Lowering LDL-cholesterol through diet: potential role in the statin era

Does Medication Status Impact the Effectiveness of Nuts in Altering Blood Pressure and Lipids? A Systematic Review and Meta-Analysis

CONTEXT

Nut consumption is attributed to improvements in risk factors for cardiovascular disease (CVD), including high blood pressure (BP) and dyslipidemia. However, it is unclear whether these effects are altered with concurrent treatment with BP and lipid-lowering medication.

OBJECTIVE

We sought to investigate the effects of the consumption of whole tree nuts and peanuts (collectively termed nuts) on BP and lipids, and whether BP and lipid-lowering medication use alters these effects.

DATA SOURCES

The MEDLINE, EMBASE, Scopus, and Web of Science databases were systematically searched through June 21, 2023, for randomized controlled trials (RCTs) assessing the effects of nut consumption on BP and/or lipids.

DATA EXTRACTION

Random effects meta-analyses (mean difference, 95% confidence interval [CI]) were conducted, with subgroup analyses based on reported participant use of BP or lipid-lowering medication, including medicated, unmedicated, unreported (ie, use not specified), and mixed (ie, included combined data from medicated and unmedicated participants). A total of 115 studies were included in the review, of which 109 were meta-analysed.

DATA ANALYSIS

Nut consumption significantly reduced triglycerides (TG), total cholesterol, low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B, with no effect on high-density lipoprotein cholesterol or blood pressure. Few studies were conducted in medicated participants only (n = 1 for lipid outcomes only), and for the studies including both medicated and unmedicated participants (ie, mixed), outcomes by medication use were not reported. Significant differences in TG and apolipoprotein B were observed between medication use groups, with nut consumption resulting in the largest reductions in unmedicated participants. Strong heterogeneity was observed with no evidence of publication bias.

CONCLUSIONS

Lipid-lowering, but not BP-lowering benefits of nut consumption were observed; however, few studies reported the effect based on participants' medication status. Future studies are required to determine if there are additional benefits of including nuts in the diet of medicated patients with cardiovascular disease.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration code CRD42022296849.

Decoding the nature and complexity of extracellular mtDNA: Types and implications for health and disease

The mitochondrial DNA (mtDNA) is replicated and canonically functions within intracellular mitochondria, but recent discoveries reveal that the mtDNA has another exciting extracellular life. mtDNA fragments and mitochondria-containing vesicular structures are detected at high concentrations in cell-free forms, in different biofluids. Commonly referred to as cell-free mtDNA (cf-mtDNA), the field is currently without a comprehensive classification system that acknowledges the various biological forms of mtDNA and whole mitochondria existing outside the cell. This absence of classification hampers the creation of precise and consistent quantification methods across different laboratories, which is crucial for unraveling the molecular and biological characteristics of mtDNA. In this article, we integrate recent findings to propose a classification for different types of Extracellular mtDNA [ex-mtDNA]. The major biologically distinct types include: Naked mtDNA [N-mtDNA], mtDNA within non-mitochondrial Membranes [M-mtDNA], Extracellular mitochondria [exM-mtDNA], and mtDNA within Mitochondria enclosed in a Membrane [MM-mtDNA]. We outline the challenges associated with accurately quantifying these ex-mtDNA types, suggest potential physiological roles for each ex-mtDNA type, and explore how this classification could establish a foundation for future research endeavors and further analysis and definitions for ex-mtDNA. By proposing this classification of circulating mtDNA forms, we draw a parallel with the clinically recognized forms of cholesterol, such as HDL and LDL, to illustrate potential future significance in a similar manner. While not directly analogous, these mtDNA forms may one day be as biologically relevant in clinical interpretation as cholesterol fractions are currently. We also discuss how advancing methodologies to reliably quantify distinct ex-mtDNA forms could significantly enhance their utility as health or disease biomarkers, and how their application may offer innovative therapeutic approaches.

Can different types of tree nuts and peanuts induce varied effects on specific blood lipid parameters? A systematic review and network meta-analysis

Tree nuts and peanuts have shown cardioprotective effects through the modulation of blood lipid levels. Despite the abundance of scientific evidence available, it remains uncertain whether the type of nut consumed influences these changes. The objective of this study was to evaluate and rank the effects of six types of nuts on total cholesterol (total-c), low-density lipoprotein (LDL-c), triglyceride (TG) and high-density lipoprotein (HDL-c) levels through a systematic search of randomized controlled trials (RCTs), a frequentist network meta-analysis (NMA), and the estimation of SUCRA values. A total of 76 RCTs were ultimately analyzed. The total c for pistachios, almond, and walnuts; LDL-c for cashews, walnuts, and almond; and TG for hazelnuts and walnuts significantly decreased, while only peanuts exhibited a significant increase in HDL-c levels. According to the rankings, the most effective type of nut for reducing total cholesterol was pistachio, cashew for LDL-c, hazelnut for TG, and peanut for increasing HDL-c levels. It should be noted that every type of nut analyzed exhibited a significant positive impact on some parameters, and specific types demonstrated enhanced advantages for particular blood lipids. These results endorse the use of personalized nutritional strategies to address and prevent dyslipidemia.Registration: PROSPERO database CRD42021270779.

