Usual Dietary Intake of Resistant Starch in US Adults from NHANES 2015-2016

Association of Dietary Resistant Starch Intake with Obesity and Metabolic Syndrome in Korean Adults

Research findings on the relationship between dietary resistant starch (RS) intake and metabolic diseases using population-based data are very scarce. This study examined the association of dietary RS intake with obesity and metabolic syndrome in Korean adults. A total of 12,491 adults (5292 men and 7199 women) were selected from the 2016-2018 Korea National Health and Nutrition Examination Survey data. The individual RS intake (g) was calculated by linking the 1-day 24 h recall data with the RS content database for common Korean foods. Obesity was defined as a BMI ≥ 25.0 kg/m2. Metabolic syndrome was defined as having three or more of the following: abdominal obesity, elevated triglycerides, low HDL cholesterol, elevated fasting blood glucose, and elevated blood pressure. Odds ratios (ORs) with 95% confidence intervals (CIs) for obesity and metabolic syndrome across quartiles (Qs) of RS intake were calculated using multiple logistic regression analysis. In men, the highest quartile of RS intake showed a significantly lower OR for metabolic syndrome compared to the lowest quartile after adjusting for covariates (OR = 0.71, 95% CI = 0.56-0.92, p-trend = 0.0057). Dietary RS intake in men was also inversely associated with obesity (Q4 vs. Q1: OR = 0.80, 95% CI = 0.67-0.97, p-trend = 0.0329) and elevated triglycerides (Q4 vs. Q1: OR = 0.80, 95% CI = 0.66-0.98, p-trend = 0.0314). In women, RS intake was not associated with metabolic syndrome. Our findings may serve as useful data for developing guidelines for RS intake and conducting further cohort and clinical studies to investigate the health effects of RS.

Beverage Consumption Patterns among U.S. Adolescents and Adults from a New 24-h Beverage Recall Survey Compared to the National Health and Nutrition Examination Survey (NHANES) 2017-2018

Beverages are major dietary components of the United States (U.S.) population. Understanding the current consumption pattern of beverages is an important element in supporting healthy diets. Our objective was to assess the validity of the 24-h beverage consumption recall data collected in 2021 through a self-administered online questionnaire (referred to as the American Beverage Association-Brandscapes Worldwide survey, ABA-BSW) by comparing it to the 24-h dietary recall data collected in the 2017-2018 National Health and Nutrition Examination Survey (NHANES). Summary statistics on the reported consumption amounts and consumption occasions (COs) of 13 beverage types (e.g., bottled water, carbonated soft drinks (CSD), tea, and others) by participants aged 13-64 years were compared between ABA-BSW (n = 20,553) and NHANES (n = 4437). The average daily consumption amount among consumers of all 13 beverage types combined was higher in ABA-BSW than in NHANES (1903 mL/day vs. 1704 mL/day). Within each beverage type, the average daily consumption amounts among consumers were generally lower in ABA-BSW except for CSD, plant-based drinks, and still juices and fruit-flavored drinks. Compared to NHANES, ABA-BSW participants reported consuming a wider variety of beverage groups, a higher number of COs per day, and lower consumption amounts within a given CO. Overall, beverage consumption patterns observed in ABA-BSW and NHANES were generally similar, supporting the design and implementation of the former survey. Further, the ABA-BSW data provide additional information on the within-day temporal beverage consumption patterns among adolescents and adults in the U.S. Differences in the observed consumption patterns between the surveys may be the result of various factors, including the survey implementation method, a consumption pattern shift between the survey time periods, beverage type availability, and impact of the COVID-19 pandemic on dietary patterns.

