Plant-based meat analogues (PBMAs) and their effects on cardiometabolic health: An 8-week randomized controlled trial comparing PBMAs with their corresponding animal-based foods

BACKGROUND

With the growing popularity of plant-based meat analogues (PBMAs), an examination of their effects on health is warranted in an Asian population.

OBJECTIVE

This research investigated the impact of consuming an omnivorous animal-based meat diet (ABMD) compared to a PBMAs diet (PBMD) on cardiometabolic health among adults with elevated risk of diabetes in Singapore.

METHODS

In an 8-week parallel design randomized controlled trial, participants (n=89) were instructed to substitute habitual protein-rich foods with fixed quantities of either PBMAs (n=44) or their corresponding animal-based meats (n=45; 2.5 servings daily) maintaining intake of other dietary components. LDL-cholesterol served as primary outcome, while secondary outcomes included other cardiometabolic disease-related risk factors (e.g. glucose, fructosamine), dietary data, and within a sub-population, ambulatory blood pressure measurements (n=40) at baseline and post-intervention, as well as a 14-day continuous glucose monitor (glucose homeostasis-related outcomes; n=37).

RESULTS

Data from 82 participants (ABMD:42, PBMD:40) were examined. Using linear mixed-effects model, there were significant interaction (time × treatment) effects for dietary trans-fat (increased in ABMD), dietary fiber, sodium and potassium (all increased in PBMD; PInteraction<0.001). There were no significant effects on the lipoprotein profile, including LDL-cholesterol. Diastolic blood pressure (DBP) was lower in the PBMD group (PInteraction=0.041) although the nocturnal DBP markedly increased in ABMD (+3.2% mean) and was reduced in PBMD (-2.6%; PInteraction=0.017). Fructosamine (PTime=0.035) and homeostatic model assessment for β-cell function were improved at week 8 (PTime=0.006) in both groups. Glycemic homeostasis was better regulated in the ABMD than PBMD groups as evidenced by interstitial glucose time in range (ABMD median: 94.1% (Q1:87.2%, Q3:96.7%); PBMD: 86.5% (81.7%, 89.4%); P=0.041). The intervention had no significant effect on the other outcomes examined.

CONCLUSIONS

A plant-based meat analogues diet did not show widespread cardiometabolic health benefits compared with omnivorous diets over 8 weeks. The composition of PBMAs may need to be considered in future trials.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ TRIAL REGISTRATION NUMBER: NCT05446753.

Effects of wolfberry (Lycium barbarum) consumption on the human plasma lipidome and its association with cardiovascular disease risk factors: a randomized controlled trial of middle-aged and older adults

Background

Long-term wolfberry intake as part of a healthy dietary pattern was recognized to have beneficial vascular outcomes. Characterization of the plasma lipidome may further provide comprehensive insights into pathways underlying these cardiovascular protective effects.

Objective

We analyzed the plasma lipidome of subjects who adhered to a healthy dietary pattern either with or without wolfberry and investigated the associations between the plasma lipidomic profile and cardiovascular health-related indicators.

Methods

In this 16-week, parallel design, randomized controlled trial, middle-aged and older adults (n = 41) were provided dietary counseling and assigned to either consume or not consume 15 g of wolfberry daily. At baseline and post-intervention, plasma lipidomics was assayed, and its relationships with classical CVD risk factors, vascular health, oxidant burden, carotenoids status, body composition, and anthropometry were examined.

Results

From the plasma lipidome, 427 lipid species from 26 sub-classes were quantified. In the wolfberry and control groups, significant changes were prominent for 27 and 42 lipid species, respectively (P < 0.05 with > 0.2-fold change). Fold changes for seven lipid species were also markedly different between the two groups. Examining the relationships between the plasma lipidome and CVD-related risk factors, total cholesterol revealed a marked positive correlation with 13 ceramide species, while HDL-cholesterol which was notably increased with wolfberry consumption showed a positive correlation with 10 phosphatidylcholine species. Oxidant burden, as represented by plasma 8-isoprostanes, was also inversely associated with lipidomic triglycerides and ether-triglycerides (41 species) and directly associated with hexosylceramides (eight species) and sphingomyelins (six species). There were no differential associations with CVD risk detected between groups.

Conclusion

Characteristic alterations to the plasma lipidome were observed with healthy dietary pattern adherence and wolfberry consumption. An examination of these fluctuations suggests potential biochemical mechanisms that may mediate the antioxidant and cardiovascular protective effects of healthy dietary pattern adherence and wolfberry intake. This study was registered at clinicaltrials.gov as NCT0353584.

