DASH eating pattern is associated with favorable left ventricular function in the multi-ethnic study of atherosclerosis

Standard and New Echocardio Techniques, Such as Global Longitudinal Strain, to Monitor the Impact of Diets on Cardiovascular Diseases and Heart Function

"The Seven Countries Study", published in 1984, was the first study to find a correlation between diet and mortality related to cardiovascular diseases (CVDs). Since then, many investigations have addressed the relationship between type of diet, or specific nutrients, and CVDs. Based on these findings, some traditional dietary models, such as the Mediterranean or Nordic diet, are recommended to prevent CVDs. Meanwhile, new diets have been proposed for optimal nutrition therapy, for example, the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean-DASH Intervention Diet for Neurodegenerative Delay (MIND). The main outcomes evaluated after implementing these dietary models are as follows: CVD-related death; the development of specific CVDs, such as myocardial infarction and hypertension; or biochemical parameters related to CVDs, i.e., non-HDL cholesterol, C-reactive protein (CPR) and homocysteine. However, the early impact of diet on heart functionality is less evaluated. Recently, the echographic measurement of left ventricle (LV) deformation by global longitudinal strain (GLS) has been introduced as a novel marker of clinical and subclinical cardiac dysfunction. This technology allows a subclinical evaluation of heart functionality since, differently from the traditional evaluation of left ventricle ejection fraction (LVEF), it is capable of detecting early myocardial dysfunction. In this review, we analyzed the available studies that correlate dietetic regimens to cardiovascular diseases, focusing on the relevance of LV strain to detect subclinical myocardial alteration related to diet. Evidence is presented that DASH and MIND can have a positive impact on heart functionality and that myocardial strain is useful for early detection of diet-related changes in cardiac function.

Association between dietary patterns and cardiovascular diseases: A review

Cardiovascular disease (CVD), especially atherosclerosis, is the primary cause of global deaths. It accounts for millions of deaths annually. Even a small reduction in CVD through preventive treatment can have a substantial impact. Dietary patterns and substances are strongly linked to chronic diseases such as atherosclerosis, hypertension, heart failure, and type 2 diabetes. An unhealthy diet could lead to traditional risk factors such as LDL levels, TG levels, diabetes, and high blood pressure while accelerating atherosclerosis progression. Recent research has shown the potential of dietary interventions to prevent and treat cardiovascular disease, particularly through healthy dietary patterns such as the Mediterranean diet or DASH. In 2016, the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) launched a new initiative aimed at enhancing the prevention and control of cardiovascular disease (CVD) by improving the management of CVD in primary care, including the optimization of dietary patterns. Here, this review summarizes several large cohort researches about the effects of dietary patterns on atherosclerosis, refines dietary components, and outlines some typical anti-atherosclerosis dietary agents. Finally, this review discusses recent mechanisms by which dietary interventions affect atherosclerosis progression.

Associations between diet quality and NT-proBNP in U.S. adults, NHANES 1999-2004

Objective

N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is a marker of cardiac wall stress and is a predictor of cardiovascular disease. Higher diet quality is associated with lower risk of cardiovascular disease. The association between diet quality and subclinical cardiovascular disease assessed by NT-proBNP is uncharacterized. We investigated the associations between diet quality, using Healthy Eating Index-2015 (HEI-2015), and NT-proBNP from the National Health and Nutrition Examination Survey (NHANES) 1999-2004.

Methods

We included 9,782 adults from NHANES 1999-2004 without self-reported cardiovascular disease. The HEI-2015 ranges from 0 to 100, with higher scores indicating better diet quality. The HEI-2015 was categorized into sex-specific quintiles. Regression models were used to quantify associations between the overall HEI-2015 score and its 13 components with log-transformed NT-proBNP. The beta coefficients were converted to percent differences.

Results

Among 9,782 participants, mean age was 45 years, 48% were men, and 72% were non-Hispanic White adults. After adjusting for sociodemographic characteristics, lifestyle factors, and medical history, those in the highest vs. lowest HEI-2015 quintile had an 8.5% (95% CI: -14.6% to -2.0%) lower NT-proBNP level. There was a dose-response association between HEI-2015 and NT-proBNP (P value for trend = 0.01). Each 1-unit higher in sodium and added sugars score indicating lower intake was associated with lower NT-proBNP by 7.7% (95% CI: -12.8% to -2.2%) and 6.5% (95% CI: -12.0% to -0.7%), respectively.

Conclusion

Higher diet quality, especially lower intakes of sodium and added sugars, was associated with lower serum levels of NT-proBNP.

Oral and gut microbiome alterations in heart failure: Epidemiology, pathogenesis and response to advanced heart failure therapies

Despite significant advances in therapies, heart failure (HF) remains a progressive disease that, once advanced, is associated with significant death and disability. Cardiac replacement therapies with left ventricular assist device (LVAD) and heart transplantation (HT) are the only treatment options for advanced HF, while lifesaving they can also be lifespan limiting due to the associated complications. Systemic inflammation is mechanistically important in HF pathophysiology and progression. However, directly targeting inflammation in HF has not been beneficial thus far. These failed attempts at therapeutics might be related to our limited understanding of the factors that cause inflammation in HF, and, therefore, to our inability to investigate these triggers in interventional studies. Observational studies have consistently demonstrated associations between alterations in the digestive (gut and oral) microbiome, inflammation and HF risk and progression. Additionally, recent data indicate that these microbial perturbations persist following LVAD and HT, along with residual inflammation and oxidative stress. Furthermore, there is rising recognition of the critical contribution of the microbiome to the metabolism of immunosuppressive drugs after HT. Cumulatively, these findings might posit a mechanistic link between microbiome alterations, systemic inflammation, and adverse outcomes in HF patients before and after cardiac replacement therapies. This review (1) provides an update on available data linking changes in digestive tract microbiota, inflammation, and oxidative stress, to HF pathogenesis and progression; (2) describes evolution of these relationships following LVAD and HT; and (3) outlines present and future intervention strategies that can manipulate the microbiome and possibly modify HF disease trajectory.

