1
|
Sun Y, McDonald T, Baur A, Xu H, Bateman NB, Shen Y, Li C, Ye K. Fish oil supplementation modifies the associations between genetically predicted and observed concentrations of blood lipids: a cross-sectional gene-diet interaction study in UK Biobank. Am J Clin Nutr 2024:S0002-9165(24)00605-1. [PMID: 39019260 DOI: 10.1016/j.ajcnut.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 07/07/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Dyslipidemia is a well-known risk factor for cardiovascular disease, the leading cause of mortality worldwide. Although habitual intake of fish oil is associated with cardioprotective effects through triglyceride reduction, the interactions of fish oil with the genetic predisposition to dysregulated lipids remain elusive. OBJECTIVES We examined whether fish oil supplementation modifies the association between genetically predicted and observed concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. METHODS A total of 441,985 participants with complete genetic and phenotypic data from the UK Biobank were included. Polygenic scores (PGS) of the 4 lipids were calculated in participants of diverse ancestries. For each lipid, multivariable linear regression models were used to assess if fish oil supplementation modified the association between PGS and the observed circulating concentration, with adjustment for relevant covariates. RESULTS Fish oil supplementation attenuates the associations between genetically predicted and observed circulating concentrations of total cholesterol, LDL cholesterol, and triglycerides while accentuating the corresponding association for HDL cholesterol among 424,090 participants of European ancestry. Consistent significant findings were obtained using PGS calculated based on multiple genome-wide association studies or alternative PGS methods. For triglycerides, each standard deviation (SD) increment in PGS is associated with 0.254 [95% confidence interval (CI): 0.248, 0.259] SD increase in the observed concentration among European-ancestry participants who reported fish oil usage. In contrast, a stronger association was observed in nonusers (0.267; 95% CI: 0.263, 0.270). Consistently, we showed that fish oil significantly attenuates the association between genetically predicted and observed concentrations of triglycerides in African-ancestry participants. CONCLUSIONS Fish oil supplementation attenuates the association between genetically predicted and observed circulating concentrations of total cholesterol, LDL cholesterol, and triglycerides while accentuating the corresponding association for HDL cholesterol in individuals of European ancestry. Further research is needed to understand the clinical implications of these findings.
Collapse
Affiliation(s)
- Yitang Sun
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States
| | - Tryggvi McDonald
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States
| | - Abigail Baur
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States
| | - Huifang Xu
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States
| | - Naveen Brahman Bateman
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States
| | - Ye Shen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Changwei Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Kaixiong Ye
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, United States; Institute of Bioinformatics, University of Georgia, Athens, GA, United States.
| |
Collapse
|
2
|
Masle AM, Kibel A, Jukić I, Čičak P, Selthofer-Relatić K, Stupin A, Mihaljević Z, Šušnjara P, Breškić Ćurić Ž, Bačun T, Drenjančević I. Enhancing Endothelial Function with Nutrient-Enriched Table Hen Eggs: A Randomized Study in Patients Recovering from Acute Coronary Syndrome. Clin Interv Aging 2024; 19:953-970. [PMID: 38807636 PMCID: PMC11131953 DOI: 10.2147/cia.s461821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
Purpose This study investigated the effect of consumption of table eggs enriched with n-3 polyunsaturated fatty acids (n-3 PUFA), lutein, vitamin E and selenium on microvascular function, oxidative stress and inflammatory mediators in patients after acute coronary syndrome (ACS). Patients and Methods In a prospective, randomized, interventional, double-blind clinical trial, ACS patients were assigned to either the Nutri4 (N=15, mean age: 57.2 ± 9.2 years), or the Control group (N=13; mean age 56.8 ± 9.6 years). The Nutri4 group consumed three enriched hen eggs daily for three weeks, providing approximately 1.785 mg of vitamin E, 0.330 mg of lutein, 0.054 mg of selenium and 438 mg of n-3 PUFAs. Biochemical parameters, including serum lipids, liver enzymes, nutrient concentrations, serum antioxidant enzyme activity (catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD)), and markers of oxidative stress (thiobarbituric acid reactive substances (TBARS) and ferric reducing ability (FRAP)), were assessed before and after the dietary interventions. Additionally, arterial blood pressure, heart rate, body composition, fluid status, anthropometric measurements, and skin microvascular blood flow responses to various stimuli (postocclusive reactive hyperemia (PORH), acetylcholine- (Ach ID), and sodium nitroprusside- (SNP ID)) were measured using laser Doppler flowmetry (LDF) throughout the study. Results The intake of Nutri4 eggs led to a significant reduction in LDL cholesterol levels, while the levels of total cholesterol remained within the established reference values. Consuming Nutri4 eggs resulted in a 12.7% increase in serum vitamin E levels, an 8.6% increase in selenium levels, and demonstrated a favorable impact on microvascular reactivity, as evidenced by markedly improved PORH and ACh ID. Nutri4 eggs exerted a significant influence on the activity of GPx and SOD, with no observed changes in TBARS or FRAP values. Conclusion The consumption of Nutri4 eggs positively influenced microvascular function in individuals with ACS, without eliciting adverse effects on oxidative stress.
Collapse
Affiliation(s)
- Ana Marija Masle
- Department of Rheumatology, Clinical Immunology and Allergology, University Hospital Osijek, Osijek, Croatia
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Scientific Center of Excellence for Personalized Health Care, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Aleksandar Kibel
- Scientific Center of Excellence for Personalized Health Care, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Physiology and Immunology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Heart and Vascular Diseases, University Hospital Osijek, Osijek, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, Osijek, Croatia
| | - Ivana Jukić
- Scientific Center of Excellence for Personalized Health Care, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Physiology and Immunology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Petra Čičak
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Pulmonology, University Hospital Osijek, Osijek, Croatia
| | - Kristina Selthofer-Relatić
- Scientific Center of Excellence for Personalized Health Care, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Heart and Vascular Diseases, University Hospital Osijek, Osijek, Croatia
- Department of Pathophysiology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Ana Stupin
- Scientific Center of Excellence for Personalized Health Care, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Physiology and Immunology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Zrinka Mihaljević
- Scientific Center of Excellence for Personalized Health Care, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Physiology and Immunology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Petar Šušnjara
- Scientific Center of Excellence for Personalized Health Care, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Physiology and Immunology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Željka Breškić Ćurić
- Scientific Center of Excellence for Personalized Health Care, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Internal Medicine, General Hospital Vinkovci, Vinkovci, Croatia
| | - Tatjana Bačun
- Department of Internal Medicine, University Hospital Osijek, Osijek, Croatia
- Department of Internal Medicine, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Ines Drenjančević
- Scientific Center of Excellence for Personalized Health Care, J. J. Strossmayer University of Osijek, Osijek, Croatia
- Department of Physiology and Immunology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek, Croatia
| |
Collapse
|
3
|
Arabi SM, Bahari H, Chambari M, Bahrami LS, Mohaildeen Gubari MI, Watts GF, Sahebkar A. Omega-3 fatty acids and endothelial function: A GRADE-assessed systematic review and meta-analysis. Eur J Clin Invest 2024; 54:e14109. [PMID: 37859571 DOI: 10.1111/eci.14109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION N-3 polyunsaturated fatty acids (PUFAs) supplementation has been reported to have an impact on flow-mediated dilatation (FMD), a conventionally used clinical technique for estimating endothelial dysfunction. However, its proven effects on endothelial function are unclear. This systematic review and meta-analysis were conducted to evaluate the effects of n-3 PUFAs supplementation on FMD of the brachial artery. METHOD This study was performed following the PRISMA guidelines. To identify eligible RCTs, a systematic search was completed in PubMed/Medline, Scopus and Web of Science using relevant keywords. A fixed- or random-effects model was utilized to estimate the weighted mean difference (WMD) and 95% confidence interval (95% CI). RESULTS Thirty-two studies (with 35 arms) were included in this meta-analysis, involving 2385 subjects with intervention duration ranging from 4 to 48 weeks. The pooled meta-analysis demonstrated a significant effect of omega-3 on FMD (WMD = 0.8%, 95% CI = 0.3-1.3, p = .001) and heterogeneity was significant (I2 = 82.5%, p < .001). CONCLUSION We found that n-3 PUFA supplementation improves endothelial function as estimated by flow-mediated dilatation of the brachial artery.
Collapse
Affiliation(s)
- Seyyed Mostafa Arabi
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Hossein Bahari
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Chambari
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Leila Sadat Bahrami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Gerald F Watts
- Cardiometabolic Service, Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Western Australia, Perth, Australia
- School of Medicine, University of Western Australia, Western Australia, Perth, Australia
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
4
|
Romeyke T, Stummer H. Multimodal Approaches in the Treatment of Chronic Peripheral Neuropathy-Evidence from Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:66. [PMID: 38248531 PMCID: PMC10815843 DOI: 10.3390/ijerph21010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
Patients with chronic peripheral neuropathy suffer greatly and their quality of life is often restricted. Drug therapy can be accompanied by undesirable side effects and intolerances, or the hoped-for effect does not materialize. Therefore, in addition to drug therapy, attempts are also made to treat the physical symptoms with complementary procedures. In the case of severe forms, the search for a suitable form of therapy is difficult. Complex treatments can be an innovative way to treat peripheral neuropathy. At the same time, several different therapy methods are carried out at high frequency by a specialized treatment team. This study aimed to provide an overview of possible complementary forms of therapy. The focus was on a comparison of two interdisciplinary complex therapies that are used in severe cases in an acute inpatient care setting in Germany. The six dimensions (energy, sleep, pain, physicality, emotional response and social isolation) of the Nottingham Health Profile (NHP) were used to assess quality of life. Both complex treatments (naturopathic complex therapy/multimodal pain therapy) showed a significant reduction in impairment in all dimensions of the NHP. In addition, a multivariate analysis was carried out to take into account several influencing variables at the same time. At the time of admission to the hospital, the degree of chronicity was recorded for each patient. This allowed statements to be made about the effect of the respective therapy depending on the chronification stage of the patient. It has been shown that patients with acutely exacerbated pain with the highest degree of chronicity also benefit from both complex treatments. The naturopathic complex treatment gives the treatment team more options. Aspects such as nutrition, methods from phytotherapy and traditional Chinese medicine can be integrated into inpatient care. Thus, a patient-centered, holistic therapy can take place. However, an interdisciplinary holistic therapy requires more time for both the practitioner and the patient. This should be taken into account in the health systems in the context of the diagnosis related groups.
Collapse
Affiliation(s)
- Tobias Romeyke
- Institute for Management and Economics in Health Care, UMIT—University of Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria;
- Waldhausklinik, Acute Hospital for Internal Medicine, Pain Therapy, Complementary and Individualized Patient Centred Medicine, 86391 Deuringen, Germany
| | - Harald Stummer
- Institute for Management and Economics in Health Care, UMIT—University of Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria;
- University Seeburg Castle, 5201 Seekirchen am Wallersee, Austria
| |
Collapse
|
5
|
Lee YS, Park JW, Joo M, Moon S, Kim K, Kim MG. Effects of Omega-3 Fatty Acids on Flow-mediated Dilatation and Carotid Intima Media Thickness: A Meta-analysis. Curr Atheroscler Rep 2023; 25:629-641. [PMID: 37552456 DOI: 10.1007/s11883-023-01137-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW To investigate the effects of omega-3 fatty acids on flow-mediated dilatation (FMD) and carotid intima-media thickness (CIMT) and explore the factors influencing these effects. RECENT FINDINGS FMD was significantly higher in the omega-3 fatty acid group compared to the control group (mean difference = 0.90%; p = 0.0003). In particular, the subgroup with CHD (both EPA + DHA < 1 g/day and ≥ 1 g/day) and the subgroup without CHD but with CHD risk factors (only EPA + DHA ≥ 1 g/day) showed significantly increased FMD after supplementation of omega-3 fatty acids. CIMT was not significantly different between the omega-3 fatty acid and control groups (standardized mean difference = -0.08; p = 0.26). Subgroup analysis of CHD patients was not conducted because of the limited number of studies. Intake of omega-3 fatty acids improved FMD in patients with CHD and patients with risk factors for CHD. Further research is needed on the effects of omega-3 fatty acids on CIMT.
Collapse
Affiliation(s)
- Young Seo Lee
- College of Pharmacy, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Ji Won Park
- College of Pharmacy, Korea University, Sejong, 30019, Republic of Korea
| | - Minjin Joo
- College of Pharmacy, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Sumin Moon
- College of Pharmacy, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Kyungim Kim
- College of Pharmacy, Korea University, Sejong, 30019, Republic of Korea.
- Institute of Pharmaceutical Science, Korea University, Sejong, 30019, Republic of Korea.
| | - Myeong Gyu Kim
- College of Pharmacy, Ewha Womans University, Seoul, 03760, Republic of Korea.
- Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea.
| |
Collapse
|
6
|
Sun Y, McDonald T, Baur A, Xu H, Bateman NB, Shen Y, Li C, Ye K. Fish oil supplementation modifies the genetic potential for blood lipids. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.22.23295987. [PMID: 37808791 PMCID: PMC10557817 DOI: 10.1101/2023.09.22.23295987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Background Dyslipidemia is a well-known risk factor for cardiovascular disease, which has been the leading cause of mortality worldwide. Although habitual intake of fish oil has been implicated in offering cardioprotective effects through triglyceride reduction, the interactions of fish oil with the genetic predisposition to dysregulated lipids remain elusive. Objectives We examined whether fish oil supplementation can modify the genetic potential for the circulating levels of four lipids, including total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. Methods A total of 441,985 participants with complete genetic and phenotypic data from the UK Biobank were included in our study. Polygenic scores (PGS) were calculated in participants of diverse ancestries. Multivariable linear regression models were used to assess associations with adjustment for relevant risk factors. Results Fish oil supplementation mitigated genetic susceptibility to elevated levels of total cholesterol, LDL-C, and triglycerides, while amplifying genetic potential for increased HDL-C among 424,090 participants of European ancestry P interaction < 0.05 . Consistent significant findings were obtained using PGS calculated based on multiple genome-wide association studies or alternative PGS methods. We also showed that fish oil significantly attenuated genetic predisposition to high triglycerides in African-ancestry participants. Conclusions Fish oil supplementation attenuated the genetic susceptibility to elevated blood levels of total cholesterol, LDL-C, and triglycerides, while accentuating genetic potential for higher HDL-C. These results suggest that fish oil may have a beneficial impact on modifying genome-wide genetic effects on elevated lipid levels in the general population.
