Association between Different Types of Plant-Based Diets and Risk of Dyslipidemia: A Prospective Cohort Study

We evaluated the associations among different types of plant-based diet indices, risk of dyslipidemia, and individual lipid disorders in Asian populations with different dietary patterns from Western populations. Participants included 4507 Korean adults aged ≥40 years without dyslipidemia and related chronic diseases at baseline (2001–2002). Dietary intakes were assessed using an average of validated food frequency questionnaires measured twice. We calculated three plant-based diet indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). During a follow-up of 14 years, 2995 incident dyslipidemia cases occurred. Comparing the highest with lowest quintiles, the multivariable-adjusted hazard ratios (HRs) for incident dyslipidemia were 0.78 (95% CI, 0.69–0.88) for PDI, 0.63 (95% CI, 0.56–0.70) for hPDI, and 1.48 (95% CI, 1.30–1.69) for uPDI (P-trend < 0.0001 for all). Associations between PDI and individual lipid disorders differed by sex. The PDI was inversely associated with risk of developing hypertriglyceridemia in men and with risk of developing low high-density lipoprotein cholesterol in women. The hPDI was inversely associated with risk of all lipid disorders, whereas the uPDI was positively associated with individual lipid disorders. The quality of plant foods is important for prevention of dyslipidemia in a population that consumes diets high in plant foods.

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The association of dietary macronutrients with anthropometric changes, using iso-energetic substitution models: Tehran lipid and glucose study

Nutrition & Metabolism ◽

10.1186/s12986-019-0411-2 ◽

2019 ◽

Vol 16 (1) ◽

Author(s):

Firoozeh Hosseini-Esfahani ◽

Glareh Koochakpoor ◽

Parvin Mirmiran ◽

Samira Ebrahimof ◽

Fereidoun Azizi

Keyword(s):

Weight Loss ◽

Lower Risk ◽

Saturated Fat ◽

Plant Proteins ◽

Dietary Intakes ◽

Food Frequency ◽

Unsaturated Fat ◽

Simple Carbohydrates

Abstract Background The consequences of optimal dietary macronutrient compositions especially quality of proteins on weight gain still remain controversial. The aim of the current study was to evaluate the iso-energetic substitution of dietary macronutrients in relation to anthropometric changes. Methods This prospective study was conducted on 2999 men and 4001 women aged 20–70 years who were followed for 3.6 years. A valid and reliable 168-item semi-quantitative food frequency questionnaire was used to assess usual dietary intakes. Weight (kg) and waist circumference (WC) (cm) changes were calculated by subtracting the weight and WC at baseline from their measurements at follow up. Participants were divided into two groups; those with no change or decrease in weight or WC and those with increase in weight or WC. Dietary macronutrients (percentage of energy) divided by 5 to calculate one unit. Results A one unit higher proportion of carbohydrates at the expense of all types of fatty acids was associated with weight loss in men (P < 0.05). A one unit higher proportion of plant proteins at the expense of animal protein (β = − 0.84), non-starch carbohydrates (β = − 0.86), saturated fat (β = − 0.76), mono-unsaturated fat (β = − 0.76) and poly-unsaturated fat (β = − 0.86) was associated with weight loss (P < 0.05). A one unit higher proportion of plant proteins at the expense of animal proteins (OR: 0.49), non-starch carbohydrates (OR: 0.49), saturated fat (OR: 0.49), mono-unsaturated fat (OR: 0.49), and poly-unsaturated fat (OR: 0.48) was associated with a lower risk of increase in WC (P < 0.05). Conclusions A higher proportion of dietary plant protein in replacement of simple carbohydrates, fats and animal proteins was associated with a lower increase in weight or WC.

