A very-low carbohydrate content in a high-fat diet modifies the plasma metabolome and impacts systemic inflammation and experimental atherosclerosis

Ketogenic diets (KDs) are very high-fat low-carbohydrate diets that promote nutritional ketosis and are widely used for weight loss, although concerns about potential adverse cardiovascular effects remain. We investigated a very high-fat KD's vascular impact and plasma metabolic signature compared to a non-ketogenic high-fat diet (HFD). Apolipoprotein E deficient (ApoE -/-) mice were fed a KD (%kcal:81:1:18, fat/carbohydrate/protein), a non-ketogenic high-fat diet with half of the fat content (HFD) (%kcal:40:42:18, fat/carbohydrate/protein) for 12 weeks. Plasma samples were used to quantify the major ketone body beta-hydroxybutyrate (BHB) and several pro-inflammatory cytokines (IL-6, MCP-1, MIP-1alpha, and TNF alpha), and to targeted metabolomic profiling by mass spectrometry. In addition, aortic atherosclerotic lesions were quantified ex-vivo by magnetic resonance imaging (MRI) on a 14-tesla system. KD was atherogenic when compared to the control diet, but KD mice, when compared to the HFD group (1) had markedly higher levels of BHB and lower levels of cytokines, confirming the presence of ketosis that alleviated the well-established fat-induced systemic inflammation; (2) displayed significant changes in the plasma metabolome that included a decrease in lipophilic metabolites and an increase in hydrophilic metabolites; (3) had significantly lower levels of several atherogenic lipid metabolites, including phosphatidylcholines, cholesterol esters, sphingomyelins, and ceramides; and (4) presented significantly lower aortic plaque burden. KD was atherogenic and was associated with specific metabolic changes but alleviated the fat-induced inflammation and lessened the progression of atherosclerosis when compared to the HFD.

An integrated biological effects assessment of the discharge water into the Sunndalsfjord from an aluminium smelter

An integrated biological effects study using field transplanted mussels was applied to determine the potential biological effects of an effluent discharge from an aluminium smelter into a Norwegian fjord. Chemical body burden and biological effects were measured in mussels positioned downstream (1, 2, 5, 10 and 20 km) from the aluminium smelters discharge for a period of 6 weeks. A suite of biomarkers, from whole organism to subcellular responses were measured. Chemical concentrations in mussel tissues were low; however, a change in the PAC (polyaromatic compound) profile from high to low pyrogenic influence provided evidence of exposure to the smelter's effluent. Overall, the biological responses observed where greater in the mussels positioned closest to the smelter (1-5 km). Lowest chemical accumulation and biomarker responses were observed in mussels positioned 10 km from the smelter and were considered as the reference field population. Mussels located furthest from the smelter (20 km) exhibited significant biomarker responses and suggested a different contaminant source within the fjord. The integrated biological response index (IBR) was applied and reflected the expected level of exposure to the smelters discharge, with highest IBR calculated in mussels positioned closest to the discharge (1-5 km). Principal component analysis (PCA) also differentiated among mussel groups, with the most impacted located closest to the smelter. Not one chemical factor could explain the biological responses observed in mussels, but the presence of PAH16, PAH41 and metals Mn, Ni and Cr were the main contributors measured to the higher stress seen in the mussels from the 1 and 5 km groups.

The World Hypertension League Science of Salt: a regularly updated systematic review of salt and health outcomes studies (Sept 2019 to Dec 2020)

The World Hypertension League Science of Salt health outcomes review series highlights high-quality publications relating to salt intake and health outcomes. This review uses a standardised method, outlined in previous reviews and based on methods developed by WHO, to identify and critically appraise published articles on dietary salt intake and health outcomes. We identified 41 articles published between September 2019 to December 2020. Amongst these, two studies met the pre-specified methodological quality criteria for critical appraisal. They were prospective cohort studies and examined physical performance and composite renal outcomes as health outcomes. Both found an association between increased/higher sodium intake and poorer health outcomes. Few studies meet criteria for high-quality methods. This review adds further evidence that dietary salt reduction has health benefits and strengthens evidence relating to health outcomes other than blood pressure and cardiovascular disease. We observe that most studies on dietary sodium do not have adequate methodology to reliably assess sodium intake and its association with health outcomes.

Preventive Nutrition: Heart Disease and Cancer

Two of the leading chronic diseases are cardiovascular disease (CVD) and cancer. A cornerstone of prevention for CVD and cancer is a healthy dietary pattern throughout the lifespan. Dietary patterns represent the totality of the diet and reflect habitual consumption of combinations and quantities of foods and nutrients that cumulatively affect health and disease. This article summarizes recent evidence on the relationship of diet quality as measured by adherence to healthy dietary patterns and CVD and cancer risk reduction. Optimal adherence to a healthy dietary pattern decreases CVD and cancer risk; even small changes in diet quality are beneficial.

O-283 Evidence based management of endometriosis – what has changed since 2013?

In 2005, under the auspices of ESHRE, a group of international experts evaluated the existing best evidence and published the first European guideline on the management of endometriosis. This highly successful project was the first guideline by ESHRE and was adopted by many counties as their national standard. A second, fully-updated edition was presented in 2013.

For the new ESHRE Endometriosis Guideline, published in February 2022, all available evidence for twelve chosen topics was gathered by a senior research specialist. Subgroups comprised of patient representatives and experts in healthcare, reproductive science and epidemiology evaluated the data according to GRADE criteria. Each subgroup wrote a chapter and formulated their recommendations which were then presented by a representative to the core group. There, a provisional document was generated and made available for stakeholder review. The resulting comments were taken into account and where relevant incorporated into the final guideline document for which approval was sought and gained from the ESHRE Executive Committee.

35 PICO (Patients, Interventions, Comparison, Outcome) and seven narrative questions were addressed resulting in 78 Research Recommendations were formulated. Where sufficient scientific evidence was lacking and the Guideline Development Group (GDG) was of the opinion that an important topic needed to be highlighted Good Clinical Practice Points where created based on experts’ experience.

During the process of reviewing the literature it became apparent that large knowledge gaps of the best clinical approach to endometriosis exist. As a result, 30 research recommendations were also produced.

One of the main differences to the 2013 version of the ESHRE guidelines is that laparoscopy is no longer the gold standard for endometriosis per se as there exist sufficient data to support the use of transvaginal ultrasound performed by an experienced operator or MRI can equally identify or rule out ovarian and most of deep endometriosis. However, it is recognised by the GDG that the required imaging standards are not ubiquitously available and for peritoneal disease both sensitivity and specificity using either imaging modalities are still poor. As opposed to the 2013 recommendation, the GDG does not anymore recommend an ultralong protocol for the women with rASRM stage III/IV endometriosis to improve IVF success rates. Furthermore, gonadotropin releasing hormone antagonists seem to be effective in the treatment of endometriosis-associate pain and, where available, could be considered as second-line treatment.

Other changes were specific chapters on endometriosis in adolescents and in menopausal women as the GDG strongly felt that these groups are concerningly underrepresented in clinical care and research. Finally, a chapter focussing on the association of endometriosis with certain forms of cancer namely subgroups of ovarian cancer, breast and thyroid cancer was added to give both patients and clinicians a better insight into the current evidence of this complex topic.

The GDG hope that the new ESHRE Endometriosis Guideline will improve the clinical management of a highly prevalent and heterogenous disease and that the freely-available patient-friendly version of the guideline empowers symptomatic and asymptomatic women to seek the best available advice, support and treatment.

Replacing Saturated Fat With Unsaturated Fat or Carbohydrate Does Not Affect Lp(a): A Secondary Data Analysis of Two Randomized Controlled Trials

Objectives

Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Lp(a) is primarily genetically regulated and current evidence suggests lifestyle interventions have minimal impact on circulating levels. However, some studies have shown increased Lp(a) following diets low in saturated fatty acids (SFA). The aim of this analysis was to assess the individual, and pooled, effects of replacing SFA with monounsaturated (MUFA), polyunsaturated fatty acids (PUFA), or carbohydrate (CHO) on Lp(a).

Methods

Data from two, three-period, randomized, crossover, trials in adults at risk for ASCVD were used. Both trials had a 2-wk run-in diet [Fat: 34% (SFA: 12-13%; MUFA: 12%; PUFA: 7%); CHO: 50-51%; Protein: 16%] followed by three diets (5-6-wks) where 5-6% of SFA was displaced with proportionate increases in MUFA, PUFA, or CHO; protein remained constant. In total, 6 SFA displacement scenarios were assessed (3 MUFA, 2 PUFA, and 1 CHO). Lp(a) was assessed using ELISA. Data were non-normally distributed and log-transformation was performed. Paired-sample t-tests and a random effects meta-analysis were used to assess between-diet differences. Data are presented as log mean differences and 95% CI unless otherwise stated.

Results

The analytic sample included 62 adults [63% male; 43 ± 12y; BMI 29.2 ± 3.8 kg/m²; Lp(a) median (IRQ) 9.20 (16.91) mg/dL]. Between-diet comparisons showed no effect of SFA reduction when the replacement nutrient was MUFA (MD: 0.01 mg/dL; 95% CI: −0.08, 0.09, MD: −0.02; 95% CI: −0.06, 0.02, and MD: 0.00; 95% CI: −0.04, 0.04), PUFA (MD: 0.00 mg/dL; 95% CI: −0.07, 0.08, and MD: 0.00; 95% CI: −0.07, 0.07) or CHO (MD: 0.00 mg/dL; 95% CI: −0.06, 0.06). In the pooled analysis, replacing SFA with MUFA, PUFA, or CHO did not affect Lp(a) (MD: 0.04 mg/dL; 95% CI: −0.16, 0.25; p = 0.662).

Conclusions

Replacing 5-6% of SFA with MUFA, PUFA, or CHO did not affect Lp(a) after 5-6-wks in adults at risk of ASCVD with low baseline Lp(a). These findings do not align with the previously observed increases in Lp(a) with low SFA diets. Future evaluation of these cohorts is needed to understand the discrepant results.

Funding Sources

Texas Tech University; Nutritional Sciences Graduate Educational Enrichment Endowment; National Center for Advancing Translational Sciences, NIH, UL1 TR002014.