Optimizing human performance in extreme environments through precision medicine: From spaceflight to high-performance operations on Earth

Humans operating in extreme environments often conduct their operations at the edges of the limits of human performance. Sometimes, they are required to push these limits to previously unattained levels. As a result, their margins for error in execution are much smaller than that found in the general public. These same small margins for error that impact execution may also impact risk, safety, health, and even survival. Thus, humans operating in extreme environments have a need for greater refinement in their preparation, training, fitness, and medical care. Precision medicine (PM) is uniquely suited to address the needs of those engaged in these extreme operations because of its depth of molecular analysis, derived precision countermeasures, and ability to match each individual (and his or her specific molecular phenotype) with any given operating context (environment). Herein, we present an overview of a systems approach to PM in extreme environments, which affords clinicians one method to contextualize the inputs, processes, and outputs that can form the basis of a formal practice. For the sake of brevity, this overview is focused on molecular dynamics, while providing only a brief introduction to the also important physiologic and behavioral phenotypes in PM. Moreover, rather than a full review, it highlights important concepts, while using only selected citations to illustrate those concepts. It further explores, by demonstration, the basic principles of using functionally characterized molecular networks to guide the practical application of PM in extreme environments. At its core, PM in extreme environments is about attention to incremental gains and losses in molecular network efficiency that can scale to produce notable changes in health and performance. The aim of this overview is to provide a conceptual overview of one approach to PM in extreme environments, coupled with a selected suite of practical considerations for molecular profiling and countermeasures.

Resistant starch improves cardiometabolic disease outcomes: A narrative review of randomized trials

Healthy dietary patterns with adequate fiber improve cardiometabolic (CM) outcomes and attenuate disease progression. Resistant starch (RS) is a fermentable fiber that affects CM outcomes; however, studies are heterogeneous and inconsistent. Thus, the purpose of this narrative review is to assess the impact of RS intake by type and amount on CM outcomes while considering subject characteristics and trial duration. Randomized crossover or parallel studies (n = 31) were selected and compared according to acute (1 day; n = 12), medium (>1-30 days; n = 8), or long (>30 days; n = 11) duration. Most acute trials in healthy adults showed improvements in postprandial glycemic outcomes irrespective of RS type or amount. However, a more pronounced reduction occurred when test meals did not match for available carbohydrate. Daily RS intake had a minimal effect on CM outcomes in medium duration trials, but insulin resistant adults had better glycemic control at 4 weeks. Several longer duration trials (8-12 weeks) showed favorable CM outcomes with daily RS intake in adults with type 2 diabetes (T2D), but not in those at risk for T2D. Furthermore, some studies reported improved lipids, inflammatory biomarkers, and heart rate. Future studies should consider matching for available carbohydrates between the RS and control groups to understand the gut microbiome's role. Furthermore, energy and fiber should be considered. Overall, the acute intake of RS improves glycemic outcomes, and consuming RS at for least 4 and up to 8 to 12 weeks in adults with prediabetes and T2D, respectively, appears to improve CM outcomes.

Consumption of Solnul™ Resistant Potato Starch Produces a Prebiotic Effect in a Randomized, Placebo-Controlled Clinical Trial

The effects of resistant starch at high doses have been well-characterized, but the potential prebiotic effects of resistant starch at doses comparable to oligosaccharide prebiotics have not been evaluated. A three-arm randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the effect of 3.5 g and 7 g daily doses of Solnul^™ resistant potato starch (RPS) on beneficial populations of gut bacteria and stool consistency after a 4-week period. The relative abundance of Bifidobacterium and Akkermansia was determined by employing 16Sv4 sequencing of stool samples. To assess the effect of RPS on laxation and bowel movements, stools were recorded and scored using the Bristol Stool Form Scale. Participants consuming 3.5 g/day of RPS experienced significantly greater changes in Bifidobacterium and Akkermansia compared to the placebo after 4 weeks. The number of diarrhea- and constipation-associated bowel movements were both significantly lower in the 3.5 g RPS arm compared to the placebo group. Participants consuming 7 g of RPS responded similarly to those in the 3.5 g arm. Our analyses demonstrate that Solnul^™ RPS has a prebiotic effect when consumed for 4 weeks at the 3.5 g per day dose, stimulating increases in beneficial health-associated bacteria and reducing diarrhea- and constipation-associated bowel movements when compared to the placebo group.