Adherence to the Mediterranean Diet Is Associated with a More Favorable Left Ventricular Geometry in Patients with End-Stage Kidney Disease

Introduction. The aim of the study was to examine the impact of adherence to a Mediterranean-style diet (MD) on left ventricular hypertrophy (LVH) and cardiac geometry in chronic kidney disease patients on dialysis (CKD-5D), given the high prevalence of cardiovascular morbidity in this population. Methods. n = 127 (77 men and 50 women) CKD-5D patients (69 on hemodialysis and 58 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied. An MD adherence score (MDS) (range 0−55, 55 representing maximal adherence) was estimated with a validated method. Echocardiographic LVH was defined by LV mass index (LVMI) > 95 g/m2 in women and >115 g/m2 in men. Based on LVMI and relative wall thickness (RWT), four LV geometric patterns were defined: normal (normal LVMI and RWT), concentric remodeling (normal LVMI and increased RWT > 0.42), eccentric LVH (increased LVMI and normal RWT), and concentric LVH (increased LVMI and RWT). Results. Patients with LVH (n = 81) as compared to patients with no LVH (n = 46) were older in age (66 ± 13 vs. 55 ± 16 years; p < 0.001) had lower MDS (24 ± 2.7 vs. 25 ± 4.3; p < 0.05) and higher malnutrition-inflammation score (5.0 ± 2.7 vs. 3.9 ± 1.9; p < 0.05), body mass index (27.5 ± 4.9 vs. 24.1 ± 3.5 kg/m2; p < 0.001), prevalence of diabetes (79% vs. 20%; p < 0.05), coronary artery disease (78% vs. 20%; p < 0.05) and peripheral vascular disease (78% vs. 20%; p < 0.01). In a multivariate logistic regression analysis adjusted for all factors mentioned above, each 1-point greater MDS was associated with 18% lower odds of having LVH (OR = 0.82, 95% CI: 0.69−0.98; p < 0.05). MDS was inversely related to LVMI (r = −0.273; p = 0.02), and in a multiple linear regression model (where LVMI was analyzed as a continuous variable), MDS emerged as a significant (Β = −2.217; p < 0.01) independent predictor of LVH. Considering LV geometry, there was a progressive decrease in MDS from the normal group (25.0 ± 3.7) to concentric remodeling (25.8 ± 3.0), eccentric (24.0 ± 2.8), and then concentric (23.6 ± 2.7) group (p < 0.05 for the trend). Conclusions. The greater adherence to an MD is associated with lesser LVH, an important cardiovascular disease risk factor; MD preserves normal cardiac geometry and may confer protection against future cardiac dysfunction in dialysis patients.

Dietary Management of Heart Failure: DASH Diet and Precision Nutrition Perspectives

Heart failure (HF) is a major health care burden increasing in prevalence over time. Effective, evidence-based interventions for HF prevention and management are needed to improve patient longevity, symptom control, and quality of life. Dietary Approaches to Stop Hypertension (DASH) diet interventions can have a positive impact for HF patients. However, the absence of a consensus for comprehensive dietary guidelines and for pragmatic evidence limits the ability of health care providers to implement clinical recommendations. The refinement of medical nutrition therapy through precision nutrition approaches has the potential to reduce the burden of HF, improve clinical care, and meet the needs of diverse patients. The aim of this review is to summarize current evidence related to HF dietary recommendations including DASH diet nutritional interventions and to develop initial recommendations for DASH diet implementation in outpatient HF management. Articles involving human studies were obtained using the following search terms: Dietary Approaches to Stop Hypertension (DASH diet), diet pattern, diet, metabolism, and heart failure. Only full-text articles written in English were included in this review. As DASH nutritional interventions have been proposed, limitations of these studies are the small sample size and non-randomization of interventions, leading to less reliable evidence. Randomized controlled interventions are needed to offer definitive evidence related to the use of the DASH diet in HF management.

DASH diet adherence and cognitive function: Multi-ethnic study of atherosclerosis

BACKGROUND AND AIMS

The Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet has been associated with better cognitive function in studies of predominantly White participants; few studies have examined this association in diverse cohorts. Our objective was to examine the association between the DASH diet and cognitive function in the diverse Multi-Ethnic Study of Atherosclerosis (MESA) cohort.

METHODS

Among 4169 MESA participants, we evaluated prospectively, the association between DASH diet adherence and cognitive function. Participants completed a food frequency questionnaire at baseline (2000-2002) and cognitive function was assessed using the Cognitive Abilities Screening Instrument (CASI), Digit Symbol Coding (DSC), and Digit Span (DS) at Exam 5 in 2010-2012 and Exam 6 (2016-2019). Regression analyses were used to evaluate the association between quintiles of DASH diet adherence with CASI, DSC, and DS performance and decline, adjusting for potential confounders. Effect modification by hypertension, diabetes, race/ethnicity, acculturation, and exercise were evaluated.

RESULTS

DASH diet adherence was not associated with cognitive performance or decline for any of the measures. There were no differences by racial/ethnic groups, with the exception that Hispanic participants reporting greater DASH diet adherence, performed worse on DS at Exam 5 (p = 0.05). Components of the DASH diet were differentially correlated with test performance: increased consumption of nuts/legumes was associated with better performance on the CASI at Exam 5 (p = 0.003) and Exam 6 (p = 0.007). Increased consumption of whole grains was associated with better DSC performance at Exam 5 (p = 0.04) and better DS performance at Exam 6 (p = 0.01).

CONCLUSIONS

DASH diet adherence was nominally associated with cognitive function with a suggestion of differences by race/ethnicity. Future work should examine more closely, the relationships between racial and ethnic groups and the impact of diet on cognitive function.

