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The fatty acid pattern of dietary fat influences the oral bioavailability of the flavonol quercetin in pigs.

We have shown recently that dietary fat content influences the bioavailability of the flavonol quercetin. In the present study, the influence of the fatty acid pattern of dietary fats on the oral bioavailability of quercetin was investigated. Quercetin (30 micromol/kg body weight) was administered to growing pigs (n 6) in test meals consisting either of 200 g of a standard pig diet (2% crude fat) or of the same diet supplemented with 15 g fat/100 g diet using either medium-chain (MCT) or long-chain fatty acid triacylglycerols (LCT). Blood samples were drawn repeatedly over a period of 24 h and analysed by HPLC. In addition, the influence of the different diets on gastric emptying was investigated in rats. In pigs, the bioavailability of quercetin was measured by quantifying its plasma metabolites with an intact flavonol structure. Bioavailability was enhanced by 38% (P<0.05) and 12% (P>0.05) after intake with the MCT and LCT diets, respectively, compared to the standard diet. Maximum plasma concentrations of quercetin were reached significantly later with the MCT diet than with the LCT or the standard diet (P<0.05). No differences in dry matter of the gastric content were observed 60 min after intake of the experimental diets in rats. Thus, administration of quercetin together with a diet containing MCT fat enhances the bioavailability of the flavonol. Absorption of quercetin was delayed significantly with this diet. However, this was probably not due to slower gastric emptying of the MCT diet.

Animals↗

Diet and mortality in a cohort of elderly people in a north European community.

BACKGROUND: In studies from Italy and Greece a Mediterranean dietary pattern predicts overall survival. Despite an increase in the movement of food around the world, there is still a wide spectrum of dietary patterns and the aim of the present study was to examine the association between a Mediterranean dietary pattern and mortality in a cohort of elderly people living in a North European Community. METHODS: Diet and nutritional status was studied among 202 men and women born 1914-1918 and living in a Danish Municipality (Roskilde) in 1988. They were followed for 6 years. RESULTS: A diet score, with seven dietary characteristics of the Mediterranean diet, was associated with a significant reduction in overall mortality. A one unit increase in the diet score predicted a 21% (95% confidence interval 2-36%) reduction in mortality. Subjects with high diet scores (> or = 4) had significantly higher plasma carotene levels than those with a low score and plasma carotene was negatively associated with mortality. CONCLUSION: A Mediterranean diet score predicts survival in a North European population. Plasma carotene may serve as an intermediate factor in this association.

Aged↗

Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects.

OBJECTIVE: To compare the long-term compliance and effects of two low-fat diets differing in carbohydrate to protein ratio on body composition and biomarkers of cardiovascular disease risk in obese subjects with hyperinsulinemia. DESIGN: Outpatient, parallel, clinical intervention study of two groups of subjects randomly assigned to either a standard protein (SP; 15% protein, 55% carbohydrate) or high-protein (HP; 30% protein, 40% carbohydrate) diet, during 12 weeks of energy restriction (approximately 6.5 MJ/day) and 4 weeks of energy balance (approximately 8.3 MJ/day). Subsequently, subjects were asked to maintain the same dietary pattern for the succeeding 52 weeks with minimal professional support. SUBJECTS: A total of 58 obese, nondietetic subjects with hyperinsulinemia (13 males/45 females, mean age 50.2 y, mean body mass index (BMI) 34.0 kg/m2, mean fasting insulin 17.8 mU/l) participated in the study. MEASUREMENTS: : Body composition, blood pressure, blood lipids, fasting glucose, insulin, CRP and sICAM-1 were measured at baseline and at weeks 16 and 68. Urinary urea/creatinine ratio was measured at baseline, week 16 and at 3 monthly intervals thereafter. RESULTS: In total, 43 subjects completed the study with similar dropouts in each group (P=0.76). At week 68, there was net weight loss (SP -2.9+/-3.6%, HP -4.1+/-5.8%; P<0.44) due entirely to fat loss (P<0.001) with no diet effect [corrected]. Both diets significantly increased HDL cholesterol concentrations (P<0.001) and decreased fasting insulin, insulin resistance, sICAM-1 and CRP levels (P<0.05). Protein intake was significantly greater in HP during the initial 16 weeks (P<0.001), but decreased in HP and increased in SP during 52-week follow-up, with no difference between groups at week 68, indicating poor long-term dietary adherence behaviour to both dietary patterns. CONCLUSION: Without active ongoing dietary advice, adherence to dietary intervention is poor. Nonetheless, both dietary patterns achieved net weight loss and improvements in cardiovascular risk factors.

