Nutritional Modulation of Non-Alcoholic Fatty Liver Disease and Insulin Resistance

Non-alcoholic fatty liver disease (NAFLD) covers a spectrum of disorders ranging from simple steatosis (non-alcoholic fatty liver, NAFL) to non-alcoholic steatohepatitis (NASH) and cirrhosis. NAFL increases the risk of liver fibrosis. If the liver is fatty due to causes of insulin resistance such as obesity and physical inactivity, it overproduces glucose and triglycerides leading to hyperinsulinemia and a low high-density lipoprotein (HDL) cholesterol concentration. The latter features predispose to type 2 diabetes and cardiovascular disease (CVD). Understanding the impact of nutritional modulation of liver fat content and insulin resistance is therefore of interest for prevention and treatment of NAFLD. Hypocaloric, especially low carbohydrate ketogenic diets rapidly decrease liver fat content and associated metabolic abnormalities. However, any type of caloric restriction seems effective long-term. Isocaloric diets containing 16%–23% fat and 57%–65% carbohydrate lower liver fat compared to diets with 43%–55% fat and 27%–38% carbohydrate. Diets rich in saturated (SFA) as compared to monounsaturated (MUFA) or polyunsaturated (PUFA) fatty acids appear particularly harmful as they increase both liver fat and insulin resistance. Overfeeding either saturated fat or carbohydrate increases liver fat content. Vitamin E supplementation decreases liver fat content as well as fibrosis but has no effect on features of insulin resistance.     

2002年上海市月饼营养质量调查

[目的 ]　了解上海市月饼的营养质量。　 [方法 ]　随机调查上海市生产广式和苏式月饼的企业 10家 ,根据厂方提供的月饼的配料及配比进行分析 ,对月饼的营养质量进行评价。　 [结果 ]　广式和苏式两类月饼营养素指标的差异无显著性 ;上海市月饼的能量、各营养素指标基本合理 ;但月饼中各类脂肪酸的构成不尽合理 ;月饼的价格与营养没有相关关系。　 [结论 ]　应进一步调整月饼的蛋白质、碳水化合物供能比及各类脂肪酸构成比 ,使营养更合理     

Compliance with the European and national nutritional objectives in a Mediterranean population

OBJECTIVE: To analyze compliance with the current European and Spanish nutritional objectives in a representative sample from Catalonia, a Spanish Mediterranean region; and to examine relationships between diet and plasma fatty acid composition. DESIGN: Cross-sectional nutritional survey. SETTING: Population based random sample derived from the Catalan Nutrition Survey. SUBJECTS: A total of 516 healthy adult men (n=203) and women (n=313). METHODS: Dietary habits were assessed by means of a quantitative food frequency questionnaire. A physical exam included height, weight, waist and hip circumferences, and a fasting blood draw. RESULTS: Gender differences were observed in nutrient and energy intakes. Women showed a better compliance with the nutritional recommendations for monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) than did men. Men showed a better compliance for saturated fatty acid (SFA) and carbohydrate than did women. However, the SFA:MUFA:PUFA ratio was similar in both gender (1.6:2.3:1.0 for men; 1.7:2.5:1.0 for women). The highest compliance was observed for nutritional goals of sodium, calcium and fruit and vegetable intakes for both genders. In addition, the present study showed that levels of certain fatty acids in plasma are clearly associated with dietary intake of foods rich in these components. The highest correlations were found for n-3 long chain polyunsaturated fatty acids with blue fish intake in both men and women (r (men)=0.36 and r (women)=0.42; P<0.001). CONCLUSIONS: The diet followed in Catalonia seems to ensure compliance with most of the intermediate nutritional objectives for the Spanish population. However, a reduction in the SFA intake and an increase in the carbohydrate intake could be recommended in order to reduce the current prevalence of overweight and obesity in this Mediterranean region. SPONSORSHIP: This study was supported by the Catalan Department of Health, the Nutrition Catalan Centre of the Institute of Catalan Studies, and Mercadona SA.     

