Intake of 12 food groups and disability-adjusted life years from coronary heart disease, stroke, type 2 diabetes, and colorectal cancer in 16 European countries

Our aim was to estimate and rank 12 food groups according to disability-adjusted life years (DALYs) from coronary heart disease (CHD), stroke, type 2 diabetes (T2D), and colorectal cancer (CRC) in 16 European countries. De novo published non-linear dose–response meta-analyses of prospective studies (based on 297 primary reports), and food consumption data from the European Food Safety Authority Comprehensive European Food Consumption Database in Exposure Assessment, and DALY estimates from the Institute for Health Metrics and Evaluation were used. By implementing disease-specific counterfactual scenarios of theoretical minimum risk exposure level (TMRELs), the proportion of DALYs attributed to 12 food groups was estimated. In addition, a novel modelling approach was developed to obtain a single (optimized) TMREL across diseases. Four scenarios were analysed (A: disease-specific TMRELs/all food-disease associations; B: disease-specific TMRELs/only significant food-disease associations; C: single TMREL/all food-disease associations; D: single TMREL/only significant food-disease associations). Suboptimal food intake was associated with the following proportions of DALYs; Scenario A (highest-estimate) and D (lowest-estimate): CHD (A: 67%, D: 52%), stroke (A: 49%, D: 30%), T2D (A: 57%, D: 51%), and CRC (A: 54%, D: 40%). Whole grains (10%) had the highest impact on DALYs, followed by nuts (7.1%), processed meat (6.4%), fruit (4.4%) and fish and legumes (4.2%) when combining all scenarios. The contribution to total DALYs of all food groups combined in the different scenarios ranged from 41–52% in Austria to 51–69% in the Czech-Republic. These findings could have important implications for planning future food-based dietary guidelines as a public health nutrition strategy

Food groups and risk of coronary heart disease, stroke and heart failure : a systematic review and dose-response meta-analysis of prospective studies

Background: Despite growing evidence for food-based dietary patterns' potential to reduce cardiovascular disease risk, knowledge about the amounts of food associated with the greatest change in risk of specific cardiovascular outcomes and about the quality of meta-evidence is limited. Therefore, the aim of this meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups (whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages [SSB]) and the risk of coronary heart disease (CHD), stroke and heart failure (HF). Methods: We conducted a systematic search in PubMed and Embase up to March 2017 for prospective studies. Summary risk ratios (RRs) and 95% confidence intervals (95% CI) were estimated using a random effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships. Results: Overall, 123 reports were included in the meta-analyses. An inverse association was present for whole grains (RRCHD: 0.95 (95% CI: 0.92-0.98), RRHF: 0.96 (0.95-0.97)), vegetables and fruits (RRCHD: 0.97 (0.96-0.99), and 0.94 (0.90-0.97); RRstroke: 0.92 (0.86-0.98), and 0.90 (0.84-0.97)), nuts (RRCHD: 0.67 (0.43-1.05)), and fish consumption (RRCHD: 0.88 (0.79-0.99), RRstroke: 0.86 (0.75-0.99), and RRHF: 0.80 (0.67-0.95)), while a positive association was present for egg (RRHF: 1.16 (1.03-1.31)), red meat (RRCHD: 1.15 (1.08-1.23), RRstroke: 1.12 (1.06-1.17), RRHF: 1.08 (1.02-1.14)), processed meat (RRCHD: 1.27 (1.09-1.49), RRstroke: 1.17 (1.02-1.34), RRHF: 1.12 (1.05-1.19)), and SSB consumption (RRCHD: 1.17 (1.11-1.23), RRstroke: 1.07 (1.02-1.12), RRHF: 1.08 (1.05-1.12)) in the linear dose-response meta-analysis. There were clear indications for non-linear dose-response relationships between whole grains, fruits, nuts, dairy, and red meat and CHD. Conclusion: An optimal intake of whole grains, vegetables, fruits, nuts, legumes, dairy, fish, red and processed meat, eggs and SSB showed an important lower risk of CHD, stroke, and HF

Comparative effects of different dietary approaches on blood pressure in hypertensive and pre-hypertensive patients: A systematic review and network meta-analysis

