Consumption of fruit and berries is inversely associated with carotid atherosclerosis in elderly men

Identifying atheroprotective fruits and vegetables by Mendelian Randomization analysis

Background

Fruits and vegetables (FVs) are widely believed to mitigate the risk of atherosclerosis (AS). However, the causal relationships between specific FVs and AS risk factors remain unclear.

Methods

This study performed two-sample Mendelian Randomization (MR) analysis to infer the causality of the intake of 28 kinds of FVs with AS, as well as its risk factors including blood low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and C-reactive protein (CRP). GWAS genetic data for these exposures and outcomes were extracted from the IEU open GWAS project. Heterogeneity was evaluated using both Inverse Variance Weighted (IVW) and MR-Egger methods. MR-Egger regression was specifically deployed to detect potential pleiotropy. Furthermore, a "leave-one-out" sensitivity analysis was conducted to determine the impact of each individual single nucleotide polymorphism (SNP) on the combined outcome.

Results

The analysis confirms a causal relationship between total fruit consumption and reduced levels of LDL-C (OR = 0.911, p = 0.007) and CRP (OR = 0.868, p = 0.008). Similarly, total vegetable intake is also causally associated with a reduction in CRP levels (OR = 0.858, p = 0.018). Specifically, garlic intake exhibits the most significant causal relationship with reduced risk of AS (OR = 0.985, p = 0.036) and also causally associated with lower levels of LDL-C and TG. Berry (OR = 0.929, p = 0.010) and potato (OR = 0.957, p = 0.020) intake both display a significant causal negative association with TG levels, while peach/nectarine consumption is significantly associated with reduced CRP levels (OR = 0.913, p = 0.010).

Conclusion

This is the first MR study that systemically examined the causality between commonly consumed FVs and AS. Our findings highlight the atheroprotective effects of various FVs, particularly garlic, on cardiovascular health and the importance of tailored nutritional recommendations to prevent AS.

Biomaterials Functionalized with Inflammasome Inhibitors-Premises and Perspectives

This review aimed at searching literature for data regarding the inflammasomes' involvement in the pathogenesis of oral diseases (mainly periodontitis) and general pathologies, including approaches to control inflammasome-related pathogenic mechanisms. The inflammasomes are part of the innate immune response that activates inflammatory caspases by canonical and noncanonical pathways, to control the activity of Gasdermin D. Once an inflammasome is activated, pro-inflammatory cytokines, such as interleukins, are released. Thus, inflammasomes are involved in inflammatory, autoimmune and autoinflammatory diseases. The review also investigated novel therapies based on the use of phytochemicals and pharmaceutical substances for inhibiting inflammasome activity. Pharmaceutical substances can control the inflammasomes by three mechanisms: inhibiting the intracellular signaling pathways (Allopurinol and SS-31), blocking inflammasome components (VX-765, Emricasan and VX-740), and inhibiting cytokines mediated by the inflammasomes (Canakinumab, Anakinra and Rilonacept). Moreover, phytochemicals inhibit the inflammasomes by neutralizing reactive oxygen species. Biomaterials functionalized by the adsorption of therapeutic agents onto different nanomaterials could represent future research directions to facilitate multimodal and sequential treatment in oral pathologies.

The gut microbiome in subclinical atherosclerosis: a population-based multi-phenotype analysis

BACKGROUND

The altered microbiota, considered as quantitative traits, has also been identified to play pivotal roles in the host vascular physiology and might contribute to diseases. To understand the role of gut microbiota on vascular physiology in the sub-clinical elderly population and how lifestyles affect the composition of host gut microbiota to further impact the pathogenesis of vascular diseases.

METHODS

Performed a population-based fecal metagenomic study over 569 elderly asymptomatic sub-clinical individuals in rural China. An association network was built based on clinical measurements and detailed epidemiologic questionnaires, including blood chemistry, arterial stiffness, carotid ultrasonography, and metagenomic datasets.

RESULTS

Carotid arterial atherosclerosis indices, including intima-media thickness (IMT), were shown essentially in the network, and were significantly associated with living habits, socio-economic status, and diet. Using mediation analysis, we found that higher frequency of taking fresh fruits, fresh vegetables, and more exercise significantly reduces carotid arteries atherosclerosis in terms of IMT, PSV and EDV values the through the mediation of Alistepes, Oligella, and Prevotella. The gut microbes explained 16.5% of the mediation effect of lifestyles on the pathogenesis of carotid atherosclerosis. After adjusted, Faecalicatena (OR = 0.20∼0.30) was shown protective in the formation of carotid athersclerosis independently, while Libanicoccus (OR = 2.39∼2.43) were hazardous to carotid arterial IMTs. KEGG/KO analyses revealed a loss of anti-inflammation function in IMT subjects.

CONCLUSIONS

Our study provided a Chinese population-wide phenotype-metagenomic network, revealing association and mediation effect of gut microbiota on carotid artery atherosclerosis, hinting at a therapeutic and preventive potential of microbiota in vascular diseases.

The role of improved social support for healthy eating in a lifestyle intervention: Texercise Select

OBJECTIVE

We examined the measurement and mediating role of social support in dietary intake among participants in Texercise Select, an intervention for improving lifestyle behaviours.

DESIGN

Quasi-experimental study. Participants reported their dietary intake, level of social support measured by the new Social Support for Healthy Eating scale, sociodemographics and disease profile. We conducted exploratory factor analysis for scale evaluation and structural equation modelling for mediation analysis to test if changes in dietary-specific social support mediate the relationship between the intervention and changes in dietary intake.

SETTING

Texas.

PARTICIPANTS

Community-dwelling middle-aged and older adults completed a self-reported survey at baseline and 3-month follow-up (intervention group n 211, comparison group n 175).

RESULTS

The majority of the sample was aged ≥70 years (mean 74·30, sd 8·54), female (82·1 %) and had at least two chronic conditions (63·5 %). The acceptable levels of reliability and validity of the dietary-specific social support scale were confirmed. Compared with the comparison group, the intervention group reported improved intake of fruit/vegetables and water, and improved dietary-specific social support. Improved dietary-specific social support mediated the association between intervention and change in fruit/vegetable intake, controlling for sociodemographics, number of chronic conditions and geographic residence. About 12 % of intervention effect was mediated by social support.

CONCLUSIONS

The current study confirms positive intervention effects on healthy eating, and highlights social support relating to dietary behaviours that may be helpful for healthy eating. Future research should investigate additional social support for developing healthy eating behavioural skills.

Reduction in saturated fat intake for cardiovascular disease

BACKGROUND

Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein.

OBJECTIVES

To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials.

SEARCH METHODS

We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019.

SELECTION CRITERIA

Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment.

MAIN RESULTS

We included 15 randomised controlled trials (RCTs) (16 comparisons, 56,675 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.70 to 0.98, 12 trials, 53,758 participants of whom 8% had a cardiovascular event, I² = 67%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 53. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes.

AUTHORS' CONCLUSIONS

The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.

Effects of total fat intake on body fatness in adults

BACKGROUND

The ideal proportion of energy from fat in our food and its relation to body weight is not clear. In order to prevent overweight and obesity in the general population, we need to understand the relationship between the proportion of energy from fat and resulting weight and body fatness in the general population.

OBJECTIVES

To assess the effects of proportion of energy intake from fat on measures of body fatness (including body weight, waist circumference, percentage body fat and body mass index) in people not aiming to lose weight, using all appropriate randomised controlled trials (RCTs) of at least six months duration.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) to October 2019. We did not limit the search by language.

SELECTION CRITERIA

Trials fulfilled the following criteria: 1) randomised intervention trial, 2) included adults aged at least 18 years, 3) randomised to a lower fat versus higher fat diet, without the intention to reduce weight in any participants, 4) not multifactorial and 5) assessed a measure of weight or body fatness after at least six months. We duplicated inclusion decisions and resolved disagreement by discussion or referral to a third party.

DATA COLLECTION AND ANALYSIS

We extracted data on the population, intervention, control and outcome measures in duplicate. We extracted measures of body fatness (body weight, BMI, percentage body fat and waist circumference) independently in duplicate at all available time points. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity, funnel plot analyses and GRADE assessment.

