A systematic review of vascular and endothelial function: effects of fruit, vegetable and potassium intake

The potassium puzzle: exploring the intriguing connection to albuminuria

Background

Studies have revealed a relationship between dietary potassium intake and albuminuria, despite the fact that the human body needs a lot of potassium. Our study concentrated on the link between dietary potassium intake and albuminuria.

Methods

This study used subgroup analysis and weighted multivariate regression analysis. Data from the National Health and Nutrition Examination Survey (NHANES) were examined to determine the urinary albumin-to-creatinine ratio (ACR) and participant age (20 years or older). ACR >30 mg/g was the threshold for albuminuria.

Results

7,564 individuals in all were included in the study. The link between the two was significant in both our original model (OR = 0.99; 95% CI, 0.98-0.99, p < 0.0001) and the minimum adjusted model (OR = 0.99; 95% CI, 0.98-0.99, p < 0.0001). A fully adjusted model did not change the significance of the negative correlation between potassium consumption and albuminuria (OR = 0.99; 95% CI, 0.98-1.00, p = 0.0005), indicating that each unit increase in potassium intake was related with a 1% decrease in the chance of developing albuminuria. The negative correlation between potassium intake and albuminuria was not significantly influenced by sex, age, BMI, hypertension, diabetes, or smoking, according to interaction tests (p for interaction >0.05).

Conclusion

Reduced risk of albuminuria was linked to higher dietary potassium intake. The particular mechanism linking the two still has to be explained by several inventive and prospective studies.

Investigation of the effects of bovine collagen peptides and mixed berries on rheological properties and biological activity of egg white-based beverage via central composite design

Modern consumer expectations have become highly diversified: they want more opportunities to meet diverse family needs (diversity of family members in age, gender, physical activity, etc. ,) and individual health goals with a huge variety of sensorial preferences. Our research is aimed to develop a protein-dense, highly bioactive, lactose- and whey protein-free beverage applying a central composite rotational design (CCRD) with 2 factors. For this purpose, an egg white-based beverage was flavored with mixed berries (factor A) and enriched with bovine collagen peptides (factor B). After suitable sample preparation, the rheological properties were investigated by an Anton Paar MCR 92 rheometer (with CC 27 system, and flow behavior was analyzed with a Herschel-Bulkley (H-B) model). The antioxidant capacity of samples was investigated by Ferric Reducing Antioxidant Power (FRAP) method, the total anthocyanin content was estimated based on a spectrophotometric method, and the total phenolic content was determined by the Folin Ciocalteu method. Our results are figured on response surfaces demonstrating that both factors and their interactions show a positive correlation with the examined parameters. Based on the CCRD, all investigated parameters are significantly influenced by at least one aspect and can be adequately estimated for further product development.

Potassium intake is associated with nutritional quality and actual diet cost: a study at formulating a low sodium high potassium (LSHP) healthy diet

Increasing potassium and reducing sodium intake have been identified as a priority intervention to reduce non-communicable diseases. A low sodium high potassium (LSHP) healthy diet can be a predictor of overall dietary quality and is associated with higher diet costs. The present study was a randomised controlled-feeding trial, formulating menus of low sodium and potassium-rich healthy diet and comparing with usual diet (a control diet based on typical Indonesian diet) to assess the association of potassium intake in the menus with other nutritional contents and diet cost. Totally seventy menus, which consisted of LSHP diets and the usual diets for a 7-d cycle, were composed from the analysis of the Indonesian food composition database. The correlation coefficient of the potassium content of all menus with nutritional quality and diet cost was analysed using the Pearson test. Multiple linear regression analysis was performed to determine the most important nutrient in determining diet cost. A comparison of nutrition quality and diet cost from the two menus was analysed using the independent t-test. LSHP diet had significantly higher carbohydrate, protein, fibre, magnesium, calcium, vitamin C, potassium density and diet cost but lower total fat, saturated fat and energy density than the usual diet (P < 0⋅05). Furthermore, there was a strong positive correlation between fibre, potassium and diet cost (coefficient correlation of >0⋅8). Potassium is a nutrient that is closely related to diet quality although the cost of the diet often may inhibit its intake. A targeted and effective strategy is required to provide affordable food for achieving a sustainable nutrient-rich diet.

