The Mediterranean diet and dietary approach to stop hypertension (DASH)-style diet are differently associated with lipid profile in a large sample of Iranian adults: a cross-sectional study of Shahedieh cohort

Effect of Dietary Approaches to Stop Hypertension (DASH) diet on lipid profile in individuals with overweight/ obesity: A GRADE-assessed systematic review and meta-analysis of clinical trials

BACKGROUND AND AIM

Obesity is a major nutritional disease that increases the risk of developing serious health conditions like dyslipidemia. Plant-based diets, like DASH (dietary approaches to stop hypertension), can help lower the risk of dyslipidemia. However, evidence on the effect of DASH diet on lipid profile in populations with overweight/obesity is inconsistent. This meta-analysis of controlled trials investigated the effects of the DASH diet on lipid profile in individuals with overweight/obesity.

METHODS AND RESULTS

A search for relevant studies was conducted in databases like PubMed, Web of Science, and Scopus until January 2024. The calculation of weighted-mean differences (WMDs) and 95 % confidence intervals (CIs) was performed based on the random-effects model. Sensitivity, meta-regression and publication bias analyses were also conducted. 22 eligible studies with 26 arms and 3562 participants were included. DASH diet significantly reduced total cholesterol (TC) (WMD: 5.05 mg/dl, 95 % CI: 8.78, -1.31, p = 0.008), low-density lipoprotein cholesterol (LDL-C) (WMD: 5.33 mg/dl, 95 % CI: 8.54, -2.11, p = 0.001) and very low-density lipoprotein cholesterol (VLDL-C) (WMD: 3.26, 95 % CI: 6.19, -0.34, p = 0.029) levels. Greater reductions were observed in studies with durations ≤8 weeks. All of the included studies were classified as high quality except two, which were classified as moderate quality. LDL-C and VLDL-C were categorized as high-grade evidence, while others were categorized as moderate.

CONCLUSIONS

DASH diet could improve the lipid profile of individuals with overweight/obesity by decreasing TC, LDL-C and VLDL-C levels. However, it doesn't have significant effects on high-density lipoprotein cholesterol and triglyceride levels.

The association between fruit and vegetable intake and the odds of asthma among children and adolescents

BACKGROUND

Previous epidemiological studies on the correlation between fruit and vegetable consumption and asthma, the majority of them were conducted in developed countries, have led to conflicting results. This study aimed to examine the relationship between fruit and vegetable intake and the risk of asthma among a large sample of children and adolescents.

METHODS

This cross-sectional study was conducted as part of the Global Asthma Network (GAN) on 7667 Iranian children and adolescents. Asthma and its related outcomes were measured using validated questionnaires. A food frequency method was used to assess the dietary intake. The association between fruit and vegetable intake and asthma and its related symptoms was examined using logistic regression.

RESULTS

After adjustment for all possible confounding variables, no significant association was found between fruit and vegetable intake and the odds of medication use for asthma and asthma confirmed by a doctor. However, an inverse significant trend was found between fruits intake and current asthma. After adjusting for age, sex, BMI, and the use of television and computers, participants who regularly consumed fruit had a 37% lower likelihood of experiencing wheezing in the past 12 months (OR = 0.63; 95% CI: 0.42-0.94, P trend = 0.001) compared to those who never or only occasionally consumed fruit. Additionally, individuals who reported consuming vegetables most or all days had a 38% reduced chance of wheezing in the past 12 months (OR = 0.62; 95% CI: 0.48-0.80, P trend < 0.001) compared to participants with infrequent vegetable intake. Participants with regular fruit and vegetable intake combined (OR = 0.50; 95% CI: 0.31-0.82, P trend < 0.001) had a 50% lower likelihood of wheezing in the past 12 months in comparison with those who never or only occasionally fruits and vegetables combined consumers.

CONCLUSION

Our findings suggest that regular consumption of fruits and vegetables on most or all days has a protective effect against wheezing in the past 12 months. Future longitudinal studies should be conducted to confirm our findings.

