Adipose tissue fatty acids as biomarkers of dietary exposure in Danish men and women

Diet, lifestyle and contaminants in three east Greenland Inuit municipalities

Persistent organic pollutants (POP) are environmental contaminants transported over long distances to the Arctic where they biomagnify in marine mammals subsistence hunted by Inuit and may therefore affect human health. Marine mammals in east Greenland are known to have the highest POP concentrations in the circumpolar Arctic area. Due to high intake of marine mammals, east Greenlandic Inuit likewise have the highest POP body burdens across the Arctic. This cross-sectional study aims to investigate the levels of POP and metals in Inuit with a high intake of top predatory species including killer whales and polar bears. Study participants include 37 men and 21 women from Kulusuk, Tasiilaq and Ittoqqortoormiit during year 2013-2015. Lipophilic POP (11 organochlorine-pesticides, 14 polychlorinated-biphenyls (PCB), 10 polybrominated diphenyl ethers), polyunsaturated fatty acids (PFUA) and cotinine were determined in plasma. Fifteen perfluoroalkylated substances (PFAS) were measured in serum and urine and the renal clearance was estimated. Finally the concentration of 10 metals were measured in whole blood. The median age was 38 years, Ittoqqortoormiit Inuit being the oldest. The smoking rate was around 70%, and Kulusuk participants had the lowest PFUA concentrations. Significant municipality differences were observed for lipophilic POP, serum PFAS, mercury, arsenic and selenium with highest concentrations in Ittoqqortoormiit Inuit. Males had higher blood concentrations of PFAS and lead. The estimated PFAS renal clearance and ratio of urine to serum were significantly higher for females, suggesting a sex difference in excretion via the kidney, maybe partly because men had higher serum PFAS concentrations. We observed that Inuit with intake of >200 g polar bear per week had significantly higher levels of PCB, PFAS, arsenic and selenium. In summary, the level of blood POP and heavy metals seems to relate to sex and the frequency intake of meat from marine mammals.

Adipose tissue n-3/n-6 fatty acids ratios versus n-3 fatty acids fractions as predictors of myocardial infarction

BACKGROUND

Tissue levels of n-3 polyunsaturated fatty acids (PUFAs) have been inversely related with risk of myocardial infarction (MI). Whether ratios of n-3 to n-6 PUFAs, reflecting both dietary intake of n-3 PUFAs and competing n-6 PUFAs, are better predictors of future MI than n-3 PUFA fractions is unclear. We aimed at investigating whether such ratios in adipose tissue better predict MI than n-3 PUFA fractions.

METHODS

Subcutaneous adipose tissue biopsies were obtained in a random sample (n=3,500) of the Diet, Cancer and Health cohort (n=57,053). Adipose tissue content of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), alpha-linolenic acid (ALA), arachidonic acid (AA) and linoleic acid (LA) was determined using gas chromatography. Fractions of selected n-3 PUFAs and n-3/n-6 PUFA ratios were correlated to the 15-year occurrence of MI in a case-cohort design.

RESULTS

A total of 2,406 participants experienced an MI during follow-up. Adipose tissue total marine n-3 PUFAs, EPA+DHA, EPA, EPA/AA, DHA/AA and (EPA+DPA+DHA)/AA were all inversely associated with risk of incident MI. Evaluating the predictive power (Harrel's C-index) of the selected metrics, fractions of marine n-3 PUFAs and ratios of EPA/AA, DHA/AA, (EPA+DHA)/AA and (EPA+DPA+DHA)/AA all refined risk prediction over age and sex alone. At multivariable analyses, however, the above ratios were the only metrics providing additional risk prediction. Differences in ratios were related to differences in food intake.

CONCLUSIONS

Both adipose tissue n-3 PUFAs fractions and ratios of n-3 PUFAs/AA were associated with a lower occurrence of MI, but ratios provided superior risk prediction. Dietary strategies affecting n-3/n-6 PUFA ratios should be further investigated for prediction of MI with dietary interventions at the population level and in intervention studies.

Association between Fatty Acid Composition in Hair and Energy Availability during Early Lactation in Simmental and German Holstein Cows

This study examined (1) if fatty acids in bovine hair are influenced by dietary energy levels and (2) if the relationship between energy availability and fatty acids in hair persists across breeds and farms. Sixty-two and 59 Fleckvieh (Simmental), and 55 German Holstein cows from three farms, respectively, were fed two levels of energy concentration of roughage (6.1 and 6.5 MJ net energy for lactation/kg dry matter) and two levels of concentrate supply (150 and 250 g/kg energy-corrected milk). The average body weight was 727 kg (Simmental) and 668 kg (Holstein). The average lactation number was 3.1. Hair samples were taken in lactation weeks 4 and 8. In Simmental cows, a lower energy deficit due to a relatively higher energy intake from high energy concentration of the roughage was associated with higher C18:2n-6 and C18:3n-3 contents in hair at week 8. In cows from all three farms, higher energy intake between lactation weeks 2 and 6 correlated with higher content of C18:2n-6 in hair samples taken in lactation weeks 4 and 8. No correlation was found for C12:0. These results provide the first evidence that increased energy intake increases the contents of C18:2n-6 in hair.

Statement on additional scientific evidence in relation to the essential composition of total diet replacement for weight control

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to revise the Opinion on the essential composition of total diet replacements for weight control (TDRs) regarding the minimum content of linoleic acid (LA) and alpha-linolenic acid (ALA) and the maximum content of magnesium (Mg). Through a comprehensive literature search, human studies were retrieved reporting on LA and ALA concentrations in adipose tissue (AT), on weight loss and gallstone formation following TDR consumption and on diarrhoea after supplemental Mg intake. The distribution of the amount of LA and ALA release from AT during weight loss when consuming TDRs was estimated using statistical simulations. Using the fifth percentile, the coverage of the adequate intake (AI) for both FA was estimated. For the risk of developing diarrhoea when consuming TDRs with an Mg content of 350 mg/day, four cross-over studies using 360-368 mg Mg/day were reviewed. The Panel concludes that (1) there is no need to add LA to TDRs, as the amount released from AT during weight loss when consuming TDRs is sufficient to cover the AI for LA; (2) a minimum of 0.8 g/day ALA is needed in TDRs in order to meet the AI for ALA; (3) the minimum fat content of TDRs of 20 g/day as derived in the Panel's previous opinion is proposed to be maintained until the availability of further evidence, given the considerable uncertainty as to the amount of fat required for reducing the risk of gallstone formation; and (4) the likelihood that Mg-induced diarrhoea occurs at a severity that may be considered of concern for overweight and obese individuals consuming TDRs is low when the total maximum Mg content in TDRs is 350 mg/day.

Time Trend of Persistent Organic Pollutants and Metals in Greenlandic Inuit during 1994-2015

Persistent organic pollutants (POPs), including polychlorinated biphenyls (PCBs), organchlorine pesticides and perfluoroalkylated substances (PFASs) and heavy metals bioaccumulate in the marine food chain in the Arctic regions, and thus, the Greenlandic population has a higher body burden due to relatively high intake of marine mammals. We assessed the temporal trend for POPs, including PCB 153; 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (p,p'-DDE); oxychlordane; six PFASs; mercury; lead and selenium in Inuit from Ilulissat, Nuuk, and across Greenland (including thirteen towns/districts), from 1994 to 2015. Data showed a significant annual decrease of 6.85-8.61% for PCB153, 6.67-8.61% for p,p'-DDE, 6.11-9.52% for oxychlordane, 5.92-6.76% for mercury and 6.48-9.43% for lead in Inuit women from Nuuk, Ilulissat, and across thirteen Greenlandic districts. The blood selenium level of all Greenlandic women increased 1.01% annually, while the trend direction was negative for Nuuk women. A similar pattern was seen for men across Greenland, with a yearly decrease of 11.3% for PCB 153, 8.61% for p,p'-DDE, 15.6% for oxychlordane, 13.1% for mercury and 12.2% for lead. Perfluorooctane sulfonate, perfluorohexane sulfonate and perfluorooctanoic acid significantly decreased 5.82-11.7% annually for both women and men across Greenland. For perfluorononanoic acid, perfluorodecanoic acid and perfluoroundecanoic acid, we observed an increasing trend for women across Greenland. In conclusion, there was a decreasing trend of the regulated POPs and metals but a potential increasing trend of the nonregulated PFASs in the Greenlandic population between 1994 and 2015. The continuing biomonitoring of contaminants of concern is important to protect the Arctic population heath.

