Nutritional advice

Objectives:
Is there a relationship between step count and changes in blood pressure (BP) in healthy adults?

Study design:
This review article included 14 trials involving healthy adults and an intervention in the form of brisk walking with a pedometer.

Net changes in blood pressure and step count in each trial were calculated and pooled. In addition, the pooled net changes of two categories (trials that achieved walking 10,000 steps a day and those that did not) were compared.

Results and conclusions:
The investigators found that pooled net changes in blood pressure improved significantly [systolic blood pressure = -3.1 mmHg and diastolic blood pressure = -1.6 mmHg].

The investigators found, however, when the trials were categorized depending on whether they achieved walking 10,000 steps a day, the pooled net change in systolic blood pressure and diastolic blood pressure did not differ significantly between both groups of subjects.

The investigators found the meta-regression analyses indicated that net change in systolic blood pressure was significantly associated with an increased step count (e.g., systolic blood pressure is expected to decrease approximately 4 mmHg if increased step count by 2000 steps a day).
However, net change in systolic blood pressure was not associated with the step count in an intervention group following the intervention.

The investigators concluded that there is no evidence that walking 10,000 steps a day lowers the blood pressure to any marked degree in healthy adults. In order to reduce systolic blood pressure by walking with a pedometer, one should be mindful of increasing one's step count to 20,000 steps per day.

Original title:
The required step count for a reduction in blood pressure: a systematic review and meta-analysis by Igarashi Y, Akazawa N and Maeda S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30127487

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Objectives:
Intervention studies suggest that incorporating walnuts into the diet may improve blood lipids without promoting weight gain. Therefore, this review article has been conducted.

Does a diet with walnuts improve blood lipids profile (such as cholesterol and triglycerides) without promoting weight gain?

Study design:
This review article included 26 clinical trials with a total of 1,059 participants.
Weighted mean differences (WMDs) were used.

Results and conclusions:
The investigators found compared with control group, a walnut-enriched diet significantly reduced total blood cholestrerol level with 6.99 mg/dL [95% CI = -9.39 to -4.58 mg/dL, p 0.001; 3.25% greater reduction].

The investigators found compared with control group, a walnut-enriched diet significantly reduced low-density lipoprotein (LDL) cholesterol level with 5.51 mg/dL [95% CI = -7.72 to -3.29 mg/dL, p 0.001; 3.73% greater reduction].

The investigators found compared with control group, a walnut-enriched diet significantly reduced triglyceride concentrations with 4.69 mg/dL [WMD = -4.69 mg/dL, 95% CI = -8.93 to -0.45 mg/dL, p = 0.03; 5.52% greater reduction].  

The investigators found more pronounced reductions in blood lipids were observed when walnut interventions were compared with American and Western diets [WMD for total blood cholestrerol level = -12.30, 95% CI = -23.17 to -1.43] and for LDL blood cholestrerol level = -8.28, 95% CI = -13.04 to -3.51, p 0.001].

The investigators found apolipoprotein B was also reduced significantly more on walnut-enriched diet compared with control group [WMD = -3.74 mg/dL, 95% CI = -6.51 to -0.97 mg/dL, p = 0.008].

The investigators found a trend towards a reduction was observed for apolipoprotein A [WMD = -2.91, 95% CI = -5.98 to 0.08, p = 0.057].

The investigators found, however, walnut-enriched diet did not lead to significant differences in weight change compared with control diet [WMD = -0.12 kg, 95% CI = -2.12 to 1.88, p = 0.90], systolic blood pressure [WMD = -0.72 mmHg, 95% CI = -2.75 to 1.30, p = 0.48] or diastolic blood pressure [WMD = -0.10 mmHg, 95% CI = -1.49 to 1.30, p = 0.88].

The investigators concluded that walnut-enriched diet improves total and LDL cholesterol levels (bad cholesterol), apolipoprotein B levels and triglyceride levels without adversely affecting body weight or blood pressure.

Original title:
Effects of walnut consumption on blood lipids and other cardiovascular risk factors: an updated meta-analysis and systematic review of controlled trials by Guasch-Ferré M, Li J, […], Tobias DK.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29931130

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Persons with atherosclerosis often have an elevated total cholesterol level, an elevated LDL cholesterol level, an elevated triglyceride level and an elevated apolipoprotein B level.

Persons with atherosclerosis are advised to choose products/meals with maximum 30 En% fat, maximum 7 En% saturated fat, maximum 0.2 gram salt per 100 kcal and minimum 1.5 grams fiber per 100 kcal. Check here which products/meals are suitable for persons with atherosclerosis.
 

Objectives:
The association of high sodium intake with risk of stroke has been accepted. But considering the proposed J/U-shaped association between sodium intake and risk of all-cause mortality, the shape of the dose-response relationship has not been determined yet. Therefore, this review article has been conducted.

Is there a dose-response association of dietary sodium and sodium-to-potassium ratio with risk of stroke in adults aged 18 years or older?

Study design:
This review article included 14 prospective cohort studies, 1 case-cohort study and 1 case-control study with a total of 261,732 participants, of which 10,150 cases of stroke.

Results and conclusions:
The investigators found a significantly increased risk of 6% [pooled RR = 1.06, 95% CI = 1.02 to 1.10, I2 = 60%, n = 14 studies] for stroke for a 1 gr/d increment in dietary sodium intake.

The investigators found a significantly increased risk of 22% [pooled RR = 1.22, 95% CI = 1.04 to 1.41, I2 = 60%, n = 5 studies] for stroke for a one-unit increment in dietary sodium-to-potassium ratio (mmol/mmol).

The investigators found the risk of stroke increased linearly with increasing dietary sodium intake and also along with the increase in dietary sodium-to-potassium ratio.

The investigators found no evidence of a J/U-shaped association in the analyses of total stroke, stroke incidence and stroke mortality.

The investigators found high sodium intake was associated with a somewhat worse prognosis among Asian countries as compared to westerns.

The investigators concluded that higher dietary sodium intake and higher dietary sodium-to-potassium ratio are associated with a higher risk of stroke in adults aged 18 years or older. Reducing dietary sodium-to-potassium ratio can be considered as a supplementary approach in parallel with the decrease in sodium intake in order to decrease stroke risk.

Original title:
Dietary sodium, sodium-to-potassium ratio, and risk of stroke: A systematic review and nonlinear dose-response meta-analysis by Jayedi A, Ghomashi F, […], Shab-Bidar S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29907351

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Find more information/studies on review article/significantly, sodium, potassium and cardiovascular diseases prevention right here.

Sodium is a component of salt. Thus, a high sodium intake means a high salt intake.
A high salt diet means, practically, a diet with a lot of products with minimum 0.3 gram salt per 100 kcal.

A low salt diet means, practically, a diet with a lot of products with maximum 0.2 gram salt per 100 kcal. These products meet a low salt diet.

Objectives:
N-3 polyunsaturated fatty acids (PUFA) have been postulated to have an anti-arrhythmic effect on postoperative atrial fibrillation (POAF), with conflicting results among studies. Therefore, this review article has been conducted.

Do n-3 polyunsaturated fatty acids reduce risk of postoperative atrial fibrillation among patients undergoing cardiac surgery?

Study design:
This review article included 4 studies with 3,570 patients.
The funnel plot and fail-safe number suggested insignificant publication bias.

Results and conclusions:
The investigators found n-3 polyunsaturated fatty acids significantly reduced risk of postoperative atrial fibrillation with 16% [RR = 0.84, 95% CI = 0.73-0.98, p = 0.03].
Significantly means it can be said with a 95% confidence that n-3 polyunsaturated fatty acids really reduced the risk of postoperative atrial fibrillation with 16%. 

