Showing papers in "European Journal of Clinical Nutrition in 2013"
TL;DR: The meaning of physiological ketosis is revisited and whether there are still some preconceived ideas about ketogenic diets, which may be presenting unnecessary barriers to their use as therapeutic tools in the physician's hand are questioned.
Abstract: Very-low-carbohydrate diets or ketogenic diets have been in use since the 1920s as a therapy for epilepsy and can, in some cases, completely remove the need for medication. From the 1960s onwards they have become widely known as one of the most common methods for obesity treatment. Recent work over the last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many pathological conditions, such as diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and the amelioration of respiratory and cardiovascular disease risk factors. The possibility that modifying food intake can be useful for reducing or eliminating pharmaceutical methods of treatment, which are often lifelong with significant side effects, calls for serious investigation. This review revisits the meaning of physiological ketosis in the light of this evidence and considers possible mechanisms for the therapeutic actions of the ketogenic diet on different diseases. The present review also questions whether there are still some preconceived ideas about ketogenic diets, which may be presenting unnecessary barriers to their use as therapeutic tools in the physician’s hand.
582 citations
TL;DR: Evidence suggests that abdominal obesity measures, such as WC or WHR, show information independent to measures of general obesity and should be used in clinical practice, in addition to BMI, to assess obesity-related mortality in adults.
Abstract: Epidemiological studies assessing general and abdominal obesity measures or their combination for mortality prediction have shown inconsistent results. We aimed to systematically review the associations of body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC) and waist-to-height ratio (WHtR) with all-cause mortality in prospective cohort studies. In this systematic review, which includes a meta-regression analysis, we analysed the associations with all-cause mortality of BMI, WHR, WC and WHtR in prospective cohort studies available in Medline, Embase, the Cochrane Database of Systematic Reviews and Esbiobase from inception through 7 May 2010. A total of 18 studies met the inclusion criteria, comprising 689, 465 participants and 48, 421 deaths during 5-24 years of follow-up. The studies were heterogeneous, mainly due to differences in categorization of anthropometric parameters (AP) and different approaches to statistical analysis. Both general and abdominal obesity measures were significantly associated with mortality. In analyses using categorical variables, BMI and WC showed predominantly U- or J-shaped associations with mortality, whereas WHR and WHtR demonstrated positive relationships with mortality. All measures showed similar risk patterns for upper quantiles in comparison to reference quantiles. The parameters of general and abdominal obesity each remained significantly associated with mortality when adjusted for the other. This evidence suggests that abdominal obesity measures such as WC or WHR, show information independent to measures of general obesity and should be used in clinical practice, in addition to BMI, to assess obesity-related mortality in adults.
218 citations
TL;DR: This paper succinctly reviews the origin, and critically evaluates the conceptual models and the implementation of bioimpedance in clinical research, including indirect assessment of assorted physiological functions and body composition, classification of hydration, regional fluid accumulation, prognosis in disease and wound healing.
Abstract: Bioimpedance is the collective term that describes safe, non-invasive methods to measure the electrical responses to the introduction of a low-level, alternating current into a living organism, and the biophysical models to estimate body composition from bioelectrical measurements. Although bioimpedance techniques have been used for more than 100 years to monitor assorted biological components, the desire to translate bioelectrical measurements into physiological variables advanced the creation of empirical prediction models that produced inconsistent results. This paper succinctly reviews the origin, and critically evaluates the conceptual models and the implementation of bioimpedance in clinical research, including indirect assessment of assorted physiological functions and body composition (fluid volumes and fat-free mass), classification of hydration, regional fluid accumulation, prognosis in disease and wound healing. Despite widespread and mounting interest in the use of bioimpedance to characterise body structure and function, most experimental findings reveal the limitations of existing physical models and reliance on multiple regression models for use in assessments of an individual. Contemporary applications of bioimpedance emphasise the value of bioimpedance variables per se in some novel biomedical applications with the objective of identifying opportunities for future outcome-based research.
215 citations
TL;DR: Regression analysis on 119 treatments indicated that change in glycaemic response was greater for intact grains than for processed foods, and intact grains as well as a variety of processed oat and barley foods containing at least 4 g of β-glucan and 30–80”g available carbohydrate can significantly reduce post-prandial blood glucose.
