अहोभुवनकल्लोलैविचित्र क्समुत्थितम् । मय्यनन्तमहाम्भोधौचित्तवातेसमुद्यते॥
मय्यनंतमहाम्भोधी चित्तवातेप्रशाम्यति । अभाग्याज्जीववणिजोजगत्पोतोषिनश्वरः ॥
Whole Grain : Health Benefits Associated with Whole Grains—Summary & Review
**There were 700 cardiovascular events over a mean follow-up of 5·1 years. After adjustment for sociodemographic variables, health behaviours and other CVD risk factors, participants eating ≥2 servings fried fish/week -- Although nuts and legumes (beans) have nutrient profiles that mayThis Opinion of the EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) provides guidance on the translation of nutrient based dietary advice into guidance, intended for the European population as a whole, on the contribution of different foods or food groups to an overall diet that would help to maintain good health through optimal nutrition (food-based dietary guidelines). The main focus of this Opinion is put on the scientific process of developing food-based dietary guidelines (FBDG) for the diverse European populations, following a stepwise approach which should ideally consist of: 1) Identification of diet-health relationships, 2) Identification of country specific diet-related health problems, 3) Identification of nutrients of public health importance, 4) Identification of foods relevant for FBDG, 5) Identification of food consumption patterns, 6) Testing and optimising FBDG and 7) Graphical representations of FBDG. FBDG should focus on the diet-disease relationships of particular relevance to the specific population and should be developed using a multi-disciplinary approach. The early involvement of stakeholders is recommended to promote the acceptance of the outcome. FBDG should be consistent with other public policies that have an impact on food availability and be integrated with other policies related to health promotion. Once established, FBDG should be implemented and their impact monitored and evaluated. reduce cardiometabolic risk, their associations with major clinical cardiometabolic endpoints have not been well established (1, 2). Nuts are rich in unsaturated fatty acids, plant protein, dietary fiber, antioxidant vitamins (eg, vitamin E and tocopherols), minerals (eg, magnesium and potassium), and phytochemicals (eg, flavonoids). Legumes are rich in protein, complex carbohydrates, fiber, and various micronutrients (eg, phytochemicals) (1). Controlled trials have shown beneficial effects of the consumption of nuts and legumes on cardiovascular disease (CVD)5 risk factors (1), and a recent trial in high risk adults showed that advice to consume a Mediterranean diet supplemented with nuts significantly reduced CVD events ~30% (3). However, to our knowledge, only one previous meta-analysis has reviewed the relation between nut consumption and ischemic heart disease (IHD) and showed an inverse relation with fatal (but not nonfatal or total) IHD (4), and relations of nut or legume consumption with other cardiometabolic endpoints such as stroke or type 2 diabetes have not been systematically reviewed. Furthermore, the previous meta-analysis (4) included only 4 studies, did not use most–covariate-adjusted risk estimates from each study, and did not assess the potential dose-response relation. To address these key gaps in knowledge, we performed a systematic review and meta-analysis of associations between nut and legume intakes and incident IHD, stroke, and diabetes.
Specific mechanisms involved in serum cholesterol reductions observed with increased fiber intake remain somewhat inconclusive. Recent research provides evidence that viscous polysaccharides act in the gastrointestinal tract to reduce blood cholesterol by decreasing absorption of cholesterol or fatty acids and decreasing absorption of biliary cholesterol or bile acids.1112 Fiber may also cause altered serum concentration of hormones or short-chain fatty acids that affect lipid metabolism. β-Glucan, the water-soluble fiber prevalent in oats and barley, has been shown in animal models to be the active agent causing the altered cholesterol metabolism.13
On the basis of results of studies of oats and barley, other proposed mechanisms include the influence of ∝-tocotrienols and compounds that have vitamin E activity and produce hepatic HMG-CoA (hydroxymethylglutaryl coenzyme A) reductase inhibition in animal models, but this has yet to be conclusively documented.14 It has been further suggested that the amino acid content of oats and the arginine-lysine ratio may also promote the hypocholesterolemic response.1516 Further studies in humans are needed to delineate and quantify these mechanisms across different fiber sources and under different biological conditions.