The association between the Mediterranean Diet and the prime diet quality score and new-diagnosed irritable bowel syndrome: a matched case-control study

Background

Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder with multifactorial etiology. Dietary patterns, including the Mediterranean Diet (Med-Diet) and the Prime Diet Quality Score (PDQS), may play a role in IBS risk. This study examined the association between adherence to the Med-Diet and PDQS and new-diagnosed IBS in an Iranian population.

Methods

A matched case-control study was conducted on 170 newly diagnosed IBS patients and 340 age- and sex-matched controls recruited from outpatient clinics in Zanjan, Iran. Dietary intake was assessed using a semiquantitative food frequency questionnaire. The Med-Diet score and PDQS were calculated, with higher scores indicating better diet quality. Conditional logistic regression was used to determine the odds of IBS across quartiles of Med-Diet and PDQS, adjusting for sociodemographic and clinical factors.

Results

Higher adherence to the Med-Diet was associated with 51% lower odds of IBS (OR: 0.49; 95% CI: 0.30-0.73, P < 0.001) in the highest quartile compared to the lowest. Similarly, participants in the highest PDQS quartile showed a significantly 59% lower odds of IBS (OR: 0.41; 95% CI: 0.26-0.51, P < 0.001) compared to the lowest quartile. Both associations remained significant after adjusting for potential confounders, including total energy intake. These findings highlight the potential clinical relevance of dietary quality in IBS prevention.

Conclusion

Higher adherence to the Med-Diet and a higher PDQS were both inversely associated with IBS risk. Specifically, individuals with higher Med-Diet scores and higher PDQS scores had a lower risk of developing IBS compared to those with lower adherence or scores. These findings suggest a potential role of these dietary patterns in modulating IBS risk, although causal relationships cannot be established from this study.

Microbial signatures and therapeutic strategies in neurodegenerative diseases

Neurodegenerative diseases (NDs), including Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS), arise from complex interactions between genetic factors, environmental exposures, and aging. Additionally, gut dysbiosis has been linked to systemic inflammation and neurodegeneration. Advances in microbiome and metabolome profiling techniques have provided deeper insights into how alterations in gut microbiota and dietary patterns affect metabolic pathways and contribute to the progression of NDs. This review explores the profiles of gut microbiome and metabolome derived biomarkers and their roles in NDs. Across phyla, families, and genera, we identified 55 microbial alterations in PD, 24 in AD, 4 in ALS, and 17 in MS. Some notable results include an increase in Akkermansia in PD, AD, and MS and a decrease in short-chain fatty acids (SCFAs) in PD and AD. We examined the effects of probiotics, prebiotics, fecal microbiota transplants (FMT), sleep, exercise, and diet on the microbiota, all of which contributed to delayed onset and alleviation of symptoms. Further, artificial intelligence (AI) and machine learning (ML) algorithms applied to omics data have been crucial in identifying novel therapeutic targets, diagnosing and predicting prognosis, and enabling personalized medicine using microbiota-modulating therapies in NDs patients.

The Efficacy of Dietary Approaches to Stop Hypertension (DASH) Diet on Lipid Profile: A Systematic Review and Meta-analysis of Clinical Controlled Trials

BACKGROUND

Dyslipidemia is considered a causal risk factor for coronary heart disease and stroke. Plant-based diets such as dietary approaches to stop hypertension (DASH) have beneficial effects on cardiovascular health. This meta-analysis was conducted to assess the effects of the DASH diet on lipid profiles based on clinical controlled trials.

METHODS

An inclusive online search was performed in medical databases including Web of Science, PubMed, Scopus, and Google Scholar up to October 2021 to identify trials assessing the effect of the DASH diet on lipid profiles.

RESULTS

Seventeen studies comprising 2218 individuals were included in this meta-analysis. In comparison to the control group, following the DASH diet resulted in a significant reduction in serum triglycerides (WMD: -5.539 mg/dl; 95% CI: -8.806, -2.272) and low-density lipoprotein cholesterol (WMD: -6.387 mg/dl; 95% CI: -12.272, -0.501). However, DASH diet could not reduce serum total cholesterol (WMD: -5.793 mg/dl; 95% CI: -12.84, 1.254), high-density lipoprotein cholesterol (WMD: 0.631 mg/dl; 95% CI: -0.749, 2.011), and total cholesterol/high-density lipoprotein cholesterol ratio (WMD: -0.11 mg/dl; 95% CI: -0.27, 0.05).

