Nutritional advice

Objectives:
The associations between intake of anthocyanins and anthocyanin-rich berries and cardiovascular risks remained to be established. Therefore, this review article has been conducted.

Do purified anthocyanin supplements and dietary intakes of anthocyanin-rich berries reduce cardiovascular risk?

Study design:
This review article included 44 eligible RCTs consisting of 52 comparison groups and 2,353 subjects and 15 prospective cohort studies with 5,54,638 subjects (persons).

7 of the 44 RCTs were crossover trials with the rest parallel-designed.
15 of the included studies investigated the effects of purified anthocyanins, all of which were produced from berries. For the remaining anthocyanin-rich berry studies, interventions were blueberry in 13 studies, cranberry in 12 studies, bilberry in 3 studies and blackcurrant in 1 study.
The intervention durations ranged from 2 weeks to 24 months with a median of 8 weeks.
24 of the 44 RCTs were rated as high quality with the others as low to moderate quality.

The follow-up periods of 15 cohort studies ranged from 4.3 to 24 years with a median of 12 years. Most of the included cohort studies used FFQ to assess dietary anthocyanin intake and only 3 of them used dietary records.
12 of the 15 cohort studies were rated as high quality.

There was no publication bias, except for the effects of purified anthocyanins on HDL cholestrerol levels [Begg's p = 0.016].

Results and conclusions:
The investigators found pooled analysis of RCTs showed that purified anthocyanin supplements significantly reduced blood LDL cholesterol (bad cholesterol) concentrations [WMD = -5.43 mg/dL, 95% CI = -8.96 to -1.90 mg/dL, p = 0.003]. 

The investigators found pooled analysis of RCTs showed that purified anthocyanin supplements significantly reduced triglyceride concentrations [WMD = -6.18 mg/dL, 95% CI = -11.67 to -0.69 mg/dL, p = 0.027, I2 = 0%]. 

The investigators found pooled analysis of RCTs showed that purified anthocyanin supplements significantly increased HDL cholesterol (good cholesterol) concentrations [WMD = 2.76 mg/dL, 95% CI = 1.34 to 4.18 mg/dL, p 0.001, I2 = 43.5%].
Subgroup analysis showed that the effects on HDL cholesterol concentrations were not significantly influenced by study duration, health status of subjects, anthocyanin doses, study quality and funding source.

The investigators found pooled analysis of RCTs showed that purified anthocyanin supplements significantly reduced tumor necrosis factor alpha concentrations [WMD = -1.62 pg/mL, 95% CI = -2.76 to -0.48 pg/mL, p = 0.005, I2 = 0%].

The investigators found pooled analysis of RCTs showed that purified anthocyanin supplements significantly reduced C-reactive protein concentrations [WMD = -0.028 mg/dL, 95% CI = -0.050 to -0.005 mg/dL, p = 0.014, I2 = 26%].

The investigators found pooled analysis of RCTs showed administration of anthocyanin-rich berries (blueberry, cranberry, bilberry and blackcurrant) significantly reduced blood total cholesterol concentrations [WMD = -4.48 mg/dL, 95% CI = -8.94 to -0.02 mg/dL, p = 0.049]. 

The investigators found pooled analysis of RCTs showed administration of anthocyanin-rich berries (blueberry, cranberry, bilberry and blackcurrant) significantly reduced C-reactive protein concentrations [WMD = -0.046 mg/dL, 95% CI = -0.070 to -0.022 mg/dL, p 0.001, I2 = 0%].

The investigators found pooled analysis of cohort studies showed high dietary anthocyanins intakes significantly reduced risk of coronary heart disease (CHD) with 17% [relative risk = 0.83, 95% CI = 0.72 to 0.95, p = 0.009, I2 = 51.2%].

The investigators found pooled analysis of cohort studies showed high dietary anthocyanins intakes significantly reduced risk of total cardiovascular disease incidence with 27% [relative risk = 0.73, 95% CI = 0.55 to 0.97, p = 0.03, I2 = 76.7%].

The investigators found pooled analysis of cohort studies showed high dietary anthocyanins intakes significantly reduced risk of cardiovascular disease deaths with 9% [relative risk = 0.91, 95% CI = 0.87 to 0.96, p 0.001, I2 = 0%].

Subgroup analysis revealed that the protective roles of dietary anthocyanins against cardiovascular disease deaths was only found in women [RR = 0.89, 95% CI = 0.82 to 0.96, p = 0.003, I2 = 0.0%] and not in men [RR = 0.92, 95% CI = 0.79 tot 1.07, p = 0.263, I2 = 0.0%].

The investigators concluded current clinical and epidemiological evidence show the protective roles of purified anthocyanin supplements during 8 weeks and anthocyanin-rich berries (blueberry, cranberry, bilberry and blackcurrant) on cardiovascular health. These results suggest that regular consumption of either purified anthocyanins or anthocyanin-rich berries could prevent cardiovascular disease through their lipid-lowering and anti-inflammatory properties. Therefore, anthocyanins and anthocyanin-rich berries should be taken into consideration when formulating cardioprotective diets in the future.

Original title:
Anthocyanins, Anthocyanin-Rich Berries, and Cardiovascular Risks: Systematic Review and Meta-Analysis of 44 Randomized Controlled Trials and 15 Prospective Cohort Studies by Xu L, Tian Z, […], Yang Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714924/

Additional information of El Mondo:
Find more information/studies on anthocyanins, lowering cholesterol levels and cardiovascular disease right here.

Objectives:
Previous studies have not fully described the relationship between high-density lipoprotein cholesterol (HDL-C) and death risks from all cause and cardiovascular disease (CVD). Therefore, this review article has been conducted.

Does a high HDL cholesterol level (good cholesterol) reduce all cause and cardiovascular disease mortality risk?

