Actualizaciones en Nutrición JUNIO 2022

Guía de práctica clínica:

Belardo D, Michos ED, Blankstein R, Blumenthal RS, Ferdinand KC, Hall K, Klatt K, Natajaran P, Ostfeld RJ, Reddy K, Rodriguez R, Sriram U, Tobias DK, Gulati M. Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An American Society For Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol. 2022;10:100323. doi: 10.1016/j.ajpc.2022.100323.

Abstract

Despite numerous advances in all areas of cardiovascular care, cardiovascular disease (CVD) is the leading cause of death in the United States (US). There is compelling evidence that interventions to improve diet are effective in cardiovascular disease prevention. This clinical practice statement emphasizes the importance of evidence-based dietary patterns in the prevention of atherosclerotic cardiovascular disease (ASCVD), and ASCVD risk factors, including hyperlipidemia, hypertension, diabetes, and obesity. A diet consisting predominantly of fruits, vegetables, legumes, nuts, seeds, plant protein and fatty fish is optimal for the prevention of ASCVD. Consuming more of these foods, while reducing consumption of foods with saturated fat, dietary cholesterol, salt, refined grain, and ultra-processed food intake are the common components of a healthful dietary pattern. Dietary recommendations for special populations including pediatrics, older persons, and nutrition and social determinants of health for ASCVD prevention are discussed.

Actualizaciones (n=2):

1. Pacheco LS, Li Y, Rimm EB, Manson JE, Sun Q, Rexrode K, Hu FB, Guasch-Ferré M. Avocado Consumption and Risk of Cardiovascular Disease in US Adults. J Am Heart Assoc. 2022;11(7):e024014. doi: 10.1161/JAHA.121.024014.

Abstract

Background Epidemiologic studies on the relationship between avocado intake and long-term cardiovascular disease (CVD) risk are lacking.

Methods and Results This study included 68 786 women from the NHS (Nurses’ Health Study) and 41 701 men from the HPFS (Health Professionals Follow-up Study; 1986-2016) who were free of cancer, coronary heart disease, and stroke at baseline. Diet was assessed using validated food frequency questionnaires at baseline and then every 4 years. Cox proportional hazards regressions were used to estimate hazard ratios and 95% CIs. A total of 14 274 incident cases of CVD (9185 coronary heart disease events and 5290 strokes) were documented over 30 years of follow-up. After adjusting for lifestyle and other dietary factors, compared with nonconsumers, those with analysis-specific higher avocado intake (≥2 servings/week) had a 16% lower risk of CVD (pooled hazard ratio, 0.84; 95% CI, 0.75-0.95) and a 21% lower risk of coronary heart disease (pooled hazard ratio, 0.79; 95% CI, 0.68-0.91). No significant associations were observed for stroke. Per each half serving/day increase in avocado intake, the pooled hazard ratio for CVD was 0.80 (95% CI, 0.71-0.91). Replacing half a serving/day of margarine, butter, egg, yogurt, cheese, or processed meats with the equivalent amount of avocado was associated with a 16% to 22% lower risk of CVD.

Conclusions Higher avocado intake was associated with lower risk of CVD and coronary heart disease in 2 large prospective cohorts of US men and women. The replacement of certain fat-containing foods with avocado could lead to lower risk of CVD.

Comentario. Se sabe desde hace tiempo que la dieta es un elemento clave para mejorar el perfil cardiometabólico y así reducir el riesgo cardiovascular. Entre los componentes bioactivos beneficiosos de los alimentos y la dieta se encuentran los ácidos grasos mono y poliinsaturados, la proteína vegetal, la fibra soluble, el ácido fólico, los minerales distintos del sodio y fitonutrientes como los esteroles vegetales y los polifenoles. Los aguacates son una fruta densa en nutrientes que contiene cantidades importantes de todos estos elementos. Por ejemplo, un aguacate mediano contiene tanto ácido oleico como 2 cucharadas de aceite de oliva. Hay datos de estudios clínicos indicando que el consumo habitual de aguacates ayuda a reducir la colesterolemia, pero en la literatura médica no había datos de estudios prospectivos sobre aguacates y riesgo cardiovascular. El trabajo de Pacheco y cols. derivado del seguimiento durante 30 años de las grandes cohortes de hombres y mujeres profesionales de la salud de la Universidad de Harvard suple con creces esta carencia, al mostrar como los consumidores de al menos 2 aguacates por semana comparados con los no consumidores tenían una disminución ajustada del riesgo de enfermedad cardiovascular y coronaria del 16% y 21%, respectivamente, si bien no hubo efecto sobre el ictus. Este estudio proporciona evidencias adicionales del beneficio cardiovascular derivado del consume de fuentes vegetales de ácidos grasos insaturados.

