Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study

Published on Oct 1, 2017in The Lancet Diabetes & Endocrinology 19.31
· DOI :10.1016/S2213-8587(17)30283-8
Andrew Mente29
Estimated H-index: 29
(McMaster University),
Mahshid Dehghan22
Estimated H-index: 22
(Population Health Research Institute)
+ 420 AuthorsR Mapanga4
Estimated H-index: 4
Abstract
Summary Background The relation between dietary nutrients and cardiovascular disease risk markers in many regions worldwide is unknown. In this study, we investigated the effect of dietary nutrients on blood lipids and blood pressure, two of the most important risk factors for cardiovascular disease, in low-income, middle-income, and high-income countries. Methods We studied 125 287 participants from 18 countries in North America, South America, Europe, Africa, and Asia in the Prospective Urban Rural Epidemiology (PURE) study. Habitual food intake was measured with validated food frequency questionnaires. We assessed the associations between nutrients (total fats, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, carbohydrates, protein, and dietary cholesterol) and cardiovascular disease risk markers using multilevel modelling. The effect of isocaloric replacement of saturated fatty acids with other fats and carbohydrates was determined overall and by levels of intakes by use of nutrient density models. We did simulation modelling in which we assumed that the effects of saturated fatty acids on cardiovascular disease events was solely related to their association through an individual risk marker, and then compared these simulated risk marker-based estimates with directly observed associations of saturated fatty acids with cardiovascular disease events. Findings Participants were enrolled into the study from Jan 1, 2003, to March 31, 2013. Intake of total fat and each type of fat was associated with higher concentrations of total cholesterol and LDL cholesterol, but also with higher HDL cholesterol and apolipoprotein A1 (ApoA1), and lower triglycerides, ratio of total cholesterol to HDL cholesterol, ratio of triglycerides to HDL cholesterol, and ratio of apolipoprotein B (ApoB) to ApoA1 (all p trend trend trend =0·0014]). Higher intakes of total fat, saturated fatty acids, and carbohydrates were associated with higher blood pressure, whereas higher protein intake was associated with lower blood pressure. Replacement of saturated fatty acids with carbohydrates was associated with the most adverse effects on lipids, whereas replacement of saturated fatty acids with unsaturated fats improved some risk markers (LDL cholesterol and blood pressure), but seemed to worsen others (HDL cholesterol and triglycerides). The observed associations between saturated fatty acids and cardiovascular disease events were approximated by the simulated associations mediated through the effects on the ApoB-to-ApoA1 ratio, but not with other lipid markers including LDL cholesterol. Interpretation Our data are at odds with current recommendations to reduce total fat and saturated fats. Reducing saturated fatty acid intake and replacing it with carbohydrate has an adverse effect on blood lipids. Substituting saturated fatty acids with unsaturated fats might improve some risk markers, but might worsen others. Simulations suggest that ApoB-to-ApoA1 ratio probably provides the best overall indication of the effect of saturated fatty acids on cardiovascular disease risk among the markers tested. Focusing on a single lipid marker such as LDL cholesterol alone does not capture the net clinical effects of nutrients on cardiovascular risk. Funding Full funding sources listed at the end of the paper (see Acknowledgments).
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References31
Published on Jan 1, 1970in Circulation 18.88
Ancel Keys67
Estimated H-index: 67
1,525 Citations
Published on Jul 1, 1965in Metabolism-clinical and Experimental 5.96
Ancel Keys67
Estimated H-index: 67
(University of Minnesota),
Joseph T. Anderson36
Estimated H-index: 36
(University of Minnesota),
Francisco Grande32
Estimated H-index: 32
(University of Minnesota)
Abstract For many dietary changes satisfactory prediction of the average change in the serum cholesterol level of man in mg./100 ml., is given by Δ Chol. = 1.35(2ΔS − ΔP) + 1.5ΔZ where S and P are percentages of total calories provided by glycerides of saturated and polyunsaturated fatty acids in the diet and Z 2 = mg. of dietary cholesterol/1000 Cal. This formula fails, however, when the dietary change involves large amounts of cocoa butter and discrepancies also appear with beef tallow or hydr...