Collapse
Affiliation(s)
- Yitang Sun
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Tryggvi McDonald
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Abigail Baur
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Huifang Xu
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Naveen Brahman Bateman
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Ye Shen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Changwei Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Kaixiong Ye
- Department of Genetics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
- Institute of Bioinformatics, University of Georgia, Athens, GA, USA
| |
Collapse
|
7
|
Rehman G, Sardar S, Alkhateeb MA, Mohamed RAEH, Al Galil FMA, Hamayun M, Shahjeer K, Iqbal T, Ahmed N, Nawaz T, Ullah R. Evaluation of Functional and Bioactive Properties of Crude Gill Extract of
Tor putitora
using Different Assays. Int J Food Sci Technol 2022. [DOI: 10.1111/ijfs.15961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gauhar Rehman
- Department of Zoology Abdul Wali Khan University Mardan Khyber Pakhtunkhwa Pakistan
| | - Sumbal Sardar
- Department of Zoology Abdul Wali Khan University Mardan Khyber Pakhtunkhwa Pakistan
| | - Mariam Abdulaziz Alkhateeb
- Department of Biology College of Sciences, Princess Nourah bint Abdulrahman University P.O. Box 84428 Riyadh 11671 Saudi Arabia
| | - Rania Ali El Hadi Mohamed
- Department of Biology College of Sciences, Princess Nourah bint Abdulrahman University P.O. Box 84428 Riyadh 11671 Saudi Arabia
| | | | - Muhammad Hamayun
- Department of Botany Abdul Wali Khan University Mardan Khyber Pakhtunkhwa Pakistan
| | - Kiran Shahjeer
- Department of Zoology Abdul Wali Khan University Mardan Khyber Pakhtunkhwa Pakistan
| | - Toheed Iqbal
- Department of Entomology, Faculty of crop protection sciences The University of Agriculture Peshawar‐Khyber Pakhtunkhwa‐ Pakistan
| | - Nazeer Ahmed
- Department of Agriculture University of Swabi Anbar 23561 Swabi‐Khyber Pakhtunkhwa Pakistan
| | - Taufiq Nawaz
- Department of Food Science and Technology The University of Agriculture Peshawar 25130 Pakistan
| | - Rafi Ullah
- Department of Agriculture University of Swabi Anbar 23561 Swabi‐Khyber Pakhtunkhwa Pakistan
| |
Collapse
|
8
|
Khorshidi M, Sayyari A, Aryaeian N, Olang B, Alaei M, Khalili M, Hosseini A, Salehi M. Effects of omega-3 supplementation on endothelial function, vascular structure, and metabolic parameters in adolescents with type 1 diabetes mellitus: A randomized clinical trial. Front Nutr 2022; 9:962773. [PMID: 35938123 PMCID: PMC9355374 DOI: 10.3389/fnut.2022.962773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/27/2022] [Indexed: 12/16/2022] Open
Abstract
Background Vascular dysfunction is a major complication of diabetes mellitus that leads to cardiovascular disease (CVD). This study aimed to examine the effects of omega-3 consumption on endothelial function, vascular structure, and metabolic parameters in adolescents with type 1 diabetes mellitus (T1DM). Methods In this randomized, double-blind, placebo-controlled clinical trial, 51 adolescents (10–18 years) with T1DM completed the study. Patients received 600 mg/day [containing 180 mg eicosapentaenoic acid (EPA) and 120 mg docosahexaenoic acid (DHA)] of omega-3 or placebo for 12 weeks. Flow-mediated dilation (FMD), carotid intima-media thickness (CIMT), high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, blood urea nitrogen (BUN), creatinine, fasting blood sugar (FBS), hemoglobin A1C (HbA1c), homeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), serum insulin (SI), urine albumin-creatinine ratio (uACR), blood pressure, and anthropometric indices were assessed at the baseline and after the intervention. Results Following supplementation, omega-3 significantly increased FMD (3.1 ± 4.2 vs. −0.6 ± 4%, p = 0.006) and decreased TG (−7.4 ± 10.7 vs. −0.1 ± 13.1 mg/dl, p = 0.022) in comparison with the placebo group. However, no significant difference was observed regarding CIMT (-0.005 ± 0.036 vs. 0.003 ± 0.021 mm, p = 0.33). Although hs-CRP was significantly decreased within the omega-3 group (p = 0.031); however, no significant change was observed compared to placebo group (p = 0.221). Omega-3 supplementation had no significant effect on other variables. Conclusion Given the elevation in FMD and reduction in TG, omega-3 supplementation can improve vascular function and may reduce the risk of cardiovascular disease in adolescents with T1DM patients.
Collapse
Affiliation(s)
- Masoud Khorshidi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Aliakbar Sayyari
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naheed Aryaeian
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences (IUMS), Tehran, Iran
- *Correspondence: Naheed Aryaeian
| | - Beheshteh Olang
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Children Emergency Department Karolinska University Hospital, Stockholm, Sweden
| | - Mohammadreza Alaei
- Department of Pediatric Endocrinology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Khalili
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Hosseini
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Salehi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Fewkes JJ, Kellow NJ, Cowan SF, Williamson G, Dordevic AL. A single, high-fat meal adversely affects postprandial endothelial function: a systematic review and meta-analysis. Am J Clin Nutr 2022; 116:699-729. [PMID: 35665799 PMCID: PMC9437993 DOI: 10.1093/ajcn/nqac153] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/29/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Endothelial dysfunction is a predictive risk factor for the development of atherosclerosis and is assessed by flow-mediated dilation (FMD). Although it is known that NO-dependent endothelial dysfunction occurs after consuming a high-fat meal, the magnitude of the effect and the factors that affect the response are unquantified. OBJECTIVES We conducted a systematic review and meta-analysis exploring the quantitative effects of a single high-fat meal on endothelial function and determined the factors that modify the FMD response. METHODS Six databases were systematically searched for original research published up to January 2022. Eligible studies measured fasting and postprandial FMD following consumption of a high-fat meal. Meta-regression was used to analyze the effect of moderator variables. RESULTS There were 131 studies included, of which 90 were suitable for quantitative meta-analysis. A high-fat meal challenge transiently caused endothelial dysfunction, decreasing postprandial FMD at 2 hours [-1.02 percentage points (pp); 95% CI: -1.34 to -0.70 pp; P < 0.01; I2 = 93.3%], 3 hours [-1.04 pp; 95% CI: -1.48 to -0.59 pp; P < 0.001; I2 = 84.5%], and 4 hours [-1.19 pp; 95% CI: -1.53 to -0.84 pp; P < 0.01; I2 = 94.6%]. Younger, healthy-weight participants exhibited a greater postprandial reduction in the FMD percentage change than older, heavier, at-risk groups after a high-fat meal ( P < 0.05). The percentage of fat in the meals was inversely associated with the magnitude of postprandial changes in FMD at 3 hours (P < 0.01). CONCLUSIONS A single, high-fat meal adversely impacts endothelial function, with the magnitude of the impact on postprandial FMD moderated by the fasting FMD, participant age, BMI, and fat content of the meal. Recommendations are made to standardize the design of future postprandial FMD studies and optimize interpretation of results, as high-fat meals are commonly used in clinical studies as a challenge to assess endothelial function and therapeutics. This trial was registered at PROSPERO as CRD42020187244.
Collapse
Affiliation(s)
- Juanita J Fewkes
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia,Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Nicole J Kellow
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia,Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Stephanie F Cowan
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | | | - Aimee L Dordevic
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia,Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
10
|
Silveira EA, Rosa LPDS, de Resende DP, Rodrigues APDS, da Costa AC, Rezende ATDO, Noll M, de Oliveira C, Junqueira-Kipnis AP. Positive Effects of Extra-Virgin Olive Oil Supplementation and DietBra on Inflammation and Glycemic Profiles in Adults With Type 2 Diabetes and Class II/III Obesity: A Randomized Clinical Trial. Front Endocrinol (Lausanne) 2022; 13:841971. [PMID: 35586621 PMCID: PMC9108866 DOI: 10.3389/fendo.2022.841971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Evidence on the effects of dietary interventions on inflammatory markers in individuals with obesity and type 2 diabetes mellitus (T2DM) is scarce. Our study evaluated the effects of extra-virgin olive oil alone and in combination with a traditional Brazilian diet on inflammatory markers and glycemic profiles in adults with both T2DM and class II/III obesity. Methods Adults aged 18-64 years with T2DM and class II/III obesity were randomized into two intervention groups: 1) extra-virgin olive oil only and 2) extra-virgin olive oil + a traditional Brazilian diet (OliveOil+DietBra). Data on sociodemographic characteristics, lifestyle, anthropometry, biochemical markers and inflammatory markers were collected. The primary outcomes were glycemic parameters and inflammatory markers. The body mass index (BMI) and weight were the secondary outcomes. Results Forty individuals with T2DM and class II/III obesity were enrolled, and 34 (85%) completed the intervention course. The intake of olive oil was 37.88 ± 12.50 mL/day in the olive oil group and 37.71 ± 12.23 mL/day in the OliveOil+DietBra group, with no significant difference between groups (p = 0.484). Compared to the olive oil only group, the OliveOil+DietBra group had significantly lower levels of fasting insulin (p = 0.047) at the end of the intervention, whereas the other glycemic parameters were not altered. In the OliveOil+DietBra group, serum levels of inflammatory cytokines, IL-1α (p = 0.006) and adiponectin (p = 0.049) were lower and those of TNFα were higher (p = 0.037). There was a significant reduction in BMI and weight compared to the baseline values in the OliveOil+DietBra group (p = 0.015). Conclusions The intervention with OliveOil+DietBra effectively decreased the levels of fasting insulin, IL-1α and adiponectin, suggesting its beneficial role in improving the inflammatory profiles and fasting insulin levels in adults with class II/III obesity and T2DM. Clinical Trial Registration ClinicalTrials.gov, identifier: NCT02463435.
Collapse
Affiliation(s)
- Erika Aparecida Silveira
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiás, Brazil
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Lorena Pereira de Souza Rosa
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiás, Brazil
- Federal Institute of Goiás, Campus Goiânia, Goiás, Brazil
| | - Danilo Pires de Resende
- Department of Biosciences, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiás, Brazil
| | | | - Adeliane Castro da Costa
- Department of Biosciences, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiás, Brazil
| | | | - Matias Noll
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiás, Brazil
- Instituto Federal Goiano, Campus Ceres, Goiás, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Ana Paula Junqueira-Kipnis
- Department of Biosciences, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiás, Brazil
| |
Collapse
|
11
|
Efficacy and Safety of Da-Chai-Hu-Tang in Lipid Profiles in High-Risk, Statin-Treated Patients with Residual HyperTG: A 12-Week, Randomized, Active-Control, Open Clinical Study. Life (Basel) 2022; 12:life12030408. [PMID: 35330160 PMCID: PMC8950495 DOI: 10.3390/life12030408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 01/02/2023] Open
Abstract
Da-Chai-Hu-Tang (DCHT) is a herbal extract that has been shown to reduce serum triglyceride (TG) levels in animal experiments as well as small clinical trials. This study aimed to evaluate the efficacy and safety of DCHT in high-risk, statin-treated patients with residual hypertriglyceridemia (hyperTG). This was a 12-week, randomized, active-controlled, open-label, single-center trial. Of these patients, 42 had high cardiovascular risks whose LDL cholesterol levels were controlled by statin treatment; however, with TG levels of 200 to 500 mg/dL they were randomly assigned 1:1 to the OMEGA3 or DCHT group. The primary endpoint was defined as the percentage change in TG at 12 weeks, and changes in other lipid profiles and endothelial cell function were included as secondary endpoints. Safety analyses were also conducted. In the OMEGA3 group, the average TG level decreased from 294.5 ± 72.0 to 210.0 ± 107.8 mg/dL (p = 0.004), and in the DCHT group, from 288.7 ± 59.1 to 227.5 ± 98.1 mg/dL (p = 0.001). The percentage change in TG was −27.6 ± 33.6 and −22.4 ± 24.1 (p = 0.58), respectively, and there was no significant difference between the two groups. There were no severe adverse events in either group. In high-risk, statin-treated patients with residual hyperTG, the administration of OMEGA3 or DCHT for 12 weeks resulted in a significant reduction in TG, and the effect of DCHT was not inferior to that of OMEGA3.
Collapse
|
12
|
Alsbirk KE, Seland JH, Assmus J. Diabetic retinopathy and visual impairment in a Norwegian diabetic coast population with a high dietary intake of fish oils. An observational study. Acta Ophthalmol 2022; 100:e532-e538. [PMID: 34472215 DOI: 10.1111/aos.14977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 07/01/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To present retinal and visual findings in a Norwegian west coast diabetic population and to elucidate the effect of dietary intake of marine polyunsaturated fatty acids (PUFAs) on the development of diabetic retinopathy (DR). METHODS In an eye practice in an archipelago of 314 km², serving a population of about 40 000, we recorded the prevalence of visual impairment and DR in a referred diabetic population. 510 consecutive patients were included, 238 females and 272 males. 50 patients had type I and 460 had type II diabetes mellitus (DM). Self-reported medication, diet supplements, HbA1c and fish consumption were registered. RESULTS In the type I group, the median age was 44.5 and median DM duration 11.5 years [1-44]. 48% had photographic evidence of DR, 8 patients (16%) had proliferative retinopathy (PDR), and 6 patients (12%) had diabetic macular oedema (DME). All had best-corrected visual acuity (BCVA) of 0.5 (log MAR 0.3) or better in the best eye. In the type II group, the median DM duration was 8 years [1-53], and median age was 66. 98% had best eye BCVA at or better than 0.5 (log MAR 0.3) in the best eye. CONCLUSION None of the 510 patients had BCVA worse than 0.3 (log MAR 0.48) due to diabetic retinopathy. Compared to similar studies, we found a very low visual impairment rate. A possible protective effect of PUFA on the prevalence and progression of diabetic microangiopathy including retinopathy is discussed.
