374 results on '"John L, Sievenpiper"'
Search Results
2. The Portfolio Diet and HbA1c in Adults Living with Type 2 Diabetes Mellitus: A Patient-Level Pooled Analysis of Two Randomized Dietary Trials
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Meaghan E. Kavanagh, Songhee Back, Victoria Chen, Andrea J. Glenn, Gabrielle Viscardi, Zeinab Houshialsadat, John L. Sievenpiper, Cyril W. C. Kendall, David J. A. Jenkins, and Laura Chiavaroli
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Portfolio Diet ,dietary portfolio ,diabetes ,glycemic index ,glycaemic index ,glucose control ,Nutrition. Foods and food supply ,TX341-641 - Abstract
(1) Background: The Portfolio Diet, a dietary pattern of cholesterol-lowering foods, is also rich in low glycemic index (GI) foods. While strong evidence supports clinically meaningful reductions in cholesterol, evidence on the relationship between the Portfolio Diet and diabetes management is lacking. (2) Objective: To evaluate the relationship between the Portfolio Diet and glycated hemoglobin (HbA1c) as a determinant of glycemic control among adults living with type 2 diabetes mellitus (T2DM). (3) Methods: Patient-level data was pooled from two randomized dietary trials of low glycemic index interventions compared to high cereal fibre control diets in adults living with T2DM where HbA1c was collected (clinicaltrials.gov identifiers: NCT00438698, NCT00438698). Dietary exposure was assessed using weighed 7-day diet records. Adherence to the Portfolio Diet and its pillars (nuts and seeds, plant protein, viscous fibre, plant sterols, monounsaturated fatty acid [MUFA] oils) was determined using the validated clinical Portfolio Diet Score (c-PDS). Multiple linear regression was used to assess the association between change in the c-PDS and change in HbA1c over 6-months with covariate adjustments. (4) Results: A total of 267 participants, predominantly White (67%) and male (63%), were included, with a mean ± standard error age of 62 ± 0.5 years, baseline BMI of 30.2 ± 0.3 kg/m2, HbA1c of 7.08 ± 0.03%, and a c-PDS of 4.1 ± 0.3 points out of 25. Change in the c-PDS was significantly associated with a change in HbA1c (β: −0.04% per point, 95% CI: −0.07, −0.02, p = 0.001). A 7.5-point (30%) increase in the c-PDS was associated with a 0.3% reduction in HbA1c. Of the individual pillars, a 1-point change in nut and seeds intake (β: −0.07%, 95% CI: −0.12, −0.02, p = 0.009) or in plant protein intake (β: −0.11%, 95% CI: −0.18, −0.03, p = 0.009) was associated with a change in HbA1c. Further analysis of plant protein intake revealed that an increase in dietary pulse intake, a particularly low-GI food, was significantly associated with a reduction in HbA1c (β: −0.24% per 1-cup points cooked pulses (226 g) or 2 c-PDS points, 95% CI: −0.45, −0.03, p = 0.028). (5) Conclusions: Among adults living with T2DM, the Portfolio Diet was associated with lower HbA1c over a 6-month period, predominantly driven by two pillars: nuts and seeds and plant protein, particularly dietary pulses. These data have implications for including the Portfolio Diet in dietary recommendations for glycemic control in T2DM. A trial demonstrating the direct causal effect of the Portfolio Diet in a diverse group is warranted.
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- 2024
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3. Water intake, hydration status and 2-year changes in cognitive performance: a prospective cohort study
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Stephanie K. Nishi, Nancy Babio, Indira Paz-Graniel, Lluís Serra-Majem, Jesús Vioque, Montserrat Fitó, Dolores Corella, Xavier Pintó, Aurora Bueno-Cavanillas, Josep A. Tur, Laura Diez-Ricote, J. Alfredo Martinez, Carlos Gómez-Martínez, Andrés González-Botella, Olga Castañer, Andrea Alvarez-Sala, Cristina Montesdeoca-Mendoza, Marta Fanlo-Maresma, Naomi Cano-Ibáñez, Cristina Bouzas, Lidia Daimiel, María Ángeles Zulet, John L. Sievenpiper, Kelly L. Rodriguez, Zenaida Vázquez-Ruiz, and Jordi Salas-Salvadó
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Hydration ,Water ,Fluids ,Serum osmolarity ,Serum osmolality ,Cognition ,Medicine - Abstract
Abstract Background Water intake and hydration status have been suggested to impact cognition; however, longitudinal evidence is limited and often inconsistent. This study aimed to longitudinally assess the association between hydration status and water intake based on current recommendations, with changes in cognition in an older Spanish population at high cardiovascular disease risk. Methods A prospective analysis was conducted of a cohort of 1957 adults (aged 55–75) with overweight/obesity (BMI between ≥ 27 and < 40 kg/m2) and metabolic syndrome from the PREDIMED-Plus study. Participants had completed bloodwork and validated, semiquantitative beverage and food frequency questionnaires at baseline, as well as an extensive neuropsychological battery of 8 validated tests at baseline and 2 years of follow-up. Hydration status was determined by serum osmolarity calculation and categorized as < 295 mmol/L (hydrated), 295–299.9 mmol/L (impending dehydration), and ≥ 300 mmol/L (dehydrated). Water intake was assessed as total drinking water intake and total water intake from food and beverages and according to EFSA recommendations. Global cognitive function was determined as a composite z-score summarizing individual participant results from all neuropsychological tests. Multivariable linear regression models were fitted to assess the associations between baseline hydration status and fluid intake, continuously and categorically, with 2-year changes in cognitive performance. Results The mean baseline daily total water intake was 2871 ± 676 mL/day (2889 ± 677 mL/day in men; 2854 ± 674 mL/day in women), and 80.2% of participants met the ESFA reference values for an adequate intake. Serum osmolarity (mean 298 ± 24 mmol/L, range 263 to 347 mmol/L) indicated that 56% of participants were physiologically dehydrated. Lower physiological hydration status (i.e., greater serum osmolarity) was associated with a greater decline in global cognitive function z-score over a 2-year period (β: − 0.010; 95% CI − 0.017 to − 0.004, p-value = 0.002). No significant associations were observed between water intake from beverages and/or foods with 2-year changes in global cognitive function. Conclusions Reduced physiological hydration status was associated with greater reductions in global cognitive function over a 2-year period in older adults with metabolic syndrome and overweight or obesity. Future research assessing the impact of hydration on cognitive performance over a longer duration is needed. Trial registration International Standard Randomized Controlled Trial Registry, ISRCTN89898870. Retrospectively registered on 24 July 2014
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- 2023
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4. Lack of Biological Plausibility and Major Methodological Issues Cast Doubt on the Association between Aspartame and Autism. Comment on Fowler et al. Daily Early-Life Exposures to Diet Soda and Aspartame Are Associated with Autism in Males: A Case-Control Study. Nutrients 2023, 15, 3772
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Sabrina Ayoub-Charette, Tauseef Ahmad Khan, Laura Chiavaroli, Bernadene A. Magnuson, and John L. Sievenpiper
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n/a ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The case–control study by Fowler et al [...]
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- 2024
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5. Ultra-processed foods: a concept in need of revision to avoid targeting healthful and sustainable plant-based foods
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Mark J Messina, John L Sievenpiper, Patricia Williamson, Jessica Kiel, and John W Erdman
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Public aspects of medicine ,RA1-1270 ,Nutritional diseases. Deficiency diseases ,RC620-627 - Published
- 2023
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6. The association between parents' stress and parental feeding practices and feeding styles: Systematic review and meta‐analysis of observational studies
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Dina Almaatani, Andreea Zurbau, Farnaz Khoshnevisan, Robert H. J. Bandsma, Tauseef A. Khan, John L. Sievenpiper, and Meta Van Den Heuvel
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child nutrition ,feeding practice ,feeding style ,general stress ,parenting stress ,systematic review ,Pediatrics ,RJ1-570 ,Gynecology and obstetrics ,RG1-991 ,Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract In the extended UNICEF framework of early childhood nutrition, parents' stress is associated with parental feeding style. However, no comprehensive review has examined the association between parents' stress and feeding styles and practices. The objective of our review was to synthesise the current literature examining the association between parents' stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. We searched; MEDLINE, EMBASE, PSYCHINFO and CINAHL from 2019 to 2021. Two investigators independently extracted relevant data and assessed the study quality and the certainty of evidence. Data were pooled using generic inverse variance with fixed effects (
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- 2023
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7. Effect of coadministration of enriched Korean Red Ginseng (Panax ginseng) and American ginseng (Panax quinquefolius L) on cardiometabolic outcomes in type-2 diabetes: A randomized controlled trial
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Elena Jovanovski, Lea Smircic-Duvnjak, Allison Komishon, Fei (Rodney) Au-Yeung, John L. Sievenpiper, Andreea Zurbau, Alexandra L. Jenkins, Mi-Kyung Sung, Robert Josse, Dandan Li, and Vladimir Vuksan
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Ginseng ,Hypertension ,Randomized controlled trial ,Type-2 diabetes ,Botany ,QK1-989 - Abstract
Background: Diabetes mellitus and hypertension often occur together, amplifying cardiovascular disease (CVD) risk and emphasizing the need for a multitargeted treatment approach. American ginseng (AG) and Korean Red Ginseng (KRG) species could improve glycemic control via complementary mechanisms. Additionally, a KRG-inherent component, ginsenoside Rg3, may moderate blood pressure (BP). Our objective was to investigate the therapeutic potential of coadministration of Rg3-enriched Korean Red Ginseng (Rg3-KRG) and AG, added to standard of care therapy, in the management of hypertension and cardiometabolic risk factors in type-2 diabetes. Methods: Within a randomized controlled, parallel design of 80 participants with type-2 diabetes (HbA1c: 6.5–8%) and hypertension (systolic BP: 140–160 mmHg or treated), supplementation with either 2.25 g/day of combined Rg3-KRG + AG or wheat-bran control was assessed over a 12-wk intervention period. The primary endpoint was ambulatory 24-h systolic BP. Additional endpoints included further hemodynamic assessment, glycemic control, plasma lipids and safety monitoring. Results: Combined ginseng intervention generated a mean ± SE decrease in primary endpoint of 24-h systolic BP (−3.98 ± 2.0 mmHg, p = 0.04). Additionally, there was a greater reduction in HbA1c (−0.35 ± 0.1% [–3.8 ± 1.1 mmol/mol], p = 0.02), and change in blood lipids: total cholesterol (−0.50 ± 0.2 mmol/l, p = 0.01), non-HDL-C (−0.54 ± 0.2 mmol/l, p = 0.01), triglycerides (−0.40 ± 0.2 mmol/l, p = 0.02) and LDL-C (−0.35 ± 0.2 mmol/l, p = 0.06) at 12 wks, relative to control. No adverse safety outcomes were observed. Conclusion: Coadministration of Rg3-KRG + AG is an effective addon for improving BP along with attaining favorable cardiometabolic outcomes in individuals with type 2 diabetes. Ginseng derivatives may offer clinical utility when included in the polypharmacy and lifestyle treatment of diabetes. Clinical trial registration: Clinicaltrials.gov identifier, NCT01578837;
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- 2021
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8. Effect of oats and oat ß-glucan on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled trials
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Tauseef A Khan, Fei Au-Yeung, Sonia Blanco Mejia, Lawrence A Leiter, John L Sievenpiper, Cyril W C Kendall, David J A Jenkins, Laura Chiavaroli, Amna Ahmed, Victoria Chen, and Andreea Zurbau
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Introduction Current health claims recognize the ability of oat ß-glucan to lower blood cholesterol; however, its ability to improve glycemic control is less certain. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to update the evidence on the effect of oats and oat ß-glucan on glycemic control in individuals with diabetes.Research design and methods MEDLINE, EMBASE and Cochrane were searched (June 2021) for RCTs of ≥2 weeks investigating the effect of oat ß-glucan on glycemic control in diabetes. The outcomes were hemoglobin A1c (HbA1c), fasting glucose, 2-hour postprandial glucose (2h-PG) from a 75 g oral glucose tolerance test, homeostatic model assessment of insulin resistance (HOMA-IR) and fasting insulin. Independent reviewers extracted the data and assessed the risk of bias. Data were pooled using the generic inverse variance method. Heterogeneity was assessed (Cochran Q) and quantified (I2). Pooled estimates were expressed as mean difference (MD) with 95% CI. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach.Results Eight trial comparisons (n=407) met the eligibility criteria. All trials were in adults with type 2 diabetes who were predominantly middle-aged, overweight and treated by antihyperglycemic medications or insulin. A median dose of 3.25 g of oat ß-glucan for a median duration of 4.5 weeks improved HbA1c (MD, −0.47% (95% CI −0.80 to −0.13), pMD=0.006), fasting glucose (−0.75 mmol/L (−1.20 to –0.31), pMD
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- 2022
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9. Effects of inulin-type fructans supplementation on cardiovascular disease risk factors: a protocol for a systematic review and meta-analysis of randomised controlled trials
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Russell J de Souza, Lawrence Mbuagbaw, John L Sievenpiper, Dena Zeraatkar, Laura Banfield, Vanessa Ha, David J A Jenkins, Jhalok Ronjan Talukdar, Matthew Adam Cooper, Lyuba Lyutvyn, Rahim Ali, Rachel Bierbrier, Sabrina Janes, and Pauline B Darling
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Medicine - Abstract
Introduction This review aims to assess the effects of dietary supplementation with inulin-type fructans (ITF) compared with no supplementation on cardiovascular disease risk factors in adults and assess the quality of trial reporting using the Consolidated Standards of Reporting Trials (CONSORT) and CONSORT for abstract (CONSORT-A) checklists.Methods and analysis We will search randomised controlled trials (RCTs) in MEDLINE, EMBASE, CINAHL, Emcare, AMED and the Cochrane Database of Systematic Reviews from inception to 31 March 2022, without any language restrictions. The RCTs need to administer ITF in adults for at least 2 weeks and assess effects on at least one cardiovascular risk factor. We will exclude RCTs that (1) assessed the postprandial effects of ITF; (2) included pregnant or lactating participants; (3) enrolled participants undergoing treatment that might affect the response to ITF. We will assess the study risk of bias (RoB) using V.2 of the Cochrane RoB tool for RCTs (RoB 2) and the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We will pool data using a random-effects model. We will use the χ2 test to compare compliance of CONSORT and CONSORT-A checklists and Poisson regression to identify factors associated with better reporting.Ethics and dissemination Ethics approval is not required for secondary analysis of already published data. We will publish the reviews in a peer-review journal.PROSPERO registration number CRD42019136745.
