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Rodrigues J, Costa M, de Sousa D, Costa AR, Lunet N, Cruz VT, Padrão P. Adherence to the Mediterranean Diet, Sodium and Potassium Intake in People at a High Risk of Dementia. Nutrients 2024; 16:1419. [PMID: 38794657 PMCID: PMC11124415 DOI: 10.3390/nu16101419] [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: 03/25/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Adequate sodium and potassium intake, along with adherence to the Mediterranean diet (MedDiet), are key factors for preventing hypertension and cerebrovascular diseases. However, data on the consumption of these nutrients within the MedDiet are scarce. This cross-sectional study aims to assess the association between MedDiet adherence and sodium/potassium intake in the MIND-Matosinhos randomized controlled trial, targeting Portuguese adults at a high risk of dementia. Good adherence to the MedDiet was defined using the Portuguese Mediterranean Diet Adherence Screener questionnaire (≥10 points), and both sodium/potassium intakes were estimated from 24-hour urine collections. The association between MedDiet adherence and these nutrients' intake (dichotomized by the median) was quantified by calculating odds ratios (OR) and respective 95% confidence intervals (95% CI) using a logistic regression. A total of 169 individuals (60.9% female; median age: 70 years; range: 36-85 years) were included. Good adherence to the MedDiet was observed among 18.3% of the sample. After adjusting for sex, age, education and using antihypertensive drugs, good MedDiet adherence was associated with higher sodium (OR = 3.11; 95% CI: 1.27-7.65) and potassium intake (OR = 9.74; 95% CI: 3.14-30.26). Increased adherence to the MedDiet may contribute to a higher potassium intake but seems to have limited effects on the adequacy of sodium levels.
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Affiliation(s)
- Joana Rodrigues
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180 Porto, Portugal; (J.R.); (M.C.)
| | - Mariana Costa
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180 Porto, Portugal; (J.R.); (M.C.)
| | - Daniela de Sousa
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal; (D.d.S.); (A.R.C.); (N.L.); (V.T.C.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Departamento de Saúde Pública e Ciências Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Ana Rute Costa
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal; (D.d.S.); (A.R.C.); (N.L.); (V.T.C.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Departamento de Saúde Pública e Ciências Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Nuno Lunet
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal; (D.d.S.); (A.R.C.); (N.L.); (V.T.C.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Departamento de Saúde Pública e Ciências Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Vítor Tedim Cruz
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal; (D.d.S.); (A.R.C.); (N.L.); (V.T.C.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Serviço de Neurologia, Unidade Local de Saúde de Matosinhos, 4464-513 Senhora da Hora, Portugal
| | - Patrícia Padrão
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, 4150-180 Porto, Portugal; (J.R.); (M.C.)
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal; (D.d.S.); (A.R.C.); (N.L.); (V.T.C.)
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
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Abrignani V, Salvo A, Pacinella G, Tuttolomondo A. The Mediterranean Diet, Its Microbiome Connections, and Cardiovascular Health: A Narrative Review. Int J Mol Sci 2024; 25:4942. [PMID: 38732161 PMCID: PMC11084172 DOI: 10.3390/ijms25094942] [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: 02/24/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
The Mediterranean diet (MD), rich in minimally processed plant foods and in monounsaturated fats but low in saturated fats, meat, and dairy products, represents one of the most studied diets for cardiovascular health. It has been shown, from both observational and randomized controlled trials, that MD reduces body weight, improves cardiovascular disease surrogates such as waist-to-hip ratios, lipids, and inflammation markers, and even prevents the development of fatal and nonfatal cardiovascular disease, diabetes, obesity, and other diseases. However, it is unclear whether it offers cardiovascular benefits from its individual components or as a whole. Furthermore, limitations in the methodology of studies and meta-analyses have raised some concerns over its potential cardiovascular benefits. MD is also associated with characteristic changes in the intestinal microbiota, mediated through its constituents. These include increased growth of species producing short-chain fatty acids, such as Clostridium leptum and Eubacterium rectale, increased growth of Bifidobacteria, Bacteroides, and Faecalibacterium prausnitzii species, and reduced growth of Firmicutes and Blautia species. Such changes are known to be favorably associated with inflammation, oxidative status, and overall metabolic health. This review will focus on the effects of MD on cardiovascular health through its action on gut microbiota.
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Affiliation(s)
- Vincenzo Abrignani
- Internal Medicine and Stroke Care Ward, University of Palermo, 90127 Palermo, Italy; (V.A.); (A.S.); (G.P.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Andrea Salvo
- Internal Medicine and Stroke Care Ward, University of Palermo, 90127 Palermo, Italy; (V.A.); (A.S.); (G.P.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Gaetano Pacinella
- Internal Medicine and Stroke Care Ward, University of Palermo, 90127 Palermo, Italy; (V.A.); (A.S.); (G.P.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Antonino Tuttolomondo
- Internal Medicine and Stroke Care Ward, University of Palermo, 90127 Palermo, Italy; (V.A.); (A.S.); (G.P.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
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Buchholz A, Deme P, Betz JF, Brandt J, Haughey N, Cervenka MC. A randomized feasibility trial of the modified Atkins diet in older adults with mild cognitive impairment due to Alzheimer's disease. Front Endocrinol (Lausanne) 2024; 15:1182519. [PMID: 38505743 PMCID: PMC10949529 DOI: 10.3389/fendo.2024.1182519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 02/05/2024] [Indexed: 03/21/2024] Open
Abstract
Background Alzheimer's disease (AD) is increasing in prevalence, but effective treatments for its cognitive impairment remain severely limited. This study investigates the impact of ketone body production through dietary manipulation on memory in persons with mild cognitive impairment due to early AD and explores potential mechanisms of action. Methods We conducted a 12-week, parallel-group, controlled feasibility trial of a ketogenic diet, the modified Atkins diet (MAD), compared to a control diet in patients with cognitive impairments attributed to AD. We administered neuropsychological assessments, including memory tests, and collected blood samples at baseline and after 12 weeks of intervention. We performed untargeted lipidomic and targeted metabolomic analyses on plasma samples to detect changes over time. Results A total of 839 individuals were screened to yield 38 randomized participants, with 20 assigned to receive MAD and 18 assigned to receive a control diet. Due to attrition, only 13 in the MAD arm and nine in the control arm were assessed for the primary endpoint, with two participants meeting ketosis levels used to define MAD adherence criteria. The average change from baseline in the Memory Composite Score was 1.37 (95% CI: -0.87, 4.90) points higher in the MAD group compared to the control group. The effect size of the intervention on baseline MAD change was moderate (Cohen's D = 0.57, 95% CI: -0.67, 1.33). In the 15 participants (nine MAD, six control) assessed for lipidomic and metabolomic-lipidomics and metabolomics, 13 metabolites and 10 lipids showed significant changes from baseline to 12 weeks, including triacylglycerols (TAGs, 50:5, 52:5, and 52:6), sphingomyelins (SM, 44:3, 46:0, 46:3, and 48:1), acetoacetate, fatty acylcarnitines, glycerol-3-phosphate, and hydroxy fatty acids. Conclusions Attrition was greatest between baseline and week 6. All participants retained at week 6 completed the study. Despite low rates of adherence by criteria defined a priori, lipidomic and metabolomic analyses indicate significant changes from baseline in circulating lipids and metabolites between MAD and control participants at 12-week postrandomization, and MAD participants showed greater, albeit nonsignificant, improvement in memory.
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Affiliation(s)
- Alison Buchholz
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Pragney Deme
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joshua F. Betz
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason Brandt
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Norman Haughey
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mackenzie C. Cervenka
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Alebna PL, Mehta A, Yehya A, daSilva-deAbreu A, Lavie CJ, Carbone S. Update on obesity, the obesity paradox, and obesity management in heart failure. Prog Cardiovasc Dis 2024; 82:34-42. [PMID: 38199320 DOI: 10.1016/j.pcad.2024.01.003] [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: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
Obesity is a major public health challenge worldwide. It is costly, predisposes to many cardiovascular (CV) diseases (CVD), is increasing at an alarming rate, and disproportionately affects people of low-socioeconomic status. It has a myriad of deleterious effects on the body, particularly on the CV system. Obesity is a major risk factor for heart failure (HF) and highly prevalent in this population, particularly in those with HF with preserved ejection fraction (HFpEF), to the extent that an obesity HFpEF phenotype has been proposed in the literature. However, once HF is developed, an obesity paradox exists where those with obesity have better short- and mid-term survival than normal or underweight individuals, despite a greater risk for hospitalizations. It may be argued that excess energy reserve, younger patient population, higher tolerability of HF therapy and better nutritional status may account for at least part of the obesity paradox on survival. Furthermore, body mass index (BMI) may not be an accurate measure of body composition, especially in HF, where there is an excess volume status. BMI also fails to delineate fat-free mass and its components, which is a better predictor of functional capacity and cardiorespiratory fitness (CRF), which particularly is increasingly being recognized as a risk modifier in both healthy individuals and in persons with comorbidities, particularly in HF. Notably, when CRF is accounted for, the obesity paradox disappears, suggesting that improving CRF might represent a therapeutic target with greater importance than changes in body weight in the setting of HF. In this narrative review, we discuss the current trends in obesity, the causal link between obesity and HF, an update on the obesity paradox, and a description of the major flaws of BMI in this population. We also present an overview of the latest in HF therapy, weight loss, CRF, and the application of these therapeutic approaches in patients with HF and concomitant obesity.
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Affiliation(s)
- Pamela L Alebna
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, United States of America
| | - Anurag Mehta
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, United States of America
| | - Amin Yehya
- Sentara Heart Hospital, Eastern Virginia Medical School, United States of America
| | - Adrian daSilva-deAbreu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Salvatore Carbone
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, United States of America; Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America.
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Colin-Ramirez E, Arcand J, Saldarriaga C, Ezekowitz JA. The current state of evidence for sodium and fluid restriction in heart failure. Prog Cardiovasc Dis 2024; 82:43-54. [PMID: 38215917 DOI: 10.1016/j.pcad.2024.01.004] [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: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/14/2024]
Abstract
The field of heart failure has evolved in terms of the therapies that are available including pharmaceutical and device therapies. There is now substantial randomized trial data to indicate that dietary sodium restriction does not provide the reduction in clinical events with accepted heterogeneity in the clinical trial results. Dietary sodium restriction should be considered for some but not all patients and with different objectives than clinical outcomes but instead for potential quality of life benefit. In addition, fluid restriction, once the mainstay of clinical practice, has not shown to be of any additional benefit for patients in hospital or in the ambulatory care setting and therefore should be considered to be used cautiously (if at all) in clinical practice. Further developments and clinical trials are needed in this area to better identify patients who may benefit or have harm from these lower cost interventions and future research should focus on large scale, high quality, clinical trials rather than observational data to drive clinical practice.
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Affiliation(s)
| | - Joanne Arcand
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Clara Saldarriaga
- Centro Cardiovascular Colombiano Clinica Santa Maria (Clinica Cardio VID), Antioquia, Colombia
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
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Forsyth F, Mulrennan S, Burt J, Hartley P, Kuhn I, Lin H, Mant J, Tan S, Zhang R, Deaton C. What are the outcomes of dietary interventions in Heart Failure with preserved Ejection Fraction? A systematic review and meta-analysis. Eur J Cardiovasc Nurs 2023; 22:679-689. [PMID: 36453073 DOI: 10.1093/eurjcn/zvac114] [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: 05/03/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 10/12/2023]
Abstract
AIMS To determine the efficacy of dietary interventions in Heart Failure with preserved Ejection Fraction (HFpEF). METHOD AND RESULTS Keyword searches were performed in five bibliographic databases to identify randomized or controlled studies of dietary interventions conducted in HFpEF or mixed heart failure (HF) samples published in the English language. Studies were appraised for bias and synthesized into seven categories based on the similarity of the intervention or targeted population. The quality of the body of evidence was assessed via the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. Twenty-five unique interventions were identified; 17 were considered for meta-analysis. Most studies were judged to be at high risk of bias. There was moderate-quality evidence that caloric restriction led to clinically meaningful improvements in blood pressure and body weight. There was moderate-quality evidence that carbohydrate restriction resulted in meaningful reductions in blood pressure. There was very low-quality evidence that protein supplementation improved blood pressure and body weight and moderate-quality evidence for clinically meaningful improvements in function. CONCLUSIONS While some types of dietary interventions appeared to deliver clinically meaningful change in critical outcomes; the study heterogeneity and overall quality of the evidence make it difficult to make firm recommendations. Greater transparency when reporting the nutritional composition of interventions would enhance the ability to pool studies. REGISTRATION PROSPERO CRD42019145388.
