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Shen M, Yuan L, Zhang J, Wang X, Zhang M, Li H, Jing Y, Zeng F, Xie J. Phytosterols: Physiological Functions and Potential Application. Foods 2024; 13:1754. [PMID: 38890982 PMCID: PMC11171835 DOI: 10.3390/foods13111754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024] Open
Abstract
Dietary intake of natural substances to regulate physiological functions is currently regarded as a potential way of promoting health. As one of the recommended dietary ingredients, phytosterols that are natural bioactive compounds distributed in plants have received increasing attention for their health effects. Phytosterols have attracted great attention from scientists because of many physiological functions, for example, cholesterol-lowering, anticancer, anti-inflammatory, and immunomodulatory effects. In addition, the physiological functions of phytosterols, the purification, structure analysis, synthesis, and food application of phytosterols have been widely studied. Nowadays, many bioactivities of phytosterols have been assessed in vivo and in vitro. However, the mechanisms of their pharmacological activities are not yet fully understood, and in-depth investigation of the relationship between structure and function is crucial. Therefore, a contemporaneous overview of the extraction, beneficial properties, and the mechanisms, as well as the current states of phytosterol application, in the food field of phytosterols is provided in this review.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jianhua Xie
- State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang 330047, China; (M.S.); (L.Y.); (J.Z.); (X.W.); (M.Z.); (H.L.); (Y.J.); (F.Z.)
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Ge Q, Yan Y, Luo Y, Teng T, Cao C, Zhao D, Zhang J, Li C, Chen W, Yang B, Yi Z, Chang T, Chen X. Dietary supplements: clinical cholesterol-lowering efficacy and potential mechanisms of action. Int J Food Sci Nutr 2024; 75:349-368. [PMID: 38659110 DOI: 10.1080/09637486.2024.2342301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
This review aims to analyse the efficacy of dietary supplements in reducing plasma cholesterol levels. Focusing on evidence from meta-analyses of randomised controlled clinical trials, with an emphasis on potential mechanisms of action as supported by human, animal, and cell studies. Certain dietary supplements including phytosterols, berberine, viscous soluble dietary fibres, garlic supplements, soy protein, specific probiotic strains, and certain polyphenol extracts could significantly reduce plasma total and low-density lipoprotein (LDL) cholesterol levels by 3-25% in hypercholesterolemic patients depending on the type of supplement. They tended to be more effective in reducing plasma LDL cholesterol level in hypercholesterolemic individuals than in normocholesterolemic individuals. These supplements worked by various mechanisms, such as enhancing the excretion of bile acids, inhibiting the absorption of cholesterol in the intestines, increasing the expression of hepatic LDL receptors, suppressing the activity of enzymes involved in cholesterol synthesis, and activating the adenosine monophosphate-activated protein kinase signalling pathway.
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Affiliation(s)
- Qian Ge
- Institute of Quality Standard and Testing Technology of Agricultural Products, Ningxia Academy of Agriculture and Forestry Sciences, Yinchuan, China
| | - Yue Yan
- Institute of Quality Standard and Testing Technology of Agricultural Products, Ningxia Academy of Agriculture and Forestry Sciences, Yinchuan, China
| | - Yang Luo
- Ningxia Institute of Science and Technology Development Strategy and Information, Yinchuan, China
| | - Tai Teng
- Ningxia Guolong Hospital Co., LTD, Yinchuan, China
| | - Caixia Cao
- People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Danqing Zhao
- Institute of Quality Standard and Testing Technology of Agricultural Products, Ningxia Academy of Agriculture and Forestry Sciences, Yinchuan, China
| | - Jing Zhang
- Institute of Quality Standard and Testing Technology of Agricultural Products, Ningxia Academy of Agriculture and Forestry Sciences, Yinchuan, China
| | - Caihong Li
- Institute of Quality Standard and Testing Technology of Agricultural Products, Ningxia Academy of Agriculture and Forestry Sciences, Yinchuan, China
| | - Wang Chen
- Institute of Quality Standard and Testing Technology of Agricultural Products, Ningxia Academy of Agriculture and Forestry Sciences, Yinchuan, China
| | - Binkun Yang
- Institute of Quality Standard and Testing Technology of Agricultural Products, Ningxia Academy of Agriculture and Forestry Sciences, Yinchuan, China
| | - Zicheng Yi
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Tengwen Chang
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Xiang Chen
- Institute of Quality Standard and Testing Technology of Agricultural Products, Ningxia Academy of Agriculture and Forestry Sciences, Yinchuan, China
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Wang L, Feng L, Prabahar K, Hernández-Wolters B, Wang Z. The effect of phytosterol supplementation on lipid profile: A critical umbrella review of interventional meta-analyses. Phytother Res 2024; 38:507-519. [PMID: 37905579 DOI: 10.1002/ptr.8052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/22/2023] [Accepted: 10/07/2023] [Indexed: 11/02/2023]
Abstract
Despite multiple investigations assessing the impact of phytosterol supplementation on serum lipid levels, there is still a great deal of debate regarding the benefits of this intervention in the management of dyslipidemia. Therefore, we aimed at clarifying this dilemma by conducting the present umbrella review of interventional meta-analyses. Scopus, PubMed, Web of Science, and EMBASE were used to search for pertinent publications on the effect of phytosterol supplementation on the lipid profile in humans up to June 2023. To compute the overall effect size (ES) and confidence intervals (CI), the random-effects model was used. The I2 statistic and Cochrane's Q-test were applied to estimate the heterogeneity among the studies. Seventeen meta-analyses with 23 study arms were included in the umbrella meta-analysis. Data pooled from the 23 eligible arms revealed that phytosterol supplementation reduces low-density lipoprotein cholesterol (LDL-C) (ES = -11.47 mg/dL; 95% CI: -12.76, -10.17, p < 0.001), total cholesterol (TC) (ES = -13.02 mg/dL; 95% CI: -15.68, -10.37, p < 0.001), and triglyceride (TG) (ES = -3.77 mg/dL; 95% CI: -6.04, -1.51, p = 0.001). Subgroup analyses showed that phytosterol administration with dosage ≥2 g/day and duration over 8 weeks and in hypercholesterolemic subjects was more likely to decrease LDL-C, TC, and TG. Phytosterol administration did not significantly modify HDL-C (ES = 0.18 mg/dL; 95% CI: -0.13, -0.51, p = 258) levels when compared to controls. The present umbrella meta-analysis confirms that phytosterol administration significantly reduces LDL-C, TC, and TG, with a greater effect with doses of ≥2 g/day and treatment duration >8 weeks, suggesting its possible application as a complementary therapy for cardiovascular risk reduction. Further studies are needed to determine the efficacy of phytosterols in patients with specific health conditions, as well as to ascertain the adverse effects, the maximum tolerable dose, and the maximum recommended duration of phytosterol administration.
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Affiliation(s)
- Le Wang
- Department of Emergency Medicine, People's Hospital of Huaiyin. Jinan, Jinan, China
- The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Li Feng
- Department of Rehabilitation Medicine, Jinan Huaiyin People's Hospital, Jinan, China
| | - Kousalya Prabahar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Benjamin Hernández-Wolters
- School of medicine, University Center for Health Science, Universidad de Guadalajara, Guadalajara, Mexico
| | - Zhenxing Wang
- Department of Cardiovascular Medicine, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
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Liu B, Chen K, Chen X, Wang J, Shu G, Ping Z, Zhang S. Health outcomes associated with phytosterols: An umbrella review of systematic reviews and meta-analyses of randomized controlled trials. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 122:155151. [PMID: 37866333 DOI: 10.1016/j.phymed.2023.155151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/17/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Phytosterols (PS), as a kind of plant active ingredients, have many benefits to human health. However, there is currently no comprehensive overview of the clinical evidence and an assessment of the evidence quality. PURPOSE We conducted an umbrella review, which incorporated verification spanning a number of meta-analyses and systematic reviews to clarify the link that existed between PS consuming and health outcomes. METHODS The databases PubMed, Embase, Web of Science and The Cochrane Library were searched for appropriate research and ultimately included 23 articles involving 79 results. Methodological quality and the validity of evidence received designation in the included meta-analyses leveraging the Assessment of Multiple Systematic Reviews (AMSTAR-2) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS The consumption of PS makes a contribution to the alleviation of metabolic conditions such as hypercholesterolemia, diabetes, obesity, and hypertension. Its most essential function is to decrease cholesterol absorption, leading to dramatically reductions in total cholesterol and low density lipoprotein cholesterol. Furthermore, utilizing PS products can have a favorable impact on managing apolipoprotein levels along with decreasing the probability of obtaining atherosclerotic cardiovascular disease. CONCLUSION This umbrella review summarized a range of beneficial functions of PS to humans, highlighting the promising potential for the development of PS into functional foods.
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Affiliation(s)
- Bing Liu
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ke Chen
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xi Chen
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jian Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guangjie Shu
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhiguang Ping
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shenshen Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, China; Food Laboratory of Zhongyuan, Luohe, China.
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Abumweis S, Alzyoud L, Alqadi S. Apolipoprotein E Genetic Variant and Blood Lipid Responses to Plant Sterols: A Systematic Review and Pooled Analysis of Clinical Trials. Prev Nutr Food Sci 2023; 28:377-385. [PMID: 38188084 PMCID: PMC10764225 DOI: 10.3746/pnf.2023.28.4.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 01/09/2024] Open
Abstract
Plant sterols/stanols are effective cholesterol-lowering agents. However, it is unclear whether the apolipoprotein E (ApoE) genetic variants influence it. We investigated whether ApoE genetic variants modulate the responses of blood lipids to dietary intervention plant sterols/stanols in adults and if the intervention dose and duration, as well as the age and status of participants, influence this effect. Randomized clinical trials were identified by searching databases in the Cochrane Library. Random-effect models were used to estimate the pooled effect size of each outcome of interest total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, and triglycerides. Meta-regression and subgroup analysis were used to investigate the effects of potential modifiers on the outcomes of interest. Eleven articles were selected from 3,248 retrieved abstracts. Plant sterol/stanol intervention was associated with a more significant reduction in LDL levels in the E3 group [-0.251 mmol/L; 95% confidence interval (95% CI), -0.488 to -0.015] compared with both the E4 and E2 groups. In E4 carriers, the plant sterol/stanol intervention dose and duration resulted in a larger decrease in LDL levels (-0.088027 mmol/L; 95% CI, -0.154690 to -0.021364). In conclusion, ApoE genetic variants affected the response of blood LDL levels to supplementation with plant sterols/stanols, as individuals with E3 variant showed significantly decreased LDL levels compared with the other genotypes. However, future studies recruiting participants according to their ApoE genetic variants are needed to confirm our conclusion.
