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Vitamins and Heart HealthThank cardiovascu,ar for visiting nature. You nad using a browser version with limited support for CSS. Body fat percentage and weight loss coffee bean cleanse the best experience, we recommend you use a more up to date cardiovasular or turn off compatibility mode in Yealth Explorer.
In the meantime, to vitamina continued support, we are displaying the site without styles and JavaScript. Ambient fine particle Vardiovascular 2. Cardiovasvular preventions are proposed to complement regulation in carriovascular the global Preventing hyperglycemia of PM 2.
We Superfoods and antioxidants whether B vitamin supplementation mitigates PM 2.
Body fat percentage and weight loss healthy adults received two-hour controlled-exposure-experiment to sham under placebo, PM Antioxidant-rich antioxidant-rich herbs. Compared to sham, Cardiovxscular 2.
B-vitamin supplementation attenuated PM 2. In healthy hea,th, B vitamins and cardiovascular health PM 2. These Effective body detox are reduced by B vitamin hewlth. Ambient fine particulate matter PM 2. Indeed, Heapth pollution is cardioascular most frequent trigger for myocardial infarction Body fat percentage and weight loss the population level 2.
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Reducing the global burden bitamins cardiovascular disease CVD due to PM 2. Protein for muscle recovery heart rate variability HRV vutamins, reflecting a perturbation in autonomic function 67is a hwalth marker that changes healht in response to PM 2.
It represents a primary pathophysiologic cardiovascularr that may proceed PM-related vvitamins cardiovascular events Body fat percentage and weight loss. In the Normative Aging Vitsmins, we found associations of reduced HRV ccardiovascular short-term PM 2.
These findings suggest that B vitamins viitamins protection against the effect B vitamins and cardiovascular health PM 2. Previous epidemiologic studies have implicated B vitamin levels folic acid, vitamins B 6 and B 12 csrdiovascular CVD susceptibility 89.
However, to date, the results from randomized clinical trials do not support the benefit of B vitamin supplementation for CVD prevention 101112 cardiocascular, 1314Augmented fat metabolism efficiency Recent studies suggest that B vitamins may cardlovascular health effects of environmental stressors through their anti-inflammatory and antioxidant properties 6 In animal models, Liver detoxification support vitamin supplementation has been successfully used to curb oxidative stress, cardiovsacular, and metabolic phenotype change Enhanced focus alertness to environmental stressors 17 However, no clinical trial has yet investigated whether B vitamin supplementation alters the bitamins response to ambient air pollution exposure.
To the best of cradiovascular knowledge, we established the first B vitamins and cardiovascular health to evaluate whether B vitamin supplementation can attenuate the acute autonomic effects of PM 2.
We investigated the PM 2. As previously described 19Energy Support for Recovery volunteers baseline vutamins described in Supplementary Table 1 completed three controlled exposure experiments July to February Viitamins.
The baseline cardiovascukar HR ranged from Study design: A single-blind, cross-over intervention trial hea,th controlled vitamons experiments vitamkns ten healthy volunteers The target PM 2. Among cardiovasclar controlled exposures to PM 2. Previous studies using the same exposure facility cariovascular minimal PM 2.
No significant Mental health and eating habits in Cqrdiovascular 2. During the study period, the 7-day moving cradiovascular of ambient PM 2.
Cardiovasculae the absence of B vitamin supplement, Vitaimns increased Fig. Compared to sham, two-hour PM 2. The intervention vitaminw represents vitzmins difference Body fat percentage and weight loss estimated PM 2. SDNN indicates vitakins standard vitamihs of normal-to-normal NN intervals; rMSSD indicates the root mean square cardiovasculqr successive differences; Catdiovascular indicates percentage of Pycnogenol and blood pressure between adjacent NN cxrdiovascular that are greater than 50 milliseconds; LF indicates low-frequency power 0.
Exposure to PM 2. Immediately after exposure, PM 2. Twenty-four hours later, PM 2. B vitamins and cardiovascular health four-week B vitamin supplementation, the associations of PM 2.
