High intake of fruit and vegetables is related to low oxidative stress and inflammation in a group of patients with type 2 diabetes

The association of dietary total antioxidant capacity and gestational diabetes: a prospective cohort study from the Mothers and their children's health (MATCH)

BACKGROUND/OBJECTIVES

There is evidence to support the hypothesis that a diet rich in antioxidants can help safeguard against the development of gestational diabetes mellitus (GDM). This study aimed to investigate the association between dietary total antioxidant capacity (DTAC) during early pregnancy and the risk of GDM.

SUBJECTS/METHODS

We included 1856 pregnant women in their first trimester from the Mothers and their Children's Health (MATCH) prospective cohort study. Prepregnancy dietary intake was assessed using a validated food frequency questionnaire (FFQ) and was used to calculate the DTAC score. Incident GDM was diagnosed based on the American Diabetes Association criteria. We estimated the association between DTAC and GDM using propensity score-based inverse probability weighting (IPW).

RESULTS

Overall, 369 (14.6%) of the pregnant women were identified with GDM. The mean DTAC score and the corresponding standard deviation (SD) was 2.82± (2.56) mmol/100 g, with a range of 0.01 to 18.55. The adjusted risk of GDM decreased by 34% (95% CI = 10%, 52%, p = 0.023) for each DTAC score increase. The results showed that women in the highest quartile of DTAC had a lower risk of developing GDM compared to those in the lowest quartile (adjusted RR: 0.29, 95% CI: 0.12, 0.68, p = 0.005).

CONCLUSION

DTAC in early pregnancy is significantly associated with a lower risk of GDM. Additional larger cohort studies are needed to validate these findings.

Dietary Patterns and Hypothyroidism in U.S. Adult Population

The thyroid gland produces hormones that are essential for various body functions. Hypothyroidism is defined as insufficient thyroid hormone production. Several studies have found associations between specific micronutrients and overall thyroid function; however, the amount of evidence regarding the relationship between dietary patterns and hypothyroidism among the U.S. population is limited. Data from three cycles of National Health and Nutrition Examination Surveys (NHANES), 2007-2008, 2009-2010, and 2011-2012, were used (n = 8317). Subjects with serum thyroid stimulating hormone >4.5 mIU/L or on levothyroxine were considered to have hypothyroidism. Age, sex, race/ethnicity, body mass index, and several lifestyle factors were considered as covariates. Three patterns were extracted using factor analysis. These were labeled as fat-processed grains-sugars-meats (FPSM), oils-nuts-potatoes-low-fat meats (ONPL), and fruits-whole grains-vegetables-dairy (FWVD) patterns. In a weighted multiple logistic regression, FPSM and ONPL were inversely associated with hypothyroidism (OR, 0.75; 95% CI, 0.57-1; p = 0.049 and OR, 0.81; 95% CI, 0.67-0.97; p = 0.025, respectively). However, FWVD demonstrated no association with hypothyroidism (p = 0.63). In conclusion, FPSM and ONPL patterns but not FWVD patterns were associated with hypothyroidism in U.S. adults. Nutrient deficiencies and their interactions may be linked to hypothyroidism.

Carbon Dioxide (CO2) Dietary Emissions Are Related to Oxidative and Inflammatory Status in Adult Population

BACKGROUND

Carbon dioxide (CO2) is a primary greenhouse gas (GHG) causing global temperature to rise. Unsustainable diets induce an increment in the risk of obesity and noncommunicable diseases but also contribute to the global GSG burden.

OBJECTIVE

To assess whether CO2 dietary emissions influence the inflammatory and oxidative status of subjects with metabolic syndrome (MetS).

METHODS

As part of the PREDIMED-Plus study, 100 adults (55-75 years old) from the Balearic Islands, Spain, were recruited and classified according to their dietary CO2 emissions. Anthropometric parameters were determined, fasting blood samples were collected and plasma, neutrophils, and peripheral blood mononuclear cells (PBMCs) were obtained. Dietary inflammatory index (DII), adherence to a Mediterranean diet (ADM), fatty liver index (FLI), and estimated glomerular filtration (eGFR) were calculated. Clinical biochemical parameters, blood count, and oxidative stress and inflammatory biomarker levels were also determined.

RESULTS

DII was higher in participants with high dietary CO2 emissions. Adherence to the MedDiet was inversely associated with CO2 emissions. Malondialdehyde (MDA) levels were higher in urine and plasma samples from subjects with high dietary CO2 emissions. Reactive oxygen species (ROS) production by PBMCs was greater in participants with high CO2 emissions. Interleukin-15, resistin, and leptin plasma levels were increased in participants with high dietary CO2 emissions.

CONCLUSION

Dietary CO2 emissions influence oxidative status and inflammation in relation to the increased prooxidative and proinflammatory status in PBMCs and plasma. These biomarkers were useful for monitoring diet sustainability and health.