The Effects of a Hypocaloric Diet Containing Peanuts on Weight Loss, Glycemic Control and Blood Pressure: A 6-Month Randomized Controlled Trial

Objectives

The objective was to examine the effect of consuming peanuts prior to two main meals per day as part of a hypocaloric weight loss diet, compared to a hypocaloric diet devoid of peanuts, on body weight, hemoglobin A1c (HbA1c), and blood pressure.

Methods

A two-arm, randomized, controlled trial was conducted. Adults (age >18 years) with a BMI of >26 kg/m² at increased risk of type 2 diabetes (AUSDRISK score >12) were randomized to the peanut group or the traditional low fat diet group (control). The peanut group was advised to consume 35 g of lightly salted, roasted peanuts prior to two main meals per day. Participants in the control group were asked to avoid peanuts/peanut butter for the duration of the trial. Both diet groups were advised to restrict energy intake (women: 5500 kJ/1300 kcal/d; men: 7000 kJ/1700 kcal/d). Outcome assessment occurred at baseline, 3 and 6 months.

Results

In total, 107 participants were randomized (65% female; mean age 58 ± 14 years, BMI 33 ± 5.4 kg/m², waist circumference 109 ± 13 cm, AUSDRISK score of 15 ± 5) and 76 participants completed the study. No between-group difference in body weight (primary outcome) was observed (p = 0.90). Mean weight loss at 6 months was 6.7 ± 5.1 kg in the cohort (p value for time < 0.001). HbA1c was lowered over time (0.1 ± 0.2%; p < 0.001) with no between group difference (p = 0.80). Systolic blood pressure was reduced to a greater extent in the peanut group vs. the control group (mean difference −5.0 mmHg; 95% CI −9.6 to −1.1 p = 0.014).

Conclusions

Intake of 35 g of peanuts prior to two main meals per day, in the context of a hypocaloric diet, resulted in weight loss comparable to a traditional weight loss diet. Greater systolic blood pressure reductions were observed with peanut intake suggesting this weight loss approach may confer greater cardiovascular risk reduction.

Funding Sources

The Peanut Institute.

Effect of Daily Avocado Intake for Six Months on Flow-Mediated Dilation: A Sub-Study of the Habitual Diet and Avocado Trial, a Randomized Controlled Study

Objectives

The Habitual diet and Avocado Trial (HAT), a multicenter parallel randomized controlled trial, was designed to examine the health effects of consuming 1 avocado per day for 6-months compared to a habitual diet limited in avocados in individuals with abdominal obesity. We assessed the effects of the intervention on endothelial function using flow-mediated dilation (FMD) of the brachial artery.

Methods

All participants were ≥25 years of age with an elevated waist circumference (≥88 cm women; ≥102 cm men). Participants were randomized into either a control group (HD: consumed &lt;2 avocados/month for 6 months) or an experimental group (AVO: consumed 1 avocado/day for 6 months). At the Pennsylvania State University, University Park site (n = 134), FMD was measured at baseline and end of the study. Within-person change scores were calculated by subtracting FMD at baseline from FMD at the end of the study. Linear regression was used to examine between-group differences in change across 6 months.

Results

The sample was 78% female (BMI 33 ± 5 kg/m2). At baseline, FMD was 7.73 ± 3.37% in the AVO group, and 6.85 ± 2.67% in the HD group. FMD decreased by −0.10 ± 2.94% in the AVO group and increased by 0.52 ± 3.17% in the HD group. There were no significant between-group differences in 6-month change in FMD (0.62%, 95%CI = −0.46–1.70, p = 0.26). The results remained unchanged after adjustment for sex, BMI, and baseline FMD (0.15%, 95%CI = −0.77–1.06, p = 0.75).

Conclusions

Results suggest that consumption of 1 avocado per day for 6 months in adults with abdominal obesity is not associated with a significant improvement in endothelial function, compared to adults following their habitual diet. Participants in this study had relatively high FMD at baseline, which may have reduced our ability to observe improvements in endothelial function.

Funding Sources

Avocado Nutrition Center and the National Center for Advancing Translational Sciences, National Institutes of Health (1UL1TR002014-01)

The Effect of Meals Containing Culinary Doses of Spices on Postprandial Endothelial Function, Lipemia and Glycemia: A Randomized, Crossover, Controlled-Feeding Study

Objectives

The objective was to examine the effect of meals containing 0.6 g (low-spice meal), 3.7 g (moderate-spice meal), and 7.4 g (high-spice meal) of herbs/spices on postprandial flow mediated dilation (FMD), triglycerides, insulin and glucose in men and post-menopausal women at-risk for cardiovascular disease.

Methods

A 3-period, randomized, crossover, controlled-feeding study was conducted. Participants consumed an average American diet containing 0.5 (low-spice diet), 3.3 (moderate-spice diet), and 6.6 (high-spice diet) g/d/2100 kcal of herbs and spices for 4-weeks. At baseline and the end of each diet period, participants were given a meal challenge (1192 kcal; carbohydrate 145 g; protein 62 g; fat 44 g; saturated fat 20 g). The spice dose in the test meal corresponded to the spice level of the diet consumed for the previous 4 weeks. Blood was sampled at 0, 30, 60, 120, 180, 240 minutes for analysis of triglycerides, glucose, and insulin. FMD was measured at 0,120 and 240 minutes.

Results

The analytic sample included 43 participants (males 65%; age 48 ± 11 years; BMI 28.9 ± 2.9 kg/m2, FMD 6.2 ± 2.3%). No between-meal differences were observed for FMD (meal P = 0.30; time P &lt; 0.001; meal by time interaction P &gt; 0.99). The area under the curve for triglycerides (P = 0.39), glucose (P = 0.49) and insulin (P = 0.07) was not different between the meals.

Conclusions

Following intake of an average American diet with three different doses of spices (0.5, 3.3 and 6.6 g/d/2100 kcal) for 4-weeks, FMD, triglyceride, glucose and insulin responses to meals containing 0.6 g, 3.7 g and 7.4 g of spices were not different. These findings suggest that following 4-weeks of exposure to spice-containing diets, spice exposure from a meal does not dose-dependently affect endothelial function, lipemia and glucose homeostasis in the 4-hours post meal.

Funding Sources

McCormick Science Institute; National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR002014.

Developmental stage and morphology of the competent blastocyst are associated with sex of the child but not with other obstetric outcomes: a multicenter cohort study

STUDY QUESTION

Are transfer day, developmental stage and morphology of the competent blastocyst in pregnancies leading to live birth associated with preterm birth, birthweight, length at birth and sex of the child?

SUMMARY ANSWER

A high score in blastocyst developmental stage and in trophectoderm (TE) showed a significant association with the sex of the child, while no other associations with obstetric outcomes were observed.

WHAT IS KNOWN ALREADY

The association between blastocyst assessment scores and obstetric outcomes have been reported in small single-center studies and the results are conflicting.

STUDY DESIGN, SIZE, DURATION

Multicenter historical cohort study based on exposure data (transfer day (blastocyst developmental stage reached by Day 5 or Day 6)) blastocyst developmental stage (1-6) and morphology (TE and inner cell mass (ICM): A, B, C)) and outcome data (preterm birth, birthweight, length at birth, and sex of the child) from women undergoing single blastocyst transfer resulting in a singleton pregnancy and live birth.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Data from 16 private and university-based facilities for clinical services and research were used. A total of 7246 women, who in 2014-2018 underwent fresh-embryo transfer with a single blastocyst or frozen-thawed embryo transfer (FET) with a single blastocyst resulting in a singleton pregnancy were identified. Linking to the Danish Medical Birth Registry resulted in a total of 4842 women with a live birth being included. Cycles with pre-implantation genetic testing and donated gametes were excluded. The analyses were adjusted for female age (n = 4842), female BMI (n = 4302), female smoking (n = 4290), parity (n = 4365), infertility diagnosis (n = 4765), type of treatment (n = 4842) and center (n = 4842); some analyses additionally included gestational age (n = 4368) and sex of the child (n = 4833).

MAIN RESULTS AND THE ROLE OF CHANCE

No statistically significant associations between blastocyst assessment scores (transfer day, developmental stage, TE, ICM) and preterm birth (8.3%) or birthweight (mean 3461.7 g) were found. The adjusted association between blastocysts with a TE score of C and a TE score of A and length at birth (mean 51.6 cm) were statistically significant (adjusted mean difference 0.4 cm (95% CI: 0.02; 0.77)). Blastocysts transferred with developmental stage score 5 compared to blastocysts transferred with score 3 had a 34% increased probability of being a boy (odds ratio (OR) 1.34 (95% CI: 1.09; 1.64). Further, TE score B blastocysts compared to TE score A blastocysts had a 31% reduced probability of being a boy (OR 0.69 (95% CI: 0.60; 0.80)).

LIMITATIONS, REASONS FOR CAUTION

It is possible that some residual confounding remains.

WIDER IMPLICATIONS OF THE FINDINGS

Blastocyst selection during ART does not appear to introduce any negative effects on obstetric outcome. Therefore, clinicians and patients can be reassured that the assessment scores of the selected blastocyst will not in themselves pose a risk of preterm birth or affect birthweight and the length at birth.

STUDY FUNDING/COMPETING INTEREST(S)

Unrestricted grant from Gedeon Richter Nordics AB, Sweden. None of the authors have any competing interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

The design and rationale of a multi-center randomized clinical trial comparing one avocado per day to usual diet: The Habitual Diet and Avocado Trial (HAT)

Excess visceral adiposity is associated with increased risk of diabetes and cardiovascular disease. In the U.S. approximately 60% of adults have visceral obesity. Despite high calorie and fat, small, well-controlled clinical studies suggest that avocado consumption has favorable effects on body weight and visceral adiposity. Additionally, short-term studies also suggest that consuming avocados increases satiety, hence, may decrease overall energy intake. The Habitual Diet and Avocado Trial HAT is a multi-center, randomized, controlled trial designed to test whether in a large, diverse cohort providing one avocado per day for consumption for six months compared to a habitual diet essentially devoid of avocados, will result in a decrease in visceral adiposity as measured by magnetic resonance imaging (MRI) in individuals with an increased waist circumference (WC). Additional outcome measures include hepatic lipid content, plasma lipid profiles, blood pressure and high sensitivity C-reactive protein. Inclusion criteria were increased WC and not currently eating more than two avocados per month. Major exclusion criteria were not eating or being allergic to avocados, and not willing or able to undergo MRI scans. From June 27, 2018 to March 4, 2020, 1008 participants were randomized at 4 clinics. The cohort was 72% women, 53% Non-Hispanic White, and had a mean age of 50 years. Follow-up was completed in October 2020 when 936 participants had final MRI scans. HAT will provide information on the effects of avocado consumption on visceral fat adiposity and cardiometabolic disease risk in a diverse sample of participants.