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- 2022
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10. Meal Replacements for Weight-Related Complications in Type 2 Diabetes: What Is the State of the Evidence?
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Jarvis C. Noronha, Cyril WC. Kendall, and John L. Sievenpiper
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meal replacement ,lifestyle intervention program ,cardiometabolic risk factors ,diabetes ,dietary patterns ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Comprehensive lifestyle management is a fundamental aspect of diabetes care. Clinical practice guidelines for the nutritional management of diabetes have evolved considerably over the last 25 years shifting from a focus on single nutrients to food- and dietary pattern-based recommendations. Use of meal replacements as a temporary short-term strategy to induce weight loss and then transitioning to a healthier dietary pattern (e.g., Mediterranean or Portfolio) for weight loss maintenance fits well with this new shift in focus of clinical practice guidelines. As adherence is the most important determinant for attaining the benefits of any diet, health professionals should recommend evidence-based dietary patterns (including meal replacements) that align best with the patient’s values, preferences, and treatment goals.
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- 2022
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11. Rationale, Design and Participants Baseline Characteristics of a Crossover Randomized Controlled Trial of the Effect of Replacing SSBs with NSBs versus Water on Glucose Tolerance, Gut Microbiome and Cardiometabolic Risk in Overweight or Obese Adult SSB Consumer: Strategies to Oppose SUGARS with Non-Nutritive Sweeteners or Water (STOP Sugars NOW) Trial and Ectopic Fat Sub-Study
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Sabrina Ayoub-Charette, Néma D. McGlynn, Danielle Lee, Tauseef Ahmad Khan, Sonia Blanco Mejia, Laura Chiavaroli, Meaghan E. Kavanagh, Maxine Seider, Amel Taibi, Chuck T. Chen, Amna Ahmed, Rachel Asbury, Madeline Erlich, Yue-Tong Chen, Vasanti S. Malik, Richard P. Bazinet, D. Dan Ramdath, Caomhan Logue, Anthony J. Hanley, Cyril W. C. Kendall, Lawrence A. Leiter, Elena M. Comelli, and John L. Sievenpiper
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low- and no-calorie sweeteners ,sweetening agents ,sugar-sweetened beverages ,water ,randomized controlled trial ,type 2 diabetes ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: Health authorities are near universal in their recommendation to replace sugar-sweetened beverages (SSBs) with water. Non-nutritive sweetened beverages (NSBs) are not as widely recommended as a replacement strategy due to a lack of established benefits and concerns they may induce glucose intolerance through changes in the gut microbiome. The STOP Sugars NOW trial aims to assess the effect of the substitution of NSBs (the “intended substitution”) versus water (the “standard of care substitution”) for SSBs on glucose tolerance and microbiota diversity. Design and Methods: The STOP Sugars NOW trial (NCT03543644) is a pragmatic, “head-to-head”, open-label, crossover, randomized controlled trial conducted in an outpatient setting. Participants were overweight or obese adults with a high waist circumference who regularly consumed ≥1 SSBs daily. Each participant completed three 4-week treatment phases (usual SSBs, matched NSBs, or water) in random order, which were separated by ≥4-week washout. Blocked randomization was performed centrally by computer with allocation concealment. Outcome assessment was blinded; however, blinding of participants and trial personnel was not possible. The two primary outcomes are oral glucose tolerance (incremental area under the curve) and gut microbiota beta-diversity (weighted UniFrac distance). Secondary outcomes include related markers of adiposity and glucose and insulin regulation. Adherence was assessed by objective biomarkers of added sugars and non-nutritive sweeteners and self-report intake. A subset of participants was included in an Ectopic Fat sub-study in which the primary outcome is intrahepatocellular lipid (IHCL) by 1H-MRS. Analyses will be according to the intention to treat principle. Baseline results: Recruitment began on 1 June 2018, and the last participant completed the trial on 15 October 2020. We screened 1086 participants, of whom 80 were enrolled and randomized in the main trial and 32 of these were enrolled and randomized in the Ectopic Fat sub-study. The participants were predominantly middle-aged (mean age 41.8 ± SD 13.0 y) and had obesity (BMI of 33.7 ± 6.8 kg/m2) with a near equal ratio of female: male (51%:49%). The average baseline SSB intake was 1.9 servings/day. SSBs were replaced with matched NSB brands, sweetened with either a blend of aspartame and acesulfame-potassium (95%) or sucralose (5%). Conclusions: Baseline characteristics for both the main and Ectopic Fat sub-study meet our inclusion criteria and represent a group with overweight or obesity, with characteristics putting them at risk for type 2 diabetes. Findings will be published in peer-reviewed open-access medical journals and provide high-level evidence to inform clinical practice guidelines and public health policy for the use NSBs in sugars reduction strategies. Trial registration: ClinicalTrials.gov identifier, NCT03543644.
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- 2023
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12. Nuts and Cardiovascular Disease Outcomes: A Review of the Evidence and Future Directions
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Andrea J. Glenn, Dagfinn Aune, Heinz Freisling, Noushin Mohammadifard, Cyril W. C. Kendall, Jordi Salas-Salvadó, David J. A. Jenkins, Frank B. Hu, and John L. Sievenpiper
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tree nuts ,peanuts ,nutrition ,cardiovascular diseases ,review ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Nuts are nutrient-rich foods that contain many bioactive compounds that are beneficial for cardiovascular health. Higher consumption of nuts has been associated with a reduced risk of several cardiovascular diseases (CVD) in prospective cohort studies, including a 19% and 25% lower risk of CVD incidence and mortality, respectively, and a 24% and 27% lower risk of coronary heart disease incidence and mortality, respectively. An 18% lower risk of stroke mortality, a 15% lower risk of atrial fibrillation, and a 19% lower risk of total mortality have also been observed. The role of nuts in stroke incidence, stroke subtypes, peripheral arterial disease and heart failure has been less consistent. This narrative review summarizes recommendations for nuts by clinical practice guidelines and governmental organizations, epidemiological evidence for nuts and CVD outcomes, nut-containing dietary patterns, potential mechanisms of nuts and CVD risk reduction, and future research directions, such as the use of biomarkers to help better assess nut intake. Although there are still some uncertainties around nuts and CVD prevention which require further research, as summarized in this review, there is a substantial amount of evidence that supports that consuming nuts will have a positive impact on primary and secondary prevention of CVD.
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- 2023
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13. The Effect of Non-Nutritive Sweetened Beverages on Postprandial Glycemic and Endocrine Responses: A Systematic Review and Network Meta-Analysis
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Roselyn Zhang, Jarvis C. Noronha, Tauseef A. Khan, Néma McGlynn, Songhee Back, Shannan M. Grant, Cyril W. C. Kendall, and John L. Sievenpiper
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non-nutritive sweetened beverages ,sugar-sweetened beverages ,postprandial ,glucose ,insulin ,GLP-1 ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: There has been an emerging concern that non-nutritive sweeteners (NNS) can increase the risk of cardiometabolic disease. Much of the attention has focused on acute metabolic and endocrine responses to NNS. To examine whether these mechanisms are operational under real-world scenarios, we conducted a systematic review and network meta-analysis of acute trials comparing the effects of non-nutritive sweetened beverages (NNS beverages) with water and sugar-sweetened beverages (SSBs) in humans. Methods: MEDLINE, EMBASE, and The Cochrane Library were searched through to January 15, 2022. We included acute, single-exposure, randomized, and non-randomized, clinical trials in humans, regardless of health status. Three patterns of intake were examined: (1) uncoupling interventions, where NNS beverages were consumed alone without added energy or nutrients; (2) coupling interventions, where NNS beverages were consumed together with added energy and nutrients as carbohydrates; and (3) delayed coupling interventions, where NNS beverages were consumed as a preload prior to added energy and nutrients as carbohydrates. The primary outcome was a 2 h incremental area under the curve (iAUC) for blood glucose concentration. Secondary outcomes included 2 h iAUC for insulin, glucagon-like peptide 1 (GLP-1), gastric inhibitory polypeptide (GIP), peptide YY (PYY), ghrelin, leptin, and glucagon concentrations. Network meta-analysis and confidence in the network meta-analysis (CINeMA) were conducted in R-studio and CINeMA, respectively. Results: Thirty-six trials involving 472 predominantly healthy participants were included. Trials examined a variety of single NNS (acesulfame potassium, aspartame, cyclamate, saccharin, stevia, and sucralose) and NNS blends (acesulfame potassium + aspartame, acesulfame potassium + sucralose, acesulfame potassium + aspartame + cyclamate, and acesulfame potassium + aspartame + sucralose), along with matched water/unsweetened controls and SSBs sweetened with various caloric sugars (glucose, sucrose, and fructose). In uncoupling interventions, NNS beverages (single or blends) had no effect on postprandial glucose, insulin, GLP-1, GIP, PYY, ghrelin, and glucagon responses similar to water controls (generally, low to moderate confidence), whereas SSBs sweetened with caloric sugars (glucose and sucrose) increased postprandial glucose, insulin, GLP-1, and GIP responses with no differences in postprandial ghrelin and glucagon responses (generally, low to moderate confidence). In coupling and delayed coupling interventions, NNS beverages had no postprandial glucose and endocrine effects similar to controls (generally, low to moderate confidence). Conclusions: The available evidence suggests that NNS beverages sweetened with single or blends of NNS have no acute metabolic and endocrine effects, similar to water. These findings provide support for NNS beverages as an alternative replacement strategy for SSBs in the acute postprandial setting.
