Nutritional Advice El Mondo

Nutritional advice

Pregnancy

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

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

2023:

  1. Probiotic/synbiotic supplements improve glucose and lipid metabolism in pregnant women with gestational diabetes mellitus
  2. Vitamin B6 supplements reduce nausea and vomiting during pregnancy

2022:

  1. Systolic blood pressure <130 mmHg prevents severe hypertension in pregnant women

2021:

  1. Oral magnesium supplementation does not reduce leg cramps during pregnancy
  2. Salt iodination alone is not sufficient to provide adequate iodine status to pregnant women
  3. Breastfeeding reduces ovarian cancer in women with BRCA1 or BRCA2 mutation
  4. Vitamin and mineral supplementation improves glycemic control in women with gestational diabetes mellitus
  5. Prenatal alcohol exposure increases placental abruption
  6. Preterm birth and low birthweight are strongest risk factors associated with increased case fatality of infants with spina bifida
  7. Enteral zinc supplementation enhances weight gain and linear growth in preterm infants
  8. >650 mg/day maternal or neonatal DHA and/or EPA supplements increase weight in childhood
  9. 400 μg folic acid during pregnancy reduce offspring's autism spectrum disorders
  10. Multiple-micronutrient supplementation improves birth outcomes among pregnant adolescents in low- and middle-income countries
  11. Vitamin A supplementation reduces bronchopulmonary dysplasia in premature infants
  12. CNS congenital abnormalities, intracranial calcifications, fetal loss, SGA, low birth weight and prematurity are associated with Zika virus infection
  13. A low maternal serum zinc level increases pre-eclampsia in African women
  14. Daily 100 mg cholesterol increase gestational diabetes mellitus

2020:

  1. Probiotic supplementation during pregnancy is beneficial for gestational age
  2. COVID-19 pandemic increases anxiety among women during pregnancy and perinatal period
  3. Coronavirus infection is more likely to affect pregnant women
  4. Rates of vaccine coverage immediately after birth are very low for BCG and HepB-BD in neonates in sub-Saharan Africa
  5. Artemisinin-based combination therapies should be treatment guidelines for uncomplicated falciparum malaria in pregnant women
  6. Higher levels of gestational vitamin D reduce multiple sclerosis in offspring
  7. Iron fortification increases haemoglobin concentration during pregnancy
  8. Probiotic supplementation has positive effects on outcomes of preterm infants in India
  9. No association between oral cholera vaccination and adverse pregnancy outcomes
  10. Influenza vaccination during pregnancy reduce infant influenza
  11. Probiotic supplementation improves outcomes of preterm infants in India
  12. Omega-3 fatty acids + vitamin E or D reduce gestational diabetes
  13. Maternal folic acid supplementation is associated with an increased birth weight
  14. Measles infection in pregnancy is dangerous for mother and fetus
  15. N-3 fatty acids supplementation reduces preeclampsia during pregnancy
  16. High maternal thyroid hormones during pregnancy increase neonatal birth weight

2019:

  1. 75 mg daily DHEA supplements increase fertility in women
  2. Higher plasma levels of free fatty acids increase gestational diabetes mellitus
  3. Pregnancy-associated malaria increases preterm birth and low birth weight
  4. HPV vaccination during pregnancy does not increase adverse pregnancy outcomes
  5. Maternal folic acid supplementation reduces childhood acute lymphoblastic leukaemia
  6. Multiple micronutrient supplementation generates positive health outcomes for both infants and pregnant women
  7. 0.6-2 gram calcium supplement reduce gestational hypertension
  8. Maternal vitamin D deficiency during pregnancy increases low birth weight
  9. Mother-infant skin to skin contact immediately after birth increases breastfeeding
  10. Steady-state red blood cell folate concentrations can be reached with 375-570 µg folic acid/day
  11. Breastfeeding can be improved by a combination of professional and laypersons
  12. High prenatal vitamin D level reduces risk autism-related traits later in life

2018:

  1. Probiotic supplementation during both prenatal and postnatal period reduces atopic dermatitis
  2. 2g inositol twice daily reduce preterm delivery rate
  3. Antioxidant supplements could increase sperm quality
  4. Egg into an infant’s diet between 3 and 6 months of age reduces egg allergy risk
  5. PUFA supplements do not improve intelligence in low birth weight children
  6. Kangaroo mother care increases breastfeeding
  7. Antenatal care and institutional delivery increase exclusive breastfeeding practices in Ethiopia
  8. Asian vegetarian mothers have an increased risk to deliver babies with low birth weight
  9. Low maternal iodine status in early pregnancy gives lower IQ
  10. Myo-inositol supplementation reduces risk of gestational diabetes and preterm delivery in pregnant women
  11. Anemia at the beginning of pregnancy increases a SGA baby
  12. Maternal probiotic supplements during pregnancy and lactation reduce eczema during childhood

2017:

  1. First-trimester use of artemisinin derivatives is not associated with an increased risk of miscarriage or stillbirth compared to quinine
  2. ABT results in higher efficacy than QBT in the second and third trimester of pregnancy with uncomplicated falciparum malaria
  3. Women’s groups practising participatory learning and action improve key behaviours on the pathway to neonatal mortality
  4. Breastfeeding during 6-9 months reduces risk of endometrial cancer
  5. Antenatal multiple micronutrient supplements provide greater birth-outcome benefits for infants born to undernourished and anaemic pregnant women
  6. Plasmodium falciparum malaria in pregnancy increases stillbirth risk
  7. Daily 1mg heme iron increases risk of gestational diabetes mellitus in pregnant women
  8. Childhood nutritional supplementation with ≥5 nutrients improves cognitive development of children in developing countries
  9. Pregnant women with malnutrition and malaria infection are at increased risk of having a low birthweight compared to women with only 1 risk factor or none
  10. Severe vitamin D deficiency (<20 ng/mL) increases risk of early spontaneous pregnancy loss
  11. Serum ceruloplasmin may be a useful screening and follow-up tool for developing preeclampsia
  12. High serum copper level increase risk of preeclampsia in Asian pregnant women
  13. Zinc sulfate supplementation does not reduce neonatal jaundice
  14. Fish consumption during pregnancy is not associated with risk of asthma and other allergy-related diseases from infancy to mid childhood
  15. Routine supplementation of full-term infant milk formula with LCPUFA cannot be recommended
  16. Vitamin D supplementation alone during pregnancy reduces risk of preterm birth
  17. Maternal vitamin B12 deficiency increases low birth weight in newborns

2013:

  1. Daily 10 to 66 mg iron supplementation during pregnancy improve maternal haematological status and birth weight

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Childbirth usually occurs about 38 weeks after conception; in women who have a menstrual cycle length of four weeks, this is approximately 40 weeks from the start of the last normal menstrual period. A pregnancy of 37 to 42 weeks is considered full-term. A pregnancy less than 37 weeks is considered pre-term, which is dangerous due to underdevelopment. Over 42 weeks is also dangerous due to septic poisoning.
Women generally don't begin to feel the baby moves until sometime between 16 and 22 weeks or later. In general, the gender can be determined with certainty after the fourteenth week. After 30 weeks of gestation, the baby is able to recognize a language.

