Nutrition and health

Objectives:
The role of zinc in the etiology of type 2 diabetes has been widely reported in recent decades. However, much remains uncertain concerning the effect of zinc on the risk of developing type 2 diabetes. Therefore, this review article has been conducted.

Does zinc reduce risk of type 2 diabetes?

Study design:
This review article included 16 studies.
There was no publication bias.

Results and conclusions:
The investigators found in 7 prospective cohort studies and 1 cross-sectional study (146,027 participants aged between 18 and 84 years and of both genders, belonging to different ethnic groups. Of which, 11,511 type 2 diabetes cases) when comparing the highest versus lowest dietary zinc intakes, a significantly reduced risk of 13% [OR = 0.87, 95% CI = 0.78-0.98, I2 = 64.5%, p = 0.003] for type 2 diabetes.
This relationship was stronger and more evident in rural compared to urban areas [rural areas: OR = 0.59, 95% CI = 0.48-0.73, I2 = 0.0%, p = 0.843 versus urban areas: OR = 0.94, 95% CI = 0.86-1.02, I2 = 43.9%, p = 0.113].

The investigators found no association between supplementary [OR = 0.94, 95% CI = 0.75-1.19, I2 = 85.4%, p = 0.009] or total zinc intake from both diet and supplementation [OR = 0.95, 95% CI = 0.82-1.11, I2 = 56.5%, p = 0.129] and type 2 diabetes risk.

The investigators found in population-based studies that high serum/plasma zinc levels significantly increased risk of type 2 diabetes with 64% [OR = 1.64, 95% CI = 1.25-2.14, I2 > 22.5%, p = 0.275].

The investigators concluded high dietary zinc intake reduces risk of type 2 diabetes. This relationship is stronger and more evident in rural compared to urban areas. However, an elevated serum/plasma zinc concentration is associated with an increased risk of type 2 diabetes in the general population.

Link:
Zinc Intake and Status and Risk of Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis by Fernández-Cao JC, Warthon-Medina M, […], Lowe NM.

Link:
https://www.mdpi.com/2072-6643/11/5/1027/htm

Additional information of El Mondo:
Find more information/studies on diabetes and zinc consumption right here.

Serum/plasma zinc levels can be increased by eating products that contain a lot of zinc and/or taking zinc supplements.
 

Objectives:
Does vitamin K reduce risk of cardiovascular disease (CVD) events and mortality?

Study design:
This review article included 21 articles with 222,592 participants.

Results and conclusions:
The investigators found dietary phylloquinone (vitamin K1) intake significantly reduced risk of total cardiovascular disease with 8% [pooled HR = 0.92, 95% CI = 0.84 to 0.99, I2 = 0%, 4 studies].
Significant means that there is an association with a 95% confidence.

The investigators found dietary menaquinone (vitamin K2) intake significantly reduced risk of total cardiovascular disease with 30% [pooled HR = 0.70, 95% CI = 0.53 to 0.93, I2 = 32.1%, 2 studies].
Significant because HR of 1 was not found in the 95% CI of 0.53 to 0.93. HR of 1 means no risk/association.

The investigators found no significant association between dietary vitamin K and all-cause mortality, cardiovascular disease mortality or stroke.

The investigators found elevated plasma desphospho-uncarboxylated MGP (dp-ucMGP), a marker of vitamin K deficiency, was associated with an increased risk of 84% [HR = 1.84, 95% CI = 1.48 to 2.28, I2 = 16.8%, 5 studies] for all-cause mortality.

The investigators found elevated plasma desphospho-uncarboxylated MGP (dp-ucMGP), a marker of vitamin K deficiency, was associated with an increased risk of 96% [HR = 1.96, 95% CI = 1.47 to 2.61, I2 = 0%, 2 studies] for cardiovascular disease mortality.

The investigators found no significant association between circulating total osteocalcin and all-cause mortality or total cardiovascular disease.

The investigators concluded higher dietary vitamin K consumption reduces risk of cardiovascular disease and higher plasma dp-ucMGP concentration, but not total circulating osteocalcin, increases risk of all-cause and cardiovascular disease mortality. However, causal relations cannot be established because of limited number of available studies and larger prospective studies and randomized clinical trials are needed to validate these findings.  

Original title:
Association of vitamin K with cardiovascular events and all-cause mortality: a systematic review and meta-analysis by Chen HG, Sheng LT, […], Pan A.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31119401

Additional information of El Mondo:
Find more information/studies on vitamin K, significantly/review article and cardiovascular disease right here.

100 grams of fresh parsley provide 548 micrograms (548 mcg) of vitamin K1 or 4.5 days.
 

Objectives:
Does magnesium reduce risk of type 2 diabetes?

Study design:
This review article included 35 cohort studies and 26 RCTs (1,168 participants).

Results and conclusions:
The investigators found compared to the lowest magnesium dietary intake, the highest level was associated with a 22% lower risk for type 2 diabetes.

The investigators found the risk for type 2 diabetes was reduced by 6% for each 100mg increment in daily magnesium dietary intake.

