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Description : Cardiometabolic Diseases and Nutrition: Risk Factors, Prevention and Treatment

Tags : CMD,Nutrition,Nutrition-Risk Factors,Nutrition

Published on : Oct 25, 2023 | Views : 895 | Downloads : 0

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Cardiometabolic Diseases and Nutrition: Risk Factors, Prevention and Treatment Prof. Reema Tayyem
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What is the Definition of Cardiometabolic Diseases (CMDs)? CMDs are a group of common but preventable conditions including heart diseases, stroke, diabetes, insulin resistance and non-alcoholic fatty liver disease (NAFLD).
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There is a global increase in the number of people who experience one or more of these conditions during their lifetime. Smoking, lack of exercise, drinking a lot of alcohol and eating an unhealthy diet are recognized as the four main drivers of this rise.
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Cardiometabolic multimorbidity is defined as the co-existence of two or more of three cardiometabolic disorders: hypertension, diabetes mellitus, NAFLD and cardiovascular diseases (CVDs). Cardiometabolic multimorbidity is becoming progressively more common globally, and the public health impact has received increased attention during the past several years.
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Association of Unhealthy Diet with CMDs
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Western Dietary Patterns This diet is often characterized by high consumption of soft drinks, red and processed meat and refined cereals, with concurrently low intake of fish, fruit and vegetables as well as whole grains. Higher western pattern score at 14 yr was associated with ↑ risk of NAFLD at 17 yr (OR: 1.59; 95%CI: 1.17–2.14; P < 0.05) before adjustment to BMI. The increase in adherence to a fast food pattern was associated with ↑ odds for NAFLD after adjustment for age, sex, EI, PA, smoked, education, MS (P < 0.01).
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Added Sugar, High Fruits and High Fructose Dietary Patterns ↑ Adherence to high fruits pattern ↑ the odds of NAFLD (OR: 4.061; 95%CI: 1.320–12.100, P < 0.05, adjusted for mentioned confounders. After adjusting for many factors, the sugar-rich pattern was associated with ↑ risk of NAFLD (HR: 1.11). Fructose-rich diets, based on sugar-sweetened beverages increase hepatic synthesis of TG and are recognized as a major mediator of NAFLD.
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In cohort studies, white rice was associated with higher risk of T2D (pooled RR, 1.16; 95%CI: 1.02 to 1.32) comparing extreme categories. At intakes above ~300g/day, a dose–response was observed (each 158g/day serving was associated with 13% (11%–15%) higher risk of T2D). Intake of brown rice was associated with lower risk of T2D (pooled RR, 0.89; 95%CI: 0.81 to 0.97) comparing extreme categories.
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Each 50g/day serving of brown rice was associated with 13% (6%–20%) lower risk of T2D. RCTs showed an increase in HDL (0.06mmol/L; 0.00 to 0.11mmol/L) in the brown compared with white rice group.
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Association of Sedentary Behavior with CMDs
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Obesity in association with sedentary behavior
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Diabetes in association with sedentary behavior
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long time spent in sedentary behavior, mainly sitting and TV time, was positively associated with the occurrence of CMDs and related biomarkers in South American adults.
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Association of Smoking with CMDs
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Because nicotine causes short-term increases in energy expenditure, smokers tend to weigh less than nonsmokers initially. However, over time, smoking increases insulin resistance and is associated with central fat accumulation, leading to the development of metabolic syndrome and T2DM. Furthermore, cigarette smoking may be the first step towards unhealthy habits, including excess alcohol consumption and caloric intake, which are linked to future metabolic disorders.
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Prevention of CMDs
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Prevention of CMDs Physical Activity (PA) Macronutrients Composition Probiotic Supplements Mediterranean Diet and other Dietary Patterns
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Macronutrients Composition and the Prevention of CMDs
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Recommendations To reduce body weight in adults with overweight or obesity, a balanced and high quality diet with carbohydrate restriction and reduced caloric intake is recommended. Recent guidelines for obesity management allow the individualized use of carbohydrate-restricted diets for obesity treatment, and most of the carbohydrate-restricted diets included in this study involved a decrease in total calorie intake.
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Carbohydrate-restricted diets should reduce total caloric intake while avoiding an increase in saturated and trans-fatty acids intake. In a cohort study examining the association between a carbohydrate-restricted diet and the mortality risk, an animal product-based carbohydrate-restricted diet was associated with increased all-cause mortality both in men and women. In contrast, a vegetable-based carbohydrate-restricted diet was associated with reduced all-cause mortality and cardiovascular mortality.
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Ketogenic diet Ketogenic diet (KD) is the most popular low-carbohydrate eating plan based on a strict restriction in carbohydrates (less than 20-50 g/d) consumption. Therefore, KD could have a positive impact on NAFLD, due to very low content of carbohydrates in the diet. However, it is not known if ketosis plays an additional role. Several mechanisms may be proposed links between ketosis and improvement of NAFLD.
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First, a ketogenic diet decreases insulin levels that lead to increased rate of fatty acid oxidation and decreased lipogenesis. Then, restriction of carbohydrates encourages the formation of ketone bodies, which cause satiety by a still-unknown mechanism. In turn, reduced calorie intake leads to weight loss. KD Insulin FA oxidation lipogenesis KB Formation Satiety and weight loss
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KD therapy is generally promising in obesity, heart failure, and hypertension, though different voices still exist. In diabetes and dyslipidemia, the performance of KD remains controversial. Various factors might account for the controversies, including genetic background, duration of therapy, food composition, quality, and sources of KDs.
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Mediterranean Diet and other Dietary Patterns
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Mediterranean Diet (MD) It is observed that many obesity-related cardiometabolic disorders can influence the function and energetic capacity of mitochondria. Mediterranean diet (MD) can improve dysfunctional mitochondria in obesity and CMDs.
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The term “Mitochondria nutrients” has been adopted in recent years, and it depicts the adequate nutrients to keep proper mitochondrial function. Different experimental models show that components of the MD, including minerals magnesium, polyphenols, plant-derived compounds, and polyunsaturated fatty acids, can improve mitochondrial metabolism, biogenesis, and antioxidant capacity.
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For example, hydroxytyrosol, a polyphenol from olive oil, was effective in the regulation of multiple high fat diet-induced MetS, especially those related to mitochondrial dysfunction, through the modulation of mitochondrial apoptotic pathway in the liver and skeletal muscles.
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Guidance to Promote Cardiometabolic Health
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Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat adequate amount and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms);
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(5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt;
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