Combined effects of saturated fat and cholesterol intakes on serum lipids: Tehran Lipid and Glucose Study

ObjectiveThis study investigated the combined effect of saturated fat and cholesterol intake on serum lipids among Tehranian adults.MethodsIn 443 subjects ≥18 y, dietary intake was assessed. Height and weight were measured and body mass index was calculated. Serum cholesterol, triacylglycerol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol levels were calculated. Cholesterol intakes ≥300 mg/d and saturated fat intakes ≥7% of total energy were defined as high intakes. Individuals were categorized into four groups based on cholesterol and saturated fat intakes.ResultsSubjects' mean age was 40.1 ± 14.6 y; those in whom cholesterol and saturated fat intake was normal had significantly less energy and fat intake than those with high cholesterol and saturated fat intakes (P < 0.01). Saturated fat intake had a significant effect on serum total and HDL-C levels. Subjects with a normal saturated fat intake had significantly less serum total and HDL-C than those who had high saturated fat intake (P < 0.01 and P < 0.05, respectively). Adjusting for age, sex, and body mass index, the main effect of cholesterol intake on HDL-C was significant (P = 0.05). Mean serum HDL-C was lower in subjects who had normal cholesterol intake than in those with high cholesterol intake.ConclusionThese results show that cholesterol and saturated fat intakes have no combined effect on serum low-density lipoprotein cholesterol level, whereas cholesterol intake per se affects serum HDL-C level.     

Comparison of Effects of Long-Term Low-Fat vs High-Fat Diets on Blood Lipid Levels in Overweight or Obese Patients: A Systematic Review and Meta-Analysis

Dietary fat plays an important role in the primary prevention of cardiovascular disease, but long-term (≥12 months) effects of different percentages of fat in the diet on blood lipid levels remain to be established. Our systematic review and meta-analysis focused on randomized controlled trials assessing the long-term effects of low-fat diets compared with diets with high amounts of fat on blood lipid levels. Relevant randomized controlled trials were identified searching MEDLINE, EMBASE, and the Cochrane Trial Register until March 2013. Thirty-two studies were included in the meta-analysis. Decreases in total cholesterol (weighted mean difference –4.55 mg/dL [–0.12 mmol/L], 95% CI –8.03 to –1.07; P=0.01) and low-density lipoprotein (LDL) cholesterol (weighted mean difference –3.11 mg/dL [–0.08 mmol/L], 95% CI –4.51 to –1.71; P<0.0001) were significantly more pronounced following low-fat diets, whereas rise in high-density lipoprotein (HDL) cholesterol (weighted mean difference 2.35 mg/dL [0.06 mmol/L], 95% CI 1.29 to 3.42; P<0.0001) and reduction in triglyceride levels (weighted mean difference –8.38 mg/dL [–0.095 mmol/L], 95% CI –13.50 to –3.25; P=0.001) were more distinct in the high-fat diet groups. Including only hypocaloric diets, the effects of low-fat vs high-fat diets on total cholesterol and LDL cholesterol levels were abolished. Meta-regression revealed that lower total cholesterol level was associated with lower intakes of saturated fat and higher intakes of polyunsaturated fat, and increases in HDL cholesterol levels were related to higher amounts of total fat largely derived from monounsaturated fat (of either plant or animal origin) in high-fat diets (composition of which was ～17% of total energy content in the form of monounsaturated fatty acids, ～8% of total energy content in the form of polyunsaturated fatty acids), whereas increases in triglyceride levels were associated with higher intakes of carbohydrates. In addition, lower LDL cholesterol level was marginally associated with lower saturated fat intake. The results of our meta-analysis do not allow for an unequivocal recommendation of either low-fat or high-fat diets in the primary prevention of cardiovascular disease.     

Impact of receiving blood cholesterol test results on dietary change

Introduction: The study objective was to determine the impact of receivin results of a blood cholesterol test on changes in dietary behaviors among individuals participating in a Health Risk Appraisal Program.Methods: This randomized trial of maintenance employees at six hospitals included two groups: Group 1 received their blood cholesterol test results at the pretest; Group 2 received results only at the posttest (16–20 weeks later). The pretest interview included (1) a 24-hour dietary recall; (2) an evaluation of dietary behaviors and suggestions on how to change; (3) height, weight, and blood cholesterol measurement. Five hundred employees participated, and 429 eligible employees completed both pretest and posttest interviews.Results: Blood cholesterol levels decreased by 4.8% (P < .001) and saturated fat intake decreased by 7.4% (P < .05). Regression analyses indicated that individuals more likely to have lowered saturated fat intake had higher pretest saturated fat intakes, had a family history of high blood cholesterol, and were light-maintenance employees (P < .05); no other variables were associated (receiving blood cholesterol test results, previous blood cholesterol test, pretest blood cholesterol levels, personal history of heart disease, BMI, age, gender, tobacco/alcohol use). Among subjects with normal cholesterol levels, those not receiving blood test results reduced saturated fat intake more than those receiving test results; both groups had similar saturated fat intakes (>12%) greater than recommended intake (<10%).Conclusions: Screening programs should include an assessment of saturated fat intake as screening for blood cholesterol may provide normocholesterolemic subjects with a false sense of security.     

