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Dietary polyphenols, metabolic syndrome and cardiometabolic risk factors: An observational study based on the DCH-NG subcohort.
Lanuza, F, Zamora-Ros, R, Bondonno, NP, Meroño, T, Rostgaard-Hansen, AL, Riccardi, G, Tjønneland, A, Landberg, R, Halkjær, J, Andres-Lacueva, C
Nutrition, metabolism, and cardiovascular diseases : NMCD. 2023;33(6):1167-1178
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Metabolic syndrome (MetS) is a cluster of metabolic disorders that increases the risk of developing chronic diseases. Cardiometabolic risk factors include high waist circumference (WC), insulin resistance, hypertension, dysglycaemia, dyslipidaemia, and altered inflammatory markers. The aim of this study was to investigate the associations between intakes of polyphenols (total polyphenols and their main classes) and the prevalence of MetS and cardiometabolic risk factors. This study is an observational sub-cohort study of 676 Danish participants of the MAX study from the Danish Diet, Cancer and Health - Next Generations (DCH-NG) cohort. Results showed that individuals with higher total polyphenol and phenolic acid intakes, were less likely to have MetS. Furthermore, for cardiovascular risk factors, intakes of total polyphenols, flavonoids and phenolic acids were associated with a lower risk of higher systolic blood pressure and lower high-density lipoprotein cholesterol. Authors conclude by suggesting that intervention studies should be undertaken to establish whether a polyphenol-rich diet can improve some cardiometabolic risk factors and can reduce or delay the onset of cardiometabolic diseases in free-living populations.
Abstract
BACKGROUND AND AIMS Polyphenol-rich foods have beneficial properties that may lower cardiometabolic risk. We aimed to prospectively investigate the relationship between intakes of dietary polyphenols, and metabolic syndrome (MetS) and its components, in 676 Danish residents from the MAX study, a subcohort of the Danish Diet, Cancer and Health-Next Generations (DCH-NG) cohort. METHODS AND RESULTS Dietary data were collected using web-based 24-h dietary recalls over one year (at baseline, and at 6 and 12 months). The Phenol-Explorer database was used to estimate dietary polyphenol intake. Clinical variables were also collected at the same time point. Generalized linear mixed models were used to investigate relationships between polyphenol intake and MetS. Participants had a mean age of 43.9y, a mean total polyphenol intake of 1368 mg/day, and 75 (11.6%) had MetS at baseline. Compared to individuals with MetS in Q1 and after adjusting for age, sex, lifestyle and dietary confounders, those in Q4 - for total polyphenols, flavonoids and phenolic acids-had a 50% [OR (95% CI): 0.50 (0.27, 0.91)], 51% [0.49 (0.26, 0.91)] and 45% [0.55 (0.30, 1.00)] lower odds of MetS, respectively. Higher total polyphenols, flavonoids and phenolic acids intakes as continuous variable were associated with lower risk for elevated systolic blood pressure (SBP) and low high-density lipoprotein cholesterol (HDL-c) (p < 0.05). CONCLUSIONS Total polyphenol, flavonoid and phenolic acid intakes were associated with lower odds of MetS. These intakes were also consistently and significantly associated with a lower risk for higher SBP and lower HDL-c concentrations.
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Estimation of Primary Prevention of Gout in Men Through Modification of Obesity and Other Key Lifestyle Factors.
McCormick, N, Rai, SK, Lu, N, Yokose, C, Curhan, GC, Choi, HK
JAMA network open. 2020;3(11):e2027421
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Gout is prevalent in most Western countries. Modifying the contributary factors such as obesity and alcohol intake could prevent gout, however the impact this could have on prevention is unknown. This cohort study of 44,654 men, aimed to estimate the proportion of gout cases that could be prevented through the modification of risk factors. The results showed that the most important risk factor for gout was body mass index (BMI) and modifying other risk factors did not prevent gout. 77% of gout cases could be prevented if all men had been of normal weight, had no alcohol intake, if they adhered to a diet known as the Dietary Approaches to Stop Hypertension (DASH) diet and if they didn't take drugs to increase urine output. It was concluded that weight loss in men determines their ability to prevent gout, regardless of whether they have modified other contributory factors. This study could be used by healthcare professionals to understand that unless weight loss is achieved in individuals who are overweight and have gout, then other interventions may have minimal impact. Recommending the DASH diet to achieve weight loss, may be more successful in the long-term management of gout.
