[Beneficial effects of chocolate on cardiovascular health]

Since ancient times, numerous health beneficial effects have been attributed to chocolate, closing up its consumption to a therapeutic use. The present study reviews some relevant studies about chocolate (and its bioactive compounds) on some cardiovascular risk factors and stresses the need of future studies. The consumption of cocoa/ chocolate (i) increases plasma antioxidant capacity, (ii) diminishes platelet function and inflammation, and (iii) decreases diastolic and systolic arterial pressures. Data currently available indicate that daily consumption of cocoa-rich chocolate (rich in polyphenols) may at least partially lower cardiovascular disease risk. Further studies are required in order to establish the bioavailability and mechanisms of action of bioactive compounds in chocolate. The study of the interaction of chocolate and its components with candidate genes will also supply necessary information regarding the individuals best suited to benefit from a potential cardiovascular disease treatment with chocolate.

Inventory management

A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices. This International Forum represents an effort to get a snap shot of inventory management practices around the world, and to understand the range of different products provided for patients. In addition to sharing current inventory management practices, this Forum is intended to foster an exchange of ideas around where we see our field moving with respect to various issues including specialty products, new technologies, and reducing recipient risk from blood transfusion products.

[Iron deficiency and overload. Implications in oxidative stress and cardiovascular health]

Although iron is an essential mineral for maintaining good health, excessive amounts are toxic. Nowadays, much interest is focused on the mechanisms and regulation of iron metabolism by down-regulation of the hormone hepcidin. The HAMP gene encodes for hepcidin appears to be exceptionally preserved. Disorders of iron metabolism could lead to iron overload, mainly causing the rare disease hereditary hemochromatosis, or on the other hand, iron deficiency and iron deficiency anaemia. Currently, these alterations constitute an important problem of public health. The genetic variation implicated in iron overload and iron deficiency anaemia, involves mutations in several genes such as HFE, TFR2,HAMP, HJV, Tf and TMPRSS6. Iron has the capacity to accept and donate electrons easily and can catalyze reactions of free radicals production. Therefore, iron overload causes lipid peroxidation and increases cardiovascular risk. Recently, a relationship between iron metabolism and insulin resistance and obesity has been described. In contrast, regarding a possible relationship between iron deficiency anaemia and cardiovascular disease, many aspects remain controversial. This review presents an overview of the most recent information concerning iron metabolism, iron bioavailability and iron overload/deficiency related diseases. The relation between iron and cardiovascular risk, in iron overload and in iron deficiency situations, is also examined. Finally, strategies to modify dietary iron bioavailability in order to prevent iron deficiency or alleviate iron overload are suggested.

Major diet-drug interactions affecting the kinetic characteristics and hypolipidaemic properties of statins

Concomitant administration of statins with food may alter statin pharmacokinetics or pharmacodynamics, increasing the risk of adverse reactions such as myopathy or rhabdomyolysis or reducing their pharmacological action. This paper reviews major interactions between statins and dietary compounds. Consumption of pectin or oat bran together with Lovastatin reduces absorption of the drug, while alcohol intake does not appear to affect the efficacy and safety of Fluvastatin treatment. Grapefruit juice components inhibit cytochrome P-4503A4, reducing the presystemic metabolism of drugs such as Simvastatin, Lovastatin and Atorvastatin. Follow-up studies on the therapeutic effect of statins in patients consuming a Mediterranean-style diet are necessary to assure the correct prescription because the oil-statin and minor oil compound-statin possible interactions have been only briefly studied. Preliminary study suggests that olive oil can increase the hypolipaemiant effect of Simvastatin with respect sunflower oil. The consumption of polyunsaturated rich oils, throughout the cytochrome P- 450 activation could decrease the half-life of some statins and therefore their hypolipaemic effects. The statins and n-3 fatty acids combined therapy gives rise to pharmacodinamic interaction that improves the lipid profile and leads greater cardioprotection. Although statins are more effective in high endogenous cholesterol production subjects and plant sterols are more effective in high cholesterol absorption efficacy subjects, plant esterols-statins combined therapy generates very positive complementary effects. This review ends suggesting possible diet-stain interactions that require further investigations (e.g. types of olive oils, fruit juices other than grapefruit, fibre or consumption of alcoholic beverages rich in polyphenols or ethanol).

