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2. A Switched-Capacitor and Series-Resonant Hybrid MHz DCX in Data Center Applications

Author

Liang, Jiawei, Wang, Liang, Liang, Junrui, Fu, Minfan, Long, Teng, and Wang, Haoyu

Abstract

In the front-end of two-stage voltage regulator modules in 48 V-based data centers, a dc transformer (DCX) is required to convert the 48 V bus to an intermediate voltage with a fixed buck ratio. In this article, we present a novel switched-capacitor and series-resonant hybrid DCX specifically for this application. The proposed DCX combines a 2:1 resonant switched-capacitor cell with a series-resonant converter, enabling a conversion ratio of 4n:1 with an n:1 transformer. It demonstrates excellent soft-charging and soft-switching performances, effectively mitigating the switching loss. Furthermore, zero-voltage switching does not rely on the transformer's magnetizing current. Therefore, the magnetizing inductance can be optimized to improve the efficiency and to facilitate a simplified magnetic design. Theoretical analysis, design considerations, and topology comparison are provided to showcase the advantages of the proposed topology. A 1 MHz, 300 W-rated, 48 V to 12 V converter prototype is designed and tested. Experimental results well validate the concept with a 97.23% peak efficiency.

Published
2024
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3. A Self-Sensing Synchronous Switch Circuit for Bidirectional Piezoelectric Energy Conversion

Author

Gao, Linglong, Teng, Li, Wang, Haoyu, Liu, Yu, Fu, Minfan, and Liang, Junrui

Abstract

Piezoelectric materials are versatile and widely used in many industrial applications. As a compact electromechanical transducer, a piezoelectric device not only transforms energy in either electrical-to-mechanical or mechanical-to-electrical directions but also conveys the deformation information into a measurable electrical signal. In most of the existing engineering designs, only one of the energy transformations or information-sensing functions is utilized. The interface circuit is the major obstacle against the integration of all these functions into a multifunctional application. This article explores the possibility of encapsulating all the sensing and bidirectional energy transformation functions in a single piezoelectric device by introducing a switched-mode synchronous switch interface circuit. Such a multifunctional design is realized with a multibranch modified buck–boost converter working under strong discontinuous conduction mode (DCM). The three functions operate in a time-sharing way; therefore, the information acquisition and energy transformation processes can be decoupled. In the experiment, we implement a prototyped self-sensing synchronous switch bidirectional energy conversion circuit (BECC) for energy harvesting and vibration excitation purposes. It samples the piezoelectric voltage at a rate of 500 Hz and successfully carries out the energy transformation tasks according to the software instructions. The switched-mode self-sensing BECC (SS-BECC) provides unprecedented convenience for the design of future multifunctional and miniaturized piezoelectric devices.

Published
2024
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15. A Dual-Mode Wireless Charger Based on Cascaded Rectifier and Hybrid Compensation

Author

Li, Zhongchang, Ning, Guangdong, Zhao, Kai, Wang, Haoyu, Liu, Yu, and Fu, Minfan

Abstract

A dual-mode wireless charger is developed by using hybrid compensations and cascaded rectifiers. The proposed system functions as a constant voltage source with passive overload protection. The AC characteristics of the resonant tank are analyzed through a circuit model, enabling the derivation of the critical load resistance and explanation of the working mechanism of normal and protection modes. Experimental results are presented to justify the voltage variation, efficiency characteristics, and dynamic response. The demonstrated 30-W system achieves a stable output voltage and 92% efficiency. Furthermore, overload protection is naturally enabled with fast transients (27 ms). Overall, the proposed system offers an efficient and reliable solution for wireless charging with passive overload protection.

Published
2024
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16. Decoupled State-Plane Analysis of Series–Series Compensated Bidirectional IPT Systems

Author

Xue, Bo, Wang, Liang, Zhao, Peng, Fu, Minfan, Liang, Junrui, and Wang, Haoyu

Abstract

In series–series compensated bidirectional inductive power transfer systems, the resonant currents are cross coupled due to the influence of multiresonant elements. This makes it difficult to analyze the system behavior using conventional state-plane analysis (SPA) method. To address this challenge, a novel decoupled SPA approach is proposed. It establishes two decoupled equivalent circuits and corresponding state-plane trajectories by decoupling the coupling coil model. Thus, resonant voltages and currents in switching instants can be derived. In addition, the zero-voltage-switching (ZVS) range with different phase shifts and frequency ratios can be determined, and the rms currents of coils can be analyzed quantitatively. To validate the proposed model, a 400-W-rated laboratory prototype is designed and tested. The experimental results align well with the theoretical predictions, and confirm the ZVS among all mosfets. The proposed method is universal and can be used to analyze other compensation networks.