The investigators found in 26 RCTs (1,168 participants) that magnesium supplementation significantly reduced:
-the fasting plasma glucose (FPG) level [SMD = -0.32, 95% CI = -0.59 to -0.05];
-2-h oral glucose tolerance test (2-h OGTT) result [SMD = -0.30, 95% CI = -0.58 to -0.02];
-fasting insulin level [SMD = -0.17, 95% CI = -0.30 to -0.04];
-homeostatic model assessment-insulin resistance (HOMA-IR) score [SMD = -0.41, 95% CI = -0.71 to -0.11];
-triglyceride (TG) level;
-systolic blood pressure (SBP) and;
-diastolic blood pressure (DBP).

The investigators found trial sequential analysis (TSA) showed an inverse association, with most benefits of magnesium supplementation on glucose metabolism being stable.

The investigators concluded magnesium dietary intake has an inverse dose-response association with type 2 diabetes incidence and supplementation appears to be advisable in terms of glucose parameters in type 2 diabetes/high-risk individuals.

Original title:
Association of Magnesium Consumption with Type 2 Diabetes and Glucose Metabolism: a Systematic Literature Review and Pooled Study with Trial Sequential Analysis by Zhao B, Deng H, [...], Zhang W.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31758631

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

Objectives:
Observational evidence suggests higher nut consumption is associated with better glycemic control. However, it is unclear if this association is causal. Therefore, this review article has been conducted.

Is there a causal relationship between consumption of tree nuts or peanuts and reduced risk of type 2 diabetes?

Study design:
This review article included a total of 40 RCTs with 2,832 unique participants, with a median duration of 3 months (range: 1-12 months).

Results and conclusions:
The investigators found overall consumption of tree nuts or peanuts had a favourable effect on HOMA-IR values [WMD = -0.23, 95% CI = -0.40 to -0.06, I2 = 51.7%] and fasting insulin levels [WMD = -0.40 μIU/mL, 95% CI = -0.73 to -0.07 μIU/mL, I2 = 49.4%].

The investigators found, however, there was no significant effect of nut consumption on fasting blood glucose levels [WMD = -0.52 mg/dL, 95% CI = -1.43 to 0.38 mg/dL, I2 = 53.4%] or HbA1c [WMD = 0.02%, 95% CI = -0.01% to 0.04%, I2 = 51.0%].

The investigators concluded consumption of peanuts or tree nuts decreases HOMA-IR and fasting insulin levels. These findings suggest that nut consumption may improve insulin sensitivity. In the future, well-designed clinical trials are required to elucidate the mechanisms that account for these observed effects.

Original title:
The effect of nuts on markers of glycemic control: a systematic review and meta-analysis of randomized controlled trials by Tindall AM, Johnston EA, […], Petersen KS.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30722007

Additional information of El Mondo:
Find more information/studies on diabetes and nut consumption right here.

Objectives:
Is there a causal relationship between grape product supplementation and improved lipid profiles in adults?

Study design:
This review article included 48 RCTs.

Results and conclusions:
The investigators found meta-analysis indicated that consumption of grape products significantly reduced the concentration of total cholesterol [MD = -6.196 mg/dL, 95% CI = -9.203 to -3.189], low-density lipoprotein cholesterol (bad cholesterol) [MD = -4.964 mg/dL, 95% CI = -7.594 to -2.334] and triglyceride [MD = -7.641 mg/dL, 95% CI = -12.120 to -3.162].

The investigators found grape product supplementation changed the HDL and LDL in a non-linear fashion based on the dose of polyphenols.

The investigators concluded that grape products have a favorable role in the achievement of a lipid profile target in adults, particularly total cholesterol, low-density lipoprotein cholesterol (bad cholesterol) and triglyceride levels.

Original title:
Effects of grape products on blood lipids: a systematic review and dose-response meta-analysis of randomized controlled trials by Ghaedi E, Moradi S, [...], Mohammadi H.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31517353

Additional information of El Mondo:
Find more information/studies on fruits, meta-analysis and cholesterol right here.
 

Objectives:
The incidence of type 2 diabetes mellitus (DM) has increased in the US over the last several years. The consumption of low-fat dairy foods has been linked with decreasing the risk of diabetes mellitus but studies have yet to show a clear correlation. Therefore, this review article has been conducted.

Is there a causal relationship between consumption of low-fat dairy foods and reduced risk of type 2 diabetes?

Study design:
This review article included 30 RCTs.
The total sample size was 2,900 with >50% female participants, but the distribution varied greatly across different studies.
The mean age of subjects ranged from 18-63 years.
The funnel plots for all 3 outcomes (HOMA-IR, waist circumference and body weight) did not suggest significant publication bias.

Results and conclusions:
The investigators found (794 individuals) comparing high intake to the control group, consumption of low-fat dairy foods significantly reduced the HOMA-IR values [MD = -1.21, 95% CI = -1.74 to -0.67, p 0.00001, I2 = 92%].

The investigators found (1,348 individuals) comparing high intake to the control group, consumption of low-fat dairy foods significantly reduced waist circumference [MD = -1.09 cm, 95% CI = -1.68 to -0.58, p 0.00001, I2 = 94%].

The investigators found for body weight (2,362 individuals), the low-fat dairy foods intervention group weighed 0.42 kg less than the control group [p 0.00001, I2 = 92%].

