The researchers divide the three groups: healthy women (group one), arterial hypertension women (group two), and the women with arterial hypertension and hypothyroidism (group three) in the trimester. The results show that group two is the highest calorie intake and the most increased fat and protein intake. The authors interpret that protein intake is essential to give the fetus a nutrition source, but excessive protein intake influences kidney function. However, the authors did not explain the effect of the high fat intake in pregnant women and fetuses.

In this study, the readers could understand the correlation of daily intake in pregnant women. It may give the clinicians more nutritional recommendations for pregnant women.

Kidney disease and hypertension (HTN) are major healthcare problems on a global scale.  This review expresses them as “a global pandemic”.  While studies have demonstrated that there is a causal effect between maternal nutritional status and fetal development, more research is supporting a relationship between maternal nutritional status and the development of kidney disease and hypertension later in life, suggesting that the developmental origins are programmed in utero during renal programming.  Developing kidneys can be impacted by maternal nutrition, resulting in a change in nephron development.  Research into prevention at this early stage of development can have a far reaching effect on prevention and healthcare.

Key findings support that the start of kidney disease and HTN may be initiated early in life during “renal programming”.  Animal models support the hypothesis that oxidative stress as a result of “suboptimal maternal nutrition” impact the development of adult kidney disease and HTN.  The research also looks into retrospective data regarding antioxidant nutrients as protective measures during the renal programming phase of development and findings are promising regarding the correlation, but “clinical translation remains a critical challenge”.  

Fascinating information regarding the clinical implications of maternal nutrition and the programmed effects on the health of offspring in adult life.  Maternal nutrition can be impactful in many programming mechanisms of fetal development, positively as well as negatively.  Specifically related to kidney disease and HTN, there are several associations in animal models including insufficient caloric intake as well as over nutrition (an oversupplied nutrient), protein restriction, iron restriction, high fructose intake, and the intake of other micronutrients to combat oxidative effects.  The clinical implications are critically important to the nutritional eduction and support of the mother while pregnant, but also to the long term health of adult offspring and education to future generations, to help combat the impact of these global health diseases. 

This study is important because the authors review one cause of kidney disease/hypertension, both of which are classified as a global pandemic. They discuss that altered kidney development can be seen due to adverse intrauterine factors. These adverse factors can be introduced through maternal nutrition and oxidative stress and can ‘reprogram’ the kidney during development. 

In rat models, the authors found multiple sources that suggested the following exposures resulted in higher blood pressure compared to control groups 1) periods of moderate/intense caloric restriction, 2) consumption of high fructose corn syrup and 3) protein restriction in diet. They also discussed, in rat models, specific amino acids that could potentially be used to prevent oxidative stress. 

The clinical implications of this article are clear, even if many of the studies mentioned were conducted in rat models – maintaining nutritious eating habits during pregnancy can potentially reduce the risk of children developing kidney disease/hypertension.

Association between plant-based diets and blood pressure in the INTERMAP study. BMJ Nutrition, Prevention & Health 2020;3:doi: 10.1136/bmjnph-2020-000077

 

The use of “plant-based diet” terminology is becoming increasing popular in current public health messages to consumers.  It is important to note that there is not a standardized definition of plant-based diet established by USDA or by the Academy of Nutrition and Dietetics, the largest organization of food and nutrition professionals in the U.S.  PCRM has established a definition as have other entities and individual practitioners.  With that being said, it is important that consumers do understand that a plant-based diet is not necessarily synonymous with a high-quality diet.  When reviewing various definitions of a plant-based diet it is assumed that it is one of a high quality, nutrient dense eating pattern.  This study distinguishes the differences between a high-quality (healthy) plant-based diet, unhealthy plant-based diet and overall plant-based diet and their association on blood pressure.   

I didn’t feel that the results were very surprising but am glad that this study addresses the quality of plant-based diets.  A high adherence to a high quality (healthy) plant-based diet was inversely associated with systolic and diastolic blood pressure.   A high adherence to an overall plant-based diet was not inversely associated with systolic and diastolic blood pressure.  Simply put: quality of the diet matters!  High adherence to an unhealthy plant-based diet was directly associated with higher systolic blood pressure.

I appreciated this study because it was a reminder that practitioners need to be aware that clients/patients may have misconceptions about plant-based diets and that education on what constitutes a high-quality plant-based diet (consisting of whole grains, fruits, vegetables, nuts, legumes, vegetable oils and tea/coffee but low in fruit juices, sugar-sweetened beverages, refined grains, processed potatoes, sweets and desserts) is important to address.  

 

Since maternal diet high in fructose has been shown to cause hypertension in adult offspring, it is important to find ways to prevent this programmed hypertension. This study investigated whether resveratrol can prevent maternal diet induced tendency toward hypertension. 

The study did confirm that male mice born exposed to high-fructose (HF) diet during gestation, lactation, and post-weaning period did develop hypertension. The mice that were also given resveratrol with their post-weaned diet, had less hypertension.  The gut microbiota was improved, renal oxidative stress was reduced, and severed nutrient-sensing signals were activated in the resveratrol group. 

Several mechanisms are at play in preventing hypertension in offspring exposed to HF diet during gestation, lactation, and early life. Resveratrol’s effect on reduction of oxidative stress, restoring nutrient-sensing signals, and improving gut microbiota could be found to change HF diet induced hypertension. and this is clinically important.

