Field Notes
Plant-Based Foods Could Help People With Cardiometabolic Disorders Live Longer
People with cardiometabolic disorders—such as obesity, diabetes, and heart disease—could increase their chances of living longer by adopting a healthy plant-based diet, according to a study presented at the American College of Cardiology’s Annual Scientific Session.
While prior studies have assessed the benefits of plant-based diets in a general population, this new study is the first to focus on their benefits in people with cardiometabolic disorders, which are rising in prevalence worldwide and bring an increased risk of premature death.
“Among populations with cardiometabolic disorders, higher adherence to a healthful plant-based diet was significantly associated with a lower risk of total, cardiovascular, and cancer mortality,” says Zhangling Chen, MD, PhD, of the department of cardiovascular medicine at the Second Xiangya Hospital of Central South University in Changsha, China, and the study’s lead author. “More intake of healthy plant-based foods, less intake of unhealthy plant-based foods, and less intake of animal-based foods are all important.”
Cardiometabolic disorders stem from a variety of genetic, environmental, and lifestyle factors and affect the health of the cardiovascular system and how the body processes food. While some medications can help manage these disorders, diet and other lifestyle factors are key in preventing the progression to serious forms of heart disease and cancer that are associated with cardiometabolic disorders.
Researchers analyzed data from 78,000 people with cardiometabolic disorders who participated in large prospective studies in the United Kingdom, United States, and China. The pooled datasets included 55,000 adults from the UK Biobank between 2006 and 2022, 18,000 US adults from the National Health and Nutrition Examination Study (NHANES) between 1999 and 2018, and almost 4,500 Chinese adults from the Chinese Longitudinal Healthy Longevity Study between 2006 and 2018.
Based on their responses to 24-hour dietary recall interviews or dietary questionnaires at baseline, researchers assigned each participant a score on two indexes. People who reported a diet high in healthy plant-based foods such as vegetables, fruits, whole grains, legumes, tea, and coffee scored higher on the healthful plant-based diet index, while those who reported a diet higher in refined grains, potatoes, sugar-sweetened beverages, and animal-based foods scored higher on the unhealthful.
Overall, closer adherence to a healthful plant-based diet was associated with a 17% to 24% lower risk of death from any cause, CVD, or cancer, while closer adherence to an unhealthful plant-based diet brought a 28% to 36% increased risk of death from any cause, CVD, or cancer.
For the analysis, researchers adjusted for confounding factors such as demographics, dietary, and lifestyle factors. Results were consistent across subgroups by age, race, sex, smoking, alcohol intake, BMI, and physical activity. They were also consistent in people with different types of cardiometabolic disorders and in people from the UK, US, and Chinese cohorts when these groups were analyzed separately, even though the UK and US groups were significantly younger, with an average age of 57 years and 59 years, respectively, compared with the Chinese group, which had an average age of 84 years.
In a separate study that only used NHANES data and did not focus on people with cardiometabolic disorders, the same research group found that a greater adherence to a healthy beverage pattern was associated with a lower risk of premature death. They defined a healthy beverage pattern as one high in tea, coffee, and low-fat milk and low in alcohol, whole-fat milk, fruit juice, and sugar-sweetened and artificially sweetened beverages.
“These findings may help individuals with cardiometabolic disorders make healthier lifestyle choices,” Chen says. “It is important to identify and develop cost-effective strategies to promote health among individuals with cardiometabolic disorders.”
For both studies, the researchers say that dietary data were self-reported by study participants at baseline and not assessed again, so the studies were not able to reflect any dietary changes participants may have made. They added that some potentially confounding factors were difficult to eliminate and suggested that additional prospective studies in diverse global populations would help to strengthen the evidence and confirm the importance of healthy food and beverage consumption patterns in broader populations.
— Source: American College of Cardiology
Lack of Essential Vitamins and Minerals Common in People With Type 2 Diabetes
Micronutrient deficiency, whereby levels of vitamins and minerals essential for healthy bodily function are far too low, is common in people with type 2 diabetes, finds a pooled data analysis of the available evidence, published in the open-access journal BMJ Nutrition Prevention & Health.
Vitamin D is the most common “missing” micronutrient, the findings show, with women at greater risk than men of these deficiencies—often referred to as “hidden hunger.”
Genetic predisposition, various environmental factors, a sedentary lifestyle, an unhealthy diet, and obesity are risk factors for the disease, explain the researchers. And previously published research suggests that micronutrients have a key role in the development of type 2 diabetes, by potentially affecting glucose metabolism and insulin signaling pathways.
In a bid to try and quantify the global prevalence of micronutrient deficiency in people with the condition, the researchers scoured research databases for relevant studies, with the aim of pooling the data.
Their analysis included 132 studies, involving 52,501 participants, and published in several languages between 1998 and 2023. Apart from three studies, the rest were hospital-based.
The pooled data analysis showed that the prevalence of micronutrient deficiency (vitamins, minerals, and electrolytes) among people with type 2 diabetes varied around the world, possibly because of diverse dietary habits, lifestyle choices, and cultural practices, the researchers suggest.
But, overall, the global prevalence was 40% to 45% in those with complications of their disease.
An extremely low level of vitamin D was the most common micronutrient deficiency, affecting 60.5% of those with type 2 diabetes. But magnesium deficiency was also common, affecting 42%, while the prevalence of iron deficiency was 28%. The global prevalence of B12 deficiency was 29%, and higher still among patients taking metformin.
Further stratification of the pooled data showed that prevalence was higher in women with the condition than in men at nearly 49%, and highest among patients in the Americas (54%).
Most of the included studies were cross-sectional, making it difficult to establish causality, nor was it clear whether the micronutrient deficiency preceded poor glycemic control or was a consequence of it, the researchers caution.
And as there are no valid population-based studies looking at micronutrient deficiency, it’s impossible to draw comparisons between patients with type 2 diabetes and the general population, they add.
“This systematic review exemplifies the double burden of malnutrition in action, whereby nutritional deficiencies and diet-related noncommunicable diseases, such as type 2 diabetes, coexist,” comments Shane McAuliffe, MSc, visiting senior academic associate for NNEdPro Global Institute for Food, Nutrition, and Health, which co-owns the journal.
“The treatment of type 2 diabetes often tends to focus on energy metabolism and macronutrients, but the identification of a higher prevalence of specific micronutrient deficiencies in those affected is a reminder that optimizing overall nutrition should always be a priority.
“The findings should help to focus research and policy initiatives aimed at furthering our understanding of the causes and effects of these deficiencies and the potential for targeted and tailored interventions.”
— Source: BMJ Group