Associations of the Dietary Approaches to Stop Hypertension dietary pattern with cardiac structure and function

BACKGROUND AND AIMS

Various food groups have been associated with measures of left ventricular geometry and function. Whether the Dietary Approaches to Stop Hypertension (DASH) dietary pattern in mid-life is associated with a favorable cardiac structure and function later in life is unknown.

METHODS AND RESULTS

The study population consisted of the Atherosclerosis Risk in Communities study participants free of cardiovascular disease at study visit 3 in 1993-1995. Dietary intake was assessed by food frequency questionnaire at study visits 1 (1987-1989) and 3 (1993-1995). Participants who underwent transthoracic echocardiograms at the Jackson field center at visit 3 (n = 1974) and at all field centers at study visit 5 (2011-2013; n = 4651) were included in this study. General linear regression was used to evaluate associations between dietary intake and markers of cardiac structure and function adjusting for potential confounders. Higher DASH score was associated with lower left ventricle mean wall thickness and higher absolute value of longitudinal strain at visit 5 (ptrend = 0.004 and < 0.001, respectively).

CONCLUSION

The DASH dietary pattern in midlife was favorably associated with left ventricle structure and systolic function later in life. These results emphasize the importance of adhering to a healthy eating plan as one lifestyle measure to preserve cardiac structure and function.

Nutrition in chronic heart failure patients: a systematic review

Nutrition is the primary source of energy production for myocardial contractility and to maintaining cardiac efficiency. Although many studies provided evidence of the benefits of nutritional intervention in chronic heart failure patients (CHF), these effects are not still completely understood. We searched in PubMed and Embase articles related to the following keywords: "chronic heart failure" with "diet," "nutrition," "insulin resistance," and "caloric restriction." Of the 975 retrieved articles, 20 have been selected. The primary endpoint was the left ventricular (LV) function and the secondary mortality rate in HF patients. Some studies showed that the Mediterranean diet (MedDiet) had a beneficial effect on cardiac function, while others did not find any positive impact. Nutritional supplements and hypercaloric intake had positive effects on underweight HF patients, while hypocaloric diet was beneficial in obese HF patients improving glucose control and cardiac function. The effect of MedDiet in HF patients showed conflicting results. Changes in the dietary pattern can reduce the evolution of HF, considering not only the quality of food but also the caloric intake. The discriminant factor to prescribe a diet regime in HF patients is represented by body mass index (BMI). A well-balanced caloric diet represents an effective therapy in overweight HF patients to reduce the mortality rate. Long-term studies evaluating cause-effect of energy and macronutrients intake on cardiac function in HF patients are necessary.

Associations of Meat and Fish Consumption With Conventional and Radiomics Cardiovascular Magnetic Resonance Phenotypes in the UK Biobank

Background: Greater red and processed meat consumption has been linked to adverse cardiovascular outcomes. However, the impact of these exposures on cardiovascular magnetic resonance (CMR) phenotypes has not been adequately studied.

Objective: We describe novel associations of meat intake with cardiovascular phenotypes and investigate underlying mechanisms through consideration of a range of covariates.

Design: We studied 19,408 UK Biobank participants with CMR data available. Average daily red and processed meat consumption was determined through food frequency questionnaires and expressed as a continuous variable. Oily fish was studied as a comparator, previously associated with favourable cardiac outcomes. We considered associations with conventional CMR indices (ventricular volumes, ejection fraction, stroke volume, left ventricular mass), novel CMR radiomics features (shape, first-order, texture), and arterial compliance measures (arterial stiffness index, aortic distensibility). We used multivariable linear regression to investigate relationships between meat intake and cardiovascular phenotypes, adjusting for confounders (age, sex, deprivation, educational level, smoking, alcohol intake, exercise) and potential covariates on the causal pathway (hypertension, hypercholesterolaemia, diabetes, body mass index).

Results: Greater red and processed meat consumption was associated with an unhealthy pattern of biventricular remodelling, worse cardiac function, and poorer arterial compliance. In contrast, greater oily fish consumption was associated with a healthier cardiovascular phenotype and better arterial compliance. There was partial attenuation of associations between red meat and conventional CMR indices with addition of covariates potentially on the causal pathway, indicating a possible mechanistic role for these cardiometabolic morbidities. However, other associations were not altered with inclusion of these covariates, suggesting importance of alternative biological mechanisms underlying these relationships. Radiomics analysis provided deeper phenotyping, demonstrating association of the different dietary habits with distinct ventricular geometry and left ventricular myocardial texture patterns.

Conclusions: Greater red and processed meat consumption is associated with impaired cardiovascular health, both in terms of markers of arterial disease and of cardiac structure and function. Cardiometabolic morbidities appeared to have a mechanistic role in the associations of red meat with ventricular phenotypes, but less so for other associations suggesting importance of alternative mechanism for these relationships.

The Dietary Approaches to Stop Hypertension (DASH) Diet Pattern and Incident Heart Failure

BACKGROUND

The Dietary Approaches to Stop Hypertension (DASH) diet pattern has shown some promise for preventing heart failure (HF), but studies have been conflicting.

OBJECTIVE

To determine whether the DASH diet pattern was associated with incident HF in a large biracial and geographically diverse population.