Published
2024
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30. Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data

Author

Marjan W Attaei, MA, Rasha Khatib, PhD, Prof Martin McKee, DSc, Prof Scott Lear, PhD, Prof Gilles Dagenais, MD, Ehimario U Igumbor, PhD, Khalid F AlHabib, MD, Prof Manmeet Kaur, PhD, Lanthe Kruger, PhD, Prof Koon Teo, PhD, Fernando Lanas, MD, Khalid Yusoff, MD, Aytekin Oguz, MD, Prof Rajeev Gupta, PhD, Afzalhussein M Yusufali, MD, Ahmad Bahonar, MD, Prof Raman Kutty, MD, Prof Annika Rosengren, MD, Prof Viswanathan Mohan, DSc, Prof Alvaro Avezum, PhD, Prof Rita Yusuf, PhD, Prof Andrzej Szuba, PhD, Sumathy Rangarajan, MSc, Clara Chow, PhD, Prof Salim Yusuf, DPhil, S Yusuf, S Rangarajan, K K Teo, C K Chow, M O'Donnell, A Mente, D Leong, A Smyth, P Joseph, S Islam, M Zhang, W Hu, C Ramasundarahettige, G Wong, L Dayal, A Casanova, M Dehghan, G Lewis, A Aliberti, A Reyes, A Zaki, B Lewis, B Zhang, D Agapay, D Hari, E Milazzo, E Ramezani, F Hussain, F Shifaly, I Kay, J Rimac, J Swallow, L Heldman, M(a) Mushtaha, M(o) Mushtaha, M Trottier, N Aoucheva, N Kandy, P Mackie, R Solano, S Chin, S Ramacham, S Shahrook, S Trottier, T Tongana, W ElSheikh, J Lindeman, M McQueen, K Hall, J Keys, X Wang, J Keneth, A Devanath, R Diaz, A Orlandini, B Linetsky, S Toscanelli, G Casaccia, JM Maini Cuneo, O Rahman, R Yusuf, AK Azad, KA Rabbani, HM Cherry, A Mannan, I Hassan, AT Talukdar, RB Tooheen, MU Khan, M Sintaha, T Choudhury, R Haque, S Parvin, A Avezum, GB Oliveira, CS Marcilio, AC Mattos, K Teo, J Dejesus, W Elsheikh, G Dagenais, P Poirier, G Turbide, D Auger, A LeBlanc De Bluts, MC Proulx, M Cayer, N Bonneville, S Lear, D Gasevic, E Corber, V de Jong, I Vukmirovich, A Wielgosz, G Fodor, A Pipe, A Shane, F Lanas, P Seron, S Martinez, A Valdebenito, M Oliveros, Li Wei, Liu Lisheng, Chen Chunming, Wang Xingyu, Zhao Wenhua, Zhang Hongye, JiaXuan, Hu Bo, Sun Yi, Bo Jian, Zhao Xiuwen, Chang Xiaohong, Chen Tao, Chen Hui, Deng Qing, Cheng Xiaoru, He Xinye, Li Jian, Li Juan, Liu Xu, Ren Bing, Wang Wei, Wang Yang, Yang Jun, Zhai Yi, Zhu Manlu, Lu Fanghong, Wu Jianfang, Li Yindong, Hou Yan, Zhang Liangqing, Guo Baoxia, Liao Xiaoyang, Zhang Shiying, BianRongwen, TianXiuzhen, Li Dong, Chen Di, Wu Jianguo, Xiao Yize, Liu Tianlu, Zhang Peng, Dong Changlin, Li Ning, Ma Xiaolan, Yang Yuqing, Lei Rensheng, Fu Minfan, He Jing, Liu Yu, Xing Xiaojie, Zhou Qiang, P Lopez-Jaramillo, PA Camacho Lopez, R Garcia, LJA Jurado, D Gómez-Arbeláez, JF Arguello, R Dueñas, S Silva, LP Pradilla, F Ramirez, DI Molina, C Cure-Cure, M Perez, E Hernandez, E Arcos, S Fernandez, C Narvaez, J Paez, A Sotomayor, H Garcia, G Sanchez, T David, A Rico, P Mony, M Vaz, A V Bharathi, S Swaminathan, K Shankar, AV Kurpad, KG Jayachitra, N Kumar, HAL Hospital, V Mohan, M Deepa, K Parthiban, M Anitha, S Hemavathy, T Rahulashankiruthiyayan, D Anitha, K Sridevi, R Gupta, RB Panwar, I Mohan, P Rastogi, S Rastogi, R Bhargava, R Kumar, J S Thakur, B Patro, PVM Lakshmi, R Mahajan, P Chaudary, V Raman Kutty, K Vijayakumar, K Ajayan, G Rajasree, AR Renjini, A Deepu, B Sandhya, S Asha, HS Soumya, R Kelishadi, A Bahonar, N Mohammadifard, H Heidari, K Yusoff, TST Ismail, KK Ng, A Devi, NM Nasir, MM Yasin, M Miskan, EA Rahman, MKM Arsad, F Ariffin, SA Razak, FA Majid, NA Bakar, MY Yacob, N Zainon, R Salleh, MKA Ramli, NA Halim, SR Norlizan, NM Ghazali, MN Arshad, R Razali, S Ali, HR Othman, CWJCW Hafar, A Pit, N Danuri, F Basir, SNA Zahari, H Abdullah, MA Arippin, NA Zakaria, I Noorhassim, MJ Hasni, MT Azmi, MI Zaleha, KY Hazdi, AR Rizam, W Sazman, A Azman, R Khatib, U Khammash, A Khatib, R Giacaman, R Iqbal, A Afridi, R Khawaja, A Raza, K Kazmi, A Dans, HU Co, JT Sanchez, L Pudol, C Zamora-Pudol, LAM Palileo-Villanueva, MR Aquino, C Abaquin, SL Pudol, ML Cabral, W Zatonski, A Szuba, K Zatonska, R Ilow#, M Ferus, B Regulska-Ilow, D Różańska, M Wolyniec, KF AlHabib, A Hersi, T Kashour, H Alfaleh, M Alshamiri, HB Altaradi, O Alnobani, A Bafart, N Alkamel, M Ali, M Abdulrahman, R Nouri, A Kruger, H H Voster, A E Schutte, E Wentzel-Viljoen, FC Eloff, H de Ridder, H Moss, J Potgieter, AA Roux, M Watson, G de Wet, A Olckers, JC Jerling, M Pieters, T Hoekstra, T Puoane, E Igumbor, L Tsolekile, D Sanders, P Naidoo, N Steyn, N Peer, B Mayosi, B Rayner, V Lambert, N Levitt, T Kolbe-Alexander, L Ntyintyane, G Hughes, R Swart, J Fourie, M Muzigaba, S Xapa, N Gobile, K Ndayi, B Jwili, K Ndibaza, B Egbujie, A Rosengren, K Bengtsson Boström, U Lindblad, P Langkilde, A Gustavsson, M Andreasson, M Snällman, L Wirdemann, K Pettersson, E Moberg, K Yeates, J Sleeth, K Kilonzo, A Oguz, AAK Akalin, KBT Calik, N Imeryuz, A Temizhan, E Alphan, E Gunes, H Sur, K Karsidag, S Gulec, Y Altuntas, AM Yusufali, W Almahmeed, H Swidan, EA Darwish, ARA Hashemi, N Al-Khaja, JM Muscat-Baron, SH Ahmed, TM Mamdouh, WM Darwish, MHS Abdelmotagali, SA Omer Awed, GA Movahedi, H Al Shaibani, RIM Gharabou, DF Youssef, AZS Nawati, ZAR Abu Salah, RFE Abdalla, SM Al Shuwaihi, MA Al Omairi, OD Cadigal, R.S. Alejandrino, J Chifamba, L Gwaunza, G Terera, C Mahachi, P Murambiwa, T Machiweni, and R Mapanga