Comparison of School vs Home Breakfast Consumption with Cardiometabolic and Dietary Parameters in Low-Income,Multiracial/Ethnic Elementary School-Aged Children

BackgroundBreakfast consumption is often associated with improving cardiometabolic parameters and diet quality. However, literature evaluating breakfast consumption with these outcomes between the school and home environments is limited.ObjectiveThis study examined relationships between breakfast consumption locations (school vs home) and cardiometabolic parameters, breakfast dietary intake, and daily dietary intake.DesignThis cross-sectional study used baseline data from TX Sprouts, a 1-year school-based gardening, nutrition, and cooking cluster-randomized trial, implemented in 16 elementary schools in Austin, TX, during 2016 to 2019.Participants/settingAnalyses included 383 low-income, multiracial/ethnic elementary school-aged children (mean age = 9.2 years; 60.6% Hispanic; 70.5% free/reduced lunch; 58.5% home breakfast consumers).Main outcome measuresCardiometabolic parameters were obtained via fasting blood draws, and dietary intake was assessed using one 24-hour dietary recall conducted on a random, unannounced weekday. Cardiometabolic and dietary parameters (ie, energy intake, macronutrients, and food group servings) for breakfast and for the day were evaluated.Statistical analyses performedMultivariate analysis of covariance was performed to examine cardiometabolic parameters and dietary intake between school and home breakfasts.ResultsSchool breakfast consumers (SBC) had lower fasting triglyceride levels than home breakfast consumers (HBC) (89.0 mg/dL vs 95.7 mg/dL; P = 0.03) (to convert to mmol/L, multiply by 0.0113). SBC had lower total fat for the day (P = 0.02) and lower total and saturated fat, sodium, and refined grains at breakfast (P ≤ 0.01) than HBC. However, SBC had lower protein at breakfast (P = 0.01) and higher carbohydrates, total sugar, and added sugar for the day and at breakfast (P ≤ 0.03) than HBC.ConclusionsSBC compared with HBC had lower fat intake, which may have contributed to the lower triglyceride level observed in SBC, but also had lower protein intake at breakfast and higher added sugar intake for the day and at breakfast. These results suggest dietary intake differed between HBC and SBC; that is, the home and school environments, but more research is needed to evaluate if such differences are due to School Breakfast Program guidelines.     

Leptin,adiponectin, and short-term and long-term weight loss after a lifestyle intervention in obese children

ObjectiveIn overweight children, high leptin levels are independently associated with higher risk for cardiovascular disease, whereas adiponectin seems to be protective against type 2 diabetes and atherosclerosis. The study examines the predictive value of leptin for weight loss after a 4- to 6-wk inpatient therapy and again after 1 y; as well as the association among weight loss, leptin, and adiponectin levels and changes in cardiometabolic risk factors after therapy.MethodsBody mass index (BMI), blood pressure, Tanner stage, and cardiometabolic risk factors were studied in 402 children (59.2% females, 13.9 ± 2.3 y, BMI 33.8 ± 5.7 kg/m²) before and after a 4-to 6-wk inpatient intervention (exercise, diet, and behavioral therapy) and BMI 1 y later (n = 206).ResultsBMI was reduced from 33.8 ± 5.7 to 30.5 ± 5.1 kg/m² (P < 0.001) during the lifestyle intervention and remained unchanged after 1 y. Baseline BMI was positively associated with leptin (r = 0.60; P < 0.001) and cardiometabolic risk factors (blood pressure, high-density lipoprotein [HDL] cholesterol, triglycerides). Baseline leptin was associated with BMI and triglycerides (r = 0.39; P < 0.001), baseline adiponectin with HDL-cholesterol (r = 0.40; P < 0.001). Baseline BMI explained 40.7% of the variance in weight loss during therapy. The combination of BMI, sex, and leptin explained 50.4% of the variance. Neither BMI nor leptin predicted weight changes over the long term.ConclusionsOverweight children maintained a substantial amount of weight loss after participation in a short-term inpatient lifestyle intervention. Baseline BMI was positively associated with weight reduction during the intervention, whereas baseline leptin had only a minor predictive value.     

