Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association

Low carbohydrate high fat-diet in real life; A descriptive analysis of cardiovascular risk factors

Aims

Low Carbohydrate High Fat (LCHF) diets are popular for weight loss or glucose control. The main source of energy in such diets is fat but the composition of nutrients varies This study aims to investigate dietary variations in a real-world LCHF population and its associations with cardiovascular risk factors.

Methods

We recruited 100 volunteers who considered themselves adherent to a LCHF diet. Their last 14 days of dietary intake was assessed using diet history interviews. Validation of energy intake against expenditure was made using activity monitors. Predictive variables for the linear regression models were selected using stepwise bidirectional assessment of Akaike information criterion (AIC).

Results

Energy intake (E%) from carbohydrates was low, 8.7 E%, and fat was the main replacement. Dietary cholesterol was associated with higher total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Dietary sodium intake was associated with higher blood pressure. Protein intake was associated with lower diastolic blood pressure but also with lower HDL. The intake of dietary fibre was associated with lower LDL and total cholesterol but with higher hemoglobin A1c (HbA1c). The intake of carbohydrates and saturated fatty acids (SFA) was not associated with any of the outcome variables.

Conclusion

In this LCHF population, variations in intake of carbohydrates and saturated fatty acids could not predict any aspects of the cardiovascular risk profile. Lower fibre intake and higher cholesterol and sodium intake predicted a less favorable cardiovascular risk profile.

Effect of egg consumption on health outcomes: An updated umbrella review of systematic reviews and meta-analysis of observational and intervention studies

AIMS

To evaluate the effect of egg consumption on health outcomes.

DATA SYNTHESIS

A systematic search in PubMed, Scopus, Lilacs, and Web of Science was developed using terms ("egg consumption" or "egg intake") and ("health" or "chronic diseases" or "diabetes" or "cancer" or "cholesterol" or "dyslipidemia"), and meta-analyses of observational or interventional studies published since January 2020 were included. The studies' quality was evaluated through AMSTAR-2 and NutriGrade, and the strength of evidence according to sample size, heterogeneity, and quality of articles. Fourteen meta-analyses were included (10 observational, 4 interventional studies). The wide range of outcomes, with substantial variability and high heterogeneity, indicated a lack of robust evidence. The overall quality of studies was critically low. The level of evidence was very weak for all the significant associations: risk of heart failure (RR 1.15; 95%CI: 1.02-1.30), cancer mortality (RR 1.13; 95%CI 1.06-1.20), higher levels of LDL cholesterol (WMD 7.39; 95%CI 5.82-8.95), total cholesterol (WMD 9.12; 95%CI 7.35-10.89), and apolipoprotein B-100 (WMD 0.06; 95%CI 0.03-0.08). Conversely, egg intake has been weakly associated with improvements in HDL cholesterol (WMD 1.37; 95%CI 0.49-2.25), apolipoprotein A1 (WMD 0.03; 95%CI 0.01-0.05), and growth parameters in children (WMD 0.47; 95%CI 0.13-0.80). No evidence of association was found among all cardiovascular outcomes and all-cause mortality risk between high vs. low egg consumption.

CONCLUSION

Due to the critically low strength of studies, insufficient evidence is available to discourage egg consumption, suggesting eggs can be part of a healthy diet.

Plant-Based Alternatives to Meat Products

Animal proteins have been used in the formulation and production of food products for many centuries, which has mainly been attributed to their excellent functional properties. However, the rearing of animals has been associated with an increased emission of greenhouse gases that contributes to global warming and climate change. Consequently, there has been a drive toward using alternative proteins, such as those from plant origins, which have been found to be more sustainable. A climate-smart strategy to contribute toward a reduction in meat consumption has been the formulation of plant-based meat analogues. The lower acceptance of these meat substitutes is mainly attributed to their sensorial, nutritional, and textural properties, which fail to resemble conventional meat. As such, there is a knowledge gap in understanding key aspects that come into play while formulating meat alternatives from plant sources by deciphering the link between the techno-functional attributes of protein and the various quality attributes of these food products. Therefore, this review aims to discuss the technical advances that have been made when it comes to plant-based meat substitutes that could drive consumer acceptance. There is also a huge impetus to diversify plant protein usage in meat analogues beyond soy and pea, which requires the applications of underutilised plant proteins to overcome their functional and organoleptic shortcomings, as well as the techno-economic challenges that have also been addressed in this work. Additionally, the nutritional equivalency of plant-based meat alternatives is reviewed, and the ways in which these products have been fabricated are discussed to assess the opportunities and challenges that exist in current product formulations. Other key determinants, such as environmental sustainability factors, prospective supply chain issues, and the market adoptability of plant-based meat alternatives, are also discussed. This review emphasises the fact that interlinking technical challenges with consumer insights and socioeconomic perspectives for protein transition is critical to ensure that innovations successfully land in the market.

Cottage cheese, a relatively underexplored cultured dairy product with potential health benefits?

Cottage cheese (CC) is a member of the "fresh cheese" family of cheeses and is widely consumed due to its culinary versatility and some perceived health benefits. However, the evidence of direct health effects of CC is not well established. This review describes the production and nutritional characteristics of CC, before exploring the evidence of health effects from human intervention, in vitro, and in vivo models. Despite widespread consumption and advocated health benefits, there is a dearth of evidence pertaining to the health effects of CC from high-quality human randomized controlled trials. To date, a limited number of human intervention models with CC have explored nutrient bioavailability, metabolic health, and appetite regulation, in small, niche study populations. Findings with in vitro and in vivo models suggest that CC may be an efficacious vehicle for bioactive compounds. In conclusion, CC is a cultured dairy product that could impose a myriad of benefits across health outcomes including cardiometabolic, gastrointestinal, body composition, appetite regulation, and nutrient status. However, there is a need for high-quality human randomized controlled trials to develop a substantiated evidence base relating to the full potential of CC in human health.

A Pilot 24-Week 'Bulk and Cut' Dietary Protocol Combined with Resistance Training Is Feasible and Improves Body Composition and TNF-α Concentrations in Untrained Adult Males

Background/Objectives: This study piloted a 24-week bodybuilding program combining resistance training (RT) with a dietary bulk-and-cut protocol in middle-aged adult males. Methods: Seven untrained males (33 ± 3.0 years; BMI = 35.0 ± 4.6 kg/m2; body fat = 36 ± 5%) completed a 24-week intervention combining RT with a dietary protocol consisting of 12-week cycles of caloric bulking (0-12 weeks) and cutting (12-24 weeks). The participant retention rate was 64%, while compliance with training was 96.7%, and adherence to dietary cycles was over 93%. To assess the preliminary efficacy of the intervention, venous blood samples and measurements of body composition (BodPod), muscle strength, and VO2max (cycle ergometer) were collected at baseline (week 0) and following the bulking (week 12) and cutting (week 24) cycles. Circulating lipids (triglycerides, total, low-density, and high-density cholesterol), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) were measured in serum. Results: The training led to significant increases in muscle strength, especially in the deadlift (+46%, p < 0.001) and squat (+65%, p < 0.001). Improvements in body composition were characterized by an increase in fat-free mass and a decrease in body fat percentage over the 24-week intervention (+3% and -6%, respectively, p < 0.05). Lipids, CRP, IL-6, and IL-10 did not change significantly, but there was a notable reduction in TNF-α (time effect p = 0.05, pη2 = 0.39), with 15% lower concentrations at week 24 compared to baseline, indicating reduced inflammation. Conclusions: Overall, the pilot intervention achieved high compliance and adherence rates, leading to improvements in body composition and lower resting TNF-α concentrations in a group of middle-aged males with obesity.

Global Levels and Variations of Cholesterol and Polar Lipids of Human Milk: A Systematic Review and Meta-analysis

Polar lipids and cholesterol are vital structural components of the milk fat globule membrane, playing a crucial role in infant growth and development; however, systematic global reports on their content in human milk are currently lacking. This study conducted a systematic literature search in Chinese and English databases, including 69,392 human milk samples from 96 studies. A random-effects model based on global data was used to assess the content of total lipids, cholesterol, gangliosides, and phospholipids in human milk and their variations with the lactation stage, geographical region, and sample year. The mean contents of total lipids, cholesterol, and total phospholipids were 2774.15 mg/100 g (95% CI: 2614.88, 2933.42 mg/100 g), 21.15 mg/100 g (18.35, 23.95 mg/100 g), and 70.72 mg/100 g (68.84, 72.60 mg/100 g), respectively, with gangliosides GM3 and GD3 at 0.63 mg/100 g (0.54, 0.72 mg/100 g) and 0.34 mg/100 g (0.32, 0.36 mg/100 g). The major phospholipids SM, PC, PE, PS, and PI averaged 24.19 mg/100 g (23.17 and 25.21 mg/100 g), 21.27 mg/100 g (19.92 and 22.62 mg/100 g), 18.28 mg/100 g (17.46 and 19.10 mg/100 g), 2.86 mg/100 g (2.32 and 3.40 mg/100 g), and 2.12 mg/100 g (1.75 and 2.49 mg/100 g). With the progression of lactation, total lipids, gangliosides, and most phospholipids (SM, PC, PS, PI) increased, while cholesterol and PE decreased. Over the years, total lipids, gangliosides, and PE showed an upward trend, whereas cholesterol and most phospholipids declined. Human milk from Europe had lower total lipid and cholesterol levels compared with other regions. While the total phospholipid content did not show significant regional differences (P > 0.05), variations in phospholipid composition were observed. These findings emphasize the importance of understanding spatiotemporal changes in human milk lipids to develop personalized nutrition strategies that support optimal infant growth and development.

