Summary of the scientific conference on dietary fatty acids and cardiovascular health: conference summary from the nutrition committee of the American Heart Association

Evaluating 12 Years of Implementing a Multidisciplinary Specialist Child and Adolescent Obesity Treatment Service: Patient-Level Outcomes

Introduction

Childhood obesity is a chronic disease that requires multidisciplinary and specialist intervention to address its complex pathophysiology, though access to treatment is limited globally. Evaluating the impact of evidence-based interventions implemented in real-world clinical settings is essential, in order to increase the translation of research into practice and enhance child health outcomes. In Ireland, the National Model of Care for Obesity highlighted the need to develop and improve healthcare services for children and adolescents with obesity.

Aims

This study aims to evaluate the impact of a family-based, Tier 3 multi-disciplinary child and adolescent obesity outpatient service (www.w82go.ie) on standardized body mass index (BMI-SDS).

Methods

Following referral by pediatricians, patients were assessed by a pediatric multidisciplinary team (physiotherapist, dietician, and psychologist) and personalized obesity treatment plans were developed. Anthropometric and demographic information were recorded at baseline and final visit. Descriptive statistics were used to explore distribution, central tendency and variation in the demographic data, change in BMI-SDS over time was assessed using a t-test, and multiple linear regression analysis was used to investigate the association of demographic factors on the change in BMI-SDS.

Results

The overall mean BMI-SDS reduction across the whole cohort (n = 692) was −0.17 (95% CI = −0.20, −0.13; P < 0.001). Younger age at admission and longer duration of treatment were associated with greater BMI-SDS reduction but there was no significant association between change in BMI-SDS and any of the other parameters (deprivation score, treatment type, sex, obesity category at admission or presence of comorbid condition).

Conclusion

Engagement in a specialist Tier 3 pediatric obesity service was associated with reductions in BMI-SDS in children and adolescents with obesity.

Immunocastration in Gilts: A Preliminary Study of the Effect of the Second Dose Administration Time on Growth, Reproductive Tract Development, and Carcass and Meat Quality

Simple Summary

Nowadays, a significant proportion of pig carcasses destined to high-quality dry-cured ham elaboration are declared unsuitable for this purpose. The main reason is the lack of backfat thickness, affecting females in particular because males are castrated. Moreover, the estrus in gilts is undesirable because it carries out productive losses. Immunocastration could resolve these problems. The protocol of immunocastration in white-breed gilts is not well established, especially in terms of the second injection. Therefore, the objective of the current trial was to evaluate the impact of immunocastration and to determine the optimum time for the second dose application in gilts intended for dry-cured ham production. In this trial, we concluded that gilt immunocastration is positive, increasing carcass fatness and decreasing reproductive tract development. Moreover, the optimum time to administer the second dose of immunocastration for this type of gilt seems to be between 9 and 12 weeks before sacrifice.

Abstract

Increasing fatness and avoiding puberty are desirable in gilts intended for high-quality dry-cured ham production. A total of 48 Duroc x (Landrace x Large White) females of 26.5 ± 3.70 kg body weight (BW) were used to evaluate the impact of immunocastration and to find the optimum application time of the second dose for immunocastration on growth; sex hormones; reproductive tract development; and carcass, meat, and fat quality. Gilts were allocated to four experimental treatments (n = 12): control (entire gilts, EG) and immunocastrated gilts (IG), providing the second dose at 12, 9, or 7 weeks before slaughter (with approximately 60, 75, or 90 kg BW, respectively). Mean slaughter BW was 125 kg. Immunocastrated gilts had lighter reproductive tracts and greater fat thickness than EG. Fat from IG was more saturated and less polyunsaturated than that from EG. Numerically, gilts immunocastrated 9 and 12 weeks before slaughter presented higher fatness than those immunocastrated 7 weeks before slaughter. In conclusion, immunocastration is a good strategy to improve the fatness of gilts destined to dry-cured ham elaboration, with the optimum time for the second dose application seemingly between 9 and 12 weeks before slaughter.

Alternative Protein Sources vs. GM Soybean Meal as Feedstuff for Pigs-Meat Quality and Health-Promoting Indicators

This study aimed to explain the possibility of partial replacement of genetically-modified soybean meal (SBM GM) with pea seeds and rapeseed meal (RSM) in complete feed mixtures for growing-finishing pigs and to determine its impact on meat quality and health-promoting indices. The pigs (n = 50) were randomly divided into five groups, 10 animals each (gilts and barrows, 1:1, 3-breed: ♀ (landrace × yorkshire) × ♂ duroc), including the control group (C) and four experimental groups (E1, E2, E3, E4), and fed complete feed mixtures. The SBM GM was the only protein source in feed mixtures for control pigs. In feed mixtures for E1-E4 groups, it was partially replaced with pea seed doses of 5.0%, 10.0%, 15.0%, and 17.5% in groups E1, E2, E3, and E4, respectively. The feed mixtures were iso-energetic and iso-protein. After completed fattening, the animals were slaughtered. M. longissimus lumborum was sampled for analyses of the chemical and physical traits. The fatty acid profile determined in intramuscular fat (IMF) was used to compute the values of the health-promoting indices. The chemical and physical characteristics of meat were comparable in all groups. The study showed a dietetically-beneficial decrease in the values of atherogenicity index (AI), thrombogenicity index (TI), and saturation (S/P) in the meat of the experimental pigs vs. control group. The values of most of the analyzed quality attributes of pork justify using alternative protein sources as partial SBM GM replacers in diets for growing-finishing pigs in sustainable animal production.

Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome

The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.

Monosodium L-glutamate and fats change free fatty acid concentrations in intestinal contents and affect free fatty acid receptors express profile in growing pigs

Background

Obesity and its related metabolic syndrome continue to be major public health problems. Monosodium L-glutamate (MSG) may cause metabolic diseases such as obesity. Meanwhile, the Chinese population has undergone rapid transition to a high-fat diet. There is little information available on the effect of MSG and fat alone, or in combination, on free fatty acids (FFAs), lipid metabolism and FFA receptors.

Objective

The aim of this study was to evaluate the effects of MSG and fat alone, or in combination, on intestinal luminal FFAs and expression of gastrointestinal FFA receptors. The aim was also to test whether dietary fat and/or MSG could affect expression of genes related to fatty acid metabolism.

Design

A total of 32 growing pigs were used and fed with four iso-nitrogenous and iso-caloric diets. Pigs in the four treatments received diets with one of two fat concentrations levels (4.4 and 9.4%) and one of two MSG dose levels (0 and 3%), in which most of the fat were brought by soybean oil. The concentration of short chain fatty acids (SCFAs) in cecum and colon, long chain fatty acids (LCFAs) in ileum, cecum and colon, and FFAs receptors expression in hypothalamus and gastrointestinal tract were determined.

Results

MSG and/or fat changed intestinal luminal SCFAs, levels of LCFAs, and showed an antagonistic effect on most of LCFAs. Simultaneously, MSG and/or fat decreased the expression of FFA receptors in hypothalamus and gastrointestinal tract. MSG and/or fat promoted fat deposition through different ways in back fat.

Conclusion

Our results support that MSG and/or fat can alter intestinal luminal FFAs composition and concentration, especially LCFAs, in addition, the expression of FFA receptors in ileum and hypothalamus could be decreased. Moreover, MSG and/or fat can promote protein deposition in back fat, and affect the distribution and metabolism of fatty acids in the body tissues and the body’s ability to perceive fatty acids; these results provide a reference for the occurrence of fat deposition and obesity caused by high-fat and monosodium glutamate diet.

Smokers report lower intake of key nutrients than nonsmokers, yet both fall short of meeting recommended intakes

Smoking is a major risk factor in the development of preventable disease which may be due to a poorer diet and the reduced nutrient intake of smokers. Our objective was to compare and evaluate the reported intake of current smokers with that of nonsmokers among participants of a study evaluating stress and smoking. We hypothesized (1) that overall energy and nutrient intake would be reduced in smokers compared with nonsmokers and (2) that smokers would have increased noncompliance with Dietary Reference Intakes (DRIs). Men and women (smokers n=138, nonsmokers n=46) completed a 3-day diet record at baseline. Mean energy and nutrient intakes were stratified by smoking status and compared with DRI levels. The mean body mass index was 28.3±0.5kg/m2 for smokers and 27.2±1.0kg/m2 for nonsmokers. Compared with nonsmokers, the smokers reported lower intakes of energy, total polyunsaturated fatty acids, linolenic acid, docosahexaenoic acid, total sugars, calcium, iron, magnesium, phosphorus, potassium, vitamin C, riboflavin, niacin, pantothenic acid, vitamin B6, folate, vitamin A, and vitamin E. Smokers reported reduced compliance with the DRIs for iron, phosphorus, vitamin C, riboflavin, and folate compared with nonsmokers. Unlike other evaluations of smokers vs nonsmokers, we observed no difference in body weight between groups. Smokers and nonsmokers alike reported dietary intakes lower than the DRIs for many nutrients. However, the reported nutrient intake of the smokers was substantially lower than nonsmokers for key nutrients, and they were more likely to not comply with the DRIs for essential nutrients, placing them at increased risk of chronic disease.

Rheology of Emulsion-Filled Gels Applied to the Development of Food Materials

Emulsion-filled gels are classified as soft solid materials and are complex colloids formed by matrices of polymeric gels into which emulsion droplets are incorporated. Several structural aspects of these gels have been studied in the past few years, including their applications in food, which is the focus of this review. Knowledge of the rheological behavior of emulsion-filled gels is extremely important because it can measure interferences promoted by droplets or particle inclusion on the textural properties of the gelled systems. Dynamic oscillatory tests, more specifically, small amplitude oscillatory shear, creep-recovery tests, and large deformation experiments, are discussed in this review as techniques present in the literature to characterize rheological behavior of emulsion-filled gels. Moreover, the correlation of mechanical properties with sensory aspects of emulsion-filled gels appearing in recent studies is discussed, demonstrating the applicability of these parameters in understanding mastication processes.

Review: Obesity and cardiometabolic syndrome in children

The cardiometabolic syndrome is highly prevalent among overweight youth. The risk of developing the cardiometabolic syndrome is likely triggered or exacerbated by concurrent obesity, unhealthy lifestyle/eating habits, and hormonal changes (puberty). Current screening recommendations include measurement of blood pressure, fasting insulin and glucose, and total cholesterol. However, limiting assessments to these measures underestimates cardiometabolic risk in overweight youth, particularly minorities. Early identification of cardiometabolic risk in its incipient stages may justify early and more aggressive intervention to prevent progression and complications. This review provides rationale for additional assessments to determine cardiometabolic risk in overweight youth and recommends treatment options.

Do Negative Emotions Predict Alcohol Consumption, Saturated Fat Intake, and Physical Activity in Older Adults?

