Flavan-3-ols and Cardiometabolic Health: First Ever Dietary Bioactive Guideline

Effect of tamarind (Tamarindus indica L.) on the cardiometabolic health of patients living with HIV and elevated triglyceride levels: a dose-response double-blind, randomized exploratory trial

Background: The increase in cardiometabolic diseases in sub-Saharan Africa calls for sustainable remedies. In particular, people living with HIV (PLWH) have an increased risk of metabolic syndrome. Tamarind (Tamarindus indica L.), a fruit native to Africa, is rich in polyphenols and may optimize cardiometabolic health. In an exploratory trial, we assessed the potential of tamarind fruit juice to improve lipid metabolism in PLWH. Methods: We conducted a 4-week, parallel double-blinded trial of 50 patients equally allocated to two doses of tamarind juice. The primary outcome was triglycerides (TG), and eligible participants were aged 30 to 60 years with TG ≥ 150 mg dL-1. Patients consumed 600 mL of tamarind juice daily, containing either 10% or 30% tamarind fruit pulp corresponding to 1556 mg or 1631 mg of the analyzed polyphenols, respectively. Fasted blood samples were analyzed for lipid profile. Blood pressure (BP) and vascular function were measured. Patients were required to maintain their habitual diet and lifestyle. Dietary intake, background polyphenol intake, and physical activity were measured. All analyses were performed according to intention-to-treat. Study registration was done at clinicalTrial.gov, NCT06058845. Results: The 30% fruit pulp juice significantly reduced TG by -39.8 mg dL-1 (95% CI: -67.7, -11.9), P = 0.006, corresponding to a 17.3% reduction of the baseline TG levels, while no statistically significant effect was noted for the 10% fruit pulp juice. None of the doses had a significant effect on total cholesterol, LDL, and HDL. The 10% fruit pulp juice significantly reduced systolic blood pressure (SBP), mean arterial pressure, and SBP (aorta) by -7.4 mmHg (95% CI: -14.5, -0.26), P = 0.043, -5.1 mmHg, 95% CI [-9.3, -0.99], P = 0.016, and -11.7 mmHg, 95% CI [-20.9, -2.6], P = 0.013, respectively. Physical activity, dietary intake, and background polyphenol intake between the study groups did not significantly change across the study period. Conclusion: Although our trial was not adequately powered to draw definitive conclusions, we showed that T. indica L. fruit juice potentially ameliorates TG metabolism and blood pressure homeostasis. This study provides a basis for future full-scale trials.

Toxicological safety, antioxidant effect, and chemoprotection determination of an extract from the babassu mesocarp (Orbignya phalerata Mart.) in preclinical studies

Reactive nitrogen species (RNS) and reactive oxygen species (ROS) play a key role in chronic diseases and aging by initiating protein oxidation, impaired cellular membrane damage and functions, and induction of DNA mutations. When endogenous antioxidants are insufficient to counteract oxidant stress, bioactive compounds might serve as physiological therapeutic agents attributed to their ability to neutralize ROS. The aim of this study was to examine the antioxidant, chemoprotective and toxicological aspects of the hydroethanolic extract from Orbignya phalerata Mart. mesocarp using in vitro and in vivo bioassays. The extract presented 9.9 mg/g of total flavonoids, primarily catechin and epicatechin. This extract exhibited no apparent toxicity upon Artemia salina (LC50 > 1000 μg/ml) or Zophobas morio larvae (LD50 > 3000 mg/kg), low hemolysis, genotoxicity, or mutagenicity utilizing Allium cepa cells. Cytotoxicity effects were observed on in L-929 murine fibroblast only at concentrations above 130 μg/ml. This extract effectively neutralized free radicals [DPPH• (EC50 25.3 μg/ml) and ABTS•+ (EC50 52.6 μg/ml)] and reduced H2O2-initiated effects on Saccharomyces cerevisiae. The chemoprotective activity of this extract was also noted in A. salina, L-929 cells, and S. cerevisiae as evidenced from oxidative damage and toxicity tests results. This constitutes the first report describing the toxicological safety profile of a babassu mesocarp extract a rich source of flavonoids (catechin and epicatechin) with antioxidant and chemoprotective activities.

Dietary flavonoids in health and diseases: A concise review of their role in homeostasis and therapeutics

Over the past few decades, extensive research has delved into the health advantages of flavonoids, exploring their physiological effects through cell-based assays, epidemiological studies, and human intervention trials. The regular intake of plant-derived flavonoids has shown therapeutic potential against noncommunicable pathophysiological conditions, including carcinoma and various inflammatory disorders. Among the myriads of flavonoids, many have been shown to inhibit the aggregation of amyloid-beta peptides in Alzheimer's disease, while anthocyanins exhibit cardioprotective effects by improving endothelial function and lowering blood pressure. In addition, their efficacy is known to manage infectious communicable diseases caused by various bacteria and viruses, such as S. pneumoniae and SARS-CoV-2. Currently, flavonoids are being used to develop new drugs for both communicable and noncommunicable diseases because of their intricate metabolism and bioavailability, leveraging their anti-inflammatory and antioxidant properties. This concise review provides insights into the potential of flavonoids for therapeutics and disease management, particularly with respect to cardiovascular health, neuroprotection, and antimicrobial action. The implications of these findings underscore the necessity for further exploration of flavonoid-rich diets and their incorporation into therapeutic practices to harness their full health benefits.

Effects of Tea (Camellia sinensis) or its Bioactive Compounds l-Theanine or l-Theanine plus Caffeine on Cognition, Sleep, and Mood in Healthy Participants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

CONTEXT

The bioactive compounds found in tea from Camellia sinensis, namely theanine, caffeine, and polyphenols, can potentially improve short-term and long-term health outcomes.

OBJECTIVE

The aim of this study was to assess the effects of tea, theanine alone, or theanine plus caffeine on cognition, mood, and sleep outcomes, using data from randomized controlled trials (RCTs) in healthy participants.

DATA SOURCES

The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, and Ovid Medline were searched up to and including August 2023.

DATA EXTRACTION

Data relevant to the participants, interventions, comparisons, outcomes (ie, cognition, mood, and sleep), and study design were extracted.

DATA ANALYSIS

Fifty RCTs were included in the review, of which 15 were eligible for at least 1 meta-analysis, most commonly performed by use of standardized mean differences (SMD), in random effects models. After intake of theanine plus caffeine, and of placebo, small-to-moderate differences were found between these interventions in the first hour (h1) and second hour (h2), that favoured theanine plus caffeine, with regard to cognition and mood outcomes such as choice reaction time (h1: SMD, -0.48; 95% CI, -1.01, 0.05), digit vigilance task accuracy (h2: SMD, 0.20; 95% CI, 0.02, 0.38), attention switching task accuracy (h2: SMD, 0.33; 95% CI, 0.13, 0.54), and overall mood (h2: SMD, 0.26; 95% CI,-0.10, 0.63). There was a small-to-moderate difference between the effects of theanine and placebo that favored theanine on choice reaction time (h1: SMD, -0.35; 95% CI,-0.61, -0.10). The CIs frequently highlighted the uncertainty surrounding the direction and magnitude of these differences.

CONCLUSIONS

This meta-analysis provides evidence that theanine plus caffeine, and theanine alone, could be beneficial for cognitive and mood outcomes. More research using tea beverages or tea-equivalent bioactive doses and research in free-living participants is needed.

PROSPERO REGISTRATION NO

CRD42022351601.

Moderate dietary flavonoid intake associated with lower prevalence of Parkinson's disease: data from the NHANES 2007-2010 and 2017-2018

OBJECTIVE

To investigate the relationship between dietary flavonoids and the prevalence of PD.

METHODS

We used data from the 2007-2010 and 2017-2018 National Health and Nutrition Examination Survey (NHANES). Dietary flavonoid intake was assessed through a two-day, 24-hour dietary recall method, and PD diagnosis was ascertained by the presence of 'Anti-Parkinson agents' among the reported prescription medications. Logistic regression, subgroup, and restricted cubic spline (RCS) models were employed to analyze the connection between dietary flavonoids and PD prevalence.

RESULTS

Our study revealed a correlation between the consumption of dietary total flavonoids, flavan-3-ols, and flavonols, and PD risk. Subgroup analysis indicated a negative correlation of dietary flavan-3-ols and total flavonoids with PD risk only among non-obese participants. Furthermore, our analysis using RCS demonstrated a nonlinear association between dietary flavonoids, flavan-3-ols, flavonols, and PD prevalence. We found that the optimal intake of total flavonoids, flavan-3-ols and flavonols wase 403.65 mg/day,346 mg/day and 26.74 mg/day, respectively. Above these thresholds, the risk of developing PD is elevated.

CONCLUSIONS

Our study highlights a significant association between moderate dietary intake of total flavonoids, flavan-3-ols, and flavonols, and a reduced risk of PD. Our work may provide new therapeutic ideas for the prevention and treatment of PD and provide dietary flavonoid intake recommendations for PD patients.