The investigators found limiting to studies that were assessed to have low risk of bias did not significantly change the point estimates or heterogeneity statistics (Q or I2) for all 3 outcomes.
Similarly excluding studies with a physical activity component did not significantly alter point estimates or heterogeneity statistics for all 3 outcomes.

The investigators concluded low-fat dairy products have a beneficial effect on HOMA-IR, waist circumference and body weight. This could impact dietary recommendations to reduce type 2 diabetes risk.

Original title:
The Effects of Dairy Intake on Insulin Resistance: A Systematic Review and Meta-Analysis of Randomized Clinical Trials by Sochol KM, Johns TS, […], Melamed ML.

Link:
https://www.mdpi.com/2072-6643/11/9/2237/htm

Additional information of El Mondo:
Find more information/studies on diabetes and dairy products intake right here.

Objectives:
In recent years, cardiovascular diseases (CVDs) have become a focus topic and global concern. There have been mixed reports on the relationship between whole grain or cereal fiber intake and the risk of type 2 diabetes. Therefore, this review article has been conducted.

Does grain or cereal fiber dietary intake reduce risk of type 2 diabetes?

Study design:
This review article included 7 cohort studies and 1 case-control study with a total of 434,903 participants and 14,728 cases of type 2 diabetes.
The average follow-up was 12.6 years.
There was no publication bias.

Results and conclusions:
The investigators found whole grain or cereal fiber dietary intake was associated with a reduced risk of 26% [combined RR = 0.74, 95% CI = 0.67 to 0.82, I2 = 56.8%, p = 0.06] for type 2 diabetes.
This reduced risk was 38% [pooled RR = 0.68, 95% CI = 0.64-0.73, I2 = 0.0%, p = 0.452] in sensitivity analysis.

The investigators found whole grain or cereal fiber dietary intake was associated with a reduced risk of 32% [combined RR = 0.68, 95% CI = 0.49 to 0.88] for type 2 diabetes among males.

The investigators found whole grain or cereal fiber dietary intake was associated with a reduced risk of 26% [combined RR = 0.74, 95% CI = 0.64 to 0.77] for type 2 diabetes among females.

The investigators concluded that increased whole grain and cereal fiber dietary intake reduce risk of type 2 diabetes.

Original title:
Whole grain and cereal fiber intake and the risk of type 2 diabetes: a meta-analysis by Wang Y, Duan Y, […], Jin Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627783/

Additional information of El Mondo:
Find more information/studies on diabetes and fiber intake right here.

Objectives:
Does green coffee bean extract (GCBE) supplementation reduce blood pressure?

Study design:
This review article included 9 RCTs.

Results and conclusions:
The investigators found a significant reduction in systolic blood pressure (SBP) [WMD = -3.093 mmHg, 95% CI = -3.914 to -2.273, I2 = 0.0%] and diastolic blood pressure (DBP) [WMD = -2.170 mmHg, 95% CI = -2.749 to -1.590, I2 = 46.5%] after green coffee supplementation with low heterogeneity among the studies.

The investigators found in subgroup analysis, a significant reduction in systolic blood pressure and diastolic blood pressure in studies with hypertensive patients, green coffee dosage 400 mg per day and administered for 4 weeks.

The investigators concluded 400 mg coffee bean extract supplementation per day during 4 weeks reduces systolic blood pressure and diastolic blood pressure in hypertensive patients.

Original title:
The effect of green coffee extract supplementation on blood pressure: A systematic review and meta-analysis of randomized controlled trials by Han B, Nazary-Vannani A, […], Kord-Varkaneh H.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31429515

Additional information of El Mondo:
Find more information/studies on coffee and reducing blood pressure right here.
 

Objectives:
Do dietary intakes or circulating concentration of major dietary antioxidants, like vitamin C, E and beta-carotene reduce risk of total cardiovascular mortality?

Study design:
This review article included a total of 15 prospective cohort studies and 3 prospective evaluations within interventional studies with 320,548 participants and 16,974 deaths from total cardiovascular mortality.

Results and conclusions:
The investigators found compared to the lowest category, the highest category of dietary vitamin C intake significantly reduced risk of total cardiovascular mortality with 21% [relative risk = 0.79, 95% CI = 0.68 to 0.89, I2 = 46%, n = 10].

The investigators found compared to the lowest category, the highest category of circulating concentration of vitamin C significantly reduced risk of total cardiovascular mortality with 40% [relative risk = 0.60, 95% CI = 0.42 to 0.78, I2 = 65%, n = 6].

The investigators found compared to the lowest category, the highest category of circulating concentration of vitamin E (α-tocopherol) significantly reduced risk of total cardiovascular mortality with 18% [relative risk = 0.82, 95% CI = 0.76 to 0.88, I2 = 0%, n = 5].

The investigators found compared to the lowest category, the highest category of circulating concentration of β-carotene significantly reduced risk of total cardiovascular mortality with 32% [relative risks = 0.68, 95% CI = 0.52 to 0.83, I2 = 50%, n = 6].

The investigators found dose-response meta-analyses demonstrated that the circulating biomarkers of antioxidants were more strongly associated with risk of total cardiovascular mortality than dietary intakes.

The investigators concluded that higher dietary vitamin C intakes and higher circulating concentrations of vitamin C, vitamin E and β-carotene are associated with a lower risk of total cardiovascular mortality.

