The Effect of Carbohydrate Restriction on Lipids, Lipoproteins, and Nuclear Magnetic Resonance-Based Metabolites: CALIBER, a Randomised Parallel Trial

Low-carbohydrate high-fat (LCHF) diets can be just as effective as high-carbohydrate, lower-fat (HCLF) diets for improving cardiovascular disease risk markers. Few studies have compared the effects of the UK HCLF dietary guidelines with an LCHF diet on lipids and lipoprotein metabolism using high-throughput NMR spectroscopy. This study aimed to explore the effect of an ad libitum 8-week LCHF diet compared to an HCLF diet on lipids and lipoprotein metabolism and CVD risk factors. For 8 weeks, n = 16 adults were randomly assigned to follow either an LCHF (n = 8, <50 g CHO p/day) or an HCLF diet (n = 8). Fasted blood samples at weeks 0, 4, and 8 were collected and analysed for lipids, lipoprotein subclasses, and energy-related metabolism markers via NMR spectroscopy. The LCHF diet increased (p < 0.05) very small VLDL, IDL, and large HDL cholesterol levels, whereas the HCLF diet increased (p < 0.05) IDL and large LDL cholesterol levels. Following the LCHF diet alone, triglycerides in VLDL and HDL lipoproteins significantly (p < 0.05) decreased, and HDL phospholipids significantly (p < 0.05) increased. Furthermore, the LCHF diet significantly (p < 0.05) increased the large and small HDL particle concentrations compared to the HCLF diet. In conclusion, the LCHF diet may reduce CVD risk factors by reducing triglyceride-rich lipoproteins and improving HDL functionality.

Impact of lifetime concentration of mannose on renal function: insights from Mendelian randomization

Background

Mannose is a sugar monomer of the aldohexose series of carbohydrates, important in human metabolism, especially in the glycosylation of certain proteins. There is a handful of controversial data from observational studies on the serum levels of mannose and risks of renal disease.

Purpose

We performed a Mendelian Randomization (MR) analysis to obtain unconfounded estimates of the casual associations between genetically instrumented serum mannose, estimated glomerular filtration rate (eGFR) and the risk for chronic kidney disease (CKD defined as eGFR &lt;60 ml/min/1.73 m2).

Methods

MR was implemented by using summary-level data from the largest ever genome-wide association studies (GWAS) conducted on serum mannose and renal function. Inverse variance weighted method (IVW), weighted median (WM)-based method, MR-Egger, MR-Robust Adjusted Profile Score (RAPS), MR-Pleiotropy RESidual Sum and Outlier (PRESSO) were also applied. Sensitivity analysis was conducted using the leave-one-out method. The analyses were performed in the total population, in non-diabetics and in patients with type 2 diabetes mellitus (T2DM).

Results

Serum mannose concentrations were not significantly associated with CKD risk (IVW: beta=1.018, p=0.273), but they were negatively related to eGFR in the total population (IVW: beta=−0.137, p=0.003), the non-diabetics (IVW: beta=−0.126, p=0.018) and the T2DM patients (IVW: beta=−0.344, p=0.004). None of the MR-Egger estimates showed heterogeneity, and the MR-PRESSO analysis did not find any possibility of outliers for all of the estimates. The pleiotropy test also indicated a low chance of pleiotropy for all estimations (p&gt;0.242), as did the MR-RAPS analysis. Leave-one-out method demonstrated that the observed associations were not driven by single-nucleotide polymorphisms.

Conclusions

Our results highlighted that individuals with genetically higher serum mannose levels have a significantly lower eGFR, regardless of the presence or absence of T2DM. However, no association between serum mannose concentrations and the risk of CKD was observed.

Funding Acknowledgement

Type of funding sources: None.

Effect of serum lipid profile on the risk of breast cancer: systematic review and meta-analysis of 1,717,054 women

Background

Dyslipidemia has been linked to breast cancer incidence. However, conflicting results exist regarding the associations between lipid components and breast cancer development.

Purpose

The aim of the present meta-analysis was to further investigate the relationships between serum lipid profile and the risk of breast cancer.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to conduct the present systematic review and meta-analysis. Databases such as the PubMed, EMBASE, and Web of Sciences, were searched up to the end of January 2021, using certain MeSH and non-MeSH keywords and their combination to extract related published articles.

Results

Twenty-six prospective studies met the inclusion criteria involving 1,717,054 women, of whom 36,590 were diagnosed with breast cancer during the follow-up. A negative and significant association was found between HDL-C levels and the risk of breast cancer [relative risk (RR): 0.85, 95% CI: 0.72–0.99, I2: 67.6%, p=0.04) (Figure). In contrast, TG (RR: 1.02, 95% CI: 0.91–1.13, I2: 54.2%, p=0.79), total cholesterol (TC) (RR: 0.98, 95% CI: 0.90–1.06, I2: 67.2%, p=0.57), apolipoprotein A (ApoA) (RR: 0.96, 95% CI: 0.70–1.30, I2: 83.5%, p=0.78) and LDL-C (RR: 0.93, 95% CI: 0.79–1.09, I2: 0%, p=0.386) were not associated with breast cancer development. In studies adjusting for hormone use and physical activity, TC was positively correlated to breast cancer risk (RR: 1.05, 95% CI: 1.01–1.10 and 1.05, 95% CI: 1.01–1.10, respectively), as was TG in studies adjusting for baseline lipids (RR: 0.92, 95% CI: 0.85–0.99) and race (RR: 1.80, 95% CI: 1.22–2.65).