Adult↗

Dietary management of blood pressure.

Hypertension is a major cause of morbidity and mortality in the United States, particularly in the African-American population. Although there have been indications since the beginning of this century that blood pressure might be influenced by dietary factors, this has been generally ignored, and the mainstay of hypertension treatment has been the use of pharmacologic antihypertensives. Attention is now being focused, however, on dietary management of hypertension because of the high cost of drug therapy, the adverse reactions associated with some antihypertensives, and the fact that hypertensives treated only by pharmacologic means remain at risk for target-organ damage. The literature is replete with evidence that vegetarian and low-sodium dietary patterns are associated with lower blood pressure levels. This implies that if many people could adopt vegetarian and low-salt dietary habits, the prevalence of hypertension would be significantly reduced. However, most people find "unsalted" vegetarian diets tasteless and unacceptable. We therefore need to identify the macro- and micronutrients (other than sodium) that directly influence blood pressure. Several studies indicate that dietary patterns rich in fiber, calcium, potassium, and magnesium are favorable for blood pressure control. This review highlights some of these findings and emphasizes the need for large clinical trials to test blood-pressure-reducing dietary patterns by incorporating the aforementioned macro- and micronutrients into socioculturally acceptable and palatable menus, especially in the African-American population.

Adult↗

The effects of diet on inflammation: emphasis on the metabolic syndrome.

Reducing the incidence of coronary heart disease with diet is possible. The main dietary strategies include adequate omega-3 fatty acids intake, reduction of saturated and trans-fats, and consumption of a diet high in fruits, vegetables, nuts, and whole grains and low in refined grains. Each of these strategies may be associated with lower generation of inflammation. This review examines the epidemiologic and clinical evidence concerning diet and inflammation. Dietary patterns high in refined starches, sugar, and saturated and trans-fatty acids, poor in natural antioxidants and fiber from fruits, vegetables, and whole grains, and poor in omega-3 fatty acids may cause an activation of the innate immune system, most likely by an excessive production of proinflammatory cytokines associated with a reduced production of anti-inflammatory cytokines. The whole diet approach seems particularly promising to reduce the inflammation associated with the metabolic syndrome. The choice of healthy sources of carbohydrate, fat, and protein, associated with regular physical activity and avoidance of smoking, is critical to fighting the war against chronic disease. Western dietary patterns warm up inflammation, while prudent dietary patterns cool it down.

Antioxidants↗

Disparities within traditional Mediterranean food patterns: an historical approach of the Greek diet.

The scope of this study was to address the historical features underpinning the Greek variant of the Mediterranean diet and to examine whether relevant differences exist among dietary patterns followed in Greece prior to World War II and those recorded in the 1960s within the Seven Countries Study framework. For this purpose, archival data on family budgets were used to extract information on food availability and composition of the diets followed by two rural Greek populations prior to World War II. Results indicate that diets followed by rural Greeks in the nineteenth century and early twentieth century were characterized by a low availability of fat sources, olive oil included. Lipids represented 22-27% of the total available energy, saturated fatty acids accounted for less than 10% of the total energy, while monounsaturated fatty acids contributed 8-9% of the energy. Our results suggest that although the dietary patterns of the nineteenth century and early twentieth century are in line with the Cretan diet of the 1960s with regards to saturated fat intake, important differences can be traced with regards to total and monounsaturated fat intake. These findings suggest that the model of the Mediterranean diet represents a dietary pattern that has not persisted over a long time period in the region.

Dietary Fats↗

Patterns in food use and their associations with nutrient intakes.

