Dietary fibre in hypertension and cardiovascular disease management: systematic review and meta-analyses

Sufficient Magnesium Intake Reduces Retinal Vein Occlusion Risk: National Health and Nutrition Examination Survey Analysis

Background/Objectives: Retinal vein occlusion (RVO) is a major cause of vision loss globally. Although magnesium (Mg) is crucial for vascular health, its association with RVO risk is unknown. Thus, we aimed to further examine this association. Methods: This cross-sectional study included participants of the Korean National Health and Nutrition Examination Survey 2017-2021 aged ≥19 years (n = 16,358). RVO diagnosis was based on fundus imaging or was self-reported. Based on their daily Mg intake, we categorized participants into low (<120 mg), intermediate (men: 120-300 mg; women: 120-400 mg), and sufficient (men: ≥300 mg; women: ≥400 mg) intake groups and compared their characteristics across groups. Results: RVO prevalence was 0.7%. Compared to the non-RVO group, the RVO group was characterized by older individuals, fewer current alcohol consumers, a higher prevalence of hypertension and chronic kidney disease, and a lower intake of fiber, iron, calcium, vitamin E, and Mg. After full adjustment, sufficient Mg intake was significantly associated with a 64% reduced risk of RVO (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18-0.71, p = 0.003). This association was particularly notable among individuals aged 19-59 years (OR 0.18, 95% CI 0.04-0.82, p = 0.027), those with hypertension (OR 0.29, 95% CI 0.13-0.67, p = 0.003), and those without glaucoma (OR 0.33, 95% CI 0.15-0.71, p = 0.004). Conclusions: Sufficient Mg intake may reduce RVO risk among adults aged <60 years, individuals with hypertension, and those without glaucoma. Further research should validate the benefits of Mg supplementation in preventing RVO.

Protective Effect of Dietary Fiber on Blood Pressure and Vascular Dysfunction Through Regulation of Sympathetic Tone and Immune Response in Genetic Hypertension

The mechanisms underlying the antihypertensive effect of dietary fibers remain poorly understood. This study investigates whether dietary fiber supplementation can prevent cardiovascular damage and high blood pressure in a genetic model of neurogenic hypertension. Six-week-old male spontaneously hypertensive rats (SHR) and their respective normotensive control, Wistar Kyoto rats (WKY), were divided into four groups: Untreated WKY, untreated SHR, SHR treated with resistant starch (SHR + RS), and SHR treated with inulin-type fructans (SHR + ITF) for 12 weeks. Additionally, a faecal microbiota transplantation (FMT) experiment was conducted, transferring faecal content from treated SHR donors to recipient SHRs. A diet rich in RS fiber reduced vascular oxidative stress, inflammation, and high blood pressure. These protective effects were associated with a reshaped gut microbiota, leading to increased short-chain fatty acid production, reduced endotoxemia, decreased sympathetic activity, and a restored balance between Th17 and Treg lymphocytes in mesenteric lymph nodes and aorta. Elevated plasma levels of acetate and butyrate in the SHR + RS group correlated with increased expression of aortic GPR41, GRP43 and PPARδ. Conversely, ITF treatment failed to prevent hypertension or endothelial dysfunction in SHR. FMT from the SHR + RS group to recipient SHR partially replicated these beneficial effects. This study highlights the antihypertensive benefits of dietary insoluble RS fiber, which are attributed to enhanced short-chain fatty acids production in the gut. This leads to improved gut permeability, reduced sympathetic tone, and diminished vascular T-cell accumulation. Therefore, dietary interventions with RS fiber may offer promising therapeutic strategies for preventing hypertension.

Plant-based diets and all-cause and cause-specific mortality among patients with cardiovascular disease: a population-based cohort study

The role of plant-based diets in preventing premature death among patients with cardiovascular disease (CVD) has remained unknown. We aim to explore the association of plant-based dietary patterns with all-cause and cause-specific mortality among patients with CVD. A total of 10 824 participants with CVD at the baseline were followed up in the UK Biobank. We constructed three types of plant-based diet indexes [an overall plant-based diet index (PDI), a healthful PDI (hPDI), and an unhealthful PDI (uPDI)] by assigning different weights to various food groups from web-based 24 h dietary recall questionnaires. The national death registry documented the primary causes of death. The Cox proportional hazards regression models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. Over a median of 9.5 years follow-up, 1273 death cases were ascertained. After multivariable adjustment, PDI had an inverse correlation with all-cause mortality [HRT3 vs. T1: 0.81 (0.70-0.94), Ptrend = 0.005] and marginal inverse association with CVD mortality [HRT3 vs. T1: 0.78 (0.61-0.99), Ptrend = 0.038], while uPDI displayed a positive correlation with all-cause mortality [HRT3 vs. T1: 1.33 (1.16-1.53), Ptrend < 0.001], CVD, and cancer mortality. Additionally, in mediation analyses, serum concentration of C-reactive protein (CRP) accounted for 6.2%, 4.0%, and 5.1% of the relationship between uPDI and all-cause, CVD, and cancer mortality, respectively. No significant associations were detected between hPDI and mortality. Our findings support dietary guidelines that recommend limiting the consumption of unhealthy plant-based foods.

The Effects of a Whole-Food Plant-Based Nutrition Education Program on Blood Pressure and Potassium in Chronic Kidney Disease: A Proof-of-Concept Study

BACKGROUND/OBJECTIVES

Whole-food plant-based diets (WFPBDs) are beneficial in managing hypertension in the general population but have not been well studied in chronic kidney disease (CKD), potentially due to concerns about hyperkalemia. We hypothesized that individuals with CKD 3 or 4 attending a 15-day WFPBD education program would achieve lower blood pressure compared to those who did not, without an increased risk of hyperkalemia.

METHODS

This was a pilot trial of 40 subjects with mild-to-moderate CKD and hypertension but without diabetes or proteinuria from a single academic center. The subjects were randomized to the 15-day education program or the control group. The changes in blood pressure, serum potassium, and other anthropometric and biochemical values were assessed.

RESULTS

Systolic blood pressure decreased from the baseline to day 15 in the intervention group by 8 mm Hg and increased in the control group by 2.7 mm Hg, although the difference in the blood pressure change did not reach statistical significance (p = 0.12). Diastolic blood pressure was not different between the two groups. Potassium changed by 0.01 mEq/L in the intervention group and -0.07 mEq/L in the control group (p = 0.52). The intervention subjects had significant decreases in body mass (-3.0 vs. -0.12 kg, p < 0.0001), total cholesterol (-39.4 vs. -5.0 mg/dL, p < 0.0001), low-density lipoprotein (-28.4 vs. -0.6 mg/dL, p < 0.0001), and high-density lipoprotein (-8.6 vs. -0.4 mg/dL, p = 0.006) compared to the controls. The changes in albumin and phosphorus were not different between the two groups.

CONCLUSIONS

The subjects with mild-to-moderate CKD attending a 15-day WFPBD education program had a non-statistically significant reduction in systolic blood pressure without an increased risk of hyperkalemia compared to those who did not attend. The intervention subjects achieved significantly greater reductions in body mass and cholesterol without adverse effects on albumin or phosphorus. Larger and longer-duration trials using this approach in a diverse group of CKD patients are warranted.

Correlation of visceral adiposity index and dietary profile with cardiovascular disease based on decision tree modeling: a cross-sectional study of NHANES

BACKGROUND

Visceral adiposity index (VAI) and diets are associated with the risk of cardiovascular disease (CVD). It is unclear how well VAI and diet predict CVD.

METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES 2017-2018). Demographic data, diets, biochemical examination, and questionnaire information were collected. VAI was calculated using body mass index, waist circumference, triglycerides, and high-density lipoprotein cholesterol. Binary logistic regression was adopted to examine the correlation of VAI and diets with CVD. A decision tree model was developed to predict CVD risk according to different factors.

RESULTS

2104 participants (mean age: 50.87 ± 17.35 years, 48.38% males) were included. Participants with high levels of VAI (≥ 2.18) had an elevated risk of CVD compared to those with low levels of VAI (≤ 0.76) (OR = 1.654, 95% CI: 1.025-2.669, P = 0.039). Compared with the low protein intake level (≤ 50.34 g), the upper intermediate (72.10-99.92 g) (OR = 0.445, 95% CI: 0.257-0.770, P = 0.004) and high (≥ 99.93 g) levels of protein intake (OR = 0.450, 95% CI: 0.236-0.858, P = 0.015) reduced CVD risk. The decision tree model unveiled that VAI, protein intake, and dietary fiber intake were predictors for CVD.

CONCLUSION

VAI and protein intake levels are independently associated with CVD risk and have predictive power for CVD. These findings can provide insights into the development of appropriate lifestyle and treatment strategies for patients to reduce the incidence of CVD.

Polysaccharides: The Sweet and Bitter Impacts on Cardiovascular Risk

Cardiovascular risk is a clinical factor that represents the probability of developing cardiovascular diseases (CVDs). This risk is shaped by non-modifiable and modifiable factors, including dietary patterns, which are the main lifestyle factor influencing CVD. Dietary polysaccharides, integral to nutrition, have varying effects on cardiovascular health depending on their type and source. They include starches, non-starch polysaccharides, and prebiotic fibers, categorized further into soluble and insoluble fibers. Soluble fibers, found in oats, legumes, and fruits, dissolve in water, forming gels that help lower serum cholesterol and modulate blood glucose levels. Insoluble fibers, present in whole grains and vegetables, aid in bowel regularity. The cardiovascular benefits of polysaccharides are linked to their ability to bind bile acids, reducing cholesterol levels, and the production of short-chain fatty acids by gut microbiota, which have anti-inflammatory properties. However, not all polysaccharides are beneficial; refined starches can lead to adverse metabolic effects, and chitosan to mixed effects on gut microbiota. This review examines the dualistic nature of polysaccharides, highlighting their beneficial roles in reducing cardiovascular risk factors and the potential adverse effects of specific types.