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Affiliation(s)
- Suhad Abumweis
- College of Pharmacy, Al Ain University, Abu Dhabi 64141, United Arab Emirates
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi 64141, United Arab Emirates
| | - Lara Alzyoud
- College of Pharmacy, Al Ain University, Abu Dhabi 64141, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi 64141, United Arab Emirates
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Lôbo IMDB, Bordallo CDOS, Sacramento JM, Leite LDO, Santana PDS. Phytosterol supplementation in capsules or tablets as adjunctive treatment for hypercholesterolemia: A systematic review of randomized controlled trials. Clin Nutr ESPEN 2023; 57:718-729. [PMID: 37739728 DOI: 10.1016/j.clnesp.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/28/2023] [Accepted: 08/17/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND The exploration of lipid-lowering resources, such as phytosterols, for the complementary nutritional treatment of hypercholesterolemia is relevant to reduce cardiovascular risk. The use of phytosterols in capsules or tablets can bring advantages in the context of diet therapy, but such format is still less studied when compared to fortified foods. OBJECTIVE Systematically review randomized clinical trials on the effects of phytosterol supplementation, in capsules or tablets, on the lipid profile and its use in the treatment of hypercholesterolemia in adults. DESIGN A systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, with a PROSPERO protocol registered under number CRD42021249539. The process was conducted by two independent reviewers. Only randomized clinical trials with phytosterol supplementation in adult individuals with hypercholesterolemia were included. The terms were searched in the databases: PubMed/MEDLINE, Cochrane Library/CENTRAL, Embase, LILACS and Web of Science, without restriction of time and language. The manual search was also performed through the list of references of articles included in this review. RESULTS The searches resulted in 977 articles. 22 articles were selected, whose full text was read, and according to the eligibility criteria 10 were incorporated into the review. The studies were separated into groups according to the association of the intervention with changes in lifestyle and the characteristics extracted from the studies were summarized and displayed in tables. Most studies have revealed a positive association between phytosterol supplementation and cholesterol reduction, despite the short duration of interventions. CONCLUSION The analyzed studies showed that phytosterol supplements can be useful to modulate the lipid profile, helping to reduce the plasma concentration of LDL cholesterol. However, more research with the aforementioned supplementation in such pharmaceutical formats should be encouraged.
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Affiliation(s)
- Izabele Maria de Barros Lôbo
- University of the State of Bahia, Department of Life Sciences - Campus I, Street Silveira Martins, 2555, Cabula, Salvador, Bahia, CEP: 41150-000, Brazil; Federal University of Bahia, School of Nutrition, Street Basilio da Gama, Canela, Salvador, Bahia, CEP: 40110-040, Brazil.
| | - Carine de Oliveira Souza Bordallo
- University of the State of Bahia, Department of Life Sciences - Campus I, Street Silveira Martins, 2555, Cabula, Salvador, Bahia, CEP: 41150-000, Brazil.
| | - Joselita Moura Sacramento
- University of the State of Bahia, Department of Life Sciences - Campus I, Street Silveira Martins, 2555, Cabula, Salvador, Bahia, CEP: 41150-000, Brazil.
| | - Luana de Oliveira Leite
- University of the State of Bahia, Department of Life Sciences - Campus I, Street Silveira Martins, 2555, Cabula, Salvador, Bahia, CEP: 41150-000, Brazil; Federal University of Bahia, School of Nutrition, Street Basilio da Gama, Canela, Salvador, Bahia, CEP: 40110-040, Brazil.
| | - Poliana da Silva Santana
- University of the State of Bahia, Department of Life Sciences - Campus I, Street Silveira Martins, 2555, Cabula, Salvador, Bahia, CEP: 41150-000, Brazil.
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Cheung B, Sikand G, Dineen EH, Malik S, Barseghian El-Farra A. Lipid-Lowering Nutraceuticals for an Integrative Approach to Dyslipidemia. J Clin Med 2023; 12:jcm12103414. [PMID: 37240523 DOI: 10.3390/jcm12103414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 05/28/2023] Open
Abstract
Dyslipidemia is a treatable risk factor for atherosclerotic cardiovascular disease that can be addressed through lifestyle changes and/or lipid-lowering therapies. Adherence to statins can be a clinical challenge in some patients due to statin-associated muscle symptoms and other side effects. There is a growing interest in integrative cardiology and nutraceuticals in the management of dyslipidemia, as some patients desire or are actively seeking a more natural approach. These agents have been used in patients with and without established atherosclerotic cardiovascular disease. We provide an updated review of the evidence on many new and emerging nutraceuticals. We describe the mechanism of action, lipid-lowering effects, and side effects of many nutraceuticals, including red yeast rice, bergamot and others.
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Affiliation(s)
- Brian Cheung
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Geeta Sikand
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Elizabeth H Dineen
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Shaista Malik
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Ailin Barseghian El-Farra
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
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Gao Y, Xun R, Xia J, Xia H, Sun G. Effects of phytosterol supplementation on lipid profiles in patients with hypercholesterolemia: a systematic review and meta-analysis of randomized controlled trials. Food Funct 2023; 14:2969-2997. [PMID: 36891733 DOI: 10.1039/d2fo03663k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Phytosterols (PSs) have been reported to improve blood lipids in patients with hypercholesterolemia for many years. However, meta-analyses of the effects of phytosterols on lipid profiles are limited and incomplete. A systematic search of randomized controlled trials (RCTs) published in PubMed, Embase, Cochrane Library, and Web of Science from inception to March 2022 was conducted according to the 2020 preferred reporting items of the guidelines for systematic reviews and meta-analysis (PRISMA) statement. These included studies of people with hypercholesterolemia, comparing foods or preparations containing PSs with controls. Mean differences with 95% confidence intervals were used to estimate continuous outcomes for individual studies. The results showed that in patients with hypercholesterolemia, taking a diet containing a certain dose of plant sterol significantly reduced total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) (TC: Weight Mean Difference (WMD) [95% CI] = -0.37 [-0.41, -0.34], p < 0.001; LDL-C: WMD [95% CI] = -0.34 [-0.37, -0.30], p < 0.001). In contrast, PSs had no effect on high density lipoprotein cholesterol (HDL-C) or triglycerides (TGs) (HDL-C: WMD [95% CI] = 0.00 [-0.01, 0.02], p = 0.742; TG: WMD [95% CI] = -0.01 [-0.04, 0.01], p = 0.233). Also, a significant effect of supplemental dose on LDL-C levels was observed in a nonlinear dose-response analysis (p-nonlinearity = 0.024). Our findings suggest that dietary phytosterols can help reduce TC and LDL-C concentrations in hypercholesterolemia patients without affecting HDL-C and TG concentrations. And the effect may be affected by the food substrate, dose, esterification, intervention cycle and region. The dose of phytosterol is an important factor affecting the level of LDL-C.
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Affiliation(s)
- Yusi Gao
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China.
| | - Ruilong Xun
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China.
| | - Jiayue Xia
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China.
| | - Hui Xia
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China.
| | - Guiju Sun
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China. .,China-DRIs Expert Committee on Other Dietary Ingredients, Beijing 100052, China
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Belardo D, Michos ED, Blankstein R, Blumenthal RS, Ferdinand KC, Hall K, Klatt K, Natajaran P, Ostfeld RJ, Reddy K, Rodriguez R, Sriram U, Tobias DK, Gulati M. Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An American Society For Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol 2022; 10:100323. [PMID: 35284849 PMCID: PMC8914096 DOI: 10.1016/j.ajpc.2022.100323] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 02/06/2023] Open
Abstract
Despite numerous advances in all areas of cardiovascular care, cardiovascular disease (CVD) is the leading cause of death in the United States (US). There is compelling evidence that interventions to improve diet are effective in cardiovascular disease prevention. This clinical practice statement emphasizes the importance of evidence-based dietary patterns in the prevention of atherosclerotic cardiovascular disease (ASCVD), and ASCVD risk factors, including hyperlipidemia, hypertension, diabetes, and obesity. A diet consisting predominantly of fruits, vegetables, legumes, nuts, seeds, plant protein and fatty fish is optimal for the prevention of ASCVD. Consuming more of these foods, while reducing consumption of foods with saturated fat, dietary cholesterol, salt, refined grain, and ultra-processed food intake are the common components of a healthful dietary pattern. Dietary recommendations for special populations including pediatrics, older persons, and nutrition and social determinants of health for ASCVD prevention are discussed.
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Key Words
- ACC, American college of cardiology
- AHA, American heart association
- ASCVD, atherosclerotic cardiovascular disease
- CER, continuous energy restriction
- CHD, coronary heart disease
- CVD, cardiovascular disease
- Cardiovascular disease
- Cardiovascular disease prevention
- Clinical trials
- DASH, dietary approaches to stop hypertension
- DHA, docosahexaenoic acid
- EPA, eicosapentanoic acid
- EVOO, extra virgin olive oil
- HDL-C, high density lipoprotein cholesterol
- HR, hazards ratio
- IER, intermittent energy restriction
- LD, low density lipoprotein cholesterol
- MUFA, monounsaturated fatty acids
- NHANES, national health and nutrition examination survey
- Nutrition
- OMT, optimal medical therapy
- PUFA, polyunsaturated fatty acids
- PURE, prospective urban rural epidemiology
- RCT, randomized controlled trial
- SFA, saturated fatty acids
- Social determinants of health
- T2D, type 2 diabetes
- TER, timed energy restriction
- US, United States
- VD, vegetarian diet
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Affiliation(s)
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ron Blankstein
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roger S. Blumenthal
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Keith C. Ferdinand
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kevin Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Kevin Klatt
- Baylor College of Medicine, Houston, TX, USA
| | - Pradeep Natajaran
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Koushik Reddy
- Department of Medicine, James A. Haley VA Medical Center – University of South Florida, Tampa, FL, USA
| | | | - Urshila Sriram
- Department of Nutrition, College of Natural, Behavioral, and Health Sciences, Simmons University, Boston, MA, USA
| | - Deirdre K. Tobias
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston MA, USA
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Xia X, Ren M, He WS, Jia C, Zhang X. The preparation of phytosteryl succinyl sucrose esters and improvement of their water solubility and emulsifying properties. Food Chem 2022; 373:131501. [PMID: 34763932 DOI: 10.1016/j.foodchem.2021.131501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/20/2021] [Accepted: 10/27/2021] [Indexed: 02/07/2023]
Abstract
Phytosterols have gained much attention due to their outstanding cholesterol-reducing effect, while the insolubility in water limits their application. The aim of this study was to synthesize a novel hydrophilic phytosteryl derivatives-phytosteryl succinyl sucrose esters (PSSEs) and investigated their water solubility and emulsifying properties. PSSEs were synthesized by esterifying phytosterol hemisuccinates with sucrose through a mild chemical reaction. PSSEs were characterized by fourier transform infrared spectroscopy, mass spectroscopy, and nuclear magnetic resonance spectroscopy. The yield of PSSEs exceeded 84% in N,N-dimethylformamide for 36 h of reaction under the selected conditions: 100 mmol/L phytosteryl hemisuccinates, 150 mmol/L sucrose, 110 mmol/L 1-ethyl-3-(3-(dimethylamino)propyl)carbodiimide hydrochlide, 10 mmol/L 4-dimethylaminopyridine and 10 mmol/L p-toluenesulfonic acid. The water insolubility of phytosterols was overcome and the water solubility of PSSEs achieved 2.13 mg/mL. The emulsifying activity of PSSEs was 2.5 times that of phytosterols, reaching 0.95 mg/mL. PSSEs with better water solubility and emulsification properties could facilitate the widespread use of phytosterols in foods.