Evaluating adherence of hospital meals to Mediterranean diet: the case of a developing country

This study aimed to assess the nutritional composition of meals served to and consumed by patients in Lebanese hospitals and to evaluate the extent to which these meals adhere to Mediterranean diet guidelines. Conducted between April 2023 and September 2023, this cross-sectional study involved 155 in-patients from various departments across 16 hospitals in Lebanon. Food quantities served were measured, and nutritional analysis was performed to evaluate the nutritional content of meals provided and eaten by patients. On average, served meals weighed 1.24 kg (SD: 0.43), providing an average of 1489 kcal energy (SD: 546.55) and 72 g of protein per hospital bed per day. These meals typically met 79% of a patient's daily estimated energy requirement (EER). On the other hand, patients consumed an average of 0.85 kg of food, providing 1084.3 kcal energy (57.3% of EER) and 50 g of protein per day. The most served food group in hospitals was the 'grains and cereals' group. Compared to the Mediterranean diet, our results showed that hospitals exceeded the recommended servings for dairy and meat products, while they served less than the recommended amounts from the vegetables, fruits, legumes. Patients did not meet their daily requirements for almost all the macro- and micro-nutrients. This study highlights the importance of public health policies, interventions, and food service management strategies to ensure patients receive adequate diets aligned with their nutritional needs.

Eggs, Dietary Choline, and Nonalcoholic Fatty Liver Disease in the Framingham Heart Study

BACKGROUND

Eggs are rich in bioactive compounds, including choline and carotenoids that may benefit cardiometabolic outcomes. However, little is known about their relationship with nonalcoholic fatty liver disease (NAFLD).

OBJECTIVES

We investigated the association between intakes of eggs and selected egg-rich nutrients (choline, lutein, and zeaxanthin) and NAFLD risk and changes in liver fat over ∼6 y of follow-up in the Framingham Offspring and Third Generation cohorts.

METHODS

On 2 separate occasions (2002-2005 and 2008-2011), liver fat was assessed using a computed tomography scan to estimate the average liver fat attenuation relative to a control phantom to create the liver phantom ratio (LPR). In 2008-2011, cases of incident NAFLD were identified as an LPR ≤0.33 in the absence of heavy alcohol use, after excluding prevalent NAFLD (LPR ≤0.33) in 2002-2005. Food frequency questionnaires were used to estimate egg intakes (classified as <1, 1, and ≥2 per week), dietary choline (adjusted for body weight using the residual method), and the combined intakes of lutein and zeaxanthin. Multivariable modified Poisson regression and general linear models were used to compute incident risk ratios (RR) of NAFLD and adjusted mean annualized liver fat change.

RESULTS

NAFLD cumulative incidence was 19% among a total of 1414 participants. We observed no associations between egg intake or the combined intakes of lutein and zeaxanthin with an incident NAFLD risk or liver fat change. Other diet and cardiometabolic risk factors did not modify the association between egg intake and NAFLD risk. However, dietary choline intakes were inversely associated with NAFLD risk (RR for tertile 3 compared with tertile 1: 0.69, 95% CI: 0.51, 0.94).

CONCLUSIONS

Although egg intake was not directly associated with NAFLD risk, eggs are a major source of dietary choline, which was strongly inversely associated with NAFLD risk in this community-based cohort.

The Management of Cardiometabolic Risk in MAFLD: Therapeutic Strategies to Modulate Deranged Metabolism and Cholesterol Levels

Background and Objectives: Fatty Liver Disease is a major health problem worldwide. We can distinguish liver steatosis as non-associated or associated with chronic/acute alcohol consumption. These two entities share similar stages ranging from hepatic fat storage (namely, steatosis) to inflammation, necrosis, and fibrosis until hepatocellular carcinoma (HCC). Over time, "Metabolic Associated Fatty Liver Disease" (MAFLD) has replaced nonalcoholic fatty liver disease (NAFLD) nomenclature and has included cardiometabolic criteria in these patients definition. Thus, obesity, type 2 diabetes mellitus (T2DM), hypertension, and dyslipidemia are MAFLD features and are of the metabolic syndrome. Importantly, there is not a specific treatment for MAFLD, but there are therapeutic strategies that act on metabolic dysfunction related to MAFLD. They can reduce the progression of liver fibrosis and its complications. Materials and Methods: For all these reasons, we conducted a narrative review of the literature, and we focused on metabolic dysfunction related to MAFLD, with a special regard for cholesterol metabolism. Results: MAFLD is a recently redefined condition that better describes the metabolism derangement responsible for fatty liver disease. This distinguishes MAFLD from NAFLD. In fact, the diagnostic criteria for MAFLD require the presence of liver steatosis together with at least one of the following: obesity, T2DM, or evidence of metabolic disorder such as hypertriglyceridemia, low high-density lipoprotein cholesterol, or hypertension. As a result, MAFLD is closely linked to an increased cardiometabolic risk. Current therapeutic approaches can be used to reduce this risk, focusing on lifestyle interventions and pharmacological strategies. Several treatments in patients diagnosed with MAFLD are mainly cholesterol-lowering remedies. Among these, Pro-protein Convertase Subtilisin/Kexin type 9 inhibitors (PCSK9i) show the most promising efficacy profile but data on liver fibrosis are lacking. Agonists of GLP-1 receptor, Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and Dipeptidyl Peptidase-4 inhibitors (DPP-4i) have a " multi-hit " action allowing their use also in diabetic patients with MAFLD. Conclusions: Lifestyle modifications, some nutraceuticals, statins, incretins, and PCSK9i have changed the natural course and significantly improved the cardiometabolic outcomes of MAFLD. Emerging cholesterol-lowering drugs, such as Bempedoic acid, can overcome low compliance to statins' use and their controversial effect on liver fibrosis. Finally, medications targeting insulin resistance allow for strategic interventions of the convoluted pathophysiology of MAFLD in multiple steps, with the potential to reduce liver steatosis, inflammation, and necrosis and, sometimes even to reverse liver fibrosis.

Lipids dysregulation in diseases: core concepts, targets and treatment strategies

Lipid metabolism is a well-regulated process essential for maintaining cellular functions and energy homeostasis. Dysregulation of lipid metabolism is associated with various conditions, including cardiovascular diseases, neurodegenerative disorders, and metabolic syndromes. This review explores the mechanisms underlying lipid metabolism, emphasizing the roles of key lipid species such as triglycerides, phospholipids, sphingolipids, and sterols in cellular physiology and pathophysiology. It also examines the genetic and environmental factors contributing to lipid dysregulation and the challenges of diagnosing and managing lipid-related disorders. Recent advancements in lipid-lowering therapies, including PCSK9 inhibitors, ezetimibe, bempedoic acid, and olpasiran, provide promising treatment options. However, these advancements are accompanied by challenges related to cost, accessibility, and patient adherence. The review highlights the need for personalized medicine approaches to address the interplay between genetics and environmental factors in lipid metabolism. As lipidomics and advanced diagnostic tools continue to progress, a deeper understanding of lipid-related disorders could pave the way for more effective therapeutic strategies.

Dietary Cholesterol and Myocardial Infarction in the Million Veteran Program

BACKGROUND

Coronary artery disease is a leading cause of morbidity and mortality in the United States. Coronary artery disease can lead to major complications including myocardial infarction (MI). The association of dietary cholesterol with coronary artery disease remains inconsistent. We examined the relation of dietary cholesterol with the incidence of MI among participants of the Million Veteran Program.

METHODS AND RESULTS

The Million Veteran Program is a prospective cohort database collecting genetic and nongenetic factors influencing chronic diseases. We analyzed data from 180 156 veterans with complete information on relevant dietary intake. The association between dietary cholesterol and MI risk was assessed using both linear and nonlinear models. Statistical significance was determined using the Wald test for linear trends and the likelihood ratio test for nonlinearity, alongside comparisons between high (≥300 mg/d) and low (<300 mg/d) cholesterol intake groups. In this study of 180 156 veterans with mean follow-up of 3.5 years, we observed a linear, dose-response association between dietary cholesterol intake and risk of MI, with every 100-mg/d increment in cholesterol intake associated with a 5% higher MI risk (relative risk [RR], 1.05 [95% CI, 1.02-1.08]). Subjects consuming >300 mg/d of cholesterol had a 15% increased MI risk compared with those consuming less (RR, 1.15 [95% CI, 1.06-1.25]).

CONCLUSIONS

We found that dietary cholesterol intake was linearly associated with greater risk of MI. These findings contribute to the growing literature highlighting the impact dietary cholesterol has on cardiovascular health. Reductions in cholesterol intake, which can be achieved by decreasing the intake of meat and eggs, may reduce the risk of incident MI.

Dietary Lipids, Gut Microbiota, and Their Metabolites: Insights from Recent Studies

Dietary lipid intake can influence the gut microbiota (GM) and their metabolites, such as short-chain fatty acids (SCFA) and bile acids, which are key mediators of health. The objective is to examine how dietary lipids' quantity and quality influence the GM and metabolite profiles. A literature review of 33 studies in animals and humans was performed on the effects of saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), trans-fatty acids (TFAs), and sterols on GM composition and gut-derived metabolites. The results show that diets rich in MUFAs, n-3 PUFAs, and short-chain FAs have the potential to enhance beneficial bacteria and metabolites. In addition, trans-palmitoleic acid, conjugated linoleic acid, and phytosterols may also have potentially beneficial effects on GM, but more research is needed. Medium-chain FAs and n-6 PUFAs have variable effects on the GM. Conversely, intakes of high-fat diets, long-chain SFAs, industrial TFAs, and cholesterol disrupt GM balance. In conclusion, animal studies clearly demonstrate that dietary fats influence the GM and related metabolites. Yet, human studies are limited. Therefore, well-designed human studies that consider the whole diet and baseline health status are needed to better understand the effects of dietary lipids on GM.

