Klein, Marguerite A.; Nahin, Richard L.; Messina, Mark J.; Rader, Jeanne I.; Thompson, Lilian U.; Badger, Thomas M.; Dwyer, Johanna T.; Kim, Young S.; Pontzer, Carol H.; Starke-Reed, Pamela E.; Weaver, Connie M.
Fonte: American Society for NutritionPublicador: American Society for Nutrition
The NIH sponsored a scientific workshop, “Soy Protein/Isoflavone Research: Challenges in Designing and Evaluating Intervention Studies,” July 28–29, 2009. The workshop goal was to provide guidance for the next generation of soy protein/isoflavone human research. Session topics included population exposure to soy; the variability of the human response to soy; product composition; methods, tools, and resources available to estimate exposure and protocol adherence; and analytical methods to assess soy in foods and supplements and analytes in biologic fluids and other tissues. The intent of the workshop was to address the quality of soy studies, not the efficacy or safety of soy. Prior NIH workshops and an evidence-based review questioned the quality of data from human soy studies. If clinical studies are pursued, investigators need to ensure that the experimental designs are optimal and the studies properly executed. The workshop participants identified methodological issues that may confound study results and interpretation. Scientifically sound and useful options for dealing with these issues were discussed. The resulting guidance is presented in this document with a brief rationale. The guidance is specific to soy clinical research and does not address nonsoy-related factors that should also be considered in designing and reporting clinical studies. This guidance may be used by investigators...
The HIV pandemic continues to place an unbearable burden on the international community, with disease prevalence remaining highest in resource-limited settings in Africa, Asia, and the Americas. HIV is most often imposed on conditions of food insecurity and consequent malnutrition, poor sanitation, and chronic exposure to a myriad of infectious (eg, malaria, tuberculosis, and diarrheal) and noncommunicable (eg, obesity, diabetes, cancer, and cardiovascular) diseases. Women and children continue to bear the greatest burden. Two essential tenets underpin our approach to HIV: 1) antiretroviral drugs (ARVs) are essential to prolong lives and to halt the spread of HIV and AIDS and 2) food and sound nutrition are essential to human health. The challenge is to apply sound principles of clinical care and nutrition science to the safe and efficacious implementation of ARVs and for long-term care for people living with HIV and AIDS. The WHO has played a leading role in developing guidelines to support this goal with the generation of general recommendations regarding nutritional needs of people living with HIV and AIDS and specific guidelines for the nutritional care of HIV-infected infants and children (<14 y of age). These proceedings represent a summary of the work accomplished at a workshop sponsored by the NIH to review the existing evidence to support changes in the recommendations regarding nutrient requirements for people living with HIV and AIDS; to support development of new WHO guidelines for adolescents and adults...
Pomegranate juice (PJ; also known as pomegreat pure juice) provides a rich and varied
source of polyphenolic compounds that may offer cardioprotective, anti-atherogenic and
antihypertensive effects. The aim of this study was to investigate the effect of PJ
consumption on glucocorticoids levels, blood pressure (BP) and insulin resistance in
volunteers at high CVD risk. Subjects (twelve males and sixteen females) participated in a
randomised, placebo-controlled cross-over study (BMI: 26·77 (sd
3·36) kg/m2; mean age: 50·4 (sd 6·1) years). Volunteers were assessed
at baseline, and at weeks 2 and 4 for anthropometry, BP and pulse wave velocity. Cortisol
and cortisone levels in urine and saliva were determined by specific ELISA methods, and
the cortisol/cortisone ratio was calculated. Fasting blood samples were obtained to assess
plasma lipids, glucose, insulin and insulin resistance (homeostasis model assessment of
insulin resistance). Volunteers consumed 500 ml of PJ or 500 ml of a placebo drink
containing a similar amount of energy. Cortisol urinary output was reduced but not
significant. However, cortisol/cortisone ratios in urine (P = 0·009) and
saliva (P = 0·024) were significantly decreased. Systolic BP decreased
from 136·4 (sd 6·3) to 128·9 (sd 5·1) mmHg (P = 0·034)...