The association of dietary resistance starch intake with all-cause and cause-specific mortality

Background

Several studies have estimated daily intake of resistant starch (RS), but no studies have investigated the relationship of RS intake with mortality.

Objective

We aimed to examine associations between RS intake and all-cause and cause-specific mortality.

Methods

Data from US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 with 24-h dietary recall data was used in current study. The main exposure in this study was RS intake, and the main outcome was the mortality status of participants until December 31, 2019. The multivariable Cox proportional hazards regression models were developed to evaluate the hazard ratios (HRs) and 95% confidence interval (95% CI) of cardiovascular disease (CVD), cancer, and all-cause mortality associated with RS intake.

Results

A total of 42,586 US adults [mean (SD) age, 46.91 (16.88) years; 22,328 (52.43%) female] were included in the present analysis. During the 454,252 person-years of follow-up, 7,043 all-cause deaths occurred, including 1,809 deaths from CVD and 1,574 deaths from cancer. The multivariable-adjusted HRs for CVD, cancer, and all-cause mortality per quintile increase in RS intake were 1 (95%CI, 0.97-1.04), 0.96 (95%CI, 0.93-1), and 0.96 (95%CI, 0.95-0.98), respectively. The associations remained similar in the subgroup and sensitivity analyses.

Conclusion

Higher RS intake is significantly associated with lower cancer and all-cause mortality, but not significantly with CVD mortality. Future studies focusing on other populations with different food sources of RS and RS subtypes are needed to access the dose-response relationship and to improve global dietary recommendations.

Resistant Starch as a Dietary Intervention to Limit the Progression of Diabetic Kidney Disease

Diabetes is the leading cause of kidney disease, and as the number of individuals with diabetes increases there is a concomitant increase in the prevalence of diabetic kidney disease (DKD). Diabetes contributes to the development of DKD through a number of pathways, including inflammation, oxidative stress, and the gut-kidney axis, which may be amenable to dietary therapy. Resistant starch (RS) is a dietary fibre that alters the gut microbial consortium, leading to an increase in the microbial production of short chain fatty acids. Evidence from animal and human studies indicate that short chain fatty acids are able to attenuate inflammatory and oxidative stress pathways, which may mitigate the progression of DKD. In this review, we evaluate and summarise the evidence from both preclinical models of DKD and clinical trials that have utilised RS as a dietary therapy to limit the progression of DKD.

Cancer Prevention with Resistant Starch in Lynch Syndrome Patients in the CAPP2-Randomized Placebo Controlled Trial: Planned 10-Year Follow-up

ABSTRACT

The CAPP2 trial investigated the long-term effects of aspirin and resistant starch on cancer incidence in patients with Lynch syndrome (LS). Participants with LS were randomized double-blind to 30 g resistant starch (RS) daily or placebo for up to 4 years. We present long-term cancer outcomes based on the planned 10-year follow-up from recruitment, supplemented by National Cancer Registry data to 20 years in England, Wales, and Finland. Overall, 463 participants received RS and 455 participants received placebo. After up to 20 years follow-up, there was no difference in colorectal cancer incidence (n = 52 diagnosed with colorectal cancer among those randomized to RS against n = 53 on placebo) but fewer participants had non-colorectal LS cancers in those randomized to RS (n = 27) compared with placebo (n = 48); intention-to-treat (ITT) analysis [HR, 0.54; 95% confidence interval (CI), 0.33-0.86; P = 0.010]. In ITT analysis, allowing for multiple primary cancer diagnoses among participants by calculating incidence rate ratios (IRR) confirmed the protective effect of RS against non-colorectal cancer LS cancers (IRR, 0.52; 95% CI, 0.32-0.84; P = 0.0075). These effects are particularly pronounced for cancers of the upper GI tract; 5 diagnoses in those on RS versus 21 diagnoses on placebo. The reduction in non-colorectal cancer LS cancers was detectable in the first 10 years and continued in the next decade. For colorectal cancer, ITT analysis showed no effect of RS on colorectal cancer risk (HR, 0.92; 95% CI, 0.62-1.34; P = 0.63). There was no interaction between aspirin and RS treatments. In conclusion, 30 g daily RS appears to have a substantial protective effect against non-colorectal cancer cancers for patients with LS.