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Affiliation(s)
- Faye Forsyth
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 OSR, UK
| | - Sandra Mulrennan
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0AY, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute, Department of Public Health & Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 OSR, UK
| | - Peter Hartley
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 OSR, UK
- Physiotherapy Department, Cambridge University Hospital NHS Foundation Trust, Addenbrookes, Cambridge CB2 OQQ, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge University Hospital NHS Foundation Trust, Addenbrookes, Cambridge CB2 OQQ, UK
| | - Helen Lin
- University of Cambridge School of Clinical Medicine, Cambridge University Hospital NHS Foundation Trust, Addenbrookes, Cambridge CB2 OQQ, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 OSR, UK
| | - Sapphire Tan
- University of Cambridge School of Clinical Medicine, Cambridge University Hospital NHS Foundation Trust, Addenbrookes, Cambridge CB2 OQQ, UK
| | - Roy Zhang
- University of Cambridge School of Clinical Medicine, Cambridge University Hospital NHS Foundation Trust, Addenbrookes, Cambridge CB2 OQQ, UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 OSR, UK
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Díez-Villanueva P, Jiménez-Méndez C, López-Lluva MT, Wasniewski S, Solís J, Fernández-Friera L, Martínez-Sellés M. Heart Failure in the Elderly: the Role of Biological and Sociocultural Aspects Related to Sex. Curr Heart Fail Rep 2023; 20:321-332. [PMID: 37498496 DOI: 10.1007/s11897-023-00619-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE OF REVIEW Heart failure (HF) entails poor prognosis, with high morbidity and mortality burden, particularly in elderly patients. Notably, important sex differences have been described between men and women with HF. In this regard, some biological and sociocultural aspects related to sex may play a key role in the different development and prognosis of HF in elderly men and women. RECENT FINDINGS Important differences between men and women with HF, especially in the elderly population, have been specifically addressed in recent studies. Consequently, specific differences in biological and sociocultural aspects have been found to associate differences in pathophysiology, baseline clinical profile, and prognosis according to sex. Moreover, differences in comorbidities and frailty and other geriatric conditions, frequent in elderly population with HF, have also been described. Biological and sociocultural differences related to sex are key in the different clinical presentation and prognosis of heart failure in elderly women. Further studies will be required to better understand some other underlying reasons that may differently impact prognosis in elderly patients with HF.
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Affiliation(s)
- Pablo Díez-Villanueva
- Cardiology Department, Hospital Universitario de La Princesa, Calle Diego de León 62, 28006, Madrid, Spain.
| | | | | | - Samantha Wasniewski
- Cardiac Imaging Unit, Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
- Universidad Camilo José Cela, Madrid, Spain
- Atria Clinic, Madrid, Spain
| | - Jorge Solís
- Atria Clinic, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Leticia Fernández-Friera
- Cardiac Imaging Unit, Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
- Universidad Camilo José Cela, Madrid, Spain
- Atria Clinic, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense and Universidad Europea de Madrid, Madrid, Spain
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Evans L, Price T, Hubert N, Moore J, Shen Y, Athukorala M, Frese S, Martinez-Guryn K, Ferguson BS. Emodin Inhibited Pathological Cardiac Hypertrophy in Response to Angiotensin-Induced Hypertension and Altered the Gut Microbiome. Biomolecules 2023; 13:1274. [PMID: 37759673 PMCID: PMC10526847 DOI: 10.3390/biom13091274] [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: 07/14/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Evidence suggests that food bioactives affect the epigenome to prevent pathological cardiac hypertrophy. Recently, we showed that emodin, an anthraquinone, attenuated pathological cardiac hypertrophy and histone deacetylase (HDAC) activity. However, we only examined the cardioprotective effects of emodin's parent compound and not those of emodin metabolites or of emodin-gut microbiome interactions. The microbiome has emerged as a key player in chronic diseases such as metabolic and cardiac disease. Thus, we hypothesized that emodin could reverse hypertension-induced changes in microbial communities. METHODS Normo- and hypertensive (angiotensin II) C57/BL6 female mice were randomly assigned to receive a vehicle (Veh; DMSO:PEG 1:1) or emodin (Emod; 30 mg/kg) for 14 days. Body weights were collected pre- and post-treatment, and blood pressure was assessed via tail cuff. At the study's end, the mice were euthanized and assessed for their heart weights. In addition, stool samples and cecal contents were collected to elucidate changes in the microbial populations using 16S rRNA sequencing. Lastly, the tissue was lysed, and RNA was isolated for qPCR. One-way ANOVA with Tukey's post hoc test was performed unless otherwise specified, and p < 0.05 was considered significant. RESULTS Emodin significantly attenuated cardiac hypertrophy in the female mice. No significant changes were observed in body weight or systolic blood pressure in response to hypertension or emodin. Lastly, analysis suggests that hypertension altered the microbiome in the cecum and cecal content, with additional evidence to support that emodin affects gut microbiota in the feces and colon. CONCLUSIONS Our data demonstrate that emodin attenuates pathological hypertrophy in female mice. Future research is needed to dissect if changes in the microbiome contributes to emodin-mediated attenuation in cardiac remodeling.
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Affiliation(s)
- Levi Evans
- Department of Nutrition, University of Nevada, Reno, Reno, NV 89557, USA (S.F.)
- Environmental Sciences Program, University of Nevada, Reno, Reno, NV 89557, USA
| | - Tori Price
- Biomedical Sciences Program, Midwestern University, Downers Grove, IL 60515, USA
| | - Nathaniel Hubert
- Biomedical Sciences Program, Midwestern University, Downers Grove, IL 60515, USA
| | - Julia Moore
- Biomedical Sciences Program, Midwestern University, Downers Grove, IL 60515, USA
| | - Yiqui Shen
- Department of Nutrition, University of Nevada, Reno, Reno, NV 89557, USA (S.F.)
| | - Maheshi Athukorala
- Department of Nutrition, University of Nevada, Reno, Reno, NV 89557, USA (S.F.)
| | - Steven Frese
- Department of Nutrition, University of Nevada, Reno, Reno, NV 89557, USA (S.F.)
| | | | - Bradley S. Ferguson
- Department of Nutrition, University of Nevada, Reno, Reno, NV 89557, USA (S.F.)
- Environmental Sciences Program, University of Nevada, Reno, Reno, NV 89557, USA
- Center of Biomedical Research Excellence for Molecular and Cellular Signal Transduction in the Cardiovascular System, University of Nevada, Reno, Reno, NV 89557, USA
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Forsyth F, Mulrennan S, Burt J, Hartley P, Kuhn I, Lin H, Mant J, Tan S, Zhang R, Deaton C. What dietary interventions have been tested in heart failure with preserved ejection fraction? A systematic scoping review. Eur J Cardiovasc Nurs 2023; 22:126-140. [PMID: 35816028 DOI: 10.1093/eurjcn/zvac062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022]
Abstract
AIMS To determine what dietary interventions have been tested in heart failure with preserved ejection fraction (HFpEF), the modulation method, and outcomes employed and to summarize any evidence for benefit. METHODS AND RESULTS We performed key word searches in five bibliographic databases from 2001 to 2021, to identify randomized or experimental dietary interventions tested in HFpEF or mixed heart failure (HF) samples. Study characteristics were summarized according to population, intervention, comparator, outcome categories and intervention complexity was assessed. Twenty-five clinical investigations were retrieved; only 10 (40%) were conducted exclusively in HFpEF; the remainder enrolled mixed HF samples. Most studies employed either highly tailored prescribed diets (n = 12, 48%) or dietary supplementation (n = 10, 40%) modalities. Dietary pattern interventions (n = 3, 12%) are less well represented in the literature. CONCLUSION Heterogeneity made pooling studies challenging. Better reporting of baseline characteristics and the use of standardized HF lexicon would ensure greater confidence in interpretation of studies involving mixed HF populations. The field would benefit greatly from explicit reporting of the biological mechanism of action (e.g. the causal pathway) that an intervention is designed to modulate so that studies can be synthesized via their underlying mechanism of action by which diet may affect HF. An extension of the current set of core outcomes proposed by the European Society of Cardiology Heart Failure Association would ensure dietary clinical endpoints are more consistently defined and measured. REGISTRATION PROSPERO: CRD42019145388.
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Affiliation(s)
- Faye Forsyth
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - Sandra Mulrennan
- Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0AY, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge CB2 0AH, UK
| | - Peter Hartley
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 0SR, UK.,Physiotherapy Department, Cambridge University Hospital NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Helen Lin
- University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - Sapphire Tan
- University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Roy Zhang
- University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
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Vieyra G, Hankinson SE, Oulhote Y, Vandenberg L, Tinker L, Mason J, Shadyab AH, Wallace R, Arcan C, Chen JC, Reeves KW. Dietary patterns and urinary phthalate exposure among postmenopausal women of the Women's Health Initiative. ENVIRONMENTAL RESEARCH 2023; 216:114727. [PMID: 36356671 PMCID: PMC10363918 DOI: 10.1016/j.envres.2022.114727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/10/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Phthalates are endocrine-disrupting chemicals linked to a higher risk of numerous chronic health outcomes. Diet is a primary source of exposure, but prior studies exploring associations between dietary patterns and phthalate exposure are limited. OBJECTIVES We evaluated the associations between dietary patterns and urinary phthalate biomarkers among a subset of postmenopausal women participating in the Women's Health Initiative (WHI). METHODS We included WHI participants selected for a nested case-control study of phthalates and breast cancer (N = 1240). Dietary intake was measured via self-administered food frequency questionnaires at baseline and year-3. We used these data to calculate scores for alignment with the Dietary Approach to Stop Hypertension (DASH), alternative Mediterranean (aMed), and Dietary Inflammatory Index (DII) diets. We measured 13 phthalate metabolites and creatinine in 2-3 urine samples per participant collected over 3-years when all participants were cancer-free. We fit multivariable generalized estimating equation models to estimate the cross-sectional associations. RESULTS DASH and aMed dietary scores were inversely associated with the sum of di(2-Ethylhexyl) phthalate (-6.48%, 95% CI -9.84, -3.00; -5.23%, 95% CI -8.73, -1.60) and DII score was positively associated (9.00%, 95% CI 5.04, 13.11). DASH and aMed scores were also inversely associated with mono benzyl phthalate and mono-3-carboxypropyl phthalate. DII scores were positively associated with mono benzyl phthalate and the sum of di-n-butyl phthalate. DISCUSSION Higher dietary alignment with DASH and aMed dietary patterns were significantly associated with lower concentrations of certain phthalate biomarkers, while an inflammatory diet pattern was associated with higher phthalate biomarker concentrations. These findings suggest that dietary patterns high in fruits, vegetables, and low-fat foods and low in processed foods may be useful in avoiding exposure to phthalates.
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Affiliation(s)
- Gabriela Vieyra
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA.
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Youssef Oulhote
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Laura Vandenberg
- Department of Environmental Health Sciences, University of Massachusetts Amherst, Amherst, Ma, 01003, USA
| | - Lesley Tinker
- Department of Cancer Prevention, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - JoAnn Mason
- Department of Medicine, Brigham and Women's Hospital, and Epidemiology, Harvard T.H. Chan School, Boston, MA, 02115, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Robert Wallace
- Department of Epidemiology and Internal Medicine, University of Iowa, USA
| | - Chrisa Arcan
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - J C Chen
- Department of Population & Public Health Sciences and Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Katherine W Reeves
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA.