This study used the frequency of food-use data collected previously in the Western New York Diet Study, a case-control study of diet and cancer at various sites, to develop measures of dietary patterns for subsequent use in epidemiologic research. Factor analysis was applied to frequency-of-use data of 110 foods for 1475 male and 780 female control subjects. Nine dietary-pattern factors were extracted for each gender. Correlational analyses examined relationships with intakes of nutrients of concern to cancer epidemiologists--energy, total fat, dietary fiber, and vitamins A and C. Findings indicate that the usual measure for assessing dietary risks, quantile of nutrient intake, reflects several dietary patterns differing in their composition of cancer risk factors. Furthermore, patterns may relate to such variables as age, ethnicity, and income, which are themselves related to cancer. This approach may provide a comprehensive measure of dietary exposure for epidemiologic research.

Diet↗

The DASH Diet, Sodium Intake and Blood Pressure Trial (DASH-sodium): rationale and design. DASH-Sodium Collaborative Research Group.

The DASH Diet, Sodium Intake and Blood Pressure Trial (DASH-Sodium) is a multicenter, randomized trial comparing the effects of 3 levels of sodium intake and 2 dietary patterns on blood pressure among adults with higher than optimal blood pressure or with stage 1 hypertension (120-159/80-95 mm Hg). The 2 dietary patterns are a control diet typical of what many Americans eat, and the DASH diet, which, by comparison, emphasizes fruits, vegetables, and low-fat dairy foods, includes whole grains, poultry, fish, and nuts, and is reduced in fats, red meat, sweets, and sugar-containing beverages. The 3 sodium levels are defined as higher (typical of current US consumption), intermediate (reflecting the upper limit of current US recommendations), and lower (reflecting potentially optimal levels). Participants are randomly assigned to 1 of the 2 dietary patterns using a parallel group design and are fed each of the 3 sodium levels using a randomized crossover design. The study provides participants with all of their food during a 2-week run-in feeding period and three 30-day intervention feeding periods. Participants attend the clinic for 1 meal per day, 5 days per week, and take home food for other meals. Weight is monitored and individual energy intake adjusted to maintain baseline weight. The primary outcome is systolic blood pressure measured at the end of each intervention feeding period. Systolic blood pressure is compared across the 3 sodium levels within each diet and across the 2 diets within each sodium level. If effects previously observed in clinical trials are additive, sodium reduction and the DASH diet together may lower blood pressure to an extent not as yet demonstrated for nonpharmacologic treatment. The DASH-Sodium results will have important implications for the prevention and treatment of high blood pressure.

Adult↗

Phylloquinone intake and risk of cardiovascular diseases in men.

BACKGROUND AND AIMS: Dietary patterns high in fruits and vegetables have been associated with lower risk of cardiovascular diseases. It is difficult to assess whether individuals are following a dietary pattern recommended for cardiovascular disease prevention in large population based studies. Therefore, the association between phylloquinone (vitamin K(1)) intake, derived mainly from green vegetables, and risk of cardiovascular diseases [total and fatal coronary heart disease (CHD), non-fatal myocardial infarction, total and ischemic stroke] was prospectively assessed. METHODS AND RESULTS: The study was conducted in 40,087 men who participated in the Health Professionals' Follow-up Study during 1986-2000. There were 1857 CHD events and 617 strokes. After adjustment for lifestyle factors, the relative risks of total CHD events in increasing quintile categories of phylloquinone intake were 1 (reference), 0.84, 0.87, 0.82 and 0.84, respectively (P for trend 0.05). However, the risk of CHD events and strokes did not remain significantly associated with phylloquinone intake after adjustment for lifestyle and other dietary factors. CONCLUSION: These results suggest that although not an independent risk factor, high phylloquinone intake may be a marker of dietary patterns associated with lower CHD risk and useful when used within that context.

Adult↗

Adequate nutrient intake can reduce cardiovascular disease risk in African Americans.

