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Faurot KR, Park J, Miller V, Honvoh G, Domeniciello A, Mann JD, Gaylord SA, Lynch CE, Palsson O, Ramsden CE, MacIntosh BA, Horowitz M, Zamora D. Dietary fatty acids improve perceived sleep quality, stress, and health in migraine: a secondary analysis of a randomized controlled trial. FRONTIERS IN PAIN RESEARCH 2023; 4:1231054. [PMID: 37954068 PMCID: PMC10634433 DOI: 10.3389/fpain.2023.1231054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Background Migraine is a prevalent disabling condition often associated with comorbid physical and psychological symptoms that contribute to impaired quality of life and disability. Studies suggest that increasing dietary omega-3 fatty acid is associated with headache reduction, but less is known about the effects on quality of life in migraine. Methods After a 4-week run-in, 182 adults with 5-20 migraine days per month were randomized to one of the 3 arms for sixteen weeks. Dietary arms included: H3L6 (a high omega-3, low omega-6 diet), H3 (a high omega-3, an average omega-6 diet), or a control diet (average intakes of omega-3 and omega-6 fatty acids). Prespecified secondary endpoints included daily diary measures (stress perception, sleep quality, and perceived health), Patient-Reported Outcome Measurement Information System Version 1.0 ([PROMIS©) measures and the Migraine Disability Assessment (MIDAS). Analyses used linear mixed effects models to control for repeated measures. Results The H3L6 diet was associated with significant improvements in stress perception [adjusted mean difference (aMD): -1.5 (95% confidence interval: -1.7 to -1.2)], sleep quality [aMD: 0.2 (95% CI:0.1-0.2)], and perceived health [aMD: 0.2 (0.2-0.3)] compared to the control. Similarly, the H3 diet was associated with significant improvements in stress perception [aMD: -0.8 (-1.1 to -0.5)], sleep quality [aMD: 0.2 (0.1, 0.3)], and perceived health [aMD: 0.3 (0.2, 0.3)] compared to the control. MIDAS scores improved substantially in the intervention groups compared with the control (H3L6 aMD: -11.8 [-25.1, 1.5] and H3 aMD: -10.7 [-24.0, 2.7]). Among the PROMIS-29 assessments, the biggest impact was on pain interference [H3L6 MD: -1.8 (-4.4, 0.7) and H3 aMD: -3.2 (-5.9, -0.5)] and pain intensity [H3L6 MD: -0.6 (-1.3, 0.1) and H3 aMD: -0.6 (-1.4, 0.1)]. Discussion The diary measures, with their increased power, supported our hypothesis that symptoms associated with migraine attacks could be responsive to specific dietary fatty acid manipulations. Changes in the PROMIS© measures reflected improvements in non-headache pain as well as physical and psychological function, largely in the expected directions. These findings suggest that increasing omega-3 with or without decreasing omega-6 in the diet may represent a reasonable adjunctive approach to reducing symptoms associated with migraine attacks. Trial Registration: ClinicalTrials.gov NCT02012790.
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Affiliation(s)
- Keturah R. Faurot
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Jinyoung Park
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Vanessa Miller
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Gilson Honvoh
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Anthony Domeniciello
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - J. Douglas Mann
- Department of Neurology, UNC School of Medicine, Chapel Hill, NC, United States
| | - Susan A. Gaylord
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Chanee E. Lynch
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Olafur Palsson
- Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Christopher E. Ramsden
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
- Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, United States
| | - Beth A. MacIntosh
- Metabolic and Nutrition Research Core, UNC Medical Center, Chapel Hill, NC, United States
| | - Mark Horowitz
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - Daisy Zamora
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, United States
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Chen DK, Metherel AH, Rezaei K, Parzanini C, Chen CT, Ramsden CE, Horowitz M, Faurot KR, MacIntosh B, Zamora D, Bazinet RP. Analysis of omega-3 and omega-6 polyunsaturated fatty acid metabolism by compound-specific isotope analysis in humans. J Lipid Res 2023; 64:100424. [PMID: 37572791 PMCID: PMC10507585 DOI: 10.1016/j.jlr.2023.100424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023] Open
Abstract
Natural variations in the 13C:12C ratio (carbon-13 isotopic abundance [δ13C]) of the food supply have been used to determine the dietary origin and metabolism of fatty acids, especially in the n-3 PUFA biosynthesis pathway. However, n-6 PUFA metabolism following linoleic acid (LNA) intake remains under investigation. Here, we sought to use natural variations in the δ13C signature of dietary oils and fatty fish to analyze n-3 and n-6 PUFA metabolism following dietary changes in LNA and eicosapentaenoic acid (EPA) + DHA in adult humans. Participants with migraine (aged 38.6 ± 2.3 years, 93% female, body mass index of 27.0 ± 1.1 kg/m2) were randomly assigned to one of three dietary groups for 16 weeks: 1) low omega-3, high omega-6 (H6), 2) high omega-3, high omega-6 (H3H6), or 3) high omega-3, low omega-6 (H3). Blood was collected at baseline, 4, 10, and 16 weeks. Plasma PUFA concentrations and δ13C were determined. The H6 intervention exhibited increases in plasma LNA δ13C signature over time; meanwhile, plasma LNA concentrations were unchanged. No changes in plasma arachidonic acid δ13C or concentration were observed. Participants on the H3H6 and H3 interventions demonstrated increases in plasma EPA and DHA concentration over time. Plasma δ13C-EPA increased in total lipids of the H3 group and phospholipids of the H3H6 group compared with baseline. Compound-specific isotope analysis supports a tracer-free technique that can track metabolism of dietary fatty acids in humans, provided that the isotopic signature of the dietary source is sufficiently different from plasma δ13C.
