Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in Prospective Urban and Rural Epidemiology study: prospective cohort study

OBJECTIVE

To evaluate the association between intakes of refined grains, whole grains, and white rice with cardiovascular disease, total mortality, blood lipids, and blood pressure in the Prospective Urban and Rural Epidemiology (PURE) study.

DESIGN

Prospective cohort study.

SETTING

PURE study in 21 countries.

PARTICIPANTS

148 858 participants with median follow-up of 9.5 years.

EXPOSURES

Country specific validated food frequency questionnaires were used to assess intakes of refined grains, whole grains, and white rice.

MAIN OUTCOME MEASURE

Composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios were estimated for associations of grain intakes with mortality, major cardiovascular events, and their composite by using multivariable Cox frailty models with random intercepts to account for clustering by centre.

RESULTS

Analyses were based on 137 130 participants after exclusion of those with baseline cardiovascular disease. During follow-up, 9.2% (n=12 668) of these participants had a composite outcome event. The highest category of intake of refined grains (≥350 g/day or about 7 servings/day) was associated with higher risk of total mortality (hazard ratio 1.27, 95% confidence interval 1.11 to 1.46; P for trend=0.004), major cardiovascular disease events (1.33, 1.16 to 1.52; P for trend<0.001), and their composite (1.28, 1.15 to 1.42; P for trend<0.001) compared with the lowest category of intake (<50 g/day). Higher intakes of refined grains were associated with higher systolic blood pressure. No significant associations were found between intakes of whole grains or white rice and health outcomes.

CONCLUSION

High intake of refined grains was associated with higher risk of mortality and major cardiovascular disease events. Globally, lower consumption of refined grains should be considered.

Association between intake of white rice and incident type 2 diabetes - An updated meta-analysis

AIMS

Meta-analyses on the association between white rice intake and incident type 2 diabetes (T2D) have been inconsistent. Since the last meta-analysis, more studies have been published with inconsistent results. We aimed to examine the rice-T2D association in Asian populations in an updated meta-analysis.

METHODS

We systematically searched the Medline and Embase databases between January 2012 (the date of the first meta-analysis) and December 2020 for prospective studies examining T2D risk and baseline rice intake. Random-effects models were applied to pool relative risks (RRs). Meta regression analyses were used to evaluate the influence of sex.

RESULTS

Six articles with eleven comparisons in Asian countries were included in the current meta-analysis. A total of 12,395 incident T2D cases were ascertained from 256,818 participants. The pooled RR was 1.25 (95% confidence interval [CI]: 1.17-1.33) comparing extreme categories of rice intake with higher heterogeneity (I² = 88%, P < 0.0001). When stratified by sex, the RR was 1.58 (1.26-1.99) among women and 1.30 (0.85-1.98) among men (P-interaction = 0.42).

CONCLUSIONS

A positive association between rice intake and incident T2D in Asian populations was found, especially among women.

Retained Rice Cake: A Unique Upper Gastrointestinal Foreign Body: Case Report and a Literature Review

As a rarely recognized foreign body in the upper gastrointestinal tract, rice cake frequently requires endoscopic removal. We herein report six patients with characteristic sonography, computed tomography (CT), spectroscopy, endoscopy, and histological findings. A review of all published cases, including ours, revealed that retained rice cake in the stomach typically shows the following: abdominal pain (93.3%), mucosal injury (93.3%) with bleeding (42.9%); high-density (120-206 Hounsfield units) CT findings; and indication for endoscopy (80%). In the esophagus, hot, toasted rice cake causes thermal injury. Primary physicians should be aware of this popular-food-induced, but rare, disorder.

Rice Consumption and Subclinical Lung Disease in US Adults: Observational Evidence From the Multi-Ethnic Study of Atherosclerosis

Rice accumulates arsenic, an established lung toxicant. Little is known about the association of rice consumption with arsenic-related health effects, particularly interstitial lung disease. Between 2000 and 2002, 6,814 white, black, Hispanic, and Chinese adults from 6 US cities were enrolled in the Multi-Ethnic Study of Atherosclerosis. We included 2,250 participants who had spirometry data, 2,557 with full-lung computed tomography (CT) scans, and 5,710 with cardiac CT scans. Rice consumption and 310 participants with urinary arsenic were assessed at baseline. Spirometry and full-lung CT-derived measures of total lung capacity and high attenuation area (HAA), and interstitial lung abnormalities were measured at examination 5. Cardiac CT-derived HAA was measured at 1-3 visits. Twelve percent of participants reported eating at least 1 serving of rice daily. Comparing data between that group with those who ate less than 1 serving weekly, the mean difference for forced vital capacity was -102 (95% confidence interval (CI): -198, -7) mL, and for forced expiratory volume in 1 second was -90 (95% CI: -170, -11) mL after adjustment for demographics, anthropometrics, dietary factors, and smoking. The cross-sectional adjusted percent difference for total lung capacity was -1.33% (95% CI: -4.29, 1.72) and for cardiac-based HAA was 3.66% (95% CI: 1.22, 6.15). Sensitivity analyses for urinary arsenic were consistent with rice findings. Daily rice consumption was associated with reduced lung function and greater cardiac-based HAA.

Ryzophagia secondary to PCOS -related menorrhagia

We report the peculiar case of a patient who consumed raw rice daily and had iron-deficiency anaemia secondary to menorrhagia with underlying polycystic ovarian syndrome. A 32-year-old lady of Asian descent presented with symptoms of fatigue, lethargy and prolonged, irregular periods for the last two months. There was noticeable increase in body weight, male pattern alopecia and facial acne. In addition, she experienced sudden, unexplained predilection towards consumption of raw rice (up to 300- 400g/day). The patient was treated with oral iron and cyclical progestin. After three weeks, her haemoglobin improved and her ryzophagia subsided. Gynaecologists should be vigilant of pica, which can occur outside of the context of pregnancy and also poses potential health risks including tooth attrition, electrolyte imbalance, intestinal obstruction and poisoning.