The pregnancy is divided into 3 periods:

  1. The first 3 months. During these months all organs of the fetus are developed.
  2. The second three months, in which the organs further develop.
  3. The last 3 months. During these 3 months the emphasis is put on growth and the unborn child gets per day 67 mg of DHA from the mother.

A woman with a BMI of 18.5-25 will gain during pregnancy about 12 kg, of which about one third is the weight of the child.

BMI before pregnancyDesired weight gain during pregnancy
<19.8

12

.5-18

19.8-2611.5-16
26-297-11.5
>296
A woman with 65 kg and 1.57 meters has a BMI of 26.4 (65/(1.57x1.57)). BMI is kg/m2.

 

Energy requirements during pregnancy
The duration of pregnancyExtra kcal per day
The first 3 months70
The second three months260
The last 3 months500


During breastfeeding mothers need on average 500 extra calories per day. Most women need 6 months to a year after childbirth to get back to their pre-pregnancy weight.

It is not desirable to lose weight during pregnancy.

The World Health Organization shows that optimal birth weight of 3.1-3.6 kg is associated with maternal weight gains of 10-14 kg.

Dietary guidelines during pregnancy:

  • A balanced diet during pregnancy contains 18-24 kJ (4.3-5.7 kcal) per kg body weight. This diet has a low GI value and includes whole grains, fruits, beans and vegetables.
  • Your daily diet (=all meals/products that you eat on a daily basis) should on average contain maximum 30 En% fat, maximum 7-10 En% saturated fat, 15-20 En% protein, 50-55 En% carbohydrates, maximum 25 En% simple sugars, maximum 0.3 gram salt per 100 kcal, minimum 1.3 grams of fiber per 100 kcal and fish providing 500 mg of EPA and DHA (with 200 mg DHA) per day.
  • Do not drink alcohol.
  • Stop smoking.
  • Take daily 400 micrograms (mcg) of folic acid supplement for a period of at least four weeks prior to the first eight weeks of pregnancy.
    400 mcg of folic acid per day reduces the risk of getting a spina bifida and cleft palate in the unborn child.
  • Eat no more than 3000 micrograms of vitamin A per day.
  • Aim for a BMI of 18.5-25 before entering the pregnancy. Research has shown that the healthiest pregnancy is associated with a pre-pregnancy BMI of 23.
  • Eat fish, providing at least 200 mg of DHA per day. DHA is needed for the development of the brain and vision of the fetus.  
  • Do not eat raw or undercooked (pink fried) meat because the mother can be infected with toxoplasmosis. Toxoplasmosis can cause permanent damage to the brains and eyes of the unborn child. Feces of cats and sandboxes are also sources of toxoplasmosis.
  • Do not eat cheeses made from raw milk (lait au cu).The listeria bacteria are found in raw milk. Listeria can be harmful to the unborn child and can even cause miscarriage.
  • Take a multivitamin supplement.
  • Take fish oil supplements (250-500 mg of EPA and DHA per tablet) if you do not eat fish. Take only dietary supplements after consulting an expert!

Dietary guidelines during breastfeeding:

  • Do not drink alcohol.
  • Stop smoking.
  • Do not drink more than 3 cups of coffee or 3 cups of tea per day. Too much caffeine (found in coffee and tea) can make the baby restless.
  • Give 4-6 months exclusively breastfeeding because breast milk is the healthiest nutrition for the baby. After 4-6 months the baby should receive supplementary feeding because breastfeeding no longer covers the daily nutritional requirements of the growing baby.
  • Do not lose more than 0.5 kg weight per week, otherwise your baby will get through breastfeeding too much toxins. Toxins in the human body are stored in fatty tissues.

Cardiovascular diseases

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

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

2023:

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

2022:

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

2021:

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

2020:

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

2019:

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

2018:

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

2017:

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

2016:

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

2015:

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

2014:

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

2013:

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

2012:

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

2011:

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

2002:

  1. 240 mg magnesium per day decrease systolic blood pressure

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

The main causes of cardiovascular diseases are:

Rules of thumb:

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

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

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

A cholesterol lowering diet contains:

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

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

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

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

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

Symptoms that may indicate a heart attack in women are:

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

Dietary guidelines for cardiovascular disease prevention:

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

 

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

Cardiovascular diseases

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

The main causes of cardiovascular diseases are:

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

Rules of thumb:

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

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

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

A cholesterol lowering diet contains:

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

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

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

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

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

Symptoms that may indicate a heart attack in women are:

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

Dietary guidelines for cardiovascular disease prevention:

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

Target values ​​for a healthy heart:

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

 

Lifestyle measures for the treatment and prevention of high blood pressure

Lifestyle changes

Recommendation

Reduction of systolic blood pressure

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

5-20 mmHg

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

2-8 mmHg

Potassium intakePer every increment of 0.6 gram

1 mmHg

Physical activities30-60 minutes of physical activity per day

4-9 mmHg

Alcohol consumptionMaximum 2 glasses for  men & 1 glass for women

2-4 mmHg

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

8-14 mmHg

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


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

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

2017:

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

Probiotic/synbiotic supplements improve glucose and lipid metabolism in pregnant women with gestational diabetes mellitus

Objectives:
The effect of probiotic/synbiotic supplementation on gestational diabetes mellitus (GDM) is controversial. Therefore, this review article has been conducted.

Do probiotic/synbiotic supplements improve glucose and lipid metabolism in pregnant women with gestational diabetes mellitus?

Study design:
This review article included 11 RCTs with a total of 390 women with gestational diabetes mellitus in probiotics/synbiotics group and 389 women with gestational diabetes mellitus in placebo group.

The mean age of those participants ranged from 26.4 years to 33.5 years.
The duration of intervention ranged from 4 weeks to 8 weeks.

Results and conclusions:
The investigators found compared with the placebo, probiotics/synbiotics supplements were associated with a statistically significant improvement in fasting plasma glucose (FPG) [MD = -2.33, 95% CI = -4.27 to -0.40, p = 0.02, I2 = 74%].  

The investigators found compared with the placebo, probiotics/synbiotics supplements were associated with a statistically significant improvement in the homoeostatic model assessment for insulin resistance (HOMA-IR) [MD = -0.40, 95% CI = -0.74 to -0.06, p = 0.02, I2 = 76%].  

The investigators found compared with the placebo, probiotics/synbiotics supplements were associated with a statistically significant improvement in fasting serum insulin (FSI) [MD = -2.47, 95% CI = -3.82 to -1.12, p = 0.0003, I2 =73%].  

The investigators found compared with the placebo, probiotics/synbiotics supplements were associated with a statistically significant improvement in total cholesterol (TC) [MD = -6.59, 95% CI = -12.23 to -0.95, p = 0.02].  

