Intake of whole grains is associated with lower risk of myocardial infarction: the Danish Diet, Cancer and Health Cohort

Whole-grain intake in mid-life and healthy ageing in the Danish Diet, Cancer and Health cohort

PURPOSE

Growing elderly populations worldwide have sparked interest in factors promoting healthy aging. Diet and other lifestyle patterns are key factors for healthy ageing; however, evidence is sparse for specific dietary guidelines that are easily implemented in everyday life. Whole grains constitute specific dietary components with unexplored potential in healthy ageing.

METHODS

We applied an illness-death multistate model to assess the association between whole-grain intake and life expectancy, both with and without disease, over a 20-year period. Healthy ageing was defined as absence of cancer, ischemic heart disease, stroke, type 2 diabetes, asthma, chronic obstructive pulmonary disease, and dementia during follow-up.

RESULTS

Based on information from 22,606 men and 25,468 women in the Danish Diet, Cancer and Health cohort, followed for an average of 13.8 and 17.5 years, respectively, a doubling in whole-grain intake was associated with 0.43 (95% CI: 0.33-0.52) and 0.15 (0.06-0.24) additional years without disease for men and women, respectively. Comparing the highest and lowest quartiles of whole-grain intake, with a special emphasis on men, we found that those with the highest intake lived, on average, one year longer without disease compared to those with the lowest intake. Additionally, although a high intake of whole grains yielded longer life expectancy, the duration of living with disease was shorter.

CONCLUSION

Intake of whole grains in mid-life was associated with healthy ageing looking 20 years ahead.

Estimating effects of whole grain consumption on type 2 diabetes, colorectal cancer and cardiovascular disease: a burden of proof study

BACKGROUND

Previous studies on whole grain consumption had inconsistent findings and lacked quantitative assessments of evidence quality. Therefore, we aimed to summarize updated findings using the Burden of Proof analysis (BPRF) to investigate the relationship of whole grain consumption on type 2 diabetes (T2D), colorectal cancer (CRC), stroke, and ischemic heart disease (IHD).

METHODS

We conducted a literature search in the Medline and Web of Science up to June 12, 2023, to identify related cohort studies and systematic reviews. The mean RR (relative risk) curve and uncertainty intervals (UIs), BPRF function, risk-outcome score (ROS), and the theoretical minimum risk exposure level (TMREL) were estimated to evaluate the level of four risk-outcome pairs.

RESULTS

In total, 27 prospective cohorts were included in our analysis. Consuming whole grain at the range of TMREL (118.5-148.1 g per day) was associated with lower risks: T2D (declined by 37.3%, 95% UI: 5.8 to 59.5), CRC (declined by 17.3%, 6.5 to 27.7), stroke (declined by 21.8%, 7.3 to 35.1), and IHD (declined by 36.9%, 7.1 to 58.0). For all outcomes except stroke, we observed a non-linear, monotonic decrease as whole grain consumption increased; For stroke, it followed a J-shaped curve (the greatest decline in the risk of stroke at consuming 100 g whole grain for a day). The relationships between whole grain consumption and four diseases are all two-star pairs (ROS: 0.087, 0.068, 0.062, 0.095 for T2D, CRC, stroke, and IHD, respectively).

CONCLUSION

Consuming 100 g of whole grains per day offers broad protective benefits. However, exceeding this threshold may diminish the protective effects against stroke. Our findings endorse replacing refined grains with whole grains as the main source of daily carbohydrates. REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: We have registered our research in PROSPERO, and the identifier of our meta-analyses is CRD42023447345.

Metabolic changes in response to varying whole-grain wheat and rye intake

Epidemiological studies have shown associations between whole-grain intake and lowered disease risk. A sufficient level of whole-grain intake to reach the health benefits has not been established, and there is limited knowledge about the impact of whole-grain intake on metabolite levels. In this clinical intervention study, we aimed to identify plasma and urine metabolites associated with two different intake levels of whole-grain wheat and rye and to correlate them with clinical plasma biomarkers. Healthy volunteers (N = 68) were divided into two groups receiving either whole-grain wheat or whole-grain rye in two four-week interventions with 48 and 96 g/d of whole grains consumed. The metabolomics of the plasma samples was performed with UPLC-QTOF-MS. Plasma alkylresorcinols were quantified with GC-MS and plasma and urinary mammalian lignans with HPLC-ECD. The high-dose intervention impacted the metabolite profile, including microbial metabolites, more in the rye-enriched diet compared with wheat. Among the increased metabolites were alkylresorcinol glucuronides, sinapyl alcohol, and pipecolic acid betaine, while the decreased metabolites included acylcarnitines and ether lipids. Plasma alkylresorcinols, urinary enterolactone, and total mammalian lignans reflected the study diets in a dose-dependent manner. Several key metabolites linked with whole-grain consumption and gut microbial metabolism increased in a linear manner between the two interventions. The results reveal that an increase in whole-grain intake, particularly rye, is strongly reflected in the metabolite profile, is correlated with clinical variables, and suggests that a diet rich in whole grains promotes the growth and/or metabolism of microbes producing potentially beneficial microbial metabolites.

Overview on the Polyphenol Avenanthramide in Oats (Avena sativa Linn.) as Regulators of PI3K Signaling in the Management of Neurodegenerative Diseases

Avenanthramides (Avns) and their derivatives, a group of polyphenolic compounds found abundantly in oats (Avena sativa Linn.), have emerged as promising candidates for neuroprotection due to their immense antioxidant, anti-inflammatory, and anti-apoptotic properties. Neurodegenerative diseases (NDDs), characterized by the progressive degeneration of neurons, present a significant global health burden with limited therapeutic options. The phosphoinositide 3-kinase (PI3K) signaling pathway plays a crucial role in cell survival, growth, and metabolism, making it an attractive target for therapeutic intervention. The dysregulation of PI3K signaling has been implicated in the pathogenesis of various NDDs including Alzheimer's and Parkinson's disease. Avns have been shown to modulate PI3K/AKT signaling, leading to increased neuronal survival, reduced oxidative stress, and improved cognitive function. This review explores the potential of Avn polyphenols as modulators of the PI3K signaling pathway, focusing on their beneficial effects against NDDs. Further, we outline the need for clinical exploration to elucidate the specific mechanisms of Avn action on the PI3K/AKT pathway and its potential interactions with other signaling cascades involved in neurodegeneration. Based on the available literature, using relevant keywords from Google Scholar, PubMed, Scopus, Science Direct, and Web of Science, our review emphasizes the potential of using Avns as a therapeutic strategy for NDDs and warrants further investigation and clinical exploration.

Cereal intake and mortality in older Chinese: a 15-year follow-up of a prospective cohort study

PURPOSE

We examined the association between whole grain and refined grain intake with all-cause, cancer and cardiovascular disease (CVD) mortality using the data from the Guangzhou Biobank Cohort Study.

METHODS

19,597 participants aged 50+ years were recruited from 2003 to 2006 and followed-up until April 2021. Multivariable Cox regression was used to calculate hazard radios (HRs) and 95% confidence intervals (CIs). Substitution analysis was used to replace a serving (50 g/day) of whole grain with a serving of refined grain.

RESULTS

During 286,821 person-years of follow-up, 4385 deaths occurred, including 1450 from cancer, 1678 from CVD and 1257 from other causes. Compared with never whole grain intake, the highest intake category of whole grain (> 300 g/week) was associated with lower risk of all-cause (HR 0.90, 95% CI 0.82-0.98) and CVD mortality (HR 0.85, 0.74-0.98). Compared with the low-intake category of refined grain (< 500 g/day), the highest intake category (> 900 g/week) was associated with a lower risk of cancer mortality (HR 0.76, 0.62-0.95), but a higher risk of CVD mortality (HR 1.25, 1.03-1.51). No significant associations were found between whole grain intake and cancer mortality nor refined grain and all-cause mortality. The HRs of all-cause, cancer and CVD mortality substituting a serving of whole grain for refined grain were 0.96 (0.94-0.99), 1.01 (0.99-1.02) and 0.95 (0.90-0.99), respectively.

