12 January - 20 June 2016

Food group consumption and disease markers

The 2016 Global Burden of Disease study suggested that nearly 20% of all deaths worldwide were accountable to dietary risk factors and previous meta-analyses of prospective observational studies suggest a lower disease risk for the consumption of food groups of plant origin compared to certain groups of animal origin and sugar-sweetened beverages (SSBs).

The 2016 Global Burden of Disease study suggested that nearly 20% of all deaths worldwide were accountable to dietary risk factors and previous meta-analyses of prospective observational studies suggest a lower disease risk for the consumption of food groups of plant origin compared to certain groups of animal origin and sugar-sweetened beverages (SSBs). Prospective observation studies are important sources of information for dietary recommendations but the current review states that due to their limitations, without additional evidence from randomized controlled (RCT) intervention studies, recommendations should be applied “cautiously”.

The current review by Schwingshackl et al., published in the American Journal of Clinical Nutrition,  notes that RCTs also have limitations and suggests that Network meta-analyses (NMA) can be used to “close the gap” between evidence from prospective observational studies and RCTs. Schwingshackl et al. state that NMA combines direct and indirect evidence from a network of trials and “enables inference about every possible comparison between a pair of interventions in the network even when some comparisons have never been evaluated in a trial”

The aim of the current review was to “investigate the hypothesis that increased intake of foods of plant origin is more effective at the primary prevention of metabolic disturbances and diseases than intake of other food groups”.  Schwingshackl et al. performed a search for randomized studies comparing at least two food groups from refined grains, whole grains, fruits and vegetables, nuts, legumes, eggs, dairy, fish, red meat and SSBs with primary outcomes including LDL cholesterol and triacylglycerol (TG) and secondary outcomes including total cholesterol, HDL cholesterol, fasting glucose, blood pressure amongst others. Trials had to be at least 4 weeks in duration, having similar energy intake across all intervention arms with adult participants. Schwingshackl et al. included 66 trials in the review covering 3595 participants and performed an NMA for each outcome along with the determination of the surface under the cumulative ranking curve (SUCRA) for ranking outcomes.

For primary outcomes, Schwingshackl et al. found that nuts were most effective at reducing LDL cholesterol compared to refined grains, eggs, fish and red meat while legumes and whole grains were more effective than refined grains, fish and red meat.  Nuts had the highest SUCRA value (93%) followed by legumes (85%) and whole grains (70%). For TG reduction, nuts and whole grains were more effective than refined grains while fish was more effective than whole grains, refined grains, fruits and vegetables, eggs and red meat. Fish had the highest SUCRA value (97%) followed by nuts (78%) and red meat (72%).

For secondary outcomes, nuts had the highest SUCRA value (92%) for total cholesterol reduction while fish had the highest SUCRA value (91%) for HDL cholesterol improvement. Whole grains showed the highest SUCRA value (87%) for improvements in fasting glucose, fruit and vegetables had the highest value (91%) for improvements in systolic blood pressure with red meat (74%) having the highest value for diastolic blood pressure improvements.

Across all outcomes, Schwingshackl et al report that nuts (66%), legumes (62%) and whole grains (62%) had the highest SUCRA values with SSBs (2%) showing the worst value.

In conclusion, Schwingshackl et al.  indicate that their review supports the original hypothesis that “increased intake of nuts, legumes, and whole grains is more effective at primary prevention of metabolic disturbances and diseases than other food groups”. They do note however, that as only 12% of the trials included were judged to have a low risk of bias and 68% reported potential conflict of interest that future NMAs using high-quality RCTs are required to confirm their results.

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Vegan and Vegetarian Food Services - RSSL can help you successfully navigate every stage of product development in this exciting growth category; from ingredient analysis and texture optimisation, to claims substantiation and due diligence. To find out more please contact Customer Services telephone 0118 918 4076 or e-mail enquiries@rssl.com

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