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Burns KF, LaMonte MJ, Blair RH, Tabung FK, Rexrode KM, Snetselaar LG, Millen AE. Developing and evaluating the construct validity of a dietary pattern predictive of plasma TMAO and choline. Nutr Metab Cardiovasc Dis 2024; 34:2190-2202. [PMID: 39003134 DOI: 10.1016/j.numecd.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND AND AIMS The metabolism of choline (highly present in animal products) can produce trimethylamine N-oxide (TMAO), a metabolite with atherosclerotic effects; however, dietary fiber may suppress this metabolic pathway. This study aimed to develop a dietary pattern predictive of plasma TMAO and choline concentrations using reduced rank regression (RRR) and to evaluate its construct validity. METHODS AND RESULTS Diet and plasma concentrations of choline (μmol/L) and TMAO (μmol/L) were assessed in 1724 post-menopausal women who participated in an ancillary study within the Women's Health Initiative Observational Study (1993-1998). The TMAO dietary pattern was developed using RRR in half of the sample (Training Sample) and applied to the other half of the sample (Validation Sample) to evaluate its construct validity. Energy-adjusted food groups were the predictor variables and plasma choline and TMAO, the response variables. ANCOVA and linear regression models were used to assess associations between each biomarker and the dietary pattern score. Discretionary fat, potatoes, red meat, and eggs were positively associated with the dietary pattern, while yogurt, fruits, added sugar, and starchy vegetables were inversely associated. Mean TMAO and choline concentrations significantly increased across increasing quartiles of the dietary pattern in the Training and Validation samples. Positive associations between the biomarkers and the TMAO dietary pattern were also observed in linear regression models (Validation Sample: TMAO, adjusted beta-coefficient = 0.037 (p-value = 0.0088); Choline, adjusted beta-coefficient = 0.011 (p-value = 0.0224). CONCLUSION We established the TMAO dietary pattern, a dietary pattern reflecting the potential of the diet to contribute to plasma concentrations of TMAO and choline.
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Affiliation(s)
- Kaelyn F Burns
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY 14214, USA.
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY 14214, USA
| | | | - Fred K Tabung
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Kathryn M Rexrode
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Linda G Snetselaar
- Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA
| | - Amy E Millen
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY 14214, USA
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2
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Hamaya R, Sun Q, Li J, Yun H, Wang F, Curhan GC, Huang T, Manson JE, Willett WC, Rimm EB, Clish C, Liang L, Hu FB, Ma Y. 24-h urinary sodium and potassium excretions, plasma metabolomic profiles, and cardiometabolic biomarkers in the United States adults: a cross-sectional study. Am J Clin Nutr 2024; 120:153-161. [PMID: 38762185 PMCID: PMC11251214 DOI: 10.1016/j.ajcnut.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/23/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND High-sodium and low-potassium intakes are associated with a higher risk of hypertension and cardiovascular disease, but there are limited data on the circulating metabolomics profiles of 24-h urinary sodium and potassium excretions in free-living individuals. OBJECTIVES We aimed to characterize the metabolomics signatures of a high-sodium and low-potassium diet in a cross-sectional study. METHODS In 1028 healthy older adults from the Women's and Men's Lifestyle Validation Studies, we investigated the association of habitual sodium and potassium intakes measured by 2 to 4 24-h urine samples with plasma metabolites (quantified using liquid chromatography-tandem mass spectrometry) and metabolomic pathways. Our primary exposures were energy-adjusted 24-h urinary sodium excretion, potassium excretion, and sodium-to-potassium ratio, calculated based on energy expenditure derived from the doubly labeled water method. We then assessed the partial correlations of their metabolomics scores, derived from elastic net regressions, with cardiometabolic biomarkers. RESULTS Higher sodium excretion was associated with 38 metabolites including higher piperine, phosphatidylethanolamine, and C5:1 carnitine. In pathway analysis, higher sodium excretion was associated with enhanced biotin and propanoate metabolism and enhanced degradation of lysine and branched-chain amino acids (BCAAs). Metabolites associated with higher potassium and lower sodium-to-potassium ratio included quinic acid and proline-betaine. After adjusting for confounding factors, the metabolomics score for sodium-to-potassium ratio positively correlated with fasting insulin (Spearman's rank correlation coefficient ρ = 0.27), C-peptide (ρ = 0.30), and triglyceride (ρ = 0.46), and negatively with adiponectin (ρ = -0.40), and high-density lipoprotein cholesterol (ρ = -0.42). CONCLUSIONS We discovered metabolites and metabolomics pathways associated with a high-sodium diet, including metabolites related to biotin, propanoate, lysine, and BCAA pathways. The metabolomics signature for a higher sodium low-potassium diet is associated with multiple components of elevated cardiometabolic risk.
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Affiliation(s)
- Rikuta Hamaya
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Qi Sun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Jun Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Huan Yun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Fenglei Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Gary C Curhan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Tianyi Huang
- Division of Women's Health, Department of Medicine, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - JoAnn E Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Walter C Willett
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Clary Clish
- Metabolomics Platform, Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Frank B Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Yuan Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
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Schorr KA, Agayn V, de Groot LCPGM, Slagboom PE, Beekman M. A plant-based diet index to study the relation between diet and disease risk among adults: a narrative review. J Nutr Health Aging 2024; 28:100272. [PMID: 38815475 DOI: 10.1016/j.jnha.2024.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
Plant-based diets (PBD) may offer various health benefits and contribute to a sustainable way of life, but, if not planned correctly, may also confer risks, e.g., by focusing on plant foods with low nutrient density, such as foods primarily consisting of refined carbohydrates. A plant-based diet index (PDI) differentiating between a healthful, unhealthful, and overall PBD, offers a promising approach to standardize and compare studies and integrate results. In this review we (1) summarize current evidence on the PDI and disease risk of relevance to public health, (2) discuss the methodology of the PDI and how it can be sensibly applied in further studies and (3) indicate areas with a lack of knowledge, such as vulnerable populations. In summary, our amalgamation shows, that adherence to a healthier plant-based diet is associated with an 8-68% lower risk for metabolic risk factors, diabetes, and cardiovascular disease, while adherence to an unhealthier plant-based diet is associated with a 10-63% higher risk. Although differences in calculation methods and underlying diet patterns between populations should be accounted for, the PDI can be a useful tool to assess adherence to different plant-based diet patterns and their association with health outcomes in cohort studies across cultures.
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Affiliation(s)
- Kerstin A Schorr
- Innoso BV, Den Haag, The Neterhlands; Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | | | - Marian Beekman
- Leiden University Medical Center, Leiden, The Netherlands
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Zha A, Li W, Wang J, Bai P, Qi M, Liao P, Tan B, Yin Y. Trimethylamine oxide supplementation differentially regulates fat deposition in liver, longissimus dorsi muscle and adipose tissue of growing-finishing pigs. ANIMAL NUTRITION (ZHONGGUO XU MU SHOU YI XUE HUI) 2024; 17:25-35. [PMID: 38464952 PMCID: PMC10920132 DOI: 10.1016/j.aninu.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 03/12/2024]
Abstract
Trimethylamine oxide (TMAO) is a microbiota-derived metabolite, and numerous studies have shown that it could regulate fat metabolism in humans and mice. However, few studies have focused on the effects of TMAO on fat deposition in growing-finishing pigs. This study aimed to investigate the effect of TMAO on fat deposition and intestinal microbiota in growing-finishing pigs. Sixteen growing pigs were randomly divided into 2 groups and fed with a basal diet with 0 or 1 g/kg TMAO for 149 d. The intestinal microbial profiles, fat deposition indexes, and fatty acid profiles were measured. These results showed that TMAO supplementation had a tendency to decrease lean body mass (P < 0.1) and significantly increased backfat thickness (P < 0.05), but it did not affect growth performance. TMAO significantly increased total protein (TP) concentration, and reduced alkaline phosphatase (ALP) concentration in serum (P < 0.05). TMAO increased the α diversity of the ileal microbiota community (P < 0.05), and it did not affect the colonic microbial community. TMAO supplementation significantly increased acetate content in the ileum, and Proteobacteria and Escherichia-Shigella were significantly enriched in the TMAO group (P < 0.05). In addition, TMAO decreased fat content, as well as the ratio of linoleic acid, n-6 polyunsaturated fatty acids (PUFA), and PUFA in the liver (P < 0.05). On the contrary, TMAO increased intramuscular fat content of the longissimus dorsi muscle, whereas the C18:2n6c ratio was increased, and the n-6 PUFA:PUFA ratio was decreased (P < 0.05). In vitro, 1 mM TMAO treatment significantly upregulated the expression of FASN and SREBP1 in C2C12 cells (P < 0.05). Nevertheless, TMAO also increased adipocyte area and decreased the CPT-1B expression in subcutaneous fat (P < 0.05). Taken together, TMAO supplementation regulated ileal microbial composition and acetate production, and regulated fat distribution and fatty acid composition in growing-finishing pigs. These results provide new insights for understanding the role of TMAO in humans and animals.