A Review of the Effects of Flavonoids on NAD(P)H Quinone Oxidoreductase 1 Expression and Activity

Cancer is a significant cause of death worldwide. It has been suggested that the consumption of flavonoids decreases the risk for cancer by increasing phase II enzymes, such as Nicotinamide Adenine Dinucleotide Phosphate Hydrogen (NAD(P)H) quinone oxidoreductase 1 (NQO1), glutathione S-transferases, and Uridine 5'-diphospho- (UDP)-glucuronosyltransferases that assist in removing carcinogens from the human body. Flavonoids are bioactive compounds found in a variety of dietary sources, including fruits, vegetables, legumes, nuts, and teas. As such, it is important to investigate which flavonoids are involved in the metabolism of carcinogens to help reduce the risk of cancer. Therefore, the objective of this narrative review was to investigate the effects of commonly consumed flavonoids on NQO1 mRNA expression, protein, and activity in human cell and murine models. PubMed was used to search for peer-reviewed journal articles, which demonstrated that selected flavonoids (e.g., quercetin, apigenin, luteolin, genistein, and daidzein) increase NQO1, and therefore, increase the excretion of carcinogens. However, more research is needed regarding the mechanisms by which flavonoids induce NQO1. Furthermore, it is suggested that future efforts focus on providing precise flavonoid recommendations to decrease the risk factors for chronic diseases.

Dietary patterns and physical activity in young South Asians and white Europeans and their potential implications for cardiovascular risk

Individuals of South Asian (SA) ethnicity have greater risk of developing cardiovascular disease (CVD) relative to white Europeans (WEs). Factors which generally contribute to increased CVD risk include physical inactivity and poor dietary habits, including high intake of salt and saturated fat. Contrastingly, diets rich in fibre, antioxidants and polyphenols are considered cardioprotective. The current questionnaire-based study aimed to examine whether the dietary habits and physical activity levels of young adult SAs living in the UK may contribute to their increased CVD risk in comparison to age-matched WEs. All participants (80 healthy individuals, 40 SA/ 40 WE (gender-balanced, aged 18-26 years) completed questionnaires to assess: general health; habitual physical activity levels, assessed by the International Physical Activity Questionnaire; and dietary patterns, assessed by EPIC-food frequency questionnaire and three-day food diaries. SAs had higher sitting times (SA: 469 ± 19.4, WE: 387 ± 21.5 min/day, p = 0.0107) and were less physically active (SA: 2050 ± 1110, WE: 4850 ± 2810 MET mins/day, p < 0.0001) than WEs. Further, SAs had lower consumption of cardioprotective nutrients, such as fibre (p = 0.0183), folate (p = 0.0242), vitamin C (p = 0.0105) and phytochemicals, such as flavonoids (p = 0.0644). SAs also consumed less alcohol (p < 0.0001), fat (p = 0.0066), sugar (p = 0.0218) and sodium (p = 0.0011) compared to WEs. These findings suggest that lower consumption of nutrients and phytochemicals that are cardioprotective, rather than excess consumption of fat, sugar and sodium, amongst young SAs may contribute to their increased CVD risk. Young SA individuals may also reduce their future CVD risk by increasing their physical activity.

The role of cocoa flavanols in modulating peripheral and cerebral microvascular function in healthy individuals and populations at-risk of cardiovascular disease: a systematic review

BACKGROUND

Cocoa flavanols (CFs) are polyphenolic molecules with proposed cardioprotective effects. Whilst extensive evidence supports their ability to ameliorate vasodilator responses within conduit vessels, their actions in the microvasculature are less clear. This systematic review of the literature aimed to determine whether CF interventions lead to improvements in microvascular vasodilator responses in healthy populations and those with increased cardiovascular disease risk.

METHODS

Database searches were conducted up to September 2023 using Medline, Embase, Pubmed and Web of Science Core Collection to identify randomised, placebo-controlled, human studies investigating the effect of CF interventions on the microvasculature (at rest and vasodilator responses). All studies were assessed for risk of-bias according to Cochrane Collaboration recommendations for randomised-controlled trials, data were extracted from studies and findings collated by vote-counting.

RESULTS

Searches identified 511 unique articles for screening, of which 19 were selected for data extraction. Vasodilator responses were enhanced in 85.7% (80.4-91.0%, p = 0.013) of all acute studies (n = 13), and in 81.8% (74.1-89.4%, p = 0.065) of studies in healthy subgroups (n = 11). Importantly, this effect was apparent in all studies with 'low risk of bias' (n = 8, p = 0.008). In contrast, there was no effect of acute CF interventions at rest. For chronic studies (n = 7), the effect of CFs was less clear, with a significant benefit reported at rest only, in all young, healthy subgroups (n = 7, p = 0.016), but no evidence of improvements in vasodilator responses.

CONCLUSIONS

CFs have the potential to improve microvascular function, particularly in healthy individuals, with benefits appearing more pronounced following acute CF supplementation. Despite this, interpretations are limited by the small number of comparable studies identified and the heterogeneity of populations studied. Overall, the effects of CFs on the microvasculature seem to be less consistent than previous evidence in the macrovasculature, suggesting that the microvessels may be less susceptible to the effect of CFs than conduit arteries.

REGISTRATION

The PROSPERO registration number for this review is CRD42023483814.

Relationship between dietary flavan-3-ols intake and mortality in metabolic syndrome population; a large cohort study

Background

Metabolic syndrome (MetS) is a global health concern linked to increased mortality. Diets rich in plant-derived compounds, such as polyphenols, have shown potential health benefits for MetS. Among these, flavan-3-ols, a class of commonly occurring polyphenolic compounds, are known for their antioxidant and anti-inflammatory properties. Therefore, we hypothesize that flavan-3-ols intake is negatively associated with mortality risk in MetS population.

Methods

This study analyzed NHANES data (2007-2008, 2009-2010, and 2017-2018). Flavan-3-ol and monomer intake were obtained from the USDA Flavonoid and FNDDS databases. Associations with mortality were assessed using Cox regression, survival differences were compared using Kaplan-Meier curves, and non-linear trends were examined using restricted cubic splines. Subgroup analyses were conducted to explore potential effect modifications.

Results

Over a median follow-up period of 114 months, 1,856 participants survived, while 329 deaths were recorded. In Model 3, participants in the highest tertile (T3) of flavan-3-ol intake exhibited a 33% lower risk of all-cause mortality compared to those in the lowest tertile (T1) (HR = 0.67, 95%CI: 0.49-0.92). For monomers, the hazard ratios ranged from 0.55 for higher levels of epigallocatechin to 0.71 for higher levels of gallocatechin. Kaplan-Meier curves indicated significant differences in survival status across dietary flavan-3-ol intake groups. However, no association was found between flavan-3-ol intake and cardiovascular mortality risk. Additionally, restricted cubic spline (RCS) analysis did not reveal any non-linear relationship, and no significant interaction effects were observed in the subgroup analysis.

Conclusion

Higher dietary intake of flavan-3-ols is negatively associated with mortality risk in MetS population.

Consuming pecans as a snack improves lipids/lipoproteins and diet quality compared with usual diet in adults at increased risk of cardiometabolic diseases: a randomized controlled trial

BACKGROUND

The vascular and cardiometabolic effects of pecans are relatively understudied.

OBJECTIVES

The aim was to examine how substitution of usual snack foods with 57 g/d of pecans affects vascular health, risk factors for cardiometabolic diseases, and diet quality, compared with continuing usual intake in individuals at risk of cardiometabolic diseases.

METHODS

A 12-wk single-blinded, parallel, randomized controlled trial was conducted. Adults with ≥1 criterion for metabolic syndrome who were free from cardiovascular disease and type 2 diabetes were included. Participants were provided with 57 g/d of pecans and instructed to replace the snacks usually consumed with the provided pecans. The control group was instructed to continue consuming their usual diet. Flow-mediated dilation (FMD),primary outcome, along with blood pressure, carotid-femoral pulse wave velocity (cf-PWV), lipids/lipoproteins, and glycemic control were measured at baseline and following the intervention. Participants completed 3 24-h recalls at 3 time points (baseline, week 6, and week 12) during the study (9 recalls in total). The Healthy Eating Index-2020 (HEI-2020) was calculated to assess diet quality.

RESULTS

In total, 138 participants (mean ± SD; 46 ± 13 y, 29.8 ± 3.7 kg/m2) were randomly assigned (69 per group). No between-group differences in FMD, cf-PWV, or blood pressure were observed. Compared with the usual diet group, pecan intake reduced total cholesterol (-8.1 mg/dL; 95% confidence interval [CI]: -14.5, -1.7), LDL cholesterol (-7.2 mg/dL; 95% CI -12.3, -2.1), non-HDL-cholesterol (-9.5 mg/dL; 95% CI -15.3, -3.7), and triglycerides concentrations (-16.4 mg/dL; 95% CI -30.0, -2.9). Weight tended to increase in the pecan group compared with the usual diet group (0.7 kg; 95% CI -0.1, 1.4). The HEI-2020 increased by 9.4 points (95% CI 5.0, 13.7) in the pecan group compared with the usual diet group.

CONCLUSIONS

Replacing usual snacks with 57 g/d of pecans for 12-wk improves lipids/lipoproteins and diet quality but does not affect vascular health in adults at risk of cardiometabolic disease. This trial was registered at clinicaltrials.gov as NCT05071807.

The Modulatory Role of Bioactive Compounds in Functional Foods on Inflammation and Metabolic Pathways in Chronic Diseases

Chronic diseases are major contributors to global morbidity and mortality. More than 70% of deaths worldwide are caused by chronic diseases, including cardiovascular diseases (CVDs), obesity, type 2 diabetes, and cancer. These diseases are characterised by chronic low-grade inflammation and metabolic dysregulation. Incorporating functional foods into daily diet has been suggested as a complementary strategy to promote health and lower the risk of non-communicable diseases. Functional foods, known as foods that confer health benefits beyond basic nutrition, have been reported to exhibit preventive and therapeutic benefits such as anti-inflammatory properties for human health. Therefore, the aim of this state-of-the-art review will synthesise the findings from recent and high-quality studies that investigated the modulatory role of some commonly reported bioactive active compounds, such as polyphenols, omega-3 fatty acids, probiotics, and prebiotics, in inflammation and metabolic pathways.