Abstract
Importance: The population impact of modifying obesity and other key risk factors for hyperuricemia has been estimated in cross-sectional studies; however, the proportion of incident gout cases (a clinical end point) that could be prevented by modifying such factors has not been evaluated. Objective: To estimate the proportion of incident gout cases that could be avoided through simultaneous modification of obesity and other key risk factors. Design, Setting, and Participants: The Health Professionals Follow-up Study is a US prospective cohort study of 51 529 male health professionals enrolled in 1986 and followed up through questionnaires every 2 years through 2012. Self-reported gout cases were confirmed through June 2015. Clean and complete data used for this analysis were available in June 2016, with statistical analyses performed from July 2016 to July 2019. Exposures: From data collected in the validated questionnaires, men were categorized to low-risk groups according to combinations of the following 4 factors: normal body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]; <25), no alcohol intake, adherence to Dietary Approaches to Stop Hypertension (DASH)-style diet (highest quintile of DASH diet score), and no diuretic use. Main Outcomes and Measures: Population attributable risks (PARs) for incident gout meeting the preliminary American College of Rheumatology survey criteria, overall and stratified by BMI. Results: We analyzed 44 654 men (mean [SD] age, 54.0 [9.8] years) with no history of gout at baseline. During 26 years of follow-up, 1741 (3.9%) developed incident gout. Among all participants, PAR for the 4 risk factors combined (BMI, diet, alcohol use, and diuretic use) was 77% (95% CI, 56%-88%). Among men with normal weight (BMI <25.0) and overweight (BMI 25.0-29.9), we estimated that more than half of incident gout cases (69% [95% CI, 42%-83%] and 59% [95% CI, 30%-75%], respectively) may have been prevented by the combination of DASH-style diet, no alcohol intake, and no diuretic use. However, among men with obesity (BMI ≥30), PAR was substantially lower and not significant (5% [95% CI, 0%-47%]). Conclusions and Relevance: The findings of this cohort study suggest that addressing excess adiposity and other key modifiable factors has the potential to prevent the majority of incident gout cases among men. Men with obesity may not benefit from other modifications unless weight loss is addressed.
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Comparison of the Effects of Fasting Glucose, Hemoglobin A1c, and Triglyceride-Glucose Index on Cardiovascular Events in Type 2 Diabetes Mellitus.
Su, WY, Chen, SC, Huang, YT, Huang, JC, Wu, PY, Hsu, WH, Lee, MY
Nutrients. 2019;11(11)
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Cardiovascular disease generally refers to the narrowing or blockage of the arteries of the heart, which can lead to a heart attack or stroke and is the major cause of death in individuals with type 2 diabetes. Identifying individuals with type 2 diabetes who are at high risk of developing cardiovascular disease could ensure better management of these patients. This retrospective observational study of 3524 individuals with type 2 diabetes aimed to investigate if the amount of sugar found in the blood over the last few months, known as haemaglobin A1c (HbA1c) can predict cardiovascular disease in individuals with type 2 diabetes. In addition, the study looked at the triglyceride-glucose (TyG) index and its relationship to cardiovascular disease outcomes. The results showed that several factors were associated with cardiovascular disease, however of main note was that the TyG index and the amount of sugar in the blood following a fast were associated with increased cardiovascular events in individuals with type 2 diabetes, but HbA1c was not. It was concluded that TyG and the blood sugar level could be used to allow early identification and management of type 2 diabetics to prevent cardiovascular events. Clinicians could use this study to justify the use of measuring the TyG index and blood sugar levels as a predictor for cardiovascular events to ensure that patients are managed not only for type 2 diabetes but also to reduce their risk of cardiovascular events in the future.