Subjects
Public aspects of medicine, RA1-1270
Abstract

Background: Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. Methods: We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level. Findings: The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had all four drug classes available were more likely to use at least one blood pressure-lowering medicine (adjusted odds ratio [OR] 2·23, 95% CI 1·59–3·12); p

Published
2017
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31. H5-Bridge-Based Bowl-Shape Wireless Charger for Multiple Loads

Author

Zhao, Peng, Ji, Xiaoxuan, Wang, Haoyu, and Fu, Minfan

Abstract

This article proposes a five-coil bowl-shape wireless charger based on an H5 bridge inverter. Inside the bowl, the five coils are customized and placed at different charging areas, which are able to offer two power channels for fast charging and multiload charging, respectively. A five-switch H5 bridge inverter is used to feed the optimal voltage through its multimode operation, which helps enhance the efficiency under various load conditions. The zero voltage switching is discussed for all the switches and achieved under the worst case, which is justified by the harmonic analysis. Finally, a 50-W experimental prototype is built and measured under various load conditions, and the peak charging efficiency is 88%.

Published
2023
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46. Omnidirectional wireless power transfer system

Author

Virginia Tech Intellectual Properties, Inc., Fu, Minfan, Lee, Fred C., Li, Qiang, Feng, Junjie, Virginia Tech Intellectual Properties, Inc., Fu, Minfan, Lee, Fred C., Li, Qiang, and Feng, Junjie

Abstract

In one example, an omnidirectional wireless power transfer system includes high frequency power generator configured to generate a supply of high frequency oscillating power, a number of transmitter-side resonant tank circuits electrically coupled to the high frequency power generator, a receptacle including a number of coils arranged for omnidirectional power transfer to an electronic device placed in the receptacle, and a controller configured to activate individual ones of the transmitter-side resonant tank circuits to wirelessly transmit power to the electronic device through near-field resonant inductive coupling. In one example, the receptacle can be embodied as a bowl, and the controller can activate individual ones of the transmitter-side resonant tank circuits over time to generate an omnidirectional field distribution for wireless power transmission. In other aspects, various transmitter-side and receiver-side tank circuits for coupling independent resonance and ZVS operation are described.