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11
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Bohmke NJ, Billingsley HE, Kirkman DL, Carbone S. Nonpharmacological Strategies in Heart Failure with Preserved Ejection Fraction. Cardiol Clin 2022; 40:491-506. [PMID: 36210133 PMCID: PMC10280381 DOI: 10.1016/j.ccl.2022.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) suffer from a high rate of cardiometabolic comorbidities with limited pharmaceutical therapies proven to improve clinical outcomes and cardiorespiratory fitness (CRF). Nonpharmacologic therapies, such as exercise training and dietary interventions, are promising strategies for this population. The aim of this narrative review is to present a summary of the literature published to date and future directions related to the efficacy of nonpharmacologic, lifestyle-related therapies in HFpEF, with a focus on exercise training and dietary interventions.
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Affiliation(s)
- Natalie J Bohmke
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA
| | - Hayley E Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA
| | - Danielle L Kirkman
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA.
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA.
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12
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Association of Healthy Eating Index-2015 and Dietary Approaches to Stop Hypertension Patterns with Insulin Resistance in Schoolchildren. Nutrients 2022; 14:nu14204232. [PMID: 36296916 PMCID: PMC9607022 DOI: 10.3390/nu14204232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Diet quality patterns are associated with a lower incidence of insulin resistance (IR) in adults. The aim of this study was to investigate the association between two diet quality indices and IR in schoolchildren and to identify the best diet quality index associated with a lower risk of IR. Methods: A total of 854 schoolchildren (8−13 years) were included in a cross-sectional study, who completed a three-day dietary record to assess their diet. Fasting plasma glucose and insulin were also measured, and anthropometric data were collected. Healthy Eating Index-2015 (HEI-2015), Dietary Approaches to Stop Hypertension (DASH), and adjusted DASH (aDASH) were calculated as diet quality indices. The homeostasis model assessment of insulin resistance (HOMA-IR) was used, and IR was defined as HOMA-IR > 3.16. Results: The prevalence of IR was 5.5%, and it was higher in girls. The mean HEI-2015 and DASH scores were 59.3 and 23.4, respectively, and boys scored lower in both indices. In girls, having a HEI-2015 score above the 33rd percentile was associated with a lower risk of IR (odds ratio [95% CI]: 0.43 [0.19−0.96], p = 0.020). Conclusion: Greater adherence to a healthy dietary pattern, as assessed by a higher HEI-2015 score, was associated with a lower risk of IR in schoolchildren, especially in girls.
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13
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Chou TY, Liu WJ, Lee CL, Wang JS. Adherence to the dietary approaches to stop hypertension diet and all-cause mortality in patients with a history of heart failure. Front Nutr 2022; 9:1015290. [PMID: 36238461 PMCID: PMC9551459 DOI: 10.3389/fnut.2022.1015290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aims We investigated the association of adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with all-cause mortality in patients with a history of heart failure. Methods We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Dietary information was obtained from a 24-h dietary recall interview. Adherence to the DASH diet was assessed using the DASH score. The primary outcome was all-cause mortality which was confirmed by the end of 2011. Weighted Cox proportional hazards regression models were used to determine the hazard ratios and 95% CI for the association of the DASH score and all-cause mortality with multivariate adjustment. Results The median DASH score was 2 among the 832 study participants. There were 319 participants who died after a median follow-up duration of 4.7 years. A higher DASH score (>2 vs. ≤ 2) was not associated with a decrease in the risk of all-cause mortality (adjusted HR 1.003, 95% CI 0.760–1.323, p = 0.983). With respect to the components of the DASH score, a lower sodium intake was not associated with a decreased risk of mortality (adjusted HR 1.045, 95% CI 0.738–1.478, p = 0.803). Conclusion A higher DASH score (>2 vs. ≤ 2) was not associated with all-cause mortality in patients with heart failure.
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Affiliation(s)
- Ting-Yu Chou
- Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Ju Liu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Lin Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Chia-Lin Lee
| | - Jun-Sing Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan
- *Correspondence: Jun-Sing Wang
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14
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Targeting Gut Microbiota as a Novel Strategy for Prevention and Treatment of Hypertension, Atrial Fibrillation and Heart Failure: Current Knowledge and Future Perspectives. Biomedicines 2022; 10:biomedicines10082019. [PMID: 36009566 PMCID: PMC9406184 DOI: 10.3390/biomedicines10082019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular diseases (CVDs) remain the major public health concern worldwide. Over the last two decades, a considerable amount of literature has been published on gut microbiota (GMB) composition and its metabolites, involved in the pathophysiology of CVDs, including arterial hypertension, atrial fibrillation, and congestive heart failure. Although many types of medicines are available to treat CVD, new therapeutic tools are needed to improve clinical outcomes. A challenge that often arises in the researchers’ community is how to manipulate the GMB to manage cardiovascular risk factors. Therapeutic strategies designed to manipulate GMB composition and/or its metabolites include dietary approaches, prebiotics/probiotics supplementation, and fecal microbiota transplantation (FMT). In this review, we have focused on three main cardiovascular pathologies (arterial hypertension, atrial fibrillation and heart failure) due to their shared common pathophysiological pathways and structural changes in myocardium, such as inflammation, hypertrophy, fibrosis, and myocardial remodeling. The main aims of the review are: (1) to summarize current knowledge on the key pathophysiologic links between GMB and CVDs, and (2) discuss the results of the studies on GMB modulation for the prevention and treatment of selected CVDs.
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15
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Ishikawa Y, Laing EM, Anderson AK, Zhang D, Kindler JM, Trivedi-Kapoor R, Sattler ELP. Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with low levels of insulin resistance among heart failure patients. Nutr Metab Cardiovasc Dis 2022; 32:1841-1850. [PMID: 35637084 DOI: 10.1016/j.numecd.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Heart failure (HF) patients are at risk of developing type 2 diabetes. This study examined the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and insulin resistance among U.S. adults with HF. METHODS AND RESULTS Using data from National Health and Nutrition Examination Survey 1999-2016 cycles, we included 348 individuals aged 20+ years with HF and no history of diabetes. DASH diet adherence index quartile 1 indicated the lowest and quartile 4 indicated the highest adherence. The highest level of insulin resistance was defined by the upper tertile of the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Associations between level of insulin resistance and DASH diet adherence and its linear trends were examined using logistic regressions. Trend analyses showed that participants in upper DASH diet adherence index quartiles were more likely older, female, non-Hispanic White, of normal weight, and had lower levels of fasting insulin than those in lower quartiles. Median values of HOMA-IR from lowest to highest DASH diet adherence index quartiles were 3.1 (interquartile range, 1.8-5.5), 2.9 (1.7-5.6), 2.1 (1.1-3.7), and 2.1 (1.3-3.5). Multivariable logistic analyses indicated that participants with the highest compared to the lowest DASH adherence showed 77.1% lower odds of having the highest level of insulin resistance (0.229, 95% confidence interval: 0.073-0.716; p = 0.017 for linear trend). CONCLUSION Good adherence to the DASH diet was associated with lower insulin resistance among community-dwelling HF patients. Heart healthy dietary patterns likely protect HF patients from developing type 2 diabetes.
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Affiliation(s)
- Yuta Ishikawa
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, GA, USA
| | - Emma M Laing
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, GA, USA
| | - Alex K Anderson
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, GA, USA
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, GA, USA; Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, NY, USA
| | - Joseph M Kindler
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, GA, USA
| | - Rupal Trivedi-Kapoor
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, GA, USA
| | - Elisabeth L P Sattler
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, GA, USA; Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, GA, USA.
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16
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Jin Y, Huang H, Zhou Q, Dong F, Lu L, Gao X, Wu Z. Prospective assessing metabolic abnormalities, lifestyle and dietary pattern in a Chinese population with heart failure: the MALD-HF study protocol. BMJ Open 2022; 12:e049225. [PMID: 35501092 PMCID: PMC9062811 DOI: 10.1136/bmjopen-2021-049225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The evidence on predictive value of lifestyle behaviours and dietary pattern on the prognosis of heart failure (HF) is limited. Our aim is to identify these factors in the setting of secondary prevention of HF. METHODS AND ANALYSIS The Metabolic Abnormalities, Lifestyle and Dietary Pattern in Heart Failure study is an ongoing, prospective cohort, single-centre study that aims to recruit 1500 patients with HF from June 2016 to June 2021. At baseline, each participant completes a questionnaire on demographic characteristics, medical history, lifestyle behaviours, sleep duration and quality, bowel movements and regular diet. Biochemical measurements, blood pressure, carotid ultrasound, echocardiography, electrocardiography and cardiac magnetic resonance are obtained and analysed. Muscle strength is assessed using the handgrip dynamometer and the MicroFet2 hand-held dynamometer. Each patient is followed for 5 years or until the occurrence of death. The primary outcome is a composite of cardiovascular mortality or hospitalisation due to worsening heart failure. The secondary end points are cardiovascular deaths and the hospitalisations due to worsening HF. The incidence of mortality and cardiovascular events is documented biennially. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of the Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, and follows the norms of the World's Association Declaration of Helsinki. The results of this study will be disseminated in peer-reviewed journals and academic conferences. TRIAL REGISTRATION NUMBER NCT03951311.
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Affiliation(s)
- Yao Jin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Huang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfen Zhou
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fengwei Dong
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Lu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Zhijun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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17
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Driggin E, Cohen LP, Gallagher D, Karmally W, Maddox T, Hummel SL, Carbone S, Maurer MS. Nutrition Assessment and Dietary Interventions in Heart Failure: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:1623-1635. [PMID: 35450580 PMCID: PMC9388228 DOI: 10.1016/j.jacc.2022.02.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 12/19/2022]
Abstract
Despite the high prevalence of nutrition disorders in patients with heart failure (HF), major HF guidelines lack specific nutrition recommendations. Because of the lack of standardized definitions and assessment tools to quantify nutritional status, nutrition disorders are often missed in patients with HF. Additionally, a wide range of dietary interventions and overall dietary patterns have been studied in this population. The resulting evidence of benefit is, however, conflicting, making it challenging to determine which strategies are the most beneficial. In this document, we review the available nutritional status assessment tools for patients with HF. In addition, we appraise the current evidence for dietary interventions in HF, including sodium restriction, obesity, malnutrition, dietary patterns, and specific macronutrient and micronutrient supplementation. Furthermore, we discuss the feasibility and challenges associated with the implementation of multimodal nutrition interventions and delineate potential solutions to facilitate addressing nutrition in patients with HF.
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Affiliation(s)
- Elissa Driggin
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA.
| | - Laura P Cohen
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Dympna Gallagher
- Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York, USA
| | - Wahida Karmally
- Columbia University Irving Medical Center, New York, New York, USA
| | - Thomas Maddox
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Scott L Hummel
- Ann Arbor Veterans Affairs Health System, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA; Virginia Commonwealth University Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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18
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Chang CY, Lee CL, Liu WJ, Wang JS. Association of Adherence to the Mediterranean Diet with All-Cause Mortality in Subjects with Heart Failure. Nutrients 2022; 14:nu14040842. [PMID: 35215491 PMCID: PMC8875916 DOI: 10.3390/nu14040842] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/29/2022] [Accepted: 02/15/2022] [Indexed: 12/17/2022] Open
Abstract
We investigated the associations of adherence to the Mediterranean diet with all-cause and cardiovascular mortality in patients with heart failure. We analyzed the National Health and Nutrition Examination Survey (NHANES) participants from 1999 to 2010, with their vital status confirmed through to the end of 2011. The alternate Mediterranean Diet Index (aMED) was used to assess study participants’ adherence to the Mediterranean diet according to information on dietary questionnaires. We conducted weighted Cox proportional hazards regression models to determine the associations of adherence to the Mediterranean diet (aMED ≥ median vs. <median) with all-cause and cardiovascular mortality in participants with a history of heart failure. A total of 832 participants were analyzed, and the median aMED was 3. After a median follow-up of 4.7 years, 319 participants had died. aMED ≥ 3 (vs. <3) was not associated with a lower risk of all-cause (adjusted HR 0.797, 95% CI 0.599–1.059, p = 0.116) and cardiovascular (adjusted HR 0.911, 95% CI 0.539–1.538, p = 0.724) mortality. The findings were consistent across several subgroup populations. Among the components of aMED, a lower intake of red/processed meat was associated with a higher risk of mortality (adjusted HR 1.406, 95% CI 1.011–1.955, p = 0.043). We concluded that adherence to the Mediterranean diet was not associated with a lower risk of all-cause and cardiovascular mortality in participants with a history of heart failure. The higher risk of mortality associated with a lower intake of red/processed meat deserves further investigation.
