The glycemic index and cardiovascular disease risk

Effects of intake of four types of snack with different timings on postprandial glucose levels after dinner

PURPOSE

It has been reported that the consumption of fruit granola (FG), mulberry leaves, and barley cookies as an afternoon snack suppresses the postprandial increase in glucose levels at dinner. However, there have been no reports on the second-meal effect of snacking on popular snacks, such as potato chips (PC), roasted sweet potato (SP), and black beans (BB), or on the interval between snacking and dinner.

METHOD

The present study was an open-label randomized crossover trial of five study groups (PC, SP, BB, FG, and no snack) regarding the second-meal effects with different intervals between snacks and dinner. The subjects consumed prescribed meals for lunch and dinner at 12:00 and 19:00, and a snack fixed at 838 kJ (= 200 kcal) at 15:00 or 17:00.

RESULTS

When the participants snacked at 15:00, the postprandial glucose elevation at dinner was suppressed in the FG and SP groups, and the area under the curve (AUC) was also low. When they snacked at 17:00, the postprandial glucose elevation was suppressed in all the groups. The AUCs for PC, FG, and SP were lower than those for no snacking. On the other hand, carbohydrate intake increased with snacking, but the total AUC of snacks and dinner did not differ in any of the groups. The duration of hyperglycemia decreased with snack intake, as did the glucose amplitude.

CONCLUSION

We believe that the intake of carbohydrates and soluble fiber in snacks is an important factor in the second-meal effect at dinner. These results will contribute to the development of snacking and research into the second-meal effect.

Dietary insulin index and load in relation to cardiometabolic risk factors in patients with type 2 diabetes mellitus: A cross-sectional study on the RaNCD cohort study

OBJECTIVES

The aim of the present study was to evaluate the link between the dietary insulin index (DII) and dietary insulin load (DIL) and cardiometabolic risk factors in patients with type 2 diabetes mellitus (T2DM).

METHOD

In this cross-sectional population-based study, 827 participants with diabetes were included based on the RaNCD (Ravansar Non-Communicable Disease) cohort study baseline data. DII and DIL were calculated based on standard formulas using food insulin index values published earlier. Logistic regression analysis was used to determine the association of DII and DIL with cardiovascular risk factors.

RESULTS

A significantly direct association was shown between DII and metabolic syndrome (MetS; odds ratio [OR], 1.32; 95% confidence interval [CI], 1.05-2.50). The odds of developing abdominal obesity in patients with the highest DII were almost twice as high as those with the lowest DII (OR, 2.06; 95% CI, 1.02-4.99). Patients in the top quintile of DIL had twice the odds of being obese than those in the bottom quintile. Furthermore, positive associations were found between DIL and both MetS (OR, 1.98; 95% CI, 1.10-4.21) and waist circumference (OR, 2.90; 95% CI, 1.10-7.20).

CONCLUSION

Higher DII and DIL were positively related to greater risks for both MetS and abdominal obesity among patients with T2DM. Additionally, higher DIL was associated with a higher risk for obesity in the Ravansar population. However, further prospective investigations are needed to clarify the cause-and-effect link between DII, DIL, and cardiovascular risk factors in patients with T2DM.

Continuous glycemia monitoring in perioperative period in patients undergoing total knee or hip arthroplasty: A protocol for a prospective observational study

In every surgical subspecialty surgical site infection (SSI) or implant infections, although occur seldom, pose a threat to patients' health. Risk factors of such states is diabetes mellitus (DM), considered one of the most widespread health-related problems of the 21st century. Orthopedists perform big joint replacements that usually concern older adults and therefore often deal with patients suffering from comorbidities. DM is frequently one of them and can furthermore often remain underdiagnosed. The other risk for complication is a rapid beginning of the rehabilitation which starts on the day following the surgery. To eliminate the debilitating impact of DM and hypoglycemia on surgical patients, we aim to investigate the relationship between the glycemia values and the postoperative outcomes in certain periods of time in patients undergoing orthopedic surgeries. Participants meeting inclusion criteria will have inserted a glycemia measuring device (Dexcom G5, Inc., San Diego, CA) in the periods of time. First time it will take place 14 days prior to the surgery and right after the surgery for the second time for the period of another 14 days. All patients will undergo standard total knee arthroplasty or total hip arthroplasty procedures. Patients will be assessed preoperatively and 14 days, 1, 3, 6, 12, and 24 months postoperatively. The assessment of the joint condition will consist of: patient-reported outcomes (The Knee injury and Osteoarthritis Outcome Score, Harris Hip Score, the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]); assessment of potential SSI and cardiovascular complications (the Finnish Diabetes Risk Score [FINDRISC], the Systematic Coronary Risk Evaluation [SCORE]) and the clinical examination. To investigate the influence of orthopedic surgery (anesthesia) on glycemia and the significance and safety of early patients mobilization after the big joints surgeries. To investigate changes of glycemia in patients with normal glycemia metabolism, potentially protecting them from hypoglycemia during hospital stay and increasing their awareness of potential development of DM in the future. Additionally, this study will correlate perioperative glycemic levels with risk of cardiovascular events in one year follow-up, and its influence on SSI and implant complications.

Comparison of Heart Rate Variability, QTc, and JT Interval Between Diabetic Patients and Healthy Controls: Role of Gender and Phases of Menstrual Cycle

Background and objectives

Type 2 Diabetes mellitus (T2DM) is a heterogeneous group of metabolic disorders with variable degrees of insulin resistance and altered glucose metabolism. Increased attention in studying the role of gonadal hormones in diabetes is not only due to their relation to insulin sensitivity, and glucose tolerance but also to the gender-specific nature of the prevalence of various diabetic complications. The cyclical change in the hormone level in females will make it necessary to consider the menstrual cycle while analyzing the risk factors for diabetes. Hence, the role of gender and menstrual cycle in T2DM are analyzed here using the simple non-invasive cardiovascular risk indices like heart rate variability (HRV), QT interval corrected for heart rate (QTc), and JT interval.

Materials and methods

In this analytical study, T2DM patients in the age group of 18-45 years with less than five years duration from diagnosis and taking not more than two anti-hyperglycemic drugs were included. Time and frequency domains of HRV analysis, QTc, and JT intervals were compared with age and BMI matched control group. The comparison of these parameters was also made between two genders in the diabetic group and they were analyzed across different phases of the menstrual cycle in female diabetic patients when physiological variation in the gonadal hormones occurred as a natural phenomenon.

