nutrition and heart_disease2012

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Heart Health Diet Somkiat Sangwatanaroj M.D. Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University [email protected]

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Page 1: Nutrition and heart_disease2012

Heart Health Diet

Somkiat Sangwatanaroj M.D.

Division of Cardiovascular Medicine,

Department of Medicine, Faculty of Medicine, Chulalongkorn University

[email protected]

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Diets cause Coronary Heart Disease ?

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Causal link diet & CHD: systematic review

Mente A. Arch Intern Med 2009;169:659-69

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Causal link diet & CHD: Cohorts Mente A. Arch Intern Med 2009;169:659-69

g Bradford Hill score is 4 when restricting analyses to cohort studies of high methodologic quality (low risk of bias).

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Mediterranean diet & mortality Meta-analysis. Sofi F. BMJ 2008;337:a1344

doi:10.1136/bmj.a1344

�‡Studies analysed prospectively association between adherence to Mediterranean diet, mortality & incidence of diseases; 12 studies, with 1,574,299 subjects followed for 3-18 yrs

�‡8 cohorts (514,816 subjects & 33,576 deaths): two point increase in the adherence score was significantly associated with a reduced risk of total mortality (9%),CV mortality (9%),cancer mortality(6�9�•�U�W���Œ�l�]�v�•�}�v�[�•�l���o�Ì�Z���]�u���Œ�[�•�����]�•�~13%)

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Mediterranean diet & mortality Meta-analysis. Sofi F. BMJ 2008;337:a1344

doi:10.1136/bmj.a1344

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Mediterranean diet & Parkinson & ���o�Ì�Z���]�u���Œ�[�•�����]�•�����•��

Meta-analysis.Sofi F. BMJ 2008;337:a1344. doi:10.1136/bmj.a1344

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aMediterranean diet Score & non-/fatal CVD Fung TT.Circulation 2009;119:1093-100

A, Multivariate (adjusted for age, BMI, smoking, physical activity, HT, Hypercholesterolemia, FHx CHD, Dietary intake & aMed scores) RR of CVD (combined CHD and stroke) by quintiles of aMed. incidence of CVD (P for trend <0.0001).

B, Multivariate (adjusted for the variables) RR of fatal CVD (combined CHD and stroke mortality) by quintiles of aMed. incidence of fatal CVD (P for trend <0.0001).

Incidence of non-fatal CVD Incidence of fatal CVD

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Mediterranean dietary pattern. Trichopoulou A. Pub Health Nutr 2004;7:943-7

�¨�—�Á�„�¨�º�°�� �Á�œ�º�Ê�°�œ�o�°�¥ �—�o�°�¥�¤�´�œ�� �œ�Î�Ê�µ�˜�µ�¨�˜�Î�É�µ

�¡�º�•�­�— �›�¦�¦�¤�•�µ�˜�· �ž�¦�µ�«�‹�µ�„�£�´�¥

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Brown rice, whole grains �Y DM risk Sun Qi. Arch Intern Med 2010;170:961-9.

�‡White & brown rice consumption relation to T2DM risk in Health Professionals Follow-up �^�š�µ���Ç���˜���E�µ�Œ�•���•�[���,�����o�š�Z���^�š�µ���Ç���/���˜���/�/�X

�‡Prospectively ascertained & updated diet, lifestyle practices & disease status among 39 765 men & 157 463 women.

�‡Multivariate adjustment for age, lifestyle & dietary risk factors, higher intake of white rice (5 servings/wk vs. 1/ month) �X��risk

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�„�·�œ�…�o�µ�ª�…�µ�ª�¤�µ�„���Á�¡�·�É�¤�Ã�°�„�µ�­�Á�•�µ�®�ª�µ�œ�¦�o�°�¥�¨�³���Ó�Ø Systematic review. n=352,384, FU 4-22 y.Hu EA.BMJ 2012;344:e1454

Each serving per day increment of white rice intake, the relative risk of type 2 diabetes was 1.11 (1.08 to 1.14)

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Fruit, vegetable & heart disease

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Fruit & vegetable 5 servings/d & CHD Meta-analysis. He FJ. J Human Hypertens 2007;21:717-28.