The overlooked impact of background diet and adherence in nutrition trials

Importance

Randomized controlled trials in nutrition (RCTN) face unique challenges such as the influence of participants' background diets and varying adherence to the intervention, factors that are difficult to quantify and can mask true intervention effects. However, the exact impact of these factors remains unclear.

Objective

To quantify the impact of background diet and adherence, estimated using validated nutritional biomarkers of flavanol intake, on the outcomes of a large-scale RCTN.

Design Setting and Participants

This study was nested within the COcoa Supplement and Multivitamin Outcomes Study (COSMOS; NCT02422745), a randomized, double-blind, placebo-controlled, 2×2 factorial trial conducted among 21,442 older adults in the United States. Analyses focused on participants (n=6,532) in the placebo and cocoa-extract intervention arms who had available biospecimens and outcome data.

Exposures

Daily supplementation with a cocoa flavanol (CF).

Main Outcomes and Measures

We used validated flavanol biomarkers in urine to assess background dietary flavanol intake and adherence to the cocoa extract intervention. Outcomes included total cardiovascular disease (CVD) events, CVD mortality, all-cause mortality, and major CVD events. Hazard ratios (HRs) with 95% CIs were estimated using intention-to-treat, per-protocol, and biomarker-based analyses.

Results

Of the 6,532 participants, 20% in both the placebo and intervention arms had a background flavanol intake similar to that provided by the intervention; only 5% had no background flavanol intake. In the intervention group, 33% of participants were not adherent based on expected biomarker levels, that was larger than the15% estimated based on self-reported pill-taking. Accounting for biomarker-estimated background diet and adherence resulted in a significant impact on effect sizes. For total CVD events, the HR (95% CI) of 0.79 (0.59-1.05) in the per-protocol analysis (PP), was reduced to 0.65 (0.47-0.89) in the biomarker-based analysis. Similar changes were observed for CVD mortality (from 0.51 (0.23; 1.14) to 0.44 (0.20; 0.97)), all-cause mortality (0.69 (0.45; 1.05) to 0.54 (0.37; 0.80)) and major CVD events (from 0.62 (0.43; 0.91) to 0.48 (0.31; 0.74)). Overall, biomarker-based analyses consistently produced stronger effect estimates than ITT and PP analyses that do not consider the impact of background diet or assess adherence using self-reported methods.

Conclusions and Relevance

These results highlight the importance of considering diet and adherence in RCTN using nutritional biomarker-based analyses. This may help to improve consistency and reliability of outcomes of RTC testing nutritional interventions.

Flavonoids as Natural Anti-Inflammatory Agents in the Atopic Dermatitis Treatment

Eczema is a complex autoimmune condition characterised mainly by inflammation and skin lesions along with physical and psychological comorbidities. Although there have been significant advances in understanding the mechanisms behind atopic dermatitis, conventionally available treatments yield inconsistent results and have some unintended consequences. In today's digital age, where knowledge is just a click away, natural-based supplements have been on the rise for a more "natural" treatment towards any type of disease. Natural compounds, particularly derived from medicinal plants, have piqued significant interest in the development of herbal remedies for chronic inflammatory skin conditions. Among many compounds, flavonoids have shown promise in treating eczema due to their strong anti-inflammatory, antioxidant, and anti-allergic properties, making them helpful in preventing allergic reactions, inflammation, and skin irritation. This review highlights the therapeutic potential of flavonoid-based bioactive compounds to manage eczema, emphasising the mechanisms of action. Additionally, providing a comprehensive analysis of the potential of emerging and established compounds, while bridging a gap between traditional and modern medicine. Flavonoids offer a variety of opportunities for further research and innovative formulations that can maximise its full benefits. Further combination of flavonoids with various approaches such as nanoencapsulation for enhanced bioavailability, hydrogel-based delivery systems for a controlled release, and additive manufacturing for personalised topical formulations, could align with future precision medicine needs.

Anthocyanin-Rich Blackcurrant Supplementation as a Nutraceutical Ergogenic Aid for Exercise Performance and Recovery: A Narrative Review

Athletes and physically active individuals consume sport nutrition supplements to enhance competitive sport performance and exercise recovery. Polyphenols have emerged as a promising area of research with application for sport and exercise nutrition owing to affecting physiologic mechanisms for exercise performance and recovery. The anthocyanin is a polyphenol that can be abundantly present in dark-colored fruits, berries, and vegetables. Anthocyanins and anthocyanin-induced metabolites will provide antioxidant and anti-inflammatory effects. The focus of this narrative review was on the observations with intake of anthocyanin-rich blackcurrant supplements on whole-body exercise performance and exercise recovery. This review included 17 studies with a randomized placebo-controlled crossover design (10 studies on performance and 8 on recovery effects) and 1 with a randomized placebo-controlled parallel group design (recovery effects). Among the performance studies, 6 studies (60%) reported positive effects, 3 studies (30%) reported no significant effects, and 1 study (10%) reported a mixed outcome. Among the recovery studies, 7 studies (78%) reported positive effects, 1 study (11%) reported no significant effects, and 1 study (11%) reported a negative effect. Studies with intake of supplements made from New Zealand blackcurrants (dose: 1.8-3.2 mg/kg and 105-315 mg anthocyanins, acute to 7-d intake) provided meaningful (but not always consistent) effects on continuous and intermittent exercise performance tasks (i.e. rowing, cycling, and running) and markers for exercise recovery. A mechanistic understanding for the beneficial exercise effects of anthocyanins for athletes and physically active individuals is still limited. Future work requires a better understanding of the specific types of anthocyanins and anthocyanin-induced metabolites and their effects on altering cell function that can enhance exercise performance and recovery.

Polyphenol-Derived Microbiota Metabolites and Cardiovascular Health: A Concise Review of Human Studies

Polyphenols, plant-derived secondary metabolites, play crucial roles in plant stress responses, growth regulation, and environmental interactions. In humans, polyphenols are associated with various health benefits, particularly in cardiometabolic health. Despite growing evidence of polyphenols' health-promoting effects, their mechanisms remain poorly understood due to high interindividual variability in bioavailability and metabolism. Recent research highlights the bidirectional relationship between dietary polyphenols and the gut microbiota, which can influence polyphenol metabolism and, conversely, be modulated by polyphenol intake. In this concise review, we summarized recent advances in this area, with a special focus on isoflavones and ellagitannins and their corresponding metabotypes, and their effect on cardiovascular health. Human observational studies published in the past 10 years provide evidence for a consistent association of isoflavones and ellagitannins and their metabotypes with better cardiovascular risk factors. However, interventional studies with dietary polyphenols or isolated microbial metabolites indicate that the polyphenol-gut microbiota interrelationship is complex and not yet fully elucidated. Finally, we highlighted various pending research questions that will help identify effective targets for intervention with precision nutrition, thus maximizing individual responses to dietary and lifestyle interventions and improving human health.

Revisiting dietary proanthocyanidins on blood glucose homeostasis from a multi-scale structural perspective

Multi-dimensional studies have consistently indicated the benefits of dietary proanthocyanidins on blood glucose homeostasis through consumption of them from fruits, cereals and nuts. Proanthocyanidins from various sources possess different structures, but even the minor variations in structures influence their regulation on blood glucose, including the degree of polymerization, galloacylation at C3, number of hydroxyl groups in B ring and linkage type. Therefore, this Review details the role of three types of proanthocyanidins (procyanidins, prodelphinidins and propelargonidins) in blood glucose control and their underlying mechanisms, and various structural features contribute to. Due to the extremely low bioavailability, proanthocyanidins mainly ameliorate high blood glucose by luminal effects: inhibit enzyme activities, improve the structure of gut microbiota, and protect the intestinal barrier function. A few absorbed proanthocyanidins exert insulin-like effects on targeted organs. Prodelphinidin gallates exhibit greater hypoglycemic activities than others, due to their galloacylation at C3 and high amounts of hydroxyl groups in B ring. Because of different action pathways, comprehensive consideration on the degree of polymerization, linkage type and density of hydroxyl groups was required. Further understanding of these relationships can concrete diet therapeutic opportunities for proanthocyanidins.

Association Between Dietary Flavonoid Intake and Cardiovascular Health in Cancer Survivors: A Cross-Sectional Study

Purpose

Flavonoids are naturally occurring compounds with diverse health-promoting properties. The purpose of this study was to explore the associations between dietary flavonoid intake and cardiovascular health in cancer survivors.

Patients and Methods

We obtained data from the National Health and Nutrition Examination Survey (NHANES) 2007-2008, 2009-2010, and 2017-2018 cycles. Weighted linear regression and restricted cubic spline (RCS) were used to explore the correlation between dietary flavonoid intake and cardiovascular health (Life's Essential 8 (LE8) score) in cancer survivors. Then, weighted quantile sum (WQS) regression and quantile-based g-computation (qgcomp) models were performed to assess the mixed effects of the six flavonoid subclasses and to determine the major flavonoid types. Additionally, the protective effect of high flavonoid intake on cardiovascular health was further evaluated in different subgroups, and mediation analysis was used to explore mediating factors.

