Serum vitamins, carotenoids, and angina pectoris: findings from the National Health and Nutrition Examination Survey III

Association between sugar-sweetened beverages and pure fruit juice with risk of six cardiovascular diseases: a Mendelian randomization study

BACKGROUND

In observational and prospective cohort studies, intake of sugar-sweetened beverages (SSBs) and pure fruit juice (PFJ) has been associated with cardiovascular disease (CVD). Still, the causality of the connection has not yet been determined. Our objective was to uncover the relationship between SSBs/PFJ and CVD.

METHODS

Genetically predicted causal associations between SSBs/PFJ (obtained in a published genome-wide association study) and six common CVDs (atrial fibrillation (AF), angina, heart failure (HF), acute myocardial infarction, hypertension, and coronary atherosclerosis) were assessed using MR analytic modeling. The primary analysis method utilized was the inverse variance weighted (IVW) method, complemented by additional methods such as the weighted median method, MR Egger regression, Cochran's Q test, MR pleiotropy residual, funnel plot, Bonferroni correction, and others for MR analysis. To ensure the robustness of the findings, F-values were calculated as a complementary test to set looser thresholds for exposing genetic instrumental variables (P < 1e-5).

RESULTS

The results of MR analysis suggested genetically causal associations between SSBs and AF (odds ratio (OR): 1.023; 95% confidence interval (CI) 1.007-1.038; P = 0.0039) as well as between PFJ and angina (OR: 0.968; 95% CI, 0.943-0.993; P = 0.0138) there was genetic causality. However, MR analysis showed no causal association between SSBs/PFJ and other CVD risks.

CONCLUSION

This study suggests that there may be a potential causal relationship between SSBs intake and AF and a causal negative association between PFJ intake and angina.

Tooth count, untreated caries and mortality in US adults: a population-based cohort study

BACKGROUND

The link between oral diseases and mortality remains under-explored. We aimed to evaluate the associations between tooth count, untreated caries and risk of all-cause and cause-specific mortality.

METHODS

Data on 24 029 adults from the National Health and Nutrition Examination Survey 1988-94/1999-2010, with mortality linkage to the National Death Index to 31 December 2015, were analysed. Baseline total number of permanent teeth and any untreated caries were assessed by trained dental professionals.

RESULTS

During up to 27 years of follow-up, 5270 deaths occurred. Fewer permanent teeth were associated with higher all-cause mortality, including heart disease and cancer mortality (all P <0.05 for trend) but not cerebrovascular disease mortality. For every 10 teeth missing, the multivariable-adjusted hazard ratios (HRs) were 1.13 (95% CI: 1.08 to 1.18) for all-cause, 1.16 (95% CI: 1.05, 1.29) for heart disease and 1.19 (95% CI: 1.09, 1.29) for cancer mortality. Untreated caries was associated with increased all-cause (HR: 1.26, 95% CI: 1.15, 1.39) and heart disease mortality (HR: 1.48, 95% CI: 1.17, 1.88) but not cerebrovascular disease/cancer mortality, after adjusting for tooth count, periodontitis and sociodemographic/lifestyle factors. Compared with those without untreated caries and with 25-28 teeth, individuals with untreated caries and 1-16 teeth had a 53% increased risk of all-cause mortality (HR: 1.53, 95% CI: 1.27, 1.85) and 96 % increased risk of heart disease mortality (HR: 1.96, 95% CI: 1.28, 3.01).

CONCLUSIONS

In nationally representative cohorts, fewer permanent teeth and untreated caries were associated with all-cause and heart disease mortality. Fewer teeth were also associated with higher cancer mortality.

Red blood cell folate concentrations and coronary heart disease prevalence: A cross-sectional study based on 1999-2012 National Health and Nutrition Examination Survey

BACKGROUND AND AIM

Folate is involved in a number of metabolic pathways. Red blood cell (RBC) folate is a well-established indicator of folate intake. However, studies focused on the association between RBC folate and coronary heart disease (CHD) are limited. The aim of the current study was to investigate the effect of RBC folate concentrations on the presence of CHD in a nationally representative sample of American adults.

METHODS AND RESULTS

In the 1999-2012 National Health and Nutrition Examination Survey (NHANES), 22,499 subjects aged 30-74 years with RBC folate concentrations, CHD status and responses to co-variates questions were included; 822 (3.65%) participants were identified as having CHD. Bio-Rad Quanta Phase II radioassay and microbiological assay were used to measure RBC folate concentrations. Firstly, we treated RBC folate as a categorical variable, based on RBC folate tertiles, and used logistic regression analysis to display the RBC folate and CHD relationship. Secondly, we explored associations using a combination of restricted cubic spline and logistic regression models, stratified by sex. After adjusting for several well-established traditional CHD risk factors, RBC folate was positively related to CHD presence in the total population and the association was more pronounced among males than females. A J-shaped pattern was observed in RBC folate concentrations for females.

CONCLUSION

Elevated RBC folate concentrations were associated with higher CHD risk. Further investigation is needed to test the association in large-scale follow-up studies.

The effects of lutein on cardiometabolic health across the life course: a systematic review and meta-analysis

BACKGROUND

The antioxidant lutein is suggested as being beneficial to cardiometabolic health because of its protective effect against oxidative stress, but evidence has not systematically been evaluated.

OBJECTIVE

We aimed to evaluate systematically the effects of lutein (intake or concentrations) on cardiometabolic outcomes in different life stages.

DESIGN

This is a systematic review with meta-analysis of literature published in MEDLINE, Embase, Cochrane Central, Web of Science, PubMed, and Google Scholar up to August 2014. Included were trials and cohort, case-control, and cross-sectional studies in which the association between lutein concentrations, dietary intake, or supplements and cardiometabolic outcomes was reported. Two independent investigators reviewed the articles.