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Affiliation(s)
- Daniel K Chen
- Temerty Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Adam H Metherel
- Temerty Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Kimia Rezaei
- Temerty Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Camilla Parzanini
- Temerty Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Chuck T Chen
- Temerty Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Christopher E Ramsden
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging and National Institute on Alcohol Abuse and Alcoholism, NIH, Baltimore, MD, USA
| | - Mark Horowitz
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging and National Institute on Alcohol Abuse and Alcoholism, NIH, Baltimore, MD, USA
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Beth MacIntosh
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA; Metabolic and Nutrition Research Core, UNC Medical Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Daisy Zamora
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging and National Institute on Alcohol Abuse and Alcoholism, NIH, Baltimore, MD, USA; Department of Psychiatry, UNC School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Richard P Bazinet
- Temerty Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
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Mayo J, Panahi S, Roghani A, Van Cott AC, Pugh MJ. Treatment of Epilepsy in the Setting of Cognitive Decline in Older Adults. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Li H, Fu Q, Philips K, Sun Y, Faurot KR, Gaylord SA, Mann JD. Leukocyte inflammatory phenotype and function in migraine patients compared with matched non-migraine volunteers: a pilot study. BMC Neurol 2022; 22:278. [PMID: 35896985 PMCID: PMC9327171 DOI: 10.1186/s12883-022-02781-4] [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: 01/07/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
Background Migraine is a neurological condition characterized by chronic inflammation. However, not much is known about the potential role of peripheral blood immune cells in the pathophysiology of migraine. Methods We investigated the status of peripheral blood immune cells of 15 adults with frequent episodic or chronic migraine recruited chronologically from a randomized clinical trial (RCT) on Nutrition for Migraine (NCCIH 5R01AT007813-05) and 15 non-migraine, healthy volunteers (control) matched by age, gender, and Body Mass Index (BMI). Continuous variables were presented as means ± standard deviationas well as medians, and comparisons between patients and healthy volunteers were performed with non-parametric Wilcoxon signed rank tests. Statistical analysis was performed using Stata (StataCorp. 2019. Stata Statistical Software). Fluorescence-Activated Cell Sorting (FACS) data were processed using FlowJo software (Ashland, OR: Becton, Dickenson and Company; 2019). Results We observed that migraineurs had a significantly lower percentage of non-classical monocytes (CD14+CD16++) in blood circulation, compared to the control group. In addition, Migraineurs also showed a significantly lower percentage of blood CD3+CD4+ helper T cells and CD4+CD25+ regulatory T cells, compared to controls. Differences in leukocyte surface markers between chronic migraine patients and their matched controls were more prominent than those between episodic migraine patients and their matched controls. Conclusions Our results suggest that migraine is associated with dysregulated peripheral immune homeostasis and that inflammation and autoimmunity may play a role in its pathophysiology. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02781-4.