The investigators found subgroup analysis revealed that the kind of supplement led to heterogeneity for FPG and FSI, while heterogeneity was not found for others.

The investigators concluded probiotic/synbiotic supplements improve glucose and lipid metabolism in pregnant women with gestational diabetes mellitus. The use of specific probiotic supplementations containing Lactobacillus acidophilus and Bifidobacterium bifidum (>1 × 106 CFU/g) may be a promising prevention and therapeutic strategy for gestational diabetes mellitus, as they could directly act on the intestinal mucosal barrier and restore the gut flora balance. However, due to the heterogeneity among existing studies, further studies are warranted to address the limitations of existing evidence and better inform the management of gestational diabetes mellitus.

Original title:
The Effects of Probiotics/Synbiotics on Glucose and Lipid Metabolism in Women with Gestational Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials by Mu J, Xian Guo X, […], Cao G.

Link:
https://www.mdpi.com/2072-6643/15/6/1375

Additional information of El Mondo:
Find more information/studies on probiotic, diabetes mellitus and pregnancy right here.

 

500 mL/d orange juice consumption causally reduce bad cholesterol

Objectives:
Does orange juice consumption causally improve lipid profile?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

Does dietary intake of calcium reduce risk of stroke?

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

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

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

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

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

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

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

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

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

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

 

 Vitamin B6 supplements reduce nausea and vomiting during pregnancy

Objectives:
Nausea and vomiting during pregnancy (NVP) are common symptoms in pregnancy. Although no definitive treatment option for NVP, pyridoxine (vitamin B6) supplementation has been used widely. Therefore, this review article has been conducted.

Does supplementation of pyridoxine alone as well as combined treatment of pyridoxine with an active ingredient as the intervention reduce nausea and vomiting during pregnancy?

Study design:
This review article included 8 RCTs.

Results and conclusions:
The investigators found 8 studies showed beneficial effects with pyridoxine alone as the supplementation, while 6 others found that the supplementation of pyridoxine in combination with another active substance had favourable effects.

The investigators found supplementation of pyridoxine alone as well as combined treatment of pyridoxine with an active ingredient as the intervention significantly improved the symptoms of nausea according to Rhode's score [0.78, 95% CI= 0.26 to 1.31, p = 0.003, I2 = 57%, p = 0.10] and PUQE score [0.75, 95% CI = 0.28 to 1.22, p = 0.002, I2 = 0%, p = 0.51], respectively.

The investigators concluded supplementation of pyridoxine (vitamin B6) alone as well as combined treatment of pyridoxine with an active ingredient as the intervention reduces nausea and vomiting during pregnancy.

Original title:
The effects of pyridoxine (vitamin B6) supplementation in nausea and vomiting during pregnancy: a systematic review and meta-analysis by Jayawardena R, Majeed S, […], Ranaweera P.

Link:
https://pubmed.ncbi.nlm.nih.gov/36719452/

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

Green tea may causally improve risk factors of cardiovascular disease

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Additional information of El Mondo:
Find more information/studies on green tea, lowering blood pressure and cardiovascular diseases right here.

Green tea causally lowers blood pressure in healthy individuals

Objectives:
Is there a causal relationship between drinking green tea and lowering blood pressure in healthy individuals?

Study design:
This review article included 9 RCTs with 345 healty individuals in the intervention group (group with green tea) and 335 healthy individuals in the control group (group without green tea).

The mean age of the individuals in the intervention group was 35.89 ± 8.52, while the mean age of the control group was 36.48 ± 7.68.
All studies clearly described allocation randomization, none had incomplete outcome data, and all used appropriate statistical analysis.
The completion rate of the consumption of green tea ranged from 85-100%.
No publication bias was observed in the studies.

Results and conclusions:
The investigators found combined results of the studies showed that green tea was effective in lowering systolic blood pressure in healthy individuals [MD = -2.99, 95% CI = -3.77 to -2.22, p 0.00001, I2 = 0%].

The investigators found combined results of the studies showed that green tea was effective in lowering diastolic blood pressure in healthy individuals [MD= -0.95, 95% CI = -1.62 to -0.27, p = 0.006, I2 = 0%]. 

The investigators concluded in healthy individuals, green tea supplementation reduces systolic blood pressure by 2.99 mmHg and diastolic blood pressure by 0.95 mmHg.

Original title:
Effect of Green Tea on Blood Pressure in Healthy Individuals: A Meta-Analysis by Ayaz EY, Dincer B and Mesci B.

Link:
https://pubmed.ncbi.nlm.nih.gov/36689359/

Additional information of El Mondo:
Find more information/studies on green tea, lowering blood pressure and cardiovascular diseases right here.

 

20 g/day olive oil reduce all-cause mortality

Objectives:
Epidemiological studies have shown the preventive effects of olive oil consumption against cardiovascular events and all-cause deaths, but the results remain inconsistent. Therefore, this meta-analysis (review article) has been conducted.

Does higher olive oil consumption reduce the risk of cardiovascular disease and all-cause mortality?

Study design:
This review article included 13 prospective cohort studies.
These studies were published between 2003 and 2022, with follow-up intervals ranging from 4 to 28 years.
Most of studies collected the dietary data on olive oil intake based on food-frequency questionnaires and the outcome events were identified using International Classification of Diseases codes or other medical records.
All of the studies were assigned a NOS score of ≥7, indicating the evidence of high methodological quality.
There was no publication bias.

Results and conclusions:
The investigators found meta-analysis of 8 cohort studies (261,016 participants and 14,033 cardiovascular disease cases) showed versus lowest consumption of olive oil, high consumption of olive oil significantly reduced risk of cardiovascular disease with 15% [pooled RR = 0.85, 95% CI = 0.77 to 0.93, p 0.001, I2 = 41%, p = 0.107].
Subgroup analyses showed no significant differences between strata of study region, sample size, follow-up duration, sex and olive oil type.
The combined risk estimate of cardiovascular disease was not altered in the sensitivity analysis by omitting each study one at a time.

The investigators found meta-analysis of 11 cohort studies (713,000 participants and 173,817 deaths) showed versus lowest consumption of olive oil, high consumption of olive oil significantly reduced risk of all-cause mortality with 17% [pooled RR = 0.83, 95% CI = 0.77 to 0.90, p 0.001, I2 = 93%, p 0.001].
Excluding each report in sequence had no influence on the pooled result.
The combined RRs were similar between subsets stratified by the aforementioned features.

The investigators found in dose-response meta-analysis, a significantly reduced risk of 4% for cardiovascular disease per 5-g/day increase in olive oil intake [RR = 0.96, 95% CI = 0.93 to 0.99, p = 0.005].

The investigators found in dose-response meta-analysis, a significantly reduced risk of 4% for all-cause mortality per 5-g/day increase in olive oil intake [RR = 0.96, 95% CI = 0.95 to 0.96, p 0.001].

The investigators found non-linear associations of olive oil intake with cardiovascular disease and all-cause mortality [both p for non-linearity 0.001], with little additional or no risk reduction observed beyond the consumption of approximately 20 g/day.