RESULTS

Seventy-one relevant articles were identified that included a total of 387,569 participants. Only 1 article investigated the effects of lutein during pregnancy, and 3 studied lutein in children. Furthermore, 31 longitudinal, 33 cross-sectional, and 3 intervention studies were conducted in adults. Meta-analysis showed a lower risk of coronary heart disease (pooled RR: 0.88; 95% CI: 0.80, 0.98) and stroke (pooled RR: 0.82; 95% CI: 0.72, 0.93) for the highest compared with the lowest tertile of lutein blood concentration or intake. There was no significant association with type 2 diabetes mellitus (pooled RR: 0.97; 95% CI: 0.77, 1.22), but higher lutein was associated with a lower risk of metabolic syndrome (pooled RR: 0.75; 95% CI: 0.60, 0.92) for the highest compared with the lowest tertile. The literature on risk factors for cardiometabolic diseases showed that lutein might be beneficial for atherosclerosis and inflammatory markers, but there were inconsistent associations with blood pressure, adiposity, insulin resistance, and blood lipids.

CONCLUSIONS

Our findings suggest that higher dietary intake and higher blood concentrations of lutein are generally associated with better cardiometabolic health. However, evidence mainly comes from observational studies in adults, whereas large-scale intervention studies and studies of lutein during pregnancy and childhood are scarce.

Antioxidants and cardiovascular disease: Still a topic of interest

Cardiovascular disease constitutes a major public health concern in industrialised nations. Over recent decades, a large body of evidence has accumulated indicating that free radicals play a critical role in cellular processes implicated in atherosclerosis. Herein, we present a mechanism of oxidative stress, focusing mainly on the development of an oxidised low density lipoprotein, and the results of a clinical trial of antioxidant therapy and epidemiological studies on the relationships between nutrient antioxidants, such as vitamin E, vitamin C, β-carotene, coenzyme Q, flavonoids and L-arginine, and coronary events. These studies indicated that a diet high in antioxidants is associated with a reduced risk of cardiovascular disease, but did not confirm a strong causality link. With regard to vitamin E, observational studies suggested that the daily use of at least 400 International Units of vitamin E is associated with beneficial effects on coronary events. However, it is apparently too early to define the clinical benefits of vitamin E for cardiovascular disease. From the results of several randomised interventional trials, it appears that no single antioxidant given to subjects at high doses has substantial benefits, and the question of whether nutrient antioxidants truly protect against cardiovascular disease remains open. This article provides an overview of the epidemiological and clinical studies related to antioxidants and cardiovascular disease.

Provitamin A carotenoids are independently associated with matrix metalloproteinase-9 in plasma samples from a general population

BACKGROUND AND AIM

Carotenoids in plasma are inversely associated with cardiovascular risk. Low levels can be explained by low dietary intake but also by a number of other factors including inflammatory activity. Given that matrix metalloproteinase (MMP)-9 has an important role in inflammation and cardiovascular disease, we hypothesized that circulating MMP-9 levels would be inversely related to total or single carotenoids in a general population cohort.

METHODS

A well-characterized population-based cohort of 285 Swedish men and women (45-69 years) was used for the present study. The intake of carotenoid-rich fruits and vegetables was estimated from a food frequency questionnaire. Levels of MMP-9, C-reactive protein (CRP), interleukin (IL)-6 and six major carotenoids [β-cryptoxanthine, α-carotene, β-carotene, lutein (+zeaxanthin) and lycopene] were determined in plasma.

RESULTS

Lower plasma levels of total and single carotenoids were associated with lower dietary intake of carotenoids, older age, male sex, lower physical activity, higher alcohol consumption, higher body mass index (BMI), higher systolic and diastolic blood pressures, lower levels of total cholesterol and HDL cholesterol and higher levels of CRP, IL-6 and MMP-9. After multivariate adjustments, plasma levels of total carotenoids and provitamin A carotenoids (β-cryptoxanthine, α-carotene and β-carotene) remained independently associated with sex, dietary intake of carotenoids, BMI, HDL cholesterol and MMP-9, whilst associations with CRP and IL-6 were not maintained. Neither dietary intake of carotenoid-rich fruits and vegetables, nor vitamin supplement use was associated with MMP-9, CRP or IL-6 levels.

CONCLUSION

Plasma carotenoids were associated with a variety of factors including age, sex, dietary intake and metabolic variables. A new finding was the independent relationship in plasma between low provitamin A carotenoids and high MMP-9, suggesting a link between these carotenoids, matrix turnover and arterial remodelling.

Association of mate tea (Ilex paraguariensis) intake and dietary intervention and effects on oxidative stress biomarkers of dyslipidemic subjects

OBJECTIVE

To evaluate the effect of long-term ingestion of mate tea, with or without dietary intervention, on the markers of oxidative stress in dyslipidemic individuals.

METHODS

Seventy-four dyslipidemic volunteers participated in this randomized clinical trial. Subjects were divided into three treatment groups: mate tea (MT), dietary intervention (DI), and mate tea with dietary intervention (MD). Biochemical and dietary variables were assessed at the beginning of the study (baseline) and after 20, 40, 60, and 90 d of treatment. Participants in the MT and MD groups consumed 1 L/d of mate tea. Those in the DI and MD groups were instructed to increase their intake of fruit, legumes and vegetables and decrease their consumption of foods rich in cholesterol and saturated and trans-fatty acids. Biomarkers of oxidative stress such as antioxidant capacity of serum (ferric reducing antioxidant potential assay), uric acid, reduced glutathione, paraoxonase-1 enzyme, lipid hydroperoxide (LOOH), and protein carbonyl were analyzed.

RESULTS

Participants in the DI group showed a significant decrease in total fat and saturated fatty acid intakes. Those in the DI and MD groups presented a significant increase in vitamin C consumption. For all groups, there was a significant increase in ferric reducing antioxidant potential and reduced glutathione concentrations but no significant changes in LOOH, protein carbonyl, and paraoxonase-1 values. The reduced glutathione concentration was positively correlated with the consumption of monounsaturated fatty acids, fiber, and vitamin C, whereas levels of LOOH were inversely correlated with intakes of vitamin C and fiber. In addition, LOOH correlated positively with low-density lipoprotein cholesterol and inversely with high-density lipoprotein cholesterol, which had a positive association with paraoxonase-1.