Associations between the Genetic Heritability of Dyslipidemia and Dietary Patterns in Korean Adults Based on Sex Differences

Dyslipidemia can be defined as an abnormality in serum lipid levels that is substantially linked to genetic variations and lifestyle factors, such as diet patterns, and has distinct sex-specific characteristics. We aimed to elucidate the genetic impact of dyslipidemia according to sex and explore the associations between genetic variants and dietary patterns in large-scale population-based cohorts. After performing genome-wide association studies (GWASs) in male, female, and entire cohorts, significant single nucleotide polymorphisms (SNPs) were identified in the three groups, and genetic risk scores (GRSs) were calculated by summing the risk alleles from the selected SNPs. After adjusting for confounding variables, the risk of dyslipidemia was 2.013-fold and 2.535-fold higher in the 3rd quartile GRS group in the male and female cohorts, respectively, than in the 1st quartile GRS group. While instant noodle and soft drink intake were significantly associated with GRS related to hyperlipidemia in male cohorts, coffee consumption was substantially related to GRS related to hyperlipidemia in female cohorts. Considering the influence of genetic factors and dietary patterns, the findings of this study suggest the potential for implementing sex-specific strategic interventions to avoid dyslipidemia.

Association between snus use and lipid status in Swedish men

Snus is a common tobacco product in Sweden, but the cardiovascular risk profile for snus users is less known than for cigarette smokers. We examined the association of snus use with lipid status, particularly in comparison to non-tobacco use and cigarette smoking, using data from 5930 men in the Northern Sweden MONICA study. Tobacco use was self-reported in 1986 to 2014 (24.4% used snus) and blood samples were collected at the same time. Harmonized analyses on non-high-density lipoprotein (non-HDL) cholesterol, HDL cholesterol, and triglycerides were conducted in 2016 to 2018. Three hundred eighty-one snus users had also been examined more than once, allowing us to study the effect of discontinued use (achieved by 21.0%). In multivariable linear regression models, snus use was associated with higher HDL cholesterol and triglyceride concentrations compared to non-tobacco use (p values ≤ 0.04), and it was associated with higher HDL cholesterol concentrations and lower triglyceride concentrations compared to cigarette smoking (p values ≤ 0.02). Snus use was not associated with non-HDL cholesterol concentrations, irrespective of the comparison group (p values ≥ 0.07). There was no indication that higher intensity of snus use led to a worse lipid profile, given that high-consumers had higher HDL cholesterol concentrations than low-consumers (p value = 0.02), or that discontinuation of snus use led to a better lipid profile, given that continued users had lower triglyceride concentrations than discontinued users (p value = 0.03). Further studies are needed to confirm or refute our findings.

A new lipid-structured model to investigate the opposing effects of LDL and HDL on atherosclerotic plaque macrophages

Atherosclerotic plaques form in artery walls due to a chronic inflammatory response driven by lipid accumulation. A key component of the inflammatory response is the interaction between monocyte-derived macrophages and extracellular lipid. Although concentrations of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) particles in the blood are known to affect plaque progression, their impact on the lipid load of plaque macrophages remains unexplored. In this paper, we develop a lipid-structured mathematical model to investigate the impact of blood LDL/HDL levels on plaque composition, and lipid distribution in plaque macrophages. A reduced subsystem, derived by summing the equations of the full model, describes the dynamics of biophysical quantities relating to plaque composition (e.g. total number of macrophages, total amount of intracellular lipid). We also derive a continuum approximation of the model to facilitate analysis of the macrophage lipid distribution. The results, which include time-dependent numerical solutions and asymptotic analysis of the unique steady state solution, indicate that plaque lipid content is sensitive to the influx of LDL relative to HDL capacity. The macrophage lipid distribution evolves in a wave-like manner towards an equilibrium profile which may be monotone decreasing, quasi-uniform or unimodal, attaining its maximum value at a non-zero lipid level. Our model also reveals that macrophage uptake may be severely impaired by lipid accumulation. We conclude that lipid accumulation in plaque macrophages may serve as a partial explanation for the defective uptake of apoptotic cells (efferocytosis) often reported in atherosclerotic plaques.