P–741 Fetal exposure to maternal perceived stress and male reproductive function in a cohort of young adults

Study question

Is exposure to maternal perceived stress during pregnancy associated with reproductive function in adult male offspring?

Summary answer

While maternal perceived stress was prevalent in the first trimesters of pregnancy, our preliminary findings indicate little association with reproductive function in young men.

What is known already

Though studies in animals point to a connection between prenatal exposure to maternal stress and reproductive function in offspring, the underlying biological mechanisms generating a deficit remain largely unclear. In humans, the few available studies focus on exposure to bereavement or other relatively strong objective stressful life events. Our individual perception of stress is, however, more likely the sum of a complex process involving both the actual input, previous experiences, coping strategies and support from our surroundings.

Study design, size, duration

Young men and their mothers were identified through records from the Danish National Birth Cohort (DNBC). Information on exposure, i.e. maternal perceived life and emotional stress, was available from telephone interviews conducted at approximately 30 weeks of gestation (1996 to 2001). Recruitment of the young men lasted from 2017 to 2019 with 1058 participants enrolled in the final FEPOS cohort.

Participants/materials, setting, methods

Each of the 1058 men in the FEPOS cohort completed an online questionnaire and clinical examinations and provided a blood and semen sample. Information on potential pre- and postnatal confounders was retrieved from the DNBC, the Danish National Patient Register and the Danish Medical Birth Register. We applied negative binomial regression models to examine associations between maternal perceived life and emotional stress scores and semen quality, testicular size and reproductive hormones among the young men.

Main results and the role of chance

Among the 1052 young men included in preliminary analyses, the majority was exposed to maternal perceived life and/or emotional stress (76% and 83%, respectively) during the first trimesters. Life stress was predominantly related to the actual pregnancy (48%), maternal disease (19%) or occupational conditions (33%). Emotional stress included especially being touchy (58%), sad (38%) or tense (36%), covering aspects of both stress, depression and anxiety. Overall, results indicate little association between maternal stress scores and measures of semen quality and testicular size. Our study involves a large cohort with prospectively collected exposure data and direct measures of several male reproductive outcomes. We applied inverse probability weighting to account for selection into the FEPOS cohort and included a range of a priori selected maternal confounders in our models.

Limitations, reasons for caution

The male fetus may be particularly sensitive to exposure during the differentiation of reproductive tissues (8–14 weeks of gestation). Our self-reported measures of exposure cover the first 30 weeks of gestation. Absence of association may, thus, be due to a lack of specific information on timing of symptoms.

Wider implications of the findings: While our preliminary findings may appear reassuring, further efforts to improve our understanding of maternal stress in relation to fetal health and potential consequences later in life are needed.

Trial registration number

Not applicable

Macronutrient Composition of the Meal May Influence Postprandial Plasma IL-6 Concentration in Men With Overweight or Obesity: An Analysis of Pooled Clinical Trial Data

Objectives

Risk of cardiovascular disease (CVD) is markedly associated with poor diet quality (e.g., a high intake of saturated fats, refined carbohydrates; and a low intake of whole grains, fruits, and vegetables). Numerous clinical studies report that consuming a high-saturated fat meal (HFM) induces postprandial inflammation. However, few studies have evaluated proinflammatory mediators after consuming a HFM compared to an average American meal (AAM). The objective of study was to investigate plasma proinflammatory cytokine levels after consumption of a HFM compared to an AAM in middle-aged men with overweight or obesity.

Methods

This pooled analysis included data from two randomized controlled trials designed to evaluate the anti-inflammatory effect of consuming a spice blend delivered in two different meals with similar calories (∼1000 kcal): (1) a HFM (33% kcal from saturated fat, 36% kcal from carbohydrate, 16% kcal from protein) or (2) an AAM (16% from saturated fat, 49% kcal from carbohydrate, ∼21% kcal from protein). Both meals had a minimal amount of spices added for palatability. The results reported are from subjects in the control group on each trial: a HFM with 1.4 g of garlic powder and an AAM with 0.6 g of a spice blend. Data from non-smoking, middle-aged (40–65 y) men with overweight/obesity (BMI ≥25 and ≤35 kg/m2), elevated waist circumference (≥94 cm), and at least one other risk factor for CVD were included in the analysis (Total n = 26; HFM consumption n = 12, AAM consumption n = 14). Plasma cytokine concentrations (IL-1β, IL-6, IL-8, TNF-α, and MCP-1) were measured at 0, 60,120, 180,240 min after meal consumption.

Results

There was a significant time-by-meal interaction on plasma IL-6 concentration (P &lt; 0.05). Plasma IL-6 concentration was significantly higher 180 min and 240 min (1189% and 362%, respectively; P &lt; 0.05) after consuming a HFM compared to an AAM. There was no effect of meal or time-by-meal interaction on other plasma cytokines.

Conclusions

Consumption of a HFM compared to an AAM resulted in a greater circulating IL-6 in men with overweight or obesity. Macronutrient composition of the meal may influence postprandial inflammatory responses.

Funding Sources

McCormick Science Institute and the National Center for Advancing Translational Sciences, NIH (1UL1TR002014–01).

Herbs and Spices Modulate Gut Microbiota Composition: A Randomized, Crossover, Controlled-Feeding Study

Objectives

The effect of culinary doses of herbs and spices, consumed as part of a well-defined dietary pattern, on gut microbiota composition has not been previously studied. The aim of this study was to examine gut microbial composition following an average American diet (carbohydrate: 50% kcal; protein: 17%; total fat: 33%; saturated fat: 11%; sodium: 3000 mg/d) containing herbs and spices at 0.5 (Low Spice Diet; LSD), 3.3 (Moderate Spice Diet; MSD) and 6.6 (High Spice Diet; HSD) g/day/2100 kcal in adults at-risk for cardiovascular disease (CVD).

Methods

Fifty-four adults (57% female; 45 ± 11 years, BMI 29.8 ± 2.9 kg/m2; waist circumference 102.8 ± 7.1 cm) were included in this three-period, randomized, crossover, controlled-feeding study. Each diet was provided for 4-weeks with a minimum 2-week wash-out period. At baseline and the end of each diet period subjects provided a fecal sample for 16S rRNA gene sequencing. QIIME2 was used for data filtration, sequence clustering, taxonomy assignment and statistical analysis. Linear discriminant analysis Effect Size (LEfSe) analyses were used to determine enriched biomarker taxa following each diet.

Results

No between-diet differences in alpha diversity were observed based on Faith's Phylogenetic Diversity, Observed Operational Taxonomic Units (OTUs), and Pielou's Evenness (Kruskal-Walllis, P &gt; 0.05). Principal coordinate analysis showed beta-diversity following the HSD significantly differed from baseline (PERMANOVA, P = 0.030). LEfSe pairwise analyses identified multiple taxa that were differentially abundant following the spice-containing diets vs. baseline. Compared to baseline, 34 taxa were enriched with the HSD, 22 taxa were enriched with the MSD and 20 taxa were enriched with the LSD. Members of the taxa enriched with the HSD are known short-chain fatty acid producers (Faecalibacterium and Butyricimonas).

Conclusions

The addition of herbs and spices at 0.5, 3.3, and 6.6 g/day/2100 kcal to an average American diet altered gut microbiota composition, and resulted in enrichment of short-chain fatty acid producers, after 4-weeks in adults at elevated risk for CVD.

Funding Sources

McCormick Science Institute; NCATS NIH (1UL1TR002014–01); Grant from the Howard Hughes Medical Institute through the Precollege and Undergraduate Science Education Program to Juniata College supported the computational research.

Effect of Daily Avocado Consumption on Vascular Health in Adults With Abdominal Obesity: A Sub-Study of the Habitual Diet and Avocado Trial, a Randomized Controlled Study

Objectives

To examine the effect of providing 1 avocado per day for consumption over a 6-month period on cardiovascular health compared to habitual dietary intake in individuals with abdominal obesity.

Methods

The Habitual diet and Avocado Trial (HAT), a multicenter parallel randomized controlled trial, included participants ≥25 years of age with an elevated waist circumference (≥88 cm women; ≥102 cm men). Participants were randomized to either an experimental group (AVO: consumed 1 avocado/day for 6 months) or a control group (HD: consumed &lt; 2 avocados/month for 6 months). At the Pennsylvania State University, University Park (n = 126), vascular health was measured using a SphygmoCor XCEL (AtCor Medical) at baseline and

at the end of the study period. Outcomes include central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), and pulse wave velocity (PWV), a marker of arterial stiffness. Mixed models were used to examine between-group differences in change across 6 months.

Results

The sample was 77% female (BMI 34 ± 4 kg/m2, waist circumference 105 ± 12 cm). No significant between-group differences in 6-month change were observed for cSBP (AVO: 1.06 mmHg 95% CI − 1.57, 3.69; HD: 0.35 mmHg 95% CI −2.26, 2.96; P = 0.62), cDBP (AVO: 0.07 mmHg 95% CI −1.82, 1.96; HD: −0.91 mmHg 95% CI − 2.79, 0.97; P = 0.34), or PWV (AVO: −0.18 m/s 95% CI −0.53, 0.17; HD: 0.08 m/s 95% CI −0.27, 0.43; P = 0.17).

Conclusions

Results suggest that providing adults with abdominal obesity 1 avocado per day to consume for 6 months is not associated with a statistically significant improvement in central blood pressure or PWV, compared to adults following their habitual diet. Additional research using larger samples and longer intervention periods is needed to clarify whether habitual avocado consumption yields clinically significant benefits to cardiovascular health.

