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Breakfast Skipping, Body Composition, and Cardiometabolic Risk: A Systematic Review and Meta-Analysis of Randomized Trials.
Bonnet, JP, Cardel, MI, Cellini, J, Hu, FB, Guasch-Ferré, M
Obesity (Silver Spring, Md.). 2020;28(6):1098-1109
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Breakfast has been considered the most important meal of the day. However, despite the fairly consistent association of breakfast consumption with decreased body weight, randomized controlled trials (RCTs) have shown equivocal results. The aim of this study was to conduct a systematic review and meta-analysis of RCTs evaluating the effect of skipping breakfast on body composition and cardiometabolic risk factors over a period of at least 4 weeks. This study is a systematic review and meta-analysis of RCTs. A total of 425 participants were included in the meta-analysis. Participant range of age was 18 to 65 years old, with a mean age of 35 years. This study demonstrates that breakfast skipping compared with breakfast consumption over the short-term (4 to 16 weeks) results in weight loss without significant changes in other body composition parameters. Furthermore, breakfast skipping, as compared with breakfast consumption, led to significant increases in low-density lipoprotein cholesterol. Authors conclude that although breakfast skipping had a modest impact on weight loss in the short term, its long-term impact on body composition and cardiometabolic health requires further study.
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of skipping breakfast on body composition and cardiometabolic risk factors. METHODS This study conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating breakfast skipping compared with breakfast consumption. Inclusion criteria included age ≥ 18, intervention duration ≥ 4 weeks, ≥ 7 participants per group, and ≥ 1 body composition measure. Random-effects meta-analyses of the effect of breakfast skipping on body composition and cardiometabolic risk factors were performed. RESULTS Seven RCTs (n = 425 participants) with an average duration of 8.6 weeks were included. Compared with breakfast consumption, breakfast skipping significantly reduced body weight (weighted mean difference [WMD] = -0.54 kg [95% CI: -1.05 to -0.03], P = 0.04, I2 = 21.4%). Percent body fat was reported in 5 studies and was not significantly different between breakfast skippers and consumers. Three studies reported on low-density lipoprotein cholesterol (LDL), which was increased in breakfast skippers as compared with breakfast consumers (WMD = 9.24 mg/dL [95% CI: 2.18 to 16.30], P = 0.01). Breakfast skipping did not lead to significant differences in blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, C-reactive protein, insulin, fasting glucose, leptin, homeostatic model assessment of insulin resistance, or ghrelin. CONCLUSIONS Breakfast skipping may have a modest impact on weight loss and may increase LDL in the short term. Further studies are needed to provide additional insight into the effects of breakfast skipping.
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Exercise and Nutrition Interventions in Patients with Head and Neck Cancer during Curative Treatment: A Systematic Review and Meta-Analysis.
Bye, A, Sandmael, JA, Stene, GB, Thorsen, L, Balstad, TR, Solheim, TS, Pripp, AH, Oldervoll, LM
Nutrients. 2020;12(11)
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Head and neck cancers (HNCs) comprises malignancies of the oral cavity, throat, larynx, salivary glands as well as nasal and paranasal sinuses. Surgery and radiotherapy (RT), sometimes combined with chemotherapy (CT) are the main treatment approaches. The aim of this study was to examine current evidence for nutritional interventions alone, physical exercise interventions alone and interventions combining nutrition and physical exercise during RT treatment for patients with HNCs. This study is a systematic review and meta-analysis of thirteen randomised controlled studies. Findings show that nutrition and physical exercise interventions have a positive effect on body composition and physical function for patients with HNCs undergoing RT (+/- concomitant CT) with a curative intent. Authors conclude that due to the pilot and feasibility design of the studies combining physical exercise and nutrition, no conclusions can be drawn concerning the effects from these studies.
