Nutritional Advice El Mondo

Nutrition and health

Elderly

Scientific studies (review articles) on the relationship between diet/nutrients and elderly prevention:
One swallow does not make a summer. A famous Dutch saying that could not be any more obvious. Just because one single scientific study about a certain topic makes certain claims, it does not necessarily mean it is true. On the other hand, a review article (a collection of scientific studies on a certain topic) of randomized, placebo-controlled double blind clinical trials (RCTs) will answer the following question:
"Do taking dietary supplements make sense?" Yes for a positive conclusion and no for a negative conclusion.

One swallow does not make a summer. A famous Dutch saying that could not be any more obvious. Just because one single scientific study about a certain topic makes certain claims, it does not necessarily mean it is true. On the other hand, a review article (a collection of scientific studies on a certain topic) of cohort studies or case-control studies will answer the following question:
"Should I change my diet?".

2024:

  1. Daily 500mg n-3 PUFA during 12 months improve cognitive functions 
  2. 15 g/day fish protein dietary intake may reduce fractures
     

2023:

  1. High selenium dietary intake reduces hip fracture
  2. Lower serum magnesium concentrations increase fractures
  3. Lower blood carotenoid level is a risk factor for dementia
  4. High antioxidant dietary intake reduces Alzheimer's disease
  5. Fish consumption reduces Alzheimer's disease

2022:

  1. High dietary intake of vitamin E reduces dementia
  2. Skim milk, poultry and non-meat animal products reduce age-related eye disease
  3. 800-1,000 IU/d vitamin D3 reduces fracture and fall risk among elderly
  4. 400 IU/day to 300,000 IU vitamin D supplementation improves handgrip strength in postmenopausal women
  5. Higher concentration of carotenoids and vitamin E in blood reduce age-related macular degeneration
  6. Protein supplementation + exercise increase lower-extremity strength in healthy older Asian adults with sarcopenia

2021:

  1. 100 µg/d vitamin K2 + 1000 mg/d calcium supplements increase lumbar spine bone mineral
  2. Mushroom consumption reduces all-cause mortality
  3. 200-700 g/d fruits and vegetables consumption decreases frailty
  4. Monounsaturated fatty acids dietary intake reduces all-cause mortality
  5. Chair-based exercise programmes improve upper extremity and lower extremity function in older adults
  6. Supplementation with 320-729 mg/d magnesium may improve sleep in older adults with insomnia
  7. <11 g/day alcohol and <2.8 cups/day coffee reduce cognitive deficits
  8. Higher plasma DHA and EPA levels reduce advanced age-related macular degeneration
  9. Alcohol consumption increases risk of any fractures
  10. 0.5-50 mg/d carotenoid supplementation improves cognitive performance among healthy adults
  11. Daily 700-1000 mg dietary calcium intake increases cardiovascular disease in healthy postmenopausal women
  12. Daily egg consumption have beneficial effects on macular pigment optical density
  13. A high dietary intake of β-cryptoxanthin reduce osteoporosis and hip fracture

2020:

  1. EPA + DHA supplements for at least 6 months increase walking speed among the elderly
  2. 54 mg/day genistein increase bone mineral density in postmenopausal women
  3. Vitamin K + D supplement increase bone mineral density
  4. Dairy products increase bone mineral density in postmenopausal women:
  5. LDL cholesterol levels >121 mg/dL increase Alzheimer's disease
  6. Dietary intake of vitamin C-rich foods reduces risk of osteoporosis
  7. Higher linoleic acid blood concentration reduces cancer mortality
  8. Statins improve activities of daily living ability in Alzheimer disease patients
  9. Carbohydrate intake does not increase risk of fracture
  10. Middle-aged people with diabetes are at higher risk of developing dementia

2019:

  1. miRNAs may be a promising biomarker for Alzheimer's disease
  2. 1 drink or more per day increases osteoporosis
  3. Low folate levels increase risk of depression among the aged people
  4. Lower vitamin E levels increase Alzheimer's disease
  5. High serum uric acid level decreases risk of fractures
  6. Soy/soy products consumption reduce risk of mortality from cardiovascular diseases
  7. High homocysteine level increases Alzheimer disease
  8. One serving of fruits and vegetables per day reduces fractures
  9. Saturated fat increases Alzheimer disease
  10. Vegetable-based diet reduces osteoporosis in postmenopausal women
  11. Diet with high total antioxidant capacity decreases cancer mortality
  12. Potato consumption does not increase risk of mortality in adults
  13. Dietary intake of 5 mg/d vitamin A reduces age-related cataract

2018:

  1. Alzheimer's disease patients have a low plasma vitamin E level
  2. A diet with high antioxidant properties reduces all-cause mortality risk
  3. All-cause mortality risk is lowest with a diet with 50-55 En% carbohydrates
  4. A low selenium level in the brain increases Alzheimer’s disease
  5. Monounsaturated fatty acids intake derived from animal sources increase risk of fracture
  6. High fish consumption decreases risk of age-related macular degeneration
  7. Coronary heart disease and heart failure increase risk of dementia
  8. Inflammatory markers are associated with an increased risk of all-cause dementia
  9. Insulin-degrading enzyme protein level is lower in Alzheimer's disease patients
  10. Vitamin D level of 25 to 35 ng/mL decreases risk of dementia and Alzheimer's disease
  11. Aerobic exercise benefits global cognition in mild cognitive impairment patients
  12. A high consumption of yogurt and cheese reduces hip fracture
  13. Regular aerobic exercise delays cognitive decline among individuals having Alzheimer's disease

2017:

  1. High tea consumption reduces hip fracture risk among women
  2. Dietary intake of n-3 PUFAs declines hip fracture risk
  3. Every 500 kcal increase per week reduce Alzheimer’s disease with 13%
  4. Higher dietary intake of vitamin A decreases total fracture risk
  5. A high vitamin D level increases walking speed among older adults
  6. Fruit and vegetables reduce risk of cognitive disorders
  7. Atrial fibrillation, previous stroke, myocardial infarction, hypertension, diabetes and previous TIA increase risk of post-stroke dementia
  8. At least 28 g/d whole grain intake reduce risk of total, cardiovascular and cancer mortality
  9. 50 mg/day dietary vitamin C intake decreases hip fracture risk
  10. At least 4 servings/week fish is associated with decreasing memory decline
  11. Low vitamin D status is related to poorer cognition in healthy adults
  12. Serum zinc/iron levels are decreased in Alzheimer's disease patients
  13. Circulatory selenium concentration is lower in Alzheimer's disease patients
  14. Higher protein intake may increase bone mineral density
  15. Tea consumption increases bone mineral density
  16. Daily 50μg vitamin K dietary intake decreases the risk of fractures
  17. Manganese deficiency may be a risk factor for Alzheimer’s disease
  18. Olive oil intake reduces risk of type 2 diabetes
  19. Weekly 100 grams fish reduces dementia of Alzheimer type
  20. Long-term cheese consumption does not increase risk of all-cause mortality
  21. Daily 100g fruit and vegetable reduces risk of cognitive impairment and dementia among elderly
  22. Decreased walking pace increases risk of dementia in elderly populations

2015:

  1. Serum non-ceruloplasmin copper is higher in Alzheimer's disease
  2. At least 580 mg/day DHA or 1 g/day DHA/EPA improves memory function in older adults with mild memory complaints

2013:

  1. 300 μg/d dietary lutein and zeaxanthin intake reduce nuclear cataract

2012:

  1. 75-87.5 nmol/L vitamin D decrease mortality in the general population
  2. Daily 54 mg soy isoflavone for 6 weeks to 12 months reduces the frequency and severity of hot flashes
  3. Diabetes increases risk of dementia and mild cognitive impairment
  4. Dietary intakes of vitamin C and E lower risk of Alzheimer's disease

2011:

  1. Alzheimer's disease patients have higher levels of copper

2009:

  1. Isoflavone-rich soy products decrease FSH and LH in premenopausal women

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Most developed world countries have accepted the chronological age of 65 years as a definition of elderly. The common problems in elderly are:

https://elmondo.org/en/dementia

  • Decreased vision
  • Pneumonia
  • Deterioration of hearing
  • Loss of appetite and thirst
  • Muscle loss
  • Malnutrition

Nutrition has a marked effect on the aging process. For example, a good nutritional status can retard the aging process while a daily energy intake below 1700 kcal can cause a deficiency of vitamins and minerals. A deficiency of vitamins and minerals can in turn accelerate the aging process.

The aging process does not begin at 65 of age, but already at 30 or even at younger age.

One consequence of elderly is the loss of muscle strength. Per year an elderly will lose around 0.25 kg muscle. Muscle loss can be counteracted by strength training (60-85% of 1RM and 3-4 times per week). Muscle loss will result in a lower resting metabolic rate.

Dietary guidelines for elderly:

  • To maintain strong bones in elderly, is advisable to choose products with 15-25 En% protein or your daily diet (=the average of all meals/products that you eat on a daily basis) should look like this:
    15-25 En% protein, 30-35 En% fat, of which 7-10 En% saturated fat, maximum 0.3 gram salt per 100 kcal and 1.3- 1.5 grams of fiber per 100 kcal. The easiest way to meet this diet is to choose for meals/products with also 15-25 En% protein, 30-35 En% fat, of which 7-10 En% saturated fat, maximum 0.3 gram salt per 100 kcal and 1.3- 1.5 grams of fiber per 100 kcal.
    However,  the most important factors for bone maintenance in elderly are 60-90 minutes of physical exercise (preferably strength training) per day in combination with 15-30 micrograms vitamin D and 1 gram calcium or more per day.
  • Stop smoking because smoking causes atherosclerosis. Atherosclerosis is a major risk factor for developing cardiovascular diseases.
  • Aim for a healthy weight. A healthy weight has a BMI of 18.5-25. BMI is weight divided by height squared (weight (kg)/height2 (m)).
  • Spend at least 60-90 minutes per day on physical exercises or at least 10000 steps per day.
  • Eat at least 2 times a week (100-150 g fish per time) oily fishes or take daily 250-500 mg EPA and DHA. EPA and DHA are found in fish oil supplements. However, fish oil supplements cannot match the positive effects of eating fish.
  • Oily fishes are sardines, herring, salmon, anchovies, eel and mackerel.
  • Eat 300 grams of vegetables and five servings of fruit per day or 30 grams of fiber per day. 10-30 grams of fiber a day decreases the LDL cholesterol levels.
  • 30 grams of fiber per dag corresponds to a daily diet of minimum 1.5 grams of fiber per 100 kcal.
  • Limit alcohol to 2-3 glasses for men and 1-2 glasses for women per day.
  • Eat no more than 6 grams of salt per day, corresponding to 2400 mg of sodium.
  • 6 grams of salt per day corresponds to a daily diet of <0.3 g salt per 100 kcal.
  • Eat no more than 200 grams of cholesterol per day at an elevated LDL cholesterol level.
  • Eat no more than 19 grams of saturated fat per day at 2500 kcal and 15 grams of saturated fat at 2000 kcal. The WHO advises 2000 kcal per day for women and 2500 kcal for men.
  • Eat with other people because group eating can increase the appetite. Elderly people often have a poor appetite.
  • Put every day 1 bottle of 2 liters of water on the table. This ensures that you’ll get enough fluid because the sensation of thirst in the elderly can be significantly reduced.
  • Take daily 15-30 micrograms (600-1200 IU) of vitamin D. Take dietary supplements always in consultation with a dietitian, nutritionist or your GP!
  • Take daily a multi-vitamin supplement.
  • Take 500 micrograms of folic acid per day at a high homocysteine ​​level.
  • Take daily 1000 mg calcium. It can be through diet or dietary supplements.
  • Do not take antioxidant supplements. They do more harm than good!
  • It is preferable to obtain antioxidants through diet (200-300 grams of vegetables and 2-5 servings of fruit per day).

Cardiovascular diseases

Scientific studies (review articles) on the relationship between diet/nutrients and cardiovascular diseases:
One swallow does not make a summer. A famous Dutch saying that could not be any more obvious. Just because one single scientific study about a certain topic makes certain claims, it does not necessarily mean it is true. On the other hand, a review article (a collection of scientific studies on a certain topic) of randomized, placebo-controlled double blind clinical trials (RCTs) will answer the following question:
"Do taking dietary supplements make sense?" Yes for a positive conclusion and no for a negative conclusion.

One swallow does not make a summer. A famous Dutch saying that could not be any more obvious. Just because one single scientific study about a certain topic makes certain claims, it does not necessarily mean it is true. On the other hand, a review article (a collection of scientific studies on a certain topic) of cohort studies or case-control studies will answer the following question:
"Should I change my diet?".