Infants' dietary arsenic exposure during transition to solid food

Early-life exposure to inorganic arsenic (i-As) may cause long-lasting health effects, but as yet, little is known about exposure among weaning infants. We assessed exposure before and during weaning and investigated the association between solid food intake and infants' urinary arsenic species concentrations. Following the recording of a comprehensive 3 day food diary, paired urine samples (pre- and post-weaning) were collected and analyzed for arsenic speciation from 15 infants participating in the New Hampshire Birth Cohort Study. Infants had higher urinary i-As (p-value = 0.04), monomethylarsonic acid (MMA) (p-value = 0.002), dimethylarsinic acid (DMA) (p-value = 0.01), and sum of arsenic species (i-As + MMA + DMA, p-value = 0.01) during weaning than while exclusively fed on a liquid diet (i.e., breast milk, formula, or a mixture of both). Among weaning infants, increased sum of urinary arsenic species was pairwise-associated with intake of rice cereal (Spearman's ρ = 0.90, p-value = 0.03), fruit (ρ = 0.70, p-value = 0.03), and vegetables (ρ = 0.86, p-value = 0.01). Our observed increases in urinary arsenic concentrations likely indicate increased exposure to i-As during the transition to solid foods, suggests the need to minimize exposure during this critical period of development.

Postprandial glycaemic response of foxtail millet dosa in comparison to a rice dosa in patients with type 2 diabetes

BACKGROUND & OBJECTIVES

Millets are rich source of dietary fibre and non-starchy polysaccharides with low glycaemic index (GI), hence can be used as a therapeutic diet. This study was conducted to estimate the effects of a millet-based dosa (foxtail dosa) compared to a rice dosa for breakfast on postprandial glucose levels in patients with type 2 diabetes mellitus (T2DM).

METHODS

The GI of rice dosa and foxtail millet dosa was estimated. A total of 105 T2DM participants were randomly selected for the study. The participants were on oral hypoglycaemic agents (OHA) and not on insulin. In this study, each individual served as their own control and experimental group. The postprandial increase in blood glucose was compared after a breakfast of rice dosa and millet dosa. Single and paired t test was used to note the change in blood glucose levels and the level of the significance.

RESULTS

The GI of foxtail millet dosa was 59.25 and rice dosa was 77.96. There was a significant reduction (P<0.001) in the postprandial glucose level of patients who consumed a millet-based dosa when compared to those who consumed a rice-based dosa. No significant reduction was observed in the fasting glucose levels.

INTERPRETATION & CONCLUSIONS

The results suggested that replacing a rice-based breakfast item with a millet-based breakfast item lowers the postprandial blood glucose levels in T2DM patients. Thus, millets may have a protective role in the management of hyperglycaemia. Further studies need to be done in a systematic manner to confirm these findings.

Health risk assessment of heavy metals through the consumption of food crops fertilized by biosolids: A probabilistic-based analysis

The objective of this study was to perform a probabilistic risk analysis (PRA) to assess the health risk of Cadmium (Cd), Copper (Cu), and Zinc (Zn) through the consumption of food crops grown on farm lands fertilized by biosolids. The risk analysis was conducted using 8 years of historical heavy metal data (2005-2013) of the municipal biosolids generated by a nearby treatment facility considering one-time and long-term biosolids land application scenarios for a range of 5-100 t/ha fertilizer application rate. The 95th percentile of the hazard index (HI) increased from 0.124 to 0.179 when the rate of fertilizer application increased from 5 to 100 t/ha at one-time biosolids land application. The HI at long-term biosolids land application was also found 1.3 and 1.9 times greater than that of one-time land application at fertilizer application rates of 5 and 100 t/ha, respectively. Rice ingestion had more contribution to the HI than vegetable ingestion. Cd and Cu were also found to have more contribution to the health risk associated to vegetable and rice ingestion, respectively. Results indicated no potential risk to the human health even at long-term biosolids land application scenario at 100 t/ha fertilizer application rate.

Rice consumption and risk of cardiovascular disease: results from a pooled analysis of 3 U.S. cohorts

BACKGROUND

Health concerns have been raised about rice consumption, which may significantly contribute to arsenic exposure. However, little is known regarding whether habitual rice consumption is associated with cardiovascular disease (CVD) risk.

OBJECTIVE

We examined prospectively the association of white rice and brown rice consumption with CVD risk.

DESIGN

We followed a total of 207,556 women and men [73,228 women from the Nurses' Health Study (1984-2010), 92,158 women from the Nurses' Health Study II (1991-2011), and 42,170 men from the Health Professionals Follow-Up Study (1986-2010)] who were free of CVD and cancer at baseline. Validated semiquantitative food-frequency questionnaires were used to assess consumption of white rice, brown rice, and other food items. Fatal and nonfatal CVD (coronary artery disease and stroke) was confirmed by medical records or self-reports.

RESULTS

During 4,393,130 person-years of follow-up, 12,391 cases of CVD were identified. After adjustment for major CVD risk factors, including demographics, lifestyle, and other dietary intakes, rice consumption was not associated with CVD risk. The multivariable-adjuted HR of developing CVD comparing ≥5 servings/wk with <1 serving/wk was 0.98 (95% CI: 0.84, 1.14) for white rice, 1.01 (0.79, 1.28) for brown rice, and 0.99 (0.90, 1.08) for total rice. To minimize the potential impact of racial difference in rice consumption, we restricted the analyses to whites only and obtained similar results: the HRs of CVD for ≥5 servings/wk compared with <1 serving/wk were 1.04 (95% CI: 0.88, 1.22) for white rice and 1.01 (0.78, 1.31) for brown rice.

