Ultra-processed food consumption deteriorates the profile of micronutrients consumed by Portuguese adults and elderly: the UPPER project.

PURPOSE: This study aims to describe micronutrient intake according to food processing degree and to investigate the association between the dietary share of ultra-processed foods and micronutrient inadequacies in a representative sample of Portuguese adult and elderly individuals. METHODS: Cross-sectional data from the National Food, Nutrition and Physical Activity Survey (2015/2016) were used. Food consumption data were collected through two 24-h food recalls, and food items were classified according to the NOVA system. Linear regression models were used to assess the association between the micronutrient density and the quintiles of ultra-processed food consumption-crude and adjusted. Negative Binomial regressions were performed to measure the prevalence ratio of micronutrient inadequacy according to ultra-processed food quintiles. RESULTS: For adults, all evaluated vitamins had significantly lower content in the fraction of ultra-processed foods compared to unprocessed or minimally processed foods, except vitamin B2. For the elderly, out of ten evaluated vitamins, seven presented significantly less content in ultra-processed foods compared to non-processed ones. The higher energy contribution of ultra-processed foods in adults was associated with a lower density of vitamins and minerals. This association was not observed in the elderly. For adults, compared with the first quintile of ultra-processed food consumption, the fifth quintile was positively associated with inadequate intakes of vitamin B6 (PR 1.51), vitamin C (PR 1.32), folate (PR 1.14), magnesium (PR 1.21), zinc (PR 1.33), and potassium (PR 1.19). CONCLUSION: Our results corroborate the importance of public health actions that promote a reduction in the consumption of ultra-processed foods.

Adherence to a Mediterranean diet, dyslipidemia and inflammation in familial hypercholesterolemia.

BACKGROUND AND AIMS: Familial Hypercholesterolemia (FH) is characterized by elevated LDL-cholesterol (LDL-C) and high atherosclerosis risk. The impact of different dietary patterns on atherosclerosis biomarkers has been poorly studied in FH. This study verified the association of adherence to a Mediterranean diet with biomarkers of dyslipidemia and low-grade inflammation in molecularly proven FH adults from Brazil (BR) and Spain (SP). METHODS AND RESULTS: In this cross-sectional study adherence to the Mediterranean diet was assessed by a validated score and generalized estimating equations were used to evaluate its association with plasma LDL-C, apolipoprotein-B (ApoB) and high sensitivity C-reactive protein (hs-CRP) concentrations. We included 92 (mean age 45 years, 58.7% females) and 98 FH individuals (mean age 46.8 years, 60.2% females) respectively from BR and SP. FH causing variants did not differ between countries. LDL-C, ApoB and hs-CRP concentrations were higher in BR than in SP: 179 (135-250) and 161 (133-193) mg/dL; 141 (109-181) and 103 (88-134) mg/dL; and 1.6 (0.8-4.0) and 0.8 (0.4-1.5) mg/L respectively (all p < 0.001). Most of BR had low adherence (n = 77, 83.7%), while the majority of SP were divided into moderate (n = 35, 35.7%) and strong adherence to the Mediterranean diet (n = 37, 37.8%), p < 0.001. There was a significant inverse association of adherence to the Mediterranean diet score with higher LDL-C, ApoB, and hs-CRP after adjusting for socio economic parameters, caloric and fatty acid intakes as well as pharmacological lipid lowering therapies. CONCLUSIONS: Higher adherence to a Mediterranean diet was associated with better dyslipidemia and low-grade inflammation profiles in FH.

Dietary Patterns in Portuguese Children and Adolescent Population: The UPPER Project.