CONCLUSION

Findings of this meta-analysis showed that following the DASH diet had beneficial effects on serum triglycerides and low-density lipoprotein cholesterol, however, it had no effect on serum total cholesterol and high-density lipoprotein cholesterol levels. Based on these results, the DASH diet can be considered a strategy for the prevention and complementary management of dyslipidemia.

Italian and Middle Eastern adherence to Mediterranean diet in relation to Body Mass Index and non-communicable diseases: nutritional adequacy of simulated weekly food plans

BACKGROUND

The Mediterranean diet (MD), known to prevent obesity, overweight and the related non communicable diseases (NCD), is based on typical dishes, foods and on a common cultural milieu. Although MD is the basis of dietary guidelines, the prevalence of obesity, overweight and NCD, is increasing both in Western regions, and even more in Middle Eastern regions (MER). This study aimed to analyze (i) the impact of different levels of adherence to the MD, in Italy and MER, on body mass index (BMI) (ii) the bromatological composition of a simulated 7-days food plan (7-DFP) based on Italian or MER typical meals, following MD criteria and the Italian or MER food base dietary guideline; (iii) the optimization of nutrients impacting on NCD.

METHODS

The 7-DFPs were implemented using a dietary software. The association between adherence to MD and BMI was evaluated by pooled estimated ORs (with 95% confidence intervals and p-values). Pooled measures were obtained by the methods appropriate for meta-analysis. The different food-based guidelines have been compared.

RESULTS

The pooled ORs of obese status comparing medium vs. high adherence to MD were: 1.19 (95% C.I.: 0.99; 1.42, p-value = 0.062) and 1.12 (95% C.I.: 0.90; 1.38, p-value = 0.311) for MER and Italy respectively. For the comparison of low vs. high adherence, the pooled ORs were 1.05 (95% C.I.: 0.88; 1.24, p-value = 0.598) for MER, and 1.20 (95% C.I.: 1.02; 1.41, p-value = 0.031) for Italy when outliers are removed. High adherence to the MD resulted as potential protective factor against obesity. In MER 7-DFP: total fats is higher (34.5 E%) vs. Italian 7-DFP (29.4 E%); EPA (20 mg) and DHA (40 mg) are lower than recommended (200 mg each); sugars (12.6 E%) are higher than recommended (< 10 E%). Calcium, Zinc, and vitamin D do not reach target values in both 7-DFPs.

CONCLUSION

This study highlights that, even when 7-DFPs follow MD and refer to nutrient needs, it is necessary to verify nutrient excesses or deficits impacting on NCD. High MD adherence is protective toward NCDs. MD principles, and energy balance should be communicated according to socioeconomic and educational levels.

The effect of dietary approaches to stop hypertension (DASH) diet on fatty liver and cardiovascular risk factors in subjects with metabolic syndrome: a randomized controlled trial

BACKGROUND

Metabolic syndrome (MetS) as a multifactorial disorder is associated with non-communicable diseases. The dietary approaches to stop hypertension (DASH) diet is a healthy dietary pattern. We investigated the effect of the DASH diet on fatty liver and cardiovascular risk factors in subjects with MetS.

METHODS

60 Subjects with MetS were assigned into the intervention group (DASH diet) or the control group (a healthy diet). Fatty liver index (FLI), hepatic steatosis index (HSI), waist circumference (WC), weight, body mass index (BMI), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) were evaluated at the beginning and after intervention. Equations of fatty liver indices such as FLI and HSI are based on liver enzymes, anthropometric variables, sex and having diabetes.

