Plant-Based Nutrition: An Essential Component of Cardiovascular Disease Prevention and Management

COVID-19-Associated Sepsis: Potential Role of Phytochemicals as Functional Foods and Nutraceuticals

The acute manifestations of coronavirus disease 2019 (COVID-19) exhibit the hallmarks of sepsis-associated complications that reflect multiple organ failure. The inflammatory cytokine storm accompanied by an imbalance in the pro-inflammatory and anti-inflammatory host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to severe and critical septic shock. The sepsis signature in severely afflicted COVID-19 patients includes cellular reprogramming and organ dysfunction that leads to high mortality rates, emphasizing the importance of improved clinical care and advanced therapeutic interventions for sepsis associated with COVID-19. Phytochemicals of functional foods and nutraceutical importance have an incredible impact on the healthcare system, which includes the prevention and/or treatment of chronic diseases. Hence, in the present review, we aim to explore the pathogenesis of sepsis associated with COVID-19 that disrupts the physiological homeostasis of the body, resulting in severe organ damage. Furthermore, we have summarized the diverse pharmacological properties of some potent phytochemicals, which can be used as functional foods as well as nutraceuticals against sepsis-associated complications of SARS-CoV-2 infection. The phytochemicals explored in this article include quercetin, curcumin, luteolin, apigenin, resveratrol, and naringenin, which are the major phytoconstituents of our daily food intake. We have compiled the findings from various studies, including clinical trials in humans, to explore more into the therapeutic potential of each phytochemical against sepsis and COVID-19, which highlights their possible importance in sepsis-associated COVID-19 pathogenesis. We conclude that our review will open a new research avenue for exploring phytochemical-derived therapeutic agents for preventing or treating the life-threatening complications of sepsis associated with COVID-19.

Canola Seed Protein: Pretreatment, Extraction, Structure, Physicochemical and Functional Characteristics

The rapid growth of the global population has led to an unprecedented demand for dietary protein. Canola seeds, being a widely utilized oil resource, generate substantial meal by-products following oil extraction. Fortunately, canola meals are rich in protein. In this present review, foremost attention is directed towards summarizing the characteristics of canola seed and canola seed protein. Afterwards, points of discussion related to pretreatment include an introduction to pulsed electric field treatment (PEF), microwave treatment (MC), and ultrasound treatment (UL). Then, the extraction method is illustrated, including alkaline extraction, isoelectric precipitation, acid precipitation, micellization (salt extraction), and dry fractionation and tribo-electrostatic separation. Finally, the structural complexity, physicochemical properties, and functional capabilities of rapeseed seeds, as well as the profound impact of various applications of rapeseed proteins, are elaborated. Through a narrative review of recent research findings, this paper aims to enhance a comprehensive understanding of the potential of canola seed protein as a valuable nutritional supplement, highlighting the pivotal role played by various extraction methods. Additionally, it sheds light on the broad spectrum of applications where canola protein demonstrates its versatility and indispensability as a resource.

Anti-inflammatory and antioxidant actions of extracts from Rheum rhaponticum and Rheum rhabarbarum in human blood plasma and cells in vitro

Rheum rhaponticum L. (rhapontic rhubarb) and Rheum rhabarbarum L. (garden rhubarb) are edible and medicinal rhubarb species used for many centuries in traditional medicine. This work is focused on the biological activity of extracts from petioles and roots of R. rhaponticum and R. rhabarbarum as well as rhapontigenin and rhaponticin, typical stilbenes present in these rhubarbs, in a context of their effects on blood physiology and cardiovascular health. Anti-inflammatory properties of the examined substances were evaluated in human peripheral blood mononuclear cells (PBMCs) and THP1-ASC-GFP inflammasome reporter cells. Due to the coexistence of inflammation and oxidative stress in cardiovascular diseases, the study design included also antioxidant assays. This part of the work involved the assessment of the protective efficiency of the examined substances against the peroxynitrite-triggered damage to human blood plasma components, including fibrinogen, a protein of critical importance for blood clotting and maintaining the haemostatic balance. Pre-incubation of PBMCs with the examined substances (1-50 μg/mL) considerably decreased the synthesis of prostaglandin E2 as well as the release of pro-inflammatory cytokines (IL-2 and TNF-α) and metalloproteinase-9. A reduced level of secreted apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) specks in the THP-1-ASC-GFP cells was also observed. The examined substances significantly diminished the extent of ONOO‾induced oxidative modifications of blood plasma proteins and lipids and normalized, or even strengthened blood plasma antioxidant capacity. Furthermore, a reduction of oxidative damage to fibrinogen, including modifications of tyrosine and tryptophan residues along with the formation of protein aggregates was found.

Snapshot of proteomic changes in Aspergillus oryzae during various stages of fermentative processing of pea protein isolate

Pea (Pisum sativum) is one of the most abundant and sustainable alternate source of protein. Although pea proteins have good quantities of most of the essential amino acids, they have a limited supply of tryptophan, methionine and cysteine. Moreover, pea proteins have poor techno-functional properties compared to proteins from animal sources, limiting their use in certain food applications. Bioprocessing techniques like solid-state fermentation (SSF) and enzymatic processing have been explored to improve the nutrient profile and functionality of pea proteins. However, there is a lack of information about proteomic changes in the food matrix during fermentation of the pea substrate. In this research, samples during SSF of pea protein isolate with Aspergillus oryzae were used for shotgun mass spectrometry (LC-MS/MS) analysis to identify the underlying functional pathways which play direct or indirect roles in enabling the colonization of the substrate leading to potential improvement of functional and nutritional value of pea protein. Results revealed the identity of A. oryzae proteins involved in different metabolic pathways that differed during various stages of SSF. Among them, methionine synthase was identified as an abundant protein, which catalyzes methionine biosynthesis. This might suggest how fermentation processes could be used to improve the presence of sulfur containing amino acids to rebalance the essential amino acid profile and improve the nutritional quality of pea proteins.

