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Carbone L, Bůžková P, Fink HA, Robbins JA, Barzilay JI, Elam RE, Isales C, Connelly MA, Mukamal KJ. Plasma Levels of Branched Chain Amino Acids, Incident Hip Fractures, and Bone Mineral Density of the Hip and Spine. J Clin Endocrinol Metab 2023; 108:e1358-e1364. [PMID: 37200158 PMCID: PMC11009785 DOI: 10.1210/clinem/dgad275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/16/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Branched chain amino acids (BCAA) are building blocks for protein, an essential component of bone. However, the association of plasma levels of BCAA with fractures in populations outside of Hong Kong or with hip fractures in particular is not known. The purpose of these analyses was to determine the relationship of BCAA including valine, leucine, and isoleucine and total BCAA (SD of the sum of Z-scores for each BCAA) with incident hip fractures and bone mineral density (BMD) of the hip and lumbar spine in older African American and Caucasian men and women in the Cardiovascular Health Study. DESIGN Longitudinal analyses of association of plasma levels of BCAA with incident hip fractures and cross-sectional BMD of the hip and lumbar spine from the Cardiovascular Health Study. SETTING Community. PARTICIPANTS A total of 1850 men (38% of cohort) and women; mean age 73 years. MAIN OUTCOME MEASURES Incident hip fractures and cross-sectional BMD of the total hip, femoral neck, and lumbar spine. RESULTS In fully adjusted models, over 12 years of follow-up, we observed no significant association between incident hip fracture and plasma values of valine, leucine, isoleucine, or total BCAA per 1 SD higher of each BCAA. Plasma values of leucine but not valine, isoleucine, or total BCAA, were positively and significantly associated with BMD of the total hip (P = .03) and femoral neck (P = .02), but not the lumbar spine (P = .07). CONCLUSIONS Plasma levels of the BCAA leucine may be associated with higher BMD in older men and women. However, given the lack of significant association with hip fracture risk, further information is needed to determine whether BCAAs would be novel targets for osteoporosis therapies.
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Affiliation(s)
- Laura Carbone
- J. Harold Harrison, MD, Distinguished University Chair in Rheumatology, Division of Rheumatology, Department of Medicine, Augusta University, Augusta, GA 30912, USA
- Charlie Norwood Veterans Affairs Medical Center, Veterans Affairs Health Care System, Augusta, GA 30912, USA
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN 55417, USA
| | - John A Robbins
- Department of Medicine, University of California, Davis, Davis, CA 95817, USA
| | - Joshua I Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Rachel E Elam
- Charlie Norwood Veterans Affairs Medical Center, Veterans Affairs Health Care System, Augusta, GA 30912, USA
- Division of Rheumatology, Department of Medicine, Augusta University, Augusta, GA 30912, USA
| | - Carlos Isales
- Charlie Norwood Veterans Affairs Medical Center, Veterans Affairs Health Care System, Augusta, GA 30912, USA
- J. Harold Harrison, MD, Distinguished University Chair in Aging, Division of Endocrinology, Department of Medicine, Augusta University, Augusta, GA 30912, USA
| | | | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Ambroszkiewicz J, Gajewska J, Mazur J, Kuśmierska K, Klemarczyk W, Rowicka G, Strucińska M, Chełchowska M. Dietary Intake and Circulating Amino Acid Concentrations in Relation with Bone Metabolism Markers in Children Following Vegetarian and Omnivorous Diets. Nutrients 2023; 15:nu15061376. [PMID: 36986105 PMCID: PMC10055473 DOI: 10.3390/nu15061376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Scientific studies reported that most vegetarians meet the total protein requirements; however, little is known about their amino acid intakes. We aimed to assess dietary intake and serum amino acid levels in relation to bone metabolism markers in prepubertal children on vegetarian and traditional diets. Data from 51 vegetarian and 25 omnivorous children aged 4–9 years were analyzed. Dietary intake of macro- and micronutrients were assessed using the nutritional program Dieta 5®. Serum amino acid analysis was performed using high-pressure liquid chromatography technique, 25-hydroxyvitamin D and parathormone–electrochemiluminescent immunoassay, and bone metabolism markers, albumin, and prealbumin levels using enzyme-linked immunosorbent assay. Vegetarian children had a significantly lower intake of protein and amino acids with median differences of about 30–50% compared to omnivores. Concentrations of four amino acids (valine, lysine, leucine, isoleucine) in serum varied significantly by diet groups and were lower by 10–15% in vegetarians than meat-eaters. Vegetarian children also had lower (p < 0.001) serum albumin levels compared to omnivores. Among bone markers, they had higher (p < 0.05) levels of C-terminal telopeptide of collagen type I (CTX-I) than omnivores. Correlation patterns between amino acids and bone metabolism markers differed in the vegetarian and omnivore groups. Out of bone markers, especially osteoprotegerin was positively correlated with several amino acids, such as tryptophan, alanine, aspartate, glutamine, and serine, and ornithine in vegetarians. Vegetarian children consumed apparently sufficient but lower protein and amino acids compared to omnivores. In circulation these differences were less marked than in the diet. Significantly lower amino acid intake and serum levels of valine, lysine, leucine, and isoleucine as well as the observed correlations between serum amino acids and biochemical bone marker levels indicated the relations between diet, protein quality, and bone metabolism.