Vitamin C is an essential nutrient in humans and must be obtained through the diet. The
aim of this study was to determine vitamin C uptake in healthy volunteers after consuming
kiwifruit (Actinidia chinensis var. Hort. 16A), and to
determine the amount of fruit required to raise plasma vitamin C to ‘healthy’ (i.e.
>50 µmol/l) and ‘optimal’ or saturating levels (i.e. >70 µmol/l). Leucocyte
and urinary vitamin C levels were also determined. A total of fifteen male university
students with below average levels of plasma vitamin C were selected for the study. Weekly
fasting blood samples were obtained for a 4-week lead-in period and following
supplementation with, sequentially, half, one, two and three Gold kiwifruit per d for 4–6
weeks each, followed by a final 4-week washout period. The results showed that addition of
as little as half a kiwifruit per d resulted in a significant increase in plasma vitamin
C. However, one kiwifruit per d was required to reach what is considered healthy levels.
Increasing the dose of kiwifruit to two per d resulted in further increases in plasma
vitamin C levels as well as increased urinary output of the vitamin, indicating that
plasma levels were saturating at this dosage. Dividing the participants into high and low
vitamin C groups based on their baseline plasma and leucocyte vitamin C levels
demonstrated that it is critical to obtain a study population with low initial levels of
the vitamin in order to ascertain a consistent effect of supplementation.
Raisins are popular snacks with a favourable nutrient profile, being high in dietary
fibre, polyphenols and a number of vitamins and minerals, in addition to being rich in
fructose. In light of evidence demonstrating improvements in glycaemic control with
moderate fructose intake and low-glycaemic index (GI) fruits, our aim was to determine the
GI, insulin index (II) and postprandial responses to raisins in an acute feeding setting.
A total of ten healthy participants (four male and six female) consumed breakfast study
meals on four occasions over a 2- to 8-week period: meal 1: white bread (WB) (108 g WB;
50 g available carbohydrate) served as the control and was consumed on two separate
occasions; meal 2: raisins (R50) (69 g raisins; 50 g available carbohydrate); and meal 3:
raisins (R20) (one serving, 28 g raisins; 20 g available carbohydrate). Postprandial
glucose and insulin were measured over a 2 h period for the determination of GI, glycaemic
load (GL) and II. The raisin meals, R50 and R20, resulted in significantly reduced
postprandial glucose and insulin responses when compared with WB
(P < 0·05). Furthermore, raisins were determined to be low-GI, -GL
and -II foods. The favourable effect of raisins on postprandial glycaemic response...
Familial hypercholesterolaemia (FH) leads to elevated plasma levels of LDL-cholesterol
and increased risk of premature atherosclerosis. Dietary treatment is recommended to all
patients with FH in combination with lipid-lowering drug therapy. Little is known about
how children with FH and their parents respond to dietary advice. The aim of the present
study was to characterise the dietary habits in children with FH. A total of 112 children
and young adults with FH and a non-FH group of children (n 36) were
included. The children with FH had previously received dietary counselling. The FH
subjects were grouped as: 12–14 years (FH (12–14)) and 18–28 years (FH (18–28)). Dietary
data were collected by SmartDiet, a short self-instructing questionnaire on diet and
lifestyle where the total score forms the basis for an overall assessment of the diet.
Clinical and biochemical data were retrieved from medical records. The SmartDiet scores
were significantly improved in the FH (12–14) subjects compared with the non-FH subjects
(SmartDiet score of 31 v. 28, respectively). More FH (12–14) subjects
compared with non-FH children consumed low-fat milk (64 v. 18 %,
respectively), low-fat cheese (29 v. 3%, respectively), used margarine
with highly unsaturated fat (74 v. 14 %...