Pairwise meta-analyses have shown beneficial effects of individual dietary approaches on blood pressure but their comparative effects have not been established. Objective: Therefore we performed a systematic review of different dietary intervention trials and estimated the aggregate blood pressure effects through network meta-analysis including hypertensive and pre-hypertensive patients. Design: PubMed, Cochrane CENTRAL, and Google Scholar were searched until June 2017. The inclusion criteria were defined as follows: i) Randomized trial with a dietary approach; ii) hypertensive and pre-hypertensive adult patients; and iii) minimum intervention period of 12 weeks. In order to determine the pooled effect of each intervention relative to each of the other intervention for both diastolic and systolic blood pressure (SBP and DBP), random effects network meta-analysis was performed. Results: A total of 67 trials comparing 13 dietary approaches (DASH, lowfat, moderate-carbohydrate, high-protein, low-carbohydrate, Mediterranean, Palaeolithic, vegetarian, low-GI/GL, low-sodium, Nordic, Tibetan, and control) enrolling 17,230 participants were included. In the network metaanalysis, the DASH, Mediterranean, low-carbohydrate, Palaeolithic, high-protein, low-glycaemic index, lowsodium, and low-fat dietary approaches were significantly more effective in reducing SBP (¡8.73 to ¡2.32 mmHg) and DBP (¡4.85 to ¡1.27 mmHg) compared to a control diet. According to the SUCRAs, the DASH diet was ranked the most effective dietary approach in reducing SBP (90%) and DBP (91%), followed by the Palaeolithic, and the low-carbohydrate diet (ranked 3rd for SBP) or the Mediterranean diet (ranked 3rd for DBP). For most comparisons, the credibility of evidence was rated very low to moderate, with the exception for the DASH vs. the low-fat dietary approach for which the quality of evidence was rated high. Conclusion: The present network meta-analysis suggests that the DASH dietary approach might be the most effective dietary measure toreduce blood pressure among hypertensive and pre-hypertensive patients based on high quality evidence

Generating the evidence for risk reduction : a contribution to the future of food-based dietary guidelines

A major advantage of analyses on the food group level is that the results are better interpretable compared with nutrients or complex dietary patterns. Such results are also easier to transfer into recommendations on primary prevention of non-communicable diseases. As a consequence, food-based dietary guidelines (FBDG) are now the preferred approach to guide the population regarding their dietary habits. However, such guidelines should be based on a high grade of evidence as requested in many other areas of public health practice. The most straightforward approach to generate evidence is meta-analysing published data based on a careful definition of the research question. Explicit definitions of study questions should include participants, interventions/exposure, comparisons, outcomes and study design. Such type of meta-analyses should not only focus on categorical comparisons, but also on linear and non-linear dose-response associations. Risk of bias of the individual studies of the meta-analysis should be assessed, rated and the overall credibility of the results scored (e.g. using NutriGrade). Tools such as a measurement tool to assess systematic reviews or ROBIS are available to evaluate the methodological quality/risk of bias of meta-analyses. To further evaluate the complete picture of evidence, we propose conducting network meta-analyses (NMA) of intervention trials, mostly on intermediate disease markers. To rank food groups according to their impact, disability-adjusted life years can be used for the various clinical outcomes and the overall results can be compared across the food groups. For future FBDG, we recommend to implement evidence from pairwise and NMA and to quantify the health impact of diet-disease relationships

3rd Helmholtz Open Science Forum „Helmholtz in the German National Research Data Infrastructure (NFDI)“

To promote dialogue on the National Research Data Infrastructure (NFDI) in the Helmholtz Association, the Helmholtz Open Science Office hosted two digital Forums in May and December 2021. The office has organized a third Forum on the topic on June 22, 2023. The objective of this event was to offer insights into the NFDI activities within the Helmholtz Association, presented from the internal perspectives of the Centers. Multiple Helmholtz Centers shared their experiences, fostering an interactive environment for questions and discussions. Furthermore, there were contributions highlighting the Base4NFDI basic service consortium