MAIN RESULTS

We included 37 RCTs (57,079 participants). There is consistent high-quality evidence from RCTs that reducing total fat intake results in small reductions in body fatness; this was seen in almost all included studies and was highly resistant to sensitivity analyses (GRADE high-consistency evidence, not downgraded). The effect of eating less fat (compared with higher fat intake) is a mean body weight reduction of 1.4 kg (95% confidence interval (CI) -1.7 to -1.1 kg, in 53,875 participants from 26 RCTs, I² = 75%). The heterogeneity was explained in subgrouping and meta-regression. These suggested that greater weight loss results from greater fat reductions in people with lower fat intake at baseline, and people with higher body mass index (BMI) at baseline. The size of the effect on weight does not alter over time and is mirrored by reductions in BMI (MD -0.5 kg/m², 95% CI -0.6 to -0.3, 46,539 participants in 14 trials, I² = 21%), waist circumference (MD -0.5 cm, 95% CI -0.7 to -0.2, 16,620 participants in 3 trials; I² = 21%), and percentage body fat (MD -0.3% body fat, 95% CI -0.6 to 0.00, P = 0.05, in 2350 participants in 2 trials; I² = 0%). There was no suggestion of harms associated with low fat diets that might mitigate any benefits on body fatness. The reduction in body weight was reflected in small reductions in LDL (-0.13 mmol/L, 95% CI -0.21 to -0.05), and total cholesterol (-0.23 mmol/L, 95% CI -0.32 to -0.14), with little or no effect on HDL cholesterol (-0.02 mmol/L, 95% CI -0.03 to 0.00), triglycerides (0.01 mmol/L, 95% CI -0.05 to 0.07), systolic (-0.75 mmHg, 95% CI -1.42 to -0.07) or diastolic blood pressure(-0.52 mmHg, 95% CI -0.95 to -0.09), all GRADE high-consistency evidence or quality of life (0.04, 95% CI 0.01 to 0.07, on a scale of 0 to 10, GRADE low-consistency evidence).

AUTHORS' CONCLUSIONS

Trials where participants were randomised to a lower fat intake versus a higher fat intake, but with no intention to reduce weight, showed a consistent, stable but small effect of low fat intake on body fatness: slightly lower weight, BMI, waist circumference and percentage body fat compared with higher fat arms. Greater fat reduction, lower baseline fat intake and higher baseline BMI were all associated with greater reductions in weight. There was no evidence of harm to serum lipids, blood pressure or quality of life, but rather of small benefits or no effect.

Reduction in saturated fat intake for cardiovascular disease

BACKGROUND

Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein.

OBJECTIVES

To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials.

SEARCH METHODS

We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019.

SELECTION CRITERIA

Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment.

MAIN RESULTS

We included 15 randomised controlled trials (RCTs) (16 comparisons, ~59,000 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 21% (risk ratio (RR) 0.79; 95% confidence interval (CI) 0.66 to 0.93, 11 trials, 53,300 participants of whom 8% had a cardiovascular event, I² = 65%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 32. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes.

AUTHORS' CONCLUSIONS

The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.

Biochemistry of blood platelet activation and the beneficial role of plant oils in cardiovascular diseases

The main function of blood platelets is to form hemostatic plugs and enable thrombosis. These properties, however, can be greatly influenced by dietary components which may inhibit certain steps of platelet activation, including platelet aggregation. Such inhibition can play a role in the prophylaxis and treatment of cardiovascular diseases associated with blood platelet hyperactivation. In fact, plant and fish oils have been identified and specifically used for this purpose. Numerous in vivo and in vitro experiments have explored the potential use of these oils to inhibit platelet activation as well as their role in reducing oxidative stress and blood pressure, and lowering triglyceride and cholesterol. This chapter presents and compares the anti-platelet effects of fish and plant oils and their constituents, especially fatty acids. Studies on healthy subjects and patients with various cardiovascular diseases are also examined. Findings indicate that both fish and plant oils contain protective components with anti-platelet activity having clearly defined mechanisms of action. Although both are excellent sources of omega fatty acids and vitamins, plant oils contain components with cardioprotective benefit in hypercholesterolemics, i.e., phytosterols. Plant oils may hence play a key role in strategies for preventing and treating cardiovascular diseases associated with platelet hyperactivation. Further studies are clearly needed to determine the precise dose of these components needed for effective prophylaxis and treatment.

Oxidative Stress in Cerebral Small Vessel Disease Dizziness Patients, Basally and After Polyphenol Compound Supplementation

Background:

Leukoaraiosis (LA) is a common radiological finding in elderly, frequently associated with several clinical disorders, including unexplained dizziness. The pathogenesis of LA is multifactorial, with a dysfunction of cerebral microcirculation resulting in chronic hypoperfusion and tissue loss, with oxidative stress involved in this cascade.

Objective:

The aim of this study was to analyse some oxidative stress biomarkers in a cohort of LA patients.

Method:

Fifty-five consecutive patients (33 males, median age 75 years) with LA were recruited. In a subgroup of 33 patients with LA and unexplained dizziness, we have then performed an open study to evaluate if 60-day supplementation with a polyphenol compound may modify these biomarkers and influence quality of life, analysed with the Dizziness Handicap Inventory (DHI) scale.

Results:

At baseline, blood oxidative stress parameters values were outside normal ranges and compared to matched healthy controls. After the two months supplementation, we observed a significant decrement of advanced oxidation protein products values and a significant improvement of DHI.

Conclusion:

Oxidative stress biomarkers may be useful to detect redox imbalance in LA and to provide non-invasive tools to monitor disease status and response to therapy.

Molecular Mechanisms of Leonurus Cardiaca L. Extract Activity in Prevention of Staphylococcal Endocarditis-Study on in Vitro and ex Vivo Models

Better understanding the mechanisms of Leonurus cardiaca L. extract (LCE) activity is necessary to prepare recommendations for the use of LCE-based herbal products for preventive/supportive purposes in case of infective endocarditis (IE) and other staphylococcal invasive infections. The aim of the study was to analyze molecular mechanisms of LCE effect on Staphylococcus aureus and blood platelets in the context of their interactions playing a pivotal role in such disorders. Using atomic force microscopy, we demonstrated that adhesion forces of S. aureus were markedly reduced after exposure to LCE at subinhibitory concentrations. The effect resulted from the impact of LCE on S. aureus cell morphology and the composition of phospholipids and fatty acids in bacterial membranes (assessed by HPLC), which modulated their stabilization, hydrophobicity, and charge. Moreover, using FACS we showed also that LCE significantly reduced GP IIb/IIIa expression on blood platelets, thus the disruption of platelet-fibrinogen interactions seems to explain antiplatelet effect of LCE. The obtained results prove the usefulness of LCE in the prevention of S. aureus adhesion, platelet activation, and vegetations development, however, also pointed out the necessity of excluding the cationic antibiotics from the treatment of S. aureus-associated IE and other invasive diseases, when motherwort herb is used simultaneously as an addition to the daily diet.

Inhibitory Potential against Digestive Enzymes Linked to Obesity and Type 2 Diabetes and Content of Bioactive Compounds in 20 Cultivars of the Peach Fruit Grown in Poland

The presented study provides important insights on the health properties of Prunus persica fruit related to their polyphenol and carotenoid profiles, antioxidant capacity and in vitro potential to inhibit enzymes relevant to type 2 diabetes (α-amylase, α-glucosidase) and obesity (pancreatic lipase) management. Such results have not been published so far. The study showed substantial differences in the chemical composition of peach fruit depending on the cultivar. At the same time, it demonstrated some common features of selected cultivars - the varieties with light flesh ('Spring Time'; 'Madison') were characterized by a high content of phenolic acids and flavonols, thus exhibiting high activity against α-amylase, while the yellow varieties with high content of carotenoids ('Harrow Diamond'; 'Harrow Beauty') showed high inhibitory activity toward porcine pancreatic lipase. Finally, it has been shown that peach fruit is an interesting raw material with a varied chemical composition and nutritional value, especially with high inhibitory potential against digestive enzymes linked to obesity and type 2 diabetes, strongly determined by the cultivar.

