Summary Background & aims Nutrition has been proposed as a potential environmental factor affecting the risk of non-alcoholic fatty liver disease (NAFLD). In the present study, the impact of ...adherence to the Mediterranean diet (MD) on the presence and severity of NAFLD was explored. Methods Seventy-three consecutive adult patients with recent NAFLD diagnosis were included. Adherence to the MD was estimated with MedDietScore. Demographic and anthropometric data, body composition analysis and several biochemical and inflammatory markers were estimated. Liver stiffness measurements by transient elastography were available in 58 patients and liver biopsies in 34 patients. Fifty-eight patients were matched with 58 healthy controls in terms of age, sex and body mass index. Results MedDietScore was negatively correlated to patients' serum alanine aminotransferase ( p = 0.03) and insulin levels ( p = 0.001), insulin resistance index ( p = 0.005) and severity of steatosis ( p = 0.006) and positively to serum adiponectin levels ( p = 0.04). Patients with non-alcoholic steatohepatitis (NASH) exhibited lower adherence to MD (29.3 ± 3.2 vs. 34.1 ± 4.4, p = 0.004) compared to those with simple fatty liver. Logistic regression analysis revealed that one unit increase in the MedDietScore was associated with 36% lower likelihood of having NASH (odds ratio: 0.64, 95% confidence interval: 0.45–0.92), after adjusting for sex and abdominal fat level. No difference in the MedDietScore was observed between patients and controls. Conclusions Higher adherence to the Mediterranean diet is not associated with lower likelihood of having NAFLD, but it is associated with less degree of insulin resistance and less severe liver disease among patients with NAFLD.
Although continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnea (OSA), lifestyle interventions have also emerged as complementary therapeutic choices. We ...aimed to explore whether the addition of a weight-loss Mediterranean diet/lifestyle intervention to OSA standard care, i.e. CPAP prescription and brief written healthy lifestyle advice, has an incremental effect on improving OSA severity, over the effect of standard care alone.
We designed a parallel, randomized, controlled, superiority clinical trial. Eligible participants were adult, overweight men and women, diagnosed with moderate-to-severe OSA apnea-hypopnea index (AHI)≥ 15 events/h through an attended overnight polysomnography. Participants were blindly randomized to a standard care group (SCG, n = 65), a Mediterranean diet group (MDG, n = 62) or a Mediterranean lifestyle group (MLG, n = 60). All three study groups were prescribed with CPAP. The SCG additionally received written healthy lifestyle advice, while intervention arms were subjected to a 6-month behavioral intervention aiming at weight loss and increasing adherence to the Mediterranean diet. The MLG also received counselling on physical activity and sleep habits. Polysomnographic data and OSA symptoms were evaluated pre- and post-intervention.
A total of 187 OSA patients were recruited. Seven patients were excluded post-randomization and 53/180 (29%) were lost to follow-up. No harms from the interventions applied were reported. According to intention-to-treat analysis (n = 180), mean (95% confidence interval) AHI change was −4.2 (−7.4, −1.0) for the SCG, −24.7 (−30.4, −19.1) for the MDG and −27.3 (−33.9, −20.6) for the MLG. Post-intervention age-, sex-, baseline- and CPAP use-adjusted AHI was significantly lower in the MDG and the MLG compared to the SCG (mean difference: −18.0, and −21.2, respectively, both P < 0.001), and the differences remained significant after further adjustment for body-weight change (P = 0.004 and 0.008, respectively). Other respiratory event indices, daytime sleepiness and insomnia were also significantly lower in both intervention arms compared to the SCG (all P < 0.05). The MLG only presented higher percent rapid-eye-movement sleep and lower daytime sleepiness compared to the MDG (both P < 0.05). Results were similar in the per-protocol analysis (n = 127).
A dietary/lifestyle intervention on top of standard care leads to greater improvements in OSA severity and symptomatology compared to standard care alone. Benefits are evident regardless of CPAP use and weight loss.