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Affiliation(s)
- Andong Zha
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
- University of Chinese Academy of Sciences, Beijing 100008, China
| | - Wanquan Li
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China
| | - Jing Wang
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China
| | - Ping Bai
- Yunnan Southwest Agriculture and Animal Husbandry Group Co., Ltd, Kunming 650224, China
| | - Ming Qi
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
- University of Chinese Academy of Sciences, Beijing 100008, China
| | - Peng Liao
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
| | - Bie Tan
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China
| | - Yulong Yin
- Laboratory of Animal Nutritional Physiology and Metabolic Process, Key Laboratory of Agro-ecological Processes in Subtropical Region, National Engineering Laboratory for Pollution Control and Waste Utilization in Livestock and Poultry Production, Institute of Subtropical Agriculture, Chinese Academy of Sciences, Changsha 410125, China
- College of Animal Science and Technology, Hunan Agricultural University, Changsha 410128, China
- University of Chinese Academy of Sciences, Beijing 100008, China
- Yunnan Southwest Agriculture and Animal Husbandry Group Co., Ltd, Kunming 650224, China
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5
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Byrd DA, Zouiouich S, Karwa S, Li XS, Wang Z, Sampson JN, Loftfield E, Huang WY, Hazen SL, Sinha R. Associations of serum trimethylamine N-oxide and its precursors with colorectal cancer risk in the Prostate, Lung, Colorectal, Ovarian Cancer Screening Trial Cohort. Cancer 2024; 130:1982-1990. [PMID: 38285606 DOI: 10.1002/cncr.35219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/07/2023] [Accepted: 01/08/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Dietary intake influences gut microbiome composition, which in turn may be associated with colorectal cancer (CRC). Associations of the gut microbiome with colorectal carcinogenesis may be mediated through bacterially regulated, metabolically active metabolites, including trimethylamine N-oxide (TMAO) and its precursors, choline, L-carnitine, and betaine. METHODS Prospective associations of circulating TMAO and its precursors with CRC risk were investigated. TMAO, choline, betaine, and L-carnitine were measured in baseline serum samples from 761 incident CRC cases and 1:1 individually matched controls in the prospective Prostate, Lung, Colorectal, Ovarian Cancer Screening Trial Cohort using targeted fully quantitative liquid chromatography tandem mass spectrometry panels. Prospective associations of the metabolites with CRC risk, using multivariable conditional logistic regression, were measured. Associations of a priori-selected dietary exposures with the four metabolites were also investigated. RESULTS TMAO and its precursors were not associated with CRC risk overall, but TMAO and choline were positively associated with higher risk for distal CRC (continuous ORQ90 vs. Q10 [95% CI] = 1.90 [CI, 1.24-2.92; p = .003] and 1.26 [1.17-1.36; p < .0001], respectively). Conversely, choline was inversely associated with rectal cancer (ORQ90 vs. Q10 [95% CI] = 0.77 [0.76-0.79; p < .001]). Red meat, which was previously associated with CRC risk in the Prostate, Lung, Colorectal, Ovarian Cancer Screening Trial Cohort , was positively associated with TMAO (Spearman rho = 0.10; p = .0003). CONCLUSIONS Serum TMAO and choline may be associated with higher risk of distal CRC, and red meat may be positively associated with serum TMAO. These findings provide insight into a potential microbially mediated mechanism underlying CRC etiology.
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Affiliation(s)
- Doratha A Byrd
- Cancer Epidemiology Program, Department of Population Sciences, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Semi Zouiouich
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Smriti Karwa
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Xinmin S Li
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zeneng Wang
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua N Sampson
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Erikka Loftfield
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Wen-Yi Huang
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Stanley L Hazen
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rashmi Sinha
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
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Wang M, Tang WW, Li XS, de Oliveira Otto MC, Lee Y, Lemaitre RN, Fretts A, Nemet I, Sotoodehnia N, Sitlani CM, Budoff M, DiDonato JA, Wang Z, Bansal N, Shlipak MG, Psaty BM, Siscovick DS, Sarnak MJ, Mozaffarian D, Hazen SL. The Gut Microbial Metabolite Trimethylamine N -oxide, Incident CKD, and Kidney Function Decline. J Am Soc Nephrol 2024; 35:749-760. [PMID: 38593157 PMCID: PMC11164118 DOI: 10.1681/asn.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/01/2024] [Indexed: 04/11/2024] Open
Abstract
Key Points In community-based US adults, higher plasma trimethylamine N -oxide levels associated with higher risk of incident CKD and greater rate of kidney function decline. Findings from our study support future clinical trials to examine whether lowering plasma trimethylamine N -oxide levels may prevent CKD development and progression. Background Trimethylamine N -oxide (TMAO) is a gut microbiota–derived metabolite of dietary phosphatidylcholine and carnitine. Experimentally, TMAO causes kidney injury and tubulointerstitial fibrosis. Little is known about prospective associations between TMAO and kidney outcomes, especially incident CKD. We hypothesized that higher plasma TMAO levels would be associated with higher risk of incident CKD and greater rate of kidney function decline. Methods We included 10,564 participants from two community-based, prospective cohorts with eGFR ≥60 ml/min per 1.73 m2 to assess incident CKD. TMAO was measured using targeted mass spectrometry at baseline and one follow-up visit. Creatinine and cystatin C were measured up to four times during follow-up and used to compute eGFR. Incident CKD was defined as an eGFR decline ≥30% from baseline and a resulting eGFR <60 ml/min per 1.73 m2. Time-varying Cox models assessed the association of serial TMAO measures with incident CKD, adjusting for sociodemographic, lifestyle, diet, and cardiovascular disease risk factors. Linear mixed models assessed the association with annualized eGFR change in 10,009 participants with at least one follow-up eGFR measure without exclusions for baseline eGFR levels. Results During a median follow-up of 9.4 years (interquartile range, 9.1–11.6 years), 979 incident CKD events occurred. Higher TMAO levels were associated with higher risk of incident CKD (second to fifth versus first quintile hazard ratio [95% confidence interval]=1.65 [1.22 to 2.23], 1.68 [1.26 to 2.25], 2.28 [1.72 to 3.02], and 2.24 [1.68 to 2.98], respectively) and greater annualized eGFR decline (second to fifth versus first quintile annualized eGFR change=−0.21 [−0.32 to −0.09], −0.17 [−0.29 to −0.05], −0.35 [−0.47 to −0.22], and −0.43 [−0.56 to −0.30] ml/min per 1.73 m2, respectively) with monotonic dose–response relationships. These associations were consistent across different racial/ethnic groups examined. The association with eGFR decline was similar to or larger than that seen for established CKD risk factors, including diabetes, per 10 mm Hg of higher systolic BP, per 10 years of older age, and Black race. Conclusions In community-based US adults, higher serial measures of plasma TMAO were associated with higher risk of incident CKD and greater annualized kidney function decline.
