Nutrition and health

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

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

Objectives:
Previous studies have shown that fish consumption and dietary intake of n-3 polyunsaturated fatty acids (n-3 PUFAs) are associated with hip fracture; however, findings were conflicting. Therefore, this review article (meta-analysis) has been conducted.

Do both dietary intake of fish and n-3 polyunsaturated fatty acids decrease hip fracture risk?

Study design:
This review article included 7 prospective cohort studies and 3 case-control studies with a total sample size of 29,2657 participants. The age of participants was 20 years or older.

Results and conclusions:
The investigators found combining 8 effect sizes from 4 prospective cohort studies and 2 case-control studies revealed a significant inverse association between fish consumption and risk of hip fracture [pooled effect size = 0.88, 95% CI = 0.79-0.98, p = 0.02].
Although this relationship became non-significant in prospective cohort studies, a significant inverse association was found in prospective cohort studies with sample size of 10,000 individuals or more and studies that considered body mass index as a covariate.

The investigators also found dietary intake of n-3 PUFAs significantly reduced risk of hip fracture with 12% [pooled effect size = 0.88, 95% CI = 0.80-0.98, p = 0.02].

The investigators concluded that both fish consumption and dietary intake of n-3 PUFAs have protective effects on bone health and decline the risk of hip fracture.

Original title:
Dietary intake of fish, n-3 polyunsaturated fatty acids and risk of hip fracture: A systematic review and meta-analysis on observational studies by Sadeghi O, Djafarian K, […], Shab-Bidar S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29244536

Additional information of El Mondo:
Find more information/studies on fish consumption, n-3 PUFAs and elderly right here.

Fatty acids in fish are all n-3 PUFAs.
 

Objectives:
There is considerable evidence of the favourable role of more physical activity (PA) in fighting against dementia. However, the shape of the dose-response relationship is still unclear. Therefore, this review article (meta-analysis) has been conducted.

Does leisure time physical activity reduce risk of all-cause dementia (ACD), Alzheimer’s disease (AD) and vascular dementia (VD) in dose-response manner?

Study design:
This review article included 15 cohort studies with 37,436 participants for all-cause dementia, with 25,031 participants for Alzheimer’s disease and with 16,797 participants for vascular dementia.
During follow-up (3-31.6 years for all-cause dementia, 3.9-31.6 years for Alzheimer’s disease and 4-11.9 years for vascular dementia), at least 2,665, 1,337 and 343 participants who were not suffering from dementia at baseline (=at the beginning of the study) were diagnosed with all-cause dementia, Alzheimer’s disease and vascular dementia, respectively.

There was no publication bias.

Results and conclusions:
The investigators found in the dose-response analysis, either all-cause dementia [p trend 0.005 and p non-linearity = 0.87] or Alzheimer’s disease [p trend 0.005 and p non-linearity = 0.10] exhibited a linear relationship with leisure time physical activity over the observed range (0-2000 kcal/week or 0-45 metabolic equivalent of task hours per week (MET-h/week)).

The investigators found for every 500 kcal or 10 MET-h increase per week, a significantly 10% [95% CI = 0.85-0.97] and 13% [95% CI = 0.79-0.96] decrease in the risk of all-cause dementia and Alzheimer’s disease, respectively.

The investigators concluded leisure time physical activity over a specific range (0-2000 kcal/week or 0-45 MET-h/week) is associated with a risk of dementia and Alzheimer’s disease in an inverse linear dose-response manner; with for every 500 kcal (calories) or 10 MET-h increase per week, a 10% and 13% decrease in the risk of all-cause dementia and Alzheimer’s disease, respectively.

Original title:
Leisure time physical activity and dementia risk: a dose-response meta-analysis of prospective studies by Xu W, Wang HF, [...], Tan L.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665289/

Additional information of El Mondo:
Find more information/studies on physical activities and dementia here.

If you do a 4 MET activity for 30 minutes, you have done 4 x 30 = 120 MET-minutes or 2.0 MET-hours of physical activity.
 

Objectives:
The aim of this meta-analysis (review article) is to evaluate the influence of dietary intake and blood level of vitamin A (total vitamin A, retinol or β-carotene) on total and hip fracture risk?

Study design:
This review article included 11 prospective cohort studies and 2 nested case-control studies, involving a total of 319,077 participants over the age of 20 years (109,056 post-menopausal women).