Results

After adjusting for all covariates, compared to those in the first quartile, participants in the fourth quartile of total flavonoids, anthocyanidins, flavonols, flavanones, and flavones intake exhibited increases in LE8 scores of 3.24% (95% CI: 0.45-6.03, P for trend=0.030), 6.25% (95% CI: 3.14-9.36, P for trend<0.001), 3.01% (95% CI: 1.33-4.69, P for trend= 0.003), 3.23% (95% CI: 0.18-6.27, P for trend=0.030), and 5.01% (95% CI: 2.42-7.61, P for trend<0.001), respectively. Meanwhile, significant non-linear relationships were supported by the RCS models. However, the weighted linear regression and RCS models did not reveal any clear correlations between isoflavone or flavan-3-ol intake and the LE8 score. Regarding mixed effects, anthocyanidin, flavonol, flavanone, and flavone intake were positively related to the LE8 score according to both the WQS and qgcomp models, and anthocyanidin intake was the major contributor.

Conclusion

Our study indicated that dietary flavonoid intake is positively associated with cardiovascular health in cancer survivors, among which anthocyanidin intake might provide the most benefit.

Lactiplantibacillus plantarum Interstrain Variability in the Production of Bioactive Phenolic Metabolites from Flavan-3-ols

Flavan-3-ols intake is associated with numerous health benefits, but these are influenced by their conversion into smaller phenolic metabolites by the gut microbiota. Thus, the identification of bacteria that metabolize flavan-3-ols could lead to targeted interventions to enhance their benefits. To this end, we screened 47 Lactiplantibacillus plantarum strains for their ability to metabolize (+)-catechin, a flavan-3-ol. Then, we assessed these strains for their capacity to convert various flavan-3-ol structures. Out of the 47 isolates, 12 released 3-(3',4'-dihydroxyphenyl)-1-(2,4,6-trihydroxyphenyl)-propan-2-ol (a form of diphenylpropan-2-ol) from (+)-catechin. All strains metabolized (+)-catechin, (-)-epicatechin, (-)-epigallocatechin, but only a subset transformed (-)-gallocatechin. Among these simple flavan-3-ol structures, (-)-epicatechin was metabolized the most. A hierarchical cluster analysis identified two groups of flavan-3-ol-metabolizing strains categorized as having "high" and "low" production of diphenylpropan-2-ols. Notably, the strains that produced higher levels of diphenylpropan-2-ol from (+)-gallocatechin and (+)-catechin also performed better with a camu-camu extract, which was studied as a complex source of flavan-3-ols and predominantly contained these two flavan-3-ols. These results demonstrate the interstrain variability in L. plantarum metabolism, which may be useful for developing tailored formulations to enhance the production of flavan-3-ols bioactive metabolites.

Non-enzymatic degradation of flavan-3-ols by ascorbic acid- and sugar-derived aldehydes during storage of apple juices and concentrates produced with the innovative spiral filter press

Potentially health-promoting concentrations of flavan-3-ols were previously shown to be retained in apple juices produced with the emerging spiral filter press. Due to the novelty of this technology, the factors governing the stability of flavan-3-ol-rich apple juices have only scarcely been studied. Therefore, we produced flavan-3-ol-rich apple juices and concentrates (16, 40, 70 °Brix) supplemented with ascorbic acid (0.0, 0.2, 1.0 g/L) according to common practice. Flavan-3-ols (DP1-7) and twelve flavan-3-ol reaction products were comprehensively characterized and monitored during storage for 16 weeks at 20 and 37 °C, employing RP-UHPLC- and HILIC-DAD-ESI(-)-QTOF-HR-MS/MS. Flavan-3-ol degradation followed a second-order reaction kinetic, being up to 3.5-times faster in concentrates (70 °Brix) than in single strength juices (16 °Brix). Furthermore, they diminished substantially faster compared to other phenolic compounds. For instance, after 16-weeks at 20 °C, the maximum loss of flavan-3-ols (-70 %) was greater than those of hydroxycinnamic acids (-18 %) and dihydrochalcones (-12 %). We observed that flavan-3-ols formed adducts with sugars and other carbonyls, such as 5-(hydroxymethyl)furfural and the ascorbic acid-derived L-xylosone. Increased degradation rates correlated particularly with increased furan aldehyde levels as found in concentrates stored at elevated temperatures. These insights could be used for optimizing production, distribution, and storage of flavan-3-ol-rich apple juices and other foods and beverages.

Genus Ribes: Ribes aureum, Ribes pauciflorum, Ribes triste, and Ribes dikuscha-Comparative Mass Spectrometric Study of Polyphenolic Composition and Other Bioactive Constituents

This study presents the metabolomic profiles of the four Ribes species (Ribes pauciflorum Turcz., Ribes triste Pall., Ribes dicuscha Fisch., and Ribes aureum Purch.). The plant material was collected during two expeditions in the Russian Far East. Tandem mass spectrometry was used to detect target analytes. A total of 205 bioactive compounds (155 compounds from polyphenol group and 50 compounds from other chemical groups) were tentatively identified from the berries and extracts of the four Ribes species. For the first time, 29 chemical constituents from the polyphenol group were tentatively identified in the genus Ribes. The newly identified polyphenols include flavones, flavonols, flavan-3-ols, lignans, coumarins, stilbenes, and others. The other newly detected compounds in Ribes species are the naphthoquinone group (1,8-dihydroxy-anthraquinone, 1,3,6,8-tetrahydroxy-9(10H)-anthracenone, 8,8'-dihydroxy-2,2'-binaphthalene-1,1',4,4'-tetrone, etc.), polyhydroxycarboxylic acids, omega-3 fatty acids (stearidonic acid, linolenic acid), and others. Our results imply that Ribes species are rich in polyphenols, especially flavanols, anthocyanins, flavones, and flavan-3-ols. These results indicate the utility of Ribes species for the health and pharmaceutical industry.

Strawberry (Fragaria x Ananassa) intake on human health and disease outcomes: a comprehensive literature review

Strawberries provide a number of potential health promoting phytonutrients to include phenolics, polyphenols, fiber, micronutrients and vitamins. The objective of this review is to provide a comprehensive summary of recent human studies pertaining to the intake of strawberry and strawberry phytonutrients on human health. A literature search conducted through PubMed and Cochrane databases consolidated studies focusing on the effects of strawberry intake on human health. Articles were reviewed considering pre-determined inclusion and exclusion criteria, including experimental or observational studies that focused on health outcomes, and utilized whole strawberries or freeze-dried strawberry powder (FDSP), published between 2000-2023. Of the 60 articles included in this review, 47 were clinical trials, while 13 were observational studies. A majority of these studies reported on the influence of strawberry intake on cardiometabolic outcomes. Study designs included those examining the influence of strawberry intake during the postprandial period, short-term trials randomized with a control, or a single arm intake period controlling with a low polyphenolic diet or no strawberry intake. A smaller proportion of studies included in this review examined the influence of strawberry intake on additional outcomes of aging including bone and brain health, and cancer risk. Data support that the inclusion of strawberries into the diet can have positive impacts during the postprandial period, with daily intake improving outcomes of lipid metabolism and inflammation in those at increased cardiovascular risk.

Improved analysis of grape seed extract by liquid chromatography-high resolution mass spectrometry (LC-HRMS) reveals that proanthocyanidin-protein interaction mechanisms in cream depend on degree of polymerization

This study aimed to comprehensively characterize chemical profiles of proanthocyanidins (PACs) from grape seed extract (GSE), examine their interactions with proteins in a cream system, and define the mechanisms mediating PAC-protein interactions. GSE PACs were fractionated and characterized by thiolysis followed by liquid chromatography-high resolution mass spectrometry (LC-HRMS) analysis. New PACs with a degree of polymerization (DP) up to 16 were identified by improved HRMS data processing methods. In the model cream system, high-DP PACs exhibited greater precipitation capacity and protein binding than low-DP PACs. Low-DP PACs primarily engaged in hydrogen bonding, while high-DP PACs predominantly utilized multiple hydrophobic interaction sites to form cream protein aggregates. Furthermore, particle size and viscosity measurement of cream revealed a progressively DP-dependent increase in aggregated fat globules and cream viscosity. These findings enhanced our understanding of PACs' structural intricacies and highlighted their functional role as PAC-rich natural ingredients in creating structured cream systems.

Dietary Flavonoid and Subclass Intakes are not Associated with Markers of Bone Health in U.S. Adults Age 50+ Years

BACKGROUND

Dietary flavonoid intakes have been associated with improved markers of bone health in Chinese and Scottish cohorts, but little data exist in middle aged to older adults in the United States.

OBJECTIVES

The objective of our research was to assess if dietary flavonoid intakes are associated with bone mineral density (BMD), bone mineral content (BMC), and bone area of the lumbar spine and femoral neck in a nationally representative population of middle aged to older U.S. adults. We further sought to investigate if relationships of the main flavonoid subgroups (i.e., anthocyanins, flavan-3-ols, flavanones, flavones, flavonols, and isoflavones) exist, as a secondary objective.

METHODS

Cross-sectional data from individuals aged 50+ years enrolled in the 2017-2018 National Health and Nutrition Examination Survey (NHANES) were used in our analyses (N = 2590). Weighted multivariate logistic regression models were used to investigate the relationship between quartiles of flavonoid intake and BMD, BMC, and bone area of the lumbar spine and femoral neck of participants.

RESULTS

Mean age of participants was 63.4 ± 0.52 years and 64.1 ± 0.52 years for men and women, respectively. Average total flavonoid intake was 217 ± 19.4 mg/day and 306 ± 26.9 mg/day for men and women, respectively. Total flavonoid intakes were not significantly associated with BMD, BMC, or bone area of the femoral neck or lumbar spine in male or female participants. Flavonoid subclass intakes were also not consistently associated with improved markers of bone health.

CONCLUSION

Although several limitations exist, this cross-sectional analysis of U.S. adults aged 50+ years provides contradictory evidence to the hypothesis that higher flavonoid and flavonoid subclass intakes beneficially impacts markers of bone health. Large prospective cohort investigations that better capture long-term dietary flavonoid intake and ascertain fractures the primary outcome, as well as randomized controlled trials, are needed to fully elucidate the effects flavonoids on bone health.