The investigators found in subgroup analyses EPA:DHA 1 significantly reduced risk of postoperative atrial fibrillation with 49% [RR = 0.51, 95% CI = 0.36-0.73, p = 0.0003].

The investigators found in subgroup analyses, when placebo was usual care, n-3 polyunsaturated fatty acids significantly reduced risk of postoperative atrial fibrillation with 41% [RR = 0.59, 95% CI = 0.44-0.80, p = 0.0005].

The investigators found in subgroup analyses, n-3 polyunsaturated fatty acids significantly reduced risk of postoperative atrial fibrillation with 32% after coronary artery bypass grafting (CABG) [RR = 0.68, 95% CI = 0.47-0.97, p = 0.03].

The investigators concluded that n-3 polyunsaturated fatty acids (PUFA), particularly at EPA/DHA ratio of  1 reduce risk of postoperative atrial fibrillation after coronary artery bypass grafting (CABG). Further studies are needed to confirm the effect of PUFA on postoperative atrial fibrillation and to assess the proper use of PUFA against postoperative atrial fibrillation.

Original title:
N-3 polyunsaturated fatty acids for prevention of postoperative atrial fibrillation: updated meta-analysis and systematic review by Wang H, Chen J and Zhao L.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29380237

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Objectives:
Oxidative stress and inflammation are key parameters in developing metabolic disorders. Hence, antioxidant intake might be an appropriate approach. Several studies have evaluated the effect of coenzyme Q10 (CoQ10) supplementation on lipid profile among patients with metabolic diseases, though findings are controversial. Therefore, this review article has been conducted.

Does coenzyme Q10 supplementation improve lipid profile of patients with metabolic disorders?

Study design:
This review article included 21 RCTs with a total of 514 patients with metabolic disorders in the coenzyme Q10 supplementation group and 525 patients with metabolic disorders in the non-coenzyme Q10 supplementation group (control group).

Results and conclusions:
The investigators found coenzyme Q10 supplementation significantly reduced serum triglycerides levels of patients with metabolic disorders [SMD = -0.28, 95% CI = -0.56 to -0.005].

The investigators found coenzyme Q10 supplementation non-significantly reduced total-cholesterol levels of patients with metabolic disorders [SMD = -0.07, 95% CI = -0.45 to 0.31].

The investigators found coenzyme Q10 supplementation non-significantly increased LDL-cholesterol (bad cholesterol) levels of patients with metabolic disorders [SMD = 0.04, 95% CI = -0.27 to 0.36].

The investigators found coenzyme Q10 supplementation non-significantly increased HDL-cholesterol (good cholesterol) levels of patients with metabolic disorders [SMD = 0.10, 95% CI = -0.32 to 0.51].

The investigators concluded that coenzyme Q10 supplementation reduces serum triglycerides levels of patients with metabolic disorders. However, it has no effects on cholesterol levels.  

Original title:
The effects of coenzyme Q10 supplementation on lipid profiles among patients with metabolic diseases: a systematic review and meta-analysis of randomized controlled trials by Sharifi N, Tabrizi R, […], Asemi Z.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29623830

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A metabolic disorder occurs when the metabolism process fails and causes the body to have either too much or too little of the essential substances, namely carbohydrates, aminoacids, fatty acids and organic acids needed to stay healthy.

Metabolic disorders can take many forms. This includes:

• a disease in the liver, pancreas, endocrine glands or other organs involved in metabolism
• nutritional deficiencies
• a missing enzyme or vitamin that’s necessary for an important chemical reaction
• abnormal chemical reactions that hinder metabolic processes

Objectives:
What are the effects of olive oil consumption compared with other plant oils on blood lipids?

Study design:
This review article included 27 RCTs, comprising 1,089 participantes.

Results and conclusions:
The investigators found compared to other plant oils, HDL cholesterol levels (good cholesterol) increased significantly more for olive oil consumption [WMD = 1.37 mg/dL, 95% CI = 0.4 to 2.36].

The investigators found, however, olive oil consumption reduced total cholesterol levels [WMD = 6.27 mg/dL, 95% CI = 2.8 to 10.6], LDL cholesterol levels (bad cholesterol) [WMD = 4.2 mg/dL, 95% CI = 1.4 to 7.01] and triglyceride levels [WMD = 4.31 mg/dL, 95% CI = 0.5 to 8.12] significantly less than other plant oils.

The investigators found that there were no significant effects on Apo lipoprotein A1 and Apo lipoprotein B.

The investigators concluded that olive oil consumption decreases serum total cholesterol, LDL cholesterol and triglyceride levels less but increases HDL cholesterol levels more than other plant oils.

Original title:
Comparison of blood lipid-lowering effects of olive oil and other plant oils: A systematic review and meta-analysis of 27 randomized placebo-controlled clinical trials by Ghobadi S, Hassanzadeh-Rostami Z, […], Faghih S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29420053

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Objectives:
Does poultry intake reduce risk of stroke?

Study design:
This review article included 7 prospective cohort studies involving 354,718 participants.

Results and conclusions:
The investigators found for the highest versus lowest categories of poultry intake a non-significantly reduced risk of 8% for total stroke [pooled RR = 0.92, 95% CI = 0.82-1.03, I2 = 19.8%, p = 0.28].

The investigators found in subgroup analysis for the highest versus lowest categories of poultry intake, a significantly reduced risk of 14% for total stroke among US people [RR = 0.86, 95% CI = 0.77-0.95, I2 = 0.0%, p = 0.38].

The investigators found in subgroup analysis for the highest versus lowest categories of poultry intake, a significantly reduced risk of 17% for total stroke among women [RR = 0.83, 95% CI = 0.72-0.93, I2 = 0.0%, p = 0.63].

The investigators found in subgroup analysis no association between the highest poultry intake and ischemic stroke risk [RR = 0.91, 95% CI = 0.79-1.02, I2 = 0.0%, p = 0.93].

The investigators found in subgroup analysis no association between the highest poultry intake and hemorrhagic stroke risk [RR = 0.82, 95% CI = 0.59-1.04, I2 = 20.5%, p = 0.28].

The investigators found one serving per week increment in poultry intake was not associated with the risk of stroke [RR = 1.00, 95% CI = 0.96-1.03, I2 = 69.0%, p = 0.004].

The investigators found nonlinear dose-response meta-analysis showed a lower risk of stroke at consumption of 1 serving/week.  

The investigators concluded that 1 serving/week poultry intake reduces risk of stroke, particularly among US people and women.

Original title:
Dietary poultry intake and the risk of stroke: A dose-response meta-analysis of prospective cohort studies by Mohammadi H, Jayedi A, […], Shab-Bidar S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29460808

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1 serving poultry corresponds to 100 gram raw poultry.
This meal provides 75 grams of poultry.
Poultry are chickens, turkeys, geese and ducks.

Objectives:
New studies indicate that resveratrol can significantly reduce plasma lipids, but the result of randomized clinical trials (RCTs) on resveratrol effect and the serum lipid profile are contradictory. Therefore, this review article (meta-analysis) has been conducted.  

Do resveratrol supplements reduce plasma lipids, like cholesterol levels?

Study design:
This review article included 21 RCTs.

Results and conclusions:
The investigators found resveratrol supplements had no significant effects on both:
-total cholesterol (TC) [WMD = 0.08 mmol/L, 95% CI = -0.23 to 0.08, p = 0.349, I2 = 87.8%];
-low-density lipoprotein (LDL-C or bad cholesterol) [WMD = -0.04 mmol/L, 95% CI = -0.21 to 0.12, p  = 0.620, I2 = 93.4%] and;
-high density lipoprotein (HDL-C or good cholesterol) [WMD = -0.01 mmol/L, 95% CI = -0.04 to 0.02, p = 0.269, I2 = 88.6%].