CONCLUSION

We have first shown that in older Chinese, whole grain intake was associated with lower risk of all-cause and CVD mortality. Our results suggest that intake of whole grain of at least 300 g/week and refined grain of ≤ 900 g/day might be suitable for older Asian. Substituting 50 g/day of whole grain for refined grain was associated with a 4-5% lower risk of all-cause and CVD mortality.

Adherence to the EAT-Lancet diet and risk of coronary events in the Malmö Diet and Cancer cohort study

BACKGROUND

The EAT-Lancet Commission proposed a globally environmentally sustainable dietary pattern featuring mainly plant-based foods in 2019. However, evidence on this dietary pattern in preventing coronary events is minimal.

OBJECTIVES

We aimed to examine the association between the EAT-Lancet diet and risk of coronary events.

METHODS

The Malmö Diet and Cancer cohort study (recruited between 1991 and 1996) included 23,877 participants aged 44.5-73.6 y (62.5% women) without CVDs and diabetes at baseline. A modified diet history was used to collect the dietary data. An EAT-Lancet diet index (range, 0-42 points) was applied on the basis of 14 food components scored 0 (nonadherence) to 3 (adherence). Coronary events were extracted from the registers. Cox proportional hazards models were used to estimate the HRs and 95% confidential intervals (CIs).

RESULTS

Over a median of 24.9 y of follow-up, 3031 coronary events occurred (incidence rate: 5.89/1000 person-years). After adjusting for age, sex, dietary assessment methods, season, total energy intake, leisure-time physical activity, alcohol consumption, smoking status, educational level, and BMI, the multivariable HR (95% CI) for coronary events among participants who had the highest adherence to the EAT-Lancet diet index (≥23 points, 8.1%) was 0.80 (0.67, 0.96) compared with those who had the lowest adherence (≤13 points, 9.7%) (P-trend = 0.01 across 5 groups of the EAT-Lancet diet). The inverse association was consistent in men and women and was robust after excluding those with misreported energy and significant diet changes or excluding coronary events occurred within the first 2 y of follow-up.

CONCLUSIONS

Our data indicate that adherence to the EAT-Lancet diet was associated with a lower risk of coronary events.

Sprouting and Hydrolysis as Biotechnological Tools for Development of Nutraceutical Ingredients from Oat Grain and Hull

Oat consumption has increased during the last decade because of the health benefits associated with its soluble dietary fiber (β-glucan), functional proteins, lipids, and the presence of specific phytochemicals, such as avenanthramides. Oat is consumed mainly as whole grain, and the hull (seed coat), comprising 25–35% of the entire grain, is removed, generating a large amount of waste/by-product from the milling industry. The objective of this study was to evaluate the use of biotechnological strategies, such as sprouting for oat grain (OG) and hydrolysis for oat hull (OH), to enhance antioxidant and anti-inflammatory properties and lower the glycemic index (GI). Sprouting produced significant (p ≤ 0.05) increases in free (32.10 to 76.62 mg GAE (100 g)−1) and bound phenols (60.45 to 124.36 mg GAE (100 g)−1), increasing significantly (p ≤ 0.05) the avenanthramide (2c, 2p and 2f) soluble phenolic alkaloid content and anti-inflammatory properties of OG. On the other hand, the hydrolysis of OH using Viscoferm (EH2-OH) and Ultraflo XL (EH21-OH) increased by 4.5 and 5-fold the release of bound phenols, respectively; meanwhile, the use of Viscoferm increased the 4.55-fold soluble β-glucan content in OH, reaching values close to those of OG (4.04 vs. 4.46 g (100 g)−1). The study shows the potential of both strategies to enhance the nutritional and bioactive properties of OG and OH and describes these processes as feasible for the industry to obtain an ingredient with high antioxidant and anti-inflammatory activities. Single or combined biotechnological tools can be used on oat grains and hulls to provide nutraceutical ingredients.

Research of the influence of xanthan gum on rheological properties of dough and quality of bread made from sprouted wheat grain

The effect of microbial polysaccharide xanthan in the amount of 0.1-0.4% on the rheological characteristics of the dough from sprouted wheat grain and quality indicators of bread was studied. It was found that when xanthan gum is added, the dough's spreading and adhesion strength decreases, and the dough's resilience-elastic and plastic-viscous characteristics improve. Bread made from sprouted wheat grains with the addition of experimental dosages of xanthan has better structural-mechanical and physicochemical properties, as evidenced by higher indicators of crumb compressibility, specific volume, and moisture compared to the control sample. To obtain bread with the best quality indicators, it is recommended to use 0.3% xanthan.

Effect of oat supplementation interventions on cardiovascular disease risk markers: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

Oat supplementation interventions (OSIs) may have a beneficial effect on cardiovascular disease (CVD) risk. However, dietary background can modulate such effect. This systematic review assesses the effects of OSIs on CVD risk markers among adults, accounting for different dietary backgrounds or control arms.

METHODS

We included randomized clinical trials (RCTs) that assessed the effect of oat, oat beta-glucan-rich extracts or avenanthramides on CVD risk markers.

RESULTS

Seventy-four RCTs, including 4937 predominantly hypercholesterolemic, obese subjects, with mild metabolic disturbances, were included in the systematic review. Of these, 59 RCTs contributed to the meta-analyses. Subjects receiving an OSI, compared to control arms without oats, had improved levels of total cholesterol (TC) [weighted mean difference and (95% CI) - 0.42 mmol/L, (- 0.61; - 0.22)], LDL cholesterol [- 0.29 mmol/L, (- 0.37; - 0.20)], glucose [- 0.25 nmol/L, (- 0.36; - 0.14)], body mass index [- 0.13 kg/m2, (- 0.26; - 0.01)], weight [- 0.94 kg, (- 1.84: - 0.05)], and waist circumference [- 1.06 cm, (- 1.85; - 0.27)]. RCTs on inflammation and/or oxidative stress markers were scarce and with inconsistent findings. RCTs comparing an OSI to heterogeneous interventions (e.g., wheat, eggs, rice, etc.), showed lowered levels of glycated haemoglobin, diastolic blood pressure, HDL cholesterol and apolipoprotein B. The majority of included RCTs (81.1%) had some concerns for risk of bias.

CONCLUSION

Dietary OSIs resulted in lowered levels of blood lipids and improvements in anthropometric parameters among participants with predominantly mild metabolic disturbances, regardless of dietary background or control. Further high-quality trials are warranted to establish the role of OSIs on blood pressure, glucose homeostasis and inflammation markers.

Oat Intake and Risk of Type 2 Diabetes, Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Meta-Analysis

Cardiovascular disease (CVD) and type 2 diabetes (T2D) remain the top disease and mortality burdens worldwide. Oats have been shown to benefit cardiovascular health and improve insulin resistance. However, the evidence linking oat consumption with CVD, T2D and all-cause mortality remains inconclusive. We conducted a comprehensive systematic review and meta-analysis of prospective cohort studies to evaluate the associations between oat consumption and risks of T2D, CVD and all-cause mortality in the general population. Five electronic databases were searched until September, 2020. Study specific relative risks (RR) were meta-analyzed using random effect models. Of 4686 relevant references, we included 9 articles, based on 8 unique studies and 471,157 participants. Comparing oat consumers versus non-consumers, RRs were 0.86 (95% CI 0.72–1.03) for T2D incidence and 0.73 (95% CI 0.5–1.07) for combined CVD incidence. Comparing participants with highest versus lowest oat intake, RRs were 0.78 (95% CI 0.74–0.82) for T2D incidence, 0.81 (95% CI 0.61–1.08) for CHD incidence and 0.79 (95% CI 0.59–1.07) for stroke. For all-cause mortality one study based on three cohorts found RR for men and women were 0.76 (95% CI 0.69–0.85) and 0.78 (95% CI 0.70–0.87), respectively. Most studies (n = 6) were of fair to good quality. This meta-analysis suggests that consumption of oat could reduce the risk for T2D and all-cause mortality, while no significant association was found for CVD. Future studies should address a lack of standardized methods in assessing overall oat intake and type of oat products, and investigate a dose-dependent response of oat products on cardiometabolic outcomes in order to introduce oat as preventive and treatment options for the public.

