Cholesterol-Lowering Efficacy of Plant Sterols in Low-Fat Yogurt Consumed as a Snack or with a Meal

Objective: Plant sterols (PS) consumed as a snack may not have the same cholesterol-lowering potential as when consumed with a meal due to poor solubilization. It was hypothesized that the consumption of a single dose, low-fat yogurt rich in PS (1.6 g/d) with a meal over an afternoon snack will lead to favourable changes in plasma lipids, plasma PS concentrations, and cholesterol synthesis without negatively affecting α-tocopherol or carotenoids levels.

Methods: Twenty-six hyperlipidemic males and females completed the randomized trial of three phases (control, single PS dose consumed with a meal, or single PS dose as an afternoon snack) while consuming controlled, low-fat diets. Plasma lipids, cholesterol synthesis rates, plasma PS and serum fat-soluble antioxidants were measured at baseline and after 4 weeks.

Results: Endpoint total cholesterol (TC) levels after the PS snack phase were decreased (p = 0.04) (5.30 ± 0.2 mmol/L) compared to the control phase (5.53 ± 0.2 mmol/L). However, endpoints for TC (5.37 ± 0.2 mmol/L) for PS dose with a meal were comparable to control phase. Low-density lipoprotein-cholesterol tended to be different (p = 0.06) at the end of the intervention phases (3.51 ± 0.1, 3.43 ± 0.1, and 3.33 ± 0.1 mmol/L; control, meal and snack, respectively). Cholesterol fractional synthesis rates were higher (p = 0.007) by 25.8% and 19.5% at the end of the snack and meal phases, respectively, compared with the control phase. Plasma campesterol and β-sitosterol concentrations, adjusted for TC, were higher (p < 0.01) in the snack phase (2.30 ± 0.3 and 0.54 ± 0.1 μmol/mmol, respectively) and in the meal phase (2.00 ± 0.3 and 0.51 ± 0.1 μmol/mmol, respectively) when compared to the control phase (1.81 ± 0.3 and 0.40 ± 0.1 μmol/mmol, respectively). No changes in α-tocopherol or carotenoids levels were detected after adjusting for TC, for all phases.

Conclusion: These results indicate that a single dose of PS in low-fat yogurt, provided as a snack, lowers cholesterol levels but does not alter fat-soluble vitamin or carotenoid concentrations in hyperlipidemic participants.     

Non-esterified plant sterols solubilized in low fat milks inhibit cholesterol absorption--a stable isotope double-blind crossover study

Summary. Background: The cholesterol absorption inhibiting properties of plant sterols in milks are unknown. The milk fat globule membrane components may enhance the absorption of cholesterol and could make plant sterols less efficient in this complex matrix. Aim of the study: To evaluate in hypercholesterolemic men the cholesterol absorption inhibiting properties of verified properly solubilized, non-esterified plant sterols in partly vegetable oil containing milks. Methods: The plant sterols in milk were determined to be properly solubilized, and to have effective in vitro functionality. Sixteen hypercholesterolemic adult men (initial total cholesterol 5.8–8.6 mM) then consumed milk containing sterols (1.8 g of non-esterified pure plant sterols/d) and control milk, alternatively, during two 6-day periods in a double blind cross over design. During the trial, cholesterol absorption was evaluated from the ratio of plasma isotopic enrichment of [26, 26, 26, 27, 27, 27–²H₆]cholesterol from oral intake (35.6 ± 0.2 μmol, ± SEM) over enrichment of [23, 24, 25, 26, 27–¹³C₅]cholesterol from intravenous injection (77.9 ± 0.5 μmol). Results: Plant sterols in low fat milks contained very few crystals > 11 μm in the presence and absence of bile salts and lysophospholipids, and inhibited cholesterol uptake in Caco-2 cell. This assured that the sterols were properly solubilized prior to the clinical trial. In the clinical study, compliance of volunteers was excellent. After tracer injections (72 h), the plasma [²H] and [¹³C] isotopic enrichments changed from 0.024 ± 0.001 and 0.072 ± 0.003 MPE (control) to 0.015 ± 0.001 and 0.074 ± 0.002 MPE during sterol treatment, respectively. Cholesterol absorption was reduced from 70.1 ± 4.2 % with control to 41.1 ± 4.0 % with milks containing plant sterol (P < 0.001). Conclusions: These results demonstrate that properly solubilized non-esterified plant sterols in milks significantly inhibit cholesterol absorption in mildly hypercholesterolemic men. Received: 10 October 2002, Accepted: 8 January 2003 Correspondence to: Etienne B. Pouteau     

