Bone Remodelling, Vitamin D Status, and Lifestyle Factors in Spanish Vegans, Lacto-Ovo Vegetarians, and Omnivores

Sustainable healthy diets are promoted, and consequently vegetarian diets are currently increasing. However, scientific information on their effects on bone health is scarce. A cross-sectional study was performed in adults (66% women) classified into three groups: omnivores (n = 93), lacto-ovo vegetarians (n = 96), and vegans (n = 112). Nutrient intake, body composition, physical activity, vitamin D status (25-hydroxycholecalciferol, 25-OHD), parathormone (PTH), and bone formation (bone alkaline phosphatase, BAP) and resorption (N-telopeptides of type I collagen, NTx) markers were determined. Lacto-ovo vegetarians and especially vegans showed lower protein, fat, calcium, phosphorous, vitamin D, retinol, iodine, and zinc intakes, and higher carbohydrate, fibre, carotenes, magnesium, and vitamin K intakes compared to omnivores. Body composition was similar in the three groups that performed vigorous physical activity regularly. Body bone mass and muscle mass were positively correlated with BAP, and time performing physical activity with 25-OHD. The prevalence of vitamin D deficiency or insufficiency (25-OHD < 75 nmol/L) was 93.7% in the studied population, and vitamin D deficiency (25-OHD < 25 nmol/L) was significantly higher in vegans. Vegetarians of both groups had increased PTH and NTx with vegans showing significantly higher PTH and NTx than omnivores. Conclusion: Adult vegetarians, especially vegans, should reduce the risk of bone loss by appropriate diet planning and vitamin D supplementation.

A microalgae docosahexaenoic acid supplement does not modify the influence of sex and diet on iron status in Spanish vegetarians or omnivores: A randomized placebo-controlled crossover study

OBJECTIVE

Plant-based diets are accepted as healthy, provided that are well-planned and include supplements. In this context, iron deficiency is a threat, and data from Spanish vegetarians are scarce. The aim of this study was to determine if a microalgae ω-3 supplement rich in docosahexaenoic acid (DHA) affected iron status in this population.

METHODS

Iron biomarkers and nutrient intake (72-h dietary records) were analyzed in 204 usual consumers of lacto-ovo vegetarian (LOV), vegan (VEG), or omnivorous (OMN) diets. A randomized double-blind, placebo-controlled crossover trial was performed in a subgroup (n = 98) to test if a microalgae DHA supplement (250 mg/d for 5 wk) changed iron status.

RESULTS

Iron intake was higher in vegetarians than omnivores (P= 0.002), fiber intake was highest in vegans followed by lacto-ovo vegetarians and omnivores, whereas calcium intake was lower in vegans than both lacto-ovo vegetarians and omnivores (all P < 0.001). Women, regardless of diet type, showed lower iron status than men. Erythrocytes, hemoglobin, hematocrit, and serum ferritin were lower in lacto-ovo vegetarians and vegans than omnivores. The prevalence of iron deficiency anemia was low (<10%), but iron depletion (ferritin <15 ng/mL) was higher in lacto-ovo vegetarians than omnivores (P = 0.003). Iron biomarkers were similar in lacto-ovo vegetarians and vegans. The DHA supplementation did not change iron status compared with placebo.

CONCLUSIONS

Spanish vegetarians had lower iron status than omnivores. Consumption of eggs and dairy products increased the risk for iron deficiency, but a microalgae DHA supplement had no effect. Dietary strategies to increase iron bioavailability in vegetarians, particularly in lacto-ovo vegetarians and women, are recommended.

Metabolic and nutritional biomarkers in adults consuming lacto-ovo vegetarian, vegan and omnivorous diets in Spain. A cross-sectional study

Knowledge on the characteristics of consumers who choose plant-based diets and the relationship with nutritional status and disease risk is needed. In the present study, 207 Spanish adults participated in a cross-sectional study, and were classified in three groups: lacto-ovo vegetarian (LOV), vegan (VEG), and omnivore (OMN). Dietary intake, anthropometry, body composition, haematology, and metabolic markers were evaluated. Body composition and body weight did not vary among groups. The majority of these adults performed moderate-vigorous physical activity, and LOV performed more moderate activity than OMN. Total energy intake (En) was similar in the three groups. However, cholesterol and fat intakes (%En) were higher in the order OMN, LOV, VEG, fibre and carbohydrate intakes showed the opposite trend, and protein intake (%En) was higher in OMN than both LOV and VEG (all p < 0.001). Systolic blood pressure (p = 0.04), erythrocytes (p < 0.001), and haematocrit (p < 0.001) were lower in LOV and VEG than OMN, and lymphocyte count was lower in LOV than OMN (p < 0.01). There were marked differences between groups in serum total-cholesterol and LDL-cholesterol that were lower in LOV and VEG than OMN (both p < 0.001). However, glucose, insulin and insulin resistance did not show group differences. Leptin and adiponectin were related with gender and body fat but not with diet. The inflammation marker interleukin-1β was lower in LOV than OMN but TNF-α did not show differences. All levels were within normal ranges. Conclusion: consumption of plant-based diets compared to omnivorous diets in combination with moderate-high physical activity appears to protect similarly from cardiometabolic diseases in Spanish adults.

Changes in fatty acid levels after consumption of a novel docosahexaenoic supplement from algae: a crossover randomized controlled trial in omnivorous, lacto-ovo vegetarians and vegans

Purpose

To determine serum fatty acids of lacto-ovo vegetarian (LOV), vegan (VEG) and omnivorous (OMN) adults, and to analyse the effects of consuming a docosahexaenoic acid (DHA) supplement of vegetable origin on fatty acid profile.

Methods

A randomized, double-blind, placebo-controlled crossover design was conducted in healthy adults. Volunteers (n = 116) were randomly assigned to a DHA-supplement (dose 250 mg/day), made from the microalgae Schizochytrium sp., or a placebo during 5-week periods separated by a 5-week washout interim period. Compliance and dietary intake were estimated and serum fatty acids were determined by gas chromatography. Results were analysed by mixed linear models.

Results

Percentage of linoleic acid (C18:2n6) in serum was the highest among the fatty acids in the three diet groups, followed by oleic (C18:1n9) and palmitic (C16:0) acids. Linoleic (C18:2n6) and alpha-linolenic (C18:3n3) acids were higher in VEG compared to OMN (p < 0.001), while in LOV, their levels were intermediate between the other groups. Women presented higher DHA (C22:6n3) than men (p < 0.001). The DHA-supplement increased serum DHA compared to placebo in the three diet groups (p < 0.001), and a higher increase was observed in VEG followed by LOV (p < 0.001). The ratio serum n-6/n-3 improved by the supplementation but remained higher in LOV and VEG than in OMN. In contrast, the DHA-supplement decreased docosapentaenoic (C22:5n3) and docosatetraenoic (C22:4n6) acids in all diet groups (p < 0.001) and increased the eicosapentaenoic to alpha-linolenic fatty acids ratio (p = 0.016).

Conclusion

The DHA-supplement at dose of 250 mg/day was effective in increasing serum DHA either in omnivorous, lacto-ovo vegetarian and vegan adults.

Clinical trial registration

Registered at Clinicaltrials.gov (www.clinicaltrials.gov), NCT04278482.

Acute supplementation with grapes in obese subjects did not affect postprandial metabolism: a randomized, double-blind, crossover clinical trial

PURPOSE

The aim of this study was to determine whether grape polyphenols have a "second-meal effect", modulating glucose and lipid elevations in the postprandial period after two successive meals in subjects with obesity.

METHODS

A randomized, double-blind, placebo-controlled, acute clinical trial was conducted. Twenty-five obese subjects (BMI =  ≥ 30 and < 40 kg/m2) were randomly divided into two groups. At an initial visit, blood was collected in a fasting state and the subjects received breakfast and 46 g of either grape powder (equivalent to 252 g fresh grapes) or placebo, both solved in water. Lunch was provided 5 h later and then blood was collected after 0, 30, 60, 120, 180, 240, 300, 330, 360, and 420 min since arrival. Two weeks later, at a second visit, the subjects received the other powder. The following were determined: glucose, insulin, triglycerides, uric acid, blood count, hemoglobin, viscosity, antioxidant capacity, and satiety perception.

