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PURPOSE OF REVIEW: Globalization and the increase in consumption of ultra-processed foods have led to a need for greater knowledge on the health impacts of certain nutrients such as artificial sweeteners. This review aims to analyse the role of artificial sweeteners (nutritive and nonnutritive) and their impact on cardiometabolic and cardiovascular disease (CVD) risk. RECENT FINDINGS: The detrimental effects of a high-calorie, high-sugar diet have been well established. In light of this, health authorities recommend limiting sugar consumption. This has led the food industry to develop different artificial sweeteners with specific properties, such as flavour and stability (nutritive artificial sweeteners: NAS), and others aimed at limiting sugar in the diet (nonnutritive artificial sweeteners: nNAS). Likewise, recent evidence explores the influence of artificial sweeteners (NAS and nNAS) on CVD risk through risk factors such as obesity and type 2 diabetes mellitus, among others. SUMMARY: This review aims to provide an updated overview of the impact of NAS and nNAS on cardiovascular health and provide recommendations regarding their consumption.
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Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Humanos , Edulcorantes/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/etiologia , Fatores de Risco , Fatores de Risco de Doenças Cardíacas , AçúcaresRESUMO
PURPOSE OF REVIEW: The basis for the prevention and treatment of cardiovascular disease (CVD) inevitably involves lifestyle modification, including dietary pattern (DP). The aim of this review is to address the different models of healthy DP with their peculiarities and nutritional components as well as their importance in the management of CVD. RECENT FINDINGS: Classical cardiovascular risk factors such as hypertension, dyslipidaemia and diabetes are strongly influenced by diet and physical activity. However, current evidence supports the role of emerging risk factors such as inflammatory status, oxidative stress and endothelial function in the development of CVD. Likewise, recent evidence explores how healthy DP can modulate CVD risk through these risk factors. SUMMARY: Although the Mediterranean diet (MedDiet) is the paradigm of the healthy DP in the light of current scientific evidence, there are other DP that we should be aware of due to their results in epidemiological studies, randomized clinical trials (RCTs) and meta-analyses on CVD risk modulation. The best-analysed DP are the MedDiet, Dietary Approaches to Stop Hypertension (DASH), the Nordic DP, the Vegetarian DP, the Portfolio DP, the Low-carbohydrate DP and the Planetary Health diet initiative.
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Doenças Cardiovasculares , Dieta Mediterrânea , Abordagens Dietéticas para Conter a Hipertensão , Hipertensão , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Dieta , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Fatores de RiscoRESUMO
Cardiovascular disease (CVD) remains the first cause of mortality in Western countries. Among cardiometabolic risk factors, dyslipidemia, and especially high low-density lipoprotein cholesterol (LDL-C) concentrations, have been extensively linked to the development and progression of atherosclerosis and to CVD events. Recent evidence has shown that the prevention of unhealthy dietary habits and sedentarism is crucial in the management of dyslipidemia. In this sense, a number of scientific societies recommend the adherence to certain healthy dietary patterns (DPs), such as the Mediterranean diet (MedDiet), the Dietary Approaches to Stop Hypertension (DASH), the Portfolio diet, the Vegetarian diet, the Nordic diet and low-carbohydrate diets, as well as increased physical activity between others. This nutritional and lifestyle advice could be adopted by government bodies and implemented in different health programs as a reliable way of providing health-care professionals with efficient tools to manage cardiometabolic risk factors and thus, prevent CVD. In this narrative review, we will discuss recent data about the effects of nutrition on dyslipidemia, mainly focusing on high LDL-C concentrations and other lipid particles related to atherogenic dyslipidemia such as triglycerides (TG) and non-high density lipoprotein cholesterol (non-HDL-C), that are related to CVD. On the other hand, we also comment on other cardiometabolic risk factors such as type 2 diabetes mellitus (T2DM), high blood pressure (HBP), inflammation and endothelial dysfunction. This review includes food groups as well as different healthy DPs.
