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Heart Health Diet
Somkiat Sangwatanaroj M.D.
Division of Cardiovascular Medicine,
Department of Medicine, Faculty of Medic...
Diets cause Coronary Heart Disease ?
Causal link diet & CHD: systematic review
Mente A. Arch Intern Med 2009;169:659-69
Causal link diet & CHD: Cohorts
Mente A. Arch Intern Med 2009;169:659-69

g

Bradford Hill score is 4 when restricting ana...
Mediterranean diet & mortality
Meta-analysis. Sofi F. BMJ 2008;337:a1344
doi:10.1136/bmj.a1344

Studies analysed prospecti...
Mediterranean diet & mortality
Meta-analysis. Sofi F. BMJ 2008;337:a1344
doi:10.1136/bmj.a1344
Mediterranean diet & Parkinson &
Meta-analysis.Sofi F. BMJ 2008;337:a1344. doi:10.1136/bmj.a1344
P for trend <0.0001).
B, Multivariate
P for trend <0.0001).
Mediterranean dietary pattern.

Trichopoulou A. Pub Health Nutr 2004;7:943-7
Brown rice, whole grains

DM risk

Sun Qi. Arch Intern Med 2010;170:961-9.

White & brown rice consumption relation to
T2D...
Systematic review. n=352,384, FU 4-22 y.Hu EA.BMJ 2012;344:e1454
Fruit, vegetable & heart disease
Fruit & vegetable 5 servings/d & CHD
Meta-analysis. He FJ. J Human Hypertens 2007;21:717-28.
Nuts, Peanuts prevent CHD
Kris-Etherton PM. J Nutr 2008;138:1746S-51S.

Pooled analysis of epidemiologic studies on nut co...
Nut & peanut butter lower CVD in T2DM women
2009;139:1333-8

Cohort of 6,309 T2DM women,
Food Frequency
Questionnaires q 2...
?
Salt intake increase stroke & CVD risk
Systematic review/meta-a. Strazzullo P. BMJ 2009;339:b4567 doi:10.1136/bmj.b4567

M...
Higher salt intake increase stroke risk (23%)
Systematic review/meta-a. Strazzullo P. BMJ 2009;339:b4567 doi:10.1136/bmj.b...
dietary salt reduction
/
vs.
RR of CHD/50 g/d processed meat
Systematic review. Circulation 2010;121:2271-83.

Case-control

RR of CHD/100 g/d total me...
-cause death
Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287

Pooled hazard ratio
(95% CI) of total
morta...
Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287
Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287
Fat: bad, better or best
Angell SY. Ann Intern Med 2009;151:129-134.
Glycemic index (GI), Glycemic load (GL)

GI = ability of food to provoke postprandial
glycemic response in man compared wi...
Rate ratio(95%CI) highest vs. lowest GI & GL in 27
cohorts.Systematic review Barclay AW. Am J Clin Nutr 2008;87:627-37

1
...
Dietary supplements ?

?
Antioxidant supplements 1ry & 2ry prevention
Bjelakovic G. JAMA. 2007;297:842-857

Electronic databases & bibliographies p...
%
Bjelakovic G. JAMA. 2007;297:842-857
Diet & lifestyle recommendation 2006.
American Heart Association. Circulation 2006;114:82-96

Although antioxidant supplem...
Vit E/C & MI,Stroke,CV death in PHSII
RCT. Sesso HD. JAMA 2008;300:2123-33.
Vit E/C & MI,Stroke,CV death in PHSII
RCT. Sesso HD. JAMA 2008;300:2123-33.
Vit E/C & MI,Stroke,CV death in PHSII
RCT. Sesso HD. JAMA 2008;300:2123-33.
Vitamin B in DM nephropathy
Diabetic Intervention with Vitamins to Improve
Nephropathy.RCT (DB, PC). House AA. JAMA 2010;303:1603-09.
5 university med...
Vit B+folic decrease GFR in DM nephropathy.
DIVINE: RCT (DB, PC). House AA. JAMA 2010;303:1603-09.
Vit B+folic increase CV events in DM nephropathy.
DIVINE: RCT (DB, PC). House AA. JAMA 2010;303:1603-09.
Take home message:
/