Metabolic MRI of myocardial and hepatic triglyceride content in response to nutritional interventions

PURPOSE OF REVIEW: To discuss the technique and clinical applications of myocardial and hepatic H magnetic resonance spectroscopy to study myocardial and hepatic triglyceride content, in relation to changes in plasma nonesterified fatty acids induced by nutritional interventions. RECENT FINDINGS: Progressive caloric restriction induces a dose-dependent increase in myocardial triglyceride content and a dose-dependent decrease in diastolic function in lean healthy men. Hepatic triglyceride content shows a differential response to progressive caloric restriction, indicating that redistribution of endogenous triglyceride stores is tissue specific, at least in lean healthy men. A short-term high-fat high-energy diet in healthy men results in major increases in hepatic fat content, whereas it does not influence myocardial triglyceride content or myocardial function. Apparently, there is a differential, tissue-specific partitioning of either triglyceride or fatty acids or both between nonadipose organs such as the human heart and liver during different physiological conditions. SUMMARY: Metabolic MRI of myocardial and hepatic triglyceride content is a promising new tool to study the effects of nutritional interventions on myocardial and hepatic lipid metabolism in relation to heart function. Future studies should aim to apply these magnetic resonance techniques to obesity and type 2 diabetes mellitus.     

Metabolic response to provision of mixed protein-carbohydrate supplementation during endurance exercise

The interaction of substrates and hormones in response to ingestion of intact proteins during endurance exercise is unknown. This study characterized substrate and hormone responses to supplementation during endurance exercise. Nine male runners participated in 3 trials in which a non-fat (MILK), carbohydrate (CHO), or placebo (PLA) drink was consumed during a 2-hour treadmill run at 65% VO2max. Circulating levels of insulin, glucagon, epinephrine, norepinephrine, growth hormone, testosterone, and cortisol were measured. Plasma substrates included glucose, lactate, free fatty acids, and select amino acids. Except for insulin and cortisol, hormones increased with exercise. While post-exercise insulin concentrations declined similarly in all 3 trials, the glucagon increase was greatest following MILK consumption. CHO blunted the post-exercise increase in growth hormone compared to levels in MILK. Free fatty acids and plasma amino acids also were responsive to nutritional supplementation with both CHO and MILK attenuating the rise in free fatty acids compared to the increase observed in PLA. Correspondingly, respiratory exchange ratio increased during CHO. Essential amino acids increased significantly only after MILK and were either unchanged or decreased in CHO. PLA was characterized by a decrease in branched-chain amino acid concentrations. Modest nutritional supplementation in this study altered the endocrine response as well as substrate availability and utilization following and during an endurance run, respectively.     

营养状况及膳食因素与癌因性疲乏的研究现状

目的 总结营养状态和膳食因素（膳食质量、食物及营养素摄入量）对癌因性疲乏的影响。方法 通过“营养素”、“食物”“PG - SGA”、“膳食质量”、“癌因性疲乏”等中文关键词及对应的英文关键词在CNKI、pubmed等数据库中进行文献检索。结果 PG - SGA评分、体重、血红蛋白水平等营养状况指标与癌因性疲乏相关,膳食质量较高者的疲乏程度较低;癌因性疲乏的程度与每日脂肪供能比及n - 6多不饱和脂肪酸与n - 3多不饱和脂肪酸的比例成正相关,与每日碳水化合物和膳食纤维摄入量成反比;抗炎、抗氧化物干预是否能够改善癌因性疲乏的结论不一致,尚需要更多的研究进行探讨。结论 营养状态与癌因性疲乏有关。膳食质量越高,疲乏程度越轻。补充以抗炎、抗氧化为主的食物或营养补充剂是否可以缓解癌因性疲乏尚需进一步研究。     

Ten-year trends in compliance with the current Spanish nutritional objectives in Balearic Islands adult population (2000–2010)

