Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System

In the paper

“The shift to a global food system started in the US and other high income industrialized countries, and was driven initially by government investment and intervention in markets, infrastructure and research intended to raise farm-sector productivity.”

In the paper

“This coincided with huge technological innovations in food processing, (24–28), the rise of to mass marketing to persuade consumers to eat more, supermarket retailing and fast food (29) (30),”

What the sources say

• Not checked yetcites [24] Connor, 1997
• Not checked yetcites [25] Wilkinson, 2004, The food processing industry, globalization and developing countries, Electron J Agr Dev Econ
• Not checked yetcites [26] Welch, 2000, Food processing: a century of change, Br Med Bull source
• Not checked yetcites [27] Fellows, 2009
• Not checked yetcites [28] Moss, 2013
• Not checked yetcites [29] Packard, 1957
• Not checked yetcites [30] Burch, 2007

In the paper

“Furthermore, unhealthy dietary patterns have negative environmental impacts, notably on climate change.”

In the paper

“The Global Burden of Disease study cites diet as a major factor behind the rise in hypertension, diabetes, obesity, and other CVD components (3).”

What the sources say

• Not checked yetcites [3] Lim, 2012, 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 source

In the paper

“Evidence from different countries, age/race/ethnicity/socioeconomic groups suggest the health effects studies of foods, macronutrients, and dietary patterns on CVD appear to be far more consistent though regional knowledge gaps are highlighted.”

In the paper

“In contrast, the modern food system is characterized by a global web of interactions between multiple actors from farm to fork, geared towards maximizing efficiency to reduce costs and increase production (Figure 1).”

In the paper

“Data relating diet to cardiovascular diseases (CVDs) has predominantly been generated from high-income countries (HIC), but over 80% of CVD deaths occur in low- and middle-income countries (LMIC).”

In the paper

“Our understanding of foods and macronutrients in relationship to CVD is broadly clear; however major gaps exist both in dietary pattern research and ways to change diets and food systems.”

In the paper

“Relatively sparse data on diet and CVD exist from these countries though new data sources are rapidly emerging (1,2).”

What the sources say

• Not checked yetcites [1] Imamura, 2015, Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment, Lancet Global Health source
• Not checked yetcites [2] Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, BMJ source

In the paper

“In addition to vastly increasing the calorie supply, the ensuing productivity boom also provided the basis of cheap feed for livestock and cheap inputs for processed foods, in turn creating incentives for the growth of manufacturers of processed foods (24).”

What the sources say

• Not checked yetcites [24] Connor, 1997

In the paper

“The 1960s also saw the start of significant agricultural transformation in LMIC, with the “Green Revolution” in which focused on increasing productivity of corn, rice and wheat.”

In the paper

“Snacking and snack foods have grown in frequency and number (43–48); eating frequency has increased;”

What the sources say

• Not checked yetcites [43] Adair, 2005, Are child eating patterns being transformed globally?, Obes Res source
• Not checked yetcites [44] Duffey, 2013, Prevalence and energy intake from snacking in Brazil: analysis of the first nationwide individual survey, Eur J Clin Nutr source
• Not checked yetcites [45] Ng, 2011, Nutrition transition in the United Arab Emirates, Eur J Clin Nutr source
• Not checked yetcites [46] Popkin, 2010, Does hunger and satiety drive eating anymore? Increasing eating occasions and decreasing time between eating occasions in the United States, Am J Clin Nutr source
• Not checked yetcites [47] Wang, 2008, Dynamic shifts in Chinese eating behaviors, Asia Pac J Clin Nutr
• Not checked yetcites [48] Duffey, 2014, Snacking is prevalent in Mexico, J Nutr

In the paper

“Many countries retain various forms of state intervention in agriculture and food systems (18,38–41), but policies to liberalize trade and private sector investment have revolutionized the entire sector in many regions (13,42).”

What the sources say

• Not checked yetcites [18] Popkin, 2008
• Not checked yetcites [38] Khandelwal, 2013, Eliciting a policy response for the rising epidemic of overweight-obesity in India, Obes Rev source
• Not checked yetcites [39] Wilde, 2013
• Not checked yetcites [40] 2006
• Not checked yetcites [41] Hawkes, 2010, An overview of global food trade
• Not checked yetcites [13] Reardon, 2014, The quiet revolution in Asia's rice value chains, Ann N Y Acad Sci source
• Not checked yetcites [42] Bruinsma, 2003

In the paper

“The way people eat has changed greatly across the globe; moreover the pace of change in LMIC’s is quickening.”

