Whole-grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study

Beneficial Effects of Synbiotics on the Gut Microbiome in Individuals with Low Fiber Intake: Secondary Analysis of a Double-Blind, Randomized Controlled Trial

Insufficient dietary fiber intake can negatively affect the intestinal microbiome and, over time, may result in gut dysbiosis, thus potentially harming overall health. This randomized controlled trial aimed to improve the gut microbiome of individuals with low dietary fiber intake (<25 g/day) during a 7-week synbiotic intervention. The metabolically healthy male participants (n = 117, 32 ± 10 y, BMI 25.66 ± 3.1 kg/m2) were divided into two groups: one receiving a synbiotic supplement (Biotic Junior, MensSana AG, Forchtenberg, Germany) and the other a placebo, without altering their dietary habits or physical activity. These groups were further stratified by their dietary fiber intake into a low fiber group (LFG) and a high fiber group (HFG). Stool samples for microbiome analysis were collected before and after intervention. Statistical analysis was performed using linear mixed effects and partial least squares models. At baseline, the microbiomes of the LFG and HFG were partially separated. After seven weeks of intervention, the abundance of SCFA-producing microbes significantly increased in the LFG, which is known to improve gut health; however, this effect was less pronounced in the HFG. Beneficial effects on the gut microbiome in participants with low fiber intake may be achieved using synbiotics, demonstrating the importance of personalized synbiotics.

Association of healthy eating index and anthropometric indices among primary school girls in southeast of Iran: a cross-sectional study

BACKGROUND

The school-age period is marked by substantial advancements in physical and cognitive development, highlighting the importance of assessing the diet quality and its impact on body weight and height. The main objective of this study was to evaluate the association between diet quality and selected anthropometric indices of primary school girls in southeast of Iran using the healthy eating index-2015 (HEI-2015).

METHODS

This cross-sectional study involved 330 students aged 6-12 years from 10 primary schools in Kerman City. Standard protocols and a dish-based food frequency questionnaire were employed to evaluate anthropometric indices and dietary intake. The HEI-2015 was utilized to assess the quality of participants' diets, with a total score ranging from zero to 100, based on thirteen food score components.

RESULTS

In the present study, older participants had higher HEI scores (p = 0.02). Additionally, participants in the highest tertile of HEI score had greaterodds of being overweight (OR: 2.13; CI = 1.17-3.85, P = 0.011) and had higher intakes of whole fruits, total fruits including fruit juice, whole grains, total protein foods, seafood and plant proteins, greens, and beans (p < 0.05). However, no significant association was found between HEI score and other anthropometric indices, obesity, and thinness.

CONCLUSIONS

The study found no significant association between HEI scores and the likelihood of being thin or obese. However, children with the highest HEI scores were more likely to beoverweight. Therefore, it is recommended to implement health programs for primary school girls in Kerman to improve their eating habits and reduce the risk of overweight and obesity.

Refined grain intake and cardiovascular disease: Meta-analyses of prospective cohort studies

Refined grains are included as part of an unhealthy, or Western, dietary pattern, which has been shown to be associated with increased risk of cardiovascular disease (CVD). To clarify the association between refined grain intake and CVD risk, Pubmed and Scopus databases were searched for relevant cohort studies from database inception to June 30, 2022. Only studies that examined refined grains as a distinct consumption category and not as part of a dietary pattern, were included. Meta-analyses were performed using Cochrane's RevMan 5.4.1 software, applying inverse variance risk ratios in random effects models for each outcome of interest. Heterogeneity was assessed with Cochrane's Q (chi2) and I2 statistics. Meta-analyses of hazard ratios (HR) and 95% confidence intervals (CI) obtained from 17 prospective cohort studies (>875,000 participants) indicated that refined grain intake was not associated with risk of CVD (HR = 1.08, 95% CI, 0.99-1.18, I2 = 70%; 9 cohorts), stroke (HR = 1.06, 95% CI 0.92-1.23, I2 = 70%; 9 cohorts), or heart failure (HR = 0.95, 95% CI 0.77-1.16, I2 = 10%; 5 cohorts). White rice intake was also not associated with risk of CVD (HR = 0.93, 95% CI 0.86-1.00, I2 = 25%; 7 cohorts) or stroke (HR = 1.03, 95% CI 0.93-1.14, I2 = 22%; 7 cohorts). No significant publication bias was evident (Egger's test P values all > 0.05). The lack of association between refined grain intake and CVD risk was observed in meta-analyses of studies that restricted analyses to only staple grain foods (e.g., bread, cereal, pasta, white rice), as well as for meta-analyses of studies that included both staple and indulgent grain foods (e.g., cakes, cookies, doughnuts, brownies, muffins, pastries). Probable confounding from unmeasured variables in studies included in the meta-analyses diminishes the overall quality of evidence. Although refined grains are included as a component of the Western dietary pattern, the results of the meta-analyses suggest that refined grains do not contribute to the higher CVD risk associated with this unhealthy dietary pattern. This information should be considered in formulation of future dietary recommendations.

Magnitude and predictors of pre-diabetes among adults in health facilities of Gondar city, Ethiopia: a cross-sectional study

Introduction

Impaired glucose tolerance currently affects 374 million (7.5%) people worldwide, and by 2030, this number is predicted to affect 454 million (8%). Urban inhabitants have an increased risk of developing pre-diabetes. Thus, the study aimed to assess the magnitude of pre-diabetes and associated factors among adults attending outpatient departments of the health facilities of Gondar, Ethiopia.

Method

From 3 March to 18 April 2020, an institution-based cross-sectional study was conducted. A systematic random sampling technique was used to select 992 participants. Data were gathered using an interviewer-administered questionnaire, and fasting blood glucose was assessed using capillary blood. Bivariable and multivariable binary logistic regression analyses were fitted to check the association between independent variables and pre-diabetes. Statistical significance was declared at a level of P of <0.05.

Results

The prevalence of pre-diabetes was 16.6% (95% CIs: 14.3-18.8%). Age [AOR = 3.66, 95% CIs (2.05, 6.52)], a family history of diabetes mellitus [AOR = 3.46, 95% CIs (2.16, 5.52)], waist circumference [AOR = 3.6, 95% CIs (2.26, 5.88)], physical activity [AOR: 5.02, 95% CIs (2.87, 8.77)], dietary diversity [AOR = 3.07, 95% CIs (1.95, 4.84)], and smoking [AOR = 2.9, 95% CI (1.42, 6.05)] were factors associated with pre-diabetes.

Conclusion

From our study, we can conclude that one in six adults in the health facilities have pre-diabetes. Age, family history of diabetes, waist circumference, physical activity, dietary diversity, and smoking were the factors associated with pre-diabetes. Therefore, it is recommended that adults should be educated on modifying their lifestyle, including their diet, and substantial care should be provided for older adults.

Prevalence and Factors Associated with Metabolic Syndrome among Non-Diabetic Saudi Adults: A Cross-Sectional Study

(1) Introduction: given the high prevalence of metabolic syndrome (MetS) in Saudi Arabia, especially in Jeddah, this study aims to understand the dietary and lifestyle-related risk factors among Jeddah's non-diabetic adults. (2) Material and Methods: Employing a cross-sectional design, non-diabetic adults were sourced from public healthcare centers. Demographics, lifestyle, and dietary habits were surveyed. Blood pressure, anthropometrics, and fasting blood samples measuring plasma glucose, serum triglycerides, and HDL cholesterol were collected. The age cut-off for MetS was ascertained using the receiver operating characteristic curve. Variables influencing MetS were evaluated using univariate logistic regression, and consequential factors underwent multivariate analysis, adjusted for age and sex. (3) Results: Among 1339 participants, 16% had MetS, with age being the strongest predictor (p < 0.001). The optimal age cut-off was 32 years. For those <32, elevated BP in men and waist circumference (WC) in women were most prevalent. For those >32, elevated WC was dominant in both sexes. Univariate logistic regression revealed that higher income and education correlated with lower MetS prevalence, while marriage and smoking were risk factors. Adjusting for age and sex, only very high income had a significant low-risk association (p = 0.034). (4) Conclusion: MetS is notable in the studied group, with age as the pivotal predictor. High income reduces MetS risk, while marital status and smoking could increase it. Since this was a cross-sectional study, cohort studies are needed to validate our findings.

Probing the potential of bioactive compounds of millets as an inhibitor for lifestyle diseases: molecular docking and simulation-based approach

Millets are becoming more popular as a healthy substitute for people with lifestyle disorders. They offer dietary fiber, polyphenols, fatty acids, minerals, vitamins, protein, and antioxidants. The nutritional importance of millets leads to the present in-silico study of selective bioactive compounds docked against the targets of lifestyle diseases, viz., diabetes, hypertension, and atherosclerosis using molecular docking and molecular simulations approach. Pharmacokinetic analysis was also carried out to analyse ADME properties and toxicity analysis, drug-likeliness, and finally target prediction for new targets for uncharacterized compounds or secondary targets for recognized molecules by Swiss Target Prediction was also done. The docking results revealed that the bioactive compound flavan-4-ol, among all the 50 compounds studied, best docked to all the four targets of lifestyle diseases, viz., Human dipeptidyl peptidase IV (-5.94 kcal mol-1 binding energy), Sodium-glucose cotransporter-2 (-6.49 kcal mol-1) diabetes-related enzyme, the Human angiotensin-converting enzyme (-6.31 kcal mol-1) which plays a significant role in hypertension, and Proprotein convertase subtilisin kexin type 9 (-4.67 kcal mol-1) for atherosclerosis. Molecular dynamics simulation analysis substantiates that the flavan-4-ol forms a better stability complex with all the targets. ADMET profiles further strengthened the candidature of the flavan-4-ol bioactive compound to be considered for trial as an inhibitor of targets DPPIV, SGLT2, PCSK9, and hACE. We suggest that more research be conducted, taking Flavon-4-ol into account where it can be used as standard treatment for lifestyle diseases.