Clinicaltrials.gov NCT02515357, https://clinicaltrials.gov/ct2/show/NCT02515357.
•A weight-loss dietary/lifestyle intervention improves OSA severity and symptoms.•CPAP therapy alone does not affect weight status.•The Mediterranean diet/lifestyle improves OSA regardless of CPAP use and weight loss.•Lifestyle interventions should be encouraged for OSA management in clinical practice.
The aim of this review was to update the evidence regarding the link between serum uric acid and cardiovascular risk, as well as the role of nutrition in the prevention and management of ...hyperuricaemia.
The review focuses on recent epidemiological evidence concerning the role of elevated serum uric acid levels in cardiovascular risk prediction. The dietary prevention and management of hyperuricaemia is also discussed with an emphasis on the adoption of prudent dietary patterns.
There is evidence supporting that elevated serum uric acid levels are positively associated with cardiovascular disease risk and might represent a useful additional marker for risk stratification. The association of serum uric acid with all-cause and cardiovascular mortality seems to be U-shaped, suggesting that both very low and very high serum uric acid levels might be detrimental for survival, the former being mediated by malnutrition. Apart from medication, the dietary management of hyperuricaemia should focus on the adoption of a prudent dietary pattern, such as the Mediterranean diet, which can both prevent gout and mitigate cardiometabolic risk.
Non-alcoholic fatty liver disease (NAFLD) is a serious health problem affecting ~25% of the global population. While NAFLD pathogenesis is still unclear, multiple NAFLD parameters, including reduced ...insulin sensitivity, impaired glucose metabolism and increased oxidative stress are hypothesised to foster the formation of advanced glycation end-products (AGEs). Given the link of AGEs with end organ damage, there is scope to examine the role of the AGE/RAGE axis activation in liver injury and NAFLD.
Age, sex and body mass index matched normo-glycemic NAFLD adults (n = 58) and healthy controls (n = 58) were enrolled in the study. AGEs were analysed by liquid chromatography-mass spectrometry (CML, CEL), fluorescence (pentosidine, AGE fluorescence), colorimetry (fructosamine) and ELISA (sRAGE). Their association with liver function, inflammation, fibrosis and stage of NAFLD was examined.
Early and advanced glycation end-products, except Nε-carboxymethyl-L-lysine (CML), were 10–30% higher, sRAGE levels 1.7-fold lower, and glycation/sRAGE ratios 4-fold higher in the NAFLD cases compared to controls. While AGEs presented weak to moderate correlations with indices of liver function and damage (AST/ALT, HOMA-IR, TNF-α and TGF-β1), including sRAGE to characterize the AGEs/sRAGE axis strengthened the associations observed. High glycation/sRAGE ratios were associated with 1.3 to 14-fold likelihood of lower AST/ALT ratios. The sum of AGEs/sRAGE ratios accurately distinguished between healthy controls and NAFLD patients (area under the curve of 0.85). Elevated AGEs/sRAGE (>7.8 mmol/pmol) was associated with a 12-fold likelihood of the presence of NAFLD.
These findings strengthen the involvement of AGEs-RAGE axis in liver injury and the pathogenesis of NAFLD.
•Proxy markers for AGE/RAGE axis are linked with inflammation and hepatic damage.•AGEs are elevated and sRAGE levels depressed in NAFLD patients compared to controls.•AGE-RAGE markers show good discriminating capacity between NAFLD cases and controls.•These findings strengthen the involvement of AGEs-RAGE axis in NAFLD pathogenesis.
Lifestyle-induced weight loss is a complementary therapeutic approach for obstructive sleep apnea (OSA). We aimed at identifying the dose-response relationship between weight loss and OSA severity ...improvement.