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Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Dieta , Lipoproteínas/metabolismo , Doenças Cardiovasculares/prevenção & controle , Dieta Vegetariana , Humanos , Fatores de RiscoRESUMO
BACKGROUND: We try to explore whether long-term consumption of two healthy dietary patterns (low-fat [LF] diet or Mediterranean diet [MedDiet]) interacts with the apolipoprotein E (APOE) single-nucleotide polymorphisms (SNPs: rs439401, rs440446 and rs7412) modulating postprandial hypertriglyceridemia (ppHTG) in coronary heart disease (CHD) patients. METHODS AND RESULTS: We selected patients from the CORDIOPREV study with genotyping and who underwent an oral fat load test (FLT) at baseline and after 3 years follow-up (n = 506). After 3 years of follow-up, we found a gene-diet interaction between the APOE rs439401 SNP and MedDiet. Specifically, T-allele carriers in the MedDiet group showed a more significant decrease in postprandial triglycerides (TG: P = 0.03) and large triacylglycerol-rich lipoproteins (TRLs) TG (large TRLs TG; P = 0.01) compared with CC subjects. Consistently, the area under the curve of TG (AUC-TG; P-interaction = 0.03) and AUC-large TRLs TG (P-interaction = 0.02) were significantly lower in T-allele carriers compared with CC subjects. CONCLUSIONS: The long-term consumption of a MedDiet modulates ppHTG through APOE genetic variants in CHD patients. This gene-diet interaction may contribute to a more precise dietary advice in CHD patients.
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Apolipoproteínas E/genética , Doença das Coronárias/complicações , Dieta Mediterrânea , Hipertrigliceridemia/genética , Hipertrigliceridemia/prevenção & controle , Alelos , Glicemia , Doença das Coronárias/genética , Dieta com Restrição de Gorduras , Feminino , Seguimentos , Humanos , Hipertrigliceridemia/sangue , Hipertrigliceridemia/etiologia , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Período Pós-Prandial , TriglicerídeosRESUMO
Coronary heart disease (CHD) represents a major global health burden. However, despite the well-known influence that dietary habits exert over the progression of this disease, there are no well-established and scientifically sound dietary approaches to prevent the onset of clinical outcomes in secondary prevention. The objective of the CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (CORDIOPREV study, clinical trials number NCT00924937) is to compare the ability of a Mediterranean diet rich in virgin olive oil versus a low-fat diet to influence the composite incidence of cardiovascular events after 7 years in subjects with documented CHD at baseline. For this purpose, we enrolled 1,002 coronary patients from Spain. Baseline assessment (2009-2012) included detailed interviews and measurements to assess dietary, social, and biological variables. Results of baseline characteristics: The CORDIOPREV study in Spain describes a population with a high body mass index (37.2% overweight and 56.3% obesity) and with a median of low-density lipoprotein cholesterol of 88.5 mg/dL (70.6% of the patients having <100 mg/dL and 20.3% patients <70 mg/dL). A total of 9.6% of the participants were active smokers, and 64.4% were former smokers. Metabolic syndrome was present in 58% of this population. To sum up, we describe here the rationale, methods, and baseline characteristics of the CORDIOPREV study, which will test for the first time the efficacy of a Mediterranean diet rich in extra virgin olive oil as compared with a low-fat diet on the incidence of CHD recurrence in a long-term follow-up study.
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Doenças Cardiovasculares/mortalidade , Doença das Coronárias/dietoterapia , Dieta com Restrição de Gorduras , Dieta Mediterrânea , LDL-Colesterol/sangue , Comorbidade , Doença das Coronárias/sangue , Doença das Coronárias/epidemiologia , Feminino , Humanos , Incidência , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Revascularização Miocárdica , Obesidade/sangue , Obesidade/epidemiologia , Azeite de Oliva , Sobrepeso/sangue , Sobrepeso/epidemiologia , Doença Arterial Periférica/epidemiologia , Prevenção Secundária , Método Simples-Cego , Acidente Vascular Cerebral/epidemiologia , Resultado do TratamentoRESUMO
BACKGROUND: We examined the degree of postprandial triglyceride (TG) response over the day, representing a highly dynamic state, with continuous metabolic adaptations, among normal-weight, overweight and obese patients, according to their metabolically healthy or abnormal status. MATERIALS AND METHODS: A total of 1002 patients from the CORDIOPREV clinical trial (NCT00924937) were submitted to an oral fat load test meal with 0·7 g fat/kg body weight (12% saturated fatty acids (SFA), 10% polyunsaturated fatty acids (PUFA), 43% monounsaturated fatty acids (MUFA), 10% protein and 25% carbohydrates). Serial blood test analysing lipid fractions and inflammation markers (high-sensitivity C-reactive protein (hs-CRP)) were drawn at 0, 1, 2, 3 and 4 h during postprandial state. We explored the dynamic response according to six body size phenotypes: (i) normal weight, metabolically healthy; (ii) normal weight, metabolically abnormal; (iii) overweight, metabolically healthy; (iv) overweight, metabolically abnormal; (v) obese, metabolically healthy; and (vi) obese, metabolically abnormal. RESULTS: Metabolically healthy patients displayed lower postprandial response of plasma TG and large triacylglycerol-rich lipoproteins (TRLs)-TG, compared with those metabolically abnormal, independently whether or not they were obese (P < 0·001 and P < 0·001, respectively). Moreover, the area under the curve (AUC) of TG and AUC of large TRLs-TG were greater in the group of metabolically abnormal compared with the group of metabolically healthy (P < 0·001 and P < 0·001, respectively). Interestingly, metabolically abnormal subjects displayed higher postprandial response of plasma hs-CRP than did the subgroup of normal, overweight and obese, metabolically healthy patients (P < 0·001). CONCLUSIONS: Our findings showed that certain types of the metabolic phenotypes of obesity are more favourable modulating phenotypic flexibility after a dynamic fat load test, through TG metabolism and inflammation homoeostasis. To identify, these phenotypes may be the best strategy for personalized treatment of obesity.