PREVENTION RELEVANCE

Regular bowel screening and aspirin reduce colorectal cancer among patients with LS but extracolonic cancers are difficult to detect and manage. This study suggests that RS reduces morbidity associated with extracolonic cancers. See related Spotlight, p. 557.

Daily Inclusion of Resistant Starch-Containing Potatoes in a Dietary Guidelines for Americans Dietary Pattern Does Not Adversely Affect Cardiometabolic Risk or Intestinal Permeability in Adults with Metabolic Syndrome: A Randomized Controlled Trial

Poor diet quality influences cardiometabolic risk. Although potatoes are suggested to adversely affect cardiometabolic health, controlled trials that can establish causality are limited. Consistent with potatoes being rich in micronutrients and resistant starch, we hypothesized that their inclusion in a Dietary Guidelines for Americans (DGA)-based dietary pattern would improve cardiometabolic and gut health in metabolic syndrome (MetS) persons. In a randomized cross-over trial, MetS persons (n = 27; 32.5 ± 1.3 year) consumed a DGA-based diet for 2 weeks containing potatoes (DGA + POTATO; 17.5 g/day resistant starch) or bagels (DGA + BAGEL; 0 g/day resistant starch) prior to completing oral glucose and gut permeability tests. Blood pressure, fasting glucose and insulin, and insulin resistance decreased (p < 0.05) from baseline regardless of treatment without any change in body mass. Oral glucose-induced changes in brachial artery flow-mediated dilation, nitric oxide homeostasis, and lipid peroxidation did not differ between treatment arms. Serum endotoxin AUC0−120 min and urinary lactulose/mannitol, but not urinary sucralose/erythritol, were lower in DGA + POTATO. Fecal microbiome showed limited between-treatment differences, but the proportion of acetate was higher in DGA + POTATO. Thus, short-term consumption of a DGA-based diet decreases cardiometabolic risk, and the incorporation of resistant starch-containing potatoes into a healthy diet reduces small intestinal permeability and postprandial endotoxemia.

Does a high dietary intake of resistant starch affect glycaemic control and alter the gut microbiome in women with gestational diabetes? A randomised control trial protocol

BACKGROUND

Gestational Diabetes Mellitus (GDM) is prevalent with lasting health implications for the mother and offspring. Medical nutrition therapy is the foundation of GDM management yet achieving optimal glycaemic control often requires treatment with medications, like insulin. New dietary strategies to improve GDM management and outcomes are required. Gut dysbiosis is a feature of GDM pregnancies, therefore, dietary manipulation of the gut microbiota may offer a new avenue for management. Resistant starch is a fermentable dietary fibre known to alter the gut microbiota and enhance production of short-chain fatty acids. Evidence suggests that short-chain fatty acids improve glycaemia via multiple mechanisms, however, this has not been evaluated in GDM.

METHODS

An open-label, parallel-group design study will investigate whether a high dietary resistant starch intake or resistant starch supplement improves glycaemic control and changes the gut microbiome compared with standard dietary advice in women with newly diagnosed GDM. Ninety women will be randomised to one of three groups - standard dietary treatment for GDM (Control), a high resistant starch diet or a high resistant starch diet plus a 16 g resistant starch supplement. Measurements taken at Baseline (24 to 30-weeks' gestation), Day 10 and Day 56 (approximately 36 weeks' gestation) will include fasting plasma glucose levels, microbial composition and short-chain fatty acid concentrations in stool, 3-day dietary intake records and bowel symptoms questionnaires. One-week post-natal data collection will include microbial composition and short-chain fatty acid concentrations of maternal and neonatal stools, microbial composition of breastmilk, birthweight, maternal and neonatal outcomes. Mixed model analysis of variance will assess change in glycaemia and permutation-based multivariate analysis of variance will assess changes in microbial composition within and between intervention groups. Distance-based linear modelling will identify correlation between change in stool microbiota, short-chain fatty acids and measures of glycaemia.

