Dietary enrichment by almond supplementation: effects on risk factors for cardiovascular disease
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Cardiovascular disease (CVD) is the leading cause of death in Europe responsible for more than 4.3 million deaths annually. The World Health Organisation funded the Monica project (1980s-1990s) which monitored ten million subjects aged 22-6Syrs, and demonstrated that coronary heart disease (CHD) mortality declined over 10 years, was due in two thirds of cases to reduced incidence of CHD (reduced risk behaviours e.g. poor diet and smoking) and one third by improved treatments. Epidemiological evidence suggests diets rich in antioxidants decrease incidence of CVD. Regular consumption of nuts, rich in vitamin E and polyphenols reduces atherosclerosis, an important risk for heart disease. Intervention studies to date using alpha tocopherol (an active component of vitamin E) have not consistently proved beneficial. This thesis aims to investigate the effect of almond supplementation on vascular risk factors in healthy young males (18-3Syrs); mature males and female(>SOyrs); and males considered at increased risk of CVD (18-3Syrs) in a cohort of 67 subjects. The effects of almond intake were assessed after 2Sg/d for four weeks followed by SOg/d for four weeks and compared to a control group which did not consume almonds or change their diet. Cardiovascular risk was assessed by plasma lipid profiles, apolipoprotein A1, plasma nitrates/nitrates, vascular flow, BMl, blood pressure, sVCAM-1 and protein oxidation. Systolic and diastolic blood pressures were reduced in almond supplemented volunteers but not in controls. Dietary monounsaturated fatty acids, polyunsaturated fatty acid content and total dietary fats were increased by almond supplementation. Neither sVCAM-1, venous occlusion plethysmography nor plasma nitrite levels were affected by almond intake in any independent group. No significant changes in plasma lipids, and apolipoprotein A1 were observed. In conclusion almonds supplementation caused a reduction in blood pressure that may be due to increased sensitivity of the baroreceptors after increased monounsaturated fatty acid intake.Topics:
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Abdominal obesity is the main component of the metabolic syndrome. Hyperplasia of visceral adipose tissue leads to numerous metabolic disorders: hypertension, dyslipidemia, insulin resistance. This clustering of the most hazardous risk factors is directly linked to type 2 diabetes and cardiovascular disease.The aim of presented trial was to evaluate the use of low-caloric diet (1200-1500 kcal/day) with modified fatty acids pool in dietetic therapy of the metabolic syndrome and additionally to estimate the total risk of various cardiovascular disease outcomes.23 obese patients aged 22-65 years: 14 men (44.0 +/- 10.9 years) and 9 women (49.7 +/- 11.3 years) with metabolic syndrome (according to NCEP ATPIII) were randomly divided into 2 groups: examined (II) and control (I) with PUFA n-3/n-6 ratio 1:5 and 1:10 respectively. There were no difference in diet composition between groups. Dietary fiber intake was over 29 g/day and both diets provide 28% of total energy from fats, 53% from carbohydrates and 18% from proteins, with < 200 mg cholesterol/day. Anthropometric (body mass, waist and hip circumference) and biochemical (plasma concentration of: glucose, triglicerydes, total cholesterol, LDL and HDL cholesterol) indicators, body composition and the value of blood pressure were controlled.After 12 weeks trial there was significant decrease in measured parameters noted: body mass (8.2 +/- 1.6 kg; p < 0.001), waist circumference (13.4 +/- 2.4 cm; p < 0.001), systolic and diastolic blood pressure: 11.5 +/- 2.2 mmHg and 7.1 +/- 09 mmHg; (p = 0.0003 i p = 0.0008) respectively. The reduction in total risk of developing coronary heart disease measured by Framingham risk score and SCORE algorithm was observed. There was no statistically significant difference between the effects of both groups: PUFA n-3/n-6 1:5 and 1:10.. These results suggest that the individually matched low-caloric diet with decreased saturated fats intake, increased intake of PUFA n-3 and dietary fibers are crucial in metabolic syndrome therapy and efficiently decrease total cardiovascular risk in these patients.
