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AHA Plugs 'Dietary Patterns' Over Dietary Cholesterol Targets – TCTMD

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The new science advisory seeks to dispel confusion around the relevance of dietary cholesterol for heart health.

With a flurry of New Year’s resolutions around the corner, a newly released advisory paper from the American Heart Association (AHA) is seeking to dispel lingering confusion over dietary cholesterol intake that may have arisen when specific targets were eliminated in the recent guidelines.

Instead, the document emphasizes that a diet rich in fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds, and liquid vegetable oils is the better bet for promoting cardiovascular health.

Whereas the 2010 Dietary Guidelines for Americans once put a limit on the consumption of dietary cholesterol at less than 300 mg/day, the 2016 update removed this specific threshold and shifted focus to more general healthy eating patterns.

“A recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health,” write Jo Ann S. Carson, PhD, RDN (University of Texas Southwestern Medical Center, Dallas), and colleagues in their review paper published online in Circulation.

“There’s just a lot of confusion out there,” Andrew M. Freeman, MD (National Jewish Health, Denver, CO), who was not involved with the document, told TCTMD, calling the 300-mg cholesterol limit “arbitrary.”

“A lot of people interpreted that as you can have a free for all and eat whatever you want, and that’s obviously that’s not what the message was,” he said. “You still have to eat well, and diets that are heart healthy are naturally low in cholesterol. So that’s the key message there.” What has complicated matters in the interim is that a variety of food industries have spun the removal of the specific cholesterol threshold to mean people can eat however much of a once-limited food item they want, Freeman added.

Stop Counting, Think Holistically

In the paper, Carson and colleagues outline all of the contemporary studies looking at dietary cholesterol as well as egg consumption and cardiovascular risk, including a meta-analysis published in March showing a positive association (HR 1.17; 95% CI, 1.09-1.26). They note some discrepancies in the literature, but ultimately conclude that it “is difficult to distinguish between the effect of dietary cholesterol per se and the effect of dietary patterns high in cholesterol or saturated fat, for example, sausage or bacon eaten with eggs.”

There’s just a lot of confusion out there. Andrew M. Freeman

Additionally, studying dietary cholesterol can be complicated by the type of dietary fat included, they write. “In many intervention studies, the fatty acid composition of the diets was not matched; likewise, because the majority of observational studies do not adjust for saturated, monounsaturated, and polyunsaturated fat, it can be difficult to distinguish between the independent effects of dietary cholesterol and dietary fat type.”

There are two aspects of diet that cannot be ignored when considering the relationship between dietary cholesterol and risk of cardiovascular disease, the authors conclude. “First, most foods contributing cholesterol to the US diet are usually high in saturated fat or consumed with foods high in saturated fat. Second, heart-healthy dietary patterns (eg, Mediterranean-style and DASH-style diets) are inherently low in cholesterol, with typical menus containing < 300 mg/d cholesterol, similar to the current US intake.”

Freeman added that there are variations in metabolisms among people, giving the example that some can eat eggs without increasing their cholesterol and others have trouble doing so. “There are some studies from a long time ago that basically showed that if you’re eating a standard American diet and you add a few eggs, your overall cholesterol number may not go up very much,” he said. “But if you’re not used to eating that amount and then you suddenly eat some, your cholesterol can go up quite a bit, and I think that’s the distinction.”

Ultimately, “it’s not so important to count the amount of cholesterol that one’s consuming, . . . but there does seem to be an increased risk of cardiovascular events when people are consuming lots of eggs,” Freeman said.

For physicians advising patients with known cardiovascular disease, “the evidence to date, at least in my mind, still significantly pushes us toward a predominantly low fat, whole food, plant-based diet,” he concluded. “And then if you have a patient that’s particularly high risk, you might really want to push them to being very, very strict and not having lots of shellfish or eggs or whatever it may be.”

 

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Mass COVID-19 vaccinations to begin in Montreal as province ramps up effort – WellandTribune.ca

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MONTREAL – Quebec’s mass vaccination campaign gets underway in earnest in the Montreal area today as the province begins inoculating members of the general public.

The province announced last week that it was booking appointments for seniors age 85 and up across the province, or 80 and above in Montreal.

Quebec began accepting appointments last Thursday, with nearly 100,000 booked on Day One of the campaign.

Some regions started vaccinating members of the general population late last week, but the campaign is expected to speed up considerably with the opening of mass vaccine clinics in the Montreal area, including one at the Olympic Stadium.

Outlying regions are mainly expected to ramp up after the March break holiday, which gets underway today.

Quebec has so far concentrated its vaccination effort on health care workers, people living in remote regions and seniors in closed environments such as long-term care and private seniors residences.

The province has chosen to delay giving second doses in favour of administering a first jab to as many people as possible, but the province’s health minister said last week it will dole out second doses beginning March 15.

Quebec Premier Francois Legault said Saturday that the start of the mass vaccination campaign was giving him “a lot of hope,” even as he expressed concern about spring break week and the spread of new virus variants.

In a Facebook message, he urged Quebecers to remain vigilant for the coming weeks to allow the province to vaccinate more people, and to wait for immunity to fully develop in those who have received a shot.

This report by The Canadian Press was first published March 1, 2021.