Measures of carbohydrate quality and their association with diet quality and cardiometabolic health outcomes in Singapore middle-aged and older adults

BACKGROUND AND AIMS

Carbohydrate quality may play a key role in cardiometabolic health and disease risk. This study aimed to assess the dietary carbohydrate quality of the free-living middle-aged and older adults in Singapore, and its association with overall diet quality and cardiometabolic health.

METHODS AND RESULTS

This cross-sectional study examined the diet and cardiometabolic disease risk indicators of middle-aged and older adults in Singapore (n = 104). Dietary carbohydrate quality was assessed as the pass and fail rate of the population to four measures of carbohydrate quality: (i) dietary fiber recommended daily allowance (RDA), (ii) whole-grain recommendation, (iii) free sugar recommendation, and (iv) carbohydrate metrics. The association between each carbohydrate quality measure and diet quality, as well as cardiometabolic health, was assessed. Except for free sugar recommendation, the carbohydrate quality of the population was found to be poor with a low adherence (20-36%) to three measures. Subjects meeting these measures had generally higher intakes of fiber, protein, and most micronutrients compared with subjects who failed. Meeting different variants of the carbohydrate metrics was associated with 60% lower odds of pre-hypertensive blood pressure (p = 0.037; p = 0.047), and meeting the dietary fiber RDA was associated with lower waist circumference (p = 0.021).

CONCLUSION

An improvement in carbohydrate quality is warranted among free-living middle-aged and older adults in Singapore. Not all measures of carbohydrate quality were equally effective in preserving overall diet quality; the carbohydrate metrics and dietary fiber RDA can be identified as effective measures in relation to cardiometabolic disease risk.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ CLINICAL TRIAL REGISTRATION: NCT03554954, 13 Sept. 2018.

The Effects of Wolfberry Consumption on the Human Plasma Lipidome and Its Potential Role in Cardiovascular Disease Risk Modulation: A Randomized Controlled Trial

Objectives

The adverse effects of dyslipidemia on cardiovascular health are well-documented. Conventionally assayed by blood lipids/lipoproteins, these classical indicators alone yield an oversimplified view of the human plasma lipidome. We previously observed an attenuation of cardiovascular disease (CVD) risk after regular wolfberry consumption for 16 weeks, with a prominent reduction in oxidative stress. To complement these findings, the objective of this study was to characterize the alterations to the plasma lipidome and explore its potential correlations to CVD risk.

Methods

In this parallel randomized controlled trial, middle-aged and older adults (55 ± 4 y) from Singapore were counselled to follow a healthy dietary pattern, either with or without consuming 15 g cooked whole wolfberry daily (WB; n = 21, CON; n = 17). Following lipid extraction of weeks 0 and 16 plasma samples, the lipidome was assayed by high-performance liquid chromatography-tandem mass spectrometry and quantified with internal standards (427 lipid species). Pearson's correlations between the fold changes (FCs) of lipid species from baseline, with corresponding changes to CVD risk-related outcomes including blood lipids/lipoproteins, blood pressure as well as vascular health and oxidative stress-related indicators were further evaluated.

Results

A comparison between the groups identified 7 distinct lipid species between WB and CON (FC > 1.2; P < 0.05). Notably, sphingomyelin 38:1, which had a markedly higher FC in WB compared to CON (FC_WB: 1.2, FC_CON: 1.0), was also significantly raised compared to baseline. Phosphatidylcholine (PC) 35:2, which increased by 1.8-fold in WB only (P < 0.05), additionally depicted an inverse linear correlation with the FC of plasma 8-isoprostanes (Pearson's correlation coefficient: −0.45, P < 0.05). Across both groups, FCs from baseline were also significant for species of triglycerides (TG; 42 species), PC (4 species), ether-TG, ether-PC, plasmalogen-PC and cholesteryl ester (1 species each) albeit independent of wolfberry intake and with no clear associations to the other CVD risk-related outcomes.

Conclusions

Characteristic alterations to the plasma lipidome observed with wolfberry consumption may potentially modulate its underlying antioxidant effect.

Funding Sources

Ministry of Education, Singapore

Association Between Dietary Protein Intake and Sleep Quality in Middle-Aged and Older Adults in Singapore

Poor sleep has been associated with the increased risk of developing detrimental health conditions. Diet and certain nutrients, such as dietary protein (PRO) may improve sleep. This cross-sectional study aimed to investigate the relationship between PRO intake, their amino acid components, and sources with sleep quality in middle-aged and older adults residing in Singapore. A dataset of 104 healthy subjects between the age of 50 and 75 years old were used. Collected data included 3-day food record and sleep quality [sleep duration, global sleep score (GSS), sleep latency (SL), and sleep efficiency (SE)]. The collected 3-day food records were extracted for PRO, tryptophan (Trp), and large neutral amino acid (LNAA) intake. PRO intake was further categorized into plant and animal PRO. A multivariate multiple linear regression (MLR) was performed to assess the association between PRO intake and sleep quality. Dietary Trp:LNAA ratio was positively associated with sleep duration (β_total: 108.234 h; p: 0.005) after multiple covariates adjustment. Similarly, plant Trp (β_plant: 2.653 h/g; p: 0.020) and plant Trp:LNAA (β_plant: 54.006 h; p: 0.008) was positively associated with sleep duration. No significant associations were observed for both SL and SE. Sleep duration in middle-aged and older Singaporean adults was positively associated with dietary Trp and Trp:LNAA, especially when obtained from plant sources.