The Association of Dietary Intake with Arterial Stiffness and Vascular Ageing in a Population with Intermediate Cardiovascular Risk-A MARK Study

The aim of this study was to analyse the association of diet with arterial stiffness and vascular ageing in a Caucasian population with intermediate cardiovascular risk. We recruited 2475 individuals aged 35–75 years with intermediate cardiovascular risk. Brachial-ankle pulse wave velocity (baPWV) was measured using a VaSera VS-1500^® device. Vascular ageing was defined in two steps. Step 1: The 20 individuals who presented kidney disease, peripheral arterial disease, or heart failure were classified as early vascular ageing (EVA). Step 2: The individuals with percentiles by age and sex above the 90th percentile of baPWV among the participants of this study were classified as EVA, and the rest of the individuals were classified as non-EVA. The diet of the participants was analysed with two questionnaires: (1) the diet quality index (DQI) questionnaire and (2) the Mediterranean diet (MD) adherence questionnaire. The mean age of the sample was 61.34 ± 7.70 years, and 61.60% were men. Adherence to the MD was 53.30%. The DQI was 54.90%. Of the entire sample, 10.70% (11.15% of the men and 9.95% of the women) were EVA. In the multiple linear regression analysis, for each additional point in the DQI questionnaire, there was a decrease of −0.081 (95%CI (confidence intervals) −0.105–−0.028) in baPWV; in the MD adherence questionnaire, there was a decrease of −0.052 (95%CI −0141–−0.008). When performing the analysis, separated by sex, the association remained significant in men but not in women. In the logistic regression analysis, there was an increase in MD adherence and a decrease in the probability of presenting EVA, both with the DQI questionnaire (OR (odds ratio) = 0.65; 95%CI 0.50–0.84) and with the MD adherence questionnaire (OR = 0.75; 95%CI 0.58–0.97). In the analysis by sex, the association was only maintained in men (with DQI, OR = 0.54; 95%CI 0.37–0.56) (with MD, OR = 0.72; 95%CI 0.52–0.99). The results of this study suggest that a greater score in the DQI and MD adherence questionnaires is associated with lower arterial stiffness and a lower probability of presenting EVA. In the analysis by sex, this association is only observed in men.

Dietary nitrate and nitrite and human health: a narrative review by intake source

Nitrate and nitrite are plant nutrients that, although ubiquitous in plant foods, are highly controversial substances in human nutrition because they are also used as additives in processed foods and may be found as contaminants in drinking water. The aim for this narrative review is to provide a thorough insight into the current literature on the relationship between dietary nitrate and nitrite and the health risks and benefits by source of intake. The results highlight beneficial effects of nitrate and nitrite consumption from plant origin on cardiovascular disease and, to date, no positive correlation has been reported with cancer. On the contrary, high intake of these compounds from processed animal-based foods is related to an increased risk of gastro-intestinal cancer. Nitrate in drinking water also raises some concern, because it appears to be related to adverse health effects. The up-to-date debate on the role of nitrate and nitrite in human nutrition seems to be justified and more research is required to verify safe consumption.

Urinary Potassium Excretion, Fibroblast Growth Factor 23, and Incident Hypertension in the General Population-Based PREVEND Cohort

High plasma fibroblast growth factor 23 (FGF23) and low potassium intake have each been associated with incident hypertension. We recently demonstrated that potassium supplementation reduces FGF23 levels in pre-hypertensive individuals. The aim of the current study was to address whether 24-h urinary potassium excretion, reflecting dietary potassium intake, is associated with FGF23, and whether FGF23 mediates the association between urinary potassium excretion and incident hypertension in the general population. At baseline, 4194 community-dwelling individuals without hypertension were included. Mean urinary potassium excretion was 76 (23) mmol/24 h in men, and 64 (20) mmol/24 h in women. Plasma C-terminal FGF23 was 64.5 (54.2-77.8) RU/mL in men, and 70.3 (56.5-89.5) RU/mL in women. Urinary potassium excretion was inversely associated with FGF23, independent of age, sex, urinary sodium excretion, bone and mineral parameters, inflammation, and iron status (St. β -0.02, p < 0.05). The lowest sex-specific urinary potassium excretion tertile (HR 1.18 (95% CI 1.01-1.37)), and the highest sex-specific tertile of FGF23 (HR 1.17 (95% CI 1.01-1.37)) were each associated with incident hypertension, compared with the reference tertile. FGF23 did not mediate the association between urinary potassium excretion and incident hypertension. Increasing potassium intake, and reducing plasma FGF23 could be independent targets to reduce the risk of hypertension in the general population.

