Carbohydrate quantity and quality in relation to body mass index

Refined grain intake and cardiovascular disease: Meta-analyses of prospective cohort studies

Refined grains are included as part of an unhealthy, or Western, dietary pattern, which has been shown to be associated with increased risk of cardiovascular disease (CVD). To clarify the association between refined grain intake and CVD risk, Pubmed and Scopus databases were searched for relevant cohort studies from database inception to June 30, 2022. Only studies that examined refined grains as a distinct consumption category and not as part of a dietary pattern, were included. Meta-analyses were performed using Cochrane's RevMan 5.4.1 software, applying inverse variance risk ratios in random effects models for each outcome of interest. Heterogeneity was assessed with Cochrane's Q (chi2) and I2 statistics. Meta-analyses of hazard ratios (HR) and 95% confidence intervals (CI) obtained from 17 prospective cohort studies (>875,000 participants) indicated that refined grain intake was not associated with risk of CVD (HR = 1.08, 95% CI, 0.99-1.18, I2 = 70%; 9 cohorts), stroke (HR = 1.06, 95% CI 0.92-1.23, I2 = 70%; 9 cohorts), or heart failure (HR = 0.95, 95% CI 0.77-1.16, I2 = 10%; 5 cohorts). White rice intake was also not associated with risk of CVD (HR = 0.93, 95% CI 0.86-1.00, I2 = 25%; 7 cohorts) or stroke (HR = 1.03, 95% CI 0.93-1.14, I2 = 22%; 7 cohorts). No significant publication bias was evident (Egger's test P values all > 0.05). The lack of association between refined grain intake and CVD risk was observed in meta-analyses of studies that restricted analyses to only staple grain foods (e.g., bread, cereal, pasta, white rice), as well as for meta-analyses of studies that included both staple and indulgent grain foods (e.g., cakes, cookies, doughnuts, brownies, muffins, pastries). Probable confounding from unmeasured variables in studies included in the meta-analyses diminishes the overall quality of evidence. Although refined grains are included as a component of the Western dietary pattern, the results of the meta-analyses suggest that refined grains do not contribute to the higher CVD risk associated with this unhealthy dietary pattern. This information should be considered in formulation of future dietary recommendations.

Interaction of MC4R rs17782313 variants and dietary carbohydrate quantity and quality on basal metabolic rate and general and central obesity in overweight/obese women: a cross-sectional study

BACKGROUND

Recent studies have shown that dietary carbohydrate quantity and quality as well as genetic variants may contribute to determining the metabolic rate and general and central obesity. This study aimed to examine interactions between melanocortin 4 receptor gene (MC4R) rs17782313 and dietary carbohydrate intake, glycemic index (GI), and glycemic load (GL) on body mass index (BMI), waist circumferences (WC), basal metabolic rate (BMR), and BMR/kg in overweight/obese women.

METHODS

A total of 282 Iranian women (BMI ≥ 25) aged 18-56 years were enrolled in this cross-sectional study. All participants were assessed for blood parameters, body composition, BMR, and dietary intake. Dietary carbohydrate intake, GI, and GL were determined using a valid, reliable 147-item food frequency questionnaire. MC4R rs17782313 was genotyped by the restriction fragment length polymorphism (PCR-RFLP) method.

RESULTS

After adjustment for age and energy intake, significant interactions were observed between carbohydrate intake and MC4R rs17782313 in terms of BMI (P Interaction = 0.007), WC (P Interaction = 0.02), and BMR/kg (P Interaction = 0.003) in this way that higher carbohydrate intake, compared with lower intake, was associated with an increase in BMI and WC for individuals with C allele carriers (TC + CC genotypes), while related to an increase in BMR/kg for those carrying the TT genotype. No significant interaction was found between MC4R rs17782313 and GI and GL on BMI, WC, BMR/kg, and BMR.

CONCLUSIONS

Interactions between the MC4R rs17782313 and carbohydrate intake probably can have an effect on BMI, WC, and BMR/kg in overweight/obese women.

Association of carbohydrate and saturated fat intake with cardiovascular disease and mortality in Australian women

BACKGROUND

Conflicting evidence surrounds the effect of dietary macronutrient intake (fat, carbohydrate and protein) on cardiovascular disease (CVD), particularly in women.

METHODS

Women (aged 50-55 years) were recruited into the Australian Longitudinal Study on Women's Health. Women were divided into quintiles according to their carbohydrate and saturated fat intake as a percentage of total energy intake (TEI). The primary endpoint was new-onset CVD (heart disease/stroke). Secondary endpoints included all-cause mortality, incident hypertension, obesity and/or diabetes mellitus. Multivariate logistic regression models assessed for associations with the primary and secondary endpoints, with adjustment for confounders.

RESULTS

A total of 9899 women (mean age 52.5±1.5 years) were followed for 15 years, with 1199 incident CVD and 470 deaths. On multivariable analysis, higher carbohydrate intake was associated with lower CVD risk (p_trend<0.01), with the lowest CVD risk for quintile 3 (41.0%-44.3% energy as carbohydrate) versus quintile 1 (<37.1% energy as carbohydrate) (OR 0.56, 95% CI 0.35 to 0.91, p=0.02). There was no significant association between carbohydrate intake and mortality (p_trend=0.69) or between saturated fat intake and CVD (p_trend=0.29) or mortality (p_trend=0.25). Both increasing saturated fat and carbohydrate intake were significantly inversely associated with hypertension, diabetes mellitus and obesity (p_trend<0.01 for all).

CONCLUSIONS

In middle-aged Australian women, moderate carbohydrate intake (41.0%-44.3% of TEI) was associated with the lowest risk of CVD, without an effect on total mortality. Increasing saturated fat intake was not associated with CVD or mortality and instead correlated with lower rates of diabetes, hypertension and obesity.

Perspective: Does Glycemic Index Matter for Weight Loss and Obesity Prevention? Examination of the Evidence on "Fast" Compared with "Slow" Carbs

High-glycemic index (high-GI) foods (so-called fast carbs) have been hypothesized to promote fat storage and increase risk of obesity. To clarify whether dietary GI impacts body weight, we searched PubMed and the Cochrane Database of Systematic Reviews for observational studies reporting associations between BMI and dietary GI, and for meta-analyses of randomized controlled trials (RCTs) comparing low-GI and high-GI diets for weight loss. Data on 43 cohorts from 34 publications, totaling 1,940,968 adults, revealed no consistent differences in BMI when comparing the highest with the lowest dietary GI groups. In the 27 cohort studies that reported results of statistical comparisons, 70% showed that BMI was either not different between the highest and lowest dietary GI groups (12 of 27 cohorts) or that BMI was lower in the highest dietary GI group (7 of 27 cohorts). Results of 30 meta-analyses of RCTs from 8 publications demonstrated that low-GI diets were generally no better than high-GI diets for reducing body weight or body fat. One notable exception is that low-GI diets with a dietary GI at least 20 units lower than the comparison diet resulted in greater weight loss in adults with normal glucose tolerance but not in adults with impaired glucose tolerance. While carbohydrate quality, including GI, impacts many health outcomes, GI as a measure of carbohydrate quality appears to be relatively unimportant as a determinant of BMI or diet-induced weight loss. Based on results from observational cohort studies and meta-analyses of RCTs, we conclude that there is scant scientific evidence that low-GI diets are superior to high-GI diets for weight loss and obesity prevention.

