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Association of Foods and Nutrients With Cardiometabolic Disease
Quick Takes
- Foods such as nuts, whole grains, and fruits and vegetables high in fiber were associated with lower cardiometabolic risk.
- Red meats and processed meats were associated with higher cardiometabolic risk.
- Sugar-sweetened beverages were also associated with risk for stroke and diabetes.
Study Questions:
What is the quality of evidence for specific dietary factors with cardiometabolic disease?
Methods:
This is a systematic review of meta-analyses of randomized clinical trials and prospective cohort studies that examined dietary factors in association with cardiometabolic outcomes among healthy adults. PubMed and reference lists were searched for eligible studies between May 2015–February 2021. Study characteristics and relative risk (RR) estimates were extracted in duplicate. For identified associations, quality of evidence was assessed using the Bradford-Hill criteria for causation.
Results:
A total of 2,058 references were identified, from which 285 full-text articles were assessed for eligibility. A total of 28 meta-analyses were included in the present study, which represented 62 associations. Ten foods, three beverages, and 12 nutrients were observed to have probable evidence of association with coronary heart disease (CHD), stroke, and/or diabetes. The majority of RRs ranged from 0.87 to 0.95 per daily serving for protective associations and from 1.06 to 1.15 for harmful associations. Larger beneficial associations were found between fiber and cardiovascular disease (RR, 0.54; 95% confidence interval [CI], 0.38-0.77 per 20 g/d). Fiber was also associated with CHD (RR, 0.59; 95% CI, 0.46-0.77 per 20 g/d). Nuts or seeds were inversely associated with CHD (RR, 0.71; 95% CI, 0.63-0.80 per 28 g/d). The most harmful associations were observed between glycemic load and CHD (RR, 1.57; 95% CI, 1.32-1.85 per 80 g/d/2000 kcal), glycemic index and CHD (RR, 1.24; 95% CI, 1.12-1.38 per 10 units), and trans-fatty acids and CHD (RR, 1.23; 95% CI, 1.11-1.37 per 2% E/d).
Conclusions:
The investigators concluded that this systematic review summarized the current quality of evidence of the associations of specific dietary factors with CHD, stroke, and diabetes. These findings may inform dietary guidance, the assessment of disease burden in specific populations, policy setting, and future research.
Perspective:
This large systematic review and meta-analysis supports associations between diet and cardiometabolic disease with beneficial effects for a diet high in fruits, vegetables, nuts, whole grains, and seafood/fish; while consumption of red meats, processed meats, and sugary beverages was associated with greater cardiometabolic risk.
Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Diet
Keywords: Cardiometabolic Risk Factors, Coronary Disease, Diabetes Mellitus, Diet, Fruit, Glycemic Index, Glycemic Load, Meat, Metabolic Syndrome, Primary Prevention, Red Meat, Risk, Seafood, Stroke, Sugar-Sweetened Beverages, Trans Fatty Acids, Vegetables, Whole Grains
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