Study design:
This review article included 32 prospective cohort studies with a total of 369,904 participants and 33,473 total deaths (9,426 cardiovascular disease deaths or cardiovascular disease mortality).

Results and conclusions:
The investigators found compared to the lowest HDL cholesterol level, the highest HDL cholesterol level significantly reduced all cause mortality risk by 18% [RR = 0.82, 95% CI = 0.73 to 0.93].
The lowest all cause mortality risk was observed at approximately 1.34 mmol/L.

The investigators found compared to the lowest HDL cholesterol level, the highest HDL cholesterol level significantly reduced cardiovascular disease mortality risk by 36% [RR = 0.64, 95% CI = 0.46 to 0.89].
The lowest cardiovascular disease mortality risk was observed at approximately 1.55 mmol/L.

The investigators found every increment of HDL cholesterol level with 1 mmol/L significantly reduced all cause mortality risk by 15% [RR = 0.85, 95% CI = 0.79 to 0.92].
Significant means that there is an association with a 95% confidence.

The investigators found every increment of HDL cholesterol level with 1 mmol/L significantly reduced cardiovascular disease mortality risk by 23% [RR = 0.77, 95% CI = 0.69 to 0.87].

The investigators found evidence of nonlinear and negative dose-response associations of HDL cholesterol level with all cause and cardiovascular disease mortality risk [p nonlinearity 0.001].

The investigators concluded HDL cholesterol level (good cholesterol) reduces all cause and cardiovascular disease mortality risk under approximately 2.05 and 2.33 mmol/L, respectively. Optimal doses require investigation via clinical practice or high-quality research.

Original title:
A dose-response meta-analysis to evaluate the relationship between high-density lipoprotein cholesterol and all-cause and cardiovascular disease mortality by Liu L, Han M, […], Hong F.

Link:
https://pubmed.ncbi.nlm.nih.gov/34676492/

Additional information of El Mondo:
Find more information/studies on cholesterol and cardiovascular disease right here.

Objectives:
The relation between sodium intake and cardiovascular disease remains controversial, owing in part to inaccurate assessment of sodium intake. Assessing 24-hour urinary excretion over a period of multiple days is considered to be an accurate method. Therefore, this review article has been conducted.

Do higher sodium and lower potassium dietary intakes, as measured in multiple 24-hour urine samples, reduce in a dose-response manner cardiovascular risk?

Study design:
This review article included 6 prospective cohort studies with a total of 10,709 healthy adults (54.2% women), of whom, 571 cardiovascular events were ascertained during a median study follow-up of 8.8 years (incidence rate: 5.9 per 1000 person-years).

The mean (±SD) age was 51.5±12.6 years.

Results and conclusions:
The investigators found that the median 24-hour urinary sodium excretion was 3,270 mg (10th to 90th percentile, 2099 to 4899).

The investigators found higher sodium excretion, lower potassium excretion and a higher sodium-to-potassium ratio were all significantly associated with a higher cardiovascular risk in analyses that were controlled for confounding factors [p ≤ 0.005 for all comparisons].

The investigators found in analyses that compared quartile 4 of the urinary biomarker (highest) with quartile 1 (lowest), the hazard ratios were 1.60 [95% CI = 1.19 to 2.14] for sodium excretion, 0.69 [95% CI = 0.51 to 0.91] for potassium excretion and 1.62 [95% CI = 1.25 to 2.10] for the sodium-to-potassium ratio.

The investigators found each daily increment of 1,000 mg in 24-hour urinary sodium excretion was significantly associated with an 18% increase in cardiovascular risk [hazard ratio = 1.18, 95% CI = 1.08 to 1.29].

The investigators found each daily increment of 1,000 mg in 24-hour urinary potassium excretion was significantly associated with an 18% decrease in cardiovascular risk [hazard ratio = 0.82, 95% CI = 0.72 to 0.94].

The investigators concluded higher sodium and lower potassium dietary intakes, as measured in multiple 24-hour urine samples, reduce in a dose-response manner cardiovascular risk. These findings may support reducing sodium intake and increasing potassium intake from current levels.

Original title:
24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk by Ma Y, He FJ, […], Hu FB.

Link:
https://pubmed.ncbi.nlm.nih.gov/34767706/

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A 24-hour urine sample is simply a collection of all urine passed over a 24-hour period of time. The test is used to check kidney function.
The normal range for 24-hour urine volume is 800 to 2,000 milliliters per day (with a normal fluid intake of about 2 liters per day).

Objectives:
Potential effects of inositol supplementation on blood pressure (BP) have been examined in several interventional studies. Nevertheless, findings in this context are controversial. Therefore, this review article has been conducted.

Do inositol supplements reduce blood pressure in humans?

Study design:
This review article included 7 eligible RCTs.

Results and conclusions:
The investigators found significant decline in both systolic blood pressure (SBP) [WMD = -5.69 mmHg, 95% CI = -7.35 to -4.02, p 0.001] and diastolic blood pressure (DBP) [WMD = -7.12 mmHg, 95% CI = -10.18 to -4.05, p 0.001] following supplementation with inositol.

The investigators found subgroup analysis showed that studies performed in individuals with metabolic syndrome with a longer duration (>8 weeks) and a dose of 4000 mg inositol supplements resulted in a more effective reduction in systolic blood pressure and diastolic blood pressure with acceptable homogeneity.

The investigators concluded that 4000 mg inositol supplements during at least 8 weeks reduce blood pressure, particularly in individuals with metabolic syndrome. Further large-scale RCTs with better design are needed to confirm these findings.

Original title:
The effect of inositol supplementation on blood pressure: A systematic review and meta-analysis of randomized-controlled trials by Tari SH, Sohouli MH, […], Rahideh ST.

Link:
https://pubmed.ncbi.nlm.nih.gov/34330516/

Additional information of El Mondo:
Find more information/studies on inositol and cardiovascular disease right here.