High cereal fibre but not total fibre is associated with a lower risk of type 2 diabetes: Evidence from the Melbourne Collaborative Cohort Study

AIM

To assess the associations of total dietary fibre and fibre from different food sources (ie, cereal, fruit and vegetables) with the risk of diabetes.

MATERIALS AND METHODS

The Melbourne Collaborative Cohort Study enrolled 41 513 participants aged 40 to 69 years from 1990 to 1994. The first and second follow-ups were conducted in 1994 to 1998 and 2003 to 2007, respectively. Self-reported diabetes incidence was recorded at both follow-ups. We analysed data from 39 185 participants, with a mean follow-up of 13.8 years. The relationships between dietary fibre intake (total, fruit, vegetable and cereal fibre) and the incidence of diabetes were assessed using modified Poisson regression, adjusted for dietary, lifestyle, obesity, socioeconomic and other possible confounders. Fibre intake was categorized into quintiles.

RESULTS

At total of 1989 incident cases were identified over both follow-up surveys. Total fibre intake was not associated with diabetes risk. Higher intake of cereal fibre (P for trend = 0.003), but not fruit (P for trend = 0.3) and vegetable fibre (P for trend = 0.5), was protective against diabetes. For cereal fibre, quintile 5 versus quintile 1 showed a 25% reduction in diabetes risk (incidence risk ratio [IRR] 0.75, 95% confidence interval [CI] 0.63-0.88). For fruit fibre, only quintile 2 versus quintile 1 showed a 16% risk reduction (IRR 0.84, 95% CI 0.73-0.96). Adjustment for body mass index (BMI) and waist-to-hip ratio eliminated the association and mediation analysis showed that BMI mediated 36% of the relationship between fibre and diabetes.

CONCLUSION

Intake of cereal fibre and, to a lesser extent, fruit fibre, may reduce the risk of diabetes, while total fibre showed no association. Our data suggest that specific recommendations regarding dietary fibre intake may be needed to prevent diabetes.

Effects of Four Different Dietary Fibre Supplements on Weight Loss and Lipid and Glucose Serum Profiles during Energy Restriction in Patients with Traits of Metabolic Syndrome: A Comparative, Randomized, Placebo-Controlled Study

Obesity and its associated complications require various lifestyle changes and treatment options. Dietary supplements are considered an attractive alternative to traditional therapy, mainly because they are accessible to the general population. The aim of this study was to investigate the additive effects of a combination of energy restriction (ER) and four dietary supplements on changes in the anthropometric and biochemical parameters in 100 overweight or obese participants who were randomly assigned one of the dietary fibre supplements containing different dietary fibres or a placebo for 8 weeks. The results confirmed that fibre supplements plus ER significantly (p < 0.01) reduced the body weight, body mass index (BMI), fat mass, and visceral fat and ameliorated the lipid profile and inflammation at 4 and 8 weeks after the start of the study, while in the placebo group, significant differences in some parameters were observed only after 8 weeks of ER. A fibre supplement containing glucomannan, inulin, psyllium, and apple fibre was the most effective at reducing the BMI, body weight, and CRP (p = 0.018 for BMI and body weight and p = 0.034 for CRP compared to placebo at the end of the intervention). Overall, the results suggest that dietary fibre supplements in combination with ER may have additional effects on weight loss and the metabolic profile. Therefore, taking dietary fibre supplements may be a feasible approach to improve weight and metabolic health in obese and overweight individuals.

Influence of Comprehensive Lifestyle Intervention (LSI) Program on Health, Fatigue, and Quality of Life in Middle-Aged Women

Background

Middle age is one of the most important times in a woman's life, and it is a time when multiple changes occur that affect the body and health. The study aimed to investigate the efficacy of a comprehensive lifestyle intervention (LSI) program, including stress management, on middle-aged women's physical, physiological, and mental health.

Methods

A total of 40 middle-aged women participated in a short-term LSI program, nutrition, exercise, and mental and physical management with various experiential activities. Physical measurements, biochemical indicators, stress hormones, chronic fatigue, and quality of life indicators were evaluated to interpret the clinical efficacy of the program.

Results

LSI program significantly improved satisfaction and quality of life in participants. Total chronic fatigue scores reduced significantly compared to scores before the start of the program. Moreover, fat mass and body fat were reduced without loss of muscle mass. Further, blood pressure and triglyceride levels significantly decreased after completing the LSI program. However, changes in stress hormone levels remained insignificant.

Conclusion

Adoption of LSI in middle-aged women demonstrated positive implications of the program. LSI efficiently regulates body fat, fat mass, fatigue, hypertension, and triglyceride levels which play a critical role in determining the quality of life. Thus, the LSI program could spread healthy lifestyles among middle-aged women.

The Burden of Carbohydrates in Health and Disease

Foods high in carbohydrates are an important part of a healthy diet, since they provide the body with glucose to support bodily functions and physical activity. However, the abusive consumption of refined, simple, and low-quality carbohydrates has a direct implication on the physical and mental pathophysiology. Then, carbohydrate consumption is postulated as a crucial factor in the development of the main Western diseases of the 21st century. We conducted this narrative critical review using MedLine (Pubmed), Cochrane (Wiley), Embase, and CinAhl databases with the MeSH-compliant keywords: carbohydrates and evolution, development, phylogenetic, GUT, microbiota, stress, metabolic health, consumption behaviors, metabolic disease, cardiovascular disease, mental disease, anxiety, depression, cancer, chronic kidney failure, allergies, and asthma in order to analyze the impact of carbohydrates on health. Evidence suggests that carbohydrates, especially fiber, are beneficial for the well-being and growth of gut microorganisms and consequently for the host in this symbiotic relationship, producing microbial alterations a negative effect on mental health and different organic systems. In addition, evidence suggests a negative impact of simple carbohydrates and refined carbohydrates on mood categories, including alertness and tiredness, reinforcing a vicious circle. Regarding physical health, sugar intake can affect the development and prognosis of metabolic disease, as an uncontrolled intake of refined carbohydrates puts individuals at risk of developing metabolic syndrome and subsequently developing metabolic disease.

Consumption of sourdough bread and changes in the glycemic control and satiety: A systematic review

The aim of this study was to carry out a systematic review of clinical trials followed by meta-analysis, to evaluate the effect of sourdough bread on glycemic control and appetite and satiety regulators such as leptin, ghrelin, GLP-1 (glucagon-like peptide-1), GLP-2 (glucagon-like peptide-2), NPY (neuropeptide Y), AgRP (agouti-related protein), PYY (peptide YY), and GIP (glucose-dependent insulinotropic polypeptide). Clinical trials compared the intake of sourdough bread to that of an industrially fermented one or control glucose solution in adults over 18 years of age. This systematic review included all randomized, parallel, or crossover trials published up to June 2021 in the EMBASE, MEDLINE, Scopus, and Web of Science databases. After the selection process, 18 studies were included. The analysis of the final average difference of the change in serum glucose after 60 minutes for the intervention indicated that the consumption of sourdough bread has a lower impact on blood glucose compared to that of industrial bread or glucose (MD = -0.29, IC 95% = [-0.46; -0.12]; I2 = 0%). The evaluation of blood glucose 120 minutes after the consumption of the intervention also indicated a lower increment in blood glucose when compared to the consumption of other types of bread or the same amount of glucose (MD = -0.21, IC 95% = [-0.32; -0.09]; I2 = 0%). The certainty of evidence varied from low to very low. The results showed that sourdough is effective in reducing the increment of postprandial glycemia, especially when prepared with whole wheat flour, although it does not reduce fasting serum insulin, nor does it change plasma PYY.