In the paper

“both at home and away-from-home-eating increasingly involve fried and processed food (47,49);”

What the sources say

• Not checked yetcites [47] Wang, 2008, Dynamic shifts in Chinese eating behaviors, Asia Pac J Clin Nutr
• Not checked yetcites [49] Monteiro, 2010, The snack attack, Am J Public Health source

In the paper

“In the 1985 to 2005 period extensive added sugar intake occurred across HIC (55) but more recently large increases have occurred in LMIC, particularly in consumption of sugar-sweetened beverages and processed foods (56–59).”

What the sources say

• Not checked yetcites [55] Duffey, 2008, High-fructose corn syrup: is this what's for dinner?, Am J Clin Nutr source
• Not checked yetcites [56] Basu, 2013, The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data, PLoS One source
• Not checked yetcites [57] Kleiman, 2012, Drinking to our health: can beverage companies cut calories while maintaining profits?, Obes Rev source
• Not checked yetcites [58] Monteiro C. The big issue is ultra-processing. Journal of the World Public Health Nutrition Association 2010. Available at: http://www.wphna.org/wn_commentary_ultraprocessing_nov2010.asp. Accessed August 7, 2015.
• Not checked yetcites [59] Monteiro, 2011, Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil, Public Health Nutr source

In the paper

“Meanwhile, production of less processed foods such as coarse grains (e.g., millet, sorghum), roots, tubers, and legumes has declined (32,33) while animal source food production grown dramatically (34).”

What the sources say

• Not checked yetcites [32] Starmer, 2006
• Not checked yetcites [33] Schaffer, 2007
• Not checked yetcites [34] Weis, 2013

In the paper

“White bread, for example, once rarely consumed in Latin America, became widespread after the introduction of high-yield wheat varieties.”

In the paper

“While this process originated with companies in industrialized countries looking for growth in foreign markets, companies based in LMICs are now also investing back into HICs.”

In the paper

“These changes in the global food system coupled with these food behavior shifts have enabled some critical changes to the global food supply, all with dietary implications.”

In the paper

“In Asia, white rice became dominant as a staple over legumes and coarse grains, with a more recent trend being rapidly rising consumption of instant noodles as a staple (52,53).”

What the sources say

• Not checked yetcites [52] Reddy, 2002, Cardiovascular diseases in the developing countries: dimensions, determinants, dynamics and directions for public health action, Public Health Nutr source
• Not checked yetcites [53] Reddy, 2004, Diet, nutrition and the prevention of hypertension and cardiovascular diseases, Public Health Nutr source

In the paper

“With urbanization there is some evidence to show that refined carbohydrate consumption is increasing, whereas consumption of traditional grains (i.e. millet, maize) is decreasing in LMIC (61,62).”

What the sources say

• Not checked yetcites [61] Radhika, 2009, Refined grain consumption and the metabolic syndrome in urban Asian Indians (Chennai Urban Rural Epidemiology Study 57), Metabolism source
• Not checked yetcites [62] Wang, 2005

In the paper

“Since 1964, average total carbohydrate intake in the US has increased from about 375 g/d to 500 g/d (from 2 to 6 kg/year of ready-to-eat cereals), but the percent of carbohydrate that is fiber has not substantially changed over this time, reflecting increased refined carbohydrates and sugar sweetened beverages (SSBs) is high in HIC (54).”

What the sources say

• Not checked yetcites [54] Gross, 2004, Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment, Am J Clin Nutr source

In the paper

“Dietary consumption patterns of other protein sources have been mixed.”

In the paper

“North and South America, Europe, and Australia/New Zealand have the highest meat intake, whereas Asia and Africa have the lowest (72,73).”

What the sources say

• Not checked yetcites [72] Anand, 2014
• Not checked yetcites [73] 2009

In the paper

“Meat consumption has increased considerably worldwide, and there is substantially greater production of meat in HIC than in LMIC (71).”

