Nutritional advice

Objectives:
Findings from observational studies on the associations between vitamin E intake and stroke risk remain controversial and the dose-response relationship between vitamin E intake and risk of stroke remains to be determined. Therefore, this review article has been conducted.

Does dietary vitamin E intake reduce risk of stroke?

Study design:
This review article included 9 prospective cohort studies involving 3,284 cases of stroke among 220,371 participants.

Results and conclusions:
The investigators found high dietary vitamin E intake significantly reduced risk of overall stroke with 17% [RR = 0.83, 95% CI = 0.73 to 0.94].
Omission of any single study (=sensitivity analysis) did not alter the summary result.

The investigators found high dietary vitamin E intake significantly reduced risk of overall stroke with 16% [RR = 0.84, 95% CI = 0.72 to 0.91] among individuals who were followed-up for 10 years.

The investigators found a non-linear association between dietary vitamin E intake and stroke risk [p = 0.0249].

The investigators concluded that a higher dietary vitamin E intake is associated with a lower stroke risk.

Original title:
Vitamin E intake and risk of stroke: a meta-analysis by Cheng P, Wang L, [...], Zhu J.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30401005

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Objectives:
Is there an association between dietary factors and the risk of gout and hyperuricemia?
 
Study design:
This review article included 10 prospective cohort studies (the follow-up duration ranged from 6 years to 26 year) and 9 cross-sectional studies.

Based on the Newcastle-Ottawa Scale (NOS), the quality assessment of included studies yielded a mean NOS score of 7.1, suggesting the presence of high methodologic quality.

Results and conclusions:
The investigators found in meta-analysis that the risk of getting gout significantly increased with:
29% [OR = 1.29, 95% CI = 1.16-1.44] for dietary red meat intake;
31% [OR = 1.31, 95% CI = 1.01-1.68] for dietary seafoods intake;
158% [OR = 2.58, 95% CI = 1.81-3.66] for dietary alcohol intake;
114% [OR = 2.14, 95% CI = 1.65-2.78] for dietary fructose intake.

The investigators found in meta-analysis that the risk of getting gout significantly decreased with:
44% [OR = 0.56, 95% CI = 0.44-0.70] for dietary dairy products intake;
15% [OR = 0.85, 95% CI = 0.76-0.96] for dietary soy foods intake;
14% [OR = 0.86, 95% CI = 0.75-0.98] for dietary high-purine vegetables intake;
53% [OR = 0.47, 95% CI = 0.37-0.59] for dietary coffee intake.

The investigators found in meta-analysis that the risk of getting hyperuricemia (an excess of uric acid in the blood) significantly increased with:
24% [OR = 1.24, 95% CI = 1.04-1.48] for dietary red meat intake;
47% [OR = 1.47, 95% CI = 1.16-1.86] for dietary seafoods intake;
106% [OR = 2.06, 95% CI = 1.60-2.67] for dietary alcohol intake;
85% [OR = 1.85, 95% CI = 1.66-2.07] for dietary fructose intake.

The investigators found in meta-analysis that the risk of getting hyperuricemia (an excess of uric acid in the blood) significantly decreased with:
50% [OR = 0.50, 95% CI = 0.37-0.66] for dietary dairy products intake;
30% [OR = 0.70, 95% CI = 0.56-0.88] for dietary soy foods intake.

The investigators found in meta-analysis that the risk of getting hyperuricemia (an excess of uric acid in the blood) non-significantly increase with:
10% [OR = 1.10, 95% CI = 0.88-1.39] for dietary high-purine vegetables intake.

The investigators found in meta-analysis that the risk of getting hyperuricemia (an excess of uric acid in the blood) non-significantly decreased with 24% [OR = 0.76, 95% CI = 0.55-1.06] for dietary coffee intake in men.
Non-significantly because OR of 1 was found in the 95% CI of 0.55 to 1.06. OR of 1 means no risk/association.

The investigators found in meta-analysis that the risk of getting hyperuricemia (an excess of uric acid in the blood) significantly increased with 58% [OR = 1.58, 95% CI = 1.16-2.16] for dietary coffee intake in women.
Significant because OR of 1 was not found in the 95% CI of 1.16 to 2.16. OR of 1 means no risk/association.