RESULTS

Postprandial increases were observed as expected in, for example, glucose and triglycerides after breakfast and lunch. The grape powder supplementation did not cause any significant modification compared to placebo, in these parameters; nor did it significantly modify plasma antioxidant capacity in the 6 h postprandial period.

DISCUSSION

Single grape powder supplementation did not modify postprandial responses in obese subjects, probably because the polyphenol dose was insufficient to induce such an effect. The result of a combination of grape with other polyphenol-rich products or chronic supplementation with grape powder on postprandial responses remains to be elucidated.

TRIAL REGISTRATION NUMBER

www.clinicaltrials.gov , NCT03741218.

Diabesity negatively affects transferrin saturation and iron status. The DICARIVA study

AIMS

The relationship between iron status, obesity and type 2 diabetes mellitus (T2DM) has scarcely been tested. This study hypothesizes that patients with obesity and T2DM have altered iron metabolism.

METHODS

537 T2DM patients were selected from the cross-sectional DICARIVA study excluding patients with high-sensitivity-C-reactive-protein (hs-CRP) ≥  10 mg/L. Three groups according to body mass index (BMI) and waist perimeter (WP) were analysed: a) BMI < 30 kg/m², non-high WP (n = 105); b) BMI < 30 kg/m², high WP (n = 202); and c) diabesity, BMI ≥  30 kg/m², high WP (n = 230). Group differences on cardiometabolic and iron status markers were tested.

RESULTS

Women had significantly lower iron, ferritin, and transferrin saturation (TSAT) but higher transferrin and total iron binding capacity than men. Triglycerides/HDL-c ratio, as insulin-resistance (IR) marker, was higher in men while hs-CRP in women. TSAT was inversely related to BMI and hs-CRP. The diabesity group showed the highest hs-CRP (p < 0.001) and IR (p < 0.001) with the lowest TSAT (p = 0.003).

CONCLUSIONS

Low TSAT was highly prevalent in diabesity, mainly in women, suggesting that IR, inflammation, and abdominal adiposity alter iron transport and accumulation. The convenience of iron supplementation in diabesity patients with low TSAT should be urgently assessed, due the pro-oxidant effects of excess iron.

Foods for Plant-Based Diets: Challenges and Innovations

Plant-based diets have become popular as a means of reducing the environmental footprint of the diet and promoting human health and animal welfare. Although the percentages of vegetarians and vegans are low compared to omnivores, their numbers have increased significantly in the last years. The use of non-animal food products other than meat alternatives is also increasing and this tendency constitutes an opportunity for the food industry. In this review, we present that plant-based meat and milk alternatives are consolidated but that there is a niche for egg, seafood alternatives, and new products which may not resemble any traditional animal food. However, not all animal food substitutes are sustainable and some of them are even ultra-processed. In addition, there are concerns on safety and labeling, and consumers demand clear information and regulation. The challenges in this field are connected with food design and technology, sensory science, nutrition, and dietetics. Moreover, adequate selection and combination of foods is important in order to achieve consumer acceptance while preventing nutritional deficiencies in those who choose this type of diet.

Relationship between iron status markers and insulin resistance: an exploratory study in subjects with excess body weight

Background

Controversy exists on the relationship between iron metabolism and cardiometabolic risk. The aim of this study was to determine if there is a link between dysmetabolic iron and cardiometabolic markers in subjects with excess body weight.

Methods

Cross-sectional study with fifty participants presenting overweight or obesity and at least another metabolic syndrome factor. Determinations: anthropometry, body composition, blood pressure, lipids, glucose, insulin, leptin, areas under the curve (AUC) for glucose and insulin after an oral glucose tolerance test, hs-C reactive protein (hs-CRP), blood count, ferritin, transferrin, transferrin saturation (TSAT), soluble transferrin receptor (sTfR). Gender-adjusted linear correlations and two independent samples t tests were used.

Results

Ferritin was positively correlated with insulin-AUC (r = 0.547, p = 0.008) and TSAT was negatively correlated with waist-hip ratio (r =  − 0.385, p = 0.008), insulin (r =  − 0.551, p < 0.001), and insulin resistance (HOMA-IR, r =  − 0.586, p < 0.001). Subjects with TSAT ≤ 20% had higher insulin (p = 0.012) and HOMA-IR (p = 0.003) compared to those with TSAT > 20%. In conclusion, the observed results suggest that iron transport and storage are altered in subjects with overweight/obesity, at the same time that they exhibit the characteristic features of insulin resistance. Nevertheless, this occurs without iron overload or deficiency. These results should be validated in wider cohorts since they suggest that iron transport and storage should be assessed when performing the clinical evaluation of subjects with excess body weight.

Iron Deficiency in Menstruating Adult Women: Much More than Anemia

Background: Iron deficiency anemia (IDA) is highly prevalent in women of child-bearing age. However, their nonhematological symptoms have been overlooked. This study aims to analyze the nonhematological features and symptoms of IDA in a group of women of reproductive age and the changes occurred during iron therapy. Materials and Methods: IDA women underwent dietary, physical activity, menstrual blood loss, and cognitive function assessment at baseline. Hematological and biochemical parameters were analyzed. Executive attention was tested by the flanker task and working memory by the 2-back task. Oral iron therapy (ferrous sulfate) was given to 35 women for 8 weeks and the changes in iron status, biochemical markers, cognitive function, and nonhematological symptoms were evaluated. Results: Patients presented nonhematological symptoms: pica, 32.4%; cheilitis, 20.6%; restless legs syndrome (RLS), 20.6%; diffuse hair loss, 55.9%; and ungual alterations, 38.2%. Two or more symptoms were present in 58.8% of women. Serum iron and working memory were correlated at baseline. Multivariate analyses show associations (odds ratio [OR], 95% confidence interval [CI]) between pica and reaction time in the working memory test (OR 2.14, 95% CI 1.19-3.87, p = 0.012); RLS with total serum protein (OR 0.08, 95% CI 0.06-0.92, p = 0.043); and cheilitis with mean corpuscular hemoglobin (OR 0.388, 95% CI 0.189-0.799, p = 0.01). Pica, cheilitis, and RLS completely resolved with iron therapy, and ungual alterations and hair loss improved in 92.3% and 84.2% of women, respectively. Better performance in executive attention and working memory was observed after iron therapy. Conclusions: More attention should be given to the nonhematological manifestations of IDA to improve the quality of life of menstruating women.

Fatty Acid Profile and Cardiometabolic Markers in Relation with Diet Type and Omega-3 Supplementation in Spanish Vegetarians

Plant-based diets are becoming increasingly popular, and scientific information concerning the nutritional status in this population is needed. This study determined the fatty acid profile of Spanish lacto-ovo vegetarians (LO-vegetarians) and vegans. Participants were 104 healthy adults, LO-vegetarians (n = 49) and vegans (n = 55). Lifestyle habits and consumption of food and omega-3 supplements were estimated by questionnaires. BMI, blood pressure, and abdominal and body fat were determined. Serum was collected to analyze fatty acids, glucose, lipids, homocysteine, insulin, and leptin. Volunteers were classified according to serum omega-6 to omega-3 (n-6/n-3) ratio into three groups: n-6/n-3 < 10, n-6/n-3 ≥ 10 to 20, and n-6/n-3 > 20. Results showed low cardiovascular risk and high insulin sensitivity with negligible differences between diet types. Linoleic acid (C18:2n-6) was the major serum fatty acid, followed by oleic (C18:1n-9) and palmitic (C16:0) acids. In contrast, serum eicosapentaenoic acid (EPA, C20:5n-3) and docosahexaenoic acid (DHA, C22:6n-3) were (median, interquartile range) 0.27, 0.18% and 1.59, and 0.93%, respectively. Users of n-3 supplements (<10% of total vegetarians) had significantly higher EPA than non-users, while frequent consumption of flax-seeds was associated with increased α-linolenic acid (C18:3n-3). However, neither n-3 supplementation nor food consumption affected DHA levels in this vegetarian population.