Polyunsaturated fatty acids for the primary and secondary prevention of cardiovascular disease

BACKGROUND

Evidence on the health effects of total polyunsaturated fatty acids (PUFA) is equivocal. Fish oils are rich in omega-3 PUFA and plant oils in omega-6 PUFA. Evidence suggests that increasing PUFA-rich foods, supplements or supplemented foods can reduce serum cholesterol, but may increase body weight, so overall cardiovascular effects are unclear.

OBJECTIVES

To assess effects of increasing total PUFA intake on cardiovascular disease and all-cause mortality, lipids and adiposity in adults.

SEARCH METHODS

We searched CENTRAL, MEDLINE and Embase to April 2017 and clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform to September 2016, without language restrictions. We checked trials included in relevant systematic reviews.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing higher with lower PUFA intakes in adults with or without cardiovascular disease that assessed effects over 12 months or longer. We included full texts, abstracts, trials registry entries and unpublished data. Outcomes were all-cause mortality, cardiovascular disease mortality and events, risk factors (blood lipids, adiposity, blood pressure), and adverse events. We excluded trials where we could not separate effects of PUFA intake from other dietary, lifestyle or medication interventions.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles and abstracts, assessed trials for inclusion, extracted data, and assessed risk of bias. We wrote to authors of included trials for further data. Meta-analyses used random-effects analysis, sensitivity analyses included fixed-effects and limiting to low summary risk of bias. We assessed GRADE quality of evidence.

MAIN RESULTS

We included 49 RCTs randomising 24,272 participants, with duration of one to eight years. Eleven included trials were at low summary risk of bias, 33 recruited participants without cardiovascular disease. Baseline PUFA intake was unclear in most trials, but 3.9% to 8% of total energy intake where reported. Most trials gave supplemental capsules, but eight gave dietary advice, eight gave supplemental foods such as nuts or margarine, and three used a combination of methods to increase PUFA.Increasing PUFA intake probably has little or no effect on all-cause mortality (risk 7.8% vs 7.6%, risk ratio (RR) 0.98, 95% confidence interval (CI) 0.89 to 1.07, 19,290 participants in 24 trials), but probably slightly reduces risk of coronary heart disease events from 14.2% to 12.3% (RR 0.87, 95% CI 0.72 to 1.06, 15 trials, 10,076 participants) and cardiovascular disease events from 14.6% to 13.0% (RR 0.89, 95% CI 0.79 to 1.01, 17,799 participants in 21 trials), all moderate-quality evidence. Increasing PUFA may slightly reduce risk of coronary heart disease death (6.6% to 6.1%, RR 0.91, 95% CI 0.78 to 1.06, 9 trials, 8810 participants) andstroke (1.2% to 1.1%, RR 0.91, 95% CI 0.58 to 1.44, 11 trials, 14,742 participants, though confidence intervals include important harms), but has little or no effect on cardiovascular mortality (RR 1.02, 95% CI 0.82 to 1.26, 16 trials, 15,107 participants) all low-quality evidence. Effects of increasing PUFA on major adverse cardiac and cerebrovascular events and atrial fibrillation are unclear as evidence is of very low quality.Increasing PUFA intake probably slightly decreases triglycerides (by 15%, MD -0.12 mmol/L, 95% CI -0.20 to -0.04, 20 trials, 3905 participants), but has little or no effect on total cholesterol (mean difference (MD) -0.12 mmol/L, 95% CI -0.23 to -0.02, 26 trials, 8072 participants), high-density lipoprotein (HDL) (MD -0.01 mmol/L, 95% CI -0.02 to 0.01, 18 trials, 4674 participants) or low-density lipoprotein (LDL) (MD -0.01 mmol/L, 95% CI -0.09 to 0.06, 15 trials, 3362 participants). Increasing PUFA probably has little or no effect on adiposity (body weight MD 0.76 kg, 95% CI 0.34 to 1.19, 12 trials, 7100 participants).Effects of increasing PUFA on serious adverse events such as pulmonary embolism and bleeding are unclear as the evidence is of very low quality.

AUTHORS' CONCLUSIONS

This is the most extensive systematic review of RCTs conducted to date to assess effects of increasing PUFA on cardiovascular disease, mortality, lipids or adiposity. Increasing PUFA intake probably slightly reduces risk of coronary heart disease and cardiovascular disease events, may slightly reduce risk of coronary heart disease mortality and stroke (though not ruling out harms), but has little or no effect on all-cause or cardiovascular disease mortality. The mechanism may be via TG reduction.

Black Chokeberry (Aronia melanocarpa(Michx.) Elliot) Fruits and Functional Drinks Differ Significantly in Their Chemical Composition and Antioxidant Activity

Black chokeberry (Aronia melanocarpa) fruits are among the richest sources of polyphenols and anthocyanins in plant kingdom and suitable raw material for production of functional foods. The popularity of chokeberries is not only due to their nutritional value but also to the constantly emerging evidence for their health-promoting effects. The current study presents detailed information about the content and composition of sugars, organic acids, and polyphenols in 23 aronia samples grown under the climatic conditions of Bulgaria, in 2016 and 2017. Sorbitol was found to be the main carbohydrate of fresh aronia fruits. Its content was in the range 6.5–13 g/100 g fresh weight (FW), representing 61%–68% of low-molecular-weight carbohydrates. Organic acids were represented by substantial amounts of quinic acid (average content 404.4 mg/100 g FW), malic acid (328.1 mg/100 g FW), and ascorbic acid (65.2 mg/100 g FW). Shikimic acid, citric acid, oxalic acid, and succinic acid were found as minor components. Chokeberries were particularly rich in proanthocyanidins, anthocyanins, and hydroxycinnamic acids. The total polyphenol content of aronia fruits varied between 1022 mg/100 g FW and 1795 mg/100 g FW and ORAC antioxidant activity from 109 µmol TE/g to 191 µmol TE/g FW. We also investigated the relationship between the chemical composition of berries and chemical compositions and antioxidant activity of aronia functional drinks—juices and nectars. The differences in the chemical composition of the fruits resulted in functional foods that differ significantly in their chemical composition and antioxidant activity. Additionally, we demonstrated that temperature of juice pressing and nectar extraction has a profound effect on the polyphenol content and composition of these products. This is very important since differences in the chemical composition of raw chokeberries and variation of technological parameters during processing could result in functional foods with different chemical composition, rendering different biological activity.

Polyunsaturated fatty acids for the primary and secondary prevention of cardiovascular disease

BACKGROUND

Evidence on the health effects of total polyunsaturated fatty acids (PUFA) is equivocal. Fish oils are rich in omega-3 PUFA and plant oils in omega-6 PUFA. Evidence suggests that increasing PUFA-rich foods, supplements or supplemented foods can reduce serum cholesterol, but may increase body weight, so overall cardiovascular effects are unclear.

OBJECTIVES

To assess effects of increasing total PUFA intake on cardiovascular disease and all-cause mortality, lipids and adiposity in adults.

SEARCH METHODS

We searched CENTRAL, MEDLINE and Embase to April 2017 and clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform to September 2016, without language restrictions. We checked trials included in relevant systematic reviews.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing higher with lower PUFA intakes in adults with or without cardiovascular disease that assessed effects over 12 months or longer. We included full texts, abstracts, trials registry entries and unpublished data. Outcomes were all-cause mortality, cardiovascular disease mortality and events, risk factors (blood lipids, adiposity, blood pressure), and adverse events. We excluded trials where we could not separate effects of PUFA intake from other dietary, lifestyle or medication interventions.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles and abstracts, assessed trials for inclusion, extracted data, and assessed risk of bias. We wrote to authors of included trials for further data. Meta-analyses used random-effects analysis, sensitivity analyses included fixed-effects and limiting to low summary risk of bias. We assessed GRADE quality of evidence.