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Affiliation(s)
- Meng Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - W.H. Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, Ohio
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, Ohio
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Xinmin S. Li
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, Ohio
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, Ohio
| | - Marcia C. de Oliveira Otto
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas
| | - Yujin Lee
- Department of Food and Nutrition, Myongji University, Yongin, South Korea
| | - Rozenn N. Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington
| | - Amanda Fretts
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Ina Nemet
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, Ohio
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, Ohio
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington
| | - Colleen M. Sitlani
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington
| | - Matthew Budoff
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Joseph A. DiDonato
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, Ohio
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, Ohio
| | - Zeneng Wang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, Ohio
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, Ohio
| | - Nisha Bansal
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Michael G. Shlipak
- Kidney Health Research Collaborative and Department of Medicine, San Francisco Veterans Administration Medical Center and University of California–San Francisco, San Francisco, California
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | | | - Mark J. Sarnak
- Department of Medicine (Nephrology), Tufts University School of Medicine, Boston, Massachusetts
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Stanley L. Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, Ohio
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, Ohio
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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7
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Jieru P, Zhang S, Cai L, Long W, Wang Y, Zhang L, Dong Y, Zhang W, Liao J, Yang C. Dietary choline intake and health outcomes in U.S. adults: exploring the impact on cardiovascular disease, cancer prevalence, and all-cause mortality. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:59. [PMID: 38711145 DOI: 10.1186/s41043-024-00528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/16/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Choline, an indispensable nutrient, plays a pivotal role in various physiological processes. The available evidence regarding the nexus between dietary choline intake and health outcomes, encompassing cardiovascular disease (CVD), cancer, and all-cause mortality, is limited and inconclusive. This study aimed to comprehensively explore the relationship between dietary choline intake and the aforementioned health outcomes in adults aged > 20 years in the U.S. METHODS This study utilized data from the National Health and Nutrition Examination Survey between 2011 and 2018. Dietary choline intake was evaluated using two 24-h dietary recall interviews. CVD and cancer status were determined through a combination of standardized medical status questionnaires and self-reported physician diagnoses. Mortality data were gathered from publicly available longitudinal Medicare and mortality records. The study utilized survey-weighted logistic and Cox regression analyses to explore the associations between choline consumption and health outcomes. Restricted cubic spline (RCS) analysis was used for dose‒response estimation and for testing for nonlinear associations. RESULTS In our study of 14,289 participants (mean age 48.08 years, 47.71% male), compared with those in the lowest quintile (Q1), the adjusted odds ratios (ORs) of CVD risk in the fourth (Q4) and fifth (Q5) quintiles of choline intake were 0.70 (95% CI 0.52, 0.95) and 0.65 (95% CI 0.47, 0.90), respectively (p for trend = 0.017). Each 100 mg increase in choline intake was associated with a 9% reduced risk of CVD. RCS analysis revealed a linear correlation between choline intake and CVD risk. Moderate choline intake (Q3) was associated with a reduced risk of mortality, with an HR of 0.75 (95% CI 0.60-0.94) compared with Q1. RCS analysis demonstrated a significant nonlinear association between choline intake and all-cause mortality (P for nonlinearity = 0.025). The overall cancer prevalence association was nonsignificant, except for colon cancer, where each 100 mg increase in choline intake indicated a 23% reduced risk. CONCLUSION Elevated choline intake demonstrates an inverse association with CVD and colon cancer, while moderate consumption exhibits a correlated reduction in mortality. Additional comprehensive investigations are warranted to elucidate the broader health implications of choline.
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Affiliation(s)
- Peng Jieru
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Shanshan Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lin Cai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wencheng Long
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yueshan Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lu Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yao Dong
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wenqi Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Juan Liao
- Department of Gastroenterology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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8
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Shi L, Guo M, Shi C, Gao G, Xu X, Zhang C, Fu J, Ni Y, Wang F, Xue X, Yu F. Distinguishing benign and malignant thyroid nodules using plasma trimethylamine N-oxide, carnitine, choline and betaine. J Cancer Res Clin Oncol 2024; 150:142. [PMID: 38503944 PMCID: PMC10951046 DOI: 10.1007/s00432-024-05666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/23/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Trimethylamine N-oxide (TMAO), a gut microbiome-derived metabolite, and its precursors (carnitine, choline, betaine) have not been fully examined in relation to thyroid cancer (TC) risk. The aim of this study was to assess the value of TMAO and its precursors in diagnosis of benign and malignant thyroid nodules. METHODS In this study, high-performance liquid chromatography-tandem mass spectrometry was utilized to measure the levels of plasma TMAO and its precursors (choline, carnitine, and betaine) in 215 TC patients, 63 benign thyroid nodules (BTN) patients and 148 healthy controls (HC). The distribution of levels of TMAO and its precursors among the three groups were compared by the Kruskal-Wallis test. Receiver operating characteristic curve (ROC) analysis was performed to evaluate the sensitivity, specificity, and the predictive accuracy of single and combined biomarkers. RESULTS In comparison to HC, TC showed higher levels of TMAO and lower levels of its precursors (carnitine, choline, and betaine) (all P < 0.001). Plasma choline (P < 0.01) and betaine (P < 0.05) were declined in BTN than HC. The levels of carnitine (P < 0.001) and choline (P < 0.05) were significantly higher in BTN than that in TC group. Plasma TMAO showed lower levels in TC with lymph node metastasis (101.5 (73.1-144.5) ng/ml) than those without lymph node metastasis (131 (84.8-201) ng/ml, P < 0.05). Combinations of these four metabolites achieved good performance in the differential diagnosis, with the area under the ROC curve of 0.703, 0.741, 0.793 when discriminating between TC and BTN, BTN and HC, TC and HC, respectively. CONCLUSION Plasma TMAO, along with its precursors could serve as new biomarkers for the diagnosis of benign and malignant thyroid nodules.
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Affiliation(s)
- Liang Shi
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Muhong Guo
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Cuixiao Shi
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Gu Gao
- Department of Health Management Center, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Xianghong Xu
- Department of Endocrinology, Nanjing First Hospital, Nanjing, 210006, China
| | - Chuan Zhang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Jingjing Fu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Yudan Ni
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Xue Xue
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Fei Yu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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9
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Dolkar P, Deyang T, Anand N, Rathipriya AG, Hediyal TA, Chandrasekaran V, Krishnamoorthy NK, Gorantla VR, Bishir M, Rashan L, Chang SL, Sakharkar MK, Yang J, Chidambaram SB. Trimethylamine-N-oxide and cerebral stroke risk: A review. Neurobiol Dis 2024; 192:106423. [PMID: 38286388 DOI: 10.1016/j.nbd.2024.106423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 01/31/2024] Open
Abstract
Trimethylamine-N-oxide (TMAO) is a gut microbiota-derived metabolite produced by the action of gut microbiota and the hepatic enzyme Flavin Mono‑oxygenase 3 (FMO3). TMAO level has a positive correlation with the risk of cardiovascular events, including stroke, and their level is influenced mainly by dietary choice and the action of liver enzyme FMO3. TMAO plays a role in the development of atherosclerosis plaque, which is one of the causative factors of the stroke event. Preclinical and clinical investigations on the TMAO and associated stroke risk, severity, and outcomes are summarised in this review. In addition, mechanisms of TMAO-driven vascular dysfunction are also discussed, such as inflammation, oxidative stress, thrombus and foam cell formation, altered cholesterol and bile acid metabolism, etc. Post-stroke inflammatory cascades involving activation of immune cells, i.e., microglia and astrocytes, result in Blood-brain-barrier (BBB) disruption, allowing TMAO to infiltrate the brain and further aggravate inflammation. This event occurs as a result of the activation of the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome pathway through the release of inflammatory cytokines and chemokines that further aggravate the BBB and initiate further recruitment of immune cells in the brain. Thus, it's likely that maintaining TMAO levels and associated gut microbiota could be a promising approach for treating and improving stroke complications.