The investigators found resveratrol supplements had significant effects on
triacylglycerol (TG) [WMD = 0.58 mmol/L, 95% CI = 0.34 to 0.82, p 0.0001, I2 = 99.8%]. But after removing 1 study the significance was eliminated.

The investigators also found that sex, age, BMI, resveratrol dosage and intervention duration could not change the results.

The investigators concluded that resveratrol supplements do not change lipid profile concentration, like cholesterol levels. Confirmation of this conclusion will require more studies exclusively on dyslipidemic patients in which the intake of lipid lowering agents is among the exclusion criteria.

Original title:
Effect of resveratrol on lipid profile: An updated systematic review and meta-analysis on randomized clinical trials by Haghighatdoost F and Hariri M.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29305228

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Objectives:
What is the relationship between serum, dietary and urinary potassium and the risk of type 2 diabetes mellitus (T2DM)?  

Study design:
This review article included 8 prospective cohort studies involved 5,053 type 2 diabetes mellitus cases among 119,993 individuals.
The follow-up durations were from 5 to 18.1 years with a baseline age range from 18 to 95 years.
Serum potassium was measured using the ion-selective electrode method. Dietary potassium was estimated from food frequency questionnaire (FFQ). Urinary potassium samples were analyzed by potentiometric methods.
Most of the included studies provided risk estimates adjusted for age, sex, race, BMI and family history of diabetes.

Results and conclusions:
The investigators found in 5 studies involving 28,944 individuals and 3,849 type 2 diabetes mellitus cases, a non-significantly reduced risk of 21% [summary RR = 0.79, 95% CI = 0.60-1.04, I2 = 76.7%] for type 2 diabetes mellitus, when comparing the highest versus lowest serum potassium levels.
However, the sensitivity analysis did show a significant inverse association between serum potassium and type 2 diabetes mellitus risk [RR = 0.63, 95% CI = 0.52-0.73, I2 = 0%].

The investigators found in random dose-response meta-regression analysis a significantly reduced risk of 17% for type 2 diabetes mellitus [RR = 0.83, 95% CI = 0.73-0.95] per 1 mmol/L increase in serum potassium.

The investigators found in 6 studies involving 112,125 individuals and 4,573 type 2 diabetes mellitus cases, a non-significantly reduced risk of 7% [RR = 0.93, 95% CI = 0.81-1.06, I2 = 0.0%, p = 0.52] for type 2 diabetes mellitus, when comparing the highest versus lowest dietary potassium intake.
The sensitivity analysis did not significantly alter the association between dietary potassium and type 2 diabetes mellitus risk.

The investigators found there was no significant dose-response relationship between dietary potassium and type 2 diabetes mellitus risk [RR for every 1000mg increase dietary potassium per day = 1.00, 95% CI = 0.96-1.05].

The investigators found in 3 studies involving 4,376 individuals and 455 type 2 diabetes mellitus cases, a non-significantly reduced risk of 17% [RR = 0.83, 95% CI = 0.39-1.75, I2 = 73.9%, p = 0.02] for type 2 diabetes mellitus, when comparing the highest versus lowest urinary potassium levels.

The investigators found there was no significant dose-response relationship between urinary potassium levels and type 2 diabetes mellitus risk [RR for 10 mmol increase in urinary potassium per 24 hours = 1.00, 95% CI = 0.95-1.05].

The investigators concluded that serum potassium levels are linearly associated with the risk of type 2 diabetes mellitus, with each 1 mmol/L increase in serum potassium lowering the risk by 17%. However, neither dietary potassium nor urinary potassium shows any association with the risk of type 2 diabetes mellitus.

Original title:
Potassium measurements and risk of type 2 diabetes: a dose-response meta-analysis of prospective cohort studies by Peng Y, Zhong GC, […], Yang G.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725047/

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Objectives:
There are some indications of regional differences in the association between fish consumption and clinical outcomes. Therefore, this review article (meta-analysis) has been conducted.  

Are there regional differences in the association between fish consumption and risk of all-cause mortality and cardiovascular (CVD) mortality?

Study design:
This review article included 14 prospective cohort studies (10 publications) with 911,348 participants, of which 75,451 incident deaths.

Results and conclusions:
The investigators found dose-response meta-analysis showed a 20 g/d increment in fish consumption significantly reduced risk of cardiovascular mortality with 4% [relative risk = 0.96, 95% CI = 0.94-0.98, I2 = 0%, n = 8]. However, subgroup analysis resulted in a significant association only in Asian studies and not in Western studies.

The investigators found dose-response meta-analysis showed a 20 g/d increment in fish consumption significantly reduced risk of all-cause mortality with 2% [relative risk = 0.98, 95% CI = 0.97-1.00, I2 = 81.9%, n = 14]. However, subgroup analysis resulted in a significant association only in Asian studies and not in Western studies.

The investigators found analysis of Western studies suggested a nearly U-shaped association, with a nadir at fish consumption of 20 g/d in analysis of both outcomes. Meanwhile, the associations appeared to be linear in Asian studies.

The investigators concluded that fish consumption, particularly 20 g/d reduces boh risk of cardiovascular mortality and all-cause mortality. Furthermore, there is potential evidence of regional differences in the association between fish consumption and mortality. Therefore, it may be helpful to examine the associations by considering types of fish consumed and methods of fish preparation.

Original title:
Fish consumption and risk of all-cause and cardiovascular mortality: a dose-response meta-analysis of prospective observational studies by Jayedi A, Shab-Bidar S, […], Djafarian K.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29317009

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Objectives:
Over the last 7 years there has been intense debate about the advice to reduce saturated fat and increase polyunsaturated fat to reduce cardiovascular (CVD) risk. Therefore, this review article (meta-analysis) has been conducted.

Does replacement of saturated fat with carbohydrate, polyunsaturated fatty acid (PUFA) or monounsaturated fatty acid (MUFA) reduce cardiovascular risk?

Study design:
This review article included cohort studies and intervention studies.

Results and conclusions:
The investigators found replacement of saturated fat with any carbohydrate, polyunsaturated fatty acid (PUFA) and monounsaturated fatty acid (MUFA) is associated with lower mortality with PUFA being more effective than MUFA [19% reduction versus 11%].

The investigators found per 5% of energy (5 En%) replacement of saturated fat with polyunsaturated fatty acid and fish oil significantly lowered risk of cardiovascular mortality with 28%.  

The investigators found replacing saturated fat with PUFA or MUFA was equally effective at reducing coronary heart disease (CHD) events

The investigators found replacement of saturated fat with whole grains significantly lowered coronary heart disease events while replacement with sugar and starch significantly increased coronary heart disease events.

The investigators found replacement of saturated fat with carbohydrate had no effect on coronary heart disease events or death.

The investigators found only PUFA replacement of saturated fat significantly lowered coronary heart disease events and cardiovascular and total mortality.

The investigators concluded reducing saturated fat and replacing it with carbohydrate will not lower coronary heart disease events or cardiovascular mortality although it will reduce total mortality. Replacing saturated fat with PUFA, MUFA or high-quality carbohydrate will lower coronary heart disease events.

Original title:
A systematic review of the effect of dietary saturated and polyunsaturated fat on heart disease by Clifton PM and Keogh JB.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29174025

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Objectives:
What are the cardiovascular benefits of indiscriminate supplementation of omega-3 supplementation?

Study design:
This review article included 8 RCTs.

Results and conclusions:
The investigators found omega-3 supplementation significantly resulted in a 8% decrease of the risk of cardiac death, unless the patients are treated by statins.

The investigators found omega-3 supplementation prolonged quality adjusted life years by about a month. Old people gained less, whereas diabetes mellitus type 2 patients and people with history of cardiovascular events gained more.

The investigators concluded omega-3 supplementation decreases risk of cardiac death, unless the patients are treated by statins.