Conclusions

In the present meta-analysis, HDL-C was inversely related to breast cancer risk. In contrast, no significant associations were found for TC (except after adjusting for hormone use and physical activity), TG (except after adjusting for baseline lipids and race), LDL-C and ApoA. Overall, data on the links between lipids and breast cancer are conflicting. However, there is increasing evidence supporting that low HDL-C is related to an increased risk for this malignancy. Further research is needed to establish the associations between different lipid components and breast cancer risk in certain populations.

Funding Acknowledgement

Type of funding sources: None.

Omega 3 fatty acid supplementation improves physical performance: a systematic review and meta-analysis of RCTs

Background

Omega 3 polyunsaturated fatty acids (n-3, PUFA) show promise for improving muscle mass, strength and measures of physical performance that may ameliorate sarcopenia.

Purpose

To perform an updated meta-analysis of n-3 interventions with detailed subgroup analysis on physical performance/strength and muscle mass, with sub-group analysis on duration, age, BMI, sex, and location, amongst others.

Methods

We followed The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) –checklist for systematic reviews and meta-analysis. Literature was searched (ISI, Scopus and PubMed databases up to October 2021) with terms related to n-3 (alpha linolenic acid, docosahexaenoic acid, eicosapentaenoic acid, fish oil etc.) muscle mass, strength and physical performance (using the 30 s Chair Stand Test [30CST] for muscle strength and endurance and the Timed Up an Go Test [TUG] for physical performance; both are useful and simple tools that can be used to assess sarcopenia). Human n-3 randomised controlled trials (RCTs) were included and assessed for methodological quality (Cochrane quality assessment tool). Weighted mean differences (WMDs) with 95% confidence intervals (CIs) and random-effect model analysis, and I-squared (I2) statistic were used to assess outcomes and heterogeneity respectively. Subgroup and sensitivity analysis were performed, and Begg's and Egger's tests evaluated publication bias. Statistical analysis used STATA 11 software and a p-value of &lt;0.05 was considered statistically significant.

Results

The primary meta-analyses for functional performance (TUG, 7 RCTs, 8 interventions, n=259) and strength (30CST, 5 RCTs, 6 interventions, n=180), favoured n-3 PUFA (p&lt;0.001). TUG (weighted mean change (WMD): −0.35 s; 95% CI: −0.53, −0.18; I2=0.0%) (Figure 1A) and 30CST (WMD: 2.23 repetitions; 95% CI: 1.34, 3.32; I2=67.6%) (Figure 1B). Subgroup analysis for TUG was significant for female sex (WMD: 2.92 reps; 95% CI: 2.37, 3.46; I2=33.1%), BMI ≥25 kg/m2 (WMD: −0.36 s; 95% CI: −0.58, −0.17; I2=16.9%), and for 30CST by duration ≥16 weeks (WMD: 2.60 reps; 95% CI: 1.37, 3.83; I2=0.0%) (all p&lt;0.001). There were no significant effects on muscle mass and handgrip strength, and subgroup analysis showed negligible influence. Publication bias was minimal and sensitivity analysis did not influence findings.

Conclusions

We showed novel favourable effects of n-3 PUFA on specific measures of strength and physical performance in some populations but not on measures of muscle mass and other strength tests. The beneficial effects of n-3 on these measures may be due to various mechanisms that regulate muscle quality (rather than quantity). Further studies are needed to elucidate the dose, duration and other influential variables.

Funding Acknowledgement

Type of funding sources: None.

Genetically Determined Serum 25-Hydroxyvitamin D Is Associated with Total, Trunk, and Arm Fat-Free Mass: A Mendelian Randomization Study

PURPOSE

Low serum vitamin D status has been associated with reduced muscle mass in observational studies although the relationship is controversial and a causal association cannot be determined from such observations. Two-sample Mendelian randomization (MR) was applied to assess the association between serum vitamin D (25(OH)D) and total, trunk, arm and leg fat-free mass (FFM).

METHODS

MR was implemented using summary-level data from the largest genome-wide association studies (GWAS) on vitamin D (n=73,699) and total, trunk, arm and leg FFM. Inverse variance weighted method (IVW) was used to estimate the causal estimates. Weighted median (WM)-based method, and MR-Egger, leave-one-out were applied as sensitivity analysis.