Dietary Fat Patterns and Outcomes in Acute Pancreatitis in Spain

Background/Objective: Evidence from basic and clinical studies suggests that unsaturated fatty acids (UFAs) might be relevant mediators of the development of complications in acute pancreatitis (AP). Objective: The aim of this study was to analyze outcomes in patients with AP from regions in Spain with different patterns of dietary fat intake.

Materials and Methods: A retrospective analysis was performed with data from 1,655 patients with AP from a Spanish prospective cohort study and regional nutritional data from a Spanish cross-sectional study. Nutritional data considered in the study concern the total lipid consumption, detailing total saturated fatty acids, UFAs and monounsaturated fatty acids (MUFAs) consumption derived from regional data and not from the patient prospective cohort. Two multivariable analysis models were used: (1) a model with the Charlson comorbidity index, sex, alcoholic etiology, and recurrent AP; (2) a model that included these variables plus obesity.

Results: In multivariable analysis, patients from regions with high UFA intake had a significantly increased frequency of local complications, persistent organ failure (POF), mortality, and moderate-to-severe disease in the model without obesity and a higher frequency of POF in the model with obesity. Patients from regions with high MUFA intake had significantly more local complications and moderate-to-severe disease; this significance remained for moderate-to-severe disease when obesity was added to the model.

Conclusions: Differences in dietary fat patterns could be associated with different outcomes in AP, and dietary fat patterns may be a pre-morbid factor that determines the severity of AP. UFAs, and particulary MUFAs, may influence the pathogenesis of the severity of AP.

Effects of seafood consumption and toenail mercury and selenium levels on cognitive function among American adults: 25 y of follow up

OBJECTIVES

The aim of this study was to examine the longitudinal association between seafood and intake of long-chain ω-3 polyunsaturated fatty acids (LCω-3 PUFA) and cognitive function and to explore the possible effect modifications owing to mercury (Hg) and selenium (Se) levels.

METHODS

Participants (N = 3231) from the CARDIA (Coronary Artery Risk Development in Young Adults) study underwent baseline examination and were reexamined in eight follow-up visits. Diet was assessed at baseline and in exam years 7 and 20. Toenail Hg and Se were measured at exam year 2. Cognitive function was measured at exam year 25 using three tests: Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), and the Stroop test. The general linear regression model was used to examine cumulative average intakes of LCω-3 PUFA and seafood in relation to the cognitive test scores; and to explore the possible effect modifications caused by Hg and Se.

RESULTS

LCω-3 PUFA intake was significantly associated with better performance in the DSST test (quintile 5 versus quintile 1; mean difference = 1.74; 95% confidence interval, 0.19-3.29; Ptrend, 0.048]), but not in the RAVLT and Stroop tests. Similar results were observed for intakes of eicosapentaenoic acid, docosahexaenoic acid, and non-fried seafood. The observed associations were more pronounced in participants with body mass index ≥25 kg/m2, but not significantly modified by toenail Hg or Se.

CONCLUSION

This longitudinal study supported the hypothesis that LCω-3 PUFA or non-fried seafood intake is associated with better cognitive performance in psychomotor speed among US adults, especially those who are overweight or obese.

Comparisons of Estimated Intakes and Plasma Concentrations of Selected Fatty Acids in Pregnancy

The growing interest in potential health effects of long-chain polyunsaturated fatty acids (PUFAs) makes it important to evaluate the method used to assess the fatty acid intake in nutrition research studies. We aimed to validate the questionnaire-based dietary intake of selected PUFAs: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), α-linolenic acid (ALA), linoleic acid (LA), and arachidonic acid (AA) within the Danish National Birth Cohort (DNBC), by comparing 345 women’s reported intake with concentration of plasma biomarkers. The applied questionnaire- and biomarker data reflect dietary intake from around the same time point in mid-pregnancy and relationships were investigated by use of Pearson and Spearman correlation and linear regression statistics. We demonstrated moderate but consistent adjusted correlations between dietary intake estimates and the corresponding plasma biomarker concentrations (differences in plasma concentration per 100 mg/day greater intake of 0.05 (95% CI: 0.02; 0.08)) and 0.05 (95% CI: 0.01; 0.08) percentage of total plasma fatty acids for EPA and DHA, respectively). The associations strengthened when restricting the analyses to women with ALA intake below the median intake. We found a weak correlation between the dietary intake of ALA and its plasma biomarker with a difference in plasma concentration of 0.07 (95% CI: 0.03; 0.10) percent of total plasma fatty acids per 1 g/day greater intake, while the dietary intake of LA and AA did not correlate with their corresponding biomarkers.

Relationship between Plasma Fatty Acid Composition and Diet over Previous Years in the Italian Centers of the European Prospective Investigation into Cancer and Nutrition (EPIC)

Fatty acid levels in plasma phospholipids were related to food intake over the previous year as estimated by semiquantitative food frequency questionnaires compiled by 280 men and 246 women from the EPIC centers of Varese, Turin, Florence and Ragusa (Italy). Fatty acid content was determined by gas chromatography and analyzed in relation to age, sex and center. The most important finding was that plasma monounsaturated fatty acid levels, mainly oleic acid, were associated with olive oil consumption (r = 0.28 men, r = 0.19 women, both P <0.01). To our knowledge, this is the first time that these nonessential plasma fatty acids have been related to their dietary source in a population eating a varied and freely chosen diet. We confirmed that long-chain n-3 fatty acids in plasma phospholipids are associated with fish consumption and that odd chain 15: 0 and 17: 0 fatty acid levels are associated with dairy products and pizza-with-mozzarella consumption. N-6 polyunsaturated fatty acid levels reflected dietary intake of seed oils, mayonnaise and biscuits. Alcohol intake was positively associated with palmitic and palmitoleic acid and negatively associated with linoleic acid. These associations suggest indirect relations between alcohol consumption and other features of diet, and also that ethanol has an effect on fat metabolism. We found numerous indirect relationships (ie, not due to dietary consumption of food sources of the fatty acids) between plasma fatty acids and diet, which we propose as due to the influence of complex life-style factors.

Dietary intake and adipose tissue content of α-linolenic acid and risk of myocardial infarction: a Danish cohort study

BACKGROUND

Intake of the plant-derived ω-3 (n-3) fatty acid α-linolenic acid (ALA, 18:3; n-3) may reduce coronary heart disease (CHD) risk, but the results of previous studies have been inconsistent.

OBJECTIVE

We aimed to investigate the association between dietary intake of ALA, adipose tissue content of ALA, and risk of incident myocardial infarction (MI).

DESIGN

A total of 57,053 participants, aged 50-64 y, were enrolled in the prospective Danish cohort study Diet, Cancer and Health between 1993 and 1997. Dietary intake of ALA was assessed with the use of a validated semiquantitative food-frequency questionnaire in the full cohort, whereas the adipose tissue content of ALA was determined with the use of gas chromatography in all incident MI cases and in a random sex-stratified sample of the total cohort (n = 3500).

RESULTS

During a median of 17 y of follow-up, we identified 2177 male and 912 female cases of MI. After appropriate exclusions, we included 2124 men and 854 women for analyses of dietary intake of ALA, whereas 1994 men and 770 women were included in the analysis of the adipose tissue content of ALA. In multivariate analyses that were conducted with the use of restricted cubic splines and adjusted for established CHD risk factors, weak positive associations in men and weak U-shaped associations in women were shown between both dietary intake and the adipose tissue content of ALA and risk of MI, but these associations were not statistically significant. Additional adjustments for dietary factors did not influence the observed associations numerically.

CONCLUSION

This study suggests that ALA has no appreciable association with risk of incident MI in either men or women.

Biomarkers of Dietary Intake Are Correlated with Corresponding Measures from Repeated Dietary Recalls and Food-Frequency Questionnaires in the Adventist Health Study-2

BACKGROUND

Accurate assessment of diet in study populations is still a challenge. Some statistical strategies that use biomarkers of dietary intake attempt to compensate for the biasing effects of reporting errors.

OBJECTIVE

The objective was to correlate biomarkers of dietary intake with 2 direct measures of dietary intake.

