroyo A, Mozaffarian D, Micha R, Rogero MM, Fisberg RM, Sarti FM. Pragmatic Carbohydrate Quality Metrics in Relation to Glycemic Index, Glycemic Load, and Front-of-Pack Warning Labels in Grain Foods. Foods 2024; 13:1299. [PMID: 38731670 PMCID: PMC11083290 DOI: 10.3390/foods13091299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
The challenges in the characterization of the nutritional quality of grain foods comprise obstacles to public health actions toward promotion of healthier grain-based foods. The present study investigated how carbohydrate metrics related to glycemic index (GI), glycemic load (GL), and warning labels of grain foods consumed by individuals living in São Paulo, Brazil. Information on intake of grain foods at individual level was obtained using 24 h recalls within a cross-sectional population-based survey conducted in 2015. There were 244 unique grain products reported by individuals in the survey, assessed through four metrics of carbohydrate quality, considering contents per 10 g of total carbohydrate: (1) ≥1 g fiber, (2) ≥1 g fiber and <1 g free sugars, (3) ≥1 g fiber and <2 g free sugars, and (4) ≥1 g fiber, and <2 g free sugars per 1 g of fiber. Outcomes included GI, GL, and inclusion of warning labels proposed by the Brazilian National Health Surveillance Agency (ANVISA), the Chilean Ministry of Health (1st and 3rd stages), and the Pan American Health Organization (PAHO). Metrics identified products with lower mean GI (-12.8 to -9.0 [p-values < 0.001]), and GL (-12.5 to -10.3 [p-values < 0.001]). Warning systems showed a certain degree of discrimination between products according to the metrics (p-value < 0.01 each); however, >50% of products with good nutritional quality according to the carbohydrate metrics still would receive warnings. Findings suggest that carbohydrate metrics identified products with lower GI and GL, and current warning labels may not adequately capture overall nutritional quality of grain foods.
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Affiliation(s)
| | - Lais Duarte Batista
- School of Public Health, University of São Paulo, São Paulo 05508-030, SP, Brazil; (L.D.B.); (M.M.R.); (R.M.F.)
| | - Angela Martinez-Arroyo
- Food Behavior Research Center (CEIC), Faculty of Pharmacy, School Nutrition and Dietetics, University of Valparaíso, Valparaíso 2381850, Chile;
| | - Dariush Mozaffarian
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA; (D.M.); (R.M.)
| | - Renata Micha
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA; (D.M.); (R.M.)
- Department of Food Science and Nutrition, University of Thessaly, 38334 Volos, Greece
| | - Marcelo Macedo Rogero
- School of Public Health, University of São Paulo, São Paulo 05508-030, SP, Brazil; (L.D.B.); (M.M.R.); (R.M.F.)
| | - Regina Mara Fisberg
- School of Public Health, University of São Paulo, São Paulo 05508-030, SP, Brazil; (L.D.B.); (M.M.R.); (R.M.F.)
| | - Flavia Mori Sarti
- School of Arts, Sciences and Humanities (EACH), University of São Paulo, São Paulo 03828-000, SP, Brazil;
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Willett WC, Hu FB, Forouhi NG. A healthy diet should consider environmental impact. Eur Heart J 2024; 45:1375. [PMID: 38447170 DOI: 10.1093/eurheartj/ehae134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Affiliation(s)
- Walter C Willett
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Ave., Boston, MA 02115, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Ave., Boston, MA 02115, USA
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Wilcox NS, Amit U, Reibel JB, Berlin E, Howell K, Ky B. Cardiovascular disease and cancer: shared risk factors and mechanisms. Nat Rev Cardiol 2024:10.1038/s41569-024-01017-x. [PMID: 38600368 DOI: 10.1038/s41569-024-01017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/12/2024]
Abstract
Cardiovascular disease (CVD) and cancer are among the leading causes of morbidity and mortality globally, and these conditions are increasingly recognized to be fundamentally interconnected. In this Review, we present the current epidemiological data for each of the modifiable risk factors shared by the two diseases, including hypertension, hyperlipidaemia, diabetes mellitus, obesity, smoking, diet, physical activity and the social determinants of health. We then review the epidemiological data demonstrating the increased risk of CVD in patients with cancer, as well as the increased risk of cancer in patients with CVD. We also discuss the shared mechanisms implicated in the development of these conditions, highlighting their inherent bidirectional relationship. We conclude with a perspective on future research directions for the field of cardio-oncology to advance the care of patients with CVD and cancer.
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Affiliation(s)
- Nicholas S Wilcox
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Uri Amit
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob B Reibel
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eva Berlin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kendyl Howell
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Mozaffarian D, Callahan EA, Glickman D, Maitin-Shepard M. Developing a national nutrition policy strategy to advance cardiometabolic health and health equity. Cell Metab 2024; 36:651-654. [PMID: 38569468 DOI: 10.1016/j.cmet.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Dariush Mozaffarian
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; Tufts University School of Medicine and Division of Cardiology, Tufts Medical Center, Boston, MA, USA.
| | - Emily A Callahan
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dan Glickman
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; Bipartisan Policy Center, Washington, DC, USA
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Yan J, Zhou J, Ding Y, Tu C. Dietary inflammatory index is associated with metabolic dysfunction-associated fatty liver disease among United States adults. Front Nutr 2024; 11:1340453. [PMID: 38559780 PMCID: PMC10978608 DOI: 10.3389/fnut.2024.1340453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background Metabolic dysfunction-associated fatty liver disease (MAFLD) is presently the most prevalent chronic liver disorder globally that is closely linked to obesity, dyslipidemia metabolic syndrome, and type 2 diabetes mellitus (T2DM). Its pathogenesis is strongly associated with inflammation, and diet is a major factor in reducing inflammation. However, current research has focused primarily on exploring the relationship between diet and NAFLD, with less research on its link to MAFLD. Methods In this research, using dietary inflammatory index (DII) as a measure to assess dietary quality, we analyzed the relationship between diet and MAFLD. Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018, including 3,633 adults with complete DII and MAFLD, were used to develop cross-sectional analyses. Logistic regression analysis was adapted for investigating the relationship between DII and MAFLD development. Additionally, subgroup analysis and threshold effect analysis were carried out. Results A positive link between DII and MAFLD was found in the fully adjusted model (OR = 1.05; 95%CI, 1.00-1.11, p < 0.05). Subgroup analysis indicated that there was no significant dependence for the connection between DII and MAFLD except for the subgroup stratified by age. Compared with other age groups, people with MAFLD had 20% higher DII scores than non-MAFLD participants in those aged 20-41 years old (OR = 1.20; 95%CI, 1.08-1.33, p < 0.001). Furthermore, we found a U-shaped curve with an inflection point of 3.06 illustrating the non-linear connection between DII and MAFLD. Conclusion As a result, our research indicates that pro-inflammatory diet may increase the chance of MAFLD development, thus improved dietary patterns as a lifestyle intervention is an important strategy to decrease the incidence of MAFLD.
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Affiliation(s)
- Jing Yan
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
- School of Public Health, Fudan University, Shanghai, China
| | - Jun Zhou
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
| | - Yuanyuan Ding
- Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China
| | - Chuantao Tu
- Department of Gastroenterology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Cha E, Choi Y, Bancks M, Faulkner MS, Dunbar SB, Umpierrez GE, Reis J, Carnethon MR, Shikany JM, Yan F, Jacobs DR. Longitudinal changes in diet quality and food intake before and after diabetes awareness in American adults: the Coronary Artery Risk Development in Young Adults (CARDIA) study. BMJ Open Diabetes Res Care 2024; 12:e003800. [PMID: 38453235 PMCID: PMC10921527 DOI: 10.1136/bmjdrc-2023-003800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/15/2023] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Limited longitudinal research is available examining how American adults make dietary changes after learning they have diabetes. We examined the associations between diabetes awareness and changes in dietary quality and food intake in a prospective cohort from the Coronary Artery Risk Development in Young Adults (CARDIA) study. RESEARCH DESIGN AND METHODS A nested case-control design was used. In the original CARDIA study, black and white participants were recruited from four US urban areas and partitioned into one control group (no diabetes over 30-year follow-up) and three case groups (early-onset, intermediate-onset, later-onset diabetes groups) based on timing of diagnosis and first awareness of diabetes. Estimated mean A Priori Diet Quality Score (APDQS), and food subgroup intake were examined at three CARDIA examinations (year (Y)0, Y7, and Y20). The mean APDQS with 95% CIs and food intake (servings/day) were compared across the one control group and three case groups using exam-specific and repeated measures linear regression. RESULTS Among 4576 participants (mean age: 25±4 years; 55% female; 49% black race), 653 incident cases (14.3%) of diabetes were observed over 30 years. APDQS was lowest at Y0 when the diabetes-free participants were aged 18-30 years (61.5-62.8), but increased over 20 years with advancing age across all groups (64.6-73.3). Lower APDQS in young adulthood was associated with a higher incidence of diabetes later in life. Diabetes awareness was associated with a net increase of 2.95 points in APDQS. The greatest increase of APDQS was when people learned of their diabetes for the first time (an increase of 5.71 in early-onset and 6.64 in intermediate-onset diabetes groups, respectively). CONCLUSIONS Advancing age and diabetes awareness were associated with more favorable dietary changes leading to improved diet quality. Optimal diet quality and healthy food intake in young adulthood seem important to prevent diabetes later in life.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, The Republic of Korea
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Yuni Choi
- Columbia University Irving Medical Center, New York, New York, USA
| | - Michael Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | | | - Jared Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University, Evanston, Illinois, USA
| | - James M Shikany
- The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Fengxia Yan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - David R Jacobs
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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Laamanen SE, Eloranta AM, Haapala EA, Sallinen T, Schwab U, Lakka TA. Associations of diet quality and food consumption with serum biomarkers for lipid and amino acid metabolism in Finnish children: the PANIC study. Eur J Nutr 2024; 63:623-637. [PMID: 38127151 PMCID: PMC10899368 DOI: 10.1007/s00394-023-03293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To investigate the associations of overall diet quality and dietary factors with serum biomarkers for lipid and amino acid metabolism in a general population of children. METHODS We studied 194 girls and 209 boys aged 6-8 years participating in the Physical Activity and Nutrition in Children study. Food consumption was assessed by 4-day food records and diet quality was quantified by the Finnish Children Healthy Eating Index (FCHEI). Fasting serum fatty acids, amino acids, apolipoproteins, as well as lipoprotein particle sizes were analyzed with high-throughput nuclear magnetic resonance spectroscopy. Data were analyzed using linear regression adjusted for age, sex, and body fat percentage. RESULTS FCHEI was directly associated with the ratio of polyunsaturated (PUFA) to saturated fatty acids (SFA) (PUFA/SFA), the ratio of PUFA to monounsaturated fatty acids (MUFA) (PUFA/MUFA), the ratio of PUFA to total fatty acids (FA) (PUFA%), the ratio of omega-3-fatty acids to total FA (omega-3 FA%), and inversely associated with the ratio of MUFA to total FA (MUFA%), alanine, glycine, histidine and very-low density lipoprotein (VLDL) particle size. Consumption of vegetable oils and vegetable-oil-based margarine (≥ 60% fat) was directly associated with PUFA/SFA, PUFA/MUFA, PUFA%, the ratio of omega-6 FA to total FA (omega-6 FA%), and inversely associated with SFA, MUFA, SFA to total FA (SFA%), MUFA%, alanine and VLDL particle size. Consumption of high-fiber grain products directly associated with PUFA/SFA, PUFA/MUFA, omega-3 FA%, omega-6 FA%, PUFA% and inversely associated with SFA and SFA%. Fish consumption directly related to omega-3 FA and omega-3 FA%. Consumption of sugary products was directly associated with histidine and VLDL particle size. Vegetable, fruit, and berry consumption had direct associations with VLDL particle size and the ratio of apolipoprotein B to apolipoprotein A1. Consumption of low fat (< 1%) milk was directly associated with phenylalanine. A higher consumption of high-fat (≥ 1%) milk was associated with lower serum MUFA/SFA and higher SFA%. Sausage consumption was directly related to SFA% and histidine. Red meat consumption was inversely associated with glycine. CONCLUSIONS Better diet quality, higher in intake of dietary sources of unsaturated fat and fiber, and lower in sugary product intake were associated with more favorable levels of serum biomarkers for lipid and amino acid metabolism independent of adiposity. TRIAL REGISTRATION ClinicalTrials.gov: NCT01803776, registered March 3, 2013.
