Journal of the American Nutrition Association最新文献

Objective: Chronic kidney disease (CKD) is highly prevalent among people with diabetes. While identifying modifiable risk factors to prevent a decline in kidney function among those living with diabetes is pivotal, there is limited evidence on dietary risk factors for CKD. In this study, we examined the associations between healthy and less healthy plant-based diets (PBDs) and the risk of CKD among those with diabetes, and to identify potential underlying mechanisms.

Methods: We conducted a prospective analysis among 7,747 UK Biobank participants with prevalent diabetes. Multivariable Cox proportional hazard regression models were used to examine the associations between healthful and unhealthful PBDs and the risk of CKD. Causal mediation analyses were further employed to explore the underlying mechanisms of the observed associations.

Results: Among 7,747 study participants with diabetes, 1,030 developed incident CKD over 10.2 years of follow-up. Higher adherence to a healthy PBD was associated with a 24% lower CKD risk (HR_{Q4 versus Q1}: 0.76 [95%CI: 0.63-0.92], p_trend = 0.002), while higher adherence to an unhealthy PBD was associated with a 35% higher risk (HR_{Q4 versus Q1}: 1.35 [95%CI: 1.11-1.65], p_trend = 0.006). The observed associations were predominantly mediated by markers of body fatness (proportion mediated: 11-25%) and kidney function (23-89%).

Conclusions: In this prospective cohort study of middle-aged adults with diabetes, adherence to a healthy PBD was associated with lower CKD risk, whereas adherence to an unhealthy PBD was associated with a higher CKD risk. Associations were primarily mediated by markers of lower body fatness and improved kidney function.

Background: Current guidelines prioritize monitoring and managing cobalamin (Cbl) deficiency but insufficiently address the issue of functional Cbl deficiency (decreased Cbl sensitivity). This study aims to investigate the prevalence burden of functional Cbl deficiency and to examine its prospective association with mortality risk, compared to Cbl deficiency, among United States (US) adults.

Method: The cohort study included 22,513 US participants aged ≥20 years from 1999 to 2014 and was followed up through December 31, 2019. Cbl sensitivity was assessed using a combination of binary classifications for Cbl and methylmalonic acid (MMA) levels, with cutoff values set at 400 pg/mL for Cbl and 250 nmol/L for MMA. Functional Cbl deficiency was defined as elevated MMA and Cbl levels. Serum Cbl levels <148 pmol/L (200 pg/mL) were classified as Cbl deficiency.

Results: In this study, approximately 2.1% of US adults had Cbl deficiency, while the age-adjusted prevalence of functional Cbl deficiency was 4.5%, corresponding to an estimated 10 million US adults. Over a median follow-up period of 10.7 years, there were 4636 recorded deaths. Compared to the MMA_lowCbl_low group (MMA ≤250 nmol/L, Cbl ≤400 pg/mL), the multivariable-adjusted hazard ratios for all-cause, cardiovascular, and cancer-related mortality in the MMA_highCbl_high group were 1.76 (95% confidence interval [CI]: 1.53-2.02, p < 0.001), 2.17 (95% CI: 1.78-2.67, p < 0.001), and 1.38 (95% CI: 0.95-2.00, p = 0.089). In contrast, the mortality risk associated with Cbl deficiency became insignificant after adjusting for similar confounders. While Cbl supplementation or dietary intake above recommended levels might alleviate Cbl deficiency, they do not appear to reduce the prevalence of functional Cbl deficiency or its associated mortality risk.

Conclusion: Compared with Cbl deficiency, functional Cbl deficiency is more frequent and is significantly associated with increased mortality risk in the general population.

Type 2 Diabetes (T2D) is a chronic multifaceted metabolic condition characterized by elevated blood glucose levels with varying degrees of insulin resistance and abnormal insulin production. Lifestyle modifications, such as those defined by the guidelines for diabetes self-management education and support (DSMES), are foundational for glycemic control. A current gap in T2D management is addressing DSMES which is tailored to best serve the diversity of patients with this disease. The purpose of this narrative review is to discuss the current literature related to lifestyle modification for T2D, the importance of culturally sensitive T2D management programs, and the impact culturally sensitive and diverse T2D management programs have on cardiometabolic health. Despite being disproportionately affected by T2D, racial and ethnic minorities have low referral rates for DSMES. This growing disparity may be exacerbated by a lack of awareness of how to adapt lifestyle modifications in a culturally competent manner and how social determinants of health (SDOH) may affect the infrastructure and resources available to diverse patient populations. Currently, there is limited research on how DSMES is addressed to include culturally and literacy-sensitive recommendations in the United States. Patient-centered care, emphasizing personalized DSMES, can lead to improved glycemic control, reduced healthcare costs, and improved cardiometabolic health. A key component of effective DSMES should include culturally and literacy-sensitive approaches with an awareness of the impact of SDOH. Understanding how ethnicity, race, and culture influence experiences with T2D management can help providers prescribe more patient-centered and sustainable recommendations.