Results and conclusions:
The investigators found higher dietary intake of retinol significantly decreased total fracture risk with 5% [RR = 0.95, 95% CI = 0.91 to 1.00, I2 = 64.64%, p = 0.04].

The investigators found higher dietary intake of retinol significantly increased hip fracture risk with 40% [RR = 1.40, 95% CI = 1.02 to 1.91, I2 = 30.01%, p = 0.40].

The investigators found higher dietary intake of vitamin A significantly decreased total fracture risk with 6% [RR = 0.94, 95% CI = 0.88 to 0.99, I2 = 35.18%, p = 0.20].

The investigators found higher dietary intake of vitamin A significantly increased hip fracture risk with 29% [RR = 1.29, 95% CI = 1.06 to 1.57, I2 = 0.00%, p = 0.60].

The investigators found lower blood level of retinol significantly increased hip fracture risk with 27% [RR = 1.27, 95% CI = 1.05 to 1.53, I2 = 0.00%, p = 0.62].

The investigators concluded that higher dietary intake of total vitamin A or retinol increases the risk of hip fracture but decreases total fracture risk. Clinical trials are warranted to confirm these results and assess the clinical applicability.

Original title:
The Effect of Vitamin A on Fracture Risk: A Meta-Analysis of Cohort Studies by Zhang X, Zhang R, [...], Chen G.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615580/

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

Vitamin A is a generic term for compounds with the biological activity of retinol. Preformed vitamin A (mainly retinol and retinyl esters) is usually found in foods derived from animal products and provitamin A (mainly β-carotene and carotenoids) is usually found in foods derived from plant products.
 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Study design:
This review article included 8 RCTs.

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

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

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

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

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

Additional information of El Mondo:
Find more information/studies on omega-3 fatty acids and cardiovascular diseases right here.

Objectives:
Vitamin D is involved in musculoskeletal health. There is no consensus on a possible association between circulating 25-hydroxyvitamin D (25OHD) concentrations and walking speed, a “vital sign” in older adults. Therefore, this meta-analysis (review article) has been conducted.

Does a high vitamin D level (expressed as circulating 25-hydroxyvitamin D (25OHD) concentrations) increase walking speed in older adults?

Study design:
This review article included 22 observational studies (17 cross-sectional and 5 longitudinal). The number of participants ranged between 54 and 4,100 (0-100% female).

Results and conclusions:
The investigators found usual walking speed was slower among participants with hypovitaminosis D, with a clinically relevant difference compared with normal vitamin D (>75 nmol/L) of -0.18m/s for severe vitamin D deficiency (≤25 nmol/L), -0.08m/s for vitamin D deficiency (≤50 nmol/L) and -0.12m/s for vitamin D insufficiency (≤75 nmol/L).

The investigators found similar results regarding the fast walking speed [mean differences = -0.04m/s for vitamin D deficiency (≤50 nmol/L) and vitamin D insufficiency (≤75 nmol/L) compared with normal vitamin D (>75 nmol/L) and Timed Up and Go test (TUG) [mean difference = 0.48s for severe vitamin D deficiency (≤25 nmol/L) compared with normal vitamin D (>75 nmol/L).

The investigators found a slow usual walking speed was positively associated with:
-severe vitamin D deficiency (≤25 nmol/L) [summary OR = 2.17, 95% CI = 1.52-3.10];
-vitamin D deficiency (≤50 nmol/L) [OR = 1.38, 95% CI = 1.01-1.89] and;
-vitamin D insufficiency (≤75nmol/L) [OR = 1.38, 95% CI = 1.04-1.83], using normal vitamin D (>75 nmol/L) as the reference.

The investigators concluded that robust evidence shows a high 25OHD concentration (vitamin D level of >75 nmol/L) increases walking speed among older adults.

Original title:
Vitamin D and walking speed in older adults: Systematic review and meta-analysis by Annweiler C, Henni S, [...], Duval GT.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29150169

Additional information of El Mondo:
Find more information/studies on review article/observational studies, vitamin D and elderly right here.

A vitamin D level of >75 nmol/L can be achieved by taking 800-1200 IU/d (800-1200 mcg/d) vitamin D3 supplements.
 

Objectives:
No quantitative assessment has been performed to specifically link the consumption of fruit and vegetables with the incident risk of cognitive disorders. Therefore, this meta-analysis (review article) has been conducted.

