Diet and Cardiometabolic Disease

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Dietary changes, physical activity, and overall lifestyle modification have become cornerstone interventions to improve cardiometabolic disease outcomes. Despite the outstanding diffusion of treatment guidelines to stop or reduce cardiometabolic disease, there is so much to be done. Furthermore, an endless number of metanalysis is dedicated to studying the effects of lifestyle changes like modifying dietary patterns or shifting to a vegetarian diet and contributing to cardiometabolic risk factors.

Furthermore, cardiometabolic disease has a broad-spectrum, which can be flared by insulin resistance in its first stages. Eventually, this first condition will develop into metabolic syndrome and potentially turn into type 2 Diabetes Mellitus and cardiovascular disease (CVD), the two most common diseases associated with high morbidity and mortality rates in the United States.

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The Cardiometabolic Disease Staging (CMDS) system

CMDS is a risk classification system that allows physicians to evaluate the patientâ€™s risk status. Nevertheless, this classification system used clinical parameters proposed by the Adult Treatment Panel III (ATP III) to diagnose metabolic syndrome and was validated by the CARDIA study as well by NHANES III-linked mortality file.

CMDS
Stage	Descriptor	Criteria
Stage 0	Metabolically healthy	No risk factors
Stage 1	One or two risk factors	Have one or two of the following risk factors: (a) Â High waist circumference (>112 cm in men and >88 cm in women) (b) Â Elevated blood pressure (systolic >130 mmHg and/or diastolic >85 mmHg) or on antihypertensive medication (c) Â Reduced serum HDL cholesterol (<1.0 mmol/L or 40 mg/dL in men; <1.3 mmol/L or 50 mg/dL in women) or on medication (d) Â Elevated fasting serum triglycerides (>1.7 mmol/L or 150 mg/dL) or on medication
Stage 2	Metabolic syndrome or prediabetes	Have only one of the following three conditions in isolation (a) Metabolic syndrome based on three or more of four risk factors: high waist circumference, elevated blood pressure, reduced HDL-C, and elevated triglycerides(b) Impaired fasting glucose (IFG; fasting glucose >5.6 mmol/L or 100 mg/dL) (c) Impaired glucose tolerance (IGT; 2-h glucose >7.8 mmol/L or 140 mg/dL)
Stage 3	Metabolic syndrome + prediabetes	Have any two of the following three conditions: (a) Metabolic syndrome (b) IFG (c) IGTÂ
Stage 4	T2DM and/or CVD	Have type 2 diabetes mellitus (T2DM) and/or cardiovascular disease (CVD): (a) T2DM (fasting glucose >126 mg/dL or 2-h glucose >200 mg/dL or on antidiabetic therapy) (b)active CVD (angina pectoris or status post a CVD event such as acute coronary artery syndrome, stent placement, coronary artery bypass, thrombotic stroke, nontraumatic amputation due to peripheral vascular disease Â

Non-pharmacologic approaches to reduce cardiometabolic risk:

Dash Diet:

The acronym DASH stands for Dietary Approaches to Stop Hypertension. Indeed, the CMDS system includes high blood pressure as a risk factor for cardiometabolic disease. Furthermore, the DASH diet emphasizes fruit, fat-free/low-fat dairy, whole grains, legumes, and nuts. On the other hand, this diet focuses on lowering dietary cholesterol intake, saturated fat, sugar, salt, red, and processed meats.

In an umbrella review that measured the positive effect of the DASH diet on cardiometabolic and cardiovascular outcomes, a positive result was found in the next conditions:

Coronary heart disease

Stroke incidence

Diabetes incidence

Reduced blood pressure

Blood lipids

Glycemic control

Bodyweight

Inflammation

The observation made in this review found an impactful correlation with the ingestion of fruits and vegetables of the DASH pattern and lower cardiovascular incidence and mortality. Also, grain and nuts consumption were associated with a 20-21% reduction of CVD incidence and a 14% drop in stroke incidence, while red meat consumption raised CVD incidence to a 15-18% risk of mortality. In terms of dietary fiber intake, each 7gr contributed to a 9% reduction in CVD and 22-24% in CHD.

DASH dietary pattern also raises the consumption of nutrient-rich food that contains magnesium, potassium, and phytochemicals. Indeed, these key nutrients are associated with lower levels of systolic blood pressure and lower mortality rate from stroke. Nevertheless, the studies determined that the potassiumâ€™s and calciumâ€™s levels directly affected the plasma renin activity and contributed to the kidney excretion of sodium.

Besides, low-fat dairy, vegetables, and fruits characteristic of the DASH diet are linked to better glycemic control outcomes and a lower Type 2 DM incidence. Furthermore, fruits and vegetables were linked with higher nitric oxide levels, which in turn improved blood pressure.

Vegetarian diet:

It is amazing what cutting some â€œbeefâ€ from our diet can do to our body. So are the contributions that a vegetarian dietary pattern has made to the treatment of cardiometabolic diseases. Indeed, a vegetarian diet has proven to have the same effects on cardiometabolic disease’s metabolic conditions.

A systematic review and meta-analysis of randomized controlled trials conducted by Viguiliouk and colleagues to study the effect of a vegetarian diet on glycemic control, weight, BMI, and waist circumference concluded that a vegetarian dietary pattern improved cardiometabolic markers.

Glycemic control:

Nevertheless, it was no easy task to follow up with the data analyzed in this review since a vegetarian pattern is described as the omission of some or all animal products. Indeed, 6,395 studies were excluded from 6,498 identified reports, but the findings were outstanding.

Blood lipids:

The results reported that following a 3week period of a vegetarian diet; patients could have reduced HbA1c, better fasting glucose and insulin, resulting in better glycemic control. When a vegetarian diet was compared to the control diet, blood lipids showed marked improvements such as reduced LDL-C and non-HDL-C but no significant improvements in triglycerides and HDL-C.

The previous reviews conclude that we can all improve our health outcomes with a balanced diet. Making a change is difficult for most of us, and I have found that my metabolic syndrome patients and my diabetic patients struggle without the help of a personalized diet. As a matter of fact, there a large amount of information out there; it is scary. I would be confused, as well. Remember that the right information and treatment for these conditions should be recognized by the general dietary guidelines and that associations like USDA, NHLBD, AHA, and ADA in the US; and your healthcare provider should follow these guidelines.- Ana Paola RodrÃguez Arciniega. Master in Clinical Nutrition