Detrimental Effects of Lipid Peroxidation in Type 2 Diabetes: Exploring the Neutralizing Influence of Antioxidants

Lipid peroxidation, including its prominent byproducts such as malondialdehyde (MDA) and 4-hydroxy-2-nonenal (4-HNE), has long been linked with worsened metabolic health in patients with type 2 diabetes (T2D). In fact, patients with T2D already display increased levels of lipids in circulation, including low-density lipoprotein-cholesterol and triglycerides, which are easily attacked by reactive oxygen molecules to give rise to lipid peroxidation. This process severely depletes intracellular antioxidants to cause excess generation of oxidative stress. This consequence mainly drives poor glycemic control and metabolic complications that are implicated in the development of cardiovascular disease. The current review explores the pathological relevance of elevated lipid peroxidation products in T2D, especially highlighting their potential role as biomarkers and therapeutic targets in disease severity. In addition, we briefly explain the implication of some prominent antioxidant enzymes/factors involved in the blockade of lipid peroxidation, including termination reactions that involve the effect of antioxidants, such as catalase, coenzyme Q₁₀, glutathione peroxidase, and superoxide dismutase, as well as vitamins C and E.

Lifestyle Changes Before and During the COVID-19 Pandemic in West Java Province, Indonesia

BACKGROUND: West Java is ranked 4th as the province with the highest number of COVID-19 cases in Indonesia up to December 1, 2020. The COVID-19 pandemic has a major impact on human health, lifestyle changes, and economic life. AIM: The purpose of this study was to analyze the impact of the COVID-19 pandemic on lifestyle changes among the community of West Java. METHODS: The study was conducted in September 2020 using a cross-sectional study design. A total of 2502 people aged ≥12 years living in West Java were involved in this study as a sample, willing to fill out a questionnaire in the form of a Google form that was distributed online through social media (WhatsApp, Facebook, and Instagram). RESULTS: The results showed that the COVID-19 pandemic had an effect on lifestyle changes in the people of West Java. During the COVID-19 pandemic, the people of West Java became more frequent to wash their hands, do regular exercise, sunbathe in the morning, consume more vegetables and fruits, and consume vitamins or supplements to increase endurance (p < 0.05). CONCLUSION: Based on the result, the community should continue to improve the COVID-19 prevention practices in breaking the chain of transmission.

Fresh fruit consumption, physical activity, and five-year risk of mortality among patients with type 2 diabetes: A prospective follow-up study

BACKGROUND AND AIMS

We explored the associations among fruit consumption, physical activity, and their dose-response relationship with all-cause and cardiovascular disease (CVD) mortality in type 2 diabetic patients.

METHODS AND RESULTS

We prospectively followed 20,340 community-dwelling type 2 diabetic patients aged 21-94 years. Information on diets and physical activity was collected using standardized questionnaires. All-cause and CVD mortality were assessed. Hazard ratios (HRs) for all-cause mortality were estimated with Cox regression models, and HRs for CVD mortality were derived from a competing risk model. Restricted cubic spline regression was used to analyze dose-response relationships. We identified 1362 deaths during 79,844 person-years. Compared to non-consumption, fruit consumption >42.9 g/d was inversely associated with all-cause mortality (HR 0.76; 95% CI 0.64-0.88), CVD mortality (HR 0.69, 0.51-0.94) and stroke mortality (HR 0.57, 0.36-0.89), but not with heart disease mortality (HR 0.93, 0.56-1.52). The HRs comparing the top vs bottom physical activity quartiles were 0.44 (0.37-0.53) for all-cause mortality, 0.46 (0.33-0.64) for CVD mortality, 0.46 (0.29-0.74) for stroke mortality and 0.51 (0.29-0.88) for heart disease mortality. Lower fruit consumption combined with a lower physical activity level was associated with a greater mortality risk. A nonlinear threshold of 80 g fruit/day was identified; all-cause mortality risk was reduced by approximately 24% at this value. A physical activity threshold of eight metabolic equivalents (MET) h/day was also identified, after which the risk of mortality did not decrease.

CONCLUSIONS

Fruit consumption and physical activity may reduce all-cause, CVD, and stroke mortality in type 2 diabetic patients.

Cardioprotective Role of Theobroma cacao against Isoproterenol-Induced Acute Myocardial Injury

BACKGROUND

Antioxidants are beneficial in myocardial infarction (MI). It is suggestive that Theobroma cacao (TC) with rich antioxidant properties can be of health benefits in myocardial injury.

AIM

The study investigated the effect of Theobroma cacao on cardioprotection in isoproterenol-induced myocardial infarction in rats.

MATERIAL AND METHODS

Male Wistar rats divided into four groups of 6 rats were used for the study. In group 1, 0.9% normal saline placebo was administered via oral gavage to the control. Group 2 was the MI induced group that was given 100 mg/kg body weight isoproterenol subcutaneously twice at an interval of 24 hours. Group 3 was administered TC for 2 weeks at 100 mg/kg bodyweight via the oral route. Group 4 was pretreated with TC (100 mg/kg) via oral route for 2 weeks, immediately followed by the administration of 100 mg/kg body weight isoproterenol subcutaneously twice at an interval of 24 hours. The rats were sacrificed using chloroform anesthesia, and blood samples collected via cardiac puncture. The serum was analyzed for troponin level, lactate dehydrogenase (LDH), and malondialdehyde (MDA) level.

RESULTS

The serum troponin, LDH, and MDA levels were found to be significantly (p<0.01) increased in the MI group compared with the control. Pretreatment with TC before MI induction significantly (p<0.01) prevented increased serum troponin, LDH, and MDA levels when compared with the MI group. There was also a significant (p<0.01) decrease in MDA in the TC group compared with the control.