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Affiliation(s)
- Xue Xia
- State Key Laboratory of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China; School of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China; International Joint Laboratory on Food Safety, Jiangnan University, Wuxi 214122, China
| | - Mingxing Ren
- State Key Laboratory of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China; School of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China; International Joint Laboratory on Food Safety, Jiangnan University, Wuxi 214122, China
| | - Wen-Sen He
- State Key Laboratory of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China; School of Food and Biological Engineering, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, Jiangsu, China.
| | - Chengsheng Jia
- State Key Laboratory of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China; School of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China; International Joint Laboratory on Food Safety, Jiangnan University, Wuxi 214122, China.
| | - Xiaoming Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China; School of Food Science and Technology, Jiangnan University, 1800 Lihu Road, Wuxi 214122, Jiangsu, China; International Joint Laboratory on Food Safety, Jiangnan University, Wuxi 214122, China
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11
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Saha S, Mukherjee U, Miller M, Peng LL, Napier C, Grobbelaar H, Oldewage-Theron W. Food and beverages promoting elderly health: six food-based dietary guidelines to plan good mixed meals for elderly South Africans. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.1956232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sanjoy Saha
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Upasana Mukherjee
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Makenzie Miller
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Li-Ling Peng
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Carin Napier
- Department of Food & Nutrition Consumer Sciences, Durban University of Technology, Durban, South Africa
- Centre for Longitudinal Research, The University of Auckland, Auckland, New Zealand
| | - Heleen Grobbelaar
- Department of Food & Nutrition Consumer Sciences, Durban University of Technology, Durban, South Africa
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
- Department of Sustainable Food Systems and Development, University of the Free State, Bloemfontein, South Africa
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12
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Poli A, Marangoni F, Corsini A, Manzato E, Marrocco W, Martini D, Medea G, Visioli F. Phytosterols, Cholesterol Control, and Cardiovascular Disease. Nutrients 2021; 13:nu13082810. [PMID: 34444970 PMCID: PMC8399210 DOI: 10.3390/nu13082810] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
The use of phytosterols (or plant sterols) for the control of plasma cholesterol concentrations has recently gained traction because their efficacy is acknowledged by scientific authorities and leading guidelines. Phytosterols, marketed as supplements or functional foods, are formally classified as food in the European Union, are freely available for purchase, and are frequently used without any health professional advice; therefore, they are often self-prescribed, either inappropriately or in situations in which no significant advantage can be obtained. For this reason, a panel of experts with diverse medical and scientific backgrounds was convened by NFI—Nutrition Foundation of Italy—to critically evaluate and summarize the literature available on the topic, with the goal of providing medical doctors and all health professionals useful information to actively govern the use of phytosterols in the context of plasma cholesterol control. Some practical indications to help professionals identify subjects who will most likely benefit from the use of these products, optimizing the therapeutic outcomes, are also provided. The panel concluded that the use of phytosterols as supplements or functional foods to control Low Density Lipoprotein (LDL) cholesterol levels should be preceded by the assessment of some relevant individual characteristics: cardiovascular risk, lipid profile, correct understanding of how to use these products, and willingness to pay for the treatment.
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Affiliation(s)
- Andrea Poli
- Nutrition Foundation of Italy, 20124 Milan, Italy;
- Correspondence: ; Tel.: +39-02-7600-6271
| | | | - Alberto Corsini
- Department of Pharmaceutical and Pharmacological Sciences, University of Milan, 20133 Milan, Italy;
- IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
| | - Enzo Manzato
- Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy;
| | - Walter Marrocco
- FIMMG—Italian Federation of General Medicine Doctors and SIMPeSV–Italian Society of Preventive and Lifestyle Medicine, 00144 Rome, Italy;
| | - Daniela Martini
- Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy;
| | - Gerardo Medea
- SIMG—Italian Society of General Medicine, 50142 Firenze, Italy;
| | - Francesco Visioli
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy;
- IMDEA-Food, CEI UAM+CSIC, 28049 Madrid, Spain
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13
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Adel Mehraban MS, Tabatabaei-Malazy O, Rahimi R, Daniali M, Khashayar P, Larijani B. Targeting dyslipidemia by herbal medicines: A systematic review of meta-analyses. JOURNAL OF ETHNOPHARMACOLOGY 2021; 280:114407. [PMID: 34252530 DOI: 10.1016/j.jep.2021.114407] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/18/2021] [Accepted: 07/08/2021] [Indexed: 12/18/2022]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The worldwide increasing prevalence of dyslipidemia has become a global health concern. Various herbal remedies have been claimed to be effective for the treatment of dyslipidemia in traditional and folkloric medicine of different regions clinical trials have been conducted to investigate their efficacy. The aim of the current systematic review is to critically assess the meta-analyses of controlled trials (CT) evaluated herb medicines for dyslipidemia. MATERIALS AND METHODS Relevant studies from Web of Science, PubMed, Scopus, and Cochrane Library databases based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist until January 2021 have been searched. All meta-analyses which pooled studies on the effect of herbal medicines on lipid profile including total cholesterol (TC), triglyceride (TG), and low- or high-density lipoprotein cholesterol (LDL-C, HDL-C) were also included. Meta-analyses of in vitro, animal or observational studies were excluded. RESULTS The overall of 141 meta-analyses were revealed. Vegetable oils, phytosterols, tea, soy protein, nuts, and curcumin have been studied frequently among the herbal medicines. Among 13 meta-analyses on vegetable oils, the greater reduce of TC (18.95 mg/dl), LDL-C (16.24 mg/dl) and TG (13.69 mg/dl) were exhibited from sunflower oil. Furthermore, rice bran oil (6.65 mg/dl) increased HDL-C significantly. Phytosterols in 12 meta-analyses demonstrated significant improvements in reducing TC, LDL-C and TG as 16.4, 23.7, and 8.85 mg/dl, respectively, and rise in HDL-C as 10.6 mg/dl. The highest reduction in serum level of TC, LDL-C and TG was reported while intake Green tea; 27.57, 24.75, and 31.87 mg/dl, accordingly within 9 meta-analyses. Average improvement of lipid profiles by 6 meta-analyses on plant proteins were 23.2, 21.7, 15.06, and 1.55 mg/dl for TC, LDL-C, TG, and HDL-C, respectively. Among 11 meta-analyses on nuts, almond showed better and significant alleviations in TC (10.69 mg/dl), walnut in LDL-C (9.23 mg/dl), pistachio in TG (22.14 mg/dl), and peanut in HDL-C (2.72 mg/dl). Overall, Curcumin, Curcuminoid, and Turmeric have resulted in the reduction of TC (25.13 mg/dl), LDL-C (39.83 mg/dl), TG (33.65 mg/dl), and an increase in the HDL-C (4.31 mg/dl). CONCLUSION The current systematic review shed light on the use of herbal medicines for the management of dyslipidemia. However, more well-conducted CTs are required to determine effective doses of herbal medicines.
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Affiliation(s)
- Mohammad Sadegh Adel Mehraban
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ozra Tabatabaei-Malazy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Roja Rahimi
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran; PhytoPharmacology Interest Group (PPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Marzieh Daniali
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran; Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Patricia Khashayar
- Center for Microsystem Technology, Imec and Ghent University, Gent-Zwijnaarde, 9052, Belgium; Osteoporosis Research Center, Endocrinpology & Metabolism Clinical Science Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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14
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Kopylov AT, Malsagova KA, Stepanov AA, Kaysheva AL. Diversity of Plant Sterols Metabolism: The Impact on Human Health, Sport, and Accumulation of Contaminating Sterols. Nutrients 2021; 13:nu13051623. [PMID: 34066075 PMCID: PMC8150896 DOI: 10.3390/nu13051623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 02/07/2023] Open
Abstract
The way of plant sterols transformation and their benefits for humans is still a question under the massive continuing revision. In fact, there are no receptors for binding with sterols in mammalians. However, possible biotransformation to steroids that can be catalyzed by gastro-intestinal microflora, microbial cells in prebiotics or cytochromes system were repeatedly reported. Some products of sterols metabolization are capable to imitate resident human steroids and compete with them for the binding with corresponding receptors, thus affecting endocrine balance and entire physiology condition. There are also tremendous reports about the natural origination of mammalian steroid hormones in plants and corresponding receptors for their binding. Some investigations and reports warn about anabolic effect of sterols, however, there are many researchers who are reluctant to believe in and have strong opposing arguments. We encounter plant sterols everywhere: in food, in pharmacy, in cosmetics, but still know little about their diverse properties and, hence, their exact impact on our life. Most of our knowledge is limited to their cholesterol-lowering influence and protective effect against cardiovascular disease. However, the world of plant sterols is significantly wider if we consider the thousands of publications released over the past 10 years.
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15
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Hoang T, Kim J. Phytonutrient supplements and metabolic biomarkers of cardiovascular disease: An umbrella review of meta-analyses of clinical trials. Phytother Res 2021; 35:4171-4182. [PMID: 33724587 DOI: 10.1002/ptr.7079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Abstract
Phytonutrients exert several pharmacological effects on humans. In this study, we performed an umbrella review of the association of phytonutrient supplements (PNSs) with biomarkers of cardiovascular disease. Relevant published systematic reviews and meta-analyses of clinical trials were identified by searching PubMed, Embase, and Cochrane Library until July 4, 2020. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) for summarized effects and I2 statistics of heterogeneity were extracted from individual studies or reanalyzed using a random-effects model. Of the 50 included studies, pooled effects of PNSs on blood pressure, lipid profiles, and glycemic control were reported in 16, 25, and 14 articles, respectively. The findings appeared to be highly heterogeneous among individual trials of included systematic reviews and meta-analyses. Ginger (WMD = -6.36 mmHg, 95% CI = -11.27, -1.46) and Hibiscus sabdariffa (WMD = -7.58 mmHg, 95% CI = -9.69, -5.46) were associated with lowered systolic blood pressure, whereas Aloe vera, Nigella sativa, and spirulina were associated with beneficial effects on both lipid profiles and glycemic control. In summary, this umbrella review has provided up-to-date evidence for the effect of PNSs on biomarkers related to hypertension, dyslipidemia, and diabetes. The results must be interpreted with caution due to potential heterogeneity.
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Affiliation(s)
- Tung Hoang
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Jeongseon Kim
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
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16
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Chen C, Lu L, Qin YT, Lv C, Wan XN, Guo XM. Combined Effects of Plant Sterols with Low Ratio of n-6/n-3 Polyunsaturated Fatty Acids against Atherosclerosis in ApoE -/- Mice. Curr Med Sci 2021; 40:1099-1106. [PMID: 33428138 DOI: 10.1007/s11596-020-2292-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
The effects of low ratio of n-6/n-3 polyunsaturated fatty acids (PUFA) have been clarified against atherosclerosis. Increasing evidence indicated that plant sterols (PS) have a significant cholesterol-lowering effect. This study explored the effects of PS combined with n-6/n-3 (2:1) PUFA on atherosclerosis and investigated the possible mechanism. In ApoE-/- mice, the milk fat in high fat diets was replaced with n-6/n-3 (2:1) PUFA alone or supplemented with 6% PS for 16 weeks. Results demonstrated that PS combined with PUFA exerted commentary and synergistic effects on ameliorating atherosclerosis, improving lipid metabolism and lipid deposition in liver, and alleviating inflammatory response. These changes were accompanied with decreased serum TC, TG, LDL-C and increased fecal cholesterol efflux, as well as the lower inflammatory cytokine CRP, IL-6, TNF-α. It is suggested that the underlying mechanism of PS combined with n-6/n-3 (2:1) PUFA promoting the fecal cholesterol efflux may be mediated by liver X receptor α/ATP-binding cassette transporter A1 pathway.