Dietary Carbohydrate Quality and Quantity and Risk of Breast Cancer among Iranian Women

OBJECTIVE

This study investigated the association between quality and quantity of carbohydrate by assessing low carbohydrates diet score (LCDS), carbohydrate quality score (CQI), glycemic index (GI), dietary glycemic load (GL), and dietary carbohydrate intake, and risk of breast cancer (BrCa) among Iranian women.

METHODS

This hospital-based case-control study was carried out in the Cancer Research Center of Imam Khomeini hospital, Iran. We included One hundred and fifty newly diagnosed BrCa cases and one hundred and fifty healthy controls in this study. Socio-demographic and dietary data and anthropometric measures were recorded.

RESULTS

We found that a higher CQI than a lower score was associated with a decrease in odds of BrCa (P = 0.04). After adjusting for potential confounders, we observed that CQI was not associated with BrCa development (P = 0.05). An increase in odds of BrCa among women in the highest tertiles of GL (P = 0.12), GI (P = 0.48), and dietary carbohydrate intake (P = 0.06) was seen, which was not statistically significant. There was also a non-significant lower chance of having BrCa with adherence to the LCDS (P = 0.09).

CONCLUSION

Our findings suggest that CQI was not related to BrCa risk among Iranian women. This relation deserves to be investigated in prospective studies.

Health benefits of whole grain: effects on dietary carbohydrate quality, the gut microbiome, and consequences of processing

Grains are important sources of carbohydrates in global dietary patterns. The majority of these carbohydrates, especially in refined-grain products, are digestible. Most carbohydrate digestion takes place in the small intestine where monosaccharides (predominantly glucose) are absorbed, delivering energy to the body. However, a considerable part of the carbohydrates, especially in whole grains, is indigestible dietary fibers. These impact gut motility and transit and are useful substrates for the gut microbiota affecting its composition and quality. For the most part, the profile of digestible and indigestible carbohydrates and their complexity determine the nutritional quality of carbohydrates. Whole grains are more complex than refined grains and are promoted as part of a healthy and sustainable diet mainly because the contribution of indigestible carbohydrates, and their co-passenger nutrients, is significantly higher. Higher consumption of whole grain is recommended because it is associated with lower incidence of, and mortality from, CVD, type 2 diabetes, and some cancers. This may be due in part to effects on the gut microbiota. Although processing of cereals during milling and food manufacturing is necessary to make them edible, it also offers the opportunity to still further improve the nutritional quality of whole-grain flours and foods made from them. Changing the composition and availability of grain carbohydrates and phytochemicals during processing may positively affect the gut microbiota and improve health.

Causal relationship between dietary macronutrient composition and anthropometric measures: A bidirectional two-sample Mendelian randomization analysis

BACKGROUND

The question whether the proportion of energy provided by fat and carbohydrates in the diet is associated with body mass index (BMI) and waist circumference (WC) is an important public health issue, but determining causality is difficult in epidemiological studies.

OBJECTIVES

Using a two-sample bidirectional Mendelian randomization (MR) in both a univariable and multivariable setting, we aimed to determine whether the relative proportion of different macronutrients in the diet (in % of total energy intake (E%)) is causally related to BMI and WC and vice versa.

METHODS

All analyses were based on genome-wide association studies including 268,922 Europeans with dietary data (SSGAC Consortium) and at least 232,101 with anthropometric measures (GIANT Consortium). An inverse-variance weighted approach using modified second-order weights within the radial regression framework was performed. Radial MR-Egger, weighted median and mode, Robust Adjusted Profile Score (RAPS), and Pleiotropy RESidual Sum and Outlier (PRESSO) methods were used in sensitivity analyses to verify MR assumptions. Additionally, multivariable MR was conducted to account for inter correlation between macronutrient intakes. All estimates represent the standard deviation (SD) change in each outcome per one SD change in the respective exposure.

RESULTS

We found that genetically predicted relative carbohydrate intake (E%) reduced BMI (β = -0.529; 95% CI: -0.745, -0.312; P-value = 2⋅10^-6) and WC (β = -0.459; 95% CI: -0.656, -0.262; P-value = 5⋅10^-6). Both effects were also supported by the multivariable approach: β = -0.441 (95% CI: -0.772, -0.109; P-value = 0.009) for BMI and β = -0.410 (95% CI: -0.667, -0.154; P-value = 0.002) for WC. Genetically predicted dietary intake of fat (E%) was weaker and positively related to both anthropometric measures. We obtained evidence that a higher BMI and WC increased the relative dietary intake of fat and protein (E%). For example, each SD higher BMI increased protein intake (E%) by 0.114 SD (95% CI: 0.081, 0.147; P-value = 9⋅10^-12) and each SD higher WC increased protein intake (E%) by 0.078 SD (95% CI: 0.035, 0.121; P-value = 4⋅10^-4). Sensitivity analyses confirmed these findings revealing consistent effect estimates.

CONCLUSIONS

Using genetic information to improve causal inference we found evidence, that a low relative carbohydrate proportion (E%) and a high proportion of fat (E%) in the diet is causally related to a higher BMI and a higher WC. Further research considering carbohydrate, fat, and protein quality and possible consequences on micronutrient intake is needed to define the implications for dietary intake recommendations.

Association between body mass index and macronutrients differs along the body mass index range of German adults: results from the German National Nutrition Survey II

The aim of the present study was to determine whether the association between body mass index (BMI) and the intake of macronutrients varies along the BMI distribution of German adults. Based on a sample of 9214 men and women aged 18-80 years from the representative cross-sectional German National Nutrition Survey (NVS) II, quantile regression was used to investigate the association between BMI and the intake of macronutrients independent of energy intake and other predictors. In both sexes, BMI was positively associated with the intake of total protein and animal protein over its entire range and negatively associated with vegetable protein. A negative association between BMI and the intake of polysaccharides was found along the entire range of BMI in men. There was a weak negative association between BMI and the intake of total fat and saturated fatty acids observed in normal-weight-range women only. In conclusion, the association between BMI and the intake of macronutrients varies along the BMI range. Animal protein intake is positively associated with BMI independent of energy intake in both sexes whereas only in men an inverse association of polysaccharide intake with BMI was shown.