Strawberries Added to the Usual Diet Suppress Fasting Plasma Paraoxonase Activity and Have a Weak Transient Decreasing Effect on Cholesterol Levels in Healthy Nonobese Subjects

Objective: Strawberries can improve oxidants–antioxidants balance and reduce some cardiovascular risk factors in obese subjects. Paraoxonase-1 (PON-1) is a high-density lipoprotein–associated enzyme with antioxidant properties that can protect from coronary artery disease in humans. We examined the effect of strawberry consumption on plasma PON-1 activity and lipid profile in healthy nonobese subjects.

Methods: Thirty-one subjects (body mass index [BMI] 24.4 ± 4.0 kg/m²) on their usual diet consumed 500 g of strawberry pulp daily for 30 days (first course) and after a 10-day washout the cycle was repeated (second course). Fasting blood and spot morning urine samples were collected before, during, and after each strawberry course (8 time points) for determination of paraoxonase and arylesterase PON-1 activities and lipid profile. Twenty subjects served as controls with respect to cholesterol and PON-1 activities changes over the study period.

Results: Strawberries decreased mean plasma paraoxonase PON-1 activity and this effect was more evident after the second course (by 11.6%, p < 0.05) than after the first course (5.4%, p = 0.06), whereas arylesterase activity was constant. Strawberries altered total cholesterol levels (p < 0.05) with a tendency to transiently decrease it (by 5.1%) only after 15 days of the first course. Triglycerides and high- and low-density lipoprotein cholesterol did not change in response to fruit consumption. No changes in PON-1 activities and lipid profile were noted in controls. Paraoxonase correlated with arylesterase activity (? from 0.33 to 0.46 at the first 7 time points, p < 0.05). This association disappeared at the end of study (? = 0.07) when the strongest inhibition of paraoxonase was noted.

Conclusions: Supplementation of the usual diet with strawberries decreased paraoxonase PON-1 activity and did not improve lipid profiles in healthy nonobese subjects. Further studies are necessary to establish the clinical significance of paraoxonase suppression and to define a group of healthy subjects who can benefit from strawberry consumption with respect to cholesterol levels.     

Daily Intake of Milk Enriched with n-3 Fatty Acids,Oleic Acid,and Calcium Improves Metabolic and Bone Biomarkers in Postmenopausal Women

Objective: Nutritional strategies can be effective for the prevention of menopause-related diseases, such as osteoporosis and cardiovascular disease. Our aim was to evaluate the effects of a dairy product enriched in polyunsaturated fatty acids, calcium, oleic acid, and vitamins on cardiovascular markers and bone metabolism in postmenopausal women with moderate cardiovascular risk.

Methods: One hundred seventeen healthy postmenopausal women (aged 45 ± 7.7 years) were allocated to 2 groups: the intervention group (IG; n = 63), who consumed 0.5 L/day of a low-lactose skimmed milk enriched with 40 mg/100 mL of eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA), 0.54 g/100 mL oleic acid, and vitamins, and the control group (CG; n = 54), who consumed 0.5 L/day of semiskimmed milk 0.5 L/day enriched with vitamins A and D.

Results: After 12 months, in the IG there was an improvement in lipid profile: a ?5.78% decrease in total cholesterol (p = 0.010), ?9.79% (p = 0.004) in low-density lipoprotein (LDL) cholesterol, ?9.56% (p < 0.001) in total cholesterol (TC)/high-density lipoprotein (HDL) ratio, and ?3.38% in LDL/HDL ratio (p < 0.001). No changes were observed in the CG. In the IG we observed a decrease of ?28.20% in high-sensitivity C-reactive protein (hs-CRP; p = 0.012). There was no effect on bone turnover markers or serum osteoprotegerin (OPG) in either of the study groups. In the IG, receptor activator of nuclear factor κB ligand (RANKL) was reduced ?17.64% (p = 0.003), with no effect in the CG.

Conclusion: In postmenopausal women with moderate cardiovascular risk, dietary supplementation with a dairy drink enriched with fatty acids (EPA+DHA), oleic acid, minerals, and vitamins induces a positive effect on cardiovascular risk and parameters of bone metabolism. Its regular consumption may be a useful nutritional support for postmenopausal women.     