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- 2023
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14. Nuts in the Prevention and Management of Type 2 Diabetes
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Stephanie K. Nishi, Effie Viguiliouk, Cyril W. C. Kendall, David J. A. Jenkins, Frank B. Hu, John L. Sievenpiper, Alessandro Atzeni, Anoop Misra, and Jordi Salas-Salvadó
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nuts ,diabetes ,glycemic control ,insulin resistance ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Diabetes is a continuously growing global concern affecting >10% of adults, which may be mitigated by modifiable lifestyle factors. Consumption of nuts and their inclusion in dietary patterns has been associated with a range of beneficial health outcomes. Diabetes guidelines recommend dietary patterns that incorporate nuts; however, specific recommendations related to nuts have been limited. This review considers the epidemiological and clinical evidence to date for the role of nut consumption as a dietary strategy for the prevention and management of type 2 diabetes (T2D) and related complications. Findings suggest nut consumption may have a potential role in the prevention and management of T2D, with mechanistic studies assessing nuts and individual nut-related nutritional constituents supporting this possibility. However, limited definitive evidence is available to date, and future studies are needed to elucidate better the impact of nuts on the prevention and management of T2D.
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- 2023
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15. A Web-Based Health Application to Translate Nutrition Therapy for Cardiovascular Risk Reduction in Primary Care (PortfolioDiet.app): Quality Improvement and Usability Testing Study
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Meaghan E Kavanagh, Laura Chiavaroli, Andrea J Glenn, Genevieve Heijmans, Shannan M Grant, Chi-Ming Chow, Robert G Josse, Vasanti S Malik, William Watson, Aisha Lofters, Candice Holmes, Julia Rackal, Kristie Srichaikul, Diana Sherifali, Erna Snelgrove-Clarke, Jacob A Udell, Peter Juni, Gillian L Booth, Michael E Farkouh, Lawrence A Leiter, Cyril W C Kendall, David J A Jenkins, and John L Sievenpiper
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Medical technology ,R855-855.5 - Abstract
BackgroundThe Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for PCs and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure that the PortfolioDiet.app meets the needs of its target end users. ObjectiveThe main objective of this project is to undertake user testing to inform modifications to the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). MethodsWe undertook a 2-phase QI project from February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, and dietitians, as well as nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for 7 days. In phase 1, a mixed-form questionnaire was administered to evaluate the users’ perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative and qualitative data, including 2 open-ended questions. The responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale was used to assess the usability of the updated PortfolioDiet.app, with a score higher than 70 being considered acceptable. ResultsA total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. In phase 1, the PortfolioDiet.app increased users’ perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Limitations identified by users included challenges navigating to resources and profile settings, limited information on plant sterols, inaccuracies in points, timed-logout frustration, request for step-by-step pop-up windows, and request for a mobile app version; when looking at positive feedback, the recipe section was the most commonly praised feature. Between the project phases, 6 modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average System Usability Scale score was 85.39 (SD 11.47), with 100 being the best possible. ConclusionsBy undertaking user testing of the PortfolioDiet.app, its limitations and strengths were able to be identified, informing modifications to the application, which resulted in a clinical tool that better meets users’ needs. The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. Although further refinements to the PortfolioDiet.app will continue to be made before its evaluation in a clinical trial, the result of this QI project is an improved clinical tool.
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- 2022
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16. Commentary: Dietary Glutamic Acid, Obesity, and Depressive Symptoms in Patients With Schizophrenia
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Tauseef A. Khan, John L. Sievenpiper, and John D. Fernstrom
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diet ,dietary protein ,glutamic acid ,MSG ,obesity ,schizophrenia ,Psychiatry ,RC435-571 - Published
- 2021
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17. Relationship Between a Plant‐Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study
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Andrea J. Glenn, Kenneth Lo, David J. A. Jenkins, Beatrice A. Boucher, Anthony J. Hanley, Cyril W. C. Kendall, JoAnn E. Manson, Mara Z. Vitolins, Linda G. Snetselaar, Simin Liu, and John L. Sievenpiper
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cardiovascular disease ,dietary patterns ,dietary portfolio ,plant‐based ,prospective cohort study ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background The plant‐based Dietary Portfolio combines established cholesterol‐lowering foods (plant protein, nuts, viscous fiber, and phytosterols), plus monounsaturated fat, and has been shown to improve low‐density lipoprotein cholesterol and other cardiovascular disease (CVD) risk factors. No studies have evaluated the relation of the Dietary Portfolio with incident CVD events. Methods and Results We followed 123 330 postmenopausal women initially free of CVD in the Women's Health Initiative from 1993 through 2017. We used Cox proportional‐hazard models to estimate adjusted hazard ratios (HRs) and 95% CI of the association of adherence to a Portfolio Diet score with CVD outcomes. Primary outcomes were total CVD, coronary heart disease, and stroke. Secondary outcomes were heart failure and atrial fibrillation. Over a mean follow‐up of 15.3 years, 13 365 total CVD, 5640 coronary heart disease, 4440 strokes, 1907 heart failure, and 929 atrial fibrillation events occurred. After multiple adjustments, adherence to the Portfolio Diet score was associated with lower risk of total CVD (HR, 0.89; 95% CI, 0.83–0.94), coronary heart disease (HR, 0.86; 95% CI, 0.78–0.95), and heart failure (HR, 0.83; 95% CI, 0.71–0.99), comparing the highest to lowest quartile of adherence. There was no association with stroke (HR, 0.97; 95% CI, 0.87–1.08) or atrial fibrillation (HR, 1.10; 95% CI, 0.87–1.38). These results remained statistically significant after several sensitivity analyses. Conclusions In this prospective cohort of postmenopausal women in the United States, higher adherence to the Portfolio Diet was associated with a reduction in incident cardiovascular and coronary events, as well as heart failure. These findings warrant further investigation in other populations.
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- 2021
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18. Nutraceuticals and Functional Foods for Cholesterol Reduction
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David J.A. Jenkins, Laura Chiavaroli, Arash Mirrahimi, Kristie Srichaikul, Julia M.W. Wong, Peter Jones, Darshna Patel, Cyril W.C. Kendall, and John L. Sievenpiper
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- 2024
19. Contributors
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Ali M. Agha, Lydia C. Alexander, Christie M. Ballantyne, Harold Bays, Deepak L. Bhatt, Roger S. Blumenthal, Michael B. Boffa, Rachel M. Bond, Julia M. Brandts, Eliot A. Brinton, Julie A. Brothers, Alberico L. Catapano, Dick C. Chan, Laura Chiavaroli, Laura Browning Cho, Leslie Cho, Danielle Cummings, Stephen R. Daniels, Matthew R. Deshotels, Erik Dove, David I. Feldman, Bengt Fellström, Keith C. Ferdinand, Carl J. Fichtenbaum, Angela Fitch, Daniel Gaudet, Henry N. Ginsberg, Ty J. Gluckman, Robert A. Hegele, Ron C. Hoogeveen, Aliza Hussain, Alan G. Jardine, David J.A. Jenkins, Peter H. Jones, Peter Jones, Sergey M. Kachur, Cyril W.C. Kendall, Joshua W. Knowles, Jon A. Kobashigawa, Marlys L. Koschinsky, Penny M. Kris-Etherton, Carl J. Lavie, Peter Libby, Santica M. Marcovina, Patrick B. Mark, Nicholas A. Marston, Seth Shay Martin, Erin D. Michos, Arash Mirrahimi, Samia Mora, Patrick M. Moriarty, Vijay Nambi, Adam J. Nelson, Stephen J. Nicholls, Steven E. Nissen, Børge Grønne Nordestgaard, Giuseppe Danilo Norata, Carl Orringer, Brian T. Palmisano, Darshna Patel, Rajan K. Patel, Vishnu Priya Pulipati, Frederick J. Raal, Daniel J. Rader, Kausik K. Ray, Chesney Richter, Paul M. Ridker, Marc S. Sabatine, Maya S. Safarova, Raul D. Santos, Joseph J. Saseen, Gregory G. Schwartz, Rachel J. Shustak, John L. Sievenpiper, Nickpreet Singh, Ann C. Skulas-Ray, Kristie Srichaikul, Neil J. Stone, Lale Tokgözoğlu, Anne Tybjærg-Hansen, Salim S. Virani, Karol Watson, Gerald F. Watts, Nanette K. Wenger, and Julia M.W. Wong
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- 2024
20. Effect of Important Food Sources of Fructose-Containing Sugars on Inflammatory Biomarkers: A Systematic Review and Meta-Analysis of Controlled Feeding Trials
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XinYe Qi, Laura Chiavaroli, Danielle Lee, Sabrina Ayoub-Charette, Tauseef A. Khan, Fei Au-Yeung, Amna Ahmed, Annette Cheung, Qi Liu, Sonia Blanco Mejia, Vivian L. Choo, Russell J. de Souza, Thomas M. S. Wolever, Lawrence A. Leiter, Cyril W. C. Kendall, David J. A. Jenkins, and John L. Sievenpiper
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inflammation ,CRP ,fructose ,sugars ,food sources ,fruit ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: Fructose-containing sugars as sugar-sweetened beverages (SSBs) may increase inflammatory biomarkers. Whether this effect is mediated by the food matrix at different levels of energy is unknown. To investigate the role of food source and energy, we conducted a systematic review and meta-analysis of controlled trials on the effect of different food sources of fructose-containing sugars on inflammatory markers at different levels of energy control. Methods: MEDLINE, Embase, and the Cochrane Library were searched through March 2022 for controlled feeding trials ≥ 7 days. Four trial designs were prespecified by energy control: substitution (energy matched replacement of sugars); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced). The primary outcome was C-reactive protein (CRP). Secondary outcomes were tumour necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). Independent reviewers extracted data and assessed risk of bias. GRADE assessed certainty of evidence. Results: We identified 64 controlled trials (91 trial comparisons, n = 4094) assessing 12 food sources (SSB; sweetened dairy; sweetened dairy alternative [soy]; 100% fruit juice; fruit; dried fruit; mixed fruit forms; sweetened cereal grains and bars; sweets and desserts; added nutritive [caloric] sweetener; mixed sources [with SSBs]; and mixed sources [without SSBs]) at 4 levels of energy control over a median 6-weeks in predominantly healthy mixed weight or overweight/obese adults. Total fructose-containing sugars decreased CRP in addition trials and had no effect in substitution, subtraction or ad libitum trials. No effect was observed on other outcomes at any level of energy control. There was evidence of interaction/influence by food source: substitution trials (sweetened dairy alternative (soy) and 100% fruit juice decreased, and mixed sources (with SSBs) increased CRP); and addition trials (fruit decreased CRP and TNF-α; sweets and desserts (dark chocolate) decreased IL-6). The certainty of evidence was moderate-to-low for the majority of analyses. Conclusions: Food source appears to mediate the effect of fructose-containing sugars on inflammatory markers over the short-to-medium term. The evidence provides good indication that mixed sources that contain SSBs increase CRP, while most other food sources have no effect with some sources (fruit, 100% fruit juice, sweetened soy beverage or dark chocolate) showing decreases, which may be dependent on energy control. Clinicaltrials.gov: (NCT02716870).