Collapse
Affiliation(s)
| | | | - Jörg Assmus
- Centre for Clinical Research Haukeland University Hospital Bergen Norway
| |
Collapse
|
13
|
Abstract
The endothelium acts as the barrier that prevents circulating lipids such as lipoproteins and fatty acids into the arterial wall; it also regulates normal functioning in the circulatory system by balancing vasodilation and vasoconstriction, modulating the several responses and signals. Plasma lipids can interact with endothelium via different mechanisms and produce different phenotypes. Increased plasma-free fatty acids (FFAs) levels are associated with the pathogenesis of atherosclerosis and cardiovascular diseases (CVD). Because of the multi-dimensional roles of plasma FFAs in mediating endothelial dysfunction, increased FFA level is now considered an essential link in the onset of endothelial dysfunction in CVD. FFA-mediated endothelial dysfunction involves several mechanisms, including dysregulated production of nitric oxide and cytokines, metaflammation, oxidative stress, inflammation, activation of the renin-angiotensin system, and apoptosis. Therefore, modulation of FFA-mediated pathways involved in endothelial dysfunction may prevent the complications associated with CVD risk. This review presents details as to how endothelium is affected by FFAs involving several metabolic pathways.
Collapse
|
14
|
AbuMweis S, Abu Omran D, Al-Shami I, Jew S. The ratio of eicosapentaenoic acid to docosahexaenoic acid as a modulator for the cardio-metabolic effects of omega-3 supplements: A meta-regression of randomized clinical trials. Complement Ther Med 2021; 57:102662. [PMID: 33418065 DOI: 10.1016/j.ctim.2021.102662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/28/2020] [Accepted: 01/02/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A large number of studies have demonstrated the effects of omega- 3 supplements containing mixtures of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), known to favorably affect many modifiable risk factors of coronary heart disease (CHD). These studies have used diverse ratios and doses of EPA and DHA. However, it is not known whether the ratio of EPA to DHA in omega-3 supplements affect their efficacy as modulators for cardiovascular risk factors. This meta-regression aimed to investigate the effect of different ratios of EPA to DHA on risk factors associated with CHD including lipid profile, blood pressure, heart rate, and inflammation. METHOD A regression analysis was carried out on 92 clinical trials with acceptable quality (Jadad score ≥ 3) that were previously identified from two databases (PubMed and Cochrane Library). RESULTS Data from studies that met the inclusion criteria for this analysis showed that the ratio of EPA to DHA was not associated with lipid profile, diastolic blood pressure, or heart rate. With all studies, the ratio of EPA to DHA was associated with C-reactive protein (CRP) (β = -1.3121 (95 % CI: -1.6610 to -0.9543), that is, the higher the EPA to DHA ratio, the greater the reduction. Using only studies that supplied EPA and DHA in the range of 2 g-6 g, the ratio of EPA to DHA was also associated with CRP (β = -2.10429 and 95 % CI: -3.89963 to -0.30895); that is, an even more pronounced reduction in CRP with a higher EPA to DHA ratio. Systolic blood pressure was only associated with an increasing EPA to DHA ratio in the 2 g-6 g range (β = 5.47129 and 95 % CI: 0.40677-10.53580), that is, a higher EPA to DHA ratio within this dose range, the greater the increase in SBP. CONCLUSION Current data suggest that the EPA to DHA ratio only correlates to the modulation of CRP by omega-3 supplementation of EPA and DHA, and SBP in studies that supplemented EPA and DHA in the range of 2 g-6 g, shedding light on potential differential effects of EPA vs. DHA on inflammation and systolic blood pressure.
Collapse
Affiliation(s)
- Suhad AbuMweis
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan; College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates.
| | | | - Islam Al-Shami
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan
| | | |
Collapse
|
15
|
Effect of omega-3 polyunsaturated fatty acids in modulation of vascular tone under physiological and pathological conditions. Eur J Pharm Sci 2020; 153:105499. [PMID: 32736093 DOI: 10.1016/j.ejps.2020.105499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022]
Abstract
Omega-3 polyunsaturated fatty acids (n-3 PUFAs), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are mainly found in marine fish oils and commercially available fish oil supplements. Several studies have documented that n-3 PUFAs can reduce the risk of cardiovascular diseases through anti-inflammatory, anti-thrombotic, and anti-atherosclerotic properties. Notably, regulation of vascular tone is one of the most important bases of cardiovascular health and especially for maintaining blood pressure within optimal physiological ranges. Recent clinical and animal studies indicate an association between n-3 PUFAs and vascular functions. In this regard, many clinical trials and basic experimental studies have been conducted so far to investigate the influence of n-3 PUFAs on vascular tone. In this review, we have summarized the results obtained from both clinical and basic studies that evaluated the effect of n-3 PUFAs under physiological and pathological conditions. Moreover, we also focus on verifying the underlying basic molecular mechanism of n-3 PUFAs on the vascular system.
Collapse
|
16
|
Impact of Lifestyles (Diet and Exercise) on Vascular Health: Oxidative Stress and Endothelial Function. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:1496462. [PMID: 33062134 PMCID: PMC7533760 DOI: 10.1155/2020/1496462] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023]
Abstract
Healthy lifestyle and diet are associated with significant reduction in risk of obesity, type 2 diabetes, and cardiovascular diseases. Oxidative stress and the imbalance between prooxidants and antioxidants are linked to cardiovascular and metabolic diseases. Changes in antioxidant capacity of the body may lead to oxidative stress and vascular dysfunction. Diet is an important source of antioxidants, while exercise offers many health benefits as well. Recent findings have evidenced that diet and physical factors are correlated to oxidative stress. Diet and physical factors have debatable roles in modulating oxidative stress and effects on the endothelium. Since endothelium and oxidative stress play critical roles in cardiovascular and metabolic diseases, dietary and physical factors could have significant implications on prevention of the diseases. This review is aimed at summarizing the current knowledge on the impact of diet manipulation and physical factors on endothelium and oxidative stress, focusing on cardiovascular and metabolic diseases. We discuss the friend-and-foe role of dietary modification (including different diet styles, calorie restriction, and nutrient supplementation) on endothelium and oxidative stress, as well as the potential benefits and concerns of physical activity and exercise on endothelium and oxidative stress. A fine balance between oxidative stress and antioxidants is important for normal functions in the cells and interfering with this balance may lead to unfavorable effects. Further studies are needed to identify the best diet composition and exercise intensity.
Collapse
|
17
|
O'Mahoney LL, Dunseath G, Churm R, Holmes M, Boesch C, Stavropoulos-Kalinoglou A, Ajjan RA, Birch KM, Orsi NM, Mappa G, Price OJ, Campbell MD. Omega-3 polyunsaturated fatty acid supplementation versus placebo on vascular health, glycaemic control, and metabolic parameters in people with type 1 diabetes: a randomised controlled preliminary trial. Cardiovasc Diabetol 2020; 19:127. [PMID: 32787879 PMCID: PMC7425064 DOI: 10.1186/s12933-020-01094-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background The role of omega-3 polyunsaturated fatty acids (n-3PUFA), and the potential impact of n-3PUFA supplementation, in the treatment and management of type 1 diabetes (T1D) remains unclear and controversial. Therefore, this study aimed to examine the efficacy of daily high-dose-bolus n-3PUFA supplementation on vascular health, glycaemic control, and metabolic parameters in subjects with T1D. Methods Twenty-seven adults with T1D were recruited to a 6-month randomised, double-blind, placebo-controlled trial. Subjects received either 3.3 g/day of encapsulated n-3PUFA or encapsulated 3.0 g/day corn oil placebo (PLA) for 6-months, with follow-up at 9-months after 3-month washout. Erythrocyte fatty acid composition was determined via gas chromatography. Endpoints included inflammation-associated endothelial biomarkers (vascular cell adhesion molecule-1 [VCAM-1], intercellular adhesion molecule-1 [ICAM-1], E-selectin, P-selectin, pentraxin-3, vascular endothelial growth factor [VEGF]), and their mediator tumor necrosis factor alpha [TNFα] analysed via immunoassay, vascular structure (carotid intima-media thickness [CIMT]) and function (brachial artery flow mediated dilation [FMD]) determined via ultrasound technique, blood pressure, glycosylated haemoglobin (HbA1c), fasting plasma glucose (FPG), and postprandial metabolism. Results Twenty subjects completed the trial in full. In the n-3PUFA group, the mean ± SD baseline n-3PUFA index of 4.93 ± 0.94% increased to 7.67 ± 1.86% (P < 0.001) after 3-months, and 8.29 ± 1.45% (P < 0.001) after 6-months. Total exposure to n-3PUFA over the 6-months (area under the curve) was 14.27 ± 3.05% per month under n-3PUFA, and 9.11 ± 2.74% per month under PLA (P < 0.001). VCAM-1, ICAM-1, E-selectin, P-selectin, pentraxin-3, VEGF, TNFα, CIMT, FMD, blood pressure, HbA1c, FPG, and postprandial metabolism did not differ between or within groups after treatment (P > 0.05). Conclusions This study indicates that daily high-dose-bolus of n-3PUFA supplementation for 6-months does not improve vascular health, glucose homeostasis, or metabolic parameters in subjects with T1D. The findings from this preliminary RCT do not support the use of therapeutic n-3PUFA supplementation in the treatment and management of T1D and its associated complications. Trial Registration ISRCTN, ISRCTN40811115. Registered 27 June 2017, http://www.isrctn.com/ISRCTN40811115.
Collapse
Affiliation(s)
| | - Gareth Dunseath
- Diabetes Research Group, Swansea University Medical School, Swansea University, Swansea, UK
| | - Rachel Churm
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UK
| | - Mel Holmes
- School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, LS2 9JT, UK
| | - Christine Boesch
- School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Karen M Birch
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Nicolas M Orsi
- Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, UK
| | - Georgia Mappa
- Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, UK
| | - Oliver J Price
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Matthew D Campbell
- School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, LS2 9JT, UK.
| |
Collapse
|
18
|
Liu X, Zhang B, Liu H, Zhang G, Zhao J, Liu L, Piao X, Song H, Zhang S, Li Y. Determination of the available energy values and amino acid digestibility of Flammulina velutipes stem waste and its effects on carcass trait and meat quality fed to growing-finishing pigs. J Anim Sci Biotechnol 2020; 11:41. [PMID: 32391146 PMCID: PMC7197121 DOI: 10.1186/s40104-020-00449-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/12/2020] [Indexed: 12/04/2022] Open
Abstract
Background Flammulina velutipes stem waste (FVS) is the by-product of mushroom industry. The objectives of this study were to determine the available energy and amino acid digestibility of FVS fed to pigs, and to evaluate the effects of dietary FVS inclusion on growth performance, biochemical profile of serum, fecal short chain fatty acid (SCFA) concentration, carcass traits, meat quality, intestinal morphology and microflora of pigs. In Exp. 1, twelve crossbred barrows with initial body weight (IBW) of 37.48 ± 4.31 kg were randomly allotted to 2 dietary treatments, including a corn basal diet and an experimental diet containing 24.35% FVS. In Exp. 2, twelve barrows fitted with an ileal T-cannula (IBW: 32.56 ± 1.67 kg) were randomly allotted to 2 dietary treatments, which included a N-free diet and an experimental diet containing 40.0% FVS. In Exp. 3, ninety growing pigs (IBW: 63.98 ± 6.89 kg) were allotted to 1 of 3 treatment diets for 63 d, including a basal diet and 2 experimental diets with 2.5% and 5% FVS, respectively. Results The digestible energy (DE) and metabolizable energy (ME) of FVS were 4.58 and 4.06 MJ/kg on dry matter basis, respectively, and the standardized ileal digestibility (SID) of indispensable AAs ranged from 17.50% to 59.47%. Pigs fed diets with 2.5% FVS showed no difference on average daily gain (ADG) and gain to feed ratio (G/F). Although dietary 5% FVS inclusion impaired apparent total tract digestibility (ATTD) of organic matter and gross energy, it elevated the SCFA concentration (P ≤ 0.04) in gut and antioxidant capacity in serum. In addition, dietary FVS inclusion depressed the backfat thickness (P = 0.03) in pigs. The longissimus dorsi muscle of pigs fed FVS revealed higher n-3 polyunsaturated fatty acid concentration and optimized fatty acid composition. Dietary 2.5% FVS inclusion also improved the intestinal development and health by increasing the villius height to crypt depth ratio (V/C) in jejunum (P < 0.01), and promoting microbial diversity and beneficial microbiota proliferation. Conclusions It is feasible to include moderate content of FVS as an unconventional fiber ingredient in diet of growing-finishing pigs.
