Plant-based dietary patterns and risk of insomnia: a prospective study.

BACKGROUND: Accumulating evidence suggests that dietary factors may affect sleep, but the associations between dietary patterns and insomnia risk have been poorly explored. The aim of this study was to investigate if plant-based diets are associated with reduced insomnia risks in a cohort study design. METHODS: Tzu Chi Health Study participants (N = 5821) recruited from 2007 to 2009 without insomnia were followed until 2018. A traditional classification method (vegetarians vs. non-vegetarians) and a healthful plant-based index (hPDI) were used to define adherence to plant-based dietary patterns. Incident cases of insomnia were ascertained by linking with the National Health Insurance Research Database (NHIRD). Associations between plant-based diets and insomnia were estimated using Cox proportional hazard models. RESULTS: A total of 464 incident cases of insomnia were identified in the 55,562 person-years of follow up. Insomnia risk was lower in vegetarians when compared to non-vegetarians, hazard ratios (HR) 0.47 (95% CI: 0.27, 0.81) and 0.71 (95% CI: 0.55, 0.91) for males and females respectively. Male participants with the highest hPDI were associated with a significant lower risk of insomnia (HR 0.50 [95% CI: 0.30, 0.85]) when compared to those in the lowest quintile. No association between adherence to hPDI and insomnia in female participants was observed. CONCLUSIONS: Our study showed that vegetarians are associated with a lower risk of insomnia, but there may be sex-specific associations between adherence to hPDI and insomnia risk. These favorable associations are important when considering plant-based diets for their potential additional sleep benefits.

A Dietitian-Led Vegan Program May Improve GlycA, and Other Novel and Traditional Cardiometabolic Risk Factors in Patients With Dyslipidemia: A Pilot Study.

Background: Systematic inflammation and lipid profiles are two major therapeutic targets for cardiovascular diseases. The effect of a nutritionally balanced vegan diet on systematic inflammation and lipoprotein subclass awaits further examination. Objective: To investigate the change in novel and traditional cardiometabolic risk factors before and after a dietitian-led vegan program, and to test the bioavailability of vitamin B12 in Taiwanese purple laver as part of a vegan diet. Design: A one-arm pilot intervention study. Participants/Setting: Nine patients with dyslipidemia participated in this 12-week vegan program. Main Outcome Measures: Nuclear Magnetic Resonance (NMR) detected GlycA signals (systematic inflammation) and lipoprotein subclass (atherogenicity); trimethylamine N-oxide (TMAO); and other cardiometabolic risk factors. Statistical Analyses Performed: Wilcoxon signed-rank test. Results: In this 12-week vegan intervention emphasizing whole foods, systematic inflammation improved as indicated by a reduction in GlycA (median: -23 µmol/L, p = 0.01). LDL-c (low-density lipoprotein cholesterol) (median -24 mg/dl, p = 0.04) and LDL-p (low-density lipoprotein particles) (median -75 nmol/L, p = 0.02) both decreased significantly. VLDL (very-low-density lipoprotein) and chylomicron particles showed a decreasing trend (-23.6 nmol/L, p = 0.05). Without caloric restriction, body mass index (BMI) (-0.7 kg/m2, p = 0.03), waist circumferences (-2.0 cm, p < 0.001), HbA1c (-0.2%, p = 0.02), and (HOMA-IR) homeostatic model assessment for insulin resistance (-0.7, p = 0.04) have all improved. The change in the TMAO and vitamin B12 status as measured by holo-transcobalamin appeared to depend on baseline diets, TMAO, and vitamin B12 status. Conclusions: A dietitian-led vegan program may improve systematic inflammation and other novel and traditional cardiometabolic risk factors in high-risk individuals.

Taiwanese Vegetarians Are Associated with Lower Dementia Risk: A Prospective Cohort Study.