Abstract
The aim of this meta-analysis was to examine the effects of nutritional and physical exercise interventions and interventions combining these interventions during radiotherapy treatment for patients with head and neck cancer on body composition, objectively measured physical function and nutritional status. Systematic electronic searches were conducted in MEDLINE (PubMed interface), EMBASE (Ovid interface), CINAHL (EBSCO interface) and Cochrane Library (Wiley interface). We identified 13 randomized controlled trials (RCTs) that included 858 patients. For body composition, using only nutrition as intervention, a significant difference between treatment and control group were observed (SMD 0.42 (95CI 0.23-0.62), p < 0.001). Only pilot RCTs investigated combination treatment and no significant difference between the treatment and control groups were found (SMD 0.21 (95CI -0.16-0.58), p = 0.259). For physical function, a significant difference between treatment and control group with a better outcome for the treatment group were observed (SMD 0.78 (95CI 0.51-1.04), p < 0.001). No effects on nutritional status were found. This meta-analysis found significantly positive effects of nutrition and physical exercise interventions alone in favor of the treatment groups. No effects in studies with combined interventions were observed. Future full-scaled RCTs combining nutrition and physical exercise is warranted.
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Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies.
Jayedi, A, Soltani, S, Zargar, MS, Khan, TA, Shab-Bidar, S
BMJ (Clinical research ed.). 2020;370:m3324
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Body mass index (BMI) may not be an adequate tool to measure obesity, as it does not describe where fat is located on the body. Distribution of fat around the middle may be related to the risk of death and may be a more accurate measure of obesity. This systematic review of 1950 studies aimed to assess the association of fat around the middle with death. The results showed that every 10cm increase in waist circumference was related to an 11% increased risk of death by any cause. Women with a waist circumference greater than 80cm and 90cm in men had a higher risk of death by any cause. Fat carried around the middle increased the risk of death by any cause, however larger thigh and hip circumferences lowered the risk. This was regardless of BMI. It was concluded that measures of centrally located fat, alongside BMI, could be used to determine the risk of death. This study could be used by healthcare professionals to understand the importance of not solely relying on BMI and measuring where fat is distributed on the body may be an additional measure to determine risk of premature death.
Abstract
OBJECTIVE To quantify the association of indices of central obesity, including waist circumference, hip circumference, thigh circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, with the risk of all cause mortality in the general population, and to clarify the shape of the dose-response relations. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed and Scopus from inception to July 2019, and the reference lists of all related articles and reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Prospective cohort studies reporting the risk estimates of all cause mortality across at least three categories of indices of central fatness. Studies that reported continuous estimation of the associations were also included. DATA SYNTHESIS A random effects dose-response meta-analysis was conducted to assess linear trend estimations. A one stage linear mixed effects meta-analysis was used for estimating dose-response curves. RESULTS Of 98 745 studies screened, 1950 full texts were fully reviewed for eligibility. The final analyses consisted of 72 prospective cohort studies with 2 528 297 participants. The summary hazard ratios were as follows: waist circumference (10 cm, 3.94 inch increase): 1.11 (95% confidence interval 1.08 to 1.13, I2=88%, n=50); hip circumference (10 cm, 3.94 inch increase): 0.90 (0.81 to 0.99, I2=95%, n=9); thigh circumference (5 cm, 1.97 inch increase): 0.82 (0.75 to 0.89, I2=54%, n=3); waist-to-hip ratio (0.1 unit increase): 1.20 (1.15 to 1.25, I2=90%, n=31); waist-to-height ratio (0.1 unit increase): 1.24 (1.12 to 1.36, I2=94%, n=11); waist-to-thigh ratio (0.1 unit increase): 1.21 (1.03 to 1.39, I2=97%, n=2); body adiposity index (10% increase): 1.17 (1.00 to 1.33, I2=75%, n=4); and A body shape index (0.005 unit increase): 1.15 (1.10 to 1.20, I2=87%, n=9). Positive associations persisted after accounting for body mass index. A nearly J shaped association was found between waist circumference and waist-to-height ratio and the risk of all cause mortality in men and women. A positive monotonic association was observed for waist-to-hip ratio and A body shape index. The association was U shaped for body adiposity index. CONCLUSIONS Indices of central fatness including waist circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, independent of overall adiposity, were positively and significantly associated with a higher all cause mortality risk. Larger hip circumference and thigh circumference were associated with a lower risk. The results suggest that measures of central adiposity could be used with body mass index as a supplementary approach to determine the risk of premature death.