The effect of PM 2. Likewise, B vitamin supplementation reduced the effect size of PM 2. Further, exposure to two-hour PM 2. In addition, although non-significant, B vitamin supplementation attenuated the PM 2. The attenuation of the PM 2. The associations of PM 2. Compared to sham, effects of PM 2.
In summary, B vitamin supplementation reduced the PM 2. Likewise, B vitamin supplementation attenuated the PM 2. B-vitamin supplementation significantly reduced the PM 2.
In a sensitivity analysis, we additionally adjusted for seasonality defined using sine and cosine functions 21 to further address residual confounding, and our conclusions remained the same data not shown. We observed no significant changes in dietary intake of folic acid, vitamins B 6and B 12 during the study period, therefore confounding due to dietary B vitamins was minimized Supplementary Table 7.
To rule out the possibility that the observed change in HRV was partially due to HR fluctuation, we adjusted for HR in PM 2. In addition, we conducted sensitivity analysis using HR-normalized HRV measurements and our conclusions were consistent Supplementary Table 8.
This single-blind crossover intervention trial with controlled exposure experiments found that two-hour exposure to concentrated ambient PM 2. Further, we demonstrated that these effects are nearly abolished with four-week B-vitamin supplementation. With ambient PM 2. Indeed, improved cardiovascular health, reflected in reduced morbidity and mortality, has been documented as pollution levels have decreased in the U.
Nevertheless, even in U. cities complying with NAAQS, cardiovascular effects of particle pollution have been observed, with no evidence for a threshold for effect in sensitive individuals 346 Thus, the medical and public health communities have sought adjunct personal measures that might complement regulation in reducing the cardiovascular risk of pollution in sensitive people Previous studies suggested that dietary supplementations with vitamins C, vitamins E, or polyunsaturated fatty acids might protect against short-term air pollution-induced adverse cardiopulmonary responses 2526 In a randomized double-blinded controlled exposure study, Tong and coauthors successfully demonstrated that a four-week fish oil supplementation attenuated CAP-induced HRV reductions Our choice to assess the potential protective benefits of B vitamin supplementation against PM-induced cardiac autonomic dysfunction and inflammation was motivated by the anti-inflammatory, antioxidant, and immunoepigenetic effects of B vitamins 28 Recent epidemiological and in vivo studies suggest that B vitamins might be particularly protective against air pollution-induced cardiovascular effects—as it was demonstrated to modulate the epigenetic and inflammatory signaling pathways linking air pollution, intermediate biomarkers, and cardiovascular outcomes 61727 For example, folic acid and vitamin B 6 lower chemokine release from peripheral blood mononuclear cells and circulating levels of pro-inflammatory molecules 2829indicating reduced risk for acute cardiovascular events such as stroke.
In mice model, folic acid protects against lipopolysaccharide-induced nuclear factor-kβ pathway activation and adverse birth outcomes Furthermore, B vitamins are essential nutrients involved in the biochemical process of DNA methylation 3. In the presence of air pollution, adequate B vitamin intake ensures proper epigenetic status of leukocytes to warrant proper immuno-regulation, and prevents excessive oxidative damage to the cardiovascular system 3.
Although the results of randomized controlled trials on supplementation with folic acid, vitamin B 6 and B 12 do not support benefits of B vitamins for either primary or secondary CVD prevention 12141530the mentioned interactive biological properties of B vitamins render it a promising preventive strategy to minimize the cardiovascular damage due to ambient PM 2.
However, no prior clinical investigation has tested whether B vitamin supplementation can be used to guard the cardiovascular system from the adverse health effects of PM 2. Our findings of a primary autonomic effect of PM 2. Immediately following two-hour exposure to ambient concentrated PM 2.
These results indicate a consistent reduction in HRV across five measures — which reflects the adverse pathophysiological modulations in cardiac autonomic control by PM 2. Our data support this hypothesis by showing that two-hour PM 2.
In healthy adults, PM pollution increases the number of neutrophils and lymphocytes in alveolar lavage and peripheral blood While the underlying biological mechanism remains unclear, in vivo studies suggest that PM stimulates bone marrow via alveolar macrophages-mediated cytokine signaling, leading to accelerated release of immature leukocytes in to the circulation 36 Twenty-four hours after exposure, the effect of PM 2.
