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Lowder J, Fallah S, Venditti C, Musa-Veloso K, Kotlov V. An open-label, acute clinical trial in adults to assess ketone levels, gastrointestinal tolerability, and sleepiness following consumption of ( R)-1,3-butanediol (Avela™). Front Physiol 2023; 14:1195702. [PMID: 37457035 PMCID: PMC10338333 DOI: 10.3389/fphys.2023.1195702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction: A study was undertaken to determine the acute effects of a beverage made with Avela™ (R)-1,3-butanediol, on blood beta-hydroxybutyrate (BHB) levels (using the Keto-Mojo monitor), gastrointestinal (GI) tolerability (using the modified visual analogue scale GI Symptoms Tool), and sleepiness (using the Stanford Sleepiness Scale). Methods: Following a 12-h overnight fast, 26 healthy adults consumed one beverage containing 11.5 g of (R)-1,3-butanediol at each of 0, 30, and 60 min, culminating in a total intake of 34.5 g of (R)-1,3-butanediol. Blood BHB levels, GI tolerability, and sleepiness were assessed at baseline (0 min), and at 30, 60, 90, 120, 180, 240, and 300 min. At 240 min, a protein bar was consumed. Results: The mean (±SD) BHB fasting baseline level, maximal concentration, time at maximal concentration, and incremental area under the curve over 300 min were 0.23 ± 0.21 mmol/L, 2.10 ± 0.97 mmol/L, 133.85 ± 57.07 min, and 376.73 ± 156.76 mmol/L*min, respectively. BHB levels at each time point were significantly increased relative to baseline. In females, BHB Tmax was significantly greater (p = 0.046), and BHB iAUC0-300 min nearly significantly greater (p = 0.06) than in males. Discussion: The beverage formulated with Avela™ had no impact on sleepiness and was generally well-tolerated, with no or mild GI symptoms reported in most participants. Mild headaches were reported as an adverse event by five participants and judged possibly related to the study product in two of the participants.
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Affiliation(s)
- James Lowder
- Principal Investigator, Impact Science Alliance, San Diego, CA, United States
| | | | | | | | - Vassili Kotlov
- Study Coordinator, Impact Science Alliance, San Diego, CA, United States
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Fallah S, Musa-Veloso K, Cao J, Venditti C, Lee HY, Hamamji S, Hu J, Appelhans K, Frankos V. Liver biomarkers in adults: Evaluation of associations with reported green tea consumption and use of green tea supplements in U.S. NHANES. Regul Toxicol Pharmacol 2021; 129:105087. [PMID: 34826597 DOI: 10.1016/j.yrtph.2021.105087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
Some events of hepatotoxicity have been linked to consumption of green tea supplements. The association between consumption of green tea or green tea supplements and abnormal liver biomarkers in adults was investigated using cross-sectional data from the 2009-2014 United States National Health and Nutrition Examination Survey (U.S. NHANES). Individuals with levels of either bilirubin or GGT, ALT, AST, and/or ALP in excess of the age- and gender-specific upper limits of normal ranges were classified as having abnormal liver biomarkers. Associations between green tea or green tea supplement use (consumption vs. not) and liver function were determined using multiple logistic regression modelling. 12,289 persons were included in the green tea analyses and 12,274 in the green tea supplement analyses. The odds of having one or more abnormal liver biomarkers were significantly reduced (p = 0.01) with consumption of green tea (OR: 0.49; 95% CI: 0.28, 0.85), while no significant association (p = 0.78) was determined for consumption of green tea supplements (OR: 0.92; 95% CI: 0.52, 1.64). Based on data from the 2009-2014 U.S. NHANES, green tea consumption was associated with reduced odds of having one or more abnormal liver biomarkers; whereas, no significant association was determined with consumption of green tea supplements.