Effects of plant sterol esters in skimmed milk and vegetable-fat-enriched milk on serum lipids and non-cholesterol sterols in hypercholesterolaemic subjects: a randomised, placebo-controlled, crossover study

Plant sterol (PS)-supplemented foods are recommended to help in lowering serum LDL-cholesterol (LDL-C). Few studies have examined the efficacy of PS-enriched skimmed milk (SM) or semi-SM enriched with vegetable fat (PS-VFM). There is also insufficient information on factors predictive of LDL-C responses to PS. We examined the effects of PS-SM (0·1 % dairy fat) and PS-VFM (0·1 % dairy fat plus 1·5 % vegetable fat) on serum lipids and non-cholesterol sterols in hypercholesterolaemic individuals. In a placebo-controlled, crossover study, forty-three subjects with LDL-C>1300 mg/l were randomly assigned to three 4-week treatment periods: control SM, PS-SM and PS-VFM, with 500 ml milk with or without 3·4 g PS esters (2 g free PS). Serum concentrations of lipids and non-cholesterol sterols were measured. Compared to control, LDL-C decreased by 8·0 and 7·4 % (P < 0·015, both) in the PS-SM and PS-VFM periods, respectively. Serum lathosterol:cholesterol (C) ratios increased by 11-25 %, while sitosterol:C and campesterol:C ratios increased by 70-120 % with both the PS-fortified milk. Adjusted LDL-C reductions were variably enhanced in participants with basal low serum lathosterol/C or conversely high sitosterol/C and campesterol/C. Subjects with post-treatment serum PS:C ratios above the median showed mean LDL-C changes of - 5·9 to - 10·4 %, compared with 1·7 to - 2·9 % below the median. In conclusion, consumption of 2 g/d of PS as PS-SM and PS-VFM lowered LDL-C in hypercholesterolaemic subjects to a similar extent. Basal and post-treatment changes in markers of cholesterol metabolism indicating low cholesterol synthesis and high cholesterol absorption predicted improved LDL-C responses to PS.     

Comparable reduction in cholesterol absorption after two different ways of phytosterol administration in humans

Purpose

Consumption of phytosterols is a nutritional strategy to reduce cholesterol absorption, but the efficacy of various phytosterol intake modalities remains uncertain. The main objective was to investigate the effects of phytosterol esters (PE) provided either as a spread (dispersed in fat) during a mixed meal or as a minidrink (micro-dispersed in liquid form) after a meal.

Methods

In a randomized, single-blinded crossover design, 12 healthy intubated volunteers tested three different liquid meal sequences with and without PE. The liquid meal (500 mL, Fortisip) contained an oral dose (80 mg) of deuterium-enriched cholesterol (D7C). The intubation was stopped at 240 min, and the fate of sterols was determined in the different phases of duodenal content samples as function of time. A second solid fat-containing meal without sterols was consumed at 270 min. D7C was quantified in chylomicrons and plasma for 8 h. The conditions tested were as follows: (1) no PE added (control), (2) PE in a spread added into a liquid meal (PE-spread meal) and (3) PE given 30 min after a liquid meal as 100-g yoghurt drink (PE-minidrink meal).

Results

Addition of PE decreased the incorporation of cholesterol into the duodenum aqueous phase including micelles. PE added as a spread or as a minidrink significantly and comparably lowered meal cholesterol occurrence in chylomicrons (?40 % for PE-spread and ?54 % for PE-minidrink, p < 0.0001) compared with the control meal.

Conclusions

PE either dispersed in fat during a meal or micro-dispersed in a liquid form after a meal resulted in a markedly reduced occurrence of meal-derived cholesterol in the circulation at a comparable extent.     

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.     

The Effects of Coenzyme Q10 Supplementation on Glucose Metabolism,Lipid Profiles,Inflammation, and Oxidative Stress in Patients With Diabetic Nephropathy: A Randomized,Double-Blind,Placebo-Controlled Trial

Objective: Data on the effects of coenzyme Q10 (CoQ10) supplementation on glucose metabolism, lipid profiles, inflammation, and oxidative stress in subjects with diabetic nephropathy (DN) are scarce. This research was done to determine the effects of CoQ10 supplementation on metabolic status in subjects with DN.

Methods: This randomized double-blind placebo-controlled clinical trial was done in 50 subjects with DN. Participants were randomly assigned into two groups to intake either 100 mg/day CoQ10 supplements (n = 25) or placebo (n = 25) for 12 weeks. Fasting blood samples were obtained at first and after 12-week intervention to quantify metabolic profiles.

