Low-carbohydrate diets for overweight and obesity: a systematic review of the systematic reviews

Low-carbohydrate diets are being widely recommended, but with apparently conflicting evidence. We have conducted a formal systematic review of the published systematic reviews of RCTs between low-carbohydrate vs. control (low-fat/energy-restricted) diets in adults with overweight and obesity. In MEDLINE, Embase, Web of Knowledge and Cochrane Database of Systematic Reviews, searched from inception to September 2017, we identified 12 systematic reviews, 10 with meta-analyses. Differences in methods, study quality, weight change and citations of published systematic reviews were assessed by AMSTAR-2. Review methods varied in definitions of low-carbohydrate diet, databases searched and bias assessment. Overall review quality was high in two, moderate in three, critically low in seven. Among meta-analyses, 4/5 with critically low quality showed low-carbohydrate diet superiority for weight loss (0.7-4.0 kg), while high quality meta-analyses reported little or no difference between diets. Greater numbers of participants correlated with smaller differences in weight loss (r = 0.73, p = 0.03). More citations correlated with lower review quality (rho = -0.9, p = 0.037), with larger differences in weight loss (rho = -0.9, p = 0.037), and with journal impact factor (rho = 1.0, p = 0.01). In conclusion, publication acceptance and citations appear to favour apparently larger effect sizes above methodological quality. Better quality reviews and RCTs are needed, before recommending low-carbohydrate diets as preferred to other approaches for energy restriction.

Polyphenols and health: Interactions between fibre, plant polyphenols and the gut microbiota

A high‐fibre diet and one rich in fruit and vegetables have long been associated with lower risk of chronic disease. There are several possible mechanisms underpinning these associations, but one likely important factor is the production of bioactive molecules from plant‐based foods by the bacteria in the colon. This links to our growing understanding of the role of the gut microbiome in promoting health. Polyphenolic‐rich plant foods have been associated with potential health effects in many studies, but the bioavailability of polyphenol compounds, as eaten, is often very low. Most of the ingested molecules enter the large intestine where they are catabolised to smaller phenolic acids that may be the key bioactive effectors. Dietary fibres, present in plant foods, are also fermented by the bacteria to short‐chain fatty acids, compounds associated with several beneficial effects on cell turnover, metabolism and eating behaviour. Polyphenols and fibre are often eaten together, but there is a lack of research investigating the interaction between these two groups of key substrates for the colonic bacteria. In a project funded by the Biotechnology and Biological Sciences Research Council Diet and Health Research Industry Club, we are investigating whether combining different fibres and polyphenol sources can enhance the production of bioactive phenolic acids to promote health. This could lead to improved dietary recommendations and to new products with enhanced potential health‐promoting actions.

The role of dietary polyphenols in the moderation of the inflammatory response in early stage colorectal cancer

Current focus in colorectal cancer (CRC) management is on reducing overall mortality by increasing the number of early-stage cancers diagnosed and treated with curative intent. Despite the success of screening programs in down-staging CRC, interval cancer rates are substantial and other strategies are desirable. Sporadic CRC is largely associated with lifestyle factors including diet. Polyphenols are phytochemicals ingested as part of a normal diet, which are abundant in plant foods including fruits/berries and vegetables. These may exert their anti-carcinogenic effects via the modulation of inflammatory pathways. Key signal transduction pathways are fundamental to the association of inflammation and disease progression including those mediated by NF-κB and STAT, PI3K and COX. Our aim was to examine the evidence for the effect of dietary polyphenols intake on tumor and host inflammatory responses to determine if polyphenols may be effective as part of a dietary intervention. There is good epidemiological evidence of a reduction in CRC risk from case-control and cohort studies assessing polyphenol intake. It would be premature to suggest a major public health intervention to promote their consumption; however, dietary change is safe and feasible, emphasizing the need for further investigation of polyphenols and CRC risk.

Dietary Iodine Exposure and Brain Structures and Cognition in Older People. Exploratory Analysis in the Lothian Birth Cohort 1936

BACKGROUND

Iodine deficiency is one of the three key micronutrient deficiencies highlighted as major public health issues by the World Health Organisation. Iodine deficiency is known to cause brain structural alterations likely to affect cognition. However, it is not known whether or how different (lifelong) levels of exposure to dietary iodine influences brain health and cognitive functions.

