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Review
. 2023 Feb 5;4(1):e212.
doi: 10.1002/mco2.212. eCollection 2023 Feb.

Dietary patterns and cardiometabolic health: Clinical evidence and mechanism

Wenting Wang  1 , Yanfei Liu  1 , Yiwen Li  1 , Binyu Luo  1 , Zhixiu Lin  2 , Keji Chen  1 , Yue Liu  1
Affiliations
Review

Dietary patterns and cardiometabolic health: Clinical evidence and mechanism

Wenting Wang et al. MedComm (2020). .

Abstract

For centuries, the search for nutritional interventions to underpin cardiovascular treatment and prevention guidelines has contributed to the rapid development of the field of dietary patterns and cardiometabolic disease (CMD). Numerous studies have demonstrated that healthy dietary patterns with emphasis on food-based recommendations are the gold standard for extending lifespan and reducing the risks of CMD and mortality. Healthy dietary patterns include various permutations of energy restriction, macronutrients, and food intake patterns such as calorie restriction, intermittent fasting, Mediterranean diet, plant-based diets, etc. Early implementation of healthy dietary patterns in patients with CMD is encouraged, but an understanding of the mechanisms by which these patterns trigger cardiometabolic benefits remains incomplete. Hence, this review examined several dietary patterns that may improve cardiometabolic health, including restrictive dietary patterns, regional dietary patterns, and diets based on controlled macronutrients and food groups, summarizing cutting-edge evidence and potential mechanisms for CMD prevention and treatment. Particularly, considering individual differences in responses to dietary composition and nutritional changes in organ tissue diversity, we highlighted the critical role of individual gut microbiota in the crosstalk between diet and CMD and recommend a more precise and dynamic nutritional strategy for CMD by developing dietary patterns based on individual gut microbiota profiles.

Keywords: cardiometabolic disease; clinical evidence; dietary patterns; gut microbiota; mechanism.

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Conflict of interest statement

The authors declare they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Historical evolution of dietary patterns. From the discovery, isolation, and synthesis of single nutrients to the exploration of the complex biological effects of food and dietary patterns, nutrition science has shifted and advanced in complex thinking. Displayed are the future research priorities of the field. Understanding the evolution of dietary patterns can provide important insights into the current state of diet‐related diseases. Abbreviation: CMD, cardiometabolic diseases; DASH, dietary approaches to stop hypertension
FIGURE 2
FIGURE 2
From healthy foods, nutrients, and dietary patterns to cardiometabolic health. The research process for analyzing nutrition and cardiometabolic health is shown in a bottom–up manner. Phase 1: identification of essential nutrients and healthy foods, such as vegetables and fruits, whole grains, and plant‐based oils (tier 4). Phase 2: establishment and development of different types of dietary patterns, such as vegetarian diets, Mediterranean diets, ketogenic diets, calorie restriction, and intermittent fasting (tier 3). Phase 3: exploration of the molecular mechanisms of dietary interventions, including nutrient response pathways, immune regulation, the role of gut microbiota and metabolites, and circadian rhythms (tier 2). Phase 4: providing personalized dietary strategies to cardiometabolic diseases (CMD) patients based on diet–genetic interactions (tier 1). Abbreviation: AMPK, AMP‐activated protein kinase; LPS, lipopolysaccharide; mTOR, mammalian target of rapamycin; SCFA, short‐chain fatty acids; SIRT, Sirtuin
FIGURE 3
FIGURE 3
Key molecular mechanisms by which dietary patterns affect cardiac metabolism. The dietary patterns that regulate nutrient‐sensing pathways (including mammalian target of rapamycin [mTOR], AMP‐activated protein kinase [AMPK], and Sirtuin‐1 [SIRT1]), the immune system, the gut microbiome, and circadian rhythms and their associated signaling events are shown. Elucidating the mechanisms of dietary intervention on cellular stress response and host metabolic dysfunction at the molecular, cellular, and metabolite levels will help to create more precise and dynamic dietary strategies. Abbreviation: ACC, acetyl‐CoA carboxylase; FOXO1, forkhead box protein O1; HIF‐1α, hypoxia‐inducible factor‐1α; IL, interleukin; MMP, matrix metalloprotease; NF‐κB, nuclear factor‐kappa B; NLRP3, NACHT, LRR, and PYD domains‐containing protein 3; PAF‐AH, platelet‐activating factor acetylE:hydrolase; SCFA, short‐chain fatty acids; Th, T‐helper; TNF, tumor necrosis factor; Treg, regulatory T cells
FIGURE 4
FIGURE 4
Schematic diagram of diet–gut microbiota–host metabolism. This figure depicts the direct effects of healthy dietary patterns on the gut microbiota to influence host metabolic phenotypes. This includes increasing gut microbiota diversity, adjusting the ratio of beneficial to harmful bacteria, and promoting increased secretion of the beneficial microbial metabolites short‐chain fatty acids (SCFAs) and branched‐chain amino acids (BCAAs). Abbreviation: BDNF, brain‐derived neurotrophic factor; LPS, lipopolysaccharide; TMAO, trimethylamine oxide
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