Nutrition as a link between obesity and cardiovascular disease: how can we stop the obesity epidemic?

summary

Overweight and obesity are associated with excess cardiovascular risk. To reduce cardiovascular risk at the population level, the prevention of overweight and obesity is key. This requires adoption of a healthy lifestyle, including less inactivity and more moderate-to-vigorous physical activity, and a healthy diet. Diet composition may facilitate weight gain prevention and weight loss. Effects of dietary fats, carbohydrates and proteins will be discussed in this context. Current evidence indicates that moderation of the intake of (saturated) fat, a moderate increase in protein content of the diet, a replacement of refined grain/high glucose index (GI) by whole-grain/low GI carbohydrates and limitation of the consumption of calorically-sweetened beverages are likely to facilitate weight control.

Keywords

Nutrition - obesity - prevention

• References

• 1 Go AS, Mozaffarian D, Roger VL. et al. Heart Disease and Stroke Statistics--2013 Update: A Report From the American Heart Association. Circulation 2013; 127: e6-e245.
• 2 Nichols MTN, Luengo-Fernandez R, Leal J. et al. European Cardiovascular Disease Statitics 2012 Edition. 2012 .
• 3 OECD. Obesity update 2012. Available from www.oecd.org/health/49716427.pdf Cited 13-01-2013.
• 4 Poirier P, Giles TD, Bray GA. et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006; 113: 898-918.
• 5 Lloyd-Jones DM, Hong Y, Labarthe D. et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation 2010; 121: 586-613.
• 6 Wildman RP, McGinn AP, Lin J. et al. Cardiovascular disease risk of abdominal obesity vs. metabolic abnormalities. Obesity 2011; 19: 853-860.
• 7 Bluher M. Adipose tissue dysfunction in obesity. Exp Clin Endocrinol Diabetes 2009; 117: 241-250.
• 8 Blaak EE, van Baak MA, Kemerink GJ. et al. Beta-adrenergic stimulation and abdominal subcutaneous fat blood flow in lean, obese, and reduced-obese subjects. Metabolism 1995; 44: 183-187.
• 9 Summers LK, Samra JS, Frayn KN. Impaired postprandial tissue regulation of blood flow in insulin resistance: a determinant of cardiovascular risk?. Atherosclerosis 1999; 147: 11-15.
• 10 Edens NK, Leibel RL, Hirsch J. Mechanism of free fatty acid re-esterification in human adipocytes in vitro. J Lipid Res 1990; 31: 1423-1431.
• 11 Sotornik R, Brassard P, Martin E. et al. Update on adipose tissue blood flow regulation. Am J Physiol Endocrinol Metab 2012; 302: E1157-1170.
• 12 McQuaid SE, Hodson L, Neville MJ. et al. Downregulation of adipose tissue fatty acid trafficking in obesity: a driver for ectopic fat deposition?. Diabetes 2011; 60: 47-55.
• 13 Tchernof A, Despres JP. Pathophysiology of human visceral obesity: an update. Physiol Rev 2013; 93: 359-404.
• 14 Yang X, Smith U. Adipose tissue distribution and risk of metabolic disease: does thiazolidinedione-induced adipose tissue redistribution provide a clue to the answer?. Diabetologia 2007; 50: 1127-1139.
• 15 Sacks HS, Fain JN. Human epicardial fat: what is new and what is missing?. Clin Exp Pharmacol Physiol 2011; 38: 879-887.
• 16 Ferland A, Eckel RH. Does sustained weight loss reverse the metabolic syndrome?. Curr Hypertens Rep 2011; 13: 456-464.
• 17 Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial: a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013. Epub ahead of print.
• 18 Katan MB. Weight-loss diets for the prevention and treatment of obesity. N Engl J Med 2009; 360: 923-925.
• 19 Sacks FM, Bray GA, Carey VJ. et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009; 360: 859-873.
• 20 Svetkey LP, Ard JD, Stevens VJ. et al. Predictors of long-term weight loss in adults with modest initial weight loss, by sex and race. Obesity 2012; 20: 1820-1828.
• 21 Kennedy ET, Ohls J, Carlson S. et al. The Healthy Eating Index: design and applications. J Am Diet Assoc 1995; 95: 1103-1108.
• 22 Yu-Poth S, Zhao G, Etherton T. et al. Effects of the National Cholesterol Education Program’s Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. Am J Clin Nutr 1999; 69: 632-646.