Novel Steroidal Saponins in Oat Identified by Molecular Networking Analysis and Their Levels in Commercial Oat Products

Through the use of the Global Natural Product Social (GNPS) feature-based networking system, a series of newly identified steroidal saponins were discovered in oat. The structures of the three new major steroidal saponins, sativacosides A-C (1-3), were characterized by analyzing their high-resolution MS, 1D and 2D NMR spectra, and an additional eight new steroidal saponins were also tentatively identified (4-11) based on their tandem mass spectra and typical fragments. Using ultrahigh-performance liquid chromatography with tandem mass spectrometry techniques, a complete profile of the new sativacoside series was established, and the contents of sativacosides A-C were quantified in 18 different commercial oat products. The total levels of sativacosides A-C varied from 62.2 to 192.9 μg/g in these 18 products, in which oat bran (11 samples) and oatmeal (3 samples) had higher levels than cold oat cereal (4 samples).

Recent Molecular Mechanisms and Beneficial Effects of Phytochemicals and Plant-Based Whole Foods in Reducing LDL-C and Preventing Cardiovascular Disease

Abnormal lipid metabolism leads to the development of hyperlipidemia, a common cause of multiple chronic disorders, including cardiovascular disease (CVD), obesity, diabetes, and cerebrovascular disease. Low-density lipoprotein cholesterol (LDL-C) currently remains the primary target for treatment of hyperlipidemia. Despite the advancement of treatment and prevention of hyperlipidemia, medications used to manage hyperlipidemia are limited to allopathic drugs, which present certain limitations and adverse effects. Increasing evidence indicates that utilization of phytochemicals and plant-based whole foods is an alternative and promising strategy to prevent hyperlipidemia and CVD. The current review focuses on phytochemicals and their pharmacological mode of actions for the regulation of LDL-C and prevention of CVD. The important molecular mechanisms illustrated in detail in this review include elevation of reverse cholesterol transport, inhibition of intestinal cholesterol absorption, acceleration of cholesterol excretion in the liver, and reduction of cholesterol synthesis. Moreover, the beneficial effects of plant-based whole foods, such as fresh fruits, vegetables, dried nuts, flax seeds, whole grains, peas, beans, vegan diets, and dietary fibers in LDL-C reduction and cardiovascular health are summarized. This review concludes that phytochemicals and plant-based whole foods can reduce LDL-C levels and lower the risk for CVD.

High-quality intake of carbohydrates is associated with lower prevalence of subclinical atherosclerosis in femoral arteries: The AWHS study

BACKGROUND AND AIMS

High-quality of the carbohydrates consumed, apart from their total amount, appear to protect from cardiovascular disease (CVD). However, the relationship between the quality of carbohydrates and the early appearance of atherosclerosis has not yet been described. Our objective was to estimate the association between the quality of dietary carbohydrates and subclinical atherosclerosis in femoral and carotid arteries.

METHODS

Cross-sectional study of femoral and carotid atherosclerosis assessed using ultrasounds of 2074 middle-aged males, 50.9 (SD 3.9) years old, with no previous CVD, and pertaining to the Aragon Workers' Health Study (AWHS) cohort. Food frequency questionnaires were used to calculate a carbohydrate quality index (CQI) defined as: consumption of dietary fiber, a lower glycemic index, the ratio of whole grains/total grains, and the ratio of solid carbohydrates/total carbohydrates. The presence of plaques across four CQI intervals was studied using adjusted logistic regression models.

RESULTS

The CQI showed a direct inverse association with subclinical atherosclerosis in femoral territories. Participants with a higher consumption of high-quality carbohydrates (13-15 points) were less likely to have femoral plaques when compared with participants in the lowest index interval (4-6 points) (OR = 0.59; 95% CI = 0.39, 0.89; p = 0.005). No association was found between the CQI and the presence of subclinical atherosclerosis in carotid territories. A lower consumption of high-quality carbohydrates tended to be associated with a greater atherosclerosis extension, considered as the odds for having more affected territories (p = 0.011).

CONCLUSIONS

Among middle-aged males, a high-quality intake of carbohydrates is associated with a lower prevalence of femoral artery subclinical atherosclerosis when compared with a lower consumption. Thus, indicating an early relationship between the quality of carbohydrates and the development of CVD.

Consumer sensory evaluation and quality of Sorghum-Peanut Meal-Okra snacks

Healthful tasty high protein, vegetable, gluten-free snacks are needed for all as well as those sensitive to gluten for in between meals and for after school events. Peanut meal a low value farm by-product was used to increase protein content and to add value for growers. Bile acid binding okra with cholesterol lowering potential and jalapeno, turmeric and ginger with healthy phytonutrients were included to increase vegetable consumption. The objective was to have healthy tasty snacks with ≥24% protein content. Gluten-free, whole grain, high protein, Sorghum-Peanut meal-Okra (SPO) and SPO-Jalapeno, SPO-Turmeric root and SPO-Ginger root snacks were sensory evaluated by 73 volunteers. Physical testing of the snacks included water activity, true and bulk density, texture and proximate analyses. Taste and Odor of the SPO and SPO-Jalapeno snacks were similar and significantly (p ≤ 0.05) higher than SPO-Turmeric root and SPO-Ginger root. Acceptability of SPO and SPO-Jalapeno snacks were both 88%; this value is quite desirable. Acceptability of SPO-Turmeric and SPO-Ginger were only 56 and 51% respectively. Turmeric and ginger have been reported with many health benefits; however these snacks were not preferred by the tasters. Water activity (Aw) of the snacks tested was SPO (0.42) < SPO-Turmeric (0.52) < SPO-Jalapeno (0.54) < SPO-Ginger (0.62). Water activity indicates that all the snacks were crispy and had longer shelf life. Expansion of these snacks was SPO-Ginger root 84%, SPO-Turmeric root 76%, SPO-Jalapeno 42% and SPO only 14%. Data suggest snacks containing spices were fluffy and would give good presentation in packaging. The objective of attaining protein level was clearly attained, as values ranged 24-26%. These snacks are easy to make in house kitchens or by food companies. These healthy snacks offer a gluten-free, high protein, tasty choice for all, including vegetarians and individuals hypersensitive to gluten.

Avenanthramide C Prevents Neuronal Apoptosis via PI3K/Akt/GSK3β Signaling Pathway Following Middle Cerebral Artery Occlusion

Avenanthramides are a group of phenolic alkaloids that have been shown to have anti-inflammatory, anti-oxidant, anti-atherogenic, and vasodilation effects. The aim of the present study was to investigate the neuroprotective effect of avenanthramide-c (Avn-c) in focal brain ischemia and reperfusion injury using middle cerebral artery occlusion (MCAo) model with mice. Male C57BL/6 mice were divided into 4 groups: sham, control (MCAo), Avn-c, and Avn-c + LY294002 (phosphoinositide 3-kinase inhibitor) group. They were subjected to 60 min MCAo followed by reperfusion. Brain infarct volume and neurological deficit scores were measured after 24 h of reperfusion. We evaluated the blood brain barrier (BBB) integrity (ZO-1, VE-cadherin and occludin) and apoptosis (Bax, Bcl2, caspase3, Cytochrome C, and poly ADP ribose polymerase(PARP)-1). We also measured GSK3β for evaluation of the downstream mechanism of Akt. We examined the effect of the Avn-c in the phosphoinositide 3-kinase pathway. Avn-c reduced neurological score and infarction size. Avn-c inhibited the MCAo-induced disruption of tight junction proteins. Avn-c decreased apoptotic protein expression (Bax, Cytochrome C, and cleaved PARP-1) and increased anti-apoptotic protein expression (Bcl2) after MCAo. Akt and GSK3β were decreased in MCAo group and were restored in Avn-c group. This effect of Avn-c was abolished by PI3K inhibitor. In summary, Avn-c showed neuroprotective effects through PI3K-Akt-GSK3β signaling pathway.

