Effects of Vegetable Proteins on Hypercholesterolemia and Gut Microbiota Modulation
Abstract: Risk assessment tools, i.e., validated risk prediction algorithms, to estimate the patient’s 10-year risk of developing cardiovascular disease (CVD) should be used to identify high-risk people for primary prevention. Current evidence confirms that appropriate monitoring and control of risk factors either reduces the likelihood of CVD or slows down its progression. It is thus crucial that all health professionals make appropriate use of all the available intervention strategies to control risk factors: from dietary improvement and adequate physical activity to the use of functional foods, food supplements, and drugs. The gut microbiota, which encompasses 1 × 1014 resident microorganisms, has been recently recognized as a contributing factor in the development of human disease. This review examines the effect of both some vegetable food components belong to the “protein food group” and the underexploited protein-rich hempseed on cholesterolemia and gut microbiota composition.
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide, mostly due to ischaemic heart disease and stroke (both haemorrhagic and ischaemic). International and national policies now support targeting of interventions to reduce risk of CVD among high-risk patients. Accordingly, there is an increasing number of risk scores available to aid in the identification of individuals with a high CVD risk .
Almost these entire scores estimate personalized prognosis in terms of both absolute risk and life expectancy free of CVD. The use of these lifetime estimations has been endorsed by prevention guidelines to facilitate doctor–patient communication or cultivate patient motivation and, as a consequence, patient compliance .
Consequently, appropriate monitoring and control of risk factors, carried out in a timely and continuous manner, can in fact now play an even greater role in prevention. Several randomized clinical trials and meta-analyses have shown that such management either reduces the likelihood of CVD or slows down its progression (Figure 1) . Moreover, hypercholesterolemia plays a key role in determining CVD and the lowering of plasma low-density lipoprotein (LDL) cholesterol (LDL-C) levels is associated with CVD risk reduction, as documented by data obtained in clinical practice .
Figure 1. Treatment effect linked to cholesterol levels on the potential age of clinical cardiovascular event appearance. Treated means a multifactor intervention, i.e., dietary and lifestyle modifications plus the consumption of functional foods plus the use of drugs.
It is thus mandatory that all health professionals make appropriate use of all the available intervention strategies to control risk factors: from dietary improvement and adequate physical activity (i.e., lifestyle changes) to the use of functional foods, food supplements, and drugs . The Western lifestyle, including over-feeding of highly refined diets and sedentary behaviour, is associated with high prevalence of chronic conditions, such as CVD, inflammatory bowel disease (IBD) and type II diabetes, which carry a remarkable socioeconomic burden . Proposed mechanisms range from generation of bioactive metabolites to inducing systemic low-grade inflammation.
The gut microbiota, which includes the trillions of resident microorganisms, including bacteria, viruses, fungi, and protozoa, has been recently recognized as a contributing factor in the development of human disease . These organisms are involved in digestion, protection against invading organisms, and regulation of metabolism and immunity. An alteration of these microbial functions has been associated with acute and chronic disease, and development of autoimmune disorders. Diet also notably has an immediate and dramatic impact on microbial structure, and may be the single most important driver of gut bacterial composition and function (Figure 2) . The effects of high protein consumption on gut microbiota composition are not yet extensively studied, but are of increasing importance .
Figure 2. Impact of the dietary intake on gut microbiota and on human disease. Athero CVD (cardiovascular disease) means Atherosclerotic cardiovascular disease.
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