Resveratrol is found in the skin of grapes, blueberries, mulberries, raspberries, and peanuts.

This study was interesting to me, because we often encounter patients who take a wide variety of supplements for different health reasons. Often, they are word of mouth recommendations from friends or from internet searches, but occasionally there are some that have recently been found to be backed by science and are drawing enough of an audience to garner interest in more studies. The article I chose was a systematic review of the data from a 12-year span looking at the effect of cinnamon in lowering blood pressure in patients who have pre-diabetes or diabetes. I was curious why it studied specifically this population, but there have been other studies (one notably in 2003) that made the mainstream media stating that cinnamon can have a modest effect on lowering a person’s fasting blood glucose, so this supplementation is more common in the diabetic population. I currently work in anesthesia, and this is a supplement we like to know about as it also (especially in 1 of its 4 forms) contains a potent anticoagulant. The review found that there was a modest but significant decrease of the systolic BP by 5.39mmHg and the diastolic BP by 2.6mmHg. All the studies reviewed were in short term use, and efficacy long term is still unknown. If there was a safe way to provide a common supplement (that would need to be controlled by the FDA to ensure that there was a consistent coumarin content and avoid anticoagulant complications) of such a household and inexpensive ingredient, and it was found to also affect blood glucose, it may be a way to help patients that have borderline BP and pre-diabetes avoid medications and the often staggering accompanying cost. 

 

 One key finding and relation to Nutrition 

A key finding from this study was that decreases in albuminuria correlated with a decrease in the number of future cardiovascular events. Albuminuria is an integrated marker for the structural and functional abnormalities seen in hypertension. These included hypertensive vascular abnormalities, endothelial dysfunction, and impairment of renal function. Levels of albuminuria can be modulated by a number of different factors including through medications that lower blood pressure (ACE inhibitors) and dietary changes that result in weight loss. If the albuminuria is mainly caused because of renal dysfunction, then curing the condition may not be possible, but slowing the progression is achievable through a combination of the above methods.    

 Clinical implication 

Monitoring albuminuria in hypertensive patients before and during treatment is very important in predicting the risk of future cardiovascular events. This means that testing for changes in albumin excretion should be closely examined throughout treatment. If a patient is successful in lowering the amount of albumin excretion from their body, then they effectively decrease the risk of cardiovascular events such as stroke and heart attack. 

Berendsen AAM, Kang JH, van de Rest O, Feskens EJM, de Groot LCPGM, Grodstein F. The Dietary Approaches to Stop Hypertension Diet, Cognitive Function, and Cognitive Decline in American Older Women. J Am Med Dir Assoc. 2017 

This study examined if there is an association between cognitive function and long-term adherence to the DASH diet, in older American women

Greater adherence to long-term DASH score was associated with better average cognitive function, irrespective of apolipoprotein E ε4 allele status. These differences were equivalent to being 1 year younger in age. Adherence to the DASH score was not associated with change in cognitive function over 6 years.

This study shows that long-term adherence to the DASH diet, may not only help with controlling hypertension but also help with keeping neurocognitive decline at bay. Given the benefits of the DASH diet on hypertension, it may be because of slowing down in the hypertension induced white matter disease process and consequent better cognition at an older age. Although we did not see any change in cognitive function over 6 years, this would significantly help in maintaining an independent lifestyle for longer. 

 

This article is important because it looks at the role different aerobic exercise trainings play on blood pressure, cardiorespiratory function, body composition, and pharmacological treatment when combined with a low-calorie diet. The researchers looked at different 16-week exercise training programs for their study. Overweight or obese participants were assigned into one of four groups. The participants were assigned to a control group or one of three 16-week exercise training groups. The control group utilized physical activity recommendations while the exercise training groups had two days each week of high volume with 45 minutes of moderate intensity continuous training, high volume and high intensity interval training, alternating high and low intensities, or low volume high intensity interval training. All participants ate the same low-calorie diet. 

 One key finding in this study is that there was a significant decrease in blood pressure in all of the groups, however BMI decreased more in the exercise groups compared to the control group. Blood pressure medication was also reduced in about 37% among participants. High intensity interval training also seemed to be more effective at lowering body mass and increasing cardiorespiratory fitness. 

 This study is important clinically because it shows that a low-calorie diet combined with aerobic exercise can be an effective nutritional method to combat obesity and hypertension. Recommending exercise combined with diet management can be an effective tool for managing hypertension and even reducing negative side effects caused by medication. I think it is important to keep in mind that exercise and diet are equally as important to our quality of life. 

 There is a suggestion in short-term trials that dietary proteins are beneficial to lower blood pressure. For example, DASH diet studies reported that fruits and vegetable with low-fat dairy products (dietary protein) had the most effect to lower BP. This study is important because it expands the theory to long-term impact of proteins by animal, plant or both. 

The method is monitoring 1361 samples from both sex, 30-54 years old with no history of HBP, CVD or diabetes for 11.3 years. 
The effect of lowering SBP/DBP by proteins was recognized, and risks of HBP was significantly reduced by high consumption of proteins from both animal and plant: 40% less. Also, the study confirmed that dietary fiber is highly beneficial to lower BP with combination of high protein intake.

The clinical implication of this study is that risks of developing HBP are not related to dietary protein. Instead, people should increase intake of animal or plant proteins to prevent HBP for long-term.

It is interesting that this study tries to recommend animal proteins when most of recent studies conclude to shift to plant-based diets.