Objectives:
Epidemiological studies have shown that higher intake of flavonoid is inversely associated with coronary heart disease (CHD) risk. However, which flavonoid subclass (including anthocyanins, flavonols) could reduce CHD risk has remained controversial. Therefore, this review article has been conducted.

Do dietary intakes of anthocyanins, proanthocyanidins, flavonols, flavones and isoflavones reduce coronary heart disease?

Study design:
This review article included 19 independent prospective cohort studies with 894,471 participants and 34,707 persons with coronary heart disease.
 
Results and conclusions:
The investigators found that dietary intakes of anthocyanins significantly reduced risk of coronary heart disease with 10% [RR = 0.90, 95% CI = 0.83 to 0.98].

The investigators found that dietary intakes of proanthocyanidins significantly reduced risk of coronary heart disease with 22% [RR = 0.78, 95% CI = 0.65 to 0.94].

The investigators found that dietary intakes of flavonols significantly reduced risk of coronary heart disease with 12% [RR = 0.88, 95% CI = 0.79 to 0.98].

The investigators found that dietary intakes of flavones significantly reduced risk of coronary heart disease with 6% [RR = 0.94, 95% CI = 0.89 to 0.99].

The investigators found that dietary intakes of isoflavones significantly reduced risk of coronary heart disease with 10% [RR = 0.90, 95% CI = 0.83 to 0.98].

The investigators found in dose-response analysis that increment of 50 mg/d dietary anthocyanins significantly reduced risk of coronary heart disease with 5%.

The investigators found in dose-response analysis that increment of 100 mg/d dietary proanthocyanidins significantly reduced risk of coronary heart disease with 5%.

The investigators found in dose-response analysis that increment of 25 mg/d dietary flavonols significantly reduced risk of coronary heart disease with 5%.

The investigators found in dose-response analysis that increment of 5 mg/d dietary flavones significantly reduced risk of coronary heart disease with 5%.

The investigators found in dose-response analysis that increment of 0.5 mg/d dietary isoflavones significantly reduced risk of coronary heart disease with 5%.

The investigators found sensitivity and subgroup analyses supported these associations.

The investigators concluded that daily dietary intakes of 50mg anthocyanins, 100 mg proanthocyanidins, 25mg flavonols, 5mg flavones or 0.5mg isoflavones reduce coronary heart disease.

Original title:
Flavonoid subclasses and coronary heart disease risk: a meta-analysis of prospective cohort studies by Fan ZK, Wang C, [...], Li D.

Link:
https://pubmed.ncbi.nlm.nih.gov/34470681/

Additional information of El Mondo:
Find more information/studies on flavonoid and cardiovascular disease right here.

Objectives:
LDL particle size and number (LDL-P) are emerging lipid risk factors. Nonsystematic reviews have suggested that diets lower in carbohydrates and higher in fats may result in increased LDL particle size when compared with higher-carbohydrate diets. Therefore, this review article has been conducted.

Do dietary interventions restricted in carbohydrates increase LDL peak particle size and decrease the numbers of total and small LDL particles?

Study design:
This review article included 38 randomized trials (of any length that reported on dietary carbohydrate restriction (intervention) compared with higher carbohydrate intake (control)) with a total of 1,785 participants.

Results and conclusions:
The investigators found dietary carbohydrate restriction were significantly associated with an increase in LDL peak particle size [SMD = 0.50, 95% CI = 0.15 to 0.86, p 0.01] and a reduction in LDL particle number [SMD = -0.24, 95% CI = -0.43 to -0.06, p = 0.02], when compared with higher carbohydrate intake.  

The investigators found the effect of carbohydrate-restricted dietary interventions on LDL peak particle size appeared to be partially explained by differences in weight loss between intervention groups and exploratory analysis revealed a shift from small dense to larger LDL subclasses.

The investigators found no statistically significant association between carbohydrate-restricted dietary interventions and mean LDL particle size [SMD = 0.20, 95% CI = -0.29 to 0.69, p = 0.37], when compared with higher carbohydrate intake.  

The investigators concluded that dietary interventions restricted in carbohydrates increase LDL peak particle size and decrease the numbers of total and small LDL particles.
 
Original title:
Effect of carbohydrate-restricted dietary interventions on LDL particle size and number in adults in the context of weight loss or weight maintenance: a systematic review and meta-analysis by Falkenhain K, Roach LA, […], Little JP.

Link:
https://pubmed.ncbi.nlm.nih.gov/34159352/

Additional information of El Mondo:
Find more information/studies on cholesterol and cardiovascular disease right here.

LDL particle number (LDL-P) is a much more accurate predictor of cardiovascular disease risk than either LDL or total cholesterol. Increased LDL-P could be one of the reasons that some people have heart attacks even though their total cholesterol and LDL cholesterol levels are not particularly high.

A low-carbohydrate diet is a diet with 20-40 En% carbohydrate. The easiest way to follow a diet with 20-40 En% carbohydrate is to choose only meals/products with 20-40 En% carbohydrate. Check here which products contain 20-40 En% carbohydrate.
However, the most practical way to follow a diet with 20-40 En% carbohydrate is, all meals/products that you eat on a daily basis should on average contain 20-40 En% carbohydrate.
20-40 En% carbohydrate means that the total amounts of carbohydrates make up for a 20-40% of the total kcal of the diet.

Use the 7-points nutritional profile app to see if your daily eaten products contain on average 20-40 En% carbohydrate.

Objectives:
Studies indicate that onion supplementation may be effective in the treatment of dyslipidemia; however, the results remain controversial. Therefore, this review article has been conducted.

Does supplementation of onion improve levels of cholesterol and triglycerides or in other words, does eating onions causally lower cholesterol and triglycerides levels?  

Study design:
This review article included 10 RCTs with 446 participants, that were randomly assigned to either the placebo group or the onion group.