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Plant-based diets and incident metabolic syndrome: Results from a South Korean prospective cohort study

PLoS Medicine ◽

10.1371/journal.pmed.1003371 ◽

2020 ◽

Vol 17 (11) ◽

pp. e1003371

Author(s):

Hyunju Kim ◽

Kyueun Lee ◽

Casey M. Rebholz ◽

Jihye Kim

Keyword(s):

Metabolic Syndrome ◽

Dietary Intake ◽

Lower Risk ◽

Density Lipoprotein ◽

Vegetarian Diet ◽

Healthy Plant ◽

Potential Measurement ◽

Plant Foods ◽

Asian Populations

Background Prior studies have shown that plant-based diets are associated with lower risk of cardiovascular risk factors and incident cardiovascular disease, but risks differed by quality of plant-based diets. No prospective studies have evaluated the associations between different types of plant-based diets and incident metabolic syndrome (MetS) and components of MetS. Furthermore, limited evidence exists in Asian populations who have habitually consumed a diet rich in plant foods for a long period of time. Methods and findings Analyses were based on a community-based cohort of 5,646 men and women (40–69 years of age at baseline) living in Ansan and Ansung, South Korea (2001–2016) without MetS and related chronic diseases at baseline. Dietary intake was assessed using a validated food frequency questionnaire. Using the responses in the questionnaire, we calculated 4 plant-based diet indices (overall plant-based diet index [PDI], healthful plant-based diet index [hPDI], unhealthful plant-based diet index [uPDI], and pro-vegetarian diet index). Higher PDI score represented greater consumption of all types of plant foods regardless of healthiness. Higher hPDI score represented greater consumption of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, tea and coffee) and lower consumption of less-healthy plant foods (refined grains, potatoes, sugar-sweetened beverages, sweets, salty foods). Higher uPDI represented lower consumption of healthy plant foods and greater consumption of less-healthy plant foods. Similar to PDI, higher pro-vegetarian diet score represented greater consumption of plant foods but included only selected plant foods (grains, fruits, vegetables, nuts, legumes, potatoes). Higher scores in all plant-based diet indices represented lower consumption of animal foods (animal fat, dairy, eggs, fish/seafood, meat). Over a median follow-up of 8 years, 2,583 participants developed incident MetS. Individuals in the highest versus lowest quintile of uPDI had 50% higher risk of developing incident MetS, adjusting for demographic characteristics and lifestyle factors (hazard ratio [HR]: 1.50, 95% CI 1.31–1.71, P-trend < 0.001). When we further adjusted for body mass index (BMI), those in the highest quintile of uPDI had 24%–46% higher risk of 4 out of 5 individual components of MetS (abdominal obesity, hypertriglyceridemia, low high-density lipoprotein [HDL], and elevated blood pressure) (P-trend for all tests ≤ 0.001). Greater adherence to PDI was associated with lower risk of elevated fasting glucose (HR: 0.80, 95% CI 0.70–0.92, P-trend = 0.003). No consistent associations were observed for other plant-based diet indices and MetS. Limitations of the study may include potential measurement error in self-reported dietary intake, inability to classify a few plant foods as healthy and less-healthy, lack of data on vegetable oil intake, and possibility of residual confounding. Conclusions In this study, we observed that greater adherence to diets consisting of a high intake of refined carbohydrates, sugars, and salty foods in the framework of plant-based diets was associated with an elevated risk of MetS. These results suggest that considering the quality of plant foods is important for prevention of MetS in a population that habitually consumes plant foods.

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Incidence and Risk Factors for Amputation in Patients With Diabetes in Japan: A Historical Cohort Study Using a Nationwide Claims Database

10.21203/rs.3.rs-125853/v1 ◽

2020 ◽

Author(s):

Masanori Kaneko ◽

Kazuya Fujihara ◽

Taeko Osawa ◽

Masahiko Yamamoto ◽

Mayuko Yamada Harada ◽

...