Recent advances and future perspective of essential oils in control Colletotrichum spp.: A sustainable alternative in postharvest treatment of fruits

The world population growth has raised concerns about food security. Agricultural systems are asked to satisfy a growing demand for food with increasingly limited resources, and simultaneously still must reduce the impacts on the environment. This scenario encourages the search for safe and sustainable production strategies. Reducing losses in the production process can be one of the main ways to guarantee food safety. In fruticulture, it is estimated that more than 50% of the production can be lost between harvest and the final consumer due to postharvest diseases caused by phytopathogenic fungi. The fungi of the genus Colletotrichum are opportunistic and are associated with several diseases, being the anthracnose the most relevant in terms of the quality and yield losses in fruit species around worldwide. To control these diseases, the use of synthetic fungicides has been the main instrument utilized, however, because of their phytotoxicity to human health, the environment, and strong selection pressure imposed by continuous applications, the fungicides have caused resistance in the pathogen populations. So reducing the excessive application of these products is indispensable for human health and for sustainable Agriculture. Towards this purpose, research has been carried out to identify the phytopathological potentiality of essential oils (EOs) extracted from plants. Therefore, this review aims to contribute to the formation of knowledge bases, about the discoveries, recent advances, and the use of EOs as a strategy to alternatively control fungal disease caused by Colletotrichum spp. in postharvest fruits. Here, we provide valuable information exploring the application potential of essential oils as commercially useful biorational pesticides for food preservation, contributing to sustainable production and global food security.

The Acute Effect of Magnesium Supplementation on Endothelial Function: A Randomized Cross-Over Pilot Study

Magnesium (Mg) deficiency might be a catalyst in the process of endothelial dysfunction, an early event in the pathogenesis of atherosclerosis. The aim of this study was to determine the acute effect of an oral Mg supplement as compared to control on endothelial function assessed by flow-mediated dilatation (FMD). Nineteen participants (39 years, body mass index (BMI) 22.9 kg/m²) completed this randomized cross-over study. Blood pressure (BP) and FMD were measured and blood samples were taken before participants drank 200 mL water, with or without an over the counter Mg supplement (450 mg and 300 mg for men and women). Measurements were repeated at 60 and 120 min. There was a statistically significant two-way interaction between treatment and time on serum Mg (p = 0.037). A difference of −0.085 mm in FMD was observed 60-min post drink in the control group, as compared to baseline FMD, and no difference was observed in the supplement group as compared to baseline. Despite the non-significant interaction between treatment and time on FMD, once adjusted for baseline, the difference seen in the control group and the lack of change in the supplement group at 60 min post-drink suggests that Mg might attenuate the reduction in FMD post-prandially.

European Society of Cardiology/European Society of Hypertension versus the American College of Cardiology/American Heart Association guidelines on the cut-off values for early hypertension: a microvascular perspective

The aim of this study was to investigate retinal and peripheral microvascular function in asymptomatic individuals that fall into different BP groups when using either the ESC/ESH or the ACC/AHA guidelines. Retinal and peripheral microvascular function was assessed in 358 participants by means of dynamic retinal vessel analysis and digital thermal monitoring, respectively. Blood pressure and lipid panel were also evaluated. Retinal vascular function measured in all groups belonging to the ACC/ASH classifications were within the normal values for age-matched normal population. Individuals classed as grade 1 hypertension according to the ESC/ESH guidelines, however, exhibited a significantly decreased artery baseline (p = 0.0004) and MC (p = 0.040), higher slopeAD (p = 0.0018) and decreased vein MC (p = 0.0446) compared to age matched normal individuals. In addition, they also had significant lower artery baseline, artery BDF, MD and MC than individuals classed as stage 1 hypertension based on the ACC/ASH guidelines (p = 0.00022, p = 0.0179, p = 0.0409 and p = 0.0329 respectively). Peripheral vascular reactivity (aTR) was lower in ESC /ESH grade I compared to those graded ACC/ASH stage I hypertension (p = 0.0122). The conclusion of this study is that microvascular dysfunctions is present at multiple levels only in individuals with ESC/ESH grade 1 hypertension. This observation could be important when deciding personalised care in individuals with early hypertensive changes.

Dried fruit consumption and cardiometabolic health: a randomised crossover trial

Fruit intake is associated with lower risk of cardiometabolic diseases. However, effects of dried fruits on cardiometabolic health are not well researched. We investigated the effect of daily dried fruit consumption compared with a carbohydrate-rich snack on cardiometabolic disease risk factors in adults with increased cardiometabolic risk. A two-period randomised crossover trial was conducted in adults (n 55) with elevated BMI and at least one additional risk factor for cardiometabolic disease to compare the effects of consuming 3/4 cup/d mixed dried fruits (plums, figs, dates and raisins) or an energy- and carbohydrate-matched control snack for 4 weeks. The primary outcome was LDL-cholesterol; secondary outcomes included other lipids and lipoproteins, glucose and insulin, C-reactive protein, blood pressure and vascular stiffness. Linear mixed models were used for data analysis. Lipid and lipoprotein concentrations did not differ between conditions; however, dried fruit increased LDL-cholesterol (0·10 mmol/l, 95 % CI 0·01, 0·20) compared with baseline. Compared with the control, dried fruit increased mean fasting glucose (0·08 mmol/l, 95 % CI 0·005, 0·16; P = 0·038). Vascular outcomes, fasting insulin and C-reactive protein did not differ between conditions. Mean weight changes did not differ (P = 0·55) but tended to increase after both conditions (dried fruit 0·3 kg, 95 % CI -0·09, 0·65; control 0·4 kg, 95 % CI 0·01, 0·75). Thus, short-term daily consumption of a large portion of mixed dried plums, figs, dates and raisins, without structured dietary guidance, did not improve cardiometabolic risk factors, compared with carbohydrate-rich snacks, in adults with increased baseline cardiometabolic risk.