The number of people living with dementia globally is increasing rapidly, and there is no effective therapy. Dietary pattern is one important risk factor for the development and progression of dementia. We undertake this study to determine whether Taiwanese vegetarian diet in midlife affects dementia incidence in later years in a prospective cohort. We followed 5710 participants (average age less than 60) in the Tzu Chi Vegetarian Study (TCVS). We started recruiting in 2005 and followed until the end of 2014 when the database changed from ICD-9-CM to ICD-10-CM codes. The incidence of dementia was obtained through linkage to the National Health Insurance Research Database. We used Cox proportional hazards regression to estimate the hazard ratio of dementia between vegetarians and nonvegetarians. There were 121 cases of dementia (37 vegetarians and 84 nonvegetarians) diagnosed. Vegetarians were associated with reduced risk of clinically overt dementia compared with nonvegetarians (hazard ratio = 0.671, confidence interval: 0.452−0.996, p < 0.05) after adjusting for gender, age, smoking, drinking, education level, marriage, regular exercise, and comorbidities with stepwise regression.

Stroke and diets - A review.

Stroke was one of the most common causes of death and disability worldwide. In addition, there was a significant increase in the disease burden of stroke in the world over the past 25 years, especially in developing countries. We searched PubMed (National Library of Medicine, USA) and Embase (Elsevier) databases using "Stroke and diets" as strategy, and additional references were obtained from the selected articles. The risk factors of stroke include age, sex, and modifiable factors such as hypertension, smoking, diet, physical activity, diabetes mellitus, alcohol consumption, psychological factors, and cardiac causes.-together account for >90% of the population attributable risk for stroke. They were discussed individually (Hypertension, Diabetes, Dyslipidemia, Gut microbiota, Nutrition), and the dietary modifications to reduce these risks were also presented. In conclusion, besides low salt intake, plant-based dietary patterns (especially vegetarian diets) that are rich in fruit, vegetables, whole grains, legumes, seeds, nuts, and dairy and low in meat, sweets, and alcohol significantly improved risk factors for stroke, and observational studies clearly demonstrated the stroke morbidity and mortality benefits. Thus, dietary intervention should be considered as an important strategy in the prevention and management of stroke.

Vegetarian Diet Is Associated with Lower Risk of Depression in Taiwan.

In order to determine whether Taiwanese vegetarian diets reduce the risks of depression, we analyzed data from the Tzu Chi Vegetarian Study (TCVS), which is a prospective cohort study following 12,062 participants from the Buddhist Tzu Chi Foundation of Taiwan since 2005. The cohort was prospectively followed by linking to the National Health Institute Research Database (NHIRD) of Taiwan and hazard ratios of depression between vegetarian and non-vegetarian groups were calculated by Cox proportional hazards regression. We assessed dietary intake using a detailed food frequency questionnaire (FFQ). Incident depression was ascertained through linkage to NHIRD which had claim records with the International Classification of Diseases, and a total of 3571 vegetarians and 7006 non-vegetarians were included in this analysis. Compared with non-vegetarians, the vegetarian group had a lower incidence of depressive disorders (2.37 vs. 3.21 per 10,000 person-years; adjusted hazard ratio (aHR): 0.70; 95% confidence interval (95% CI): 0.52-0.93). Thus, Taiwanese vegetarians had a lower risk of developing subsequent depressive disorders compared with non-vegetarians. This indicated that diet may be an important measure for the prevention of depression. However, to generalize to the global population requires further study.

A Vegetarian Diet Is Associated with a Lower Risk of Cataract, Particularly Among Individuals with Overweight: A Prospective Study.

