TOP 3 of Legumes for Human and Planetary Health

Objectives

The identification of the TOP3 of Legumes for the promotion of Human and Planetary Health.

Methods

We analyzed 10 legumes, according to 10 main nutritional characteristics highlighted by the Food and Agriculture Organization of the United Nations (FAO) as the main reasons for their consumption, in a step-by-step approach integrating risks and benefits, according to three levels of analysis: Identification of health effects associated with its consumption; Assessment of the nutritional contribution of its consumption to the Daily Reference Value (%DRV); and Integration of health and sustainability components.

Results

It was found that all legumes seem to promote improvements in risk factors associated with the development of chronic diseases. As for the nutritional contribution of each legume, analyzed according to official recommendations, considering its protective components (protein, fiber, iron, folate, and potassium), the Common Lupine, Cowpea, and Soybean, were ranked as the most beneficial for health. Considering its components to be limited (glycemic index, saturated fat, cholesterol, and sodium) the Azuki Bean and Chickpea seem to be the least harmful legumes for human health. Regarding the link between health and sustainability, the pulses presenting better impact for human and planetary health are Fava, followed by Common Lupine and Common Beans, if cooked without salt and produced locally.

Conclusions

As an integral part of a balanced dietary pattern, this study strengthens the evidence that the consumption of legumes, which are dense in protective nutrients when compared with the concentrations of harmful nutrients, plays an important role in the promotion of human and planetary health, and its consumption should be privileged and promoted in Portugal.

Funding Sources

R.A. thanks FCT/MCTES for the financial support to CESAM (UIDP/50,017/2020 + UIDB/50,017/2020), through national funds.

Gla-Rich Protein, Magnesium and Phosphate Associate with Mitral and Aortic Valves Calcification in Diabetic Patients with Moderate CKD

Accelerated and premature cardiovascular calcification is a hallmark of chronic kidney disease (CKD) patients. Valvular calcification (VC) is a critical indicator of cardiovascular disease and all-cause mortality in this population, lacking validated biomarkers for early diagnosis. Gla-rich protein (GRP) is a cardiovascular calcification inhibitor recently associated with vascular calcification, pulse pressure, mineral metabolism markers and kidney function. Here, we examined the association between GRP serum levels and mitral and aortic valves calcification in a cohort of 80 diabetic patients with CKD stages 2–4. Mitral and aortic valves calcification were detected in 36.2% and 34.4% of the patients and associated with lower GRP levels, even after adjustments for age and gender. In this pilot study, univariate, multivariate and Poisson regression analysis, show that low levels of GRP and magnesium (Mg), and high levels of phosphate (P) are associated with mitral and aortic valves calcification. Receiver operating characteristic (ROC) curves showed that the area under the curve (AUC) values of GRP for mitral (0.762) and aortic (0.802) valves calcification were higher than those of Mg and P. These results suggest that low levels of GRP and Mg, and high levels of P, are independent and cumulative risk factors for VC in this population; the GRP diagnostic value might be potentially useful in cardiovascular risk assessment.

The effects of phosphatidic acid on performance and body composition - a scoping review

Phosphatidic acid (PA) is a lipid mediator proposed to increase muscle protein synthesis via direct stimulation of the mammalian target of rapamycin (mTOR) and may act as an anabolic supplemental aid. Evidence on the effectiveness of PA as an anabolic supplement is equivocal. We aimed to systematically assess the effect of PA on performance and body composition. Due to the small number of studies, this is a scoping review. A comprehensive search was performed in Pubmed, SPORTDiscus and Web of Science, from the 1 January 2010 to the 31 August 2020. Our search retrieved 2009 articles, which when filtered, resulted in six studies, published between 2012 and 2019, which were analysed further. Five studies were performed in adult male populations and one in an elderly male population. From these, three studies suggested no effect of PA on lean body mass , while the remaining showed a possible positive effect (body composition and performance improvements). In one of these, the supplement included other potentially anabolic substances, precluding an isolated effect of PA. After a thorough analysis of the studies included, the evidence does not support the supplementation with PA to increase performance or improve body composition in young or elderly men.

Contribution of Plant-Based Foods to Protein Intake in the Portuguese Population

Objectives

Plant-based foods (PBFs) are in cutting edge of nutrition due to well-established physical and environmental health benefits. The knowledge of amino acid (AA) composition of PBFs is crucial to evaluate the protein intake. This work aims to assess how PBFs can contribute to the protein intake, according to the Mediterranean diet's reference portions.