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Affiliation(s)
- Phurbu Dolkar
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Tenzin Deyang
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Nikhilesh Anand
- Department of Pharmacology, American University of Antigua, College of Medicine, Saint John's, Po Box W-1451, Antigua and Barbuda
| | | | - Tousif Ahmed Hediyal
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India; Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Vichitra Chandrasekaran
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India; Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Naveen Kumar Krishnamoorthy
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India; Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Vasavi Rakesh Gorantla
- Department of Biomedical sciences, Research Faculty, West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901, USA
| | - Muhammed Bishir
- Institute of NeuroImmune Pharmacology and Department of Biological Sciences, Seton Hall University, South Orange, New Jersey 07079, USA
| | - Luay Rashan
- Biodiversity Research Centre, Dohfar University, Salalah, Sultanate of Oman
| | - Sulie L Chang
- Institute of NeuroImmune Pharmacology and Department of Biological Sciences, Seton Hall University, South Orange, New Jersey 07079, USA
| | - Meena Kishore Sakharkar
- Drug discovery and Development Research Group, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Jian Yang
- Drug discovery and Development Research Group, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada.
| | - Saravana Babu Chidambaram
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India; Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India.
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10
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Shen X, Tilves C, Kim H, Tanaka T, Spira AP, Chia CW, Talegawkar SA, Ferrucci L, Mueller NT. Plant-based diets and the gut microbiome: findings from the Baltimore Longitudinal Study of Aging. Am J Clin Nutr 2024; 119:628-638. [PMID: 38218318 PMCID: PMC10972708 DOI: 10.1016/j.ajcnut.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Mounting evidence indicates that although some plant-based diets are healthful, others are not. Changes in the gut microbiome and microbiome-dependent metabolites, such as trimethylamine N-oxide (TMAO), may explain differential health effects of plant-based diets. However, human data are sparse on whether qualitatively distinct types of plant-based diets differentially affect gut microbiome diversity, composition, particularly at the species level, and/or metabolites. OBJECTIVES We aimed to examine cross-sectional associations of different plant-based indices with adult gut microbiome diversity, composition, and the metabolite TMAO. METHODS We studied 705 adults in the Baltimore Longitudinal Study of Aging with data for diet, fecal microbiome (shotgun metagenomic sequencing), and key covariates. We derived healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI) using data from food frequency questionnaires. We examined plant-based diet indices with microbiome α-diversity (richness and evenness measures), β-diversity (Bray-Curtis and UniFrac measures), composition (species level), and plasma TMAO. We used regression models to determine associations before and after adjustment for age, sex, education, physical activity, smoking status, body mass index, and total energy intake. RESULTS The analytic sample (mean age, 71.0 years, SD = 12.8 years) comprised 55.6% female and 67.5% non-Hispanic White participants. hPDI was positively and uPDI negatively associated with microbiome α-diversity, driven by microbial evenness (Pielou P < 0.05). hPDI was also positively associated with relative abundance of 3 polysaccharide-degrading bacterial species (Faecalibacterium prausnitzii, Eubacterium eligens, and Bacteroides thetaiotaomicron) and inversely associated with 6 species (Blautia hydrogenotrophica, Doreasp CAG 317, Eisenbergiella massiliensis, Sellimonas intestinalis, Blautia wexlerae, and Alistipes shahii). Furthermore, hPDI was inversely associated with TMAO. Associations did not differ by age, sex, or race. CONCLUSIONS Greater adherence to a healthful plant-based diet is associated with microbiome features that have been linked to positive health; adherence to an unhealthful plant-based diet has opposing or null associations with these features.
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Affiliation(s)
- Xinyi Shen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, United States; Tufts University School of Medicine, Tufts University, Boston, MA, United States
| | - Curtis Tilves
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, United States; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Hyunju Kim
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, United States
| | - Toshiko Tanaka
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States
| | - Chee W Chia
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Sameera A Talegawkar
- Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Noel T Mueller
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, United States; Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States.
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11
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Rosenfeld RM, Juszczak HM, Wong MA. Scoping review of the association of plant-based diet quality with health outcomes. Front Nutr 2023; 10:1211535. [PMID: 37637943 PMCID: PMC10447911 DOI: 10.3389/fnut.2023.1211535] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction The association of plant-based dietary patterns with health outcomes has traditionally been assessed without considering nutritional value. The plant-based dietary index (PDI), first published in 2016, overcomes this limitation with both a healthful PDI (hPDI) and an unhealthful PDI (uPDI), based on the quality of plant foods consumed plus the frequency of animal foods. We sought to summarize the breadth of research using the hPDI and uPDI to gain insight into how the quality of plant-based dietary patterns might be associated with health outcomes. Methods Scoping review of studies that used the PDI, hPDI, or uPDI to report associations with health outcomes. Multiple databases were searched from 2010 through April 2023 with 2 authors independently assessing eligibility and extracting data. In addition to assessing the association of the indices to health outcomes, we determined the frequency of concordant or discordant findings for hPDI versus PDI and for hPDI versus uPDI. Results We included 95 articles (54% longitudinal, 37% cross-sectional, and 9% case-control) with a median sample size of 3,646. Higher hPDI levels were associated with favorable health outcomes in 36% of comparisons (most often for obesity, mortality, diabetes, cardiovascular disease, and psychiatric disorders), compared to 25% for the PDI and only 2% for the uPDI. Conversely, higher levels of the uPDI were associated with unfavorable health outcomes in 33% of comparisons, in contrast to under 1% for the hPDI and 2% for the PDI. When the hPDI association to an outcome was discordant with the uPDI or PDI, the significance and directionality always favored the hPDI over the uPDI, and nearly always favored the hPDI over the PDI. Discussion Dietary indices that account for the quality of plant foods can show health benefits that might be missed by a generic plant-based index. A greater focus on the quality of plant foods could improve nutrition guidelines, raise awareness about the benefits of adding unrefined plant foods to the diet, and empower consumers to make incremental additions of such foods to displace unhealthy foods. We anticipate increasing use of indices that address food quality in future research.
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Affiliation(s)
- Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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12
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Guizar-Heredia R, Noriega LG, Rivera AL, Resendis-Antonio O, Guevara-Cruz M, Torres N, Tovar AR. A New Approach to Personalized Nutrition: Postprandial Glycemic Response and its Relationship to Gut Microbiota. Arch Med Res 2023; 54:176-188. [PMID: 36990891 DOI: 10.1016/j.arcmed.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023]
Abstract
A prolonged and elevated postprandial glucose response (PPGR) is now considered a main factor contributing for the development of metabolic syndrome and type 2 diabetes, which could be prevented by dietary interventions. However, dietary recommendations to prevent alterations in PPGR have not always been successful. New evidence has supported that PPGR is not only dependent of dietary factors like the content of carbohydrates, or the glycemic index of the foods, but is also dependent on genetics, body composition, gut microbiota, among others. In recent years, continuous glucose monitoring has made it possible to establish predictions on the effect of different dietary foods on PPGRs through machine learning methods, which use algorithms that integrate genetic, biochemical, physiological and gut microbiota variables for identifying associations between them and clinical variables with aim of personalize dietary recommendations. This has allowed to improve the concept of personalized nutrition, since it is now possible to recommend through these predictions specific dietary foods to prevent elevated PPGRs that are highly variable among individuals. Additional components that can enrich the predictive algorithms are findings of nutrigenomics, nutrigenetics and metabolomics. Thus, this review aims to summarize the evidence of the components that integrate personalized nutrition focused on the prevention of PPGRs, and to show the future of personalized nutrition by laying the groundwork for the development of individualized dietary management and its impact on the improvement of metabolic diseases.