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- 2022
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21. Important Food Sources of Fructose-Containing Sugars and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Controlled Trials
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Danielle Lee, Laura Chiavaroli, Sabrina Ayoub-Charette, Tauseef A. Khan, Andreea Zurbau, Fei Au-Yeung, Annette Cheung, Qi Liu, Xinye Qi, Amna Ahmed, Vivian L. Choo, Sonia Blanco Mejia, Vasanti S. Malik, Ahmed El-Sohemy, Russell J. de Souza, Thomas M. S. Wolever, Lawrence A. Leiter, Cyril W. C. Kendall, David J. A. Jenkins, and John L. Sievenpiper
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alanine aminotransferase ,aspartate aminotransferase ,intrahepatocellular lipid ,non-alcoholic fatty liver disease ,sugars ,sugar-sweetened beverages ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: Fructose providing excess calories in the form of sugar sweetened beverages (SSBs) increases markers of non-alcoholic fatty liver disease (NAFLD). Whether this effect holds for other important food sources of fructose-containing sugars is unclear. To investigate the role of food source and energy, we conducted a systematic review and meta-analysis of controlled trials of the effect of fructose-containing sugars by food source at different levels of energy control on non-alcoholic fatty liver disease (NAFLD) markers. Methods and Findings: MEDLINE, Embase, and the Cochrane Library were searched through 7 January 2022 for controlled trials ≥7-days. Four trial designs were prespecified: substitution (energy-matched substitution of sugars for other macronutrients); addition (excess energy from sugars added to diets); subtraction (excess energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients). The primary outcome was intrahepatocellular lipid (IHCL). Secondary outcomes were alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Independent reviewers extracted data and assessed risk of bias. The certainty of evidence was assessed using GRADE. We included 51 trials (75 trial comparisons, n = 2059) of 10 food sources (sugar-sweetened beverages (SSBs); sweetened dairy alternative; 100% fruit juice; fruit; dried fruit; mixed fruit sources; sweets and desserts; added nutritive sweetener; honey; and mixed sources (with SSBs)) in predominantly healthy mixed weight or overweight/obese younger adults. Total fructose-containing sugars increased IHCL (standardized mean difference = 1.72 [95% CI, 1.08 to 2.36], p < 0.001) in addition trials and decreased AST in subtraction trials with no effect on any outcome in substitution or ad libitum trials. There was evidence of influence by food source with SSBs increasing IHCL and ALT in addition trials and mixed sources (with SSBs) decreasing AST in subtraction trials. The certainty of evidence was high for the effect on IHCL and moderate for the effect on ALT for SSBs in addition trials, low for the effect on AST for the removal of energy from mixed sources (with SSBs) in subtraction trials, and generally low to moderate for all other comparisons. Conclusions: Energy control and food source appear to mediate the effect of fructose-containing sugars on NAFLD markers. The evidence provides a good indication that the addition of excess energy from SSBs leads to large increases in liver fat and small important increases in ALT while there is less of an indication that the removal of energy from mixed sources (with SSBs) leads to moderate reductions in AST. Varying uncertainty remains for the lack of effect of other important food sources of fructose-containing sugars at different levels of energy control.
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- 2022
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22. Important food sources of fructose-containing sugars and adiposity: A systematic review and meta-analysis of controlled feeding trials
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Laura Chiavaroli, Annette Cheung, Sabrina Ayoub-Charette, Amna Ahmed, Danielle Lee, Fei Au-Yeung, XinYe Qi, Songhee Back, Néma McGlynn, Vanessa Ha, Ethan Lai, Tauseef A. Khan, Sonia Blanco Mejia, Andreea Zurbau, Vivian L. Choo, Russell J. de Souza, Thomas MS. Wolever, Lawrence A. Leiter, Cyril WC. Kendall, David JA. Jenkins, and John L. Sievenpiper
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Nutrition and Dietetics ,Medicine (miscellaneous) - Published
- 2023
23. The Environmental Sustainability of Plant-Based Dietary Patterns: A Scoping Review
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Cassandra N. Carey, Melanie Paquette, Sandhya Sahye-Pudaruth, Abolfazl Dadvar, Dorothy Dinh, Khosrow Khodabandehlou, Fred Liang, Ekta Mishra, Mandeep Sidhu, Ramon Brown, Shilpa Tandon, Jessica Wanyan, Richard P. Bazinet, Anthony J. Hanley, Vasanti Malik, John L. Sievenpiper, and David JA. Jenkins
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Nutrition and Dietetics ,Medicine (miscellaneous) - Published
- 2023
24. Combination of Multiple Low-Risk Lifestyle Behaviors and Incident Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies
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Tauseef A. Khan, David Field, Victoria Chen, Suleman Ahmad, Sonia Blanco Mejia, Hana Kahleová, Dario Rahelić, Jordi Salas-Salvadó, Lawrence A. Leiter, Matti Uusitupa, Cyril W.C. Kendall, and John L. Sievenpiper
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Advanced and Specialized Nursing ,Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
OBJECTIVECombined low-risk lifestyle behaviors (LRLBs) have been associated with a reduction in type 2 diabetes risk. This relationship has not been systematically quantified.RESEARCH DESIGN AND METHODSA systematic review and meta-analysis was conducted to assess the association of combined LRLBs with type 2 diabetes. Databases were searched up to September 2022. Prospective cohort studies reporting the association between a minimum of three combined LRLBs (including healthy diet) with incident type 2 diabetes were included. Independent reviewers extracted data and assessed study quality. Risk estimates of extreme comparisons were pooled using a random-effects model. Global dose-response meta-analysis (DRM) for maximum adherence was estimated using a one-stage linear mixed model. The certainty of the evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).RESULTSThirty cohort comparisons (n = 1,693,753) involving 75,669 incident type 2 diabetes cases were included. LRLBs, with author-defined ranges, were healthy body weight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption. LRLBs were associated with 80% lower risk of type 2 diabetes (relative risk [RR] 0.20; 95% CI 0.17–0.23), comparing the highest with lowest adherence. Global DRM for maximum adherence to all five LRLBs reached 85% protection (RR 0.15; 95% CI 0.12–0.18). The overall certainty of the evidence was graded as high.CONCLUSIONSThere is a very good indication that a combination of LRLBs that includes maintaining a healthy bodyweight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption is associated with a lower risk of incident type 2 diabetes.
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- 2023
25. Sugar-sweetened beverage consumption and weight gain in children and adults: a systematic review and meta-analysis of prospective cohort studies and randomized controlled trials
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Michelle Nguyen, Sarah E. Jarvis, Maria G. Tinajero, Jiayue Yu, Laura Chiavaroli, Sonia Blanco Mejia, Tauseef A. Khan, Deirdre K. Tobias, Walter C. Willett, Frank B. Hu, Anthony J. Hanley, Catherine S. Birken, John L. Sievenpiper, and Vasanti S. Malik
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Nutrition and Dietetics ,Medicine (miscellaneous) - Published
- 2023
26. Glycemic Index Versus Wheat Fiber on Arterial Wall Damage in Diabetes: A Randomized Controlled Trial
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David J.A. Jenkins, Laura Chiavaroli, Arash Mirrahimi, Sandra Mitchell, Dorothea Faulkner, Sandhya Sahye-Pudaruth, Melanie Paquette, Judy Coveney, Omodele Olowoyeye, Darshna Patel, Sathish Chandra Pichika, Balachandran Bashyam, Tishan Maraj, Chantal Gillett, Russell J. de Souza, Livia S.A. Augustin, Sonia Blanco Mejia, Stephanie K. Nishi, Lawrence A. Leiter, Robert G. Josse, Gail E. McKeown-Eyssen, Alan R. Berger, Philip W. Connelly, Korbua Srichaikul, Cyril W.C. Kendall, John L. Sievenpiper, and Alan R. Moody
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Male ,Dietary Fiber ,Blood Glucose ,Advanced and Specialized Nursing ,Diabetes Mellitus, Type 2 ,Glycemic Index ,Cardiovascular Diseases ,Endocrinology, Diabetes and Metabolism ,Internal Medicine ,Humans ,Female ,Triticum ,Diet - Abstract
OBJECTIVE High cereal fiber and low-glycemic index (GI) diets are associated with reduced cardiovascular disease (CVD) risk in cohort studies. Clinical trial evidence on event incidence is lacking. Therefore, to make trial outcomes more directly relevant to CVD, we compared the effect on carotid plaque development in diabetes of a low-GI diet versus a whole-grain wheat-fiber diet. RESEARCH DESIGN AND METHODS The study randomized 169 men and women with well-controlled type 2 diabetes to counseling on a low GI-diet or whole-grain wheat-fiber diet for 3 years. Change in carotid vessel wall volume (VWV) (prespecified primary end point) was assessed by MRI as an indication of arterial damage. RESULTS Of 169 randomized participants, 134 completed the study. No treatment differences were seen in VWV. However, on the whole-grain wheat-fiber diet, VWV increased significantly from baseline, 23 mm3 (95% CI 4, 41; P = 0.016), but not on the low-GI diet, 8 mm3 (95% CI −10, 26; P = 0.381). The low-GI diet resulted in preservation of renal function, as estimated glomerular filtration rate, compared with the reduction following the wheat-fiber diet. HbA1c was modestly reduced over the first 9 months in the intention-to-treat analysis and extended with greater compliance to 15 months in the per-protocol analysis. CONCLUSIONS Since the low-GI diet was similar to the whole-grain wheat-fiber diet recommended for cardiovascular risk reduction, the low-GI diet may also be effective for CVD risk reduction.