This study examined anger, depression, and stress as related to alcohol consumption, saturated fat intake, and physical activity. Participants were 23 older adults enrolled in either an outpatient or in-residence executive health program. Participants completed (a) a health-risk appraisal assessing medical history and current health habits, (b) the State-Trait Anger Expression Inventory (STAXI), and (c) the Center for Epidemiological Studies-Depression Questionnaire. Bivariate correlations revealed that anxiety was negatively correlated with alcohol consumption. High levels of depression, trait anger, and outward anger expression style were positively associated with saturated fat intake. Trait anger was also associated with less aerobic exercise. Inward anger expression was positively correlated with regular participation in strength training. Results suggest that anger, anger expression style, and depression interact with healthy and unhealthy behavior patterns and that these interactions may be complex.

Dietary intake of fats and fatty acids in the Korean population: Korea National Health and Nutrition Examination Survey, 2013

BACKGROUND/OBJECTIVES

The aim of this study was to estimate average total fat and fatty acid intakes as well as identify major food sources using data from the Korea National Health and Nutrition Examination Survey (KNHANES) VI-1 (2013).

SUBJECTS/METHODS

Total fat and fatty acid intakes were estimated using 24-hour dietary recall data on 7,048 participants aged ≥ 3 years from the KNHANES VI-1 (2013). Data included total fat, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), n-3 fatty acid (n-3 FA), and n-6 fatty acid (n-6 FA) levels. Population means and standard errors of the mean were weighted in order to produce national estimates and separated based on sex, age, income, as well as residential region. Major food sources of fat, SFA, MUFA, PUFA, n-3 FA, and n-6 FA were identified based on mean consumption amounts of fat and fatty acids in each food.

RESULTS

The mean intake of total fat was 48.0 g while mean intakes of SFA, MUFA, PUFA, n-3 FA, and n-6 FA were 14.4 g, 15.3 g, 11.6 g, 1.6 g, and 10.1 g, respectively. Intakes of MUFA and SFA were each higher than that of PUFA in all age groups. Pork was the major source of total fat, SFA, and MUFA, and soybean oil was the major source of PUFA. Milk and pork were major sources of SFA in subjects aged 3-11 years and ≥ 12 years, respectively. Perilla seed oil and soybean oil were main sources of n-3 FA in subjects aged ≥ 50 years and aged < 50 years, respectively.

CONCLUSIONS

Estimation of mean fatty acid intakes of this study using nationally represented samples of the Korean population could be useful for developing and evaluating national nutritional policies.

Hypolipidemic activity of Taraxacum mongolicum associated with the activation of AMP-activated protein kinase in human HepG2 cells

This study investigated the hypolipidemic effect and potential mechanisms of T. mongolicum extracts. T. mongolicum was extracted by refluxing three times with water (TM-1), 50% ethanol (TM-2) and 95% ethanol (TM-3). TM-2 contained components with the most effective hypolipidemic potentials in HepG2 cells. Extended administration of TM-2 stimulated a significant reduction in body weight and levels of serum triglyceride LDL-C and total cholesterol in rats. To evaluate the bioactive compounds, we successively fractionated TM-2 with n-hexane (TM-4), dichloromethane (TM-5), ethyl acetate (TM-6), and water (TM-7). TM-4 fraction had the most effective hypolipidemic potential in HepG2 cells, and it decreased the expression of fatty acid synthase (FASN) and inhibited the activity of acetyl-coenzyme A carboxylase (ACC) through the phosphorylation of AMP-activated protein kinase (AMPK). Linoleic acid, phytol and tetracosanol are bioactive compounds identified from TM-4. These results suggest that T. mongolicum is expected to be useful for hypolipidemic effects.

South Asian Ethnicity and Cardiovascular Risk

South Asians (SAs), in their countries or after migration, are at high risk of coronary artery disease (CAD) and mortality compared to other ethnic groups. It has been shown that >90% of CAD global risk could be attributed to 9 modifiable risk factors (RFs) worldwide. However, these conventional RFs may not fully explain this high risk of CAD among SAs. Therefore, attention has been directed toward nonconventional RFs. In this narrative review, we evaluate the conventional and emerging cardiovascular RFs characterizing SAs. These factors may explain the high morbidity and mortality among SAs. Further prospective studies are urgently needed to set algorithms for the optimal management of these RFs in high-risk populations like SAs.

Intake of Tibetan hull-less barley is associated with a reduced risk of metabolic related syndrome in rats fed high-fat-sucrose diets

The objective of this study was to assess the effects of whole grain Tibetan hull-less barley on metabolic related syndrome induced by high-fat-sucrose diets in rats. The diets were designed to reflect the dietary patterns of Chinese individuals (>30% energy fat) with refined wheat flour (HFS-W) or Tibetan hull-less barley (HFS-THB) as the main carbohydrate sources. Rats fed HFS-W had increased body weight, abdominal fat deposition, liver weight, liver fat deposition, triglyceride (TG), fasting blood glucose (FBG), serum fasting insulin (FINS), and homeostasis model assessment of insulin resistance (HOMA-IR) scores, and decreased low-density lipoprotein cholesterol (LDL-C) levels compared to rats fed a basal diet (BD). However, rats fed HFS-THB had reduced body weight gain, dyslipidemia, and insulin resistance. These findings indicate that whole Tibetan hull-less barley is a functional food that can reduce the prevalence of metabolic related syndrome induced by high-fat-sucrose diets.

