Whole-diet interventions and cardiovascular risk factors in postmenopausal women: A systematic review of controlled clinical trials.

OBJECTIVES: Menopause is accompanied by many metabolic changes, increasing the risk of cardiometabolic diseases. The impact of diet, as a modifiable lifestyle factor, on cardiovascular health in general populations has been well established. The purpose of this systematic review is to summarize the evidence on the effects of whole diet on lipid profile, glycemic indices, and blood pressure in postmenopausal women. METHODS: Embase, Medline, Cochrane Central Register of Controlled Trials, and Google Scholar were searched from inception to February 2021. We included controlled clinical trials in postmenopausal women that assessed the effect of a whole-diet intervention on lipid profile, glycemic indices, and/or blood pressure. The risk of bias in individual studies was assessed using RoB 2 and ROBINS-I tools. SUMMARY OF EVIDENCE: Among 2,134 references, 21 trials met all eligibility criteria. Overall, results were heterogenuous and inconsistent. Compared to control diets, some studies showed that participants experienced improvements in total cholesterol (TC), low-density lipoprotein cholesterol (LDL), systolic blood pressure (SBP), fasting blood sugar (FBS), and apolipoprotein A (Apo-A) after following fat-modified diets, but some adverse effects on triglycerides (TG), very low-density lipoprotein cholesterol (VLDL), lipoprotein(a) (Lp(a)), and high-density lipoprotein cholesterol (HDL) concentrations were also observed. A limited number of trials found some effects of the Paleolithic, weight-loss, plant-based, or energy-restricted diets, or of following American Heart Association recommendations on TG, TC, HDL, insulin, FBS, or insulin resistance. CONCLUSION: Current evidence suggests that diet may affect levels of some lipid profile markers, glycemic indices, and blood pressure among postmenopausal women. However, due to the large heterogeneity in intervention diets, comparison groups, intervention durations, and population characteristics, findings are inconclusive. Further well-designed clinical trials are needed on dietary interventions to reduce cardiovascular risk in postmenopausal women.

Estimating Reductions in Ethnic Inequalities in Child Adiposity from Hypothetical Diet, Screen Time, and Sports Participation Interventions.

BACKGROUND: Childhood obesity is a global epidemic, and its prevalence differs by ethnicity. The objective of this study was to estimate the change in ethnic inequalities in child adiposity at age 10 resulting from interventions on diet at age 8 and screen time and sports participation at age 9. METHODS: We conducted a population-based cohort study, the Generation R Study, from 9,749 births in Rotterdam (2002-2006), of which 9,506 children remained in the analysis. We measured ethnicity, diet, screen time, and sports participation through questionnaires; we measured weight, body mass index (BMI), fat mass index, and fat-free mass index directly. We used sequential G-estimation to estimate the reduction in inequality that would result from the interventions. RESULTS: We observed that sociodemographic characteristics, diet, screen time, sports participation, and all adiposity measurements were more favorable in children from Western versus non-Western ethnic backgrounds: weight = -1.2 kg (95% confidence interval [CI] = -1.7, -0.8), BMI = -1.0 kg/m (CI = -1.2, -0.9), and fat mass index = -0.8 kg/m (CI = -0.9, -0.7). We estimated that extreme intervention (maximum diet score of 10, no screen time, and >4 hours/week of sports) reduced ethnic inequalities by 21% (CI = 8%, 35%) for weight, 9% (CI = 4%, 14%) for BMI, and 9% (CI = 6%, 13%) for fat mass index. A diet score ≥5 points, screen time ≤2 hours/day, and sports participation >2 hours/week reduced ethnic inequalities by 17% (CI = 6%, 28%) for weight, 7% (CI = 3%, 11%) for BMI, and 7% (CI = 4%, 10%) for fat mass index. CONCLUSIONS: Our results are consistent with the hypothesis that interventions integrating diet, screen time, and sports participation have a moderate impact on reducing ethnic inequalities in child adiposity.

Change in postmenarche anthropometric indicators in indigenous and nonindigenous adolescents from Chile.