The number of participants in each study ranged from 12 to 92.
The duration of intervention in the included studies ranged from 2 to 12 weeks.
There was no evidence of publication bias.

Results and conclusions:
The investigators found the pooled findings of 10 studies showed that onion supplementation significantly increased high-density lipoprotein cholesterol (good cholesterol or HDL cholesterol) levels [MD = 2.29 mg/dL, 95% CI = 0.87 to 3.72, I2 = 0%], when compared to the control group.

The investigators found the pooled findings of 10 studies showed that onion supplementation significantly decreased low-density lipoprotein cholesterol (bad cholesterol or LDL cholesterol) levels [MD = -6.64 mg/dL, 95% CI = -10.91 to -2.36, I2 = 32%], when compared to the control group.
The pooled effect size of LDL cholesterol was not affected by any of the studies in sensitivity analysis.

The investigators found the pooled findings of 10 studies showed no association between onion supplementation and lower triglycerides (TG) levels [MD = -6.55 mg/dL, 95% CI = -15.64 to 2.53, I2 = 45%], when compared to the control group.

The investigators found the pooled findings of 9 studies showed that onion supplementation significantly increased total cholesterol (TC) levels [MD = -5.39 mg/dL, 95% CI = -10.68 to -0.09, I2 = 49%], when compared to the control group.

The investigators found in subgroup analysis that onion supplementation showed a greater benefit in lowering total cholesterol [MD = -17.23 mg/dL, 95% CI = -27.99 to -6.47, I2 = 8%] and LDL cholesterol levels [MD = -12.70 mg/dL, 95% CI = -23.12 to -2.27, I2 = 0%] in subjects with dyslipidemia.

The investigators found in subgroup analysis that onion supplementation longer than 10 weeks showed more increases in HDL cholesterol concentrations [MD = 2.81 mg/dL, 95% CI = 1.08 to 5.54, I2 = 17%].

The investigators concluded supplementation of onion is beneficial to control dyslipidemia, including improving levels of HDL, LDL and total cholesterol, but could not reduce triglycerides levels. The therapeutic benefits of onion for dyslipidemia need to be treated with caution considering that some of the results are not robust.

Original title:
Effect of onion on blood lipid profile: A meta-analysis of randomized controlled trials by Huang W, Tang G, [...], Wei Z.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269690

Additional information of El Mondo:
Find more information/studies on vegetable consumption, lowering cholesterol and cardiovascular disease right here.

Dyslipidemia is defined as having blood lipid levels that are too high or low. Blood lipids are fatty substances, such as triglycerides and cholesterol.

A causal relationship can be found in RCTs.

Objectives:
Personalized nutrition and protective diets and lifestyles represent a key cancer research priority. The association between consumption of specific dietary components and colorectal cancer (CRC) incidence has been evaluated by a number of population-based studies, which have identified certain food items as having protective potential, though the findings have been inconsistent. Therefore, this review article has been conducted.

Which food groups reduce risk of colorectal cancer?

Study design:
This review article included 46 studies (case-control studies and cohort studies).

Results and conclusions:
The investigators found in pooled analyses that colorectal cancer risk was significantly reduced with 10% in patients with higher vs lower consumption of cruciferous vegetables [OR = 0.90, 95% CI = 0.85 to 0.95, p = 0.00, I2 = 31.02%].
This reduced risk was only significant in case-control studies, but not in cohort studies.

The investigators found in pooled analyses that colorectal cancer risk was significantly reduced with 10% in patients with higher vs lower consumption of citrus fruits [OR = 0.90, 95% CI = 0.84 to 0.96, p = 0.00, I2 = 21.65%].
This reduced risk was only significant in case-control studies, but not in cohort studies.

The investigators found in pooled analyses that colorectal cancer risk was significantly reduced with 17% in patients with higher vs lower consumption of garlic [OR = 0.83, 95% CI = 0.76 to 0.91, p = 0.00, I2 = 32.64%].
This reduced risk was only significant in case-control studies, but not in cohort studies.

The investigators found in pooled analyses that colorectal cancer risk was significantly reduced with 11% in patients with higher vs lower consumption of tomatoes [OR = 0.89, 95% CI = 0.84 to 0.95, p = 0.00, I2 = 0%].
This reduced risk was only significant in case-control studies, but not in cohort studies.

The investigators found in subgroup analysis of cohort studies that colorectal cancer risk was significantly reduced with 26% in patients with higher vs lower consumption of nut [OR = 0.74, 95% CI = 0.58 to 0.94, p = 0.01, I2 = 35.48%].

The investigators concluded that an increased consumption of cruciferous vegetables, citrus fruits, garlic and tomatoes may reduce colorectal cancer risk. May reduce because the reduced risk is only found in case-control studies and not in cohort studies.

Original title:
Phytochemically rich dietary components and the risk of colorectal cancer: A systematic review and meta-analysis of observational studies by Borgas P, Gonzalez G, […], Reza Mirnezami R.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223713/

Additional information of El Mondo:
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Objectives:
Is an increased homocysteine (Hcy) level an independent predictor of unfavorable outcomes in acute ischemic stroke (AIS)?

Study design:
This review article included 17 cohort studies (4 of them were retrospective studies and the remaining 13 were prospective studies) with 15,636 patients with acute ischemic stroke.

There was no publication bias.

Results and conclusions:
The investigators found the patients with acute ischemic stroke group had significantly higher levels of homocysteine than the control group [SMD = 5.11, 95% CI = 1.87 to 8.35, p = 0.002].
The results of subgroup analyses on ethnicity showed that the associations were statistically significant in both Caucasian and Asian patients [Caucasian: OR = 3.56, 95% CI = 2.54 to 4.98, p 0.00001, I2 = 20% and Asian: HR = 1.39, 95% CI = 1.19 to 1.63, p 0.00001, I2 = 86%], but not in African patients [OR = 1.04, 95% CI = 0.99 to 1.10, p = 0.11].

