Eating and arterial endothelial function: a meta‐analysis of the acute effects of meal consumption on flow‐mediated dilation

Abstract

Given that endothelial dysfunction precedes atherosclerotic cardiovascular disease, exploring the parameters that modify postprandial flow-mediated dilation (FMD) is important for public health. The objectives of the study are to estimate the population effect of meal ingestion on FMD and to determine how the effect varied based on patient characteristics and modifiable methodological features. Articles published before June 2015 were located using MEDLINE, PubMed and Web of Science. One hundred fifty-four effects were derived from 78 articles involving 2,548 subjects were selected. Included articles required measurement of FMD in adults before and after meal ingestion. Effects were analysed using an unstandardized mean gain random effects model, and significant moderators were analysed using meta-regression. Meal consumption significantly reduced FMD by a heterogeneous mean effect size delta (Δ) of -2.03 (95% CI: [-2.28, -1.77]), an ~2% reduction in FMD. FMD reductions were larger among normal weight individuals, males, those with a cardio-metabolic disorder, those with elevated baseline FMD, and individuals with impaired glucose tolerance at baseline. Macronutrient meal ingestion significantly reduced FMD, an effect that was moderated by body mass index, sex and two-way interactions between disease status and both baseline FMD and baseline blood glucose levels.

Dietary macronutrients do not differently affect postprandial vascular endothelial function in apparently healthy overweight and slightly obese men

“…Thom and colleagues suggested in their recent meta-analysis involving 78 acute studies that the intake of a single meal significantly decreased postprandial FMD values after 1, 2 and 3 h in most, but not in all studies [6]. Heterogeneity in outcomes between studies was observed.…”

“…NO is a key determinant of endothelial function, since it exerts important vasodilatory, anti-inflammatory, antithrombotic, anti-proliferative, and anti-adhesive effects [2,4]. It has been hypothesized that meal ingestion as well as meal composition may change NO bioavailability [5][6][7]. Since we spend most time of the day in the postprandial state, repeated reductions in NO bioavailability caused by meal consumption may thus contribute to the development of CVD [8].…”

“…It has been estimated that an increase of 1% point (PP) in fasting FMD is associated with a reduction of 8-13% in overall CVD risk [9,10]. Unfortunately, studies on the effects of meal intake on postprandial FMD are not consistent and a recent meta-analysis reported an overall decrease in postprandial FMD, but heterogeneity in effects between the studies was high [6]. Most studies in healthy and overweight individuals observed a decrease in FMD after consumption of a high-fat meal [11][12][13].…”

Hypertriglyceridemia and atherosclerosis

“…It has been shown that the flow-mediated or acetylcholine-induced vasodilatation is associated with nitric oxide (NO) released by endothelium, which is one of sensitive index of endothelium-dependent vasodilation. Clinical studies found that the postprandial rapid rise in serum TG levels after a high-fat meal was significantly related to endothelial dysfunction via evaluating the impairment in flow-mediated vasodilatation [ 55 ]. It has also been shown that the remnant lipoprotein contributes to the impairment of endothelium-dependent vasomotor function in human coronary arteries [ 56 ].…”

Regular Aerobic, Resistance, and Cross-Training Exercise Prevents Reduced Vascular Function Following a High Sugar or High Fat Mixed Meal in Young Healthy Adults

“…FMD is predominately mediated by the release of nitric oxide (NO), a gaseous compound with antiadhesive, antithrombotic, and vasodilatory properties (Joyner and Green, 2009 ). The effect of acute feeding has been well summarized (Thom et al, 2016 ). Both fat- and carbohydrate-rich foods generally regarded as healthful have not been shown to reduce FMD (e.g., walnuts or oatmeal) (Brock et al, 2006 ; Cortes et al, 2006 ; Karatzi et al, 2008 ).…”