Nutritional review: beneficial outcomes from legumes, mushrooms, alcohol, coffee and tea

Researchers from the American College of Cardiology Nutrition & Lifestyle Workgroup of the Prevention of Cardiovascular Disease Council discuss nutritional "hypes" and controversies around dairy products, added sugar, legumes, coffee and tea, alcohol, energy drinks, mushrooms, fermented foods, Omega-3s and vitamin B12. The review article publishes today in the Journal of the American College of Cardiology.

"The current nutritional recommendations show a heart-healthy diet is high in fruits, vegetables, whole grains and nuts in moderation," said Andrew Freeman, MD, FACC, director of cardiovascular prevention and wellness at National Jewish Health and the review's lead author. "However, there are many food groups which can result in confusion for patients, including dairy, added sugar, coffee and alcohol."

While low-fat dairy can significantly lower blood pressure, several studies have shown a link between dairy intake and increased LDL cholesterol, fractures and all-cause mortality. There is no clear consensus on dairy intake among experts, but after a review of multiple meta-analyses, the researchers determined that dairy should be consumed with caution, as it is unclear if there is benefit or harm, and, as it serves as a big source of saturated fat and salt in the US, should be limited if consumed at all.

Consumption of added sugars (table sugar and high fructose corn syrup) has been linked to increased risk for coronary heart disease, stroke and worsened atherosclerotic cardiovascular disease. The researchers strongly recommend that individuals eliminate added sugars from their diet as much as possible, including processed foods and sugar-sweetened beverages such as regular soda, fruit drinks and sports drinks.

Legumes, which encompasses beans, chickpeas, lentils, peas and soybeans have been shown to successfully reduce coronary heart disease and improve blood glucose, LDL-C, systolic blood pressure and weight.

"Legumes are affordable and a rich source of protein," Freeman said. "We should be incorporating more beans and bean-dishes like hummus into our diets to promote heart health."

The review also covered the following nutritional topics:

Coffee. Overall the habitual consumption of coffee is associated with lower risks of all-cause and cardiovascular mortality, and there is no association between coffee and hypertension development.
Tea. Both black and green tea consumption without added sugars, sweeteners, or milks and creams appear to be safe and even associated with improved cardiovascular health and blood lipids.

Alcohol. While the relationship between alcohol consumption and cardiovascular disease is complicated, low-to-moderate intake is associated with reduced risk of total cardiovascular disease. However, due to risks of falls, certain cancers and liver disease, the researchers don't recommend that individuals consume alcohol for cardiovascular benefit.

Additionally, the following topics were reviewed:

• Energy drinks
• Mushrooms
• Fermented Foods
• Omega-3 Fatty Acids
• Vitamin B12

Current evidence supports consumption of plant-based proteins, legumes, OM3s, mushrooms, coffee and tea without added sugars, low-to-moderate amounts of alcohol and fermented foods. The verdict on dairy as part of a heart-healthy diet is still out, and if consumed, full-fat dairy should be avoided.

"There is no perfect, one size fits all dietary pattern for preventing heart disease," Freeman said. "But, most of the evidence continues to reinforce that a predominantly plant-based diet lower in fat, added sugars, added salt, processed foods, and with limited if any animal products seem to be where the data is pointing us. It is important for clinicians to stay on top of rising food trends and current scientific evidence to provide meaningful and accurate nutritional advice for patients."

Link found between bitter-taste sensitivity and cancer risk

High bitter-taste sensitivity is associated with a significantly increased risk of cancer in older British women, according to researchers who conducted a unique study of 5,500 women whose diet, lifestyle and health has been tracked for about 20 years.