RESULTS

30 subjects in the intervention group and 29 subjects in the control group completed the study. We found a significant reduction in the intervention group compared to the control group in FLI (-13.06 ± 10.03 vs. -2.90 ± 6.82;P < 0.001), HSI (-2.72 ± 2.59 vs. -0.81 ± 3.80;P = 0.02), WC (-6.02 ± 4.24 vs. -2.24 ± 4.28;P = 0.001), weight (-3.39 ± 2.53 vs. -1.51 ± 2.72;P = 0.008), BMI (-1.25 ± 0.93 vs. -0.56 ± 1.01;P = 0.008), DBP (-5.16 ± 3.92 vs. -1.50 ± 7.04;P = 0.01), SBP (-6.97 ± 8.21 vs. -1.36 ± 6.83;P = 0.006), TG (-18.50 ± 14.32 vs. 0.60 ± 23.81;P < 0.001), TC (-16.10 ± 17.94 vs. -5.07 ± 23.62;P = 0.04) and LDL-c (-13.50 ± 9.58 vs. -4.90 ± 18.28;P = 0.02). These results remained significant after adjusting for confounding factors, except for TC (P = 0.25).

CONCLUSIONS

The DASH diet was more effective than the control diet in managing fatty liver and cardiovascular risk factors.

TRIAL REGISTRATION

The trial was registered on 21 October 2022 at Iranian Registry of Clinical Trials (IRCT20180201038585N12, URL: https://irct.behdasht.gov.ir/trial/66161 ).

Association between DASH and novel atherogenic risk factors, anthropometric indices and foot ulcer indicators in type 2 diabetic patients with foot ulcer: a cross-sectional study

Purpose

Diabetes can cause nerve damage, vascular issues, and reduced blood flow to organs such as the feet, leading to foot deformities and ulcers due to high glucose levels. A healthy dietary pattern like DASH can improve insulin sensitivity and weight loss. Due to limited data and rare evidence, our study aims to investigate the relationship between DASH diet adherence and anthropometric, cardiovascular, and foot ulcer indicators.

Methods

The study included 339 diabetic patients with foot ulcers (122 females and 217 males). The study gathered data on patient dietary intake, anthropometric measurements, biochemistry, foot ulcers, and novel atherogenic risk factors per international definitions.

Results

The average BMI of the participants was 29.2 ± 5.0, 28.1 ± 4.3, and 28.2 ± 4.2 in the tertiles of DASH index (P-value: 0.18). By increasing the adherence to the DASH index, the monofilament score did not change significantly OR: 1.47; CI: (0.81-2.67). Also, foot ulcer area did not change significantly between DASH tertiles OR: 1.01; CI: (0.56-1.83). Atherogenic risk factors also decreased among the DASH tertiles, but statistically not significant.

Conclusion

DASH adherence did not change neuropathy score and cholindex and cardiovascular risk factors significantly and has no significant effect on foot ulcer size.

Impact of fundamental components of the Mediterranean diet on the microbiota composition in blood pressure regulation

BACKGROUND

The Mediterranean diet (MedDiet) is a widely studied dietary pattern reflecting the culinary traditions of Mediterranean regions. High adherence to MedDiet correlates with reduced blood pressure and lower cardiovascular disease (CVD) incidence and mortality. Furthermore, microbiota, influenced by diet, plays a crucial role in cardiovascular health, and dysbiosis in CVD patients suggests the possible beneficial effects of microbiota modulation on blood pressure. The MedDiet, rich in fiber and polyphenols, shapes a distinct microbiota, associated with higher biodiversity and positive health effects. The review aims to describe how various Mediterranean diet components impact gut microbiota, influencing blood pressure dynamics.

MAIN BODY

The MedDiet promotes gut health and blood pressure regulation through its various components. For instance, whole grains promote a healthy gut microbiota given that they act as substrates leading to the production of short-chain fatty acids (SCFAs) that can modulate the immune response, preserve gut barrier integrity, and regulate energy metabolism. Other components of the MedDiet, including olive oil, fuits, vegetables, red wine, fish, and lean proteins, have also been associated with blood pressure and gut microbiota regulation.

CONCLUSION

The MedDiet is a dietary approach that offers several health benefits in terms of cardiovascular disease management and its associated risk factors, including hypertension. Furthermore, the intake of MedDiet components promote a favorable gut microbiota environment, which, in turn, has been shown that aids in other physiological processes like blood pressure regulation.