The investigators concluded that olive oil consumption reduces the risk of cardiovascular disease and all-cause mortality. Such benefits seem to be obtained with an intake of olive oil up to 20 g/day. These results support the current dietary recommendations to increase the intake of olive oil instead of other fats for improving human health and longevity. Future prospective studies are required to further depict the dose-dependent cardiovascular and survival effects in relation to olive oil consumption.

Original title:
Olive oil consumption and risk of cardiovascular disease and all-cause mortality: A meta-analysis of prospective cohort studies by Xia M, Zhong Y, [...], Qian C.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9623257/

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

 

25-200 g/d peanuts may causally reduce total cholesterol levels

Objectives:
Although numerous studies have reported the protective effect of nut consumption on cardiovascular risk, evidence for the role of peanuts in maintaining cardiometabolic health is inconclusive. Therefore, this meta-analysis (review article) has been conducted.

Does a high consumption of peanuts improve causally cardiovascular risk factors, such as cholesterol levels and LDL/HDL ratio?

Study design:
This review article included 10 RCTs (8 parallel RCTs and 3 crossover RCTs) with a total of 643 participants (316 males and 327 females) aged between 18 and 84 years from Asia, North America, Europa, South America and Australia.

The administered doses of peanuts ranged between 25 and 200 g/d, with follow-up periods of 2-24 weeks.

The strength of evidence varied from very low to moderate, depending on the outcomes.

Results and conclusions:
The investigators found meta-analysis of clinical trials revealed that peanut consumption was significantly associated with a decrease in triglycerides levels compared to the control interventions [MD = -0.13, 95% CI = -0.20 to -0.07, p 0.0001].
This significant reduction was most acute in healthy subjects [MD = -0.13, 95% CI = -0.25 to -0.00, p = 0.04] and in those who consumed peanuts or peanut butter [MD = -0.14, 95% CI = -0.20 to -0.07, p 0.0001].

The investigators found meta-analysis of clinical trials revealed that peanut consumption signicantly lowered total cholesterol levels among healthy consumers [MD = -0.40, 95% CI = -0.71 to -0.09, p = 0.01].

The investigators found meta-analysis of clinical trials revealed that peanut consumption signicantly lowered total cholesterol levels among healthy consumers [MD = -0.40, 95% CI = -0.71 to -0.09, p = 0.01].

The investigators found meta-analysis of clinical trials revealed that peanut consumption resulted in a signicantly lower LDL-cholesterol/HDL-cholesterol ratio among healthy consumers [MD = -0.19, 95% CI = -0.36 to -0.01, p = 0.03].

The investigators found, however, individuals at high cardiometabolic risk experienced a significant increase in body weight after the peanut interventions [MD = 0.97, 95% CI = 0.54 to 1.41, p 0.0001], although not in body fat or body mass index.

The investigators found, according to the dose-response analyses, body weight increased slightly with higher doses of peanuts.

The investigators concluded that consumption of 25-200 g/d peanuts during 2-24 weeks may causally reduce triglycerides and total cholesterol levels. May reduce because the strength of evidence varied from very low to moderate. To gain more knowledge about the effects of peanut products on cardiometabolic risk factors, more carefully designed studies in larger populations are needed.

Original title:
Effect of Peanut Consumption on Cardiovascular Risk Factors: A Randomized Clinical Trial and Meta-Analysis by Parilli-Moser I, Hurtado-Barroso S, […], Lamuela-Raventós RM.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9011914/

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

Brassica vegetables causally reduce total cholesterol

Objectives:
Previous studies on the effect of Brassica vegetables on blood glucose and lipid profile have reported inconclusive findings. Therefore, this meta-analysis (review article) has been conducted.

Does higher Brassica vegetables consumption improve causally cardiovascular risk factors (levels of triglycerides, cholesterol, fasting blood sugar and glycated haemoglobin)?

Study design:
This review article included 9 RCTs with a total of 548 participants.

Results and conclusions:
The investigators found pooled analysis indicated a significant reduction in total cholesterol (TC) [SMD = -0.28, 95% CI = -0.48 to -0.08, p = 0.005] following Brassica vegetables consumption.

The investigators found, overall, Brassica vegetables had no significant impact on serum levels of triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood sugar and glycated hemoglobin.

The investigators concluded that consumption of Brassica vegetables causally reduces total cholesterol concentration. However, further high-quality studies are needed to firmly establish the clinical efficacy of these plants.

Original title:
The effect of Brassica vegetables on blood glucose levels and lipid profiles in adults. A systematic review and meta-analysis by Darand M, Alizadeh S and Mansourian M.

Link:
https://pubmed.ncbi.nlm.nih.gov/35412701/

Additional information of El Mondo:
Find more information/studies on Brassica vegetables consumption, cholesterol and cardiovascular disease right here.

Brassica vegetables are broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, kale and turnips.

Higher dietary fiber intake improves causally cardiovascular risk factors

Objectives:
Although several meta-analyses have revealed the beneficial effects of dietary fiber intake on human health, some have reported inconsistent findings. Therefore, this umbrella meta-analysis (review article) has been conducted.

Does higher dietary fiber intake improve causally cardiovascular risk factors?

Study design:
This umbrella review article included 52 meta-analyses of RCTs with a total of 47,197 subjects.

Of the 52 meta-analyses, 35 used high-quality studies, 9 used studies with moderate quality, 7 did not report the quality of the included studies and 1 used low-quality studies.

The dosages and durations of dietary fiber intervention ranged from 3 g/day to 30 g/day (except for one study, which used guar gum at 15 mg/day and another study that used brown rice at 225 g/d) and 4 to 13 weeks, respectively.

Results and conclusions:
The investigators found, overall, higher dietary fiber intake significantly reduced:
-fasting plasma glucose [ES = -0.55, 95% CI = -0.73 to -0.38, p 0.001];
-fasting plasma insulin [ES = -1.22, 95% CI = -1.63 to -0.82, p 0.001];
-homeostasis model assessment of insulin resistance (HOMA-IR) [ES = -0.43, 95% CI = -0.60 to -0.27, p 0.001];

-glycosylated hemoglobin (HbA1c) [ES = -0.38, 95% CI = -0.50 to -0.26, p 0.001];
-serum level of total cholesterol [ES = -0.28, 95% CI = -0.39 to -0.16, p 0.001];
-low-density lipoprotein cholesterol (bad cholesterol) [ES = -0.25, 95% CI = -0.34 to -0.16, p 0.001];
-tumor necrosis factor-alpha serum levels [ES = -0.78, 95% CI = -1.39 to -0.16, p = 0.013];
-systolic blood pressure [ES = -1.72, 95% CI= -2.13 to -1.30, p 0.001];
-diastolic blood pressure [ES = -0.67, 95% CI = -0.96 to -0.37, p 0.001].
Significant means that there is an association with a 95% confidence.

The investigators found sensitivity analysis showed that the overall ESs did not change by excluding any individual meta-analysis.