Original title:
Dietary and circulating vitamin C, vitamin E, β-carotene and risk of total cardiovascular mortality: a systematic review and dose-response meta-analysis of prospective observational studies by Jayedi A, Rashidy-Pour A, […], Shab-Bidar S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30630552

Additional information of El Mondo:
Find more information/studies on antioxidants, vitamin C, E, β-carotene and cardiovascular diseases right here.

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

Objectives:
Dietary polyphenols, including flavonoids, have been the focus of major recent attentions due to their wide content in a variety of foods commonly consumed and the findings from numerous studies showing evidence of an association with positive outcomes on human health. Therefore, this review article has been conducted.

Does dietary intake of flavonoids (e.g., anthocyanins, isoflavones, flavones, flavonols, flavanones, flavan-3-ols) reduce hypertension?

Study design:
This review article included 15 cross-sectional investigations and 7 prospective cohort studies (1 study reported on 3 prospective cohort studies).
5 prospective cohort studies, comprising 200,256 individuals and 45,732 cases of hypertension were included in the quantitative analysis.

All studies included covariates that may have significantly influenced the endpoint outcome (hypertension), such as age, sex (when not analyzed separately), BMI, education, physical activity and smoking status. However, not all studies adjusted for key dietary factors that might influence risk of hypertension, such as sodium and potassium intake.

There was no publication bias.

Results and conclusions:
The investigators found analysis by extreme quantiles of intake of flavonoid showed a non-significant association with decreased risk of hypertension [risk ratio = 0.96, 95% CI = 0.89 to 1.03, I2 = 74%, p = 0.01].
Non-significant because RR of 1 was found in the 95% CI of 0.89 to 1.03. RR of 1 means no risk/association.

The investigators found taking into consideration individual flavonoid subclasses, dietary intake of anthocyanins was associated with 8% reduction in risk of hypertension, when comparing highest vs. lowest exposure [risk ratio = 0.92, 95% CI = 0.88 to 0.97].
Significant because RR of 1 was not found in the 95% CI of 0.88 to 0.97. RR of 1 means no risk/association.

The investigators concluded dietary intakes of anthocyanins reduce risk of hypertension. However, further studies are needed to elucidate the retrieved association between polyphenol consumption and decreased risk of hypertension and to clarify whether individual subclasses, rather than the total content of polyphenols, may exert beneficial effects on blood pressure.

Original title:
Dietary Polyphenol Intake, Blood Pressure, and Hypertension: A Systematic Review and Meta-Analysis of Observational Studies by Godos J, Vitale M, […], Grosso G.

Link:
https://www.mdpi.com/2076-3921/8/6/152/htm

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

Objectives:
Preventing cardiovascular disease (CVD) is the top priority in public health. Hyperlipidemia and hypertension are key contributors to cardiovascular disease which can be easily modified with dietary and lifestyle interventions. Therefore, this review article has been conducted.

Does cashew consumption reduce blood lipids levels (i.e., triglyceride, total cholesterol, HDL cholesterol (good cholesterol) and LDL cholesterol (bad cholesterol) and blood pressure?

Study design:
This review article included 5 RCTs with 246 participants receiving cashew nut (intervention group) and 235 receiving placebo (placebo group).

There was no publication bias.

Results and conclusions:
The investigators found overall analysis showed a statistically significant reducing effect of cashew nut consumption on triglyceride levels [WMD = -14.39, 95% CI = -27.30 to -1.49, I2 = 82%].
Significant means that there is an association with a 95% confidence.

The investigators found overall analysis showed a statistically significant reducing effect of cashew nut consumption on systolic blood pressure [WMD = -1 mm/Hg, 95% CI = -5.12 to -3.01, I2 = 0%].

The investigators found overall analysis showed a statistically significant reducing effect of cashew nut consumption on diastolic blood pressure [WMD = -4.06 mm/Hg, 95% CI = -1.65 to -0.35, I2 = 0%].

The investigators found, however, no statistically significant changes of other cardiovascular risk markers including total cholesterol [WMD = -1.89, 95% CI = -9.17 to 5.39, p = 0.61], LDL cholesterol [WMD = -5.49, 95% CI = -16.76 to 5.78, p = 0.34] and HDL cholesterol [WMD = -0.67, 95% CI = -2.54 to 1.19, p = 0.48] were observed after cashew nut consumption.
No statistically significant because the calculated p-values of e.g. 0.61 or 0.34 were larger than the p-value of 0.05.

The investigators concluded that cashew consumption improves triglyceride levels as well as systolic and diastolic blood pressure with no significant effects on other cardiometabolic factors (i.e., total cholesterol, HDL cholesterol (good cholesterol) and LDL cholesterol (bad cholesterol)). Further studies are warranted with different calories and dietary compositions.

Original title:
The Effect of Cashew Nut on Cardiovascular Risk Factors and Blood Pressure: A Systematic Review and Meta-analysis (P06-117-19) by Mahboobi S.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6573847/

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

Objectives:
Although many studies have shown that low zinc status is associated with diabetes, the putative effects of zinc supplementation on glycemic control are inconclusive. Therefore, this review article (meta-analysis) has been conducted.

Does zinc supplementation reduce risk of diabetes mellitus?

