Dietary proteins and aspects of the metabolic syndrome : evidence from observational studies and short-term interventions
Nielen, M. van - \ 2015
Wageningen University. Promotor(en): Edith Feskens, co-promotor(en): Marco Mensink. - Wageningen : Wageningen University - ISBN 9789462574793 - 131
metabool syndroom - diabetes mellitus - stofwisselingsstoornissen - diabetes type 2 - hart- en vaatziekten - sojaeiwit - arginine - eiwitinname - ziekte-incidentie - ontsteking - cohortstudies - metabolic syndrome - diabetes mellitus - metabolic disorders - type 2 diabetes - cardiovascular diseases - soya protein - arginine - protein intake - disease incidence - inflammation - cohort studies
Background Type 2 diabetes (T2D) and cardiovascular diseases (CVD) are important causes of morbidity and mortality worldwide. The metabolic syndrome (MetS) identifies people at elevated risk of T2D and CVD by its mutual risk factors, such as abdominal obesity, atherogenic dyslipidemia, raised blood pressure and impaired glucose tolerance. Improvements in individual aspects of MetS could be risk-reducing for T2D and CVD and could thus be clinically relevant. Besides by using drug therapy, this can be achieved by lifestyle changes, such as weight loss, increasing physical activity and changes in dietary composition. In addition to general dietary recommendations, such as diets rich in fiber, fruits and vegetables and low in refined grains and saturated fatty acids, increasing dietary protein and soy intake seem promising approaches to prevent MetS. Short-term trials report positive effects of dietary protein intake on weight loss and weight maintenance after weight loss. The postprandial and short-term effect of protein and soy consumption on insulin resistance, glucose homeostasis, and other aspects of MetS are not frequently studied in humans in energy balance. Also, the long-term association between dietary protein intake and T2D incidence is uncertain, it even seemed risk-increasing in prior research.
Objectives We evaluated the impact of dietary protein intake on T2D incidence, aspects of MetS and other cardio-metabolic risk factors, by observational studies (long-term) and interventions (short-term). We studied not only total protein intake, but also specific protein types, more specifically soy protein and arginine-rich protein. We explored the long-term association between total, animal, and plant protein intake and the incidence of T2D. We further investigated the effects of a 4-week strictly controlled weight-maintaining moderate-high-protein diet rich in soy on insulin sensitivity and other cardio-metabolic risk factors. Next, we investigated if inflammatory markers were also changed as a possible pathway through which dietary protein affects cardio-metabolic risk factors. Lastly, we examined whether protein, and more specific arginine-rich protein, added to a high fat meal improved postprandial metabolism and cardiovascular risk factors.
Methods The association between dietary protein intake and T2D incidence was studied in the EPIC-InterAct case-cohort study (nincident cases= 12,403; nsubcohort=16,154).
In a randomized crossover trial of 2 4-week periods diets with a moderate-high-protein content, i.e. 22 energy percent (En%) protein, 27En% fat, and 50En% carbohydrate, were studied (n=15). In a diet with protein from mixed sources (HPmix) we partly replaced meat products with soy products (HPsoy) to investigate the effect of soy protein intake on insulin resistance, glucose homeostasis, and other aspects of MetS.
A high-fat challenge test was used to study postprandial metabolic markers, inflammatory markers and arterial stiffness (n=18). We compared the postprandial response after a high-fat liquid control meal (95g fat) without protein with meals with 30g added protein.
Results Intake of total protein (per 10 g: HR 1.06 [95% CI 1.02–1.09], Ptrend < 0.001) and animal protein (per 10 g: HR 1.05 [95% CI 1.02–1.08], Ptrend < 0.001) was associated with higher incidence of T2D, after adjustment for main confounders including other dietary factors.