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- 2022
27. Low-carbohydrate vegan diets in diabetes for weight loss and sustainability: a randomized controlled trial
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David J A, Jenkins, Peter J H, Jones, Mohammad M H, Abdullah, Benoit, Lamarche, Dorothea, Faulkner, Darshna, Patel, Sandhya, Sahye-Pudaruth, Melanie, Paquette, Balachandran, Bashyam, Sathish C, Pichika, Meaghan E, Kavanagh, Pooja, Patel, Fred, Liang, Ramon, Brown, Tiffany, Zhao, Mila, Phan, Gajuna, Mathiyalagan, Shilpa, Tandon, Vladmir, Vuksan, Elena, Jovanovski, John L, Sievenpiper, Cyril W C, Kendall, Lawrence A, Leiter, and Robert G, Josse
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Nutrition and Dietetics ,Medicine (miscellaneous) - Abstract
Low-carbohydrate, high animal fat and protein diets have been promoted for weight loss and diabetes treatment. We therefore tested the effect of a low-carbohydrate vegan diet in diabetes as a potentially healthier and more ecologically sustainable low-carbohydrate option.We sought to compare the effectiveness of a low-carbohydrate vegan diet with a moderate-carbohydrate vegetarian diet on weight loss and metabolic measures in diabetes.One hundred and sixty-four male and female participants with type 2 diabetes were randomly assigned to advice on either a low-carbohydrate vegan diet, high in canola oil and plant proteins, or a vegetarian therapeutic diet, for 3 mo, with both diets recommended at 60% of calorie requirements. Body weight, fasting blood, blood pressure, and 7-d food records, to estimate potential greenhouse gas emissions, were obtained throughout the study with tests of cholesterol absorption undertaken at baseline and end of study on 50 participants.Both low-carbohydrate vegan and vegetarian diets similarly but markedly reduced body weight (-5.9 kg; 95% CI: -6.5, -5.28 kg; and -5.23 kg; 95% CI: -5.84, -4.62 kg), glycated hemoglobin (-0.99%; 95% CI: -1.07, -0.9%; and -0.88%; 95% CI: -0.97, -0.8%), systolic blood pressure (-4 mmHg; 95% CI: -7, -2 mmHg; and -6 mmHg; 95% CI: -8, -3 mmHg), and potential greenhouse gas emissions, but only for potential greenhouse gas emissions was there a significant treatment difference of -0.63 kgCO2/d (95% CI: -0.99, -0.27 kgCO2/d) favoring the low-carbohydrate vegan diet.Low-carbohydrate vegan and vegetarian diets reduced body weight, improved glycemic control and blood pressure, but the more plant-based diet had greater potential reduction in greenhouse gas emissions.Trial registration number: clinicaltrials.gov identifier NCT02245399.
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- 2022
28. Relation of Different Fruit and Vegetable Sources With Incident Cardiovascular Outcomes: A Systematic Review and Meta‐Analysis of Prospective Cohort Studies
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Andreea Zurbau, Fei Au‐Yeung, Sonia Blanco Mejia, Tauseef A. Khan, Vladimir Vuksan, Elena Jovanovski, Lawrence A. Leiter, Cyril W. C. Kendall, David J. A. Jenkins, and John L. Sievenpiper
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cardiovascular outcomes ,cohort ,fruit ,nutrition ,vegetables ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Public health policies reflect concerns that certain fruit sources may not have the intended benefits and that vegetables should be preferred to fruit. We assessed the relation of fruit and vegetable sources with cardiovascular outcomes using a systematic review and meta‐analysis of prospective cohort studies. Methods and Results MEDLINE, EMBASE, and Cochrane were searched through June 3, 2019. Two independent reviewers extracted data and assessed study quality (Newcastle‐Ottawa Scale). Data were pooled (fixed effects), and heterogeneity (Cochrane‐Q and I2) and certainty of the evidence (Grading of Recommendations Assessment, Development, and Evaluation) were assessed. Eighty‐one cohorts involving 4 031 896 individuals and 125 112 cardiovascular events were included. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (risk ratio, 0.93 [95% CI, 0.89–0.96]; 0.91 [0.88–0.95]; and 0.94 [0.90–0.97], respectively), coronary heart disease (0.88 [0.83–0.92]; 0.88 [0.84–0.92]; and 0.92 [0.87–0.96], respectively), and stroke (0.82 [0.77–0.88], 0.82 [0.79–0.85]; and 0.88 [0.83–0.93], respectively) incidence. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (0.89 [0.85–0.93]; 0.88 [0.86–0.91]; and 0.87 [0.85–0.90], respectively), coronary heart disease (0.81 [0.72–0.92]; 0.86 [0.82–0.90]; and 0.86 [0.83–0.89], respectively), and stroke (0.73 [0.65–0.81]; 0.87 [0.84–0.91]; and 0.94 [0.90–0.99], respectively) mortality. There were greater benefits for citrus, 100% fruit juice, and pommes among fruit sources and allium, carrots, cruciferous, and green leafy among vegetable sources. No sources showed an adverse association. The certainty of the evidence was “very low” to “moderate,” with the highest for total fruit and/or vegetables, pommes fruit, and green leafy vegetables. Conclusions Fruits and vegetables are associated with cardiovascular benefit, with some sources associated with greater benefit and none showing an adverse association. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03394339.
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- 2020
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29. Important Food Sources of Fructose‐Containing Sugars and Incident Hypertension: A Systematic Review and Dose‐Response Meta‐Analysis of Prospective Cohort Studies
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Qi Liu, Sabrina Ayoub‐Charette, Tauseef Ahmad Khan, Fei Au‐Yeung, Sonia Blanco Mejia, Russell J. de Souza, Thomas M.S. Wolever, Lawrence A. Leiter, Cyril W.C. Kendall, and John L. Sievenpiper
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dairy ,fruit ,fruit juice ,hypertension ,SSBs ,yogurt ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Sugar‐sweetened beverages are associated with hypertension. We assessed the relation of important food sources of fructose‐containing sugars with incident hypertension using a systematic review and meta‐analysis of prospective cohort studies. Methods and Results We searched MEDLINE, EMBASE, and Cochrane (through December week 2, 2018) for eligible studies. For each food source, natural log‐transformed risk ratios (RRs) for incident hypertension were pooled using pair‐wise meta‐analysis and linear and nonlinear dose‐response meta‐analyses. Certainty in our evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. We identified 26 reports, including 15 prospective cohorts (930 677 participants; 363 459 cases). Sugar‐sweetened beverages showed harmful (RRper‐355‐mL, 1.10 [95% CI, 1.08, 1.12]) whereas fruit (RRper‐240‐g, 0.94 [95% CI, 0.96, 0.99]) and yogurt showed protective associations (RRper‐125‐g, 0.95 [95% CI, 0.94, 0.97]) with incident hypertension throughout the dose range. One hundred percent fruit juice showed a protective association only at moderate doses (RRat‐100‐mL, 0.97 [95% CI, 0.94, 0.99]). The pair‐wise protective association of dairy desserts was not supported by linear dose‐response analysis. Fruit drinks or sweet snacks were not associated with hypertension. Certainty of the evidence was “low” for sugar‐sweetened beverages, 100% fruit juice, fruit, and yogurt and “very low” for fruit drinks, sweet snacks, and dairy desserts. Conclusions The harmful association between sugar‐sweetened beverages and hypertension does not extend to other important food sources of fructose‐containing sugars. Further research is needed to improve our estimates and better understand the dose‐response relationship between food sources of fructose‐containing sugars and hypertension. Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02702375.
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- 2019
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30. Prospective Association of the Portfolio Diet with All-Cause and Cause-Specific Mortality Risk in the Mr. OS and Ms. OS Study
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Kenneth Lo, Andrea J. Glenn, Suey Yeung, Cyril W. C. Kendall, John L. Sievenpiper, David J. A. Jenkins, and Jean Woo
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Portfolio Diet ,Asian population ,mortality ,cardiovascular disease ,cancer ,prospective cohort ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The Portfolio Diet has demonstrated its cardiovascular benefit from interventions, but the association between Portfolio Diet adherence and the risk of all-cause and cause-specific mortality has not been examined in Chinese population. The present study has collected Portfolio Diet adherence (assessed by food frequency questionnaire), lifestyle factors and mortality status of 3991 participants in the Mr. Osteoporosis (OS) and Ms. OS Study. Cox regression models were used to examine the association between the Portfolio Diet adherence and mortality risk (all-cause, cardiovascular disease or cancer). The highest quartile of the Portfolio Diet score was associated with a 28% lower risk of all-cause (hazard ratio, HR: 0.72) and cancer (HR: 0.72) mortality, respectively. The association between Portfolio Diet adherence and cardiovascular disease mortality did not reach statistical significance (HR: 0.90, 95% CI = 0.64, 1.26). Among male participants, the highest adherence to the Portfolio Diet was also associated with a lower risk of all-cause (HR: 0.63) and cancer mortality (HR: 0.59), and there was an inverse association between food sources of plant protein and the risk of cardiovascular mortality (HR: 0.50). However, most associations between the Portfolio Diet and mortality were not significant among females. The protection for cancer mortality risk might reach the plateau at the highest adherence to the Portfolio Diet for females. To conclude, greater adherence to the Portfolio Diet was significantly associated with a lower risk of mortality in Hong Kong older adults, and the associations appeared stronger among males.
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- 2021
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31. Systematic review and meta-analysis examining the relationship between postprandial hypotension, cardiovascular events, and all-cause mortality
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David J A, Jenkins, Sandhya, Sahye-Pudaruth, Khosrow, Khodabandehlou, Fred, Liang, Maaria, Kasmani, Jessica, Wanyan, Maggie, Wang, Keishini, Selvaganesh, Melanie, Paquette, Darshna, Patel, Andrea J, Glenn, Korbua, Srichaikul, Cyril W C, Kendall, and John L, Sievenpiper
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Stroke ,Cross-Sectional Studies ,Nutrition and Dietetics ,Cardiovascular Diseases ,Humans ,Medicine (miscellaneous) ,Prospective Studies ,Hypotension ,Aged - Abstract
Postprandial hypotension (PPH) has been reported to be associated with syncope, falls, adverse cardiovascular outcomes, and increased all-cause mortality. It has been reported to have an incidence as high as 30% in the elderly and persons with diabetes. We therefore performed a meta-analysis to determine the relation of PPH with cardiovascular disease (CVD) events and all-cause mortality.Our objective was to conduct a systematic review and meta-analysis of cohort and cross-sectional studies to determine the association of PPH with CVD and all-cause mortality.We searched the databases MEDLINE, EMBASE, and Cochrane library up to 13 April 2022 for prospective cohort and cross-sectional studies that examined the association of PPH with CVD outcomes and all-cause mortality. Data were analyzed using the generic inverse variance method with a random-effects model. Grading of Recommendations, Assessment, Development, and Evaluation approach assessed the certainty of evidence.Seven studies that included 2389 participants met our inclusion criteria. PPH was associated with each outcome individually, including increased all-cause mortality, total CVD, CVD mortality, and stroke. CVD outcomes and all-cause mortality combined were also associated with PPH (RR: 1.52; 95% CI: 1.05, 2.18; P = 0.03; I2 = 77%). The certainty of evidence was graded as very low due to significant heterogeneity and the limited number of studies.This assessment indicates an association of PPH with CVD and all-cause mortality. Further studies are required to improve CVD and mortality estimates, but the potential seriousness of CVD and all-cause mortality as outcomes of PPH justifies more screening, diagnosis, and research.