A 6-week supplementation with grape pomace to subjects at cardiometabolic risk ameliorates insulin sensitivity, without affecting other metabolic syndrome markers

Grape polyphenols have shown a promising role in the modulation of metabolic syndrome (MetS), mostly in animal models. However, clinical studies are scarce and they usually only consider a fraction of polyphenols, ignoring the non-extractable polyphenols (high molecular weight compounds or associated with macromolecules such as dietary fibre). This study aimed at evaluating the effect of grape pomace, rich in both extractable and non-extractable polyphenols, on markers of MetS. Fifty subjects (22 women) aged 20-65 with at least two MetS factors were randomly assigned to the product (daily dose of 8 g of dried grape pomace) or to the control group in a 6 week crossover design with a 4 week wash-out. Samples were collected at the beginning and at the end of both periods; half of the participants were subjected to an oral glucose tolerance test at the beginning and the end of the supplementation period. Grape pomace supplementation significantly improved fasting insulinaemia (p < 0.01), without affecting other cardiometabolic risk parameters. A tendency towards an improvement in postprandial insulinaemia was observed, particularly in those subjects with higher fasting insulin levels. Therefore, supplementation with grape pomace may be a strategy for improving insulin sensitivity in subjects at high cardiometabolic risk.

Methylmalonic Acid Levels and their Relation with Cobalamin Supplementation in Spanish Vegetarians

Cobalamin deficiency represents a health issue for vegetarians, especially vegans, if supplements are not consumed. Vitamin B12 serum levels, traditionally used to assess the vitamin B12 status, can be normal under functional deficiency conditions. In this regard, methylmalonic acid (MMA) has proven to be a more specific marker to detect subclinical vitamin B12 deficiency. In this study, we present for the first time the cobalamin status of Spanish vegetarians using both vitamin B12 and MMA markers, and the effects of the plant-based diet and the intake of vitamin B12 supplements. Healthy adults were recruited (n = 103, 52% vegans). Dietary preferences and use of supplements were assessed by questionnaires and serum samples were collected and stored. Vitamin B12 was measured by chemiluminiscence and MMA by liquid chromatography tandem mass spectrometry (LC-MS/MS) using solid phase extraction for sample preparation. Obtained values, median (IQR), were: vitamin B12, 278.9 (160.2) pmol/l and MMA, 140.2 (78.9) nmol/l. No significant differences between lacto-ovo vegetarians and vegans were observed. Considering these two markers, 10% of the participants were mild vitamin B12 deficient. Supplementation (75% of the participants) was associated with higher vitamin B12 (p < 0.001) and lower MMA (p = 0.012). In conclusion, Spanish vegetarians have low risk of vitamin B12 deficiency due to vitamin B12 supplementation and the MMA determination is useful to detect mild deficiency.

Aldosterone changes after consumption of a sodium-bicarbonated mineral water in humans. A four-way randomized controlled trial

Abnormally high aldosterone levels are associated to hypertension and cardiovascular disease. A sodium-rich mineral water was previously shown to reduce several markers of cardiovascular risk and did not increase blood pressure in healthy adults. We aimed to study the effects of consuming the same mineral water compared to a control water on aldosterone levels, and if the effects vary due to the presence of meal in healthy adults. The design was a four-way randomized controlled crossover 120-min-postprandial trial. Twenty-one healthy men and women participated in the study. Exclusion criteria are diabetes, hypertension, and being a usual consumer of carbonic mineral water. Two different mineral waters, high-sodium and bicarbonate mineral water (BW, sodium, 1 g/L; bicarbonate, 2 g/L) and low-mineral content control water (CW), were consumed with or without a standard meal (500 mL per meal). Statistical analysis was performed by repeated measures ANOVA. The results are as follows: serum sodium did not vary, and serum potassium decreased throughout the assay (p = 0.01) without water influence. Consumption of BW significantly decreased aldosterone levels at 30 (p = 0.046), 60 (p = 0.009), and 120 (p = 0.025) min when consumed alone, and at 120 min (p = 0.019) when consumed with meal, compared to CW. Moreover, the effect of BW on aldosterone levels was significant in women but not in men. In conclusion, consumption of a sodium-bicarbonated mineral water, in presence or absence of meal, induces aldosterone inhibition in healthy women, which is suggested to be a physiological response that protects them against hypertension. This trial is registered at clinicaltrial.gov as NCT01334840.

An Intervention with Mineral Water Decreases Cardiometabolic Risk Biomarkers. A Crossover, Randomised, Controlled Trial with Two Mineral Waters in Moderately Hypercholesterolaemic Adults

Water intake is essential for health maintenance and disease prevention. The effects of an intervention with two mineral waters, sodium-bicarbonated mineral water (BW) or control mineral water low in mineral content (CW), on cardiometabolic risk biomarkers were studied. In a randomised-controlled crossover-trial, sixty-four moderately hypercholesterolaemic adults were randomly assigned to consume 1 L/day of either BW (sodium, 1 g/L; bicarbonate, 2 g/L) or CW with the main meals for eight weeks, separated by an eight-week washout period. Blood lipids, lipid oxidation, glucose, insulin, aldosterone, urine pH, urinary electrolytes, blood pressure, body weight, fluid intake, energy, and nutrients from total diet and beverages were determined. Total cholesterol, LDL cholesterol, and glucose decreased (p < 0.01), oxidised LDL tended to decrease (p = 0.073), and apolipoprotein B increased during the intervention, without water type effect. Energy and carbohydrates from beverages decreased since soft drinks and fruit juice consumptions decreased throughout the trial. BW increased urinary pH (p = 0.006) and reduced calcium/creatinine excretion (p = 0.011). Urinary potassium/creatinine decreased with both waters. Consumption of 1 L/day of mineral water with the main meals reduces cardiometabolic risk biomarkers, likely to be attributed to a replacement of soft drinks by water. In addition, BW does not affect blood pressure and exerts a moderate alkalizing effect in the body.

Effect of Vitamin D Supplementation on Blood Pressure: A Systematic Review and Meta-analysis Incorporating Individual Patient Data

IMPORTANCE

Low levels of vitamin D are associated with elevated blood pressure (BP) and future cardiovascular events. Whether vitamin D supplementation reduces BP and which patient characteristics predict a response remain unclear.

OBJECTIVE

To systematically review whether supplementation with vitamin D or its analogues reduce BP.

DATA SOURCES

We searched MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and http://www.ClinicalTrials.com augmented by a hand search of references from the included articles and previous reviews. Google was searched for gray literature (ie, material not published in recognized scientific journals). No language restrictions were applied. The search period spanned January 1, 1966, through March 31, 2014.

STUDY SELECTION

We included randomized placebo-controlled clinical trials that used vitamin D supplementation for a minimum of 4 weeks for any indication and reported BP data. Studies were included if they used active or inactive forms of vitamin D or vitamin D analogues. Cointerventions were permitted if identical in all treatment arms.

DATA EXTRACTION AND SYNTHESIS

We extracted data on baseline demographics, 25-hydroxyvitamin D levels, systolic and diastolic BP (SBP and DBP), and change in BP from baseline to the final follow-up. Individual patient data on age, sex, medication use, diabetes mellitus, baseline and follow-up BP, and 25-hydroxyvitamin D levels were requested from the authors of the included studies. For trial-level data, between-group differences in BP change were combined in a random-effects model. For individual patient data, between-group differences in BP at the final follow up, adjusted for baseline BP, were calculated before combining in a random-effects model.

MAIN OUTCOMES AND MEASURES

Difference in SBP and DBP measured in an office setting.

RESULTS

We included 46 trials (4541 participants) in the trial-level meta-analysis. Individual patient data were obtained for 27 trials (3092 participants). At the trial level, no effect of vitamin D supplementation was seen on SBP (effect size, 0.0 [95% CI, -0.8 to 0.8] mm Hg; P=.97; I2=21%) or DBP (effect size, -0.1 [95% CI, -0.6 to 0.5] mm Hg; P=.84; I2=20%). Similar results were found analyzing individual patient data for SBP (effect size, -0.5 [95% CI, -1.3 to 0.4] mm Hg; P=.27; I2=0%) and DBP (effect size, 0.2 [95% CI, -0.3 to 0.7] mm Hg; P=.38; I2=0%). Subgroup analysis did not reveal any baseline factor predictive of a better response to therapy.

CONCLUSIONS AND RELEVANCE

Vitamin D supplementation is ineffective as an agent for lowering BP and thus should not be used as an antihypertensive agent.