Objective: Structured lipids containing medium-chain fatty acids, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) from fish oil (EPA/MCT) and it improve overall endurance. However, their effects on local muscle endurance remain unclear. This study aimed to investigate the effects of EPA/MCT intake on muscle endurance during leg extension exercises and subsequent muscle fatigue.

Methods: This 8-week, placebo-controlled, randomized, double-blind parallel-group trial involved 20 healthy young men. Subjects were randomly assigned to an EPA/MCT group (10 subjects) and a placebo group (PL group, 10 subjects). They consumed 4560 mg of the test food daily for 8 wk before an exercise intervention. The EPA/MCT supplement contained 600 mg of EPA, 260 mg of DHA, and 1890 mg of MCT (1110 mg of octanoic acid and 780 mg of decanoic acid). After the 8-week intervention, the subjects performed four sets of leg extension exercises at 40% of their body weight until exhaustion. The number of repetitions per set and the total repetitions across the four sets served as indicators of muscle endurance. Isometric maximum voluntary contraction (MVC), range of motion, circumference, muscle thickness, echo intensity, and muscle stiffness were measured before and after exercise to assess muscle fatigue.

Results: There was no difference between the groups in the number of repetitions for sets 1-4 or in the total number of repetitions during the leg extension exercise. In the EPA/MCT group, a significant negative correlation was observed between the increase in the blood EPA/AA ratio and the rate of decrease in the number of repetitions. Additionally, the decrease in MVC after exercise was significantly smaller in the EPA/MCT group than in the PL group.

Conclusion: Our study results suggest that an 8-week intake of EPA/MCT can increase the blood EPA/AA ratio and improve muscle endurance performance. Additionally, EPA/MCT intake reduces muscle fatigue after exercise.

Excess body adiposity, referred to as overweight and obesity, represents a major health concern given that it increases the risk of various diseases, including cardiovascular diseases, type 2 diabetes, and cancer. Body weight reduction can be achieved via a wide variety of dietary strategies as long as an energy deficit is achieved. However, the effect of such diets on disease risk and mortality will depend on the foods included. Increasing evidence shows that consumption of whole plant foods (e.g., fruits, vegetables, whole grains, nuts, seeds, legumes) in place of animal foods (e.g., meat, poultry, dairy, fish, eggs, and seafood and their derivatives) and non-whole plant foods (e.g., refined grains, French fries, sugar-sweetened beverages) is associated with improvements in cardiometabolic risk factors and lower risk of chronic diseases and mortality. This review focuses on the effect of a whole plant-foods diet on overweight and obesity from observational to clinical studies and discusses the potential mechanisms involved. According to existing evidence, a whole plant foods diet seems to be more advantageous than other dietary approaches for the prevention and treatment of excess adiposity given that it is composed of the foods that lead to the best health outcomes.

Objective: Life expectancy and obesity prevalence are increasing worldwide, leading to an increase in the prevalence of cardiovascular disease. High-density lipoprotein (HDL) functionality and immunosenescence play key roles in cardiovascular disease, longevity, and quality of aging. Both molecular hallmarks of aging are impacted by obesity and metabolic syndrome and can be modulated by lifestyle. We aimed to evaluate the effect of a lifestyle intervention focused on an energy-reduced Mediterranean diet (erMedDiet), physical activity (PA), and behavioral support on HDL cholesterol efflux capacity (CEC) and immunosenescence.

Method: CEC and immunosenescent T cells were determined in 60 participants from the control group (CG) and 56 from the intervention group (IG) of the PREDIMED-Plus trial at baseline and after 1 and 3 years of follow-up. PREDIMED-Plus is a randomized, controlled, parallel-group trial with an IG of erMedDiet, PA promotion, and behavioral support for weight loss and a CG of usual primary care advice. The sample included 116 volunteers from the PREDIMED-Plus-IMDEA subsample of the PREDIMED-Plus trial. Men aged 55 to 75 years and women aged 60 to 75 years with a body mass index between 27 and 40 kg/m² and metabolic syndrome were included.

Results: Participants within the IG had significantly improved CEC (2.42% and 10.69% after 1 and 3 years of follow-up) and a decreased in senescent T cell profile (-3.32% ± 12.54% and -6.74% ± 11.2%, p < 0.001, after 1 and 3 years of follow-up). Baseline obesity status impacted the response to the intervention.

Conclusions: A weight loss intervention program with erMedDiet and PA ameliorated senescence markers.

Objective: Physalis Peruviana Linnaeus (PPL) is an herbaceous species characterized by a wide variety of bioactive compounds to which anti-inflammatory properties have been attributed. This makes this fruit a possible complementary therapy for diseases that involve chronic inflammation, such as inflammatory bowel diseases (IBD). In the present study, the effect of a PPL extract on the expression of inflammatory markers in the Caco-2 cell line was evaluated.

Methods: An in vitro gastric digest (50 g PPL pulp) was performed, obtaining an extract that was used to challenge Caco-2 cells for 24 and 72 hours. This extract was characterized by LC-MS/MS. Then, the relative mRNA expression of NF-kB, TLR4, IL-18 and MCP-1 was determined through qRT-PCR and the protein levels of TNF-α, IL-6, IL-8, IL-18 and MCP-1 through Luminex Immunoassay.