CONCLUSIONS

Greater habitual consumption of white rice or brown rice is not associated with CVD risk. These findings suggest that rice consumption may not pose a significant CVD risk among the U.S. population when consumed at current amounts. More prospective studies are needed to explore these associations in other populations.

Food protein-induced enterocolitis syndrome to trivial oral mucosal contact

Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E (IgE)-mediated gastrointestinal food hypersensitivity, mostly in infants. Patients usually present very ill and often misdiagnosed as acute gastroenteritis, sepsis, ileus, metabolic disorders, necrotizing enterocolitis, or severe gastroesophageal reflux disease. We present a case of an infant who had three acute FPIES episodes: the first was at 5 months of age after chewing on a cellophane wrapper, the second was due to sweet potato, and the third was due to rice cereal. It was realized that in the first episode, the wrapper was covering a rice cake. Evaluation at 7 months of age, while asymptomatic, showed normal complete blood count, low serum immunoglobulin E level, and negative allergy skin prick tests, indicating non-IgE sensitivity. Conclusion This case of FPIES has peculiar features in that it occurred in an exclusively breastfed infant and by non-ingestant oral contact with a trivial quantity of rice allergen.

A comparison of spider communities in Bt and non-Bt rice fields

To assess the potential adverse effects of a Bt rice line (Japonica rice cultivar, Nakdong) expressing a synthetic cry1Ac1 gene, C7-1-9-1-B, which was highly active against all larval stages of Cnaphalocrocis medinalis (Guenée) (Lepidoptera: Crambidae), we investigated the community structure of spiders in Bt and non-Bt rice fields during the rice-growing season in 2007 and 2008 in Chungcheongnam-do, Korea. Spiders were surveyed with a sweep net and suction device. Suction sampling captured more spiders, measured in terms of species level and abundance, than sweeping. Araneidae and Thomisidae were captured more by sweeping, and certain species were captured only by sweeping. These findings show that both suction and sweep sampling methods should be used because these methods are most likely complementary. In total, 29 species in 23 genera and nine families were identified from the 4,937 spiders collected, and both Bt and non-Bt rice fields showed a typical Korean spider assemblage. The temporal patterns of spider species richness and spider abundance were very similar between Bt and non-Bt rice, although significant differences in species richness were observed on a few occasions. Overall, spider community structure, including diversity, the dominant species, and abundance did not differ between Bt and non-Bt rice. The results of the study indicated that the transgenic Cry1Ac rice lines tested in this study had no adverse effects on the spider community structure of the rice fields.

Infants with FPIES to solid food proteins--chicken, rice and oats

We present two cases of Food Protein Induced Enterocolitis Syndrome (FPIES), a non-IgE mediated food hypersensitivity. FPIES induces severe vomiting 1.5-to-3 hours post ingestion of the offending food, and may be associated with diarrhoea, hypovolemic shock and acidosis. Avoidance of that food will lead to resolution of symptoms and prevents further episodes.

Evaluation of seasonal dietary exposure to arsenic, cadmium and lead in schoolchildren through the analysis of meals served by public schools of Ribeirão Preto, Brazil

Dietary exposure to arsenic (AS), cadmium (Cd), and lead (Pb) of Brazilian schoolchildren living in Ribeirão Preto, Brazil, was assessed. Food samples including rice, beans, vegetables, fruits, and meat served daily by public schools were collected as presented in different seasons. Metallic elements were determined by inductively coupled plasma-mass spectrometry (ICP-MS).The main sources of As, Cd, and Pb were found to be rice, vegetables, and pork, respectively. Further, in some food types there were seasonal differences in the concentrations of metallic elements. The mean daily intakes of As, Cd, and Pb based upon the association between food consumption data and the observed concentrations of metals in their diet were 6.9 μg, 0.9 μg, and 0.6 μg for As, Cd, and Pb, respectively. These findings are below the toxicological reference values provided by the European Food Safety Authority (EFSA) and the World Health Organization (WHO).

Development and systematic oxidative stress of a rat model of chronic bronchitis and emphysema induced by biomass smoke

BACKGROUND

Epidemiological research and meta-analyses of published data have shown that biomass smoke (BS) is a risk factor for chronic obstructive pulmonary disease (COPD). However, the link between BS and COPD lacks experimental confirmation.

OBJECTIVES

To verify whether BS can induce pathologic changes and systemic oxidative stress, which may be relevant to the development of emphysema and chronic bronchitis in rats.

METHODS

Rats were exposed to BS, cigarette smoke (CS), or clean air (sham) for 14 weeks. During the exposure, the O2, SO2, and CO levels were monitored. Pathological changes in the lungs, systemic oxidative stress, and inflammation biomarkers, together with GSTM1 and GSTP1 mRNA expression in the lung were measured. The glutamate-cysteine ligase catalytic subunit (GCLC) protein expression in the lung was measured using immunohistochemistry and western blotting.

RESULTS

The O2, CO, and SO2 levels were 20.31 ± 0.03%, 981.72 ± 64.76, and 2.59 ± 0.26 mg/m(3) for the BS group, respectively, while their levels in the CS group were 20.28 ± 0.15%, 745.56 ± 30.83, and 12.64 ± 0.591 mg/m(3) respectively. As with the rats exposed to CS, the BS rats showed an increased number of inflammatory cells in the bronchoalveolar lavage fluid, an increased pulmonary mean linear intercept and a decreased pulmonary mean alveolar number. Characteristics of chronic bronchitis and peribronchial fibrosis were also found in the BS-exposed rat lungs. Reduced body weight, systemic oxidative stress, and increased GCLC protein expression in the lungs were observed in the rats exposed to BS and CS.

