Pecan-enriched diets decrease postprandial lipid peroxidation and increase total antioxidant capacity in adults at-risk for cardiovascular disease

Pecans are a rich source of antioxidants, but the effect of regular consumption on post-meal responses is unknown. The objective of this study was to examine the impact of daily pecan consumption for 8 weeks on fasting and postprandial lipid peroxidation, total antioxidant capacity (TAC), and tocopherols in adults at higher risk for cardiovascular disease (CVD) (hypercholesterolemia or elevated adiposity). We hypothesized that daily pecan consumption would result in increased fasting γ-tocopherol, increased fasting and postprandial TAC, and decreased fasting and postprandial lipid peroxidation. This was a randomized, parallel, controlled trial with 3 treatments: two pecan groups and a nut free control (n = 16). The ADD group (n = 15) consumed pecans as part of a free-living diet, and the SUB group (n = 16) substituted the pecans for isocaloric foods from their habitual diet. At the pre- and post-intervention, a high saturated fat breakfast shake was consumed with postprandial blood draws over 2h. In the ADD and SUB groups, postprandial lipid peroxidation was suppressed (iAUC: 0.9 ± 1.3 to -2.9 ± 2.0 and 4.5 ± 1.7 to 0.7 ± 1.1 µM/2h, respectively; P <0.05) and TAC was elevated (iAUC: -240.8 ± 110.2 to 130.9 ± 131.7 and -227.6 ± 131.2 to 208.7 ± 145.7 µM Trolox Equivalents/2h, respectively; P <0.01) from pre- to post-intervention. Furthermore, there was an increase in γ-tocopherol from pre- to post-intervention within the ADD (1.4 ± 0.1 to 1.8 ± 0.1 µg/mL; P <0.001) and SUB groups (1.8 ± 0.2 to 2.1 ± 0.2 µg/mL; P <0.05). There were no changes in any variable within the control group. These findings suggest that daily pecan consumption protects against oxidative stress that occurs following a high-fat meal in adults at risk for CVD.     

Pecans acutely increase plasma postprandial antioxidant capacity and catechins and decrease LDL oxidation in humans

Bioactive constituents of pecan nuts such as γ-tocopherol and flavan-3-ol monomers show antioxidant properties in vitro, but bioavailability in humans is not known. We examined postprandial changes in plasma oxygen radical absorbance capacity (ORAC) and in concentrations of tocopherols, catechins, oxidized LDL, and malondialdehyde (MDA) in response to pecan test meals. Sixteen healthy men and women (23-44 y, BMI 22.7 ± 3.4) were randomly assigned to 3 sequences of test meals composed of whole pecans, blended pecans, or an isocaloric meal of equivalent macronutrient composition but formulated of refined ingredients in a crossover design with a 1-wk washout period between treatments. Blood was sampled at baseline and at intervals up to 24 h postingestion. Following the whole and blended pecan test meals, plasma concentrations of γ-tocopherols doubled at 8 h (P < 0.001) and hydrophilic- and lipophilic-ORAC increased 12 and 10% at 2 h, respectively. Post whole pecan consumption, oxidized LDL decreased 30, 33, and 26% at 2, 3, and 8 h, respectively (P < 0.05), and epigallocatechin-3-gallate concentrations at 1 h (mean ± SEM; 95.1 ± 30.6 nmol/L) and 2 h (116.3 ± 80.5 nmol/L) were higher than at baseline (0 h) and after the control test meal at 1 h (P < 0.05). The postprandial molar ratio of MDA:triglycerides decreased by 37, 36, and 40% at 3, 5, and 8 h, respectively (P < 0.05), only when whole and blended pecan data were pooled. These results show that bioactive constituent of pecans are absorbable and contribute to postprandial antioxidant defenses.     

