Carbohydrate quality changes and concurrent changes in cardiovascular risk factors: a longitudinal analysis in the PREDIMED-Plus randomized trial

Martínez‐González, Miguel Ángel; Fernández-Lázaro, César I; Toledo, Estefanía; Díaz‐López, Andrés; Corella, Dolores; Goday, Albert; Romaguera, Dora; Vioque, Jesús; Alonso‐Gómez, Ángel M.; Wärnberǵ, Julia; Martínéz, J. Alfredo; Serra-Majem, Luís; Estruch, Ramón; Tinahones, Francisco J.; Lapetra, José; Pintó, Xavier; Tur, Josep A.; López‐Miranda, José; Cano-Ibáñez, Naomi; Delgado-Rodrı́guez, Miguel; Matía‐Martín, Pilar; Daimiel, Lidia; Sánchez, Vicente Martín; Vidal, Josep; Vázquez, Clotilde; Ros, Emilio; Buil‐Cosiales, Pilar; Portolés, Olga; Soria-Florido, María Trinidad; Konieczna, Jadwiga; Navarrete-Muñoz, Eva M.; Tojal-Sierra, Lucas; Fernández-García, José Carlos; Abete, Itziar; Henríquez-Sánchez, Patricia; Muñoz‐Garach, Araceli; Santos‐Lozano, José Manuel; Corbella, Emili; Bibiloni, María del Mar; Becerra‐Tomás, Nerea; Barragán, Rocío; Castañer, Olga; Fiol, Miquel; Hera, Manoli García de la; Belló-Mora, María C; Gea, Alfredo; Babió, Nancy; Fitó, Montse; Ruiz‐Canela, Miguel; Zazpe, Itzíar; Salas‐Salvadó, Jordi

doi:10.1093/ajcn/nqz298

Cited by 56 publications

(49 citation statements)

References 41 publications

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“…Using the CHNS 2009, the present study examined the impact of dietary carbohydrate intake on dyslipidemia and its components using the LCD scores. It was found that higher LCD scores were significantly associated with higher intake of legumes, nuts, fish, and other non-carbohydrate food sources, consistent with the results of an improved carbohydrate quality index from an original study [20] (Table A1). Furthermore, in the present study, it was also found that participants with higher LCD scores lived in urban areas, had high income, consumed alcohol, performed light physical activity, and had higher educational levels.…”

Section: Discussionsupporting

confidence: 75%

Association between Three Low-Carbohydrate Diet Scores and Lipid Metabolism among Chinese Adults

2020

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This study investigated the blood lipid levels of 5921 Chinese adults aged >18 years using data from the China Health and Nutrition Survey 2009. Diet information was collected through 3 day, 24 h recalls by trained professionals. The low-carbohydrate diet (LCD) score was determined according to the percentage of energy obtained from carbohydrate, protein, and fat consumption. Dyslipidemia was defined when one or more of the following abnormal lipid levels were observed: high cholesterol levels, high triglyceride levels, and low high-density lipoprotein cholesterol levels. Multivariate adjusted odds ratios (ORs) and their 95% confidence intervals (95% CIs) were calculated using logistic regression models. After adjusting the confounding variables, in males, the OR of hypercholesterolemia was 1.87 (95% CI, 1.23–2.85; p for trend = 0.0017) and the OR of hypertriglyceridemia was 1.47 (95% CI, 1.04–2.06; p for trend = 0.0336), on comparing the highest and lowest quartiles of the LCD score. The animal-based LCD score showed a similar trend. The OR of hypercholesterolemia was 2.15 (95% CI, 1.41–3.29; p for trend = 0.0006) and the OR of hypertriglyceridemia was 1.51 (95% CI, 1.09–2.10; p for trend = 0.0156). However, there was no significant difference between plant-based LCD scores and dyslipidemia. In females, lipid profiles did not differ much among the quartiles of LCD scores—only the animal-based LCD score was statistically significant with hypercholesterolemia. The OR of hypercholesterolemia was 1.64 (95% CI, 1.06–2.55), on comparing the highest and lowest quartiles of the LCD score. In conclusion, a higher LCD score, indicating lower carbohydrate intake and higher fat intake, especially animal-based fat, was significantly associated with higher odds of hypercholesterolemia and hypertriglyceridemia in Chinese males. Future studies investigating the potential mechanisms by which macronutrient types and sex hormones affect lipid metabolism are required.

