Postprandial lipid and vascular responses following consumption of a commercially-relevant interesterified palmitic acid-rich spread in comparison to functionally-equivalent non-interesterified spread and spreadable butter: a randomised controlled trial in healthy adults

Background: Interesterification is an industrial processing technique used widely where hard fats are essential for functionality and consumer acceptability, e.g. margarines and lower fat spreads. Objective: The aim of this study was to compare acute cardiovascular effects of functionally equivalent spreads (similar solid fat content) made with interesterified (IE) or non-IE palm-based fats, or spreadable butter. Methods: A randomised, controlled, 4-armed crossover, double-blind study (25 men, 25 women; 35-75 years; healthy; mean BMI 24.5, SD 3.8), compared effects of mixed nutrient meals containing 50 g fat from functionally equivalent products [IE spread, non-IE spread and spreadable butter (SB), with rapeseed oil (RO) as a reference treatment: with 16.7%, 27.9%, 19.3% and 4% palmitic acid, respectively] on 8 h postprandial changes in plasma triacylglycerol (TAG) and endothelial dysfunction (flow-mediated dilatation; FMD). Circulating reactive oxygen species (estimated using a neutrophil oxidative burst assay), glucose, insulin, NEFA, lipoprotein particle profiles, inflammatory markers (glycoprotein acetylation (Glyc-A) and IL-6), and biomarkers of endotoxemia were measured. Results: Postprandial plasma TAG concentrations after test meals were similar. However following RO versus the 3 spreads, there were significantly higher postprandial apolipoprotein B concentrations, and small HDL and LDL particle concentrations, and lower postprandial extra-large, large, and medium HDL particle concentrations, as well as smaller average HDL and LDL particle sizes. There were no differences following IE compared to the other spreads. Postprandial FMD% did not decrease after high-fat test meals, and there were no differences between treatments. Postprandial serum IL-6 increased similarly after test meals, but RO provoked a greater increase in postprandial concentrations of glycoprotein acetyls (GlycA), as well as 8 h sCD14, an endotoxemia marker. All other postprandial outcomes were not different between treatments. Conclusions: In healthy adults, a commercially-available IE-based spread did not evoke a different postprandial triacylglycerol, lipoprotein subclass, oxidative stress, inflammatory or endotoxemic response to functionally-equivalent, but compositionally-distinct alternative spreads. Clinical trial registry number: NCT03438084 (https://ClinicalTrials.gov).

Exploration of the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes working in UK healthcare-The Shift-Diabetes Study: A qualitative study using the theoretical domains framework

AIM

To identify factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings.

METHODS

Semi-structured qualitative interviews based on the theoretical domains framework (TDF) were conducted with a convenience sample (n = 15) of shift workers (32-59 years) diagnosed with T2D who worked night shifts as part of a mixed shift schedule. The TDF was applied to analyse transcripts using a combined deductive framework and inductive thematic analysis approach. Identified influences were mapped to the behaviour change technique taxonomy to identify potential strategies to change dietary behaviour in this context.

RESULTS

Key barriers to healthy dietary behaviours were access and cost of food available during night work (TDF domain: Environment Context and Resources). Factors identified as both enablers and barriers included: availability of staff facilities and time to take a break, (Environment Context and Resources), the physical impact of night work (Beliefs About Consequences), eating in response to stress or tiredness (Emotion), advance planning of meals/food and taking own food to work (Behavioural Regulation). Potential techniques to address these influences and improve dietary behaviour in this context include: meal planning templates, self-monitoring and biofeedback, and increasing accessibility and availability of healthier food choices during night shifts.

CONCLUSIONS

The dietary behaviour of shift workers with T2D is influenced by interacting individual, socio-cultural and environmental factors. Intervention should focus on environmental restructuring and strategies that enable monitoring and meal planning.

Individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes working in UK healthcare: A cross-sectional survey

BACKGROUND

The present study aimed to understand the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings.