The health behavior of Sri Lankan Buddhist nuns with type 2 diabetes: duty, devotion, and detachment

Sri Lanka has experienced an increase in the rate of type 2 diabetes. Selfmanagement of diabetes among Sri Lanka's Buddhist nuns, who depend on food donations and limit physical activity in accord with the monastic code of conduct, presents unique challenges and has not been previously studied. The purpose of this focused ethnographic study of 10 Buddhist nuns was to understand how they managed their illness within the restrictions on diet and physical activity. Three themes-duty, devotion, and detachment-explained and described their health behavior regarding type 2 diabetes within the context of their daily routines and obligations.

Immunomodulation by dietary long chain omega-3 fatty acids and the potential for adverse health outcomes

Recommendations to consume fish for prevention of cardiovascular disease (CVD), along with the U.S. Food and Drug Administration-approved generally recognized as safe (GRAS) status for long chain omega-3 fatty acids, may have had the unanticipated consequence of encouraging long-chain omega-3 (ω-3) fatty acid [(eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] supplementation and fortification practices. While there is evidence supporting a protective role for EPA/DHA supplementation in reducing sudden cardiac events, the safety and efficacy of supplementation with LCω-3PUFA in the context of other disease outcomes is unclear. Recent studies of bacterial, viral, and fungal infections in animal models of infectious disease demonstrate that LCω-3PUFA intake dampens immunity and alters pathogen clearance and can result in reduced survival. The same physiological properties of EPA/DHA that are responsible for the amelioration of inflammation associated with chronic cardiovascular pathology or autoimmune states, may impair pathogen clearance during acute infections by decreasing host resistance or interfere with tumor surveillance resulting in adverse health outcomes. Recent observations that high serum LCω-3PUFA levels are associated with higher risk of prostate cancer and atrial fibrillation raise concern for adverse outcomes. Given the widespread use of supplements and fortification of common food items with LCω-3PUFA, this review focuses on the immunomodulatory effects of the dietary LCω-3PUFAs, EPA and DHA, the mechanistic basis for potential negative health outcomes, and calls for biomarker development and validation as rational first steps towards setting recommended dietary intake levels.

Differences in Selected Lifestyle Risk Factors for Cardiovascular Disease Between Sri Lankans in Oslo, Norway, and in Kandy, Sri Lanka

Sri Lankans in Oslo have previously been shown to have lower risk of cardiovascular disease compared with those in Kandy, Sri Lanka. Here we present lifestyle risk factors for cardiovascular diseases: frequency and type of fat consumed, frequency of fruit and vegetable intake, alcohol consumption, and leisure time physical activity between 1145 Sri Lankans living in Oslo and 678 Tamils and Sinhalese Sri Lankans living in Kandy as possible explanatory factors for the differences observed. Those in Oslo were consuming healthier fats and reported higher levels of physical activity but frequency of vegetable and fruit consumption was lower. Alcohol consumption among women was negligible. Type of fats consumed might be protective for Oslo group compared with predominantly saturated fat diet in Kandy. Higher leisure time physical activity may also be protective for the Oslo group. Higher frequency of consumption of vegetables and fruits may be beneficial in Kandy.

Lipase-catalysed interesterification between canola oil and fully hydrogenated canola oil in contact with supercritical carbon dioxide

The processing parameters in enzymatic reactions using CO2-expanded (CX) lipids have strong effects on the physical properties of liquid phase, degree of interesterification, and physicochemical properties of the final reaction products. CX-canola oil and fully hydrogenated canola oil (FHCO) were interesterified using Lipozyme TL IM in a high pressure stirred batch reactor. The effects of immobilised enzyme load, pressure, substrate ratio and reaction time on the formation of mixed triacylglycerols (TG) from trisaturated and triunsaturated TG were investigated. The optimal immobilised enzyme load, pressure, substrate ratio and time for the degree of interesterification to reach the highest equilibrium state were 6% (w/v) of initial substrates, 10 MPa, blend with 30% (w/w) of FHCO and 2h, respectively. The physicochemical properties of the initial blend and interesterified products with different FHCO ratios obtained at optimal reaction conditions were determined in terms of TG composition, thermal behaviour and solid fat content (SFC). The amounts of saturated and triunsaturated TG decreased while the amounts of mixed TG increased as a result of interesterification. Thus, the interesterified product had a lower melting point, and broader melting and plasticity ranges compared to the initial blends. These findings are important for better understanding of CX-lipid reactions and for optimal formulation of base-stocks of margarine and confectionary fats to meet industry demands.

Evidence of lifestyle modification in the management of hypercholesterolemia

BACKGROUND

Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide. The growth of ageing populations in developing countries with progressively urbanized lifestyles are major contributors. The key risk factors for CHD such as hypercholesterolemia, diabetes mellitus, and obesity are likely to increase in the future. These risk factors are modifiable through lifestyle.

OBJECTIVES

To review current literature on the potential benefit of cholesterol lowering in CHD risk reduction with a particular focus on the evidence of non-pharmacological/lifestyle management of hypercholesterolemia.

METHODS

Medline/PubMed systematic search was conducted using a two-tier approach limited to all recent English language papers. Primary search was conducted using key words and phrases and all abstracts were subsequently screened and relevant papers were selected. The next tier of searching was conducted by (1) reviewing the citation lists of the selected papers and (2) by using PubMed weblink for related papers. Over 3600 reports were reviewed.

RESULTS

Target cholesterol levels set out in various guidelines could be achieved by lifestyle changes, including diet, weight reduction, and increased physical activity with the goal of reducing total cholesterol to <200 mg/dL and LDL-C<100 mg/dL. Various dietary constituents such as green tea, plant sterols, soy protein have important influences on total cholesterol. Medical intervention should be reserved for those patients who have not reached this goal after 3 months of non-pharmacological approach.