RESULTS

Genetically higher serum 25(OH)D levels had a positive effect on total (IVW = Beta: 0.042, p = 0.038), trunk (IVW = Beta: 0.045, p = 0.023) and arm (right arm IVW = Beta: 0.044, p = 0.002; left arm IVW = Beta: 0.05, p = 0.005) FFM. However, the association with leg FFM was not significant (right leg IVW = Beta: 0.03, p = 0.238; left leg IVW = Beta: 0.039, p = 0.100). The likelihood of heterogeneity and pleiotropy was determined to be low (statistically non-significant), and the observed associations were not driven by single SNPs. Furthermore, MR pleiotropy residual sum and outlier test did not highlight any outliers.

CONCLUSIONS

Our results illustrate the potentially causal, positive effect of serum 25(OH)D concentration on total, trunk and upper body appendicular fat-free mass.

Longer sleep duration may negatively affect renal function

Background

Observational studies evaluating the link between sleep duration and kidney function reported controversial results. In the present study, Mendelian Randomization (MR) analysis was applied to obtain unconfounded estimates of the casual association of genetically determined sleep duration with estimated glomerular filtration rate (eGFR) and the risk of chronic kidney disease (CKD).

Methods

Data from the largest genome-wide association studies (GWAS) on self-reported and accelerometer derived sleep duration, eGFR and CKD were analysed in total, as well as separately in diabetic and non-diabetic individuals. Inverse variance weighted method (IVW), weighted median (WM)-based method, MR-Egger, as well as MR-Pleiotropy RESidual Sum and Outlier (PRESSO) were applied. To rule out the impact of single single-nucleotide polymorphism (SNP), the leave-one-out method was used.

Results

Overall, individuals with genetically longer self-reported sleep duration had a higher CKD risk (IVW: beta=0.358, p=0.047). Furthermore, in non-diabetics, longer self-reported sleep duration was negatively associated eGFR (IVW: beta=−0.024, p=0.020). Similarly, accelerometer derived sleep duration was negatively related to eGFR in the total population (IVW: beta=−0.019, p=0.047) and the non-diabetic individuals (IVW: beta=−0.025, p=0.014) (Table). No significant association was found between self-reported sleep duration and eGFR in the whole population (IVW: beta=−0.019, p=0.072) and T2DM patients (IVW: beta=0.028, p=0.484). None of the estimated associations was subjected to a significant level of heterogeneity. Furthermore, MR-PRESSO analysis did not show any chance of outliers for all estimates. The pleiotropy test, with very negligible intercept and insignificant p value. The results of the MR-RAPS were identical with the IVW estimates, highlighting again no possibility of pleiotropy. The leave-one-out method demonstrated that the links were not driven by single SNPs.

Conclusions

For the first time, the present study shed a light on the potential harmful effects of longer sleep duration (measured both objectively and subjectively) on kidney function. This finding was observed in the total population and in non-diabetic individuals, but not in those with diabetes. Further research is needed to elucidate the links between sleep duration, eGFR and CKD.

Funding Acknowledgement

Type of funding source: None

Omega-6 fatty acids and risk of cardiovascular disease: insight from systematic review and meta-analysis of randomized controlled trials and a mendelian randomization study

Background

Omega-6 polyunsaturated fatty acids (PUFAs) represent almost 15% of the total energy intake in the Western countries. Their effects on several cardiovascular (CV) risk factors are still controversial.

Purpose

We performed a systematic review and meta-analysis of randomized control trials (RCTs) as well as a Mendelian randomization (MR) analysis to evaluate the links (or possible causality) between supplementation or serum levels of omega-6 PUFA, CV disease (CVD) and cardiometabolic risk factors.

Methods

Selected databases were searched until 31 August 2019 to identify prospective studies investigating the effects of omega-6 PUFAs supplementation on CVD events/mortality. Random-effects model meta-analysis was performed for quantitative data synthesis. Trial sequential analysis (TSA) was used to evaluate the optimal sample size to detect a 20% reduction in outcomes after administration of omega-6 PUFAs. Inverse variance weighted method (IVW), weighted median-based method, MR-Egger and MR-Pleiotropy RESidual Sum and Outlier (PRESSO) were applied for MR.

Results

In the meta-analysis of 9 studies with 4,433 participants we showed that omega-6 PUFAs supplementation was not associated with CVD event risk - RR 0.94 (95% CI: 0.77–1.15, heterogeneity p=0.031; I2=66.2%, n=4 studies). The pooled estimate (RR) of the effect of omega-6 PUFAs supplementation on CVD death was 1.06 (95% C:I 0.73–1.55, heterogeneity p=0.011; I2=66.2%, n=6 studies), on CHD events 0.84 (95% CI: 0.61–1.16, heterogeneity p=0.001; I2=79.4%), on MI 0.87 (95% CI: 0.74–1.01, heterogeneity p=0.381; I2=2.3%) (Figure), and on stroke 1.36 (95% CI: 0.45–4.07, heterogeneity p=0.082; I2=55.3%). In MR analysis we showed that individuals with genetically higher serum adrenic acid (AA; 22:4, n-6) levels had a greater risk of CHD events (IVW=Beta: 0.526, p=0.007), MI (IVW=Beta: 0.606, p=0.017) and stroke (IVW=Beta: 1.694, p=0.009), as well as higher levels of FBG (IVW=Beta: 0.417, p=1.0x10–3), LDL-C (IVW=Beta: 0.806, p=4.9x10–5), HDL-C (IVW=Beta: −0.820, p=4.3x10–17), whereas lower levels of TG (IVW=Beta: −1.064, p=1.2x10–12) and TC (IVW=Beta: −1.064, p=1.2x10–12).