Original title:
The cardiovascular benefits of indiscriminate supplementation of omega-3 fatty acids; meta-analysis and decision-making approach by Leshno M, Goldbourt U, [...], Lichtenberg D.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29171335

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Objectives:
Beetroot is considered a complementary treatment for hypertension because of its high content of inorganic NO3.

The aim of this meta-analysis (review article) is to clarify several aspects of beetroot juice supplementation on systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Study design:
This review article included 22 RCTs with a total of 47 intervention (n = 650) and 43 control (n = 598) groups.

Results and conclusions:
The investigators found overall, systolic blood pressure [-3.55 mmHg, 95% CI = -4.55 to -2.54 mmHg] and diastolic blood pressure [-1.32 mmHg, 95% CI = -1.97 to -0.68 mmHg] were significantly lower in the beetroot juice-supplemented groups than in the control groups.

The investigators found the mean difference of systolic blood pressure was larger between beetroot juice-supplemented and control groups in the longer than in the shorter (≥14 compared with 14 days) study durations [-5.11 compared with -2.67 mmHg].

The investigators found the mean difference of systolic blood pressure was larger between beetroot juice-supplemented and control groups in the highest compared with the lowest (500 compared with 70 and 140 mL/d] doses of beetroot juice [-4.78 compared with -2.37 mmHg].

The investigators found a positive correlation between beetroot juice doses and the mean differences of blood pressures.

The investigators found a smaller effect size of blood pressures after supplementation with higher NO3 (milligrams per 100 mL beetroot juice).

The investigators found a weak effect size in a meta-analysis of trials that used NO3-depleted beetroot juice as a placebo compared with other interventions [-3.09 compared with -4.51 mmHg for systolic blood pressure and -0.81 compared with -2.01 mmHg for diastolic blood pressure].

The investigators concluded beetroot juice supplementation, particularly 500 mL/d beetroot juice during at least 14 days, reduces blood pressure.

Original title:
The Nitrate-Independent Blood Pressure-Lowering Effect of Beetroot Juice: A Systematic Review and Meta-Analysis by Bahadoran Z, Mirmiran P, […], Ghasemi A.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29141968

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Objectives:
What is the relationship of the intake of whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat and sugar-sweetened beverages (SSBs) and the risk of hypertension?

Study design:
This review article included 28 prospective cohort studies.

Results and conclusions:
The investigators found in dose-response meta-analysis of 4 studies with 28,069 incident hypertension cases, a significantly reduced risk of 8% [RR = 0.92, 95% CI = 0.87-0.98, I2 = 88%, p 0.0001] for hypertension for 30 g/day whole grains. Significant means that there is an association with a 95% confidence.
The reduced risk was highest (15%) at 90 g/day whole grains.

The investigators found in dose-response meta-analysis of 6 studies, a significantly reduced risk of 3% [RR = 0.97, 95% CI = 0.96-0.99, I2 = 64%, p = 0.02] for hypertension for 100 g/day fruits.
The strongest risk reduction was 7% at 300 g/day fruits.

The investigators found in dose-response meta-analysis of 9 studies with 31,509 incident hypertension cases, a significantly reduced risk of 5% [RR = 0.95, 95% CI = 0.94-0.97, I2 = 0%, p = 0.50] for hypertension for 200 g/day dairy products.
The strongest risk reduction was 15% at 800 g/day dairy products.

The investigators found in dose-response meta-analysis of 7 studies with 97,745 incident hypertension cases, a significantly increased risk of 14% [RR = 1.14, 95% CI = 1.02-1.28, I2 = 88%, p 0.001] for hypertension for 100 g/day red meat.
The increased risk was highest (40%) at 200 g/day red meat.

The investigators found in dose-response meta-analysis of 4 studies, a significantly increased risk of 12% [RR = 1.12, 95% CI = 1.00-1.26, I2 = 82%, p 0.001] for hypertension for 50 g/day processed meat.

The investigators found in dose-response meta-analysis of 4 studies, a significantly increased risk of 7% [RR = 1.07, 95% CI = 1.04-1.10, I2 = 64%, p = 0.04] for hypertension for 250 mL/day sugar-sweetened beverages.
The increased risk was highest (13%) at 450 mL/day sugar-sweetened beverages.

The investigators found compared with nonconsumption, an intake of 2 servings red meat/d [170g, RR = 1.35], 1 serving processed meat/d [35g, RR = 1.07], 1 serving fish/d [100g, RR = 1.08] and 2 servings sugar-sweetened beverages/d [500mL, RR = 1.14 was associated with a 78% increased risk of hypertension. On the other hand, a risk reduction by 44% would be achieved by not consuming these foods (red meat, processed meat, fish and sugar-sweetened beverages).

The investigators concluded a daily dietary intake of 30g whole grains, 100g fruits, 200g dairy products reduce risk of hypertension, whereas a daily dietary intake of 100g red meat, 50g processed meat, and 250mL sugar-sweetened beverages increase risk of hypertension. These findings need to be seen under the light of very-low to low credibility of meta-evidence. However, the findings support the current dietary recommendations in the primary prevention of hypertension.

Original title:
Food Groups and Risk of Hypertension: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies by Schwingshackl L, Schwedhelm C, […], Boeing H.

Link:
http://advances.nutrition.org/content/8/6/793.long

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Objectives:
Previous meta‐analyses on meat intake and risk of stroke did not report the effect of white meat (poultry meat, excluding fish) and did not examine stroke incidence and mortality separately. Therefore, this review article (meta-analysis) has been conducted.

What is the relationship of total (red and processed meat), red (unprocessed or fresh red meat) and processed (processed red meat) meat consumption along with white meat on risk of stroke incidence and mortality disease risk?

Study design:
This review article included 15 prospective cohort studies (254,742 participants with 9,522 stroke incidents and 487,150 participants with 12,999 cases of stroke mortality). The follow-up duration varied from 5.5 to 26 years.

There was no significant publication bias based on the Egger test except that the evaluation of total meat with stroke incidence reached the significance threshold.

The average score for study quality assessed by the Newcastle‐Ottawa Scale was 7.29 (range 7-8) for studies on meat consumption and stroke incidence and 6.87 (range 6-8) for those on stroke mortality.

Results and conclusions:
The investigators found that a high total meat (red and processed meat) consumption resulted in a significantly higher risk of 18% [pooled relative risk = 1.18, 95% CI = 1.09-1.28, I2 = 0%] for total stroke incidence. Significantly means that there is an association with a 95% confidence.

The investigators found that a high red meat consumption resulted in a significantly higher risk of 11% [pooled relative risk = 1.11, 95% CI = 1.03-1.20, I2 = 0%] for total stroke incidence.

The investigators found that a high processed meat consumption resulted in a significantly higher risk of 17% [pooled relative risk = 1.17, 95% CI = 1.08-1.25, I2 = 0%] for total stroke incidence.

The investigators found that a high white meat consumption resulted in a significantly lower risk of 13% [pooled relative risk = 0.87, 95% CI = 0.78-0.97, I2 = 0%] for total stroke incidence.

The investigators found, however, no significant associations between consumption of total [RR = 0.97, 95% CI = 0.85-1.11, I2 = 0%] or red meat [RR = 0.87, 95% CI = 0.64-1.18, I2 = 70.9%] and stroke mortality. No significant associations because RR of 1 was found in the 95% CI of 0.64 to 1.18. RR of 1 means no risk/association.

The investigators found that a high total meat consumption was associated with an increased risk of 41% for hemorrhagic stroke [RR = 1.41, 95% CI = 1.08-1.84, I2 = 0%], but no significant association was found between a high total meat consumption and ischemic stroke [RR = 1.16, 95% CI = 0.94-1.43, I2 = 40.6%].