Published
2019

49. Association of dietary nutrients with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study

Author

Andrew Mente, Mahshid Dehghan, Sumathy Rangarajan, Matthew McQueen, Gilles Dagenais, Andreas Wielgosz, Scott Lear, Wei Li, Hui Chen, Sun Yi, Yang Wang, Rafael Diaz, Alvaro Avezum, Patricio Lopez-Jaramillo, Pamela Seron, Rajesh Kumar, Rajeev Gupta, Viswanathan Mohan, Sumathi Swaminathan, Raman Kutty, Katarzyna Zatonska, Romaina Iqbal, Rita Yusuf, Noushin Mohammadifard, Rasha Khatib, Nafiza Mat Nasir, Noorhassim Ismail, Aytekin Oguz, Annika Rosengren, Afzalhussein Yusufali, Edelweiss Wentzel-Viljoen, Thandi Puoane, Jephat Chifamba, Koon Teo, Sonia S Anand, Salim Yusuf, S Yusuf, S Rangarajan, K K Teo, C K Chow, M O'Donnell, A Mente, D Leong, A Smyth, P Joseph, A Merchant, S Islam, M Zhang, W Hu, C Ramasundarahettige, G Wong, S Bangdiwala, L Dyal, A Casanova, M Dehghan, G Lewis, A Aliberti, A Arshad, A Reyes, A Zaki, B Lewis, B Zhang, D Agapay, D Hari, E Milazzo, E Ramezani, F Hussain, F Shifaly, G McAlpine, I Kay, J Lindeman, J Rimac, J Swallow, L Heldman, M(a) Mushtaha, M(o) Mushtaha, M Trottier, M Riggi, N Aoucheva, N Kandy, P Mackie, R Solano, S Chin, S Ramacham, S Shahrook, S Trottier, T Tongana, W ElSheikh, Y Iyengar, M McQueen, K Hall, J Keys, X Wang, J Keneth, A Devanath, R Diaz, A Orlandini, B Linetsky, S Toscanelli, G Casaccia, JM Maini Cuneo, O Rahman, R Yusuf, AK Azad, KA Rabbani, HM Cherry, A Mannan, I Hassan, AT Talukdar, RB Tooheen, MU Khan, M Sintaha, T Choudhury, R Haque, S Parvin, A Avezum, GB Oliveira, CS Marcilio, AC Mattos, K Teo, J Dejesus, W Elsheikh, G Dagenais, P Poirier, G Turbide, D Auger, A LeBlanc De Bluts, MC Proulx, M Cayer, N Bonneville, S Lear, D Gasevic, E Corber, V de Jong, I Vukmirovich, A Wielgosz, G Fodor, A Pipe, A Shane, F Lanas, P Seron, S Martinez, A Valdebenito, M Oliveros, Li Wei, Liu Lisheng, Chen Chunming, Wang Xingyu, Zhao Wenhua, Zhang Hongye, Jia Xuan, Hu Bo, Bo Jian, Zhao Xiuwen, Chang Xiaohong, Chen Tao, Chen Hui, Deng Qing, Cheng Xiaoru, He Xinye, Li Jian, Li Juan, Liu Xu, Ren Bing, Wang Wei, Wang Yang, Yang Jun, Zhai Yi, Zhu Manlu, Lu Fanghong, Wu Jianfang, Li Yindong, Hou Yan, Zhang Liangqing, Guo Baoxia, Liao Xiaoyang, Zhang Shiying, Bian Rongwen, Tian Xiuzhen, Li Dong, Chen Di, Wu Jianguo, Xiao Yize, Liu Tianlu, Zhang Peng, Dong Changlin, Li Ning, Ma Xiaolan, Yang Yuqing, Lei Rensheng, Fu Minfan, He Jing, Liu Yu, Xing Xiaojie, Zhou Qiang, P Lopez-Jaramillo, PA Camacho Lopez, R Garcia, LJA Jurado, D Gómez-Arbeláez, JF Arguello, R Dueñas, S