Evaluating the differential benefits of varying carbohydrate-restricted diets on lipid profiles and cardiovascular risks in dyslipidemia: a meta-analysis and systematic review

Background: carbohydrate-restricted diets (CRDs) have gained attention to address metabolic dysregulation commonly observed in dyslipidemia, a condition posing significant risks to cardiovascular health. However, the effectiveness of CRDs in improving cardiovascular health remains contentious. This meta-analysis comprehensively evaluated the long-term effects of CRDs on glucolipid metabolism and weight loss in individuals with dyslipidemia. Methods: extensive searches were conducted in PubMed, Web of Science, Scopus, the Cochrane Library, and EMBASE. Randomized controlled trials examining the effects of CRDs on glucolipid metabolism and weight loss in adults with dyslipidemia over a minimum of three weeks were included. This analysis compared the differential effects between moderate-low carbohydrate diets (MLCDs) and low carbohydrate diets (LCDs), including a targeted evaluation of animal-based CRDs and dyslipidemic individuals based on the BMI status, thereby addressing gaps in current knowledge. Results: Our findings indicated that CRDs significantly enhanced lipid profiles, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and apolipoprotein B (ApoB), and contributed to weight management in individuals with dyslipidemia. MLCDs were more effective than LCDs in improving all lipid profiles except for TG, which was more effectively managed by LCDs. Animal-based CRDs did not significantly impact lipid profiles. Dyslipidemic individuals with overweight and obesity showed significant changes in TG and ApoB. A noteworthy negative correlation was also observed between TC, TG, and low-density lipoprotein cholesterol levels with higher dietary fiber intake, supporting the beneficial impact of fiber on cardiovascular health. Conclusions: These results for the first time highlighted the potential of adopting MLCDs, particularly those with sufficient fiber content, as a powerful strategy for reducing the risk of cardiovascular diseases in patients suffering from dyslipidemia.

Linking dietary fiber to human malady through cumulative profiling of microbiota disturbance

Dietary fiber influences the composition and metabolic activity of microbial communities, impacting disease development. Current understanding of the intricate fiber-microbe-disease tripartite relationship remains fragmented and elusive, urging a systematic investigation. Here, we focused on microbiota disturbance as a robust index to mitigate various confounding factors and developed the Bio-taxonomic Hierarchy Weighted Aggregation (BHWA) algorithm to integrate multi-taxonomy microbiota disturbance data, thereby illuminating the complex relationships among dietary fiber, microbiota, and disease. By leveraging microbiota disturbance similarities, we (1) classified 32 types of dietary fibers into six functional subgroups, revealing correlations with fiber solubility; (2) established associations among 161 diseases, uncovering shared microbiota disturbance patterns that explain disease co-occurrence (e.g., type II diabetes and kidney diseases) and distinct microbiota patterns that discern symptomatically similar diseases (e.g., inflammatory bowel disease and irritable bowel syndrome); (3) designed a body-site-specific microbiota disturbance scoring scheme, computing a disturbance score (DS) for each disease and highlighting the pronounced capacity of Crohn's disease to disturb gut microbiota (DS = 14.01) in contrast with food allergy's minimal capacity (DS = 0.74); (4) identified 1659 fiber-disease associations, predicting the potential of dietary fiber to modulate specific microbiota changes associated with diseases of interest; (5) established murine models of inflammatory bowel disease to validate the preventive and therapeutic effects of arabinoxylan that notably perturbed the Bacteroidetes and Firmicutes phyla, as well as the Bacteroidetes and Lactobacillus genera, aligning with our model predictions. To enhance data accessibility and facilitate targeted dietary intervention development, we launched an interactive webtool-mDiFiBank at https://mdifibank.org.cn/.

Global burden of cardiovascular diseases attributable to diet low in vegetables from 1990 to 2021 and forecasting the future trends: a population-based study

BACKGROUND

This investigation examines the worldwide impact of cardiovascular diseases (CVD) resulting from inadequate vegetable consumption, based on the 2021 Global Burden of Disease Study data.

METHOD

The study assessed the global, regional, and national repercussions of low vegetable intake on CVD, with a focus on variations among different age and gender demographics. It further analyzed the correlation between disease burden and the Socio-Demographic Index (SDI), and employed an ARIMA model to predict future trends in CVD associated with insufficient vegetable consumption up to 2050.

RESULT

In 2021, a diet lacking in vegetables was responsible for roughly 682,400 deaths and 16 million disability-adjusted life years (DALYs) attributed to CVD, indicating a declining pattern over recent year. Individuals aged 75 and older were predominantly affected. Future projections indicate an expected rise in CVD incidence in lower-middle SDI regions, with African nations potentially experiencing increased challenges related to low vegetable consumption by 2030 and 2050.

CONCLUSION

The findings underscore the critical necessity for preventive measures against CVD and emphasize the significance of improving dietary habits, particularly vegetable intake.

The effects of whey protein supplementation on indices of cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

The increasing prevalence of cardiometabolic diseases highlights the urgent need for practical interventions to mitigate their associated public health burden. Whey protein supplementation has emerged as a potential intervention for improving markers of cardiometabolic health. The aim of this systematic review and meta-analysis was to examine the effect of whey protein ingestion on cardiometabolic profile in adults.

METHODS

A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library from inception until June 2024. Eligible RCTs compared the effect of whey protein supplementation compared to placebo or a carbohydrate-based control on markers of cardiometabolic health. Using the random effects inverse-variance model, we estimated the mean difference (MD) in blood pressure, high- and low-density lipoproteins (HDL-cholesterol, LDL-cholesterol), total cholesterol, triglycerides, and homeostatic model assessment for insulin resistance (HOMA-IR) index.

RESULTS

This meta-analysis included 21 RCTs. Whey protein supplementation had no effect on HDL-cholesterol concentration but did elicit a reduction in LDL-cholesterol in individuals aged <50 years (P < 0.01) and when combined with exercise (MD: -5.38, 95 % confidence interval (95 % CI): -8.87 to -1.88, I2 = 0 %, P < 0.01). Total cholesterol was reduced with interventions that combined whey protein supplementation and exercise (MD: -8.58, -14.32 to -2.83, I2 = 55 %, P < 0.01), irrespective of age, protein dose, and body mass index ≥25 kg/m2 (MD: -6.71, 95 % CI: -11.60 to -1.83, I2 = 74 %, P < 0.01). Whey protein supplementation of ≥12 weeks was associated with reduced triglyceride levels (MD: -6.61, 95 % CI: -11.06 to -2.17, I2 = 70 %, P < 0.01). There was no clinically relevant effect of whey protein supplementation on blood pressure and HOMA-IR, however, changes pertinent to HDL-cholesterol, total cholesterol, and triglyceride reduction were primarily displayed in healthy adults.

CONCLUSIONS

Whey protein supplementation may be an effective intervention for reducing LDL and total cholesterol levels, particularly in healthy, overweight/obese adults aged <50 years, with the greatest benefits observed when combined with exercise. Healthy adults also showed a benefit regarding triglyceride levels.

Association Between Avocado Consumption and Diabetes in Mexican Adults: Results From the 2012, 2016, and 2018 Mexican National Health and Nutrition Surveys

BACKGROUND

Avocado contains numerous vitamins, minerals, and phytochemicals that can contribute to reducing the risk of metabolic syndrome and diabetes. However, limited studies have examined the association between avocados and diabetes risk.

OBJECTIVE

This study aimed to examine the association between avocado consumption and diabetes by sex in Mexican adults.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTING

Participants included a subsample of adults (aged 20 years and older) from the 2012, 2016, and 2018 Mexican National Health and Nutrition Survey. Avocado consumption was assessed using a 7-day, semiquantitative food frequency questionnaire, and participants were classified as avocado consumers (consuming any amount of avocado) or nonconsumers.

MAIN OUTCOME MEASURES

Participants were considered to have diabetes if they answered "yes" to "Has a doctor ever told that you have diabetes or high blood sugar?"

STATISTICAL ANALYSES PERFORMED

This analysis assessed the association between avocado intake and diabetes using multivariate logistic models by sex and adjusted for relevant covariates.

RESULTS

Of 28 239 Mexican National Health and Nutrition Survey 2012, 2016, and 2018 participants, 25 640 met the criteria (ie, have diabetes outcome and plausible energy and avocado intakes) for this study. More than half of the participants were women, and approximately 45% were avocado consumers, with an average (SE) avocado consumption of 34.7 (0.9) among men and 29.8 (0.8) g/day among women. Avocado consumers had lower odds of diabetes in both unadjusted (odds ratio [OR] 0.762, 95% CI 0.639 to 0.907) and adjusted (OR 0.792, 95% CI 0.632 to 0.993) models among women but not men (OR 1.192, 95% CI: 0.907 to 1.566 and OR 0.914, 95% CI 0.675 to 1.239 for unadjusted and adjusted models, respectively).

CONCLUSIONS

Avocado consumption was associated with a lower risk of diabetes, which remained significant even when adjusted for relevant covariates. However, this finding was observed in only women, not men, underscoring the importance of personalized nutrition in diabetes care and prevention.