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Affiliation(s)
- Suvi E Laamanen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Aino-Maija Eloranta
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Eero A Haapala
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Taisa Sallinen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Timo A Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
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Mozaffarian D, Aspry KE, Garfield K, Kris-Etherton P, Seligman H, Velarde GP, Williams K, Yang E. "Food Is Medicine" Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:843-864. [PMID: 38383100 DOI: 10.1016/j.jacc.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
"Food Is Medicine" (FIM) represents a spectrum of food-based interventions integrated into health care for patients with specific health conditions and often social needs. Programs include medically tailored meals, groceries, and produce prescriptions, with varying levels of nutrition and culinary education. Supportive advances include expanded care pathways and payment models, e-screening for food and nutrition security, and curricular and accreditation requirements for medical nutrition education. Evidence supports positive effects of FIM on food insecurity, diet quality, glucose control, hypertension, body weight, disease self-management, self-perceived physical and mental health, and cost-effectiveness or cost savings. However, most studies to date are quasiexperimental or pre/post interventions; larger randomized trials are ongoing. New national and local programs and policies are rapidly accelerating FIM within health care. Remaining research gaps require rigorous, iterative evaluation. Successful incorporation of FIM into health care will require multiparty partnerships to assess, optimize, and scale these promising treatments to advance health and health equity.
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Affiliation(s)
- Dariush Mozaffarian
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
| | - Karen E Aspry
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Kathryn Garfield
- Center for Health Law and Policy Innovation, Harvard Law School, Cambridge, Massachusetts, USA
| | | | | | - Gladys P Velarde
- University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Kim Williams
- University of Louisville, Louisville, Kentucky, USA
| | - Eugene Yang
- University of Washington School of Medicine, Seattle, Washington, USA
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Jenkins DJA, Willett WC, Yusuf S, Hu FB, Glenn AJ, Liu S, Mente A, Miller V, Bangdiwala SI, Gerstein HC, Sieri S, Ferrari P, Patel AV, McCullough ML, Le Marchand L, Freedman ND, Loftfield E, Sinha R, Shu XO, Touvier M, Sawada N, Tsugane S, van den Brandt PA, Shuval K, Khan TA, Paquette M, Sahye-Pudaruth S, Patel D, Siu TFY, Srichaikul K, Kendall CWC, Sievenpiper JL. Association of glycaemic index and glycaemic load with type 2 diabetes, cardiovascular disease, cancer, and all-cause mortality: a meta-analysis of mega cohorts of more than 100 000 participants. Lancet Diabetes Endocrinol 2024; 12:107-118. [PMID: 38272606 DOI: 10.1016/s2213-8587(23)00344-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND There is debate over whether the glycaemic index of foods relates to chronic disease. We aimed to assess the associations between glycaemic index (GI) and glycaemic load (GL) and type 2 diabetes, cardiovascular disease, diabetes-related cancers, and all-cause mortality. METHODS We did a meta-analysis of large cohorts (≥100 000 participants) identified from the Richard Doll Consortium. We searched the Cochrane Library, MEDLINE, PubMed, Embase, Web of Science, and Scopus for cohorts that prospectively examined associations between GI or GL and chronic disease outcomes published from database inception to Aug 4, 2023. Full-article review and extraction of summary estimates data were conducted by three independent reviewers. Primary outcomes were incident type 2 diabetes, total cardiovascular disease (including mortality), diabetes-related cancers (ie, bladder, breast, colorectal, endometrial, hepatic, pancreatic, and non-Hodgkin lymphoma), and all-cause mortality. We assessed comparisons between the lowest and highest quantiles of GI and GL, adjusting for dietary factors, and pooling their most adjusted relative risk (RR) estimates using a fixed-effects model. We also assessed associations between diets high in fibre and whole grains and the four main outcomes. The study protocol is registered with PROSPERO, CRD42023394689. FINDINGS From ten prospective large cohorts (six from the USA, one from Europe, two from Asia, and one international), we identified a total of 48 studies reporting associations between GI or GL and the outcomes of interest: 34 (71%) on various cancers, nine (19%) on cardiovascular disease, five (10%) on type 2 diabetes, and three (6%) on all-cause mortality. Consumption of high GI foods was associated with an increased incidence of type 2 diabetes (RR 1·27 [95% CI 1·21-1·34]; p<0·0001), total cardiovascular disease (1·15 [1·11-1·19]; p<0·0001), diabetes-related cancer (1·05 [1·02-1·08]; p=0·0010), and all-cause mortality (1·08 [1·05-1·12]; p<0·0001). Similar associations were seen between high GL and diabetes (RR 1·15 [95% CI 1·09-1·21]; p<0·0001) and total cardiovascular disease (1·15 [1·10-1·20]; p<0·0001). Associations between diets high in fibre and whole grains and the four main outcomes were similar to those for low GI diets. INTERPRETATION Dietary recommendations to reduce GI and GL could have effects on health outcomes that are similar to outcomes of recommendations to increase intake of fibre and whole grain. FUNDING Banting and Best and the Karuna Foundation.
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Affiliation(s)
- David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada.
| | - Walter C Willett
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Frank B Hu
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea J Glenn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Simin Liu
- Center for Global Cardiometabolic Health, Department of Epidemiology, Department of Medicine, and Department of Surgery, Brown University, Providence, RI, USA
| | - Andrew Mente
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Victoria Miller
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pietro Ferrari
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | | | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erikka Loftfield
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xiao-Ou Shu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and Statistics, Nutritional Epidemiology Research Team, Bobigny, France; French Network for Nutrition and Cancer Research, Jouy-en-Josas, France
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan; International University of Health and Welfare Graduate School of Public Health, Tokyo, Japan
| | - Piet A van den Brandt
- GROW School for Oncology and Developmental Biology, and Department of Epidemiology, Care and Public Health Research Institute-School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Tauseef Ahmad Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
| | - Melanie Paquette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Darshna Patel
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Teenie Fei Yi Siu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Korbua Srichaikul
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
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12
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Haramshahi M, A-Elgadir TME, Daabo HMA, Altinkaynak Y, Hjazi A, Saxena A, Najm MAA, Almulla AF, Alsaalamy A, Kashani MA. Nutrient patterns and risk of diabetes mellitus type 2: a case-control study. BMC Endocr Disord 2024; 24:10. [PMID: 38229053 DOI: 10.1186/s12902-024-01540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/09/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUNDS Although the significance of diet in preventing or managing diabetes complications is highlighted in current literature, there is insufficient evidence regarding the correlation between nutrient patterns and these complications. The objective of this case-control study is to investigate this relationship by analyzing the dietary intake of nutrients in participants with and without type 2 diabetes (T2D). METHODS A case-control study was conducted at the Tabriz Center of Metabolism and Endocrinology to investigate the relationship between nutrient patterns and type 2 diabetes (T2D). The study enrolled 225 newly diagnosed cases of T2D and 225 controls. The dietary intake of nutrients was assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Principal component analysis using Varimax rotation was used to obtain nutrient patterns. Logistic regression analysis was performed to estimate the risk of T2D. RESULTS The participants' mean (SD) age and BMI were 39.8 (8.8) years and 27.8 (3.6) kg/m2, respectively. The results identified three major nutrient patterns. The first nutrient pattern was characterized by high consumption of sucrose, animal protein, vitamin E, vitamin B1, vitamin B12, calcium, phosphorus, zinc, and potassium. The second nutrient pattern included fiber, plant protein, vitamin D, Riboflavin, Vitamin B5, copper, and Magnesium. The third nutrient pattern was characterized by fiber, plant protein, vitamin A, riboflavin, vitamin C, calcium, and potassium. Individuals in the highest tertile of nutrient pattern 3 (NP3) had a lower risk of T2D compared to those in the lowest tertile after adjusting for confounders. The odds ratio was 0.52 with a 95% confidence interval of 0.30-0.89 and a P_trend of 0.039. CONCLUSION This study found that conforming to a nutrient pattern consisting of plant protein, vitamin C, vitamin A, vitamin B2, potassium, and calcium is linked to a lower likelihood of developing T2D.The initial results suggest that following a nutrient pattern that includes these nutrients may reduce the risk of T2D. However, further research is required to confirm the relationship between nutrient patterns and T2D.