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Effectiveness and safety of carbohydrate counting in the management of adult patients with type 1 diabetes mellitus: a systematic review and meta-analysis.
Vaz, EC, Porfírio, GJM, Nunes, HRC, Nunes-Nogueira, VDS
Archives of endocrinology and metabolism. 2018;62(3):337-345
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Glycaemic control of patients with diabetes mellitus is important because it impacts the development of diabetic complications. Carbohydrate counting is a meal planning tool that allows for great variation and flexibility in food choices among individuals with diabetes mellitus. The aim of the study was to evaluate the effectiveness and safety of carbohydrate counting in the treatment of adult patients with type 1 diabetes mellitus using a systematic literature review. The study included randomised controlled trials with at least 3 months of follow-up, and evaluation of outcomes in which patients were randomly divided into two groups. The meta-analysis showed that the final haemoglobin A1c (HbA1c) - a test that shows the average blood glucose levels for the last two to three months - was significantly lower in the carbohydrate counting group than in the control group. Authors conclude that the meta-analysis showed evidence favouring the use of carbohydrate counting in the management of adult patients with type 1 diabetes mellitus. However, this benefit was limited to the final HbA1c.
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness and safety of carbohydrate counting (CHOC) in the treatment of adult patients with type 1 diabetes mellitus (DM1). MATERIALS AND METHODS We performed a systematic review of randomized studies that compared CHOC with general dietary advice in adult patients with DM1. The primary outcomes were changes in glycated hemoglobin (HbA1c), quality of life, and episodes of severe hypoglycemia. We searched the following electronic databases: Embase, PubMed, Lilacs, and the Cochrane Central Register of Controlled Trials. The quality of evidence was analyzed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of 3,190 articles were identified, and two reviewers independently screened the titles and abstracts. From the 15 potentially eligible studies, five were included, and 10 were excluded because of the lack of randomization or different control/intervention groups. Meta-analysis showed that the final HbA1c was significantly lower in the CHOC group than in the control group (mean difference, random, 95% CI: -0.49 (-0.85, -0.13), p = 0.006). The meta-analysis of severe hypoglycemia and quality of life did not show any significant differences between the groups. According to the GRADE, the quality of evidence for severe hypoglycemia, quality of life, and change in HbA1c was low, very low, and moderate, respectively. CONCLUSION The meta-analysis showed evidence favoring the use of CHOC in the management of DM1. However, this benefit was limited to final HbA1c, which was significantly lower in the CHOC than in the control group.
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Headache Associated with Coeliac Disease: A Systematic Review and Meta-Analysis.
Zis, P, Julian, T, Hadjivassiliou, M
Nutrients. 2018;10(10)
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Coeliac disease (CD) is the best-recognised gluten-related disorder (GRD), and it is characterized by a small bowel enteropathy occurring in genetically susceptible individuals whilst exposed to the protein gliadin. The aim of this study was to systematically review the current literature in order to establish the relationship between headache and CD. This study is a systematic review of 40 articles, studying a total of 42,388 individuals with either headache or GRD. Results show that: - There is an increased prevalence of headache amongst patients with CD. - There is an increased prevalence of CD amongst patients with idiopathic headache. - Headaches associated with CD are mainly migraines. - Gluten-free diet is a very effective treatment for headaches associated with CD. Authors conclude that further studies on the prevalence of gluten sensitivity in patients with idiopathic headache are needed, including further research on the pathogenetic mechanisms.