Considering the nature, extent, and purpose of food processing, this study aims to identify dietary patterns (DPs) and their associations with sociodemographic factors and diet quality in Portuguese children and adolescents. Cross-sectional data were obtained from the National Food, Nutrition and Physical Activity Survey (2015-2016) of the Portuguese population. Dietary intake was obtained from two non-consecutive days and food items were classified according to the NOVA system. The proportion (in grams) of foods in the total daily diet was considered to identify DPs by latent class analysis, with age and sex as concomitant variables. Associations of DPs with sociodemographic characteristics were assessed using multinomial logistic regression. Linear regressions adjusted by sociodemographic characteristics tested associations of DPs with diet quality. DPs identified were: "Unhealthy" (higher sugar-sweetened beverages, industrial breads, and sausages intake), "Traditional" (higher vegetables, fish, olive oil, breads, ultra-processed yogurts, and sausages intake), and "Dairy" (higher intake of milk, yogurt, and milk-based beverages). "Unhealthy" was associated with older ages and lower intake of dietary fibre and vitamins and the highest free sugars and ultra-processed foods (UPF), although all DPs presented significant consumption of UPF. These findings should be considered for the design of food-based interventions and school-feeding policies in Portugal.

An Ultra-Processed Food Dietary Pattern Is Associated with Lower Diet Quality in Portuguese Adults and the Elderly: The UPPER Project.

This study aimed to identify dietary patterns (DPs) and their associations with sociodemographic factors and diet quality in Portuguese adults and the elderly. Cross-sectional data were obtained from the National Food, Nutrition and Physical Activity Survey (2015-2016), with two non-consecutive dietary 24 h recalls. Food items were classified according to the NOVA system and its proportion (in grams) in the total daily diet was considered to identify DPs by latent class analysis, using age and sex as concomitant variables. Multinomial logistic and linear regressions were performed to test associations of DPs with sociodemographic characteristics and diet quality, respectively. Three DPs were identified: "Traditional" (higher vegetables, fish, olive oil, breads, beer and wine intake), "Unhealthy" (higher pasta, sugar-sweetened beverages, confectionery and sausages intake) and "Diet concerns" (lower intake of cereals, red meat, sugar-sweetened and alcoholic beverages). "Unhealthy" was associated with being younger and lower intake of dietary fiber and vitamins and the highest free sugars and ultra-processed foods (UPF). "Diet concerns" was associated with being female and a more favorable nutrient profile, but both DPs presented a higher contribution of UPF than the "Traditional" DP. These findings should be considered for the design of food-based interventions and public policies for these age groups in Portugal.

Association of Omnivorous and Vegetarian Diets With Antioxidant Defense Mechanisms in Men.

Background Evidence that a vegetarian diet rich in antioxidants contributes to cardiovascular health are growing, however, the underlying molecular mechanisms remain unknown. HO-1 (heme-oxygenase-1), a marker of adaptive response, is protective against oxidative stress and has shown cardioprotective effects. Therefore, we evaluated circulating HO-1 levels and the effect of plasma from omnivorous and vegetarians in endothelial cells (human umbilical vein endothelial cells) on modulating NRF2 (nuclear factor erythroid 2-like 2)/HO-1 and nitric oxide production. Methods and Results From 745 participants initially recruited, 44 omnivorous and 44 vegetarian men matched by age and absence of cardiovascular risk factors and diseases were included in this study. Circulating HO-1 was measured using ELISA and human umbilical vein endothelial cells were incubated with plasma from omnivorous and vegetarians. Higher circulating HO-1 concentrations were found in omnivorous compared with vegetarians. Plasma from omnivorous and not from vegetarians induced NRF2/HO-1 and nitric oxide production in human umbilical vein endothelial cells, and increased reactive oxygen species production and caspase activity after incubation with stressor stimulus. Conclusions We suggest that HO-1 induction in omnivorous may indicate a pro-oxidative status since HO-1 is activated under oxidative stress a state not seen in vegetarians.

Shortening telomere is associated with subclinical atherosclerosis biomarker in omnivorous but not in vegetarian healthy men.