Role of berries in vascular function: a systematic review of human intervention studies

CONTEXT

Berries are a source of polyphenols with recognized health-promoting activities. Several studies suggest that consumption of berries may improve vascular function.

OBJECTIVE

The aim of this systematic review is to provide evidence of short- and long-term benefits of berries on outcomes of vascular function.

DATA SOURCES

Human intervention studies were collected from PubMed and Scopus databases.

STUDY SELECTION

Studies were eligible if they investigated the effects of acute or chronic berry consumption on one or more markers of vascular function in humans and provided a characterization of the berry polyphenolic content. Only randomized controlled trials were included, and studies were excluded if berries were combined with other foods.

DATA EXTRACTION

After selection, 22 randomized controlled trials were included and analyzed, most of which were performed in healthy individuals or patients with cardiovascular risk factors.

RESULTS

The overall results seem to suggest a protective role of berries in vascular function, likely dependent on the time of exposure, the type and dose of berry, and the biomarkers analyzed. Flow-mediated dilation and reactive hyperemia index (markers of vascular reactivity) improved following short-term interventions, while pulse wave velocity and augmentation index (markers of arterial stiffness) improved only after medium- to long-term intervention.

CONCLUSIONS

Current evidence suggests that berries, at physiological relevant doses, may have a role in the modulation of vascular function and stiffness. High-quality human intervention trials are encouraged in order to strengthen these findings and to better elucidate the mechanisms involved in such modulation.

The effect of egg and its derivatives on vascular function: A systematic review of interventional studies

BACKGROUND & AIMS

Cardiovascular diseases (CVDs) are considered as a major cause of health loss for all regions of the world. Atherosclerosis is one of the most important underlying causes of CVDs. Vascular dysfunction is the primary marker of atherosclerosis. Various studies have investigated the effect of egg intake on CVDs. This study aimed to determine the effect of egg and its derivatives consumption on vascular function.

METHODS

Using a comprehensive search strategy, the searching was conducted on PubMed, Scopus and Google Scholar search engines resources (from inception up to Feb 2020). Intended exposure and outcome were egg or its derivatives intake, and vascular function measuring methods, respectively.

RESULTS

A total of 35 papers were found through search databases. Finally, seven trials were included, which were published between 2005 and 2018. Results showed that acute and chronic consumption of whole eggs did not have a significant adverse effect on flow-mediated dilatation (FMD). Also, lutein-enriched egg yolk and egg ovalbumin-derived protein hydrolysate did not have significant positive effects on FMD and pulse wave velocity (PWV), respectively. However, one month egg-yolk-derived phospholipid (PL) preparation intervention increased FMD by 3.4% (p < 0.05), and replacing a portion of a glucose challenge with whole eggs or egg whites improved postprandial FMD (p < 0.05).

CONCLUSIONS

We concluded that consumption of whole egg, despite being rich in cholesterol, has no adverse effect on vascular function, and even some of egg derivatives may improve vascular function. Further research is needed to justify the potential effects of egg or its derivatives on vascular function.

The effects of betalain-rich cacti (dragon fruit and cactus pear) on endothelial and vascular function: a systematic review of animal and human studies

Dragon fruit (Hylocereus) and cactus pear (Opuntia) are cacti species that have been widely used globally as a reliable source of food as well as traditional folk remedies. They have become of scientific interest recently due to their high levels of bioactive phytochemical compounds, in particular betalains. Earlier systematic reviews have explored the impact of supplementation of these cactus species on obesity, type-2 diabetes mellitus and cardiovascular risk factors: body weight and composition, serum triglycerides, cholesterol, blood glucose and blood pressure. However, effects on vascular health and endothelial function have yet to be reviewed. In order to address this gap in the literature, a systematic review has been conducted to evaluate the physiological effects of Hylocereus and Opuntia cacti on endothelial and vascular function in in vivo animal models and human studies. An electronic search was performed in the following databases: PubMed (MEDLINE), EMBASE (via Ovid), CINAHL, Scopus, Web of Science®, and The Cochrane Library (CENTRAL). All journals were searched since inceptions up to January 2020 without language restriction. Outcomes of interest were blood pressure, arterial stiffness, vascular reactivity and biochemical markers of endothelial dysfunction. Two investigators independently performed the study selection and data extraction. From 394 references, only 16 studies (9 animal and 7 human) fulfilled the eligibility criteria. Animal studies suggested a potential increase in vasodilation and serum nitric oxide and a reduction in vascular stiffness and blood pressure. The small number of human studies showed a reduction in heart rate as well as an increase in heart rate variability. Although these findings appear to indicate improvement in vascular health, there is a severe lack of robust, randomised human intervention studies to identify underlying mechanisms, optimal dose and long-term effects of cacti consumption.