Conclusions

In the pooled analysis different omega-6 PUFAs supplementation did not affect the risk of MI, stroke and CHD event/mortality or the serum concentration of cardiometabolic parameters (data not presented), however in MR analysis, higher AA levels significantly associated with the risk of CHD, MI and stroke, as well as with elevated levels of FBG, LDL-C and HDL-C and reduced levels of TC and TG. There is probably lack of class effect for omega-6 PUFAs, therefore further studies are needed to assess the effects of omega-6 PUFAs on cardiometabolic outcomes.

Funding Acknowledgement

Type of funding source: None

Adiposity mediates the association between bilirubin, glucose/insulin homeostasis and inflammation

Background and purpose

The exact contribution of adiposity on the link between bilirubin and glucose/insulin homeostasis and inflammatory factors has not been defined. We aimed to quantify the role of adiposity on this association.

Methods

The variables of interest were extracted from the National Health and Nutrition Examination Survey (NHANES 2005–2010). We assessed the role of body mass index (BMI) as an adiposity factor. Analysis of co-variance and causal mediation analysis were conducted based on survey design and sample weights.

Results

Overall, 10,880 men and 11,462 women were included in the present analysis (mean age=47.2 years). Mean circulating bilirubin for the overall population, men and women was 0.74±0.02, 0.83±0.03 and 0.65±0.03 mg/dl, respectively (p&lt;0.001, for the comparison between sexes). In an adjusted model, glucose/insulin homeostasis and inflammatory factors were more favorable for participants with a higher level of bilirubin in both sexes (p&lt;0.001 for all). The extent of the mediation was maximal between the homeostatic model assessment of insulin resistance and bilirubin (men: 45%, women: 58%). In post-menopausal women, 47 and 13% of the changes in insulin and triglyceride-glucose index in response to bilirubin levels could be explained by alterations in BMI. In smokers, BMI could mediate 53% of the association between bilirubin and insulin (p&lt;0.001). Similar results were obtained when participants with normal liver function were analyzed separately (see Figure).

Conclusions

Using advanced statistical techniques we analyzed the complex link of bilirubin with inflammation and glucose/insulin homeostasis and identified a role for adiposity. We also suggest that bilirubin has an anti-inflammatory role.

Funding Acknowledgement

Type of funding source: None

P705Step by step diagnosis and management of statin intolerance: position paper from an international lipid expert panel

Background

Statin intolerance is a clinical syndrome whereby adverse effects associated with statin therapy (most commonly muscle symptoms) result in the discontinuation of therapy. Statin discontinuation is associated with increased risk of adverse cardiac outcomes. Many patients who initially experience adverse effects are able to tolerate statin therapy to some extent. Careful stepwise diagnosis and management of individuals who experience adverse effects is essential to enable optimal reduction of cardiovascular risk.

Purpose

In this Position Paper of the International Lipid Expert Panel (ILEP), we present a step by step approach to the diagnosis and practical management of statin intolerance resulting from muscle symptoms, and other adverse effects with demonstrated statin causality.

Methods

Relevant clinical evidence and international clinical guidelines were discussed and assimilated by ILEP members. Consensus was used to formulate recommendations for the diagnosis and management of statin intolerance.

Results

Consensus resulted in the adoption of three parts to the recommendation. 1) diagnosis of Statin Intolerance; 2) advice for management of all patients with statin intolerance; 3) specific advice for patients who have partial (rather than complete) statin intolerance. Patients with partial statin intolerance are likely to make up the vast majority (even 95%) of statin-intolerant individuals. Each part of the recommendation consists of a four-step process and has an associated acronym to aid memory (see attached recommendations). We adopted the Banach and Mikhailidis four-step approach to diagnosis and we developed novel recommendations for management.

Summary of the ILEP SI recommendations.

Conclusions

We present recommendations, which will enable clinicians to distinguish between rare, severe adverse effects; true statin intolerance, and symptoms incorrectly attributed to statin therapy. In each case we summarize guidelines, clinical evidence and expert opinion pertaining to the optimal management of cardiovascular disease in these patients.

Acknowledgement/Funding

None

2154Apolipoprotein B/apolipoprotein A-I ratio is comparable with C-reactive protein in predicting cancer mortality: results from two multi-ethnic US populations

Background

There is a lack of evidence regarding the link between apolipoproteins and cancer mortality.

Purpose

By using two nationally representative samples of US adults, we prospectively evaluated the associations between apolipoprotein B (apoB) levels and apoB/apolipoprotein A-I (apoA-I) ratio with cancer mortality. We also examined the role of C-reactive protein (CRP) in these associations.