Postprandial lipaemia and endothelial adhesion molecules in pre- and postmenopausal Spanish women

BACKGROUND

Postprandial hyperlipaemia is an independent risk factor for atherosclerosis.

OBJECTIVES

To compare postprandial lipaemia and fasting adhesion molecules levels in healthy young premenopausal(PrW) and postmenopausal (PoW) Spanish women.

SUBJECTS AND METHODS

Twenty healthy PrW and 18 healthy PoW participated in a postprandial 7-hour intervention study. All participants were given a fat-rich standard meal (11.8% saturated, 39.7% monounsaturated, and 6.6% polyunsaturated) after a 12 h fast. Blood samples were taken at baseline and at 60, 120, 240, 360 and 420 min after eating. Triacylglycerols (TAG), total cholesterol (Chol), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular adhesion molecule-1 (sVCAM-1) were determined in fasting serum samples and TAG and total Chol postprandial levels were measured.

RESULTS

Anthropometric data, serum lipid and sICAM-1 presented significant higher values in PoW compared to PrW, but sVCAM-1 did not significantly differ between groups. Postprandial TAG and Chol concentrations in PoW were significantly higher than in PrW (p < 0.0001). There was a significant time influence (p < 0.0001) in TAG in PrW and PoW, while time to peak and peak concentration were significantly higher in PoW than PrW. Chol concentrations showed a significant reduction after 1 h, to reach values similar to baseline after 6 h in PrW but not in PoW.

CONCLUSIONS

Lipid postprandial response to a fat rich meal and soluble intercellular adhesion molecules concentrations indicate a higher cardiovascular risk pattern in postmenopausal compared to premenopausal women. Soluble vascular adhesion molecule levels seem to be influenced not only by age and menopause, but also other factors like usual diet.

N-3 fatty acids in glucose metabolism and insulin sensitivity

Polyunsaturated fatty acids (PUFA) of the n-3 series are essential for normal growth and development. The health effects of these fatty acids include reduction of cardiovascular risk due to antiarrhythmic, antiinflammatory, anti-thrombotic and lipid lowering actions. An increase in unsaturation of the muscle membrane fatty acids is associated with improved insulin sensitivity. Higher proportion of n-3 fatty acids may have beneficial roles, such as antiobesity effects and protection against the metabolic syndrome and type 2 diabetes mellitus through a number of metabolic effects. However, controversy exists on the different effects of n-6 and n-3 polyunsaturated fatty acids as well as on the interacting effect of dietary saturated and monounsaturated fat. In addition, some adverse effects have been described concerning the use of fish oil supplements containing high doses of n-3 fatty acids. Several studies show Eskimos diabetes risk, while results of nutritional interventions on the influence of consuming diets rich in oily fish or other food rich in n-3 fatty acids is very limited. This article reviews the possible mechanisms through which n-3 PUFA are involved in glucose level control and insulin sensitivity. Intervention and epidemiological studies together with recent findings on the nutrigenomic field related with this subject are also briefly reviewed.

[Usefulness and controversial issues of middle-chain fatty acids consumption on lipid-protein metabolism and obesity]