The research examined the relationship between the ability to taste the bitter-tasting chemical phenylthiocarbamide, known as PTC, or the presence of specific genetic differences in the bitter taste receptor, TAS2R38, which binds to PTC, and risk of cancer in a subset of the UK Women's Cohort Study.
The UK Women's Cohort Study was established in 1995 by nutritional epidemiologists at Leeds University to explore links between diet and chronic disease, cancer in particular. The study had an initial middle-aged female population of 35,000. The researchers obtained cancer incidence data from Great Britain's National Health Service Central Register.
Researchers analyzed the food intake of women in the study, using a 217-item food-frequency questionnaire administered when the women joined the cohort in the late 1990s. Researchers hypothesized that women with higher bitter-taste sensitivity would consume fewer vegetables and have higher incidence of cancer.
Although there was no correlation between bitter-taste sensitivity and vegetable intake, researchers did find that, among older women, bitter-taste sensitivity was associated with greater cancer risk, according to lead researcher Joshua Lambert, associate professor of food science in the College of Agricultural Sciences, Penn State.
Lambert, who collaborated with scientists in Leeds University's nutritional epidemiology group while he was on sabbatical in England conducting the research, noted that depending on the level of sensitivity to bitter tastes, study participants were classified as super-tasters, tasters and non-tasters. The findings were published online this month in the European Journal of Nutrition.
"The difference in cancer incidence between the women with the highest bitter-taste sensitivity and those with the lowest was striking," he said. "Super-tasters had about a 58 percent higher risk of cancer incidence, and the tasters had about a 40 percent higher risk of developing cancer, compared to women who were classified as non-tasters."
However, in this analysis, high bitter-taste sensitivity didn't yield the expected link to dietary choices that could explain the higher cancer incidence, Lambert pointed out.
"Our hypothesis was that women who had higher bitter-taste sensitivity -- either they were PTC tasters or super-tasters, or they had the TAS2R38 diplotype to suggest that they were tasters or super-tasters -- would be at higher risk of developing cancer than women who were non-tasters. We thought that would happen because over their lifetime they would have consumed fewer bitter-tasting vegetables, which have been reported to have cancer preventive activities," he said.
"When we looked at the data, we saw that for women over 60, our hypothesis was partially correct. Cancer risk was higher among women classified as tasters or super-tasters, but we didn't see any differences in bitter-tasting vegetable consumption."
Super-tasters and tasters didn't eat fewer vegetables than the non-tasters, Lambert noted. They reported consuming as many Brussels sprouts and as much broccoli, for instance, as the non-tasters.
So where does that leave researchers? Anxious to do more studies to unravel the factors that drive the relationship between bitter-taste sensitivity and cancer, Lambert said. He and colleagues in Penn State's Department of Food Science and Department of Public Health Sciences submitted a grant application in May to the American Institute for Cancer Research to fund a study on the relationship between bitter-taste sensitivity and colon cancer risk in American men and women.
But it also has them thinking that the relationship between bitter-taste sensitivity and cancer likely relates more to overall diet quality than just vegetable consumption, according to Lambert. He said that more and more, cancer experts suspect that dietary connections to the disease will only be revealed if researchers study the bigger picture.
"Our hypothesis that women with greater bitter-taste sensitivity would eat fewer vegetables, putting them at heightened risk for cancer, was perhaps too narrow a concept," he said. "If you have an aversion to bitter taste, you are also less likely to drink alcohol, and alcohol is a risk factor for cancer. So, do the risks of eating too few vegetables outweigh the benefits of not drinking alcohol in terms of your overall cancer risk, or vice versa? We just don't know, yet."
Although researchers didn't see the relationship between bitter-taste sensitivity and vegetable consumption that they expected, that doesn't mean it doesn't exist in the wider context of the total diet, Lambert suggested.
"Maybe, if we pull back and look at the whole-diet level, we will see that women who are super-tasters have a poorer quality overall diet compared to women who are non-tasters," he said.

Hormone therapy: good for relief of menopause symptoms or for risk of bone loss, but no effect on heart disease

Heart disease is still the number one killer of US women, and hormone therapy remains a top treatment for menopause symptoms. A new study connects these two facts to demonstrate little effect of hormone therapy on artery thickness as a precursor to heart disease. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

