Diabetes type to, hjerte- og karsykdommer og kosthold

Plantebasert kosthold kan forebygge diabetes type to
Studieresultatene viser at høyt kjøttforbruk kan øke risikoen for type 2 diabetes og hjerte- og karsykdommer, mens et mer plantebasert kosthold kan gi helsefordeler

Kosthold spiller en viktig rolle i utvikling av hjerte- og karsykdommer som hjerteinfarkt, hjertekrampe, hjerneslag o.a., fedme og type 2 diabetes. Begrensning av animalske produkter i kosten og større andel av grønnsaker, belgvekster, frukt, fullkorn og nøtter kan forebygge livsstilssykdommene.

Les også:

Kjøtt og livsstilssykdommer

Flere studier har funnet sammenheng mellom kjøttforbruk og risiko for hjerte- og karsykdommer og type 2 diabetes. Her er oversikt av både flere oppfølgingsstudier (prospektive kohortstudier), noen intervensjonsstudier og systematiske gjennomganger og metaanalyser av kohortstudier av kjøttforbruk og sykdomsrisiko. Resultatene tyder på at kjøttforbruket er ugunstig/kan øke risikoen for type 2 diabetes og hjerte- og karsykdommer, og begrensning av kjøttkonsumet kan gi helsefordeler.

«For T2DM, CHD, and stroke, the evidence is strongest. Per 100 g of total meat, the pooled relative risk (RR) for T2DM is 1.15 (95 % CI 1.07-1.24), for (unprocessed) red meat 1.13 (95 % CI 1.03-1.23), and for poultry 1.04 (95 % CI 0.99-1.33); per 50 g of processed meat, the pooled RR is 1.32 (95 % CI 1.19-1.48). Hence, the strongest association regarding T2DM is observed for processed (red) meat. A similar observation has been made for CHD. For stroke, however, a recent meta-analysis shows moderately elevated risks for meat consumers, for processed as well as for fresh meats. For the microvascular complications of diabetes, few prospective data were available, but suggestions for elevated risks can be derived from findings on hyperglycemia and hypertension. The results are discussed in the light of the typical nutrients and other compounds present in meat–that is, saturated and trans fatty acids, dietary cholesterol, protein and amino acids, heme-iron, sodium, nitrites and nitrosamines, and advanced glycation end products. In light of these findings, a diet moderate to low in red meat, unprocessed and lean, and prepared at moderate temperatures is probably the best choice from the public health point of view.»
  • Pan A, Sun Q, Bernstein AM, Manson JE, Willett WC, Hu FB. Changes in red meat consumption and subsequent risk of type 2 diabetes mellitus: three cohorts of US men and women. JAMA Intern Med. 2013 Jul 22;173(14):1328-35. doi: 10.1001/jamainternmed.2013.6633. http://archinte.jamanetwork.com/article.aspx?articleid=1697785

Tre prospektive kohortstudier av amerikanske menn og kvinner er analysert. Tidsavhengige Cox-regresjonsmodeller ble brukt til å beregne risiko med justering for alder, familiehistorie, rase, sivilstand, innledende inntak av rødt kjøtt, røykestatus, samt innledende og endringer i andre livsstilsfaktorer (fysisk aktivitet, alkoholinntak, totalt energiinntaket, og kvaliteten på kostholdet) .

Økning i inntaket av rødt kjøtt i løpet av en 4 – års periode var assosiert med forhøyet risiko for diabetes type 2 i løpet av de påfølgende fire år i hver årsklasse. Resultatene gir ytterligere bevis for at å begrense inntaket av rødt kjøtt over tid gir ensidige fordeler for T2DM forebygging.

«Increasing red meat consumption over time is associated with an elevated subsequent risk of T2DM, and the association is partly mediated by body weight. Our results add further evidence that limiting red meat consumption over time confers benefits for T2DM prevention.»
  • Chen GC, Lv DB, Pang Z, Liu QF. Red and processed meat consumption and risk of stroke: a meta-analysis of prospective cohort studies. Eur J Clin Nutr. 2013 Jan;67(1):91-5. doi: 10.1038/ejcn.2012.180. Epub 2012 Nov 21.

Forfatterne har vurdert sammenheng mellom inntak av rødt og bearbeidet kjøtt og risiko for hjerneslag ved å gjennomføre en metaanalyse av prospektive kohortstudier. Fem store uavhengige prospektive kohortstudier ble identifisert, med totalt 239 251 deltagere og 9593 slagtilfeller.