/
/ ]

[

[< %]

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Nutrition and heart_disease2012
Nutrition and heart_disease2012
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Nutrition and heart_disease2012
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Nutrition and heart_disease2012
Nutrition and heart_disease2012
Nutrition and heart_disease2012
Nutrition and heart_disease2012
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Nutrition and heart_disease2012
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Transcript of "Nutrition and heart_disease2012"

  1. 1. Heart Health Diet Somkiat Sangwatanaroj M.D. Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University Somkiat.s@chula.ac.th
  2. 2. Diets cause Coronary Heart Disease ?
  3. 3. Causal link diet & CHD: systematic review Mente A. Arch Intern Med 2009;169:659-69
  4. 4. Causal link diet & CHD: Cohorts Mente A. Arch Intern Med 2009;169:659-69 g Bradford Hill score is 4 when restricting analyses to cohort studies of high methodologic quality (low risk of bias).
  5. 5. Mediterranean diet & mortality Meta-analysis. Sofi F. BMJ 2008;337:a1344 doi:10.1136/bmj.a1344 Studies analysed prospectively association between adherence to Mediterranean diet, mortality & incidence of diseases; 12 studies, with 1,574,299 subjects followed for 3-18 yrs 8 cohorts (514,816 subjects & 33,576 deaths): two point increase in the adherence score was significantly associated with a reduced risk of total mortality (9%),CV mortality (9%),cancer mortality(6 13%)
  6. 6. Mediterranean diet & mortality Meta-analysis. Sofi F. BMJ 2008;337:a1344 doi:10.1136/bmj.a1344
  7. 7. Mediterranean diet & Parkinson & Meta-analysis.Sofi F. BMJ 2008;337:a1344. doi:10.1136/bmj.a1344
  8. 8. P for trend <0.0001). B, Multivariate P for trend <0.0001).
  9. 9. Mediterranean dietary pattern. Trichopoulou A. Pub Health Nutr 2004;7:943-7
  10. 10. Brown rice, whole grains DM risk Sun Qi. Arch Intern Med 2010;170:961-9. White & brown rice consumption relation to T2DM risk in Health Professionals Follow-up Prospectively ascertained & updated diet, lifestyle practices & disease status among 39 765 men & 157 463 women. Multivariate adjustment for age, lifestyle & dietary risk factors, higher intake of white rice (5 servings/wk vs. 1/ month) risk
  11. 11. Systematic review. n=352,384, FU 4-22 y.Hu EA.BMJ 2012;344:e1454
  12. 12. Fruit, vegetable & heart disease
  13. 13. Fruit & vegetable 5 servings/d & CHD Meta-analysis. He FJ. J Human Hypertens 2007;21:717-28.
  14. 14. Nuts, Peanuts prevent CHD Kris-Etherton PM. J Nutr 2008;138:1746S-51S. Pooled analysis of epidemiologic studies on nut consumption and CHD risk.
  15. 15. Nut & peanut butter lower CVD in T2DM women 2009;139:1333-8 Cohort of 6,309 T2DM women, Food Frequency Questionnaires q 2-4 yrs (1980-2002) Incident MI, revascularization & stroke 54,656 person-yr FU, 452 (MI & revascularization) & 182 stroke cases
  16. 16. ?
  17. 17. Salt intake increase stroke & CVD risk Systematic review/meta-a. Strazzullo P. BMJ 2009;339:b4567 doi:10.1136/bmj.b4567 Medline (1966-2008),Embase (1988-),AMED (1985-), CINAHL (1982-), Psychinfo (1985-) & Cochrane Library. Relative risks & 95% CI and random effect model, weighting for inverse of variance. Heterogeneity, publication bias, subgroup, & meta-regression analyses. 19 independent cohort samples from 13 studies, with 177,025 participants (follow-up 3.5-19 yrs) & > 11,000 vascular events