Beneficial Effects of Cocoa Flavanols on Microvascular Responses in Young Men May Be Dependent on Ethnicity and Lifestyle

Cocoa flavan-3-ols affect endothelium-dependent responses in resistance vessels and microcirculation has received little attention. We tested the effects of dark chocolate consumption (396 mg total flavanols/day for 3 days) in two Groups of 10 men (18-25 years; non-smokers) each comprising equal numbers of White European (WE) and South Asian (SA) ethnicity. In Group 1, dark chocolate did not affect reactive hyperaemia in forearm muscle, but augmented muscle dilatation evoked by acute mental stress, and reactive hyperaemia and acetylcholine (ACh)-evoked dilatation in cutaneous microcirculation. Conversely, in Group 2, chocolate did not affect cutaneous reactive hyperaemia or ACh-evoked dilatation, but these responses were blunted in Group 1 relative to Group 2. Further, when Groups 1 and 2 were combined, responses were blunted in SAs relative to WEs, augmented by chocolate in SAs only. In Group 2 individuals whose ACh-evoked dilatation was attenuated by nitric oxide synthase (NOS) inhibition, ACh-evoked dilatation was not altered after chocolate, but the attenuating effect of NOS inhibition was lost. Conversely, in Group 2 individuals whose ACh-evoked dilatation was enhanced by NOS inhibition, ACh-evoked dilatation was also augmented by chocolate. We propose that in resistance and microvessels of young men, cocoa flavan-3-ols preferentially augment endothelium-dependent dilator responses whose responses are depressed by familial and lifestyle factors more prevalent in SAs than Wes. Flavan-3-ols may facilitate the NOS pathway but also influence other endothelium-dependent dilators.

Assessing the Impact of (Poly)phenol-Rich Foods on Cardiometabolic Risk in Postmenopausal Women: A Dietary Trial

Menopause is a critical stage in a woman's life in which cardiometabolic alterations appear, such as insulin resistance or a predisposition to visceral fat deposits, leading to an increased risk of cardiometabolic diseases (R-CMBs). New strategies to reduce the R-CMBs in postmenopausal women using natural compounds without adverse effects are desirable. In this sense, plant-based diets rich in fruits and vegetables could play a fundamental role due to the high content of bioactive compounds found in these diets, such as (poly)phenols, known for their antioxidant, anti-inflammatory and vasodilator properties. The aim of this research was to carry out a dietary trial to evaluate the effect of the daily intake of different (poly)phenol-rich foods (PP-rich foods) for 2 months on the modulation of the main cardiometabolic risk biomarkers of postmenopausal women. The results showed a slight improvement in blood pressure (BP), lipid profile and oxidative stress, endothelial function and inflammatory biomarkers. These findings suggest that daily consumption of PP-rich foods alleviated the R-CMBs of postmenopausal women by reducing the oxidative stress and, thus, the risk of cardiovascular events; however, the magnitude of the cardioprotective effect of (poly)phenols depends on inter-individual variability.

Flavan-3-ols and Vascular Health: Clinical Evidence and Mechanisms of Action

Cardiovascular diseases (CVDs) are one of the main causes of mortality and morbidity worldwide. A healthy diet rich in plant-derived compounds such as (poly)phenols appears to have a key role in improving cardiovascular health. Flavan-3-ols represent a subclass of (poly)phenols of great interest for their possible health benefits. In this review, we summarized the results of clinical studies on vascular outcomes of flavan-3-ol supplementation and we focused on the role of the microbiota in CVD. Clinical trials included in this review showed that supplementation with flavan-3-ols mostly derived from cocoa products significantly reduces blood pressure and improves endothelial function. Studies on catechins from green tea demonstrated better results when involving healthy individuals. From a mechanistic point of view, emerging evidence suggests that microbial metabolites may play a role in the observed effects. Their function extends beyond the previous belief of ROS scavenging activity and encompasses a direct impact on gene expression and protein function. Although flavan-3-ols appear to have effects on cardiovascular health, further studies are needed to clarify and confirm these potential benefits and the rising evidence of the potential involvement of the microbiota.

Effects of apples (Malus domestica) and their derivatives on metabolic conditions related to inflammation and oxidative stress and an overview of by-products use in food processing

Apple (Malus domestica) is the third most produced fruit worldwide. It is a well-known source of bioactive compounds mainly represented by hydroxycinnamic acids, flavan-3-ols, dihydrochalcones, dehydroascorbic acid, carotenoids, chlorogenic acid, epicatechin, and phloridzin. Due to the lack of a recent evaluation of the clinical trials associated with apple consumption, this review investigated the effects of this fruit on metabolic conditions related to inflammation and oxidative stress and reviewed the applications of apple waste on food products. Thirty-three studies showed that apples or its derivatives exhibit anti-inflammatory and antioxidant actions, improve blood pressure, body fat, insulin resistance, dyslipidemia, and reduce cardiovascular risks. Apples have a great economic impact due to its several applications in the food industry and as a food supplement since it has impressive nutritional value. Dietary fiber from the fruit pomace can be used as a substitute for fat in food products or as an improver of fiber content in meat products. It can also be used in bakery and confectionary products or be fermented to produce alcohol. Pomace phytocompounds can also be isolated and applied as antioxidants in food products. The potential for the use of apples and by-products in the food industry can reduce environmental damage.

The Interplay between Endogenous and Foodborne Pro-Oxidants and Antioxidants in Shaping Redox Homeostasis

Oxidative stress has been known about in biological sciences for several decades; however, the understanding of this concept has evolved greatly since its foundation. Over the past years, reactive oxygen species, once viewed as solely deleterious, have become recognized as intrinsic components of life. In contrast, antioxidants, initially believed to be cure-all remedies, have failed to prove their efficacy in clinical trials. Fortunately, research on the health-promoting properties of antioxidants has been ongoing. Subsequent years showed that the former assumption that all antioxidants acted similarly was greatly oversimplified. Redox-active compounds differ in their chemical structures, electrochemical properties, mechanisms of action, and bioavailability; therefore, their efficacy in protecting against oxidative stress also varies. In this review, we discuss the changing perception of oxidative stress and its sources, emphasizing everyday-life exposures, particularly those of dietary origin. Finally, we posit that a better understanding of the physicochemical properties and biological outcomes of antioxidants is crucial to fully utilize their beneficial impact on health.

Reliance on self-reports and estimated food composition data in nutrition research introduces significant bias that can only be addressed with biomarkers

The chemical composition of foods is complex, variable, and dependent on many factors. This has a major impact on nutrition research as it foundationally affects our ability to adequately assess the actual intake of nutrients and other compounds. In spite of this, accurate data on nutrient intake are key for investigating the associations and causal relationships between intake, health, and disease risk at the service of developing evidence-based dietary guidance that enables improvements in population health. Here, we exemplify the importance of this challenge by investigating the impact of food content variability on nutrition research using three bioactives as model: flavan-3-ols, (-)-epicatechin, and nitrate. Our results show that common approaches aimed at addressing the high compositional variability of even the same foods impede the accurate assessment of nutrient intake generally. This suggests that the results of many nutrition studies using food composition data are potentially unreliable and carry greater limitations than commonly appreciated, consequently resulting in dietary recommendations with significant limitations and unreliable impact on public health. Thus, current challenges related to nutrient intake assessments need to be addressed and mitigated by the development of improved dietary assessment methods involving the use of nutritional biomarkers.

Dietary fiber: Still alive

Dietary fiber (DF) was established as a key dietary constituent some decades ago, as were some of its mechanisms of action and health effects. Although there is consolidated evidence on many features regarding DF, at the same time there are still many aspects to be explored in the field, e.g., deeper explorations of the contribution of phenolic compounds linked to cell walls to the biological activities of DF, or of the relevance of the gut-brain axis. At the same time, increasing DF intake should be seen as a major public health problem since worldwide intakes are quite far from recommendations. The awareness of this fact by public bodies should lead, among others, to the assessment of effective strategies for promoting DF intake among general population or specific groups; and to consider potential regulatory modifications in order to clarify several aspects potentially misleading for consumers.

Association between Flavonoid Intake and Cognitive Executive Function among African American and White Adults in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) Study

Healthy dietary patterns rich in flavonoids may benefit cognitive performance over time. Among socioeconomically disadvantaged groups, the association between flavonoid intake and measures of cognition is unclear. This study sought to identify associations between flavonoid intake and cognitive performance among Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study participants (n = 1947) across three study visits. Flavonoid intakes were assessed via two 24-h dietary recalls. Cognitive performance was assessed via the Trail Making Test (TMT)-A and TMT-B, which provide measures of attention and executive function, respectively. Mixed effects linear regression was used to model TMT scores over three study visits against visit 1 (v1) flavonoid intake, time (years from v1), and the interaction between v1 flavonoid intake and time, capturing both the cross-sectional association between flavonoid intake and time at v1 as well as the longitudinal association between v1 flavonoid intake and the change in TMT scores over time. Prior to adjustment, inverse cross-sectional associations at v1 were observed between (1) anthocyanidin intake and TMT-A scores for the overall sample and (2) total flavonoid, anthocyanidin, flavan-3-ol, flavone, and flavonol intake and TMT-B scores for the overall sample and among White adults. Only the association between anthocyanidin intake and TMT-B at v1 among White adults persisted after adjustment (for demographic characteristics such as age). One possible explanation for the few significant associations is universally low flavonoid intakes resulting from the consumption of an unhealthy dietary pattern.