CONCLUSIONS

BS can cause emphysema and chronic bronchitis similar to that caused by CS, which is accompanied by systemic oxidative stress and inflammation.

Identification of an abundant 56 kDa protein implicated in food allergy as granule-bound starch synthase

Rice, the staple food of south and east Asian counties, is considered to be hypoallergenic. However, several clinical studies have documented rice-induced allergy in sensitive patients. Rice proteins with molecular weights of 14-16, 26, 33, and 56 kDa have been identified as allergens. Recently, it was documented that the 56 kDa rice allergen was responsible for rice-induced anaphylaxis. The 14-16 kDa allergens have been identified as α-amylase inhibitors; the 26 kDa protein has been identified as α-globulin; and the 33 kDa protein has been identified as glyoxalase I. However, the identity of the 56 kDa rice allergen has not yet been determined. In this study, we demonstrate that serum from patients allergic to maize shows IgE binding to a 56 kDa protein that was present in both maize and rice but not in the oil seeds soybean and peanut. The 56 kDa IgE-binding protein was abundant in the rice endosperm. We have purified this protein from rice endosperm and demonstrated its reactivity to IgE antibodies from the serum of maize-allergic patients. The purified protein was subjected to matrix-assisted laser desorption ionization-time of flight-tandem mass spectrometry analysis, resulting in identification of this rice allergen as granule-bound starch synthase, a product of the Waxy gene. Immunoblot analysis using protein extracts from a waxy mutant of rice revealed the absence of the 56 kDa IgE-binding protein. Our results demonstrate that the 56 kDa rice allergen is granule-bound starch synthase and raise the possibility of using waxy mutants of rice as a potential source of the hypoallergenic diet for patients sensitized to the 56 kDa rice allergen.

A case of rice allergy in a patient with baker's asthma

A case of rice allergy in a patient with bakers asthma is described. On ISAC 112 IgE reactivity to wheat alpha-amylase/trypsin inhibitor (nTri a aA_TI) and lipid tranfer protein (rTri a 14) was found. We hypothesize that the reaction by oral ingestion was elicited by homologous molecules in rice seeds.

Chemical composition, nutritional and toxicological evaluation of rice (Oryza sativa) grown in fly ash amended soils

BACKGROUND

The purpose of the present study was to evaluate nutritional and toxicological aspects of rice grown in fly ash amended soils. Rice was grown on soils with fly ash (200 t ha(-1) ) and without fly ash at two different geographical locations of India.

RESULTS

One kilogram each of 36 samples randomly collected from three replicates of rice grown with and without fly ash was subjected to various analytical techniques to determine the nutrient composition, mineral and heavy metal content. Moisture, protein and ash content of the rice samples showed no difference between fly ash treated and controls. Similar observations were also made on trace and heavy elements. Further, the rice grown on soils treated with fly ash was incorporated in the diet at 90% level and was fed to Wistar/NIN rats for 26 weeks for carrying out protein and toxicological evaluation.

CONCLUSION

Results indicated that there is no difference between rice samples grown in soils with or without fly ash. Studies also clearly indicated that there were no adverse effects on hematological, biochemical or histopathological parameters when rice was fed to rats for 6 months. This indicates that rice grown on fly ash treated soils may be safe for human consumption.

White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review

OBJECTIVES

To summarise evidence on the association between white rice consumption and risk of type 2 diabetes and to quantify the potential dose-response relation.

DESIGN

Meta-analysis of prospective cohort studies.

DATA SOURCES

Searches of Medline and Embase databases for articles published up to January 2012 using keywords that included both rice intake and diabetes; further searches of references of included original studies.

STUDY SELECTION

Included studies were prospective cohort studies that reported risk estimates for type 2 diabetes by rice intake levels.

DATA SYNTHESIS

Relative risks were pooled using a random effects model; dose-response relations were evaluated using data from all rice intake categories in each study.

RESULTS

Four articles were identified that included seven distinct prospective cohort analyses in Asian and Western populations for this study. A total of 13,284 incident cases of type 2 diabetes were ascertained among 352,384 participants with follow-up periods ranging from 4 to 22 years. Asian (Chinese and Japanese) populations had much higher white rice consumption levels than did Western populations (average intake levels were three to four servings/day versus one to two servings/week). The pooled relative risk was 1.55 (95% confidence interval 1.20 to 2.01) comparing the highest with the lowest category of white rice intake in Asian populations, whereas the corresponding relative risk was 1.12 (0.94 to 1.33) in Western populations (P for interaction=0.038). In the total population, the dose-response meta-analysis indicated that for each serving per day increment of white rice intake, the relative risk of type 2 diabetes was 1.11 (1.08 to 1.14) (P for linear trend<0.001).

CONCLUSION

Higher consumption of white rice is associated with a significantly increased risk of type 2 diabetes, especially in Asian (Chinese and Japanese) populations.

Assessing dietary exposure to cadmium in a metal recycling community in Vietnam: age and gender aspects

This study estimates the dietary exposure to cadmium (Cd), and associated potential health risks, for individuals living and working in a metal recycling community (n=132) in Vietnam in comparison to an agricultural (reference) community (n=130). Individual-level exposure to Cd was estimated through analysis of staple foodstuffs combined with information from a food frequency questionnaire. Individual-level exposure estimates were compared with published 'safe' doses to derive a Hazard Quotient (HQ) for each member of the study population. Looking at the populations as a whole, there were no significant differences in the diets of the two villages. However, significantly more rice was consumed by working age adults (18-60 years) in the recycling village compared to the reference village (p<0.001). Rice was the main staple food with individuals consuming 461±162g/d, followed by water spinach (103±51kg/d). Concentrations of Cd in the studied foodstuffs were elevated in the metal recycling village. Values of HQ exceeded unity for 87% of adult participants of the metal recycling community (39% had a HQ>3), while 20% of adult participants from the reference village had an HQ>1. We found an elevated health risk from dietary exposure to Cd in the metal recycling village compared to the reference community. WHO standard of 0.4mg Cd/kg rice may not be protective where people consume large amounts of rice/have relatively low body weight.