BACKGROUND: Cataracts are caused by oxidative stress in the lens of the eyes and plant-based dietary patterns can contain a wide variety of protective antioxidants. However, strict vegetarians with inadequate vitamin B-12 intakes can have elevated homocysteine levels, which could increase the risk of cortical cataracts. Whether the benefits of a vegetarian diet outweigh its risks in the development of cataracts warrants investigation. OBJECTIVE: Our aim was to study the prospective association between a Taiwanese vegetarian dietary pattern and cataract risk. DESIGN: This was a prospective cohort study. PARTICIPANTS/SETTING: The Tzu Chi Health Study recruited 6,002 participants from 2007 to 2009 at Dalin Tzu Chi Hospital. Diet was assessed through a validated food frequency questionnaire. Participants 40 years and older and without cataracts at recruitment (3,095 nonvegetarians and 1,341 vegetarians) were followed until the end of 2014, death, or occurrence of cataracts. MAIN OUTCOME MEASURES: Cataract incident cases ((International Classification of Diseases, 9th Revision, Clinical Modification code 366) were identified by linkage to the National Health Insurance Research Database in Taiwan. STATISTICAL ANALYSIS: Cox proportional hazard regression with age as the underlying scale was used to estimate the association between dietary patterns and cataract risk while adjusting for potential confounders. RESULTS: Compared with nonvegetarians, vegetarians had higher intakes of soy, vegetables, nuts, whole grains, dietary fiber, vitamin C, folate, and vitamin A equivalent. In the 25,103 person-years of follow-up, 476 incident cases of cataracts were identified. A vegetarian diet was associated with a 20% reduced risk of cataracts (hazard ratio 0.80, 95% CI 0.65 to 0.99; P = 0.04) after adjusting for sex, education, smoking, alcohol drinking habits, physical activities, Tzu Chi volunteer status, hypertension, diabetes, hyperlipidemia, corticosteroid prescription, and body mass index (calculated as kg/m2). This association was more pronounced among individuals with overweight (defined as body mass index ≥24 in Taiwan [hazard ratio 0.70, 95% CI 0.50 to 0.99; P = 0.04]). CONCLUSIONS: A vegetarian diet was associated with a lower risk of cataracts, particularly in study participants with overweight.

Negative Affectivity Is Associated with a Higher Systolic and Diastolic Blood Pressure in Normotensive Middle-Aged and Older Adults: A Cross-Sectional Study.

BACKGROUND AND OBJECTIVES: Type D personality, characterized by two stable traits (social inhibition and negative affectivity), is associated with adverse cardiovascular events. A possible mediating factor for this association could be hypertension. Previous research has shown that individuals with Type D personality were associated with an increased risk of hypertension. However, the association of negative affectivity and social inhibition on blood pressure in normotensive individuals has not yet been reported. Therefore, the aim of this study was to investigate whether negative affectivity and social inhibition were associated with systolic and diastolic blood pressure in normotensive middle-aged and older Taiwanese adults. MATERIALS AND METHODS: A cross-sectional study design was used. Individuals attending general health examination at a regional hospital in southern Taiwan who were 40 to 75 years old were recruited. Patients with self-reported hypertension or currently receiving antihypertensive medication were excluded. Negative affectivity and social inhibition were assessed with the 14-item Type D Scale-Taiwanese version. Multiple linear regression analyses were conducted to determine the association of Z-score transformed negative affectivity and social inhibition on blood pressure. RESULTS: A total of 92 patients with a mean age of 51.5 years were included in the study, and 15 (16.3%) were defined as having a Type D personality. The Z-score transformed negative affectivity score (p = 0.035, effect size = 0.18) and Z-score transformed social inhibition score (p = 0.054, effect size = 0.17) were significantly associated with a higher systolic blood pressure. In addition, the Z-score transformed negative affectivity score (p = 0.036, effect size = 0.28) and Z-score transformed social inhibition score (p = 0.154, effect size = 0.24) were significantly associated with a higher diastolic blood pressure. CONCLUSIONS: Negative affectivity of the Type D personality was significantly associated with higher systolic and diastolic blood pressure, with a medium effect size, in apparently healthy middle-aged and older adults. Assessment of negative affectivity may be clinically useful in identifying individuals at risk of hypertension.

The risk of urinary tract infection in vegetarians and non-vegetarians: a prospective study.

Urinary tract infection (UTI) is caused principally by ascending Escherichia coli infection via an intestine-stool-urethra route. Recent studies found that the strains of E. coli causing UTIs, called extra-intestinal pathogenic E. coli (ExPEC), were distinct from the intestinal pathogenic strains and normal commensal strains. Further analysis found the meat including poultry and pork is the major reservoir for ExPECs. Vegetarians avoid meat and should theoretically have less exposure to ExPEC. However, no study thus far has examined whether vegetarian diets reduce the risk of UTI. Our aim was to examine the association between vegetarian diet and UTI risk in a Taiwanese Buddhist population. We prospectively followed 9724 Buddhists free of UTI from 2005 to 2014. During the 10-year follow-up, 661 incident UTI cases were confirmed. Diet was assessed through a food frequency questionnaire. Cox regression was used to evaluate the prospective association between a vegetarian diet on risk of UTI while adjusting for age, sex, educational level, alcohol-drinking, smoking, hypertension, diabetes mellitus, hyperlipidemia, and disease conditions predisposing to UTIs. Overall, vegetarian diet was associated with 16% lower hazards (hazard ratio [HR]: 0.84, 95% confidence interval [CI]: 0.71-0.99). In subgroup analysis, the protective association between vegetarian diet and UTI is observed mainly in the female (HR: 0.82, 95% CI: 0.69-0.99), never smokers (HR: 0.80, 95% CI: 0.67-0.95), and for uncomplicated UTI (HR: 0.81, 95% CI: 0.68-0.98).

Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan.

OBJECTIVE: To determine how a vegetarian diet affects stroke incidence in 2 prospective cohorts and to explore whether the association is modified by dietary vitamin B12 intake. METHODS: Participants without stroke in the Tzu Chi Health Study (cohort 1, n = 5,050, recruited in 2007-2009) and the Tzu Chi Vegetarian Study (cohort 2, n = 8,302, recruited in 2005) were followed until the end of 2014. Diet was assessed through food frequency questionnaires in both cohorts at baseline. Stroke events and baseline comorbidities were identified through the National Health Insurance Research Database. A subgroup of 1,528 participants in cohort 1 were assessed for serum homocysteine, vitamin B12, and folate. Associations between vegetarian diet and stroke incidences were estimated by Cox regression with age as time scale, adjusted for sex, education, smoking, alcohol, physical activities, body mass index (only in cohort 1), hypertension, diabetes, dyslipidemia, and ischemic heart diseases. RESULTS: Vegetarians had lower serum vitamin B12 and higher folate and homocysteine than nonvegetarians. In cohort 1, 54 events occurred in 30,797 person-years follow-up. Vegetarians (vs nonvegetarians) experienced lower risk of ischemic stroke (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.08-0.88). In cohort 2, 121 events occurred in 76,797 person-years follow-up. Vegetarians (vs nonvegetarians) experienced lower risk of overall stroke (HR, 0.52; 95% CI, 0.33-0.82), ischemic stroke (HR, 0.41; 95% CI, 0.19-0.88), and hemorrhagic stroke (HR, 034; 95% CI, 0.12-1.00). Our explorative analysis showed that vitamin B12 intake may modify the association between vegetarian diet and overall stroke (p interaction = 0.046). CONCLUSION: Taiwanese vegetarian diet is associated with a lower risk of ischemic and hemorrhagic strokes.

Vegetarian diet and risk of gout in two separate prospective cohort studies.

BACKGROUNDS & AIMS: Plant-based diets may target multiple pathways in gout pathogenesis (uric acid reduction and anti-inflammation) while improving gout associated cardiometabolic comorbidities. We aim to prospectively examine the relationship between a vegetarian diet and gout, and to explore if this relationship is independent of hyperuricemia. METHODS: We followed 4903 participants in the Tzu Chi Health Study (Cohort1, recruited in 2007-2009) and 9032 participants in the Tzu Chi Vegetarian Study (Cohort2, recruited in 2005) until end of 2014. Baseline serum uric acid was measured in Cohort1. Vegetarian status was assessed through a diet questionnaire that includes dietary habits and a food frequency questionnaire. Incidence of gout was ascertained by linkage to the National Health Insurance Database. Hazard Ratio of gout in vegetarians versus nonvegetarians was assessed by Cox regression, adjusted for age, sex, lifestyle and metabolic risk factors. Hyperuricemia was additionally adjusted in Cohort1. RESULTS: In Cohort1, lacto-ovo vegetarians had the lowest uric acid concentration, followed by vegans, then nonvegetarians (men: 6.05, 6.19, 6.32 mg/dL, respectively; women: 4.92, 4.96, 5.11 mg/dL, respectively); 65 gout cases occurred in the 29,673 person-years of follow-up; vegetarians experienced a lower risk of gout (without adjustment for hyperuricemia: HR: 0.33; 95% CI: 0.14, 0.79; with adjustment for hyperuricemia: HR: 0.40; 95% CI: 0.17, 0.97). In Cohort2, 161 gout cases occurred in the 83,019 person-years follow-up, and vegetarians also experienced a lower risk of gout (HR: 0.61; 95% CI: 0.41, 0.88). CONCLUSION: Taiwanese vegetarian diet is associated with lower risk of gout. This protective association may be independent of baseline hyperuricemia. STUDY REGISTERED: URL: https://www.clinicaltrials.gov. Unique Identifier: NCT03470584.