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Affiliation(s)
- Jadwiga Ambroszkiewicz
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
- Correspondence:
| | - Joanna Gajewska
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Joanna Mazur
- Department of Humanization in Medicine and Sexology, Collegium Medicum, University of Zielona Gora, 65-729 Zielona Gora, Poland
| | - Katarzyna Kuśmierska
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Witold Klemarczyk
- Department of Nutrition, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Grażyna Rowicka
- Department of Nutrition, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Małgorzata Strucińska
- Department of Nutrition, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Magdalena Chełchowska
- Department of Screening Tests and Metabolic Diagnostics, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
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van der Heijden I, Monteyne AJ, Stephens FB, Wall BT. Alternative dietary protein sources to support healthy and active skeletal muscle aging. Nutr Rev 2023; 81:206-230. [PMID: 35960188 DOI: 10.1093/nutrit/nuac049] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
To mitigate the age-related decline in skeletal muscle quantity and quality, and the associated negative health outcomes, it has been proposed that dietary protein recommendations for older adults should be increased alongside an active lifestyle and/or structured exercise training. Concomitantly, there are growing environmental concerns associated with the production of animal-based dietary protein sources. The question therefore arises as to where this dietary protein required for meeting the protein demands of the rapidly aging global population should (or could) be obtained. Various non-animal-derived protein sources possess favorable sustainability credentials, though much less is known (compared with animal-derived proteins) about their ability to influence muscle anabolism. It is also likely that the anabolic potential of various alternative protein sources varies markedly, with the majority of options remaining to be investigated. The purpose of this review was to thoroughly assess the current evidence base for the utility of alternative protein sources (plants, fungi, insects, algae, and lab-grown "meat") to support muscle anabolism in (active) older adults. The solid existing data portfolio requires considerable expansion to encompass the strategic evaluation of the various types of dietary protein sources. Such data will ultimately be necessary to support desirable alterations and refinements in nutritional guidelines to support healthy and active aging, while concomitantly securing a sustainable food future.
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Affiliation(s)
- Ino van der Heijden
- Department of Sport and Health Sciences, College of Life Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Alistair J Monteyne
- Department of Sport and Health Sciences, College of Life Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Francis B Stephens
- Department of Sport and Health Sciences, College of Life Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Benjamin T Wall
- Department of Sport and Health Sciences, College of Life Environmental Sciences, University of Exeter, Exeter, United Kingdom
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Vargas-Morales JM, Guizar-Heredia R, Méndez-García AL, Palacios-Gonzalez B, Schcolnik-Cabrera A, Granados O, López-Barradas AM, Vázquez-Manjarrez N, Medina-Vera I, Aguilar-López M, Tovar-Palacio C, Ordaz-Nava G, Rocha-Viggiano AK, Medina-Cerda E, Torres N, Ordovas JM, Tovar AR, Guevara-Cruz M, Noriega LG. Association of BCAT2 and BCKDH polymorphisms with clinical, anthropometric and biochemical parameters in young adults. Nutr Metab Cardiovasc Dis 2021; 31:3210-3218. [PMID: 34511290 DOI: 10.1016/j.numecd.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/26/2021] [Accepted: 07/13/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM Circulating amino acids are modified by sex, body mass index (BMI) and insulin resistance (IR). However, whether the presence of genetic variants in branched-chain amino acid (BCAA) catabolic enzymes modifies circulating amino acids is still unknown. Thus, we determined the frequency of two genetic variants, one in the branched-chain aminotransferase 2 (BCAT2) gene (rs11548193), and one in the branched-chain ketoacid dehydrogenase (BCKDH) gene (rs45500792), and elucidated their impact on circulating amino acid levels together with clinical, anthropometric and biochemical parameters. METHODS AND RESULTS We performed a cross-sectional comparative study in which we recruited 1612 young adults (749 women and 863 men) aged 19.7 ± 2.1 years and with a BMI of 24.9 ± 4.7 kg/m2. Participants underwent clinical evaluation and provided blood samples for DNA extraction and biochemical analysis. The single nucleotide polymorphisms (SNPs) were determined by allelic discrimination using real-time polymerase chain reaction (PCR). The frequencies of the less common alleles were 15.2 % for BCAT2 and 9.83 % for BCKDH. The subjects with either the BCAT2 or BCKDH SNPs displayed no differences in the evaluated parameters compared with subjects homozygotes for the most common allele at each SNP. However, subjects with both SNPs had higher body weight, BMI, blood pressure, glucose, and circulating levels of aspartate, isoleucine, methionine, and proline than the subjects homozygotes for the most common allele (P < 0.05, One-way ANOVA). CONCLUSION Our findings suggest that the joint presence of both the BCAT2 rs11548193 and BCKDH rs45500792 SNPs induces metabolic alterations that are not observed in subjects without either SNP.