METHODS AND RESULTS

Among participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study of adults aged ≥45 years who were free of suspected HF at baseline in 2003-2007, the DASH diet score was derived from the baseline food frequency questionnaire. The main outcome was incident HF defined as the first adjudicated HF hospitalization or HF death through December 31, 2016. We estimated hazard ratios for the associations of DASH diet score quartiles with incident HF, and incident HF with reduced ejection fraction and HF with preserved ejection fraction using the Lunn-McNeil extension to the Cox model. We tested for several prespecified interactions, including with age. Compared with the lowest quartile, individuals in the second to fourth DASH diet score quartiles had a lower risk for incident HF after adjustment for sociodemographic and health characteristics: quartile 2 hazard ratio, 0.69 (95% confidence interval [CI], 0.56-0.85); quartile 3 hazard ratio, 0.71 (95% CI, 0.58-0.87); and quartile 4 hazard ratio, 0.73 (95% CI, 0.58-0.92). When stratifying results by age, quartiles 2-4 had a lower hazard for incident HF among those age <65 years, quartiles 3-4 had a lower hazard among those age 65-74, and the quartiles had similar hazard among those age ≥75 years (Pinteraction = .003). We did not find a difference in the association of DASH diet with incident HF with reduced ejection fraction vs HF with preserved ejection fraction (P = .11).

CONCLUSIONS

DASH diet adherence was inversely associated with incident HF, specifically among individuals <75 years old.

The effects of rice bran oil on left ventricular systolic function, cardiometabolic risk factors and inflammatory mediators in men with coronary artery disease: a randomized clinical trial

BACKGROUND/OBJECTIVE

In the current study, we aimed to explore the effects of rice bran oil (RBO) in adjunct to conventional medical therapy on left ventricular ejection fraction (LVEF), cardiometabolic risk factors, and inflammatory mediators in male patients with coronary artery disease (CAD).

SUBJECTS/METHODS

The present randomized controlled trial included 40 men diagnosed with CAD (mean age = 55.76 years) who were randomly allocated into two groups to receive either 30 grams per day of RBO (intervention group) or sunflower oil (control group) plus a standard diet for eight weeks. At the initial visit, demographic and anthropometric data and blood samples were collected. LVEF levels and serum concentrations of lipid profile, glucose, uric acid, hs-CRP, and TNF-α were investigated.

RESULTS

A total of 37 participants completed the study (n = 18 in the intervention group, n = 19 in the control group). Analysis of covariance (ANCOVA) adjusted for baseline values, age and body mass index revealed that RBO significantly improved LVEF (51.34%) and reduced triglyceride (125.01 mg dl^-1), blood sugar (110.4 mg dl^-1), total cholesterol (123.01 mg dl^-1) and low density lipoprotein (56.88 mg dl^-1) levels compared to sunflower oil ((45.56%), (155.93 mg dl^-1), (128.94 mg dl^-1), (163.93 mg dl^-1) and (83.79 mg dl^-1), respectively) following a 8-week trial (P-values < 0.05). Additionally, the test demonstrated that RBO consuming patients had significantly lower levels of serum uric acid (4.60 mg dl^-1), TNF-α (6.99 ng L^-1) and hs-CRP (2.11 mg L^-1) compared to the control group ((5.92 mg dl^-1), (15.23 ng L^-1), (4.47 mg L^-1), respectively) (P-value < 0.05). However, no significant changes were found regarding weight, blood pressure or serum HDL levels throughout the trial.

CONCLUSION

Consumption of 30 grams per day RBO within a standard diet could be considered an effective non-pharmacological approach in improving LVEF, cardiometabolic risk factors, and inflammatory state in CAD. However, future trials are recommended for more clarification.

Associations of the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet with cardiac remodelling in the community: the Framingham Heart Study

Normal cardiac function is directly associated with the maintenance of cerebrovascular health. Whether the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet, designed for the maintenance of neurocognitive health, is associated with cardiac remodelling is unknown. We evaluated 2512 Framingham Offspring Cohort participants who attended the eighth examination cycle and had available dietary and echocardiographic data (mean age 66 years; 55 % women). Using multivariable regression, we related the cumulative MIND diet score (independent variable) to left ventricular (LV) ejection fraction, left atrial emptying fraction, LV mass (LVM), E/e' ratio (dependent variables; primary), global longitudinal strain, global circumferential strain (GCS), mitral annular plane systolic excursion, longitudinal segmental synchrony, LV hypertrophy and aortic root diameter (secondary). Adjusting for age, sex and energy intake, higher cumulative MIND diet scores were associated with lower values of indices of LV diastolic (E/e' ratio: logβ = -0·03) and systolic function (GCS: β = -0·04) and with higher values of LVM (logβ = 0·02), all P ≤ 0·01. We observed effect modification by age in the association between the cumulative MIND diet score and GCS. When we further adjusted for clinical risk factors, the associations of the cumulative MIND diet score with GCS in participants ≥66 years (β = -0·06, P = 0·005) and LVM remained significant. In our community-based sample, relations between the cumulative MIND diet score and cardiac remodelling differ among indices of LV structure and function. Our results suggest that favourable associations between a higher cumulative MIND diet score and indices of LV function may be influenced by cardiometabolic and lifestyle risk factors.

Dietary Patterns and Their Association with CVD Risk Factors among Bangladeshi Adults: A Cross-Sectional Study

PURPOSE

The objective of this study was to evaluate the association between dietary patterns and CVD risk factors among adults.

METHODS

Demographic data, knowledge, attitude, practices toward CVD related data, dietary data, and some biochemical data were collected from 250 participants at Coronary Care Unit of Jashore 250 bedded Sadar Hospital in Jashore district. A multinomial logit regression method was used to examine the association between LDL and TG levels with the dietary diversity of CVD risk patients.

RESULTS

According to the BMI, most of the respondents were overweight. The respondent's practice level was poor than their knowledge and attitude level toward CVD. A positive correlation was found among the respondents' knowledge, attitude, and practice. Most of the CVD patient's troponin value and BP level were found higher than the acceptable limit. Along with their lipid profile level was not good. Most of them were in borderline risk condition of CVD and some had high risk. The patients who consumed a higher amount of red meat, egg, cheese, fast food, soft drinks, and salty snacks had more probability of increasing LDL and TG level in blood which was the major risk factors of CVD than the patients who consumed fish, chicken, pulse, nuts, fruits, and vegetables in their diet regularly.