Abstract
The triglyceride-glucose (TyG) index has been correlated with insulin resistance. We aim to investigate the role of the TyG index on cardiovascular (CV) events in type 2 diabetes mellitus and compare the roles of fasting glucose, hemoglobin A1c, and the TyG index in predicting CV events. This retrospective study enrolled 3524 patients with type 2 diabetes from the Kaohsiung Medical University Research Database in 2009 in this longitudinal study and followed them until 2015. The TyG index was calculated as log (fasting triglyceride level (mg/dL) × fasting glucose level (mg/dL)/2). CV events included myocardial infarction, unstable angina, stroke, hospitalization for coronary artery disease, peripheral artery disease, and CV-related death. The association between variables and CV events was assessed using a multivariable stepwise Cox proportional hazard analysis. Two hundred and fifteen CV events (6.1%) were recorded during a follow-up period of 5.93 years. The multivariable stepwise analysis showed that high fasting glucose (HR, 1.007; p < 0.001) and a high TyG index (HR, 1.521; p = 0.004) but not hemoglobin A1c or triglycerides were associated with a higher rate of CV events. Adding fasting glucose and the TyG index to the basic model improved the predictive ability of progression to a CV event (p < 0.001 and p = 0.018, respectively), over that of hemoglobin A1c (p = 0.084) and triglyceride (p = 0.221). Fasting glucose and the TyG index are useful parameters and stronger predictive factors than hemoglobin A1c and triglyceride for CV events and may offer an additional prognostic benefit in patients with type 2 diabetes.
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Visceral obesity, skeletal muscle mass and resistin in metabolic syndrome development.
Rodríguez-López, CP, González-Torres, MC, Cruz-Bautista, I, Nájera-Medina, O
Nutricion hospitalaria. 2019;36(1):43-50
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Obesity is a growing public health problem at a national and global level. Visceral adipose tissue (VAT) is the most bioactive component that is related with the release of inflammatory mediators which gives rise to insulin resistance, mainly local, and subsequently in liver and skeletal muscle. The aim of this study was to determine the relationship of body components with the concentration of resistin as an inflammatory marker in patients with overweight and obesity. The study is an observational, cross-sectional clinical study which analysed 40 participants with an age range between 18 and 40 years. Results indicate that: - as body mass index and VAT increased, anthropometric measurements, body composition, and biochemical indicators were altered. - persons with obesity and increased VAT had the highest proportions of metabolic syndrome (MS). - an increase in skeletal muscle is related with increased BMI and with the presence of increased VAT. - there was a significant increase in resistin concentration in individuals without MS and increased VAT compared to those without MS and normal VAT. Authors conclude that resistin might be acting as an inflammatory adipocytokine [a bioactive product produced by adipose tissue], contributing to the increase in frequency of MS in those persons who present increased levels of this cytokine.
Abstract
INTRODUCTION Background: obesity implies an increase in the visceral adipose tissue (VAT), which is a risk factor for various metabolic diseases. VAT releases proinflammatory mediators, like resistin. In addition, it has been noted that the skeletal muscle mass (SMM) is involved in the development of metabolic syndrome (MS). Objective: this study was designed to determine the relationship of body components (VAT and SMM) with MS and resistin in patients with obesity. Methods: body composition and anthropometric and biochemical measurements to assess MS, and ELISA tests for resistin were carried out in 40 patients aged 18-40 years. Results: overweight and obesity were observed in 72% of patients; visceral obesity was found in 53% and 35% had MS. A positive correlation between VAT and SMM in patients with MS was detected. In the entire population, an increase of 1 kg of SMM was found to be associated with an increase of 3 cm2 of VAT, and an increase of 4 cm2 of VAT was observed in individuals with MS. According to resistin, people with increased VAT had higher concentration than persons with normal VAT. Furthermore, an increase of 1 cm2 of VAT accounted for a person entertaining a 3.3 fold greater risk of MS for different values of SMM and resistin. Conclusion: the transcendence and significance of