Cardiovascular disease kills nearly as many Americans each year as the next seven leading causes of death combined. The prevalence of cardiovascular disease and most of its associated risk factors is markedly higher and increasing more rapidly among African Americans than in any other racial or ethnic group. Improving these statistics may be simply a matter of improving diet quality. In recent years, a substantial and growing body of evidence has revealed that dietary patterns complete in all food groups, including nutrient-rich dairy products, are essential for preventing and reducing cardiovascular disease and the conditions that contribute to it. Several cardiovascular risk factors, including hypertension, insulin resistance syndrome, and obesity, have been shown to be positively influenced by dietary patterns that include adequate intake of dairy products. The benefits of nutrient-rich dietary patterns have been specifically tested in randomized, controlled trials emphasizing African American populations. These studies demonstrated proportionally greater benefits for African Americans without evidence of adverse effects such as symptoms of lactose intolerance. As currently promoted for the prevention of certain cancers and osteoporosis, regular consumption of diets that meet recommended nutrient intake levels might also be the most effective approach for reducing cardiovascular disease risk in African Americans.

Black People↗

Combination of dietary factors in relation to breast-cancer occurrence.

Combinations of dietary factors were studied in relation to breast-cancer occurrence among 133 breast cancer cases and 289 population controls in The Netherlands. Dietary factors were classified according to their possible mechanism of action, i.e., relating either to the intestinal microflora (total fat, fiber, fermented milk products) or to the anti-oxidant hypothesis (beta-carotene, selenium and polyunsaturated fatty acids). From 6 interactions evaluated, the combination of high fiber intake and high intake of fermented milk products was the only one suggesting synergistic protection (age-and-fat-adjusted OR for interaction = 0.48, 95% confidence interval (CI) = 0.21 - 1.13). In order to estimate the extent to which the above dietary factors together might be related to breast cancer, subjects with a supposedly favorable dietary pattern (low fat intake, high fiber intake, high intake of fermented milk products; high intake of beta-carotene and selenium, low intake of polyunsaturated fatty acids) were compared with subjects with an unfavorable dietary pattern. This resulted in an age-adjusted odds ratio of 0.40 (95% CI = 0.14 - 1.15), which was largely attributable to the combination of low intake of fat and high intake of fermented milk products and fiber (age-adjusted OR = 0.33, 95% CI = 0.15 - 0.73). The other factors did not appreciably affect the odds ratio. These analyses show in a quantitative way that a dietary pattern which combines low intake of fat and high intake of fiber and fermented milk products might provide substantial protection against breast cancer.

Adult↗

Mediterranean diet and reduction in the risk of a first acute myocardial infarction: an operational healthy dietary score.

BACKGROUND: Although an important secondary prevention trial reported an impressive protection by a Mediterranean dietary pattern on reinfarction and cardiovascular death, scarce direct epidemiologic evidence is currently available regarding the role of the Mediterranean diet in the aetiology of coronary heart disease. AIMS: The aim of the study was to quantify the risk reduction of incident myocardial infarction provided by a Mediterranean dietary pattern. METHODS: We included 342 subjects (171 patients who suffered their first acute myocardial infarction and 171 matched controls) in a case-control study. A validated semi-quantitative food frequency questionnaire (136 items) was used. We defined an a priori Mediterranean dietary pattern. We assessed six food items that we considered protective: 1) olive oil, 2) fiber, 3) fruits, 4)vegetables, 5) fish and 6) alcohol. For each of these six dietary factors, we calculated the distribution according to quintiles within the study and assigned each participant a score of 1 to 5 corresponding to the quintile of intake, with 1 representing the lowest and 5 representing the highest quintile. We also estimated the quintiles of two other elements assumed to be associated with a higher risk: 7) meat/meat products and 8) some items with high glycaemic load (white bread, pasta and rice). For these two elements we inversely ranked the score, with 1 representing the highest and 5 representing the lowest quintile. Finally, we summed up the eight quintile values for each participant.A second score ( post hoc pattern) was built using only a single cut-off point for these eight elements. The cut-off points for each element in this post hoc pattern were decided according to the dose-response relationships between the consumption of each food item and the risk of myocardial infarction observed in the analyses that used quintiles of each food item. RESULTS: For both patterns, we found that the higher the score, the lower the odds ratio of myocardial infarction. A significant linear trend was apparent after adjustment for the main cardiovascular risk factors. For each additional point in the a priori Mediterranean pattern (observed range: 9-38) the odds ratio (95 % confidence intervals) was 0.92 (0.86-0.98). This estimate was 0.55 (0.42-0.73) when we used the post hoc pattern (range: 0-8). CONCLUSIONS: Our data support the hypothesis that a Mediterranean diet (that emphasizes olive oil, fiber, fruits, vegetables, fish and alcohol and reduces meat/meat products) can be an effective measure for reducing the risk of myocardial infarction. However, our results support the exclusion of refined cereals with a high glycaemic load as healthy elements of this pattern.

