Millions of cardiovascular deaths attributed to not eating enough fruits and vegetables
Study tracks toll of suboptimal fruit and vegetable intake by region, age and gender
June 10, 2019
Science Daily/American Society for Nutrition
Preliminary findings from a new study reveal that inadequate fruit and vegetable consumption may account for millions of deaths from heart disease and strokes each year. The study estimated that roughly 1 in 7 cardiovascular deaths could be attributed to not eating enough fruit and 1 in 12 cardiovascular deaths could be attributed to not eating enough vegetables.
Low fruit intake resulted in nearly 1.8 million cardiovascular deaths in 2010, while low vegetable intake resulted in 1 million deaths, according to researchers. Overall, the toll of suboptimal fruit intake was almost double that of vegetables. The impacts were most acute in countries with the lowest average intakes of fruits and vegetables.
"Fruits and vegetables are a modifiable component of diet that can impact preventable deaths globally," said lead study author Victoria Miller, a postdoctoral researcher at the Friedman School of Nutrition Science and Policy at Tufts University. "Our findings indicate the need for population-based efforts to increase fruit and vegetable consumption throughout the world."
Miller will present the research findings at Nutrition 2019, the American Society for Nutrition annual meeting, held June 8-11, 2019 in Baltimore.
Fruits and vegetables are good sources of fiber, potassium, magnesium, antioxidants and phenolics, which have been shown to reduce blood pressure and cholesterol. Fresh fruits and vegetables also improve the health and diversity of good bacteria in the digestive tract. People who eat more of these foods also are less likely to be overweight or obese, lowering their risk of cardiovascular disease.
"Global nutrition priorities have traditionally focused on providing sufficient calories, vitamin supplementation and reducing additives like salt and sugar," said senior study author Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts University. "These findings indicate a need to expand the focus to increasing availability and consumption of protective foods like fruits, vegetables and legumes -- a positive message with tremendous potential for improving global health."
Based on dietary guidelines and studies of cardiovascular risk factors, the researchers defined optimal fruit intake as 300 grams per day, equivalent to roughly two small apples. Optimal intake of vegetables, including legumes, was defined as 400 grams per day, equivalent to about three cups of raw carrots.
The researchers estimated average national intakes of fruit and vegetables from diet surveys and food availability data representing 113 countries (about 82 percent of the world's population), then combined this information with data on causes of death in each country and data on the cardiovascular risk associated with inadequate fruit and vegetable consumption. The work is part of the Global Dietary Database project funded by the Bill & Melinda Gates Foundation.
Based on data from 2010, the scientists estimated that suboptimal fruit consumption results in nearly 1.3 million deaths from stroke and more than 520,000 deaths from coronary heart disease (narrowing of the heart's arteries) worldwide each year. Suboptimal vegetable consumption was estimated to result in about 200,000 deaths from stroke and more than 800,000 deaths from coronary heart disease.
The impact of inadequate fruit and vegetable intake was greatest in countries with the lowest fruit and vegetable consumption. Countries in South Asia, East Asia and Sub-Saharan Africa had low fruit intake and high rates of associated stroke deaths. Countries in Central Asia and Oceania had low vegetable intake and high rates of associated coronary heart disease.
In the United States, suboptimal vegetable intake may account for 82,000 cardiovascular deaths while suboptimal fruit intake accounted for 57,000 deaths. Cardiovascular disease is the number one cause of death in the United States and worldwide.
By age group, suboptimal fruit and vegetable intake had the greatest perceived proportional impact on cardiovascular disease deaths among younger adults. By gender, suboptimal fruit and vegetable intake had the greatest proportional impact on cardiovascular disease deaths in men, likely because women tend to eat more fruits and vegetables, Miller noted.
https://www.sciencedaily.com/releases/2019/06/190610100624.htm
High intake of dietary fiber and whole grains associated with reduced risk of non-communicable diseases
January 10, 2019
Science Daily/The Lancet
Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g to 29g or more of dietary fiber a day, according to a series of systematic reviews and meta-analyses.
People who eat higher levels of dietary fibre and whole grains have lower rates of non-communicable diseases compared with people who eat lesser amounts, while links for low glycaemic load and low glycaemic index diets are less clear. Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g to 29g or more of dietary fibre a day, according to a series of systematic reviews and meta-analyses published in The Lancet.
The results suggest a 15-30% decrease in all-cause and cardiovascular related mortality when comparing people who eat the highest amount of fibre to those who eat the least. Eating fibre-rich foods also reduced incidence of coronary heart disease, stroke, type 2 diabetes and colorectal cancer by 16-24%. Per 1,000 participants, the impact translates into 13 fewer deaths and six fewer cases of coronary heart disease.