What the sources say

• Not checked yetcites [71] Kearney, 2010, Food consumption trends and drivers, Philos Trans R Soc Lond B Biol Sci source

In the paper

“Relatively, HIC such as Canada, US, and Western Europe, tend to consume the lowest quantities of legumes per capita in the world, whereas LMIC within Africa and India consume the greatest quantities of legumes, along with certain South American countries where beef is uncommon, such as Colombia and Peru (77–79).”

What the sources say

• Not checked yetcites [77] Schneider, 2002, Overview of the market and consumption of puises in Europe, Br J Nutr source
• Not checked yetcites [78] Oniang, 2003, Contemporary African food habits and their nutritional and health implications, Asia Pac J Clin Nutr
• Not checked yetcites [79] Aykroyd, 1982, Legumes in human nutrition. Food and Agriculture Organization of the United Nations, FAO Food Nutr Rep

In the paper

“China has the highest per capita consumption of fish in the world, followed by Oceania, North America, and Europe (74).”

What the sources say

• Not checked yetcites [74] 2012

In the paper

“Total production of tree nuts in 2012 was 3.5 million metric tons, a 5.5% increase from 2011. World consumption of tree nuts in 2011 exceeded 3 million metric tons (81).”

What the sources say

• Not checked yetcites [81] 2012

In the paper

“For example, 58% of calories consumed by Mexicans come from packaged foods and beverages, which is similar throughout the Americas (83) and even with the US (66%) (65,84).”

What the sources say

• Not checked yetcites [83] Popkin, 2014, Nutrition, agriculture and the global food system in low and middle income countries, Food Policy source
• Not checked yetcites [65] Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, Br Med J source
• Not checked yetcites [84] Slining, 2013, Food companies' calorie-reduction pledges to improve U.S. diet, Am J Prev Med source

In the paper

“However, trans-fat consumption is very high in many LMIC while decreasing markedly in HIC.”

In the paper

“In 1958–1962, soybean, palm, and rapeseed/canola oils represented 20% of the 29 million metric tons of fat produced globally/year, while butter, lard, and tallow represented 37%. By 1996–2001, these oils accounted for 52% of the 103 million metric tons of fat produced globally/year, while butter, lard, and tallow contributed 20% (64).”

What the sources say

• Not checked yetcites [64] Aldersey C. Consumer trends and usage of fats and oils. Paper presented at: 14th Biennial Sunflower Conference; June 24-26, 2003; Australia.

In the paper

“This has implications for consumption of fatty acids.”

In the paper

“A third key change has been the increasing global consumption of meat, which has been made economically feasible by subsidized production of crops for animal feed – most importantly corn and soybeans (soybean oil is a byproduct of soymeal production for animals) (66–69).”

What the sources say

• Not checked yetcites [66] Delgado, 1999
• Not checked yetcites [67] Delgado, 2003, Rising consumption of meat and milk in developing countries has created a new food revolution, J Nutr
• Not checked yetcites [68] Popkin, 2003, Dynamics of the nutrition transition toward the animal foods sector in China and its implications: a worried perspective, J Nutr
• Not checked yetcites [69] 2007

In the paper

“Palm oil (deodorized) has become an increasing source of saturated fatty acids; and partially hydrogenated fats are the main source of trans-fatty acids”

In the paper

“Oilseeds are now among the most widely traded crops, and are also processed to create margarines and vegetable shortenings and into partially hydrogenated fats and bleached deodorized oils for use in processed foods, (see also Supplementary Box 2).”

In the paper

“This was initially driven by rising production of soybeans in the US, later in Argentina and Brazil, and then palm oil in East Asia.”

In the paper

“The consumption of legumes declined in the US from 1960 and into the 1980’s, with reduced consumption patterns observed globally (8).”

What the sources say

• Not checked yetcites [8] Popkin, 2012, Global nutrition transition and the pandemic of obesity in developing countries, Nutr Rev source

In the paper

“In 75 countries representing 61.8% of the world’s adult population, global saturated fat consumption was ≈9% of energy; though considerable variation existed across countries (range: 2 to 28%).”

What the sources say

• Not checked yetcites [65] Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, Br Med J source

In the paper

“A second key change has been the increasing intake of vegetable oils, including processed vegetable oils, and a decline in consumption of animal fats (2,63).”