CONCLUSION

The ingestion of mate tea independently of the dietary intervention increased plasma and blood antioxidant protection in patients with dyslipidemia.

Astaxanthin in cardiovascular health and disease

Oxidative stress and inflammation are established processes contributing to cardiovascular disease caused by atherosclerosis. However, antioxidant therapies tested in cardiovascular disease such as vitamin E, C and β-carotene have proved unsuccessful at reducing cardiovascular events and mortality. Although these outcomes may reflect limitations in trial design, new, more potent antioxidant therapies are being pursued. Astaxanthin, a carotenoid found in microalgae, fungi, complex plants, seafood, flamingos and quail is one such agent. It has antioxidant and anti-inflammatory effects. Limited, short duration and small sample size studies have assessed the effects of astaxanthin on oxidative stress and inflammation biomarkers and have investigated bioavailability and safety. So far no significant adverse events have been observed and biomarkers of oxidative stress and inflammation are attenuated with astaxanthin supplementation. Experimental investigations in a range of species using a cardiac ischaemia-reperfusion model demonstrated cardiac muscle preservation when astaxanthin is administered either orally or intravenously prior to the induction of ischaemia. Human clinical cardiovascular studies using astaxanthin therapy have not yet been reported. On the basis of the promising results of experimental cardiovascular studies and the physicochemical and antioxidant properties and safety profile of astaxanthin, clinical trials should be undertaken.

Spirulina is an effective dietary source of zeaxanthin to humans

Zeaxanthin is a predominant xanthophyll in human eyes and may reduce the risk of cataracts and age-related macular degeneration. Spirulina is an algal food that contains a high concentration of zeaxanthin. In order to determine the zeaxanthin bioavailability of spirulina for dietary supplementation in humans, spirulina was grown in nutrient solution with2H2O for carotenoid labelling. Single servings of2H-labelled spirulina (4·0–5·0 g) containing 2·6–3·7 mg zeaxanthin were consumed by fourteen healthy male volunteers (four Americans and ten Chinese) with 12 g dietary fat. Blood samples were collected over a 45 d period. The serum concentrations of total zeaxanthin were measured using HPLC, and the enrichment of labelled zeaxanthin was determined using LC-atmospheric pressure chemical ionisation-MS (LC-APCI-MS). The results showed that intrinsically labelled spirulina zeaxanthin in the circulation was detected at levels as low as 10 % of the total zeaxanthin for up to 45 d after intake of the algae. A single dose of spirulina can increase mean serum zeaxanthin concentration in humans from 0·06 to 0·15 μmol/l, as shown in our study involving American and Chinese volunteers. The average 15 d area under the serum zeaxanthin response curve to the single dose of spirulina was 293 nmol × d/μmol (range 254–335) in American subjects, and 197 nmol × d/μmol (range 154–285) in Chinese subjects. It is concluded that the relative bioavailability of spirulina zeaxanthin can be studied with high sensitivity and specificity using2H labelling and LC-APCI-MS methodology. Spirulina can serve as a rich source of dietary zeaxanthin in humans.

Folate and vitamin B-12 biomarkers in NHANES: history of their measurement and use

NHANES measured folate and vitamin B-12 status biomarkers, starting with serum folate from NHANES I (1974-1975) through 2010. Subsequent NHANES measured additional biomarkers [eg, red blood cell folate, serum vitamin B-12, total homocysteine (tHcy), methylmalonic acid, serum folic acid, and 5-methyltetrahydrofolic acid]. Examples of the uses of these data are wide ranging and include public policy applications, the derivation of reference intervals, and research. Periodically, the National Center for Health Statistics and its federal partners convene expert panels to review the use of the folate- and vitamin B-12-related biomarkers in NHANES. These panels have evaluated the need for results to be comparable across time and with published data and the use of crossover studies and adjustment equations to ensure comparability. With the recent availability of reference methods and materials for serum folate and tHcy, NHANES has started to use traceability approaches to enhance the accuracy and comparability of its results. A major user concern over the years has been the use of cutoffs to estimate the prevalence of inadequate folate and vitamin B-12 status. Because these cutoffs depend on the measurement procedure, several expert panels suggested approaches for dealing with cutoff challenges. This review summarizes the history and use of folate- and vitamin B-12-related biomarkers beginning with NHANES I (1974-1975) through 2010.

Astaxanthin: a potential therapeutic agent in cardiovascular disease

Astaxanthin is a xanthophyll carotenoid present in microalgae, fungi, complex plants, seafood, flamingos and quail. It is an antioxidant with anti-inflammatory properties and as such has potential as a therapeutic agent in atherosclerotic cardiovascular disease. Synthetic forms of astaxanthin have been manufactured. The safety, bioavailability and effects of astaxanthin on oxidative stress and inflammation that have relevance to the pathophysiology of atherosclerotic cardiovascular disease, have been assessed in a small number of clinical studies. No adverse events have been reported and there is evidence of a reduction in biomarkers of oxidative stress and inflammation with astaxanthin administration. Experimental studies in several species using an ischaemia-reperfusion myocardial model demonstrated that astaxanthin protects the myocardium when administered both orally or intravenously prior to the induction of the ischaemic event. At this stage we do not know whether astaxanthin is of benefit when administered after a cardiovascular event and no clinical cardiovascular studies in humans have been completed and/or reported. Cardiovascular clinical trials are warranted based on the physicochemical and antioxidant properties, the safety profile and preliminary experimental cardiovascular studies of astaxanthin.

Marine carotenoids: biological functions and commercial applications

Carotenoids are the most common pigments in nature and are synthesized by all photosynthetic organisms and fungi. Carotenoids are considered key molecules for life. Light capture, photosynthesis photoprotection, excess light dissipation and quenching of singlet oxygen are among key biological functions of carotenoids relevant for life on earth. Biological properties of carotenoids allow for a wide range of commercial applications. Indeed, recent interest in the carotenoids has been mainly for their nutraceutical properties. A large number of scientific studies have confirmed the benefits of carotenoids to health and their use for this purpose is growing rapidly. In addition, carotenoids have traditionally been used in food and animal feed for their color properties. Carotenoids are also known to improve consumer perception of quality; an example is the addition of carotenoids to fish feed to impart color to farmed salmon.