Association between dietary antioxidant indices and hypertension among Chinese adults

The effect of dietary antioxidants on blood pressure (BP) regulation and hypertension risk remains largely unknown. This study aimed to comprehensively assess the impacts of dietary antioxidants on systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP), and hypertension risk among Chinese adults. The cross-sectional study assessed data from 12,046 Chinese adults, evaluating dietary antioxidant quality scores (DAQS) and total antioxidant capacity (DTAC) via a validated food frequency questionnaire. MAP was derived using the formula DBP + (0.412 ×PP), with PP calculated as SBP - DBP. The relationship between DAQS, DTAC, and hypertension prevalence was analyzed using multivariable logistic regression. Among participants not taking antihypertensive medications, those in the highest groups of DTAC and DAQS had significantly lower SBP, DBP, MAP, and PP compared to those in the lowest groups (all p-trends <0.001). Relative to the lowest quintile (Q1) of DTAC (adjusted odds ratios (OR) for hypertension decreased in Q2 (OR 0.90, 95%CI 0.79-1.03), Q3 (OR 0.65, 95% CI 0.56-0.76), Q4 (OR 0.51, 95% CI 0.43-0.60), and Q5 (OR 0.38, 95% CI 0.31-0.46) (p trend <0.001). For DQAS, hypertension OR of category 5 was 0.38 (95% CI 0.32-0.46) compared to that of category 1. Increased vitamin A, Zinc, and selenium intake correlated with reduced hypertension risk. A significant non-linear DTAC and linear DAQS relationships were observed and hypertension risk. Antioxidant-rich diets markedly lowered SBP, DBP, MAP, PP, and hypertension risk.

Legume intakes on cardiometabolic profile and gut microbiome function: systematic review and meta-analyses of randomised controlled trials

BACKGROUND

Legumes are widely considered one of the most beneficial food groups to consume. They are high in fibre and plant-based protein as well as naturally low in sodium, saturated fats, and sugars. However, legumes do not feature prominently in the modern diet, and previous evidence syntheses show inconsistent results on cardiometabolic risk profile when increasing legume intakes. This review examines the impact of legume intake on cardiometabolic profile and gut microbiome.

METHODS

EMBASE, OVID Medline, and the Cochrane Central Register of Controlled Trials were searched up to 15 May 2024 with checking of relevant reference lists and bibliographies. Relevant data were extracted into pre-tested forms and risk of bias was assessed with Cochrane RoB2. Searches, screening, and risk of bias assessment were done independently by two reviewers. We have considered trials where legumes were provided to adults, with and without pre-existing conditions (i.e. type 2 diabetes, heart disease or dyslipidaemia), in randomised controlled trials of at least six weeks duration on cardiometabolic risk factors and gut microbiome outcomes. Trial data were pooled using random effects models. Prespecified regression analyses were then performed to identify the factors influencing pooled results. Certainty of evidence was assessed with GRADE.

RESULTS

We identified 30 papers of 24 trials with 33 eligible comparisons where legumes (daily average 86 g (range 2-251)) were provided to 1,938 participants. No eligible studies reported on microbiome outcomes. There was moderate certainty evidence that higher legume intakes improved total cholesterol (mean difference (MD) -0.23mmol/L, 95%CI -0.33 to -0.13), LDL cholesterol (MD -0.16mmol/L (-0.24 to -0.08)), and fasting blood glucose (MD -0.18mmol/L (-0.30 to -0.06)). The majority of trial comparisons (70%) provided an isoenergetic control food. Pooled results were influenced by underlying differences between trials such as type and format of legumes provided, but not consistently across multiple outcomes.

CONCLUSIONS

Increasing legume intakes improved some blood lipid and glucose parameters, but not all. Isoenergetic comparisons in trials may obscure changes in cardiometabolic risk factors due to greater satiation or reduced intake, and no trials greater than six weeks duration were identified to consider the microbiome-mediated health effects with greater legume intakes. Future trials in these areas are necessary.

TRIAL REGISTRATION

Prospero ID CRD42023456953.

Development and Pragmatic Randomized Controlled Trial of Healthy Ketogenic Diet Versus Energy-Restricted Diet on Weight Loss in Adults with Obesity

Introduction: The ketogenic diet (KD) is widely used for weight management by reducing appetite, enhancing fat oxidation, and facilitating weight loss. However, the high content of total and saturated fats in a conventional KD may elevate low-density lipoprotein (LDL)-cholesterol levels, a known risk factor for cardiovascular diseases, highlighting the need for healthier alternatives. This study aimed to investigate the effect of a newly developed Healthy Ketogenic Diet (HKD) versus an Energy-Restricted Diet (ERD) on weight loss and metabolic outcomes among adults with obesity. Methods: Multi-ethnic Asian adults (n = 80) with body mass index ≥ 27.5 kg/m2 were randomized either to HKD (n = 41) or ERD (n = 39) for 6 months. Both groups followed an energy-restricted healthy diet, emphasizing on reducing saturated and trans fats. The HKD group additionally limited net carbohydrate intake to no more than 50 g per day. Dietary adherence was supported via the Nutritionist Buddy app with dietitian coaching. The primary outcome was weight change from baseline at 6 months. Secondary outcomes included weight change at 3 months and 1 year, along with changes in metabolic profiles. Data were analyzed using linear regression with an intention-to-treat approach. Results: The HKD group achieved significantly greater mean weight loss at 6 months than the ERD group (-7.8 ± 5.2 kg vs. -4.2 ± 5.6 kg, p = 0.01). The mean weight loss percentage at 6 months was 9.3 ± 5.9% and 4.9 ± 5.8% for the HKD and ERD groups, respectively (p = 0.004). Improvements in metabolic profiles were also significantly better in the HKD group [glycated hemoglobin (-0.3 ± 0.3% vs. -0.1 ± 0.2%, p = 0.008), systolic blood pressure (-7.7 ± 8.9 mmHg vs. -2.6 ± 12.2 mmHg, p = 0.005), and aspartate transaminase (-7.6 ± 15.5 IU/L vs. 0.6 ± 11.5 IU/L, p = 0.01)], with no increase in LDL-cholesterol (-0.12 ± 0.60 mmol/L vs. -0.04 ± 0.56 mmol/L, p = 0.97) observed in either group. Conclusions: The HKD was more effective than the ERD in promoting weight loss and improving cardiometabolic outcomes without elevation in LDL-cholesterol. It can be recommended for therapeutic intervention in patients with obesity.

The role for ω-3 polyunsaturated and short chain fatty acids in hypertension: An updated view on the interaction with gut microbiota

As of 2024, arterial hypertension is still considered the leading modifiable cardiovascular risk factor and, due to high rates of undertreatment and poor blood pressure control, the major contributor to human morbidity and mortality. Development of new treatment options and better interventions in lifestyle correction have become a priority of experimental and clinical research. In the last decades, dietary supplementation of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) and generation of gut microbiota-derived short chain fatty acids (SCFAs) have surged as potential and promising interventions for hypertension and cardiovascular prevention. ω-3 PUFAs are considered "essential" fatty acids that can be obtained only from dietary sources. Although previous intervention trials were not consistent in reporting a significant benefit of ω-3 PUFAs, the recent REDUCE-IT trial has provided robust evidence in support of their role in cardiovascular prevention. Recent studies have also identified the intestinal microbiota as a potential player in the pathophysiology and progression of hypertension. Although this might occur through many pathways, generation of SCFAs that is highly dependent on dietary fiber intake is primarily involved, providing an additional target for the development of novel therapeutic strategies. For these reasons, some scientific societies currently recommend dietary supplementation of ω-3 PUFAs and fiber-containing foods in patients with hypertension. In this narrative review, we summarize the results of studies that examined the effects of ω-3 PUFAs and SCFAs on blood pressure, highlighting the mechanisms of action on the vascular system and their possible impact on hypertension, hypertension-related organ damage and, ultimately, cardiovascular outcomes.

Fibrous foes: First report on insidious microplastic contamination in dietary fiber supplements

Regular consumption of health supplements to balance dietary intake has gained popularity worldwide. One such supplement that has gained popularity among consumers is dietary fibers. Microplastic (MPs) contamination in various food products is being reported worldwide. However, there is a paucity of understanding of the occurrence of MPs in dietary supplements. This study addresses this gap by investigating the degree of MPs contamination in dietary fiber supplements. Nine commonly consumed (powder and gummy-based) over-the-counter dietary fiber supplements in Australia were tested in this study. Microscopic examination revealed the presence of MPs fibers and fragments in all the tested products. Further categorization showed that MPs particles were of various colours, including black, blue, red, green, and white. The order of polymer abundance was Polyamide > Polydiallyl Phthalate > polyethylene polypropylene diene > Polyurethane = Polyethylene terephthalate > Polyethylene = Ethylene acrylic acid copolymer. Among the supplements, powder-based samples had higher MPs (at the adult dosage suggested by the manufacturer) than gummy-based product. The average predicted ingestion of microplastics from these supplements (all nine samples) was 5.89 ± 2.89 particles day-1. The dietary exposure for children and adults ranged from 0.1-0.48 and 0.18-4.08 particles day-1, respectively. Based on the microplastic contamination factor (MCF), among the nine samples tested, 69.81% exhibited a moderate level, while 20.76% showed a significant level of microplastic contamination. The polymer risk index (pRi) indicates products with very high and high-risk categories. The possible sources of MPs contamination in the products were studied. To our knowledge, this is the first study to record and quantify the presence of MPs in dietary fiber supplements, which is a direct source of MPs exposure to humans via., ingestion.