Impact of following a healthy dietary pattern with co-consuming wolfberry on number and function of blood outgrowth endothelial cells from middle-aged and older adults

Blood outgrowth endothelial cells (BOECs) have received growing attention in relation to cardiovascular disease (CVD). However, the effect of diet intervention, a primary strategy for CVD prevention, on BOECs is not reported. This study aims to investigate the effect of following a healthy dietary pattern (HDP) with or without wolfberry consumption, healthy food with potential cardiovascular benefits, on the number and function of BOECs in middle-aged and older adults. Twenty-four subjects consumed either an HDP only (n = 9) or an HDP supplemented with 15 g day^-1 wolfberries (n = 15) for 16 weeks. At pre- and post-intervention, vascular health biomarkers and composite CVD risk indicators were assessed. BOECs were derived from peripheral blood mononuclear cells and their angiogenic and migration activities were measured. Isolated BOECs have typical endothelial cobblestone morphology, express von Willebrand factor and KDR. Consuming an HDP improved the BOEC colony's growth rate, which was demonstrated by significant time effects in the colony's culture time between passages 1 and 2 (P = 0.038). Both interventions increased BOECs' tube formation capacity. Moreover, HDP intervention contributed to a time effect on BOEC migration activity (P = 0.040 for t_1/2gap). Correlation analysis revealed that BOEC colony number was positively associated with blood pressure, atherogenic index, vascular age, and Framingham risk score. In conclusion, adherence to an HDP improved BOECs' function in middle-aged and older populations, while additional wolfberry consumption did not provide an enhanced effect. Our results provide mechanistic dissection on the beneficial effects on BOECs of dietary pattern modification.

Cardiovascular disease risk reduction with wolfberry consumption: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

Wolfberry is rich in bioactive compounds which may lower cardiovascular disease risk. This meta-analysis aimed to systematically evaluate the effects of wolfberry-based randomized controlled trials (RCTs) on overall cardiovascular health.

METHODS

Four online databases (PubMed, CINAHL Plus, Medline and Cochrane Library) were searched to shortlist relevant RCTs. Outcomes of interests included blood lipids and lipoproteins, blood pressure, biomarkers of oxidative stress, inflammation and other cardiovascular health-related indicators. Random-effects models were used to provide a weighted mean difference (WMD) and/or Hedges' g for quantitative synthesis. This was coupled with subcategory analyses which stratified RCTs according to the form in which wolfberry was administered (whole wolfberry versus wolfberry extract).

RESULTS

From the 785 articles identified, 10 were selected for meta-analysis. Compared to the control, groups which consumed wolfberry showed a reduction in blood triglycerides [WMD_pooled (95% confidence interval): - 0.14 (- 0.19, - 0.09) mmol/L] and increased blood high-density lipoprotein cholesterol [WMD_pooled: 0.06 (0.02, 0.09) mmol/L]. Notably, effects for both triglycerides [WMD_whole: - 0.14 (- 0.19, - 0.09) mmol/L; WMD_extract: - 0.07 (- 0.30, 0.16) mmol/L] and high-density lipoprotein cholesterol [WMD_whole: 0.06 (0.02, 0.09) mmol/L; WMD_extract: 0.05 (- 0.02, 0.13) mmol/L] were more prominent after whole wolfberry interventions. Additionally, blood malondialdehyde equivalents were also significantly decreased in wolfberry consuming groups [Hedges' g_pooled: - 1.45 (- 2.75, - 0.16)]. No changes were observed for the other lipids and lipoproteins as well as blood pressure.

CONCLUSIONS

Wolfberry consumption is effective in improving blood lipids and lipoproteins profile and lowering oxidative stress. This supports the incorporation of wolfberry, particularly as whole fruits, into dietary patterns targeted at improving cardiovascular health.