Collapse
Affiliation(s)
- Xuzhou Liu
- 1Institute of Mycology, Engineering Research Center of Chinese Ministry of Education for Edible and Medicinal Fungi, Jilin Agricultural University, Changchun, 130118 China
| | - Bo Zhang
- 1Institute of Mycology, Engineering Research Center of Chinese Ministry of Education for Edible and Medicinal Fungi, Jilin Agricultural University, Changchun, 130118 China
| | - Hansuo Liu
- 2State Key Laboratory of Animal Nutrition, Ministry of Agriculture Feed Industry Centre, China Agricultural University, Beijing, 100193 China
| | - Gang Zhang
- 2State Key Laboratory of Animal Nutrition, Ministry of Agriculture Feed Industry Centre, China Agricultural University, Beijing, 100193 China
| | - Jinbiao Zhao
- 2State Key Laboratory of Animal Nutrition, Ministry of Agriculture Feed Industry Centre, China Agricultural University, Beijing, 100193 China
| | - Ling Liu
- 2State Key Laboratory of Animal Nutrition, Ministry of Agriculture Feed Industry Centre, China Agricultural University, Beijing, 100193 China
| | - Xiangshu Piao
- 2State Key Laboratory of Animal Nutrition, Ministry of Agriculture Feed Industry Centre, China Agricultural University, Beijing, 100193 China
| | - Hui Song
- 1Institute of Mycology, Engineering Research Center of Chinese Ministry of Education for Edible and Medicinal Fungi, Jilin Agricultural University, Changchun, 130118 China
| | - Shuai Zhang
- 2State Key Laboratory of Animal Nutrition, Ministry of Agriculture Feed Industry Centre, China Agricultural University, Beijing, 100193 China
| | - Yu Li
- 1Institute of Mycology, Engineering Research Center of Chinese Ministry of Education for Edible and Medicinal Fungi, Jilin Agricultural University, Changchun, 130118 China
| |
Collapse
|
19
|
Wu H, Xu L, Ballantyne CM. Dietary and Pharmacological Fatty Acids and Cardiovascular Health. J Clin Endocrinol Metab 2020; 105:dgz174. [PMID: 31678992 PMCID: PMC7174038 DOI: 10.1210/clinem/dgz174] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/01/2019] [Indexed: 12/30/2022]
Abstract
CONTEXT The effects of dietary intake of different fatty acids and pharmacological use of fatty acids, specifically long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFAs), on cardiovascular health and atherosclerotic cardiovascular disease (ASCVD) prevention have been examined in a large number of observational studies and clinical trials. This review summarizes recent data and discusses potential mechanisms. EVIDENCE ACQUISITION The review is based on the authors' knowledge of the field supplemented by a PubMed search using the terms seafood, fish oil, saturated fatty acids, omega-3 fatty acids, eicosapentaenoic acid, docosahexaenoic acid, polyunsaturated fatty acids, monounsaturated fatty acids, and ASCVD. EVIDENCE SYNTHESIS We mainly discuss the recent clinical trials that examine the effects of different types of dietary fatty acids and pharmacological use of n-3 PUFA products on ASCVD prevention and the potential mechanisms. CONCLUSIONS While replacement of dietary saturated fat with unsaturated fat, polyunsaturated fat in particular, or intake of LC n-3 PUFA-rich seafood has generally shown benefit for ASCVD prevention and is recommended for cardiovascular benefits, data on effects of n-3 PUFA products on ASCVD health are inconsistent. However, recent clinical trials support benefits of prescription EPA in ASCVD prevention. n-3 PUFAs may contribute to ASCVD prevention through multiple mechanisms, including lowering plasma triglyceride levels, anti-inflammatory effects, antithrombotic effects, and effects on endothelial function.
Collapse
Affiliation(s)
- Huaizhu Wu
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Lu Xu
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | |
Collapse
|
20
|
Li ZH, Zhong WF, Liu S, Kraus VB, Zhang YJ, Gao X, Lv YB, Shen D, Zhang XR, Zhang PD, Huang QM, Chen Q, Wu XB, Shi XM, Wang D, Mao C. Associations of habitual fish oil supplementation with cardiovascular outcomes and all cause mortality: evidence from a large population based cohort study. BMJ 2020; 368:m456. [PMID: 32131999 PMCID: PMC7249244 DOI: 10.1136/bmj.m456] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate the associations of habitual fish oil supplementation with cardiovascular disease (CVD) and mortality in a large prospective cohort. DESIGN Population based, prospective cohort study. SETTING UK Biobank. PARTICIPANTS A total of 427 678 men and women aged between 40 and 69 who had no CVD or cancer at baseline were enrolled between 2006 and 2010 and followed up to the end of 2018. MAIN EXPOSURE All participants answered questions on the habitual use of supplements, including fish oil. MAIN OUTCOME MEASURES All cause mortality, CVD mortality, and CVD events. RESULTS At baseline, 133 438 (31.2%) of the 427 678 participants reported habitual use of fish oil supplements. The multivariable adjusted hazard ratios for habitual users of fish oil versus non-users were 0.87 (95% confidence interval 0.83 to 0.90) for all cause mortality, 0.84 (0.78 to 0.91) for CVD mortality, and 0.93 (0.90 to 0.96) for incident CVD events. For CVD events, the association seemed to be stronger among those with prevalent hypertension (P for interaction=0.005). CONCLUSIONS Habitual use of fish oil seems to be associated with a lower risk of all cause and CVD mortality and to provide a marginal benefit against CVD events among the general population.
Collapse
Affiliation(s)
- Zhi-Hao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Wen-Fang Zhong
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Simin Liu
- Departments of Epidemiology, Medicine, and Surgery, and Center for Global Cardiometabolic Health, Brown University, Providence, RI, USA
| | - Virginia Byers Kraus
- Duke Molecular Physiology Institute and Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Yu-Jie Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Yue-Bin Lv
- National Institute of Environmental Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Dong Shen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xi-Ru Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Pei-Dong Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Qing-Mei Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xian-Bo Wu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiao-Ming Shi
- National Institute of Environmental Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Dong Wang
- School of Health Services Management, Southern Medical University, Guangzhou, Guangdong, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
21
|
Homocysteine and Asymmetrical Dimethylarginine in Diabetic Rats Treated with Docosahexaenoic Acid-Loaded Zinc Oxide Nanoparticles. Appl Biochem Biotechnol 2020; 191:1127-1139. [PMID: 31960366 DOI: 10.1007/s12010-020-03230-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/08/2020] [Indexed: 12/17/2022]
Abstract
Hyperglycemia, the hallmark of diabetes mellitus, is considered one of the endothelial dysfunction risk factors, the main reason of vascular complication. In this study, we aimed to evaluate homocysteine (Hcy) and asymmetrical dimethylarginine (ADMA) levels in diabetic rats and the possibility to attenuate the elevation of these two parameters by supplementation of docosahexaenoic acid (DHA) alone or loaded zinc oxide nanoparticles (ZnONPs) to improve endothelial dysfunction in streptozotocin (STZ)-induced diabetic rats. Forty male albino rats weighing 180-200 g were classified as control, diabetic, diabetic treated with DHA, and diabetic treated with DHA-loaded zinc oxide nanoparticles (DHA/ZnONPs) groups. Fasting blood glucose, insulin, ADMA, Hcy, and nitric oxide (NO) were estimated. Fatty acids (linoleic acid (LA), arachidonic acid (AA), DHA, α-linolenic acid (ALA), and oleic acid (OA)) were also evaluated by reversed phase HPLC using a UV detector. The results showed that fasting blood sugar, insulin resistance, LA, AA, OA, ADMA, and Hcy increased significantly in diabetic rats compared with control while fasting insulin, DHA, ALA, and NO decreased significantly in diabetic rats. In both treated groups, fasting blood sugar, insulin resistance, LA, AA, OA, ADMA, and Hcy significantly decreased as compared with the diabetic group while fasting insulin, DHA, ALA, and NO were significantly increased. In conclusion, DHA and DHA/ZnONP supplementation protect against diabetic complications and improve endothelial dysfunction as well as hyperhomocysteinemia in diabetes. DHA/ZnONP-treated group appeared more efficient than DHA alone.
Collapse
|
22
|
Heshmati J, Morvaridzadeh M, Maroufizadeh S, Akbari A, Yavari M, Amirinejad A, Maleki-Hajiagha A, Sepidarkish M. Omega-3 fatty acids supplementation and oxidative stress parameters: A systematic review and meta-analysis of clinical trials. Pharmacol Res 2019; 149:104462. [PMID: 31563611 DOI: 10.1016/j.phrs.2019.104462] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/25/2019] [Accepted: 09/20/2019] [Indexed: 01/04/2023]
Abstract
Omega-3 fatty acids (omega-3 FAs) supplementation effects on oxidants and antioxidants are always controversial. Oxidative stress (OS) is one of the major mechanisms that contribute to the pathogenesis of several chronic diseases. The present systematic review and meta-analysis aimed to summarize the finding of randomized clinical trials (RCTs) examining the effects of omega-3 FAs on OS markers. Five databases including PubMed, Embase, Scopus, Web of science, and Cochrane were searched up to May 5th, 2019 with no language restriction. RCTs included if they compared OS indices among subjects who received omega-3 FAs supplements and subjects who supplemented with placebo. To estimate the effects of omega-3 FAs supplementation, standardized mean difference (SMD) with 95% confidence intervals (95% CI) were pooled using random effects model. Of 5,887 publications, 39 trials involving 2,875 participants were included for the meta-analysis. The pooled analysis of data indicated that omega-3 FAs significantly increased serum total antioxidant capacity (TAC) (SMD: 0.48, 95% CI: 0.23, 0.72, P< 0.001; I2= 60%), glutathione peroxidase (GPx) (SMD: 0.73, 95% CI: 0.30, 1.16, P= 0.001; I2= 83%) activity and decreased malondialdehyde (MDA) (SMD= -0.42, 95% CI: -0.62, -0.21; P < 0.001; I2= 74%) compared to the placebo group. However, the effects of omega-3 FAs on nitric oxide (NO) (SMD: -0.17 , 95% CI: -0.77, 0.43, P = 0.57; I2= 91%), reduced glutathione (GSH) (SMD= 0.23, 95% CI= -0.17, 0.64, P= 0.25; I2= 75%), superoxide dismutase (SOD) (0.12 , 95% CI: -0.40, 0.65, P= 0.64; I2= 89%) and catalase (CAT) (0.16, 95% CI: -0.33, 0.65, P= 0.52; I2= 75%,) activities was not significant. Supplementation with omega-3 FAs significantly improves MDA, TAC levels, and GPx activity. Thus, omega-3 FAs can be mentioned as enhancer factors in antioxidant defense against reactive oxygen species (ROS).
Collapse
Affiliation(s)
- Javad Heshmati
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mojgan Morvaridzadeh
- Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saman Maroufizadeh
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Abolfazl Akbari
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Yavari
- Department of Nutritional Science, Texas Tech University, Lubbock, TX, USA
| | - Ali Amirinejad
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Arezoo Maleki-Hajiagha
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran.
| |
Collapse
|
23
|
Ruiz-León AM, Lapuente M, Estruch R, Casas R. Clinical Advances in Immunonutrition and Atherosclerosis: A Review. Front Immunol 2019; 10:837. [PMID: 31068933 PMCID: PMC6491827 DOI: 10.3389/fimmu.2019.00837] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/01/2019] [Indexed: 12/11/2022] Open
Abstract
Atherosclerosis is a chronic low-grade inflammatory disease that affects large and medium-sized arteries and is considered to be a major underlying cause of cardiovascular disease (CVD). The high risk of mortality by atherosclerosis has led to the development of new strategies for disease prevention and management, including immunonutrition. Plant-based dietary patterns, functional foods, dietary supplements, and bioactive compounds such as the Mediterranean Diet, berries, polyunsaturated fatty acids, ω-3 and ω-6, vitamins E, A, C, and D, coenzyme Q10, as well as phytochemicals including isoflavones, stilbenes, and sterols have been associated with improvement in atheroma plaque at an inflammatory level. However, many of these correlations have been obtained in vitro and in experimental animals' models. On one hand, the present review focuses on the evidence obtained from epidemiological, dietary intervention and supplementation studies in humans supporting the role of immunonutrient supplementation and its effect on anti-inflammatory response in atherosclerotic disease. On the other hand, this review also analyzes the possible molecular mechanisms underlying the protective action of these supplements, which may lead a novel therapeutic approach to prevent or attenuate diet-related disease, such as atherosclerosis.
Collapse
Affiliation(s)
- Ana María Ruiz-León
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Mediterranean Diet Foundation, Barcelona, Spain
| | - María Lapuente
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ramon Estruch
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain.,CIBER 06/03: Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Casas
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain.,CIBER 06/03: Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
24
|
Yang B, Shi L, Wang AM, Shi MQ, Li ZH, Zhao F, Guo XJ, Li D. Lowering Effects of n-3 Fatty Acid Supplements on Blood Pressure by Reducing Plasma Angiotensin II in Inner Mongolia Hypertensive Patients: A Double-Blind Randomized Controlled Trial. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:184-192. [PMID: 30511840 DOI: 10.1021/acs.jafc.8b05463] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Whether n-3 fatty acid (FA) has hypotensive actions among Chinese adults remains inconclusive. Hypertensive patients from Inner Mongolia, China ( n = 126) were recruited to a double-blind, randomized controlled trial. We investigated the effects of n-3 FA supplements on blood pressure (BP, mm Hg), plasma concentrations of angiotensin II (Ang II, pg/mL), and nitric oxygen (NO, μmol/L), using fish oil ( n = 41, 4 capsules/day, equivalent to 2 g of eicosapentaenoic acid plus docosahexaenoic acid) and flaxseed oil ( n = 42, 4 capsules/day, equivalent to 2.5 g of α-linolenic acid). Comparing to the control group (corn oil, n = 43), the mean systolic BP (-4.52 ± 9.28 vs -1.51 ± 9.23, P = 0.040) and the plasma Ang II levels (-12.68 ± 10.87 vs -4.93 ± 9.08, P = 0.023) were significantly lowered in the fish oil group, whereas diastolic BP ( P = 0.285) and plasma NO levels ( P = 0.220) were not. Such findings suggest that marine-based n-3 FA has a hypotensive efficacy in Chinese hypertensive patients possibly through inhibiting Ang II-dependent vasoconstrictions.