Dietary phytochemical index is favorably associated with oxidative stress status and cardiovascular risk factors in adults with obesity

Phytochemicals are bioactive compounds found in plant-based foods. Consumption of phytochemical-rich foods has been associated with cardiovascular and metabolic diseases prevention in various populations. To quantify the phytochemical content of the diet, dietary phytochemical index (DPI) was established which is defined as the proportion of daily energy intake derived from foods rich in phytochemicals. The purpose of this study was to evaluate the association between the DPI and oxidative stress markers and cardiovascular risk factors in obese adults. In this cross-sectional study, a total of 140 adults aged 20-60 years and body mass index (BMI) of ≥ 30 kg/m² were included. A validated food frequency questionnaire (FFQ) was used to collect information on dietary intakes. The DPI was calculated based on the following formula: DPI = [daily energy obtained from foods rich in phytochemicals (kcal)/total daily energy intake (kcal) × 100]. There was an inverse association between DPI and serum concentrations of Malondialdehyde (MDA) (P = 0.004), triglyceride (TG) (P-trend = 0.003), high-sensitive C-reactive protein (hs-CRP) (P = 0.017), and erythrocyte superoxide dismutase (SOD) activity (P = 0.024). Total antioxidant capacity (TAC) was positively associated with DPI score (P = 0.045). No significant relationship was found between the DPI score and fasting blood sugar (FBS), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total oxidant status (TOS), glutathione peroxidase (GPx), catalase (CAT), and anthropometric parameters as well as systolic and diastolic blood pressure. The current study found that there was a significant inverse association between DPI and oxidative stress, inflammation, and hypertriglyceridemia as cardiovascular disease (CVD) risk factors in obese population. However, further research is needed to confirm these findings.

The Association between Plant-Based Diet Indices and Metabolic Syndrome in Chinese Adults: Longitudinal Analyses from the China Health and Nutrition Survey

Objectives: To investigate the association between a plant-based diet and metabolic syndrome (MetS) among Chinese adults. Methods: Based on the data from the 2004–2015 China Health and Nutrition Survey and the corresponding edition of China Food Composition, we calculated the healthy plant-based diet indices (hPDI) and unhealthy plant-based diet indices (uPDI). The Cox proportional hazards regression model was used to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs) for MetS. Mediation analysis was further conducted to explore the mediator role of Body Mass Index (BMI) in the association between hPDI and MetS. Results: We included 10,013 participants, and over a median follow-up of 5 years, 961 patients (9.60%) developed MetS. Compared to those in the lowest quintile of hPDI score, we found that those in the highest quintile of hPDI score had a 28% lower ([HR]: 0.72, 95% CI 0.56–0.93, Ptrend = 0.021) risk of developing MetS and had a 20% lower (hazard ratio [HR]: 0.80, 95% CI 0.70–0.92, Ptrend = 0.004) risk of developing abdominal obesity. No significant associations were observed between uPDI and the MetS, but those in the highest quintile of uPDI score had a 36% higher (hazard ratio [HR]: 1.36, 95% CI 1.20–1.64, Ptrend < 0.001) risk of developing abdominal obesity, compared to those in the lowest quintile of uPDI score. In exploratory analysis, we observed that BMI at baseline mediated 27.8% of the association between hPDI and incident MetS, and BMI at baseline mediated 29.7% of the association between hPDI and abdominal obesity. Conclusion: The current findings reveal a possible causal relationship between a healthy plant-based diet and a reduced risk of MetS, especially abdominal obesity. It is observed that BMI may mediate the relationship between hPDI score and MetS. Controlling early dietary patterns and BMI may help reduce the risk of MetS.

Catechin isolated from faba beans (Vicia faba L.): insights from oxidative stress and hypoglycemic effect in yeast cells through confocal microscopy, flow cytometry, and in silico strategy

The present aim of this investigation was to evaluate the effect of catechin from faba beans on oxidative stress and glucose uptake in yeast cells. Flow cytometry approach indicated that 2-NBDG (1.98 ± 0.37) seed extract had a lower relative fluorescence signal than methanol (5.98 ± 0.67) and acetone seed extract (4.43 ± 0.55). In comparison to the control and seed extract, H₂O₂ exposure increased the apoptosis rate of yeast cells from 8.20% to 64.80%. Yeast cells incubated with H₂O₂ produced significantly more ROS intensity (162 ± 4.32, p < 0.05) than control cells (118 ± 2.52, p < 0.05) and less than seed extract-treated cells. Molecular dynamics simulation studies were performed for cat:α-amylase (catechin-α-amylase complex) which revealed the stable and mixed mode of inhibition during a simulation. The synergistic action of polyphenols or catechin present in seed extract may be responsible for the anti-oxidative stress and hypoglycaemic effects. The findings of this study may provide insight into the further development of a novel antidiabetic drug for T2DM. Communicated by Ramaswamy H. Sarma.

