Browse the evidence

Dietary intake of risk-increasing factors (processed meat, red meat, sugar-sweetened beverages, sodium, saturated fat) has a greater detrimental cardiometabolic impact on younger adults (25-44 years) than on older adults, while risk-reducing factors (fruits, vegetables, nuts, whole grains, PUFA, seafood omega-3) provide the greatest benefit to middle-aged adults (45-69 years).

Your diet matters most right now. If you are under 45, eating processed meats, sugary drinks, and excess sodium is causing the maximum possible damage to your heart and metabolic health. Conversely, if you are between 45 and 69, prioritizing fruits, vegetables, nuts, and whole grains yields the highest health return. Do not wait until you are older to fix your diet; the window for maximum benefit (and minimum harm) is now.

Women experience smaller detrimental cardiometabolic effects from diet than men, as measured by the Adverse Diet-Health Index (IDHIadverse).

Men are statistically more vulnerable to the negative cardiometabolic effects of a poor diet than women. This means men should be particularly vigilant about limiting processed meats, sodium, and sugar, as their bodies may suffer greater immediate harm from these factors compared to women.

Sodium and Sugar-Sweetened Beverages (SSB) are the primary drivers of adverse cardiometabolic health impacts globally, with sodium being the largest contributor in most regions and SSB being the largest in Latin America and the Caribbean.

To improve your heart health, focus on reducing sodium and sugary drinks. In most parts of the world, cutting sodium is the single most effective dietary change you can make. If you live in Latin America or the Caribbean, cutting sugary drinks is likely your highest-impact move. Reducing these two factors will yield the greatest reduction in cardiometabolic risk.

Dietary iodine intake is primarily derived from dairy products in Canadian adults, and public health policies promoting salt restriction and reduced dairy consumption may inadvertently increase the risk of iodine deficiency.

If you are following a low-sodium diet for blood pressure, be aware that you might be consuming less iodine. Dairy products are a major source of iodine in the Canadian diet. Ensure you are getting enough iodine through other sources like fish, eggs, or supplements if you significantly cut back on dairy and salted foods.

Regional variations in iodine status exist in Canada, with residents of Quebec City and Vancouver having significantly lower iodine status compared to those in Hamilton and Ottawa, driven by differences in dietary habits and environmental exposure to inhibitors.

Where you live affects your iodine status. People in Quebec City and Vancouver were found to have lower iodine levels than those in Hamilton and Ottawa. This is likely due to local dietary differences (less dairy/bread) and higher exposure to inhibitors like smoking. Check your local food sources.

A national penny-per-ounce sugar-sweetened beverage (SSB) tax is highly cost-effective for preventing obesity-associated cancers and reducing health disparities among low-income populations in the United States.

Implementing a one-cent-per-ounce tax on sugary drinks is a highly cost-effective strategy to prevent cancer and save healthcare money, especially for low-income Americans. The policy reduces consumption through price elasticity, leading to lower obesity rates and fewer obesity-related cancers.

GLP-1 receptor agonists should be discontinued immediately upon confirmation of pregnancy due to the lack of approved safety data, despite current evidence not showing teratogenicity.

Stop taking your GLP-1 medication as soon as you get a positive pregnancy test. Your doctor will likely switch you to insulin or diet management to keep your blood sugar stable, which is the standard of care for diabetes in pregnancy.

Treatment with second-generation antipsychotics (SGAs) significantly increases hunger and appetite, with an odds ratio of 1.51 for appetite increase compared to controls.

If you are taking second-generation antipsychotics (like olanzapine, clozapine, or risperidone), expect an increase in hunger and appetite. This is a known biological side effect linked to how the drug interacts with brain receptors, not a lack of willpower. Discuss this with your prescriber; they may monitor your diet or adjust medication to manage this increased drive to eat.

Patients treated with SGAs show higher cravings for fat and carbohydrates compared to other food types, and exhibit small increases in dietary disinhibition and restrained eating.