METHODS

Subjects provided repeated 24-h dietary recalls and 2 food-frequency questionnaires (FFQs) separated by ∼3 y. Correlations between biomarkers and reported dietary intakes as measured by the recalls and FFQs were de-attenuated for within-person variability. The Adventist Health Study-2 (AHS-2) has a large database of biomarkers of dietary intake (blood, urine, adipose tissue) from a calibration study (909 analytic subjects) representing the cohort. Participants were black and non-black Adventists in the United States and Canada.

RESULTS

Dietary items with higher-valued de-attenuated correlations (≥0.50) between biomarkers and recalls included some fatty acids (FAs), the non-fish meats, fruit (non-black subjects), some carotenoids, vitamin B-12 (non-black subjects), and vitamin E. Moderately valued correlations (0.30-0.49) were found for very long chain ω-3 (n-3) FAs, some carotenoids, folate, isoflavones, cruciferous vegetables, fruit (black subjects), and calcium. The highest correlation values in non-black and black subjects were 0.69 (urinary 1-methyl-histidine and meat consumption) and 0.72 (adipose and dietary 18:2 ω-6), respectively. Correlations comparing biomarkers with recalls were generally similar for black and non-black subjects, but correlations between biomarkers and the FFQ were slightly lower than corresponding recall correlations. Correlations between biomarkers and a single FFQ estimate (the usual cohort situation) were generally much lower.

CONCLUSIONS

Many biomarkers that have relatively high-valued correlations with dietary intake were identified and were usually of similar value in black and non-black subjects. These may be used to correct effects of dietary measurement errors in the AHS-2 cohort, and in some cases they also provide evidence supporting the validity of the dietary data.

Food intake and serum persistent organic pollutants in the Greenlandic pregnant women: The ACCEPT sub-study

The Greenlandic Inuit have high blood concentrations of environmental persistent organic pollutants (POPs). High POP concentrations have been associated with age, smoking and consumption of marine mammals. Studies have indicated that exposure to POPs during pregnancy may adversely affect fetal and child development. To assess geographical differences in diet, lifestyle and environmental contaminant exposure among pregnant women in Greenland, blood samples and questionnaire data were collected from 207 pregnant women in five Greenlandic regions (North, Disco Bay, West, South and East). Blood samples were analyzed for 11 organochlorine pesticides (OCPs), 14 polychlorinated biphenyls (PCBs), 5 polybrominated diphenyl ethers (PBDEs), 15 perfluoroalkylated substances (PFASs) and 63 metals. A trend of higher intake of marine mammals in the East and North regions was reflected by a higher n-3/n-6 fatty acid ratio. Participants in the East region tended also to have higher intake of terrestrial species. A significant higher seabird intake was seen for pregnant women in the West region. Significant regional differences were found for blood concentrations of PCBs, OCPs, PFASs and mercury, with higher levels in the North and East regions. PFASs were significantly associated with PCBs and OCPs in most of the regions. In the North region, PFASs were associated with both selenium and mercury. No significant regional difference was observed for PBDEs. The regional differences of blood levels of POPs and mercury were related to differences in intake of the traditional food. Compared to earlier reports, decreased levels of legacy POPs, Hg and Pb and perfluorooctane sulfonate and perfluorooctanoic acid were observed, but the levels of PFAS congeners perfluorohexane sulfonate and perfluorononanoic acid were sustained. The detection of POPs and heavy metals in maternal blood indicates fetal exposure to these compounds possibly influencing fetal development.

Cross-sectional relationships between dietary fat intake and serum cholesterol fatty acids in a Swedish cohort of 60-year-old men and women

BACKGROUND

The present study aimed to describe the relationship between self-reported dietary intake and serum cholesterol fatty acids (FAs) in a Swedish population of 60-year-old men and women.

METHODS

Cross-sectional data collected in 1997-1998 from 4232 individuals residing in Stockholm County were used. Five diet scores were created to reflect the intake of saturated fats in general, as well as fats from dairy, fish, processed meat and vegetable oils and margarines. Gas chromatography was used to assess 13 FAs in serum cholesterol esters. The association between each diet score and specific FAs was assessed by percentile differences (PD) with 95% confidence intervals (CI) at the 10th, 25th, 50th, 75th and 90th percentile of each FA across levels of diet scores using quantile regression.

RESULTS

Fish intake was associated with high proportions of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). For each point increase in fish score, the 50th PD in EPA and DHA was 32.78% (95% CI = 29.22% to 36.35%) and 10.63% (95% CI = 9.52% to 11.74%), respectively. Vegetable fat intake was associated with a high proportion of linoleic acid and total polyunsaturated fatty acids (PUFA) and a low proportion of total saturated fatty acids (SFA). The intake of saturated fats in general and dairy fat was slightly associated with specific SFA, although the intake of fat from meat was not.

CONCLUSIONS

In the present study population, using a rather simple dietary assessment method, the intake of fish and vegetable fats was clearly associated with serum PUFA, whereas foods rich in saturated fats in general showed a weak relationship with serum SFA. Our results may contribute to increased knowledge about underlying biology in diet-cardiovascular disease associations.

Plasma Fatty Acids in Zambian Adults with HIV/AIDS: Relation to Dietary Intake and Cardiovascular Risk Factors

Objective. To determine whether 24 hr dietary recalls (DR) are a good measure of polyunsaturated fatty acid (PUFA) intake when compared to plasma levels, and whether plasma PUFA is associated with markers of HIV/AIDS progression and cardiovascular disease (CVD) risk. Methods. In a cross-sectional study among 210 antiretroviral therapy-naïve HIV-infected adults from Lusaka, Zambia, we collected data on medical history and dietary intake using 24 hr DR. We measured fatty acids and markers of AIDS progression and CVD risk in fasting plasma collected at baseline. Results. PUFA intakes showed modest correlations with corresponding plasma levels; Spearman correlations were 0.36 (p < 0.01) for eicosapentaenoic acid and 0.21 (p = 0.005) for docosahexaenoic acid. While there were no significant associations (p > 0.05) between total plasma PUFA and C-reactive protein (CRP) or lipid levels, plasma arachidonic acid was inversely associated with CRP and triglycerides and positively associated with HDL-C, CD4+ T-cell count, and plasma albumin (p < 0.05). Plasma saturated fatty acids (SFA) were positively associated with CRP (β = 0.24; 95% CI: 0.08 to 0.40, p = 0.003) and triglycerides (β = 0.08; 95% CI: 0.03 to 0.12, p < 0.01). Conclusions. Our data suggest that a single DR is inadequate for assessing PUFA intake and that plasma arachidonic acid levels may modulate HIV/AIDS progression and CVD risk.

Baseline patterns of adipose tissue fatty acids and long-term risk of breast cancer: a case-cohort study in the Danish cohort Diet, Cancer and Health

BACKGROUND/OBJECTIVES

The evidence regarding fatty acids and breast cancer risk is inconclusive. Adipose tissue fatty acids can be used as biomarkers of fatty acid intake and of endogenous fatty acid exposure. Fatty acids in adipose tissue are correlated owing to common dietary sources and shared metabolic pathways, which group fatty acids into naturally occurring patterns. We aimed to prospectively investigate associations between adipose tissue fatty acid patterns and long-term risk of total breast cancer and breast cancer subtypes characterised by oestrogen and progesterone receptor status (ER and PR).

SUBJECTS/METHODS

This case-cohort study was based on data from the Danish cohort Diet, Cancer and Health. At baseline, a fat biopsy and information on lifestyle and reproductive factors were collected. From the 31 original fatty acids measured, patterns of fatty acids were identified using the treelet transform. During a median follow-up of 5.3 years, 474 breast cancer cases were identified. Hazard ratios and 95% confidence intervals of risk of total breast cancer and of subtypes according to quintiles of factor score were determined by weighted Cox proportional hazards regression.

RESULTS

After adjustment for potential confounders, factor scores for the seven patterns identified by the treelet transform were not associated with risk of total breast cancer, nor with risk of ER+, ER-, PR+ or PR- tumours.

CONCLUSIONS

No clear associations between the patterns of fatty acids at baseline and long-term risk of total breast cancer or ER+, ER-, PR+ or PR- tumours were observed.