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Affiliation(s)
- Hongtao Li
- Department of Science and Mathematics, Hulman Hall Room116, Saint Mary-of-the-Woods College, 1 St Mary of Woods Coll, IN, 47876, USA. .,Department of Physical Medicine and Rehabilitation Program On Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Qiang Fu
- School of Pharmacology, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003, People's Republic of China
| | - Kamaira Philips
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Yufei Sun
- School of Pharmacology, Institute of Aging Medicine, Binzhou Medical University, Yantai, 264003, People's Republic of China
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation Program On Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Susan A Gaylord
- Department of Physical Medicine and Rehabilitation Program On Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - John Douglas Mann
- Department of Physical Medicine and Rehabilitation Program On Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA.,Department of Neurology, University of North Carolina, Chapel Hill, NC, USA
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Faurot KR, Cole WR, MacIntosh BA, Dunlap M, Moore CB, Roberson B, Guerra M, Domenichiello AF, Palsson O, Rivera W, Nothwehr A, Arrieux J, Russell K, Jones C, Werner JK, Clark R, Diaz-Arrastia R, Suchindran C, Mann JD, Ramsden CE, Kenney K. Targeted dietary interventions to reduce pain in persistent post-traumatic headache among service members: Protocol for a randomized, controlled parallel-group trial. Contemp Clin Trials 2022; 119:106851. [PMID: 35842107 PMCID: PMC9662694 DOI: 10.1016/j.cct.2022.106851] [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: 02/15/2022] [Revised: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Post-traumatic headache (PTH) is common after traumatic brain injury (TBI), especially among active-duty service members (SMs), affecting up to 35% of patients with chronic TBI. Persistent PTH is disabling and frequently unresponsive to treatment and is often migrainous. Here, we describe a trial assessing whether dietary modifications to increase n-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and reduce n-6 linoleic acid (LA), will alter nociceptive lipid mediators and result in clinical improvements in persistent PTH. METHODS This prospective, randomized, controlled trial tests the efficacy, safety, and biochemical effects of targeted, controlled alterations in dietary n-3 and n-6 fatty acids in 122 adult SMs and military healthcare beneficiaries with diagnosed TBI associated with actively managed persistent frequent (>8 /month) PTH with migraine. Following a 4-week baseline, participants are randomized to one of two equally intensive dietary regimens for 12 additional weeks: 1) increased n-3 EPA + DHA with low n-6 LA (H3L6); 2) usual US dietary content of n-3 and n-6 fatty acids (Control). During the intervention, participants receive diet arm-specific study oils and foods sufficient for 75% of caloric needs and comprehensive dietary counseling. Participants complete daily headache diaries throughout the intervention. Clinical outcomes, including the Headache Impact Test (HIT-6), headache hours per day, circulating blood fatty acid levels, and bioactive metabolites, are measured pre-randomization and at 6 and 12 weeks. Planned primary analyses include pre-post comparisons of treatment groups on clinical measures using ANCOVA and mixed-effects models. Similar approaches to explore biochemical and exploratory clinical outcomes are planned. CLINICALTRIALS gov registration: NCT03272399.
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Affiliation(s)
- Keturah R Faurot
- Department of Physical Medicine & Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Wesley R Cole
- Department of Brain Injury Medicine, Intrepid Spirit Center, Womack Army Medical Center, Fort Bragg, NC, United States of America; Matthew Gfeller Center, Department of Exercise and Sport Science, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Beth A MacIntosh
- Metabolic and Nutrition Research Core, University of North Carolina Health, Chapel Hill, NC, United States of America
| | - Margaret Dunlap
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States of America; Traumatic Brain Injury Clinic, Neurology Department, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America
| | - Carol B Moore
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Brittney Roberson
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; The Geneva Foundation, Bethesda, MD, United States of America
| | - Melissa Guerra
- Department of Physical Medicine and Rehabilitation, South Texas Veterans Healthcare System, San Antonio, TX, United States of America
| | - Anthony F Domenichiello
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States of America
| | - Olafur Palsson
- Department of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Wanda Rivera
- Traumatic Brain Injury Clinic, Neurology Department, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America; Intrepid Spirit Center, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America; Department of Neurology, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America
| | - Ann Nothwehr
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - Jacques Arrieux
- Department of Brain Injury Medicine, Intrepid Spirit Center, Womack Army Medical Center, Fort Bragg, NC, United States of America
| | - Katie Russell
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States of America
| | - Cecily Jones
- Kent State University, Kent, OH, United States of America
| | - J Kent Werner
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Ruth Clark
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - Ramon Diaz-Arrastia
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Chirayath Suchindran
- Department of Biostatistics, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - J Douglas Mann
- Department of Neurology, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Christopher E Ramsden
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States of America; National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States of America
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States of America
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Saunders EFH, Mukherjee D, Myers T, Wasserman E, Hameed A, Krishnamurthy VB, MacIntosh B, Domenichiello A, Ramsden CE, Wang M. Adjunctive dietary intervention for bipolar disorder: a randomized, controlled, parallel-group, modified double-blinded trial of a high n-3 plus low n-6 diet. Bipolar Disord 2022; 24:171-184. [PMID: 34218509 PMCID: PMC9157563 DOI: 10.1111/bdi.13112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the preliminary efficacy of a high n-3 plus low n-6 (H3-L6) dietary intervention in improving mood stability in Bipolar Disorder (BD) when compared to dietary intervention with usual U.S. levels of n-6 and n-3 polyunsaturated fatty acid (PUFA) intakes (control diet, CD). METHODS This 2-arm, parallel-group, randomized, modified double-blind, controlled 48-week study of 12-week intensive diet intervention in subjects with BD was conducted at a single suburban-rural site in the mid-Atlantic region. Participants with DSM-IV TR BD I or II with hypomanic or depressive symptoms were randomized, stratified on gender (N = 82). The intervention included the provision of group-specific study foods and dietary counseling. Variability of mood symptoms was measured by a twice-daily, 12-week ecological momentary analysis (EMA) paradigm, and group differences were analyzed using multilevel models. Circulating n-3 and n-6 fatty acids were measured at baseline and after 4, 8, and 12 weeks of diet exposure. RESULTS All 82 randomized participants were included in biochemical analyses. Seventy participants completed at least 2 EMA surveys and were included in primary EMA analyses. Variability in mood, energy, irritability, and pain as measured using EMA was reduced in the H3-L6 group compared to the CD group. No significant differences in mean ratings of mood symptoms, or any other symptom measures, were detected. The dietary intervention effect on target PUFAs significantly differed by the group over time. CONCLUSIONS A dietary intervention adjunctive to usual care showed preliminary efficacy in improving variability in mood symptoms in participants with BD. TRIAL REGISTRATION ClinicalTrials.Gov NCT02272010.