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Affiliation(s)
- Morteza Haramshahi
- Faculty of medicine, Tabriz University of medical sciences, Tabriz, Iran
| | | | | | - Yahya Altinkaynak
- Department of Medical Services and Techniques, Ardahan University, Ardahan, Turkey
| | - Ahmed Hjazi
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Jeddah, Saudi Arabia
| | - Archana Saxena
- Department of Management, Uttaranchal Institute of Management, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Mazin A A Najm
- Pharmaceutical Chemistry Department, College of Pharmacy, Al-Ayen University, Thi-Qar, Iraq
| | - Abbas F Almulla
- College of technical engineering, The Islamic University, Najaf, Iraq
| | - Ali Alsaalamy
- College of technical engineering, Imam Ja'afar Al-Sadiq University, Al-Muthanna, 66002, Iraq
| | - Mohammad Amin Kashani
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
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13
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Kronsteiner-Gicevic S, Tello M, Lincoln LE, Kondo JK, Naidoo U, Fung TT, Willett WC, Thorndike AN. Validation of the Rapid Prime Diet Quality Score Screener (rPDQS), A Brief Dietary Assessment Tool With Simple Traffic Light Scoring. J Acad Nutr Diet 2023; 123:1541-1554.e7. [PMID: 37244591 DOI: 10.1016/j.jand.2023.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Dietary pattern is a determinant of chronic disease, but nonregistered dietitian nutritionist (non-RDN) clinicians rarely assess diet because of barriers such as time constraints and lack of valid, brief diet quality assessment tools. OBJECTIVE The study aimed to evaluate the relative validity of a brief diet quality screener using both a numeric scoring system and a simple traffic light scoring system. DESIGN A cross-sectional study was conducted using the CloudResearch online platform to compare participants' responses to the 13-item rapid Prime Diet Quality Score screener (rPDQS) and the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. PARTICIPANTS/SETTING The study was conducted in July and August 2021 and included 482 adults ≥18 years of age or older sampled to be representative of the US population. MAIN OUTCOME MEASURES All participants completed the rPDQS and an ASA24; of these, 190 completed a second ASA24 and rPDQS. Responses to rPDQS items were coded using both traffic light (eg, green = healthiest intake, red = least healthy intake) and numeric (eg, consume < 1 time a week, consume ≥ 2 times per day) scoring methods and were compared with food group equivalents and Healthy Eating Index-2015 (HEI-2015) scores estimated from ASA24s. STATISTICAL ANALYSES Deattenuated Pearson correlation coefficients were calculated to account for within-person variation in 24-hour diet recalls. RESULTS Overall, 49% of participants were female, 62% were ≥35 years, and 66% were non-Hispanic White, 13% non-Hispanic Black, 16% Hispanic/Latino, and 5% Asian. For both food groups to encourage (eg, vegetables, whole grains) and to consume in moderation (eg, processed meats, sweets), there were statistically significant associations with intakes assessed by rPDQS, using both traffic light and numeric scoring methods. Total rPDQS scores correlated with the HEI-2015, r = 0.75 (95% confidence interval [CI] = 0.65, 0.82). CONCLUSIONS The rPDQS is a valid, brief diet quality screener that identifies clinically relevant patterns of food intake. Future research is needed to test whether the simple traffic light scoring system is an effective tool that can help non-RDN clinicians provide brief dietary counseling or make referrals to registered dietitian nutritionists, as needed.
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14
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Lara-Castor L, Micha R, Cudhea F, Miller V, Shi P, Zhang J, Sharib JR, Erndt-Marino J, Cash SB, Mozaffarian D. Sugar-sweetened beverage intakes among adults between 1990 and 2018 in 185 countries. Nat Commun 2023; 14:5957. [PMID: 37788998 PMCID: PMC10614169 DOI: 10.1038/s41467-023-41269-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Sugar-sweetened beverages (SSBs) are associated with cardiometabolic diseases and social inequities. For most nations, recent estimates and trends of intake are not available; nor variation by education or urbanicity. We investigated SSB intakes among adults between 1990 and 2018 in 185 countries, stratified subnationally by age, sex, education, and rural/urban residence, using data from the Global Dietary Database. In 2018, mean global SSB intake was 2.7 (8 oz = 248 grams) servings/week (95% UI 2.5-2.9) (range: 0.7 (0.5-1.1) in South Asia to 7.8 (7.1-8.6) in Latin America/Caribbean). Intakes were higher in male vs. female, younger vs. older, more vs. less educated, and urban vs. rural adults. Variations by education and urbanicity were largest in Sub-Saharan Africa. Between 1990 and 2018, SSB intakes increased by +0.37 (+0.29, +0.47), with the largest increase in Sub-Saharan Africa. These findings inform intervention, surveillance, and policy actions worldwide, highlighting the growing problem of SSBs for public health in Sub-Saharan Africa.
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Affiliation(s)
- Laura Lara-Castor
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- University of Thessaly, Volos, Greece
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Victoria Miller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Medicine, McMaster University, Hamilton, Canada
- Population Health Research Institute, Hamilton, Canada
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jianyi Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Julia R Sharib
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Josh Erndt-Marino
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Tufts University School of Medicine, Boston, MA, USA.
- Department of Medicine, Tufts Medical Center, Boston, MA, USA.
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15
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Kim DD, Wang L, Lauren BN, Liu J, Marklund M, Lee Y, Micha R, Mozaffarian D, Wong JB. Development and Validation of the US Diabetes, Obesity, Cardiovascular Disease Microsimulation (DOC-M) Model: Health Disparity and Economic Impact Model. Med Decis Making 2023; 43:930-948. [PMID: 37842820 PMCID: PMC10625721 DOI: 10.1177/0272989x231196916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 07/27/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Few simulation models have incorporated the interplay of diabetes, obesity, and cardiovascular disease (CVD); their upstream lifestyle and biological risk factors; and their downstream effects on health disparities and economic consequences. METHODS We developed and validated a US Diabetes, Obesity, Cardiovascular Disease Microsimulation (DOC-M) model that incorporates demographic, clinical, and lifestyle risk factors to jointly predict overall and racial-ethnic groups-specific obesity, diabetes, CVD, and cause-specific mortality for the US adult population aged 40 to 79 y at baseline. An individualized health care cost prediction model was further developed and integrated. This model incorporates nationally representative data on baseline demographics, lifestyle, health, and cause-specific mortality; dynamic changes in modifiable risk factors over time; and parameter uncertainty using probabilistic distributions. Validation analyses included assessment of 1) population-level risk calibration and 2) individual-level risk discrimination. To illustrate the application of the DOC-M model, we evaluated the long-term cost-effectiveness of a national produce prescription program. RESULTS Comparing the 15-y model-predicted population risk of primary outcomes among the 2001-2002 National Health and Nutrition Examination Survey (NHANES) cohort with the observed prevalence from age-matched cross-sectional 2003-2016 NHANES cohorts, calibration performance was strong based on observed-to-expected ratio and calibration plot analysis. In most cases, Brier scores fell below 0.0004, indicating a low overall prediction error. Using the Multi-Ethnic Study of Atherosclerosis cohorts, the c-statistics for assessing individual-level risk discrimination were 0.85 to 0.88 for diabetes, 0.93 to 0.95 for obesity, 0.74 to 0.76 for CVD history, and 0.78 to 0.81 for all-cause mortality, both overall and in three racial-ethnic groups. Open-source code for the model was posted at https://github.com/food-price/DOC-M-Model-Development-and-Validation. CONCLUSIONS The validated DOC-M model can be used to examine health, equity, and the economic impact of health policies and interventions on behavioral and clinical risk factors for obesity, diabetes, and CVD. HIGHLIGHTS We developed a novel microsimula'tion model for obesity, diabetes, and CVD, which intersect together and - critically for prevention and treatment interventions - share common lifestyle, biologic, and demographic risk factors.Validation analyses, including assessment of (1) population-level risk calibration and (2) individual-level risk discrimination, showed strong performance across the overall population and three major racial-ethnic groups for 6 outcomes (obesity, diabetes, CVD, and all-cause mortality, CVD- and DM-cause mortality)This paper provides a thorough explanation and documentation of the development and validation process of a novel microsimulation model, along with the open-source code (https://github.com/food-price/ DOCM_validation) for public use, to serve as a guide for future simulation model assessments, validation, and implementation.