According to the American Heart Association, heart disease is responsible for one in three deaths of US women each year. That means about one woman dies every minute. Statistics like these drive a continued interest in the medical field to study risk factors that may affect the incidence of heart disease. This includes the ongoing debate regarding the effect of hormone therapy on the progression of cardiovascular disease.
The well-known Kronos Early Estrogen Prevention Study (KEEPS) was designed to compare the effects of lower doses of either oral conjugated equine estrogens (CEE) or transdermal estradiol on the progression of atherosclerosis (hardening and thickening of the arteries), the most common cause of heart attacks and strokes. After 4 years of therapy, no differences in artery thickness were detected among the oral CEE-, transdermal estradiol-, and placebo-treated groups. In this new study, a subgroup of KEEPS participants were further evaluated for 3 years after the initial study.
The results of the follow-up study appear in the article "Changes in carotid artery intima-media thickness 3 years after cessation of menopausal hormone therapy: follow-up from the Kronos Early Estrogen Prevention Study." Study results demonstrate that the cessation of hormone therapy at the lower doses did not accelerate changes in the thickness of the arteries.
"In the KEEPS trial, low doses of hormone therapy (oral or transdermal) given for 4 years close to menopause did not improve carotid artery intima-media thickness (CIMT), and this study shows no rebound effect on progression of CIMT after stopping the hormones," says Dr. JoAnn Pinkerton, executive director of NAMS. "In contrast, the Early Versus Late Intervention Trial With Estradiol (ELITE) found benefits on CIMT when hormone therapy was given early but not when started more than 10 years from menopause. The primary indication for the use of hormone therapy should be for relief of bothersome menopause symptoms or for those at elevated risk of bone loss. There may be beneficial effects on reduction of heart disease, but it should not be used for its prevention."

Use of nicotine during pregnancy may increase risk of sudden infant death syndrome

Nicotine exposure during pregnancy, whether from smoking cigarettes, or nicotine patches and e-cigarettes, increases risk of sudden infant death syndrome -- sometimes known as "cot death" -- according to new research published in the Journal of Physiology.

Sudden infant death syndrome (SIDS) is the sudden and unexpected death of an infant under 12 months of age that occurs typically while sleeping. Failure of autoresuscitation, the ability to recover normal heart rate and breathing following gasping caused by lack of oxygen in the brain, has been recorded in human SIDS cases.
Smoking increases risk for SIDS. Over the last decade, use of cigarettes has declined significantly, however, over 10% of pregnant women still smoke during pregnancy. Over recent years nicotine replacement therapies, such as nicotine patches or e-cigarettes, have been prescribed to women who wish to quit smoking during their pregnancy. However these nicotine replacement therapies may not protect infants from SIDS. With increasing numbers of nicotine patch and electronic cigarette users during pregnancy, there is an increasing urgency to better understand the impact of nicotine exposure on the development of babies during pregnancy.
The researchers showed that exposure of the mother to nicotine during pregnancy can affect the baby's central nervous system and impair the baby's cardiorespiratory responses to stressful environments, e.g. asphyxia, especially in babies who have both serotonin and serotonin receptors deficiency in the brain. This can damage a key biological mechanism called autoresuscitation that protects the infant from a severe lack of oxygen. Such failure of autoresuscitation increases the likelihood of SIDS because the infant is unable to recover from environmental stresses that cause lack of oxygen, such as getting tangled in bedding, a minor illness or a breathing obstruction.
This research suggests that the use of nicotine, e.g. nicotine patches or electronic cigarettes, are not a safe alternative to cigarettes during pregnancy, because exposure to nicotine by any route may be harmful to a baby's cardiorespiratory function and increase the risk of SIDS.
The research conducted by the Geisel school of Medicine at Dartmouth, Lebanon, New Hampshire, tested whether use of nicotine during pregnancy and nursing is more likely to elicit autoresuscitation defects in developing animals. They exposed rats to nicotine through maternal blood or milk and then looked at their response to repeated periods of severe low oxygen.
Stella Lee, the corresponding author of the study, commented on future research "Sudden infant death syndrome is such a distressing tragedy for families. We still don't fully understand the causes, but this research is important because it helps mothers reduce the risk."
Aihua Li, a senior author on the project added "We will continue to identify the possible predictors of risk and consider how we can treat infants who have a compromised autoresuscitation mechanism."