Maternal exposure to high levels of dioxins in relation to birth weight in women affected by Yusho disease

BACKGROUND

Studies on the association of maternal exposure to polychlorinated dibenzo-p-dioxin (PCDDs), polychlorinated dibenzofurans (PCDFs), and polychlorinated biphenyls (PCBs) with decreased birth weight in humans have produced conflicting results. In Japan in 1968, an accidental human exposure to rice oil contaminated with PCDDs, PCDFs, and PCBs, led to the development of Yusho disease.

OBJECTIVE

The Yusho cohort was used to evaluate the effect of maternal exposure to PCDDs, PCDFs, and PCBs on birth weight.

METHODS

Blood samples, obtained from 101 Yusho women (190 births) who gave birth after exposure, were analyzed for congeners of seven PCDDs, ten PCDFs, and four non-ortho PCBs.

RESULTS

Total PCDD TEQ (adjusted beta=-161.9g; 95% CI, -265.3 to -58.6), total PCDF TEQ (adjusted beta=-105.9g; 95% CI, -179.5 to -32.2), and total non-ortho PCBs (adjusted beta=-178.4g; 95% CI, -318.3 to -38.5) levels were inversely associated with birth weight. Significant inverse associations with birth weight were also found for total PCDD TEQ, total PCDF TEQ, and total non-ortho PCB TEQ levels among male, but not female, infants. Significant inverse associations with birth weight were also found for nine congeners among all infants; the adjusted beta coefficients were largest for 1,2,3,6,7,8-HxCDD and smallest for 2,3,4,7,8-PeCDF.

CONCLUSION

In the setting of exposure to high levels of dioxins, maternal blood levels of PCDDs, PCDFs and PCBs are associated with lower birth weight in Yusho patients. The association exhibited gender-specific differences, as male infants are more susceptible than females to growth restriction induced by in utero dioxin exposures.

Dietary intake of cadmium from Bangladeshi foods

Human exposure to cadmium (Cd) is associated with various diseases and high levels of Cd have been detected in Bangladeshi population warranting further research to identify the source of this exposure. In this study, Cd levels in 327 and 94 samples of Bangladeshi food and non-food samples, respectively, were determined using inductively coupled plasma mass spectrometry. This is the largest number of Bangladeshi food and nonfood samples investigated for their Cd content. High Cd levels were detected in leafy vegetables (mean 31 [SD 29]μg/kg). Of these vegetables, lal shak (Amaranthus tricolor) contained the highest Cd level (303 μg/kg [wet weight]; mean 100.5 [SD 95]μg/kg). Bangladeshi rice also showed significant concentration of Cd (mean 37.2 [SD 30]μg/kg). Of particular concern is the very high level of Cd detected in some puffed rice, which we attribute to the illegal practice of using urea for whitening the puffed rice. Tobacco leaves, which are commonly consumed during betel quid chewing by Bangladeshis, contain significant levels of Cd (mean 95 [SD 87]μg/kg). The total daily intake (TDI) of Cd from foods for Bangladeshis was estimated to be 34.55 μg/d. This is rather high when compared to the TDI of Cd for other populations. Our analysis reveals that this is mainly due to the very high intake of rice and vegetables, and lower consumption of animal products (which are low in Cd), by the Bangladeshis. We also determined the provisional maximum tolerable daily intake and target hazard quotients values for Cd. Clearly a more balanced diet is necessary to reduce the Cd intake in the Bangladeshi population, especially by reducing the very high intake of rice and certain leafy vegetables. Food manufacturing and agricultural practices needs to be altered to reduce the entry of Cd into the food chain.

PRACTICAL APPLICATION

Exposure to high levels of Cd can be harmful to human health and this study provides a comprehensive analysis of Cd levels in a variety of food items from Bangladesh. The findings are of particular importance to consumers of Bangladeshi foods in both Bangladesh and in other countries. Data obtained will be valuable resources for food safety and regulatory bodies as our study suggests entry of Cd in foods through use of illegal chemicals in food manufacturing processes.

A transgressive brown rice mediates favourable glycaemic and insulin responses

BACKGROUND

We evaluated glycaemic response of a brown rice variant (BR) developed by cross-breeding. Subjects (n = 9) consumed 50 g carbohydrate equivalents of BR, white rice (WR) and the polished brown rice (PR) in comparison to 50 g glucose reference (GLU) in a cross-over design. Plasma glucose and insulin at 0, 15, 45, 60, 90, 120 and 180 min were measured and incremental area under the curve (IAUC) and indices for glucose (GI) and insulin (II) calculated.

RESULTS

BR compared to PR or WR produced the lowest postprandial glycaemia (GI: 51 vs 79 vs 86) and insulinaemia (II: 39 vs 63 vs 68) irrespective of amylose content (19 vs 23 vs 26.5%). Only BR was significantly different from GLU for both plasma glucose (P = 0.012) and insulin (P = 0.013) as well as IAUC(glu) (P = 0.045) and IAUC(ins) (P = 0.031). Glycaemic and insulinaemic responses correlated positively (r = 0.550, P < 0.001). Linear trends for IAUC(glu) and IAUC(ins) indicated a greater secretion of insulin tied in with a greater glycaemic response for WR (r(2) = 0.848), moderate for PR (r(2) = 0.302) and weakest for BR (r(2) = 0.122).