Fiber Intake and Mortality
Several longitudinal observational studies have reported significant inverse associations between total fiber intake and both cardiovascular and all causes of mortality.1718 Part of this phenomenon may reflect the accompanying inverse association that is often observed between fiber and fat intake when calories are controlled.19 For example, in the Zutphen Study,18 men in the lowest quintile of dietary fiber intake exhibited a four times higher rate of CHD mortality compared with men in the highest quintile, even though total caloric intake was about the same. Numerous studies comparing vegetarians and nonvegetarians have reported lower levels of serum cholesterol and lower mortality rates in the former, but whether fiber is the active agent involved or simply a reflection of greater intake of complex carbohydrates and less saturated fat is not easily deciphered.202122
Other epidemiological evidence is less consistent. The rate of CHD mortality was reported to be inversely associated with fiber intake across 20 industrialized nations, but adjustment for fat intake removed the association.23 Similarly a 20-year cohort study of 1001 middle-aged men in Ireland and Boston reported significant inverse association between fiber intake and risk of CHD, but the association diminished when other risk factors were controlled.24 In a 12-year follow-up study of 859 men and women aged 50 to 79 years, a 6-g increment in daily fiber intake was associated with a 25% reduction in ischemic heart disease mortality, independent of calories, fat, and other dietary variables.25 A recent study among 850 men in the Yi province of China reported that lower serum cholesterol and blood pressure levels were associated with higher intakes of fiber from oats and buckwheat.26 Total fat and dietary cholesterol intakes were also significantly lower in those with the highest fiber intakes, but caloric intakes were similar across all fiber groups. These studies and others illustrate the complexity of measuring the independent impact of fiber on lipids and/or mortality rates within the limitations of available diet assessment methodology, disparate food composition data, and the difficulty of controlling confounding factors.27
Results of Clinical and Metabolic Studies
A growing number of metabolic research studies have reported total cholesterol reductions of 10% to 15% with diets enriched with fiber from oats,282930 beans,3132 or psyllium,33 but these diets were also reduced in fat. Other studies have investigated adding supplements of pectin and guar gum with subsequent cholesterol reductions of 10% or more, but gastrointestinal side effects were more common.193435
In the past decade more than 30 clinical studies have evaluated the impact of oats and other fiber-rich foods as part of Step I or similar fat-modified diets in outpatient, free-living, and controlled settings. The majority of studies report the greatest lipid-lowering benefits occur among persons with elevated baseline cholesterol levels. A meta-analysis of pooled data from 13 randomized, controlled trials with baseline and follow-up dietary data further controlled for the impact of the fat-modified diet alone. Fiber from two servings of oats enhanced cholesterol reduction by an additional 2% to 3% beyond what was achieved by fat modification.36
Some studies on dietary fiber and lipid response have reported equivocal results.373839 In its review of evidence to determine whether to approve a food manufacturer’s petition for a health claim that links increased oat fiber intake with cholesterol lowering, the Food and Drug Administration 40 applied rigorous evaluation criteria to all available data. Studies that did not support the soluble fiber lipid-lowering relation were often criticized for small sample sizes, inadequate dietary data to evaluate adherence to the recommended diet, and/or lack of standardized sources of fiber. Of all the studies reviewed, the majority favored the association with doses ranging from 34 g total dietary fiber (2.5 g soluble fiber) to 123 g (10.3 g soluble fiber). 40 A dose-response study specifically designed to evaluate this question among hypercholesterolemic persons found maximal lipid lowering was achieved with 56 g versus 84 g of oat bran, suggesting a possible threshold effect.15 Fifty-six grams of oat bran is equivalent to approximately two servings (two-thirds cup dry).
Studies of fiber supplements containing psyllium have reported greater reductions of 15% in LDL-cholesterol levels as part of the usual American diet and 9% as part of a Step I diet.33 More recently a fiber supplement containing a mixture of guar gum, pectin, soy fiber, pea fiber, and corn bran lowered LDL cholesterol by 7% to 8% in hypercholesterolemic participants after 15 weeks compared with those taking a placebo.41 These reductions persisted throughout the 51-week follow-up period with continued use of supplements. Potential risks of excessive use of fiber supplements include reduced mineral absorption and a myriad of gastrointestinal disturbances. Fiber from natural dietary sources is preferred to avoid these problems and supply numerous other nutritional benefits. A fiber supplement added to a diet otherwise high in saturated fat and cholesterol provides dubious cardiovascular advantages. Indeed, such an approach can be detrimental if it instills a false sense of security that precludes further attention to other aspects of the diet, such as high saturated fat intake.
Observational epidemiological evidence consistently demonstrates lower incidence of CHD and other long-term diseases among those with the highest intake of fruits, vegetables, and grains.254243 Such a dietary pattern appears to offer protective effects that transcend lipid lowering and overall is typically lower in total fat, saturated fat, and cholesterol.
Effects of Fiber on Other Risk Factors
Inverse associations between fiber and blood pressure have also been reported.444546 Some intervention studies among hypertensive and normotensive individuals have reported reductions in blood pressure in response to increased fiber intake, but these results are not conclusive.84748 Confounding factors in these studies include obesity, use and amount of antihypertensive medication, and comorbidity. A vegetarian diet appears to induce blood pressure reduction in hypertensive individuals, but independent effects of dietary fiber have yet to be elucidated.
Similarly, high-fiber vegetarian diets have also been associated with reduced risk of obesity.8204950 It has been hypothesized that high-fiber foods may favorably impact satiety and slow gastric emptying, thereby sustaining a feeling of fullness that prohibits overeating.68 Intake of high-fiber foods may also improve glycemic control in diabetic individuals and reduce risk of insulin resistance.151 Clinical trials to address each of these factors and isolate independent effects of fiber on weight control versus glucose metabolism are needed.