Abstract: Oat and barley foods have been shown to reduce human glycaemic response, compared to similar wheat foods or a glucose control. The strength of the evidence supporting the hypothesis that the soluble fibre, mixed linkage β-glucan, reduces glycaemic response was evaluated. A search of the literature was conducted to find clinical trials with acute glycaemic response as an end point using oat or barley products. Of the 76 human studies identified, 34 met the inclusion and exclusion criteria. Dose response and ratio of β-glucan to available carbohydrate as predictors of glycaemic response were assessed. Meals provided 0.3-12.1 g oat or barley β-glucan, and reduced glycaemic response by an average of 48 ± 33 mmol · min/l compared to a suitable control. Regression analysis on 119 treatments indicated that change in glycaemic response (expressed as incremental area under the post-prandial blood-glucose curve) was greater for intact grains than for processed foods. For processed foods, glycaemic response was more strongly related to the β-glucan dose alone (r(2)=0.48, P<0.0001) than to the ratio of β-glucan to the available carbohydrate (r(2)=0.25, P<0.0001). For processed foods containing 4 g of β-glucan, the linear model predicted a decrease in glycaemic response of 27 ± 3 mmol · min/l, and 76% of treatments significantly reduced glycaemic response. Thus, intact grains as well as a variety of processed oat and barley foods containing at least 4 g of β-glucan and 30-80 g available carbohydrate can significantly reduce post-prandial blood glucose.
208 citations
TL;DR: The circulating concentrations of several hormones and nutrients which influence appetite were altered after weight loss induced by a ketogenic diet, compared with after refeeding.
Abstract: Diet-induced weight loss is accompanied by compensatory changes, which increase appetite and encourage weight regain. There is some evidence that ketogenic diets suppress appetite. The objective is to examine the effect of ketosis on a number of circulating factors involved in appetite regulation, following diet-induced weight loss. Of 50 non-diabetic overweight or obese subjects who began the study, 39 completed an 8-week ketogenic very-low-energy diet (VLED), followed by 2 weeks of reintroduction of foods. Following weight loss, circulating concentrations of glucose, insulin, non-esterified fatty acids (NEFA), β-hydroxybutyrate (BHB), leptin, gastrointestinal hormones and subjective ratings of appetite were compared when subjects were ketotic, and after refeeding. During the ketogenic VLED, subjects lost 13% of initial weight and fasting BHB increased from (mean±s.e.m.) 0.07±0.00 to 0.48±0.07 mmol/l (P<0.001). BHB fell to 0.19±0.03 mmol/l after 2 weeks of refeeding (P<0.001 compared with week 8). When participants were ketotic, the weight loss induced increase in ghrelin was suppressed. Glucose and NEFA were higher, and amylin, leptin and subjective ratings of appetite were lower at week 8 than after refeeding. The circulating concentrations of several hormones and nutrients which influence appetite were altered after weight loss induced by a ketogenic diet, compared with after refeeding. The increase in circulating ghrelin and subjective appetite which accompany dietary weight reduction were mitigated when weight-reduced participants were ketotic.
196 citations
TL;DR: Consumption of a ‘Mediterranean-style’ dietary pattern by mid-aged women may have a protective influence against the onset of depressive symptoms, suggesting that dietary patterns have a potential role in the prevention and management of depressive Symptoms.
Abstract: To investigate the association between dietary patterns and prevalence and incidence 3 years later of depressive symptoms using data from the mid-aged cohort in the Australian Longitudinal Study on Women’s Health. Participants (aged 50–55 years) completed a food frequency questionnaire in 2001. Depressive symptoms were measured in 2001 and 2004 using the validated 10-item Centre for Epidemiologic Studies Depression scale. Multiple logistic regression was used for cross-sectional analysis (8369 women) and longitudinal analysis (7588) to assess the associations between dietary patterns and prevalence of depressive symptoms, and then for longitudinal analysis (6060) on their associations with the incidence of depressive symptoms in 2004, while adjusting for sociodemographic and lifestyle factors. Six dietary patterns were identified from factor analysis: cooked vegetables, fruit, Mediterranean style, meat and processed meat, dairy, and high fat and sugar. A higher consumption of the Mediterranean-style diet had a cross-sectional association with lower prevalence of depressive symptoms in 2001, adjusted odds ratio 0.82 (95% confidence interval 0.77–0.88); and longitudinally with lower incidence of depressive symptoms in 2004, adjusted odds ratio 0.83 (0.75–0.91). None of the associations found for other dietary patterns remained statistically significant after adjustment for confounders. A dose–response relationship was found cross-sectionally when women were grouped according to quintiles of Mediterranean-style diet (P-value for trend <0.001). Consumption of a ‘Mediterranean-style’ dietary pattern by mid-aged women may have a protective influence against the onset of depressive symptoms. These findings suggest that dietary patterns have a potential role in the prevention and management of depressive symptoms.