A Systematic Review and Meta-Analysis of the Impact of Different Intensity of Dietary Counselling on Cardiometabolic Health in Middle-Aged and Older Adults

Dietary counselling has been identified as one of the nutritional strategies to alleviate cardiometabolic health conditions. Its effectiveness however may vary due to factors such as intensity level and provider while this has not been comprehensively studied. This systematic review and meta-analysis aimed to assess the effects of dietary counselling on the cardiometabolic health in middle-aged and older adults and the sub-group analyses with dietary counselling intensity and the provider were also assessed. Four databases including PubMed, CINAHL Plus with Full Text, Cochrane Library and EMBASE were systematically searched. Data from 22 randomised controlled trials (RCTs) were compiled and those from 9 RCTs were utilised for meta-analysis. Dietary counselling lowered total cholesterol (TC) and fasting blood sugar (FBS) but had no impact on triglycerides (TG) and low-density lipoprotein (LDL). Sub-group analysis revealed significant lowering effect of high intensity dietary counselling for TG (weighted mean difference (WMD): −0.24 mmol/L, 95% confidence intervals (CIs): −0.40 to −0.09), TC (WMD: −0.31 mmol/L, 95% CIs: −0.49 to −0.13), LDL (WMD: −0.39 mmol/L, 95% CIs: −0.61 to −0.16) and FBS (WMD: −0.69 mmol/L, 95% CIs: −0.99 to −0.40) while medium or low intensity dietary counselling did not show favouring effects. Counselling provider showed differential responses on cardiometabolic health between dietitian and all other groups. The findings from this systematic review and meta-analysis suggest that dietary counselling is a beneficial dietary strategy to improve cardiometabolic health in middle-aged and older adults with the emphasis on the counselling intensity.

Enhancing the cardiovascular protective effects of a healthy dietary pattern with wolfberry (Lycium barbarum): A randomized controlled trial

BACKGROUND

The consumption of wolfberry (Lycium barbarum), a rich source of carotenoids and bioactive polysaccharides, may serve as a potential dietary strategy for cardiovascular disease (CVD) risk management although limited studies examined its effects as whole fruits.

OBJECTIVES

To investigate the impact of wolfberry consumption as part of a healthy dietary pattern on vascular health-related outcomes and classical CVD risk factors in middle-aged and older adults in Singapore.

METHODS

This is a 16-week, parallel design, randomized controlled trial. All participants (n = 40) received dietary counselling to follow healthy dietary pattern recommendations with the wolfberry group given additional instructions to cook and consume 15 g/d whole, dried wolfberry with their main meals. Biomarkers of vascular function (flow-mediated dilation, plasma total nitrate/nitrite, endothelin-1, and intercellular adhesion molecule-1), vascular structure (carotid intima-media thickness) and vascular regeneration (endothelial progenitor cell count, plasma angiopoietin 1 and angiopoietin 2), were assessed at baseline and postintervention. Serum lipid-lipoproteins and blood pressure were evaluated every 4 weeks.

RESULTS

All participants showed an improved compliance toward the healthy dietary pattern. This was coupled with marked rises in total nitrate/nitrite concentrations (mean change wolfberry: 3.92 ± 1.73 nmol/mL; control: 5.01 ± 2.55 nmol/L) and reductions in endothelin-1 concentrations (wolfberry: -0.19 ± 0.06 pg/mL; control: -0.15 ± 0.08 pg/mL). Compared with the control which depicted no changes from baseline, the wolfberry group had a significantly higher HDL cholesterol (0.08 ± 0.04 mmol/L), as well as lower Framingham predicted long-term CVD risk (-0.8 ± 0.5%) and vascular age (-1.9 ± 1.0 y) postintervention. No differences were observed in the other vascular health-related outcomes.

CONCLUSIONS

In middle-aged and older adults, adherence to a healthy dietary pattern improves vascular tone. Incorporating wolfberry to the diet further improves blood lipid-lipoprotein profile and may lower long-term CVD risk. This study was registered at clinicatrials.gov as NCT03535844.

Improvement of the Carotenoids Bioaccessibility from Vegetable Salads Using Excipient Emulsions: Impacts of the Emulsification and the Type of Dietary Fats

Objectives

Carotenoids which are rich in fruits and vegetables, are known for their health-promoting benefits. However, due to their hydrophobicity, carotenoids are poorly absorbed in human body and there is a need to improve their absorption. This study aimed to evaluate the effects of the emulsification and the type of dietary fat on the bioaccessibility of carotenoids from vegetable salads.

Methods

Oil-in-water emulsions were formed using the high-pressure homogenizer with whey protein isolate as the emulsifier. A mixture of raw vegetable salads, including tomatoes, baby spinach, carrots, romaine lettuce and Chinese wolfberry, were co-digested with 4 different types of dietary fats: olive oil-in-water emulsion (OLE), olive oil-water mixture (OLN), coconut oil-in-water emulsion (COE) and coconut oil-water mixture (CON). The bioaccessibility of 5 main

carotenoids (lutein, zeaxanthin, α-carotene, β-carotene and lycopene) was evaluated via a simulated in-vitro gastrointestinal model and the carotenoids were detected by high-performance liquid chromatography.