2024:

  1. Folic acid supplementation reduces stroke
  2. 50 to 250 mg/day dietary betaine intake increase stroke mortality
  3. Higher alcohol intake increases stroke
  4. 25 mg carotenoid supplements decrease blood pressure
  5. Coenzyme Q10 supplements improve endothelial function 

2023:

  1. 500 mL/d orange juice consumption causally reduce bad cholesterol
  2. 30g/d whole grains consumption reduce all-cause mortality
  3. Dietary intake of 200-700 mg/day calcium reduces stroke among Asians
  4. Green tea may causally improve risk factors of cardiovascular disease
  5. Green tea causally lowers blood pressure in healthy individuals

2022:

  1. 20 g/day olive oil reduce all-cause mortality
  2. 25-200 g/d peanuts may causally reduce total cholesterol levels
  3. Brassica vegetables causally reduce total cholesterol
  4. Higher dietary fiber intake improves causally cardiovascular risk factors
  5. 500 mg/d dietary flavonoid intake reduces cardiovascular disease, diabetes and hypertension
  6. Serum vitamin D concentrations between 40 and 75 nmol/L reduce hypertension in adult
  7. 200 mg/day flavan-3-ols dietary intake reduce stroke
  8. Dietary oat supplementation may improve BMI among obese participants with mild metabolic disturbances

2021:

  1. Purified anthocyanin supplements reduce cardiovascular risk
  2. HDL cholesterol level under 2.33 mmol/L reduces cardiovascular disease mortality
  3. Higher sodium and lower potassium reduce in a dose-response manner cardiovascular risk
  4. 4000 mg inositol supplements reduce blood pressure
  5. 25 mg/d dietary flavonols or 5 mg/d dietary flavones reduce coronary heart disease
  6. Low-carbohydrate diets decrease LDL particle number
  7. Onion causally increases good cholesterol
  8. Dyslipidemia increases severity and mortality of COVID-19
  9. Best cut-off point of homocysteine for predicting acute ischemic stroke is 20.0 μmol/L
  10. Green leafy vegetables reduce cardiovascular disease
  11. Clinical screening for blood pressure in cerebral palsy is needed
  12. White meat reduces all-cause mortality
  13. Obesity increases atrial fibrillation recurrence in patients undergoing catheter ablation
  14. Cardiovascular drugs may not be associated with poor COVID-19 outcomes
  15. Low to moderate alcohol intake decreases venous thromboembolism
  16. Rice bran oil causally decreases cholesterol and triglyceride levels in adults
  17. Most prevalent neurological comorbidity in COVID-19 is cerebrovascular disease
  18. Weekly 175-350 grams oily fish lower cardiovascular disease among patients with vascular disease
  19. Mortality is more frequently in COVID-19 patients with chronic kidney diseases and cardiovascular disease
  20. Soy consumption causally lowers blood pressure in adults
  21. Daily 700-1000 mg dietary calcium intake increases cardiovascular disease in healthy postmenopausal women
  22. High NT-pro BNP and CK-MB levels in COVID-19 patients correlate with worse outcomes
  23. Diet with <30 En% carbohydrates causally increases adiponectin concentration in adults
  24. Omega-3 fatty acids consumption reduce recurrent venous thromboembolism

2020:

  1. 1-mg/day dietary heme iron intake increase cardiovascular disease mortality
  2. <3 cups/d coffee is essential for the prevention of dyslipidemia
  3. Higher intakes of total protein reduce all-cause mortality
  4. 2-3 servings/week fish reduce all-cause mortality in patients with type 2 diabetes
  5. Every 1 gram sodium increases cardiovascular disease risk by 6%
  6. Most prevalent comorbidities among COVID-19 are hypertension, diabetes, cardiovascular disease, liver disease, lung disease, malignancy, cerebrovascular disease, COPD and asthma
  7. A higher fish consumption reduces coronary heart disease
  8. Dietary intake of vitamin B6 and folate reduces stroke
  9. A high serum vitamin C reduces blood pressure
  10. Male, age, cardiovascular disease, hypertension and diabetes mellitus increase mortality in patients with COVID-19
  11. Green tea reduces blood pressure in subjects with hypertension
  12. Potassium intake from 3,128 mg per day increases blood pressure
  13. Tomato consumption reduces bad cholesterol levels
  14. 200-1500 mg/d dietary calcium intakes do not increase cardiovascular disease
  15. 1-3 eggs/day during 3 to 12 weeks have no effect on blood pressure
  16. 100 mg/day magnesium dietary intake reduce type 2 diabetes
  17. Alzheimer disease increases risk of hemorrhagic stroke
  18. Pneumococcal vaccination may decrease all-cause mortality in patients with cardiovascular disease
  19. 100-g/d fish consumption decreases liver cancer
  20. Yogurt intake is associated with a reduced risk of type 2 diabetes
  21. Daily 1 cup tea decreases all-cause mortality among elderly
  22. Hypertension, diabetes, COPD, cardiovascular disease and cerebrovascular disease are major risk factors for patients with COVID-19
  23. Hypertension, cardiovascular diseases, diabetes mellitus, smoking, COPD, malignancy and chronic kidney disease are risk factors for COVID-19 infection
  24. Flaxseed supplementation decreases plasma lipoprotein(a) levels
  25. Higher linoleic acid blood concentration reduces cancer mortality
  26. Cardiovascular metabolic diseases increase risk of corona virus infection
  27. Vitamin C supplements during ≥6 weeks reduce blood pressure
  28. Quercetin supplements decrease triglycerides levels
  29. Heart failure increases risk of all-cause dementia
  30. Low-carbohydrate diet reduces cardiovascular disease

2019:

  1. Grape products reduce bad cholesterol in adults
  2. <400 mg coffee bean extract supplementation reduces blood pressure in hypertensive patients
  3. Higher circulating concentration of vitamin C, vitamin E and β-carotene reduce cardiovascular mortality
  4. Saturated fat increases Alzheimer disease
  5. Dietary intakes of anthocyanins reduce hypertension
  6. Cashew consumption improves triglyceride levels
  7. Coenzyme Q10 supplements reduce inflammation in patients with coronary artery disease
  8. Kiwifruit does not improve cardiovascular risk factors
  9. Trans fatty acids intake increases cardiovascular disease
  10. Diet with high total antioxidant capacity decreases cancer mortality
  11. Peanut consumption more than 12 weeks increases good cholesterol

2018:

  1. High dietary vitamin E intake reduces risk of stroke
  2. Diet with medium-chain saturated fatty acids leads to higher HDL cholesterol
  3. 150 g/day French-fries consumption increases risk of hypertension
  4. 10,000 steps a day do not decrease blood pressure in healthy adults
  5. Walnut-enriched diet reduces cholesterol and triglyceride levels
  6. Higher sodium intake and higher dietary sodium-to-potassium ratio are associated with a higher risk of stroke
  7. EPA/DHA ratio of < 1 reduces risk of postoperative atrial fibrillation after coronary artery bypass grafting
  8. Coronary heart disease and heart failure increase risk of dementia
  9. Coenzyme Q10 supplementation reduces serum triglycerides levels of patients with metabolic disorders
  10. Olive oil consumption decreases LDL cholesterol and triglyceride less than other plant oils
  11. 1 serving/week poultry intake reduces risk of stroke among US people
  12. Resveratrol supplements do not reduce LDL-cholesterol levels
  13. 20g/d of fish consumption reduce risk of CVD mortality

2017:

  1. Replacing saturated fat with PUFA will lower coronary heart disease events
  2. Omega-3 supplementation decreases risk of cardiac death
  3. 500 mL/d beetroot juice reduces blood pressure
  4. Atrial fibrillation, previous stroke, myocardial infarction, hypertension, diabetes and previous TIA increase risk of post-stroke dementia
  5. Daily dietary intake of 30g whole grains, 100g fruits and 200g dairy products reduce risk of hypertension
  6. At least 28 g/d whole grain intake reduce risk of total, cardiovascular and cancer mortality
  7. Red and processed meat increase risk of stroke
  8. 8.7 g/day viscous soluble fiber during 7 weeks reduces blood pressure
  9. A diet with <10 En% saturated fat reduces cholesterol and blood pressure in children
  10. Consumption of whole grains, fish, vegetables and fruit decrease risk of cardiovascular diseases
  11. Coenzyme Q10 supplements result in lower mortality and improved exercise capacity of patients with heart failure
  12. EPA and DHA supplements reduce risk of cardiovascular diseases
  13. Up to 12g/day nut consumption is associated with reduced all-cause and coronary heart disease mortality
  14. 1-724 mg/day anthocyanin supplementation improve vascular health
  15. Weekly 30-180 gram chocolate consumption reduces risk of coronary heart disease, stroke and diabetes
  16. Resistance training reduces blood pressure in prehypertensive and hypertensive subjects
  17. Perioperative antioxidant vitamin therapy in patients undergoing cardiac surgery reduces the incidence of postoperative atrial fibrillation and duration of hospital stay
  18. No association between dietary choline/betaine with incident cardiovascular disease
  19. 0.1-7 drinks/week reduce risk of heart failure
  20. 100-mg/day flavonoids decrease risk of all-cause and cardiovascular disease mortality
  21. Potassium supplementation for at least 4 weeks reduces blood pressure of patients with essential hypertension
  22. 100 mg/day dietary magnesium intake is associated with lower risk of hypertension
  23. Daily 1 egg increases heart failure risk
  24. A daily dose of ≥200 g yogurt intake decreases cardiovascular disease risk
  25. Sesame consumption reduces systolic blood pressure
  26. Higher lycopene exposure reduces risk of cardiovascular diseases
  27. Abdominal adiposity and higher body fat mass increase risk of atrial fibrillation
  28. Tomatoes reduce cardiovascular risk among adults

2016:

  1. Elevated serum phosphorus concentration increases risk of all-cause mortality among men without chronic kidney disease
  2. Garlic supplementation reduces cardiovascular disease risk

2015:

  1. Vitamin B1 deficiency increases systolic heart failure risk
  2. A high GL diet is a risk factor of stroke events

2014:

  1. Olive oil consumption reduces stroke
  2. Perioperative antioxidant supplementations with NAC, PUFA and vitamin C prevent atrial fibrillation after cardiac surgery

2013:

  1. A reduction of 4.4 g/day salt causes important falls in blood pressure in people with both raised and normal blood pressure

2012:

  1. A low GI diet decreases LDL-cholesterol
  2. Flavonoid supplements show significant improvements in vascular function and blood pressure

2011:

  1. Daily dietary intake of 1.6g potassium decreases risk of stroke

2002:

  1. 240 mg magnesium per day decrease systolic blood pressure

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Cardiovascular disease is a class of diseases that involves the heart or blood vessels (arteries, capillaries and veins). Cardiovascular diseases are TIA, heart attack, stroke and vascular disease of the large vessels, such as claudication. Cardiovascular diseases are currently number 1 cause of death in the Western world.

The main causes of cardiovascular diseases are:

Rules of thumb:

  • % reduction of cholesterol = % risk reduction of cardiovascular disease.
  • Per kg weight loss = 1 mmHg blood pressure reduction. So from 130 to 120 mmHg would practically mean 10 kg weight loss.
  • Each gram of salt above 6 grams of salt per day will increase the blood pressure by 1 mmHg.

Daily intake of 3 grams of plant sterols or stanols during 2-3 weeks reduces the LDL cholesterol level by 11.3%. However, avoiding dietary cholesterol is not the solution to a high cholesterol level.  The solution is to choose products with maximum 30 En% fat, and maximum 7 En% saturated fat.

It is very difficult to decrease the cholesterol level by 15% by diet only.

A cholesterol lowering diet contains:

  • Products with maximum 30 En%
  • Products with maximum 7 En% saturated fat
  • Products with maximum 15 En% protein
  • Up to 200 grams of cholesterol per day
  • Products with at least 1.5 grams of fiber per 100 kcal

Heredity also plays a role in cardiovascular diseases. The inherited forms of cardiovascular disease are:

  • Hypertrophic cardiomyopathy (=a heart disease in which the heart muscle is thickened)
  • Dilated cardiomyopathy (=a heart disease in which the heart muscle is dilated)
  • Long-QT syndrome
  • Catecholaminergic polymorphic ventricular tachycardia (CPVT)
  • Brugada syndrome
  • Arrhythmogenic right ventricular dysplasia (ARVD)
  • Familial hypercholesterolemia (FH)

Symptoms of myocardial infarction in men and women are not the same.