188 citations
TL;DR: An 18-week dietary intervention using a low-fat plant-based diet in a corporate setting improves body weight, plasma lipids, and, in individuals with diabetes, glycemic control.
Abstract: To determine the effects of a low-fat plant-based diet program on anthropometric and biochemical measures in a multicenter corporate setting. Employees from 10 sites of a major US company with body mass index ⩾25 kg/m2 and/or previous diagnosis of type 2 diabetes were randomized to either follow a low-fat vegan diet, with weekly group support and work cafeteria options available, or make no diet changes for 18 weeks. Dietary intake, body weight, plasma lipid concentrations, blood pressure and glycated hemoglobin (HbA1C) were determined at baseline and 18 weeks. Mean body weight fell 2.9 kg and 0.06 kg in the intervention and control groups, respectively (P<0.001). Total and low-density lipoprotein (LDL) cholesterol fell 8.0 and 8.1 mg/dl in the intervention group and 0.01 and 0.9 mg/dl in the control group (P<0.01). HbA1C fell 0.6 percentage point and 0.08 percentage point in the intervention and control group, respectively (P<0.01). Among study completers, mean changes in body weight were −4.3 kg and −0.08 kg in the intervention and control groups, respectively (P<0.001). Total and LDL cholesterol fell 13.7 and 13.0 mg/dl in the intervention group and 1.3 and 1.7 mg/dl in the control group (P<0.001). HbA1C levels decreased 0.7 percentage point and 0.1 percentage point in the intervention and control group, respectively (P<0.01). An 18-week dietary intervention using a low-fat plant-based diet in a corporate setting improves body weight, plasma lipids, and, in individuals with diabetes, glycemic control.
181 citations
TL;DR: An eight-electrode, segmental multifrequency BIA is a valid tool to estimate body composition in healthy euvolemic adults compared with the validity and precision of other two-compartment reference methods.
Abstract: What makes a BIA equation unique? Validity of eight-electrode multifrequency BIA to estimate body composition in a healthy adult population
175 citations
TL;DR: Although the BIA method shows promise for estimating body composition in athletes, future research should focus on the development of general athlete-specific equations using a TBW-based three- or four-compartment model.
Abstract: The purpose of the current review was to evaluate how body composition can be utilised in athletes, paying particular attention to the bioelectrical impedance analysis (BIA) technique. Various body composition methods are discussed, as well as the unique characteristics of athletes that can lead to large errors when predicting fat mass (FM) and fat-free mass (FFM). Basic principles of BIA are discussed, and past uses of the BIA technique in athletes are explored. Single-prediction validation studies and studies tracking changes in FM and FFM are discussed with applications for athletes. Although extensive research in the area of BIA and athletes has been conducted, there remains a large gap in the literature pertaining to a single generalised athlete equation developed using a multiple-compartment model that includes total body water (TBW). Until a generalised athlete-specific BIA equation developed from a multiple-compartment is published, it is recommended that generalised equations such as those published by Lukaski and Bolonchuk and Lohman be used in athletes. However, BIA equations developed for specific athletes may also produce acceptable values and are still acceptable for use until more research is conducted. The use of a valid BIA equation/device should produce values similar to those of hydrostatic weighing and dual-energy X-ray absorptiometry. However, researchers and practitioners need to understand the individual variability associated with BIA estimations for both single assessments and repeated measurements. Although the BIA method shows promise for estimating body composition in athletes, future research should focus on the development of general athlete-specific equations using a TBW-based three- or four-compartment model.
170 citations
TL;DR: The trial suggests aged garlic extract to be an effective and tolerable treatment in uncontrolled hypertension, and may be considered as a safe adjunct treatment to conventional antihypertensive therapy.
Abstract: Hypertension affects about 30% of adults worldwide. Garlic has blood pressure-lowering properties and the mechanism of action is biologically plausible. Our trial assessed the effect, dose–response, tolerability and acceptability of different doses of aged garlic extract as an adjunct treatment to existing antihypertensive medication in patients with uncontrolled hypertension. A total of 79 general practice patients with uncontrolled systolic hypertension participated in a double-blind randomised placebo-controlled dose–response trial of 12 weeks. Participants were allocated to one of three garlic groups with either of one, two or four capsules daily of aged garlic extract (240/480/960 mg containing 0.6/1.2/2.4 mg of S-allylcysteine) or placebo. Blood pressure was assessed at 4, 8 and 12 weeks and compared with baseline using a mixed-model approach. Tolerability was monitored throughout the trial and acceptability was assessed at 12 weeks by questionnaire. Mean systolic blood pressure was significantly reduced by 11.8±5.4 mm Hg in the garlic-2-capsule group over 12 weeks compared with placebo (P=0.006), and reached borderline significant reduction in the garlic-4-capsule group at 8 weeks (−7.4±4.1 mm Hg, P=0.07). Changes in systolic blood pressure in the garlic-1-capsule group and diastolic blood pressure were not significantly different to placebo. Tolerability, compliance and acceptability were high in all garlic groups (93%) and highest in the groups taking one or two capsules daily. Our trial suggests aged garlic extract to be an effective and tolerable treatment in uncontrolled hypertension, and may be considered as a safe adjunct treatment to conventional antihypertensive therapy.