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Affiliation(s)
- Chen Chen
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li Lu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ya-Ting Qin
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chao Lv
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Ning Wan
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Mei Guo
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Bergamin A, Mantzioris E, Cross G, Deo P, Garg S, Hill AM. Nutraceuticals: Reviewing their Role in Chronic Disease Prevention and Management. Pharmaceut Med 2020; 33:291-309. [PMID: 31933188 DOI: 10.1007/s40290-019-00289-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Over half the adult population in many Western countries consume nutraceuticals because of their purported therapeutic benefits, accessibility and convenience. Several studies have demonstrated that they may also serve as a useful adjunct to pharmaceuticals to better manage chronic conditions or offset negative side effects. Individuals are advised to consult their physician before using nutraceuticals, but this advice is often overlooked. Thus, the community pharmacist plays an increasingly important role in assisting consumers with selecting a nutraceutical that is safe and for which there is evidence of therapeutic efficacy. Therefore, the aim of this review is to summarise the clinical evidence, safety and purported mechanisms of action for selected nutraceuticals in the management of chronic diseases, including obesity, diabetes, hypertension, hypercholesterolemia and inflammatory-based diseases.
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Affiliation(s)
- Amanda Bergamin
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Evangeline Mantzioris
- School of Pharmacy and Medical Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Giordana Cross
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Permal Deo
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Sanjay Garg
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Alison M Hill
- School of Pharmacy and Medical Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia.
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18
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Marques-Vidal P. Comparison of lifestyle changes and pharmacological treatment on cardiovascular risk factors. Heart 2020; 106:852-862. [PMID: 32354801 DOI: 10.1136/heartjnl-2019-316252] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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19
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Salehi-Sahlabadi A, Varkaneh HK, Shahdadian F, Ghaedi E, Nouri M, Singh A, Farhadnejad H, Găman MA, Hekmatdoost A, Mirmiran P. Effects of Phytosterols supplementation on blood glucose, glycosylated hemoglobin (HbA1c) and insulin levels in humans: a systematic review and meta-analysis of randomized controlled trials. J Diabetes Metab Disord 2020; 19:625-632. [PMID: 32550215 DOI: 10.1007/s40200-020-00526-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/03/2020] [Indexed: 02/06/2023]
Abstract
Background In the literature, there are still controversies regarding the effect of phytosterol(PS) supplementation on fasting blood sugar (FBS), insulin levels and glycosylated hemoglobin (HbA1c) in humans. We aimed to assess the impact of PS supplementation on FBS, HbA1c and insulin levels by conducting a systematic review and meta-analysis of the available randomized controlled trials (RCTs). Methods A comprehensive search was conducted to identify all RCTs published up to May 2019 in the following databases: PubMed-MEDLINE, Web of Science, Cochrane Library and Scopus. The mean difference with 95% confidence intervals (CIs) was pooled using a random-effects model (DerSimonian-Laird method). Results Twenty-six arms from 20 RCTs were included in the present meta-analysis. Our findings show that PS supplementation decreases insulin levels (mean difference [MD]: -6.426 μU/ml, 95% CI: -7.187, -5.665, P- value = 0.000). However, PS supplementation did not have significant effects on FBS and HbA1c levels. Following PS supplementation, significant changes in FBS (mean difference [MD]: -1.942 mg/dl, 95% CI: -3.637, -0.246, P- value = 0.025) and HbA1c (mean difference [MD]: -0.059%, 95% CI: -0.114, -0.004, P- value = 0.035) based on PS dosage (mg/d) were recorded. Conclusions In patients with a baseline BMI <25 kg/m2, PS consumption significantly increased FBS levels. Patients who consumed 1-2 g/day of PS had a lower FBS and lower HbA1c levels.
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Affiliation(s)
- Ammar Salehi-Sahlabadi
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Kord Varkaneh
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnaz Shahdadian
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran, Isfahan, Iran
| | - Ehsan Ghaedi
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mehran Nouri
- Students' Research Committee, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ambrish Singh
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, Tasmania TAS 7000 Australia
| | - Hossein Farhadnejad
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Yuan L, Zhang F, Jia S, Xie J, Shen M. Differences between phytosterols with different structures in regulating cholesterol synthesis, transport and metabolism in Caco-2 cells. J Funct Foods 2020. [DOI: 10.1016/j.jff.2019.103715] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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21
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Jones PJH, Shamloo M, MacKay DS, Rideout TC, Myrie SB, Plat J, Roullet JB, Baer DJ, Calkins KL, Davis HR, Barton Duell P, Ginsberg H, Gylling H, Jenkins D, Lütjohann D, Moghadasian M, Moreau RA, Mymin D, Ostlund RE, Ras RT, Ochoa Reparaz J, Trautwein EA, Turley S, Vanmierlo T, Weingärtner O. Progress and perspectives in plant sterol and plant stanol research. Nutr Rev 2019; 76:725-746. [PMID: 30101294 DOI: 10.1093/nutrit/nuy032] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Current evidence indicates that foods with added plant sterols or stanols can lower serum levels of low-density lipoprotein cholesterol. This review summarizes the recent findings and deliberations of 31 experts in the field who participated in a scientific meeting in Winnipeg, Canada, on the health effects of plant sterols and stanols. Participants discussed issues including, but not limited to, the health benefits of plant sterols and stanols beyond cholesterol lowering, the role of plant sterols and stanols as adjuncts to diet and drugs, and the challenges involved in measuring plant sterols and stanols in biological samples. Variations in interindividual responses to plant sterols and stanols, as well as the personalization of lipid-lowering therapies, were addressed. Finally, the clinical aspects and treatment of sitosterolemia were reviewed. Although plant sterols and stanols continue to offer an efficacious and convenient dietary approach to cholesterol management, long-term clinical trials investigating the endpoints of cardiovascular disease are still lacking.
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Affiliation(s)
- Peter J H Jones
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maryam Shamloo
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dylan S MacKay
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd C Rideout
- Department of Exercise and Nutrition Sciences, University of Buffalo, Buffalo, New York, USA
| | - Semone B Myrie
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jogchum Plat
- Department of Human Biology, Maastricht University, Maastricht, the Netherlands
| | - Jean-Baptiste Roullet
- Division of Metabolism, Child Development and Rehabilitation Center-Portland, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - David J Baer
- US Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, Beltsville, Maryland, USA
| | - Kara L Calkins
- Department of Pediatrics, Division of Neonatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA; and the UCLA Mattel's Children's Hospital, Los Angeles, California, USA
| | | | - P Barton Duell
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Henry Ginsberg
- Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York, USA
| | - Helena Gylling
- University of Helsinki and the Helsinki University Central Hospital, Helsinki, Finland
| | - David Jenkins
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; and the Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Dieter Lütjohann
- Institute for Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Mohammad Moghadasian
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert A Moreau
- Eastern Regional Research Center, US Department of Agriculture, Agricultural Research Service, Wyndmoor, Pennsylvania, USA
| | - David Mymin
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard E Ostlund
- Division of Endocrinology, Metabolism and Lipid Research, Washington University, St Louis, USA
| | - Rouyanne T Ras
- Unilever Research & Development Vlaardingen, Vlaardingen, the Netherlands
| | | | - Elke A Trautwein
- Unilever Research & Development Vlaardingen, Vlaardingen, the Netherlands
| | | | - Tim Vanmierlo
- Department of Immunology and Biochemistry, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
| | - Oliver Weingärtner
- Klinik für Innere Medizin I, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Germany; Abteilung für Kardiologie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Oldenburg, Germany
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22
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Alehagen U, Johansson P, Aaseth J, Alexander J, Surowiec I, Lundstedt-Enkel K, Lundstedt T. Significant Changes in Metabolic Profiles after Intervention with Selenium and Coenzyme Q10 in an Elderly Population. Biomolecules 2019; 9:biom9100553. [PMID: 31575091 PMCID: PMC6843494 DOI: 10.3390/biom9100553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 01/08/2023] Open
Abstract
Selenium and coenzyme Q10 (SeQ10) are important for normal cellular function. Low selenium intake leads to increased cardiovascular mortality. Intervention with these substances with healthy elderly persons over a period of four years in a double-blind, randomised placebo-controlled prospective study showed reduced cardiovascular mortality, increased cardiac function, and a lower level of NT-proBNP. Therefore, we wanted to evaluate changes in biochemical pathways as a result of the intervention with SeQ10 using metabolic profiling. From a population of 443 healthy elderly individuals that were given 200 µg selenium and 200 mg coenzyme Q10, or placebo daily for four years, we selected nine males on active intervention and nine males on placebo for metabolic profiling in the main study. To confirm the results, two validation studies (study 1 n = 60 males, study 2 n = 37 males) were conducted. Principal component analyses were used on clinical and demographic data to select representative sets of samples for analysis and to divide the samples into batches for analysis. Gas chromatography time-of-flight mass spectrometry-based metabolomics was applied. The metabolite data were evaluated using univariate and multivariate approaches, mainly T-tests and orthogonal projections to latent structures (OPLS) analyses. Out of 95 identified metabolites, 19 were significantly decreased due to the intervention after 18 months of intervention. Significant changes could be seen in the pentose phosphate, the mevalonate, the beta-oxidation and the xanthine oxidase pathways. The intervention also resulted in changes in the urea cycle, and increases in the levels of the precursors to neurotransmitters of the brain. This adds information to previous published results reporting decreased oxidative stress and inflammation. This is the first-time metabolic profiling has been applied to elucidate the mechanisms behind an intervention with SeQ10. The study is small and should be regarded as hypothesis-generating; however, the results are interesting and, therefore, further research in the area is needed. This study was registered at Clinicaltrials.gov, with the identifier NCT01443780.
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Affiliation(s)
- Urban Alehagen
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden.
| | - Peter Johansson
- Department of Social and Welfare Studies, Linköping University, SE-581 83 Linköping, Sweden.
- Department of Internal Medicine, Linköping University, SE-581 83 Linköping, Sweden.
- Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden.
| | - Jan Aaseth
- Research Department, Innlandet Hospital Trust, N-2380 Brumunddal, Norway.
| | - Jan Alexander
- Norwegian Institute of Public Health, N-0403 Oslo, Norway.