Vegetarian Diets and Medical Expenditure in Taiwan-A Matched Cohort Study.

Vegetarian diets and lifestyle have been shown to reduce the risk of many chronic non-communicable diseases, which now accounts for the major global burden of diseases. We aimed to determine the contribution of vegetarian diets and lifestyle to the actual direct medical cost in a population-based study. Through linkage to the National Health Insurance Research Database of Taiwan, we compared the health care utilization and medical expenditure of 2166 vegetarians and 4332 age-sex-matched omnivores recruited from the Buddhist Tzu Chi Foundation. Diet and lifestyle questionnaires were self-administered and prospectively collected. We used the general linear model to estimate the 5-year average medical expenditure in vegetarians versus omnivores while adjusting for age, sex, education, exercise habits, smoking, and alcohol drinking. Medical expenses related to non-diet associated lifestyle factors (smoking, alcohol drinking, active community volunteering, and religious emotional support) were estimated through a comparison with the published population medical cost data standardized to match the age and sex characteristics of the cohort. Tzu Chi vegetarians had significantly lower outpatient visits. This translated into 13% lower outpatient (p = 0.007) and 15% lower total medical expenditures (p = 0.008) when compared with the Tzu Chi omnivores, who had an additional 10% lower medical expenditure when compared with the general population. No difference in dental visits and expenses were found between diet groups. Vegetarian diets are associated with significantly lower medical care expenditure and could be an effective strategy to alleviate the medical-economic burden in selected populations.

Exploring the Impact of a Telehealth Care System on Organizational Capabilities and Organizational Performance from a Resource-Based Perspective.

This study explored the effects of information technology (IT) resources-in conjunction with IT infrastructure and organizational resources-on organizational capabilities and performance. The study further analyzed the mediating effect of organizational capabilities on the relationship between IT resources and organizational performance. A cross-sectional research design was adopted, and questionnaire copies were administered to senior care supervisors of Taiwanese day care centers, care institutions, and hospitals. In total, 328 valid questionnaire responses were obtained. The study results are summarized as follows: (1) A direct effect analysis revealed that IT infrastructure significantly affected service performance and financial performance; organizational resources significantly affected service performance but did not significantly affect financial performance. (2) A mediation model analysis indicated that organizational capabilities exerted a mediating effect on the relationship between IT resources and organizational performance. These results can serve as a reference for medical care organizations in developing strategies for reviewing internal IT resources, integrating internal and external capabilities, creating a competitive advantage, and boosting their performance.

Negative affectivity and social inhibition are associated with increased cardiac readmission in patients with heart failure: A preliminary observation study.

BACKGROUND: Type D personality was hypothesized to influence clinical and patient-centered outcomes patients with heart failure. The aim of this study was to investigate the association between negative affectivity and social inhibition components of Type D personality and cardiac readmission in patients with heart failure. METHODS: A prospective observational study design was used. A total of 222 patients with heart failure were recruited from the department of cardiology in two regional hospitals in Taiwan. The 14-item Type D Scale-Taiwanese version was used to assess negative affectivity and social inhibition of the patients. Logistic regression analyses were conducted to determine the association of both Z-score transformed and dichotomized negative affectivity and social inhibition with 6-month and 18-month cardiac readmissions. RESULTS: A total of 55 patients (24.8%) and 89 patients (40.1%) had cardiac readmissions within 6 months and 18 months, respectively. Multiple logistic regression analyses of Z-score transformed negative affectivity and social inhibition were significantly associated with (1) 6-month cardiac readmission with odds ratios of 1.62 (P = 0.003) and 1.48 (P = 0.014), respectively and (2) 18-month cardiac readmission with odds ratios of 1.45 (P = 0.013) and 1.38 (P = 0.031), respectively. Similar findings were obtained when negative affectivity and social inhibition were analyzed as dichotomized scores. CONCLUSIONS: Negative affectivity and social inhibition components of the Type D personality were significantly associated with a higher risk of cardiac readmission in both 6 months and 18 months after the initial hospitalization in patients with heart failure.