Linking the Low-Density Lipoprotein-Cholesterol (LDL) Level to Arsenic Acid, Dimethylarsinic, and Monomethylarsonic: Results from a National Population-Based Study from the NHANES, 2003–2020

Arsenic (As) contamination is a global public health problem. Elevated total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) are risk factors for cardiovascular diseases, but data on the association of urinary arsenic species’ level and LDL-C are limited. We performed an association analysis based on urinary arsenic species and blood TC and LDL-C in US adults. Methods: Urinary arsenic, arsenic acid (AA), dimethylarsinic (DMA), monomethylarsonic (MMA), TC, LDL-C, and other key covariates were obtained from the available National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2020. Multiple linear regression analysis and generalized linear model are used to analyze linear and nonlinear relationships, respectively. Results: In total, 6633 adults aged 20 years were enrolled into the analysis. The median total urinary arsenic level was 7.86 µg/L. A positive association of urinary arsenic concentration quartiles was observed with TC (β: 2.42 95% CI 1.48, 3.36). The OR for TC of participants in the 80th versus 20th percentiles of urinary total arsenic was 1.34 (95% CI 1.13, 1.59). The OR for LDL-C of participants in the 80th versus 20th percentiles of urinary total arsenic was 1.36 (95% CI 1.15, 1.62). For speciated arsenics analysis, the OR for arsenic acid and TC was 1.35 (95% CI 1.02, 1.79), whereas the OR for DMA and LDL-L was 1.20 (95% CI 1.03, 1.41), and the OR for MMA and LDL-L was 1.30 (95% CI 1.11, 1.52). Conclusions: Urinary arsenic and arsenic species were positively associated with increased LDL-C concentration. Prevention of exposure to arsenic and arsenic species maybe helpful for the control of TC and LDL-C level in adults.

Mediterranean Dietary Treatment in Hyperlipidemic Children: Should It Be an Option?

BACKGROUND

Diet is considered the cornerstone of lipid management in hyperlipidemic children but evidence to demonstrate the effects of nutrient benefits on the lipid profile is limited.

AIM

The aim of this study is to evaluate the impact of the Mediterranean diet on low-density lipoprotein (LDL-C) and non-high density lipoprotein (HDL-C) decrease in primary hyperlipidemia affected children and in the achievement of therapeutical target levels.

METHODS

A retrospective cohort study was used, recruiting n = 223 children (10.05 ± 3.26 mean age years) with familial hypercholesterolemia (FH) (n = 61, 27%) and polygenic hypercholesterolemia (PH) (n =162, 73%). Secondary hyperlipidemias were excluded. Based on LDL-C and non-HDL-C decrease, participants were divided into two groups, named the Responder Group and Non-Responder Group. Participants and their families underwent dietary education by an expert nutritionist and were asked to fill in a weekly diary to be delivered at visits. Dietary indications were in line with daily caloric requirement, daily food quality and quantity intakes typical of the Mediterranean diet. These include carbohydrates, extra virgin olive oil, yoghurt and milk derivatives, fish and vegetable proteins, fresh seasonal vegetables and fresh fruits. Nuts or almonds were also recommended. The advice to limit intakes of meat, in particular red meat, and caution against junk food and sugar added food and beverages was provided. At medical visits, carried out at baseline (T0) and 6 months later (T1), children underwent anthropometric measurements and blood collection. Standard kits and methods were applied for lipid analysis. Statistical methods were performed by SAS version 9.4 (SAS Institute, Cary, NC, USA). Signed informed consent was given by parents according to the Declaration of Helsinki and the study was approved by the Local Committee.

RESULTS

The Responder Group (n = 156/223, 70%) included 45 FH and 111 PH children, while the Non-Responder Group (n = 67/223, 30%) included 16 FH and 51 PH children. The Responder Group showed total cholesterol (TC), LDL-C and non-HDL-C median percentage decreases of 9.45, 13.51 and 10.90, respectively. These statistically significant changes (p ≤ 0.0001) were similar in the FH and PH subgroups but just PH subjects reached the LDL-C and non-HDL-C target, which fell below 130 mg/dL and 145 mg/dL, respectively. Saturated fatty acids (SFAs) were the main dietary parameter that distinguished between the Responder Group and the Non-Responder Group (p = 0.014). Positive correlations were found at T1 between dietary total lipids, SFAs and cholesterol with serum LDL-C, non-HDL-C and TC variations. These latter serum parameters had an inverse correlation with dietary carbohydrate at T1. Among macronutrients, SFAs were finally demonstrated to be the predictor of serum lipids variation at T1.

CONCLUSIONS

The dietary intervention with a Mediterranean diet in children with primary hyperlipidemia significantly improves the lipid profile both in FH and PH subgroups and allows target levels of LDL-C and non-HDL-C in PH subjects to be reached. Responsiveness benefits should be primarily attributed to the reduction in SFAs, but changes in dietary lipids, cholesterol and carbohydrate intake may also play a role. In contrast, the Non-Responder Group showed a worsening of lipid profile regarding the unchanged diet.