Funding Sources

Hass Avocado Board and the National Center for Advancing Translational Sciences, National Institutes of Health (1UL1TR002014-01).

A Culinary Dose of Herbs and Spices Improves 24-Hour Blood Pressure in Adults at Risk for Cardiometabolic Diseases: A Randomized, Crossover, Controlled-Feeding Study

Objectives

Intake of a herb/spice containing meal attenuates post-prandial lipemia, hyperglycemia and oxidative stress, and improves endothelial function. No randomized controlled trials have examined the cardiometabolic effects of longer-term intake of mixed herbs and spices. We aimed to assess the effect of an average American diet containing herbs and spices at 0.5 (Low Spice Diet; LSD), 3.3 (Moderate Spice Diet; MSD) and 6.6 (High Spice Diet; HSD) g/day/2100 kcal on lipids/lipoproteins as well as other risk factors for cardiometabolic diseases in at-risk adults.

Methods

A three-period, randomized, crossover, controlled-feeding study including 71 participants (55% female; 44 ± 11 years, BMI 29.7 ± 2.9 kg/m2; waist circumference 102.4 ± 7.3 cm) was conducted. Each diet was provided for 4-weeks with a minimum 2-week wash-out period. Outcomes were assessed at baseline and the end of each diet period. On 2 separate days at each time point a fasting blood draw was taken for analysis of lipids/lipoproteins, glucose and insulin. A SphygmoCor XCEL was used for pulse wave analysis and pulse wave velocity assessment, and participants wore an ambulatory blood pressure monitor for a 24-hour period.

Results

No between-diet effects were observed for LDL-cholesterol, the primary outcome. Between-diet differences were observed for mean 24-hour systolic (P &lt; 0.001) and diastolic (P &lt; 0.001) blood pressure. The HSD lowered mean 24-hour systolic and diastolic blood pressure compared to the MSD (−2.2 mmHg; 95% CI −0.7, −3.8; P = 0.002 and −1.6 mmHg; 95% CI −0.6, −2.5; P &lt; 0.001, respectively) and LSD (−2.1 mmHg; 95% CI −3.6, −0.6; P = 0.004 and −1.7 mmHg; 95% CI −0.7, −2.7; P &lt; 0.001, respectively); no differences were detected between the LSD and MSD. No between-diet effects were observed for clinic measured blood pressure, markers of glycemia, or vascular function.

Conclusions

In the context of a suboptimal U.S. style diet, addition of a culinary dose of mixed herbs and spices (6.6 g/day/2100kcal) improved 24-hour blood pressure after 4-weeks, compared to lower doses (0.5 and 3.3 g/day/2100 kcal), in adults at elevated risk for cardiometabolic diseases.

Funding Sources

McCormick Science Institute and the National Center for Advancing Translational Sciences, National Institutes of Health (1UL1TR002014–01).

Peanut Intake Enriches Butyrate Producing Bacteria and Expression of a Gene Associated With Butyrate Production in Adults With Elevated Fasting Glucose: An RCT

Objectives

To assess the effect of consuming 28 g/d of peanuts for 6-weeks, compared to an isocaloric lower fat, higher carbohydrate (LFHC) snack, on gut microbiota composition in adults with elevated fasting glucose. Further, to identify functional and compositional differences in responders using metatranscriptomics.

Methods

In a randomized, crossover trial, 50 adults (52% male; 42 ± 15 y; BMI 28.3 ± 5.6 kg/m2; glucose 100 ± 8 mg/dL) consumed 28g/d of dry roasted, unsalted, peanuts (160 kcal) or a LFHC snack for 6-wk with a 4-wk washout period. Fecal samples were collected at the baseline and endpoint of each period. Gut microbiota composition was measured using 16 rRNA sequencing and QIIME2 for amplicon sequence variant assignment. Metatranscriptomic sequencing was conducted on baseline and endpoint samples from subjects with the greatest reduction in glucose following the peanut condition (n = 24), to measure gene expression related to microbial metabolic pathways. The NUGEN library preparation method was used to generate cDNA. MetaPhlan2 and HUMAnN2 were used for taxonomic and functional gene annotation, and iPATH3 and Pathview were used for mapping to functional gene pathways.

Results

No between-condition difference in α or β microbiota diversity was observed. Following peanut intake, roseburia and ruminococcaceae were significantly enriched (LDA &gt; 2; P &lt; 0.05). Metatranscriptomics showed enrichment of the K03518 (aerobic carbon-monoxide dehydrogenase small subunit) gene following peanut intake (P &lt; 0.05).

Conclusions

Enrichment of roseburia was observed following consumption of 28 g/d of peanuts in adults with elevated fasting glucose. Metatranscriptomics revealed enrichment of the K03518 gene, which is associated with short chain fatty acid production and degradation of β-mannans. These results suggest peanut intake enriches a known butyrate producer and the increased expression of a gene implicated in butyrate production adds further support for peanut-induced gut microbiome modulation.

Funding Sources

The Peanut Institute and the National Center for Advancing Translational Sciences, National Institutes of Health (1UL1TR002014-01).

Soybean oil lowers circulating cholesterol levels and coronary heart disease risk, and has no effect on markers of inflammation and oxidation

To reduce risk of coronary heart disease, replacement of saturated fats (SFAs) with polyunsaturated fats (PUFA) is recommended. Strong and concordant evidence supports this recommendation, but controversy remains. Some observational studies have reported no association between SFAs and coronary heart disease, likely because of failure to account for the macronutrient replacing SFAs, which determines the direction and strength of the observed associations. Controversy also persists about whether ω-6 (nω-6) PUFA or a high dietary ratio of nω-6 to ω-3 (nω-3) fatty acids leads to proinflammatory and pro-oxidative states. These issues are relevant to soybean oil, which is the leading edible oil consumed globally and in the United States. Soybean oil accounts for over 40% of the US intake of both essential fatty acids. We reviewed clinical and epidemiologic literature to determine the effects of soybean oil on cholesterol levels, inflammation, and oxidation. Clinical evidence indicates that soybean oil does not affect inflammatory biomarkers, nor does it increase oxidative stress. On the other hand, it has been demonstrated that when dietary SFAs are replaced with soybean oil, blood cholesterol levels are lowered. Regarding the nω-6:nω-3 dietary ratio, health agencies have consistently rejected the importance of this ratio, instead emphasizing the importance of consuming sufficient amounts of each type of fat. Thus, several lines of evidence indicate that soybean oil can positively contribute to overall health and reduction of risk of coronary heart disease.

Change in mean salt intake over time using 24-h urine versus overnight and spot urine samples: a systematic review and meta-analysis

Background

Little is known about the capacity of overnight and spot urine samples to estimate changes in mean salt intake over time. The objective of this review was to compare the estimates of change in mean population salt intake based on 24-h urine and overnight/spot urine samples.

Methods

Studies were systematically identified through searches of peer-reviewed databases (Medline, Embase, Global Health, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) and grey literature. Studies that reported estimates of mean salt intake for at least two time points based on both 24-h and overnight/spot urines were deemed eligible. The capacity of overnight/spot urine samples to estimate the change in mean salt intake was assessed both at the individual-study level and overall through random-effects meta-analyses. The level of heterogeneity was assessed through the I² statistic. Subgroup and sensitivity analyses were conducted to explore possible sources of heterogeneity, and check the robustness of the findings from the primary analysis.

Results

A total of 1244 records were identified, 50 were assessed as full text, and 14 studies met the criteria, capturing data on 7291 participants from seven countries. Nine and five studies collected overnight and spot urines, respectively. The comparison of the change in mean salt intake between 24-h and overnight/spot urines showed some inconsistencies at the individual study-level. The pooled mean change in salt intake was − 0.43 g/day (95% CI − 1.16 to 0.30; I² = 95%) using 24-h urines, and − 0.22 g/day (− 0.65 to 0.20; I² = 87%) using overnight/spot urines, with a pooled difference-in-differences between the two methods of 0.27 g/day (− 0.23 to 0.77; I² = 89%). Subgroup analyses showed substantial heterogeneity for most subgroups. Sensitivity analyses did not change the effect observed in the primary analysis.

Conclusion

The evidence for the capacity of overnight/spot urines to estimate changes in mean salt intake over time is uncertain. More research where overnight/spot urines are collected in parallel with 24-h urines is needed to enable a more in-depth evaluation of these alternative approaches to estimating change in mean salt intake.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-020-00651-8.

Perspective: Design and Conduct of Human Nutrition Randomized Controlled Trials

In the field of human nutrition, randomized controlled trials (RCTs) are considered the gold standard for establishing causal relations between exposure to nutrients, foods, or dietary patterns and prespecified outcome measures, such as body composition, biomarkers, or event rates. Evidence-based dietary guidance is frequently derived from systematic reviews and meta-analyses of these RCTs. Each decision made during the design and conduct of human nutrition RCTs will affect the utility and generalizability of the study results. Within the context of limited resources, the goal is to maximize the generalizability of the findings while producing the highest quality data and maintaining the highest levels of ethics and scientific integrity. The aim of this document is to discuss critical aspects of conducting human nutrition RCTs, including considerations for study design (parallel, crossover, factorial, cluster), institutional ethics approval (institutional review boards), recruitment and screening, intervention implementation, adherence and retention assessment, and statistical analyses considerations. Additional topics include distinguishing between efficacy and effectiveness, defining the research question(s), monitoring biomarker and outcome measures, and collecting and archiving data. Addressed are specific aspects of planning and conducting human nutrition RCTs, including types of interventions, inclusion/exclusion criteria, participant burden, randomization and blinding, trial initiation and monitoring, and the analysis plan.

Necessary duration of follow-up to assess complications of mesh in hernia surgery: a time-lapse study based on 460 explants

PURPOSE

Risk of complications following hernia repair is the key parameter to assess risk/benefit ratio of a technique. As mesh devices are permanent, their risks are life-long. Too many reports in the past assessed mesh safety prematurely after short follow-ups. We aimed to explore what length of follow up would reveal the full extent of complications.

METHODS

Time lapses between implantation and excision were analyzed in 460 cases of meshes excised for complications after hernia repair. Patterns of percentage growth and time lapses at 50th and 95th percentiles were used to compare groups of different hernia type, age, gender and reason for excision.