Study design:
This review article included 32 RCTs, involving a total of 1,700 participants in 14 countries.

Results and conclusions:
The investigators found overall, compared with their respective control groups, the subjects in the zinc supplementation group had a statistically significant reduction in concentrations of :
-fasting glucose [WMD = -14.15 mg/dL, 95% CI = -17.36 to -10.93 mg/dL];
-2-h postprandial glucose [WMD = -36.85 mg/dL, 95% CI = -62.05 to -11.65 mg/dL];
-fasting insulin [WMD = -1.82 mU/L, 95% CI = -3.10 to -0.54 mU/L];
-homeostasis model assessment for insulin resistance [WMD = -0.73, 95% CI = -1.22 to -0.24]:
-glycated hemoglobin [WMD = -0.55%, 95% CI = -0.84 to -0.27%] and;
-high-sensitivity C-reactive protein [WMD = -1.31 mg/L, 95% CI = -2.05 to -0.56 mg/L].

The investigators found, moreover, subgroup analyses revealed that the effects of zinc supplementation on fasting glucose were significantly influenced by diabetic status and the formulation of the zinc supplement.

The investigators concluded several key glycemic indicators are significantly reduced by zinc supplementation, particularly the fasting glucose in subjects with diabetes and in subjects who received an inorganic zinc supplement. Together, these findings support the notion that zinc supplementation may have clinical potential as an adjunct therapy for preventing or managing diabetes.

Original title:
Zinc supplementation improves glycemic control for diabetes prevention and management: a systematic review and meta-analysis of randomized controlled trials by Wang X, Wu W, [...], Wang F.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31161192

Additional information of El Mondo:
Find more information/studies on diabetes and zinc right here.

Objectives:
Dietary proteins, including those obtained from animal and plant sources, have inconsistently been correlated with type 2 diabetes mellitus (T2DM) risk. Therefore, this review article (meta-analysis) has been conducted.

Does dietary protein intake increase risk of type 2 diabetes mellitus?

Study design:
This review article included 21 cohort studies with a total of 487,956 individuals and 38,350 T2DM cases (persons with type 2 diabetes mellitus).

Results and conclusions:
The investigators found high total dietary protein intake was associated with an increased risk of 10% for type 2 diabetes mellitus [RR = 1.10, p = 0.006] whereas moderate total dietary protein intake was not significantly associated with type 2 diabetes mellitus risk [RR = 1.00,  p = 0.917].  
Not significantly because the calculated p-value of 0.917 was larger than the p-value of 0.05.

The investigators found, moreover, an increased risk of 13% [RR = 1.13, p = 0.013] for type 2 diabetes mellitus was observed with high  dietary animal protein intake whereas moderate animal protein intake had little or no effect on type 2 diabetes mellitus risk [RR = 1.06, p = 0.058].

The investigators found, high dietary intake of plant protein did not affect type 2 diabetes mellitus risk [RR = 0.93, p = 0.074], whereas moderate intake was associated with a reduced risk of 6% for type 2 diabetes mellitus [RR = 0.94, p  0.001].

The investigators concluded high dietary total protein and dietary animal protein intakes are associated with an increased risk of type 2 diabetes mellitus, whereas moderate plant protein intake is associated with a decreased risk of type 2 diabetes mellitus.

Original title:
Dietary protein intake and subsequent risk of type 2 diabetes: a dose-response meta-analysis of prospective cohort studies by Ye J, Yu Q, [...], Wang Y.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30929078

Additional information of El Mondo:
Find more information/studies on diabetes and protein right here.

A diet with high protein intake is a diet with a minimum of 35 En% protein (En% = energy percentage). These products from the supermarket contain at least 35 En% protein.
35 En% protein means that the amounts of protein contribute 35% to the total calories (kcal) of the diet.
If the diet contains 2000 kcal, 175 grams of protein contribute 35% to this 2000 kcal.
1 gram of protein gives 4 kcal. Thus, 175 grams of protein provide 700 kcal and 700 kcal is 35% of 2000 kcal.

A diet with moderate protein consumption is a diet with 20-25 En% protein. The easiest way to follow a diet with moderate protein consumption is to choose only products/meals that also contain 20-25 En% protein. These products from the supermarket contain 20-25 En% protein.

 

Objectives:
Does coenzyme Q10 (CoQ10) supplementation improve biomarkers of inflammation and oxidative stress among patients with coronary artery disease (CAD)?

Study design:
This review article included 13 RCTs.

Given the presence of heterogeneity, random-effects model or fixed-effect model were used to pool standardized mean differences (SMDs) as summary effect sizes.

Results and conclusions:
The investigators found pooled findings for biomarkers of inflammation and oxidative stress demonstrated that coenzyme Q10 supplementation significantly increased superoxide dismutase (SOD) [SMD = 2.63, 95% CI = 1.17 to 4.09, p  0.001, I2 = 94.5%] and catalase (CAT) levels [SMD = 1.00, 95% CI = 0.57 to 1.43, p  0.001, I2 = 24.5%] among patients with coronary artery disease.

