Dietary fiber and lifestyle influence serum lipids in free living adult men

Serum/plasma biomarkers and the progression of cardiometabolic multimorbidity: a systematic review and meta-analysis

Background

The role of certain biomarkers in the development of single cardiometabolic disease (CMD) has been intensively investigated. Less is known about the association of biomarkers with multiple CMDs (cardiometabolic multimorbidity, CMM), which is essential for the exploration of molecular targets for the prevention and treatment of CMM. We aimed to systematically synthesize the current evidence on CMM-related biomarkers.

Methods

We searched PubMed, Embase, Web of Science, and Ebsco for relevant studies from inception until August 31st, 2022. Studies reported the association of serum/plasma biomarkers with CMM, and relevant effect sizes were included. The outcomes were five progression patterns of CMM: (1) no CMD to CMM; (2) type 2 diabetes mellitus (T2DM) followed by stroke; (3) T2DM followed by coronary heart disease (CHD); (4) T2DM followed by stroke or CHD; and (5) CHD followed by T2DM. Newcastle-Ottawa Quality Assessment Scale (NOS) was used to assess the quality of the included studies. A meta-analysis was conducted to quantify the association of biomarkers and CMM.

Results

A total of 68 biomarkers were identified from 42 studies, which could be categorized into five groups: lipid metabolism, glycometabolism, liver function, immunity, and others. Lipid metabolism biomarkers were most reported to associate with CMM, including TC, TGs, HDL-C, LDL-C, and Lp(a). Fasting plasma glucose was also reported by several studies, and it was particularly associated with coexisting T2DM with vascular diseases. According to the quantitative meta-analysis, HDL-C was negatively associated with CHD risk among patients with T2DM (pooled OR for per 1 mmol/L increase = 0.79, 95% CI = 0.77-0.82), whereas a higher TGs level (pooled OR for higher than 150 mg/dL = 1.39, 95% CI = 1.10-1.75) was positively associated with CHD risk among female patients with T2DM.

Conclusion

Certain serum/plasma biomarkers were associated with the progression of CMM, in particular for those related to lipid metabolism, but heterogeneity and inconsistent findings still existed among included studies. There is a need for future research to explore more relevant biomarkers associated with the occurrence and progression of CMM, targeted at which is important for the early identification and prevention of CMM.

Association Between Dietary Fiber Intake and Cardiometabolic Risk Factors in Adolescents in the United States

OBJECTIVE

To determine the association between dietary fiber intake and markers of cardiometabolic risk in adolescents, with blood pressure (BP) as the primary outcome of interest and secondary outcome measures including other established markers of childhood cardiometabolic risk, such as obesity, lipids, albuminuria, estimated glomerular filtration rate (eGFR), and uric acid.

STUDY DESIGN

Dietary fiber intake was assessed by two 24-hour dietary recall interviews, which were averaged and corrected for body weight. Logistic and linear regression models were used to analyze the cross-sectional association between dietary fiber and cardiometabolic markers. Participants aged 13-17 years in the National Health and Nutritional Examination Survey 2009-2018 who completed a 24-hour dietary recall survey were included. Exclusion criteria included pregnancy, small for gestational age status, and history of major health comorbidities.

RESULTS

In fully adjusted regression models, low dietary fiber intake was significantly associated with greater diastolic blood pressure (β = -13.29; 95% CI, -20.66 to -5.93), body mass index z-score (β = -0.91; 95% CI, -1.47 to -0.34), and uric acid (β = -0.80; 95% CI, -1.44 to -0.16).

CONCLUSIONS

The association found between low dietary fiber intake and poor childhood cardiometabolic risk markers indicate a need for prospective studies using fiber intake as a dietary intervention in childhood and as a tool for prevention of many chronic conditions.

The effects of guar gum supplementation on lipid profile in adults: a GRADE-assessed systematic review, meta-regression and dose-response meta-analysis of randomised placebo-controlled trials