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Affiliation(s)
- Juan M Vargas-Morales
- Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | | | - Ana L Méndez-García
- Departamento de Fisiología de la Nutrición, Mexico; Facultad de Enfermería, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | | | - Alejandro Schcolnik-Cabrera
- Département de Biochimie et Médecine Moléculaire, Université de Montréal, Montréal, QC, Canada; Maisonneuve-Rosemont Hospital Research Centre, Montréal, QC, Canada
| | | | | | | | | | | | - Claudia Tovar-Palacio
- División de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | | | | | - Eduardo Medina-Cerda
- Centro de Salud Universitario, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Nimbe Torres
- Departamento de Fisiología de la Nutrición, Mexico
| | - José M Ordovas
- Nutrition and Genomics Laboratory, JM-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
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Serum amino acid concentrations are modified by age, insulin resistance, and BCAT2 rs11548193 and BCKDH rs45500792 polymorphisms in subjects with obesity. Clin Nutr 2021; 40:4209-4215. [PMID: 33583659 DOI: 10.1016/j.clnu.2021.01.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 12/21/2020] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS The amino acid profile of young adults is modified by sex, body mass index (BMI) and insulin resistance (IR). However, we do not know if age or the presence of specific polymorphisms in the genes of BCAT2 and BCKDH contribute to changes in the amino acid profile, especially in subjects with obesity. Therefore, we have evaluated the effect of age, the presence of IR and the polymorphisms of BCAT2 rs11548193 and BCKDH rs45500792 on the concentration of amino acids in subjects with obesity. METHODS This was a cross-sectional study conducted with 487 subjects with obesity. Participants underwent a physical examination in which their clinical history was obtained and a blood sample was taken for biochemical, hormonal, and DNA analysis. RESULTS Adults <30 years old with obesity had higher levels of alanine, arginine, aspartate, histidine, leucine, lysine, methionine, phenylalanine, proline, serine and valine than adults ≥30 years old. Interestingly, regardless of age, we found that arginine, aspartate, serine decreased, while proline and tyrosine increased in the presence of IR; tyrosine and sum of branched-chain amino acids (∑BCAA) were the amino acids that increased in the presence of BCAT2 rs11548193 and BCKDH rs45500792 polymorphisms. CONCLUSIONS We found that the amino acid profiles of subjects with obesity are differentially modified by age, the presence of IR, and the presence of the BCAT2 rs11548193 and BCKDH rs45500792 polymorphisms.
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Koochakpoor G, Salari-Moghaddam A, Keshteli AH, Afshar H, Esmaillzadeh A, Adibi P. Dietary intake of branched-chain amino acids in relation to depression, anxiety and psychological distress. Nutr J 2021; 20:11. [PMID: 33514378 PMCID: PMC7847030 DOI: 10.1186/s12937-021-00670-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/25/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is no previous study that examined the association between branched-chain amino acids (BCAAs) intake and odds of psychological disorders. The aim of this study was to investigate the association between dietary BCAAs and odds of psychological disorders including depression, anxiety, and psychological distress in a large sample of Iranian adults. METHODS In this cross-sectional study on 3175 Iranian adults aged 18-55 years, a validated food frequency questionnaire was used to assess dietary intakes. BCAAs intake was computed by summing up the amount of valine, leucine, and isoleucine intake from all food items in the questionnaire. Psychological health was examined through the use of Iranian validated version of the Hospital Anxiety and Depression Scale (HADS). Psychological distress was assessed using General Health Questionnaire (GHQ). For depression and anxiety, scores of 8 or more on either subscale were considered as psychological disorders and scores of 0-7 were defined as "normal". In terms of psychological distress, the score of 4 or more was defined as psychological distress. RESULTS Mean age of study participants was 36.2 ± 7.8 years. Overall, 26.4% (n = 837) of study subjects had depression, 11.9% (n = 378) had anxiety and 20.9% (n = 665) were affected by psychological distress. After controlling for potential confounders, participants in the highest tertile of total BCAAs intake had lower odds of depression (OR: 0.76; 95% CI: 0.60-0.96) and anxiety (OR: 0.66; 95% CI: 0.47-0.91) compared with those in the lowest tertile. Participants in the top tertile of valine intake had a lower odds of depression (OR: 0.76; 95% CI: 0.60-0.96) and anxiety (OR: 0.65; 95% CI: 0.47-0.90) compared with those in the bottom tertile. A significant inverse association was also seen between leucine intake and depression (OR: 0.77; 95% CI: 0.61-0.98) and anxiety (OR: 0.66; 95% CI: 0.47-0.91). In addition, a significant inverse association was observed between isoleucine intake and odds of depression (OR: 0.75; 95% CI: 0.59-0.95) and anxiety (OR: 0.62; 95% CI: 0.45-0.86). There was no significant association between isoleucine intake and odds of psychological distress. CONCLUSION Evidence indicating an inverse association between dietary intake of BCAAs and odds of depression and anxiety was found. Prospective studies are required to confirm these findings.