Protein Sources Alternative to Meat: State of the Art and Involvement of Fermentation

Meat represents an important protein source, even in developing countries, but its production is scarcely sustainable, and its excessive consumption poses health issues. An increasing number of Western consumers would replace, at least partially, meat with alternative protein sources. This review aims at: (i) depicting nutritional, functional, sensory traits, and critical issues of single-cell proteins (SCP), filamentous fungi, microalgae, vegetables (alone or mixed with milk), and insects and (ii) displaying how fermentation could improve their quality, to facilitate their use as food items/ingredients/supplements. Production of SCP (yeasts, filamentous fungi, microalgae) does not need arable land and potable water and can run continuously, also using wastes and byproducts. Some filamentous fungi are also consumed as edible mushrooms, and others are involved in the fermentation of traditional vegetable-based foods. Cereals, pseudocereals, and legumes may be combined to offer an almost complete amino acid profile. Fermentation of such vegetables, even in combination with milk-based products (e.g., tarhana), could increase nutrient concentrations, including essential amino acids, and improve sensory traits. Different insects could be used, as such or, to increase their acceptability, as ingredient of foods (e.g., pasta). However, insects as a protein source face with safety concerns, cultural constraints, and a lack of international regulatory framework.

Effect of food processing on antioxidants, their bioavailability and potential relevance to human health

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Processing alters the amount, matrix interaction, and structure of antioxidants.

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It is not easy to dissociate processing effects from food matrix effects.

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It is still difficult to make general statements on the effects of processing on bioavailability.

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Facilitated release by heat, pressure, etc. contributes to increased bioaccessibility.

It has long been recognized that the antioxidants present in fresh plant materials may be very different to those we ingest via our foods. This is often due to the use of food processing strategies involving thermal/non-thermal treatments. Current research mostly focuses on determining what is present in vegetative starting materials; how this is altered during processing; how this influences activity in the gut and following uptake into bloodstream; and which in vivo physiological effects this may have on human body. Having a better understanding of these different steps and their importance in a health-and-nutrition-context will place us in a better position to breed for improved crop varieties and to advise the food industry on how to optimize processing strategies to enhance biochemical composition of processed foods. This review provides an overview of what is currently known about the influence which food processing treatments can have on antioxidants and gives some pointers as to their potential relevance.

Amaro I, Fabricio Salinas J. Statistical Analysis of Mortality by Non-Communicable Diseases (NCDs) and food supply in Ecuador, 1990-2017

An unhealthy diet is a risk factor for non-communicable diseases (NCDs). Data on the average protein supply and meat products between 1990-2017 consumed by the Ecuadorian population are collected. The HJ-Biplot method is used to identify clusters with MultBiplot software to obtain a two-dimensional representation of the data in the plane along with the quality of representation of the variables and the total variance explained. This work aims to determine how much the source of protein, animal or vegetal, influences the amount of death caused by non-communicable diseases such as Cardiovascular diseases and Diabetes Mellitus. Finally, a Hierarchical Cluster Analysis is carried out with the food supply related to those diseases. It can be concluded that NCD mortality is primarily explained by the average protein supply of animal and meat products in Ecuador. Keywords: Ecuador, Non-Communicable Diseases, Cardiovascular disease, Diabetes, HJ-Biplot, food, proteins.]

Achieving nutritional security in India through iron and zinc biofortification in pearl millet (Pennisetum glaucum (L.) R. Br.)

The health problems caused by iron (Fe) and zinc (Zn) deficiency plague developing and underdeveloped countries. A vegetarian person mainly depends on cereal based diet with low quantity of Fe and Zn. Biofortification is an economical and sustainable approach to challenge the micronutrient malnutrition problem globally. Pearl millet (Pennisetum glaucum (L.) R. Br.) is one of the nutri-cereals and mostly grown under hot, dry conditions on infertile soils of low water-holding capacity, where other crops generally fail. It contains anti-nutrient compounds like phytic acid and polyphenols which reduce the mineral bioavailability because of their chelating properties. Biofortification of pearl millet is like a double-edged sword which cuts down the economic burden and simultaneously supplies required nutrition to the poor, offering a great scope for food security as well as nutritional security. With this background, this review focus on biofortification of grain Fe and Zn content in pearl millet. Genetic research on Fe and Zn uptake and accumulation in pearl millet grain is crucial in identifying the 'bottlenecks' in biofortification. The review also reveals the need and strategies for increasing bioavailability of Fe and Zn in humans by increasing promoters and decreasing anti-nutritional factors in pearl millet.

Plant-Based Diets and Peritoneal Dialysis: A Review

Whole food plant-based diets are gaining popularity as a preventative and therapeutic modality for numerous chronic health conditions, including chronic kidney disease, but their role and safety in end-stage kidney disease patients on peritoneal dialysis (PD) is unclear. Given the general public’s increased interest in this dietary pattern, it is likely that clinicians will encounter individuals on PD who are either consuming, considering, or interested in learning more about a diet with more plants. This review explores how increasing plant consumption might affect those on PD, encompassing potential benefits, including some specific to the PD population, and potential concerns.