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Published on Dec 1, 2007in The Lancet 53.25
Sarah Lewington41
Estimated H-index: 41
,
Gary Whitlock26
Estimated H-index: 26
+ 6 AuthorsRory Collins128
Estimated H-index: 128
Background Age, sex, and blood pressure could modify the associations of total cholesterol (and its main two fractions, HDL and LDL cholesterol) with vascular mortality. This meta-analysis combined prospective studies of vascular mortality that recorded both blood pressure and total cholesterol at baseline, to determine the joint relevance of these two risk factors. Methods Information was obtained from 61 prospective observational studies, mostly in western Europe or North America, consisting o...
1,418 Citations Source Cite
Published on Jun 24, 2014in Circulation 18.88
Robert H. Eckel93
Estimated H-index: 93
,
John M. Jakicic65
Estimated H-index: 65
+ 13 AuthorsSidney C. Smith Mdfacc160
Estimated H-index: 160
Preamble and Transition to ACC/AHA Guidelines to The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular diseases (CVDs); improve the management …
1,106 Citations Source Cite
Published on Jan 1, 1970in Circulation 18.88
Stuart Bondurant1
Estimated H-index: 1
503 Citations Source Cite
Published on May 1, 2014in American Journal of Cardiology 3.17
Aaqib H. Malik1
Estimated H-index: 1
(Yale University),
Yasir Akram2
Estimated H-index: 2
+ 2 AuthorsValentine Yanchou Njike23
Estimated H-index: 23
(Yale University)
The impact of sugar-sweetened beverages (SSBs) on blood pressure (BP) has been debated, with some evidence suggesting that their increased intake is related to higher risk of developing hypertension. We conducted a systematic review exploring the relation between consumption of SSB and BP. A comprehensive search in 5 electronic databases along with a bibliography search was performed. The keywords "sugar sweetened beverages," "sugary drinks," "added sugars," "blood pressure," and "hypertension" ...
53 Citations Source Cite
Published on May 1, 1996in Preventive Medicine 3.48
Pirjo Pietinen74
Estimated H-index: 74
,
Erkki Vartiainen81
Estimated H-index: 81
+ 2 AuthorsPekka Puska54
Estimated H-index: 54
Abstract Background. Coronary heart disease mortality has declined in Finland by 55% among men and 68% among women between 1972 and 1992. About three-quarters of this decline has been explained by changes in the main coronary risk factors, the decrease in serum cholesterol being the most important one. The aim of this study was to analyze to what extent dietary changes could explain the change in serum cholesterol. Methods. Cardiovascular risk factor surveys have been carried out in Finland from...
178 Citations Source Cite
Lukas Schwingshackl29
Estimated H-index: 29
,
Georg F. Hoffmann62
Estimated H-index: 62
Abstract Dietary fat plays an important role in the primary prevention of cardiovascular disease, but long-term (≥12 months) effects of different percentages of fat in the diet on blood lipid levels remain to be established. Our systematic review and meta-analysis focused on randomized controlled trials assessing the long-term effects of low-fat diets compared with diets with high amounts of fat on blood lipid levels. Relevant randomized controlled trials were identified searching MEDLINE, EMBAS...
72 Citations Source Cite
Published on Sep 1, 2007in Molecular Nutrition & Food Research 5.15
Joseph Kanner1
Estimated H-index: 1
Lipid oxidation in foods is one of the major degradative processes responsible for losses in food quality. The oxidation of unsaturated fatty acids results in significant generation of dietary advanced lipid oxidation endproducts (ALEs) which are in part cytotoxic and genotoxic compounds. The gastrointestinal tract is constantly exposed to dietary oxidized food compounds, after digestion a part of them are absorbed into the lymph or directly into the blood stream. After ingestion of oxidized fat...
155 Citations Source Cite
Published on Oct 1, 2011in The Lancet 53.25
Salim Yusuf Mb Bs DPhil Frcpc182
Estimated H-index: 182
(Population Health Research Institute),
Shofi qul Islam1
Estimated H-index: 1
(Population Health Research Institute)
+ 20 AuthorsAlvaro Avezum69
Estimated H-index: 69
Summary Background Although most cardiovascular disease occurs in low-income and middle-income countries, little is known about the use of effective secondary prevention medications in these communities. We aimed to assess use of proven effective secondary preventive drugs (antiplatelet drugs, β blockers, angiotensin-converting-enzyme [ACE] inhibitors or angiotensin-receptor blockers [ARBs], and statins) in individuals with a history of coronary heart disease or stroke. Methods In the Prospectiv...
