Dietary components and risk of cardiovascular disease and all-cause mortality: a review of evidence from meta-analyses

Abstract

Aims The optimal diet for cardiovascular health is controversial. The aim of this review is to summarize the highest level of evidence and rank the risk associated with each individual component of diet within its food group. Methods and results A systematic search of PudMed was performed to identify the highest level of evidence available from systematic reviews or meta-analyses that evaluated different dietary components and their associated risk of all-cause mortality and cardiovascular disease. A total of 16 reviews were included for dietary food item and all-cause mortality and 17 reviews for cardiovascular disease. Carbohydrates were associated with a reduced risk of all-cause mortality (whole grain bread: relative risk (RR) 0.85, 95% confidence interval (CI) 0.82–0.89; breakfast cereal: RR 0.88, 95% CI 0.83–0.92; oats/oatmeal: RR 0.88, 95% CI 0.83–0.92). Fish consumption was associated with a small benefit (RR 0.98, 95% CI 0.97–1.00) and processed meat appeared to be harmful (RR 1.25, 95% CI 1.07–1.45). Root vegetables (RR 0.76, 95% CI 0.66–0.88), green leafy vegetables/salad (RR 0.78, 95% CI 0.71–0.86), cooked vegetables (RR 0.89, 95% CI 0.80–0.99) and cruciferous vegetables (RR 0.90, 95% CI 0.85–0.95) were associated with reductions in all-cause mortality. Increased mortality was associated with the consumption of tinned fruit (RR 1.14, 95% CI 1.07–1.21). Nuts were associated with a reduced risk of mortality in a dose–response relationship (all nuts: RR 0.78, 95% CI 0.72–0.84; tree nuts: RR 0.82, 95% CI 0.75–0.90; and peanuts: RR 0.77, 95% CI 0.69–0.86). For cardiovascular disease, similar associations for benefit were observed for carbohydrates, nuts and fish, but red meat and processed meat were associated with harm. Conclusions Many dietary components appear to be beneficial for cardiovascular disease and mortality, including grains, fish, nuts and vegetables, but processed meat and tinned fruit appear to be harmful.

Optimum nutritional strategies for cardiovascular disease prevention and rehabilitation (BACPR)

“…Summary messages regarding dietary protein are presented in table 1. Detailed study7–13 analysis examining protein intake and CVD are presented in online supplementary table 1.…”

“…Indeed, randomised controlled trials show that the quality of meat (in addition to the whole diet) is likely to be an important factor to consider in explaining this relationship, with evidence suggesting that the addition of lean red meat to an already low saturated fat cardioprotective diet does not impact negatively on blood lipids 9. The saturated fat content of the comparison diet10 may be an additional piece of the puzzle in explaining the impact dietary protein (and its source) has on cardiovascular health 11…”

“…In this study,17 only cereal fibre was significantly associated with a reduction in cardiovascular and all-cause mortality in both men and women. One of the most prominent sources of cereal fibre is whole grain, and whole grain is frequently cited as being beneficial for health11 18; however, there is disparity between meta-analyses of cohort studies and results from randomised controlled trials 19. Such discrepancy between this and prospective studies likely highlights the importance of adequately defining whole grain, and taking a whole diet approach when considering cardioprotective foods.…”

“…However, debate exists on the physical amounts to be consumed, with some suggestions of CHD benefit over 400 g/day26 and others showing little further benefit of over 300 g/day 27. Existing randomised controlled trials have shown inconsistent effects on established cardiovascular risk markers such as inflammation, blood pressure or lipids,28 29 and some varieties appear to lack evidence of CVD benefit altogether 11 27. Indeed, tinned/canned fruit has been positively associated with all-cause and CVD mortality11 27 although the reasons for this observation are not clear and could potentially reflect socioeconomic status.…”

Biomarkers of a Healthy Nordic Diet—From Dietary Exposure Biomarkers to Microbiota Signatures in the Metabolome

“…However, TMAO can also be directly absorbed from dietary sources, mainly fish [86]. Fish has been long linked with positive health effects including protection from cardiovascular diseases [87]. For example a recent report on the European Prospective Investigation Into Cancer and Nutrition (EPIC)-Oxford study concluded that fish eaters and vegetarians had 13% lower rates of ischemic heart disease than meat eaters [88] and dietary patterns rich in fish, such as the Nordic diet and Mediterranean diet, are among most stably reported health-beneficial dietary schemes [3].…”