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�Ú���ü�Ú� �ò�õ��Ú���õ�þ���ú�<���Ú��ó�������Ú�������������û�à����ú�÷�ý�Ú���?������ú�÷���î

Dauchet L. Neurology 2005;65:1193 - 97

�Ã�°�„�µ�­�Á�„�·�—�°�´�¤�¡�§�„�¬�r���°�´�¤�¡�µ�˜���¨�—�¨�Š �‡ �Ò�Ò��% �™�o�µ�„�·�œ�Ÿ�¨�Å�¤�o�Á�¡�·�É�¤�…�¹�Ê�œ�š�»�„���Ç�� �Ò���­�n�ª�œ� �̃n�°�ª�´�œ �‡ �Ô��% �™�o�µ�„�·�œ�Ÿ�´�„���Á�¡�·�É�¤�…�¹�Ê�œ�š�»�„���Ç ���Ò���­�n�ª�œ� �̃n�°�ª�´�œ �‡ �Ö��% �™�o�µ�„�·�œ�Ÿ�´�„�Â�¨�³�Ÿ�¨�Å�¤�o�Á�¡�·�É�¤�…�¹�Ê�œ �š�»�„���Ç���Ò���­�n�ª�œ� �̃n�°�ª�´�œ

�‹�µ�„���Ø���„�µ�¦�«�¹�„�¬�µ���•�µ�¥���Ú�Ñ.�Ö�Ò�Ô���‡�œ���®�•�·�Š���Ò�Õ�Ò.�Ö�Ô�×���‡�œ�� �Â�¨�³�Á�„�·�—�°�´�¤�¡�§�„�¬�r���°�´�¤�¡�µ�˜���Ó.�Ú�Ö�Ö���‡�œ

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Nuts, Peanuts prevent CHD Kris-Etherton PM. J Nutr 2008;138:1746S-51S.

Pooled analysis of epidemiologic studies on nut consumption and CHD risk.

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Nut & peanut butter lower CVD in T2DM women �E�µ�Œ�•���[�•���,�����o�š�Z���^�š�µ���Ç�X���:���E�µ�š�Œ��2009;139:1333-8

�‡Cohort of 6,309 T2DM women, �Æ���&�9�'���R�U��cancer at baseline, Food Frequency Questionnaires q 2-4 yrs (1980-2002)

�‡Incident MI, revascularization & stroke

�‡54,656 person-yr FU, 452 (MI & revascularization) & 182 stroke cases

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�™�´�É�ª� �̈·�­�Š�Å�®�œ���Å�¤�n�‡�ª�¦�„�·�œ���Á�¡�¦�µ�³�¤�¸�°�³�¢� �̈µ�š�È�°�„�Ž�·�œ��?

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Salt intake increase stroke & CVD risk Systematic review/meta-a. Strazzullo P. BMJ 2009;339:b4567 doi:10.1136/bmj.b4567

�‡Medline (1966-2008),Embase (1988-),AMED (1985-), CINAHL (1982-), Psychinfo (1985-) & Cochrane Library.

�‡Relative risks & 95% CI and random effect model, weighting for inverse of variance. Heterogeneity, publication bias, subgroup, & meta-regression analyses.

�‡19 independent cohort samples from 13 studies, with 177,025 participants (follow-up 3.5-19 yrs) & > 11,000 vascular events

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Higher salt intake increase stroke risk (23%)

Systematic review/meta-a. Strazzullo P. BMJ 2009;339:b4567 doi:10.1136/bmj.b4567

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�þ�í���Ú�þ�����������ä���í���û�ú�������ò���������ü dietary salt reduction �í���Ú���;�����o�Ú� �ò�û���p���Ý�����ú�í��ò����/�þ�í���Û�ú��ò

�;

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�;�'�L�H�W�D�U�\���V�D�O�W��3 g/d (Na 1.2g/d) Bibbins-Domingo K. N Engl J Med 2010;362:590-9