Recent meta-analytic work indicated that guar gum supplementation might improve lipid profile markers in different populations. However, critical methodological limitations such as the use of some unreliable data and the lack of inclusion of several relevant studies, and the scarcity in assessments of regression and dose-specific effects make it difficult to draw meaningful conclusions from the meta-analysis. Therefore, current evidence regarding the effects of guar gum supplementation on lipid profile remains unclear. The present systematic review, meta-regression and dose-response meta-analysis aimed to examine the effects of guar gum supplementation on lipid profile (total cholesterol (TC), LDL, TAG and HDL) in adults. Relevant studies were obtained by searching the PubMed, SCOPUS, Embase and Web of Science databases (from inception to September 2021). Weighted mean differences (WMD) and 95 % CI were estimated via a random-effects model. Heterogeneity, sensitivity analysis and publication bias were reported using standard methods. Pooled analysis of nineteen randomised controlled trials (RCT) revealed that guar gum supplementation led to significant reductions in TC (WMD: -19·34 mg/dl, 95 % CI -26·18, -12·49, P < 0·001) and LDL (WMD: -16·19 mg/dl, 95 % CI -25·54, -6·83, P = 0·001). However, there was no effect on TAG and HDL among adults in comparison with control group. Our outcomes suggest that guar gum supplementation lowers TC and LDL in adults. Future large RCT on various populations are needed to show further beneficial effects of guar gum supplementation on lipid profile and establish guidelines for clinical practice.

The Structure of Relationships between the Human Exposome and Cardiometabolic Health: The Million Veteran Program

The exposome represents the array of dietary, lifestyle, and demographic factors to which an individual is exposed. Individual components of the exposome, or groups of components, are recognized as influencing many aspects of human physiology, including cardiometabolic health. However, the influence of the whole exposome on health outcomes is poorly understood and may differ substantially from the sum of its individual components. As such, studies of the complete exposome are more biologically representative than fragmented models based on subsets of factors. This study aimed to model the system of relationships underlying the way in which the diet, lifestyle, and demographic components of the overall exposome shapes the cardiometabolic risk profile. The current study included 36,496 US Veterans enrolled in the VA Million Veteran Program (MVP) who had complete assessments of their diet, lifestyle, demography, and markers of cardiometabolic health, including serum lipids, blood pressure, and glycemic control. The cohort was randomly divided into training and validation datasets. In the training dataset, we conducted two separate exploratory factor analyses (EFA) to identify common factors among exposures (diet, demographics, and physical activity) and laboratory measures (lipids, blood pressure, and glycemic control), respectively. In the validation dataset, we used multiple normal regression to examine the combined effects of exposure factors on the clinical factors representing cardiometabolic health. The mean ± SD age of participants was 62.4 ± 13.4 years for both the training and validation datasets. The EFA revealed 19 Exposure Common Factors and 5 Physiology Common Factors that explained the observed (measured) data. Multivariate regression in the validation dataset revealed the structure of associations between the Exposure Common Factors and the Physiology Common Factors. For example, we found that the factor for fruit consumption was inversely associated with the factor summarizing total cholesterol and low-density lipoprotein cholesterol (LDLC, p = 0.008), and the latent construct describing light levels of physical activity was inversely associated with the blood pressure latent construct (p < 0.0001). We also found that a factor summarizing that participants who frequently consume whole milk are less likely to frequently consume skim milk, was positively associated with the latent constructs representing total cholesterol and LDLC as well as systolic and diastolic blood pressure (p = 0.0006 and <0.0001, respectively). Multiple multivariable-adjusted regression analyses of exposome factors allowed us to model the influence of the exposome as a whole. In this metadata-rich, prospective cohort of US Veterans, there was evidence of structural relationships between diet, lifestyle, and demographic exposures and subsequent markers of cardiometabolic health. This methodology could be applied to answer a variety of research questions about human health exposures that utilize electronic health record data and can accommodate continuous, ordinal, and binary data derived from questionnaires. Further work to explore the potential utility of including genetic risk scores and time-varying covariates is warranted.

Emerging Processing Technologies for the Recovery of Valuable Bioactive Compounds from Potato Peels

Potato peel (PP) is the major underutilised by-product in the potato-processing industry and a potential source of valuable bioactive molecules. Among them, glycoalkaloids and polyphenols are important precursors for steroid hormones and natural antioxidants, respectively. Moreover, the huge quantities of industrial potato-peel waste that are produced are a rich source of primary metabolites, which principally include starch as well as non-starch polysaccharides, proteins, lipids, lignin and cellulose. All carbohydrates are prone to undergo fermentation to produce ethanol, lactic and acetic acid. Finally, the main portion of PP is made up of alcohol-insoluble matter with a dietary fibre content of approximatively 40%. The present review summarises the recent advances and emerging technologies in potato-peel extraction and further valorisation processing in the food industry.

Application and Development Prospects of Dietary Fibers in Flour Products

Dietary fibers are often characterized by high nutritional quality, as they are able to cure many chronic diseases and improve texture, sensory characteristics, and shelf life of foods. Here, the following aspects of dietary fibers have been reviewed: nutritional properties, including the ability to regulate blood sugar levels, effects on microorganisms, antioxidant effect, potential role in losing weight, ability to regulate blood lipids, application in flour products such as bread and Chinese noodles, challenges such as dark color, rough texture, and poor solubility, and potential solutions that include modification methods. The primary purpose of this review is to comprehensively evaluate potential applications of dietary fibers in flour products, addressing common problems and reviewing potential solutions to promote further study and applications of dietary fibers.

