Monica Dinu

Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies

ABSTRACT Background: Beneficial effects of vegetarian and vegan diets on health outcomes have been supposed in previous studies. Objectives: Aim of this study was to clarify the association between vegetarian, vegan diets, risk factors for chronic diseases, risk of all-cause mortality, incidence, and mortality from cardio-cerebrovascular diseases, total cancer and specific type of cancer (colorectal, breast, prostate and lung), through meta-analysis. Methods: A comprehensive search of Medline, EMBASE, Scopus, The Cochrane Library, and Google Scholar was conducted. Results: Eighty-six cross-sectional and 10 cohort prospective studies were included. The overall analysis among cross-sectional studies reported significant reduced levels of body mass index, total cholesterol, LDL-cholesterol, and glucose levels in vegetarians and vegans versus omnivores. With regard to prospective cohort studies, the analysis showed a significant reduced risk of incidence and/or mortality from ischemic heart disease (RR 0.75; 95% CI, 0.68 to 0.82) and incidence of total cancer (RR 0.92; 95% CI 0.87 to 0.98) but not of total cardiovascular and cerebrovascular diseases, all-cause mortality and mortality from cancer. No significant association was evidenced when specific types of cancer were analyzed. The analysis conducted among vegans reported significant association with the risk of incidence from total cancer (RR 0.85; 95% CI, 0.75 to 0.95), despite obtained only in a limited number of studies. Conclusions: This comprehensive meta-analysis reports a significant protective effect of a vegetarian diet versus the incidence and/or mortality from ischemic heart disease (−25%) and incidence from total cancer (−8%). Vegan diet conferred a significant reduced risk (−15%) of incidence from total cancer.

Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials

Research has shown that a greater adherence to the Mediterranean diet is associated with a reduced risk of major chronic disease. However, the existing literature leads to debate for different issues, such as the measurement of the adherence to the Mediterranean diet, the use of a wide variety of dietary indices with various food components and the large heterogeneity across the studies. In order to summarise the evidence and evaluate the validity of the association between the adherence to the Mediterranean diet and multiple health outcomes, an umbrella review of the evidence across meta-analyses of observational studies and randomised clinical trials (RCTs) was performed. Thirteen meta-analyses of observational studies and 16 meta-analyses of RCTs investigating the association between the adherence to the Mediterranean diet and 37 different health outcomes, for a total population of over than 12 800 000 subjects, were identified. A robust evidence, supported by a P-value<0.001, a large simple size, and not a considerable heterogeneity between studies, for a greater adherence to the Mediterranean diet and a reduced the risk of overall mortality, cardiovascular diseases, coronary heart disease, myocardial infarction, overall cancer incidence, neurodegenerative diseases and diabetes was found. For most of the site-specific cancers, as well as for inflammatory and metabolic parameters, the evidence was only suggestive or weak and further studies are needed to draw firmer conclusions. No evidence, on the other hand, was reported for bladder, endometrial and ovarian cancers, as well as for LDL (low density lipoprotein)-cholesterol levels.

Validation of a literature-based adherence score to Mediterranean diet: the MEDI-LITE score

Abstract Numerous studies have demonstrated a relationship between adherence to Mediterranean diet and prevention of chronic degenerative diseases. The aim of this study was to validate a novel instrument to measure adherence to Mediterranean diet based on the literature (the MEDI-LITE score). Two-hundred-and-four clinically healthy subjects completed both the MEDI-LITE score and the validated MedDietScore (MDS). Significant positive correlation between the MEDI-LITE and the MDS scores was found in the study population (R = .70; p < .0001). Furthermore, statistically significant positive correlations were found for all the nine different food groups. According to the receiver operating characteristic (ROC) curve analysis, MEDI-LITE evidenced a significant discriminative capacity between adherents and non-adherents to the Mediterranean diet pattern (optimal cut-off point = 8.50; sensitivity = 96%; specificity = 38%). In conclusion, our findings show that the MEDI-LITE score well correlate with MDS in both global score and in most of the items related to the specific food categories.

Ancient wheat species and human health: Biochemical and clinical implications

Wheat is the major staple food in many diets. Based on the increase in worldwide mortality attributable to diet-related chronic diseases, there is an increasing interest in identifying wheat species with greater health potential, more specifically for improved anti-oxidant and anti-inflammatory properties. In particular, ancient varieties (defined as those species that have remained unchanged over the last hundred years) are gaining interest since several studies suggested that they present a healthier nutritional profile than modern wheats. This manuscript reviews the nutritional value and health benefits of ancient wheats varieties, providing a summary of all in vitro, ex vivo, animal and human studies that have thus far been published. Differences in chemical composition, and biochemical and clinical implications of emmer, einkorn, spelt, khorasan and various regional Italian varieties are discussed. Although many studies based on in vitro analyses of grain components provide support to the premise of a healthier nutritional and functional potential of ancient wheat, other in vitro studies performed are not in support of an improved potential of ancient varieties. In the light of existing evidence derived from in vivo experiments, the ancient wheat varieties have shown convincing beneficial effects on various parameters linked to cardio-metabolic diseases such as lipid and glycaemic profiles, as well as the inflammatory and oxidative status. However, given the limited number of human trials, it is not possible to definitively conclude that ancient wheat varieties are superior to all modern counterparts in reducing chronic disease risk.