Symptoms of myocardial infarction in men are chest pressure, sweating and pain radiating to the arms and jaw.

Symptoms that may indicate a heart attack in women are:

  • Palpitations (pounding heart)
  • Sudden dizziness, a feeling of weakness
  • Insomnia
  • An uncomfortable feeling in the stomach, possibly with nausea
  • A sudden onset of extreme fatigue
  • Shortness of breath
  • Burning sensation below the sternum
  • Unpleasant clamping or tightness in the chest
  • Unpleasant sensation or pain between the shoulder blades, pain in the neck

Dietary guidelines for cardiovascular disease prevention:

  • Choose products with maximum 30 En% fat, products with maximum 7 En% saturated fat, products with maximum 0.3 gram salt per 100 kcal, products with minimum 1.5 grams of fiber per 100 kcal and for fish which provides at least 1000 mg of EPA and DHA per day or in other words, your daily diet (=all meals/products that you eat on a daily basis on average) should contain maximum 30 En% fat, of which maximum 7 En% saturated fat, maximum 0.3 gram salt per 100 kcal and minimum 1.5 grams of fiber per 100 kcal.
  • Stop smoking because smoking causes atherosclerosis.
  • Aim for a healthy weight. A healthy weight has a BMI of 18.5-25. BMI is weight divided by height squared (weight (kg)/height2 (m)).
  • Spend at least 60-90 minutes of physical exercises per day or at least 10000 steps per day.
  • Eat at least 2 times (100-150 g fish per time) a week oily fish. Oily fishes are sardines, herring, salmon, anchovies, eel and mackerel.
  • Eat 250 mg omega-3 fatty acids per day. Omega-3 fatty acids are alpha-linolenic acid, EPA and DHA.
  • Eat 300 grams of vegetables and five servings of fruit per day or 30 grams of fiber per day.
    30 grams of fiber per dag corresponds to a daily diet of minimum 1.5 grams of fiber per 100 kcal.
    10 to 30 grams of fiber a day decreases the LDL cholesterol levels.
  • Eat plenty of whole grains (brown bread, brown rice and oats) and legumes.
  • Limit alcohol consumption to 2 glasses for men and 1 glass for women per day.
  • Eat no more than 6 grams of salt per day, corresponding to 2400 mg of sodium.
  • Eat no more than 200 grams of cholesterol per day at an elevated LDL-cholesterol level.
  • Eat no more than 19 grams of saturated fat per day at 2500 calories diet and 15 grams of saturated fat at 2000 kcal diet. The WHO advises 2000 kcal per day for women and 2500 kcal for men.
  • Take 500 micrograms of folic acid per day at a high homocysteine ​​level.
  • Do not take antioxidant supplements. They do more harm than good!
    Consult your doctor or a dietician when taking dietary supplements!
Target values ​​for a healthy heart:
MeasurementReference values
Total cholesterol level< 4.5 mmol/l
HDL cholesterol level for men> 0.9 mmol/l
HDL cholesterol level for women > 1.1 mmol/l
LDL cholesterol level< 2.5 mmol/l
Triglycerides (blood fats) level< 2.5 mmol/l
Fasting blood sugar level< 6 mmol/l
HbA1c< 7%
Homocysteine level< 12 micromol/l
Blood pressure120/80 mmHg.
120 is systolic blood pressure &
 80 is diastolic blood pressure
Blood pressure in people over 60 years140/90 mmHg

 

Lifestyle measures for the treatment and prevention of high blood pressure
Lifestyle changesRecommendationReduction of systolic blood pressure
Weight lossA healthy weight has a BMI of 18.5-25 kg/m25-20 mmHg
Salt reductionUp to 6 grams of salt a day or 2400 mg of sodium per day2-8 mmHg
Potassium intakePer every increment of 0.6 gram1 mmHg
Physical activities30-60 minutes of physical activity per day4-9 mmHg
Alcohol consumptionMaximum 2 glasses for  men & 1 glass for women2-4 mmHg
DASH dietNutritional pattern rich in fruits, vegetables and low-fat products8-14 mmHg
This table shows that the best way to prevent high blood pressure is to maintain a healthy weight

Cancer

Scientific studies (review articles) on the relationship between diet/nutrients and cancer prevention:
One swallow does not make a summer. A famous Dutch saying that could not be any more obvious. Just because one single scientific study about a certain topic makes certain claims, it does not necessarily mean it is true. On the other hand, a review article (a collection of scientific studies on a certain topic) of randomized, placebo-controlled double blind clinical trials (RCTs) will answer the following question:
"Do taking dietary supplements make sense?" Yes for a positive conclusion and no for a negative conclusion.

One swallow does not make a summer. A famous Dutch saying that could not be any more obvious. Just because one single scientific study about a certain topic makes certain claims, it does not necessarily mean it is true. On the other hand, a review article (a collection of scientific studies on a certain topic) of cohort studies or case-control studies will answer the following question:
"Should I change my diet?".

 

2024:

  1. Higher carotenoids levels reduce breast cancer
  2. Daily 61g tofu reduce cancer 
  3. Daily 150-200mg dietary vitamin C reduce gastric cancer 

2023:

  1. 10 mg/d isoflavone dietary intake reduce breast cancer
  2. Higher tissue levels of linoleic acid reduce prostate cancer
  3. High blood vitamin B6 levels reduce colorectal cancer
  4. Higher choline dietary intake may reduce breast cancer

2022:

  1. Fruits and vegetables reduce endometrial cancer
  2. Higher blood levels of alpha-linolenic acid reduce colorectal cancer
  3. High folate dietary intake reduces colon cancer in people with medium or high alcohol consumption
  4. Higher dietary intake of processed meat increases hepatocellular carcinoma
  5. Dietary intake of vegetables and vitamin C could reduce renal cell carcinoma
  6. A high olive oil consumption reduces cancer risk
  7. Postoperative coffee or caffeine consumption causally reduces postoperative ileus

2021:

  1. 600 mg/d vitamin E supplementation decreases chemotherapy-induced peripheral neuropathy
  2. Dendritic cell vaccine provides no benefits for newly diagnosed glioblastoma
  3. Breastfeeding reduces ovarian cancer in women with BRCA1 or BRCA2 mutation
  4. No association between consumption of carrot and bladder cancer
  5. Omega-3 PUFA supplementation may reduce chemotherapy-induced peripheral neuropathy
  6. High consumption of cruciferous vegetables, citrus fruits, garlic and tomatoes may reduce colorectal cancer
  7. Obesity increases colorectal cancer in men with Lynch Syndrome
  8. Dietary calcium intake reduces colorectal adenomas
  9. High consumption of dietary trans fat increases prostate cancer and colorectal cancer
  10. Hyperlipidemia, obesity and high alcohol consumption are risk factors of early-onset colorectal cancer
  11. Guarana supplementation does not reduce cancer-related fatigue
  12. CoQ10 supplementation reduces markers of inflammation and MMPs in patients with breast cancer
  13. Obesity is a risk factor for mortality from primary liver cancer
  14. Branched-chain amino acids supplementation during oncological surgical period may reduce post-operative morbidity from infections and ascites
  15. High saturated fat increases liver cancer
  16. Coffee and tea consumption reduce glioma
  17. Higher mushroom consumption reduces breast cancer
  18. 1 cup/d green tea reduces esophageal cancer among women
  19. Malignancy increases severe/critical COVID-19
  20. Anti-cancer therapy have no adverse effects on severity and mortality in cancer patients with COVID-19
  21. No association between potato consumption and cancers
  22. 100 mg/d dietary magnesium intakes reduce cancer mortality
  23. Daily 60 to 80 grams citrus fruit reduce lung cancer
  24. A low selenium level increases breast cancer
  25. No association between fish intake and pancreatic cancer
  26. No association between dietary acrylamide intake and breast, endometrial and ovarian cancer

2020:

  1. Vegetable and fruit consumption reduce biliary cancer
  2. Tree nuts reduce cancer mortality
  3. A high plasma folate level does not reduce breast cancer
  4. Higher intakes of total protein reduce all-cause mortality
  5. Higher vitamin C dietary intake reduces breast cancer
  6. Habitual tea consumption reduces nasopharyngeal cancer
  7. Ovarian cancer survivors should consume 300 g/d vegetables and 300 g/d fruit
  8. Fat, cholesterol and vitamin A increase ovarian cancer
  9. Circulating concentrations of α-carotene, β-carotene and lutein and zeaxanthin reduce bladder cancer
  10. Dietary omega-3 PUFAs intake reduce digestive system cancers
  11. 40 g/day of pickled vegetable increase gastric cancer
  12. Higher vitamin B2 and B6 dietary intake decreases ER-/PR- breast cancer
  13. 30 min/day light-intensity physical activity reduce cancer mortality
  14. 100-g/d fish consumption decreases liver cancer
  15. Dietary intake of vitamin A reduces ovarian cancer among North Americans
  16. Nitrite dietary intake increases non-Hodgkin lymphoma in females
  17. Carbohydrate dietary intake may decrease esophageal cancer
  18. Hepatitis C increases pancreatic cancer
  19. Higher linoleic acid blood concentration reduces cancer mortality
  20. Waist circumference is a significant risk factor of liver cancer
  21. Tea consumption may reduce colorectal cancer in female
  22. Daily 20 grams tree nuts reduces cancer of the digestive system
  23. Green tea reduces stomach cancer
  24. Dietary salt intake increases risk of esophageal cancer
  25. Garlic could reduce risk of colorectal cancer

2019:

  1. Dietary fiber intake reduces endometrial cancer
  2. High β-carotene concentration reduces bladder cancer
  3. High consumption of polyunsaturated fat increases skin cancer
  4. 100g fruit per day decrease lung cancer in former smokers
  5. Carrot consumption decreases the lung cancer adenocarcinoma
  6. 0.5 g/day dietary trans fat intake increases ovarian cancer
  7. High serum iron levels increase breast cancer risk
  8. Egg consumption is not associated with brain cancer risk
  9. Tea reduces brain cancer in American population
  10. Decaffeinated coffee consumption could reduce ovarian cancer
  11. Diet with high total antioxidant capacity decreases cancer mortality
  12. Omega-3 fatty acids in fish consumption reduce breast cancer in Asian patients
  13. Physical activity reduces lung cancer among smokers
  14. Trans fatty acids are not associated with risk of breast cancer
  15. Daily 100 μg dietary folate intake reduce oestrogen-receptor-negative breast cancer
  16. 100-300 g/day fruit or vegetables reduce all-cause mortality

2018:

  1. 10g dietary fiber intake per day may reduce ovarian cancer risk
  2. 1 μg/day dietary B12 intake increases esophageal cancer
  3. Protein intake does not increase prostate cancer
  4. No association between vitamin A, C, D, E and lycopene and risk of non-Hodgkin lymphoma
  5. Wine consumption is not associated with colorectal cancer
  6. Dietary carrot intake reduces breast cancer
  7. High intake of dietary flavonols, flavones and anthocyanidins may decrease colorectal cancer
  8. Calcium intake of <750 mg per day could be a risk factor for prostate cancer
  9. No association between carbohydrate intake and prostate cancer risk
  10. 5 mg/day vitamin B2 intake reduces colorectal cancer risk
  11. Moderate consumption of white wine increases the risk of prostate cancer
  12. Citrus fruit intake reduces risk of esophageal cancer
  13. Daily 10 mcg dietary intake of vitamin D decreases risk of pancreatic cancer
  14. Every 5 kg/m2 increase in BMI corresponds to a 2% increase in breast cancer risk in women
  15. A high dietary cholesterol intake might increase lung cancer risk
  16. Daily higher cooked tomatoes and sauces consumption reduces prostate cancer risk

2017:

  1. Saturated fat increases breast cancer mortality among women
  2. Daily dietary intake of 100g red meat and 50g processed meat increase risk of colorectal cancer
  3. Daily 2-4 g carnitine does not reduce cancer-related fatigue
  4. At least 28 g/d whole grain intake reduce risk of total, cardiovascular and cancer mortality
  5. High intake of cooked carrot might be associated with a low incidence of urothelial cancer
  6. Breastfeeding during 6-9 months reduces risk of endometrial cancer
  7. N-3 PUFA supplementation improves immune function and reduces the level of inflammation in gastrointestinal cancer patients postoperatively
  8. Plant-based dietary patterns decrease cancer risk
  9. Up to 12g/day nut consumption is associated with reduced all-cause and coronary heart disease mortality
  10. A high intake of red meat increases risk of lung cancer among non-smokers
  11. High serum selenium levels reduce risk of cervical cancer among women
  12. Both high vitamin E intake and circulating vitamin E levels could reduce cervical neoplasia risk
  13. High intakes of saturated fat increase risk of lung cancer
  14. Vitamin and antioxidant supplements have no overall preventive effect against bladder cancer
  15. At least 1600 mg/day calcium may reduce the recurrence of colorectal adenomas
  16. High levels of physical activity reduce risk of breast cancer in postmenopausal women with a BMI until 30
  17. Daily 100g processed and red meat intake increase esophageal cancer risk
  18. No more than 175 mg/d dietary DHA intake reduces endometrial cancer
  19. Daily 621 mg dietary calcium has protective effect against esophageal cancer in Asian populations
  20. 1-3 servings/d vegetables may lower risk of renal cell carcinoma
  21. Daily 20 grams legume reduces risk of prostate cancer
  22. Daily 300 mcg dietary iodine may decrease risk of thyroid cancer
  23. Daily 2 mg dietary lycopene consumption reduces prostate cancer risk
  24. At least 7 cups/day green tea intake reduce prostate cancer
  25. 1 mg/day dietary vitamin B2 intake reduces risk of breast cancer
  26. Higher dietary carbohydrate intake increases colorectal cancer risk in men
  27. A high total fat consumption increases non-Hodgkin's lymphoma
  28. Daily 2 mg dietary vitamin E intake reduces lung cancer risk
  29. 20 mg/d isoflavones dieatary intake reduces risk of colorectal neoplasms in Asians
  30. Elevated serum selenium levels may decrease high-grade prostate cancer among current and former smokers

2015:

  1. 100-400g/day fruits and vegetables reduce risk of lung cancer
  2. High garlic and onion consumption are likely to reduce gastric cancer risk
  3. Manganese deficiency may increase breast cancer
  4. High dietary vitamin B9, D, B6 and B2 intake reduces risk of colorectal cancer
  5. Red meat induced colorectal cancer is not modified by NAT2 enzyme activity

2014:

  1. Low-fat diet reduces recurrence of breast cancer
  2. Cruciferous vegetable intake protects against cancer of the colon
  3. Recreational physical activity reduces risk of gastric cancer
  4. Daily 200-320 micrograms dietary folate intake reduce breast cancer risk
  5. 100 g/day red meat intake may increase gastric cancer risk
  6. Red meat consumption increases esophageal cancer risk
  7. White meat and fish consumption reduce risk of hepatocellular carcinoma

2012:

  1. High salt intake increases gastric cancer
  2. High intake of vegetables and fruit decreases risk of esophageal squamous cell carcinoma

2011:

  1. Olive oil consumption probably reduces breast cancer and cancer of the digestive system

XXXXXXXXXXXXXXXX

The human body consists of organs like liver, lungs and heart. Organs consist of tissues and tissue consists of cells. Under normal circumstances cells only divide when needed, e.g. at recovery, growth and wound healing. This process is also called controlled cell division. Controlled cell division is necessary and innocent. However, it becomes dangerous when cell division within a particular organ is no longer under control. In that case, is called cancer. Cancer is a disorder, characterized by uncontrolled cell division in a particular organ. Cancer is often deadly when there is metastasis.

The oxidative DNA damage is a major risk factor for developing cancer. Antioxidants can protect the DNA against oxidative damage. Oxidative damages can be caused by free radicals.

The word "cancer" is derived from the Latin word "cancer", which means "lobster". There are several types of cancer.

Cancer mortality can be reduced if cases are detected and treated early. There are 2 components of early detection efforts:

  • early diagnosis
  • screening

Cancer is a leading cause of death worldwide.
The most common in 2020 (in terms of new cases of cancer) were:

  • breast
  • lung
  • colon and rectum
  • prostate
  • skin (non-melanoma)
  • stomach

The most common causes of cancer death in 2020 were:

  • lung
  • colon and rectum
  • liver
  • stomach
  • breast

Between 30 and 50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies.

Dietary guidelines for cancer prevention:

  • 7-points nutritional profile of cancer prevention is a diet with:
    1. maximum 30 En% fat
    2. maximum 7 En% saturated fat
    3. maximum 0.2 grams salt per 100 kcal
    4. minimum 1.5 grams fiber per 100 kcal
    5. maximum 70 En% carbohydrates
    6. maximum 25 En% sugar
    7. maximum 35 En% protein
  • The easiest way to follow this diet is to choose only products/meals with:
    1. maximum 30 En% fat
    2. maximum 7 En% saturated fat
    3. maximum 0.2 grams salt per 100 kcal
    4. minimum 1.5 grams fiber per 100 kcal
    5. maximum 70 En% carbohydrates
    6. maximum 25 En% sugar
    7. maximum 35 En% protein
  • However, the most practical way to follow this diet is, all your daily consumed products/meals should contain on average:
    1. maximum 30 En% fat
    2. maximum 7 En% saturated fat
    3. maximum 0.2 grams salt per 100 kcal
    4. minimum 1.5 grams fiber per 100 kcal
    5. maximum 70 En% carbohydrates
    6. maximum 25 En% sugar
    7. maximum 35 En% protein
  • Use the 7-points nutritional profile app to see if your daily diet contains:
    1. maximum 30 En% fat
    2. maximum 7 En% saturated fat
    3. maximum 0.2 grams salt per 100 kcal
    4. minimum 1.5 grams fiber per 100 kcal
    5. maximum 70 En% carbohydrates
    6. maximum 25 En% sugar
    7. maximum 35 En% protein
  • Eat fish that provides at least 250 mg EPA and DHA per day.
  • Aim for a healthy weight. A healthy weight has a BMI of 18.5-25. BMI is weight divided by height squared (weight (kg)/height2 (m)).
  • Spend at least 60-90 minutes per day on physical exercises or at least 10,000 steps per day.
  • Eat 25-30 grams of vegetables and 2-5 servings of fruit a day or at least 25 grams of fiber per day.
    25grams of fiber per day corresponds to a daily diet of 1.3 grams of fiber per 100 kcal.
  • Eat plenty of whole grains, such as brown bread, oatmeal and legumes.
  • Limit to 2 glasses of alcohol for men and 1 glass for women a day or <20 g alcohol per day.
  • Eat no more than 6 grams of salt per day, corresponding to 2400 mg of sodium.
    6 grams salt per day corresponds to a daily diet of <0.3 g salt per 100 kcal.
  • Do not take antioxidant supplements. They do more harm than good!
  • Eat no more than 500g of red meat per week. Red meat increases the risk of developing colorectal cancer.

Different types of cancer:

Cardiovascular diseases

Cardiovascular disease is a class of diseases that involves the heart or blood vessels (arteries, capillaries and veins). Cardiovascular diseases are TIA, heart attack, stroke and vascular disease of the large vessels, such as claudication. Cardiovascular diseases are currently number 1 cause of death in the Western world.

The main causes of cardiovascular diseases are:

  • Arteriosclerosis (a thickening and hardening of arteries)
  • Type 2 diabetes
  • High blood pressure
  • High cholesterol levels
  • High homocysteine ​​levels
  • Obesity

Rules of thumb:

  • % reduction of cholesterol = % risk reduction of cardiovascular disease.
  • Per kg weight loss = 1 mmHg blood pressure reduction. So from 130 to 120 mmHg would practically mean 10 kg weight loss.
  • Each gram of salt above 6 grams of salt per day will increase the blood pressure by 1 mmHg.

Daily intake of 3 grams of plant sterols or stanols during 2-3 weeks reduces the LDL cholesterol level by 11.3%. However, avoiding dietary cholesterol is not the solution to a high cholesterol level.  The solution is to choose products with maximum 30 En% fat, and maximum 7 En% saturated fat.

It is very difficult to decrease the cholesterol level by 15% by diet only.

A cholesterol lowering diet contains:

  • Products with maximum 30 En% fat
  • Products with maximum 7 En% saturated fat
  • Products with maximum 15 En% protein
  • Up to 200 grams of cholesterol per day
  • Products with at least 1.5 grams of fiber per 100 kcal
     

Heredity also plays a role in cardiovascular diseases. The inherited forms of cardiovascular disease are:

  • Hypertrophic cardiomyopathy (=a heart disease in which the heart muscle is thickened)
  • Dilated cardiomyopathy (=a heart disease in which the heart muscle is dilated)
  • Long-QT syndrome
  • Catecholaminergic polymorphic ventricular tachycardia (CPVT)
  • Brugada syndrome
  • Arrhythmogenic right ventricular dysplasia (ARVD)
  • Familial hypercholesterolemia (FH)

Symptoms of myocardial infarction in men and women are not the same.

Symptoms of myocardial infarction in men are chest pressure, sweating and pain radiating to the arms and jaw.

Symptoms that may indicate a heart attack in women are:

  • Palpitations (pounding heart)
  • Sudden dizziness, a feeling of weakness
  • Insomnia
  • An uncomfortable feeling in the stomach, possibly with nausea
  • A sudden onset of extreme fatigue
  • Shortness of breath
  • Burning sensation below the sternum
  • Unpleasant clamping or tightness in the chest
  • Unpleasant sensation or pain between the shoulder blades, pain in the neck

Dietary guidelines for cardiovascular disease prevention:

  • Choose products with maximum 30-35 En% fat, products with maximum 7-10 En% saturated fat, products with maximum 0.1 gram of sodium per 100 g (100 ml) product, products with minimum 1.5 grams of fiber per 100 kcal and for fish which provides at least 1000 mg of EPA and DHA per day.
  • Stop smoking because smoking causes atherosclerosis.
  • Aim for a healthy weight. A healthy weight has a BMI of 18.5-25. BMI is weight divided by height squared (weight (kg)/height2 (m)).
  • Spend at least 60-90 minutes of physical exercises per day or at least 10000 steps per day.
  • Eat at least 2 times (100-150 g fish per time) a week oily fish. Oily fishes are sardines, herring, salmon, anchovies, eel and mackerel.
  • Eat 250 mg omega-3 fatty acids per day. Omega-3 fatty acids are alpha-linolenic acid, EPA and DHA.
  • Eat 300 grams of vegetables and five servings of fruit per day or 30 grams of fiber per day.
    30 grams of fiber per dag corresponds to a daily diet of minimum 1.5 grams of fiber per 100 kcal.
    10 to 30 grams of fiber a day decreases the LDL cholesterol levels.
  • Eat plenty of whole grains (brown bread, brown rice and oats) and legumes.
  • Limit alcohol consumption to 2 glasses for men and 1 glass for women per day.
  • Eat no more than 6 grams of salt per day, corresponding to 2400 mg of sodium.
  • Eat no more than 200 grams of cholesterol per day at an elevated LDL-cholesterol level.
  • Eat no more than 19 grams of saturated fat per day at 2500 calories diet and 15 grams of saturated fat at 2000 kcal diet. The WHO advises 2000 kcal per day for women and 2500 kcal for men.
  • Take 500 micrograms of folic acid per day at a high homocysteine ​​level.
  • Do not take antioxidant supplements. They do more harm than good!
    Consult your doctor or a dietician when taking dietary supplements!

Target values ​​for a healthy heart:

MeasurementReference values
Total cholesterol level< 4.5 mmol/l
HDL cholesterol level for men> 0.9 mmol/l
HDL cholesterol level for women > 1.1 mmol/l
LDL cholesterol level< 2.5 mmol/l
Triglycerides (blood fats) level< 2.5 mmol/l
Fasting blood sugar level< 6 mmol/l
HbA1c< 7%
Homocysteine level< 12 micromol/l
Blood pressure120/80 mmHg.
120 is systolic blood pressure &
 80 is diastolic blood pressure
Blood pressure in people over 60 years140/90 mmHg

 

Lifestyle measures for the treatment and prevention of high blood pressure

Lifestyle changes

Recommendation

Reduction of systolic blood pressure

Weight lossA healthy weight has a BMI of 18.5-25 kg/m2

5-20 mmHg

Salt reductionUp to 6 grams of salt a day or 2400 mg of sodium per day

2-8 mmHg

Potassium intakePer every increment of 0.6 gram

1 mmHg

Physical activities30-60 minutes of physical activity per day

4-9 mmHg

Alcohol consumptionMaximum 2 glasses for  men & 1 glass for women

2-4 mmHg

DASH dietNutritional pattern rich in fruits, vegetables and low-fat products

8-14 mmHg

This table shows that the best way to prevent high blood pressure is to maintain a healthy weight


Scientific studies on the relationship between diet/nutrients and cardiovascular diseases.
Review articles of randomized, placebo-controlled double-blind clinical trials (RCTs) will answer the following question:
"Is taking dietary supplements make sense?". Yes at a positive conclusion and no at a negative conclusion.