Results: After 12 weeks of treatment, compared with the placebo, CoQ10 supplementation resulted in significant decreases in serum insulin levels (?3.4 ± 6.8 vs +0.8 ± 6.4 µIU/mL, p = 0.02), homeostasis model of assessment-estimated insulin resistance (?1.0 ± 2.0 vs +0.2 ± 1.8, p = 0.03), homeostasis model of assessment-estimated B cell function (?12.3 ± 26.3 vs +3.5 ± 23.1, p = 0.02) and HbA1c (?1.1 ± 1.0 vs ?0.1 ± 0.2%, p < 0.001), and a significant improvement in quantitative insulin sensitivity check index (+0.009 ± 0.01 vs ?0.006 ± 0.01, p = 0.01). In addition, CoQ10 supplementation significantly decreased plasma malondialdehyde (MDA) (?0.6 ± 0.5 vs +0.5 ± 1.0 µmol/L, p < 0.001) and advanced glycation end products levels (AGEs) (?316.4 ± 380.9 vs +318.6 ± 732.0 AU, p < 0.001) compared with the placebo. Supplementation with CoQ10had no significant impacts on fasting plasma glucose (FPG), lipid profiles, and matrix metalloproteinase-2 (MMP-2) compared with the placebo.

Conclusions: Taken together, our study demonstrated that CoQ10 supplementation for 12 weeks among DN patients had favorable effects on glucose metabolism, MDA, and AGEs levels, but unchanged FPG, lipid profiles, and MMP-2 concentrations.     

Lipid effects of a dietary supplement softgel capsule containing plant sterols/stanols in primary hypercholesterolemia

ObjectiveThis randomized, placebo-controlled, crossover trial assessed the lipid-altering efficacy of a softgel capsule dietary supplement, providing esterified plant sterols/stanols 1.8 g/d, in 28 participants (～75% women) with primary hypercholesterolemia (fasting low-density lipoprotein cholesterol [LDL-C] levels ≥130 and <220 mg/dL), a mean age of 58.4 y, and a mean body mass index of 27.9 kg/m².MethodsAfter a 5-wk National Cholesterol Education Program (NCEP) Therapeutic Lifestyle Changes (TLC) diet and a single-blinded placebo lead-in, subjects received double-blinded placebo or sterol/stanol softgel capsules for 6 wk and then crossed over to the opposite product for 6 wk while continuing the TLC diet. Fasting lipids were assessed in duplicate at the end of the diet lead-in (baseline) and the end of each treatment.ResultsThe mean baseline lipid concentrations (milligrams per deciliter) were 223 for total cholesterol (TC), 179 for non–high-density lipoprotein cholesterol (non-HDL-C), 154 for low-density lipoprotein cholesterol, 44 for HDL-C, 125 for triacylglycerols, and 5.2 for TC/HDL-C. Differences from the control responses (plant sterol/stanol minus control) in the per-protocol sample were significant (P < 0.05) for LDL-C (?9.2%), non-HDL-C (?9.0%), TC (?7.4%), TC/HDL-C (?5.4%), and triacylglycerols (?9.1%). The HDL-C responses were not significantly different between treatments.ConclusionThe incorporation of softgel capsules providing esterified plant sterols/stanols 1.8 g/d into the NCEP TLC diet produced favorable changes in atherogenic lipoprotein cholesterol levels in these subjects with hypercholesterolemia.     

Potential Cardioprotective Effects of Sumac Capsule in Patients With Hyperlipidemia: A Triple-Blind Randomized,Placebo-Controlled Crossover Trial

Objective: Alternative medicine and herbal drugs have been taken into account for managing cardiovascular risk factors. Sumac (Rhus coriaria L.) is rich in biologically active ingredients known to improve cardiovascular health. We investigated the effect of sumac on systolic (SBP) and diastolic (DBP) blood pressure, flow-mediated dilation (FMD), body mass index (BMI), and serum concentrations of lipids and fasting blood sugar (FBS) in participants with hyperlipidemia in a triple-blind randomized placebo- controlled crossover trial.