CONCLUSION

These results suggest that Theobroma cacao protects against isoproterenol-induced myocardial injury, possibly by preventing oxidative stress and consequent lipid peroxidation.

Does Organic Sprouted Whole Wheat Grain Flourless Bread Decreases DNA Damage in Diabetic Patients?

Diabetes is one of the main health concerns, especially in developed countries. During the last few decades, the percentage of diabetic persons is constantly increasing. Although the genetic factors have a strong influence in the development of diabetes, environmental influence (physical inactivity, inadequate nutrition leading to obesity) also have an important impact. The main objective of this investigation was to evaluate the possible influence of organic sprouted whole wheat grain flourless bread Tonus® (product of Trivit, Becej, Serbia) on DNA damage at various stages of progression through type 2 diabetes mellitus (T2DM). In addition to control (non-diabetic) subjects we analyzed obese, pre-diabetic and diabetic patients, for a total of four experimental groups. All subjects used to eat Mediterranean diet for at least two years before being included in our study. In each of four groups we had five persons practicing the Mediterranean diet but instead of bread they consumed flourless bread Tonus®. The DNA damage was evaluated on peripheral blood mononuclear cells by alkaline single cell gel electrophoresis (Comet) assay at the very beginning (before starting the Tonus® bread diet), and after exactly the three months of consumption of Tonus® bread. Statistical analysis revealed that only in patients with type 2 diabetes, Tonus® bread intake led to decreased DNA damage compared to the level of DNA damage of these patients before they started Tonus® bread diet. We assume that decrease of body weight and hyperinsulinemia caused by Tonus® bread in the diet might be one of the main causes of decreased DNA damage.

The Effect of Lifestyle Intervention on Systemic Oxidative Stress in Women with Obesity and Infertility: A Post-Hoc Analysis of a Randomized Controlled Trial

We aimed to study whether lifestyle intervention could reduce systemic oxidative stress (OS) and the association between OS and cardiometabolic outcomes in women with obesity and infertility. From 2009 to 2012, infertile women with a BMI ≥ 29 kg/m² were randomly assigned to a six-month lifestyle intervention followed by infertility treatment (N = 289) or to prompt infertility treatment (N = 285). Fasting serum free thiols (FT) concentrations were determined by colorimetry at baseline, at three and six months after randomization. Generalized estimating equations and restricted cubic spline regressions were used to estimate mean differences in serum FT levels between groups and to explore associations between serum FT levels and cardiometabolic outcomes. Baseline serum FT levels did not differ between the two groups (N = 203 in the intervention group vs N = 226 in the control group, 222.1 ± 48.0 µM vs 229.9 ± 47.8 µM, p = 0.09). Body weight decreased by 3.70 kg in the intervention group compared with the control group at six months (95% confidence interval [CI]: −7.61 to 0.21, p = 0.06). No differences in serum FT levels were observed between groups at either three months (N = 142 vs N = 150, mean differences: −1.03 µM, 95% CI: −8.37 to 6.32, p = 0.78) or six months (N = 104 vs N = 96, mean differences: 2.19 µM, 95% CI: −5.90 to 10.28, p = 0.60). In a pooled analysis of all available measurements, triglycerides (crude B: 5.29, 95% CI: 1.08 to 9.50, p = 0.01), insulin (crude B: 0.62, 95% CI: 0.26 to 0.98, p = 0.001), and homeostasis model assessment of insulin resistance (crude B: 2.50, 95% CI: 1.16 to 3.38, p < 0.001) were positively associated with serum FT levels. High-sensitivity C-reactive protein (hs-CRP) was negatively associated with serum FT levels (crude B: −0.60, 95% CI: −1.11 to −0.10, p = 0.02). The change in hs-CRP during the lifestyle intervention was strongly and inversely associated with serum FT levels (crude B: −0.41, 95% CI: −0.70 to −0.13, p = 0.005). No significant deviations from linear associations were observed between serum FT and hs-CRP. We do not observe an improvement in systemic OS in women with obesity and infertility with modest weight loss. There were potential associations between OS and biomarkers of cardiometabolic health. Trial registration: This trial was registered on 16 November 2008 at the Dutch trial register (NTR1530).

Tomatoes consumed in-season prevent oxidative stress in Fischer 344 rats: impact of geographical origin

Tomatoes (Lycopersicon esculentum Mill.) constitute an important source of health-promoting compounds including bioactive antioxidants, such as flavonoids, that can differ in terms of composition and quantity depending on the conditions that tomatoes are cultivated. Otherwise, biological rhythms modulate oxidative stress. Therefore, the aim of this study was to evaluate the antioxidant properties of seasonally consumed tomatoes from two different geographical origins (local LT or non-local NLT) in Fischer 344 rats. The results show that LT and NLT have a specific phenolic signature and that each tomato gives a particular response toward biomarkers evaluated, which in turn showed a photoperiod-dependent effect. Remarkably, when tomatoes were administered in-season they improved or sustained antioxidant biomarkers, thus reducing oxidative stress values. It is noteworthy that the protective effect of tomatoes against oxidative stress depends on the geographical origin of the crop. Therefore, tomatoes consumed in-season may improve health by preventing oxidative stress.