METHODS

From 1091 participants initially enrolled in The Lothian Birth Cohort Study 1936, we obtained whole diet data from 882. Three years later, from 866 participants (mean age 72 yrs, SD±0.8), we obtained cognitive information and ventricular, hippocampal and normal and abnormal tissue volumes from brain structural magnetic resonance imaging scans (n=700). We studied the brain structure and cognitive abilities of iodine-rich food avoiders/low consumers versus those with a high intake in iodine-rich foods (namely dairy and fish).

RESULTS

We identified individuals (n=189) with contrasting diets, i) belonging to the lowest quintiles for dairy and fish consumption, ii) milk avoiders, iii) belonging to the middle quintiles for dairy and fish consumption, and iv) belonging to the middle quintiles for dairy and fish consumption. Iodine intake was secured mostly though the diet (n=10 supplement users) and was sufficient for most (75.1%, median 193 µg/day). In individuals from these groups, brain lateral ventricular volume was positively associated with fat, energy and protein intake. The associations between iodine intake and brain ventricular volume and between consumption of fish products (including fish cakes and fish-containing pasties) and white matter hyperintensities (p=0.03) the latest being compounded by sodium, proteins and saturated fats, disappeared after type 1 error correction.

CONCLUSION

In this large Scottish older cohort, the proportion of individuals reporting extreme (low vs. high)/medium iodine consumption is small. In these individuals, low iodine-rich food intake was associated with increased brain volume shrinkage, raising an important hypothesis worth being explored for designing appropriate guidelines.

Changing guards: time to move beyond body mass index for population monitoring of excess adiposity

With the obesity epidemic, and the effects of aging populations, human phenotypes have changed over two generations, possibly more dramatically than in other species previously. As obesity is an important and growing hazard for population health, we recommend a systematic evaluation of the optimal measure(s) for population-level excess body fat. Ideal measure(s) for monitoring body composition and obesity should be simple, as accurate and sensitive as possible, and provide good categorization of related health risks. Combinations of anthropometric markers or predictive equations may facilitate better use of anthropometric data than single measures to estimate body composition for populations. Here, we provide new evidence that increasing proportions of aging populations are at high health-risk according to waist circumference, but not body mass index (BMI), so continued use of BMI as the principal population-level measure substantially underestimates the health-burden from excess adiposity.

Protein-phenolic interactions and inhibition of glycation - combining a systematic review and experimental models for enhanced physiological relevance

BACKGROUND

while antiglycative capacity has been attributed to (poly)phenols, the exact mechanism of action remains unclear. Studies so far are often relying on supra-physiological concentrations and use of non-bioavailable compounds.

METHODS

to inform the design of a physiologically relevant in vitro study, we carried out a systematic literature review of dietary interventions reporting plasma concentrations of polyphenol metabolites. Bovine Serum Albumin (BSA) was pre-treated prior to in vitro glycation: either no treatment (native), pre-oxidised (incubated with 10 nM H2O2, for 8 hours) or incubated with a mixture of phenolic acids at physiologically relevant concentrations, for 8 hours). In vitro glycation was carried out in the presence of (i) glucose only (0, 5 or 10 mM), (ii) glucose (0, 5 or 10 mM) plus H2O2 (10 nM), or (iii) glucose (0, 5 or 10 mM) plus phenolic acids (10-160 nM). Fructosamine was measured using the nitro blue tetrazolium method.

RESULTS

following (high) dietary polyphenol intake, 3-hydroxyphenylacetic acid is the most abundant phenolic acid in peripheral blood (up to 338 μM) with concentrations of other phenolic acids ranging from 13 nM to 200 μM. The presence of six phenolic acids with BSA during in vitro glycation did not lower fructosamine formation. However, when BSA was pre-incubated with phenolic acids, significantly lower concentration of fructosamine was detected under glycoxidative conditions (glucose 5 or 10 mM plus H2O2 10 nM) (p < 0.001 vs. native BSA).

CONCLUSION

protein pre-treatment, either with oxidants or phenolic acids, is an important regulator of subsequent glycation in a physiologically relevant system. High quality in vitro studies under conditions closer to physiology are feasible and should be employed more frequently.

Validation of a short food frequency questionnaire specific for iodine in U.K. females of childbearing age

BACKGROUND

Widespread subclinical iodine insufficiency has recently been reported in Europe, based on urinary iodine using World Health Organization/Food and Agriculture Organization criteria, in particular among young women. Although urinary iodine concentration (UIC) is a useful measurement of the iodine status in a population, it does not provide an insight into the habitual iodine intake of this population. This is compounded by the fact that very few iodine-specific food frequency questionnaires (FFQ) have been validated so far. The present study aimed to develop and validate a new, simple, rapid survey tool to assess dietary iodine exposure in females of childbearing age.

