Actualizaciones en Nutrición ABRIL 2022

Guía de práctica clínica:

Lichtenstein AH, Appel LJ, Vadiveloo M, Hu FB, Kris-Etherton PM, Rebholz CM, Sacks FM, Thorndike AN, Van Horn L, Wylie-Rosett J. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement from the American Heart Association. Circulation. 2021 Dec 7;144(23):e472-e487. doi: 10.1161/CIR.0000000000001031.

Abstract

Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.

Actualizaciones (n=2):

1. Kopecky SL, Alias S, Klodas E, Jones PJH. Reduction in Serum LDL Cholesterol Using a Nutrient Compendium in Hyperlipidemic Adults Unable or Unwilling to Use Statin Therapy: A Double-Blind Randomized Crossover Clinical Trial. J Nutr. 2022 Feb 8;152(2):458-465. doi: 10.1093/jn/nxab375.

Abstract

Background: Many hyperlipidemic patients prescribed β-hydroxy-β-methylglutaryl coenzyme A reductase inhibitors (statins) are unable or unwilling to take them. A hedonically acceptable snack-based solution formulated from cholesterol-lowering food ingredients could represent a therapeutic alternative but has not been tested in this population.

Objectives: To evaluate the effect of snacks containing a compendium of functional bioactives on fasting LDL cholesterol in statin candidates unwilling to use or intolerant to ≥1 statin drug. Secondary outcomes included changes in circulating total cholesterol (TC), triglycerides, HDL cholesterol, fasting glucose, insulin, and high-sensitivity C-reactive protein concentrations, as well as effects of single-nucleotide polymorphisms (SNPs) on outcome.

Methods: This multicenter, randomized, double-blind, free-living crossover study was composed of 2 regimented phases of 4 wk each, separated by a 4-wk washout. Eighteen men and 36 women, with a mean ± SD age of 49 ± 12 y and mean ± SD LDL cholesterol of 131 ± 32.1 mg/dL, were instructed to ingest a variety of ready-to-eat snacks twice daily as a substitute for something they were consuming already. Other behavior changes were actively discouraged. Treatment products provided ≥5 g fiber, 1000 mg ω-3 (n-3) fatty acids, 1000 mg phytosterols, and 1800 μmol antioxidants per serving. Control products were calorie-matched like-items drawn from the general grocery marketplace. Serum lipids were measured at baseline and the end of each phase and compared using the ANOVA model. Compliance to study foods was confirmed by serum 18:3n-3 concentration assessment.

Results: Comparing intervention phase endpoints, LDL cholesterol was reduced a mean ± SD of 8.80 ± 1.69% (P < 0.0001), and TC was reduced a mean ± SD of 5.08 ± 1.12% (P < 0.0001) by treatment foods compared with control foods, whereas effects on other analytes did not differ between treatments. SNPs were not significantly related to outcomes (P ≥ 0.230). Compliance with study foods was 95%.

Conclusions: Consumption of hedonically acceptable snacks containing a compendium of cholesterol-lowering bioactive compounds can rapidly and meaningfully reduce LDL cholesterol in adult patients unable or unwilling to take statin drugs.

Comentario. En todas las recomendaciones para la prevención y tratamiento del riesgo cardiovascular derivado del colesterol se afirma que la base es el cambio de la dieta habitual a una saludable, preferiblemente de base vegetal. Sin embargo, raras veces el clínico tiene una noción de qué reducción del colesterol-LDL se puede conseguir con un sencillo cambio dietético basado en alimentos preparados a base de productos vegetales naturales. En este estudio clínico aleatorizado y doble-ciego se reclutaron individuos con hipercolesterolemia moderada candidatos a tratamiento con estatinas pero que nos las toleraban o eran reacios a tomarlas. La intervención consistió en dos refrigerios (snacks) diarios preparados con mezclas de harina de avena, tortitas, barritas de arándanos y de chocolate, barras de cereales (granola) y batidos de fruta con dos formulaciones: una control, con productos enteramente disponibles comercialmente, y otra de tratamiento activo, preparadas por la misma industria alimentaria con aspecto y sabor idénticos, pero enriquecidas con alimentos y nutrientes activos contra el colesterol (frutos secos, frutas del bosque, avena, fibra y esteroles vegetales). Los refrigerios se consumieron en sustitución del desayuno y de una parte del almuerzo o cena. La reducción observada de casi el 9% del colesterol-LDL a las 4 semanas de una intervención dietética saludable, natural y bien tolerada ejemplifica la eficacia de la dieta como componente esencial del estilo de vida en el control de los factores de riesgo cardiovascular. En este estudio los participantes no tomaban fármacos hipocolesteromiantes, pero la evidencia científica obtenida a partir de estudios con ingredientes alimentarios similares a los usados en el presente trabajo, particularmente con esteroles vegetales, indica que el efecto sobe el colesterol-LDL es aditivo al de las estatinas, por lo que serían útiles en todos los pacientes hipercolesterolémicos, tratados o no con fármacos.

