Probing effects of food, drinks on cardiovascular disease

• NHF, FG, other stakeholders charge Nigerians to make healthy food choices
• Nordic diet lowers risk of cardiovascular disease, type 2 diabetes, death

Medical experts have emphasised the need for Nigerians to make healthy food choices and also promote awareness of the rising number of people suffering from cardiovascular diseases.

Healthy diets

A risk factor is defined as any attribute, characteristic or exposure of an individual, which increases the likelihood of developing a disease. Recognised risk factors for the development of cardiovascular disease include advancing age, hypertension, diabetes mellitus, raised serum lipids, use of tobacco products, obesity and physical inactivity.

Minister of State for Health, Dr. Olorunimbe Mamora, in his remarks, said the nation needs integrative collaborations from all stakeholders to deliver quality, accessible and affordable health services to Nigerians given the recent national experience with COVID 19 pandemic from 2019-2022 with high negative impacts on patients with cardiovascular diseases.

Olorunimbe, who was represented by Prof. Wasiu Adeyemo, the Chairman, Medical Advisory Committee (CMAC), Lagos University Teaching Hospital (LUTH), said that the National Summit is being organised in furtherance of the recent World Health Assembly, which endorsed the Non-Communicable Diseases Action Plan 2020-2030 and recommended promotion of healthy diets by Member states, international partners and Non Governmental Organisations (NGOs).

The minister said “cardiovascular diseases could be controlled to a large extent if we all make healthy food choices. Many of these non-communicable diseases (NCDs) are related to what we eat and what we drink. We should always endeavor to have control of what we eat.”

He further said that the Nigerian Police and Strategic Plan of Action on NCDs, a Federal Ministry of Health document, when finalised would look at different ways to manage NCDs.

He also said that NCDs is the rising cause of morbidity and mortality in the country.

Mamora called for actionable plans to further advance sustainable health interventions, especially in the area of cardiovascular health through the media, research, manufacturing industries and consumer interactions.

The minister commended NHF for taking the initiative by bringing all stakeholders in the field of food, drinks, manufacturing and consumer advocacy together to deliberate on the topical issue and to critically look at how the health of Nigerians can be improved by making the right choices of what “we eat and drink backed by scientific evidence through in-depth research and appropriate interventions.”

NHF who recently organised a national summit on food, drinks and cardiovascular health in Nigeria brought together different stakeholders focusing on science, evidence, manufacturer and consumer advocacy in recognition of the rising prevalence of cardiovascular disease in Nigeria and the importance of prevention strategies through the promotion of healthy diets.

Executive Director of NHF, Dr. Kingsley K. Akinroye, said the objectives of the summit was to promote awareness on the rising prevalence of cardiovascular diseases in Nigeria, to review the current data on national and global trends of the impact of food and drinks on cardiovascular health, ascertain the roles of the different stakeholders/sectors and promote collaboration, identify intervention measures (best buys) which can be instituted in Nigeria, and also to proffer solutions to curb the scourge of the adverse effect on the cardiovascular health of Nigerians.

Akinroye said: “This will be an advocacy tool to advise all stakeholders and all policymakers at the three-tier of government on the accepted best practice to curb the increasing health and socioeconomic burden caused by dietary choices, which lead to non-communicable diseases of which cardiovascular disease is significant.”

The chairman, NHF, Executive Council, Dr. Olufemi Mobolaji- Lawal, advised Nigerians to be very conscious of what they eat and reduce intake of sugar, salts and foods high in cholesterol.

A public health physician and President, National Postgraduate Medical College, Ijanikin, Lagos, Prof. Akin Osibogun, in a paper titled “Dietary Sugar and Risk of Cardiovascular Health: An Update” said the cardiovascular disease was previously not a major disease worldwide but have now risen to be a major cause of morbidity and mortality.

Osibogun, who is the immediate former Chief Medical Director of Lagos University Teaching Hospital (LUTH) Idi-Araba, and Chairman, Lagos State Primary Health Care Board, said increasing prevalence rates of CVD have also been observed in many developing countries and it has been projected worldwide, that CVD would rise from the second most common cause of death in 1990, to the first and account for 36 per cent of all deaths in 2020. He said at the beginning of the 20-century, CVD accounted for less than 10 per cent of all deaths worldwide. By the beginning of the 21st century, it accounted for nearly half of all deaths in the developed world and 25 per cent in the developing world; by 2020, it will claim 25 million deaths each year and will surpass infectious diseases as the world’s leading cause of death and disability.

Osibogun and his team of researchers in a study titled “Prevalence of cardiovascular risk factors amongst traders in an urban market in Lagos, Nigeria” and published in The Nigerian Postgraduate Medical Journal said the workplace, which is a neglected area of social life, is the work environment in which adults spend the majority of their waking hours and performing activities.

Both scientists and workers have characterised these activities, as demanding, constraining and highly stressful. The work environment in this study was a marketplace. Traders in Nigeria are a unique set of workers, in that they are mostly self-employed and belong to the informal labour sector.

Osibogun said the implication of this is that unlike formal workers they are not exposed to pre-employment medical screening or periodic medical checks. In addition, they may have no health plan. They may thus be an ideal target for focused preventive measures.

Few researchers in Nigeria have carried out prevalence studies on hypertension and obesity amongst traders. One of these studies found an established risk of obesity amongst urban market women in Nigeria. The prevalence of obesity was thought to be higher amongst sedentary market men and women, with the degree of obesity also found to be associated with the prevalence of hypertension.