Abstract
OBJECTIVE The aim of this systematic review was to explore the relationship between coeliac disease (CD) and headache. The objectives were to establish the prevalence of each entity amongst the other, to explore the role of gluten free diet (GFD), and to describe the imaging findings in those affected by headaches associated with CD. METHODOLOGY A systematic computer-based literature search was conducted on the PubMed database. Information regarding study type, population size, the age group included, prevalence of CD amongst those with headache and vice versa, imaging results, the nature of headache, and response to GFD. RESULTS In total, 40 articles published between 1987 and 2017 qualified for inclusion in this review. The mean pooled prevalence of headache amongst those with CD was 26% (95% CI 19.5⁻33.9%) in adult populations and 18.3% (95% CI 10.4⁻30.2%) in paediatric populations. The headaches are most often migraine-like. In children with idiopathic headache, the prevalence of CD is 2.4% (95% CI 1.5⁻3.7%), whereas data for adult populations is presently unavailable. Brain imaging can be normal, although, cerebral calcifications on CT, white matter abnormalities on MRI and deranged regional cerebral blood flow on SPECT can be present. GFD appears to be an effective management for headache in the context of CD, leading to total resolution of headaches in up to 75% of patients. CONCLUSIONS There is an increased prevalence of CD amongst idiopathic headache and vice versa. Therefore, patients with headache of unknown origin should be screened for CD, as such patients may symptomatically benefit from a GFD.
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Lifestyle Risk Factors for Serrated Colorectal Polyps: A Systematic Review and Meta-analysis.
Bailie, L, Loughrey, MB, Coleman, HG
Gastroenterology. 2017;152(1):92-104
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Colorectal cancer (CRC) is a heterogeneous disease thought to result from the accumulation of various aberrant mutations in the cells lining the colorectal mucosa. The aim of this systematic review and meta-analysis was to evaluate modifiable and lifestyle factors and the risk of serrated polyps (a type of growth that stick out from the surface of the colon or rectum) of the colorectum. A search of 3 databases yielded a potential 2446 studies for inclusion, from which 43 remained for systematic review. Results indicate that smoking, alcohol consumption, body fatness, dietary fat and meat consumption increased the risk of developing serrated polyps. Whereas, nonsteroidal anti-inflammatory drugs, aspirin and dietary folate decreased this risk. Authors conclude that their findings strengthen public health messages promoting awareness and change in order to reduce the risk of these precancerous lesions and consequently CRC.
Abstract
BACKGROUND & AIMS Certain subsets of colorectal serrated polyps (SP) have malignant potential. We performed a systematic review and meta-analysis to investigate the association between modifiable lifestyle factors and risk for SPs. METHODS We conducted a systematic search of Medline, Embase, and Web of Science for observational or interventional studies that contained the terms risk or risk factor, and serrated or hyperplastic, and polyps or adenomas, and colorectal (or synonymous terms), published by March 2016. Titles and abstracts of identified articles were independently reviewed by at least 2 reviewers. Adjusted relative risk (RR) and 95% confidence interval (CI) were combined using random effects meta-analyses to assess the risk of SP, when possible. RESULTS We identified 43 studies of SP risk associated with 7 different lifestyle factors: smoking, alcohol, body fatness, diet, physical activity, medication, and hormone-replacement therapy. When we compared the highest and lowest categories of exposure, factors we found to significantly increase risk for SP included tobacco smoking (RR, 2.47; 95% CI, 2.12-2.87), alcohol intake (RR, 1.33; 95% CI, 1.17-1.52), body mass index (RR, 1.40; 95% CI, 1.22-1.61), and high intake of fat or meat. Direct associations for smoking and alcohol, but not body fat, tended to be stronger for sessile serrated adenomas/polyps than hyperplastic polyps. In contrast, factors we found to significantly decrease risks for SP included use of nonsteroidal anti-inflammatory drugs (RR, 0.77; 95% CI, 0.65-0.92) or aspirin (RR, 0.81; 95% CI, 0.67-0.99), as well as high intake of folate, calcium, or fiber. No significant associations were detected between SP risk and physical activity or hormone replacement therapy. CONCLUSIONS Several lifestyle factors, most notably smoking and alcohol, are associated with SP risk. These findings enhance our understanding of mechanisms of SP development and indicate that risk of serrated pathway colorectal neoplasms could be reduced with lifestyle changes.
