Nutritional fats and the risk of type 2 diabetes and cancer

A new mathematical approach to improve the original dietary inflammatory index (DII) calculation

Accumulating evidence links dietary intake to inflammatory processes involved in non-communicable disease (NCD) development. The dietary inflammatory index (DII) designed by Shivappa et al. has been shown to capture the inflammatory potential of dietary behavior in a large number of epidemiological studies. Thus, the DII may serve as future tool to assess someone's nutritional inflammatory capacities and hence, the individual risks for NCD development later in life. The calculation method of the DII, however, can benefit from alternative mathematical steps, particularly regarding the transformation from standardized daily food consumption to percentile scores. Here, we provide novel approaches, the scaling-formula (SF) and scaling-formula with outlier detection (SFOD) methods, with the aim to optimize the DII calculation method proposed by Shivappa and colleagues. We illustrate on simulated data specific limitations of the original DII calculation and show the benefits of the SF/SFOD by using simulated data and data from the prospective TEENDIAB study cohort, which supports the application of SF/SFOD in future epidemiological and clinical studies.

Positive Externalities of Climate Change Mitigation and Adaptation for Human Health: A Review and Conceptual Framework for Public Health Research

Anthropogenic climate change is adversely impacting people and contributing to suffering and increased costs from climate-related diseases and injuries. In responding to this urgent and growing public health crisis, mitigation strategies are in place to reduce future greenhouse gas emissions (GHGE) while adaptation strategies exist to reduce and/or alleviate the adverse effects of climate change by increasing systems' resilience to future impacts. While these strategies have numerous positive benefits on climate change itself, they also often have other positive externalities or health co-benefits. This knowledge can be harnessed to promote and improve global public health, particularly for the most vulnerable populations. Previous conceptual models in mitigation and adaptation studies such as the shared socioeconomic pathways (SSPs) considered health in the thinking, but health outcomes were not their primary intention. Additionally, existing guidance documents such as the World Health Organization (WHO) Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities is designed primarily for public health professionals or healthcare managers in hospital settings with a primary focus on resilience. However, a detailed cross sectoral and multidisciplinary conceptual framework, which links mitigation and adaptation strategies with health outcomes as a primary end point, has not yet been developed to guide research in this area. In this paper, we briefly summarize the burden of climate change on global public health, describe important mitigation and adaptation strategies, and present key health benefits by giving context specific examples from high, middle, and low-income settings. We then provide a conceptual framework to inform future global public health research and preparedness across sectors and disciplines and outline key stakeholders recommendations in promoting climate resilient systems and advancing health equity.

Does Roux-en-Y Construction Really Bring Benefit of Type 2 Diabetes Mellitus Remission After Gastrectomy in Patients with Gastric Cancer? A Systematic Review and Meta-Analysis

INTRODUCTION

To evaluate whether the extent of gastrectomy or the reconstruction method brings benefit of type 2 diabetes mellitus (T2DM) remission after gastrectomy in patients with gastric cancer.

METHODS

PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were searched to find eligible studies published from inception to July 31, 2020.

RESULTS

A total of nine studies (1424 patients) were included. At the first year and the end of follow-up time after gastrectomy, the total gastrectomy group had better T2DM remission than the subtotal gastrectomy group, and the Roux-en-Y reconstruction (R-Y) group had better T2DM remission compared with the non-R-Y group. There was no difference between R-Y and non-R-Y in terms of subtotal gastrectomy (OR 1.08, 95% CI 0.63-1.84, P = 0.78). However, total gastrectomy with R-Y had better T2DM remission than subtotal gastrectomy with R-Y (OR 2.75, 95% CI 1.19-6.35, P = 0.02).

CONCLUSION

Total gastrectomy with R-Y had better T2DM remission. The extent of gastrectomy rather than the reconstruction method might play an important role in T2DM remission after gastrectomy in patients with gastric cancer.

Dietary Adequacy among Multi-Ethnic Urban Youth in Edmonton: Findings from the Wellness and Health in Youth - Aboriginal and All Communities in Transition NOW (WHY ACT NOW) Project

OBJECTIVE

The development of obesity and chronic diseases in adulthood often results from a childhood pattern of dietary excesses. This study aimed to identify dietary inadequacies and excesses of multiethnic youth in Edmonton.