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Affiliation(s)
| | - Asma Salari-Moghaddam
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - Ammar Hassanzadeh Keshteli
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Afshar
- Department of Psychiatry, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran.
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular -Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Peyman Adibi
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Greger M. A Whole Food Plant-Based Diet Is Effective for Weight Loss: The Evidence. Am J Lifestyle Med 2020; 14:500-510. [PMID: 32922235 PMCID: PMC7444011 DOI: 10.1177/1559827620912400] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
What does the best available balance of scientific evidence show is the optimum way to lose weight? Calorie density, water content, protein source, and other components significantly influence the effectiveness of different dietary regimes for weight loss. By "walling off your calories," preferentially deriving your macronutrients from structurally intact plant foods, some calories remain trapped within indigestible cell walls, which then blunts the glycemic impact, activates the ileal brake, and delivers prebiotics to the gut microbiome. This may help explain why the current evidence indicates that a whole food, plant-based diet achieves greater weight loss compared with other dietary interventions that do not restrict calories or mandate exercise. So, the most effective diet for weight loss appears to be the only diet shown to reverse heart disease in the majority of patients. Plant-based diets have also been found to help treat, arrest, and reverse other leading chronic diseases such as type 2 diabetes and hypertension, whereas low-carbohydrate diets have been found to impair artery function and worsen heart disease, the leading killer of men and women in the United States. A diet centered on whole plant foods appears to be a safe, simple, sustainable solution to the obesity epidemic.
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Vitamin B12 Deficiency Is Prevalent Among Czech Vegans Who Do Not Use Vitamin B12 Supplements. Nutrients 2019; 11:nu11123019. [PMID: 31835560 PMCID: PMC6950550 DOI: 10.3390/nu11123019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 02/06/2023] Open
Abstract
As not much is known about the prevalence and predictors of nutritional deficiencies among vegans in the Czech Republic, we evaluated whether supplement use and duration of adherence to the vegan diet are associated with the risk of cobalamin and iron deficiencies. Associations between self-reported supplementation and duration of vegan diet with biomarkers of cobalamin (serum cobalamin, holotranscobalamin, homocysteine, folate) and iron status (serum ferritin, iron binding capacity, transferrin and saturation of transferrin) were assessed by cross-sectional analyses of medical data from a clinical nutrition center. Data from 151 (72 females) adult vegans (age 18–67 years), who were free of major chronic diseases and 85 (40 females) healthy non-vegans (age 21–47 years) were analyzed. Overall, vegans had significantly lower cobalamin, hemoglobin and ferritin levels, but higher folate and MCV values compared to non-vegans. Vegans not using cobalamin supplements were at higher risk of low plasma cobalamin than regularly supplementing vegans (OR: 4.41, 95% CI 1.2–16.16 for cobalamin, OR: 19.18, 95% CI 1.02–359.42 for holotranscobalamin), whereas no significant differences in cobalamin status related to duration of the vegan diet were observed. Regularly supplementing vegans had similar levels of cobalamin/holotranscobalamin as non-vegans. Despite lower ferritin and hemoglobin levels, there was no indication of a higher risk of iron-deficiency among vegans. To conclude cobalamin deficiency risk depends on supplementation status and not on the duration of an exclusive vegan diet, which underlines the need to integrate cobalamin status monitoring and counselling on supplement use in routine clinical care in the Czech Republic.