Status of novel cardiovascular risk factor and cardiovascular disease risk in an urban Cuban population--a pilot study

Cardiovascular disease is the main cause of death in Cuba, yet the prevalence of novel risk factors is not known. To examine the prevalence of risk factors of traditional and novel cardiovascular diseases (CVDs) among an urban Cuban population, a cross-sectional pilot survey was undertaken in Havana city, Cuba. Ninety-seven adults aged 45-60 years registered to receive medical care at a policlinic. The prevalences of rates of CVD risk factors were: hypertension (> or =140/90 mmHg) (53.6%), hypercholesterolaemia (total cholesterol >5.2 mmol/L) (47.0%), low high-density lipoprotein (HDL)-cholesterol (<1.03 mmol/L) (64.3%); diabetes (self-reported) (24.6%); metabolic syndrome (ATP III criteria) (58.2%); overweight and obesity (body mass index > or = 25 kg/m2) (78.0%); current smoking (39.3%); elevated level of C-reactive protein (3 15 micromol/L) (11.1%). The total carotenoid status was independently associated with waist-circumference and risk of diabetes and metabolic syndrome. In this small unrepresentative sample of people aged 40-65 years from Havana city, there was a high prevalence of traditional and novel CVD risk factors. The total serum carotenoid status appeared to be associated with an increased prevalence of CVD risk factors.     

A new thrombophilia risk factor: the increase of plasma factor VIII

Factor VIII (FVIII) is key component of the fluid phase of the blood coagulation system. Recent evidence suggests a direct relationship between high plasma levels of FVIII and an increased risk for arterial and venous thrombosis. Thus material reviews the most important clinical and epidemiological evidence about this prothrombotic association. Main function of FVIII is to activate FX functioning as a cofactor for activated FIX in the presence of phospholipids and calcium. Since its deficiency has been historically associated with a hemorrhagic disease (namely hemophilia A), it was never studied its role in thrombosis. In order to explain the association FVIII and thrombosis, defects in its synthesis that increase its plasma concentration as well as postranslational modifications that allow a higher activity, have been proposed. Since 1977 it was suggested that increased plasma concentrations of FVIII and thrombosis may be associated. Shortly after, several other studies confirmed this association. Indeed, patients with stroke of acute myocardial infarction having high plasma levels of FVIII have a shorter survival. On the other hand, deep venous thrombosis is more frequent in patients with high plasma levels of FVIII. This rise in plasma FVIII concentration is also associated with recurrent venous thrombosis. The increment of plasma FVIII concentration is not due to an acute phase reaction. Plasma concentrations of FVIII above 100-150 IU/dL increase 3-fold the risk of thrombosis while concentrations above 150 IU/dL increase the the same risk 6-fold. While it is established the real importance of FVIII as a cause of thrombosis, every patient at risk of thrombosis must have a quantification of this factor. Evaluation of plasma FVIII concentration must be performed in patients with suspected thrombophilia since there is evidence that shows that high plasma FVIII levels is an independent thrombophilic risk factor. There are not effective therapeutic interventions able to normalize the high concentrations of FVIII. Therefore, appropriate prophylaxis during high thrombosis risk clinical episodes is the best alternative for the patient.     

Action Schools! BC: a school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children

OBJECTIVE: Our primary objective was to determine whether a novel 'active school' model--Action Schools! BC--improved the cardiovascular disease (CVD) risk profile in elementary-school children. Our secondary objective was to determine the percentage of children with elevated CVD risk factors. METHODS: We undertook a cluster-randomized controlled school-based trial with 8 elementary schools across 1 school year, in British Columbia, Canada, beginning in 2003. Boys and girls (n=268, age 9-11 years) were randomly assigned (by school) to usual practice (UP, 2 schools) or intervention (INT, 6 schools) groups. We assessed change between groups in cardiovascular fitness (20-m Shuttle Run), blood pressure (BP), and body mass index (BMI, wt/ht(2)). We evaluated total cholesterol (TC), total:high-density cholesterol (TC:HDL-C), low-density lipoprotein, apolipoprotein B, C-reactive protein and fibrinogen on a subset of volunteers (n=77). RESULTS: INT children had a 20% greater increase in fitness and a 5.7% smaller increase in BP compared with children attending UP schools (P<0.05). Forty five percent of children had at least one elevated risk factor (fitness, BP or BMI) at baseline. There were no significant differences between groups for change in BMI or in any of the blood variables. CONCLUSION: Action Schools! BC was an effective school-based physical activity model for improving the CVD risk profile of elementary-school children. Our multi-component intervention exposed children to fitness enhancing physical activity. It may be important for education stakeholders to adequately resource the delivery of the active school models if cardiovascular health benefits are to be achieved on a population basis.     