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Affiliation(s)
- Chih-Yun Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-Y.C.); (C.-L.L.)
| | - Chia-Lin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-Y.C.); (C.-L.L.)
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Wei-Ju Liu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Correspondence: (W.-J.L.); (J.-S.W.); Tel.: +886-4-23592525 (W.-J.L. & J.-S.W.)
| | - Jun-Sing Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-Y.C.); (C.-L.L.)
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, National Chung Hsing University, Taichung 40227, Taiwan
- Correspondence: (W.-J.L.); (J.-S.W.); Tel.: +886-4-23592525 (W.-J.L. & J.-S.W.)
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19
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Tantisattamo E, Kalantar-Zadeh K, Molnar MZ. Nutritional and dietary interventions to prolong renal allograft survival after kidney transplantation. Curr Opin Nephrol Hypertens 2022; 31:6-17. [PMID: 34750333 DOI: 10.1097/mnh.0000000000000757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Diet plays an important role in slowing progression of chronic kidney disease in native and transplanted kidneys. There is limited evidence on the association on dietary intake with renal allograft function. Mechanisms of major nutrients and dietary patterns with focusing on a plant-based diet related to kidney transplant health and longevity are reviewed. RECENT FINDINGS High dietary protein intake may adversely affect renal allograft. Low protein plant-focused diets such as Dietary Approaches to Stop Hypertension, plant-dominant low-protein diet and Mediterranean diets appear associated with favorable outcomes in slowing renal allograft function decline. The mechanism may be related to a change in renal hemodynamic by decreasing glomerular hyperfiltration from low dietary protein intake and plant-based ingredients. Recent observational studies of association between dietary protein intake and kidney allograft outcomes are conflicting. Although strong evidence is still lacking, a low protein diet of 0.6-0.8 g/kg/day with at least 50% of the protein source from plant-based components in kidney transplant recipients with stable kidney allograft function should be considered as the dietary target. SUMMARY Dietary intervention with low-protein plant-focused meals may improve outcomes in kidney transplant recipients, but the evidence remains limited and further studies are warranted.
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Affiliation(s)
- Ekamol Tantisattamo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, Veterans Affairs Long Beach Healthcare System, Long Beach, California.,Multi-Organ Transplant Center, Section of Nephrology, Department of Internal Medicine, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, Veterans Affairs Long Beach Healthcare System, Long Beach, California.,Lundquist Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Miklos Z Molnar
- Division of Nephrology and Hypertension, Department of Medicine, University of Utah, Utah, USA
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Psychosocial Risk and Health Behaviors as Predictors of Clinical Events in Patients Wait-Listed for a New Heart: Results from 7 Years of Follow-Up. Life (Basel) 2021; 11:life11121438. [PMID: 34947969 PMCID: PMC8706706 DOI: 10.3390/life11121438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
We examined the long-term relationship of psychosocial risk and health behaviors on clinical events in patients awaiting heart transplantation (HTx). Psychosocial characteristics (e.g., depression), health behaviors (e.g., dietary habits, smoking), medical factors (e.g., creatinine), and demographics (e.g., age, sex) were collected at the time of listing in 318 patients (82% male, mean age = 53 years) enrolled in the Waiting for a New Heart Study. Clinical events were death/delisting due to deterioration, high-urgency status transplantation (HU-HTx), elective transplantation, and delisting due to clinical improvement. Within 7 years of follow-up, 92 patients died or were delisted due to deterioration, 121 received HU-HTx, 43 received elective transplantation, and 39 were delisted due to improvement. Adjusting for demographic and medical characteristics, the results indicated that frequent consumption of healthy foods (i.e., foods high in unsaturated fats) and being physically active increased the likelihood of delisting due improvement, while smoking and depressive symptoms were related to death/delisting due to clinical deterioration while awaiting HTx. In conclusion, psychosocial and behavioral characteristics are clearly associated with clinical outcomes in this population. Interventions that target psychosocial risk, smoking, dietary habits, and physical activity may be beneficial for patients with advanced heart failure waiting for a cardiac transplant.
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21
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Dietary Management of Heart Failure: DASH Diet and Precision Nutrition Perspectives. Nutrients 2021; 13:nu13124424. [PMID: 34959976 PMCID: PMC8708696 DOI: 10.3390/nu13124424] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022] Open
Abstract
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.
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22
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Defagó MD, Mozaffarian D, Irazola VE, Gutierrez L, Poggio R, Serón P, Mores N, Calandrelli M, Ponzo J, Rubinstein AL, Elorriaga N. Dietary patterns and blood pressure in Southern Cone of Latin America. Nutr Metab Cardiovasc Dis 2021; 31:3326-3334. [PMID: 34629255 DOI: 10.1016/j.numecd.2021.08.048] [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: 04/13/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS in the Southern Cone of Latin America, previous studies have shown that blood hypertension is one of the most significant risk factor for cardiovascular disease, and diet plays a fundamental role. We analyzed the cross-sectional relationship between dietary patterns (DP) and blood pressure values in people involved in the CESCAS I Study. METHODS AND RESULTS the participants (n = 4626) were derived from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). To define DP, a food-frequency questionnaire was applied and principal component analysis was performed. Blood pressure was determined according to standardized guidelines. A multivariate regression model was developed to determine the association between each DP and blood pressure values, according to the quartile (Q) of adherence to DP. Two predominant DP were detected, Prudent (PDP, higher consumption of fruits, vegetables, legumes, whole grains, fish, seafood and nuts) and Western (WDP, higher consumption of red and processed meats, dressings, sweets, snacks and refined grains). A significant inverse association was found between adherence to PDP and systolic and diastolic blood pressure (-1.85 and -1.29 mmHg for Q4 vs Q1, respectively). Adherence to WDP was positively associated with systolic blood pressure (2.09 mmHg for Q4 vs Q1). CONCLUSION the WDP detected in the studied population is positively associated with higher levels of blood pressure, while greater adherence to healthy DP has a positive impact on blood pressure.
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Affiliation(s)
- María D Defagó
- Instituto de Investigaciones en Ciencias de la Salud (INICSA), CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina; Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina; Southern Cone American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Vilma E Irazola
- Southern Cone American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Laura Gutierrez
- Southern Cone American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Rosana Poggio
- Southern Cone American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Pamela Serón
- Universidad de La Frontera, CIGES, Temuco, Chile
| | - Nora Mores
- Municipalidad de Marcos Paz, Buenos Aires, Argentina
| | - Matias Calandrelli
- Southern Cone American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jacqueline Ponzo
- Escuela de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Adolfo L Rubinstein
- Southern Cone American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Natalia Elorriaga
- Southern Cone American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; Centro de Investigaciones en Epidemiología y Salud Pública (CIESP-CONICET), Buenos Aires, Argentina
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23
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Fernández-Pombo A, Rodríguez-Carnero G, Castro AI, Cantón-Blanco A, Seoane LM, Casanueva FF, Crujeiras AB, Martínez-Olmos MA. Relevance of nutritional assessment and treatment to counteract cardiac cachexia and sarcopenia in chronic heart failure. Clin Nutr 2021; 40:5141-5155. [PMID: 34461588 DOI: 10.1016/j.clnu.2021.07.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/24/2021] [Accepted: 07/21/2021] [Indexed: 12/18/2022]
Abstract
Chronic heart failure (CHF) is frequently associated with the involuntary loss of body weight and muscle wasting, which can determine the course of the disease and its prognosis. While there is no gold standard malnutrition screening tool for their detection in the CHF population, several bioelectrical and imaging methods have been used to assess body composition in these patients (such as Dual Energy X-Ray Absorptiometry and muscle ultrasound, among other techniques). In addition, numerous nutritional biomarkers have been found to be useful in the determination of the nutritional status. Nutritional considerations include the slow and progressive supply of nutrients, avoiding high volumes, which could ultimately lead to refeeding syndrome and worsen the clinical picture. If oral feeding is insufficient, hypercaloric and hyperproteic supplementation should be considered. β-Hydroxy-β-methylbutyrate and omega-3 polyunsaturated fatty acid administration prove to be beneficial in certain patients with CHF, and several interventional studies with micronutrient supplementation have also described their possible role in these subjects. Taking into account that CHF is sometimes associated with gastrointestinal dysfunction, parenteral nutritional support may be required in selected cases. In addition, potential therapeutic options regarding nutritional state and muscle wasting have also been tested in clinical studies. This review summarises the scientific evidence that demonstrates the necessity to carry out a careful nutritional evaluation and nutritional treatment to prevent or improve cardiac cachexia and sarcopenia in CHF, as well as improve its course.
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Affiliation(s)
- Antía Fernández-Pombo
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Gemma Rodríguez-Carnero
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Ana I Castro
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain
| | - Ana Cantón-Blanco
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain
| | - Luisa M Seoane
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain; Endocrine Physiopathology Group, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Felipe F Casanueva
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain; Laboratory of Molecular and Cellular Endocrinology, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana B Crujeiras
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain.
| | - Miguel A Martínez-Olmos
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
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24
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Krittanawong C, Kaplin S, Tang WHW, Jneid H, Virani SS, Messerli FH. Social media and predictive analysis regarding dietary approaches to stop hypertension. Prog Cardiovasc Dis 2021; 68:88-90. [PMID: 34245778 DOI: 10.1016/j.pcad.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Chayakrit Krittanawong
- The Michael E. DeBakey VA Medical Center, Houston, TX, USA; Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.
| | - Scott Kaplin
- Department of Cardiovascular Medicine, NYU Langone - Long Island, Mineola, NY, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hani Jneid
- The Michael E. DeBakey VA Medical Center, Houston, TX, USA; Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Salim S Virani
- The Michael E. DeBakey VA Medical Center, Houston, TX, USA; Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Franz H Messerli
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA; University of Bern, Switzerland; Jagiellonian University Krakow, Poland
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25
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Abstract
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.
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Affiliation(s)
- Vittorio Emanuele Bianchi
- Endocrinology and Metabolism, Clinical Center Stella Maris, Strada Rovereta, 42-47891 Falciano, Falciano, San Marino.
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Mediterranean, DASH, and Alternate Healthy Eating Index Dietary Patterns and Risk of Death in the Physicians' Health Study. Nutrients 2021; 13:nu13061893. [PMID: 34072912 PMCID: PMC8227858 DOI: 10.3390/nu13061893] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/09/2023] Open
Abstract
Objective: Our primary objective was to examine the associations of the Mediterranean (MED), the Dietary Approaches to Stop Hypertension (DASH), and the Alternate Healthy Eating Index (AHEI) diet with total mortality. Our secondary objective was to examine the association of these three dietary patterns with cardiovascular disease (CVD) and cancer mortality. Research: Design and Methods: We prospectively studied 15,768 men from the Physicians’ Health Study who completed a semi-quantitative food-frequency questionnaire. Scores from each dietary pattern were divided into quintiles. Multivariable Cox regression models were used to estimate hazard ratio’s (95% confidence intervals) of mortality. Results: At baseline, average age was 65.9 ± 8.9 years. There were 1763 deaths, including 488 CVD deaths and 589 cancer deaths. All diet scores were inversely associated with risk for all-cause mortality: Hazard ratios (95% CI) of all-cause mortality from lowest to highest quintile for MED diet were 1.0 (reference), 0.85 (0.73–0.98), 0.80 (0.69–0.93), 0.77 (0.66–0.90), and 0.68 (0.58–0.79); corresponding values were 1.0 (reference), 0.96 (0.82–1.12), 0.95 (0.82–1.11), 0.88 (0.75–1.04), and 0.83 (0.71–0.99) for DASH diet and 1.0 (reference), 0.88 (0.77–1.02), 0.82 (0.71–0.95), 0.69 (0.59, 0.81), and 0.56 (0.47–0.67) for AHEI diet, after adjusting for age, energy, smoking, exercise, BMI, hypertension, coronary heart disease, congestive heart failure, diabetes, and atrial fibrillation. For cause-specific mortality, MED and AHEI scores were inversely associated with lower risk for CVD mortality, whereas AHEI and MED scores were inversely associated with lower risk for cancer mortality. Conclusion: Within this cohort of male physicians, AHEI, MED, and DASH scores were each inversely associated with mortality from all causes.