2. Donat-Vargas C, Sandoval-Insausti H, Peñalvo JL, Moreno Iribas MC, Amiano P, Bes-Rastrollo M, Molina-Montes E, Moreno-Franco B, Agudo A, Mayo CL, Laclaustra M, De La Fuente Arrillaga C, Chirlaque López MD, Sánchez MJ, Martínez-González MA, Pilar GC. Olive oil consumption is associated with a lower risk of cardiovascular disease and stroke. Clin Nutr. 2022 Jan;41(1):122-130. doi: 10.1016/j.clnu.2021.11.002.

Abstract

Background & aims: The specific association of olive oil consumption with coronary heart disease (CHD) or stroke has not been totally established.

Objective: to examine whether olive oil consumption is associated with subclinical atherosclerosis, the risk of total cardiovascular disease (CVD), CHD, and stroke.

Methods: Three cohorts were included: AWHS (2318 men), SUN Project (18,266 men and women), and EPIC-Spain (39,393 men and women). Olive oil consumption was measured at baseline using validated questionnaires.

Results: In the AWHS, 747 participants had a positive coronary artery calcium score (CACS>0), and the OR (95% CI) was 0.89 (0.72, 1.10) in those with virgin olive oil consumption ≥30 g/day (v. <10 g/day). In the SUN Project (follow-up 10.8 years) 261 total CVD cases occurred, and the HR was 0.57 (0.34, 0.96) for consumptions ≥30 g/day (v. <10 g/day). In the EPIC-Spain (follow-up 22.8 years) 1300 CHD cases and 938 stroke cases occurred; the HRs for stroke according, 0 to <10 (ref), 10 to <20, 20 to <30, and ≥30 g/day of olive oil consumption, were 0.84 (0.70, 1.02), 0.80 (0.66, 0.96), 0.89 (0.74, 1.07). A weaker association was observed for CHD. The association was stronger among those consuming virgin olive oil, instead of common (refined).

Conclusions: Olive oil is associated with lower risk of CVD and stroke. The maximum benefit could be obtained with a consumption between 20 and 30 g/day. The association could be stronger for virgin olive oil and might operate from the early stages of the disease.

Comentario. Existe evidencia científica abundante sobre el papel cardioprotector del aceite de oliva en el contexto de la dieta mediterránea, pero los hallazgos de estudios epidemiológicos en relación con la incidencia de enfermedad cardiaca coronaria (ECC) y accidente vascular cerebral (AVC) no son del todo consistentes. Además, existe poca información sobre la influencia en el riesgo cardiovascular del aceite de oliva virgen (AOV) en comparación con el aceite de oliva refinado (AOR). Esta publicación reúne datos de tres grandes estudios epidemiológicos españoles sobre determinantes de enfermedades cardiovasculares en los que se investigó el aceite de oliva virgen y refinado. En uno de estos trabajos se describen valores transversales (estudio de salud de trabajadores de Aragón) y en los otros dos, datos longitudinales (proyecto SUN de graduados universitarios y estudio EPIC de España de dieta y cáncer). En el estudio de Aragón se relacionó el consumo de aceite de oliva con el calcio coronario determinado mediante TAC y la presencia de placas carotídeas o femorales medidas por ecografía; la conclusión fue que la aterosclerosis preclínica tendía a ser menor cuanto más aceite de oliva virgen. En los estudios SUN y EPIC se buscaron asociaciones prospectivas con incidencia de enfermedades cardiovasculares, incluyendo ECC y AVC. Los resultados de ambos estudios mostraron tendencias a menor incidencia de AVC y en menor grado de ECC con mayor consumo de aceite de oliva, particularmente de AOV. De este trabajo merece destacarse la importancia de utilizar AOV en lugar de AOR en la cocina y en la mesa, ya que su riqueza en polifenoles le confiere un papel destacado en la protección cardiovascular.

Congresos

V Congreso de Alimentación, Nutrición y Dietética

Academia Española de Nutrición y Dietética

Logroño, 25-26 de noviembre de 2022

MasterCongresos S.L. www.mastercongresos.com

22nd IUNS-ICN 
INTERNATIONAL CONGRESS OF NUTRITION IN TOKYO 

December 6-11, 2022

The Organizing Committee is expecting to hold the in-person conference, but there is the possibility of changing it to virtual or hybrid according to the future pandemic situation. https://icn22.org/