The investigators found pooled findings for biomarkers of inflammation and oxidative stress demonstrated that coenzyme Q10 supplementation significantly reduced malondialdehyde (MDA) [SMD = -4.29, 95% CI = -6.72 to -1.86, p = 0.001, I2 = 97.6%] and diene levels [SMD = -2.40, 95% CI = -3.11 to -1.68, p  0.001, I2 = 72.6%] among patients with coronary artery disease.

The investigators found among patients with coronary artery disease no significant effect of coenzyme Q10 supplementation on:
-C-reactive protein (CRP) [SMD = -0.62, 95% CI = -1.31 to 0.08, p = 0.08, I2 = 87.9%];
-tumor necrosis factor alpha (TNF-α) [SMD = 0.22, 95% CI = -1.07 to 1.51, p = 0.73, I2 = 89.7%];
-interleukin-6 (IL-6) [SMD = -1.63, 95% CI = -3.43 to 0.17, p = 0.07, I2 = 95.2%] and;
-glutathione peroxidase (GPx) levels [SMD = 0.14, 95% CI = -0.77 to 1.04, p = 0.76, I2 = 78.7%].
No significant because the calculated p-values were larger than the p-value of 0.05.

The investigators concluded coenzyme Q10 supplementation increases superoxide dismutase and catalase and decreases malondialdehyde and diene levels, but has no affect on C-reactive protein, tumor necrosis factor alpha, interleukin-6 and glutathione peroxidase levels among patients with coronary artery disease.

Original title:
The effects of coenzyme Q10 supplementation on biomarkers of inflammation and oxidative stress in among coronary artery disease: a systematic review and meta-analysis of randomized controlled trials by Jorat MV, Tabrizi R, […], Asemi Z.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30758695

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

Malondialdehyde and diene are biomarkers of oxidative stress. Oxidative stress can arise when human cells cannot adequately destroy the excess of free radicals formed.

Free radicals can be rendered harmless by antioxidants such as vitamins C and E and by antioxidative enzymes such as superoxide dismutase and catalase.

Objectives:
The role of gut microbiota in the management of diabetes has been shown. Several current trials are investigating the effect of probiotics and prebiotics, which are widely used to modulate intestinal microbiota, on inflammatory factors and biomarkers of oxidative stress in diabetic patient. However, their findings are controversial. Therefore, this review article (meta-analysis) has been conducted.

Do probiotic and synbiotic supplementation improve biomarkers of inflammation and oxidative stress in diabetic patients?

Study design:
This review article included 16 RCTs (n = 1,060).

Randomized controlled trials (RCTs) reported the effect of probiotics or synbiotics on circulating (serum and plasma) inflammatory marker (hs-CRP) and oxidative stress indicators (malondialdehyde [MDA], glutathione [GSH], nitric oxide [NO] and total antioxidant capacity [TAC]) among patients with diabetes.

The methodological quality varied across these trials.

Results and conclusions:
The investigators found probiotic and synbiotic supplementation significantly decreased hs-CRP level [SMD = -0.38, 95% CI = -0.51 to -0.24, p = 0.000] and the oxidative stress indicator malondialdehyde [SMD = -0.61, 95% CI = -0.89 to -0.32, p = 0.000] in diabetic patients compared to those in subjects receiving placebos.

The investigators found, in addition, probiotic and synbiotic supplementation significantly increased total antioxidant capacity [SMD = 0.31, 95% CI = 0.09 to 0.52, p = 0.006], nitric oxide [SMD = 0.62, 95% CI = 0.25 to 0.99, p = 0.001] and glutathione [SMD = 0.41, 95% CI = 0.26, 0.55, p = 0.000] levels.

The investigators concluded that probiotic and synbiotic supplementation improve biomarkers of inflammation and oxidative stress in diabetic patients. Further studies are needed to develop clinical practice guidelines for the management of inflammation and oxidative stress in these patients.

Original title:
The effect of probiotic and synbiotic supplementation on biomarkers of inflammation and oxidative stress in diabetic patients: A systematic review and meta-analysis of randomized controlled trials by Zheng HJ, Guo J, [...], Wang Y.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30794924

Additional information of El Mondo:
Find more information/studies on diabetes and probiotic and synbiotic supplementation right here.

Oxidative stress is an imbalance between free radicals and antioxidants in your body. Antioxidants can reduce oxidative stress.
 

Objectives:
Does kiwifruit improve metabolic health in participants with cardiovascular risk factors, including hypercholesterolemia, hypertension, diabetes type 2 and smokers?

Study design:
This review article included 5 RCTs involving 489 participants.

Results and conclusions:
The investigators found no significant effect of kiwifruit on:
-systolic blood pressure (SBP) [MD = -1.72 mmHg, 95% CI = -4.27 to 0.84];
-diastolic blood pressure (DBP) [MD = -2.35 mmHg, 95% CI = -5.10 to 0.41];
-total cholesterol (TC) [MD = -0.14 mmol/L, 95% CI = -0.71 to 0.43];
-triglyceride (TG) [MD = -0.23 mmol/L, 95% CI = -0.66 to 0.20];
-low-density lipoprotein cholesterol (bad cholesterol or LDL) [MD = -0.41 mmol/L, 95% CI = -0.99 to 0.18];
-high-density lipoprotein cholesterol (good cholesterol or HDL) [MD = 0.15 mmol/L, 95% CI = -0.18 to 0.48];
-fasting plasma glucose (FPG) [MD = -0.08 mmol/L, 95% CI = -0.37 to 0.21];
-homeostasis model assessment of insulin resistance (HOMA-IR) [MD = -0.29, 95% CI = -0.61 to 0.02] and;
-body weight (BW) [MD = 1.08 kg, 95% CI = -4.22 to 2.05].