Association between dietary fiber intake and chronic kidney disease in adults with and without hypertension in the United States: a cross-sectional study of NHANES 2009-2020

While previous research has highlighted the potential advantages of increasing dietary fiber intake (DFI) for managing hypertension and chronic kidney disease (CKD), there is a gap in large-scale empirical studies examining the relationship between DFI and CKD among hypertensive and nonhypertensive cohorts independently. This study involved 22,871 participants sourced from the NHANES database spanning 2009 to 2020, who were divided into hypertensive (n = 9,861) and nonhypertensive (n = 13,010) groups. The analysis revealed a significant inverse correlation between DFI and CKD prevalence across the sample after adjusting for various covariates (OR = 0.98, 95% CI: 0.97-0.99, p = 0.001). Within the subset of hypertensive individuals, this inverse association mirrors the findings of the overall sample, indicating that a higher DFI was associated with a reduced occurrence of CKD (OR = 0.97, 95% CI: 0.96-0.99, p < 0.001). However, this correlation was not detected in the nonhypertensive group (OR = 0.99, 95% CI: 0.98-1.01, p = 0.285). The RCS analysis further confirmed a pronounced nonlinear inverse relationship between DFI and CKD prevalence in both the entire cohort and the hypertensive group but not in the nonhypertensive group. Further scrutiny of the hypertensive group revealed that individuals with a higher DFI had 33% lower odds of CKD progression for the moderate risk level and 36% lower odds for the high to very high risk level. Subgroup analyses confirmed the consistency of these relationships across various demographics. In summary, this investigation revealed a significant inverse relationship between DFI and CKD prevalence in US adults with hypertension, a relationship not observed in nonhypertensive individuals.

The OMNIVEG STUDY: Health outcomes of shifting from a traditional to a vegan Mediterranean diet in healthy men. A controlled crossover trial

BACKGROUND AND AIM

The Mediterranean diet is a plant-based dietary pattern with well-established health benefits such as the reduced risk of cardiovascular disease. Additionally, incorporating more plant-based foods into a Mediterranean diet may provide further health benefits. The study aimed to assess the effect of shifting from a traditional Mediterranean diet to a vegan Mediterranean diet on cardiorespiratory fitness and lipid profile in physically active and healthy men.

METHODS AND RESULTS

Participants underwent a baseline period with adhesion to the general patterns of the Mediterranean diet for three weeks and then they changed to an isocaloric vegan version of the Mediterranean diet for four weeks, with a 7-day washout period between diets. The shift from the traditional Mediterranean diet to the vegan Mediterranean diet required substituting animal-based foods with plant-based foods that contain comparable amounts of protein and fat. Fourteen participants with a mean age of 24.6 ± 7.0 years (range: 18-37 years), completed the study protocol. The change from the traditional to the vegan Mediterranean diet reduced blood concentration of total cholesterol (-22.6 mg/dl, p < 0.01, Effect size [ES] = 1.07) and low-density lipoprotein cholesterol (-12.8 mg/dl, p < 0.01, ES = 0.72). An inverse correlation was observed between the intake of dietary fibre and LDL-C (partial rho = -0.43, p = 0.040).

CONCLUSIONS

The adoption of a vegan Mediterranean diet with plant-based proteins and fats instead of the traditional Mediterranean diet improved several cardiometabolic health outcomes in physically active and healthy men.

CLINICAL TRIAL REGISTRY

NCT06008886.

The nutritional contribution and relationship with health of bread consumption: a narrative review

Bread consumption dates back thousands of years, being one of the oldest and most widespread staple food worldwide. While bread is often associated with taste, pleasure, and tradition, its perception as a vehicle of nutrition and health remains complex. Today, there is no scientific consensus on whether bread consumption is beneficial or deleterious to human health. The objective of this review is therefore to present and discuss epidemiological and clinical evidence on the nutritional contribution of bread and its relationship with health. We also present different aspects of bread such as flour type and inclusions that may modulate this relationship. Studies included in this review investigate bread as part of a dietary pattern as well as the effect of bread alone on overweight, cardiometabolic health, and digestive health. Bread is an integral part of diets around the world, with a significant contribution to key nutrients. Although evidence on the impact of bread consumption on health is still lacking and depends on the overall diet, whole grain breads have shown consistent beneficial effects on human health. Substitution modeling studies and well-designed clinical trials are warranted to fill the research gaps and understand the role of bread consumption in health and disease.

Addressing Mental Health in Rural Settings: A Narrative Review of Blueberry Supplementation as a Natural Intervention

Depression and anxiety are major public health issues; however, there is an unmet need for novel, effective, and accessible treatments, particularly in rural communities. Blueberries are an unexplored nutraceutical for these conditions due to their excellent nutritional profile, with particularly high levels of polyphenols and anthocyanins and benefits on mood, cognition, and health. Here, we present a narrative review of the literature concerning the etiology and treatments of major depressive disorder (MDD) and generalized anxiety disorder (GAD). In both animal and human studies, blueberry supplementation can ameliorate behavioral symptoms of both anxiety and depression. The mechanistic underpinnings of these behavioral improvements are not fully defined, but likely involve biochemical alterations in the gut-brain axis, including to inflammatory cytokines, reactive oxygen species, and growth factors. We also review the limitations of traditional therapies in rural settings. Finally, we assess the potential benefit of nutraceutical interventions, particularly blueberries, as novel therapeutics for these distinct, yet related mental health issues.

The Role of Dietary Ingredients and Herbs in the Prevention of Non-Communicable Chronic Liver Disease

BACKGROUND

Liver diseases are among the most commonly diagnosed conditions, with the main risk factors being inappropriate lifestyles, including poor diet, excessive alcohol consumption, low physical activity and smoking, including electronic cigarettes. Non-communicable chronic liver diseases also often develop as a result of accompanying overweight and obesity, as well as type 2 diabetes.

METHODS

The literature on risk factors for non-communicable chronic liver diseases, which show a high strong influence on their occurrence, was analysed.

RESULTS

Measures to prevent non-communicable chronic liver disease include the selection of suitable food ingredients that have proven protective effects on the liver. Such ingredients include dietary fibre, probiotics, herbs, various types of polyphenols and fatty acids (omega-3).

CONCLUSIONS

Because of their liver-protective effects, nutritionists recommend consuming vegetables, fruits, herbs and spices that provide valuable ingredients with anti-inflammatory and anti-cancer effects. These components should be provided with food and, in the case of probiotics, supplementation appears to be important. As a preventive measure, a diet rich in these nutrients is therefore recommended, as well as one that prevents overweight and other diseases that can result in liver disease.

Association of oxidative balance score with all-cause mortality among individuals with chronic kidney disease: a cohort study

BACKGROUND

The Oxidative Balance Score (OBS) is employed for evaluating the body's overall level of oxidative stress. This study aimed to investigate the association between OBS and mortality in individuals with chronic kidney disease (CKD) using a cohort study design.

METHODS

We used data from adult participants(≥ 20 years old) in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. CKD is diagnosed based on the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. OBS, which consists of 16 dietary factors and 4 lifestyle factors, categorized into pro-oxidants and antioxidants, with a total score range of 0 to 40 .The OBS was divided into four quartiles (Q1 to Q4), with Q1 (5-12), Q2 (13-18), Q3 (19-24), and Q4 (25-36). We excluded patients with missing data on OBS, CKD, and key covariates.Cox regression analysis were used to examine the relationship between OBS and all-cause mortality in CKD patients. Sensitivity analyses included subgroup analysis and multiple imputation.

RESULTS

We included a total of 3,984 patients with CKD. During an average follow-up period of 103 months, 1,263 cases (31.7%) of all-cause mortality were recorded. In the fully adjusted model, compared to Q1 the hazard ratios (HRs) and 95% confidence intervals (CIs) for Q4 were as follows: OBS 0.80 (0.68, 0.95) (p = 0.012), dietary OBS 0.78 (0.66, 0.92) (p = 0.003), and lifestyle OBS 0.83 (0.70, 0.99) (p = 0.038). Our sensitivity analyses further confirmed the robustness of these results.

CONCLUSIONS

Higher OBS was negatively correlated with all-cause mortality risk in American adults with CKD.

Constipation is associated with an increased risk of major adverse cardiac events in a UK population

Traditional cardiovascular risk factors, including hypertension, only explain part of major adverse cardiac events (MACEs). Understanding what other risk factors contribute to MACE is essential for prevention. Constipation shares common risk factors with hypertension and is associated with an increased risk of several cardiovascular diseases. We hypothesized that constipation is an underappreciated risk factor for MACE. We used the population healthcare and genomic data in the UK Biobank (n = 408,354) to study the contribution of constipation (ICD10 K59.0) to the risk of MACE, defined by any episode of acute coronary syndrome (ACS), ischemic stroke, and heart failure (HF). Analyses were controlled for traditional cardiovascular risk factors. We also assessed genetic correlations (rg) between constipation and MACE. Constipation cases (n = 23,814) exhibited a significantly higher risk of MACE compared with those with normal bowel habits [odds ratio (OR) = 2.15, P < 1.00 × 10-300]. Constipation was also significantly associated with individual MACE subgroups, in order: HF (OR = 2.72, P < 1.00 × 10-300), ischemic stroke (OR = 2.36, P = 2.02 × 10-230), and ACS (OR = 1.62, P = 5.82 × 10-113). In comparison with patients with constipation-free hypertension, patients with hypertension with constipation showed significantly higher odds of MACE (OR = 1.68, P = 1.05 × 10-136) and a 34% increased risk of MACE occurrence (P = 2.3 × 10-50) after adjustment for medications that affect gut motility and other traditional cardiovascular risk factors. Finally, we detected positive genetic correlations between constipation and MACE subgroups ACS (rg = 0.27, P = 2.12 × 10-6), ischemic stroke (rg = 0.23, P = 0.011), and HF (rg = 0.21, P = 0.0062). We identified constipation as a potential risk factor independently associated with higher MACE prevalence. These findings warrant further studies on their causal relationship and identification of pathophysiological mechanisms.NEW & NOTEWORTHY Analyzing 408,354 participants of the UK Biobank, we show that constipation cases exhibited a significantly higher risk of major adverse cardiac events (MACEs) than those with regular bowel habits. In comparison with patients with constipation-free hypertension, patients with hypertension with constipation showed significantly higher odds of MACE and a 34% increased risk of subsequent MACE occurrence. Finally, we detected positive genetic correlations between constipation and MACE. This association holds potential for therapeutic exploitation and prevention based on individuals' risk assessment.