• 23 Bray GA, Popkin BM. Dietary fat intake does affect obesity!. Am J Clin Nutr 1998; 68: 1157-1173.
• 24 Astrup A, Grunwald GK, Melanson EL. et al. The role of low-fat diets in body weight control: a meta-analysis of ad libitum dietary intervention studies. Int J Obes Relat Metab Disord 2000; 24: 1545-1552.
• 25 van Baak MA, Astrup A. Consumption of sugars and body weight. Obes Rev 2009; 10 (Suppl. 01) 9-23.
• 26 Hooper L, Abdelhamid A, Moore HJ. et al. Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies. Br Med J 2013; 345: e7666.
• 27 Strik CM, Lithander FE, McGill AT. et al. No evidence of differential effects of SFA, MUFA or PUFA on post-ingestive satiety and energy intake: a randomised trial of fatty acid saturation. Nutr J 2010; 9: 24.
• 28 Piers LS, Walker KZ, Stoney RM. et al. The influence of the type of dietary fat on postprandial fat oxidation rates: monounsaturated (olive oil) vs saturated fat (cream). Int J Obes Relat Metab Disord 2002; 26: 814-821.
• 29 Buckley JD, Howe PR. Long-chain omega-3 polyunsaturated fatty acids may be beneficial for reducing obesity-a review. Nutrients 2010; 2: 1212-1230.
• 30 Li JJ, Huang CJ, Xie D. Anti-obesity effects of conjugated linoleic acid, docosahexaenoic acid, and eicosapentaenoic acid. Mol Nutr Food Res 2008; 52: 631-645.
• 31 Schwingshackl L, Strasser B, Hoffmann G. Effects of monounsaturated fatty acids on cardiovascular risk factors: a systematic review and meta-analysis. Ann Nutr Metab 2011; 59: 176-186.
• 32 Hauner H, Bechthold A, Boeing H. et al. Evidence-based guideline of the German Nutrition Society: carbohydrate intake and prevention of nutrition-related diseases. Ann Nutr Metab 2012; 60 (Suppl. 01) 1-58.
• 33 Santos FL, Esteves SS, da Costa Pereira A. et al. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obes Rev 2012; 13: 1048-1066.
• 34 Hu T, Mills KT, Yao L. et al. Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol 2012; 176 (Suppl. 07) S44-S54.
• 35 Ruxton CH, Gardner EJ, McNulty HM. Is sugar consumption detrimental to health? A review of the evidence 1995-2006. Crit Rev Food Sci Nutr 2010; 50: 1-19.
• 36 Gibson S. Sugar-sweetened soft drinks and obesity: a systematic review of the evidence from observational studies and interventions. Nutr Res Rev 2008; 21: 134-147.
• 37 Wolff E, Dansinger ML. Soft drinks and weight gain: how strong is the link?. Medscape J Med 2008; 10: 189.
• 38 Olsen NJ, Heitmann BL. Intake of calorically sweetened beverages and obesity. Obes Rev 2009; 10: 68-75.
• 39 Malik VS, Popkin BM, Bray GA. et al. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 2010; 121: 1356-1364.
• 40 Pan A, Hu FB. Effects of carbohydrates on satiety: differences between liquid and solid food. Curr Opin Clin Nutr Metab Care 2011; 14: 385-390.
• 41 de Ruyter JC, Olthof MR, Seidell JC. et al. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med 2012; 367: 1397-1406.
• 42 Maersk M, Belza A, Stodkilde-Jorgensen H. et al. Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Am J Clin Nutr 2012; 95: 283-289.
• 43 Brouns F, Bjorck I, Frayn KN. et al. Glycaemic index methodology. Nutr Res Rev 2005; 18: 145-171.
• 44 Jenkins DJ, Wolever TM, Taylor RH. et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr 1981; 34: 362-366.
• 45 Ludwig DS, Majzoub JA, Al-Zahrani A. et al. High glycemic index foods, overeating, and obesity. Pediatrics 1999; 103: E26.
• 46 Ludwig DS. Clinical update: the low-glycaemic-index diet. Lancet 2007; 369: 890-892.
• 47 Brand-Miller J, McMillan-Price J, Steinbeck K. et al. Dietary glycemic index: health implications. J Am Coll Nutr 2009; 28 (Suppl) 446S-449S.
• 48 Brand-Miller J, Buyken AE. The glycemic index issue. Curr Opin Lipidol 2012; 23: 62-67.
• 49 McMillan-Price J, Brand-Miller J. Dietary approaches to overweight and obesity. Clin Dermatol 2004; 22: 310-314.
• 50 Livesey G, Taylor R, Hulshof T. et al. Glycemic response and health--a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes. Am J Clin Nutr 2008; 87: 258S-268S.
• 51 van Dam RM, Seidell JC. Carbohydrate intake and obesity. Eur J Clin Nutr 2007; 61 (Suppl. 01) S75-S99.