Methods: Thirty adults with dyslipidemia (mild to moderate elevation of plasma total cholesterol and/or triglycerides [TG; total cholesterol ≥ 6.0 mmol/L or TG ≥ 1.7 mmol/L and TG ≤ 5.0 mmol/L]) were assigned randomly to a sumac or a placebo group. Participants in the sumac group received sumac capsules (500 mg/twice daily) for the first 4 weeks, followed by 2 weeks’ washout period; the patients were then switched to a 4-week interval and received placebo for 4 weeks in the second period. The placebo group received these treatments in reverse order. FMD, BMI, SBP, DBP, lipids, and FBS were measured at baseline and after each period.

Results: Differences between placebo group and sumac group (placebo-sumac) were significantly decreased for BMI (0.21 ± 0.075 kg/m²), SBP (1.87 ± 0.83 mm Hg), DBP (1.32 ± 0.46 mm Hg), and total cholesterol (14.42 ± 4.95 mmol/L) and significantly increased for FMD (?0.23% ± 0.065%). Plasma level of TG did not change significantly across the treatment.

Conclusion: Sumac consumption may decrease cardiovascular risk factors in persons with mild to moderate hyperlipidemia.     

Phytosterols protect against diet-induced hypertriglyceridemia in Syrian golden hamsters

Background

In addition to lowering LDL-C, emerging data suggests that phytosterols (PS) may reduce blood triglycerides (TG), however, the underlying mechanisms are not known.

Methods

We examined the TG-lowering mechanisms of dietary PS in Syrian golden hamsters randomly assigned to a high fat (HF) diet or the HF diet supplemented with PS (2%) for 6 weeks (n?=?12/group). An additional subset of animals (n?=?12) was provided the HF diet supplemented with ezetimibe (EZ, 0.002%) as a positive control as it is a cholesterol-lowering agent with known TG-lowering properties.

Results

In confirmation of diet formulation and compound delivery, both the PS and EZ treatments lowered (p?<?0.05) intestinal cholesterol absorption (24 and 31%, respectively), blood non-HDL cholesterol (61 and 66%, respectively), and hepatic cholesterol (45 and 55%, respectively) compared with the HF-fed animals. Blood TG concentrations were lower (p?<?0.05) in the PS (49%) and EZ (68%)-treated animals compared with the HF group. The TG-lowering response in the PS-supplemented group was associated with reduced (p?<?0.05) intestinal SREBP1c mRNA (0.45 fold of HF), hepatic PPARα mRNA (0.73 fold of HF), hepatic FAS protein abundance (0.68 fold of HD), and de novo lipogenesis (44%) compared with the HF group. Similarly, lipogenesis was lower in the EZ-treated animals, albeit through a reduction in the hepatic protein abundance of ACC (0.47 fold of HF).

Conclusions

Study results suggest that dietary PS are protective against diet-induced hypertriglyceridemia, likely through multiple mechanisms that involve modulation of intestinal fatty acid metabolism and a reduction in hepatic lipogenesis.     

The effect of plant sterol-enriched turkey meat on cholesterol bio-accessibility during in vitro digestion and Caco-2 cell uptake

This study evaluated the effect of a plant sterol-enriched turkey product on cholesterol bio-accessibility during in vitro digestion and cholesterol uptake by Caco-2 monolayers. Turkey products, one plant sterol-enriched (PS) and one plant sterol-free (C), were produced in an industrial pilot plant. Before simulated digestion, matrices were spiked with cholesterol (1:5 weight ratio of cholesterol to plant sterol). Plant sterols were included at a concentration equivalent to the minimum daily intake recommended by the European Food Safety Authority (EFSA) for cholesterol lowering. After simulated digestion, the percentage of cholesterol micellarization and uptake by Caco-2 cells in the presence of PS meat were measured. Compared to C meat, PS meat significantly inhibited cholesterol micellarization on average by 24% and Caco-2 cell accumulation by 10%. This study suggests that plant sterols in meat can reduce cholesterol uptake by intestinal epithelia and it encourages efforts to make new PS-based functional foods.     

Blueberry anthocyanins at doses of 0.5 and 1 % lowered plasma cholesterol by increasing fecal excretion of acidic and neutral sterols in hamsters fed a cholesterol-enriched diet

Purpose

The present study investigated the underlying mechanism associated with the hypocholesterolemic activity of blueberry anthocyanins by examining its effect on fecal sterol excretion and gene expression of major receptors, enzymes, and transporters involved in cholesterol metabolism.