What the sources say

• Not checked yetcites [2] Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, BMJ source
• Not checked yetcites [63] Drewnowski, 1997, The nutrition transition: new trends in the global diet, Nutr Rev source

In the paper

“On average, fish consumption is 2 to 3 times higher in HIC than LMIC (74), although with marked heterogeneity within income categories.”

What the sources say

• Not checked yetcites [74] 2012

In the paper

“Processed meats (which refers to post-butchering modifications of foods such as curing, smoking, or addition of sodium nitrate), account for a modest proportion of all meat consumed in HIC (unpublished data from the PURE study) (71).”

What the sources say

• Not checked yetcites [71] Kearney, 2010, Food consumption trends and drivers, Philos Trans R Soc Lond B Biol Sci source

In the paper

“The proportion for China is 28.5% and rising rapidly (36,82,83).”

What the sources say

• Not checked yetcites [36] Reardon, 2012, Supermarket revolution in Asia and emerging development strategies to include small farmers, Proceedings of the National Academy of Sciences source
• Not checked yetcites [82] Zhou, 2015, The food retail revolution in China and its association with diet and health, Food Policy source
• Not checked yetcites [83] Popkin, 2014, Nutrition, agriculture and the global food system in low and middle income countries, Food Policy source

In the paper

“At very low levels of intake animal food consumption may not induce harm, providing high quality protein and iron, whereas excess animal food intake in HIC may be linked to adverse health outcomes, particularly from processed meats (70).”

What the sources say

• Not checked yetcites [70] Sinha, 2009, Meat intake and mortality: A prospective study of over half a million people, Arch Intern Med source

In the paper

“In India, for example, vanaspati, a vegetable ghee used in bakery products, fried snacks and foods sold by street vendors is a leading source of trans-fats, as is bakery shortening.”

In the paper

“Between 1990 and 2010, global saturated fat, dietary cholesterol, and trans-fat intakes remained stable (trans-fats going down in HIC and up in LMIC), while n-6, seafood n-3, and plant n-3 fat intakes each increased (65).”

What the sources say

• Not checked yetcites [65] Micha, 2014, Global, regional, and national consumption levels of dietary fats and oils in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys, Br Med J source

In the paper

“Eggs are similarly consumed in higher quantities (2–6 times) in HIC relative to LMIC, with a 14% decline in consumption in HIC observed between 1980–2000, and no change was observed in LMIC (76).”

What the sources say

• Not checked yetcites [76] 2003

In the paper

“Between 1973 and1997, dairy consumption per capita (kg) increased in LMIC by ~48% and is projected to almost double (93% increase) by 2020.”

In the paper

“Globally, although there has been little or no increase in sea fish consumption per capita since the 1960s, catches per year have risen exponentially (75) and freshwater fish intake has intake has increased during this time (71).”

What the sources say

• Not checked yetcites [75] Watson, 2001, Systematic distortions in world fisheries catch trends, Nature source
• Not checked yetcites [71] Kearney, 2010, Food consumption trends and drivers, Philos Trans R Soc Lond B Biol Sci source

In the paper

“In the US, 32.6% of adults consumed fruit two or more times per day and 27.2% ate vegetables three or more times per day (90).”

What the sources say

• Not checked yetcites [90] 2007, Fruit and vegetable consumption among adults–United States, 2005, Morb Mortal Wkly Rep

In the paper

“Carbohydrate refinement is common in HICs and increasing in LMIC (111,112).”

What the sources say

• Not checked yetcites [111] Hu, 2012, White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review, BMJ source
• Not checked yetcites [112] Aune, 2013, Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis of cohort studies, Eur J Epidemiol source

In the paper

“It is also noteworthy that the FAO estimates that one-third of all food produced for human consumption globally is wasted before it is consumed, which has both social and environmental costs that have been precisely measured in the US (100–102).”

What the sources say

• Not checked yetcites [100] 2013
• Not checked yetcites [101] Hall, 2009, The progressive increase of food waste in America and its environmental impact, PLoS One source
• Not checked yetcites [102] Parfitt, 2010, Food waste within food supply chains: quantification and potential for change to 2050, Phil Trans R Soc B: Bio Sci source

In the paper

“In addition to being a major force in many environmental problems, world agriculture is also extremely vulnerable to climate change, biodiversity loss, declining freshwater availability, and the inevitable limits of non-renewable resources (e.g., fossil energy, high grade phosphorous) although vulnerability is highly uneven on a world scale (96).”