CONCLUSION

CHD remains as a leading cause of death worldwide and hypercholesterolemia is an important cause of CHD. Non-pharmacological methods provide initial as well as long-term measures to address this issue.

Investigations of human platelet-type 12-lipoxygenase: role of lipoxygenase products in platelet activation

Human platelet-type 12-lipoxygenase (12-LOX) has recently been shown to play an important role in regulation of human platelet function by reacting with arachidonic acid (AA). However, a number of other fatty acids are present on the platelet surface that, when cleaved from the phospholipid, can be oxidized by 12-LOX. We sought to characterize the substrate specificity of 12-LOX against six essential fatty acids: AA, dihomo-γ-linolenic acid (DGLA), eicosapentaenoic acid (EPA), α-linolenic acid (ALA), eicosadienoic acid (EDA), and linoleic acid (LA). Three fatty acids were comparable substrates (AA, DGLA, and EPA), one was 5-fold slower (ALA), and two showed no reactivity with 12-LOX (EDA and LA). The bioactive lipid products resulting from 12-LOX oxidation of DGLA, 12-(S)-hydroperoxy-8Z,10E,14Z-eicosatrienoic acid [12(S)-HPETrE], and its reduced product, 12(S)-HETrE, resulted in significant attenuation of agonist-mediated platelet aggregation, granule secretion, αIIbβ3 activation, Rap1 activation, and clot retraction. Treatment with DGLA similarly inhibited PAR1-mediated platelet activation as well as platelet clot retraction. These observations are in surprising contrast to our recent work showing 12(S)-HETE is a prothrombotic bioactive lipid and support our hypothesis that the overall effect of 12-LOX oxidation of fatty acids in the platelet is dependent on the fatty acid substrates available at the platelet membrane.

Energy intake and leukocyte telomere length in young adults

BACKGROUND

Dietary energy restriction in mammals, particularly at a young age, extends the life span. Leukocyte telomere length (LTL) is thought to be a bioindicator of aging in humans. High n-6 (omega-6) PUFA intake may accelerate LTL attrition.

OBJECTIVE

We determined whether lower energy and higher PUFA intakes in young adulthood are associated with shorter LTL in cross-sectional and longitudinal analyses.

DESIGN

In a longitudinal observational study (405 men, 204 women), diet was determined at baseline by a semiquantitative food-frequency questionnaire, and LTL was determined by Southern blots at mean ages of 30.1 y (baseline) and 43.2 y (follow-up). Spearman correlations and multivariable linear regression were used.

RESULTS

Baseline energy intake was inversely associated with follow-up LTL in men (standardized β = -0.171, P = 0.0005) but not in women (P = 0.039 for sex interaction). The difference in men between the highest and lowest quintiles of energy was 244 base pairs (bp) (95% CI: 59, 429 bp) and between extreme quintiles of LTL was 440 kcal (95% CI: 180, 700 kcal). Multivariable adjustment modestly attenuated the association (β = -0.157, P = 0.002). Inverse associations, which were noted for all macronutrients, were strongest for the unsaturated fatty acids. In multivariable models including energy and the macronutrients (as percentage of energy), the significant inverse energy-LTL association (but not the PUFA-LTL association) persisted. The energy-LTL association was restricted to never smokers (standardized β = -0.259, P = 0.0008; P = 0.050 for the smoking × calorie interaction).

CONCLUSIONS

The inverse calorie intake-LTL association is consistent with trial data showing beneficial effects of calorie restriction on aging biomarkers. Further exploration of energy intake and LTL dynamics in the young is needed.

Mediterranean-style diet and risk of ischemic stroke, myocardial infarction, and vascular death: the Northern Manhattan Study

BACKGROUND

A dietary pattern common in regions near the Mediterranean appears to reduce risk of all-cause mortality and ischemic heart disease. Data on blacks and Hispanics in the United States are lacking, and to our knowledge only one study has examined a Mediterranean-style diet (MeDi) in relation to stroke.

OBJECTIVE

In this study, we examined an MeDi in relation to vascular events.

DESIGN

The Northern Manhattan Study is a population-based cohort to determine stroke incidence and risk factors (mean ± SD age of participants: 69 ± 10 y; 64% women; 55% Hispanic, 21% white, and 24% black). Diet was assessed at baseline by using a food-frequency questionnaire in 2568 participants. A higher score on a 0-9 scale represented increased adherence to an MeDi. The relation between the MeDi score and risk of ischemic stroke, myocardial infarction (MI), and vascular death was assessed with Cox models, with control for sociodemographic and vascular risk factors.

RESULTS

The MeDi-score distribution was as follows: 0-2 (14%), 3 (17%), 4 (22%), 5 (22%), and 6-9 (25%). Over a mean follow-up of 9 y, 518 vascular events accrued (171 ischemic strokes, 133 MIs, and 314 vascular deaths). The MeDi score was inversely associated with risk of the composite outcome of ischemic stroke, MI, or vascular death (P-trend = 0.04) and with vascular death specifically (P-trend = 0.02). Moderate and high MeDi scores were marginally associated with decreased risk of MI. There was no association with ischemic stroke.

CONCLUSIONS

Higher consumption of an MeDi was associated with decreased risk of vascular events. Results support the role of a diet rich in fruit, vegetables, whole grains, fish, and olive oil in the promotion of ideal cardiovascular health.