Diversity of Plant Sterols Metabolism: The Impact on Human Health, Sport, and Accumulation of Contaminating Sterols

The way of plant sterols transformation and their benefits for humans is still a question under the massive continuing revision. In fact, there are no receptors for binding with sterols in mammalians. However, possible biotransformation to steroids that can be catalyzed by gastro-intestinal microflora, microbial cells in prebiotics or cytochromes system were repeatedly reported. Some products of sterols metabolization are capable to imitate resident human steroids and compete with them for the binding with corresponding receptors, thus affecting endocrine balance and entire physiology condition. There are also tremendous reports about the natural origination of mammalian steroid hormones in plants and corresponding receptors for their binding. Some investigations and reports warn about anabolic effect of sterols, however, there are many researchers who are reluctant to believe in and have strong opposing arguments. We encounter plant sterols everywhere: in food, in pharmacy, in cosmetics, but still know little about their diverse properties and, hence, their exact impact on our life. Most of our knowledge is limited to their cholesterol-lowering influence and protective effect against cardiovascular disease. However, the world of plant sterols is significantly wider if we consider the thousands of publications released over the past 10 years.

Weight cycling is associated with adverse cardiometabolic markers in a cross-sectional representative US sample

BACKGROUND

Whether weight cycling (repeated weight loss and regain) is associated with cardiometabolic health is unclear. Study objective was to examine whether weight cycling since young adulthood (ie, 25 years of age) was associated with cardiometabolic markers.

METHODS

Data from a nationally representative cross-sectional US sample (National Health and Nutrition Examination Survey, 1999-2014) were used. Weight history was based on self-reported weight at age 25, 10 years prior and 1 year prior to the survey (n=4190, 51% male). Using current self-reported weight as the anchor, participants were classified as (1) stable weight, (2) weight losers, (3) weight gainers and (4) weight cyclers. Cardiometabolic markers included fasting lipids, insulin sensitivity and blood pressure. Multiple linear regressions were used to analyse weight history (reference: stable weight) and adjusted for covariates. Analyses incorporated the sampling design and survey weights and were stratified by sex or weight status.

RESULTS

Compared with females with stable weight, female weight cyclers had worse lipids and homeostasis model assessment for insulin resistance (HOMA-IR) (all ps<0.05). Compared with males with stable weight, male weight cyclers had worse high-density lipoprotein cholesterol (HDL) and HOMA-IR (ps<0.05). Weight cyclers with normal weight had worse HDL and low-density lipoprotein cholesterol (ps<0.05), and weight cyclers with overweight or obesity had worse HOMA-IR (p=0.05). Blood pressure was not associated.

CONCLUSION

Weight cycling is adversely associated with cardiometabolic markers but associations differ by sex and weight status. While weight cycling is consistently associated with worse cardiometabolic markers among females, results are mixed among males. Weight cycling is associated with worse lipid measures for normal weight persons, and marginally worse insulin sensitivity for those with overweight/obesity.

A Conservative Weight Loss Intervention Relieves Bowel Symptoms in Morbidly Obese Subjects with Irritable Bowel Syndrome: A Prospective Cohort Study

BACKGROUND

Irritable bowel syndrome (IBS) is common in subjects with morbid obesity; the effect of weight loss programs on bowel symptoms is largely unknown.

METHODS

This prospective cohort study explored bowel symptoms, health scores, and biomarkers in subjects with morbid obesity during a six-month-long conservative weight loss intervention. Bowel symptoms were assessed with IBS-severity scoring system (IBS-SSS) and Gastrointestinal Symptom Rating Scale-IBS. Changes in all variables and associations between the changes in bowel symptoms and the other variables were analysed.

RESULTS

Eighty-eight subjects (81% females) were included. Body mass index was reduced from 42.0 (3.6) to 38.7 (3.5) (p < 0.001). IBS-SSS was reduced from 116 (104) to 81 (84) (p=0.001). In all, 19 out of 25 variables improved significantly. In subjects with and without IBS at inclusion, the improvement in IBS-SSS was 88 (95% CI 55 to 121) and 10 (95% CI -9 to 29), respectively. Improved bowel symptoms were associated with improved subjective well-being, sense of humour, and vitamin D and negatively associated with reduced body mass index.

CONCLUSION

Body mass index and health scores improved during a conservative weight loss intervention. Subjects with IBS before the intervention had a clinically significant improvement in bowel symptoms.

Mixed Messages, Mixed Outcomes: Exposure to Direct-to-Consumer Advertising for Statin Drugs is Associated with More Frequent Visits to Fast Food Restaurants and Exercise

This study examines whether exposure to direct-to-consumer advertising (DTCAs) for statin drugs is associated with non-pharmaceutical behaviors to prevent cardiovascular disease. We focus on the relationship between statin drug DTCA exposure and the frequency of (a) visits to fast-food restaurants and (b) exercise. We combine data on the televised broadcast availability of statin drug DTCAs in large media markets in the United States with 18 waves of the Simmons National Consumer Survey (NCS; n = 120, 229) from 2001 to 2009. We find that statin drug DTCA exposure is associated, in a dose-response pattern, with modest increases in the frequency of exercise and large increases in the frequency of fast-food-restaurant visits. The relationship between statin DTCA exposure and fast-food-restaurant visits were largely consistent in direction but differed in magnitude between those without a previous diagnosis of high cholesterol and those treating high cholesterol with a statin. We conclude with a discussion of the implications of these results for future research on pharmaceutical DTCA and population health.