Abdominal obesity
Dyslipidemia
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Cardiovascular disease (CVD) is associated with dyslipidemia and frequently with insulin resistance, both of which are in general no alleviated by antilipidemic drugs. Our objective was to examine whether a dietary supplement containing omega-3 fatty acids (n-3 FA) can reduce the levels of serum lipids, fasting insulin and glucose in documented CVD patients treated by statins or bezafibrates. In a double-blind placebo-controlled trial of parallel design, 52 patients, age 69.2 years +/- 3.6 treated by antilipidemic drugs, were randomly assigned to receive daily 7 gr of a dietary concentrated supplement containing 67% n-3 FA (185 mg EPA and 465 mg/g DHA) in a form of spread (Yamega Ltd, Israel) or olive oil spread (placebo) and recommended to reduce the consumption of omega-6 fatty acids for 12 weeks. The average values +/- SD before and after dietary supplementations were compared.44 patients (23 in the n-3 FA group) completed the study. In the n-3FA group we observed a significant decrease (p < 0.05) of total cholesterol (12.2%). LDL-cholesterol (16.8%), triglycerides (36.1%), insulin in hyperinsulinemic subjects (> 20 microunits/ml) (34.9%), and no significant changes in HDL-cholesterol and glucose. No hyperglycemia was detected. In the olive oil group we observed a significant decrease (p < 0.05) in the LDL-cholesterol values of 15.5% and no significant changes in the other parameters. No side effects were reported during the study in any of the participants. Our findings demonstrate that the incorporation of the dietary supplement containing EPA and DHA omega-3 fatty acids reduces significantly the above risk factors for CVD.
Dyslipidemia
Lipid Profile
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Background: Greater consumption of omega-3 fatty acids has been associated with lower cardiovascular disease risk. Randomized controlled trials indicate direct, albeit small, beneficial effects of omega-3 fatty acids on plasma triglycerides and blood pressure, yet few studies have tested their impact on insulin resistance and the clustered risk factors comprising the metabolic syndrome. Hypothesis: Short-term supplementation with marine omega-3 polyunsaturated fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) will improve aggregated cardiometabolic risk (CMR) in healthy middle-aged adults Methods: We conducted a double-blind, placebo-controlled, parallel group clinical trial. Subjects were 30-54 year-old adults free of atherosclerotic disease and diabetes whose intake of EPA and DHA totaled <300 mg/day. Each was randomly assigned to daily fish oil supplements (2g/day containing 1000 mg EPA and 400mg DHA) or matching soybean oil placebo for 18 weeks. Aggregate CMR at baseline and post-intervention was calculated as the standardized sum of standardized distributions of blood pressure, BMI, and fasting serum triglycerides, glucose, and HDL (reverse scored). Missing data due to dropouts (n=17) and outliers (1-6 per variable) were replaced by multivariate imputation. Outcome analyses were conducted with linear regressions of all randomized subjects based on intention-to-treat. Results: Participants were 272 healthy adult (57% (154 out of 272) women; 17% (47 out of 272) minority; mean age 42) Pittsburgh-area residents. At baseline, demographics, health parameters, physical activity and EPA and DHA consumption did not differ significantly between treatment groups. No overall treatment effect was found, whereas gender moderated the effects of treatment on CMR risk (gender, p=.001 and gender*treatment interaction term p=.011). In gender-specific analyses, supplementation lowered CMR risk relative to placebo in men(p=.036, effect size=.629, standard error (SE) =.282) but not women (p=.168, effect size .261, SE=.222). Of the individual CMR variables, only HDL-cholesterol in men revealed a significant improvement (p=.012). In men receiving placebo, HDL-cholesterol fell by 1.1 mg/dl, whereas in those receiving fish oil, HDL rose by 1.7 mg/dl. As has been noted in other samples, compared to women men had greater CMR and lower HDL-cholesterol. Conclusions: Increased intake of n-3 fatty acids over 4 months reduced CMR in healthy, mid-life men but not women. This finding may be due to poorer baseline CMR and HDL characteristic of men, or to gender differences in fatty acid metabolism. Further study of gender differences in cardiometabolic risk and fatty acid metabolism may lead to gender-tailored preventive interventions.