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Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies.
Azad, MB, Abou-Setta, AM, Chauhan, BF, Rabbani, R, Lys, J, Copstein, L, Mann, A, Jeyaraman, MM, Reid, AE, Fiander, M, et al
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2017;189(28):E929-E939
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Obesity is a major public health challenge that contributes to type 2 diabetes and cardiovascular disease. Evidence that sugar consumption is fuelling this epidemic has stimulated the increasing popularity of non-nutritive sweeteners including aspartame, sucralose and stevioside. The aim of this study was to synthesize evidence of whether routine consumption of non-nutritive sweeteners by adults and adolescents is associated with adverse long-term cardiometabolic effects. This study is a systemic review and meta-analysis of randomised controlled trials and prospective cohort studies. It includes 37 studies involving a total of 406910 individuals. The study shows that small RCTs with short follow-up (median 6 months) suggest that consumption of non-nutritive sweeteners is not consistently associated with decreases in body weight, BMI or waist circumference. However, in larger prospective cohort studies with longer follow-up periods (median 10 years), intake of non-nutritive sweeteners is significantly associated with modest long-term increases in each of these measures. Authors conclude that caution in the use of non-nutritive sweeteners is warranted until the long-term risks and benefits of these products are fully characterised.
Abstract
BACKGROUND Nonnutritive sweeteners, such as aspartame, sucralose and stevioside, are widely consumed, yet their long-term health impact is uncertain. We synthesized evidence from prospective studies to determine whether routine consumption of non-nutritive sweeteners was associated with long-term adverse cardiometabolic effects. METHODS We searched MEDLINE, Embase and Cochrane Library (inception to January 2016) for randomized controlled trials (RCTs) that evaluated interventions for nonnutritive sweeteners and prospective cohort studies that reported on consumption of non-nutritive sweeteners among adults and adolescents. The primary outcome was body mass index (BMI). Secondary outcomes included weight, obesity and other cardiometabolic end points. RESULTS From 11 774 citations, we included 7 trials (1003 participants; median follow-up 6 mo) and 30 cohort studies (405 907 participants; median follow-up 10 yr). In the included RCTs, nonnutritive sweeteners had no significant effect on BMI (mean difference -0.37 kg/m2; 95% confidence interval [CI] -1.10 to 0.36; I2 9%; 242 participants). In the included cohort studies, consumption of nonnutritive sweeteners was associated with a modest increase in BMI (mean correlation 0.05, 95% CI 0.03 to 0.06; I2 0%; 21 256 participants). Data from RCTs showed no consistent effects of nonnutritive sweeteners on other measures of body composition and reported no further secondary outcomes. In the cohort studies, consumption of nonnutritive sweeteners was associated with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events. Publication bias was indicated for studies with diabetes as an outcome. INTERPRETATION Evidence from RCTs does not clearly support the intended benefits of nonnutritive sweeteners for weight management, and observational data suggest that routine intake of nonnutritive sweeteners may be associated with increased BMI and cardiometabolic risk. Further research is needed to fully characterize the long-term risks and benefits of nonnutritive sweeteners. Protocol registration: PROSPERO-CRD42015019749.