Fiber and Children’s Diets
As a preventive strategy, it has been recommended that children older than 2 years should gradually adopt the Step I diet, reducing total and saturated fat intake to 30% and 10% of total calories, respectively. Children should also derive the majority of calories from complex carbohydrates.2 Such a diet inherently offers the benefits of increased fiber and nutrient intake from a host of dietary sources as well, but lingering concerns about reduced energy intake and compromised growth have prompted suggested fiber guidelines from the pediatric community. It has been proposed that the “age plus 5” rule be applied when determining the appropriate amounts of dietary fiber for young children.52 This means, for example, a five-year-old should consume 5+5=10 g of fiber per day. This should be easy to accomplish within the boundaries of the Step I diet. Once a child’s caloric intake approaches that of an adult, ie, 1500 calories or more, 25 total grams should be well tolerated.
Conclusions
The greatest impact on lowering total and LDL cholesterol is derived from reduced intakes of saturated fat and cholesterol as well as weight reduction in obese persons. Diets high in complex carbohydrates and fiber are associated with reduced mortality rates from CHD and other chronic diseases. Fiber found in oats, barley, and pectin-rich fruits and vegetables provides adjunctive lipid-lowering benefits beyond those achieved by reductions in total and saturated fat alone. The AHA recommends a total dietary fiber intake of 25 to 30 g/d from foods, not supplements, to ensure nutrient adequacy and maximize the cholesterol-lowering impact of a fat-modified diet. Current dietary fiber intakes among adults in the United States average about 15 g, or half the recommended amount.53
‘Fiber, Lipids, and Coronary Heart Disease’ was approved by the American Heart Association Science Advisory and Coordinating Committee in December 1996.
Background/Objectives:
There is convincing evidence that a high dietary fiber intake may lower the risk of coronary heart disease. However, the role of fiber in the prevention of stroke is unclear. We examined the associations of dietary fiber and fiber-rich food intake with risk of stroke within the Alpha-tocopherol, Beta-carotene Cancer Prevention Study. Although nuts and legumes (beans) have nutrient profiles that may reduce cardiometabolic risk, their associations with major clinical cardiometabolic endpoints have not been well established (1, 2). Nuts are rich in unsaturated fatty acids, plant protein, dietary fiber, antioxidant vitamins (eg, vitamin E and tocopherols), minerals (eg, magnesium and potassium), and phytochemicals (eg, flavonoids). Legumes are rich in protein, complex carbohydrates, fiber, and various micronutrients (eg, phytochemicals) (1). Controlled trials have shown beneficial effects of the consumption of nuts and legumes on cardiovascular disease (CVD)5 risk factors (1), and a recent trial in high risk adults showed that advice to consume a Mediterranean diet supplemented with nuts significantly reduced CVD events ~30% (3). However, to our knowledge, only one previous meta-analysis has reviewed the relation between nut consumption and ischemic heart disease (IHD) and showed an inverse relation with fatal (but not nonfatal or total) IHD (4), and relations of nut or legume consumption with other cardiometabolic endpoints such as stroke or type 2 diabetes have not been systematically reviewed. Furthermore, the previous meta-analysis (4) included only 4 studies, did not use most–covariate-adjusted risk estimates from each study, and did not assess the potential dose-response relation. To address these key gaps in knowledge, we performed a systematic review and meta-analysis of associations between nut and legume intakes and incident IHD, stroke, and diabetes.
Exclusion criteria
We excluded studies with concomitant major interventions that could not be separated from nut or legume consumption. Studies were also excluded if they only reported soft CVD outcomes (eg, angina) or intermediate risk factors (eg, blood lipids, insulin resistance, or metabolic syndrome), only providing crude (unadjusted) risk estimates if observational, focused on comparing vegetarians with nonvegetarians, or had a follow-up duration
Data extraction
Data were extracted by using a standardized electronic format independently and in duplicate by 2 investigators. Information included the first author name, contact information, publication year, study name, location, design, population (age, sex, race, and sample size), duration of follow-up, exposure definition, exposure assessment, exposure categories, dose in each category, outcome definition, outcome ascertainment, statistical analysis method, and covariates. Also, for each exposure category, we collected data on the median exposure, number of participants, person-years, number of events, and risk estimate and its corresponding uncertainty. For nuts, analyses were standardized to 4 weekly servings [28.4 g (1 oz)/serving (7)] on the basis of intakes associated with lowest risk in observational studies (8) and dietary targets set by advocacy organization (9). For consistency, analyses for legumes were also standardized to 4 weekly servings [100 g/serving (7)]. Differences in data extraction between investigators were unusual and were resolved by consensus.
Quality assessment
We assessed study quality on the basis of 5 criteria including the appropriateness and reporting of inclusion and exclusion criteria, assessment of exposure, assessment of outcome, control of confounding, and evidence of bias as previously reported (10). Each study received a score of zero or one (one being better) for each criterion, and an overall quality score was calculated as the sum of individual scores. For descriptive purposes, quality scores from 0 to 3 were generally considered lower quality, and scores from 4 to 5 were considered higher quality.