CONCLUSION

This study suggests that the consumption of fatty foods, fast foods, and soft drinks leads to the probability of increasing LDL and TG levels in CVD risk patients.

Associations Between Dietary Patterns and Subclinical Cardiac Injury: An Observational Analysis From the DASH Trial

BACKGROUND

The DASH diet has been found to lower blood pressure (BP) and low-density lipoprotein cholesterol levels.

OBJECTIVE

To compare diets rich in fruits and vegetables with a typical American diet in their effects on cardiovascular injury in middle-aged adults without known preexisting cardiovascular disease (CVD).

DESIGN

Observational study based on a 3-group, parallel-design, randomized trial conducted in the United States from 1994 to 1996. (ClinicalTrials.gov: NCT00000544).

SETTING

3 of the 4 original clinical trial centers.

PARTICIPANTS

326 of the original 459 trial participants with available stored specimens.

INTERVENTION

Participants were randomly assigned to 8 weeks of monitored feeding with a control diet typical of what many Americans eat; a diet rich in fruits and vegetables but otherwise similar to the control diet; or the DASH diet, which is rich in fruits, vegetables, low-fat dairy, and fiber and has low levels of saturated fat and cholesterol. Weight was kept constant throughout feeding.

MEASUREMENTS

Biomarkers collected at baseline and 8 weeks: high-sensitivity cardiac troponin I (hs-cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP).

RESULTS

The mean age of participants was 45.2 years, 48% were women, 49% were black, and mean baseline BP was 131/85 mm Hg. Compared with the control diet, the fruit-and-vegetable diet reduced hs-cTnI levels by 0.5 ng/L (95% CI, -0.9 to -0.2 ng/L) and NT-proBNP levels by 0.3 pg/mL (CI, -0.5 to -0.1 pg/mL). Compared with the control diet, the DASH diet reduced hs-cTnI levels by 0.5 ng/L (CI, -0.9 to -0.1 ng/L) and NT-proBNP levels by 0.3 pg/mL (CI, -0.5 to -0.04 pg/mL). Levels of hs-CRP did not differ among diets. None of the markers differed between the fruit-and-vegetable and DASH diets.

LIMITATION

Short duration, missing specimens, and an inability to isolate the effects of specific foods or micronutrients.

CONCLUSION

Diets rich in fruits and vegetables given over 8 weeks were associated with lower levels of markers for subclinical cardiac damage and strain in adults without preexisting CVD.

PRIMARY FUNDING SOURCE

National Institutes of Health, National Heart, Lung, and Blood Institute.

Dietary metabolism, the gut microbiome, and heart failure

Advances in our understanding of how the gut microbiota contributes to human health and diseases have expanded our insight into how microbial composition and function affect the human host. Heart failure is associated with splanchnic circulation congestion, leading to bowel wall oedema and impaired intestinal barrier function. This situation is thought to heighten the overall inflammatory state via increased bacterial translocation and the presence of bacterial products in the systemic blood circulation. Several metabolites produced by gut microorganisms from dietary metabolism have been linked to pathologies such as atherosclerosis, hypertension, heart failure, chronic kidney disease, obesity, and type 2 diabetes mellitus. These findings suggest that the gut microbiome functions like an endocrine organ by generating bioactive metabolites that can directly or indirectly affect host physiology. In this Review, we discuss several newly discovered gut microbial metabolic pathways, including the production of trimethylamine and trimethylamine N-oxide, short-chain fatty acids, and secondary bile acids, that seem to participate in the development and progression of cardiovascular diseases, including heart failure. We also discuss the gut microbiome as a novel therapeutic target for the treatment of cardiovascular disease, and potential strategies for targeting intestinal microbial processes.

How dietary patterns affect left ventricular structure, function and remodelling: evidence from the Kardiovize Brno 2030 study

Little is still known about the effect of dietary patterns on left ventricular hypertrophy (LVH). Here, we derived dietary patterns by principal component analysis (PCA) and evaluated their association with LV structure, function, and remodelling. Our cross-sectional study included 438 members (aged 25–65 years; 59.1% women) of the Kardiovize Brno 2030 with no history of cardiovascular disease. Two dietary patterns were derived using PCA, namely prudent and western. Primary outcomes were echocardiographic parameters and LV geometric patterns, such as concentric LV remodelling (cLVR), concentric LVH (cLVH), and eccentric LVH (eLVH). Interestingly, participants with high adherence to the prudent dietary pattern had decreased odds of cLVH after adjustment for socio-demographic, clinical and behavioral covariates (OR = 0.24, 95% CI = 0.08–0.88; p = 0.031). By contrast, several echocardiographic parameters increased with increasing adherence to the western dietary pattern, which resulted in higher odds of cLVH among participants with high adherence (OR = 5.38, 95% CI = 1.17–23.58; p = 0.035). Although our findings may have an immediate relevance for public-health strategies, further large-size prospective studies should be encouraged to better understand the observed association and their causality.

Association between dietary inflammatory index and bone density in lactating women at 6 months postpartum: a longitudinal study

Background

Chronic inflammation contributes to the risk of osteoporosis and fracture. Dietary Inflammatory Index (DII), a novel method appraising the inflammatory potential of diet, has been utilized to examine the association between diet and bone health among postmenopausal women or the elderly. However, its relationship with bone density (BD) in lactating women has not been studied.

Methods

The prospective study was conducted to assess the possible association between DII and maternal BD during lactation. We enrolled 150 lactating women in the cohort. Participants were measured ultrasonic BD as baseline values at 1 month postpartum. After five-month follow up, the participants’ BD were measured again. DII scores were calculated from semi-quantitative food frequency questionnaires (FFQ) and divided into tertiles. We compared the differences in the changes of BD at 6 months postpartum without or with adjustment for potential covariates across the tertiles.

