Operationalization of the One Health approach in two rural municipalities of Niger

Despite multiple efforts made by its government to improve public health, Niger still regularly faces numerous disasters including epidemics. Between 2017 and 2019, a consortium was established between Doctors of the World and Veterinarians Without Borders to implement a “One Health” project. This approach aims to reduce the populations' vulnerabilities to health risks related to environmental disasters and improve the health system's resilience at several levels. By promoting interdisciplinary between human, veterinary and environmental health issues, it aims to tackle emerging diseases with pandemic risk. The project was implemented in 2 municipalities: Sakoira and Ingall. For the first time, a program focused on preventing health and environmental risks rather than responding to a crisis.

An external evaluation based on 278 interviews identified 5 project's achievements: (1) the increase in availability and accessibility of human and veterinary pharmaceutical products which improved vaccination coverage and medicalization while lowering treatment and prevention costs; (2) the mobilization and coordination of human and animal health professionals, national authorities and municipalities; (3) the strengthening of joint epidemiological surveillance through professional and community actors in order to reduce the response time to epidemics and disasters; (4) the strengthening of communities' understanding of health risks and how to prevent them; (5) the capacity building of professionals regarding the One Health approach at national, regional and local level.

Coordination between human and animal health professionals has made possible the design and implementation of joint actions. These actions have enabled to: build capacity for 43 health providers, 116 community health workers and 41 livestock auxiliaries, vaccinate, de-worm and treat 24311 small and 7590 large ruminants, give primary health care to 4190 people, sensitize 2268 people on human and animal health.

Key messages

The project is innovative as it focuses on preventing epidemic risks instead of responding to crisis. Collaboration between human and animal health actors is the main success factor of the project.

Critical Care Society of Southern Africa adult patient blood management guidelines: 2019 Round-table meeting, CCSSA Congress, Durban, 2018

The CCSSA PBM Guidelines have been developed to improve patient blood management in critically ill patients in southern Africa. These consensus recommendations are based on a rigorous process by experts in the field of critical care who are also practicing in South Africa (SA). The process comprised a Delphi process, a round-table meeting (at the CCSSA National Congress, Durban, 2018), and a review of the best available evidence and international guidelines. The guidelines focus on the broader principles of patient blood management and incorporate transfusion medicine (transfusion guidelines), management of anaemia, optimisation of coagulopathy, and administrative and ethical considerations. There are a mix of low-middle and high-income healthcare structures within southern Africa. Blood products are, however, provided by the same not-for-profit non-governmental organisations to both private and public sectors. There are several challenges related to patient blood management in SA due most notably to a high incidence of anaemia, a frequent shortage of blood products, a small donor population, and a healthcare system under financial strain. The rational and equitable use of blood products is important to ensure best care for as many critically ill patients as possible. The summary of the recommendations provides key practice points for the day-to-day management of critically ill patients. A more detailed description of the evidence used to make these recommendations follows in the full clinical guidelines section.

AB0759 FOUR-YEAR EFFICACY AND SAFETY OF GUSELKUMAB IN PSORIASIS PATIENTS WITH AND WITHOUT PSORIATIC ARTHRITIS: A POOLED ANALYSIS FROM VOYAGE 1 AND VOYAGE 2

Background:

Guselkumab (GUS), a fully human monoclonal antibody, selectively binds and blocks interleukin-23. VOYAGE 1 and VOYAGE 2 are two ongoing Phase 3, randomized, double-blind, placebo (PBO)/active comparator-controlled clinical trials of GUS in patients (pts) with moderate-to-severe psoriasis (PsO).

Objectives:

This post-hoc analysis reports pooled results through 4 years among a subgroup of moderate-to-severe PsO pts with self-reported psoriatic arthritis (PsA) at baseline.