ObjectiveThe Balearic Islands, a well-known Spanish tourist destination for Europeans, is undergoing profound social events, which are reflected in the current food patterns of this population. The aim of this study was to assess 10-year trends (2000–2010) in compliance with the current Spanish nutritional objectives among the adult population of the Balearic Islands.MethodsTwo independent cross-sectional dietary surveys were carried out among the adult population (16–65 y) of the Balearic Islands in 2000 (n = 1200) and 2010 (n = 1350). Dietary habits were assessed by means of two non-consecutive 24-h diet recalls.ResultsThe proportion of adults complying with the nutritional objectives for consumption of dietary fiber, folate, saturated fatty acids, cholesterol, carbohydrate, and fruit has increased over the 10-y span. In 2009 and 2010, 25% of participants met the nutritional objectives for folate, calcium, monounsaturated fatty acid, cholesterol, and fruit. These results are not affected by age, occupational status, or birthplace.ConclusionsThe percentage of compliers with the Spanish nutritional objectives has increased for 6 to 11 items over the 10-y period. A reduction in saturated fatty acid and cholesterol intake, and an increase in dietary fiber, carbohydrate, fruit, vegetables, folate, and calcium intake should be recommended.     

Saturated fatty acids: simple molecular structures with complex cellular functions

PURPOSE OF REVIEW: This review summarizes recent findings on the biological functions of saturated fatty acids. Some of these findings suggest that saturated fatty acids may have important and specific regulatory roles in the cells. Until now these roles have largely been outweighed by the negative impact of dietary saturated fatty acids on atherosclerosis biomarkers. Elucidated biochemical mechanisms like protein acylation (N-myristoylation, S-palmitoylation) and putative physiological roles are described. RECENT FINDINGS: The review will focus on the following topics: new aspects on the metabolism of saturated fatty acids; recent reports on the biochemical functions of saturated fatty acids; current investigations on the physiological roles (elucidated and putative) of saturated fatty acids; and a discussion of the nutritional dietary recommendations (amounts and types) of saturated fatty acids. SUMMARY: Dietary saturated fatty acids are usually associated with negative consequences for human health. Experimental results on the relationship between doses, physiological effects, specificities and functions of individual saturated fatty acids are, however, conflicting. In this context, this review describes emerging recent evidence that some saturated fatty acids have important and specific biological roles. Such data are needed to allow a balanced view in terms of potential nutritional benefits of saturated fatty acids, and, if necessary, reassessment of the current nutritional dietary recommendations.     

The influence of diet,sex, IGF2 and RYR1 genotypes and anatomical location on pork loin composition

The composition of pork loin can be modified by nutritional means to improve the nutritional quality of its fatty acid composition. The effects of a modified diet – enriched mainly in n-3 fatty acids – on fat composition in several anatomical locations in the loin is described here. Saturated fatty acid content was reduced to less than one third of total fatty acids. n-6/n-3 ratio was reduced from about 17 to less than 5. Polyunsaturated fatty acids were reduced to less than 30% of total fat. The effects of several variables such as sex, weight, individual and IGF2 and RYR1 genotypes on loin composition are studied. In an effort to establish a labelling strategy that emphasizes the healthy nutritional properties of pork meat, a statistical model that makes it possible to estimate fat composition and quantity is presented.     

Pulse consumption, satiety, and weight management

The prevalence of obesity has reached epidemic proportions, making finding effective solutions to reduce obesity a public health priority. One part of the solution could be for individuals to increase consumption of nonoilseed pulses (dry beans, peas, chickpeas, and lentils), because they have nutritional attributes thought to benefit weight control, including slowly digestible carbohydrates, high fiber and protein contents, and moderate energy density. Observational studies consistently show an inverse relationship between pulse consumption and BMI or risk for obesity, but many do not control for potentially confounding dietary and other lifestyle factors. Short-term (≤1 d) experimental studies using meals controlled for energy, but not those controlled for available carbohydrate, show that pulse consumption increases satiety over 2-4 h, suggesting that at least part of the effect of pulses on satiety is mediated by available carbohydrate amount or composition. Randomized controlled trials generally support a beneficial effect of pulses on weight loss when pulse consumption is coupled with energy restriction, but not without energy restriction. However, few randomized trials have been conducted and most were short term (3-8 wk for whole pulses and 4-12 wk for pulse extracts). Overall, there is some indication of a beneficial effect of pulses on short-term satiety and weight loss during intentional energy restriction, but more studies are needed in this area, particularly those that are longer term (≥1 y), investigate the optimal amount of pulses to consume for weight control, and include behavioral elements to help overcome barriers to pulse consumption.     