MAIN RESULTS

We included 49 RCTs randomising 24,272 participants, with duration of one to eight years. Eleven included trials were at low summary risk of bias, 33 recruited participants without cardiovascular disease. Baseline PUFA intake was unclear in most trials, but 3.9% to 8% of total energy intake where reported. Most trials gave supplemental capsules, but eight gave dietary advice, eight gave supplemental foods such as nuts or margarine, and three used a combination of methods to increase PUFA.Increasing PUFA intake probably has little or no effect on all-cause mortality (risk 7.8% vs 7.6%, risk ratio (RR) 0.98, 95% confidence interval (CI) 0.89 to 1.07, 19,290 participants in 24 trials), but probably slightly reduces risk of coronary heart disease events from 14.2% to 12.3% (RR 0.87, 95% CI 0.72 to 1.06, 15 trials, 10,076 participants) and cardiovascular disease events from 14.6% to 13.0% (RR 0.89, 95% CI 0.79 to 1.01, 17,799 participants in 21 trials), all moderate-quality evidence. Increasing PUFA may slightly reduce risk of coronary heart disease death (6.6% to 6.1%, RR 0.91, 95% CI 0.78 to 1.06, 9 trials, 8810 participants) andstroke (1.2% to 1.1%, RR 0.91, 95% CI 0.58 to 1.44, 11 trials, 14,742 participants, though confidence intervals include important harms), but has little or no effect on cardiovascular mortality (RR 1.02, 95% CI 0.82 to 1.26, 16 trials, 15,107 participants) all low-quality evidence. Effects of increasing PUFA on major adverse cardiac and cerebrovascular events and atrial fibrillation are unclear as evidence is of very low quality.Increasing PUFA intake slightly reduces total cholesterol (mean difference (MD) -0.12 mmol/L, 95% CI -0.23 to -0.02, 26 trials, 8072 participants) and probably slightly decreases triglycerides (MD -0.12 mmol/L, 95% CI -0.20 to -0.04, 20 trials, 3905 participants), but has little or no effect on high-density lipoprotein (HDL) (MD -0.01 mmol/L, 95% CI -0.02 to 0.01, 18 trials, 4674 participants) or low-density lipoprotein (LDL) (MD -0.01 mmol/L, 95% CI -0.09 to 0.06, 15 trials, 3362 participants). Increasing PUFA probably causes slight weight gain (MD 0.76 kg, 95% CI 0.34 to 1.19, 12 trials, 7100 participants).Effects of increasing PUFA on serious adverse events such as pulmonary embolism and bleeding are unclear as the evidence is of very low quality.

AUTHORS' CONCLUSIONS

This is the most extensive systematic review of RCTs conducted to date to assess effects of increasing PUFA on cardiovascular disease, mortality, lipids or adiposity. Increasing PUFA intake probably slightly reduces risk of coronary heart disease and cardiovascular disease events, may slightly reduce risk of coronary heart disease mortality and stroke (though not ruling out harms), but has little or no effect on all-cause or cardiovascular disease mortality. The mechanism may be via lipid reduction, but increasing PUFA probably slightly increases weight.

Dietary Supplements with Antiplatelet Activity: A Solution for Everyone?

Dietary supplements can have beneficial effects on a number of risk factors for cardiovascular diseases, and interest in the use of nonpharmacologic nutraceutical-based treatments for cardiovascular disorders is growing. The aim of this review is to present the role of dietary supplements with antiplatelet activity in the prophylaxis and treatment of cardiovascular disorders. In addition, this paper describes their effects on another very important element of hemostasis-blood coagulation. However, because controlled human clinical experiments are too limited to clearly identify the antiplatelet and anticoagulant properties of dietary supplements, used alone or in combination with classical antiplatelet therapy (e.g., with aspirin), most information in this article is based on in vitro studies. Therefore, it cannot be unequivocally stated whether dietary supplements are universally safe and bring benefits to all. Some authors suggest that blood platelet count and function should be monitored in patients taking such supplements, especially before and after surgery, as well as other hemostasis parameters such as coagulation times.

Preventive mechanism of bioactive dietary foods on obesity-related inflammation and diseases

This review focuses on the molecular biological mechanism of obesity-induced inflammation and the reciprocal interactions between the major molecular mechanisms and a range of dietary bioactive compounds.

Bioactive polyphenols and cardiovascular disease: chemical antagonists, pharmacological agents or xenobiotics that drive an adaptive response?

Polyphenols are widely regarded to have a wide range of health-promoting qualities, including beneficial effects on cardiovascular disease. Historically, the benefits have been linked to their well-recognized powerful antioxidant activity. However, the concept that the beneficial effects are attributable to direct antioxidant activity in vivo does not pay sufficient heed to the fact that polyphenols degrade rapidly, are poorly absorbed and rapidly metabolized, resulting in very low bioavailability. This review explores alternative mechanisms by which polyphenols, or their metabolites, exert biological activity via mechanisms that can be activated by physiologically relevant concentrations. Evidence is presented to support the action of phenolic derivatives on receptors and signalling pathways to induce adaptive responses that drive changes in endogenous antioxidant, antiplatelet, vasodilatory and anti-inflammatory effects. The implications are that in vitro antioxidant measures as predictors of polyphenol protective activity in vivo hold little relevance and that closer attention needs to be paid to bioavailable metabolites to understand the mode of action of these diet-derived components.

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.

The multifunctionality of berries toward blood platelets and the role of berry phenolics in cardiovascular disorders

Diet and nutrition have an important influence on the prophylaxis and progression of cardiovascular disease; one example is the inhibition of blood platelet functions by specific components of fruits and vegetables. Garlic, onion, ginger, dark chocolate and polyunsaturated fatty acids all reduce blood platelet aggregation. A number of fruits contain a range of cardioprotective antioxidants and vitamins, together with a large number of non-nutrient phytochemicals such as phenolic compounds, which may possess both antioxidant properties and anti-platelet activity. Fresh berries and berry extracts possess high concentrations of phenolic compounds, i.e. phenolic acid, stilbenoids, flavonoids and lignans. The aim of this review article is to provide an overview of current knowledge of the anti-platelet activity of berries, which form an integral part of the human diet. It describes the effects of phenolic compounds present in a number of berries, i.e. black chokeberries - aronia berries (Aronia melanocarpa), blueberries (Vaccinium myrtillus), cranberries (Vaccinium sect. Oxycoccus), sea buckthorn berries (Hippophae rhamnoides) and grapes (Vitis), as well as various commercial products from berries (i.e. juices), on platelets and underlying mechanisms. Studies show that the effects of berries on platelet activity are dependent on not only the concentrations of the phenolic compounds in the berries or the class of phenolic compounds, but also the types of berry and the form (fresh berry, juice or medicinal product). Different results indicate that berries may play a role in the prevention of cardiovascular disorders, but the development of well-controlled clinical studies with berries is encouraged.

Recent Progress in Anti-Obesity and Anti-Diabetes Effect of Berries

Berries are rich in polyphenols such as anthocyanins. Various favorable functions of berries cannot be explained by their anti-oxidant properties, and thus, berries are now receiving great interest as food ingredients with “beyond antioxidant” functions. In this review, we discuss the potential health benefits of anthocyanin-rich berries, with a focus on prevention and treatment of obesity and diabetes. To better understand the physiological functionality of berries, the exact molecular mechanism of their anti-obesity and anti-diabetes effect should be clarified. Additionally, the relationship of metabolites and degradation products with health benefits derived from anthocyanins needs to be elucidated. The preventive effects of berries and anthocyanin-containing foods on the metabolic syndrome are not always supported by findings of interventional studies in humans, and thus further studies are necessary. Use of standardized diets and conditions by all research groups may address this problem. Berries are tasty foods that are easy to consume, and thus, investigating their health benefits is critical for health promotion and disease prevention.