Methods:

1829 pts were randomized to GUS 100 mg at Weeks (Wks) 0, 4, and 12, then every 8 wks (q8wk); PBO at Wks 0, 4, and 12, GUS at Wks 16 and 20 then q8wk; or adalimumab (ADA) 80 mg at Wk 0, 40 mg at Wk 1, then 40 mg q2wk until Wk 47 (VOYAGE 1) or Wk 23 (VOYAGE 2). In VOYAGE 1, all pts received open-label GUS 100 mg q8wk during Wks 52-204. VOYAGE 2 incorporated a randomized withdrawal study design, followed by open-label GUS during Wks 76-204. Pooled subgroup analyses using the combined GUS group were conducted based on self-reported PsA status at baseline. Efficacy based on Investigator Global Assessment (IGA) score and Psoriasis Area and Severity Index (PASI) response was assessed using prespecified treatment failure rules (nonresponder status for all time points after discontinuing due to lack of efficacy, worsening of PsO, or use of a prohibited treatment).

Results:

For pooled VOYAGE 1 and VOYAGE 2 pts (N=1721), combined GUS and ADA to GUS response rates at Wks 100, 156, and 204 were: PASI 90 80.6%, 80.0%, and 80.4%; PASI 100 50.1%, 49.9%, and 52.2%; IGA 0/1 83.6%, 83.3%, and 81.7%; and IGA 0 54.3%, 52.9%, and 53.9, respectively. In the pooled subgroup analysis of pts with and without PsA, response rates were similar across the Wk 100, Wk 156, and Wk 204 evaluations (Table). Rates of adverse events through Wk 204 were comparable for pts with PsA vs those without PsA at baseline.

Conclusion:

Among GUS-treated pts with moderate-to-severe PsO with and without self-reported PsA at baseline, stable, durable, and high levels of skin responses, as well as comparable safety outcomes, through 4 years were observed.

Table.

Acknowledgments:

None

Disclosure of Interests:

Kristian Reich Grant/research support from: Janssen Research & Development, LLC, Jan Dutz Grant/research support from: Janssen Research & Development, LLC, Peter Foley Grant/research support from: Janssen Research & Development, LLC, Diamant Thaçi Grant/research support from: Janssen Research & Development, LLC, Ronald Vender Grant/research support from: Janssen Research & Development, LLC, Michael Song Employee of: Janssen Research & Development, LLC, Megan Miller Employee of: Janssen Research & Development, LLC, Yin You Employee of: Janssen Research & Development, LLC, Shu Li Employee of: Janssen Research & Development, LLC, Yaung-Kaung Shen Employee of: Janssen Research & Development, LLC, April Armstrong Grant/research support from: Janssen Research & Development, LLC

0528 Insomnia as a Mechanism for Improvement in Alcohol Problems Among Young Adults

Introduction

More than half of heavy-drinking young adults report symptoms of insomnia, which have been associated with alcohol-related problems. This study examined improvement in insomnia (via Cognitive Behavioral Therapy for Insomnia; CBT-I) as a mechanism for improvement in alcohol-related problems.

Methods

Fifty-six heavy-drinking young adults with insomnia (ages 18-30y) were randomized to CBT-I (n=28) or single-session sleep hygiene control (SH; n=28). Of those, 43 (77%) completed post-treatment (24 SH, 19 CBT-I) and 48 (86%) completed 1-month follow-up (25 SH, 23 CBT-I). Multiple imputation was used to estimate missing data. Treatment outcomes were assessed using multilevel models. Mediation was tested using bootstrapped confidence intervals for indirect effects in the PROCESS macro.