Methods

Hamsters were divided into three groups and fed a 0.1 % cholesterol diet containing 0 % (CTL), 0.5 % (BL), and 1.0 % (BH) blueberry anthocyanins, respectively, for six weeks. Plasma total cholesterol (TC), triacylglycerols (TAG), and non-high-density lipoproteins cholesterol (non-HDL-C) were measured using the enzymatic kits, and the gene expression of transporters, enzymes, and receptors involved in cholesterol absorption and metabolism was quantified using the quantitative PCR. GC analysis was used to quantify hepatic cholesterol and fecal acidic and neutral sterols.

Results

Dietary supplementation of 0.5 and 1.0 % blueberry anthocyanins for 6 weeks decreased plasma TC concentration by 6–12 % in a dose-dependent manner. This was accompanied by increasing the excretion of fecal neutral and acidic sterols by 22–29 % and 41–74 %, respectively. Real-time PCR analyses demonstrated that incorporation of blueberry anthocyanins into diet down-regulated the genes of NPC1L1, ACAT-2, MTP, and ABCG 8. In addition, blueberry anthocyanins were also able to down-regulate the gene expression of hepatic HMG-CoA reductase.

Conclusion

The cholesterol-lowering activity of blueberry anthocyanins was most likely mediated by enhancing the excretion of sterols accompanied with down-regulation on gene expression of intestinal NPC1L1, ACAT-2, MTP, and ABCG 8.     

Effectiveness of a community-based intervention for weight loss on cardiometabolic risk factors among overweight and obese women in a low socio-economic urban community: findings of the MyBFF@home

Background

The effectiveness of lifestyle intervention for weight loss on cardiometabolic risk factors among overweight and obese individuals in the community setting remains inconclusive. This study aimed to evaluate the effect of a 6-month weight loss lifestyle intervention on cardiometabolic risk factors among overweight and obese women and the sustainability of the changes in those markers at 12-month follow-up, comparing an intervention group with a control group.

Methods

A total of 243 participants from MyBFF@home were included in this study. Fasting blood samples at baseline, 6- and 12-month were assessed for fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides. The effect of the intervention on cardiometabolic risk markers were investigated within and between study groups using t-test and general linear model (GLM) repeated measure ANOVA.

Results

Results from repeated measures ANOVA showed intervention effect only in TC where significant reduction was found in the intervention group (? 0.26 mmol/L [95% CI: – 0.47 to ? 0.06], p?<?0.01) compared to the control group (? 0.06 mmol/L [95% CI: – 0.28 to 0.17]) at 12 months. At 6 months, TC was reduced significantly in both groups but only intervention group retained the reduction in maintenance phase while, the level increased significantly in the control group (0.22 mmol/L [95% CI: 0.06 to 0.38]). This attributed to significant increase in TC/HDL-C ratio in the control group during maintenance phase (0.32 [95% CI: 0.15 to 0.50], p?<?0.001). The intervention group also showed trend of reduction in FPG at 6 months and further decreased during maintenance phase (??0.19 mmol/L [95% CI: – 0.32 to ? 0.06], p?<?0.01). At 6 months HDL-C was maintained in the intervention group but reduced significantly in the control group (??0.05 mmol/L [95% CI: – 0.10 to ? 0.01], p?<?0.05). No significant difference was detected in both markers when compared between groups.

Conclusions

In the context of low socio-economic communities, this study supports that weight loss related lifestyle modifications over a 6-month period could improve selected cardiometabolic risk factors, particularly fasting glucose, TC and HDL-C in overweight and obese women with favourable sustainability over a 12-month period.

     

The Combined Effects of Exercise,Diet, and a Multi-Ingredient Dietary Supplement on Body Composition and Adipokine Changes in Overweight Adults

Background: Very few weight and fat loss supplements undergo finished-product research to examine efficacy. The purpose of this study was to determine the effects of an 8-week diet and exercise program on body composition, hip and waist girth, and adipokines and evaluate whether a dietary supplement containing raspberry ketone, capsaicin, caffeine, garlic, and Citrus aurantium enhanced outcomes.

Methods: Overweight men and women completed this randomized, placebo-controlled, double-blind study. Participants consumed 4 capsules/d of supplement (EXP; n = 18) or placebo (PLA; n = 18). Participants underwent 8 weeks of daily supplementation, calorie restriction (500 kcal < RMR [resting metabolic rate] × 1.2), and supervised progressive exercise training 3 times a week. Body composition, girth, and adipokines were assessed at baseline and postintervention (T1 and T2).