CONCLUSION

The brown rice variant had the lowest GI and II values but these advantages were lost with polishing.

Effects of genetically modified T2A-1 rice on faecal microflora of rats during 90 day supplementation

BACKGROUND

Many animal studies have been performed on products with the Bacillus thuringiensis insecticidal toxin-encoding gene (Bt products), but less have focused on its effects on intestinal microflora owing to difficulties in culturing. This 90 day study was designed to assess unintended effects of genetically modified T2A-1 rice (GMR) on selected intestinal bacteria (Lactobacillus group, Bifidobacterium genus, Escherichia coli subgroup, Enterococcus genus and Clostridium perfringens) of rats by the real-time polymerase chain reaction (PCR) method.

RESULTS

During the whole experiment, no statistically significant differences in the numbers of specific bacteria and total bacteria were found between the GMR group and its parental group. At all stages of the experiment the two main probiotics (Lactobacillus group and Bifidobacterium genus) in faeces accounted for 11-23% of the total bacteria, whereas the conditional pathogens (E. coli subgroup, Enterococcus genus and C. perfringens) made up less than 1% of the total bacteria. B/E (log(10) copies of Bifidobacterium genome g(-1) faeces/log(10) copies of E. coli genome g(-1) faeces) ratios from 1.19 to 1.34 were obtained. Furthermore, significant correlations (P < 0.01) between the real-time PCR method and the plate count method were found, with r values ranging from 0.60 to 0.75.

CONCLUSION

No adverse effects on the numbers of specific bacteria in rat faeces were observed as a result of GMR feeding. The real-time PCR method is recommended in further studies on the composition and dynamics of the intestinal bacteria community for better safety assessment of GM materials.

Rice cake ileus--a rare and ethnic but important disease status in east-southern Asia

INTRODUCTION

Rice cake is a traditional but very popular food in Asia including Japan and has never been known as a cause of ileus. Rice cake is now becoming widespread in the United States and European countries along with other Japanese foods. We may encounter rice cake ileus all over the world. This study was aimed at characterizing the rice cake ileus.

METHODS

We consecutively encountered 14 patients with rice cake ileus from April 2003 to October 2010 in our hospital. All of the characteristics of the cases were reviewed and analyzed.

RESULTS

All patients had ingested rice cake by swallowing without chewing. It has most frequently occurred in January (57.1%). The main symptoms were abdominal colicky pain (100%) and nausea (85.7%) and physical findings included abdominal tenderness (100%) and muscular defense (28.6%). All patients improved by conservative therapy including fluid supply (100%), naso-gastric tube (28.6%) and long tube (28.6%) insertion. No patient needed emergency open surgery.

CONCLUSION

Rice cake ileus which is caused by swallowing the rice cake without chewing, frequently occurs in January, has previous history of abdominal surgery and shows high density intestinal contents on CT and only needs conservative therapy. Globalism in food culture may provide a new disease entity. Therefore, we should be aware of this type of ileus and be prepared to manage it appropriately.

Acarbose reduces the risk of pre-lunch hypoglycemia in elderly people with diabetes eating rice porridge for breakfast

To decrease the risk of postprandial hyperglycemia and late hypoglycemia in elderly people with diabetes who eat rice porridge for breakfast, we administered 50mg acarbose to 30 elderly people with type 2 diabetes. The results demonstrated that acarbose could prevent the fluctuations in post-breakfast blood glucose levels.

Lack of correlation between cadmium level in local brown rice and renal failure mortality among the residents: a nation-wide analysis in Japan

OBJECTIVES

Cadmium is a ubiquitous hazardous element with nephro-toxicity after long-term exposure. The present study was initiated to examine possible effects of dietary cadmium (Cd) intake on health of local residents across Japan. For this purpose, Cd in locally harvested brown rice (Cd-BR) was taken as the parameter of Cd exposure, and two measures of mortality, i.e., standardized mortality ratio (SMR) and age-adjusted renal insufficiency mortality rate (AARIMR) were employed as parameters of over-all health effects including effects on kidney.

METHODS

Japan consists of 47 prefectures. Data on Cd in 37,250 brown rice samples harvested in 1997-1998 in the 47 prefectures were made available from the Ministry of Agriculture, Forestry and Fisheries, Japan. SMR and AARIMR data (for the year 2000) by two genders in the 47 prefectures were cited from publications of the Ministry of Health, Labour and Welfare, Japan. Possible correlation of Cd in brown rice (Cd-BR) with SMR and AARIMR was examined by Poisson regression analysis.

RESULTS

The geometric mean (GM) Cd-BR for Japan as a whole was 0.040 mg/kg with a geometric standard deviation (GSD) of 2.72. Prefectural GM values varied from a low of <0.01 mg/kg to a high of 0.089 mg/kg. Nevertheless, SMR (in a range of 89.9-119.5 for men and 87.1-111.7 for women) did not correlate with Cd-BR significantly. AARIMR (in a range of 5.3-11.9 and 3.2-8.4 for men and women, respectively) tended to decrease as a function of increasing Cd-BR both in men and women, although the correlation was insignificant in both genders.

CONCLUSIONS

No evidence was obtained in the present analysis to suggest that either mortality as a whole or the mortality due to renal failure is affected by dietary intake of Cd in rice.

[Primary investigation on metabolism of hpt gene in transgenic rice modified with cowpea trypsin inhibitor gene in rats]

OBJECTIVE

The metabolism characteristic in the gastrointestinal tract and possibility of transfer from gastrointestinal tract into liver and kidney was investigated.