Adipose tissue trans-fatty acids and changes in body weight and waist circumference

Previous studies have suggested that the intake of trans-fatty acids (TFA) plays a role in the development of obesity. The proportions of adipose tissue fatty acids not synthesised endogenously in humans, such as TFA, usually correlate well with the dietary intake. Hence, the use of these biomarkers may provide a more accurate measure of habitual TFA intake than that obtained with dietary questionnaires. The objective of the present study was to investigate the associations between the proportions of specific TFA in adipose tissue and subsequent changes in weight and waist circumference (WC). The relative content of fatty acids in adipose tissue biopsies from a random sample of 996 men and women aged 50-64 years drawn from a Danish cohort study was determined by GC. Baseline data on weight, WC and potential confounders were available together with information on weight and WC 5 years after enrolment. The exposure measures were total trans-octadecenoic acids (18:1t), 18:1 Δ6-10t, vaccenic acid (18:1 Δ11t) and rumenic acid (18:2 Δ9c, 11t). Data were analysed using multiple regression with cubic spline modelling. The median proportion of total adipose tissue 18:1t was 1.52% (90% central range 0.98, 2.19) in men and 1.47% (1.01, 2.19) in women. No significant associations were observed between the proportions of total 18:1t, 18:1 Δ6-10t, vaccenic acid or rumenic acid and changes in weight or WC. The present study suggests that the proportions of specific TFA in adipose tissue are not associated with subsequent changes in weight or WC within the exposure range observed in this population.

Measures taken to restore the Danish Diet, Cancer and Health Biobank after flooding: a framework for future biobank restorations

We here describe the July 2011 flooding of the Danish Diet, Cancer and Health biobank, which contained blood and urine samples and fat tissue biopsies from 57,053 Danes. We use this as a starting point to detail empirically derived knowledge on how to best restore and secure a biobank and test the quality of flooded samples; a process which has taken place over the subsequent 2-year period. The aim is to generate a framework for such a restoration process, which may be useful in relation to future biobank floods. The framework includes four steps: 1) freeze-drying of the samples, 2) cleaning and reorganization of the samples, 3) quality testing of the samples, and 4) documentation and communication. Furthermore, we present general experiences derived with regard to planning, financing, and stakeholder contact in such a restoration process.

Gender differences in the long-chain polyunsaturated fatty acid status: systematic review of 51 publications

BACKGROUND/AIMS

Sex hormones may influence the activity of enzymes which are involved in the synthesis of long-chain polyunsaturated fatty acids. The objective of this review was to assess the role of gender in determining the fatty acid composition of human samples, like plasma and erythrocyte membrane lipids, and adipose tissue.

METHODS

The method included a structured search strategy on MEDLINE, Scopus and the Cochrane databases, with formal inclusion/exclusion criteria, data extraction procedure and meta-analysis.

RESULTS

We evaluated 51 publications, dated from 1975 to 2011. Meta-analysis showed significantly lower values of both arachidonic acid (AA) and docosahexaenoic acid (DHA) in total plasma lipids (32 and 33 studies) and in plasma phospholipids (PL; 21 and 23 studies) in men than in women. Primary analysis of the phospholipid fraction showed the mean difference in AA to be 0.42% weight/weight (95% CI: 0.18-0.65, n = 7,769) and in DHA 0.37% weight/weight (95% CI: 0.24-0.51, n = 8,541), while there was no gender difference in the values of linoleic acid and α-linolenic acid.

CONCLUSIONS

This systematic review based on 51 publications showed significantly lower contribution of AA and DHA to plasma total lipids and plasma PL in men than in women. Gender distribution should be regarded as a significant potential confounding factor in every study assessing data on fatty acid composition.

Assessing dietary intake: Who, what and why of under-reporting

Under-reporting of food intake is one of the fundamental obstacles preventing the collection of accurate habitual dietary intake data. The prevalence of under-reporting in large nutritional surveys ranges from 18 to 54% of the whole sample, but can be as high as 70% in particular subgroups. This wide variation between studies is partly due to different criteria used to identify under-reporters and also to non-uniformity of under-reporting across populations. The most consistent differences found are between men and women and between groups differing in body mass index. Women are more likely to under-report than men, and under-reporting is more common among overweight and obese individuals. Other associated characteristics, for which there is less consistent evidence, include age, smoking habits, level of education, social class, physical activity and dietary restraint. Determining whether under-reporting is specific to macronutrients or food is problematic, as most methods identify only low energy intakes. Studies that have attempted to measure under-reporting specific to macronutrients express nutrients as percentage of energy and have tended to find carbohydrate under-reported and protein over-reported. However, care must be taken when interpreting these results, especially when data are expressed as percentages. A logical conclusion is that food items with a negative health image (e.g. cakes, sweets, confectionery) are more likely to be under-reported, whereas those with a positive health image are more likely to be over-reported (e.g. fruits and vegetables). This also suggests that dietary fat is likely to be under-reported. However, it is necessary to distinguish between under-reporting and genuine under-eating for the duration of data collection. The key to understanding this problem, but one that has been widely neglected, concerns the processes that cause people to under-report their food intakes. The little work that has been done has simply confirmed the complexity of this issue. The importance of obtaining accurate estimates of habitual dietary intakes so as to assess health correlates of food consumption can be contrasted with the poor quality of data collected. This phenomenon should be considered a priority research area. Moreover, misreporting is not simply a nutritionist's problem, but requires a multidisciplinary approach (including psychology, sociology and physiology) to advance the understanding of under-reporting in dietary intake studies.

Intake of ruminant trans fatty acids and changes in body weight and waist circumference

BACKGROUND/OBJECTIVES

Follow-up studies have suggested that total intake of trans fatty acids (TFA) is a risk factor for gain in body weight and waist circumference (WC). However, in a cross-sectional study individual TFA isomers in adipose tissue had divergent associations with anthropometry. Our objective was to investigate the association between intake of TFA from ruminant dairy and meat products and subsequent changes in weight and WC. Furthermore, potential effect modification by sex, age, body mass index and WC at baseline was investigated.

SUBJECTS/METHODS

Data on weight, WC, habitual diet and lifestyle were collected at baseline in a Danish cohort of 30,851 men and women aged 50-64 years. Follow-up information on weight and WC was collected 5 years after enrolment. The associations between intake of ruminant TFA (R-TFA) and changes in weight and WC were analysed using multiple linear regression with cubic spline modelling.

RESULTS

Intake of R-TFA, both absolute and energy-adjusted intake, was significantly associated with weight change. Inverse associations were observed at lower intakes with a levelling-off at intakes >1.2 g/day and 0.4 energy percentage (E %). Absolute, but not energy-adjusted, intake of R-TFA was significantly associated with WC change. An inverse association was observed at lower intakes with a plateau above an intake of 1.2 g/day.

CONCLUSIONS

The present study suggests that intake of R-TFA is weakly inversely associated with changes in weight, whereas no substantial association with changes in WC was found.

Three-way assessment of long-chain n-3 PUFA nutrition: by questionnaire and matched blood and skin samples

The long-chain n-3 PUFA, EPA, is believed to be important for skin health, including roles in the modulation of inflammation and protection from photodamage. FFQ and blood levels are used as non-invasive proxies for assessing skin PUFA levels, but studies examining how well these proxies reflect target organ content are lacking. In seventy-eight healthy women (mean age 42·8, range 21-60 years) residing in Greater Manchester, we performed a quantitative analysis of long-chain n-3 PUFA nutrition estimated from a self-reported FFQ (n 75) and correlated this with n-3 PUFA concentrations in erythrocytes (n 72) and dermis (n 39). Linear associations between the three n-3 PUFA measurements were assessed by Spearman correlation coefficients and agreement between these measurements was estimated. Average total dietary content of the principal long-chain n-3 PUFA EPA and DHA was 171 (SD 168) and 236 (SD 248) mg/d, respectively. EPA showed significant correlations between FFQ assessments and both erythrocyte (r 0·57, P< 0·0001) and dermal (r 0·33, P= 0·05) levels, as well as between erythrocytes and dermis (r 0·45, P= 0·008). FFQ intake of DHA and the sum of n-3 PUFA also correlated well with erythrocyte concentrations (r 0·50, P< 0·0001; r 0·27, P= 0·03). Agreement between ranked thirds of dietary intake, blood and dermis approached 50% for EPA and DHA, though gross misclassification was lower for EPA. Thus, FFQ estimates and circulating levels of the dietary long-chain n-3 PUFA, EPA, may be utilised as well-correlated measures of its dermal bioavailability.