The Isocaloric Substitution of Plant-Based and Animal-Based Protein in Relation to Aging-Related Health Outcomes: A Systematic Review

Plant-based and animal-based protein intake have differential effects on various aging-related health outcomes, but less is known about the health effect of isocaloric substitution of plant-based and animal-based protein. This systematic review summarized current evidence of the isocaloric substitutional effect of plant-based and animal-based protein on aging-related health outcomes. PubMed and Embase databases were searched for epidemiologic observational studies published in English up to 15 March 2021. Studies that included adults ≥18 years old; use of a nutritional substitution model to define isocaloric substitution of plant protein and animal protein; health outcomes covering mortality, aging-related diseases or indices; and reported association estimates with corresponding 95% confidence intervals were included. Nine cohort studies and 3 cross-sectional studies were identified, with a total of 1,450,178 subjects included in this review. Consistent and significant inverse association of substituting plant protein for various animal proteins on all-cause mortality was observed among 4 out of 5 studies with relative risks (RRs) from 0.54 to 0.95 and on cardiovascular disease (CVD) mortality among all 4 studies with RRs from 0.58 to 0.91. Among specific animal proteins, the strongest inverse association on all-cause and CVD mortality was identified when substituting plant protein for red and/or processed meat protein, with the effect mainly limited to bread, cereal, and pasta protein when replacing red meat protein. Isocaloric substitution of plant-based protein for animal-based protein might prevent all-cause and CVD-specific mortality. More studies are needed on this topic, particularly for cancer incidence and other specific aging-related diseases.

Association between Grain and Legume Consumption and the Risk of Coronary Artery Obstruction among Jordanians Based on Angiography Results

Accumulating evidence suggests that consumption of whole grains and legumes is associated with reduced risk of cardiovascular disease (CVD), whereas the risk is increased by consuming refined grains and cereals. This study aimed to investigate the association between grain and legume consumption and the risk of CVD. The study was conducted using a convenient sampling method with a total of 399 participants who underwent coronary angiography. Cases and controls were matched by age with a 1:1 ratio. Standardized and validated questionnaires were used to collect socio- demographic, health, lifestyle, and dietary data. Intake of more than 1 serving/d of white bread increased the risk of CVD significantly with an adjusted odds ratio (AOR) of 3.06 [95% confidence interval (CI): 1.37∼6.84], while consuming more than 1 serving/d of wholegrain bread reduced the risk significantly to approximately 53% (AOR: 0.47, 95% CI: 0.24∼0.93). Similar trends between consuming white bread on daily basis and increased risk of CVD, and consuming wholegrain bread and reduced risk of CVD were also observed. In addition, consuming unsweetened cornflakes on a weekly basis had a protective effect against CVD (AOR: 0.15, 95% CI: 0.03∼0.96). Intake of legumes reduced the risk of CVD, although only insignificantly for all the tested legumes. The present study calls for consideration of consuming wholegrain bread prevent CVD in the Jordanian population.

Defining whole-grain foods - does it change estimations of intakes and associations with CVD risk factors: an Australian and Swedish perspective

Historically, there are inconsistencies in the calculation of whole-grain intake, particularly through use of highly variable whole-grain food definitions. The current study aimed to determine the impact of using a whole-grain food definition on whole-grain intake estimation in Australian and Swedish national cohorts and investigate impacts on apparent associations with CVD risk factors. This utilised the Australian National Nutrition and Physical Activity Survey 2011-2012, the Swedish Riksmaten adults 2010-2011 and relevant food composition databases. Whole-grain intakes and associations with CVD risk factors were determined based on consumption of foods complying with the Healthgrain definition (≥30 % whole grain (dry weight), more whole than refined grain and meeting accepted standards for 'healthy foods' based on local regulations) and compared with absolute whole-grain intake. Compliance of whole-grain containing foods with the Healthgrain definition was low in both Sweden (twenty-nine of 155 foods) and Australia (214 of 609 foods). Significant mean differences of up to 24·6 g/10 MJ per d of whole-grain intake were highlighted using Swedish data. Despite these large differences, application of a whole-grain food definition altered very few associations with CVD risk factors, specifically, changes with body weight and blood glucose associations in Australian adults where a whole-grain food definition was applied, and some anthropometric measures in Swedish data where a high percentage of whole-grain content was included. Use of whole-grain food definitions appears to have limited impact on measuring whole-grain health benefits but may have greater relevance in public health messaging.

Circulating tryptophan metabolites and risk of colon cancer: Results from case-control and prospective cohort studies

Dysregulation of tryptophan metabolism has been linked to colorectal tumorigenesis; however, epidemiological studies investigating tryptophan metabolites in relation to colorectal cancer risk are limited. We studied associations of plasma tryptophan, serotonin and kynurenine with colon cancer risk in two studies with cancer patients and controls, and in one prospective cohort: ColoCare Study (110 patients/153 controls), the Colorectal Cancer Study of Austria (CORSA; 46 patients/390 controls) and the European Prospective Investigation into Cancer and Nutrition (EPIC; 456 matched case-control pairs). Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for colon cancer risk. Tryptophan was inversely associated with colon cancer risk in ColoCare (OR per 1-SD = 0.44; 95% CI, 0.31-0.64) and EPIC (OR per 1-SD = 0.86; 95% CI, 0.74-0.99). Comparing detectable vs nondetectable levels, serotonin was positively associated with colon cancer in CORSA (OR = 6.39; 95% CI, 3.61-11.3) and EPIC (OR = 2.03; 95% CI, 1.20-3.40). Kynurenine was inversely associated with colon cancer in ColoCare (OR per 1-SD = 0.74; 95% CI, 0.55-0.98), positively associated in CORSA (OR per 1-SD = 1.79; 95% CI, 1.27-2.52), while no association was observed in EPIC. The kynurenine-to-tryptophan ratio was positively associated with colon cancer in ColoCare (OR per 1-SD = 1.38; 95% CI, 1.03-1.84) and CORSA (OR per 1-SD = 1.44; 95% CI, 1.06-1.96), but not in EPIC. These results suggest that higher plasma tryptophan may be associated with lower colon cancer risk, while increased serotonin may be associated with a higher risk of colon cancer. The kynurenine-to-tryptophan ratio may also reflect altered tryptophan catabolism during colon cancer development.

Whole- and Refined-Grain Consumption and Longitudinal Changes in Cardiometabolic Risk Factors in the Framingham Offspring Cohort

BACKGROUND

Greater whole grain (WG) consumption is associated with reduced risk of cardiovascular disease (CVD); however, few prospective studies have examined WG or refined grain (RG) intake and intermediate cardiometabolic risk factors.

OBJECTIVES

We examined the longitudinal association between WG and RG intake on changes in waist circumference (WC); fasting HDL cholesterol, triglyceride, and glucose concentrations; and blood pressure.

METHODS

Subjects were participants in the Framingham Offspring cohort study [n = 3121; mean ± SD baseline age: 54.9 ± 0.2 y; BMI (kg/m2) 27.2 ± 0.1]. FFQ, health, and lifestyle data were collected approximately every 4 y over a median 18-y follow-up. Repeated measure mixed models were used to estimate adjusted mean changes per 4-y interval in risk factors across increasing categories of WG or RG intake.

RESULTS

Greater WG intake was associated with smaller increases in WC (1.4 ± 0.2 compared with 3.0 ± 0.1 cm in the highest compared with the lowest category, respectively; P-trend < 0.001), fasting glucose concentration (0.7 ± 0.4 compared with 2.6 ± 0.2 mg/dL; P-trend < 0.001), and systolic blood pressure (SBP; 0.2 ± 0.5 compared with 1.4 ± 0.3 mm Hg; P-trend < 0.001) per 4-y interval. When stratified by sex, a stronger association with WC was observed among females than males. Higher intake of WG was associated with greater increases in HDL cholesterol and declines in triglyceride concentrations; however, these differences did not remain significant after adjustment for change in WC. Conversely, greater RG intake was associated with greater increases in WC (2.7 ± 0.2 compared with 1.8 ± 0.1 cm, P-trend < 0.001) and less decline in triglyceride concentration (-0.3 ± 1.3 compared with -7.0 ± 0.7 mg/dL, P-trend < 0.001).

CONCLUSIONS

Among middle- to older-age adults, replacing RG with WG may be an effective dietary modification to attenuate abdominal adiposity, dyslipidemia, and hyperglycemia over time, thereby reducing the risk of cardiometabolic diseases.

PROTOCOL: The association between whole-grain dietary intake and noncommunicable diseases: A systematic review and meta-analysis

Our primary research questions are: (1) What is the association between whole grains (WG) intake and the prevalence of NCDs (i.e., type 2 diabetes, cardiovascular disease, obesity, cancer, mortality) and their biomarkers? (2) Which biomarker(s) has/have the greatest association with WG intake when combining multiple biomarkers together in the same analysis? Our secondary research question is: (3) Are there dose-response relationships between WG intake and biomarkers and prevalence of NCDs which could help inform a universal recommendation for WG intake?

Physicochemical Properties and Drivers of Liking and Disliking for Cooked Rice Containing Various Types of Processed Whole Wheat

For utilization of whole wheat (WW) in cooked rice products, WW was processed by four different methods (steeping (S_WW), milling (M_WW), enzymatic treatment (E_WW), and passing through a roll mill (1 mm) (R_WW)). Additionally, the physicochemical properties of cooked rice containing various processed wheat were investigated. The hardness of the cooked rice decreased significantly with R_WW and E_WW compared to WW. As a result of a consumer acceptance test, the cooked rice samples containing M_WW and E_WW with high liking scores frequently included 'chewiness' as a reason for liking, and the cooked rice with WW and S_WW was mentioned as being 'too hard' as a reason for disliking. The cooked rice with R_WW, which had the lowest liking score, was mentioned as having appearance characteristics such as 'husk', 'clumpy appearance', and 'messy appearance' as reasons for disliking. The overall results of this study suggest the inclusion of M_WW or E_WW with cooked rice considering health-related benefits and consumer acceptability.