Does Stage of Change Modify the Effectiveness of an Educational Intervention to Improve Diet among Family Members of Hospitalized Cardiovascular Disease Patients?

Objective

The purpose of this study was to evaluate whether effectiveness of a special intervention to improve diet vs a control intervention differs by readiness to reduce dietary saturated fat based on the Transtheoretical Model Stages of Change among family members of hospitalized cardiovascular disease patients.

Design

Stages of change (ie, precontemplation, contemplation, preparation, action, maintenance) were assessed by standardized questionnaire. Diet was measured by Block 98 Food Frequency Questionnaire at baseline and 1 year in participants in the Family Intervention Trial for Heart Health (n=501; 36% racial/ethnic minorities; 66% female). Therapeutic Lifestyle Change diet education was provided to each special intervention subject tailored to baseline stage of change.

Statistical analyses

Multivariable linear regression was used to examine whether the effect of the intervention was modified by stage of change.

Results

Baseline saturated fat and cholesterol intakes were lower among those in maintenance stage vs others (9.9% vs 11.2% kcal; P<0.0001 and 112.2 vs 129.7 mg/1,000 kcal; P=0.0003, respectively). Overall, change in the percentage of calories from saturated fat from baseline to 1 year was −0.7 in the special intervention vs −0.4 in the control intervention (P=0.18). Among participants in contemplation, greater reductions in saturated fat (−2.1% vs  + 0.3% kcal; P=0.04) and cholesterol (−34.0 vs  + 32.6 mg/1,000 kcal; P=0.01) were seen in the special intervention vs control intervention. The special intervention was more likely than control intervention to achieve new adherence to a diet of <10% saturated fat/<300 mg cholesterol at 1 year among those not in maintenance stage (30% vs 15%; P=0.03). Control intervention participants were more likely than special intervention to revert to lower levels on the stage of change continuum from baseline to 1 year (17% vs 7%; P=0.002).

Conclusion

Effectiveness of an intervention to lower saturated fat varies by baseline stage of change among family members of hospitalized cardiovascular patients. This can be important to consider when designing research or clinical diet interventions.     

Cardiometabolic factors and disease duration in patients with Parkinson’s disease

ObjectivePrevious studies have reported that patients with Parkinson’s disease (PD) have a favorable cardiometabolic risk profile. The aim of this study was to investigate the relationship between cardiometabolic risk factors and the duration of disease.MethodsOne hundred and fifty patients with PD (56.7% men) were studied, measuring body mass index (BMI), waist circumference (WC), body fat percentage (BF%) by impedance, fasting glucose, serum lipids, and transaminases.ResultsIn sex- and age-adjusted correlation models, duration of PD was inversely related to BMI (r = ?0.20; P < 0.05) and BF% (r = ?0.29; P < 0.005). Using multivariable regression models (adjustments: age, gender, smoking status, levodopa dose and, alternatively, BMI, WC, or BF%), high-density lipoprotein (HDL) levels were positively correlated with disease duration (P < 0.01 for all). In models adjusted for WC and BF%, total HDL-cholesterol ratio was also inversely associated with duration of PD (P < 0.05 for both). No other association between biochemical variables and the duration of PD was found. Moreover, no dose–response effect of levodopa on metabolic risk factors was observed.ConclusionsHDL levels and total HDL-cholesterol ratio were favorably associated with duration of PD. This factor may contribute to cardiometabolic protection in PD. The mechanisms underlying this association deserve further investigation.     

Dietary fat saturation distinctly affects apolipoprotein gene expression and high density lipoprotein size distribution in two strains of Golden Syrian hamsters