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Affiliation(s)
- David D. Kim
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lu Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Brianna N. Lauren
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Junxiu Liu
- Department of Population Health Science and Policy, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Yujin Lee
- Department of Food and Nutrition, Myongji University, Yongin, South Korea
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - John B. Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA
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16
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Wang L, Cohen JF, Maroney M, Cudhea F, Hill A, Schwartz C, Lurie P, Mozaffarian D. Evaluation of health and economic effects of United States school meal standards consistent with the 2020-2025 dietary guidelines for Americans. Am J Clin Nutr 2023; 118:605-613. [PMID: 37527964 PMCID: PMC10550836 DOI: 10.1016/j.ajcnut.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/10/2023] [Accepted: 05/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The current school meal nutrition standards, established in 2010, are not fully aligned with the 2020-2025 Dietary Guideline for Americans (DGA). This study evaluates the potential short-term and long-term health and economic benefits of strengthening the school meal standards on added sugars, sodium, and whole grains to be aligned with current guidelines. METHODS We used comparative risk assessment frameworks based on nationally representative data incorporating current demographics, dietary habits, and risk factors of United States children aged 5-18 y from 3 cycles of the National Health and Nutrition Examination Survey (2013-2018). To estimate short-term impact, the model incorporated estimated dietary changes owing to potential new DGA-aligned school meal nutrition standards and the effect of these changes on childhood body mass index (in kg/m2) and blood pressure. To estimate long-term impact, the model further incorporated data on the sustainability of childhood dietary changes into adulthood, and on demographics and risk factors of United States adults, diet-disease associations, and disease-specific national mortality. RESULTS In a best-case scenario assuming full school compliance, implementing new DGA-aligned nutritional standards would lower elementary children's BMI by an average 0.14 (95% UI: 0.08-0.20) kg/m2 and systolic blood pressure by 0.13 (95% UI: 0.06-0.19) (95% mm Hg. Later in life, the new standards were estimated to prevent 10,600 [95% uncertainty interval (UI): 4820-16,800) annual deaths from cardiovascular disease (CVD), diabetes, and cancer in adulthood; and save 355,000 (95% UI: 175,000-538,000) disability-adjusted life years and $19.3 (95% UI: 9.35-30.3) B in direct and indirect medical costs each year. Accounting for plausible (incomplete) school compliance, implementation would save an estimated 9110 (95% UI: 2740-15,100) deaths, 302,000 (95% UI: 120,000-479,000) disability-adjusted life years, and $15.9 (95% UI: 4.54-27.2) B in healthcare-related costs per year in later adulthood. CONCLUSIONS Stronger school meal nutrition standards on added sugars, sodium, and whole grains aligned with the 2020-2025 DGA recommendations may improve diet, childhood health, and future adult burdens of CVD, diabetes, cancer, and associated economic costs.
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Affiliation(s)
- Lu Wang
- Friedman School of Nutrition Science and Policy, Boston, MA, United States
| | - Juliana Fw Cohen
- Department of Health Sciences, Merrimack College, North Andover, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Meghan Maroney
- Center for Science in the Public Interest, Washington, DC, United States
| | - Fredrick Cudhea
- Friedman School of Nutrition Science and Policy, Boston, MA, United States
| | - Alla Hill
- Center for Science in the Public Interest, Washington, DC, United States
| | - Colin Schwartz
- Center for Science in the Public Interest, Washington, DC, United States
| | - Peter Lurie
- Center for Science in the Public Interest, Washington, DC, United States
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Boston, MA, United States; Division of Cardiology, Tufts Medical Center, Boston, MA, United States.
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17
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Choo JM, Murphy KJ, Wade AT, Wang Y, Bracci EL, Davis CR, Dyer KA, Woodman RJ, Hodgson JM, Rogers GB. Interactions between Mediterranean Diet Supplemented with Dairy Foods and the Gut Microbiota Influence Cardiovascular Health in an Australian Population. Nutrients 2023; 15:3645. [PMID: 37630835 PMCID: PMC10459086 DOI: 10.3390/nu15163645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
The impact of a Mediterranean diet on the intestinal microbiome has been linked to its health benefits. We aim to evaluate the effects of a Mediterranean diet supplemented with dairy foods on the gut microbiome in Australians at risk of cardiovascular disease. In a randomised controlled cross-over study, 34 adults with a systolic blood pressure ≥120 mmHg and with risk factors for cardiovascular disease were randomly allocated to a Mediterranean diet with 3-4 daily serves of dairy foods (Australian recommended daily intake (RDI) of 1000-1300 mg per day (MedDairy)) or a low-fat (LFD) control diet. Between each 8-week diet, participants underwent an 8-week washout period. Microbiota characteristics of stool samples collected at the start and end of each diet period were determined by 16S rRNA amplicon sequencing. MedDairy-associated effects on bacterial relative abundance were correlated with clinical, anthropometric, and cognitive outcomes. No change in the overall faecal microbial structure or composition was observed with either diet (p > 0.05). The MedDairy diet was associated with changes in the relative abundance of several bacterial taxa, including an increase in Butyricicoccus and a decrease in Colinsella and Veillonella (p < 0.05). Increases in Butyricicoccus relative abundance over 8 weeks were inversely correlated with lower systolic blood pressure (r = -0.38, p = 0.026) and positively correlated with changes in fasting glucose levels (r = 0.39, p = 0.019), specifically for the MedDairy group. No significant associations were observed between the altered taxa and anthropometric or cognitive measures (p > 0.05). Compared to a low-fat control diet, the MedDairy diet resulted in changes in the abundance of specific gut bacteria, which were associated with clinical outcomes in adults at risk of CVD.
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Affiliation(s)
- Jocelyn M. Choo
- Microbiome Research and Host Health, Lifelong Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; (J.M.C.); (G.B.R.)
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Karen J. Murphy
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; (A.T.W.); (E.L.B.); (C.R.D.)
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia;
| | - Alexandra T. Wade
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; (A.T.W.); (E.L.B.); (C.R.D.)
- Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Yanan Wang
- CSIRO MOSH-Future Science Platform, Health & Biosecurity, Adelaide, SA 5001, Australia;
| | - Ella L. Bracci
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; (A.T.W.); (E.L.B.); (C.R.D.)
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia;
| | - Courtney R. Davis
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; (A.T.W.); (E.L.B.); (C.R.D.)
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia;
| | - Kathryn A. Dyer
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia;
| | - Richard J. Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia;
| | - Jonathan M. Hodgson
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia;
- Medical School, University of Western Australia, 35 Stirling Highway, Perth, WA 6000, Australia
| | - Geraint B. Rogers
- Microbiome Research and Host Health, Lifelong Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; (J.M.C.); (G.B.R.)
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
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18
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Ye KX, Sun L, Lim SL, Li J, Kennedy BK, Maier AB, Feng L. Adequacy of Nutrient Intake and Malnutrition Risk in Older Adults: Findings from the Diet and Healthy Aging Cohort Study. Nutrients 2023; 15:3446. [PMID: 37571385 PMCID: PMC10421189 DOI: 10.3390/nu15153446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
There is a lack of data on the adequacy of nutrient intake and prevalence of malnutrition risk in Asian populations. The aim was to report on the nutrient intake and prevalence of malnutrition risk in a community sample of older adults in Singapore. Analysis was performed on 738 (n = 206 male, n = 532 male, aged 67.6 ± 6.0 years) adults 60 years and above. Intakes of macro- and micronutrients were evaluated against the Recommended Dietary Allowances (RDAs). Malnutrition risk was assessed using the Nutrition Screening Initiative Determine Your Nutritional Health checklist. It was found that 90.5% older adults exceeded the sugar intake, 68.5% males and 57.1% females exceeded the intake limit for saturated fat, and 33% males had inadequate dietary fiber intake when compared to the RDAs. Inadequate dietary calcium intake was found in 49.5% males and 55.3% females. There were 22.3% of older adults at moderate to high malnutrition risk. Singaporean older adults need to reduce their dietary intakes of sugar and saturated fat and increase their intakes in dietary fiber and calcium. Current findings provide public health awareness on the importance of healthy eating and will facilitate decision making by health promotors to deliver targeted nutrition care programs.
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Affiliation(s)
- Kaisy Xinhong Ye
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119007, Singapore;
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore 119228, Singapore; (B.K.K.); (A.B.M.)
| | - Lina Sun
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China;
| | - Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore 118177, Singapore;
| | - Jialiang Li
- Department of Statistics & Applied Probability, National University of Singapore, Singapore 119077, Singapore;
| | - Brian K. Kennedy
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore 119228, Singapore; (B.K.K.); (A.B.M.)
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Andrea Britta Maier
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore 119228, Singapore; (B.K.K.); (A.B.M.)
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Lei Feng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119007, Singapore;
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore 119228, Singapore; (B.K.K.); (A.B.M.)
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19
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Mozaffarian D. Identifying nutritional priorities for global health: time for a more PURE focus on protective foods. Eur Heart J 2023; 44:2580-2582. [PMID: 37414412 PMCID: PMC10361008 DOI: 10.1093/eurheartj/ehad325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Affiliation(s)
- Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
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20
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Ross AB, Shertukde SP, Livingston Staffier K, Chung M, Jacques PF, McKeown NM. The Relationship between Whole-Grain Intake and Measures of Cognitive Decline, Mood, and Anxiety-A Systematic Review. Adv Nutr 2023; 14:652-670. [PMID: 37085091 PMCID: PMC10334137 DOI: 10.1016/j.advnut.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 03/15/2023] [Accepted: 04/07/2023] [Indexed: 04/23/2023] Open
Abstract
Greater intake of whole grains, compared to refined grains, is consistently associated with a reduced risk of cardiovascular disease and type 2 diabetes, both of which are associated with cognitive decline. To better understand the relationship between whole-grain intake, cognition, mood, and anxiety, a systematic review was conducted to synthesize available evidence linking whole grains to these outcomes. Four electronic databases were searched from inception to August 2021 for potentially relevant observational and interventional studies. Risk of bias (RoB) assessments were performed using the newly developed Nutrition Quality Evaluation Strengthening Tools, and the Grades of Recommendation, Assessment, Development, and Evaluation approach was used to determine the strength of evidence for each outcome. In total, 23 studies [4 randomized controlled trials (RCTs) and 19 observational studies] met the predefined eligibility criteria. Of these,12 studies included analysis of whole-grain intake and cognitive decline, 9 included mood outcomes, and 2 included both cognition and mood outcomes. The overall evidence for an association between whole-grain intake and cognition is inconclusive. With respect to mood outcomes, evidence from RCTs prospective cohort and case-control studies suggest that higher intake is linked to improved outcomes for mood and depression although the evidence is mixed for cross-sectional studies. Reporting of whole-grain intake fell short of suggested standards, and the strength of available evidence was low or very low for all outcomes. A high RoB toward studies reporting results was also noted, complicating both the interpretation of some studies and the combined evidence. Of note, few well-designed RCTs assessing the effect of whole-grain intake on measures of cognition, mood, and anxiety were identified, highlighting the need for more studies in this area. The available, although limited, evidence suggests that greater whole-grain intake is associated with better mood and anxiety-related scores and is inconclusive regarding cognitive outcomes. PROSPERO registration: CRD42021266355.