Characteristics of respondents to telephone and household cardiovascular disease risk factor surveys

Telephone surveys have been used for years to study a wide varietyof topics ranging from public opinions to health information,and they will most likely be an important tool in the planning,conducting and evaluation of community-based health promotionprograms designed to accomplish the broad public health goalsset forth by the US Government for the year 2000. Many studieshave compared the results from telephone and household surveysand found that, for some kinds of information, respondent characteristicsand data quality of telephone surveys are similar to those ofmore time consuming and costly face-to-face household surveys.From March 1989 to May 1990, 1328 adults from Pawtucket, RIwere interviewed either in person or by telephone about cardiovasculardisease (CVD)-related risk factors, behaviours and knowledge,as well as selected demographic characteristics. Demographiccharacteristics of respondents to the two surveys were quitesimilar except for race, which differed significantly betweenthe two surveys. Some self-reported CVD-related characteristicswere similar between the two surveys (smoking, history of highblood pressure or cholesterol and self-rated blood pressureor cholesterol compared with others of similar age and sex),while others were not (CVD knowledge index, body mass index,prevalence of obesity, blood pressure, prevalence of hypertensionand physical activity). With careful attention to the limitationsof telephone surveys, this survey method can confidently beapplied to the evaluation of other health promotion programsthus allowing more extensive data collection at less cost.     

Parental history and cardiovascular disease risk factor variables in children

As part of a total community study of cardiovascular disease (CVD) risk factor variables in children (ages 5–17 years), parental histories of heart attacks, hypertension, diabetes, and stroke were obtained for each of 4,074 participating children. Subsequently, each child was examined for serum total cholesterol, triglycerides, lipoproteins (LP) and glucose, measurement of height, weight, triceps skinfold thickness, and blood pressure (BP), and had a physical examination. A family history of high BP was reported by 26.5% of all children, diabetes by 7.1%, heart attacks by 6.8%, and stroke by 2.1%. The children of parents with heart attacks or diabetes were heavier and had different lipid and LP profiles than children without this background. Children of reported hypertensive parents had higher systolic and diastolic BP, were heavier and had thicker skinfolds. The heaviest children were more likely to have a parental history of diabetes, hypertension, and heart attack. Children in the highest decile for systolic or diastolic BP were more likely to come from a family reporting hypertension. Children with the highest cholesterol, triglycerides, β + pre-β-LP and lowest α-LP values tended to have parents with heart attacks or diabetes. These data indicate that familial tendencies in multiple CVD risk factors are observable early in life. Children of parents with CVD or manifested risk factors clearly differ in their own risk factor profiles from children of parents without these conditions.     

Polymorphisms in serine hydroxymethyltransferase 1 and methylenetetrahydrofolate reductase interact to increase cardiovascular disease risk in humans

The enzymes serine hydroxymethyltransferase 1 (gene name SHMT1) and methylenetetrahydrofolate reductase (gene name MTHFR) regulate key reactions in folate-mediated one-carbon metabolism. Common genetic variants with the potential to influence disease risk exist in both genes. A prior report from the Normative Aging Study indicated no association of the SHMT1 rs1979277 SNP with cardiovascular disease (CVD), but a strong gene-gene interaction was detected with MTHFR rs1801133. We investigated the effect of the SHMT1 rs1979277 SNP and the SHMT1 rs1979277-MTHFR rs1801133 interaction in 2 epidemiologic cohort studies. In the Nurses' Health Study (NHS), the MTHFR rs1801133 variant genotypes were associated with an increased CVD risk and there was an interaction between SHMT1 and MTHFR such that the association of the MTHFR rs1801133 CT genotype (vs. CC; the TT genotype could not be evaluated) was stronger in the presence of the SHMT1 rs1979277 TT genotype (OR = 4.34, 95% CI = 1.2, 16.2; P = 0.049). In the Health Professionals Follow-Up Study, the MTHFR rs1801133 genotype was not associated with CVD risk, nor was there an interaction with SHMT1 rs1979277. The association of genetic variation in the SHMT1 gene, alone and in interaction with MTHFR, in relation to CVD risk is relatively understudied at the population level and results in the NHS confirmed a past report of gene-gene interaction, which is consistent with mechanisms suggested by basic science studies.     