Plasma lipoprotein levels, high density lipoprotein (HDL) particle size distribution and tissue mRNA levels for several apolipoproteins were determined in two strains of Golden Syrian hamsters characterized as high (F1B) or low (LVG) responders to atherogenic diets. Twenty-four male hamsters per strain were fed semipurified diets containing 0.2 g/100 g diet cholesterol and 15 g/100 g diet fat enriched (13 g/100 g) with either coconut oil or soybean oil for 18 weeks. HDL size was analyzed by non-denaturing gradient (4–30%) polyacrylamide gel electrophoresis, and categorized into four HDL subspecies according to Stoke’s diameter. Hepatic and intestinal mRNA apolipoprotein concentrations were measured using solution hybridization/ribonuclease protection assay. Compared to F1B hamsters, the LVG hamsters showed a less atherogenic lipoprotein profile; with lower triglycerides (P < 0.01) and higher HDL cholesterol (P < 0.01) levels. Consumption of a polyunsaturated fatty acid (PUFA) diet induced the decrease in triglyceride levels (42% in LVG, P < 0.05 and 51% in F1B, P < 0.01) and in HDL cholesterol (15% in LVG, P < 0.05 and 28% in F1B, P < 0.01). LVG animals had a greater proportion of larger HDL particles than F1B animals regardless of the diet (P < 0.01). Consumption of the soybean oil diet, compared with coconut oil diet, lowered the proportion of HDL2b and increased the proportion of HDL2a and HDL3 in LVG animals. However, F1B animals consuming the PUFA diet had a decrease in the percentage of HDL2b and HDL2a and a marked increase in HDL3. ApoA-I mRNA levels were higher in F1B animals (P < 0.01), and were not affected by dietary fat saturation in either strain of hamsters. ApoA-II mRNA levels were higher in the LVG strain (P < 0.001), and increased with fat saturation of both strains (P < 0.05). The average ratio of intestinal apoC-II/C-III mRNA was 3.2 times higher in LVG animals (P < 0.05) as compared with F1B animals. This is consistent with a higher lipolytic activity in LVG animals that will result in lower triglyceride concentrations and increased HDL particle size. Dietary induced effects on HDL particle size may be attributed to the higher levels of apoA-II mRNA as well as an increased neutral lipid exchange between HDL and triglyceride-rich lipoproteins due to the elevated triglyceride levels in animals fed on saturated diet.     

Dietary intervention with emphasis on folate intake reduces serum lipids but not plasma homocysteine levels in hyperlipidemic patients

Hyperlipidemia and hyperhomocysteinemia are regarded as major risk factors for cardiovascular disease. Medical nutrition therapy (MNT), which involves a combination of nutritional diagnosis, therapy, and counseling for at-risk patients, has been proposed as a protocol to control these risk factors. The purpose of this study was to investigate the effect of an intensive MNT, specifically tailored to Korean hyperlipidemic patients, on levels of serum lipids and plasma homocysteine. Forty hyperlipidemic patients with blood levels of total cholesterol ≥200 mg/dL or triacylglycerol ≥150 mg/dL were recruited from the Kyung Hee University Medical Center (Seoul, Korea). They were randomly divided into control (no treatment) or experimental (MNT treatment) groups. A registered dietitian performed MNT, emphasizing dietary folate intake based on the guidelines for Korean hyperlipidemic patients; this was performed 5 times during the 12 weeks of the experiment. After the MNT period, we observed that body mass index (P < .001) and fat percentage (P < .05) was significantly decreased in the experimental group but not in the control group. Daily energy consumption, as well as carbohydrate, fat, and cholesterol intakes, all decreased significantly (P < .05) in the MNT group, whereas folate intake increased (P < .05). Blood levels of triacylglycerol (−30.8%), total cholesterol (−20.9%), low-density lipoprotein cholesterol (−14.5%), and ratio of low-density lipoprotein/high-density lipoprotein (−17.1%) were significantly lower in the experimental group after MNT (P < .001) compared with the control group. Plasma homocysteine levels were unchanged (P = .98); however, the levels of folate (P < .01), vitamin B₆ (P < .01), and vitamin B₁₂ (P < .05) increased significantly in the experimental group. These results indicate that MNT, with an emphasis on folate intake, can be effective at reducing blood levels of lipids and improving the blood levels of folate, vitamin B₆, and vitamin B₁₂ in Korean hyperlipidemic patients.     

The Effect of a Low Fructose and Low Glycemic Index/Load (FRAGILE) Dietary Intervention on Indices of Liver Function,Cardiometabolic Risk Factors,and Body Composition in Children and Adolescents With Nonalcoholic Fatty Liver Disease (NAFLD)