Chemopreventive and Therapeutic Effects of Edible Berries: A Focus on Colon Cancer Prevention and Treatment

Colon cancer is one of the most prevalent diseases across the world. Numerous epidemiological studies indicate that diets rich in fruit, such as berries, provide significant health benefits against several types of cancer, including colon cancer. The anticancer activities of berries are attributed to their high content of phytochemicals and to their relevant antioxidant properties. In vitro and in vivo studies have demonstrated that berries and their bioactive components exert therapeutic and preventive effects against colon cancer by the suppression of inflammation, oxidative stress, proliferation and angiogenesis, through the modulation of multiple signaling pathways such as NF-κB, Wnt/β-catenin, PI3K/AKT/PKB/mTOR, and ERK/MAPK. Based on the exciting outcomes of preclinical studies, a few berries have advanced to the clinical phase. A limited number of human studies have shown that consumption of berries can prevent colorectal cancer, especially in patients at high risk (familial adenopolyposis or aberrant crypt foci, and inflammatory bowel diseases). In this review, we aim to highlight the findings of berries and their bioactive compounds in colon cancer from in vitro and in vivo studies, both on animals and humans. Thus, this review could be a useful step towards the next phase of berry research in colon cancer.

Elderly Taiwanese who spend more on fruits and vegetables and less on animal-derived foods use less medical services and incur lower medical costs

A higher intake of fruits and vegetables (F&V) compared with animal-derived foods is associated with lower risks of all-cause-, cancer- and CVD-related mortalities. However, the association between consumption patterns and medical costs remains unclear. The effects of various food group costs on medical service utilisation and costs were investigated. The study cohort was recruited through the Elderly Nutrition and Health Survey in Taiwan between 1999 and 2000 and followed-up for 8 years until 2006. It comprised free-living elderly participants who provided a 24-h dietary recall. Daily energy-adjusted food group costs were estimated. Annual medical service utilisation and costs for 1445 participants aged 65-79 years were calculated from the National Health Insurance claim data. Generalised linear models were used to appraise the associations between the food group costs and medical service utilisation and costs. Older adults with the highest F&V cost tertile had significantly fewer hospital days (30%) and total medical costs (19%), whereas those in the highest animal-derived group had a higher number of hospital days (28%) and costs (83%) as well as total medical costs (38%). Participants in the high F&V and low animal-derived cost groups had the shortest annual hospitalisation stays (5·78 d) and lowest costs (NT$38,600) as well as the lowest total medical costs (NT$75,800), a mean annual saving of NT$45 200/person. Older adults who spend more on F&V and less on animal-derived foods have a reduced medical-care system burden. This provides opportunities for nutritionally related healthcare system investment strategies.

Antiatherogenic and Cardioprotective Effects of Black Chokeberry (Aronia melanocarpa) Juice in Aging Rats

Age-related diseases are a social problem of global significance and their prevention by natural products is a research area of particular interest. The present study is an approach to counteract the risk factors for atherosclerosis arising in the aging process by supplementation of chokeberry juice. It employed a model of healthy adult rats monitored for a number of somatometric, serum lipidogram, and histopathological parameters, related to risk factors and their response to supplementation with antioxidant-rich chokeberry juice. The results were used to calculate different atherogenic and cardioprotective indices, and all results were compared to those of young healthy rats. Chokeberry juice proved an extremely rich source of polyphenols resulting in very high antioxidant activity. Treatment with Aronia juice significantly lowered the proatherogenic low-density lipoprotein fraction of the animals studied and led to a 16.5% decrease in their total cholesterol. Atherogenic indices in Aronia-supplemented animals clearly showed lower atherogenic risk and cardioprotective indices indicated protection of the cardiovascular system. Besides that, chokeberry juice retarded the age-related changes in the aortic wall and can be recommended as a prophylactic tool for healthy aging.

Effects of total fat intake on body weight

BACKGROUND

In order to prevent overweight and obesity in the general population we need to understand the relationship between the proportion of energy from fat and resulting weight and body fatness in the general population.

OBJECTIVES

To assess the effects of proportion of energy intake from fat on measures of weight and body fatness (including obesity, waist circumference and body mass index) in people not aiming to lose weight, using all appropriate randomised controlled trials (RCTs) and cohort studies in adults, children and young people

SEARCH METHODS

We searched CENTRAL to March 2014 and MEDLINE, EMBASE and CINAHL to November 2014. We did not limit the search by language. We also checked the references of relevant reviews.

SELECTION CRITERIA

Trials fulfilled the following criteria: 1) randomised intervention trial, 2) included children (aged ≥ 24 months), young people or adults, 3) randomised to a lower fat versus usual or moderate fat diet, without the intention to reduce weight in any participants, 4) not multifactorial and 5) assessed a measure of weight or body fatness after at least six months. We also included cohort studies in children, young people and adults that assessed the proportion of energy from fat at baseline and assessed the relationship with body weight or fatness after at least one year. We duplicated inclusion decisions and resolved disagreement by discussion or referral to a third party.

DATA COLLECTION AND ANALYSIS

We extracted data on the population, intervention, control and outcome measures in duplicate. We extracted measures of weight and body fatness independently in duplicate at all available time points. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity and funnel plot analyses.

MAIN RESULTS

We included 32 RCTs (approximately 54,000 participants) and 30 sets of analyses of 25 cohorts. There is consistent evidence from RCTs in adults of a small weight-reducing effect of eating a smaller proportion of energy from fat; this was seen in almost all included studies and was highly resistant to sensitivity analyses. The effect of eating less fat (compared with usual diet) is a mean weight reduction of 1.5 kg (95% confidence interval (CI) -2.0 to -1.1 kg), but greater weight loss results from greater fat reductions. The size of the effect on weight does not alter over time and is mirrored by reductions in body mass index (BMI) (-0.5 kg/m(2), 95% CI -0.7 to -0.3) and waist circumference (-0.3 cm, 95% CI -0.6 to -0.02). Included cohort studies in children and adults most often do not suggest any relationship between total fat intake and later measures of weight, body fatness or change in body fatness. However, there was a suggestion that lower fat intake was associated with smaller increases in weight in middle-aged but not elderly adults, and in change in BMI in the highest validity child cohort.

AUTHORS' CONCLUSIONS

Trials where participants were randomised to a lower fat intake versus usual or moderate fat intake, but with no intention to reduce weight, showed a consistent, stable but small effect of low fat intake on body fatness: slightly lower weight, BMI and waist circumference compared with controls. Greater fat reduction and lower baseline fat intake were both associated with greater reductions in weight. This effect of reducing total fat was not consistently reflected in cohort studies assessing the relationship between total fat intake and later measures of body fatness or change in body fatness in studies of children, young people or adults.

Reduction in saturated fat intake for cardiovascular disease

BACKGROUND

Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally it is unclear whether the energy from saturated fats that are lost in the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. This review is part of a series split from and updating an overarching review.

OBJECTIVES

To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA) or monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials.

SEARCH METHODS

We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE (Ovid) on 5 March 2014. We also checked references of included studies and reviews.

SELECTION CRITERIA

Trials fulfilled the following criteria: 1) randomised with appropriate control group; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) not multifactorial; 4) adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 5) intervention at least 24 months; 6) mortality or cardiovascular morbidity data available.

DATA COLLECTION AND ANALYSIS

Two review authors working independently extracted participant numbers experiencing health outcomes in each arm, and we performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses and funnel plots.

MAIN RESULTS

We include 15 randomised controlled trials (RCTs) (17 comparisons, ˜59,000 participants), which used a variety of interventions from providing all food to advice on how to reduce saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.72 to 0.96, 13 comparisons, 53,300 participants of whom 8% had a cardiovascular event, I² 65%, GRADE moderate quality of evidence), but effects on all-cause mortality (RR 0.97; 95% CI 0.90 to 1.05; 12 trials, 55,858 participants) and cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 12 trials, 53,421 participants) were less clear (both GRADE moderate quality of evidence). There was some evidence that reducing saturated fats reduced the risk of myocardial infarction (fatal and non-fatal, RR 0.90; 95% CI 0.80 to 1.01; 11 trials, 53,167 participants), but evidence for non-fatal myocardial infarction (RR 0.95; 95% CI 0.80 to 1.13; 9 trials, 52,834 participants) was unclear and there were no clear effects on stroke (any stroke, RR 1.00; 95% CI 0.89 to 1.12; 8 trials, 50,952 participants). These relationships did not alter with sensitivity analysis. Subgrouping suggested that the reduction in cardiovascular events was seen in studies that primarily replaced saturated fat calories with polyunsaturated fat, and no effects were seen in studies replacing saturated fat with carbohydrate or protein, but effects in studies replacing with monounsaturated fats were unclear (as we located only one small trial). Subgrouping and meta-regression suggested that the degree of reduction in cardiovascular events was related to the degree of reduction of serum total cholesterol, and there were suggestions of greater protection with greater saturated fat reduction or greater increase in polyunsaturated and monounsaturated fats. There was no evidence of harmful effects of reducing saturated fat intakes on cancer mortality, cancer diagnoses or blood pressure, while there was some evidence of improvements in weight and BMI.