Whole Grains, Refined Grains, and Cancer Risk: A Systematic Review of Meta-Analyses of Observational Studies

PubMed, Web of Science, and the Cochrane Database of Systematic Reviews were searched for meta-analyses that provided risk estimates (±95% confidence intervals) for associations between intakes of whole and refined grains and risk of total and site-specific cancer. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Only meta-analyses that included whole grains and refined grains as separate food groups, and not as part of dietary patterns, were included. A total of 17 publications were identified that met inclusion criteria. Within these, results from a total of 54 distinct meta-analyses were reported for whole grains and 5 meta-analyses for refined grains. For total cancer mortality, 7 meta-analyses of cohort studies indicated that whole grain intake was associated with 6% to 12% lower risk in comparison of highest vs. lowest intake groups, and 3% to 20% lower risk for doses ranging from 15 to 90 g/day. For site-specific cancers, meta-analyses indicated that whole grain intake was consistently associated with lower risks of colorectal, colon, gastric, pancreatic, and esophageal cancers. Limited data were available for refined grains, with only 4 publications providing risk estimates, and only 1 of the meta-analyses included more than 3 studies. High intake of refined grains was associated with increased risk of colon and gastric cancer. By contrast, in the only dose-response meta-analysis, each 90 g/day consumption of refined grains was associated with a 6% lower risk of total cancer. In addition to the limited number of published meta-analyses on refined grains, results were also weakened due to the fact that refined grains were frequently defined to include both staple grain foods and indulgent grain foods, and the majority of studies included in the meta-analyses provided no specific definition of refined grains. Overall, meta-analyses of cohort and case-control studies consistently demonstrate that whole grain intake is associated with lower risk of total and site-specific cancer, and support current dietary recommendations to increase whole grain consumption. By contrast, the relationship between refined grain intake and cancer risk is inconclusive.

Do Refined Grains Have a Place in a Healthy Dietary Pattern: Perspectives from an Expert Panel Consensus Meeting

Although dietary guidance recommends increasing consumption of whole grains and concurrently limiting consumption of refined and/or enriched grain foods, emerging research suggests that certain refined grains may be part of a healthy dietary pattern. A scientific expert panel was convened to review published data since the release of 2015 dietary guidance in defined areas of grain research, which included nutrient intakes, diet quality, enrichment/fortification, and associations with weight-related outcomes. Based on a 1-d roundtable discussion, the expert panel reached consensus that 1) whole grains and refined grains can make meaningful nutrient contributions to dietary patterns, 2) whole and refined grain foods contribute nutrient density, 3) fortification and enrichment of grains remain vital in delivering nutrient adequacy in the American diet, 4) there is inconclusive scientific evidence that refined grain foods are linked to overweight and obesity, and 5) gaps exist in the scientific literature with regard to grain foods and health.

MALMEM: model averaging in linear measurement error models

We develop model averaging estimation in the linear regression model where some covariates are subject to measurement error. The absence of the true covariates in this framework makes the calculation of the standard residual-based loss function impossible. We take advantage of the explicit form of the parameter estimators and construct a weight choice criterion. It is asymptotically equivalent to the unknown model average estimator minimizing the loss function. When the true model is not included in the set of candidate models, the method achieves optimality in terms of minimizing the relative loss, whereas, when the true model is included, the method estimates the model parameter with root n rate. Simulation results in comparison with existing Bayesian information criterion and Akaike information criterion model selection and model averaging methods strongly favour our model averaging method. The method is applied to a study on health.

Dietary Intake across Reproductive Life Stages of Women in India: A Cross-Sectional Survey from 4 Districts of India

Nutritional deficiencies among women of reproductive age, especially from socially backward classes, are widely prevalent in India. The present study aimed to assess the nutrient intakes and analyse their associations with sociodemographic attributes among socially backward adolescent girls, newly married women, pregnant women, and lactating mothers from four districts of India. Further, the study looked at the associations between nutrient intakes and anthropometric measurements (body mass index, BMI; waist circumference; and waist-hip ratio, WHR) among adolescents and newly married women. This community-based cross-sectional study used the 24-hour recall method of the dietary survey to assess the food intake of women and girls. Nonparametric tests of associations between sociodemographic characteristics and the median nutrient intakes were conducted. Expected and observed increments in energy and nutrient intakes of pregnant and lactating women from the base (requirement of an adult woman) were calculated. A total of 477 pregnant women, 455 lactating mothers, 532 newly married women, and 223 adolescent girls were interviewed. According to the 24-h dietary recall, only 35% of adolescent girls, 57% newly married women, 40% pregnant women, and 34% lactating mothers were able to meet 70% of the recommended energy requirements. A large percentage of pregnant women had less than 50% of the recommended intakes of iron, calcium, and folic acid. Women living in nuclear families, urban slums, and those from backward classes had lower intakes of almost all the nutrients compared to their counterparts (p < 0.001). There were no significant differences in the nutrient intakes of adolescents, newly married, pregnant, and lactating women, and all had poor dietary intakes. We found positive relationships of all three anthropometric measurements (BMI, waist circumference, and WHR) with fats and inverse associations with carbohydrates. Public health interventions should work towards improving the nutrition of these vulnerable populations.

Eating Vegetables First at Start of Meal and Food Intake among Preschool Children in Japan

Eating behavior is an important aspect for dietary quality and long-term health. This study examined associations between eating vegetables first at a meal and food intakes among preschool children in Tokyo, Japan. We used cross-sectional data of 135 preschool children from seven nursery schools in Adachi City, Tokyo, Japan. Caregivers completed a survey on child’s eating behaviors and a diet questionnaire. Linear regression was used to examine frequency of eating vegetables first at a meal and food intakes; percent difference and the corresponding 95% confidence interval (95% CI) were presented. Overall, 25.2% of children reported eating vegetables first at a meal every time, 52.6% sometimes, and 22.2% not often or never. In the multivariate analysis, higher vegetable intake remained significant after adjusting for other covariates (compared with the group of eating vegetables first not often or never, the group reported sometimes: 27%, 95% CI: 0–63%; the group reported every time: 93%, 95% CI: 43–159%). No significant difference in intake by frequency categories of eating vegetables first was observed for other food groups, including fruits, meat, fish, cereals, and sweets. Children eating vegetables first at a meal more was associated with higher total intake of vegetables compared with children who did not eat vegetables first, among Japanese preschool children.

Diet and liver cancer risk: a narrative review of epidemiological evidence

Primary liver cancer is the third leading cause of cancer-related death worldwide. Most patients are diagnosed at late stages with poor prognosis; thus, identification of modifiable risk factors for primary prevention of liver cancer is urgently needed. The well-established risk factors of liver cancer include chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV), heavy alcohol consumption, metabolic diseases such as obesity and diabetes, and aflatoxin exposure. However, a large proportion of cancer cases worldwide cannot be explained by current known risk factors. Dietary factors have been suspected as important, but dietary aetiology of liver cancer remains poorly understood. In this review, we summarised and evaluated the observational studies of diet including single nutrients, food and food groups, as well as dietary patterns with the risk of developing liver cancer. Although there are large knowledge gaps between diet and liver cancer risk, current epidemiological evidence supports an important role of diet in liver cancer development. For example, exposure to aflatoxin, heavy alcohol drinking and possibly dairy product (not including yogurt) intake increase, while intake of coffee, fish and tea, light-to-moderate alcohol drinking and several healthy dietary patterns (e.g. Alternative Healthy Eating Index) may decrease liver cancer risk. Future studies with large sample size and accurate diet measurement are warranted and need to consider issues such as the possible aetiological heterogeneity between liver cancer subtypes, the influence of chronic HBV or HCV infection, the high-risk populations (e.g. cirrhosis) and a potential interplay with host gut microbiota or genetic variations.