Results

HRV parameters were reduced and the QTc and JT intervals were prolonged in diabetic patients of both genders. Reduction in low-frequency (LF) band power and high-frequency (HF) band power of HRV analysis in diabetic females were statistically significant in the luteal phase of the menstrual cycle in comparison with age and BMI-matched healthy controls. There was no significant difference in the HRV parameters, QTc, and JT interval between the male and female diabetic groups. HF band power is significantly reduced in the menstrual phase and relatively higher in the follicular phase when compared to the luteal phase among female diabetic patients.

Conclusion

The reduced sympathetic and parasympathetic activity were observed in diabetic patients of both genders and they were significant in the luteal phase of diabetic females compared to the healthy control group. Vagal activity is relatively higher in the follicular phase of the menstrual cycle in female diabetic patients.

ICT-Guided Glycemic Information Sharing Through Artificial Neural Telecare Network

The revolutionary and retrospective changes in the use of ICT have propelled the introduction of telecare health services in the crucial corona virus pandemic times. There have been revolutionary changes that happened with the advent of this novel corona virus. The proposed technique is based on secured glycemic information sharing between the server and users using artificial neural computational learning suite. Using symmetric Tree Parity Machines (TPMs) at the server and user ends, salp swarm-based session key has been generated for the proposed glycemic information modular encryption. The added taste of this paper is that without exchanging the entire session key, both TPMs will get full synchronized in terms of their weight vectors. With rise in the intake of highly rated Glycemic Indexed (GI) foods in today’s COVID-19 lockdown lifestyle, it contributes a lot in the formation of cavities inside the periodontium, and several other diseases likes of COPD, Type I and Type II DM. GI-based food pyramid depicts the merit of the food in the top to bottom spread up approach. High GI food items helps in more co-morbid diseases in patients. It is recommended to have foods from the lower radars of the food pyramid. The proposed encryption with salp swarm-generated key has been more resistant to Man-In-The-Middle attacks. Different mathematical tests were carried on this proposed technique. The outcomes of those tests have proved its efficacy, an acceptance of the proposed technique. The total cryptographic time observed on four GI modules was 0.956 ms, 0.468 ms, 0.643 ms, and 0.771 ms.

Digestibility and structure changes of rice starch following co-fermentation of yeast and Lactobacillus strains

Rice is sometimes fermented with microorganisms to develop health-promoting foods, but the contribution of a short-term fermentation (a necessary step for fermented rice cake-preparation) to properties of rice starch is not resolved yet. The effects of microorganism fermentation with different amount of starter cultures on multi-scale structures and digestibility of rice starch were investigated. The amount of starter cultures significantly affected structures and digestibility of fermented starch. The fermentation with a lower amount of starter cultures induced starch degradation (corrosion of starch granules, reduction of lamellar orders and compactness, decrease in crystallinity, double helix, short ranger-ordered structures, and molar mass) and a slightly reassembly, which increased the content of slowly digestible starch (SDS). While, the fermentation produced more starch fractions with Mw between 0.60 × 10⁷ g/mol and 1.50 × 10⁷ g/mol as the amount of starter cultures increased, and these starch molecules tended to reassemble and form more ordered multi-scale structures including double helical and short range-ordered structures, starch lamellar orders and compactness, which elevated SDS content. The SDS content of fermented starchy foods could be improved via controlling starch reassembly and multi-scale ordered structures through modulating the amount of starter cultures during fermentation.

A head-to-head comparison review of biological and toxicological studies of isomaltulose, d-tagatose, and trehalose on glycemic control

Diabetes mellitus is the most common metabolic disorder contributing to significant morbidity and mortality in humans. Different preventive and therapeutic agents, as well as various pharmacological strategies or non-pharmacological tools, improve the glycemic profile of diabetic patients. Isomaltulose, d-tagatose, and trehalose are naturally occurring, low glycemic sugars that are not synthesized by humans but widely used in food industries. Various studies have shown that these carbohydrates can regulate glucose metabolism and provide support in maintaining glucose homeostasis in patients with diabetes, but also can improve insulin response, subsequently leading to better control of hyperglycemia. In this review, we discussed the anti-hyperglycemic effects of isomaltulose, D-tagatose, and trehalose, comparing their properties with other known sweeteners, and highlighting their importance for the development of the pharmaceutical and food industries.

Additional Benefit of Chinese Medicine Formulae Including Dioscoreae rhizome (Shanyao) for Diabetes Mellitus: Current State of Evidence

Background

Chinese medicine has been used to treat diabetes symptoms for thousands of years. Dioscoreae rhizome or Shanyao is a Chinese medicinal herb that is routinely used in the treatment of diabetes mellitus (DM).

Objective

The purpose of this study is to evaluate the evidence of the added benefits and safety of herbal formulae containing Shanyao in clinical studies and the possible mechanisms of Shanyao in the prevention and treatment of DM in experimental studies.

Methods

We searched nine databases for randomized controlled trials (RCTs) that included Shanyao in the formulae in the treatment of type 2 DM. Furthermore, experimental studies on the prevention and treatment of DM by Shanyao in English- and Chinese-language databases were identified.

Results

Fifty-three moderate quality RCTs with herbal formulae containing Shanyao were identified. Results from meta-analysis indicated that Shanyao alone or formulae containing Shanyao in addition to conventional treatments could benefit people with type 2 DM in lowering blood glucose, blood lipids and reducing insulin resistance. Moreover, adverse events were significantly lower in the CHM plus conventional group than those in the conventional group. Shanyao may exert the benefit through various mechanisms including inhibition of α-glucosidase and DPP-IV activity, increase of endogenous GLP-1 and immune regulating activities.

Conclusion

Evidence from this review suggested that there appeared to be added clinical benefits associated with the use of Shanyao for DM, whether as a food supplement or as a CHM combined with hypoglycemic agents with a good safety profile.