Alcohol Drinking↗

What do vegetarians in the United States eat?

BACKGROUND: Dietary patterns and nutrient intakes of vegetarians in a nationally representative survey have not been described. OBJECTIVE: We sought to profile and compare nutrient and food consumption patterns of self-defined vegetarians and nonvegetarians in a representative sample of the US population. DESIGN: Data from 13 313 participants (age: >/= 6 y) in the Continuing Survey of Food Intake by Individuals (CSFII) 1994-1996, 1998 were used to compare vegetarian and nonvegetarian dietary patterns. Self-defined vegetarians and nonvegetarians were those who responded positively or negatively, respectively, to the question "Do you consider yourself to be a vegetarian?" The vegetarian and nonvegetarian groups were further characterized as "no meat" or "ate meat" on the basis of a consumption cutoff of 10 g meat/d reported on 2 nonconsecutive 24-h dietary recalls. RESULTS: Self-defined vegetarians whose recalls did not include meat represented 0.9% of this nationally representative sample of noninstitutionalized persons residing in the United States. Compared with nonvegetarians who ate meat, self-defined vegetarians aged >/= 20 y had lower body mass indexes regardless of whether they ate meat. Diets of self-defined vegetarians tended to be lower in total fat, saturated fat, and cholesterol and higher in fiber than did the diets of nonvegetarians who ate meat. Self-defined vegetarians whose recalls contained no meat consumed more grains, legumes, vegetables (green leafy and yellow), fruit, and wine, whereas those who ate meat consumed more fruit than did nonvegetarians. CONCLUSION: Self-defined vegetarians may consume red meat, poultry, or fish. However, their dietary patterns are generally healthier than are those of nonvegetarians.

Adolescent↗

The Mediterranean diets: What is so special about the diet of Greece? The scientific evidence.

The term "Mediterranean diet," implying that all Mediterranean people have the same diet, is a misnomer. The countries around the Mediterranean basin have different diets, religions and cultures. Their diets differ in the amount of total fat, olive oil, type of meat and wine intake; milk vs. cheese; fruits and vegetables; and the rates of coronary heart disease and cancer, with the lower death rates and longer life expectancy occurring in Greece. Extensive studies on the traditional diet of Greece (the diet before 1960) indicate that the dietary pattern of Greeks consists of a high intake of fruits, vegetables (particularly wild plants), nuts and cereals mostly in the form of sourdough bread rather than pasta; more olive oil and olives; less milk but more cheese; more fish; less meat; and moderate amounts of wine, more so than other Mediterranean countries. Analyses of the dietary pattern of the diet of Crete shows a number of protective substances, such as selenium, glutathione, a balanced ratio of (n-6):(n-3) essential fatty acids (EFA), high amounts of fiber, antioxidants (especially resveratrol from wine and polyphenols from olive oil), vitamins E and C, some of which have been shown to be associated with lower risk of cancer, including cancer of the breast. These findings should serve as a strong incentive for the initiation of intervention trials that will test the effect of specific dietary patterns in the prevention and management of patients with cancer.

Animals↗

Overeating, dietary selection patterns and sucrose intake in growing rats.

Weaning rats were allowed access to food for either 5 hours or 24 hours per day. Within each food availability condition one group had access to a complete diet and one group had access to the complete diet and a 32% solution of sucrose. Caloric intake and rates of growth were considerably higher in the 24 hour access group. The availability of sucrose led to a small (10--15%) but consistent elevation in caloric intake in the ad lib condition but did not influence growth in either food availability condition. Absolute levels of sucrose intake and the proportion of calories taken from the sucrose solution were consistently higher in the ad lib group and increased with increases in body size for both groups. Dilution of the chow component or the sucrose component of the diet did not alter dietary selection patterns in either food availability condition. It appears that access to a palatable carbohydrate solution can lead to overeating in the rat but these solutions do not induce the rat to select imbalanced diets that compromise growth.