Review articles of cohort studies or case-control studies will answer the following question:
"Should I change my diet?".

2017:

  1. Abdominal adiposity and higher body fat mass increase risk of atrial fibrillation
  2. Tomatoes reduce cardiovascular risk among adults

Cancer

The human body consists of organs like liver, lungs and heart. Organs consists of tissues, and tissue consists of cells. Under normal circumstances cells only divide when needed, e.g. at recovery, growth and wound healing. This process is also called controlled cell division. Controlled cell division is necessary and innocent. However, it becomes dangerous when cell division within a particular organ is no longer under control. In that case, is called cancer. Cancer is a disorder, characterized by uncontrolled cell division in a particular organ. Cancer is often deadly when there is metastasis.

The oxidative DNA damage is a major risk factor for developing cancer. Antioxidants can protect the DNA against oxidative damage. Oxidative damages can be caused by free radicals.

The word "cancer" is derived from the Latin word "cancer", which means "lobster". There are several types of cancer.

Cancer mortality can be reduced if cases are detected and treated early. There are two components of early detection efforts:

  • Early diagnosis
  • Screening

Cancer is a leading cause of death worldwide. The main types of cancer are lung, stomach, liver, colorectal, breast and cervical cancer.
Cancer of the lung is the most common cancer in the world.
Lung, stomach, liver, colon and breast cancer cause the most cancer deaths each year.

35% of cancer cases is due to a wrong diet, such as high fat, high salt and/or less fruit and vegetables diet.

Dietary guidelines for cancer prevention:

  • Choose products with maximum 35 En% fat, products with maximum 10 En% saturated fat, products with maximum 0.5 g of sodium per 100 g (100 ml) product, products with minimum 1.3 grams of fiber per 100 kcal and fish providing at least 250 mg EPA and DHA per day.
  • Aim for a healthy weight. A healthy weight has a BMI of 18.5-25. BMI is weight divided by height squared (weight (kg)/height2 (m)).
  • Spend at least 60-90 minutes per day on physical exercises or at least 10000 steps per day.
  • Eat 25-30 grams of vegetables and 2-5 servings of fruit a day or 25-30 grams of fiber per day.
    30 grams of fiber per dag corresponds to a daily diet of minimum 1.5 grams of fiber per 100 kcal.
  • Eat plenty of whole grains, such as brown bread, oatmeal and legumes.
  • Limit to 2-3 glasses of alcohol for men, and 1-2 glasses for women a day or <30 g alcohol per day.
  • Eat no more than 6 grams of salt per day, corresponding to 2400 mg of sodium.
    6 grams salt per day corresponds to a daily diet of <0.3 g salt per 100 kcal.
  • Do not take antioxidant supplements. They do more harm than good!
  • Eat no more than 500 g of red meat per week. Red meat increases the risk of developing colorectal cancer.

Scientific studies on the relationship between diet/nutrients and cancer.
Review articles of randomized, placebo-controlled double-blind clinical trials (RCTs) will answer the following question:
"Is taking dietary supplements make sense?". Yes at a positive conclusion and no at a negative conclusion.

Review articles of cohort studies or case-control studies will answer the following question:
"Should I change my diet?".

  1. Elevated serum selenium levels may decrease high-grade prostate cancer among current and former smokers

Daily 500mg n-3 PUFA during 12 months improve cognitive functions

Objectives:
Omega-3 polyunsaturated fatty acids (n-3 PUFA) have been suggested as a cognitive enhancing agent, though their effect is doubtful. Therefore, this review article has been conducted.

Does supplementation of n-3 PUFA improve cognitive functions of non-demented individuals exclusively of middle age or older? 

Study design:
This review article included 24 RCTs with a total of 9,660 participants.
The length of intervention ranged from 3 to 36 months and the daily dose of n-3 PUFA ranged from 230 to 4000 mg/day. 
6  studies were conducted in countries where the nationwide blood levels of DHA + EPA were notably low, measuring ≤ 4% in erythrocyte equivalents. 

Results and conclusions:
The investigators found that the beneficial effect on executive function demonstrated an upward trend within the initial 12 months of intervention. 
This effect was prominently observed with a daily intake surpassing 500 mg of n-3 PUFA and up to 420 mg of eicosapentaenoic acid (EPA). 

The investigators found a descending curve following 12 months of n-3 PUFA intervention and when the dosage of EPA exceeded 420 mg/d.  

The investigators found, furthermore, these trends exhibit heightened significance in regions where the levels of blood docosahexaenoic acid (DHA) + EPA are not very low.

The investigators concluded supplementation of n-3 PUFA (a daily intake surpassing 500mg n-3 PUFA or up to 420mg of EPA during 12 months) has potential benefits to executive function in non-demented individuals exclusively of middle age or older, particularly in individuals whose dietary DHA + EPA level is not substantially diminished. 

Original title: 
The influence of n-3 polyunsaturated fatty acids on cognitive function in individuals without dementia: a systematic review and dose–response meta-analysis by Suh SW, Lim E, […], Kim KW. 

Link: 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10929146/

Additional information of El Mondo:
Find more information/studies on EPA and DHA and elderly right here. 

50 to 250 mg/day dietary betaine intake increase stroke mortality

 

Objectives:
Do dietary choline and betaine increase mortality risk?

 

Study design:
This review article included 6 cohort studies comprising 482,778 total participants, 57,235 all-cause, 9,351 cardiovascular disease and 4,400 stroke deaths.

 

Results and conclusions:
The investigators found linear dose-response analysis showed that each 100 mg/day increase in dietary choline intake was significantly associated with 6% increases in risk of all-cause mortality [RR = 1.06, 95% CI = 1.03 to 1.10, I2 = 83.7%, p < 0.001].

 

The investigators found linear dose-response analysis showed that each 100 mg/day increase in dietary choline intake was significantly associated with 11% increases in risk of cardiovascular diseases mortality [RR = 1.11, 95% CI = 1.06 to 1.16, I2 = 54.3%, p = 0.02].

 

The investigators found the result of the nonlinear dose-response analysis showed a significant relationship between dietary betaine intake and stroke mortality at the dosages of 50 to 250 mg/day [p non-linearity= 0.0017]. 

 

The investigators concluded 100 mg/day of choline consumption is associated with a 6% and 11% higher risk of all-cause and cardiovascular disease mortality, respectively. In addition, a positive relationship between betaine dietary intake and stroke mortality at doses of 50 to 250 mg/day is observed. Due to the small number of the included studies and heterogeneity among them more well-designed prospective observational studies considering potential confounding variables are required. 

 

Original title: 
Higher dietary choline intake is associated with increased risk of all-cause and cause-specific mortality: A systematic review and dose-response meta-analysis of cohort studies by Sharifi-Zahabi E, Soltani S, […], Shidfar F. 
 

Link:
https://pubmed.ncbi.nlm.nih.gov/39341000/

 

Additional information of El Mondo:
Find here more information/studies about RCTs/significant, choline, and stroke. 

 

Betaine-rich foods are

  • American Indian/Alaska native foods
  • Baked products
  • Beef products
  • Cereal grains and pasta
  • Restaurant foods
  • Snacks
  • Vegetables and vegetable products

 

Higher alcohol intake increases stroke

Objectives:
The relationship between beverage consumption and risk of cardiovascular disease has been extensively examined in cross-sectional studies. However, limited studies have investigated beverage consumption as a longer-term habitual behavior, which is important owing to potential cumulative harmful or beneficial cardiovascular effects. Therefore, this review article has been conducted.

What is the relationship between sex-specific long-term consumption of beverages [sugar-sweetened beverages (SSBs) or artificial-sweetened beverages (ASBs), tea, coffee, fruit juices, energy drinks and alcohol] and cardiovascular disease-related mortality? 

Study design:
This review article included 20 prospective cohort studies. The length of follow-up ranged from 5.5 years to 40 years. 
There was no publication bias. 

Results and conclusions:
The investigators found long-term coffee consumption of 2-6 cups per day significantly reduced cardiovascular disease-related mortality with 37% in males [pooled HR = 0.63, 95% CI = 0.46 to 0.87, p = 0.005, I2 = 0%] but not in females [HR = 0.78, 95% CI = 0.60 to 1.02, p = 0.07]. 

The investigators found long-term higher intake of tea was significantly associated with a 19% lower risk of cardiovascular disease-related mortality in all adults [pooled HR = 0.81, 95% CI = 0.72 to 0.92, p ≤ 0.001]. 

The investigators found higher alcohol intake was significantly associated with a 44% higher stroke in males [pooled HR = 1.44, 95% CI = 1.06 to 1.94, p = 0.02] and a 126% higher stroke in females [pooled HR = 2.26, 95% CI = 1.34 to 3.81, p = 0.002]. 

The investigators found higher sugar-sweetened beverage was significantly associated with a 31% higher risk in cardiovascular disease-related mortality [pooled HR = 1.31, 95% CI = 1.16 to 1.46, p ≤ 0.0001]. 
However, no effect was found between artificial-sweetened beverages and cardiovascular disease-related mortality while comparing the highest intake with lowest intake [pooled HR = 1.05, 95% CI = 0.87 to 1.26, p = 0.61, I2 = 61%].
 
The investigators concluded long-term habitual coffee consumption (2-6 cups per day) is beneficial for males and tea consumption is beneficial for all adults. Long-term high alcohol and sugar-sweetened beverage consumption increased risk of cardiovascular disease-related mortality for both males and females. However, it is not possible to draw conclusions on the potential benefit or harm of the long-term consumption of fruit juice and energy drinks on cardiovascular disease-related mortality owing to the limited number of studies available.

Original title: 
Long-Term Consumption of 6 Different Beverages and Cardiovascular Disease-Related Mortality: A Systematic Review and Meta-Analysis of Prospective Cohort Studies by Bhandari B, Zeng L, […], Xu X. 

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10904171/


Additional information of El Mondo:
Find more information/studies on RCT’s/sensitivity analysis, coffee, alcohol and cardiovascular diseases right here. 

Daily 150-200mg dietary vitamin C reduce gastric cancer

Objectives:
Previous studies suggest that dietary vitamin C is inversely associated with gastric cancer (GC), but most of them did not consider intake of fruit and vegetables. Therefore, this review article has been conducted.

Do higher dietary vitamin C intakes reduce gastric cancer risk after adjusting for intake of fruit and vegetables?

Study design:
This review article included 14 case-control studies with in total 5,362 cases (persons with gastric cancer) and 11,497 controls (persons without gastric cancer).

More cases were male (61.88% vs. 54.64%), older than 60 years (63.37% vs. 57.87%) and had low socioeconomic status (57.29% vs. 45.66%) compared with controls. 
In addition, a higher proportion of cases than controls were obese (21.34% vs. 19.06%), current smokers (26.58% vs. 24.14%) and ever drinkers (64.85 vs. 63.29%). 
Similarly, H. pylori seropositivity (63.82% vs. 61.86%) was more common among cases than among controls when considering only participants from the 7 studies with available information. 
A larger proportion of controls reported high intake of fruit and vegetables compared with cases. 
Most cases were of noncardia (57.03%) and intestinal type gastric cancer (33.01%). 
Cases had a lower median intake of vitamin C and fewer of them were in the highest quartiles of intake compared with controls.

Results and conclusions:
The investigators found individuals in the highest quartile of dietary vitamin C intake had a significantly reduced risk of 36% for gastric cancer compared with those in the lowest quartile [OR = 0.64, 95% CI = 0.58 to 0.72]. 

 

The investigators found, however, when additionally adjusting for BMI and intake of fruit and vegetables, the observed association was attenuated and the OR for the highest versus lowest quartile of dietary vitamin C was 0.85 [95% CI = 0.73 to 0.98].

 

The investigators found a significant inverse association for noncardia gastric cancer, as well as for both intestinal and diffuse types of the disease. 

 

The investigators found dose-response analysis showed decreasing ORs of gastric cancer up to 150-200 mg/day of vitamin C [OR = 0.54, 95% CI = 0.41 to 0.71], whereas ORs for higher intakes were close to 1.0. 