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Phytosterol compositions of enriched products influence their cholesterol-lowering efficacy: a meta-analysis of randomized controlled trials. Eur J Clin Nutr 2019; 73:1579-1593. [DOI: 10.1038/s41430-019-0504-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 09/07/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022]
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Dietary Patterns and Cardiometabolic Outcomes in Diabetes: A Summary of Systematic Reviews and Meta-Analyses. Nutrients 2019; 11:nu11092209. [PMID: 31540227 PMCID: PMC6770579 DOI: 10.3390/nu11092209] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD) conducted a review of existing systematic reviews and meta-analyses to explain the relationship between different dietary patterns and patient-important cardiometabolic outcomes. To update the clinical practice guidelines for nutrition therapy in the prevention and management of diabetes, we summarize the evidence from these evidence syntheses for the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Portfolio, Nordic, liquid meal replacement, and vegetarian dietary patterns. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. We summarized the evidence for disease incidence outcomes and risk factor outcomes using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs), respectively. The Mediterranean diet showed a cardiovascular disease (CVD) incidence (RR: 0.62; 95%CI, 0.50, 0.78), and non-significant CVD mortality (RR: 0.67; 95%CI, 0.45, 1.00) benefit. The DASH dietary pattern improved cardiometabolic risk factors (P < 0.05) and was associated with the decreased incidence of CVD (RR, 0.80; 95%CI, 0.76, 0.85). Vegetarian dietary patterns were associated with improved cardiometabolic risk factors (P < 0.05) and the reduced incidence (0.72; 95%CI: 0.61, 0.85) and mortality (RR, 0.78; 95%CI, 0.69, 0.88) of coronary heart disease. The Portfolio dietary pattern improved cardiometabolic risk factors and reduced estimated 10-year coronary heart disease (CHD) risk by 13% (−1.34% (95%CI, −2.19 to −0.49)). The Nordic dietary pattern was correlated with decreased CVD (0.93 (95%CI, 0.88, 0.99)) and stroke incidence (0.87 (95%CI, 0.77, 0.97)) and, along with liquid meal replacements, improved cardiometabolic risk factors (P < 0.05). The evidence was assessed as low to moderate certainty for most dietary patterns and outcome pairs. Current evidence suggests that the Mediterranean, DASH, Portfolio, Nordic, liquid meal replacement and vegetarian dietary patterns have cardiometabolic advantages in populations inclusive of diabetes.
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Reaver A, Hewlings S, Westerman K, Blander G, Schmeller T, Heer M, Rein D. A Randomized, Placebo-Controlled, Double-Blind Crossover Study to Assess a Unique Phytosterol Ester Formulation in Lowering LDL Cholesterol Utilizing a Novel Virtual Tracking Tool. Nutrients 2019; 11:nu11092108. [PMID: 31491873 PMCID: PMC6769481 DOI: 10.3390/nu11092108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 11/25/2022] Open
Abstract
Elevated blood concentration of low-density lipoprotein cholesterol (LDLc) is a primary risk factor for developing cardiovascular disease. Lifestyle interventions including an increase in dietary phytosterols as well as medications have proven effective in lowering LDLc. The primary objective of this randomized, placebo controlled, double blind, crossover study was to determine the impact of a new phytosterol emulsion for dietary supplements (1.5 g/day phytosterol equivalents) on LDLc concentrations. Thirty-two healthy adults were randomly assigned to receive placebo or treatment followed by a washout period, followed by placebo or treatment, each phase lasting one month. Secondary endpoints related to cardiovascular health were also assessed. Study management, including screening, recruitment, monitoring, compliance, and data collection, were done remotely (a siteless clinical trial) utilizing a novel virtual tool. Phytosterol supplementation significantly lowered LDLc concentrations by 10.2% (16.17 mg/dL or 0.419 mmol/L, p = 0.008 by paired t-test, p = 0.014 by Wilcoxon signed rank testing). No secondary biomarkers were found to change significantly. Supplementation with phytosterols in a new dietary supplement formulation efficiently and safely decreases LDLc within one month in a free-living setting.
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Affiliation(s)
| | - Susan Hewlings
- Nutrasource, Guelph, ON N1G0B4, Canada
- Department of Nutrition, Central Michigan University, Mount Pleasant, MI 48859, USA
| | | | - Gil Blander
- Segterra (Inside Tracker), Cambridge, MA 02142, USA
| | - Thorsten Schmeller
- BASF SE, Nutrition and Health, Human Nutrition, 68623 Lampertheim, Germany
| | - Marianne Heer
- BASF SE, Nutrition and Health, Human Nutrition, 68623 Lampertheim, Germany
| | - Dietrich Rein
- BASF SE, Nutrition and Health, Human Nutrition, 68623 Lampertheim, Germany.
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Abstract
Cardiovascular ageing and the atherosclerotic process begin very early in life, most likely in utero. They progress over decades of exposure to suboptimal or abnormal metabolic and hormonal risk factors, eventually culminating in very common, costly, and mostly preventable target-organ pathologies, including coronary heart disease, stroke, heart failure, aortic aneurysm, peripheral artery disease, and vascular dementia. In this Review, we discuss findings from preclinical and clinical studies showing that calorie restriction (CR), intermittent fasting, and adjusted diurnal rhythm of feeding, with adequate intake of specific macronutrients and micronutrients, are powerful interventions not only for the prevention of cardiovascular disease but also for slowing the accumulation of molecular damage leading to cardiometabolic dysfunction. Furthermore, we discuss the mechanisms through which a number of other nondietary interventions, such as regular physical activity, mindfulness-based stress-reduction exercises, and some CR-mimetic drugs that target pro-ageing pathways, can potentiate the beneficial effects of a healthy diet in promoting cardiometabolic health.
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Guzman JR, Paterniti DA, Liu Y, Tarn DM. Factors Related to Disclosure and Nondisclosure of Dietary Supplements in Primary Care, Integrative Medicine, and Naturopathic Medicine. ACTA ACUST UNITED AC 2019; 5. [PMID: 32051918 PMCID: PMC7015169 DOI: 10.23937/2469-5793/1510109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Patients infrequently disclose use of dietary supplements to providers. Little is known about factors that motivate patients to disclose supplement use. The study aimed to identify reported factors motivating patients’ disclosure and nondisclosure of dietary supplement use and explore differences based on type of supplement and provider practice. Methods: Mixed methods study combining qualitative content analysis of semi-structured interviews with statistical analyses to assess differences in identified factors by provider practice type and supplement type. Seventy-eight English-speaking patients who reported taking 466 dietary supplements in the previous 30 days were recruited from primary care and Complementary and Alternative Medicine (CAM), and Integrative Medicine (IM) offices in Southern California. Results: We identified nine themes related to disclosure and nine related to nondisclosure of dietary supplement use. Major themes were features of the office visit, circumstances in patient health and medical care, and provider/patient characteristics. The most commonly raised theme promoting disclosure of supplement use was provider inquiry. Patients associate disclosure with having concerns about a supplement but also with annual physical exams and some routine topics of discussion, including self-care, lab results, and new medication prescriptions. Themes related to nondisclosure included lack of provider inquiry, features of the office visit, such as supplements being unrelated to the visit purpose, and patients’ convictions that supplements are safe or not important to discuss. Themes did not vary by supplement type. Primary care patients were more likely than CAM/IM patients to attribute nondisclosure to convictions that supplements were beneficial, not worth mentioning, or equivalent to food (p ≤ 0.001). Conclusions: When providers fail to ask directly about dietary supplement use, disclosure is often an impromptu decision that is driven by the content of provider-patient interactions. Ensuring disclosure of dietary supplement use to prevent potential drug-supplement interactions or adverse health outcomes likely requires consistent, proactive provider queries about supplement use.
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Affiliation(s)
- Jennifer R Guzman
- Department of Anthropology, State University of New York at Geneseo, USA
| | - Debora A Paterniti
- Department of Sociology, Sonoma State University, USA.,Departments of Internal Medicine and Sociology, University of California - Davis, USA
| | | | - Derjung M Tarn
- Department of Family Medicine, University of California - Los Angeles, USA
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Zhao Y, Yang B, Xu T, Wang M, Lu B. Photooxidation of phytosterols in oil matrix: Effects of the light, photosensitizers and unsaturation degree of the lipids. Food Chem 2019; 288:162-169. [DOI: 10.1016/j.foodchem.2019.02.105] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 01/26/2023]
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Blanco Mejia S, Messina M, Li SS, Viguiliouk E, Chiavaroli L, Khan TA, Srichaikul K, Mirrahimi A, Sievenpiper JL, Kris-Etherton P, Jenkins DJA. A Meta-Analysis of 46 Studies Identified by the FDA Demonstrates that Soy Protein Decreases Circulating LDL and Total Cholesterol Concentrations in Adults. J Nutr 2019; 149:968-981. [PMID: 31006811 PMCID: PMC6543199 DOI: 10.1093/jn/nxz020] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/05/2018] [Accepted: 01/25/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Certain plant foods (nuts and soy protein) and food components (viscous fibers and plant sterols) have been permitted by the FDA to carry a heart health claim based on their cholesterol-lowering ability. The FDA is currently considering revoking the heart health claim for soy protein due to a perceived lack of consistent LDL cholesterol reduction in randomized controlled trials. OBJECTIVE We performed a meta-analysis of the 46 controlled trials on which the FDA will base its decision to revoke the heart health claim for soy protein. METHODS We included the 46 trials on adult men and women, with baseline circulating LDL cholesterol concentrations ranging from 110 to 201 mg/dL, as identified by the FDA, that studied the effects of soy protein on LDL cholesterol and total cholesterol (TC) compared with non-soy protein. Two independent reviewers extracted relevant data. Data were pooled by the generic inverse variance method with a random effects model and expressed as mean differences with 95% CI. Heterogeneity was assessed and quantified. RESULTS Of the 46 trials identified by the FDA, 43 provided data for meta-analyses. Of these, 41 provided data for LDL cholesterol, and all 43 provided data for TC. Soy protein at a median dose of 25 g/d during a median follow-up of 6 wk decreased LDL cholesterol by 4.76 mg/dL (95% CI: -6.71, -2.80 mg/dL, P < 0.0001; I2 = 55%, P < 0.0001) and decreased TC by 6.41 mg/dL (95% CI: -9.30, -3.52 mg/dL, P < 0.0001; I2 = 74%, P < 0.0001) compared with non-soy protein controls. There was no dose-response effect or evidence of publication bias for either outcome. Inspection of the individual trial estimates indicated most trials (∼75%) showed a reduction in LDL cholesterol (range: -0.77 to -58.60 mg/dL), although only a minority of these were individually statistically significant. CONCLUSIONS Soy protein significantly reduced LDL cholesterol by approximately 3-4% in adults. Our data support the advice given to the general public internationally to increase plant protein intake. This trial was registered at clinicaltrials.gov as NCT03468127.
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Affiliation(s)
- Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | | | - Siying S Li
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Effie Viguiliouk
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada
| | - Korbua Srichaikul
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Arash Mirrahimi
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Penny Kris-Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital,Toronto, ON, Canada,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Address correspondence to DJAJ (e-mail: )
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Dumolt JH, Rideout TC. The Lipid-lowering Effects and Associated Mechanisms of Dietary Phytosterol Supplementation. Curr Pharm Des 2019; 23:5077-5085. [PMID: 28745211 DOI: 10.2174/1381612823666170725142337] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/01/2017] [Accepted: 07/21/2017] [Indexed: 12/12/2022]
Abstract
Phytosterols (PS) are plant-based structural analogous of mammalian cholesterol that have been shown to lower blood cholesterol concentrations by ~10%, although inter-individual response to PS supplementation due to subject-specific metabolic and genetic factors is evident. Recent work further suggests that PS may act as effective triglyceride (TG)-lowering agents with maximal TG reductions observed in hypertriglyceridemic subjects. Although PS have been demonstrated to interfere with cholesterol and perhaps TG absorption within the intestine, they also have the capacity to modulate the expression of lipid regulatory genes through liver X receptor (LXR) activation. Identification of single-nucleotide polymorphisms (SNP) in key cholesterol and TG regulating genes, in particular adenosine triphosphate binding cassette G8 (ABCG8) and apolipoprotein E (apoE) have provided insight into the potential of utilizing genomic identifiers as an indicator of PS responsiveness. While PS supplementation is deemed safe, expanding research into the atherogenic potential of oxidized phytosterols (oxyphytosterols) has emerged with their identification in arterial lesions. This review will highlight the lipid-lowering utility and associated mechanisms of PS and discuss novel applications and future research priorities for PS pertaining to in utero PS exposure for long-term cardiovascular disease risk protection and combination therapies with lipidlowering drugs.