Trans Fatty Acids Technical Advisor, Network for Health Equity and Development (NHED), Dr. Jerome Mafeni, in a paper titled “Progress on Lipids and Cardiovascular Health in Nigeria” described CVD as a “time-bomb globally and in Nigeria.”

He said: “Globally, 523 million persons in 2019 had CVD, up from 422milion in 2015, while 18.6 million died from CVD in 2019 up from 8.92million in 2015 and it is the leading cause of disease globally accounting for one-third of all global deaths.”

Mafeni noted that CVD has become a monumental burden on Nigeria’s lean resources; sufferers have to deal with complications including hypertensive heart disease (22 per cent), cardiomyopathies (11.5 per cent), stroke survivals (6.7 per cent), ischaemic (coronary) heart disease (0.7 per cent), congenital heart disease (one per cent) of all births in a year and rheumatic heart disease (2.6 per cent), which are negative products of trans fat and poor eating habits.

He calculated that of all the risk factors of CVD in Nigeria, an unhealthy diet resulting from excessive intake of foods high in TFA is number one (74.8 degrees) followed by physical inactivity (52 degrees) and abnormal lipids (40 degrees).

Meanwhile, researchers investigated the health effects of a healthy Nordic diet (HND) using metabolic analysis. They found that the diet positively affects glucose metabolism, cholesterol, and cardiometabolic risk. They conclude that metabolic analysis is an effective way to assess dietary outcomes.

The HND consists of berries, fish, root vegetables, and rapeseed oil. It is known to benefit various aspects of health, including weight loss, blood pressure, inflammation, and blood lipid profiles.

Studies also show that HND lowers the risk of cardiovascular disease, type 2 diabetes, and death.

Nutritional research often faces challenges due to a lack of objective measures, as studies typically rely on subjective tools, such as food consumption questionnaires. Using biomarkers instead can allow researchers to measure dietary health effects more accurately.

In the present study, researchers from Scandinavia assessed the metabolic effects of HND on glucose metabolism, blood lipid profiles, and inflammatory markers using data from a randomized control trial from 2013.

When examining metabolites in the blood and urine of the participants, they found a link between closer adherence to the diet and more benefit on low-grade inflammation and lipid profiles, as well as indicators of glucose metabolism.

The study was published in the journal Clinical Nutrition.

The 2013 study enrolled 200 participants with overweight and metabolic syndrome. The average age of the participants was 55 years.

After an initial four-week period, during which the participants consumed their typical diets, the researchers randomly assigned them to follow either HND or a control diet, defined as the average nutrient intake across Nordic countries.

The researchers then instructed the participants in the HND group to increase their consumption of whole-grain products, such as rye and barley, alongside berries, fruit, and vegetables.

Those in the control group received instructions to eat low fiber wheat products, including refined white bread and pasta, and not to moderate their consumption of vegetables and fruit.

Both diets contained similar amounts of calories to keep the participants’ weight stable throughout the study. The researchers followed the participants for either 18 or 24 weeks and had them provide blood and urine samples at the beginning and end of the intervention, as well as at week 12.

For the present metabolic profiling study, the researchers analyzed data from 98 participants in the HND group and 71 in the control group.

They found that those who adhered to HND most had different fat-soluble metabolites in their blood than others. The researchers link these metabolites to better glucose regulation, improved cholesterol profile, and reduced cardiometabolic risk.

These findings build upon the initial results from 2013, stating that although HND has a positive effect on lipid profiles and inflammation, it does not affect blood glucose metabolism.

“Participants with higher levels of the metabolites sourced from the Nordic diet had lower triglyceride levels than those with lower levels of the metabolites, even though none of the participants lost weight during the study,” said Dr. Dahm.

“Assuming that greater intake of the Nordic diet leads to higher levels of blood metabolites, this means that a better quality diet can improve some health parameters, even in the absence of weight loss.”

To explain their findings, the researchers say that fish, flaxseed, sunflower, and rapeseed — all staples in HND — contain healthy fats.

“We can only speculate as to why a change in fat composition benefits our health so greatly,“ says Lars Ove Dragsted, one of the study authors. “However, we can confirm that the absence of highly processed food and less saturated fats from animals have a very positive effect on us.”

“The fat composition in the Nordic diet, which is higher in omega-3 and omega-6 unsaturated fats, [probably explains many of] the health effects we find from the Nordic diet, even when the weight of participants remains constant,” he adds.

Christopher Gardner, Ph.D., Rehnborg Farquhar Professor at Stanford University, not involved in the study, told MNT that the findings are not surprising. “The intervention was focused on healthy foods, and specifically listed berries, veggies, fish, whole grains, [low fat] dairy products, and rapeseed oil.”

“I can think of multiple mechanisms for cardiometabolic benefits, regardless of weight loss: less saturated fat, more unsaturated fat, more fiber, and lower sodium. All of these would beneficially impact lipids, glucose, blood pressure, inflammation,” he added.

The authors of the present study conclude that assessing metabolites is an effective way to evaluate the health benefits of different diets.

They say, however, that their findings have some limitations. For example, their analysis may have overlooked some metabolites that other profiling techniques may have found. They also say that their sample size was relatively small.

Gardner added that these results may have been due to a generally healthier diet rather than due to anything particular to HND: “[The results could have arisen from the] Nordic, Mediterranean, vegetarian, DASH, [or] whole food plant-based diet, or half a dozen others. Many of the components of [HND] are similar to these [other diets].”