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Affiliation(s)
| | - Shruti P Shertukde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Kara Livingston Staffier
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States
| | - Mei Chung
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Paul F Jacques
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States; Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States
| | - Nicola M McKeown
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States; Programs of Nutrition, Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
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21
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Mozaffarian D. Sugar, sugary drinks, and health: has the evidence achieved the sweet spot for policy action? Lancet Diabetes Endocrinol 2023; 11:448-451. [PMID: 37276874 DOI: 10.1016/s2213-8587(23)00151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
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22
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Thorisdottir B, Arnesen EK, Bärebring L, Dierkes J, Lamberg-Allardt C, Ramel A, Nwaru BI, Söderlund F, Åkesson A. Legume consumption in adults and risk of cardiovascular disease and type 2 diabetes: a systematic review and meta-analysis. Food Nutr Res 2023; 67:9541. [PMID: 37288088 PMCID: PMC10243120 DOI: 10.29219/fnr.v67.9541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 06/09/2023] Open
Abstract
Objectives This study aimed to systematically review the evidence for associations between consumption of legumes and cardiovascular disease (CVD), type 2 diabetes (T2D) and their risk factors among healthy adults. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus up to 16 May 2022 for ≥4 weeks long randomized (RCT) and non-randomized controlled trials and prospective cohort studies with follow-up ≥12 months, assessing legume intake (beans/lentils/peas/soybeans, excluding peanuts and legume-products/protein/powder/flour) as the intervention or exposure. Outcomes were CVD, coronary heart disease (CHD), stroke, T2D and in intervention trials only: changes in blood lipids, glycemic markers, and blood pressure. Risk of bias (RoB) was evaluated with Cochrane's RoB2, ROBINS-I, and US Department of Agriculture (USDA)'s RoB-NObS. Effect sizes were pooled using random-effects meta-analyses and expressed as relative risk or weighed mean differences with 95% confidence intervals, heterogeneity quantified as I2. The evidence was appraised according to World Cancer Research Fund's criteria. Results Of the 181 full-text articles assessed for eligibility, 47 were included: 31 cohort studies (2,081,432 participants with generally low legume consumption), 14 crossover RCTs (448 participants), one parallel RCT and one non-randomized trial. Meta-analyses of cohort studies were suggestive of null associations for CVD, CHD, stroke and T2D. Meta-analyses of RCTs suggested a protective effect on total cholesterol (mean difference -0.22 mmol/L), low density lipoprotein (LDL)-cholesterol (-0.19 mmol/L), fasting glucose (-0.19 mmol/L), and HOMA-IR (-0.30). Heterogeneity was high (I2 = 52% for LDL-cholesterol, >75% for others). The overall evidence for associations between consumption of legumes and risk of CVD and T2D was considered limited - no conclusion. Conclusion Legume consumption was not found to influence risk of CVD and T2D in healthy adult populations with generally low legume consumption. However, protective effects on risk factors, seen in RCTs, lend some support for recommending legume consumption as part of diverse and healthy dietary patterns for prevention of CVD and T2D.
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Affiliation(s)
- Birna Thorisdottir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Erik Kristoffer Arnesen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jutta Dierkes
- Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | | | - Alfons Ramel
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Bright I. Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Söderlund
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Åkesson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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23
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Forouhi NG. Embracing complexity: making sense of diet, nutrition, obesity and type 2 diabetes. Diabetologia 2023; 66:786-799. [PMID: 36786838 PMCID: PMC9925928 DOI: 10.1007/s00125-023-05873-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/13/2022] [Indexed: 02/15/2023]
Abstract
Nutrition therapy has been emphasised for decades for people with type 2 diabetes, and the vital importance of diet and nutrition is now also recognised for type 2 diabetes prevention. However, the complexity of diet and mixed messages on what is unhealthy, healthy or optimal have led to confusion among people with diabetes and their physicians as well as the general public. What should people eat for the prevention, management and remission of type 2 diabetes? Recently, progress has been made in research evidence that has advanced our understanding in several areas of past uncertainty. This article examines some of these issues, focusing on the role of diet in weight management and in the prevention and management of type 2 diabetes. It considers nutritional strategies including low-energy, low-fat and low-carbohydrate diets, discusses inter-relationships between nutrients, foods and dietary patterns, and examines aspects of quantity and quality together with new developments, challenges and future directions.
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Affiliation(s)
- Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK.
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24
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Frias JP, Lee ML, Carter MM, Ebel ER, Lai RH, Rikse L, Washington ME, Sonnenburg JL, Damman CJ. A microbiome-targeting fibre-enriched nutritional formula is well tolerated and improves quality of life and haemoglobin A1c in type 2 diabetes: A double-blind, randomized, placebo-controlled trial. Diabetes Obes Metab 2023; 25:1203-1212. [PMID: 36594522 DOI: 10.1111/dom.14967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
AIMS To investigate a prebiotic fibre-enriched nutritional formula on health-related quality of life and metabolic control in type 2 diabetes. MATERIALS AND METHODS This was a 12-week, double-blind, placebo-controlled study with an unblinded dietary advice only comparator arm. Participants were randomized 2:1:1 to a prebiotic fibre-enriched nutritional formula (Active), a placebo fibre-absent nutritional formula (Placebo), or non-blinded dietary advice alone (Diet). Primary endpoint was change in core Type 2 Diabetes Distress Assessment System (cT2-DDAS) at week 12. Glycated haemoglobin (HbA1c) change was a key secondary endpoint. RESULTS In total, 192 participants were randomized. Mean age was 54.3 years, HbA1c 7.8%, and body mass index 35.9 kg/m2 . At week 12, cT2-DDAS reduced significantly in Active versus Placebo (-0.4, p = .03), and HbA1c was reduced significantly in Active vs Placebo (-0.64%, p = .01). Gut microbiome sequencing revealed that the relative abundance of two species of butyrate-producing bacteria (Roseburia faecis and Anaerostipes hadrus) increased significantly in Active vs. Placebo. CONCLUSIONS A microbiome-targeting nutritional formula significantly improved cT2-DDAS and HbA1c, suggesting the potential for prebiotic fibre as a complement to lifestyle and/or pharmaceutical interventions for managing type 2 diabetes.
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Affiliation(s)
- Juan P Frias
- Velocity Clinical Research, Los Angeles, California, USA
| | - Martin L Lee
- UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Matthew M Carter
- Department of Microbiology and Immunology, Stanford University School Medicine, Palo Alto, California, USA
| | - Emily R Ebel
- Department of Microbiology and Immunology, Stanford University School Medicine, Palo Alto, California, USA
| | | | | | | | - Justin L Sonnenburg
- Department of Microbiology and Immunology, Stanford University School of Medicine, Chan Zuckerberg Biohub, San Francisco, California, USA
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25
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O'Hearn M, Lara-Castor L, Cudhea F, Miller V, Reedy J, Shi P, Zhang J, Wong JB, Economos CD, Micha R, Mozaffarian D. Incident type 2 diabetes attributable to suboptimal diet in 184 countries. Nat Med 2023; 29:982-995. [PMID: 37069363 PMCID: PMC10115653 DOI: 10.1038/s41591-023-02278-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/28/2023] [Indexed: 04/19/2023]
Abstract
The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8-14.4 million) incident T2D cases, representing 70.3% (68.8-71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0-27.1%)), excess refined rice and wheat intake (24.6% (22.3-27.2%)) and excess processed meat intake (20.3% (18.3-23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4-87.7%)) and Latin America and the Caribbean (81.8% (80.1-83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1-60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.
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Affiliation(s)
- Meghan O'Hearn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Food Systems for the Future Institute, Chicago, IL, USA.
| | - Laura Lara-Castor
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Victoria Miller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Julia Reedy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jianyi Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - John B Wong
- Tufts University School of Medicine, Boston, MA, USA
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Food Science and Nutrition, University of Thessaly, Volos, Greece
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Tufts University School of Medicine, Boston, MA, USA.
- Department of Medicine, Tufts Medical Center, Boston, MA, USA.
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26
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Crona BI, Wassénius E, Jonell M, Koehn JZ, Short R, Tigchelaar M, Daw TM, Golden CD, Gephart JA, Allison EH, Bush SR, Cao L, Cheung WWL, DeClerck F, Fanzo J, Gelcich S, Kishore A, Halpern BS, Hicks CC, Leape JP, Little DC, Micheli F, Naylor RL, Phillips M, Selig ER, Springmann M, Sumaila UR, Troell M, Thilsted SH, Wabnitz CCC. Four ways blue foods can help achieve food system ambitions across nations. Nature 2023; 616:104-112. [PMID: 36813964 PMCID: PMC10076219 DOI: 10.1038/s41586-023-05737-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 01/17/2023] [Indexed: 02/24/2023]
Abstract
Blue foods, sourced in aquatic environments, are important for the economies, livelihoods, nutritional security and cultures of people in many nations. They are often nutrient rich1, generate lower emissions and impacts on land and water than many terrestrial meats2, and contribute to the health3, wellbeing and livelihoods of many rural communities4. The Blue Food Assessment recently evaluated nutritional, environmental, economic and justice dimensions of blue foods globally. Here we integrate these findings and translate them into four policy objectives to help realize the contributions that blue foods can make to national food systems around the world: ensuring supplies of critical nutrients, providing healthy alternatives to terrestrial meat, reducing dietary environmental footprints and safeguarding blue food contributions to nutrition, just economies and livelihoods under a changing climate. To account for how context-specific environmental, socio-economic and cultural aspects affect this contribution, we assess the relevance of each policy objective for individual countries, and examine associated co-benefits and trade-offs at national and international scales. We find that in many African and South American nations, facilitating consumption of culturally relevant blue food, especially among nutritionally vulnerable population segments, could address vitamin B12 and omega-3 deficiencies. Meanwhile, in many global North nations, cardiovascular disease rates and large greenhouse gas footprints from ruminant meat intake could be lowered through moderate consumption of seafood with low environmental impact. The analytical framework we provide also identifies countries with high future risk, for whom climate adaptation of blue food systems will be particularly important. Overall the framework helps decision makers to assess the blue food policy objectives most relevant to their geographies, and to compare and contrast the benefits and trade-offs associated with pursuing these objectives.