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Affiliation(s)
- Shafagh Fallah
- Intertek Health Sciences Inc., Mississauga, Ontario, Canada
| | | | - Joyce Cao
- Herbalife Nutrition, Torrance, CA, USA
| | | | - Han Youl Lee
- Intertek Health Sciences Inc., Mississauga, Ontario, Canada
| | - Samer Hamamji
- Intertek Health Sciences Inc., Mississauga, Ontario, Canada
| | - Jiang Hu
- Herbalife Nutrition, Torrance, CA, USA
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Lee HY, Jack M, Poon T, Noori D, Venditti C, Hamamji S, Musa-Veloso K. Effects of Unsweetened Preloads and Preloads Sweetened with Caloric or Low-/No-Calorie Sweeteners on Subsequent Energy Intakes: A Systematic Review and Meta-Analysis of Controlled Human Intervention Studies. Adv Nutr 2021; 12:1481-1499. [PMID: 33439973 PMCID: PMC8321874 DOI: 10.1093/advances/nmaa157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/02/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Abstract
Effects of isocaloric (sweetness differences but constant calories) preloads and isosweet (caloric differences but constant sweetness) preloads, as well as preloads that were neither isosweet nor isocaloric (sweetness and caloric differences) on subsequent ad libitum meal and total (preload + ad libitum) energy intakes were investigated. Thirty-five crossover studies were eligible for inclusion, representing 116 comparisons (41, isocaloric; 41, isosweet; and 34, neither isosweet nor isocaloric). References of existing reviews and literature from 4 databases were searched. The calculated raw mean differences in ad libitum and total energy intakes were pooled in meta-analyses using a random-effects model and the inverse of the variance as the weighting factor. Energy intakes at an ad libitum meal were significantly lower for low-/no-calorie sweetener (LNCS)-sweetened compared with unsweetened preloads in the isocaloric comparison (-55.5 kcal; 95% CI: -82.9, -28.0 kcal; P < 0.001); however, the difference in energy intake was not significant in additional sensitivity analyses (i.e., removal of comparisons where the matrix was a capsule and when xylitol was the LNCS). For the isosweet comparison, although the pooled energy intake at the ad libitum meal was significantly greater with the LNCS-sweetened preload compared with the caloric sweetener (CS)-sweetened preload (58.5 kcal; 95% CI: 35.4, 81.7 kcal; P < 0.001), the pattern was reversed when total energy intake was considered (-132.4 kcal; 95% CI: -163.2, -101.6 kcal; P < 0.001), explained by only partial compensation from the CS-sweetened preload. The results were similar when assessing ad libitum and total energy intakes when unsweetened compared with CS-sweetened preloads were consumed. Unsweetened or LNCS-sweetened preloads appear to have similar effects on intakes when compared with one another or with CS-sweetened preloads. These findings suggest that LNCS-sweetened foods and beverages are viable alternatives to CS-sweetened foods and beverages to manage short-term energy intake.
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Affiliation(s)
- Han Youl Lee
- Intertek Health Sciences, Inc., Mississauga, Ontario Canada
| | - Maia Jack
- American Beverage Association, Science and Regulatory Affairs, Washington, DC, USA
| | - Theresa Poon
- Intertek Health Sciences, Inc., Mississauga, Ontario Canada
| | - Daniel Noori
- Intertek Health Sciences, Inc., Mississauga, Ontario Canada
| | | | - Samer Hamamji
- Intertek Health Sciences, Inc., Mississauga, Ontario Canada
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Musa-Veloso K, Racey M, MacFarlane A, Bier D, Lamarche B, Trumbo P, House J. Challenges in the design, interpretation, and reporting of randomized controlled clinical studies on the health effects of whole foods. Appl Physiol Nutr Metab 2021; 46:1152-1158. [PMID: 34048662 DOI: 10.1139/apnm-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Given the challenges with nutrition research, the Canadian Nutrition Society and Intertek Health Sciences Inc held an expert consultation in late 2019 to discuss the development and implementation of best practices for clinical trials on whole foods. Key challenges in the design, interpretation, and reporting of clinical efficacy studies on whole foods and opportunities for the future development of best practices are reported. Novelty: Outlines existing tools, resources, and checklists for clinical nutrition trials and provides clear and tangible steps to develop best practices for studies on whole foods.
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Affiliation(s)
- Kathy Musa-Veloso
- Health Claims and Clinical Trials, Food and Nutrition Group, Intertek Health Sciences Inc., Suite 201, 2233 Argentia Road, Mississauga, ON L5N 2X7, Canada
| | - Megan Racey
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Amanda MacFarlane
- Bureau of Nutritional Sciences, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa, ON K1A 0K9, Canada
| | - Dennis Bier
- Pediatrics-Nutrition, Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA
| | - Benoît Lamarche
- Centre Nutrition, santé et société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, 2440 Hochelaga Blvd., Quebec City, QC G1V 0A6, Canada
| | - Paula Trumbo
- Adjunct Faculty, Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Ave., St. Paul, MN 55108, USA
| | - James House
- Faculty of Agriculture and Food Sciences, University of Manitoba, 208A Human Ecology Building, 66 Chancellors Circle, Winnipeg, MB R3T 2N2, Canada
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Musa-Veloso K, Noori D, Venditti C, Poon T, Johnson J, Harkness LS, O'Shea M, Chu Y. A Systematic Review and Meta-Analysis of Randomized Controlled Trials on the Effects of Oats and Oat Processing on Postprandial Blood Glucose and Insulin Responses. J Nutr 2021; 151:341-351. [PMID: 33296453 DOI: 10.1093/jn/nxaa349] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/31/2020] [Accepted: 10/12/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Oats are a whole grain cereal with potentially favorable effects on the postprandial glycemic response; however, the effects of oat processing on these glycemic benefits are not well understood. OBJECTIVES The study objective was to determine the effects of differently processed oats on the postprandial blood glucose and insulin responses relative to refined grains. METHODS Eleven electronic databases were systematically searched to identify studies published up to and including May 2019. Randomized controlled trials comparing the postprandial blood glucose and insulin responses to oats compared with any refined grain were included, so long as the available carbohydrate content of the test meals was similar. Pooled effect sizes were computed using the difference in incremental area under the curves for blood glucose and insulin following the consumption of oats compared with the refined grain control. RESULTS Ten publications were included, with intact oat kernels studied in 3 comparisons, thick oat flakes (>0.6 mm) in 7 comparisons, and thin/quick/instant oat flakes (≤0.6 mm) in 6 comparisons. Compared with the consumption of the refined grain control, the consumption of intact oat kernels was associated with significant reductions in postprandial blood glucose (-45.5 mmol x min/L; 95% CI: -80.1, -10.9 mmol x min/L; P = 0.010) and insulin (-4.5 nmol x min/L; 95% CI: -7.1, -1.8 nmol x min/L; P = 0.001) responses; the consumption of thick oat flakes was associated with significant reductions in postprandial blood glucose (-30.6 mmol x min/L; 95% CI: -40.4, -20.9 mmol x min/L; P < 0.001) and insulin (-3.9 nmol x min/L; 95% CI: -5.3, -2.5 nmol x min/L; P < 0.001) responses; but, the consumption of thin/quick/instant oat flakes was not associated with any effects on the postprandial blood glucose and insulin responses. CONCLUSIONS A disruption in the structural integrity of the oat kernel is likely associated with a loss in the glycemic benefits of oats.