The effect of flour-based foods intake in the reduction of cardiometabolic risk: A systematic review

Cardiometabolic risk triggers a state of chronic and subclinical inflammation, conferring a higher risk of morbidity and mortality. Thus, minimal processing of foods with high nutritional value, in the form of flour, becomes an effective dietary strategy in preventing and treating cardiometabolic risk factors. This systematic review aims to evaluate the evidence on the effect of flour-based food intake on reducing the most common cardiometabolic risk factors. We included all randomized controlled trials published up to April 2023 in the main databases PubMed, Scopus and Web of Science. Eleven clinical trials were included. The amount of flour used in the studies ranged from 1.5 g to 36 g/day, and the supplementation period ranged from six weeks to 120 days. Green jackfruit flour, green banana flour, soy flour, flour from rind of the yellow passion fruit, and fenugreek powder demonstrated significant results in improve parameters of glucose homeostasis. Chia flour, green banana flour, soy flour, and fenugreek powder showed improvements in blood pressure measurements. Brazil nut flour and chia flour reduced total cholesterol. Chia flour also increased HDL cholesterol levels. The evidence presented in the current systematic review indicates that flour-derived foods intake is related to improve cardiometabolic risk factors parameters.

Association between diet quality and all-cause mortality in a large Dutch cohort

Food-based dietary guidelines are helpful for governments and health agencies to encourage healthy eating at the population level. In order to assess adherence to such guidelines, index scores have been developed, the version in the Netherlands being the Dutch Healthy Diet-index (2015) (DHD2015-index), which reflect adherence to the 2015 Dutch dietary guidelines. Because a higher diet quality, i.e. a higher adherence to the dietary guidelines, is associated with better health outcomes, a higher DHD2015-index score would also mean better outcomes on measures of health, such as all-cause mortality. The present study aimed to elucidate this by investigating the association between DHD2015-index score and mortality in the Dutch population using data from 97 999 participants in the Lifelines cohort study. For the analyses, Cox Proportional Hazards regression was used, whilst accounting for age, sex, physiological measurements, exercise, and biochemical and lifestyle variables. There was a strong negative association between DHD2015-index score and mortality. Hazard ratios for DHD2015-index scores below 60 were approximately 1.2x larger than the mean. Every 10 unit increase in DHD2015-index scores between 60 and 90 led to a 0.1 reduction in hazard ratio, and every 10 unit increase between 90 and the highest DHD2015-index scores led to a reduction in hazard ratios of 0.05. The hazard ratio for the lowest quartile of DHD2015-index scores was 1.14 (95% CI = 1.04-1.26), whereas that for the highest quartile was 0.88 (95% CI = 0.84-0.92). Our results show a clear inverse relationship between DHD2015-index score and all-cause mortality.

Broadening horizons: intestinal microbiota as a novel biomarker and potential treatment for hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy (HDP) are severe complications of pregnancy with high morbidity and are a major cause of increased maternal and infant morbidity and mortality. Currently, there is a lack of effective early diagnostic indicators and safe and effective preventive strategies for HDP in clinical practice, except for monitoring maternal blood pressure levels, the degree of proteinuria, organ involvement and fetal conditions. The intestinal microbiota consists of the gut flora and intestinal environment, which is the largest microecosystem of the human body and participates in material and energy metabolism, gene expression regulation, immunity regulation, and other functions. During pregnancy, due to changes in hormone levels and altered immune function, the intestinal microecological balance is affected, triggering HDP. A dysregulated intestinal microenvironment influences the composition and distribution of the gut flora and changes the intestinal barrier, driving beneficial or harmful bacterial metabolites and inflammatory responses to participate in the development of HDP and promote its malignant development. When the gut flora is dysbiotic and affects blood pressure, supplementation with probiotics and dietary fiber can be used to intervene. In this review, the interaction between the intestinal microbiota and HDP was investigated to explore the feasibility of the gut flora as a novel biomarker of HDP and to provide a new strategy and basis for the prevention and treatment of clinical HDP.

Recommendations for the Use of Dietary Fiber to Improve Blood Pressure Control

According to several international, regional, and national guidelines on hypertension, lifestyle interventions are the first-line treatment to lower blood pressure (BP). Although diet is one of the major lifestyle modifications described in hypertension guidelines, dietary fiber is not specified. Suboptimal intake of foods high in fiber, such as in Westernized diets, is a major contributing factor to mortality and morbidity of noncommunicable diseases due to higher BP and cardiovascular disease. In this review, we address this deficiency by examining and advocating for the incorporation of dietary fiber as a key lifestyle modification to manage elevated BP. We explain what dietary fiber is, review the existing literature that supports its use to lower BP and prevent cardiovascular disease, describe the mechanisms involved, propose evidence-based target levels of fiber intake, provide examples of how patients can achieve the recommended targets, and discuss outstanding questions in the field. According to the evidence reviewed here, the minimum daily dietary fiber for adults with hypertension should be >28 g/day for women and >38 g/day for men, with each extra 5 g/day estimated to reduce systolic BP by 2.8 mm Hg and diastolic BP by 2.1 mm Hg. This would support a healthy gut microbiota and the production of gut microbiota-derived metabolites called short-chain fatty acids that lower BP. Awareness about dietary fiber targets and how to achieve them will guide medical teams on better educating patients and empowering them to increase their fiber intake and, as a result, lower their BP and cardiovascular disease risk.

Dietary Adequacy of Individuals with Cardiovascular Disease According to Clinical Guidelines in the Brazilian Cardioprotective Nutritional (BALANCE)

BACKGROUND

Achieving nutritional goals established by scientific societies is a constant challenge and not always achieved.

OBJECTIVE

To investigate the dietary adequacy of individuals with cardiovascular disease (CVD), participants in the Cardioprotective Brazilian Food Program residing in the Northeast region of Brazil, according to the recommendations of the Brazilian Society of Cardiology (SBC).

METHODS

Cross-sectional analysis with data from the study implementing the Brazilian Cardioprotective Diet (DICA BR), which evaluated individuals with CVD treated in specialized cardiovascular health centers in eight states in the Northeast region. Food consumption was obtained by 24-hour dietary records and dietary adequacy followed SBC recommendations. Values of p < 0.05 were considered significant.

RESULTS

647 patients were studied, with a mean (standard deviation) age of 63.1 (9.4) years, 50.2% of whom were female. When evaluating food intake, a low adequacy of carbohydrates (52.3%), proteins (70.9%), lipids (38.8%), and fiber (22.4%) was observed. It was observed that the majority of women consumed a low-protein diet (59.2%) and the elderly had a greater inadequacy in carbohydrate consumption (52.6%). Regarding sodium intake, men had a higher intake (72.9%), while the elderly showed a 13% reduction. Furthermore, it was shown that men ate more fiber (28.1%) and individuals with higher education had a high consumption of saturated fatty acids (70.5%).

CONCLUSIONS

Most individuals did not achieve the recommended dietary therapy goals for secondary cardiovascular prevention. The findings of the present study reinforce the need to implement structured strategies to encourage healthy eating habits in these individuals.

Dietary supplements: clinical cholesterol-lowering efficacy and potential mechanisms of action

This review aims to analyse the efficacy of dietary supplements in reducing plasma cholesterol levels. Focusing on evidence from meta-analyses of randomised controlled clinical trials, with an emphasis on potential mechanisms of action as supported by human, animal, and cell studies. Certain dietary supplements including phytosterols, berberine, viscous soluble dietary fibres, garlic supplements, soy protein, specific probiotic strains, and certain polyphenol extracts could significantly reduce plasma total and low-density lipoprotein (LDL) cholesterol levels by 3-25% in hypercholesterolemic patients depending on the type of supplement. They tended to be more effective in reducing plasma LDL cholesterol level in hypercholesterolemic individuals than in normocholesterolemic individuals. These supplements worked by various mechanisms, such as enhancing the excretion of bile acids, inhibiting the absorption of cholesterol in the intestines, increasing the expression of hepatic LDL receptors, suppressing the activity of enzymes involved in cholesterol synthesis, and activating the adenosine monophosphate-activated protein kinase signalling pathway.

The development of an EU-wide nutrition and physical activity expert knowledge base to support a personalised mobile application across various EU population groups

A healthy lifestyle comprising regular physical activity and an adequate diet is imperative for the prevention of non-communicable diseases such as hypertension and some cancers. Advances in information computer technology offer the opportunity to provide personalised lifestyle advice directly to the individual through devices such as smartphones or tablets. The overall aim of the PROTEIN project (Wilson-Barnes et al., 2021) was to develop a smartphone application that could provide tailored and dynamic nutrition and physical activity advice directly to the individual in real time. However, to create this mobile health (m-health) smartphone application, a knowledge base of reference ranges for macro-/micronutrient intake, anthropometry, biochemical, physiological and sleep parameters was required to underpin the parameters of the recommender systems. Therefore, the principal aim of this emerging research paper is to describe the process by which experts in nutrition and physiology from the PROTEIN consortium collaborated to develop the nutritional and physical activity requirements, based upon existing recommendations, for 10 separate population groups living within the EU including, but not limited to healthy adults, adults with type 2 diabetes mellitus, cardiovascular disease, excess weight, obesity and iron deficiency anaemia. A secondary aim is to describe the development of a library of 24-h meal plans appropriate for the same groups and also encompassing various dietary preferences and allergies. Overall, the consortium devised an extensive nutrition and physical activity knowledge base that is pertinent to 10 separate EU user groups, is available in 7 different languages and is practically implemented via a library of culturally appropriate, 24-h meal plans.

