B P4 C29 Nutrition and Cardiovascular and Metabolic Diseases Flashcards
Beyond the empiric failure of this approach to stem the obesity epidemic worldwide, new evidence indicates that the _____ of food is the major driver of energy imbalance and weight gain
Quality
More highly processed foods drive greater ad libitum energy intake (+____ kcal/day) and weight gain, while carbohydrate quality and quantity also influence energy expenditure.
+508 kcal/day
Diet _____ is thus a major determinant of long-term energy imbalance, which can be considered a downstream mediator, not an upstream determinant, of the obesity epidemic
Quality
Because habitual excess energy intakes as small as approximately _____ kcal/d may explain much of the obesity epidemic, subtle effects on these pathways are sufficient, when sustained, to account for population shifts in weight
50 to 100 kcal/day
Higher fruit and vegetable intake associates with less _____ and lower incidence of _____
Less long-term weight gain
Lower incidence of CHD and stroke
_____ similarly appears fairly neutral for glycemia and DM and associates with modestly lower risk of CVD.
100% fruit juice
Consumption of nuts lowers total cholesterol, LDL-cholesterol, ApoB, triglycerides, and insulin resistance in trials; associates with lower incidence of CHD in prospective studies and was a key component of a large Mediterranean diet trial that reduced abdominal obesity and risk of hard CVD endpoints by _____%
30%
Nuts are rich in unsaturated fats, vegetable protein, fiber, folate, minerals, tocopherols, and phenolic compounds.
Consumption of nuts lowers
Lower:
Total cholesterol
LDL-cholesterol
ApoB
TG
Insulin resistance
In observational cohorts, bean intake _____ associates with total CVD, CHD, and incident hypertension, but not significantly with stroke or DM
Inversely
A whole grain is a seed including its
__________ - exterior skin; providing fiber, B-vitamins, minerals, flavonoids, and tocopherols
__________ - starchy interior; nearly all glucose)
__________ - plant embryo; providing fatty acids, antioxidants, and phytonutrients
Bran
Endosperm
Germ
_________ include refined grains (e.g., white flour, white rice), stripped of their bran and germ to leave only starchy endosperm, and added sugars.
Refined carbohydrates
All refined carbohydrates (sugars or starch) produce rapid, dose dependent glycemic responses, with similar overall health harms.
All _____ produce rapid, dose-dependent glycemic responses, with similar overall health harms.
Refined carbohydrates (sugars or starch)
Thus, refined carbohydrate (i.e., starch) in foods should be considered a “hidden sugar.”
Foods rich in refined grains, starches, and added sugars associated with risk of ______
Long-term weight gain
Added sugars in beverages appear most deleterious, perhaps owing to a combination of large portion sizes, rapid intake patterns, and limited effects on satiety.
Foods containing whole grains or dietary fiber associate with lower risk of _____
Lower risk of:
CVD
DM
Long-term weight gain
One pragmatic rule-of-thumb is to choose foods containing at least ____, which implicitly balances the relative proportions of starch, sugar, whole grain, bran, and added fiber.
1 g of fiber for every 10 g of carbohydrate per serving (carbohydrate:fiber ratio <10:1)
Regular fish consumption ( _____ servings/week) associates with modestly lower risk of CHD and stroke
1 to 2 servings/week
Greatest benefits may accrue from nonfried oily (dark meat) fish, that contain up to 10-fold more omega-3 fats than other types. Fish also contain other unsaturated fats, selenium, and vitamin D, which could provide benefit.
Mechanistic, observational, and trial data suggest that fish may have stronger benefits for _____ CHD rather than nonfatal myocardial infarction (MI) or stroke, suggesting potential specificity for pathways of acute ischemia-induced ventricular arrhythmia
Fatal
Greatest benefits of fish intake may accrue from _____fish, that contain up to 10-fold more omega-3 fats than other types
Nonfried oily (dark meat)
_____ in fish has no detectable influence on CVD events or incident hypertension
Methylmercury
Prevalent guidelines recommend ________ meat to lower dietary cholesterol and saturated fat.
Lean meats
Available evidence suggests that processed meats (i.e.,preserved with sodium or other additives,such as deli meats, sausage, hot dogs, bacon, etc.) increase risk of CVD, stroke, and DM; with unprocessed red meats having generally smaller associations, gram for gram, with these endpoints
Based on available evidence, processed meats should be avoided, and unprocessed meats eaten up to _____ servings/ wk or less.
1-2 servings/week or less
When combined with its relatively low content of bioactive nutrients, these findings suggest that poultry consumption has ______ cardiometabolic effects.
Minimal
______ appear similarly neutral for CVD risk in general populations
Eggs
Overall evidence suggests minimal cardiometabolic effects of poultry intake or occasional egg intake (e.g.,up to 2 to 3 per week); consistent with recent similar conclusions on dietary cholesterol
In long-term cohorts, _______ associates with lower risk of stroke, _____ with lower risk of CHD, and _____ with lower risk of DM
Milk intake: lower stroke risk
Cheese: lower CHD risk
Yogurt, cheese, butter: lower DM risk
In sum, current evidence supports recommendations for modest dairy intake (____ servings/day), especially of yogurt and cheese, with more research needed to define the relevant active ingredients and health effects of dairy fat.
2 to 3 servings per day
Ecologic data, prospective cohorts, and trials provide convincing evidence that SSB intake increases ________.
Adiposity
Per serving, SSBs more strongly associate with ______ than nearly any other dietary factor.
Long-term weight gain
Calories in liquid form, compared with solid foods, appear to be less satiating and increase total calories consumed.
