Actualizaciones en Nutrición FEBRERO 2022
Guía de práctica clínica:
American Diabetes Association Professional Practice Committee; American Diabetes Association Professional Practice Committee: Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, Freeman R, Green J, Huang E, Isaacs D, Kahan S, Leon J, Lyons SK, Peters AL, Prahalad P, Reusch JEB, Young-Hyman D, Das S, Kosiborod M. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan 1;45(Supplement_1):S144-S174. doi: 10.2337/dc22-S010. (Open access)
Abstract
The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Actualizaciones (n=2):
- Miller V, Micha R, Choi E, Karageorgou D, Webb P, Mozaffarian D. Evaluation of the Quality of Evidence of the Association of Foods and Nutrients with Cardiovascular Disease and Diabetes: A Systematic Review. JAMA Netw Open. 2022 Feb 1;5(2):e2146705. doi: 10.1001/jamanetworkopen.2021.46705. (Open access)
Abstract
Importance: Poor diet is a leading global factor associated with cardiometabolic disease (CMD). Understanding the quality of evidence of the associations between specific dietary factors and CMD, including effect size (relative risk [RR]) and uncertainty, is essential to guide policy and consumer actions to achieve healthy diet and public health goals.
Objective: To assess the quality of evidence of the associations between specific dietary factors and CMD as well as the quantitative evidence for RRs and the uncertainty of these risk estimates.
Evidence review: PubMed and the reference lists of eligible articles were searched between May 1, 2015, and February 26, 2021, for systematic reviews with meta-analyses of randomized clinical trials and prospective cohort studies that analyzed the consumption of 1 or more of the dietary factors of interest; reported dose-response meta-analyses; included healthy adults; and assessed 1 or more of the outcomes of interest. Study characteristics and RR estimates were extracted in duplicate. For identified associations, quality of evidence was assessed using the Bradford-Hill criteria for causation.
Findings: A total of 2058 potentially relevant reports were identified, from which 285 full-text articles were assessed for eligibility. The final selection of articles included 28 meta-analyses representing 62 associations between diet and CMD. Among these associations, 10 foods, 3 beverages, and 12 nutrients had at least probable evidence of associations with coronary heart disease, stroke, and/or diabetes. Most RRs ranged from 0.87 to 0.96 per daily serving change for protective associations and from 1.06 to 1.15 per daily serving change for harmful associations. Most identified associations were protective (n = 38) and a smaller number were harmful (n = 24), with a higher risk associated with higher intake.
Conclusions and relevance: This systematic review summarized the current quality of evidence of the associations of specific dietary factors with coronary heart disease, stroke, and diabetes. These findings may inform dietary guidance, the assessment of disease burden in specific populations, policy setting, and future research.
Comentario: La epidemiología nutricional está en continua reevaluación a medida que la publicación de estudios prospectivos y, en menor medida, de estudios clínicos aleatorizados, ofrecen nuevas evidencias o refutan datos anteriores sobre la asociación entre consumo de alimentos y nutrientes e incidencia de enfermedades cardiovasculares (ECV) y diabetes tipo 2 (DM2). En esta última evaluación de la calidad de la evidencia de tales asociaciones, se revisan 28 meta-análisis recientes (publicados entre mayo 2015 y febrero 2021) que examinan 62 asociaciones entre factores dietéticos y enfermedades cardiometabólicas con análisis dosis-respuesta. El estudio, que debe interpretarse como un meta-análisis de meta-análisis, recopila los datos de 10 alimentos, 3 bebidas y 12 nutrientes con al menos una evidencia probable de asociaciones con enfermedad coronaria, ictus y/o diabetes, de las cuales 38 fueron protectoras y 24 perjudiciales. Entre los factores dietéticos con mayor grado de evidencia científica, los saludables para ECV fueron: frutas, verduras, frutos secos y semillas, cereales integrales, chocolate, leche, té, fibra alimentaria, fibra de frutas, fibra de verduras, ácidos grasos poliinsaturados (AGP) en sustitución de carbohidratos, AGP en sustitución de ácidos grasos saturados y potasio. Conferían protección de DM2 con mayor probabilidad: cereales integrales, yogur, fibra alimentaria, fibra de cereales y AGP en sustitución de carbohidratos. Los alimentos y nutrientes con mayores evidencias de ser perjudiciales en general lo eran tanto para las ECV como la DM2: patatas (solo DM2), carnes rojas, carnes procesadas, bebidas azucaradas, índice glicémico, carga glicémica, ácidos grasos trans (solo ECV), proteína animal (solo DM) y sodio (solo ECV). Las conclusiones de este pormenorizado análisis refuerzan en su mayor parte el mensaje del Documento de Recomendaciones de la SEA 2018 sobre estilo de vida en la prevención cardiovascular (Clin Investig Arterioscler. 2018;30:280-310), añadiendo nuevas evidencias, en general confirmatorias de lo reseñado en este documento.