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- 2022
32. Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials
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Paraskevi Massara, Andreea Zurbau, Andrea J. Glenn, Laura Chiavaroli, Tauseef A. Khan, Effie Viguiliouk, Sonia Blanco Mejia, Elena M. Comelli, Victoria Chen, Ursula Schwab, Ulf Risérus, Matti Uusitupa, Anne-Marie Aas, Kjeld Hermansen, Inga Thorsdottir, Dario Rahelić, Hana Kahleová, Jordi Salas-Salvadó, Cyril W. C. Kendall, and John L. Sievenpiper
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Randomised controlled trial ,Inflammation ,Nutrition and Dietetics ,Nordic diet ,Endocrinology, Diabetes and Metabolism ,Cholesterol, HDL ,Body Weight ,Insulins ,Cholesterol, LDL ,Prospective cohort ,Cardiovascular disease ,Näringslära ,Stroke ,Meta-analysis ,Cholesterol ,Apolipoproteins ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Systematic review ,Internal Medicine ,Humans ,Prospective Studies ,Obesity ,Randomized Controlled Trials as Topic - Abstract
Aims/hypothesis Nordic dietary patterns that are high in healthy traditional Nordic foods may have a role in the prevention and management of diabetes. To inform the update of the EASD clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of Nordic dietary patterns and cardiometabolic outcomes. Methods We searched MEDLINE, EMBASE and The Cochrane Library from inception to 9 March 2021. We included prospective cohort studies and RCTs with a follow-up of ≥1 year and ≥3 weeks, respectively. Two independent reviewers extracted relevant data and assessed the risk of bias (Newcastle–Ottawa Scale and Cochrane risk of bias tool). The primary outcome was total CVD incidence in the prospective cohort studies and LDL-cholesterol in the RCTs. Secondary outcomes in the prospective cohort studies were CVD mortality, CHD incidence and mortality, stroke incidence and mortality, and type 2 diabetes incidence; in the RCTs, secondary outcomes were other established lipid targets (non-HDL-cholesterol, apolipoprotein B, HDL-cholesterol, triglycerides), markers of glycaemic control (HbA1c, fasting glucose, fasting insulin), adiposity (body weight, BMI, waist circumference) and inflammation (C-reactive protein), and blood pressure (systolic and diastolic blood pressure). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence. Results We included 15 unique prospective cohort studies (n=1,057,176, with 41,708 cardiovascular events and 13,121 diabetes cases) of people with diabetes for the assessment of cardiovascular outcomes or people without diabetes for the assessment of diabetes incidence, and six RCTs (n=717) in people with one or more risk factor for diabetes. In the prospective cohort studies, higher adherence to Nordic dietary patterns was associated with ‘small important’ reductions in the primary outcome, total CVD incidence (RR for highest vs lowest adherence: 0.93 [95% CI 0.88, 0.99], p=0.01; substantial heterogeneity: I2=88%, pQpp<0.05). No studies assessed CHD or stroke mortality. In the RCTs, there were small important reductions in LDL-cholesterol (mean difference [MD] −0.26 mmol/l [95% CI −0.52, −0.00], pMD=0.05; substantial heterogeneity: I2=89%, pQp<0.05). For the other outcomes there were ‘trivial’ reductions or no effect. The certainty of the evidence was low for total CVD incidence and LDL-cholesterol; moderate to high for CVD mortality, established lipid targets, adiposity markers, glycaemic control, blood pressure and inflammation; and low for all other outcomes, with evidence being downgraded mainly because of imprecision and inconsistency. Conclusions/interpretation Adherence to Nordic dietary patterns is associated with generally small important reductions in the risk of major CVD outcomes and diabetes, which are supported by similar reductions in LDL-cholesterol and other intermediate cardiometabolic risk factors. The available evidence provides a generally good indication of the likely benefits of Nordic dietary patterns in people with or at risk for diabetes. Registration ClinicalTrials.gov NCT04094194. Funding Diabetes and Nutrition Study Group of the EASD Clinical Practice. Graphical abstract
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- 2022
33. Dietary Glycaemic Index Labelling: A Global Perspective
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Alan W. Barclay, Livia S. A. Augustin, Furio Brighenti, Elizabeth Delport, C. Jeyakumar Henry, John L. Sievenpiper, Kathy Usic, Yang Yuexin, Andreea Zurbau, Thomas M.S. Wolever, Arne Astrup, Mònica Bulló, Anette Buyken, Antonio Ceriello, Peter R. Ellis, Marie-Ann Vanginkel, Cyril W.C. Kendall, Carlo La Vecchia, Geoffrey Livesey, Andrea Poli, Gabriele Riccardi, Jordi Salas-Salvadó, Antonia Trichopoulou, Kalpana Bhaskaran, David J.A. Jenkins, Walter C. Willett, and Jennie C. Brand-Miller
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glycaemic index ,diabetes ,food labels ,food regulation ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The glycaemic index (GI) is a food metric that ranks the acute impact of available (digestible) carbohydrates on blood glucose. At present, few countries regulate the inclusion of GI on food labels even though the information may assist consumers to manage blood glucose levels. Australia and New Zealand regulate GI claims as nutrition content claims and also recognize the GI Foundation’s certified Low GI trademark as an endorsement. The GI Foundation of South Africa endorses foods with low, medium and high GI symbols. In Asia, Singapore’s Healthier Choice Symbol has specific provisions for low GI claims. Low GI claims are also permitted on food labels in India. In China, there are no national regulations specific to GI; however, voluntary claims are permitted. In the USA, GI claims are not specifically regulated but are permitted, as they are deemed to fall under general food-labelling provisions. In Canada and the European Union, GI claims are not legal under current food law. Inconsistences in food regulation around the world undermine consumer and health professional confidence and call for harmonization. Global provisions for GI claims/endorsements in food standard codes would be in the best interests of people with diabetes and those at risk.
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- 2021
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34. Development of a Portfolio Diet Score and Its Concurrent and Predictive Validity Assessed by a Food Frequency Questionnaire
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Andrea J. Glenn, Beatrice A. Boucher, Chloe C. Kavcic, Tauseef A. Khan, Melanie Paquette, Cyril W. C. Kendall, Anthony J. Hanley, David J. A. Jenkins, and John L. Sievenpiper
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portfolio diet ,validity ,diet index ,dietary pattern ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The Portfolio Diet, a plant-based portfolio of cholesterol-lowering foods, has been shown to reduce low-density lipoprotein cholesterol (LDL-C), and other cardiovascular risk factors, in randomized controlled trials (RCTs). It is not known if these beneficial effects translate to a lower incidence of cardiovascular disease (CVD). To support examinations between Portfolio Diet adherence and disease, a Portfolio Diet score (PDS) was developed and its predictive and concurrent validity was assessed within the Toronto Healthy Diet Study, a six-month RCT in overweight adults. Predictive validity was assessed using change in the PDS measured by food frequency questionnaire (FFQ) and concomitant change in LDL-C from baseline to six months using multiple linear regression, adjusted for potential confounders (n = 652). Concurrent validity was assessed in a subset of participants (n = 50) who completed the FFQ and a 7-day diet record (7DDR) at baseline. The PDS determined from each diet assessment method was used to derive correlation coefficients and Bland–Altman plots to assess the between-method agreement. The change in PDS was inversely associated with change in LDL-C (β coefficients: −0.01 mmol/L (95% confidence intervals (CIs): −0.02, −0.002; p = 0.02). The correlation between the PDS from the FFQ and 7DDR was 0.69 (95% CIs: 0.48, 0.85). The Bland–Altman plot showed reasonable agreement between the score from the FFQ and 7DDR. These findings indicate predictive validity of the PDS with lower LDL-C, and reasonable concurrent validity of the PDS as assessed by an FFQ against a 7DDR.
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- 2021
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35. Perspective: Soy-based Meat and Dairy Alternatives, Despite Classification as Ultra-processed Foods, Deliver High-quality Nutrition on Par with Unprocessed or Minimally Processed Animal-based Counterparts
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Mark Messina, John L Sievenpiper, Patricia Williamson, Jessica Kiel, and John W Erdman
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Meat ,Nutrition and Dietetics ,Food Handling ,Soybean Proteins ,Animals ,Fast Foods ,Humans ,Medicine (miscellaneous) ,Cattle ,Female ,Soybeans ,Diet ,Food Science - Abstract
In many non-Asian countries, soy is consumed via soy-based meat and dairy alternatives, in addition to the traditional Asian soyfoods, such as tofu and miso. Meat alternatives are typically made using concentrated sources of soy protein, such as soy protein isolate (SPI) and soy protein concentrate (SPC). Therefore, these products are classified as ultra-processed foods (UPFs; group 4) according to NOVA, an increasingly widely used food-classification system that classifies all foods into 1 of 4 groups according to the processing they undergo. Furthermore, most soymilks, even those made from whole soybeans, are also classified as UPFs because of the addition of sugars and emulsifiers. Increasingly, recommendations are being made to restrict the consumption of UPFs because their intake is associated with a variety of adverse health outcomes. Critics of UPFs argue these foods are unhealthful for a wide assortment of reasons. Explanations for the proposed adverse effects of UPFs include their high energy density, high glycemic index (GI), hyper-palatability, and low satiety potential. Claims have also been made that UPFs are not sustainably produced. However, this perspective argues that none of the criticisms of UPFs apply to soy-based meat and dairy alternatives when compared with their animal-based counterparts, beef and cow milk, which are classified as unprocessed or minimally processed foods (group 1). Classifying soy-based meat and dairy alternatives as UPFs may hinder their public acceptance, which could detrimentally affect personal and planetary health. In conclusion, the NOVA classification system is simplistic and does not adequately evaluate the nutritional attributes of meat and dairy alternatives based on soy.
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- 2022
36. Cumulative Meta‐Analysis of the Soy Effect Over Time
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David J. A. Jenkins, Sonia Blanco Mejia, Laura Chiavaroli, Effie Viguiliouk, Siying S. Li, Cyril W. C. Kendall, Vladmir Vuksan, and John L. Sievenpiper
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cholesterol reduction ,US Food and Drug Administration heart health claim ,soy protein ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Soy protein foods have attracted attention as useful plant protein foods with mild cholesterol‐lowering effects that are suitable for inclusion in therapeutic diets. But on the basis of the lack of consistency in significant cholesterol reduction by soy in 46 randomized controlled trials, the US Food and Drug Administration (FDA) is reassessing whether the 1999 heart health claim for soy protein should be revoked. Methods and Results We have, therefore, performed a cumulative meta‐analysis on the 46 soy trials identified by the FDA to determine if at any time, since the 1999 FDA final rule that established the soy heart health claim, the soy effect on serum cholesterol lost significance. The cumulative meta‐analysis for both total cholesterol and low‐density lipoprotein cholesterol demonstrated preservation of the small, but significant, reductions seen both before and during the subsequent 14 years since the health claim was originally approved. For low‐density lipoprotein cholesterol, the mean reduction in 1999 was −6.3 mg/dL (95% CI, −8.7 to −3.9 mg/dL; P=0.00001) and remained in the range of −4.2 to −6.7 mg/dL (P=0.0006 to P=0.0002, respectively) in the years after 1999. At no time point did the total cholesterol or low‐density lipoprotein cholesterol reductions lose significance or were the differences at individual time points in the cumulative meta‐analysis significantly different from those seen in 1999 when the health claim was approved. Conclusions A cumulative meta‐analysis of the data selected by the FDA indicates continued significance of total cholesterol and low‐density lipoprotein cholesterol reduction after soy consumption and supports the rationale behind the original soy FDA heart health claim.