[Reactive hypoglycemia - an interdisciplinary approach of the disease of XXI Century]

Reactive hypoglycemia is characterized by low blood glucose level in non-diabetic patients. It manifests as a syndrome of adrenergic and neuroglycopenic symptoms in the postprandial period, and their resolution occurs after consuming carbohydrates. The etiology of reactive hypoglycemia is not fully understood. It may occur in patients after gastrointestinal surgery due to too fast gastric emptying. Decreases in postprandial glucose are also observed in people with a pre-diabetes condition in which insulin secretion is disturbed. Hypoglycaemia can also be seen in patients with insulin resistance and hyperinsulinism. The aim of this study was to summarize existing knowledge about reactive hypoglycemia - etiology, diagnostic model and treatment.

Association between Dietary Glycaemic Index and Glycaemic Load and Adiposity Indices in Polycystic Ovary Syndrome

Objective: Obesity is a key contributor to metabolic and reproductive outcomes in polycystic ovary syndrome (PCOS). The role of the dietary glycemic index (GI) and load (GL), and adiposity has been debated and studies on PCOS are scarce. We aimed to compare the dietary GI and GL and several anthropometric measurements in PCOS and control women. The association between dietary GI and GL and adiposity indices was examined in this cross-sectional study.Methods and materials: A study population consisted of 65 previously diagnosed with PCOS and 65 healthy women. All participants underwent detailed anthropometric, dietary and physical activity evaluation and categorized based on GI and GL tertiles.Results: When dietary GL was adjusted for age, physical activity level (PAL), and duration of diagnosis, there was a statistically significant inverse association between dietary GL and waist/hip ratio (WHR) (OR: 0.136; 95% CI: 0.021-0.874; p = 0.036) in women with PCOS. Both dietary GI (OR: 8.869; 95% CI: 1.194-65.910; p = 0.033 for tertile 2 in adjustment model) and GL (OR: 7.200; 95% CI: 1.635-31.712; p = 0.009 for tertile 3 in crude model; OR: 5.801; 95% CI: 1.242-27.096; p = 0.025 for tertile 3 in adjustment model) positively associated with WHR in healthy subjects. Also, positive association was observed between dietary GI and waist/height ratio (WHtR) (OR: 0.229; 95% CI: 0.063-0.826; p = 0.024 for tertile 2; OR: 0.277; 95% CI: 0.078-0.988; p = 0.048 for tertile 3) in healthy controls, however after adjustment for age and PAL, statistical significance was lost (OR: 1.051; 95% CI: 0.152-7.261; p = 0.959 for tertile 2; OR: 1.522; 95% CI: 0.225-10.297; p = 0.667 for tertile 3).Conclusion: The results of this study consistent with the literature that PCOS is associated with increased adiposity indices. There was no association between dietary GI/GL and BMI, WC, WHtR, and ABSI but dietary GL was inversely associated WHR in PCOS patients.

The Metabolic Concept of Meal Sequence vs. Satiety: Glycemic and Oxidative Responses with Reference to Inflammation Risk, Protective Principles and Mediterranean Diet

With increasing exposure to eating opportunities and postprandial conditions becoming dominant states, acute effects of meals are garnering interest. In this narrative review, meal components, combinations and course sequence were questioned vis-à-vis resultant postprandial responses, including satiety, glycemic, oxidative and inflammatory risks/outcomes vs. protective principles, with reference to the Mediterranean diet. Representative scientific literature was reviewed and explained, and corresponding recommendations discussed and illustrated. Starting meals with foods, courses and/or preloads high in innate/added/incorporated water and/or fibre, followed by protein-based courses, delaying carbohydrates and fatty foods and minimizing highly-processed/sweetened hedonic foods, would increase satiety-per-calorie vs. obesogenic passive overconsumption. Similarly, starting with high-water/fibre dishes, followed by high-protein foods, oils/fats, and delayed/reduced slowly-digested whole/complex carbohydrate sources, optionally closing with simpler carbohydrates/sugars, would reduce glycaemic response. Likewise, starting with foods high in innate/added/incorporated water/fibre/antioxidants, high monounsaturated fatty acid foods/oils, light proteins and whole/complex carbohydrate foods, with foods/oils low in n-6 polyunsaturated fatty acids (PUFA) and n-6:n-3 PUFA ratios, and minimal-to-no red meat and highly/ultra-processed foods/lipids, would reduce oxidative/inflammatory response. Pyramids illustrating representative meal sequences, from most-to-least protective foods, visually communicate similarities between axes, suggesting potential unification for optimal meal sequence, consistent with anti-inflammatory nutrition and Mediterranean diet/meal principles, warranting application and outcome evaluation.

Glycemic Index of Slowly Digestible Carbohydrate Alone and in Powdered Drink-Mix

Consumer interest in food and beverages with carbohydrates offering steady glucose release and lower glycemic index (GI) continues to rise. Glycemic index is one of the metrics for carbohydrate quality. Slowly digestible carbohydrates (SDC) offer an ingredient solution to improve carbohydrate quality and meet consumer needs. SUSTRA^TM 2434 slowly digestible carbohydrate is a blend of tapioca flour and corn starch. The study objective was to determine the glycemic index of the SDC ingredient alone and in a powdered drink-mix. In a randomized, single-blind study, heathy adults (n = 14) consumed four test drinks, delivering 50 g available carbohydrates on separate days to measure GI. Participants either consumed dextrose in water (placebo), SDC ingredient in water, SDC drink-mix powder reconstituted in skim milk, or control drink-mix reconstituted in skim milk (without SDC). Post-prandial glucose response was measured over 4 h. SDC exhibited lower GI (0–2 h) and higher steady glucose release (beyond 2 h). SDC alone (GI = 27) and SDC in drink-mix (GI = 30.3) showed significantly lower GI (−27%) compared to dextrose (100) and the control drink-mix (41.5). SUSTRA^TM 2434 SDC is a low glycemic ingredient, suitable for product innovations with potential for low glycemic and steady glucose release claims.

Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association?

Refined grain intake is widely assumed to be associated with adverse health outcomes, including increased risk for cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity. The 2015 Dietary Guidelines Advisory Committee recommended that to improve dietary quality, the US population should replace most refined grains with whole grains. This recommendation was based largely on results from studies that examined dietary patterns, not separate food groups. A Western dietary pattern typically includes red and processed meat, sugar-sweetened foods and beverages, French fries, and high-fat dairy products, as well as refined grains, and has been linked to increased risk of many chronic diseases. However, when evaluated as a distinct food category, 11 meta-analyses of prospective cohort studies, which included a total of 32 publications with data from 24 distinct cohorts, demonstrated that refined grain intake was not associated with all-cause mortality, T2D, CVD, coronary heart disease (CHD), stroke, hypertension, or cancer. By contrast, consumption of red and processed meat was consistently associated with increased risk of these same health outcomes. Refined grain consumption up to 6-7 servings/d (1 serving = 30 g) was not associated with higher risk of CHD, T2D, hypertension, or all-cause mortality. Moreover, total grain intake was not associated with risk of CVD, CHD, stroke, or cancer, but was associated with lower risk of all-cause mortality. Consequently, the recommendation to reduce refined grain intake based on results from studies linking a Western dietary pattern to numerous adverse health outcomes is contrary to a substantial body of published scientific evidence. Future research needs to better define refined grain intake to distinguish between staple grain foods and indulgent grain foods, and to better design randomized controlled trials to resolve discrepancies between results from observational studies and such trials with regard to determining the benefits of whole grains compared with refined grains.