Quantitative Analysis and Anti-inflammatory Activity Evaluation of the A-Type Avenanthramides in Commercial Sprouted Oat Products

Avenanthramides (AVAs) are unique phytochemicals in oat that contain two distinct groups of compounds. The first group is constituted by N-cinnamoylanthranilic acids with a single double bond (referred to as C type), and the other group is constituted by N-avenalumoylanthranilic acids with two double bonds (referred to as A type). C-type AVAs have been reported with their chemical profiles and levels in commercial oat products as well as their bioactivities. However, the accurate levels of A-type AVAs in commercial sprouted oat products and their bioactivity are still unknown. In this study, we purified seven A-type AVAs from sprouted oat bran and characterized their structures with corresponding mass spectrometry and nuclear magnetic resonance data. Among them, five compounds were isolated from oat bran for the first time. The purified A-type AVAs were used as authentic standards to establish the chemical profile of A-type AVAs in oat and to quantify the levels of all individual A-type AVAs in six commercial sprouted oat products using ultra-high-performance liquid chromatography with tandem mass spectrometry. The total A-type AVA contents in the various oat products ranged from 7.85 to 133.3 μg/g. Furthermore, the inhibition of lipopolysaccharide-induced nitric oxide production and inducible nitric oxide synthase expression by A- and C-type AVAs in macrophages were compared. The most abundant A-type AVAs (2p_d, 2c_d, and 2f_d) have similar anti-inflammatory activity to the major C-type AVAs (2p, 2c, and 2f). To the best of our knowledge, this is the first report on the bioactivity of A-type AVAs.

Domestic Processing Effects on Antioxidant Capacity, Total Phenols and Phytate Content of Sorghum

Background:

Whole grains may reduce chronic disease risks and these benefits are related to food matrix components, especially phenolic acids. However, food processing may change the total phenol content and antioxidant capacity.

Objective:

This study aims to evaluate the effect of processing on the antioxidant capacity and total phenols, tannins and phytate contents in the sorghum grain of seven genotypes.

Methods:

Antioxidant capacity (AC), total phenolic content (TPC), tannins and phytate content were evaluated in unheated sorghum grains (USG), heated sorghum grains (HSG) and popped sorghum grains (PSG) of seven genotypes.

Results:

AC ranged from 66.5% to 92.9% in USG, decreased after PSG in all genotypes, and maintained after HSG, except for BRS 506. TPC and tannins were higher in BRS 305. PSG decreased tannin content in all genotypes. TPC of HSG was higher than the USG in BRS 310, BRS 305, BR 501 and BR 700 genotypes. PSG affected TPC content mainly in BRS 305 and BR 700. AC and tannins were especially affected by the popping conditions. There was no difference in the phytate content among all genotypes, which were maintained after HSG in BRS 506, BRS 305, BR 700 and CMSXS 136.

Conclusion:

AC, TPC, tannins and phytate content were affected by the processing conditions, however, those changes may be related to the compounds type and sorghum genotype.

Triterpenoid Saponins in Oat Bran and Their Levels in Commercial Oat Products

Oats are commonly consumed as whole grains and generally considered as a healthy food. However, the bioactive compounds in oats have not been fully investigated. In this study, we reported for the first time the purification, structure elucidation, and chemical profile of the major triterpenoid saponins in oat bran as well as the quantification of the major triterpenoid saponins in commercial oat products. Thirteen triterpenoid saponins (1-13) were purified from oat bran. Their structures were characterized by analyzing their high-resolution mass spectrometry (MS), one-dimensional (1-D), and two-dimensional (2-D) NMR spectra. All of the purified triterpenoid saponins have been reported from oat bran for the first time, in which compounds (1-8) are newly discovered compounds and compound (9) is a new natural product. Using ultra-high-performance liquid chromatography with tandem mass spectrometry techniques, a complete profile of oat triterpenoid saponins was established, and the contents of the 13 purified triterpenoid saponins were quantitated in 19 different commercial oat products. The total levels of the 13 triterpenoid saponins varied from 1.77 to 18.20 μg/g in these 19 products, in which oat bran (11 samples) and oatmeal (three samples) had higher levels than cold oat cereal (five samples). Among the 11 commercial oat bran samples, the average total levels of the 13 triterpenoid saponins in the five sprouted oat samples are slightly higher than those in the regular oat bran products.

High-Protein Nutritious Flatbreads and an Option for Gluten-Sensitive Individuals

Whole grain quinoa and wheat, high-protein vegetable flatbreads were evaluated by tasters and a physical analysis was conducted. The objective was to produce nutritious, tasty gluten-free (quinoa) as well as gluten-containing (wheat) flatbreads. Flatbreads were Quinoa Peanut Oilcake Broccoli (QPCBROC), Wheat Peanut Oilcake Broccoli (WPCBROC), Quinoa Peanut Oilcake Beets (QPCBEET) and Wheat Peanut Oilcake Beets (WPCBEET). Peanut Oilcake would increase protein and add value to this farm byproduct. Bile acid binding broccoli and beets with cholesterol-lowering potential were used. Tasters preferred QPCBROC flatbreads for all sensory parameters. Acceptance of flatbreads was QPCBROC (83%), WPCBROC (70%), QPCBEET (78%) and WPCBEET (69%); these values were statistically similar. The objective of ≥25% protein content was exceeded by 5–8% and that of ≥70% acceptance was adequately achieved. These flatbreads were low in fat (5–6%) and contained essential minerals (4%) with only ≤1% added salt. Porosity and expansion data suggest that these flatbreads would take up relatively little shelf space. These flatbreads require only three ingredients and can be made in a household kitchen or by commercial production. These flatbreads offer a nutritious, tasty choice for all, and quinoa flatbreads offer an option for gluten-sensitive individuals.

Quantitative assessment of betainized compounds and associations with dietary and metabolic biomarkers in the randomized study of the healthy Nordic diet (SYSDIET)

BACKGROUND

Recently, a group of betainized compounds have been suggested to play a role in health effects in relation to a whole-grain-rich diet.

OBJECTIVES

The aims of this study were to develop a quantitative mass spectrometric method for selected betainized compounds in human plasma, and to investigate their association with nutrient intake and measures of metabolic health in participants of the SYSDIET study.

METHODS

The SYSDIET study was a controlled randomized intervention including individuals with metabolic syndrome, where the healthy Nordic diet (HND) group increased intakes of whole grains, canola oil, berries, and fish, whereas the control diet (CD) group consumed low-fiber cereal products, milk fat, and restricted amounts of fish and berries. A quantitative LC combined with triple quadrupole MS method for betainized compounds was developed and applied to fasting plasma samples from baseline (week 0) and the end of the intervention (week 18 or 24). Concentrations of betainized compounds were correlated with intakes of selected nutrients and fiber and measures of metabolic health.

RESULTS

Pipecolic acid betaine (PAB) concentrations were significantly higher in the HND group than in the CD group (P = 0.00032) at the end of the intervention and correlated directly (P < 0.0001) with intakes of dietary fiber (r = 0.376) and a biomarker related to whole-grain rye intake, namely the ratio of alkylresorcinol C17:0 to C21:0 (r = 0.442). PAB was associated inversely with fasting plasma insulin consistently at the beginning and at the end of the intervention (P < 0.001, r = -0.300; P < 0.01, r = -0.250, respectively), as well as IL-1 receptor antagonist (P < 0.01, r = -0.232 at the beginning; P < 0.01, r = -0.236 at the end) and serum LDL/HDL cholesterol (P < 0.01, r = -0.239 at the beginning; P < 0.01, r = -0.241 at the end).

CONCLUSIONS

Among adults with the metabolic syndrome, PAB plasma concentrations were associated with fasting insulin, inflammation, and lipids and were significantly increased with adoption of the HND. Further studies are needed to clarify the biological functions of betainized compounds. This trial was registered at clinicaltrials.gov as NCT00992641.

Biomarkers of cereal food intake

Background/objectives

Cereal foods are major contributors to the daily energy, protein, and dietary fiber intake all over the world. The role of cereals in human health is dependent on whether they are consumed as refined or whole grain and on cereal species. To unravel the underlying mechanisms of health effects attributed to specific cereal foods and to provide more precise dietary advice, there is a need for improved dietary assessment of whole-grain intake. Dietary biomarkers of specific cereals, different fractions or cereal-containing foods could offer such a possibility. The aim of this review was to summarize the current status on biomarkers of different cereals, fractions, and specific cereal foods.

Subjects and methods

A literature review was conducted and putative biomarkers of different cereals and pseudo-cereals (wheat, oats, rye, barley, rice, and quinoa) as well as for different grain fractions (whole grain, refined grain, bran) and foods were summarized and discussed.