Effects of chronic consumption of specific fruit (berries, citrus and cherries) on CVD risk factors: a systematic review and meta-analysis of randomised controlled trials

Purpose

This review aims to compare the magnitude of the effects of chronic consumption of fruits; specifically berries, citrus and cherries on cardiovascular disease (CVD) risk factors.

Methods

PubMed, Web of Science, Scopus, and psycARTICLES were searched from inception until January 2020. Forty-five chronic (≥ 1 week) randomised controlled trials assessing CVD risk factors including endothelial (dys)function, blood pressure (BP), blood lipids and inflammatory biomarkers were included.

Results

Investigated interventions reported improvements in endothelial function (n = 8), inflammatory biomarkers and lipid status (n = 14), and BP (n = 10). Berries including juice of barberry, cranberry, grape, pomegranate, powder of blueberry, grape, raspberry and freeze-dried strawberry significantly reduced SBP by 3.68 mmHg (95% CI − 6.79 to − 0.58; P = 0.02) and DBP by 1.52 mmHg (95% CI − 2.87 to − 0.18, P = 0.04). In subgroup analysis, these associations were limited to cranberry juice (SBP by 1.52 mmHg [95% CI − 2.97 to − 0.07; P = 0.05], DBP by 1.78 mmHg [95% CI − 3.43 to − 0.12, P = 0.04] and cherry juice (SBP by 3.11 mmHg [95% CI − 4.06 to − 2.15; P = 0.02]). Berries also significantly elevated sVCAM-1 levels by 14.57 ng/mL (85% CI 4.22 to 24.93; P = 0.02).

Conclusion

These findings suggest that supplementing cranberry or cherry juice might contribute to an improvement in blood pressure. No other significant improvements were observed for other specified fruits. More research is warranted comparing different classes of fruit and exploring the importance of fruit processing on their cardiovascular-protective effects.

Electronic supplementary material

The online version of this article (10.1007/s00394-020-02299-w) contains supplementary material, which is available to authorized users.

The effect of garlic on vascular function: A systematic review of randomized clinical trials

BACKGROUNDS AND AIMS

Atherosclerosis and its associated cardiovascular disease (CVD) represent a major global health problem worldwide and vascular dysfunction is important in its pathogenesis. Clinical trials investigating the effect of garlic on vascular function measured by several non-invasive methods and their results are inconsistent. This study aimed to summarize the current evidence regarding the effectiveness of garlic as one of the world's most ancient medicines on measures of vascular reactivity and/or stiffness in adults.

METHODS

All published RCTs in English were systematically searched on PubMed, Scopus and Google Scholar search engines up to Oct 2019. The exposure and outcome variable of interest were garlic and vascular function measurements. Ten trials which met inclusion criteria were included in this study.

RESULTS

A total of 45 studies were found through search databases. After excluding duplicates, the 25 remaining studies were screened by title and abstract which 15 of them excluded. Finally, ten trials were included in this review study, which were published between 2004 and 2018.

CONCLUSIONS

Findings were inconsistent. However, garlic has the potential to improve vascular function, particularly in subjects with cardiovascular risk factors. Additional human studies on garlic and its constituents should consider the population and the specific type of garlic preparation.

Vegetable dietary pattern associated with low risk of preeclampsia possibly through reducing proteinuria

BACKGROUND

Evidence on the potential roles that dietary patterns play in the risk of preeclampsia remains limited.

OBJECTIVE

To examine the associations between dietary patterns during pregnancy and the risk of preeclampsia.

STUDY DESIGN

We analyzed data from a cluster randomized controlled trial among 987 healthy pregnant women in three rural counties in northwestern China. Maternal diet during the whole pregnancy was assessed using a 107-item food frequency questionnaire with proportion size administered before delivery. Principal component factor analysis with varimax rotation was used to identify common dietary patterns. Preeclampsia was diagnosed by trained clinicians and recorded in delivery records.