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27
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Diet Quality Indices in the SUN Cohort: Observed Changes and Predictors of Changes in Scores Over a 10-Year Period. J Acad Nutr Diet 2021; 121:1948-1960.e7. [PMID: 33906824 DOI: 10.1016/j.jand.2021.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dietary quality indices (DQI) are widely used in nutritional epidemiology. However, how they might change over time in a Mediterranean population is not well understood. OBJECTIVE To evaluate within-participant longitudinal changes in scores for nine a priori-defined DQIs: Fat Quality Index (FQI), Carbohydrate Quality Index (CQI), Pro-vegetarian Dietary Pattern (PVG), Mediterranean Diet Adherence Screener (MEDAS), Mediterranean Diet Score (MDS), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND), Prime Diet Quality Score (PDQS) and Alternate Healthy Eating Index (AHEI-2010) in the "Seguimiento Universidad de Navarra" (SUN) cohort, a well-known Mediterranean cohort of university graduates, and to identify baseline predictors of improvement in MEDAS and AHEI-2010 after 10 years of follow-up. DESIGN In this longitudinal cohort study, DQI scores were calculated based on responses from a validated semiquantitative food-frequency questionnaire (FFQ). PARTICIPANTS/SETTING Spanish university graduates enrolled in the SUN cohort before March 2008, who completed the 10-year FFQ and reported total dietary intake at baseline and after 10 years of follow-up, included 2,244 men and 3,271 women, whose mean age at baseline was 36.3 years (standard deviation [SD], 10.7). MAIN OUTCOME MEASURES Main outcome measures were within-participant longitudinal changes for FQI, CQI, PVG, MEDAS, MDS, DASH, MIND, PDQS, and AHEI-2010. STATISTICAL ANALYSES PERFORMED Adjusted logistic regression models were used to evaluate within-participant longitudinal changes and to identify baseline predictors of improvements ≥10% in MEDAS and AHEI-2010 scores after 10 years of follow-up. RESULTS The comparison of the nine scores of DQI calculated at baseline and after 10 years of follow-up showed an improvement in all DQI scores except for PDQS. The greatest changes in DQIs were found for MEDAS (from 6.2 to 7.2, +22.9%) and MDS (from 4.3 to 4.4, +15.4%). The strongest predictors at baseline for ≥10% improvements in MEDAS or AHEI-2010 scores varied across indices. Being female, ≥35 years old, and more physically active at baseline were associated with improvement, whereas snacking between meals was associated with <10% improvements in both indices. CONCLUSIONS In this cohort, the changes in nine a priori-defined DQI scores suggested modest improvements in diet quality, in which MEDAS and MDS scores showed the largest improvements. Additional longitudinal studies, especially intervention trials with long follow-up, are warranted to establish the most appropriate DQIs to assess long-term changes in diet quality in adult populations.
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28
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Vydiswaran VGV, Romero DM, Zhao X, Yu D, Gomez-Lopez I, Lu JX, Iott BE, Baylin A, Jansen EC, Clarke P, Berrocal VJ, Goodspeed R, Veinot TC. Uncovering the relationship between food-related discussion on Twitter and neighborhood characteristics. J Am Med Inform Assoc 2021; 27:254-264. [PMID: 31633756 PMCID: PMC7025333 DOI: 10.1093/jamia/ocz181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/11/2019] [Accepted: 09/27/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Initiatives to reduce neighborhood-based health disparities require access to meaningful, timely, and local information regarding health behavior and its determinants. We examined the validity of Twitter as a source of information for neighborhood-level analysis of dietary choices and attitudes. Materials and Methods We analyzed the “healthiness” quotient and sentiment in food-related tweets at the census tract level, and associated them with neighborhood characteristics and health outcomes. We analyzed keywords driving the differences in food healthiness between the most and least-affluent tracts, and qualitatively analyzed contents of a random sample of tweets. Results Significant, albeit weak, correlations existed between healthiness and sentiment in food-related tweets and tract-level measures of affluence, disadvantage, race, age, U.S. density, and mortality from conditions associated with obesity. Analyses of keywords driving the differences in food healthiness revealed foods high in saturated fat (eg, pizza, bacon, fries) were mentioned more frequently in less-affluent tracts. Food-related discussion referred to activities (eating, drinking, cooking), locations where food was consumed, and positive (affection, cravings, enjoyment) and negative attitudes (dislike, personal struggles, complaints). Discussion Tweet-based healthiness scores largely correlated with offline phenomena in the expected directions. Social media offer less resource-intensive data collection methods than traditional surveys do. Twitter may assist in informing local health programs that focus on drivers of food consumption and could inform interventions focused on attitudes and the food environment. Conclusions Twitter provided weak but significant signals concerning food-related behavior and attitudes at the neighborhood level, suggesting its potential usefulness for informing local health disparity reduction efforts.
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Affiliation(s)
- V G Vinod Vydiswaran
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA.,School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel M Romero
- School of Information, University of Michigan, Ann Arbor, Michigan, USA.,Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan, USA.,Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan, USA
| | - Xinyan Zhao
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Deahan Yu
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Iris Gomez-Lopez
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Jin Xiu Lu
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Bradley E Iott
- School of Information, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Ana Baylin
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Erica C Jansen
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Philippa Clarke
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Veronica J Berrocal
- Department of Statistics, Donald Bren School of Information and Computer Science, University of California, Irvine, California, USA
| | - Robert Goodspeed
- Urban and Regional Planning Program, Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, Michigan, USA
| | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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29
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Ishikawa Y, Sattler ELP. Nutrition as Treatment Modality in Heart Failure. Curr Atheroscler Rep 2021; 23:13. [PMID: 33594492 DOI: 10.1007/s11883-021-00908-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review aims to discuss recent evidence and controversies regarding nutrition as a treatment modality for heart failure (HF) patients. RECENT FINDINGS Adequate nutrition is known to promote health-related quality of life by addressing malnutrition and promoting optimal functioning among older adults and has an established role in the prevention of HF; however, evidence is limited on the effects of nutrition as a treatment modality in HF. While guidance of sodium restriction to address fluid overload is an ongoing debate among experts, evidence from case studies and small clinical trials suggest a positive impact of plant-based and Dietary Approaches to Stop Hypertension (DASH) dietary patterns on HF-related pathophysiology, quality of life, hospital admissions, and mortality. More clinical trials are needed to establish an evidence base to support dietary management strategies for patients with HF. Clinical and Translational Science Alliances (CTSAs) may provide infrastructure to overcome enrollment barriers.
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Affiliation(s)
- Yuta Ishikawa
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, 305 Stanford Drive, Dawson Hall, Athens, GA, 30602, USA
| | - Elisabeth L P Sattler
- Department of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, 305 Stanford Drive, Dawson Hall, Athens, GA, 30602, USA. .,Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, 250 West Green Street, R.C. Wilson Pharmacy, Athens, GA, 30602, USA.
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30
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Zhang Y, Wang Y, Ke B, Du J. TMAO: how gut microbiota contributes to heart failure. Transl Res 2021; 228:109-125. [PMID: 32841736 DOI: 10.1016/j.trsl.2020.08.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/04/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022]
Abstract
An increasing amount of evidence reveals that the gut microbiota is involved in the pathogenesis and progression of various cardiovascular diseases. In patients with heart failure (HF), splanchnic hypoperfusion causes ischemia and intestinal edema, allowing bacterial translocation and bacterial metabolites to enter the blood circulation via an impaired intestinal barrier. This results in local and systemic inflammatory responses. Gut microbe-derived metabolites are implicated in the pathology of multiple diseases, including HF. These landmark findings suggest that gut microbiota influences the host's metabolic health, either directly or indirectly by producing several metabolites. In this review, we mainly discuss a newly identified gut microbiota-dependent metabolite, trimethylamine N-oxide (TMAO), which appears to participate in the pathologic processes of HF and can serve as an early warning marker to identify individuals who are at the risk of disease progression. We also discuss the potential of the gut-TMAO-HF axis as a new target for HF treatment and highlight the current controversies and potentially new and exciting directions for future research.
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Affiliation(s)
- Yixin Zhang
- Beijing Anzhen Hospital, Capital Medical University, Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yuan Wang
- Beijing Anzhen Hospital, Capital Medical University, Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Bingbing Ke
- Beijing Anzhen Hospital, Capital Medical University, Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Jie Du
- Beijing Anzhen Hospital, Capital Medical University, Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China.
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31
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Mamic P, Chaikijurajai T, Tang WHW. Gut microbiome - A potential mediator of pathogenesis in heart failure and its comorbidities: State-of-the-art review. J Mol Cell Cardiol 2020; 152:105-117. [PMID: 33307092 DOI: 10.1016/j.yjmcc.2020.12.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/22/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
Gut microbiome (GMB) has been increasingly recognized as a contributor to development and progression of heart failure (HF), immune-mediated subtypes of cardiomyopathy (myocarditis and anthracycline-induced cardiotoxicity), response to certain cardiovascular drugs, and HF-related comorbidities, such as chronic kidney disease, cardiorenal syndrome, insulin resistance, malnutrition, and cardiac cachexia. Gut microbiome is also responsible for the "gut hypothesis" of HF, which explains the adverse effects of gut barrier dysfunction and translocation of GMB on the progression of HF. Furthermore, accumulating evidence has suggested that gut microbial metabolites, including short chain fatty acids, trimethylamine N-oxide (TMAO), amino acid metabolites, and bile acids, are mechanistically linked to pathogenesis of HF, and could, therefore, serve as potential therapeutic targets for HF. Even though there are a variety of proposed therapeutic approaches, such as dietary modifications, prebiotics, probiotics, TMAO synthesis inhibitors, and fecal microbial transplant, targeting GMB in HF is still in its infancy and, indeed, requires further preclinical and clinical evidence. In this review, we aim to highlight the role gut microbiome plays in HF pathophysiology and its potential as a novel therapeutic target in HF.
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Affiliation(s)
- Petra Mamic
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University Medical Center, Stanford, CA, United States of America
| | - Thanat Chaikijurajai
- Kaufman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America; Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - W H Wilson Tang
- Kaufman Center for Heart Failure Treatment and Recovery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America.
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Effects of the Dietary Approaches to Stop Hypertension (DASH) on Pregnancy/Neonatal Outcomes and Maternal Glycemic Control: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Complement Ther Med 2020; 54:102551. [PMID: 33183669 DOI: 10.1016/j.ctim.2020.102551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & OBJECTIVE No systematic review to date has appraised the impact of the Dietary Approaches to Stop Hypertension (DASH) eating plan on maternal glycemic control and pregnancy outcomes. Thus, we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to ascertain whether the DASH diet in pregnant women ameliorates their glycemic control and neonatal outcomes when compared to standard diets. METHODS We performed a comprehensive systematic review and meta-analysis of RCTs on PubMed/MEDLINE, Web of Science, SCOPUS, and Embase from the inception until October 2019. RESULTS Six studies met the eligibility criteria and were included in the quantitative meta-analysis. The pregnant women had cardiometabolic disorders such as gestational diabetes, obesity, and hypertension. The meta-analysis suggested a significant effect of DASH diet on fasting plasma levels of glucose (WMD = -6.239 mg/dl; 95% CI: -11.915, -0.563, p = 0.031), but not for the homeostasis model assessment of insulin resistance (WMD = -1.038; 95% CI: -2.704, 0.627, p = 0.22). Following the DASH diet during pregnancy decreased the risk of gestational preeclampsia (RR = 0.667; 95% CI: 0.451, 0.987, p = 0.043), macrosomia (birth weight >4000 g) (RR = 0.294; 95% CI: 0.120, 0.721, p = 0.043), and large for gestational age (RR = 0.452; 95% CI: 0.211, 0.969, p = 0.041). Consuming DASH diet during pregnancy neither increased nor decreased the risk of cesarean section, polyhydramnios, preterm birth (<37 weeks), and small for gestational age. The mean newborn head circumference (cm) (WMD = -0.807; 95% CI: -1.283, -0.331, p = 0.001) and ponderal index (kg/m3) (RR = -0.396; 95% CI: -0.441, -0.350, p = 0.000) in the group receiving the DASH diet were lower than in the control group. CONCLUSION The adherence of pregnant women with cardiometabolic disorders to DASH eating pattern has a significant effect on decreasing fasting plasma glucose levels, ponderal index, incidence of preeclampsia, fetal macrosomia, large for gestational age, and newborn head circumference.