Silva, LP Pradilla, F Ramirez, DI Molina, C Cure-Cure, M Perez, E Hernandez, E Arcos, S Fernandez, C Narvaez, J Paez, A Sotomayor, H Garcia, G Sanchez, T David, A Rico, P Mony, M Vaz, A V Bharathi, S Swaminathan, K Shankar AV Kurpad, KG Jayachitra, N Kumar, HAL Hospital, V Mohan, M Deepa, K Parthiban, M Anitha, S Hemavathy, T Rahulashankiruthiyayan, D Anitha, K Sridevi, R Gupta, RB Panwar, I Mohan, P Rastogi, S Rastogi, R Bhargava, R Kumar, J S Thakur, B Patro, PVM Lakshmi, R Mahajan, P Chaudary, V Raman Kutty, K Vijayakumar, K Ajayan, G Rajasree, AR Renjini, A Deepu, B Sandhya, S Asha, HS Soumya, R Kelishadi, A Bahonar, N Mohammadifard, H Heidari, K Yusoff, TST Ismail, KK Ng, A Devi, NM Nasir, MM Yasin, M Miskan, EA Rahman, MKM Arsad, F Ariffin, SA Razak, FA Majid, NA Bakar, MY Yacob, N Zainon, R Salleh, MKA Ramli, NA Halim, SR Norlizan, NM Ghazali, MN Arshad, R Razali, S Ali, HR Othman, CWJCW Hafar, A Pit, N Danuri, F Basir, SNA Zahari, H Abdullah, MA Arippin, NA Zakaria, I Noorhassim, MJ Hasni, MT Azmi, MI Zaleha, KY Hazdi, AR Rizam, W Sazman, A Azman, R Khatib, U Khammash, A Khatib, R Giacaman, R Iqbal, A Afridi, R Khawaja, A Raza, K Kazmi, A Dans, HU Co, JT Sanchez, L Pudol, C Zamora-Pudol, LAM Palileo-Villanueva, MR Aquino, C Abaquin, SL Pudol, ML Cabral, W Zatonski, A Szuba, K Zatonska, R Ilow, M Ferus, B Regulska-Ilow, D Rózanska, M Wolyniec, KF AlHabib, A Hersi, T Kashour, H Alfaleh, M Alshamiri, HB Altaradi, O Alnobani, A Bafart, N Alkamel, M Ali, M Abdulrahman, R Nouri, A Kruger, H H Voster, A E Schutte, E Wentzel-Viljoen, FC Eloff, H de Ridder, H Moss, J Potgieter, AA Roux, M Watson, G de Wet, A Olckers, JC Jerling, M Pieters, T Hoekstra, T Puoane, E Igumbor, L Tsolekile, D Sanders, P Naidoo, N Steyn, N Peer, B Mayosi, B Rayner, V Lambert, N Levitt, T Kolbe-Alexander, L Ntyintyane, G Hughes, R Swart, J Fourie, M Muzigaba, S Xapa, N Gobile, K Ndayi, B Jwili, K Ndibaza, B Egbujie, A Rosengren, K Bengtsson Boström, A Gustavsson, M Andreasson, M Snällman, L Wirdemann, K Yeates, J Sleeth, K Kilonzo, A Oguz, N Imeryuz, Y Altuntas, S Gulec, A Temizhan, K Karsidag, KBT Calik, AAK Akalin, OT Caklili, MV Keskinler, AN Erbakan, AM Yusufali, W Almahmeed, H Swidan, EA Darwish, ARA Hashemi, N Al-Khaja, JM Muscat-Baron, SH Ahmed, TM Mamdouh, WM Darwish, MHS Abdelmotagali, SA Omer Awed, GA Movahedi, H Al Shaibani, RIM Gharabou, DF Youssef, AZS Nawati, ZAR Abu Salah, RFE Abdalla, SM Al Shuwaihi, MA Al Omairi, OD Cadigal, R.S. Alejandrino, J Chifamba, L Gwaunza, G Terera, C Mahachi, P Murambiwa, T Machiweni, and R Mapanga