Plant-based diets: a review of the definitions and nutritional role in the adult diet

Plant-based (PB) diets are associated with good health and are also recommended for environmental sustainability. The present review aimed to summarise the definitions of PB diets globally and to investigate the nutritional role of PB diets in adults. This review found that there is a wide range of PB definitions ranging from the traditional vegetarian diets (including vegan) to semi-vegetarian/flexitarian diets. Furthermore, other diets which were originally developed due to their associations with positive health outcomes, such as the portfolio, Mediterranean-style, DASH, healthy US-style, planetary health and Nordic-style diets, have been encompassed in PB definitions due to their emphasis on certain PB components. This review has highlighted that those consuming a PB diet are more likely to meet recommended intakes for carbohydrate, dietary fibre and vitamin E and are less likely to meet recommendations for protein, vitamin B12 and iodine compared to omnivores. Regardless of consumer type, neither PB consumers nor omnivores met recommendations for intakes of vitamin D, calcium and sodium. While intakes of protein, n-3, iron and zinc were generally sufficient from the PB diet, it is important to acknowledge the lower bioavailability of these nutrients from PB foods compared to animal-derived products. As dietary patterns shift towards a more PB diet, there is a need for further studies to investigate the role of PB diets for nutritional adequacy and status in populations currently accustomed to consuming a primarily omnivorous diet.

Early nutritional influences of cardiovascular health

INTRODUCTION

Increasing evidence shows that nutritional choices during children's formative years, including prenatally, impacts the development of adult onset cardiovascular diseases (CVDs), such as hypertension, myocardial infarction, or stroke.

AREAS COVERED

This literature review aims to synthesize the current body of evidence on nutritional factors, from conception through adolescence, which may influence a person's risk factors for future development of CVD.

EXPERT OPINION

Given the escalating healthcare costs associated with CVD, it is imperative that medical professionals and scientists remain steadfast in prioritizing and promoting early CVD prevention, even within the first few years of life. Though not the only contributing risk factor, diet is a modifiable risk factor and has been shown to have a profound impact on the reduction of cardiovascular morbidity and mortality in adult literature. Nutritional choices should be targeted on multiple levels: prenatally with the mother, individually with the patient, in conjunction with their family unit, and also within the broader community wherein they reside. Healthcare providers can play a key advocacy role for local and national food environment policy changes.

Association between Unhealthful Plant-Based Diets and Possible Risk of Dyslipidemia

The relationship between the various types of diets derived from plants and vulnerability of dyslipidemia has rarely been investigated, and limited data exist in Asians whose dietary pattern is fairly different from that of the Western population. We aim to analyze the relationship between three plant-based diet indices (PDI) and the risk of dyslipidemia. Participants included 173,209 Korean adults who were aged ≥40 years from the Korean Genome and Epidemiology Study_Health Examination (2004–2013). A food frequency questionnaire (FFQ) was used to assess dietary intake. Three PDI were quantified for the study: overall PDI, healthful PDI (hPDI), and unhealthful PDI (uPDI). Among the 147,945 included, 48,166 (32.6%) of participants had dyslipidemia. Great adherence to uPDI was related with 15% greater odds of having dyslipidemia (OR: 1.15; 95% CI: 1.11–1.20, p-trend < 0.0001). No significant association was observed between PDI, hPDI, and dyslipidemia. The association between uPDI and dyslipidemia was significantly stronger among participants aged ≥55 years when compared to participants aged <55 years (p-value for interaction = 0.001). The quality of plant foods is vital in preventing dyslipidemia among people consuming high plant-based food diets.

β-Carotene biofortification of chia sprouts with plant growth regulators

Chia (Salvia hispanica) is a native plant species from South America that is very appreciated for its oleaginous seeds in the agri-food field. Chia seeds are natural sources of many bioactive compounds which provide benefits to human health. Nevertheless, chia sprouts have better nutritional properties than seeds, such as antioxidants, essential amino acids, and phenolic compounds. Among all these beneficial compounds, β-carotene has not been studied in chia sprouts. β-carotene is a precursor of vitamin A, which contributes to maintaining our health status. In this study, to improve β-carotene content in chia sprouts, some plant growth regulators (abscisic acid, methyl jasmonate and methyl salicylate) were applied exogenously to germinating chia seeds. Gibberellins A4/A7 and cytokinin 6-benzyladenine (Promalin®) were also applied, combined with the other regulators, to antagonize a possible inhibition in the germination. Seeds were grown in darkness for 4 days, then seeds were exposed to a short light stimulus (30') and finally to a continued light stimulus (48h). β-carotene, xanthophylls, chlorophylls, de-epoxidation status of xanthophyll cycle (DPS), germination rate, and sprouts fresh weight were analysed. The results show that sprouts treated with methyl salicylate in-creased 2,35 fold their β-carotene content when they were exposed to light for 30'+48h. Sprouts fresh weight and germination were not affected by methyl salicylate. Although more research is needed before industrial application, it is concluded that methyl salicylate can be used to improve β-carotene contents in chia sprouts.

Total protein, not amino acid composition, differs in plant-based versus omnivorous dietary patterns and determines metabolic health effects in mice

Plant-based dietary patterns are associated with improved cardiometabolic health, but causal dietary components are unclear. Protein has been proposed to play a role, but the importance of protein quantity versus quality remains unknown. We investigated the contributions of total protein amount, amino acid (AA) composition, and plant versus animal source. Analysis of total protein and AA composition of food items and dietary patterns revealed differences between individual food items, but few differences between AA profiles of vegan versus omnivorous dietary patterns. Effects of protein quantity, but not quality, on cardiometabolic health markers were observed in mice using semi-purified diets with crystalline AAs in plant versus animal-based ratios and naturally sourced diets with whole-food ingredients. Our data show relatively little difference in protein quality between plant-based and omnivorous dietary patterns and that reduced total protein intake in plant-based dietary patterns may be a contributor to the benefits of plant-based diets.