The investigators found subgroup analysis revealed that the study population and type of dietary fiber could be partial sources of heterogeneity.

The investigators concluded that the present umbrella meta-analysis strongly support the beneficial effects of dietary fiber intake for the improvement cardiovascular risk factors, in particular cholesterol, fasting blood sugar, HbA1c, tumor necrosis factor-alpha and fasting insulin level, blood pressure and HOMA-IR value. However, it should be noted that the health-promoting effects of dietary fiber intake may differ between populations with different metabolic diseases.

Original title:
Associations between dietary fiber intake and cardiovascular risk factors: An umbrella review of meta-analyses of randomized controlled trials by Fu L, Zhang G, […], Tan M.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9511151/

Additional information of El Mondo:
Find more information/studies on dietary fiber consumption, diabetes, high blood pressure and cardiovascular disease right here.

A high dietary fiber intake corresponds to a diet with at least 1.5 grams fiber per 100 kcal. Use the 7-points nutrition profile app to see if your daily diet contains 1.5 grams fiber per 100 kcal.
These products in the supermarket contain 1.5 grams fiber per 100 kcal.

An umbrella review article is a scientific article which only includes meta-analyses (also called review articles). The results found in an umbrella review article are more reliable than found in an individual review article.

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

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

500 mg/d dietary flavonoid intake reduces cardiovascular disease, diabetes and hypertension

Objectives:
Several epidemiological studies have suggested that flavonoid intake is associated with a decreased risk of cardiometabolic disease. However, the results remained inconsistent and there is no dose-response meta-analysis for specific outcomes. Therefore, this review article has been conducted.

Is there a dose-response relationship between dietary flavonoid intake and reduced risk of cardiometabolic disease?

Study design:
This review article included 47 prospective cohort studies with a total of 1,346,676 participants and 127,507 persons with cardiometabolic disease.

Results and conclusions:
The investigators found for every 500 mg/d increase in dietary flavonoid intake a reduced risk of 7% [summary RR = 0.93, 95% CI = 0.88 to 0.98] for cardiovascular disease.
Significant means that there is an association with a 95% confidence.

The investigators found for every 500 mg/d increase in dietary flavonoid intake a reduced risk of 11% [summary RR = 0.89, 95% CI = 0.84 to 0.94] for diabetes.
Significant because summary RR of 1 was not found in the 95% CI of 0.84 to 0.94. Summary RR of 1 means no risk/association.

The investigators found for every 500 mg/d increase in dietary flavonoid intake a reduced risk of 3% [summary RR = 0.97, 95% CI = 0.94 to 0.99] for hypertension.
Significantly means it can be said with a 95% confidence that every 500 mg/d increase in dietary flavonoid intake really reduced risk of hypertension with 3%.

The investigators found a linearity dose-response association between total dietary flavonoid intake and cardiovascular disease [p nonlinearity = 0.541] and diabetes [p nonlinearity = 0.077].

The investigators concluded that a higher level of dietary flavonoid intake, at least 500 mg/d  is beneficial for the prevention of cardiometabolic diseases, particularly cardiovascular disease, diabetes and hypertension.

Original title:
Total dietary flavonoid intake and risk of cardiometabolic diseases: A dose-response meta-analysis of prospective cohort studies by Li T, Zhao Y, […], Liu J.

Link:
https://pubmed.ncbi.nlm.nih.gov/36148848/

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Cardiometabolic diseases are a group of common but often preventable conditions including heart attack, stroke, diabetes, insulin resistance and non-alcoholic fatty liver disease.

Serum vitamin D concentrations between 40 and 75 nmol/L reduce hypertension in adult

Objectives:
Findings of observational studies that evaluated the association of serum vitamin D status and high blood pressure were contradictory. Therefore, this review article has been conducted.

Does a high serum vitamin D concentration reduce risk of hypertension in the adult population?

Study design:
This review article included 10 prospective cohort, 1 nested case-control study and 59 cross-sectional studies.
Overall 66,757 and 260,944 participants were included in cohort and cross-sectional studies, respectively.
Among cohort studies, the NOS scores were between 6 and 9.
Among cross-sectional studies, the NOS scores ranged between 4 and 10.
There was no publication bias.

Results and conclusions:
The investigators found in the pooled analysis of cohort studies (66,757 participants) a 16% significant decrease in risk of hypertension in participants who had a high level of serum vitamin D compared with those with low level [pooled RR = 0.84, 95% CI = 0.73 to 0.96, I2 = 64%, p = 0.001].
Sensitivity analysis showed that excluding each stuy had no significant effect on pooled RR.

The investigators found combining effect sizes of 10 cohort studies involving a total of 63,602 individuals and 25,019 cases of hypertension showed that each 25 nmol/L increase in serum vitamin D level resulted in a 5% reduction in risk of hypertension [RR = 0.95, 95% CI = 0.90 to 1.00].
Also, a significant non-linear association between serum vitamin D levels and hypertension was observed [p non-inearity 0.001].
A reduction trend in risk of hypertension was observed for serum vitamin D levels between 45 and 70 nmol/L, although for higher vitamin D levels the risk did not decrease anymore and eventually started increasing.

The investigators found meta-analysis of cross-sectional studies showed that highest level of vitamin D in comparison to the lowest level was associated with a 16% significant decrease in risk of hypertension [OR overall = 0.86, 95% CI = 0.79 to 0.90, I2 = 67.5%, p 0.001].
Sensitivity analysis determined that the exclusion of each study did not significantly affect the overall estimate.

The investigators found combining effect sizes of 30 cross-sectional studies involving a total of 139,685 individuals and 40,178 cases of hypertension showed that each 25 nmol/L increase in serum vitamin D level resulted in a 6% reduction in risk of hypertension [OR = 0.94, 95% CI = 0.90 to 0.99].  

Also, a significant non-linear association between serum vitamin D levels and hypertension was seen [p non-linearity 0.001].
A reduction trend in risk of hypertension was observed for serum vitamin D levels between 40 and 75 nmol/L, although higher vitamin D levels did not reduce odds of hypertension.

The investigators concluded that serum vitamin D concentrations between 40 and 75 nmol/L reduce risk of hypertension in the adult population, in both prospective cohort and cross-sectional studies.

Original title:
Serum Vitamin D Levels in Relation to Hypertension and Pre-hypertension in Adults: A Systematic Review and Dose-Response Meta-Analysis of Epidemiologic Studies by Mokhtari E, Hajhashemy Z and Saneei P.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8961407/

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Unsaturated fatty acids improve absorption of carotenoids

Objectives:
Dietary fats are one of the well-known stimulators of carotenoid absorption, but the effects of the quantity and the type of dietary fats on carotenoid absorption have not yet been studied systematically. Therefore, this review article has been conducted.

Do dietary fats improve the absorption of carotenoids?

Study design:
This review article included a total of 27 in vitro studies and 12 RCTs.