Subjects
Male, medicine.medical_specialty, Apolipoprotein B, Endocrinology, Diabetes and Metabolism, Blood lipids, Blood Pressure, 030204 cardiovascular system & hematology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, High-density lipoprotein, Risk Factors, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Dietary Carbohydrates, Humans, 030212 general & internal medicine, chemistry.chemical_classification, biology, Cholesterol, business.industry, medicine.disease, Dietary Fats, Lipids, Diet, Cross-Sectional Studies, chemistry, Cardiovascular Diseases, Saturated fatty acid, biology.protein, lipids (amino acids, peptides, and proteins), Apolipoprotein A1, Female, business, Biomarkers, Polyunsaturated fatty acid
Abstract

Summary Background The relation between dietary nutrients and cardiovascular disease risk markers in many regions worldwide is unknown. In this study, we investigated the effect of dietary nutrients on blood lipids and blood pressure, two of the most important risk factors for cardiovascular disease, in low-income, middle-income, and high-income countries. Methods We studied 125 287 participants from 18 countries in North America, South America, Europe, Africa, and Asia in the Prospective Urban Rural Epidemiology (PURE) study. Habitual food intake was measured with validated food frequency questionnaires. We assessed the associations between nutrients (total fats, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, carbohydrates, protein, and dietary cholesterol) and cardiovascular disease risk markers using multilevel modelling. The effect of isocaloric replacement of saturated fatty acids with other fats and carbohydrates was determined overall and by levels of intakes by use of nutrient density models. We did simulation modelling in which we assumed that the effects of saturated fatty acids on cardiovascular disease events was solely related to their association through an individual risk marker, and then compared these simulated risk marker-based estimates with directly observed associations of saturated fatty acids with cardiovascular disease events. Findings Participants were enrolled into the study from Jan 1, 2003, to March 31, 2013. Intake of total fat and each type of fat was associated with higher concentrations of total cholesterol and LDL cholesterol, but also with higher HDL cholesterol and apolipoprotein A1 (ApoA1), and lower triglycerides, ratio of total cholesterol to HDL cholesterol, ratio of triglycerides to HDL cholesterol, and ratio of apolipoprotein B (ApoB) to ApoA1 (all p trend trend trend =0·0014]). Higher intakes of total fat, saturated fatty acids, and carbohydrates were associated with higher blood pressure, whereas higher protein intake was associated with lower blood pressure. Replacement of saturated fatty acids with carbohydrates was associated with the most adverse effects on lipids, whereas replacement of saturated fatty acids with unsaturated fats improved some risk markers (LDL cholesterol and blood pressure), but seemed to worsen others (HDL cholesterol and triglycerides). The observed associations between saturated fatty acids and cardiovascular disease events were approximated by the simulated associations mediated through the effects on the ApoB-to-ApoA1 ratio, but not with other lipid markers including LDL cholesterol. Interpretation Our data are at odds with current recommendations to reduce total fat and saturated fats. Reducing saturated fatty acid intake and replacing it with carbohydrate has an adverse effect on blood lipids. Substituting saturated fatty acids with unsaturated fats might improve some risk markers, but might worsen others. Simulations suggest that ApoB-to-ApoA1 ratio probably provides the best overall indication of the effect of saturated fatty acids on cardiovascular disease risk among the markers tested. Focusing on a single lipid marker such as LDL cholesterol alone does not capture the net clinical effects of nutrients on cardiovascular risk. Funding Full funding sources listed at the end of the paper (see Acknowledgments).