Statistical analysis
To maximize the use of information across all categories of exposure in each study, we conducted dose-response meta-analyses by using the 2-step generalized least-squares trend model (11, 12). Study-specific dose-response risk estimates were computed from the ln of risk estimates across categories of nut and legume intakes, with the consumption level in each category accounted for; and these study-specific risk estimates were pooled to derive an overall risk estimate. HRs and ORs were considered approximations of RRs. For each category of exposure, required inputs were the multivariable-adjusted risk estimate, its corresponding SE, person-years of follow-up (for RCTs and prospective cohorts) or number of subjects (for case-control studies), median exposure, and number of cases. When only sex-stratified results were reported by a study, these estimates were first pooled within each study by using the 2-step generalized least-squares trend method to derive the overall study-specific risk estimate. Analyses were performed by using random-effects inverse-variance weights. We compared these findings to fixed-effects inverse-variance weights in sensitivity analyses.
The between-study heterogeneity was assessed by using Cochran’s Q and the I2 statistic. I2 values of 25%, 50%, and 75% were considered to represent low, moderate, and high heterogeneity, respectively (13). Potential explanatory sources of heterogeneity were explored by using meta-regression including age (continuous; and categorical
RESULTS
Of 3851 articles identified, 27 studies met inclusion and exclusion criteria (Figure 1), including 2 RCT reports, 23 prospective cohort reports, and 2 retrospective case-control studies. These represented one unique trial, 13 unique prospective cohorts, and 2 unique retrospective case-control studies that comprised 501,791 unique participants. The weighted mean (±SD) age of populations was 53.4 ± 4.0 y, with a weighted mean follow-up of 13.1 ± 6.3 y (Tables 1 and 2). Sixteen studies were from North America, 8 studies were from Europe, and 3 studies were from Asia. Median intakes of nuts across categories within each study ranged from 0 to 213 g/wk and of legumes from 0 to 938 g/wk. Nearly all studies adjusted for major potential confounders including age, sex, tobacco use, physical activity, alcohol intake, and intakes of saturated fat, trans fat, fiber, vegetables, and fruit. Several studies also adjusted for factors that could be either confounders or intermediates in the causal pathway (eg, blood pressure and hypercholesterolemia) (16–21); such adjustment could inappropriately attenuate observed risk estimates. Nearly all studies received a high-quality score (≥4).
Vegetables and fruit are extremely important in human nutrition as sources of nutrients and non-nutritive food constituents as well as for the reduction in disease risks. While their importance as sources of nutrients and non-nutritive food constituents is generally accepted, there are still uncertainties regarding their relevance for the prevention of diseases. For this reason, it has to be determined first, for which diseases studies have detected an association between the consumption of vegetables and fruit and the risk of disease, and subsequently, how this association has to be judged. This information provides an important basis to judge the preventive potential of a diet rich in vegetables and fruit. For example, this would allow to estimate the changes regarding the incidence of certain diseases that have to be expected if, for example, the “5 a day” recommendation on the consumption of about 650 g vegetables and fruit per day would be implemented by the majority of subjects in Germany.
Therefore, a working group within the German Nutrition Society (DGE) was established in 2006 with the aim to evaluate the evidence on the role of vegetables and fruit regarding the prevention of certain chronic diseases. The available data were recorded by comprehensive literature search, and the respective strength of the evidence was determined by criteria defined in advance. This evaluation of the evidence was published in 2007 in German as a DGE-statement [1].
As further studies on the association between the consumption of vegetables and fruit and the risk of disease have been published since 2007, it was necessary to update the statement. Therefore, the available data on the diseases selected in 2007 once again were comprehensively recorded with focus on prospective epidemiologic observational and intervention studies, and based upon these study data, the evidence regarding a preventive effect was judged.
Subjects/Methods:
Between 1985 and 1988, 26 556 Finnish male smokers aged 50–69 years, who had no history of stroke, completed a dietary questionnaire. During a mean follow-up of 13.6 years, 2702 cerebral infarctions, 383 intracerebral hemorrhages and 196 subarachnoid hemorrhages were ascertained.
Results:
After adjustment for cardiovascular risk factors and folate and magnesium intakes, there was no significant association between intake of total fiber, water-soluble fiber, water-insoluble fiber, or fiber derived from fruit or cereal sources and risk of any stroke subtype. Vegetable fiber intake, as well as the consumption of fruit, vegetables and cereals, was inversely associated with the risk of cerebral infarction; the multivariate relative risks for the highest quintile of intake as compared with the lowest were 0.86 (95% confidence interval (CI): 0.76–0.99) for vegetable fiber, 0.82 (95% CI: 0.73–0.93) for fruit, 0.75 (95% CI: 0.66–0.85) for vegetables and 0.87 (95% CI: 0.74–1.03) for cereals. Vegetable consumption was inversely associated with risk of subarachnoid hemorrhage (relative risk for highest versus lowest quintile: 0.62; 95% CI: 0.40–0.98), and cereal consumption was inversely associated with risk of intracerebral hemorrhage (relative risk: 0.64; 95% CI: 0.41–1.01).