The investigators found, moreover, high homocysteine levels were closely associated with gender, B12 deficiency, smoking and patients who received tissue plasminogen activator treatment.
However, no significant difference was found between increased homocysteine levels and age, drinking, hypertension, diabetes mellitus and hyperlipidemia.

The investigators found, in addition, the cut-off value (20.0 μmol/L) might be an optimum cut-off index for acute ischemic stroke patients in clinical practice.

The investigators concluded that the homocysteine level may serve as an independent predictor for unfavorable survival outcomes in acute ischemic stroke patients, particularly in Caucasian and Asian acute ischemic stroke patients. Further studies can be conducted to clarify this relationship.

Original title:
The Prognostic Value of Homocysteine in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis by Huang S, Cai J and Tian Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907516/

Additional information of El Mondo:
Find more information/studies on cardiovascular disease right here.

Objectives:
Low- and middle-income countries (LMICs) are currently experiencing increasing cardiovascular disease (CVD) rates. Green leafy vegetables (GLV), which are abundant in these countries, are known to be particularly rich in cardioprotective nutrients. Therefore, this review article has been conducted.

Does green leafy vegetables consumption reduce cardiovascular disease?

Study design:
This review article included 17 cohort studies.

Results and conclusions:
The investigators found green leafy vegetables consumption significantly reduced incident cardiovascular disease events with 7% [pooled RR = 0.93, 95% CI = 0.92 to 0.95].

The investigators found in subgroup analyses that green leafy vegetables consumption significantly reduced incident cerebral infarction with 8% [RR = 0.92, 95% CI = 0.88 to 0.96].

The investigators found in subgroup analyses that green leafy vegetables consumption significantly reduced heart disease with 7% [RR = 0.93, 95% CI = 0.87 to 0.99].

The investigators found in subgroup analyses that green leafy vegetables consumption significantly reduced other cardiovascular disease events with 5% [RR = 0.95, 95% CI = 0.93 to 0.98].

The investigators concluded that green leafy vegetables consumption reduces incident cardiovascular disease, particularly incident cerebral infarction and heart disease. These findings are especially important in low- and middle-income countries where the burden of cardiovascular disease remains high.

Original title:
Dietary intakes of green leafy vegetables and incidence of cardiovascular diseases by Ojagbemi A, Okekunle AP, […], Owolabi M.

Link:
https://pubmed.ncbi.nlm.nih.gov/34128951/

Additional information of El Mondo:
Find more information/studies on vegetable consumption and cardiovascular disease right here.

The green leafy vegetables are:

arugula
beet greens
bok choy
cabbage
collard greens
endive
kale
microgreens
romaine lettuce
spinach
swiss chard
turnip greens
watercress

Objectives:
Does a high BMI increase liver cancer mortality and occurrence of primary liver cancer?

Study design:
This review article included 28 prospective cohort studies with 8,135,906 subjects, of which 6,059,561 subjects (persons) with primary liver cancer occurrence and 2,077,425 subjects with liver cancer-related mortality.

Results and conclusions:
The investigators found in the meta-analysis, that an increase in BMI significantly increased the occurrence of primary liver cancer with 69% [HR = 1.69, 95% CI = 1.50 to 1.90, I2 = 56%].
Significant means that there is an association with a 95% confidence.

The investigators found that a BMI>25 (overweight) significantly increased the occurrence of primary liver cancer with 36% [HR = 1.36, 95% CI = 1.02 to 1.81].
Significant because HR of 1 was not found in the 95% CI of 1.02 to 1.81. HR of 1 means no risk/association.

The investigators found that a BMI>30 (obesity) significantly increased the occurrence of primary liver cancer with 77% [HR = 1.77, 95% CI = 1.56 to 2.01].
Significantly means it can be said with a 95% confidence that a BMI>30 really increased the occurrence of primary liver cancer with 77%.

The investigators found that a BMI>35 significantly increased the occurrence of primary liver cancer with 208% [HR = 3.08, 95% CI = 1.21 to 7.86].

The investigators found that an increase in BMI significantly increased liver cancer-related mortality with 61% [HR = 1.61, 95% CI = 1.14 to 2.27].

The investigators concluded that high BMI increases liver cancer mortality and occurrence of primary liver cancer. Obesity (BMI>30) is an independent risk factor for the occurrence of and mortality from primary liver cancer.

Original title:
Obesity and the risk of primary liver cancer: A systematic review and meta-analysis by Sohn W, Lee S, [...], Yoon SK.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820201/

Additional information of El Mondo:
Find more information/studies on cancer and obesity/overweight right here.

Am I overweight?

Which products are suitable for persons with overweight?

Use the 7-points nutritional profile app to see if your daily eaten products are suitable for you if you are overweight.

Objectives:
The association of meat consumption with mortality and morbidity for non-communicable diseases has been extensively studied. However, the relation of white meat consumption with health outcomes remains controversial. Therefore, this review article has been conducted.

Does consumption of white meat reduce mortality and morbidity rate?

Study design:
This review article included 22 prospective cohort studies with 3,132,149 subjects.
11 studies (14 data-sets) reported data on all-cause mortality, 10 studies (15 datasets) on cardiovascular mortality and 10 studies (11 datasets) on non-fatal cardiovascular events.
The evaluation of methodological quality of each study showed a median NOS score of 6.

Funnel plot examination suggested the absence of publication bias and of small-study effect, confirmed by the Egger’s test for all-cause mortality.

Results and conclusions:
The investigators found the analysis of the 11 studies (14 datasets) on all-cause mortality showed a statistically significant lower mortality rate of 6% for subjects in the highest vs. lowest unprocessed white meat consumption category [OR = 0.94, 95% CI = 0.90 to 0.97, p 0.001, I2 = 95.6%, p 0.001].