Annual�; �L�Q�F�L�G�H�Q�W���V�W�U�R�N�H���§5-15% Annual �; �W�R�W�D�O���G�H�D�W�K���§2 -12%

Highest estimate for effect of salt reduction on systolic BP

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Gradual salt reduction: cost-effectiveness Bibbins-Domingo K. N Engl J Med 2010;362:590-9

�v�š�Î�µ�Á�°�Š�w�����¨�—�Á�„�¨�º�°�����‡�»�o�¤�‡�n�µ���„�ª�n�µ���v�„�·�œ�¥�µ�w���¨�—�‡�ª�µ�¤�—�´�œ

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�°�µ�®�µ�¦�ž�¦�»�Š�Â� �̃n�Š��vs.���°�µ�®�µ�¦�›�¦�¦�¤�•�µ�˜�·

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Øù ą Ĕď Â./èòÚ ÂõÚÿÚø ĈîëòÖè°ÜäùÈĀÖ¬È ÿßõćâāîÂóëāäÅìæîÕÿæøîÕìòèĂÉ ĒĖ%

RR of CHD/50 g/d processed meat Systematic review. Circulation 2010;121:2271-83.

RR of CHD/100 g/d total meat

Case-control

Case-control

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�Z�������u�����š���]�v�š���l�����X���o�o-cause death Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287

�‡ Pooled hazard ratio (95% CI) of total mortality for a 1-serving/day increase was 1.13 (1.07-1.20) for unprocessed red meat and 1.20 (1.15-1.24) for processed red meat.

Health Professionals Follow -up Study

Nursesô Health Study

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�Z�������u�����š���]�v�š���l�����X�����s���������š�Z Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287

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�Z�������u�����š���]�v�š���l�����X�������v�����Œ���������š�Z Pan A. Arch Intern Med 2012; doi:10.1001/archinternmed.2011.2287

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Fat: bad, better or best

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Trans fatty acid & coronary heart disease: Zutphen Elderly Study. Oomen CM. Lancet 2001; 357: 746-51

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�E���Á���z�}�Œ�l�����]�š�Ç�[�•���š�Œ���v�•���(���š���Œ���•�š�Œ�]���š�]�}�v Angell SY. Ann Intern Med 2009;151:129-134.

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Glycemic index (GI), Glycemic load (GL)

�‡GI = ability of food to provoke postprandial glycemic response in man compared with reference food: �±Glucose or bread (GI = 100)

�±Glucose : Bread GI = 100 : 70

�‡GL = product of amount of available CHO in specified serving size & GI / 100 �± GL = CHO x GI / 100

Atkinson FS. Diabetes Care 2008 ; 31: 2281 - 83

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Rate ratio(95%CI) highest vs. lowest GI & GL in 27 cohorts.Systematic review Barclay AW. Am J Clin Nutr 2008;87:627-37

1 Final fully adjusted models only.

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Dietary supplements ?

�°�µ�®�µ�¦�Á�­�¦�·�¤��?

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

�‡ Electronic databases & bibliographies published by Oct 2005.

�‡ Randomized trials, adults, beta carotene, vitamin A, vitamin C (ascorbic acid), vitamin E & selenium either singly or combined vs placebo or vs no intervention.

�‡ Randomization, blinding, and follow-up: markers of bias.

�‡ The effect of antioxidant supplements on all-cause mortality: random-effects meta-analyses as RR with 95% CIs. Meta-regression to assess the effect of covariates across the trials.

�‡ 68 Randomized trials ( n = 232,606 from 385 publications).