Results

CBT-I participants reported greater decreases in insomnia severity than those in the sleep hygiene group [group X time interaction, F(2,59)=11.29, p<.001], both post-treatment and at 1-month follow-up. Both groups decreased significantly in diary-assessed sleep quality [time, F(2,55)=40.30, p<.001], with a marginally significant interaction in favor of the CBT-I group [F(2,55)=2.69, p=.08]. There were no significant group by time interactions in the prediction of actigraphy-assessed sleep variables, although again, there was a marginally significant interaction in the prediction of actigraphy-assessed sleep efficiency [F(2,66)=2.75, p=.07]. Both groups reported significant decreases in drinking quantity over time [time, F(2,58=13.88, p<.001]. However, CBT-I participants reported greater decreases in alcohol-related consequences than those in the sleep hygiene group [F(2,67)=4.13, p=.02]. In the mediation model, CBT-I did not have a direct effect on change in alcohol-related consequences (B=1.49, SE=1.06, 95%CI=-0.65, 3.62); however, it influenced change in 1-month alcohol-related consequences indirectly through its influence on post-treatment insomnia symptoms (B=-1.09, SE=0.57, 95%CI=-2.30, -0.05).

Conclusion

CBT-I is effective in treating insomnia among heavy-drinking young adults and may be associated with reductions in alcohol-related problems due to its impact on insomnia symptoms.

Support

This work was supported by funding from the University of Missouri System Research Board Office (PI Miller). Mary Beth Miller’s contribution to this project was also supported by the National Institute on Alcohol Abuse and Alcoholism [grant number K23AA026895].

1076 Self-referential Language In Trauma Narratives Predicts Shorter Sleep Duration In Women With Ptsd

Introduction

The use of self-referential language, defined as first-person singular pronouns (e.g. I, me, my), in trauma narratives has been found to predict post-traumatic stress disorder (PTSD) severity. Additionally, taking a self-immersed perspective correlates with higher blood pressure reactivity than a self-distanced perspective. Given this relationship between self-immersed perspectives and physiological processes, we investigated the relationship between self-referential language and sleep in people with PTSD, as dysfunctional sleep is a major treatment target in this disorder.

Methods

Seventy-five participants (49 females; Mage=31.8, SDage=8.8) meeting DSM-5 criteria for PTSD were administered the PTSD Checklist for the DSM-5 (PCL-5) and the Pittsburg Sleep Quality Index (PSQI). Sleep duration was assessed with the PSQI. Participants provided typed descriptions of their traumatic event, which were then analyzed using the Linguistic Inquiry and Word Count 2015 software to count instances of first-person singular pronouns (“I” words). Linear regression, with PCL-5 scores and “I” words entered stepwise, was used to predict scores on the PSQI sleep duration subscale. Use of “I” words between the sexes was also compared.

Results

For females but not males, PTSD severity significantly predicted sleep duration (R2=.207, p=.001). Additionally, the number of “I” words in the trauma narratives predicted an additional 8% of the variance in sleep duration for females (R2 change=.083, β=.288, p=.029) but not males. Females used significantly more self-referential language in their narratives (M=11.84, SD=8.42) compared to males (M=5.25, SD=6.10, p=.001).

Conclusion

After controlling for PTSD severity, self-referential language in trauma narratives significantly predicted shorter sleep duration in females. While speculative, this finding suggests that treatment approaches for PTSD may benefit from a focus on targeting self-referential processes to improve sleep and PTSD in females but not males. As dysfunctional sleep is a hallmark of PTSD, further investigation into this relationship may illuminate a new treatment avenue for this disorder.

Support

W81XWH-14-1-0570

Time course and management of key adverse events during the randomized phase III SOLAR-1 study of PI3K inhibitor alpelisib plus fulvestrant in patients with HR-positive advanced breast cancer

BACKGROUND

Alpelisib (α-selective phosphatidylinositol 3-kinase inhibitor) plus fulvestrant is approved in multiple countries for men and postmenopausal women with PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer following progression on or after endocrine therapy. A detailed understanding of alpelisib's safety profile should inform adverse event (AE) management and enhance patient care.

PATIENTS AND METHODS

AEs in the phase III SOLAR-1 trial were assessed in patients with and without PIK3CA mutations. The impact of protocol-specified AE-management recommendations was evaluated, including an amendment to optimize hyperglycemia and rash management.