Structure and in vitro digestibility on complex of corn starch with soy isoflavone

Rapid starch digestion rate is negative for the normal level of human blood glucose. This study investigated the protective effects of corn starch (CS) complexed with soy isoflavone (SI) on the control of starch digestibility and glycemic index (GI). The structure of the corn starch-soy isoflavone (CS-SI) complexes was characterized by Fourier transform infrared (FT-IR), X-ray diffraction (XRD), Thermogravimetric analysis (TGA), and Differential scanning calorimetry (DSC), and the complexes digestibility was evaluated using in vitro digestion model. The results of FT-IR spectrum showed that, compared with corn starch, new characteristic peaks were not occurred in CS-SI complexes, and the value of R1047/1022 was decreased, which indicated the short-range structure of CS-SI complexes had been reduced. The V-shaped structure characteristic peaks occurred obviously in CS-SI complexes detected by XRD patterns, which formed a new crystalline structure. The thermal stability was improved in CS-SI complexes revealed by TGA and DTG curves that the thermal cracking temperature increased from 315°C to 320°C. The enthalpy (ΔH) of CS-SI complexes decreased from 2.34 J/g to 1.75 J/g showed by DSC data, which indicated that the ordered structure of starch was destroyed. Furthermore, the content of resistant starch increased from 10.53% to 21.78% and predicted glycemic index (pGI) reduced in CS-SI complexes. In conclusion, the digestibility and pGI of starch can be improved by complexed with soy isoflavone.

Nutritional interventions during bed rest and spaceflight: prevention of muscle mass and strength loss, bone resorption, glucose intolerance, and cardiovascular problems

Bed rest is necessary for many medical conditions but also used as a ground-based model for space flight (along with head-down tilt to simulate fluid shifts in microgravity). The purpose of this review is to examine nutritional interventions during bed rest and spaceflight for prevention of muscle and strength loss, glucose intolerance, bone resorption, and cardiovascular problems. Increased dietary protein intake and supplementation with amino acids, β-hydroxy-β-methylbutyrate, or cofactors with antioxidant properties are effective for ameliorating bed rest-induced loss of muscle mass and strength. Previous literature involving bed rest with dietary protein/amino acid supplementation had mixed findings, likely due to differences in dosage. Although high protein intake in some studies prevents bed rest-induced muscle loss, it also increases bone resorption. High calcium intake and vitamin D supplementation are not beneficial for preventing bone degradation during bed rest or spaceflight. Very few studies investigated countermeasures to prevent glucose intolerance and cardiovascular risks during bed rest/spaceflight. Low-glycemic index diets might be beneficial for the prevention of bed rest-induced glucose intolerance and cardiovascular problems. The present evidence warrants additional studies on the exact threshold of protein/amino acid intake to prevent the loss of muscle mass and strength during bed rest/spaceflight specifically to maintain the beneficial effects of proteins on muscle mass and function without increasing bone resorption. Furthermore, it is suggested to study the effects of vitamin K supplementation on bone health during bed rest/spaceflight and determine the role of long-term low-glycemic index diets on glucose regulation and cardiovascular health during extended bed rest.

Glycemic load, dietary fiber, and added sugar and fecundability in 2 preconception cohorts

BACKGROUND

Glycemic load (GL) reflects the quantity and quality of carbohydrates in the diet; dietary fiber and added sugar are components of GL. Few epidemiologic studies have assessed the association between these dietary factors and fecundability.

OBJECTIVE

We prospectively evaluated the associations of GL, total carbohydrates, dietary fiber, and added sugar with fecundability.

METHODS

Snart Foraeldre (SF) and Pregnancy Study Online (PRESTO) are parallel web-based prospective preconception cohorts of couples attempting to conceive in Denmark and North America. At baseline, female participants completed a web-based questionnaire on demographic and lifestyle factors and a validated FFQ. We calculated GL, total carbohydrate intake, total dietary fiber, carbohydrate-to-fiber ratio, and added sugar based on reported frequencies for individual foods, standard recipes for mixed foods, and average serving sizes. The analysis included 2709 SF participants and 4268 PRESTO participants. We used proportional probabilities regression models to estimate fecundability ratios (FR) and 95% CIs.

RESULTS

Compared with an average daily GL of ≤100, FRs for an average daily GL of ≥141 were 0.89 (95% CI: 0.73, 1.08) in SF and 0.87 (95% CI: 0.77, 0.98) in PRESTO participants. Compared with consuming ≤16 g/d of dietary fiber, FRs for consuming ≥25 g/d were 0.99 (95% CI: 0.81, 1.22) in SF and 1.06 (95% CI: 0.94, 1.20) in PRESTO. Compared with a carbohydrate-to-fiber ratio of ≤8, FRs for a ratio of ≥13 were 0.86 (95% CI: 0.73, 1.01) in SF and 0.87 (95% CI: 0.78, 0.98) in PRESTO. Compared with ≤27 g/d of added sugar, FRs for ≥72 g/d were 0.87 (95% CI: 0.68, 1.10) in SF and 0.86 (95% CI: 0.75, 0.99) in PRESTO participants.

CONCLUSIONS

Among women attempting to conceive in Denmark and North America, diets high in GL, carbohydrate-to-fiber ratio, and added sugar were associated with modestly reduced fecundability.

The association between glycemic index, glycemic load, and metabolic syndrome: a systematic review and dose-response meta-analysis of observational studies

PURPOSE

The association of glycemic index (GI) and glycemic load (GL) with metabolic syndrome (MetS) is controversial. Therefore, we conducted this first systematic review and dose-response meta-analysis of observational studies to quantify these associations.

METHODS

We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies up to 1 April 2019. Summary odds ratios (OR) and 95% confidence intervals (CI) were calculated by a random-effects model. This study was registered with PROSPERO (CRD42019131788).

RESULTS

We included eight high-quality (n = 5) or medium-quality (n = 3) cross-sectional studies in the final meta-analysis, comprising 6058 MetS events and 28,998 participants. The summary ORs of MetS for the highest versus lowest categories were 1.23 (95% CI 1.10-1.38, I² = 0, tau² = 0, n = 5) for dietary GI, 1.06 (95% CI 0.89-1.25, I² = 36.2%, tau² = 0.0151, n = 6) for dietary GL. The summary OR was 1.12 (95% CI 1.00-1.26, I² = 0, tau² = 0, n = 3) per 5 GI units, 0.96 (95% CI 0.83-1.10, I² = 33.4%, tau² = 0.0059, n = 2) per 20 GL units.

CONCLUSIONS

Dietary GI was positively associated with the prevalence of MetS. However, no significant association was found between dietary GL and the prevalence of MetS. Further studies with prospective design are needed to establish potential causal relationship between dietary GI and the MetS.