Perfluorinated compounds are related to breast cancer risk in Greenlandic Inuit: a case control study

BACKGROUND

Breast cancer (BC) is the most common cancer for women in the western world. From very few cases an extraordinary increase in BC was observed in the Inuit population of Greenland and Canada although still lower than in western populations. Previous data suggest that exposure to persistent organic pollutants (POPs) might contribute to the risk of BC. Rat studies showed that perfluorinated compounds (PFCs) cause significantly increase in mammary fibroadenomas. This study aimed at evaluating the association between serum levels of POPs/PFCs in Greenlandic Inuit BC cases and their controls, and whether the combined POP related effect on nuclear hormone receptors affect BC risk.

METHODS

Thirty-one BC cases and 115 controls were sampled during 2000-2003 from various Greenlandic districts. The serum levels of POPs, PFCs, some metals and the combined serum POP related effect on estrogen- (ER), androgen- (AR) and Ah-receptor (AhR) transactivity were determined. Independent student t-test was used to compare the differences and the odds ratios were estimated by unconditional logistic regression models.

RESULTS

We observed for the very first time a significant association between serum PFC levels and the risk of BC. The BC cases also showed a significantly higher concentration of polychlorinated biphenyls at the highest quartile. Also for the combined serum POP induced agonistic AR transactivity significant association to BC risk was found, and cases elicited a higher frequency of samples with significant POP related hormone-like agonistic ER transactivity. The AhR toxic equivalent was lowest in cases.

CONCLUSIONS

The level of serum POPs, particularly PFCs, might be risk factors in the development of BC in Inuit. Hormone disruption by the combined serum POP related xenoestrogenic and xenoandrogenic activities may contribute to the risk of developing breast cancer in Inuit. Further investigations are needed to document these study conclusions.

Marine n-3 Polyunsaturated Fatty Acids in Adipose Tissue and the Risk of Acute Coronary Syndrome

Background—

Marine n-3 polyunsaturated fatty acids may reduce coronary mortality. Previous data in relation to nonfatal coronary disease, however, have been inconsistent, which may be explained by the use of heterogeneous methods to assess the intake of marine n-3 polyunsaturated fatty acids. We investigated the hypothesis that the content of total and individual marine n-3 polyunsaturated fatty acids in adipose tissue is negatively associated with the incidence of acute coronary syndrome (ACS), including both fatal and nonfatal coronary disease.

Methods and Results—

In the Diet, Cancer and Health, a Danish cohort study, 57 053 subjects were enrolled and had an adipose tissue biopsy taken at inclusion. During a mean follow-up period of 7.6 years, we identified and verified all cases (n=1012) with an incident acute coronary syndrome diagnosis, and a random sample of the cohort (n=1630) had their fatty acid composition in adipose tissue determined by gas chromatography. We found negative dose-response associations between the content of total marine n-3 polyunsaturated fatty acids and individual n-3 polyunsaturated fatty acids in adipose tissue and the risk of acute coronary syndrome. Comparing men in the highest and lowest quintiles gave a hazard ratio of 0.65 (95% confidence interval, 0.45 to 0.95) for total n-3 polyunsaturated fatty acids and 0.51 (95% confidence interval, 0.36 to 0.73) for docosahexaenoic acid. Nonfatal cases constituted >86% of cases, and the association was driven primarily by a reduction in the risk of nonfatal acute coronary syndrome. No consistent associations were found among women.

Conclusion—

Intake of marine n-3 polyunsaturated fatty acids may protect against acute coronary syndrome in men.

Fish oil, selenium and mercury in relation to incidence of hypertension: a 20-year follow-up study

OBJECTIVES

Long-chain omega-3 polyunsaturated fatty acids (LCω3PUFAs), selenium (Se) and mercury (Hg) are three important components in fish. The cardioprotective effect of LCω3PUFA intake has been recognized; however, the hypothesis that this benefit may be greatest with high Se and low Hg levels has not been investigated.

DESIGN

A cohort of 4508 American adults aged 18-30, without hypertension at baseline in 1985, were enrolled. Six follow-ups were conducted at examinations in 1987, 1990, 1992, 1995, 2000 and 2005. Diet was assessed by a validated interviewer-administered quantitative food frequency questionnaire at exams in 1985, 1992 and 2005. Incident hypertension was defined as first occurrence at any follow-up examination of systolic blood pressure (BP) ≥ 140 mmHg, diastolic BP ≥ 90 mmHg or taking antihypertensive medication. Toenail clippings were collected in 1987, and Se and Hg levels were quantified by instrumental neutron-activation analysis.

RESULT

Participants in the highest LCω3PUFA intake quartile had a significantly lower incidence of hypertension (hazard ratio: 0.65; 95% CI: 0.53-0.79; P(trend) < 0.01) compared to those in the lowest quartile after adjustment for potential confounders. Docosahexaenoic acid showed a greater inverse association than eicosapentaenoic acid. The inverse association of LCω3PUFA intake with hypertension appeared more pronounced at higher Se and lower Hg levels, although interaction tests were statistically nonsignificant.

CONCLUSIONS

Our findings indicated that LCω3PUFA intake was inversely associated with incidence of hypertension. The prior hypothesis that the potential antihypertensive effect of LCω3PUFA intake varies depending on joint levels of Se and Hg received modest support and cannot be ruled out.

The role of adipose tissue in mediating the beneficial effects of dietary fish oil

Fish oil improves several features of metabolic syndrome (MetS), such as dyslipidemia, insulin resistance and hepatic steatosis. Fish oil may mediate some of its beneficial effects by modulating the storage and/or secretory functions of adipose tissue (AT). The storage of triglycerides in AT is regulated by the availability of free fatty acids and the degree of lipolysis in AT. Fish oil has been shown to reduce lipolysis in several studies, indicating improved triglyceride storage. Importantly, AT secretes a variety of adipokines and fish oil feeding is associated with remarkable changes in the plasma levels of two key adipokines, adiponectin and leptin. Much attention has been focused on the contribution of adiponectin in fish oil-mediated improvements in MetS. However, emerging evidence also indicates a role of leptin in modulating the components of the MetS upon fish oil feeding. In addition to improving the storage and secretory functions of AT, fish oil, and the n-3 fatty acids found in fish oil, has been shown to reduce inflammation in AT. These effects may be in part a result of activation of peroxisome proliferator-activated receptor γ or inhibition of Toll-like receptor 4. Thus, there is compelling evidence that fish oil mediates its beneficial effects on MetS by improving AT storage and secretory functions and by reducing inflammation.

An association between dietary arachidonic acid, measured in adipose tissue, and ulcerative colitis

BACKGROUND & AIMS

Dietary arachidonic acid, an n-6 polyunsaturated fatty acid (n-6 PUFA), might be involved in the etiology of ulcerative colitis (UC). We performed a prospective cohort study to determine whether high levels of arachidonic acid in adipose tissue samples (which reflects dietary intake) are associated with UC.

METHODS

We analyzed data collected from 57,053 men and women in the EPIC-Denmark Prospective Cohort Study from 1993 to 1997. Adipose tissue biopsy samples were collected from gluteal regions at the beginning of the study, the cohort was monitored over subsequent years, and participants who developed UC were identified. A subcohort of 2510 randomly selected participants were used as controls. Concentrations of arachidonic acid were measured in adipose tissue samples. In the analysis, arachidonic acid levels were divided into quartiles; relative risks (RR) were calculated and adjusted for smoking, use of aspirin and nonsteroidal anti-inflammatory drugs, and levels of n-3 PUFAs.

RESULTS

A total of 34 subjects (56% men) developed incident UC at a median age of 58.8 years (range, 50.0-69.0 years). Those in the highest quartile for arachidonic acid concentrations in adipose tissue had an RR for UC of 4.16 (95% confidence interval [CI]: 1.56-11.04); a trend per 0.1% increase in arachidonic acid of 1.77 in RR was observed (95% CI: 1.38-2.27). The fraction attributed the highest levels of arachidonic acid was 40.3%.

CONCLUSIONS

Individuals with the highest relative concentrations of arachidonic acid in adipose tissue have a significantly greater risk of developing UC. Dietary modifications might therefore prevent UC or reduce disease symptoms.