Telomere length is considered to be a biomarker of biological aging and age-related disease. There are few studies that have evaluated the association between telomere length and diet, and none of them have evaluated the impact of a vegetarian diet on telomere length and its correlation with cardiovascular biomarkers in apparently healthy subjects. Therefore, our objectives were to evaluate leukocyte telomere length (LTL) in vegetarians and omnivorous subjects and its association with classical cardiovascular risk biomarkers. From the total of 745 participants initially recruited, 44 omnivorous and 44 vegetarian men apparently healthy were selected for this study and LTL was measured in 39 omnivorous and 41 vegetarians by Real-Time Quantitative PCR reaction. Although telomere length was not different between omnivorous and vegetarians, we found a strong negative correlation between LTL and IMT (intima-media thickness) in omnivorous, but not in vegetarian group. In addition, omnivorous who were classified with short telomere length had higher carotid IMT compared to vegetarians. Our data suggest that telomere length can be a marker of subclinical atherosclerosis in the omnivorous group.

Consumption of animal-based and processed food associated with cardiovascular risk factors and subclinical atherosclerosis biomarkers in men.

OBJECTIVE: To evaluate the frequency of food consumption in apparently healthy men and their association with cardiovascular risk factors and biomarkers of subclinical atherosclerosis. METHODS: In this observational study, 88 men had their food standard obtained through the food frequency questionnaire (FFQ). Associations of dietary patterns with cardiovascular risk factors, such as anthropometric data, laboratory and clinical evaluations, carotid-femoral arterial stiffness (IMT) and pulse wave velocity were evaluated. RESULTS: The highest values were observed, for most of the risk factors evaluated, with the highest frequency of weekly consumption of dairy products, meats, sweets, fats, cold meats, sodas, milk and white chocolate; and lower frequency of weekly consumption of fruits, cereals, vegetables, legumes, oilseeds, and soy. There was no significant difference for coffee and dark chocolate. CONCLUSIONS: A diet with high consumption of animal products has a higher correlation with cardiovascular risk factors; the opposite is true for the consumption of plant-based food, associated with the profile of more favorable biomarkers for cardiovascular health and better biochemical and structural parameters.

Association of dietary components with dyslipidemia and low-grade inflammation biomarkers in adults with heterozygous familial hypercholesterolemia from different countries.

The association of components of a low saturated fat (SFA) and of a Mediterranean diet was tested with atherosclerosis biomarkers in 190 familial hypercholesterolemia adults (FH) from Brazil (BR) and Spain (SP). Median blood LDL-C, Apolipoprotein B (apoB), and C reactive protein (hs-CRP) concentrations were higher in BR than in SP: 179.0 vs.161 mg/dL; 141 vs. 103 mg/dL; and 1.6 vs. 0.8 mg/L respectively (all p < 0.001). In BR there was lower median total fat (22.3 vs. 38.3%) and SFA (8.1 vs. 12.5%) but higher cholesterol (283.3 mg vs.188.9 mg) and carbohydrate (57.1 vs. 42.5%) consumption (all p < 0.001). Inverse associations were encountered between fibers, mono, and polyunsaturated fats and their ratios to SFA with LDL-C and ApoB (all p < 0.001). There was a direct association respectively of cholesterol with lipid biomarkers and of carbohydrates and trans-fatty acids with hs-CRP while other fats showed inverse relations with the latter (p < 0.001).

Prevalence of Metabolic Syndrome and Framingham Risk Score in Apparently Healthy Vegetarian and Omnivorous Men.