Partly replacing meat with soy in a moderate-high-protein diet resulted in greater insulin sensitivity (FSIGT: SI:34 ± 29 vs. 22 ± 17 (mU/L)-1min-1, P=0.048; disposition index:4974 ± 2543 vs. 2899 ± 1878, P=0.038). After HPsoy total cholesterol was 4% lower than after HPmix (4.9 ± 0.7 vs. 5.1 ± 0.6 mmol/L, P=0.001) and LDL cholesterol was 9% lower (2.9 ± 0.7 vs. 3.2 ± 0.6 mmol/L, P=0.004). The summary score for inflammation was lower after HPsoy compared with HPmix (ɀ-score: -0.2 ± 0.3 vs. -0.1 ± 0.2, P=0.04), after excluding participants with CRP>6mg/L and extreme outliers. Individual inflammatory markers were not significantly different.
Adding protein to a high-fat meal increased the postprandial insulin response. No differences between arginine-rich and protein low in arginine on postprandial responses were seen. Intact proteins and hydrolysates resulted in similar responses.
Conclusion High total and animal protein intake was associated with modestly elevated T2D incidence in a large cohort of European adults. In contrast, a moderate-high-protein diet for 4 weeks improved many cardio-metabolic risk factors. Partly replacing meat with soy in this moderate-high-protein diet had clear advantages regarding insulin sensitivity and total and LDL cholesterol, and it improved the overall inflammatory state, although not showing clear benefits at individual inflammation markers. We hypothesized to see an origin of these short-term health effects in postprandial properties of arginine-rich protein. However, arginine-rich protein was not superior to a protein low in arginine added to a high-fat meal, regarding postprandial excursions in glucose, insulin, lipids and inflammatory markers.
In view of the rapidly increasing prevalence of MetS and T2D, limiting iso-energetic diets high in dietary proteins, particularly from animal sources, should be considered as on the long-term protein intake seems to increase T2D and CVD risk. However, at the short-term partly replacing meat with soy in a moderate high-protein diet could be preventive for several aspects of MetS, such as improvements in insulin sensitivity, total and LDL cholesterol and possibly a reduced inflammatory state.
A weekly alternating diet between caloric restriction and medium-fat protects the liver from fatty liver development in middle-aged C57BL/6J mice
Rusli, F. ; Boekschoten, M.V. ; Zubia, A.A. ; Lute, C. ; Müller, M.R. ; Steegenga, W.T. - \ 2015
Molecular Nutrition & Food Research 59 (2015)3. - ISSN 1613-4125 - p. 533 - 543.
metabolic syndrome - insulin-resistance - small-intestine - induced obesity - adipose-tissue - life-span - disease - prevalence - population - expression
Scope : We aimed to investigate whether a novel dietary intervention consisting of an every-other-week calorie restricted diet could prevent non-alcoholic fatty liver disease (NAFLD) development induced by a medium-fat diet. Methods and results : Nine week-old male C57BL/6J mice received either a 1) control (C), 2) 30E% calorie restricted (CR), 3) medium-fat (MF; 25E% fat) or 4) intermittent (INT) diet, a diet alternating weekly between 40E% CR and an ad libitum MF diet until sacrifice at the age of 12 months. The metabolic, morphological, and molecular features of NAFLD were examined. The INT diet resulted in healthy metabolic and morphological features as displayed by the continuous CR diet: glucose tolerant, low hepatic triglyceride content, low plasma alanine aminotransferase. In contrast, the C- and MF-exposed mice with high body weight developed signs of NAFLD. However, the gene expression profiles of INT-exposed mice differed to those of CR-exposed mice and showed to be more similar with those of C- and MF-exposed mice with a comparable body weight. Conclusions : Our study reveals that the INT diet maintains metabolic health and reverses the adverse effects of the MF diet, thus effectively prevent the development of NAFLD in 12-month-old male C57BL/6J mice.