Consumption of Buckwheat Products and Cardiovascular Risk Profile: A Randomized, Single-Blinded Crossover Trial

Background: Lifestyle modifications, especially dietary interventions, assume an increasingly more important role in the population-based approach to cardiovascular diseases risk reduction. Buckwheat is a highly nutritional food component that has been shown to provide a wide range of beneficial effects. Objective: The aim of the study was to examine whether a replacement diet with buckwheat products could provide additive protective effects in reducing cardiovascular risk factors, including blood glucose, insulin, lipids, oxidative damage and pro-inflammatory markers, in comparison to a similar replacement diet using products made from organic wheat. Methods: Twenty-one participants at high risk for cardiovascular disease (11 F; 10 M; mean age 51.3 ± 13.4) were randomized to receive products (bread, pasta, biscuits and crackers), made from either buckwheat-enriched semi-wholegrain wheat or control semi-wholegrain wheat for 8 weeks in a single-blinded crossover trial. A washout period of 8 weeks was implemented between the two intervention phases, in which participants were permitted to eat all foods according to their normal eating habits. Blood analyses were performed at the start and end of each intervention period, respectively. Results: Consumption of buckwheat products resulted in a significant amelioration in total cholesterol (-4.7%), low-density lipoprotein cholesterol (-8.5%), triglycerides (-15%), glucose (-5.8%) and insulin (-17%) from baseline levels, independently of age, sex, body mass index and hypertension. Moreover, thiobarbituriic acid reactive substances (TBARs) levels were significantly reduced by 29.5%. A concomitant significant increase in plasma ORAC levels (+9.7%) was observed. No significant differences from baseline in the same participants were observed after consumption of the control products. Conclusion: Our results suggest that a replacement diet with buckwheat products exert a protective effect on the development of cardiovascular disease by reducing circulating cardiovascular risk factors and markers of oxidative stress.

Low-Calorie Vegetarian Versus Mediterranean Diets for Reducing Body Weight and Improving Cardiovascular Risk Profile: CARDIVEG Study (Cardiovascular Prevention With Vegetarian Diet)

Background: Only a few randomized dietary intervention studies that investigated the effects of lacto-ovo vegetarian diet (VD) in clinically healthy omnivorous subjects are available. Methods: We randomly assigned to overweight omnivores with a low-to-moderate cardiovascular risk profile a low-calorie VD compared with a low-calorie Mediterranean diet (MD), each lasting 3 months, with a crossover design. The primary outcome was the difference in body weight, body mass index, and fat mass changes between the 2 groups. Secondary outcomes were differences in circulating cardiovascular disease risk parameters changes between the 2 groups. Results: One hundred eighteen subjects (mean age: 51.1 years, females: 78%) were enrolled. The total participation rate at the end of the study was 84.7%. No differences between the 2 diets in body weight were observed, as reported by similar and significant reductions obtained by both VD (−1.88 kg) and MD (−1.77 kg). Similar results were observed for body mass index and fat mass. In contrast, significant differences between the 2 interventions were obtained for low-density lipoprotein cholesterol, triglycerides, and vitamin B12 levels. The difference between the VD and MD groups, in terms of end-of-diet values, was recorded at 9.10 mg/dL for low-density lipoprotein cholesterol (P=0.01), 12.70 mg/dL for triglycerides (P<0.01), and 32.32 pg/mL for vitamin B12 (P<0.01). Finally, no significant difference was found between VD and MD interventions in oxidative stress markers and inflammatory cytokines, except for interleukin-17, which improved only in the MD group. Forty-six participants during the VD period and 35 during the MD period reached the target values for ≥1 cardiovascular risk factor. Conclusions: Both VD and MD were effective in reducing body weight, body mass index, and fat mass, with no significant differences between them. However, VD was more effective in reducing low-density lipoprotein cholesterol levels, whereas MD led to a greater reduction in triglyceride levels. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02641834.

A Heart-Healthy Diet: Recent Insights and Practical Recommendations

Purpose of ReviewThe purpose of this study is to review the current evidence on the relationship between diet and heart, giving practical recommendations for cardiovascular prevention.Recent FindingsA heart-healthy diet should maximize the consumption of whole grains, vegetables, fruit, and legumes and discourage the consumption of meat and meat products as well as refined and processed foods. Plant-based diets fully meet these criteria, and the evidence supporting the protective effect of these dietary patterns evolved rapidly in recent years. Among plant-based diets, the Mediterranean and vegetarian diets gained the greater interest, having been associated with numerous health benefits such as reduced levels of traditional and novel risk factors and lower risk of cardiovascular disease. These positive effects may be explained by their high content of dietary fiber, complex carbohydrate, vitamins, minerals, polyunsaturated fatty acids, and phytochemicals.SummaryCurrent evidence suggests that both Mediterranean and vegetarian diets are consistently beneficial with respect to cardiovascular disease.