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Effect of Probiotics on Metabolic Outcomes in Pregnant Women with Gestational Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Taylor, BL, Woodfall, GE, Sheedy, KE, O'Riley, ML, Rainbow, KA, Bramwell, EL, Kellow, NJ
Nutrients. 2017;9(5)
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The gut microbiota is an important ecosystem consisting of both residential and pathogenic bacteria. The microbiota produce bioactive compounds shown to benefit host metabolism. A variety of factors influence the gut microbiome, including host genetics, illness, antibiotic use, dietary patterns, weight loss and pregnancy. Throughout pregnancy the gut microbiota undergoes significant changes. The aim of this study is to determine the effect of 6-8-week probiotic supplementation versus placebo on glucose homeostasis, lipid levels and gestational weight gain in pregnant women diagnosed with gestational diabetes mellitus. This study is a systemic review based on four randomised controlled trials involving 288 participants. All studies included healthy pregnant women, age range between 18 – 40 years, who were diagnosed with gestational diabetes mellitus at 24 – 30 weeks gestation by oral glucose tolerance test. The study found that a 6 – 8-week probiotic intervention did not improve fasting blood glucose or LDL-cholesterol levels. However, probiotic supplementation in women with gestational diabetes mellitus was associated with significant reductions in insulin resistance. Authors conclude that while probiotic supplementation resulted in a significant reduction in insulin resistance in pregnant women with gestational diabetes mellitus, there was no significant effect on fasting blood glucose or LDL-cholesterol.
Abstract
The metabolic effects of probiotic administration in women with gestational diabetes mellitus (GDM) is unknown. The objective of this review was to investigate the effect of probiotics on fasting plasma glucose (FPG), insulin resistance (HOMA-IR) and LDL-cholesterol levels in pregnant women diagnosed with GDM. Seven electronic databases were searched for RCTs published in English between 2001 and 2017 investigating the metabolic effects of a 6-8 week dietary probiotic intervention in pregnant women following diagnosis with GDM. Eligible studies were assessed for risk of bias and subjected to qualitative and quantitative synthesis using a random effects model meta-analyses. Four high quality RCTs involving 288 participants were included in the review. Probiotic supplementation was not effective in decreasing FBG (Mean Difference = -0.13; 95% CI -0.32, 0.06, p = 0.18) or LDL-cholesterol (-0.16; 95% CI -0.45, 0.13, p = 0.67) in women with GDM. However, a significant reduction in HOMA-IR was observed following probiotic supplementation (-0.69; 95% CI -1.24, -0.14, p = 0.01). There were no significant differences in gestational weight gain, delivery method or neonatal outcomes between experimental and control groups, and no adverse effects of the probiotics were reported. Probiotic supplementation for 6-8 weeks resulted in a significant reduction in insulin resistance in pregnant women diagnosed with GDM. The use of probiotic supplementation is promising as a potential therapy to assist in the metabolic management of GDM. Further high quality studies of longer duration are required to determine the safety, optimal dose and ideal bacterial composition of probiotics before their routine use can be recommended in this patient group.
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Body composition status and the risk of migraine: A meta-analysis.
Gelaye, B, Sacco, S, Brown, WJ, Nitchie, HL, Ornello, R, Peterlin, BL
Neurology. 2017;88(19):1795-1804
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Both migraine and obesity are conditions associated with substantial personal and societal burdens. The aim of this study was to evaluate the pooled risk of migraine by body composition status as characterized by the WHO physical status categories and the influence of age and sex on this relationship. This study is a meta-analysis of twelve studies with data from 288,981 unique participants. The age of the participants ranged between 18 and 98 years. Results indicate that obesity and underweight status are associated with an increased risk of migraine, and that age and sex are important covariates for the increased risk. Authors conclude that further research to better understand the mechanisms underlying the association between body composition and migraine, has the potential to advance the understanding of migraine and lead to the development of targeted therapeutic strategies based on obesity status.