Published
2017

50. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study

Author

Victoria Miller, Andrew Mente, Mahshid Dehghan, Sumathy Rangarajan, Xiaohe Zhang, Sumathi Swaminathan, Gilles Dagenais, Rajeev Gupta, Viswanathan Mohan, Scott Lear, Shrikant I Bangdiwala, Aletta E Schutte, Edelweiss Wentzel-Viljoen, Alvaro Avezum, Yuksel Altuntas, Khalid Yusoff, Noorhassim Ismail, Nasheeta Peer, Jephat Chifamba, Rafael Diaz, Omar Rahman, Noushin Mohammadifard, Fernando Lana, Katarzyna Zatonska, Andreas Wielgosz, Afzalhussein Yusufali, Romaina Iqbal, Patricio Lopez-Jaramillo, Rasha Khatib, Annika Rosengren, V Raman Kutty, Wei Li, Jiankang Liu, Xiaoyun Liu, Lu Yin, Koon Teo, Sonia Anand, Salim Yusuf, R Diaz, A Orlandini, B Linetsky, S Toscanelli, G Casaccia, JM Maini Cuneo, O Rahman, R Yusuf, AK Azad, KA Rabbani, HM Cherry, A Mannan, I Hassan, AT Talukdar, RB Tooheen, MU Khan, M Sintaha, T Choudhury, R Haque, S Parvin, A Avezum, GB Oliveira, CS Marcilio, AC Mattos, K Teo, S Yusuf, J Dejesus, D Agapay, T Tongana, R Solano, I Kay, S Trottier, J Rimac, W Elsheikh, L Heldman, E Ramezani, G Dagenais, P Poirier, G Turbide, D Auger, A LeBlanc De Bluts, MC Proulx, M Cayer, N Bonneville, S Lear, D Gasevic, E Corber, V de Jong, I Vukmirovich, A Wielgosz, G Fodor, A Pipe, A Shane, F Lanas, P Seron, S Martinez, A Valdebenito, M Oliveros, Li Wei, Liu Lisheng, Chen Chunming, Wang Xingyu, Zhao Wenhua, Zhang Hongye, Jia Xuan, Hu Bo, Sun Yi, Bo Jian, Zhao Xiuwen, Chang Xiaohong, Chen Tao, Chen Hui, Deng Qing, Cheng Xiaoru, He Xinye, Li Jian, Li Juan, Liu Xu, Ren Bing, Wang Wei, Wang Yang, Yang Jun, Zhai Yi, Zhu Manlu, Lu Fanghong, Wu Jianfang, Li Yindong, Hou Yan, Zhang Liangqing, Guo Baoxia, Liao Xiaoyang, Zhang Shiying, Bian Rongwen, Tian Xiuzhen, Li Dong, Chen Di, Wu Jianguo, Xiao Yize, Liu Tianlu, Zhang Peng, Dong Changlin, Li Ning, Ma Xiaolan, Yang Yuqing, Lei Rensheng, Fu Minfan, He Jing, Liu Yu, Xing Xiaojie, Zhou Qiang, P Lopez-Jaramillo, PA Camacho Lopez, R Garcia, LJA Jurado, D Gómez-Arbeláez, JF Arguello, R Dueñas, S Silva, LP Pradilla, F Ramirez, DI Molina, C Cure-Cure, M Perez, E Hernandez, E Arcos, S Fernandez, C Narvaez, J Paez, A Sotomayor, H Garcia, G Sanchez, T David, A Rico, P Mony, M Vaz, A V Bharathi, S Swaminathan, K Shankar AV Kurpad, KG Jayachitra, N Kumar, HAL Hospital, V Mohan, M Deepa, K Parthiban, M Anitha, S Hemavathy, T Rahulashankiruthiyayan, D Anitha, K Sridevi, R Gupta, RB Panwar, I Mohan, P Rastogi, S Rastogi, R Bhargava, R Kumar, J S Thakur, B Patro, PVM Lakshmi, R Mahajan, P Chaudary, K Vijayakumar, K Ajayan, G Rajasree, AR Renjini, A Deepu, B Sandhya, S Asha, HS Soumya, R Kelishadi, A Bahonar, N Mohammadifard, H Heidari, K Yusoff, TST Ismail, KK Ng, A Devi, NM Nasir, MM Yasin, M Miskan, EA Rahman, MKM Arsad, F Ariffin, SA Razak, FA Majid, NA Bakar, MY Yacob, N Zainon, R Salleh, MKA Ramli, NA Halim, SR Norlizan, NM Ghazali, MN Arshad, R Razali, S Ali, HR Othman, CWJCW Hafar, A Pit, N Danuri, F Basir, SNA Zahari, H Abdullah, MA Arippin, NA Zakaria, I Noorhassim, MJ Hasni, MT Azmi, MI Zaleha, KY Hazdi, AR Rizam, W Sazman, A Azman, R Khatib, U Khammash, A Khatib, R Giacaman, R Iqbal, A Afridi, R Khawaja, A Raza, K Kazmi, W Zatonski, A Szuba, K Zatonska, R Ilow, M Ferus, B Regulska-Ilow, D Rózanska, M Wolyniec, null Alkamel, M Ali, M A Kruger, H H Voster, A E Schutte, E Wentzel-Viljoen, FC Eloff, H de Ridder, H Moss, J Potgieter, AA Roux, M Watson, G de Wet, A Olckers, JC Jerling, M Pieters, T Hoekstra, T Puoane, E Igumbor, L Tsolekile, D Sanders, P Naidoo, N Steyn, N Peer, B Mayosi, B Rayner, V Lambert, N Levitt, T Kolbe-Alexander, L Ntyintyane, G Hughes, R Swart, J Fourie, M Muzigaba, S Xapa, N Gobile, K Ndayi, B Jwili, K Ndibaza, B Egbujie, A Rosengren, K Bengtsson Boström, A Gustavsson, M Andreasson, M Snällman, L Wirdemann, A Oguz, N Imeryuz, Y Altuntas, S Gulec, A Temizhan, K Karsidag, KBT Calik, AAK Akalin, OT Caklili, MV Keskinler, AN Erbakan, AM Yusufali, W Almahmeed, H Swidan, EA Darwish, ARA Hashemi, N Al-Khaja, JM Muscat-Baron, SH Ahmed, TM Mamdouh, WM Darwish, MHS Abdelmotagali, SA Omer Awed, GA Movahedi, F Hussain, H Al Shaibani, RIM Gharabou, DF Youssef, AZS Nawati, ZAR Abu Salah, RFE Abdalla, SM Al Shuwaihi, MA Al Omairi, OD Cadigal, R.S. Alejandrino, J Chifamba, L Gwaunza, G Terera, C Mahachi, P Murambiwa, T Machiweni, R Mapanga, 10922180 - Schutte, Aletta Elisabeth, and 10998497 - Wentzel-Viljoen, Edelweiss