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Affiliation(s)
| | - Daniel Noori
- Intertek Health Sciences Inc., Mississauga, Ontario, Canada
| | | | - Theresa Poon
- Intertek Health Sciences Inc., Mississauga, Ontario, Canada
| | - Jodee Johnson
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition Sciences, Barrington, IL, USA
| | - Laura S Harkness
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition Sciences, Barrington, IL, USA
| | - Marianne O'Shea
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition Sciences, Barrington, IL, USA
| | - YiFang Chu
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition Sciences, Barrington, IL, USA
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Venditti C, Musa-Veloso K, Lee HY, Poon T, Mak A, Darch M, Juana J, Fronda D, Noori D, Pateman E, Jack M. Determinants of Sweetness Preference: A Scoping Review of Human Studies. Nutrients 2020; 12:nu12030718. [PMID: 32182697 PMCID: PMC7146214 DOI: 10.3390/nu12030718] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/26/2020] [Accepted: 03/04/2020] [Indexed: 11/16/2022] Open
Abstract
Factors associated with sweetness preference are multi-faceted and incredibly complex. A scoping review was undertaken to identify determinants of sweetness preference in humans. Using an online search tool, ProQuest ™, a total of 99 publications were identified and subsequently grouped into the following categories of determinants: Age, dietary factors, reproductive hormonal factors, body weight status, heritable, weight loss, sound, personality, ethnicity and lifestyle, previous exposure, disease, and 'other' determinants. Methodologies amongst studies were heterogenous in nature (e.g., there was variability across studies in the sweetness concentrations tested, the number of different sweetness concentrations used to assess sweetness preference, and the methods utilized to measure sweetness preference), rendering interpretation of overall findings challenging; however, for certain determinants, the evidence appeared to support predictive capacity of greater sweetness preference, such as age during certain life-stages (i.e., young and old), being in a hungry versus satiated state, and heritable factors (e.g., similar sweetness preferences amongst family members). Recommendations for the design of future studies on sweetness preference determinants are provided herein, including an "investigator checklist" of criteria to consider.
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Affiliation(s)
- Carolina Venditti
- Intertek Health Sciences, Inc., Suite 201, 2233 Argentia Road, Mississauga, ON L5N 2X7, Canada
- Correspondence:
| | - Kathy Musa-Veloso
- Intertek Health Sciences, Inc., Suite 201, 2233 Argentia Road, Mississauga, ON L5N 2X7, Canada
| | - Han Youl Lee
- Intertek Health Sciences, Inc., Suite 201, 2233 Argentia Road, Mississauga, ON L5N 2X7, Canada
| | - Theresa Poon
- Intertek Health Sciences, Inc., Suite 201, 2233 Argentia Road, Mississauga, ON L5N 2X7, Canada
| | - Alastair Mak
- Intertek Health Sciences, Inc., Suite 201, 2233 Argentia Road, Mississauga, ON L5N 2X7, Canada
| | - Maryse Darch
- Intertek Health Sciences, Inc., Suite 201, 2233 Argentia Road, Mississauga, ON L5N 2X7, Canada
| | - Justine Juana
- Intertek Health Sciences, Inc., Suite 201, 2233 Argentia Road, Mississauga, ON L5N 2X7, Canada
| | - Dylan Fronda
- Intertek Health Sciences, Inc., Suite 201, 2233 Argentia Road, Mississauga, ON L5N 2X7, Canada
| | - Daniel Noori
- Intertek Health Sciences, Inc., Suite 201, 2233 Argentia Road, Mississauga, ON L5N 2X7, Canada
| | - Erika Pateman
- Intertek Health Sciences, Inc., Suite 201, 2233 Argentia Road, Mississauga, ON L5N 2X7, Canada
| | - Maia Jack
- American Beverage Association, Science and Regulatory Affairs, 1275 Pennsylvania Ave. NW, Washington, DC 200042, USA
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Musa-Veloso K, Venditti C, Lee HY, Darch M, Floyd S, West S, Simon R. Systematic review and meta-analysis of controlled intervention studies on the effectiveness of long-chain omega-3 fatty acids in patients with nonalcoholic fatty liver disease. Nutr Rev 2019; 76:581-602. [PMID: 29917092 PMCID: PMC6367993 DOI: 10.1093/nutrit/nuy022] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Context Treatment options for nonalcoholic fatty liver disease (NAFLD) are needed. Objective The aim of this review was to systematically assess the effects of omega-3 long-chain
polyunsaturated fatty acids (n-3 LC-PUFAs), particularly eicosapentaenoic acid and
docosahexaenoic acid, on liver-related and metabolic outcomes in adult and pediatric
patients with NAFLD. Data Sources The online information service ProQuest Dialog was used to search 8 literature
databases. Study Selection Controlled intervention studies in which the independent effects of n-3 LC-PUFAs could