Application of the BRAFO tiered approach for benefit-risk assessment to case studies on dietary interventions

The respective examples, described in this paper, illustrate how the BRAFO-tiered approach, on benefit-risk assessment, can be tested on a wide range of case studies. Various results were provided, ranging from a quick stop as the result of non-genuine benefit-risk questions to continuation through the tiers into deterministic/probabilistic calculations. The paper illustrates the assessment of benefits and risks associated with dietary interventions. The BRAFO tiered approach is tested with five case studies. In each instance, the benefit-risk approach is tested on the basis of existing evaluations for the individual effects done by others; no new risk or benefit evaluations were made. The following case studies were thoroughly analysed: an example of food fortification, folic acid fortification of flour, macronutrient replacement/food substitution; the isocaloric replacement of saturated fatty acids with carbohydrates; the replacement of saturated fatty acids with monounsaturated fatty acids; the replacement of sugar-sweetened beverages containing mono- and disaccharides with low calorie sweeteners and an example of addition of specific ingredients to food: chlorination of drinking water.

Efficacy of silkworm (Bombyx mori L.) chrysalis oil as a lipid source in adult Wistar rats

The effects of silkworm chrysalis oil, rich in n-3 α-linolenic acid (ALA), on lipid metabolism in Wistar rats were investigated. The rats were fed diets containing 7% soybean oil (control), silkworm chrysalis oil (SWO), or fish oil (FO) for 8weeks. Plasma triglyceride and glucose levels were significantly lower in the SWO group after 8weeks compared to the control and FO groups. The total cholesterol and blood urea nitrogen levels were higher in the control group than in the SWO and FO groups at 8weeks post-consumption. However, aspartate amino transferase and alanine amino transferase levels were not significantly different among all groups. A higher arachidonic acid (AA) content was detected in the control group, while lower AA levels were observed with the increase in EPA and DHA in the SWO and FO groups. These results suggest that n-3 α-linolenic acid-rich silkworm chrysalis oil can improve hyperlipidaemia and hyperglycaemia.

Adherence to an (n-3) fatty acid/fish intake pattern is inversely associated with metabolic syndrome among Puerto Rican adults in the Greater Boston area

Combinations of fatty acids may affect risk of metabolic syndrome. Puerto Ricans have a disproportionate number of chronic conditions compared with other Hispanic groups. We aimed to characterize fatty acid intake patterns of Puerto Rican adults aged 45-75 y and living in the Greater Boston area (n = 1207) and to examine associations between these patterns and metabolic syndrome. Dietary fatty acids, as a percentage of total fat, were entered into principle components analysis. Spearman correlation coefficients were used to examine associations between fatty acid intake patterns, nutrients, and food groups. Associations with metabolic syndrome were analyzed by using logistic regression and general linear models with quintiles of principal component scores. Four principal components (factors) emerged: factor 1, short- and medium-chain SFA/dairy; factor 2, (n-3) fatty acid/fish; factor 3, very long-chain (VLC) SFA and PUFA/oils; and factor 4, monounsaturated fatty acid/trans fat. The SFA/dairy factor was inversely associated with fasting serum glucose concentrations (P = 0.02) and the VLC SFA/oils factor was negatively related to waist circumference (P = 0.008). However, these associations were no longer significant after additional adjustment for BMI. The (n-3) fatty acid/fish factor was associated with a lower likelihood of metabolic syndrome (Q5 vs. Q1: odds ratio: 0.54, 95% CI: 0.34, 0.86). In summary, principal components analysis of fatty acid intakes revealed 4 dietary fatty acid patterns in this population. Identifying optimal combinations of fatty acids may be beneficial for understanding relationships with health outcomes given their diverse effects on metabolism.

Association of metabolic syndrome with obesity measures, metabolic profiles, and intake of dietary fatty acids in people of Asian Indian origin

OBJECTIVE

The present community-based cross-sectional study was aimed to examine the association of metabolic syndrome (MS) with obesity measures, metabolic profiles, and intake of dietary fatty acids in Asian Indian population.

PATIENTS AND METHODS

A total of 350 adult (30 years and above) individuals (184 males and 166 females) inhabiting in and around Kolkata, India participated in this study. MS was defined using the protocol specifically designed for Asian Indian population.

RESULTS

The prevalence of MS in the study was 31.4%. The prevalence was significantly higher (P < 0.01) in females (48.2%) as compared to males (16.3%). It was observed that males without MS had significantly higher mean waist circumference (WC P < 0.05); waist-hip ratio (WHR; P < 0.001); triglyceride (TG; P < 0.05); very low density lipoprotein cholesterol (VLDLc; P < 0.05) and fasting blood glucose (FBG; P < 0.01) as compared to females without MS. Significant differences were also observed for dietary intake of total fatty acids (TFA; P < 0.001); saturated fatty acids (SFA; P < 0.001) and polyunsaturated fatty acids (PUFA; P < 0.001) between individuals with and without MS. However, no significant association was observed in individuals with MS after controlling for age and sex. On the other, WC and body mass index (BMI) had significant correlation with SFA: mono unsaturated fatty acids (MUFA; P < 0.01) in individuals without MS even after controlling for age and sex.

CONCLUSION

It seem reasonable to argue that while dealing with MS in Asian Indians, clinicians should consider obesity measures, metabolic profiles and dietary fatty acids simultaneously.