 

The investigators concluded that consumption of 150-200 mg/day of vitamin C reduce gastric cancer risk. However, further well-designed prospective studies, aimed at disentangling the complex relationships between intake of fruit and vegetables, vitamins and other antioxidants and gastric cancer, are warranted to prove causality of the observed relationship between vitamin C and gastric cancer.

 

Original title: 
Dietary intake of vitamin C and gastric cancer: a pooled analysis within the Stomach cancer Pooling (StoP) Project by Sassano M, Seyyedsalehi  MS, […], Boffetta P. 

 

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11016516/


Additional information of El Mondo:
Find more information/studies on cohort studies/significantly, viamin C and cancer right here. 

Daily 61g tofu reduce cancer

Objectives:
The association between soy product consumption and cancer risk varies among studies. Therefore, this review article has been conducted.

Do higher soy product consumption reduce cancer risk?

Study design:
This review article included 17 cohort studies and 35 case-control studies with a total of 861,372 participants and 44,932 cases (persons with cancer). 

Regarding quality assessment, the case-control studies achieved an average score of 6.7. The mean score of the cohort study was 7.2, which satisfied the criterion of high quality. 
All analyses adjusted for age and most studies adjusted for smoking status (n = 38), drinking status (n = 29), total energy intake (n = 27), BMI (n = 26) and education level (n = 26). 

Results and conclusions:
The investigators found in pooled analysis of cohort studies and case-control studies that higher consumption of total soy products significantly reduced risk of cancer with 31% [RR = 0.69, 95% CI = 0.60 to 0.80, I2 = 82.7%, p < 0.001]. 
However, this reduced risk was not significant in cohort studies (RR = 0.90, 95% CI = 0.80 to 1.01].

The investigators found higher tofu consumption significantly reduced cancer risk in both men and women.

The investigators found higher consumption of total soy products significantly reduced risk of cancer amond women with 24% [RR = 0.76, 95% CI = 0.65 to 0.89].

The investigators found in subgroup analysis that higher consumption of total soy products was significantly associated with a reduced risk for gastrointestinal cancer [RR = 0.74, 95% CI = 0.61 to 0.89], prostate cancer [RR = 0.47, 95% CI = 0.31 to 0.71], lung cancer [RR = 0.67, 95% CI = 0.52 to 0.86], upper aerodigestive tract cancer [RR = 0.33, 95% CI = 0.22 to 0.49] and multiple myeloma [RR = 0.10, 95% CI = 0.01 to 0.97], but not in bladder or liver cancer.

The investigators found in pooled analysis of cohort studies and case-control studies that higher consumption of tofu significantly reduced risk of cancer with 22% [RR = 0.78, 95% CI = 0.70 to 0.86, I2 = 47.9%, p = 0.004]. 
However, this reduced risk was not significant in cohort studies [RR = 0.89, 95% CI = 0.78 to 1.01, p = 0.186].

The investigators found in pooled analysis of cohort studies and case-control studies that higher consumption of soymilk significantly reduced risk of cancer with 25% [RR = 0.75, 95% CI = 0.60 to 0.86, I2 = 47.9%, p = 0.004]. 
However, this reduced risk was not significant in cohort studies [RR = 1.10, 95% CI = 0.76 to 1.58].

The investigators found a 54g per day increment of total soy products significantly reduced cancer risk by 11%, a 61g per day increment of tofu significantly reduced cancer risk by 12%, and a 23g per day increment of soymilk significantly reduced cancer risk by 28%, while none of the other soy products were associated with cancer risk. 

The investigators concluded that daily consumption of 54g total soy products, 61g tofu or 23g soymilk is associated with a lower cancer risk. More prospective cohort studies are still needed to confirm the causal relationship between soy product consumption and cancer risk.

Original title: 
Soy Product Consumption and the Risk of Cancer: A Systematic Review and Meta-Analysis of Observational Studies by Wang C, Ding K, […], Hong H. 

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11013307/


Additional information of El Mondo:
Find more information/studies on cohort studies/significantly, soy and cancer right here. 

15 g/day fish protein dietary intake may reduce fractures

Objectives:
Previous cohort studies have indicated that consumption of total and animal proteins are related to fracture risk; however, results were inconclusive. Therefore, this review article has been conducted.

Does a high dietary intake of protein reduce risk of fractures?

Study design:
This review article included 20 cohort studies with serious to moderate risk of bias involving 780,322 individuals. 

Results and conclusions:
The investigators found a non-statistically significant relation between intake of animal proteins and dairy products and all fracture risk. 

The investigators found, however, a significantly 43% decreased incidence of fracture per 100 g/day total protein dietary intake [RR = 0.57, 95% CI = 0.36 to 0.93]. 

The investigators found, however, a significantly 5% decreased incidence of fracture per 15 g/day fish protein dietary intake [RR = 0.95, 95% CI = 0.91 to 0.99]. 

The investigators found every 100 g/day total and animal protein dietary intake and every 15 g/day fish dietary intake were significantly linked to 48%, 50% and 5% lower hip fracture risk. 

The investigators found greater dietary animal protein intake might reduce risk of hip but not fracture at any site. 

The investigators concluded greater total protein (per 100 g/day) and fish (per 15 g/day) dietary intake may reduce risk of any or hip fracture. May reduce because the cohort studies had serious to moderate risk of bias.

Original title: 
Association between total and animal proteins with risk of fracture: A systematic review and dose-response meta-analysis of cohort studies by Zeraattalab-Motlagh S, Mortazavi AS, […], Mohammadi H.

 

Link: 
https://pubmed.ncbi.nlm.nih.gov/37855886/ 


Additional information of El Mondo:
Find more information/studies on proteins and elderly right here. 

100 grams of protein consumption per day corresponds to a diet with 20 En% protein. A diet with 20 En% protein mainly consists of products with 20 En% protein. Find here which products in the supermarket contain 20 En% protein.

 

20 En% protein means that the number of grams of protein contributes 20% to the total calorie content of the product in question.

 

Calculate here whether your daily diet contains 20 En% protein. This tab is only visible after gratis inlog. 

25 mg carotenoid supplements decrease blood pressure

Carotenoidensupplementen en blloeddruk

Objectives:
Hypertension (HTN) is regarded as a serious public health issue throughout the world. High blood pressure (BP) may be improved by carotenoid supplementation; however, randomized controlled trials (RCTs) provide conflicting evidence. Therefore, this review article has been conducted.

Do carotenoid supplements reduce blood pressure?

Study design:
This review article included 19 RCTs involving 1,151 participants.
Evidence for all systolic blood pressure, diastolic blood pressure and heart rate values was high quality.

Results and conclusions:
The investigators found carotenoid supplementation significantly reduced the systolic blood pressure (SBP) [WMD = -2.492 mmHg, 95% CI = -4.52 to -0.47, p = 0.016] and diastolic blood pressure (DBP) [MD = -1.60 mmHg, 95% CI = -2.73 to -0.47, p = 0.005]. 

The investigators found greater effects were observed in Asian participants, those aged >50 years, nonhealthy participants and participants with a baseline systolic blood pressure ≥130 mmHg and diastolic blood pressure ≥80 mmHg and at carotenoid dose >10 mg. 

The investigators found dose-response analysis showed that carotenoid supplementation decreased systolic blood pressure and diastolic blood pressure levels at doses of, respectively, 0-25 and 0-20 mg/d. 

The investigators concluded daily 10-25 mg carotenoid supplementation decrease blood pressure, especially in nonhealthy study participants with high blood presurre baseline levels.

Original title: 
Effect of carotenoid supplementation on blood pressure in adults: a GRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials by Behzadi M, Akbarzadeh M, […], Bideshki MV. 

Link:
https://pubmed.ncbi.nlm.nih.gov/38219250/

Additional information of El Mondo:
Find more information/studies on RCT’s/sensitivity analysis, carotenoids and cardiovascular diseases right here.

Heart patients are advised to choose low fat, low salt and fiber rich products. These products can be found here. 

Patients with a high blood pressure are advised to choose low salt products. These products can be found here. 

Higher carotenoids levels reduce breast cancer

Objectives:
Carotenoids appear to have anticancer effects. Prospective evidence for the relation between serum carotenoids and breast cancer is controversial. Therefore, this review article has been conducted.

Do higher carotenoids levels (likes, α-carotene, β-carotene, β-cryptoxanthin, lycopene, zeaxanthin and lutein) reduce breast cancer risk among women?

Study design:
This review article included 17 nested case-control studies and 1 cohort study, published between 1984 and 2016 with a total of 20,188 participants. 
Median follow-up ranged from 8 months to 21 years during which 7,608 breast cancer cases were reported. 
All studies assessed circulating carotenoids using high-performance liquid chromatography. The majority of studies carried out on circulating carotenoids and the risk of breast cancer were adjusted for the following variables: BMI (n = 9), dietary variables (n = 8), age (n = 9), alcohol (n = 6), age at menarche (n = 6) and age at first birth (n = 8). 
According to the quality assessment, except for 2 studies, other publications had high quality. 

There was no publication bias. 

Results and conclusions:
The investigators found that the highest levels of total carotenoids compared to the lowest were significantly related to a 24% lower risk of breast cancer [relative risk (RR) = 0.76, 95% CI = 0.62 to 0.93, I2 = 45.6%, p = 0.075]. 
According to the sensitivity analysis, no study affected the overall RR. 

The investigators found according to linear dose-response analysis, the risk of breast cancer decreased by 2% for every 10 μg/dL of total carotenoids [RR = 0.98, 95% CI = 0.97 to 0.99]. A steady drop in the risk of breast cancer was observed for total carotenoid concentrations <1200 μg/dL followed by a plateau. The level of evidence was graded as low.

The investigators found that the highest levels of α-carotene compared to the lowest were significantly related to a 23% lower risk of breast cancer [relative risk (RR) = 0.77, 95% CI = 0.68 to 0.87, I2 = 0.0%, p = 0.48]. 
According to the sensitivity analysis, no study affected the overall RR. 

The investigators found according to linear dose-response analysis, the risk of breast cancer decreased by 22% for every 10 μg/dL of α-carotene [RR = 0.78, 95% CI = 0.66 to 0.93]. 
No evidence for nonlinear association was found. The level of evidence was graded as low. 

The investigators found that the highest levels of β-carotene compared to the lowest were significantly related to a 20% lower risk of breast cancer [relative risk (RR) = 0.80, 95% CI = 0.65 to 0.98, I2 = 56.5%, p = 0.004]. 
According to the sensitivity analysis, no study affected the overall RR. 

The investigators found according to linear dose-response analysis, the risk of breast cancer decreased by 4% for every 10 μg/dL of β-carotene [RR = 0.96, 95% CI = 0.93 to 0.99]. No evidence for nonlinear association was found. The level of evidence was graded as low. 

The investigators found that the highest levels of β-cryptoxanthin compared to the lowest were significantly related to a 15% lower risk of breast cancer [relative risk (RR) = 0.85, 95% CI = 0.74 to 0.96, I2 = 0.0%, p = 0.80]. 
According to the sensitivity analysis, no study affected the overall RR. 

The investigators found according to linear dose-response analysis, the risk of breast cancer decreased by 10% for every 10 μg/dL of β-cryptoxanthin [RR = 0.90, 95% CI = 0.82 to 0.99]. 

The investigators found that the highest levels of lycopene compared to the lowest were significantly related to a 14% lower risk of breast cancer [relative risk (RR) = 0.86, 95% CI = 0.76 to 0.98, I2 = 0.0%, p = 0.46]. 
According to the sensitivity analysis, no study affected the overall RR. 

The investigators found that the highest levels of lutein compared to the lowest were significantly related to a 30% lower risk of breast cancer [relative risk (RR) = 0.70, 95% CI = 0.52 to 0.93, I2 = 17.1%, p = 0.30]. 
According to the sensitivity analysis, no study affected the overall RR. 

The investigators concluded that higher levels of carotenoids, α-carotene, β-carotene, β-cryptoxanthin, lycopene and lutein are related to a decreased risk of breast cancer. Additionally, each 10 μg/dL of total carotenoids, α-carotene, β-carotene and β-cryptoxanthin reduce breast cancer risk with 2%, 22%, 4% and 10%, respectively. 

Original title: 
The Association between Circulating Carotenoids and Risk of Breast Cancer: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies by Dehnavi MK, Ebrahimpour-Koujan S, […], Azadbakht L.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10694674/ 

Additional information of El Mondo:
Find more information/studies on cohort studies/significantly, carotenoids and breast cancer right here. 

10 mg/d isoflavone dietary intake reduce breast cancer

Objectives:
Epidemiological studies that focus on the relationship between dietary isoflavone intake and the risk of breast cancer still lead to inconsistent conclusions. Therefore, this review article has been conducted.