Results: From the characterization of the extract, compounds with bioactive potential such as isothiocyanates, indoles and coumarins were found. Treatment of Caco-2 cells with PPL extract (80 µg/ml), particularly for 72 hours, produced a reduction of IL-18 and MCP-1 mRNA expression (p < 0.01), in addition to IL-18 (p < 0.01), IL-8 (p < 0.0001) and MCP-1 (p < 0.01) protein levels, however, no effects on NF-kB p65 (p = 0.09) and TLR4 (p = 0.20) mRNA expression were observed.

Conclusion: The results obtained in this study open the possibility that the regular consumption of 50 g of PPL could constitute a possible complementary therapy for the treatment of IBD, improving the quality of life of these patients.

Objective: The objective of this study was to examine the differences in fruit and/or vegetable consumption (FVC) among Brazilian adults by examining various social markers, such as gender, race, income, and education level.

Method: A cross-sectional study of 88,531 Brazilian adults aged 18 years or older who participated in the 2019 National Health Survey was conducted. The dependent variable was irregular FVC (<5 d/wk). Individuals at the highest risk for irregular FVC include those who are men and Black and who have lower education levels and lower income. Individuals at lower risk include those who are women and White and who have higher education levels and higher income. The prevalence of irregular FVC was calculated considering the levels of the social risk index for FVC and the intersections among two, three, and four risk categories. Odds ratio (OR) and 95% confidence interval (CI) analyses were performed to compare groups at higher risk with those at lower risk.

Results: The prevalence of irregular FVC was 57.2% in the general population, 38.1% for individuals in the lowest risk group, 47.5% for individuals in one risk category, 57.9% for individuals in two risk categories, 67.6% for individuals in three risk categories, and 74.4% for individuals in the highest-risk group, and there were significant differences at each level. The highest risk group had a 4.36 (95% CI, 3.86-4.92) times greater chance of irregular FVC.

Conclusions: The complex path to promote FVC among the Brazilian population underscores the need for intersectoral policies aimed at reducing inequalities.

Objective: Experimental studies suggest that carotenoids and tocopherols modulate pancreatic carcinogenesis because they have antioxidant and other functions. We investigated the associations between intakes of these compounds and the risk of pancreatic cancer in a case-control study conducted in 1994-1998.

Methods: The present analysis included 150 cases of pancreatic cancer recruited from all hospitals in the metropolitan area of the Twin Cities and Mayo Clinic and 459 controls randomly selected from the general population and frequency matched to cases by age, sex, and race. The intakes of carotenoids and tocopherols were assessed with a validated food frequency questionnaire. Unconditional logistic regression analysis was performed to evaluate the associations of interest.

Results: The energy-adjusted intake of lutein/zeaxanthin was significantly lower in cases (2410 µg/day) than in controls (3020 µg/day). After adjustment for confounders, persons in the fourth quartile of lutein/zeaxanthin intake had a reduced risk of pancreatic cancer compared with those in the first quartile [odds ratio (OR) (95% CI): 0.40 (0.17-0.91)]. There were no significant associations with intakes of other carotenoids and tocopherols considered and with a composite score created from all individual carotenoids examined. We did not detect any significant interactions of intakes of carotenoids and tocopherols with age, sex, cigarette smoking, or alcohol intake in relation to pancreatic cancer risk.

Conclusion: The present study suggests an inverse association between lutein/zeaxanthin intake and pancreatic cancer risk, but a potential beneficial effect was not observed for other carotenoids and tocopherols.

Obesity has been identified as a rapidly rising pandemic within the developed world, potentially increasing the risks of type 2 diabetes and cardiovascular disease. Various studies have identified a positive association between stress, elevated cortisol levels and obesity. Mechanisms of the stress response lead to hyperpalatable food preference and increased appetite through the activation of the HPA axis, elevated cortisol and the resulting interactions with the dopaminergic system, neuropeptide Y, ghrelin, leptin and insulin. The methodology of this review involved a Systematic Search of the Literature with a Critical Appraisal of papers considering ashwagandha, mediation and mindfulness in relation to mechanisms of the stress response. It incorporated 12 searches yielding 330 hits. A total of 51 studies met the inclusion criteria and were critically appraised with ARRIVE, SIGN50 and Strobe checklists. Data from the 51 studies was extracted, coded into key themes and summarized in a narrative analysis. Thematic analysis identified 4 key themes related to ashwagandha and 2 key themes related to meditation. Results provide an overview of evidence assessing the efficacy of ashwagandha and meditation in relation to weight loss interventions by supporting the stress response and the pathways highlighted. Results of Clinical studies indicate that ashwagandha supports weight loss through reduced stress, cortisol and food cravings. Pre-clinical studies also suggest that ashwagandha possesses the capacity to regulate food intake by improving leptin and insulin sensitivity and reducing addictive behaviors through dopamine regulation. Clinical studies on meditation indicate it may enhance a weight loss protocol by reducing the stress response, cortisol release and blood glucose and improving eating behaviors.