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Mariotti F. Animal and Plant Protein Sources and Cardiometabolic Health. Adv Nutr 2019; 10:S351-S366. [PMID: 31728490 PMCID: PMC6855969 DOI: 10.1093/advances/nmy110] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/24/2018] [Accepted: 11/09/2018] [Indexed: 12/22/2022] Open
Abstract
The sources or types of protein in the diet have long been overlooked regarding their link to cardiometabolic health. The picture is complicated by the fact that animal and plant proteins are consumed along with other nutrients and substances which make up the "protein package" so plant and animal protein come with clear nutrient clusters. This review aimed at deciphering the relation between plant and animal protein and cardiometabolic health by examining different nutritional levels (such as amino acids, protein type, protein foods, protein patterns, and associated overall dietary and nutrient patterns) and varying levels of scientific evidence [basic science, randomized controlled trials (RCTs), observational data]. Plant protein in Western countries is a robust marker of nutrient adequacy of the diet, whereas the contribution of animal protein is highly heterogeneous. Yet recent data from large cohorts have confirmed that total and animal proteins are associated with the risk of cardiovascular disease and diabetes, even when fully adjusting for lifestyle and dietary or nutritional factors. Here again, there is marked variability depending on the type of animal protein. Protein from processed red meat and total red meat on the one hand, and from legumes, nuts, and seeds on the other, are often reported at the extremes of the risk range. RCTs using purified proteins have contributed little to the topic to date, inasmuch as the findings cannot readily be extrapolated to current or near-future diets, but RCTs studying whole protein foods have shown a beneficial effect of pulses. Despite the fact that many of the benefits of plant protein reported in observational or interventional studies may stem from the protein package that they convey and the nutrients that they displace, there are also important indications that protein per se may affect cardiometabolic health via the many amino acids that are present in typically contrasting levels in plant compared with animal proteins.
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Affiliation(s)
- François Mariotti
- UMR PNCA, AgroParisTech, INRA, Université Paris-Saclay, 75005, Paris, France
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Tharrey M, Mariotti F, Mashchak A, Barbillon P, Delattre M, Huneau JF, Fraser GE. Patterns of amino acid intake are strongly associated with cardiovascular mortality, independently of the sources of protein. Int J Epidemiol 2019; 49:312-321. [DOI: 10.1093/ije/dyz194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 12/29/2022] Open
Abstract
Abstract
Background
The intake of specific amino acids (AA) has been associated with cardiovascular health, but amino acids are consumed together as dietary protein. Here we investigated the association between identified patterns of amino acid intake and cardiovascular mortality.
Methods
A total of 2216 cardiovascular deaths among 79 838 men and women from the Adventist Health Study-2 were included in our analysis. Baseline dietary patterns based on the participants' amino acids intakes were derived by factor analysis. Using Cox regression analyses, we estimated multivariate-adjusted hazard ratios (HRs) adjusted for sociodemographic and lifestyle factors and other dietary components.
Results
Three patterns of amino acids were identified. Factor 1 was positively associated with cardiovascular disease (CVD) mortality [hazard ratio (HR)Q5-Q1: 1.62, 98.75% confidence interval (CI): 1.15, 2.28; P-trend <0.001]; and Factors 2 and 3 were inversely associated with CVD mortality (HR Q5-Q1 Factor 2: 0.74, 98.75% CI: 0.53, 1.04; P-trend <0.01 and HR Q5-Q1 Factor 3: 0.65, 98.75% CI: 0.44, 0.95; P-trend <0.05]. The associations with Factor 1 (with high loadings on indispensable amino acids such as branched chain amino acids, lysine, methionine) and Factor 3 (with high loadings on non-indispensable amino acids, namely arginine, glycine, aspartate+asparagine) remained significant after further adjustment for nutrient intake and for the five protein source patterns identified previously (HR Q5-Q1: 1.56 (0.99, 2.45) and 0.55 (0.35, 0.85); P-trends < 0.01).
Conclusions
Indispensable AA have a positive and some non-indispensable AA have a negative, independent, strong association with the risk of cardiovascular mortality.