RESULTS

Patients were randomly assigned to receive fulvestrant plus alpelisib (n = 284) or placebo (n = 287). The most common grade 3/4 AEs with alpelisib were hyperglycemia (grade 3, 32.7%; grade 4, 3.9%), rash (grade 3, 9.9%), and diarrhea (grade 3, 6.7%). Median time to onset of grade ≥3 toxicity was 15 days (hyperglycemia, based on fasting plasma glucose), 13 days (rash), and 139 days (diarrhea). Metformin alone or in combination with other antidiabetic agents was used by most patients (87.1%) with hyperglycemia. Preventive anti-rash medication resulted in lower incidence (any grade, 26.7% versus 64.1%) and severity of rash (grade 3, 11.6% versus 22.7%) versus no preventative medication. Discontinuations due to grade ≥3 AEs were lower following more-detailed AE management guidelines (7.9% versus 18.1% previously). Patients with PIK3CA mutations had a median alpelisib dose intensity of 248 mg/day. Median progression-free survival with alpelisib was 12.5 and 9.6 months for alpelisib dose intensities of ≥248 mg/day and <248 mg/day, respectively, compared with 5.8 months with placebo.

CONCLUSIONS

Hyperglycemia and rash occurred early during alpelisib treatment, while diarrhea occurred at a later time point. Early identification, prevention, and intervention, including concomitant medications and alpelisib dose modifications, resulted in less severe toxicities. Reductions in treatment discontinuations and improved progression-free survival at higher alpelisib dose intensities support the need for optimal AE management. CLINICALTRIALS.

GOV ID

NCT02437318.

The relationship between alcohol consumption and the desire to own a firearm: an empirical study on citizens of São Paulo city, Brazil

OBJECTIVE

The main objective of this study was to investigate the association between alcohol consumption (use and bingeing) and the desire to own a firearm for protection.

STUDY DESIGN

We used data from three random cross-sectional victimisation surveys conducted in São Paulo city, Brazil, in 2003, 2008 and 2013 with people aged ≥16 years.

METHODS

We performed tests for equality of proportions. Our analysis was performed separately for each victimisation survey to check the robustness of the results. We also used probit models, estimated by the maximum likelihood method, to analyse the relationship between desire to own a firearm and alcohol consumption, controlling for many other variables.

RESULTS

In 2013, although only 1.5% of the population surveyed reported living in a household with a firearm, 15.7% report that they would possess a firearm if they could, and 13.0% believed they would be safer/more protected from violence if they had a firearm. The desire to own a firearm is higher among people who consume alcoholic beverages than among those who do not and is higher as alcohol binge frequency increases.

CONCLUSION

In São Paulo city, alcohol consumption and binge drinking are positively associated with the desire to own a firearm.