Results

Several putative biomarkers have been suggested for different cereals, due to their unique presence in these grains. Among the biomarkers, odd-numbered alkylresorcinols are the most well-studied and -evaluated biomarkers and reflect whole-grain wheat and rye intake. Even-numbered alkylresorcinols have been suggested to reflect quinoa intake. Recent studies have also highlighted the potential of avenanthramides and avenacosides as specific biomarkers of oat intake, and a set of biomarkers have been suggested to reflect rice bran intake. However, there are yet no specific biomarkers of refined grains. Most biomarker candidates remain to be evaluated in controlled interventions and free-living populations before applied as biomarkers of intake in food and health studies.

Conclusion

Several putative biomarkers of different cereals have been suggested and should be validated in human studies using recently developed food intake biomarker validation criteria.

Contribution of gut microbiota to metabolism of dietary glycine betaine in mice and in vitro colonic fermentation

BACKGROUND

Accumulating evidence is supporting the protective effect of whole grains against several chronic diseases. Simultaneously, our knowledge is increasing on the impact of gut microbiota on our health and on how diet can modify the composition of our bacterial cohabitants. Herein, we studied C57BL/6 J mice fed with diets enriched with rye bran and wheat aleurone, conventional and germ-free C57BL/6NTac mice on a basal diet, and the colonic fermentation of rye bran in an in vitro model of the human gastrointestinal system. We performed 16S rRNA gene sequencing and metabolomics on the study samples to determine the effect of bran-enriched diets on the gut microbial composition and the potential contribution of microbiota to the metabolism of a novel group of betainized compounds.

RESULTS

The bran-enriched study diets elevated the levels of betainized compounds in the colon contents of C57BL/6 J mice. The composition of microbiota changed, and the bran-enriched diets induced an increase in the relative abundance of several bacterial taxa, including Akkermansia, Bifidobacterium, Coriobacteriaceae, Lactobacillus, Parasutterella, and Ruminococcus, many of which are associated with improved health status or the metabolism of plant-based molecules. The levels of betainized compounds in the gut tissues of germ-free mice were significantly lower compared to conventional mice. In the in vitro model of the human gut, the production of betainized compounds was observed throughout the incubation, while the levels of glycine betaine decreased. In cereal samples, only low levels or trace amounts of other betaines than glycine betaine were observed.

CONCLUSIONS

Our findings provide evidence that the bacterial taxa increased in relative abundance by the bran-based diet are also involved in the metabolism of glycine betaine into other betainized compounds, adding another potential compound group acting as a mediator of the synergistic metabolic effect of diet and colonic microbiota.

Long-Term Whole Grain Wheat and Rye Intake Reflected by Adipose Tissue Alkylresorcinols and Breast Cancer: A Case-Cohort Study

Whole grain rye (WGR) and whole grain wheat (WGW) have been suggested to protect against the development of breast cancer. In this study, we estimated long-term intake of WGR and WGW, using both a food frequency questionnaire (FFQ) and alkylresorcinol concentrations in adipose tissue biopsies, in relation to the risk of developing invasive breast cancer in a case-cohort study (n = 414 in the case group, n = 933 in the subcohort group) on the Danish “Diet, Cancer and Health” cohort. The median follow-up time of the subcohort was 5.3 years. Total WGR and WGW intake estimated with FFQ or reflected by total alkylresorcinol concentration in adipose tissue was not significantly associated with risk of breast cancer. However, after adjustment for total WGR and WGW intake, women in the highest quartile of relative WGR intake, reflected by the alkylresorcinol C17:0/C21:0 ratio, had a higher risk of overall breast cancer and estrogen-receptor-positive (ER+) breast cancer than women in the lowest quartile of relative WGR intake, while the risk of estrogen-receptor-negative (ER-) breast cancer incidence was unaffected. Similar results were obtained with the FFQ data. Based on these data, further investigation of the role of specific grain types in reducing or increasing breast cancer risk, and their overall impact on health, is warranted.

Postprandial Glycaemic and Insulinaemic Responses after Consumption of Activated Wheat and Triticale Grain Flakes

Increasing evidence shows that whole grain consumption is protective against metabolic disorders. Protective bioactive substances of whole grains include fibre and antioxidants. Activation of grains can increase the amount of phenolic compounds and their bioavailability, but there is little evidence about their effect on glycaemic and insulinemic responses. Therefore, the aim of this study was to investigate glycaemic and insulinemic responses after consumption of flakes made from activated wheat and activated triticale grains. Eighteen healthy subjects (7 men and 11 women) were given activated wheat or activated triticale flakes. As a reference, a standard glucose solution was used. Plasma glucose and serum insulin were measured during 120 minutes. Both, activated wheat and activated triticale flakes, show improved glycaemic profile, inducing a lower and more stable glycaemic response. However, statistically significant differences in insulin response were found only in the group who have taken activated triticale flakes and not in the group who have taken activated wheat flakes. Activated triticale flakes induced lower insulin response in all postprandial phases and a more stable concentration of insulin. Thus, activated triticale flakes could be beneficial for the prevention and treatment of metabolic disorders.

A 12-wk whole-grain wheat intervention protects against hepatic fat: the Graandioos study, a randomized trial in overweight subjects

Background

Whole-grain wheat (WGW) is described as nutritionally superior to refined wheat (RW) and thus advocated as the healthy choice, although evidence from intervention studies is often inconsistent. The liver, as the central organ in energy metabolism, might be an important target organ for WGW interventions.

Objective

The aim of this study was to investigate the potential benefits of WGW consumption compared with RW consumption on liver health and associated parameters.

Design

We performed a double-blind, parallel trial in which 50 overweight 45- to 70-y-old men and postmenopausal women were randomly allocated to a 12-wk intervention with either WGW (98 g/d) or RW (98 g/d) products. Before and after the intervention we assessed intrahepatic triglycerides (IHTGs) and fat distribution by proton magnetic resonance spectroscopy/magnetic resonance imaging, fecal microbiota composition, adipose tissue gene expression, and several fasting plasma parameters, as well as postprandial plasma lipids after a mixed meal.

Results

Fasting plasma cholesterol, triglycerides, nonesterified fatty acids, and insulin were not affected by RW or WGW intervention. We observed a substantial increase of 49.1% in IHTGs in the RW when compared with the WGW group (P = 0.033). Baseline microbiota composition could not predict the increase in IHTGs after RW, but gut microbiota diversity decreased in the RW group when compared with the WGW group (P = 0.010). In the WGW group, we observed increased postprandial triglyceride levels compared with the RW group (P = 0.020). In addition, the WGW intervention resulted in a trend towards lower fasting levels of the liver acute-phase proteins serum amyloid A (P = 0.057) and C-reactive protein (P = 0.064) when compared to the RW intervention.

Conclusions

A 12-wk RW intervention increases liver fat and might contribute to the development of nonalcoholic fatty liver disease, whereas a 12-wk 98-g/d WGW intervention prevents a substantial increase in liver fat. Our results show that incorporating feasible doses of WGW in the diet at the expense of RW maintains liver health. The study was registered at clinicaltrials.gov as NCT02385149.

Diets rich in whole grains increase betainized compounds associated with glucose metabolism

Background

Epidemiologic evidence suggests that diets rich in whole grains are associated with a reduced risk of developing chronic diseases and all-cause mortality. However, the molecular mechanisms behind these beneficial metabolic effects are poorly understood.

Objective

Our aim was to investigate novel trimethylated (betainized) compounds from mice and humans, and their association with whole grain-rich diets and insulin resistance and insulin secretion.

Design

Fasting plasma samples were obtained in a mouse (C57BL/6J male) feeding trial and a controlled dietary intervention. The mouse trial involved feeding the mice a rye and wheat bran-enriched feed which was compared with a high-fat diet. In the human trial, participants recruited from Kuopio, Finland (n = 69) and Naples, Italy (n = 54) with characteristics of the metabolic syndrome were randomly assigned to either a whole grain-enriched diet or a control diet for 12 wk. Plasma concentrations of betainized compounds were analyzed with the use of liquid chromatography-tandem mass spectrometry. Insulin resistance and insulin secretion were assessed in an oral-glucose-tolerance test and a meal-glucose-tolerance test.