Results and conclusions:
The investigators found meta-regression of in vitro studies showed that the bioaccessibility of carotenoids, except for lycopene, was positively associated with the concentration of dietary fats.

The investigators found meta-analysis of RCTs showed that the bioavailability of carotenoids was enhanced when a higher quantity of dietary fats was co-consumed.

The investigators found, moreover, fats rich in unsaturated fatty acids resulted in greater improvement in carotenoid bioavailability [SMD = 0.90, 95% CI = 0.69 to 1.11] as compared with fats rich in saturated fatty acids [SMD = 0.27, 95% CI = 0.08 to 0.47].

The investigators concluded that co-consuming dietary fats, particularly those rich in unsaturated fatty acids, with carotenoid-rich foods can improve the absorption of carotenoids.

Original title:
Effects of dietary fats on the bioaccessibility and bioavailability of carotenoids: a systematic review and meta-analysis of in vitro studies and randomized controlled trials by Yao Y, Tan P and Kim JE.

Link:
https://pubmed.ncbi.nlm.nih.gov/34897461/

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200 mg/day flavan-3-ols dietary intake reduce stroke

Objectives:
Epidemiological studies indicate that higher intakes of flavonoids are associated with reduced stroke risk. However, which subtypes play significant roles to protect against stroke remain unclear. Therefore, this review article has been conducted.

Does dietary intake of different flavonoid subclasses (flavanones, flavan-3-ols) reduce risk of stroke?

Study design:
This review article included 10 independent prospective cohort studies with 387,076 participants and 9,564 events (persons with stroke).

Results and conclusions:
The investigators found higher intakes of flavanones significantly reduced risk of stroke with 15% [RR = 0.85, 95% CI = 0.78 to 0.93].

The investigators found dose-response analysis showed that 50 mg/day increment of flavanones dietary intake was significantly associated with 11% reduction in stroke risk [RR = 0.89, 95% CI = 0.84 to 0.94].

The investigators found dose-response analysis showed that 200 mg/day increment of flavan-3-ols dietary intake was significantly associated with 14% reduction in stroke risk [RR = 0.86, 95% CI = 0.75 to 0.98].

The investigators found no association with respect to other flavonoid subclasses.

The investigators concluded that both 50 mg/day flavanones and 200 mg/day flavan-3-ols dietary intake reduce stroke risk. The findings of these associations of the present study need to be confirmed in other regions and ethnic origins.

Original title:
A meta-analysis of prospective cohort studies of flavonoid subclasses and stroke risk by Li XQ, Wang C, […], Guo XF.

Link:
https://pubmed.ncbi.nlm.nih.gov/35023220/

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Dietary oat supplementation may improve BMI among obese participants with mild metabolic disturbances

Objectives:
Oat supplementation interventions (OSIs) may have a beneficial effect on cardiovascular disease (CVD) risk. However, dietary background can modulate such effect. Therefore, this review article has been conducted.

Does dietary oat supplementation lower levels of blood lipids (cholesterol, triglycerides) and improve anthropometric parameters (glucose level, body mass index, weight, blood pressure, waist circumference) among participants with predominantly mild metabolic disturbances?

Study design:
This review article included 74 RCTs with a total of 4,937 predominantly hypercholesterolemic, obese subjects, with mild metabolic disturbances. Of these, 59 RCTs contributed to the meta-analyses.

The majority of included RCTs (81.1%) had some concerns for risk of bias.

Results and conclusions:
The investigators found oat supplementation (as oat, oat beta-glucan-rich extracts or avenanthramides), compared to control arms without oats, significantly improved levels of:
-total cholesterol (TC) [WMD = -0.42 mmol/L, 95% CI = -0.61 to -0.22];
-LDL cholesterol [WMD = -0.29 mmol/L, 95% CI = -0.37 to -0.20];
-glucose [WMD = -0.25 nmol/L, 95% CI = -0.36 to -0.14];
-body mass index [WMD = -0.13 kg/m2, 95% CI = -0.26 to -0.01];
-weight [WMD = -0.94 kg, 95% CI = -1.84 to -0.05] and;
-waist circumference [WMD = -1.06 cm, 95% CI = -1.85 to -0.27].

The investigators found RCTs on inflammation and/or oxidative stress markers were scarce and with inconsistent findings.

The investigators found RCTs comparing an oat supplementation intervention to heterogeneous interventions (e.g., wheat, eggs, rice, etc.), showed lowered levels of glycated haemoglobin, diastolic blood pressure, HDL cholesterol and apolipoprotein B.

The investigators concluded dietary oat supplementation (as oat, oat beta-glucan-rich extracts or avenanthramides) may lower levels of blood lipids and improve anthropometric parameters among obese participants with predominantly mild metabolic disturbances, regardless of dietary background or control. May lower because the majority of included RCTs had some concerns for risk of bias. Therefore, further high-quality trials are warranted to establish the role of oat supplementation intervention on blood pressure, glucose homeostasis and inflammation markers.

Original title:
Effect of oat supplementation interventions on cardiovascular disease risk markers: a systematic review and meta-analysis of randomized controlled trials by Llanaj E, Dejanovic GM, […], Muka T.

Link:
https://pubmed.ncbi.nlm.nih.gov/34977959/

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These products are suitable for persons with cardiovascular diseases.

 


 

Purified anthocyanin supplements reduce cardiovascular risk

Objectives:
The associations between intake of anthocyanins and anthocyanin-rich berries and cardiovascular risks remained to be established. Therefore, this review article has been conducted.

Do purified anthocyanin supplements and dietary intakes of anthocyanin-rich berries reduce cardiovascular risk?

Study design:
This review article included 44 eligible RCTs consisting of 52 comparison groups and 2,353 subjects and 15 prospective cohort studies with 5,54,638 subjects (persons).

7 of the 44 RCTs were crossover trials with the rest parallel-designed.
15 of the included studies investigated the effects of purified anthocyanins, all of which were produced from berries. For the remaining anthocyanin-rich berry studies, interventions were blueberry in 13 studies, cranberry in 12 studies, bilberry in 3 studies and blackcurrant in 1 study.
The intervention durations ranged from 2 weeks to 24 months with a median of 8 weeks.
24 of the 44 RCTs were rated as high quality with the others as low to moderate quality.

The follow-up periods of 15 cohort studies ranged from 4.3 to 24 years with a median of 12 years. Most of the included cohort studies used FFQ to assess dietary anthocyanin intake and only 3 of them used dietary records.
12 of the 15 cohort studies were rated as high quality.

There was no publication bias, except for the effects of purified anthocyanins on HDL cholestrerol levels [Begg's p = 0.016].

Results and conclusions:
The investigators found pooled analysis of RCTs showed that purified anthocyanin supplements significantly reduced blood LDL cholesterol (bad cholesterol) concentrations [WMD = -5.43 mg/dL, 95% CI = -8.96 to -1.90 mg/dL, p = 0.003]. 