METHODS

Iodine was measured in a duplicate 24-h urine collection. Iodine intake was measured with duplicate 4-day semi-quantitative food diaries and the FFQ. Correlation, cross-classification and Bland-Altman analyses were used to estimate agreement, bias and the reliability of the method. The triangular (triad) method was used to calculate validity coefficients.

RESULTS

Forty-three women, aged 19-49 years, took part in the validation of the 17-items FFQ. Median (interquartile range) UIC was 74 (47-92) μg L(-1) , which is indicative of mild iodine insufficiency. The FFQ showed good agreement with food diaries with respect to classifying iodine intake (82% of subjects were classified in the same or adjacent quartile). The FFQ was moderately correlated with the food diaries (rs  = 0.45, P = 0.002) and urinary excretion in μg L(-1) (rs  = 0.34, P = 0.025) but not in μg day(-1) (P = 0.316). The validity coefficients were 0.69, 0.66 and 0.52 for the food diaries, FFQ and urinary iodine excretion, respectively.

CONCLUSIONS

The FFQ provides a rapid and reliable estimate of dietary iodine exposure to identify those population subgroups at risk of iodine deficiency.

Role of oxidative stress in physiological albumin glycation: a neglected interaction

Protein glycation is a key mechanism involved in chronic disease development in both diabetic and nondiabetic individuals. About 12-18% of circulating proteins are glycated in vivo in normoglycemic blood, but in vitro studies have hitherto failed to demonstrate glucose-driven glycation below a concentration of 30mM. Bovine serum albumin (BSA), reduced BSA (mercaptalbumin) (both 40g/L), and human plasma were incubated with glucose concentrations of 0-30mM for 4 weeks at 37°C. All were tested preoxidized for 8h before glycation with 10nM H2O2 or continuously exposed to 10nM H2O2 throughout the incubation period. Fructosamine was measured (nitroblue tetrazolium method) at 2 and 4 weeks. Oxidized BSA (both preoxidized and continuously exposed to H2O2) was more readily glycated than native BSA at all glucose concentrations (p = 0.03). Moreover, only oxidized BSA was glycated at physiological glucose concentration (5mM) compared to glucose-free control (glycation increased by 35% compared to native albumin, p < 0.05). Both 5 and 10mM glucose led to higher glycation when mercaptalbumin was oxidized than when unoxidized (p < 0.05). Fructosamine concentration in human plasma was also significantly higher when oxidized and exposed to 5mM glucose, compared to unoxidized plasma (p = 0.03). The interaction between glucose concentration and oxidation was significant in all protein models (p < 0.05). This study has for the first time demonstrated albumin glycation in vitro, using physiological concentrations of albumin, glucose, and hydrogen peroxide, identifying low-grade oxidative stress as a key element early in the glycation process.

Polyphenolic and hydroxycinnamate contents of whole coffee fruits from China, India, and Mexico

Air-dried whole coffee fruits, beans, and husks from China, India, and Mexico were analyzed for their chlorogenic acids (CGA), caffeine, and polyphenolic content. Analysis was by HPLC and Orbitrap exact mass spectrometry. Total phenol, total flavonol, and antioxidant capacity were measured. The hydroxycinnamate profile consisted of caffeoylquinic acids, feruloyquinic acids, dicaffeoylquinic acids, and caffeoyl-feruloylquinic acids. A range of flavan-3-ols as well as flavonol conjugates were detected. The CGA content was similar for both Mexican and Indian coffee fruits but was much lower in the samples from China. Highest levels of flavan-3-ols were found in the Indian samples, whereas the Mexican samples contained the highest flavonols. Amounts of CGAs in the beans were similar to those in the whole fruits, but flavan-3-ols and flavonols were not detected. The husks contained the same range of polyphenols as those in the whole fruits. The highest levels of caffeine were found in the Robusta samples.

The antioxidant and chlorogenic acid profiles of whole coffee fruits are influenced by the extraction procedures

Commercial whole coffee fruit extracts and powder samples were analyzed for chlorogenic acids (CGA), caffeine and antioxidant activities. CGA and caffeine were characterized by LC-MS(n) and HPLC accordingly, and quantified by UV absorbance. ORAC, HORAC, NORAC, SORAC and SOAC (antioxidant capacities) were assessed. Three caffeoylquinic acids, three feruloylquinic acids, three dicaffeoylquinic acids, one p-coumaroylquinic acid, two caffeoylferuloylquinic acids and three putative chlorogenic lactones were quantified, along with a methyl ester of 5-caffeoylquinic acid (detected in one sample, the first such report in any coffee material). Multistep whole coffee fruit extracts displayed higher CGA content than single-step extracts, freeze-dried, or air-dried whole raw fruits. Caffeine in multistep extracts was lower than in the single-step extracts and powders. Antioxidant activity in whole coffee fruit extracts was up to 25-fold higher than in powders dependent upon the radical. Total antioxidant activity of samples displayed strong correlation to CGA content.