Cardiovascular Disease and the Mediterranean Diet: Insights into Sex-Specific Responses

Cardiovascular disease (CVD) is a leading cause of mortality and disease burden in women globally. A healthy diet is important for the prevention of CVD. Research has consistently favoured the Mediterranean diet as a cardio-protective diet. Several studies have evaluated associations between the Mediterranean diet and cardiovascular outcomes, including traditional risk factors like hypertension, type 2 diabetes mellitus, and obesity. In addition, consistent evidence suggests that the components of the Mediterranean diet have a synergistic effect on cardiovascular risk due to its anti-inflammatory profile and microbiome effects. While the benefits of the Mediterranean diet are well-established, health advice and dietary guidelines have been built on largely male-dominant studies. Few studies have investigated the beneficial associations of the Mediterranean diet in sex-specific populations, including those with non-traditional risk factors that are specific to women, for instance polycystic ovarian syndrome and high-risk pregnancies, or more prevalent in women, such as chronic inflammatory diseases. Therefore, this review aims to provide a comprehensive overview of the current evidence regarding the Mediterranean diet in women in relation to cardiovascular health outcomes.

Dietary approaches to stop hypertension (DASH) diet improves hepatic fibrosis, steatosis and liver enzymes in patients with non-alcoholic fatty liver disease: a randomized controlled trial

PURPOSE

Recent evidence suggests that adherence to dietary approaches to stop hypertension (DASH) diet can be effective in managing non-alcoholic fatty liver disease (NAFLD). We investigated the effect of DASH diet on hepatic fibrosis, steatosis and liver enzymes in patients with NAFLD.

METHODS

This 12-week randomized controlled trial was conducted among seventy patients with NAFLD who were randomly assigned into two groups including intervention group (DASH diet containing 50-55% carbohydrate, 15-20% protein, and 30% total fat) and the control group (a healthy diet containing 50-55% carbohydrate, 15-20% protein, and 30% total fat). Both diets were calorie-restricted (500-700 kcal lower than the energy requirement). The primary outcomes included hepatic fibrosis, hepatic steatosis, alanine transaminase (ALT), aspartate transaminase (AST) and gamma-glutamyl transpeptidase (GGT).

RESULTS

At the baseline, there was no significant difference between two groups in the level of hepatic fibrosis (P = 0.63), hepatic steatosis (P = 0.53), ALT (P = 0.93), AST (P = 0.18) and GGT (P = 0.76). A significant reduction was found in the intervention group compared to the control group in hepatic fibrosis (23 grades reduction vs. 7 grades reduction; P = 0.008) and hepatic steatosis (31 grades reduction vs. 9 grades reduction; P = 0.03) after intervention. In addition, a significant change was observed in the intervention group compared to control group in ALT ( - 8.50 ± 8.98 vs.  - 2.09 ± 7.29; P = 0.002), and AST ( - 5.79 ± 6.83 vs.  - 0.51 ± 6.62; P = 0.002).

CONCLUSIONS

Adherence to DASH diet may be effective in management of NAFLD.

TRIAL REGISTRATION

The trial was registered on 06 February 2022 at Iranian Registry of Clinical Trials (IRCT20170117032026N3) with URL: https://www.irct.ir/trial/60887 .

Adherence to a Mediterranean type of diet in the world: a geographical analysis based on a systematic review of 57 studies with 1,125,560 participants

This systematic review aimed to assess the level and time-trends of adherence to Mediterranean-type diets (MTD) among the general population, globally. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a comprehensive literature search of the MEDLINE and Scopus databases was carried out, until 04/09/2023, based on specific criteria. Fifty-seven studies with 1,125,560 apparently healthy adults from Europe (n = 37), US (n = 8), Asia (n = 8), Australia (n = 4) and Africa (n = 1) were included. Adherence to an MTD was moderate with a significant decline observed in the last decade. European countries, mainly driven by Mediterranean countries, showed higher adherence than other regions. Geographical analysis revealed that adherence to an MTD is related to both geographic location and socioeconomic status throughout the world.