Background: Nonalcoholic fatty liver disease (NAFLD) is a common liver disease in obese children. Diets high in added fructose (high fructose corn syrup; HFCS) and glycemic index (GI)/glycemic load (GL) are associated with increased risk of NAFLD. Lifestyle modification is the main treatment, but no guidelines regarding specific dietary interventions for childhood NAFLD exist. We hypothesized that reductions in dietary fructose (total, free, and HFCS)/GI/GL over 6 months would result in improvements in body composition and markers of liver dysfunction and cardiometabolic risk in childhood NAFLD. Methods: Children and adolescents with NAFLD (n = 12) and healthy controls (n = 14) 7–18 years were studied at baseline and 3 and 6 months post–dietary intervention. Plasma markers of liver dysfunction (ALT, AST, γGT), cardiometabolic risk (TG, total cholesterol, LDL‐HDL cholesterol, Apo‐B100, Apo‐B48, Apo‐CIII, insulin, homeostasis model of assessment of insulin resistance [HOMA‐IR]), inflammation (TNF‐α, IL‐6, IL‐10), anthropometric, and blood pressure (BP) were studied using validated methodologies. Results: Significant reductions in systolic BP (SBP), percentage body fat (BF), and plasma concentrations of ALT (P = .04), Apo‐B100 (P < .001), and HOMA‐IR were observed in children with NAFLD at 3 and 6 months (P < .05). Dietary reductions in total/free fructose/HFCS and GL were related to reductions in SBP (P = .01), ALT (P = .004), HOMA‐IR (P = .03), and percentage BF in children with NAFLD. Reductions in dietary GI were associated with reduced plasma Apo‐B100 (P = .02) in both groups. With the exception of Apo‐B100, no changes in laboratory variables were observed in the control group. Conclusion: Modest reductions in fructose (total/free, HFCS) and GI/GL intake result in improvements of plasma markers of liver dysfunction and cardiometabolic risk in childhood NAFLD.     

The Relationships between Sugar-Sweetened Beverage Intake and Cardiometabolic Markers in Young Children

BackgroundThe consumption of sugar-sweetened beverages has been implicated as a major contributor to the development of obesity and cardiometabolic disease.ObjectiveTo evaluate the relationships between sugar-sweetened beverage intake and cardiometabolic markers in young children.DesignA cross-sectional analysis of the National Health and Nutrition Examination Survey data collected by the National Center for Health Statistics.ParticipantsA total of 4,880 individuals aged 3 to 11 years from nationally representative samples of US children participating in the National Health and Nutrition Examination Survey during 1999-2004 were studied.Main outcome measuresConcentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, and C-reactive protein as well as waist circumference and body mass index percentile for age–sex.Statistical analyses performedMultivariate linear regression analyses were performed to determine independent associations between each outcome variable and the number of serving equivalents of sugar-sweetened beverages consumed after adjusting for age, sex, race, poverty status, physical activity, and energy intake.ResultsIncreased sugar-sweetened beverage intake was independently associated with increased C-reactive protein concentrations (P=0.003), increased waist circumference (P=0.04), and decreased high-density lipoprotein cholesterol concentrations (P<0.001). Subgroup analyses demonstrated differences in the association of sugar-sweetened beverage intake with metabolic markers and anthropometric measurements among age ranges, sex, and racial/ethnic groups.ConclusionsIn this cross-sectional analysis of children's dietary data, sugar-sweetened beverage intake was independently associated with alterations in lipid profiles, increased markers of inflammation, and increased waist circumference in children. Prospective studies are needed, but awareness of these trends is essential in combating the growing metabolic and cardiovascular disease burden in the pediatric population.     

Enhancement of a modified Mediterranean-style, low glycemic load diet with specific phytochemicals improves cardiometabolic risk factors in subjects with metabolic syndrome and hypercholesterolemia in a randomized trial

Background

As the worldwide dietary pattern becomes more westernized, the metabolic syndrome is reaching epidemic proportions. Lifestyle modifications including diet and exercise are recommended as first-line intervention for treating metabolic syndrome. Previously, we reported that a modified Mediterranean-style, low glycemic load diet with soy protein and phytosterols had a more favorable impact than the American Heart Association Step 1 diet on cardiovascular disease (CVD) risk factors. Subsequently, we screened for phytochemicals with a history of safe use that were capable of increasing insulin sensitivity through modulation of protein kinases, and identified hops rho iso-alpha acid and acacia proanthocyanidins. The objective of this study was to investigate whether enhancement of a modified Mediterranean-style, low glycemic load diet (MED) with specific phytochemicals (soy protein, phytosterols, rho iso-alpha acids and proanthocyanidins; PED) could improve cardiometabolic risk factors in subjects with metabolic syndrome and hypercholesterolemia.

Methods

Forty-nine subjects with metabolic syndrome and hypercholesterolemia, aged 25–80, entered a randomized, 2-arm, 12-week intervention trial; 23 randomized to the MED arm; 26 to the PED arm. Forty-four subjects completed at least 8 weeks [MED (n = 19); PED (n = 25)]. All subjects were instructed to follow the same aerobic exercise program. Three-day diet diaries and 7-day exercise diaries were assessed at each visit. Fasting blood samples were collected at baseline, 8 and 12 weeks for analysis.