The investigators found pooled analysis of RCTs showed that purified anthocyanin supplements significantly reduced triglyceride concentrations [WMD = -6.18 mg/dL, 95% CI = -11.67 to -0.69 mg/dL, p = 0.027, I2 = 0%]. 

The investigators found pooled analysis of RCTs showed that purified anthocyanin supplements significantly increased HDL cholesterol (good cholesterol) concentrations [WMD = 2.76 mg/dL, 95% CI = 1.34 to 4.18 mg/dL, p 0.001, I2 = 43.5%].
Subgroup analysis showed that the effects on HDL cholesterol concentrations were not significantly influenced by study duration, health status of subjects, anthocyanin doses, study quality and funding source.

The investigators found pooled analysis of RCTs showed that purified anthocyanin supplements significantly reduced tumor necrosis factor alpha concentrations [WMD = -1.62 pg/mL, 95% CI = -2.76 to -0.48 pg/mL, p = 0.005, I2 = 0%].

The investigators found pooled analysis of RCTs showed that purified anthocyanin supplements significantly reduced C-reactive protein concentrations [WMD = -0.028 mg/dL, 95% CI = -0.050 to -0.005 mg/dL, p = 0.014, I2 = 26%].

The investigators found pooled analysis of RCTs showed administration of anthocyanin-rich berries (blueberry, cranberry, bilberry and blackcurrant) significantly reduced blood total cholesterol concentrations [WMD = -4.48 mg/dL, 95% CI = -8.94 to -0.02 mg/dL, p = 0.049]. 

The investigators found pooled analysis of RCTs showed administration of anthocyanin-rich berries (blueberry, cranberry, bilberry and blackcurrant) significantly reduced C-reactive protein concentrations [WMD = -0.046 mg/dL, 95% CI = -0.070 to -0.022 mg/dL, p 0.001, I2 = 0%].

The investigators found pooled analysis of cohort studies showed high dietary anthocyanins intakes significantly reduced risk of coronary heart disease (CHD) with 17% [relative risk = 0.83, 95% CI = 0.72 to 0.95, p = 0.009, I2 = 51.2%].

The investigators found pooled analysis of cohort studies showed high dietary anthocyanins intakes significantly reduced risk of total cardiovascular disease incidence with 27% [relative risk = 0.73, 95% CI = 0.55 to 0.97, p = 0.03, I2 = 76.7%].

The investigators found pooled analysis of cohort studies showed high dietary anthocyanins intakes significantly reduced risk of cardiovascular disease deaths with 9% [relative risk = 0.91, 95% CI = 0.87 to 0.96, p 0.001, I2 = 0%].

Subgroup analysis revealed that the protective roles of dietary anthocyanins against cardiovascular disease deaths was only found in women [RR = 0.89, 95% CI = 0.82 to 0.96, p = 0.003, I2 = 0.0%] and not in men [RR = 0.92, 95% CI = 0.79 tot 1.07, p = 0.263, I2 = 0.0%].

The investigators concluded current clinical and epidemiological evidence show the protective roles of purified anthocyanin supplements during 8 weeks and anthocyanin-rich berries (blueberry, cranberry, bilberry and blackcurrant) on cardiovascular health. These results suggest that regular consumption of either purified anthocyanins or anthocyanin-rich berries could prevent cardiovascular disease through their lipid-lowering and anti-inflammatory properties. Therefore, anthocyanins and anthocyanin-rich berries should be taken into consideration when formulating cardioprotective diets in the future.

Original title:
Anthocyanins, Anthocyanin-Rich Berries, and Cardiovascular Risks: Systematic Review and Meta-Analysis of 44 Randomized Controlled Trials and 15 Prospective Cohort Studies by Xu L, Tian Z, […], Yang Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714924/

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HDL cholesterol level under 2.33 mmol/L reduces cardiovascular disease mortality

Objectives:
Previous studies have not fully described the relationship between high-density lipoprotein cholesterol (HDL-C) and death risks from all cause and cardiovascular disease (CVD). Therefore, this review article has been conducted.

Does a high HDL cholesterol level (good cholesterol) reduce all cause and cardiovascular disease mortality risk?

Study design:
This review article included 32 prospective cohort studies with a total of 369,904 participants and 33,473 total deaths (9,426 cardiovascular disease deaths or cardiovascular disease mortality).

Results and conclusions:
The investigators found compared to the lowest HDL cholesterol level, the highest HDL cholesterol level significantly reduced all cause mortality risk by 18% [RR = 0.82, 95% CI = 0.73 to 0.93].
The lowest all cause mortality risk was observed at approximately 1.34 mmol/L.

The investigators found compared to the lowest HDL cholesterol level, the highest HDL cholesterol level significantly reduced cardiovascular disease mortality risk by 36% [RR = 0.64, 95% CI = 0.46 to 0.89].
The lowest cardiovascular disease mortality risk was observed at approximately 1.55 mmol/L.

The investigators found every increment of HDL cholesterol level with 1 mmol/L significantly reduced all cause mortality risk by 15% [RR = 0.85, 95% CI = 0.79 to 0.92].
Significant means that there is an association with a 95% confidence.

The investigators found every increment of HDL cholesterol level with 1 mmol/L significantly reduced cardiovascular disease mortality risk by 23% [RR = 0.77, 95% CI = 0.69 to 0.87].

The investigators found evidence of nonlinear and negative dose-response associations of HDL cholesterol level with all cause and cardiovascular disease mortality risk [p nonlinearity 0.001].

The investigators concluded HDL cholesterol level (good cholesterol) reduces all cause and cardiovascular disease mortality risk under approximately 2.05 and 2.33 mmol/L, respectively. Optimal doses require investigation via clinical practice or high-quality research.

Original title:
A dose-response meta-analysis to evaluate the relationship between high-density lipoprotein cholesterol and all-cause and cardiovascular disease mortality by Liu L, Han M, […], Hong F.

Link:
https://pubmed.ncbi.nlm.nih.gov/34676492/

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Oral magnesium supplementation does not reduce leg cramps during pregnancy

Objectives:
Leg cramps are one of the common symptoms during pregnancy. About 30%-50% of pregnant women experience leg cramps twice a week. Leg cramps may cause severe pain and sleep disturbance, hinder performance of daily activities and may lengthen the duration of pregnancy and the type of childbirth. Therefore, this review article has been conducted.

Does oral magnesium supplementation reduce leg cramps during pregnancy?

Study design:
This review article included 4 RCTs with a total of 332 pregnant women.

Results and conclusions:
The investigators found the frequency of leg cramps during pregnancy was not significantly decreased in the magnesium group compared to the control group (group without magnesium) [WMD = -0.47, 95% CI = -1.14 to 0.20, p = 0.167].

The investigators found oral magnesium supplementation did not significantly improved the recovery from leg cramps during pregnancy compared to the control group [OR = 0.47, 95% CI = 0.14 to 1.52, p = 0.207].

The investigators found oral magnesium supplementation had no significant side effects in the treatment group (group with magnesium) compared to the control group [OR = 1.82, 95% CI = 0.90 to 3.69, p = 0.094].