BACKGROUND: Recent studies have shown a lower prevalence of metabolic syndrome (MSyn) in vegetarians (VEG) despite the inconclusive evidence from others. OBJECTIVE: To verify the association between diet and other lifestyle characteristics and the prevalence of MSyn, cardiovascular risk factors (CRF), and Framingham Risk Score (FRS) in apparently healthy VEG and omnivorous (OMN) men. METHODS: In this cross-sectional study, 88 apparently healthy men ≥ 35 years, 44 VEG and 44 OMN, were assessed for anthropometric data, blood pressure, blood lipids, glucose, C-reactive protein (CRP) and FRS. To test the association between lifestyle and MSyn, Student t test, chi-square test, and multiple logistic regression model were used. A significance level of 5% was considered in all statistical analyses. RESULTS: Several CRF were significantly lower in VEG than in OMN: body mass index, systolic blood pressure, diastolic blood pressure, fasting serum total cholesterol, LDL-cholesterol, apolipoprotein b, glucose, and glycated hemoglobin (all p < 0.05). The FRS mean was lower in VEG than in OMN (2.98 ± 3.7 vs 4.82 ± 4.8, p = 0.029). The percentage of individuals with MSyn was higher among OMN than among VEG (52.3 vs.15.9%) (p < 0.001). The OMN diet was associated with MSyn (OR: 6.28 95%CI 2.11-18.71) and alterations in most MSyn components in the multiple regression model independently of caloric intake, age and physical activity. CONCLUSION: The VEG diet was associated with lower CRF, FRS and percentage of individuals with MSyn.

Better Adequacy of Food Intake According to Dietary Recommendations of National Cholesterol Education Program in Vegetarian Compared to Omnivorous Men

Abstract Background The lower frequency of cardiovascular (CV) risk factors observed in vegetarians compared to omnivores may be due to more appropriate nutrient intake according to recommendations for the prevention of cardiovascular diseases. Objective To compare the dietary adequacy according to the recommendations of the National Cholesterol Education Program (NCEP) in apparently healthy vegetarian (VEG) and omnivorous (OMN) men. Methods This was a cross-sectional study, conducted with apparently healthy men (44 omnivorous and 44 vegetarians, ≥ 35 years), who were assessed for daily food consumption, anthropometric data, physical exercise status, and clinical data. Multiple logistic regression was used to test the association between the type of diet and the dietary adequacy. Significant values were considered for p<0.05. Results Several clinical CV risk markers were significantly lower in VEG when compared to OMN: body mass index (BMI) (23.1 vs. 27.3 kg/m2), systolic blood pressure (119.5 vs. 129.2 mmHg), and diastolic blood pressure (75.7 vs. 83.9 mmHg). VEG presented significant lower values of blood lipids and glucose. No significant difference was observed in caloric intake; however, VEG consumed significantly more carbohydrates, dietary fibers, and polyunsaturated fats. VEG presented an adequate consumption of dietary cholesterol and saturated and polyunsaturated fatty acids, regardless of caloric intake and age. Conclusion VEG were more likely to consume saturated fatty acids, dietary cholesterol, and fibers according to the recommendations of NCEP, factors that may contribute to lower levels of CV risk markers than OMN.

Reduced subclinical carotid vascular disease and arterial stiffness in vegetarian men: The CARVOS Study.

BACKGROUND: Dietary habits play an important role in the development of atherosclerosis, the most important cause of morbidity and mortality in the world. The objective of this study was to verify if vegetarian (VEG) diet could be related a better profile of subclinical vascular disease evaluated by arterial stiffness and functional and structural properties of carotid arteries, compared to omnivorous (OMN) diet. METHODS: In this cross-sectional study, 44 VEG and 44 OMN apparently healthy men ≥35years of age, in order to not have confounding risk factors of subclinical atherosclerosis, were assessed for anthropometric data, blood pressure, blood lipids, glucose, C reactive protein (CRP), and arterial stiffness determined by carotid-femoral pulse wave velocity (PWV). Also, carotid intima-media thickness (c-IMT) and distensibility were evaluated. RESULTS: VEG men had lower body mass index, systolic and diastolic blood pressures, fasting serum total cholesterol, LDL and non-HDL-cholesterol, apolipoprotein B, glucose and glycated hemoglobin values in comparison with OMN individuals (all p values <0.05). Markers of vascular structure and function were different between VEG and OMN: PWV 7.1±0.8m/s vs. 7.7±0.9m/s (p<0.001); c-IMT 593±94 vs. 661±128µm (p=0.003); and relative carotid distensibility 6.39±1.7 vs. 5.72±1.8% (p=0.042), respectively. After a multivariate linear regression analysis, a VEG diet was independently and negatively associated with PWV (p value 0.005). CONCLUSIONS: A VEG diet is associated with a more favorable cardiovascular diseases biomarker profile and better vascular structural and functional parameters.