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Affiliation(s)
- Erika F. H. Saunders
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA, USA
| | - Dahlia Mukherjee
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA, USA
| | - Tiffany Myers
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA, USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Ahmad Hameed
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA, USA
| | | | - Beth MacIntosh
- Metabolic and Nutrition Research Core, University of North Carolina, Chapel Hill, NC, USA
| | | | - Christopher E. Ramsden
- National Institute on Aging, National Institutes of Health, Baltimore, MD, USA,National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
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Ramsden CE, Zamora D, Faurot KR, MacIntosh B, Horowitz M, Keyes GS, Yuan ZX, Miller V, Lynch C, Honvoh G, Park J, Levy R, Domenichiello AF, Johnston A, Majchrzak-Hong S, Hibbeln JR, Barrow DA, Loewke J, Davis JM, Mannes A, Palsson OS, Suchindran CM, Gaylord SA, Mann JD. Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial. BMJ 2021; 374:n1448. [PMID: 34526307 PMCID: PMC8244542 DOI: 10.1136/bmj.n1448] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine whether dietary interventions that increase n-3 fatty acids with and without reduction in n-6 linoleic acid can alter circulating lipid mediators implicated in headache pathogenesis, and decrease headache in adults with migraine. DESIGN Three arm, parallel group, randomized, modified double blind, controlled trial. SETTING Ambulatory, academic medical center in the United States over 16 weeks. PARTICIPANTS 182 participants (88% women, mean age 38 years) with migraines on 5-20 days per month (67% met criteria for chronic migraine). INTERVENTIONS Three diets designed with eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and linoleic acid altered as controlled variables: H3 diet (n=61)-increase EPA+DHA to 1.5 g/day and maintain linoleic acid at around 7% of energy; H3-L6 diet (n=61)-increase n-3 EPA+DHA to 1.5 g/day and decrease linoleic acid to ≤1.8% of energy; control diet (n=60)-maintain EPA+DHA at <150 mg/day and linoleic acid at around 7% of energy. All participants received foods accounting for two thirds of daily food energy and continued usual care. MAIN OUTCOME MEASURES The primary endpoints (week 16) were the antinociceptive mediator 17-hydroxydocosahexaenoic acid (17-HDHA) in blood and the headache impact test (HIT-6), a six item questionnaire assessing headache impact on quality of life. Headache frequency was assessed daily with an electronic diary. RESULTS In intention-to-treat analyses (n=182), the H3-L6 and H3 diets increased circulating 17-HDHA (log ng/mL) compared with the control diet (baseline-adjusted mean difference 0.6, 95% confidence interval 0.2 to 0.9; 0.7, 0.4 to 1.1, respectively). The observed improvement in HIT-6 scores in the H3-L6 and H3 groups was not statistically significant (-1.6, -4.2 to 1.0, and -1.5, -4.2 to 1.2, respectively). Compared with the control diet, the H3-L6 and H3 diets decreased total headache hours per day (-1.7, -2.5 to -0.9, and -1.3, -2.1 to -0.5, respectively), moderate to severe headache hours per day (-0.8, -1.2 to -0.4, and -0.7, -1.1 to -0.3, respectively), and headache days per month (-4.0, -5.2 to -2.7, and -2.0, -3.3 to -0.7, respectively). The H3-L6 diet decreased headache days per month more than the H3 diet (-2.0, -3.2 to -0.8), suggesting additional benefit from lowering dietary linoleic acid. The H3-L6 and H3 diets altered n-3 and n-6 fatty acids and several of their nociceptive oxylipin derivatives in plasma, serum, erythrocytes or immune cells, but did not alter classic headache mediators calcitonin gene related peptide and prostaglandin E2. CONCLUSIONS The H3-L6 and H3 interventions altered bioactive mediators implicated in headache pathogenesis and decreased frequency and severity of headaches, but did not significantly improve quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT02012790.