Purification and Immobilization of Burkholderia gladioli Cholesterol Oxidase on Calcium Alginate, with Robust Catalytic Stability for Cholesterol Oxidation In Vitro

Cholesterol oxidase (COX) is a key enzyme in diagnostic kits of cardiovascular diseases via oxidation of cholesterol producing smart enantiomerically compounds; however, the enzyme catalytic stability is the challenge. So, the objective of this study was to purify COX from novel endophytic bacterial isolates of medicinal plants that could have unique catalytic efficiency for the desired applications. Among the recovered forty bacterial isolates, Burkholderia gladioli EFBL PQ721377, an endophyte of Eruca sativa, had the highest COX productivity (14.7 μmol/mg/min). The COX productivity of B. gladioli has been maximized by with the response surface methodology, giving the highest productivity 30.9 μmol/mg/min, by ~ 2.0-fold increment compared to control. The enzyme was purified to its molecular homogeneity with subunit structure 40 kDa. The enzyme was entrapped in Ca-alginate with immobilization yield 87.5%, and the efficiency and homogeneity in Ca-alginate beads were assessed by FTIR and SEM-EDX analyses. The free and Ca-alginate-COX conjugates have the same maximum reaction temperature at 37-40 °C, reaction pH at 7.5 and pH stability at 6.5-8.0. The thermal stability of Ca-alginate-COX was increased by ~ 7.0 folds compared to the free one, ensuring the protective role of alginate beads on enzyme tertiary structure. Ca-alginate-COX had a higher potency of oxidation of human serum cholesterol, than the free one, confirming the feasibility of the product release, and allosteric activation of the enzyme, with a reliable operative stability till the fifth cycle, for production of cholest-4-en-3-one, as the precursor of various drugs.

Delving into biomarkers and predictive modeling for CVD mortality: a 20-year cohort study

Accurate prediction of cardiovascular disease (CVD) mortality is essential for effective treatment decisions and risk management. Current models often lack comprehensive integration of key biomarkers, limiting their predictive power. This study aims to develop a predictive model for CVD-related mortality using a machine learning-based feature selection algorithm and assess its performance compared to existing models. We analyzed data from a cohort of 4,882 adults recruited between 1999 and 2004, followed for up to 20 years. After applying the Boruta algorithm for feature selection, key biomarkers including NT-proBNP, cardiac troponins, and homocysteine were identified as significant predictors of CVD mortality. Predictive models were built using these biomarkers alongside demographic and clinical variables. Model performance was evaluated using the concordance index (C-index), sensitivity, specificity, and accuracy, with internal validation conducted through bootstrap sampling. Additionally, decision curve analysis (DCA) was performed to assess clinical benefit. The combined model, incorporating both biomarkers and demographic variables, demonstrated superior predictive performance with a C-index of 0.9205 (95% CI: 0.9129-0.9319), outperforming models with demographic variables alone (C-index: 0.9030 (95% CI: 0.8938-0.9147)) or biomarkers alone (C-index: 0.8659 (95% CI: 0.8519-0.8826)). Cox regression analysis further identified key predictors of CVD mortality, including elevated AST/ALT, TyG, BUN, and systolic blood pressure, with protective factors such as higher chloride and iron levels. Nomogram construction and DCA confirmed that the combined model provided substantial net benefit across various time points. The integration of cardiac biomarkers, lipid profiles, and inflammatory markers significantly improves the accuracy of predictive models for CVD-related mortality. This novel approach offers enhanced prognostication, with potential for further optimization through the inclusion of additional clinical and lifestyle data.

Association between egg consumption and risk of obesity: A comprehensive review: EGG CONSUMPTION AND OBESITY

Eggs serve as a vital source of high-quality protein and lipids in the human diet, contributing significantly to nutritional intake; however, the relation between egg intake and health risks has been controversial. This study aimed to assess the relationship between egg intake and obesity and the effects of the various nutrients in eggs on obesity were separately investigated. This review involved searching Scopus, PubMed, Google Scholar for relevant articles from 2002 to 2022. Studies suggested that moderate egg consumption exerts little effect on blood lipid levels, that due to the body regulates endogenous cholesterol production in response to the external cholesterol intake. Furthermore, certain studies also verified that the presence of other nutrients in eggs, such as lecithin, unsaturated fatty acids, and apolipoproteins, not only does not contribute to elevated blood lipids but also plays a role in regulating lipid metabolism to prevent obesity. Additionally, the study reveals that different cooking methods significantly impact the nutritional composition of eggs, with soft-boiled eggs generally being the most advantageous for human health. This article reveals that dietary cholesterol or moderate egg intake was not significantly associated with a higher risk of obesity in healthy adults. Nevertheless, cholesterol-sensitive individuals should ensure moderate cholesterol intake.

Cholesterol, triglycerides, HDL, and nitric oxide as determinants of resting heart rate variability in non-hospitalized mild post-COVID individuals: a cross-sectional study

BACKGROUND

The association between plasma lipids, nitric oxide (NO) and cardiovascular risk has been well documented in the literature, however, the association between these outcomes and heart rate variability (HRV) in COVID-19 remains incipient as there is no scientific evidence that has investigated this outcome.

OBJECTIVE

Investigate whether metabolic outcomes may be associated with cardiac autonomic behavior arising from short-term HRV variables in non-hospitalized mild post-COVID individuals.

METHODS

This is a cross-sectional study. Individuals of both sexes, aged ≥ 18 years, who tested positive for SARS-CoV-2 according to the RT-PCR test, without the need for hospitalization, were included. The HRV was collected in the supine position for at least 10 min for later analysis in the Kubios software. Metabolic outcomes [high density lipoprotein (HDL) (mg/dL), cholesterol (mg/dL), triglycerides (mg/dL) and NO (µmol/L)] were collected through a blood sample.

RESULTS

Seventy-three individuals were included (post-COVID = 32; control = 41). HRV was worse in the post-COVID group when compared to the control group (p < 0.05). Cholesterol, HDL, triglycerides and NO showed significant correlations with HRV indices. Regression models indicated that cholesterol and triglycerides, as well as NO, explain up to 30.3% of the variations in certain HRV indices, suggesting an impact of metabolic outcomes on autonomic modulation.

CONCLUSION

There is a relationship between plasma lipids, NO and HRV in non-hospitalized individuals with mild COVID-19. Metabolic outcomes are associated and explain between 16.6% and 30.30% of certain variables of resting HRV in post-COVID individuals.

CLINICAL TRIAL NUMBER

Not applicable.

Analysis of 26 Studies of the Impact of Coconut Oil on Lipid Parameters: Beyond Total and LDL Cholesterol

Coconut oil (CNO) is often characterized as an "artery-clogging fat" because it is a predominantly saturated fat that ostensibly raises total cholesterol (TChol) and LDL cholesterol (LDL-C). Whereas previous analyses assessed CNO based on the relative effects on lipid parameters against other fats and oils, this analysis focuses on the effects of CNO itself. Here, we review the literature on CNO and analyze 984 lipid profile data sets from 26 CNO studies conducted over the past 40 years. This analysis shows considerable heterogeneity among CNO studies regarding participant selection, the amount consumed, and the study duration. The analysis reveals that, overall, CNO consumption gives variable TChol and LDL-C values, but that the HDL-cholesterol (HDL-C) values increase and triglycerides (TG) decrease. This holistic lipid assessment, together with the consideration of lipid ratios, shows that CNO does not pose a health risk for heart disease. Because the predominantly medium-chain fatty acid profile of CNO is significantly different from that of lard and palm oil, studies using these as reference materials do not apply to CNO. This paper concludes that the recommendation to avoid consuming coconut oil due to the risk of heart disease is not justified.

Egg Consumption and Mortality: A Prospective Cohort Study of Australian Community-Dwelling Older Adults

BACKGROUND/OBJECTIVES

Egg consumption in adults has been linked with a modestly increased risk of all-cause and CVD mortality. However, evidence on adults aged 65 y+ is limited. The objective of this study was to investigate the association between egg intake and mortality in community-dwelling older adults.

METHODS

In this prospective cohort study, 8756 adults aged 70+ years, participants in the ASPirin in Reducing Events in the Elderly (ASPREE) Longitudinal Study of Older Persons, self-reported the frequency of their total egg intake: never/infrequently (rarely/never, 1-2 times/month), weekly (1-6 times/week), and daily (daily/several times per day). All-cause and cause-specific (cardiovascular disease [CVD] and cancer) mortality was established from at least two sources: medical records, death notices, next of kin, or death registry linkage. The association between egg intake and mortality was assessed using Cox proportional hazards regression analysis, adjusted for socio-demographic, health-related, and clinical factors and overall dietary quality.

RESULTS

Over the median 5.9-year follow-up period, a total of 1034 all-cause deaths (11.8%) were documented. A 29% lower risk of CVD mortality (HR (95% CI): 0.71 [0.54-0.92]) and a 17% (HR (95% CI): 0.83 [0.71-0.96]) lower risk of all-cause mortality were observed among those who consumed eggs weekly, compared to those who consumed eggs never/infrequently; no statistically significant association was observed for weekly consumption and cancer mortality. In contrast, compared to those that never or infrequently consumed eggs, daily consumption had slightly higher odds of mortality, though these results did not reach statistical significance.