RESULTS

The 50th and 95th case percentiles in the dataset were at 3.75 and 15.0 years between mesh implantation and excision. For hernia types, the longest time lapses were for groin hernias (4.0 and 16.11 years at 50th and 95th percentiles). The shortest were for umbilical hernias (2.16 and 9.68 years). Males had later excisions than females (4.11 and 16.1 vs. 2.47 and 9.79 years). Younger patients (< 45 y.o.) had later excisions than older patients (4.12 and 17.68 vs. 3.37 and 10.0 years). Out of all subgroups, the longest time lapses were for groin hernias in younger males (4.77 and 18.89 years) and for mesh erosion into organs (4.67 and 17.0 years).

CONCLUSIONS

Follow-up of more than 15 years is needed to fully assess complications after mesh hernia repair. Especially longer periods are needed to detect mesh erosion into organs and complications in younger males. Presently, short observations and lack of reporting standard in the literature prohibit accurate assessment of complication risks. We propose to use cumulative incidence for standardized risk reporting (y% risk at x years). This will show time-dependent patterns and allow comparisons between different techniques and studies of variable duration. Standardization will also help to predict long-term risks beyond shorter (practical) follow-ups and facilitate real-time monitoring during surveillance.

The Effect of Chronic Spice Consumption on Plasma Pro-Inflammatory Cytokine Levels and Monocyte Function in Adults with Overweight/Obesity

Objectives

Obesity-induced, chronic, low-grade inflammation is involved in the pathogenesis of cardiovascular disease (CVD). Numerous spices have anti-inflammatory properties in animal models and humans. However, few studies have examined the anti-inflammatory effect of spices in the context of daily meal consumption, which is typically how spices are consumed. The objective of this study was to investigate the anti-inflammatory effect of chronic spice consumption in adults with overweight/obesity at risk for CVD.

Methods

Nonsmoking adults (30–75 years old) with overweight/obesity (BMI ≥ 25 and ≤ 35 kg/m2), elevated waist circumference (≥94 cm for men and ≥ 80 cm for women) and at least one other risk factor for CVD were recruited for a 3-period, crossover, randomized controlled-feeding study (n = 63). In random order, participants consumed an Average American Diet (AAD) for 4 weeks containing: 1) 0.6 g of spice blend per 2100 kcal, 2) 3.2 g of spice blend per 2100 kcal, or 3) 6.4 g of spice blend per 2100 kcal with a≥2-week washout period between each test period. The spice blend was comprised of 24 popular spices. Blood was collected at baseline and after each test period. Peripheral blood mononuclear cells were isolated, and the % of monocyte subsets (classical; CD14++CD16−, intermediate; CD14++CD16+, non-classical; CD14+CD16++) were quantified using flow cytometry. Plasma pro-inflammatory cytokine levels (TNF-α, IL-1β, IL-6, IL-8, MCP-1) were measured using ELISA. In a subset of participants (n = 6), transendothelial migratory function of each monocyte subset through MCP-1 stimulated human umbilical vein endothelial cells was evaluated.

Results

Plasma IL-6 was significantly reduced after consuming the AAD containing 3.2 g compared to 0.6 g of spice blend in men and postmenopausal women (P = 0.031). Transendothelial migration of classical monocytes was significantly reduced following consumption of the AAD containing 3.2 g and 6.4 g of the spice blend compared to 0.6 g of spice blend (P = 0.011).

Conclusions

Consumption of an AAD with spices for 4 weeks attenuated inflammatory outcomes including plasma IL-6 and transendothelial migration of classical monocytes in adults with overweight/obesity.

Funding Sources

McCormick Science Institute.

Dried Fruit Consumption Is Associated with Greater Diet Quality and Intakes of Shortfall Nutrients in NHANES 2007–16

Objectives

The 2015–2020 Dietary Guidelines for Americans recognize dried fruits as acceptable alternatives to fresh fruit but caution that, consumed in excess, they can contribute excess calories. The aim of this study was to characterize dried fruit consumption and the contribution of dried fruits to nutrient intakes and diet quality.

Methods

A cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES), 2007–2016 was performed. Survey-weighted analyses were used to estimate mean dried fruit intakes in adults 20 years or older (n = 25,590) who completed a dietary recall. Dried fruit consumers (≥1/4 cup-equivalent/day) were defined in respondents with two complete dietary recalls (n = 22,311). Regression analyses compared cardiometabolic health and diet quality in consumers and non-consumers, with adjustment for demographic and lifestyle factors. Within-person differences in nutrient and food group intakes on days when dried fruits were consumed versus not were assessed in respondents who consumed dried fruit on only one of two dietary recalls (n = 1222) using multivariate linear regression.

Results

Mean dried fruit intake was 0.04 ± 0.001 cup-equivalents and represented 3.6% of total fruit consumed by adults. The major food source was plain dried fruit (49%), followed by cereals (19%). Consumers (7.2% of adults) had higher quality diets than non-consumers (HEI-2015 score 60.6, versus 52.6; P &lt; 0.001) and lower mean BMI, waist circumference, and systolic blood pressure (P ≤ 0.001), after adjustment for potential confounders. Total fruit, nuts and seeds, total carbohydrates, dietary fiber, potassium, and polyunsaturated fat intakes were greater on days when dried fruits were consumed versus not consumed (P &lt; 0.01). In women, total and monounsaturated fat and protein intakes were also greater, while men consumed more whole grains and added sugars on dried fruits consumption days. Total calorie intakes were higher in men and women (205–209 kcal, P ≤ 0.002) when dried fruits were consumed.

Conclusions

Dried fruit consumption is associated with higher diet quality and greater intakes of shortfall nutrients. However, dried fruits do not appear to displace other calorie sources when consumed.

Funding Sources

None.

Dose-Response Effects of Strawberries on Atherogenic Lipoproteins: A Randomized Controlled Crossover Trial

Objectives

Previous research indicates that consumption of strawberries may provide benefits for reduction of atherogenic lipoproteins but has not identified an optimal dose. Our objective was to evaluate effects of 2 doses of strawberry powder, approximately equivalent to 1 and 3 servings of strawberries per day, on serum lipoprotein concentrations.

Methods

Middle-aged adults (n = 40, age 49 ± 1 year) with elevated LDL-C (140 ± 4 mg/dL) and elevated BMI (29.4 ± 0.4 kg/m2) consumed 0 g/d (control), 13 g/d (low-dose), and 40 g/d (high-dose) of freeze-dried strawberry powder in a randomized crossover design (4-week supplementation periods separated by a 2 week compliance break). Fasting blood samples were obtained on two separate days (and averaged) at study-entry baseline and following each supplementation period.

Results

There were significant main effects of treatment (P ≤ 0.05) for calculated LDL-C, nonHDL-C, and total cholesterol (TC). In post hoc tests, the low-dose resulted in 5% lower LDL-C vs. the high-dose (P = 0.01), 4% lower nonHDL-C vs. control (P = 0.04), and 3% lower TC for the low-dose vs. control and high-dose (P ≤ 0.04). Compared to baseline, low-dose strawberry supplementation also significantly reduced direct LDL-C (−6.8 mg/dL, P = 0.02), but there was not a main effect of treatment.

Conclusions

Our results suggest that low-dose supplementation with freeze dried strawberry powder, roughly equivalent to one serving of strawberries per day, was superior to high-dose supplementation for improving atherogenic lipoproteins in overweight adults.

Funding Sources

California Strawberry Commission.

Effect of Mediterranean Diets with Varying Amounts of Lean Beef on Measures of Vascular Health

Objectives

To evaluate the effects of Mediterranean (MED) diets with different quantities of lean beef (0.5, 2.5 and 5.5 oz/day) compared to an Average American diet (AAD) on brachial and central blood pressure, pulse wave velocity (PWV) and augmentation index (AI).

Methods

We conducted a multicenter, 4-period controlled feeding, randomized crossover study at Penn State University and USDA-Beltsville to evaluate the effects of MED diets (CHO 42%, PRO 17%, FAT 41%, SFA 8%, MUFA 26%, PUFA 8%) with different quantities of lean beef (0.5, 2.5 and 5.5 oz/day) compared to an average American diet (AAD; CHO 52%, PRO 15%, FAT 33%, SFA 12%, MUFA 13%, PUFA 8%) on vascular health. Participants (n = 66) included generally healthy males and females (BMI = 20–38 kg/m2) 30 to 67 years. Participants were randomized to each of the 4 diets for 4 weeks with an approximate 2-week break between treatments. Central blood pressure, PWV and AI were measured using the SphygmoCor ECEL-System. Endpoints were assessed at baseline and the end of each 4-week diet period.

Results

There was a significant treatment effect for PWV (P &lt; 0.01); PWV was lower following consumption of the MED diets containing 0.5 oz. lean beef/day (6.86 m/sec ± 0.14; P &lt; 0.05) and 2.5 oz. of lean beef/day (6.84 m/sec ± 0.15; P &lt; 0.01) compared to the AAD (7.10 m/sec ± 0.14). Compared to the AAD, both the 0.5 oz./day (−3.30 mmHg ± 0.76) and 2.5 oz./day (−2.94 mmHg ± 0.76) MED diets elicited greater reductions in central systolic blood. A similar pattern was observed for central diastolic pressure. Compared to AAD, all three MED diets significantly decreased brachial systolic and diastolic pressures (P &lt; 0.01 for all). Compared to baseline only the MED 0.5 elicited a significant reduction in AI (P &lt; 0.01).

Conclusions

This study demonstrated improvements in measures of arterial stiffness and central blood pressure following Mediterranean diets containing low to moderate amounts of lean beef.

Funding Sources

National Cattleman's Beef Association, The Penn State Clinical and Translational Research Institute, Pennsylvania State University Clinical and Translational Science Award, and NIH/National Center for Advancing Translational Sciences grant no. UL1TR000127.

Fasting Glucose Response to Evening Snacks That Differ by Carbohydrate and Fat Composition: A 6-Week, Randomized, Crossover Trial in Subjects with Impaired Fasting Glucose

Objectives

To examine the effect of consuming one ounce of peanuts (PNUT) as an evening snack on fasting plasma glucose and other cardiovascular disease risk factors, compared to an isocaloric lower fat higher carbohydrate snack (LFHC), in individuals with IFG.