A Khorasan Wheat-Based Replacement Diet Improves Risk Profile of Patients With Nonalcoholic Fatty Liver Disease (NAFLD): A Randomized Clinical Trial

ABSTRACT Objective: KAMUT khorasan is an ancient grain with widely acclaimed health benefits. The aim of this study was to investigate the effects of a replacement diet with ancient khorasan wheat products in patients with NAFLD, in comparison to a similar replacement diet with control products made from organic semi-whole-grain modern wheat. Methods: Forty NAFLD patients (12 M/28 F; age 55.2 ± 10.4 years) with mild to moderate liver steatosis were included. The experimental design was a randomized, double-blind, parallel-arm study with 20 participants assigned to consume either KAMUT khorasan or control wheat products (pasta, bread, crackers, biscuits) over a 3-month period. Anthropometric measurements, blood analyses, and ultrasonography examination were performed at both the beginning and end of each dietary intervention. Results: After the implementation of a general linear model for repeated measurements adjusted for baseline demographic details, risk factors, and medication, alanine aminotransferase (ALT) was significantly reduced by 12%, aspartate aminotransferase (AST) by 14%, alkaline phosphatase (ALP) by 8%, and cholesterol by 6% only in the khorasan group (p < 0.05 for all). Similarly, significant reductions in circulating proinflammatory tumor necrosis factor-alpha by 50%, interleukin l-receptor antagonist-alpha by 37%, interleukin-8 by 24%, and interferon gamma by 24% were evident only in participants who consumed the khorasan products (p < 0.05 for all). Finally, significant improvements in the liver steatosis grading, Doppler perfusion index values, and reactive oxygen species (ROS) production were evident after consumption of both the khorasan and control products. Conclusions: This study suggests that a short-term replacement diet with ancient KAMUT khorasan products is most effective in reducing metabolic risk factors and ameliorating the liver profile in patients with NAFLD.

Symptomatic efficacy of buckwheat products in Non-Celiac Gluten Sensitivity (NCGS)

BACKGROUND AND OBJECTIVES Buckwheat (Fagopyrum esculentum) is a gluten-free grain with acclaimed benefi-cial effects on human health. Our aim was to assess the effect of buckwheat products on intestinal/extra-intestinal symptoms and biochemical parameters in patients with Non-Celiac Gluten Sensitivity (NCGS). METHODS AND STUDY DESIGN A randomized, crossover trial with two intervention phases was conducted on 19 NCGS patients over a 12 week-period. The participants were assigned to consume products made from buckwheat or to maintain their normal gluten-free diet for 6 weeks in a random order. Symptoms due to NCGS were evaluated using two questionnaires. RESULTS During the intervention period with buckwheat products, patients experienced a signifi-cant decrease in the severity of abdominal pain and bloating (p=0.03). In contrast, the control group showed a significant worsening trend for the majority of NCGS symptoms such as nausea, headache, joint/muscle pain, and attention disorders. The replacement diet with buckwheat products also resulted in a significant increase of serum magnesium (+4.7%) and a significant reduction in the circulating levels of some pro-inflammatory cytokines such as interferon gamma (-33.3%) and monocyte chemotactic protein-1 (-46.5%). CONCLUSION The study supports the positive effects of buckwheat for NCGS patients, showing that this alternative cereal can contribute to the re-duction of both negative gastro-intestinal and related symptoms, and nutritional deficiencies, and lead to an im-provement in inflammatory profile.

Health and Nutrition Studies Related to Cereal Biodiversity: A Participatory Multi-Actor Literature Review Approach

Recently, a large and growing body of literature has investigated the health potential of different wheat species. In particular, a considerable number of studies dealing with nutritional aspects has grown up around the theme of the recovery of ancient wheat varieties (species that have remained unchanged over the last hundred years). According to several studies, indeed, ancient varieties present a healthier nutritional profile than modern ones. In the framework of the European project “CERERE, CEreal REnaissance in Rural Europe: embedding diversity in organic and low-input food systems”, this paper aimed to review recent research on the issue of health and nutritional cereal systems by adopting an innovative and participatory multi-actor approach which involved practitioners along with researchers. The participatory approach is the main innovation and peculiarity of this literature review. Nevertheless, the review highlights the many positive effects derived from eating whole and ancient grains such as a significant reduction in the risk of chronic diseases such as cancer, cardiovascular disease, and also a more favorable long-term weight management and increase in satiety. This review may be considered as a fruitful starting point that integrates research results to foster current and future healthier and sustainable practices in cereal systems.