What the sources say

• Not checked yetcites [96] McIntyre, 2009

In the paper

“In 2012, 40.6% of Canadians aged 12 and older, reported consuming fruit and vegetables five or more times per day (91).”

What the sources say

• Not checked yetcites [91] Wang, 2003, Why do some overweight children remain overweight, whereas others do not?, Public Health Nutr source

In the paper

“This study suggests that the adverse effect on CHD risk may not be mediated by short term effects on classical risk factors, but that postprandial hyperglycemia and hyperinsulinemia or hyperlipidemia may play a mediating role;”

What the sources say

• Not checked yetcites [109] Mensink, 2003, Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials, Am J Clin Nutr source

In the paper

“However, in a 5-week controlled-feeding trial of 163 generally healthy but overweight adults, low compared with high-glycemic index diets did not improve insulin sensitivity, lipid levels, or systolic blood pressure in the context of a healthy, DASH-like dietary pattern, and a low compared with high-glycemic index diet increased LDL-C when the carbohydrate content of the diet was high (109).”

What the sources say

• Not checked yetcites [109] Mensink, 2003, Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials, Am J Clin Nutr source

In the paper

“The major causes are beef and other large animals for GHG and the metabolic losses associated with shifting the product of nearly one third of the world’s arable land to concentrated animals, which effectively magnifies the resource budgets and pollution loads of industrial monocultures (34).”

What the sources say

• Not checked yetcites [34] Weis, 2013

In the paper

“In controlled-feeding studies, replacing saturated fat with carbohydrates lowers low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and increases triglycerides (109).”

What the sources say

• Not checked yetcites [109] Mensink, 2003, Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials, Am J Clin Nutr source

In the paper

“Dietary interventions which raise HDL-C may not necessarily translate into CVD risk reduction, as serum HDL-c has recently been called into question regarding its role in the causal pathway of CVD (110).”

What the sources say

• Not checked yetcites [110] Voight, 2012, Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study, Lancet source

In the paper

“The component that is “ultra-processed” – ready to eat, of snack, foods – varies depending on the method of measurement but is increasing wherever it is studied at all income levels (50,85,86).”

What the sources say

• Not checked yetcites [50] Monteiro, 2013, Ultra-processed products are becoming dominant in the global food system, Obes Rev source
• Not checked yetcites [85] Monteiro, 2012, The impact of transnational “Big Food” companies on the south: A view from Brazil, PLoS Med source
• Not checked yetcites [86] Monteiro, 2011, Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil, Public Health Nutr source

In the paper

“Many of the world’s poorest regions are poised to be most adversely affected by rising average temperatures, aridity, and water stress, as well as through increasingly severe extreme weather events like drought or flooding; in fact some feel this is already occurring (97–99).”

What the sources say

• Not checked yetcites [97] Hertel, 2010, The poverty implications of climate-induced crop yield changes by 2030, Global Environ Change source
• Not checked yetcites [98] Cline, 2007
• Not checked yetcites [99] 2014

In the paper

“While all of these changes across LMIC display great heterogeneity (92), the global food system has clearly reached all corners of the LMIC urban and rural sector and major shifts in diets appear to be accelerating.”

What the sources say

• Not checked yetcites [92] Hall, 2009, Global variability in fruit and vegetable consumption, Am J Prev Med source

In the paper

“The expansion of low-input agriculture and extensive ranching are also major factors in deforestation, which bear heavily on both climate change (as carbon is released from vegetation and soils and sequestration capacity diminishes) and biodiversity loss.”

In the paper

“According to the NHANES, between 1999 and 2006 the average US full-calorie CSD intake decreased, while intake of diet CSDs, low-calorie fruit drinks, and other sweetened beverages increased (122).”

What the sources say

• Not checked yetcites [122] World Health Organization. Draft Guidelines on free sugars released for public consultation. 2014. Geneva, Switzerland.

In the paper

“These products will gradually enter the markets in China, Brazil, and other LMICs.”