METHODS

48 SD rats were allotted into 8 subgroups randomly, 6 groups rats of them were fed with transgenic rice diets and 2 groups rats were fed with non-transgenic rice diets. All rats were fed with transgenic and non-transgenic rice for two weeks. All rats were fast and sacrificed, the contents of stomach, jejunum, the lower part of ileum, cecum and rectum were taken out at 2, 4, 6, 8, 10 and 24 hours respectively after eating final diets. Fed two groups of SD rats with transgenic diet and non-transgenic rice diet respectively for 4 weeks, the liver and kidney were sampled and stored. All samples was examined by PCR.

RESULTS

The fragment of hpt was found the was only detected in stomach and jejunum, but none of the five fragments was detected in the lower part of ileum, cecum and rectum. The degradation of hpt was time-relationship and long-length fragment relationship, the longer was the action time, the more serious was the degradation. Foreign hpt gene was not detected in liver and kidney.

CONCLUSION

hpt gene was easy to degraded in gastrointestinal tract and was not detectable in hepatic tissue and nephridial tissues.

Rice (Oryza sativa) allergy in rhinitis and asthma patients: a clinico-immunological study

Sensitization to foods varies in different countries reflecting a possible interaction of genetic factors, cultural and dietary habits. Rice is a major food consumed world wide and needs evaluation for IgE mediated reactions. The present study was carried out to identify rice allergy in patients of rhinitis and asthma and identify the allergenic proteins in raw and cooked rice. Of 1200 patients screened using standard questionnaire, 165 presented with history of rice allergy. Of these, 20 (12.1%) patients demonstrated marked positive skin prick test (SPT) and 13 showed significantly raised specific IgE to rice compared to normal controls. Double blind placebo controlled food challenge (DBPCFC) confirmed rice allergy in 6/10 patients. Immunoblot with hypersensitive individual patients' sera showed 14-16, 33, 56 and 60 kDa proteins as major IgE-binding components in rice. Boiled rice retained four IgE reactive proteins of 16, 23, 33 and 53 kDa. In summary, IgE-mediated rice allergy affects 0.8% [(0.42-1.58) at 95% CI] of asthma and rhinitis cases. The subjects with severe SPT reactions (4 mm or above) and specific IgE, 6.9 ng/ml to rice demonstrated positive blinded food challenge with clinical symptoms.

Wild rice, hypoallergenic rice--immunologic comparison

Rice is a cereal that is mainly produced and widely consumed in Asian countries including Korea. Several reports have suggested a role of IgE-mediated hypersensitivity in asthma and eczema associated with ingestion or inhalation of rice. In Japan, hypoallergenic rices are used for a substitute of common rice in some atopic patients. We performed this study to identify major allergens of rice and changed allergenicity in cooked and hypoallergenic rice. We purified crude extracts from a variety of rice and analyzed their protein distributions by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Based on UniCAP test and skin-prick test, we selected sera with high sensitivity and analyzed specific IgE binding to rice by immunoblotting. In addition, the inhibition rate among some rice was determined by enzyme linked immunosorbent assay and CAP test. As the result of this study, rice with various origins and polishing levels had no difference in protein band pattern. After cooking, it was difficult to detect protein bands distributed in raw rice; and, even through IgE immunoblot analysis, it was impossible to differentiate between wild and hypoallergenic rice. In addition, both wild and hypoallergenic rice still had IgE binding activity on their remaining protein bands. In conclusion, almost all proteins of rice were excluded or weakened in the process of boiling and IgE binding activity still remained even in hypoallergenic rice.

Efficacy and safety of Monascus purpureus Went rice in subjects with hyperlipidemia

OBJECTIVE

The purpose of this study was to assess the lipid-lowering effect of Monascus purpureus Went rice on serum lipids in patients with hyperlipidemia, and to assess its safety by reporting adverse events and clinical laboratory measurements.

DESIGN AND METHODS

This was a randomized, double-blind, placebo-controlled study. In all, 79 patients (aged 23-65 years) with a mean baseline low-density lipoprotein cholesterol (LDL-C) level of 5.28 mmol/l (203.9 mg/dl) received a twice daily dose of placebo or Monascus purpureus Went rice (600 mg) for 8 weeks.

RESULTS

At week 8, Monascus purpureus Went rice therapy reduced LDL-C by 27.7%, total cholesterol by 21.5%, triglycerides by 15.8% and apolipoprotein B by 26.0%. High-density lipoprotein cholesterol and apolipoprotein A-I levels were increased by 0.9 and 3.4% respectively (not significant). No patient in the Monascus purpureus Went rice treatment group had an alanine aminotransferase (ALT), aspartate aminotransferase (AST) or creatine phosphokinase (CPK) measurement that was > or = 3 times the upper limit of normal at week 4 and week 8.

CONCLUSION

Monascus purpureus Went rice significantly reduced LDL-C, total cholesterol, triglycerides and apolipoprotein B levels, and was well tolerated in patients with hyperlipidemia. However, this study only provides data from an 8-week trial and long-term safety and efficacy data are needed.

Difficulty in defecation in infants with gastroesophageal reflux treated with smaller volume feeds thickened with rice cereal

We prospectively evaluated the incidence of difficulty in defecation in infants with gastroesophageal reflux who were treated with smaller volume feeds thickened with rice cereal and also assessed the effect of changing the cereal to oatmeal. We evaluated 53 thriving infants with uncomplicated gastroesophageal reflux who were treated with smaller volume feeds thickened with rice cereal. Parents maintained records of bowel movements for 7 days. Rice was substituted by oatmeal cereal in those infants developing difficulty in defecation and another 7 days' record was kept. Of the 53 infants enrolled, 34 (64%) reported no difficulty in defecation, 8 (15%) reported mild difficulty, and 11 (21%) reported severe difficulty in defecation during rice-based feedings. In these symptomatic 19 infants, after rice was substituted by oatmeal cereal, 10 infants (52.6%) reported no symptoms, 6 (31.6%) had mild symptoms, and 3 (15.8%) continued to have severe symptoms. We conclude that difficulty in defecation is common during treatment of infants with gastroesophageal reflux with smaller volume feeds thickened with rice cereal. Substitution of rice with oatmeal cereal results in partial or complete resolution of symptoms in most of these infants.