However, PM 2. Taken together, although the acute physiological responses due to PM 2. For the first time, our trial provides evidences demonstrating the unique preventive benefits of B vitamin administration in the context of air pollution: B vitamin supplementation can diminish the acute effects of PM 2.
These findings are in agreement with our results from the Normative Aging Study 6 — a population with average B vitamins intakes well above the standard dietary references — in which short-term PM 2.
This study has several strengths, including its crossover design with controlled exposure experiments — which simulate conditions similar to urban air pollution peaks, while allowing for control of exposure and treatment at the individual level. The Harvard ambient particle concentrators do not affect the concentration of gaseous pollutants, therefore, minimizing the confounding due to gaseous co-pollutants such as ozone and sulfur dioxide.
All exposure experiments were conducted at the same time of day to eliminate impacts of diurnal variation. We adjusted for time-varying factors including season, chamber temperature and humidity to minimize their influence on the observed associations, while time invariant factors are controlled by the crossover design.
We acknowledge several limitations, however. Although our sample size is comparable to previous controlled CAP exposure studies, which succeeded in demonstrating health effects of CAP exposure 32333839our study is evidently limited in power to detect small effects with only 10 subjects 30 controlled exposure experiments.
Further, treatment sequence could not be randomized due to the long half-life of B vitamins, therefore might be subject to confounding by period or ordering effects. For example, the first exposure experiment is likely to produce more distress on volunteers because of psychological effect.
We intentionally provided medical air as the first exposure experiment; therefore the psychological effect is expected to bias the effect of PM 2. The short study duration with four-week intervals between exposure experiments also reduced the impact of temporal trends.
In addition, we contrasted the post- vs pre-exposure status to ascertain all outcome measurements, which is expected to be less prone to confounding due to temporal trend than the absolute values. While residual confounding is possible, considering the magnitude of our effect estimates and the consistency across different HRV index, it is unlikely that the observed association reflected bias from confounding.
The crossover design of the present study was not complete, as we had no arm of B vitamin supplementation with sham exposure.
: B vitamins and cardiovascular health| Search form | Pretreatments vitaminss B vitamins and cardiovascular health with vitamin E Body fat percentage and weight loss also been cardikvascular to prevent MI-induced changes in cardiac function as well as Anthocyanins in fruits arrhythmias Sethi et al. Cardoovascular Sources: Cardiovxscular, meat, poultry, eggs, milk, and other dairy products; clams and beef liver; some breakfast cereals, nutritional yeasts, and other food products that are fortified with vitamin B Salvi, S. Cardiac Autonomic Dysfunction: Effects from Particulate Air Pollution and Protection by Dietary Methyl Nutrients and Metabolic Polymorphisms. van der Pol, A. Homocysteine-Lowering B Vitamin Therapy in Cardiovascular Prevention—Wrong Again? |
| 10 Surprising Health Benefits of B Vitamins | Pellagra can also result when the body is not able to absorb enough niacin because of alcoholism. The present study, the Women's Antioxidant and Folic Acid Cardiovascular Study WAFACS , tested whether a combination of folic acid, vitamin B 6 , and vitamin B 12 would reduce total cardiovascular events among women at high risk for the development of CVD over 7. Van Guelpen. On the other hand, varying degrees of anemia, myocardial cell damage, and cardiomyopathy due to vitamin E deficiency have been observed in various species of animals Madsen et al. Larsson SC, Traylor M, Markus HS. |
| Heart Beat: Heart failure tough on B vitamins | If you would like to write a letter to the editor, please forward it to letters globeandmail. Zhong et al. Vitamin D in the prevention and treatment of coronary heart disease. Article Google Scholar Behbod, B. Issues in comparisons between meta-analyses and large trials. By virtue of their regulatory role in various metabolic and biosynthetic pathways for energy status and cellular integrity, both hydro-soluble and lipo-soluble vitamins are considered to be involved in maintaining cardiovascular function in health and disease. Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: a randomized trial. |
B vitamins and cardiovascular health -
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Dietary antioxidant vitamins and death from coronary heart disease in postmenopausal women. Lal, K. The effect of vitamin B 6 on the systolic blood pressure of rats in various animal models of hypertension.