RESULTS

Nineteen participants (1.9%) were diagnosed with preeclampsia. Gestational hypertension and proteinuria were only weakly correlated with each other (Kappa = 0.06): 10.7% participants with gestational hypertension only, 8.8% with proteinuria only, 1.9% with both, and 78.6% with neither. Five common dietary patterns were identified: vegetable, meat, fruit, snack, and wheat staple patterns. After adjusting for calories, other dietary pattern scores and baseline blood pressure, a higher vegetable pattern scores was associated with lower risk of preeclampsia (P for trend = 0.041; the highest vs lowest quartile, adjusted relative risk = 0.20 [95% confidence interval, 0.04-0.98]). A similar association was also observed for the risk of proteinuria (P for trend = 0.015): the highest vs lowest quartiles of the vegetable pattern score, adjusted relative risk = 0.44 (95% confidence interval, 0.24-0.80). The other four pattern scores were not associated with preeclampsia.

CONCLUSIONS

Adherence to vegetable dietary pattern may be associated with the lower risk of preeclampsia, possibly through reducing development of proteinuria. The original full study was registered at clinicaltrials.gov as NCT02537392.

Insufficient Fruit and Vegetable Intake in a Low- and Middle-Income Setting: A Population-Based Survey in Semi-Urban Tanzania

A daily intake of 5 portions of fruit and vegetables (FV) is recommended for protection against non-communicable diseases (NCDs). Inadequate FV intake is a global problem but resource-poor countries like Tanzania are most deprived and constitute settings where little is known for informing public health interventions. This study aimed to describe the prevalence of inadequate FV intake, frequency of FV intake, portions of FV intake and their associations with socio-demographic/lifestyle factors in South-Eastern Tanzania. Data on FV dietary indicators, socio-demographic factors, smoking, alcohol and healthcare use were collected from 7953 participants (≥15 years) of the population-based MZIMA open community cohort (2012–2013). Multivariable logistic regression was used to examine associations between FV intake outcomes and their socio-demographic/lifestyle determinants. Most (82%) of the participants did not meet the recommended daily FV intake While only a fraction consumed fruits daily (15.5%), almost half consumed vegetables daily (44.2%). However, the median (IQR) number of vegetable portions consumed was lower (2(1)/person/day) than that for fruits (2(2)/person/day) People with higher education were more likely to consume fruits daily. Independent correlates of inadequate FV intake included young age, being male, low education, low-income occupations, low alcohol, high tobacco and low healthcare use. Public health interventions should target the socio-economically deprived and culturally-rooted preferences while prioritizing promotion of vegetable for most immediate gain in overall FV intake.

Nutrition and other lifestyle influences on arterial aging

As our world's population ages, cardiovascular diseases (CVD) will become an increasingly urgent public health problem. A key antecedent to clinical CVD and many other chronic disorders of aging is age-related arterial dysfunction, characterized by increased arterial stiffness and impaired arterial endothelial function. Accumulating evidence demonstrates that diet and nutrition may favorably modulate these arterial functions with aging, but many important questions remain. In this review, we will summarize the available information on dietary patterns and nutritional factors that have been studied for their potential to reduce arterial stiffness and improve endothelial function with age, with an emphasis on: 1) underlying physiological mechanisms, and 2) emerging areas of research on nutrition and arterial aging that may hold promise for preventing age-related CVD.

Dietary acid load and chronic kidney disease in elderly adults: Protein and potassium intake

BACKGROUND

Dietary net endogenous acid production (NEAP), which represents total dietary load of nonvolatile acid, may affect kidney function. Estimated NEAP (eNEAP) is calculated indirectly by the ratio of protein and potassium intake. A few studies are available assessing the association between eNEAP and chronic kidney disease (CKD), and its relation to dietary protein and potassium intake in the elderly.

METHODS

A total 1,369 community-dwelling elderly Koreans in the Kangbuk Samsung Cohort Study (KSCS) were evaluated using a food frequency questionnaire (FFQ) and comprehensive health examination. We evaluated the association between eNEAP and the CKD. We also examined their relation to protein and potassium intake.

RESULTS

eNEAP was correlated with potassium intake (r = -0.410, P < 0.001), but was not correlated with protein intake (r = -0.004, P = 0.879). In a full multivariate adjustment for sociodemographic factors, dietary factors, and comorbidities, the participants with higher eNEAP quartiles (Q2, Q3, Q4) had higher odds of CKD compared to the lowest eNEAP quartile (Q1); OR (95% CI) were 1.47 (0.78-2.72), 1.66 (0.85-3.23), and 2.30 (1.16-4.60) respectively (P for trend = 0.019). The odds of CKD decreased for participants with higher potassium intake quartiles (Q2, Q3, Q4) compared to the lowest potassium intake quartile (Q1); OR (95% CI) were 0.52 (0.28-0.95), 0.50 (0.26-0.96), and 0.50 (0.21-0.99) respectively (P for trend = 0.050). Protein intake was not associated with CKD. The association between eNEAP and CKD was similar in subgroup analysis.