Results: Significant decreases in weight (?2.6 ± 0.57 kg, p < 0.001), fat mass (?1.8 ± 0.20 kg; p < 0.001), and percentage body fat (?3.7% ± 0.29%, p < 0.001) and a significant increase in lean body mass (LBM; 1.5 ± 0.26 kg; p < 0.001) were seen from T1 to T2 in both groups. For men, only those in the EXP group increased LBM from T1 to T2 (1.3 ± 0.38 kg; p < 0.05). Hip girth was also reduced, with the women in the EXP group (?10.7 ± 2.15 cm, p < 0.001) having a greater reduction. There was a time by group interaction, with significant decreases in leptin (p < 0.001) and significant increases in adiponectin (p < 0.05) in the EXP group.

Conclusions: Significant improvements in adipokines and leptin support the utility of exercise, diet, and fat loss for impacting inflammatory biomarkers. The improvement in adiponectin with EXP may suggest a unique health mechanism.     

Effects of Hydrolyzed Whey versus Other Whey Protein Supplements on the Physiological Response to 8 Weeks of Resistance Exercise in College-Aged Males

Objective: The objective of this study was to compare the chronic effects of different whey protein forms on body composition and performance when supplemented with resistance training.

Methods: Resistance-trained men (N = 56, 21.4 ± 0.4 years, 79.5 ± 1.0 kg) participated in an 8-week resistance training regimen (2 upper-body sessions and 2 lower-body sessions per week) and received one of 4 double-blinded treatments: 30 g/serving carbohydrate placebo (PLA) or 30 g/serving protein from either (a) 80% whey protein concentrate (WPC), (b) high-lactoferrin-containing WPC (WPC-L), or (c) extensively hydrolyzed WPC (WPH). All subjects consumed 2 servings of treatment per day; specifically, once immediately before and after training and between meals on nontraining days. Blood collection, one repetition maximum (1RM) testing for bench press and hack squat, and body composition assessment using dual-energy x-ray absorptiometry (DXA) occurred prior to training and 48 hours following the last training session.

Results: Total body skeletal muscle mass increased in all groups (p < 0.0125). There were similar between-group increases in upper-body (4%–7%, analysis of covariance [ANCOVA] interaction p = 0.73) and lower-body (24%–35%, ANCOVA interaction p = 0.85) 1RM strength following the intervention. Remarkably, WPH reduced fat mass (?6%), which was significantly different from PLA (+4.4%, p < 0.0125). No time or between-group differences were present for serum markers of health, metabolism, or muscle damage, with the exception of blood urea nitrogen being significantly lower for WPH than WPC (p < 0.05) following the intervention.

Conclusions: WPH may augment fat loss but did not provide any other advantages when used in combination with resistance training. More mechanistic research is needed to examine how WPH affects adipose tissue physiology.     

The Effect of a Vegetarian vs Conventional Hypocaloric Diabetic Diet on Thigh Adipose Tissue Distribution in Subjects with Type 2 Diabetes: A Randomized Study

Objective: The aim of our study was to compare the effects of a vegetarian and a conventional diet on thigh adipose tissue distribution in subjects with type 2 diabetes (T2D).

Methods: Seventy-four subjects with T2D were randomly assigned to either follow a vegetarian diet (V, n = 37) or a control group who followed an isocaloric conventional anti-diabetic diet (C, n = 37). Both diets were calorie restricted (?500 kcal/day). To measure insulin sensitivity, the hyperinsulinemic (1 mU.kg^?1.min^?1) isoglycemic clamp was conducted. β-Cell function was assessed using a mathematical model after a test meal. Magnetic resonance imaging of the thigh was performed. All subjects were examined at 0, 3, and 6 months. Statistical analyses were performed using repeated measures analysis of variance and a multivariate regression model.

Results: Greater reduction was observed in total leg area in V (?13.6 cm² [95% confidence interval [CI], ?14.2 to ?12.9] in V vs ?9.9 cm² [95% CI, ?10.6 to ?9.2] in C; Gxt p < 0.001). The reduction in subcutaneous fat was comparable in response to both diets (Gxt, p = 0.64). Subfascial fat was reduced only in response to a vegetarian diet (?0.82 [95% CI, ?1.13 to ?0.55] cm² in V vs ?0.44 [95% CI, ?0.78 to +0.02] cm² in C; Gxt, p = 0.04). The reduction in intramuscular fat tended to be greater in response to a vegetarian diet (?1.78 [95% CI, ?2.26 to ?1.27] cm² in V vs ?0.57 [95% CI, ?1.06 to ?0.09] cm² in C; Gxt, p = 0.12). Changes in subcutaneous and subfascial fat correlated with changes in glycated hemoglobin (HbA1c), fasting plasma glucose, and β-cell insulin sensitivity. After adjustment for changes in body mass index (BMI), correlations remained significant for changes in fasting plasma glucose and β-cell insulin sensitivity and with changes in triglycerides.