Results

Both arms experienced equal weight loss (MED: -5.7 kg; PED: -5.9 kg). However, at 12 weeks, the PED arm experienced greater reductions (P < 0.05) in cholesterol, non-HDL cholesterol, triglycerides (TG), cholesterol/HDL and TG/HDL compared with the MED arm. Only the PED arm experienced increased HDL (P < 0.05) and decreased TG/HDL (P < 0.01), and continued reduction in apo B/apo A-I from 8 to 12 weeks. Furthermore, 43% of PED subjects vs. only 22% of MED subjects had net resolution of metabolic syndrome. The Framingham 10-year CVD risk score decreased by 5.6% in the PED arm (P < 0.01) and 2.9% in the MED arm (P < 0.05).

Conclusion

These results demonstrate that specific phytochemical supplementation increased the effectiveness of the modified Mediterranean-style low glycemic load dietary program on variables associated with metabolic syndrome and CVD.     

Growth and lipid metabolism responses in rats fed different dietary fat sources

An experiment with male albino rats was conducted to examine the effect of dietary fat sources on growth performance and apparent digestibility of total fat and fatty acids. The effect on plasma and organ cholesterol concentrations as well as lipoproteins cholesterol and fatty acid profile of hepatic phospholipids was also examined. Forty 3 week old rats were fed purified diets containing 0.041% cholesterol and 7% fat (wt/wt) from soy oil (SO), or cow ghee (GH), or 25% fish oil (FO) plus soy oil (SF) or 25% fish oil plus 75% ghee (GF), or 50% soy oil plus 50% ghee (SG) for a period of 35 days. Final body weight, weight gain, organ weights and feed efficiency ratio showed no significant differences (P < 0.05) among the dietary treatments. The apparent digestibility of total dietary fat and saturated fatty acids in the animals fed diet containing cow ghee only or in combination with fish oil or soy oil was significantly lower than the other dietary groups. Consumption of ghee with combination of fish oil or soy oil lead to significant improvement in the fat apparent digestibility of dietary fat. Total cholesterol and triglyceride concentrations of plasma and organs as well as lipoprotein cholesterol levels were higher in animals fed diets containing ghee. For rats fed diet containing cow ghee in combination with fish oil or soy oil, the cholesterol content of total plasma, lipoprotein fractions (VLDL, LDL and HDL) and organs was decreased significantly. Furthermore, dietary fats altered the fatty acids composition of hepatic phosphlipid fatty acids composition. Feeding dietary fish oil reduced arachidonic acid (20:4) and increased linoleic acid (18:2) and eicosapentaenoic acid (20:5) contents. The reduction in the arachidonic acid was being more pronounced in animals fed dietary ghee with combination of fish oil.     

Development and Evaluation of a Brief Questionnaire to Assess Dietary Fat Quality in Low-income Overweight Women in the Southern United States

ObjectiveTo develop a brief questionnaire to assess dietary fat quality, the Dietary Fat Quality Assessment (DFQA), for use in dietary counseling to reduce heart disease risk.MethodsA subsample of 120 underserved, midlife women enrolled in a randomized, controlled weight loss trial completed baseline and follow-up telephone surveys. Main outcome measures included dietary fat components (total fat, saturated fat, polyunsaturated fat, monounsaturated fat, omega-3 fatty acids, and cholesterol).ResultsAssessments of major dietary fat components using the DFQA and a food frequency questionnaire were significantly correlated, with correlation coefficients of 0.54–0.66 (P < .001). Intra-class correlation coefficients to assess reliability ranged from 0.48 to 0.59 for each of the fat components studied.Conclusions and ImplicationsThe DFQA provides a reasonable assessment of dietary fat quality associated with coronary heart disease risk and may prove useful as a brief assessment tool to guide dietary counseling given to reduce heart disease risk.     

Cord blood lipids and lipoproteins: Merida,Venezuela, and Cincinnati,Ohio

Cord blood lipids and lipoproteins were compared in 95 neonates in Merida, Venezuela, and 455 in Cincinnati, Ohio, to determine whether, like Venezuelan children and adults, Venezuelan neonates had higher plasma triglyceride and lower high-density lipoprotein cholesterol (C-HDL) levels. Cord plasma cholesterol and low-density lipoprotein cholesterol (C-LDL) did not differ significantly between Venezuelan and Cincinnati neonates (P > 0.1). Venezuelan neonates of both sexes had higher cord plasma triglyceride (P < 0.004), and lower C-HDL levels (P < 0.001). These cross-cultural differences were not overtly attributable to systematic differences in laboratory methodology, subject selection, or sampling techniques, since these were either similar or identical in the two populations studied. The cross-sectional persistence of lipoprotein differences in Venezuelan neonates, children, and adults (when compared with Americans) could reflect the expression of differing cross-cultural, racial, genetic, nutritional, or environmental factors or their interactions. Since there is a strong inverse correlation of C-HDL with coronary heart disease, the elucidation of any identifiable etiologies of Venezuelan—American differences in C-HDL might have considerable importance in identifying “protective” racial, genetic, nutritional, or environmental differences relative to the development of coronary heart disease.     