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We used an empirically developed questionnaire-based AIDI to assess anti-inflammatory diet potential.11 The AIDI was based on frequency of consumption of 16 foods, including 11 foods with anti-inflammatory potential and five foods with pro-inflammatory potential. The following foods with anti-inflammatory potential were included in the index: total fruits and vegetables (cut-off ≥6 servings/day); tea (≥3 servings/day); coffee (≥2 servings/day); whole grain bread (≥2 servings/day); breakfast cereal (≥1 servings/day); low-fat cheese (≥1 servings/day); olive oil and canola oil (>0 servings/day); chocolate (≥1 servings/day); nuts (≥2 servings/week); red wine (2–7 servings/week); and beer (2–14 servings/week). The following foods with pro-inflammatory potential were included: unprocessed red meat (≤0.5 servings/day); processed red meat (≤0.5 servings/day); organ meats (0 servings/day); chips (0 servings/day); and soft-drink beverages (0 servings/day).11 Age-specific portion sizes of foods included in the AIDI are presented in online supplementary Table S1.
When the cut-off criteria were met, the consumption for each food item was scored as 1, and when not met as 0.11 The AIDI ranged from 0 to 16; 0 indicated a diet with the lowest anti-inflammatory potential, while 16 a diet with the highest anti-inflammatory potential. The questionnaire-based AIDI was validated in a subgroup of the SMC (n = 3503, age 56–74 years) using plasma high-sensitivity C-reactive protein (hsCRP) concentration. The Spearman correlation coefficient between the AIDI and hsCRP was −0.18, and each 1-unit increment in the AIDI score was associated with a 0.07 [95% confidence interval (CI) 0.04–0.10] mg/L lower hsCRP.11
In a separate study, the FFQ used to calculate the AIDI has been validated using four 1-week weighted diet records among 129 women from the SMC. For foods included in the AIDI, the Spearman correlation coefficients between estimates from the FFQ and diet records varied from 0.34 for organ meats to 0.89 for red wine (Wolk A., unpublished data).
Assessment of covariates
Data on education level, weight, height, time per day spending on walking and/or cycling, use of aspirin, corticosteroids, and dietary supplements, history of hypercholesterolaemia, and family history of myocardial infarction were collected in the 1997 questionnaires. Participants were asked about smoking status, age at which they started smoking, average number of cigarettes smoked daily at different ages (15–20, 21–30, 31–40, 41–50, and 51–60 years of age and current age), and age at quitting smoking (if applicable). Pack-years were calculated by multiplying the number of years of smoking by the reported number of cigarettes smoked per day within respective age groups. BMI was calculated as the body weight (kilograms) divided by the height squared (meters). Data on history of diabetes, hypertension, atrial fibrillation and ischaemic heart disease were collected via linkage with the Swedish registers, i.e. data about diabetes via linkage with the Swedish National Diabetes Register and the Swedish National Patient Register (ICD-10 codes: E10–E14), and data about hypertension (ICD-10 code: I109), atrial fibrillation (ICD-10 code: I48), and ischaemic heart disease incidence (ICD-10 codes: I20–I25) via linkage with the Swedish National Patient Register.
Follow-up and ascertainment of heart failure
Participants were followed from 1 January 1998 to the date of diagnosis of HF, death, or the end of follow-up (31 December 2014), whichever occurred first.
Dates of the first recorded diagnosis of HF were ascertained through linkage with the Swedish Patient Register (inpatient and outpatient registers). The completeness of the register is almost 100%.17 HF events were defined according to the International Classification of Diseases and Related Health Problems, 10th Revision (ICD code I50 and I11.0). In the study, we included the first HF event recorded in the registers listed either as the primary diagnosis or in any diagnosis position. The HF diagnosis in the Swedish hospital discharge was validated and 95% of patients with these codes as primary diagnosis and 76% with HF diagnosed as the second diagnosis position in the patient register had HF diagnosed on the basis of medical record review using European Society of Cardiology criteria.18
Statistical analysis
Age-standardized means and standard deviations or median and interquartile range (IQR) or percentages, as appropriate, were used to describe participant characteristics in quintiles of the AIDI, i.e. scores of ≤4, 5, 6, 7, and ≥8. Baseline characteristics across the AIDI quintiles were compared using a one-way analysis of variance (ANOVA), the Kruskal–Wallis test and the Chi-square test, where appropriate. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% CI for incident HF by quintiles of the AIDI. Initially models were adjusted for age (years, continuous) and sex (men, women). Multivariable-adjusted models were adjusted for age (years, continuous), sex (men, women), education (primary, high school, or university), smoking status (never; ex-smokers <20, 20–39, or ≥40 pack-years; or current <20, 20–39, or ≥40 pack-years), BMI (<20, 20–24.9, 25–29.9, or ≥30 kg/m2), walking/cycling (<20, 20–40, 40–60, or >60 min/day), corticosteroid use (yes, no), aspirin use (yes, no), dietary supplement use (regular, non-regular, no use), history of diabetes (yes, no), hypertension (yes, no), hypercholesterolaemia (yes, no), atrial fibrillation (yes, no), family history of myocardial infarction (yes, no), and energy intake (kcal/day, continuous). Missing data on educational level (0.5%), smoking status (1.6%), BMI (3.4%), walking/cycling (8.7%), corticosteroid use (10.3%), aspirin use (10.7%) and dietary supplement use (6.9%) were included to the models as separate categories. AIDI as a continuous variable was used to calculate P-values for trend. The shape of the associations between AIDI and risk of HF using a restricted cubic-spline regression analysis with three knots (at the 10th, 50th and 90th percentile) was examined.19 Models were repeated within strata of sex and smoking status. Moreover, a sensitivity analysis excluding the first 3 years of follow-up was conducted to assess whether the results might have been influenced by reverse causation bias. Interactions of sex and smoking status with quintiles of AIDI and sex were assessed using likelihood ratio tests. The assumption of proportional hazards was tested by regressing scaled Schoenfeld residuals against survival time, and no evidence of departure from the assumption was found. All statistical analyses were performed using Stata 14 (StataCorp, College Station, TX, USA); and two-sided P-values ≤0.05 were considered statistically significant.