A simple and feasible questionnaire to estimate menstrual blood loss: relationship with hematological and gynecological parameters in young women

Background

Menstrual blood loss (MBL) has been shown to be an important determinant in iron status, work performance and well-being. Several methods have been developed to estimate MBL, the standard quantitative method however has limited application in clinical practice as it is expensive and requires women to collect, store and submit their sanitary products for analysis. We therefore aimed to develop a MBL-score based on a questionnaire, and to validate it by several hematological and biochemical parameters in women of childbearing age.

Methods

A total of 165 healthy young women were recruited. Hematological (hematocrit, hemoglobin, erythrocyte, leucocyte and platelet counts) and iron status (serum iron, serum ferritin, serum transferrin, and total iron binding capacity) parameters were analyzed at baseline. Women were asked to fulfill two gynecological questionnaires: a general questionnaire, to inform about the volunteer’s general menstrual characteristics; and a MBL questionnaire, to provide details of the duration of menstruation, number of heavy blood loss days, and number and type of pads and/or tampons used during the heaviest bleeding day, for all consecutive menstrual periods during 16 weeks. A MBL-score was calculated for each period and women, and its reliability determined by the Cronbach’s alpha coefficient. Pearson’s linear correlation tests were performed between blood parameters and the MBL-score. Two clusters were formed according the MBL-score (cluster 1: low MBL and cluster 2: high MBL).

Results

Significant higher MBL-score was observed in women who reported having a history of anemia (p = 0.015), staining the bed at night during menstruation (p < 0.001) and suffering inter-menstrual blood loss (p = 0.044), compared to those who did not. Women who used hormonal contraceptives presented lower MBL-scores than the others (p = 0.004). The MBL-score was negatively associated with log-ferritin (p = 0.006) and platelet count (p = 0.011). Women in cluster 1 presented higher ferritin (p = 0.043) than women in cluster 2.

Conclusions

We developed an easy and practical method for estimating menstrual blood loss based on a score calculated from a questionnaire in healthy women at childbearing age. The MBL-score is highly reliable and reflects menstrual blood loss validated by hematological and biochemical parameters.

Influence of diet, menstruation and genetic factors on iron status: a cross-sectional study in Spanish women of childbearing age

The aim of this study was to investigate the combined influence of diet, menstruation and genetic factors on iron status in Spanish menstruating women (n = 142). Dietary intake was assessed by a 72-h detailed dietary report and menstrual blood loss by a questionnaire, to determine a Menstrual Blood Loss Coefficient (MBLC). Five selected SNPs were genotyped: rs3811647, rs1799852 (Tf gene); rs1375515 (CACNA2D3 gene); and rs1800562 and rs1799945 (HFE gene, mutations C282Y and H63D, respectively). Iron biomarkers were determined and cluster analysis was performed. Differences among clusters in dietary intake, menstrual blood loss parameters and genotype frequencies distribution were studied. A categorical regression was performed to identify factors associated with cluster belonging. Three clusters were identified: women with poor iron status close to developing iron deficiency anemia (Cluster 1, n = 26); women with mild iron deficiency (Cluster 2, n = 59) and women with normal iron status (Cluster 3, n = 57). Three independent factors, red meat consumption, MBLC and mutation C282Y, were included in the model that better explained cluster belonging (R2 = 0.142, p < 0.001). In conclusion, the combination of high red meat consumption, low menstrual blood loss and the HFE C282Y mutation may protect from iron deficiency in women of childbearing age. These findings could be useful to implement adequate strategies to prevent iron deficiency anemia.

Intronic SNP rs3811647 of the human transferrin gene modulates its expression in hepatoma cells

INTRODUCTION

Transferrin (Tf) exerts a crucial function in the maintenance of systemic iron homeostasis. The expression of the Tf gene is controlled by transcriptional mechanism, although little is known about genetic factors influence.

OBJECTIVE

To study the role of rs3811647 in Tf expression using an in-vitro assay on hepatoma cells.

DESIGN AND METHODS

Hep3B cells were co-transfected with constructs containing A (VarA-Tf-luc) and G (VarG-Tf-luc) variants of rs3811647, using luciferase as a surrogate reporter of Tf expression.

RESULTS

Luciferase assays showed a higher intrinsic enhancer activity (p < 0.05) in the A compared with the G variant. In silico analysis of SNP rs3811647 showed that the A allele might constitute a binding site for the transcription factor glucocorticoid receptor (GR).

CONCLUSION

The A allele of SNP rs3811647 increases Tf expression in a manner that might underlie inter-individual variation in serum transferrin levels observed in different population groups.

Changes in blood pressure and lipid levels in young women consuming a vitamin D-fortified skimmed milk: a randomised controlled trial

Vitamin D exerts a variety of extra-skeletal functions.

AIM

to know the effects of the consumption of a vitamin D-fortified skimmed milk on glucose, lipid profile, and blood pressure in young women.

METHODS

a randomised, placebo-controlled, double-blind parallel-group trial of 16 weeks duration was conducted in young women with low iron stores who consumed a skimmed milk fortified with iron and 200 IU/day (5 μg) of vitamin D (D-fortified group, n = 55), or a placebo without vitamin D (D-placebo group, n = 54). A reference group (n = 56) of iron-sufficient women was also recruited.

RESULTS

baseline serum 25-hydroxyvitamin D was inversely correlated with total-cholesterol (r = -0.176, p = 0.023) and low density lipoprotein-cholesterol (LDL-chol) (r = -0.176, p = 0.024). During the assay, LDL-cholesterol increased in the D-placebo group (p = 0.005) while it tended to decrease in the D-fortified group (p = 0.07). Neither group displayed changes in total-cholesterol, high density lipoprotein-cholesterol (HDL-chol), triglycerides or glucose levels. Systolic (p = 0.017) and diastolic (p = 0.010) blood pressure decreased during the assay in the D-fortified group without significant differences compared to the D-placebo.

CONCLUSION

consumption of a dairy product fortified with vitamin D reduces systolic and diastolic blood pressure but does not change lipid levels in young women.

Identification of a novel quantitative trait nucleotype related to iron status in a calcium channel gene

Several iron-related parameters have been reported to show significant heritability, and thus, seemed to be genetically regulated. A genome wide family-based study revealed two regions that showed a linkage signal with transferrin receptor levels. The aim of the study was to identify genetic markers associated with iron status biomarkers. Ten SNPs selected from the literature were tested, and parameters related to iron metabolism were analysed, in a group (n=284) of Spanish women. Data were analyzed using Bayesian Model Averaging (BMA) test and decision trees. The rs1375515, located in an intronic region of the calcium channel gene CACNA2D3, showed strong associations with levels of mean corpuscular volume according to BMA test, and with levels of haemoglobin and ferritin according to decision trees. The allele G was associated to low levels of these parameters which suggests higher iron deficiency anaemia risk. This SNP along with the C282Y mutation explained significant differences in the distribution of individuals in three iron-related clinical phenotypes (normal, iron deficient and iron deficiency anaemic). In conclusion, the rs1375515, or other genetic polymorphisms in linkage, may play important roles in iron status, probably by affecting the function of a calcium channel. These findings may be useful for further investigation in the etiology of iron diseases.

Bone remodelling is reduced by recovery from iron-deficiency anaemia in premenopausal women

Iron-deficiency anaemia (IDA), one of the most common and widespread health disorders worldwide, affects fundamental metabolic functions and has been associated with deleterious effects on bone. Our aim was to know whether there are differences in bone remodelling between a group of premenopausal IDA women and a healthy group, and whether recovery of iron status has an effect on bone turnover markers. Thirty-five IDA women and 38 healthy women (control group) were recruited throughout the year. IDA women received pharmacological iron treatment. Iron biomarkers, aminoterminal telopeptide of collagen I (NTx), procollagen type 1 N-terminal propeptide (P1NP), 25-hydroxyvitamin D, and parathormone (PTH) were determined at baseline for both groups and after treatment with pharmacological iron for the IDA group. IDA subjects were classified as recovered (R) or non-recovered (nR) from IDA after treatment. NTx levels were significantly higher (p <0.001), and P1NP levels tended to be lower in IDA women than controls after adjusting for age and body mass index (BMI), with no differences in 25-hydroxyvitamin D or PTH. After treatment, the R group had significantly lower NTx and P1NP levels compared to baseline (p <0.05 and p <0.001 respectively), whilst no significant changes were seen in the nR group. No changes were seen in 25-hydroxyvitamin D or PTH for either group. IDA is related to higher bone resorption independent of age and BMI. Recovery from IDA has a concomitant beneficial effect on bone remodelling in premenopausal women, decreasing both bone resorption and formation.