Effects of Glycemic Index and Cereal Fiber on Postprandial Endothelial Function, Glycemia, and Insulinemia in Healthy Adults

Both glycemic index and dietary fiber are associated with cardiovascular disease risk, which may be related in part to postprandial vascular effects. We examined the effects of both glycemic index (GI) and dietary (mainly cereal) fiber on postprandial endothelial function. Eleven adults (5 men; 6 women; age = 42.4 ± 16.1 years; weight = 70.5 ± 10.7 kg; height = 173.7 ± 8.7 cm) consumed four different breakfast meals on separate, randomized occasions: High-Fiber, Low-GI (HF-LGI: Fiber = 20.4 g; GI = 44); Low-Fiber, Low-GI (LF-LGI: Fiber = 4.3 g; GI = 43); Low-Fiber, High-GI (LF-HGI: Fiber = 3.6 g; GI = 70); High-Fiber, High-GI (HF-HGI: Fiber = 20.3 g; GI = 71). Meals were equal in total kcal (~600) and macronutrient composition (~90 g digestible carbohydrate; ~21 g protein; ~15 g fat). The HF-LGI meal resulted in a significant increase in flow-mediated dilation (FMD) 4 h after meal ingestion (7.8% ± 5.9% to 13.2% ± 5.5%; p = 0.02). FMD was not changed after the other meals. Regardless of fiber content, low-GI meals resulted in ~9% lower 4-h glucose area under curve (AUC) (p < 0.05). The HF-LGI meal produced the lowest 4-h insulin AUC, which was ~43% lower than LF-HGI and HF-HGI (p < 0.001), and 28% lower than LF-LGI (p = 0.02). We conclude that in healthy adults, a meal with low GI and high in cereal fiber enhances postprandial endothelial function. Although the effect of a low-GI meal on reducing postprandial glucose AUC was independent of fiber, the effect of a low-GI meal on reducing postprandial insulin AUC was augmented by cereal fiber.

Comparison of Low Glycaemic Index and High Glycaemic Index Potatoes in Relation to Satiety: A Single-Blinded, Randomised Crossover Study in Humans

High glycaemic index (GI) foods have been proposed to reduce satiety and thus promote overweight and obesity. Generally, potatoes have a high GI, but they also provide many beneficial nutrients and they are a highly important food source globally. In this study, we investigated how a low GI potato affected subjective satiety as compared to a high GI potato. Twenty healthy men (aged 18–40 years; body mass index (BMI) 18–27 kg/m²) participated in this single-blinded, controlled, randomised crossover trial. On each of the two trial days, the subjects were given a 500-gram portion of either a low or high GI potato variety (Carisma^® low GI and Arizona high GI). Subjective appetite sensations were measured at baseline and at +15 min, +45 min, +75 min, +105 min, and +135 min after consumption of the test meal until an ad libitum meal was served at +150 min. No significant differences in the primary endpoint, satiety, were found between the two potato varieties (all p > 0.05). Furthermore, no significant differences were found in the secondary endpoints; hunger, fullness, and prospective food consumption, or ad libitum energy intake (all p > 0.05). In conclusion, the results of this study do not indicate that the GI of potatoes is important for satiety in normal-weight men.

Improvement in Nutritional Attributes of Rice Starch with Dodecyl Gallate Complexation: A Molecular Dynamic Simulation and in Vitro Study

To improve starch functionalities such as digestibility and antioxidant activity, rice starch was complexed with antioxidant dodecyl gallate (DG). Molecular dynamics simulation showed that the starch-DG inclusion complex was favorable, and in 50 ns, the dodecyl segment resided in the helix of the amylose cavities but the gallate tail left outside. This theoretical finding was validated by UV-vis spectroscopy, calorimetric, and crystalline measurements, indicating V-type crystalline structures containing type I and type II inclusion complexes can be formed after DG complexation. Meritedly, starch digestibility was mitigated by synchronously increasing slowly digestible starch (5.12-22.83%) and resistant starch content (8.69-14.17%), and the antioxidant activity was also significantly increased. Such inclusion complexes thereby acted as a carrier for targeting delivery of DG to the human lower gastrointestinal tract with potent antioxidant activity. Complexation with DG synergistically improved starch digestibility and antioxidant activity, favoring the intervention against chronic diseases, by ameliorating the postprandial glycemic response and oxidative stress.

Consumer acceptability of gluten-free cookies containing raw cooked and germinated pinto bean flours

Beany and grassy flavors in raw edible bean flours reduce consumer acceptability of bean-based baked products. In order to improve consumer acceptability, beans may be further processed by cooking and germination. However, these operations drive up the cost of end-products. Therefore, it is necessary to develop formulations, using raw edible bean flours that have acceptable sensory attributes. In this study, cooked, germinated, and germinated/steam-blanched (GSB) pinto bean flours were used to make gluten-free cookies, and their sensory characteristics evaluated to determine how their consumer acceptability scores compared. Taste panelists (31) graded cookies made from raw pinto beans with an overall value of 6 on a 9-point hedonic scale (p < .05). This rating was not significantly different from cookies formulated with germinated and GSB flours. Therefore, gluten-free cookies can be made using raw pinto bean flours at a 40% inclusion level, with similar sensory characteristics as those prepared with flours treated by cooking and germination. Instrumental measurement of cookie hardness and color showed no significant difference in hardness, but significant differences in color. The germinated bean flour produced cookies with a significantly lower L* value and significantly higher a*, b*, Chroma and hue values compared to the other treatments. There was no significant difference in the cookie spread ratio. Proximate composition, water absorption index (WAI), water solubility index (WSI) and gelatinization properties of the flour treatments were characterized.

Potatoes and risk of obesity, type 2 diabetes, and cardiovascular disease in apparently healthy adults: a systematic review of clinical intervention and observational studies

BACKGROUND

Potatoes have been related to increased risks of obesity, type 2 diabetes (T2D), and cardiovascular disease (CVD) mainly because of their high glycemic index.

OBJECTIVE

We conducted a systematic review to evaluate the relation between intake of potatoes and risks of obesity, T2D, and CVD in apparently healthy adults.

DESIGN

MEDLINE, Embase, the Web of Science, and the Cochrane Central Register of Controlled Trials were searched for intervention and prospective observational studies that investigated adults without any known illnesses at baseline, recorded intake of potatoes, and measured adiposity (body weight, body mass index, or waist circumference), cases of T2D, cases of cardiovascular events, or risk markers thereof.