Association of Gestational Hypertension with Sociodemographic and Anthropometric Factors, Perinatal Outcomes, Breastfeeding Practices, and Mediterranean Diet Adherence: A Cross-Sectional Study

Background and Objectives: Gestational hypertension has been associated with several pregnancy short-term and long-term complications, affecting both the mother and her infant's health. The present study aims to assess the potential association of gestational hypertension with sociodemographic and anthropometry factors, perinatal outcomes, breastfeeding habits, and Mediterranean diet (MD) compliance. Materials and Methods: This is a cross-sectional study conducted on 5271 mothers that was carried out after delivery. The anthropometry characteristics and perinatal outcomes were retrieved from the mothers' medical records. Sociodemographic characteristics, MD adherence, and breastfeeding habits were assessed via one-to-one interviews of the assigned women with qualified staff. Results: Maternal older age, being employed, family history of gestational hypertension, overweight/obesity before gestation, and abnormal gestational weight gain (GWG) independently increased the risk of developing gestational hypertension. Moreover, gestational hypertension was independently related with a greater incidence of abnormal childbirth body weight and preterm birth, not exclusively breastfeeding, and lower levels of MD adherence. Conclusions: This study highlights the importance of informing future mothers about the risk factors of gestational hypertension, underlining also that a healthy lifestyle, which simultaneously includes a healthy nutritional pattern such as MD, may decrease the risk of developing gestational hypertension and the subsequent pregnancy complications.

Association of pre-pregnancy maternal overweight/obesity and dietary intake during pregnancy with the concentrations of persistent organic pollutants in the human milk of women from Rio de Janeiro, Brazil

Persistent organic pollutants (POPs) are toxic chemical compounds that can bioaccumulate, adhere to lipid matrices, and affect human health. This study aimed to investigate the association between maternal pre-pregnancy overweight/obesity and dietary intake during pregnancy and POP concentrations in the human milk of women from Rio de Janeiro, Brazil. One hundred and forty-seven women were followed from the third trimester of pregnancy until 119 days postpartum, and 77 human milk samples were analyzed between 2 and 119 days postpartum. POP concentrations were analyzed using gas chromatography-triple quadrupole mass spectrometry. Pregnancy dietary intake was estimated using a semi-quantitative food frequency questionnaire, and pre-pregnancy body mass index at baseline was classified as normal or overweight/obesity. Multiple logistic and linear regression models were performed to investigate the association between pre-pregnancy overweight/obesity, dietary intake during pregnancy, and POP concentrations in human milk. The models were adjusted for maternal age, maternal schooling, total cholesterol serum concentrations, and time postpartum. The analyses were corrected for multiple comparisons using the Benjamini-Hochberg test. Significant associations were observed between pre-pregnancy overweight/obesity and dichlorodiphenyldichloroethane (ppDDE), polychlorinated biphenyl (PCB)74, PCB138, PCB153, PCB170, PCB180, total PCBs, total 4PCBs, total 2 organochlorine pesticides (OCPs), and total POP concentrations. Higher daily lipid intake during pregnancy increased human milk hexachlorobenzene (HCB). This study showed that pre-pregnancy overweight/obesity and total lipid intake during pregnancy were associated with POP concentrations in the milk of women from Rio de Janeiro, Brazil. To promote adequate nutritional status since preconception and surveillance and control of POP in the environment could be essential to ensure binomial mother-infant health and biomonitoring studies and programs for these POPs should be stimulated.

High-Fructose Diet-Induced Hyperuricemia Accompanying Metabolic Syndrome-Mechanisms and Dietary Therapy Proposals

Fructose is often used as a food ingredient due to its low production costs and sweetening power. In recent years, it has been noticed that people on a Western diet high in fructose have high levels of uric acid in their blood. It was recognized that the specific metabolism of fructose in the body might cause increased production of uric acid, which then may affect the intensification of lipogenesis and the development of metabolic syndrome (MetS), insulin resistance, gout, cardiovascular diseases, leptin resistance, or non-alcoholic fatty liver disease. So far, to treat hyperuricemia, it has been recommended to use a low-purine diet characterized by limiting protein-containing products. However, this recommendation often leads to an increased intake of carbohydrate-rich foods that may contain fructose. Increased fructose consumption may enhance the secretion of uric acid again and, consequently, does not have therapeutic effects. Therefore, instead of a low-purine diet, using healthy diets, such as DASH or the Mediterranean diet, which can benefit metabolic parameters, could be a better proposal. This article provides an overview of this approach, focusing on MetS and hyperuricemia among high-fructose dieters.