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Affiliation(s)
- Christopher E Ramsden
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
- Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daisy Zamora
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beth MacIntosh
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Metabolic and Nutrition Research Core, UNC Medical Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark Horowitz
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - Gregory S Keyes
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - Zhi-Xin Yuan
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - Vanessa Miller
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanee Lynch
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gilson Honvoh
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jinyoung Park
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Russell Levy
- Cytokine Analysis Core, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony F Domenichiello
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - Angela Johnston
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sharon Majchrzak-Hong
- Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
| | - Joseph R Hibbeln
- Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
| | - David A Barrow
- Cytokine Analysis Core, UNC Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Loewke
- Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
| | - John M Davis
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew Mannes
- Department of Perioperative Medicine, NIH Clinical Center, Bethesda, MD, USA
| | - Olafur S Palsson
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chirayath M Suchindran
- Department of Biostatistics, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susan A Gaylord
- Department of Physical Medicine and Rehabilitation, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Douglas Mann
- Department of Neurology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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8
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MacIntosh BA, Ramsden CE, Honvoh G, Faurot KR, Palsson OS, Johnston AD, Lynch C, Anderson P, Igudesman D, Zamora D, Horowitz M, Gaylord S, Mann JD. Methodology for altering omega-3 EPA+DHA and omega-6 linoleic acid as controlled variables in a dietary trial. Clin Nutr 2021; 40:3859-3867. [PMID: 34130033 PMCID: PMC8293619 DOI: 10.1016/j.clnu.2021.04.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Increasing dietary intake of n-3 EPA+DHA and lowering dietary n-6 LA is under investigation as a therapeutic diet for improving chronic pain syndromes as well as other health outcomes. Herein we describe the diet methodology used to modulate intake of n-3 and n-6 PUFA in a free living migraine headache population and report on nutrient intake, BMI and diet acceptability achieved at week 16 of the intensive diet intervention and week 22 follow-up time-point. METHODS A total of 178 participants were randomized and began one of three diet interventions: 1) a high n-3 PUFA, average n-6 PUFA (H3) diet targeting 1500 mg EPA+DHA/day and 7% of energy (en%) from n-6 linoleic acid (LA), 2) a high-n-3 PUFA, low-n-6 PUFA (H3L6) targeting 1500 mg EPA+DHA/day and <1.8 en% n-6 LA or 3) a Control diet with typical American intakes of both EPA+DHA (<150 mg/day) and 7 en% from n-6 LA. Methods used to achieve diet change to week 16 include diet education, diet counseling, supply of specially prepared foods, self-monitoring and access to online diet materials. Only study oils and website materials were provided for the follow-up week 16 to week 22 periods. Diet adherence was assessed by multiple 24 h recalls administered throughout the trial. Diet acceptability was assessed in a subset of participants at 4 time points by questionnaire. RESULTS At week 16 H3 and H3L6 diet groups significantly increased median n-3 EPA+DHA intake from 48 mg/2000 kcals at baseline to 1484 mg/2000 kcals (p < 0.0001) and from 44 mg/2000 kcals to 1341 mg/2000 kcals (p < 0.0001), respectively. In the Control group, EPA+DHA intake remained below the typical American intake with baseline median at 60 mg/2000 kcals and 80 mg/2000 kcals (p = 0.6) at week 16. As desired, LA intake was maintained in the H3 and Control group with baseline median of 6.5 en% to 7.1 en% (p = 0.4) at week 16 and from 6.5 en% to 6.8 en% (p = 1.0) at week 16, respectively. In the H3L6 group, n-6 LA decreased from 6.3 en% at baseline to 3.2 en% (p < 0.0001) at week 16. There were no significant changes in BMI or diet acceptability throughout the trial or between diet groups. CONCLUSIONS We find this diet method to be acceptable to research participants and successful in altering dietary n-3 EPA+DHA with and without concurrent decreases in n-6 LA. If n-6 LA of less than 3 en% is desired, additional techniques to limit LA may need to be employed.