Middle-chain fatty acids (MCFA) contain 6-12 carbon atoms and are digested, absorbed and metabolized differently than long-chain fatty acids (LCFA). This work reviews some of the potential and real utilities of MCFA and their role on health. For this reason, they are used in enteral and parenteral nutrition because of their good absorption, and in premature-feeding milk-based formulas in order to improve calcium absorption. MCFA have become particularly important because of their possible role in treating and preventing obesity. Since they are more water soluble, they are taken-up by chylomicrons, and it is believed that they do not directly participate in lipogenesis. They are able to increase the thermogenic effect of foods, and its metabolism increases the production of ketonic agents with the subsequent anorexigenic effect. However, high doses of MCFA are required to obtain significant effects on weight reduction. The effects on lipid-protein metabolism are controversial. So, although they seem to reduce the post-prandial triglyceridemic response, the results their effects are not uniform regarding triglyceridemia and cholesterolemia. In spite of this, more and more products are being designed incorporating MCFA to treat obesity and overweight, having been considered as "GRAS" (Generally Recommended as Safe") components by the ADA. Further long-term studies are needed to warrant the usefulness of consumption of these compounds, particularly in the treatment and prevention of obesity.

A comparative study of iron bioavailability from cocoa supplemented with ferric pyrophosphate or ferrous fumarate in rats

BACKGROUND

Food iron fortification can be a good strategy to prevent iron deficiency. Iron bioavailability from cocoa powder enriched with ferric pyrophosphate encapsulated in liposomes or ferrous fumarate was assessed in rats.

METHODS

Three groups of rats consumed during 28 days either a control diet or two diets prepared with ferric pyrophosphate- or ferrous fumarate-enriched cocoa powder as the unique source of iron. Body weight and food intake were monitored and last-week feces were collected. On day 28, animals were sacrificed and livers and spleens were removed. Hemoglobin and total iron binding capacity (TIBC) were determined.

RESULTS

There were no significant differences in body weight and food intake. Apparent iron absorption and % absorption/intake were significantly lower in rats consuming enriched cocoa compared to the control group, without significant differences due to the iron form. Enriched cocoa groups showed significantly lower spleen iron content and concentration than the control. Liver iron was lower in the ferric pyrophosphate group compared to the other two groups. Hemoglobin and TIBC values showed a deficient iron status in ferric pyrophosphate rats.

CONCLUSION

Cocoa powder is a good vehicle for iron fortification when enriched with ferrous fumarate compared to ferric pyrophosphate encapsulated in liposomes.

[Nutrition and dietary recommendations for the elderly "Public Health" Working Group of the Spanish Nutrition Society]

With the increase of life expectancy, the desire to maintain good health, functionality and maximum quality of life at advanced ages, for which nutrition plays a critical role, is a priority for the elderly. Though genetic factors are a determinant of life expectancy, there are several extrinsic factors which have a great influence on the quality of life of the elderly. Diet and nutritional status have a great influence, especially in the prevention and treatment of several diseases, which affect this heterogeneous and vulnerable age group. The nutritional status and needs of elderly people are associated with age-related biological, psychological and often socio-economic changes. All of these changes can increase the risk of developing a number of age-related diseases. In developed countries the elderly are the most affected by malnutrition, either because of a deficiency (energy and several nutrients) or an excess, leading to obesity and related diseases. This review highlights the most important factors affecting nutritional status in elderly people and focus on the need to maintain adequate physical activity level and an optimal physic, psychic and social functional capacity. It discusses dietary reference intakes and guidelines to improve and/or maintain adequate nutritional status in older people in order to reduce susceptibility to some illness and disease.

Silicon, aluminium, arsenic and lithium: essentiality and human health implications

Ultratrace elements are currently being studied to determine their nutritional significance and impact on health, taking into account their possible toxic effects. Some elements are essential to one or more specific biological functions in humans while other are nonessential. Nevertheless, the latter may produce desirable pharmacological effects or, on the contrary, possess harmful properties which depend on the inherent toxic potential of the element, the amount ingested and the intrinsic characteristics of the individual. This review updates the information on the essentiality and toxicological aspects of silicon, aluminium, arsenic, and lithium and considers the involvement's in degenerative diseases, such as cardiovascular diseases, osteoporosis and Alzheimer's disease. Silicon and lithium are protective while aluminium and arsenic have toxic effects.