Methods

Fifty-one individuals with IFG (52% male; 42 ± 15 y; BMI 28 ± 5.6 kg/m2; glucose 105 ± 4.9 mg/dL) were enrolled in this two-period, randomized, crossover trial. In random order, subjects consumed each snack in the evening (after dinner and before bedtime) for 6 weeks (PNUT: 164 kcal, 14 g fat, 2.2 g saturated fat, 6 g carbohydrate, 7 g protein, 2.4 g fiber; LFHC: 165 kcal, 6 g fat, 2 g saturated fat, 22 g carbohydrate, 7 g protein, 3.0 g fiber). Subjects were told not to consume other caloric foods/beverages after dinner. On two consecutive days at the beginning and end of each diet period a fasting blood sample was assessed for plasma glucose, serum lipids/lipoproteins, and insulin. Blood pressure (BP) and pulse wave velocity (PWV) were measured at each time point.

Results

Compared with baseline (100 mg/dL, 95% CI 99, 102), glucose was unchanged following both conditions (PNUT: −0.9 mg/dL 95% CI −2.1, 1.3; LFHC: −0.4 mg/dL 95% CI −2.6, 0.8) with no between-condition difference (P &gt; 0.05). Changes for LDL-C from baseline differed between conditions (−4.8 mg/dL; 95% CI −9.2, −0.4); there were no within-condition changes from baseline (LFHC −2.3 mg/dL, 95% CI −5.7, 1.0; PNUT 2.5 mg/dL, 95% CI −0.9, 5.8). Greater triglyceride lowering was observed with PNUT (−17 mg/dL, 95% CI −28, −6.2) vs. LFHC (−5.7 mg/dL, 95% CI −17, 5.1). There were no condition effects for weight, HDL-C, insulin, BP or PWV. In a post hoc analysis of subjects who had IFG (&gt;99 mg/dL) at baseline (107 mg/dL, 95% CI 106, 108), glucose was lowered compared to baseline for both conditions (PNUT: −2.6 mg/dL, 95% CI −4.6, −0.6; LFHC: −3.1 mg/dL, 95% CI −5.1, −1.0).

Conclusions

In individuals with IFG, consuming a relatively low-calorie, mixed macronutrient, nighttime snack improves fasting glucose levels. Greater reductions in triglycerides were observed with evening peanut consumption, which may be explained by the lower carbohydrate and higher fat content.

Funding Sources

The Peanut Institute Supported by the National Center for Advancing Translational Sciences, National Institutes of Health.

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

The elimination of specific dietary cholesterol target recommendations in recent guidelines has raised questions about its role with respect to cardiovascular disease. This advisory was developed after a review of human studies on the relationship of dietary cholesterol with blood lipids, lipoproteins, and cardiovascular disease risk to address questions about the relevance of dietary cholesterol guidance for heart health. Evidence from observational studies conducted in several countries generally does not indicate a significant association with cardiovascular disease risk. Although meta-analyses of intervention studies differ in their findings, most associate intakes of cholesterol that exceed current average levels with elevated total or low-density lipoprotein cholesterol concentrations. Dietary guidance should focus on healthy dietary patterns (eg, Mediterranean-style and DASH [Dietary Approaches to Stop Hypertension]–style diets) that are inherently relatively low in cholesterol with typical levels similar to the current US intake. These patterns emphasize fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds, and liquid vegetable oils. A recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health.

Estimating mean population salt intake in Fiji and Samoa using spot urine samples

BACKGROUND

There is an increasing interest in finding less costly and burdensome alternatives to measuring population-level salt intake than 24-h urine collection, such as spot urine samples. However, little is known about their usefulness in developing countries like Fiji and Samoa. The purpose of this study was to evaluate the capacity of spot urine samples to estimate mean population salt intake in Fiji and Samoa.

METHODS

The study involved secondary analyses of urine data from cross-sectional surveys conducted in Fiji and Samoa between 2012 and 2016. Mean salt intake was estimated from spot urine samples using six equations, and compared with the measured salt intake from 24-h urine samples. Differences and agreement between the two methods were examined through paired samples t-test, intraclass correlation coefficient analysis, and Bland-Altman plots and analyses.

RESULTS

A total of 414 participants from Fiji and 725 participants from Samoa were included. Unweighted mean salt intake based on 24-h urine collection was 10.58 g/day (95% CI 9.95 to 11.22) in Fiji and 7.09 g/day (95% CI 6.83 to 7.36) in Samoa. In both samples, the INTERSALT equation with potassium produced the closest salt intake estimate to the 24-h urine (difference of - 0.92 g/day, 95% CI - 1.67 to - 0.18 in the Fiji sample and + 1.53 g/day, 95% CI 1.28 to 1.77 in the Samoa sample). The presence of proportional bias was evident for all equations except for the Kawasaki equation.

CONCLUSION

These data suggest that additional studies where both 24-h urine and spot urine samples are collected are needed to further assess whether methods based on spot urine samples can be confidently used to estimate mean population salt intake in Fiji and Samoa.

Association Between Diet Quality and Brachial-ankle Pulse Wave Velocity (baPWV) (P18-021-19)

Objectives

Suboptimal diet is the leading cause of cardiovascular disease (CVD) and is implicated in the etiology of vascular dysfunction. Arterial stiffness is a pathological vascular change that is associated with higher subsequent risk of CVD. This study aims to investigate the cross-sectional association between diet quality and arterial stiffness, as assessed by brachial-ankle pulse wave velocity (baPWV).

Methods

Data from the Kailuan Study, a prospective cohort from China, were utilized for these analyses. Baseline data from subjects who were free of CVD were included (n = 22,563). Dietary intake was assessed by a semi-quantitative validated food frequency questionnaire. Diet quality was quantified using the American Heart Association diet score (range 0 to 5), which is based on the consumption of fruits/vegetables, fish, sodium, sweets/sugar-sweetened beverages, and whole grains. Participants were categorized into three groups based on their diet quality: poor (0–1), intermediate (2–3), and ideal quality (4–5). Participants also had baPWV measured. General linear models were used to calculate adjusted means with 95% confidence intervals (95% CI) for baPWV across diet quality groups, after adjusting for age, sex, BMI, education level, smoking status, blood pressure, fasting blood glucose, LDL cholesterol, and HDL cholesterol. Logistic regression analysis was used to estimate the odds ratios for arterial stiffness (baPWV ≥ 1400 cm/s) across diet quality categories.

Results

Greater diet quality was associated with lower baPWV values (P-trend < 0.001). Adjusted mean baPWV was 1436 cm/s (95% CI: 1417–1454), 1428 cm/s (95% CI: 1408–1447), and 1397 cm/s (95% CI: 1365–1430) for poor, intermediate, and ideal diet quality, respectively. We observed a non-significant inverse trend between diet quality and odds of having arterial stiffness (adjusted OR between two extreme groups = 0.81, 95% CI: 0.61–1.07, P trend = 0.11).

Conclusions

In this cross-sectional analysis greater diet quality was associated with lower baPWV values in individuals without CVD.

Funding Sources

The start-up grant from the college of health and human development and the department of nutritional sciences, Penn State University and the Institute for CyberScience Seed Grant Program, Penn State University.

Plasma Linoleic Acid Is Associated with Less Adiposity and Lower Risk of Metabolic Syndrome: An NHANES Analysis (P08-121-19)

Objectives

To examine relationships between plasma fatty acids, dietary intake of fatty acids, adiposity and risk of metabolic syndrome (MetSyn) in the National Health and Nutrition Examination Survey (NHANES) dataset.

Methods

Plasma fatty acids levels (n = 24) measured in NHANES 2001–2003 (n = 1674) and dietary intake of fatty acids (n = 19) from NHANES 2001–2014 (n = 9108) were used for these analyses. The association between plasma fatty acid levels, intake of fatty acids and body weight, BMI, waist circumference, and number of criteria for MetSyn was assessed. Backwards stepwise multiple regression analyses adjusted for age, sex, ethnicity, prescription of anti-hypertensive, lipid-lowering of anti-diabetic medication, modified Health Eating Index-2015 score, physical activity, poverty to income ratio, smoking, and calorie intake were conducted to identify fatty acids that were predictive of the outcomes of interest. Logistic regression analysis, adjusted for the aforementioned covariates, was used to assess the odds of MetSyn, and overweight/obesity associated with each fatty acid.

Results

Higher levels of the plasma saturated fatty acids myristic acid (14:0), stearic acid (18:0), and docosanoic acid (22:0) were associated with greater BMI, waist circumference, and number of MetSyn criteria (P < 0.01). Arachidic acid (20:0) and lignoceric acid (24:0) were inversely associated with BMI, waist circumference, and number of MetSyn criteria. Plasma linoleic acid (18:2) was the only PUFA inversely associated with BMI (β = −0.002), waist circumference (β = −0.005), and number of MetSyn criteria (β −0.0003) (all P < 0.01). Plasma linoleic acid was also correlated with lower risk of being overweight or obese (odds ratio (OR) 0.9995; P < 0.03) and having an elevated waist circumference (OR 0.9992; P < 0.01). These results were not supported by the dietary fatty acid intake data.

Conclusions

These data from a representative U.S. cohort indicate that plasma medium and longer chain saturated fats were generally associated with greater adiposity and more criteria for MetSyn, whereas these relationships were not detected for MUFA. Linoleic acid was the only PUFA associated with less adiposity and lower risk of MetSyn and, thus also lower risk of cardiometabolic disease.

Funding Sources

ACH Food Companies, Inc.

Effect of a Mediterranean Diet with Varying Quantities of Lean Beef on non-HDL and HDL Lipid Particles: A Randomized Controlled Feeding Cross-Over Trial (OR36-05-19)

Objectives

To evaluate the effects of a Mediterranean (Med) style diet with varying quantities of lean beef on non-HDL and HDL lipid subspecies. We hypothesized that a Med diet with lean beef would confer cardiovascular benefits beyond a standard lipid panel and be superior to an average American diet (AAD).

