Background Higher ultra-processed food intake has been linked with several cardiometabolic and cardiovascular diseases. However, prospective evidence from US populations remains scarce. Objectives To test the hypothesis that higher intake of ultra-processed foods is associated with higher risk of coronary artery disease. Methods A total of 13,548 adults aged 45–65 y from the Atherosclerosis Risk in Communities study were included in the analytic sample. Dietary intake data were collected through a 66-item FFQ. Ultra-processed foods were defined using the NOVA classification, and the level of intake (servings/d) was calculated for each participant and divided into quartiles. We used Cox proportional hazards models and restricted cubic splines to assess the association between quartiles of ultra-processed food intake and incident coronary artery disease. Results There were 2006 incident coronary artery disease cases documented over a median follow-up of 27 y. Incidence rates were higher in the highest quartile of ultra-processed food intake (70.8 per 10,000 person-y; 95% CI: 65.1, 77.1) compared with the lowest quartile (59.3 per 10,000 person-y; 95% CI: 54.1, 65.0). Participants in the highest compared with lowest quartile of ultra-processed food intake had a 19% higher risk of coronary artery disease (HR: 1.19; 95% CI: 1.05, 1.35) after adjusting for sociodemographic factors and health behaviors. An approximately linear relation was observed between ultra-processed food intake and risk of coronary artery disease. Conclusions Higher ultra-processed food intake was associated with a higher risk of coronary artery disease among middle-aged US adults. Further prospective studies are needed to confirm these findings and to investigate the mechanisms by which ultra-processed foods may affect health.
Background: Legumes are an inexpensive, healthy source of protein, fiber, and micronutrients, have low greenhouse gas and water footprints, and enrich soil through nitrogen fixation. Although higher legume consumption is recommended under US dietary guidelines, legumes currently comprise only a minor part of the US diet.Objectives: To characterize the types of legumes most commonly purchased by US consumers and patterns of legume purchases by state and region, seasonality of legume purchases, and to characterize adults that have a higher intake of legumes.Methods: We examined grocery market, chain supermarket, big box and club stores, Walmart, military commissary, and dollar store retail scanner data from Nielsen collected 2017–2019 and dietary intake from the National Health and Nutrition Examination Survey (NHANES), 2017–2018.Results: The five leading types of legumes purchased in the US were pinto bean, black bean, kidney bean, lima bean, and chickpea. The mean annual per capita expenditure on legumes based on grocery purchases was $4.76 during 2017–2019. The annual per capita expenditure on legumes varied greatly by state with highest expenditure in Louisiana, South Carolina, Florida, Alabama, Mississippi, and lowest expenditure in Washington, New York, and Wisconsin. There were large regional differences in the most commonly purchased legumes. Of 4,741 adults who participated in the 24-h dietary recall in NHANES, 2017–2018, 20.5% reported eating any legumes in the previous 24 h. Those who consumed legumes were more likely to be Hispanic, with a higher education level, with a larger household size (all P < 0.05), but were not different by age, gender, or income level compared to those who did not consume legumes.Conclusion: Although legumes are inexpensive, healthy, and a sustainable source of protein, per capita legume intake remains low in the US and below US dietary guidelines. Further insight is needed into barriers to legume consumption in the US.
<b><i>Introduction:</i></b> Telemedicine (TM) has shown to provide potential benefits on clinical outcomes in patients with chronic kidney disease but limited evidences published in the peritoneal dialysis (PD) population. This study aimed to explore the long-term effects of TM on the mortality and technique failure. <b><i>Methods:</i></b> The Peritoneal Dialysis Telemedicine-assisted Platform Cohort Study (PDTAP Study) was conducted prospectively in 27 hospitals in China since 2016. Patient and practice data were collected through the doctor-end of the TM app (Manburs) for all participants. TM including self-monitoring records, on-line education materials, and real-time physician-patient contact was only performed for the patient-end users of the Manburs. The primary outcome was all-cause mortality. The secondary outcomes were cause-specific mortality and all-cause and cause-specific permanent transfer to hemodialysis. <b><i>Results:</i></b> A total of 7,539 PD patients were enrolled between June 2016 and April 2019, with follow-up till December 2020. Patients were divided into two cohorts: TM group (39.1%) and non-TM group (60.9%). A propensity score was used to create 2,160 matched pairs in which the baseline covariates were well-balanced. There were significantly lower risks of all-cause mortality (HR 0.59 [0.51, 0.67], <i>p</i> < 0.001), CVD mortality (HR 0.59 [0.49, 0.70], <i>p</i> < 0.001), all-cause transfer to hemodialysis (0.57 [0.48, 0.67], <i>p</i> < 0.001), transfer to hemodialysis from PD-related infection (0.67 [0.51, 0.88], <i>p</i> = 0.003), severe fluid overload (0.40 [0.30, 0.55], <i>p</i> < 0.001), inadequate solute clearance (0.49 [0.26, 0.92], <i>p</i> = 0.026), and catheter-related noninfectious complications (0.41 [0.17, 0.97], <i>p</i> = 0.041) in the TM group compared with the non-TM group. <b><i>Conclusion:</i></b> This study indicated real-world associations between TM usage and reduction in patient survival and technique survival through a multicenter prospective cohort.
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