Prevention and Reversal of Morbidity in Today's Cardiovascular Patient: Role of Lifestyle Modification and Nutrition in the Current Era

PURPOSE OF REVIEW

The prevalence of cardiovascular disease despite good medical therapy is on the rise, driven by risk factors such as hypertension, diabetes, hypercholesterolemia, and obesity. As healthcare providers, we must seek to better advise patients on preventative strategies through lifestyle changes.

RECENT FINDINGS

Guideline recommendations have been published by professional societies on the prevention of heart disease through lifestyle changes; however, limited education and experience with these lifestyle-modifying methods hinders appropriate counseling and treatment of patients. Robust data support the use of lifestyle medicine to reduce cardiovascular morbidity and risk. These include, a more plant-based whole food diet, regular exercise, stress relief, connectedness, and other lifestyle approaches. This review will help further the understanding of the front-line clinician in cardiovascular prevention.

Care by Midwives, Obstetricians, and Dietitians for Pregnant Women Following a Strict Plant-Based Diet: A Cross-Sectional Study

With an growing number of people on a strict plant-based diet, its potential effect on pregnancy and lactation becomes increasingly important. It is, however, unclear how obstetric caregivers currently handle and think about a strict plant-based diet in pregnancy. The aim of the study was therefore to evaluate the self-reported knowledge and advice given by Dutch obstetric caregivers and dietitians when treating pregnant women on a strict plant-based diet. A cross-sectional study was performed by sending an online survey to Dutch midwife practices, obstetricians, and dietitian practices. Descriptive statistics are reported. A total of 121 midwives, 179 obstetricians, and 111 dietitians participated in this study. The majority of midwives (80.2%) and obstetricians (93.9%) considered a strict plant-based diet to be a significant risk factor for nutrient deficiency during pregnancy. Maternal dietary preferences, including a potential strict plant-based diet, were discussed at the first prenatal appointment by 59.5% of midwives and 24.1% of obstetricians. A self-reported lack of knowledge concerning the strict plant-based diet was mentioned by 66.1% of midwives and 75.4% of obstetricians. Obstetric caregivers mostly considered the identification of this dietary habit and subsequent referral to a dietitian or a reliable website as optimal care for pregnant women on the strict plant-based diet. However, only 38.7% of dietitians indicated to have sufficient knowledge to counsel these women. Although obstetric caregivers thought that a strict plant-based diet in pregnancy may lead to increased risks of nutritional deficiencies, the majority report to have insufficient knowledge to provide adequate advice. Only a minority referred these women to dietitians, of whom a minority indicated to have adequate knowledge on this specific diet. These results suggest that current care is suboptimal for an increasing number of pregnant women. Women on a strict plant-based diet could benefit from increased knowledge about this topic among obstetric caregivers and dietitians, as well as from clear guidelines regarding this diet during pregnancy.

The potential of fermentation on nutritional and technological improvement of cereal and legume flours: A review

Nowadays there is an increasing demand for vegetable protein sources as an alternative to that of animal origin, not only for its greater environmental sustainability but also for its relationship with lower risk of suffering cardiovascular diseases. Legumes, cereals and seeds are seen as a good proteinaceous source providing as well dietetic fiber and phytochemicals with antioxidant properties. However, their digestibility and bioavailability are limited by the presence of anti-nutritional factors (ANFs) but susceptible of being improved by soaking, cooking or fermentation. The objective of this work is to review the solid-state and submerged fermentation effect on nutritional and functional properties of legumes, cereals and seeds. The microorganisms involved (bacteria, fungus and yeasts) are able to produce enzymes that degrade ANFs giving rise to more digestible flours with a more interesting nutritional, sensorial and technological profile. Solid-state fermentation is more commonly used for its higher efficiency, accepting agro-industrial residues as substrates and its lower volume of effluents. Fermented legumes had their technological properties enhanced while an increment in antioxidant properties was characteristic of cereals. The present review highlights fermentation of cereals and legumes mainly as a key process that at industrial scale could generate new products with enhanced nutritional and technological properties.

Inverse Association of Poultry, Fish, and Plant Protein Consumption with the Incidence of Cardiovascular Disease

Cardiovascular disease (CVD) remains a major cause of death and disability worldwide and food intake plays an important role in its onset or prevention. It is also well known that consumption of red meat (processed and unprocessed) is associated with an increased incidence of CVD, coronary heart disease (CHD), and premature death. However, little is known about the association of consumption of poultry, fish, and plant protein with the incidence of CVD, CHD, and mortality. Several recent studies, reviews and meta-analyses have shown an inverse association of consumption of these foods with the incidence of CVD, CHD, and death. In order to get a better perspective about the current consumption of these foods, a focused Medline search of the English language literature was conducted between 2010 and 2020 using the terms poultry, fish, plant protein consumption, cardiovascular disease, coronary heart disease, mortality; 28 papers with pertinent information were retrieved. The analysis of data from these papers suggest an inverse relationship between the consumption of these foods and the incidence of de novo CVD or worsening of preexisting CVD. They also demonstrate that the consumption of these foods is still low and that great effort should be made to inform the public about the benefits of switching from red meat to an increased consumption of poultry, fish, and plant protein. All the data from the retrieved papers regarding the consumption of these foods, together with collateral literature, will be discussed in this review.