The investigators concluded that oral magnesium supplementation is not effective in the treatment of leg cramps during pregnancy.

Original title:
Effect of oral magnesium supplementation for relieving leg cramps during pregnancy: A meta-analysis of randomized controlled trials by Liu J, Song G, [...], Meng T.

Link:
https://pubmed.ncbi.nlm.nih.gov/34247796/

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Higher sodium and lower potassium reduce in a dose-response manner cardiovascular risk

Objectives:
The relation between sodium intake and cardiovascular disease remains controversial, owing in part to inaccurate assessment of sodium intake. Assessing 24-hour urinary excretion over a period of multiple days is considered to be an accurate method. Therefore, this review article has been conducted.

Do higher sodium and lower potassium dietary intakes, as measured in multiple 24-hour urine samples, reduce in a dose-response manner cardiovascular risk?

Study design:
This review article included 6 prospective cohort studies with a total of 10,709 healthy adults (54.2% women), of whom, 571 cardiovascular events were ascertained during a median study follow-up of 8.8 years (incidence rate: 5.9 per 1000 person-years).

The mean (±SD) age was 51.5±12.6 years.

Results and conclusions:
The investigators found that the median 24-hour urinary sodium excretion was 3,270 mg (10th to 90th percentile, 2099 to 4899).

The investigators found higher sodium excretion, lower potassium excretion and a higher sodium-to-potassium ratio were all significantly associated with a higher cardiovascular risk in analyses that were controlled for confounding factors [p ≤ 0.005 for all comparisons].

The investigators found in analyses that compared quartile 4 of the urinary biomarker (highest) with quartile 1 (lowest), the hazard ratios were 1.60 [95% CI = 1.19 to 2.14] for sodium excretion, 0.69 [95% CI = 0.51 to 0.91] for potassium excretion and 1.62 [95% CI = 1.25 to 2.10] for the sodium-to-potassium ratio.

The investigators found each daily increment of 1,000 mg in 24-hour urinary sodium excretion was significantly associated with an 18% increase in cardiovascular risk [hazard ratio = 1.18, 95% CI = 1.08 to 1.29].

The investigators found each daily increment of 1,000 mg in 24-hour urinary potassium excretion was significantly associated with an 18% decrease in cardiovascular risk [hazard ratio = 0.82, 95% CI = 0.72 to 0.94].

The investigators concluded higher sodium and lower potassium dietary intakes, as measured in multiple 24-hour urine samples, reduce in a dose-response manner cardiovascular risk. These findings may support reducing sodium intake and increasing potassium intake from current levels.

Original title:
24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk by Ma Y, He FJ, […], Hu FB.

Link:
https://pubmed.ncbi.nlm.nih.gov/34767706/

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A 24-hour urine sample is simply a collection of all urine passed over a 24-hour period of time. The test is used to check kidney function.
The normal range for 24-hour urine volume is 800 to 2,000 milliliters per day (with a normal fluid intake of about 2 liters per day).

4000 mg inositol supplements reduce blood pressure

Objectives:
Potential effects of inositol supplementation on blood pressure (BP) have been examined in several interventional studies. Nevertheless, findings in this context are controversial. Therefore, this review article has been conducted.

Do inositol supplements reduce blood pressure in humans?

Study design:
This review article included 7 eligible RCTs.

Results and conclusions:
The investigators found significant decline in both systolic blood pressure (SBP) [WMD = -5.69 mmHg, 95% CI = -7.35 to -4.02, p 0.001] and diastolic blood pressure (DBP) [WMD = -7.12 mmHg, 95% CI = -10.18 to -4.05, p 0.001] following supplementation with inositol.

The investigators found subgroup analysis showed that studies performed in individuals with metabolic syndrome with a longer duration (>8 weeks) and a dose of 4000 mg inositol supplements resulted in a more effective reduction in systolic blood pressure and diastolic blood pressure with acceptable homogeneity.

The investigators concluded that 4000 mg inositol supplements during at least 8 weeks reduce blood pressure, particularly in individuals with metabolic syndrome. Further large-scale RCTs with better design are needed to confirm these findings.

Original title:
The effect of inositol supplementation on blood pressure: A systematic review and meta-analysis of randomized-controlled trials by Tari SH, Sohouli MH, […], Rahideh ST.

Link:
https://pubmed.ncbi.nlm.nih.gov/34330516/

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25 mg/d dietary flavonols or 5 mg/d dietary flavones reduce coronary heart disease

Objectives:
Epidemiological studies have shown that higher intake of flavonoid is inversely associated with coronary heart disease (CHD) risk. However, which flavonoid subclass (including anthocyanins, flavonols) could reduce CHD risk has remained controversial. Therefore, this review article has been conducted.

Do dietary intakes of anthocyanins, proanthocyanidins, flavonols, flavones and isoflavones reduce coronary heart disease?

Study design:
This review article included 19 independent prospective cohort studies with 894,471 participants and 34,707 persons with coronary heart disease.
 
Results and conclusions:
The investigators found that dietary intakes of anthocyanins significantly reduced risk of coronary heart disease with 10% [RR = 0.90, 95% CI = 0.83 to 0.98].

The investigators found that dietary intakes of proanthocyanidins significantly reduced risk of coronary heart disease with 22% [RR = 0.78, 95% CI = 0.65 to 0.94].

The investigators found that dietary intakes of flavonols significantly reduced risk of coronary heart disease with 12% [RR = 0.88, 95% CI = 0.79 to 0.98].

The investigators found that dietary intakes of flavones significantly reduced risk of coronary heart disease with 6% [RR = 0.94, 95% CI = 0.89 to 0.99].

The investigators found that dietary intakes of isoflavones significantly reduced risk of coronary heart disease with 10% [RR = 0.90, 95% CI = 0.83 to 0.98].

The investigators found in dose-response analysis that increment of 50 mg/d dietary anthocyanins significantly reduced risk of coronary heart disease with 5%.

The investigators found in dose-response analysis that increment of 100 mg/d dietary proanthocyanidins significantly reduced risk of coronary heart disease with 5%.

The investigators found in dose-response analysis that increment of 25 mg/d dietary flavonols significantly reduced risk of coronary heart disease with 5%.

The investigators found in dose-response analysis that increment of 5 mg/d dietary flavones significantly reduced risk of coronary heart disease with 5%.

The investigators found in dose-response analysis that increment of 0.5 mg/d dietary isoflavones significantly reduced risk of coronary heart disease with 5%.

The investigators found sensitivity and subgroup analyses supported these associations.

The investigators concluded that daily dietary intakes of 50mg anthocyanins, 100 mg proanthocyanidins, 25mg flavonols, 5mg flavones or 0.5mg isoflavones reduce coronary heart disease.

Original title:
Flavonoid subclasses and coronary heart disease risk: a meta-analysis of prospective cohort studies by Fan ZK, Wang C, [...], Li D.

Link:
https://pubmed.ncbi.nlm.nih.gov/34470681/

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