be isolated were eligible for inclusion. Data Extraction The 18 unique studies that met the criteria for inclusion were divided into 2 sets, and
data transcriptions and study quality assessments were conducted in duplicate. Each
effect size was expressed as the weighted mean difference and 95%CI, using a
random-effects model and the inverse of the variance as a weighting factor. Results Based on the meta-analyses, supplementation with n-3 LC-PUFAs resulted in statistically
significant improvements in 6 of 13 metabolic risk factors, in levels of 2 of 3 liver
enzymes, in liver fat content (assessed via magnetic resonance imaging/spectroscopy),
and in steatosis score (assessed via ultrasonography). Histological measures of disease
[which were assessed only in patients with nonalcoholic steatohepatitis (NASH)] were
unaffected by n-3 LC-PUFA supplementation. Conclusions Omega-3 LC-PUFAs are useful in the dietary management of patients with NAFLD.
Additional trials are needed to better understand the effects of n-3 LC-PUFAs on
histological outcomes in patients with NASH. Systematic Review Registration PROSPERO CRD42017055951.
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Affiliation(s)
- Kathy Musa-Veloso
- Intertek Scientific & Regulatory Consultancy, Health, Environmental & Regulatory Services (HERS), Mississauga, Ontario, Canada
| | - Carolina Venditti
- Intertek Scientific & Regulatory Consultancy, Health, Environmental & Regulatory Services (HERS), Mississauga, Ontario, Canada
| | - Han Youl Lee
- Intertek Scientific & Regulatory Consultancy, Health, Environmental & Regulatory Services (HERS), Mississauga, Ontario, Canada
| | - Maryse Darch
- Intertek Scientific & Regulatory Consultancy, Health, Environmental & Regulatory Services (HERS), Mississauga, Ontario, Canada
| | - Seth Floyd
- Intertek Scientific & Regulatory Consultancy, Health, Environmental & Regulatory Services (HERS), Mississauga, Ontario, Canada
| | - Spencer West
- Intertek Scientific & Regulatory Consultancy, Health, Environmental & Regulatory Services (HERS), Mississauga, Ontario, Canada
| | - Ryan Simon
- Intertek Scientific & Regulatory Consultancy, Health, Environmental & Regulatory Services (HERS), Mississauga, Ontario, Canada
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Mitchell E, Musa-Veloso K, Fallah S, Lee H, Zakharkin S, Gibson S. 100% Juice Contributes to Micronutrient Intakes in US, UK And Brazilian Consumers. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Musa-Veloso K, Poon T, Harkness LS, O'Shea M, Chu Y. The effects of whole-grain compared with refined wheat, rice, and rye on the postprandial blood glucose response: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2018; 108:759-774. [PMID: 30321274 DOI: 10.1093/ajcn/nqy112] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 05/01/2018] [Indexed: 12/30/2022] Open
Abstract
Background Whole grains are often referred to collectively, despite differences in their composition, physical structure, processing, and potential health benefits. Objective The aim of this study was to compare the postprandial blood glucose response of whole-grain with refined wheat, rice, or rye, while controlling for the food delivery matrix and the processing of the grain (e.g., grinding, germination). Design Eleven electronic databases were systematically searched to identify studies published up to and including November 2017. Randomized controlled trials comparing the effects of whole-grain wheat, rice, or rye with those of each grain's refined counterpart on postprandial blood glucose area under the curve (AUC) were included. Pooled effect sizes were computed by using the difference in the blood glucose AUC after the consumption of the whole compared with the refined grain. Results Twenty publications were included, with 10, 14, and 5 strata (or active-control comparisons) on whole-grain wheat, rice, and rye, respectively. The consumption of ground (wholemeal) wheat, compared with white wheat, was not associated with a significant reduction in blood glucose AUC (-6.7 mmol/L ⋅ min; 95% CI: -25.1, 11.7 mmol/L ⋅ min; P = 0.477). The consumption of wholemeal rye, compared with endosperm rye, was not associated with a significant reduction in blood glucose AUC (-5.5 mmol/L ⋅ min; 95% CI: -24.8, 13.8 mmol/L ⋅ min; P = 0.576). The consumption of intact (whole-grain) rice, compared with white rice, was associated with a significant reduction in blood glucose AUC (-40.5 mmol/L ⋅ min; 95% CI: -59.6, -21.3 mmol/L ⋅ min; P < 0.001). Conclusions Compared with white rice, whole-grain rice significantly attenuates the postprandial blood glucose response. In most of the studies on wheat and rye, the postprandial blood glucose responses to foods formulated with wholemeal compared with refined flours were compared. Whether reductions in the blood glucose AUC can be achieved with whole-grain (as opposed to wholemeal) wheat and rye requires further investigation.