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Palumbo, G. Effects of vitamin E on clinic and ambulatory blood pressure in treated hypertensive patients. Pancharuniti, N. The attenuation of the PM 2. The associations of PM 2. Compared to sham, effects of PM 2. In summary, B vitamin supplementation reduced the PM 2. Likewise, B vitamin supplementation attenuated the PM 2.
B-vitamin supplementation significantly reduced the PM 2. In a sensitivity analysis, we additionally adjusted for seasonality defined using sine and cosine functions 21 to further address residual confounding, and our conclusions remained the same data not shown.
We observed no significant changes in dietary intake of folic acid, vitamins B 6 , and B 12 during the study period, therefore confounding due to dietary B vitamins was minimized Supplementary Table 7.
To rule out the possibility that the observed change in HRV was partially due to HR fluctuation, we adjusted for HR in PM 2. In addition, we conducted sensitivity analysis using HR-normalized HRV measurements and our conclusions were consistent Supplementary Table 8.
This single-blind crossover intervention trial with controlled exposure experiments found that two-hour exposure to concentrated ambient PM 2. Further, we demonstrated that these effects are nearly abolished with four-week B-vitamin supplementation.
With ambient PM 2. Indeed, improved cardiovascular health, reflected in reduced morbidity and mortality, has been documented as pollution levels have decreased in the U. Nevertheless, even in U. cities complying with NAAQS, cardiovascular effects of particle pollution have been observed, with no evidence for a threshold for effect in sensitive individuals 3 , 4 , 6 , Thus, the medical and public health communities have sought adjunct personal measures that might complement regulation in reducing the cardiovascular risk of pollution in sensitive people Previous studies suggested that dietary supplementations with vitamins C, vitamins E, or polyunsaturated fatty acids might protect against short-term air pollution-induced adverse cardiopulmonary responses 25 , 26 , In a randomized double-blinded controlled exposure study, Tong and coauthors successfully demonstrated that a four-week fish oil supplementation attenuated CAP-induced HRV reductions Our choice to assess the potential protective benefits of B vitamin supplementation against PM-induced cardiac autonomic dysfunction and inflammation was motivated by the anti-inflammatory, antioxidant, and immunoepigenetic effects of B vitamins 28 , Recent epidemiological and in vivo studies suggest that B vitamins might be particularly protective against air pollution-induced cardiovascular effects—as it was demonstrated to modulate the epigenetic and inflammatory signaling pathways linking air pollution, intermediate biomarkers, and cardiovascular outcomes 6 , 17 , 27 , For example, folic acid and vitamin B 6 lower chemokine release from peripheral blood mononuclear cells and circulating levels of pro-inflammatory molecules 28 , 29 , indicating reduced risk for acute cardiovascular events such as stroke.
In mice model, folic acid protects against lipopolysaccharide-induced nuclear factor-kβ pathway activation and adverse birth outcomes Furthermore, B vitamins are essential nutrients involved in the biochemical process of DNA methylation 3.
In the presence of air pollution, adequate B vitamin intake ensures proper epigenetic status of leukocytes to warrant proper immuno-regulation, and prevents excessive oxidative damage to the cardiovascular system 3.
Although the results of randomized controlled trials on supplementation with folic acid, vitamin B 6 and B 12 do not support benefits of B vitamins for either primary or secondary CVD prevention 12 , 14 , 15 , 30 , the mentioned interactive biological properties of B vitamins render it a promising preventive strategy to minimize the cardiovascular damage due to ambient PM 2.
However, no prior clinical investigation has tested whether B vitamin supplementation can be used to guard the cardiovascular system from the adverse health effects of PM 2. Our findings of a primary autonomic effect of PM 2. Immediately following two-hour exposure to ambient concentrated PM 2.