166 citations
TL;DR: Almonds provide post-ingestive metabolic and appetitive benefits and did not increase the risk for weight gain, which suggests that almonds may be a healthful snack option.
Abstract: Snacks contribute toward a significant proportion of human total daily energy intake. This study investigated the effects of almonds, a satiating and nutrient-rich, common snack, on postprandial glycemia, appetite, short-term body weight and fasting blood parameters when consumed with meals or alone as a snack. This was a 4-week randomized, parallel-arm study that entailed consuming almonds (43 g/day) with breakfast (BF) or lunch (LN), alone as a morning (MS) or afternoon (AS) snack or no almonds (CL). Participants (N=137) with increased risk for type 2 diabetes completed an oral glucose tolerance test (OGTT) and acute-feeding session at baseline, followed by almond consumption for 4 weeks before repeating the OGTT and acute-feeding trials. Anthropometric, biochemical and appetite responses were assessed. Almonds lowered serum glucose responses postprandially. Effects were most prominent in the snack groups. Almonds, consumed as snacks, also reduced hunger and desire to eat during the acute-feeding session. After 4 weeks, anthropometric measurements and fasting blood biochemistries did not differ from the control group or across intervention groups. Without specific guidance, daily energy intake was reduced to compensate for energy from the provided almonds. Dietary monounsaturated fat and α-tocopherol intakes were significantly increased in all almond groups. Almonds provide post-ingestive metabolic and appetitive benefits and did not increase the risk for weight gain. This suggests that almonds may be a healthful snack option.
TL;DR: The results show that the effect of industrially produced trans fatty acids on heart health seen in observational studies is larger than predicted from changes in lipoprotein concentrations.
Abstract: This review asks the question if further research on trans fatty acids and cardiovascular health is needed. We therefore review the evidence from human studies on trans fatty acids and cardiovascular health, and provide a quantitative review of effects of trans fatty acid intake on lipoproteins. The results show that the effect of industrially produced trans fatty acids on heart health seen in observational studies is larger than predicted from changes in lipoprotein concentrations. There is debate on the effect of ruminant trans fatty acids and cardiovascular disease. Of special interest is conjugated linoleic acid (CLA), which is produced industrially for sale as supplements. Observational studies do not show higher risks of cardiovascular disease with higher intakes of ruminant trans fatty acids. However, CLA, industrial and ruminant trans fatty acids all raise plasma low-density lipoprotein and the total to high-density lipoprotein ratio. Gram for gram, all trans fatty acids have largely the same effect on blood lipoproteins. In conclusion, the detrimental effects of industrial trans fatty acids on heart health are beyond dispute. The exact size of effect will remain hard to determine. Further research is warranted on the effects of ruminant trans fatty acids and CLA on cardiovascular disease and its risk factors.
TL;DR: BIA is a central tool in the clinical examination of patients addressing hydration, functional body mass, energy stores and prognosis, and may also serve as a monitor of disease load; a low-phase angle is associated with poor prognosis.
Abstract: It is 50 years since Thomasett demonstrated the application of the measurement of the impedance of the human body to the estimation of total body water...
TL;DR: It is indicated that consumption of red and/or processed meat increase risk of stroke, in particular, ischemic stroke.
Abstract: Red and processed meat consumption and risk of stroke: a meta-analysis of prospective cohort studies
TL;DR: Overall, a healthy diet was characterized by a high consumption of whole-grain bread, raw vegetables and a low consumption of red meat and possibly butter, which is generally in line with previous findings.
Abstract: Diet and risk of chronic diseases: results from the first 8 years of follow-up in the EPIC-Potsdam study
TL;DR: BIA-estimated percentage of BF varies greatly with population and age and is directly and closely related to various health outcomes such as CVDs, which is in contrast to BMI where both high and low BMIs are associated with increased risk of developing chronic diseases.