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13
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Wang M, Wang Z, Lee Y, Lai HTM, de Oliveira Otto MC, Lemaitre RN, Fretts A, Sotoodehnia N, Budoff M, DiDonato JA, McKnight B, Tang WHW, Psaty BM, Siscovick DS, Hazen SL, Mozaffarian D. Dietary Meat, Trimethylamine N-Oxide-Related Metabolites, and Incident Cardiovascular Disease Among Older Adults: The Cardiovascular Health Study. Arterioscler Thromb Vasc Biol 2022; 42:e273-e288. [PMID: 35912635 PMCID: PMC9420768 DOI: 10.1161/atvbaha.121.316533] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Effects of animal source foods (ASF) on atherosclerotic cardiovascular disease (ASCVD) and underlying mechanisms remain controversial. We investigated prospective associations of different ASF with incident ASCVD and potential mediation by gut microbiota-generated trimethylamine N-oxide, its L-carnitine-derived intermediates γ-butyrobetaine and crotonobetaine, and traditional ASCVD risk pathways. METHODS Among 3931 participants from a community-based US cohort aged 65+ years, ASF intakes and trimethylamine N-oxide-related metabolites were measured serially over time. Incident ASCVD (myocardial infarction, fatal coronary heart disease, stroke, other atherosclerotic death) was adjudicated over 12.5 years median follow-up. Cox proportional hazards models with time-varying exposures and covariates examined ASF-ASCVD associations; and additive hazard models, mediation proportions by different risk pathways. RESULTS After multivariable-adjustment, higher intakes of unprocessed red meat, total meat, and total ASF associated with higher ASCVD risk, with hazard ratios (95% CI) per interquintile range of 1.15 (1.01-1.30), 1.22 (1.07-1.39), and 1.18 (1.03-1.34), respectively. Trimethylamine N-oxide-related metabolites together significantly mediated these associations, with mediation proportions (95% CI) of 10.6% (1.0-114.5), 7.8% (1.0-32.7), and 9.2% (2.2-44.5), respectively. Processed meat intake associated with a nonsignificant trend toward higher ASCVD (1.11 [0.98-1.25]); intakes of fish, poultry, and eggs were not significantly associated. Among other risk pathways, blood glucose, insulin, and C-reactive protein, but not blood pressure or blood cholesterol, each significantly mediated the total meat-ASCVD association. CONCLUSIONS In this large, community-based cohort, higher meat intake associated with incident ASCVD, partly mediated by microbiota-derived metabolites of L-carnitine, abundant in red meat. These novel findings support biochemical links between dietary meat, gut microbiome pathways, and ASCVD.
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Affiliation(s)
- Meng Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Zeneng Wang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Yujin Lee
- Department of Food and Nutrition, Myongji University, Yongin, South Korea 17055
| | - Heidi TM Lai
- Imperial College London, Department of Primary Care and Public Health, London, SW7 2AZ, UK
| | - Marcia C. de Oliveira Otto
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX
| | - Rozenn N. Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Amanda Fretts
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Matthew Budoff
- Los Angeles BioMedical Research Institute, Harbor UCLA Medical Center, CA
| | - Joseph A. DiDonato
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Barbara McKnight
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
- Department of Biostatistics, University of Washington, Seattle, WA
| | - W. H. Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | | | - Stanley L. Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Mutalub YB, Abdulwahab M, Mohammed A, Yahkub AM, AL-Mhanna SB, Yusof W, Tang SP, Rasool AHG, Mokhtar SS. Gut Microbiota Modulation as a Novel Therapeutic Strategy in Cardiometabolic Diseases. Foods 2022; 11:2575. [PMID: 36076760 PMCID: PMC9455664 DOI: 10.3390/foods11172575] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
The human gut harbors microbial ecology that is in a symbiotic relationship with its host and has a vital function in keeping host homeostasis. Inimical alterations in the composition of gut microbiota, known as gut dysbiosis, have been associated with cardiometabolic diseases. Studies have revealed the variation in gut microbiota composition in healthy individuals as compared to the composition of those with cardiometabolic diseases. Perturbation of host-microbial interaction attenuates physiological processes and may incite several cardiometabolic disease pathways. This imbalance contributes to cardiometabolic diseases via metabolism-independent and metabolite-dependent pathways. The aim of this review was to elucidate studies that have demonstrated the complex relationship between the intestinal microbiota as well as their metabolites and the development/progression of cardiometabolic diseases. Furthermore, we systematically itemized the potential therapeutic approaches for cardiometabolic diseases that target gut microbiota and/or their metabolites by following the pathophysiological pathways of disease development. These approaches include the use of diet, prebiotics, and probiotics. With the exposition of the link between gut microbiota and cardiometabolic diseases, the human gut microbiota therefore becomes a potential therapeutic target in the development of novel cardiometabolic agents.
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Affiliation(s)
- Yahkub Babatunde Mutalub
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia or
- Department of Clinical Pharmacology, College of Medical Sciences, Abubakar Tafawa Balewa University, Bauchi 74027, Nigeria
| | - Monsurat Abdulwahab
- Department of Midwifery, College of Nursing Sciences, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi 74027, Nigeria
| | - Alkali Mohammed
- Department of Medicine, College of Medical Sciences, Abubakar Tafawa Balewa University, Bauchi 74027, Nigeria
| | - Aishat Mutalib Yahkub
- College of Medical Sciences, Abubakar Tafawa Balewa University, Bauchi 74027, Nigeria
| | - Sameer Badri AL-Mhanna
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Wardah Yusof
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Suk Peng Tang
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia or
| | - Aida Hanum Ghulam Rasool
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia or
| | - Siti Safiah Mokhtar
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia or
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15
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Associations of Diet with Urinary Trimethylamine-N-Oxide (TMAO) and Its Precursors among Free-Living 10-Year-Old Children: Data from SMBCS. Nutrients 2022; 14:nu14163419. [PMID: 36014922 PMCID: PMC9413070 DOI: 10.3390/nu14163419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
Trimethylamine-N-oxide (TMAO), a diet-derived cometabolite linked to cardiometabolic disease, has been associated with elevated dietary status, particularly in people with kidney failure and adults with dietary modulations. However, the influence of the current diet on TMAO levels in free-living children has not been adequately described. This study was to explore associations of food compositions and dietary diversity with urinary TMAO and its precursor concentrations. Urinary TMAO and its precursor concentrations of 474 healthy children from the Sheyang Mini Birth Cohort were quantified by ultra-performance liquid chromatography−Q Exactive high-resolution mass spectrometer (UPLC-Q Exactive HRMS). Individual food compositions from 24 h dietary recall data were classified into 20 groups and diversity scores were calculated according to the guidelines of the Food and Agriculture Organization of the United Nations (FAO). Associations of urinary TMAO and its precursors with food compositions and dietary diversity scores were assessed by generalized linear regression models. In models adjusted for potential confounders, urinary TMAO was significantly associated with intakes of fish (β, regression coefficient = 0.155, p < 0.05) and vegetables (β = 0.120, p < 0.05). Eggs intake showed positive associations with TMAO’s precursors (trimethylamine: β = 0.179, p < 0.05; choline: β = 0.181, p < 0.05). No association between meat intake and TMAO was observed, whereas meat and poultry intakes were related to the levels of acetyl-L-carnitine and L-carnitine (β: 0.134 to 0.293, p < 0.05). The indicators of dietary diversity were positively correlated to TMAO concentration (β: 0.027 to 0.091, p < 0.05). In this free-living children-based study, dietary factors were related to urinary TMAO and its precursors, especially fish, meat, and eggs. As such, dietary diversity was positively related to the level of TMAO.