Ernährungsepidemiologie: neue Erkenntnisse für die Analyse von Mahlzeiten

By retaining the meal structure of repeated non-consecutive 24-hour diet recalls in a sample of 814 adults from an EPIC-Potsdam sub-cohort study, we aimed to investigate the role of meals in the formation of commonly-used habitual dietary patterns, the origin of variance in dietary intake, as well as the relative importance of predictors of intake in the context of meals and individuals. A commonly used method (Principal Component Analysis, PCA) and a novel method (networks using Gaussian Graphical Models, GGM) for deriving habitual dietary patterns were applied to habitual and meal-specific food intakes and compared to the correlation and consistency of consumption structures between 39 food groups. Multi-level linear regression models were applied to investigate variance in energy and macronutrient intake in the meal and participant levels and important predictors of intake were identified. Energy misreporting was considered in sensitivity analyses. The findings showed different correlation structures between meals. Breakfast was the most consistent meal across the days, but dinner was the meal that contributed the most to the formation of habitual dietary patterns. Variance in energy and macronutrient intake was mostly explained by differences between meal types but not between individuals. Place of meal was the most important intake-level predictor of energy and macronutrient intake. Week/weekend day was important in the breakfast meal, and prior interval (hours passed since last meal) was especially important for the afternoon snack and dinner for carbohydrate intake. On the participant level, sex was the main predictor of energy and macronutrient intake. Energy misreporting accounted for a substantial proportion of the explained variance in carbohydrate intake, especially at the afternoon snack. In conclusion, this thesis revealed that meals are important units of investigations for understanding habitual dietary intake and eating behavior. The here applied statistical methods offer a novel way to study diet in the context of meals and should be applied to different populations to better understand their eating behavior. This knowledge will provide pivotal information useful for planning interventions aiming to influence dietary intake.Die Rolle von Mahlzeiten in der Entstehung von häufig verwendeten habituellen Ernährungsmustern wurde untersucht. Im Speziellen wurden dabei der Ursprung der Varianz in der Nahrungsaufnahme und die relative Wichtigkeit von Prädiktoren für die Aufnahme im Rahmen von Mahlzeiten und Individuen betrachtet. Die Datenanalyse basiert auf drei 24-Stunden-Ernährungsprotokollen von 814 Erwachsenen aus einer Querschnittsstudie der EPIC-Potsdam-Kohorte. Verzehrsdaten wurden in 39 Lebensmittelgruppen eingeordnet. Zwei Methoden, eine etablierte (Hauptkomponentenanalyse, PCA) und eine neuere (Netzwerke mit Gaussian Graphische Modelle, GGM) wurden zur Ableitung von Ernährungsmustern auf habituelle und Mahlzeit-spezifische Ernährungsdaten angewendet und bezüglich Korrelation und Konsistenz verglichen. Lineare multi-level Regressionsmodelle wurden angewendet, um die Varianz der Energie- und Makronährstoffaufnahme auf Mahlzeiten- und Teilnehmerebene zu untersuchen, wodurch wichtige Prädiktoren für die Aufnahme identifiziert wurden. Falschangaben in der Energieaufnahme (Under-/Over-reporting) wurden in Sensitivitätsanalysen berücksichtigt. Unsere Ergebnisse zeigten unterschiedliche Korrelationsstrukturen zwischen den Mahlzeiten. Das Frühstück war die konsistenteste Mahlzeit über die Tage hinweg, aber das Abendessen war die Mahlzeit, die am meisten zur Entstehung habitueller Ernährungsmuster beitrug. Die Varianz bei der Aufnahme von Energie und Makronährstoffen wurde hauptsächlich durch Unterschiede zwischen den Mahlzeitentypen und nicht zwischen Individuen erklärt. Der Ort der Mahlzeit (z.B. außerhaus, zuhause) war der wichtigste Indikator für Energie- und Makronährstoffaufnahme. Ob es Wochentag oder Wochenendtag war, war beim Frühstück relevant, während der zeitliche Abstand zur letzten Mahlzeit besonders wichtig für den Nachmittagssnack und das Abendessen für Kohlehydrataufnahme war. Auf der Ebene der Teilnehmer war Geschlecht der Hauptindikator für Energie- und Makronährstoffaufnahme. Ein wesentlicher Teil der erklärten Varianz für Kohlehydrataufnahme, insbesondere beim Nachmittagssnack, entfiel auf Falschangaben in der Energieaufnahme. Zusammenfassend konnte in dieser Promotionsschrift gezeigt werden, dass Mahlzeiten wichtige Untersuchungseinheiten sind, um die habituelle Ernährung und die Entstehung von Essgewohnheiten zu verstehen. Die verwendeten statistischen Methoden bieten einen neuartigen Weg, Ernährung im Kontext von Mahlzeiten zu untersuchen. Solche Methoden sollten auf verschiedene Bevölkerungen angewendet werden, um ihre Essgewohnheiten besser zu verstehen. Dieses Wissen liefert wichtige Informationen um Maßnahmen zur Beeinflussung der Nahrungsaufnahme zu entwerfen