Serum lipids and neopterin in urine as new biomarkers of malnutrition and inflammation in the elderly

ObjectiveLevels of serum lipids are influenced by malnutrition and inflammation. The study aimed to find the relation of the lipidogram to positive and negative markers of inflammation in geriatric patients. Attention was paid to neopterin in urine as a non-protein positive bioindicator of inflammation.MethodsIt was a local, monocentric, prospective clinical study in hospitalized patients older than 80 y. The study included 101 patients (54 women, 47 men). The average age of the entire group was 85.37 ± 4.88 y. The dependence of the values of total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triacylglycerols (TAGs) on C-reactive protein (CRP), neopterin in urine, and prealbumin was examined.ResultsWhen we compared CRP and serum lipids, we found a statistically significant negative correlation between levels of CRP and total cholesterol (P < 0.05), HDL (P < 0.01), and LDL (P < 0.05). Also the level of neopterin in urine was negatively correlated with levels of total cholesterol (P < 0.05) and HDL (P < 0.01). A statistically highly significant interaction was demonstrated between levels of prealbumin and total cholesterol (P < 0.001), HDL (P < 0.001), LDL (P < 0.001), and TAG (P < 0.05).ConclusionA significant negative correlation between levels of inflammation markers (neopterin in urine, CRP) and total cholesterol and HDL was found. LDL was influenced to a lesser extent. A close relation between serum lipids and prealbumin was also demonstrated. Total cholesterol, HDL, and LDL can be considered novel biomarkers of malnutrition and inflammation in geriatric patients.     

Relationships of Self-Reported Dietary Factors and Perceived Acne Severity in a Cohort of New York Young Adults

BackgroundRecent observational and experimental evidence suggests that diet may contribute to acne prevalence.ObjectivesTo examine the differences in select dietary factors (glycemic index [GI], total sugar, added sugar, fruit/fruit juice, fruit/vegetables, vegetables, saturated fat, trans fat, and number of milk and fish servings perday) between groups of self-reported acne severity. Secondary objectives were to investigate the differences in food-aggravated acne beliefs and acne-specific quality-of-life between groups of self-reported acne severity.DesignThis study utilized a cross-sectional design.Participants/settingA total of 248 (115 male, 133 female) participants, age 18 to 25 years, completed questionnaires designed to measure self-reported acne severity, select dietary factors, food-aggravated acne beliefs, acne-specific quality-of-life, and anthropometric and demographic characteristics. The Block fat/sugar/fruit/vegetable food frequency questionnaire assessed usual dietary intake. Data were collected in New York City between January and May 2012.Statistical analyses performedOne-way between groups analysis of variance examined differences in dietary factors, anthropometric characteristics, and acne-specific quality-of-life between groups of self-reported acne. χ² tests compared food-aggravated acne beliefs and demographic characteristics between groups of self-reported acne.ResultsCompared with participants with no or mild acne, participants with moderate to severe acne reported greater dietary GI (P<0.001), added sugar (P<0.001), total sugar (P<0.001), number of milk servings per day (P<0.001), saturated fat (P<0.001), and trans-fatty acids (P<0.001), and fewer servings of fish per day (P=0.002). Among all participants, 58.1% perceived diet to aggravate or influence acne.ConclusionsThis study suggests that diet, particularly dietary GI, saturated fat, trans fat, milk, and fish may influence or aggravate acne development. Future research is necessary to elucidate the proposed mechanisms linking diet and acne and determine the impact of medical nutrition therapy on acne development.     

Effects on Cholesterol Balance and LDL Cholesterol in the Rat of a Soft-Ripened Cheese Containing Vegetable Oils

Objective: The purpose of this study was to examine effects of a modified soft-ripened cheese containing vegetable oils on cholesterol status, using the rat as the experimental model and the traditional soft-ripened cheese as the control.

Methods: Adult male Wistar rats (≈370 g) were divided into two dietary groups (20 rats/group) and fed either the standard diet (STD, containing traditional cheeses made from whole milk) or the experimental diet (EXP, containing modified cheeses made from the combination of skim milk with the following fat mixture: milk fat/oleic acid-enriched sunflower oil/soybean oil mixture). Lipids of the diets came solely from cheeses (14 g/100 g diet); the EXP diet contained (3-fold) less saturated fat, (2-fold) less cholesterol, and (15-fold) more phytosterols than the STD diet.