Subjects
Gerontology, Adult, Male, medicine.medical_specialty, Internationality, Vegetable, 030204 cardiovascular system & hematology, Lower risk, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Cause of Death, Epidemiology, Vegetables, Confidence Intervals, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Family history, Prospective cohort study, Developing Countries, Cause of death, Aged, Proportional Hazards Models, business.industry, Proportional hazards model, Developed Countries, Hazard ratio, Fabaceae, General Medicine, Feeding Behavior, Middle Aged, Cardiovascular disease, Survival Analysis, Legume, Cardiovascular Diseases, Fruit, Multivariate Analysis, Income, Female, business, Risk Reduction Behavior, Demography, Cohort study
Abstract

13 p., Background The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia. Methods We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE] in 135335 individuals aged 35 to 70 years without cardiovascular disease from 613 communities in 18 low-income, middle-income, and highincome countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease. The follow-up period varied based on the date when recruitment began at each site or country. The main clinical outcomes were major cardiovascular disease (defined as death from cardiovascular causes and non-fatal myocardial infarction, stroke, and heart failure), fatal and non-fatal myocardial infarction, fatal and non-fatal strokes, cardiovascular mortality, non-cardiovascular mortality, and total mortality. Cox frailty models with random effects were used to assess associations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality. Findings Participants were enrolled into the study between Jan 1, 2003, and March 31, 2013. For the current analysis, we included all unrefuted outcome events in the PURE study database through March 31, 2017. Overall, combined mean fruit, vegetable and legume intake was 3·91 (SD 2·77) servings per day. During a median 7·4 years (5·5–9·3) of followup, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented. Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex, and centre (random effect). The estimates were substantially attenuated in the multivariable adjusted models for major cardiovascular disease (hazard ratio [HR] 0·90, 95% CI 0·74–1·10, ptrend=0·1301), myocardial infarction (0·99, 0·74–1·31; ptrend=0·2033), stroke (0·92, 0·67–1·25; ptrend=0·7092), cardiovascular mortality (0·73, 0·53–1·02; ptrend=0·0568), non-cardiovascular mortality (0·84, 0·68–1·04; ptrend =0·0038), and total mortality (0·81, 0·68–0·96; ptrend

Published
2017

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