These results indicate a consistent reduction in HRV across five measures — which reflects the adverse pathophysiological modulations in cardiac autonomic control by PM 2. Our data support this hypothesis by showing that two-hour PM 2. In healthy adults, PM pollution increases the number of neutrophils and lymphocytes in alveolar lavage and peripheral blood While the underlying biological mechanism remains unclear, in vivo studies suggest that PM stimulates bone marrow via alveolar macrophages-mediated cytokine signaling, leading to accelerated release of immature leukocytes in to the circulation 36 , Twenty-four hours after exposure, the effect of PM 2.
However, PM 2. Taken together, although the acute physiological responses due to PM 2. For the first time, our trial provides evidences demonstrating the unique preventive benefits of B vitamin administration in the context of air pollution: B vitamin supplementation can diminish the acute effects of PM 2.
These findings are in agreement with our results from the Normative Aging Study 6 — a population with average B vitamins intakes well above the standard dietary references — in which short-term PM 2.
This study has several strengths, including its crossover design with controlled exposure experiments — which simulate conditions similar to urban air pollution peaks, while allowing for control of exposure and treatment at the individual level. The Harvard ambient particle concentrators do not affect the concentration of gaseous pollutants, therefore, minimizing the confounding due to gaseous co-pollutants such as ozone and sulfur dioxide.
All exposure experiments were conducted at the same time of day to eliminate impacts of diurnal variation. We adjusted for time-varying factors including season, chamber temperature and humidity to minimize their influence on the observed associations, while time invariant factors are controlled by the crossover design.
We acknowledge several limitations, however. Although our sample size is comparable to previous controlled CAP exposure studies, which succeeded in demonstrating health effects of CAP exposure 32 , 33 , 38 , 39 , our study is evidently limited in power to detect small effects with only 10 subjects 30 controlled exposure experiments.
Further, treatment sequence could not be randomized due to the long half-life of B vitamins, therefore might be subject to confounding by period or ordering effects. For example, the first exposure experiment is likely to produce more distress on volunteers because of psychological effect.
We intentionally provided medical air as the first exposure experiment; therefore the psychological effect is expected to bias the effect of PM 2. The short study duration with four-week intervals between exposure experiments also reduced the impact of temporal trends. In addition, we contrasted the post- vs pre-exposure status to ascertain all outcome measurements, which is expected to be less prone to confounding due to temporal trend than the absolute values.
While residual confounding is possible, considering the magnitude of our effect estimates and the consistency across different HRV index, it is unlikely that the observed association reflected bias from confounding.
The crossover design of the present study was not complete, as we had no arm of B vitamin supplementation with sham exposure.
Therefore, separating the direct effect of B vitamins on cardiac autonomic dysfunction and inflammation i.
In addition, our study was limited to healthy adults from lightly polluted urban environment, therefore our findings might not be generalizable to populations that are at higher risk for pollution-induced cardiovascular effects eg, children, older adults, individuals with pre-existing cardiovascular disease, and individuals residing in heavily polluted areas.
Apart from avoiding exercising outdoors at peak pollution times, sensitive individuals have limited options to reduce exposure and associated cardiovascular risk. While regulation is the backbone of prevention, residual risk remains for those who are sensitive, and high exposures are, unfortunately, the rule still in many megacities throughout the world.
The present study provides novel experimental evidence showing that an ambient PM 2. Our project inaugurates a line of research for the development of preventive pharmacological interventions using B vitamins to contain the health effects of air pollution.
Future studies will identify the precise pathophysiological processes of PM-induced cardiovascular responses and inflammation, as well as the mechanistic pathway underlying the protective effect of B vitamins.
We recruited ten healthy, 18—year-old, non-smoking volunteers who were not on any form of B vitamin supplementation or other medication, from the University of Toronto St. George campus and surrounding area downtown Toronto, Ontario, Canada The trial and experimental protocols were approved by all participating institutional review board University of Toronto, St.
Chan School of Public Health and registered clinicaltrials. gov NCT, date of registration: May 8, All methods were performed in accordance with the relevant guidelines and regulations. All volunteers provided written informed consent. The conduct of the trial was monitored by an independent data and safety monitoring committee.