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16
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McArthur KL, Zhang M, Hong X, Wang G, Buckley JP, Wang X, Mueller NT. Trimethylamine N-Oxide and Its Precursors Are Associated with Gestational Diabetes Mellitus and Pre-Eclampsia in the Boston Birth Cohort. Curr Dev Nutr 2022; 6:nzac108. [PMID: 35949367 PMCID: PMC9356535 DOI: 10.1093/cdn/nzac108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/14/2022] [Accepted: 06/08/2022] [Indexed: 12/01/2022] Open
Abstract
Background Trimethylamine N-oxide (TMAO) and its precursors choline, betaine, and carnitine have been associated with cardiometabolic disease in nonpregnant adults. However, studies examining TMAO and its precursors in relation to cardiometabolic conditions during pregnancy are lacking. Objectives The primary objective was to estimate the association of TMAO and its precursors in maternal and cord plasma with gestational diabetes mellitus (GDM) and pre-eclampsia (PE) among women in the Boston Birth Cohort. A secondary objective was to determine whether associations vary by race/ethnicity. Methods ORs for each outcome according to tertiles and to an SD increment of TMAO, choline, betaine, and carnitine were estimated using logistic regression. Final models were adjusted for covariates. Results Among 1496 women, 115 women had GDM and 159 had PE during the index pregnancy. Intermetabolite correlations of TMAO and its precursors were stronger within cord plasma (r = 0.38-0.87) than within maternal plasma (r = 0.08-0.62). Maternal TMAO was associated with higher odds of GDM (third compared with first tertile OR: 1.75; 95% CI: 1.04, 2.94), whereas maternal choline, betaine, and carnitine were not associated with GDM. Maternal TMAO and choline were not associated with PE, whereas carnitine was associated with higher (OR: 1.86; 95% CI: 1.18, 2.94) and betaine with lower odds of PE (OR: 0.37; 95% CI: 0.23, 0.59). In cord plasma, TMAO was not associated with GDM or PE, but choline, betaine, and carnitine were associated with higher odds of PE (OR: 3.11; 95% CI: 1.62, 5.96; OR: 2.65; 95% CI: 1.42, 4.93; OR: 2.56; 95% CI: 1.39, 4.69, respectively). Cord choline was associated with lower odds of GDM (OR: 0.52; 95% CI: 0.27, 0.99), whereas other cord metabolites were not significantly associated with GDM. Associations did not vary by race/ethnicity. Conclusions TMAO and its precursors were associated with GDM and PE, but the associations differed based on the metabolite medium (maternal compared with cord plasma).This trial was registered at clinicaltrials.gov as NCT03228875.
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Affiliation(s)
- Kristen L McArthur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mingyu Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessie P Buckley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Noel T Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
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17
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Dhakal S, Moazzami Z, Perry C, Dey M. Effects of Lean Pork on Microbiota and Microbial-Metabolite Trimethylamine-N-Oxide: A Randomized Controlled Non-Inferiority Feeding Trial Based on the Dietary Guidelines for Americans. Mol Nutr Food Res 2022; 66:e2101136. [PMID: 35182101 DOI: 10.1002/mnfr.202101136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/19/2022] [Indexed: 11/09/2022]
Abstract
SCOPE Trimethylamine-N-oxide (TMAO) is a microbiota-dependent and primarily animal-protein-derived proatherogenic metabolite. The ecological impact of pork-the most popular animal protein worldwide-on the human microbiome, and in the physiological context of TMAO and other biogenic amines, remains unclear. Poultry being the recommended heart-healthier animal protein, we inquired-if pork intake results in inferior-to-chicken TMAO-response while consuming a US. Dietary Guidelines (DGA)-diet? METHODS AND RESULTS In a randomized, controlled, all-food-provided, crossover, feeding trial, healthy adults consumed 156 g/day of lean-pork or chicken (active-control) as primary proteins. Mixed-effect modeling shows pork as noninferior to chicken for circulating TMAO response and microbiota-generated essential TMAO-precursor-trimethylamine (97.5% CI, n = 36/protein). Markers of lipid metabolism, inflammation and oxidative stress, serum levels of betaine, choline, L-carnitine, composition and functional-capability of the microbiota, and association of baseline TMAO-levels with TMAO-response (both, r>0.6, p = 0.0001) were nondistinguishable between the protein groups. TMAO reduction and similar shifts in microbiota and biogenic-amine signatures postdiet in both groups indicate a background DGA-effect. CONCLUSIONS Unlike extrapolating negative results, we present noninferiority-testing based evidence that consuming pork as a predominant protein within an omnivorous DGA-diet does not exacerbate TMAO-response. Results highlight the importance of understanding protein-TMAO interactions within dietary patterns. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Samitinjaya Dhakal
- Department of Health and Nutritional Sciences, South Dakota State University, Box 2275A, Brookings, SD, 57007
| | - Zahra Moazzami
- Department of Health and Nutritional Sciences, South Dakota State University, Box 2275A, Brookings, SD, 57007.,Food Science and Nutrition, University of Minnesota, St. Paul, MN, 55108
| | - Cydne Perry
- Department of Health and Nutritional Sciences, South Dakota State University, Box 2275A, Brookings, SD, 57007.,Applied Health Science, Indiana University, Bloomington, IN, 47405
| | - Moul Dey
- Department of Health and Nutritional Sciences, South Dakota State University, Box 2275A, Brookings, SD, 57007
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18
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Yu N, Gu N, Wang Y, Zhou B, Lu D, Li J, Ma X, Zhang J, Guo X. The Association of Plasma Trimethylamine N-Oxide with Coronary Atherosclerotic Burden in Patients with Type 2 Diabetes Among a Chinese North Population. Diabetes Metab Syndr Obes 2022; 15:69-78. [PMID: 35035225 PMCID: PMC8754460 DOI: 10.2147/dmso.s339698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE We aimed to examine the association between plasma trimethylamine N-oxide (TMAO), a gut microbial metabolite from dietary phosphatidylcholine, and coronary atherosclerotic burden in patients with type 2 diabetes (T2D). METHODS In total, 349 patients with T2D were studied, including 70 controls and 279 patients with coronary artery disease (CAD) by coronary angiography. Coronary atherosclerotic burden is quantified by the number of diseased coronary branches and SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score. Plasma TMAO levels were determined by UHPLC-MS/MS technique. RESULTS The TMAO concentration was significantly higher in the patients with triple vessel disease (TVD) (3.33 [IQR: 1.81-6.65] μM) than those without TVD (2.62 [IQR: 1.50-4.73] μM) (P = 0.015). A similar difference was found between patients with SYNTAX score >22 (3.93 [IQR: 1.81-6.82] μM) and those with SYNTAX score ≤22 (2.54 [IQR: 1.44-4.54] μM) (P = 0.014). TMAO was not significantly correlated with the presence of CAD. Among patients with eGFR <60 mL/min/1.73 m2, the highest tertile of TMAO was significantly associated with TVD (OR = 25.28, 95% CI [2.55-250.33], P = 0.006) and SYNTAX score >22 (OR = 7.23, 95% CI [1.51-34.64], P = 0.013) independent of known risk factors of CAD, compared with lower TMAO tertiles. CONCLUSION TMAO was not independently correlated with the presence of CAD and severity of coronary atherosclerosis in the included population. Nevertheless, the significant association between circulating TMAO and higher coronary atherosclerotic burden was observed in patients with eGFR of lower than 60 mL/min/1.73 m2.