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Affiliation(s)
- Kathy Musa-Veloso
- Intertek Scientific & Regulatory Consultancy, Mississauga, Ontario, Canada
| | - Theresa Poon
- Intertek Scientific & Regulatory Consultancy, Mississauga, Ontario, Canada
| | | | - Marianne O'Shea
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition Sciences, Barrington, IL
| | - YiFang Chu
- Quaker Oats Center of Excellence, PepsiCo R&D Nutrition Sciences, Barrington, IL
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Marinangeli CPF, Foisy S, Shoveller AK, Porter C, Musa-Veloso K, Sievenpiper JL, Jenkins DJA. An Appetite for Modernizing the Regulatory Framework for Protein Content Claims in Canada. Nutrients 2017; 9:nu9090921. [PMID: 28832556 PMCID: PMC5622681 DOI: 10.3390/nu9090921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/30/2017] [Accepted: 07/13/2017] [Indexed: 12/25/2022] Open
Abstract
The need for protein-rich plant-based foods continues as dietary guidelines emphasize their contribution to healthy dietary patterns that prevent chronic disease and promote environmental sustainability. However, the Canadian Food and Drug Regulations provide a regulatory framework that can prevent Canadian consumers from identifying protein-rich plant-based foods. In Canada, protein nutrient content claims are based on the protein efficiency ratio (PER) and protein rating method, which is based on a rat growth bioassay. PERs are not additive, and the protein rating of a food is underpinned by its Reasonable Daily Intake. The restrictive nature of Canada’s requirements for supporting protein claims therefore presents challenges for Canadian consumers to adapt to a rapidly changing food environment. This commentary will present two options for modernizing the regulatory framework for protein content claims in Canada. The first and preferred option advocates that protein quality not be considered in the determination of the eligibility of a food for protein content claims. The second and less preferred option, an interim solution, is a framework for adopting the protein digestibility corrected amino acid score as the official method for supporting protein content and quality claims and harmonizes Canada’s regulatory framework with that of the USA.
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Affiliation(s)
| | - Samara Foisy
- Loblaw Companies Limited, 1 President's Choice Circle, Brampton, ON L6Y 5S5, Canada.
| | - Anna K Shoveller
- Department of Animal Biosciences, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada.
| | - Cara Porter
- Loblaw Companies Limited, 1 President's Choice Circle, Brampton, ON L6Y 5S5, Canada.
| | - Kathy Musa-Veloso
- Intertek Scientific & Regulatory Consultancy, 2233 Argentia Road-Suite 201, Mississauga, ON L5N 2X7, Canada.
| | - John L Sievenpiper
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5B 1W8, Canada.
- Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
- Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
| | - David J A Jenkins
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5B 1W8, Canada.
- Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
- Department of Medicine, Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
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Berge K, Musa-Veloso K, Harwood M, Hoem N, Burri L. Krill oil supplementation lowers serum triglycerides without increasing low-density lipoprotein cholesterol in adults with borderline high or high triglyceride levels. Nutr Res 2014; 34:126-33. [DOI: 10.1016/j.nutres.2013.12.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/11/2013] [Accepted: 12/12/2013] [Indexed: 11/25/2022]
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Clarke K, Tchabanenko K, Pawlosky R, Carter E, Todd King M, Musa-Veloso K, Ho M, Roberts A, Robertson J, Vanitallie TB, Veech RL. Kinetics, safety and tolerability of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate in healthy adult subjects. Regul Toxicol Pharmacol 2012; 63:401-8. [PMID: 22561291 DOI: 10.1016/j.yrtph.2012.04.008] [Citation(s) in RCA: 211] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/24/2012] [Accepted: 04/26/2012] [Indexed: 10/28/2022]
Abstract
Induction of mild states of hyperketonemia may improve physical and cognitive performance. In this study, we determined the kinetic parameters, safety and tolerability of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate, a ketone monoester administered in the form of a meal replacement drink to healthy human volunteers. Plasma levels of β-hydroxybutyrate and acetoacetate were elevated following administration of a single dose of the ketone monoester, whether at 140, 357, or 714 mg/kg body weight, while the intact ester was not detected. Maximum plasma levels of ketones were attained within 1-2h, reaching 3.30 mM and 1.19 mM for β-hydroxybutyrate and acetoacetate, respectively, at the highest dose tested. The elimination half-life ranged from 0.8-3.1h for β-hydroxybutyrate and 8-14 h for acetoacetate. The ketone monoester was also administered at 140, 357, and 714 mg/kg body weight, three times daily, over 5 days (equivalent to 0.42, 1.07, and 2.14 g/kg/d). The ketone ester was generally well-tolerated, although some gastrointestinal effects were reported, when large volumes of milk-based drink were consumed, at the highest ketone monoester dose. Together, these results suggest ingestion of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate is a safe and simple method to elevate blood ketone levels, compared with the inconvenience of preparing and consuming a ketogenic diet.