Dietary fatty acids affect plasma markers of inflammation in healthy men fed controlled diets: a randomized crossover study

BACKGROUND: The effect of individual dietary fatty acids on emerging risk factors for cardiovascular disease that are associated with subclinical inflammation is unknown. OBJECTIVE: The goal was to evaluate the role of dietary fat and specific fatty acids, especially trans fatty acids, in altering concentrations of markers of inflammation in humans fed controlled diets. DESIGN: In a randomized crossover design, 50 men consumed controlled diets for 5 wk that provided 15% of energy from protein, 39% of energy from fat, and 46% of energy from carbohydrate. Eight percent of fat or fatty acids was replaced across diets with the following: cholesterol, oleic acid, trans fatty acids (TFAs), stearic acid (STE), TFA+STE (4% of energy each), and 12:0-16:0 saturated fatty acids (LMP). RESULTS: Fibrinogen concentrations were higher after consumption of the diet enriched in stearic acid than after consumption of the carbohydrate diet. C-reactive protein concentrations were higher after consumption of the TFA diet than after consumption of the carbohydrate diet, but were not significantly different after consumption of the TFA and TFA+STE diets than after consumption of the LMP diet. Interleukin 6 concentrations were lower after consumption of the oleic acid diet than after consumption of the LMP, TFA, and STE diets. E-selectin concentrations were higher after consumption of the TFA diet than after consumption of the carbohydrate diet. Consumption of the TFA but not the TFA+STE diet resulted in higher E-selectin concentrations than did the LMP diet. CONCLUSIONS: These data provide evidence that dietary fatty acids can modulate markers of inflammation. Although stearic acid minimally affects LDL cholesterol, it does appear to increase fibrinogen concentrations.     

Nuts: source of energy and macronutrients

On the basis of the high fat content of nuts, they are traditionally considered as foods that provide a high amount of energy. However, epidemiologic and clinical observations do not indicate an association between nut intake and increased BMI. There is a notorious variability in macronutrient composition among nuts, although they have some consistent patterns. Nuts contain all major macronutrients: protein, carbohydrate, and fat. The total protein content is relatively high, which makes them a good source of plant protein (especially for vegetarians). Although nuts contain low amounts of some essential amino acids, this is not a nutritional concern due to the complement of protein. In addition, nuts have a low lysine:arginine ratio, which is inversely associated with the risk of developing hypercholesterolemia and atherosclerosis. Carbohydrates are the second highest macronutrient in nuts in terms of total calories provided. The fat fraction is characterized by a high amount of unsaturated fatty acids and a low content of saturated fatty acids. In conclusion, the high content in unsaturated fatty acids, the low lysine:arginine ratio, and the presence of other bioactive molecules (such as fibre, phytosterols, vitamin and other antioxidants, and minerals) make the addition of nuts to healthy diets a useful tool for the prevention of cardiovascular heart diseases.     

ROLE OF FAT AND FATTY ACIDS IN MODULATION OF ENERGY EXCHANGE

Dietary fat is a better-than-expected energy source for growth, compared with carbohydrate or protein, and polyunsaturated fatty acids are more easily oxidized than saturated fatty acids.     