Arterial stiffness, blood pressure (BP) and blood lipids may be improved by milk in
adults and the effects may be mediated via proteins. However, limited is known about the
effects of milk proteins on central aortic BP and no studies have examined the effects in
children. Therefore, the present trial examined the effect of milk and milk proteins on
brachial and central aortic BP, blood lipids, inflammation and arterial stiffness in
overweight adolescents. A randomised controlled trial was conducted in 193 overweight
adolescents aged 12–15 years. They were randomly assigned to drink 1 litre of water,
skimmed milk, whey or casein for 12 weeks. The milk-based test drinks contained 35 g
protein/l. The effects were compared with the water group and a pretest control group
consisting of thirty-two of the adolescents followed 12 weeks before the start of the
intervention. Outcomes were brachial and central aortic BP, pulse wave velocity and
augmentation index, serum C-reactive protein and blood lipids. Brachial and central aortic
diastolic BP (DBP) decreased by 2·7% (P = 0·036) and 2·6 %
(P = 0·048), respectively, within the casein group and the changes were
significantly different from those of the pretest control group
(P = 0·040 and P = 0·034...
It is known that Fe deficiency has a negative impact on cognitive function in children by
altering brain energy metabolism and neurotransmitter function. It is unclear whether Fe
deficiency has detrimental effects on cognition, mental health and fatigue in women of
childbearing age. Our aim was to systematically review the literature to determine whether
Fe deficiency in women of childbearing age affects cognition, mental health and fatigue,
and whether a change in Fe status results in improvements in cognition, mental health and
fatigue. Studies using Fe supplement interventions were reviewed to examine the effect of
Fe deficiency in women of childbearing age (13–45 years) on their cognition, mental health
and fatigue. English-language articles ranging from the earliest record to the year 2011
were sourced. The quality of retrieved articles was assessed and the Fe pathology,
cognitive, mental health and fatigue data were extracted. Means and standard deviations
from cognitive test data were included in meta-analyses of combined effects. Of the 1348
studies identified, ten were included in the review. Three studies showed poorer cognition
and mental health scores and increased fatigue with Fe deficiency at baseline. Seven
studies reported an improvement in cognitive test scores after Fe treatment. Results of
three of these studies were included in meta-analyses of the effect of Fe supplement
intervention on cognition. The results of the meta-analyses showed a significant
improvement in Arithmetic scores after treatment (P < 0·01)...
Milk consumption decreases inflammatory stress in overweight and obese subjects. Casein
is the major protein in milk and enhances the secretion of insulin that has
anti-inflammatory activity. The aim of the present study was to compare the acute effect
of meals rich in casein and carbohydrate and a combination of both nutrients on
postprandial plasma concentrations of IL-6, a marker of inflammation, in obese women. A
total of twenty-five obese women aged 38–68 years consumed isoenergetic meals rich in
potato (POT) or casein (CA) or a combination of both these meals (POT + CA), in random
order in a cross-over trial. After an overnight fast, blood samples were collected before
and at 1 and 4 h after the meals and circulating concentrations of IL-6, glucose, insulin
and NEFA were measured. Plasma IL-6 concentrations increased significantly
(P < 0·001) during 4 h after the meals. The AUC of postprandial
IL-6 concentrations was not significantly (P = 0·77) different among the
meals. Postprandial serum insulin concentration AUC was significantly higher during the
POT + CA meal compared with the POT meal (P = 0·001) and the CA meal
(P < 0·05), which in turn was significantly higher than the POT
meal (P < 0·05). These data show that while ingestion of CA alone
or combined with POT acutely increases circulating insulin concentrations...
Previous studies have shown that fish protein, as well as marine n-3
PUFA, may have beneficial effects on cardiovascular risk profile. The objectives of this
study were to investigate the combined effects of fish gelatine (FG) and
n-3 PUFA supplementation on (1) energy intake and body weight, (2) lipid
profile and (3) inflammatory and CVD markers in free-living insulin-resistant males and
females. Subjects were asked to consume, in a crossover study design with two experimental
periods of 8 weeks each, an n-3 PUFA supplement and n-3
PUFA supplement plus FG (n-3 PUFA + FG). n-3 PUFA + FG
led to an increase in protein intake and a decrease in carbohydrate intake compared with
n-3 PUFA (P < 0·02) in males and females.