Collapse
Affiliation(s)
- Bo Yang
- Institute of Lipids Medicine , Wenzhou Medical University , Chashan University Town, Wenzhou , China 325035
- Department of Food Science and Nutrition , Zhejiang University , Hangzhou , China 310029
| | - Lin Shi
- Ejin Horo Banner Centre for Disease Prevention and Control, Ordos , Inner Mongolia , China 017200
| | - Ai-Min Wang
- Ejin Horo Banner Centre for Disease Prevention and Control, Ordos , Inner Mongolia , China 017200
| | - Mei-Qi Shi
- Department of Food Science and Nutrition , Zhejiang University , Hangzhou , China 310029
| | - Zi-Hao Li
- Department of Food Science and Nutrition , Zhejiang University , Hangzhou , China 310029
| | - Feng Zhao
- Institute of Nutrition and Health , Qingdao University , 308 Ningxia Road , Qingdao , China 266003
| | - Xiao-Juan Guo
- Institute of Lipids Medicine , Wenzhou Medical University , Chashan University Town, Wenzhou , China 325035
| | - Duo Li
- Institute of Nutrition and Health , Qingdao University , 308 Ningxia Road , Qingdao , China 266003
- Department of Food Science and Nutrition , Zhejiang University , Hangzhou , China 310029
| |
Collapse
|
25
|
Takenouchi Y, Ohtake K, Nobe K, Kasono K. Eicosapentaenoic acid ethyl ester improves endothelial dysfunction in type 2 diabetic mice. Lipids Health Dis 2018; 17:118. [PMID: 29788974 PMCID: PMC5964666 DOI: 10.1186/s12944-018-0770-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/04/2018] [Indexed: 12/29/2022] Open
Abstract
Background Eicosapentaenoic acid (EPA) is thought to have many beneficial effects, such as anti-atherosclerogenic and anti-inflammatory properties. However, few studies have reported its effects of endothelial dysfunction in diabetes and its direct effects on the aorta. Here, we investigated the effects of EPA treatment on impaired endothelium-dependent relaxation of the aorta in KKAy mice, a model of type 2 diabetes. Methods Male KKAy mice were fed a high-fat (HF) diet for 8 weeks to induce diabetes, after which they were divided into two groups. One group was fed a HF diet, and the other group was fed a HF diet containing EPA ethyl ester (EPA-E, 10 mg/day) for 4 weeks. Then, the vascular reactivities of prepared aortic rings were measured in an organ bath to determine if EPA-E administration changed vascular function in these diabetic mice. In addition, we examined effect of EPA-E and its metabolites to vascular action using aorta separated from C57BL/6 J mice. Results Although EPA-E administration did not change the plasma glucose and insulin levels in diabetic mice, total cholesterol levels were significantly decreased. The aorta extracted from EPA-E untreated diabetic mice showed impaired endothelium-dependent relaxation in response to acetylcholine (ACh). However, EPA-E administration improved the relaxation response to ACh to the control levels observed in non-diabetic C57BL/6 J mice. On the other hand, endothelium-independent relaxation in response to sodium nitroprusside did not significantly differ among these three groups. The enhanced contractile response by phenylephrine in diabetic mice was not altered by the administration of EPA-E. In addition, the direct administration of EPA-E metabolites such as EPA, docosahexaenoic acid, and docosapentaenoic acid led to vasodilation in the aortic rings of C57BL/6 J mice. Conclusion These results showed that chronic EPA-E administration prevented the development of endothelial dysfunction in KKAy mice, partly via the direct action of EPA-E metabolites on the aorta.
Collapse
Affiliation(s)
- Yasuhiro Takenouchi
- Department of Pharmacology, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan. .,Laboratory of Physiology, Faculty of Pharmaceutical Sciences, Josai University, Sakado, Saitama, 350-0295, Japan.
| | - Kazuo Ohtake
- Laboratory of Physiology, Faculty of Pharmaceutical Sciences, Josai University, Sakado, Saitama, 350-0295, Japan
| | - Koji Nobe
- Division of Pharmacology, Department of Pharmacology, Toxicology Therapeutics, School of Pharmacy, Showa University, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Keizo Kasono
- Laboratory of Physiology, Faculty of Pharmaceutical Sciences, Josai University, Sakado, Saitama, 350-0295, Japan
| |
Collapse
|
26
|
Effects of a hypoenergetic diet rich in α-linolenic acid on fatty acid composition of serum phospholipids in overweight and obese patients with metabolic syndrome. Nutrition 2018; 49:74-80. [DOI: 10.1016/j.nut.2017.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/05/2017] [Accepted: 11/01/2017] [Indexed: 11/20/2022]
|
27
|
Felau SM, Sales LP, Solis MY, Hayashi AP, Roschel H, Sá-Pinto AL, Andrade DCOD, Katayama KY, Irigoyen MC, Consolim-Colombo F, Bonfa E, Gualano B, Benatti FB. Omega-3 Fatty Acid Supplementation Improves Endothelial Function in Primary Antiphospholipid Syndrome: A Small-Scale Randomized Double-Blind Placebo-Controlled Trial. Front Immunol 2018; 9:336. [PMID: 29552010 PMCID: PMC5840153 DOI: 10.3389/fimmu.2018.00336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/06/2018] [Indexed: 12/18/2022] Open
Abstract
Endothelial cells are thought to play a central role in the pathogenesis of antiphospholipid syndrome (APS). Omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation has been shown to improve endothelial function in a number of diseases; thus, it could be of high clinical relevance in APS. The aim of this study was to evaluate the efficacy of n-3 PUFA supplementation on endothelial function (primary outcome) of patients with primary APS (PAPS). A 16-week randomized clinical trial was conducted with 22 adult women with PAPS. Patients were randomly assigned (1:1) to receive placebo (PL, n = 11) or n-3 PUFA (ω-3, n = 11) supplementation. Before (pre) and after (post) 16 weeks of the intervention, patients were assessed for endothelial function (peripheral artery tonometry) (primary outcome). Patients were also assessed for systemic markers of endothelial cell activation, inflammatory markers, dietary intake, international normalized ratio (INR), and adverse effects. At post, ω-3 group presented significant increases in endothelial function estimates reactive hyperemia index (RHI) and logarithmic transformation of RHI (LnRHI) when compared with PL (+13 vs. -12%, p = 0.06, ES = 0.9; and +23 vs. -22%, p = 0.02, ES = 1.0). No changes were observed for e-selectin, vascular adhesion molecule-1, and fibrinogen levels (p > 0.05). In addition, ω-3 group showed decreased circulating levels of interleukin-10 (-4 vs. +45%, p = 0.04, ES = -0.9) and tumor necrosis factor (-13 vs. +0.3%, p = 0.04, ES = -0.95) and a tendency toward a lower intercellular adhesion molecule-1 response (+3 vs. +48%, p = 0.1, ES = -0.7) at post when compared with PL. No changes in dietary intake, INR, or self-reported adverse effects were observed. In conclusion, 16 weeks of n-3 PUFA supplementation improved endothelial function in patients with well-controlled PAPS. These results support a role of n-3 PUFA supplementation as an adjuvant therapy in APS. Registered at http://ClinicalTrials.gov as NCT01956188.
Collapse
Affiliation(s)
- Sheylla M Felau
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucas P Sales
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marina Y Solis
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Paula Hayashi
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Lúcia Sá-Pinto
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Danieli Castro Oliveira De Andrade
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Keyla Y Katayama
- Heart Institute (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Claudia Irigoyen
- Heart Institute (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Eloisa Bonfa
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fabiana B Benatti
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,School of Applied Sciences, Universidade Estadual de Campinas (UNICAMP), Limeira, Brazil
| |
Collapse
|
28
|
Treatment with omega-3 polyunsaturated fatty acids does not improve endothelial function in patients with type 2 diabetes and very high cardiovascular risk: A randomized, double-blind, placebo-controlled study (Omega-FMD). Atherosclerosis 2018. [PMID: 29518747 DOI: 10.1016/j.atherosclerosis.2018.02.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Numerous recent studies conducted in different clinical settings have focused on the benefits of omega-3 polyunsaturated fatty acids (n-3 PUFAs) in the prevention of cardiovascular diseases. There is limited evidence that patients with type 2 diabetes (T2D) and very high cardiovascular risk can also benefit from a high dose of n-3PUFAs, especially those on optimal medical therapy as recommended by the guidelines. The aim of the present study was to assess the impact of high-dose n-3 PUFA treatment on endothelial function in patients with T2D and established atherosclerotic cardiovascular disease (ASCVD). METHODS We conducted a prospective randomized double-blind, placebo-controlled, 2-center study, in which endothelial function was measured using flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD). Serum fatty acids composition was measured by gas chromatography. All measurements were done at baseline and after 3 months of treatment with PUFAs at a dose of 2 g/d (n = 36) or placebo (n = 38). RESULTS The majority of the study population was treated with optimal medical therapy. Despite significantly higher concentrations of eicosapentaenoic acid (EPA) and docosahexaenoic acid in the n-3 PUFA group after 3-month treatment, we did not observe significant changes in endothelial function indices (FMD and NMD). However, in regression analysis, only baseline FMD was associated with EPA concentration before 3 months of n-3 PUFA treatment. CONCLUSIONS Three months of high-dose n-3 PUFA treatment in very high-risk patients with ASCVD and T2D did not improve the endothelial function indices.
Collapse
|
29
|
Zehr KR, Walker MK. Omega-3 polyunsaturated fatty acids improve endothelial function in humans at risk for atherosclerosis: A review. Prostaglandins Other Lipid Mediat 2017; 134:131-140. [PMID: 28802571 DOI: 10.1016/j.prostaglandins.2017.07.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/12/2017] [Accepted: 07/26/2017] [Indexed: 12/12/2022]
Abstract
Epidemiology studies and clinical trials show that omega-3 polyunsaturated fatty acids (n-3 PUFAs) can prevent atherosclerotic morbidity and evidence suggests this may be mediated by improving endothelial dysfunction. Endothelial dysfunction is characterized by reduced vasodilation and a pro-inflammatory, pro-thrombotic state, and is an early pathological event in the development of atherosclerosis. Flow-mediated dilation (FMD), a gold standard for assessing endothelial dysfunction, is a predictor of future cardiovascular events and coronary heart disease risk. Notably, risk factors for endothelial dysfunction include classic risk factors for atherosclerosis: Elevated lipids, diabetes, hypertension, elevated BMI, cigarette smoking, and metabolic syndrome. In this paper, we review the ability of n-3 PUFAs to improve endothelial dysfunction in individuals with classic risk factors for atherosclerosis, but lacking diagnosed atherosclerotic disease, with the goal of identifying those individuals that might gain the most vasoprotection from n-3 PUFA supplements. We include trials using eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), or alpha-linolenic acid (ALA) alone, or EPA+DHA; and assessing endothelial function by FMD, forearm blood flow, or peripheral arterial tonometry. We found that n-3 PUFAs improved endothelial dysfunction in 16 of 17 studies in individuals with hyperlipidemia, elevated BMI, metabolic syndrome, or that smoked cigarettes, but only in 2 of 5 studies in diabetics. Further, these trials showed that use of EPA+DHA consistently improve endothelial dysfunction; ALA-enriched diets appear promising; but use of EPA or DHA alone requires further study. We conclude that individuals with hyperlipidemia, elevated BMI, metabolic syndrome, or that smoke could derive vaosprotective benefits from EPA+DHA supplementation.
Collapse
Affiliation(s)
- Kayla R Zehr
- Department of Pharmaceutical Sciences, University of New Mexico, NM, 87131, United States
| | - Mary K Walker
- Department of Pharmaceutical Sciences, University of New Mexico, NM, 87131, United States.
| |
Collapse
|
30
|
Ghosh A, Gao L, Thakur A, Siu PM, Lai CWK. Role of free fatty acids in endothelial dysfunction. J Biomed Sci 2017; 24:50. [PMID: 28750629 PMCID: PMC5530532 DOI: 10.1186/s12929-017-0357-5] [Citation(s) in RCA: 250] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
Plasma free fatty acids levels are increased in subjects with obesity and type 2 diabetes, playing detrimental roles in the pathogenesis of atherosclerosis and cardiovascular diseases. Increasing evidence showing that dysfunction of the vascular endothelium, the inner lining of the blood vessels, is the key player in the pathogenesis of atherosclerosis. In this review, we aimed to summarize the roles and the underlying mechanisms using the evidence collected from clinical and experimental studies about free fatty acid-mediated endothelial dysfunction. Because of the multifaceted roles of plasma free fatty acids in mediating endothelial dysfunction, elevated free fatty acid level is now considered as an important link in the onset of endothelial dysfunction due to metabolic syndromes such as diabetes and obesity. Free fatty acid-mediated endothelial dysfunction involves several mechanisms including impaired insulin signaling and nitric oxide production, oxidative stress, inflammation and the activation of the renin-angiotensin system and apoptosis in the endothelial cells. Therefore, targeting the signaling pathways involved in free fatty acid-induced endothelial dysfunction could serve as a preventive approach to protect against the occurrence of endothelial dysfunction and the subsequent complications such as atherosclerosis.
Collapse
Affiliation(s)
- Arijit Ghosh
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, HKSAR, China
- Department of Biomedical Sciences, City University of Hong Kong, HKSAR, China
| | - Lei Gao
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, HKSAR, China
| | - Abhimanyu Thakur
- Department of Biomedical Sciences, City University of Hong Kong, HKSAR, China
| | - Parco M. Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, HKSAR, China
| | - Christopher W. K. Lai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, HKSAR, China
| |
Collapse
|
31
|
Elajami TK, Alfaddagh A, Lakshminarayan D, Soliman M, Chandnani M, Welty FK. Eicosapentaenoic and Docosahexaenoic Acids Attenuate Progression of Albuminuria in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease. J Am Heart Assoc 2017; 6:JAHA.116.004740. [PMID: 28710178 PMCID: PMC5586259 DOI: 10.1161/jaha.116.004740] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Albuminuria is a marker of inflammation and an independent predictor of cardiovascular morbidity and mortality. The current study evaluated whether eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation attenuates progression of albuminuria in subjects with coronary artery disease. Methods and Results Two‐hundred sixty‐two subjects with stable coronary artery disease were randomized to either Lovaza (1.86 g of EPA and 1.5 g of DHA daily) or no Lovaza (control) for 1 year. Percent change in urine albumin‐to‐creatinine ratio (ACR) was compared. Mean (SD) age was 63.3 (7.6) years; 17% were women and 30% had type 2 diabetes mellitus. In nondiabetic subjects, no change in urine ACR occurred in either the Lovaza or control groups. In contrast, ACR increased 72.3% (P<0.001) in diabetic subjects not receiving Lovaza, whereas those receiving Lovaza had no change. In diabetic subjects on an angiotensin‐converting enzyme‐inhibitor or angiotensin‐receptor blocker, those receiving Lovaza had no change in urine ACR, whereas those not receiving Lovaza had a 64.2% increase (P<0.001). Change in ACR was directly correlated with change in systolic blood pressure (r=0.394, P=0.01). Conclusions EPA and DHA supplementation attenuated progression of albuminuria in subjects with type 2 diabetes mellitus and coronary artery disease, most of whom were on an angiotensin‐converting enzyme‐inhibitor or angiotensin‐receptor blocker. Thus, EPA and DHA supplementation should be considered as additional therapy to an angiotensin‐converting enzyme‐inhibitor or angiotensin‐receptor blocker in subjects with type 2 diabetes mellitus and coronary artery disease. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01624727.