METHODS

A cross-sectional survey of a convenience sample of 473 multiethnic youth between 11 and 18 years was conducted in 12 schools in Edmonton between October 2013 and March 2014. Data were analyzed to determine for each participant mean daily energy and nutrient intakes, dietary adequacy, and nutrient densities. Participants were divided by self-identified ethnicity (Indigenous, European, African and Middle Eastern, and Asian).

RESULTS

For all nutrients examined, the mean percentage of calories from fat was higher among European (31.7%) and Indigenous youth (31.8%) compared to African and Middle Eastern (28.3%) and Asian youth (29.0%), while Asian youth had the highest percentage of calories from protein (17.7%) compared to other ethnic groups (Indigenous = 15.5%; African & Middle Eastern = 16.5%; European = 16.2%). The majority of youth fell below the recommended values for dietary fiber (83.3-92.0%), vitamins D (84.4-90.2%), and E (89.5-92.0%). More than 50% fell below the dietary reference intakes (DRIs) for vitamin A, vitamin B5, calcium, and magnesium; >30% were below the DRI for folate, zinc, and vitamins B6, and C. The diet of girls contained a greater density of fiber compared to boys (9.3 vs. 8.0 g/1000 kcal; p-value = 0.002).

CONCLUSIONS

Inadequate dietary intake is evident among the majority of multiethnic youth in Edmonton. There is a need to develop strategies to reduce the burden of poor nutrition status for youth.

An update on potential links between type 2 diabetes mellitus and Alzheimer's disease

Alzheimer's disease (AD) and type 2 diabetes (T2D) major feature is insulin resistance. Brain and peripheral insulin resistance lead to hyperglycemia, which contributes to the development of T2D-linked comorbidities, such as obesity and dyslipidemia. Individuals with hyperglycemia in AD present with neuronal loss, formation of plaques and tangles and reduced neurogenesis. Inflammation seems to play an essential role in the development of insulin resistance in AD and T2D. We conducted a literature review about the links between AD and T2D. Alterations in glucose metabolism result from changes in the expression of the insulin receptor substrates 1 and 2 (IRS-1 and IRS-2), and seem to be mediated by several inflammatory pathways being present in both pathologies. Although there are some similarities in the insulin resistance of AD and T2D, brain and peripheral insulin resistance also have their discrete features. Failure to activate IRS-1 is the hallmark of AD, while inhibition of IRS-2 is the main feature in T2D. Inflammation mediates the alterations in glucose metabolism in AD and T2D. Targeting inflammation and insulin receptors may be a successful strategy to prevent and ameliorate T2D and AD symptoms.

Adherence to Canada's Food Guide recommendations among Alberta's multi-ethnic youths is a major concern: findings from the WHY ACT NOW project

BACKGROUND

Dietary habits formed during youth may result in the development of obesity and chronic diseases in adulthood. We aimed to determine the frequency of the consumption of foods and beverages and the degree of adherence to Canada's Food Guide recommendations among multi-ethnic youths.

METHODS

Participants were recruited from 12 schools in the Edmonton, Alberta area by use of posters, school newsletters and advertisements. A 30-item food frequency questionnaire was administered by a trained interviewer to assess dietary intake in a convenience sample of 557 (328 females and 229 males) youths aged 11-23 years; for the purpose of the present study, only the 14-18 years age group was considered in the analysis. Participants were divided by sex and self-identified ethnicity into four groups [Indigenous, African & Middle Eastern (AME), Asian, and European]. Statistical analysis of the data was undertaken using t-tests, Welch's analysis of variance and Games-Howell tests. P < 0.05 was considered statistically significant.

RESULTS

Vegetables and Fruit recommendations were the least likely to be followed, with 90.7-96.8% of participants in all groups not consuming the recommended number of servings day^-1 . The mean frequency of fruit consumption was lower among Indigenous youths compared to Asian youths (0.90 versus 1.37 times day^-1 ). A greater proportion of males than females (55.9% versus 44.3%) did not meet the minimum recommendations for Meat and Alternatives (P = 0.016). The percentage of youths not adhering to recommendations for Milk and Alternatives was 81.7% for Indigenous, 73.3% for AME, 78.6% for Asian and 63.5% for European youths. Indigenous youths more frequently consumed potato chips and soft drinks compared to other ethnic youths. The most frequently consumed beverage was milk (1.25 times day^-1 ).