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Billingsley HE, Hummel SL, Carbone S. The role of diet and nutrition in heart failure: A state-of-the-art narrative review. Prog Cardiovasc Dis 2020; 63:538-551. [PMID: 32798501 PMCID: PMC7686142 DOI: 10.1016/j.pcad.2020.08.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/09/2020] [Indexed: 02/07/2023]
Abstract
Heart Failure (HF) incidence is increasing steadily worldwide, while prognosis remains poor. Though nutrition is a lifestyle factor implicated in prevention of HF, little is known about the effects of macro- and micronutrients as well as dietary patterns on the progression and treatment of HF. This is reflected in a lack of nutrition recommendations in all major HF scientific guidelines. In this state-of-the-art review, we examine and discuss the implications of evidence contained in existing randomized control trials as well as observational studies covering the topics of sodium restriction, dietary patterns and caloric restriction as well as supplementation of dietary fats and fatty acids, protein and amino acids and micronutrients in the setting of pre-existing HF. Finally, we explore future directions and discuss knowledge gaps regarding nutrition therapies for the treatment of HF.
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Affiliation(s)
- Hayley E Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Scott L Hummel
- University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, United States of America; Ann Arbor Veterans Affairs Health System, Ann Arbor, MI, United States of America
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America.
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Martin-Conty JL, Martin-Rodríguez F, Criado-Álvarez JJ, Castillo-Sarmiento CA, Maestre-Miquel C, Mohedano-Moriano A, Polonio-López B, Durantez-Fernández C, Castro-Villamor MÁ, Viñuela A. How Health Habits Influence the Physiological Response During a Physical Activity in Extreme Temperatures? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176374. [PMID: 32882968 PMCID: PMC7503269 DOI: 10.3390/ijerph17176374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022]
Abstract
Background: The purpose of the study was to determine to what degree the health habits of university students influence their physiological response during a 10-min high-intensity exercise. Methods: We conducted a cross-sectional cohort study with 59 health science students, in which we analyzed their adherence to a Mediterranean and low-fat diet, as well as their activity levels. We correlated these factors with the physiological response (lactic acid and heart rate) and a series of anthropometric parameters in intense physical activity (cardiopulmonary resuscitation (CPR) for 10 min) in three scenarios: extreme cold, extreme heat and a control situation at room temperature. Results: The results of this study demonstrate that in university students, a greater adherence to the Mediterranean diet was associated with a better response to physical exercise, in this case, 10-min CPR, in hostile environments. Conclusions: Following healthy eating guidelines improves physical performance and delays the appearance of fatigue; both are important aspects for a better performance of CPR.
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Affiliation(s)
- José Luis Martin-Conty
- Faculty of Health Sciences, Universidad de Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.L.M.-C.); (J.J.C.-Á.); (A.M.-M.); (B.P.-L.); (C.D.-F.); (A.V.)
| | - Francisco Martin-Rodríguez
- Advanced Clinical Simulation Center, School of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain; (F.M.-R.); (M.Á.C.-V.)
| | - Juan José Criado-Álvarez
- Faculty of Health Sciences, Universidad de Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.L.M.-C.); (J.J.C.-Á.); (A.M.-M.); (B.P.-L.); (C.D.-F.); (A.V.)
- Integrated Care Management of Talavera de la Reina, Health Services of Castilla-La Mancha (SESCAM), 45600 Talavera de la Reina, Spain
| | | | - Clara Maestre-Miquel
- Faculty of Health Sciences, Universidad de Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.L.M.-C.); (J.J.C.-Á.); (A.M.-M.); (B.P.-L.); (C.D.-F.); (A.V.)
- Correspondence: ; Tel.: +34-619653361
| | - Alicia Mohedano-Moriano
- Faculty of Health Sciences, Universidad de Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.L.M.-C.); (J.J.C.-Á.); (A.M.-M.); (B.P.-L.); (C.D.-F.); (A.V.)
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.L.M.-C.); (J.J.C.-Á.); (A.M.-M.); (B.P.-L.); (C.D.-F.); (A.V.)
| | - Carlos Durantez-Fernández
- Faculty of Health Sciences, Universidad de Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.L.M.-C.); (J.J.C.-Á.); (A.M.-M.); (B.P.-L.); (C.D.-F.); (A.V.)
| | - Miguel Ángel Castro-Villamor
- Advanced Clinical Simulation Center, School of Medicine, Universidad de Valladolid, 47005 Valladolid, Spain; (F.M.-R.); (M.Á.C.-V.)
| | - Antonio Viñuela
- Faculty of Health Sciences, Universidad de Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.L.M.-C.); (J.J.C.-Á.); (A.M.-M.); (B.P.-L.); (C.D.-F.); (A.V.)
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Brandt J, Buchholz A, Henry-Barron B, Vizthum D, Avramopoulos D, Cervenka MC. Preliminary Report on the Feasibility and Efficacy of the Modified Atkins Diet for Treatment of Mild Cognitive Impairment and Early Alzheimer's Disease. J Alzheimers Dis 2020; 68:969-981. [PMID: 30856112 DOI: 10.3233/jad-180995] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ketone bodies, the products of fat metabolism, are a source of energy for the brain and are available even when glucose supplies are inadequate (such as with severe carbohydrate deprivation) or its metabolism is faulty (as it is in Alzheimer's disease). This phase I/II randomized clinical trial examined the feasibility of using a modified Atkins diet (MAD) to induce ketogenesis in persons with mild cognitive impairment (MCI) or early AD, and the effect of this diet on memory and other clinical outcomes. In the first 2.5 years of active recruitment, only 27 eligible and willing patients enrolled. After extensive assessment and education, they and their study partners were randomly assigned for 12 weeks to either the MAD or the National Institute on Aging (NIA) recommended diet for seniors. As of April 2018, 9 patients in the MAD arm and 5 in the NIA arm have completed the trial. In spite of extensive teaching, coaching, and monitoring, adherence to both diets was only fair. Among those in the MAD arm who generated at least trace amounts of urinary ketones, there was a large (effect size = 0.53) and statistically significant (p = 0.03) increase in Memory Composite Score between the baseline and week-6 assessment. MAD participants also reported increased energy between baseline and week-6 assessment. Despite challenges to implementing this trial, resulting in a small sample, our preliminary data suggest that the generation of even trace ketones might enhance episodic memory and patient-reported vitality in very early AD.
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Affiliation(s)
- Jason Brandt
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison Buchholz
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bobbie Henry-Barron
- Institute for Clinical and Translational Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diane Vizthum
- Institute for Clinical and Translational Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dimitrios Avramopoulos
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Institute of Genetic Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mackenzie C Cervenka
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bilgen F, Chen P, Poggi A, Wells J, Trumble E, Helmke S, Teruya S, Catalan T, Rosenblum HR, Cornellier ML, Karmally W, Maurer MS, Hummel SL. Insufficient Calorie Intake Worsens Post-Discharge Quality of Life and Increases Readmission Burden in Heart Failure. JACC-HEART FAILURE 2020; 8:756-764. [PMID: 32653445 DOI: 10.1016/j.jchf.2020.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the relationship between calorie intake and post-discharge outcomes in hospitalized patients with heart failure (HF). BACKGROUND Malnutrition increases adverse outcomes in HF, and dietary sodium restriction may inadvertently worsen nutritional intake. METHODS In a dietary intervention trial, baseline nutritional intake in HF inpatients was estimated using the Block Food Frequency Questionnaire (FFQ), and the Nutritional Risk Index (NRI) was calculated. Insufficient calorie intake was defined as <90% of metabolic needs, and a 15-point micronutrient deficiency score was created. Adjusted linear, logistic, and negative binomial regression were used to evaluate associations between insufficient calorie intake and quality of life (using the Kansas City Cardiomyopathy Questionnaire Clinical Summary [KCCQ-CS]), readmission risk, and days rehospitalized over 12 weeks. RESULTS Among 57 participants (70 ± 8 years of age; 31% female; mean body mass index 32 ± 8 kg/m2); median sodium and calorie intake amounts were 2,987 mg/day (interquartile range [IQR]: 2,160 to 3,540 mg/day) and 1,602 kcal/day (IQR: 1,201 to 2,142 kcal/day), respectively; 11% of these patients were screened as malnourished by the NRI. All patients consuming <2,000 mg/day sodium had insufficient calorie intake; this group also more frequently had dietary micronutrient and protein deficiencies. At 12 weeks, patients with insufficient calorie intake had less improvement in the KCCQ-CS score (β = -14.6; 95% confidence interval [CI]: -27.3 to -1.9), higher odds of readmission (odds ratio: 14.5; 95% CI: 2.2 to 94.4), and more days rehospitalized (incident rate ratio: 31.3; 95% CI: 4.3 to 229.3). CONCLUSIONS Despite a high prevalence for obesity and rare overt malnutrition, insufficient calorie intake was associated with poorer post-discharge quality of life and increased burden of readmission in patients with HF. Inpatient dietary assessment could improve readmission risk stratification and identify patients for nutritional intervention. (Geriatric Out of Hospital Randomized Meal Trial in Heart Failure [GOURMET-HF] NCT02148679).
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Affiliation(s)
| | - Peiyu Chen
- University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Stephen Helmke
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Sergio Teruya
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | | | | | | | - Wahida Karmally
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Mathew S Maurer
- Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Scott L Hummel
- University of Michigan, Ann Arbor, Michigan; Columbia University, New York, New York.
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de Souza RJ, Dehghan M, Mente A, Bangdiwala SI, Ahmed SH, Alhabib KF, Altuntas Y, Basiak-Rasała A, Dagenais GR, Diaz R, Amma LI, Kelishadi R, Khatib R, Lear SA, Lopez-Jaramillo P, Mohan V, Poirier P, Rangarajan S, Rosengren A, Ismail R, Swaminathan S, Wentzel-Viljoen E, Yeates K, Yusuf R, Teo KK, Anand SS, Yusuf S. Association of nut intake with risk factors, cardiovascular disease, and mortality in 16 countries from 5 continents: analysis from the Prospective Urban and Rural Epidemiology (PURE) study. Am J Clin Nutr 2020; 112:208-219. [PMID: 32433740 DOI: 10.1093/ajcn/nqaa108] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/21/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The association of nuts with cardiovascular disease and deaths has been investigated mostly in Europe, the USA, and East Asia, with few data available from other regions of the world or from low- and middle-income countries. OBJECTIVE To assess the association of nuts with mortality and cardiovascular disease (CVD). METHODS The Prospective Urban Rural Epidemiology study is a large multinational prospective cohort study of adults aged 35-70 y from 16 low-, middle-, and high-income countries on 5 continents. Nut intake (tree nuts and ground nuts) was measured at the baseline visit, using country-specific validated FFQs. The primary outcome was a composite of mortality or major cardiovascular event [nonfatal myocardial infarction (MI), stroke, or heart failure]. RESULTS We followed 124,329 participants (age = 50.7 y, SD = 10.2; 41.5% male) for a median of 9.5 y. We recorded 10,928 composite events [deaths (n = 8,662) or major cardiovascular events (n = 5,979)]. Higher nut intake (>120 g per wk compared with <30 g per mo) was associated with a lower risk of the primary composite outcome of mortality or major cardiovascular event [multivariate HR (mvHR): 0.88; 95% CI: 0.80, 0.96; P-trend = 0.0048]. Significant reductions in total (mvHR: 0.77; 95% CI: 0.69, 0.87; P-trend <0.0001), cardiovascular (mvHR: 0.72; 95% CI: 0.56, 0.92; P-trend = 0.048), and noncardiovascular mortality (mvHR: 0.82; 95% CI: 0.70, 0.96; P-trend = 0.0046) with a trend to reduced cancer mortality (mvHR: 0.81; 95% CI: 0.65, 1.00; P-trend = 0.081) were observed. No significant associations of nuts were seen with major CVD (mvHR: 0.91; 95% CI: 0.81, 1.02; P-trend = 0.14), stroke (mvHR: 0.98; 95% CI: 0.84, 1.14; P-trend = 0.76), or MI (mvHR: 0.86; 95% CI: 0.72, 1.04; P-trend = 0.29). CONCLUSIONS Higher nut intake was associated with lower mortality risk from both cardiovascular and noncardiovascular causes in low-, middle-, and high-income countries.