Association between Dietary Inflammatory Index, Dietary Patterns, Plant-Based Dietary Index and the Risk of Obesity

Evidence on the association between various dietary constructs and obesity risk is limited. This study aims to investigate the longitudinal relationship between different diet indices and dietary patterns with the risk of obesity. Non-obese participants (n = 787) in the North West Adelaide Health Study were followed from 2010 to 2015. The dietary inflammatory index (DII^®), plant-based dietary index (PDI) and factor-derived dietary pattern scores were computed based on food frequency questionnaire data. We found the incidence of obesity was 7.62% at the 5-year follow up. In the adjusted model, results from multivariable log-binomial logistic regression showed that a prudent dietary pattern (RR_Q5 vs. _Q1 = 0.38; 95% CI: 0.15–0.96), healthy PDI (RR = 0.31; 95% CI: 0.12–0.77) and overall PDI (RR = 0.56; 95% CI: 0.23–1.33) were inversely associated with obesity risk. Conversely, the DII (RR = 1.59; 95% CI: 0.72–3.50), a Western dietary pattern (RR = 2.16; 95% CI: 0.76–6.08) and unhealthy PDI (RR = 1.94; 95% CI: 0.81–4.66) were associated with increased risk of obesity. Based on the cubic spline analysis, the association between an unhealthy PDI or diet quality with the risk of obesity was non-linear. In conclusion, an anti-inflammatory diet, healthy diet or consumption of healthy plant-based foods were all associated with a lower risk of developing obesity.

Strategies to Prevent or Remediate Cancer and Treatment-Related Aging

Up to 85% of adult cancer survivors and 99% of adult survivors of childhood cancer live with an accumulation of chronic conditions, frailty, and/or cognitive impairments resulting from cancer and its treatment. Thus, survivors often show an accelerated development of multiple geriatric syndromes and need therapeutic interventions. To advance progress in this area, the National Cancer Institute convened the second of 2 think tanks under the auspices of the Cancer and Accelerated Aging: Advancing Research for Healthy Survivors initiative. Experts assembled to share evidence of promising strategies to prevent, slow, or reverse the aging consequences of cancer and its treatment. The meeting identified research and resource needs, including geroscience-guided clinical trials; comprehensive assessments of functional, cognitive, and psychosocial vulnerabilities to assess and predict age-related outcomes; preclinical and clinical research to determine the optimal dosing for behavioral (eg, diet, exercise) and pharmacologic (eg, senolytic) therapies; health-care delivery research to evaluate the efficacy of integrated cancer care delivery models; optimization of intervention implementation, delivery, and uptake; and patient and provider education on cancer and treatment-related late and long-term adverse effects. Addressing these needs will expand knowledge of aging-related consequences of cancer and cancer treatment and inform strategies to promote healthy aging of cancer survivors.

The Potential Benefit of Monitoring Oxidative Stress and Inflammation in the Prevention of Non-Communicable Diseases (NCDs)

The significant increase in worldwide morbidity and mortality from non-communicable diseases (NCDs) indicates that the efficacy of existing strategies addressing this crisis may need improvement. Early identification of the metabolic irregularities associated with the disease process may be a key to developing early intervention strategies. Unhealthy lifestyle behaviours are well established drivers of the development of several NCDs, but the impact of such behaviours on health can vary considerably between individuals. How can it be determined if an individual's unique set of lifestyle behaviours is producing disease? Accumulating evidence suggests that lifestyle-associated activation of oxidative and inflammatory processes is primary driver of the cell and tissue damage which underpins the development of NCDs. However, the benefit of monitoring subclinical inflammation and oxidative activity has not yet been established. After reviewing relevant studies in this context, we suggest that quantification of oxidative stress and inflammatory biomarkers during the disease-free prodromal stage of NCD development may have clinical relevance as a timely indicator of the presence of subclinical metabolic changes, in the individual, portending the development of disease. Monitoring markers of oxidative and inflammatory activity may therefore enable earlier and more efficient strategies to both prevent NCD development and/or monitor the effectiveness of treatment.

The association of dietary inflammatory index with urinary risk factors of kidney stones formation in men with nephrolithiasis

Objective

Inflammation plays a leading role in the pathogenesis of nephrolithiasis. The association of the dietary inflammatory index (DII) with urinary lithogenic factors is unclear. This study aimed to evaluate the relation of DII to urinary risk factors of kidney stones formation.

Results

Of 264 participants, 61.4% (n = 162), 72% (n = 190), 74.6% (n = 197), 68.6% (n = 181), and 80.3% (n = 212) had hyperoxaluria, hypercreatininuria, hypercalciuria, hyperuricosuria, hypocitraturia, respectively. There was a significant increasing trajectory in urinary calcium, uric acid, and creatinine as well as a decreasing trend in urinary citrate across tertiles of DII score (all P = ≤0.001). After multivariate adjustment for energy intake, age, physical activity and body mass index, high DII scores were associated with elevated odds of having hypercreatininuria (OR = 2.80, 95%CI: 1.10–7.12, P_trend = 0.04), hypercalciuria (OR = 7.44, 95%CI: 2.62–21.14, P_trend ≤ 0.001), hyperuricosuria (OR = 2.22, 95%CI: 1.001–4.95, P_trend = 0.05), and hypocitraturia (OR = 5.84, 95%CI: 2.14–15.91, P_trend ≤ 0.001). No association was identified between DII and hyperoxaluria.