Development of food groupings to guide dietary advice for people with diabetes

Objective: To describe the development and characteristics of a food categorisation system and its application to guide advice for diabetes treatment. Design and methods: Foods commonly consumed by 16 adults with diabetes were grouped by macronutrient content and type of fat to form a set of reference food groups for dietary advice. Means for energy and macronutrients from individual food groups were then used to construct an overall intake pattern targeting 8000 kJ and relative amounts of carbohydrate, protein and fat (saturated fatty acids (SFA) < 10%E and (polyunsaturated fatty acids) PUFA ～ 10%E). Variation in energy and macronutrients contributed by all foods partitioned into each food group was assessed by the coefficient of variation of data on the whole diet. Results: To differentiate between sources of fat, 13 food groups emerged and 10 were deemed acceptable to nutritional guidelines for diabetes treatment. The food group pattern was judged adequate for the achievement of dietary recommendations with low‐potential variation in total energy (5%) and macronutrient proportions (protein 6%, fat 6%, carbohydrate 3%), but higher for fat types (SFA 22%, (monounsaturated fatty acids) MUFA 11%, PUFA 12%). Targeted proportions for fat types were achieved only when daily servings of PUFA‐rich, oils, nuts and oily fish or soy were included in an ideal intake pattern. Conclusions: In theory, a dietary pattern constructed from food group sources of macronutrients and individual fat types results in low‐potential variation from recommended nutrient targets and, therefore, is appropriate to guide advice for the treatment of diabetes.     

Colonic energy salvage in chronic pancreatic exocrine insufficiency

BACKGROUND: Chronic pancreatic exocrine insufficiency results in maldigestion. As a result, increased amounts of undigested nutrients reach the colon, providing more substrate for bacterial fermentation to produce short-chain fatty acids, which could therefore provide additional energy supplement. METHODS: This study aimed to assess carbohydrate malabsorption in patients with chronic pancreatic exocrine insufficiency after ingestion of a standard diet and to calculate energy salvaged by colonic bacterial metabolism. A 72-hour stool collection was done on 10 adult patients receiving a 3-day standard diet containing 100 g fat, 329 g carbohydrate, and 154 g protein, and short-chain fatty acids, fat, carbohydrate, and nitrogen excretion were assessed. A breath hydrogen test after ingestion of 200 g (dry weight) cooked maize meal (test meal) and 10 g oral inulin (standard), respectively, was subsequently done on the patients and 15 healthy adult controls. RESULTS: Breath hydrogen production after ingestion of maize meal and inulin, respectively, and calculated carbohydrate malabsorption were significantly greater in patients (21.4% +/- 17%) than in controls (10.2 +/- 1.4%; p < .05). Patients malabsorbed 70.4 g/d (281.6 kcal) carbohydrate in the standard diet. Total carbohydrate loss in stool amounted to 8.1 g/d (2.4%), and 62.3 g/d (19%) was hence salvaged as short-chain fatty acids for energy provision. Colonic bacterial fermentation therefore converted 88.5% of malabsorbed carbohydrate to short-chain fatty acids, 92.8% of which was absorbed and 7.2% excreted. This suggests that 10.2% of energy expenditure/requirement in these patients is derived from salvage of malabsorbed carbohydrate. CONCLUSIONS: Colonic bacterial metabolism is a significant source of energy salvage in patients with pancreatic enzyme deficiency.     

Saturated and cis- and trans-unsaturated fatty acids intake in rural and urban Costa Rican adolescents

OBJECTIVE: The purpose of this study is to determine whether intake of saturated fatty acids and cis- and trans-unsaturated fatty acids is associated with an urban compared to a rural lifestyle, and whether these associations are responsible for differences in plasma lipid concentrations. METHODS: Two hundred seventy-five adolescents, aged 12 to 19 years, living in rural and urban areas of San José, Costa Rica, were included in the study. All participants completed three-day food records, provided a fasting blood sample, and carried out a modified Harvard Step Test. RESULTS: Compared to rural, urban adolescents reported higher intakes of energy-adjusted individual and total saturated fatty acids, total n-3, total n-6 (p < 0.05). Compared to rural, urban adolescents had higher intake of 18:1 (3.65 vs. 3.25, p = 0.0001) and 18:2 (0.62 vs. 0.80, p = 0.001) trans fatty acids, as well as lower intake of carbohydrate (p < 0.05). Palm shortening was the main source of saturated fat (32%), and partially hydrogenated soybean oil used for cooking was the main source of n-3 fatty acids (33%), n-6 fatty acids (33%) and trans fatty acids (34%). Compared to rural, urban adolescents had lower systolic and diastolic blood pressure and higher plasma HDL cholesterol concentration (44 vs. 40 mg/dL, p < 0.0001), but were more likely to be sedentary (68% vs. 57%, p < 0.0001). Among environmental factors, higher carbohydrate intake was a significant determinant of a lower HDL cholesterol (beta coeff = -1.45, p = 0.04), while lauric and myristic fatty acids correlated with increased LDL cholesterol (beta coeff = 3.6, 1.7, p < 0.05). CONCLUSIONS: A diet containing less carbohydrate and less saturated fatty acids contributes to a more beneficial lipid profile in Costa Rican adolescents, but a trend towards high trans fatty acids intake, particularly in the urban area, is worrisome given the well-known adverse effects of trans fatty acids.     