AUTHORS' CONCLUSIONS

The findings of this updated review are suggestive of a small but potentially important reduction in cardiovascular risk on reduction of saturated fat intake. Replacing the energy from saturated fat with polyunsaturated fat appears to be a useful strategy, and replacement with carbohydrate appears less useful, but effects of replacement with monounsaturated fat were unclear due to inclusion of only one small trial. This effect did not appear to alter by study duration, sex or baseline level of cardiovascular risk. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturated fats. The ideal type of unsaturated fat is unclear.

Mediterranean diet and carotid atherosclerosis in the Northern Manhattan Study

OBJECTIVE

Adherence to a Mediterranean-style diet (MeDi) may protect against clinical vascular events by reducing atherosclerosis, but data is limited. This is the first observational study of the association between MeDi adherence and carotid plaque thickness and area.

METHODS

The study included 1374 participants of the population-based Northern Manhattan Study with diet assessed and carotid intima-media thickness (cIMT) and plaque measured using B-mode ultrasound (mean age 66 ± 9 years, 60% female, 60% Hispanic, 18% White, 19% Black). A MeDi adherence score (range = 0-9, 9 representing maximal adherence) was examined continuously and in quintiles (3/4/5/6-9 vs. 0-2).

RESULTS

Mean cIMT = 0.9 ± 0.1 mm and 57% had plaque (median plaque thickness = 1.5 mm, 75th percentile = 2.2; median plaque area = 4.2 mm(2), 75th percentile = 15.8). There was no association between MeDi and cIMT or plaque presence. MeDi adherence was inversely associated with the 75th percentile of plaque thickness and median of plaque area in quantile regression analyses. These associations persisted after controlling for demographics, smoking, physical activity, and total energy consumption (effect of a 1-point increase in MeDi score on the 75th percentile of plaque thickness = -0.049 mm, p = 0.03; median of plaque area = -0.371 mm(2), p = 0.03), and when additionally controlling for vascular disease biomarkers, medication use, BMI, and previous cardiac disease. The protective associations appeared strongest for those with a MeDi score of 5 (4th quintile) vs. 0-2 (bottom quintile). Differential effects of a MeDi on plaque thickness and area across race/ethnic groups was suggested.

CONCLUSIONS

Moderate and strict adherence to a MeDi may protect against a higher burden of carotid atherosclerotic plaque, which may mediate the protection against clinical vascular events. Efforts to improve adherence to a MeDi are critical to reducing the burden of atherosclerotic disease.

The association between carotid intima media thickness and individual dietary components and patterns

AIMS

To review: 1) the correlation between individual dietary components and carotid intima media thickness (cIMT); 2) the relationship between dietary patterns and cIMT; 3) the effect of dietary interventions on cIMT progression.

DATA SYNTHESIS

An electronic search for epidemiological and intervention trials investigating the association between dietary components or patterns of intake and cIMT was performed in PUBMED, EMBASE and the Cochrane Library. Epidemiological data shows that a higher intake of fruit, wholegrains and soluble fibre and lower consumption of saturated fat in favour of polyunsaturated fat is associated with lower cIMT. In people at high risk of cardiovascular disease >93 g/day of fruit is associated with lower cIMT. Lower cIMT has also been observed when >0.79 serves/day of wholegrains and >25 g/day of fibre, predominately in the soluble form is consumed. Saturated fat is positively associated with cIMT, for every 10 g/day increase in saturated fat cIMT is 0.03 mm greater. Olive oil is inversely associated with cIMT, with a benefit seen when >34 g/day is consumed. While there are many epidemiological studies exploring the association between dietary intake and cIMT there are few intervention studies. Intervention studies show that a Mediterranean diet may reduce cIMT progression, especially in those with a higher cIMT.

CONCLUSIONS

A Mediterranean style dietary pattern, which is high in fruits, wholegrains, fibre and olive oil and low in saturated fat, may reduce carotid atherosclerosis development and progression. However further research from randomised controlled trials is required to understand the association between diet and cIMT and the underlying mechanisms.

Fruit and vegetable intake among older adults: a scoping review

Older adults are the fastest growing segment of the world population. Older adults are also at heightened risk of chronic conditions (such as diabetes, heart disease, and cancer) and specific geriatric conditions (such as cognitive impairment, frailty, and falls). Research studies have examined the relationship between fruit and vegetable intake and subsequent health outcomes and the correlates of fruit and vegetable intake in the U.S. population. However, relatively few studies have specifically examined health impacts and correlates of fruit and vegetable intake among older adults, who have unique biophysical and socioeconomic circumstances. Evidence is reviewed to (1) describe findings related to consumption and chronic, geriatric, and other health outcomes among older adults and (2) describe patterns in fruit and vegetable consumption among older adults and how these patterns vary within and among populations. This review addresses specific barriers faced by older adults in obtaining and consuming fruits and vegetables in community settings. Recommendations for practice and policy are discussed.

Increased dietary fruit intake was associated with lower burden of carotid atherosclerosis in Chinese patients with Type 2 diabetes mellitus

BACKGROUND

Previous studies demonstrated that high fruit consumption was associated with a lower risk of cardiovascular events in patients with Type 2 diabetes mellitus. However, the relationship between fruit intake and carotid atherosclerosis in these patients is unknown. We studied the relationship between dietary fruit intake and carotid intima-media thickness in patients with Type 2 diabetes.

METHODS

A total of 255 Chinese patients with Type 2 diabetes were recruited. Dietary fruit intake was assessed by a validated food-frequency questionnaire, and carotid intima-media thickness was measured by high-resolution ultrasonography.

RESULTS

Among patients with three different tertiles of fruit intake (14.5 ± 8.6 vs. 41.5 ± 7.1 vs. 92.6 ± 39.7 g/day), there was no difference in their clinical characteristics (all P > 0.05). Patients with the highest tertile of fruit intake had a significantly higher BMI and diastolic blood pressure than those with the lowest tertile intake. Furthermore, serum high-sensitivity C-reactive protein, 8-isoprostane and superoxide dismutase were similar among the three tertiles of patients (all P > 0.05). However, patients with the highest tertile of fruit intake had lower carotid intima-media thickness (0.97 ± 0.02 vs. 1.08 ± 0.03 mm, P = 0.046) and prevalence of carotid plaque (11.76 vs. 1.18%, P = 0.022) than those with the lowest tertile of fruit intake. Multivariate regression analysis revealed the highest tertile of fruit intake (β = -0.086, P = 0.049) was independently associated with carotid intima-media thickness.

CONCLUSIONS

Our results demonstrated that, in Chinese patients with Type 2 diabetes, higher dietary fruit intake was associated with a lower burden of carotid atherosclerosis as reflected by lower carotid intima-media thickness and prevalence of carotid plaque.

Combined use of multiple methodologies for the measurement of total antioxidant capacity in UK commercially available vegetable juices

Substantial evidence exists to support the hypothesis that high fruit and vegetable consumption, rich in antioxidants, can reduce the incidence of several disease states. The aim of this study was to compare the results obtained by six spectrophotometric biochemical methods including the ferric reducing antioxidant power (FRAP), 2, 2-diphenyl-1-picryhydrazyl (DPPH•), 2,2-azinobis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS•⁺), copper (II) reducing capacity (CUPRAC) and Cerium (IV) reducing antioxidant capacity (CERAC) assays as well as Folin-Ciocalteu method (FC) for the measurement of total antioxidant capacity (TAC) and total polyphenols (TP) in different commercially available vegetable juices. There was a significant positive correlation between the results obtained for FRAP, ABTS•⁺, CUPRAC, CERAC and FC (0.68 ≤ r ≤ 0.96, P < 0.01). DPPH• was only correlated with CERAC (r = 0.66, P < 0.01). Beetroot juice had the highest TAC and TP regardless of the method of analysis.