RESULTS

In total, 13 studies were deemed eligible; 5 studies were related to obesity, 7 studies were related to T2D, and one study was related to CVD. Only observational studies were identified; there were 3 studies with moderate, 9 studies with serious, and one study with critical risk of bias. The association between potatoes (not including french fries) and adiposity was neutral in 2 studies and was positive in 2 studies. French fries were positively associated with adiposity in 3 of 3 studies. For T2D, 2 studies showed a positive association, whereas 5 studies showed no or a negative association with intake of potatoes and T2D. French fries were positively associated with T2D in 3 of 3 studies that distinguished this relation. For CVD, no association was observed.

CONCLUSIONS

The identified studies do not provide convincing evidence to suggest an association between intake of potatoes and risks of obesity, T2D, or CVD. French fries may be associated with increased risks of obesity and T2D although confounding may be present. In this systematic review, only observational studies were identified. These findings underline the need for long-term randomized controlled trials. This trial was registered at the PROSPERO International prospective register of systematic reviews (www.crd.york.ac.uk/PROSPERO/) as CRD42015026491.

Mediterranean Diet and Cardiovascular Disease: A Critical Evaluation of A Priori Dietary Indexes

The aim of this paper is to analyze the a priori dietary indexes used in the studies that have evaluated the role of the Mediterranean Diet in influencing the risk of developing cardiovascular disease. All the studies show that this dietary pattern protects against cardiovascular disease, but studies show quite different effects on specific conditions such as coronary heart disease or cerebrovascular disease. A priori dietary indexes used to measure dietary exposure imply quantitative and/or qualitative divergences from the traditional Mediterranean Diet of the early 1960s, and, therefore, it is very difficult to compare the results of different studies. Based on real cultural heritage and traditions, we believe that the a priori indexes used to evaluate adherence to the Mediterranean Diet should consider classifying whole grains and refined grains, olive oil and monounsaturated fats, and wine and alcohol differently.

Inflammaging and cancer: a challenge for the Mediterranean diet

Aging is considered the major risk factor for cancer, one of the most important mortality causes in the western world. Inflammaging, a state of chronic, low-level systemic inflammation, is a pervasive feature of human aging. Chronic inflammation increases cancer risk and affects all cancer stages, triggering the initial genetic mutation or epigenetic mechanism, promoting cancer initiation, progression and metastatic diffusion. Thus, inflammaging is a strong candidate to connect age and cancer. A corollary of this hypothesis is that interventions aiming to decrease inflammaging should protect against cancer, as well as most/all age-related diseases. Epidemiological data are concordant in suggesting that the Mediterranean Diet (MD) decreases the risk of a variety of cancers but the underpinning mechanism(s) is (are) still unclear. Here we review data indicating that the MD (as a whole diet or single bioactive nutrients typical of the MD) modulates multiple interconnected processes involved in carcinogenesis and inflammatory response such as free radical production, NF-κB activation and expression of inflammatory mediators, and the eicosanoids pathway. Particular attention is devoted to the capability of MD to affect the balance between pro- and anti-inflammaging as well as to emerging topics such as maintenance of gut microbiota (GM) homeostasis and epigenetic modulation of oncogenesis through specific microRNAs.

Worsened arterial stiffness in high-risk cardiovascular patients with high habitual carbohydrate intake: a cross-sectional vascular function study

Background

Previous studies suggested that high dietary carbohydrate intake is associated with increased cardiovascular risk through raised triglyceride and decreased high-density lipoprotein-cholesterol levels. However, the relation between carbohydrate intake and arterial stiffness has not been established. The purpose of this study was to examine this relation among high-risk cardiovascular patients.

Methods

We studied the relation between dietary macronutrient intake and arterial stiffness in 364 patients with documented cardiovascular diseases or risk equivalent (coronary artery diseases 62%, ischemic stroke 13%, diabetes mellitus 55%) and in 93 age-and-sex matched control subjects. Dietary macronutrient intake was assessed using a validated food-frequency questionnaire (FFQ) for Chinese. Heart-ankle pulse wave velocity (PWV) was measured non-invasively with a Vascular Profiling System (VP2000, Colin Corp. USA). A dietary pattern with ≥60% total energy intake derived from carbohydrates was defined as a high-carbohydrate diet according to the Dietary Reference Intakes (DRI) for Chinese.

Results

Subjects who consumed a high-carbohydrate diet had significantly higher mean PWV than those who did not consume a high-carbohydrate diet (P = 0.039). After adjustment for potential confounders, high-carbohydrate diet was associated with significantly increased PWV [B = 73.50 (10.81 to 136.19), P = 0.022]. However, there was no significant association between high-carbohydrate diet and PWV in controls (P = 0.634).

Conclusions

High-carbohydrate diet is associated with increased arterial stiffness in patients with established cardiovascular disease or risk equivalent.

Expanding the indication spectrum: renal denervation in diabetes

Catheter-based renal denervation (RDN) has been shown to reduce sympathetic nerve activity and blood pressure in patients with resistant hypertension. Increased central sympathetic activity is a main contributor to the pathophysiology of several important chronic cardiovascular diseases, including diabetes and the metabolic syndrome. Indeed several recently published pilot studies and case reports suggest beneficial effects of RDN on glucose metabolism in patients with resistant hypertension. This review highlights the background of approaching the renal sympathetic nerves as a potential new therapeutic option to improve glycaemic control in patients with resistant hypertension.

Postprandial glucose and NF-κB responses are regulated differently by monounsaturated fatty acid and dietary fiber in impaired fasting glucose subjects

Recently, much attention has been paid to observational studies that have linked postprandial glycemic response with the risk of cardiovascular disease. In this study, we investigated whether the nutrient composition of dietary formula might affect the postprandial inflammation in impaired fasting glucose (IFG) subjects. Eight subjects underwent three trials in a double-blind, randomized, crossover study with a 1-week washout period. The subjects were given three formulas according to serving size: (1) high-fiber formula (FF); (2) high-monounsaturated fatty acid formula (MF); and (3) control formula (CF). The area under the curves (AUCs) for glucose decreased 0.65- and 0.54-fold in the FF and MF trials, respectively, when compared with CF. A similar pattern was observed for the postprandial insulin response. However, as observed by the phosphorylation of proteolytic degradation product IκB, the AUC for activation of nuclear transcription factor κB (NF-κB) in peripheral blood mononuclear cells was significantly decreased in the FF trial, but not with MF (P=.0114). These findings demonstrated that postprandial glucose and inflammatory responses might be regulated differently by the nutrient composition of dietary formulas in IFG subjects.