Abstract: Bioelectrical impedance analysis (BIA) is a relatively simple, inexpensive and non-invasive technique to measure body composition and is therefore suitable in field studies and larger surveys. We performed an overview of BIA-derived body fat percentages (BF%) from 55 published studies of healthy populations aged 6–80 years. In addition, the relationship between body mass index (BMI) and body composition is documented in the context of BIA as a good alternative to closely differentiate which composition of the body better relates to the risk of cardiovascular diseases (CVDs)and all-cause mortality. BIA-estimated percentage of BF varies greatly with population and age. BIA-estimated BF% is directly and closely related to various health outcomes such as CVDs, which is in contrast to BMI where both high and low BMIs are associated with increased risk of developing chronic diseases. Studies, among others using BIA, suggest that low BMI may reflect low muscle and high BMI fat mass (FM). BIA-derived lean and FM is directly associated with morbidity and mortality. To the contrary, BMI is rather of limited use for measuring BF% in epidemiological studies.
TL;DR: In this paper, a review is focused on dysphagia in children with cerebral palsy: types of deficits, clinical and instrumental evaluation, management decision making and evidence of effectiveness of interventions.
Abstract: Children with cerebral palsy (CP) are at risk for aspiration with oral feeding with potential pulmonary consequences, and commonly have reduced nutrition/hydration status and prolonged stressful meal times. There is considerable variability in the nature and severity of swallowing problems in these children whose needs change over time. Children with generalized severe motor impairment (for example, spastic quadriplegia) are likely to experience greater swallowing deficits than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. This review is focused on dysphagia in children with CP: types of deficits, clinical and instrumental evaluation, management decision making and evidence of effectiveness of interventions.
TL;DR: It is concluded that in contrast to conventional yogurt, daily consumption of probiotic yogurt for 9 weeks maintains serum insulin levels and might help pregnant women prevent developing insulin resistance.
Abstract: Effect of daily consumption of probiotic yoghurt on insulin resistance in pregnant women: a randomized controlled trial
TL;DR: There is currently insufficient evidence to recommend dietary AGE restriction for the alleviation of the proinflammatory milieu in healthy individuals and patients with diabetes or renal failure, and additional long-term high-quality RCTs with larger sample sizes measuring patient-important outcomes are required to strengthen the evidence supporting the effects of AGE-restricted diets.
Abstract: The benefits of advanced glycation end-product (AGE)-restricted diets in humans are unclear. This review aimed to determine the effect of dietary AGE restriction on the inflammatory profiles of healthy adults and adults with diabetes or renal failure. Eight computer databases were searched for controlled feeding trials published in English between January 1997 and December 2012. Human trials were included if at least one group received an AGE-restricted dietary intervention. A total of 12 trials reporting on 289 participants were included in the review. Five trials (42%) were of high methodological quality. Meta-analysis of two long-term (16 week) trials provided evidence favoring an AGE-restricted diet for the reduction of 8-isoprostanes (standardized mean difference 0.9; 95% confidence interval (CI): 0.3-1.5) and tumor necrosis factor-α (1.3; 95% CI: 0.6-1.9) in healthy adults. Intermediate-term dietary AGE restriction in adults with chronic renal failure reduced serum VCAM-1 (0.9; 95% CI: 0.1-1.7). Individual trials provided some evidence that long-term dietary AGE restriction reduces HOMA-IR (1.4; 95% CI: 0.3-2.6) and AGE-modified low-density lipoprotein (2.7; 95% CI: 1.6-3.9) in adults with type 2 diabetes. Generalisability is limited, as 75% of studies were of less than 6 weeks duration and more than half were of low methodological quality. Evidence quality ranged from low to very low, limiting the conclusions that can be drawn from this review. There is currently insufficient evidence to recommend dietary AGE restriction for the alleviation of the proinflammatory milieu in healthy individuals and patients with diabetes or renal failure. Additional long-term high-quality RCTs with larger sample sizes measuring patient-important outcomes are required to strengthen the evidence supporting the effects of AGE-restricted diets.
TL;DR: Dietary patterns characterized by intakes of red meat, whole-grain bread, tea and coffee were linked to relevant metabolites and could be potential targets for chronic disease prevention.