Methods

Protein quality was determined in 58 PBFs belonging to cereals and tubers, vegetables, fruits, legumes, animal protein substitutes and algae available in Portuguese markets. The AA score and specific intake estimated in agreement with WHO, National recommendation and Portuguese food consumption patterns, after UPLC/PDA analysis.

Results

The highest protein content found in algae, with 35.1 ± 1.2 g/100g DW, and animal protein substitutes with 26.1 ± 0.8 g/100g. Regarding the essential AA scores, by food group,

histidine, threonine and aromatic amino acids (AAA) present scores above 1 (1 to 3.5) and lysine, valine and isoleucine current results below 1 for all food groups, despite that lysine in legumes have a 0.9 score. Only legumes for leucine, and cereals and meat substitutes for sulfur AA have scores greater than 1. They are considering the maximum recommended portions, for Portuguese consumption, each of the food groups supplies between 400% of AAA and 100% of lysine regarding essential AA. According to data of consumption on specific plant food groups, an average of 80% of the recommended intake is represented by AAA, and the Portuguese population consumes 15% lysine. The primary sources, of essential AA that contribute to the Portuguese intake, are cereals and tubers with 67.9% of AAA in men and 56.3% in women and 10% of lysine in men and 8.3% in women. The groups of vegetables, legumes and fruits contribute less than 10% of all essential AA.

Conclusions

Complementarity and diversity of PBFs can reduce some essential AA to achieve the established protein recommendations. A combination of different food groups, such as cereals and legumes, should be taken into account. Increasing seaweed consumption, legumes, and vegetables should be encouraged to the general population.

Funding Sources

INSA2020DAN1844 - Characterization of commercially available processed plant-based products.

Case Study, Plant-Based Diet and Igf-1 Modulation in Her2-positive Breast Cancer

Objectives

Breast cancer is the most common type of cancer in women worldwide and is therefore a field of research that has gained particular relevance. Stimulation of insulin-like factor-1 (IGF-1) would increase breast cancer risk and promote relapse. Here we present a case study of a woman with HER2-positive breast cancer that, after chemotherapy and radiotherapy, followed a Healthful Predominantly Plant-based Diet. This work aimed to investigate IGF-1 plasma levels modulation through this eating pattern.

Methods

For 210 days, diet was based on regular consumption of whole grains, fruits, vegetables, nuts and seeds, legumes, and olive oil as a source of monounsaturated fat, while reducing intake of less healthy plant foods as well as other animal foods. Blood markers including IGF-1, Glycemia, Total Cholesterol, and also Body Mass Index were assessed at baseline and after 210 days.

Results

At baseline IGF-1 was 21 nmol/L and decreased to 16.3 nmol/L, Glycemia was 80 mg/dL and increased to 85 mg/dL, Total Cholesterol was 155 mg/dL and increased to 161 mg/dL, and BMI was 21.7 kg/m2 decreased to 20.6 kg/m2, after 210 days. A decrease of 22.4% in IGF-1 and an increase of 6.3% in Glycemia were noted in plasma levels of this 49 years old woman.

Conclusions

Predominantly Healthful Plant-based Diet seems to modulate IGF-1 and Glycemia plasma levels in a woman diagnosed with HER2-positive breast cancer. Future research should explore mechanistic pathways through which plant-based diets may confirm these results on IGF-1 levels and to clear whether a Predominantly Healthful Plant-Based Diet might be clinically useful in HER2-positive breast cancer.

Funding Sources

No funding sources.

P0873GLA-RICH PROTEIN (GRP) AS AN EARLY AND NOVEL MARKER ASSOCIATED WITH VASCULAR CALCIFICATION AND CKD-MINERAL AND BONE DISORDER (MBD) IN DIABETIC PATIENTS WITH CKD: A PILOT COHORT STUDY

Background and Aims

Cardiovascular disease (CVD) is the most life-threatening complication in chronic kidney disease (CKD) patients. In addition to traditional risk factors, most patients with CKD display abnormal mineral metabolism with underlying hormonal dysregulation, defined as chronic kidney disease-mineral and bone disorder (CKD-MBD). CKD-MBD involves changes in mineral ion homeostasis, bone quality and turnover, cardiovascular and soft tissue calcifications, which highly contribute for cardiovascular complications. Vascular calcification (VC) is associated with significant morbidity and mortality and a strong predictor of cardiovascular risk in CKD patients. Early preventive measures, including new diagnostic/prognostic tools, are required to reduce the development and progression of VC, left ventricular hypertrophy and arterial stiffness, which are crucial for the prevention of CVD outcomes in CKD patients. Gla-rich protein (GRP) is a vitamin K-dependent protein with a dual capacity to function as an inhibitor of pathological calcification and anti-inflammatory agent in the cardiovascular system, whose clinical utility is unknown. Our aim with this study was to evaluate the potential of GRP as a new marker for CKD-MBD and vascular calcification, in type 2 diabetic patients with chronic kidney disease (CKD) stages 2-4.

