The world is experiencing an obesity pandemic, with rates of obesity rising for more than two decades. Obesity is defined as a body mass index (BMI) of 30 kg/m2 or greater. Of particular concern are the risks that millions of obese people are likely to develop chronic diseases and at earlier ages than their parents might have. The risk of venous thrombosis increases with obesity, so that the incidence of this pathology is also expected to rise significantly. There is remarkable and consistent evidence from a systematic review, as well as cohort and case–control studies that obesity might predispose to venous thromboembolism (VTE). The risk appears to be at least double that for normal weight subjects (BMI 20 to 24.9 kg/m2). Plausible mechanisms exist to explain this relationship, including the physical effects of body fat limiting venous return and a proinflammatory, prothrombotic, and hypofibrinolytic milieu. Loss of body weight has been shown to reduce the concentrations of coagulation factors and plasminogen activator inhibitor-1 toward the normal range. Whether weight loss would prevent secondary occurrence of VTE in the absence of anticoagulant therapy could not be discerned from this literature search.
The relationship between vegetable consumption and measures of adiposity was assessed in cohort studies. Seven databases were searched from inception until October 2018. The quality of individual studies was assessed using the Joanna Briggs Institute Critical Appraisal of Cohort Studies tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to determine the quality of the body of evidence. Ten studies were included. Six measured change in vegetable intake over time. Two showed that increasing vegetable consumption resulted in weight loss of 0.09–0.1 kg over four years (p < 0.001). Increased vegetable intake was also associated with a reduced risk of weight gain and overweight or obesity (Odds ratios (ORs) ranged from 0.18 to 0.88) in other studies. Four studies measured vegetable intake at the baseline only. One showed that intakes >4 servings/day reduced the risk of weight gain (OR 0.27 (95% confidence interval (CI) 0.08–0.99) and another found an inverse association with waist circumference in women (−0.36 cm per vegetable serving/day). This review provides moderate quality evidence for an inverse association between vegetable intake and weight-related outcomes in adults. When these findings are coupled with no apparent harm from vegetable consumption, the evidence-base can be used with acceptable confidence to guide practice and policy.
31 January 2014 in Journal of Human Nutrition and Dietetics