METHODS

A cross-sectional study was conducted using data collected from an anonymous online survey. Participant agreement was measured using five-point Likert scale (strongly disagree to strongly agree) against 38 belief statements informed by the Theoretical Domains Framework (TDF) of behaviour change.

RESULTS

From the complete responses (n = 119), 65% worked shifts without nights, 27% worked mixed shift rota including nights and 8% worked only night shifts. The statements ranked with the highest agreements were in the TDF domains: Environment Context/Resources (ECR) - mainly identified as a barrier to healthy eating, Behaviour Regulation (BR) and intention (IN) - identified as enablers to healthy eating. For the belief statement 'the available options for purchasing food are too expensive' (ECR), 80% of night workers and 75% non-night workers agreed/strongly agreed. Taking their own food to work to prevent making unhealthy food choices (BR) had agreement/strong agreement in 73% of non-night and 70% night workers; 74% non-night workers and 80% of night workers agreed/strongly agreed with the statement 'I would like to eat healthily at work' (IN). Mixed shift workers agreed that following dietary advice was easier when working a non-night compared to a night shift (p = 0.002).

CONCLUSIONS

Access and affordability of food were identified as important determinants of dietary behaviour during shifts. The findings support interventions targeting the food environment for shift workers with T2D.

Towards targeted dietary support for shift workers with type 2 diabetes (Shift-Diabetes study): A mixed-methods case study protocol

BACKGROUND

Blood glucose is higher in people working night shifts compared to day workers. Changes to eating behaviour, activity and sleep patterns in addition to circadian disruption are likely to impact glucose management in night-shift workers with type 2 diabetes.

AIM

To investigate current dietary intake and glucose variability during night work, including barriers and facilitators to dietary behaviour in this context.

METHODS

A mixed-methods case study will be conducted. Shift workers with type 2 diabetes working in a hospital setting will be recruited to this two-part study. Part 1: 70 participants will complete a 10-day observational study collecting data on continuous glucose, diet (self-report diary), sleep and physical activity during a period covering night work, rest days and non-night workdays. Mean glucose concentration and variability, and the mean healthy diet index score, will be compared between days of night work, non-night work and rest, after adjusting for other individual factors (sleep/physical activity/demographics). Part 2: A sample (n~13) will complete semi-structured interviews based on behavioural science frameworks to explore barriers/enablers to dietary behaviour when working night shifts. This will inform a quantitative survey to explore the generalisability of interview findings.

DISCUSSION

Findings from Part 1 and 2 will be triangulated to identify potential intervention strategies to address key barriers and enablers to healthier eating, and in turn improved glucose control, in shift workers with type 2 diabetes. This will be facilitated through stakeholder consultation and application of behavioural science frameworks. Shift-Diabetes study registration: ISRCTN11764942.

No Difference in Lipemic Response or Endothelial Function Following Interesterified and Non-Interesterified Functionally Equivalent Fats: A Randomized Controlled Trial

Objectives

Interesterified (IE) fats are now used as hard fats to replace harmful trans fats, however the cardiometabolic health impact of the most commonly consumed IE fat blends are unknown. The InterCardio study (NCT03438084) investigated the effect of the most commonly consumed IE spread versus functionally equivalent hard fats and a control oil, on postprandial lipemia (PPL) and acutely changing markers of endothelial function.

Methods

A four-armed, double blind, randomized controlled trial in healthy males and females (n = 50) aged 35–75 years compared sequential test meals (0 h; 897 kcal, 50 g fat, 16 g protein, 88 g carbohydrate, 5 h; 550 kcal, 30 g fat, 15 g protein, 39 g carbohydrate) on postprandial plasma triacylglycerol (TG) concentrations, endothelial function (flow mediated dilation (FMD)), plasma nitrite concentrations and NADPH oxidase activity. Test fats were: a commercially available IE spread, a functionally equivalent non-IE spread, spreadable butter (SB), and a high-MUFA oil (rapeseed oil) as control. Melt curve data for the spreadable fats showed similar solid fat content at 37°C (IE; 0.3%, non-IE; 0.4%, SB; 0%). Blood was collected at fasting and regular intervals up to 8 hrs, and FMD was measured at fasting, 4.5 hrs and 7.5 hrs.