This is a secondary analysis of a 6-month clinical trial in 180 adult, overweight/obese moderate-to-severe OSA patients. Participants were randomized to a standard care, a Mediterranean diet, or a Mediterranean lifestyle arm. All patients were prescribed with continuous positive airway pressure (CPAP), while intervention arms additionally participated in a weight-loss dietary/lifestyle intervention. Based on percent change in weight at 6 months, participants were categorized into a weight-stable/gain (WS/GG) group or 3 weight-loss groups (WLG): < 5%WLG, 5%-10%WLG, and ≥ 10%WLG. Polysomnographic data and OSA symptoms were evaluated preintervention and postintervention.
Respiratory events and oximetry indices improved only in patients who lost weight and improvements were proportional to the degree of weight loss. Median percent change in apnea-hypopnea index (AHI) was -11.7%, - 37.9%, and - 49.3% in the < 5%WLG, 5%-10%WLG, and ≥ 10%WLG, respectively (
< .001). Compared to the WS/GG, the age-, sex-, baseline-, and CPAP use-adjusted relative risk (95% confidence interval) of severe OSA (AHI ≥ 30 events/h) was 0.45 (0.23-0.87) in the 5%-10%WLG and 0.32 (0.17-0.64) in the ≥ 10%WLG; the risk was also lower in the ≥ 10%WLG vs the < 5%WLG (0.42 0.22-0.82). Insomnia and daytime sleepiness also improved more in participants exhibiting ≥ 5% weight loss.
Even a < 5% weight loss can reduce respiratory events, but a ≥ 5% and ideally ≥ 10% weight loss is necessary for reducing the prevalence of severe OSA.
Registry: ClinicalTrials.gov; Name: Mediterranean Diet/Lifestyle Intervention in Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT02515357; Identifier: NCT02515357.
Georgoulis M, Yiannakouris N, Kechribari I, et al. Dose-response relationship between weight loss and improvements in obstructive sleep apnea severity after a diet/lifestyle intervention: secondary analyses of the "MIMOSA" randomized clinical trial.
. 2022;18(5):1251-1261.
Although lifestyle changes have been investigated as a therapeutic choice in regard to obstructive sleep apnea (OSA) severity, data exploring associations between apnea and hypopnea indices and ...dietary habits are scarce.
The aim was to investigate possible relationships between apnea and hypopnea indices and red meat intake in a cohort of Greek patients with mild or moderate to severe OSA evaluated by polysomnography.
This is a cross-sectional study. Data were collected from November 2014 through July 2018.
The sample consisted of 243 patients (21 to 70 years old) who were recently diagnosed with OSA, by overnight attended polysomnography in the Sleep Disorders Center of “Evangelismos” Hospital, Athens Medical School (Greece). The patients included were free of other chronic diseases and had not changed their dietary habits for at least 6 months before evaluation.
Information on participants’ dietary intake, food group consumption, physical activity, smoking, sleep habits, and anthropometric measures were collected. Dietary intake was evaluated by food frequency questionnaire and 24-hour dietary recalls. Adherence to the Mediterranean diet was also evaluated using the Mediterranean Diet Score.
General linear models were used to examine the relation between red meat intake and sleep parameters, while adjusting for potential confounders. Multiple logistic regression was also applied to estimate the association between red meat intake and the likelihood of severe OSA.
Higher intakes of total red meat and unprocessed red meat were associated with higher values of apnea and hypopnea indices, after controlling for age, sex, waist circumference, socioeconomic parameters, smoking, physical activity, adequacy of nighttime sleep, and intake of foods or food components in the Mediterranean diet other than red meat (P trend for increasing quartiles of intake ≤0.02). Compared with patients in the lowest quartile of energy-adjusted total red meat intake (≤0.59 servings/day per 1,000 kcal), patients in the highest quartile (≥1.18 servings/day) had three times higher likelihood of having severe OSA (odds ratio: 3.09, 95% CI: 1.17 to 8.14).