Prevalence and predictors of irritable bowel syndrome in patients with morbid obesity: a cross-sectional study

BACKGROUND

Irritable bowel syndrome has been reported as more common in patients with morbid obesity than in the general population. The reason for this association is unknown. The aims of this study were to study the prevalence of irritable bowel syndrome and other functional bowel disorders in patients with morbid obesity, and to search for predictors of irritable bowel syndrome.

METHODS

Patients opting for bariatric surgery at two obesity centers in South-Eastern Norway were included. Functional bowel disorders were diagnosed according to the Rome III criteria. Predictors were evaluated in a multivariable logistic regression analysis with irritable bowel syndrome as the dependent variable.

RESULTS

A total of 350 (58%) out of 603 consecutive patients were included. The prevalence rates of irritable bowel syndrome at the two centers were 17/211 (8%) and 37/139 (27%) respectively. High low-density lipoprotein (OR 2.10; 95% CI 1.34-3.29), self-reported psychiatric disorders (OR 2.39; 95% CI 1.12-5.08) and center (OR 5.22; 95% CI 2.48-10.99) were independent predictors of irritable bowel syndrome.

CONCLUSIONS

At one of the two obesity centers, the prevalence of irritable bowel syndrome was threefold higher than in the general population in the same region. The high prevalence appears to be related to dietary differences or altered absorption or metabolism of fat. Attention to irritable bowel syndrome is important in the care of patients with morbid obesity.

Antihypercholesterolemic Effects of Fruit Aqueous Extract of Copernicia prunifera (Miller) H. E. Moore in Mice Diet-Induced Hypercholesterolemia

The present objective of the investigation is to evaluate the antihypercholesterolemic activity of the aqueous fruit pulp extract (APE) of Copernicia prunifera (Miller) H. E. Moore (Arecaceae family). Various chemical characterization methods like thin layer chromatography, Fourier transform infrared spectroscopy, 1H and 13C NMR, and molecular weight by gel permeation chromatography have been employed to characterize the extracted pectin. The present study demonstrated that hypercholesterolemic diet (HD) created hypercholesterolemia, caused significant increases in body weight, total cholesterol, and low-density lipoprotein, and caused decreases in high-density lipoprotein in serum compared with SD group. Two doses (APE 150 and 300 mg/Kg b.w./day) were administered to hyperlipidemic mice for 90 days. APE reversed body weight changes, changed serum lipids to normal values, and significantly inhibited the changes of lipid peroxidation and inflammation in the liver tissues. The renal parameters analyzed (urea and creatinine) altered by diet were reverted to normal values. Our results revealed that aqueous fruit pulp extracts of carnauba reduced hypercholesterolemia showing a potential preventive effect against cardiovascular diseases without side effects cause.

The Health Potential of Fruits and Vegetables Phytochemicals: Notable Examples

Fruit and vegetables are essential components of a healthy diet. The World Health Organization (WHO) recommends an intake of five to eight portions (400-600 g) daily of fruits and vegetables to reduce risk of cardiovascular disease, cancer, poor cognitive performance, and other diet-related diseases, as well as for the prevention of micronutrient deficiencies. Much of their potential for disease prevention is thought to be provided by phytochemicals, among which the preventive activity of antioxidants is most well documented. Since numerous meta-studies published indicate variable and often contradictory results about the impact of isolated phytochemicals on health, their consumption as supplements must be carried out with care, because doses may exceed the recommended nutritional intake. Nonetheless, there is a general consensus that whole fruit and vegetable intake is more important in providing health benefits than that of only one of their constituent, because of additive and synergistic effects. This review describes the most recent literature regarding the health benefits of some selected fruits and vegetables. Importantly, since some phytochemicals regulate the same genes and pathways targeted by drugs, diets rich in fruits and vegetables in combination with medical therapies are being considered as novel approaches to treatment. Therefore, phytochemicals in fruits and vegetable might be a promising tool for the prevention and/or amelioration of a wide range of diseases.