Characterizing human adipose tissue lipids by long echo time 1H-MRS in vivo at 1.5 Tesla: validation by gas chromatography

The aim of this study was to investigate the use of (1)H-MRS with various echo times to characterize subcutaneous human adipose tissue (SAT) triglyceride composition and to validate the findings with fatty acid (FA) analysis of SAT biopsies by gas chromatography (GC). (1)H-MRS spectra were acquired with a 1.5 Tesla clinical imager from the SAT of 17 healthy volunteers, with 10 undergoing SAT biopsy. Spectra were localized with PRESS and a series of echo times; 30, 50, 80, 135, 200, 300 and 540 ms were acquired with TR = 3000 ms. Prior knowledge from phantom measurements was used to construct AMARES fitting models for the lipid spectra. SAT FA composition were compared with serum lipid levels and subject characteristics in 17 subjects.Long TE (135, 200 ms) spectra corresponded better with the GC data than short TE (30, 50 ms) spectra. TE = 135 ms was found optimal for determining diallylic content (R = 0.952, p < 0.001) and TE = 200 ms was optimal for determining olefinic content (R = 0.800, p < 0.01). The improved performance of long TE spectra is a result of an improved baseline and better peak separation, due to J-modulation and suppression of water. The peak position of the diallylic resonance correlated with the average double bond content of polyunsatured fatty acids with R = 0.899 (p < 0.005). The apparent T(2) of the methylene resonance displayed relatively small inter-individual variation, 88.1 +/- 1.1 ms (mean +/- SD). The outer methyl triplet line of omega-3 PUFA at 1.08 ppm could be readily detected and quantitated from spectra obtained at TE = 540. The omega-3 resonance correlated with the omega-3 content determined by GC with R = 0.737 (p < 0.05, n = 8). Age correlated significantly with SAT diallylic content (R = 0.569, p = 0.017, n = 17), but serum lipid levels showed no apparent relation to SAT FA composition. We conclude that long TE (1)H-MRS provides a robust non-invasive method for characterizing adipose tissue triglycerides in vivo.

Food-frequency questionnaires: a review of their design, validation and utilisation

A review of the literature concerning the design, utilisation and validation of food-frequency questionnaires (FFQ) has been carried out using a semi-systematic approach to obtaining, reviewing and extracting data from articles. Databases were searched from 1980 to 1999. The present review identified 227 validation (from 1980 to September 1999) and 164 utilisation (for 1998 only) studies. A number of design issues have been evaluated through the present review. These include: the need to consider how portion sizes have been described, self-defined giving higher mean correlations; how an FFQ was administered, interviewer-administered giving higher mean correlations for some nutrients; how many items to include on an FFQ, those with the largest number of items having higher correlations. Validation techniques were described. Most validation studies involved comparing an FFQ against another dietary assessment method; only 19 % compared an FFQ to a biomarker. Measurement differences were most commonly assessed by correlation coefficients as opposed to other more appropriate methods. Mean correlation coefficients were highest for Ca and fat, and lowest for vitamin A and vegetables. The utilisation studies showed that FFQ were most commonly used in cross-sectional surveys, with ninety-three of the FFQ being designed to be disease-specific. The present review results were presented to a group of experts and a consensus arrived at concerning the development, validation and use of FFQ. Recommendations derived from the consensus arising from the literature review are presented as an appendix to the present paper.

Correlation between serum phospholipid fatty acids and dietary intakes assessed a few years earlier

The fatty acid composition of serum phospholipids has been shown to reflect dietary intakes in the previous weeks or months. However, how serum phospholipids relate to fatty acid intakes over a few years has hardly been examined. We designed a cross-sectional study within the E3N cohort, the French component of the European Prospective Investigation into Cancer and Nutrition in which female participants completed a 208-item diet history questionnaire in 1993-1995 and provided blood samples in 1995-1998. The study included 1,114 women who were free of cancer at the time of blood collection. Serum phospholipid fatty acid composition was assessed by capillary gas chromatography. Partial Spearman correlations adjusted for age and body mass index showed weak to moderate, although statistically significant, positive associations between dietary and serum oleic, linoleic, arachidonic, eicosapentaenoic, and docosahexaenoic acids. Moreover, serum oleic acid was directly associated with olive oil, linoleic acid with sunflower oil, pentadecanoic acid with dairy products, long-chain n-3 fatty acids with fatty fish, and trans-monounsaturated fatty acids with manufactured foods. In conclusion, serum phospholipid pentadecanoic acid, oleic, trans-monounsaturated, and polyunsaturated fatty acids are suitable biomarkers for usual dietary intakes, although the association may weaken as the time lag between dietary assessment and blood collection increases.

Dietary intake of total marine n-3 polyunsaturated fatty acids, eicosapentaenoic acid, docosahexaenoic acid and docosapentaenoic acid and the risk of acute coronary syndrome – a cohort study

Dietary intake of marine n-3 PUFA has been negatively associated with the risk of CHD among subjects with known CHD, whereas an effect in healthy subjects is less documented. We assessed the hypothesis that dietary intake of marine n-3 PUFA is negatively associated with the risk of acute coronary syndrome (ACS) in healthy subjects. In the Danish Diet, Cancer and Health cohort study, 57 053 participants were enrolled. Dietary intake of total n-3 PUFA, including EPA, docosapentaenoic acid (DPA) and DHA, was assessed. During a mean follow-up period of 7·6 years, we identified all cases (n 1150) from this cohort with an incident ACS diagnosis in the Danish National Patient Registry or the Cause of Death Registry. Diagnoses were verified through medical record review. In Cox proportional hazard models, we adjusted for established risk factors for CHD. Men in the four highest quintiles of n-3 PUFA intake (>0·39 g n-3 PUFA per d) had a lower incidence of ACS compared with men in the lowest quintile. The hazard ratio was 0·83 (95 % CI 0·67, 1·03) when we compared men in the second lowest and lowest quintile of n-3 PUFA intake. Higher intake of n-3 PUFA did not strengthen this association. Associations for EPA, DPA and DHA were all negative, but less consistent. No convincing associations were found among women. In conclusion, we found borderline significant negative associations between the intake of marine n-3 PUFA and ACS among healthy men.

Marine n-3 polyunsaturated fatty acids in adipose tissue and breast cancer risk: a case-cohort study from Denmark

OBJECTIVE

The aim of this study was to investigate the association between the content of marine n-3 polyunsaturated fatty acids (PUFA) in adipose tissue, a biomarker for the long-term intake of seafood, and the subsequent development of breast cancer (BC).

DESIGN

We designed a case-cohort study based on a cohort of healthy Danish women, who in the 1990 s donated adipose tissue biopsies to a biobank in order to investigate the role of diet for the development of cancer and chronic disease. During follow-up, incident cases of BC were identified through national registries, and the content of n-3 PUFA in adipose tissue was compared between cases and the cohort sample.

RESULTS

During follow-up, 463 new cases of BC were identified. After adjusting for potential confounders, no significant association between the content of marine n-3 PUFA and BC was found. When comparing the highest with the lowest quintile, the hazard ratio (HR) was 0.96 (95% CI 0.64-1.43) for total marine n-3 PUFA, 0.84 (95% CI 0.58-1.23) for eicosapentaenoic acid (EPA), and 1.08 (95% CI 0.73-1.58) for docosahexaenoic acid (DHA).

CONCLUSION

This study does not indicate any association between the content of total or individual marine n-3 PUFA in adipose tissue and development of BC.

Rheumatoid cachexia is associated with dyslipidemia and low levels of atheroprotective natural antibodies against phosphorylcholine but not with dietary fat in patients with rheumatoid arthritis: a cross-sectional study

INTRODUCTION

Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) independent of traditional risk factors. The aim of this study was to analyze the associations between diet, body composition, lipids and atheroprotective natural antibodies against phosphorylcholine (anti-PC) in patients with RA.

METHODS

A total of 80 RA patients (76% women), mean age (standard deviation (SD)) 61.4 (12) years and median disease duration of 6 years, were assessed by food frequency questionnaire (FFQ), fatty acid profile in adipose tissue and whole-body dual energy x ray absorptiometry (DXA). Rheumatoid cachexia was defined as fat free mass index below the 25th percentile and fat mass index above the 50th percentile of a reference population. Blood lipids, oxidized low-density lipoprotein (oxLDL) and anti-PC levels were determined.