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Obesidade/metabolismo , Triglicerídeos/metabolismo , Adaptação Fisiológica/fisiologia , Adulto , Idoso , Glicemia/metabolismo , Pressão Sanguínea/fisiologia , Tamanho Corporal/fisiologia , Proteína C-Reativa/metabolismo , Ritmo Circadiano/fisiologia , Doença das Coronárias/dietoterapia , Doença das Coronárias/metabolismo , Dieta com Restrição de Gorduras , Dieta Mediterrânea , Gorduras na Dieta/administração & dosagem , Feminino , Homeostase/fisiologia , Humanos , Hiperlipidemias/metabolismo , Inflamação/metabolismo , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Sobrepeso/metabolismo , Sobrepeso/fisiopatologia , Fenótipo , Período Pós-Prandial/fisiologia , Estudos ProspectivosRESUMO
Cardiovascular disease (CVD) still being the most common cause of death in worldwide. In spite of development of new lipid-lowering therapies which optimize low-density lipoprotein cholesterol (LDL-c) levels, recurrence of CVD events implies addressing factors related with residual cardiovascular (CV) risk. The key determinants of residual CV risk include triglyceride-rich lipoproteins (TRLs) and remnant cholesterol (RC), lipoprotein(a) [Lp(a)] and inflammation including its biochemical markers such as high sensitivity C reactive protein (hs-CRP). On the other hand, unhealthy lifestyle habits, environmental pollution, residual thrombotic risk and the residual metabolic risk determined by obesity and type 2 diabetes (T2D) have a specific weight in the residual CV risk. New pharmacologic therapies and pathways are being explored such as inhibition of apolipoprotein C-III (apoC-III) and angiopoietin-related protein 3 (ANGPTL3) in order to explore if a reduction in TRLs and RC reduce CVD events. Therapeutic target of inflammation plays an attractive way to reduce the atherosclerotic process and to date, approved therapies as colchicine plays a beneficial effect in chronic inflammation and residual CV risk. Lp(a) constitutes one of the most residual CV risk factor due to linkage with CVD and aortic valve stenosis. New and hopeful treatments including antisense oligonucleotides (ASO) and small-interfering ribonucleic acid (siRNA) which interfere in LP(a) codification have been developed to achieve an adequate control in Lp(a) levels. This review points out the paradigms of residual CV risk, discus how we should manage their features and summarize the different therapies targeting each residual CV risk factor.
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Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Humanos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/tratamento farmacológico , Fatores de Risco , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Triglicerídeos/metabolismo , Triglicerídeos/uso terapêutico , LDL-Colesterol , Lipoproteína(a) , Inflamação/complicações , Fatores de Risco de Doenças Cardíacas , Proteína 3 Semelhante a AngiopoietinaRESUMO
This study assesses the association between sleep duration and plasma lipid profiles in people with diabetes mellitus (DM). Sleep duration data were obtained in 91 patients from the POWER2DM study (NCT03588104). The patients were divided in tertiles, based on their sleep duration, and blood samples were obtained at the beginning and after 9 months. Significant differences were found, specifically, patients in Tertile 3 (≥ 7.51 h) showed lower plasma levels of high-density lipoprotein cholesterol HDL-c (p < 0.05), apolipoprotein A1 (apo-A1; p < 0.05) and low HDL-c/apo-A1 ratio (p < 0.05). This study shows that sleep duration is associated with plasma lipid profiles in people with DM.