Anti-Inflammatory Strategies Targeting Metaflammation in Type 2 Diabetes

One of the concepts explaining the coincidence of obesity and type 2 diabetes (T2D) is the metaflammation theory. This chronic, low-grade inflammatory state originating from metabolic cells in response to excess nutrients, contributes to the development of T2D by increasing insulin resistance in peripheral tissues (mainly in the liver, muscles, and adipose tissue) and by targeting pancreatic islets and in this way impairing insulin secretion. Given the role of this not related to infection inflammation in the development of both: insulin resistance and insulitis, anti-inflammatory strategies could be helpful not only to control T2D symptoms but also to treat its causes. This review presents current concepts regarding the role of metaflammation in the development of T2D in obese individuals as well as data concerning possible application of different anti-inflammatory strategies (including lifestyle interventions, the extra-glycemic potential of classical antidiabetic compounds, nonsteroidal anti-inflammatory drugs, immunomodulatory therapies, and bariatric surgery) in the management of T2D.

Association of dietary intake of fruit and green vegetables with PTEN and P53 mRNA gene expression in visceral and subcutaneous adipose tissues of obese and non-obese adults

OBJECTIVE

The present study investigates the association of dietary intake of fruit and green Vegetables with PTEN and P53 mRNA gene expression in visceral (VAT) and subcutaneous adipose tissues (SAT) of obese and non-obese adults.

METHODS

VAT and SAT were obtained from 151 individuals, aged ~40 years, who had undergone elective abdominal surgery. The participants were grouped according to their body mass index (BMI), as obese (BMI > 30 kg/m²) and non-obese (BMI = 18.5-30 kg/m²). Dietary intakes were obtained using a valid and reliable food-frequency questionnaire (FFQ). Real-time PCR was carried out for PTEN and P53 mRNA expressions. Associations between expression levels and dietary parameters were analyzed.

RESULTS

P53 mRNA expression of obese participants was significantly higher than the non-obese, only in VAT (p < 0.001). After adjusting for total energy intake, age and BMI, fruit intake was inversely associated with P53 gene expression in both VAT (β = -0.38, P = 0.01) and SAT (β = -0.35, P = 0.03) among non-obese participants. Furthermore, fruit consumption was inversely associated with P53 gene expression in obese individuals, only in VAT (β = -0.21, P = 0.05). More so, intake of green vegetables in obese subjects was negatively associated with P53 gene expression in VAT (β = -0.27, P = 0.01) and SAT (β = -0.28, P < 0.001). On the other hand, after adjustment for total energy intake, age and BMI, a positive association was observed between fruit intake and PTEN in VAT (β = 0.27, P = 0.01) and SAT (β = 0.34, P < 0.001) among obese participants. In addition, dietary consumption of fruits in non-obese individuals was negatively associated withPTEN expression in SAT (β = -0.48, P < 0.001).

CONCLUSION

Dietary intake of fruit and green vegetables was associated with P53 gene expression in VAT and SAT of obese participants, suggesting their protective role in regulating P53 mRNA expression in adipose tissue. Furthermore, higher fruit intake was inversely associated with PTEN mRNA levels in non-obese participants, implying the anti-adipogenic role of PTEN gene expression.

Micronutrients and Oral Health an Opportunity to Prevent Oral Diseases

Nutrition plays an important role in oral health as it affects the growth of craniofacial, dental and periodontal structures. When adequate food is not unavailable, oral health may be impaired, and even overexposure to the diet may also inversely affect. Therefore, there is interdependency between nutrition and oral health. The importance of Micronutrients in normal function is becoming increasingly apparent and insufficient micronutrient intake has both short term and long-term consequences. Micronutrient assessment of suspected individual and appropriate supplement therapy may assist in dental disease prevention.

Sociodemographic and lifestyle factors associated with the neutrophil-to-lymphocyte ratio

PURPOSE

The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation with established prognostic value in patients with cancer. Although high NLR is associated with poorer clinical outcomes, factors that influence the magnitude of NLR independently of disease are poorly understood.

METHODS

We identified 48,023 adults who participated in the National Health and Nutrition Examination Survey (1999-2016). Demographic, socioeconomic, and lifestyle factors associated with the magnitude of NLR after adjusting for comorbidities including heart disease, cancer, diabetes, and hypertension, and medications including aspirin, were identified. Effect modification by comorbidity status and demographics was explored.

RESULTS

Female gender, age less than 60 years, and non-Hispanic black race/ethnicity were associated with lower NLR. Marital statuses of widowed, separated, or never married demonstrated increased NLR as compared with those who were currently married. Never-smoking and moderate alcohol consumption were associated with lower NLR. Participation in physical activity was associated with decreased NLR after adjustment for potential confounders, primarily among non-Hispanic whites.

CONCLUSIONS

Multiple demographic and lifestyle factors are independently associated with NLR. Sex, age, race, marital status, body mass index, physical activity, smoking history, and alcohol consumption should all be routinely collected and adjusted for to improve the accuracy of assessment of the prognostic power of NLR.