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- 2019
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37. Relation of Vegetarian Dietary Patterns With Major Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies
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Andrea J. Glenn, Effie Viguiliouk, Maxine Seider, Beatrice A. Boucher, Tauseef A. Khan, Sonia Blanco Mejia, David J. A. Jenkins, Hana Kahleová, Dario Rahelić, Jordi Salas-Salvadó, Cyril W. C. Kendall, and John L. Sievenpiper
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vegetarian dietary patterns ,vegetarian diets ,cardiovascular disease ,prospective cohort studies ,systematic review ,meta-analysis ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Background: Vegetarian dietary patterns are recommended for cardiovascular disease (CVD) prevention and management due to their favorable effects on cardiometabolic risk factors, however, the role of vegetarian dietary patterns in CVD incidence and mortality remains unclear.Objective: To update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we undertook a systematic review and meta-analysis of the association of vegetarian dietary patterns with major cardiovascular outcomes in prospective cohort studies that included individuals with and without diabetes using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.Methods: MEDLINE, EMBASE, and Cochrane databases were searched through September 6th, 2018. We included prospective cohort studies ≥1 year of follow-up including individuals with or without diabetes reporting the relation of vegetarian and non-vegetarian dietary patterns with at least one cardiovascular outcome. Two independent reviewers extracted data and assessed study quality (Newcastle-Ottawa Scale). The pre-specified outcomes included CVD incidence and mortality (total CVD, coronary heart disease (CHD) and stroke). Risk ratios for associations were pooled using inverse variance random effects model and expressed as risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2-statistic). The overall certainty of the evidence was assessed using GRADE.Results: Seven prospective cohort studies (197,737 participants, 8,430 events) were included. A vegetarian dietary pattern was associated with reduced CHD mortality [RR, 0.78 (CI, 0.69, 0.88)] and incidence [0.72 (0.61, 0.85)] but were not associated with CVD mortality [0.92 (0.84, 1.02)] and stroke mortality [0.92 (0.77, 1.10)]. The overall certainty of the evidence was graded as “very low” for all outcomes, owing to downgrades for indirectness and imprecision.Conclusions: Very low-quality evidence indicates that vegetarian dietary patterns are associated with reductions in CHD mortality and incidence but not with CVD and stroke mortality in individuals with and without diabetes. More research, particularly in different populations, is needed to improve the certainty in our estimates.Clinical Trial Registration:Clinicaltrials.gov, identifier: NCT03610828.
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- 2019
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38. Abstract P521: Association Between Dietary Phytosterols and Risk of Cardiovascular Disease Mortality in US Adults: Findings From the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994
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Julianah O Oguntala, Andreea Zurbau, Meaghan E Kavanagh, Andrea Glenn, Laura Chiavaroli, Tauseef A Khan, Sonia Blanco Meija, David J Jenkins, Cyril Kendall, and John L Sievenpiper
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Phytosterols (plant sterols) are naturally occurring components of plant food sources, including vegetable oils, nuts, cereals and legumes. Their chemical structure impedes intestinal cholesterol absorption and regular consumption has been related to lower serum low-density cholesterol (LDL-C), a causal risk factor for cardiovascular disease (CVD). The association between dietary plant sterol intake and CVD has yet to be determined. Objective: We aimed to examine the association of phytosterol consumption in the diet with cardiovascular mortality in US adults the National Health & Nutrition Examination Survey III (NHANES III), 1988-1994. Methods: We conducted a prospective cohort analysis on National Health and Nutrition Examination Survey (NHANES, 1988-1994 [III]), linked with the National Death Index mortality data (2015) to associate dietary phytosterol intake from 24h dietary recall data with CVD mortality. We included 13,004 adults aged ≥20 years who were non-pregnant, free of CVD at baseline and completed ≥1 24h dietary recall with plausible caloric intake data. We excluded individuals with death occurring within 1 year of baseline. We created a database quantifying the phytosterol content of foods in the 24h dietary recall data and estimated usual intake by quintiles using the NCI method. We determined the risk function by regression calibration and estimated CVD mortality risk between the 10 th (Q1) and 90 th (Q5) percentiles of usual intake. Data was adjusted for sex, age, smoking status and ethnicity. Results: Over a mean±SD follow-up period of 21.2±5.1y, 949 CVD deaths occurred in a population with a mean±SD age of 44.2±14.3y, BMI 26.7±4.7 kg/m 2 and mean dietary plant sterol usual intake of 272.3 mg/day. The top sources of dietary phytosterols were from potatoes 23%), wheat and other grains (21%) and beans, legumes and nuts (13%). Mean usual intake plant intake in the 10 th (Q1) and 90 th (Q5) percentiles of the population was 150.1 and 414.0 mg/day. The estimated relative risk for CVD mortality between Q1 (ref) and Q5 was 0.972 (p Conclusions: Preliminary analyses suggest a CVD death risk reduction of 2.8% in the highest versus lowest intakes of dietary plant sterols in the US population. We plan to expand the multivariable model to include the Healthy Eating Index (diet quality) and assess stratification by healthful and unhealthful sources of phytosterols and linear and non-linear dose response analyses to determine the robustness of the association. OSF Registration: osf.io/da4sg Funding: Amgen Scholars Program, Canadian Institutes of Health Research (CIHR), Banting and Best Diabetes Centre (BBDC), Toronto 3D Knowledge Synthesis and Clinical Trials foundation
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- 2023
39. Abstract P214: The Portfolio Dietary Pattern and Risk of Cardiovascular Disease in US Adults
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Andrea J Glenn, Marta Guasch, Vasanti Malik, Cyril Kendall, Joann E Manson, Eric B Rimm, Walter Willett, Qi Sun, David Jenkins, John L Sievenpiper, and Frank B Hu
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: The plant-based portfolio dietary pattern includes recognized cholesterol-lowering foods shown to improve several cardiovascular disease (CVD) risk factors in clinical trials. Epidemiological evidence on the association between longer-term adherence to the portfolio dietary pattern and CVD risk remains more limited. Objective: To examine whether the portfolio dietary pattern is associated with the risk of total CVD, coronary heart disease (CHD, including myocardial infarction and fatal coronary deaths), and stroke. Methods: Participants included 73,925 women in the Nurses’ Health Study (NHS) (1984-2014), 92,354 women in the NHS2 (1991-2017) and 43,970 men from the Health Professionals Follow-up Study (HPFS) (1986-2016) without CVD and cancer at baseline. Diet was assessed using validated food frequency questionnaires at baseline and every four years using a portfolio diet score (PDS) which positively ranks plant protein (soy & pulses), nuts, viscous fiber sources, phytosterols (mg/day) and plant monounsaturated fat sources, and negatively ranks foods high in saturated fat and dietary cholesterol. Cox proportional hazards regressions were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for covariates. Results: During up to 30 years of follow-up, 16,917 incident CVD cases, including 10,666 CHD cases and 6,473 stroke cases, were documented. After multivariable adjustment of lifestyle and other dietary factors, comparing the highest to the lowest quintile, participants with a higher PDS had a lower risk of total CVD (pooled HR: 0.84; 95% CI: 0.80-0.89, P trendP trendP trend=0.001). In addition, a 25-percentile higher PDS was associated with a lower risk of total CVD (pooled HR: 0.91; 95% CI: 0.88-0.93), CHD (pooled HR: 0.89; 95% CI: 0.86-0.92) and stroke (pooled HR: 0.93; 95% CI: 0.89-0.97). Results remained largely consistent across sensitivity and subgroup analyses. Conclusions: Greater adherence to the portfolio dietary pattern was consistently associated with lower risk of CVD, including CHD and stroke, in three large prospective cohorts of U.S. men and women.
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- 2023
40. Relation of fruit juice with adiposity and diabetes depends on how fruit juice is defined: a re-analysis of the EFSA draft scientific opinion on the tolerable upper intake level for dietary sugars
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Victoria Chen, Tauseef A. Khan, Laura Chiavaroli, Amna Ahmed, Danielle Lee, Cyril W. C. Kendall, and John L. Sievenpiper
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Nutrition and Dietetics ,Medicine (miscellaneous) - Published
- 2023
41. Flecainide and elevated liver enzymes in α1-antitrypsin deficiency
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David J.A. Jenkins, MD, PhD, FRCP, Michael Freeman, MD, FRCPC, Iqwal Mangat, MD, FRCPC, Koruba Srichaikul, MD, MSc, Viranda H. Jayalath, MSc, Dorothea Faulkner, RD, PhD, John L. Sievenpiper, MD, PhD, FRCPC, Cyril W.C. Kendall, PhD, Alexander Romaschin, PhD, Young-In Kim, MD, FRCPC, and Paul Dorian, MD, FRCPC, FHRS
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Atrial fibrillation ,Flecainide ,Cardiovascular disease ,Liver toxicity ,Drug adverse event ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2016
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42. Effect of Replacing Animal Protein with Plant Protein on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Effie Viguiliouk, Sarah E. Stewart, Viranda H. Jayalath, Alena Praneet Ng, Arash Mirrahimi, Russell J. de Souza, Anthony J. Hanley, Richard P. Bazinet, Sonia Blanco Mejia, Lawrence A. Leiter, Robert G. Josse, Cyril W.C. Kendall, David J.A. Jenkins, and John L. Sievenpiper
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plant protein ,animal protein ,diabetes ,glycemic control ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Previous research on the effect of replacing sources of animal protein with plant protein on glycemic control has been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of this replacement on glycemic control in individuals with diabetes. We searched MEDLINE, EMBASE, and Cochrane databases through 26 August 2015. We included RCTs ≥ 3-weeks comparing the effect of replacing animal with plant protein on HbA1c, fasting glucose (FG), and fasting insulin (FI). Two independent reviewers extracted relevant data, assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2-statistic). Thirteen RCTs (n = 280) met the eligibility criteria. Diets emphasizing a replacement of animal with plant protein at a median level of ~35% of total protein per day significantly lowered HbA1c (MD = −0.15%; 95%-CI: −0.26, −0.05%), FG (MD = −0.53 mmol/L; 95%-CI: −0.92, −0.13 mmol/L) and FI (MD = −10.09 pmol/L; 95%-CI: −17.31, −2.86 pmol/L) compared with control arms. Overall, the results indicate that replacing sources of animal with plant protein leads to modest improvements in glycemic control in individuals with diabetes. Owing to uncertainties in our analyses there is a need for larger, longer, higher quality trials. Trial Registration: ClinicalTrials.gov registration number: NCT02037321.