The investigators found subgroup analysis limiting to studies of whole kiwifruit and duration of intervention of at least 8 weeks again revealed no such effect of kiwifruit on total cholesterol, triglyceride, LDL cholesterol and HDL cholesterol.

The investigators concluded kiwifruit has no effect on metabolic health, as measured by systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, LDL cholesterol and HDL cholesterol, fasting plasma glucose, homeostasis model assessment of insulin resistance (HOMA-IR) and body weight in participants with cardiovascular risk factors including hypercholesterolemia, hypertension, diabetes type 2 and smokers. Due to limited evidence and high heterogeneity of the study results, the potential of kiwifruit as a nonpharmaceutical alternative for metabolic health should be further evaluated in well-defined, well-controlled trials with larger sample size and standardized preparation.

Original title:
Effect of kiwifruit on metabolic health in patients with cardiovascular risk factors: a systematic review and meta-analysis by Suksomboon N, Poolsup N and Lin W.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350646/

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

Objectives:
Several epidemiological studies have investigated the association between dietary fat intake and cardiovascular disease. However, dietary recommendations based on systematic review and meta-analysis might be more credible. Therefore, this review article has been conducted.

Does dietary fat intake increase cardiovascular disease risk?

Study design:
This review article included 56 cohort studies.
Egger test showed no evidence of significant publication bias.

Results and conclusions:
The investigators found highest versus lowest levels of total dietary fat were not associated with cardiovascular disease risk [RR = 0.97, 95% CI = 0.93-1.01, I2 = 54.0%].
Sensitivity analysis showed that no individual study had an excessive influence on the pooled effect.
In addition, the analysis was repeated stratified according to each covariate. The results were consistent with that observed in meta-regression.

The investigators found highest versus lowest levels of dietary trans fatty acids intake were associated with a 14% increase of the risk of cardiovascular disease [RR = 1.14, 95% CI = 1.08-1.21, I2 = 26.1%].
Sensitivity analysis showed that no individual study had an excessive influence on the pooled effect.

The investigators found dose-response analysis showed the risk of cardiovascular disease significantly increased with 16% [RR = 1.16, 95% CI = 1.07-1.25, p-linearity = 0.033] for an increment of 2% energy/day (2 En%/day) of dietary trans fatty acids intake.

The investigators found highest versus lowest levels of dietary saturated fatty acids intake were not associated with the risk of cardiovascular disease [RR = 0.97, 95% CI = 0.93-1.02, I2 = 56.8%].
Sensitivity analysis showed that no individual study had an excessive influence on the pooled effect
In addition, the analysis was repeated stratified according to each covariate. The results were consistent with that observed in meta-regression.

The investigators found highest versus lowest levels of dietary monounsaturated fatty acids intake were not associated with the risk of cardiovascular disease [RR = 0.97, 95% CI = 0.93-1.01, I2 = 50.3%].
Sensitivity analysis showed that no individual study had an excessive influence on the pooled effect.
In addition, the analysis was repeated stratified according to each covariate. The results were consistent with that observed in meta-regression.

The investigators found highest versus lowest levels of dietary polyunsaturated fatty acids intake were not associated with the risk of cardiovascular disease [RR = 0.97, 95% CI = 0.93-1.004, I2 = 55.8%].
Sensitivity analysis showed that no individual study had an excessive influence on the pooled effect.
In addition, the analysis was repeated stratified according to each covariate. The results were consistent with that observed in meta-regression.

The investigators found in studies that has been followed up more than 10 years, that dietary polyunsaturated fatty acids intake significantly reduced cardiovascular disease risk with 5% [RR = 0.95, 95% CI = 0.91-0.99, I2 = 62.4%].

The investigators concluded there is a cardio-protective effect of dietary polyunsaturated fatty acids intake in studies that has been followed up more than 10 years. While, an increment of 2% energy/day (2 En%/day) of dietary trans fatty acids intake increases risk of cardiovascular disease.

Original title:
Dietary total fat, fatty acids intake, and risk of cardiovascular disease: a dose-response meta-analysis of cohort studies by Zhu Y, Bo Y and Liu Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451787/

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

Objectives:
Various mechanisms link higher total homocysteine to higher insulin resistance and risk of type 2 diabetes (T2D). Folate supplementation is recognized as a way to lower homocysteine. However, randomized controlled trials (RCTs) show inconsistent results on insulin resistance and type 2 diabetes outcomes. Therefore, this review article (meta-analysis) has been conducted.

Does folate supplementation improve insulin resistance and type 2 diabetes outcomes?

Study design:
This review article included 29 RCTs (22,250 participants) that assessed the effect of placebo-controlled folate supplementation alone or in combination with other B vitamins on fasting glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c) or risk of type 2 diabetes.

The meta-analysis was conducted using both random- and fixed-effects models to calculate weighted mean differences (WMDs) or risk ratios with 95% CIs.
Heterogeneity was low in all meta-analyses.