OBJECTIVE: To analyze the change in anthropometric indicators between menarche and 36 months after menarche among indigenous and non-indigenous adolescents from the Araucanía Region of Chile. METHOD: This was a concurrent cohort study. Of 8,504 girls interviewed, 114 indigenous adolescents and 123 nonindigenous adolescents who had recently experienced menarche were selected. Body mass index (BMI), BMI by age (BMI z-score), waist circumference (WC) and body fat percentage (BF%) were evaluated at menarche and 6, 12, 18, 24, 30, and 36 months postmenarche. Linear models estimated with generalized estimating equations were used to quantify disparities adjusted for baseline anthropometric values, age at menarche, place of residence, and socioeconomic level. RESULTS: Indigenous girls presented menarche 4 months later than nonindigenous girls and had significantly higher BMI (1.5 kg/m2 ), BMI z-score (0.4), WC (2.9 cm), and BF% (1.7%) at menarche. Adjusted results did not show an association between being indigenous and post-menarche anthropometric variables: BMI = 0.1 kg/m2 (CI = -0.3; 0.5), BMI z-score = 0 (CI = -0.1; 0.1), WC = 0.7 cm (CI = -0.6; 2.0), and BF% = 0.5% (CI = -0.2; 1.3). It is important to mention that the mean BMI z-score of both groups were in the overweight category. CONCLUSION: At menarche, indigenous girls had higher values than nonindigenous girls for all anthropometric variables, and this trend remained after menarche, with no further change in ethnic disparity over the subsequent three years. This reinforces the need to implement interventions to prevent or control excess weight prior to menarche, with emphasis on indigenous girls.

Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study.

BACKGROUND: International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries. METHODS: Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated. FINDINGS: Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations. INTERPRETATION: We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems. FUNDING: The Lowitja Institute.

[Fruit and vegetable intake, and blood pressure. A population research]. / Consumo de frutas, verduras y presión arterial. Un estudio poblacional.

Consuming fruits and vegetables is known to lower blood pressure. However, it is unclear how much should be consumed in order to achieve this effect. The aim of this study was to analyze the association between fruit and vegetable consumption and blood pressure. A cross-sectional study was conducted among a random sample of 777 adults between the ages of 32 and 38 from the Region of Valparaiso, Chile. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and a survey was carried out to quantify consumption trends over the past month. The fruit and vegetable intake was divided into three groups: less than 200 g, 200-400 g, and more than 400 g. In the analysis, multiple linear regression models were used and were adjusted for sex, BMI, physical activity, socioeconomic status, smoking, and sodium intake. It was observed that increasing intake of fruits and vegetables lowers the systolic blood pressure (ß = -3.37 , 95% CI : -6.45 to -0.29; for consumption between 200 and 400 g ) (ß = -4.02, 95% CI: -7.06 to -0.98; for consumption great than 400 g), while an effect on diastolic pressure is only seen in those who meet the WHO recommendation of consuming more than 400 g per day (ß -2.87, CI = -5.17 to -0.57). In conclusion, consuming fruits and vegetables in amounts larger than 400 g per day, provides a protective effect against increases in both systolic and diastolic blood pressure.

Consumo de frutas, verduras y presión arterial: Un estudio poblacional / Fruit and vegetable intake, and blood pressure: A population research

Se ha descrito que consumir frutas y verduras disminuye la presión arterial. Sin embargo, no está clara la magnitud del efecto según la cantidad consumida. El objetivo de este estudio fue analizar la asociación entre consumo de frutas y verduras, y presión arterial. Se realizó un estudio transversal en una muestra aleatoria de 777 adultos entre 32 y 38 años de la Región de Valparaíso, Chile. Se midió presión arterial sistólica (PAS) y diastólica (PAD), y se aplicó una encuesta de tendencia de consumo cuantificada del último mes. La ingesta de frutas y verduras se dividió en tres grupos: menor a 200 g, 200 a 400 g, mayor a 400 g. Para el análisis se utilizaron modelos de regresión lineal múltiple ajustados por sexo, IMC, actividad física, nivel socioeconómico, tabaquismo e ingesta de sodio. Se observó que a medida que aumenta la ingesta de frutas y verduras disminuye la presión arterial sistólica(β=-3,37; IC 95%: -6,45 a -0,29; en consumo entre 200 y 400 g) (β=- 4,02; IC 95%: -7,06 a -0,98; en consumo mayor a 400 g), mientras que en la presión diastólica solamente se ve el efecto en los que cumplen la recomendación de la OMS de consumir más de 400 g al día (β-2,87; IC=-5,17 a -0,57). Se concluye que consumir frutas y verduras en cantidades mayores a 400 g, tiene un efecto protector en el aumento de la presión arterial tanto sistólica como diastólica.