CONCLUSIONS

The consumption of eggs 1-6 times per week was associated with a lower risk of all-cause mortality and CVD mortality in community-dwelling adults aged 70 years and over. These findings may be important to inform the development of evidence-based guidelines for egg consumption.

Higher Animal-Based Protein Intake Levels Show a Greater Likelihood of Having Metabolic Syndrome in Single-Person Households Among Korean Adults

BACKGROUND/OBJECTIVES

Despite the increasing intake of animal-based protein and the growing number of single-person households (SPHs) in Korean populations, no studies have analyzed the relationship of protein intake by source with metabolic syndrome (MetS) according to household type. This study examined the association between protein intake (plant- and animal-based sources) and MetS risk factors in SPH and multi-person households (MPHs) among Korean adults.

METHOD

A total of 12,022 participants aged 30-64 years (SPH: 982; MPH: 11,040) were selected from the 2016-2021 Korea National Health and Nutrition Examination Survey. Protein intake level was defined as the percentage contribution of food source to daily intake, assessed using 24 h recall dietary data.

RESULTS

The animal-based protein intake level was slightly higher in SPHs (51.2%) compared to MPHs (49.5%), whereas the contributions of plant sources from vegetables, fruits, and whole grains were higher in MPHs (p < 0.01). The prevalence of MetS and abdominal obesity increased with higher animal-based protein intake levels across all household types. Only in SPHs, each 1% rise in the proportion of animal-based protein was positively associated with increased blood pressure (OR = 1.013, 95% CI: 1.004-1.022). Moreover, the interaction between animal-based protein intake levels and household type was significantly associated with a higher prevalence of elevated triglycerides (TGs) (MPH[Q1] vs. SPH[Q4] OR = 1.51; p for interaction = 0.0335). However, these two risk factors did not show significant association in MPHs.

CONCLUSIONS

The results suggest that reducing dietary animal protein could help manage MetS risk factors, particularly increased blood pressure, and elevated TGs in SPHs of Korean adults. In conclusion, dietary guidelines that promote a higher intake of plant-based protein over animal-based protein for the health of the SPH population would be valuable from a public health perspective.

The Role of Primary Care in Achieving Life's Essential 8: A Scientific Statement From the American Heart Association

To reduce morbidity and mortality rates of cardiovascular disease, an urgent need exists to improve cardiovascular health among US adults. In 2022, the American Heart Association issued Life's Essential 8, which identifies and defines 8 health behaviors and factors that, when optimized through a combination of primary prevention, risk factor management, and effective treatments, can promote ideal cardiovascular health. Because of its central role in patient care across the life span, primary care is in a strategic position to promote Life's Essential 8 and improve cardiovascular health in the United States. High-quality primary care is person-centered, team-based, community-aligned, and designed to provide affordable optimized health care. The purpose of this scientific statement from the American Heart Association is to provide evidence-based guidance on how primary care, as a field and practice, can support patients in implementing Life's Essential 8. The scientific statement aims to describe the role and functions of primary care, provide evidence for how primary care can be leveraged to promote Life's Essential 8, examine the role of primary care in providing access to care and mitigating disparities in cardiovascular health, review challenges in primary care, and propose solutions to address challenges in achieving Life's Essential 8.

Health interest of cholesterol and phytosterols and their contribution to one health approach: Review

Plants and animals are potential sources of food, particularly lipids. They are sources of nutrients for humans, and are used in various applications in food industries. Foods whose lipids consumed, have benefits for animal and human health. Sterols are among the compounds essential to the well-being of living beings. Phytosterols are derived from plants and algae, and zoosterols from animals dominated by cholesterol. Cholesterol is found in small quantities in some plant lipids. Also, cholesterol is produced by herbivorous insects by metabolizing phytosterols. Oilseeds and vegetable oils contain sterols and are the richest natural sources of phytosterols. Vegetables and fruit also contain small quantities. These compounds play an undeniable role in our diet. Foods, particularly vegetable oils, when produced, preserved and used according to established prescriptions, help to ensure consumer health and prevent certain pathologies. Sterols, and in particular phytosterols, play a number of roles in the pharmaceutical field (therapeutic steroids), nutrition (anti-cholesterol, anti-cancer properties). These natural molecules with their nutritional and therapeutic properties have a positive impact on human and animal health, and possibly on vegetative growth (development cycle of plants). The same is true for cholesterol, which has multiple functions in humans and animals. Also, a diet based on plants or their by-products with positive effects on human and animal health is closely in line with the objectives of the 'One health approach'. Indeed, sterols can have adverse effects on health when established standards are not respected. As a result, the health benefits of sterols (cholesterol and phytosterols) require particular attention, given their contribution to the public health problems facing our countries. The aim of the present research is to highlight the health benefits of cholesterol and phytosterols for living organisms, particularly humans, and their contribution to the One Health approach.

What Is the Relationship Between Sensory Attributes Identified Using CATA (Check-All-That-Apply) Questionnaire and Consumer Acceptance of Cookies Using Plant-Based Oils?

The purpose of this study was to investigate sensory attributes identified using a CATA questionnaire and consumer acceptance of cookies using plant-based oils and to determine which sensory attributes influence and improve purchase intention of cookies using plant-based oils. Frequency analysis, one-way analysis of variance, correspondence analysis, Pearson correlation analysis, and multiple factor analysis were used for statistical evaluation. Six cookie samples, five with types of vegetable oil (canola, brown rice, coconut, soybean, olive) and one with butter, were evaluated by 112 consumers. Of the 28 sensory attributes, the 11 sensory terms of milk, savory, sweet aroma/odor, sweet, roasted grain, milk taste/flavor, hardness, "crispy", "stuffy", roughness, and "crumble" were significantly different among samples (p < 0.001). In the consumer acceptance and purchase intention tests, participants evaluated 12 attributes, namely, overall liking, appearance, color, aroma/smell, overall taste, savory flavor, flavor, sweet taste, aftertaste, texture, "smooth", "crispy", "try again", recommendations, and familiarity, on a 9-point structured hedonic scale. All attributes except "smooth" were significantly different among the six cookie samples tested (p < 0.001). Samples with coconut oil and butter had the highest consumer acceptance. In particular, in a correspondence analysis, the samples with butter and coconut oil positioned in the positive direction (+) of Dimension (Component) 1 were closely related with mouthfeel, sweet aroma, sweet taste, "crispy", "try again", recommendation, familiarity, and overall liking. Our results suggest that cookies with coconut oil could be a substitute for animal-fat-based cookies with butter. We hope that our research will provide fundamental data for the development of vegan bakery products that meet the needs of consumers and food companies.

Nutrition Interventions for Youth with Dyslipidemia: Who, What, When, and Where?

PURPOSEOF REVIEW

A heart-healthy lifestyle adopted during childhood and sustained throughout life can reduce cardiovascular disease risk in youth with dyslipidemia. In this review, we discuss nutrition recommendations for youth (< 18 years-of-age) with dyslipidemia, compare recommendations for youth versus those for adults, review published data regarding nutrition management in the pediatric population, and discuss strategies for successful implementation in a clinical setting.

RECENT FINDINGS

Recent publications highlight the characteristics of genetic and acquired hypertriglyceridemia disorders, dietary adjuncts used for lipid-lowering, and the effectiveness of a multi-disciplinary team approach. Nutrition interventions remain a cornerstone of lipid management and cardiovascular disease risk reduction in youth with dyslipidemia. Nutrition counseling should include age and developmentally appropriate education while also addressing barriers to implementing a heart-healthy lifestyle. A registered dietitian nutritionist plays an important role within a multidisciplinary clinic setting by providing dietary recommendations to address the needs of youth with dyslipidemia.

Impact of a 15% spirulina (Limnospira platensis) dietary inclusion on productive performance and meat traits in naked neck and fully feathered slow-growing broiler strains

Global population is rising, leading to higher demand for meat and concerns on environmental and economic impacts of conventional feedstuffs that corn and soybean meal have. Recently there has been a shift towards more sustainable feedstuffs such as Spirulina (Limnospira platensis) due to its nutritional value and ability to be produced locally. Consumer awareness prompts shifts towards free range poultry production but presents environmental challenges due to climate change. The naked neck (Na) gene, which reduces feather coverage, and enhances growth under adverse conditions offers a possible solution for improved welfare and efficiency. This study aims to investigate the impact of a diet with 15% Spirulina inclusion on growth performance, carcass traits, and meat quality of two slow-growth broiler strains: naked neck (NN) and fully feathered (FF). Forty, 1-day-old male broilers, 20 per strain, were randomly assigned to either a control or a diet containing 15% Spirulina, housed individually in cages and fed ad libitum for 84 d. Growth, carcass, and meat traits were evaluated. Results indicated that animals fed a control diet generally outperformed those fed a Spirulina diet in final body weight (BW), average daily gain (ADG), feed intake (FI), and feed conversion rate (FCR) (P < 0.001). Additionally, Spirulina incorporation led to an increase in the length of the gastrointestinal tract and digesta viscosity in the duodenum plus jejunum (P < 0.05). Although there were no significant differences in breast muscle yield between dietary groups, SP-fed broilers had higher yellowness (*b) values in meat (P < 0.05). Except for the decrease in water holding capacity (WHC) observed in the NN group animals (P < 0.05), there were no significant differences between the strains for the remaining meat quality traits (P > 0.05). The 15% Spirulina inclusion increased the concentrations of n-3 polyunsaturated fatty acids (PUFA) (P < 0.0001) in breast meat and decreased (P < 0.0001) nutritional ratios. Overall, under thermoneutral conditions, animals from the NN strain showed negative effects on growth parameters. Spirulina inclusion improved certain aspects of breast meat quality, particularly fatty acid profiles.