Low-glycaemic index diets in the management of blood lipids: a systematic review and meta-analysis

BACKGROUND

Dietary glycaemic index (GI) is a measure of the postprandial glycaemic response to carbohydrates. Observational studies have found increased triglycerides and decreased high-density lipoprotein levels in patients consuming higher GI foods.

OBJECTIVE

Our aim was to review and synthesize the evidence on the effect of low-glucose index diets on serum lipid levels.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials on the effect of low-GI diets on serum lipid levels. We searched PubMed, Embase and Cochrane Library for published, English-language, randomized controlled trials comparing low-GI and high-GI diets for the management of blood lipids in the general population with at least 4 weeks of follow-up. We conducted a meta-analysis assuming a random effects model.

RESULTS

Four studies met the criteria for inclusion in the systematic review and meta-analysis. The individual studies did not always show a significant effect of a low-GI diet on serum lipids; however, when combined in a meta-analysis, low-GI diets were shown to have a significant effect on decreasing total cholesterol and low-density lipoprotein (LDL) cholesterol over a short time span (5-12 weeks). There was no significant effect on high-density lipoprotein or triglyceride levels. The forest plots for total cholesterol and LDL cholesterol did not show significant statistical heterogeneity (I (2) = 0%).

CONCLUSION

This meta-analysis suggests that a low-GI diet may help lower total and LDL cholesterol. The generalizability of these findings is likely limited by heterogeneity in individual study definitions of low- or high-GI diets.

Effect of consumption of micronutrient enriched wheat steamed bread on postprandial plasma glucose in healthy and type 2 diabetic subjects

BACKGROUND

Steamed wheat bread have previously been shown to induce comparatively high postprandial plasma glucose responses, on the contrary, buckwheat products induced lower postprandial plasma glucose. The present study was to assess the effects of micronutrient enriched bread wheat variety Jizi439 and buckwheat on postprandial plasma glucose in healthy and diabetic subjects comparing with buckwheat and other bread wheat varieties.

METHODS

Two experiments were conducted to study the effects of bread wheat variety Jizi439 on the postprandial plasma glucose levels of the randomly selected subjects. The first experiment involved three types of steamed bread with equivalent of 50 g available carbohydrate fed to 10 normal weight young healthy subjects. Two types of steamed bread were made from two purple-grain bread wheat varieties, Jizi439 and Chu20, respectively, and the third type was made from the mixture of different white grain wheat varieties. Plasma glucose levels of each subject were measured at 15, 30, 45, 60, 120 min after eating. Glucose was used as a reference, the total area under curve (AUC) and glycemic index (GI) was calculated for test meal. The second experiment was performed among ten type 2 diabetics who were served equivalent of 50 g available carbohydrate of steamed bread made from Jizi 439, the mixture of white grain bread wheat and buckwheat, respectively. The plasma glucose increment was determined two hours thereafter.

RESULTS

In the first experiment, consumption of the steamed bread made from Jizi439 resulted in the least increase in plasma glucose and the GI was significantly lower than that of Chu20 and the mixture. In the second experiment, the average of postprandial 2 h plasma glucose increment of Jizi439 was 2.46 mmol/L which was significantly lower than that of the mixture of white wheat but was not significantly different from buckwheat.

CONCLUSIONS

The results indicated that consumption of Jizi439 steamed bread resulted in significantly lower plasma glucose in both healthy and diabetic subjects, compared with other types of test foods, except buckwheat bread. The steam bread made from Jizi439 would be an ideal food for preventing and treatment of diabetes.

Effects of dietary composition on energy expenditure during weight-loss maintenance

CONTEXT

Reduced energy expenditure following weight loss is thought to contribute to weight gain. However, the effect of dietary composition on energy expenditure during weight-loss maintenance has not been studied.

OBJECTIVE

To examine the effects of 3 diets differing widely in macronutrient composition and glycemic load on energy expenditure following weight loss.

DESIGN, SETTING, AND PARTICIPANTS

A controlled 3-way crossover design involving 21 overweight and obese young adults conducted at Children's Hospital Boston and Brigham and Women's Hospital, Boston, Massachusetts, between June 16, 2006, and June 21, 2010, with recruitment by newspaper advertisements and postings.

INTERVENTION

After achieving 10% to 15% weight loss while consuming a run-in diet, participants consumed an isocaloric low-fat diet (60% of energy from carbohydrate, 20% from fat, 20% from protein; high glycemic load), low-glycemic index diet (40% from carbohydrate, 40% from fat, and 20% from protein; moderate glycemic load), and very low-carbohydrate diet (10% from carbohydrate, 60% from fat, and 30% from protein; low glycemic load) in random order, each for 4 weeks.

MAIN OUTCOME MEASURES

Primary outcome was resting energy expenditure (REE), with secondary outcomes of total energy expenditure (TEE), hormone levels, and metabolic syndrome components.

RESULTS

Compared with the pre-weight-loss baseline, the decrease in REE was greatest with the low-fat diet (mean [95% CI], -205 [-265 to -144] kcal/d), intermediate with the low-glycemic index diet (-166 [-227 to -106] kcal/d), and least with the very low-carbohydrate diet (-138 [-198 to -77] kcal/d; overall P = .03; P for trend by glycemic load = .009). The decrease in TEE showed a similar pattern (mean [95% CI], -423 [-606 to -239] kcal/d; -297 [-479 to -115] kcal/d; and -97 [-281 to 86] kcal/d, respectively; overall P = .003; P for trend by glycemic load < .001). Hormone levels and metabolic syndrome components also varied during weight maintenance by diet (leptin, P < .001; 24-hour urinary cortisol, P = .005; indexes of peripheral [P = .02] and hepatic [P = .03] insulin sensitivity; high-density lipoprotein [HDL] cholesterol, P < .001; non-HDL cholesterol, P < .001; triglycerides, P < .001; plasminogen activator inhibitor 1, P for trend = .04; and C-reactive protein, P for trend = .05), but no consistent favorable pattern emerged.

CONCLUSION

Among overweight and obese young adults compared with pre-weight-loss energy expenditure, isocaloric feeding following 10% to 15% weight loss resulted in decreases in REE and TEE that were greatest with the low-fat diet, intermediate with the low-glycemic index diet, and least with the very low-carbohydrate diet.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00315354.