Method

Adults aged ≥20 years, enrolled in the Third National Health and Nutrition Examination Survey (NHANES-III, 1988–1994) and continuous NHANES (2005–2010), and followed up to December 31st 2011, were included in the present analysis. Multiple Cox regressionswere applied to evaluate the associations between the variables of interest and cancer mortality.

Results

Overall, 7,695 participants were included (mean age: 49.2 years; 50.4% men, median follow-up: 19.1 years). In the fully adjusted (for age, gender, race, poverty to income ratio, educational status, body mass index, alcohol and dietary intake, smoking, dyslipidemia, hypertension and diabetes) model, participants in the highest quartile (Q4) of apoB/apoA-I had a significantly greater risk for cancer mortality [hazard ratio (HR): 1.40, 95% confidence interval (CI): 1.25–1.93] compared with those in the first quartile (Q1) (Figure). In the same model, a positive and significant association between apoB levels and fatal cancer was observed for individuals in the Q3 (HR: 1.12, 95% CI: 1.09–1.16) and Q4 (HR: 1.17, 95% CI: 1.09–1.25) compared with those in the Q1. When CRP levels were added in the analysis, the apoB/apoA-I ratio, but not apoB levels, remained significantly related to cancer mortality (Q4= HR: 1.17, 95% CI 1.09–1.25). In contrast, CRP levels were not able to predict cancer death after correction for apoB/apoA-I ratio.

Cancer death and quartiles of ApoB/ApoA1

Conclusions

In a large representative sample of the US adult population, the apoB/apoA-I ratio and apoB levels significantly predicted cancer mortality, independently of several cardiometabolic risk factors. The predictive value of apoB/apoA-I, but not apoB levels, remained significant after taking into account CRP, whereas CRP was not associated with cancer mortality after adjustment for apoB/apoA-I ratio. If further evidence supports our findings, apoA-I and apoB measurements could be considered in general health-care policies.

Acknowledgement/Funding

None

1446A greater healthy behaviors score is associated with a lower risk of all-cause and cause specific mortality: insight from two prospective multi-ethnic surveys

Background

Mortality from non-communicable diseases (NCDs) is influenced bymodifiable risk factors. Simple tools which do not require laboratory tests, (blood pressure (BP) [B], exercise [E], weight [W], alimentation [A] (fruit and vegetable consumption), and tobacco [T] (BEWAT) may estimate the risk of all-cause and cause specific mortality.

Purpose

Therefore, we evaluated the link between BEWAT and mortality in a randomly selected sample of the US population.

Method

Adults aged ≥20 years, enrolled in the Third National Health and Nutrition Examination Survey (NHANES-III, 1988–1994) and continuous NHANES (2005–2010), and followed up to December 31st 2011, were included in the present analysis. Multiple Cox regressionswere applied to evaluate the associations between the total BEWAT score and each of its components with all-cause and cause specific mortality.

Results

Overall, 22,968 participants (47.1% men) were included in the present analysis (mean age: 47.4 years). Individuals in the highest BEWAT tertile (T3) had a 25% lower risk of mortality compared with T1 [hazard ratio (HR): 0.75, 95% confidence interval (CI): 0.71–0.79], further corrections slightly diluted the magnitude of link to 22% (HR: 0.78, 95% CI: 0.75–0.81) (Figure). In a fully adjusted model, individuals in T3 also had a 26% lower risk of cardiovascular disease (CVD) mortality compared with those in T1 (HR: 0.74, 95% CI: 0.64–0.83), similar trends were observed across the BEWAT tertiles for cancer mortality risk (participants in T3 had a 31 and 26% lower risk for cancer death in Models 1 and 2, respectively). For sensitivity analyses after excluding smoking from the total BEWAT score, in the fully adjusted model the association between the BEWAT score and cancer death was attenuated but remained significant (HR: 0.80, 95% CI: 0.72–0.89 for T3 vs T1). Furthermore, total BEWAT score (without the BP component) could still predict CVD mortality (T3= HR: 0.71, 95% CI: 0.61–0.82).

All-cause death and BEWAT tertiles.

Conclusion

A higher BEWAT status is beneficial regarding all-cause and cause specific mortality. Our results highlight the value of modifiable risk factors as a simple and affordable variable for evaluating the risk of mortality.

P6229Potato consumption is associated with total and cause-specific mortality: a population-based cohort study and pooling of prospective studies with 73,717 participants

Background

The long-term effect of potato consumption on mortality and cardiometabolic risk factors is still largely unknown.

Purpose

Using the National Health and Nutrition Examination Surveys (NHANES) 1999–2010, we evaluated the long-term impact of potato intake on total and cause-specific (cardiovascular disease [CVD],cerebrovascular disease and cancer] mortality, and the results were next validated in the systematic review and meta-analysis of cohort studies investigating pooled associations of potato consumption with all-cause and cause-specific death.