Pode a humanidade prevenir as próximas pandemias por meio da nutrição vegetariana? / Can humankind prevent the next pandemics through the vegetarian nutrition?

As pandemias que enfrentamos podem ser um problema aparentemente novo para muitos, mas vários outros desastres de saúde pública já ocorreram em diferentes partes do mundo. A maioria das doenças infecciosas emergentes (60,3%) é causada por patógenos zoonóticos por meio da transmissão cruzada de espécies. No início da cadeia de transmissão zoonótica, a transmissão ocorre entre diferentes espécies animais; na segunda fase, a transmissão ocorre entre animais e humanos, até que a última fase do processo de transmissão ocorra entre humanos, levando a pandemias mundiais.1 Surpreendentemente, levando em consideração esse fato, Benatar et al. reconheceram, em 2007, que não se considerava que mudar a forma como os humanos tratam os animais, seja por não comê-los ou pelo menos por limitar radicalmente seu consumo, poderia ser a melhor forma de prevenir uma pandemia futura desconhecida.2

The pandemics we are facing may be an apparently new problem for many, but several other public health disasters have already occurred in different parts of the world. Most emerging infectious diseases (60.3%) are caused by zoonotic pathogens through the cross-transmission of species. In the beginning of the zoonotic transmission chain, transmission occurs between different animal species; in the second stage, transmission occurs between animals and humans, until the last stage of the transmission process takes place amonghumans, leading to worldwide pandemics.1Surprisingly, taking this factinto account, Benatar et al. recognized, in 2007, that mankinddid not consider that changing the way humans treat animals, either by noteating them or at least by radically limiting their consumption could be the best way to prevent an unknown future pandemics.2

Consumption of animal-based and processed food associated with cardiovascular risk factors and subclinical atherosclerosis biomarkers in men

SUMMARY OBJECTIVE To evaluate the frequency of food consumption in apparently healthy men and their association with cardiovascular risk factors and biomarkers of subclinical atherosclerosis. METHODS In this observational study, 88 men had their food standard obtained through the food frequency questionnaire (FFQ). Associations of dietary patterns with cardiovascular risk factors, such as anthropometric data, laboratory and clinical evaluations, carotid-femoral arterial stiffness (IMT) and pulse wave velocity were evaluated. RESULTS The highest values were observed, for most of the risk factors evaluated, with the highest frequency of weekly consumption of dairy products, meats, sweets, fats, cold meats, sodas, milk and white chocolate; and lower frequency of weekly consumption of fruits, cereals, vegetables, legumes, oilseeds, and soy. There was no significant difference for coffee and dark chocolate CONCLUSIONS A diet with high consumption of animal products has a higher correlation with cardiovascular risk factors; the opposite is true for the consumption of plant-based food, associated with the profile of more favorable biomarkers for cardiovascular health and better biochemical and structural parameters.

RESUMO OBJETIVO Avaliar a frequência do consumo alimentar de indivíduos homens aparentemente saudáveis e a associação desta com fatores de risco cardiovascular e biomarcadores de aterosclerose subclínica. MÉTODOS Neste estudo observacional, 88 homens tiveram o padrão alimentar obtido por meio do questionário de frequência alimentar (QFA). Foram avaliadas as associações dos padrões alimentares com os fatores de risco cardiovascular, como dados antropométricos, avaliações laboratoriais e clínica, rigidez arterial determinada pela carótida-femoral (IMT) e velocidade da onda de pulso (VOP). RESULTADOS O padrão observado para a maioria dos fatores de risco avaliados foi de valores mais altos, segundo maior frequência de consumo semanal de lácteos, carnes, doces, gorduras/frituras, embutidos, refrigerantes, chocolates ao leite e branco; e de menor frequência de consumo semanal de frutas, cereais, legumes, verduras, leguminosas, oleaginosas e soja. Não houve diferença significativa para café e chocolate amargo. CONCLUSÕES Uma dieta com alto consumo de produtos animais apresenta maior correlação com fatores de risco cardiovascular, sendo o oposto para o consumo de alimentos de origem vegetal, associado ao perfil de biomarcadores de saúde cardiovascular mais favorável e melhores parâmetros bioquímicos e estruturais.