Resultatene fra denne meta-analyse tyder på at inntak av rødt og/eller bearbeidet kjøtt øker risikoen for hjerneslag, særlig infarkt.

«Five large independent prospective cohort studies were identified. These studies contained a total of 2 39 251 subjects and 9593 stroke events. (…)  In the dose-response analysis, the risk of stroke increased significantly by 10% and 13% for each 100 g per day increment in total and red meat consumption, respectively, and by 11% for each 50 g per day increment in processed meat consumption.
Findings from this meta-analysis indicate that consumption of red and/or processed meat increase risk of stroke, in particular, ischemic stroke.»
  • Bradbury KE, Crowe FL, Appleby PN, Schmidt J a, Travis RC, Key TJ. Serum concentrations of cholesterol, apolipoprotein A-I and apolipoprotein B in a total of 1694 meat-eaters, fish-eaters, vegetarians and vegans. Eur J Clin Nutr. Nature Publishing Group; 2013;(April):1–6.
  • Micha R, Michas G, Mozaffarian D. Unprocessed red and processed meats and risk of coronary artery disease and type 2 diabetes–an updated review of the evidence.  Curr Atheroscler Rep. 2012 Dec;14(6):515-24. doi: 10.1007/s11883-012-0282-8.  http://www.ncbi.nlm.nih.gov/pubmed/23001745
«The overall findings suggest that neither unprocessed red nor processed meat consumption is beneficial for cardiometabolic health, and that clinical and public health guidance should especially prioritize reducing processed meat consumption.»
«Results from this meta-analysis indicate that consumption of fresh red meat and processed red meat as well as total red meat is associated with increased risk of total stroke and ischemic stroke, but not hemorrhagic stroke.»
  • Aune, D., Ursin, G., og Veierod, M. B. Diabetologia (52), 11, 2277-2287. Diabetologia. 2009 Nov;52(11):2277-87. doi: 10.1007/s00125-009-1481-x. Epub 2009 Aug 7: Meat consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies  http://www.ncbi.nlm.nih.gov/pubmed/19662376
    «The estimated summary RR and 95% confidence interval of type 2 diabetes comparing high vs low intake was 1.17 (95% CI 0.92-1.48) for total meat, 1.21 (95% CI 1.07-1.38) for red meat and 1.41 (95% CI 1.25-1.60) for processed meat.»
  • Szeto YT, Kwok TCY, Benzie IFF. Effects of a long-term vegetarian diet on biomarkers of antioxidant status and cardiovascular disease risk. Nutrition. 2004;20:863–6.

Les også: Sunne matvarer: Bønner, linser og erter

Egg

  • Shin JY, Xun P, Nakamura Y, He K.: Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2013 Jul;98(1):146-59. doi: 10.3945/ajcn.112.051318. Epub 2013 May 15 http://www.ncbi.nlm.nih.gov/m/pubmed/23676423/
  • Rong Y, Chen L, Zhu T, Song Y, Yu M, Shan Z, Sands A, Hu FB, Liu L.: Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of prospective cohort. BMJ. 2013 Jan 7;346:e8539. doi: 10.1136/bmj.e8539. http://www.ncbi.nlm.nih.gov/pubmed/23295181

Les også: Egg og diabetes

Vegetriske kosttyper

  • Crowe FL, Appleby PN, Travis RC, Key TJ. Risk of ischaemic heart disease among British vegetarians and non-vegetarians: results from the EPIC-Oxford cohort study. Proceedings of the Nutrition Society. 2012.
  • Crowe FL, Appleby PN, Travis RC, Key TJ. Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the EPIC-Oxford cohort study. Am J Clin Nutr. 2013 Mar;97(3):597-603. doi: 10.3945/ajcn.112.044073. Epub 2013 Jan 30. PubMed PMID: 23364007.

RESULTS:After an average follow-up of 11.6 y, there were 1235 IHD cases (1066 hospital admissions and 169 deaths). Compared with nonvegetarians, vegetarians had a lower mean BMI [in kg/m(2); -1.2 (95% CI: -1.3, -1.1)], non-HDL-cholesterol concentration [-0.45 (95% CI: -0.60, -0.30) mmol/L], and systolic blood pressure [-3.3 (95% CI: -5.9, -0.7) mm Hg]. Vegetarians had a 32% lower risk (HR: 0.68; 95% CI: 0.58, 0.81) of IHD than did nonvegetarians, which was only slightly attenuated after adjustment for BMI and did not differ materially by sex, age, BMI, smoking, or the presence of IHD risk factors.
CONCLUSION:Consuming a vegetarian diet was associated with lower IHD risk, a finding that is probably mediated by differences in non-HDL cholesterol, and systolic blood pressure.