Strong adherence to dietary and lifestyle recommendations is associated with decreased type 2 diabetes risk in the AusDiab cohort study

We aimed to determine whether adherence to the Australian dietary guidelines and an index of healthy behavior was associated with a lower risk of type 2 diabetes (T2D) and to provide estimates of the proportion of preventable cases. Participants of the AusDiab cohort study were followed for 12 years (n = 6242), starting from May 1999, during which T2D cases were identified. The associations between T2D risk and a score of adherence to the dietary guidelines, its components, and a score of adherence to an index of healthy behaviors, (which included smoking, recreational physical activity, waist circumference and adherence to the dietary guidelines), were estimated using Cox proportional hazards ratios (HR) and 95% confidence intervals. The proportion of preventable cases was estimated using the population attributable fraction (PAF). Strong adherence to the dietary guidelines was not associated with T2D risk (HR = 0.64 [95% CI 0.39-1.06]), unless moderate alcohol consumption was considered as beneficial instead of no alcohol consumption (HR = 0.59 [0.36-0.96]). However, strong adherence to the guidelines regarding fruit and dairy intake were both associated with decreased risk of T2D (HR = 0.68 [0.51-0.91]; 0.56 [0.38-0.84], respectively) and could have prevented 23-37% of cases (PAF = 23.3% [7.3-38.2]; 37.1% [14.6-56.0], respectively). Strong adherence to the index of healthy behaviors was associated with decreased risk of T2D (HR = 0.30 [0.17-0.51]) and estimated to prevent almost 60% of T2D (PAF = 59.4% [34.3-76.6]). More than half of T2D cases could be preventable in Australia through modifying health behavior. These results could serve as a basis for prevention programs based on lifestyle modification.

Nutrition Risk is Associated with Leukocyte Telomere Length in Middle-Aged Men and Women with at Least One Risk Factor for Cardiovascular Disease

Poor diet quality has been associated with several age-related chronic conditions, but its relationship to telomere length, a biological marker of cellular aging, is unclear. The purpose of this cross-sectional study was to determine whether overall diet quality was associated with relative leukocyte telomere length (rLTL) in a sample (n = 96) of nonsmoking middle-aged adults in Appalachia with at least one risk factor for cardiovascular disease. Diet quality was assessed using the Healthy Eating Index (HEI-2015), the alternate Mediterranean diet score (aMed), and the Dietary Screening Tool (DST). Peripheral rLTL was measured by quantitative real-time polymerase chain reaction. The associations between potentially confounding sociodemographic, lifestyle and health-related factors and the first and fourth rLTL quartile groups were examined using Chi-square or Fisher’s Exact tests or logistic regression. The relationships between diet quality index scores and rLTL as a continuous variable were analyzed using simple linear regression and multivariate linear models, analogous to linear covariance analyses. The rLTL ranged from 0.46 to 1.49 (mean ± SEM was 1.02 ± 0.18). Smoking history, income level, and cardiovascular health (Life’s Simple 7) were associated with the lowest and highest quartiles of rLTL and were used as covariates. In adjusted and unadjusted models, participants considered “at nutrition risk” by the DST were more likely to have shorter rLTL than those “not at risk or at potential risk” (p = 0.004). However, there was no evidence that adherence to the 2015–2020 Dietary Guidelines for Americans or to a Mediterranean diet was associated with rLTL in this sample. Intervention studies are needed to determine if improving the diet quality of those at nutrition risk results in reduced telomere attrition over time.

Protective Effects of Tamarillo (Cyphomandra betacea) Extract against High Fat Diet Induced Obesity in Sprague-Dawley Rats

This study aims to investigate the protective effect of Cyphomandra betacea in adult male Sprague-Dawley rats fed with high fat diet. Rats were fed on either normal chow or high fat diet for 10 weeks for obesity induction phase and subsequently received C. betacea extract at low dose (150 mg kg(-1)), medium dose (200 mg kg(-1)), or high dose (300 mg kg(-1)) or placebo via oral gavages for another 7 weeks for treatment phase. Treatment of obese rats with C. betacea extracts led to a significant decrease in total cholesterol and significant increase in HDL-C (p < 0.05). Also there was a trend of positive reduction in blood glucose, triglyceride, and LDL-C with positive reduction of body weight detected in medium and high dosage of C. betacea extract. Interestingly, C. betacea treated rats showed positive improvement of superoxide dismutase (SOD) activity and glutathione peroxidase (GPx) activity along with a significant increase of total antioxidant status (TAS) (p < 0.05). Further, rats treated with C. betacea show significantly lower in TNF-α and IL-6 activities (p < 0.05). This study demonstrates the potential use of Cyphomandra betacea extract for weight maintenance and complimentary therapy to suppress some obesity complication signs.

Phenolic and flavonoid contents and anti-oxidative potential of epicarp and mesocarp of Lagenaria siceraria fruit: a comparative study

OBJECTIVE

To conduct a comparative analysis of the phenolic and flavonoid contents and anti-oxidative potential of epicarp and mesocarp of Lagenaria siceraria fruit.

METHODS

The dried methanolic extracts of mesocarp and epicarp of the fruit and their hexane, chloroform, ethyl acetate, n-butanolic and aqueous fractions were subjected to antioxidant assays including ferric reducing antioxidant potential, 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid, reducing power capacity, 2,2-diphenyl-1-picrylhydrazyl, lipid peroxidation inhibitory and phosphomolybdate assays. Total phenolic and flavonoid contents were also determined.