White adipose tissue reference network: a knowledge resource for exploring potential health-relevant relations
Kelder, T. ; Summer, G. ; Caspers, M. ; Schothorst, E.M. van; Keijer, J. ; Duivenvoorde, Loes ; Klaus, S. ; Volgt, A. ; Bohnert, L. ; Pico, C. ; Palou, A. ; Bonet, M.L. ; Dembinska-Kiec, A. ; Malczewska-Malec, M. ; Kieć-Wilk, Beata ; Bas, J.M. del; Caimari, A. ; Arola, L. ; Erk, M. van; Ommen, Ben van; Radonjic, M. - \ 2015
Genes & Nutrition 10 (2015)1. - ISSN 1555-8932
metabolic syndrome - high-fat - transcription factor - biological networks - insulin-secretion - gene-expression - cell biology - short-term - obesity - diet
Optimal health is maintained by interaction of multiple intrinsic and environmental factors at different levels of complexity-from molecular, to physiological, to social. Understanding and quantification of these interactions will aid design of successful health interventions. We introduce the reference network concept as a platform for multi-level exploration of biological relations relevant for metabolic health, by integration and mining of biological interactions derived from public resources and context-specific experimental data. A White Adipose Tissue Health Reference Network (WATRefNet) was constructed as a resource for discovery and prioritization of mechanism-based biomarkers for white adipose tissue (WAT) health status and the effect of food and drug compounds on WAT health status. The WATRefNet (6,797 nodes and 32,171 edges) is based on (1) experimental data obtained from 10 studies addressing different adiposity states, (2) seven public knowledge bases of molecular interactions, (3) expert's definitions of five physiologically relevant processes key to WAT health, namely WAT expandability, Oxidative capacity, Metabolic state, Oxidative stress and Tissue inflammation, and (4) a collection of relevant biomarkers of these processes identified by BIOCLAIMS ( http://bioclaims.uib.es ). The WATRefNet comprehends multiple layers of biological complexity as it contains various types of nodes and edges that represent different biological levels and interactions. We have validated the reference network by showing overrepresentation with anti-obesity drug targets, pathology-associated genes and differentially expressed genes from an external disease model dataset. The resulting network has been used to extract subnetworks specific to the above-mentioned expert-defined physiological processes. Each of these process-specific signatures represents a mechanistically supported composite biomarker for assessing and quantifying the effect of interventions on a physiological aspect that determines WAT health status. Following this principle, five anti-diabetic drug interventions and one diet intervention were scored for the match of their expression signature to the five biomarker signatures derived from the WATRefNet. This confirmed previous observations of successful intervention by dietary lifestyle and revealed WAT-specific effects of drug interventions. The WATRefNet represents a sustainable knowledge resource for extraction of relevant relationships such as mechanisms of action, nutrient intervention targets and biomarkers and for assessment of health effects for support of health claims made on food products.
Consumption of fatty foods and incident type 2 diabetes in populations from eight European countries
Buijsse, B. ; Boeing, H. ; Drogan, D. ; Schulze, M.B. ; Feskens, E.J.M. ; Amiano, P. ; The InterAct Consortium, A. - \ 2015
European Journal of Clinical Nutrition 69 (2015). - ISSN 0954-3007 - p. 455 - 461.
coronary-heart-disease - dietary-fat - postprandial glycemia - insulin sensitivity - meat consumption - nut consumption - saturated fat - epic-interact - metabolic syndrome - physical-activity
Background/Objectives: Diets high in saturated and trans fat and low in unsaturated fat may increase type 2 diabetes (T2D) risk, but studies on foods high in fat per unit weight are sparse. We assessed whether the intake of vegetable oil, butter, margarine, nuts and seeds and cakes and cookies is related to incident T2D. Subjects/Methods: A case-cohort study was conducted, nested within eight countries of the European Prospective Investigation into Cancer (EPIC), with 12¿403 incident T2D cases and a subcohort of 16¿835 people, identified from a cohort of 340¿234 people. Diet was assessed at baseline (1991–1999) by country-specific questionnaires. Country-specific hazard ratios (HRs) across four categories of fatty foods (nonconsumers and tertiles among consumers) were combined with random-effects meta-analysis. Results: After adjustment not including body mass index (BMI), nonconsumers of butter, nuts and seeds and cakes and cookies were at higher T2D risk compared with the middle tertile of consumption. Among consumers, cakes and cookies were inversely related to T2D (HRs across increasing tertiles 1.14, 1.00 and 0.92, respectively; P-trend
The cross-sectional association between uric acid and atherosclerosis and the role of low-grade inflammation: the CODAM study
Wijnands, J.M.A. ; Boonen, A. ; Dagnelie, P.C. ; Greevenbroek, M.M.J. van; Kallen, C.J.H. van der; Ferreira, I. ; Schalkwijk, C.G. ; Feskens, E.J.M. ; Stehouwer, C.D.A. ; Linden, S. van der; Arts, I.C.W. - \ 2014
RHEUMATOLOGY 53 (2014)11. - ISSN 1462-0324 - p. 2053 - 2062.