Dietary glycemic index and glycemic load in relation to general obesity and central adiposity among adults

BACKGROUND & AIMS

Although the association between dietary Glycemic Index (GI), Glycemic Load (GL) and general/abdominal obesity has extensively been examined, limited data are available in this regard in developing countries. The aim of this study was to examine the association between dietary GI and GL with general and abdominal obesity.

METHODS

This cross-sectional study was conducted among adults in Isfahan, Iran. Dietary GI and GL were assessed using a validated dish-based 106-item semi-quantitative food frequency questionnaire (DS-FFQ). Data regarding height, weight and waist circumference were collected using a self-reported questionnaire. Overweight or obesity was defined as body mass index ≥25 kg/m², and abdominal obesity was defined as waist circumference ≥80 cm for women and ≥94 cm for men.

RESULTS

There was no significant association between dietary GI and GL and general obesity. After adjustment for potential confounders, participants in the highest quintile of dietary GI had a higher chance for abdominal obesity (OR: 1.29; 95% CI: 1.01-1.64), compared with those in the lowest quintile. No significant association was observed between dietary GL and abdominal obesity. After adjustment for potential confounders, women in the top quintile of dietary GI had higher chance for abdominal obesity compared with those in the bottom quintile (OR: 1.48, 95% CI: 1.02-2.15). No significant association was found between dietary GI and abdominal obesity among men. We failed to find any significant association between dietary GI and general obesity in either gender [Comparing top vs. bottom quintiles, for men: OR: 0.97; 95% CI: 0.74-1.29 and for women: OR: 1.01; 95% CI: 0.75-1.40]. No significant association was found between dietary GL and general [for men: OR: 1.13; 95% CI: 0.85-1.49 and for women: OR: 1.01; 95% CI: 0.76-1.35], as well as abdominal obesity [for men: OR: 1.21; 95% CI: 0.88-1.67 and for women: OR: 1.25; 95% CI: 0.88-1.77].

CONCLUSIONS

We found a significant positive association between dietary GI and abdominal obesity. When we conducted analyses stratified by gender, we also observed such association in women, but not in men. No other significant associations were observed between dietary GI and GL with general or abdominal obesity.

Dietary patterns interact with chromosome 9p21 rs1333048 polymorphism on the risk of obesity and cardiovascular risk factors in apparently healthy Tehrani adults

PURPOSE

Gene-dietary patterns may contribute to determining body composition and related biochemical indices. The aim of this study was to evaluate interactions between rs1333048 polymorphism and major dietary patterns on body fat percentage, general and central obesity, and related biochemical measurements.

METHODS

This cross-sectional study was conducted on 265 healthy Tehrani adults with mean age of 35 years (47.5% men, 52.5% women). Dietary patterns (DPs) were extracted by factor analysis. Bioelectrical impedance analysis was used for body analysis and rs1333048 was genotyped by the restriction fragment length polymorphism (PCR-RFLP) method.

RESULTS

Three DPs were extracted: restricted refined grains DP, legumes DP and healthy DP. AA genotype compared to CC genotype had greater odds for general obesity before (OR 3.14; 95% CI 1.008-9.60, P = 0.045) and after (OR 3.11; 95% CI 1.008-9.60, P = 0.048) adjusting for potential confounders. Individuals with AA genotype were more likely to be centrally obese before (OR 2.09; 95% CI 1.006-4.35, P = 0.048) and after (OR 2.63; 95% CI 1.12-6.17, P = 0.026) controlling for potential confounders. Significant interactions were observed between Legumes DP and rs1333048 SNP on waist circumference (P = 0.047), body fat % (BFP) (P = 0.048), hs-Crp (P = 0.042), BMI (P = 0.073), WHtR (P = 0.063) and odds for general obesity (P = 0.051). Following this DP reduced all these items for individuals with CC genotype, whereas increased them for people who carry CA or AA genotypes.

CONCLUSIONS

The findings indicate that there are significant associations between AA genotype of rs1333048 SNP and general and central obesity, and significant interaction between alleles of this SNP and major dietary patterns on the odds of general obesity, BFP, waist circumference, BMI, WHtR and hs-Crp.

Changes in Dietary Intake and Adherence to the NU-AGE Diet Following a One-Year Dietary Intervention among European Older Adults-Results of the NU-AGE Randomized Trial

BACKGROUND

The Mediterranean Diet has been proposed as an effective strategy to reduce inflammaging, a chronic low grade inflammatory status, and thus, to slow down the aging process. We evaluated whether a Mediterranean-like dietary pattern specifically targeting dietary recommendations of people aged over 65 years (NU-AGE diet) could be effective to shift dietary intake of older adults towards a healthful diet.

METHODS

Adults aged 65⁻80 years across five EU-centers were randomly assigned to a NU-AGE diet group or control group. The diet group followed one year of NU-AGE dietary intervention specifying consumption of 15 food groups plus the use of a vitamin D supplement. Participants in the diet group received counselling and individually tailored dietary advice, food products and a vitamin D supplement. Dietary intake was assessed by means of seven-day food records at baseline and one-year follow-up. A continuous NU-AGE index (0⁻160 points) was developed to assess NU-AGE diet adherence.

RESULTS

In total 1296 participants were randomized and 1141 participants completed the intervention (571 intervention, 570 control). After one year, the diet group improved mean intake of 13 out of 16 NU-AGE dietary components (p < 0.05), with a significant increase in total NU-AGE index (difference in mean change = 21.3 ± 15.9 points, p < 0.01).

CONCLUSIONS

The NU-AGE dietary intervention, based on dietary recommendations for older adults, consisting of individual dietary counselling, free healthy foods and a vitamin D supplement, may be a feasible strategy to improve dietary intake in an aging European population.