Methods

Vital status through December 31, 2011 was ascertained. Cox proportional hazards were applied to determine the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of mortality for each quartile of the potato intake, with the lowest quartile (Q1 – with the lowest intake) used as reference. We used adjusted Cox regression to determine the risk ratio (RR) and 95% CI, as well as random effects models and generic inverse variance methods to synthesize quantitative and pooled data, followed by a leave-one-out method for sensitivity analysis.

Results

Among the 24,856 participants included, 3433 deaths occurred during the mean follow-up of 6.4 years. In multivariate adjusted Cox models, total (42%), CVD (65%), cerebrovascular (26%) and cancer (52%) mortality risk was greater in individuals with higher potato consumption than those with the lowest intake (p<0.001 for all comparisons). However this link disappeared after adjustment for confounding factors (see Table below). Results from pooling current prospective studies with 73,717 participants revealed a non-significant association between total (RR: 1.25, 0.98–1.60, p=0.066), CVD (RR: 0.99, 0.90–1.08, p=0.845) and stroke mortality (RR: 0.94, 0.85–1.03, p=0.214) with potato consumption. Individuals with a higher potato intake had a less favorable profile of cardiometabolic factors, including greater WC (97.2 vs. 99.5 cm, p<0.001) and a less favorable profile of systolic and diastolic blood pressure, levels of triglycerides (TGs), high-density lipoprotein-cholesterol (HDL-C) and TG/HDL-C ratio (p<0.001 for all comparisons).

HRs for mortality across potato intake.

Conclusions

Our results highlighted the neutral effect of potato intake on long-term mortalities; whereas potato consumption was adversely related to cardiometabolic risk factors. These findings should be taken into consideration for public health strategies, establishing the position for potatoes in the food pyramid.

Acknowledgement/Funding

None

P5313The association between coffee and caffeine consumption and renal function: insight from individual-level data, Mendelian randomization, and meta-analysis

Background

The reported relationship between coffee intake and renal function is poorly understood.

Purpose

By applying on two-sample Mendelian randomization (MR) and systematic review and meta-analysis we investigated the association between caffeine and coffee intake with prevalent CKD and markers of renal function.

Methods

For the individual data analysis we analysed the NHANES data on renal function markers and caffeine intake. MR was implemented by using summary-level data from genome-wide association studies conducted on coffee intake (N=91,462) and kidney function (N=133,413). Inverse variance weighted method (IVW), weighted median-based method, MR-Egger, MR-RAPS, MR-PRESSO were applied. Random effects models and generic inverse variance methods were used for the meta-analysis.

Results

Finally, we included the data of 18,436 participants, 6.9% had prevalent CKD (based on eGFR). Caffeine intake for general population was 131.1±1.1 mg. The % of pts. with CKD, by caffeine quartile was 16.6% in Q1 (lowest), 13.9% in Q2, 12.2% in Q3 and 11.0% in Q4 (p<0.001). After adjustment, for increasing quartiles for caffeine consumption, mean urine albumin, albumin-creatinine ratio and eGFR did not change significantly (p>0.234). In fully adjusted logistic regression models, there was no significant difference in chances of CKD prevalence (p-trend=0.745) (Table). In the same line, results of MR showed no impact of coffee intake on CKD (IVW=β: −0.0191, SE: 0.069, p=0.781) (Figure), on eGFR (overall= IVW= β: −0.0005, SE: 0.005, p=0.926) both in diabetic (IVW= β: −0.006, SE: 0.009, p=0.478), and non-diabetic patients (IVW= β: −6.772, SE: 0.006, p=0.991). Results from the meta-analysis indicted that coffee consumption was not significantly associated with CKD (OR: 0.85, 95% CI 0.71–1.02, p=0.090, n=6 studies, I2=0.32). These findings were robust in sensitivity analyses.

Levels of CKD markers across caffeine Qs Characteristics Quartiles of Caffeine p-value First Second Third Fourth Number of participants (n) 4609 4611 4608 4608 Log Urine Albumin (mg/L) 2.20±0.02 2.16±0.02 2.19±0.02 2.17±0.02 0.239 Serum Creatinine (mg/dL) 0.89±0.003 0.90±0.004 0.91±0.002 0.88±0.003 0.234 Log ACR (mg/g) 2.14±0.02 2.10±0.02 2.11±0.02 2.16±0.02 0.352 eGFR (ml/min/1.73m2) 91.2±0.7 92.8±0.4 90.2±0.5 89.6±0.3 0.415

MR on the impact of coffee intake on CKD

Conclusions

By implementing on different strategies we have highlighted no significant association between coffee consumption with renal function and chance of CKD.

Acknowledgement/Funding

None

45Association of types of dietary fats and all-cause and cause-specific mortality: a prospective cohort study and meta-analysis of prospective studies with 1,148,117 participants

Background

The associations between dietary fats with mortality are poorly delineated.

Purpose

Using a large prospective cohort we evaluated the link between total fat, mono-unsaturated (MUFA), polyunsaturated (PUFA) and saturated fatty acid (SFA) consumption and all-cause, coronary heart disease (CHD), stroke, and diabetes (T2D)-associated mortality in a representative sample of US adults. We then added our results to a systematic review and meta-analysis.