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Affiliation(s)
- Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
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Musa-Veloso K, Poon TH, Elliot JA, Chung C. A comparison of the LDL-cholesterol lowering efficacy of plant stanols and plant sterols over a continuous dose range: results of a meta-analysis of randomized, placebo-controlled trials. Prostaglandins Leukot Essent Fatty Acids 2011; 85:9-28. [PMID: 21345662 DOI: 10.1016/j.plefa.2011.02.001] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine if plant stanols and plant sterols differ with respect to their low-density lipoprotein cholesterol (LDL-CH) lowering efficacies across a continuous dose range. METHODS Dose-response relationships were evaluated separately for plant stanols and plant sterols and reductions in LDL-CH, using a first-order elimination function. RESULTS Altogether, 113 publications and 1 unpublished study report (representing 182 strata) complied with the pre-defined inclusion and exclusion criteria and were included in the assessment. The maximal LDL-CH reductions for plant stanols (16.4%) and plant stanol ester (17.1%) were significantly greater than the maximal LDL-CH reductions for plant sterols (8.3%) and plant sterol ester (8.4%). These findings persisted in several additional analyses. DISCUSSION AND CONCLUSIONS Intakes of plant stanols in excess of the recommended 2g/day dose are associated with additional and dose-dependent reductions in LDL-CH, possibly resulting in further reductions in the risk of coronary heart disease (CHD).
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Musa-Veloso K, Poon T. Author's reply: Low-dose eicosapentaenoic acid and/or docosahexaenoic acid and triglyceride lowering. Nutr Rev 2010. [DOI: 10.1111/j.1753-4887.2010.00318.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Musa-Veloso K, Binns MA, Kocenas AC, Poon T, Elliot JA, Rice H, Oppedal-Olsen H, Lloyd H, Lemke S. Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid dose-dependently reduce fasting serum triglycerides. Nutr Rev 2010; 68:155-67. [PMID: 20384846 DOI: 10.1111/j.1753-4887.2010.00272.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The objectives of this review were to determine whether the long-chain omega-3 fatty acids eicosapentaenoic acid and/or docosahexaenoic acid dose-dependently reduce fasting serum triglycerides (TG) and, if so, to create a mathematical model that may be used to predict potential percent reductions in fasting serum TG levels at the recommended intakes of 200-500 mg/day. The assessment included 15 randomized controlled trials that met pre-defined inclusion and exclusion criteria. Across these 15 studies, the dose-response was modeled using a first-order elimination curve. The response variable was defined as percent change from baseline in fasting serum TG, adjusted for the placebo effect. A weighting factor equal to the product of each study's sample size and quality score was used. Using the equation of the dose-response curve, predicted reductions in fasting serum TG levels at the recommended long-chain omega-3 fatty acid intakes of 200-500 mg/day are 3.1 to 7.2%.
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Musa-Veloso K, Card JW, Wong AW, Cooper DA. Influence of observational study design on the interpretation of cancer risk reduction by carotenoids. Nutr Rev 2009; 67:527-45. [PMID: 19703260 DOI: 10.1111/j.1753-4887.2009.00225.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Recently published literature has been reviewed to determine whether lycopene, beta-carotene, alpha-carotene, and beta-cryptoxanthin are associated with reductions in cancer risk and whether study findings differ by study design. A total of 57 publications meeting pre-defined inclusion and exclusion criteria were identified, with the majority (55) being observational studies. None of the intervention studies supported a significant reduction in cancer risk with carotenoid (beta-carotene) supplementation. The majority of observational studies did not support significant reductions in cancer risk with increased carotenoid dietary intakes/circulating levels. A larger percentage of case-control studies supported significant associations between increased dietary intakes/circulating levels of carotenoids relative to prospective (cohort and nested case-control) studies. Compared to prospective studies, case-control studies cannot be used to establish temporality and may be more susceptible to selection and recall biases. Thus, diet-disease relationships suggested by case-control studies should ideally be confirmed by additional evidence from prospective studies.