The investigators found a positive association between total meat consumption and stroke incidence, regardless of sex, number of cases and follow‐up duration.

The investigators found when stratified by adjustment variables, studies that adjusted for family history of myocardial infarction, fruit and vegetable intake and use of aspirin showed a statistically significant relationship between total meat intake and risk of stroke compared with other studies that did not include those as adjustment variables.

The investigators found that a high red meat consumption was associated with an increased risk of 24% for ischemic stroke [RR = 1.24, 95% CI = 1.05-1.46, I2 = 17.7%], but no significant association was found between a high red meat consumption and hemorrhagic stroke [RR = 1.11, 95% CI = 0.89-1.38, I2 = 0%].

The investigators found that a high processed meat consumption was linked to neither ischemic [RR = 1.10, 95% CI = 0.96-1.27, I2 = 11.4%] nor hemorrhagic stroke [RR = 1.19, 95% CI = 0.95-1.49, I2 = 8.10%].

The investigators concluded that higher consumption of red or processed meat is associated with an increase in the risk of stroke, while higher intake of white meat is related to a reduction in stroke incidence. Therefore, recommendations for replacing proportions of red and processed meat to white meat for the prevention of stroke may be considered in clinical practice.

Original title:
Role of Total, Red, Processed, and White Meat Consumption in Stroke Incidence and Mortality: A Systematic Review and Meta-Analysis of Prospective Cohort Studies by Kim K, Hyeon J, […], Park SM.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634267/

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

Objectives:
Dietary fiber intake, especially viscous soluble fiber, has been established as a means to reduce cardiometabolic risk factors. Whether this is true for blood pressure remains controversial. Therefore, this review article (meta-analysis) has been conducted.

Does viscous soluble fiber supplementation reduce cardiovascular disease risk?

Study design:
This review article included 22 (n = 1430) and 21 RCTs (N = 1343) for systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively.

5 types of viscous fiber supplementation were β-glucan from oats and barley, guar gum, konjac, pectin and psyllium.

Results and conclusions:
The investigators found viscous soluble fiber supplementation significantly reduced systolic blood pressure [MD = -1.59 mmHg, 95% CI = -2.72 to -0.46, I2 = 72%, p 0.01] and diastolic blood pressure [MD = -0.39 mmHg, 95% CI = -0.76 to -0.01, I2 = 67%, p 0.01] at a median dose of 8.7 g/day (1.45-30 g/day) over a median follow-up of 7-weeks.

The investigators found within the five fiber types, systolic blood pressure reductions were observed only for supplementation using psyllium fiber [MD = -2.39 mmHg, 95% CI = -4.62 to -0.17].

The investigators concluded 8.7 g/day viscous soluble fiber supplementation, particularly psyllium fiber during 7 weeks reduces systolic blood pressure (SBP) and diastolic blood pressure (DBP). Therefore, inclusion of viscous fiber to habitual diets may have additional value in reducing cardiovascular risk via improvement in blood pressure.

Original title:
The effect of viscous soluble fiber on blood pressure: A systematic review and meta-analysis of randomized controlled trials by Khan K, Jovanovski E, […], Vuksan V.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29153856

Additional information of El Mondo:
Find more information/studies on fiber consumption, hypertension and cardiovascular diseases right here.

Objectives:
Elevated cholesterol has been linked to cardiovascular disease in adults and preclinical markers of atherosclerosis in children, thus reducing saturated (SFA) and trans-fatty acids (TFA) intake from an early age may help to reduce cholesterol and the risk of cardiovascular disease later in life. The World Health Organization (WHO) is currently updating its guidance on SFA and TFA intake in adults and children. Therefore, this review article (meta-analysis) has been conducted.

Does a diet with low saturated fatty acids reduce cholesterol and blood pressure in children and adolescents between 2 to 19 years of age?

Study design:
This review article included 8 RCTs (5 trials had a duration of 1 year and 3 had a duration of ≥ 1year with a total of 2,430 individual children and adolescents between 2 to 19 years of age) and 3 cohort studies.

Minimum duration was 13 days for RCTs and one year for cohort studies.

Saturated fatty acids intake was assessed using 24hr dietary recalls in 4 trials, 3-day diet records in 3 trials and food frequency questionnaires and/or checklists in 2 trials.

No trials were identified meeting the inclusion criteria for trans-fatty acids.

Publication bias was not assessed as the number of trials found was not sufficient to conduct funnel plot analyses for any outcome measure.

Results and conclusions:
The investigators found compared with control diets, there was a highly statistically significant effect of reduced saturated fatty acids intake on total cholesterol [MD = -0.16 mmol/L, 95% CI = -0.25 to -0.07, I2 = 64%], LDL cholesterol [MD = -0.13 mmol/L, 95% CI = -0.22 to -0.03, I2 = 77%] and diastolic blood pressure [MD = -1.45 mmol/L, 95% CI = -2.34 to -0.56].
The effects on cholesterol were greatest among those in which saturated fatty acids was replaced primarily with PUFA or MUFA and when the intervention group achieved a reduction in saturated fatty acids to below 10% of total energy intake.

The investigators found subgroup analysis of the effect of the initial lipid status of the participants showed a significantly different effect of saturated fatty acids reduction on total cholesterol [p = 0.05] between trials involving normolipidaemic/mixed status children [MD -0.21 mmol/L, 95% CI = -0.31 to -0.12] vs hyperlipidaemic children [MD = -0.08 mmol/L, 95% CI = -0.15 to -0.01].

The investigators found subgroup analysis of the effect of the initial lipid status of the participants showed the reduction in LDL cholesterol (bad cholesterol) was greater among the trials conducted in normolipidaemic/mixed status [MD -0.21 mmol/L, 95% CI = -0.30 to -0.13] vs hyperlipidaemic children [MD = -0.02 mmol/L, 95% CI = -0.14 to -0.11].

The investigators found there were no significant associations observed for HDL cholesterol (good cholesterol), triglycerides or apolipoproteins A1 or B.

The investigators found there were no significant associations observed between reduced saturated fatty acids intake and weight, height, body mass index (BMI) or waist circumference.

The investigators found there was no evidence of adverse effects of reducing saturated fatty acids intake in children on micronutrient intakes, cognitive development or sexual maturation in the small number of trials reporting these outcomes.  

The investigators concluded a diet with low saturated fatty acids reduces total cholesterol, LDL cholesterol and diastolic blood pressure in children and adolescents between 2 to 19 years of age without evidence of adverse effects on growth and development. The greatest effect on cholesterol occurred when saturated fatty acids was replaced with PUFA or a mixture of PUFA/MUFA and when saturated fatty acids intake was less than 10% of total energy intake. Therefore, dietary guidelines for children and adolescents should continue to recommend diets low in saturated fat.

Original title:
Health effects of saturated and trans-fatty acid intake in children and adolescents: Systematic review and meta-analysis by Morenga L and Montez JM.

Link:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186672

Additional information of El Mondo:
Find more information/studies on fat consumption, body mass index, hypertension, cholesterol and cardiovascular diseases right here.  

A diet with saturated fatty acids intake less than 10% of total energy intake is a diet with less than 10 En% saturated fat.
A diet with less than 10 En% saturated fat is a diet that is largely made up of meals/products with less than 10 En% saturated fat. Practically, this means that all meals/products that you eat on a daily basis should on average contain less than 10 En% saturated fat. Check here which products contain less than 10 En% saturated fat.

Objectives:
Despite growing evidence for food-based dietary patterns' potential to reduce cardiovascular disease risk, knowledge about the amounts of food associated with the greatest change in risk of specific cardiovascular outcomes and about the quality of meta-evidence is limited. Therefore, this review article (meta-analysis) has been conducted.