Results

All 4 test fats increased TG levels postprandially, reaching peak concentrations at 6 hrs. There was no significant treatment or treatment x time effects on plasma TAG concentrations (P = 0.684), nor incremental areas under the curves up to 4 and 8 hrs; mean iAUC0–8 h (95% CI) were 5.4 mmol/L.h (4.3, 6.4) for IE spread, 5.7 mmol/L.h (4.3, 6.8) for non-IE spread, 5.5 mmol/L.h (4.0, 7.0) for SB and 5.9 mmol/L.h (4.3,6.8) for rapeseed oil. There were no significant treatment effects on endothelial function, while nitrite concentrations and NADPH oxidase activity reduced postprandially. Mean NAPDH oxidase activity following IE spread, non-IE spread, SB and rapeseed oil at 6 h were 322, 333, 270, and 268 respectively.

Conclusions

In the first study to investigate the acute effects of commercially relevant IE and non-IE spreads and SB, we report no adverse effect of IE fats on acutely changing cardiometabolic risk factors relative to a high-MUFA reference oil. The similar effects on endothelial function and postprandial lipemia is likely to be due to their similar solid fat content at body temperature.

Funding Sources

BBSRC.

Snacking on whole almonds for 6 weeks improves endothelial function and lowers LDL cholesterol but does not affect liver fat and other cardiometabolic risk factors in healthy adults: the ATTIS study, a randomized controlled trial

BACKGROUND

There is convincing evidence that daily whole almond consumption lowers blood LDL cholesterol concentrations, but effects on other cardiometabolic risk factors such as endothelial function and liver fat are still to be determined.

OBJECTIVES

We aimed to investigate whether isoenergetic substitution of whole almonds for control snacks with the macronutrient profile of average snack intakes, had any impact on markers of cardiometabolic health in adults aged 30-70 y at above-average risk of cardiovascular disease (CVD).

METHODS

The study was a 6-wk randomized controlled, parallel-arm trial. Following a 2-wk run-in period consuming control snacks (mini-muffins), participants consumed either whole roasted almonds (n = 51) or control snacks (n = 56), providing 20% of daily estimated energy requirements. Endothelial function (flow-mediated dilation), liver fat (MRI/magnetic resonance spectroscopy), and secondary outcomes as markers of cardiometabolic disease risk were assessed at baseline and end point.

RESULTS

Almonds, compared with control, increased endothelium-dependent vasodilation (mean difference 4.1%-units of measurement; 95% CI: 2.2, 5.9), but there were no differences in liver fat between groups. Plasma LDL cholesterol concentrations decreased in the almond group relative to control (mean difference -0.25 mmol/L; 95% CI: -0.45, -0.04), but there were no group differences in triglycerides, HDL cholesterol, glucose, insulin, insulin resistance, leptin, adiponectin, resistin, liver function enzymes, fetuin-A, body composition, pancreatic fat, intramyocellular lipids, fecal SCFAs, blood pressure, or 24-h heart rate variability. However, the long-phase heart rate variability parameter, very-low-frequency power, was increased during nighttime following the almond treatment compared with control (mean difference 337 ms2; 95% CI: 12, 661), indicating greater parasympathetic regulation.

CONCLUSIONS

Whole almonds consumed as snacks markedly improve endothelial function, in addition to lowering LDL cholesterol, in adults with above-average risk of CVD.This trial was registered at clinicaltrials.gov as NCT02907684.

Almonds Improve Endothelial Function and Lower LDL Cholesterol, But Do Not Affect Liver Fat in Adults at Moderate Risk of Cardiovascular Disease: A Randomized Controlled Trial

Objectives

The ATTIS study aimed to investigate whether substituting almonds for typical snacks (high in refined starch, free sugars and saturated fats, and low in fibre) influenced cardiometabolic risk factors. Primary outcomes, endothelial function and liver fat, were measured in healthy adults aged 30–70 y who were habitual snackers and at moderate risk of developing cardiovascular disease (CVD). It was hypothesized that snacking on almonds would improve endothelial function and decrease liver fat.