Multiple risk factor reduction in the prevention of cardiovascular disease

Two hundred and forty members of Varian Corporation were screened for risk of heart disease. After random assignment, 12 high risk subjects were treated with a behavior modification treatment; 10 with individual counseling; and 14 with single-time physician consultation. Treatment for the first two groups lasted for a period of 11 weeks.Treatment objectives were to achieve behavior change affecting weight, smoking, diet, and physical activity and change in cholesterol and triglyceride levels as deemed necessary from each subject's individual risk score. It was predicted that behavior modification and individual counseling treatments would achieve significantly greater initial change than the physician consultation and that the behavior modification treatment would maintain changes longer than either the individual counseling treatment or physician consultation. Posttest data confirm the first prediction; three-month follow-up data support the second.     

Effect of Spirulina maxima on postprandial lipemia in young runners: a preliminary report

Trained people exhibit low plasma concentrations of triacylglcyerols in both fasting and postprandial states. Exercise practice is commonly believed to improve postprandial lipemia. In addition, elevated postprandial lipemia is an indicator of poor lipid clearance, and it has been associated with atherosclerosis, insulin resistance, and obesity. Spirulina maxima is an edible microorganism with a high nutritional value. When it is consumed, beneficial properties to health have been demonstrated, such as hypolipemic and antihypertensive properties in human beings. This work evaluates the effects of orally administrated S. maxima on postprandial lipemia in a young Mexican sporting population after 15 days of consumption, as a possible alternative treatment to improve their lipid clearance. Forty-one runners (10-26 years old; 21 men and 20 women) volunteered to participate in the study. All of them were physically active for at least 1 year before the study and were not undergoing training during the study. The subjects consumed 5 g of Spirulina during 15 days. Before and after the treatment with Spirulina, they consumed (12 h fasting) a standardized meal with high fat content (53.2% total calories). Postprandial lipemia was measured at 1.5, 3, and 4.5 h after the fatty meal. Fasting plasma triacylglycerol (TAG) concentrations were lower after Spirulina treatment than before treatment. In addition, the postprandial area under the curve of TAG concentrations was lower after the treatment with Spirulina. Sixty-two percent of the youngest runners (10-16 years) studied exhibited the best response to the treatment. Orally administered S. maxima decreased postprandial lipemia in sporting teenagers. The youngest people were the most responsive to the beneficial effects of Spirulina on postprandial lipemia.     

Total plasma homocysteine level and risk of cardiovascular disease: a meta-analysis of prospective cohort studies

The role of homocysteine as a risk factor for cardiovascular disease remains controversial because positive reports from case-control studies may be the consequence of reverse causality bias, and positive and negative results have been reported in cohort studies. This is a meta-analysis of published cohort studies. An average relative risk (ARR) was calculated using fixed and random effect models. The likelihood of publication and selection bias, and the impact of each study on the ARR were also evaluated. Fourteen eligible studies were retrieved. We found no evidence of publication bias (P =.62) nor heterogeneity (P =.56). The ARRs from a fixed effect model were 1.49 (95% CI: 1.31-1.70) for cardiac events, and 1.37 (95% CI: 0.99- 1.99) for ischemic stroke. Duration of follow up and age did not significantly change the ARRs. Hyperhomocysteinemia moderately increases the risk of a first cardiovascular event, regardless of age and follow-up duration.     

Pregnancy complications as a risk factor for metabolic and cardiovascular disease in later life

In recent years several large epidemiological studies have been published that demonstrate that women who experience gestational diabetes, pregnancy-induced hypertension or pre-eclampsia have an increased risk of developing type-2 diabetes mellitus and cardiovascular disease. 15-50% of women who experience gestational diabetes develop type-2 diabetes mellitus; the risk is particularly high in those who require insulin therapy during pregnancy. - Chronic hypertension frequently develops years after a pregnancy complicated by pregnancy-induced hypertension, especially in women who have had pregnancy-induced hypertension in multiple pregnancies. Women who experience pre-eclampsia in the first 36 weeks of pregnancy or in multiple pregnancies have an increased risk of cardiovascular morbidity and mortality in later life. Therefore gestational diabetes, pregnancy-induced hypertension and pre-eclampsia provide an opportunity to identify individuals with an increased risk of type-2 diabetes mellitus and cardiovascular disease at an early age. This may create new perspectives on prevention.     