Heart-healthy diets including phytostanol ester consumption to reduce the risk of atherosclerotic cardiovascular diseases. A clinical review

The risk of atherosclerotic cardiovascular diseases (ASCVDs) can be reduced by lowering low-density lipoprotein cholesterol (LDL-C) concentrations. Nevertheless, ASCVDs still cause most deaths worldwide. Here, we discuss the prevention of ASCVD and the event risk with a focus on heart-healthy diets, i.e., low intakes of saturated and trans-fatty acids and cholesterol, and high intakes of unsaturated fatty acids, viscous fibre, and dietary phytostanols as fatty acid esters, according to international dyslipidaemia treatment guidelines. Calculations based on both FINRISK and Cholesterol Treatment Trialists' Collaborators regression equations indicate that heart-healthy diets combined with phytostanol ester reduce LDL-C concentrations to such an extent that the 10-year estimated reduction in the incidence of coronary artery disease would be 23%. This information can be used, in particular, to prevent the development of subclinical atherosclerosis in healthy middle-aged populations and the progression of atherosclerosis to ASCVD. The outcome of simple and feasible dietary changes, and, when needed, combined with statins, can be significant: reduced mortality, an increased number of healthy life-years, and reduced healthcare costs.

Reduced circulating CD63+ extracellular vesicle levels associate with atherosclerosis in hypercholesterolaemic mice and humans

AIMS

The association and co-isolation of low-density lipoproteins (LDL) and extracellular vesicles (EVs) have been shown in blood plasma. Here we explore this relationship to better understand the role of EVs in atherogenesis.

METHODS AND RESULTS

Wild type (WT), PCSK9-/-, and LDLR-/- C57BL/6 mice were used in this study. Eleven week-old male mice were fed high-fat diet (HFD) for 12 weeks or kept on normal diet until old age (22-months). Cardiac function was assessed by ultrasound, cholesterol was quantified with a colorimetric kit and circulating EVs were measured using flow cytometry. Plaques were analysed post-mortem using Oil-Red-O staining of the aortic arch. EVs were measured from platelet free blood plasma samples of normal and hypercholesterolaemic clinical patients. Based on annexin V and CD63 staining, we found a significant increase in EV levels in LDLR-/- and PCSK9-/- mice after HFD, but CD81 showed no significant change in either group. There was no significant change in plaque formation after HFD. PCSK9-/- mice show a favourable cardiac function after HFD. Blood cholesterol levels progressively increased during HFD, with LDLR-/- mice showing high levels while PCSK9-/- were significantly lowered compared to WT animals. In mice at old age, similar cholesterol levels were observed as in young mice. In old age, LDLR-/- mice showed significantly increased plaques. At old age, ejection fraction was decreased in all groups of mice, as were CD63+ EVs. Similarly to mice, in patients with hypercholesterolaemia, CD63+ EVs were significantly depleted.

CONCLUSIONS

This research demonstrates an inverse relationship between circulating EVs and cholesterol, making EVs a potential marker for cardiovascular disease (CVD). HFD causes reduced cardiac function, but atherosclerotic development is slowly progressing in hypercholesterolaemic models and only observed with old animals. These results also bring further evidence for the benefit of using of PCSK9 inhibitors as therapeutic agents in CVD.

The Influence of Cholesterol on Membrane Targeted Bioactive Peptides: Modulating Peptide Activity Through Changes in Bilayer Biophysical Properties

Cholesterol is a biological molecule that is essential for cellular life. It has unique features in terms of molecular structure and function, and plays an important role in determining the structure and properties of cell membranes. One of the most recognized functions of cholesterol is its ability to increase the level of lipid packing and rigidity of biological membranes while maintaining high levels of lateral mobility of the bulk lipids, which is necessary to sustain biochemical signaling events. There is increased interest in designing bioactive peptides that can act as effective antimicrobial agents without causing harm to human cells. For this reason, it becomes relevant to understand how cholesterol can affect the interaction between bioactive peptides and lipid membranes, in particular by modulating the peptides' ability to penetrate and disrupt the membranes through these changes in membrane rigidity. Here we discuss cholesterol and its role in modulating lipid bilayer properties and discuss recent evidence showing how cholesterol modulates bioactive peptides to different degrees.

Influence of dietary cholesterol on metabolic syndrome risk in middle-aged Korean adults: using the Korean Genome and Epidemiology Study (KoGES)

BACKGROUND

The association between dietary cholesterol and metabolic diseases remains controversial. However, the majority of studies focus on egg intake, and there is a limitation in the availability of prospective cohort studies. Our study examined the association between dietary cholesterol and the incidence risk of metabolic syndrome (MetS) in middle aged adults using large prospective cohort study in Republic of Korea.

METHODS

The Health Examinees cohort from the Korean Genome and Epidemiology Study was used from baseline to follow-up. Dietary cholesterol intake was assessed by the validated semi-quantitative food frequency questionnaire. Participants were classified as quintile groups according to adjusted dietary cholesterol for total energy intake. MetS was defined as more than 3 of the 5 components of MetS. Hazard ratio (HR) and 95% confidence intervals (CI) for MetS were evaluated by multivariable cox regression analyses.

RESULTS

Of the total 40,578 participants, metabolic syndrome developed in 4,172 (10.28%) individuals during an average follow-up period of approximately 4.76 years. Dietary cholesterol did not exhibit a significant association with the risk of MetS after adjusting for potential confounding factors, but a trend was observed indicating an increased risk with higher intake (p for trend = 0.044). Among the components of MetS, the incidence risk of high waist circumference (HR: 1.164, 95% CI: 1.049-1.290), high blood pressure (HR: 1.188, 95% CI: 1.075-1.313), high serum triglyceride (HR: 1.132, 95% CI: 1.044-1.227) and high fasting blood glucose (HR: 1.217, 95% CI: 1.132-1.308) in the group that consumed the highest dietary cholesterol intake was increased compared with the group that consumed the lowest dietary cholesterol intake. Dose-response relationship suggested a positive linear association between dietary cholesterol intake and the risk of high waist circumference (p-linearity = 0.004), blood pressure (p-linearity = 0.012), and triglycerides (p-linearity = 0.005).

CONCLUSION

This study suggests a positive association between dietary cholesterol intake and the risk of MetS and its components (abdominal obesity, hypertension, hypertriglyceridemia, and hyperglycemia) in middle-aged Korean adults.

Associations between dietary fatty acid and plasma fatty acid composition in non-alcoholic fatty liver disease: secondary analysis from a randomised trial with a hypoenergetic low-carbohydrate high-fat and intermittent fasting diet

Dietary fatty acids (FA) affect metabolic risk factors. The aim of this study was to explore if changes in dietary fat intake during energy restriction were associated with plasma FA composition. The study also investigated if these changes were associated with changes in liver fat, liver stiffness and plasma lipids among persons with non-alcoholic fatty liver disease. Dietary and plasma FA were investigated in patients with non-alcoholic fatty liver disease (n 48) previously enrolled in a 12-week-long open-label randomised controlled trial comparing two energy-restricted diets: a low-carbohydrate high-fat diet and intermittent fasting diet (5:2), to a control group. Self-reported 3 d food diaries were used for FA intake, and plasma FA composition was analysed using GC. Liver fat content and stiffness were measured by MRI and transient elastography. Changes in intake of total FA (r 0·41; P = 0·005), SFA (r 0·38; P = 0·011) and MUFA (r 0·42; P = 0·004) were associated with changes in liver stiffness. Changes in plasma SFA (r 0·32; P = 0·032) and C16 : 1n-7 (r 0·33; P = 0·028) were positively associated with changes in liver fat, while total n-6 PUFA (r -0·33; P = 0·028) and C20 : 4n-6 (r -0·42; P = 0·005) were inversely associated. Changes in dietary SFA, MUFA, cholesterol and C20:4 were positively associated with plasma total cholesterol and LDL-cholesterol. Modifying the composition of dietary fats during dietary interventions causes changes in the plasma FA profile in patients with non-alcoholic fatty liver disease. These changes are associated with changes in liver fat, stiffness, plasma cholesterol and TAG. Replacing SFA with PUFA may improve metabolic parameters in non-alcoholic fatty liver disease patients during weight loss treatment.

Chinese expert consensus on blood lipid management in patients with diabetes (2024 edition)

Diabetes is a significant independent risk factor for atherosclerotic cardiovascular disease (ASCVD), with dyslipidemia playing a critical role in the initiation and progression of ASCVD in diabetic patients. In China, the current prevalence of dyslipidemia in diabetes is high, but the control rate remains low. Therefore, to enhance lipid management in patients with diabetes, the Endocrinology and Metabolism Physician Branch of the Chinese Medical Doctor Association, in collaboration with the Experts' Committee of the National Society of Cardiometabolic Medicine, has convened experts to develop a consensus on the management of dyslipidemia in patients with type 1 or type 2 diabetes. The development of this consensus is informed by existing practices in lipid management among Chinese diabetic patients, incorporating contemporary evidence-based findings and guidelines from national and international sources. The consensus encompasses lipid profile characteristics, the current epidemiological status of dyslipidemia, ASCVD risk stratification, and lipid management procedures in diabetic patients. For the first time, both low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol have been recommended as primary targets for lipid intervention in diabetic patients. The consensus also includes a summary and recommendations for lipid management strategies in special diabetic populations, including children and adolescents, individuals aged 75 years and older, patients with chronic kidney disease, metabolic-associated fatty liver disease, and those who are pregnant. This comprehensive consensus aims to improve cardiovascular outcomes in diabetic patients by contributing to the dissemination of key clinical advancements and guiding clinical practice.