Dietary Factors in Reducing Risk of Cardiovascular Diseases

Diet influences many modifiable risk factors for cardiovascular diseases (CVDs). Considering this, moderation of total dietary fat, particularly trans and saturated fats, as well as cholesterol is recommended. Dietary fats should come mainly from plants and fatty fish, providing monounsaturated and polyunsaturated (including omega-3) fatty acids. Carbohydrate sources to emphasize include whole grains, legumes, vegetables, fruits, and other fiber-rich sources, rather than sugars. Although vitamins such as E, C, and some B vitamins are associated with reduced CVD risk, data do not support the use of supplements, but foods rich in these nutrients are advocated. Dietary minerals such as potassium, magnesium, and calcium may be beneficial to heart health, while reduction of dietary sodium decreases risk of hypertension. A large variety of phytonutrients are also associated with reduced CVD risk. Other dietary factors receiving research attention regarding CVD risk. Other dietary factors receiving research attention regarding CVD risk include caffeine, alcobol, and meal frequency, although more work is needed in these areas. In contrast, data are quite robust to support the importance of healthy body weight management in cardiovascular health. In general, diets based on a variety of less processed foods, mainly of plant origin, in the context of an active lifestyle, are conducive to heart health.

Beneficial Effect of Higher Dietary Fiber Intake on Plasma HDL-C and TC/HDL-C Ratio among Chinese Rural-to-Urban Migrant Workers

Research has shown that high-dose supplemental dietary fiber intake has beneficial effects on cardiovascular risk factors. To clarify such a relationship, we examined the association between daily dietary fiber intake and plasma lipids using a cross-sectional design including 1034 (M 502, F 532) rural-to-urban workers in China. We found a dose-response relationship between increased dietary fiber intakes and increase of HDL cholesterol in male workers. There was also a dose-response relationship between increased dietary fiber intake and decreased total cholesterol to HDL cholesterol (TC/HDL-C) ratio in both male and female workers, after adjusting for potential confounders (p for trend, all p < 0.05). When the average dietary fiber intake increased from less than 18 g/day to over 30 g/day, the average HDL cholesterol level increased by 10.1%, and the TC/HDL-C ratio decreased by 14.4% for males (p = 0.020) and by 11.1% for females (p = 0.048). In conclusion, higher daily dietary fiber consumption is associated with beneficial effect on cholesterol for rural-to-urban workers in China, suggesting its potential beneficial effect on decreasing the risk of cardiovascular diseases.

The relationship between pain and eating among overweight and obese individuals with osteoarthritis: an ecological momentary study

The relationship between pain and overweight/obesity is bidirectional – excess weight can cause pain, yet eating food high in calories, fat and sugar has been shown to alleviate pain. It appears likely that overweight/obese individuals may turn to these types of foods when they experience pain, leading to weight gain; however, this phenomenon has not been examined to date. The authors of this study set out to elucidate the relationship between pain and food intake in obese and overweight patients with osteoarthritis.

BACKGROUND:

Osteoarthritis (OA) patients who are overweight or obese report higher levels of pain compared with their normal-weight OA counterparts. Evidence suggests that overweight or obese OA patients also experience pain relief from eating foods high in calories, fat or sugar. Eating to alleviate pain may be problematic because it can lead to additional weight gain, which may contribute to heightened pain.

OBJECTIVES:

To investigate the relationship between pain and food intake using ecological momentary assessments in a sample of 71 over-weight and obese OA patients.

METHODS:

Participants completed two consecutive days of diary entries in which they recorded their levels of pain, mood and food intake throughout the day. Data were analyzed using generalized estimating equations that modelled pain as a predictor of calorie, fat and sugar intake. All models were adjusted for sex, body mass index, negative mood, time and treatment history.

RESULTS:

Pain significantly predicted calorie (Z=2.57; P=0.01) and fat intake (Z=1.99; P=0.05).

CONCLUSIONS:

Using ecological momentary assessments as a novel approach, the present study provides preliminary data supporting a relationship between pain and food intake among overweight and obese OA patients. Continued advances in our understanding of the relationship between pain and eating behaviour may help to optimize intervention strategies for these patients.