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Affiliation(s)
- Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | | | - Andrew Mente
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | | | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yuksel Altuntas
- Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Teaching and Research Hospital , Istanbul, Turkey
| | | | | | - Rafael Diaz
- Estudios Clinicos Latinoamerica (ECLA), Rosario, Santa Fe, Argentina
| | - Leela Itty Amma
- Health Action by People/Amrita Institute of Medical Sciences, Kerala, India
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine.,Advocate Research Institute, Advocate Health Care, Chicago, IL, USA
| | - Scott A Lear
- Population Health Research Institute, Hamilton, ON, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Patricio Lopez-Jaramillo
- Instituto Masira, Medical School, Facultad de Ciencias de la Salud, Universidad de Santander (UDES) and Fundacion Oftalmologica de Santander (FOSCAL), Bucaramanga, Colombia
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Chennai, India.,Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Canada
| | | | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rosnah Ismail
- Community Health Department, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | | | - Edelweiss Wentzel-Viljoen
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Karen Yeates
- Department of Medicine, Division of Nephrology, Queens University, Ontario, Canada
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Koon K Teo
- Population Health Research Institute, Hamilton, ON, Canada.,Department of Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada.,Department of Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton, ON, Canada.,Department of Medicine, Faculty of Health Sciences, McMaster University, Ontario, Canada
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Halatchev IG, McDonald JR, Wu WC. A patient-centred, comprehensive model for the care for heart failure: the 360° heart failure centre. Open Heart 2020; 7:e001221. [PMID: 32624480 PMCID: PMC7337888 DOI: 10.1136/openhrt-2019-001221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Ilia G Halatchev
- Cardiology, Saint Louis VA Medical Center John Cochran Division, Saint Louis, Missouri, USA
- Cardiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Jay R McDonald
- Infectious Diseases, Saint Louis VA Medical Center John Cochran Division, Saint Louis, Missouri, USA
- Infectious Diseases, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Wen-Chin Wu
- Cardiology, Providence VA Medical Center, Providence, Rhode Island, USA
- Cardiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
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Juraschek SP, Kovell LC, Appel LJ, Miller ER, Sacks FM, Christenson RH, Rebuck H, Chang AR, Mukamal KJ. Associations Between Dietary Patterns and Subclinical Cardiac Injury: An Observational Analysis From the DASH Trial. Ann Intern Med 2020; 172:786-794. [PMID: 32423348 PMCID: PMC7388686 DOI: 10.7326/m20-0336] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Stephen P Juraschek
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (S.P.J., K.J.M.)
| | - Lara C Kovell
- University of Massachusetts Medical School, Worcester, Massachusetts (L.C.K.)
| | - Lawrence J Appel
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland (L.J.A., E.R.M.)
| | - Edgar R Miller
- The Johns Hopkins University School of Medicine, The Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland (L.J.A., E.R.M.)
| | - Frank M Sacks
- Harvard T.H. Chan School of Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts (F.M.S.)
| | | | - Heather Rebuck
- University of Maryland School of Medicine, Baltimore, Maryland (R.H.C., H.R.)
| | | | - Kenneth J Mukamal
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (S.P.J., K.J.M.)
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Evans LW, Athukorala M, Martinez-Guryn K, Ferguson BS. The Role of Histone Acetylation and the Microbiome in Phytochemical Efficacy for Cardiovascular Diseases. Int J Mol Sci 2020; 21:E4006. [PMID: 32503339 PMCID: PMC7313062 DOI: 10.3390/ijms21114006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular diseases (CVD) are the main cause of death worldwide and create a substantial financial burden. Emerging studies have begun to focus on epigenetic targets and re-establishing healthy gut microbes as therapeutic options for the treatment and prevention of CVD. Phytochemicals, commonly found in fruits and vegetables, have been shown to exert a protective effect against CVD, though their mechanisms of action remain incompletely understood. Of interest, phytochemicals such as curcumin, resveratrol and epigallocatechin gallate (EGCG) have been shown to regulate both histone acetylation and microbiome re-composition. The purpose of this review is to highlight the microbiome-epigenome axis as a therapeutic target for food bioactives in the prevention and/or treatment of CVD. Specifically, we will discuss studies that highlight how the three phytochemicals above alter histone acetylation leading to global changes in gene expression and CVD protection. Then, we will expand upon these phytochemicals to discuss the impact of phytochemical-microbiome-histone acetylation interaction in CVD.
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Affiliation(s)
- Levi W. Evans
- Department of Nutrition, University of Nevada Reno, Reno, NV 89557, USA; (L.W.E.); (M.A.)
| | - Maheshi Athukorala
- Department of Nutrition, University of Nevada Reno, Reno, NV 89557, USA; (L.W.E.); (M.A.)
| | | | - Bradley S. Ferguson
- Department of Nutrition, University of Nevada Reno, Reno, NV 89557, USA; (L.W.E.); (M.A.)
- Center of Biomedical Research Excellence for Molecular and Cellular Signal Transduction in the Cardiovascular System, University of Nevada Reno, Reno, NV 89557, USA
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Cardio-Metabolic Effects of High-Fat Diets and Their Underlying Mechanisms-A Narrative Review. Nutrients 2020; 12:nu12051505. [PMID: 32455838 PMCID: PMC7284903 DOI: 10.3390/nu12051505] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/12/2022] Open
Abstract
The majority of the epidemiological evidence over the past few decades has linked high intake of fats, especially saturated fats, to increased risk of diabetes and cardiovascular disease. However, findings of some recent studies (e.g., the PURE study) have contested this association. High saturated fat diets (HFD) have been widely used in rodent research to study the mechanism of insulin resistance and metabolic syndrome. Two separate but somewhat overlapping models—the diacylglycerol (DAG) model and the ceramide model—have emerged to explain the development of insulin resistance. Studies have shown that lipid deposition in tissues such as muscle and liver inhibit insulin signaling via the toxic molecules DAG and ceramide. DAGs activate protein kinase C that inhibit insulin-PI3K-Akt signaling by phosphorylating serine residues on insulin receptor substrate (IRS). Ceramides are sphingolipids with variable acyl group chain length and activate protein phosphatase 2A that dephosphorylates Akt to block insulin signaling. In adipose tissue, obesity leads to infiltration of macrophages that secrete pro-inflammatory cytokines that inhibit insulin signaling by phosphorylating serine residues of IRS proteins. For cardiovascular disease, studies in humans in the 1950s and 1960s linked high saturated fat intake with atherosclerosis and coronary artery disease. More recently, trials involving Mediterranean diet (e.g., PREDIMED study) have indicated that healthy monounsaturated fats are more effective in preventing cardiovascular mortality and coronary artery disease than are low-fat, low-cholesterol diets. Antioxidant and anti-inflammatory effects of Mediterranean diets are potential mediators of these benefits.
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Soltani S, Arablou T, Jayedi A, Salehi-Abargouei A. Adherence to the dietary approaches to stop hypertension (DASH) diet in relation to all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. Nutr J 2020; 19:37. [PMID: 32321528 PMCID: PMC7178992 DOI: 10.1186/s12937-020-00554-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/07/2020] [Indexed: 12/20/2022] Open
Abstract
Background Although previous investigations have proposed an association between Dietary Approaches to Stop Hypertension (DASH)-style diet and lower mortality from chronic diseases, the exposure-response relationship is not clear. The present systematic review and meta-analysis aimed to explore the linear and non-linear dose-response association between adherence to the DASH diet and all-cause and cause-specific mortality. Methods Database search was performed in PubMed, Scopus, and EMBASE for prospective cohort studies investigating the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and risk of mortality. Summary hazard ratios (HRs) and 95% confidence intervals (CI) were estimated with the use of a random-effects model for the linear and nonlinear relationships. The two-stage hierarchical regression model was applied to test the potential non-linear dose-response associations. Results The inclusion criteria were met by 17 studies (13 publications). The scores reported for adherence to the DASH diet in different studies were converted to a conventional scoring method in which the adherence score might range between 8 to 40. The linear analysis revealed that summary HRs were 0.95 (95% CI: 0.94–0.96, I2 = 91.6%, n = 14) for all-cause, 0.96 (95% CI: 0.95–0.98, I2 = 82.4%, n = 12) for CVD, 0.97 (95% CI: 0.96–0.98, I2 = 0.00%, n = 2) for stroke, and 0.97 (95% CI: 0.95–0.98, I2 = 63.7%, n = 12) for cancer mortality per each 5-point increment of adherence to the DASH diet. There was also evidence of non-linear associations between the DASH diet and all-cause and cause-specific mortality as the associations became even more evident when the adherence scores were more than 20 points (P < 0.005). Conclusion Even the modest adherence to the DASH diet is associated with a lower risk of all-cause and cause-specific mortality. The higher adherence to the diet also strengthens the risk-reducing association. Registration This review was registered in the international prospective register of systematic reviews (PROSPERO) database (registration ID: CRD42018086500).
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Affiliation(s)
- Sepideh Soltani
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Arablou
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jayedi
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran.,Department of community nutrition, School of nutritional sciences and dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Salehi-Abargouei
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. .,Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code, Yazd, 8915173160, Iran.
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Nutrition intervention in heart failure: should consumption of the DASH eating pattern be recommended to improve outcomes? Heart Fail Rev 2020; 24:565-573. [PMID: 30923990 DOI: 10.1007/s10741-019-09781-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Heart failure (HF) is a chronic, systemic disorder that presents a serious and growing public health problem due to its high prevalence, mortality, and cost of care. Due to the aging of the population and medical advances that prolong the life of HF patients, more effective, widespread strategies for improved HF management in this rapidly growing patient population are needed. While the prevalence of malnutrition in HF patients has been well characterized, evidence is limited regarding the effects of specific macro- and micronutrient deficiencies on HF outcomes and their interaction with other aspects of HF management, including pharmacotherapy. There is a mounting appreciation for the effects of nutritional intervention on pathophysiology, treatment, and outcomes in patients with HF. Heart-healthy dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH), carry importance for the prevention and treatment of hypertension. While preliminary evidence looks promising regarding effects of DASH eating pattern consumption on ventricular function and 30-day hospitalizations in HF patients, more research is needed to confirm its effects on short-term and long-term HF outcomes while better understand underlying mechanisms in the context of HF pharmacotherapy.
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Marolt C, Miller A, Carlozzi NE, Karmally W, Helmke S, Teruya S, Wells J, Trumble E, Maurer MS, Hummel SL. Assessing Barriers to Healthy Eating in Hospitalized Older Adults With Heart Failure: Psychometric Properties of Two Questionnaires. J Card Fail 2020; 26:223-226. [DOI: 10.1016/j.cardfail.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
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Current understanding of gut microbiota alterations and related therapeutic intervention strategies in heart failure. Chin Med J (Engl) 2020; 132:1843-1855. [PMID: 31306229 PMCID: PMC6759126 DOI: 10.1097/cm9.0000000000000330] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: The purpose of this review is to stress the complicated interactions between the microbiota and the development of heart failure. Moreover, the feasibility of modulating intestinal microbes and metabolites as novel therapeutic strategies is discussed. Data sources: This study was based on data obtained from PubMed up to March 31, 2019. Articles were selected using the following search terms: “gut microbiota,” “heart failure,” “trimethylamine N-oxide (TMAO),” “short-chain fatty acid (SCFA),” “bile acid,” “uremic toxin,” “treatment,” “diet,” “probiotic,” “prebiotic,” “antibiotic,” and “fecal microbiota transplantation.” Results: Accumulated evidence has revealed that the composition of the gut microbiota varies obviously in people with heart failure compared to those with healthy status. Altered gut microbial communities contribute to heart failure through bacterial translocation or affecting multiple metabolic pathways, including the trimethylamine/TMAO, SCFA, bile acid, and uremic toxin pathways. Meanwhile, modulation of the gut microbiota through diet, pre/probiotics, fecal transplantation, and microbial enzyme inhibitors has become a potential therapeutic approach for many metabolic disorders. Specifically, a few studies have focused on the cardioprotective effects of probiotics on heart failure. Conclusions: The composition of the gut microbiota in people with heart failure is different from those with healthy status. A reduction in SCFA-producing bacteria in patients with heart failure might be a notable characteristic for patients with heart failure. Moreover, an increase in the microbial potential to produce TMAO and lipopolysaccharides is prominent. More researches focused on the mechanisms of microbial metabolites and the clinical application of multiple therapeutic interventions is necessarily required.