Effect of Organic Acid Applications on Organoleptic Properties of Ground Pork

ObjectivesThe objective of this study was to determine the impact of intervention treatments on the organoleptic properties of ground pork during shelf-life.Materials and MethodsPork trimmings were divided into 22 kg batches for each individual treatment (n = 4 batches). Treatments included control (no intervention), PAA+Titon [Sulfuric acid and sodium sulfate (pH 1.3) combined with peracetic acid (350 ppm)], PAA+Acetic [Peracetic acid (400 ppm) with 2% acetic acid], and LA [Lactic acid (3%)]. After application of each designated treatment, trimmings were ground (coarse and then fine ground) and packaged into 454-g vacuum packaged rollstock packaging. Each package was then stored in dark storage for 0, 7, 14, 21, and 28 d at 2–4°C (n = 8 packages per treatment and time combination). Once each package had reached their designated storage length, packages were removed from storage for sampling. Shelf-life measurements taken included TBARS, raw product odor acceptability, aerobic plate count and psychrotrophic plate count bacterial enumeration. All bacterial enumeration data were converted into log10 for statistical analysis, and the PROC MIXED procedure of SAS was used to determine differences between least squared means (SAS Inst. Inc., Version 9.4, Cary, NC). Odor acceptability was determined using a PROC FREQ.ResultsFor aerobic plate counts (APC), in the ground pork product, a treatment by day interaction occurred (P = 0.007). Psychrotrophic bacterial counts did not differ by treatment or sampling day (P > 0.05). PAA+Titon and LA had decreased lipid oxidation compared to PAA+Acetic and control pork samples over the 28 d of storage. Lipid oxidation didn’t change for all 4 treatments on Days 0, 14, 21, and 28; however, there was an unexplainable spike in lipid oxidation for samples on Day 7. Overall pork odor acceptability differed by storage length (P = 0.02), but not by treatment (P > 0.05). Overall Pork odor acceptability decreased as storage length increased. Acidic off-odor differed by storage length (P = 0.002), but not by treatment (P > 0.05). Acidic off-odor increased as storage length increased. Overall oxidation off-odor did not differ by treatment or aging (P > 0.05). Sweaty off-odor development differed by aging day (P = 0.01) but not by treatment (P > 0.05). Sweaty off-odor reached its highest point within Day 14 and 21 and then decreased. An increasing sour off-odor development differed by ground pork storage length (P = 0.001), but not by treatment (P > 0.05).ConclusionThere were no dramatic negative organoleptic changes to pork trim when treated with selected organic acid interventions prior to grinding, meanwhile there is organoleptic changes by storage length.

Perceived Norms Influence Perceptions of Risk and Attitudes for Food Technologies

ObjectivesUnderstanding the factors that influence consumer attitudes and risk perception is critical for effective marketing of new food technologies. Many variables impact attitudes and risk perception. However, food technology research has largely focused on demographic variables, and often only single technologies (e.g., GMOs). Our goal was to determine how psychological variables differentially influence attitudes and risk perception for a range of food technologies: antibiotics, hormones, vaccines, GMOs, sustainability, and animal welfare technologies. We examined how attitudes and risk perception for these technologies related to four social psychological variables from the Theory of Planned Behavior (TPB): perceived norms, past behavior, familiarity, and perceived control. In addition, we measured general Food Technology Neophobia (FTN), Trust in Science (TIS), chemical reasoning (CR).Materials and MethodsParticipants (n = 394) provided demographics followed by TPB, attitude, and risk perception surveys for each of the six technologies. Then they completed FTN, TIS, and a CR survey measuring dose–response beliefs (DR), beliefs in unknown risks (UR), the role of risk in society (RS), and naturalness/knowledge of chemicals (NKC). Multiple regression analyses were used to test for associations among the survey measures.ResultsThe multiple regression models were all significant (p < 0.05). Variance accounted for (R2) ranged from 0.49 to0.69 (See Table 1 for summary). Perceived norms were the strongest predictor of attitudes and risk with higher values being associated with stronger attitudes (standardized betas ranging from 0.51 to 0.71) and lower risk perception (–0.54 to –0.40). There were a number of technology-specific associations, including familiarity increasing perceptions of risk for hormones, and NKC being primarily associated with animal welfare and sustainability technologies.ConclusionThe present findings show a critical role for perceived norms– a person’s perception that people they like also approve of or use a technology– across all technologies. This suggests that social factors like norms play a major role in consumer acceptance of food technologies. Other predictors varied in strength across technologies suggesting marketing may benefit from strategies tailored to specific technologies.Table 1Standardized betas (> 0.10 in bold) from selected coefficients of regression models predicting risk perceptions and attitudes (rows) for each technology (columns)