Reduced or modified dietary fat for preventing cardiovascular disease

BACKGROUND

Reduction and modification of dietary fats have differing effects on cardiovascular risk factors (such as serum cholesterol), but their effects on important health outcomes are less clear.

OBJECTIVES

To assess the effect of reduction and/or modification of dietary fats on mortality, cardiovascular mortality, cardiovascular morbidity and individual outcomes including myocardial infarction, stroke and cancer diagnoses in randomised clinical trials of at least 6 months duration.

SEARCH METHODS

For this review update, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, were searched through to June 2010. References of Included studies and reviews were also checked.

SELECTION CRITERIA

Trials fulfilled the following criteria: 1) randomised with appropriate control group, 2) intention to reduce or modify fat or cholesterol intake (excluding exclusively omega-3 fat interventions), 3) not multi factorial, 4) adult humans with or without cardiovascular disease, 5) intervention at least six months, 6) mortality or cardiovascular morbidity data available.

DATA COLLECTION AND ANALYSIS

Participant numbers experiencing health outcomes in each arm were extracted independently in duplicate and random effects meta-analyses, meta-regression, sub-grouping, sensitivity analyses and funnel plots were performed.

MAIN RESULTS

This updated review suggested that reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14% (RR 0.86, 95% CI 0.77 to 0.96, 24 comparisons, 65,508 participants of whom 7% had a cardiovascular event, I(2) 50%). Subgrouping suggested that this reduction in cardiovascular events was seen in studies of fat modification (not reduction - which related directly to the degree of effect on serum total and LDL cholesterol and triglycerides), of at least two years duration and in studies of men (not of women). There were no clear effects of dietary fat changes on total mortality (RR 0.98, 95% CI 0.93 to 1.04, 71,790 participants) or cardiovascular mortality (RR 0.94, 95% CI 0.85 to 1.04, 65,978 participants). This did not alter with sub-grouping or sensitivity analysis.Few studies compared reduced with modified fat diets, so direct comparison was not possible.

AUTHORS' CONCLUSIONS

The findings are suggestive of a small but potentially important reduction in cardiovascular risk on modification of dietary fat, but not reduction of total fat, in longer trials. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates. The ideal type of unsaturated fat is unclear.

Effect of mulberry silage supplementation during late fattening stage of Hanwoo (Bos taurus coreanae) steer on antioxidative enzyme activity within the longissimus muscle

This study was conducted to determine the possible application of mulberry silage as a functional feed in the feeding management of Hanwoo, Korean native cattle, for high quality beef production. Twenty Hanwoo steers in the last stage of fattening were randomly assigned to two groups with (MSS) or without (Control) supplemental mulberry silage. The Control group was fed on a standard total mixed commercial ration, while the MSS group was fed on a total mixed commercial ration formulated with mulberry silage at the rate of 10%, fresh matter basis, for 30 days. The mulberry silage contained active ingredients such as 1-deoxynojirimycin, γ-aminobutyric acid, and phenol compounds. In the present study, the oxidative stress biomarkers such as glutathione, superoxide dismutase, glutathione peroxidase, catalase, and glutathione-S-transferase were improved in the MSS group compared with the Control group. Electron spin resonance assays showed that 1,1-diphenyl-2-picrylhydrazyl radical scavenging activity was significantly elevated by 75.5% in the MSS group (P < 0.001). Moreover, the MSS group exhibited stronger scavenging activity against hydroxyl radicals, superoxide radicals, and alkyl radicals, and the radical scavenging activity occurred in a dose-dependent manner. Findings from the present study suggest that mulberry silage may be useful as a functional feed by improving the antioxidant activity against various reactive radicals for beef cattle.

Dietary anthocyanin-rich plants: biochemical basis and recent progress in health benefits studies

Anthocyanins are one type of flavonoid phytopigment. Although the role of anthocyanins as a functional food factor remains relatively less established than that of other flavonoids, progress in this area has been made at the molecular level in recent years. This review discusses the potential health benefits of plant-derived anthocyanin-rich foods, with a focus on the role of anthocyanins in obesity control, diabetes control, cardiovascular disease prevention, and improvement of visual and brain functions, areas that have attracted much attention. Such health benefits are not necessarily derived from the antioxidant effect of anthocyanins, but in fact are produced by currently unestablished chemical properties beyond the antioxidant capacity of the molecules. However, a better understanding of the physiological functionality of anthocyanins remains to be elucidated. It is desirable, therefore, to clarify the molecular type and composition of the anthocyanins that confer specific health benefits and to conduct further investigation into the underlying molecular mechanisms. The pharmacological actions of anthocyanins could not be fully established without knowledge on the effects of treatment of anthocyanins alone, the effects of non-anthocyanin components, and the possible interactions between anthocyanin and non-anthocyanin species.

Fruit consumption is associated with lower carotid intima-media thickness and C-reactive protein levels in patients with type 2 diabetes mellitus

Preliminary evidence in support of fruit intake for the prevention of cardiovascular disease in patients with type 2 diabetes mellitus (T2DM) is still limited. The objective of this study was to evaluate the association between fruit consumption and cardiovascular risk factors such as carotid intima-media thickness (CIMT) and high-sensitive C-reactive protein (hsCRP) in patients with T2DM. In this cross-sectional study, 407 patients with T2DM were recruited from August 2007 to December 2009. Dietary assessment based on 3-day 24-hour recall interviews, hsCRP levels, and CIMT were examined. Participants were categorized into three tertiles based on fruit intake. Comparisons of the participants' clinical characteristics among the three categories were performed using either one-way analysis of variance or analysis of covariance. In patients with type 2 diabetes with CIMT ≥1 mm, the intake of fruit was lower (P=0.001), whereas the serum hsCRP level was higher (P<0.001) compared with patients showing CIMT <1 mm. Results of the multivariable logistic regression analysis showed that the odds ratios of CIMT and hsCRP were 8% and 31% lower, respectively, in participants in the top tertile compared with those in the lowest tertile (P=0.018 and P<0.001, respectively) after adjustment for potential confounders. Hence, a reduction in hsCRP concentration and CIMT were found to be associated with an increase in fruit intake. Sufficient daily intake of fruits should, therefore, be considered as an important component of a medical nutritional therapy strategy for the prevention of cardiovascular diseases in patients with T2DM.

Reduced or modified dietary fat for preventing cardiovascular disease

BACKGROUND

Reduction and modification of dietary fats have differing effects on cardiovascular risk factors (such as serum cholesterol), but their effects on important health outcomes are less clear.

OBJECTIVES

To assess the effect of reduction and/or modification of dietary fats on mortality, cardiovascular mortality, cardiovascular morbidity and individual outcomes including myocardial infarction, stroke and cancer diagnoses in randomised clinical trials of at least 6 months duration.

SEARCH STRATEGY

For this review update, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, were searched through to June 2010. References of Included studies and reviews were also checked.

SELECTION CRITERIA

Trials fulfilled the following criteria: 1) randomised with appropriate control group, 2) intention to reduce or modify fat or cholesterol intake (excluding exclusively omega-3 fat interventions), 3) not multi factorial, 4) adult humans with or without cardiovascular disease, 5) intervention at least six months, 6) mortality or cardiovascular morbidity data available.

DATA COLLECTION AND ANALYSIS

Participant numbers experiencing health outcomes in each arm were extracted independently in duplicate and random effects meta-analyses, meta-regression, sub-grouping, sensitivity analyses and funnel plots were performed.

MAIN RESULTS

This updated review suggested that reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14% (RR 0.86, 95% CI 0.77 to 0.96, 24 comparisons, 65,508 participants of whom 7% had a cardiovascular event, I(2) 50%). Subgrouping suggested that this reduction in cardiovascular events was seen in studies of fat modification (not reduction - which related directly to the degree of effect on serum total and LDL cholesterol and triglycerides), of at least two years duration and in studies of men (not of women). There were no clear effects of dietary fat changes on total mortality (RR 0.98, 95% CI 0.93 to 1.04, 71,790 participants) or cardiovascular mortality (RR 0.94, 95% CI 0.85 to 1.04, 65,978 participants). This did not alter with sub-grouping or sensitivity analysis.Few studies compared reduced with modified fat diets, so direct comparison was not possible.

