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 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.
 

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.

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.

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.

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.