Method

In an observational prospective study including all eligible type 2 diabetic patients with CKD stages 2-4 (n=80) followed in outpatient nephrology consultation from 2010 to 2017, we explored correlations between levels of GRP in serum with mineral metabolism and inflammation markers, CKD developmental stage, vascular calcification and pulse pressure (PP). Vascular calcification score (VCS) was evaluated using the plain x-ray of the hands and pelvis (Adragão score), and increased cardiovascular risk was considered for VCS≥3. Measurements of GRP in serum were performed using a recently developed sandwich ELISA assay. Descriptive statistics, ANOVA and post hoc analysis with Scheffe test were used for analysis. Forward stepwise logistic regression (likelihood ratio) analysis was applied to identify predictive factors for VCS and PP, and ROC curves were used to assess the sensitivity and specificity of GRP in relation to these exposure factors.

Results

Spearman’s correlation analysis revealed the strong positive correlation between levels of serum GRP and eGFR (r=0.863, p<0.0001) and α klotho (r=0.647, p<0.0001), while a negative correlation with phosphate (P) (r=-0.715, <0.0001), FGF23 (r=-0.676, <0.0001), VCS (r=-0.822, p<0.0001), PP (r=-0.533, p<0.0001), calcium x phosphate (CaxP) (r=-0.302, p=0.006) and IL-6 (r=-0.349, p=0.002). Serum GRP levels were found to progressively decreased from stage 2 to stage 4 CKD. Multivariate analysis identified low levels of eGFR and GRP, and high levels of FGF-23 as independent risk factors for both the VCS and PP. The area under the ROC curves for GRP was 0.865±0.046, 95% CI (0.776-0.955), p<0.0001 for VCS and 0.782±0.054, 95% CI (0.677-0.887), p<0.0001 for PP.

Conclusion

Reduced levels of GRP were associated with higher levels of vascular calcification promoters such as P, FGF-23 and CaxP, and with lower levels of the VC inhibitor α-Klotho, indicating a correlation between GRP and the dysregulation of phosphate metabolism characteristic of CKD-MBD. In addition, this pilot cohort study indicates that GRP levels might be a significant clinical predictor of vascular calcifications in diabetic patients with CKD.

Funding

This research was funded by the Portuguese Society of Nephrology (SPN) through project funding 2016, by the Portuguese national funds from FCT - Foundation for Science and Technology through the transitional provision DL57/2016/CP1361/CT0006 and project UID/Multi/04326/2019.

Acknowledgments

To SPN by the attribution of the Jacinto Simões award (2018) financed by Fresenius medical care.

Gla-Rich Protein (GRP) as an Early and Novel Marker of Vascular Calcification and Kidney Dysfunction in Diabetic Patients with CKD: A Pilot Cross-Sectional Study

Vascular calcification (VC) is one of the strongest predictors of cardiovascular risk in chronic kidney disease (CKD) patients. New diagnostic/prognostic tools are required for early detection of VC allowing interventional strategies. Gla-rich protein (GRP) is a cardiovascular calcification inhibitor, whose clinical utility is here highlighted. The present study explores, for the first time, correlations between levels of GRP in serum with CKD developmental stage, mineral metabolism markers, VC and pulse pressure (PP), in a cohort of 80 diabetic patients with mild to moderate CKD (stages 2–4). Spearman’s correlation analysis revealed a positive association of GRP serum levels with estimated glomerular filtration rate (eGFR) and α-Klotho, while a negative correlation with phosphate (P), fibroblast growth factor 23 (FGF-23), vascular calcification score (VCS), PP, calcium (x) phosphate (CaxP) and interleukin 6 (IL-6). Serum GRP levels were found to progressively decrease from stage 2 to stage 4 CKD. Multivariate analysis identified low levels of eGFR and GRP, and high levels of FGF-23 associated with both the VCS and PP. These results indicate an association between GRP, renal dysfunction and CKD-mineral and bone disorder. The relationship between low levels of GRP and vascular calcifications suggests a future, potential utility for GRP as an early marker of vascular damage in CKD.