Vasculoprotective effects of ginger (Zingiber officinale Roscoe) and underlying molecular mechanisms

Ginger (Zingiber officinale Roscoe) is a common and widely used spice. It is rich in various chemical constituents, including phenolic compounds, terpenes, polysaccharides, lipids, organic acids, and raw fibers. Herein, we reviewed its effects on the vascular system. Studies utilizing cell cultures or animal models showed that ginger constituents alleviate oxidative stress and inflammation, increase nitric oxide synthesis, suppress vascular smooth muscle cell proliferation, promote cholesterol efflux from macrophages, inhibit angiogenesis, block voltage-dependent Ca2+ channels, and induce autophagy. In clinical trials, ginger was shown to have a favorable effect on serum lipids, inflammatory cytokines, blood pressure, and platelet aggregation. Taken together, these studies point to the potential benefits of ginger and its constituents in the treatment of hypertension, coronary artery disease, peripheral arterial diseases, and other vascular diseases.

Development and testing of the Sustainable Nutrition Environment Measures Survey for retail stores in Ontario

OBJECTIVE

To develop and test a tool to assess the price and availability of low-carbon footprint and nutritionally balanced dietary patterns in retail food environments in Ontario, Canada.

DESIGN

Availability and price of selected food from discount and regular grocery stores (n 23) in urban/rural areas of northern/southern Ontario were assessed with the Sustainable Nutrition Environment Measures Survey in 2017.

SETTING

Ontario, Canada.

RESULTS

Inter-rater reliability was high for price (intra-class correlation coefficients = 0·819) and for availability (Cohen's κ = 0·993). The tool showed 78 % of the selected food items were available in all stores. Overall, price differences were small between urban and rural locations, and northern and southern Ontario. The greatest price difference was between discount and regular stores.

CONCLUSIONS

The tool showed excellent inter-rater agreement. Researchers and public health dietitians can use this tool for research, practice and policy to link consumer-level health outcomes to the retail environment.

Diet, Lifestyle and Cardiovascular Diseases: Linking Pathophysiology to Cardioprotective Effects of Natural Bioactive Compounds

Heart and blood vessels disorders comprise one of the main causes of death worldwide. Pharmacologically active natural compounds have been used as a complementary therapy in cardiovascular disease around the world in a traditional way. Dietary, natural bioactive compounds, as well as healthy lifestyles, are considered to prevent coronary artery diseases. Pre-clinical and clinical studies reported that consumption of plant-food bioactive derivatives including polyphenolic compounds, peptides, oligosaccharides, vitamins, unsaturated fatty acids possess protective effects on cardiovascular diseases. This review aims to summarize the cardiovascular risk factors, pre-clinical studies and clinical trials related to cardioprotective properties of the plant-food-derived bioactive compounds. Molecular mechanisms by the natural bioactive compounds exert their cardiovascular protective properties have also been highlighted.

Patterns of amino acid intake are strongly associated with cardiovascular mortality, independently of the sources of protein

Background

The intake of specific amino acids (AA) has been associated with cardiovascular health, but amino acids are consumed together as dietary protein. Here we investigated the association between identified patterns of amino acid intake and cardiovascular mortality.

Methods

A total of 2216 cardiovascular deaths among 79 838 men and women from the Adventist Health Study-2 were included in our analysis. Baseline dietary patterns based on the participants' amino acids intakes were derived by factor analysis. Using Cox regression analyses, we estimated multivariate-adjusted hazard ratios (HRs) adjusted for sociodemographic and lifestyle factors and other dietary components.

Results

Three patterns of amino acids were identified. Factor 1 was positively associated with cardiovascular disease (CVD) mortality [hazard ratio (HR)Q5-Q1: 1.62, 98.75% confidence interval (CI): 1.15, 2.28; P-trend &lt;0.001]; and Factors 2 and 3 were inversely associated with CVD mortality (HR Q5-Q1 Factor 2: 0.74, 98.75% CI: 0.53, 1.04; P-trend &lt;0.01 and HR Q5-Q1 Factor 3: 0.65, 98.75% CI: 0.44, 0.95; P-trend &lt;0.05]. The associations with Factor 1 (with high loadings on indispensable amino acids such as branched chain amino acids, lysine, methionine) and Factor 3 (with high loadings on non-indispensable amino acids, namely arginine, glycine, aspartate+asparagine) remained significant after further adjustment for nutrient intake and for the five protein source patterns identified previously (HR Q5-Q1: 1.56 (0.99, 2.45) and 0.55 (0.35, 0.85); P-trends &lt; 0.01).

Conclusions

Indispensable AA have a positive and some non-indispensable AA have a negative, independent, strong association with the risk of cardiovascular mortality.

A comparison of L-carnitine and several cardiovascular-related biomarkers between healthy vegetarians and omnivores

OBJECTIVE

A plant-based diet has been associated with a reduced risk of cardiovascular (CV) diseases. This study aimed to determine the levels and correlations of CV-related biomarkers and the beneficial role of dietary habits.

METHODS

A total of 63 healthy vegetarians (n = 32) and omnivores (n = 31) were recruited. The baseline characteristics were recorded and measured (including lipid profiles, blood glucose, etc.). Liquid chromatography-mass spectrometry method was developed for the simultaneous determination of seven circulating CV-related biomarkers.