Low iron status as a factor of increased bone resorption and effects of an iron and vitamin D-fortified skimmed milk on bone remodelling in young Spanish women

PURPOSE

This study aimed to determine whether there is a relationship between iron status and bone metabolism, and to compare the effects of the consumption, as part of the usual diet, of an iron or iron and vitamin D-fortified skimmed milk on bone remodelling in iron-deficient women.

METHODS

Young healthy iron-deficient or iron-sufficient women (serum ferritin ≤30 ng/mL or >30 ng/mL, respectively) were recruited. Iron-deficient women were assigned to a nutritional intervention consisting of a randomised, controlled, double-blind, parallel design trial of 16 weeks during winter. They consumed, as part of their usual diet, an iron (Fe group, n = 54) or iron and vitamin D-fortified (Fe+D group, n = 55) flavoured skimmed milk (iron, 15 mg/day; vitamin D3, 5 μg/day, 200 IU). The iron-sufficient women followed their usual diet without supplementation (R group, n = 56). Dietary intake, body weight, iron biomarkers, 25-hydroxyvitamin D (25OHD), parathyroid hormone (PTH), procollagen-type 1 N-terminal propeptide (P1NP), and aminoterminal telopeptide of collagen I (NTx) were determined.

RESULTS

Negative correlations were found between baseline log-ferritin and log-NTx (p < 0.001), and between transferrin and P1NP (p = 0.002). Serum 25OHD increased (from 62 ± 21 to 71 ± 21 nmol/L, mean ± SD, p < 0.001) while P1NP and NTx decreased in Fe+D during the assay (p = 0.004 and p < 0.001, respectively). NTx was lower in Fe+D compared to Fe at week 8 (p < 0.05) and was higher in Fe and Fe+D compared to R throughout the assay (p < 0.01). PTH did not show changes.

CONCLUSIONS

Iron deficiency is related with higher bone resorption in young women. Consumption of a dairy product that supplies 5 μg/day of vitamin D3 reduces bone turnover and increases circulating 25OHD to nearly reach an optimal vitamin D status, defined as 25OHD over 75 nmol/L.

Relationship between vitamin D deficiency, bone remodelling and iron status in iron-deficient young women consuming an iron-fortified food

BACKGROUND

Iron and vitamin D deficiencies are two of the most widespread nutritional disorders in the world. Our aim was to know whether the consumption of an iron-fortified fruit juice modifies bone remodelling and the possible influence of baseline vitamin D status on the recovery of iron status in a group of iron-deficient women.

METHODS

Iron biomarkers, 25-hydroxyvitamin D levels and dietary intake were measured in 123 iron-deficient menstruating women. A subgroup (n = 41) participated in a randomised double-blind placebo-controlled study of 16-weeks during winter. They consumed a placebo fruit juice (P) or iron-fortified fruit juice (F). Dietary intake, 25-hydroxyvitamin D, parathormone (PTH), bone alkaline phosphatase (ALP), aminoterminal telopeptide of collagen I (NTX) and iron biomarkers were determined.

RESULTS

Ninety-two per cent of the iron-deficient women were vitamin D deficient or insufficient. Transferrin saturation and 25-hydroxyvitamin D were positively correlated. Iron status improved in F, 25-hydroxyvitamin D decreased in F and P, and PTH, ALP and NTX levels were within the normal range and did not vary. Women with 25-hydroxyvitamin D ≥ 50 nmol/L compared with 25-hydroxyvitamin D < 50 nmol/L showed a higher increase in transferrin saturation (a marker of iron supply to tissues) during iron recovery.

CONCLUSION

The prevalence of vitamin D deficiency or insufficiency is very high in iron-deficient women. The recovery of iron status by consuming an iron-fortified food does not affect 25-hydroxyvitamin D levels; however, the increase in iron supply to tissues is lower if the women also present vitamin D deficiency. Although bone health does not seem to be affected in this group of women, correction of iron and vitamin D deficiencies should be promoted in young women to improve present and future health.

Four variants in transferrin and HFE genes as potential markers of iron deficiency anaemia risk: an association study in menstruating women

BACKGROUND

Iron deficiency anaemia is a worldwide health problem in which environmental, physiologic and genetic factors play important roles. The associations between iron status biomarkers and single nucleotide polymorphisms (SNPs) known to be related to iron metabolism were studied in menstruating women.

METHODS

A group of 270 Caucasian menstruating women, a population group at risk of iron deficiency anaemia, participated in the study. Haematological and biochemical parameters were analysed and 10 selected SNPs were genotyped by minisequencing assay. The associations between genetic and biochemical data were analysed by Bayesian Model Averaging (BMA) test and decision trees. Dietary intake of a representative subgroup of these volunteers (n = 141) was assessed, and the relationship between nutrients and iron biomarkers was also determined by linear regression.

RESULTS

Four variants, two in the transferrin gene (rs3811647, rs1799852) and two in the HFE gene (C282Y, H63D), explain 35% of the genetic variation or heritability of serum transferrin in menstruating women. The minor allele of rs3811647 was associated with higher serum transferrin levels and lower transferrin saturation, while the minor alleles of rs1799852 and the C282Y and H63D mutations of HFE were associated with lower serum transferrin levels. No association between nutrient intake and iron biomarkers was found.

CONCLUSIONS

In contrast to dietary intake, these four SNPs are strongly associated with serum transferrin. Carriers of the minor allele of rs3811647 present a reduction in iron transport to tissues, which might indicate higher iron deficiency anaemia risk, although the simultaneous presence of the minor allele of rs1799852 and HFE mutations appear to have compensatory effects. Therefore, it is suggested that these genetic variants might potentially be used as markers of iron deficiency anaemia risk.

[Beneficial effects of chocolate on cardiovascular health]

Since ancient times, numerous health beneficial effects have been attributed to chocolate, closing up its consumption to a therapeutic use. The present study reviews some relevant studies about chocolate (and its bioactive compounds) on some cardiovascular risk factors and stresses the need of future studies. The consumption of cocoa/ chocolate (i) increases plasma antioxidant capacity, (ii) diminishes platelet function and inflammation, and (iii) decreases diastolic and systolic arterial pressures. Data currently available indicate that daily consumption of cocoa-rich chocolate (rich in polyphenols) may at least partially lower cardiovascular disease risk. Further studies are required in order to establish the bioavailability and mechanisms of action of bioactive compounds in chocolate. The study of the interaction of chocolate and its components with candidate genes will also supply necessary information regarding the individuals best suited to benefit from a potential cardiovascular disease treatment with chocolate.

A sodium-bicarbonated mineral water reduces gallbladder emptying and postprandial lipaemia: a randomised four-way crossover study

BACKGROUND

Sodium-bicarbonated mineral waters are reported to have beneficial digestive and hypocholesterolaemic properties. The aim of the study was to investigate the effects of consumption of a sodium-bicarbonated mineral water (BW) with or without a meal, compared to a low mineral content water as the control water (CW), on postprandial serum triacylglycerols (TAG), cholecystokinin (CCK) and gallbladder volume.

METHODS

The study design was a four-way randomised controlled crossover trial. Healthy adult men and women (>18 and <40 years, TAG <2.82 mmol/L) consumed 0.5 L of CW + standard meal; 0.5 L of BW + standard meal; and 0.5 L of CW without meal or 0.5 L of BW without meal.

RESULTS

BW consumed without meal had no significant effect on the study parameters compared to CW. However, BW with meal induced a lower concentration of serum TAG at 30 min (p = 0.01) and 60 min (p = 0.03) postprandial times, lower CCK concentrations at 30 min (p = 0.002), and higher gallbladder volume at 30 min (p = 0.03), 60 min (p = 0.01) and 120 min (p = 0.04). Gallbladder ejection fraction was lower with the BW (p = 0.03), whilst area under the curve and peak contraction amplitude (lowest gallbladder volume) were higher (p = 0.01, p = 0.02, respectively) compared to the CW.