Keyword(s):

Cox Regression ◽

Historical Cohort ◽

Cox Regression Analysis ◽

Claims Database ◽

Hazard Ratios ◽

Patients With Diabetes ◽

Mortality Predictors ◽

Hba1c Levels

Abstract Background: Because amputation negatively affects the quality of life of patients with diabetes and increases the risk of cardiovascular events and mortality, predictors of amputation must be identified. However, no large cohort studies have been conducted regarding the incidence of amputation in patients with diabetes in East Asia.Methods: We analyzed data from a nationwide claims database in Japan accumulated from 2008–2016, involving 17,288 patients with diabetes aged 18–72 y (2942 women, mean age 50.2 y, HbA1c 7.2%).Results: The mean follow-up time was 5.3 years, and 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age and HbA1c levels were independent predictors of amputation (hazard ratios [HRs], 1.09 and 1.43; 95% confidence intervals [CIs], 1.01–1.16 and 1.12–1.82, respectively). Compared with patients aged <60 y and with HbA1c <8%, the HR for patients aged ≥60 y and with HbA1c ≥8% was 32.1 (95% CI, 7.30–141.2).Conclusions: Improved glycemic control may lower amputation risk.

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Quality of Plant-based Diet and Risk of Total, Ischemic, and Hemorrhagic Stroke

Neurology ◽

10.1212/wnl.0000000000011713 ◽

2021 ◽

pp. 10.1212/WNL.0000000000011713

Author(s):

Megu Y Baden ◽

Zhilei Shan ◽

Fenglei Wang ◽

Yanping Li ◽

JoAnn E Manson ◽

...

Keyword(s):

Diet Quality ◽

Medical Records ◽

Hemorrhagic Stroke ◽

Stroke Risk ◽

Vegetarian Diet ◽

Health Study ◽

Follow Up Study ◽

Hazard Ratios

Objective:To determine whether a healthful plant-based diet is related to lower stroke risk, we examined the associations of plant-based diet quality with risk of total, ischemic, and hemorrhagic stroke.Methods:The participants were 73,890 women in Nurses’ Health Study (NHS; 1984 to 2016), 92,352 women in NHSII (1991 to 2017), and 43,266 men in Health Professionals Follow-Up Study (1986 to 2012) without cardiovascular disease and cancer at baseline. Plant-based diet quality was evaluated by the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI). Participants who reported their meat and/or fish intakes were zero or less than one serving per month were categorized as vegetarians, and others were classified as non-vegetarians. Strokes with available medical records were subtyped as ischemic or hemorrhagic.Results:During the follow-up, 6,241 total stroke cases (including 3,015 ischemic and 853 hemorrhagic strokes) were documented. Compared to participants with the lowest PDIs, among participants with the highest PDIs the hazard ratios (HRs) for total stroke were 0.94 (95% confidence interval 0.86 to 1.03) for PDI, 0.90 (0.83 to 0.98) for hPDI, and 1.05 (0.96 to 1.15) for uPDI. Participants in the highest hPDI showed marginally lower HR for ischemic stroke (0.92 [0.82 to 1.04]) and no consistent associations for hemorrhagic stroke. We observed no association between a vegetarian diet and total stroke (1.00 [0.76 to 1.32]), although the number of cases was small.Conclusions:Lower risk of total stroke was observed by those who adhered to a healthful plant-based diet.

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Vegetarian diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study

Proceedings of The Nutrition Society ◽

10.1017/s002966512000021x ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Tammy Y.N. Tong ◽