Sex–treatment interactions were observed for TAG (P = 0·03) and highly
sensitive C-reactive protein (hsCRP) (P = 0·001) levels. In females,
n-3 PUFA reduced plasma TAG by 8 % and n-3 PUFA + FG
by 23 %, whereas in males, n-3 PUFA reduced plasma TAG by 25 % and
n-3 PUFA + FG by 11 %. n-3 PUFA increased serum hsCRP
by 13 % and n-3 PUFA + FG strongly reduced hsCRP by 40 % in males,
whereas in females, n-3 PUFA reduced serum hsCRP by 6 % and
n-3 PUFA + FG increased hsCRP by 20 %. In conclusion, supplementation
with FG may enhance the lipid-lowering effect of marine n-3 PUFA in
females and beneficially counteract the effect of n-3 PUFA on serum hsCRP
in males. Further studies are needed to identify the sex-dependent mechanisms responsible
for the divergent effects of FG on TAG and hsCRP levels in females and males...
The fruit of the date palm (Phoenix dactylifera L.) is a rich source of dietary fibre and polyphenols. We have investigated gut bacterial changes induced by the whole date fruit extract (digested date extract; DDE) and its polyphenol-rich extract (date polyphenol extract; DPE) using faecal, pH-controlled, mixed batch cultures mimicking the distal part of the human large intestine, and utilising an array of microbial group-specific 16S rRNA oligonucleotide probes. Fluorescence microscopic enumeration indicated that there was a significant increase in the growth of bifidobacteria in response to both treatments, whilst whole dates also increased bacteroides at 24 h and the total bacterial counts at later fermentation time points when compared with DPE alone. Bacterial metabolism of whole date fruit led to the production of SCFA, with acetate significantly increasing following bacterial incubation with DDE. In addition, the production of flavonoid aglycones (myricetin, luteolin, quercetin and apigenin) and the anthocyanidin petunidin in less than 1 h was also observed. Lastly, the potential of DDE, DPE and metabolites to inhibit Caco-2 cell growth was investigated, indicating that both were capable of potentially acting as antiproliferative agents in vitro...
A population-based cross-sectional study was carried out in the northern neighbourhoods of Ouagadougou (Burkina Faso), to examine the relationship of nutritional deficiencies and cardiometabolic risk factors (CMRF) with lifestyle in adults. We randomly selected 330 households stratified by income tertile. In each income stratum, 110 individuals aged 25–60 years and having lived in Ouagadougou for at least 6 months were randomly selected. We performed anthropometric, dietary intake and physical activity measurements, and blood sample collection. Cluster analysis of dietary intake identified two dietary patterns: ‘urban’ (29 % of subjects) and ‘traditional’ (71 %). The ‘urban’ cluster exhibited a higher intake of fat and sugar, whereas a higher intake of plant protein, complex carbohydrate and fibre was observed in the ‘traditional’ pattern. Female sex, low income and lack of education were associated with the ‘traditional’ cluster, as well as Fe and vitamin A deficiency. CMRF prevalence (abdominal obesity, hypertension, hyperglycaemia, dyslipidaemia) was similar in both clusters. Subjects in the ‘traditional’ cluster spent more time in physical activity and had less sedentary time than those in the ‘urban’ cluster. ‘Traditional’ dietary pattern...
Wheat bran extract (WBE) is a food-grade soluble fibre preparation that is highly enriched in arabinoxylan–oligosaccharides. In this placebo-controlled cross-over human intervention trial, tolerance to WBE as well as the effects of WBE on faecal parameters, including faecal output and bowel habits, were studied. After a 2-week run-in period, twenty healthy volunteers consumed WBE (15 g/d in the first week, 30 g/d in the second week), oligofructose (15 g/d in the first week, 30 g/d in the second week) and placebo (for 2 weeks) in a random order, with 2-week washout periods between each treatment period. Subjects collected a 72 h stool sample for analysis of faecal output, stool pH and stool moisture concentration. Additionally, the volunteers completed questionnaires scoring occurrence frequency and distress severity of eighteen gastrointestinal (GI) symptoms. An overall GI symptom measure was calculated to analyse the overall effect of WBE and oligofructose on GI symptoms. Intake of both 30 g/d WBE and 30 g/d oligofructose lowered stool pH, indicative of increased colonic fermentation, and increased stool moisture concentration as compared with placebo intake. Intake of 30 g/d oligofructose increased the overall GI symptom measure by 1·9-fold as compared with placebo intake. Intake of WBE at doses up to 30 g/d did not affect the overall GI symptom measure. WBE exerts beneficial effects on stool characteristics and is well tolerated at up to 30 g/d. Oligofructose exerts comparable beneficial effects on stool characteristics. However...