Results

The women in Q1 of DII scores had less bone mass loss than those in Q2 and Q3 without adjustment for any covariates (p < 0.01); after adjusting demographic characteristics such as BMI (kg/m²) at 6 months postpartum, educational level, metabolic equivalent (MET), daily energy intake (kcal/d), we found that participants in the highest tertile of DII scores had much more bone loss than those in the lowest tertile (p = 0.038). However, in the test for trend, no significant association between DII and the changes of maternal BD at 6 months postpartum was observed.

Conclusions

Chinese lactating women with higher DII scores have more bone mass loss; however significant differences and trends are attenuated and/or disappear depending on covariates and confounders that are taken into account in statistical analysis. The further study should be conducted in larger population to explore whether the significant association between DII and BD exists in Chinese lactating women.

Dietary Approaches to Stop Hypertension Diet Concordance and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis

INTRODUCTION

In observational studies, the association between the Dietary Approaches to Stop Hypertension (DASH) diet and incident heart failure has been inconsistent. It was hypothesized that higher DASH diet concordance has a protective effect on heart failure in a multi-ethnic cohort.

METHODS

The Multi-Ethnic Study of Atherosclerosis cohort includes men and women of multiple ethnicities who were aged 45-84 years and free of clinical cardiovascular disease at baseline. Participants were recruited between 2000 and 2002 from six U.S. communities and followed for incident cardiovascular health events through 2015 for the purpose of this data set. Diet was measured using food-frequency questionnaires. Cox proportional hazards analysis was used to investigate the associations of the DASH diet concordance with incident heart failure in 2017-2018.

RESULTS

During a median 13 years of follow-up, 179 of 4,478 participants developed heart failure, corresponding to a rate of 3.4 per 1,000 person years. Heart failure incidence rates did not vary significantly by DASH quintile for the population as a whole. In participants younger than 75 years, highest DASH concordance was associated with a lower risk of incident heart failure compared with those in the lowest quintile (hazard ratio=0.4, 95% CI=0.2, 0.9 vs all participants hazard ratio=1.0, 95% CI=0.2, 0.9) after adjusting for demographics, energy consumption, and known cardiovascular confounders.

CONCLUSIONS

This study supports the hypothesis that DASH is beneficial in heart failure prevention within the individuals aged less than 75 years subgroup, an idea that to date was substantiated only by much smaller studies or in less diverse patient populations.

Nutritional Interventions in Heart Failure: Challenges and Opportunities

PURPOSE OF REVIEW

There is a growing body of evidence that nutritional factors influence the incidence of heart failure (HF). The current manuscript aims to collate evidence relating to nutritional intervention in the treatment of HF as well as to provide context regarding challenges and opportunities in the field.

RECENT FINDINGS

Despite the accepted importance of nutritional factors relating to cardiovascular disease severity, there is surprisingly little human intervention research regarding dietary intake and HF. Further, existing nutritional interventions in HF were mostly pilot studies with small samples and short follow-up. There is consistent evidence that nutritional factors majorly influence HF. Despite limited research, there is evidence that nutritional modification can rapidly and profoundly influence multiple aspects of HF. There is an urgent need for well-conducted research to ascertain if nutritional modification can alter the long-term course of HF.

Dietary Composition and Cardiovascular Risk: A Mediator or a Bystander?

The role of nutrition in the pathogenesis of cardiovascular disease has long been debated. The established notion of the deleterious effects of fat is recently under question, with numerous studies demonstrating the benefits of low-carbohydrate, high-fat diets in terms of obesity, diabetes, dyslipidemia, and metabolic derangement. Monounsaturated and polyunsaturated fatty acids, especially n-3 PUFAs (polyunsaturated fatty acids), are the types of fat that favor metabolic markers and are key components of the Mediterranean Diet, which is considered an ideal dietary pattern with great cardioprotective effects. Except for macronutrients, however, micronutrients like polyphenols, carotenoids, and vitamins act on molecular pathways that affect oxidative stress, endothelial function, and lipid and glucose homeostasis. In relation to these metabolic markers, the human gut microbiome is constantly revealed, with its composition being altered by even small dietary changes and different microbial populations being associated with adverse cardiovascular outcomes, thus becoming the target for potential new treatment interventions. This review aims to present the most recent data concerning different dietary patterns at both the macro- and micronutrient level and their association with atherosclerosis, obesity, and other risk factors for cardiovascular disease.

Dietary patterns and components to prevent and treat heart failure: a comprehensive review of human studies

Growing evidence has emerged about the role of dietary patterns and components in heart failure (HF) incidence and severity. The objective here is to provide a comprehensive summary of the current evidence regarding dietary patterns/components and HF. A comprehensive search of online databases was conducted using multiple relevant keywords to identify relevant human studies. The Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets have consistently been associated with decreased HF incidence and severity. Regarding specific dietary components, fruit, vegetables, legumes and whole grains appear beneficial. Current evidence suggests that red/processed meats, eggs and refined carbohydrates are harmful, while fish, dairy products and poultry remain controversial. However, there is a notable lack of human intervention trials. The existing but limited observational and interventional evidence from human studies suggests that a plant-based dietary pattern high in antioxidants, micronutrients, nitrate and fibre but low in saturated/trans-fat and Na may decrease HF incidence/severity. Potential mechanisms include decreased oxidative stress, homocysteine and inflammation but higher antioxidant defence and NO bioavailability and gut microbiome modulation. Randomised, controlled trials are urgently required.

Red meat consumption and cardiovascular target organ damage (from the Strong Heart Study)

OBJECTIVE

The aim of this study was to investigate whether red meat consumption is related to changes in left ventricular mass (LVM), left atrial diameter and carotid atherosclerosis in American Indians.