A Plant-Based High-Carbohydrate, Low-Fat Diet in Overweight Individuals in a 16-Week Randomized Clinical Trial: The Role of Carbohydrates

The effects of carbohydrates on body weight and insulin sensitivity are controversial. In this 16-week randomized clinical trial, we tested the role of a low-fat, plant-based diet on body weight, body composition and insulin resistance. As a part of this trial, we investigated the role of changes in carbohydrate intake on body composition and insulin resistance. Participants (n = 75) were randomized to follow a plant-based high-carbohydrate, low-fat (vegan) diet (n = 38) or to maintain their current diet (n = 37). Dual-energy X-ray absorptiometry was used to measure body composition. Insulin resistance was assessed with the Homeostasis Model Assessment (HOMA-IR) index. A repeated measure ANOVA model was used to test the between-group differences from baseline to 16 weeks. A linear regression model was used to test the relationship between carbohydrate intake, and body composition and insulin resistance. Weight decreased significantly in the vegan group (treatment effect -6.5 [95% CI -8.9 to -4.1] kg; Gxt, p < 0.001). Fat mass was reduced in the vegan group (treatment effect -4.3 [95% CI -5.4 to -3.2] kg; Gxt, p < 0.001). HOMA-IR was reduced significantly in the vegan group (treatment effect -1.0 [95% CI -1.2 to -0.8]; Gxt, p = 0.004). Changes in consumption of carbohydrate, as a percentage of energy, correlated negatively with changes in BMI (r = -0.53, p < 0.001), fat mass (r = -0.55, p < 0.001), volume of visceral fat (r = -0.35, p = 0.006), and HOMA (r = -0.27, p = 0.04). These associations remained significant after adjustment for energy intake. Changes in consumption of total and insoluble fiber correlated negatively with changes in BMI (r = -0.43, p < 0.001; and r = -0.46, p < 0.001, respectively), fat mass (r = -0.42, p < 0.001; and r = -0.46, p < 0.001, respectively), and volume of visceral fat (r = -0.29, p = 0.03; and r = -0.32, p = 0.01, respectively). The associations between total and insoluble fiber and changes in BMI and fat mass remained significant even after adjustment for energy intake. Increased carbohydrate and fiber intake, as part of a plant-based high-carbohydrate, low-fat diet, are associated with beneficial effects on weight, body composition, and insulin resistance.

Trends in frequency of type 2 diabetes in Mexico and its relationship to dietary patterns and contextual factors

OBJECTIVE

To analyse the evolution of the frequency of type 2 diabetes (T2D) and its relationship to eating patterns in Mexico from 1961 to 2013, and the Gini coefficient, Human Development Index (HDI) and Gross Domestic Product (GDP). Mexico ranked sixth in world prevalence of diabetes in 2015 with an estimated 11.4 million Mexicans affected.

METHOD

Using data from the Balance Sheets Food published by the Food and Agriculture Organization of the United Nations (FAO), the means of apparent food consumption (kcal/person/day) were grouped by decades. Data for mortality rate for diabetes were obtained from 1990 until 2015. Spearman's correlation coefficient was calculated between the diabetes mellitus mortality rate and all food groups. Pearson's correlation explored the relationship between socio economic indicators and the prevalence of T2D diabetes.

RESULTS

The mortality rate for T2D has increased over the last decades. An increase of 647.9kcal/person/day in apparent food consumption was observed. Cereal and legume consumption decreased, while apparent sugar, animal food and animal fat and vegetable oil consumption increased substantially. HDI and GDP showed a directly proportional relationship to diabetes. Spearman's correlation coefficient was statistically significant only for sugar. The Gini coefficient suggests that in lower inequalities there is an increased frequency of diabetes.

CONCLUSIONS

The increase in the mortality rate of type 2 diabetes was constant during the study period, which coincides with the increase in energy density of Mexican eating patterns from 1961 to 2013. The higher the Gini coefficient, HDI and GDP, the higher the mortality observed for diabetes.

Comparison of Dietary Intake between Polycystic Ovary Syndrome Women and Controls

Polycystic Ovary syndrome (PCOS) is a complicated endocrinopathy affecting women in reproductive age. The crucial role of obesity and insulin resistance in progression of metabolic and cardiovascular features of PCOS has been confirmed. Although it has been suggested that there is a possible association between dietary pattern and risk of PCOS, few studies investigating the diet composition of PCOS women. The aim of this study was to compare the dietary intakes between women with polycystic ovary syndrome (PCOS) and eumenorrheic non hirsute women. This was a case control study of 142 women with PCOS and 140 eumenorrheic non hirsute healthy age and BMI matched controls. We compared the dietary intakes of our study group using a validated food frequency questionnaire (FFQ), using T-test or Mann-Whitney to compare the means of two groups. One way Anova was used to compare the tertiles of GI and GL in each group and a two way ANOVA was used to compare between tertiles of GI-GL and groups. The results demonstrated that energy and macronutrient intakes in PCOS women compared to controls were similar. PCOS group consumed more food items with high glycemic index (p=0.042) and less legumes (P=0.026) and vegetables (p=0.037) than controls. Both groups in the highest tertile of glycemic load (GL) had higher body mass index and waist circumference. Considering the results of this study, it was concluded that PCOS women had a dietary pattern that was characterized by a higher consumption of high GI food items and lower legumes and vegetables.

An Analysis of Contributors to Energy Intake Among Middle Aged and Elderly Adults

Adulthood and middle age is widely recognized as the time of life when unhealthy eating habits may develop. Data from various studies have demonstrated that changes in eating habits may also occur during old age. It is essential to acknowledge that a high consumption of certain food groups such as sweetened beverages, meat and eggs may contribute to an increased energy intake. This obviously results in high body mass index (BMI) and consequently an increased risk of non-communicable diseases (NCDs) and obesity. Energy intake among middle aged and elderly individuals may be influenced by socio demographic factors (for example: age, gender, socio economic status), social factors (for example: marital status), environmental factors like access to food commodities as well as nutrition knowledge and physical activity level. The present review highlights eating habits, contribution of specific food groups to energy intake and the influence of several factors on energy intake among the middle aged and elderly population.

Macronutrient Distribution and Dietary Sources in the Spanish Population: Findings from the ANIBES Study

Our aim was to analyze dietary macronutrient intake and its main sources according to sex and age. Results were derived from the ANIBES ("Anthropometry, Intake and Energy Balance in Spain") cross-sectional study using a nationally-representative sample of the Spanish population (9-75 years old). Mean dietary protein intake was 74.5 ± 22.4 g/day, with meat and meat products as the main sources (33.0%). Mean carbohydrate intake was 185.4 ± 60.9 g/day and was higher in children and adolescents; grains (49%), mainly bread, were the main contributor. Milk and dairy products (23%) ranked first for sugar intake. Mean lipid intake was 78.1 ± 26.1 g/day and was higher in younger age groups; contributions were mainly from oils and fats (32.5%; olive oil 25.6%) and meat and meat products (22.0%). Lipid profiles showed relatively high monounsaturated fatty acid intake, of which olive oil contributed 38.8%. Saturated fatty acids were mainly (>70%) combined from meat and meat products, milk and dairy products and oils and fats. Polyunsaturated fatty acids were mainly from oils and fats (31.5%). The macronutrient intake and distribution in the Spanish population is far from population reference intakes and nutritional goals, especially for children and adolescents.

A critical review of low-carbohydrate diets in people with Type 2 diabetes

AIMS

The efficacy of low-carbohydrate diets (LCD) in people with Type 2 diabetes has divided the nutrition community. This review seeks to re-examine the available data to clarify understanding.