Which food-based dietary patterns reduce risk of cardiovascular diseases, such as coronary heart disease (CHD), stroke and heart failure (HF)?

Study design:
This review article included 123 prospective cohort studies.

Results and conclusions:
The investigators found whole grains significantly reduced risk of coronary heart disease with 5% [RR = 0.95, 95% CI = 0.92-0.98]. Significantly means that there is an association with a 95% confidence.

The investigators found whole grains significantly reduced risk of heart failure with 4% [RR = 0.96, 95% CI = 0.95-0.97]. Significantly because RR of 1 was not found in the 95% CI of 0.95 to 0.97. RR of 1 means no risk/association.

The investigators found vegetables significantly reduced risk of coronary heart disease with 3% [RR = 0.97, 95% CI = 0.96-0.99]. Significantly means it can be said with a 95% confidence that a intake of vegetables really decreased the risk of getting coronary heart disease with 3%.  

The investigators found fruits significantly reduced risk of coronary heart disease with 6% [RR = 0.94, 95% CI = 0.90-0.97].

The investigators found vegetables significantly reduced risk of stroke with 8% [RR = 0.92, 95% CI = 0.86-0.98].

The investigators found fruits significantly reduced risk of stroke with 10% [RR = 0.90, 95% CI = 0.84-0.97].

The investigators found nuts non-significantly reduced risk of coronary heart disease with 33% [RR = 0.67, 95% CI = 0.43-1.05]. Non-significantly means that there is no association with a 95% confidence.

The investigators found fish consumption significantly reduced risk of stroke with 14% [RR = 0.86, 95% CI = 0.75-0.99].

The investigators found fish consumption significantly reduced risk of heart failure with 20% [RR = 0.80, 95% CI = 0.67-0.95].

The investigators found egg significantly increased risk of heart failure with 16% [RR = 1.16, 95% CI = 1.03-1.31].

The investigators found red meat significantly increased risk of coronary heart disease with 15% [RR = 1.15, 95% CI = 1.08-1.23].

The investigators found red meat significantly increased risk of stroke with 12% [RR = 1.12, 95% CI = 1.06-1.17].

The investigators found red meat significantly increased risk of heart failure with 8% [RR = 1.08, 95% CI = 1.02-1.14].

The investigators found processed meat significantly increased risk of coronary heart disease with 27% [RR = 1.27, 95% CI = 1.09-1.49].

The investigators found processed meat significantly increased risk of stroke with 17% [RR = 1.17, 95% CI = 1.02-1.34].

The investigators found processed meat significantly increased risk of heart failure with 12% [RR = 1.12, 95% CI = 1.05-1.19].

The investigators found sugar-sweetened beverages significantly increased risk of coronary heart disease with 17% [RR = 1.17, 95% CI = 1.11-1.23].

The investigators found sugar-sweetened beverages significantly increased risk of heart failure with 7% [RR = 1.07, 95% CI = 1.02-1.12].

The investigators found sugar-sweetened beverages significantly increased risk of stroke with 8% [RR = 1.08, 95% CI = 1.05-1.12].

The investigators found there were clear indications for non-linear dose-response relationships between whole grains, fruit, nuts, dairy and red meat and coronary heart disease.

The investigators concluded there is a relationship between food-based dietary patterns and risk of cardiovascular diseases, with an increased risk for consumption of eggs, red meat, processed meat and sugar-sweetened beverages and a decreased risk for consumption of whole grains, vegetables, fruit and fish.

Original title:
Food groups and risk of coronary heart disease, stroke and heart failure: A systematic review and dose-response meta-analysis of prospective studies by Bechthold A, Boeing H, […], Schwingshackl L.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29039970

Additional information of El Mondo:
Find more information/studies on food groups and cardiovascular diseases right here. 

Objectives:
The therapeutic efficacy of coenzyme Q10 on patients with cardiac failure remains controversial. Therefore, this review article (meta-analysis) has been conducted.

Do patients with heart failure benefit from coenzyme Q10 supplements?

Study design:
This review article included a total of 14 RCTs with 1064 patients in coenzyme Q10 (treatment) group and 1085 patients in placebo (control) group.

Egger’s test results showed no significant evidence of publication bias in either endpoint.

Results and conclusions:
The investigators found compared with placebo, coenzyme Q10 supplementation significantly decreased mortality risk with 31% [RR = 0.69, 95% CI = 0.50 to 0.95, p = 0.02, I2 = 0%].

The investigators found a greater improvement in exercise capacity was established in patients who used coenzyme Q10 than in those who used placebo [SMD = 0.62, 95% CI = 0.02 to 0.30, p = 0.04, I2 = 54%].

The investigators found patients who used coenzyme Q10 and placebo associated with similar left heart ejection fraction [SMD = 0.14, 95% CI = -0.08 to 0.37, p = 0.22, I2 = 54%].

The investigators found no significant difference between coenzyme Q10 and placebo for NYHA classification [SMD = -0.70, 95% CI = -1.92 to 0.51, p = 0.26, I2 = 89%].

The investigators concluded in patients with heart failure, the administration of coenzyme Q10 results in lower mortality and improved exercise capacity compared with the effects of placebo treatment.

Original title:
Efficacy of coenzyme Q10 in patients with cardiac failure: a meta-analysis of clinical trials by Lei L and Liu Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525208/

Additional information of El Mondo:
Find more information/studies on coenzyme Q10 and cardiovascular diseases right here. 

Objectives:
Several previous meta-analyses show a consistent inverse association between nut consumption and all-cause mortality, but the associations with cause-specific mortality remain uncertain. Therefore, this meta-analysis (review article) has been conducted.

Does nut consumption reduce all-cause and cause-specific mortality?

Study design:
This review article included 18 prospective cohort studies with 81,034 deaths.

Results and conclusions:
The investigators found random-effects meta-analysis of 18 studies with 81,034 deaths showed a significant reduced risk of 19% [summary RR = 0.81, 95% CI = 0.78-0.84] for all-cause mortality for high compared with low nut consumption. This significant reduced risk was broadly consistent within subgroups according to various study and population characteristics and within sensitivity analyses that took into account potential confounders.

The investigators found random-effects meta-analysis of 17 studies with 20,381 deaths showed a significant reduced risk of 25% [summary RR = 0.75, 95% CI = 0.71-0.79] for cardiovascular mortality for high compared with low nut consumption. This significant reduced risk was broadly consistent within subgroups according to various study and population characteristics and within sensitivity analyses that took into account potential confounders.

The investigators found random-effects meta-analysis of 14 studies with 10,438 deaths showed a significant reduced risk of 27% [summary RR = 0.73, 95% CI = 0.67-0.80] for coronary heart disease mortality for high compared with low nut consumption. This significant reduced risk was broadly consistent within subgroups according to various study and population characteristics and within sensitivity analyses that took into account potential confounders.

The investigators found random-effects meta-analysis of 13 studies with 4,850 deaths showed a significant reduced risk of 18% [summary RR = 0.82, 95% CI = 0.73-0.91] for stroke mortality for high compared with low nut consumption. This significant reduced risk was broadly consistent within subgroups according to various study and population characteristics and within sensitivity analyses that took into account potential confounders.

The investigators found random-effects meta-analysis of 11 studies with 21,353 deaths showed a significant reduced risk of 13% [summary RR = 0.87, 95% CI = 0.80-0.93] for cancer mortality for high compared with low nut consumption. This significant reduced risk was broadly consistent within subgroups according to various study and population characteristics and within sensitivity analyses that took into account potential confounders.

The investigators found peanut (5 studies) and tree nut (3 studies) consumption were similarly associated with mortality risks.

The investigators found dose-response analyses suggested evidence for nonlinear associations between nut consumption and mortality [p-nonlinearity 0.001 for all outcomes except cancer mortality], with mortality risk levelling off at the consumption of about 3 servings per week (12g/day).