Does consumption of fruit and vegetables reduce risk of cognitive disorders?

Study design:
This review article included 6 cohort studies involving a total of 21,175 participants.

Results and conclusions:
The investigators found in pooled analysis that consumption of fruit and vegetables significantly reduced risk of cognitive disorders with 26% [pooled RR = 0.74, 95% BI = 0.62-0.88, I2 = 68%; the significant heterogeneity might be attributed to the ethnic difference].

The investigators concluded that consumption of fruit and vegetables reduces risk of cognitive disorders. However, further large prospective studies should be performed to quantify the potential dose-response patterns of fruit and/or vegetables intake and to explore the role of fruit or vegetables consumption separately on cognitive disorders in different populations.

Original title:
Intake of Fruit and Vegetables and the Incident Risk of Cognitive Disorders: A Systematic Review and Meta-Analysis of Cohort Studies by Wu L, Sun D and Tan Y.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29188891

Additional information of El Mondo:
Find more information/studies on fruit and vegetables and dementia right here.
 

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

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

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

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

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

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

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

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

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

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

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

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

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

Objectives:
Currently, dementia is considered untreatable and there are many factors that cause dementia. However, previous studies were unable to identify the factors that affect directly. Therefore, this meta-analysis (review article) has been conducted.

What are the risk factors for prognostic dementia in stroke patients?

Study design:
This review article included 7 hospital-based cohorts of consecutive patients with stroke and 1 population-based cross-sectional study.

Results and conclusions:
The investigators found:
a significantly increased risk of 68% [pooled relative ratio = 1.68, 95% CI = 1.28 to 2.22, I2 = 72%] for atrial fibrillation;
a significantly increased risk of 59% [pooled relative ratio = 1.59, 95% CI = 1.33 to 1.91] for previous stroke;
a significantly increased risk of 40% [pooled relative ratio = 1.40, 95% CI = 1.23 to 1.59, I2% = 14%] for myocardial infarction;
a significantly increased risk of 36% [pooled relative ratio = 1.36, 95% CI = 1.20 to 1.53, I2 = 46%] for hypertension;
a significantly increased risk of 25% [pooled relative ratio = 1.25, 95% CI = 1.11 to 1.41, I2 = 0%] for diabetes mellitus and;
a significantly increased risk of 25% [pooled relative ratio = 1.25, 95% CI = 1.08 to 1.45, I2 = 16%] for previous transient ischemic attack (TIA).

The investigators concluded that strongly risk factors associated with increased risk of post-stroke dementia are atrial fibrillation, previous stroke, myocardial infarction, hypertension, diabetes and previous TIA. However, there are other risk factors related to dementia. Therefore, further studies are needed to investigate and develop the risk score value to forecast the dementia incident in stroke patients.

Original title:
Risk factors associated with post-stroke dementia: a systematic review and meta-analysis by Surawan J, Areemit S, […], Saensak S.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641826/

Additional information of El Mondo:
Find more information/studies on stroke, diabetes, hypertension, dementia and elderly right here.
 

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

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

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

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

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

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

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

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

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

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

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

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

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

Objectives:
Whole grains are rich source of nutrients and have shown beneficial effects on human health. Therefore, this meta-analysis (review article) has been conducted.

Do taking whole grains reduce mortality risk?

Study design:
This review article included 19 cohort studies with in total 1,041,692 participants and 96,710 deaths.

Results and conclusions:
The investigators found when comparing the highest versus the lowest categories of whole grain, a significantly reduced risk of 16% [RR = 0.84, 95% CI = 0.81-0.88, n = 9] for total mortality.

The investigators found when comparing the highest versus the lowest categories of whole grain, a significantly reduced risk of 17% [RR = 0.83, 95% CI = 0.79-0.86, n = 8] for cardiovascular mortality.

The investigators found when comparing the highest versus the lowest categories of whole grain, a non-significantly reduced risk of 6% [RR = 0.94, 95% CI = 0.87-1.01, n = 14] for cancer mortality.

The investigators found a nonlinear relationship of whole grain intake with risk of total, cardiovascular and cancer mortality.

The investigators found each 28 g/d intake of whole grains was associated with a 9% [pooled RR = 0.91, 95% CI = 0.90-0.93] lower risk for total mortality.