The results provide evidence of a positive association between total red meat and unprocessed red meat intake with apnea or hypopnea indices and suggest that red meat consumption is associated with OSA severity.
Background
Given that obesity is a well‐known risk factor for obstructive sleep apnoea (OSA) development, dietary habits may be involved in its pathogenesis. However, little is known about the ...associations between dietary habits and OSA severity. The present study aimed to investigate possible associations between cereal grain intake and apnoea/hypopnoea indices in OSA patients.
Methods
This was a cross‐sectional study of 269 patients (21–70 years; 73.2% males) diagnosed with OSA via an attended in‐hospital polysomnography. Information on demographics, medical history, anthropometric indices and lifestyle habits were collected at enrolment. Biochemical measurements were performed in all study participants using standard procedures. Cereal grain consumption was evaluated using a validated food frequency questionnaire. Severe OSA was defined as having an apnoea‐hypopnoea index ≥30 events h–1.
Results
In adjusted analyses, higher intake of refined cereal grains was positively associated with apnoea‐hypopnoea index (ptrend = 0.022), after adjusting for age, sex, socio‐economic parameters, smoking habits, waist circumference, physical activity level, adequacy of night‐time sleep, diet's quality as assessed by a relevant score, insulin resistance and C‐reactive protein levels). Multiple logistic regression analysis also showed that energy‐adjusted refined grain intake was associated with increased likelihood of severe OSA (odds ratio = 1.56, 95% confidence interval = 1.06–2.30). Νo association between apnoea/hypopnoea indices and non‐refined grain intake was observed in this study.
Conclusions
The findings show that obstructive sleep apnoea (OSA) is associated with cereal grain intake and suggest that a higher intake of refined cereal grains may be a risk factor for OSA severity.
Highlights
Data regarding the role of dietary habits in obstructive sleep apnoea severity are scarce.
Higher intake of refined cereal grains is positively associated with apnoea‐hypopnoea index.
Higher refined grain intake is associated with increased likelihood of severe obstructive sleep apnoea (OSA).
Refined cereal grain intake may be a risk factor for OSA severity.
Dietary habits have been associated with obstructive sleep apnea (OSA); however, the underlying mechanisms remain unclear. We hypothesized that adherence to dietary patterns may be associated with ...Apnea-Hypopnea Index (AHI) and OSA severity and that insulin resistance, oxidative stress, and inflammation may act as potential mediators of these associations. This was a cross-sectional study among 269 adult participants with polysomnography-diagnosed moderate-to-severe OSA. Dietary and physical activity habits were assessed through validated questionnaires, and biochemical, inflammatory, and oxidative stress markers were measured for all volunteers. Dietary patterns were identified using principal component analysis, and mediation analyses was also performed. A “Western-type” dietary pattern (characterized by high intakes of full-fat dairy, refined grains, potatoes, red meat, sweets, salty snacks, and soft drinks and low intakes of low-fat dairy and whole grains) was positively associated with AHI. Mediation analyses also revealed that insulin resistance partially explained this association. In multivariable models controlling for age, sex, smoking, socioeconomic status, obesity presence, energy intake, and physical activity level, participants in the highest quartile of adherence to the Western-type dietary pattern had ∼3.5 times higher likelihood of suffering from severe OSA, compared with participants in the lowest quartile of adherence (odds ratio 95% confidence interval: 3.45 1.21-9.94, P trend across quartiles: 0.024). After further adjustment for Homeostasis Model of Assessment-Insulin Resistance and high-sensitivity C-reactive protein, this association lost significance. Higher adherence to a less healthy, Western-type dietary pattern is positively associated with AHI and OSA severity, which may partially be mediated through insulin resistance.