The investigators concluded that nut consumption is associated with reduced all-cause and cause-specific mortality, with the strongest reduction for coronary heart disease (CHD) mortality. Both tree nuts and peanuts lower mortality and most of the survival benefits could be achieved at a relative low level of nut consumption (up to 12g/day).

Original title:
Nut consumption in relation to all-cause and cause-specific mortality: a meta-analysis 18 prospective studies by Chen GC, Zhang R, [...], Qin LQ.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28875220

Additional information of El Mondo:
Find more information/studies on nut consumption, cancer, cardiovascular disease and stroke right here.
 

Objectives:
Anthocyanins are of interest due to their anti-oxidative and vasodilatory properties. Earlier reviews have shown that berries and other anthocyanin rich foods or extracts can improve vascular health. However, the effect of anthocyanins on vascular function has not yet been reviewed. Therefore, this review article (meta-analysis) has been conducted.

Does anthocyanin supplementation improve vascular function?

Study design:
This review article included 29 RCTs (15 were parallel and 14 were crossover designs).
Anthocyanin intakes ranged from 1 to 724 mg/day.
Most studies (n = 19) involved participants in the middle to older age group (mean age ≥ 40 years).
The number of participants that completed each study ranged from 10 to 146.
Intervention durations ranged from 1 h to 6 h in the acute studies and one week to six months in the chronic studies.

There was no publication bias.

Results and conclusions:
The investigators found compared to placebo-control, acute anthocyanin supplementation (1-8 h post consumption of anthocyanin doses between 7 and 724 mg) significantly improved FMD [SMD = 3.92%, 95% CI = 1.47 to 6.38, p = 0.002, I2 = 91.8%].
No improvements were observed in PAT-RHI [SMD = 0.08, 95% CI = -0.34 to 0.50, p = 0.71, I2 = 0%].
Collectively, (i.e., the pooling of studies using FMD and/or PAT-RHI) anthocyanins may improve vascular reactivity [overall SMD = 2.41, 95% CI = 0.91 to 3.91, p = 0.002, I2 = 92.6%].

The investigators found compared to placebo-control, acute anthocyanin supplementation (1-8 h post consumption of anthocyanin doses between 7 and 724 mg) also significantly improved arterial stiffness, using PWV [SMD = -1.27 m/s, 95% CI = -1.96 to -0.58, p = 0.000, I2 = 17.9%].

The investigators found pulse wave velocity was improved following acute anthocyanin supplementation only [SMD = -1.27 m/s, 95% CI = -1.96 to -0.58, p = 0.000, I2 = 17.8%]. 

The investigators found compared to placebo-control, chronic anthocyanin supplementation (one week to six months and used anthocyanin doses of 12 to 320 mg/day) significantly improved FMD [SMD = 0.84%, 95% CI = 0.55 to 1.12, p = 0.000, I2 = 62.5%].
Collectively (i.e., the pooling of studies using FMD and/or PAT-RHI), chronic anthocyanin supplementation may improve vascular reactivity [overall SMD = 0.77, 95% CI = 0.37 to 1.16, p = 0.000, I2 = 85.3%].

The investigators concluded that both acute and chronic anthocyanin supplementation improve vascular health, particularly with respect to vascular reactivity measured by FMD. However, more research is required to determine the optimal dosage and the long-term effects of anthocyanin consumption.

Original title:
The Effect of Anthocyanin-Rich Foods or Extracts on Vascular Function in Adults: A Systematic Review and Meta-Analysis of Randomised Controlled Trials by Fairlie-Jones L, Davison K, […], Hill AM.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579701/

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

Objectives:
Although epidemiological studies have examined the role of chocolate in preventing cardiometabolic disease, the results remain inconsistent. Therefore, this review article (meta-analysis) has been conducted.

Does chocolate consumption reduce risk of coronary heart disease (CHD), stroke and diabetes?

Study design:
This review article included 14 prospective cohort studies, with 508,705 participants from six countries and 7,267 coronary heart disease (CHD) cases, 8,197 stroke cases and 13,271 diabetes cases.
The follow-up duration of the studies ranged from 5 to 16 years.
One serving was defined as 30g of chocolate.
The majority of chocolate consumed in the included studies was milk or dark chocolate.

Results and conclusions:
The investigators found in 6 cohort studies for the highest versus lowest intake of chocolate a significant reduced risk of 10% for coronary heart disease [pooled RR = 0.90, 95% CI = 0.82-0.97, I2 = 24.3%, p = 0.25]. Leave-one-out sensitivity analysis had no significant influence on the pooled results.

The investigators found regarding CHD subtype, a significant reduced risk of 14% [RR = 0.86, 95% CI = 0.77-0.96] for myocardial infarction.

The investigators found for studies with follow-up duration of 10 years a significant reduced risk of 28% for coronary heart disease [RR = 0.72, 95% CI = 0.57-0.92].

The investigators found for studies with follow-up duration of ≥10 years a significant reduced risk of 8% for coronary heart disease [RR = 0.92, 95% CI = 0.86-0.99].

The investigators found in dose-response meta-analysis of 5 studies a curvilinear association between chocolate consumption and risk of coronary heart disease [p for nonlinearity = 0.006].

The investigators found in dose-response meta-analysis, compared with no intake, a significant reduced risk of 6% for coronary heart disease for 1 serving (30g) chocolate per week [RR = 0.94, 95 CI = 0.90-0.99].   

The investigators found in dose-response meta-analysis, compared with no intake, a significant reduced risk of 9% for coronary heart disease for 3 servings (90g) chocolate per week [RR = 0.91, 95 CI = 0.85-0.97].   

The investigators found in dose-response meta-analysis, compared with no intake, a significant reduced risk of 11% for coronary heart disease for 7 servings (210g) chocolate per week [RR = 0.89, 95 CI = 0.83-0.95].   

The investigators found in dose-response meta-analysis, compared with no intake, a significant reduced risk of 12% for coronary heart disease for 10 servings (300g) chocolate per week [RR = 0.88, 95 CI = 0.81-0.95].   

The investigators found in 8 reports from 7 studies for the highest versus lowest level of chocolate consumption a significant reduced risk of 16% for stroke [pooled RR = 0.84, 95% CI = 0.78-0.90, I2 = 0%, p = 0.49]. The pooled risk of total stroke was not obviously modified in the sensitivity analysis by excluding one study at a time
Egger’s test suggested the presence of publication bias [p = 0.008]. However, after introducing the “trim and fill” method to adjust this bias, the overall risk estimate remained significant in favor of chocolate intake [RR = 0.86, 95% CI = 0.79-0.92].

The investigators found with regard to stroke subtypes, a significant reduced risk of 13% [RR = 0.87, 95% CI = 0.78-0.96] for cerebral infarction and a significant reduced risk of 17% [RR = 0.83, 95% CI = 0.71-0.97] for hemorrhagic stroke.

The investigators found in the stratified analysis by gender, a significant reduced risk of 13% of total stroke for male [RR = 0.87, 95% CI = 0.79-0.97] and a significant reduced risk of 16% of total stroke for female [RR = 0.84, 95% CI = 0.74-0.94].

The investigators found a significant reduced risk of 44% for studies with follow-up durations of 10 years [RR = 0.56, 95% CI = 0.37-0.85].

The investigators found a significant reduced risk of 15% for studies with follow-up durations of ≥10 years [RR = 0.85, 95% CI = 0.79-0.91].

The investigators found in 7 reports from 6 studies a nonlinear correlation between chocolate intake and risk of stroke [p for nonlinearity = 0.001].