  18. 18. Higher salt intake increase stroke risk (23%) Systematic review/meta-a. Strazzullo P. BMJ 2009;339:b4567 doi:10.1136/bmj.b4567
  19. 19. dietary salt reduction /
  20. 20. vs.
  21. 21. RR of CHD/50 g/d processed meat Systematic review. Circulation 2010;121:2271-83. Case-control RR of CHD/100 g/d total meat
  22. 22. -cause death Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287 Pooled hazard ratio (95% CI) of total mortality for a 1serving/day increase was 1.13 (1.07-1.20) for unprocessed red meat and 1.20 (1.15-1.24) for processed red meat.
  23. 23. Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287
  24. 24. Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287
  25. 25. Fat: bad, better or best
  26. 26. Angell SY. Ann Intern Med 2009;151:129-134.
  27. 27. Glycemic index (GI), Glycemic load (GL) GI = ability of food to provoke postprandial glycemic response in man compared with reference food: Glucose or bread (GI = 100) Glucose : Bread GI = 100 : 70 GL = product of amount of available CHO in specified serving size & GI / 100 GL = CHO x GI / 100 Atkinson FS. Diabetes Care ; 31: 2281- 83 2008
  28. 28. Rate ratio(95%CI) highest vs. lowest GI & GL in 27 cohorts.Systematic review Barclay AW. Am J Clin Nutr 2008;87:627-37 1 Final fully adjusted models only.
  29. 29. Dietary supplements ? ?
  30. 30. Antioxidant supplements 1ry & 2ry prevention Bjelakovic G. JAMA. 2007;297:842-857 Electronic databases & bibliographies published by Oct 2005. Randomized trials, adults, beta carotene, vitamin A, vitamin C (ascorbic acid), vitamin E & selenium either singly or combined vs placebo or vs no intervention. Randomization, blinding, and follow-up: markers of bias. The effect of antioxidant supplements on all-cause mortality: random-effects meta-analyses as RR with 95% CIs. Metaregression to assess the effect of covariates across the trials. 68 Randomized trials ( n = 232,606 from 385 publications).
  31. 31. % Bjelakovic G. JAMA. 2007;297:842-857
  32. 32. Diet & lifestyle recommendation 2006. American Heart Association. Circulation 2006;114:82-96 Although antioxidant supplements vitamin E, beta-carotene, selenium etc) are not recommended, food sources of antioxidant nutrients, principally from a variety of plantderived foods such as fruits, vegetables, whole grains, and vegetable oils are recommended.
  33. 33. Vit E/C & MI,Stroke,CV death in PHSII RCT. Sesso HD. JAMA 2008;300:2123-33.
  34. 34. Vit E/C & MI,Stroke,CV death in PHSII RCT. Sesso HD. JAMA 2008;300:2123-33.
  35. 35. Vit E/C & MI,Stroke,CV death in PHSII RCT. Sesso HD. JAMA 2008;300:2123-33.
  36. 36. Vitamin B in DM nephropathy
  37. 37. Diabetic Intervention with Vitamins to Improve Nephropathy.RCT (DB, PC). House AA. JAMA 2010;303:1603-09. 5 university medical centers Canada, May 2001-July 2007, 238 type 1 or 2 DM and clinical diagnosis of diabetic nephropathy. 1 tablet of B vitamins: folic acid (2.5 mg/d), vitamin B6 (25 mg/d), vitamin B12 (1 mg/d), or matching placebo. Change in radionuclide GFR at 36 months. Dialysis and composite of MI, stroke, revascularization, and all-cause mortality.
  38. 38. Vit B+folic decrease GFR in DM nephropathy. DIVINE: RCT (DB, PC). House AA. JAMA 2010;303:1603-09.
  39. 39. Vit B+folic increase CV events in DM nephropathy. DIVINE: RCT (DB, PC). House AA. JAMA 2010;303:1603-09.
  40. 40. Take home message: / / / ] [ [< %] /
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