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Musa-Veloso K, Likhodii SS, Rarama E, Benoit S, Liu YMC, Chartrand D, Curtis R, Carmant L, Lortie A, Comeau FJE, Cunnane SC. Breath acetone predicts plasma ketone bodies in children with epilepsy on a ketogenic diet. Nutrition 2006; 22:1-8. [PMID: 16183255 DOI: 10.1016/j.nut.2005.04.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Accepted: 04/19/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The high-fat ketogenic diet has long been used to treat refractory childhood seizures, but whether there is a relation between the degree of ketosis and effectiveness of seizure control remains unclear. Frequent measurements of plasma ketones are difficult in children so the goal was to determine the utility of breath acetone as a marker of systemic ketosis and seizure control in children given the ketogenic diet because of seizures refractory to medication. METHODS In experiment I, breath acetone and plasma ketones were assessed every 2 h during an 8-h test day in seven children. In experiment II, a preliminary assessment of the possible relation between breath acetone and seizure frequency was made over 14 d in five children and one adolescent on the ketogenic diet. RESULTS Breath acetone was positively and curvilinearly related to plasma acetone (r2 = 0.99, P < 0.0001), plasma acetoacetate (r2 = 0.89, P < 0.0001), and plasma beta-hydroxybutyrate (r2 = 0.94, P < 0.0001). No significant relation was found between breath acetone and seizure frequency or change in seizure frequency. CONCLUSIONS Breath acetone is indicative of systemic ketosis while on the ketogenic diet. However, owing to the wide range of seizure types and plasma acetone, more subjects will be needed to determine whether there is a clear link between breath acetone and seizure frequency or decreased seizure frequency while on the high-fat ketogenic diet.
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Affiliation(s)
- Kathy Musa-Veloso
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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Nestmann ER, Lynch BS, Musa-Veloso K, Goodfellow GH, Cheng E, Haighton LA, Lee-Brotherton VM. Safety assessment and risk–benefit analysis of the use of azodicarbonamide in baby food jar closure technology: Putting trace levels of semicarbazide exposure into perspective – A review. ACTA ACUST UNITED AC 2005; 22:875-91. [PMID: 16192074 DOI: 10.1080/02652030500195312] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The discovery of trace levels of semicarbazide (SEM) in bottled foods (especially baby foods) led to a consideration of the safety of this hydrazine compound by regulatory agencies worldwide. Azodicarbonamide, which is used in the jar-sealing technology known as Press On-Twist Off (or Push-Twist/PT) closures for the formation of a hermetic, plastisol seal, partially degrades with the heat of processing to form trace amounts of SEM. This review has evaluated the potential toxicological risks of resulting exposure to SEM and also the benefit of the PT technology (with azodicarbonamide) in the context of possible microbial contamination. It also considers the potential impact on infant nutrition if parents come to the conclusion that commercial baby foods are unsafe. SEM shows limited genotoxicity in vitro that is largely prevented by the presence of mammalian metabolic enzymes. Negative results were found in vivo in DNA alkaline elution, unscheduled DNA synthesis and micronucleus assays. This pattern is in contrast to the genotoxic hydrazines that also have been shown to cause tumours. Carcinogenicity studies of SEM are of limited quality, show a questionable weak effect in mice at high doses, which are not relevant to human exposure at trace levels, and show no effect in the rat. The IARC has assigned SEM as Group 3, 'Not classifiable as to its carcinogenicity to humans'. Based on estimates of exposure to infants consuming baby foods (with the assumption of SEM levels at the 95th percentile of 20 ng g(-1) in all of the consumed 'ready-to-eat' foods) compared with a no observed adverse effect level (NOAEL) in developmental toxicity studies, the margin of safety is more than 21 000. Since the risk of an adverse effect is negligible, it is clear that any theoretical risk is outweighed by the benefits of continuing use of the PT closure (with azodicarbonamide blowing agent) to ensure both the microbial integrity and availability of commercial baby foods as a valuable source of infant nutrition.
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Abstract
Ketosis is believed to be necessary to the anticonvulsant mechanism of the ketogenic diet; however, the relationship between ketosis and seizure control has not been established. The various analytical methods for the assessment of ketosis are reviewed, and their application in the area of epilepsy and the ketogenic diet is evaluated. The clinical challenges inherent in interpreting measures of ketosis are discussed, as are suggestions for future studies.
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Affiliation(s)
- K Musa-Veloso
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, 150 College Street, Room 308, Toronto, Ontario, Canada M5S 3E2.
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Abstract
We summarize here the evidence indicating that carbon from alpha-linolenate and linoleate is readily recycled into newly synthesized lipids. This pathway consumes the majority of these fatty acids that is not beta-oxidized as a fuel. Docosahexaenoate undergoes less beta-oxidation and carbon recycling than do alpha-linolenate or linoleate, but is it still actively metabolized by this pathway? Among polyunsaturates, arachidonate appears to undergo the least beta-oxidation and carbon recycling, an observation that may help account for the resistance of brain membranes to loss of arachidonate during dietary deficiency of n-6 polyunsaturates. Preliminary evidence suggests that de novo lipid synthesis consumes carbon from alpha-linolenate and linoleate in preference to palmitate, but this merits systematic study. Active beta-oxidation and carbon recycling of 18-carbon polyunsaturates does not diminish the importance of being able to convert alpha-linolenate and linoleate to long-chain polyunsaturates but suggests that a broad perspective is required in studying the metabolism of polyunsaturates in general and alpha-linolenate and linoleate in particular.