Does a high isoflavone dietary intake reduce risk of breast cancer among women?

Study design:
This review article included 7 cohort studies and 17 case-control studies with a total of 902,438 females.
The verification of breast cancer in these studies was based on either a cancer registry record or a histological diagnosis.
The exposure assessment of all included studies was based on a food frequency questionnaire (FFQ) via either face-to-face interviews or self-administrative questionnaires.

The publication biases were evaluated using Begg’s test and Egger’s test. The shape of the funnel plots showed asymmetry [p = 0.001] and the Egger’s test found virtual publication bias [p 0.001]. However, the trim-and-fill method failed to identify any potentially missing studies, indicating the publication bias did not affect the results.

Results and conclusions:
The investigators found in the meta-analysis a significantly reduced risk of 29% for breast cancer [summary OR = 0.71, 95% CI = 0.72 to 0.81, I2 = 82.6%] when comparing the highest to the lowest isoflavone dietary intake.
The result remained the same in sensitivity analysis.

The investigators found in subgroup analysis a statistically significant protective effect of 38% for isoflavone dietary intake on breast cancer in the case-control studies [OR = 0.62, 95% CI = 0.50 to 0.76], while no such effect was observed in the cohort studies [OR = 0.94, 95% CI = 0.86 to 1.02].

The investigators found in subgroup analysis a statistically significant protective effect of 38% for isoflavone dietary intake on breast cancer in Asian women [OR = 0.62, 95% CI = 0.52 to 0.74], while no such effect was observed in non-Asian women [OR = 0.97, 95% CI = 0.88 to 1.06].

The investigators found when the highest isoflavone dietary intake was lower than 10 mg/d, the negative relationship between isoflavone dietary intake and breast cancer disappeared [OR = 1.01, 95% CI = 0.94 to 1.08], whereas a statistically significant protective effect of 37% [OR = 0.63, 95% CI = 0.53 to 0.75] was found, when the highest isoflavone dietary intake was above 10 mg/d.
However, a statistically significant difference in the protective effect of isoflavone dietary intake on breast cancer was observed regardless of whether the women were pre- or postmenopausal and regardless of whether they were ER positive or negative.

The investigators concluded at least 10 mg/d isoflavone dietary intake is helpful in reducing breast cancer risk, particularly among Asian women.

Original title:
Isoflavone Consumption and Risk of Breast Cancer: An Updated Systematic Review with Meta-Analysis of Observational Studies by Yang J, Shen H,  […], Qin Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10224089/

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

High selenium dietary intake reduces hip fracture

Objectives:
Previous studies have suggested that selenium as a trace element is involved in bone health, but findings related to the specific effect of selenium on bone health remain inconclusive. Therefore, this review article has been conducted.

Do both high dietary selenium intake and high serum selenium levels increase bone density?

Study design:
This review article included 8 cross-sectional studies, 7 case-control studies and 3 prospective cohort studies and 1 RCT with a total of 69,672 subjects.

The number of participants ranged from 60 to 21,939, while the mean age varied from 39.4 to 75.8 years, with mean selenium intake ranging from 41.2 to 154.4 μg/d or mean serum selenium level ranging from 66.7 to 131.1 μg/L.
All the observational studies had a NOS score ≥ 4, namely moderate- to high-quality scores.
There was no publication bias.

Results and conclusions:
The investigators found a significantly positive association between dietary selenium intake [β = 0.04, 95% CI = 0.00 to 0.07, p = 0.029, I2 = 95.91%] as well as serum selenium [β = 0.13, 95% CI = 0.00 to 0.26, p = 0.046, I2 = 86.60%] and bone mineral density.

The investigators found high dietary selenium intake significantly reduced risk of hip fracture with 56% [OR = 0.44, 95% CI = 0.37 to 0.52, p 0.001, I2 = 65.2%].

The investigators found osteoporosis patients had lower serum selenium level than healthy controls [WMD = -2.01, 95% CI = -3.91 to -0.12, p = 0.037, I2 = 0%].

The investigators concluded persons with higher dietary selenium intake and higher serum selenium have higher bone mineral density. Furthermore, high selenium dietary intake reduces hip fracture.

Original title:
The association between selenium and bone health: a meta-analysis by Xie H, Wang N, […], Wang Y.

Link:
https://boneandjoint.org.uk/article/10.1302/2046-3758.127.BJR-2022-0420.R1

Additional information of El Mondo:
Find more information/studies on selenium and preventing fractures right here.

Circulating concentration of selenium in blood (serum selenium level) can be increased by eating foods that are high in selenium and/or taking selenium supplements.

Higher tissue levels of linoleic acid reduce prostate cancer

Objectives:
Findings on the association of dietary intake and tissue biomarkers of linoleic acid (LA) with the risk of prostate cancer are conflicting. Also, no meta-analysis summarized available findings in this regard. Therefore, this review article has been conducted.

Do higher tissue levels or higher dietary intakes of linoleic acid reduce prostate cancer risk in men?

Study design:
This review article included 15 prospective cohort studies with 511,622 participants with an age range of ≥18 years.

During the follow-up periods ranging from 5 to 21 years, 39,993 cases of prostate cancer, 5,929 cases of advanced prostate cancer and 1,661 cases of fatal prostate cancer were detected.

Results and conclusions:
The investigators found higher tissue levels of linoleic acid were significantly associated with a reduced risk of 14% for prostate cancer [RR = 0.86, 95% CI = 0.77 to 0.96].   
However, a significant association was not seen for advanced prostate cancer [RR = 0.86, 95% CI = 0.65 to 1.13].

The investigators found in dose-response analysis, each 5% increase in tissue levels of linoleic acid was significantly associated with a 14% lower risk of prostate cancer.

The investigators found no significant association between dietary intake of linoleic acid and risk of total [RR = 1.00, 95% CI = 0.97 to 1.04], advanced [RR = 0.98, 95% CI = 0.90 to 1.07] and fatal prostate cancer [RR = 0.97, 95% CI = 0.83 to 1.13].
Not significant because RR of 1 was found in the 95% CI of 0.83 to 1.13. RR of 1 means no risk/association.

The investigators concluded higher tissue levels of linoleic acid reduce prostate cancer in men.

Original title:
Dietary intake and biomarkers of linoleic acid and risk of prostate cancer in men: A systematic review and dose-response meta-analysis of prospective cohort studies by Yousefi M, Eshaghian N, […], Sadeghi O.

Link:
https://pubmed.ncbi.nlm.nih.gov/37077161/

Additional information of El Mondo:
Find more information/studies on linoleic acid and prostate cancer right here.

Tissue levels of linoleic acid can be increased by eating foods that are high in linoleic acid and/or taking linoleic acid supplements.
 

Sunflower oil, corn oil, soybean oil, rice bran oil, canola (rapeseed) oil are high in linoleic acid.

 

 

500 mL/d orange juice consumption causally reduce bad cholesterol

Objectives:
Does orange juice consumption causally improve lipid profile?

Study design:
This review article included 9 RCTs with a total of 386 participants.
The mean age of the participants ranged from 36 to 56 years.
All the RCTs used a parallel study design.
The dosage of orange juice ranged from 250 to 1000 mL/d.
The duration of interventions ranged from 3 to 12 weeks.

Results and conclusions:
The investigators found orange juice consumption significantly reduced LDL cholesterol (bad cholesterol) levels [WMD  = -8.35 mg/dL, 95% CI = -15.43 to 1.26, p = 0.021, I2 = 45.8%, p = 0.055].

The investigators found in subgroup analysis based on the administered dosage, LDL cholesterol levels significantly decreased following the consumption of >500 mL/d orange juice [WMD = -9.85 mg/dL, 95% CI = -18.18 to -1.52, p = 0.02].
Moreover, the subgroup analyses based on the duration of intervention revealed that the effect of orange juice supplementation on LDL cholesterol levels was significantly greater in trials lasting ≤8 weeks [WMD = -7.91 mg/dL, 95% CI = -15.91 to -36, p = 0·04].
Also, studies conducted on both genders were observed to be significantly more likely to reduce blood LDL-C levels [WMD = -12.61 mg/dL, 95% CI = -21.19 to -4.04, p = 0.004].

The investigators concluded that  at least 500 mL/d orange juice consumption causally reduce LDL cholesterol (bad cholesterol) levels.

Original title:
Orange juice intake and lipid profile: a systematic review and meta-analysis of randomised controlled trials by Amini MR, Sheikhhossein F, […], Askarpour M.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052563/

Additional information of El Mondo:
Find more information/studies on orange juice consumption, cholesterol and cardiovasculair disease right here.
 

High blood vitamin B6 levels reduce colorectal cancer

Objectives:
Does a high dietary intake of vitamin B6 or a high blood PLP levels (vitamin B6 level in blood) reduce the risk of colorectal cancer?

Study design:
This review article included 20 cohort studies and 8 case-control studies.

Results and conclusions:
The investigators found higher dietary intake of vitamin B6 significantly reduced the risk of colorectal cancer with 20% [combined OR = 0.80, 95% CI = 0.68 to 0.94].

The investigators found higher blood PLP level significantly reduced the risk of colorectal cancer with 46% [combined OR = 0.54, 95% CI = 0.35 to 0.84].

The investigators found subgroup analysis revealed that higher dietary intake of vitamin B6 significantly reduced the risk of colorectal cancer in women with 21% [combined OR = 0.79, 95% CI = 0.65 to 0.96].

The investigators found subgroup analysis revealed that higher blood PLP level significantly reduced the risk of colorectal cancer in women with 59% [combined OR = 0.41, 95% CI = 0.30 to 0.57].

The investigators found subgroup analysis revealed that higher dietary intake of vitamin B6 significantly reduced the risk of colon cancer in men and women with 24% [combined OR = 0.76, 95% CI = 0.64 to 0.91].

The investigators found subgroup analysis revealed that higher blood PLP level significantly reduced the risk of colon cancer in men and women with 44% [combined OR = 0.56, 95% CI = 0.42 to 0.73].

The investigators concluded that higher dietary intake of vitamin B6 and higher blood PLP level (vitamin B6 level in blood) reduce colorectal cancer risk, particularly colon cancer.

Original title:
Association Between Vitamin B6 and the Risk of Colorectal Cancer: A Meta-analysis of Observational Studies by Lai J, Guo M, […], Li J.

Link:
https://pubmed.ncbi.nlm.nih.gov/36961108/

Additional information of El Mondo:
Find more information/studies on vitamin B6 and colorectal cancer right here.

Circulating concentration of vitamin B6 in blood can be increased by eating foods that are high in vitamin B6 and/or taking vitamin B6 supplements.
 

30g/d whole grains consumption reduce all-cause mortality

Objectives:
Although relationships between the intake of whole grains and refined grains and the incidence of cardiovascular disease (CVD) events and all-cause mortality have been investigated, the conclusions have been inconclusive. Therefore, this review article has been conducted.

Does consumption of whole grains reduce risk of stroke, coronary heart disease, heart  failure, cardiovascular disease and all-cause mortality?

Study design:
This review article included 68 prospective cohort studies (46 for whole grains and 22 for refined grains) with 1,624,407 participants.

The included studies had follow-up periods between 5.4 y and 26 y, with sample sizes varying from 535 to 461,047 participants.

Based on NOS, the mean score of the included studies was 7.74 for whole grains and 7.45 for refined grains.

Egger’s test and funnel plot did not indicate any publication bias for the relationships between 30g/d increases in whole grain consumption and the risk of stroke [p = 0.481], cardiovascular disease [p= 0.144] or all-cause mortality [p = 0.409].

The quality of meta-evidence for the association between whole grain consumption and risks of stroke, coronary heart disease, heart failure, cardiovascular disease and all-cause mortality was moderate, moderate, low, high and high, respectively.
The quality of evidence for refined grain was low.

Results and conclusions:
The investigators found a significantly reduced risk of 3% for stroke per 30-g increase in daily whole grain consumption [RR = 0.97, 95% CI = 0.96 to 0.99, I2 = 0%].

The investigators found a significantly reduced risk of 6% for coronary heart disease (CHD) per 30-g increase in daily whole grain consumption [RR = 0.94, 95% CI = 0.92 to 0.97, I2 = 54.4%].
Sensitivity analyses indicated that the result was stable.

The investigators found a significantly reduced risk of 8% for cardiovascular disease (CVD) per 30-g increase in daily whole grain consumption [RR = 0.92, 95% CI = 0.88 to 0.96, I2 = 82.9%].
Sensitivity analyses indicated that the result was stable.