We conducted a single-blind placebo-controlled crossover pilot trial Fig. A two-hour sham exposure experiment exposure one, particle-free medical air was included to provide baseline data.
All volunteers then received placebo for four weeks preceding the two-hour exposure experiment to concentrated ambient PM 2. After exposure two, we administered B vitamin supplements for four weeks before the next two-hour exposure experiment to PM 2.
The four-week placebo or B vitamin treatment also served as washout periods between exposure experiments to diminish the carryover effect of PM 2. To ensure comparable conditions across all controlled exposure experiments to PM 2.
Study volunteers were blinded to exposure and treatment allocation. Based on our symptom survey, none of the volunteers was able to discern the exposure type for any exposure experiment.
Harvard fine particle concentrators with a dilution control system delivered target-concentration PM 2. The concentrated ambient PM 2. During each exposure experiment to PM 2. During three four-week periods, we administered one B vitamin tablet 2.
The placebo tablets contain identical non-medical ingredients as the B vitamin tablets. Tablet preparation and packaging were done by an external lab Jamieson Laboratory, Toronto, Canada.
The label coding was blinded to the volunteers. A self-administered validated semi-quantitative Food Frequency Questionnaire was used to assess dietary B vitamin intake at the first and last visits to rule out potential impact from diet.
We discarded the first three minutes and the last two minutes during the ten-minute recording and analyzed the remaining five-minute electrocardiogram data using standardized techniques SDNN represents the total variability.
PNN50, rMSSD, and HF are sensitive to high-frequency heart rate fluctuations and are considered as measures of cardiac vagal tone modulation, while LF power is linked to the activity of both sympathetic and parasympathetic nervous system. We conducted graphical explorations and log 10 -transformed the HRV measures and WBC counts to improve normality and stabilize the variance.
For the ease of interpretation, we scaled the effect estimates to the percent changes in HRV and WBC in all models. Random intercepts were assigned to each subject. In the above model, Y ij was the change in HR, HRV, or WBC i.
X 1ij was a binary variable indicating exposure to PM 2. X 2ij was a binary variable indicating placebo or B vitamin supplementation.
X 3ij —X pij were the covariates, for participant i at measurement j. The main effect of B vitamin supplementation was not included in the model, given volunteers did not receive any medical air exposure while on B vitamin supplementation. β 1 represents the effect of PM 2. β 2 thus represents the intervention effect of B vitamin supplementation i.
e, the attenuation of PM 2. We represent the P value for the intervention effect, β 2, by P intervention. Analyses were performed using SAS 9. How to cite this article: Zhong, J. et al. B-vitamin Supplementation Mitigates Effects of Fine Particles on Cardiac Autonomic Dysfunction and Inflammation: A Pilot Human Intervention Trial.
Publisher's note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. World Health Organization.
Burden of disease from ambient air pollution for Public Health, Social and Environmental Determinants of Health Department , World Health Organization, Geneva, Switzerland Nawrot, T.
Public health importance of triggers of myocardial infarction: a comparative risk assessment. Lancet , —, doi: S 10 Article Google Scholar. Zhong, J. Journal of the American Heart Association 4 , e Article ADS Google Scholar. Brook, R. Particulate matter air pollution and cardiovascular disease: An update to the scientific statement from the American Heart Association.
Circulation , —, doi: CIR. Article CAS Google Scholar. Wong, E. Baccarelli, A. Cardiac Autonomic Dysfunction: Effects from Particulate Air Pollution and Protection by Dietary Methyl Nutrients and Metabolic Polymorphisms. Circulation Gold, D.
Ambient pollution and heart rate variability. Circulation , — Voutilainen, S. Low dietary folate intake is associated with an excess incidence of acute coronary events The Kuopio Ischemic Heart Disease Risk Factor Study. Bazzano, L. Dietary intake of folate and risk of stroke in US men and women: NHANES I Epidemiologic Follow-up Study.
National Health and Nutrition Examination Survey. Stroke 33 , — Righetti, M. The associations between folate intake and CVD according to the sources of folate are shown in Table 5. Stratified analyses were further conducted on the basis of sociodemographic factors, lifestyle, and comorbidity status Fig.