'Invisible' stool blood linked to heightened risk of death from all causes

'Invisible' blood detected in the stools is linked to a heightened risk of death from all causes, as well as from bowel cancer, reveals research published online in the journal Gut.

In particular, it is associated with a heightened risk of dying from circulatory, respiratory, digestive, blood, hormone and neuropsychological diseases, and other types of cancer, the findings indicate.
A test to pick up the presence of unseen blood in the stools, known as the faecal occult blood test, or FOBT for short, is currently used to screen for bowel cancer or its precursor, polyps, in older people.
Previous research has indicated that stool blood might predict life expectancy, independent of its association with bowel cancer. But potentially influential factors, including drugs that might predispose to internal bleeding -- aspirin, for example -- were not accounted for.
To try and address this, the researchers drew on linked prescribing, bowel cancer screening, and death registry data for nearly 134,000 people in Tayside, Scotland, from March 2000 to the end of March 2016.
In all, 131,207 people, aged between 50 and 74, tested negative for unseen stool blood and 2714 (just over 2%) tested positive during this period. Their survival was tracked from the date of this first test until death or the end of March 2016, whichever came first.
Older age, increasing levels of deprivation, and male gender were associated with a greater likelihood of a positive test result. Prescriptions for aspirin or other drugs that boost the risk of digestive tract bleeds were also more likely to be associated with a positive test result.
Overall, people who had a positive FOBT result were nearly eight times as likely to die of bowel cancer as those who tested negative, after taking account of gender, age, deprivation, and drug treatment.
But more surprising was that a positive FOBT result was also associated with a 58 percent heightened risk of death from all causes other than bowel cancer.
It was associated with a significantly greater risk of death from circulatory, respiratory, digestive tract, neuropsychological, blood and hormone diseases, as well as other types of cancer, after taking account of potentially influential factors.
The researchers point out that older age, male gender, and increasing levels of deprivation are themselves risk factors for death from all causes. Yet even after adjusting for these factors, a positive FOBT result was still strongly associated with early death.
"Although increased [unseen stool blood] cannot be a cause of death, it may reflect the reason why male gender, age and deprivation are such strong risk factors," they suggest.
This is an observational study, and as such, can't establish cause. And there are no obvious explanations for their findings, point out the researchers.
But they speculate that generalised inflammation, manifest in gut inflammation and bleeding, may provide the missing link, particularly as there is good evidence that most solid cancers and Alzheimer's disease develop against a background of chronic/systemic inflammation.
They go on to suggest that a positive FOBT result might be used to alert bowel cancer screening programme participants who don't have the disease -- and around half of those who test positive don't -- to the possibility that they might be at risk of other potentially life-limiting illness, and the need for a healthier lifestyle and/or preventive drug treatment.
In a linked commentary, Professor Uri Ladabaum of Stanford University School of Medicine, writes that hidden stool blood "may be telling us more than we might have thought. If the eye is the window to the soul, is a faecal test the window to general health?"
He continues: "Perhaps more importantly, if occult blood in faeces is a predictor of life expectancy and multiple [non-bowel cancer] causes of death, the inevitable next questions concern the implications for organised [bowel cancer] screening programmes or opportunistic [bowel cancer] screening."

