Table 1. Metabolic and dietary risk factors, their definitions, data sources, optimal levels and cardiometabolic disease outcomes (coronary heart disease, stroke, diabetes and other CVD).
| Risk factor (definitions) | Data sources1 | Optimal level2 | Disease Outcomes3 |
|---|---|---|---|
| Dietary Factors | |||
| Low intake of fruits | Brazilian Household Budget Survey (2008–2009) | 300 ± 30 g/d | IHD, ischemic stroke, hemorrhagic stroke |
| Low intake of whole grains (food ≥ 1.0 g fiber per 10 g of carbohydrate) | 2.5 (50 g) ± 0.25 servings/d | IHD, ischemic stroke, hemorrhagic stroke, diabetes | |
| High intake of sodium4 | 2000 ± 200 mg/d | Blood pressure-mediated effect on IHD, ischemic stroke, hemorrhagic stroke, hypertensive heart disease, aortic aneurism, rheumatic heart disease, inflammatory heart disease, other CVD | |
| Low intake of nuts and seeds | 16 ± 1.6 g/day | IHD, diabetes | |
| Low intake of vegetables and beans (excluding vegetable juices, starchy e.g. potatoes, corn, and salted or pickled vegetables); includes intakes of beans and other legumes, except soy milk) | 400 ± 40 g/d¥ [18] | IHD, ischemic stroke, hemorrhagic stroke | |
| High intake of processed meats | 0 g/d | IHD, diabetes | |
| Low intake of fish and shellfish | 50 ± 5 g/day | IHD, ischemic and hemorrhagic stroke | |
| High intake of trans-fats (mainly partially hydrogenated vegetable oils and ruminant products) | 0.5 ± 0.05% of total calories[19] | IHD | |
| Low PUFA intake as a replacement for SFA | 12 ± 1.2% of total calories5[20] | IHD | |
| High intake of red meat (unprocessed) excluding poultry, fish, eggs and all processed meat | 100 ± 10 g/week | diabetes | |
| High intake of sugar-sweetened beverages (≥ 50 kcal per 8 oz (226.8 g) serving, excluding 100% fruit and vegetable juices) | 0 g/d | Direct effect on DM, BMI-mediated effects on IHD, ischemic stroke, diabetes, hypertensive heart disease | |
| Metabolic factors | |||
| High fasting plasma glucose | Ramos et al. 1998; Barreto et el. 2001; Marcopito et al., 2005; Makdisse et al. 2008; Marquezine et al., 2008 | 5.3 ± 0.3 mmol/L | IHD, ischemic stroke, hemorrhagic stroke, diabetes |
| High total serum cholesterol | Ramos et al. 1998; Fornes et al., 2002; Marcopito et al., 2005; Makdisse et al. 2008; Marquezine et al., 2008 | 4.0 ± 0.9 mmol/L | IHD, ischemic stroke |
| High systolic blood pressure | De Lolio et al., 1990; Ramos et al. 1998; Barreto et el. 2001; Freitas et el. 2001; Moraes et al., 2003; Lessa et al.,2006; Marcopito et al., 2005; Hartmann et al., 2007; Pereira et al. 2007; Castro et at. 2007; Marquezine et al., 2008 | 115 ± 6 mm Hg | IHD, ischemic stroke, hemorrhagic stroke, hypertensive heart disease, aortic aneurism, rheumatic heart disease, inflammatory heart disease, other CVD |
| High BMI | Moraes et al. (2003), Barreto et al. (2001), Makdisse et al., 2008 | 23 ± 1 kg/m2 [21, 22] | IHD, ischemic stroke, DM, hypertensive heart disease |
IHD: ischemic heart disease, CVD: cardiovascular disease, DM: diabetes mellitus; BMI: body-mass index; PUFA: polyunsaturated fatty acids
1 data sources for risk factor exposures from nationally representative surveys and/or epidemiological studies conducted in Brazil.
2or dietary risks, a population SD of 10% of the mean was utilized, while for metabolic risks, the population SD of the optimal distribution was determined using a regression evaluating the mean to SD relationship of the corresponding risk factor [23].
3 Cardiometabolic diseases with convincing or probable evidence of an etiologic association with risk factors of interest [9].
4 High sodium intake was included as a risk factor for aortic aneurism, rheumatic heart disease and inflammatory heart disease based on evidence on the influence of elevated blood pressure on mortality from (not onset or incidence of) these outcomes. In other words, higher BP increases risk of death once these conditions have occurred
5 as a replacement for saturated fat.