Methods

We evaluated 35,080 participants from the National Health and Nutrition Examination Surveys (NHANES) 1988–1999 (19.2 years follow-up) and 1999–2010 (12 years follow-up), with vital status available through December 31, 2011. Cox proportional hazard regression models were used to evaluate the association between baseline quartiles of fat consumption (g/day, 24h recall) and all-cause or cause-specific mortality. For the systematic review, selected databases were searched up to November 2018 and 29 prospective cohorts (n=1,148,117) met inclusion criteria. The DerSimonian-Laird method and generic inverse variance methods were used for random effects meta-analyses.

Results

In fully adjusted models from our prospective study, there was a negative association between total fat (hazard ratio [HR]:0.90, 95% confidence interval [CI]: 0.82, 0.99, Q4 vs. Q1) and PUFA (0.81,95% CI: 0.78–0.84) consumption and all-cause mortality (Figure), whereas SFA were positively associated with mortality (1.08, 95% CI: 1.04–1.11). In the meta-analysis we found a significant negative association between total fat (HR: 0.89, 95% CI: 0.82–0.97, I2:27%), MUFA (0.93, 95% CI: 0.87–0.99, I2:56%) and PUFA (0.86, 95% CI: 0.80–0.93, I2:63%) consumption and all-cause mortality. No significant association was observed between total fat and both CVD and CHD mortality (0.92, 95% CI: 0.79–1.08, I2:46%, and 1.03, 95% CI: 0.99–1.09, I2:42%, respectively), while a positive association between SFA intake and CHD mortality (1.10, 95% CI: 1.01–1.20, I2:52.6%) was observed. Neither MUFA nor PUFA were associated with CVD and CHD mortality. Inverse associations were observed between MUFA (0.80, 95% CI: 0.67–0.96, I2:0%) and PUFA (0.84, 95% CI: 0.80–0.90, I2:0%) intakes and stroke mortality.

All-cause death and total fat intake.

Conclusions

Our results highlight differential associations of total fat, MUFA and PUFA intake with all-cause mortality, but no association of them with CVD and CHD mortalities. SFA intake was significantly associated with higher all-cause mortality inNHANES and with CHD mortality in our meta-analysis. The type of fat intake appears to be associated with important health outcomes.

Acknowledgement/Funding

None

The effect of electro-acupuncture on pro-oxidant antioxidant balance values in overweight and obese subjects: a randomized controlled trial study

Objective To undertake a randomized controlled trial in 196 obese subjects to examine the effect of electro-acupuncture on serum pro-oxidant antioxidant balance (PAB) values. Methods Subjects received authentic acupuncture (cases) or sham acupuncture (controls) for 6 weeks in combination with a low-calorie diet. In the following 6 weeks, they received the low-calorie diet alone. Serum PAB was measured at baseline, and 6 and 12 weeks later. Results We found that serum PAB values decreased significantly in the group receiving the authentic acupuncture compared to the sham treatment (p<0.001) at week 6, and whilst serum PAB increased significantly (p<0.05) in the second phase of the study, a significant difference between two groups remained at 12 weeks (p<0.05). Conclusions Electro-acupuncture in combination with a low-calorie diet was more effective at reducing serum PAB values in obese subjects compared to diet alone. Further work is required to determine the mechanism by which electro-acupuncture has this effect.

Link of dietary patterns with metabolic syndrome: analysis of the National Health and Nutrition Examination Survey

BACKGROUND

Population-based interventions aimed at halting the increasing prevalence of metabolic syndrome (MetS) require thorough understanding of dietary interplays. Objective is to identify the independent dietary nutrients associated with MetS and its components using dietary pattern identification and the single-nutrient approaches in The United States.

METHODS

This is a cross-sectional observation. Participants are selected from the National Health and Nutrition Examination Survey (NHANES) with available dietary intake, biochemical and anthropometrical data from 2001 to 2012. Exposure is diet obtained from 24-h dietary recall. Main outcome measure is MetS and its components.

RESULTS

Overall, 23 157 eligible individuals including 6561 with MetS were included in the final analysis. Using principle component analysis, we identified three food patterns that explained 50.8% of the variance of the dietary nutrient consumption. The highest quartile of the factor score representative of saturated/monounsaturated fatty acids or the first dietary pattern was associated with 1.27-fold (95% confidence interval (CI): 1.10-1.46, P=0.001) higher odds of association with MetS when compared with the first quartile. The second pattern representative of vitamins and trace elements had an odds ratio of 0.79 (95% CI: 0.70-0.89, P<0.001) for association with MetS, and the third pattern representative of polyunsaturated fatty acids did not have any association with MetS. The nutrient-by-nutrient approach showed that mild alcohol intake and lower consumption of total saturated fatty acids and sodium were associated with lower risk of MetS.

CONCLUSIONS

Application of multiple complementary analytic approaches reveals more comprehensive dietary determinants of MetS and its components as potential intervening targets.