Results

The bioaccessibility (mean ± SD) of total carotenoids was enhanced when vegetable salads were co-digested with the oil-in-water emulsion (23.5 ± 2.8%) than the oil-water mixture (15.4 ± 7.6%) (P &lt; 0.05). Specifically, OLE showed an increase in the bioaccessibility of α-carotene (OLE: 24.5 ± 2.4%, OLN: 19.0 ± 0.6%, P &lt; 0.05) and β-carotene (OLE: 20.4 ± 1.0%, OLN: 14.6 ± 2.5%, P &lt; 0.05), compared to OLN, while no differences were observed for lutein, zeaxanthin and lycopene. On the other hand, COE resulted in higher bioaccessibility of all the individual carotenoids as compared to CON (P &lt; 0.05), except for the zeaxanthin. Overall, the bioaccessibility of total carotenoids was higher with olive oil (24.0 ± 2.8%) than coconut oil (14.9 ± 6.9%) (P &lt; 0.05).

Conclusions

Findings from this study indicate that emulsification of dietary fats and olive oil enhance the bioaccessibility of carotenoids. Using excipient olive oil-in-water emulsion in particular, may be a potential way to improve the absorption of carotenoids when it is added into the carotenoids-rich vegetable salads as salads dressing.

Funding Sources

National University of Singapore, Agency for Science, Technology and Research.

Wolfberry Consumption with a Healthy Dietary Pattern Lowers Oxidative Stress and Improves Carotenoids Status in Middle-Aged and Older Adults: A Randomized Controlled Trial

Objectives

The incorporation of zeaxanthin rich wolfberry (Lycium barbarum) into a healthy dietary pattern may augment its antioxidant effects although evidence evaluating whole fruits is lacking. The objectives of this study are to (1) investigate the impact of dietary counselling, either with or without whole dried wolfberry on oxidative stress status in middle-aged and older Singaporean adults and (2) delineate underlying mechanisms by examining associations with the corresponding changes in carotenoids status.

Methods

In this 16-week, parallel design randomized controlled trial, 40 subjects (29 F, 11 M; aged 50 to 64 y) received dietary counselling to follow a healthy dietary pattern. Compared to the control group (CG, n = 18), the wolfberry group (WG, n = 22) additionally cooked and consumed 15 g/d whole dried wolfberry with their main meals. Biomarkers of oxidative stress (plasma malondialdehyde (MDA)

by thiobarbituric acid reactive substance assay and 8-isoprostanes by ELISA) were measured at baseline and week 16. Plasma and dietary carotenoids analyzed by HPLC and 3-day food records respectively were measured at baseline, week 8 and week 16 while skin carotenoids status (SCS) by resonance Raman spectroscopy was assayed every 4 weeks.

Results

Plasma 8-isoprostanes showed a time effect (P &lt; 0.05), attributed to the marked decline in the WG only (WG: −19.0 ± 43.6 ng/L; CG: −7.7 ± 38.7 ng/L, mean ± SD) though no effect was observed for MDA. A significant interaction effect (P &lt; 0.001), driven by higher plasma zeaxanthin (WG: +0.08 ± 0.13 nmol/L; CG: −0.03 ± 0.05 nmol/L) and SCS (WG: +4242 ± 4938 a.u.; CG: +1713 ± 5921 a.u.) was observed in the WG with a marked increase evident from week 8 onwards although concentrations of the other plasma carotenoids were maintained. Moreover, the change value for plasma zeaxanthin in the WG was inversely associated with the corresponding changes in plasma 8-isoprostanes (−0.21 (−0.43, 0.00) ng/µmol, regression coefficient (95% CI); P = 0.05). This same association was absent in the CG.

Conclusions

Consuming wolfberry with a healthy dietary pattern attenuates oxidative stress in middle-aged and older adults and this may be attributed to the rich zeaxanthin content in wolfberry.

Funding Sources

National University of Singapore Ministry of Education, Singapore Agency for Science, Technology and Research.