The investigators found an overall neutral association between high unprocessed white meat consumption and cardiovascular mortality and morbidity.

The investigators concluded that consumption of unprocessed white meat reduces all-cause mortality.

Original title:
White Meat Consumption, All-Cause Mortality, and Cardiovascular Events: A Meta-Analysis of Prospective Cohort Studies by Lupoli R, Vitale M, […], Vaccaro O.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924043/

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Objectives:
Does carotenoid (like astaxanthin, lutein/zeaxanthin, β-cryptoxanthin and lycopene) supplementation have protective effects on inflammatory biomarkers (like C-reactive protein and interleukin-6)?

Study design:
This review article included 26 RCTs with 35 effect sizes.

Results and conclusions:
The investigators found carotenoid supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.54 mg/L, 95% CI = -0.71 to -0.37, p 0.001].
Significantly because the calculated p-value of 0.001 was less than the p-value of 0.05.

The investigators found carotenoid supplementation significantly reduced interleukin-6 (IL-6) [WMD = -0.54 pg/mL, 95% CI = -1.01 to -0.06, p = 0.025].
Significant means that there is an association with a 95% confidence.

The investigators found in subgroup analyses that astaxanthin supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.30 mg/L, 95% CI = -0.51 to -0.09, p = 0.005].

The investigators found in subgroup analyses that lutein/zeaxanthin supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.30 mg/L, 95% CI = -0.45 to -0.15, p 0.001].

The investigators found in subgroup analyses that β-cryptoxanthin supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.35 mg/L, 95% CI = -0.54 to -0.15, p 0.001].

The investigators found in subgroup analyses that lycopene supplementation significantly reduced interleukin-6 (IL-6) [WMD = -1.08 pg/mL, 95% CI = -2.03 to -0.12, p = 0.027].

The investigators concluded that carotenoid supplementation (like astaxanthin, lutein/zeaxanthin, β-cryptoxanthin and lycopene) has protective effects on inflammatory biomarkers.

Original title:
Carotenoids supplementation and inflammation: a systematic review and meta-analysis of randomized clinical trials by Hajizadeh-Sharafabad F, Zahabi ES, […], Alizadeh M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33998846/

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Objectives:
Does coffee or tea consumption reduce the risk of glioma?

Study design:
This review article included 12 unique studies (cohort and case-control studies) comprising of 1,960,731 participants with 2,987 glioma cases.

Results and conclusions:
The investigators found in pooled analyses that higher tea consumption was significantly associated with a lower risk of 16% for glioma [RR = 0.84, 95% CI = 0.71 to 0.98, p = 0.030, I2 = 16.42%].

The investigators found in cohort studies that higher coffee consumption was significantly associated with a lower risk of 15% for glioma [RR = 0.85, 95% CI = 0.72 to 1.00, p = 0.046, I2 = 0%].

The investigators found in cohort studies that higher tea consumption was significantly associated with a lower risk of 19% for glioma [RR = 0.81, 95% CI = 0.70 to 0.93, p = 0.004, I2 = 0%].

The investigators found in dose-response meta-analysis that every one cup of coffee per day significantly decreased the risk of glioma by 3% [RR = 0.97, 95% CI = 0.94 to 0.99, p = 0.016, p non-linearity = 0.054]. 

The investigators found in dose-response meta-analysis that every one cup of tea per day significantly decreased the risk of glioma by 3% [RR = 0.97, 95% CI = 0.94 to 1.00, p = 0.048]. 

The investigators found meta-regression showed that the association between coffee and glioma was reduced by smoking [p = 0.029].

The investigators concluded both coffee (at least one cup of coffee per day) and tea consumption (at least one cup of tea per day) reduce the risk of glioma.

Original title:
Coffee and tea consumption and the risk of glioma: a systematic review and dose-response meta-analysis by Pranata R, Feraldho A, […], July J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33750490/

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Glioma is a type of tumor that occurs in the brain and spinal cord. About 33 percent of all brain tumors are gliomas, which originate in the glial cells that surround and support neurons in the brain, including astrocytes, oligodendrocytes and ependymal cells.
Gliomas can affect all ages, but they are most often seen in adults. Gliomas are slightly more likely to occur in men than in women and more common in Caucasians than in African Americans.

Objectives:
The associations of alcohol consumption and venous thromboembolism (VTE) have been investigated widely, but the conclusions were inconsistent. Therefore, this review article has been conducted.

Does alcohol intake decrease risk of venous thromboembolism?

Study design:
This review article included 14 cohort studies and 4 case-control studies.

Results and conclusions:
The investigators found, compared with non-drinkers, the risk of venous thromboembolism was significantly decreased with 7% [RR = 0.93, 95% CI = 0.88 to 0.99] for alcohol drinkers.

The investigators found, compared with no alcohol intake, the risk of venous thromboembolism was significantly decreased with 9% [RR = 0.91, 95% CI = 0.84 to 0.99] for low to moderate alcohol intake (0.1-14.0 drinks/week).

The investigators concluded that low to moderate alcohol intake (0.1-14.0 drinks/week) decreases risk of venous thromboembolism. However, precautions are needed when providing personal drinking advice considering the potential harm of alcohol. Further studies are warranted to determine whether moderate alcohol consumption has a causal role in venous thromboembolism.

Original title:
Meta-analysis of alcohol consumption and venous thromboembolism by Zhang X, Chen X, [...], Li K.

Link:
https://pubmed.ncbi.nlm.nih.gov/33824981/

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Objectives:
Dyslipidemia/hyperlipidemia is recognized among the risk factors for lifestyle related diseases. A healthy diet, rich in vegetable oils such as rice bran oil (RBO), may aid to improve serum lipid levels. Therefore, this review article has been conducted.

Does rice bran oil decrease causally the levels of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and triglyceride (TG) levels in adults?