In the paper

“Vegetable oils that are primarily comprised of mono- (e.g., olive oil) and polyunsaturated fatty acids appear to reduce CHD risk, and sources of the n-3 polyunsaturated fat alpha-linolenic acid (ALA), such as rapeseed or canola oil, are cardioprotective.”

In the paper

“In the National Health and Nutrition Examination Survey III (NHANES III), with 831 CVD deaths during 163,039 person-years of follow-up, consumption of ≥ 7 SSB servings/week was associated with a 29% increased CVD mortality risk compared with < 1 serving/week (120), with no increased risk up to 6 drinks/week.”

What the sources say

• Not checked yetcites [120] Yang, 2014, Added sugar intake and cardiovascular diseases mortality among US adults, JAMA Intern Med source

In the paper

“Few studies have investigated the association between SSBs and CVD events. Those that have report increased CHD and stroke risk with SSB consumption.”

In the paper

“In a meta-analysis of prospective studies of SSB and hypertension, CHD, and stroke, the RR for a 1-serving increase in SSB/d was 1.17 (95 % CI 1.10, 1.24) for CHD and 1.08 (95% CI: 1.04 to 1.12) for incident hypertension, but no clear effect was seen for total stroke (RR 1.06, 95 % CI 0.97, 1.15) (123).”

What the sources say

• Not checked yetcites [123] Xi, 2015, Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis, Br J Nutr source

In the paper

“Replacing saturated fat with monounsaturated or polyunsaturated fat reduces low-density lipoprotein cholesterol (LDL-C) and preserves HDL-C (109).”

What the sources say

• Not checked yetcites [109] Mensink, 2003, Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials, Am J Clin Nutr source

In the paper

“A potential explanation of the SSB-T2DM association is the high content of rapidly-absorbed sugar from corn syrup, which increases blood glucose and insulin and de novo lipogenesis –which may contribute to pancreatic beta cell dysfunction and eventually T2DM (131).”

What the sources say

• Not checked yetcites [131] Janssens, 1999, Effects of soft drink and table beer consumption on insulin response in normal teenagers and carbohydrate drink in youngsters, Eur J Cancer Prev source

In the paper

“Furthermore, low-glycemic index diets improve glycemic control and serum lipids in RCTs of participants with T2DM with major implications for CHD risk reduction in this vulnerable segment of the population whose numbers are increasing rapidly globally (116–119).”

What the sources say

• Not checked yetcites [116] Brand-Miller, 2003, Low–Glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials, Diabetes Care source
• Not checked yetcites [117] Livesey, 2008, Glycemic response and health—a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes, Am J Clin Nutr source
• Not checked yetcites [118] Jenkins, 2008, Effect of a low–glycemic index or a high–cereal fiber diet on type 2 diabetes: A randomized trial, JAMA source
• Not checked yetcites [119] Goff, 2013, Low glycaemic index diets and blood lipids: A systematic review and meta-analysis of randomised controlled trials, Nutr Metab Cardiovasc Dis source

In the paper

“Trans-fatty acids increase CHD risk compared with other macronutrients, with strong evidence of adverse effects of small amounts of trans-fats on lipids (109,139) and CVD risk (140,141).”

What the sources say

• Not checked yetcites [109] Mensink, 2003, Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials, Am J Clin Nutr source
• Not checked yetcites [139] Brouwer, 2010, Effect of animal and industrial trans fatty acids on HDL and LDL cholesterol levels in humans–a quantitative review, PLoS One source
• Not checked yetcites [140] Bendsen, 2011, Consumption of industrial and ruminant trans fatty acids and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies, Eur J Clin Nutr source
• Not checked yetcites [141] Mozaffarian, 2006, Trans fatty acids and cardiovascular disease, N Engl J Med source

In the paper

“In a pooled analysis of Nurses’ Health (NHS) and Health Professionals Follow-up Study (HPFS) data, a one SSB serving/day increment is associated with a 1-kg weight gain over a four-year period (126), possibly due to incomplete compensation for this energy at other meals.”

What the sources say

• Not checked yetcites [126] Mozaffarian, 2011, Changes in diet and lifestyle and long-term weight gain in women and men, N Engl J Med source

In the paper

“Macronutrient exchange generally does not influence markers of glucose homeostasis, though in two relatively large trials, replacing SFA with either MUFA or carbohydrate improved indices of glucose homeostasis (150,151).”