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We investigated whether long-term consumption of two healthy diets (low-fat (LF) or Mediterranean (Med)) interacts with SIRT1 genotypes to modulate aging-related processes such as leucocyte telomere length (LTL), oxidative stress (OxS) and inflammation in patients with coronary heart disease (CHD). LTL, inflammation, OxS markers (at baseline and after 4 years of follow-up) and SIRT1-Single Nucleotide Polymorphisms (SNPs) (rs7069102 and rs1885472) were determined in patients from the CORDIOPREV study. We analyzed the genotype-marker interactions and the effect of diet on these interactions. Regardless of the diet, we observed LTL maintenance in GG-carriers for the rs7069102, in contrast to carriers of the minor C allele, where it decreased after follow-up (p = 0.001). The GG-carriers showed an increase in reduced/oxidized glutathione (GSH/GSSG) ratio (p = 0.003), lower lipid peroxidation products (LPO) levels (p < 0.001) and a greater decrease in tumor necrosis factor-alpha (TNF-α) levels (p < 0.001) after follow-up. After the LF diet intervention, the GG-carriers showed stabilization in LTL which was significant compared to the C allele subjects (p = 0.037), although the protective effects found for inflammation and OxS markers remained significant after follow-up with the two diets. Patients who are homozygous for the SIRT1-SNP rs7069102 (the most common genotype) may benefit from healthy diets, as suggested by improvements in OxS and inflammation in patients with CHD, which may indicate the slowing-down of the aging process and its related diseases.
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Doença das Coronárias , Dieta Mediterrânea , Envelhecimento/genética , Doença das Coronárias/genética , Genótipo , Dissulfeto de Glutationa , Humanos , Inflamação/genética , Polimorfismo de Nucleotídeo Único , Sirtuína 1/genética , Fator de Necrose Tumoral alfa/genéticaRESUMO
OBJECTIVES: We evaluated the association of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) rectal colonisation with crude mortality and whether this association is independent of the risk of KPC-Kp infection. METHODS: This was a prospective cohort study of patients followed-up 90 days after a study of rectal colonisation. Cox regression was used to study the variables associated with crude mortality. Sensitivity analyses for 90-day crude mortality in different subcohorts were performed. RESULTS: A total of 1244 patients (1078 non-colonised and 166 colonised) were included. None of the non-colonised patients and 78 (47.0%) of the colonised patients developed KPC-Kp infection. The 90-day crude mortality was 18.0% (194/1078) in non-colonised patients and 41.6% (69/166) in colonised patients. Rectal colonisation was not associated with crude mortality [hazard ratio (HR) = 1.03, 95% confidence interval (CI) 0.69-1.54; P = 0.85] when the model was adjusted for severe KPC-Kp infection [INCREMENT-CPE score (ICS) > 7]. KPC-Kp infection with ICS > 7 was associated with an increased risk of all-cause mortality (HR = 2.21, 95% CI 1.35-3.63; P = 0.002). In the sensitivity analyses, KPC-Kp colonisation was not associated with mortality in any of the analysed subcohorts, including patients who did not develop KPC-Kp infection (HR = 0.93, 95% CI 0.60-1.43; P = 0.74). CONCLUSION: KPC-Kp rectal colonisation was not associated with crude mortality. Mortality increased when colonised patients developed severe KPC-Kp infection (ICS > 7). Rectal colonisation was a necessary although insufficient condition to die from a KPC-Kp infection.