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Affiliation(s)
- Beatrice I Crona
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden.
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Science, Stockholm, Sweden.
| | - Emmy Wassénius
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Science, Stockholm, Sweden
| | - Malin Jonell
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Science, Stockholm, Sweden
| | - J Zachary Koehn
- Stanford Center for Ocean Solutions, Stanford University, Stanford, CA, USA
| | - Rebecca Short
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | | | - Tim M Daw
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Christopher D Golden
- Dept. of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Dept. of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Dept. of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jessica A Gephart
- Dept. of Environmental Science, American University, Washington, DC, USA
| | | | - Simon R Bush
- Wageningen University and Research, Wageningen, The Netherlands
| | - Ling Cao
- School of Oceanography, Shanghai Jiao Tong University, Shanghai, China
| | - William W L Cheung
- Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jessica Fanzo
- Bloomberg School of Public Health, Berman Institute of Bioethics, Johns Hopkins University, Washington DC, USA
- Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC, USA
| | - Stefan Gelcich
- Instituto Milenio en Socio-Ecologia Costera, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center of Applied Ecology and Sustainability, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Avinash Kishore
- International Food Policy Research Institute (IFPRI), New Delhi, India
| | - Benjamin S Halpern
- National Center for Ecological Analysis and Synthesis, UC Santa Barbara, Santa Barbara, CA, USA
- Bren School of Environmental Science and Management, UC Santa Barbara, Santa Barbara, CA, USA
| | | | - James P Leape
- Stanford Center for Ocean Solutions, Stanford University, Stanford, CA, USA
| | - David C Little
- Institute of Aquaculture, University of Stirling, Stirling, UK
| | - Fiorenza Micheli
- Stanford Center for Ocean Solutions, Stanford University, Stanford, CA, USA
- Hopkins Marine Station, Oceans Department, Stanford University, Pacific Grove, CA, USA
| | - Rosamond L Naylor
- Department of Earth System Science, Stanford University, Stanford, CA, USA
- Center on Food Security and the Environment, Stanford University, Stanford, CA, USA
| | | | - Elizabeth R Selig
- Stanford Center for Ocean Solutions, Stanford University, Stanford, CA, USA
| | - Marco Springmann
- Oxford Martin Programme on the Future of Food, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - U Rashid Sumaila
- Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
- School of Public Policy and Global Affairs, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Max Troell
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Science, Stockholm, Sweden
- Beijer Institute of Ecological Economics, Royal Swedish Academy of Science, Stockholm, Sweden
| | | | - Colette C C Wabnitz
- Stanford Center for Ocean Solutions, Stanford University, Stanford, CA, USA
- Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
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27
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Glenn AJ, Gu X, Hu FB, Wang M, Willett WC. Concerns about the Burden of Proof studies. Nat Med 2023; 29:823-825. [PMID: 37059835 PMCID: PMC10129864 DOI: 10.1038/s41591-023-02294-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/07/2023] [Indexed: 04/16/2023]
Affiliation(s)
- Andrea J Glenn
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Xiao Gu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Molin Wang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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28
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Miller V, Webb P, Cudhea F, Zhang J, Reedy J, Shi P, Erndt-Marino J, Coates J, Micha R, Mozaffarian D. Children's and adolescents' rising animal-source food intakes in 1990-2018 were impacted by age, region, parental education and urbanicity. NATURE FOOD 2023; 4:305-319. [PMID: 37117550 DOI: 10.1038/s43016-023-00731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/09/2023] [Indexed: 04/30/2023]
Abstract
Animal-source foods (ASF) provide nutrition for children and adolescents' physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world's child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 15-19 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes.
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Affiliation(s)
- Victoria Miller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
- Population Health Research Institute, Hamilton, Ontario, Canada.
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jianyi Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Julia Reedy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Josh Erndt-Marino
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jennifer Coates
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Food Science and Nutrition, University of Thessaly, Thessaly, Greece
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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29
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Reynolds AN, Mann J. Government inaction and the preventable diabetes pandemic. Nat Med 2023; 29:791-792. [PMID: 37069362 DOI: 10.1038/s41591-023-02259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Andrew N Reynolds
- Edgar Diabetes and Obesity Research Centre, Department of Medicine, University of Otago, Dunedin, New Zealand.
- The Riddet Institute, Palmerston North, New Zealand.
| | - Jim Mann
- Edgar Diabetes and Obesity Research Centre, Department of Medicine, University of Otago, Dunedin, New Zealand
- The Riddet Institute, Palmerston North, New Zealand
- The Healthier Lives National Science Challenge, Dunedin, New Zealand
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30
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Rozanski A, Sakul S, Narula J, Berman D. Assessment of lifestyle "vital signs" in healthcare settings. Prog Cardiovasc Dis 2023; 77:107-118. [PMID: 36848965 DOI: 10.1016/j.pcad.2023.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
Unhealthy lifestyles, such as maintenance of poor diets and physical inactivity, are a powerful driver of disease-producing risk factors and chronic illnesses. This has led to an increasing call to assess adverse lifestyle factors in healthcare settings. This approach could be aided by designating health-related lifestyle factors as "vital signs" that can be recorded during patient visits. Just such an approach has been used for assessing patients' smoking habits since the 1990s. In this review, we assess the rationale for addressing six other health-related lifestyle factors, beyond smoking, in patient care settings: physical activity (PA), sedentary behavior (SB), participation in muscle strengthening exercises, mobility limitations, diet, and sleep quality. For each domain, we evaluate the evidence that supports currently proposed ultra-short screening tools. Our analysis indicates strong medical evidence to support the use of one to two-item screening questions for assessing patients' PA, SB, muscle strengthening activities, and presence of "pre-clinical" mobility limitations. We also present a theoretical basis for measuring patients' diet quality through use of an ultrashort dietary screen, based on evaluation of healthy food intake (fruits/vegetables) and unhealthy food intake (high consumption of highly processed meats and/or consumption of sugary foods and beverages) and a proposed evaluation of sleep quality using a single-item screener. The result is a 10-item lifestyle questionnaire that is based on patient self-report. As such, this questionnaire has the potential to be employed as a practical tool for assessing health behaviors in clinical care settings without impairing the normal workflow of healthcare providers.
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Affiliation(s)
- Alan Rozanski
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Sakul Sakul
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jagat Narula
- Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Daniel Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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Arnesen EK, Thorisdottir B, Bärebring L, Söderlund F, Nwaru BI, Spielau U, Dierkes J, Ramel A, Lamberg-Allardt C, Åkesson A. Nuts and seeds consumption and risk of cardiovascular disease, type 2 diabetes and their risk factors: a systematic review and meta-analysis. Food Nutr Res 2023; 67:8961. [PMID: 36816545 PMCID: PMC9930735 DOI: 10.29219/fnr.v67.8961] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
Objectives We aimed to systematically review studies and evaluate the strength of the evidence on nuts/seeds consumption and cardiometabolic diseases and their risk factors among adults. Methods A protocol was pre-registered in PROSPERO (CRD42021270554). We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Scopus up to September 20, 2021 for prospective cohort studies and ≥12-week randomized controlled trials (RCTs). Main outcomes were cardiovascular disease (CVD), coronary heart disease (CHD), stroke and type 2 diabetes (T2D), secondary total-/low density lipoprotein (LDL)-cholesterol, blood pressure and glycaemic markers. Data extraction and risk of bias (RoB) assessments (using RoB 2.0 and RoB-NObS) were performed in duplicate. Effect sizes were pooled using random-effects meta-analyses and expressed as relative risk (RR) or weighted mean differences with 95% confidence intervals (CI); heterogeneity quantified as I 2. One-stage dose-response analyses assessed the linear and non-linear associations with CVD, CHD, stroke and T2D. The strength of evidence was classified per the World Cancer Research Fund criteria. Results After screening 23,244 references, we included 42 papers from cohort studies (28 unique cohorts, 1,890,573 participants) and 18 RCTs (2,266 participants). In the cohorts, mainly populations with low consumption, high versus low total nuts/seeds consumption was inversely associated with total CVD (RR 0.81; 95% CI 0.75, 0.86; I 2 = 67%), CVD mortality (0.77; 0.72, 0.82; I 2 = 59.3%), CHD (0.82; 0.76, 0.89; I 2 = 64%), CHD mortality (0.75; 0.65, 0.87; I 2 = 66.9%) and non-fatal CHD (0.85; 0.75, 0.96; I 2 = 62.2%). According to the non-linear dose-response analyses, consumption of 30 g/day of total nuts/seeds was associated with RRs of similar magnitude. For stroke and T2D the summary RR for high versus low intake was 0.91 (95% CI 0.85, 0.97; I 2 = 24.8%) and 0.95 (0.75, 1.21; I 2 = 82.2%). Intake of nuts (median ~50 g/day) lowered total (-0.15 mmol/L; -0.22, -0.08; I 2 = 31.2%) and LDL-cholesterol (-0.13 mmol/L; -0.21, -0.05; I 2 = 68.6%), but not blood pressure. Findings on fasting glucose, HbA1c and insulin resistance were conflicting. The results were robust to sensitivity and subgroup analyses. We rated the associations between nuts/seeds and both CVD and CHD as probable. There was limited but suggestive evidence for no association with stroke. No conclusion could be made for T2D. Conclusion There is a probable relationship between consumption of nuts/seeds and lower risk of CVD, mostly driven by CHD, possibly in part through effects on blood lipids. More research on stroke and T2D may affect the conclusions. The evidence of specific nuts should be further investigated.