Soy constituents: modes of action in low-density lipoprotein management

Reviewed here are the modes of action of soy components used as ingredients in foods, which can lower plasma levels of low-density lipoprotein (LDL) and cholesterol, which are markers for the risk for atherosclerosis. Soy ingredients act via more than one mode of action including the following: LDL absorption suppression, cholesterol efflux stimulation, LDL resorption stimulation, LDL oxidation prevention, LDL particle size increase, cholesterol synthesis reduction, and bile secretion increase. Individual genetics, lifestyle, and nutrition habits alter LDL management and a better understanding of the various modes of actions of soy ingredients may facilitate the composition of effective ingredient cocktails. The optimization of food components offers further alternatives to LDL management to augment drug therapy for patients who are unable to reach their target LDL cholesterol levels or who are suffering from side effects or drug insensitivity.

Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials

The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.

Nutrition protocols for the prevention of cardiovascular disease

Cardiovascular disease is the number one cause of death in the United States, and prevention of cardiovascular disease is at the top of the public health agenda. Evidence shows that reducing the incidence of coronary heart disease with diet is possible. More than a half century of evidence from epidemiologic, experimental, and clinical trials pinpoints a positive correlation between lifestyle and dietary factors as they relate to blood lipids, blood pressure, and coronary heart disease risk, and a number of evidence-based nutrition guidelines have emerged. The National Cholesterol Education Program's Therapeutic Lifestyle Changes diet includes unsaturated fats, fiber, and plant sterols/stanols. The whole foods approach incorporates increased consumption of fruits, vegetables, whole grains, and fish; and the American Heart Association guidelines emphasize functional foods like soy protein, nuts, and alcohol. These guidelines display the rationale for nutrition intervention as a primary prevention for cardiovascular disease. In addition, body weight, body mass index, waist circumference, and waist-to-hip ratio are examined as risk factors for cardiovascular disease. This article highlights key nutrients and lifestyle factors in preventing cardiovascular disease and identifies practical applications for clinicians.

Impacto do exercício físico isolado e combinado com dieta sobre os níveis séricos de HDL, LDL, colesterol total e triglicerídeos

Adequados hábitos alimentares e a prática de exercícios físicos exercem efeito benéfico sobre as dislipidemias. Se associados, podem ainda otimizar as mudanças do perfil lipoprotéico plasmático, sendo, além disso, intervenções de custo moderado quando comparados com tratamentos medicamentosos e dependentes de alta tecnologia. Este estudo tem por objetivo avaliar o impacto do exercício físico isolado e combinado com dieta sobre o perfil lipídico em indivíduos com sobrepeso/obesos. O presente trabalho é do tipo retrospectivo analítico observacional. Nele foi analisada a evolução do perfil lipídico e do peso, por período entre três e seis meses, de 30 indivíduos, divididos em dois grupos: grupo exercício (prática de exercício físico) e grupo dieta (prática de exercício físico associada à intervenção nutricional). Foram encontradas reduções estatisticamente significativas no CT (-14,4mg/dl; P = 0,022) e no LDL-c (-20,9mg/dl; P = 0,013) para os componentes do grupo exercício. Tal redução também ocorreu em relação à razão CT/HDL-c (-0,9; P = 0,005) para os componentes do grupo dieta. Foi observada elevação dos níveis de HDL-c, apenas no grupo dieta (+4,2 mg/dl). Nesse mesmo grupo verificou-se diminuição no CT (-8mg/dl) e no LDL-c (-9,8mg/dl), bem como redução de peso (-2,6kg), no entanto, tais resultados não foram estatisticamente significativos. Quanto aos níveis de TG, não foi verificada evolução positiva em ambos os grupos. Concluiu-se que o efeito isolado do exercício físico foi mais evidente em relação às variáveis CT e LDL-c. Os TG não sofreram modificações positivas com a prática exclusiva de exercícios físicos ou com sua associação à dieta. Para as variáveis HDL-c e peso, a combinação da dieta com o exercício físico apresentou maiores benefícios.

[High-carbohydrate diets: effects on lipid metabolism, body adiposity and its association with physical activity and cardiovascular disease risk]

For many years the reduction in the dietary fat has been recommended to the population, in order to prevent cardiovascular diseases, obesity, type 2 diabetes mellitus, among other chronic diseases. The consequence has been the replacement of carbohydrates by fat, resulting in the adoption of high carbohydrate diets. However, it has been still discussed if very rich carbohydrate diets should be recommended to the general population. Researches point out controversies about the association between these dietary habits and harmful effects on health and metabolic aspects, such as raise in de novo lipogenesis and triglyceride concentration, reduction in HDL concentration and effects on adiposity. This review evaluates the effects of diet modification, particularly the high-carbohydrate diet, in cardiovascular risk factors such as dyslipidemia and obesity. It also reviews its interaction with physical activity since it is still unknown with which extension it can minimize possible harmful effects of high carbohydrate diets in the long term.

Mediterranean diet and essential tremor. A case-control study

BACKGROUND

Higher adherence to the Mediterranean diet (MeDi) has been related to lower Alzheimer's disease risk. Some dietary factors have been studied in patients with essential tremor (ET), but the MeDi's effect has not been investigated.

METHODS

Adherence to the MeDi was calculated from a food frequency questionnaire administered in a case-control study of environmental epidemiology of ET in the New York Tri-State area. Logistic regression models were used to examine whether adherence to the MeDi predicted ET (vs. control) outcome. The models adjusted for age, gender, ethnicity, education, caloric intake, body mass index, smoking, ethanol consumption, coffee intake and blood harmane concentrations.