Gut microbiota connects the brain and the heart: potential mechanisms and clinical implications

Nowadays, high morbidity and mortality of cardiovascular diseases (CVDs) and high comorbidity rate of neuropsychiatric disorders contribute to global burden of health and economics. Consequently, a discipline concerning abnormal connections between the brain and the heart and the resulting disease states, known as psychocardiology, has garnered interest among researchers. However, identifying a common pathway that physicians can modulate remains a challenge. Gut microbiota, a constituent part of the human intestinal ecosystem, is likely involved in mutual mechanism CVDs and neuropsychiatric disorder share, which could be a potential target of interventions in psychocardiology. This review aimed to discuss complex interactions from the perspectives of microbial and intestinal dysfunction, behavioral factors, and pathophysiological changes and to present possible approaches to regulating gut microbiota, both of which are future directions in psychocardiology.

Dietary patterns associated with hypertension among stroke-free indigenous Africans: insights from the Stroke Investigative Research and Educational Network study

BACKGROUND

The dietary factors associated with the high burden of hypertension among indigenous Africans remain poorly understood. We assessed the relationship between dietary patterns and hypertension among indigenous Africans.

METHOD

In this study, 1550 participants with hypertension matched (for age: ± 5 years, sex and ethnicity) with 1550 participants without hypertension were identified from the stroke-free population in the Stroke Investigative Research and Educational Network study in Ghana and Nigeria. Food consumption was assessed using a food frequency questionnaire, and dietary information was summarized using principal component analysis to identify seven dietary patterns. Conditional logistic regression was applied to compute the odds ratio (OR) and 95% confidence interval (CI) for the risk of hypertension by tertiles of dietary patterns adjusting for age, education, income, smoking, alcohol use, physical inactivity, family history of cardiovascular diseases, obesity and salt intake at a two-sided P less than 0.05.

RESULTS

Multivariable-adjusted OR [95% confidence interval (CI)] for risk of hypertension by second and third tertiles [using the lowest (first) tertile as reference] of dietary patterns were 0.62 (0.48-0.80), 0.70 (0.54-0.90) for whole grains and fruit drinks; 0.87 (0.68-1.12), 0.83 (0.64-1.08) for fruits; 0.85 (0.65-1.10), 0.97 (0.75-1.26) for vegetables, legumes and potatoes; 0.78 (0.60-1.00), 0.84 (0.65-1.08) for fried foods and sweetened drinks; 1.13 (0.88-1.45), 0.80 (0.62-1.03) for poultry product and organ meat; 1.11 (0.86-1.43), 0.88 (0.68-1.14) for red meat; and 1.14 (0.88-1.48), 1.09 (0.84-1.43) for processed foods ( P  < 0.05).

CONCLUSION

A higher adherence to dietary consumption of whole grains and fruits was inversely associated with low odds of hypertension in this population.

The correlation between fruit intake and all-cause mortality in hypertensive patients: a 10-year follow-up study

OBJECTIVE

Extensive research has consistently shown the beneficial impact of fruit consumption on overall health. While some studies have proposed a potential association between fruit consumption and hypertension management, the influence of fruit consumption on mortality rates among hypertensive individuals remains uncertain. Consequently, aim of this study is to evaluate whether fruit consumption is associated with all-cause mortality among hypertensive patients.

METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES), conducted between 2003 and 2006. Ten-year follow-up data from the National Death Index (NDI) were used to assess all-cause mortality. Cox proportional hazard model was utilized to explore the impact of fruit intake on all-cause mortality among hypertensive individuals.

RESULTS

The study included a cohort of 2,480 patients diagnosed with hypertension, and during the follow-up period, a total of 658 deaths from various causes were recorded. The COX regression analysis demonstrated that hypertensive patients who consumed apples three to six times per week exhibited a significantly reduced risk of all-cause mortality (HR = 0.60, 95%CI: 0.45-0.78, p < 0.001) in comparison to those who consumed apples less than once per month. Likewise, consuming bananas three to six times per week also led to a comparable outcome (HR = 0.76, 95%CI: 0.59-0.97, p = 0.027). Moreover, Combined consumption of bananas and apples three to six times per week exhibited a noteworthy decrease in all-cause mortality (HR = 0.57, 95%CI: 0.39-0.84, p = 0.005) when compared to individuals who consumed these fruits less frequently. Conversely, no significant association was found between the consumption of other fruits, including pears, pineapples, and grapes, and all-cause mortality.

CONCLUSION

The study discovered that moderate consumption of apples and bananas was associated with a reduced risk of all-cause mortality in patients with hypertension.

Higher insoluble fiber intake is associated with a lower risk of prostate cancer: results from the PLCO cohort

Studies regarding the relationship between fiber intake and prostate cancer (PCa) have conflicting results. Therefore, this study examined the relationship between fiber intake and the risk of PCa by using data from Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. A total of 54,336 participants in the United States, consisting of 6,414 patients with PCa, were included in this study. Multivariate Cox regression models were applied to estimate adjusted hazard ratios (aHRs) and corresponding 95% confidence intervals (CIs). Compared with individuals in the lowest quartile, individuals in the highest quartile of insoluble fiber intake had a significantly lower risk of PCa (aHR, 0.87; 95% CI, 0.78-0.98). By contrast, no significant associations were detected between total fiber intake (aHR, 0.90; 95% CI, 0.80-1.01) or soluble fiber intake (aHR, 0.90; 95% CI, 0.80-1.02). Subgroup analyses showed that insoluble fiber was related to a decreased risk of PCa in subjects with the following characteristics: age > 65 years, nonsmoking or former smokers, education level ≤ high school, non-Hispanic white ethnicity, or without a family history of PCa. In addition, significant combined effects of insoluble fiber intake, age and family history of PCa on the risk of PCa were observed, but no combined effects of smoking status and insoluble fiber intake were observed. In addition, total fiber, insoluble fiber, and soluble fiber intake had no influence on the mortality of PCa patients. These results show that all 3 measures of fiber suggest a protective association, but insoluble fiber may have a stronger association with the risk of PCa. Future studies are warranted to further investigate these relationships.

Antihypertensive effect and mechanism of the traditional recipe of medicine food homology (Buyang Huanwu Decoction) in China: Meta analysis and network pharmacological exploration

Background

Hypertension has become a part of the lives of many people worldwide. With the development, an increasing number of people have begun to control their hypertension through products of medicine food homology, such as Buyang Huanwu Decoction (BYHWD). However, there has been no objective review of the regulation of hypertension by BYHWD.

Methods

As of 9 October 2023, this review made a detailed search of nine databases to look for random controlled trials (RCTs) focused on the use of BYHWD for treating hypertension. This was followed by network pharmacological analysis, and molecular docking assessment using AutoDockTools to explore the mode of action.

Results

BYHWD was effective in reducing SBP (MD: 0.767; 95 % CI: 0.629, 0.905; p = 0.000), DBP (MD: 0.427; 95 % CI: 0.292, 0.561; p = 0.000), 24h SBP (MD: 0.665; 95 % CI: 0.368, 0.962; p = 0.000), 24h DBP (MD: 0.547; 95 % CI: 0.318, 0.777; p = 0.000), dSBP (MD: 0.625; 95 % CI: 0.395, 0.855; p = 0.000), dDBP (MD: 0.632; 95 % CI: 0.401, 0.862; p = 0.000), nSBP (MD: 0.859; 95 % CI: 0.340, 1.377; p = 0.001), nDBP (MD: 0.704; 95 % CI: 0.297, 1.112; p = 0.001), pv (MD: 1.311; 95 % CI: 0.363, 2.259; p = 0.007) and NIHSS (MD: 1.149; 95 % CI: 0.100, 2.199; p = 0.032), and elevating CER (OR = 2.848; 95 % CI: 1.388, 5.843; p = 0.004). However, BYHWD did not significantly reduce HCY, and there was no significant difference in the incidence of AE. In terms of the mechanism of action, the main active ingredient of BYHWD is quercetin, and the core targets are AKT1, MMP9, and others. Molecular docking also showed that quercetin mainly interacts with the amino acid residue CYS-28 of MMP2. Second, the KEGG analysis showed that BYHWD mainly act on HIF-1, Apelin, and cGMP-PKG signalling pathways, and GO analysis showed that it related to the apical part of the cell, circulatory system processes, and nuclear receptor activity. Conclusion: BYHWD can lowered blood pressure, reduced plasma viscosity, and restored neurological function with good tolerability, and had no significant effect on HCY levels. This study further demonstrated that quercetin is the main active ingredient of BYHWD that acts via the AKT1 and HIF-1 signalling pathways. These results provide new guidance for people's dietary choices by the general public.

Total and different dietary fiber subtypes and the risk of all-cause, cardiovascular, and cancer mortality: a dose-response meta-analysis of prospective cohort studies

We aimed to conduct a comprehensive review of the association between dietary fiber and the risk of mortality. We did a systematic search in PubMed, Scopus, and Web of Science up to November 2022 to find prospective cohort studies of the relationship between total and subtypes of dietary fiber and the risk of all-cause, cardiovascular (CVD), and cancer mortality in the general population. The hazard ratios (HRs) and 95% CIs were calculated using a random-effects model. A total of 28 studies with 1 613 885 participants were included. Higher intake of total and subtypes of dietary fiber including cereal, vegetable, legume, soluble, and insoluble fiber, but not fruit fiber, was associated with a lower risk of all-cause mortality, with HRs ranging from 0.77 for insoluble fiber to 0.93 for legume fiber. Similar findings were observed for CVD mortality, where higher intake of total and all subtypes of dietary fiber was each associated with a lower risk. Higher intake of total, cereal, vegetable, and insoluble fiber was also associated with a lower risk of cancer mortality. No association was found between the intake of fruit, legume, and soluble fiber and cancer mortality. Dose-response meta-analyses suggested an inverse association between total fiber intake and the risk of all-cause, CVD, and cancer mortality. The certainty of evidence was rated moderate for the association of total fiber with all-cause, CVD, and cancer mortality. In conclusion, our findings highlight the potential advantages of consuming a wide range of dietary fiber subtypes against all-cause, CVD, and cancer mortality. Registry and registry number: PROSPERO (CRD42021226816).