RESULTS

L-carnitine (L-Car), L-methionine, and ascorbic acid (AA) were significantly higher in vegetarians than in omnivores. In the vegetarians, L-Car had a negative correlation with triacylglycerols (P = 0.042) and blood glucose (P = 0.048) and a positive correlation with high-density lipoprotein cholesterol (P = 0.049). L-Car was also positively correlated with L-lysine (P = 0.009), L-methionine (P = 0.006), and AA (P = 0.035). The vegetarians' AA also had a negative correlation with L-homocysteine (P = 0.028). In the omnivores, L-Car was negatively correlated with total cholesterol (P = 0.008), low-density lipoprotein cholesterol (P = 0.004), and high-density lipoprotein cholesterol (P = 0.038). Omnivores' body mass index was positively correlated with L-homocysteine (P = 0.033), and age was positively correlated with trimethylamine N-oxide (P < 0.001) and blood glucose (P = 0.007), but not in vegetarians.

CONCLUSIONS

Our results suggest that vegetarians have an elevated level of L-Car, which might be associated with endogenous biosynthesis and diet composition. Circulating L-Car might play an important role in CV protection, especially in vegetarians.

Dialysis or a Plant-Based Diet in Advanced CKD in Pregnancy? A Case Report and Critical Appraisal of the Literature

Pregnancy is increasingly reported in chronic kidney disease (CKD), reflecting higher awareness, improvements in materno-foetal care, and a more flexible attitude towards “allowing” pregnancy in the advanced stages of CKD. Success is not devoid of problems and an important grey area regards the indications for starting dialysis (by urea level, clinical picture, and residual glomerular filtration rate) and for dietary management. The present case may highlight the role of plant-based diets in dietary management in pregnant CKD women, aimed at retarding dialysis needs. The case. A 28-year-old woman, affected by glomerulocystic disease and unilateral renal agenesis, in stage-4 CKD, was referred at the 6th week of amenorrhea: she weighed 40 kg (BMI 16.3), was normotensive, had no sign of oedema, her serum creatinine was 2.73 mg/dL, blood urea nitrogen (BUN) 35 mg/dL, and proteinuria 200 mg/24 h. She had been on a moderately protein-restricted diet (about 0.8 g/kg/real body weight, 0.6 per ideal body weight) since childhood. Low-dose acetylsalicylate was added, and a first attempt to switch to a protein-restricted supplemented plant-based diet was made and soon stopped, as she did not tolerate ketoacid and aminoacid supplementation. At 22 weeks of pregnancy, creatinine was increased (3.17 mg/dL, BUN 42 mg/dL), dietary management was re-discussed and a plant-based non-supplemented diet was started. The diet was associated with a rapid decrease in serum urea and creatinine; this favourable effect was maintained up to the 33rd gestational week when a new rise in urea and creatinine was observed, together with signs of cholestasis. After induction, at 33 weeks + 6 days, she delivered a healthy female baby, adequate for gestational age (39th centile). Urea levels decreased after delivery, but increased again when the mother resumed her usual mixed-protein diet. At the child’s most recent follow-up visit (age 4 months), development was normal, with normal weight and height (50th–75th centile). In summary, the present case confirms that a moderate protein-restricted diet can be prescribed in pregnancies in advanced CKD without negatively influencing foetal growth, supporting the importance of choosing a plant-based protein source, and suggests focusing on the diet’s effects on microcirculation to explain these favourable results.

Dietary Patterns Affect the Gut Microbiome-The Link to Risk of Cardiometabolic Diseases

Clusters of bacterial species within the gut microenvironment, or gut enterotype, have been correlated with cardiometabolic disease risk. The metabolic products and metabolites that bacteria produce, such as short-chain fatty acids, secondary bile acids, and trimethylamine, may also affect the microbial community and disease risk. Diet has a direct impact on the gut microenvironment by providing substrates to and promoting the colonization of resident bacteria. To date, few dietary patterns have been evaluated for their effect on the gut microbiome, but the Mediterranean diet and Vegetarian diets have shown favorable effects for both the gut microbiome and cardiometabolic disease risk. This review examines the gut microbiome as a mediator between these dietary patterns and cardiometabolic disease risk.

Dietary patterns affect maternal macronutrient intake levels and the fatty acid profile of breast milk in lactating Chinese mothers

OBJECTIVES

Fatty acids (FA) in human milk play an important role in meeting the nutritional demands and promoting the growth and development of breastfeeding infants. Breast milk FA is sensitive to maternal dietary habits, and dietary patterns are better used to explain the effect of diet on FA. Few studies have examined the association between maternal dietary patterns and the FA components of breast milk in developing countries. In this study, we aimed to determine whether dietary patterns affect the FA profile of breast milk in lactating Chinese mothers with the overall goal to optimize the management of infant feeding.

METHODS

A total of 274 lactating women ranging from 22 d to 6 mo postpartum were included, and samples of their breast milk were collected together with completed questionnaires. Using a principal component analysis, four dietary patterns were identified in a rotated component matrix. FA profiles were detected using capillary gas chromatography and presented as the percentage by weight of total FA.

RESULTS

Maternal intake of energy, carbohydrates, and proteins showed differences between the different dietary patterns. In addition, there were significant differences in the total proportions of saturated, polyunsaturated, and ω-6 polyunsaturated fatty acids in breast milk among the four patterns (P < 0.001; P = 0.025; P = 0.038, respectively).