METHODS

A comprehensive search of databases was used to identify meta-analyses of LCD in Type 2 diabetes. To improve the quality of the studies analysed, the following inclusion criteria were applied: randomized control trials ≥ 4 weeks in people aged > 18 years with Type 2 diabetes; a carbohydrate intake ≤ 45% of total energy intake per day; and a dietary intake assessment at the end of the study. The resulting studies were subjected to a thematic analysis.

RESULTS

Nine meta-analyses were identified containing 153 studies. Twelve studies met our amended inclusion criteria. There were no significant differences in metabolic markers, including glycaemic control, between the two diets, although weight loss with a LCD was greater in one study. Carbohydrate intake at 1 year in very LCD (< 50 g of carbohydrates) ranged from 132 to 162 g. In some studies, the difference between diets was as little as 8 g/day of carbohydrates.

CONCLUSION

Total energy intake remains the dietary predictor of body weight. A LCD appears no different from a high-carbohydrate diet in terms of metabolic markers and glycaemic control. Very LCDs may not be sustainable over a medium to longer term as carbohydrate intake in diets within studies often converged toward a more moderate level. The variable quality of studies included in earlier meta-analyses likely explains the previous inconsistent findings between meta-analyses.

Effects of natural raw meal (NRM) on high-fat diet and dextran sulfate sodium (DSS)-induced ulcerative colitis in C57BL/6J mice

BACKGROUND/OBJECTIVES

Colitis is a serious health problem, and chronic obesity is associated with the progression of colitis. The aim of this study was to determine the effects of natural raw meal (NRM) on high-fat diet (HFD, 45%) and dextran sulfate sodium (DSS, 2% w/v)-induced colitis in C57BL/6J mice.

MATERIALS/METHODS

Body weight, colon length, and colon weight-to-length ratio, were measured directly. Serum levels of obesity-related biomarkers, triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), insulin, leptin, and adiponectin were determined using commercial kits. Serum levels of pro-inflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6 were detected using a commercial ELISA kit. Histological study was performed using a hematoxylin and eosin (H&E) staining assay. Colonic mRNA expressions of TNF-α, IL-1β, IL-6, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2) were determined by RT-PCR assay.

RESULTS

Body weight and obesity-related biomarkers (TG, TC, LDL, HDL, insulin, leptin, and adiponectin) were regulated and obesity was prevented in NRM treated mice. NRM significantly suppressed colon shortening and reduced colon weight-to-length ratio in HFD+DSS induced colitis in C57BL/6J mice (P < 0.05). Histological observations suggested that NRM reduced edema, mucosal damage, and the loss of crypts induced by HFD and DSS. In addition, NRM decreased the serum levels of pro-inflammatory cytokines, TNF-α, IL-1β, and IL-6 and inhibited the mRNA expressions of these cytokines, and iNOS and COX-2 in colon mucosa (P < 0.05).

CONCLUSION

The results suggest that NRM has an anti-inflammatory effect against HFD and DSS-induced colitis in mice, and that these effects are due to the amelioration of HFD and/or DSS-induced inflammatory reactions.

Snacks, sweetened beverages, added sugars, and schools

Concern over childhood obesity has generated a decade-long reformation of school nutrition policies. Food is available in school in 3 venues: federally sponsored school meal programs; items sold in competition to school meals, such as a la carte, vending machines, and school stores; and foods available in myriad informal settings, including packed meals and snacks, bake sales, fundraisers, sports booster sales, in-class parties, or other school celebrations. High-energy, low-nutrient beverages, in particular, contribute substantial calories, but little nutrient content, to a student's diet. In 2004, the American Academy of Pediatrics recommended that sweetened drinks be replaced in school by water, white and flavored milks, or 100% fruit and vegetable beverages. Since then, school nutrition has undergone a significant transformation. Federal, state, and local regulations and policies, along with alternative products developed by industry, have helped decrease the availability of nutrient-poor foods and beverages in school. However, regular access to foods of high energy and low quality remains a school issue, much of it attributable to students, parents, and staff. Pediatricians, aligning with experts on child nutrition, are in a position to offer a perspective promoting nutrient-rich foods within calorie guidelines to improve those foods brought into or sold in schools. A positive emphasis on nutritional value, variety, appropriate portion, and encouragement for a steady improvement in quality will be a more effective approach for improving nutrition and health than simply advocating for the elimination of added sugars.

Can whole grain help in weight management?

BACKGROUND

Evidence from epidemiological studies suggests that higher whole grain intake is associated with improvements in body weight measures. Evidence from randomized controlled intervention studies is controversial.

OBJECTIVE

To assess the scientific evidence, using a descriptive systematic approach, related to the relationship/effects of whole grain on weight management.

METHODS

Medicine Medical Subject Headings (MeSH) were used to search in Medline and Scopus, dating from 1980 to July 2013. Subsequently, 2 researchers assessed independently the resulting abstracts, using hierarchically targeted selection criteria.

RESULTS

A moderate body of evidence from epidemiological studies consistently demonstrates that a higher intake of whole grains is associated with lower body weight, BMI, waist circumference, abdominal adiposity, and weight gain. The evidence from intervention studies is, in comparison, limited and less consistent. Current evidence fails to clearly demonstrate that whole grain intake can contribute to weight loss independent of hypocaloric diets. The lack of consistency in intervention studies may partly be explained by heterogeneity in study duration, types and amounts of whole grain foods included, population, and sample sizes.

CONCLUSIONS

Future epidemiological and intervention studies are needed to address the limitations observed in the current body of evidence, importantly using a consistent definition of whole grain foods, and the amount of whole grains consumed. Furthermore, studies need to be conducted on diets that potentially include single grains.

Reprint of: A parallel randomized trial on the effect of a healthful diet on inflammageing and its consequences in European elderly people: design of the NU-AGE dietary intervention study

BACKGROUND

The proportion of European elderly is expected to increase to 30% in 2060. Combining dietary components may modulate many processes involved in ageing. So, it is likely that a healthful diet approach might have greater favourable impact on age-related decline than individual dietary components. This paper describes the design of a healthful diet intervention on inflammageing and its consequences in the elderly.

METHODS

The NU-AGE study is a parallel randomized one-year trial in 1250 apparently healthy, independently living European participants aged 65-80 years. Participants are randomised into either the diet group or control group. Participants in the diet group received dietary advice aimed at meeting the nutritional requirements of the ageing population. Special attention was paid to nutrients that may be inadequate or limiting in diets of elderly, such as vitamin D, vitamin B12, and calcium. C-reactive protein is measured as primary outcome.

DISCUSSION

The NU-AGE study is the first dietary intervention investigating the effect of a healthful diet providing targeted nutritional recommendations for optimal health and quality of life in apparently healthy European elderly. Results of this intervention will provide evidence on the effect of a healthful diet on the prevention of age related decline.

Glycemic index, glycemic load and childhood obesity: A systematic review

Background:

Several evidences have been reported so far in terms of the relationship between obesity and glycemic index and glycemic load in children. However, the number of review studies that have dealt with recent findings is quite low. The purpose of present study is to review the existing evidences in this regard.