VAT as a main factor in triggering the chronic inflammatory process and MS, the SMM and resistin were also related. INTRODUCCIÓN: Introducción: la obesidad implica un aumento del tejido adiposo visceral (TAV), el cual es un factor de riesgo para varias enfermedades metabólicas. El VAT se relaciona con mediadores proinflamatorios, como la resistina. Además, se ha observado que la masa musculoesquelética (MME) interviene en el desarrollo del síndrome metabólico (SM). Objetivo: este estudio fue diseñado para determinar la relación de la composición corporal (TAV y MME) con el SM y la resistina en pacientes con obesidad. Métodos: se realizaron medidas antropométricas, de composición corporal y bioquímica para determinar el SM y prueba de ELISA para resistina en 40 pacientes de 18 a 40 años de edad. Resultados: se observó sobrepeso y obesidad en el 72% de los participantes, obesidad visceral en el 53% y el 35% presentó SM. Se detectó una correlación positiva entre el TAV y la MME en pacientes con SM. En el grupo de estudio encontramos que un aumento de un 1 kg de MME se asociaba con un incremento de 3 cm2 de TAV y en individuos con SM, con un incremento de 4 cm2 de TAV. En relación con la resistina, las personas con TAV incrementado presentan concentraciones más altas que las personas con TAV normal. Además, se observó que un aumento de 1 cm2 de TAV representa un riesgo 3,3 veces mayor que para las personas de padecer SM para diferentes valores de MME y de resistina. Conclusión: además de la trascendencia y la importancia del TAV como factor principal para desencadenar el proceso inflamatorio crónico y el SM, se observó que la MME y la resistina también están relacionadas.
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The Association between Mediterranean Diet and the Risk of Falls and Physical Function Indices in Older Type 2 Diabetic People Varies by Age.
Tepper, S, Alter Sivashensky, A, Rivkah Shahar, D, Geva, D, Cukierman-Yaffe, T
Nutrients. 2018;10(6)
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Diabetes is associated with high risk for disability, and accelerated rate of decline in physical capacity. The aim of the study is to examine whether a higher adherence to a Mediterranean Diet in a Mediterranean country is associated with walking speed, better physical function and decreased risk for falls. This cross-sectional study includes data of 117 individuals, of which 40% were females, with Type 2 diabetes aged over 60 years. Results indicate that those individuals with a higher adherence to the Mediterranean Diet were at lower risk for falls and had greater muscle strength. The relationship between physical performance measured by walking speed, walking distance and Mediterranean Diet differed by age. Authors conclude that there is an association between the balances indices, risk for falls, muscle strength, aerobic capacity, and Mediterranean Diet among 60+ individuals with diabetes.
Abstract
BACKGROUND AND AIMS Diabetes and dysglycemia increase the risk of frailty and decreased physical abilities. Adherence to the Mediterranean Diet (MD) may reduce this risk. We hypothesized that adherence to the MD is associated with physical function in older type-2 diabetic patients and that the association is stratified by age. METHODS AND RESULTS We recruited type-2 diabetes patients aged >60 years at the Center for Successful Aging with Diabetes at Sheba Medical Center. Health status and demographic data were obtained from medical records. Food Frequency Questionnaire was used for nutritional assessment and calculation of MD score. Physical function indices were determined by a physiotherapist and included: Berg Balance test, Timed Get-Up-and-Go, 6-min walk (6 MW), 10-m walk (10 MW), Four Square Step Test, 30-s chair stand and Grip strength, and activities and instrumental activities of daily living. Among 117 participants (age 70.6 ± 6.5), high adherence to MD was associated with better score on functional tests (low vs. high MD adherence: 9.7% vs. 25%, ANOVA p = 0.02). A significant age by MD interaction was found: a higher adherence to MD was associated with a better 6 MW (low vs. high: 387 ± 35 m vs. 483 ± 26 m; p = 0.001) and higher 10 MW (low vs. high: 1.8 ± 0.16 m/s vs. 2.0 ± 0.13 m/s; p = 0.02) in participants aged >75 years. These associations remained significant after controlling for gender, age, BMI, and physical activity. CONCLUSION In the current study, we showed relationships between strength, physical performance, and MD among older diabetic patients. Future studies are needed to confirm this association and establish temporal relationships.