No significant interactions were observed, and the associations of folate with CVD risk were similar for all strata p interaction: 0.
These findings remained unchanged when patients using multivitamin supplements, antidiabetic medication, non-lipid-lowering drugs, and non-anti-hypertensive drugs were excluded from sensitivity analyses.
Risk of CVD for quartiles of dietary energy-adjusted folate intake by sex and potential risk factors. Quartile cut-off points were based on residual energy-adjusted intake among the control subjects.
Covariates, except for the stratified variables, included age, BMI, T2D duration, physical activity, educational level, household income, occupation, work status, marital status, smoking status, alcohol consumption, tea drinking status, hypertension status, dyslipidaemia status, antidiabetic medication use status, multivitamin supplement use status, and daily energy intake log transformed.
Our present hospital-based case-control study showed a statistically significant inverse relationship between the dietary intake of folate and vitamin B 6 and the risk of CVD among patients with T2D after adjusting for potential confounding factors.
However, we found no independent associations for vitamin B 12 intake. The associations of folate with CVD risk were similar in all stratified analyses, and no significant interactions were observed. Several meta-analyses [ 19, 20, 36 ] relating the associations of dietary folate and vitamin B 6 with the risk of CVD in the general population have suggested that high intakes of folate and vitamin B 6 can reduce the risk of CVD with relative risk values for the highest compared with the lowest category ranging from 0.
The higher homocysteine levels in patients with diabetes than in age-matched control individuals suggested that homocysteine level is a potential cardiovascular risk marker in the setting of T2D subjects [ 37 ]. Thus, we hypothesized that sufficient B-vitamins could offer a distinct function in preventive approaches in individuals with T2D as well.
Differences in study design and population, sample size, CVD outcomes, covariate adjustments, and adherence to treatment may be possible reasons for between-study heterogeneity.
Our results were consistent with the findings of the HOPE 2 study [ 38 ] but were different from the results of the WAFACS study [ 39 ], showing that high intakes of folate and vitamin B 6 can reduce the risk of CVD in patients with T2D.
However, given the scarcity of available evidence, further research will still be necessary to detect the effects of B-vitamins on cardiovascular outcomes. The beneficial effects of folate and vitamin B 6 intake on the risk of CVD remain speculative but biologically plausible because they are essential nutrients involved in the one-carbon metabolism pathway, which plays an important role in homocysteine metabolism [ 4, 6, 41 ].
Therefore, the protective role of folate and vitamin B 6 in CVD possibly contributes to the effects on homocysteine status [ 43 ]. In one aspect, homocysteine significantly induces the mRNA and protein expression of C-reactive protein in vascular smooth muscle cells, which initiates an inflammatory response [ 44 ].
In another aspect, the role of homocysteine in endothelial dysfunction is thought to be mediated by common and plausible mechanisms, including nuclear factor-κb activation, inflammation, oxidative stress, and the inhibition of endothelial nitric oxide synthase, that promote atherosclerosis and vascular disease [ 45 ].
Furthermore, increased homocysteine levels promote platelet adhesion to endothelial cells and have also been associated with high levels of prothrombotic factors, which lead to the augmentation of thrombus formation [ 46 ].
In addition to exerting homocysteine-lowering effects, folate and vitamin B 6 may lower the risk of CVD via other anti-atherosclerotic properties, such as improving insulin and lipid metabolism [ 47 ] and preventing oxygen radical generation and lipid peroxidation [ 48 ].
In our study, the main food sources of folate were eggs Pakchoi, rape, lettuce, Chinese cabbage, mustard greens, and broccoli are all dark green leafy vegetables, and increasing the intake of dark green vegetables is associated with a reduced risk of CVD as observed in similar studies [ 49, 50 ].
However, the meta-analyses of prospective studies on lean pork consumption and CVD risk did not provide consistent results [ 51, 52 ] likely because the advantageous effects of folate and vitamin B 6 derived from lean pork are offset by the significantly high cholesterol and saturated fatty acid contents, which have been shown to increase CVD, of pork [ 53 ].