RESULTS

Ethyl acetate fractions of epicarp and mesocarp had considerable amounts of phenolics (243.50 and 109.50 μg/mL of gallic acid equivalents, respectively). 2,2-diphenyl-1-picrylhydrazyl radical scavenging activity of ethyl acetate fractions of both the plant parts showed higher activity than vitamin C with IC50 (0.75 and 3.91 mg, respectively). In phosphormolybdate assay, the hexane fractions of both the parts showed highest activity [1.16 and 2.99 μg/mL of ascorbic acid equivalents (AAE) for epicarp and mesocarp, respectively], mesocarp being much potent than epicarp. The n-butanolic fraction of mesocarp also showed much higher activity (1.13 μg/mL AAE) than that of epicarp (0.74 μg/mL AAE), while the chloroform and ethyl acetate fractions of epicarp were also considerably potent. In ferric reducing antioxidant potential assay, the chloroform fractions of both the fruit parts were most active. The hexane fractions of both the parts showed highest activity in reducing power assay, epicarp being more potent than mesocarp. In 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid assay, the antioxidant activities of ethyl acetate and chloroform fractions of both the parts were comparable to gallic acid and vitamin C. In lipid peroxidation inhibitory assay, all the samples were moderate to good activity sustainable over the period of 72 h, indicating the presence of both slow and fast releasing antioxidants.

CONCLUSIONS

The findings of the study suggest that epicarp is a better source of antioxidants than the mesocarp, and the ethyl acetate fractions of both the parts contain higher contents of antioxidants.

A randomised controlled trial of increasing fruit and vegetable intake and how this influences the carotenoid concentration and activities of PON-1 and LCAT in HDL from subjects with type 2 diabetes

Background

High density lipoproteins (HDL) have many cardioprotective roles; however, in subjects with type 2 diabetes (T2D) these cardioprotective properties are diminished. Conversely, increased fruit and vegetable (F&V) intake may reduce cardiovascular disease risk, although direct trial evidence of a mechanism by which this occurs in subjects with T2D is lacking. Therefore, the aim of this study was to examine if increased F&V consumption influenced the carotenoid content and enzymes associated with the antioxidant properties of HDL in subjects with T2D.

Methods

Eighty obese subjects with T2D were randomised to a 1- or ≥6-portion/day F&V diet for 8-weeks. Fasting serum was collected pre- and post-intervention. HDL was subfractionated into HDL₂ and HDL₃ by rapid ultracentrifugation. Carotenoids were measured in serum, HDL₂ and HDL₃ by high performance liquid chromatography. The activity of paraoxonase-1 (PON-1) was measured in serum, HDL₂ and HDL₃ by a spectrophotometric assay, while the activity of lecithin cholesterol acyltransferase (LCAT) was measured in serum, HDL₂ and HDL₃ by a fluorometric assay.

Results

In the ≥6- vs. 1-portion post-intervention comparisons, carotenoids increased in serum, HDL₂ and particularly HDL₃, (α-carotene, p = 0.008; β-cryptoxanthin, p = 0.042; lutein, p = 0.012; lycopene, p = 0.016), as did the activities of PON-1 and LCAT in HDL₃ (p = 0.006 and 0.044, respectively).

Conclusion

To our knowledge, this is the first study in subjects with T2D to demonstrate that increased F&V intake augmented the carotenoid content and influenced enzymes associated with the antioxidant properties of HDL. We suggest that these changes would enhance the cardioprotective properties of this lipoprotein.

Clinical trial registration

ISRCTN21676269

Effect of β-carotene on catechol-induced genotoxicity in vitro: evidence of both enhanced and reduced DNA damage

Intake of antioxidants from the diet has been recognized to have beneficial health effects, but the potential benefit of taking antioxidants such as β-carotene as supplements is controversial. The aim of the present study was to evaluate the potential protective effects of a physiologically relevant concentration (2 μM) of β-carotene on the DNA damaging effects of catechol in mouse lymphoma L5178Y cells. Two different exposure protocols were used: simultaneous exposure to β-carotene and catechol for 3 h; and exposure to catechol for 3 h after 18 h pre-treatment with the vitamin. DNA damage was evaluated using the comet assay (employing one procedure for general damage, and another procedure, which also included oxidative DNA damage). Independent of exposure protocol and procedure for comet assay, β-carotene did not increase the basal level of DNA damage. However, at the highest concentration of catechol (1 mM), β-carotene was found to clearly increase the level of catechol-induced DNA damage, especially in the pre-treated cells. Interestingly, an opposite effect was observed at lower concentrations of catechol, but the β-carotene related reduction of catechol-induced genotoxicity was significant (P < 0.05) only for the procedure including oxidative damage induced by 0.5 mM catechol. Taken together our results indicate that β- carotene can both reduce and enhance the DNA damaging effects of a genotoxic agent such as catechol. This indicates that it is the level of catechol-induced DNA damage that seems to determine whether β-carotene should be regarded as a beneficial or detrimental agent when it comes to its use as a dietary supplement.

Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases

EDITORIAL NOTE

This Cochrane Review has been superseded by a review entitled Vegan dietary pattern for the primary and secondary prevention of cardiovascular diseases (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013501.pub2/full) https://pubmed.ncbi.nlm.nih.gov/33629376/

BACKGROUND

There is increasing evidence that high consumption of fruit and vegetables is beneficial for cardiovascular disease (CVD) prevention.