SSB intake also associates with significantly higher incidence of CVD and especially DM
While coffee and tea provide caffeine, these plant extracts—derived from beans and leaves—contain other bioactive compounds.
Unrelated to caffeine content, frequent coffee intake (e.g., _____ cups/day) associates with less insulin resistance, DM, CVD, and in a few studies, heart failure
3-4 cups per day
Acutely, caffeinated coffee worsens _____.
BP
Insulin resistance
Glucose intolerance
Longer-term, habitual coffee intake does not affect BP, endothelial function, nor glucose metabolism, suggesting _____ and/or other partly offsetting factors.
Tachyphylaxis
Glucose induces _____ and related disturbances, as well as _____ at high levels
- Postprandial hyperglycemia
- Hyperinsulinemia
- Hepatic de novo lipogenesis
_________ has little influence on blood glucose or insulin, but more directly stimulates hepatic de novo lipogenesis, hepatic and visceral adiposity, and uric acid production
Fructose
The dose, rapidity of digestion, accompanying nutrients, and food structure (liquid, solid) may each modify health effects of sugars.
Like coffee, frequent tea drinking (e.g., 3+ cups/day) associates with lower CVD and DM, with borderline statistical significance
In randomized trials, certain types of tea modestly
Lower BP - _____
Lower LDL-cholesterol - ______
Lower fasting glucose - _______
Lower BP (green, black, sour)
Lower LDL-cholesterol (green)
Lower fasting glucose (green, sour)
________ does not consistently associate with lower risk of CVD in cohort studies, and associates with higher risk of DM
MUFA intake
For instance, olive oil, but not mixed animal and plant sources of MUFA, associates with lower CHD; while plant oil sources of MUFA reduce LDL proteoglycan binding, suggesting anti-atherogenic effects.
The predominant PUFA is _______, derived principally from plant oils
n-6 linoleic acid (LA, 18:2n-6)
Flaxseed, canola, walnuts, and soybeans provide ______
alpha-linoleic acid (ALA, 18:3n-3)
Seafood provides _____ and ______
Eicosapentaenoic acid (EPA, 20:5n-3)
Docosahexaenoic acid (DHA, 22:6n-3)
These are essential fatty acids
Linoleic acid
Alpha-Linoleic acid
While harms of n-6 PUFA have been speculated upon, metabolic interventions, cohort studies, and clinical trials demonstrate health benefits.
____ lowers LDL-cholesterol and triglyceride-rich lipoproteins, raises HDL-cholesterol, lowers HbA1c and fasting insulin, and improves insulin secretion capacity.
Linoleic acid
While pro-inflammatory effects have been theorized, such effects are not seen in humans
LA may actually reduce hepatic steatosis and systemic inflammation
LA also associates with lower CHD and DM
The long-chain _____, derived from fish and shellfish, produce multiple physiologic benefits in human trials, improving heart rate, blood pressure, triglyceride-rich lipoproteins, endothelial function, adiponectin, cardiac function, and inflammatory responses
n-3 PUFA EPA and DHA
The trial that showed supplementation with high-dose purified EPA (4 g/day) reduced combined CVD by 25% (HR 0.75; 95% CI 0.68 to 0.83)
REDUCE IT trial
Much higher levels of _____, coming from partially hydrogenated vegetable oils, consistently associate with higher CVD
Industrial TFA
TFA consumption raises LDLcholesterol, ApoB, triglycerides, and lipoprotein(a), and lowers HDL cholesterol and ApoA
Promotes inflammation, endothelial dysfunction, insulin resistance, visceral adiposity, and arrhythmia
Increased dietary _____ in combination with strength-training increases muscle mass more than strength-training alone in generally healthy middle-aged and older adults
Protein
Sodium raises BP in a dose-dependent fashion, with stronger effects among _______
Older individuals, hypertensives, and Blacks
The National Academies of Sciences, Engineering, and Medicine reviewed all the evidence and set the recommended Na intake at <_____ mg/day
Below 2300 mg/day
In short-term trials, ____ supplements also modestly lower BP, although with substantial heterogeneity between studies.
Ca and Mg supplements
However, calcium supplements with or without vitamin D may increase risk of MI in controlled trials
This micronutrient lowers BP, with stronger effects among hypertensive individuals and when dietary sodium intake is high; also associate with lower risk of stroke
Potassium
Potassium also attenuates, while insufficient dietary potassium exacerbates, the BP-raising effects of sodium.
Overall, the evidence supports the importance of potassium-rich food for the reduction of BP and CVD
In trials, potassium lowers ____, with stronger effects among hypentensive individuals and when dietary sodium intake is high; and potassium-rich diets associate with lower risk of stroke
Lowers BP
Potassium also attenuates, while insufficient dietary potassium exacerbates, the BP-raising effects of sodium. Overall, the evidence supports the importance of potassium-rich foods for reducing BP and CVD.
Higher plasma vitamin D levels associate with lower CVD, but are largely driven by _____, not diet.
Sun exposure
Meta-analysis of 21 large supplement trials shows no significant benefits, nor do vitamin D supplements improve blood pressure or glycemic control. Vitamin D supplementation is not indicated to improve cardiometabolic health
Give the recommendations for:
Fish
Vegetables/beans
Whole grains
Nuts
Meat
Dairy
Eggs
Fish - 1 to 2 servings of fish, especially oily fish, per week
Vegetables and beans- 3 - 4 servings per day
Whole grains - 3 servings per day
Nuts - 4 - 5 servings per week
Meat - processed meats should be avoided, and unprocessed meats eaten up to 1 to 2 servings/wk or less
Dairy - modest dairy intake 2 to 3 servings/day
Eggs - 2 to 3 per week