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Infecções por Klebsiella , Klebsiella pneumoniae , Proteínas de Bactérias , Humanos , Klebsiella , Estudos Prospectivos , Estudos Retrospectivos , beta-LactamasesRESUMO
MicroRNAs (miRNAs) regulate the expression of genes associated with the development of diseases, including type 2 diabetes mellitus (T2DM). However, the use of miRNAs to predict T2DM remission has been poorly studied. Therefore, we aimed to investigate whether circulating miRNAs could be used to predict the probability of T2DM remission in patients with coronary heart disease. We included the newly diagnosed T2DM (n = 190) of the 1,002 patients from the CORDIOPREV study. Seventy-three patients reverted from T2DM after 5 years of dietary intervention with a low-fat or Mediterranean diet. Plasma levels of 56 miRNAs were measured by OpenArray. Generalized linear model, receiver operating characteristic (ROC), Cox regression, and pathway analyses were performed. ROC analysis based on clinical variables showed an area under the curve (AUC) of 0.66. After a linear regression analysis, seven miRNAs were identified as the most important variables in the group's differentiation. The addition of these miRNAs to clinical variables showed an AUC of 0.79. Cox regression analysis using a T2DM remission score including miRNAs showed that high-score patients have a higher probability of T2DM remission (hazard ratio [HR]low versus high, 4.44). Finally, 26 genes involved in 10 pathways were related to the miRNAs. We have identified miRNAs (hsa-let-7b, hsa-miR-101, hsa-miR-130b-3p, hsa-miR-27a, hsa-miR-30a-5p, hsa-miR-375, and hsa-miR-486) that contribute to the prediction of T2DM remission in patients with coronary heart disease.
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In order to assess whether previous hepatic IR (Hepatic-IRfasting) and beta-cell functionality could modulate type 2 diabetes remission and the need for starting glucose-lowering treatment, newly-diagnosed type 2 diabetes participants who had never received glucose-lowering treatment (190 out of 1002) from the CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (a prospective, randomized and controlled clinical trial), were randomized to consume a Mediterranean or a low-fat diet. Type 2 diabetes remission was defined according to the American Diabetes Association recommendation for levels of HbA1c, fasting plasma glucose and 2h plasma glucose after oral glucose tolerance test, and having maintained them for at least 2 consecutive years. Patients were classified according to the median of Hepatic-IRfasting and beta-cell functionality, measured as the disposition index (DI) at baseline. Cox proportional hazards regression determined the potential for Hepatic-IRfasting and DI indexes as predictors of diabetes remission and the probability of starting pharmacological treatment after a 5-year follow-up. Low-Hepatic-IRfasting or high-DI patients had a higher probability of diabetes remission than high-Hepatic-IRfasting or low-DI subjects (HR:1.79; 95% CI 1.06-3.05; and HR:2.66; 95% CI 1.60-4.43, respectively) after a dietary intervention with no pharmacological treatment and no weight loss. The combination of low-Hepatic-IRfasting and high-DI presented the highest probability of remission (HR:4.63; 95% CI 2.00-10.70). Among patients maintaining diabetes, those with high- Hepatic-IRfasting and low-DI showed the highest risk of starting glucose-lowering therapy (HR:3.24;95% CI 1.50-7.02). Newly-diagnosed type 2 diabetes patients with better beta-cell functionality and lower Hepatic-IRfasting had a higher probability of type 2 diabetes remission in a dietary intervention without pharmacological treatment or weight loss, whereas among patients not achieving remission, those with worse beta-cell functionality and higher Hepatic-IRfasting index had the highest risk of starting glucose-lowering treatment after 5 years of follow-up.
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Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Resistência à Insulina , Células Secretoras de Insulina/fisiologia , Alanina Transaminase/sangue , Diabetes Mellitus Tipo 2/etiologia , Dieta Mediterrânea , Ácidos Graxos/sangue , Feminino , Teste de Tolerância a Glucose , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemiantes/uso terapêutico , Células Secretoras de Insulina/patologia , Fígado/fisiologia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND AIM: The incidence of type 2 diabetes mellitus (T2DM) has increased worldwide. One of the first actions to reduce the risk of this disease is to implement healthy dietary models; however, no universal dietary strategies have so far been established. In addition, MicroRNAs (miRNAs) are emerging as new biomarkers to predict disease. We aimed to study whether miRNAs could be used to select the nutritional therapy to prevent T2DM development in patients with cardiovascular disease. METHODS: All patients from the CORDIOPREV study without T2DM at baseline according to the American Diabetes Association (ADA) diagnostic criteria (n = 462) were included in the present study. Of them, after a median dietary intervention period of 60 months with two diets (Low fat or Mediterranean diets), 107 developed T2DM and 355 subjects did not develop the disease. The plasma levels of 24 miRNAs were measured at baseline by qRT-PCR. The risk of T2DM was evaluated by Cox regression analysis based on the plasma levels of the miRNAs at baseline and according to the dietary intervention. Finally, pathways analyses were carried out to identify target genes regulated by the miRNAs studied and cellular processes which could be associated with T2DM development. RESULTS: Cox regression analyses showed that patients with low plasma levels of miR-145 at baseline showed a higher risk of developing T2DM after consumption of an LFHCC diet. In addition, patients with low levels of miR-29a, miR-28-3p and miR-126 and high plasma levels of miR-150 at baseline showed a higher risk of developing T2DM after consumption of the Med diet. Finally, pathways analysis showed an interaction of miR-126 and miR-29a in the modulation of FoxO, TNF-α, PI3K-AKT, p53 and mTOR signaling, associated with T2DM development. CONCLUSION: Our results suggest that circulating miRNAs could be used in clinical practice as a new tool for selecting the most suitable diet to prevent type 2 diabetes mellitus development in patients with cardiovascular disease. CLINICAL TRIALS NUMBER: NCT00924937.