In vitro fermentation characteristics, in vivo ileal and total tract nutrient digestibilities, and fecal microbiota responses of dogs to α-cyclodextrin

The objectives were to examine in vitro fermentation characteristics, in vivo nutrient digestibility, fecal microbiota, and serum lipid profiles as affected by α-cyclodextrin (ACD) supplementation. Short-chain fatty acid (SCFA) production was measured after in vitro fermentation for 3, 6, 9, and 12 h of ACD, β-cyclodextrin, and γ-cyclodextrin. Five mixed-breed hounds were used in a Latin square design. Each experimental period comprised 14 d, including 10 d for diet adaptation and 4 d for fecal collection. Dogs were fed, twice a day, an extruded diet made with poultry byproduct meal and brewer's rice as the main ingredients. Dogs were supplemented with 0, 1, 2, 3, or 4 g of ACD diluted in 15 mL of water twice daily for a total of 0, 2, 4, 6, and 8 g ACD/d. Maximal in vitro production of total SCFA was lowest for ACD. However, the greatest maximal production of propionate was noted for ACD treatment. Total tract nutrient digestibility and fecal DM concentration linearly decreased ( < 0.05) for treatment groups receiving ACD; no changes were observed for ileal digestibility. Serum cholesterol and triglyceride concentrations were within normal ranges for dogs and were not different among treatments. Similarly, no changes in fecal microbiota were observed. Overall, ACD supplementation appears to have no effect on nutrient absorption in the small intestine but may alter fermentation in the large bowel, which could lead to a higher proportion of propionate production as observed in the in vitro experiment.

Nanomedicines for Endothelial Disorders

The endothelium lines the internal surfaces of blood and lymphatic vessels and has a critical role in maintaining homeostasis. Endothelial dysfunction is involved in the pathology of many diseases and conditions, including disorders such as diabetes, cardiovascular diseases, and cancer. Given this common etiology in a range of diseases, medicines targeting an impaired endothelium can strengthen the arsenal of therapeutics. Nanomedicine - the application of nanotechnology to healthcare - presents novel opportunities and potential for the treatment of diseases associated with an impaired endothelium. This review discusses therapies currently available for the treatment of these disorders and highlights the application of nanomedicine for the therapy of these major disease complications.

Dietary supplementation contributes to lifestyle improvement in hypercholesterolemic patients in real-life contexts

AIMS

Assess the evolution of cardiovascular lifestyle behaviors in hypercholesterolemic patients concomitantly with changes in their daily intake of phytosterol-supplemented yoghurt (Phyto-SY).

METHODS

Nationwide prospective observational study conducted in general practices across France and Spain. Each practitioner suggested lifestyle changes to five consecutive patients with hypercholesterolemia (whether or not they were taking hypocholesterolemic drugs) and recommended daily consumption of Phyto-SY. The study design involved an inclusion visit, a patient's self-monitoring assessment after 1 month, and a final visit after 4 months. Primary evaluation criterion: changes in dietary habits assessed by a standardized Nutritional Lifestyle score. Secondary criteria: changes in lipid profile, anthropometry (waist circumference) and lifestyle behavior.

RESULTS

A total of 2376 hypercholesterolemic patients (of whom 54.8% were women) were included. The average age was 56.2 years old. The Nutritional Lifestyle score improved from 15.4 ± 5.4 to 8.7 ± 4.0 (p < 0.0001). Total cholesterol decreased by 10.6% (<0.0001), HDL-C increased by 8.0% (<0.0001), and LDL-C fell by 12.7% (<0.0001). Similar results were observed in patients treated with statins and those who were not. Frequency of walking (>30 min) increased from 59.3% to 78.3% (p < 0.0001). The overweight rate decreased from 22.8% to 17.5% (p < 0.0001) and waist circumference from 94.6 ± 13.3 cm to 93.0 ± 12.8 cm (p < 0.0001). Nutritional Lifestyles and other lifestyle markers' improvement were parallel to adherence to Phyto-SY adherence.

CONCLUSION

Improvements in Nutritional Lifestyle scores, which included regular consumption of Phyto-SY over 4 months, was significantly linked to healthier lifestyles and to beneficial modifications in atherogenic lipid profiles, which reflected patient empowerment in a 'real life' context.

Dietary modulators of statin efficacy in cardiovascular disease and cognition

Cardiovascular disease remains the leading cause of morbidity and mortality in the United States and other developed countries, and is fast growing in developing countries, particularly as life expectancy in all parts of the world increases. Current recommendations for the prevention of cardiovascular disease issued jointly from the American Academy of Cardiology and American Heart Association emphasize that lifestyle modification should be incorporated into any treatment plan, including those on statin drugs. However, there is a dearth of data on the interaction between diet and statins with respect to additive, complementary or antagonistic effects. This review collates the available data on the interaction of statins and dietary patterns, cognition, genetics and individual nutrients, including vitamin D, niacin, omega-3 fatty acids, fiber, phytochemicals (polyphenols and stanols) and alcohol. Of note, although the available data is summarized, the scope is limited, conflicting and disparate. In some cases it is likely there is unrecognized synergism. Virtually no data are available describing the interactions of statins with dietary components or dietary pattern in subgroups of the population, particularly those who may benefit most were positive effects identified. Hence, it is virtually impossible to draw any firm conclusions at this time. Nevertheless, this area is important because were the effects of statins and diet additive or synergistic harnessing the effect could potentially lead to the use of a lower intensity statin or dose.