Materials and Methods:

First of all, the phrases: “Glycaemic index”, “Glycaemic load”, “Glycemic index” OR “Glycemic load” accompanied by one of the words: “Adolescent”, “Young”, “Youth” “Children” OR “Child” were searched in texts of articles existing in ISI and PUBMED databases which were obtained out of 1001 articles. Among these, some articles, which reviewed the relationship of obesity with glycemic index and glycemic load, were selected. Finally, 20 articles were studied in current review study.

Results:

The majority of cross-sectional studies have found children's obesity directly linked with glycemic index and glycemic load; however, cohort studies found controversial results. Also, the intervention studies indicate the negative effect of glycemic index and glycemic load on obesity in children.

Conclusion:

Published evidences reported inconsistent results. It seems that existing studies are not sufficient and more studies are needed in this regard.

Fermented wheat powder induces the antioxidant and detoxifying system in primary rat hepatocytes

Many plants exhibit antioxidant properties which may be useful in the prevention of oxidative stress reactions, such as those mediated by the formation of free radical species in different pathological situations. In recent years a number of studies have shown that whole grain products in particular have strong antioxidant activity. Primary cultures of rat hepatocytes were used to investigate whether and how a fermented powder of wheat (Lisosan G) is able to modulate antioxidant and detoxifying enzymes, and whether or not it can activate Nrf2 transcription factor or inhibit NF-kB activation. All of the antioxidant and detoxifying enzymes studied were significantly up-regulated by 0.7 mg/ml Lisosan G treatment. In particular,

NAD(P)H

quinone oxidoreductase and heme oxygenase-1 were induced, although to different degrees, at the transcriptional, protein and/or activity levels by the treatment. As for the Nrf2 transcription factor, a partial translocation of its protein from the cytosol to the nucleus after 1 h of Lisosan G treatment was revealed by immunoblotting. Lisosan G was also observed to decrease H2O2-induced toxicity Taken together, these results show that this powder of wheat is an effective inducer of ARE/Nrf2-regulated antioxidant and detoxifying genes and has the potential to inhibit the translocation of NF-kB into the nucleus.

High-fiber rye diet increases ileal excretion of energy and macronutrients compared with low-fiber wheat diet independent of meal frequency in ileostomy subjects

Background

Whole-grain foods and cereal dietary fiber intake is associated with lower body weight. This may partly result from lower energy utilization of high-fiber diets.

Objective

In the present study, the impact on ileal excretion of energy and macronutrients in response to a rye bread high-fiber diet compared to a refined wheat low-fiber diet was investigated. Furthermore, the effect of meal frequency on apparent absorption of nutrients was studied for the first time.

Design

Ten participants that had undergone ileostomy consumed standardized iso-caloric diets, including low-fiber wheat bread (20 g dietary fiber per day) for 2 weeks followed by high-fiber rye bread (52 g dietary fiber per day) for 2 weeks. The diets were consumed in an ordinary (three meals per day) and a nibbling (seven meals per day) meal frequency in a cross-over design. Ileal effluents were collected during 24 h at the third day of each of the four dietary periods and analyzed for gross energy and nutrient contents.

Results

The results showed that intake of rye bread high-fiber diet compared to the refined wheat low-fiber diet caused an increase in ileal excretion of energy and macronutrients. The effect was independent of meal frequency. This suggests that a high intake of rye may result in lower availability of macronutrients for small intestinal digestion and absorption. A regular intake of rye may therefore have implications for weight management.

A parallel randomized trial on the effect of a healthful diet on inflammageing and its consequences in European elderly people: design of the NU-AGE dietary intervention study

BACKGROUND

The proportion of European elderly is expected to increase to 30% in 2060. Combining dietary components may modulate many processes involved in ageing. So, it is likely that a healthful diet approach might have greater favourable impact on age-related decline than individual dietary components. This paper describes the design of a healthful diet intervention on inflammageing and its consequences in the elderly.

METHODS

The NU-AGE study is a parallel randomized one-year trial in 1250 apparently healthy, independently living European participants aged 65-80 years. Participants are randomised into either the diet group or control group. Participants in the diet group received dietary advice aimed at meeting the nutritional requirements of the ageing population. Special attention was paid to nutrients that may be inadequate or limiting in diets of elderly, such as vitamin D, vitamin B12, and calcium. C-reactive protein is measured as primary outcome.

DISCUSSION

The NU-AGE study is the first dietary intervention investigating the effect of a healthful diet providing targeted nutritional recommendations for optimal health and quality of life in apparently healthy European elderly. Results of this intervention will provide evidence on the effect of a healthful diet on the prevention of age related decline.

Carbohydrates, dietary fiber, and resistant starch in white vegetables: links to health outcomes

Vegetables are universally promoted as healthy. Dietary Guidelines for Americans 2010 recommend that you make half of your plate fruits and vegetables. Vegetables are diverse plants that vary greatly in energy content and nutrients. Vegetables supply carbohydrates, dietary fiber, and resistant starch in the diet, all of which have been linked to positive health outcomes. Fiber lowers the incidence of cardiovascular disease and obesity. In this paper, the important role of white vegetables in the human diet is described, with a focus on the dietary fiber and resistant starch content of white vegetables. Misguided efforts to reduce consumption of white vegetables will lower intakes of dietary fiber and resistant starch, nutrients already in short supply in our diets.

Beverages and body weight: challenges in the evidence-based review process of the Carbohydrate Subcommittee from the 2010 Dietary Guidelines Advisory Committee

Concern about the role of beverages, especially those containing sugar, in the obesity epidemic continues to escalate. Bans on sugar-sweetened beverages and chocolate milk have expanded from the school cafeteria to the ballpark and convenience store. This review describes the experience of the 2010 Dietary Guidelines Advisory Committee (DGAC) in conducting an evidence-based review of dietary exposure and health outcomes. The following four topics relevant to fluids and body weight were reviewed: added sugar, noncaloric sweeteners, food form and body weight, and macronutrients and satiety. There were limited and conflicting data on how liquids and solids affect energy intake and body weight. Fluid intake is typically not tracked in prospective, cohort longitudinal studies; thus, data are not available on fluid intake and health status from studies using the strongest epidemiologic designs. Despite public perception that beverages are linked to increased body weight compared with whole foods, evidence-based reviews of this topic do not support that liquid calories are processed differently in the body. The practical recommendation to replace caloric beverages with water as an aid to control weight is based on calorie reduction, rather than a link between added-sugar intake and obesity.

Dietary strategies to increase satiety

Obesity has a multifactorial etiology. Although obesity is widespread and associated with serious health hazards, its effective prevention and treatment have been challenging. Among the currently available treatment approaches, lifestyle modification to induce a negative energy balance holds a particularly larger appeal due to its wider reach and relative safety. However, long-term compliance with dietary modifications to reduce energy intake is not effective for the majority. The role of many individual nutrients, foods, and food groups in inducing satiety has been extensively studied. Based on this evidence, we have developed sample weight-loss meal plans that include multiple satiating foods, which may collectively augment the satiating properties of a meal. Compared to a typical American diet, these meal plans are considerably lower in energy density and probably more satiating. A diet that exploits the satiating properties of multiple foods may help increase long-term dietary compliance and consequentially enhance weight loss.