Results
The range (median) of the AIDI was 0–12 (6) in men and 0–13 (6) in women. Age-standardized baseline characteristics of both studied cohorts by quintiles of the AIDI are presented in Table 1. More men and women in the highest quintile of the AIDI compared to those in the lowest quintile had university education, reported walking and/or cycling ≥40 min/day, regularly used dietary supplements and were less likely to be current smokers. Consumption of foods with anti-inflammatory potential increased with increasing AIDI, and consumption of those with pro-inflammatory potential decreased.
Table 1. Age-standardized baseline characteristics of 40 514 men from the Cohort of Swedish Men and 34 809 women from the Swedish Mammography Cohort by quintiles of the anti-inflammatory diet index (maximum score = 16)
The prevalence of pre-obesity and obesityFootnote1 has been rising in recent decades in European countries. For example, in the EPIC–DIOGENES cohort, the prevalence of obesity in 60- to 65-year-olds increased within 8.6 years of follow-up from 21.5 to 27.8 %. In this cohort study, it was also observed that in the current generation of elderly people, overweight persisted into old age once it has been developed [7]. Overweight or obesity occurs disproportionately often in individuals that have unfavourable socioeconomic indicators regarding education, income, and professional position [8]. Particularly, alarming is the sharp increase in obesity in children and adolescents. According to the data of the PreVENT Study, which includes the results of the German representative national KiGGS Study and also of other large surveys in Germany (KOPS, IDEFICS, CHILT), 12 % of the 3- to 6-year-old, 17.9 % of the 7- to 10-year-old, 18.9 % of the 11- to 13-year-old, and 15.0 % of the 14- to 17-year-old children and adolescents are overweight.Footnote2 Averaged over all age groups, nowadays, 6 % of the children and adolescents are obeseFootnote3 (Müller M, own results).
Overweight occurs if energy intake is higher than energy expenditure. Compared with many other foods, the volume of vegetables and fruit in relation to the energy content is larger. Due to the favourable volume to energy ratio of vegetables, and fruit, satiety signals can emerge without consuming a large amount of energy [9]. The extent is not known to which individual constituents of vegetables and fruit such as dietary fibre are involved in the regulation of hunger and saturation and hence body weight.
The association between vegetable and fruit consumption and weight development was summarised in the ISAFRUIT Project of the EU from 2008 [12]. Eleven out of the 16 identified studies observed an inverse association, including 3 intervention studies and 8 prospective observational studies. In addition to the 8 prospective studies of the ISAFRUIT summary, including 5 studies that showed an inverse relation, there are other prospective studies on the association between the consumption of vegetables and fruit and weight change, which either have been published later than the ISAFRUIT summary or have not been included in the summary. They either showed an inverse relation [13–16] or no relation or relations that were only evident in subgroups differentiated by gender or food groups [17–19]. In one of the studies, a positive relation was observed [20]. Some of the studies investigated the consumption of vegetables and fruit in relation to a dietary pattern. In these studies, the role of vegetable and fruit consumption per se is difficult to assess. In longitudinal investigations in infants and children (observation periods were between 1 and 8 years), the consumption of vegetables and fruit did not have a significant influence on the maintenance of normal weightFootnote4 or the incidence of overweight [21, 22]. Children with persistent overweight throughout the observation period had a higher fat and a lower vegetable and fruit consumption than overweight children, who could reduce weight during the observation period [23]. However, it is not possible to detect differences in the effects of fat and vegetables and fruit in this study. The same weak or not evident influence was seen in results from cross-sectional studies ([24, 25], PreVENT unpublished data). Contradictory, a prospective study showed that a high consumption of fruit juice had a minor positive influence on weight gain [26].