METHODS

We prospectively analyzed echocardiographic and carotid ultrasound data of 1090 adults aged 40 years and older enrolled in the Strong Heart Family Study who were free of cardiovascular disease at baseline - 535 (49%) were hypertensive and 555 (51%) participants were nonhypertensive. Processed and unprocessed red meat intake was ascertained by using a Block food-frequency questionnaire at baseline. Cardiac and vascular biomarkers were assessed at baseline and 4 years later. Marginal models with multivariate adjustment were used to assess the associations of red meat intake with LVM, left atrial diameter, intima-media thickness and presence and extent of carotid atherosclerosis.

RESULTS

Participants with hypertension were older, had a higher BMI, were more likely to be diabetic and less physically active. Processed and unprocessed red meat consumption was related to an increase in the presence of atherosclerotic plaques in male and female hypertensive individuals. In male hypertensive participants, processed meat intake was further observed to be associated with an increase in intima-media thickness, atrial diameter but not LVM. In nonhypertensive participants, neither unprocessed nor processed red meat intake was associated with changes in cardiac parameters or carotid atherosclerosis.

CONCLUSION

Over a 4-year period, red meat consumption was related to cardiovascular target organ damage in hypertensive American Indians. These findings emphasize the importance of dietary measures for cardiovascular disease prevention.

Racial differences in dietary antioxidant intake and cardiac event-free survival in patients with heart failure

Background:

Heart failure is a chronic, burdensome condition with higher re-hospitalization rates in African Americans than Whites. Higher dietary antioxidant intake is associated with lower oxidative stress and improved endothelial function. Lower dietary antioxidant intake in African Americans may play a role in the re-hospitalization disparity between African American and White patients with heart failure.

Objective:

The objective of this study was to examine the associations among race, dietary antioxidant intake, and cardiac event-free survival in patients with heart failure.

Methods:

In a secondary analysis of 247 patients with heart failure who completed a four-day food diary, intake of alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein, zeaxanthin, lycopene, vitamins C and E, zinc, and selenium were assessed. Antioxidant deficiency was defined as intake below the estimated average requirement for antioxidants with an established estimated average requirement, or lower than the sample median for antioxidants without an established estimated average requirement. Patients were followed for a median of one year to determine time to first cardiac event (hospitalization or death). Survival analysis was used for data analysis.

Results:

African American patients had more dietary antioxidant deficiencies and a shorter cardiac event-free survival compared with Whites ( p = .007 and p = .028, respectively). In Cox regression, race and antioxidant deficiency were associated with cardiac event-free survival before and after adjusting for covariates.

Conclusion:

African Americans with heart failure had more dietary antioxidant deficiencies and shorter cardiac event-free survival than Whites. This suggests that encouraging African American patients with heart failure to consume an antioxidant-rich diet may be beneficial in lengthening cardiac event-free survival.

Mediterranean Diet and Other Dietary Patterns in Primary Prevention of Heart Failure and Changes in Cardiac Function Markers: A Systematic Review

Background: Heart failure (HF) is a complex syndrome and is recognized as the ultimate pathway of cardiovascular disease (CVD). Studies using nutritional strategies based on dietary patterns have proved to be effective for the prevention and treatment of CVD. Although there are studies that support the protective effect of these diets, their effects on the prevention of HF are not clear yet. Methods: We searched the Medline, Embase, and Cochrane databases for studies that examined dietary patterns, such as dietary approaches to stop hypertension (DASH diet), paleolithic, vegetarian, low-carb and low-fat diets and prevention of HF. No limitations were used during the search in the databases. Results: A total of 1119 studies were identified, 14 met the inclusion criteria. Studies regarding the Mediterranean, DASH, vegetarian, and Paleolithic diets were found. The Mediterranean and DASH diets showed a protective effect on the incidence of HF and/or worsening of cardiac function parameters, with a significant difference in relation to patients who did not adhere to these dietary patterns. Conclusions: It is observed that the adoption of Mediterranean or DASH-type dietary patterns may contribute to the prevention of HF, but these results need to be analyzed with caution due to the low quality of evidence.

A Review of Plant-based Diets to Prevent and Treat Heart Failure

Evidence supporting the role of nutrition in heart failure (HF) incidence and severity is growing. A comprehensive search of online databases was conducted using relevant keywords to identify human studies including diet and HF. Several plant-based diets have consistently been associated with decreased HF incidence and severity, notably the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets. Several other plant-based dietary patterns, including low-fat diets and the rice diet, also show promise. Higher dietary quality, as assessed using different scores, seems to provide protective qualities. Fruit, vegetables, legumes and wholegrains appear to be beneficial, whereas red/processed meats, eggs and refined carbohydrates appear harmful. Some evidence suggests detrimental effects of dairy products and poultry, but more research is needed. There is observational and interventional evidence that a plant-based diet high in antioxidants, micronutrients, nitrate and fibre but low in saturated/trans fats may decrease the incidence and severity of HF. Potential mechanisms for this include decreased oxidative stress, homocysteine and inflammation levels, as well as higher antioxidant defence and nitric oxide bioavailability with gut microbiome modulation. Well-designed randomised, controlled nutrition intervention trials specific to HF are urgently required.

Development and Evaluation of a Dietary Approaches to Stop Hypertension Dietary Index with Calorie-Based Standards in Equivalent Units: A Cross-Sectional Study with 24-Hour Dietary Recalls from Adult Participants in the National Health and Nutrition Examination Survey 2007-2010

BACKGROUND

Dietary indexes to assess accordance with the Dietary Approaches to Stop Hypertension (DASH) dietary pattern are useful tools in studies with health-related outcomes. However, scoring algorithms of the dietary index can affect the range of its applications.

OBJECTIVE

The purposes of this study were to develop a DASH dietary index with calorie-based standards in equivalent units and to evaluate the validity and reliability of the index.