The investigators found each 28 g/d intake of whole grains was associated with a 14% [pooled RR = 0.86, 95% CI = 0.83-0.89] lower risk for cardiovascular mortality.

The investigators found each 28 g/d intake of whole grains was associated with a 3% [pooled RR = 0.97, 95% CI = 0.95-0.99] lower risk for cancer mortality.

The investigators concluded that a higher whole grain intake (at least 28 g/d) reduces risk of total, cardiovascular and cancer mortality. These findings support current dietary guidelines to increase the intake of whole grains. Government officials, scientists and medical staff should take actions to promote whole grains intake.
 
Original title:
Association of whole grain intake with all-cause, cardiovascular, and cancer mortality: a systematic review and dose-response meta-analysis from prospective cohort studies by Zhang B, Zhao Q, [...], Wang X.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29091078

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Does viscous soluble fiber supplementation reduce cardiovascular disease risk?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Objectives:
Previous studies had inconsistent findings regarding the association between vitamin C intake and the risk of hip fracture. Therefore, this meta-analysis (review article) has been conducted.

Does taking dietary vitamin C reduce risk of hip fracture?

Study design:
This review article included 6 articles, containing 7908 controls and 2899 cases of hip fracture.

Results and conclusions:
The investigators found when comparing the highest versus the lowest categories of vitamin C, that dietary vitamin C was statistically correlated with a lower risk of 27% for hip fracture [overall OR = 0.73, 95% CI = 0.55-0.97, I2 = 69.1%].

The investigators found that every increment of 50 mg/day dietary vitamin C intake significantly reduced risk of hip fracture with 5% [OR = 0.95, 95% CI = 0.91-1.00, p = 0.05].

The investigators concluded that increasing dietary vitamin C (at least 50 mg/day) intake decreases the risk of hip fracture. In order to verify the association of vitamin C intake and hip fracture risk, further well-designed largely randomized controlled trials (RCTs) are needed.

Original title:
Dietary vitamin C intake and the risk of hip fracture: a dose-response meta-analysis by Sun Y, Liu C, […], Lu Q.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29101410

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

Objectives:
Fish are a primary source of long-chain omega-3 fatty acids, which may help delay cognitive aging. Therefore, this meta-analysis (review article) has been conducted.

Does a higher fish intake reduce cognitive decline?

Study design:
This review article included 5 cohort studies (23,688 Caucasians aged ≥65 years, 88% female and median follow-up range of 3.9-9.1 years).

Results and conclusions:
The investigators found in multivariate analyses, higher fish intake was associated with slower decline in both global cognition and memory [p-trend ≤ 0.031].

The investigators found consuming ≥4 versus 1 fish serving/week was associated with 0.018 [95% CI = 0.004-0.032] standard units lower rate of memory decline; an effect estimate equivalent to that found for 4 years of age.

The investigators found for global cognition, no comparisons of higher versus low fish intake reached statistical significance.

The investigators found no evidence of effect modification by Alzheimer's.

The investigators concluded that increasing fish intake (at least 4 servings/week) is associated with decreasing memory decline of older persons.

Original title:
Fish intake, genetic predisposition to alzheimer's disease and decline in global cognition and memory in five cohorts of older persons by Samieri C, Morris MC,[…], Grodstein F.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29053784

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A typical serving size of fish can range from 3 to 6 oz., depending on the type of fish and its preparation. The American Heart Association considers 3.5 oz. of cooked fish, or about 3/4 cup, to be a single serving.
 

Objectives:
With an aging population and no cure for dementia on the horizon, risk factor modification prior to disease onset is an urgent health priority. Therefore, this meta-analysis (review article) has been conducted.

What is the effect of low vitamin D status or vitamin D supplementation on cognition in midlife and older adults without a diagnosis of dementia?

Study design:
This review article included 26 observational (cross-sectional and longitudinal cohort) studies and 3 intervention studies (n = 19-9,556).

Results and conclusions:
The investigators found in 26 observational studies that low vitamin D status was associated with worse cognitive performance [OR = 1.24, CI = 1.14-1.35] and cognitive decline [OR = 1.26, CI = 1.09-1.23] in midlife and older adults without a diagnosis of dementia; with cross-sectional yielding a stronger effect compared to longitudinal studies.