Modulating the Gut Microbiome in Multiple Sclerosis Management: A Systematic Review of Current Interventions

This review attempted to explore all recent clinical studies that have investigated the clinical and autoimmune impact of gut microbiota interventions in multiple sclerosis (MS), including dietary protocols, probiotics, fecal microbiota transplantation (FMT), and intermittent fasting (IF). Methods: Thirteen studies were held between 2011 and 2023 this demonstrated interventions in gut microbiome among patients with MS and their impact the clinical parameters of the disease. These included specialized dietary interventions, the supply of probiotic mixtures, FMT, and IF. Results: Dietary interventions positively affected various aspects of MS, including relapse rates, EDSS disability scores, MS-related fatigue, and metabolic features. Probiotic mixtures showed promising results on MS-related fatigue, EDSS parameters, inflammation; meanwhile, FMT-though a limited number of studies was included-indicated some clinical improvement in similar variables. IF showed reductions in EDSS scores and significant improvement in patients' emotional statuses. Conclusions: In dietary protocols, clinical MS parameters, including relapse rate, EDSS, MFIS, FSS, and MSQoL54 scales, were significantly improved through the application of a specific diet each time. Probiotic nutritional mixtures promote a shift in inflammation towards an anti-inflammatory cytokine profile in patients with MS. The administration of such mixtures affected disability, mood levels, and quality of life among patients with MS. FMT protocols possibly demonstrate a therapeutic effect in some case reports. IF protocols were found to ameliorate EDSS and FAMS scores. All interventional means of gut microbiome modulation provided significant conclusions on several clinical aspects of MS and highlight the complexity in the relationship between MS and the gut microbiome.

Dietary fruits and vegetables and risk of cardiovascular diseases in elderly Chinese

BACKGROUND

Evidence regarding the potential effect of fruit and vegetable consumption on cardiovascular diseases (CVD) was limited and inconsistent among Asian people.

METHODS

We prospectively examined associations of fruit and vegetable consumption with the risk of CVD among 9740 participants aged 65 years and older (mean baseline age: 88 years) in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2008-2018). Dietary data were collected using a validated food frequency questionnaire.

RESULTS

During 37 366 person-years of follow-up, a total of 3738 CVD cases were recorded. After adjusting for demographics, dietary, lifestyle and economical social factors, higher intakes of total fruits and vegetables were associated with lower risk of CVD [comparing with extreme quintiles, hazard ratio and 95% confidence interval: 0.84 (0.74, 0.95)]. The inverse association was mainly driven by vegetable consumption [0.86 (0.77, 0.95)]. Furthermore, the inverse association was stronger for the risk of hypertension [0.84 (0.72, 0.98)]. These associations were consistent across age, sex, body mass index, residence, exercise status, smoking, drinking, meat intake, modified hPDI and health status.

CONCLUSIONS

This study suggests higher intakes of total fruits and vegetables are associated with a lower risk of CVD among elderly Chinese people, supporting the current recommendations of increasing fruit and vegetable consumption as part of a healthy diet for the prevention of CVD.

Properties and physiological effects of dietary fiber-enriched meat products: a review

Meat is a rich source of high biological proteins, vitamins, and minerals, but it is devoid of dietary fiber, an essential non-digestible carbohydrate component such as cellulose, hemicellulose, pectin, lignin, polysaccharides, and oligosaccharides. Dietary fibers are basically obtained from various cereals, legumes, fruits, vegetables, and their by-products and have numerous nutritional, functional, and health-benefiting properties. So, these fibers can be added to meat products to enhance their physicochemical properties, chemical composition, textural properties, and organoleptic qualities, as well as biological activities in controlling various lifestyle ailments such as obesity, certain cancers, type-II diabetes, cardiovascular diseases, and bowel disorders. These dietary fibers can also be used in meat products as an efficient extender/binder/filler to reduce the cost of production by increasing the cooking yield as well as by reducing the lean meat content and also as a fat replacer to minimize unhealthy fat content in the developed meat products. So, growing interest has been observed among meat processors, researchers, and scientists in exploring various new sources of dietary fibers for developing dietary fiber-enriched meat products in recent years. In the present review, various novel sources of dietary fibers, their physiological effects, their use in meat products, and their impact on various physicochemical, functional, and sensory attributes have been focused.

Healthy grocery delivery in the usual care for adults recovering from an acute coronary event: protocol for a three-arm randomised controlled trial

INTRODUCTION

Coronary heart disease is a major contributor to the global burden of disease. Appropriate nutrition is a cornerstone of the prevention and treatment of coronary heart disease; however, barriers including cost and access to recommended foods limits long-term adherence for many. We are conducting, in adults with coronary heart disease, a randomised controlled trial comparing usual care with two dietary interventions in which usual care is augmented by 12 weeks free delivered groceries.

METHODS AND ANALYSIS

Three hundred adults recovering from an acute coronary event will be recruited from outpatient cardiovascular services in three regions of Aotearoa New Zealand. Participants will be randomly allocated to three arms: usual care (control group), usual care and the free delivery of foods high in dietary fibre or usual care and the free delivery of foods high in unsaturated fats. Interventions duration is 12 weeks, with a further 12 months follow-up. The primary outcome measures are change in low-density lipoprotein (LDL) cholesterol concentration following the intervention, and a cost-effectiveness analysis of healthcare access and social costs in the year after the intervention. A broad range of secondary outcome measures include other blood lipids, anthropometry, glycaemia, inflammatory markers, gut microbiome, dietary biomarkers, food acceptability, dietary change and the facilitators and barriers to dietary change. The trial will determine whether the free provision of groceries known to reduce cardiovascular risk within usual care will be clinically beneficial and justify the cost of doing so. Results may also provide an indication of the relative benefit of foods rich in dietary fibre or unsaturated fats in coronary heart disease management.

ETHICS AND DISSEMINATION

This trial, The Healthy Heart Study, has Health and Disability Ethics Committee approval (20/NTB/121), underwent Māori consultation, and has locality authority to be conducted in Canterbury, Otago and Southland.

TRIAL REGISTRATION NUMBER

ACTRN12620000689976, U1111-1250-1499.

Nutritional status of flexitarians compared to vegans and omnivores - a cross-sectional pilot study

BACKGROUND

In the Western world, there has been a notable rise in the popularity of plant-based, meat-reduced flexitarian diets. Nevertheless, there is insufficient data on the nutritional status of individuals following this dietary pattern. The aim of this study was to investigate the intake and endogenous status of various nutrients in a healthy German adult study population consisting of flexitarians (FXs), vegans (Vs) and omnivores (OMNs).

METHODS

In this cross-sectional study, dietary intake of 94 non-smoking adults (32 FXs, 33 Vs, 29 OMNs) between 25 and 45 years of age was assessed using 3-day dietary records. In addition, blood samples were collected to determine different endogenous nutrient status markers.

RESULTS

32%, 82% and 24% of the FXs, Vs, and OMNs respectively reported using dietary supplements. In the FXs, intake of total energy as well as macronutrients and most micronutrients were within the reference range. FXs had higher intakes of fiber, retinol-equ., ascorbic acid, folate-equ., tocopherol-equ., calcium, and magnesium compared to OMNs. However, cobalamin intake in FXs (2.12 µg/d) was below the reference (4 µg/d). Based on 4cB12, 13% of FXs showed a cobalamin undersupply [< -0.5 to -2.5] compared to 10% of OMNs, and 9% of Vs. The median 25(OH)D serum concentrations in FXs, Vs and OMNs were 46.6, 55.6, and 59.6 nmol/L. The prevalence of an insufficient/deficient vitamin-D status [< 49.9 nmol 25(OH)D/L] was highest in FXs (53%), followed by Vs (34%) and OMNs (27%). In FXs and Vs, the supplement takers had better cobalamin and vitamin-D status than non-supplement takers. Anemia and depleted iron stores were found only occasionally in all groups. In women, the prevalence of pre-latent iron deficiency and iron deficiency was highest in FXs (67%) compared to Vs (61%) and OMNs (54%).

CONCLUSION

Our findings indicated that all three diets delivered sufficient amounts of most macro- and micronutrients. However, deficiencies in cobalamin, vitamin-D, and iron status were common across all diets. Further studies are needed to investigate the nutrient supply status and health consequences of meat-reduced plant-based diets. The study was registered in the German Clinical Trial Register (number: DRKS 00019887, data: 08.01.2020).

Vegetable and Fruit Intake Variety and Cardiovascular Health and Mortality: A Systematic Review and Meta-Analysis of Observational Studies

INTRODUCTION

A multitude of evidence supports the consumption of a higher quantity of vegetables and fruits for their cardiovascular benefits. Nonetheless, the extent to which variety is associated with cardiovascular health remains unclear.

OBJECTIVE

To conduct a systematic review and meta-analysis of observational studies (prospective cohort and cross-sectional studies) assessing the role of a variety of vegetable and fruit consumption in cardiovascular morbidity and mortality in adults.

DATA SOURCES

MEDLINE-PubMed, Cochrane databases, and reference lists were searched through March 2023.

DATA EXTRACTION

Two independent reviewers extracted data and assessed the risk of bias (National Heart, Lung, and Blood Institute Tool and Newcastle-Ottawa Scale).