Broken bones among older people increase risk of death for up to 10 years

Broken bones among older people increase their risk of death for up to 10 years, according to a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Older people with broken bones face a higher risk of death, and that risk can stay elevated for years. Hip fractures are known to increase the mortality risk among older people, and this is the first study to identify how long this risk lasts for different fractures. Non-hip fractures contribute to more than two-thirds of all fragility fractures and can include fractures of the femur, pelvis, clavicle or lower leg.
"A fracture is the starting point for much wider health issues that persist long after the fracture has healed and can ultimately result in earlier death," said Jacqueline Center, M.B.B.S., Ph.D., of the Garvan Institute of Medical Research in Sydney, Australia. "We tracked the increased risk of death for fractures in different bones and found that they vary. The heightened risk can last for over a decade after a hip fracture, and for most other fractures (apart from distal or minor fractures), the increased risk is for about five years."
This nationwide, registry-based follow-up study included all individuals in Denmark over the age of 50 who first experienced fragility fractures in 2001 and were followed up to 10 years for their mortality risk.
In the year after breaking a hip, men faced a 33 percent higher risk of death and women had a 20 percent higher risk. For femur or pelvic fractures, the one-year excess mortality was between 20 percent and 25 percent. A significant risk of death was still observed 10 years after a person broke a hip, and approximately five years following non-hip fractures.
"Our findings emphasize just how crucial early intervention is," Center said. "We need to understand the risk of breaking a bone before the fracture happens and treat that individual accordingly. While intervention after the first fracture is critical, we also need to diagnose those at risk of breaking bones before these major health impacts have occurred."
Other authors of the study include: Thach Tran and Dana Bliuc of the Garvan Institute of Medical Research; Louise Hansen of Aalborg University in Aalborg East, Denmark; Bo Abrahamsen of Holbæk Hospital in Holbæk, Denmark, and University of Southern Denmark in Odense, Denmark; Joop van den Bergh of Maastricht University Medical Center in Maastricht, The Netherlands, and VieCuri Medical Centre of Noord-Limburgm in Venlo, The Netherlands; John A. Eisman of the Garvan Institute of Medical Research, St Vincent's Hospital, University of New South Wales, and University of Notre Dame Australia in Sydney, Australia; Tineke van Geel of Maastricht University; Piet Geusens of Maastricht University Medical Center and University Hasselt in Hasselt, Belgium; Peter Vestergaard of Aalborg University and Aalborg University Hospital; and Tuan V. Nguyen of the Garvan Institute of Medical Research and University of New South Wales.
The study received support from the National Health Medical Research Council Australia.
The study, "Persistence of Excess Mortality Following Individual Non-Hip Fractures: A Relative Survival Analysis," will be published online, ahead of print.

High fruit and vegetable consumption may reduce risk of breast cancer

Women who eat a high amount of fruits and vegetables each day may have a lower risk of breast cancer, especially of aggressive tumors, than those who eat fewer fruits and vegetables, according to a new study led by researchers from Harvard T.H. Chan School of Public Health. In their findings, cruciferous vegetables such as broccoli, and yellow and orange vegetables, had a particularly significant association with lower breast cancer risk.
"Although prior studies have suggested an association, they have been limited in power, particularly for specific fruits and vegetables and aggressive subtypes of breast cancer," said first author Maryam Farvid, research scientist in the Department of Nutrition. "This research provides the most complete picture of the importance of consuming high amounts of fruit and vegetables for breast cancer prevention."
The study was published online July 6, 2018 in the International Journal of Cancer.
The researchers analyzed diet questionnaires submitted every four years by participants in the Nurses' Health Study (88,301 women, starting in 1980) and the Nurses' Health Study II (93,844 women, starting in 1991). Data on other potential breast cancer risk factors such as age, weight, smoking status, and family cancer history were taken from biennial questionnaires.
They found that women who ate more than 5.5 servings of fruits and vegetables each day had an 11% lower risk of breast cancer than those who ate 2.5 or fewer servings. (A serving is defined as one cup of raw leafy vegetables, half a cup of raw or cooked vegetables, or half a cup of chopped or cooked fruits.)
To find out whether the benefits of fruit and vegetable consumption differed among various types of breast cancers, the researchers conducted an analysis by tumor hormone receptor status and molecular subtype. They found that higher consumption of fruits and vegetables was particularly associated with lower risk of more aggressive tumors including ER-negative, HER2-enriched, and basal-like tumors.
Previous work by this research group linked reduced breast cancer risk with higher fiber intake, but the benefits of fruits and vegetables found in this study appear to be independent of their fiber content, according to the researchers. This suggests that other constituents of these foods, such as antioxidants and other micronutrients, may also be important in reducing breast cancer risk.
"While a diet with lots of fruits and vegetables is associated with many other health benefits, our results may provide further impetus for women to increase their intake of fruits and vegetables," said senior author Heather Eliassen, associate professor at Harvard Medical School and Harvard Chan School and associate epidemiologist at Brigham and Women's Hospital.