CONCLUSIONS

The majority of youths did not consume minimum daily recommended servings of Vegetables and Fruit, Milk and Alternatives, and/or Meat and Alternatives food groups. Evidence-based dietary interventions and public health strategies are needed.

Dietary predictors of early-onset ischaemic heart disease in a sample drawn from a Pakistani population

OBJECTIVE

A relationship between dietary pattern and ischaemic heart disease (IHD) has long been established through empirical research. It is well documented that an unhealthy diet-rich in animal products (eggs and meat), salt, fried and salty food, ghee and butter and low in fruit, vegetables and fish-is associated with a risk of IHD. However, limited empirical evidence exists from studies conducted in Pakistan, so this study was designed to explore the association of dietary pattern with risk of IHD in this country.

DESIGN

Case-control study.

SETTING

190 cases with a diagnosis of first onset of angina and myocardial infarction and 380 age- and gender-matched community controls were recruited from five major hospitals in the city of Lahore, Pakistan.

METHOD

A Food Frequency Questionnaire was used to gather information on dietary patterns from the study sample (age 35-55), who provided written consent to participate.

RESULTS

Binary logistic regression analysis revealed that eggs, sweets, butter, desi ghee, desserts and beef were significant risk factors for IHD, and fish and fruit were significant protective dietary predictors of IHD.

CONCLUSIONS

50-73% of variance in IHD due to dietary pattern can be predicted with 91.8% accuracy within the study sample. The study lays ground for future research, as well as providing help in planning preventive dietary strategies to counter the escalating burden of IHD in Pakistan.

Dietary patterns are associated with hyperhomocysteinemia in an urban Pakistani population

Little attention has been given to the association of dietary patterns with plasma homocysteine. Our objective in this study was to identify major dietary patterns and investigate their association with plasma homocysteine. In a cross-sectional survey, 872 healthy adults (355 males, 517 females; aged 18-60 y) were enrolled from an urban population in Karachi. Dietary intake was assessed by a FFQ. We used factor analysis to define major dietary patterns. Fasting concentrations of plasma or serum homocysteine, folate, pyridoxal-phosphate (PLP; coenzyme form of vitamin B-6), and vitamin B-12 were measured. Three major dietary patterns were identified and labeled as "prudent diet," "high animal-protein diet," and "high plant-protein diet." We observed a protective effect of the prudent dietary pattern for the highest quartile of intake compared with the lowest quartile of hyperhomocysteinemia when the model was adjusted for age, gender, household income, BMI, tobacco chewing, and smoking [OR = 0.52 (95% CI = 0.30-0.90); P = 0.01]. The high plant-protein diet pattern was inversely related to hyperhomocysteinemia, with a higher intake being protective. Compared with the 1st quartile, the adjusted OR was 0.42 (95% CI = 0.25-0.69; P = 0.001) for the 4th quartile. The high animal-protein diet was positively associated with hyperhomocysteinemia, with participants in the highest quartile of intake having the greatest increase in risk [OR = 2.10 (95% CI = 1.22-3.60); P = 0.007]. Plasma homocysteine concentrations appeared to be correlated more with circulating folate (r = -0.25; P < 0.001) than with PLP (r = -0.02; P = 0.663) or vitamin B-12 (r = -0.16; P < 0.001). A diet rich in fruits and uncooked vegetables decreased the risk of hyperhomocysteinemia, whereas diets rich in red meat, chicken, and tea with milk were positively associated with hyperhomocysteinemia.

Dietary patterns and the risk of acute myocardial infarction in 52 countries: results of the INTERHEART study

BACKGROUND

Diet is a major modifiable risk factor for cardiovascular disease, but it varies markedly in different regions of the world. The objectives of the present study were to assess the association between dietary patterns and acute myocardial infarction (AMI) globally.