OBJECTIVES

The primary objective is to determine the effectiveness of i) advice to increase fruit and vegetable consumption ii) the provision of fruit and vegetables to increase consumption, for the primary prevention of CVD.

SEARCH METHODS

We searched the following electronic databases: The Cochrane Library (2012, issue 9-CENTRAL, HTA, DARE, NEED), MEDLINE (1946 to week 3 September 2012); EMBASE (1980 to 2012 week 39) and the Conference Proceedings Citation Index - Science on ISI Web of Science (5 October 2012). We searched trial registers, screened reference lists and contacted authors for additional information where necessary. No language restrictions were applied.

SELECTION CRITERIA

Randomised controlled trials with at least three months follow-up (follow-up was considered to be the time elapsed since the start of the intervention) involving healthy adults or those at high risk of CVD. Trials investigated either advice to increase fruit and vegetable intake (via any source or modality) or the provision of fruit and vegetables to increase intake. The comparison group was no intervention or minimal intervention. Outcomes of interest were CVD clinical events (mortality (CVD and all-cause), myocardial infarction (MI), coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), angiographically-defined angina pectoris, stroke, carotid endarterectomy, peripheral arterial disease (PAD)) and major CVD risk factors (blood pressure, blood lipids, type 2 diabetes). Trials involving multifactorial lifestyle interventions (including different dietary patterns, exercise) or where the focus was weight loss were excluded to avoid confounding.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. Trials of provision of fruit and vegetables were analysed separately from trials of dietary advice.

MAIN RESULTS

We identified 10 trials with a total of 1730 participants randomised, and one ongoing trial. Six trials investigated the provision of fruit and vegetables, and four trials examined advice to increase fruit and vegetable consumption.The ongoing trial is examining the provision of an avocado-rich diet.The number and type of intervention components for provision, and the dietary advice provided differed between trials.None of the trials reported clinical events as they were all relatively short term. There was no strong evidence for effects of individual trials of provision of fruit and vegetables on cardiovascular risk factors, but trials were heterogeneous and short term. Furthermore, five of the six trials only provided one fruit or vegetable. Dietary advice showed some favourable effects on blood pressure (systolic blood pressure (SBP): mean difference (MD) -3.0 mmHg (95% confidence interval (CI) -4.92 to -1.09), diastolic blood pressure (DBP): MD -0.90 mmHg (95% CI -2.03 to 0.24)) and low-density lipoprotein (LDL) cholesterol but analyses were based on only two trials. Three of the 10 included trials examined adverse effects, which included increased bowel movements, bad breath and body odour.

AUTHORS' CONCLUSIONS

There are very few studies to date examining provision of, or advice to increase the consumption of, fruit and vegetables in the absence of additional dietary interventions or other lifestyle interventions for the primary prevention of CVD. The limited evidence suggests advice to increase fruit and vegetables as a single intervention has favourable effects on CVD risk factors but more trials are needed to confirm this.

Effect of daily supplementation of fruits on oxidative stress indices and glycaemic status in type 2 diabetes mellitus

This study sought to examine whether consumption of two low-calorie fruit/day for 3-months can effectively improve oxidative stress, anthropometry, blood pressure and glycaemic control in type 2 diabetes mellitus. Study involved 123 patients who were assigned to receive either standard care or with additional dietary therapy. Dietary intervention resulted in significant reduction in malondialdehyde, plasma glucose, glycated haemoglobin and improvement in antioxidants like vitamin C and reduced glutathione when compared to controls. Mean plasma levels of vitamin C increased by 64% (p < 0.001). There were no differences in waist circumference, waist-to-hip ratio, blood pressure, vitamin E and superoxide dismutase in the intervention group at follow-up. Diet rich in fruits can improve some antioxidants which are likely to reduce oxidative stress in type 2 diabetes. Regular consumption of fruits can lower the glycaemic status in these patients. The study supports the usefulness of plasma vitamin C as a biomarker for fruit intake.

Diet, inflammation, and glycemic control in type 2 diabetes: an integrative review of the literature

Type 2 diabetes (T2D) is a growing national health problem affecting 35% of adults ≥20 years of age in the United States. Recently, diabetes has been categorized as an inflammatory disease, sharing many of the adverse outcomes as those reported from cardiovascular disease. Medical nutrition therapy is recommended for the treatment of diabetes; however, these recommendations have not been updated to target the inflammatory component, which can be affected by diet and lifestyle. To assess the current state of evidence for which dietary programs contain the most anti-inflammatory and glycemic control properties for patients with T2D, we conducted an integrative review of the literature. A comprehensive search of the PubMed, CINAHL, Scopus, and Web of Science databases from January 2000 to May 2012 yielded 786 articles. The final 16 studies met the selection criteria including randomized control trials, quasiexperimental, or cross-sectional studies that compared varying diets and measured inflammatory markers. The Mediterranean and DASH diets along with several low-fat diets were associated with lower inflammatory markers. The Mediterranean diet demonstrated the most clinically significant reduction in glycosylated hemoglobin (HbA(1c)). Information on best dietary guidelines for inflammation and glycemic control in individuals with T2D is lacking. Continued research is warranted.

Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases

This is the protocol for a review and there is no abstract. The objectives are as follows: The primary objective is to determine the effectiveness of i) advice to increase fruit and vegetable consumption ii) the provision of fruit and vegetables to increase consumption, for the primary prevention of CVD.