Dietary habits and diet quality have been associated with obstructive sleep apnea (OSA). Higher adherence to a less healthy, “Western-type” dietary pattern (characterized by high intakes of full-fat dairy, refined grains, potatoes, red meat, sweets, salty snacks, and soft drinks and low intakes of low-fat dairy and whole grains) was positively associated with Apnea-Hypopnea Index (AHI) and OSA severity, which may partially be mediated through insulin resistance. Display omitted
Long-term prognostic value of LDL-C, HDL-C, lp Georgoulis, Michael; Chrysohoou, Christina; Georgousopoulou, Ekavi ...
Lipids in health and disease,
12/2022, Letnik:
21, Številka:
1
Journal Article
Recenzirano
Background The link between blood lipids and cardiovascular disease (CVD) is complex. Our aim was to assess the differential effect of blood lipids on CVD risk according to age, sex, body weight, ...diet quality, use of lipid-lowering drugs and presence of hypercholesterolemia. Methods In this secondary analysis of the ATTICA prospective cohort study, serum blood lipids, i.e., total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and liproprotein(a) Lp(a), and sociodemographic, anthropometric, lifestyle and clinical parameters were evaluated at baseline (2001/2002) in 2020 CVD-free men and women. CVD incidence was recorded at the 10-year follow-up (2011/2012). Results All blood lipids assessed were univariately related to CVD risk; however, associations remained significant only for HDL-C and TG in multivariate models adjusted for age, sex, body mass index, smoking, Mediterranean Diet Score, physical activity, presence of hypercholesterolemia, hypertension and diabetes mellitus, use of lipid-lowering drugs, and family history of CVD RR per 1 mg/dL (95% CI): 0.983 (0.967, 1.000) and 1.002 (1.001, 1.003), respectively. In stratified analyses, TC and LDL-C predicted CVD risk in younger subjects, normal-weight subjects, and those not on lipid-lowering drugs, while HDL-C and TG were significant predictors in older subjects, those with low adherence to the Mediterranean diet, and hypercholesterolemic subjects; a significant effect on CVD risk was also observed for TG in males, overweight participants and lipid-lowering medication users and for Lp(a) in older subjects and females (all p less than or equai to 0.050). Conclusions The impact of blood lipids on CVD risk differs according to several biological, lifestyle and clinical parameters. Keywords: Lipidemic profile, Low-density lipoprotein cholesterol, Lipoprotein(a), High-density lipoprotein cholesterol, Hyperlipidemia, Dyslipidemia, Triglycerides, Cardiovascular risk
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Dietary habits are a significant predictor of hypertension (HTN). We aimed to evaluate the long-term association between adherence to the Mediterranean diet and HTN incidence.
This was a prospective ...study among 1415 non-hypertensive adults (44% men, age: 41 ± 13 years) followed up for 20 years. Anthropometric, lifestyle, and clinical parameters were evaluated at baseline. Adherence to the Mediterranean diet was evaluated both at baseline and 10 years through the MedDietScore (range: 0-55, higher values indicate greater adherence).
At the 20-year follow-up, 314 new HTN cases were recorded. HTN incidence was 35.5%, 22.5%, and 8.7% in the lowest, middle, and upper tertile of baseline MedDietScore, respectively (p < 0.001). For each 1-point increase in baseline MedDietScore, the 20-year HTN risk decreased by 7% relative risk (RR): 0.925, 95% confidence interval (CI): 0.906, 0.943, and this effect remained significant after adjustment for age, sex, and baseline lifestyle and clinical confounders, i.e., body mass index, physical activity, smoking, systolic and diastolic blood pressure, family history of HTN, and presence of hypercholesterolemia and diabetes mellitus (RR: 0.973, 95%CI: 0.949, 0.997). In a similar multiadjusted model, compared to subjects who were consistently away from the Mediterranean diet (in the lowest MedDietScore tertile both at baseline and 10 years), only those who were consistently close (in the middle and upper MedDietScore tertiles both at baseline and 10 years) exhibited a 47% lower 20-year HTN risk.
A high adherence to the Mediterranean diet, particularly when longitudinally sustained, is associated with lower incidence of HTN.
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