Plant-Based Diet, Cholesterol, and Risk of Gallstone Disease: A Prospective Study.

Vegetarian diets may lower symptomatic gallstone disease via cholesterol lowering. This study aimed to examine the risk of symptomatic gallstone disease (GSD) in Taiwanese vegetarians vs. nonvegetarians in a prospective cohort and to explore if this association is related to cholesterol concentration. We prospectively followed 4839 participants, and in the 29,295 person-years of follow-up, 104 new incident GSD cases were confirmed. Diet was assessed through a validated food frequency questionnaire. Symptomatic GSD was ascertained through linkage to the Taiwan National Health Insurance Research Database. Blood cholesterol profiles were measured at recruitment. Cox regression was applied to assess the effect of diet on symptomatic GSD, adjusting for age, education, smoking, alcohol, physical activities, diabetes, kidney diseases, body mass index, lipid-lowering medication, and hypercholesterolemia. Vegetarian diet was associated with a decreased risk of symptomatic GSD compared with nonvegetarian diet in women (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.28⁻0.96) but not in men. In women, nonvegetarians with hypercholesterolemia had 3.8 times the risk of GSD compared with vegetarians with normal cholesterol (HR, 3.81, 95% CI, 1.61⁻9.01). A vegetarian diet may therefore protect against GSD independent of baseline hypercholesterolemia. A nonvegetarian diet and hypercholesterolemia may have an additive effect in increasing GSD risk in women.

Identification of TMAO-producer phenotype and host-diet-gut dysbiosis by carnitine challenge test in human and germ-free mice.

OBJECTIVE: The gut microbiota-derived metabolite, trimethylamine N-oxide (TMAO) plays an important role in cardiovascular disease (CVD). The fasting plasma TMAO was shown as a prognostic indicator of CVD incident in patients and raised the interest of intervention targeting gut microbiota. Here we develop a clinically applicable method called oral carnitine challenge test (OCCT) for TMAO-related therapeutic drug efforts assessment and personalising dietary guidance. DESIGN: A pharmacokinetic study was performed to verify the design of OCCT protocol. The OCCT was conducted in 23 vegetarians and 34 omnivores to validate gut microbiota TMAO production capacity. The OCCT survey was integrated with gut microbiome, host genotypes, dietary records and serum biochemistry. A humanised gnotobiotic mice study was performed for translational validation. RESULTS: The OCCT showed better efficacy than fasting plasma TMAO to identify TMAO producer phenotype. The omnivores exhibited a 10-fold higher OR to be high TMAO producer than vegetarians. The TMAO-associated taxa found by OCCT in this study were consistent with previous animal studies. The TMAO producer phenotypes were also reproduced in humanised gnotobiotic mice model. Besides, we found the faecal CntA gene was not associated with TMAO production; therefore, other key relevant microbial genes might be involved. Finally, we demonstrated the urine TMAO exhibited a strong positive correlation with plasma TMAO (r=0.92, p<0.0001) and improved the feasibility of OCCT. CONCLUSION: The OCCT can be used to identify TMAO-producer phenotype of gut microbiota and may serve as a personal guidance in CVD prevention and treatment. TRIAL REGISTRATION NUMBER: NCT02838732; Results.

Blood Pressure Reactivity and Recovery to Anger Recall in Hypertensive Patients with Type D Personality.

BACKGROUND: Type D, otherwise known as distressed personality type, has been associated with an increased risk of cardiovascular morbidity and mortality. Blood pressure reactivity and recovery to stress could be a possible underlying pathway linking type D personality and cardiovascular events. METHODS: A total of 41 patients with hypertension were recruited from a regional hospital in southern Taiwan. Demographic and clinical characteristics were obtained from all participants. Type D personality was assessed using the 14-item Type D Scale-Taiwanese version. Systolic blood pressure, diastolic blood pressure, and heart rate were measured at the end of baseline, anger recall, verbal, and recovery phases of an anger recall task. Analysis of covariance was used to examine differences in blood pressure and heart rate at the anger recall, verbal, and recovery phase between patients with or without type D personality. RESULTS: After adjusting for baseline measurements, sex, and age, systolic blood pressure (p = 0.002) and diastolic blood pressure (p = 0.011) at the recovery phase were significantly higher in the patients with type D personality. No significant differences in blood pressure or heart rate were observed in the anger recall or verbal phase between the two groups of patients. CONCLUSIONS: The findings of this study support the notion that prolonged blood pressure recovery rather than high reactivity could be an underlying pathway linking type D personality and the risk of future cardiovascular events among patients with hypertension.