Infographics Influence Attitudes and Risk Perceptions for Food Technologies

ObjectivesFood technologies have facilitated a healthier, more efficient, and sustainable food supply. They nevertheless often face resistance from consumers. Compared to organic and traditional farming techniques, food produced with technologies tends to be associated with higher perceptions of risk, lower attitudes, and fewer perceived benefits. Countering resistance toward technologies poses a serious challenge because persuasive appeals have the potential to amplify preexisting attitudes instead of changing them. We tested six infographics for their ability to improve attitudes and risk perception toward six food technologies: hormones, antibiotics, GM crops, vaccines, sustainability technology, and animal welfare technology. Our objective was to determine whether these infographics would successfully shift perceived risk and attitudes toward these technologies.Materials and MethodsParticipants (n = 810) from English speaking countries (in North America, Europe, and Australia) were recruited from Amazon’s MTurk service. They answered a survey assessing their levels of risk perception and attitudes regarding each of the six food technologies, followed by a general food technology neophobia (FTN) survey. An experimental condition (n = 416) saw an infographic before answering questions about each technology and a control condition (n = 394) did not. Linear mixed effects models implemented in R were used to test risk and attitude differences among technologies and whether the infographics affected risk perception and attitudes.ResultsLinear mixed effects models revealed that there was a significant interaction between technology and condition for both risk: F(54040) = 5.068, p < 0.001, and attitudes: F(54040) = 26.34, p < 0.001. Overall, there was a tendency for risk perception to decrease (g = –.36, z = 6.89, p < 0.001) and attitudes to increase (g = .48, z = 9.38, p < 0.001), in the condition that saw the infographics. However, there were larger decreases in risk perception and increases in attitudes for hormones (risk: z = 5.05, p < 0.001; attitudes: z = 8.30, p < 0.001), GMOs (risk: z = 6.89, p < 0.001; attitudes: 13.21, p < 0.001), vaccines (risk: z = 6.45, p < 0.001; attitudes: z = 6.11, p < 0.001), and antibiotics (risk: 5.06, p < 0.001; attitudes: z = 7.83, p < 0.001), but smaller changes for sustainability (risk: z = 2.77, p = 0.03; attitudes: z = 2.89, p = 0.02) and animal welfare (risk: z = 4.91, p < 0.001; attitudes: z = 3.51, p = 0.003). Including FTN in the models did not affect the overall pattern of results, suggesting that the changes in risk perception and attitudes were not due to simply a general change in FTN.ConclusionOur results found that infographics provide a potential avenue for improving attitudes and risk perception for food technologies. Across six different infographics, we found attitudes and risk perception improved for hormones, antibiotics, vaccines, GMOs, sustainability technologies, and animal welfare technologies. These results are important because such persuasive appeals can often backfire, yet here we observed general improvement. In future studies it will be critical to examine how such attitude and risk perception changes relate to consumer behavior (e.g., willingness-to-pay), and which specific strategies in the infographics led to the improved attitudes.

Effect of Electrolyte Administration on Carcass Weight and pH Decline of Australian Feedlot Lambs