Calories or protein? The effect of dietary restriction on lifespan in rodents is explained by calories alone

Almost exactly 100years ago Osborne and colleagues demonstrated that restricting the food intake of a small number of female rats extended their lifespan. In the 1930s experiments on the impact of diet on lifespan were extended by Slonaker, and subsequently McCay. Slonaker concluded that there was a strong impact of protein intake on lifespan, while McCay concluded that calories are the main factor causing differences in lifespan when animals are restricted (Calorie restriction or CR). Hence from the very beginning the question of whether food restriction acts on lifespan via reduced calorie intake or reduced protein intake was disputed. Subsequent work supported the idea that calories were the dominant factor. More recently, however, this role has again been questioned, particularly in studies of insects. Here we review the data regarding previous studies of protein and calorie restriction in rodents. We show that increasing CR (with simultaneous protein restriction: PR) increases lifespan, and that CR with no PR generates an identical effect. None of the residual variation in the impact of CR (with PR) on lifespan could be traced to variation in macronutrient content of the diet. Other studies show that low protein content in the diet does increase median lifespan, but the effect is smaller than the CR effect. We conclude that CR is a valid phenomenon in rodents that cannot be explained by changes in protein intake, but that there is a separate phenomenon linking protein intake to lifespan, which acts over a different range of protein intakes than is typical in CR studies. This suggests there may be a fundamental difference in the responses of insects and rodents to CR. This may be traced to differences in the physiology of these groups, or reflect a major methodological difference between 'restriction' studies performed on rodents and insects. We suggest that studies where the diet is supplied ad libitum, but diluted with inert components, should perhaps be called dietary or caloric dilution, rather than dietary or caloric restriction, to distinguish these potentially important methodological differences.

Development of a radioscandium immunoconjugate for radioimmunotherapy

Developing monoclonal antibodies labeled with beta-emitters has led to the introduction of important agents in radioimmunotherapy. In this work, Sc-46 chloride was obtained by thermal neutron activation flux of natural metallic scandium sample followed by dissolution in acidic media (radionuclidic purity via beta and gamma ray spectroscopy, 99.9% ; radiochemical purity via ITLC, >99%) and used in radiolabeling of rituximab after conjugation with DOTA-NHS-ester. The specific activity was however not high. The conjugates were purified by molecular filtration and used in the radiolabeling. The radiochemical purity (ITLC), stability studies (ITLC and size exclusion chromatography), determination of average number of DOTA conjugated per mAb (chelate: antibody ratio, 5.8:1) and gel electrophoresis of [ 46Sc]Sc-DOTA-anti-CD20 were determined followed by biodistribution studies for 46Sc and [ 46Sc]Sc-DOTA-anti-CD20 i n wild type rats up to 72 h. The binding of the radiolabeled antibody was showed to be 60% on Raji cells. The final compound was stable in presence of PBS at 37 ºC and room temperature. The accumulation of the radiolabeled antibody in liver, spleen, kidney, heart and other tissues demonstrates a pattern similar to the other radiolabeled anti-CD20 immunoconjugates. The present study shows the possibility of antibody labeling for future use in radioimmunotherapy by 47Sc.

A new radiopharmaceutical compound (131I-PR81) for radioimmunotherapy of breast cancer: labeling of antibody and its quality control

PR81 is a monoclonal antibody that binds with high affinity to MUC1, which is over expressed on breast and other tumors. The objective of this study was to evaluate the application of this antibody against MUC1 as a radioimmunotherapeutical agent. Monoclonal antibody (PR81) against MUC1 was prepared, characterized, purified, and labeled with 131I. The immunoreactivity of radiolabeled mAb PR81with MUC1 (the native protein), BSA-P20 (a 20 amino acid corresponding the tandem repeat of MUC1) and MCF7 cell line were performed by RIA. In vitro stability of radiolabeled mAb in human serum was determined by thin layer chromatography (TLC). Cell toxicity and in vitro internalization studies were performed with the MCF7 cell line, and the tissue biodistribution of the radioiodinated PR81 was evaluated in normal BALB/c mice at 4, 24 and 48 hrs. The tumor imaging was performed in BALB/c mice with breast xenograft tumors at 24 and 72 hr after the complex injection. The labeling efficiency was found to be 59.9% ± 7.9%. MAb-131I conjugates showed high immunoreactivity towards MUC1 protein, BSA-P20 and MCF7 cell line. In vitro stability of the labeled product in human serum was found to be more than %50 over 24 hr. Cell toxicity and in vitro internalization studies showed that the mAb-131I conjugate inhibited 80% growth of the MCF7 cultured cell lines in vitro in a high concentration and up to %60 of the conjugate internalized after 24 h. Biodistribution studies were performed in normal BALB/c mice at 4, 24 and 48 hrs post-injection and no important accumulation was observed in vital organs. The tumors were visualized with high sensitivity after 24 and 72 hr in radioimmunoscintographical studies. These results show that the new radiopharmaceutical may be considered as a promising candidate for therapy of breast cancer.