Study design:
This review article included 8 eligible RCTs with 14 effect sizes.
The effect sizes were expressed as weighted mean difference (WMD) with 95% confidence intervals (CI).
 
Results and conclusions:
The investigators found that the consumption of rice bran oil significantly decreased serum
total cholesterol [WMD = -7.29 mg/dL, 95% CI = -11.32 to -3.25, p = 0.000];
LDL- cholesterol (bad cholesterol) [WMD = -7.62 mg/dL, 95% CI = -11.10 to -4.14, p = 0.000] and;
triglyceride [WMD = -9.19 mg/dL, 95% CI = -17.99 to -0.38, p = 0.041] levels in adults.
Significantly because the calculated p-value of = 0.041 was less than the p-value of 0.05.

The investigators concluded that the consumption of rice bran oil causally decreases serum
total cholesterol, LDL-cholesterol (bad cholesterol) and triglyceride levels in adults. Hence, it may play a role in reducing dyslipidemia/hyperlipidemia risk.

Original title:
The impact of rice bran oil consumption on the serum lipid profile in adults: a systematic review and meta-analysis of randomized controlled trials by Pourrajab B, Sohouli MH, […], Shidfar F.

Link:
https://pubmed.ncbi.nlm.nih.gov/33715544/

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Objectives:
Recently, it has been shown that coronavirus disease 2019 (COVID-19), which has caused a pandemic since December 2019, can be accompanied by some neurological disorders and therefore, this review article has been conducted.

What are the most prevalent neurological manifestations of COVID-19 infection?

Study design:
This review article included 26 observational studies and 31 case reports with a total of 6,597 COVID-19 patients.

Results and conclusions:   
The investigators found the most prevalent general symptoms were fever, cough and dyspnea with 84.6% [95% CI = 75.3 to 92.1, I2 = 98.7%], 61.3% [95% CI = 55.3 to 67.0, I2 = 94.6%] and 34.2% [95% CI = 25.6 to 43.4, I2 = 97.7%], respectively.

The investigators found neurological symptoms observed among COVID-19 patients were fatigue, gustatory dysfunction, anorexia, olfactory dysfunction, headache, dizziness and nausea with 42.9% [95% CI = 36.7 to 49.3, I2 = 92.8%], 35.4% [95% CI = 11.2 to 64.4, I2 = 99.2%], 28.9% [95% CI = 19.9 to 38.8, I2 = 96.3%], 25.3% [95% CI = 1.6 to 63.4, I2 = 99.6%], 10.1% [95% CI = 2.7 to 21.0, I2 = 99.1%], 6.7% [95% CI = 3.7 to 10.5, I2 = 87.5%] and 5.9% [95% CI = 3.1 to 9.5, I2 = 94.5%], respectively.

The investigators found the most prevalent neurological comorbidity in COVID-19 was cerebrovascular disease with 4.3% [95% CI = 2.7 to 6.3, I2 = 78.7%].

The investigators concluded the most prevalent neurological manifestations of COVID-19 include fatigue, gustatory dysfunction, anorexia, olfactory dysfunction, headache, dizziness and nausea. Cerebrovascular disorders can either act as a risk factor for poorer prognosis in COVID-19 patients or occur as a critical complication in these patients. Guillain-Barre syndrome, encephalitis and meningitis have also been reported as complications of COVID-19.

Original title:
Neurological Symptoms, Comorbidities, and Complications of COVID-19: A Literature Review and Meta-Analysis of Observational Studies by Vakili K, Mobina Fathi  M, […], Rezaei-Tavirani M.

Link:
https://pubmed.ncbi.nlm.nih.gov/34044408/

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Objectives:
Cohort studies report inconsistent associations between fish consumption, a major source of long-chain ω-3 fatty acids and risk of cardiovascular disease (CVD) and mortality. Whether the associations vary between those with and those without vascular disease is unknown. Therefore, this review article has been conducted.

Do the associations of fish consumption with risk of cardiovascular disease or of mortality differ between individuals with and individuals without vascular disease?

Study design:
This review article included 4 cohort studies from 58 countries with 191,558 participants with a mean (SD) age of 54.1 (8.0) years and 91,666 (47.9%) were male.
 
Results and conclusions:
The investigators found during 9.1 years of follow-up in PURE, compared with little or no fish intake (≤50 g/mo), an intake of 350 g/wk or more was not associated with risk of major cardiovascular disease [HR = 0.95, 95% CI = 0.86 to 1.04] or total mortality [HR = 0.96, 95% CI = 0.88 to 1.05].
Not associated because HR of 1 was found in the 95% CI of 0.86 to 1.04. HR of 1 means no risk/association.

The investigators found, by contrast, in the 3 cohorts of patients with vascular disease, the HR for risk of major cardiovascular disease [HR = 0.84, 95% CI = 0.73 to 0.96] and total mortality [HR = 0.82, 95% CI = 0.74 to 0.91] was lowest with dietary intakes of at least 175 g/wk (or approximately 2 servings/wk) compared with 50 g/mo or lower, with no further apparent decrease in HR with consumption of 350 g/wk or higher. 

The investigators found fish with higher amounts of ω-3 fatty acids (also called oily fish) were strongly associated with a lower risk of cardiovascular disease [HR = 0.94, 95% CI = 0.92 to 0.97 per 5-g increment of intake], whereas other fish were neutral (collected in 1 cohort of patients with vascular disease).
The association between fish intake and each outcome varied by cardiovascular disease status, with a lower risk found among patients with vascular disease but not in general populations [for major cardiovascular disease: I2 = 82.6%, p = 0.02 and for death: I2 = 90.8%, p = 0.001].

The investigators concluded that fish intake of 175-350g weekly is associated with lower risk of major cardiovascular disease and mortality among patients with prior cardiovascular disease but not in general populations. The consumption of fish (especially oily fish) should be evaluated in randomized trials of clinical outcomes among people with vascular disease.