However, the investigators found in 3 intervention studies that vitamin D supplementation showed no significant benefit on cognition compared with control [SMD = 0.21, CI = -0.05 to 0.46].

The investigators concluded that observational evidence demonstrates low vitamin D is related to poorer cognition in midlife and older adults without a diagnosis of dementia; however, interventional studies are yet to show a clear benefit from vitamin D supplementation. From the evidence to date, there is likely a therapeutic age window relevant to the development of disease and therefore vitamin D therapy. Longitudinal lifespan studies are necessary to depict the optimal timing and duration in which repletion of vitamin D may protect against cognitive decline and dementia in aging, to better inform trials and practice towards a successful therapy.

Original title:
A Systematic Review and Meta-Analysis of The Effect of Low Vitamin D on Cognition by Goodwill AM and Szoeke C.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28758188

Additional information of El Mondo:
Find more information/studies on vitamin D, review article/significant, elderly and dementia right here.
 

Objectives:
Many publications have investigated the association between metal ions and the risk of Alzheimer's disease (AD), but the results were ambiguous. Therefore, this meta-analysis (review article) has been conducted.

What is the association between serum copper/zinc/iron levels and Alzheimer's disease risk?

Study design:
This review article included 44 case-control studies.

Results and conclusions:
The investigators found in 35 case-control studies (2,128 Alzheimer's disease patients and 2,889 healthy controls. The mean age of the patient groups was >54), that serum copper levels were significant higher in Alzheimer's disease patients [MD = 9.13, 95% CI = 6.17 to 12.09, p 0.00001].

The investigators found in 22 case-control studies (1,027 Alzheimer's disease patients and 1,949 healthy controls. The mean age of the patient groups was >54), that serum zinc levels were significant lower in Alzheimer's disease patients [MD = -7.80, 95% CI = -11.61 to -3.99, p 0.0001].

The investigators found in 25 case-control studies (1,379 Alzheimer's disease patients and 1,664 healthy controls. The mean age of the patient groups was >62.74), that serum iron levels were significant lower in Alzheimer's disease patients [MD = -13.01, 95% CI = -20.75 to -5.27, p = 0.001].

The investigators concluded that serum copper levels are significantly increased, while serum zinc/iron levels are significantly decreased in Alzheimer's disease patients.

Original title:
Serum Copper, Zinc, and Iron Levels in Patients with Alzheimer's Disease: A Meta-Analysis of Case-Control Studies by Li DD, Zhang W, [...], Zhao P.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605551/

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Do patients with heart failure benefit from coenzyme Q10 supplements?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Does anthocyanin supplementation improve vascular function?

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

There was no publication bias.

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

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

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

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

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

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

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

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Objectives:
Available studies in the literature on the selenium levels in Alzheimer's disease (AD) are inconsistent with some studies reporting its decrease in the circulation, while others reported an increase or no change as compared to controls. Therefore, this meta-analysis (review article) has been conducted.

Do lower circulatory (plasma/serum and blood), erythrocyte and cerebrospinal fluid (CSF) selenium levels increase Alzheimer's disease risk?

Study design:
This review article included 12 case-control/observational studies reporting selenium concentrations in Alzheimer's disease and controls.

Results and conclusions:
The investigators found random-effects meta-analysis indicated a decrease in circulatory [SMD = -0.44], erythrocellular [SMD = -0.52] and cerebrospinal fluid [SMD = -0.14] selenium levels in Alzheimer's disease patients compared to controls

The investigators found stratified meta-analysis demonstrated that the selenium levels were decreased in both the subgroups with [SMD = -0.55] and without [SMD = -0.37] age matching between Alzheimer's disease and controls.

The investigators also found a direct association between decreased selenium levels and glutathione peroxidase (GPx) in Alzheimer's disease.

The investigators concluded that circulatory selenium concentration is significantly lower in Alzheimer's disease patients compared to controls and this decrease in selenium is directly correlated with an important antioxidant enzyme, the glutathione peroxidase, in Alzheimer's disease.

Original title:
A systematic review and meta-analysis of the circulatory, erythrocellular and CSF selenium levels in Alzheimer's disease: A metal meta-analysis (AMMA study-I) by Reddya VS, Bukkeb S, […], Pandeye AK.

Link:
http://www.sciencedirect.com/science/article/pii/S0946672X1630205X%20

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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