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Affiliation(s)
- Jerad H Dumolt
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14214, United States
| | - Todd C Rideout
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14214, United States
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Ruiz-León AM, Lapuente M, Estruch R, Casas R. Clinical Advances in Immunonutrition and Atherosclerosis: A Review. Front Immunol 2019; 10:837. [PMID: 31068933 PMCID: PMC6491827 DOI: 10.3389/fimmu.2019.00837] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/01/2019] [Indexed: 12/11/2022] Open
Abstract
Atherosclerosis is a chronic low-grade inflammatory disease that affects large and medium-sized arteries and is considered to be a major underlying cause of cardiovascular disease (CVD). The high risk of mortality by atherosclerosis has led to the development of new strategies for disease prevention and management, including immunonutrition. Plant-based dietary patterns, functional foods, dietary supplements, and bioactive compounds such as the Mediterranean Diet, berries, polyunsaturated fatty acids, ω-3 and ω-6, vitamins E, A, C, and D, coenzyme Q10, as well as phytochemicals including isoflavones, stilbenes, and sterols have been associated with improvement in atheroma plaque at an inflammatory level. However, many of these correlations have been obtained in vitro and in experimental animals' models. On one hand, the present review focuses on the evidence obtained from epidemiological, dietary intervention and supplementation studies in humans supporting the role of immunonutrient supplementation and its effect on anti-inflammatory response in atherosclerotic disease. On the other hand, this review also analyzes the possible molecular mechanisms underlying the protective action of these supplements, which may lead a novel therapeutic approach to prevent or attenuate diet-related disease, such as atherosclerosis.
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Affiliation(s)
- Ana María Ruiz-León
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Mediterranean Diet Foundation, Barcelona, Spain
| | - María Lapuente
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ramon Estruch
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain.,CIBER 06/03: Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Casas
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain.,CIBER 06/03: Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
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32
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Jia C, Xia X, Liu P, Wang H, Zhang J, Zhang X. Mild and Efficient Preparation of Phytosteryl Amino Acid Ester Hydrochlorides and Their Emulsifying Properties. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:1749-1759. [PMID: 30657680 DOI: 10.1021/acs.jafc.8b07153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of this work was to produce a series of phytosteryl amino acid ester hydrochlorides by a two-step method, which involved esterification of phytosterols with N- tert-butoxycarbonyl (BOC) amino acid and deprotection of the BOC group. The highest yield of over 95.0% was obtained when the catalysts were the mixtures of 1-ethyl-3-(3-(dimethylamino)propyl)carbodiimide hydrochlide, 4-dimethylaminopyridine, and triethylamine. It was found that batch charging of the reactants and catalysts was conducive to improving the yield. In addition, over 99.0% of the BOC group deprotection degree was achieved using the HCl/ethyl acetate deprotection method. All of the compounds were characterized by fourier transform infrared spectroscopy, mass spectroscopy, and nuclear magnetic resonance spectroscopy. The emulsifying properties of phytosterols and phytosteryl amino acid ester hydrochlorides were also investigated. The results showed higher emulsifying properties of phytosteryl amino acid ester hydrochlorides, which could favor its wide application in food systems.
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Affiliation(s)
- Chengsheng Jia
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology , Jiangnan University , 1800 Lihu Road , Wuxi , Jiangsu 214122 , People's Republic of China
| | - Xue Xia
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology , Jiangnan University , 1800 Lihu Road , Wuxi , Jiangsu 214122 , People's Republic of China
| | - Ping Liu
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology , Jiangnan University , 1800 Lihu Road , Wuxi , Jiangsu 214122 , People's Republic of China
| | - Huiqi Wang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology , Jiangnan University , 1800 Lihu Road , Wuxi , Jiangsu 214122 , People's Republic of China
| | - Jiarui Zhang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology , Jiangnan University , 1800 Lihu Road , Wuxi , Jiangsu 214122 , People's Republic of China
| | - Xiaoming Zhang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology , Jiangnan University , 1800 Lihu Road , Wuxi , Jiangsu 214122 , People's Republic of China
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Kempinski C, Jiang Z, Zinck G, Sato SJ, Ge Z, Clemente TE, Chappell J. Engineering linear, branched-chain triterpene metabolism in monocots. PLANT BIOTECHNOLOGY JOURNAL 2019; 17:373-385. [PMID: 29979490 PMCID: PMC6335073 DOI: 10.1111/pbi.12983] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/20/2018] [Accepted: 06/22/2018] [Indexed: 05/09/2023]
Abstract
Triterpenes are thirty-carbon compounds derived from the universal five-carbon prenyl precursors isopentenyl diphosphate (IPP) and dimethylallyl diphosphate (DMAPP). Normally, triterpenes are synthesized via the mevalonate (MVA) pathway operating in the cytoplasm of eukaryotes where DMAPP is condensed with two IPPs to yield farnesyl diphosphate (FPP), catalyzed by FPP synthase (FPS). Squalene synthase (SQS) condenses two molecules of FPP to generate the symmetrical product squalene, the first committed precursor to sterols and most other triterpenes. In the green algae Botryococcus braunii, two FPP molecules can also be condensed in an asymmetric manner yielding the more highly branched triterpene, botryococcene. Botryococcene is an attractive molecule because of its potential as a biofuel and petrochemical feedstock. Because B. braunii, the only native host for botryococcene biosynthesis, is difficult to grow, there have been efforts to move botryococcene biosynthesis into organisms more amenable to large-scale production. Here, we report the genetic engineering of the model monocot, Brachypodium distachyon, for botryococcene biosynthesis and accumulation. A subcellular targeting strategy was used, directing the enzymes (botryococcene synthase [BS] and FPS) to either the cytosol or the plastid. High titres of botryococcene (>1 mg/g FW in T0 mature plants) were obtained using the cytosolic-targeting strategy. Plastid-targeted BS + FPS lines accumulated botryococcene (albeit in lesser amounts than the cytosolic BS + FPS lines), but they showed a detrimental phenotype dependent on plastid-targeted FPS, and could not proliferate and survive to set seed under phototrophic conditions. These results highlight intriguing differences in isoprenoid metabolism between dicots and monocots.
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Affiliation(s)
- Chase Kempinski
- Plant Biology ProgramUniversity of KentuckyLexingtonKYUSA
- Department of Pharmaceutical SciencesUniversity of KentuckyLexingtonKYUSA
| | - Zuodong Jiang
- Plant Biology ProgramUniversity of KentuckyLexingtonKYUSA
- Department of Pharmaceutical SciencesUniversity of KentuckyLexingtonKYUSA
- Present address:
Department of Soil and Crop SciencesTexas A&M UniversityCollege StationTX77843USA
| | - Garrett Zinck
- Department of Pharmaceutical SciencesUniversity of KentuckyLexingtonKYUSA
| | - Shirley J. Sato
- Center for BiotechnologyUniversity of Nebraska‐LincolnLincolnNEUSA
| | - Zhengxiang Ge
- Center for BiotechnologyUniversity of Nebraska‐LincolnLincolnNEUSA
| | | | - Joe Chappell
- Plant Biology ProgramUniversity of KentuckyLexingtonKYUSA
- Department of Pharmaceutical SciencesUniversity of KentuckyLexingtonKYUSA
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Francini-Pesenti F, Spinella P, Calò LA. Potential role of phytochemicals in metabolic syndrome prevention and therapy. Diabetes Metab Syndr Obes 2019; 12:1987-2002. [PMID: 31632110 PMCID: PMC6778731 DOI: 10.2147/dmso.s214550] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/09/2019] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome (MetS) is a set of cardiovascular risk factors which severely increases the risk of type II diabetes, renal disease and cardiovascular disease. Over the last decades, the role of dietary bioactive substances in features of MetS has been extensively investigated. Due to their multiple properties, these plant-derived natural compounds have demonstrated to provide positive effects in obesity, diabetes, renal and in cardiovascular disease. Catechins of green tea and caffeine reduce body mass index and waist circumference. Catechins, anthocyanins and proanthocyanidins of cocoa reduce blood pressure and blood glucose. Curcumin and silymarin exert hepatoprotective effects. Monacolins of red yeast rice are effective cholesterol-lowering agents. However, inconsistent or conflicting results have been found in clinical trials when other promising compounds in vitro or in animal studies, such as policosanol, curcumin or silymarin, were used. Low oral bioavailability of substances, ineffective dosages, inadequate treatment duration and insufficient statistical approach may explain the lack of effectiveness observed in some human studies. Further clinical studies are needed to better understand the role of bioactive compounds in the prevention and management of MetS.
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Affiliation(s)
| | - Paolo Spinella
- Department of Medicine (DIMED), Nutrition Unit, University of Padova-Azienda Ospedaliera, Padova, Italy
| | - Lorenzo A Calò
- Department of Medicine (DIMED), Nephrology, Dialysis and Transplantation Unit, University of Padova-Azienda Ospedaliera, Padova, Italy
- Correspondence: Lorenzo A CalòDepartment of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova-Azienda Ospedaliera, Via Giustiniani 2, Padova35128, ItalyTel +39 049 821 3071Fax +39 049 821 7921Email
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LDL-Cholesterol Lowering of Plant Sterols and Stanols-Which Factors Influence Their Efficacy? Nutrients 2018; 10:nu10091262. [PMID: 30205492 PMCID: PMC6163911 DOI: 10.3390/nu10091262] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 11/16/2022] Open
Abstract
The LDL-cholesterol (LDL-C) lowering effect of plant sterols/stanols (PSS) is summarized in several meta-analyses showing a dose-response relationship with intakes of 1.5 to 3 g/day lowering LDL-C by 7.5% to 12%. This review summarizes evidence for the impact of various factors potentially influencing the LDL-C-lowering efficacy of PSS. PSS are efficacious in all food formats and in food supplements. Some factors related to food format, e.g., solid vs. liquid foods, seem to impact efficacy, while there is no difference between free PSS and esters. Compared to multiple daily intakes, once-a-day intake of PSS, especially in the morning with light breakfast, leads to a sub-optimal LDL-C lowering. However, intake frequency seems influenced by intake occasion, i.e., with or without a meal, and time of day. Meal intake is a critical factor for an optimal LDL-C lowering efficacy of PSS. While age has no impact, gender is suggested to influence the LDL-C lowering effect of PSS with greater reductions reported for men than women; but overall evidence is inconclusive and larger studies show no gender by treatment interaction. In conclusion, PSS are efficacious in all foods and food supplements; for optimal efficacy they should be consumed with a (main) meal and twice daily.
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Cabral CE, Klein MRST. Phytosterols in the Treatment of Hypercholesterolemia and Prevention of Cardiovascular Diseases. Arq Bras Cardiol 2018; 109:475-482. [PMID: 29267628 PMCID: PMC5729784 DOI: 10.5935/abc.20170158] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/05/2017] [Indexed: 12/20/2022] Open
Abstract
Phytosterols are bioactive compounds found in foods of plant origin, which can be
divided into plant sterols and plant stanols. Clinical studies consistently
indicate that the intake of phytosterols (2 g/day) is associated with a
significant reduction (8-10%) in levels of low-density lipoprotein cholesterol
(LDL-cholesterol). Thus, several guidelines recommend the intake of 2 g/day of
plant sterols and/or stanols in order to reduce LDL-cholesterol levels. As the
typical western diet contains only about 300 mg/day of phytosterols, foods
enriched with phytosterols are usually used to achieve the recommended intake.
