Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Apr 27;12(4):e0175149.
doi: 10.1371/journal.pone.0175149. eCollection 2017.

Etiologic Effects and Optimal Intakes of Foods and Nutrients for Risk of Cardiovascular Diseases and Diabetes: Systematic Reviews and Meta-Analyses From the Nutrition and Chronic Diseases Expert Group (NutriCoDE)

Affiliations
Free PMC article
Review

Etiologic Effects and Optimal Intakes of Foods and Nutrients for Risk of Cardiovascular Diseases and Diabetes: Systematic Reviews and Meta-Analyses From the Nutrition and Chronic Diseases Expert Group (NutriCoDE)

Renata Micha et al. PLoS One. .
Free PMC article

Abstract

Background: Dietary habits are major contributors to coronary heart disease, stroke, and diabetes. However, comprehensive evaluation of etiologic effects of dietary factors on cardiometabolic outcomes, their quantitative effects, and corresponding optimal intakes are not well-established.

Objective: To systematically review the evidence for effects of dietary factors on cardiometabolic diseases, including comprehensively assess evidence for causality; estimate magnitudes of etiologic effects; evaluate heterogeneity and potential for bias in these etiologic effects; and determine optimal population intake levels.

Methods: We utilized Bradford-Hill criteria to assess probable or convincing evidence for causal effects of multiple diet-cardiometabolic disease relationships. Etiologic effects were quantified from published or de novo meta-analyses of prospective studies or randomized clinical trials, incorporating standardized units, dose-response estimates, and heterogeneity by age and other characteristics. Potential for bias was assessed in validity analyses. Optimal intakes were determined by levels associated with lowest disease risk.

Results: We identified 10 foods and 7 nutrients with evidence for causal cardiometabolic effects, including protective effects of fruits, vegetables, beans/legumes, nuts/seeds, whole grains, fish, yogurt, fiber, seafood omega-3s, polyunsaturated fats, and potassium; and harms of unprocessed red meats, processed meats, sugar-sweetened beverages, glycemic load, trans-fats, and sodium. Proportional etiologic effects declined with age, but did not generally vary by sex. Established optimal population intakes were generally consistent with observed national intakes and major dietary guidelines. In validity analyses, the identified effects of individual dietary components were similar to quantified effects of dietary patterns on cardiovascular risk factors and hard endpoints.

Conclusions: These novel findings provide a comprehensive summary of causal evidence, quantitative etiologic effects, heterogeneity, and optimal intakes of major dietary factors for cardiometabolic diseases, informing disease impact estimation and policy planning and priorities.

Conflict of interest statement

Competing Interests: Dr. Mozaffarian, Dr. Micha, and Ms Shulkin report grants from NIH/NHLBI and Gates Foundation during the conduct of the study. Dr. Peñalvo report grants from NIH/NHLBI during the conduct of the study. Dr. Singh reports grants from Bill & Melinda Gates Foundation during the conduct of the study. Dr. Mozaffarian reports personal fees from Haas Avocado Board, Pollock Communications, Life Sciences Research Organization, Boston Heart Diagnostics, GOED, DSM, Unilever North American, and UpToDate, outside the submitted work. All other authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Similar articles

See all similar articles

Cited by 39 articles

See all "Cited by" articles

References

    1. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117–71. Epub 2014/12/23. 10.1016/S0140-6736(14)61682-2 - DOI - PMC - PubMed
    1. UN General Assembly. United Nations high-level meeting on noncommunicable disease prevention and control. NCD summit to shape the international agenda New York2011. http://www.who.int/nmh/events/un_ncd_summit2011/en/.
    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–60. Epub 2012/12/19. 10.1016/S0140-6736(12)61766-8 - DOI - PMC - PubMed
    1. US Burden of Disease Collaborators. The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. JAMA: the journal of the American Medical Association. 2013;310(6):591–608. Epub 2013/07/12. 10.1001/jama.2013.13805 - DOI - PMC - PubMed
    1. Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(10010):2287–323. Epub 2015/09/15. 10.1016/S0140-6736(15)00128-2 - DOI - PMC - PubMed

MeSH terms

Feedback