• 52 Thomas DE, Elliott EJ, Baur L. Low glycaemic index or low glycaemic load diets for overweight and obesity. Cochrane Database Syst Rev 2007; 3: CD005105.
• 53 Larsen TM, Dalskov SM, van Baak M. et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med 2010; 363: 2102-2113.
• 54 Grant SM, Wolever TM. Perceived barriers to application of glycaemic index: valid concerns or lost in translation?. Nutrients 2011; 3: 330-340.
• 55 Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004; 79: 537-543.
• 56 White JS. Straight talk about high-fructose corn syrup: what it is and what it ain’t. Am J Clin Nutr 2008; 88: 1716S-1721S.
• 57 Anderson GH. Much ado about high-fructose corn syrup in beverages: the meat of the matter. Am J Clin Nutr 2007; 86: 1577-1578.
• 58 Forshee RA, Storey ML, Allison DB. et al. A critical examination of the evidence relating high fructose corn syrup and weight gain. Crit Rev Food Sci Nutr 2007; 47: 561-582.
• 59 Bray GA. Fructose: pure, white, and deadly? Fructose, by any other name, is a health hazard. J Diabetes Sci Technol 2010; 4: 1003-1007.
• 60 Bray GA. Potential health risks from beverages containing fructose found in sugar or high-fructose corn syrup. Diabetes Care 2013; 36: 11-12.
• 61 Aller EE, Abete I, Astrup A. et al. Starches, sugars and obesity. Nutrients 2011; 3: 341-369.
• 62 Tappy L, Le KA. Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev 2010; 90: 23-46.
• 63 Moran TH. Fructose and satiety. J Nutr 2009; 139: 1253S-1256S.
• 64 Dolan LC, Potter SM, Burdock GA. Evidence-based review on the effect of normal dietary consumption of fructose on blood lipids and body weight of overweight and obese individuals. Crit Rev Food Sci Nutr 2010; 50: 889-918.
• 65 Payne AN, Chassard C, Lacroix C. Gut microbial adaptation to dietary consumption of fructose, artificial sweeteners and sugar alcohols: implications for host-microbe interactions contributing to obesity. Obes Rev 2012; 13: 799-809.
• 66 Sievenpiper JL, de Souza RJ, Mirrahimi A. et al. Effect of fructose on body weight in controlled feeding trials: a systematic review and meta-analysis. Ann Intern Med 2012; 156: 291-304.
• 67 Stanhope KL, Schwarz JM, Keim NL. et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest 2009; 119: 1322-1334.
• 68 Wanders AJ, van den Borne JJ, de Graaf C. et al. Effects of dietary fibre on subjective appetite, energy intake and body weight: a systematic review of randomized controlled trials. Obes Rev 2011; 12: 724-739.
• 69 Ye EQ, Chacko SA, Chou EL. et al. Greater whole-grain intake is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain. J Nutr 2012; 142: 1304-1313.
• 70 Kristensen M, Toubro S, Jensen MG. et al. Whole grain compared with refined wheat decreases the percentage of body fat following a 12-week, energy-restricted dietary intervention in postmenopausal women. J Nutr 2012; 142: 710-716.
• 71 Westerterp-Plantenga MS, Lemmens SG, Westerterp KR. Dietary protein - its role in satiety, energetics, weight loss and health. Br J Nutr 2012; 108 (Suppl. 02) S105-S112.
• 72 Clifton P. Effects of a high protein diet on body weight and comorbidities associated with obesity. Br J Nutr 2012; 108 (Suppl. 02) S122-S129.
• 73 Wycherley TP, Moran LJ, Clifton PM. et al. Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2012; 96: 1281-1298.
• 74 Santesso N, Akl EA, Bianchi M. et al. Effects of higher- versus lower-protein diets on health outcomes: a systematic review and meta-analysis. Eur J Clin Nutr 2012; 66: 780-788.
• 75 Halkjaer J, Olsen A, Overvad K. et al. Intake of total, animal and plant protein and subsequent changes in weight or waist circumference in European men and women: the Diogenes project. Int J Obes 2011; 35: 1104-1113.
• 76 Shay CM, Van Horn L, Stamler J. et al. Food and nutrient intakes and their associations with lower BMI in middle-aged US adults: the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP). Am J Clin Nutr 2012; 96: 483-491.
• 77 Chen M, Pan A, Malik VS. et al. Effects of dairy intake on body weight and fat: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2012; 96: 735-747.