The investigators concluded that the risk of hyperuricemia and gout is positively correlated with the dietary intake of red meat, seafoods, alcohol or fructose and negatively with dairy products or soy foods. High-purine vegetables show no association with hyperuricemia, but negative association with gout. Coffee intake is negatively associated with gout risk, whereas it is positively associated with hyperuricemia risk in women.

Original title:
Dietary factors and risk of gout and hyperuricemia: a meta-analysis and systematic review by Li R, Yu K and Li C.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30485934

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Objectives:
Postherpetic neuralgia (PHN) is the most distressful complication of herpes zoster. Postherpetic neuralgia results in an impaired quality of life and higher healthcare utilization. Vitamin B12 has been proven to be effective in pain relief for various conditions. Therefore, this review article has been conducted.

Do postherpetic neuralgia patients benefit from vitamin B12 supplementation?

Study design:
This review article included 4 RCTs (published between 2013 and 2016) including 383 participants.

Results and conclusions:
The investigators found compared with the placebo group, the vitamin B12 group exhibited a significant decrease in the Numeric Rating Scale score, with a mean difference of -4.01 [95% CI = -4.70 to -3.33].

The investigators found compared with the placebo group, vitamin B12 administration improved the quality of life of postherpetic neuralgia patients with moderate quality evidence and significantly decreased the number of patients using analgesics.

The investigators concluded that vitamin B12 appears to be an attractive complementary therapy for postherpetic neuralgia patients. However, further investigation is needed before conclusive recommendations can be made.

Original title:
Vitamin B12 for herpetic neuralgia: A meta-analysis of randomised controlled trials by Wang JY, Wu YH, [...], Lu PH.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30477853

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Postherpetic neuralgia (PHN) is a nerve pain (neuralgia) that persists after a shingles rash has cleared. Postherpetic neuralgia is caused by the chickenpox (varicella-zoster) virus.
 

Objectives:
Does magnesium supplementation reduce C-reactive protein concentrations in humans?

Study design:
This review article included 8 RCTs (2004-2014) with 349 participants.

The mean age of participants ranged from 18 to 85 years.
The range of duration of the supplementation intervention across studies was from 8 h to 6.5 months.
The consumed range of magnesium dose in these studies was from 320 to 1500 mg/day. The baseline level (at the start of the study) of the CRP varied between the studies from 0.42 mg/dL as minimum to 9.4 mg/dL as maximum.

Results and conclusions:
The investigators found magnesium supplementation significantly reduced serum CRP levels [WMD = -1.33 mg/dL, 95% CI = -2.63 to -0.02, p 0.001, I2 = 29.1%, p 0.123] across all studies.
In leave-one-out sensitivity analyses, the pooled effect estimates remained similar across all studies for CRP levels [WMD = -1.33 mg/dL, 95% CI = -2.63 to -0.02].

The investigators found after adjustment of the effect size for potential publication bias using the “trim and fill” correction, no potentially missing studies were imputed in the funnel plot [WMD = -1.33 mg/dL, 95% CI = -2.63 to -0.02]. The “fail-safe N” test showed that 146 studies would be needed to bring the WMD down to a non-significant [p > 0.05] value.

The investigators found in random-effects meta-regression changes in serum CRP levels were independent of the dosage of magnesium [slope = -0.004, 95% CI = -0.03 to 0.02, p = 0.720, and duration [slope = -0.06, 95% CI = -0.37 to 0.24, p = 0.681] of supplementation.

The investigators found in 4 RCTs that subjects with a baseline CRP of ≥ 2 mg/dL had more significant reduction in the serum CRP level [WMD = -2.95 mg/dL, 95% CI = -3.35 to -2.25, p 0.001, I2 = 1.1%, p = 0.952] compared with subjects with a baseline CRP of 2 mg/dL [WMD = -0.23 mg/dL, 95% CI = -0.195 to -0.326, p 0.001, I2 = 1.3% p = 0.923].

The investigators found magnesium supplementation non-significantly reduced IL-6 levels [WMD = -0.16 pg/dL, 95% CI = -3.52 to 3.26, p = 0.236, I2 = 2.3%, p = 0.802] across all studies.