AUTHORS' CONCLUSIONS

The findings are suggestive of a small but potentially important reduction in cardiovascular risk on modification of dietary fat, but not reduction of total fat, in longer trials. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates. The ideal type of unsaturated fat is unclear.

Association between meat consumption and carotid intima-media thickness in Korean adults with metabolic syndrome

OBJECTIVES

The effect of meat consumption on cardiometabolic risk has been continuously studied, but their associations are not conclusive. The aim of this study is to examine the association between the consumption of meat or red meat and carotid intima-media thickness (IMT) in healthy Korean adults.

METHODS

This study evaluated 2374 community-dwelling adults (933 men and 1441 women) who were free of cardiovascular disease or cancer, living in a rural area in Korea. Total meat and red meat intakes were assessed with a validated 103 item-food frequency questionnaire. Carotid IMT was evaluated ultrasonographically, IMTmax was defined as the highest value among IMT of bilateral common carotid arteries.

RESULTS

After adjustment for potential confounding factors, the mean IMTmax tended to increase in higher meat consumption groups in both men and women with metabolic syndrome (p for trend= 0.027 and 0.049, respectively), but not in participants without metabolic syndrome. Frequent meat consumption (≥5 servings/week) was significantly associated with higher IMTmax in men with metabolic syndrome (by 0.08 mm, p=0.015). Whereas, the association was not significant in women (by 0.05 mm, p=0.115). Similar but attenuated findings were shown with red meat intake.

CONCLUSIONS

Our findings suggest that a higher meat consumption may be associated with a higher carotid IMT in Korean adults with metabolic syndrome. The frequent meat consumption (≥5 servings/week), compared with the others, was associated with a higher carotid IMTmax only in men with metabolic syndrome. Further research is required to explore optimal meat consumption in people with specific medical conditions.

Greater variety in fruit and vegetable intake is associated with lower inflammation in Puerto Rican adults

BACKGROUND

Puerto Rican adults have prevalent metabolic abnormalities, but few studies have explored fruit and vegetable (FV) intake and coronary heart disease (CHD) risk in this population.

OBJECTIVE

We tested the hypothesis that greater FV intake and variety are associated with a lower 10-y risk of CHD and C-reactive protein (CRP) concentrations.

DESIGN

In a cross-sectional study of ≈1200 Puerto Rican adults aged 45-75 y, we assessed FV intake with a food-frequency questionnaire. The 10-y risk of CHD was assessed with the Framingham risk score (FRS) in participants free of cardiovascular disease. CRP was measured in fasting serum.

RESULTS

Variety, but not quantity, of FV intake was inversely associated with FRS after adjustment for the following: sex; waist circumference; perceived stress; alcohol use; intakes of energy, trans fatty acids, and saturated fatty acids; and use of supplements, cardiovascular medications, and diabetes medications (P = 0.02). However, the association was attenuated after adjustment for income (P = 0.11). Variety, but not quantity, was associated with a lower serum CRP concentration after adjustment for age, sex, smoking status, alcohol use, servings of FV, white blood cell count, diastolic blood pressure, diabetes, nonsteroidal antiinflammatory medication use, intakes of energy and vitamin B-6, waist circumference, perceived stress, and income. The adjusted odds of a high CRP concentration for those in the highest compared with the lowest tertile of FV variety was 0.68 (95% CI: 0.49, 0.94).

CONCLUSIONS

FV variety, but not quantity, appears to be important in reducing inflammation. Although the results are suggestive, larger studies are needed to confirm a possible association with CHD risk score.

The regular consumption of a polyphenol-rich apple does not influence endothelial function: a randomised double-blind trial in hypercholesterolemic adults

BACKGROUND/OBJECTIVES

Epidemiological studies suggest that apple consumption is associated with a reduction in cardiovascular disease risk. Apple polyphenols may contribute to explain these effects. Endothelial dysfunction has been associated with early stage of atherosclerosis and polyphenols from various dietary sources have been shown to reverse it. The aim of the present study was to investigate the effect of the consumption of a polyphenol-rich apple on endothelial function.

SUBJECTS/METHODS

In all, 30 hypercholesterolemic volunteers were included in a double-blind, randomized crossover trial. They successively consumed 40 g of two lyophilized apples, polyphenol-rich and polyphenol-poor, providing respectively 1.43 and 0.21 g polyphenols per day during two 4-week periods separated by a 4-week washout period.

RESULTS

Brachial artery flow-mediated vasodilation (FMD) was assessed at the beginning and at the end of each intervention period. FMD did not differ between the polyphenol-rich and the polyphenol-poor apples, neither did the other cardiovascular disease risk factors (plasma lipids, homocysteine, antioxidant capacity).

CONCLUSIONS

These data suggest that over a 4-week period, the consumption of a polyphenol-rich apple does not improve vascular function in hypercholesterolemic patients.

Dietary zinc intake is inversely related to subclinical atherosclerosis measured by carotid intima-media thickness

The relationship between dietary Zn intake and the risk of atherosclerosis remains unclear, and no epidemiological studies have been reported on the effects of dietary Zn intake on morphological changes in the vascular wall. We examined the relationship between dietary Zn intake and common carotid intima-media thickness (IMT) as a marker of subclinical atherosclerosis among the middle-aged and elderly populations. A cross-sectional analysis of a prospective cohort baseline study was performed with 4564 adults aged 40–89 years and free of clinical CVD. Dietary data were collected by trained interviewers using an FFQ. Common carotid IMT was measured using a B-mode ultrasound imaging technique. Subclinical atherosclerosis was determined using carotid IMT, and defined as >80th percentile of carotid IMT or ≥ 1 mm of carotid IMT. After adjustment for potential confounders, the mean carotid IMT in the low Zn intake group was higher than that in the high Zn intake group. When subclinical atherosclerosis was defined as >80th percentile value of IMT or ≥ 1 mm of carotid IMT, after adjustment for potential confounders, Zn intake was inversely related to subclinical atherosclerosis (5thv.1st quintile, OR 0·64, 95 % CI 0·45, 0·90,Pfor trend = 0·069; 5thv.1st quintile, OR 0·34, 95 % CI 0·16, 0·70,Pfor trend = 0·005, respectively). In persons free of clinical CVD, dietary Zn intake was inversely correlated with subclinical atherosclerosis. The present findings suggest a putative protective role of dietary Zn intake against the development of atherosclerosis.

Correlation of erythrocyte fatty acid composition and dietary intakes with markers of atherosclerosis in patients with myocardial infarction

The purpose of this study was to examine the hypothesis that erythrocytes that are low in n-3 fatty acids and high in trans-fatty acids and nutrient intakes are associated with the risk of atherosclerosis. Fifty patients with acute nonfatal myocardial infarction were recruited to measure their dietary intake, erythrocyte fatty acid composition, intima medial thickness (IMT), and the Gensini score, which are markers of atherosclerosis. Trans-oleic acid of erythrocytes was positively (P = .05) correlated with the carotid IMT. After adjusting for age, sex, and energy intake, the IMT was negatively associated with the intake of protein, fat, phosphate, zinc, vitamin B(1), vitamin B(2), vitamin B(6), niacin, linoleic acid, linolenic acid, total fatty acids, total n-3 fatty acids, and total n-6 fatty acids. The Gensini score was also negatively associated with the intake of protein, fat, phosphate, sodium, zinc, vitamin E, vitamin B(1), vitamin B(2), vitamin B(6), niacin, linolenic acid, total fatty acids, and total n-3 fatty acids. In conclusion, lower levels of trans-oleic acid (elaidic acid) in erythrocytes and higher intakes of vitamins, minerals, and n-3 fatty acids were associated with the decreased risk of atherosclerosis. However, these findings need further investigation in randomized controlled clinical trials before public health recommendations for atherosclerosis prevention can be made.