- Hasbani NR, Ligthart S, Brown MR, Heath AS, Bebo A, Ashley KE, Boerwinkle E, Morrison AC, Folsom AR, Aguilar D, De Vries PS. American Heart Association’s Life’s Simple 7: Lifestyle Recommendations, Polygenic Risk, and Lifetime Risk of Coronary Heart Disease. Circulation. 2022 Jan 31. doi: 10.1161/CIRCULATIONAHA.121.053730. Epub ahead of print. (Open access)
Abstract
Background: Understanding the effect of lifestyle and genetic risk on the lifetime risk of coronary heart disease (CHD) is important to improving public health initiatives. Our objective was to quantify remaining lifetime risk and years free of CHD according to polygenic risk and the American Heart Association’s Life’s Simple 7 (LS7) guidelines in a population-based cohort study.
Methods: Our analysis included data from participants of the ARIC (Atherosclerosis Risk in Communities) study: 8372 White and 2314 Black participants; 45 years of age and older; and free of CHD at baseline examination. A polygenic risk score (PRS) comprised more than 6 million genetic variants was categorized into low (<20th percentile), intermediate, and high (>80th percentile). An overall LS7 score was calculated at baseline and categorized into “poor,” “intermediate,” and “ideal” cardiovascular health. Lifetime risk and CHD-free years were computed according to polygenic risk and LS7 categories.
Results: The overall remaining lifetime risk was 27%, ranging from 16.6% in individuals with an ideal LS7 score to 43.1% for individuals with a poor LS7 score. The association of PRS with lifetime risk differed according to ancestry. In White participants, remaining lifetime risk ranged from 19.8% to 39.3% according to increasing PRS categories. Individuals with a high PRS and poor LS7 had a remaining lifetime risk of 67.1% and 15.9 fewer CHD-free years than did those with intermediate polygenic risk and LS7 scores. In the high-PRS group, ideal LS7 was associated with 20.2 more CHD-free years compared with poor LS7. In Black participants, remaining lifetime risk ranged from 19.1% to 28.6% according to increasing PRS category. Similar lifetime risk estimates were observed for individuals of poor LS7 regardless of PRS category. In the high-PRS group, an ideal LS7 score was associated with only 4.5 more CHD-free years compared with a poor LS7 score.
Conclusions: Ideal adherence to LS7 recommendations was associated with lower lifetime risk of CHD for all individuals, especially in those with high genetic susceptibility. In Black participants, adherence to LS7 guidelines contributed to lifetime risk of CHD more so than current PRSs. Improved PRSs are needed to properly evaluate genetic susceptibility for CHD in diverse populations.
Comentario: Con el objetivo de reducir la mortalidad por enfermedades cardiovasculares (CV) en un 20% para la década siguiente, en 2010 la American Heart Association (AHA) propuso mejorar la salud CV de la población mediante un mensaje sencillo y atractivo. Para ello se obviaron las consabidas referencias a los factores de riesgo CV convencionales y se definieron 7 parámetros o métricas de salud cardiovascular ideal, todos susceptibles de modificarse mediante cambios del estilo de vida, que se denominaron Life’s Simple 7 (LS7). El LS7 comprende las siguientes conductas y factores de salud: índice de masa corporal <25 kg/m2, no fumar, dieta saludable, actividad física moderada (150 minutos o más por semana), colesterol total < 200 mg/dL, presión arterial sistólica < 120 mm Hg y diastólica < 80 mm Hg y glucemia basal < 100 mg/dL (Lloyd-Jones DM, et al. Circulation. 2010;121:586–613). Desde entonces diversos estudios prospectivos han descrito que el cumplimiento de un mayor número de métricas LS7 se asociaba a una reducción sustancial de la mortalidad total, CV y por cardiopatía isquémica. En este estudio de una gran cohorte prospectiva de EEUU se asocia el LS7 con el riesgo para toda la vida de desarrollar un evento CV en función de una puntuación de riesgo poligénico construida con el estudio de más de 6 millones de variantes genéticas. Cabe resaltar que el LS7 tenia una capacidad predictiva de riesgo CV mayor que la del puntaje poligénico y que, confirmando datos previos consistentes de diversas cohortes, un buen estilo de vida representado por una puntuación elevada en el LS7 contrarrestaba la mayor parte del riesgo CV derivado de una alta susceptibilidad genética. El mensaje para la población de riesgo es de una claridad meridiana: el estilo de vida favorable protege de modo sustancial independientemente de los factores genéticos adversos.
Congresos:
Feria Alimentaria 2022
Fecha: 4-7 Abril
Sede: Fira Internacional de Barcelona
Congreso anual de la American Nutrition Society: NUTRITION 2022: NUTRITION 2022 LIVE ONLINE (NUTRITION 2022 LIVE ONLINE). https://nutrition.org/nutrition-2022/
Fecha: 14-16 Junio 2022.