Cardiovascular Risk Factor Management After Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy (HDP) are associated with significantly increased risk of developing future cardiovascular disease (CVD). Obstetricians play a crucial role in CVD prevention for postpartum women and birthing people with HDP because they are primarily responsible for immediate postpartum management and can assist with care transitions to other health care practitioners for long-term management of CVD risk factors. Standardized calculators can be used to evaluate long-term CVD risk, which can help guide intensity of treatment. Emerging technologies such as remote blood pressure monitoring demonstrate promise for improving outcomes among patients with HDP. After HDP, all patients should be advised of their increased CVD risk. A plan should be made to initiate lifestyle modifications and antihypertensive therapy to achieve optimal blood pressure control with a target of lower than 130/80 mm Hg, assess lipids within 2-3 years of delivery, and evaluate for development of type 2 diabetes. Other CVD risk factors such as nicotine use should similarly be identified and addressed. In this review, we summarize the essential components of managing CVD risk after a pregnancy complicated by HDP, including blood pressure monitoring, risk stratification tools, and evidence-based lifestyle recommendations.

Stretchable ionic-electronic bilayer hydrogel electronics enable in situ detection of solid-state epidermal biomarkers

Continuous and in situ detection of biomarkers in biofluids (for example, sweat) can provide critical health data but is limited by biofluid accessibility. Here we report a sensor design that enables in situ detection of solid-state biomarkers ubiquitously present on human skin. We deploy an ionic-electronic bilayer hydrogel to facilitate the sequential dissolution, diffusion and electrochemical reaction of solid-state analytes. We demonstrate continuous monitoring of water-soluble analytes (for example, solid lactate) and water-insoluble analytes (for example, solid cholesterol) with ultralow detection limits of 0.51 and 0.26 nmol cm-2, respectively. Additionally, the bilayer hydrogel electrochemical interface reduces motion artefacts by a factor of three compared with conventional liquid-sensing electrochemical interfaces. In a clinical study, solid-state epidermal biomarkers measured by our stretchable wearable sensors showed a high correlation with biomarkers in human blood and dynamically correlated with physiological activities. These results present routes to universal platforms for biomarker monitoring without the need for biofluid acquisition.

Western diets and chronic diseases

'Westernization', which incorporates industrial, cultural and dietary trends, has paralleled the rise of noncommunicable diseases across the globe. Today, the Western-style diet emerges as a key stimulus for gut microbial vulnerability, chronic inflammation and chronic diseases, affecting mainly the cardiovascular system, systemic metabolism and the gut. Here we review the diet of modern times and evaluate the threat it poses for human health by summarizing recent epidemiological, translational and clinical studies. We discuss the links between diet and disease in the context of obesity and type 2 diabetes, cardiovascular diseases, gut and liver diseases and solid malignancies. We collectively interpret the evidence and its limitations and discuss future challenges and strategies to overcome these. We argue that healthcare professionals and societies must react today to the detrimental effects of the Western diet to bring about sustainable change and improved outcomes in the future.

Lifestyle factors as determinants of atherosclerotic cardiovascular health

A sedentary lifestyle, low levels of physical activity and fitness, poor dietary patterns, and psychosocial stress are strongly associated with increased morbidity and mortality from atherosclerotic cardiovascular disease (ASCVD). Conversely, engaging in regular physical activity, maintaining optimal fitness levels, adhering to a heart-healthy dietary pattern, effectively managing body weight, ensuring adequate sleep, implementing stress-reduction strategies, and addressing psychosocial risk factors are associated with a reduced risk of ASCVD. This comprehensive review synthesizes current evidence from large observational studies and randomized controlled trials on lifestyle factors as determinants of ASCVD health. It also briefly reviews mechanistic insights into how factors such as low shear stress, increased reactive oxygen species production, chronic inflammation, platelets and coagulation activation, endothelial dysfunction, and sympathetic hyperactivity contribute to the initiation and exacerbation of ASCVD risk factors. These include obesity, hyperglycemia, type 2 diabetes, hypertension, and dyslipidemia, subsequently leading to the development and progression of atherosclerosis, ultimately resulting in chronic ASCVD or acute cardiovascular events. To bridge the translational gap between epidemiologic and trial-based evidence and clinical practice, practical recommendations are summarized to facilitate the translation of scientific knowledge into actionable interventions to promote ASCVD health. Acknowledged is the gap between the evidence-based knowledge and adoption within healthcare systems, which remains a crucial objective in advancing cardiovascular health at the population level.

Adverse cardiac events of hypercholesterolemia are enhanced by sitagliptin in sprague dawley rats

BACKGROUND

Cardiovascular disease (CVD) affects millions worldwide and is the leading cause of death among non-communicable diseases. Western diets typically comprise of meat and dairy products, both of which are rich in cholesterol (Cho) and methionine (Met), two well-known compounds with atherogenic capabilities. Despite their individual effects, literature on a dietary combination of the two in the context of CVD are limited. Therefore, studies on the combined effects of Cho and Met were carried out using male Sprague Dawley rats. An additional interest was to investigate the cardioprotective potential of sitagliptin, an anti-type 2 diabetic drug. We hypothesized that feeding a dietary combination of Cho and Met would result in adverse cardiac effects and would be attenuated upon administration of sitagliptin.

METHODS

Adult male Sprague-Dawley rats were fed either a control (Con), high Met (1.5%), high Cho (2.0%), or high Met (1.5%) + high Cho (2.0%) diet for 35 days. They were orally gavaged with an aqueous preparation of sitagliptin (100 mg/kg/d) or vehicle (water) from day 10 through 35. On day 36, rats were euthanized, and tissues were collected for analysis.

RESULTS

Histopathological evaluation revealed a reduction in myocardial striations and increased collagen deposition in hypercholesterolemia (HChol), responses that became exacerbated upon sitagliptin administration. Cardiac pro-inflammatory and pro-fibrotic responses were adversely impacted in similar fashion. The addition of Met to Cho (MC) attenuated all adverse structural and biochemical responses, with or without sitagliptin.

CONCLUSIONS

Adverse cardiac outcomes in HChol were enhanced by the administration of sitagliptin, and such effects were alleviated by Met. Our findings could be significant for understanding or revisiting the risk-benefit evaluation of sitagliptin in type 2 diabetics, and especially those who are known to consume atherogenic diets.

Impact of a Mediterranean-Inspired Diet on Cardiovascular Disease Risk Factors: A Randomized Clinical Trial

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. This study focused on evaluating the impact of a Mediterranean-type diet combined with physical exercise on CVD risk factors of high-risk individuals. A randomized clinical trial (RCT) recruited individuals (≥50 years old) with no history of acute myocardial infarction, but with high CVD risk criteria according to the SCORE2/SCORE2 OP. Anthropometric and biochemical parameters were assessed at baseline and after 12 weeks of diet and exercise intervention. Participants were randomly assigned into 3 groups: no intervention group (Group 1a), physical exercise group (Group 1b), and physical exercise (±2 h/week) plus diet group (Group 2). Briefly, the dietary intervention was based on the principles of an isocaloric Mediterranean diet (MD), with seven main meals/week centered on plant-based foods (legumes and pulses). The combined effect of exercise and the diet showed significant decrease in WC (p = 0.002), BST (p < 0.001), visceral fat (p < 0.001), and TG (p = 0.029), compared with control groups. The intervention significantly increased legume intake (p < 0.001), as well as adherence to the MD, which associates with WC decrease (p = 0.024) and visceral fat (p = 0.017). A combined intervention of exercise and diet should be endorsed as an efficient modifier of cardiometabolic parameters.

The incidence of heart attacks among young individuals in Mosul City

BACKGROUND

Rapid socioeconomic progress has greatly affected the world, and the risk of cardiovascular diseases (CVDs) has increased. The growing burden of CVDs has become a major public health issue. The study aimed to identify the main risk factors that lead to the contribution of heart attacks among young people in Mosul City, Iraq.

MATERIALS AND METHODS

The study was dependent on achieving the objectives through a descriptive study design that was performed in the emergency medical wards of three teaching hospitals in Mosul City, Iraq. The sample was the convenience of patients who were admitted to the emergency department and who had signs and symptoms of heart attacks during the period of data collection starting from November 1, 2022, until April 1, 2023. The participants were 247 cases recorded during that period, and their ages ranged between 20 and 45 years. The tool used in this study from the World Health Organization (WHO) is related to risk factors for CVDs and consists of eleven items.

RESULTS

Approximately seventy percent of the study sample was male, 68.4% were less than 39 years, and 35.6% of them were diagnosed with heart diseases (angina and myocardial infarction) that require hospitalization, and there are several risk factors in the study sample, the most prominent of which were physical inactivity (88.6%), following unhealthy diet patterns (87.5%) and hypertension (69.3%).

CONCLUSION

The study concluded that the risky health factors that contribute to the occurrence of heart attacks among young people in this study are hypertension, high blood cholesterol, unhealthy diet, heavy smoking, stress, family history, alcohol drinking, obesity, and diabetes mellitus (DB).

Dietary choline intake in European and non-european populations: current status and future trends-a narrative review

BACKGROUND

Choline is a nutrient necessary for the proper functioning of the body with a multidimensional impact on human health. However, comprehensive studies evaluating the dietary intake of choline are limited. The aim of this narrative review is to analyze current trends in choline intake in European and non-European populations. The secondary aim was to discuss possible future choline trends.