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Evans LW, Bender A, Burnett L, Godoy L, Shen Y, Staten D, Zhou T, Angermann JE, Ferguson BS. Emodin and emodin-rich rhubarb inhibits histone deacetylase (HDAC) activity and cardiac myocyte hypertrophy. J Nutr Biochem 2020; 79:108339. [PMID: 32007664 DOI: 10.1016/j.jnutbio.2019.108339] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/29/2019] [Accepted: 12/20/2019] [Indexed: 12/25/2022]
Abstract
Pathological cardiac hypertrophy is a classical hallmark of heart failure. At the molecular level, inhibition of histone deacetylase (HDAC) enzymes attenuate pathological cardiac hypertrophy in vitro and in vivo. Emodin is an anthraquinone that has been implicated in cardiac protection. However, it is not known if the cardio-protective actions for emodin are mediated through HDAC-dependent regulation of gene expression. Therefore, we hypothesized that emodin would attenuate pathological cardiac hypertrophy via inhibition of HDACs, and that these actions would be reflected in an emodin-rich food like rhubarb. In this study, we demonstrate that emodin and Turkish rhubarb containing emodin inhibit HDAC activity in vitro, with fast-on, slow-off kinetics. Moreover, we show that emodin increased histone acetylation in cardiomyocytes concomitant to global changes in gene expression; gene expression changes were similar to the well-established pan-HDAC inhibitor trichostatin A (TSA). We additionally present evidence that emodin inhibited phenylephrine (PE) and phorbol myristate acetate (PMA)-induced hypertrophy in neonatal rat ventricular myocytes (NRVMs). Lastly, we demonstrate that the cardioprotective actions of emodin are translated to an angiotensin II (Ang) mouse model of cardiac hypertrophy and fibrosis and are linked to HDAC inhibition. These data suggest that emodin blocked pathological cardiac hypertrophy, in part, by inhibiting HDAC-dependent gene expression changes.
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Affiliation(s)
- Levi W Evans
- Department of Nutrition, University of Nevada, Reno, NV, USA; Environmental Sciences, University of Nevada, Reno, NV, USA
| | - Abigail Bender
- Department of Biochemistry and Molecular Biology, University of Nevada, Reno, NV, USA
| | - Leah Burnett
- Department of Biochemistry and Molecular Biology, University of Nevada, Reno, NV, USA
| | - Luis Godoy
- Department of Nutrition, University of Nevada, Reno, NV, USA
| | - Yi Shen
- Department of Nutrition, University of Nevada, Reno, NV, USA; Department of Biochemistry and Molecular Biology, University of Nevada, Reno, NV, USA
| | - Dante Staten
- Environmental Sciences, University of Nevada, Reno, NV, USA
| | - Tong Zhou
- Department of Biochemistry and Molecular Biology, University of Nevada, Reno, NV, USA
| | | | - Bradley S Ferguson
- Department of Nutrition, University of Nevada, Reno, NV, USA; Environmental Sciences, University of Nevada, Reno, NV, USA; Center of Biomedical Research Excellence for Molecular and Cellular Signal Transduction in the Cardiovascular System, University of Nevada, Reno, NV, USA.
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Salas-Salvadó J, Becerra-Tomás N, Papandreou C, Bulló M. Dietary Patterns Emphasizing the Consumption of Plant Foods in the Management of Type 2 Diabetes: A Narrative Review. Adv Nutr 2019; 10:S320-S331. [PMID: 31728494 PMCID: PMC6855981 DOI: 10.1093/advances/nmy102] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/03/2018] [Accepted: 10/29/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of type 2 diabetes (T2D) is increasing worldwide. This complex and multifactorial metabolic condition affects both the quality and expectancy of life in adults. Therefore, appropriate lifestyle strategies are needed in order to reduce the burden of T2D. Dietary patterns characterized by a high consumption of fruits, vegetables, whole grains, legumes, nuts, and seeds, and a minimal consumption of animal products, have been suggested as a dietary approach to prevent and control T2D and related micro- and macrovascular complications. This narrative review summarizes epidemiologic and clinical trial evidence on the role of the most widely studied dietary patterns that emphasize the consumption of plant foods [vegetarian, vegan, Mediterranean, and DASH (Dietary Approaches to Stop Hypertension) diets] in the management of T2D and its complications. Furthermore, their potential underlying mechanisms are discussed. Dietary patterns emphasizing the consumption of plant foods appear to confer beneficial effects on glycemic control in different diabetic populations. Several components of these dietary patterns might confer benefits on glycemia and counterbalance the detrimental effects of animal-based foods. The limited evidence on T2D-related complications makes it difficult to draw solid conclusions.
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Affiliation(s)
- Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain,University Hospital of Sant Joan de Reus, Nutrition Unit, Reus, Spain,Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Institute of Health Carlos III, Madrid, Spain,Address correspondence to JS-S (e-mail: )
| | - Nerea Becerra-Tomás
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain,University Hospital of Sant Joan de Reus, Nutrition Unit, Reus, Spain,Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Christopher Papandreou
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain,University Hospital of Sant Joan de Reus, Nutrition Unit, Reus, Spain,Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Mónica Bulló
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain,University Hospital of Sant Joan de Reus, Nutrition Unit, Reus, Spain,Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Institute of Health Carlos III, Madrid, Spain
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Mediating-Moderating Effect of Allostatic Load on the Association between Dietary Approaches to Stop Hypertension Diet and All-Cause and Cause-Specific Mortality: 2001-2010 National Health and Nutrition Examination Surveys. Nutrients 2019; 11:nu11102311. [PMID: 31569527 PMCID: PMC6836046 DOI: 10.3390/nu11102311] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023] Open
Abstract
This secondary analysis of survey data examined mediating-moderating effects of allostatic load score (calculated using the Rodriquez method) on the association between nutrient-based Dietary Approaches to Stop Hypertension (DASH) diet score (Mellen Index) and the all-cause and cause-specific mortality risks among 11,630 adults ≥ 30 years of age from the 2001-2010 National Health and Nutrition Examination Surveys with no history of cardiovascular disease or cancer at baseline, and who were followed-up for ~9.35 years. Multivariable models were adjusted for demographic, socioeconomic, lifestyle, and health characteristics. All-cause, cardiovascular disease, and cancer-specific mortality rates were estimated at 6.5%, 1.1%, and 1.9%, respectively. The median DASH total score was 3.0 (range: 1-8) (with 78.3% scoring < 4.5), whereas the median allostatic load score was 3 (range: 0-9). The DASH diet, fiber, and magnesium were negatively correlated with allostatic load, whereas allostatic load predicted higher all-cause mortality, irrespective of the DASH diet. Whereas protein was protective, potassium increased all-cause mortality risk, irrespective of allostatic load. Potassium was protective against cardiovascular disease-specific mortality but was a risk factor for cancer-specific mortality. Although no moderating effects were observed, mediation by the allostatic load on cardiovascular disease-specific mortality was observed for DASH total score and selected component scores. Direct (but not indirect) effects of DASH through the allostatic load were observed for all-cause mortality, and no direct or indirect effects were observed for cancer-specific mortality. From a public health standpoint, the allostatic load may be a surrogate for the preventive effects of the DASH diet and its components on cardiovascular disease-specific mortality risk.
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Mediterranean diet adherence and congestive heart failure: Relationship with clinical severity and ischemic pathogenesis. Nutrition 2019; 70:110584. [PMID: 31759318 DOI: 10.1016/j.nut.2019.110584] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 06/24/2019] [Accepted: 08/27/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To our knowledge, no study has addressed the relationship between adherence to a Mediterranean diet style and severity of heart failure. The aim of this retrospective study was to evaluate the relationship between adherence to the Mediterranean diet assessed using the calculation of Mediterranean diet score and congestive heart failure (CHF), its severity, and pathogenesis. METHODS We analyzed charts and collected data of all consecutive patients with a diagnosis of CHF at admission to our Internal Medicine Ward from 2008 to 2014. RESULTS We analyzed 209 patients with CHF and 200 controls. Patients with CHF showed a significantly lower mean MeDi score than controls. At receiver operating characteristic curve analysis, we found a good sensitivity and specificity of mean MeDi score to predict CHF. We also observed a significant positive correlation between MeDi score and ischemic pathogenesis of CHF, a positive relationship between New York Heart Association (NYHA) class and ischemic heart disease, and a significant negative relationship between NYHA class and MeDi score. CONCLUSION The beneficial effects of adherence to the Mediterranean diet suggest a possible answer to the question of the biochemical bases of our data, which should be seen as the direct consequence of the anti-inflammatory, antioxidant, and anti-remodeling effects linked to the diet.
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Joyce BT, Wu D, Hou L, Dai Q, Castaneda SF, Gallo LC, Talavera GA, Sotres-Alvarez D, Van Horn L, Beasley JM, Khambaty T, Elfassy T, Zeng D, Mattei J, Corsino L, Daviglus ML. DASH diet and prevalent metabolic syndrome in the Hispanic Community Health Study/Study of Latinos. Prev Med Rep 2019; 15:100950. [PMID: 31367513 PMCID: PMC6657306 DOI: 10.1016/j.pmedr.2019.100950] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 06/25/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023] Open
Abstract
The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for lowering blood pressure and preventing cardiovascular disease (CVD), but little data exist on these associations in US Hispanics/Latinos. We sought to assess associations between DASH score and prevalence of metabolic syndrome (MetS) and its components in diverse Hispanics/Latinos. We studied 10,741 adults aged 18–74 in the multicenter Hispanic Community Health Study/Study of Latinos. Dietary intake was measured using two 24-hour recalls, and MetS defined per the 2009 harmonized guidelines. We assessed cross-sectional associations of DASH score and MetS (and its dichotomized components) using survey logistic regression, and DASH and MetS continuous components using linear regression. We also stratified these models by Hispanic/Latino heritage group to explore heritage-specific associations. We found no associations between DASH and MetS prevalence. DASH was inversely associated with both measures of blood pressure (p < 0.01 for systolic and p < 0.001 for diastolic) in the overall cohort. DASH was also inversely associated with diastolic blood pressure in the Mexican (p < 0.05), Central American (p < 0.05), and South American (p < 0.01) groups; triglycerides (p < 0.05) in the Central American group; fasting glucose overall (p < 0.01) and in the Mexican group (p < 0.01); and waist circumference overall (p < 0.05) and in the South American group (p < 0.01). DASH was positively associated with HDL-cholesterol (p < 0.01) in the Central American group. DASH may better capture diet-MetS associations in Hispanic/Latino subpopulations such as Central/South Americans; this study also adds evidence that Hispanics/Latinos should be analyzed by heritage. Further research, and/or culturally tailored DASH measures will help further explain between-heritage differences.
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Affiliation(s)
- Brian T. Joyce
- Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Dr., Suite 1400, Chicago, IL 60611, USA
- Corresponding author.
| | - Donghong Wu
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Lifang Hou
- Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Dr., Suite 1400, Chicago, IL 60611, USA
| | - Qi Dai
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sheila F. Castaneda
- San Diego State University, Graduate School of Public Health, Division of Health Promotion and Behavioral Science, San Diego, CA, USA
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Gregory A. Talavera
- Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, CA, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeannette M. Beasley
- Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Tasneem Khambaty
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Tali Elfassy
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Leonor Corsino
- Department of Medicine/Endocrinology, Duke University School of Medicine, Durham, NC, USA
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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