The investigators found magnesium supplementation significantly increased TNF-α levels [WMD = 1.97 pg/dL, 95% CI = 1.12 to 2.82, p = 0.043, I2 = 2.1%, p = 0.869] across all studies.

The investigators found magnesium supplementation non-significantly decreased fasting blood glucose (FBG) levels [WMD = -0.61 mg/dL, 95% CI = -2.72 to 1.48, p = 0.182, I2 = 6.1%, p = 0.742] across all studies.

The investigators found magnesium supplementation non-significantly decreased systolic blood pressure levels [WMD = -0.93 mmHg, 95% CI = -3.03 to 1.20, p = 0.293, I2 = 3.6%, p = 0.526] across all studies.

The investigators found magnesium supplementation non-significantly decreased diastolic blood pressure levels [WMD = -0.30 mmHg, 95% CI = -2.80 to 2.19, p = 0.639, I2 = 3.8%, p = 0.489] across all studies.

The investigators found magnesium supplementation non-significantly increased BMI levels [WMD = 0.27 kg/m², 95% CI = -0.59 to 1.15, p = 0.542, I2 = 2.0%, p = 0.906] across all studies.  

The investigators concluded that 320 to 1500 mg/day magnesium supplementation decreases serum CRP levels, especially with the baseline values ≥ 2 mg/dL. To provide more conclusive results and clarify the mechanistic pathways, RCTs with a larger sample size and a long-term follow-up period are warranted.

Original title:
Effect of magnesium supplements on serum C-reactive protein: a systematic review and meta-analysis by Mazidi M, Rezaie P and Banach M.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040119/

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Objectives:
Medium-chain saturated fatty acids (MCFAs) may affect circulating lipids and lipoproteins differently than long-chain saturated fatty acids (LCSFAs), but the results from human intervention trials have been equivocal. Therefore, this review article has been conducted.

Have medium-chain saturated fatty acids (MCFAs) and long-chain saturated fatty acids (LCSFAs) differential impacts on blood lipids and lipoproteins in humans?

Study design:
This review article included 11 crossover and 1 parallel trial with a total of 299 participants [weighted mean ± SD age: 38 ± 3 y; weighted mean ± SD body mass index (kg/m²): 24 ± 2]

There was no evidence of statistical heterogeneity for HDL cholesterol, apoA-I and triglyceride concentrations. However, significant heterogeneity was observed for the total cholesterol [I2 = 49%] and LDL cholesterol analysis [I2 = 58%].

Results and conclusions:
The investigators found diets enriched with medium-chain saturated fatty acids led to significantly higher HDL cholesterol (good cholesterol) concentrations than diets enriched with long-chain saturated fatty acids [MD = 0.11 mmol/L, 95% CI = 0.07 to 0.15 mmol/L] with no effect on triglyceride, LDL cholesterol (bad cholesterol) and total cholesterol concentrations.

The investigators found consumption of diets rich in medium-chain saturated fatty acids significantly increased apolipoprotein A-I (apoA-I) concentrations compared with diets rich in long-chain saturated fatty acids [MD = 0.08 g/L, 95% CI = 0.02 to 0.14 g/L].  

The investigators concluded diets enriched with medium-chain saturated fatty acids lead to higher HDL cholesterol concentrations and apolipoprotein A-I (apoA-I) concentrations than diets enriched with long-chain saturated fatty acids. However, further investigations are warranted to elucidate the mechanism by which the lipid profile is altered.

Original title:
Differential effects of medium- and long-chain saturated fatty acids on blood lipid profile: a systematic review and meta-analysis by Panth N, Abbott KA, […], Garg ML.

Link:
https://academic.oup.com/ajcn/article-abstract/108/4/675/5100313?redirectedFrom=fulltext

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Medium-chain saturated fatty acids (MCFAs) have approximately 6 to 12 carbon atoms in the chain. Coconut oil, palm kernel oil and coconut milk are by far the foods with the highest amounts of medium-chain saturated fatty acids.

Apolipoprotein AI (apo AI) is the major apoprotein of HDL and its serum concentration also correlates inversely with the risk for coronary heart disease (CHD).