Paul N. Appleby ◽

Aurora Perez-Cornago ◽

Timothy J. Key

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Hip Fractures ◽

Cox Regression ◽

Dietary Intakes ◽

Site Specific ◽

Main Site ◽

Hazard Ratios ◽

Prospective Cohorts

AbstractIntroductionIt has been speculated that vegetarians or vegans may have higher risks of fractures than meat eaters, but there is limited evidence from prospective cohorts. We aimed to assess the risks of total and site-specific fractures in people of different diet groups, in a prospective cohort with a large proportion of non-meat eaters.Materials and methodsIn EPIC-Oxford, dietary information was collected at baseline (1993–2001) and at follow-up around 14 years later (≈2010). Participants were categorised into five diet groups (≈20,106 regular meat eaters: ≥ 50 g of meat per day, ≈9,274 low meat eaters: < 50 g of meat per day, ≈8,037 fish eaters, ≈15,499 vegetarians and ≈1,982 vegans, with minor variations in numbers for each outcome after pre-specified exclusions) at both time points. Using multivariable Cox regression adjusted for socio-demographic, lifestyle, and physiological confounders, we estimated the risks of total and site-specific fractures (arm, wrist, hip, leg, ankle, and other main sites i.e. clavicle, rib and vertebra) in the different diet groups, with outcomes identified through record linkage.ResultsOver an average of 17.6 years of follow-up, we observed 3,941 cases of total fractures, 566 arm fractures, 889 wrist fractures, 945 hip fractures, 366 leg fractures, 520 ankle fractures, and 467 other main site fractures. Compared with meat eaters, vegetarians had marginally higher risks of total fractures (hazard ratios and 95% confidence intervals: 1.10; 1.00–1.20) and arm fractures (1.28; 1.01–1.63), while vegans had significantly higher risks of total fractures (1.44; 1.21–1.72) and leg fractures (2.06; 1.22–3.47), and marginally higher risks of arm fractures (1.60, 1.01–2.54). For hip fractures, the risks were higher in fish eaters (1.28; 1.03–1.59), vegetarians (1.27; 1.05–1.55) and vegans (2.35; 1.67–3.30, p-heterogeneity < 0.0001) than regular meat eaters. There were no significant differences in risks of wrist, ankle or other main site fractures by diet groups. Overall, the significant associations appeared stronger without adjustment for body mass index (e.g. 1.52; 1.27–1.81 in vegans for total fractures), and were slightly attenuated with additional adjustment for total protein (1.41; 1.17–1.69) or dietary calcium (1.32; 1.10–1.59).DiscussionIn conclusion, non-meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures. The higher risks might be partly explained by the lower body mass index in these diet groups, but differences in dietary intakes of protein and calcium are likely relevant as well. Given the observational design of this study, causality and potential mechanisms should be further investigated.

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Dynamic Changes in Quality of Life, Psychological Status, and Body Image in Women With Different Types of Breast Cancer Surgery: 8-year Follow Up

10.21203/rs.3.rs-1115792/v1 ◽

2022 ◽

Author(s):

Sriyani padmalatha K.M ◽

Yi-Lin Wu ◽

Shikha Kukreti ◽

Chang-Chun Chen ◽

Chia-Ni Lin ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Body Image ◽

World Health ◽

Dynamic Changes ◽

Depression Status ◽

Different Types ◽

Anxiety Depression

Abstract PurposeTo explore the dynamic changes in Quality of Life (QoL), anxiety/depression status, and body image (BI) of women who received different types of breast cancer (BC) surgery within an 8-years follow-up period.MethodsWomen with major BC surgeries were invited to complete the World Health Organization Quality of Life–Brief (WHOQOL-BREF), the European quality of life five dimensions questionnaire (EQ-5D), and a body image scale within 8 years of surgery. Kernel smoothing methods were applied to describe dynamic changes in QoL, anxiety/depression, and BI at different time points. Linear mixed effects models were constructed to identify the interaction between time, different types of surgery, and the determinants of QoL in these patients.ResultsA total of 1,803 women who had undergone a mastectomy, a modified radical mastectomy (MRM), and breast reconstruction (BR) were included. The BR group exhibited a high QoL score of WHOQOL one to five years after surgery with some fluctuations. The MRM group had comparatively stable, low QoL scores of WHOQOL items and less depressed/anxious. BR group generally showed fluctuated, lower scores of BI two years after operation, but they exhibited more anxiety/depression status after five years. Medical comorbidities, the status of anxiety/depression, and BI were the major factors influencing all domains and items of the WHOQOL BREF.ConclusionWhile MRM may decrease the likelihood of depression in patients with BC and BR would significantly improve their QoL in the first 5 years. We recommend that these findings should be considered and discussed in the patient participatory decision-making for breast surgery.