Fat transforms ascorbic acid from inhibiting to promoting acid-catalysed N-nitrosation

BACKGROUND

The major potential site of acid nitrosation is the proximal stomach, an anatomical site prone to a rising incidence of metaplasia and adenocarcinoma. Nitrite, a pre-carcinogen present in saliva, can be converted to nitrosating species and N-nitroso compounds by acidification at low gastric pH in the presence of thiocyanate.

AIMS

To assess the effect of lipid and ascorbic acid on the nitrosative chemistry under conditions simulating the human proximal stomach.

METHODS

The nitrosative chemistry was modelled in vitro by measuring the nitrosation of four secondary amines under conditions simulating the proximal stomach. The N-nitrosamines formed were measured by gas chromatography-ion-trap tandem mass spectrometry, while nitric oxide and oxygen levels were measured amperometrically.

RESULTS

In absence of lipid, nitrosative stress was inhibited by ascorbic acid through conversion of nitrosating species to nitric oxide. Addition of ascorbic acid reduced the amount of N-nitrosodimethylamine formed by fivefold, N-nitrosomorpholine by >1000-fold, and totally prevented the formation of N-nitrosodiethylamine and N-nitrosopiperidine. In contrast, when 10% lipid was present, ascorbic acid increased the amount of N-nitrosodimethylamine, N-nitrosodiethylamine and N-nitrosopiperidine formed by approximately 8-, 60- and 140-fold, respectively, compared with absence of ascorbic acid.

CONCLUSION

The presence of lipid converts ascorbic acid from inhibiting to promoting acid nitrosation. This may be explained by nitric oxide, formed by ascorbic acid in the aqueous phase, being able to regenerate nitrosating species by reacting with oxygen in the lipid phase.

A comparative study of ultrasonic cavitation and Fenton's reagent for bisphenol A degradation in deionised and natural waters

Bisphenol A (BPA), a xenobiotic that exhibits endocrine disrupting action can be found in surface water. Its complete elimination can be obtained by advanced oxidation processes, notably upon the application of ultrasonic waves. In order to evaluate the feature of ultrasound relevance and the involvement of the hydroxyl radical in the BPA sonochemical degradation, ultrasound action was compared to Fenton's reaction in the cases of deionised acidic water (pH 3) and natural water (pH 7.6, main ions concentration: Ca(2+)=486mgL(-1), Na(+)=9.1mgL(-1), Cl(-)=10mg L(-1), SO(4)(2-)=1187mgL(-1), HCO(3)(-)=402mgL(-1)). Ultrasound was performed at 300kHz and 80W. Fenton's process was operated using ferrous sulphate (100micromolL(-1)) and continuous H(2)O(2) addition at the rate as it is produced when sonication is applied in water in absence of substrate. Experiments carried out in deionised water show that both processes exhibit identical BPA elimination rate and identical primary intermediates. Main chemical pathways involve reactions with OH radical. Chemical oxygen demand (COD) and total organic carbon (TOC) analyses show that the Fenton's process is slightly more efficient than ultrasonic treatment for the removal of BPA by-products in the case of deionised water. Experiments conducted in natural water evidenced the inhibition of the Fenton process while the ultrasound action was not hampered.

Reduction of chloroform formation potential of humic acid by sonolysis and ultraviolet irradiation

This study is concerned with the changes of chloroform formation potential during the reaction of humic acid (HA) and sodium hypochlorite caused by different oxidative pretreatments: ultraviolet (UV) irradiation, ultrasonic (US) irradiation or combined UV-US irradiations. The UV and US decomposition of a reagent HA in water was investigated. The characterization of the oxidized HA sample by UV absorptiometry, synchronous fluorescence spectroscopy and size exclusion chromatography points a synergetic effect of the combined process. The values of the chlorine demand and chloroform formation potential were conventionally determined after a 96 h reaction at neutral pH. It was found that all applied processes decreased the concentration of chloroform but the highest decrease was observed for the UV-US treatment.