 

Objectives:
Dietary salt reduction in the general population lowers blood pressure and cardiovascular risk. Despite being widely recommended, there is limited evidence as to whether this is applicable to individuals with end-stage renal disease (ESRD) receiving dialysis. Therefore, this review article has been conducted.

Study design:
This review article included 4 RCTs (91 participants), of which 3 were crossover trials and 1 was a parallel study.
Participants were 18 years and over; a reduction in salt intake of at least 1 g/day over 1 week and no concomitant interventions during the study.
The primary outcome was change in systolic and diastolic blood pressure.

Results and conclusions:
The investigators found dietary salt reduction was associated with an 8.4 mmHg [95% CI = 4.8-12.0, Ι2 = 0%] reduction in systolic blood pressure and a 4.4 mmHg [95% CI = 2.2-6.6, Ι2 = 0%] reduction in diastolic blood pressure.

The investigators concluded that a reduction in salt intake of at least 1 g/day over 1 week reduces blood pressure among individuals with end-stage renal disease (ESRD) receiving dialysis.

Original title:
The effect of dietary salt on blood pressure in individuals receiving chronic dialysis: a systematic review and meta-analysis of randomised controlled trials by Cole NI, Swift PA, […], Suckling RJ.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30413764

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Objectives:
The association between coffee consumption and the circulating level of adiponectin and leptin has been evaluated in several epidemiological studies with conflicting results. Therefore, this review article has been conducted.

Is there an association between coffee consumption and the circulating level of adiponectin and leptin in humans?

Study design:
This review article included 12 cross-sectional studies.

Results and conclusions:
The investigators found when compared the highest versus the lowest coffee intake category, coffee consumption was associated with a higher circulating adiponectin level [SMD = 0.11, 95% CI = 0.06 to 0.17, p 0.001].

The investigators found in subgroup analysis when compared the highest versus the lowest coffee intake category, coffee consumption was associated with a higher circulating adiponectin level in women [SMD = 0.11, 95% CI = 0.02 to 0.20, p = 0.01], but not in men [SMD = 0.03, 95% CI = -0.08 to 0.14, p = 0.59].

The investigators found when compared the highest versus the lowest coffee intake category, coffee consumption was associated with a lower circulating leptin level [SMD = -0.19, 95% CI = -0.28 to -0.10, p 0.001].

The investigators concluded that coffee consumption is associated with a higher circulating level of adiponectin in women and a lower circulating level of leptin. However, more well-designed prospective cohort studies and randomised controlled trials are needed to further elaborate the concerned issues.

Original title:
Associations of coffee consumption with circulating level of adiponectin and leptin. A meta-analysis of observational studies by Zhang Y and Zhang DZ.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29513118

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Adiponectin is a unique adipokine, which is specifically and abundantly expressed in adipose tissues and improves insulin resistance. Having insulin resistance may increase the risk of type 2 diabetes and metabolic syndrome.

Objectives:
Is there a relationship between different types of potato consumption and risk of all-cause mortality, coronary heart disease (CHD), stroke, type 2 diabetes (T2D), colorectal cancer (CRC) and hypertension?

Study design:
This review article included 28 reports.

The quality of evidence was rated mostly low (moderate quality of evidence for the risk-associations of French-fries).

Results and conclusions:
The investigators found per one daily/serving (150 g/day) increase of total potato consumption did not associate with:
-all-cause mortality [RR = 0.88, 95% CI = 0.69-1.12];
-coronary heart disease [RR = 1.03, 95% CI = 0.96-1.09];
-stroke [RR = 0.98, 95% CI = 0.93-1.03] and;
-colorectal cancer [RR = 1.05, 95% CI = 0.92-1.20].

The investigators found consumption of one daily/serving (150 g/day) of boiled/baked/mashed-potatoes was also not associated with risk of hypertension [RR = 1.08, 95% CI = 0.96-1.21].
No association because RR of 1 was found in the 95% CI of 0.96 to 1.21. RR of 1 means no risk/association.

The investigators found consumption of one daily/serving (150 g/day) of boiled/baked/mashed-potatoes significantly increased risk of type 2 diabetes with 8% [RR = 1.08, 95% CI = 1.01-1.18].
Significantly because RR of 1 was not found in the 95% CI of 1.01 to 1.18. RR of 1 means no risk/association.