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Affiliation(s)
- Na Yu
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Nan Gu
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Yuxin Wang
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Bin Zhou
- Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Difei Lu
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Xiaowei Ma
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, People’s Republic of China
- Correspondence: Xiaowei Ma Department of Endocrinology, Peking University First Hospital, Beijing, People’s Republic of ChinaTel/Fax +86-010-83572574 Email
| | - Junqing Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, People’s Republic of China
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19
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Hughes RL, Holscher HD. Fueling Gut Microbes: A Review of the Interaction between Diet, Exercise, and the Gut Microbiota in Athletes. Adv Nutr 2021; 12:2190-2215. [PMID: 34229348 PMCID: PMC8634498 DOI: 10.1093/advances/nmab077] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/19/2021] [Accepted: 05/27/2021] [Indexed: 12/11/2022] Open
Abstract
The athlete's goal is to optimize their performance. Towards this end, nutrition has been used to improve the health of athletes' brains, bones, muscles, and cardiovascular system. However, recent research suggests that the gut and its resident microbiota may also play a role in athlete health and performance. Therefore, athletes should consider dietary strategies in the context of their potential effects on the gut microbiota, including the impact of sports-centric dietary strategies (e.g., protein supplements, carbohydrate loading) on the gut microbiota as well as the effects of gut-centric dietary strategies (e.g., probiotics, prebiotics) on performance. This review provides an overview of the interaction between diet, exercise, and the gut microbiota, focusing on dietary strategies that may impact both the gut microbiota and athletic performance. Current evidence suggests that the gut microbiota could, in theory, contribute to the effects of dietary intake on athletic performance by influencing microbial metabolite production, gastrointestinal physiology, and immune modulation. Common dietary strategies such as high protein and simple carbohydrate intake, low fiber intake, and food avoidance may adversely impact the gut microbiota and, in turn, performance. Conversely, intake of adequate dietary fiber, a variety of protein sources, and emphasis on unsaturated fats, especially omega-3 (ɷ-3) fatty acids, in addition to consumption of prebiotics, probiotics, and synbiotics, have shown promising results in optimizing athlete health and performance. Ultimately, while this is an emerging and promising area of research, more studies are needed that incorporate, control, and manipulate all 3 of these elements (i.e., diet, exercise, and gut microbiome) to provide recommendations for athletes on how to "fuel their microbes."
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Affiliation(s)
- Riley L Hughes
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Hannah D Holscher
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Division of Nutrition Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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20
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Kang JW, Zivkovic AM. Are eggs good again? A precision nutrition perspective on the effects of eggs on cardiovascular risk, taking into account plasma lipid profiles and TMAO. J Nutr Biochem 2021; 100:108906. [PMID: 34801688 DOI: 10.1016/j.jnutbio.2021.108906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/28/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
Although eggs are a nutrient dense food delivering high quality protein and micronutrients, given that eggs are also rich in cholesterol and choline, whether egg intake is contraindicated for individuals at risk for cardiovascular disease (CVD) remains controversial. In this mini review, we provide a Precision Nutrition perspective, highlighting the importance of two factors: the effect of egg cholesterol on plasma cholesterol concentrations in most people and in cholesterol hyper-absorbers, and the effect of egg choline on plasma concentrations of trimethylamine-N-oxide (TMAO), a microbe-host co-metabolite independently associated with increased CVD risk. We discuss recent evidence from intervention studies showing that in most individuals egg intake does not have a deleterious effect on plasma lipid profiles, but also highlight that some individuals are cholesterol hyper-absorbers or individuals who are not able to maintain cholesterol homeostasis by suppressing endogenous cholesterol synthesis, and that for these individuals the intake of eggs and other dietary sources of cholesterol would be contraindicated. We also discuss the complex relationship between dietary sources of choline vs. phosphatidylcholine, the gut microbiome, and plasma TMAO concentrations, highlighting the high inter-individual variability in TMAO production and gut microbiome profiles among healthy individuals and those with metabolic conditions. Precision Nutrition approaches that allow the clinician to stratify risk and improve dietary recommendations for individual patients are desirable for improving patient compliance and health outcomes. More clinical studies are needed to determine how to identify individuals at risk for CVD for whom egg intake is contraindicated vs. those for whom egg intake is not associated with negative effects on plasma lipid profiles nor plasma TMAO concentrations.
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Affiliation(s)
- Jea Woo Kang
- Department of Nutrition, University of California, Davis, California
| | - Angela M Zivkovic
- Department of Nutrition, University of California, Davis, California.
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21
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Rueda-Robles A, Rubio-Tomás T, Plaza-Diaz J, Álvarez-Mercado AI. Impact of Dietary Patterns on H. pylori Infection and the Modulation of Microbiota to Counteract Its Effect. A Narrative Review. Pathogens 2021; 10:875. [PMID: 34358024 PMCID: PMC8308520 DOI: 10.3390/pathogens10070875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022] Open
Abstract
Helicobacter pylori (H. pylori) is a Gram-negative bacterium that colonizes the stomach and can induce gastric disease and intra-gastric lesions, including chronic gastritis, peptic ulcers, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. This bacterium is responsible for long-term complications of gastric disease. The conjunction of host genetics, immune response, bacterial virulence expression, diet, micronutrient availability, and microbiome structure influence the disease outcomes related to chronic H. pylori infection. In this regard, the consumption of unhealthy and unbalanced diets can induce microbial dysbiosis, which infection with H. pylori may contribute to. However, to date, clinical trials have reported controversial results and current knowledge in this field is inconclusive. Here, we review preclinical studies concerning the changes produced in the microbiota that may be related to H. pylori infection, as well as the involvement of diet. We summarize and discuss the last approaches based on the modulation of the microbiota to improve the negative impact of H. pylori infection and their potential translation from bench to bedside.
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Affiliation(s)
- Ascensión Rueda-Robles
- Center of Biomedical Research, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Avda. del Conocimiento s/n., Armilla, 18016 Granada, Spain;
| | - Teresa Rubio-Tomás
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
- School of Medicine, University of Crete, 70013 Heraklion, Crete, Greece
| | - Julio Plaza-Diaz
- Children’s Hospital Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada;
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain
| | - Ana I. Álvarez-Mercado
- Center of Biomedical Research, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Avda. del Conocimiento s/n., Armilla, 18016 Granada, Spain;
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain
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22
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Craven H, McGuinness D, Buchanan S, Galbraith N, McGuinness DH, Jones B, Combet E, Mafra D, Bergman P, Ellaway A, Stenvinkel P, Ijaz UZ, Shiels PG. Socioeconomic position links circulatory microbiota differences with biological age. Sci Rep 2021; 11:12629. [PMID: 34135381 PMCID: PMC8209159 DOI: 10.1038/s41598-021-92042-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/20/2021] [Indexed: 12/23/2022] Open
Abstract
Imbalanced nutrition is associated with accelerated ageing, possibly mediated by microbiota. An analysis of the circulatory microbiota obtained from the leukocytes of participants in the MRC Twenty-07 general population cohort was performed. We now report that in this cohort, the most biologically aged exhibit a significantly higher abundance of circulatory pathogenic bacteria, including Neisseria, Rothia and Porphyromonas, while those less biologically aged possess more circulatory salutogenic (defined as being supportive of human health and wellbeing) bacteria, including Lactobacillus, Lachnospiraceae UCG-004 and Kocuria. The presence of these salutogenic bactreria is consistent with a capacity to metabolise and produce Nrf2 agonists. We also demonstrate that associated one carbon metabolism, notably betaine levels, did not vary with chronological age, but displayed a difference with socioeconomic position (SEP). Those at lower SEP possessed significantly lower betaine levels indicative of a poorer diet and poorer health span and consistent with reduced global DNA methylation levels in this group. Our data suggest a clear route to improving age related health and resilience based on dietary modulation of the microbiota.
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Affiliation(s)
- Hannah Craven
- Wolfson Wohl Translational Research Centre, Institute of Cancer Sciences, MVLS, Garscube Estate, University of Glasgow, Switchback Road, Glasgow, G61 1QH, UK
| | - Dagmara McGuinness
- Wolfson Wohl Translational Research Centre, Institute of Cancer Sciences, MVLS, Garscube Estate, University of Glasgow, Switchback Road, Glasgow, G61 1QH, UK
| | - Sarah Buchanan
- Wolfson Wohl Translational Research Centre, Institute of Cancer Sciences, MVLS, Garscube Estate, University of Glasgow, Switchback Road, Glasgow, G61 1QH, UK
| | | | | | - Brian Jones
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Emilie Combet
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Denise Mafra
- Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - Peter Bergman
- Division of Renal Medicine M99, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anne Ellaway
- Institute of Health and Wellbeing, MVLS, University of Glasgow, Glasgow, UK
| | - Peter Stenvinkel
- Division of Renal Medicine M99, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Umer Z Ijaz
- School of Engineering, University of Glasgow, Glasgow, UK.
| | - Paul G Shiels
- Wolfson Wohl Translational Research Centre, Institute of Cancer Sciences, MVLS, Garscube Estate, University of Glasgow, Switchback Road, Glasgow, G61 1QH, UK.
