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Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review.
Mozaffarian, D
Circulation. 2016;133(2):187-225
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Diet-related cardiometabolic conditions, such as heart disease and diabetes, pose a significant health and economic burden across the world. In recent years, scientific advances and research have generated enormous insights, yet there remain many controversies and unanswered questions. This extensive review summarizes recent evidence of key-dietary components and their impact on cardiometabolic health. Amongst the topics covered are dietary patterns, food quality and processing, genetics, personalized nutrition, supplements, functional foods and the existing knowledge on selected food groups such as carbohydrates, meat and fats alongside relevant vitamins, minerals and plant compounds. The author highlights how an oversimplified concept of nutrition from previous decades, has led to an array of conflicting advice and undermined the nuanced and complex impact that diet and nutrition can have on the body. Thus in light of the evidence, food-based interventions and dietary patterns are suggested as favourable, with less focus on dietary components in isolation. Throughout the paper, the need for adjunct support to facilitate sustainable health-promoting behaviour changes is recognized. Calling for additional measures to address behaviour change, health systems reforms, targeting socioeconomic inequalities, employing novel technologies, and adequate policymaking. This overview of recent evidence yields a comprehensive source of information, worthwhile reviewing when designing personalised diet plans in support of cardiometabolic health.
Abstract
Suboptimal nutrition is a leading cause of poor health. Nutrition and policy science have advanced rapidly, creating confusion yet also providing powerful opportunities to reduce the adverse health and economic impacts of poor diets. This review considers the history, new evidence, controversies, and corresponding lessons for modern dietary and policy priorities for cardiovascular diseases, obesity, and diabetes mellitus. Major identified themes include the importance of evaluating the full diversity of diet-related risk pathways, not only blood lipids or obesity; focusing on foods and overall diet patterns, rather than single isolated nutrients; recognizing the complex influences of different foods on long-term weight regulation, rather than simply counting calories; and characterizing and implementing evidence-based strategies, including policy approaches, for lifestyle change. Evidence-informed dietary priorities include increased fruits, nonstarchy vegetables, nuts, legumes, fish, vegetable oils, yogurt, and minimally processed whole grains; and fewer red meats, processed (eg, sodium-preserved) meats, and foods rich in refined grains, starch, added sugars, salt, and trans fat. More investigation is needed on the cardiometabolic effects of phenolics, dairy fat, probiotics, fermentation, coffee, tea, cocoa, eggs, specific vegetable and tropical oils, vitamin D, individual fatty acids, and diet-microbiome interactions. Little evidence to date supports the cardiometabolic relevance of other popular priorities: eg, local, organic, grass-fed, farmed/wild, or non-genetically modified. Evidence-based personalized nutrition appears to depend more on nongenetic characteristics (eg, physical activity, abdominal adiposity, gender, socioeconomic status, culture) than genetic factors. Food choices must be strongly supported by clinical behavior change efforts, health systems reforms, novel technologies, and robust policy strategies targeting economic incentives, schools and workplaces, neighborhood environments, and the food system. Scientific advances provide crucial new insights on optimal targets and best practices to reduce the burdens of diet-related cardiometabolic diseases.
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Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial.
Kiecolt-Glaser, JK, Belury, MA, Andridge, R, Malarkey, WB, Glaser, R
Brain, behavior, and immunity. 2011;25(8):1725-34
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Dietary intake of both omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) influence inflammation, and observational studies have linked lower omega-3 PUFAs with inflammation and depression. The aim of this trial was to investigate the effects of omega-3 PUFA supplementation on inflammatory cytokine production and symptoms of depression and anxiety. Sixty-eight medical students aged 21 to 29 were enrolled in the study and were randomised to either receive omega-3 PUFA pills or placebo pills that approximated the average fat intake consumed by adults. This study found that students who received omega-3 PUFAs showed a decrease both in inflammatory cytokine production and anxiety symptoms compared with controls. This study provides the first evidence that omega-3 PUFAs may be beneficial for individuals with anxiety.
Abstract
Observational studies have linked lower omega-3 (n-3) polyunsaturated fatty acids (PUFAs) and higher omega-6 (n-6) PUFAs with inflammation and depression, but randomized controlled trial (RCT) data have been mixed. To determine whether n-3 decreases proinflammatory cytokine production and depressive and anxiety symptoms in healthy young adults, this parallel group, placebo-controlled, double-blind 12-week RCT compared n-3 supplementation with placebo. The participants, 68 medical students, provided serial blood samples during lower-stress periods as well as on days before an exam. The students received either n-3 (2.5 g/d, 2085 mg eicosapentaenoic acid and 348 mg docosahexanoic acid) or placebo capsules that mirrored the proportions of fatty acids in the typical American diet. Compared to controls, those students who received n-3 showed a 14% decrease in lipopolysaccharide (LPS) stimulated interleukin 6 (IL-6) production and a 20% reduction in anxiety symptoms, without significant change in depressive symptoms. Individuals differ in absorption and metabolism of n-3 PUFA supplements, as well as in adherence; accordingly, planned secondary analyses that used the plasma n-6:n-3 ratio in place of treatment group showed that decreasing n-6:n-3 ratios led to lower anxiety and reductions in stimulated IL-6 and tumor necrosis factor alpha (TNF-α) production, as well as marginal differences in serum TNF-α. These data suggest that n-3 supplementation can reduce inflammation and anxiety even among healthy young adults. The reduction in anxiety symptoms associated with n-3 supplementation provides the first evidence that n-3 may have potential anxiolytic benefits for individuals without an anxiety disorder diagnosis. ClinicalTrials.gov identifier: NCT00519779.