Consuming fruits and vegetables is known to lower blood pressure. However, it is unclear how much should be consumed in order to achieve this effect. The aim of this study was to analyze the association between fruit and vegetable consumption and blood pressure. A cross-sectional study was conducted among a random sample of 777 adults between the ages of 32 and 38 from the Region of Valparaiso, Chile. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and a survey was carried out to quantify consumption trends over the past month. The fruit and vegetable intake was divided into three groups: less than 200 g, 200-400 g, and more than 400 g. In the analysis, multiple linear regression models were used and were adjusted for sex, BMI, physical activity, socioeconomic status, smoking, and sodium intake. It was observed that increasing intake of fruits and vegetables lowers the systolic blood pressure (β = -3.37 , 95% CI : -6.45 to -0.29; for consumption between 200 and 400 g ) (β =-4.02 , 95% CI: -7.06 to -0.98; for consumption great than 400 g), while an effect on diastolic pressure is only seen in those who meet the WHO recommendation of consuming more than 400 g per day (β -2,87, CI = -5.17 to -0.57). In conclusion, consuming fruits and vegetables in amounts larger than 400 g per day, provides a protective effect against increases in both systolic and diastolic blood pressure.

Postmenarche growth: cohort study among indigenous and non-indigenous Chilean adolescents.

BACKGROUND: In Chile, indigenous and non-indigenous schoolchildren have the same stature when they begin school but indigenous adults are shorter, indicating the importance of analyzing growth during puberty. The aim of this study was to compare the growth of indigenous and non-indigenous girls during the 36 months after menarche in Chile's Araucanía Region. METHODS: A concurrent cohort study was conducted to compare growth in the two ethnic groups, which were comprised of 114 indigenous and 126 non-indigenous girls who recently experienced menarche and were randomly selected. Height was measured at menarche and at 6, 12, 18, 24 and 36 months post-menarche. General linear models were used to analyze growth and a generalized estimating equation model was used to compare height at 36 months post-menarche. RESULTS: At menarche, the Z-score of height/age was less for indigenous than non-indigenous girls (-0.01 vs. -0.61, p < 0.001). Indigenous girls grew at a slower rate than non-indigenous girls (6.5 vs. 7.2 cm, p = 0.02), and height at 36-months post-menarche reached -0.82 vs. -0.35 cm (p <0.001). In an adjusted model at 36 months post-menarche, indigenous girls were 1.6 cm shorter than non-indigenous girls (95% confidence interval: -3.13 to -0.04). CONCLUSIONS: The height of indigenous girls at menarche was lower than that of non-indigenous girls and they subsequently grew less, maintaining the gap between the two groups. At the end of the follow-up period, the indigenous girls were shorter than their non-indigenous peers.

Is waist circumference a better predictor of blood pressure, insulin resistance and blood lipids than body mass index in young Chilean adults?

BACKGROUND: It has been reported that waist circumference (WC) is a better predictor of cardiovascular risk factors than body mass index (BMI), although the findings have not been consistent. The aim of this study was to assess which measurement, BMI or WC, is more strongly associated with blood pressure, homeostatic model assessment (HOMA) and blood lipids in young Chilean adults. METHODS: 999 subjects aged 22 to 28 years were randomly selected from a registry of individuals born between 1974 and 1978 at the Hospital of Limache, Chile. Weight, height, WC, blood pressure, HOMA and lipoproteins were assessed in a cross-sectional study. RESULTS: In multivariable regressions BMI and WC were associated with blood pressure, HOMA and lipoproteins at similar level of explained variation (R2 between 1.6 % for Low Density Lipoproteins (LDL) and 15.6 %, the highest for HOMA and triglycerides) and similarly OR in standardised logistic regressions between 1.1 (95 % CI: 0.9 and 1.4) for LDL and 2.9 (95 % CI: 2.4 and 3.4) for elevated HOMA. When both WC and BMI were included in the model collinearity was high and only for HOMA was there a small independent contribution of each index (R2 = 1 %); for other outcomes the pattern was inconsistent. CONCLUSION: The strength of the associations of WC and BMI for any cardiovascular risk factors was similar, but highest for HOMA and triglycerides. WC and BMI are equally useful for monitoring the consequences of obesity in young adults.