What the sources say

• Not checked yetcites [150] Vessby, 2001, Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: the KANWU Study, Diabetologia source
• Not checked yetcites [151] Perez-Jimenez, 2001, A Mediterranean and a high-carbohydrate diet improve glucose metabolism in healthy young persons, Diabetologia source

In the paper

“Associations have been seen between major food sources of saturated fat, such as red and processed meat, and development of T2DM (152,153), though dairy products, notably fermented dairy, may be protective (154,155).”

What the sources say

• Not checked yetcites [152] Pan, 2013, Changes in red meat consumption and subsequent risk of type 2 diabetes mellitus: three cohorts of US men and women, JAMA Intern Med source
• Not checked yetcites [153] Micha, 2012, Unprocessed red and processed meats and risk of coronary artery disease and type 2 diabetes–an updated review of the evidence, Curr Atheroscler Rep source
• Not checked yetcites [154] Gao, 2013, Dairy products consumption and risk of type 2 diabetes: systematic review and dose-response meta-analysis, PLoS One source
• Not checked yetcites [155] Sluijs, 2012, The amount and type of dairy product intake and incident type 2 diabetes: results from the EPIC-InterAct Study, Am J Clin Nutr source

In the paper

“Both types of meat are associated with higher T2DM risk, although gram-for-gram the effect size is notably larger for processed meats.”

In the paper

“The paper is based on a World Heart Federation international workshop to review the state of knowledge on this topic.”

In the paper

“Meat is rich in protein, iron, zinc, and B-vitamins, but can also contain significant amounts of cholesterol and saturated fatty acids, which raise LDL-C and lower triglyceride (157).”

What the sources say

• Not checked yetcites [157] Mozaffarian, 2010, Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials, PLoS Med source

In the paper

“A high red meat intake (rich in heme iron), increases endogenous formation of N-nitroso compounds in the gastrointestinal tract that are associated with increased epithelial proliferation, oxidative stress, and iron-induced hypoxia signaling (166–168).”

What the sources say

• Not checked yetcites [166] Bingham, 2002, Effect of white versus red meat on endogenous N-nitrosation in the human colon and further evidence of a dose response, J Nutr
• Not checked yetcites [167] Bastide, 2011, Heme iron from meat and risk of colorectal cancer: a meta-analysis and a review of the mechanisms involved, Cancer Prev Res source
• Not checked yetcites [168] Joosen, 2009, Effect of processed and red meat on endogenous nitrosation and DNA damage, Carcinogenesis source

In the paper

“This review of diet, dietary patterns and CVD is not based on new systematic reviews or meta-analyses but represents a careful review of many published meta-analyses, seminal primary studies, and recent research by the scholars who participated in the Consensus conference.”

In the paper

“However, increased low-fat dairy consumption is associated with lower LDL-C, triglycerides, plasma insulin, insulin resistance, waist circumference, BMI, possibly blood pressure (BP); and reduced diabetes risk (174–182).”

What the sources say

• Not checked yetcites [174] Chen, 2012, Effects of dairy intake on body weight and fat: a meta-analysis of randomized controlled trials, Am J Clin Nutr source
• Not checked yetcites [175] Kai, 2013, Low-fat and high-fat dairy products are differently related to blood lipids and cardiovascular risk score, Eur J Prev Cardiol source
• Not checked yetcites [176] Pereira, 2002, Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study, JAMA source
• Not checked yetcites [177] Fumeron, 2011, Dairy consumption and the incidence of hyperglycemia and the metabolic syndrome results from a French prospective study, Data from the Epidemiological Study on the Insulin Resistance Syndrome (DESIR), Diabetes Care source
• Not checked yetcites [178] Rideout, 2013, Consumption of low-fat dairy foods for 6 months improves insulin resistance without adversely affecting lipids or bodyweight in healthy adults: a randomized free-living cross-over study, Nutr J source
• Not checked yetcites [179] Choi, 2005, Dairy consumption and risk of type 2 diabetes mellitus in men: a prospective study, Arch Internal Med source
• Not checked yetcites [180] Liu, 2006, A prospective study of dairy intake and the risk of type 2 diabetes in women, Diabetes Care source
• Not checked yetcites [181] Elwood, 2010, The consumption of milk and dairy foods and the incidence of vascular disease and diabetes: an overview of the evidence, Lipids source
• Not checked yetcites [182] Tong, 2011, Dairy consumption and risk of type 2 diabetes mellitus: a meta-analysis of cohort studies, Eur J Clin Nutr source

In the paper

“In more recent analyses, red meats, particularly processed red meats, were associated with increased CVD, CHD, stroke, and cancer mortality, while poultry was not (170–172).”