METHODS

Calorie-based standards for nine components were determined based on recommended intakes in the DASH eating plan and dietary intakes estimated from two 24-hour dietary recalls of adult participants in the National Health and Nutrition Examination Survey 2007-2008, 2009-2010 (n=9,720). Evaluation tests included descriptive analyses of index scores among US adults stratified by sex and smoking status. Spearman's rank correlations were used to examine the relationships among components and total scores. The developed index was compared with two DASH dietary indexes that use different scoring algorithms to examine the association between total scores and blood pressure status through multivariable regression models.

RESULTS

The newly developed index consisted of seven food group and two nutrient components. The mean and median of total scores among US adults were 42.3 (95% CI 41.6 to 43.0) and 41.6 of 90 points, respectively. The mean total scores among adult women and non-current smokers were higher than their counterparts (P<0.001). The absolute correlation coefficients among the components and between each component and the sum of other components were ≤0.33 and ≤0.35, respectively. After adjusting for age and race/ethnicity, an association between total scores and blood pressure status was found in adult women (P<0.001), but not in adult men. The same pattern was found when the two indexes were used, but the strength of the association varied across the three indexes.

CONCLUSIONS

The developed index appeared to measure accordance with the DASH dietary pattern based on the dietary data from US adults. Further studies are warranted for various applications of the index.

An obesity-preventive lifestyle score is negatively associated with pediatric asthma

PURPOSE

Lifestyle (diet and physical activity) may increase asthma risk, but evidence in this area is lacking. The aims of the present study were to calculate an obesity-preventive lifestyle score comprising of eating and physical activity behaviors and investigate the overall effect of lifestyle on asthma in children.

METHODS

A cross-sectional case-control study was carried out in 514 children (217 asthma cases and 297 healthy controls). Data were collected on medical history, anthropometry, dietary intake, and physical activity. We constructed an overweight/obesity-preventive score (OPLS) using study-specific quartile rankings for nine target lifestyle behaviors that were either favorable or unfavorable in preventing obesity (i.e., screen time was an unfavorable lifestyle behavior). The score was developed using the recommendations of the Expert Committee of American Academy of Pediatrics. Score values ranged from 0-18 points; the higher the score, the more protective against high body weight.

RESULTS

The OPLS was negatively associated with obesity indices (BMI, waist circumference, and hip circumference), (p < 0.05). Control children had a higher score when compared to asthma cases (9.3 ± 2.7 vs. 8.6 ± 2.9, p = 0.007). A high OPLS was protective against physician-diagnosed asthma (OR 0.92; 95% CI 0.86-0.98, p = 0.014), adjusted for several confounders. The OPLS was no longer protective after adjustment for BMI.

CONCLUSION

Higher adherence to an obesity-preventive lifestyle score-consistent with several behaviors for the prevention of childhood overweight/obesity-is negatively associated with obesity indices and lowers the odds for asthma in children. Lifestyle behaviors that contribute to a higher body weight may contribute to the obesity-asthma link. These findings are hypothesis-generating and warrant further investigation in prospective intervention studies.

Mediterranean diet score and left ventricular structure and function: the Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Data are limited on the relation between dietary patterns and left ventricular (LV) structure and function.

OBJECTIVE

We examined cross-sectional associations of a diet-score assessment of a Mediterranean dietary pattern with LV mass, volume, mass-to-volume ratio, stroke volume, and ejection fraction.

DESIGN

We measured LV variables with the use of cardiac MRI in 4497 participants in the Multi-Ethnic Study of Atherosclerosis study who were aged 45-84 y and without clinical cardiovascular disease. We calculated a Mediterranean diet score from intakes of fruit, vegetables, nuts, legumes, whole grains, fish, red meat, the monounsaturated fat:saturated fat ratio, and alcohol that were self-reported with the use of a food-frequency questionnaire. We used linear regression with adjustment for body size, physical activity, and cardiovascular disease risk factors to model associations and assess the shape of these associations (linear or quadratic).

RESULTS

The Mediterranean diet score had a slight U-shaped association with LV mass (adjusted means: 146, 145, 146, and 147 g across quartiles of diet score, respectively; P-quadratic trend = 0.04). The score was linearly associated with LV volume, stroke volume, and ejection fraction: for each +1-U difference in score, LV volume was 0.4 mL higher (95% CI: 0.0, 0.8 mL higher), the stroke volume was 0.5 mL higher (95% CI: 0.2, 0.8 mL higher), and the ejection fraction was 0.2 percentage points higher (95% CI: 0.1, 0.3 percentage points higher). The score was not associated with the mass-to-volume ratio.

CONCLUSIONS

A higher Mediterranean diet score is cross-sectionally associated with a higher LV mass, which is balanced by a higher LV volume as well as a higher ejection fraction and stroke volume. Participants in this healthy, multiethnic sample whose dietary patterns most closely conformed to a Mediterranean-type pattern had a modestly better LV structure and function than did participants with less-Mediterranean-like dietary patterns. This trial was registered at clinicaltrials.gov as NCT00005487.

Nutrition and Cardiovascular Disease: Finding the Perfect Recipe for Cardiovascular Health

The increasing burden of cardiovascular disease (CVD) despite the progress in management entails the need of more effective preventive and curative strategies. As dietary-associated risk is the most important behavioral factor influencing global health, it appears the best target in the challenge against CVD. Although for many years, since the formulation of the cholesterol hypothesis, a nutrient-based approach was attempted for CVD prevention and treatment, in recent years a dietary-based approach resulted more effective in reducing cardiovascular risk worldwide. After the publication of randomized trials on the remarkable effects of the Mediterranean diet and the Dietary Approach to Stop Hypertension (DASH) diet on CVD, new efforts were put on research about the effects of complex dietary interventions on CVD. The purpose of this paper is to review the evidence on dietary interventions in the prevention and disease modification of CVD, focusing on coronary artery disease and heart failure, the main disease responsible for the enormous toll taken by CVD worldwide.