Results and conclusions:
The investigators found when compared with placebo, folate supplementation significantly lowered fasting insulin [WMD = -13.47 pmol/L, 95% CI = -21.41 to -5.53 pmol/L, p 0.001] and HOMA-IR [WMD = -0.57 units, 95% CI = -0.76 to -0.37 units, p 0.0001], but no overall effects were observed for fasting glucose or HbA1c.

The investigators found subgroup analysis showed no signs of effect modification except for change in homocysteine, with the most pronounced effects in trials with a change of >2.5 µmol/L.
Changes in homocysteine after folate supplementation correlated with changes in fasting glucose [β = 0.07, 95% CI = 0.01 to 0.14, p = 0.025] and HbA1c [β = 0.46, 95% CI = 0.06 to 0.85, p = 0.02].

The investigators found only 2 studies examined folate supplementation on risk of type 2 diabetes and they found no change in RR [pooled RR = 0.91, 95% CI = 0.80 to 1.04, p = 0.16].

The investigators concluded that folate supplementation lowers fasting insulin and HOMA-IR. However, folate supplementation does not reduce risk of type 2 diabetes.

Original title:
Effect of folate supplementation on insulin sensitivity and type 2 diabetes: a meta-analysis of randomized controlled trials by Lind MV, Lauritzen L, [...], Eriksen JN.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30615110

Additional information of El Mondo:
Find more information/studies on diabetes and folate (also called folic acid) right here.
 

Objectives:
Several studies have been conducted on the effects of peanut consumption on cardiovascular diseases (CVD) risk factors. However, the findings are conflicting and appear inconsistent. Therefore, this review article has been conducted.

Does peanut consumption reduce cardiovascular disease risk?

Study design:
This review article included 13 RCTs.

Results and conclusions:
The investigators found peanuts consumption had no significant effect on:
-weight [WMD = -0.11 kg, p = 0.773];
-waist circumference [WMD = -1.41 cm, p = 0.139];
-body mass index [WMD = -0.14 kg/m², p = 0.428];

-systolic and diastolic blood pressure [WMD = -0.09 mmHg, p = 0.939 and WMD = 0.60 mmHg, p = 0.652, respectively];
-low-density lipoprotein (LDL or bad) cholesterol [WMD = -3.31 mg/dL, p = 0.472];
-triglyceride [WMD = -7.59 mg/dL, p = 0.180];
-total cholesterol [WMD = 3.15 mg/dL, p = 0.171];
-fasting blood sugar [WMD = 0.57 mg/dL, p = 0.604] and;
-serum insulin [WMD = -0.40, p = 0.582].

The investigators found peanuts consumption had a positive significant effect on high-density lipoprotein (HDL or good) cholesterol [WMD = 2.72 mg/dL, p = 0.001].
Significant because the calculated p-value of 0.001 was smaller than the p-value of 0.05.

The investigators found peanut consumption had a positive significant effect on HDL cholesterol, especially at the type of peanut oil, high-oleic peanut and peanut sprout and in healthy subjects and for consumption more than 12 weeks, while had no significant effect on other cardiovascular diseases risk factors.

The investigators concluded both high-oleic peanut and peanut sprout consumption during at least 12 weeks increases HDL cholesterol (good cholesterol) in healthy subjects.

Original title:
Peanut and cardiovascular disease risk factors: A systematic review and meta-analysis by Jafari Azad B, Daneshzad E and Azadbakht L.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30638042

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

Objectives:
Evidence from randomized controlled trials (RCTs) suggests that viscous dietary fiber may offer beneficial effects on glycemic control and, thus, an improved cardiovascular disease risk profile. Therefore, this review article (meta-analysis) has been conducted.

Does viscous dietary fiber supplementation improve glycemic control in type 2 diabetes?

Study design:
This review article included 28 RCTs of ≥3 weeks in duration that assessed the effects of viscous fiber on markers of glycemic control in type 2 diabetes with a total of 1,394 participants.

Results and conclusions:
The investigators found that viscous fiber at a median dose of ∼13.1 g/day significantly reduced HbA1c in type 2 diabetes [MD = -0.58%, 95% CI = -0.88 to -0.28, p = 0.0002] compared with control and in addition to standard of care.

The investigators found that viscous fiber at a median dose of ∼13.1 g/day significantly reduced fasting blood glucose in type 2 diabetes [MD = -0.82 mmol/L, 95% CI = -1.32 to -0.31, p = 0.001] compared with control and in addition to standard of care. 

The investigators found that viscous fiber at a median dose of ∼13.1 g/day significantly reduced HOMA-insulin resistance in type 2 diabetes [MD = -1.89, 95% CI = -3.45 to -0.33, p = 0.02] compared with control and in addition to standard of care.

The investigators found the certainty of evidence was graded moderate for HbA1c, fasting glucose, fasting insulin and HOMA-IR and low for fructosamine.

The investigators concluded that 13.1 g/day viscous fiber supplements improve conventional markers of glycemic control beyond usual care and should be considered in the management of type 2 diabetes.

Original title:
Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials by Jovanovski E, Khayyat R, […], Vuksan V.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30617143

Additional information of El Mondo:
Find more information/studies on diabetes and dietary fiber right here.