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Affiliation(s)
- Erik Kristoffer Arnesen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway,Erik Kristoffer Arnesen, Division of Clinical Nutrition, Institute of Basic Medical Science, University of Oslo, Box 1046 Blindern, NO-0317 Oslo, Norway.
| | | | - Linnea Bärebring
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Söderlund
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bright I. Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ulrike Spielau
- Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway,Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jutta Dierkes
- Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway,Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway,Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Alfons Ramel
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | | | - Agneta Åkesson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Langer RD, Ward LC, Larsen SC, Heitmann BL. Can change in phase angle predict the risk of morbidity and mortality during an 18-year follow-up period? A cohort study among adults. Front Nutr 2023; 10:1157531. [PMID: 37200946 PMCID: PMC10186468 DOI: 10.3389/fnut.2023.1157531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/22/2023] [Indexed: 05/20/2023] Open
Abstract
Introduction Phase angle (PhA, degrees), measured via bioimpedance (BIA, 50 kHz), is an index that has been used as an indicator of nutritional status and mortality in several clinical situations. This study aimed to determine the relationship between 6-year changes in PhA and total mortality as well as the risk of incident morbidity and mortality from cardiovascular disease (CVD) and coronary heart disease (CHD) during 18 years of follow-up among otherwise healthy adults. Methods A random subset (n = 1,987) of 35-65 years old men and women was examined at the baseline in 1987/1988 and 6 years later in 1993/1994. Measures included weight, height, and whole-body BIA, from which PhA was calculated. Information on lifestyle was obtained through a questionnaire. The associations between 6-year PhA changes (ΔPhA) and incident CVD and CHD were assessed by Cox proportional hazard models. The median value of ΔPhA was used as the reference value. The hazard ratio (HR) model and confidence intervals (CIs) of incident CVD and CHD were used according to the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ΔPhA. Results During 18 years of follow-up, 205 women and 289 men died. A higher risk of both total mortality and incident CVD was present below the 50th percentile (Δ = -0.85°). The highest risk was observed below the 5th percentile (ΔPhA = -2.60°) in relation to total mortality (HR: 1.55; 95% CI: 1.10-2.19) and incident CVD (HR: 1.52; 95% CI: 1.16-2.00). Discussion The larger the decrease in PhA, the higher the risk of early mortality and incident CVD over the subsequent 18 years. PhA is a reliable and easy measure that may help identify those apparently healthy individuals who may be at increased risk of future CVD or dying prematurely. More studies are needed to confirm our results before it can be definitively concluded that PhA changes can improve clinical risk prediction.
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Affiliation(s)
- Raquel D. Langer
- Research Unit for Dietary Studies, Parker Institute, Copenhagen, Denmark
- Growth and Development Laboratory, Center for Investigation in Pediatrics, State University of Campinas, Campinas, Brazil
- *Correspondence: Raquel D. Langer
| | - Leigh C. Ward
- School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, Brisbane, QLD, Australia
| | - Sofus C. Larsen
- Research Unit for Dietary Studies, Parker Institute, Copenhagen, Denmark
- Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Berit L. Heitmann
- Research Unit for Dietary Studies, Parker Institute, Copenhagen, Denmark
- Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Boden Initiative, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Marcrum SC, Engelke M, Goedhart H, Langguth B, Schlee W, Vesala M, Simoes JP. The Influence of Diet on Tinnitus Severity: Results of a Large-Scale, Online Survey. Nutrients 2022; 14:nu14245356. [PMID: 36558515 PMCID: PMC9784733 DOI: 10.3390/nu14245356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
Optimization of dietary intake is an essential component in the multidimensional effort to prevent and manage chronic disease. Recently, demand has increased for nutrition-focused management strategies for chronic tinnitus. The primary aim of this study was to evaluate 10 dietary items for their association with changes in subjective tinnitus severity. A secondary aim was to develop an algorithm to better identify those individuals who might benefit from dietary modification strategies. A total of 5017 anonymous users of the TinnitusTalk forum completed an online survey regarding how various dietary items affected the severity of their tinnitus. Results suggest that, while intake of caffeine [positive effect (PE): 0.4%; negative effect (NE): 16.2%], alcohol (PE: 2.7%; NE: 13.3%, and salt (PE: 0.1%; NE: 9.9%) was most likely to influence tinnitus severity, it did so only for a small proportion of participants and reported effects were most commonly mild. Further, though a classification algorithm was able to leverage participant demographic, comorbidity, and tinnitus characteristics to identify those individuals most likely to benefit from dietary modification above chance levels, further efforts are required to achieve significant clinical utility. Taken together, these results do not support dietary modification as a primary treatment strategy for chronic tinnitus in the general population, though clinically meaningful effects might be observable in certain individuals.
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Affiliation(s)
- Steven C. Marcrum
- Department of Otolaryngology, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-941-944-9462
| | - Milena Engelke
- Department of Psychiatry and Psychotherapy, University of Regensburg, Bezirksklinikum Regensburg, 93053 Regensburg, Germany
| | | | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Bezirksklinikum Regensburg, 93053 Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Bezirksklinikum Regensburg, 93053 Regensburg, Germany
- Institute for Information and Process Management, Eastern University of Applied Sciences, 9000 St. Gallen, Switzerland
| | | | - Jorge P. Simoes
- Department of Psychiatry and Psychotherapy, University of Regensburg, Bezirksklinikum Regensburg, 93053 Regensburg, Germany
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O’Hearn M, Erndt-Marino J, Gerber S, Lauren BN, Economos C, Wong JB, Blumberg JB, Mozaffarian D. Validation of Food Compass with a healthy diet, cardiometabolic health, and mortality among U.S. adults, 1999-2018. Nat Commun 2022; 13:7066. [PMID: 36414619 PMCID: PMC9681774 DOI: 10.1038/s41467-022-34195-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022] Open
Abstract
The Food Compass is a nutrient profiling system (NPS) to characterize the healthfulness of diverse foods, beverages and meals. In a nationally representative cohort of 47,999 U.S. adults, we validated a person's individual Food Compass Score (i.FCS), ranging from 1 (least healthful) to 100 (most healthful) based on cumulative scores of items consumed, against: (a) the Healthy Eating Index (HEI) 2015; (b) clinical risk factors and health conditions; and (c) all-cause mortality. Nationally, the mean (SD) of i.FCS was 35.5 (10.9). i.FCS correlated highly with HEI-2015 (R = 0.81). After multivariable-adjustment, each one SD (10.9 point) higher i.FCS associated with more favorable BMI (-0.60 kg/m2 [-0.70,-0.51]), systolic blood pressure (-0.69 mmHg [-0.91,-0.48]), diastolic blood pressure (-0.49 mmHg [-0.66,-0.32]), LDL-C (-2.01 mg/dl [-2.63,-1.40]), HDL-C (1.65 mg/d [1.44,1.85]), HbA1c (-0.02% [-0.03,-0.01]), and fasting plasma glucose (-0.44 mg/dL [-0.74,-0.15]); lower prevalence of metabolic syndrome (OR = 0.85 [0.82,0.88]), CVD (0.92 [0.88,0.96]), cancer (0.95 [0.91,0.99]), and lung disease (0.92 [0.88,0.96]); and higher prevalence of optimal cardiometabolic health (1.24 [1.16,1.32]). i.FCS also associated with lower all-cause mortality (HR = 0.93 [0.89,0.96]). Findings were similar by age, sex, race/ethnicity, education, income, and BMI. These findings support validity of Food Compass as a tool to guide public health and private sector strategies to identify and encourage healthier eating.
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Affiliation(s)
- Meghan O’Hearn
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | | | - Suzannah Gerber
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Brianna N. Lauren
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Christina Economos
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - John B. Wong
- grid.67033.310000 0000 8934 4045Tufts Medical Center, Tufts University School of Medicine, Boston, MA USA ,grid.67033.310000 0000 8934 4045Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA USA
| | - Jeffrey B. Blumberg
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Dariush Mozaffarian
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA ,grid.67033.310000 0000 8934 4045Tufts Medical Center, Tufts University School of Medicine, Boston, MA USA
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Ashraf R, Duncan AM, Darlington G, Buchholz AC, Haines J, Ma DWL. The degree of food processing is associated with anthropometric measures of obesity in Canadian families with preschool-aged children. Front Nutr 2022; 9:1005227. [PMID: 36211496 PMCID: PMC9537364 DOI: 10.3389/fnut.2022.1005227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022] Open
Abstract
Adopting a healthy diet remains central for the prevention of obesity. In adults, higher intake of ultra-processed food is associated with a greater risk of overweight and obesity. However, little is known about the degree of food processing and its association with anthropometric measures in families with preschool-aged children, a critical period for the development of dietary patterns. This cross-sectional study included preschool-aged children (n = 267) between 1.5 and 5 years of age and their parents (n = 365) from 242 families enrolled in the Guelph Family Health Study. Dietary assessment was completed using ASA24-Canada-2016. Foods and beverages were classified based on their degree of food processing using the NOVA Classification (unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods). Associations between the energy contribution (% kcal) of each NOVA category and anthropometric measures were examined using linear regression models with generalized estimating equations, adjusted for sociodemographic variables. The energy contribution of ultra-processed foods was the highest relative to the other NOVA categories among parents (44.3%) and children (41.3%). The energy contribution of unprocessed or minimally processed foods was 29.1% for parents and 35.3% for children, processed foods was 24.0% for parents and 21.3% for children, and processed culinary ingredients was 2.6% for parents and 2.1% for children. Ultra-processed foods (% kcal) were positively associated with BMI (β = 0.04, 95% CI: 0.01–0.07, P = 0.02), waist circumference (β = 0.11, 95% CI: 0.03–0.18, P = 0.008) and body weight (β = 0.13, 95% CI: 0.03–0.22, P = 0.01) in parents, but not children. Unprocessed foods (% kcal) were negatively associated with waist circumference in parents (β = −0.09, 95% CI: 0.18–0.01, P = 0.03) and children (β = −0.03, 95% CI: 0.05–0.01, P = 0.01), as well as body weight (β = −0.12, 95% CI: 0.23–0.00, P = 0.04) in parents. The degree of food processing primarily influenced anthropometric outcomes in parents. Nevertheless, diets of children were similar, suggesting that such exposure in families may eventually lead to outcomes observed in parents.