DISCUSSION

To improve outcomes for GDM dyads, evaluation of a high dietary intake of resistant starch to improve glycaemia through the gut microbiome needs to be established. This will expand the dietary interventions available to manage GDM without medication.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry, ACTRN12620000968976p . Registered 28 September 2020.

Precision Nutrition Model Predicts Glucose Control of Overweight Females Following the Consumption of Potatoes High in Resistant Starch

Individual glycemic responses following dietary intake result from complex physiological processes, and can be influenced by physical properties of foods, such as increased resistant starch (RS) from starch retrogradation. Predictive equations are needed to provide personalized dietary recommendations to reduce chronic disease development. Therefore, a precision nutrition model predicting the postprandial glucose response (PPGR) in overweight women following the consumption of potatoes was formulated. Thirty overweight women participated in this randomized crossover trial. Participants consumed 250 g of hot (9.2 g RS) or cold (13.7 g RS) potatoes on two separate occasions. Baseline characteristics included demographics, 10-day dietary records, body composition, and the relative abundance (RA) and α-diversity of gut microbiota. Elastic net regression using 5-fold cross-validation predicted PPGR after potato intake. Most participants (70%) had a favorable PPGR to the cold potato. The model explained 32.2% of the variance in PPGR with the equation: 547.65 × (0 [if cold, high-RS potato], ×1, if hot, low-RS potato]) + (BMI [kg/m²] × 40.66)—(insoluble fiber [g] × 49.35) + (Bacteroides [RA] × 8.69)—(Faecalibacterium [RA] × 73.49)—(Parabacteroides [RA] × 42.08) + (α-diversity × 110.87) + 292.52. This model improves the understanding of baseline characteristics that explain interpersonal variation in PPGR following potato intake and offers a tool to optimize dietary recommendations for a commonly consumed food.

Pasta from yellow lentils: How process affects starch features and pasta quality

The effects of conventional extrusion (CV) and extrusion-cooking (EC) were investigated on 100% yellow lentils (YL). Both the extrusion processes led to pasta with good cooking quality (cooking loss: 7.0-7.1 g/100 g, firmness: 530-608 N), even in overcooking (cooking loss: 7.7-7.9 g/100 g, firmness: 418-513 N). Contrary to what is known for gluten-free cereals, CV is effective in producing pasta from native YL with no need for a pre-gelatinization step. However, pasta from EC showed a higher compression energy (2898 versus 2448 N*mm). In this sample, starch presented a higher degree of gelatinization (75.5 versus 57.6 g/100 g) and lower enthalpy (0.97 versus 1.07 J/g). At the same time, EC promoted a more compact structure that required higher temperature for melting (66.49 versus 63.16 °C) and showing pasting properties (79.1 versus 74.7 °C). Thus, by selecting suitable extrusion conditions it is possible to improve the cooking behavior of 100% pulse pasta.

Potential Application of Resistant Starch Sorghum in Gluten-Free Pasta: Nutritional, Structural and Sensory Evaluations

Gluten-free (GF) pasta samples containing rice flour replaced with 0, 5, 10, 15 g/100 g (w/w) of a resistant starch ingredient from annealed sorghum starch (annRS) were formulated. The highest total dietary fiber and RS contents (p < 0.05) were measured in uncooked pasta with 15 g/100 g of annRS addition (15-annRS). After cooking, the 15-annRS pasta was characterized by an RS content of 5.8 g/100 g dry matter, confirming the thermal resistance of annRS. The use of annRS positively influenced the optimal cooking time, the cooking loss, the firmness, and the stickiness of the cooked samples, with not remarkably change in color after cooking. The starch hydrolysis index values decreased as the level of annRS increased. Despite a significant decrease in the overall sensory with increasing levels of annRS, all samples were characterized by a value > 5, which is considered the limit of acceptability. The use of annRS in GF pasta up to 15 g/100 g can contribute to creating GF products with high total dietary fiber content, slowly digestible starch properties, and without drastically compromising the sensory attributes.