Abstract
OBJECTIVE To evaluate the association between migraine and body composition status as estimated based on body mass index and WHO physical status categories. METHODS Systematic electronic database searches were conducted for relevant studies. Two independent reviewers performed data extraction and quality appraisal. Odds ratios (OR) and confidence intervals (CI) were pooled using a random effects model. Significant values, weighted effect sizes, and tests of homogeneity of variance were calculated. RESULTS A total of 12 studies, encompassing data from 288,981 unique participants, were included. The age- and sex-adjusted pooled risk of migraine in those with obesity was increased by 27% compared with those of normal weight (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.16-1.37, p < 0.001) and remained increased after multivariate adjustments. Although the age- and sex-adjusted pooled migraine risk was increased in overweight individuals (OR 1.08; 95% CI 1.04, 1.12, p < 0.001), significance was lost after multivariate adjustments. The age- and sex-adjusted pooled risk of migraine in underweight individuals was marginally increased by 13% compared with those of normal weight (OR 1.13; 95% CI 1.02, 1.24, p < 0.001) and remained increased after multivariate adjustments. CONCLUSIONS The current body of evidence shows that the risk of migraine is increased in obese and underweight individuals. Studies are needed to confirm whether interventions that modify obesity status decrease the risk of migraine.
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Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies.
Dinu, M, Abbate, R, Gensini, GF, Casini, A, Sofi, F
Critical reviews in food science and nutrition. 2017;57(17):3640-3649
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Vegetarian diet is experiencing a considerable popularity in the general population. The aim of this study was to obtain an estimate of the association between vegetarian, vegan diets, and multiple health outcomes, including risk factors for chronic diseases, risk of all-cause mortality, incidence and mortality from cardio-cerebrovascular diseases, total cancer and specific types of cancer. This study is a comprehensive systematic review with meta-analysis of all cross-sectional and cohort studies. A total of 108 articles were included in the meta-analysis with a total population of over 130,000 vegetarians and 15,000 vegans. Results indicate that: - vegetarians and vegans show significantly lower levels of the most relevant risk factor for chronic disease such as body mass index, lipid variables and fasting glucose, when compared to non-vegetarians and nonvegans. - a significant protection versus ischemic heart disease and cancer is present in vegetarian subjects, however this protection is not significant for overall mortality, cardio and cerebrovascular diseases. - vegan diet seems to be associated with a lower rate of cancer incidence (interpreted with caution due to the small sample size of the study). Authors conclude that their findings may be useful for helping to give correct information to subjects who want to adopt vegetarian or vegan dietary patterns.
Abstract
BACKGROUND Beneficial effects of vegetarian and vegan diets on health outcomes have been supposed in previous studies. OBJECTIVES Aim of this study was to clarify the association between vegetarian, vegan diets, risk factors for chronic diseases, risk of all-cause mortality, incidence, and mortality from cardio-cerebrovascular diseases, total cancer and specific type of cancer (colorectal, breast, prostate and lung), through meta-analysis. METHODS A comprehensive search of Medline, EMBASE, Scopus, The Cochrane Library, and Google Scholar was conducted. RESULTS Eighty-six cross-sectional and 10 cohort prospective studies were included. The overall analysis among cross-sectional studies reported significant reduced levels of body mass index, total cholesterol, LDL-cholesterol, and glucose levels in vegetarians and vegans versus omnivores. With regard to prospective cohort studies, the analysis showed a significant reduced risk of incidence and/or mortality from ischemic heart disease (RR 0.75; 95% CI, 0.68 to 0.82) and incidence of total cancer (RR 0.92; 95% CI 0.87 to 0.98) but not of total cardiovascular and cerebrovascular diseases, all-cause mortality and mortality from cancer. No significant association was evidenced when specific types of cancer were analyzed. The analysis conducted among vegans reported significant association with the risk of incidence from total cancer (RR 0.85; 95% CI, 0.75 to 0.95), despite obtained only in a limited number of studies. CONCLUSIONS This comprehensive meta-analysis reports a significant protective effect of a vegetarian diet versus the incidence and/or mortality from ischemic heart disease (-25%) and incidence from total cancer (-8%). Vegan diet conferred a significant reduced risk (-15%) of incidence from total cancer.