525 Citations Source Cite
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Cited By33
Published on Nov 1, 2017in The Lancet 53.25
Mahshid Dehghan22
Estimated H-index: 22
(Population Health Research Institute),
Andrew Mente29
Estimated H-index: 29
(McMaster University)
+ 352 AuthorsAnders H. Rosengren83
Estimated H-index: 83
(University of Gothenburg)
Summary Background The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear. Methods The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35–70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median fo...
145 Citations Source Cite
Published on Nov 1, 2017in The Lancet 53.25
Christopher E. Ramsden16
Estimated H-index: 16
(National Institutes of Health),
Anthony F. Domenichiello12
Estimated H-index: 12
(National Institutes of Health)
6 Citations Source Cite
Published on Oct 1, 2017in The Lancet Diabetes & Endocrinology 19.31
Nita G. Forouhi73
Estimated H-index: 73
(University of Cambridge),
Naveed Sattar113
Estimated H-index: 113
(University of Oxford),
Fumiaki Imamura27
Estimated H-index: 27
(University of Cambridge)
1 Citations Source Cite
Published on Oct 1, 2017in Deutsche Medizinische Wochenschrift 0.52
Katharina Lechner , Nicole Erickson4
Estimated H-index: 4
+ 1 AuthorsFlorian Horn
Cardiovascular disease is the number one cause of death globally. Poor diet constitutes a key factor in the initiation and progression of cardiovascular disease and has become the leading risk factor for disability and death worldwide. Therefore, addressing suboptimal nutrition is of key prognostic relevance in primary and secondary prevention of metabolic vascular syndrome. Metabolic vascular syndrome is a multidimensional network of acquired cardiometabolic risk factors closely related to insu...
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Published on Mar 1, 2018in Nutrition Bulletin
Anne Marie Minihane42
Estimated H-index: 42
(University of East Anglia)
1 Citations Source Cite
Published on Jan 15, 2018in BMJ 23.56
George Henderson1
Estimated H-index: 1
(Auckland University of Technology)
The umbrella review of coffee consumption and health by Poole and colleagues includes a gentle plea to consider a randomised controlled trial of coffee for chronic liver disease as well as the outcomes of a focus group, which indicate interest in this particular usage.1 I hope that such a trial does result from this publication. I was able to find one …
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Published on Apr 1, 2018in Diabetes Therapy 2.22
Sarah J. Hallberg2
Estimated H-index: 2
(Indiana University Health),
Amy L. McKenzie8
Estimated H-index: 8
+ 8 AuthorsStephen D. Phinney29
Estimated H-index: 29
Introduction Carbohydrate restriction markedly improves glycemic control in patients with type 2 diabetes (T2D) but necessitates prompt medication changes. Therefore, we assessed the effectiveness and safety of a novel care model providing continuous remote care with medication management based on biometric feedback combined with the metabolic approach of nutritional ketosis for T2D management.
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Published on Mar 26, 2018in Nutrients 4.20
Pavel Grasgruber3
Estimated H-index: 3
,
Jan Cacek3
Estimated H-index: 3
+ 2 AuthorsMartin Sebera3
Estimated H-index: 3
The aim of this study was a large-scale ecological analysis of nutritional and other environmental factors potentially associated with the incidence of cardiovascular diseases (CVDs) in the global context. Indicators of CVDs from 158 countries were compared with the statistics of mean intake (supply) of 60 food items between 1993 and 2011, obesity rates, health expenditure and life expectancy. This comparison shows that the relationship between CVD indicators (raised blood pressure, CVD mortalit...
2 Citations Source Cite
Published on Jul 16, 2018in American Journal of Hypertension 3.05
Satoshi Murao8
Estimated H-index: 8
,
Yasunori Takata22
Estimated H-index: 22
(Ehime University)
+ 2 AuthorsFumikazu Kohi2
Estimated H-index: 2
2 Citations Source Cite
Núria Plana18
Estimated H-index: 18
,
Cèlia Rodríguez-Borjabad2
Estimated H-index: 2
+ 5 Authorsen representación del proyecto Decopin
Resumen Introduccion La hipercolesterolemia familiar (HF) infantil esta infradiagnosticada y su diagnostico no es facil en la practica clinica . El objetivo fue evaluar que caracteristicas clinicas, bioquimicas y de imagen vascular pueden ayudarnos a detectar a ninos/as y adolescentes con hipercolesterolemia afectados de HF. Metodos Doscientos veintidos ninos y adolescentes de entre 4 y 18 anos fueron reclutados para participar en un proyecto de deteccion precoz de HF (proyecto DECOPIN). La HF s...
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