In addition, a meta-analysis of clinical trials suggested that increasing fibre intakes was associated with lower bodyweight and cholesterol, compared with lower intakes.
The study was commissioned by the World Health Organization to inform the development of new recommendations for optimal daily fibre intake and to determine which types of carbohydrate provide the best protection against non-communicable diseases (NCDs) and weight gain.
Most people worldwide consume less than 20 g of dietary fibre per day. In 2015, the UK Scientific Advisory Committee on Nutrition recommended an increase in dietary fibre intake to 30 g per day, but only 9% of UK adults manage to reach this target. In the US, fibre intake among adults averages 15 g a day. Rich sources of dietary fibre include whole grains, pulses, vegetables and fruit.
"Previous reviews and meta-analyses have usually examined a single indicator of carbohydrate quality and a limited number of diseases so it has not been possible to establish which foods to recommend for protecting against a range of conditions," says corresponding author Professor Jim Mann, the University of Otago, New Zealand.
"Our findings provide convincing evidence for nutrition guidelines to focus on increasing dietary fibre and on replacing refined grains with whole grains. This reduces incidence risk and mortality from a broad range of important diseases."
The researchers included 185 observational studies containing data that relate to 135 million person years and 58 clinical trials involving 4,635 adult participants. They focused on premature deaths from and incidence of coronary heart disease, cardiovascular disease and stroke, as well as incidence of type 2 diabetes, colorectal cancer and cancers associated with obesity: breast, endometrial, esophageal and prostate cancer. The authors only included studies with healthy participants, so the findings cannot be applied to people with existing chronic diseases.
For every 8g increase of dietary fibre eaten per day, total deaths and incidence of coronary heart disease, type 2 diabetes and colorectal cancer decreased by 5-27%. Protection against stroke, and breast cancer also increased. Consuming 25g to 29g each day was adequate but the data suggest that higher intakes of dietary fibre could provide even greater protection.
For every 15g increase of whole grains eaten per day, total deaths and incidence of coronary heart disease, type 2 diabetes and colorectal cancer decreased by 2-19%. Higher intakes of whole grains were associated with a 13-33% reduction in NCD risk -- translating into 26 fewer deaths per 1,000 people from all-cause mortality and seven fewer cases of coronary heart disease per 1,000 people. The meta-analysis of clinical trials involving whole grains showed a reduction in bodyweight. Whole grains are high in dietary fibre, which could explain their beneficial effects.
The study also found that diets with a low glycaemic index and low glycaemic load provided limited support for protection against type 2 diabetes and stroke only. Foods with a low glycaemic index or low glycaemic load may also contain added sugars, saturated fats, and sodium. This may account for the links to health being less clear.
"The health benefits of fibre are supported by over 100 years of research into its chemistry, physical properties, physiology and effects on metabolism. Fibre-rich whole foods that require chewing and retain much of their structure in the gut increase satiety and help weight control and can favourably influence lipid and glucose levels. The breakdown of fibre in the large bowel by the resident bacteria has additional wide-ranging effects including protection from colorectal cancer." says Professor Jim Mann.
While their study did not show any risks associated with dietary fibre, the authors note that high intakes might have ill-effects for people with low iron or mineral levels, for whom high levels of whole grains can further reduce iron levels. They also note that the study mainly relates to naturally-occurring fibre rich foods rather than synthetic and extracted fibre, such as powders, that can be added to foods.
Commenting on the implications and limitations of the study, Professor Gary Frost, Imperial College London, UK, says, "[The authors] report findings from both prospective cohort studies and randomised controlled trials in tandem. This method enables us to understand how altering the quality of carbohydrate intake in randomised controlled trials affects non-communicable disease risk factors and how these changes in diet quality align with disease incidence in prospective cohort studies. This alignment is seen beautifully for dietary fibre intake, in which observational studies reveal a reduction in all-cause and cardiovascular mortality, which is associated with a reduction in bodyweight, total cholesterol, LDL cholesterol, and systolic blood pressure reported in randomised controlled trials... There are some important considerations that arise from this Article. First, total carbohydrate intake was not considered in the systematic review and meta-analysis... Second, although the absence of association between glycaemic index and load with non-communicable disease and risk factors is consistent with another recent systematic review, caution is needed when interpreting these data, as the number of studies is small and findings are heterogeneous. Third, the absence of quantifiable and objective biomarkers for assessing carbohydrate intake means dietary research relies on self-reported intake, which is prone to error and misreporting. Improving the accuracy of dietary assessment is a priority area for nutrition research. The analyses presented by Reynolds and colleagues provides compelling evidence that dietary fibre and whole grain are major determinants of numerous health outcomes and should form part of public health policy."
https://www.sciencedaily.com/releases/2019/01/190110184737.htm
Spiritual retreat can lower depression, raise hope in heart patients
August 1, 2011
Science Daily/University of Michigan Health System
Attending a non-denominational spiritual retreat can help patients with severe heart trouble feel less depressed and more hopeful about the future, a University of Michigan Health System study has found.