DATA ANALYSIS

Data were pooled (fixed and random [DerSimonian and Laird] effects for <5 and ≥5 study comparisons, respectively), and heterogeneity was assessed using the Cochran Q statistic and quantified (I2 statistic). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the overall certainty of the evidence. Five cross-sectional (n = 45,761) and seven prospective studies (n = 253,422) met the eligibility criteria. Greater variety of vegetable and fruit consumption was prospectively related to decreased all-cause mortality (risk ratio, 0.89 [95% CI, 0.82-0.97], seven study comparisons, n = 196,925), while no significant associations were observed with assessed cardiovascular-related mortality or morbidity. For all outcomes, the certainty of the evidence was graded as "low" or "very low" owing to inconsistency and/or imprecision.

CONCLUSIONS

Overall, this study shows that greater variety in vegetable and fruit consumption may reduce all-cause mortality and highlights the need for additional studies with a higher degree of evidence to better understand its role in cardiovascular health.

A Review of Healthy Dietary Choices for Cardiovascular Disease: From Individual Nutrients and Foods to Dietary Patterns

Cardiovascular disease (CVD) remains the first cause of mortality globally. Diet plays a fundamental role in cardiovascular health and is closely linked to the development of CVD. Numerous human studies have provided evidence on the relationship between diet and CVD. By discussing the available findings on the dietary components that potentially influence CVD progression and prevention, this review attempted to provide the current state of evidence on healthy dietary choices for CVD. We focus on the effects of individual macronutrients, whole food products, and dietary patterns on the risks of CVD, and the data from population-based trials, observational studies, and meta-analyses are summarized. Unhealthy dietary habits, such as high intake of saturated fatty acids, sugar-sweetened beverages, red meat, and processed meat as well as high salt intake are associated with the increased risk of CVD. Conversely, increased consumption of plant-based components such as dietary fiber, nuts, fruits, and vegetables is shown to be effective in reducing CVD risk factors. The Mediterranean diet appears to be one of the most evidence-based dietary patterns beneficial for CVD prevention. However, there is still great debate regarding whether the supplementation of vitamins and minerals confers cardioprotective benefits. This review provides new insights into the role of dietary factors that are harmful or protective in CVD, which can be adopted for improved cardiovascular health.

Psychosocial and environmental risk factors of obesity and hypertension in children and adolescents-a literature overview

Childhood obesity has become a worldwide epidemic in the 21st century. Its treatment is challenging and often ineffective, among others due to complex, often not obvious causes. Awareness of the existence and meaning of psychosocial and environmental risk factors seems to be an essential element in the prevention and treatment of obesity and its complications, especially arterial hypertension. In this review, we will discuss the role of that risk factors linking obesity and increased cardiovascular disorders including the role of nutritional factors (including the role of unhealthy diet, inadequate hydration), unhealthy behaviors (e.g. smoking, alcohol and drugs, sedentary behavior, low physical activity, disrupted circadian rhythms, sleep disorders, screen exposure), unfavorable social factors (such as dysfunctional family, bullying, chronic stress, mood disorders, depression, urbanization, noise, and environmental pollution), and finally differences in cardiovascular risk in girls and boys.

Effect of soluble fiber on blood pressure in adults: a systematic review and dose-response meta-analysis of randomized controlled trials

OBJECTIVES

Pervious epidemiologic evidence indicates that soluble fiber is protective against hypertention: however, randomized controlled trials (RCTs) have presented varying results. In the present study, we aimed to conduct a systematic review and dose-response meta-analysis to summarize published RCTs which assess the effect of soluble fiber supplementation on systolic blood pressure (SBP) and diastolic blood pressure (DBP).

METHODS

Scopus, PubMed, and ISI Web of Sciences were searched to identify relevant studies up to Aug 2022. We estimated the change in blood pressure for each 5 g/d increment in soluble fiber supplementation in each trial and then calculated the weighted mean difference (WMD) and 95%CI using a random-effects model. We estimated dose-dependent effects using a dose-response meta-analysis of differences in means. The risk of bias for study was assessed using the Cochrane tool. Publication bias was evaluated via funnel plot and Begg's test and Egger's test.

RESULTS

Eighty-three eligible studies with total sample size of 5,985 participants were included in the meta-analysis. Soluble fiber supplementation significantly decreased SBP (WMD: -1.36 mmHg, 95% CI: -2.13 to -0.60, P < 0.001; I2 = 47.1%, P < 0.001) and DBP (WMD: -0.72 mmHg, 95% CI: -1.26 to -0.18, P = 0.009; I2 = 45.4%, P < 0.001). Each 5 g/d increment in soluble fiber supplementation had a significant reduction in SBP (WMD: -0.54 mmHg; 95%CI: -0.86, -0.22, P = 0.001; I2 = 52.2, Phet < 0.001) and DBP (WMD: -0.28 mmHg; 95%CI: -0.49, -0.80, P = 0.007; I2 = 43.1%, Phet < 0.001). The levels of SBP decreased proportionally with the increase in soluble fiber supplementation up to 20 g/d (MD20g/d: -1.79 mmHg, 95%CI: -2.86, -0.71).

CONCLUSION

Current evidence indicated the beneficial effect of soluble fiber supplementation on blood pressure. Our findings suggest that soluble fiber supplementation could contribute to the management of hypertension and the reduction of cardiovascular disease risk.

Experience and perceptions among rheumatoid arthritis patients following a telehealth-delivered dietary intervention: a qualitative study

The effects of dietary modifications have been assessed in people living with rheumatoid arthritis (RA) with consistent benefits reported from clinical trials. However, the lived experience of making and sustaining positive dietary changes for people with RA remains unknown. The aim of this qualitative study was to explore the experiences of adults with RA and their perceptions of a 12-week telehealth-delivered dietary intervention and to assess the acceptability of the programme. Qualitative data was collected via four online focus groups with participants who had just completed a 12-week dietary intervention programme delivered through telehealth methods. Thematic analysis was used to code and summarize the identified key themes. Twenty-one adults with RA (47.5 ± 12.3 years, 90.5% females) were included in this qualitative study. Overarching themes included: (a) motivation to join the programme, (b) benefits of the programme, (c) factors influencing adherence to dietary prescription, and (d) advantages and disadvantages of telehealth. The study demonstrated that a dietary intervention delivered through telehealth methods by a Registered Dietitian (RD) appears to be well-accepted and may be used to complement face-to-face care for people with RA. The identified factors influencing the adoption of a healthier eating pattern will aid in the development of future dietary interventions for a RA population.

The Role of Hemp (Cannabis sativa L.) as a Functional Food in Vegetarian Nutrition

Recently, there has been a renewed interest in Cannabis sativa and its uses. The recreational use of inflorescences as a source of THC has led to the legal restriction of C. sativa cultivation to limit the detrimental effects of psychotropic substance abuse on health. However, this has also limited the cultivation of textile/industrial varieties with a low content of THC used for textile and nutritional purposes. While previously the bans had significantly penalized the cultivation of C. sativa, today many countries discriminate between recreational use (marijuana) and industrial and food use (hemp). The stalks of industrial hemp (low in psychotropic substances) have been used extensively for textile purposes while the seeds are nutritionally versatile. From hemp seeds, it is possible to obtain flours applicable in the bakery sector, oils rich in essential fatty acids, proteins with a high biological value and derivatives for fortification, supplementation and nutraceutical purposes. Hemp seed properties seem relevant for vegetarian diets, due to their high nutritional value and underestimated employment in the food sector. Hemp seed and their derivatives are a valuable source of protein, essential fatty acids and minerals that could provide additional benefit to vegetarian nutrition. This document aims to explore the information available in the literature about hemp seeds from a nutritional point of view, highlighting possible beneficial effects for humans with particular attention to vegetarian nutrition as a supplemental option for a well-planned diet.

Benefits of Fiber-Enriched Foods on Satiety and Parameters of Human Well-Being in Adults with and without Cardiometabolic Risk

Consumption of fiber-rich foods is linked to beneficial effects on chronic diseases and gut health, while implications towards improving satiety and parameters of well-being remain unclear. A randomized placebo-controlled intervention study was conducted to compare the effects of fiber-enriched foods to their non-enriched counterparts in adults over a 12-week period on selected clinical parameters-satiety, quality of life, body sensation, and life satisfaction-subjective health status, and importance of diet for well-being. Quality of life (QOL) differed significantly between intervention and control groups at baseline, throughout, and at the end of the study. No effects on satiety, satisfaction with life, or the importance of diet for well-being could be shown between groups. With higher fiber intake, body sensation ratings increased. A higher BMI was significantly associated with lower-body sensation, subjective health status and quality of life. Fiber-enriched foods do not seem to affect feeling of satiety or parameters of well-being. Larger samples and additional methods are necessary to fully explore the effect of increased fiber intake on patient-related outcomes in more detail.

The Importance of Dietary Fiber for Metabolic Health

Dietary fiber are non-digestible carbohydrates that are diverse, have varied functions, and are acquired by consuming plant-based foods. Some forms of fiber are digested by the gut microbiota and produce bioactive metabolites called short chain fatty acids-butyrate, acetate, and propionate. Dietary fiber is able to alter human physiology through multiple mechanisms that can result in health benefits. Unfortunately, nearly 19 out of 20 Americans do not consume the minimum recommended amount of fiber each day. This bears profound relevance to public health because at least six of the ten leading causes of death are potentially preventable or clinically improved through dietary means. Additionally, these same conditions share a common underlying pathophysiology-metabolic dysfunction. This can manifest as abdominal obesity, high blood pressure, insulin resistance, dyslipidemia, or collectively as metabolic syndrome. In this review, we will assess the evidence that consumption of dietary fiber undermines these forms of metabolic dysfunction, examine the mechanism of action for these physiologic effects, and consider the potential for dietary fiber to improve human health on a public health level by simply encouraging our patients to consume more plant-based foods in abundance and diversity.