Dr Ray O’Connor takes a look at the latest clinical papers on general lifestyle health, including diet and sleep health
There have been several recent papers studying various aspects of lifestyle that are worth looking at. A recent review on various diets1 concluded that although many diets have been developed with the initial aim of controlling body weight, dietary composition also has important health effects that are independent of the effects on adiposity.
Dr Ray O’Connor
An overall inspection of the literature suggests that plant-based diets with a moderate lipid content, characterized by the consumption of vegetables, fruits, whole-grain cereals, legumes or pulses, nuts, and unsaturated fats, with low-to-moderate amounts of poultry and seafood and low quantities of red meat and sugar, may offer substantial health benefits.
The Mediterranean diet may be an option, at least for some population groups. Educating health professionals about diets and the potential effects of these diets on diseases is imperative. Advice on healthy eating should be incorporated into clinical practice and taught in medical curricula, and health care professionals should propose variations of plant-based diets by considering individual preferences, cost, affordability and cultural issues.
Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. The aim of this systematic review and meta-analysis2 was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults.
UPF intake was assessed through food frequency questionnaires in the Nurses’ Health Study (NHS; n = 75,735), Nurses’ Health Study II (NHSII; n = 90,813), and Health Professionals Follow-Up Study (HPFS; n = 40,409). The conclusion was that total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk.
Poor sleep health is associated with increased all-cause mortality and incidence of many chronic conditions. Here, using objectively measured, longitudinal sleep data from commercial wearable devices – linked to electronic health record data from the ‘All of Us’ Research Program – the authors show that sleep patterns, including sleep stages, duration and regularity, are associated with chronic disease incidence.3
Of the 6,785 participants included in this study, 71 per cent were female, 84 per cent self-identified as white and 71 per cent had a college degree; the median age was 50.2 years and the median sleep monitoring period was 4.5 years. The findings were that rapid eye movement sleep and deep sleep were inversely associated with the odds of incident atrial fibrillation and that increased sleep irregularity was associated with increased odds of incident obesity, hyperlipidemia, hypertension, major depressive disorder and generalized anxiety disorder.
Moreover, J-shaped associations were observed between average daily sleep duration and hypertension, major depressive disorder and generalized anxiety disorder. These findings show that sleep stages, duration and regularity are all important factors associated with chronic disease development.
Current US physical activity (PA) guidelines prescribe moderate to vigorous PA (MVPA) time of at least 150 minutes per week for health. An analogous step-based recommendation has not been issued due to insufficient evidence.
The objective of this cohort study4 was to examine the associations of MVPA time and step counts with all-cause mortality and cardiovascular disease (CVD). The study analysed data from an ongoing follow-up study of surviving participants of the Women’s Health Study. A total of 14,399 women (mean age, 71.8 years) were included.
The median MVPA time and step counts were 62 minutes per week and 5183 steps per day, respectively. The authors concluded that suggest that among females 62 years or older, MVPA time and step counts were qualitatively similar in their associations with all-cause mortality and CVD. Thus, step count–based goals should be considered for future guidelines along with time-based goals, allowing for the accommodation of personal preferences.
References:
- Yannakoulia M et al. Nutrition in Medicine: Diets. N Engl J Med 2024;390:2098-106. doi: 10.1056/NEJMra2211889
- Mendoza K et al. Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies. The Lancet Regional Health – Americas 2024;37: 100859 Published Online 2 September 2024. https://doi.org/10.1016/j.lana.2024.100859
- Zheng N et al. Sleep patterns and risk of chronic disease as measured by long-term monitoring with commercial wearable devices in the All of Us Research Program. Nature Medicine 2024. https://doi.org/10.1038/s41591-024-03155-8
- Hamaya R et al. Time- vs Step-Based Physical Activity Metrics for Health. JAMA Intern Med. doi:10.1001/jamainternmed.2024.0892 Published online May 20, 2024.