Although phytosterols decrease LDL-cholesterol levels, there is no evidence that
they reduce the risk of cardiovascular diseases; on the contrary, some studies
suggest an increased risk of atherosclerosis with increasing serum levels of
phytosterols. This review aims to address the evidence available in the
literature on the relationship between phytosterols and risk of cardiovascular
disease.
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Affiliation(s)
- Carlos Eduardo Cabral
- Divisão de Nutrição - Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil
| | - Márcia Regina Simas Torres Klein
- Divisão de Nutrição - Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil.,Departamento de Nutrição Aplicada - Instituto de Nutrição - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brazil
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Banach M, Patti AM, Giglio RV, Cicero AFG, Atanasov AG, Bajraktari G, Bruckert E, Descamps O, Djuric DM, Ezhov M, Fras Z, von Haehling S, Katsiki N, Langlois M, Latkovskis G, Mancini GBJ, Mikhailidis DP, Mitchenko O, Moriarty PM, Muntner P, Nikolic D, Panagiotakos DB, Paragh G, Paulweber B, Pella D, Pitsavos C, Reiner Ž, Rosano GMC, Rosenson RS, Rysz J, Sahebkar A, Serban MC, Vinereanu D, Vrablík M, Watts GF, Wong ND, Rizzo M. The Role of Nutraceuticals in Statin Intolerant Patients. J Am Coll Cardiol 2018; 72:96-118. [PMID: 29957236 DOI: 10.1016/j.jacc.2018.04.040] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 02/08/2023]
Abstract
Statins are the most common drugs administered for patients with cardiovascular disease. However, due to statin-associated muscle symptoms, adherence to statin therapy is challenging in clinical practice. Certain nutraceuticals, such as red yeast rice, bergamot, berberine, artichoke, soluble fiber, and plant sterols and stanols alone or in combination with each other, as well as with ezetimibe, might be considered as an alternative or add-on therapy to statins, although there is still insufficient evidence available with respect to long-term safety and effectiveness on cardiovascular disease prevention and treatment. These nutraceuticals could exert significant lipid-lowering activity and might present multiple non-lipid-lowering actions, including improvement of endothelial dysfunction and arterial stiffness, as well as anti-inflammatory and antioxidative properties. The aim of this expert opinion paper is to provide the first attempt at recommendation on the management of statin intolerance through the use of nutraceuticals with particular attention on those with effective low-density lipoprotein cholesterol reduction.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Medical University of Lodz, and the Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.
| | - Angelo Maria Patti
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Rosaria Vincenza Giglio
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Arrigo F G Cicero
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
| | - Atanas G Atanasov
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, Poland; Department of Pharmacognosy, University of Vienna, Vienna, Austria
| | - Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosovo, and the Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Eric Bruckert
- Institute of Cardiometabolism and Nutrition (ICAN), Endocrinology Department, Hopital Pitié Salpetrière, Paris, France
| | - Olivier Descamps
- Department of Internal Medicine, Centres Hospitaliers Jolimont, Haine Saint-Paul, Belgium; Department of Cardiology, Cliniques Universitaires Saint-Luc, Bruxells, Belgium
| | - Dragan M Djuric
- Institute of Medical Physiology "Richard Burian" Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marat Ezhov
- National Cardiology Research Center, Moscow, Russia
| | - Zlatko Fras
- Preventive Cardiology Unit, Department of Vascular Medicine, Division of Internal Medicine, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Niki Katsiki
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Michel Langlois
- Department of Laboratory Medicine, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Gustavs Latkovskis
- Faculty of Medicine and Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia
| | - G B John Mancini
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom
| | - Olena Mitchenko
- Dyslipidaemia Department, Institute of Cardiology AMS of Ukraine, Kiev, Ukraine
| | - Patrick M Moriarty
- Division of Clinical Pharmacology, Division of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Paul Muntner
- Department of Epidemiology, University of Alabama Birmingham, Birmingham, Alabama
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Demosthenes B Panagiotakos
- School of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Gyorgy Paragh
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Bernhard Paulweber
- First Department of Internal Medicine, Paracelsus Private Medical University, Salzburg, Austria
| | - Daniel Pella
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Košice, Slovakia
| | - Christos Pitsavos
- Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Željko Reiner
- University Hospital Centre Zagreb, School of Medicine University of Zagreb, Department of Internal Medicine, Zagreb, Croatia
| | - Giuseppe M C Rosano
- Cardiovascular Clinical Academic Group St. George's Hospitals NHS Trust University of London, London, United Kingdom; IRCCS San Raffaele Roma, Rome, Italy
| | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacek Rysz
- Department of Hypertension, Medical University of Lodz, and the Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute and Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maria-Corina Serban
- Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Dragos Vinereanu
- University of Medicine and Pharmacy "Carol Davila," and Department of Cardiology, University and Emergency Hospital, Bucharest, Romania
| | - Michal Vrablík
- Third Department of Internal Medicine, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Gerald F Watts
- Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
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Chiavaroli L, Nishi SK, Khan TA, Braunstein CR, Glenn AJ, Mejia SB, Rahelić D, Kahleová H, Salas-Salvadó J, Jenkins DJA, Kendall CWC, Sievenpiper JL. Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Prog Cardiovasc Dis 2018; 61:43-53. [PMID: 29807048 DOI: 10.1016/j.pcad.2018.05.004] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The evidence for the Portfolio dietary pattern, a plant-based dietary pattern that combines recognized cholesterol-lowering foods (nuts, plant protein, viscous fibre, plant sterols), has not been summarized. OBJECTIVE To update the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of controlled trials using GRADE of the effect of the Portfolio dietary pattern on the primary therapeutic lipid target for cardiovascular disease prevention, low-density lipoprotein cholesterol (LDL-C), and other established cardiometabolic risk factors. METHODS We searched MEDLINE, EMBASE, and The Cochrane Library through April 19, 2018. We included controlled trials ≥ 3-weeks assessing the effect of the Portfolio dietary pattern on cardiometabolic risk factors compared with an energy-matched control diet free of Portfolio dietary pattern components. Two independent reviewers extracted data and assessed risk of bias. The primary outcome was LDL-C. Data were pooled using the generic inverse-variance method and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q statistic) and quantified (I2-statistic). GRADE assessed the certainty of the evidence. RESULTS Eligibility criteria were met by 7 trial comparisons in 439 participants with hyperlipidemia, in which the Portfolio dietary pattern was given on a background of a National Cholesterol Education Program (NCEP) Step II diet. The combination of a portfolio dietary pattern and NCEP Step II diet significantly reduced the primary outcome LDL-C by ~17% (MD, -0.73 mmol/L, [95% CI, -0.89 to -0.56 mmol/L]) as well as non-high-density lipoprotein cholesterol, apolipoprotein B, total cholesterol, triglycerides, systolic and diastolic blood pressure, C-reactive protein, and estimated 10-year coronary heart disease (CHD) risk, compared with an NCEP Step 2 diet alone (p < 0.05). There was no effect on high-density lipoprotein cholesterol or body weight. The certainty of the evidence was high for LDL-cholesterol and most lipid outcomes and moderate for all others outcomes. CONCLUSIONS Current evidence demonstrates that the Portfolio dietary pattern leads to clinically meaningful improvements in LDL-C as well as other established cardiometabolic risk factors and estimated 10-year CHD risk.
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Affiliation(s)
- Laura Chiavaroli
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie K Nishi
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tauseef A Khan
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Catherine R Braunstein
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea J Glenn
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sonia Blanco Mejia
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dario Rahelić
- Department of Endocrinology, Diabetes and Clinical Pharmacology, Dubrava University Hospital, Zagreb, Croatia
| | - Hana Kahleová
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic; Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain; Human Nutrition Department, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - David J A Jenkins
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - Cyril W C Kendall
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada.
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Jing J, Wei T, Su W, Liu Y, Yao W, Zhu H, Fu T. Structural Related Effects of Natural Steroid Molecules on Cholesterol Crystallization in Model Bile and Ethanol. ChemistrySelect 2018. [DOI: 10.1002/slct.201800237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jie Jing
- Schcool of pharmacy; Nanjing university of Chinese medicine; 138 Xianlin Ave. Nanjing China 210023
| | - Tongxin Wei
- Schcool of pharmacy; Nanjing university of Chinese medicine; 138 Xianlin Ave. Nanjing China 210023
| | - Wenqiang Su
- Schcool of pharmacy; Nanjing university of Chinese medicine; 138 Xianlin Ave. Nanjing China 210023
| | - Yonghai Liu
- Schcool of pharmacy; Nanjing university of Chinese medicine; 138 Xianlin Ave. Nanjing China 210023
| | - Weiwei Yao
- Schcool of pharmacy; Nanjing university of Chinese medicine; 138 Xianlin Ave. Nanjing China 210023
| | - Huaxu Zhu
- Schcool of pharmacy; Nanjing university of Chinese medicine; 138 Xianlin Ave. Nanjing China 210023
| | - Tingming Fu
- Schcool of pharmacy; Nanjing university of Chinese medicine; 138 Xianlin Ave. Nanjing China 210023
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40
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Phytosterols and their derivatives: Structural diversity, distribution, metabolism, analysis, and health-promoting uses. Prog Lipid Res 2018; 70:35-61. [DOI: 10.1016/j.plipres.2018.04.001] [Citation(s) in RCA: 208] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 01/08/2023]
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41
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Houston M. Dyslipidemia. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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42
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Devries S. Coronary Artery Disease. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shen T, Xing G, Zhu J, Zhang S, Cai Y, Li D, Xu G, Xing E, Rao J, Shi R. Effects of 12-week supplementation of marine Omega-3 PUFA-based formulation Omega3Q10 in older adults with prehypertension and/or elevated blood cholesterol. Lipids Health Dis 2017; 16:253. [PMID: 29282085 PMCID: PMC5745982 DOI: 10.1186/s12944-017-0617-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/19/2017] [Indexed: 02/05/2023] Open
Abstract
Backgrounds To study the effects of supplementation of a marine omega-3 poly-unsaturated fatty acids (n3-PUFA) formulation (Omega3Q10) in older adults with hypertension and/or hypercholesterolemia. Methods A total of 97 people were enrolled to receive 12-week supplementation of either Omega3Q10 (n = 48) or soybean oil (n = 49). Total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and hypertension-related symptoms were determined before and after the supplementation. Results There were no baseline differences between the two groups. Omega3Q10 supplementation significantly reduced diastolic blood pressure (DBP) (from 81.6 ± 5.3 mmHg to 79.3 ± 5.2 mmHg, P < 0.05). Blood concentrations of TC and LDL-C decreased significantly and blood HDL-C level increased significantly after 12 weeks of Omega3Q10 (5.5 ± 0.7 vs. 5.3 ± 0.5, P < 0.05; 3.7 ± 0.8 vs. 3.3 ± 0.6, P < 0.05; 1.2 ± 0.6 vs. 1.3 ± 0.5, P < 0.05, respectively) and soybean oil supplementation (5.7 ± 0.8 vs. 5.6 ± 0.7, P < 0.05; 3.6 ± 0.7 vs. 3.4 ± 0.8, P < 0.05; 1.0 ± 0.8 vs. 1.2 ± 0.7, P < 0.05, respectively) but no group differences were found. A significantly greater proportion of the people in the Omega3Q10 group became free from headache and palpitations & chest tightness symptoms after the 12-week supplementation compared to that of the soybean oil group (95.5% vs. 71.4%, P < 0.01; 95.8 vs. 75.5%, P < 0.01, respectively). Conclusion 12-week supplementation of Fish oil-based PUFA appear to be more effective in improving DBP and hypertension-related symptoms than soybean oil in old adults with hypertension and hypercholesterolemia although both supplementation improved TC, LDL-C and HDL-C concentrations.