2. Delgado-Lista J, Alcala-Diaz JF, Torres-Peña JD, Quintana-Navarro GM, Fuentes F, Garcia-Rios A, Ortiz-Morales AM, Gonzalez-Requero AI, Perez-Caballero AI, Yubero-Serrano EM, Rangel-Zuñiga OA, Camargo A, Rodriguez-Cantalejo F, Lopez-Segura F, Badimon L, Ordovas JM, Perez-Jimenez F, Perez-Martinez P, Lopez-Miranda J; CORDIOPREV Investigators. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet. 2022 May 14;399(10338):1876-1885. doi: 10.1016/S0140-6736(22)00122-2.

Abstract

Background: Mediterranean and low-fat diets are effective in the primary prevention of cardiovascular disease. We did a long-term randomised trial to compare the effects of these two diets in secondary prevention of cardiovascular disease.

Methods: The CORDIOPREV study was a single-centre, randomised clinical trial done at the Reina Sofia University Hospital in Córdoba, Spain. Patients with established coronary heart disease (aged 20-75 years) were randomly assigned in a 1:1 ratio by the Andalusian School of Public Health to receive a Mediterranean diet or a low-fat diet intervention, with a follow-up of 7 years. Clinical investigators (physicians, investigators, and clinical endpoint committee members) were masked to treatment assignment; participants were not. A team of dietitians did the dietary interventions. The primary outcome (assessed by intention to treat) was a composite of major cardiovascular events, including myocardial infarction, revascularisation, ischaemic stroke, peripheral artery disease, and cardiovascular death. This study is registered with ClinicalTrials.gov, NCT00924937.

Findings: From Oct 1, 2009, to Feb 28, 2012, a total of 1002 patients were enrolled, 500 (49·9%) in the low-fat diet group and 502 (50·1%) in the Mediterranean diet group. The mean age was 59·5 years (SD 8·7) and 827 (82·5%) of 1002 patients were men. The primary endpoint occurred in 198 participants: 87 in the Mediterranean diet group and 111 in the low-fat group (crude rate per 1000 person-years: 28·1 [95% CI 27·9-28·3] in the Mediterranean diet group vs 37·7 [37·5-37·9] in the low-fat group, log-rank p=0·039). Multivariable-adjusted hazard ratios (HRs) of the different models ranged from 0·719 (95% CI 0·541-0·957) to 0·753 (0·568-0·998) in favour of the Mediterranean diet. These effects were more evident in men, with primary endpoints occurring in 67 (16·2%) of 414 men in the Mediterranean diet group versus 94 (22·8%) of 413 men in the low-fat diet group (multiadjusted HR 0·669 [95% CI 0·489-0·915], log-rank p=0·013), than in 175 women for whom no difference was found between groups.

Interpretation: In secondary prevention, the Mediterranean diet was superior to the low-fat diet in preventing major cardiovascular events. Our results are relevant to clinical practice, supporting the use of the Mediterranean diet in secondary prevention.

Comentario. La comunidad científica nutricional española esperaba desde hace un tiempo la publicación del estudio CORDIOPREV. Tras 7 años de seguimiento, los resultados de este estudio clínico aleatorizado de intervención nutricional con dieta mediterránea suplementada con aceite de oliva virgen extra en comparación con una dieta baja en grasa total demuestran su utilidad en la prevención secundaria cardiovascular, con una reducción de eventos isquémicos entre el 22% y el 25%, más acusada en hombres que en mujeres. Hay que resaltar que el grueso de episodios isquémicos que disminuyeron con la dieta mediterránea fue la necesidad de revascularización coronaria, lo cual en España se considera un evento isquémico duro. Los resultados del CORDIOPREV en prevención secundaria cardiovascular complementan perfectamente los del estudio PREDIMED en prevención primaria, con una eficacia preventiva similar (28-30%) de eventos cardiovasculares, certificando la dieta mediterránea como el patrón alimentario ideal para la salud cardiovascular.

Congreso

44º Congreso Nacional SEMERGEN

Sevilla, 5-8 de octubre de 2022

https://semergen.es/congresonacional/