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Doenças Cardiovasculares/dietoterapia , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta com Restrição de Gorduras , Dieta Mediterrânea , MicroRNAs/sangue , Adulto , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Diabetes Mellitus Tipo 2/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Método Simples-Cego , Adulto JovemRESUMO
BACKGROUND: Fibroblast growth factor 23 (FGF23) is a major determinant of mineral metabolism derangements and emerges as a possible risk factor underlying the negative cardiovascular outcome in CKD patients. However, its contribution in non-CKD individuals is less clear. This cross-sectional study investigated the associations between FGF23 and mineral metabolism parameters and with carotid atherosclerosis in a population at high cardiovascular risk with preserved renal function. METHODS: We employed 939 subjects with coronary heart disease enrolled in the CORDIOPREV study (mean eGFR=93.0⯱â¯0.7â¯ml/min/1.73 m2 and median FGF23=44.9 (IQR=13.1) pg/ml), in which intima-media thickness of both common carotid arteries (IMT-CC) was measured. RESULTS: Adjusted for anthropometric factors, FGF23 associated positively with creatinine, phosphate, calcium and 25(OH)-vitaminD and negatively with eGFR and calcitriol. In multivariable-adjusted models all of them were independent contributors to FGF23 levels. FGF23 showed a positive relationship with IMT-CC; both the higher third and fourth quartiles associated significantly with IMT-CC (Beta= 0.135 and 0.187, respectively) and after additional adjustment for established cardiovascular risk factors and morbidities FGF23 remained as a significant contributor to IMT-CC. Logistic regression analysis confirmed its predictive ability to differentiate patients at higher atherosclerotic risk defined by an IMT-CC≥0.7â¯mm (OR for FGF23 quartiles 3 and 4â¯vs. 1: 1.860; 95%CI 1.209-2.862 and 2.114; 95%CI 1.339-3.337, respectively). CONCLUSION: Even in the setting of a normally functioning phosphate-FGF23-calcitriol system, FGF23 independently associated with IMT-CC, a surrogate of atherosclerotic vascular dysfunction. This supports the notion of FGF23 as a predictor of cardiovascular risk independent of renal failure.
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Doenças das Artérias Carótidas , Nefropatias , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Espessura Intima-Media Carotídea , Estudos Transversais , Fator de Crescimento de Fibroblastos 23 , Fatores de Crescimento de Fibroblastos , Humanos , Fatores de RiscoRESUMO
AIM: Our objective was to investigate the role of two healthy diets in modulating the risk of type 2 diabetes (T2DM) development associated with each prediabetes diagnosis criteria in coronary heart disease patients. Additionally, we explored the pathophysiological characteristics and the risk of developing T2DM in patients with different prediabetes criteria. METHODS: We included 462 patients from the CORDIOPREV study without T2DM at baseline: 213 had prediabetes defined by impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) (PreDM-IFG/IGT); 180 had prediabetes by isolated hemoglobin glycated plasma levels (PreDM-isolated-HbA1c), and 69 were not prediabetics (non-PreDM), according to the American Diabetes Association criteria. Patients were randomized to consume either a Mediterranean or a low-fat diet. We performed a COX proportional hazards regression analysis to determine the T2DM risk according to diet and the prediabetes criteria after a median follow-up of 60 months. RESULTS: We found higher T2DM risk (HR: 2.98; 95% CI 1.27-6.98) in PreDM-IFG/IGT than in PreDM-isolated-HbA1c (HR: 2.31; 95% CI 0.97-5.49) compared with non-PreDM. Long-term consumption of a low-fat diet was associated with a lower risk of T2DM when compared to the Mediterranean diet in the PreDM-IFG/IGT group (HR: 3.20; 95% CI 0.75-13.69 versus HR: 4.70; 95% CI 1.12-19.67, respectively). Moreover, we found the highest risk of T2DM development associated with patients who had both IFG and IGT (HR: 2.15; 95% CI 1.11-4.16). Patients who had both IFG and IGT and consumed a low-fat diet had a lower T2DM risk than those who consumed a Mediterranean diet (HR: 1.53; 95% CI 0.53-4.39 versus HR: 3.33; 95% CI 1.34-8.30, respectively). CONCLUSION: Our results suggest that the type of diet consumed may modulate the risk of T2DM development according to the prediabetes diagnosis criteria. Specifically, our study showed that the consumption of a low-fat diet was more beneficial than a Mediterranean diet in patients with IFG and IGT. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.govNCT00924937.