Contribution of diet and major depression to incidence of acute myocardial infarction (AMI)

BACKGROUND

Despite significant improvements in the treatment of coronary heart disease (CHD), it is still a major cause of mortality and morbidity among the Iranian population. Epidemiological studies have documented that risk factors including smoking and the biochemical profile are responsible for the development of acute myocardial infarction (AMI). Psychological factors have been discussed as potential risk factors for coronary heart disease. Among emotional factors, depression correlates with coronary heart disease, particularly myocardial infarction.

METHODS

This case-control study was conducted on 120 cases (69 males and 51 females) of acute myocardial infarction (AMI) and 120 controls, with a mean age of 62.48 ± 15.39 years. Cases and controls were matched by age, residence and sex.

RESULTS

The results revealed that severe depression was independently associated with the risk of AMI (P = 0.025, OR = 2.6, 95% CI 1.1-5.8). The analysis of variables indicated that risk factors for developing depression were unmarried, low levels of polyunsaturated fatty acids (PUFAs), total dietary fiber (TDF) and carbohydrates. The levels of these dietary factors were lowest in severely depressed patients compared to those categorised as moderate or mild cases. Furthermore, severely depressed subjects were associated with higher levels of total cholesterol, high systolic blood pressure (SBP) and WHR. Age, income, a family history of coronary heart disease, education level, sex, employment and smoking were not associated with severe depression.

CONCLUSION

The present study demonstrated that severe depression symptoms are independent risk factors for AMI. Furthermore, severe depression was associated with an unhealthy diet and AMI risk factors.

Fruit and vegetable consumption and risk factors for cardiovascular disease

The international guidelines issued by the World Health Organization recommend reduction in dietary saturated fat and cholesterol intakes as means to prevent hypercholesterolemia and cardiovascular disease (CVD); however, only limited data are available on the benefits of fruit and vegetable consumption on CVD risk factors in a community-based population. The aim of this study was to examine whether, and to what extent, intake of fruits and vegetables is inversely associated with CVD risk factors in adults. In this population-based cross-sectional study, a representative sample of 840 Tehranian adults (male and female) aged 18 to 74 years was randomly selected in 1998. Multivariate logistic regression adjusted for lifestyle and nutritional confounders was used in 2 models. After adjusting for confounders, dietary fruit and vegetable were found to be significantly and inversely associated with CVD risk factors. Adjusted odds ratio for high low-density lipoprotein concentrations were 1.00, 0.88, 0.81, and 0.75 (P for trend < .01) in the first model, which was adjusted for age, sex, keys score, body mass index, energy intake, smoking status, dietary cholesterol, and history of diabetes mellitus and coronary artery disease, a trend which was not appreciably altered by additional adjustment for education, physical activity, and saturated, polyunsaturated, and total fat intakes. This association was observed across categories of smoking status, physical activity, and tertiles of the Keys score. Exclusion of subjects with prevalent diabetes mellitus or coronary artery disease did not alter these results significantly. Consumption of fruits and vegetables is associated with lower concentrations of total and low-density lipoprotein cholesterol and with the risk of CVD per se in a dose-response manner.

Prevalence of Hyperlipidemia and Its Risk Factors for the Middle-Aged and Elderly in the Guangxi Hei Yi Zhuang and Han Populations

BACKGROUND

Han is the largest and Zhuang is the second largest among the 56 nationalities in China. Geographically and linguistically, Zhuang can be classified into 43 ethnic subgroups, among which Hei Yi (which means "black worship" and "black dressing") Zhuang is the most conservative group, according to its unique culture and customs. Little is known about the lipid profiles and corresponding risk factors of hyperlipidemia in this population. Therefore, the aim of this study was to compare the effects of demographic characteristics, health-related behaviors, and lifestyle factors on the prevalence of hyperlipidemia for the middle-aged and elderly in the Guangxi Hei Yi Zhuang and Han populations.

METHODS

A sample of 657 people of Hei Yi Zhuang aged 40 years and over was randomly selected from 7 villages in Napo County, Guangxi, China. Information on demographic characteristics, health-related behaviors, and lifestyle factors was collected by questionnaire. Blood pressure, height, weight, waist circumference, and serum lipid and apolipoprotein (apo) levels were measured, and body mass index (BMI) was calculated as a measure of weight relative to height. The results were compared with those in 520 people of Han living in the same region.