Original title:
Associations of Fish Consumption With Risk of Cardiovascular Disease and Mortality Among Individuals With or Without Vascular Disease From 58 Countries by Mohan D, Mente A, […], Yusuf S.

Link:
https://pubmed.ncbi.nlm.nih.gov/33683310/

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Objectives:
Soy has several beneficial effects on cardiovascular disease (CVD). However, results of clinical trial studies are equivocal. Therefore, this review article has been conducted.

Is there a causal relationship between soy consumption and improvements in blood pressure in adults?

Study design:
This review article included 17 RCTs.

Results and conclusions:
The investigators found pooled effects from 17 studies revealed a significant improvement in systolic blood pressure (SBP) [MD = -1.64, 95% CI = -3.25 to -0.04 mmHg, I2 = 50.5%] following soy consumption, in comparison with controls (groups without soy consumption).

The investigators found pooled effects from 17 studies revealed a significant improvement in diastolic blood pressure (DBP) [MD = -1.21, 95% CI = -2.29 to -0.12 mmHg, I2 = 50.7%] following soy consumption, in comparison with controls (groups without soy consumption).

The investigators found subgroup analysis demonstrated a reduction in both systolic blood pressure and diastolic blood pressure in younger participants with lower baseline blood pressure and intervention durations of 16 weeks.

The investigators concluded there is a causal relationship between soy consumption and improvements in blood pressure in adults.

Original title:
Soy intake is associated with lowering blood pressure in adults: A systematic review and meta-analysis of randomized double-blind placebo-controlled trials by Mosallanezhad Z, Ranjbar S, […], Jalali M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33636295/

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Objectives:
Evidence suggests that vitamin C supplementation could be a potential therapy in type 2 diabetes. However, its effectiveness and evidence quality require further evaluation. Therefore, this review article has been conducted.

Does oral vitamin C supplementation improve glycemic control, cardiovascular risk factors and oxidative stress in people with type 2 diabetes?

Study design:
This review article included 28 RCTs with in totaal 1,574 participants.
RCTs were predominantly short term (6 months) with a small number of participants (n 100).

Results and conclusions:
The investigators found that oral vitamin C supplementation significantly reduced systolic blood pressure [mean difference = -6.27, 95% CI = -9.60 to -2.96 mmHg, p = 0.0002, with moderate evidence certainty].

The investigators found that oral vitamin C supplementation significantly reduced HbA1c levels [mean difference = -0.54%, 95% CI = -0.90 to -0.17, p = 0.004, with very low evidence certainty].

The investigators found that oral vitamin C supplementation significantly reduced diastolic blood pressure [mean difference = -3.77, 95% CI = -6.13 to -1.42 mmHg, p = 0.002, with very low evidence certainty].

The investigators concluded evidence from short-term RCTs suggests that oral vitamin C supplementation may improve glycemic control and blood pressure in people with type 2 diabetes. However, vitamin C supplementation cannot currently be recommended as a therapy until larger, long-term and high-quality trials confirm these findings.

Original title:
Effects of Vitamin C Supplementation on Glycemic Control and Cardiovascular Risk Factors in People With Type 2 Diabetes: A GRADE-Assessed Systematic Review and Meta-analysis of Randomized Controlled Trials by Mason SA, Keske MA and Wadley GD.

Link:
https://pubmed.ncbi.nlm.nih.gov/33472962/

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Objectives:
Is fish or omega-3 fatty acids consumption associated with a lower risk of venous thromboembolism (VTE)?

Study design:
This review article included 8 prospective cohort studies.
The follow-up duration ranged from 0.5 to 19 years.
The sample size ranged from 595 to 80,263.
The fish and omega-3 fatty acids consumption was assessed by food-frequency questionnaire (FFQ) in all studies.
The diagnosis of venous thromboembolism was obtained in registered medical record (imaging or autopsy) and food was considered as the source of omega-3 fatty acids in all included studies.
Begg's rank-correlation test showed no evidence of publication bias.

Results and conclusions:
The investigators found the overall multi-variable adjusted RR showed no significant relationship between fish consumption and the risk of venous thromboembolism [RR = 1.02, 95% CI = 0.93 to 1.11, p = 0.709, I2 = 33%, p = 0.176].
The sensitivity analysis showed only minimal changes in magnitude of the pooled RR when any study was excluded from the meta-analysis, suggesting that no individual study had excessive influence on these robust aggregate results.

The investigators found the overall multi-variable adjusted RR showed that omega-3 fatty acids consumption was associated with a lower risk of 11% for venous thromboembolism [RR = 0.89, 95% CI = 0.80 to 0.98, p = 0.024, I2 = 0%, p = 0.469].
The sensitivity analysis showed only minimal changes in magnitude of the pooled RR when any study was excluded from the meta-analysis, suggesting that no individual study had excessive influence on these robust aggregate results.

The investigators found the overall multi-variable adjusted RR showed that omega-3 fatty acids consumption was associated with a lower risk of 55% for recurrent venous thromboembolism [RR = 0.45, 95% CI = 0.25 to 0.81, p = 0.008, I2 = 26.4%, p = 0.244].
Significant because RR of 1 was not found in the 95% CI of 0.25 to 0.81. RR of 1 means no risk/association.

The investigators concluded omega-3 fatty acids consumption is associated with a lower risk of both venous thromboembolism and recurrent venous thromboembolism.

Original title:
Associations of Fish and Omega-3 Fatty Acids Consumption With the Risk of Venous Thromboembolism. A Meta-Analysis of Prospective Cohort Studies by Zhang Y, Ding J, [...],Li Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793732/

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Venous thromboembolism (VTE) is a condition in which a blood clot forms most often in the deep veins of the leg, groin or arm (known as deep vein thrombosis, DVT) and travels in the circulation, lodging in the lungs (known as pulmonary embolism, PE).