β-Cryptoxanthin- and α-carotene-rich foods have greater apparent bioavailability than β-carotene-rich foods in Western diets

β-Carotene (BC), β-cryptoxanthin (CX) and α-carotene (AC) are common carotenoids that form retinol. The amount of retinol (vitamin A) formed from carotenoid-rich foods should depend chiefly on the bioavailability (absorption and circulation time in the body) of carotenoids from their major food sources and the selectivity and reactivity of carotene cleavage enzymes towards them. The objective of the present study was to estimate the apparent bioavailability of the major sources of provitamin A (AC, BC and CX) from the diet by comparing the concentrations of these carotenoids in blood to their dietary intakes. Dietary intakes were estimated by FFQ (three studies in this laboratory, n 86; apparent bioavailability calculated for six other studies, n 5738) or by food record (two studies in our laboratory, n 59; apparent bioavailability calculated for two other studies, n 54). Carotenoid concentrations were measured by reversed-phase HPLC. Apparent bioavailability was calculated as the ratio of concentration in the blood to carotenoid intake. Then apparent bioavailabilities for AC and CX were compared to BC. Eating comparable amounts of AC-, CX- and BC-rich foods resulted in 53 % greater AC (99 % CI 23, 83) and 725 % greater CX (99 % CI 535, 915) concentrations in the blood. This suggests that the apparent bioavailability of CX from typical diets is greater than that of BC. Thus, CX-rich foods might be better sources of vitamin A than expected.

Astaxanthin, oxidative stress, inflammation and cardiovascular disease

It is accepted that oxidative stress and inflammation play an integral role in the pathophysiology of many chronic diseases including atherosclerotic cardiovascular disease. The xanthophyll carotenoid dietary supplement astaxanthin has demonstrated potential as an antioxidant and anti-inflammatory therapeutic agent in models of cardiovascular disease. There have been at least eight clinical studies conducted in over 180 humans using astaxanthin to assess its safety, bioavailability and clinical aspects relevant to oxidative stress, inflammation or the cardiovascular system. There have been no adverse outcomes reported. Studies have demonstrated reduced markers of oxidative stress and inflammation and improved blood rheology. A larger number of experimental studies have been performed using astaxanthin. In particular, studies in a variety of animals using a model of myocardial ischemia and reperfusion have demonstrated protective effects from prior administration of astaxanthin both intravenously and orally. Future clinical studies and trials will help determine the efficacy of antioxidants such as astaxanthin on vascular structure, function, oxidative stress and inflammation in a variety of patients at risk of, or with, established cardiovascular disease. These may lead to large intervention trials assessing cardiovascular morbidity and mortality.

Comparison of overall obesity and body fat distribution in predicting risk of mortality

Results of studies comparing overall obesity and abdominal adiposity or body fat distribution with risk of mortality have varied considerably. We compared the relative importance and joint association of overall obesity and body fat distribution in predicting risk of mortality. Participants included 5,799 men and 6,429 women aged 30-102 years enrolled in the third National Health and Nutrition Examination Survey who completed a baseline health examination during 1988-1994. During a 12-year follow-up (102,172 person-years), 1,188 men and 925 women died. In multivariable-adjusted analyses, waist-to-thigh ratio (WTR) in both sexes (Ptrend<0.01 for both) and waist-to-hip ratio (WHR) in women (Ptrend 0.001) were positively associated with mortality in middle-aged adults (30-64 years), while BMI and waist circumference (WC) exhibited U- or J-shaped associations. Risk of mortality increased with a higher WHR and WTR among normal weight (BMI 18.5-24.9 kg/m2) and obese (BMI>or=30.0 kg/m2) adults. In older adults (65-102 years), a higher BMI in both sexes (Ptrend<0.05) and WC in men (Ptrend 0.001) were associated with increased survival, while remaining measures of body fat distribution exhibited either no association or an inverse relation with mortality. In conclusion, ratio measures of body fat distribution are strongly and positively associated with mortality and offer additional prognostic information beyond BMI and WC in middle-aged adults. A higher BMI in both sexes and WC in men were associated with increased survival in older adults, while a higher WHR or WTR either decreased or did not influence risk of death.

Overall obesity and abdominal adiposity as predictors of mortality in u.s. White and black adults

PURPOSE

The association of overall obesity and abdominal adiposity in predicting risk of all-cause mortality in white and black adults was compared.

METHODS

This prospective study included a national sample of 3219 non-Hispanic white and 2,561 non-Hispanic black adults 30 to 64 years of age enrolled in the third National Health and Nutrition Examination Survey during 1988-1994. Multiple measures of adiposity were measured and calculated, including body mass index (BMI), waist circumference, waist-to-hip ratio (WHR), and waist-to-thigh ratio (WTR). Vital status was ascertained with the National Death Index through 2000.

RESULTS

During 12 years of follow-up (51,133 person-years), 188 white and 222 black adults died. After adjustment for age, education, smoking, and existing disease, positive dose-response associations between WTR and mortality in both sexes and races, and WHR in white and black women were observed (p(trend) < 0.05 for all). These results were unchanged after additional adjustment for BMI. In contrast, BMI and waist circumference alone exhibited curvilinear-shaped associations with mortality. A higher WTR was associated with a higher risk of mortality among normal weight (BMI: 18.5-24.9 kg/m(2)) and obese (BMI: > or =30.0 kg/m(2)) white and black adults.

CONCLUSIONS

These results suggest ratio measures of abdominal adiposity, particularly WTR in both sexes and WHR in women, strongly and positively predict mortality, independent of BMI, among white and black adults. Furthermore, WTR offers additional prognostic information beyond that provided by BMI alone.