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Affiliation(s)
- Marion Tharrey
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
- UMR PNCA, AgroParisTech, INRA, Université Paris-Saclay, Paris, France
- MOISA, INRA, CIHEAM-IAMM, CIRAD, Montpellier SupAgro, Univ Montpellier, Montpellier, France
| | - Francois Mariotti
- UMR PNCA, AgroParisTech, INRA, Université Paris-Saclay, Paris, France
| | - Andrew Mashchak
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Pierre Barbillon
- UMR MIA-Paris, AgroParisTech, INRA, Université Paris-Saclay, Paris, France
| | - Maud Delattre
- UMR MIA-Paris, AgroParisTech, INRA, Université Paris-Saclay, Paris, France
| | | | - Gary E Fraser
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
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The use of coupled gas chromatography columns for the determination of individual isomers of trans fatty acids in the adipose tissue of vegans. MONATSHEFTE FUR CHEMIE 2019. [DOI: 10.1007/s00706-019-02481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Novin ZS, Ghavamzadeh S, Mehdizadeh A. The Weight Loss Effects of Branched Chain Amino Acids and Vitamin B6: A Randomized Controlled Trial on Obese and Overweight Women. INT J VITAM NUTR RES 2019; 88:80-89. [PMID: 30841823 DOI: 10.1024/0300-9831/a000511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Branched chain amino acids (BCAA), with vitamin B6 have been reported to improve fat metabolism and muscle synthesis. We hypothesized that supplementation with BCAA and vitamin B6 would result in more weight loss and improve body composition and blood markers related to cardiovascular diseases. Our aim was to determine whether the mentioned supplementation would affect weight loss, body composition, and cardiovascular risk factors during weight loss intervention. To this end, we performed a placebo-controlled randomized clinical trial in 42 overweight and obese women (BMI = 25-34.9 kg/m2). Taking a four-week moderate deficit calorie diet (-500 kcal/day), participants were randomized to receive BCAA (6 g/day) with vitamin B6 (40 mg/day) or placebo. Body composition variables measured with the use of bioelectrical impedance analysis, homeostatic model assessment, and plasma insulin, Low density lipoprotein, High density lipoprotein, Total Cholesterol, Triglyceride, and fasting blood sugar were measured. The result indicated that, weight loss was not significantly affected by BCAA and vitamin B6 supplementation (-2.43 ± 1.02 kg) or placebo (-1.64 ± 1.48 kg). However, significant time × treatment interactions in waist to hip ratio (P = 0.005), left leg lean (P = 0.004) and right leg lean (P = 0.023) were observed. Overall, supplementation with BCAA and vitamin B6 could preserve legs lean and also attenuated waist to hip ratio.
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Rousseau M, Guénard F, Garneau V, Allam-Ndoul B, Lemieux S, Pérusse L, Vohl MC. Associations Between Dietary Protein Sources, Plasma BCAA and Short-Chain Acylcarnitine Levels in Adults. Nutrients 2019; 11:nu11010173. [PMID: 30650556 PMCID: PMC6356602 DOI: 10.3390/nu11010173] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 01/11/2023] Open
Abstract
Elevated plasma branched-chain amino acids (BCAA) and C3 and C5 acylcarnitines (AC) levels observed in individuals with insulin resistance (IR) might be influenced by dietary protein intakes. This study explores the associations between dietary protein sources, plasma BCAA levels and C3 and C5 ACs in normal weight (NW) or overweight (OW) individuals with or without metabolic syndrome (MS). Data from 199 men and women aged 18⁻55 years with complete metabolite profile were analyzed. Associations between metabolic parameters, protein sources, plasma BCAA and AC levels were tested. OW/MS+ consumed significantly more animal protein (p = 0.0388) and had higher plasma BCAA levels (p < 0.0001) than OW/MS- or NW/MS- individuals. Plasma BCAA levels were not associated with BCAA intakes in the whole cohort, while there was a trend for an association between plasma BCAA levels and red meat or with animal protein in OW/MS+. These associations were of weak magnitude. In NW/MS- individuals, the protein sources associated with BCAA levels varied greatly with adjustment for confounders. Plasma C3 and C5 ACs were associated with plasma BCAA levels in the whole cohort (p < 0.0001) and in subgroups based on OW and MS status. These results suggest a modest association of meat or animal protein intakes and an association of C3 and C5 ACs with plasma BCAA levels, obesity and MS.
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Affiliation(s)
- Michèle Rousseau
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, QC G1V 0A6, Canada.
- School of Nutrition, Laval University, Quebec City, QC G1V 0A6, Canada.
| | - Frédéric Guénard
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, QC G1V 0A6, Canada.
- School of Nutrition, Laval University, Quebec City, QC G1V 0A6, Canada.
| | - Véronique Garneau
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, QC G1V 0A6, Canada.
- School of Nutrition, Laval University, Quebec City, QC G1V 0A6, Canada.
| | - Bénédicte Allam-Ndoul
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, QC G1V 0A6, Canada.
- School of Nutrition, Laval University, Quebec City, QC G1V 0A6, Canada.
| | - Simone Lemieux
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, QC G1V 0A6, Canada.
- School of Nutrition, Laval University, Quebec City, QC G1V 0A6, Canada.
| | - Louis Pérusse
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, QC G1V 0A6, Canada.
- Department of Kinesiology, Laval University, Quebec City, QC G1V 0A6, Canada.
| | - Marie-Claude Vohl
- Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, QC G1V 0A6, Canada.
- School of Nutrition, Laval University, Quebec City, QC G1V 0A6, Canada.