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There is convincing evidence that daily whole almond consumption lowers blood LDL cholesterol concentrations, but effects on other cardiometabolic risk factors such as endothelial function and liver fat are still to be determined.We aimed to investigate whether isoenergetic substitution of whole almonds for control snacks with the macronutrient profile of average snack intakes, had any impact on markers of cardiometabolic health in adults aged 30-70 y at above-average risk of cardiovascular disease (CVD).The study was a 6-wk randomized controlled, parallel-arm trial. Following a 2-wk run-in period consuming control snacks (mini-muffins), participants consumed either whole roasted almonds (n = 51) or control snacks (n = 56), providing 20% of daily estimated energy requirements. Endothelial function (flow-mediated dilation), liver fat (MRI/magnetic resonance spectroscopy), and secondary outcomes as markers of cardiometabolic disease risk were assessed at baseline and end point.Almonds, compared with control, increased endothelium-dependent vasodilation (mean difference 4.1%-units of measurement; 95% CI: 2.2, 5.9), but there were no differences in liver fat between groups. Plasma LDL cholesterol concentrations decreased in the almond group relative to control (mean difference -0.25 mmol/L; 95% CI: -0.45, -0.04), but there were no group differences in triglycerides, HDL cholesterol, glucose, insulin, insulin resistance, leptin, adiponectin, resistin, liver function enzymes, fetuin-A, body composition, pancreatic fat, intramyocellular lipids, fecal SCFAs, blood pressure, or 24-h heart rate variability. However, the long-phase heart rate variability parameter, very-low-frequency power, was increased during nighttime following the almond treatment compared with control (mean difference 337 ms2; 95% CI: 12, 661), indicating greater parasympathetic regulation.Whole almonds consumed as snacks markedly improve endothelial function, in addition to lowering LDL cholesterol, in adults with above-average risk of CVD.This trial was registered at clinicaltrials.gov as NCT02907684.
Liver function
Resistin
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The aim of this thesis was to investigate how dietary fatty acids affect the risk for cardiometabolic disease, i.e. cardiovascular disease (CVD), type 2 diabetes and obesity. The overall hypothesis was that unsaturated fatty acids and especially the predominant polyunsaturated fatty acid (PUFA) linoleic acid (LA), 18:2n-6, would decrease cardiometabolic risk compared with saturated fatty acids (SFAs), in line with current recommendations to partly replace dietary SFA with PUFA.Papers I and V were observational studies based on the community-based cohort Uppsala Longitudinal Study of Adult Men (ULSAM). Adipose tissue fatty acid composition was determined as biomarker for dietary fat intake. Studies II, III and IV were randomised short-term interventions on human volunteers, in which different dietary fats were provided to the participants.In 71-year-old men, adipose tissue LA and α-linolenic acid (18:3n-3) were associated with insulin sensitivity (euglycaemic clamp), although this association was diminished for LA after adjusting for lifestyle variables. Different SFA displayed divergent associations; only palmitic acid (16:0) was inversely associated with insulin sensitivity (Paper I). In Cox regression analyses, LA was modestly associated with decreased all-cause mortality, but not CVD mortality during 15 years follow-up (Paper V).In a 3+3-week cross-over study on 20 weight-stable volunteers with dyslipidaemia, all foods were provided. A rapeseed oil-based diet distinctly lowered low-density lipoprotein cholesterol and triglycerides compared with a dairy-fat based diet (butter, cream and fatty cheese). Insulin sensitivity or coagulation factors were not affected (Paper II).In a 10-week randomised trial on 67 abdominally obese participants, PUFA (mostly sunflower oil) decreased liver fat compared with SFA (mostly butter) under isocaloric conditions. In individuals considered highly compliant to study diets, lipoproteins were also decreased during the PUFA diet (Paper III).In a 7-week double-blind randomised trial on 41 healthy volunteers, PUFA (sunflower oil) decreased the total:HDL cholesterol ratio compared with SFA (palm oil) during moderate weight gain (1.5 kg) (Paper IV).In conclusion, LA (PUFA) intake is associated with decreased cardiometabolic risk compared with higher SFA intake, overall supporting a beneficial role of non-tropical vegetable oils in place of solid fats in preventing fatty liver and cardiometabolic disorders.
