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Canadian Journal of Cardiology

Diet and Nutrition in Peripheral Artery Disease: A Systematic Review

Published:March 17, 2022DOI:https://doi.org/10.1016/j.cjca.2022.01.021

      Abstract

      Background

      Patients with peripheral artery disease (PAD) suffer from high rates of morbidity and mortality. Dietary optimisation is recommended for patients with atherosclerotic vascular disease, but the relationship between dietary intake and PAD remains unclear. This review systematically collates the literature describing the relationship between dietary intake and nutritional status, and the presence and progression of PAD.

      Methods

      The MEDLINE, Embase, Emcare, and AMED databases were searched from inception to December 2020. Studies were included if they reported on the association between diet and PAD in the general population or on relationships between diet and vascular complications in individuals with established PAD.

      Results

      A total of 3536 unique articles were retrieved, and 40 were selected for inclusion. Most studies were observational. A subgroup analysis of the Prevención con Dieta Mediterránea (PREDIMED) study was the only randomised controlled trial assessing the role of diet and presence of PAD and suggested that the Mediterranean diet may be protective against the development of PAD. Nutritional risk scores, such as the Geriatric Nutritional Risk Index (GNRI), show promise in predicting major vascular complications in patients with established PAD. The GNRI and the Controlling Nutritional Status (CONUT) score are both predictors of postoperative vascular outcomes, including amputation-free survival and overall survival, in patients undergoing either open surgical or endovascular therapy.

      Conclusions

      There is a paucity of high-quality data describing the relationship between dietary intake and PAD. The Mediterranean diet may have a role in preventing PAD, but this needs to be confirmed in larger dedicated studies.

      Résumé

      Contexte

      Les taux de morbidité et de mortalité sont élevés chez les personnes atteintes de maladie artérielle périphérique (MAP). Une optimisation de l’alimentation est recommandée chez les personnes atteintes de maladie vasculaire athéroscléreuse, mais la relation entre l’apport alimentaire et la MAP n’est toujours pas claire. Cette revue systématique a rassemblé tous les articles traitant de la relation entre l’apport alimentaire et l’état nutritionnel d’une part et la présence et la progression de la MAP d’autre part.

      Méthodologie

      Une recherche a été effectuée dans les bases de données MEDLINE, Embase, Emcare et AMED, de la date de leur création à décembre 2020. Les études recensées ont été incluses à l’analyse si elles faisaient mention d’un lien entre l’alimentation et la MAP dans la population générale ou d’un lien entre l’alimentation et les complications vasculaires chez les personnes atteintes de MAP établie.

      Résultats

      Au total, 3 536 articles ont été trouvés, et 40 d’entre eux ont été retenus pour l’analyse. Il s’agissait d’études observationnelles dans la plupart des cas. Le seul essai contrôlé randomisé à avoir évalué le lien entre l’alimentation et la présence de la MAP est une analyse de sous-groupes de l’étude Prevención con Dieta Mediterránea (PREDIMED). Cette analyse semblait indiquer que le régime méditerranéen protégerait contre la survenue de la MAP. Certains scores de risque nutritionnel, comme l’indice GNRI (Geriatric Nutritional Risk Index), sont prometteurs pour prédire les complications vasculaires importantes chez les personnes atteintes de MAP établie. Le score GNRI et le score Controlling Nutritional Status (CONUT) sont deux prédicteurs des résultats vasculaires postopératoires, y compris de la survie sans amputation et de la survie globale, chez les personnes ayant subi une chirurgie effractive ou reçu un traitement endovasculaire.

      Conclusions

      Il existe très peu de données de grande qualité sur le lien entre l’apport alimentaire et la MAP. Le régime méditerranéen pourrait se révéler utile pour la prévention de la MAP, mais cette utilité doit être confirmée par des études de grande envergure portant plus précisément sur la question.

      Graphical abstract

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