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Okekunle AP, Wu X, Feng R, Li Y, Sun C. Higher intakes of energy-adjusted dietary amino acids are inversely associated with obesity risk. Amino Acids 2018; 51:373-382. [PMID: 30377838 DOI: 10.1007/s00726-018-2672-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022]
Abstract
We assessed the relationship between energy-adjusted amino acids (EAA) intakes and obesity risk using data on nutrient intakes derived from the Chinese food composition tables to determine dietary intakes (DI) among 1109 obese and 3009 normal weight subjects. Dietary patterns (DP) were identified using principal component analysis, multivariable-adjusted odds ratio (OR) and 95% confidence interval (CI) of obesity risk by quartiles of EAA intakes was estimated using logistic regression with two-sided P < 0.05. Multivariable-adjusted OR and 95% CI for obesity risk were 1.00, 0.801 (0.573, 1.119), 0.718 (0.504, 1.024) and 0.532 (0.353, 0.803) P-trend = 0.003 across energy-adjusted quartiles of total AA intakes. Similarly, higher DI of 13 AA; isoleucine, leucine, valine, lysine, cysteine, phenylalanine, tyrosine, threonine, histidine, aspartic acid, glutamic acid, proline, and serine were associated with lower risk of obesity. Furthermore, six DP; 'Wheaten food and Rice', 'Fruit, Vegetables and Milk', 'Snack, Beverage and Ice cream', 'Potatoes, Soybean & Egg', 'Livestock & Poultry meat' and 'Fish' were identified. Multivariable-adjusted OR and 95% CI across quartiles of DP adherence for obesity risk were 1.00, 0.737 (0.535, 1.017), 0.563 (0.406, 0.779), 0.724 (0.518, 1.011) P-trend = 0.018 for 'Fruit, Vegetables and Milk', 1.00, 0.734 (0.531, 1.013), 0.841(0.609, 1.161), 0.657 (0.478, 0.904) P-trend = 0.027 for 'Potatoes, Soybean & Egg' and 1.00, 1.106 (0.791, 1.548), 1.367(0.975, 1.917), 1.953 (1.399, 2.726) P-trend = 0.000 for 'Fish'. Additionally, lower adherence to 'Snack, Beverage and Ice cream' and 'Fish' patterns is associated with a protective higher AA intake-obesity risk relationship. Energy-adjusted AA intakes were inversely associated with obesity risk, but the associations appear modifiable by DP adherence of respondents.
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Affiliation(s)
- Akinkunmi Paul Okekunle
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Xiaoyan Wu
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Rennan Feng
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Ying Li
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang Province, People's Republic of China.
| | - Changhao Sun
- Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, Heilongjiang Province, People's Republic of China.
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Guevara-Cruz M, Vargas-Morales JM, Méndez-García AL, López-Barradas AM, Granados-Portillo O, Ordaz-Nava G, Rocha-Viggiano AK, Gutierrez-Leyte CA, Medina-Cerda E, Rosado JL, Morales JC, Torres N, Tovar AR, Noriega LG. Amino acid profiles of young adults differ by sex, body mass index and insulin resistance. Nutr Metab Cardiovasc Dis 2018; 28:393-401. [PMID: 29422298 DOI: 10.1016/j.numecd.2018.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS An increase in plasma branched-chain amino acids is associated with a higher risk of developing type 2 diabetes and cardiovascular diseases. However, little is known about the basal plasma amino acid concentrations in young adults. Our aim was to determine the plasma amino acid profiles of young adults and to evaluate how these profiles were modified by sex, body mass index (BMI) and insulin resistance (IR). METHODS AND RESULTS We performed a transversal study with 608 Mexican young adults aged 19.9 ± 2.4 years who were applicants to the Universidad Autónoma de San Luis Potosí. The subjects underwent a physical examination and provided a clinical history and a blood sample for biochemical, hormonal and amino acid analyses. The women had higher levels of arginine, aspartate and serine and lower levels of α-aminoadipic acid, cysteine, isoleucine, leucine, methionine, proline, tryptophan, tyrosine, urea and valine than the men. The obese subjects had higher levels of alanine, aspartate, cysteine, ornithine, phenylalanine, proline and tyrosine and lower levels of glycine, ornithine and serine than the normal weight subjects. Subjects with IR (defined as HOMA > 2.5) had higher levels of arginine, alanine, aspartate, isoleucine, leucine, phenylalanine, proline, tyrosine, taurine and valine than the subjects without IR. Furthermore, we identified two main groups in the subjects with obesity and/or IR; one group was composed of amino acids that positively correlated with the clinical, biochemical and hormonal parameters, whereas the second group exhibited negative correlations. CONCLUSION This study demonstrates that young adults with obesity or IR have altered amino acid profiles characterized by an increase in alanine, aspartate, proline and tyrosine and a decrease in glycine.