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Diabetes Mellitus Tipo 2/prevenção & controle , Dieta com Restrição de Gorduras/estatística & dados numéricos , Dieta Mediterrânea/estatística & dados numéricos , Estado Pré-Diabético/dietoterapia , Estado Pré-Diabético/diagnóstico , Diabetes Mellitus Tipo 2/sangue , Dieta com Restrição de Gorduras/métodos , Feminino , Seguimentos , Intolerância à Glucose/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estudos Prospectivos , Medição de RiscoRESUMO
SCOPE: The differences between the baseline gut microbiota of patients who developed type 2 diabetes (T2D) consuming a low-fat (LF) or a Mediterranean (Med) diet are explored and risk scores are developed to predict the individual risk of developing T2D associated with the consumption of LF or Med diet. METHODS AND RESULTS: All the patients from the CORDIOPREV study without T2D at baseline (n = 462) whose fecal sample are available, are included. Gut microbiota is analyzed by 16S sequencing and the risk of T2D after a median follow-up of 60 months assessed by Cox analysis. Linear discriminant analysis effect size (LEfSe) analysis shows a different baseline gut microbiota in patients who developed T2D consuming LF and Med diets. A higher abundance of Paraprevotella, and lower Gammaproteobacteria and B. uniformis are associated with T2D risk when an LF diet is consumed. In contrast, higher abundances of Saccharibacteria, Betaproteobacteria, and Prevotella are associated with T2D risk when a Med diet is consumed. CONCLUSION: The results suggest that different interactions between the microbiome and dietary patterns may partially determine the risk of T2D development, which may be used for selecting personalized dietary models to prevent T2D.
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The beneficial effects of a Mediterranean diet on human health and, in particular, on lowering risk of cardiovascular disease, has been mainly attributed to its high content to extra virgin olive oil (EVOO). While its main fatty acid, oleic acid, is considered important to these effects, EVOO has other biological properties that depend on, or are potentiated by other minor components of this oil. Initially, the mechanisms considered as possible causes of this cardioprotective effect of EVOO were based on the incidence on the so-called traditional risk factors (especially lipids and blood pressure). However, the high relative reduction in the prevalence of cardiovascular morbidity and mortality were not proportional to the limited findings about regulation of those traditional risk factors. In addition to several studies confirming the above effects, current research on beneficial effect of EVOO, and in particular in conjunction with Mediterranean style diets, is being focused on defining its effects on newer cardiovascular risk factors, such as inflammation, oxidative stress, coagulation, platelet aggregation, fibrinolysis, endothelial function or lipids or on the modulation of the conditions which predispose people to cardiovascular events, such as obesity, metabolic syndrome or type 2 diabetes mellitus. In the current review, we will mainly focus on reviewing the current evidence about the effects that EVOO exerts on alternative factors, including postprandial lipemia or coagulation, among others, discussing the underlying mechanism by which it exerts its effect, as well as providing a short review on future directions.