Heart patients who participated in a four-day retreat that included techniques such as meditation, guided imagery, drumming, journal writing and outdoor activities saw immediate improvement in tests measuring depression and hopefulness. Those improvements persisted at three- and six-month follow-up measurements.
The study was the first randomized clinical trial to demonstrate an intervention that raises hope in patients with acute coronary syndrome, a condition that includes chest pain and heart attack. Previous research has shown that hope and its opposite, hopelessness, have an impact on how patients face uncertain futures.
"The study shows that a spiritual retreat like the Medicine for the Earth program can jumpstart and help to maintain a return to psycho-spiritual well-being," says study lead author Sara Warber, M.D., associate professor of family medicine at the U-M Medical School and director of U-M's Integrative Medicine program. "These types of interventions may be of particular interest to patients who do not want to take antidepressants for the depression symptoms that often accompany coronary heart disease and heart attack."
The findings were published in the July issue of Explore: the Journal of Science and Healing.
The retreat group was compared to two other groups: one received standard cardiac care and the other participated in a lifestyle change retreat run by the U-M Cardiovascular Center that focused on nutrition, physical exercise and stress management.
The spiritual retreat portion of the study was conducted at the Windrise Retreat Center in Metamora, Michigan, about 50 miles north of Detroit. In the Medicine for the Earth program, participants are encouraged to see themselves as part of an interconnected web of life. The approach is founded on the work of co-author Sandra Ingerman, M.A., who wrote the book Medicine for the Earth: How to Transform Personal and Environmental Toxins, which emphasizes principles of love, harmony, beauty, unity and peace.
The study used a number of standard mental and physical benchmarks to assess the success of the program.
The spiritual retreat group went from a baseline score of 12 on the Beck Depression Inventory, indicating mild to moderate depression, to an improved score of 6 immediately afterward, a 50-percent reduction. Their scores remained that low half a year later. The lifestyle group saw their scores drop from 11 to 7 and remain there. The control group's score started at 8 and went down to 6.
Participants also showed marked improvement in their scores on a test measuring hope. Scores on the State Hope Scale can range from 6 to 48, with higher scores indicating greater hope. All three study groups started with average scores between 34 and 36. After the spiritual retreat, participants' average scores rose and stayed at 40 or above, while the other two groups' averages remained significantly lower, ranging from 35 to 38, three and six months later.
"Our work adds an important spiritual voice to the current discussion of the importance of psychological well-being for patients facing serious medical issues, such as acute coronary artery disease," Warber says.
http://www.sciencedaily.com/releases/2011/08/110801094724.htm
Mentally stressed young women with heart disease have reduced blood flow to heart
November 16, 2014
Science Daily/American Heart Association
Young women with stable coronary heart disease are more likely than men of the same age to develop reduced blood flow to the heart if they're under emotional stress. Women 55 years and younger under mental stress had three times greater reduction in blood flow to the heart than men.
Compared to men of the same age, when subjected to a mental stress test, women:
· age 55 and younger had three times greater reduction in blood flow to the heart;
· age 56-64 had double the reduction in blood flow to the heart; and
· age 65 and older had no difference in blood flow to the heart.
"Women who develop heart disease at a younger age make up a special high-risk group because they are disproportionally vulnerable to emotional stress," said Viola Vaccarino, M.D., Ph.D., study author and chairwoman of Cardiovascular Research and Epidemiology at Emory University's Rollins School of Public Health in Atlanta, Georgia.
Women generally develop heart disease later in life than men. However, younger women who have premature heart attacks are more likely to die than men of similar age. Risk factors, such as diabetes or high blood pressure, don't explain these mortality differences.
Young and middle-age women may be more vulnerable to emotional stress because they face considerable burden of stressors in everyday life such as managing kids, marriage, jobs and caring for parents, Vaccarino said. Biology may also play a role -- for example, a greater propensity towards abnormal blood vessel function during emotional stress, such as exaggerated constriction of coronary or peripheral blood vessels.
http://www.sciencedaily.com/releases/2014/11/141116094330.htm