A novel Nutrient Rich Food (NRFa11.3) score uses flavonoids and carotenoids to identify antioxidant-rich spices, herbs, vegetables, and fruit

Introduction

Nutrient profiling (NP) models designed to evaluate the healthfulness of plant-based foods ought to incorporate bioactive phytochemicals. Herbs and spices are one food group of current interest.

Methods

Two new versions of the well-established Nutrient Rich Food (NRF) index were applied to spices, herbs, vegetables, fruit, and other plant-based foods. Analyses used the US Department of Agriculture (USDA) SR-28 nutrient composition database merged with the USDA Expanded Flavonoid database 3.3. The NRF4.3 model was based on protein, fiber, potassium, and vitamin C. The NRFa11.3 model was based on micronutrients with reported antioxidant activity (vitamin C, vitamin E, selenium, copper, and zinc), carotenoids (alpha and beta carotene, beta-cryptoxanthin, lycopene, lutein/zeaxantin) and flavonoids. Saturated fat, added sugar, and sodium were nutrients to limit. The NRF algorithm was based on sums of percent daily values (%DVs) capped at 100%.

Results

The NRF4.3 model awarded high scores to herbs and spices, cocoa powder, and nuts, but did not discriminate well among vegetables and fruit. The NRFa11.3 model performed better. Green leafy, red orange and cruciferous vegetables had the highest carotenoid content. Highest in flavonoids were cocoa powder, herbs and spices, and berries. Highest combined NRFa11.3 values were observed for herbs and spices, green leafy vegetables, cocoa, nuts, and red-orange and cruciferous vegetables.

Discussion

Fresh and dry herbs and spices, often ignored by NP models, were particularly nutrient-rich and may provide non-negligible amounts of key phytonutrients to the human diet.

Dietary Flavonoid Intakes in France Are Linked to Brewed Tea Consumption and to Socioeconomic Status: Analyses of the Third French Individual and National Food Consumption (INCA3) Survey for Children and Adults

Flavonoids from green and black tea may benefit cardiovascular health. Brewed tea consumption and flavonoid intake in France have not been previously explored. This study assessed the dietary intake of flavonoids among French children and adults, using 3 days' dietary recall for 3896 persons aged >4 y in the Third French Individual and National Food Consumption Survey (INCA3). Foods consumed by INCA 3 participants were manually matched with the flavonoid content of foods from the French PhenolExplorer database and the US Department of Agriculture expanded flavonoid database (2018 version). The six subclasses of flavonoids were flavan-3-ols, flavanones, anthocyanidins, flavonols, flavones, and isoflavones. Flavonoid intake was stratified by age subgroups (children and adults separately) and examined using socio-demographics and tea consumption patterns. Mean flavonoid intake was 210 mg/d. Flavonoids in the French diet were predominantly flavan-3-ols (147 mg/d), of which tea is the main source. The effects of age, education, income, and socio-professional category (SPC) on flavonoid intake were all significant (p < 0.0001). Brewed tea consumers were 31.88% of French adults and 3.79% of children. Brewed tea consumption and flavonoid intake were highly correlated. The highest brewed tea and flavonoid intakes were found among individuals with the highest SPC and education levels. Flavonoid intake in France was associated with brewed tea consumption and with higher education and income.

New light on changes in the number and function of blood platelets stimulated by cocoa and its products

Hyperactivation of blood platelets, one of the causes of heart attack, and other cardiovascular diseases (CVDs), is influenced by various dietary components, including phenolic compounds from vegetables, fruits, teas, wines, cocoa and its products, including chocolate. The present paper sheds new light on the effect of cocoa and its products, especially dark chocolate, on the number and function of blood platelets, and the anti-platelet activity of their constituent phenolic compounds. A review was performed of papers identified in various electronic databases, including PubMed, Science Direct, Scopus, Web of Knowledge, and Google Scholar, with the aim of determining whether their anti-platelet activity may serve as part of a sweet strategy in countering CVDs. Various studies demonstrate that cocoa consumption, especially in the form of dark chocolate, with a high flavanol concentration, has anti-platelet activity and may play a significant role in cardioprotection; they also note that cocoa consumption may be a good strategy in diminishing cardiovascular risk, including hyperactivation of blood platelets.

Assessing the Gut Microbiota's Ability to Metabolize Oligomeric and Polymeric Flavan-3-ols from Aronia and Cranberry

Clinical trials investigating the health effects of flavan-3-ols yield heterogeneous results due to interindividual variability in the gut microbiota metabolism. In fact, different groups in the population have similar metabolic profiles following (-)-epicatechin and (+)-catechin gut microbial metabolism and can be regrouped into so-called metabotypes. In this study, the capacity of 34 donors to metabolize polymeric B-type flavan-3-ols from aronia and oligomeric A-type flavan-3-ols from cranberry is investigated by in vitro fecal batch fermentations. Less than 1% of the flavan-3-ols from both sources are converted into microbial metabolites, such as phenyl-γ-valerolactones (PVLs). To further confirm this result, gut microbial metabolites from flavan-3-ols are quantified in urine samples collected from participants, before and after a 4-day supplementation of cranberry extract providing 82.3 mg of flavan-3-ols per day. No significant difference is observed in the urinary excretion of flavan-3-ols microbial metabolites. Hence, it demonstrates by both in vitro and in vivo approaches that flavan-3-ols from aronia and cranberry are poorly degraded by the gut microbiota. The beneficial health impacts of these molecules likely stem from their capacity to affect gut microbiota and their interactions with the gut epithelium, rather than from their breakdown into smaller metabolites.

Chemical Profile and Antioxidant and Antimicrobial Activity of Rosa canina L. Dried Fruit Commercially Available in Serbia

The aim of this work was to give as much information as possible on Rosa canina dried fruit that is commercially available in Serbia. In order to provide the chemical composition, the UHPLC-DAD-ESI-MS method was employed for both polar and non-polar extracts of samples obtained with a solvent mixture consisting of hexane, acetone, and ethanol in a volume ratio of 2:1:1, respectively, and 0.05% (w/v) butylated hydroxytoluene. In addition, the total content levels of lycopene, β-carotene, total polyphenols, and flavonoids were determined by means of UV-vis spectrophotometry. The antioxidant activity was tested by applying four different methods: ABTS, DPPH, FRAP, and CUPRAC. Overall, nine compounds were identified. The results of chemical composition analysis were used as the basis for the interpretation of the calculated results for the antioxidant and antimicrobial activity. The obtained results for R. canina dried fruit extract are as follows: β-carotene-7.25 [mg/100 g fruit weight]; lycopene-2.34 (mg/100 g FW); total polyphenol content (TPC)-2980 [mg GAE/kg FW]; total flavonoid content (TFC)-1454 [mg CE/kg FW]; antioxidant activity-ABTS 12.3 [μmol/100 g FW], DPPH 6.84, FRAP 52.04, and CUPRAC 15,425; and antimicrobial activity-Staphylococcus aureus MIC/MMC 4/0 [mg∙mL-1], Enterococcus faecalis 4/0, Bacillus cereus 4/0, Escherichia coli 4/0, Salmonella enteritidis 4/4, Enteroabacter aerogenes 4/0, Pseudomonas aeruginosa 2/0, and Candida albicans 2/0.

Dietary (poly)phenols and cardiometabolic health: from antioxidants to modulators of the gut microbiota

(Poly)phenols are plant secondary metabolites widely abundant in plant foods and beverages comprising a very large number of compounds with diverse structure and biological activities. Accumulating evidence indicates that these compounds exert beneficial effects against cardiometabolic diseases, and this review will provide a summary of current knowledge in this area. Epidemiological and clinical data collectively suggest that intake of flavonoids reduces the risk of cardiovascular disease (CVD), with the evidence being particularly strong for the flavan-3-ol subclass. However, to provide adequate dietary recommendations, a better understanding of their estimated content in foods and intake among the general public is needed. Regarding mechanisms of action, we now know that it is unlikely that (poly)phenols act as direct antioxidants in vivo, as it was hypothesised for decades with the popularity of in vitro antioxidant capacity assays. One of the reasons is that upon ingestion, (poly)phenols are extensively metabolised into a wide array of circulating metabolites with different bioactivities than their precursors. Well-conducted in vitro and in vivo studies and human nutrigenomic analysis have revealed new molecular targets that may be underlying the health benefits of (poly)phenols, such as the nitric oxide pathway. Recently, a bi-directional relationship was established between (poly)phenols and the gut microbiota, suggesting that individual gut microbial metabolising capacity may be a key factor explaining the variability in the cardiometabolic response to (poly)phenols. Future research is needed to elucidate which are the key factors affecting such capacity, and whether it can be modulated, along with the mechanisms of action.

Effects of plant polyphenols on lipid oxidation in pea and soy protein solutions

Significant lipid-derived off-flavors hinder broader acceptance and applicability of plant protein ingredients. Polyphenols are strong antioxidants and can react with protein and carbonyl compounds to reduce oxidative off-flavor development. The effects of polyphenols (catechin, tannic acid (TA), grape seed extract (GSE), and green tea extract (GTE)) on lipid oxidation in pea and soy protein solutions were investigated. All polyphenols reduced lipid oxidation products and volatile compound concentration versus their respective controls. TA, GSE, and GTE reduced the secondary products in pea and soy proteins by an average of 75 % and 50 %, respectively, versus controls, compared to catechin's 61 % and 13 %, respectively. The chemical structures of TA, GSE, and GTE likely allowed them to interact more effectively than catechin with proteins, especially lipoxygenase. However, no significant differences between the polyphenols' antioxidant capacities were observed. Thus, polyphenols predominantly reduced lipid oxidation via interactions with proteins, rather than electron transfer or radical quenching.

