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The effects of dietary and nutrient interventions on arterial stiffness:

a systematic review

Pase M et al.

Am J Clin Nutr 2010; Dec 8

(e-pub ahead of print)

Page 1 Pase M et al. Am J Clin Nutr 2010; Dec 8 (e-pub ahead of print)

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Pronutritionist’s background

• Arterial stiffness is caused by aging and is often referred as calcification of vasculature. However, age related stiffening of arteries is not only caused by calcium, but also collagen formation and other phenomena

• Early and a hallmark marker of arterial stiffness is deterioration endothelial function

• Elastic (compliant) arteries are linked to vitality and long life

• Increase in arterial stiffness has detrimental effects on cardiovascular dynamics and health outcomes

• Some dietary factors may affect arterial stiffness– Recently Finnish investigators have shown that low intake of

vegetables increases during childhood is linked to arterial stiffness in mid-life (Aatola et al. 2010)

– Trans fats

– - Pase M et al. Am J Clin Nutr 2010; Dec 8

(e-pub ahead of print)www.pronutritionist.net

Methods• A systematic review of randomized controlled clinical trials

– dietary and nutrient interventions as a monotherapy for arterial stiffness and associated wave-reflections

– Sole endothelial function studies were excluded

• 38 studies were included (127 excluded)

• Inclusion criteria:– randomized and controlled

– sample size of >15 subjects/arm

– adults

– use of a nonactive control

– the outcome variable was a validated measure of arterial stiffness

– used a specific dietary or nutrient intervention administered orally in the form of supplements, powder or a beverage

Page 3 Pase M et al. Am J Clin Nutr 2010; Dec 8 (e-pub ahead of print)

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Main results (1/3)

www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8 (e-pub ahead of print)

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1. Fish oil2. Soy (isoflavones)3. Salt reduction4. Fermented milk

1. Caffeine

Worsens Improves

Neutral effect on arterial stiffness (2/3)

www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8 (e-pub ahead of print)

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Vitamin CVitamin C

Vitamin EVitamin E

Folic acidFolic acid

AlcoholAlcohol

CLACLA

NOT included or limited evidence (remain unanswered) (3/3)

www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8 (e-pub ahead of print)

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Green/ Black teaGreen/ Black tea

Herbal productsHerbal products

Fats (TFA, SFA, PUFA MUFA)Fats (TFA, SFA, PUFA MUFA)

Dietary nitrates and nitritesDietary nitrates and nitrites

CocoaCocoa

Factors proved to reduce arterial stiffness

• Omega-3 fish oils– reduces pulse wave velocity (PWV) and increases arterial

compliance

– Minimum dose required in studies: 540 mg EPA combined with 360 mg DHA a day

• Soy isoflavones

• Consumption of fermented-milk products that contain bioactive peptides– In hypertensive patients with small to moderate effects

– Limited but consistent evidence

• Salt restriction– ≈ 6 g/d

– Only in one study

www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8 (e-pub ahead of print)

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Factors that had neutral or negative effects or lacked evidence

• The evidentiary support for intakes of vitamins, micronutrients, and herbal medicines was insufficient

• Limited but consistent evidence suggested that caffeine intake acutely increased arterial stiffness

www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8 (e-pub ahead of print)

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Pronutritionist’s discussion (1/2)

• Fish-oil and soy consumption are often linked to improved cardiovascular survival. One possible explanation is that they both improve arterial elasticity

• Coffee consumption is linked to decreased stroke and diabetes incidence. Therefore the observed negative effects of caffeine might be transient or they might be offset by coffee’s polyphenols

• Even if inconclusive, some evidence exist that salt intake per se is harmful for cardiovascular outcomes. Potential mechanism beyond blood pressure might be worsening of endothelial function

• In observational and animal studies trans fat is also strongly linked to markers of arterial stiffness (Micha & Mozaffarian 2009)

• www.pronutritionist.netPase M et al. Am J Clin Nutr 2010; Dec 8

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Pronutritionist’s discussion (2/2)

• This meta-analysis adds some more proof for the protective effects of soy, fish and reduction of salt in maintaining cardiovascular health, but has merely looked into individual components of diet as determinants of arterial elasticity

• It is likely that that the interplay of many nutrients and some dietary patterns (like Mediterranean diet Marin et al. 2011 or high consumption of vegetables Aatola et al. 2010) ) are even more powerful determinants of “arterial youth” (ie. avoidance of arterial stiffness)

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