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Affiliation(s)
- Tian Shen
- Department of Community Health and Behavior Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China
| | - Guoqiang Xing
- Imaging Institute of Rehabilitation and Development of Brain Function, the Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, 637000, People's Republic of China. .,Lotus Biotech.com LLC, John Hopkins University-MCC, 9601 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Jingfen Zhu
- Department of Community Health and Behavior Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China
| | - Shuxian Zhang
- Department of Community Health and Behavior Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China
| | - Yong Cai
- Department of Community Health and Behavior Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China. .,Department of Community Health and Family Medicine, Shanghai Jiao Tong University School of Public Health, Shanghai, 200025, People's Republic of China.
| | - Donghua Li
- Tang Qiao Community Health Service Center, Pudong New District, Shanghai, 200127, People's Republic of China
| | - Gang Xu
- Department of Community Health and Behavior Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, People's Republic of China
| | - Evan Xing
- Biochemistry Program, University of Maryland, Baltimore, MD, 21201, USA
| | - Jianyu Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
| | - Rong Shi
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
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Santini A, Novellino E. Nutraceuticals in hypercholesterolaemia: an overview. Br J Pharmacol 2017; 174:1450-1463. [PMID: 27685833 PMCID: PMC5429323 DOI: 10.1111/bph.13636] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 12/30/2022] Open
Abstract
Growing attention is now being given to the possible preventive/alternative ways to avoid illness onset. Changes in lifestyle and food habits are taking over from the conventional pharmaceutical-based approach, especially for chronic pathologies. Nutraceuticals have been proposed as key tools for the prevention and cure of some pathological conditions. This is leading research to develop new formulations based on these pharma-foods addressed in a specific way to prevent and cure health issues, which, in turn, will have an effect on therapy-related costs sustained by any National Health Organization. According to existing regulations, nutraceuticals cannot be categorized as either food or drugs but, by definition, often inhabit a grey area in between the two, being assimilated into food supplements, notwithstanding the beneficial properties that they can provide for some pathological conditions. A nutraceuticals-based approach for health management, in particular for some pathological conditions, has resulted in a worldwide growing 'nutraceutical' revolution. An outstanding example is the approach to the 'metabolic syndrome', which includes overweight, obesity and cardiovascular-related diseases, causing a sort of cascade of chronic health conditions, which is becoming a norm in modern life. Hypercholesterolaemia is one of these. It represents an example of a pathology that can be linked to both a poor lifestyle and dietary habits. The nutraceutical approach to hypercholesterolaemia is described in the present review as a possible alternative to the conventional drug-based therapy. LINKED ARTICLES This article is part of a themed section on Principles of Pharmacological Research of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.11/issuetoc.
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Affiliation(s)
| | - Ettore Novellino
- Department of PharmacyUniversity of Napoli Federico IINaplesItaly
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45
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Sosnowska B, Penson P, Banach M. The role of nutraceuticals in the prevention of cardiovascular disease. Cardiovasc Diagn Ther 2017; 7:S21-S31. [PMID: 28529919 PMCID: PMC5418215 DOI: 10.21037/cdt.2017.03.20] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 02/27/2017] [Indexed: 12/21/2022]
Abstract
Cardiovascular disease (CVD) ranks among the most common health-related and economic issues worldwide. Dietary factors are important contributors to cardiovascular risk, either directly, or through their effects on other cardiovascular risk factors including hypertension, dyslipidemia and diabetes mellitus. Nutraceuticals are natural nutritional compounds, which have been shown to be efficacious in preventative medicine or in the treatment of disease. Several foods and dietary supplements have been shown to protect against the development of CVD. The aim of this review is to present an update on the most recent evidence relating to the use of nutraceuticals in the context of the prevention and treatment of CVD.
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Affiliation(s)
- Bozena Sosnowska
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Peter Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
- Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
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Abstract
Atherosclerosis is a chronic inflammatory disease affecting large and medium arteries and is considered to be a major underlying cause of cardiovascular disease (CVD). Although the development of pharmacotherapies to treat CVD has contributed to a decline in cardiac mortality in the past few decades, CVD is estimated to be the cause of one-third of deaths globally. Nutraceuticals are natural nutritional compounds that are beneficial for the prevention or treatment of disease and, therefore, are a possible therapeutic avenue for the treatment of atherosclerosis. The purpose of this Review is to highlight potential nutraceuticals for use as antiatherogenic therapies with evidence from in vitro and in vivo studies. Furthermore, the current evidence from observational and randomized clinical studies into the role of nutraceuticals in preventing atherosclerosis in humans will also be discussed.
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Affiliation(s)
- Joe W E Moss
- Cardiff School of Biosciences, Cardiff University, Sir Martin Evans Building, Museum Avenue, Cardiff CF10 3AX, UK
| | - Dipak P Ramji
- Cardiff School of Biosciences, Cardiff University, Sir Martin Evans Building, Museum Avenue, Cardiff CF10 3AX, UK
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47
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Sahebkar A, Serban MC, Gluba-Brzózka A, Mikhailidis DP, Cicero AF, Rysz J, Banach M. Lipid-modifying effects of nutraceuticals: An evidence-based approach. Nutrition 2016; 32:1179-92. [PMID: 27324061 DOI: 10.1016/j.nut.2016.04.007] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 04/04/2016] [Accepted: 04/17/2016] [Indexed: 01/14/2023]
Abstract
The present review provides an up-to-date summary of the findings on the lipid-lowering effects of the most important nutraceuticals and functional foods. Based on current knowledge, nutraceuticals might exert significant lipid-lowering, and their use has several advantages: A number of important questions remain to be addressed, including whether longer durations of therapy would result in a better response and the exact safety profile of nutraceuticals, especially at doses higher than those consumed in an average diet. Additionally, data regarding the effects of nutraceutical supplementation on the incidence of cardiovascular outcomes are lacking, and it is not clear whether additional lipid lowering by nutraceuticals can modify the residual cardiovascular risk that remains after statin therapy.
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Affiliation(s)
- Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Metabolic Research Centre, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Maria-Corina Serban
- Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Anna Gluba-Brzózka
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London, London, United Kingdom
| | - Arrigo F Cicero
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland.
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Megson IL, Whitfield PD, Zabetakis I. Lipids and cardiovascular disease: where does dietary intervention sit alongside statin therapy? Food Funct 2016; 7:2603-14. [PMID: 27109548 DOI: 10.1039/c6fo00024j] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Seven Countries Study suggested an association between serum cholesterol and cardiovascular disease (CVD). However, the association was not consistent across the various cohorts of participants in different countries; while it was very clear in US and Northern European cohorts, it was weak in Southern European and Japanese cohorts. Nevertheless, the study triggered research into cholesterol-lowering drug strategies, ultimately leading to the development of statins amongst others. Clinical evidence in support of statins is strong and the vast majority of the medical community advocate these drugs as highly effective first-line therapeutics in primary and secondary prevention of CVD. However, growing evidence of side-effects associated with statins in a significant proportion of patients suggests that these drugs are not a universal solution to CVD. There is a need, therefore, to revisit the evidence and to re-appraise the relative importance of cholesterol amongst many other lipids as potential modulators of atherogenesis. In this review, we assess the relative merits of statin therapy in CVD versus dietary interventions that impact on lipids other than cholesterol, including omega-3 fatty acids and polar lipid fractions of various foods (e.g. fish and olive oil). We conclude that careful design around the lipid components of dietary interventions presents a credible alternative in patients who are intolerant to statins or averse to taking such drugs.
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Affiliation(s)
- Ian L Megson
- Department of Diabetes & Cardiovascular Science, University of the Highlands & Islands, UK
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Gleize B, Nowicki M, Daval C, Koutnikova H, Borel P. Form of phytosterols and food matrix in which they are incorporated modulate their incorporation into mixed micelles and impact cholesterol micellarization. Mol Nutr Food Res 2016; 60:749-59. [DOI: 10.1002/mnfr.201500586] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/12/2015] [Accepted: 12/29/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Béatrice Gleize
- INRA, UMR 1260 «Nutrition, Obesity and Risk of Thrombosis»; Marseille France
- INSERM; UMR 1062 Marseille France
- Aix-Marseille University; Marseille France
| | - Marion Nowicki
- INRA, UMR 1260 «Nutrition, Obesity and Risk of Thrombosis»; Marseille France
- INSERM; UMR 1062 Marseille France
- Aix-Marseille University; Marseille France
| | | | | | - Patrick Borel
- INRA, UMR 1260 «Nutrition, Obesity and Risk of Thrombosis»; Marseille France
- INSERM; UMR 1062 Marseille France
- Aix-Marseille University; Marseille France
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Clum G, Gustat J, O'Malley K, Begalieva M, Luckett B, Rice J, Johnson C. Factors Influencing Consumption of Fruits and Vegetables in Older Adults in New Orleans, Louisiana. J Nutr Health Aging 2016; 20:678-84. [PMID: 27499299 DOI: 10.1007/s12603-016-0695-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND OBJECTIVES The objective of this study was to identify demographic, social and structural factors associated with intake of fruit and vegetables in older adults in New Orleans, Louisiana. DESIGN A cross-sectional randomly sampled, address-based telephone survey of households in Orleans Parish, Louisiana was conducted with the household's main grocery shopper. SETTING All participants were in the New Orleans metro area and were surveyed in 2011. PARTICIPANTS Participants were 2,834 residents identified as the households' main grocery shopper in Orleans Parish, Louisiana. Participants were primarily female (75%), African-American (53%), approximately 10 percent of the sample reported receipt of government assistance. Approximately 37% of the sample was age 65 and older. MEASUREMENTS Measures included a telephone administered survey assessing demographic characteristics, food intake, access to supermarkets and other food sources, transportation, self-reported health, and frequency of grocery shopping. RESULTS Older adults consumed fewer fresh fruits and vegetables (FV) than younger adults (p<0.01). Bivariate associations with decreased FV included older age, receipt of government assistance, African American race, use of mobility aid, and poorer health. Multivariate factors associated with lower consumption include age, African American race, and poorer self-reported health. Women reported more fruit and vegetable consumption than men. CONCLUSIONS FV consumption is associated with improved health and reduced mortality. Older adults are less likely to consume fruits and vegetables, therefore addressing reduced FV consumption in older adults is a potential target for improving health outcomes in older adults. Specifically targeting African Americans and those with poorer health, as well as males may be an important focus for interventions.
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Affiliation(s)
- G Clum
- Gretchen Clum, 1440 Canal st tw 19, New Orleans, LA 70112, USA,
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