25-Hydroxyvitamin D deficiency is independently associated with cardiovascular disease in the Third National Health and Nutrition Examination Survey

OBJECTIVE

Serum 25-hydroxyvitamin D [25(OH)D] levels are inversely associated with important cardiovascular disease (CVD) risk factors. However, the association between 25(OH)D levels and prevalent CVD has not been extensively examined in the general population.

METHODS

We performed a cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey (1988-1994) and examined the association between serum 25(OH)D levels and prevalence of CVD in a representative population-based sample of 16,603 men and women aged 18 years or older. Prevalence of CVD was defined as a composite measure inclusive of self-reported angina, myocardial infarction or stroke.

RESULTS

In the whole population, there were 1308 (8%) subjects with self-reported CVD. Participants with CVD had a greater frequency of 25(OH)D deficiency [defined as serum 25(OH)D levels <20 ng/mL] than those without (29.3% vs. 21.4%; p<0.0001). After adjustment for age, gender, race/ethnicity, season of measurement, physical activity, body mass index, smoking status, hypertension, diabetes, elevated low-density lipoprotein cholesterol, hypertriglyceridemia, low high-density lipoprotein cholesterol, chronic kidney disease and vitamin D use, participants with 25(OH)D deficiency had an increased risk of prevalent CVD (odds ratio 1.20 [95% confidence interval (CI) 1.01-1.36; p=0.03]).

CONCLUSIONS

These results indicate a strong and independent relationship of 25(OH)D deficiency with prevalent CVD in a large sample representative of the US adult population.

Antioxidants in cardiovascular health and disease: key lessons from epidemiologic studies

The free radical theory of aging posits that oxidative stress is among the major mechanisms in aging and age-related disease, including cardiovascular disease (CVD). Numerous in vitro and animal studies have supported the role of low-density lipoprotein (LDL) oxidation in atherosclerosis. This has led to the hypothesis that antioxidants could be used as an inexpensive means of prevention and possibly, treatment of coronary artery disease, stroke, peripheral vascular disease, and other CVD-related diseases. Epidemiologic cohort studies with large numbers of men, women, and diverse populations have been largely supportive of this hypothesis. However, interventional trials have been controversial, with some positive findings, many null findings, and some suggestion of harm in certain high-risk populations. Because of the mismatch between the epidemiologic studies and the interventional trials, some researchers have advocated ending antioxidant work. Others have questioned the validity of the LDL oxidative hypothesis itself. Clearly, further research is needed to understand the reasons for the mismatch between the epidemiologic and interventional work. Recent smaller interventional studies with carefully chosen populations, such as those under high levels of oxidative stress, have yielded largely positive results. This suggests that we need more hypothesis-driven and rigorous clinical trial designs. This should help clarify the true potential utility of antioxidants in CVD and may lead to a better understanding of the role of oxidative stress in atherosclerosis.

beta-Cryptoxanthin from supplements or carotenoid-enhanced maize maintains liver vitamin A in Mongolian gerbils ( Meriones unguiculatus) better than or equal to beta-carotene supplements

Maize with enhanced provitamin A carotenoids (biofortified), accomplished through conventional plant breeding, maintains vitamin A (VA) status in Mongolian gerbils (Meriones unguiculatus). Two studies in gerbils compared the VA value of beta-cryptoxanthin with beta-carotene. Study 1 (n 47)examined oil supplements and study 2 (n 46) used maize with enhanced beta-cryptoxanthin and beta-carotene. After 4 weeks' depletion, seven or six gerbils were killed; remaining gerbils were placed into weight-matched groups of 10. In study 1, daily supplements were cottonseed oil, and 35, 35 or 17.5 nmol VA (retinyl acetate), beta-cryptoxanthin or beta-carotene, respectively, for 3 weeks. In study 2, one group of gerbils was fed a 50% biofortified maize diet which contained 2.9 nmol beta-cryptoxanthin and 3.2 nmol beta-carotene/g feed. Other groups were given equivalent b-carotene or VA supplements based on prior-day intake from the biofortified maize or oil only for 4 weeks. In study 1, liver retinol was higher in the VA (0.74 (SD 0.11) micromol) and beta-cryptoxanthin (0.5 (SD 0.10) micromol) groups than in the beta-carotene (0.49 (SD 0.13) micromol) and control (0.41 (SD 0.16) micromol)groups (P<0.05). In study 2, the VA (1.17 (SD 0.19) micromol) and maize (0.71 (SD 0.18) micromol) groups had higher liver retinol than the control (0.42 (SD 0.16) micromol) group (P<0.05), whereas the beta-carotene (0.57 (SD 0.21) micromol) group did not. Bioconversion factors (i.e. 2.74 microg beta-cryptoxanthin and 2.4 microg beta-carotene equivalents in maize to 1 microg retinol) were lower than the Institute of Medicine values.

Low plasma levels of oxygenated carotenoids in patients with coronary artery disease

BACKGROUND AND AIMS

Low circulating levels of carotenoids have been associated with cardiovascular disease. The distribution of different carotenoids in blood may have an impact on the cardioprotective capacity. The aim of the present study was to determine the plasma levels of 6 major carotenoids in patients with coronary artery disease (CAD) and relate the findings to clinical, metabolic and immune parameters.

METHODS AND RESULTS

Plasma levels of oxygenated carotenoids (lutein, zeaxanthin, beta-cryptoxanthin) and hydrocarbon carotenoids (alpha-carotene, beta-carotene, lycopene) were determined in 39 patients with acute coronary syndrome, 50 patients with stable CAD and 50 controls. Serological assays for inflammatory activity and flow cytometrical analysis of lymphocyte subsets were performed. Both patient groups had significantly lower plasma levels of oxygenated carotenoids, in particular lutein+zeaxanthin, compared to controls. Low levels of oxygenated carotenoids were associated with smoking, high body mass index (BMI), low high density lipoprotein (HDL) cholesterol and, to a minor degree, inflammatory activity. Plasma levels of lutein+zeaxanthin were independently associated with the proportions of natural killer (NK) cells, but not with other lymphocytes, in blood.