CONCLUSION

Consumption of BW with a meal induces lower levels of CCK and reduces gallbladder emptying and postprandial TAG levels. It is proposed that this sodium-bicarbonated mineral water could be used as part of the habitual diet by the general population in order to reduce cardiovascular risk.

Inventory management

A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices. This International Forum represents an effort to get a snap shot of inventory management practices around the world, and to understand the range of different products provided for patients. In addition to sharing current inventory management practices, this Forum is intended to foster an exchange of ideas around where we see our field moving with respect to various issues including specialty products, new technologies, and reducing recipient risk from blood transfusion products.

Major diet-drug interactions affecting the kinetic characteristics and hypolipidaemic properties of statins

Concomitant administration of statins with food may alter statin pharmacokinetics or pharmacodynamics, increasing the risk of adverse reactions such as myopathy or rhabdomyolysis or reducing their pharmacological action. This paper reviews major interactions between statins and dietary compounds. Consumption of pectin or oat bran together with Lovastatin reduces absorption of the drug, while alcohol intake does not appear to affect the efficacy and safety of Fluvastatin treatment. Grapefruit juice components inhibit cytochrome P-4503A4, reducing the presystemic metabolism of drugs such as Simvastatin, Lovastatin and Atorvastatin. Follow-up studies on the therapeutic effect of statins in patients consuming a Mediterranean-style diet are necessary to assure the correct prescription because the oil-statin and minor oil compound-statin possible interactions have been only briefly studied. Preliminary study suggests that olive oil can increase the hypolipaemiant effect of Simvastatin with respect sunflower oil. The consumption of polyunsaturated rich oils, throughout the cytochrome P- 450 activation could decrease the half-life of some statins and therefore their hypolipaemic effects. The statins and n-3 fatty acids combined therapy gives rise to pharmacodinamic interaction that improves the lipid profile and leads greater cardioprotection. Although statins are more effective in high endogenous cholesterol production subjects and plant sterols are more effective in high cholesterol absorption efficacy subjects, plant esterols-statins combined therapy generates very positive complementary effects. This review ends suggesting possible diet-stain interactions that require further investigations (e.g. types of olive oils, fruit juices other than grapefruit, fibre or consumption of alcoholic beverages rich in polyphenols or ethanol).

Postprandial lipaemia and endothelial adhesion molecules in pre- and postmenopausal Spanish women

BACKGROUND

Postprandial hyperlipaemia is an independent risk factor for atherosclerosis.

OBJECTIVES

To compare postprandial lipaemia and fasting adhesion molecules levels in healthy young premenopausal(PrW) and postmenopausal (PoW) Spanish women.

SUBJECTS AND METHODS

Twenty healthy PrW and 18 healthy PoW participated in a postprandial 7-hour intervention study. All participants were given a fat-rich standard meal (11.8% saturated, 39.7% monounsaturated, and 6.6% polyunsaturated) after a 12 h fast. Blood samples were taken at baseline and at 60, 120, 240, 360 and 420 min after eating. Triacylglycerols (TAG), total cholesterol (Chol), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular adhesion molecule-1 (sVCAM-1) were determined in fasting serum samples and TAG and total Chol postprandial levels were measured.

RESULTS

Anthropometric data, serum lipid and sICAM-1 presented significant higher values in PoW compared to PrW, but sVCAM-1 did not significantly differ between groups. Postprandial TAG and Chol concentrations in PoW were significantly higher than in PrW (p < 0.0001). There was a significant time influence (p < 0.0001) in TAG in PrW and PoW, while time to peak and peak concentration were significantly higher in PoW than PrW. Chol concentrations showed a significant reduction after 1 h, to reach values similar to baseline after 6 h in PrW but not in PoW.

CONCLUSIONS

Lipid postprandial response to a fat rich meal and soluble intercellular adhesion molecules concentrations indicate a higher cardiovascular risk pattern in postmenopausal compared to premenopausal women. Soluble vascular adhesion molecule levels seem to be influenced not only by age and menopause, but also other factors like usual diet.

Reduction in cardiovascular risk by sodium-bicarbonated mineral water in moderately hypercholesterolemic young adults

The effects of drinking sodium-bicarbonated mineral water on cardiovascular risk in young men and women with moderate cardiovascular risk were studied. Eighteen young volunteers (total cholesterol levels >5.2 mmol/L) without any disease participated. The study consisted of two 8-week intervention periods. Subjects consumed, as supplement to their usual diet, 1 L/day control low mineral water, followed by 1 L/day bicarbonated mineral water (48 mmol/L sodium, 35 mmol/L bicarbonate and 17 mmol/L chloride). Determinations were performed at the end of the control water period and on Weeks 4 and 8 of the bicarbonated water period. Body weight, body mass index (BMI), blood pressure, dietary intake, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, apolipoprotein (Apo) A-I, Apo B, triacylgycerols, glucose, insulin, adiponectin, high-sensitivity C-reactive protein (hs-CRP), soluble adhesion molecules [soluble intercellular adhesion molecule (sICAM) and soluble vascular adhesion molecule (sVCAM)], sodium and chloride urinary excretion, and urine pH were measured. Dietary intake, body weight and BMI showed no significant variations. Systolic blood pressure decreased significantly after 4 weeks of bicarbonated water consumption, without significant differences between Weeks 4 and 8. After bicarbonated water consumption, significant reductions in total cholesterol (by 6.3%; P=.012), LDL cholesterol (by 10%; P=.001), total/HDL cholesterol (P=.004), LDL/HDL cholesterol (P=.001) and Apo B (P=.017) were observed. Serum triacylglycerol, Apo A-I, sICAM-1, sVCAM-1 and hs-CRP levels did not change. Serum glucose values tended to decrease during the bicarbonated water intervention (P=.056), but insulin levels did not vary. This sodium-bicarbonated mineral water improves lipid profile in moderately hypercholesterolemic young men and women and could therefore be applied in dietary interventions to reduce cardiovascular risk.

Design and evaluation of a treatment programme for Spanish adolescents with overweight and obesity. The EVASYON Study

Background

The prevalence of overweight and obesity (OW/OB) among adolescents worldwide has increased since the 60 s. Spain has reached one of the highest OW/OB prevalence rates among adolescents from European countries. The aim of this methodological paper is to describe the design and evaluation in the EVASYON study (Development, implementation and evaluation of the efficacy of a therapeutic programme for adolescents with OW/OB: integral education on nutrition and physical activity).

Methods/Design

The EVASYON was planned by a multidisciplinary team to treat OW/OB in Spanish adolescents. The EVASYON is a multi-centre study conducted in 5 hospitals in 5 Spanish cities (Granada, Madrid, Pamplona, Santander and Zaragoza) and two hundred and four OW/OB Spanish adolescents were recruited for this intervention. The treatment was implemented for approximately one-year follow-up. The adolescents were treated in groups of a maximum of 10 subjects; each group had 20 visits during the treatment period in two phases: intensive during the first 2 months (1^st to 9^th visits), and extensive during the last 11 months (10^th to 20^th visits). In order to assess the efficacy of the treatment, 8 dimensions were measured: diet; physical activity and fitness; eating behaviour; body composition; haematological profile; metabolic profile; minerals and vitamins; immuno-inflammatory markers. Moreover, genetic polymorphisms were also determined.

Discussion

The treatment programme developed in the EVASYON study was designed as a national pilot study to be implemented as an effective treatment for adolescents with OW/OB into the Spanish Health Care Service.

N-3 fatty acids in glucose metabolism and insulin sensitivity

Polyunsaturated fatty acids (PUFA) of the n-3 series are essential for normal growth and development. The health effects of these fatty acids include reduction of cardiovascular risk due to antiarrhythmic, antiinflammatory, anti-thrombotic and lipid lowering actions. An increase in unsaturation of the muscle membrane fatty acids is associated with improved insulin sensitivity. Higher proportion of n-3 fatty acids may have beneficial roles, such as antiobesity effects and protection against the metabolic syndrome and type 2 diabetes mellitus through a number of metabolic effects. However, controversy exists on the different effects of n-6 and n-3 polyunsaturated fatty acids as well as on the interacting effect of dietary saturated and monounsaturated fat. In addition, some adverse effects have been described concerning the use of fish oil supplements containing high doses of n-3 fatty acids. Several studies show Eskimos diabetes risk, while results of nutritional interventions on the influence of consuming diets rich in oily fish or other food rich in n-3 fatty acids is very limited. This article reviews the possible mechanisms through which n-3 PUFA are involved in glucose level control and insulin sensitivity. Intervention and epidemiological studies together with recent findings on the nutrigenomic field related with this subject are also briefly reviewed.