Implementation of Christian Orthodox fasting improves plasma adiponectin concentrations compared with time-restricted eating in overweight premenopausal women

The exact mechanisms mediating the metabolic effects of Orthodox fasting remain unclear. Plasma adiponectin, biochemical and anthropometrical data were evaluated in 55 Orthodox fasters (OF) and 42 time-restricted eating controls (all women, mean age 47.8 years) at three time points: baseline, end of the dietary intervention (7 weeks) and 5 weeks after participants returned to their typical dietary habits (12 weeks from baseline). In the OF group, there was an increase in adiponectin values at 12 weeks compared with baseline (9815.99 vs 8983.52 mg/ml, p = 0.02) and a reduction in body fat mass between baseline and 12 weeks (35.44 vs 32.17%, p = 0.004) and between 7 and 12 weeks (35.33 vs 32.17%, p = 0.003). In the same group, an inverse correlation between adiponectin and waist circumference values was observed over the entire study period. Our results provide novel evidence that Orthodox fasting has favourable metabolic effects related to improved adiponectin concentrations.

Reference values for intake of six types of soluble and insoluble fibre in healthy UK inhabitants based on the UK Biobank data

OBJECTIVE

To obtain a set of reference values for the intake of different types of dietary fibre in a healthy UK population.

DESIGN

This descriptive cross-sectional study used the UK Biobank data to estimate the dietary patterns of healthy individuals. Data on fibre content in different foods were used to calculate the reference values which were then calibrated using real-world data on total fibre intake.

SETTING

UK Biobank is a prospective cohort study of over 500 000 individuals from across the United Kingdom with the participants aged between 40 and 69 years.

PARTICIPANTS

UK Biobank contains information on over 500 000 participants. This study was performed using the data on 19 990 individuals (6941 men, 13 049 women) who passed stringent quality control and filtering procedures and had reported above-zero intake of the analysed foods.

RESULTS

A set of reference values for the intake of six different types of soluble and insoluble fibres (cellulose, hemicelluloses, pectin and lignin), including the corresponding totals, was developed and calibrated using real-world data.

CONCLUSIONS

To our knowledge, this is the first study to establish specific reference values for the intake of different types of dietary fibre. It is well known that effects exerted by different types of fibre both directly and through modulation of microbiota are numerous. Conceivably, a deficit or excess intake of specific types of dietary fibre may detrimentally affect human health. Filling this knowledge gap opens new avenues for research in discussion in studies of nutrition and microbiota and offers valuable tools for practitioners worldwide.

Avenanthramide Metabotype from Whole-Grain Oat Intake is Influenced by Faecalibacterium prausnitzii in Healthy Adults

BACKGROUND

Oat has been widely accepted as a key food for human health. It is becoming increasingly evident that individual differences in metabolism determine how different individuals benefit from diet. Both host genetics and the gut microbiota play important roles on the metabolism and function of dietary compounds.

OBJECTIVES

To investigate the mechanism of individual variations in response to whole-grain (WG) oat intake.

METHODS

We used the combination of in vitro incubation assays with human gut microbiota, mouse and human S9 fractions, chemical analyses, germ-free (GF) mice, 16S rRNA sequencing, gnotobiotic techniques, and a human feeding study.

RESULTS

Avenanthramides (AVAs), the signature bioactive polyphenols of WG oat, were not metabolized into their dihydro forms, dihydro-AVAs (DH-AVAs), by both human and mouse S9 fractions. DH-AVAs were detected in the colon and the distal regions but not in the proximal and middle regions of the perfused mouse intestine, and were in specific pathogen-free (SPF) mice but not in GF mice. A kinetic study of humans fed oat bran showed that DH-AVAs reached their maximal concentrations at much later time points than their corresponding AVAs (10.0-15.0 hours vs. 4.0-4.5 hours, respectively). We observed interindividual variations in the metabolism of AVAs to DH-AVAs in humans. Faecalibacterium prausnitzii was identified as the individual bacterium to metabolize AVAs to DH-AVAs by 16S rRNA sequencing analysis. Moreover, as opposed to GF mice, F. prausnitzii-monocolonized mice were able to metabolize AVAs to DH-AVAs.

CONCLUSIONS

These findings demonstrate that the presence of intestinal F. prausnitzii is indispensable for proper metabolism of AVAs in both humans and mice. We propose that the abundance of F. prausnitzii can be used to subcategorize individuals into AVA metabolizers and nonmetabolizers after WG oat intake. This study was registered at clinicaltrials.gov as NCT04335435.

Polyphenols Rich Diets and Risk of Type 2 Diabetes

Type 2 diabetes is an increasing health concern worldwide. Both genetic and environmental risk factors as improper dietary habits or physical inactivity are known to be crucial in the pathogenesis of type 2 diabetes. Polyphenols are a group of plant-derived compounds with anti-inflammatory and antioxidant properties that are associated with a low prevalence of metabolic conditions characterized by insulin resistance, including obesity, diabetes, and hypertension. Moreover, there is now full awareness that foods that are rich in phytochemicals and polyphenols could play an important role in preserving human cardiovascular health and substantial clinical evidence indicates that regular dietary consumption of such foods affects favorably carbohydrate metabolism. This review briefly summarizes the evidence relating dietary patterns rich in polyphenols with glucose metabolism and highlights the potential benefits of these compounds in the prevention of type 2 diabetes.

Low Dietary Magnesium and Overweight/Obesity in a Mediterranean Population: A Detrimental Synergy for the Development of Hypertension. The SUN Project

Hypertension is the strongest independent modifiable risk factor for cardiovascular disease. We aimed to investigate the association of magnesium intake with incident hypertension in a Mediterranean population, and the potential modification of this association by body mass index BMI. We assessed 14,057 participants of the SUN (Seguimiento Universidad de Navarra) prospective cohort (67.0% women) initially free of hypertension. At baseline, a validated 136-item food frequency questionnaire was administered. We used Cox models adjusted for multiple socio-demographic, anthropometric, and lifestyle factors, and prevalent conditions present at baseline. Among a mean 9.6 years of follow-up we observed 1406 incident cases of medically diagnosed hypertension. An inverse association in multivariable-adjusted models was observed for progressively higher magnesium intake up to 500 mg/d vs. intake < 200 mg/d, which was greater among those with a BMI > 27 kg/m². Lean participants with magnesium intake < 200 mg/d vs. >200 mg/d also had a higher risk of incident hypertension. Adherence to the Mediterranean diet did not modify these associations. In conclusion, dietary magnesium intake < 200 mg/d was independently associated with a higher risk of developing hypertension in a Mediterranean cohort, stronger for overweight/obese participants. Our results emphasize the importance of encouraging the consumption of magnesium-rich foods (vegetables, nuts, whole cereals, legumes) in order to prevent hypertension.

Differences in Capacity of High-Amylose Resistant Starch, Whole-Grain Flour, and a Combination of Both to Modify Intestinal Responses of Male Sprague Dawley Rats Fed Moderate and High Fat Diets

Gastrointestinal tract (GIT) responses to a high-amylose resistant starch (RS) product were compared to those observed when RS was combined with whole grain (WG) and to controls with low RS intake in rats fed moderate or high fat diets. Regardless of fat intake, rats fed RS or WG + RS diets had higher cecum weights, higher intestinal quantities of short chain fatty acids, and lower intestinal content pH, and their GIT cells had increased gene expression for gluconeogenesis and barrier function compared to controls. Whereas RS resulted in greater GIT content acetate and propionate and lowest pH, the WG + RS diets yielded higher butyrate. Rats fed the RS diet with MF had higher cecum weights than those fed either the RS diet with HF or the WG + RS diet with either MF or HF. Diets containing combinations of RS and other dietary fibers should be considered for RS-mediated GIT benefits.

Inverse association of improved adherence to dietary guidelines with metabolic syndrome: the Seoul Metabolic Syndrome Management program

BACKGROUND/OBJECTIVES

The Seoul Metabolic Syndrome Management (SMESY) program is a 1-yr lifestyle modification program targeting metabolic syndrome (MetS) in Seoul residents. This study investigated the associations between adherence to dietary guidelines and MetS among the SMESY program participants.

SUBJECTS/METHODS

Data of 54,385 participants aged 20–64 yrs who completed the SMESY program in 2015, had information on adherence to dietary guidelines, and were not medicated for diabetes, hypertension, or dyslipidemia were analyzed. Participants underwent MetS screening and completed a lifestyle questionnaire including adherence to 10 dietary guidelines before and after participation. Participants were classified according to the number of MetS risk factors at baseline (MetS group, ≥ 3; risk group, 1–2; healthy group, none). Adherence to dietary guidelines was determined from the number of “yes” responses regarding the fulfillment of each guideline on ≥ 5 days/week. Multiple logistic regression was used to evaluate associations between newly diagnosed MetS and changes in adherence to dietary guidelines.