Prevalence of Metabolic Syndrome and Framingham Risk Score in Apparently Healthy Vegetarian and Omnivorous Men / Prevalência de Síndrome Metabólica e Escore de Risco de Framingham em Homens Vegetarianos e Onívoros Aparentemente Saudáveis

Abstract Background: Recent studies have shown a lower prevalence of metabolic syndrome (MSyn) in vegetarians (VEG) despite the inconclusive evidence from others. Objective: To verify the association between diet and other lifestyle characteristics and the prevalence of MSyn, cardiovascular risk factors (CRF), and Framingham Risk Score (FRS) in apparently healthy VEG and omnivorous (OMN) men. Methods: In this cross-sectional study, 88 apparently healthy men ≥ 35 years, 44 VEG and 44 OMN, were assessed for anthropometric data, blood pressure, blood lipids, glucose, C-reactive protein (CRP) and FRS. To test the association between lifestyle and MSyn, Student t test, chi-square test, and multiple logistic regression model were used. A significance level of 5% was considered in all statistical analyses. Results: Several CRF were significantly lower in VEG than in OMN: body mass index, systolic blood pressure, diastolic blood pressure, fasting serum total cholesterol, LDL-cholesterol, apolipoprotein b, glucose, and glycated hemoglobin (all p < 0.05). The FRS mean was lower in VEG than in OMN (2.98 ± 3.7 vs 4.82 ± 4.8, p = 0.029). The percentage of individuals with MSyn was higher among OMN than among VEG (52.3 vs.15.9%) (p < 0.001). The OMN diet was associated with MSyn (OR: 6.28 95%CI 2.11-18.71) and alterations in most MSyn components in the multiple regression model independently of caloric intake, age and physical activity. Conclusion: The VEG diet was associated with lower CRF, FRS and percentage of individuals with MSyn.

Resumo Fundamento: Estudos recentes mostraram menor prevalência de Síndrome Metabólica (SM) em vegetarianos (VEG), apesar de evidências inconclusivas de outros. Objetivo: Verificar associação entre dieta e características do estilo de vida e a prevalência de SM, fatores de risco cardiovascular (FRCV) e Escore de Framingham (EF) em homens VEG e onívoros (ONI) aparentemente saudáveis. Métodos: Neste estudo transversal, 88 homens aparentemente saudáveis ≥ 35 anos, VEG (n = 44) e ONI (n = 44), foram avaliados quanto a dados antropométricos, pressão arterial, lípides plasmáticos, glicemia, proteína C reativa e EF. Para testar associação entre estilo de vida e SM, o teste t de Student, o teste qui-quadrado e a regressão logística múltipla foram utilizados. Foi considerado nível de significância de 5% em todas as análises estatísticas. Resultados: Os níveis dos FRCV avaliados foram menores nos VEG do que nos ONI: índice de massa corporal, pressão arterial sistólica e diastólica, colesterol total, LDL-colesterol, apolipoproteína b, glicemia e hemoglobina glicada (p < 0,05). O EF foi menor nos VEG do que nos ONI (2,98 ± 3,7 vs. 4,82 ± 4,8; p = 0,029). A porcentagem de indivíduos com SM foi maior entre ONI do que entre VEG (52,3 vs.15,9%) (p < 0,001). A dieta ONI foi associada com a SM (OR: 6,28 IC95% 2,11-18,71) e alterações na maioria dos componentes da SM no modelo de regressão logística múltipla, independentemente de ingestão calórica, idade e atividade física. Conclusão: A dieta VEG foi associada com menores taxas de FRC e menores EF e porcentagem de indivíduos com SM.