METHODS

The search strategy involved a systematic approach to identifying relevant literature that met specific inclusion criteria. Observational studies and randomized clinical trials were searched for in PubMed and Scopus databases from January 2016 to April 2024. This review includes the characteristics of study groups, sample sizes, methods used to assess choline intake and time period, databases used to determine intake, choline intakes, and the main sources of choline in the diet. The review considered all population groups for which information on choline intake was collected.

RESULTS

In most studies performed in Europe after 2015 choline intake did not exceed 80% of the AI standard value. The mean choline intake for adults in different European countries were 310 mg/day, while the highest value was reported for Polish men at 519 mg/day. In non-European countries, mean choline intakes were 293 mg/day and above. The main reported sources of choline in the diet are products of animal origin, mainly eggs and meat. The available data describing the potential intake of these products in the EU in the future predict an increase in egg intake by another 8% compared to 2008-2019 and a decrease in meat intake by about 2 kg per capita from 2018 to 2030.

CONCLUSIONS

In the last decade, choline intake among adults has been insufficient, both in Europe and outside it. In each population group, including pregnant women, choline intake has been lower than recommended. Future choline intake may depend on trends in meat and egg consumption, but also on the rapidly growing market of plant-based products. However, the possible changes in the intake of the main sources of choline may lead to either no change or a slight increase in overall choline intake.

Daily standing time, dietary fiber, and intake of unsaturated fatty acids are beneficially associated with hepatic insulin sensitivity in adults with metabolic syndrome

Background

Obesity is associated with impaired glucose metabolism and hepatic insulin resistance. The aim was to investigate the associations of hepatic glucose uptake (HGU) and endogenous glucose production (EGP) to sedentary behavior (SB), physical activity (PA), cardiorespiratory fitness, dietary factors, and metabolic risk markers.

Methods

Forty-four adults with metabolic syndrome (mean age 58 [SD 7] years, BMI ranging from 25-40kg/; 25 females) were included. HGU was measured by positron emission tomography during the hyperinsulinemic-euglycemic clamp. EGP was calculated by subtracting the glucose infusion rate during clamp from the glucose rate of disappearance. SB and PA were measured with hip-worn accelerometers (26 [SD3] days). Fitness was assessed by maximal bicycle ergometry with respiratory gas measurements and dietary intake of nutrients by 4-day food diaries.

Results

HGU was not associated with fitness or any of the SB or PA measures. When adjusted for sex, age, and body fat-%, HGU was associated with whole-body insulin sensitivity (β=0.58), water-insoluble dietary fiber (β=0.29), energy percent (E%) of carbohydrates (β=-0.32), saccharose (β=-0.32), mono- and polyunsaturated fatty acids (β=0.35, β=0.41, respectively). EGP was associated with whole-body insulin sensitivity (β=-0.53), and low-density lipoprotein cholesterol [β=-0.31], and when further adjusted for accelerometry wear time, EGP was associated with standing [β=-0.43]. (p-value for all< 0.05).

Conclusions

Standing more, consuming a diet rich in fiber and unsaturated fatty acids, and a lower intake of carbohydrates, especially sugar, associate beneficially with hepatic insulin sensitivity. Habitual SB, PA, or fitness may not be the primary modulators of HGU and EGP. However, these associations need to be confirmed with intervention studies.

Pork Meat Composition and Health: A Review of the Evidence

Meat has been part of the human diet for centuries and it is a recognizable source of high-biologic-value protein and several micronutrients; however, its consumption has been associated with an increased risk of non-communicable diseases (e.g., cardiovascular diseases, cancer). These concerns are mostly related to red meat. However, meat composition is quite variable within species and meat cuts. The present study explores the composition of pork meat, and the differences among different pork meat cuts and it reviews the evidence on the influence of its consumption on health outcomes. Pork meat contributes to 30% of all meat consumed worldwide and it offers a distinct nutrient profile; it is rich in high-quality protein, B-complex vitamins, and essential minerals such as zinc and iron, though it contains moderate levels of saturated fat compared to beef. Additionally, research on sustainability points out advantages from pork meat consumption considering that it is a non-ruminant animal and is included in one of the five more sustainable dietary patterns. In what concerns the data on the influence of pork meat consumption on health outcomes, a few clinical studies have shown no harmful effects on cardiovascular risk factors, specifically blood lipids. Several arguments can justify that pork meat can be an option in a healthy and sustainable diet.

Dietary Intake among Lebanese Adults: Findings from the Updated LEBANese natiONal Food Consumption Survey (LEBANON-FCS)

BACKGROUND

The rates of obesity, undernutrition, and other non-communicable diseases are on the rise among Lebanese adults. Therefore, it is crucial to evaluate the food consumption habits of this population to understand diet quality, analyze consumption trends, and compare them to healthy diets known to reduce risks of non-communicable diseases.

AIM

To evaluate the food consumption patterns, energy intake, as well as macro- and micro-nutrient intake among a nationally representative sample of Lebanese adults aged 18-64 years old.

METHODS

A cross-sectional study was carried out from May to September 2022 involving 444 participants from all eight Lebanese governorates. Sociodemographic and medical information was gathered through a questionnaire, food consumption was evaluated using a validated FFQ and 24 h recall, and anthropometric measurements were recorded.

RESULTS

There was a notable lack of adherence to three healthy diets (Mediterranean, EAT-Lancet, USDA) among Lebanese adults. Their dietary pattern is characterized by high energy, added sugars, sodium, and saturated fat intake while being low in healthy fats, vitamin A, D, and E. Adult women are falling short of meeting their daily calcium, vitamin D, iron, and vitamin B12 requirements, putting them at increased risk of anemia, osteoporosis, and other health issues. Grains and cereals were the most consumed food groups, and most participants were found to be overweight or obese.

CONCLUSIONS

In conclusion, the results highlight the need for public health policies and interventions aimed at encouraging Lebanese adults to make healthier food choices and transition towards diets like the Mediterranean, EAT-Lancet, or USDA diet. These diets have been shown to promote overall health and wellbeing.

Evolving Strategies for Use of Phytochemicals in Prevention and Long-Term Management of Cardiovascular Diseases (CVD)

This report describes major pathomechanisms of disease in which the dysregulation of host inflammatory processes is a major factor, with cardiovascular disease (CVD) as a primary model, and reviews strategies for countermeasures based on synergistic interaction between various agents, including drugs and generally regarded as safe (GRAS) natural medical material (NMM), such as Ginkgo biloba, spice phytochemicals, and fruit seed flavonoids. The 15 well-defined CVD classes are explored with particular emphasis on the extent to which oxidative stressors and associated ischemia-reperfusion tissue injury contribute to major symptoms. The four major categories of pharmaceutical agents used for the prevention of and therapy for CVD: statins, beta blockers (β-blockers), blood thinners (anticoagulants), and aspirin, are presented along with their adverse effects. Analyses of major cellular and molecular features of drug- and NMM-mediated cardioprotective processes are provided in the context of their development for human clinical application. Future directions of the evolving research described here will be particularly focused on the characterization and manipulation of calcium- and calcineurin-mediated cascades of signaling from cell surface receptors on cardiovascular and immune cells to the nucleus, with the emergence of both protective and pathological epigenetic features that may be modulated by synergistically-acting combinations of drugs and phytochemicals in which phytochemicals interact with cells to promote signaling that reduces the effective dosage and thus (often) toxicity of drugs.

Associations of Dietary Cholesterol Consumption With Incident Diabetes and Cardiovascular Disease: The Role of Genetic Variability in Cholesterol Absorption and Disease Predisposition

OBJECTIVE

Whether genetic susceptibility to disease and dietary cholesterol (DC) absorption contribute to inconsistent associations of DC consumption with diabetes and cardiovascular disease (CVD) remains unclear.

RESEARCH DESIGN AND METHODS

DC consumption was assessed by repeated 24-h dietary recalls in the UK Biobank. A polygenetic risk score (PRS) for DC absorption was constructed using genetic variants in the Niemann-Pick C1-Like 1 and ATP Binding Cassettes G5 and G8 genes. PRSs for diabetes, coronary artery disease, and stroke were also created. The associations of DC consumption with incident diabetes (n = 96,826) and CVD (n = 94,536) in the overall sample and by PRS subgroups were evaluated using adjusted Cox models.

RESULTS

Each additional 300 mg/day of DC consumption was associated with incident diabetes (hazard ratio [HR], 1.17 [95% CI, 1.07-1.27]) and CVD (HR, 1.09 [95% CI, 1.03-1.17]), but further adjusting for BMI nullified these associations (HR for diabetes, 0.99 [95% CI, 0.90-1.09]; HR for CVD, 1.04 [95% CI, 0.98-1.12]). Genetic susceptibility to the diseases did not modify these associations (P for interaction ≥0.06). The DC-CVD association appeared to be stronger in people with greater genetic susceptibility to cholesterol absorption assessed by the non-high-density lipoprotein cholesterol-related PRS (P for interaction = 0.04), but the stratum-level association estimates were not statistically significant.

CONCLUSIONS

DC consumption was not associated with incident diabetes and CVD, after adjusting for BMI, in the overall sample and in subgroups stratified by genetic predisposition to cholesterol absorption and the diseases. Nevertheless, whether genetic predisposition to cholesterol absorption modifies the DC-CVD association requires further investigation.