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Affiliation(s)
- M Guevara-Cruz
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - J M Vargas-Morales
- Facultad de Ciencias Química, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - A L Méndez-García
- Facultad de Enfermería, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - A M López-Barradas
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - O Granados-Portillo
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - G Ordaz-Nava
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - A K Rocha-Viggiano
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - C A Gutierrez-Leyte
- Departamento de Ciencia y Tecnología de Alimentos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - E Medina-Cerda
- Centro de Salud Universitario, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - J L Rosado
- Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Juriquilla, Querétaro, Mexico
| | - J C Morales
- Departamento de Ciencia y Tecnología de Alimentos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - N Torres
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - A R Tovar
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico.
| | - L G Noriega
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico.
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16
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Okekunle AP, Wu X, Duan W, Feng R, Li Y, Sun C. Dietary Intakes of Branched-Chained Amino Acid and Risk for Type 2 Diabetes in Adults: The Harbin Cohort Study on Diet, Nutrition and Chronic Non-Communicable Diseases Study. Can J Diabetes 2017; 42:484-492.e7. [PMID: 29625864 DOI: 10.1016/j.jcjd.2017.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 10/25/2017] [Accepted: 12/05/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To assess the association between branched-chain amino acid (BCAA) intakes and risk for type 2 diabetes. METHODS Dietary intakes were assessed in 1,804 people with type 2 diabetes and 7,020 controls with information on nutrient intakes, including BCAAs derived from Chinese food composition tables. Principal component analysis was used to identify dietary patterns (DPs) and multivariable-adjusted odds ratios (ORs) of type 2 diabetes, and 95% confidence intervals (CIs) by quartiles of BCAAs were estimated using logistic regression with 2-sided p<0.05. RESULTS Multivariable-adjusted ORs and 95% CI were 1.00, 1.297 (1.087 to 1.548), 1.380 (1.153 to 1.652) and 1.561 (1.291 to 1.888), p<0.0001, across energy-adjusted quartiles of total BCAA intakes. We identified 6 DPs: wheaten foods; vegetables, fruit and milk; beverages and snacks; potatoes, soybean and egg; meat; and fish. Multivariable-adjusted ORs and 95% CI across quartiles of total BCAA intakes for people with type 2 diabetes within the 4th quartile of DPs were 1.00, 1.337 (0.940 to 1.903); 1.579 (1.065 to 2.343); 2.412 (1.474 to 3.947); Pfor trend=0.001 for vegetables, fruit and milk, 1.00, 1.309 (0.930 to 1.842), 1.328 (0.888 to 1.985), 2.044 (1.179 to 3.544); Pfor trend=0.028 for meat and 1.00, 1.043 (0.720 to 1.509), 1.497 (0.969 to 2.312), 1.896 (1.067 to 3.367); Pfor trend=0.017 for fish. CONCLUSIONS BCAA intakes and type 2 diabetes risk depend on the context of DPs, not exclusively on BCAA intake.
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Affiliation(s)
- Akinkunmi Paul Okekunle
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Xiaoyan Wu
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Wei Duan
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Rennan Feng
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Ying Li
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China.
| | - Changhao Sun
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China.
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Lamming DW, Baar EL, Arriola Apelo SI, Tosti V, Fontana L. Short-term consumption of a plant protein diet does not improve glucose homeostasis of young C57BL/6J mice. ACTA ACUST UNITED AC 2017; 4:239-245. [PMID: 29276793 PMCID: PMC5734132 DOI: 10.3233/nha-170025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recently, it has become apparent that dietary macronutrient composition has a profound impact on metabolism, health and even lifespan. Work from many laboratories now suggest that dietary protein quality - the precise amino acid composition of the diet, as well as possibly the source of dietary protein - may also be critical in regulating the impact of diet on health. Perhaps in part due to the naturally low methionine content of plants, vegan diets are associated with a decreased risk of diabetes and improved insulin sensitivity, but this association is confounded by the lower overall protein intake of vegans. Here, we test the effect of consuming isocaloric rodent diets with similar amino acid profiles derived from either plant protein or dairy protein. We find that male C57BL/6J mice consuming either diet have similar glycemic control, as assessed by glucose, insulin, and pyruvate tolerance tests, and have similar overall body composition. We conclude that short-term feeding of plant protein has no positive or negative effect on the metabolic health of young male C57BL/6J mice, and suggest that dietary interventions that alter either dietary protein levels or the levels of specific essential amino acids are more likely to improve metabolic health than alterations in dietary protein source.
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Affiliation(s)
- Dudley W Lamming
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Emma L Baar
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Sebastian I Arriola Apelo
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Dairy Science, University of Wisconsin-Madison, Madison, WI, USA
| | - Valeria Tosti
- Department of Medicine, Washington University in St. Louis, MO, USA
| | - Luigi Fontana
- Department of Medicine, Washington University in St. Louis, MO, USA.,Department of Clinical and Experimental Science, Brescia University, Brescia, Italy.,CEINGE Biotecnologie Avanzate, Napoli, Italy
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