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Section: Discussionsupporting

confidence: 75%

Association between Three Low-Carbohydrate Diet Scores and Lipid Metabolism among Chinese Adults

2020

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“…Within the large variety of plantbased foods the qualitative nature of its major constituent carbohydrate may be crucial. A comparison of plant-based patterns of eating found that when carbohydrates were largely complex, rather than refined, cardiovascular mortality decreased [45].…”

Section: Individual Food Groups and Nutrients Plant Based Foodsmentioning

confidence: 99%

“…The neutral or optimal intake of carbohydrate was 50-55% of energy, which resembles the amount likely to be consumed within current guidelines for cardiovascular prevention. However, a recent analysis of the quality of dietary carbohydrate at around 40% consumed energy in subjects participating in the PREDIMED trial reaffirmed that at equivalent intakes of carbohydrates quality was an important determinant of improved cardiometabolic status [45]. The carbohydrate quality index included measures of dietary fibre, whole grain, glycaemic index and proportion of solid (versus liquid) foods.…”

Section: Dietary Carbohydrate Sugar and Fibrementioning

confidence: 99%

Practical Guidance for Food Consumption to Prevent Cardiovascular Disease

Nestel

Beilin

Clifton

et al. 2021

Heart, Lung and Circulation

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This dietary guidance, informed by best contemporary evidence, aims to assist medical practitioners and allied health professionals in advising patients for the primary and secondary prevention of cardiovascular disease (CVD). While differing in some details from other current guidelines, the core messages accord with those published in 2019 by the American College of Cardiology/American Heart Association and the European Society of Cardiology/European Atherosclerosis Society; the National Lipid Association in 2014 and the NH&MRC Australian Dietary Guidelines in 2013. These were assessed through the Appraisal of Guidelines for Research and Evaluation (AGREE II) and the levels of evidence and classes of a recommendation developed using the GRADE system. Recommendations with high levels of evidence include increased consumption of plant based foods comprising mainly complex, fibre enriched carbohydrates (wholegrains, fruits and vegetables) while limiting intake of refined starches; partial replacement of saturated fats with monounsaturated or polyunsaturated fats and oils; reduced salt intake; achievement and maintenance of healthy weight; and low-tomoderate consumption of alcohol. Additional guidance but with moderate levels of evidence includes increased consumption of fish (and fish oils where indicated); reduction in sugar-sweetened beverages and added sugars; avoidance of butter and cream especially in those at increased CVD risk but encouragement of yoghurt; allow moderate consumption of lean meat but limit intake of processed meats; and limit cholesterol-rich foods such as eggs and crustaceans for those at increased CVD risk. Guidance has been formulated qualitatively on food categories of commonly eaten foods while avoiding prescriptive quantitative measures that are less readily translatable. This approach accords with current guidelines such as the American College of Cardiology/American Heart Association 2019 guidelines and is understandable and readily implemented.

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“…The PREDIMED (PREvención con DIeta MEDiterránea) study has found that harmful effects of metabolic syndrome on cardiovascular health occurs less often when adherence to the Mediterranean diet (MedDiet) is high [ 3 ]. Lately, the PREDIMED-Plus study has proved that higher adherence to a MedDiet improved nutritional density [ 4 ], as well as weight loss in the first year of treatment [ 5 , 6 ]. These results support this intervention as a proper weight management and disease prevention strategy [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Dietary Quality Changes According to the Preceding Maximum Weight: A Longitudinal Analysis in the PREDIMED-Plus Randomized Trial

Bouzas¹,

Bibiloni²,

García³

et al. 2020

Nutrients

Self Cite

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One-year dietary quality change according to the preceding maximum weight in a lifestyle intervention program (PREDIMED-Plus trial, 55–75-year-old overweight or obese adults; n = 5695) was assessed. A validated food frequency questionnaire was used to assess dietary intake. A total of 3 groups were made according to the difference between baseline measured weight and lifetime maximum reported weight: (a) participants entering the study at their maximum weight, (b) moderate weight loss maintainers (WLM), and (c) large WLM. Data were analyzed by General Linear Model. All participants improved average lifestyle. Participants entering the study at their maximum weight were the most susceptible to improve significantly their dietary quality, assessed by adherence to Mediterranean diet, DII and both healthful and unhealthful provegetarian patterns. People at maximum weight are the most benefitted in the short term by a weight management program. Long term weight loss efforts may also reduce the effect of a weight management program.

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Carbohydrate quality changes and concurrent changes in cardiovascular risk factors: a longitudinal analysis in the PREDIMED-Plus randomized trial

Cited by 56 publications

References 41 publications

Association between Three Low-Carbohydrate Diet Scores and Lipid Metabolism among Chinese Adults

Association between Three Low-Carbohydrate Diet Scores and Lipid Metabolism among Chinese Adults

Practical Guidance for Food Consumption to Prevent Cardiovascular Disease

Dietary Quality Changes According to the Preceding Maximum Weight: A Longitudinal Analysis in the PREDIMED-Plus Randomized Trial

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