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Self-perceived changes in oral health-related quality of life after receiving different types of conventional prosthetic treatments: A cohort follow-up study

Journal of Dentistry ◽

10.1016/j.jdent.2013.01.006 ◽

2013 ◽

Vol 41 (6) ◽

pp. 493-503 ◽

Cited By ~ 35

Author(s):

Javier Montero ◽

Raquel Castillo-Oyagüe ◽

Christopher D. Lynch ◽

Alberto Albaladejo ◽

Antonio Castaño

Keyword(s):

Quality Of Life ◽

Oral Health ◽

Health Related Quality ◽

Follow Up Study ◽

Different Types ◽

Related Quality ◽

Health Related

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The role of different lipid measures for incident hypertension during more than 12 years follow-up: Tehran Lipid and Glucose Study

British Journal Of Nutrition ◽

10.1017/s0007114521004657 ◽

2021 ◽

pp. 1-32

Author(s):

Amirreza Hadaegh ◽

Samaneh Akbarpour ◽

Maryam Tohidi ◽

Niloofar Barzegar ◽

Somayeh Hosseinpour-Niazi ◽

...

Keyword(s):

Drug Users ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipid Lowering ◽

Continuous Variables ◽

Incident Hypertension ◽

Hazard Ratios ◽

Cox Proportional Hazard Regression ◽

Lowering Drug

Abstract To examine the associations of different lipid measures and related indices with incident hypertension during a median follow-up of 12.89 years. Fasting levels of total cholesterol (TC), triglycerides (TG), high and low density lipoprotein cholesterol (HDL-C and LDL-C, respectively), and related indices (TC/HDL-C and TG/HDL-C) were determined in 7335 Iranian adults (men=3270) free of hypertension, aged 39.0 [standard deviation (SD):13.2] years. Multivariate Cox proportional hazard regression was applied and lipid parameters were considered either as categorical or continuous variables. During follow-up, 2413 (men=11260) participants experienced hypertension. Using the first quartile as reference, significant trends were found between quartiles of TG, HDL-C, TC/HDL-C, and TG/HDL-C in multivariate models; moreover considering these measures as continuous variables, a 1 SD increase in each of these parameters was significantly associated with risk of incident hypertension; the corresponding hazard ratios and confidence intervals were 1.06(1.02-1.10), 0.94(0.89-0.98), 1.04(1.01-1.09), and 1.04(1.01-1.07), respectively. The association between lipid measures and incident hypertension did not change after excluding lipid lowering drug users and those with type 2 diabetes mellitus and were independent of the baseline categories of blood pressure (P for interaction > 0.08). To take into account the nutrition data, a re-analysis on a subgroup (n=1705), showed that a 1-SD increase in TG and TG/HDL-C were associated with incident hypertension, after adjusting for dietary cofounders [1.15(1.08–1.24) and 1.03(1.01–1.04), respectively]. These findings indicate that TG, TG/HDL-C, and TC/HDL-C were independently associated with higher risk while HDL-C was associated with lower risk of incident hypertension.

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Diet quality and risk and severity of COVID-19: a prospective cohort study

10.1101/2021.06.24.21259283 ◽

2021 ◽

Author(s):

Jordi Merino ◽

Amit D Joshi ◽

Long Nguyen ◽

Emily Leeming ◽

David Alden Drew ◽

...