Postprandial impairment of flow-mediated dilation and elevated methylglyoxal after simple but not complex carbohydrate consumption in dogs

Hyperglycemia produces oxidative stress, which may impair endothelial function. Methylglyoxal, a reactive intermediate metabolite of glucose, is known to cause oxidative stress and is produced when excess carbohydrate is consumed in diabetic patients, but postprandial responses in healthy patients are unknown. We hypothesize that methylglyoxal levels will cause impaired endothelial function via increased oxidative stress after consuming a high glycemic index meal in healthy animals. Normal-weight laboratory beagles (n = 6) were used in a crossover study that tested postprandial responses of 4 complex carbohydrate sources (barley, corn, peas, rice) vs a simple carbohydrate (glucose). Blood samples were taken prefeeding and at timed intervals after feeding to measure serum glucose, insulin, nitrotyrosine, and methylglyoxal. Flow-mediated dilation (FMD), cardiac function (echocardiography), and blood pressure measurements were determined before and 60 minutes after feeding. The mean (±SEM) glycemic indices of the complex carbohydrate sources were 29 ± 5 for peas, 47 ± 10 for corn, 51 ± 7 for barley, and 55 ± 6 for rice. Postprandial FMD was lowest in the glucose group and significantly different from both the corn group and the FMD value for all complex carbohydrates combined. Methylglyoxal was significantly elevated at 60 minutes postprandial after glucose compared with the other carbohydrate sources. No significant effects of carbohydrate source were observed for blood pressure, nitrotyrosine, or echocardiographic variables. The novel finding of this study was that methylglyoxal levels increased after a single feeding of simple carbohydrate and may be linked to the observed postprandial decrease in endothelial function. Thus, consuming low-glycemic-index foods may protect the cardiovascular system by reducing oxidative stress.

Low glycaemic index dietary interventions in youth with cystic fibrosis: a systematic review and discussion of the clinical implications

A systematic review was conducted to assess what is known about the effect of low glycaemic index (GI) diets on glycaemic control, weight and quality of life in youth with cystic fibrosis (CF). Eligibility criteria were systematic reviews, randomised and non-randomised trials of low GI dietary interventions in CF. Outcomes examined were glycaemic control, quality of life, anthropometry and respiratory function. Reference lists were manually searched and experts in the field were consulted. Four studies met the eligibility criteria; two were excluded because they did not include data on any of the outcomes. The remaining two were studies that examined GI secondary to any other intervention: one used GI as a factor in enteral feeds and the other incorporated low GI dietary education into its treatment methodology. There is insufficient evidence to recommend use of low GI diets in CF. Since there is evidence to support use of low GI diets in type 1, type 2 and gestational diabetes, low GI diets should be tested as an intervention for CF. The potential risks and benefits of a low GI diet in CF are discussed.

Dietary fiber, gut peptides, and adipocytokines

The consumption of dietary fiber (DF) has increased since it was related to the prevention of a range of illnesses and pathological conditions. DF can modify some gut hormones that regulate satiety and energy intake, thus also affecting lipid metabolism and energy expenditure. Among these gut hormones are ghrelin, glucagon-like peptide 1, peptide YY, and cholecystokinin. Adipose tissue is known to express and secrete a variety of products known as "adipocytokines," which are also affected by DF. Some of the most relevant adipocytokines include adiponectin, leptin, tumor necrosis factor-α, and interleukin-6. The release of adipocytokines, by either adipocytes or macrophage-infiltrated adipose tissue, leads to a chronic subinflammatory state that could play a central role in the development of insulin resistance and type 2 diabetes, therefore increasing the risk of cardiovascular disease associated with obesity. DF modulation of these molecules could also have positive effects on obesity, insulin resistance, and hyperlipidemia. This review is focused on the effects of DF on the above-mentioned gut peptides and adipocytokines.

Effect of renal sympathetic denervation on glucose metabolism in patients with resistant hypertension: a pilot study

BACKGROUND

Hypertension is associated with impaired glucose metabolism and insulin resistance. Chronic activation of the sympathetic nervous system may contribute to either condition. We investigated the effect of catheter-based renal sympathetic denervation on glucose metabolism and blood pressure control in patients with resistant hypertension.

METHODS AND RESULTS

We enrolled 50 patients with therapy-resistant hypertension. Thirty-seven patients underwent bilateral catheter-based renal denervation, and 13 patients were assigned to a control group. Systolic and diastolic blood pressures, fasting glucose, insulin, C peptide, hemoglobin A(1c), calculated insulin sensitivity (homeostasis model assessment-insulin resistance), and glucose levels during oral glucose tolerance test were measured before and 1 and 3 months after treatment. Mean office blood pressure at baseline was 178/96±3/2 mm Hg. At 1 and 3 months, office blood pressure was reduced by -28/-10 mm Hg (P<0.001) and -32/-12 mm Hg (P<0.001), respectively, in the treatment group, without changes in concurrent antihypertensive treatment. Three months after renal denervation, fasting glucose was reduced from 118±3.4 to 108±3.8 mg/dL (P=0.039). Insulin levels were decreased from 20.8±3.0 to 9.3±2.5 μIU/mL (P=0.006) and C-peptide levels from 5.3±0.6 to 3.0±0.9 ng/mL (P=0.002). After 3 months, homeostasis model assessment-insulin resistance decreased from 6.0±0.9 to 2.4±0.8 (P=0.001). Additionally, mean 2-hour glucose levels during oral glucose tolerance test were reduced significantly by 27 mg/dL (P=0.012). There were no significant changes in blood pressure or metabolic markers in the control group.

CONCLUSIONS

Renal denervation improves glucose metabolism and insulin sensitivity in addition to a significantly reducing blood pressure. However, this improvement appeared to be unrelated to changes in drug treatment. This novel procedure may therefore provide protection in patients with resistant hypertension and metabolic disorders at high cardiovascular risk.

CLINICAL TRIAL REGISTRATION

URL: http://www.ClinicalTrials.gov. Unique identifiers: NCT00664638 and NCT00888433.

Fasting plasma glucose in non-diabetic participants and the risk for incident cardiovascular events, diabetes, and mortality: results from WOSCOPS 15-year follow-up

AIMS

The evidence base for fasting plasma glucose (FPG) in the non-diabetic range as a risk factor for cardiovascular disease (CVD) is inconclusive. We investigated this question in the West of Scotland Coronary Prevention Study (WOSCOPS).