The investigators found a significantly reduced risk of 6% for all-cause mortality per 30-g increase in daily whole grain consumption [RR = 0.94, 95% CI = 0.92 to 0.97, I2 = 89.8%].
Sensitivity analyses indicated that the result was stable.

The investigators found whole grain consumption was linearly associated with coronary heart disease [p nonlinearity = 0.231] and nonlinearly associated with cardiovascular disease [p nonlinearity = 0.002] and all-cause mortality [p nonlinearity = 0.001].

The investigators concluded that consumption of at least 30g/d whole grains reduce stroke, coronary heart disease, cardiovascular disease and all-cause mortality.

Original title:
Consumption of whole grains and refined grains and associated risk of cardiovascular disease events and all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies by Hu H, Zhao Y, […], Hu D.

Link:
https://www.sciencedirect.com/science/article/pii/S0002916522105186?via%3Dihub

Additional information of El Mondo:
Find more information/studies on whole grain consumption, cardiovasculair disease and stroke right here.

 

Dietary intake of 200-700 mg/day calcium reduces stroke among Asians

Objectives:
Prospective cohorts are inconsistent regarding the association between dietary calcium intake and the risk of stroke. Therefore, this review article has been conducted.

Does dietary intake of calcium reduce risk of stroke?

Study design:
This review article included 18 prospective cohort studies witth19,557 stroke cases (persons) among 882,181 participants.

Results and conclusions:
The investigators found a nonlinear association between calcium intake and risk of stroke [p nonlinearity 0.003].

The investigators found compared with the lowest value of zero assumed as the reference, dietary intake of 200 mg/day calcium significantly reduced stroke risk with 5% [95% CI = 0.92 to 0.98].
This protective effect was only found in Asian countries.

The investigators found compared with the lowest value of zero assumed as the reference, dietary intake of 300 mg/day calcium significantly reduced stroke risk with 6% [95% CI = 0.90 to 0.98].
This protective effect was only found in Asian countries.

The investigators found compared with the lowest value of zero assumed as the reference, dietary intake of 500 mg/day calcium significantly reduced stroke risk with 5% [95% CI = 0.90 to 0.99].
This protective effect was only found in Asian countries.

The investigators found no protective effect for stroke at dietary intake of 700 mg/day calcium or higher.

The investigators concluded dietary intake of 200-700 mg/day calcium reduces stroke risk among Asians.

Original title:
Dietary calcium intake and the risk of stroke: Meta-analysis of cohort studies by Wang ZM, Bu XX, […], Nie ZL.

Link:
https://pubmed.ncbi.nlm.nih.gov/36958976/

Additional information of El Mondo:
Find more information/studies on calcium and stroke right here.

 

Lower serum magnesium concentrations increase fractures

Objectives:
Magnesium, an essential cation for numerous cellular processes, is a major component of bone. However, its relationship with the risk of fractures is still uncertain. Therefore, this review article has been conducted.

Do lower serum magnesium concentrations increase risk of incident fractures?

Study design:
This review article included 3 prospective cohort studies and 1 retrospective cohort study with a total of 119,755 participants and a mean follow-up duration of 79 months.
The mean age was 62 years, with a mean percentage of 33% women.
The analyses were adjusted for a mean of 15 potential confounders.
All 4 studies included in the meta-analysis were of high quality (Newcastle-Ottawa Scale of 9 for all).

Results and conclusions:
The investigators found lower serum magnesium concentrations were associated with a significantly higher risk of 58% for incident fractures [RR = 1.579, 95% CI = 1.216 to 2.051, p = 0.001, I2 = 46.9%].
The results were not affected by any heterogeneity [I2 = 31.2%, p = 0.201] nor publication bias [Egger’s test = 0.94 ± 0.43, p = 0.10]. After trimming, the recalculated effect size was only slightly reduced [RR = 1.25, 95% CI = 1.09 to 1.43].
Significant because RR of 1 was not found in the 95% CI of 1.09 to 1.43. RR of 1 means no risk/association.

The investigators concluded lower serum magnesium concentrations increase risk of incident fractures.

Original title:
Association between Serum Magnesium and Fractures: A Systematic Review and Meta-Analysis of Observational Studies by Dominguez LJ, Rodas-Regalado S, […], Barbagallo M.

Link:
https://www.mdpi.com/2072-6643/15/6/1304

Additional information of El Mondo:
Find more information/studies on magnesium and preventing fractures right here.

Circulating concentration of magnesium in blood can be increased by eating foods that are high in magnesium and/or taking magnesium supplements.

Lower blood carotenoid level is a risk factor for dementia

Objectives:
Given their potent antioxidation properties, carotenoids play a role in delaying and preventing dementia and mild cognitive impairment (MCI). However, observational studies have found inconsistent results regarding the associations between blood carotenoid levels and the risk of dementia and MCI. Therefore, this review article has been conducted.

Is a lower blood carotenoid level (like lycopene, zeaxanthin, lutein) a risk factor for dementia or mild cognitive impairment?

Study design:
This review article included 23 studies with 1,422 patients with dementia, 435 patients with mild cognitive impairment and 4,753 controls (persons without dementia or mild cognitive impairment).

Results and conclusions:
The investigators found meta-analysis showed that patients with dementia had lower blood lycopene [SMD = -0.521, 95% CI = -0.74 to -0.301], α-carotene [SMD = -0.489, 95% CI = -0.697 to -0.281] β-carotene [SMD = -0.476, 95% CI = -0.784 to -0.168], lutein [SMD = -0.516, 95% CI = -0.753 to -0.279], zeaxanthin [SMD = -0.571, 95% CI = -0.910 to -0.232] and β-cryptoxanthin [SMD = -0.617, 95% CI = -0.953 to -0.281] than the controls.

The investigators found owing to insufficient data, no similar and stable relationship between blood carotenoid levels and mild cognitive impairment was observed.

The investigators concluded lower blood carotenoid level is a risk factor for dementia.

Original title:
Low blood carotenoid status in dementia and mild cognitive impairment: A systematic review and meta-analysis by Wang L, Zhao T, […], Jiang Q.

Link:
https://pubmed.ncbi.nlm.nih.gov/36997905/

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Find more information/studies on carotenoids and Alzheimer 's disease right here.

Circulating concentration of lycopene in blood can be increased by eating foods that are high in lycopene and/or taking lycopene supplements.

 

High antioxidant dietary intake reduces Alzheimer's disease

Objectives:
Does a high antioxidant dietary intake reduce risk of Alzheimer's disease and dementia?

Study design:
This review article included 17 cohort studies with 98,264 participants, of which 7,425 had dementia after 3-23 years of follow-up.

Results and conclusions:
The investigators found a high antioxidant dietary intake significantly reduced the incidence of Alzheimer's disease with 15% [RR = 0.85, 95% CI= 0.79 to 0.92, I2 = 45.5%].
However, this reduced risk was not significant for dementia [RR = 0.84, 95% CI = 0.77 to 1.19, I2 = 54.6%].
Significant because RR of 1 was not found in the 95% CI of 0.79 to 0.92. RR of 1 means no risk/association.

The investigators concluded that a high antioxidant dietary intake reduces Alzheimer's disease.

Original title:
Association of Dietary and Supplement Intake of Antioxidants with Risk of Dementia: A Meta-Analysis of Cohort Studies by Zhao R, Han X, […], You H.

Link:
https://pubmed.ncbi.nlm.nih.gov/36846999/

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Higher choline dietary intake may reduce breast cancer

Objectives:
The associations between dietary intakes and circulating blood levels of methionine, choline or betaine and breast cancer risk remain currently unclear. Therefore, this review article has been conducted.

Do higher dietary intakes and circulating blood levels of methionine, choline or betaine reduce breast cancer risk?

Study design:
This review article included 8 prospective cohort studies and 10 case-control studies.

Results and conclusions:
The investigators found in case-control studies that higher dietary choline intake significantly reduced breast cancer risk with 62% [OR = 0.38, 95% CI = 0.16 to 0.86].
However, this reduced risk was not significant in prospective cohort studies [HR = 1.01, 95% CI = 0.92 to 1.12].

The investigators concluded that higher choline dietary intake may reduce breast cancer risk. May reduce because this reduced risk is not found in cohort studies.

Original title:
The association between dietary intakes of methionine, choline and betaine and breast cancer risk: A systematic review and meta-analysis by Van Puyvelde H, Dimou N, […], De Bacquer D.

Link:
https://pubmed.ncbi.nlm.nih.gov/36701983/

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Green tea may causally improve risk factors of cardiovascular disease

Objectives:
Is there a causal relationship between drinking green tea and improving risk factors of cardiovascular disease, like cholesterol, fasting blood sugar, blood pressure, HbA1c, HOMA-IR?

Study design:
This review article included 55 RCTs with 63 effect sizes with 2,487 participants in the green tea group and 2,387 in the placebo group (group without green tea).

The participants’ mean age ranged between 18 and 68.7 years and the period of intervention ranged between 2 to 48 weeks.
Some of the studies enrolled only males or females and some of them included both genders.

TC, LDL, HDL, FBS, HbA1c and DBP-related evidence had moderate quality due to the serious inconsistency reasons. Additionally, it was shown that evidence regarding TG, fasting insulin, SBP and CRP had low quality due to serious imprecision and inconsistency reasons. The evidence relating to HOMA-IR was also downgraded to very low quality because of the serious inconsistency, imprecision and publication bias.

Results and conclusions:
The investigators found green tea supplementation significantly reduced total cholesterol levels (TC) [WMD = -7.62, 95% CI = -10.51 to -4.73, p ≤ 0.001, I2 = 90.9%].
This significantly reduced effect was also found if females or both males and females were included, the dosage of supplementation was less than 1,000 mg/d, the baseline BMI was between 25-29.9 kg/m2 and the baseline value of TC was more than 200 mg/dL.

The investigators found green tea supplementation significantly reduced LDL cholesterol levels (LDL-C) [WMD = -5.80, 95% CI = -8.30 to -3.30, p ≤ 0.001, I2 = 90.5%].
This significantly reduced effect was also found if males or both males and females were included, the baseline BMI was between 25-29.9 kg/m2 and participants were not affected by T2DM.

The investigators found green tea supplementation significantly reduced fasting blood sugar levels (FBS) [WMD = -1.67, 95% CI = -2.58 to -0.75, p ≤ 0.001, I2 = 72.2%].

This significantly reduced effect was also found when the baseline BMI of participants was between 25-29.9 kg/m2, female or both male and female were included, the duration of intervention was more than 12 weeks, the dosage of supplementation was less than 1,000 mg/d and baseline values of FBS were less than 100 mg/dL.

The investigators found green tea supplementation significantly reduced HbA1c levels [WMD = -0.15, 95% CI = -0.26 to -0.04, p = 0.008, I2 = 71.3%].
This significantly reduced effect was also found if the duration of intervention was ≤ 12 weeks, the dosage of supplementation was ≥ 1,000 mg/d, baseline values of HbA1c were less than 6.5%, male or both genders were involved and the baseline value of BMI was ≥ 30 kg/m2.

The investigators found green tea supplementation significantly reduced diastolic blood pressure (DBP) [WMD = -0.87, 95% CI = -1.45 to -0.29, p = 0.003, I2 = 92.4%].
This significantly reduced effect was also found if the duration of intervention was ≤ 12 weeks, the dosage of supplementation was less than 1,000 mg/d, baseline values of DBP were more than 80 mmHg and the baseline value of BMI was ≥ 30 kg/m2.

The investigators found green tea supplementation significantly increased HDL cholesterol levels (HDL-C) [WMD = 1.85, 95% CI = 0.87 to 2.84, p = 0.010, I2 = 94.4%].
This significantly increased effect was also found if females were included, the baseline BMI was lower more than 30 kg/m2, there was no past medical history of T2DM, the duration of intervention was more than 12 weeks, the dosage of supplementation was less than 1,000 mg/d and baseline values of HDL were more than 50 mg/dL.

The investigators found sensitivity analysis showed no significant difference in results with removing one single study for all considered cardiovascular risk factors including lipid profiles, glycemic indices, SBP and DBP and CRP.

The investigators concluded drinking ≤1,000 mg/d green tea may causally improve risk factors of cardiovascular disease. May improve because the RCTs are of low quality.

Original title:
The effects of green tea supplementation on cardiovascular risk factors: A systematic review and meta-analysis by Zamani M, Kelishadi MR, […], Asbaghi O.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871939/

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