Impact of vegan diets on gut microbiota: An update on the clinical implications.

Numerous studies indicate that microbiota plays an important role in human health. Diet is a factor related to microbiota which also influences human health. The relationships between diet, microbiota, and human health are complex. This review focuses on the current literature on vegan diets and their unique impact on gut microbiota. We also report on the health benefits of a vegan diet for metabolic syndrome, cardiovascular disease, and rheumatoid arthritis concerning relevant impacts from gut microbiota. Despite evidence supporting the clinical relevance of vegan gut microbiota to human health, the whole mechanism awaits further investigation.

Vegetarian diet, food substitution, and nonalcoholic fatty liver.

OBJECTIVES: Vegetarian diets have been shown to improve insulin resistance and reduce body weight, but the effects on nonalcoholic fatty liver require further confirmation. We aim to investigate the association between vegetarian diets, major food groups, and nonalcoholic fatty liver, and to compare the degree of liver fibrosis between vegetarians and nonvegetarians in those with fatty liver. MATERIALS AND METHODS: We analyzed cross-sectional data from the Tzu Chi Health Study which included 2127 nonvegetarians and 1273 vegetarians who did not smoke or habitually drink alcohol and had no hepatitis B or hepatitis C. Fatty liver and liver fibrosis were determined using ultrasonography and the nonalcoholic fatty liver disease fibrosis score, respectively. Diet was assessed through a validated food frequency questionnaire. RESULTS: Vegetarian diets were associated with lower odds of fatty liver (odds ratio = 0.79, 95% confidence interval: 0.68-0.91) after adjusting for age, gender, education, history of smoking and alcohol drinking. Adjustment for body mass index (BMI) attenuated the protective association. Vegetarians had less severe fibrosis than nonvegetarians. Replacing a serving of soy with a serving of meat or fish was associated with 12%-13% increased risk, and replacing a serving of whole grains with a serving of refined grains, fruits, and fruit juice was associated with 3%-12% increased the risk of fatty liver. CONCLUSION: Vegetarian diets, replacing meat and fish with soy, and replacing refined carbohydrates with whole grains, may be inversely associated with nonalcoholic fatty liver related to BMI.

Vegetarian diet, change in dietary patterns, and diabetes risk: a prospective study.

BACKGROUND/OBJECTIVES: Vegetarian diets are inversely associated with diabetes in Westerners but their impact on Asians-whose pathophysiology differ from Westerners-is unknown. We aim to investigate the association between a vegetarian diet, change in dietary patterns and diabetes risk in a Taiwanese Buddhist population. METHODS: We prospectively followed 2918 non-smoking, non-alcohol drinking Buddhists free of diabetes, cancer, and cardiovascular diseases at baseline, for a median of 5 years, with 183 incident diabetes cases confirmed. Diet was assessed through a validated food frequency questionnaire at baseline and a simple questionnaire during follow-ups. Incident cases of diabetes were ascertained through follow-up questionnaires, fasting glucose and HbA1C. Stratified Cox Proportional Hazards Regression was used to assess the effect of diets on risk of diabetes. RESULTS: Consistent vegetarian diet was associated with 35% lower hazards (HR: 0.65, 95% CI: 0.46, 0.92), while converting from a nonvegetarian to a vegetarian pattern was associated with 53% lower hazards (HR: 0.47, 95% CI: 0.30, 0.71) for diabetes, comparing with nonvegetarians while adjusting for age, gender, education, physical activity, family history of diabetes, follow-up methods, use of lipid-lowering medications, and baseline BMI. CONCLUSION: Vegetarian diet and converting to vegetarian diet may protect against diabetes independent of BMI among Taiwanese.