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Affiliation(s)
- Beth A MacIntosh
- Metabolic and Nutrition Research Core, UNC Medical Center, 102 Mason Farm Rd., CB#7777, NC, 27599, USA.
| | - Christopher E Ramsden
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, NIH, Baltimore, MD, USA; Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA; Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Gilson Honvoh
- Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA; Department of Biostatistics, Gillings School of Global Public Health, Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Olafur S Palsson
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Angela D Johnston
- Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Chanee Lynch
- Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Paula Anderson
- Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Daria Igudesman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daisy Zamora
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA; Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, NIH, Baltimore, MD, USA
| | - Mark Horowitz
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, NIH, Baltimore, MD, USA
| | - Susan Gaylord
- Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - John D Mann
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Abstract
Chronic posttraumatic headache (PTH) is among the most common and disabling sequelae of traumatic brain injury (TBI). Current PTH treatments are often only partially effective and have problematic side effects. We previously showed in a small randomized trial of patients with chronic nontraumatic headaches that manipulation of dietary fatty acids decreased headache frequency, severity, and pain medication use. Pain reduction was associated with alterations in oxylipins derived from n-3 and n-6 fatty acids, suggesting that oxylipins could potentially mediate clinical pain reduction. The objective of this study was to investigate whether circulating oxylipins measured in the acute setting after TBI could serve as prognostic biomarkers for developing chronic PTH. Participants enrolled in the Traumatic Head Injury Neuroimaging Classification Protocol provided serum within 3 days of TBI and were followed up at 90 days postinjury with a neurobehavioral symptom inventory (NSI) and satisfaction with life survey. Liquid chromatography-tandem mass spectrometry methods profiled 39 oxylipins derived from n-3 docosahexaenoic acid (DHA), and n-6 arachidonic acid and linoleic acid. Statistical analyses assessed the association of oxylipins with headache severity (primary outcome, measured by headache question on NSI) as well as associations between oxylipins and total NSI or satisfaction with life survey scores. Among oxylipins, 4-hydroxy-DHA and 19,20-epoxy-docosapentaenoate (DHA derivatives) were inversely associated with headache severity, and 11-hydroxy-9-epoxy-octadecenoate (a linoleic acid derivative) was positively associated with headache severity. These findings support a potential for DHA-derived oxylipins as prognostic biomarkers for development of chronic PTH.
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10
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Simopoulos AP, Serhan CN, Bazinet RP. The need for precision nutrition, genetic variation and resolution in Covid-19 patients. Mol Aspects Med 2021; 77:100943. [PMID: 33551236 PMCID: PMC7843119 DOI: 10.1016/j.mam.2021.100943] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/20/2022]
Abstract
The health of the individual and the population in general is the result of interaction between genetics and various environmental factors, of which diet/nutrition is the most important. The focus of this paper is on the association of high n-6 PUFA or low n-3 PUFA due to genetic variation and/or dietary intake, with changes in specialized pro-resolving mediators (SPMs), cytokine storm, inflammation-resolution and Covid-19. Human beings evolved on a diet that was balanced in the n-6 and n-3 essential fatty acids with a ratio of n-6/n-3 of 1-2/1 whereas today this ratio is 16/1. Such a high ratio due to high amounts of n-6 fatty acids leads to a prothrombotic and proinflammatory state and is associated with obesity, diabetes, cardiovascular disease, and some forms of cancer. In addition to the high intake of n-6 fatty acids that increases inflammation there is genetic variation in the biosynthesis of n-6 linoleic acid (LA) to arachidonic acid (ARA) and of linolenic (ALA) to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Present day humans have two common FADS haplotypes that differ dramatically in their ability to generate long-chain fatty acids. The more efficient, evolutionary derived haplotype increases the efficiency of synthesizing essential long-chain fatty acids from precursors and could have provided an advantage in environments with limited access to dietary long-chain fatty acids ARA, EPA and DHA. In the modern world this haplotype has been associated with lifestyle-related diseases, such as cardiovascular disease, obesity, diabetes, all of which are characterized by increased levels of inflammation. African Americans and Latino populations have increased susceptibility and higher death rates from SARS-CoV-2 than whites. These populations are characterized by increased numbers of persons (about 80%) that are fast metabolizers, leading to increased production of ARA, as well as poor intake of fruits and vegetables. The combinations of fast metabolism and high n-6 intake increases their inflammatory status and possibly susceptibility of SARS-CoV-2. In vitro and human studies indicate that the specialized pro-resolving mediators (SPM) produced from the n-3, EPA and DHA influence the resolution of inflammation, allowing the tissues to return to function and homeostasis. The SPMs each counter-regulate cytokine storms, as well as proinflammatory lipid mediators via NFκB and inflammasome down regulation and reduce the proinflammatory eicosanoids produced from ARA. The nutritional availability of dietary n-3 fatty acids from marine oils enriched with SPM intermediate precursors, along with increasing local biosynthesis of SPMs to functional concentrations may be an approach of value during SARS-CoV2 infections, as well as in prevention, and shortening their recovery from infections. It is evident that populations differ in their genetic variants and their frequencies and their interactions with the food they eat. Gene-nutrient interactions is a very important area of study that provides specific dietary advice for individuals and subgroups within a population in the form of Precision Nutrition. Nutritional science needs to focus on Precision Nutrition, genetic variants in the population and a food supply composed of Nutrients that have been part of our diet throughout evolution, which is the diet that our genes are programmed to respond.