Current Treatment of Familial Hypercholesterolaemia

Familial hypercholesterolaemia is an autosomal-dominant disorder associated with mutations in the LDL receptor gene resulting in markedly elevated plasma low-density lipoprotein cholesterol levels. FH is significantly underrecognised with as many as 1 in 300 having the heterozygous form and 1 in 1 million having the homozygous form of the disease. Early diagnosis and treatment of FH is paramount to reduce the risk of premature atherosclerotic cardiovascular disease and death. The goal of treatment is to reduce LDL-C by 50 % from baseline levels with lifestyle modification, pharmacologic lipid-lowering therapy, LDL apheresis and in rare cases, liver transplantation. Pharmacologic treatment ranges from statin medications to newer agents such as lomitapide, mipomersin and PCSK9 inhibitors. Combination therapy is frequently required to achieve goal lipoprotein level reductions and prevent complications.

Combining functional features of whole-grain barley and legumes for dietary reduction of cardiometabolic risk: a randomised cross-over intervention in mature women

The usefulness of dietary strategies against cardiometabolic risk is increasingly being acknowledged. Legumes and whole grains can modulate risk markers associated with cardiometabolic diseases, but their possible additive/synergistic actions are unknown. The objective of the present study was to assess, in healthy subjects, the effect of a diet including specific whole-grain barley products and legumes with prior favourable outcomes on cardiometabolic risk parameters in semi-acute studies. A total of forty-six overweight women (50–72 years, BMI 25–33 kg/m2and normal fasting glycaemia) participated in a randomised cross-over intervention comparing a diet rich in kernel-based barley products, brown beans and chickpeas (D1, diet 1 (functional diet)) with a control diet (D2, diet 2 (control diet)) of similar macronutrient composition but lacking legumes and barley. D1 included 86 g (as eaten)/d brown beans, 82 g/d chickpeas, 58 g/d whole-grain barley kernels and 216 g/d barley kernel bread. Both diets followed the Nordic Nutrition Recommendations, providing similar amounts of dietary fibre (D1: 46·9 g/d; D2: 43·5 g/d), with wheat-based products as the main fibre supplier in D2. Each diet was consumed for 4 weeks under weight-maintenance conditions. Both diets decreased serum total cholesterol, LDL-cholesterol and HDL-cholesterol levels, but D1 had a greater effect on total cholesterol and LDL-cholesterol levels (P< 0·001 andP< 0·05, respectively). D1 also reduced apoB (P< 0·001) and γ-glutamyl transferase (P< 0·05) levels, diastolic blood pressure (P< 0·05) and the Framingham cardiovascular risk estimate (P< 0·05). D1 increased colonic fermentative activity, as judged from the higher (P< 0·001) breath hydrogen levels recorded. In conclusion, a specific barley/legume diet improves cardiometabolic risk-associated biomarkers in a healthy cohort, showing potential preventive value beyond that of a nutritionally well-designed regimen.

Effects of soya oligosaccharides and soya oligopeptides on lipid metabolism in hyperlipidaemic rats

In the present study, we aimed to examine the effects of soya oligosaccharides (SOS) and soya oligopeptides (SOP) on blood lipid levels, release of vasoactive substances, antioxidant activity and faecal bile acid (FBA) excretion in rats fed a high-fat diet (HFD). Male Sprague-Dawley rats were evenly divided into five groups according to diets as follows: regular diet (control), HFD, HFD enriched with 2 % of SOS (SOS), HFD enriched with 3 % of SOP (SOP) and HFD enriched with 2 % SOS and 3 % SOP (SOSP). The results showed that SOS and SOP significantly reduced plasma total cholesterol, LDL-cholesterol and TAG, whereas HDL-cholesterol concentration was significantly increased. Furthermore, SOS and SOP reduced plasma apoB, apoE and the apoB:apoAI ratio, whereas apoAI was significantly increased. Moreover, SOS and SOP also reduced plasma thromboxane A₂ (TXA₂) and the TXA₂:prostacyclin (PGI₂) ratio, whereas plasma PGI₂ and nitric oxide were significantly increased. In addition, SOS and SOP significantly reduced serum and liver malondialdehyde concentrations and increased FBA excretion. However, we did not observe obvious influences of SOS and SOP on superoxide dismutase activities in the liver of HFD-fed rats. The combination of 2 % SOS and 3 % SOP showed a more marked effect than SOS or SOP alone in improving the lipid profile, release of vasoactive substances and increasing FBA excretion (P < 0.05). In summary, SOS and SOP might help prevent atherosclerosis through improving abnormal blood lipid levels, regulating vasoactive substances and protecting against oxidative stress.