RESULTS

148 ET cases adhered less to MeDi (0-9 scale with higher scores indicating higher adherence) than 250 controls (mean 4.3 +/- 1.7 vs. 4.7 +/- 1.7; p = 0.03). Higher adherence to MeDi was associated with lower odds for ET [0.78 (0.61-0.99); p = 0.042]. As compared to subjects at the lowest MeDi adherence tertile, those at the middle tertile had lower ET odds [0.41 (0.16-1.05)], while subjects at the highest tertile had an even lower ET odds [0.29 (0.10-0.82); p for trend 0.021].

CONCLUSIONS

Compared to controls, ET cases adhered less to MeDi. The gradual reduction in ET odds with higher MeDi adherence tertiles suggests a possible dose-response effect. The mechanisms that underlie this association merit further study.

A biopsychosocial approach to examining tobacco-related health disparities among racially classified social groups

AIMS

To articulate a broader, multi-causal model that incorporates psychosocial and environmental factors that can differ systematically across racially classified social groups (RCSGs) and impact biological pathways related to the development of tobacco-related diseases.

METHODS

This paper is built upon a review of the existing scientific literature on selected biopsychosocial factors (diet/nutrition, obesity, alcoholic intake, psychosocial stress, occupational/environmental exposures and exposure to other diseases and illnesses) and tobacco use in examining the biological contributions to differences in tobacco-related health outcomes among RCSGs.

FINDINGS

Recent work has focused on RCSG genetic variations as a possible explanation for differences in tobacco-related health disparities. It is argued in this paper that, given the genetic heterogeneity 'within' RCSGs, it is unlikely that across RCSG genetic variations are likely to be the major source of differences impacting biological pathways in tobacco-related health outcomes. The evidence shows that results, even at the level of within-population genetic variations, have been limited and often inconsistent. A conceptual framework is proposed to account for biological pathways related to the development of tobacco-related diseases.

CONCLUSIONS

Determinants of tobacco-related health disparities are not understood clearly. The contribution of biological factors may be important. Current efforts to determine biological differences in tobacco use and related diseases among RCSGs have focused primarily on genetic variations. However, this approach has limitations. An alternative biopsychosocial framework that examines the potential biological mechanisms through which life experiences and behavior might affect tobacco use and health outcomes in these population groups is needed, including those of life-style (e.g. diet/nutrition, obesity, physical exercise, alcohol consumption), psychosocial (e.g. stress and coping), occupational/environmental exposures and the presence of other diseases/illnesses.

Trends in food availability in Portugal in 1966–2003

BACKGROUND

Dietary intake has changed considerably in South European countries, but whether those changes were similar between countries is currently unknown.

AIM OF THE STUDY

To assess the trends in food availability in Portugal and four other Mediterranean countries from 1966 to 2003.

METHODS

Food and Agricultural Organization food balance sheets from Portugal, France, Italy, Greece and Spain. Trends were assessed by linear regression.

RESULTS

The per capita availability of calories has increased in Portugal, France, Greece, Italy and Spain in the past 40 years. Portugal presented the most rapid growth with an annual increase of 28.5 +/- 2.2 kcal (slope +/- standard error), or +1000 kcal overall. In animal products, Portugal had an annual increase of 20.7 +/- 0.9 kcal, much higher than the other four countries. Conversely, the availabilities of vegetable and fruit only showed a slight growth of 1.0 +/- 0.1 kcal/year and 2.5 +/- 0.4 kcal/year, respectively, thus increasing the ration of animal to vegetable products. Olive oil availability increased in all countries with the notable exception of Portugal, where a significant decrease was noted. Wine supply decreased in all five countries; in contrast, beer supply started to take up more alcohol share. Percentage of total calories from fat increased from nearly 25% to almost 35% in Portugal during the study period, mainly at the expenses of calories from carbohydrates, whereas the share of protein showed just a slight increase. Furthermore, fat and protein were increasingly provided by animal products.

CONCLUSIONS

Portugal is gradually moving away from the traditional Mediterranean diet to a more Westernized diet as well as France, Greece, Italy and Spain. Noticeably, the trends of diet transition were observed relatively faster in Portugal than in the other four Mediterranean countries.

Fatty acid composition of nuts--implications for cardiovascular health

It is well established that, due to their high content of saturated fatty acids (SFA), the intake of meat and meat products is strongly associated with elevated blood cholesterol concentrations and an increased risk of hypertension, diabetes and cardiovascular diseases. Conversely, the intake of foods rich in unsaturated fatty acids, such as those contained in most vegetable fats and oils and oily fish, is associated with improved lipid profiles, a lower potency of intermediate biomarkers of atherosclerosis and lesser incidence of cardiovascular diseases. There are persuasive evidences that dietary substitution of monounsaturated fatty acids (MUFA) or n-6 polyunsaturated fatty acids (PUFA) for SFA lowers blood cholesterol and may have beneficial effects on inflammation, thrombosis, and vascular reactivity. MUFA may have an advantage over PUFA because enrichment of lipoprotein lipids with MUFA increases their resistance to oxidation. Marine n-3 PUFA have a number of anti-atherosclerotic effects, including anti-arrhythmic properties and, at relatively high doses, reduce serum triglycerides. These effects appear to be shared in part by vegetable n-3 PUFA. Nuts are natural foods rich in unsaturated fatty acids; most nuts contain substantial amounts of MUFA, while walnuts are especially rich in both n-6 and n-3 PUFA. Healthy fats in nuts contribute to the beneficial effects of frequent nut intake observed in epidemiological studies (prevention of coronary heart disease, diabetes, and sudden death) and in short-term feeding trials (cholesterol lowering, LDL resistance to oxidation, and improved endothelial function).