Increasing epidemiological evidence suggests that maternal nutrition and environmental exposure early in development play an important role in susceptibility to disease in later life. In addition, these disease outcomes seem to pass through subsequent generations. Epigenetic modifications provide a potential link between the nutrition status during critical periods in development and changes in gene expression that may lead to disease phenotypes. An increasing body of evidence from experimental animal studies supports the role of epigenetics in disease susceptibility during critical developmental periods, including periconceptional period, gestation, and early postnatal period. The rapid improvements in genetic and epigenetic technologies will allow comprehensive investigations of the relevance of these epigenetic phenomena in human diseases.
Acquired Immune Deficiency Syndrome (AIDS) and impaired or threatened nutritional status seem to be closely related. It is now known that AIDS results in many nutritional disorders including anorexia, vomiting, protein-energy malnutrition (PEM), nutrient deficiencies, and gastrointestinal, renal, and hepatic dysfunction (1-7, 8).
Reversibly, nutritional status may also have an impact on the development of AIDS among HIV-infected people. Not all individuals who have tested antibody positive for the Human Immunodeficiency Virus (HIV) have developed AIDS or have even shown clinical symptoms (9, 10). A poor nutritional status, especially PEM, has a depressing effect on immunity which may predispose an individual to infection (11). It has been proposed that a qualitatively or quantitatively deficient diet could be among the factors precipitating the transition from HIV-positive to AIDS (12, 13).
The interrelationship between nutrition and AIDS reveals the importance of having a multidisciplinary health care team approach to treatment (11), including having a registered dietitian on the medical team. With regards to alimentation, the main responsibility of a dietitian is to inform the public concerning sound nutritional practices and encourage healthy food habits (14). In individuals with inadequate nutritional behavior...
BACKGROUND: Preterm human milk-fed infants often experience suboptimal growth despite the use of human milk fortifier (HMF). The extra protein supplied in fortifiers may be inadequate to meet dietary protein requirements for preterm infants. OBJECTIVE: We assessed the effect of human milk fortified with a higher-protein HMF on growth in preterm infants. DESIGN: This is a randomized controlled trial in 92 preterm infants born at <31 wk gestation who received maternal breast milk that was fortified with HMF containing 1.4 g protein/100 mL (higher-protein group) or 1.0 g protein/100 mL (current practice) until discharge or estimated due date, whichever came first. The HMFs used were isocaloric and differed only in the amount of protein or carbohydrate. Length, weight, and head-circumference gains were assessed over the study duration. RESULTS: Length gains did not differ between the higher- and standard-protein groups (mean difference: 0.06 cm/wk; 95% CI: -0.01, 0.12 cm/wk; P = 0.08). Infants in the higher-protein group achieved a greater weight at study end (mean difference: 220 g; 95% CI: 23, 419 g; P = 0.03). Secondary analyses showed a significant reduction in the proportion of infants who were less than the 10th percentile for length at the study end in the higher-protein group (risk difference: 0.186; 95% CI: 0.370...
Minimal educational requirements for Registered Dietitians (RDs) include a bachelor’s degree and practice program. Recently, a master’s degree was recommended. Studies have not established whether education affects employment. A secondary analysis of 2005 Dietetics Practice Audit data determined whether job responsibility, individuals supervised, and activities differed between 1,626 bachelor’s RDs (B-RDs) and 767 master’s (M-RDs) RDs, registered ≤5 years. Chi-square and ANOVA analyzed differences between B-RDs and M-RDs, at entry-level (0-3 years experience) and beyond-entry-level (3+-5 years experience). Beyond-entry-level B-RDs (31.8%) and entry-level M-RDs (31.9%) reported “supervisor/executive” responsibility more than entry-level B-RDs (26.5%; p=0.01). A higher percentage of M-RDs supervised (29.2%) than B-RDs (24.7%; p=0.02); however, B-RDs supervised more individuals (7.38 ± 4.89) than M-RDs (6.25 ± 4.87; t=2.32; p=0.021). A master’s degree has limited benefits; experience may affect responsibility, individuals supervised, and activities more than education.