RESULTS

In the MetS group, MetS prevalence decreased after the SMESY program (men, −41.9%p; women, −48.7%p), and all risk factors were significantly improved (P < 0.0001). All groups exhibited improved adherence to all dietary guidelines after participation (P < 0.0001). In the MetS group with positively changed adherence scores, the MetS prevalence decreased by −44.1%p for men and −49.5%p for women, whereas the prevalence in those with negative changes decreased by −38.1%p for men and −48.6%p for women. In the risk group, those with positively changed adherence scores had significantly decreased odds ratios (ORs) for newly diagnosed MetS compared with those with negative changes (OR, 0.70; 95% confidence interval [CI], 0.61–0.80 for men; OR, 0.88; 95% CI, 0.79–0.99 for women).

CONCLUSIONS

The SMESY program may effectively reduce the risk of MetS among adults with risk factors by improving adherence to dietary guidelines.

Whole Grain Food Definition Effects on Determining Associations of Whole Grain Intake and Body Weight Changes: A Systematic Review

Within epidemiological and intervention studies, whole grain consumption has generally shown positive associations with reductions in markers of overweight and obesity. However, studies use varied methods of determining whole grain intake, including different definitions of a whole grain food, which may explain varied results. This systematic review aimed to identify how different methods of reporting and calculating whole grain intake, including whole grain food definitions, affect reported associations between whole grain intake and body weight measures in adults. Systematic searching of PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register for Controlled Trials (CENTRAL), and MEDLINE (all years to 11 June, 2020) identified eligible studies. Cohort and cross-sectional studies assessing whole grain intake and body weight measures in adults were included. Studies that did not specify methods used to calculate whole grain intake were excluded. Twenty-one cross-sectional studies (from 24 articles) and 9 prospective cohort studies (from 7 articles) were included in the review. Many cross-sectional studies showed whole grain intake was, to some degree, significantly associated with body weight measures, whereas associations varied greatly among cohort studies. Studies calculating whole grain intake using total grams of intake, USDA databases, or ≥25% whole grain in combination with listing specific foods, showed consistent beneficial effects of increasing whole grain intake on body weight. Studies with general lists of foods included as "whole grain foods" or lower cut-offs for whole grain content were inconsistent. The majority of studies reported whole grain intake as servings/day or grams whole grain/day. This review suggests that an association between whole grain and body weight measures remains likely, although precise associations are difficult to determine due to heterogeneity in methodologies and an inability to formally compare studies. Moving forward, application of a standardized methodology to calculate whole grain intake is essential.

Human clinical trial to assess the effect of consumption of multigrain Indian bread on glycemic regulation in type 2 diabetic participants

The efficacy of multigrain flatbread in regulating the lipid profile and carbohydrate homeostasis among type 2 diabetic patients was studied in 100 type 2 diabetic participants. The results revealed that the anthropometric parameters remained unaltered in both test and control groups. The fasting blood glucose levels (140.70 ± 8.43 versus 132.89 ± 5.63 mg/dl) did not significantly decrease. In contrast, the insulin levels (12.96 ± 1.06 versus 10.83 ± 1.03 μIU/ml) and HbA1c levels (8.01 ± 0.27 versus 7.40 ± 0.21%) in the test group decreased significantly, and it was associated with a decrease in insulin resistance. The LDL levels in the test group decreased after the intervention (116.0 ± 5.67 versus 98.7 ± 5.68 mg/dl), while triglycerides and VLDL increased significantly and HDL levels remained unaltered. A significant decrease in average blood pressure (systolic/diastolic) was noticed among the test group participants. The human RBP4 and hs-CRP remained unaltered. PRACTICAL APPLICATIONS: Millets are rich in fibers, has complex carbohydrate, protein, and is lower in fat content. Millets provide a wide range of nutrients, phytochemicals, and are gluten-free with low glycemic nature. Their intake can reduce factors such as insulin resistance and oxidative stress responsible for the pathogenesis of type 2 diabetes and cardiovascular diseases. Our study indicated the use of multigrain flatbreads prepared from millets helped reduce serum insulin, LDL cholesterol, HbA1c levels, and incidentally blood pressure levels with a significant increase in insulin sensitivity in type 2 diabetes participants. The results suggest using the multigrain flatbread meal as a food supplement or meal replacer in diabetic participants in terms of glucose control and insulin sensitivity.

Association Between Plant and Animal Protein Intake and Overall and Cause-Specific Mortality

IMPORTANCE

Although emphasis has recently been placed on the importance of high-protein diets to overall health, a comprehensive analysis of long-term cause-specific mortality in association with the intake of plant protein and animal protein has not been reported.

OBJECTIVE

To examine the associations between overall mortality and cause-specific mortality and plant protein intake.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study analyzed data from 416 104 men and women in the US National Institutes of Health-AARP Diet and Health Study from 1995 to 2011. Data were analyzed from October 2018 through April 2020.

EXPOSURES

Validated baseline food frequency questionnaire dietary information, including intake of plant protein and animal protein.

MAIN OUTCOMES AND MEASURES

Hazard ratios and 16-year absolute risk differences for overall mortality and cause-specific mortality.

RESULTS

The final analytic cohort included 237 036 men (57%) and 179 068 women. Their overall median (SD) ages were 62.2 (5.4) years for men and 62.0 (5.4) years for women. Based on 6 009 748 person-years of observation, 77 614 deaths (18.7%; 49 297 men and 28 317 women) were analyzed. Adjusting for several important clinical and other risk factors, greater dietary plant protein intake was associated with reduced overall mortality in both sexes (hazard ratio per 1 SD was 0.95 [95% CI, 0.94-0.97] for men and 0.95 [95% CI, 0.93-0.96] for women; adjusted absolute risk difference per 1 SD was -0.36% [95% CI, -0.48% to -0.25%] for men and -0.33% [95% CI, -0.48% to -0.21%] for women; hazard ratio per 10 g/1000 kcal was 0.88 [95% CI, 0.84-0.91] for men and 0.86 [95% CI, 0.82-0.90] for women; adjusted absolute risk difference per 10 g/1000 kcal was -0.95% [95% CI, -1.3% to -0.68%] for men and -0.86% [95% CI, -1.3% to -0.55%] for women; all P < .001). The association between plant protein intake and overall mortality was similar across the subgroups of smoking status, diabetes, fruit consumption, vitamin supplement use, and self-reported health status. Replacement of 3% energy from animal protein with plant protein was inversely associated with overall mortality (risk decreased 10% in both men and women) and cardiovascular disease mortality (11% lower risk in men and 12% lower risk in women). In particular, the lower overall mortality was attributable primarily to substitution of plant protein for egg protein (24% lower risk in men and 21% lower risk in women) and red meat protein (13% lower risk in men and 15% lower risk in women).

CONCLUSIONS AND RELEVANCE

In this large prospective cohort, higher plant protein intake was associated with small reductions in risk of overall and cardiovascular disease mortality. Our findings provide evidence that dietary modification in choice of protein sources may influence health and longevity.

Effectiveness of probiotics, prebiotics, and prebiotic-like components in common functional foods

The bioactive ingredients in commonly consumed foods include, but are not limited to, prebiotics, prebiotic-like components, probiotics, and postbiotics. The bioactive ingredients in functional foods have also been associated with beneficial effects on human health. For example, they aid in shaping of gut microflora and promotion of immunity. These functional components also contribute in preventing serious diseases such as cardiovascular malfunction and tumorigenesis. However, the specific mechanisms of these positive influences on human health are still under investigation. In this review, we aim to emphasize the major contents of probiotics, prebiotics, and prebiotic-like components commonly found in consumable functional foods, and we present an overview of direct and indirect benefits they provide on human health. The major contributors are certain families of metabolites, specifically short-chain fatty acids and polyunsaturated fatty acids produced by probiotics, and prebiotics, or prebiotic-like components such as flavonoids, polyphenols, and vitamins that are found in functional foods. These functional ingredients in foods influence the gut microbiota by stimulating the growth of beneficial microbes and the production of beneficial metabolites that, in turn, have direct benefits to the host, while also providing protection from pathogens and maintaining a balanced gut ecosystem. The complex interactions that arise among functional food ingredients, human physiology, the gut microbiota, and their respective metabolic pathways have been found to minimize several factors that contribute to the incidence of chronic disease, such as inflammation oxidative stress.

Is frequency of potato and white rice consumption associated with cardiometabolic risk factors in children and adolescents: the CASPIAN-V study

Background

This study evaluated the association of frequency of potato and rice consumption with cardiometabolic risk factors in children and adolescents.

Methods

This nationwide cross-sectional survey was conducted on 14,400 children and adolescents. Fasting blood was obtained from a sub-sample of 4200 randomly selected students. Physical examination and laboratory tests were conducted under standard protocols. Metabolic Syndrome (Mets) was defined based on the Adult Treatment Panel III criteria modified for the pediatric age group. The self-reported frequency consumption of white rice and potato was reported on a daily or non-daily basis.