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Doenças Cardiovasculares/dietoterapia , Dieta Mediterrânea , Azeite de Oliva/administração & dosagem , Humanos , Azeite de Oliva/farmacologiaRESUMO
This study aimed to ascertain whether there is an independent association between serum magnesium (Mg) and the Carotid Intima-Media Thickness (IMT-CC), a well-accepted atherosclerotic-biomarker surrogate of cardiovascular disease (CVD), in a population with high cardiovascular risk. Serum Mg and traditional atherosclerotic risk factors were recorded in 939 patients (mean age, 59.6 ± 0.3 years, 83.2% men) with coronary heart disease (CHD) enrolled in the CORDIOPREV trial. Serum Mg strongly associated with IMT-CC. Before adjusting for potential confounding factors, IMT-CC decreased by 0.111 ± 0.011 mm per mg/dl increase in serum Mg (p < 0.001). After adjustment, the effect of Mg did not appear mediated through factors related to glucose metabolism, the lipid profile or the mineral metabolism and renal function. Multivariate models showed the lower Mg levels (quartile 1) as a strong independent factor contributing to IMT-CC along with age, sex, SBP, HDL-C, and diuretic use. Logistic regression analysis confirmed the predictive ability of serum Mg to differentiate patients at higher atherosclerotic risk as defined by an IMT-CC ≥ 1.0 mm, yielding a OR for the lower quartile of 10.623 (95%CI 2.311-48.845; P = 0.002) and a ROC-derived cutoff of 1.61 mg/dl. Therefore, our findings outline low serum magnesium as a possible independent risk factor for carotid atherosclerosis.
Assuntos
Doenças das Artérias Carótidas/sangue , Doença das Coronárias/sangue , Magnésio/sangue , Placa Aterosclerótica/sangue , Idoso , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/patologia , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/patologia , Espessura Intima-Media Carotídea , Doença das Coronárias/patologia , Feminino , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/patologia , Fatores de RiscoRESUMO
Advanced glycation end products (AGEs) and oxidative stress are elevated with aging and dysmetabolic conditions. Because a Mediterranean (Med) diet reduces oxidative stress, serum AGEs levels, and gene expression related to AGEs metabolism in healthy elderly people, we studied whether supplementation with coenzyme Q10 (CoQ) was of further benefit. Twenty participants aged ≥ 65 (10 men and 10 women) were randomly assigned to each of three isocaloric diets for successive periods of 4 weeks in a crossover design: Med diet, Med + CoQ, and a Western high-saturated-fat diet (SFA diet). After a 12-hour fast, volunteers consumed a breakfast with a fat composition similar to the previous diet period. Analyses included dietary AGEs consumed, serum AGEs and AGE receptor-1 (AGER1), receptor for AGEs (RAGE), glyoxalase I (GloxI), and estrogen receptor α (ERα) mRNA levels. Med diet modulated redox-state parameters, reducing AGEs levels and increasing AGER1 and GloxI mRNA levels compared with the SFA diet. This benefit was accentuated by adding CoQ, in particular, in the postprandial state. Because elevated oxidative stress/inflammation and AGEs are associated with clinical disease in aging, the enhanced protection of a Med diet supplemented with CoQ should be assessed in a larger clinical trial in which clinical conditions in aging are measured.
Assuntos
Dieta Mediterrânea , Produtos Finais de Glicação Avançada/metabolismo , Período Pós-Prandial , Ubiquinona/análogos & derivados , Idoso , Estudos Cross-Over , Dieta Hiperlipídica , Suplementos Nutricionais , Feminino , Humanos , Lactoilglutationa Liase/metabolismo , Masculino , Estresse Oxidativo , RNA Mensageiro/metabolismo , Espanha , Ubiquinona/farmacologiaRESUMO
INTRODUCTION AND OBJECTIVES: Microcirculation disturbances have been associated to most of the cardiovascular risk factors as well as to multiple inflammatory diseases. However, whether these abnormalities are specifically augmented in patients with coronary heart disease is still unknown. We aimed to evaluate if there is a relationship between the presence of coronary heart disease and the existence of functional and structural capillary abnormalities evaluated in the cutaneous microcirculation by videocapillaroscopy. MATERIAL AND METHODS: Two matched samples of 30 participants with and without coronary heart disease but with similar clinical and anthropometric characteristics were evaluated by videocapillaroscopy at the dorsal skin of the third finger of the non-dominant hand. We calculated basal capillary density as well as capillary density after a period of arterial and venous occlusion in order to evaluate functionality and maximum capillary density. We also measured capillary recruitment. RESULTS: Microvascular capillary density at rest was significantly lower in patients suffering from coronary heart disease than in controls. This fact was also found after dynamic tests (arterial and venous occlusion), suggesting functional impairments. Capillary recruitment of the samples was not different in our sample. CONCLUSIONS: In our study, patients with coronary heart disease exhibit functional and structural microvascular disturbances. Although this is a very preliminary study, these findings open the door for further studying the microvascular functionality in coronary patients and how it relates to the response to treatment and/or the prognosis of the disease.