Magnesium and trace elements in the elderly: intake, status and recommendations

Imbalances between mineral intakes and recommended amounts have been observed in different groups of elderly subjects. Nevertheless, assessment of the status of magnesium and trace elements in the elderly is difficult, even for iron because infection and inflammation increases ferritin. Mineral bioavailability may change due to ageing. Therefore, formulation of mineral recommendations is complex and individual recommendations are sometimes necessary. A number of surveys show magnesium, zinc, selenium and chromium intakes by old persons to be lower than the corresponding reference nutrient intakes. Contrarily, intakes of iron are generally adequate or higher than recommended, and it has been suggested that increased storage of iron in the elderly may be related with the development of age-related diseases through the increase in oxidative stress. Low iron status together with iron excess may be common in an elderly population. The same applies for zinc. Magnesium and selenium deficiencies among the elderly are also well documented, especially among the institutionalised and people with pathologies. Chromium deficiency is associated with type II diabetes mellitus. Recommended iron intake is lower for elderly women compared to young, because menstruation ceases after menopause, but in old men, it is similar to that of young men. Dietary Reference Values for the rest of the elements are similar to those of adults, although several suggestions have been made about the quantities. This review examines various aspects of the changes in mineral bioavailability due to ageing, of data published on mineral intakes and status, and finally the dietary recommendations for this vulnerable population group.

Does processing of a powder or in-bottle-sterilized liquid infant formula affect calcium bioavailability?

Processing of infant formulas can induce Maillard reaction or lactose isomerization, among other changes. These reactions were evaluated with furosine and lactulose, respectively. Protein alteration was assessed with sodium dodecylsulfate-polyacrylamide gel electrophoresis. Repercussions on calcium bioavailability in powder and in-bottle-sterilized liquid infant formulas were studied. Lactulose, advanced Maillard-reaction products, and denatured proteins were higher in liquid infant formula. After in vitro digestion, soluble non-dialyzed calcium was significantly higher in liquid than in powder infant formula, but there were no differences in dialyzed insoluble calcium. Two-week-old rat pups drank the powder or liquid infant formula for 7 d. Food intake and final body weight were significantly lower in those fed liquid formula. Accordingly, the intake, apparent absorption, and retention of calcium were measured; the percentages of retention versus absorption and retention versus intake were significantly lower, although calcium digestibility (percentage of absorption versus intake) was higher. These results show that, although calcium in the sterilized infant formula was available in vitro and was absorbed more efficiently in vivo, it was poorly used by suckling rats. The low acceptability of this formula and the interaction of calcium with lactulose and advanced but absorbable Maillard-reaction products might explain the results. Thus, for calcium bioavailability, we recommend the powder instead of the conventional sterilized infant formula.

Selected trace elements and minerals in cord blood: association with lipids and lipoproteins at birth

Recent studies have found that some minerals are associated with lipoprotein metabolism, peroxidation and coronary heart disease. The present study was designed to obtain information on the relationship between the concentrations of minerals and trace elements and those of lipids, lipoproteins and apolipoproteins (Apo) in cord blood. Seventy-nine healthy singleton normoweight full-term newborns without foetal distress according to Apgar scores were studied. The quartile distribution of neonates, according to serum concentrations of the different minerals studied, displayed significant differences in lipid values between infants in the lowest and highest quartiles of: magnesium, for HDL-cholesterol, Apo A-I, Apo B and the HDL-cholesterol/Apo A-I ratio; iron, for HDL-cholesterol and the HDL-cholesterol/Apo A-I ratio; copper, for triglycerides and the LDL-cholesterol/Apo B ratio. With the exception of calcium, several significant correlations were found between the minerals and trace elements and the lipids, Apo and lipoproteins tested.