CONCLUSION

Among carotenoids, lutein+zeaxanthin and beta-cryptoxanthin were significantly reduced in CAD patients independent of clinical setting. The levels were correlated to a number of established cardiovascular risk factors. In addition, the relationship between NK cells and lutein+zeaxanthin may indicate a particular role for certain carotenoids in the immunological scenario of CAD.

Beta-Carotene Supplementation Attenuates Cardiac Remodeling Induced by One-Month Tobacco-Smoke Exposure in Rats

OBJECTIVE

The objectives were to analyze the cardiac effects of exposure to tobacco smoke (ETS), for a period of 30 days, alone and in combination with beta-carotene supplementation (BC).

RESEARCH METHODS AND PROCEDURES

Rats were allocated into: Air (control, n = 13); Air + BC (n = 11); ETS (n = 11); and BC + ETS (n = 9). In Air + BC and BC + ETS, 500 mg of BC were added to the diet. After three months of randomization, cardiac structure and function were assessed by echocardiogram. After that, animals were euthanized and morphological data were analyzed post-mortem. One-way and two-way ANOVA were used to assess the effects of ETS, BC and the interaction between ETS and BC on the variables.

RESULTS

ETS presented smaller cardiac output (0.087 +/- 0.001 vs. 0.105 +/- 0.004 l/min; p = 0.007), higher left ventricular diastolic diameter (19.6 +/- 0.5 vs. 18.0 +/- 0.5 mm/kg; p = 0.024), higher left ventricular (2.02 +/- 0.05 vs. 1.70 +/- 0.03 g/kg; p < 0.001) and atrium (0.24 +/- 0.01 vs. 0.19 +/- 0.01 g/kg; p = 0.003) weight, adjusted to body weight of animals, and higher values of hepatic lipid hydroperoxide (5.32 +/- 0.1 vs. 4.84 +/- 0.1 nmol/g tissue; p = 0.031) than Air. However, considering those variables, there were no differences between Air and BC + ETS (0.099 +/- 0.004 l/min; 19.0 +/- 0.5 mm/kg; 1.83 +/- 0.04 g/kg; 0.19 +/- 0.01 g/kg; 4.88 +/- 0.1 nmol/g tissue, respectively; p > 0.05). Ultrastructural alterations were found in ETS: disorganization or loss of myofilaments, plasmatic membrane infolding, sarcoplasm reticulum dilatation, polymorphic mitochondria with swelling and decreased cristae. In BC + ETS, most fibers showed normal morphological aspects.

CONCLUSION

One-month tobacco-smoke exposure induces functional and morphological cardiac alterations and BC supplementation attenuates this ventricular remodeling process.

Spinach or carrots can supply significant amounts of vitamin A as assessed by feeding with intrinsically deuterated vegetables

BACKGROUND

The vitamin A value of spinach and carrots needs to be measured directly.

OBJECTIVE

The objective was to determine the vitamin A value of intrinsically labeled dietary spinach and carrots in humans.

DESIGN

Spinach and carrots were intrinsically labeled by growing these plants in 25 atom% 2H2O nutrient solution. Growth in this medium yielded a range of trans beta-carotene (tbeta-carotene) isotopomers with a peak enrichment at molecular mass plus 10 mass units. Seven men with a mean (+/-SD) age of 59.0 +/- 6.3 y and a body mass index (in kg/m2) of 25.7 +/- 1.5 consumed puréed spinach (300 g, 20.8 micromol tbeta-carotene equivalents) or carrots (100 g, 19.2 micromol tbeta-carotene equivalents) with a standardized liquid diet (no extra fiber) in random order 4 mo apart. Seven women with a mean (+/-SD) age of 55.5 +/- 6.3 y and a body mass index of 26.4 +/- 4.2 consumed puréed spinach only (300 g, 20.0 micromol tbeta-carotene equivalents). A reference dose of [13C8]retinyl acetate (8.9 micromol) in oil was given to each subject 1 wk after each vegetable dose. Blood samples were collected over 35 d.

RESULTS

Areas under the curve for total labeled serum beta-carotene responses were 42.4 +/- 8.5 nmol.d per micromol spinach beta-carotene and 119.8 +/- 23.0 nmol.d per micromol carrot beta-carotene (P < 0.01). Compared with the [13C8]retinyl acetate reference dose, spinach tbeta-carotene conversion to retinol was 20.9 +/- 9.0 to 1 (range: 10.0-46.5 to 1) and carrot tbeta-carotene conversion to retinol was 14.8 +/- 6.5 to 1 (range: 7.7-24.5 to 1) by weight.

CONCLUSIONS

Spinach and carrots can provide a significant amount of vitamin A even though the amount is not as great as previously proposed. Food matrices greatly affect the bioavailability of plant carotenoids, their efficiency of conversion to vitamin A, or both.

LDL Susceptibility to Copper-Induced Oxidation after Administration of a Single Dose of Free or Esterified Beta-Cryptoxanthin

BACKGROUND

The oxidative modification of LDL is believed to be an initial step in atherosclerosis. Thus, antioxidative substances such as carotenoids may have a role in the prevention of coronary heart disease. We examined the susceptibility of LDL to Cu2+ oxidation in young adults before and after a single dose of beta-cryptoxanthin.

METHODS

1.3 mg of beta-cryptoxanthin was administered to 12 apparently healthy young volunteers. Six of the volunteers received esters, the other six free beta-cryptoxanthin. The plasma concentration of beta-cryptoxanthin and the susceptibility of LDL to copper-induced oxidation ex vivo in terms of the duration of lag time were measured before and 12 h after beta-cryptoxanthin ingestion.

RESULTS

A single dose of beta-cryptoxanthin significantly increased the mean plasma beta-cryptoxanthin concentration and the mean cholesterol adjusted beta-cryptoxanthin concentration by 117 and 133%, respectively. No effect on the length of lag time was assessed. However, in LDL isolated from plasma 12 h after beta-cryptoxanthin administration the lengths of lag time correlated significantly with the plasma beta-cryptoxanthin concentration and with the cholesterol adjusted beta-cryptoxanthin levels. The lag time did not differ significantly between volunteers who received esters and those who received the same dosage as free beta-cryptoxanthin. At both measuring points, smokers, male volunteers and women using oral contraceptives tended to exhibit lower beta-cryptoxanthin concentrations and lower cholesterol adjusted beta-cryptoxanthin concentrations as well as increased LDL oxidizability compared to nonsmokers and women not using oral contraceptives.