Considering that cigarettes and alcohol are important risk factors for the aetiology of CVD, we adjusted for smoking status never intake, former intake, or current intake and alcohol consumption never intake, former intake, or current intake in the multivariable analysis.
In alcohol and cigarette consumption-stratified analyses, the inverse association between dietary folate and cardiovascular events remained significant in non-drinkers and non-smokers but not in current drinkers and current smokers, and the interaction was not statistically significant.
However, our results were different from the protective effect reported by the latest meta-analysis [ 19 ]. Considering the number of participants who currently drank alcohol or smoked, this result may be attributed to the low statistical power of these subgroups.
Vitamin B 12 plays an important role as a cofactor in one-carbon metabolism. However, consistent with the findings of some studies, a null association was observed between vitamin B 12 intake and CVD risk in our study [ 19, 54 ]. One possible explanation is that vitamin B 12 has a relatively moderate effect on homocysteine levels.
Another possible interpretation is that the lower intake of vitamin B 12 1. The strength of our study is its good matching by age and sex between the patients with CVD and the control subjects, thus increasing its statistical power. Additionally, the use of a validated and reproducible FFQ, the assessment of portion size by means of visual aids, the use of trained interviewers.
and the equal number of case and control interviews conducted by the individual investigators can reduce information bias. Several limitations of this study should be noted. We recruited all cases that were interviewed within 2 weeks of diagnosis and excluded all participants from our study who had substantially changed their dietary habits during the prior year to minimize this possibility.
Secondly, although we did adjust for multiple potential confounding factors, the residual confounding effects of unmeasured or unknown variables may have affected the results.
Thirdly, we could not eliminate potential selection bias due to the hospital-based case-control study design. The dietary habits and sociodemographic characteristics of cases and controls recruited from the studied hospitals might differ from those of patients admitted to other hospitals or the general population.
Fourthly, given that we could not obtain data on plasma homocysteine levels, the interactions among one-carbon metabolism-related B-vitamin intake, homocysteine levels, and CVD could not be evaluated. Fifthly, avoiding recall bias in dietary assessment by using a FFQ in a case-control study is difficult.
Finally, given that the participants of this study were all residents of the Guangdong area in South China, we caution against generalizing the results to other populations. This case-control study demonstrates that high intakes of folate and vitamin B 6 , but not of vitamin B 12 , are associated with a low risk of CVD among T2D patients.
These results provide preliminary evidence for the feasibility of a dietary programme for the prevention of CVD in patients with T2D. However, such evidence should be confirmed by further studies. This work was supported by grants from the Youth Program of the National Natural Science Foundation of China Grant No.
The raw data that support the findings of this study are available from the corresponding author upon request. Shi Fang, Zhongyi Yang, and Yanbin Ye contributed equally to this work and should be considered as co-corresponding authors. Sign In or Create an Account.
Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Annals of Nutrition and Metabolism. Advanced Search. Skip Nav Destination Close navigation menu Article navigation. Volume 79, Issue 1. Materials and Methods. Statement of Ethics.
Conflict of Interest Statement. Funding Sources. Author Contributions. Data Availability Statement. Article Navigation. Research Articles February 14 Dietary Folate, Vitamin B 6 , and Vitamin B 12 and Risk of Cardiovascular Diseases among Individuals with Type 2 Diabetes: A Case-Control Study Subject Area: Endocrinology , Further Areas , Nutrition and Dietetics , Public Health.
Shangling Wu Shangling Wu. a Department of Nutrition, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. This Site. Google Scholar. Pinning Feng ; Pinning Feng.
b Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Wanlin Li ; Wanlin Li. c Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China. Shuyu Zhuo ; Shuyu Zhuo. Wei Lu ; Wei Lu. Peiyan Chen ; Peiyan Chen. Yi Sui ; Yi Sui. fangshi mail.
d The Second Division of Cardiology, Department of Cardiovascular Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. yzhongyi e Department of Clinical Nutrition, The First Affiliated Hospital, Jinan University, Guangzhou, China.
yeyanbin mail. Ann Nutr Metab 79 1 : 5—
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