The investigators found for each 150 g/day increase in French-fries consumption a significantly increased risk of type 2 diabetes with 66% [RR =1.66, 95% CI = 1.43-1.94].

The investigators found for each 150 g/day increase in French-fries consumption a significantly increased risk of hypertension with 37% [RR =1.37, 95% CI = 1.15-1.63].
Significantly means that there is an association with a 95% confidence.

The investigators concluded that 150 g/day increase in French-fries consumption is associated with an increased risk of type 2 diabetes and an increased risk of hypertension.

Original title:
Potatoes and risk of chronic disease: a systematic review and dose-response meta-analysis by Schwingshackl L, Schwedhelm C, […], Boeing H.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29987352

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

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

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

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

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

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

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

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

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

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Objectives:
Inflammation is associated with an increased risk of a range of chronic diseases. A diet high in fruit and vegetables may help to reduce inflammation, as fruit and vegetables are rich sources of antioxidants and other biologically active substances, which may improve immune function. Therefore, this meta-analysis (systematic review) has been conducted.

Does fruit or vegetables intake reduce inflammation and improve immune function?

Study design:
This review article included 71 clinical trials and 12 were observational studies (n = 10 cross-sectional studies and n = 2 cohort studies).

Results and conclusions:
The investigators found among observational studies (n = 10 studies) an inverse association between intakes of fruit or vegetables and inflammatory biomarkers.

The investigators found the majority of the intervention studies (n = 48 studies) reported beneficial effects of fruit or vegetable intake on ≥1 biomarker of systemic or airway inflammation.

The investigators found a meta-analysis of included studies showed that fruit or vegetable intake significantly decreased circulating levels of C-reactive protein and tumor necrosis factor-α [p 0.05] and significantly increased the γδ-T cell population [p 0.05].

The investigators concluded that higher intakes of fruit and vegetables lead to both a reduction in proinflammatory mediators and an enhanced immune cell profile.

Original title:
Effects of fruit and vegetable consumption on inflammatory biomarkers and immune cell populations: a systematic literature review and meta-analysis by Hosseini B, Berthon BS, […], Wood LG.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29931038

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The level of C-reactive protein (CRP), which can be measured in your blood, increases when there's inflammation in your body.

Tumour necrosis factor-alpha (TNF-alpha) is recognized as an important mediator in many cytokine-dependent inflammatory events.

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Objectives:
Although glucosamine and chondroitin sulfate have showed beneficial effects on joint tissues in osteoarthritis (OA), their therapeutic use in the clinical setting is still debatable. Therefore, this meta-analysis (systematic review) has been conducted.

Do glucosamine and chondroitin sulfate supplements relieve pain of knee osteoarthritis?

Study design:
This review article included RCTs.

The pain of knee osteoarthritis was measured using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and/or the Visual Analog Scale (VAS).

Results and conclusions:
The investigators found that glucosamine supplements significantly reduced pain of knee osteoarthritis (expressed as Visual Analog Scale (VAS) [WMD = - 7.41 mm, 95% CI = - 14.31 to - 0.51, p = 0.04].
Significant means that there is an association with a 95% confidence.

The investigators found that chondroitin supplements significantly reduced pain of knee osteoarthritis (expressed as Visual Analog Scale (VAS) [WMD = - 8.35 mm, 95% CI = - 11.84 to - 4.85, p  0.00001].
Significant because the found p-value of 0.00001 is less than 0.05.

The investigators found that the combination of glucosamine and chondroitin supplements non-significantly reduced pain of knee osteoarthritis (expressed as Visual Analog Scale (VAS) [WMD = - 0.28 mm, 95% CI = - 8.87 to 8.32, p = 0.95].
Non-significantly because the found p-value of 0.95 is greater than 0.05.

The investigators found that none of the glucosamine, chondroitin supplements or their combination had a significant positive effect on the total WOMAC index and its subscores.

The investigators concluded that oral supplementation with glucosamine or chondroitin sulfate reduces pain in knee osteoarthritis. However, there is no additional effect using both therapeutic agents in combination for the management of symptomatic knee osteoarthritis.