METHODS AND RESULTS

INTERHEART is a standardized case-control study involving participants from 52 countries. The present analysis included 5761 cases and 10 646 control subjects. We identified 3 major dietary patterns using factor analysis: Oriental (high intake of tofu and soy and other sauces), Western (high in fried foods, salty snacks, eggs, and meat), and prudent (high in fruit and vegetables). We observed an inverse association between the prudent pattern and AMI, with higher levels being protective. Compared with the first quartile, the adjusted ORs were 0.78 (95% CI 0.69 to 0.88) for the second quartile, 0.66 (95% CI 0.59 to 0.75) for the third, and 0.70 (95% CI 0.61 to 0.80) for the fourth (P for trend <0.001). The Western pattern showed a U-shaped association with AMI (compared with the first quartile, the adjusted OR for the second quartile was 0.87 [95% CI 0.78 to 0.98], whereas it was 1.12 [95% CI 1.00 to 1.25] for the third quartile and 1.35 [95% CI 1.21 to 1.51] for the fourth quartile; P for trend <0.001), but the Oriental pattern demonstrated no relationship with AMI. Compared with the first quartile, the OR of a dietary risk score derived from meat, salty snacks, fried foods, fruits, green leafy vegetables, cooked vegetables, and other raw vegetables (higher score indicating a poorer diet) increased with each quartile: second quartile 1.29 (95% CI 1.17 to 1.42), third quartile 1.67 (95% CI 1.51 to 1.83), and fourth quartile 1.92 (95% CI 1.74 to 2.11; P for trend <0.001). The adjusted population-attributable risk of AMI for the top 3 quartiles compared with the bottom quartile of the dietary risk score was 30%.

CONCLUSIONS

An unhealthy dietary intake, assessed by a simple dietary risk score, increases the risk of AMI globally and accounts for approximately 30% of the population-attributable risk.

The melanocortin antagonist AgRP (83-132) increases appetitive responding for a fat, but not a carbohydrate, reinforcer

Consumption of a diet high in fat is a risk factor for a number of health problems, including obesity, type 2 diabetes and cardiovascular disease. Considerable pharmacological, genetic, and molecular evidence suggests that the hypothalamic melanocortin system plays a critical role in the control of food intake and body weight and, specifically, in fat ingestion. Administration of a melanocortin antagonist, agouti-related peptide (AgRP) (83-132) selectively increases intake of pure fat and high-fat mixed diets. Here, we examined possible mechanisms for this fat-specific effect of AgRP (83-132). In Experiment 1, we determined that intracerebroventricular administration of AgRP (83-132) selectively increased operant responding for a peanut oil, but not a sucrose, reinforcer when tested under a progressive ratio schedule. Experiment 2 employed a Pavlovian conditioning paradigm, in which icv AgRP enhanced appetitive responding toward stimuli that had previously been paired with peanut oil and reduced responding toward stimuli previously paired with sucrose, in the absence of consumption of either macronutrient. Finally, in Experiment 3, we tested the hypothesis that the MC system acts in anticipation of a fat consumption and found that hypothalamic AgRP mRNA was slightly, though not significantly, elevated in an environment predicting fat availability relative to one predicting carbohydrate availability. Collectively, these data indicate that, in addition to increasing free intake of dietary fats, AgRP (83-132) promotes responding for the opportunity to consume a fat reinforcer, as well as appetitive responding to fat-paired stimuli in the absence of ingestive stimulation. These results suggest a possible role for AgRP in the increased fat intake associated with obesity.

Assessing fat-related dietary behaviors among black women: reliability and validity of a new Food Habits Questionnaire

OBJECTIVE

To describe the development of the SisterTalk Food Habits Questionnaire (STFHQ).

DESIGN

Formative research was conducted to adapt previous tools for the study's target population. A pilot tool (168 questions) was tested. The new 94-question tool was then used for evaluation of the SisterTalk project. Lastly, a 4-week reliability calibration study of the revised STFHQ was conducted in comparison with a food frequency questionnaire (FFQ).

ANALYSIS

Reliability was assessed using test-retest correlations. Validity was assessed by correlations between STFHQ scores with FFQ calculated calories, total fat (g) and percentage of calories from fat. Three scoring methods (ie, introductory, product, and detail) were calculated along with inclusion or exclusion of dining out questions and alternate methods of scoring for food items not consumed.

RESULTS

Reliability (correlation) was 0.87. Inclusion of dining out questions and imputation of zero for food items never consumed were more highly associated with fat intake than other scoring methods. The introductory score was most highly correlated with fat (g), whereas the product and detail scoring methods correlated highest with percentage of calories from fat. Responsiveness to the SisterTalk intervention was highest with the detail score.

CONCLUSIONS AND IMPLICATIONS

The STFHQ is a reliable and valid tool that may be useful for evaluating dietary change for black women.