SGA treatment is associated with increased cravings for fats and carbohydrates, as well as higher dietary disinhibition (loss of control over eating) and restrained eating (strict dieting). This combination can make weight management difficult. Focus on managing cravings and avoiding extreme restriction, which may backfire, by working with a dietitian to create a sustainable eating plan.

HMB-Free Acid (HMB-FA) provides a minor, statistically significant improvement in lower body strength (leg press) compared to HMB-Calcium and placebo, but this effect is likely too small to be practically meaningful for hypertrophy.

HMB-Free Acid might give you a tiny boost in leg press strength compared to the calcium version or placebo, but it won't help you build more muscle or improve upper body strength. The difference is likely too small to matter for your overall progress.

One-anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) result in significantly greater reductions in areal bone mineral density (aBMD) at the total hip, femoral neck, and lumbar spine compared to sleeve gastrectomy (SG) within the first year post-surgery.

If you are considering bariatric surgery, know that bypass procedures (OAGB and RYGB) lead to greater bone density loss at the hip and spine than sleeve gastrecty (SG) in the first year. This is likely due to malabsorption of calcium and vitamin D. You should discuss bone health monitoring and supplementation strategies with your surgeon, especially if you choose a bypass procedure.

Despite significant losses in absolute muscle strength and lean mass, relative muscle strength (strength per unit of body weight or lean mass) and physical function (sit-to-stand time, 6-minute walk distance) improve significantly within one year of metabolic/bariatric surgery, regardless of the specific surgical procedure.

You will lose some muscle mass and absolute strength after surgery, which is normal. However, because you are losing a lot of body weight, your relative strength (strength for your body size) and physical function (walking, standing up) will likely improve. Focus on maintaining muscle through protein intake and light activity rather than fearing the inevitable loss.

Very low calorie diets (VLCD) produce superior short-term weight loss (approx. 4 kg more than behavioral programs) and modest long-term benefits (1.3-1.4 kg) compared to standard behavioral weight loss programs, though long-term maintenance requires adjunctive support.

If you need significant weight loss, a Very Low Calorie Diet (VLCD) under medical supervision produces more weight loss than standard diet advice alone, both immediately and up to 5 years later. However, because regain is common, you should plan for long-term support (like meal replacements or medication) to keep the weight off.

High protein diets (increasing protein by >5% of energy) provide a modest but statistically significant advantage in fat mass loss and triglyceride reduction compared to normal protein diets, with a small effect on total weight loss.

To maximize fat loss, ensure your protein intake is significantly higher than standard recommendations (aiming for a >5% increase in energy from protein). This small shift helps preserve lean mass and lowers triglycerides, even if total weight loss doesn't change drastically.

Discontinuation of anti-obesity medications leads to significant weight regain (approx. 6.9% of lost weight) and return of hunger, indicating AOMs are for chronic management, not short-term fixes.

Do not view these medications as a 6-month fix. They are chronic treatments. If you stop, your biology will push you to regain weight. Plan for long-term use or have a robust maintenance strategy if you must stop, understanding the high risk of regain.

Semaglutide, a GLP-1 receptor agonist, significantly reduces hepatic steatosis, inflammation, and liver stiffness in patients with MAFLD, although its effect on reducing fibrosis stage remains uncertain.

Semaglutide, used for diabetes and obesity, has been shown to significantly reduce liver fat and inflammation in MAFLD patients. However, its ability to reverse liver scarring (fibrosis) is not yet clear. It is available in both injection and oral forms.

SGLT2 inhibitors (flozins) such as dapagliflozin and empagliflozin show promise in reducing liver steatosis and inflammation in MAFLD patients, with several Phase 3 and 4 trials ongoing.

SGLT2 inhibitors like dapagliflozin and empagliflozin are oral diabetes drugs that are being studied for MAFLD. They help reduce liver fat and inflammation, and may also help with weight loss. They are not yet approved specifically for MASH, but trials are ongoing.