Plasmatic Klotho and FGF23 Levels as Biomarkers of CKD-Associated Cardiac Disease in Type 2 Diabetic Patients

Background: Research over the past decade has focused on the role of Klotho as a cardio protective agent that prevents the effects of aging on the heart and reduces the burden of cardiovascular disease CVD. The role of the interaction between fibroblast growth factor 23-(FGF-23)/Klotho in Klotho-mediated actions is still under debate. The main objective was to ascertain the potential use of plasmatic Klotho and FGF23 as markers for CKD-associated cardiac disease and mortality. Methods: This was a prospective analysis conducted in an outpatient diabetic nephropathy clinic, enrolling 107 diabetic patients with stage 2–3 CKD. Patients were divided into three groups according to their left ventricular mass index and relative wall thickness. Results: Multinomial regression analysis demonstrated that low Klotho and higher FGF-23 levels were linked to a greater risk of concentric hypertrophy. In the generalized linear model (GLM), Klotho, FGF-23 and cardiac geometry groups were statistically significant as independent variables of cardiovascular hospitalization (p = 0.007). According to the Cox regression model, fatal cardiovascular events were associated with the following cardiac geometric classifications; eccentric hypertrophy (p = 0.050); concentric hypertrophy (p = 0.041), and serum phosphate ≥ 3.6 mg/dL (p = 0.025), FGF-23 ≥ 168 (p = 0.0149), α-klotho < 313 (p = 0.044). Conclusions: In our population, Klotho and FGF23 are associated with cardiovascular risk in the early stages of CKD.

Phosphorus as an early marker of morbidity and mortality in type 2 chronic kidney disease diabetic patients

AIMS

To evaluate the association of different phosphorus levels with cardiovascular mortality and hospitalizations risk in type-2 diabetic patients in phase 3/4 of CKD.

METHODS

An observational, prospective study involving 119 patients divided into groups according to baseline phosphorus levels: 1, ≤3.60 mg/dL; 2, 3.60-4.60 mg/dL; and 3, >4.60 mg/dL. Baseline characteristics were analyzed and compared. Multivariate Cox regression and Multivariate Logistic regression were used to find out the predictors of cardiovascular mortality and hospitalizations, respectively. T-test was used to investigate the association of phosphorus and start of hemodialysis.

RESULTS

Patients of group 3 presented lower clearance and Hb and increased PTH, Ca×P, LVMI, HOMA, uric acid, IL-6 and more hospitalization days. Patients' mean survival on groups 1, 2 and 3 was 62.5 ± 1.95, 60.1 ± 2.85 and 52.6 ± 2.84 months, respectively (p = 0.001). Phosphorus and creatinine levels were independent predictors of mortality, and phosphorus, creatinine, PTH and age were independent predictors of hospitalizations in this population. Patients who entered hemodialysis presented greater phosphorus levels than those who did not (5.04 ± 1.31 vs. 4.14 ± 1.09; p = 0.001).

CONCLUSIONS

Phosphorus was a predictor of cardiovascular mortality and hospitalizations. Phosphorus levels might have a significant clinical use, possibly translated as an early marker of mortality and hospitalizations in this population.

Diagnosis of prosthetic aortic graft infection by magnetic resonance imaging

The accuracy of magnetic resonance imaging (MRI) in the diagnosis of prosthetic aortic graft infection was evaluated in 18 patients with history and findings suggestive of this complication. The prospective interpretation of MRI was compared with surgical findings. Sixteen patients had a graft infection verified at operation. Fourteen patients had infection of the retroperitoneal portion of the graft; two patients had an infection limited to one of the groins; no graft infection was found at surgical exploration in the remaining two patients. Perigraft infection was correctly diagnosed on the basis of MRI findings in 14 of 16 cases; findings were false negative in one case, questionable in another case, and correctly excluded graft infection in two of two cases. MRI also defined the extent of infection in 14 of 16 cases. MRI findings that supported the clinical suspicion of graft infection were perigraft fluid collections remaining more than 3 months after surgery. Furthermore, local inflammation was suggested by an increased signal intensity of adjacent muscle on T2-weighted images in some cases. CT scans were performed in 12 patients; these enabled a correct diagnosis in five and provided indeterminate or false information in seven. These results indicate that MRI is helpful in the diagnosis of aortic graft infection. Furthermore, MRI provides information about the extent of infection crucial for planning therapy.