CONCLUSION

Dietary acid load was associated with CKD. Among the nutrients related to dietary acid load, potassium intake was negatively associated with CKD, but protein intake was not associated with CKD in elderly adults.

Proanthocyanidins from Vitis vinifera inhibit oxidative stress-induced vascular impairment in pulmonary arteries from diabetic rats

BACKGROUND

Vitis vinifera L. (grape seed extract) is a natural source of proanthocyanidins with antioxidant and free radical-scavenging activities.

HYPOTHESIS

Grape seed extract supplementation may prevent vascular endothelium impairment associated with diabetes mellitus in rat pulmonary artery.

STUDY DESIGN

We evaluated endothelial function of rat pulmonary artery ex-vivo at the intermediate stage (4 weeks) of streptozotocin (STZ)-induced diabetes mellitus. We also evaluated the protective effect of grape seed extract administered daily, beginning the day after diabetes induction, or 15 days after diabetes induction, until the day of sacrifice. In addition, we compared the effect of grape seed extract supplementation with that of vitamin C.

METHODS

Rats were made diabetic with streptozotocin (STZ, 65mg/kg i.v.). Thirty days later rats were sacrificed and pulmonary vessels reactivity and endothelial function compared to that of age-matched healthy animals.

RESULTS

Concentration-response curves to ACh, NE, sodium nitroprusside (NO donor), but not to histamine and iloprost (prostacyclin analog), were significantly altered 4 weeks after STZ-injection. Antioxidant supplementation (3mg/kg/day) with either vitamin C or grape seed extract, starting the day after diabetes induction, significantly improved vasodilation to ACh and SNP. Norepinephrine-induced contractions were preserved by grape seed extract, but not vitamin C supplementation. Conversely, vitamin C but not grape seed extract showed beneficial effects contrasting the loss of body weight in diabetic animals. Abnormal vascular function was not reversed when antioxidant supplementations were postponed 15 days after the induction of diabetes.

CONCLUSIONS

This study provides scientific support for the therapeutic potential of an antioxidant therapy in endothelial impairment associated with diabetes. A daily supplementation of grape seed proanthocyanidins and/or vitamin C given at the earlier stage of disease may have a complementary role in the pharmacological therapy of diabetes and pulmonary vascular dysfunction.

Effect of potassium supplementation on vascular function: A meta-analysis of randomized controlled trials

BACKGROUND

Effects of potassium supplementation on vascular function remain conflicting. This meta-analysis aimed to summarized current literature to fill the gaps in knowledge.

METHODS

A literature search was performed on PubMed database through April, 2016. The measurements of vascular function included pulse wave velocity (PWV), augmentation index (AI), pulse pressure (PP), flow mediated dilatation (FMD), glycerol trinitrate responses (GTN), and intercellular cell adhesion molecule-1 (ICAM-1). Data were pooled as standardized mean difference (SMD) with 95% confidence intervals.

RESULTS

Seven randomized controlled trials examining 409 participants were included, with dosage of potassium ranging from 40 to 150mmol/day, and duration of intervention from 6days to 12months. Pooling results revealed a significant improvement in PP (SMD -0.280, 95% CI -0.493 to -0.067, p=0.010), but no improvement in PWV (SMD -0.342, 95% CI -1.123 to 0·440, p=0.391), AI (SMD -0.114, 95% CI -0.282 to 0.054, p=0.184), FMD (SMD 0·278, 95% CI -0.321 to 0.877, p=0.363), GTN (SMD -0.009, 95% CI -0.949 to 0.930, p=0.984), and ICAM-1 (SMD -0.238, 95% CI -0.720 to 0.244, p=0.333).

CONCLUSIONS

Potassium supplementation was associated with significant improvement of PP, rather than other measurements of vascular function. However, the small number of researches and wide variation of evidences make it difficult to make a definitive conclusion.