Methods

We conducted a multicenter, 4-period controlled feeding, randomized crossover study at Penn State University and USDA-Beltsville to evaluate the effects of a Med diet (CHO 42%, PRO 17%, FAT 41%, SFA 8%, MUFA 26%, PUFA 8%) with different quantities of lean beef (0.5, 2.5 and 5.5 oz/day) compared to an average American diet (AAD; CHO 52%, PRO 15%, FAT 33%, SFA 12%, MUFA 13%, PUFA 8%) on CVD risk factors. Participants (n = 66) included generally healthy normal to overweight/obese males and females (BMI = 20–38 kg/m2) 30 to 67 years. Participants were randomized to each of the 4 diets for 4 weeks with an approximate 2-week break between treatments. Fasting blood samples were collected on two consecutive days at baseline (start of study), and at the end of each diet period.

Results

All three Med diets decreased LDL-C versus AAD (−10.5 ± 2.0, −9.0 ± 2.0, −6.8 ± 2.0 mg/dL, P < 0.0001 for the 0.5, 2.5 and 5.5 oz., respectively). All Med diets elicited similar reductions in total LDL particle number and large particle number (P < 0.01 for both) compared to baseline, however only the Med diets with 0.5 oz./day (−91.2 ± 23 nmol/L) and 2.5 oz./day (−85.3 ± 23 nmol/L) were significantly decreased versus AAD (P < 0.01). There were no treatment differences for IDL or small LDL particles. All diets reduced HDL-C and HDL particle number from baseline (P < 0.01).

Conclusions

A healthy Med style diet containing 2.5 oz./day of lean beef elicits similar improvements in lipid subspecies compared to a traditional Med style diet containing 0.5 oz./day. The Med style diet containing 5.5 oz./day of lean beef had similar effects on lipid subspecies to the AAD, therefore our findings suggest that £2.5 oz./day of lean beef can be included in a Med diet and not compromise the cardiovascular benefits of a Med diet.

Funding Sources

This study was funded by the Beef Checkoff. This study also was supported by the USDA, ARS and the Penn State Clinical and Translational Research Institute.

The Postprandial Effect of Spice Consumption Delivered in a High-Fat Meal on Pro-Inflammatory Cytokine Secretion in Overweight/Obese Men (OR12-06-19)

Objectives

Postprandial lipidemia is a risk factor for cardiovascular disease. The postprandial inflammation that occurs concurrently with lipidemia following ingestion of a high-fat meal (HFM) may contribute to this association. Numerous individual spices have anti-inflammatory properties in vitro and in vivo in animal models and humans. However, the effect of consumption of a spice blend on inflammatory mediators has not been examined in humans in a randomized controlled trial. The objective of this study was to investigate the postprandial effect of spice consumption delivered in a HFM on inflammatory cytokine responses.

Methods

Overweight/obese (BMI ≥25 and ≤35 kg/m2), nonsmoking, men (40–65 years old) with elevated waist circumference (≥94 cm) and at least one other risk factor for cardiovascular disease were recruited for a 3-period crossover study (n = 12). In random order, participants consumed the following dietary interventions: 1) a HFM (1076 kcal, 39% kcal from saturated fat), 2) a HFM containing 2 g of spice blend, or 3) a HFM containing 6 g of spice blend with a ≥3-day washout period between each test meal. The spice blend consisted of black pepper, basil, bay leaf, cinnamon, coriander, cumin, ginger, oregano, parsley, rosemary, red pepper, thyme and turmeric. Participants fasted overnight and blood was collected before, and hourly for four hours after the HFM. Peripheral blood mononuclear cells (PBMCs) were isolated at each time point, and the number of monocytes (CD14+/HLA-DR+) were quantified by flow cytometry. PBMCs were stimulated with lipopolysaccharide (LPS) and pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-8, MCP-1) were quantified by ELISA in the supernatants.

Results

Monocyte number (P = 0.001), and the secretion of IL-1β (P = 0.036) and TNF-α (P = 0.046) from LPS-stimulated PBMCs were significantly elevated during the four-hour time period after HFM consumption compared to the baseline. However, the presence of 6 g of spice in the HFM reduced the secretion of IL-6 (P = 0.046), IL-8 (P = 0.031), TNF-α (P = 0.001) and MCP-1 (P = 0.063) from PBMCs at 60 min after the meal.

Conclusions

Consumption of a HFM containing a spice blend attenuated postprandial inflammation in overweight/obese men.

Funding Sources

McCormick Science Institute; Penn State Clinical and Translational Science Institute

Walnuts and Vegetable Oils Differentially Affect the Gut Microbiome and Associations with Cardiovascular Risk Factors (OR29-06-19)

Objectives

To examine gut bacterial composition following a higher-saturated fatty acids (SFA) run-in, standard Western diet (SWD) and 3 study diets where SFA was replaced with: whole walnuts (WD); vegetable oils in a fatty acid matched diet devoid of walnuts (WFMD); vegetable oils in an oleic acid replaces α-linolenic acid (ALA) diet (ORAD) and devoid of walnuts. Correlations between the bacterial composition and cardiovascular disease (CVD) risk factors were also explored.

Methods

Adults at CVD risk (n = 42) were included in this secondary analysis of a randomized, crossover, controlled-feeding study that reported improvements in CVD risk factors. Only significantly changed risk factors were correlated with significantly enriched bacteria. Fecal collections followed a 2-week run-in diet and three 6-week diet periods. Linear discriminant analysis Effect Size plots were used to determine enriched taxa.

Results

Following the WD, Roseburia (mean relative abundance = 4.2%, LDA = 4, P = 0.0008), Eubacterium eligensgroup (1.4%, 4, 0.05), Lachnospiraceae UCG001 (1.2%, 3, 0.03), Lachnospiraceae UCG004 (1.0%, 3, 0.04) and Leuconostocaceae (0.03%, 3, 0.05) were abundant relative to the SWD. Relative to the SWD, Roseburia (mean relative abundance = 3.6%, LDA = 4, P = 0.02) and Eubacterium eligensgroup (1.5%, 3, 0.02) were enriched following the WFMD, and following the ORAD Clostridialesvadin BB60 (0.3%, 2, 0.04) was most abundant. Significant associations existed between enriched bacteria following the WD and CVD risk factors. Eubacterium eligens correlated with brachial (R = −0.5, P = 0.0009) and central mean arterial pressure (MAP; −0.5, 0.002), and central diastolic blood pressure (cDBP; −0.5, 0.0006). Lachnospiraceae correlated with brachial (R = −0.4, P = 0.02) and central MAP (−0.4, 0.02), cDBP (−0.3, 0.04), total cholesterol (TC; −0.4, 0.03), and non-HDL-C (−0.4, 0.02). Leuconostocaceae correlated with brachial (R = 0.3, P = 0.03) and central MAP (0.3, 0.03).

Conclusions

Similar eubiotic bacteria were enriched by the WD and WFMD suggesting ALA and linoleic acid affect the gut microbiome. Enrichment of Lachnospiraceae and associations with improved CVD risk factors suggests the microbiome contributes to the beneficial health effects of walnuts.

Funding Sources

The California Walnut Commission and National Center for Advancing Translational Sciences, NIH.

Supporting Tables, Images and/or Graphs

Effects of a High Fat Meal Challenge with Different Doses of Spice Blend on Postprandial Fatty Acid Suppression (P08-094-19)

Objectives

High fat meals can increase inflammation and plasma triglycerides. Poor suppression of postprandial adipocyte lipolysis results in higher levels of non-esterified fatty acids (NEFA) in insulin resistant subjects. This impaired suppression of NEFA may exacerbate hypertriglyceridemia following a high fat meal by increasing available fatty acids. We have shown myristic acid (MA) and stearic acid (SA) are less suppressed than other fatty acids 1 hour following a glucose challenge, and this pattern may indicate optimal adipocyte insulin sensitivity. It is unknown if the same pattern occurs in other contexts, such as high fat meal.

Methods

Plasma samples were collected from 12 obese male subjects at baseline and 4 time points following a high fat meal (1076 kcal, 39% kcal from saturated fat) on three visits. Meals contained either 0, 2, or 6 grams of a spice blend. Plasma was analyzed by GC-MS to measure multiple fatty acids, including MA, SA, palmitic acid (PA), oleic acid (OA), and linoleic acid (LA).

Results

At 1 hour following the high fat meal, MA and SA were less suppressed than OA, PA, and LA (P < 0.0001). Total NEFA concentrations were most suppressed (61%; CI: 46%, 76%) at 2 hours following the meal and remained suppressed until 4 hours. PA (59%, P < 0.0001), SA (43%, P < 0.001), OA (68%, P < 0.0001), and LA (71%, P < 0.0001) also achieved maximal suppression at 2 hours and remained suppressed. MA was suppressed (34%, P = 0.0002) at 1 hour, then returned to baseline. Compared to baseline, all saturated fatty acids increased as % of total NEFA at 2 hours (MA: 0 hr, 1.8%, 2 hr, 3.7%, P < 0.0001; PA: 0 hr, 24%, 2 hr, 26%, P = 0.009; SA: 0 hr, 8%, 2 hr, 12%, P < 0.0001), while the unsaturated fatty acids decreased (OA: 0 hr, 33%, 2 hr, 25%, P < 0.0001; LA: 0 hr, 24%, 2 hr, 19%, P < 0.0001). There was no significant effect of spice.

Conclusions

NEFA was most suppressed at 2 hours following a high fat meal challenge, but MA and SA were suppressed less than all other fatty acids. Saturated fatty acids increased as a % of total NEFA following the meal challenge, while unsaturated fatty acids decreased. These data support our previous findings that MA and SA are less suppressed by insulin than other fatty acids.

Funding Sources

McCormick Science Institute; Penn State Department of Nutritional Sciences; National Center for Advancing Translational Sciences, NIH, (UL1 TR002014).

Dried Fruit and Vascular Health: A Randomized Crossover Trial (P12-018-19)

Objectives

To evaluate the effect of consuming ¾ cup/day of mixed dried fruits versus a calorie- and carbohydrate-matched snack, on vascular health in adults at risk for cardiometabolic disease.