Conclusions: Our data indicate the importance of both subcutaneous and subfascial fat in relationship to glucose and lipid metabolism.

Abbreviations: BMI , body mass index; C , control group; FPG , fasting plasma glucose; Gxt , interaction between group and time; HbA1c , glycated hemoglobin; MCR , metabolic clearance rate of glucose; OPLS , orthogonal projections to latent structure; T2D , type 2 diabetes; V , vegetarian group     

Editorial

Aim: Compare the long-term effects of an energy-restricted very low-carbohydrate, high-fat (LC) diet with an isocaloric high-carbohydrate, low-fat (HC) diet on exercise tolerance and capacity in overweight and obese adults.

Methods: Seventy-six adults (25 males; age 49.2 ± 1.1 years; BMI 33.6 ± 0.5 kg/m²) were randomized to either a hypocaloric (6–7 MJ/day) LC diet (35% protein, 4% carbohydrate, 61% fat) or isocaloric HC diet (24% protein, 46% carbohydrate, 30% fat) for 52 weeks. Pre- and postintervention, participants’ body weight and composition, handgrip, and isometric knee extensor strength were assessed and participants performed an incremental exercise test to exhaustion.

Results: Forty-three participants completed the study (LC = 23; HC = 20). Overall, peak relative oxygen uptake increased (+11.3%) and reductions occurred in body weight (?14.6%), body fat percentage (?6.9% [absolute]), isometric knee extensor strength (?12.4%), handgrip strength (?4.5%), and absolute peak oxygen uptake (?5.2%; p ≤ 0.02 time for all) with no diet effect (p ≥ 0.18). During submaximal exercise, rating of perceived exertion did not change in either group (p = 0.16 time, p = 0.59 Time × Group). Compared to the HC diet, the LC diet had greater reductions in respiratory exchange ratio (LC ?0.04 ± 0.01, HC ?0.00 ± 0.01; p = 0.03), and increased fat oxidation (LC 15.0 ± 5.3% [of energy expenditure], HC 0.5 ± 3.9%; p = 0.04).

Conclusion: In overweight and obese patients, an LC diet promoted greater fat utilization during submaximal exercise. Both an LC diet and an HC diet had similar effects on aerobic capacity and muscle strength, suggesting that long-term consumption of an LC weight loss diet does not adversely affect physical function or the ability to perform exercise.     

Milk phospholipid and plant sterol-dependent modulation of plasma lipids in healthy volunteers

Purpose

Hypolipidemic and/or hypocholesterolemic effects are presumed for dietary milk phospholipid (PL) as well as plant sterol (PSt) supplementation. The aim was to induce changes in plasma lipid profile by giving different doses of milk PL and a combination of milk PL with PSt to healthy volunteers.

Methods

In an open-label intervention study, 14 women received dairy products enriched with moderate (3 g PL/day) or high (6 g PL/day) dose of milk PL or a high dose of milk PL combined with PSt (6 g PL/day + 2 g PSt/day) during 3 periods each lasting 10 days.

Results

Total cholesterol concentration and HDL cholesterol concentration were reduced following supplementation with 3 g PL/day. No significant change in LDL cholesterol concentration was found compared with baseline. High PL dose resulted in an increase of LDL cholesterol and unchanged HDL cholesterol compared with moderate PL dose. The LDL/HDL ratio and triglyceride concentration remained constant within the study. Except for increased phosphatidyl ethanolamine concentrations, plasma PL concentrations were not altered during exclusive PL supplementations. A combined high-dose PL and PSt supplementation led to decreased plasma LDL cholesterol concentration, decreased PL excretion, increased plasma sphingomyelin/phosphatidyl choline ratio, and significant changes in plasma fatty acid distribution compared with exclusive high-dose PL supplementation.

Conclusion

Milk PL supplementations influence plasma cholesterol concentrations, but without changes of LDL/HDL ratio. A combined high-dose milk PL and PSt supplementation decreases plasma LDL cholesterol concentration, but it probably enforces absorption of fatty acids or fatty acid-containing hydrolysis products that originated during lipid digestion.