CONCLUSION

A single dose of beta-cryptoxanthin does not enhance the duration of LDL lag time ex vivo in healthy young subjects.

Kava use, dyslipidaemia and biomarkers of dietary quality in Aboriginal people in Arnhem Land in the Northern Territory (NT), Australia

Heavy kava use has been associated with sudden death in Aboriginal Australians in Arnhem Land (Northern Territory, Australia) where poor diets and a high incidence of premature coronary heart disease are known. Heavy kava users may suffer additional risk if further malnourished. Among 98 people (62 males, 36 females) in one community, 36 never used kava, 26 were past users, and 36 were continuing users. Across kava-using groups skinfold thickness, body mass index and body fat decreased. Total- and LDL-cholesterol were elevated in kava users compared to both former users and never users. HDL-cholesterol was higher in current users vs never users. Across kava-using groups, triglycerides, homocysteine and diet-derived antioxidant vitamins alpha-tocopherol and retinol, did not vary. Plasma carotenoid levels (indicative of vegetable and fruit intake) were very low, but when adjusted for plasma cholesterol, did not vary between kava-using groups. An obsession for kava drinking may mediate kava's direct effects on nutritional status.

From 1989 to 2001: what have we learned about the "biological actions of beta-carotene"?

Dr. James Allen Olson helped us to define the role of beta-carotene in human health by categorizing these as "functions, actions and associations." In the last decade, significant research has shown that beta-carotene acts as an antioxidant in biologically relevant systems, affects several aspects of human immune function and higher intake/serum levels are associated with improvements in certain physiological functions such as lung function. The unexpected findings of increased lung cancer in beta-carotene supplemented smokers in the ATBC and CARET intervention studies have resulted in the need for expanded research efforts to define the mechanism(s) of action of beta-carotene. Recent survey data as well as laboratory animal studies continue to find an inverse association between beta-carotene and cancer risk. Because beta-carotene is the major source of vitamin A for the majority of the world's population, it is critical to define the safe levels of intake from foods and supplements.

Measurements of the major isoforms of vitamins A and E and carotenoids in the blood of people with spinal-cord injuries

We used reversed-phase HPLC with diode array detection to simultaneously measure the major isoforms of vitamins A, E, and the carotenoids in serum from 55 healthy people with spinal cord injuries. Typically, the method measured retinol (vitamin A), alpha-tocopherol (vitamin E) and beta-carotene, alpha-carotene, lutein, lycopene, and cryptoxanthin (carotenoids). gamma-Tocopherol (vitamin E), 25-hydroxycalciferol (vitamin D), and the carotenoid zeaxanthin could also be measured when they were present in high concentrations. Healthy people with spinal cord injuries were more likely than similar people without injuries to have low concentrations of alpha-tocopherol, and to a lesser extent retinol and beta-carotene.

Lipid standardization of serum fat-soluble antioxidant concentrations: the YALTA study

BACKGROUND

Blood lipids can influence fat-soluble antioxidant concentrations and confound their interpretation as indicators of antioxidant intake status and disease risk.

OBJECTIVES

The objectives were to identify lipoproteins that can confound the interpretation of serum fat-soluble antioxidants, to evaluate the amount of the confounding, and to recommend a method for standardizing blood concentrations of fat-soluble antioxidants.

DESIGN

Several methods of lipid standardization of fat-soluble antioxidants were evaluated in a large cohort of young adults with the use of both cross-sectional and longitudinal data analysis.

RESULTS

Tocopherol and carotenoid concentrations were associated with plasma total cholesterol and its components, LDL, HDL, and VLDL cholesterol (estimated as plasma total triacylglycerols/5), some of which were independent predictors for all of the fat-soluble antioxidants. Among supplement nonusers, the most amphipathic (polar) of the antioxidants (alpha-tocopherol, gamma-tocopherol, and zeaxanthin plus lutein) and lycopene were associated strongly with these lipid fractions (R(2) = 0.09, 0.40). Consistent with a causal association in which blood antioxidant concentrations change as blood lipid concentrations change, similar relations were found for changes in blood antioxidant and lipid concentrations over a 7-y period. Concentrations of the remaining carotenoids (beta-cryptoxanthin, alpha-carotene, and beta-carotene) had a weaker association with plasma lipoproteins (R(2) < 0.06). Similar relations were found for supplement users.

CONCLUSIONS

The simultaneous adjustment of the concentrations of tocopherols, zeaxanthin plus lutein, and lycopene for VLDL, HDL, and LDL cholesterol is recommended. This method is practical and can provide a basis for the standardization of carotenoid and tocopherol concentrations.

Carotenoids: separation methods applicable to biological samples

Epidemiologic and clinical studies have shown that a high intake of vegetables and fruit, with consequently high intakes and circulating concentrations of carotenoids, is associated with reduced risk of cardiovascular and other chronic diseases. The antioxidant properties of carotenoids are thought to contribute to these effects. The analysis of carotenoids in plasma, foods and tissues has thus become of interest in studies examining the role of diet in chronic disease prevention and management. High-performance liquid chromatography with ultra-violet or photodiode array detection is most often employed in routine use. We review these and other current methods for carotenoid analysis and information on sample stability relevant to epidemiological studies. The carotenoids remain an important and intriguing subject of study, with relevance to prevention of several important "lifestyle-related" diseases. Research into their physiological functions and their use as dietary markers requires sensitive, accurate and precise measurement. Further advances in these methodological areas will contribute to basic, clinical and public health research into the significance of carotenoid compounds in disease prevention.

Serum carotenoid concentrations in US children and adolescents

BACKGROUND

Carotenoids, a class of phytochemicals, may affect the risk of several chronic conditions.

OBJECTIVE

Our objective was to describe the distributions and correlates of serum carotenoid concentrations in US children and adolescents.