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Niacin
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Refined grains
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Iran, as an Eastern Mediterranean country,has accepted the western lifestyle with respect to nutrition habits, physical inactivity and smoking which contribute to higher prevalence of cardiovascular disease (CVD) risk factors among the Iranian community. In recent years (2006)CVD is the first cause of death in Iran with 167.7 deaths per 100,000 people, 23.4% wasted age (the years which person lives with disability) and 37% of all deaths were due to CVD.Two hundred (200) male subjects with age ≥40 years old were recruited in single-blinded, randomized intervention study at Persian Gulf Health Research Center, Bushehr University of Medical Sciences.The objective of this study was to determine biomarkers risk of CVD, measured at baseline and subsequently after 12 weeks of supplementation with vitamin E (400 IU), C (500 mg), beta-carotene (15 mg), and combined (E, C, and betacarotene) supplements and placebo, respectively. Socio-economic indices, dietary intake, anthropometry, biochemical indices, were collected. As for biochemical test studied include fasting blood sugar (FBS), lipid profile: total triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), antioxidant vitamins (E, C, and beta-carotene) and inflammatory factors: high sensitive C-reactive protein (hs CRP), 8-iso-prostaglandin F2α, enzymatic oxidative defense: glutathione peroxidase (Gpx), superoxide dismutase (SOD), and also oxidized LDL (oxLDL), and total homocysteine (tHcy) were measured.The mean age of the subjects was 52.85±7.96 years old and the mean BMI was 27.56±4.26 kg/m2. In C group, dietary scores were for cereal 94.7, bread 93.1, beef 73.4. In E group, cereal had dietary score of 95.2, followed by bread 93.4.In beta-carotene group, cereal had dietary scores of 96.2, bread 90.8, dates 85.2. In combined group, dietary scores for cereal were 96.2, bread 94.2 and dates 85.9. In placebo group, rice received scores of 95.2, followed by bread 92.2.Among the subjects, 12.3 % had high fasting blood sugar (FBS) level and 80.1 % were normal level. Those subjects that had hypercholesterolemia and hypertriglyceridemia were 19.9 % and 41.4 % respectively. This study also showed that 13.3 % of the total subjects had high level of LDL-C and 6.6 % with lower level of HDL-C. Result also indicated that 8-iso-PGF2α significantly decreased in groups E 17.62 % (p=.000), beta-carotene 17.56 % (p=.002), and combined 14.97 % (p=.014). For hs-CRP was significantly decreased in groups C 28.14 % (p=.036), E 23.27 % (p=.020), beta-carotene 27.93 (p=.021), and combined 23.69 (p=.0005). The oxidized LDL was significantly decreased in groups C 18.32 % (p=.005), E 23.86 % (p=.000), beta-carotene 17.31 % (p=.000), and combined 19.07 %(p=.000). However, SOD was found to have significantly increased in groups C 26.76 % (p=.0003), and combined 35.77% (p=.000). Whereas for Gpx, result also shown to have significantly increased in groups E 7.13 % (p=.003), and combined 5.34 % (p=.017)before and after the intervention. In conclusion, the findings from this study demonstrated that supplementation of antioxidant vitamins improved some of enzymatic antioxidant systems included SOD and Gpx, and decreased harmful biomarkers for cardiovascular diseases included hs-CRP, oxLDL, and 8-iso-PGF2α.People at risk for heart disease should be encouraged to use supplementation of antioxidant vitamins to reduce the occurance of cardiovascular diseases.
beta-Carotene
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We investigated the association of dietary fatty acids and plasma antioxidative vitamins with blood pressure in 722 eastern Finnish men aged 54 years, examined in the Kuopio Ischaemic Heart Disease Risk Factor Study in 1984-1986, who had no known hypertension nor any cerebrovascular disease. Allowing for the major anthropometric, dietary, medical and psychological determinants of blood pressure in a multivariate regression analysis, plasma ascorbic acid concentration had a moderate, independent inverse association (P less than 0.0001) and the estimated dietary intake of linolenic acid an inverse (P = 0.026) independent association with mean resting blood pressure. The marked elevation of blood pressure at the lowest levels of plasma vitamin C concentration supports the hypothesis of the role of antioxidants in the aetiology of hypertension.
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