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Affiliation(s)
- Rahbika Ashraf
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Alison M. Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Gerarda Darlington
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | - Andrea C. Buchholz
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
| | - David W. L. Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
- *Correspondence: David W. L. Ma,
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Hollis-Hansen K, Janda KM, Tiscareño M, Filipowicz C, van den Berg A. Objective and perceived barriers and facilitators of daily fruit and vegetable consumption among under-resourced communities in Central Texas. Appetite 2022; 176:106130. [PMID: 35700839 PMCID: PMC9392474 DOI: 10.1016/j.appet.2022.106130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Fruit and vegetable consumption (FVC) continues to be low, particularly among people living in under-resourced communities. Identifying barriers and facilitators of FVC and whether those barriers and facilitators differ for racially and ethnically minoritized people is imperative for developing effective and equitable public health policies and interventions. METHODS A baseline cohort of 390 participants from Central Texas communities historically lacking healthy food retailers completed a survey including FVC, 7 psychosocial barriers and facilitators of FVC, distance to a grocery retailer, participation in government assistance programs, and race/ethnicity. RESULTS Not having time to prepare fruits and vegetables was the only significant psychosocial barrier identified (B = -.11, t(390) = 2.04, P = .04), but was not significant after accounting for sociodemographic variables. Significant facilitators of daily FVC were liking F&V (B=.31, t(390) = 6.40, P<.001), participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (B=.14, t(390) = 2.81, P = .005), and Hispanic/Latino(a) ethnicity (B = -.21, t(390) = 4.30, P<.001). The final model accounted for 17% of the variance in daily FVC (R2=.17, F(4, 375) = 7.69, P < .001). Black, white and Other race participants were more likely to report having difficulty using F&V before spoiling than Hispanic/Latino(a) participants (P = .003). White and Other race participants were more likely to report that F&V were hard to prepare (P = .006) and that they didn't have time to prepare F&V (P = .005). DISCUSSION When designing public health policy and interventions to increase FVC, researchers could prioritize identifying ways to alleviate time constraints, increase F&V liking, and help eligible participants to enroll in WIC. Strategies that reduce the risk of F&V spoiling and make F&V easier to prepare may also benefit some groups.
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Affiliation(s)
| | - Kathryn M Janda
- UTHealth School of Public Health in Austin, USA; Michael and Susan Dell Center for Healthy Living, USA.
| | | | - Claire Filipowicz
- UT Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, USA
| | - Alexandra van den Berg
- UTHealth School of Public Health in Austin, USA; Michael and Susan Dell Center for Healthy Living, USA
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Randall ZD, Brouillard AM, Deych E, Rich MW. Demographic, behavioral, dietary, and clinical predictors of high-sensitivity C-reactive protein: The National Health and Nutrition Examination Surveys (NHANES). AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 21:100196. [PMID: 38559751 PMCID: PMC10978421 DOI: 10.1016/j.ahjo.2022.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/10/2022] [Accepted: 08/20/2022] [Indexed: 04/04/2024]
Abstract
Aims High-sensitivity C-reactive protein (hs-CRP), a marker of inflammation, is associated with atherosclerosis, and recent studies indicate that therapies targeting inflammation are associated with reductions in cardiovascular risk. However, factors predictive of elevated hs-CRP in the general population have not been elucidated. Methods In this cross-sectional study, multivariable logistic regression analysis was used to identify independent predictors of elevated hs-CRP (≥3 mg/L) utilizing the National Health and Nutrition Examination Survey (NHANES) 2015-2016 cycle. The model was verified using the independent NHANES 2017-2018 cycle. Candidate variables comprised demographic, behavioral, dietary, and clinical factors. The study included 5412 adults from the 2015-2016 cohort and 5856 adults from the 2017-2018 cohort. Results Significant independent predictors of elevated hs-CRP included: older age (OR 1.09 per decade; 95 % CI 1.03-1.14; P = 0.024), female sex (OR 1.57; 95 % CI 1.36-1.80; P = 0.003), Black vs White race (OR 1.31; 95 % CI 1.10-1.56; P = 0.037), increased BMI (OR 1.12 per kg/m2; 95 % CI 1.10-1.14; P < 0.001), elevated white blood cell count (OR 1.21 per 1000 white blood cells/μL; 95 % CI 1.15-1.28; P = 0.002), and self-reported poor vs excellent health (OR 1.73; 95 % CI 1.04-2.22; P = 0.012). The model had excellent discrimination with a c-statistic of 0.77 in the 2015-2016 cycle and 0.76 in the 2017-2018 cycle. Conclusion Older age, female sex, Black race, increased BMI, higher white blood cell count, and self-reported poor health were independent predictors of elevated hs-CRP levels. Additional studies are needed to determine if behavioral modifications can lower hs-CRP and whether this translates to reduced risk for cardiovascular disease and other conditions associated with chronic inflammation.
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Affiliation(s)
| | | | - Elena Deych
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Michael W. Rich
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
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Affiliation(s)
- Kimber L Stanhope
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California - Davis, Davis, CA, USA.
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Allen TS, Bhatia HS, Wood AC, Momin SR, Allison MA. State-of-the-Art Review: Evidence on Red Meat Consumption and Hypertension Outcomes. Am J Hypertens 2022; 35:679-687. [PMID: 35561332 DOI: 10.1093/ajh/hpac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Hypertension (HTN) is a well-established risk factor for cardiovascular diseases (CVDs), including ischemic heart disease, stroke, heart failure, and atrial fibrillation. The prevalence of HTN, as well as mortality rates attributable to HTN, continue to increase, particularly in the United States and among Black populations. The risk of HTN involves a complex interaction of genetics and modifiable risk factors, including dietary patterns. In this regard, there is accumulating evidence that links dietary intake of red meat with a higher risk of poorly controlled blood pressure and HTN. However, research on this topic contains significant methodological limitations, which are described in the review. The report provided below also summarizes the available research reports, with an emphasis on processed red meat consumption and how different dietary patterns among certain populations may contribute to HTN-related health disparities. Finally, this review outlines potential mechanisms and provides recommendations for providers to counsel patients with evidence-based nutritional approaches regarding red meat and the risk of HTN, as well as CVD morbidity and mortality.
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Affiliation(s)
- Tara Shrout Allen
- Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, San Diego, California, USA
| | - Harpreet S Bhatia
- Division of Cardiovascular Medicine, University of California, San Diego, San Diego, California, USA
| | - Alexis C Wood
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Shabnam R Momin
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew A Allison
- Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, San Diego, California, USA
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A Produce Prescription Program in Eastern North Carolina Results in Increased Voucher Redemption Rates and Increased Fruit and Vegetable Intake among Participants. Nutrients 2022; 14:nu14122431. [PMID: 35745161 PMCID: PMC9229115 DOI: 10.3390/nu14122431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
Few produce prescription programs have taken place in rural areas, in the context of existing public health programs. Thus, the purpose of this mixed-methods study was to examine voucher redemption rates, change in fruit and vegetable intake, and suggestions for improvement among participants enrolled in a produce prescription program occurring in existing public health programs throughout rural eastern North Carolina. We examined voucher redemption rates and conducted pre- (n = 125) and post-intervention surveys assessing fruit and vegetable intake. t-tests were used to examine changes in intake pre- versus post-intervention among 50 participants. Participants (n = 32) also completed a semi-structured, telephone interview. Qualitative data were thematically analyzed to determine potential improvements. The overall voucher redemption rate was 52%. There was a 0.29 (standard deviation = 0.91, p = 0.031) cup increase in self-reported fruit intake comparing post- to pre-intervention data. Qualitative analyses indicated that participants enjoyed the financial benefits of the program and wanted it to continue. The produce prescription program was successful in increasing self-reported fruit intake among participants. More research is needed to determine if changes in intake persist when measured objectively, and on best methods for the program’s financial sustainability.
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The Dose-Response Effects of Consuming High Fructose Corn Syrup-Sweetened Beverages on Hepatic Lipid Content and Insulin Sensitivity in Young Adults. Nutrients 2022; 14:nu14081648. [PMID: 35458210 PMCID: PMC9030734 DOI: 10.3390/nu14081648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 01/27/2023] Open
Abstract
Increased hepatic lipid content and decreased insulin sensitivity have critical roles in the development of cardiometabolic diseases. Therefore, our objective was to investigate the dose-response effects of consuming high fructose corn syrup (HFCS)-sweetened beverages for two weeks on hepatic lipid content and insulin sensitivity in young (18-40 years) adults (BMI 18-35 kg/m2). In a parallel, double-blinded study, participants consumed three beverages/day providing 0% (aspartame: n = 23), 10% (n = 18), 17.5% (n = 16), or 25% (n = 28) daily energy requirements from HFCS. Magnetic resonance imaging for hepatic lipid content and oral glucose tolerance tests (OGTT) were conducted during 3.5-day inpatient visits at baseline and again at the end of a 15-day intervention. During the 12 intervening outpatient days participants consumed their usual diets with their assigned beverages. Significant linear dose-response effects were observed for increases of hepatic lipid content (p = 0.015) and glucose and insulin AUCs during OGTT (both p = 0.0004), and for decreases in the Matsuda (p = 0.0087) and Predicted M (p = 0.0027) indices of insulin sensitivity. These dose-response effects strengthen the mechanistic evidence implicating consumption of HFCS-sweetened beverages as a contributor to the metabolic dysregulation that increases risk for nonalcoholic fatty liver disease and type 2 diabetes.
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Abstract
Background Methods Findings Interpretation Funding
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