Wolfberry (Lycium barbarum) Consumption with a Healthy Dietary Pattern Lowers Oxidative Stress in Middle-Aged and Older Adults: A Randomized Controlled Trial

Incorporating zeaxanthin-rich wolfberry (Lycium barbarum) into a healthy dietary pattern may augment its antioxidant potential. The present 16-week, parallel design randomized controlled trial aimed to investigate the impact of adhering to a healthy dietary pattern, either with or without whole dried wolfberry (15 g/d) on oxidative stress status (plasma malondialdehyde and 8-iso-prostaglandin F2α) in middle-aged and older adults. Changes to carotenoids status (plasma and skin carotenoids) and body composition were further evaluated to explore potential mechanisms which underlie the antioxidant properties of wolfberry. Plasma 8-iso-prostaglandin F2α, plasma zeaxanthin and skin carotenoids status were significantly raised in the wolfberry consuming group (n = 22; p < 0.05) compared to the control group which showed no changes (n = 18). Likewise in the wolfberry group only, inverse association was observed between the change values of plasma zeaxanthin and plasma 8-iso-prostaglandin F2α (−0.21 (−0.43, 0.00) ng/µmol, regression coefficient (95% CI); p = 0.05). Wolfberry consumption with a healthy dietary pattern may serve as a dietary strategy to attenuate lipid peroxidation among middle-aged and older adults who are at a heightened risk of oxidative stress induced age-related disorders. The antioxidant properties of wolfberry may be attributed to its rich zeaxanthin content.

Skin carotenoids status as a potential surrogate marker for cardiovascular disease risk determination in middle-aged and older adults

BACKGROUND AND AIMS

Upon consumption, carotenoids, which may attenuate cardiovascular disease (CVD) risk, diffuse from the blood and accumulate in the skin. This study aimed to assess the associations between dietary, plasma, and skin carotenoids with CVD risk indicators and to examine the mediational role of plasma carotenoids in the relationship between skin carotenoids status (SCS) and CVD risk.

METHODS AND RESULTS

Dietary, plasma, and skin carotenoids were assessed in a cross-sectional study from a community in Singapore (n = 103) aged 50 to 75 y. Multiple linear regression and binary logistics regression models were used to examine the associations between the carotenoids status with classical CVD risk factors and composite CVD risk indicators. After controlling for covariates, SCS and plasma carotenoids were inversely associated with systolic blood pressure (skin: P < 0.001; plasma: P < 0.05) and diastolic blood pressure (skin: P < 0.001; plasma: P < 0.005). Additionally, each increment of 1000 in SCS was associated with an odds ratio of 0.924 (P < 0.01) for metabolic syndrome diagnosis and 0.945 (P < 0.05) for moderate to high CVD risk classification. Associations between SCS and composite CVD risk indicators were null when adjusted for the corresponding plasma carotenoids, indicating complete mediation. Dietary carotenoids, however, showed no relationship with the CVD risk indicators.

CONCLUSION

Carotenoids bioavailability may be important for cardiovascular protection. SCS, driven by the corresponding plasma carotenoids, could be a potential noninvasive surrogate marker for CVD risk determination in middle-aged and older adults.

CLINICAL TRIAL REGISTRATION

NCT03554954, https://clinicaltrials.gov/.

TRIAL REGISTRATION DATE

13 June 2018.

Incorporating healthy dietary changes in addition to an increase in fruit and vegetable intake further improves the status of cardiovascular disease risk factors: A systematic review, meta-regression, and meta-analysis of randomized controlled trials

CONTEXT

Fruit and vegetable (FV) intake has been associated with a reduced risk of cardiovascular disease (CVD). Beyond increasing FV intake, the incorporation of other healthy dietary changes may help to further attenuate CVD risk.

OBJECTIVE

A systematic review and meta-analysis was conducted to determine the effect of increasing FV intake to > 3 servings daily as well as incorporating other healthy dietary changes on classical CVD risk factors through a systematic review, meta-regression, and meta-analysis of randomized controlled trials.

DATA SOURCES

The following databases were searched: PubMed, CINAHL Plus with Full Text, Medline (ProQuest), and Cochrane Library.

DATA EXTRACTION

82, 24, and 10 articles were selected for the systematic review, meta-regression, and meta-analysis, respectively.

DATA ANALYSIS

Meta-regression analysis showed a dose-dependent response between the number of FV servings consumed in each intervention group and the blood triglyceride change value. Pooled weighted mean differences from the meta-analysis suggested that increasing FV intake to > 3 servings daily contributes to significant decreases in triglyceride (-0.10 mmol/L; 95%CI, -0.18 to -0.01) and diastolic blood pressure (-1.99 mmHg; 95%CI, -2.28 to -1.70) as well as marginal decreases in total cholesterol and low-density lipoprotein cholesterol. While improvements were observed in the triglyceride and high-density lipoprotein cholesterol response following the incorporation of other healthy dietary changes, no additional cardiovascular benefits were observed when FV intake was increased from > 3 to > 5 servings daily.

CONCLUSION

Increasing FV intake to > 3 servings daily improves CVD risk factors, most distinctly triglyceride, especially when complemented with other healthy dietary changes.