The investigators found in dose-response meta-analysis, compared with no intake, a significant reduced risk of 9% for stroke for 1 serving chocolate per week [RR = 0.91, 95% CI = 0.86-0.97].   

The investigators found in dose-response meta-analysis, compared with no intake, a significant reduced risk of 13% for stroke for 3 servings chocolate per week [RR = 0.87, 95% CI = 0.81-0.94].   

The investigators found in dose-response meta-analysis, compared with no intake, a significant reduced risk of 15% for stroke for 7 servings chocolate per week [RR = 0.85, 95% CI = 0.76-0.93].   

The investigators found in dose-response meta-analysis, compared with no intake, a significant reduced risk of 17% for stroke for 10 servings chocolate per week [RR = 0.83, 95% CI = 0.72-0.94].   

The investigators found in 4 studies using “trim and fill” method, for the highest versus lowest intake of chocolate, a non-significant reduced risk of 8% for diabetes [pooled RR = 0.92, 95% CI = 0.78-1.08].

The investigators found in stratified analysis by sex, a significant reduced risk of 21% [RR = 0.79, 95% CI = 0.65-0.96] for men and a non-significant reduced risk of 8% [RR = 0.92, 95% CI = 0.72-1.17] for women.
Similarly, the risks of diabetes were not different between subsets of studies with follow-up durations of below or over 10 years [p for interaction = 0.51].

The investigators found in dose-response meta-analysis of 6 reports, a curvilinear association between chocolate intake and risk of diabetes [p for nonlinearity 0.001].

The investigators found in dose-response meta-analysis, compared with no intake, a significant reduced risk of 20% for diabetes for 1 serving chocolate per week [RR = 0.80, 95% CI = 0.71-0.91]. Significant means that there is an association with a 95% confidence.

The investigators found in dose-response meta-analysis, compared with no intake, a significant reduced risk of 24% for diabetes for 3 servings chocolate per week [RR = 0.76, 95% CI = 0.63-0.91]. Significant because RR of 1 was not found in the 95% CI of 0.63 to 0.91. RR of 1 means no risk/association.

The investigators found in dose-response meta-analysis, compared with no intake, a non-significant reduced risk of 17% for diabetes for 7 servings chocolate per week [RR = 0.83, 95% CI = 0.67-1.03]. Non-significant means it cannot be said with a 95% confidence that 7 servings chocolate per week really decreased the risk of diabetes with 17%.

The investigators found in dose-response meta-analysis, compared with no intake, a non-significant reduced risk of 11% for diabetes for 10 servings chocolate per week [RR = 0.89, 95% CI = 0.69-1.16].   

The investigators found in general, the dose-response pattern was J-shaped and the peak reduction in diabetes risk occurred at an intake of 2 servings/week [RR = 0.75, 95% CI = 0.63-0.89], with no protective effects observed when consuming chocolate > 6 servings/week.

The investigators concluded that chocolate consumption confers reduced risks of coronary heart disease, stroke and diabetes. Consuming chocolate in moderation (1-6 servings/week or 30-180g) may be optimal for the prevention of these burdensome diseases. However, additional large prospective studies are required to confirm the observed benefits of chocolate in populations with different characteristics and to establish the optimum frequency of chocolate intake for preventing cardiometabolic disease.

Original title:
Chocolate Consumption and Risk of Coronary Heart Disease, Stroke, and Diabetes: A Meta-Analysis of Prospective Studies by Yuan S, Li X, […], Lu J.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537803/

Additional information of El Mondo:
Find more information/studies on chocolate, diabetes and cardiovascular diseases right here.

Objectives:
The clinical benefits of perioperative antioxidant vitamin therapy in cardiac patients remain controversial. Therefore, this review article (meta-analysis) has been conducted.

Do patients undergoing cardiac surgery benefit from perioperative antioxidant vitamin therapy?

Study design:
This review article included 12 RCTs with 1584 cardiac patients.

Results and conclusions:
The investigators found compared with placebo or no antioxidant vitamin therapy that administration of antioxidant vitamin therapy resulted in a significant reduction:
-in postoperative atrial fibrillation (POAF) [RR = 0.55, 95% CI = 0.42 to 0.73, p  0.0001];
-duration of hospital stay [MD = -0.68, 95% CI = -0.98 to -0.39, p  0.00001];
-intensive care unit length of stay [MD = -0.21, 95% CI = -0.30 to -0.12, p  0.00001] and;      
-intubation time [MD = -2.41, 95% CI = -3.83 to -0.98, p = 0.001].

The investigators also found a trend towards a decrease in postoperative complications [RR = 0.72, 95% CI = 0.48-1.08, p = 0.11] and duration of postoperative atrial fibrillation [MD = -1.950, 95% CI = -3.28 to 0.29, p = 0.10].

The investigators concluded that perioperative antioxidant vitamin therapy in patients undergoing cardiac surgery reduces the incidence of postoperative atrial fibrillation, duration of hospital stay, intensive care unit length of stay and intubation time.

Original title:
The clinical benefits of perioperative antioxidant vitamin therapy in patients undergoing cardiac surgery: a meta-analysis by Geng J, Qian J, […], Shen Z.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28645181

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

Objectives:
Studies implicate choline and betaine metabolite trimethylamine N-oxide (TMAO) in cardiovascular disease (CVD). Therefore, this review article (meta-analysis) has been conducted.

Is there an association between choline and betaine dietary intake and cardiovascular disease?

Study design:
This review article included a total of 6 prospective cohort studies comprising 18,076 incident cardiovascular disease events, 5,343 cardiovascular disease deaths among 184,010 participants.

There was no evidence for heterogeneity among studies.
Only 2 studies provided data on phosphatidylcholine and cardiovascular disease mortality.

Results and conclusions:
The investigators found in random effects meta-analysis, incident cardiovascular disease was not associated with choline [RR = 1.00, 95% CI = 0.98-1.02] or betaine [RR = 0.99, 95% CI = 0.98-1.01] dietary intake.
Results did not vary by study outcome (incident coronary heart disease, stroke, total cardiovascular disease).

The investigators found random effects meta-analysis did not support an association between choline and cardiovascular disease mortality [RR = 1.09, 95% CI = 0.89-1.35], but one study supported a positive association and there was significant heterogeneity [I2 = 84%, p 0.001].

The investigators concluded that there is no association between dietary choline/betaine intake with incident cardiovascular disease, but further research into choline and cardiovascular disease mortality are needed.

Original title:
Dietary Choline and Betaine and Risk of CVD: A Systematic Review and Meta-Analysis of Prospective Studies by Meyer KA and Shea JW.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28686188

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

Objectives:
Controversy exists on the association between alcohol consumption and risk of heart failure (HF). Therefore, this review article (meta-analysis) has been conducted.

Is there an association between alcohol consumption and risk of heart failure?

Study design:
This review article included a total of 13 prospective cohort studies, with 13,738 heart failure cases among 355,804 participants.

Results and conclusions:
The investigators found light alcohol drinking (0.1-7 drinks/week) significantly reduced risk of heart failure with 14% [RR = 0.86, 95% CI = 0.81-0.90]. However, there was no statistically significant association between moderate (7.1-14 drinks/week), high (14.1-28 drinks/week), or heavy (>28 drinks/week) alcohol consumption and heart failure risk.

The investigators found former drinking significantly increased risk of heart failure with 22% [RR = 1.22, 95% CI = 1.11-1.33] compared with never or occasional drinking.

The investigators concluded that light alcohol drinking (0.1-7 drinks/week) is associated with a lower risk of heart failure, while former drinking is associated with a higher risk of heart failure.

Original title:
Alcohol consumption and risk of heart failure: Meta-analysis of 13 prospective studies by Susanna C. Larsson, […], Alicja Wolk

Link:
http://www.sciencedirect.com/science/article/pii/S0261561417301681

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