Results

The betaines that were increased in mouse plasma after bran-enriched feeding were identified de novo via chemical synthesis and liquid chromatography-tandem mass spectrometry, and confirmed to be associated with an increased intake of whole-grain products in humans. In particular, the concentrations of pipecolic acid betaine were increased at the end of the whole-grain intervention in both the Kuopio cohort (P < 0.001) and the Naples cohort (P < 0.05), and these concentrations inversely correlated with the postprandial glucose concentration. Furthermore, the concentration of valine betaine was substantially increased during the intervention in Naples (P < 0.001) with an inverse correlation with the postprandial insulin concentration. In addition, the concentrations of other betaines, e.g., glycine betaine and proline betaine, correlated with glucose and insulin concentrations at the end of the intervention.

Conclusions

Novel betainized compounds in humans are associated with diets rich in whole grains, and they improve insulin resistance and insulin secretion. These results suggest that these novel compounds may contribute to the beneficial effects of whole grain-rich diets. The studies were registered at clinicaltrials.gov as NCT00945854 (Naples) and NCT00573781 (Kuopio).

Analysis of avenanthramides in oat products and estimation of avenanthramide intake in humans

Avenanthramides are phenolic compounds found only in oats, and are of interest due to suggested bioactivities, including anti-inflammatory effects and induction of apoptosis. The objective of this work was to optimise a high performance liquid chromatography (HPLC) method for analysis of avenanthramides in food, and analyse the avenanthramide content in 45 oat fractions and products. The optimised HPLC method was based on triplicate extraction of 100 mg sample with 1 ml 80% ethanol in phosphate buffer (pH 2.8) and used gallacetophenone as an internal standard. Avenalumic acid-derived avenanthramide homologues 2f_d and 2p_d were also present, making up to 20% of the total avenanthramides detected in oats. The amounts of avenanthramides detected in oat products was 2-82 µg/g. It was estimated that mean avenanthramide intake among oat consumers ranges from 0.3 to 2.1 mg/day, considerably lower than the amount used in studies that have investigated biological effects of avenanthramides in humans.

Higher Whole-Grain Intake Is Associated with Lower Risk of Type 2 Diabetes among Middle-Aged Men and Women: The Danish Diet, Cancer, and Health Cohort

BACKGROUND

Type 2 diabetes is a major health concern worldwide. Whole grains and cereal fiber may offer protective effects on type 2 diabetes risk. However, few studies have been conducted in cohorts with detailed information on whole-grain cereal intakes and product types and with wide ranges of intake.

Objective

We investigated the associations between whole-grain intake, including intakes of different cereal types and products, and the risk of type 2 diabetes in a population with wide and diverse whole-grain intake.

Methods

We used data from the Danish Diet, Cancer, and Health cohort including 55,465 participants aged 50-65 y at baseline. Of these, 7417 participants were diagnosed with type 2 diabetes during follow-up (median: 15 y). Detailed information on the intake of whole-grain products was available from a food-frequency questionnaire, and total whole-grain intake and whole-grain cereal types (wheat, rye, oats) were calculated in grams per day. Associations were examined by using Cox proportional hazards models with adjustment for potential confounders.

Results

Whole-grain intake was associated with an 11% and 7% lower risk of type 2 diabetes per whole-grain serving (16 g) per day for men and women, respectively [HR (95% CI)-men: 0.89 (0.87, 0.91); women: 0.93 (0.91, 0.96)]. For men, the intake of all whole-grain cereal types investigated (wheat, rye, oats) was significantly associated with a lower risk of type 2 diabetes, but only wheat and oats intake was significantly associated for women. Among the different whole-grain products, rye bread, whole-grain bread, and oatmeal/muesli were significantly associated with a lower risk of type 2 diabetes for both men and women.

Conclusions

In this cohort study, we found consistent associations between high whole-grain intake and lower risk of type 2 diabetes. Overall, an association was found for all different cereals and whole-grain products tested.

Whole grain intake associated molecule 5-aminovaleric acid betaine decreases β-oxidation of fatty acids in mouse cardiomyocytes

Despite epidemiological evidence showing that diets rich in whole grains reduce the risk of chronic life-style related diseases, biological mechanisms for these positive effects are mostly unknown. Increased 5-aminovaleric acid betaine (5-AVAB) levels in plasma and metabolically active tissues such as heart have been associated with consumption of diets rich in whole grains. However, biological effects of 5-AVAB are poorly understood. We evaluated 5-AVAB concentrations in human and mouse heart tissue (3-22 µM and 38-78 µM, respectively) using mass spectrometry. We show that 5-AVAB, at physiological concentration range, dose-dependently inhibits oxygen consumption due to β-oxidation of fatty acids, but does not otherwise compromise mitochondrial respiration, as measured with oxygen consumption rate in cultured mouse primary cardiomyocytes. We also demonstrate that this effect is caused by 5-AVAB induced reduction of cellular L-carnitine. Reduced L-carnitine levels are at least partly mediated by the inhibition of cell membrane carnitine transporter (OCTN2) as evaluated by in silico docking, and by siRNA mediated silencing of OCTN2 in cultured cardiomyocytes. 5-AVAB caused inhibition of β-oxidation of fatty acids is a novel mechanism on how diets rich in whole grains may regulate energy metabolism in the body. Elucidating potentially beneficial effects of 5-AVAB e.g. on cardiac physiology will require further in vivo investigations.

Evaluating Whole Grain Intervention Study Designs and Reporting Practices Using Evidence Mapping Methodology

Consumption of whole grains have been associated with reduced risk of chronic diseases in many observational studies; yet, results of intervention studies are mixed. We aimed to use evidence mapping to capture the methodological and reporting variability in whole grain intervention studies that may contribute to this inconsistency. We conducted a reproducible search in OVID Medline for whole grain human intervention studies (published 1946 to February 2018). After screening based on a priori criteria, we identified 202 publications describing a total of 213 unique trials. Over half (55%) were acute trials, lasting ≤1 day, 30% were moderate duration studies (up to 6 weeks) and 15% were of longer duration (more than 6 weeks). The majority of acute trials (75%) examined measures of glycaemia and/or insulinemia, while most of the longer trials included measures of cardiometabolic health (71%), appetite/satiety (57%) and weight/adiposity (56%). Among the moderate and long duration trials, there was a wide range of how whole grains were described but only 10 publications referenced an established definition. Only 55% of trials reported the actual amount of whole grains (in grams or servings), while 36% reported the amount of food/product and 9% did not report a dose at all. Of the interventions that provided a mixture of whole grains, less than half (46%) reported the distribution of the different grain types. Reporting of subject compliance also varied and only 22% used independent biomarkers of whole grain intake. This evidence map highlights the need to standardize both study protocols and reporting practices to support effective synthesis of study results and provide a stronger foundation to better inform nutrition scientists and public health policy.

Fats in Foods: Current Evidence for Dietary Advice

Current discussion of the importance of food fats in the risk of coronary heart disease (CHD) often suffers from preconceptions, misunderstandings, insufficient knowledge, and selective reasoning. As a result, the sustained controversy about dietary fat recommendations can be contradictory and confusing. To clarify some of these issues, the International Expert Movement to Improve Dietary Fat Quality in cooperation with the International Union of Nutritional Sciences (IUNS) organized a symposium at the 21st meeting of the IUNS, October 17, 2017, Buenos Aires, Argentina, to summarize the key scientific evidence underlying the controversy on the relationship between the saturated and unsaturated fat consumption and CHD risk. Presenters also discussed, using examples, the rationale for and implications of the partial replacement of foods rich in saturated fats by those rich in unsaturated fats. Presentations included strategies to fit healthier fats into meals. This report summarizes the symposium presentations.

Evaluating the ≤10:1 wholegrain criterion in identifying nutrient quality and health implications of UK breads and breakfast cereals

OBJECTIVE

To evaluate the nutrient quality of breads and breakfast cereals identified using the wholegrain definition of ≤10:1 carbohydrate:fibre ratio.

DESIGN

Following a cross-sectional study design, nutritional information was systematically gathered from food labels of breads and breakfast cereals that met the ≤10:1 carbohydrate:fibre criterion. The median nutrient content was compared with the UK Food Standards Agency's nutrient profiling standards and the associations between carbohydrate:fibre ratio and other nutrients were analysed. Subgroup analyses were undertaken for products with and without fruit, nuts and/or seeds.