Collapse
Affiliation(s)
- Tarec K Elajami
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Abdulhamied Alfaddagh
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Dharshan Lakshminarayan
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Michael Soliman
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Madhuri Chandnani
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Francine K Welty
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| |
Collapse
|
32
|
AbuMweis S, Jew S, Tayyem R, Agraib L. Eicosapentaenoic acid and docosahexaenoic acid containing supplements modulate risk factors for cardiovascular disease: a meta-analysis of randomised placebo-control human clinical trials. J Hum Nutr Diet 2017; 31:67-84. [PMID: 28675488 DOI: 10.1111/jhn.12493] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Over 200 clinical trials have examined the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplements on risk factors associated with cardiovascular disease. However, an updated analysis of the evidence is lacking. The aim of the present meta-analysis was to quantify the effect of supplements containing EPA and DHA on risk factors for cardiovascular disease. METHODS An analysis was carried on 171 clinical trials with acceptable quality (Jadad score ≥3) that were identified from a comprehensive electronic search strategy of two databases (Pubmed and Cochrane Library). A random effect model was used to obtain an overall estimate on outcomes of interest. Heterogeneity between trial results was tested for using a standard chi-squared test. RESULTS Compared with control, EPA and DHA supplements produced significant reductions of triglycerides of 0.368 mmol L-1 [95% confidence interval (CI) = -0.427 to -0.309], systolic blood pressure of 2.195 mmHg (95% CI = -3.172 to -1.217), diastolic blood pressure of 1.08 mmHg (95% CI = -1.716 to -0.444), heart rate of 1.37 bpm (95% CI = -2.41 to -0.325) and C-reactive protein of 0.343 mg L-1 (95% CI = -0.454 to -0.232). This analysis indicates an increase in both low-density lipoprotein cholesterol (mean difference = 0.150 mmol L-1 ; 95% CI = 0.058-0.243) and high-density lipoprotein cholesterol (mean difference = 0.039 mmol L-1 ; 95% CI = 0.024-0.054). The triglyceride-lowering effect was dose-dependent. CONCLUSIONS The lipid-lowering, hypotensive, anti-arrhythmic and anti-inflammatory actions of EPA and DHA supplements were confirmed in this analysis of randomised placebo-control blinded clinical trials.
Collapse
Affiliation(s)
- S AbuMweis
- Department of Clinical Nutrition and Dietetics, The Hashemite University, Zarqa, Jordan
| | - S Jew
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, MB, Canada
| | - R Tayyem
- Department of Nutrition and Food Technology, Faculty of Agriculture, The University of Jordan, Amman, Jordan
| | - L Agraib
- Department of Clinical Nutrition and Dietetics, The Hashemite University, Zarqa, Jordan
| |
Collapse
|
33
|
Zarei M, Fakher S, Tabei SMB, Javanbakht MH, Derakhshanian H, Farahbakhsh-Farsi P, Sadeghi MR, Mostafavi E, Djalali M. Effects of vitamin A, C and E, or omega-3 fatty acid supplementation on the level of paraoxonase and arylesterase activity in streptozotocin-induced diabetic rats: an investigation of activities in plasma, and heart and liver homogenates. Singapore Med J 2017; 57:153-6. [PMID: 26996784 DOI: 10.11622/smedj.2015102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION This study was designed and conducted to evaluate the effects of vitamin A, C and E supplementation, and omega-3 fatty acid supplementation on the activity of paraoxonase and arylesterase in an experimental model of diabetes mellitus. METHODS A total of 64 male Sprague Dawley® rats, each weighing 250 g, were randomly distributed into four groups: (a) normal control; (b) diabetic control; (c) diabetic with vitamin A, C and E supplementation; and (d) diabetic with omega-3 fatty acid supplementation. The animals were anaesthetised after four weeks of intervention, and paraoxonase and arylesterase activity in blood plasma, and liver and heart homogenates were measured. RESULTS Arylesterase activity in the heart and liver homogenates was significantly lower in the diabetic control group than in the normal control group (p < 0.01). Vitamin A, C and E supplementation, and omega-3 fatty acid supplementation significantly increased liver arylesterase activity (p < 0.05). No significant change was observed in paraoxonase activity and other investigated factors. CONCLUSION Vitamin A, C and E, or omega-3 fatty acid supplementation were found to increase liver arylesterase activity in streptozotocin-induced diabetic rats. These supplements may be potential agents for the treatment of diabetes mellitus complications.
Collapse
Affiliation(s)
- Mahnaz Zarei
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Fakher
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Hassan Javanbakht
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Derakhshanian
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Farahbakhsh-Farsi
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Sadeghi
- Department of Reproductive Endocrinology and Embryology, Avesina Research Institute, Tehran, Iran
| | - Ebrahim Mostafavi
- Department of Pathology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Djalali
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
34
|
Jax T, Stirban A, Terjung A, Esmaeili H, Berk A, Thiemann S, Chilton R, von Eynatten M, Marx N. A randomised, active- and placebo-controlled, three-period crossover trial to investigate short-term effects of the dipeptidyl peptidase-4 inhibitor linagliptin on macro- and microvascular endothelial function in type 2 diabetes. Cardiovasc Diabetol 2017; 16:13. [PMID: 28109295 PMCID: PMC5251248 DOI: 10.1186/s12933-016-0493-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/28/2016] [Indexed: 01/15/2023] Open
Abstract
Background Studies of dipeptidyl peptidase (DPP)-4 inhibitors report heterogeneous effects on endothelial function in patients with type 2 diabetes (T2D). This study assessed the effects of the DPP-4 inhibitor linagliptin versus the sulphonylurea glimepiride and placebo on measures of macro- and microvascular endothelial function in patients with T2D who represented a primary cardiovascular disease prevention population. Methods This crossover study randomised T2D patients (n = 42) with glycated haemoglobin (HbA1c) ≤7.5%, no diagnosed macro- or microvascular disease and on stable metformin background to linagliptin 5 mg qd, glimepiride 1–4 mg qd or placebo for 28 days. Fasting and postprandial macrovascular endothelial function, measured using brachial flow-mediated vasodilation, and microvascular function, measured using laser-Doppler on the dorsal thenar site of the right hand, were analysed after 28 days. Results Baseline mean (standard deviation) age, body mass index and HbA1c were 60.3 (6.0) years, 30.3 (3.0) kg/m2 and 7.41 (0.61)%, respectively. After 28 days, changes in fasting flow-mediated vasodilation were similar between the three study arms (treatment ratio, gMean [90% confidence interval]: linagliptin vs glimepiride, 0.884 [0.633–1.235]; linagliptin vs placebo, 0.884 [0.632–1.235]; glimepiride vs placebo, 1.000 [0.715–1.397]; P = not significant for all comparisons). Similarly, no differences were seen in postprandial flow-mediated vasodilation. However, under fasting conditions, linagliptin significantly improved microvascular function as shown by a 34% increase in hyperaemia area (P = 0.045 vs glimepiride), a 34% increase in resting blow flow (P = 0.011 vs glimepiride, P = 0.003 vs placebo), and a 25% increase in peak blood flow (P = 0.009 vs glimepiride, P = 0.003 vs placebo). There were no significant differences between treatments in postprandial changes. Linagliptin had no effect on heart rate or blood pressure. Rates of overall adverse events with linagliptin, glimepiride and placebo were 27.5, 61.0 and 35.0%, respectively. Fewer hypoglycaemic events were seen with linagliptin (5.0%) and placebo (2.5%) than with glimepiride (39.0%). Conclusions Linagliptin had no effect on macrovascular function in T2D, but significantly improved microvascular function in the fasting state. Trial registration ClinicalTrials.gov identifier—NCT01703286; registered October 1, 2012 Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0493-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Thomas Jax
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstr. 9, 41460, Neuss, Germany. .,Herzzentrum Wuppertal, Universität Witten/Herdecke, Witten, Germany.
| | - Alin Stirban
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstr. 9, 41460, Neuss, Germany
| | - Arne Terjung
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstr. 9, 41460, Neuss, Germany
| | | | - Andreas Berk
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Sandra Thiemann
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Robert Chilton
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Nikolaus Marx
- RWTH Aachen University, University Hospital Aachen, Aachen, Germany
| |
Collapse
|
35
|
Casanova MA, Medeiros F, Trindade M, Cohen C, Oigman W, Neves MF. Omega-3 fatty acids supplementation improves endothelial function and arterial stiffness in hypertensive patients with hypertriglyceridemia and high cardiovascular risk. ACTA ACUST UNITED AC 2016; 11:10-19. [PMID: 27876342 DOI: 10.1016/j.jash.2016.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/23/2016] [Accepted: 10/18/2016] [Indexed: 01/07/2023]
Abstract
Association between hypertriglyceridemia and cardiovascular (CV) disease is still controversial. The purpose of this study was to compare omega-3 and ciprofibrate effects on the vascular structure and function in low and high CV risk hypertensive patients with hypertriglyceridemia. Twenty-nine adults with triglycerides 150-499 mg/dL were divided into low (<7.5%) and high (≥7.5%) CV risk, randomized to receive omega-3 fatty acids 1800 mg/d or ciprofibrate 100 mg/d for 12 weeks. Treatment was switched after 8-week washout. Clinical evaluation and vascular tests were assessed at baseline and after intervention. Peripheral (131 ± 3 to 125 ± 3 mm Hg, P < .05) and aortic (124 ± 3 to 118 ± 2 mg/dL, P < .05) systolic blood pressure were decreased by ciprofibrate in low-risk patients. In high-risk patients, pulse wave velocity was reduced (10.4 ± 0.4 to 9.4 ± 0.3 m/s, P < .05) and flow-mediated dilation was increased (11.1 ± 1.6 to 13.5 ± 1.2%, P < .05) by omega-3. In conclusion, omega-3 improved arterial stiffness and endothelial function, pointing out the beneficial effect of this therapy on vascular aging, in high-risk patients.
Collapse
Affiliation(s)
- Marcela A Casanova
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Fernanda Medeiros
- Department of Applied Nutrition, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michelle Trindade
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Célia Cohen
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wille Oigman
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mario Fritsch Neves
- Department of Clinical Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
36
|
Koh KK, Oh PC, Sakuma I, Lee Y, Han SH, Shin EK. Vascular and metabolic effects of omega-3 fatty acids combined with fenofibrate in patients with hypertriglyceridemia. Int J Cardiol 2016; 221:342-6. [PMID: 27424313 DOI: 10.1016/j.ijcard.2016.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 07/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Effects of omega-3 fatty acids (n-3 FA) combined with fenofibrate are not yet investigated, compared with fenofibrate. METHODS This was a randomized, single-blind, placebo-controlled, parallel study. Age, sex, and body mass index were matched among groups. All patients were recommended to maintain a low fat diet. Fifty patients with hypertriglyceridemia in each group were given placebo, n-3 FA 2g+fenofibrate 160mg (combination), or fenofibrate 160mg, respectively daily for 2months. RESULTS Placebo, combination, and fenofibrate significantly decreased triglycerides by 7%, 41% and 30%, respectively and triglycerides/HDL cholesterol ratio by 11%, 45% and 32%, respectively relative to baseline measurements (all P<0.05 by paired t-test). When compared with placebo and fenofibrate, these with combination were significant (P<0.001 by ANOVA). When compared with placebo, both combination and fenofibrate significantly decreased apolipoprotein B and non-HDL cholesterol and improved flow-mediated dilation and reduced CRP and fibrinogen (all P<0.05 by ANOVA), however, there were no significant differences between combination and fenofibrate. When compared with placebo, both combination and fenofibrate significantly reduced insulin and glucose (both P<0.05 by ANOVA), and improved insulin sensitivity (P=0.005 by ANOVA). However, there were no significant differences between combination and fenofibrate. CONCLUSIONS When compared with fenofibrate, combination significantly decreased triglycerides and triglycerides/HDL cholesterol ratio. Otherwise, combination and fenofibrate significantly reduced apolipoprotein B and non-HDL cholesterol and improved flow-mediated dilation and reduced CRP and fibrinogen to a similar extent. Also, combination and fenofibrate significantly improved insulin sensitivity to a similar extent by reducing insulin and glucose in patients with hypertriglyceridemia.