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Mass COVID-19 vaccinations to begin in Montreal as province ramps up effort – Sudbury.com

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MONTREAL — Quebec’s mass vaccination campaign gets underway in earnest in the Montreal area today as the province begins inoculating members of the general public.

The province announced last week that it was booking appointments for seniors age 85 and up across the province, or 80 and above in Montreal.

Quebec began accepting appointments last Thursday, with nearly 100,000 booked on Day One of the campaign.

Some regions started vaccinating members of the general population late last week, but the campaign is expected to speed up considerably with the opening of mass vaccine clinics in the Montreal area, including one at the Olympic Stadium.

Outlying regions are mainly expected to ramp up after the March break holiday, which gets underway today.

Quebec has so far concentrated its vaccination effort on health care workers, people living in remote regions and seniors in closed environments such as long-term care and private seniors residences.

The province has chosen to delay giving second doses in favour of administering a first jab to as many people as possible, but the province’s health minister said last week it will dole out second doses beginning March 15.

Quebec Premier Francois Legault said Saturday that the start of the mass vaccination campaign was giving him “a lot of hope,” even as he expressed concern about spring break week and the spread of new virus variants.

In a Facebook message, he urged Quebecers to remain vigilant for the coming weeks to allow the province to vaccinate more people, and to wait for immunity to fully develop in those who have received a shot. 

This report by The Canadian Press was first published March 1, 2021.

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From lockdowns to spring break, provinces split on next steps in COVID-19 fight – CP24 Toronto's Breaking News

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Canada’s COVID-19 hotspots showed diverging approaches to handling the crisis on Sunday, as Ontario and Prince Edward Island prepared for new lockdowns while Quebec entered a week of spring break complete with some activities meant to ease the monotony of life during a global pandemic.

Prince Edward Island announced it was entering a 72-hour lockdown starting at midnight as the province struggled to contain an outbreak of COVID-19.

The short-term public health order was announced as officials reported five new infections of the disease in a province that has seen few cases for most of the pandemic. The Island has now recorded 17 new infections over the past five days.

Health officials identified two clusters of COVID-19 in the cities of Summerside and Charlottetown, and said it’s possible the island has community spread of the virus. The province has a total of just 132 cases of COVID-19 since the pandemic began.

The three-day lockdown requires residents to stay home as much as possible and will close all kindergarten to Grade 12 schools, with post-secondary education moving online only.

“We would rather go harder and stronger now than wait for an outbreak like we have seen in other provinces that could put us in an extended period of lockdown for weeks or even months,” Premier Dennis King said late Sunday during a briefing with reporters.

Ontario, meanwhile, passed the 300,000 case mark on Sunday as the government prepared to hit a so-called ’emergency brake’ in two northern public health units grappling with surging case numbers.

The Thunder Bay and Simcoe-Muskoka District health units will enter the lockdown phase of the province’s pandemic response plan on Monday in order interrupt transmission of COVID-19 at a time when new variants are gaining steam.

The province has also pushed back its spring break until April in an effort to limit community spread.

Quebec, in contrast, has allowed movie theatres, pools and arenas to open with restrictions in place to give families something to do as the traditional winter break kicks off, even as most other health rules remain in place.

The province opted to allow students and teachers the traditional March break, even though Premier Francois Legault has said he’s worried about the week off and the threat posed by more contagious virus variants.

Quebec’s health minister said the situation in the province was stable on Sunday, with 737 new cases and nine additional deaths – even as confirmed cases linked to variants of concern jumped by more than 100 to 137.

Most of the variant cases have been identified as the B.1.1.7 mutation first identified in the United Kingdom, including 84 in Montreal.

Ontario, meanwhile, reported 1,062 new infections linked to the pandemic on Sunday as it became the first province to record more than 300,000 total cses of COVID-19 since the onset of the pandemic.

The country’s chief public health officer urged Canadians on Sunday to continue following public health measures as a way of buying critical time as vaccine programs ramp up.

“Aiming to have the fewest interactions with the fewest number of people, for the shortest time, at the greatest distance possible is a simple rule that we can all apply to help limit the spread of COVID-19,” Dr. Theresa Tam said in a statement.

Canada’s immunization program received a boost last week with the approval of a third COVID-19 vaccine, raising hopes that provinces will be able to inoculate their most vulnerable populations before the more contagious variants can fully take hold.

Toronto announced Sunday that it was expanding the first phase of its COVID-19 vaccination drive to include residents experiencing homelessness, noting that they have a higher risk of serious health impacts due to COVID-19 and are vulnerable to transmission in congregate settings.

Quebec, meanwhile, is set to begin vaccination of the general population on Monday, beginning with seniors 80 and over in the Montreal area, or 85 and over in the rest of the province.

While some regions with extra doses began administering shots late last week, the pace of inoculation will ramp up on Monday when mass vaccination clinics in Montreal throw open their doors.

Case counts were more stable elsewhere in the country.

Manitoba reported just 50 new COVID-19 infections on Sunday and two new virus-related deaths, while Saskatchewan saw its overall tally climb by 181 but did not log any new deaths.

Alberta reported three new virus-related deaths and 301 new infections, including 29 identified as variants of concern.

In Atlantic Canada, Nova Scotia logged three new cases while officials in Newfoundland and Labrador reported seven.

This report by The Canadian Press was first published Feb. 28, 2021

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