Association of a Low-Carbohydrate High-Fat Diet With Plasma Lipid Levels and Cardiovascular Risk

Background

Low-carbohydrate high-fat (LCHF) diets have attracted interest for a variety of conditions. In some individuals, these diets trigger hypercholesterolemia. There are limited data on their effects on cardiovascular disease risk.

Objectives

The purpose of this study was to investigate the association between LCHF dietary patterns, lipid levels, and incident major adverse cardiovascular events (MACE).

Methods

In a cohort from the UK Biobank, participants with ≥1 24-hour dietary questionnaire were identified. A LCHF diet was defined as <100 g/day and/or <25% total daily energy from carbohydrates/day and >45% total daily energy from fat, with participants on a standard diet (SD) not meeting these criteria. Each LCHF case was age- and sex-matched 1:4 to SD individuals.

Results

Of the 2034 LCHF and 8136 SD identified participants, 305 LCHF and 1220 SD individuals completed an enrollment assessment concurrently with lipid collection. In this cohort, low-density lipoprotein-cholesterol (LDL-C) and apolipoprotein B levels were significantly increased in the LCHF vs SD group (P < 0.001). 11.1% of LCHF and 6.2% of SD individuals demonstrated severe hypercholesterolemia (LDL-C >5 mmol/L, P < 0.001). After 11.8 years, 9.8% of LCHF vs 4.3% of SD participants experienced a MACE (P < 0.001). This difference remained significant after adjustment for cardiovascular risk factors (HR: 2.18, 95% CI: 1.39-3.43, P < 0.001). Individuals with an elevated LDL-C polygenic risk score had the highest concentrations of LDL-C on a LCHF diet. Similar significant changes in lipid levels and MACE associations were confirmed in the entire cohort and in ≥2 dietary surveys.

Conclusions

Consumption of a LCHF diet was associated with increased LDL-C and apolipoprotein B levels, and an increased risk of incident MACE.

Effects of derivatization coupled with GC-FID analysis of cholesterol in some bakery products

Cholesterol analysis by derivatization technique is a time consuming, costly, and complex process while analyzing cholesterol without derivation is a simple, and quick method.Researchers analyzed cholesterol using both derivatization and non-derivatization techniques successfully. The objective of this study was to investigate the effect of derivatization in cholesterol analysis particularly on bakery goods.The retention time of non-derivatized cholesterol (11.62 min) and non-derivatized α-tocopherol standard (11.60 min) was very close in HP-5 capillary GC column andthey eluted together while injected as mixed standard. As a result, cholesterol content determined by non-derivatized technique could be overestimated due to the presence of α-tocopherol inbakery products. The peak resolution (Rs) between derivatized cholesterol and derivatized α-tocopherol standard using the appliedgradient GC condition was 3.1 which is well separated (>1.5) based on AOAC guidelines. The derivatized gas chromatographic cholesterol analysis method was verified by limit of detection (LOD; 0.03 mg/100 g), limit of quantification (LOQ; 0.08 mg/100 g), linearity (R2; 0.999),precision (repeatability: relative standard deviation (RSD) 1.5 %; reproducibility: RSD 1.9 %), and accuracy (102.1 % recovery). The verified cholesterol analysis method was subsequently applied to determine cholesterol content in selected bakery items, yielding a range of 2.76 ± 0.06 mg/100 g (chrysanthemum bread) to 114.26 ± 4.72 mg/100 g (castella).

Standard and New Echocardio Techniques, Such as Global Longitudinal Strain, to Monitor the Impact of Diets on Cardiovascular Diseases and Heart Function

"The Seven Countries Study", published in 1984, was the first study to find a correlation between diet and mortality related to cardiovascular diseases (CVDs). Since then, many investigations have addressed the relationship between type of diet, or specific nutrients, and CVDs. Based on these findings, some traditional dietary models, such as the Mediterranean or Nordic diet, are recommended to prevent CVDs. Meanwhile, new diets have been proposed for optimal nutrition therapy, for example, the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean-DASH Intervention Diet for Neurodegenerative Delay (MIND). The main outcomes evaluated after implementing these dietary models are as follows: CVD-related death; the development of specific CVDs, such as myocardial infarction and hypertension; or biochemical parameters related to CVDs, i.e., non-HDL cholesterol, C-reactive protein (CPR) and homocysteine. However, the early impact of diet on heart functionality is less evaluated. Recently, the echographic measurement of left ventricle (LV) deformation by global longitudinal strain (GLS) has been introduced as a novel marker of clinical and subclinical cardiac dysfunction. This technology allows a subclinical evaluation of heart functionality since, differently from the traditional evaluation of left ventricle ejection fraction (LVEF), it is capable of detecting early myocardial dysfunction. In this review, we analyzed the available studies that correlate dietetic regimens to cardiovascular diseases, focusing on the relevance of LV strain to detect subclinical myocardial alteration related to diet. Evidence is presented that DASH and MIND can have a positive impact on heart functionality and that myocardial strain is useful for early detection of diet-related changes in cardiac function.

The Lipid-Heart Hypothesis and the Keys Equation Defined the Dietary Guidelines but Ignored the Impact of Trans-Fat and High Linoleic Acid Consumption

In response to a perceived epidemic of coronary heart disease, Ancel Keys introduced the lipid-heart hypothesis in 1953 which asserted that high intakes of total fat, saturated fat, and cholesterol lead to atherosclerosis and that consuming less fat and cholesterol, and replacing saturated fat with polyunsaturated fat, would reduce serum cholesterol and consequently the risk of heart disease. Keys proposed an equation that would predict the concentration of serum cholesterol (ΔChol.) from the consumption of saturated fat (ΔS), polyunsaturated fat (ΔP), and cholesterol (ΔZ): ΔChol. = 1.2(2ΔS - ΔP) + 1.5ΔZ. However, the Keys equation conflated natural saturated fat and industrial trans-fat into a single parameter and considered only linoleic acid as the polyunsaturated fat. This ignored the widespread consumption of trans-fat and its effects on serum cholesterol and promoted an imbalance of omega-6 to omega-3 fatty acids in the diet. Numerous observational, epidemiological, interventional, and autopsy studies have failed to validate the Keys equation and the lipid-heart hypothesis. Nevertheless, these have been the cornerstone of national and international dietary guidelines which have focused disproportionately on heart disease and much less so on cancer and metabolic disorders, which have steadily increased since the adoption of this hypothesis.

Microbiome interactions with different risk factors in development of myocardial infarction

Among all non-communicable diseases, Cardiovascular Diseases (CVDs) stand as the leading global cause of mortality. Within this spectrum, Myocardial Infarction (MI) strikingly accounts for over 15 % of all deaths. The intricate web of risk factors for MI, comprising family history, tobacco use, oral health, hypertension, nutritional pattern, and microbial infections, is firmly influenced by the human gut and oral microbiota, their diversity, richness, and dysbiosis, along with their respective metabolites. Host genetic factors, especially allelic variations in signaling and inflammatory markers, greatly affect the progression or severity of the disease. Despite the established significance of the human microbiome-nutrient-metabolite interplay in associations with CVDs, the unexplored terrain of the gut-heart-oral axis has risen as a critical knowledge gap. Moreover, the pivotal role of the microbiome and the complex interplay with host genetics, compounded by age-related changes, emerges as an area of vital importance in the development of MI. In addition, a distinctive disease susceptibility and severity influenced by gender-based or ancestral differences, adds a crucial insights to the association with increased mortality. Here, we aimed to provide an overview on interactions of microbiome (oral and gut) with major risk factors (tobacco use, alcohol consumption, diet, hypertension host genetics, gender, and aging) in the development of MI and therapeutic regulation.

Are novel plant-based meat alternatives the healthier choice?

The global market for plant-based meat alternatives (PBMAs) is expanding quickly. In this narrative review, analysis of the most recent scientific literature was achieved to understand the nutritional profile, health implications, and the challenges faced by PBMAs. On the positive side, most PBMAs are good sources of dietary fiber, contain phytochemicals, have comparable levels of iron, and are lower in calories, saturated fat, and cholesterol than meat. However, PBMAs frequently contain anti-nutrients, have less protein, iron, and vitamin B12, are lower in protein quality, and also have higher amounts of sodium. Substituting PBMAs for meats may cause iron, vitamin B12, and less likely protein deficiency for these vulnerable population such as women, older adults, and individuals with disorders. PBMAs fall into the category of ultra-processed foods, indicating a need to develop minimally processed, clean-label products. Replacing red meat with healthy plant-based foods is associated with lower risks of cardiovascular diseases, type 2 diabetes, and total mortality. There is a lack of robust, long-term evidence on the role of PBMAs consumption in health. As the nutrient contents of PBMAs can vary, consumers must read nutrition facts labels and ingredient lists to select a product that best fits their nutritional and health objectives.

An overview of the cholesterol metabolism and its proinflammatory role in the development of MASLD

Cholesterol is an essential lipid molecule in mammalian cells. It is not only involved in the formation of cell membranes but also serves as a raw material for the synthesis of bile acids, vitamin D, and steroid hormones. Additionally, it acts as a covalent modifier of proteins and plays a crucial role in numerous life processes. Generally, the metabolic processes of cholesterol absorption, synthesis, conversion, and efflux are strictly regulated. Excessive accumulation of cholesterol in the body is a risk factor for metabolic diseases such as cardiovascular disease, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease (MASLD). In this review, we first provide an overview of the discovery of cholesterol and the fundamental process of cholesterol metabolism. We then summarize the relationship between dietary cholesterol intake and the risk of developing MASLD, and also the animal models of MASLD specifically established with a cholesterol-containing diet. In the end, the role of cholesterol-induced inflammation in the initiation and development of MASLD is discussed.