Food protein-induced enterocolitis syndrome: case presentations and management lessons

Enterocolitis induced in infants by cow's milk and/or soy protein has been recognized for decades. Symptoms typically begin in the first month of life in association with failure to thrive and may progress to acidemia and shock. Symptoms resolve after the causal protein is removed from the diet but recur with a characteristic symptom pattern on re-exposure. Approximately 2 hours after reintroduction of the protein, vomiting ensues, followed by an elevation of the peripheral blood polymorphonuclear leukocyte count, diarrhea, and possibly lethargy and hypotension. The disorder is generally not associated with detectable food-specific IgE antibody. There are increasing reports of additional causal foods, prolonged clinical courses, and onset outside of early infancy, leading to description of a food protein-induced enterocolitis syndrome. The disorder poses numerous diagnostic and therapeutic challenges. The purpose of this report is to delineate the characteristic clinical features and review the possible pathophysiologic basis to frame a rational strategy toward management.

Rice-induced enterocolitis in an infant: TH1/TH2 cellular hypersensitivity and absent IgE reactivity

BACKGROUND

Although food allergy is common in children, rice allergy is unusual in Western cultures.

OBJECTIVE

To report a case of T-cell-mediated rice intolerance in an 11-month-old girl.

METHODS

To evaluate the intolerance to rice in this patient, a graded rice food challenge was performed. To examine the immunologic reactivity to rice, in vitro lymphoproliferative responses and cytokine synthesis of rice-stimulated peripheral blood lymphocytes (PBLs) was performed. Subsequently, skin patch testing to rice and other foods was performed.

RESULTS

Allergy skin prick test results were negative for rice and positive for egg, milk, and soy. Specific IgE antibodies to rice, egg, peanut, wheat, walnut, codfish, milk, soybean, corn, shrimp, scallops, and clams were undetectable. Results of a single-blind rice food challenge were positive, manifested by emesis that persisted for more than an hour and required intravenous hydration. In vitro lymphoproliferation by the patient's PBLs to rice stimulation was positive. In addition, cytokine synthesis of interferon-gamma, interleukin 10 (IL-10), tumor necrosis factor a, and IL-5 by the patient's rice-stimulated PBLs was elevated, indicating a TH1/TH2 cell response to rice. Endoscopy revealed normal esophageal, gastric, and duodenal mucosa; a biopsy specimen revealed mild esophagitis. Duodenal explant T cells were initially established by stimulation with rice and IL-2. After a 2-day rest, the lymphocytes were restimulated with rice for 7 days and revealed increased interferon-gamma and IL-5 synthesis. Twenty billion colony forming units of Lactobacillus GG were added to the patient's diet twice daily. After 6 weeks, rice rechallenge resulted in emesis within 1 hour. Results of patch testing were positive to rice, wheat, and barley but negative to soy, which the patient tolerated on food challenge.

CONCLUSIONS

Although this patient did not demonstrate IgE antibody to rice, TH1/TH2 cell-mediated responses to rice were detected, and the patient experienced significant morbidity. Patch testing for gastrointestinal food allergies may be useful when the food specific IgE antibody is negative. Probiotic therapy in this patient did not ameliorate her sensitivity to rice, and food elimination remains the only reliable treatment for TH1/TH2-mediated food hypersensitivity.

Carbohydrate-induced hypertriglyceridaemia among West Indian diabetic and non-diabetic subjects after ingestion of three local carbohydrate foods

BACKGROUND AND OBJECTIVE

Studies suggest that the link between postprandial hyperglycaemia and cardiovascular risk in type 2 diabetes mellitus might be related to postprandial hypertriglyceridaemia and the increased levels of the highly atherogenic small and dense low density lipoprotein (LDL) particles. In this study we therefore aimed to determine which of the three popular carbohydrate foods has the highest potential of increasing postprandial triglyceride levels in type 2 diabetic patients and in healthy non diabetic individuals.

METHODS

All subjects were studied on three different occasions seven days apart after an overnight fast. On each day of study, anthropometric indices were measured and after collecting fasting blood sample, subjects consumed bread, roti or rice within 10 min and water taken as wished. Subsequently, 7 ml of venous blood samples were collected at 60, 90, 120 and 150 min for insulin, glucose and lipids determinations.

RESULTS

The diabetic and non diabetic healthy subjects had similar baseline body mass index, insulin, triglyceride, total and LDL-cholesterol. The mean percentage triglyceride increase after ingestion of the test foods was highest with bread and lowest with rice irrespective of diabetic status or ethnicity, and despite similar baseline triglyceride, insulin and body mass index levels, the diabetic patients of East Indian origin had comparatively higher incremental triglyceride levels for the three test foods than those of African origin.

INTERPRETATION AND CONCLUSION

Contrary to anecdotal perception, the commercially prepared whole wheat bread has the highest propensity to induce hypertriglyceridaemia especially among diabetic patients of East Indian origin.

Cereal-induced anaphylaxis in an adult after eating a baby cereal formula

Ingestion of infant cereal formula as a cause of anaphylaxis has been exclusively described in children. We report the case of a man who experienced an anaphylactic reaction after eating his son's cereal formula. We believe that cereals constitute a rising problem and a hidden allergen that can cause severe reactions. Although these reactions are not fully understood, they may possibly be a life-long event.