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Affiliation(s)
- Stephen C Cunnane
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada M5S 3E2.
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Fraser DD, Whiting S, Andrew RD, Macdonald EA, Musa-Veloso K, Cunnane SC. Elevated polyunsaturated fatty acids in blood serum obtained from children on the ketogenic diet. Neurology 2003; 60:1026-9. [PMID: 12654976 DOI: 10.1212/01.wnl.0000049974.74242.c6] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors analyzed blood metabolites in nine children with epilepsy prior to starting the ketogenic diet (KD) and 3 to 4 weeks after KD therapy. Elevated beta-hydroxybutyrate and cortisol levels were observed in all children on the KD. Free fatty acids increased 2.2-fold on the KD, with significant elevations in most polyunsaturated fatty acids (PUFA; arachidonate increased 1.6- to 2.9-fold and docosahexaenoate increased 1.5- to 4.0-fold). The rise in total serum arachidonate correlated with improved seizure control. Elevated PUFA may represent a key anticonvulsant mechanism of the KD.
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Affiliation(s)
- D D Fraser
- Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada.
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Abstract
High-fat ketogenic diets increase ketones (acetoacetate, beta-hydroxybutyrate, and acetone) and are used to treat refractory seizures. Although ketosis is an integral aspect of these therapeutic regimens, the direct importance of ketosis to seizure control needs further investigation. An examination of this relationship requires a reliable, minimally invasive measure of ketosis that can be performed frequently. In the present study, we examined the use of breath acetone as a measure of ketosis in children with refractory seizures on a classic ketogenic diet. Results were compared with breath acetone levels in epilepsy and healthy controls. Children on the ketogenic diet had significantly higher fasting breath acetone compared with epilepsy or healthy controls (2530 +/- 600 nmol/L versus 19 +/- 9 nmol/L and 21 +/- 4 nmol/L, respectively; p < 0.05). One hour after consumption of a ketogenic breakfast meal, breath acetone increased significantly in epilepsy and healthy controls (p < 0.05), but not in children on a ketogenic diet. Children who were on the ketogenic diet for longer periods of time had a significantly lower fasting breath acetone (R(2) = 0.55, p = 0.014). In one child on the ketogenic diet, breath acetone was determined hourly over a 9-h period, both by gas chromatography and by a prototype hand-held breath acetone analyzer. Preliminary results using this hand-held breath acetone analyzer are encouraging. Breath acetone may be a useful tool in examining the relationship between ketosis and seizure control and enhancing our understanding of the mechanism of the ketogenic diet.
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Affiliation(s)
- Kathy Musa-Veloso
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 3E2, Canada.
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Abstract
BACKGROUND Ketogenic diets are used therapeutically to treat intractable seizures. Clinically, it appears that the maintenance of ketosis is crucial to the efficacy of the diet in ameliorating seizures. To understand how ketosis and seizure protection are related, a reliable, noninvasive measure of ketosis that can be performed frequently with minimal discomfort is needed. OBJECTIVE The objective was to determine which index, breath acetone or urinary acetoacetate, is more strongly related to the plasma ketones acetoacetate and beta-hydroxybutyrate. DESIGN After fasting overnight for 12 h, 12 healthy adults consumed 4 ketogenic meals over 12 h. Blood, breath, and urine samples were collected hourly. Blood was analyzed for plasma acetoacetate and beta-hydroxybutyrate, breath for acetone, and urine for acetoacetate. RESULTS By the end of the 12-h dietary treatment, plasma acetoacetate, plasma beta-hydroxybutyrate, and breath acetone had increased 3.5-fold, whereas urinary acetoacetate increased 13-fold when measured enzymatically and 25-fold when measured with urinary ketone dipsticks. Plasma acetoacetate was best predicted by breath acetone (R(2) = 0.70, P < 0.0001). Plasma beta-hydroxybutyrate was equally predicted by breath acetone and urinary acetoacetate (R(2) = 0.54, P = 0.0040). CONCLUSIONS Breath acetone is as good a predictor of ketosis as is urinary acetoacetate. Breath acetone analysis is noninvasive and can be performed frequently with minimal discomfort to patients. As an indicator of ketosis in epilepsy patients consuming a ketogenic diet, breath acetone may be useful for understanding the mechanism of the diet, elucidating the importance of ketosis in seizure protection, and ultimately, enhancing the efficacy of the diet by improving patient monitoring.
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Affiliation(s)
- Kathy Musa-Veloso
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada.
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