Age Factors↗

Assessing endothelial function as a risk factor for cardiovascular disease.

The vascular endothelium plays a key role in the prevention of atherosclerosis. Endothelial dysfunction is an antecedent of clinical cardiovascular disease and can be viewed as the final pathway between coronary risk factors and the development of atherosclerosis. The development of a noninvasive method of assessing endothelial health (ie, measurement of flow- mediated dilation of the brachial artery) has enabled investigators to evaluate the effects of dietary patterns on vascular function. Emerging evidence indicates that dietary fats may acutely impair endothelial function, but this effect is dependent on the type of fat and on the other nutrients consumed. Although inconclusive, studies in cohorts of modest size suggest that antioxidants, L-arginine, and folic acid may modulate endothelial function. Additional research is needed to define the impact of complex, long-term dietary patterns on the vascular endothelium.

Antioxidants↗

Is principal components analysis necessary to characterise dietary behaviour in studies of diet and disease?

OBJECTIVE: To assess the relative ability of principal components analysis (PCA)-derived dietary patterns to correctly identify cases and controls compared with other methods of characterising food intake. SUBJECTS: Participants in this study were 232 endometrial cancer cases and 639 controls from the Western New York Diet Study, 1986-1991, frequency-matched to cases on age and county of residence. DESIGN: Usual intake in the year preceding interview of 190 foods and beverages was collected during a personal interview using a detailed food-frequency questionnaire. Principal components analysis identified two major dietary patterns which we labelled 'healthy' and 'high fat'. Classification on disease status was assessed with separate discriminant analyses (DAs) for four different characterisation schemes: stepwise DA of 168 food items to identify the subset of foods that best discriminated between cases and controls; foods associated with each PCA-derived dietary pattern; fruits and vegetables (47 items); and stepwise DA of USDA-defined food groups (fresh fruit, canned/frozen fruit, raw vegetables, cooked vegetables, red meat, poultry, fish and seafood, processed meats, snacks and sweets, grain products, dairy, and fats). RESULTS: In general, classification of disease status was somewhat better among cases (54.7% to 67.7%) than controls (54.0% to 63.1%). Correct classification was highest for fruits and vegetables (67.7% and 62.9%, respectively) but comparable to that of the other schemes (49.5% to 66.8%). CONCLUSIONS: Our results suggest that the use of principal components analysis to characterise dietary behaviour may not provide substantial advantages over more commonly used, less sophisticated methods of characterising diet.

Case-Control Studies↗

The effects of high phosphorus intake on calcium homeostasis.

Survey data confirm that the dietary pattern of many American women who are at high risk of developing osteoporosis is typically high in phosphorus and low in calcium. The imbalance between calcium and phosphorus intake may become more pronounced with continued changes in food preferences and the growing use of phosphorus-containing food additives. Recent studies in young women have shown that a high phosphorus diet moderately low in calcium results in a mild secondary hyperparathyroidism that persists over 4 weeks. Plasma levels of calcitriol did not change despite changes in PTH and serum ionized calcium. Studies on men have shown that dietary phosphorus at levels within the normal range of intakes can affect the renal production and serum concentration of calcitriol. High phosphorus intakes for ten days reduced their plasma calcitriol levels; a 70% reduction in phosphate intake significantly increased their plasma calcitriol. Thus, several lines of evidence indicate that prolonged high phosphorus intake may impair the usual homeostatic mechanisms that come into play when dietary calcium is limited. This, in turn, could impair achievement of maximal bone mass or accelerate bone loss. Although no clinical studies have linked high phosphorus intake with lower bone mass or higher rates of bone loss in humans, this relationship has been demonstrated in animal models. For example, young beagles fed high phosphorus, moderately low calcium diets showed a significant reduction in vertebral bone mass. Current dietary patterns of high phosphorus, low calcium consumption result in persistent changes in calcium regulating hormones that are not conducive to maximizing peak bone mass during growth or slowing the rate of aging bone loss. The net effect of the present dietary pattern on bone status, particularly in teenage and young adult women, needs to be determined. Optimal nutrition early in life, which may include higher calcium and lower phosphorus intakes, together with adequate exercise, may be the most cost-effective approach to the prevention of osteoporotic fractures.

Animals↗