Health-Promoting Opportunities of Hemp Hull: The Potential of Bioactive Compounds

Hemp hull is the outer coat of the hemp seed, derived from the plant Cannabis sativa L., Cannabaceae. While much attention has been paid to hemp seed for its oil, protein and micronutrient content, far less attention has been given to hemp hull, a side stream of hemp processing. Hemp hull is a source of bioactive compounds, dietary fiber, minerals as well as protein, lipids and carbohydrates. Of note, two bioactive compounds, n-trans-caffeoyltyramine and n-trans-feruloyltyramine have been identified in hemp hull as key bioactive compounds that support gut health, liver function and other physiological processes. Both of these compounds were identified as agonists of the transcription factor, hepatic nuclear factor-4 alpha which has been implicated in gene expression that governs gut permeability, factors associated with inflammatory bowel diseases, and hepatic lipid homeostasis. Additionally, the dietary fibers in hemp hull have been demonstrated to be novel prebiotics, which may further amplify hemp hull's effect on gut health and metabolic health. This review article summarizes the nutritional content of hemp hull, explores the physiological effects of bioactive compounds found in hemp hull, and identifies opportunities for further research on hemp hull for human health benefit.

Dietary Nitrate from Plant Foods: A Conditionally Essential Nutrient for Cardiovascular Health

Under specific conditions, such as catabolic stress or systemic inflammation, endogenous nutrient production becomes insufficient and exogenous supplementation (for example, through dietary intake) is required. Herein, we propose consideration of a dietary nitrate from plant foods as a conditionally essential nutrient for cardiovascular health based on its role in nitric oxide homeostasis. Nitrate derived from plant foods may function as a conditionally essential nutrient, whereas nitrate obtained from other dietary sources, such as drinking water and cured/processed meats, warrants separate consideration because of the associated health risks. We have surveyed the literature and summarized epidemiological evidence regarding the effect of dietary nitrate on cardiovascular disease and risk factors. Meta-analyses and population-based observational studies have consistently demonstrated an inverse association of dietary nitrate with blood pressure and cardiovascular disease outcomes. Considering the available evidence, we suggest 2 different approaches to providing dietary guidance on nitrate from plant-based dietary sources as a nutrient: the Dietary Reference Intakes developed by the National Academies of Sciences, Engineering, and Medicine, and the dietary guidelines evaluated by the Academy of Nutrition and Dietetics. Ultimately, this proposal underscores the need for food-based dietary guidelines to capture the complex and context-dependent relationships between nutrients, particularly dietary nitrate, and health.

Cirsiliol induces autophagy and mitochondrial apoptosis through the AKT/FOXO1 axis and influences methotrexate resistance in osteosarcoma

BACKGROUND

Osteosarcoma (OS) is the most common primary malignant bone tumor in children and adolescents, with poor outcomes for patients with metastatic disease or chemotherapy resistance. Cirsiliol is a recently found flavonoid with anti-tumor effects in various tumors. However, the effects of cirsiliol in the regulation of aggressive behaviors of OS remain unknown.

METHODS

The effect of cirsiliol on the proliferation of OS cells was detected using a cell counting kit-8 (CCK-8) assay and 5-ethynyl-2'-deoxyuridine (EdU) staining, while cell apoptosis was detected using flow cytometry. Immunofluorescence was applied to visualize the expression level of the mitochondria, lysosomes and microtubule-associated protein light chain 3 (LC3). A computational molecular docking technique was used to predict the interaction between cirsiliol and the AKT protein. The impact of cirsiliol on resistance was investigated by comparing it between a methotrexate (MTX)-sensitive OS cell line, U2OS, and a MTX-resistant OS cell line, U2OS/MTX. Finally, in situ xenogeneic tumor models were used to validate the anti-tumor effect of cirsiliol in OS.

RESULTS

Cirsiliol inhibited cell proliferation and induced apoptosis in both U2OS and U2OS/MTX300 OS cells. In addition, treatment with cirsiliol resulted in G2 phase arrest in U2OS/MTX300 and U2OS cells. Cell fluorescence probe staining results showed impaired mitochondria and increased autophagy in OS cells after treatment with cirsiliol. Mechanistically, it was found that cirsiliol targeted AKT by reducing the phosphorylation of AKT, which further activated the transcriptional activity of forkhead Box O transcription factor 1 (FOXO1), ultimately affecting the function of OS cells. Moreover, in situ tumorigenesis experiments showed that cirsiliol inhibited the tumorigenesis and progression of OS in vivo.

CONCLUSIONS

Cirsiliol inhibits OS cell growth and induces cell apoptosis by reducing AKT phosphorylation and further promotes FOXO1 expression. These phenomena indicate that cirsiliol is a promising treatment option for OS.

Definition of system suitability and proficiency testing acceptance criteria for the standardization of quality control methodologies of botanical bioactives: A case study for the development of AOAC Official Method of Analysis 2020.05 flavanols and procyanidins

Flavanols and procyanidins are bioactives found in many foods including cocoa. The characterization of cocoa flavanols and procyanidins (CF) has historically been challenged by the lack of commercially available standards and weak chromatographic separation performances. The recent release of a reference material and the final authorization of an AOAC Official Method of Analysis (AOAC 2020.05) technically enables the standardization of CF testing. However, the practical implementation of CF testing for routine testing remains challenging for new laboratories, highlighting the need to define guidelines and acceptance criteria to verify normal method performance and user proficiency. This study leveraged the data generated from the recent multi-laboratory validation to define normal method performances. While the challenges associated with HILIC separation can be alleviated through a thorough system equilibration, monitoring system performances remains critical to routine operation and a laboratory's ability to generate reliable data. Guidelines for routine analysis were developed for system precision and bracketing standard recovery, as well as acceptance criteria for the analysis of the reference material. These guidelines not only complete a body of work that provide accessible, reliable, and robust CF analysis solution to research and quality laboratories, but also provide an example to facilitate the establishment and implementation of future international testing standards for botanical bioactives.

Untargeted-based metabolomics analysis and in vitro/in silico antiviral activity of extracts from Phyllanthus brasiliensis (Aubl.) Poir

INTRODUCTION

This study describes the molecular profile and the potential antiviral activity of extracts from Phyllanthus brasiliensis, a plant widely found in the Brazilian Amazon. The research aims to shed light on the potential use of this species as a natural antiviral agent.

METHODS

The extracts were analysed using liquid chromatography-mass spectrometry (LC-MS) system, a potent analytical technique to discover drug candidates. In the meantime, in vitro antiviral assays were performed against Mayaro, Oropouche, Chikungunya, and Zika viruses. In addition, the antiviral activity of annotated compounds was predicted by in silico methods.

RESULTS

Overall, 44 compounds were annotated in this study. The results revealed that P. brasiliensis has a high content of fatty acids, flavones, flavan-3-ols, and lignans. Furthermore, in vitro assays revealed potent antiviral activity against different arboviruses, especially lignan-rich extracts against Zika virus (ZIKV), as follows: methanolic extract from bark (MEB) [effective concentration for 50% of the cells (EC50 ) = 0.80 μg/mL, selectivity index (SI) = 377.59], methanolic extract from the leaf (MEL) (EC50  = 0.84 μg/mL, SI = 297.62), and hydroalcoholic extract from the leaf (HEL) (EC50  = 1.36 μg/mL, SI = 735.29). These results were supported by interesting in silico prediction, where tuberculatin (a lignan) showed a high antiviral activity score.

CONCLUSIONS

Phyllanthus brasiliensis extracts contain metabolites that could be a new kick-off point for the discovery of candidates for antiviral drug development, with lignans becoming a promising trend for further virology research.

Characterization of the Interindividual Variability Associated with the Microbial Metabolism of (-)-Epicatechin

Although the relationship between gut microbiota and flavan-3-ol metabolism differs greatly between individuals, the specific metabolic profiles, known as metabotypes, have not yet been clearly defined. In this study, fecal batch fermentations of 34 healthy donors inoculated with (-)-epicatechin were stratified into groups based on their conversion rate of (-)-epicatechin and their quali-quantitative metabolic profile. Fast and slow converters of (-)-epicatechin, high producers of 1-(3'-hydroxyphenyl)-3-(2″,4″,6″-trihydroxyphenyl)-propan-2-ol (3-HPP-2-ol) and 5-(3',4'-dihydroxyphenyl)-γ-valerolactone (3,4-DHPVL) were identified. Fecal microbiota analysis revealed that fast conversion of (-)-epicatechin was associated with short-chain fatty acid (SCFA)-producing bacteria, such as Faecalibacterium spp. and Bacteroides spp., and higher levels of acetate, propionate, butyrate, and valerate were observed for fast converters. Other bacteria were associated with the conversion of 1-(3',4'-dihydroxyphenyl)-3-(2″,4″,6″-trihydroxyphenyl)-propan-2-ol into 3-HPP-2-ol (Lachnospiraceae UCG-010 spp.) and 3,4-DHPVL (Adlercreutzia equolifaciens). Such stratification sheds light on the mechanisms of action underlying the high interindividual variability associated with the health benefits of flavan-3-ols.