Original title:
Effect of glucosamine and chondroitin sulfate in symptomatic knee osteoarthritis: a systematic review and meta-analysis of randomized placebo-controlled trials by Simental-Mendía M, Sánchez-García A, […], Simental-Mendía LE.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29947998

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Objectives:
In the past, some observational studies have been carried out on the relationship between milk and dairy intake and risk of acne occurrence. However, their results were conflicting. Therefore, this meta-analysis (systematic review) has been conducted.

Does milk and dairy intake increase risk of acne?

Study design:
This review article included observational studies.

Results and conclusions:
The investigators found for highest compared with lowest category of dairy intake a significantly increased risk of 161% for acne [OR = 2.61, 95% CI = 1.20 to 5.67].

Significant means that there is an association with a 95% confidence.

The investigators found for highest compared with lowest category of total milk intake a significantly increased risk of 48% for acne [OR = 1.48, 95% CI = 1.31 to 1.66].
Significantly means it can be said with a 95% confidence that a high total milk intake really increased the risk of getting acne with 48%. 

The investigators found for highest compared with lowest category of low-fat milk intake a significantly increased risk of 25% for acne [OR = 1.25, 95% CI = 1.10 to 1.43].
Significant because OR of 1 was not found in the 95% CI of 1.10 to 1.43. RR of 1 means no risk/association.

The investigators found for highest compared with lowest category of skim milk intake a significantly increased risk of 82% for acne [OR = 1.82, 95% CI = 1.34 to 2.47].

The investigators found results of dose-response analysis revealed a significant linear relationship between dairy, whole milk and skim milk and risk of acne and a nonlinear association between dairy, milk, low-fat milk and skim milk intake and acne.

The investigators concluded there is a positive relationship between dairy, total milk, whole milk, low-fat and skim milk consumption and acne occurrence. In contrary, there is no significant association between yogurt/cheese and acne development.

Original title:
Dairy intake and acne development: A meta-analysis of observational studies by Aghasi M, Golzarand M, […], Taheri F.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29778512

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

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

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

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

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

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

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

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

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

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

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Objectives:
The evidence is mixed on the use of long chain omega 3 fatty acids in the prevention and management of childhood asthma. Therefore, this meta-analysis (systematic review) has been conducted.

Does fish consumption reduce risk of childhood asthma?

Study design:
This review article included 23 observational studies on fish intake in association with childhood asthma.

Results and conclusions:
The investigators found in 15/23 studies early introduction of fish (6-9 months) and regular consumption (at least once a week) improved asthma symptoms and reduced risk in children 0-14 years as compared to no fish consumption; 6/23 showed no effect and 2/23 studies suggested adverse effects.

The investigators found a significantly reduced risk of 25% [OR = 0.75, 95% CI = 0.60-0.95] for all fish intake on current asthma in children up to 4.5 years old. 

The investigators found a significantly reduced risk of 38% [OR = 0.62, 95% CI = 0.48-0.80] for all fish intake on current wheeze in children up to 4.5 years old.

The investigators found as compared to no fish intake, a significantly reduced risk of 65% [OR = 0.35, 95% CI = 0.18-0.67] for fatty fish intake on asthma in children 8-14 years old. 

The investigators concluded that introduction of fish early in life (6-9 months) and regular consumption of all fish (at least once a week) reduces asthma and wheeze in children up to 4.5 years old, while fatty fish intake has beneficial effects in older children (8-14 years). Future well-designed clinical trials are recommended to confirm the promising findings documented in this literature analysis.

Original title:
The role of fish intake on asthma in children: A meta-analysis of observational studies by Papamichael MM, Shrestha SK, [...], Erbas B.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29524247

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

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

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

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

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

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

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

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

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

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

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

Metabolic disorders can take many forms. This includes:

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

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

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

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

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

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

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

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

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

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Objectives:
Does poultry intake reduce risk of stroke?

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

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

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

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

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

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

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

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

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

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

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

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

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

Do resveratrol supplements reduce plasma lipids, like cholesterol levels?

Study design:
This review article included 21 RCTs.