METHODS AND RESULTS

In WOSCOPS, we related FPG in 6447 men (mean age 55 years) with hypercholesterolaemia, but no history of CVD or diabetes, to the risk of cardiovascular events and mortality over 14.7 years of follow-up; 2381 non-fatal/fatal cardiovascular events and 1244 deaths occurred. Participants were divided into fifths of baseline FPG, Q1 (< or =4.3 mmol/L) to Q5 (>5.1-6.9 mmol/L). Q2 was designated the referent based on previous studies which have suggested a J-shaped relationship between FPG and CVD. Compared with Q2 (>4.3-4.6 mmol/L), men in Q5 had no elevated risk for cardiovascular events [hazard ratio (HR) 0.95 (0.83-1.08)], or all-cause mortality [HR 0.96 (0.80-1.15)] in fully adjusted analyses despite a significant risk for incident diabetes [HR 22.05 (10.75-45.22)]. After further dividing Q5 into fifths, Q5a-e, individuals in Q5e (FPG 5.8-6.9 mmol/L) were also not at increased risk of cardiovascular events [HR 1.05 (0.82-1.35)] or other endpoints compared with Q2. All results were similar using Q1 as the referent.

CONCLUSION

Elevations in FPG in the non-diabetic range were not associated with long-term risk of cardiovascular events in middle-aged men in WOSCOPS. These data suggest that the current FPG cutoff for diagnosing diabetes also appropriately identifies western men at risk of CVD.

Diversity in the glucose transporter-4 gene (SLC2A4) in humans reflects the action of natural selection along the old-world primates evolution

BACKGROUND

Glucose is an important source of energy for living organisms. In vertebrates it is ingested with the diet and transported into the cells by conserved mechanisms and molecules, such as the trans-membrane Glucose Transporters (GLUTs). Members of this family have tissue specific expression, biochemical properties and physiologic functions that together regulate glucose levels and distribution. GLUT4 -coded by SLC2A4 (17p13) is an insulin-sensitive transporter with a critical role in glucose homeostasis and diabetes pathogenesis, preferentially expressed in the adipose tissue, heart muscle and skeletal muscle. We tested the hypothesis that natural selection acted on SLC2A4.

METHODOLOGY/PRINCIPAL FINDINGS

We re-sequenced SLC2A4 and genotyped 104 SNPs along a approximately 1 Mb region flanking this gene in 102 ethnically diverse individuals. Across the studied populations (African, European, Asian and Latin-American), all the eight common SNPs are concentrated in the N-terminal region upstream of exon 7 ( approximately 3700 bp), while the C-terminal region downstream of intron 6 ( approximately 2600 bp) harbors only 6 singletons, a pattern that is not compatible with neutrality for this part of the gene. Tests of neutrality based on comparative genomics suggest that: (1) episodes of natural selection (likely a selective sweep) predating the coalescent of human lineages, within the last 25 million years, account for the observed reduced diversity downstream of intron 6 and, (2) the target of natural selection may not be in the SLC2A4 coding sequence.

CONCLUSIONS

We propose that the contrast in the pattern of genetic variation between the N-terminal and C-terminal regions are signatures of the action of natural selection and thus follow-up studies should investigate the functional importance of different regions of the SLC2A4 gene.

Dietary glycemic index, dietary glycemic load, blood lipids, and coronary heart disease

Objective. To examine the associations of dietary glycemic index (GI) and dietary glycemic load (GL) with blood lipid concentrations and coronary heart disease (CHD) in nondiabetic participants in the Health Worker Cohort Study (HWCS). Materials and Methods. A cross-sectional analysis was performed, using data from adults who participated in the HWCS baseline assessment. We collected information on participants' socio-demographic conditions, dietary patterns and physical activity via self-administered questionnaires. Dietary GI and dietary GL were measured using a validated food frequency questionnaire. Anthropometric and clinical measurements were assessed with standardized procedures. CHD risk was estimated according to the sex-specific Framingham prediction algorithms. Results. IIn the 5,830 individuals aged 20 to 70 who were evaluated, dietary GI and GL were significantly associated with HDL-C, LDL-C, LDL-C/HDL-C ratio, and triglycerides serum levels. Subjects with high dietary GI have a relative risk of 1.56 (CI 95%; 1.13-2.14), and those with high dietary GL have a relative risk of 2.64 (CI 95%; 1.15-6.58) of having an elevated CHD risk than those who had low dietary GI and GL. Conclusions. Our results suggest that high dietary GI and dietary GL could have an unfavorable effect on serum lipid levels, which are in turn associated with a higher CHD risk.

Effects of glycemic load on metabolic health and type 2 diabetes mellitus

A large body of epidemiologic evidence has demonstrated that the combination of a Western diet and lifestyle is primarily responsible for the increased metabolic disease risk, such as obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome, noted in society today. Thus finding optimal intervention strategies to combat these growing epidemics is imperative. Despite some controversy, a growing body of literature indicates that one aspect of diet that likely affects phenotypic outcomes and metabolic disease risk is the glycemic load (GL). This brief review will provide an overview of the GL concept, discuss epidemiologic work investigating relationships between both GL and metabolic risk factors, as well as intervention studies that have assessed the impact of GL on phenotypic outcomes related to T2DM and cardiovascular disease. Overall, a low dietary GL may be protective against metabolic disease and should be considered as a healthful dietary component.

Functional Foods as Modifiers of Cardiovascular Disease

There is growing consensus that systemic inflammation is at the heart of cardiovascular disease (CVD). Inflammation is a key feature of the immune system, functioning to defend tissue integrity and function. However, chronic stimulation of inflammatory mediators leads to lasting vascular reactivity, insulin resistance, hyperlipidemia, and, subsequently, chronic disease. Dietary practices to minimize inflammatory stimuli and CVD risk include regular intakes of fatty fish rich in the eicosapentaenoic and docosahexaenoic acids that compete with the more pervasive membrane fatty acid, arachidonic acid, disrupting the metabolic cascades that stimulate inflammation. Another effective dietary strategy is to consume less arachidonic acid by reducing beef, poultry, fish, and eggs from the diet (e.g., adopting a vegetarian-like diet). Since oxidative stress plays a prominent role in immune system activation, regular ingestion of ample amounts of fruits and vegetables (8+ servings/d) rich in antioxidant compounds, the polyphenols, carotenoids, and vitamin C (e.g., citrus, tomatoes, berries, carrots, and greens), lowers inflammatory mediators and risk for chronic disease. Whole grains, legumes, and nuts have also been demonstrated in clinical trials to effectively reduce inflammatory mediators and risk for CVD. Hence, as proclaimed in antiquity, 'let food be thy medicine and medicine be thy food'.