Metformin-like effect of Salvia officinalis (common sage): is it useful in diabetes prevention?

Common sage (Salvia officinalis L.) is among the plants that are claimed to be beneficial to diabetic patients, and previous studies have suggested that some of its extracts have hypoglycaemic effects in normal and diabetic animals. In the present study, we aimed to verify the antidiabetic effects of an infusion (tea) of common sage, which is the most common form of this plant consumed. Replacing water with sage tea for 14d lowered the fasting plasma glucose level in normal mice but had no effect on glucose clearance in response to an intraperitoneal glucose tolerance test. This indicated effects on gluconeogenesis at the level of the liver. Primary cultures of hepatocytes from healthy, sage-tea-drinking rats showed, after stimulation, a high glucose uptake capacity and decreased gluconeogenesis in response to glucagon. Essential oil from sage further increased hepatocyte sensitivity to insulin and inhibited gluconeogenesis. Overall, these effects resemble those of the pharmaceutical drug metformin, a known inhibitor of gluconeogenesis used in the treatment and prevention of type 2 diabetes mellitus. In primary cultures of rat hepatocytes isolated from streptozotocin (STZ)-induced diabetic rats, none of these activities was observed. The present results seem to indicate that sage tea does not possess antidiabetic effects at this level. However, its effects on fasting glucose levels in normal animals and its metformin-like effects on rat hepatocytes suggest that sage may be useful as a food supplement in the prevention of type 2 diabetes mellitus by lowering the plasma glucose of individuals at risk.

POMC and orexin mRNA expressions induced by anticipation of a corn-oil emulsion feeding are maintained at the high levels until oil ingestion

We investigated the gene expression dynamics of several hypothalamic neuropeptides associated with appetite regulation when rats are anticipating being fed a corn-oil emulsion. For 5 days at the same hour each day, rats were fed 5% corn oil emulsified with 0.3% xanthan gum or the vehicle for 20 min. On Day 6, the 5% corn oil emulsion or the vehicle (Vehicle) was presented to the rats, some of which (Oil-intake) were allowed to eat it and some of which (Oil-anticipation) were kept from eating it. Despite waiting a corn-oil, the mRNA levels of proopiomelanocortin (POMC), a beta-endorphin precursor, and orexin showed increases, and high levels of mRNAs of POMC and orexin were maintained for 30 min after the corn-oil was placed before the rats, and only gradually decreased through 150 min. However, the mRNA levels of POMC and orexin in the hypothalamus were decreased within 30 min after starting to ingest the corn-oil emulsion. These results suggest that POMC and orexin mRNA expression was induced by the anticipation in rats after learning the palatability of 5% corn oil emulsion, and the induced mRNA expression based on the anticipation was maintained for at least for 30 min as the rats eagerly waited for ingestion.

Role of vitamins, minerals and supplements in the prevention and management of prostate cancer

The authors review the current literature on the complementary and alternative medicines most frequently utilized by prostate cancer patients and those at risk for the disease. Products covered are vitamin E, vitamin A, selenium, zinc, soy, lycopene, pomegranate juice, green tea and omega-3 fatty acids. There is no definitive proof that any of the nutritional supplements discussed can impact the course of prostate cancer or its development. The authors believe that simply taking a standard daily multivitamin should be sufficient to ensure that patients have the appropriate levels of vitamins and minerals without risking the over utilization of vitamins, minerals, and supplements which can lead to numerous negative side effects.

Daily increase of fat ingestion mediated via mu-opioid receptor signaling pathway

We investigated the involvement of opioid receptors such as the mu and delta receptors in the predominant elevation of corn oil appetite just after 5-day repeated treatment of corn oil ingestion. Rats were given 5% corn oil emulsified with 0.3% xanthan gum for 20 min at the same hour for 5 consecutive days. A strong appetite for fat was formed after the 5 days presentation, and it was inhibited by naloxonazine, a selective antagonist of the mu-1 receptor, at doses of 3 mg/kg, but not by antagonists of the opioid delta receptor. In days 6, after the formation of a strong appetite for corn oil, an additional injection of naloxonazine suppressed fat intake 0-30, 30-60, 60-90 and 90-150 min after the presentation of the corn oil, but antagonists of the opioid delta receptor did not. These data suggested that the opioid mu receptor is involved in the sharp elevation of corn oil appetite during repeated presentation of corn oil to rats.