Keyword(s):

Diet Quality ◽

Lower Risk ◽

Socioeconomic Deprivation ◽

Healthy Plant ◽

Cox Models ◽

Plant Foods ◽

Hazard Ratios ◽

High Deprivation ◽

Diet Score

Objective: Poor metabolic health and certain lifestyle factors have been associated with risk and severity of coronavirus disease 2019 (COVID-19), but data for diet are lacking. We aimed to investigate the association of diet quality with risk and severity of COVID-19 and its intersection with socioeconomic deprivation. Design: We used data from 592,571 participants of the smartphone-based COVID Symptom Study. Diet quality was assessed using a healthful plant-based diet score, which emphasizes healthy plant foods such as fruits or vegetables. Multivariable Cox models were fitted to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for COVID-19 risk and severity defined using a validated symptom-based algorithm or hospitalization with oxygen support, respectively. Results: Over 3,886,274 person-months of follow-up, 31,815 COVID-19 cases were documented. Compared with individuals in the lowest quartile of the diet score, high diet quality was associated with lower risk of COVID-19 (HR, 0.91; 95% CI, 0.88-0.94) and severe COVID-19 (HR, 0.59; 95% CI, 0.47-0.74). The joint association of low diet quality and increased deprivation on COVID-19 risk was higher than the sum of the risk associated with each factor alone (Pinteraction=0.005). The corresponding absolute excess rate for lowest vs highest quartile of diet score was 22.5 (95% CI, 18.8-26.3) and 40.8 (95% CI, 31.7-49.8; 10,000 person-months) among persons living in areas with low and high deprivation, respectively. Conclusions: A dietary pattern characterized by healthy plant-based foods was associated with lower risk and severity of COVID-19. These association may be particularly evident among individuals living in areas with higher socioeconomic deprivation.

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Low-Density Lipoprotein Cholesterol Target Attainment in Patients With Established Cardiovascular Disease: Analysis of Routine Care Data

JMIR Medical Informatics ◽

10.2196/16400 ◽

2020 ◽

Vol 8 (4) ◽

pp. e16400

Author(s):

T Katrien J Groenhof ◽

Daniel Kofink ◽

Michiel L Bots ◽

Hendrik M Nathoe ◽

Imo E Hoefer ◽

...

Keyword(s):

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Routine Care ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

Target Attainment ◽

History Of ◽

Over Time

Background Direct feedback on quality of care is one of the key features of a learning health care system (LHS), enabling health care professionals to improve upon the routine clinical care of their patients during practice. Objective This study aimed to evaluate the potential of routine care data extracted from electronic health records (EHRs) in order to obtain reliable information on low-density lipoprotein cholesterol (LDL-c) management in cardiovascular disease (CVD) patients referred to a tertiary care center. Methods We extracted all LDL-c measurements from the EHRs of patients with a history of CVD referred to the University Medical Center Utrecht. We assessed LDL-c target attainment at the time of referral and per year. In patients with multiple measurements, we analyzed LDL-c trajectories, truncated at 6 follow-up measurements. Lastly, we performed a logistic regression analysis to investigate factors associated with improvement of LDL-c at the next measurement. Results Between February 2003 and December 2017, 250,749 LDL-c measurements were taken from 95,795 patients, of whom 23,932 had a history of CVD. At the time of referral, 51% of patients had not reached their LDL-c target. A large proportion of patients (55%) had no follow-up LDL-c measurements. Most of the patients with repeated measurements showed no change in LDL-c levels over time: the transition probability to remain in the same category was up to 0.84. Sequence clustering analysis showed more women (odds ratio 1.18, 95% CI 1.07-1.10) in the cluster with both most measurements off target and the most LDL-c measurements furthest from the target. Timing of drug prescription was difficult to determine from our data, limiting the interpretation of results regarding medication management. Conclusions Routine care data can be used to provide feedback on quality of care, such as LDL-c target attainment. These routine care data show high off-target prevalence and little change in LDL-c over time. Registrations of diagnosis; follow-up trajectory, including primary and secondary care; and medication use need to be improved in order to enhance usability of the EHR system for adequate feedback.

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