Therapeutic reduction of central adiposity via bariatric surgery or incretin-based drugs significantly reduces the risk of heart failure hospitalizations and worsening heart failure events in patients with HFpEF, whereas blood pressure lowering alone yields only modest benefits unrelated to the magnitude of BP reduction.

For HFpEF patients, focusing solely on blood pressure medication is insufficient. Prioritizing significant weight loss through bariatric surgery or incretin-based medications (like semaglutide or tirzepatide) is critical, as these interventions directly reduce the hormonal and mechanical drivers of heart failure, leading to a 50-60% reduction in worsening heart failure events.

Central adiposity (measured by waist-to-height ratio) is a stronger predictor of HFpEF development and severity than systemic hypertension, and adiposity drives hypertension rather than vice versa.

HFpEF patients should prioritize weight loss and visceral fat reduction over aggressive blood pressure targeting alone, as adiposity is the primary driver of the disease process and arterial stiffness.

Achieving optimal levels of waist circumference, glomerular filtration rate, and urine albumin-to-creatinine ratio (each weighted 2 points) and glycated hemoglobin/blood pressure (each weighted 1 point) is significantly associated with a lower risk of heart failure in type 2 diabetes.

For individuals with Type 2 Diabetes, managing heart failure risk requires a multi-faceted approach. Prioritize achieving target levels for waist circumference, kidney function (GFR and urine albumin), blood pressure, and blood sugar. The study suggests that controlling waist circumference and kidney markers may offer greater protection against heart failure than controlling blood pressure or blood sugar alone.

Longitudinal improvement in the cardiometabolic health score is significantly associated with a lower risk of heart failure.

If you have Type 2 Diabetes, working to improve your cardiometabolic health over time—such as reducing waist circumference, improving kidney markers, or better controlling blood pressure and blood sugar—can significantly lower your risk of developing heart failure, even if you started with a lower health score.

Bariatric surgery's glycemic benefits in patients with BMI <35 kg/m2 are primarily driven by caloric restriction and weight loss rather than unique metabolic or hormonal mechanisms.

For patients with BMI <35, surgery is not a 'metabolic cure' distinct from weight loss. The glycemic benefits are largely due to the caloric restriction and weight loss achieved. While surgery is more effective at producing and sustaining this weight loss than lifestyle changes alone, the underlying mechanism is energy balance, not a unique surgical hormone effect. Patients should understand that achieving similar weight loss through other means could yield similar metabolic improvements, though sustaining that loss is the primary challenge.

In older Asian populations, a vegetable-based low-carbohydrate diet (high unsaturated fat/plant protein, low refined carbs) is associated with increased all-cause and cardiovascular disease (CVD) mortality, whereas a meat-based low-carbohydrate diet (high saturated fat/animal protein, refined carbs) is associated with decreased mortality.

For older adults in Asian populations, simply reducing carbohydrates is not enough; the source of the remaining calories is critical. A 'vegetable-based' low-carb diet (emphasizing unsaturated fats and plant proteins while reducing refined carbs) was linked to higher mortality. Conversely, a 'meat-based' low-carb diet (emphasizing animal proteins and saturated fats) was linked to lower mortality. This suggests that for this demographic, replacing refined carbs with animal products may be beneficial, whereas replacing them with plant oils and proteins might not be, potentially due to cooking methods (high-heat frying of plant oils) or specific nutrient profiles.

Iso-caloric substitution of 3% of total energy from animal protein for saturated fat, mono-unsaturated fat, or carbohydrates is associated with a statistically significant increase in all-cause and cardiovascular mortality.

If you are replacing 3% of your daily calories with animal protein (e.g., by eating more meat or dairy) and reducing fats or carbs, this study suggests your risk of dying from heart disease or any cause may increase. To mitigate this, prioritize plant-based proteins or ensure that the animal protein replaces less healthy components like refined sugars or saturated fats, though even then, risk remains elevated compared to plant-based swaps.