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The adventitia, the outer layer of the blood vessel wall, may be the most complex layer of the wall and may be the master regulator of wall physiology and pathobiology. This review proposes a major shift in thinking to apply a functional lens to the adventitia rather than only a structural lens. Human and experimental in vivo and in vitro studies show that the adventitia is a dynamic microenvironment in which adventitial and perivascular adipose tissue cells initiate and regulate important vascular functions in disease, especially intimal hyperplasia and atherosclerosis. Although well away from the bloodwall interface, where much pathology has been identified, the adventitia has a profound influence on the population of intimal and medial endothelial, macrophage, and smooth muscle cell function. Vascular injury and dysfunction of the perivascular adipose tissue promote expansion of the vasa vasorum, activation of fibroblasts, and differentiation of myofibroblasts. This regulates further biologic processes, including fibroblast and myofibroblast migration and proliferation, inflammation, immunity, stem cell activation and regulation, extracellular matrix remodeling, and angiogenesis. A debate exists as to whether the adventitia initiates disease or is just an important participant. We describe a mechanistic model of adventitial function that brings together current knowledge and guides the design of future investigations to test specific hypotheses on adventitial pathobiology.

ObjectiveIntake of white rice has been associated with elevated risk for type 2 diabetes (T2D), while studies on brown rice are conflicting. To inform dietary guidance, we synthesised the evidence on white rice and brown rice with T2D risk.DesignSystematic review and meta-analysis.Data sourcesPubMed, EMBASE and Cochrane databases were searched through November 2021.Eligibility criteriaProspective cohort studies of white and brown rice intake on T2D risk (≥1 year), and randomised controlled trials (RCTs) comparing brown rice with white rice on cardiometabolic risk factors (≥2 weeks).Data extraction and synthesisData were extracted by the primary reviewer and two additional reviewers. Meta-analyses were conducted using random-effects models and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the Newcastle Ottawa Scale for prospective cohort studies and the Cochrane Risk of Bias Tool for RCTs. Strength of the meta-evidence was assessed using NutriGrade.ResultsNineteen articles were included: 8 cohort studies providing 18 estimates (white rice: 15 estimates, 25 956 cases, n=5 77 426; brown rice: 3 estimates, 10 507 cases, n=1 97 228) and 11 RCTs (n=1034). In cohort studies, white rice was associated with higher risk of T2D (pooled RR, 1.16; 95% CI: 1.02 to 1.32) comparing extreme categories. At intakes above ~300 g/day, a dose–response was observed (each 158 g/day serving was associated with 13% (11%–15%) higher risk of T2D). Intake of brown rice was associated with lower risk of T2D (pooled RR, 0.89; 95% CI: 0.81 to 0.97) comparing extreme categories. Each 50 g/day serving of brown rice was associated with 13% (6%–20%) lower risk of T2D. Cohort studies were considered to be of good or fair quality. RCTs showed an increase in high-density lipoprotein-cholesterol (0.06 mmol/L; 0.00 to 0.11 mmol/L) in the brown compared with white rice group. No other significant differences in risk factors were observed. The majority of RCTs were found to have some concern for risk of bias. Overall strength of the meta-evidence was moderate for cohort studies and moderate and low for RCTs.ConclusionIntake of white rice was associated with higher risk of T2D, while intake of brown rice was associated with lower risk. Findings from substitution trials on cardiometabolic risk factors were inconsistent.PROSPERO registration numberCRD42020158466.

Objectives Sugar-sweetened beverages (SSBs) have been increasingly linked to the obesity epidemic, however, the evidence on 100% fruit juice and body weight remains controversial. The objective of this research was to synthesize the available evidence on SSBs and 100% fruit juice on body weight in children and adults. Methods MEDLINE, EMBASE, and Cochrane were searched through October 11th, 2020 for prospective cohort studies (≥ 6 months) and randomized controlled trials (RCTs) (≥ 2 weeks) assessing the effect of SSBs and 100% fruit juice on BMI and body weight in children and adults. Eligible trials assessed SSBs or 100% fruit juice added to the diet in adults, and reduced from the diet in children against a non-caloric control. Data were pooled using random effects models and presented as b coefficients with 95% CIs for cohort studies and mean differences (MD)s with 95% CIs for RCTs. Results are reported in compliance with the PRISMA guidelines, and the protocol was registered on PROSPERO (ID: CRD42020209915). Results Sixty-two articles were identified for SSBs: 40 in children (33 cohorts, 7 RCTs) and 22 in adults (14 cohorts, 8 RCTs), and 22 articles were identified for 100% fruit juice: 13 in children (13 cohorts, 0 RCTs), and 9 studies in adults (3 cohorts, 6 RCTs). Among cohort studies, each serving/day increase in SSB was associated with an increase in BMI in children and body weight in adults (0.06 kg/m2; 95% CI: 0.03, 0.10 and 0.47 kg; 95% CI: 0.24, 0.69, respectively). For 100% fruit juice, each serving/day increase was associated with an increase in body weight in adults (0.19 kg; 95% CI: 0.04, 0.34) while no association was found for children (0.02 kg/m2; 95% CI: −0.01, 0.05). RCTs in children indicated a reduction in BMI gain when SSB consumption was reduced (MD = −0.21 kg/m2; 95% CI: −0.42, 0.00). RCTs in adults indicated an increase in body weight when SSBs were added to the diet (MD = 0.76 kg; 95% CI: 0.51, 1.0), however no effect on weight was found for the addition of 100% fruit juice (MD = 0.08 kg; 95% CI: −0.79, 0.96). Conclusions SSB consumption promotes weight gain in both children and adults. Evidence from cohort studies indicate a positive association between 100% fruit juice and weight gain in adults and a marginal association among children. Findings from RCTs on 100% fruit juice in adults showed no effect, and there is a need for trials among children. Funding Sources None.