Abstract: Serum metabolites have been linked to higher risk of chronic diseases but determinants of serum metabolites are not clear. We aimed to investigate the association between habitual diet as a modifiable risk factor and relevant serum metabolites. This cross-sectional study comprised 2380 EPIC-Potsdam participants. Intake of 45 food groups was assessed by food frequency questionnaire and concentrations of 127 serum metabolites were measured by targeted metabolomics. Reduced rank regression was used to find dietary patterns that explain the maximum variation of metabolites. In the multivariable-adjusted model, the proportion of explained variation by habitual diet was ranked as follows: acyl-alkyl-phosphatidylcholines (5.7%), sphingomyelins (5.1%), diacyl-phosphatidylcholines (4.4%), lyso-phosphatidylcholines (4.1%), acylcarnitines (3.5%), amino acids (2.2%) and hexose (1.6%). A pattern with high intake of butter and low intake of margarine was related to acylcarnitines, acyl-alkyl-phosphatidylcholines, lyso-phosphatidylcholines and hydroxy-sphingomyelins, particularly with saturated and monounsaturated fatty acid side chains. A pattern with high intake of red meat and fish and low intake of whole-grain bread and tea was related to hexose and phosphatidylcholines. A pattern consisting of high intake of potatoes, dairy products and cornflakes particularly explained methionine and branched chain amino acids. Dietary patterns related to type 2 diabetes-relevant metabolites included high intake of red meat and low intake of whole-grain bread, tea, coffee, cake and cookies, canned fruits and fish. Dietary patterns characterized by intakes of red meat, whole-grain bread, tea and coffee were linked to relevant metabolites and could be potential targets for chronic disease prevention.
TL;DR: SMF-BIA had acceptable accuracy for the estimation of whole-body and appendicular FM and LM in frail older women, although SMF- BIA underestimated LM and overestimated FM relative to DXA.
Abstract: We aimed to examine the accuracy of segmental multi-frequency bioelectrical impedance analysis (SMF-BIA) for the assessment of whole-body and appendicular fat mass (FM) and lean soft tissue mass (LM) in frail older women, using dual-energy X-ray absorptiometry (DXA) as a reference method. All 129 community-dwelling Japanese frail older women with a mean age of 80.9 years (range, 75–89 years) from the Frailty Intervention Trial were recruited. The agreements between SMF-BIA and DXA for whole-body and appendicular body composition were assessed using simple linear regression and Bland–Altman analysis. High coefficients of determination (R2) for whole-body FM (R2=0.94, s.e. of estimate (SEE)=1.2 kg), whole-body LM (R2=0.85, SEE=1.4 kg), and appendicular FM (R2=0.82, SEE=1.1 kg) were observed between SMF-BIA and DXA. The R2 coefficient for appendicular LM was moderate (R2=0.76, SEE=0.8 kg). Bland–Altman plots demonstrated that there was systematic (constant) bias (that is, DXA minus SMF-BIA) with overestimation of whole-body FM (bias=−1.2 kg, 95% confidence interval (CI)=−1.5 to −0.1) and underestimation of whole-body LM (bias=2.1 kg, 95% CI=1.8–2.3) by SMF-BIA. Similar, the appendicular measurements also demonstrated systematic bias with overestimation of appendicular FM (bias=−0.3 kg, 95% CI=−0.5 to −0.1) and underestimation of whole-body LM (bias=1.5 kg, 95% CI=1.4–1.7) by SMF-BIA. In addition, the individual level accuracy demonstrated a non-proportional bias for whole-body LM (r=0.08, P=0.338) and appendicular FM (r=0.07, P=0.413). SMF-BIA had acceptable accuracy for the estimation of whole-body and appendicular FM and LM in frail older women, although SMF-BIA underestimated LM and overestimated FM relative to DXA.
TL;DR: Many commonly consumed snack foods in Brazil are classified, in the US, as being high in solid fats and added sugars, and per capita and per consumer energy from snacks requires further exploration.
Abstract: Prevalence and energy intake from snacking in Brazil: analysis of the first nationwide individual survey
National Institutes of Health1, Maastricht University Medical Centre2, Umeå University3, Baker IDI Heart and Diabetes Institute4, University of Eastern Finland5, Sheba Medical Center6, Tel Aviv University7, Danube University Krems8, King Abdulaziz University9, AstraZeneca10, University of Helsinki11
TL;DR: Abdominal obesity indicators such as WC, WHR, WSR and WHHR, are stronger predictors for CVD mortality than general obesity indicator of BMI.
Abstract: BACKGROUND/OBJECTIVES: Body mass index (BMI) is the most commonly used surrogate marker for evaluating the risk of cardiovascular disease (CVD) mortality in relation to general obesity, while abdom ...
TL;DR: The findings suggest that consumption of energy-dense, nutrient-poor foods occurred as early as 9 months of age, with some of these foods tracking highly over the weaning period, which supports the importance of promoting healthy dietary trajectories from infancy.