Results

The participation rate for the whole study and for blood sampling were 99 and 91.5%, respectively. Overall, 49.4% of the participants were girls while 50.6% were boys. The frequency of daily consumption of white rice and potato was 84.4 and 21.3%, respectively. In the multivariable linear regression model, daily consumption of potato increased body mass index (β: 0.05, SE: 0.20, p = 0.010), waist (β: 0.63, SE: 0.24, p = 0.008), and hip circumferences (β: 0.62, SE: 0.26, p = 0.019). Moreover, in the multivariable logistic regression, daily consumption of potato was significantly associated with an increased risk of overweight (OR: 1.21, 95% CI: 1.04–1.39, P = 0.012). The potato and rice consumption had no statistically significant association with other cardiometabolic risk factors.

Conclusions

Daily consumption of potato was significantly associated with higher anthropometric measures, whereas rice consumption had no statistically significant association with cardiometabolic risk factors. Future research to examine the possible obesogenic effects of intake of potato on children and adolescents is recommended.

Identification of Aroma Differences in Refined and Whole Grain Extruded Maize Puffs

Differences in the aroma profiles of extruded maize puffs made from refined grain and whole grain flour were investigated. Gas chromatography/mass spectrometry/olfactometry (GC/MS/O) analysis reported 13 aroma compounds with a flavor dilution (FD) value ≥16. Quantitative analysis identified eight compounds as statistically different, of which seven compounds were higher in concentration in the whole grain sample. Sensory recombination and descriptive analysis further supported the analytical data, with higher mean aroma intensities for cooked, corn chip, roasted, and toasted attributes for the whole grain sample. Generally, the compounds responsible for perceived differences in whole grain maize extruded puffs were associated with increased levels of Maillard reaction products, such as 2-ethyl-3,5-dimethylpyrazine and 2-acetyl-2-thiazoline.

Nutraceuticals and Pharmaceuticals

Aim. To provide a definition and classification of nutraceutical products and to show their significane in modern integrative medicine.

Background. Nutraceuticals are foodstuffs and their components, which have a positive effect on human health, including preventive maintenance and treatment of diseases. Nutraceuticals include healthy and functional foods, as well as biologically active food additives (BAFA). Healthy foods are nutritional foodstuffs without any artificial modification. These include organic, whole, and natural foods. Alongside a high nutritional value, functional food products have a positive effect on the human body due to functional food ingredients. BAFAs are food additives that contains one or several food ingredients (vitamins, mineral substances, plant components, amino acids and others). Specialists express conflicting viewpoints concerning nutraceuticals. Some nutraceuticals, such as probiotics, have confirmed their effectiveness in clinical trials, while the beneficial properties of others require further elucidation.

Conclusions. The application of nutraceuticals, as well as their combined use with pharmaceuticals, in accordance with recommendations by scientific professional associations formulated on the basis of valid research studies can lead to an improvement in the quality of the life and longevity of the population. This position forms a basis for the development of integrative medicine — a contemporary approach to the treatment of diseases.

Quantifying Diet Intake and Its Association with Cardiometabolic Risk in the UK Airwave Health Monitoring Study: A Data-Driven Approach

We used data-driven approaches to identify independent diet exposures among 45 candidate variables, for which we then probed cross-sectional associations with cardiometabolic risk (CMR). We derived average daily caloric intake and macronutrient composition, daily meal frequencies, and irregularity of energy and macronutrient intake from 7-day food diaries in the Airwave Health Monitoring Study participants (N = 8090). We used K-means and hierarchical clustering to identify non-redundant diet exposures with representative exposures for each cluster chosen by silhouette value. We then used multi-variable adjusted logistic regression to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI) for CMR (≥3 criteria: dyslipidemia, hypertension, central adiposity, inflammation and impaired glucose control) across diet exposure quartiles. We identified four clusters: i) fat intake, ii) carbohydrate intake, iii) protein intake and intake regularity, and iv) meal frequencies and energy intake. Of these clusters, higher carbohydrate intake was associated with lower likelihood of CMR (PR = 0.89, 95%CI = 0.81–0.98; p_trend = 0.02), as was higher fiber intake (PR = 0.76, 95%CI = 0.68–0.85; p_trend < 0.001). Higher meal frequency was also associated with lower likelihood of CMR (PR = 0.76, 95%CI = 0.68–0.85; p_trend < 0.001). Our results highlight a novel, data-driven approach to select non-redundant, minimally collinear, primary exposures across a host of potentially relevant exposures (including diet composition, temporal distribution, and regularity), as often encountered in nutritional epidemiology.

Development and Validation of a Questionnaire to Measure Adherence to the Mediterranean Diet in Korean Adults

The Mediterranean diet (MD) has beneficial effects on cardiovascular diseases, cancer, and mortality. Although various attempts have been made for estimating adherence to the MD using diet quality indices, few studies involving validated questionnaires for estimating adherence have been performed in Asian populations. We aimed to develop and validate the Korean version of the Mediterranean Diet Adherence Screener (K-MEDAS) by including 211 participants that visited health check-up centers and 116 participants with overweight or hypercholesterolemia that visited obesity clinic. The participants completed both the K-MEDAS and a 106-item food frequency questionnaire (FFQ). We translated 13 questions and developed 1 question. Considering the agreement between the K-MEDAS and FFQ, nine of the 14 questions showed moderate or high kappa values (≥0.4). The total MD scores measured by the K-MEDAS and FFQ showed substantial concordance (intraclass correlation coefficient = 0.678, 95% confidence interval: 0.520, 0.785). Multiple linear regression analyses revealed significant inverse associations between MD score and the levels of serum total cholesterol, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol, after adjusting for confounding variables. We found that K-MEDAS is valid tool for assessing adherence to the MD in the Korean population.

Whole grain and cereal fibre intake in the Australian Health Survey: associations to CVD risk factors

OBJECTIVE

To explore associations of whole grain and cereal fibre intake to CVD risk factors in Australian adults.

DESIGN

Cross-sectional analysis. Intakes of whole grain and cereal fibre were examined in association to BMI, waist circumference (WC), blood pressure (BP), serum lipid concentrations, C-reactive protein, systolic BP, fasting glucose and HbA1c.

SETTING

Australian Health Survey 2011-2013.

PARTICIPANTS

A population-representative sample of 7665 participants over 18 years old.

RESULTS

Highest whole grain consumers (T3) had lower BMI (T0 26·8 kg/m2, T3 26·0 kg/m2, P < 0·0001) and WC (T0 92·2 cm, T3 90·0 cm, P = 0·0005) compared with non-consumers (T0), although only WC remained significant after adjusting for dietary and lifestyle factors, including cereal fibre intake (P = 0·03). Whole grain intake was marginally inversely associated with fasting glucose (P = 0·048) and HbA1c (P = 0·03) after adjusting for dietary and lifestyle factors, including cereal fibre intake. Cereal fibre intake was inversely associated with BMI (P < 0·0001) and WC (P < 0·0008) and tended to be inversely associated with total cholesterol, LDL-cholesterol and apo-B concentrations, although associations were attenuated after further adjusting for BMI and lipid-lowering medication use.

CONCLUSIONS

The extent to which cereal fibre is responsible for the CVD-protective associations of whole grains may vary depending on the mediators involved. Longer-term intervention studies directly comparing whole grain and non-whole grain diets of similar cereal fibre contents (such as through the use of bran or added-fibre refined grain products) are needed to confirm independent effects.

Whole grain intake compared with cereal fibre intake in association to CVD risk factors: a cross-sectional analysis of the National Diet and Nutrition Survey (UK)

Objective:

To investigate how intakes of whole grains and cereal fibre were associated to risk factors for CVD in UK adults.

Design:

Cross-sectional analyses examined associations between whole grain and cereal fibre intakes and adiposity measurements, serum lipid concentrations, C-reactive protein, systolic blood pressure, fasting glucose, HbA1c, homocysteine and a combined CVD relative risk score.

Setting:

The National Diet and Nutrition Survey (NDNS) Rolling Programme 2008–2014.

Participants:

A nationally representative sample of 2689 adults.

Results:

Participants in the highest quartile (Q4) of whole grain intake had lower waist–hip ratio (Q1 0·872; Q4 0·857; P = 0·04), HbA1c (Q1 5·66 %; Q4 5·47 %; P = 0·01) and homocysteine (Q1 9·95 µmol/l; Q4 8·76 µmol/l; P = 0·01) compared with participants in the lowest quartile (Q1), after adjusting for dietary and lifestyle factors, including cereal fibre intake. Whole grain intake was inversely associated with C-reactive protein using multivariate analysis (P = 0·02), but this was not significant after final adjustment for cereal fibre. Cereal fibre intake was also inversely associated with waist–hip ratio (P = 0·03) and homocysteine (P = 0·002) in multivariate analysis.

Conclusions:

Similar inverse associations between whole grain and cereal fibre intakes to CVD risk factors suggest the relevance of cereal fibre in the protective effects of whole grains. However, whole grain associations often remained significant after adjusting for cereal fibre intake, suggesting additional constituents may be relevant. Intervention studies are needed to compare cereal fibre intake from non-whole grain sources to whole grain intake.

Whole grain food diet slightly reduces cardiovascular risks in obese/overweight adults: a systematic review and meta-analysis

BACKGROUND

The effects of whole grain diet on cardiovascular risks in obese and overweight adults is not well established. Our goal was to conduct a systematic review and meta-analysis on the effect of whole grain diet on cardiovascular risks in obese/overweight adults.