CONCLUSIONS

The results demonstrate that maternal dietary patterns can affect macronutrient intake levels and milk FA profiles in lactating Chinese women. These results are of great significance in understanding how a maternal diet can both improve maternal macronutrient intake and the FA nutritional status of breast milk.

Association of circulating metabolites with healthy diet and risk of cardiovascular disease: analysis of two cohort studies

Diet may modify metabolomic profiles towards higher or lower cardiovascular disease (CVD) risk. We aimed to identify metabolite profiles associated with high adherence to dietary recommendations - the Alternative Healthy Eating Index (AHEI) - and the extent to which metabolites associated with AHEI also predict incident CVD. Relations between AHEI score and 80 circulating lipids and metabolites, quantified by nuclear magnetic resonance metabolomics, were examined using linear regression models in the Whitehall II study (n = 4824, 55.9 ± 6.1 years, 28.0% women) and were replicated in the Cardiovascular Risk in Young Finns Study (n = 1716, 37.7 ± 5.0 years, 56.3% women). We used Cox models to study associations between metabolites and incident CVD over the 15.8-year follow-up in the Whitehall II study. After adjustment for confounders, higher AHEI score (indicating healthier diet) was associated with higher degree of unsaturation of fatty acids (FA) and higher ratios of polyunsaturated FA, omega-3 and docosahexaenoic acid relative to total FA in both Whitehall II and Young Finns studies. A concordance of associations of metabolites with higher AHEI score and lower CVD risk was observed in Whitehall II. Adherence to healthy diet seems to be associated with specific FA that reduce risk of CVD.

Nuts and Cardiovascular Disease

There is compelling evidence showing that nut intake confers protection against cardiovascular disease (CVD). We conducted a review of the literature with respect to observational studies and randomized trials completed in the past ≈25 years that examined nut intake and CVD endpoints. We included findings from major cohort studies, a large intervention trial, and numerous smaller nut trials. Collectively, data from observational and intervention studies indicate strong and significant association between nut intake and decreased risk of fatal and non-fatal coronary heart disease, myocardial infarction, and sudden death; and somewhat weak association with stroke. The primary mechanism by which nuts protect against CVD is through the improvement of lipid and apolipoprotein profile. Increasing evidence also indicates that nut consumption may confer protection against CVD via lowering of oxidative stress, inflammation, and improvement in endothelial function. Nut components, such as unsaturated fatty acids, l-arginine, beneficial minerals, phenolic compounds and phytosterols, appear to be of paramount importance for their health effects.

Epigenetics, Nutrition, Disease and Drug Development

Epigenetic mechanisms comprising of DNA methylation, histone modifications and gene silencing by RNA interference have been strongly linked to the development and progression of various diseases. These findings have triggered research on epigenetic functions and signal pathways as targets for novel drug discovery. Dietary intake has also presented significant influence on human health and disease development and nutritional modifications have proven important in prevention, but also the treatment of disease. Moreover, a strong link between nutrition and epigenetic changes has been established. Therefore, in attempts to develop novel safer and more efficacious drugs, both nutritional requirements and epigenetic mechanisms need to be addressed.

Plant-based diets and cardiovascular health

Plant-based diets, defined in terms of low frequency of animal food consumption, have been increasingly recommended for their health benefits. Numerous studies have found plant-based diets, especially when rich in high quality plant foods such as whole grains, fruits, vegetables, and nuts, to be associated with lower risk of cardiovascular outcomes and intermediate risk factors. This review summarizes the current evidence base examining the associations of plant-based diets with cardiovascular endpoints, and discusses the potential biological mechanisms underlying their health effects, practical recommendations and applications of this research, and directions for future research. Healthful plant-based diets should be recommended as an environmentally sustainable dietary option for improved cardiovascular health.

Effects of Multivitamin, Multimineral and Phytonutrient Supplementation on Nutrient Status and Biomarkers of Heart Health Risk in a Russian Population: A Randomized, Double Blind, Placebo Controlled Study

The primary objective of this clinical study was to evaluate the effect of a dietary multivitamin, multimineral and phytonutrient (VMP) supplement on blood nutrient status and biomarkers of heart health risk in a Russian population. One hundred twenty healthy adults (40-70 years) were recruited for a 56-day (eight-week) randomized, double blind, placebo controlled study with parallel design. Subjects were divided into two groups and received either a VMP or a placebo (PLA) supplement. Blood nutrient levels of β-carotene, α-tocopherol, vitamin C, B6, B12, red blood cell (RBC) folate, Zinc and Selenium were measured at baseline and on Days 28 and 56, and quercetin was measured at baseline and on Day 56. Blood biomarkers of heart health, i.e. homocysteine (Hcy), high-sensitivity C-reactive protein (hs-CRP), oxidized LDL (ox-LDL), gamma-glutamyl transferase (GGT), uric acid and blood lipid profile, were measured at baseline and Day 56. Dietary VMP supplementation for 56 days significantly increased circulating levels of quercetin, vitamin C, RBC folate and partially prevented the decline in vitamin B6 and B12 status. Both serum Hcy and GGT were significantly reduced (-3.97 ± 10.09 µmol/L; -1.68 ± 14.53 U/L, respectively) after VMP supplementation compared to baseline. Dietary VMP supplementation improved the nutrient status and reduced biomarkers of heart health risk in a Russian population.