Impact of polyphenol oxidase on the bioavailability of flavan-3-ols in fruit smoothies: a controlled, single blinded, cross-over study

Flavan-3-ols are bioactive compounds found in a variety of fruits and vegetables (F&V) that have been linked to positive health benefits. Increasing habitual flavan-3-ol intake is challenged by the generally low consumption of F&V. While smoothies are a commonly endorsed, consumer-accepted means to increase the daily intake of these important foods, fruits used for smoothie preparation can have a high polyphenol oxidase (PPO) activity and thus potentially affect the content and bioavailability of flavan-3-ols. To assess whether or not consuming freshly prepared smoothies made with different PPO-containing fruit impacts the bioavailability of the flavan-3-ols, a controlled, single blinded and cross-over study was conducted in healthy men (n = 8) who consumed a flavan-3-ol-containing banana-based smoothie (high-PPO drink), a flavan-3-ol-containing mixed berry smoothie (low-PPO drink) and flavan-3-ols in a capsule format (control). The peak plasma concentration (Cmax) of flavan-3-ol metabolites after capsule intake was 680 ± 78 nmol L-1, which was similar to the levels detected after the intake of the low PPO drink. In contrast, the intake of the high PPO drink resulted in a Cmax of 96 ± 47 nmol L-1, 84% lower than that obtained after capsule intake. In a subsequent study (n = 11), flavan-3-ols were co-ingested with a high-PPO banana drink but contact prior to intake was prevented. In this context, plasma flavan-3-ol levels were still reduced, suggesting an effect possibly related to post-ingestion PPO activity degrading flavan-3-ols in the stomach. There was a substantial range in the PPO activity detected in 18 different fruits, vegetables and plant-derived dietary products. In conclusion, bioavailability of flavan-3-ols, and most likely other dietary polyphenol bioactives, can be reduced substantially by the co-ingestion of high PPO-containing products, the implications of which are of importance for dietary advice and food preparation both at home and in industrial settings.

Next-generation analytical platforms for antioxidant capacity assessment: The urge for realistic and physiologically relevant methods

Bioactive compounds, such as carotenoids, alkaloids, and phenolics, are well known because of their alleged health benefits when consumed regularly in a balanced healthy diet. Some well-documented bioactivities are antioxidant, antihypertensive, antihyperglycemic, antilipidemic, anti-obesity, anti-inflammatory, and antimicrobial capacities. Trying to associate the chemical composition of distinct sources and their bioactivity using in vitro methods, several assays have been developed, implemented, and optimised to recapitulate human physiological conditions. However, in most cases, pitfalls are apparent, and no single test tube-based assay can predict in vivo responses. The need for a more physiologically relevant cell-based method to evaluate the antioxidant capacity of putative antioxidants is apparent. Therefore, in this Review, the current state-of-the-art in food science and nutrition is aligned with cell biology/bioengineering approaches to propose combining in vitro digestion and absorption to obtain a bioavailable fraction containing antioxidants. Overall, human plasma, 2-dimensional human cell lines, such as erythrocytes, lymphocytes, hepatocytes, enterocytes and, ultimately, 3-dimensional spheroids (organoids) could be used as biologically relevant models to assess the antioxidant activity of compounds, foods, and nutraceuticals. This versatile approach is deemed suitable, accurate, reproducible, and physiologically relevant to evaluate the protective effects of antioxidants against ROS-mediated oxidation in vitro.

5-(3',4'-Dihydroxyphenyl)-γ-Valerolactone Is a Substrate for Human Paraoxonase: A Novel Pathway in Flavan-3-ol Metabolism

SCOPE

Dietary flavan-3-ols are known to mediate cardiovascular benefits. Currently, it is assumed that the levels of flavan-3-ol catabolites detected in humans, 5-(3',4'-dihydroxyphenyl)-γ-valerolactone (γVL) and 5-(3',4'-dihydroxyphenyl)-γ-valeric acid (γVA), and their corresponding phase II metabolites, are determined exclusively by the action of the gut microbiome. However, a family of human proteins, paraoxonase (PON), can theoretically hydrolyze γVL metabolites into the corresponding γVAs. This study aims to determine if PON is involved in γVL and γVA metabolism in humans.

METHODS AND RESULTS

A rapid conversion of γVL into γVA is detected in serum ex vivo (half-life = 9.8 ± 0.3 min) that is catalyzed by PON1 and PON3 isoforms. Phase II metabolites of γVL are also reacted with PON in serum. Following an intake of flavan-3-ol in healthy males (n = 13), the profile of γVA metabolites detected is consistent with that predicted from the reactivity of γVL metabolites with PON in serum. Furthermore, common PON polymorphisms are evaluated to assess the use of γVL metabolites as biomarkers of flavan-3-ol intake.

CONCLUSION

PONs are involved in flavan-3-ol metabolic pathway in humans. PON polymorphisms have a minor contribution to inter-individual differences in the levels of γVL metabolites, without affecting their use as a nutritional biomarker.

Perspective: Challenges and Future Directions in Clinical Research with Nuts and Berries

Consumption of nuts and berries are considered part of a healthy eating pattern. Nuts and berries contain a complex nutrient profile consisting of essential vitamins and minerals, fiber, polyunsaturated fatty acids, and phenolics in quantities that improve physiological outcomes. The spectrum of health outcomes that may be impacted by the consumptions of nuts and berries includes cardiovascular, gut microbiome, and cognitive, among others. Recently, new insights regarding the bioactive compounds found in both nuts and berries have reinforced their role for use in precision nutrition efforts. However, challenges exist that can affect the generalizability of outcomes from clinical studies, including inconsistency in study designs, homogeneity of test populations, variability in test products and control foods, and assessing realistic portion sizes. Future research centered on precision nutrition and multi-omics technologies will yield new insights. These and other topics such as funding streams and perceived risk-of-bias were explored at an international nutrition conference focused on the role of nuts and berries in clinical nutrition. Successes, challenges, and future directions with these foods are presented here.

Performance of Urinary Phenyl-γ-Valerolactones as Biomarkers of Dietary Flavan-3-ol Exposure

BACKGROUND

Phenyl-γ-valerolactones (PVLs) have been identified as biomarkers of dietary flavan-3-ol exposure, although their utility requires further characterization.

OBJECTIVES

We investigated the performance of a range of PVLs as biomarkers indicative of flavan-3-ol intake.

METHODS

We report the results of 2 companion studies: a 5-way randomized crossover trial (RCT) and an observational cross-sectional study. In the RCT (World Health Organization, Universal Trial Number: U1111-1236-7988), 16 healthy participants consumed flavan-3-ol-rich interventions (of apple, cocoa, black tea, green tea, or water [control]) for 1 d each. First morning void samples and 24-h urine samples were collected with diet standardized throughout. For each participant, 1 intervention period was extended (to 2 d) to monitor PVL kinetics after repeat exposure. In the cross-sectional study, 86 healthy participants collected 24-h urine samples, and concurrent weighed food diaries from which flavan-3-ol consumption was estimated using Phenol-Explorer. A panel of 10 urinary PVLs was quantified using liquid chromatography tandem mass spectrometry.

RESULTS

In both studies, 2 urinary PVLs [5-(3'-hydroxyphenyl)-γ-valerolactone-4'-sulfate and putatively identified 5-(4'-hydroxyphenyl)-γ-valerolactone-3'-glucuronide] were the principal compounds excreted (>75%). In the RCT, the sum of these PVLs was significantly higher than the water (control) after each intervention; individually, there was a shift from sulfation toward glucuronidation as the total excretion of PVLs increased across the different interventions. In the extended RCT intervention period, no accumulation of these PVLs was observed after consecutive days of treatment, and after withdrawal of treatment on the third day, there was a return toward negligible PVL excretion. All results were consistent, whether compounds were measured in 24-h urine or first morning void samples. In the observational study, the sum of the principal PVLs correlated dose dependently (Rs = 0.37; P = 0.0004) with dietary flavan-3-ol intake, with similar associations for each individually.

CONCLUSIONS

Urinary 5-(3'-hydroxyphenyl)-γ-valerolactone-4'-sulfate and putatively identified 5-(4'-hydroxyphenyl)-γ-valerolactone-3'-glucuronide are recommended biomarkers for dietary flavan-3-ol exposure.

Nutrition interventions for adults with dyslipidemia: A Clinical Perspective from the National Lipid Association

Lifestyle habits can have a profound impact on atherosclerotic cardiovascular disease (ASCVD) risk. The National Lipid Association previously published recommendations for lifestyle therapies to manage dyslipidemia. This Clinical Perspective provides an update with a focus on nutrition interventions for the three most common dyslipidemias in adults: 1) low-density lipoprotein cholesterol (LDL-C) elevation; 2) triglyceride (TG) elevation, including severe hypertriglyceridemia with chylomicronemia; and 3) combined dyslipidemia, with elevations in both LDL-C and TG levels. Lowering LDL-C and non-high-density lipoprotein cholesterol are the primary objectives for reducing ASCVD risk. With severe TG elevation (≥500 mg/dL), the primary objective is to prevent pancreatitis and ASCVD risk reduction is secondary. Nutrition interventions that lower LDL-C levels include reducing cholesterol-raising fatty acids and dietary cholesterol, as well as increasing intakes of unsaturated fatty acids, plant proteins, viscous fibers, and reducing adiposity for patients with overweight or obesity. Selected dietary supplements may be employed as dietary adjuncts. Nutrition interventions for all patients with elevated TG levels include restricting intakes of alcohol, added sugars, and refined starches. Additional lifestyle factors that reduce TG levels are participating in daily physical activity and reducing adiposity in patients with overweight or obesity. For patients with severe hypertriglyceridemia, an individualized approach is essential. Nutrition interventions for addressing concurrent elevations in LDL-C and TG include a combination of the strategies described for lowering LDL-C and TG. A multidisciplinary approach is recommended to facilitate success in making and sustaining dietary changes and the assistance of a registered dietitian nutritionist is highly recommended.