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Affiliation(s)
| | - Charles N Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - Richard P Bazinet
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
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11
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Miller VE, Faurot KR, Palssson OS, MacIntosh BA, Suchindran C, Honvoh G, Gaylord S, Ramsden CE, Mann JD. Comparing prospective headache diary and retrospective four-week headache questionnaire over 20 weeks: Secondary data analysis from a randomized controlled trial. Cephalalgia 2020; 40:1523-1531. [PMID: 32799667 PMCID: PMC9060397 DOI: 10.1177/0333102420949180] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Headache diaries and recall questionnaires are frequently used to assess headache frequency and severity in clinical and research settings. METHODS Using 20 weeks of data from an intervention trial with 182 participants, we evaluated concordance between an electronic headache diary administered on a daily basis and designed to capture the presence and severity of headaches on an hourly basis (the headache diary) and a recall questionnaire, with retrospective estimation of the number of headache days assessed on a monthly basis. We further examined whether the duration or severity of headaches assessed by the electronic diary impacted concordance between these two measures. RESULTS Over the course of four 28-day periods, people with migraine participating in a dietary intervention reported an average of 13.7 and 11.1 headache days in the headache diary and recall questionnaire, respectively. CONCLUSION Over time, the concordance between headache days reported in these two measures tended to increase; however, the recall questionnaire headache estimates were lower than the diary measures in all four periods. When analysis was restricted to headaches lasting 8 hours or more, the number of headache days was more closely aligned with days reported in the recall questionnaire, indicating that the accuracy of recall estimates is likely to be influenced by headache duration. Restriction of analyses to moderate-to-severe headaches did not change results as much as headache duration. The findings indicate that recall questionnaires administered on a monthly basis may underestimate headache frequency and therefore should not be used interchangeably with headache diaries.Clinical Trials.gov Identifier: NCT02012790.
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Affiliation(s)
- Vanessa E Miller
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Olafur S Palssson
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beth A MacIntosh
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chirayath Suchindran
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gilson Honvoh
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Susan Gaylord
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher E Ramsden
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Douglas Mann
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Karimian J, Abedi S, Shirinbakhshmasoleh M, Moodi F, Moodi V, Ghavami A. The effects of quinoa seed supplementation on cardiovascular risk factors: A systematic review and meta‐analysis of controlled clinical trials. Phytother Res 2020; 35:1688-1696. [DOI: 10.1002/ptr.6901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Jahangir Karimian
- Department of General Courses, School of Management and Medical Information Sciences Isfahan University of Medical Sciences Isfahan Iran
| | - Sajjad Abedi
- Department of Pharmacy Tehran University of Medical Sciences Tehran Iran
| | | | - Farzan Moodi
- School of Medicine Iran University of Medical Sciences Tehran Iran
| | - Vihan Moodi
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences (TUMS) Tehran Iran
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Abed Ghavami
- Student Research Committee, Department of Clinical Nutrition, School of Nutrition and Food Science Isfahan University of Medical Sciences Isfahan Iran
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13
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Slavin M, Li HA, Frankenfeld C, Cheskin LJ. What is Needed for Evidence-Based Dietary Recommendations for Migraine: A Call to Action for Nutrition and Microbiome Research. Headache 2020; 59:1566-1581. [PMID: 31603554 DOI: 10.1111/head.13658] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The gastrointestinal symptoms of migraine attacks have invited numerous dietary hypotheses for migraine etiology through the centuries. Substantial efforts have been dedicated to identifying dietary interventions for migraine attack prevention, with limited success. Meanwhile, mounting evidence suggests that the reverse relationship may also exist - that the biological mechanisms of migraine may influence dietary intake. More likely, the truth involves some combination of both, where the disease influences food intake, and the foods eaten impact the manifestations of the disease. In addition, the gut's microbiota is increasingly suspected to influence the migraine brain via the gut-brain axis, though these hypotheses remain largely unsubstantiated. OBJECTIVE This paper presents an overview of the strength of existing evidence for food-based dietary interventions for migraine, noting that there is frequently evidence to suggest that a dietary risk factor for migraine exists but no evidence for how to best intervene; in fact, our intuitive assumptions on interventions are being challenged with new evidence. We then look to the future for promising avenues of research, notably the gut microbiome. CONCLUSION The evidence supports a call to action for high-quality dietary and microbiome research in migraine, both to substantiate hypothesized relationships and build the evidence base regarding nutrition's potential impact on migraine attack prevention and treatment.