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- 2015
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43. Pure 100% fruit juices – more than just a source of free sugars? A review of the evidence of their effect on risk of cardiovascular disease, type 2 diabetes and obesity
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Emma Derbyshire, C. H. S. Ruxton, and John L. Sievenpiper
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Nutrition and Dietetics ,business.industry ,Environmental health ,Diabetes mellitus ,medicine ,Medicine (miscellaneous) ,Fruit juice ,Disease ,Type 2 diabetes ,medicine.disease ,business ,Obesity ,Public health policy - Published
- 2021
44. Effect of honey on cardiometabolic risk factors: a systematic review and meta-analysis
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Amna Ahmed, Zujaja Tul-Noor, Danielle Lee, Shamaila Bajwah, Zara Ahmed, Shanza Zafar, Maliha Syeda, Fakeha Jamil, Faizaan Qureshi, Fatima Zia, Rumsha Baig, Saniya Ahmed, Mobushra Tayyiba, Suleman Ahmad, Dan Ramdath, Rong Tsao, Steve Cui, Cyril W C Kendall, Russell J de Souza, Tauseef A Khan, and John L Sievenpiper
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Nutrition and Dietetics ,Medicine (miscellaneous) - Abstract
Context Excess calories from free sugars are implicated in the epidemics of obesity and type 2 diabetes. Honey is a free sugar but is generally regarded as healthy. Objective The effect of honey on cardiometabolic risk factors was assessed via a systematic review and meta-analysis of controlled trials using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Data Sources MEDLINE, Embase, and the Cochrane Library databases were searched up to January 4, 2021, for controlled trials ≥1 week in duration that assessed the effect of oral honey intake on adiposity, glycemic control, lipids, blood pressure, uric acid, inflammatory markers, and markers of nonalcoholic fatty liver disease. Data Extraction Independent reviewers extracted data and assessed risk of bias. Data were pooled using the inverse variance method and expressed as mean differences (MDs) with 95%CIs. Certainty of evidence was assessed using GRADE. Data Analysis A total of 18 controlled trials (33 trial comparisons, N = 1105 participants) were included. Overall, honey reduced fasting glucose (MD = −0.20 mmol/L, 95%CI, −0.37 to −0.04 mmol/L; low certainty of evidence), total cholesterol (MD = −0.18 mmol/L, 95%CI, −0.33 to −0.04 mmol/L; low certainty), low-density lipoprotein cholesterol (MD = −0.16 mmol/L, 95%CI, −0.30 to −0.02 mmol/L; low certainty), fasting triglycerides (MD = −0.13 mmol/L, 95%CI, −0.20 to −0.07 mmol/L; low certainty), and alanine aminotransferase (MD = −9.75 U/L, 95%CI, −18.29 to −1.21 U/L; low certainty) and increased high-density lipoprotein cholesterol (MD = 0.07 mmol/L, 95%CI, 0.04–0.10 mmol/L; high certainty). There were significant subgroup differences by floral source and by honey processing, with robinia honey, clover honey, and raw honey showing beneficial effects on fasting glucose and total cholesterol. Conclusion Honey, especially robinia, clover, and unprocessed raw honey, may improve glycemic control and lipid levels when consumed within a healthy dietary pattern. More studies focusing on the floral source and the processing of honey are required to increase certainty of the evidence. Systematic Review Registration PROSPERO registration number CRD42015023580.
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- 2022
45. Dietary Fibre Consensus from the International Carbohydrate Quality Consortium (ICQC)
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Livia S. A. Augustin, Anne-Marie Aas, Arnie Astrup, Fiona S. Atkinson, Sara Baer-Sinnott, Alan W. Barclay, Jennie C. Brand-Miller, Furio Brighenti, Monica Bullo, Anette E. Buyken, Antonio Ceriello, Peter R. Ellis, Marie-Ann Ha, Jeyakumar C. Henry, Cyril W. C. Kendall, Carlo La Vecchia, Simin Liu, Geoffrey Livesey, Andrea Poli, Jordi Salas-Salvadó, Gabriele Riccardi, Ulf Riserus, Salwa W. Rizkalla, John L. Sievenpiper, Antonia Trichopoulou, Kathy Usic, Thomas M. S. Wolever, Walter C. Willett, and David J. A. Jenkins
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dietary fibre ,labelling ,carbohydrate quality ,ICQC ,consensus ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Dietary fibre is a generic term describing non-absorbed plant carbohydrates and small amounts of associated non-carbohydrate components. The main contributors of fibre to the diet are the cell walls of plant tissues, which are supramolecular polymer networks containing variable proportions of cellulose, hemicelluloses, pectic substances, and non-carbohydrate components, such as lignin. Other contributors of fibre are the intracellular storage oligosaccharides, such as fructans. A distinction needs to be made between intrinsic sources of dietary fibre and purified forms of fibre, given that the three-dimensional matrix of the plant cell wall confers benefits beyond fibre isolates. Movement through the digestive tract modifies the cell wall structure and may affect the interactions with the colonic microbes (e.g., small intestinally non-absorbed carbohydrates are broken down by bacteria to short-chain fatty acids, absorbed by colonocytes). These aspects, combined with the fibre associated components (e.g., micronutrients, polyphenols, phytosterols, and phytoestrogens), may contribute to the health outcomes seen with the consumption of dietary fibre. Therefore, where possible, processing should minimise the degradation of the plant cell wall structures to preserve some of its benefits. Food labelling should include dietary fibre values and distinguish between intrinsic and added fibre. Labelling may also help achieve the recommended intake of 14 g/1000 kcal/day.
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- 2020
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46. Destigmatizing Carbohydrate with Food Labeling: The Use of Non-Mandatory Labelling to Highlight Quality Carbohydrate Foods
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Christopher P.F. Marinangeli, Scott V. Harding, Andrea J. Glenn, Laura Chiavaroli, Andreea Zurbau, David J.A. Jenkins, Cyril W.C. Kendall, Kevin B. Miller, and John L. Sievenpiper
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quality carbohydrate ,dietary fibre ,whole grains ,health claims ,glycemic index ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Dietary carbohydrates are components of healthy foods, but many carbohydrate foods have recently been stigmatized as primary causes of diet-related risk factors for chronic disease. There is an opportunity to enhance efforts within the food landscape to encourage the consumption of higher quality carbohydrate foods. The use of labelling is one strategy that permits consumers to identify healthy carbohydrate foods at the point-of-purchase. This review discusses the regulatory frameworks and examples of associated non-mandatory food labelling claims that are currently employed to highlight healthy carbohydrate foods to consumers. The existing labelling frameworks discussed here align with established measures of carbohydrate quality, such as 1. dietary fibre nutrient content claims and associated dietary fibre-based health claims; 2. the presence of whole carbohydrate foods and ingredients that are intact or reconstituted, such as whole grains; and 3. low glycemic index and glycemic response claims. Standards from Codex Alimentarius, and regulations from Australia and New Zealand, Canada, Europe, and the United States will be used to illustrate the means by which food labelling can be used by consumers to identify quality carbohydrate foods.
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- 2020
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47. The Effects of Different Quantities and Qualities of Protein Intake in People with Diabetes Mellitus
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Andreas F.H. Pfeiffer, Eva Pedersen, Ursula Schwab, Ulf Risérus, Anne-Marie Aas, Matti Uusitupa, Anastasia Thanopoulou, Cyril Kendall, John L. Sievenpiper, Hana Kahleová, Dario Rahélic, Jordi Salas-Salvadó, Stephanie Gebauer, and Kjeld Hermansen
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protein intake ,type 2 diabetes ,hypocaloric diet ,weight loss ,animal protein ,plant protein ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The recommended amount and quality of protein in diets of diabetic patients are highly controversial. In order to provide evidence-based information, the Diabetes Nutrition Study Group (DNSG) used a grading procedure used for quality of evidence and strength of recommendations (GRADE). A protein intake of 10% to 20% of energy intake (E%) or about 0.8 to 1.3 g/kg body weight in people below 65 years of age, and 15% to 20% of E% in people above 65 years of age appeared safe in weight-stable conditions. There were no intervention studies addressing metabolic effects, mortality, or cardiovascular events over prolonged periods. Body weight is closely linked to metabolic control and high protein diets are often recommended. Weight-loss diets that include 23% to 32% of E% as protein for up to one year reduced blood pressure and body weight slightly but significantly more than lower protein diets, whereas blood lipids, fasting blood glucose, and HbA1c improved similarly with higher or lower protein intakes in participants with a glomerular filtration rate (GFR) >60 mL/min/1.73 m2. Patients with a GFR 2 did not show a faster decline of GFR or kidney function with protein intakes around 0.8 g/kg body weight as compared with lower intakes, thereby arguing against a restriction. The effects of protein intake on diabetic eye or nerve disease have not been reported. There are a number of studies that have compared different types of animal proteins (milk, chicken, beef, pork, and fish) or compared animal with plant protein in diabetic patients and have reported a greater reduction of serum cholesterol with plant protein. In summary, the suggested range of protein intake appears to be safe and can be adapted according to personal dietary preferences.
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- 2020
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48. Prevention of Type 2 Diabetes by Lifestyle Changes: A Systematic Review and Meta-Analysis
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Matti Uusitupa, Tauseef A. Khan, Effie Viguiliouk, Hana Kahleova, Angela A Rivellese, Kjeld Hermansen, Andreas Pfeiffer, Anastasia Thanopoulou, Jordi Salas-Salvadó, Ursula Schwab, and John L. Sievenpiper
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prevention ,type 2 diabetes ,diet ,lifestyles ,complications ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Prevention of type 2 diabetes (T2D) is a great challenge worldwide. The aim of this evidence synthesis was to summarize the available evidence in order to update the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy. We conducted a systematic review and, where appropriate, meta-analyses of randomized controlled trials (RCTs) carried out in people with impaired glucose tolerance (IGT) (six studies) or dysmetabolism (one study) to answer the following questions: What is the evidence that T2D is preventable by lifestyle changes? What is the optimal diet (with a particular focus on diet quality) for prevention, and does the prevention of T2D result in a lower risk of late complications of T2D? The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess the certainty of the trial evidence. Altogether seven RCTs (N = 4090) fulfilled the eligibility criteria and were included in the meta-analysis. The diagnosis of incident diabetes was based on an oral glucose tolerance test (OGTT). The overall risk reduction of T2D by the lifestyle interventions was 0.53 (95% CI 0.41; 0.67). Most of the trials aimed to reduce weight, increase physical activity, and apply a diet relatively low in saturated fat and high in fiber. The PREDIMED trial that did not meet eligibility criteria for inclusion in the meta-analysis was used in the final assessment of diet quality. We conclude that T2D is preventable by changing lifestyle and the risk reduction is sustained for many years after the active intervention (high certainty of evidence). Healthy dietary changes based on the current recommendations and the Mediterranean dietary pattern can be recommended for the long-term prevention of diabetes. There is limited or insufficient data to show that prevention of T2D by lifestyle changes results in a lower risk of cardiovascular and microvascular complications.
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- 2019
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49. Effect of Plant Protein on Blood Lipids: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
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Siying S. Li, Sonia Blanco Mejia, Lyubov Lytvyn, Sarah E. Stewart, Effie Viguiliouk, Vanessa Ha, Russell J. de Souza, Lawrence A. Leiter, Cyril W. C. Kendall, David J. A. Jenkins, and John L. Sievenpiper
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animal protein ,cholesterol ,dyslipidemia ,lipids ,meta‐analysis ,protein ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundThere is a heightened interest in plant‐based diets for cardiovascular disease prevention. Although plant protein is thought to mediate such prevention through modifying blood lipids, the effect of plant protein in specific substitution for animal protein on blood lipids remains unclear. To assess the effect of this substitution on established lipid targets for cardiovascular risk reduction, we conducted a systematic review and meta‐analysis of randomized controlled trials using the Grading of Recommendations Assessment, Development, and Evaluation system. Methods and ResultsMEDLINE, EMBASE, and the Cochrane Registry were searched through September 9, 2017. We included randomized controlled trials of ≥3 weeks comparing the effect of plant protein in substitution for animal protein on low‐density lipoprotein cholesterol, non–high‐density lipoprotein cholesterol, and apolipoprotein B. Two independent reviewers extracted relevant data and assessed risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences with 95% confidence intervals. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The overall quality (certainty) of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. One‐hundred twelve randomized controlled trials met the eligibility criteria. Plant protein in substitution for animal protein decreased low‐density lipoprotein cholesterol by 0.16 mmol/L (95% confidence interval, −0.20 to −0.12 mmol/L; P
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- 2017
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50. Response to Comment on Lee et al. Relation of Change or Substitution of Low- and No-Calorie Sweetened Beverages With Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Prospective Cohort Studies. Diabetes Care 2022;45:1917–1930
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Jennifer J. Lee, Tauseef Khan, and John L. Sievenpiper
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Advanced and Specialized Nursing ,Endocrinology, Diabetes and Metabolism ,Internal Medicine - Published
- 2023
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