Sodium-bicarbonated mineral water decreases aldosterone levels without affecting urinary excretion of bone minerals

AIM To assess in healthy postmenopausal women the influence of consuming sodium-bicarbonated mineral water on postprandial evolution of serum aldosterone and urinary electrolyte excretion.

METHODS

Eighteen postmenopausal women consumed 500 ml of two sodium-bicarbonated mineral waters (sodium-bicarbonated mineral water 1 and sodium-bicarbonated mineral water 2) and a low-mineral water with a standard meal. Postprandial blood samples were taken at 60, 120, 240, 360 and 420 min and aldosterone concentrations were measured. Postprandial urinary minerals were determined.

RESULTS

Urinary and total mineral excretion and urinary mineral concentrations did not differ except for sodium concentration, which was significantly higher with sodium-bicarbonated mineral water 1 than with low-mineral water (P = 0.005). There was a time effect (P = 0.003) on the aldosterone concentration. At 120 min, aldosterone concentrations were lower with sodium-bicarbonated mineral water 1 (P = 0.021) and sodium-bicarbonated mineral water 2 (P = 0.030) compared with low-mineral water.

CONCLUSION

Drinking a sodium-rich bicarbonated mineral water with a meal increases urinary sodium concentration excretion without changes in the excretion of potassium and bone minerals.

Oily fish increases iron bioavailability of a phytate rich meal in young iron deficient women

BACKGROUND

Iron deficiency is a major health problem worldwide, and is associated with diets of low iron bioavailability. Non-heme iron absorption is modulated by dietary constituents, one of which is the so-called "meat factor", present in meat, fish (oily and lean) and poultry, which is an important enhancer of iron absorption in humans. Food processing also affects iron bioavailability.

OBJECTIVE

To evaluate the effect of consuming sous vide cooked salmon fish on non-heme iron bioavailability from a bean meal, rich in phytate, in iron-deficient women.

DESIGN

Randomized crossover trial in 21 young women with low iron stores (ferritin < 30 microg/L). Two test meals were extrinsically labelled with stable isotopes of iron (Fe-57 or Fe-58). Iron bioavailability was measured as the incorporation of stable isotopes into erythrocytes 14 d after meals consumption.

RESULTS

The addition of fish to the bean meal significantly increased (p < 0.001) iron absorption. Serum ferritin concentration and iron absorption were inversely correlated for both the bean meal (R(2) = 0.294, p = 0.011) and the fish and bean meal (R(2) = 0.401, p = 0.002).

CONCLUSION

Sous vide cooked salmon fish increases iron absorption from a high phytate bean meal in humans.

[Usefulness and controversial issues of middle-chain fatty acids consumption on lipid-protein metabolism and obesity]

Middle-chain fatty acids (MCFA) contain 6-12 carbon atoms and are digested, absorbed and metabolized differently than long-chain fatty acids (LCFA). This work reviews some of the potential and real utilities of MCFA and their role on health. For this reason, they are used in enteral and parenteral nutrition because of their good absorption, and in premature-feeding milk-based formulas in order to improve calcium absorption. MCFA have become particularly important because of their possible role in treating and preventing obesity. Since they are more water soluble, they are taken-up by chylomicrons, and it is believed that they do not directly participate in lipogenesis. They are able to increase the thermogenic effect of foods, and its metabolism increases the production of ketonic agents with the subsequent anorexigenic effect. However, high doses of MCFA are required to obtain significant effects on weight reduction. The effects on lipid-protein metabolism are controversial. So, although they seem to reduce the post-prandial triglyceridemic response, the results their effects are not uniform regarding triglyceridemia and cholesterolemia. In spite of this, more and more products are being designed incorporating MCFA to treat obesity and overweight, having been considered as "GRAS" (Generally Recommended as Safe") components by the ADA. Further long-term studies are needed to warrant the usefulness of consumption of these compounds, particularly in the treatment and prevention of obesity.

A comparative study of iron bioavailability from cocoa supplemented with ferric pyrophosphate or ferrous fumarate in rats

BACKGROUND

Food iron fortification can be a good strategy to prevent iron deficiency. Iron bioavailability from cocoa powder enriched with ferric pyrophosphate encapsulated in liposomes or ferrous fumarate was assessed in rats.

METHODS

Three groups of rats consumed during 28 days either a control diet or two diets prepared with ferric pyrophosphate- or ferrous fumarate-enriched cocoa powder as the unique source of iron. Body weight and food intake were monitored and last-week feces were collected. On day 28, animals were sacrificed and livers and spleens were removed. Hemoglobin and total iron binding capacity (TIBC) were determined.

RESULTS

There were no significant differences in body weight and food intake. Apparent iron absorption and % absorption/intake were significantly lower in rats consuming enriched cocoa compared to the control group, without significant differences due to the iron form. Enriched cocoa groups showed significantly lower spleen iron content and concentration than the control. Liver iron was lower in the ferric pyrophosphate group compared to the other two groups. Hemoglobin and TIBC values showed a deficient iron status in ferric pyrophosphate rats.

CONCLUSION

Cocoa powder is a good vehicle for iron fortification when enriched with ferrous fumarate compared to ferric pyrophosphate encapsulated in liposomes.

Bone remodelling is not affected by consumption of a sodium-rich carbonated mineral water in healthy postmenopausal women

This study was designed to investigate the possible effects of consuming Na-rich carbonated mineral water on bone remodelling and urinary mineral excretion in postmenopausal women. Women (n18) included were amenorrhoeic (>1 year), healthy and not obese (BMI <30 kg/m2). No woman was taking oestrogen replacement therapy, mineral and vitamin supplements, phyto-oestrogens or medications known to affect bone and lipid metabolism. In two consecutive interventions that lasted 8 weeks each, women drank 1 litre of control mineral water daily and 1 litre of carbonated mineral water, rich in Na, HCO–3inf super and Cl−, daily. Body weight and height were measured, BMI was calculated and blood pressure was measured. Blood samples were taken from fasting subjects and serum obtained to analyse the biochemical bone markers, procollagen I amino-terminal propeptide (PINP) and β-carboxy-terminal telopeptide of collagen (β-CTX). At the end of each period, 24 h urine samples were collected to determine Ca, Mg, P, Na+, K+, Cl−, urine excretion and urinary pH. No changes in body weight, BMI or blood pressure were observed during the experimental period. Ca excretion was lower after the intake of carbonated water than after intake of the control water (P=0·037) while P excretion was higher (P=0·015). Total urine, Na and Cl−excretion did not differ between the two periods but urinary pH was increased after the intake of carbonated mineral water. PINP and β-CTX did not differ between the two periods. Daily consumption of 1 litre of Na-rich carbonated mineral water for 8 weeks does not affect bone remodelling in healthy postmenopausal women.

The G277S transferrin mutation does not affect iron absorption in iron deficient women

BACKGROUND

Iron deficiency anaemia is one of the most important nutritional diseases, with high prevalence worldwide. The G277S transferrin mutation has been implicated as a risk factor for iron deficiency in menstruating women. However, the subject is controversial and there are no data concerning the possible influence of this polymorphism on iron absorption.

AIM OF THE STUDY

To undertake a pilot study to investigate the effect of carrying the G277S transferrin mutation on non-haem iron absorption from a meal in young menstruating women compared to wild-type controls.

METHODS

Menstruating women with low iron stores (serum ferritin < 30 microg/l) or who had suffered from iron deficiency anaemia or had a family history of anaemia were recruited (n = 162). Haematological parameters were analysed, including haemoglobin, ferritin, total-iron binding capacity and transferrin saturation. Non-haem iron absorption from a meal was measured in 25 non-anaemic women either with the G277S/G277G (n = 10) or the wild type G277G/G277G (n = 15) genotype. The incorporation of stable isotopes of iron into erythrocytes was used to measure absorption.