Self-assembled nanostructures of fully hydrated monoelaidin-elaidic acid and monoelaidin-oleic acid systems

In recent years, there has been a surge of interest in exploring the effect of trans-fatty acids (TFAs) on biological membrane properties. The research studies are motivated by an increasing body of evidence suggesting that the consumption of TFAs increases the risk of developing negative health effects such as coronary heart disease and cancer. The ultimate goal of studying the lipid-fatty acid interactions at the molecular level is to predict the biological role of fatty acids in cells. In this regard, it is interesting to elucidate the effect of loading TFAs and their counterpart cis-fatty acids (CFAs) on the physical properties of lipid model membranes. Here, the present study focuses on discussing the following: (1) the effect of mixing monoelaidin (ME, TFA-containing lipid) with its counterpart monoolein (MO, CFA-containing lipid) on modulating the fully hydrated self-assembled structure, and (2) the influence of solubilizing oleic acid (OA) and its trans counterpart elaidic acid (EA) on the fully hydrated ME system. The ME model membrane was selected due to its sensitivity to variations in lipid composition and temperature. Synchrotron small-angle X-ray scattering (SAXS) was applied for studying the temperature-dependent structural behavior of the fully hydrated ME/MO-based system prepared with an equal ME/MO weight ratio and also for characterizing the fully hydrated OA- and EA-loaded ME systems. Wide-angle X-ray (WAXS) experiments were also performed for characterizing the formed crystalline lamellar phases at ambient temperatures. The results demonstrate the significant influence of the partial replacement of ME by MO on the phase behavior. The addition of MO induces the lamellar-nonlamellar phase transitions at ambient temperatures and promotes the formation of the inverted type hexagonal (H(2)) phase above 72 °C. The fully hydrated ME/EA and ME/OA systems with their rich polymorphism exhibit an interesting temperature-dependent complex behavior. The experimental findings show that the temperature-induced phase transitions are dictated by the solubilized fatty acid concentration and its configuration. Both EA and OA have a significant impact on the fully hydrated ME system. Similar to previous published studies, OA induces a significantly stronger mean negative membrane curvature as compared to EA. The two phase diagrams are discussed in terms of water-lipid and lipid-fatty acid interactions, membrane bending, and lipid packing concepts. A newly observed interesting epitaxial relationship for the lamellar-hexagonal phase transition in the EA-loaded ME system is illustrated and discussed in detail.

Miscellaneous non-inflammatory musculoskeletal conditions. Rare thesaurismosis and xanthomatosis

The focus will be on xanthomatosis, a tissue danger signal which needs to be recognized by the clinician, and its relationship with monogenetic lipoprotein disorders (cholesterol, triglycerides), bile acid and sterol metabolism, particularly on metabolic pathways and genetics as well as on musculoskeletal and cardiovascular involvement, and their implications for clinical management. The critical question is to assess coronary heart disease risk, requiring correct identification of the pattern of lipoprotein disorders and of the causes (primary or secondary). Familial hypercholesterolemia must be suspected in adults and children with raised total cholesterol, especially when there is a personal or a family history of premature coronary heart disease, usually requiring potent statins to achieve adequate LDL-cholesterol lowering, even if we do not know safety of long-term therapy and whether treatments of dyslipidemia early in life prevent cardiovascular diseases in adulthood. Cerebrotendinous xanthomatosis is a treatable disease and must be suspected if there is a history of infantile chronic diarrhea and/or juvenile cataracts, even in the absence of tendon xanthomas. Current evidence for the prevention and screening, diagnosis, and treatment of dyslipidemia are available for the clinicians.

Antiglycation and antioxidant properties of soy sauces

Diabetes-induced hyperglycemia increases formation of advanced glycation end products (AGEs) and metal-catalyzed production of free radicals. This study compared the antioxidant capacities of dark and light soy sauces of different brands and investigated their abilities to inhibit AGEs and whether their mechanism of action was pre- or post-Amadori or involved chelation of transition metals. The antioxidant capacities of soy sauces were compared using the 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonate) method and by measuring their total phenolic contents. Model proteins (lysozyme, albumin) were glycated using fructose with or without soy sauces with subsequent analysis of cross-linked AGEs by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The effect of soy sauces on pre- and post-Amadori inhibition of AGEs was investigated by measuring fructosamine and AGEs following reincubation of ribose-glycated (ribated) lysozyme, respectively. Dark soy sauces had higher antioxidant capacities and phenolic content and were more effective inhibitors of post-Amadori-derived cross-linked AGEs. However, light soy sauces were more effective at inhibiting fructosamine and had more potent metal chelation properties. This study reports the antiglycation properties of soy sauces, but further studies are required to determine the constituents responsible for this effect and whether soy sauce consumption can reduce oxidative stress and AGEs in diabetic subjects.