What the sources say

• Not checked yetcites [170] Rohrmann, 2013, Meat consumption and mortality–results from the European prospective investigation into cancer and nutrition, BMC Med source
• Not checked yetcites [171] Pan, 2012, Red meat consumption and mortality: results from 2 prospective cohort studies, Arch Intern Med source
• Not checked yetcites [172] Bernstein, 2010, Major dietary protein sources and risk of coronary heart disease in women, Circulation source

In the paper

“compared to saturated fat, vegetable oils rich in polyunsaturated fats reduce the TC:HDL-C ratio and CHD incidence”

In the paper

“In the PURE study fish intake was inversely associated with CVD outcomes in South America, China, North America, and Europe (RR: 0.76–0.84) but positively associated in South Asia (RR: 1.97).”

In the paper

“INTERHEART found fish intake beneficial in North America and Europe (RR: 0.73; 95% CI: 0.62–0.87) but harmful in the Middle East (RR: 1.59; 95% CI: 1.32–1.93).”

In the paper

“Eggs are also a source of dietary cholesterol (a medium egg contains ~225 milligrams of cholesterol) (187).”

What the sources say

• Not checked yetcites [187] McCance, 1960

In the paper

“In DART-2 oily fish did not affect all-cause mortality or CVD events after 3–9y, and increased sudden cardiac death, largely confined to the subgroup given fish oil capsules (200).”

What the sources say

• Not checked yetcites [200] Ness, 2003, Advice to eat fish and mood: a randomised controlled trial in men with angina, Nutr Neurosci source

In the paper

“In DART-1, fish lowered all-cause mortality and trended towards reducing CVD events after 2 y (194).”

What the sources say

• Not checked yetcites [194] Shin, 2013, Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis, Am J Clin Nutr source

In the paper

“Despite their high energy density, nuts do not contribute to weight gain, changes in waist circumference, or obesity perhaps owing to their satiating effects and increased fecal energy losses. (215,216).”

What the sources say

• Not checked yetcites [215] Flores-Mateo, 2013, Nut intake and adiposity: meta-analysis of clinical trials, Am J Clin Nutr source
• Not checked yetcites [216] Smith, 2015, Changes in intake of protein foods, carbohydrate amount and quality, and long-term weight change: results from 3 prospective cohorts, Am J Clin Nutr source

In the paper

“Fish are a source of protein, vitamin D, multiple B vitamins, essential amino acids, and trace elements; and the long-chain omega-3 (n-3) fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) (195,196), though amounts vary over tenfold across seafood species.”

What the sources say

• Not checked yetcites [195] Zheng, 2012, Fish consumption and CHD mortality: an updated meta-analysis of seventeen cohort studies, Public Health Nutr source
• Not checked yetcites [196] Mente, 2009, A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease, Arch Intern Med source

In the paper

“However, significant variations exist across regions, with a benefit of daily egg consumption in China but possible harm in South Asia.”

In the paper

“In observational studies, nuts lower CHD (196,212,213) and hypertension risk (213); but not stroke (207, (213).”

What the sources say

• Not checked yetcites [196] Mente, 2009, A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease, Arch Intern Med source
• Not checked yetcites [212] Kris-Etherton, 2001, The effects of nuts on coronary heart disease risk, Nutr Rev source
• Not checked yetcites [213] Zhou, 2014, Nut consumption in relation to cardiovascular disease risk and type 2 diabetes: a systematic review and meta-analysis of prospective studies, Am J Clin Nutr source

In the paper

“Follow-up of DART-1 at 5y also showed increased rates of CVD in the fish/fish oil group that did not persist through the 10y assessment (202).”

What the sources say

• Not checked yetcites [202] Ness, 2002, The long-term effect of dietary advice in men with coronary disease: follow-up of the Diet and Reinfarction trial (DART), Eur J Clin Nutr source