Methods

Following a 2-week run-in period consuming control snacks, a 6-week parallel arm trial was conducted where participants were randomized to isoenergetic treatments: 1) control snacks (mini-muffins) replicating an average snack nutrient profile, calculated from snack foods identified in 4-d food diaries from a national dietary intake database, or 2) dry-roasted whole almonds, providing 20% estimated energy requirement. Endothelial function (via flow-mediated dilation (FMD)); abdominal subcutaneous and visceral fat, and liver, muscle and pancreatic fat (via MRI/MRS); day- and night-time heart rate variability (HRV) and 24 h ambulatory blood pressure (ABP); blood biomarkers of insulin sensitivity and lipid profile; and fecal short chain fatty acids (SCFA) were assessed at baseline and endpoint. A total of 107 participants (75 F, 32 M; mean age 56.2 y, SD 10.4) were randomized and 105 subjects completed the trial.

Results

Almonds significantly increased FMD (mean difference 4.1%, 95% CI 2.2, 5.9), the long-phase HRV index, night-time very-low frequency power (mean difference 337 ms2, 95% CI 12, 661) and plasma oleic acid levels (mean difference 228 μmol, 95% CI 7, 449) relative to control adjusted for baseline BMI and baseline dependent outcome values, but there were no treatment differences in ABP and subcutaneous, visceral, liver, muscle and pancreatic fat. Plasma LDL cholesterol levels were significantly decreased by almonds (mean difference −0.25 mmol/L, 95% CI −0.45, −0.04), but no differences were found in other blood lipids, insulin sensitivity, nor fecal SCFA levels.

Conclusions

These novel findings suggest almonds may be cardioprotective by increasing availability of nitric oxide and improving cardiac autonomic function, in addition to their well-established LDL cholesterol-lowering properties.

Funding Sources

Almond Board of California.

[Isolated resection of the caudate lobe in metastasis of colorectal cancer]

The presence of metastatic lesions confined to the caudate lobe (CL or segment I) is quite a rare event. Even more rare is the decision to perform an isolate CL resection. Segmental resection in the liver is justified by the evidence that primary and secondary lesions, in early stage, are confined to the originating segment, and therefore a segmentectomy can be considered for the CL as well. Anatomy of the CL was deeply studied through the years since the surgical approach to this liver segment requires a detailed knowledge of its surgical anatomy and only after 1985 the surgical technique for CL isolate resection was established. We report our experience with 1 case of isolate colo-rectal metastasis confined to the caudate lobe and describe the surgical technique employed.

Superselective intra-arterial radiometabolic therapy with I-131 lipiodol in hepatocellular carcinoma

Superselective transcatheter arterial radioembolization with radioiodinated lipiodol and gelatin sponges was evaluated in 11 patients with nodular hepatocellular carcinoma. Thirteen tumor nodules were treated using 3-5 ml of lipiodol labeled with 259 to 2220 MBq of I-131 followed by gelatin sponge with the following results: 1) there was elevated uptake in 12 tumor nodules with high tumor-to-background ratios: 2) there was excellent clinical tolerance to the treatment (stable cirrhosis in 5 patients and cirrhosis progression in 2 cases); 3) there was good disease control with size reduction in five tumor lesions (41%) and no increase in seven lesions (59%) followed for 2 years; 4) there was a 2-year survival rate of 70%; and 5) three deaths due to hepatic failure at 2, 3, and 20 months after therapy. Superselective arterial radioembolization with I-131 lipiodol is a useful palliative approach to inoperable hepatocarcinoma, providing long-term local control without severe complications in the progression of cirrhosis.

[Chronic splenic tuberculosis. Description of a case]

The authors report a case of chronic splenic tuberculosis. They underline the diagnostic difficulties, notwithstanding the remarkable progresses in radiological technics, essentially related to the rarity of this tubercular site and they outlined the exact surgical indication to the splenectomy.