METHODS

PubMed, Embase and Cochrane were systematically scanned for randomized controlled trials (RCTs), and studies were selected based on certain inclusion and exclusion criteria. The primary outcome was the effectiveness of whole grain food consumption in reducing body weight. The secondary outcomes were the effect of whole grain food consumption on cardiovascular disease (CVD) risk factors including plasma low-density lipoprotein cholesterol (LDL-C), insulin resistance index, blood pressure, body mass index (BMI), C-reactive protein (CRP), and waist circumference in obese/overweight adults.

RESULTS

Our results showed that whole grain consumption was associated with lower body weight (mean difference (MD) = - 0.5, 95% confidence intervals (CI) [- 0.74, 0.25], I2 = 35%, P < 0.0001) and lower CRP (MD = -0.36, 95% CI [- 0.54, - 0.18], I2 = 69%, P < 0.0001), compared with the control group. However, there were no significant differences in LDL-C (MD = -0.08, 95% CI [- 0.16, 0.00], I2 = 27%, P = 0.05), waist circumference (MD = -0.12, 95% CI [- 0.92, 0.68], I2 = 44%, P = 0.76), systolic blood pressure (MD = -0.11, 95% CI [- 1.55, 1.33], I2 = 3%, P = 0.88), diastolic blood pressure (MD = -0.44, 95% CI [- 1.44, 0.57], I2 = 15%, P = 0.39), and fasting glucose (MD = -0.05, 95% CI [- 0.12, 0.01], I2 = 31%, P = 0.11) between the two groups.

CONCLUSION

This study suggests that whole grain food consumption can slightly reduce body weight and CRP in obese/overweight population.

The Effect of a Low GI Diet on Truncal Fat Mass and Glycated Hemoglobin in South Indians with Type 2 Diabetes-A Single Centre Randomized Prospective Study

Background: There has been no previous study that has investigated the effect of a low glycemic index (LGI) diet with local recipes of South Indian cuisine on the body fat composition using dual-energy X-ray absorptiometry (DXA). Truncal obesity has been associated with the risk of metabolic disorders and cardiovascular diseases. Aim: The aim of this study was to examine the effect of a low GI diet on glycemic control and body composition in people with type 2 diabetes in South India. Method: This was a prospective and randomized controlled study that was conducted over a period of 24 weeks. A total of 40 participants were recruited from the Department of Endocrinology and Diabetes Outpatient in Kerala, South India. All the patients had type 2 diabetes and were randomly assigned and given advice and instructions to follow either a low GI diet plan (n = 18) or their usual diet, which served as control (n = 18). The advice was reinforced throughout the study period. Dietary compliance was evaluated based on a 24 h dietary recall at weeks 3, 11, 12, 18, 23, and 24. The age of the subjects ranged from 35 to 65 years. Anthropometric, body composition, and cardio-metabolic parameters were measured according to standard procedures. T-tests were conducted to compare differences between intervention and control groups and the Pearson correlation coefficient was used to evaluate associations between the variables. Results: There were significant reductions (p < 0.05) in the low GI diet compared to the control group with respect to weight, body mass index (BMI), and triceps skinfold thickness. Similarly, significant reductions were observed in the low GI diet group with respect to region, total fat, android, and gynoid fat mass and the differences between the groups were significant at p < 0.05. There was also a positive correlation between BMI and android fat mass (r = 0.745), total fat mass (r = 0.661), total truncal mass (r = 0.821), and truncal fat (r = 0.707). There was a significant reduction in glycated hemoglobin in the low GI diet group compared to the control group at p < 0.05. Conclusion: This study has demonstrated that there was a significant reduction (p < 0.05) of truncal obesity and glycated hemoglobin in patients with type 2 diabetes on a local diet of South Indian cuisine with low GI compared with the control.

Whole Grain Wheat Consumption Affects Postprandial Inflammatory Response in a Randomized Controlled Trial in Overweight and Obese Adults with Mild Hypercholesterolemia in the Graandioos Study

BACKGROUND

Whole grain wheat (WGW) consumption is associated with health benefits in observational studies. However, WGW randomized controlled trial (RCT) studies show mixed effects.

OBJECTIVES

The health impact of WGW consumption was investigated by quantification of the body's resilience, which was defined as the "ability to adapt to a standardized challenge."

METHODS

A double-blind RCT was performed with overweight and obese (BMI: 25-35 kg/m2) men (n = 19) and postmenopausal women (n = 31) aged 45-70 y, with mildly elevated plasma total cholesterol (>5 mmol/L), who were randomly assigned to either 12-wk WGW (98 g/d) or refined wheat (RW). Before and after the intervention a standardized mixed-meal challenge was performed. Plasma samples were taken after overnight fasting and postprandially (30, 60, 120, and 240 min). Thirty-one biomarkers were quantified focusing on metabolism, liver, cardiovascular health, and inflammation. Linear mixed-models evaluated fasting compared with postprandial intervention effects. Health space models were used to evaluate intervention effects as composite markers representing resilience of inflammation, liver, and metabolism.

RESULTS

Postprandial biomarker changes related to liver showed decreased alanine aminotransferase by WGW (P = 0.03) and increased β-hydroxybutyrate (P = 0.001) response in RW. Postprandial changes related to inflammation showed increased C-reactive protein (P = 0.001), IL-6 (P = 0.02), IL-8 (P = 0.007), and decreased IL-1B (P = 0.0002) in RW and decreased C-reactive protein (P < 0.0001), serum amyloid A (P < 0.0001), IL-8 (P = 0.02), and IL-10 (P < 0.0001) in WGW. Health space visualization demonstrated diminished inflammatory (P < 0.01) and liver resilience (P < 0.01) by RW, whereas liver resilience was rejuvenated by WGW (P < 0.05).

CONCLUSIONS

Twelve-week 98 g/d WGW consumption can promote liver and inflammatory resilience in overweight and obese subjects with mildly elevated plasma cholesterol. The health space approach appeared appropriate to evaluate intervention effects as composite markers. This trial was registered at www.clinicaltrials.gov as NCT02385149.

Whole-grain consumption and its effects on hepatic steatosis and liver enzymes in patients with non-alcoholic fatty liver disease: a randomised controlled clinical trial

Non-alcoholic fatty liver disease (NAFLD) is a considerable challenge to public health across the globe. Whole grain is highly recommended as an inseparable part of a healthy diet and has been proposed as an effective way to manage NAFLD. The objective in the present study was to evaluate the effects of whole-grain consumption on hepatic steatosis and liver enzymes as primary outcomes in patients with NAFLD. Over the 12 weeks of this open-label, randomised controlled clinical trial, 112 patients (mean age 43 (sd 8·7) years; BMI 32·2 (sd 4·3) kg/m2) were randomly assigned to two groups to receive dietary advice, either to obtain at least half of their cereal servings each day from whole-grain foods or from usual cereals. By the end of the study, the grades of NAFLD showed a significant decrease in the intervention group (P < 0·001). In addition, a significant reduction in serum concentration of alanine aminotransferase (P < 0·001), aspartate aminotransferase (P < 0·001), γ-glutamyltransferase (P = 0·009), systolic blood pressure (P = 0·004) and diastolic blood pressure (P = 0·008) was observed in the intervention group compared with the control group. After adjusting, however, no significant differences were found between the two groups in terms of lipid profile, glycaemic status and anthropometric measurements. Overall, our study demonstrated that consumption of whole grains for 12 weeks had beneficial effects on hepatic steatosis and liver enzymes concentrations in patients with NAFLD.

Dietary non-enzymatic antioxidant capacity and the risk of myocardial infarction: the Swedish National March Cohort

Background

Results from randomized trials of antioxidant supplementation have cast doubt on observational data linking diets high in antioxidants to a reduced risk of cardiovascular diseases. We hypothesized that supplementation of one or a few antioxidants might not simulate the complex actions of all antioxidants in the human diet. We therefore investigated the association between dietary Non Enzymatic Antioxidant Capacity (NEAC), reflecting the antioxidant potential of the whole diet, and the risk of myocardial infarction (MI).

Methods

In the Swedish National March Cohort, 34 543 men and women free from cardiovascular diseases and cancer were followed through record linkages from 1997 until 2010. NEAC was assessed with a validated food-frequency questionnaire at baseline. The distribution of NEAC was categorized into sex-specific quartiles. We fitted multivariable Cox proportional hazards regression models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

Results

During a mean follow-up time of 12.7 years, we identified 1142 incident cases of MI. Successively higher quartiles (Qs) of dietary NEAC were accompanied by a monotonic trend of decreasing MI incidence, both for overall MI (HR Q4 vs Q1: 0.77; 95% CI: 0.61-0.96; p for trend = 0.008) and non-fatal MI (HR Q4 vs Q1: 0.72; 95% CI: 0.56-0.92; p for trend = 0.004). No such association was found for fatal MI.

Conclusions

A diet rich in antioxidants might protect from MI.