Relationship between moderate food restriction during pregnancy and Fe, Zn and Cu contents in maternal tissues and foetuses

This study was undertaken to monitor Fe, Zn and Cu contents in several maternal tissues and the products of conception of rats submitted to moderate food restriction during pregnancy. Two groups of female rats, nonpregnant (NP) and pregnant (P1), were fed ad libitum. A second group of pregnant rats (restricted diet, P2) was fed for 14 days with the same intake as NP, then the intake was increased by 5% from day 14 to day 21. A significant decrease in liver Fe content was noted in P1 and P2 pregnant rats on day 21, being more marked in livers of P2. Increases in Cu and Zn contents in liver were induced during pregnancy, but the values were significantly lower in P2 than in P1. On day 21, no significant differences due to food restriction were noted in serum concentrations of these trace elements, placental weight and placental Fe. However, dam body weight gain, placental Zn and Cu contents were reduced in P2. Foetuses of undernourished dams exhibited at term lower weight and smaller amounts of Fe, Zn and Cu than those in P1. These results confirm that moderate food restriction during pregnancy produces intrauterine growth retardation and that newborns have low trace element contents (particularly in Cu), which make them dependent on correct postnatal supply.

Iron metabolism in rats consuming oil from fresh or fried sardines

The influence of the consumption of diets containing oil from either fresh sardines or fried sardines, under domestic conditions, on the dietary iron metabolism of rats has been investigated. Three groups of rats were fed, over 28 d, semipurified diets containing 8% of: olive oil (OO), fresh sardine (Clupea pilchardus) oil (SO) and oil from sardines previously fried in olive oil (FSO). Body mass and food intake were monitored and, during the periods 5-12 d and 21-28 d, faeces and urine were collected. At the end of the experiment, the animals were killed and blood, liver, spleen and a segment of skin were stored. Food intake and body mass decreased markedly in the SO rats. These parameters were slightly increased in the FSO group compared with OO. Iron absorption and retention were lower in SO than in OO or FSO. This was primarily caused by the poor food intake but also by the lower efficiency of absorption and high urinary Fe losses. Liver and spleen iron contents were reduced by half in SO compared with the other groups, partly owing to the smaller size of the organs, and liver Fe concentration also decreased. These results, together with the high total iron binding capacity, the decreased level of hemoglobin and total erythrocytic iron found in the SO animals, indicate that the consumption of fresh sardine oil as the only dietary fat resulted in iron depletion. The SO animals showed a higher Fe accumulation in skin than OO or FSO. It was concluded that a diet high in sardine fatty acid administered as a unique source of fat, can cause metabolic alterations including iron depletion, but these negative effects of sardine oil disappear with frying, probably owing to the exchange that takes place between fatty acids in the olive oil used in frying and those in the sardine oil.

Influence of moderate food restriction on calcium metabolism in pregnant rats

Two groups of female rats, non-pregnant (NP) and pregnant (P1), were fed ad libitum. A second group of pregnant rats (restricted diet, P2) were restricted for 14 d to the same intake as NP, and their ration was then increased by 5% from d 14 to d 21. For the first 3 d P1 and P2 absorbed a higher percentage of calcium than NP. During the final wk of pregnancy serum calcium decreased and 1,25-dihydroxycholecalciferol increased regardless of the dietary regimen. In both P1 and P2, femur calcium was higher than in NP on d 7 and apparent bone density increased during the 2nd wk of pregnancy and decreased from then on, this decrease being more pronounced in P2. On d 21, P2 fetuses were smaller and contained a smaller amount of calcium than those in P1, although the calcium concentration in the body remained similar in both groups of fetuses.

[Pregnant rats consuming diets with uncooked and fried olive oil, mineral levels in their offspring and changes in their body storage levels]