Abstract: The objectives of the present study were to describe food and nutrient intakes in children aged 9 and 18 months, and to assess tracking of intakes between these two ages. Participants were 177 children of first-time mothers from the control arm of the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program. Dietary intake was collected at 9 and 18 months using three 24 h diet recalls. Tracking was assessed for food and nutrient intakes using logistic regression analysis and estimating partial correlation coefficients, respectively. Although overall nutrient intakes estimated in this study did not indicate a particular risk of nutrient deficiency, our findings suggest that consumption of energy-dense, nutrient-poor foods occurred as early as 9 months of age, with some of these foods tracking highly over the weaning period. Intakes of healthier foods such as fruits, vegetables, dairy products, eggs, fish and water were also relatively stable over this transition from infancy to toddlerhood, along with moderate tracking for riboflavin, iodine, fibre, calcium and iron. Tracking was low but close to ρ=0.3 for zinc, magnesium and potassium intakes. The tracking of energy-dense, nutrient-poor foods has important implications for public health, given the development of early eating behaviours is likely to be modifiable. At this stage of life, dietary intakes are largely influenced by the foods parents provide, parental feeding practices and modelling. This study supports the importance of promoting healthy dietary trajectories from infancy.
TL;DR: It is concluded that vitamin D deficiency is associated with an increased risk of developing Obesity in the next 4 years.
Abstract: The aim of this study was to assess the relationship between obesity and vitamin D status cross-sectionally, the relationship between obesity and the incidence of hypovitaminosis D prospectively and inversely the relationship between vitamin D status and incidence of obesity in a population-based cohort study in Spain. At baseline (1996–1998), 1226 subjects were evaluated and follow-up assessments were performed in 2002–2004 and 2005–2007, participants undergoing an interview and clinical examination with an oral glucose tolerance test. At the second visit, 25-hydroxyvitamin D and intact parathyroid hormone concentrations were also measured. Prevalence of obesity at the three visits was 28.1, 36.2 and 39.5%, respectively. The prevalence of vitamin D deficiency (25-hydroxyvitamin D ⩽20 ng/ml (⩽50 nmol/l)) was 34.7%. Neither obesity at baseline (OR=0.98, 95% CI: 0.69-1.40, P=0.93) nor the development of obesity between baseline and the second evaluation (OR=0.80, 95% CI: 0.48–1.33, P=0.39) were significantly associated with vitamin D status. In subjects who were non-obese (BMI <30 kg/m2) at the second evaluation, 25-hydroxyvitamin D values ⩽17 ng/ml (⩽42.5 nmol/l) were significantly associated with an increased risk of developing obesity in the next 4 years (OR=2.35, 95% CI: 1.03–5.4, P=0.040 after diverse adjustments). We conclude that vitamin D deficiency is associated with an increased risk of developing obesity.
TL;DR: In this frail elderly population, 25(OH)D status is low and suggests a modest association with reduced ALM and impaired physical performance, which highlights the need for well-designed intervention trials to assess the impact of vitamin D supplementation in pre-frail and frail elderly people.
Abstract: Low vitamin D status is associated with reduced muscle mass and impaired physical performance in frail elderly people
TL;DR: This paper addresses current criticisms of GI and outlines reasons why GI is valid: (1) GI methodology is accurate and precise enough for practical use; (2) GI is a property of foods; and (3)GI is biologically meaningful and relevant to virtually everyone.
Abstract: Recent criticisms of the glycaemic index (GI) focus on its validity with assertions that GI methodology is not valid, GI values are inaccurate and imprecise, GI does not predict what foods are healthy and that whole grain and fibre are better markers of carbohydrate quality than GI. None of the critics provide sound reasons for rejecting GI because some of their arguments are based on flagrant errors in understanding and interpretation while others are not supported by current data or are inconsistent with other nutritional recommendations. This paper addresses current criticisms of GI and outlines reasons why GI is valid: (1) GI methodology is accurate and precise enough for practical use; (2) GI is a property of foods; and (3) GI is biologically meaningful and relevant to virtually everyone. Current dietary guidelines recommend increased consumption of whole grains and dietary fibre but do not mention GI. However, this is illogical because the evidence that GI affects health outcomes is at least as good or better than that for whole grains and fibre. GI is a novel concept from a regulatory point of view and a number of problems need to be addressed to successfully translate GI knowledge into practice. The problems are not insurmountable but no progress can be made until bias and misunderstanding about GI can be overcome and there is better agreement about what is the actual state of knowledge on GI so that the real issues can be identified and addressed.