Collapse
Affiliation(s)
- Kwang Kon Koh
- Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea; Gachon Cardiovascular Research Institute, Incheon, Republic of Korea.
| | - Pyung Chun Oh
- Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea; Gachon Cardiovascular Research Institute, Incheon, Republic of Korea
| | - Ichiro Sakuma
- Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea; Gachon Cardiovascular Research Institute, Incheon, Republic of Korea
| | - Yonghee Lee
- Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea; Gachon Cardiovascular Research Institute, Incheon, Republic of Korea
| | - Seung Hwan Han
- Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea; Gachon Cardiovascular Research Institute, Incheon, Republic of Korea
| | - Eak Kyun Shin
- Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea; Gachon Cardiovascular Research Institute, Incheon, Republic of Korea
| |
Collapse
|
37
|
Auger C, Said A, Nguyen PN, Chabert P, Idris-Khodja N, Schini-Kerth VB. Potential of Food and Natural Products to Promote Endothelial and Vascular Health. J Cardiovasc Pharmacol 2016; 68:11-8. [PMID: 26974893 DOI: 10.1097/fjc.0000000000000382] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endothelial dysfunction is now well established as a pivotal early event in the development of major cardiovascular diseases including hypertension, atherosclerosis, and diabetes. The alteration of the endothelial function is often triggered by an imbalance between the endothelial formation of vasoprotective factors including nitric oxide (NO) and endothelium-dependent hyperpolarization, and an increased level of oxidative stress involving several prooxidant enzymes such as NADPH oxidase and, often also, the appearance of cyclooxygenase-derived vasoconstrictors. Preclinical studies have indicated that polyphenol-rich food and food-derived products such as grape-derived products, black and red berries, green and black teas and cocoa, and omega-3 fatty acids can trigger activating pathways in endothelial cells promoting an increased formation of nitric oxide and endothelium-dependent hyperpolarization. Moreover, intake of such food-derived products has been associated with the prevention and/or the improvement of an established endothelial dysfunction in several experimental models of cardiovascular diseases and in humans with cardiovascular diseases. This review will discuss both experimental and clinical evidences indicating that different types of food and natural products are able to promote endothelial and vascular health, as well as the underlying mechanisms.
Collapse
Affiliation(s)
- Cyril Auger
- UMR CNRS 7213, Laboratoire de Biophotonique et Pharmacologie, Faculté de Pharmacie, Université de Strasbourg, Strasbourg, France
| | | | | | | | | | | |
Collapse
|
38
|
Effects of Omega-3 Fatty Acid Supplementation on Diabetic Nephropathy Progression in Patients with Diabetes and Hypertriglyceridemia. PLoS One 2016; 11:e0154683. [PMID: 27135947 PMCID: PMC4852914 DOI: 10.1371/journal.pone.0154683] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/18/2016] [Indexed: 12/21/2022] Open
Abstract
Beneficial effects of omega-3 fatty acid (O3FA) supplementation in a wide range of disease condition have been well studied. However, there is limited information regarding the effects of O3FAs on chronic kidney disease (CKD), especially in diabetic nephropathy (DN) with hypertriglyceridemia. We investigate whether O3FA supplementation could help maintain renal function in patients with diabetes and hypertriglyceridemia. Total 344 type 2 diabetic patients with a history of O3FA supplementation for managing hypertriglyceridemia were included. Reduction in urine albumin to creatinine ratio (ACR) and glomerular filtrate rate (GFR) were examined. Subgroup analyses were stratified according to the daily O3FA doses. Serum total cholesterol, triglyceride, and urine ACR significantly reduced after O3FA supplementation. Overall, 172 (50.0%) patients did not experience renal function loss, and 125 (36.3%) patients had a GFR with a positive slope. The patients treated with O3FAs at 4g/day showed greater maintenance in renal function than those treated with lower dosages (p < 0.001). This dose dependent effect remains significant after adjustment for multiple variables. O3FA supplementation in diabetic patients with hypertriglyceridemia shows benefits of reducing albuminuria and maintaining renal function. The effects are dependent on the dose of daily O3FA supplementation.
Collapse
|
39
|
Amador-Licona N, Díaz-Murillo TA, Gabriel-Ortiz G, Pacheco-Moises FP, Pereyra-Nobara TA, Guízar-Mendoza JM, Barbosa-Sabanero G, Orozco-Aviña G, Moreno-Martínez SC, Luna-Montalbán R, Vázquez-Valls E. Omega 3 Fatty Acids Supplementation and Oxidative Stress in HIV-Seropositive Patients. A Clinical Trial. PLoS One 2016; 11:e0151637. [PMID: 27015634 PMCID: PMC4807787 DOI: 10.1371/journal.pone.0151637] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/01/2016] [Indexed: 01/16/2023] Open
Abstract
HIV-seropositive patients show high incidence of coronary heart disease and oxidative stress has been described as relevant key in atherosclerosis development. The aim of this study was to assess the effect of omega 3 fatty acids on different markers of oxidative stress in HIV-seropositive patients. We performed a randomized parallel controlled clinical trial in The Instituto Mexicano del Seguro Social, a public health hospital. 70 HIV-seropositive patients aged 20 to 55 on clinical score A1, A2, B1 or B2 receiving highly active antiretroviral therapy (HAART) were studied. They were randomly assigned to receive omega 3 fatty acids 2.4 g (Zonelabs, Marblehead MA) or placebo for 6 months. At baseline and at the end of the study, anthropometric measurements, lipid profile, glucose and stress oxidative levels [nitric oxide catabolites, lipoperoxides (malondialdehyde plus 4-hydroxialkenals), and glutathione] were evaluated. Principal HAART therapy was EFV/TDF/FTC (55%) and AZT/3TC/EFV (15%) without difference between groups. Treatment with omega 3 fatty acids as compared with placebo decreased triglycerides (-0.32 vs. 0.54 mmol/L; p = 0.04), but oxidative stress markers were not different between groups.
Collapse
Affiliation(s)
- Norma Amador-Licona
- Department of Education and Research, UMAE HE No.1, Bajio, Instituto Mexicano del Seguro Social, Mexico City, Mexico
- * E-mail:
| | - Teresa A. Díaz-Murillo
- Department of Education and Research, UMAE HE No.1, Bajio, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Genaro Gabriel-Ortiz
- Laboratory of oxidative stress & Pathology, Centro de Investigacion Biomedica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Mexico
| | | | - Texar A. Pereyra-Nobara
- Department of Education and Research, UMAE HE No.1, Bajio, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | | | | | - Sandra C. Moreno-Martínez
- Department of Education and Research, UMAE HE No.1, Bajio, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Rafael Luna-Montalbán
- Department of Education and Research, UMAE HE No.1, Bajio, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Eduardo Vázquez-Valls
- Laboratory of oxidative stress & Pathology, Centro de Investigacion Biomedica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Mexico
| |
Collapse
|
40
|
Minihane AM, Armah CK, Miles EA, Madden JM, Clark AB, Caslake MJ, Packard CJ, Kofler BM, Lietz G, Curtis PJ, Mathers JC, Williams CM, Calder PC. Consumption of Fish Oil Providing Amounts of Eicosapentaenoic Acid and Docosahexaenoic Acid That Can Be Obtained from the Diet Reduces Blood Pressure in Adults with Systolic Hypertension: A Retrospective Analysis. J Nutr 2016; 146:516-23. [PMID: 26817716 DOI: 10.3945/jn.115.220475] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/17/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although many randomized controlled trials (RCTs) have examined the effects of the n-3 (ω-3) fatty acids eicosapentaenoic acid (EPA; 20:5n-3) and docosahexaenoic acid (DHA; 22:6n-3) on blood pressure (BP) and vascular function, the majority have used doses of EPA+DHA of >3 g/d, which are unlikely to be achieved by dietary manipulation. OBJECTIVE The objective was to examine, by using a retrospective analysis from a multicenter RCT, the impact of recommended EPA+DHA intakes achievable through diet on systolic and diastolic BPs and microvascular function in adults in the United Kingdom. METHODS In a double-blind, placebo-controlled RCT, healthy men and women (n = 312) consumed a control oil or fish oil (FO) providing 0.7 or 1.8 g EPA+DHA/d, in random order, each for 8 wk. Fasting BP and microvascular function (using laser Doppler iontophoresis) were assessed and plasma collected for the quantification of markers of vascular function. Participants were retrospectively genotyped for the endothelial nitric oxide synthase (eNOS) rs1799983 variant. RESULTS No effects of n-3 fatty acid treatment or any treatment × eNOS genotype interactions were evident in the group as a whole for any of the clinical or biochemical outcomes. Assessment of response according to hypertension status at baseline indicated a significant (P = 0.046) FO-induced reduction (mean: 5 mm Hg) in systolic BP, specifically in those with isolated systolic hypertension (n = 31). No dose response was observed. CONCLUSIONS These findings indicate that in adults with isolated systolic hypertension, daily doses of EPA+DHA as low as 0.7 g show clinically meaningful BP reductions, which, at a population level, could be associated with lower cardiovascular disease risk. Confirmation of findings in an RCT in which participants are prospectively recruited on the basis of BP status is required to draw definite conclusions.
Collapse
Affiliation(s)
- Anne M Minihane
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom;
| | - Christopher K Armah
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
| | - Elizabeth A Miles
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jacqueline M Madden
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Muriel J Caslake
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Chris J Packard
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Bettina M Kofler
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
| | - Georg Lietz
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, United Kingdom; and
| | - Peter J Curtis
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, United Kingdom; and
| | - Christine M Williams
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom
| | - Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospitals Southampton National Health Service (NHS) Foundation Trust and the University of Southampton, Southampton, United Kingdom
| |
Collapse
|
41
|
Clifton P. From sodium intake restriction to nitrate supplementation: Different measures with converging mechanistic pathways? Nutr Metab Cardiovasc Dis 2015; 25:1079-1086. [PMID: 26614018 DOI: 10.1016/j.numecd.2015.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/01/2015] [Accepted: 09/16/2015] [Indexed: 02/05/2023]
Abstract
Endothelial nitric oxide synthase is at the centre of endothelial physiology producing nitric oxide which dilates blood vessels, inhibits platelet aggregation and smooth muscle cell proliferation and reduces adhesion molecule production. The laminar shear stress is a common test used usually as the flow mediated dilatation test (FMD) which is sensitive to saturated fat, sodium and potassium although with the latter ion it is possible potassium has direct effects on ion channels in the smooth muscle cell as well as the endothelial cell. High blood pressure and blood cholesterol both reduce nitric oxide production, the latter probably by increasing caveolin-1 which binds nitric oxide synthase. Saturated fat reduces nitric oxide by elevating LDL cholesterol and caveolin-1 while insulin stimulates nitric oxide synthase activity by serine phosphorylation. Polyphenols from tea, coffee and cocoa and virgin olive oil enhance FMD and eNOS activity is essential for this activity. Wine polyphenols produce mixed results and it is not clear at present that they are beneficial. Blackberries and other polyphenol-rich fruit also enhance FMD. Dietary nitrate from beetroot and green leafy vegetables is converted to nitrite by salivary microbes and then to nitric oxide and this acts directly on the smooth muscle to lower blood pressure particularly in a low oxygen environment. Dietary nitrate also improves work efficiency and improves flow mediated dilatation.
Collapse
Affiliation(s)
- P Clifton
- University of South Australia, P5-16, GPO Box 2471, Adelaide SA 5000, Australia.
| |
Collapse
|
42
|
Schwingshackl L, Christoph M, Hoffmann G. Effects of Olive Oil on Markers of Inflammation and Endothelial Function-A Systematic Review and Meta-Analysis. Nutrients 2015; 7:7651-75. [PMID: 26378571 PMCID: PMC4586551 DOI: 10.3390/nu7095356] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/30/2015] [Accepted: 09/06/2015] [Indexed: 11/16/2022] Open
Abstract
The aim of the present systematic review was to synthesize data from randomized controlled trials investigating the effects of olive oil on markers of inflammation or endothelial function. Literature search in electronic databases Cochrane Trial Register, EMBASE, and MEDLINE was performed. Thirty studies enrolling 3106 participants fulfilled the selection criteria. Pooled effects of different interventions were assessed as mean difference using a random effects model. Olive oil interventions (with daily consumption ranging approximately between 1 mg and 50 mg) resulted in a significantly more pronounced decrease in C-reactive protein (mean difference: −0.64 mg/L, (95% confidence interval (CI) −0.96 to −0.31), p < 0.0001, n = 15 trials) and interleukin-6 (mean difference: −0.29 (95% CI −0.7 to −0.02), p < 0.04, n = 7 trials) as compared to controls, respectively. Values of flow-mediated dilatation (given as absolute percentage) were significantly more increased in individuals subjected to olive oil interventions (mean difference: 0.76% (95% CI 0.27 to 1.24), p < 0.002, n = 8 trials). These results provide evidence that olive oil might exert beneficial effects on endothelial function as well as markers of inflammation and endothelial function, thus representing a key ingredient contributing to the cardiovascular-protective effects of a Mediterranean diet. However, due to the heterogeneous study designs (e.g., olive oil given as a supplement or as part of dietary pattern, variations in control diets), a conservative interpretation of the results is necessary.
Collapse
Affiliation(s)
- Lukas Schwingshackl
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Athanstraße 14 (UZAII), Vienna A-1090, Austria; E-Mails: (L.S.); (M.C.)
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany
| | - Marina Christoph
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Athanstraße 14 (UZAII), Vienna A-1090, Austria; E-Mails: (L.S.); (M.C.)
| | - Georg Hoffmann
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Athanstraße 14 (UZAII), Vienna A-1090, Austria; E-Mails: (L.S.); (M.C.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +43-1-4277-54950; Fax: +43-1-4277-9549
| |
Collapse
|
43
|
Zanetti M, Grillo A, Losurdo P, Panizon E, Mearelli F, Cattin L, Barazzoni R, Carretta R. Omega-3 Polyunsaturated Fatty Acids: Structural and Functional Effects on the Vascular Wall. BIOMED RESEARCH INTERNATIONAL 2015; 2015:791978. [PMID: 26301252 PMCID: PMC4537737 DOI: 10.1155/2015/791978] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/26/2015] [Indexed: 01/24/2023]
Abstract
Omega-3 polyunsaturated fatty acids (n-3 PUFA) consumption is associated with reduced cardiovascular disease risk. Increasing evidence demonstrating a beneficial effect of n-3 PUFA on arterial wall properties is progressively emerging. We reviewed the recent available evidence for the cardiovascular effects of n-3 PUFA focusing on structural and functional properties of the vascular wall. In experimental studies and clinical trials n-3 PUFA have shown the ability to improve arterial hemodynamics by reducing arterial stiffness, thus explaining some of its cardioprotective properties. Recent studies suggest beneficial effects of n-3 PUFA on endothelial activation, which are likely to improve vascular function. Several molecular, cellular, and physiological pathways influenced by n-3 PUFA can affect arterial wall properties and therefore interfere with the atherosclerotic process. Although the relative weight of different physiological and molecular mechanisms and the dose-response on arterial wall properties have yet to be determined, n-3 PUFA have the potential to beneficially impact arterial wall remodeling and cardiovascular outcomes by targeting arterial wall stiffening and endothelial dysfunction.