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Affiliation(s)
- Margaret Slavin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
| | - Huilun Amber Li
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
| | - Cara Frankenfeld
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
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14
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Di Tanna GL, Porter JK, Lipton RB, Brennan A, Palmer S, Hatswell AJ, Sapra S, Villa G. Migraine day frequency in migraine prevention: longitudinal modelling approaches. BMC Med Res Methodol 2019; 19:20. [PMID: 30674285 PMCID: PMC6343253 DOI: 10.1186/s12874-019-0664-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 01/14/2019] [Indexed: 01/03/2023] Open
Abstract
Background Health economic models are critical tools to inform reimbursement agencies on health care interventions. Many clinical trials report outcomes using the frequency of an event over a set period of time, for example, the primary efficacy outcome in most clinical trials of migraine prevention is mean change in the frequency of migraine days (MDs) per 28 days (monthly MDs [MMD]) relative to baseline for active treatment versus placebo. Using these cohort-level endpoints in economic models, accounting for variation among patients is challenging. In this analysis, parametric models of change in MMD for migraine preventives were assessed using data from erenumab clinical studies. Methods MMD observations from the double-blind phases of two studies of erenumab were used: one in episodic migraine (EM) (NCT02456740) and one in chronic migraine (CM) (NCT02066415). For each trial, two longitudinal regression models were fitted: negative binomial and beta binomial. For a thorough comparison we also present the fitting from the standard multilevel Poisson and the zero inflated negative binomial. Results Using the erenumab study data, both the negative binomial and beta-binomial models provided unbiased estimates relative to observed trial data with well-fitting distribution at various time points. Conclusions This proposed methodology, which has not been previously applied in migraine, has shown that these models may be suitable for estimating MMD frequency. Modelling MMD using negative binomial and beta-binomial distributions can be advantageous because these models can capture intra- and inter-patient variability so that trial observations can be modelled parametrically for the purposes of economic evaluation of migraine prevention. Such models have implications for use in a wide range of disease areas when assessing repeated measured utility values. Electronic supplementary material The online version of this article (10.1186/s12874-019-0664-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gian Luca Di Tanna
- Economic Modelling Center of Excellence, Amgen Europe GmbH, Suurstoffi 22, P.O. Box 94, CH-6343, Rotkreuz, Switzerland.
| | - Joshua K Porter
- Economic Modelling Center of Excellence, Amgen Europe GmbH, Suurstoffi 22, P.O. Box 94, CH-6343, Rotkreuz, Switzerland
| | | | | | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | | | | | - Guillermo Villa
- Economic Modelling Center of Excellence, Amgen Europe GmbH, Suurstoffi 22, P.O. Box 94, CH-6343, Rotkreuz, Switzerland
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Ramos-Vega A, Rosales-Mendoza S, Bañuelos-Hernández B, Angulo C. Prospects on the Use of Schizochytrium sp. to Develop Oral Vaccines. Front Microbiol 2018; 9:2506. [PMID: 30410471 PMCID: PMC6209683 DOI: 10.3389/fmicb.2018.02506] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022] Open
Abstract
Although oral subunit vaccines are highly relevant in the fight against widespread diseases, their high cost, safety and proper immunogenicity are attributes that have yet to be addressed in many cases and thus these limitations should be considered in the development of new oral vaccines. Prominent examples of new platforms proposed to address these limitations are plant cells and microalgae. Schizochytrium sp. constitutes an attractive expression host for vaccine production because of its high biosynthetic capacity, fast growth in low cost culture media, and the availability of processes for industrial scale production. In addition, whole Schizochytrium sp. cells may serve as delivery vectors; especially for oral vaccines since Schizochytrium sp. is safe for oral consumption, produces immunomodulatory compounds, and may provide bioencapsulation to the antigen, thus increasing its bioavailability. Remarkably, Schizochytrium sp. was recently used for the production of a highly immunoprotective influenza vaccine. Moreover, an efficient method for transient expression of antigens based on viral vectors and Schizochytrium sp. as host has been recently developed. In this review, the potential of Schizochytrium sp. in vaccinology is placed in perspective, with emphasis on its use as an attractive oral vaccination vehicle.
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Affiliation(s)
- Abel Ramos-Vega
- Grupo de Inmunología and Vacunología, Centro de Investigaciones Biológicas del Noroeste, La Paz, Mexico
| | - Sergio Rosales-Mendoza
- Laboratorio de Biofarmacéuticos Recombinantes, Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico.,Sección de Biotecnología, Centro de Investigación en Ciencias de la Salud y Biomedicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | | | - Carlos Angulo
- Grupo de Inmunología and Vacunología, Centro de Investigaciones Biológicas del Noroeste, La Paz, Mexico
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