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

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

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

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

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

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

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Objectives:
Zinc is an essential trace element for living organisms and their biological processes. Zinc plays a key role in more than 300 enzymes and it is involved in cell communication, proliferation, differentiation and survival. Zinc also plays a role in regulating the immune system with implications in pathologies where zinc deficiency and inflammation are observed. Therefore, this meta-analysis (systematic review) has been conducted.

Do zinc deficiency increase risk of autoimmune disorders?

Study design:
This review article included 62 case-control studies.

The manner of collecting and investigating zinc samples was very heterogeneous.

Results and conclusions:
The investigators found in fixed model that serum zinc concentration of autoimmune disease patients was significantly lower than in controls [mean effect = -1.19, 95% CI = -1.26 to -1.11].

The investigators found in fixed model that plasma zinc concentration of autoimmune disease patients was significantly lower than in controls [mean effect = -3.97, 95% CI = -4.08 to -3.87].

The investigators concluded that a deficiency of zinc in serum and plasma increases risk of autoimmune disorders in humans.

Original title:
Zinc Status and Autoimmunity: A Systematic Review and Meta-Analysis by Sanna A, Firinu D, […], Valera P.

Link:
http://www.mdpi.com/2072-6643/10/1/68/htm

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An autoimmune disease is a condition in which your immune system mistakenly attacks your body. These are the most common autoimmune diseases:  

1. Addison’s disease: Caused by an adrenal hormone insufficiency. Addison’s disease can lead to muscle weakness and fatigue, nausea, weight loss, irritability, low blood pressure, low blood sugar and depression.
2. Celiac disease (gluten allergy): Celiac disease is a reaction to gluten (found in barley, rye and wheat) that causes damage to the lining of the small intestine.
3. Graves’ disease: Caused by extremely overactive thyroid gland. People who have Graves’ disease may have difficulty sleeping, bulging of the eyes, irritability, brittle hair, unexplained weight loss, sensitivity to heat, muscle weakness, light menstrual periods and shakiness of the hands. On the other hand, some people with Graves’ disease may experience no symptoms at all.
4. Hashimoto’s disease: Caused by inflammation of the thyroid gland. Although sometimes no symptoms occur, Hashimoto’s thyroiditis often results in a goiter (enlargement of the thyroid gland, which may be visible as a bulge in the neck), weight gain, fatigue, muscle weakness, depression, cold sensitivity, dry hair and skin, and constipation.
5. Inflammatory bowel disease: This disease refers to a group of inflammatory diseases of the colon and small intestine.
6. Multiple Sclerosis or MS: This disease affects the brain and spinal cord. People who have MS may experience weakness, trouble with balance and coordination, problems speaking and walking, tremors, paralysis and numbness in the extremities.
7. Psoriasis: This is a skin condition that causes redness and irritation as well as thick, flaky, silver-white patches.
8. Pernicious anemia: Caused by the inability to absorb vitamin B12 leading to a decrease in red blood cells.
9. Reactive arthritis: Caused by inflammation of joints, the urethra and eyes.
10. Raynaud’s phenomenon: People with Raynaud’s have a problem with blood flow, resulting in numbness, tingling of the fingers, discoloration, toes and tip of the nose with exposure to cold temperatures.
11. Rheumatoid arthritis: In rheumatoid arthritis, autoimmunity causes the immune system to attack tissues in the joints. It typically affects the small joints in your hands and feet causing painful swelling, stiffness and loss of movement in the joints that can eventually result in bone erosion and joint deformity.
12. Scleroderma: Scleroderma is a connective tissue disease that causes changes in skin, muscles, blood vessels and internal organs.
13. Sjögren’s syndrome: Caused by destruction of the glands that produce tears and saliva causing dry eyes and mouth.
14. Systemic lupus erythematosus: In lupus, antibodies made by the immune system attack the body. Systemic lupus erythematosus can affect skin, kidneys, joints and brain.
15. Type 1 diabetes: In type 1 diabetes, the immune system attacks cells in the pancreas that produce insulin. When your insulin levels are insufficient, your body cannot control your blood glucose level, which can lead to a number of problems, including kidney failure, stroke, vision loss, circulation problems and heart disease.

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

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

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

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

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

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

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

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

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

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