Improving the prediction of cardiovascular risk: interaction between LDL and HDL cholesterol

BACKGROUND: The ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol (or the ratio of low-density lipoprotein [LDL] to HDL) is currently advocated to estimate the coronary risk associated with LDL and HDL cholesterol levels. METHODS: We analyzed the relation between LDL and HDL cholesterol levels to predict the risk of future coronary events. Using data from the Lipid Research Clinics Follow-up Cohort, we developed multivariate equations to predict coronary deaths among 4684 men and women followed for approximately 12 years. We used these equations to compare the predictive power of the LDL/HDL ratio with the independent effects of LDL and HDL and an LDL-HDL interaction term. We then used each model to forecast the 10-year risk of coronary death based on various lipid levels after adjustment for conventional risk factors (eg, blood pressure, gender, cigarette smoking). RESULTS: Levels of LDL and HDL and the interaction between them are all independent risk factors for coronary death. The benefits of increasing HDL are strongest among persons with high LDL. Conversely, the benefits of decreasing LDL are greatest among those with low HDL. We confirmed these observations in a published dataset showing the effects of treatment of hyperlipidemia. Predictions of benefits of treatment that were based on interaction of LDL and HDL were more accurate than predictions without interaction. CONCLUSIONS: The LDL/HDL ratio alone may not fully capture the complex interaction between LDL and HDL and the relation of each to coronary risk.     

Influence of a stearic acid-rich structured triacylglycerol on postprandial lipemia, factor VII concentrations, and fibrinolytic activity in healthy subjects

BACKGROUND: An elevated postprandial lipid concentration is believed to be atherogenic and to increase the risk of thrombosis. OBJECTIVE: The objective was to test whether the consumption of a stearic acid-rich structured triacylglycerol has adverse effects on postprandial fibrinolytic activity and lipemia, factor VII coagulant (FVII:c) activity, and activated FVII (FVIIa) concentrations. DESIGN: A randomized crossover design was used to compare the effects on middle-aged healthy men (n = 17) and women (n = 18) of meals enriched with cocoa butter, high-oleate sunflower oil (oleate), or a structured triacylglycerol containing stearic acid. RESULTS: The mean increases from fasting in plasma triacylglycerol 3 h after the oleate, cocoa butter, and structured triacylglycerol meals were 1.36 (95% CI: 1.17, 1.56), 1.39 (1.17,1.63), and 0.65 (0.50, 0.82) mmol/L, respectively. Tissue plasminogen activator activity increased and plasminogen activator type 1 activity decreased after all 3 meals. Plasma FVII:c increased after the oleate and cocoa butter meals but not after the structured triacylglycerol meal. The values 6 h after the oleate and cocoa butter meals were 11.3% (7.0%, 15.6%) and 9.9% (4.7%, 15.2%), respectively, and were significantly different (P < 0.0001 and P = 0.001, respectively) from the value after the triacylglycerol meal [2.1% (-1.1%, 5.3%)]. Plasma FVIIa increased after all 3 meals, more so after the oleate and cocoa butter meals than after the structured triacylglycerol meal. CONCLUSION: The consumption of stearic acid in the form of a structured triacylglycerol leads to less of an increase in plasma triacylglycerol and in FVII:c than does a meal enriched in cocoa butter or oleate.     

Determination of dietary habits as a risk factor of cardiovascular heart disease in Turkish adolescents