Socioeconomic status and age at menarche in indigenous and non-indigenous Chilean adolescents.

The objective was to analyze the relationship between socioeconomic status and age at menarche among indigenous and non-indigenous girls in the Araucanía Region of Chile, controlling for nutritional status and mother's age at menarche. A total of 8,624 randomly selected girls from 168 schools were screened, resulting in the selection of 207 indigenous and 200 non-indigenous girls who had recently experienced menarche. Age at menarche was 149.6 ± 10.7 months in the indigenous group and 146.6 ± 10.8 months in the non-indigenous group. Among the non-indigenous, the analysis showed no significant association between age at menarche and socioeconomic status. In the indigenous group, age at menarche among girls with low socioeconomic status was 5.4 months later than among those with higher socioeconomic status. There were no differences in nutritional status according to socioeconomic level. Obesity was associated with earlier menarche. Menarche occurred earlier than in previous generations. An inverse relationship between socioeconomic status and age at menarche was seen in the indigenous group only; low socioeconomic status was associated with delayed menarche, regardless of nutritional status or mother's age at menarche.

Socioeconomic status and age at menarche in indigenous and non-indigenous Chilean adolescents / Nivel socioeconómico y edad de la menarquia en adolescentes chilenas indígenas y no indígenas

The objective was to analyze the relationship between socioeconomic status and age at menarche among indigenous and non-indigenous girls in the Araucanía Region of Chile, controlling for nutritional status and mother's age at menarche. A total of 8,624 randomly selected girls from 168 schools were screened, resulting in the selection of 207 indigenous and 200 non-indigenous girls who had recently experienced menarche. Age at menarche was 149.6±10.7 months in the indigenous group and 146.6±10.8 months in the non-indigenous group. Among the non-indigenous, the analysis showed no significant association between age at menarche and socioeconomic status. In the indigenous group, age at menarche among girls with low socioeconomic status was 5.4 months later than among those with higher socioeconomic status. There were no differences in nutritional status according to socioeconomic level. Obesity was associated with earlier menarche. Menarche occurred earlier than in previous generations. An inverse relationship between socioeconomic status and age at menarche was seen in the indigenous group only; low socioeconomic status was associated with delayed menarche, regardless of nutritional status or mother's age at menarche.

El objetivo fue analizar la relación entre nivel socioeconómico y edad de menarquia en adolescentes indígenas y no indígenas de la Región de la Araucanía, Chile, controlando el efecto del estado nutricional, y la edad de menarquia de las madres. Se estudiaron 8.624 niñas de 168 escuelas elegidas aleatoriamente, seleccionando 207 indígenas y 200 no indígenas que habían tenido recientemente la menarquia. La edad de menarquia ocurrió a los 149,6±10,7 meses en indígenas y a los 146,6±10,8 meses en no indígenas. En el grupo no indígena, hubo una relación significativa entre edad de menarquia y nivel socioeconómico. En el grupo indígena, edad de menarquia del nivel socioeconómico bajo fue de 5,4 meses más tarde que el nivel socioeconómico más alto. No se observaron diferencias de estado nutricional por nivel socioeconómico. La obesidad adelantó la menarquia y la edad de menarquia ocurrió antes que la de sus madres. Existe una relación inversa entre nivel socioeconómico y edad de menarquia sólo en el grupo indígena; en los niveles socioeconómicos más bajos la edad de menarquia se retrasa independiente del estado nutricional y de la edad de menarquia de la madre.

[What kind of intervention has the best results to reduce the weight in overweighted or obese adults?]. / Qué tipo de intervención tiene mejores resultados en la disminución de peso en adultos con sobrepeso u obesidad? Revisión sistemática y metaanálisis.