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23
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Brunt VE, Casso AG, Gioscia-Ryan RA, Sapinsley ZJ, Ziemba BP, Clayton ZS, Bazzoni AE, VanDongen NS, Richey JJ, Hutton DA, Zigler MC, Neilson AP, Davy KP, Seals DR. Gut Microbiome-Derived Metabolite Trimethylamine N-Oxide Induces Aortic Stiffening and Increases Systolic Blood Pressure With Aging in Mice and Humans. Hypertension 2021; 78:499-511. [PMID: 33966451 DOI: 10.1161/hypertensionaha.120.16895] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Vienna E Brunt
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
| | - Abigail G Casso
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
| | - Rachel A Gioscia-Ryan
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
| | - Zachary J Sapinsley
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
| | - Brian P Ziemba
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
| | - Zachary S Clayton
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
| | - Amy E Bazzoni
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
| | - Nicholas S VanDongen
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
| | - James J Richey
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
| | - David A Hutton
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
| | - Melanie C Zigler
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
| | - Andrew P Neilson
- Department of Food Science and Technology (A.P.N.).,Now with Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Kannapolis (A.P.N.)
| | - Kevin P Davy
- Department of Human Nutrition, Foods, and Exercise (K.P.D.), Virginia Tech, Blacksburg
| | - Douglas R Seals
- From the Department of Integrative Physiology, University of Colorado Boulder (V.E.B., A.G.C., R.A.G.-R., Z.J.S., B.P.Z., Z.S.C., A.E.B., N.S.V., J.J.R., D.A.H., M.C.Z., D.R.S.)
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24
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Lombardo M, Aulisa G, Marcon D, Rizzo G, Tarsisano MG, Di Renzo L, Federici M, Caprio M, De Lorenzo A. Association of Urinary and Plasma Levels of Trimethylamine N-Oxide (TMAO) with Foods. Nutrients 2021; 13:nu13051426. [PMID: 33922680 PMCID: PMC8145508 DOI: 10.3390/nu13051426] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction: Trimethylamine N-oxide (TMAO) may play a key mediator role in the relationship between the diet, gut microbiota and cardiovascular diseases, particularly in people with kidney failure. The aim of this review is to evaluate which foods have a greater influence on blood or urinary trimethylamine N-oxide (TMAO) levels. Methods: 391 language articles were screened, and 27 were analysed and summarized for this review, using the keywords “TMAO” AND “egg” OR “meat” OR “fish” OR “dairy” OR “vegetables” OR “fruit” OR “food” in December 2020. Results: A strong correlation between TMAO and fish consumption, mainly saltwater fish and shellfish, but not freshwater fish, has been demonstrated. Associations of the consumption of eggs, dairy and meat with TMAO are less clear and may depend on other factors such as microbiota or cooking methods. Plant-based foods do not seem to influence TMAO but have been less investigated. Discussion: Consumption of saltwater fish, dark meat fish and shellfish seems to be associated with an increase in urine or plasma TMAO values. Further studies are needed to understand the relationship between increased risk of cardiovascular disease and plasma levels of TMAO due to fish consumption. Interventions coupled with long-term dietary patterns targeting the gut microbiota seem promising.
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Affiliation(s)
- Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy; (G.A.); (D.M.); (M.C.)
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00173 Rome, Italy;
- Correspondence:
| | - Giovanni Aulisa
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy; (G.A.); (D.M.); (M.C.)
| | - Daniele Marcon
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy; (G.A.); (D.M.); (M.C.)
| | - Gianluca Rizzo
- Independent Researcher, via Venezuela 66, 98121 Messina, Italy;
| | - Maria Grazia Tarsisano
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy;
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (A.D.L.)
| | - Massimo Federici
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00173 Rome, Italy;
| | - Massimiliano Caprio
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy; (G.A.); (D.M.); (M.C.)
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, 00166 Rome, Italy
| | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, via Montpellier 1, 00133 Rome, Italy; (L.D.R.); (A.D.L.)
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25
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Sugano M, Matsuoka R. Nutritional Viewpoints on Eggs and Cholesterol. Foods 2021; 10:494. [PMID: 33669005 PMCID: PMC7996514 DOI: 10.3390/foods10030494] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 12/17/2022] Open
Abstract
Although most current epidemiologic studies indicate no significant association between consuming one egg daily and blood cholesterol levels and cardiovascular risk, arguments still persist with a positive association. Since the diet is one of the most influential factors for this association, we illustrate characteristic features in Japanese people whose dietary pattern is distinct from that, for example, the US (United States) population. Available epidemiologic studies in healthy Japanese people show no association between consumption of one egg daily and blood cholesterol level, consistent with those observed in the US population. However, when consumption of major nutrients and food sources of cholesterol are compared to the US population, Japanese people may have an extra-reserve against the influence of eggs on cardiovascular risk markers, despite consuming relatively more eggs. Further discussion on the influence of nutrients contained in the egg and dietary pattern, including interaction with gut microbes, is necessary. In addition, special consideration at the personalized level is needed for judgment regarding dietary cholesterol not only for hypercholesterolemic patients but for hyper-responsive healthy persons. Although randomized controlled trials with long-term follow-up are required to evaluate the association between consumption of eggs and human health, available information, at least from the nutritional viewpoint, suggests that egg is a healthy and cost-efficient food worldwide.
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Affiliation(s)
- Michihiro Sugano
- Kyushu University, Fukuoka 819-0395, Japan;
- Prefectural University of Kumamoto, Kumamoto 862-8502, Japan
- Japan Egg Science Society, Tokyo 182-0002, Japan
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26
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Bays HE, Taub PR, Epstein E, Michos ED, Ferraro RA, Bailey AL, Kelli HM, Ferdinand KC, Echols MR, Weintraub H, Bostrom J, Johnson HM, Hoppe KK, Shapiro MD, German CA, Virani SS, Hussain A, Ballantyne CM, Agha AM, Toth PP. Ten things to know about ten cardiovascular disease risk factors. Am J Prev Cardiol 2021; 5:100149. [PMID: 34327491 PMCID: PMC8315386 DOI: 10.1016/j.ajpc.2021.100149] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Given rapid advancements in medical science, it is often challenging for the busy clinician to remain up-to-date on the fundamental and multifaceted aspects of preventive cardiology and maintain awareness of the latest guidelines applicable to cardiovascular disease (CVD) risk factors. The “American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2021 Update” is a summary document (updated yearly) regarding CVD risk factors. This “ASPC Top Ten CVD Risk Factors 2021 Update” summary document reflects the perspective of the section authors regarding ten things to know about ten sentinel CVD risk factors. It also includes quick access to sentinel references (applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the “ASPC Top Ten CVD Risk Factors 2021 Update” to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.
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Affiliation(s)
- Harold E. Bays
- Medical Director / President, Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY USA
- Corresponding author.
| | - Pam R. Taub
- University of California San Diego Health, San Diego, CA USA
| | | | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard A. Ferraro
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison L. Bailey
- Chief, Cardiology, Centennial Heart at Parkridge, Chattanooga, TN USA
| | - Heval M. Kelli
- Northside Hospital Cardiovascular Institute, Lawrenceville, GA USA
| | - Keith C. Ferdinand
- Professor of Medicine, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA USA
| | - Melvin R. Echols
- Assistant Professor of Medicine, Department of Medicine, Cardiology Division, Morehouse School of Medicine, New Orleans, LA USA
| | - Howard Weintraub
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - John Bostrom
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - Heather M. Johnson
- Christine E. Lynn Women's Health & Wellness Institute, Boca Raton Regional Hospital/Baptist Health South Florida, Clinical Affiliate Associate Professor, Florida Atlantic University, Boca Raton, FL USA
| | - Kara K. Hoppe
- Assistant Professor, Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Charles A. German
- Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Salim S. Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Aliza Hussain
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Christie M. Ballantyne
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Ali M. Agha
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
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