Intervention studies with vegetables and fruit without focus on weight reduction were systematically analysed in a review [27]. The few studies that only had vegetables and fruit as an intervention either showed no changes in weight development or observed weight changes were comparable to the control group. A slightly more favourable effect regarding weight development was observed in studies with simultaneous fat reduction, as in some of these interventions, spontaneous weight loss occurred. Intervention studies on weight reduction are investigations that only indirectly provide information on the role of vegetables and fruit for weight development. Instructions to eat more vegetables and fruit to stabilise weight resulted in variable extents of weight reduction including substantial weight loss. This weight loss had been linked to reduced energy density [28]. It was shown in an intervention study that at fat reduction, an increase in vegetable intake enhances weight loss [29]. However, another intervention study with 1,510 women with breast cancer did not observe weight loss with such an intervention over 4 years [30].
In summary, these studies showed that an increase in vegetable and fruit consumption might be a suitable measure to facilitate initial weight loss and subsequent weight stability [27]. In this context, it seems also to be important to address energy reduction as well. We could not identify studies investigating in children and adolescents, whether an increase in vegetable and fruit consumption influences body weight.
For the range of normal weight and slight overweight, the Women’s Health Initiative (WHI) Dietary Modification Trial reported about the role of vegetables and fruit for long-term weight stability. In this randomised intervention study including 48,385 women (aged 50–79 years), the intervention group was given specific advice regarding an increase in the consumption of both vegetables and fruit (target ≥5 portions/day) and cereal products (target ≥6 portions/day) as well as a reduced intake of fat (target
It can be concluded from both the prospective and the intervention studies that there is possible evidence that an increase in the consumption of vegetables and fruit contributes to weight stability (i.e. no weight increase occurs). There is also probable evidence that an increase in vegetable and fruit consumption alone does not result in weight loss. There is probable evidence that an increase in the consumption of vegetables and fruit leads to weight reduction, if this replaces foods rich in fat or energy. In children and adolescents, there is only insufficient evidence regarding an association between the consumption of vegetables and fruit and weight development due to a lack of intervention studies and the existence of only a few cohort studies with no risk relation.
Type 2 diabetes mellitus
Type 2 diabetes mellitus is one of the most common and most expensive chronic diseases. According to the International Diabetes Federation, the diabetes prevalence in the 20- to 79-year-olds was 6.4 % for women [32] with large regional differences (e.g. 3.8 % in Africa, 6.9 % in Europe, and 10.2 % in North America). Due to ageing of populations, this prevalence is expected to increase to 7.7 % by the year 2030 with an expected 237 million affected individuals. These estimates include millions of undetected cases, because at the beginning, the disease often is free of symptoms and is only diagnosed years later [33], but does not include the rise of prevalence due to changes in other major risk factors beyond age, like the rise of obesity prevalence rates and adoption of Westernised diet and lifestyle habits in many parts of the world. The prognosis of affected individuals is crucially determined by the presence of accompanying risk factors and by the development of micro- and macroangiopathic complications. Cardiovascular events like myocardial infarction, stroke, and peripheral arterial circulation disorders are predominant [34].
Type 2 diabetes mellitus develops due to a complex interaction between genetic predisposition and lifestyle. The actual manifestation of the disease is preceded by a phase of impaired glucose regulation, in which the cardiovascular risk is already increased. Particularly important among the lifestyle factors that promote or accelerate the manifestation of type 2 diabetes mellitus are bad nutritional habits and a lack of physical activity [35]. However, the most important risk factor for the development of type 2 diabetes mellitus is truncal obesity, which also is the result of an unfavourable lifestyle including overeating and a lack of physical activity.
The results of several prospective cohort studies that investigated whether the consumption of vegetables and fruit is associated with the risk of type 2 diabetes mellitus were summarised in 2 meta-analyses. The meta-analysis by Hamer and Chida [36] including 5 cohort studies in total did not show a relation between the consumption of fruit and/or vegetables and the risk of diabetes. Individuals who consumed at least 5 portions of vegetables and fruit per day had a relative risk (RR) of 0.96 (95 % CI 0.79–1.17) compared with persons with low consumption (lowest quintile or non-consumers; 3 cohort studies). For vegetables and fruit analysed separately (4 cohort studies each), there also was no association (RR regarding ≥3 vs.
In addition to the studies considered in the meta-analyses, some other prospective cohort studies exist, but in general, they also did not observe a significant relation between the overall consumption of vegetables and fruit and the risk of diabetes [38–40]. However, in the EPIC-Norfolk Study [40], a significant risk reduction was observed with increased fruit consumption (RR for the comparison of highest and lowest quintile: 0.70; 95 % CI 0.54–0.90). In a meta-analysis of cohort studies, no significant associations were observed between the intake of dietary fibre from fruit (9 individual cohort studies; RR comparing extreme quintiles/quartiles 0.96; 95 % CI 0.88–1.04) or vegetables (7 individual cohort studies; RR comparing extreme quintiles/quartiles 1.04; 95 % CI 0.94–1.15) and the risk of diabetes [41].