TL;DR: Hydration biomarkers in 24hU are strongly correlated with daily total fluid intake volume in sedentary adults in free-living conditions; however, the margin of error in the present models limits the applicability of estimating fluid intake from urinary biomarkers.
Abstract: SUBJECTS/METHODS: During 4 consecutive weekdays, 82 adults (age, 31.6±4.3 years; body mass index, 23.2±2.7 kg/m 2 ; 52% female) recorded food and fluid consumed, collected one first morning urine (FMU) void and three 24-h (24hU) samples. The strength of linear association between urinary hydration biomarkers and fluid intake volume was evaluated using simple linear regression and Pearson’s correlation. Multivariate partial least squares (PLS) modeled the association between fluid intake and 24hU hydration biomarkers. RESULTS: Strong associations (|r|X0.6; Po0.001) were found between total fluid intake volume and 24hU osmolality, color, specific gravity (USG), volume and solute concentrations. Many 24hU biomarkers were collinear (osmolality versus color: r ¼ 0.49–0.76; USG versus color: r ¼ 0.46–0.78; osmolality versus USG: 0.86–0.97; Po0.001). Measures in FMU were not strongly correlated to intake. Multivariate PLS and simple linear regression using urine volume explained 450% of the variance in fluid intake volume (r 2 ¼ 0.59 and 0.52, respectively); however the error in both models was high and the limits of agreement very large. CONCLUSIONS: Hydration biomarkers in 24hU are strongly correlated with daily total fluid intake volume in sedentary adults in free-living conditions; however, the margin of error in the present models limits the applicability of estimating fluid intake from urinary biomarkers.
TL;DR: Attention should be drawn to the living circumstances, changes in appetite or health, the general heath perception, F&V intake, choice of foods easy to chew and having a low or high BMI.
Abstract: The elderly constitute a population group with a high prevalence of non-communicable chronic diseases and high risk of malnutrition. The aim of this study was to identify factors associated to nutritional risk in free-living European elderly. The sample included 644 European citizens, free living in the community, aged 65 years or more. The sample was quota controlled for age groups (65–74, ⩾75 years), gender (male/female) and living circumstances (living alone/with others). Logistic regression was performed to identify factors associated with nutritional risk. Several variables regarding socio-demographic characteristics, food choice, health status and the satisfaction with food-related life were included in the analysis. According to the recoded score of the ‘Determine your nutritional health’ (NSI checklist), 53% of the elderly were at nutritional risk. Nutritional risk was more likely to occur in elderly who considered that it was more important to choose foods ‘easy to chew’; with lower average number of fruit and vegetables (FV those that did not identify changes in their appetite; and those that felt changes in health status. In this sample, the lowest nutritional risk was found for body mass index (BMI) around 18.5 kg/m2. Country of residence, gender and age were not found to have a significant effect on nutritional risk. Attention should be drawn to the living circumstances, changes in appetite or health, the general heath perception, F&V intake, choice of foods easy to chew and having a low or high BMI.
TL;DR: The results indicate that high sodium intake may be a potential risk factor for weight gain independent of calorie intake.
Abstract: It is unclear whether the amount of sodium consumed and the degree of saltiness of food is associated with obesity. We examined the association between sodium intake and obesity using the concept of sodium density. This study included 5025 children (7–18 years) and 20 586 adults (⩾19 years) who participated in the Korean National Health and Nutrition Examination Survey(KNHANES), 2007–2010. We defined sodium density(mg/g) as the ratio of daily dietary sodium intake (mg/day) and daily food weight consumed (g/day). We examined the association between sodium density and obesity, and abdominal obesity in children and adults. The overall prevalences of obesity and abdominal obesity were 31.4 and 24.5%, respectively, in adults and 4.5 and 6.5%, respectively, in children. The multivariate-adjusted odds ratio (OR) for obesity in adults with the highest quintile of sodium density compared with the lowest quintile was 1.18 (95% confidence interval (CI), 1.04–1.35), and a significant dose–response association (P for trend=0.002) was observed. The OR for abdominal obesity in adults with the highest quintile of sodium density was not statistically significant after adjusting for confounding factors, but showed a significant dose–response association (P for trend=0.043). In children, OR values for obesity and abdominal obesity in the highest quintile of sodium density were 1.78 (95% CI, 1.13–2.80) and 2.13 (95% CI, 1.16–3.91), respectively, and both showed significant dose–response associations (P for trend <0.001). Our results indicate that high sodium intake may be a potential risk factor for weight gain independent of calorie intake.