RESULTS

The prevalence of hyperlipidemia in the Hei Yi Zhuang was significantly lower than that in the Han (36.2% vs 42.3%; p < .05). The levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol, and apo B in Hei Yi Zhuang were also significantly lower than those in the Han (p < .05 to .001), but the levels of high-density lipoprotein cholesterol and the ratio of apo A-I to apo B in the Hei Yi Zhuang were significantly higher than those in the Han (p < .01 and < .001, respectively). There were no significant differences in apo A-I levels between the two ethnic groups (p > .05). The prevalence of hyperlipidemia was positively correlated with BMI and blood pressure in the Hei Yi Zhuang. Hyperlipidemia was positively associated with age, BMI, and blood pressure and negatively associated with gender (female higher) in the Han.

CONCLUSIONS

In the present study of the middle-aged and elderly population, the Hei Yi Zhuang have a more favorable lipid profile and a lower prevalence of hyperlipidemia than do the Han, and there is also a significant difference in the risk factors for hyperlipidemia between the two ethnic groups, which might result from the effects of different demographic characteristics, health-related behaviors, and lifestyle factors.

Dietary cholesterol does not increase biomarkers for chronic disease in a pediatric population from northern Mexico

BACKGROUND

An increased incidence of coronary artery disease (CAD) is prevalent in northern Mexico. Effects of specific dietary components on risk factors for CAD have not been evaluated in children.

OBJECTIVE

The purpose was to evaluate the effects of dietary cholesterol provided by whole eggs on the lipoprotein profile, LDL size, and phenotype in children from this region.

DESIGN

Children (29 girls and 25 boys aged 8-12 y) were randomly assigned to either 2 eggs/d (EGG period; 518 additional mg cholesterol) or the equivalent amount of egg whites (SUB period; 0 additional mg cholesterol) for 30 d. After a 3-wk washout period, the children were assigned to the alternate treatment.

RESULTS

Subjects were classified as hyporesponders (no increase or </=0.05 mmol/L increase in plasma cholesterol for 100 mg additional cholesterol) or hyperresponders (>/=0.06 mmol/L increase). During the EGG period, the hyperresponders (n = 18) had an elevation in both LDL cholesterol (from 1.54 +/- 0.38 to 1.93 +/- 0.36 mmol/L) and HDL cholesterol (from 1.23 +/- 0.26 to 1.35 +/- 0.29 mmol/L) with no changes in LDL:HDL. In contrast, hyporesponders (n = 36) had no significant alterations in plasma LDL or HDL cholesterol. All subjects had an increase in LDL peak diameter during the EGG period (P < 0.01) and a decrease (P < 0.01) in the smaller LDL subfractions. In addition, 5 of the children having LDL phenotype B (15%) shifted from this high-risk pattern to pattern A after the EGG treatment.

CONCLUSIONS

Intake of 2 eggs/d results in the maintenance of LDL:HDL and in the generation of a less atherogenic LDL in this population of Mexican children.

Fruit and vegetable consumption and LDL cholesterol: the National Heart, Lung, and Blood Institute Family Heart Study

BACKGROUND

An elevated LDL-cholesterol concentration is associated with an increased risk of cardiovascular disease. The association between fruit and vegetable consumption and LDL has been inconsistent.

OBJECTIVE

The objective was to determine whether a high intake of fruit and vegetables is inversely associated with LDL concentrations.

DESIGN

We used data collected from 4466 subjects in the National Heart, Lung, and Blood Institute Family Heart Study to study the association between fruit and vegetable consumption and serum LDL. We used a food-frequency questionnaire to assess fruit and vegetable intakes and regression models to estimate adjusted mean LDL according to fruit and vegetable consumption.

RESULTS

The mean (+/-SD) age of the men (n = 2047) was 51.5 +/- 14.0 y and that of the women (n = 2419) was 52.2 +/- 13.7 y. The average daily serving of fruit and vegetables was 3.2 +/- 1.7 for men and was 3.5 +/- 1.8 for women. Fruit and vegetable consumption was inversely related to LDL: in the categories 0-1.9, 2.0-2.9, 3.0-3.9, and > or = 4 servings/d, multivariate-adjusted mean (95% CI) LDL concentrations were 3.36 (3.28, 3.44), 3.35 (3.27, 3.43), 3.26 (3.17, 3.35), and 3.17 (3.09, 3.25) mmol/L, respectively, for men (P for trend < 0.0001) and 3.35 (3.26, 3.44), 3.22 (3.14, 3.30), 3.21 (3.13, 3.29), and 3.11 (3.04, 3.18), respectively, for women (P for trend < 0.0001). This association was observed across categories of age, education, smoking status, physical activity, and tertiles of Keys score. Exclusion of subjects with prevalent diabetes mellitus or coronary artery disease did not alter these results significantly.

CONCLUSION

Consumption of fruit and vegetables is inversely related to LDL in men and women.