DESIGN

Using data from the third National Health and Nutrition Examination Survey (1988-1994), a cross-sectional study, we examined the distributions of serum concentrations of alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein and zeaxanthin, and lycopene among 4231 persons aged 6-16 y.

RESULTS

After adjustment for age, sex, race or ethnicity, poverty-income ratio, body mass index status, HDL- and non-HDL-cholesterol concentrations, C-reactive protein concentration, and cotinine concentration, only HDL-cholesterol (P < 0.001) and non-HDL-cholesterol (P < 0.001) concentrations were directly related to all carotenoid concentrations. Age (P < 0.001) and body mass index status (P < 0.001) were inversely related to all carotenoid concentrations except those of lycopene. Young males had slightly higher carotenoid concentrations than did young females, but the differences were significant only for lycopene concentrations (P = 0.029). African American children and adolescents had significantly higher beta-cryptoxanthin (P < 0.001), lutein and zeaxanthin (P < 0.001), and lycopene (P = 0.006) concentrations but lower alpha-carotene (P < 0.001) concentrations than did white children and adolescents. Mexican American children and adolescents had higher alpha-carotene (P < 0.001), beta-cryptoxanthin (P < 0.001), and lutein and zeaxanthin (P < 0.001) concentrations but lower lycopene (P = 0.001) concentrations than did white children and adolescents. C-reactive protein concentrations were inversely related to beta-carotene (P < 0.001), lutein and zeaxanthin (P < 0.001), and lycopene (P = 0.023) concentrations. Cotinine concentrations were inversely related to alpha-carotene (P = 0.002), beta-carotene (P < 0.001), and beta-cryptoxanthin (P < 0.001) concentrations.

CONCLUSION

These data show significant variations in serum carotenoid concentrations among US children and adolescents and may be valuable as reference ranges for this population.

Improvements in circulating cholesterol, antioxidants, and homocysteine after dietary intervention in an Australian Aboriginal community

BACKGROUND

Poor nutrition contributes to high rates of coronary heart disease among Australian Aboriginal populations. Since late 1993, the Aboriginal community described here has operated a healthy lifestyle program aimed at reducing the risk of chronic disease.

OBJECTIVE

We evaluated the effectiveness of a community-directed intervention program to reduce coronary heart disease risk through dietary modification.

DESIGN

Intervention processes included store management policy changes, health promotion activities, and nutrition education aimed at high-risk individuals. Dietary advice was focused on decreasing saturated fat and sugar intake and increasing fruit and vegetable intake. Evaluation of the program included conducting sequential, cross-sectional risk factor surveys at 2-y intervals; measuring fasting cholesterol, lipid-soluble antioxidants, and homocysteine concentrations; and assessing smoking status. Nutrient intakes were estimated from analysis of food turnover in the single community store.

RESULTS

There was a significant reduction in the prevalence of hypercholesterolemia (age-adjusted prevalences were 31%, 21%, and 15% at baseline, 2 y, and 4 y, respectively; P < 0.001). There were significant increases in plasma concentrations of alpha-tocopherol, lutein and zeaxanthin, cryptoxanthin, and beta-carotene across the population. Retinol and lycopene concentrations did not change significantly. Mean plasma homocysteine concentrations decreased by 3 micromol/L. There was no significant change in smoking prevalence between the 2 follow-up surveys. There was an increase in the density of fresh fruit and vegetables and carotenoids in the food supply at the community store.

CONCLUSION

This community-directed dietary intervention program reduced the prevalence of coronary heart disease risk factors related to diet.

The relation of serum levels of antioxidant vitamins C and E, retinol and carotenoids with pulmonary function in the general population

Reduced pulmonary function is an important predictor of mortality in the general population, and antioxidant vitamins are thought to positively influence pulmonary function. Vitamin C, vitamin E, retinol, and carotenoids are powerful antioxidants but information about the joint relation of serum levels of these antioxidants to pulmonary function is limited. We analyzed the association of FEV(1) and FVC with serum vitamins C and E, retinol, and carotenoids (beta-cryptoxanthin, lutein/zeaxanthin, beta-carotene, and lycopene) in a cross-sectional study. The analysis was carried out in a sample of 1,616 randomly selected residents of Western New York, USA, age 35 to 79 yr and free of respiratory disease. Lung function was adjusted for height, age, sex, and race and expressed as percentage of predicted normal FEV(1) (FEV(1)%) and FVC (FVC%). Participants in the lowest quartile of each of the serum antioxidants had consistently lower FEV(1)% and FVC% than those in higher quartiles. Multiple linear regression analysis revealed significant associations of vitamin C, vitamin E, beta-cryptoxanthin, lutein/zeaxanthin, beta-carotene, and retinol with FEV(1)% when these variables were investigated individually after adjustment for other covariates (smoking status, pack-years of smoking, weight, eosinophil count, and education). When all of these antioxidant vitamins were analyzed simultaneously in a multivariate regression model, the strongest association was seen with vitamin E and beta-cryptoxanthin. Only retinol showed an independent effect on FEV(1)% after controlling for vitamin E and beta-cryptoxanthin. As for FEV(1)%, vitamin E and beta-cryptoxanthin were most strongly related to FVC% when all variables were considered in the multivariate regression model. The differences in FEV(1) associated with a reduction of one standard deviation of serum vitamin E or beta-cryptoxanthin were equivalent to the negative influence of approximately 1 to 2 yr of aging. Our findings support the hypothesis that antioxidant vitamins may play a role in respiratory health and that vitamin E and beta-cryptoxanthin appear to be stronger correlates of lung function than other antioxidant vitamins.

Carotenoids and chronic diseases

Chronic diseases such as cancer and cardiovascular diseases are the major causes of deaths in North America. Dietary intake of fruits and vegetables has been suggested to have protective effects against such chronic diseases. Carotenoids are important plant pigments which are thought to contribute towards the beneficial effects of fruit and vegetable consumption. This review focuses on the role of carotenoids and particularly lycopene in chronic diseases.