Consuming Wolfberry (Lycium Barbarum L.) with a Healthy Dietary Pattern Improves the Function of Blood Outgrowth Endothelial Cells Derived from Middle-Aged and Older Adults

Objectives

Endothelial progenitor cells (EPCs), a novel biomarker of cardiovascular disease, are involved in the maintenance of endothelial homeostasis and vascular repair and the number of EPCs could be altered by dietary modification. Wolfberry is widely known for the potential cardiovascular benefits, however, its impact on EPC count and function is not reported. This study aims to investigate the effect of consuming wolfberry as part of a healthy dietary pattern (HDP) on the number and function of EPCs derived from blood (BOECs).

Methods

Twenty-four subjects from Singapore were randomized and consumed either HDP only (HDPO; n = 9; mean age 55 ± 3 years) or HDP supplemented with 15 g/day wolfberry (HDPW; n = 15; mean age 56 ± 4 years) for 16 weeks. At pre- and post-intervention, 27 mL peripheral blood was collected from subject for the isolation of BOECs. Immunofluorescence staining with von Willebrand factor (VWF) and flow cytometry analysis with cell surface markers including KDR and CD34 were performed to verify the obtained BOECs. In-vitro tube formation assay was performed to measure the angiogenic properties of BOECs. Endothelial-dependent flow-mediated dilation (FMD) and intima-media thickness (IMT) were also measured by ultrasonographic imaging.

Results

Isolated BOECs have typical endothelial cobblestone morphology, express VWF and KDR, and partly express CD34. Compared with pre-intervention, both HDPO and HDPW groups showed an increase in total colony numbers of BOECs (from 1.8 ± 0.5 to 3.1 ± 1.1, P = 0.28 and 2.7 ± 0.8 to 3.2 ± 0.6, P = 0.51, respectively). For the tube formation capacity of BOECs, adherence to a HDP contributed to a time effect on both the total mesh area (P = 0.02) and mean mesh size (P &lt; 0.01). However, further improvement in total master segment length (6.9 ± 1.6 to 11.4 ± 1.0 mm, P = 0.03), total mesh area (0.2 ± 0.1 to 0.7 ± 0.1 mm2, P = 0.03), and mean mesh size (0.02 ± 0.006 to 0.05 ± 0.003 mm2, P &lt; 0.001) were only observed in the HDPW group compared with pre-intervention and not in the HDPO group. No changes of FMD and IMT were detected after intervention.

Conclusions

Adherence to a HDP increases colony count and enhances angiogenic function of BOECs, and the angiogenic capability of BOECs is further improved by wolfberry supplement in Singaporean middle-aged and older adults.

Funding Sources

Ministry of Education, Singapore.

Enhancing the Cardiovascular Protective Effects of a Healthy Dietary Pattern with Wolfberry (Lycium barbarum): A Randomized Controlled Trial

Objectives

The study aimed to investigate the impact of wolfberry (Lycium barbarum) consumption as part of a healthy dietary pattern on cardiovascular health in Singaporean middle-aged and older adults. It was hypothesized that the consumption of wolfberry could further enhance the cardiovascular protective effects of a healthy dietary pattern.

Methods

This was a 16 week, parallel design, randomized controlled trial where 40 Singaporean men and women (aged 50 to 64 years) received dietary counselling to follow a healthy dietary pattern either with or without 15 g/day of dried whole wolfberry, cooked and consumed as part of their meals. Blood pressure, serum lipid-lipoprotein concentrations and dietary compliance using 3-day food records were monitored every 4 weeks. Further evaluation of cardiovascular disease (CVD) biomarkers, broadly classified as serological (total nitrate/nitrite, endothelin-1, intercellular adhesion molecule-1, angiopoietin-1, angiopoietin-2 and von-Willebrand factor), structural (carotid intima-media thickness using B-mode ultrasonography) and functional (flow-mediated dilation using B-mode ultrasonography and circulating endothelial progenitor cells (CD34+/KDR+) by fluorescence-activated cell sorting) were analyzed before and after intervention.

Results

Adherence to a healthy dietary pattern contributed to a time dependent effect on both the plasma total nitrate/nitrite (P &lt; 0.01) and plasma endothelin-1 (P &lt; 0.005) which were raised and lowered respectively at week 16. However, changes were significant only in the wolfberry group (total nitrate/nitrite: 15.9 ± 1.8 to 19.4 ± 2.2 μmol/L, P &lt; 0.05; endothelin-1: 1.31 ± 0.12 to 1.11 ± 0.10 ng/L, P &lt; 0.01) and not in the control group. Moreover, a significant increase in serum high density lipoprotein (HDL) cholesterol was also detected solely in the wolfberry group (1.56 ± 0.10 to 1.65 ± 0.10 mmol/L, P &lt; 0.05). The other serological, structural and functional biomarkers of cardiovascular health showed no observable change after the intervention.