SETTING

Products from four major supermarket stores in the UK.

SUBJECTS

Breads (n 162) and breakfast cereals (n 266).

RESULTS

Breads which met the ≤10:1 criterion typically contained medium fat, low saturated fat, low sugar and medium Na. Breakfast cereals typically contained medium fat, low saturated fat, high sugar and low Na. In both groups, as the carbohydrate:fibre ratio decreased, fat content increased (bread: P=0·029, r=-0·171; breakfast cereal: P=0·033, r=-0·131) and, in breakfast cereals, as the ratio increased, sugar content increased (P<0·0005, r=0·381). Breakfast cereals with fruit, nuts and/or seeds contained, per 100 g, more energy (P=0·002), fat, saturated fat and sugar (all P<0·0005), while seeded breads had more energy, fat and saturated fat (all P<0·0005).

CONCLUSIONS

Overall, breads and breakfast cereals meeting the ≤10:1 criterion have good nutritional quality, suggesting that the criterion could be useful in public health and/or food labelling. The utility of applying the ≤10:1 criterion to products containing fruit, nuts and/or seeds is less clear and requires further research.

Glycaemic, gastrointestinal and appetite responses to breakfast porridges from ancient cereal grains: A MRI pilot study in healthy humans

Cereal grain based porridges are commonly consumed throughout the world. Whilst some data are available for varieties that are popular in the Western world such as oats and rye, other 'ancient' grains used in the East and in Africa such as millets are thought to have beneficial health effects, such as a suppression of post prandial hunger and circulating glucose levels. These grains, a sustainable food source due to their tolerance of extreme weather and growing conditions, are commonly found throughout Asia and Africa. However, knowledge of the physiological responses to these grain varieties is very limited. This study aimed to collect initial pilot data on the physiological and gastrointestinal responses to breakfast porridges made with two millet varieties and oats and rye grains. A total of n=15 completed the oats and rye, n=9 the finger millet n=12 the pearl millet meals. MRI scans were undertaken at baseline, immediately after consumption and then hourly postprandially. Blood glucose was measured at baseline, immediately after consumption and then every 15min until t=80min, then every 20min until t=120min, followed on each occasion by completion of VAS. Seven participants completed the entire protocol and were included in the final analysis. A subgroup analysis with the n=10 paired comparison between the same individuals that completed the oats, rye and pearl millet was also considered. The gastric volume AUC was higher for pearl millet than oats and rye (n=10, p<0.001). The incremental area under the curve (iAUC) for blood glucose was not significantly different between the meals although this showed a trend to be lower for pearl millet. Hunger was lower for pearl millet compared to oats and rye (n=10, p=0.01). There was a significant correlation between total gastric volume AUC and average appetite AUC r=-0.47, p<0.010. Isoenergetic breakfast porridges from 'ancient' varieties of millet grains showed physiological responses that were comparable with those from common Western varieties known to have beneficial health effects. Pearl millet appeared to induce lower postprandial blood glucose response and appetite scores though the differences were not conclusive compared with the other porridges and further work is needed. Improved knowledge of the effects of different cereal grains could help direct dietary advice and ultimately improve health outcomes in the general population worldwide.

Whole Grain Consumption and Risk of Ischemic Stroke: Results From 2 Prospective Cohort Studies

BACKGROUND AND PURPOSE

Higher intake of whole grains may exert cardiometabolic benefits, although findings on stroke risk are inconclusive. The potentially differential effects of individual whole grain foods on ischemic stroke have not been examined.

METHODS

We analyzed whole grain consumption in relation to ischemic stroke among 71 750 women from the Nurses' Health Study and 42 823 men from the Health Professionals Follow-up Study who were free of cardiovascular disease, diabetes mellitus, and cancer at baseline (1984 and 1986, respectively) through 2010 using a Cox proportional hazards model. Validated semiquantitative food frequency questionnaires were used to assess consumption of whole grain intake, including whole grain cold breakfast cereal, dark bread, oatmeal, brown rice, popcorn, bran, and germ. Self-reported incident cases of ischemic stroke were confirmed through medical record review.

RESULTS

During 2 820 128 person-years of follow-up in the 2 cohorts, 2458 cases of ischemic stroke were identified and confirmed. Intake of total whole grains was not associated with risk of ischemic stroke after adjustment for covariates: the pooled hazard ratio (95% confidence interval) comparing extreme intake levels was 1.04 (0.91-1.19). However, intake of whole grain cold breakfast cereal and total bran was inversely associated with ischemic stroke after multivariate adjustment: the pooled hazard ratios (95% confidence intervals) were 0.88 (0.80-0.96; Ptrend=0.008) and 0.89 (0.79-1.00; Ptrend=0.004), respectively. Other whole grain foods were not associated with a lower risk of ischemic stroke.

CONCLUSIONS

Although overall consumption of whole grains was not associated with lower risk of ischemic stroke, greater consumption of whole grain cold breakfast cereal and bran was significantly associated with a lower risk of ischemic stroke. More studies are needed to replicate these associations between individual whole grain foods and risk of ischemic stroke among other populations.

Food groups and risk of coronary heart disease, stroke and heart failure: A systematic review and dose-response meta-analysis of prospective studies

BACKGROUND

Despite growing evidence for food-based dietary patterns' potential to reduce cardiovascular disease risk, knowledge about the amounts of food associated with the greatest change in risk of specific cardiovascular outcomes and about the quality of meta-evidence is limited. Therefore, the aim of this meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups (whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages [SSB]) and the risk of coronary heart disease (CHD), stroke and heart failure (HF).

METHODS

We conducted a systematic search in PubMed and Embase up to March 2017 for prospective studies. Summary risk ratios (RRs) and 95% confidence intervals (95% CI) were estimated using a random effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships.

RESULTS

Overall, 123 reports were included in the meta-analyses. An inverse association was present for whole grains (RRCHD: 0.95 (95% CI: 0.92-0.98), RRHF: 0.96 (0.95-0.97)), vegetables and fruits (RRCHD: 0.97 (0.96-0.99), and 0.94 (0.90-0.97); RRstroke: 0.92 (0.86-0.98), and 0.90 (0.84-0.97)), nuts (RRCHD: 0.67 (0.43-1.05)), and fish consumption (RRCHD: 0.88 (0.79-0.99), RRstroke: 0.86 (0.75-0.99), and RRHF: 0.80 (0.67-0.95)), while a positive association was present for egg (RRHF: 1.16 (1.03-1.31)), red meat (RRCHD: 1.15 (1.08-1.23), RRstroke: 1.12 (1.06-1.17), RRHF: 1.08 (1.02-1.14)), processed meat (RRCHD: 1.27 (1.09-1.49), RRstroke: 1.17 (1.02-1.34), RRHF: 1.12 (1.05-1.19)), and SSB consumption (RRCHD: 1.17 (1.11-1.23), RRstroke: 1.07 (1.02-1.12), RRHF: 1.08 (1.05-1.12)) in the linear dose-response meta-analysis. There were clear indications for non-linear dose-response relationships between whole grains, fruits, nuts, dairy, and red meat and CHD.

CONCLUSION

An optimal intake of whole grains, vegetables, fruits, nuts, legumes, dairy, fish, red and processed meat, eggs and SSB showed an important lower risk of CHD, stroke, and HF.

Perspective: An Extension of the STROBE Statement for Observational Studies in Nutritional Epidemiology (STROBE-nut): Explanation and Elaboration

Nutritional epidemiology is an inherently complex and multifaceted research area. Dietary intake is a complex exposure and is challenging to describe and assess, and links between diet, health, and disease are difficult to ascertain. Consequently, adequate reporting is necessary to facilitate comprehension, interpretation, and generalizability of results and conclusions. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement is an international and collaborative initiative aiming to enhance the quality of reporting of observational studies. We previously presented a checklist of 24 reporting recommendations for the field of nutritional epidemiology, called "the STROBE-nut." The STROBE-nut is an extension of the general STROBE statement, intended to complement the STROBE recommendations to improve and standardize the reporting in nutritional epidemiology. The aim of the present article is to explain the rationale for, and elaborate on, the STROBE-nut recommendations to enhance the clarity and to facilitate the understanding of the guidelines. Examples from the published literature are used as illustrations, and references are provided for further reading.