Berry Fruit Consumption and Metabolic Syndrome

Metabolic Syndrome is a cluster of risk factors which often includes central obesity, dyslipidemia, insulin resistance, glucose intolerance, hypertension, endothelial dysfunction, as well as a pro-inflammatory, pro-oxidant, and pro-thrombotic environment. This leads to a dramatically increased risk of developing type II diabetes mellitus and cardiovascular disease, which is the leading cause of death both in the United States and worldwide. Increasing evidence suggests that berry fruit consumption has a significant potential in the prevention and treatment of most risk factors associated with Metabolic Syndrome and its cardiovascular complications in the human population. This is likely due to the presence of polyphenols with known antioxidant and anti-inflammatory effects, such as anthocyanins and/or phenolic acids. The present review summarizes the findings of recent dietary interventions with berry fruits on human subjects with or at risk of Metabolic Syndrome. It also discusses the potential role of berries as part of a dietary strategy which could greatly reduce the need for pharmacotherapy, associated with potentially deleterious side effects and constituting a considerable financial burden.

Effect of improving dietary quality on carotid intima media thickness in subjects with type 1 and type 2 diabetes: a 12-mo randomized controlled trial

BACKGROUND

People with diabetes are at a heightened risk of cardiovascular disease compared with the general population. To our knowledge, randomized controlled trials investigating the effect of improving dietary quality on carotid intima media thickness, a marker of subclinical atherosclerosis and predictor of cardiovascular disease, have not been conducted in populations with diabetes.

OBJECTIVE

We aimed to determine whether increasing fruit (+1 serving; 150 g/d), vegetable (+2 servings; 150 g/d), and dairy (+1 serving; 200-250 g/d) intakes slows 12-mo common carotid artery intima media thickness (CCA IMT) progression, compared with a control group continuing to consume their usual diet, in people with type 1 and type 2 diabetes.

DESIGN

A 12-mo randomized controlled trial was conducted. The primary outcome was mean CCA IMT, measured at baseline and 12 mo, with B-mode ultrasound. Participants in the intervention group received counseling from a dietitian at baseline and 1, 3, 6, and 9 mo, and compliance was measured with a food-frequency questionnaire at baseline, 3 mo, and 12 mo. The control group continued consuming their usual diet.

RESULTS

In total, 118 participants completed the study. Vegetable (46 g/d; 95% CI: 14, 77 g/d; P < 0.001) and fruit (179 g/d; 95% CI: 119, 239 g/d; P < 0.001) intakes were increased at 3 mo in the intervention group compared with the control group. This increase was not maintained at 12 mo, but intake increased overall in the cohort (fruit, 48 g/d; vegetables, 14 g/d). An increase in dairy consumption was not achieved, but yogurt intake was higher in the intervention group at 3 mo (38 g; 95% CI: 12, 65 g; P < 0.001); this was not maintained at 12 mo. At 12 mo, CCA IMT regressed (mean ± SD: -0.01 ± 0.04 mm; P < 0.001), with a greater effect in the treatment group (mean ± SD: -0.02 ± 0.04 mm compared with -0.004 ± 0.04 mm; P = 0.009).

CONCLUSION

Improving dietary quality in people with well-controlled type 1 and type 2 diabetes may slow CCA IMT progression. This trial was registered at https://www.anzctr.org.au as ACTRN12613000251729.

Cross-sectional and longitudinal comparisons of metabolic profiles between vegetarian and non-vegetarian subjects: a matched cohort study

Several previous cross-sectional studies have shown that vegetarians have a better metabolic profile than non-vegetarians, suggesting that a vegetarian dietary pattern may help prevent chronic degenerative diseases. However, longitudinal studies on the impact of vegetarian diets on metabolic traits are scarce. We studied how several sub-types of vegetarian diets affect metabolic traits, including waist circumference, BMI, systolic blood pressure (SBP), diastolic blood pressure, fasting blood glucose, total cholesterol (TC), HDL, LDL, TAG and TC:HDL ratio, through both cross-sectional and longitudinal study designs. The study used the MJ Health Screening database, with data collected from 1994 to 2008 in Taiwan, which included 4415 lacto-ovo-vegetarians, 1855 lacto-vegetarians and 1913 vegans; each vegetarian was matched with five non-vegetarians based on age, sex and study site. In the longitudinal follow-up, each additional year of vegan diet lowered the risk of obesity by 7 % (95 % CI 0·88, 0·99), whereas each additional year of lacto-vegetarian diet lowered the risk of elevated SBP by 8 % (95 % CI 0·85, 0·99) and elevated glucose by 7 % (95 % CI 0·87, 0·99), and each additional year of ovo-lacto-vegetarian diet increased abnormal HDL by 7 % (95 % CI 1·03, 1·12), compared with non-vegetarians. In the cross-sectional comparisons, all sub-types of vegetarians had lower likelihoods of abnormalities compared with non-vegetarians on all metabolic traits (P<0·001 for all comparisons), except for HDL and TAG. The better metabolic profile in vegetarians is partially attributable to lower BMI. With proper management of TAG and HDL, along with caution about the intake of refined carbohydrates and fructose, a plant-based diet may benefit all aspects of the metabolic profile.