Activity energy expenditure (AEE) during free-living conditions can be assessed using
devices based on different principles. To make proper comparisons of different devices'
capacities to assess AEE, they should be evaluated in the same population. Thus, in the
present study we evaluated, in the same group of subjects, the ability of three devices to
assess AEE in groups and individuals during free-living conditions. In twenty women, AEE
was assessed using RT3 (three-axial accelerometry) (AEERT3), Actiheart (a
combination of heart rate and accelerometry) (AEEActi) and IDEEA (a
multi-accelerometer system) (AEEIDEEA). Reference AEE (AEEref) was
assessed using the doubly labelled water method and indirect calorimetry. Average
AEEActi was 5760 kJ per 24 h and not significantly different from
AEEref (5020 kJ per 24 h). On average, AEERT3 and
AEEIDEEA were 2010 and 1750 kJ per 24 h lower than AEEref,
respectively (P < 0·001). The limits of agreement (± 2
sd) were 2940 (Actiheart), 1820 (RT3) and 2650 (IDEEA) kJ per 24 h. The variance
for AEERT3 was lower than for AEEActi (P = 0·006).
The RT3 classified 60 % of the women in the correct activity category while the
corresponding value for IDEEA and Actiheart was 30 %. In conclusion...
Miami-Dade County has approximately 27,000 people living with HIV (PLWH), and the highest HIV incidence in the nation. PLWH have reported several types of sleep disturbances. Caffeine is an anorexic and lipolytic stimulant that may adversely affect sleep patterns, dietary intakes and body composition. High caffeine consumption (>250 mg. per day or the equivalent of >4 cups of brewed coffee) may also affect general functionality, adherence to antiretroviral treatment (ART) and HIV care. This study assess the relationship of high caffeine intake with markers of disease progression, sleep quality, insomnia, anxiety, nutritional intakes and body composition.
A convenience sample of 130 PLWH on stable ART were recruited from the Miami Adult Studies on HIV (MASH) cohort, and followed for three months. After consenting, questionnaires on Modified Caffeine Consumption (MCCQ), Pittsburg Insomnia Rating Scale (PIRS), Pittsburg Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), socio-demographics, drug and medication use were completed. CD4 count, HIV viral load, anthropometries, and body composition measures were obtained.
Mean age was 47.89±6.37 years, 60.8% were male and 75.4% were African-Americans. Mean caffeine intake at baseline was 337.63 ± 304.97 mg/day (Range: 0-1498 mg/day) and did not change significantly at 3 months. In linear regression...
Nutrition plays a fundamental role in the maintenance of health and the treatment of disease, and serves as the crossroads for many disciplines. Biochemistry and Molecular Biology represents a key brand of science to ascertain the mechanism of action of nutrients and other food bioactive compounds in health and disease. The aim of the present Jesús M. Culebras lecture is to consider the future of the relationships between Molecular Biology and Clinical Nutrition and to discuss the use of molecular and genetic tools to study molecular responses to dietary factors and the metabolic consequences of food and to consider major challenges on human nutrition sciences in the 21st century. Particular emphasis is given to the identification and use of novel biomarkers in inflammatory diseases. Likewise, the importance of the human microbiome and how microorganisms can be safely utilized in the prevention and management of infectious and chronic diseases are discussed. Moreover, the key role of nutrigenetics, nutrigenomics and epigenetics in the new era of nutrition is considered. Nutrigenetics refers to the role of DNA sequence variation in the responses to nutrients, whereas nutrigenomics is the study of the role of nutrients in gene expression. Epigenetics is the study of mitotically heritable alterations in gene expression potential that are not caused by DNA sequence alterations. In the past decade...