Summary Background To investigate dietary habits and evaluate these with regard to cardiovascular risk status in Turkish adolescents aged 12–19 years. Methods A total of 300 adolescents, 135 males and 165 females aged between 12 and 19, were included in the study. Dietary intake was determined by using 3–day food records (including 1 weekend day). Adolescents smoking habits and familial chronic diseases were recorded. The values obtained for energy and nutrient intakes were compared with RDA and DRI and recommendations given by AHA. Results The mean energy intakes of male and female subjects were 1964 ± 723 kcal and 1804 ± 486 kcal respectively. According to NHANES III, age–standardized (CDC: Centers for Disease Control and Prevention) prevalence of overweight indicated that 20.7% among male and 17.5% among female adolescents were at risk for becoming overweight. The prevalence of premature CHD family history was found to be 9.6% for males and 11.5 % for females. The prevalence of current smoking was found to be 22.2 % for males and 18.2 % for females. In addition, 29.6% of the males and 37.6% of the females were physically inactive (p < 0.05); however, male adolescents (48.2%) were significantly more likely than female adolescents (52.1 %) to report sufficient moderate physical activity (p < 0.05). The dietary fiber intake was slightly below the recommended intake of 10 g per 1000 kcal. Compared to the AHA averages, these adolescents had significantly higher intake of total fat, saturated fat, sodium and dietary cholesterol and lower intake of polyunsaturated fat, monounsaturated fat and dietary fiber. The Turkish adolescents also had higher amounts of energy from fat. The mean percentage of energy from fat was 34.2 ± 6% TE for males and 35.2 ± 6.8 % TE for females; saturated fat was 11.8 ± 6.8 % TE for males and 12.1 ± 8.9 for females. The intake of fat and saturated fat was higher than the AHA recommendations. The polyunsaturated to saturated fat ratio was 0.4 ± 0.2 and reflected a high saturated fat (12.0 ± 7.7% TE) and low polyunsaturated fat (5.5 ± 3.9 % TE) diet. In addition, the percentage of adolescents who did not meet 66% of RDA for vitamin E, B6, and folates and the recommendation for RDA dietary fiber is presented. Approximately, 80% of adolescents failed to meet the dietary recommendation of the AHA for polyunsaturated fatty acids, and about 26.7% reported a cholesterol intake higher than 100 mg/1000 kcal. Conclusion It can be said that fiber, total fat, saturated fatty acid, cholesterol and sodium intake of Turkish adolescents are found to be high; however, their vitamin E, vitamin B6 and folate intake are found to be low compared to AHA recommendations. Turkish adolescents fruit and vegetable intake are also found to be low.     

Trends in cardiovascular disease risk factor prevalence among male transport workers: Bulgaria, 1986 to 1997

OBJECTIVES: This study investigated cardiovascular risk factors among male transport workers in Bulgaria. METHODS: Comparisons were made of data from independent surveys conducted among male transport workers aged 30 to 59 years in Sofia, Bulgaria, during 1986 (n = 1146) and 1996-1997 (n = 638). RESULTS: Smoking prevalence increased from 49% to 59% between 1986 and 1996-1997. Among current smokers, the percentage smoking 15 or more cigarettes per day decreased. The prevalence of elevated body mass index, hypertension, or angina pectoris did not change. CONCLUSIONS: Smoking prevalence rates increased during the study period; the prevalence of other risk factors remained high.     

Characteristics of participants and nonparticipants in a community cardiovascular disease risk factor screening: the Minnesota Heart Health Program

This research attempts to characterize participants and nonparticipants in a cardiovascular risk screening and education program in terms of their beliefs about personal susceptibility to heart disease, integration into the community, and general pattern of health-promoting behaviors. Telephone surveys were conducted with 76 participants and 76 nonparticipants in the risk factor screening. Participation was strongly related to several health-promoting behaviors (dental checkups and seat belt use) and several measures of integration into the community. Health beliefs (in personal threat, susceptibility to disease, and the efficacy of preventive action) were not related to participation. Future research in the area of program participation may need to move beyond the model of disease-specific health beliefs to the realms of social pressures to participate and general health values.     

Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk

BACKGROUND: Although the effects of individual foods or nutrients on the development of diseases and their risk factors have been investigated in many studies, little attention has been given to the effect of overall dietary patterns. OBJECTIVE: Our objective was to examine the associations of 2 major dietary patterns, Western and prudent, with biomarkers of obesity and cardiovascular disease (CVD) risk. DESIGN: We used factor analysis to define major dietary patterns for a subsample of men (n = 466) from the Health Professionals Follow-up Study by using dietary information collected from food-frequency questionnaires (FFQs) in 1994. We calculated partial correlation coefficients between pattern scores and biomarker values adjusted for age, smoking status, energy and alcohol intake, physical activity, hours of television watching, and body mass index. RESULTS: We derived 2 major dietary patterns that were generally reproducible over time. The first pattern (prudent) was characterized by higher intakes of fruit, vegetables, whole grains, and poultry. The second pattern (Western) was characterized by higher intakes of red meats, high-fat dairy products, and refined grains. Using pattern scores from 1994 and adjusting for potential confounders, we found significant positive correlations between the Western pattern and insulin, C-peptide, leptin, and homocysteine concentrations, and an inverse correlation with plasma folate concentrations. The prudent pattern was positively correlated with plasma folate and inversely correlated with insulin and homocysteine concentrations. CONCLUSION: Major dietary patterns are predictors of plasma biomarkers of CVD and obesity risk, suggesting that the effect of overall diet on CVD risk may be mediated through these biomarkers.