Collapse
Affiliation(s)
- Michela Zanetti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Andrea Grillo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Pasquale Losurdo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Emiliano Panizon
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Filippo Mearelli
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Luigi Cattin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Rocco Barazzoni
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Renzo Carretta
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| |
Collapse
|
44
|
Yao M, Hou L, Xie T, Liu Y, Dai D, Shi Y, Lian K, Jiang L. The biosynthesis of DHA is increased in the liver of diabetic rats induced by high-fat diets and STZ, in correlation with increased activity of peroxisomal β-oxidation. EUR J LIPID SCI TECH 2015. [DOI: 10.1002/ejlt.201400606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Min Yao
- Department of Biochemistry Molecular Biology; Key Laboratory of Neural Vascular Biology China Administration of Education; Hebei Medical University; Shijiazhuang P. R. China
| | - Lianguo Hou
- Department of Biochemistry Molecular Biology; Key Laboratory of Neural Vascular Biology China Administration of Education; Hebei Medical University; Shijiazhuang P. R. China
| | - Tian Xie
- Department of Biochemistry Molecular Biology; Key Laboratory of Neural Vascular Biology China Administration of Education; Hebei Medical University; Shijiazhuang P. R. China
| | - Yang Liu
- Department of Biochemistry Molecular Biology; Key Laboratory of Neural Vascular Biology China Administration of Education; Hebei Medical University; Shijiazhuang P. R. China
| | - Dongxue Dai
- Department of Biochemistry Molecular Biology; Key Laboratory of Neural Vascular Biology China Administration of Education; Hebei Medical University; Shijiazhuang P. R. China
| | - Yun Shi
- Department of Biochemistry Molecular Biology; Key Laboratory of Neural Vascular Biology China Administration of Education; Hebei Medical University; Shijiazhuang P. R. China
| | - Kaoqi Lian
- School of Public Health; Hebei Medical University; Shijiazhuang P. R. China
| | - Lingling Jiang
- Department of Biochemistry Molecular Biology; Key Laboratory of Neural Vascular Biology China Administration of Education; Hebei Medical University; Shijiazhuang P. R. China
| |
Collapse
|
45
|
LeMieux MJ, Kalupahana NS, Scoggin S, Moustaid-Moussa N. Eicosapentaenoic acid reduces adipocyte hypertrophy and inflammation in diet-induced obese mice in an adiposity-independent manner. J Nutr 2015; 145:411-7. [PMID: 25733455 DOI: 10.3945/jn.114.202952] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obesity is associated with an overexpansion of adipose tissue, along with increases in blood pressure, glycemia, inflammation, and thrombosis. Research to develop nutritional interventions to prevent or treat obesity and its associated diseases is greatly needed. Previously, we demonstrated the ability of eicosapentaenoic acid (EPA) to prevent high-fat (HF) diet-induced obesity, insulin resistance, and inflammation in mice. OBJECTIVE The objective of the current study was to determine the mechanisms mediating the anti-inflammatory and antilipogenic actions of EPA. METHODS In a previous study, male C57BL/6J mice were fed a low-fat diet (10% of energy from fat), an HF diet (45% of energy from fat), or an HF diet supplemented with EPA (45% of energy from fat; 36 g/kg EPA; HF+EPA) for 11 wk or an HF diet for 6 wk and then switched to the HF+EPA diet for 5 wk. In this study, we used histology/immunohistochemistry, gene expression, and metabolomic analyses of white adipose tissue from these mice. In addition, cultured mouse 3T3-L1 adipocytes were treated with 100 μM EPA for 48 h and then used for extracellular flux assays with untreated 3T3-L1 adipocytes used as a control. RESULTS Compared with the HF diet, the HF+EPA diet significantly reduced body weight, adiposity, adipocyte size, and macrophage infiltration into adipose tissue. No significant differences in overall body weight or fat pad weights were observed between HF-fed mice vs. those fed the HF+EPA diet for a short time after first inducing obesity with the HF diet. Interestingly, both histology and immunohistochemistry results showed a significantly lower mean adipocyte size and macrophage infiltration in mice fed the HF diet and then switched to the HF+EPA diet vs. those fed HF diets only. This indicated that EPA was able to prevent as well as reverse HF-diet-induced adipocyte inflammation and hypertrophy and that some of the metabolic effects of EPA were independent of body weight or adiposity. In addition, adipose tissue metabolomic data and cultured adipocyte extracellular flux bioenergetic assays indicated that EPA also regulated mitochondrial function by increasing fatty acid oxidation and oxygen consumption, respectively. CONCLUSION With the use of mice and cultured adipocytes, we showed that EPA ameliorates HF-diet effects at least in part by increasing oxygen consumption and fatty acid oxidation and reducing adipocyte size, adipogenesis, and adipose tissue inflammation, independent of obesity.
Collapse
Affiliation(s)
- Monique J LeMieux
- Department of Nutritional Sciences, College of Human Sciences and Obesity Research Cluster, Texas Tech University, Lubbock, TX; and
| | - Nishan S Kalupahana
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Shane Scoggin
- Department of Nutritional Sciences, College of Human Sciences and Obesity Research Cluster, Texas Tech University, Lubbock, TX; and
| | - Naima Moustaid-Moussa
- Department of Nutritional Sciences, College of Human Sciences and Obesity Research Cluster, Texas Tech University, Lubbock, TX; and
| |
Collapse
|
46
|
Yamano T, Kubo T, Shiono Y, Shimamura K, Orii M, Tanimoto T, Matsuo Y, Ino Y, Kitabata H, Yamaguchi T, Hirata K, Tanaka A, Imanishi T, Akasaka T. Impact of Eicosapentaenoic Acid Treatment on the Fibrous Cap Thickness in Patients with Coronary Atherosclerotic Plaque: An Optical Coherence Tomography Study. J Atheroscler Thromb 2015; 22:52-61. [DOI: 10.5551/jat.25593] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Makoto Orii
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yoshiki Matsuo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | | | - Kumiko Hirata
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Toshio Imanishi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| |
Collapse
|
47
|
Impact of DHA on metabolic diseases from womb to tomb. Mar Drugs 2014; 12:6190-212. [PMID: 25528960 PMCID: PMC4278225 DOI: 10.3390/md12126190] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/25/2014] [Accepted: 12/11/2014] [Indexed: 12/19/2022] Open
Abstract
Long chain polyunsaturated fatty acids (LC-PUFAs) are important mediators in improving and maintaining human health over the total lifespan. One topic we especially focus on in this review is omega-3 LC-PUFA docosahexaenoic acid (DHA). Adequate DHA levels are essential during neurodevelopment and, in addition, beneficial in cognitive processes throughout life. We review the impact of DHA on societal relevant metabolic diseases such as cardiovascular diseases, obesity, and diabetes mellitus type 2 (T2DM). All of these are risk factors for cognitive decline and dementia in later life. DHA supplementation is associated with a reduced incidence of both stroke and atherosclerosis, lower bodyweight and decreased T2DM prevalence. These findings are discussed in the light of different stages in the human life cycle: childhood, adolescence, adulthood and in later life. From this review, it can be concluded that DHA supplementation is able to inhibit pathologies like obesity and cardiovascular disease. DHA could be a dietary protector against these metabolic diseases during a person’s entire lifespan. However, supplementation of DHA in combination with other dietary factors is also effective. The efficacy of DHA depends on its dose as well as on the duration of supplementation, sex, and age.
Collapse
|
48
|
A select review reporting the quality of studies measuring endothelial dysfunction in randomised diet intervention trials. Br J Nutr 2014; 113:89-99. [PMID: 25374114 DOI: 10.1017/s0007114514003353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A quality assessment of the primary studies reported in the literature carried out using select dietary ingredients (DI) purported to affect vascular endothelial function was conducted through a systematic PubMed search from January 2000 to August 2012. A total of seventy randomised controlled trials with defined DI (folic acid (fifteen), n-3 fatty acids (twenty), cocoa (fifteen) and isoflavones (twenty)) and standardised measures of vascular endothelial function were evaluated. Jadad scores, quality scoring parameters for DI and flow-mediated dilation (FMD) methodology used were ascertained. A total of 3959 randomised subjects, mean age 51 (se 0·21) years (range 9-79 years), were represented in the dataset. The mean Jadad scores did not differ statistically among the DI studies, with the majority of the studies being of good quality. Higher DI quality scores were achieved by studies using the botanical ingredients cocoa and isoflavones than by those using the nutrient ingredients folic acid and n-3 fatty acids. The mean DI quality scores were 4·13 (se 0·34), 5·20 (se 0·47), 6·13 (se 0·41) and 6·00 (se 0·59) for the folic acid, n-3 fatty acid, cocoa and isoflavone intervention studies, respectively (and significantly different). The mean Corretti FMD scores were 7·27 (se 0·56), 7·46 (se 0·79), 6·29 (se 0·61) and 7·11 (se 0·56) for the folic acid, n-3 fatty acid, cocoa and isoflavone intervention studies, respectively (NS). FMD studies failed to adequately describe the equipment used and more than half failed to provide an adequate description of the procedures used for vascular image acquisition and measurement. DI can be utilised for dietary intervention studies; however, the methodology should be clearly reported using the guidelines for assessment for both DI and FMD.
Collapse
|
49
|
Agbor LN, Wiest EF, Rothe M, Schunck WH, Walker MK. Role of CYP1A1 in modulating the vascular and blood pressure benefits of omega-3 polyunsaturated fatty acids. J Pharmacol Exp Ther 2014; 351:688-98. [PMID: 25316121 DOI: 10.1124/jpet.114.219535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The mechanisms that mediate the cardiovascular protective effects of omega 3 (n-3) polyunsaturated fatty acids (PUFAs) have not been fully elucidated. Cytochrome P450 1A1 efficiently metabolizes n-3 PUFAs to potent vasodilators. Thus, we hypothesized that dietary n-3 PUFAs increase nitric oxide (NO)-dependent blood pressure regulation and vasodilation in a CYP1A1-dependent manner. CYP1A1 wild-type (WT) and knockout (KO) mice were fed an n-3 or n-6 PUFA-enriched diet for 8 weeks and were analyzed for tissue fatty acids and metabolites, NO-dependent blood pressure regulation, NO-dependent vasodilation of acetylcholine (ACh) in mesenteric resistance arterioles, and endothelial NO synthase (eNOS) and phospho-Ser1177-eNOS expression in the aorta. All mice fed the n-3 PUFA diet showed significantly higher levels of n-3 PUFAs and their metabolites, and significantly lower levels of n-6 PUFAs and their metabolites. In addition, KO mice on the n-3 PUFA diet accumulated significantly higher levels of n-3 PUFAs in the aorta and kidney without a parallel increase in the levels of their metabolites. Moreover, KO mice exhibited significantly less NO-dependent regulation of blood pressure on the n-3 PUFA diet and significantly less NO-dependent, ACh-mediated vasodilation in mesenteric arterioles on both diets. Finally, the n-3 PUFA diet significantly increased aortic phospho-Ser1177-eNOS/eNOS ratio in the WT compared with KO mice. These data demonstrate that CYP1A1 contributes to eNOS activation, NO bioavailability, and NO-dependent blood pressure regulation mediated by dietary n-3 PUFAs.
Collapse
Affiliation(s)
- Larry N Agbor
- Department of Pharmaceutical Sciences, University of New Mexico, Albuquerque, New Mexico (L.N.A., E.F.W., M.K.W.); Lipidomix GmbH, Berlin, Germany (M.R.); and Max-Delbrück Center for Molecular Medicine, Berlin, Germany (W.-H.S.)
| | - Elani F Wiest
- Department of Pharmaceutical Sciences, University of New Mexico, Albuquerque, New Mexico (L.N.A., E.F.W., M.K.W.); Lipidomix GmbH, Berlin, Germany (M.R.); and Max-Delbrück Center for Molecular Medicine, Berlin, Germany (W.-H.S.)
| | - Michael Rothe
- Department of Pharmaceutical Sciences, University of New Mexico, Albuquerque, New Mexico (L.N.A., E.F.W., M.K.W.); Lipidomix GmbH, Berlin, Germany (M.R.); and Max-Delbrück Center for Molecular Medicine, Berlin, Germany (W.-H.S.)
| | - Wolf-Hagen Schunck
- Department of Pharmaceutical Sciences, University of New Mexico, Albuquerque, New Mexico (L.N.A., E.F.W., M.K.W.); Lipidomix GmbH, Berlin, Germany (M.R.); and Max-Delbrück Center for Molecular Medicine, Berlin, Germany (W.-H.S.)
| | - Mary K Walker
- Department of Pharmaceutical Sciences, University of New Mexico, Albuquerque, New Mexico (L.N.A., E.F.W., M.K.W.); Lipidomix GmbH, Berlin, Germany (M.R.); and Max-Delbrück Center for Molecular Medicine, Berlin, Germany (W.-H.S.)
| |
Collapse
|
50
|
Oh PC, Koh KK, Sakuma I, Lim S, Lee Y, Lee S, Lee K, Han SH, Shin EK. Omega-3 fatty acid therapy dose-dependently and significantly decreased triglycerides and improved flow-mediated dilation, however, did not significantly improve insulin sensitivity in patients with hypertriglyceridemia. Int J Cardiol 2014; 176:696-702. [DOI: 10.1016/j.ijcard.2014.07.075] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/16/2014] [Accepted: 07/24/2014] [Indexed: 01/29/2023]
|