Methods

Men and women (n = 55) with overweight or obesity and at least one additional risk factor for cardiometabolic disease were enrolled in a 2-period single-blind randomized crossover trial. Participants received the following treatments for 4 weeks (separated by a 2–4 week washout): 1) ¾ cup mixed unsweetened dried fruits (equal parts raisins, dried plums, figs, and dates); 2) a calorie- and carbohydrate-matched processed snack. Endpoints were assessed at baseline, and the end of each treatment. Participants were advised to consume 1 serving/day of fresh fruit and incorporate study foods into their usual diets. The SphygmoCor XCEL was used to evaluate brachial and central blood pressure (BP), augmentation index, and carotid-femoral pulse wave velocity (PWV).

Results

At baseline, participants (47% female) had a mean BMI of 28.5 ± 2.7 kg/m2 and mean BP was 111 ± 9/77 ± 8 mmHg. More than half the subjects (56%) had a normal BP (<120/<80 mmHg) at baseline. End-of-treatment mean body weights were not different (P = 0.57). There was no difference in end-of-treatment mean values for brachial and central BP, augmentation index, augmentation pressure, or PWV (all P > 0.05). There was a significant difference in mean central pulse pressure (PP) following the dried fruit treatment versus control (1.6 ± 0.8 mmHg, P = 0.048). This was likely driven by a trend toward lower central diastolic BP (−1.2 ± 0.7 mmHg; P = 0.12) after the fruit, versus control.

Conclusions

Daily consumption of 1.5 cup-equivalents of mixed dried fruits for 4 weeks did not affect systolic BP or measures of arterial stiffness versus an isocaloric carbohydrate-matched snack in adults at increased risk of cardiometabolic disease. A significant difference in end-of-treatment mean central PP merits further study.

Funding Sources

International Nut & Dried Fruit Council; the California Dried Plum Board; National Center for Advancing Translational Sciences, NIH.

Effects of health star labelling on the healthiness of adults' fast food meal selections: An experimental study

The addition of Health Star Rating (HSR) labelling to menus at fast food outlets is feasible, however how this would impact consumer menu selection remains unclear. The aim of this study was to test whether the addition of HSR labelling to kilojoule (kJ) labelling on menus at fast food outlets would prompt consumers to select healthier meals. Using a between-subjects experimental design, 1007 adults aged 18-49 were allocated to one of four menu labelling conditions: (i) no labelling; (ii) kilojoule labelling; (iii) HSR labelling; and (iv) kilojoule + HSR labelling. Respondents were presented with their assigned menu online and instructed to select an evening meal as they would at a fast food restaurant. The main analyses tested differences by menu labelling condition in the total mean kilojoule content and Nutrient Profiling Score (NPS) of respondents' evening meal selections using one-way ANOVA. The mean kilojoule content of meals did not differ significantly by menu labelling condition. However, respondents in the kilojoule + HSR labelling condition selected healthier meals (lower mean NPS) than those who viewed menu boards with kilojoule labelling only (M = 2.88 cf. M = 3.78, p = 0.046). In addition, in a post hoc per-protocol analysis of respondents who reported using menu labelling to assist their meal selection, respondents shown kilojoule + HSR menu labelling selected meals with a significantly lower kilojoule content compared to those shown HSR labelling only (4751 kJ cf. 5745 kJ, p = 0.038). Findings provide evidence that adding HSRs to kilojoule labelling on menu boards at fast food outlets has the potential to assist adults to make healthier evening meal selections.

Effects of an Advocacy Trial on Food Industry Salt Reduction Efforts-An Interim Process Evaluation

The decisions made by food companies are a potent factor shaping the nutritional quality of the food supply. A number of non-governmental organizations (NGOs) advocate for corporate action to reduce salt levels in foods, but few data define the effectiveness of advocacy. This present report describes the process evaluation of an advocacy intervention delivered by one Australian NGO directly to food companies to reduce the salt content of processed foods. Food companies were randomly assigned to intervention (n = 22) or control (n = 23) groups. Intervention group companies were exposed to pre-planned and opportunistic communications, and control companies to background activities. Seven pre-defined interim outcome measures provided an indication of the effect of the intervention and were assessed using intention-to-treat analysis. These were supplemented by qualitative data from nine semi-structured interviews. The mean number of public communications supporting healthy food made by intervention companies was 1.5 versus 1.8 for control companies (p = 0.63). Other outcomes, including the mean number of news articles, comments and reports (1.2 vs. 1.4; p = 0.72), a published nutrition policy (23% vs. 44%; p = 0.21), public commitment to the Australian government's Food and Health Dialogue (FHD) (41% vs. 61%; p = 0.24), evidence of a salt reduction plan (23% vs. 30%; p = 0.56), and mean number of communications with the NGO (15 vs. 11; p = 0.28) were also not significantly different. Qualitative data indicated the advocacy trial had little effect. The absence of detectable effects of the advocacy intervention on the interim markers indicates there may be no impact of the NGO advocacy trial on the primary outcome of salt reduction in processed foods.

Effectiveness of a Communication for Behavioral Impact (COMBI) Intervention to Reduce Salt Intake in a Vietnamese Province Based on Estimations From Spot Urine Samples

This study evaluated the effectiveness of the Communication for Behavioral Impact (COMBI)–Eat Less Salt intervention conducted in Viet Tri, Vietnam. The behavior change intervention was implemented in four wards and four communes for one year, which included mass media communication, school interventions, community programs, and focus on high‐risk groups. Mean sodium excretion was estimated from spot urine samples using different equations. A subsample provided 24‐hour urine to validate estimates from spot urine. Information about salt‐related knowledge and behaviors was also collected. There were 513 participants at both baseline and follow‐up. Mean sodium excretion estimated from spot urines fell significantly from 8.48 g/d at baseline to 8.05 g/d at follow‐up (P=.001). All spot equations demonstrated a significant reduction in sodium levels; however, the change was smaller than the measured 24‐hour urine. Participants showed improved knowledge and behaviors following the intervention. The COMBI intervention was effective in lowering average population salt intake and improving knowledge and behaviors.

Regulatory T cell frequencies are increased in preterm infants with clinical early-onset sepsis

The predisposition of preterm neonates to invasive infection is, as yet, incompletely understood. Regulatory T cells (Tregs ) are potential candidates for the ontogenetic control of immune activation and tissue damage in preterm infants. It was the aim of our study to characterize lymphocyte subsets and in particular CD4(+) CD25(+) forkhead box protein 3 (FoxP3)(+) Tregs in peripheral blood of well-phenotyped preterm infants (n = 117; 23 + 0 - 36 + 6 weeks of gestational age) in the first 3 days of life in comparison to term infants and adults. We demonstrated a negative correlation of Treg frequencies and gestational age. Tregs were increased in blood samples of preterm infants compared to term infants and adults. Notably, we found an increased Treg frequency in preterm infants with clinical early-onset sepsis while cause of preterm delivery, e.g. chorioamnionitis, did not affect Treg frequencies. Our data suggest that Tregs apparently play an important role in maintaining maternal-fetal tolerance, which turns into an increased sepsis risk after preterm delivery. Functional analyses are needed in order to elucidate whether Tregs have potential as future target for diagnostics and therapeutics.

[Methodology of the S3 guidelines on alcohol and tobacco-related disorders]

BACKGROUND

From 2010 until 2015 two interdisciplinary evidence-based guidelines were developed to summarize the current knowledge regarding screening, diagnostics and treatment of alcohol and tobacco-related disorders.

METHODS

Both guidelines were prepared under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde, DGPPN) and the German Society for Addiction Research and Therapy (Deutsche Gesellschaft für Suchtforschung und -therapie, DG-Sucht). To meet the methodological criteria for the highest quality guidelines (S3 criteria) as defined by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) the following criteria were realized: (1) a systematic search, selection and appraisal of the international literature, (2) a structured process to reach consensus and (3) inclusion of all relevant representatives of future guideline users.

RESULTS

More than 60 clinical experts and researchers analyzed the scientific literature. In total 41 international and national guidelines (23 for alcohol and 18 for tobacco) were used. Moreover, 83 systematic Cochrane reviews (alcohol 28, tobacco 55) and 5863 articles (alcohol 2213, tobacco 3650) were analyzed. A total of 7 expert groups formulated 174 recommendations for the screening, diagnosis and treatment of alcohol-related disorders. Six expert groups created 81 recommendations for the screening, diagnosis and treatment of tobacco-related disorders. Approximately 50 scientific associations, professional organizations, patient and family initiatives, as well as representatives of the healthcare system formed a consensus group. In seven 1 and 2-day conferences, all clinical recommendations were discussed and approved by this group. Both guidelines will be revised on a regular basis to guarantee that the clinical recommendations are kept up to date.

CONCLUSIONS

Both systematically developed, evidence-based treatment guidelines are comprehensive instruments to provide orientation and assist the decision-making process for physicians, psychologists and other therapists as well as patients and their families in the diagnosis and treatment of alcohol and tobacco use related disorders.

A mechanism of mesh-related post-herniorrhaphy neuralgia

PURPOSE

The objective is to compare nerve densities in explanted polypropylene meshes in patients with or without chronic pain. Pain has supplanted recurrences as a complication of hernia surgery. The increased incidence of pain mirrors a parallel increase in the use of polypropylene meshes. Neither triple neurectomy nor careful nerve preservation has brought relief. Perhaps because we have forgotten that nerves, in response to some evolutionary mechanism, tend to regenerate, undergo changes imposed by prosthetic elements and architecture, mimicking entrapment and compartment syndromes.

METHODS

A total of 33 hernia meshes have been analyzed: 17 excised due to severe pain, two for combined pain and recurrence, 14 sampled during revision for recurrence without pain. Each mesh had standardized sampling for histology and the nerves were highlighted by S100 stain. Nerve densities were assessed within the mesh spaces and in tissue outside the mesh.

RESULTS

The density of nerves present in the standardized mesh samples of patients complaining of pain was much more elevated than in the mesh of those patients who had a recurrence but no pain. The difference was statistically significant (p < 0.001). Excluding two patients who had both pain and recurrence, the difference was even more marked (p < 0.0001).

CONCLUSIONS

Re-innervation and neo-innervation are known to take place following hernia repairs in indigenous tissue as well as through polypropylene meshes. However, when pain is an overriding issue dictating mesh explant, the degree of mesh innervation is significantly higher when compared to mesh excised for recurrence. That increase has been confirmed statistically.