RESULTS AND CONCLUSIONS

There were no significant differences in iron status indices or non-haem iron absorption between genotypes. However, G277S carriers did not show the usual inverse association between iron stores and non-haem iron absorption. Further studies should focus on the effects of a combination of polymorphisms in iron metabolism genes on iron absorption.

Heat Processing in Infant Formulas Induces Changes in Copper Tissue Levels in Suckling and Weanling Rats

AIM

To assess the effects of dehydration, conventional in-bottle sterilization, and ultrahigh-temperature (UHT) sterilization, involved in the production of infant formulas, on the copper bioavailability in rats at two stages.

METHODS

Two-week-old suckling rats were fed a reconstituted powder (P1) and an in-bottle-sterilized liquid infant formula (SC1) in a drinking bottle for 7 days. Weanling rats were fed P1, SC1, another powder (P2), and a liquid UHT formula (UHT2) complemented with a standard rat diet. Intake, body weight, and percentage copper absorption were calculated, and whole-body, serum, liver, skin, and erythrocyte copper concentrations were determined.

RESULTS

Food intake, body weight, and copper intake were reduced in suckling rats consuming SC1, but the percentage copper absorption increased, and whole-body and tissue copper concentrations were unaffected, except for the erythrocyte copper concentration which was significantly higher as compared with pups fed P1. In weanling rats, the only difference observed was the significantly higher liver copper concentration in animals fed the diet containing P1 as compared with the diets containing SC1 and UHT2.

CONCLUSIONS

Consuming the SC1 formula induced high erythrocyte copper levels in suckling rats, whereas the equivalent dehydrated formula (P1) induced elevated liver copper concentrations in weanling rats. This is associated with the different Maillard reaction products resulting from the processing of each infant formula and with the developmental stage of the animals.

Sodium bicarbonated mineral water decreases postprandial lipaemia in postmenopausal women compared to a low mineral water

The role of bicarbonated mineral waters on lipid metabolism and lipoprotein concentrations in man has scarcely been investigated. The present study aimed to investigate whether drinking sodium bicarbonated mineral water affects postprandial cholesterol and triacylglycerol metabolism in postmenopausal women. In a three-way, randomised, crossover study, eighteen healthy postmenopausal women consumed two sodium bicarbonated mineral waters (bicarbonated mineral water 1 and bicarbonated mineral water 2) and a low mineral water (500 ml of each) with a standard fat-rich meal (4552 kJ; 75.3 g fat). The bicarbonated waters were rich in sodium and bicarbonate and bicarbonated mineral water 1 contained 5.7 times more fluoride than bicarbonated mineral water 2. Fasting blood samples and postprandial blood samples were taken at 30, 60, 120, 240, 360 and 420 min after the end of the meal consumption. Cholesterol and triacylglycerols were determined in serum and chylomicrons. A significant water consumption effect was observed in the total area under the curve (TAUC) of serum and chylomicron triacylglycerols (ANOVA, P=0.008 and P=0.027, respectively). TAUC of serum triacylglycerols for bicarbonated mineral water 2 was significantly lower compared to low mineral water (Bonferroni, P=0.039). Peak concentration of serum triacylglycerols showed a significant water effect (P=0.025). Changes in chylomicron cholesterol were not significantly affected by the type of water. Bicarbonated mineral waters 1 and 2 did not show any significant differences. Drinking sodium bicarbonate-rich mineral waters reduces postprandial lipaemia in healthy postmenopausal women compared to drinking a low mineral water.

Iron bioavailability from powdered and in-bottle-sterilized infant formulas in suckling and weanling rats

OBJECTIVE

The Maillard reaction and lactose isomerization may be induced during the manufacture of infant formulas. We studied the effects of dehydration and sterilization on iron bioavailability from an infant formula in suckling and weanling rats.

METHODS

In experiment 1, a previously reconstituted powdered infant formula and an in-bottle-sterilized liquid infant formula from the same manufacturer were fed from drinking bottles to 2-wk-old suckling rat pups for 7 d. In experiment 2, the same formulas were complemented with AIN-76 and fed to weanling rats for 7 d after a 4-d adaptation period. In both experiments, intake, body weight, and fecal and urinary excretions were monitored, and the following iron indexes were calculated: apparent absorption and retention and the coefficients percentage of absorption versus intake, percentage of retention versus absorption, and percentage of retention versus intake.

RESULTS

The liquid infant formula resulted in lower body weights on day 4, particularly among the younger rats that had significantly lower food intakes (P = 0.045). In weanling rats fed powdered and liquid infant formulas, food intake and body weight were not significantly different. The pups showed significantly higher absorption (percentage of absorption versus intake) and retention (percentages of retention versus absorption and retention versus intake) efficiencies than did the weanling rats (P < 0.001 for the three indexes). Hemoglobin values (P = 0.001) and liver iron concentrations (P = 0.009) were significantly higher in the weanling rats than in the pups. In contrast, erythrocyte iron concentrations and hematocrit were higher in the pups (P = 0.016 and 0.053, respectively).

CONCLUSIONS

In rat pups, iron bioavailability is negatively affected by the consumption of in-bottle-sterilized infant formula, possibly as the result of the content of Maillard reaction products, altered proteins, and lactulose. However, when this formula is included in a mixed diet and given to weanling rats, this detrimental effect no longer occurs.

Food, energy and macronutrient intake of postmenopausal women from a menopause program

OBJECTIVE

This study aimed to analyse the food, energy and macronutrient intake of a group of postmenopausal women participating in a health-care-program.

METHODS

Subjects included were 38 healthy postmenopausal women aged between 46 and 60 years, recruited from the Menopause Program of the Madrid City Council. Physical activity, some anthropometric data and dietary information was obtained using a modified version of the dietary history method, which contained a 24-hour-recall and a food frequency questionnaire covering the preceding month as reference period. Dietary quality indexes, including those of the energy provided by macronutrients, alcohol and fatty acids and PUFA + MUFA/SFA and PUFA/SFA ratios were calculated.

RESULTS

This group consumed a diet very similar to the traditional Mediterranean diet. Intake of vegetables (415 +/- 165 g/d), fruits (396 +/- 178 g/d) and fish (131 +/- 69 g/d) was high and a wide variety of these products was consumed. Potato and cereal (157 +/- 76 g/d) intake was low. Dairy products, meat, poultry and eggs were only a modest part of this diet. The fat quality (PUFA + MUFA/SFA = 2.26) was satisfactory.

CONCLUSION

The diet of this group of postmenopausal women attending a prevention program closely conforms to current nutritional guidelines. Physical activity, body weight and intake of vegetable foods are adequate and may be very useful to counterbalance the increased risk of several pathologies after menopause. However, consumption of carbohydrate rich foods is lower than recommended. Participation in the menopause health-care-program is useful for weight control and dietary advice.

Mineral and vitamin status in elderly persons from Northwest Spain consuming an Atlantic variant of the Mediterranean diet

AIM

To assess dietary intake and serum mineral and vitamin levels in elderly people from Northwest Spain consuming a Mediterranean diet, rich in vegetables, fruit, meat, fish, olive oil, dairy products and moderate in wine.

METHODS

Cross-sectional observational study in four retirement homes. Forty-five men and 65 women participated. Dietary intake and serum calcium, magnesium, iron, retinol, alpha-tocopherol, albumin, cholesterol, glucose and hematological parameters were determined.

RESULTS

Mean consumption of fruit plus vegetables was 600 g/day. Men consumed significantly more legumes, fruit, meat, and alcoholic beverages, but fewer vegetables than women. Women presented higher carbohydrate and lower alcohol energy contributions. Men consumed significantly more thiamin, niacin equivalents, riboflavin, retinol equivalents and iron. Vitamin D intake was 2.2 +/- 1.2 microg/day and folate intake was 204 +/- 47 microg/day without gender differences. Prevalence of anemia was 6.7% and that of high ferritin, 1.8%. Serum cholesterol and retinol were higher in women. Mean serum alpha-tocopherol/cholesterol ratio in the whole population was 6.3 +/- 2.3 mmol/mol without gender differences.

CONCLUSION

This elderly population consumes an Atlantic-Mediterranean diet that appears, according to biochemical and hematological parameters, appropriate. However, more fatty fish and leafy green vegetables and the inclusion of fortified foods in the diet might optimize micronutrient status.