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�ª�·�˜�µ�¤�·�œ�Á�°���®�¦�º�°���¦�n�ª�¤�„�´�•�°�µ�®�µ�¦�Á�­�¦�·�¤�°�º�É�œ���Ö���„�µ�¦�«�¹�„�¬�µ

�Á�¡�·�É�¤�Ã�°�„�µ�­� �̃µ�¥���Ò�×% �Á�¤�º�É�°�Á�š�¸�¥�•�„�´�•�¥�µ�®� �̈°�„���®� �̈´�Š�‹�µ�„�ž�¦�´�•�ž�´�‹�‹�´�¥�°�º�É�œ Bjelakovic G. JAMA. 2007;297:842-857

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Diet & lifestyle recommendation 2006. American Heart Association. Circulation 2006;114:82-96

�‡Although antioxidant supplements����vitamin E,

beta-carotene, selenium etc) are not recommended, food sources of antioxidant��nutrients, principally from a variety of plant-derived foods such as fruits, vegetables, whole grains, and vegetable oils are��recommended.

�‡�Ä�®�o�„�·�œ�‹�µ�„�°�µ�®�µ�¦���Á�•�n�œ���Ÿ�´�„���Ÿ�¨�Å�¤�o���›�´�•�¡�º�•�Å�¤�n�…�´�—�…�µ�ª

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Vit E/C & MI,Stroke,CV death in PHSII RCT. Sesso HD. JAMA 2008;300:2123-33.

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Vit E/C & MI,Stroke,CV death in PHSII RCT. Sesso HD. JAMA 2008;300:2123-33.

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Vit E/C & MI,Stroke,CV death in PHSII RCT. Sesso HD. JAMA 2008;300:2123-33.

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Vitamin B in DM nephropathy

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Diabetic Intervention with Vitamins to Improve Nephropathy.RCT (DB, PC). House AA. JAMA 2010;303:1603-09.

�‡5 university medical centers Canada, May 2001-July 2007, 238 type 1 or 2 DM and clinical diagnosis of diabetic nephropathy.

�‡1 tablet of B vitamins: folic acid (2.5 mg/d), vitamin B6 (25 mg/d), vitamin B12 (1 mg/d), or matching placebo.

�‡Change in radionuclide GFR at 36 months. Dialysis and composite of MI, stroke, revascularization, and all-cause mortality.

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Vit B+folic decrease GFR in DM nephropathy. DIVINE: RCT (DB, PC). House AA. JAMA 2010;303:1603-09.

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Vit B+folic increase CV events in DM nephropathy. DIVINE: RCT (DB, PC). House AA. JAMA 2010;303:1603-09.

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Take home message: �®�n�°�„� �̈´�•�•�o�µ�œ �‡�¡�º�•�­�—���Ÿ�´�„�­�—���Ó��� �n �µ�¤�º�°/�¤�º �Ê�°���Ÿ�¨�Å�¤�o�­�—���Ó��� �n �µ�¤�º�°/�ª�´�œ��

�‡�¨�—�Á�„�¨�º�°���œ�Î �Ê�µ�ž�¨�µ���‡�¦�¹�É�Š �™�¹�Š���Ò���•�o�°�œ�Ã� �̃p�³���˜�n�°�¤�º �Ê�°�� �‡�Á�œ�º�Ê�°�œ�o�°�¥���¨�—�Á�œ�º �Ê�°�Â�—�Š[�Ó�Ô���•�µ�š/�¤�º �Ê�°]���Á�¨�¸�É�¥�Š�ž�¦�»�Š�Â�˜�n�Š�� �‡�—�o�°�¥�¤�´�œ���¨�—�Å�…�¤�´�œ�•�œ�·�—�š�¦�µ�œ�­�r[<�Ò%]���Ä�•�o�œ�Î �Ê�µ�¤�´�œ�¦�Î�µ�…�o�µ�ª��

�‡�œ�Î�Ê�µ�˜�µ�¨�˜�Î�É�µ���¡�°�—�¸�š�¸�É���×���•�o�°�œ�•�µ/�ª�´�œ�� �‡�›�¦�¦�¤�•�µ�˜�·���—�¸�„�ª�n�µ���ž�¦�»�Š�Â�˜�n�Š�� �‡�ž�¦�µ�«�‹�µ�„�£�´�¥���¦�³�ª�´�Š�…�°�Š�Â�™�¤��

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