Nutrition and health

Objectives:
Do dietary choline and betaine increase mortality risk?

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

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

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

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

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

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

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

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

Betaine-rich foods are

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

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

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

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

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

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

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

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

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

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

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

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

Do carotenoid supplements reduce blood pressure?

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

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

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

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

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

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

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

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

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

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

Objectives:
Does a low salt intake reduce blood pressure?

Study design:
This review article included 34 randomized trials with 3230 participants (the median age was 50 (range 22-73)), of which 22 were in hypertensive individuals and 12 in normotensive individuals. Of the 34 trials, 23 used crossover design and 11 used paralleled comparisons. 22 of the 34 trials were double blind, in 11 the observer was blind to blood pressure and one did not report any blinding procedure.

The study duration varied from 4 weeks to 3 years (median 4 weeks). With the usual salt intake the median 24 hour urinary sodium was 160 mmol (range 125-200 mmol), equivalent to a salt intake of 9.4 g/day (range 7.3-11.7 g/day) and the median blood pressure was 141/86 mmHg.

Despite the fact that only 7 out of 34 trials performed intention to treat analysis, the percentage of participants lost to follow-up after randomization was small (6.7% on average).

Results and conclusions:
The investigators found meta-analysis showed that the mean change in urinary sodium (reduced salt v usual salt) was -75 mmol/24 h (equivalent to a reduction of 4.4 g/day salt), and with this reduction in salt intake, the mean change in blood pressure was -4.18 mmHg [95% CI = -5.18 to -3.18, I2 = 75%] for systolic blood pressure and -2.06 mmHg [95% CI = -2.67 to -1.45, I2 = 68%] for diastolic blood pressure.

The investigators found meta-regression showed that age, ethnic group, blood pressure status (hypertensive or normotensive) and the change in 24 hour urinary sodium were all significantly associated with the fall in systolic blood pressure, explaining 68% of the variance between studies.

The investigators found a 100 mmol reduction in 24 hour urinary sodium (equivalent to a reduction 6 g/day salt) was associated with a fall in systolic blood pressure of 5.8 mmHg [95% CI = -2.5 to -9.2,  p = 0.001] after adjustment for age, ethnic group and blood pressure status.
For diastolic blood pressure, age, ethnic group, blood pressure status and the change in 24 hour urinary sodium explained 41% of the variance between studies.

The investigators found meta-analysis by subgroup showed that in people with hypertension the mean effect was -5.39 mmHg [95% CI = -6.62 to -4.15, I2 = 61%] for systolic blood pressure and -2.82 mmHg [95% CI = -3.54 to -2.11, I2 = 52%] for diastolic blood pressure.
In normotensive people, the figures were -2.42 mmHg [95% CI = -3.56 to -1.29, I2 = 66%] and -1.00 mmHg [95% CI = -1.85 to -0.15, I2 = 66%], respectively.

The investigators found further subgroup analysis showed that the decrease in systolic blood pressure was significant in both white and black people and in men and women.

The investigators found meta-analysis of data on hormones and lipids showed that the mean change was:
0.26 ng/mL/h [95% CI = 0.17 to 0.36, I2 = 70%] for plasma renin activity;
73.20 pmol/L [95% CI = 44.92 to 101.48, I2 = 62%] for aldosterone;
187 pmol/L [95% CI = 39 to 336, I2 = 5%] for noradrenaline (norepinephrine);
37 pmol/L [95% CI = -1 to 74, I2 = 12%] for adrenaline (epinephrine);
0.05 mmol/L [95% CI = -0.02 to 0.11, I2 = 0%] for total cholesterol;
0.05 mmol/L [95% CI = -0.01 to 0.12, I2 = 0%] for low density lipoprotein cholesterol (LDL-cholesterol or bad cholesterol);
-0.02 mmol/L [95% CI = -0.06 to 0.01, I2 = 16%] high density lipoprotein cholesterol (HDL-cholesterol or good cholesterol) and:
0.04 mmol/L [95% CI = -0.02 to 0.09, I2 = 0%] for triglycerides.

The investigators concluded a modest reduction in salt intake of 4.4 g/day for 4 or more weeks causes, from a population viewpoint, important falls in blood pressure in people with both raised and normal blood pressure.
Salt reduction is associated with a small physiological increase in plasma renin activity, aldosterone and noradrenaline and no significant change in lipid concentrations.
The current recommendations to reduce salt intake from 9-12 to 5-6 g/day will have a major effect on blood pressure, but a further reduction to 3 g/day will have a greater effect and should become the long term target for population salt intake.

Original title:
Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials by He FJ, Li J and MacGregor GA.

Link:
http://www.bmj.com/content/346/bmj.f1325

Additional information of El Mondo:
Find more studies/information on sodium intake and hypertension right here.
A daily diet with a maximum of 3 grams salt per day is a diet with a maximum of 0.15 gram salt per 100 kcal.
A daily diet with a maximum of 0.15 gram salt per 100 kcal is a diet with mainly products/meals with a maximum of 0.15 gram salt per 100 kcal.