Decreased plasma serotonin and other metabolite changes in healthy adults after consumption of wholegrain rye: an untargeted metabolomics study

BACKGROUND

Wholegrain consumption has been associated with beneficial health effects including reduction of diabetes and cancer risk; however, the underlying mechanisms are not fully understood.

OBJECTIVE

The aim of this study was to characterize the effects of wholegrain rye intake on circulating metabolites in a human intervention study using untargeted metabolomics.

METHODS

The intervention consisted of 2 successive 4-wk periods in a randomized crossover design, where 15 adults consumed wholegrain rye bread (WGR) or white wheat bread enriched with fermented rye bran (WW+RB), following a 4-wk rye-free period with white wheat bread (WW). Fasting plasma samples were collected at the end of each period and analyzed using liquid chromatography-mass spectrometry. Metabolic profiles were compared to identify compounds discriminating WGR from the WW+RB and WW periods. Because peripheral serotonin is produced mainly in the gut, a hypothesis of its altered biosynthesis as a response to increased cereal fiber intake was tested by measuring intestinal serotonin of mice fed for 9 wk on a high-fat diet supplemented with different sources of fiber (rye bran flour, ground wheat aleurone, or powdered cellulose).

RESULTS

Five endogenous metabolites and 15 rye phytochemicals associated with WGR intake were identified. Plasma concentrations of serotonin, taurine, and glycerophosphocholine were significantly lower after the WGR than WW period (Q < 0.05). Concentrations of 2 phosphatidylethanolamine plasmalogens, PE(18:2/P-18:0) and PE(18:2/P-16:0), were lower after the WGR period than the WW+RB period (Q < 0.05). The concentration of serotonin was significantly lower in the colonic tissue of mice that consumed rye bran or wheat aleurone compared with cellulose (P < 0.001).

CONCLUSIONS

Wholegrain rye intake decreases plasma serotonin in healthy adults when compared with refined wheat. Intake of rye bran and wheat aleurone decreases colonic serotonin in mice. These results suggest that peripheral serotonin could be a potential link between wholegrain consumption and its associated health effects.Data used in the study were derived from a trial registered at www.clinicaltrials.gov as NCT03550365.

The Relationship between Whole Grain Intake and Body Weight: Results of Meta-Analyses of Observational Studies and Randomized Controlled Trials

Results from some observational studies suggest that higher whole grain (WG) intake is associated with lower risk of weight gain. Ovid Medline was used to conduct a literature search for observational studies and randomized controlled trials (RCTs) assessing WG food intake and weight status in adults. A meta-regression analysis of cross-sectional data from 12 observational studies (136,834 subjects) and a meta-analysis of nine RCTs (973 subjects) was conducted; six prospective cohort publications were qualitatively reviewed. Cross-sectional data meta-regression results indicate a significant, inverse correlation between WG intake and body mass index (BMI): weighted slope, −0.0141 kg/m² per g/day of WG intake (95% confidence interval (CI): −0.0207, −0.0077; r = −0.526, p = 0.0001). Prospective cohort results generally showed inverse associations between WG intake and weight change with typical follow-up periods of five to 20 years. RCT meta-analysis results show a nonsignificant pooled standardized effect size of −0.049 kg (95% CI −0.297, 0.199, p = 0.698) for mean difference in weight change (WG versus control interventions). Higher WG intake is significantly inversely associated with BMI in observational studies but not RCTs up to 16 weeks in length; RCTs with longer intervention periods are warranted.

Quantity, Quality, and Timing of Carbohydrate Intake and Blood Pressure

PURPOSE OF REVIEW

This review discusses recent evidence on the association of dietary carbohydrates (quantity, quality, and timing of intake) with hypertension (HTN) risk and out-of-clinic blood pressure (BP) measures.

RECENT FINDINGS

Studies on carbohydrate quantity are inconclusive, but low carbohydrate diets may be associated with lower BP. Plant-based carbohydrate-containing foods such as fruits, vegetables, and whole grains may lower HTN risk and 24-h BP. Excessive sugar intakes from sugar-sweetened beverages are associated with higher BP levels and HTN risk, with evidence of a dose-response relationship. Preliminary data suggest that timing of carbohydrate intake may influence HTN risk and 24-h BP. The role of carbohydrate nutrition in HTN's etiology warrants further investigation. Additional studies are needed to investigate the influence of dietary carbohydrates on HTN risk and the circadian pattern of BP, evaluate potential sex and racial/ethnic differences in these associations, and elucidate underlying mechanisms.

Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association?

Refined grain intake is widely assumed to be associated with adverse health outcomes, including increased risk for cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity. The 2015 Dietary Guidelines Advisory Committee recommended that to improve dietary quality, the US population should replace most refined grains with whole grains. This recommendation was based largely on results from studies that examined dietary patterns, not separate food groups. A Western dietary pattern typically includes red and processed meat, sugar-sweetened foods and beverages, French fries, and high-fat dairy products, as well as refined grains, and has been linked to increased risk of many chronic diseases. However, when evaluated as a distinct food category, 11 meta-analyses of prospective cohort studies, which included a total of 32 publications with data from 24 distinct cohorts, demonstrated that refined grain intake was not associated with all-cause mortality, T2D, CVD, coronary heart disease (CHD), stroke, hypertension, or cancer. By contrast, consumption of red and processed meat was consistently associated with increased risk of these same health outcomes. Refined grain consumption up to 6-7 servings/d (1 serving = 30 g) was not associated with higher risk of CHD, T2D, hypertension, or all-cause mortality. Moreover, total grain intake was not associated with risk of CVD, CHD, stroke, or cancer, but was associated with lower risk of all-cause mortality. Consequently, the recommendation to reduce refined grain intake based on results from studies linking a Western dietary pattern to numerous adverse health outcomes is contrary to a substantial body of published scientific evidence. Future research needs to better define refined grain intake to distinguish between staple grain foods and indulgent grain foods, and to better design randomized controlled trials to resolve discrepancies between results from observational studies and such trials with regard to determining the benefits of whole grains compared with refined grains.

The role of bioactives in energy metabolism and metabolic syndrome

Some food bioactives potentially exert anti-obesity effects. Anthocyanins (ACN), catechins, β-glucan (BG) and n-3 long chain PUFA (LCPUFA) are among the most promising candidates and have been considered as a strategy for the development of functional foods counteracting body weight gain. At present, clinical trials, reviews and meta-analyses addressing anti-obesity effects of various bioactives or bioactive-rich foods show contradictory results. Abdominal obesity is an important criterion for metabolic syndrome (MetS) diagnosis along with glucose intolerance, dyslipidaemia and hypertension. Food bioactives are supposed to exert beneficial effects on these parameters, therefore representing alternative therapy approaches for the treatment of MetS. This review summarises outcomes on MetS biomarkers in recent clinical trials supplementing ACN, catechins, BG and n-3 LCPUFA, focusing mainly on anti-obesity effects. Overall, it is clear that the level of evidence for the effectiveness varies not only among the different bioactives but also among the different putative health benefits suggested for the same bioactive. Limited evidence may be due to the low number of controlled intervention trials or to inconsistencies in trial design, i.e. duration, dose and/or the method of bioactive supplementation (extracts, supplements, rich or enriched food). At present, the question 'Are bioactives effective in weight management and prevention of metabolic syndrome?' remains inconclusive. Thus, a common effort to harmonise the study design of intervention trials focusing on the most promising bioactive molecules is urgently needed to strengthen the evidence of their potential in the treatment of obesity, MetS and related diseases.

Physicochemical properties of malted finger millet (Eleusine coracana) and pearl millet (Pennisetum glaucum)

Germinated and raw finger millet (Eleusine coracana) and pearl millet (Pennisetum glaucum) were investigated for their physicochemical (pH, total titratable acidity (TTA), proximate, mineral analysis), phytochemical, and antioxidant properties. The results showed that there were decreases in pH (8.50-7.60) with a corresponding increase in TTA (0.0038-0.18 g/L) during germination of the millets. Proximate composition of the millets revealed slight increases in protein (7.61%-7.81%; 10.57%-11.87%) and crude fiber (5.54%-8.81%; 1.07%-2.55%) with reductions in fat (3.84%-2.73%; 7.69%-2.30%) after germination for finger and pearl millet, respectively. The millets were found to be rich sources of minerals, which include magnesium (1,028.42-1,763.50 ppm), calcium (36.42-4,158.40 ppm), sodium (150.00-510.00 ppm), potassium (470.00-4,500 ppm), zinc (20.00-40.00 ppm), and iron (66.00-121.00 ppm) which either decreased or increased with germination. The results of the phytochemical composition revealed that during germination, alkaloid (36.03-74.53 mg/g) and saponin (4.46-31.91 mg/g) contents were found to increase while there were reductions in tannin (0.88-1.64 mg/g) and phytate (7.00-17.72 mg/g) content of the flour. For finger millet, DPPH ranged from 70.00% to 72.14% and pearl millet (49.95%-64.01%), while for FRAP, pearl millet (53.69-53.76 mg/g) demonstrated better activity compared to finger millet (46.91-53.54 mg/g). Findings from this work may suggest that further studies should be carried out on germinated finger and pearl millets to examine their abilities to serve as functional foods.