Association between alcohol consumption and serum paraoxonase and arylesterase activities: a cross-sectional study within the Bavarian population

High alcohol consumption is an important risk factor for chronic disease and liver degeneration. Paraoxonase (PON1) and arylesterase (AE) are functions of the enzyme paraoxonase, which is synthesised by the liver. Paraoxonase circulates in plasma bound to HDL and hydrolyses lipid peroxides, protecting lipoproteins against oxidative modification. It has been shown that excessive alcohol consumption leads to a reduction of serum PON1 and AE activities; however, studies investigating the association with low and moderate alcohol consumption are scarce. We investigated the cross-sectional association between alcohol consumption and serum activities of PON1 and AE using data from the population-based Bavarian Food Consumption Survey II survey. PON1 and AE activities were quantified in serum samples of 566 male and female study participants (aged 18-80 years), and dietary intake including alcohol consumption was estimated from three 24-h dietary recalls. The association between alcohol consumption and PON1 and AE activities was analysed using linear regression, adjusted for age, sex and socio-economic status. There was no strong association between alcohol consumption and enzymatic activities of PON1 and AE in the Bavarian population. PON1 activity was seen to be lowest in non-drinkers (0 g/d) and highest in people who consumed 15·1-30 g of alcohol/d. AE activity increased across alcohol consumption categories, with a mean maximum difference of 14 U/ml (P for linear trend 0·04). These associations were attenuated after adjustment for blood concentrations of HDL. The results of this study do not support the hypothesis that alcohol consumption is related to important alterations in PON1 and AE activities

Plasma inflammation markers of the tumor necrosis factor pathway but not C-reactive protein are associated with processed meat and unprocessed red meat consumption in Bavarian adults

BACKGROUND High consumption of red and processed meats has been linked to higher chronic disease risk. It has been hypothesized that inflammation markers may mediate part of this association. Most previous studies on the association of red meat intake with circulating inflammation markers used C-reactive protein (CRP) but rarely other markers, and not all differentiated between processed meat and unprocessed red meat. OBJECTIVE We investigated the cross-sectional association of processed meat and unprocessed red meat consumption with plasma concentrations of CRP, interleukin 6 (IL-6), tumor necrosis factor (TNF)-α, soluble TNF receptor (sTNF-R) 1, and sTNF-R2 in German adults. METHODS Inflammation markers were quantified in the plasma of 553 adults (233 men and 320 women) aged 18-80 y within the cross-sectional Bavarian Food Consumption Survey II. Dietary intake was estimated from three 24-h dietary recalls. The association between red meat consumption and inflammation markers was analyzed with the use of multivariable-adjusted linear regression. RESULTS Processed meat consumption was borderline significantly associated with higher IL-6 [relative difference per 50-g increment: 5% (95% CI: -1%, 10%)] but not with CRP (2%; 95% CI: -6%, 10%), and it was inversely associated with total TNF-α (-3%; 95% CI: -6%, -1%), sTNF-R1 (-3%; 95% CI: -4%, -1%), and sTNF-R2 (-2%; 95% CI: -4%, 0%) concentrations. Unprocessed red meat consumption was not associated with CRP (-5%; 95% CI: -15%, 5%) or IL-6 (-1%; 95% CI: -9%, 7%) but was inversely associated with sTNF-R1 (-3%; 95% CI: -5%, -1%) and sTNF-R2 (-4%; 95% CI: -7%, -2%). CONCLUSIONS Our results suggest an inverse association between both processed meat and unprocessed red meat with inflammation markers of the TNF pathway in Bavarian adults but no association with CRP. Further research on the role of TNF pathway markers in chronic inflammation is warranted

Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis

The aim of the present systematic review and meta-analysis was to gain further insight into the effects of adherence to Mediterranean Diet (MedD) on risk of overall cancer mortality, risk of different types of cancer, and cancer mortality and recurrence risk in cancer survivors. Literature search was performed using the electronic databases PubMed, and Scopus until 25 August 2017. We included randomized trials (RCTs), cohort (for specific tumors only incidence cases were used) studies, and case-control studies. Study-specific risk ratios, hazard ratios, and odds ratios (RR/HR/OR) were pooled using a random effects model. Observational studies (cohort and case-control studies), and intervention trials were meta-analyzed separately. The updated review process showed 27 studies that were not included in the previous meta-analysis (total number of studies evaluated: 83 studies). An overall population of 2,130,753 subjects was included in the present update. The highest adherence score to a MedD was inversely associated with a lower risk of cancer mortality (RRcohort: 0.86, 95% CI 0.81 to 0.91, I2 = 82%; n = 14 studies), colorectal cancer (RRobservational: 0.82, 95% CI 0.75 to 0.88, I2 = 73%; n = 11 studies), breast cancer (RRRCT: 0.43, 95% CI 0.21 to 0.88, n = 1 study) (RRobservational: 0.92, 95% CI 0.87 to 0.96, I2 = 22%, n = 16 studies), gastric cancer (RRobservational: 0.72, 95% CI 0.60 to 0.86, I2 = 55%; n = 4 studies), liver cancer (RRobservational: 0.58, 95% CI 0.46 to 0.73, I2 = 0%; n = 2 studies), head and neck cancer (RRobservational: 0.49, 95% CI 0.37 to 0.66, I2 = 87%; n = 7 studies), and prostate cancer (RRobservational: 0.96, 95% CI 0.92 to 1.00, I2 = 0%; n = 6 studies). Among cancer survivors, the association between the adherence to the highest MedD category and risk of cancer mortality, and cancer recurrence was not statistically significant. Pooled analyses of individual components of the MedD revealed that the protective effects appear to be most attributable to fruits, vegetables, and whole grains. The updated meta-analysis confirms an important inverse association between adherence to a MedD and cancer mortality and risk of several cancer types, especially colorectal cancer. These observed beneficial effects are mainly driven by higher intakes of fruits, vegetables, and whole grains. Moreover, we were able to report for the first time a small decrease in breast cancer risk (6%) by pooling seven cohort studies

Impact of different dietary approaches on glycemic control and cardiovascular risk factors in patients with type 2 diabetes: a protocol for a systematic review and network meta-analysis

BACKGROUND: Dietary advice is one of the cornerstones in the management of type 2 diabetes mellitus. The American Diabetes Association recommended a hypocaloric diet for overweight or obese adults with type 2 diabetes in order to induce weight loss. However, there is limited evidence on the optimal approaches to control hyperglycemia in type 2 diabetes patients. The aim of the present study is to assess the comparative efficacy of different dietary approaches on glycemic control and blood lipids in patients with type 2 diabetes mellitus in a systematic review including a standard pairwise and network meta-analysis of randomized trials. METHODS AND DESIGN: We will conduct searches in Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, PubMed (from 1966), and Google Scholar. Citations, abstracts, and relevant papers will be screened for eligibility by two reviewers independently. Randomized controlled trials (with a control group or randomized trials with at least two intervention groups) will be included if they meet the following criteria: (1) include type 2 diabetes mellitus, (2) include patients aged ≥18 years, (3) include dietary intervention (different type of diets: e.g., Mediterranean dietary pattern, low-carbohydrate diet, low-fat diet, vegetarian diet, high protein diet); either hypo, iso-caloric, or ad libitum diets, (4) minimum intervention period of 12 weeks. For each outcome measure of interest, random effects pairwise and network meta-analyses will be performed in order to determine the pooled relative effect of each intervention relative to every other intervention in terms of the post-intervention values (or mean differences between the changes from baseline value scores). Subgroup analyses are planned for study length, sample size, age, and sex. DISCUSSION: This systematic review will synthesize the available evidence on the comparative efficacy of different dietary approaches in the management of glycosylated hemoglobin (primary outcome), fasting glucose, and cardiovascular risk factors in type 2 diabetes mellitus patients. The results of the present network meta-analysis will influence evidence-based treatment decisions since it will be fundamental for based recommendations in the management of type 2 diabetes