Conclusions

Incorporating wolfberry to your daily meals may augment the cardiovascular protective benefits of a healthy dietary pattern by improving the regulation of vascular tone and plasma lipid-lipoprotein profile in Singaporean middle-aged and older adults.

Funding Sources

Ministry of Education, Singapore.

Skin Carotenoid Status Is a Potential Surrogate Marker for Cardiovascular Disease Risk Determination in Middle-Aged and Older Adults

Objectives

The study aimed to examine the associations between skin carotenoid status and plasma carotenoids with classical cardiovascular disease (CVD) risk factors among a middle-aged and older Singaporean population. It was hypothesized that skin carotenoid status and plasma carotenoids could be used as an indicator for CVD risk.

Methods

This cross-sectional study recruited 45 men and 59 women, aged 50 to 75 years, from a community in Singapore (n = 104). Dietary information was obtained using 3-day food records, skin carotenoid status was measured using resonance Raman spectroscopy and plasma carotenoids were analyzed with high-performance liquid chromatography. CVD risk was determined using classical risk factors including blood pressure (BP), serum lipid-lipoprotein concentrations, as well as overall CVD risk predictors such as the number of metabolic syndrome components and a 10-year CVD risk prediction using the Framingham Heart Study risk score calculator.

Results

Multiple linear regression with covariate adjustments indicated that skin carotenoid status and plasma carotenoids were inversely associated with systolic BP (skin: standardized regression coefficient (β) = −0.341, P &lt; 0.001; plasma: β = −0.258, P &lt; 0.05), diastolic BP (skin: β = −0.378, P &lt; 0.001; plasma: β = −0.309, P &lt; 0.005) as well as both the number of metabolic syndrome components (skin: β = −0.383, P &lt; 0.001; plasma: β = −0.434, P &lt; 0.001) and the 10-year CVD risk prediction (skin: β = −0.347, P &lt; 0.001; plasma: β = −0.334, P &lt; 0.001). The associations between skin carotenoid status with metabolic syndrome and the 10-year CVD risk were null with the inclusion of plasma carotenoids as a covariate which suggested its role as a mediator. Despite the positive linear association between skin carotenoid status and dietary carotenoids intake (Pearson's coefficient: 0.204, P &lt; 0.001), dietary carotenoids were not directly correlated with the CVD risk factors analyzed.

Conclusions

Skin carotenoid status can function not only as a dietary biomarker, but also, as a potential surrogate marker for CVD risk in middle-aged and older Singaporeans.

Funding Sources

National University of Singapore Ministry of Education, Singapore Agency for Science, Technology and Research (Singapore).

Effects of fatty acids composition in a breakfast meal on the postprandial lipid responses: a systematic review and meta-analysis of randomised controlled trials

Replacement of food rich in saturated fatty acids (SFAs) with unsaturated fatty acids (UFAs) is a well-known dietary strategy to reduce the risk of cardiovascular disease while its impact on postprandial blood lipids is less examined. This study assessed the effects of fatty acids composition on the postprandial triglycerides and cholesterol responses. Seventeen randomised controlled trials were identified and pooled analysis results revealed that consumption of a UFAs-rich or an SFAs-rich breakfast meal did not acutely affect postprandial triglycerides and cholesterol responses. However, subgroup analysis observed that triglycerides incremental area under the curve was lower with an SFAs-rich meal (SMD: -0.36; 95% CI: -0.57, -0.15) over a less than 8 h duration, while was higher (SMD: 0.59; 95% CI: 0.05, 1.23) over a longer postprandial duration. It suggests that the postprandial duration is of importance when evaluating the effects of fatty acids composition on blood lipid responses.

Daily consumption of essence of chicken improves cognitive function: a systematically searched meta-analysis of randomized controlled trials

Essence of chicken (EC) is a dietary supplement with potential benefits on one's cognitive performance. The purpose of this meta-analysis is to evaluate the effects of consuming EC on cognitive function, applying extensively represented domains. Six databases were systematically searched to yield 1760 articles. These articles were independently screened to obtain 8 eligible articles with a pooled population of 794 subjects which is more than twice the population size considered in the previous meta-analyses. Largely, favorable effects on cognitive function were observed following daily EC intake, specifically in the working memory domain (standardized mean difference: 0.31, 95% CI: 0.16, 0.46), one of the core components in executive function which showed statistically significant results. Furthermore, the observed results were also robust to sensitivity analyses and subgroup analyses. This suggests that when consumed daily, EC may improve the mental processing aspect of cognitive function amongst the healthy population.