RESULTS

The mean body mass index for the women and men was 25.0 and 27.0, respectively. Central obesity was found in 57% of the women (waist circumference >80 cm) and in 89% of the men (waist circumference >94 cm). In all, 18% of the women and 26% of the men had rheumatoid cachexia. These patients had significantly higher total cholesterol (P < 0.033), LDL (P < 0.029), and trendwise oxLDL (P = 0.056) as well as lower anti-PC IgM (P = 0.040), higher frequency of hypertension (69%) and metabolic syndrome (25%) than those without. The patients reported a high dietary intake of saturated fat, which partly correlated with fatty acid composition in adipose tissue and significantly with disease activity. However, patients with or without cachexia did not differ with respect to dietary fat intake or intake of Mediterranean-like diet. Additionally, patients on a Mediterranean-like diet had high levels of anti-PC (P < 0.001).

CONCLUSIONS

About one in five patients with low-active RA displayed rheumatoid cachexia. This condition was associated with high levels of LDL cholesterol, low levels of atheroprotective anti-PC and high frequency of hypertension, which is of interest in the context of CVD in RA. The cachexia could not be related to diet fat intake. However, patients on a Mediterranean-like diet had high anti-PC levels in spite of similar frequency of cachexia. High anti-PC levels may provide some protection against CVD.

Comparison of 3 ad libitum diets for weight-loss maintenance, risk of cardiovascular disease, and diabetes: a 6-mo randomized, controlled trial

BACKGROUND

The optimal dietary content and type of fat and carbohydrate for weight management has been debated for decades.

OBJECTIVE

The objective was to compare the effects of 3 ad libitum diets on the maintenance of an initial weight loss of >or=8% and risk factors for CVD and diabetes during a 6-mo controlled dietary intervention.

DESIGN

Nondiabetic overweight or obese [mean +/- SD body mass index (in kg/m(2)): 31.5 +/- 2.6] men (n = 55) and women (n = 76) aged 28.2 +/- 4.8 y were randomly assigned to a diet providing a moderate amount of fat (35-45% of energy) and >20% of fat as monounsaturated fatty acids (MUFA diet; n = 54), to a low-fat (20-30% of energy) diet (LF diet; n = 51), or to a control diet (35% of energy as fat; n = 26). Protein constituted 10-20% of energy in all 3 diets. All foods were provided free of charge from a purpose-built supermarket.

RESULTS

More subjects dropped out of the MUFA (28%) group than out of the LF group (16%) and control group (8%) (MUFA compared with control: P < 0.05). All groups regained weight (MUFA: 2.5 +/- 0.7 kg; LF: 2.2 +/- 0.7 kg; and control: 3.8 +/- 0.8 kg; NS). Body fat regain was lower in the LF (0.6 +/- 0.6%) and MUFA (1.6 +/- 0.6%) groups than in the control group (2.6 +/- 0.5%) (P < 0.05). In the MUFA group, fasting insulin decreased by 2.6 +/- 3.5 pmol/L, the homeostasis model assessment of insulin resistance by 0.17 +/- 0.13, and the ratio of LDL to HDL by 0.33 +/- 0.13; in the LF group, these variables increased by 4.3 +/- 3.0 pmol/L (P < 0.08) and 0.17 +/- 0.10 (P < 0.05) and decreased by 0.02 +/- 0.09 (P = 0.005), respectively; and in the control group, increased by 14.0 +/- 4.3 pmol/L (P < 0.001), 0.57 +/- 0.17 (P < 0.001), and 0.05 +/- 0.14 (P = 0.036), respectively. Dietary adherence was high on the basis of fatty acid changes in adipose tissue.

CONCLUSIONS

Diet composition had no major effect on preventing weight regain. However, both the LF and MUFA diets produced less body fat regain than did the control diet, and the dropout rate was lowest in the LF diet group, whereas fasting insulin decreased and the homeostasis model assessment of insulin resistance and ratio of LDL to HDL improved with the MUFA diet. This trial was registered at clinicaltrials.gov as NCT00274729.

Xenohormone transactivities are inversely associated to serum POPs in Inuit

BACKGROUND

The persistent organic pollutants (POPs) are highly lipophilic and resistant to biodegradation and found in e.g. seafood and marine mammals. Greenlandic Inuit have high intake of marine food and thus high POP burden that varies according to local conditions and dietary preference. We do for the very first time report the serum POP related non-steroidal xenohormone activity of Inuit across Greenland. The aims were 1) to determine the integrated xenohormone bioactivities as an exposure biomarker of the actual lipophilic serum POP mixture measuring the effect on estrogen (ER) and androgen receptor (AR) transactivity in citizens from different Greenlandic districts and 2) to evaluate associations to serum POP markers (14 PCBs and 10 pesticides) and lifestyle characteristics.

METHODS

Serum samples from 121 men and 119 women from Nuuk, Sisimiut and Qaanaaq were extracted using SPE-HPLC fractionation to obtain the serum POP fraction free of endogenous hormones. The serum POP fraction was used for determination of xenohormone transactivity using ER and AR reporter gene assays.

RESULTS

In overall, the xenohormone transactivities differed between districts as well as between the genders. Associations between the transactivities and age, n-3/n-6 and smoker years were observed. The xenoestrogenic and xenoandrogenic transactivities correlated negatively to the POPs for the combined female and male data, respectively.

CONCLUSION

The non-steroidal xenohormone transactivities can be used as an integrated biomarker of POP exposure and lifestyle characteristics. The actual serum POP mixtures antagonized the age adjusted sex hormone receptor functions. Comparison of different study populations requires in addition to age inclusion of diet and lifestyle factors.

Endocannabinoids and nutrition

The endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG) are bioactive lipids derived from the n-6 family of polyunsaturated fatty acids that are essential fatty acids. Symptoms of essential fatty acid deficiency in rats - growth retardation, scaly skin, and increased transepidermal water loss - can mainly be attributed to lack of linoleic acid as a structural element of the epidermis. Arachidonic acid, however, also serve essential functions, particularly in cellular signalling via its precursor role for numerous oxygenated derivatives such as prostaglandins, leukotrienes, hepoxilins and other eicosanoids. Furthermore, arachidonic acid is also a structural part of endocannabinoids that have signalling functions in relation to modulation of neurotransmitter release, which might involve physiological and pathophysiological phenomena such as regulation of appetite, energy metabolism, pain perception, memory and learning. Furthermore, along with AEA formation other acylethanolamides are always formed - e.g., oleoylethanolamide (OEA), that can inhibit food intake, and palmitoylethanolamide, that is anti-inflammatory - possibly through activation of peroxisome proliferator activated receptor alpha (PPAR alpha) and/or GPR119. As all these unsaturated fatty acids are ingested daily in smaller or larger amounts, one can ask whether different dietary fats can affect the levels of these fatty acids in the tissues and thereby the quantitative formation of these bioactive signalling molecules. Generally, in vivo arachidonic-acid-derived eicosanoid production can be increased and decreased by prolonged feeding with pharmacological levels of arachidonic acid and long-chain (n-3) fatty acids (fish oil), respectively. Changes in levels of these two fatty acids within the traditional human diet hardly affects the eicosanoid production, however. Moreover, preliminary data suggest that dietary intake of arachidonic acid and fish oil also doesn't easily affect endocannabinoid formation; however, dietary fat in terms of saturated, polyunsaturated and monounsaturated seems to affect tissue levels of AEA, 2-AG and OEA.

Fatty acid composition of adipose tissue and blood in humans and its use as a biomarker of dietary intake

Accurate assessment of fat intake is essential to examine the relationships between diet and disease risk but the process of estimating individual intakes of fat quality by dietary assessment is difficult. Tissue and blood fatty acids, because they are mainly derived from the diet, have been used as biomarkers of dietary intake for a number of years. We review evidence from a wide variety of cross-sectional and intervention studies and summarise typical values for fatty acid composition in adipose tissue and blood lipids and changes that can be expected in response to varying dietary intake. Studies in which dietary intake was strictly controlled confirm that fatty acid biomarkers can complement dietary assessment methodologies and have the potential to be used more quantitatively. Factors affecting adipose tissue and blood lipid composition are discussed, such as the physical properties of triacylglycerol, total dietary fat intake and endogenous fatty acid synthesis. The relationship between plasma lipoprotein concentrations and total plasma fatty acid composition, and the use of fatty acid ratios as indices of enzyme activity are also addressed.