The present cohort studies were usually adjusted for BMI, as the possible effect of a higher vegetable and fruit consumption on body weight could not be separated from the potential confounding effect of body weight. Therefore, the results of the cohort studies describe the relation between vegetable and fruit consumption and the risk of diabetes excluding this important factor, through which the consumption can ultimately influence the risk of diabetes. In randomised controlled intervention studies, it was shown that a change in lifestyle with a focus on weight reduction through dietary changes can reduce the conversion from impaired glucose tolerance to type 2 diabetes [42–44]. However, the role of vegetable and fruit consumption remained unclear in these studies, as the interventions were designed multifactorially and included increased physical activity in addition to dietary changes [43, 44]. It may still be expected that higher consumption of vegetables and fruit can lower the risk of diabetes, as such a dietary change might prevent the development of obesity ([27], see “Obesity”). In the intervention arm of the WHI Dietary Modification Trial (see “Obesity”), an increase in vegetable and fruit consumption by 1 portion combined with a reduction in the fat proportion by 8 % of energy intake did not result in a changed risk of type 2 diabetes mellitus over 7 years [45].
In summary, it can be concluded that most of the studies and their meta-analysis indicate a lack of an association between the consumption of vegetables and fruit and the risk of diabetes. Because of this, there is probable evidence that the risk of developing type 2 diabetes mellitus is not influenced by the consumption of vegetables and fruit. However, vegetables and fruit indirectly influence the prevention of type 2 diabetes mellitus, as consumption thereof might lower the risk of weight gain in adults.
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Conclusions:
These findings suggest a beneficial effect of the consumption of fruits, vegetables and cereals on stroke risk.Existing evidence indicates that whole grains have a beneficial health effect; much of the evidence comes from observational studies that have demonstrated an association between whole grain intake and disease risk reduction. Evidence from intervention studies is variable. There is consistent epidemiological evidence that whole grain foods substantially lower the risk of chronic diseases such as CHD, diabetes, and cancer and also play a role in body weight management and digestive health. The essential macro- and micronutrients along with the phytonutrients present in whole grains synergistically contribute to their beneficial effects. Current evidence lends credence to the recommendations to incorporate whole grain foods into a healthy diet and lifestyle program. Future research needs to examine the role of whole grain foods in disease prevention and management to gain a better understanding of their mechanisms of action. Given the current evidence, the importance of whole grains in the diet of individuals is best summarized by Dr. Chris Seal, who very elegantly states, “When shopping in a supermarket there will be a range of healthy, nutritious whole grains foods, be sure to get them and beware of spurious imitations. After a little time their taste grows on you and refined foods will no longer satisfy you. Soon, only the ill-informed will avoid whole grains foods. Whole grains are not a luxury, and no house is complete unless they are provided at every meal .”
अविनाशिनमात्मानमेकं विज्ञाय तत्त्वतः। तवात्मज्ञस्यधीरस्यकथमर्थार्जने रतिः॥ आत्मज्ञानादहोप्रीतिर्विषयभ्रमगोचरे। शुक्रज्ञानतोलोभोयथारजतविभ्रमे॥
JUGAL KISHORE SHARMA 91-9414416705
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##मैं पिछले20 वर्षो से थाइराइड,डायबेटिक,हार्ट संबंधित रोग,लीवर आदि प्रमुख बीमारियों का खानपान में परिवर्तन कर शतप्रतिशत इलाज का प्रयास कर रहा हू, सही आहार एंव न्युनतम होम्योपेथिक दवाओं से पूर्णतया बीमारी को जड़ से खत्म किया जा सकता है ऐसा मेरा यह मानना है, तथा मैने शतप्रतिश हजारो लोगों में तथा हर आयुवर्ग में सफल प्रयोग किया है, न्युनतम व्यय- प्राय हम हम जो सात्विक भोजन पर व्यय करते है उसी के अनुरूप ही व्यय है को किया जाकर हमारी दैनिक आदतों में बीमारी से लड़ने तथा ठीक होने के प्रयास मोजूद है । यह कि आहार में प्रमुख परिवर्तन करके ही बीमारियों से लड़ा जा सकता है तथा बीमारियों से निजात पाई जा सकती है । PL USE THE BARLEY,SHORGUM,MILLET,GRAM,MAIZE LENTIL LIKE MOONG AND MOTH
For the last 20 years, I am trying to cure 100% of the major diseases like thyroid, diabetic, heart related diseases, liver etc. It is, and I have done 100% successful experiment in thousands of people and in every age group, the minimum expenditure - usually the expenditure we spend on sattvik the whole grain 8-9 type coarse gains- the veg food is the same as it should be done in our daily habits to fight disease and get cured. The effort exists. That only by making major changes in the diet, diseases can be fought and diseases can be overcome.
Benefits of Multigrain-Health.gov's 2015-2020 Dietary Guidelines for Americans suggests that you eat 6 ounces of grain daily and get at least half of that from whole grains,
Benefits of Multigrain - How can We are diet plan with whole grains,bean and lentils Present study was undertaken for development of gluten free processed products i.e. cookies and pasta by incorporation of gluten-free ingredients in different proportions. Gluten free raw ingredients i. e. finger millet (FM), pearl millet (PM), soya bean (SB) and ground