Some parameters relating nutritional utilization of Ca, Mg, Fe and Zn were studied in rats fed with diets including raw and fried fats in order to study more in depth the diet fat/mineral utilization interaction. Wistar rats having initial weights of 176 g were divided into two groups and fed isocaloric diets having 15% fat content as raw olive oil and fried olive oil (from 15 potato fryings), during pregnancy. Weight and dietary intake were controlled and mineral content changes in plasma, liver, spleen and carcass were assessed, as well as litter mineral uptake. Throughout the study, dietary intake of pregnant rats fed raw (R) and fried oil (F), body weight gain and final weight gain were similar. Serum Fe, Zn and Ca levels decreased at a similar rate in both groups. Liver Fe levels decreased more in the F group while spleen Fe decreased more in the R group, these changes started on day 18. Liver Zn levels did not show clear changes but spleen Zn decreased during the last three days of pregnancy. Carcass Ca levels of pregnant rats from the R and F groups did not show any differences at the end of pregnancy. Body weight gain, Ca, Mg, Fe and Zn uptake of the litter were similar in both groups throughout the study. The placentas and the offspring of treated rats showed similar absolute and relative mineralization values. These findings lead us to conclude that fried olive oil retained the same characteristics as raw olive oil regarding mineral utilization.

Several aspects of mineral/protein nutrition in relation to consumption of an oil involved in the toxic syndrome

An oil involved in the 'toxic syndrome' and two similar mixtures of oils, one with and the other without added oleoanilides, were studied for their effects on the utilization of protein, calcium, magnesium, phosphorus, sodium, potassium and zinc. Forty-eight female Wistar rats initially weighing about 75 g were fed for 28 days on the same semi-synthetic diet containing: virgin olive oil, or a mixture of canbra oil (50%), refined olive-pomace oil (20%), grapeseed oil (20%) and animal fat (10%), or the same dietary mixture supplemented with either 700 ppm oleoanilides or the alleged toxic oil. Weight, food intake and nutritional balances were monitored. The food intake of the animals fed the toxic oil began to decrease at the end of the trial, producing a reduction in the amount of nutrients ingested, but no weight loss. This oil also negatively affected the digestion of protein, potassium, sodium and zinc, the mechanism of which, in the case of the first two, appears to be related to the source of the fat. It also decreased metabolic utilization while favouring protein catabolism and the elimination of phosphorus, magnesium and potassium. No substantial modifications were noted in the animals' bones.

Effects of consuming toxic oils and oleoanilides on fat digestibility and adipose tissue composition of rats

An oil implicated in the Spanish "toxic syndrome" was studied for its effect on fat digestibility and adipose-tissue composition in rats. The effects produced by the mixture of oils and those induced by the presence of oleoanilides were assessed separately. For 4 wk, Wistar rats were fed diets containing either a mixture of oils similar to that constituting the toxic oil, the same mixture of oils supplemented with oleoanilides, or the toxic oil (which also contained oleoanilides) and were then compared with a group fed olive oil. Food consumption fluctuated sharply in the group fed the toxic oil, falling significantly in the last week of the study. The digestibility coefficient of the various fats was similar, although the rats fed the toxic oil did absorb less fat because of the lower intake. The nitrogen content of the periovarian adipose tissue was highest in the rats fed the toxic oil, and the adipose-tissue fatty acids most affected by this treatment were linoleic and linolenic acid. The delta-9 desaturase activity, measured in terms of the C16:1/C16:0 and C18:1/C18:0 ratios, was significantly less in the group fed the toxic oil, which suggests functional modifications of the adipocyte related to lipogenesis.

[Impact of alcohol consumption on the mineral composition of the body in the rat]

The influence of consumption of increasing ethanol solutions of 5, 7.5 and 10%/99.5% (v/v), on total body mineral composition, but particularly the ethanol effect on the contents of Ca, P, Mg, Zn, Na and K, for eight weeks was studied in the adult rat. Both females and males voluntarily lower their liquid intake when daily ethanol ingestion is about 1.4 and 1.7 g, respectively. These ethyl ingestions introduce some modifications in male body composition, but not in females, with an increase in the relative water content and a decrease of the carcass dry substance. The latter would be the main reason for the decrease in male body content of Ca, P, Zn, Mg and K, at least from the 7.5% v/v solution. Ca, P and Zn seem to be the most modified elements. Likewise, there are negative influences regarding Na, but they are not clearly evidenced until ethanol consumption reaches 1.9 g per day. Female body weight did not undergo any change, under any tested experimental conditions or their body ashes suffer any deterioration.