Evidence has shown that interventions which involve changes in a person's lifestyle, such as diet and physical activity, lead to weight loss and thus reduce the risk factors of cardiovascular disease. However, the effectiveness and necessary duration of specific interventions are unclear. The purpose of this research was to evaluate and compare the effect on weight of interventions based on diet, exercise and a combination of both. The research subjects were overweight and obese adults, at six and twelve months after the beginning of the intervention. First a systematic review was carried out, followed by a meta-analysis. Initially, 24 studies were selected which met the established criteria for inclusion; twelve of these demonstrated the required level of quality. The diet-based interventions resulted in reductions of-6.66 kilograms (95% confidence interval (CI): -9.04 to -4.28) and -3.80 kilograms (CI: -5.50 to -2.10) at six and twelve months, respectively. Those who engaged in exercise showed a loss of -2.21 kilograms (CI: -4.62 to -0.21) and -2.00 kilograms (CI: -5.70 to -1.70) at six and twelve months, respectively, while those who changed their diets and engaged in exercise showed a loss of -10.86 kilograms (CI: -13.22 to -8.49) and -6.50 kilograms (CI: -8.09 to -4.90) at six and twelve months. The combination of diet and exercise showed the best effect in reducing weight among overweight and obese people, followed by diet alone while exercise alone didn't reach significant results. The effect of these interventions was greater during the first six months of intervention.

¿Qué tipo de intervención tiene mejores resultados en la disminución de peso en adultos con sobrepeso u obesidad? Revisión Sistemática y Metaanálisis

Se ha demostrado que intervenciones basadas en cambios de estilo de vida, tales como dietas y actividad física, provocarían una reducción de peso capaz de disminuir los factores de riesgo cardiovascular. Sin embargo, persiste la interrogante de cuál es el tipo de intervención y duración más efectiva. El objetivo de este trabajo fue evaluar y comparar el efecto en el peso de intervenciones basadas en dieta, ejercicio y una combinación de ambos, en adultos con sobrepeso y obesidad, a los seis y doce meses de ejecución. Se realizó una revisión sistemática y posteriormente un metaanálisis, seleccionándose 12 estudios que cumplieron los criterios de inclusión y nivel de calidad exigido. Las intervenciones con dieta mostraron disminuciones de -6,66 kilos (intervalo de confianza del 95% (IC): -9,04 a -4,28) y -3,80 kilos (IC: -5,50 a -2,10) a los seis y doce meses respectivamente, las intervenciones con ejercicio presentaron reducciones de -2,21 kilos (IC: -4,62 a 0,21) y -2,00 kilos (IC: -5,70 a 1,70) a los seis y doce meses respectivamente y aquellas con dieta más ejercicio reducciones de -10,86 kilos (IC: -13,22 a -8,49) y -6,50 kilos (IC: -8,09 a -4,90) a los seis y doce meses de ejecución. La combinación de dieta y ejercicio fue más efectiva en la disminución de peso en personas con sobrepeso y obesidad, seguida por la dieta, mientras que el ejercicio no tuvo resultados significativos. En los tres tipos de intervenciones el efecto fue mayor durante los primeros seis meses de ejecución.

Evidence has shown that interventions which involve changes in a person’s lifestyle, such as diet and physical activity, lead to weight loss and thus reduce the risk factors of cardiovascular disease. However, the effectiveness and necessary duration of specific interventions are unclear. The purpose of this research was to evaluate and compare the effect on weight of interventions based on diet, exercise and a combination of both. The research subjects were overweight and obese adults, at six and twelve months after the beginning of the intervention. First a systematic review was carried out, followed by a meta-analysis. Initially, 24 studies were selected which met the established criteria for inclusion; twelve of these demonstrated the required level of quality. The diet-based interventions resulted in reductions of -6.66 kilograms (95% confidence interval (CI): -9.04 to -4.28) and -3.80 kilograms (CI: -5.50 to -2.10) at six and twelve months, respectively. Those who engaged in exercise showed a loss of -2.21 kilograms (CI: -4.62 to -0.21) and -2.00 kilograms (CI: -5.70 to -1.70) at six and twelve months, respectively, while those who changed their diets and engaged in exercise showed a loss of -10.86 kilograms (CI: -13.22 to -8.49) and -6.50 kilograms (CI: -8.09 to -4.90) at six and twelve months. The combination of diet and exercise showed the best effect in reducing weight among overweight and obese people, followed by diet alone while exercise alone didn’t reach significant results. The effect of these interventions was greater during the first six months of intervention.