Nutritional support in hepatic encephalopathy

Hepatic encephalopathy (HE) is a syndrome of global cerebral dysfunction resulting from underlying liver disease or portal-systemic shunting. HE can present as one of four syndromes, depending on the rapidity of onset of hepatic failure and the presence or absence of preexisting liver disease. The precise pathogenesis is unknown but likely involves impaired hepatic detoxification of ammonia as well as alterations in brain transport and metabolism of amino acids and amines. The etiology of malnutrition in hepatic failure is multifactorial. Nutritional deficits may be clinically manifest as marasmus or kwashiorkor, or both. Nutritional support in HE is directed toward reducing morbidity related to underlying malnutrition and concurrent disease. However, reaching nutritional goals is often complicated by protein and carbohydrate intolerance. The use of protein restriction in HE is controversial. Modified formulas that are supplemented in branched chain amino acids may be of value in patients who exhibit protein intolerance with standard feeding solutions or in patients who present with advanced degrees of encephalopathy.     

The linoleic acid and trans fatty acids of margarines.

Fifty brands of margarine were analysed for cis-polyunsaturated acids by lipoxidase, for trans fatty acid by infared spectroscopy, and for fatty acid composition by gas-liquid chromatography. High concentrations of trans fatty acids tended to be associated with low concentrations of linoleic acid. Later analyses on eight of the brands, respresenting various proportions of linoleic to trans fatty acids, indicated that two of them contained still higher levels of trans fatty acids (greater than 60%) and negligible amounts of linoleic acid. It is proposed that margarine could be a vehicle for the distribution of some dietary linoleic acid and that the level of linoleic acid and the summation of the saturated plus trans fatty acids be known to ascertain nutritional characteristics.     

Cyclic fatty acid monomers from heated oil modify the activities of lipid synthesizing and oxidizing enzymes in rat liver

Cyclic fatty acid monomers purified from a heated linseed oil were given for 2 wk to adult rats as triacylglycerol at two dose levels, i.e., 0.1 and 1 g/100 g diet, to determine their effect on some aspects of lipid metabolism. Indirect evidence of a peroxisome proliferator-like effect was observed, as determined by an elevation of some characteristic enzyme activities, such as peroxisomal acyl-CoA oxidase, and the microsomal omega- but also (omega-1)-laurate hydroxylase (CYP4A1 and CYP2E1, respectively). The dietary cyclic fatty acids induced a coordinated regulation between the activities of the lipogenic enzymes studied (Delta9-desaturase, phosphatidate phosphohydrolase) and peroxisomal oxidation, but not with mitochondrial beta-oxidation. The dose-dependent decrease of Delta9-desaturase activity (P < 0.05) with cyclic fatty acid monomer intake was accompanied by a similar decrease of the monounsaturated fatty acid level in liver. The increase in the gamma-linolenic acid level also suggested an increase in Delta6-desaturase activity with cyclic fatty acid intake (P < 0.05). In addition, our results strongly suggested that the altered liver levels of eicosapentaenoic and arachidonic acids were due to the peroxisomal retroconversion process in rats fed cyclic acids. Finally, an effect of these cyclic compounds on the carbohydrate metabolism cannot be disregarded because they decreased liver glycogen concentration. We conclude that cyclic fatty acid monomers affect different aspects of lipid metabolism, including a phenotypic peroxisome proliferator response. This provides the ground for further studies investigating the biochemical pathways that underlie the nutritional effect of such molecules.