  • Pettersen BJ, Anousheh R, Fan J, Jaceldo-Siegl K, Fraser GE. Vegetarian diets and blood pressure among white subjects: results from the Adventist Health Study-2 (AHS-2). Public Health Nutrition. 2012. p. 1909–16.
  • Michael J. Orlich, MD; Pramil N Singh, DrPH; Joan Sabaté, MD, DrPH; Karen Jaceldo-Siegl, DrPH; Jing Fan, MS; Synnove Knutsen, MD, PhD; W. Lawrence Beeson; Gary E. Fraser, MBchB, PhD: Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2. JAMA Intern Med. 2013;173(13):1230-1238.doi:10.1001/jamainternmed.2013.6473.
  • S. Tonstad, K. Stewart, K. Oda, M. Batech, R.P. Herring, G.E. Fraser: Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutrition, Metabolism & Cardiovascular Diseases. Volume 23, Issue 4 , Pages 292-299, April 2013 http://www.sciencedirect.com/science/article/pii/S0939475311001700
  • «Conclusion.Vegetarian diets (vegan, lacto ovo, semi-) were associated with a substantial and independent reduction in diabetes incidence. In Blacks the dimension of the protection associated with vegetarian diets was as great as the excess risk associated with Black ethnicity.»
    • Michael J. Orlich, MD; Pramil N Singh, DrPH; Joan Sabaté, MD, DrPH; Karen Jaceldo-Siegl, DrPH; Jing Fan, MS; Synnove Knutsen, MD, PhD; W. Lawrence Beeson, DrPH; Gary E. Fraser, MBchB, PhD: Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2. JAMA Intern Med. 2013;173(13):1230-1238. doi:10.1001/jamainternmed.2013.6473.
    • Yessenia Tantamango-Bartley, Karen Jaceldo-Siegl,Jing Fan, Gary Fraser: Vegetarian Diets and the Incidence of Cancer in a Low-risk Population. Cancer Epidemiol Biomarkers Prev; 22(2); 286–94. ©2012 AACR http://cebp.aacrjournals.org/content/22/2/286.abstract
    • Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutrition, Metabolism and Cardiovascular Diseases. 2011.
    • Trapp CB, Barnard ND. Usefulness of vegetarian and vegan diets for treating type 2 diabetes. Curr Diab Rep. 2010;10:152–8.
    • Kahleova H, Matoulek M, Malinska H, Oliyarnik O, Kazdova L, Neskudla T, et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes. Diabet Med. 2011;28:549–59.
    • Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 2009;32:791–6.
    • Barnard ND, Cohen J, Jenkins DJ, Turner-McGrievy G, Gloede L, Green A, Ferdowsian H: A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr 2009, 89(5):1588S-1596S;
    • Craig WJ, Mangels AR: Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc 2009, 109(7):1266-1282;
    • Fraser GE: Vegetarian diets: what do we know of their effects on common chronic diseases? Am J Clin Nutr 2009, 89(5):1607S-1612S;
    • Appleby PN, Davey GK, Key TJ: Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC-Oxford. Public Health Nutr 2002, 5(5):645-654; http://andevidencelibrary.com/worksheet.cfm?worksheet_id=253254&auth=1
    • Dean Ornish, MD; Larry W. Scherwitz, PhD; James H. Billings, PhD, MPH; K. Lance Gould, MD; Terri A. Merritt, MS; Stephen Sparler, MA; William T. Armstrong, MD; Thomas A. Ports, MD; Richard L. Kirkeeide, PhD; Charissa Hogeboom, PhD; Richard J. Brand, PhD: Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. JAMA. 1998;280(23):2001-2007. doi:10.1001/jama.280.23.2001. http://jama.jamanetwork.com/article.aspx?articleid=188274
    «Conclusions.— More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.»
    • Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould KL: Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990, 336(8708):129-133; http://www.ncbi.nlm.nih.gov/pubmed/1973470

    Bør vegetarianere spise fisk for bedre helse?

    • Mangat I. Do vegetarians have to eat fish for optimal cardiovascular protection? Am J Clin Nutr. 2009 May;89(5):1597S-1601S. doi: 10.3945/ajcn.2009.26736I. Epub 2009 Mar 25.

    Les også: Animalske matvarer og ulemper