Pancreatic ectopic fat is characterized by adipocyte infiltration and altered lipid composition

OBJECTIVE

Sustained exposure to lipids is deleterious for pancreatic islet function. This could be mediated through increased pancreatic fat following increased dietary fat and in obesity, which has implications for the onset of type 2 diabetes. The aims of this study were to determine changes in extent and composition of pancreatic, hepatic, and visceral fat in mice fed a high-fat diet (HFD, 40% by weight) compared with a control diet (5% fat) of similar fatty acid composition, and to compare composition and extent of pancreatic fat in human type 2 diabetes.

METHODS AND PROCEDURES

Mice were fed HFD for 3 or 15 weeks. Human postmortem pancreas was examined from subjects with type 2 diabetes (n = 9) and controls (n = 7). Tissue lipid content and composition were determined by gas chromatography and pancreatic adipocyte infiltration quantified by morphometry.

RESULTS

Pancreatic triacylglycerol (TG) content was 20x greater (P < 0.05) in HFD mice and there were more pancreatic perilipin-positive adipocytes compared with controls after 15 weeks. The proportions of 18:1n -9 and 18:2n -6 in pancreatic TG and the 20:4n -6/18:2n -6 ratio in phospholipids, were higher (both P < 0.05) after HFD compared with controls. Human pancreatic TG content was correlated with the proportion of pancreatic perilipin-positive adipocytes (r = 0.64, P < 0.05) and associated with unsaturated fatty acid enrichment (P < 0.05).

DISCUSSION

Adipocyte infiltration in pancreatic exocrine tissue is associated with high-fat feeding in mice and pancreatic TG content in humans. This alters the fatty acid milieu of the islet which could contribute to islet dysfunction.

Co-existence of fatty acids changes in aorta artery and adipose tissue; comparison between CAD and non CAD patients

BACKGROUND

This study was aimed to evaluate composition and possible co-existence of change in fatty acids of aorta artery and adipose tissue in two groups of patients with different degree of atherosclerosis.

METHODS

Twenty-one angiographically documented coronary artery diseases (CAD) patients, and the same numbers of age, sex and body mass index-matched angiographically documented non CAD patients enrolled in this study. They were operated electively for coronary artery bypass grafting (CABG) or aortic valve replacement surgery (AVR), respectively. Small segments of ascending aorta artery and adipose tissue were dissected form the two groups during open heart surgery and subjected to fatty acid analysis.

RESULTS

The results showed that in the CAD group, amounts of saturated and omega6 unsaturated fatty acids were higher, while the percent of monounsaturated and omega3 unsaturated fatty acids were lower than the non CAD patients for both aorta artery and adipose tissue samples. A moderate correlation was seen between amounts of fatty acids in adipose tissue and aorta artery.

CONCLUSION

As there are many reports which show that adipose tissue can only be used as a suitable indicator of dietary intake of exogenous fatty acids (e.g. polyunsaturated and trans fatty acids), our study suggests that modification of fatty acids with endogenous synthesis and metabolism (e.g. saturated and monounsaturated fatty acids) which were observed in both adipose tissue and aorta artery of CAD patients, may be produced during atherogenesis.

AhR transcriptional activity in serum of Inuits across Greenlandic districts

BACKGROUND

Human exposure to lipophilic persistent organic pollutants (POPs) including polychlorinated dibenzo-p-dioxins/furans (PCDDs/PCDFs), polychlorinated biphenyls (PCBs) and organochlorine pesticide is ubiquitous. The individual is exposed to a complex mixture of POPs being life-long beginning during critical developmental windows. Exposure to POPs elicits a number of species- and tissue-specific toxic responses, many of which involve the aryl hydrocarbon receptor (AhR). The aim of this study was to compare the actual level of integrated AhR transcriptional activity in the lipophilic serum fraction containing the actual POP mixture among Inuits from different districts in Greenland, and to evaluate whether the AhR transactivity is correlated to the bio-accumulated POPs and/or lifestyle factors.

METHODS

The study included 357 serum samples from the Greenlandic districts: Nuuk and Sisimiut (South West Coast), Qaanaaq (North Coast) and Tasiilaq (East Coast). The bio-accumulated serum POPs were extracted by ethanol: hexane and clean-up on Florisil columns. Effects of the serum extract on the AhR transactivity was determined using the Hepa 1.12cR mouse hepatoma cell line carrying an AhR-luciferase reporter gene, and the data was evaluated for possible association to the serum levels of 14 PCB congeners, 10 organochlorine pesticide residues and/or lifestyle factors.

RESULTS

In total 85% of the Inuit samples elicited agonistic AhR transactivity in a district dependent pattern. The median level of the AhR-TCDD equivalent (AhR-TEQ) of the separate genders was similar in the different districts. For the combined data the order of the median AhR-TEQ was Tasiilaq > Nuuk > or = Sisimiut > Qaanaaq possibly being related to the different composition of POPs. In overall, the AhR transactivity was inversely correlated to the levels of sum POPs, age and/or intake of marine food.

CONCLUSION

i) We observed that the proportion of dioxin like (DL) compounds in the POP mixture was the dominating factor affecting the level of serum AhR transcriptional activity even at very high level of non DL-PCBs; ii) The inverse association between the integrated serum AhR transactivity and sum of POPs might be explained by the higher level of compounds antagonizing the AhR function probably due to selective POP bioaccumulation in the food chain.

Study design, exposure variables, and socioeconomic determinants of participation in Diet, Cancer and Health: a population-based prospective cohort study of 57,053 men and women in Denmark

AIMS

Diet is considered an important aspect of lifestyle related to cancer development. To contribute further knowledge within this field a Danish prospective cohort study "Diet, Cancer and Health" has been initiated. The aims of this paper are to give a description of the study design, measurement procedures, and differences between participants and non-participants with special reference to socioeconomic characteristics.

METHODS

A total of 160,725 individuals 50-64 years of age living in Copenhagen or Aarhus were invited to participate. Information concerning diet and other lifestyle factors was obtained from 57,053 participants using questionnaires and interviews. Anthropometric measurements were taken and biological material collected. In addition, detailed (selected) socioeconomic information on all invited persons including 103,671 non-participants was obtained from statistical registers in Statistics Denmark.

RESULTS

Differences were seen between participants and non-participants on a number of socioeconomic factors. The highest participation in relation to education was found among participants with higher education, with a significant tendency to be highest in the second highest level of higher education (3-4 years). Married people were more likely to participate than persons living alone or cohabiting.

CONCLUSION

Results from the prospective cohort study "Diet, Cancer and Health" support the general assumption that lower socioeconomic groups are underrepresented in epidemiological studies.

Comparison between plasma and erythrocyte fatty acid content as biomarkers of fatty acid intake in US women

BACKGROUND

Erythrocyte fatty acids may be superior to plasma fatty acids for reflecting long-term fatty acid intake because of less sensitivity to recent intake and a slower turnover rate.

OBJECTIVE

The objective was to compare the fatty acid content of erythrocytes with that of plasma with respect to their abilities to reflect usual fatty acid intake.

DESIGN

Fatty acids in plasma and erythrocytes were measured by capillary gas-liquid chromatography in 306 US women aged 43-69 y. Fatty acid intake was assessed with a food-frequency questionnaire, which was validated for measuring intakes of various fatty acids.

RESULTS

Docosahexaenoic acid (DHA, 22:6n-3) in erythrocytes and plasma provided the strongest correlations with its intake, but erythrocyte DHA concentrations [Spearman's partial correlation coefficient (r(s))=0.56] were better than plasma DHA concentrations (r(s)=0.48) as a biomarker. Total trans fatty acids (r(s)=0.43) and total 18:1 trans isomers (r(s)=0.42) in erythrocytes were also more strongly correlated with intake than were those in plasma (r(s)=0.30 and r(s)=0.29, respectively). Moderate correlations were observed for linoleic acid (18:2n-6; erythrocytes, r(s)=0.24; plasma, r(s)=0.25), alpha-linolenic acid (18:3n-3; erythrocytes, r(s)=0.18; plasma, r(s)=0.23), and eicosapentaenoic acid (20:5 n-3; erythrocytes, r(s)=0.38; plasma, r(s)=0.21). For polyunsaturated and trans fatty acids, correlations between intakes and biomarkers improved moderately when average intakes over previous years were used.

CONCLUSION

Erythrocyte n-3 fatty acids of marine origin and trans fatty acid content are suitable biomarkers for long-term intake.