ObjectivesThis study was conducted to determine how the administration of electrolytes to Australian feedlot lambs would affect the carcass weight and pH decline.Materials and MethodsAustralian feedlot lambs (n = 200) were weighed (LW = 59.0 ± 2.7 kg) prior to the first administration of electrolyte and assigned randomly to 1 of 4 treatment groups (n = 50/group). Treatment groups consisted of no electrolyte (CON), a commercially available electrolyte (E1; Generade, Mount Barker, SA, 5251), an electrolyte formulated by a consulting nutritionist (E2), and experimental electrolyte formulation (E3). Electrolyte formulation was proprietary but contained the following ingredients: sodium bicarbonate, sodium chloride, potassium compounds, magnesium compounds, glucose and lysine. Electrolytes were delivered through the feed at specified dosage rates per treatment of 100ml/d (E1), 50 g/d (E2), and 17 g/d (E3) for 4 d. The administration of E2 and E3 began after weighing and sorting on d 1; E3 was started on d 3 and was only fed for 2 d prior to slaughter. Half of each treatment group was assigned to 1 of 2 consecutive harvest days with equal representation among treatments. Individual live weights were recorded after 4 d and prior to transportation to the abattoir. Individual live weights were recorded on arrival at the abattoir and again immediately before slaughter to determine transportation shrink and shrink during holding at the abattoir. Hot carcass weights were recorded. Longissimus pH was recorded when carcasses first entered the chiller following slaughter and were recorded again at 60 min and 120 min to monitor pH decline over the course of 2 h. On the following day after chilling, cold carcass weights were recorded, and cooler shrink was calculated.ResultsTreatment influenced all live weights (P < 0.01). The use of electrolytes in comparison to the control had a significant impact on the 4-d gain, as E3 lambs had greater gain than E1 or CON prior to transportation. All lambs administered an electrolyte maintained the live weight advantage over CON through pre-slaughter live weight collection; however, E2 and E3 were similar for transport shrink percentage, but were both greater (P < 0.05) when compared to E1 and CON, which were also similar. HCW, CCW, and cooler shrink percentage were not influenced by electrolyte treatment (P ≥ 0.25).No interaction between treatment and time was detected for pH (P = 0.07), suggesting pH declined at similar rates; however, CON had greater (P < 0.05) pH values (6.00) than any of the electrolyte-treated lamb carcasses (5.79–5.89), regardless of time postmortem.ConclusionResults suggest the administration of the various electrolytes does create live weight differences between the treatments and especially apart from CON, as evidenced by the improved 4-d gain and transportation shrink. Electrolytes, however, did not affect carcass weights. The intended usage for electrolytes should reduce stress, therefore resulting in a positive influence on meat quality by reducing the incidence of high pH and dark cutting. Although the administration of electrolytes did not affect the decline of pH, it did influence the ultimate pH value. The CON had greater final pH, indicating that the use of electrolytes on Australian feedlot lambs can benefit meat quality.

Maintenance of Response With up to 4 Years of Continuous Guselkumab Treatment: Results From the VOYAGE 1 Phase 3 Trial

Abstract not available.

Differential effect of short-term popular diets on TMAO and other cardio-metabolic risk markers

BACKGROUND

Dietary nutrient intake and its metabolism by the gut microbiome have recently been implicated in cardiovascular disease (CVD) risk. In particular, trimethylamine N-oxide (TMAO), a metabolite of the gut microbiota, has been shown to be a predictor of incident CVD events. Elevated levels of branched-chain amino acids (BCAA) have also been associated with an increased propensity for insulin resistance.

METHODS

To study the association of dietary intake with systemic TMAO, its nutrient precursors, and BCAA levels on fasting plasma levels of TMAO and its nutrient precursors and BCAA, we conducted an exploratory post-hoc analysis of 3 popular diets - high fat (Atkins), Mediterranean (South Beach), and very low fat (Ornish) - using plasma samples from a prior randomized, crossover study, with each isocaloric dietary phase lasting 4 weeks. Metabolites were quantified using stable isotope dilution HPLC with on-line tandem mass spectrometry.

RESULTS

Compared to the low fat Ornish phase, the high fat Atkins dietary phase was characterized by increased levels of TMAO (3.3 vs. 1.8 μM, p = 0.01), and the BCAA valine (272.8 vs. 235.8 μM, p = 0.005) and leucine (105.9 vs. 96.4 μM, p = 0.01). The high fat Atkins dietary phase was also associated with higher levels of TMAO (3.3 vs 1.6 μM, p = 0.04), valine (272.8 vs. 240.7 μM, p = 0.004), and leucine (105.9 vs. 96.4 μM, p = 0.01) compared to baseline.

CONCLUSIONS

These data suggest that over a 4-week interval, a saturated fat diet that is predominantly animal-based, compared to an isocaloric, low fat, predominantly plant-based diet, is associated with heightened risk for cardiometabolic derangements, as monitored by a higher plasma levels of both TMAO and BCAA.