Avenacosides: Metabolism, and potential use as exposure biomarkers of oat intake

SCOPE

Exposure biomarkers used for objective estimation of whole-grain (WG) intake are essential for epidemiologic studies of WG consumption, however, up to now, no exposure biomarkers were developed for WG oat intake. This study investigates the potential of oat unique components, Avenacoside-B (AVE-B) and -A (AVE-A), as exposure biomarkers of oat intake.

METHODS AND RESULTS

An in vivo study performed in mice and an in vitro batch fecal fermentation study were used to investigate the potential metabolic routes of AVE-B and -A. Twelve healthy volunteers were recruited in the human urinary pharmacokinetic study, each participant received a single dose of oat bran as breakfast, 48 h urine samples were collected at baseline and after treatment period, and AVE-B and -A were quantified by LC-MS/MS. Deglycosylation metabolic route was identified as the major metabolic path for AVE-B and -A. Urinary AVE-B and -A concentrations increased rapidly after oat ingestion, reached their maximum excretion rates (ER_max ) fairly simultaneously within 5 h, then decreased gradually. And the mean eliminate half-lives (T_1/2 ) for AVE-B and -A were determined as 6.22 and 4.55 h, respectively.

CONCLUSION

Oat AVE-B and -A have great potential to be used as specific exposure biomarkers to reflect oat intake.

[Therapeutic education in primary cardiovascular prevention: 4 years sustained interest]

BACKGROUND

Our patient therapeutic education program yields improvements in health after one year. But what can we see after 4 years, when the patient alone is responsible for following the program?

PATIENTS AND METHODS

Two hundred and ninety-one patients participated in the first part of our study and were followed during one year. Four years into the ongoing study, we reviewed the progress of the first 200 patients. We compared the already published Risk Factors and Eating Habits scores between the beginning of the study (T0), one year later (T1) and after 4 years (T4).

RESULTS

The Risk Factor score at T0 is 9.5±7.8, moving to 7±7.5 at T1, and then to 6.8±7.8 at T4 (P<0.001 between T0 and T1 and T0 and T4). Endurance physical activities saw the greatest improvement: 0.79±5 at T0, -1.07±4.5 at T1 and -1.61±4.5 at T4 (P<0.001 between T0 and T1 and T0 and T4). The Eating Habits score went from -18.2±7.3 to -22.2±6.4 and then to -23.5±6.4 (P<0.001 between T0 and T1 and T0 and T4). The best results were obtained through increased consumption of whole grains, green vegetables and fish.

CONCLUSION

The positive results of the progress of risk factors and eating habits, noted after one year, are even greater four years after the end of the therapeutic education program.

Dietary Modeling of Foods for Advanced CKD Based on General Healthy Eating Guidelines: What Should Be on the Plate?

Chronic kidney disease (CKD) is a major public health problem with significant clinical, societal, and psychosocial burdens. Nutrition therapy has been an integral part of the medical management of patients with CKD for more than a century, with the main goals of preserving kidney function and preventing complications. Nutrition abnormalities may emerge well before dialysis therapy is initiated and are associated with poor outcomes. It is therefore important to revisit nutrition management in the advanced stages of CKD to gain a broader insight into its role and effect on patient outcomes. Traditionally, nutrition recommendations have focused on the prescription of energy (calories) and macro- and micronutrients. Today, dietary modeling also focuses on the evidence for food consumption on health. This review argues that advanced non-dialysis-dependent CKD nutrition requirements to a large extent align with healthy eating guidelines for the general population and should not be based on deprivation or be unusually restrictive. The best currently available evidence for the CKD diet is likely to be derived from CKD nutrition prescriptions in conjunction with evidence underpinning national dietary guidelines and evidence of healthy dietary patterns, such as Mediterranean-style and Dietary Approaches to Stop Hypertension (DASH)-style eating. Positive messages from these dietary patterns should improve acceptance of CKD dietary interventions among patients.

Sensory evaluation of gluten-free quinoa whole grain snacks

Sensory evaluation of quinoa gluten-free whole grain low fat and salt snacks was conducted. The snacks were Quinoa, Quinoa-Cayenne Pepper, Quinoa-Ginger and Quinoa-Turmeric. Cayenne pepper, ginger and turmeric are common spices that contain health promoting nutrients. Cayenne pepper has been associated with enhancing heat production. Ginger has been reported to improve blood flow and prevent joint pains. Turmeric has been observed to have wound healing potential. All the snacks contained 6% corn oil and 2% salt. Snack dough was prepared using 120 mL water for 100 g dry ingredients. About 20 g of snack dough was placed on center of preheated KrumKake Express Baker and cooked for 2 min. Seventy in-house volunteers judged Color/Appearance of Quinoa, Quinoa-Cayenne Pepper and Quinoa-Ginger snacks significantly (p ≤ 0.05) higher than Quinoa-Turmeric snacks. Odor/Aroma of Quinoa-Ginger snacks was significantly higher than other snacks tested. Texture/Mouth-feel of Quinoa-Cayenne Pepper, Quinoa-Ginger and Quinoa-Turmeric snacks was similar and significantly higher than Quinoa snacks. Taste/Flavor and Acceptance was similar in four kinds of snacks tested. Water activity of all the snacks tested ranged from 0.41–0.55 suggesting that these snacks were crispy with good antimicrobial stability. These snacks would be quite filling due to their expansion of 2.6–3.1 times due to high porosity. Acceptance of snacks tested was Quinoa 79%, Quinoa-Cayenne Pepper 77%, Quinoa-Ginger 73% and Quinoa-Turmeric 70%. These snacks contained only 3–4 ingredients and could be made in any house kitchen or commercial production. Acceptance of 70–79% is very desirable. These healthy nutritious gluten-free quinoa snacks offer choice for all including vegetarians and individuals hypersensitive to gluten.

Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies

OBJECTIVE

 To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality.

DATA SOURCES

 PubMed and Embase searched up to 3 April 2016.

STUDY SELECTION

 Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality.

DATA SYNTHESIS

 Summary relative risks and 95% confidence intervals calculated with a random effects model.

RESULTS

 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings-for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I(2)=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I(2)=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I(2)=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I(2)=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I(2)=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I(2)=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I(2)=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I(2)=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I(2)=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I(2)=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular disease and/or all cause mortality, but there was little evidence of an association with refined grains, white rice, total rice, or total grains.

CONCLUSIONS

 This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes. These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality.

Whole grains and public health

Small increases in population intake could bring substantial benefits

Association between dietary fibre intake and fruit, vegetable or whole-grain consumption and the risk of CVD: results from the PREvención con DIeta MEDiterránea (PREDIMED) trial

Prospective studies assessing the association between fibre intake or fibre-rich food consumption and the risk of CVD have often been limited by baseline assessment of diet. Thus far, no study has used yearly repeated measurements of dietary changes during follow-up. Moreover, previous studies included healthy and selected participants who did not represent subjects at high cardiovascular risk. We used yearly repeated measurements of diet to investigate the association between fibre intake and CVD in a Mediterranean cohort of elderly adults at high cardiovascular risk. We followed-up 7216 men (55-80 years) and women (60-80 years) initially free of CVD for up to 7 years in the PREvención con DIeta MEDiterránea study (registered as ISRCTN35739639). A 137-item validated FFQ was repeated yearly to assess diet. The primary end point, confirmed by a blinded ad hoc Event Adjudication Committee, was a composite of cardiovascular death, myocardial infarction and stroke. Time-dependent Cox's regression models were used to estimate the risk of CVD according to baseline dietary exposures and to their yearly updated changes. We found a significant inverse association for fibre (P for trend=0·020) and fruits (P for trend=0·024) in age-sex adjusted models, but the statistical significance was lost in fully adjusted models. However, we found a significant inverse association with CVD incidence for the sum of fruit and vegetable consumption. Participants who consumed in total nine or more servings/d of fruits plus vegetables had a hazard ratio 0·60 (95 % CI 0·40, 0·96) of CVD in comparison with those consuming <5 servings/d.