Results: Although serum triglyceride and total cholesterol concentrations were not affected by the type of diet, the EXP diet resulted in a significant reduction of LDL-cholesterol (31%, p<0.001) and a significant increase of HDL-cholesterol (11%, p<0.05), compared to the STD diet. Thus, a marked reduction (39%) of serum LDL/HDL cholesterol ratio was observed in the EXP group (p<0.001). In addition, the two quantitative balances (excreted/ingested) of cholesterol and total neutral sterols (for which phytosterols were excluded) were significantly higher by 183% and 174%, respectively for the EXP group, compared to the STD group (p<0.05). On another hand, rats fed the EXP diet excreted more cholesterol than they ingested dietary cholesterol (cholesterol balance ? 1), indicating that those animals eliminated some endogenous cholesterol in their feces, while the opposite was true for rats fed the STD diet (cholesterol balance < 1). Finally, fecal bile salt concentration was not significantly different between the two dietary groups.

Conclusions: The partial substitution of milk fat by vegetable oils in soft-ripened cheese resulted in a decreased blood LDL/HDL cholesterol ratio and an increased fecal excretion of endogenous cholesterol and neutral sterols and, thus, markedly improved its nutritional qualities. Therefore, the consumption of the described modified cheese may meet the demand of subjects who wish to lower their risk for atherosclerosis and cardiovascular disease.     

Gender and Race Disparities in Cardiovascular Disease Risk Factors among New York City Adults: New York City Health and Nutrition Examination Survey (NYC HANES) 2013–2014

While gender and racial/ethnic disparities in cardiovascular disease (CVD) risk factors have each been well characterized, few studies have comprehensively examined how patterns of major CVD risk factors vary and intersect across gender and major racial/ethnic groups, considered together. Using data from New York City Health and Nutrition Examination Survey 2013–2014—a population-based, cross-sectional survey of NYC residents ages 20 years and older—we measured prevalence of obesity, hypertension, hypercholesterolemia, smoking, and diabetes across gender and race/ethnicity groups for 1527 individuals. We used logistic regression with predicted marginal to estimate age-adjusted prevalence ratio by gender and race/ethnicity groups and assess for potential additive and multiplicative interaction. Overall, women had lower prevalence of CVD risk factors than men, with less hypertension (p?=?0.040), lower triglycerides (p?<?0.001), higher HDL (p?<?0.001), and a greater likelihood of a heart healthy lifestyle, more likely not to smoke and to follow a healthy diet (p?<?0.05). When further stratified by race/ethnicity, however, the female advantage was largely restricted to non-Latino white women. Non-Latino black women had significantly higher risk of being overweight or obese, having hypertension, and having diabetes than non-Latino white men or women, or than non-Latino black men (p?<?0.05). Non-Latino black women also had higher total cholesterol compared to non-Latino black men (184.4 vs 170.5 mg/dL, p?=?0.010). Despite efforts to improve cardiovascular health and narrow disparities, non-Latino black women continue to have a higher burden of CVD risk factors than other gender and racial/ethnic groups. This study highlights the importance of assessing for intersectionality between gender and race/ethnicity groups when examining CVD risk factors.     

Eating Habits among US Firefighters and Association with Cardiometabolic Outcomes

Cardiovascular disease is the leading cause of on-duty mortality among firefighters, with obesity as an important risk factor. However, little is known regarding the dietary patterns which are characteristic in this population and how these patterns relate to cardiometabolic outcomes. The aim of this study was to identify the dietary patterns of US firefighters and examine their association with cardiometabolic outcomes. The participants (n = 413) were from the Indianapolis Fire Department, and were recruited for a Federal Emergency Management Agency (FEMA)-sponsored Mediterranean diet intervention study. All of the participants underwent physical and medical examinations, routine laboratory tests, resting electrocardiograms, and maximal treadmill exercise testing. A comprehensive food frequency questionnaire was administered, and dietary patterns were derived using principal component analysis. The mean body mass index (BMI) was 30.0 ± 4.5 kg/m² and the percentage of body fat was 28.1 ± 6.6%. Using principal component analysis, two dietary patterns were identified, namely a Mediterranean diet and a Standard American diet. Following the adjustment for gender, BMI, maximal oxygen consumption (VO₂ max), max metabolic equivalents (METS), age, and body fat percent, the Mediterranean diet was positively associated with high-density lipoprotein (HDL) cholesterol (β = 1.20, p = 0.036) in linear regression models. The Standard American diet was associated with an increase in low-density lipoprotein (LDL) cholesterol (β = −3.76, p = 0.022). In conclusion, the Mediterranean diet was associated with more favorable cardiometabolic profiles, whereas the Standard American diet had an inverse association. These findings could help in providing adequate nutrition recommendations for US firefighters to improve their health.