peripheral arterial-disease - c-reactive protein - type-2 diabetes-mellitus - nitric-oxide production - metabolic syndrome - carotid atherosclerosis - cardiovascular-disease - hypertensive patients - risk-factor - subclinical atherosclerosis
Objectives. The aims of this study were to investigate (i) associations between uric acid and prevalent cardiovascular disease (CVD), ankle-arm blood pressure index (AAIx) and carotid intima-media thickness (CIMT) in the total population and in predefined subgroups according to glucose metabolism status and (ii) the extent to which these associations are explained by low-grade inflammation. Methods. Cross-sectional analyses were conducted among 530 individuals [60.6% men, mean age 58.9 years (S. D. 6.9), 52.6% normal glucose metabolism (NGM)] at increased risk of CVD from the Cohort of Diabetes and Atherosclerosis Maastricht study. A low-grade inflammation score was computed by averaging the z-scores of eight inflammation markers [CRP, TNF-alpha, IL-6, IL-8, serum amyloid A, intercellular adhesion molecule 1 (ICAM-1), ceruloplasmin and haptoglobin]. Results. After adjustment for traditional CVD risk factors, plasma uric acid (per S. D. of 81 mu mol/l) was associated with CVD in individuals with NGM [odds ratio (OR) = 1.66, 95% CI 1.06, 2.58] but not with disturbed glucose metabolism (DGM) (OR = 0.81, 95% CI 0.55, 1.19, P interaction = 0.165). Uric acid was associated with CIMT in the total population (beta = 0.024, 95% CI 0.007, 0.042) and slightly more strongly in individuals with NGM (beta = 0.030, 95% CI 0.006, 0.054) than DGM (beta = 0.018, 95% CI -0.009, 0.044, P interaction = 0.443). There was no association between uric acid and AAIx in any group (P interaction = 0.058). Uric acid was associated with low-grade inflammation in the total population (beta = 0.074, 95% CI 0.013, 0.134, P interaction = 0.737). Adding low-grade inflammation to the models did not attenuate any of the associations. Conclusion. The associations for uric acid with CIMT, and with CVD in NGM only, were not explained by low-grade inflammation. A difference in the strength of the associations between individuals with NGM and DGM was suggested.
Predicting major outcomes in type 1 diabetes: a model development and validation study
Soedamah-Muthu, S.S. ; Vergouwe, Y. ; Costacou, T. ; Miller, R.G. ; Zgibor, J. ; Chaturvedi, N. ; Snell-Bergeon, J.K. ; Maahs, D.M. ; Rewers, M. ; Forsblom, C. ; Harjutsalo, V. ; Groop, P.H. ; Fuller, J.H. ; Moons, K.G.M. ; Orchard, T.J. - \ 2014
Diabetologia 57 (2014)11. - ISSN 0012-186X - p. 2304 - 2314.
coronary-heart-disease - eurodiab prospective complications - all-cause mortality - cardiovascular-disease - pittsburgh epidemiology - risk-factors - intensive treatment - iddm complications - metabolic syndrome - association
Aims/hypothesis Type 1 diabetes is associated with a higher risk of major vascular complications and death. A reliable method that predicted these outcomes early in the disease process would help in risk classification. We therefore developed such a prognostic model and quantified its performance in independent cohorts. Methods Data were analysed from 1,973 participants with type 1 diabetes followed for 7 years in the EURODIAB Prospective Complications Study. Strong prognostic factors for major outcomes were combined in a Weibull regression model. The performance of the model was tested in three different prospective cohorts: the Pittsburgh Epidemiology of Diabetes Complications study (EDC, n¿=¿554), the Finnish Diabetic Nephropathy study (FinnDiane, n¿=¿2,999) and the Coronary Artery Calcification in Type 1 Diabetes study (CACTI, n¿=¿580). Major outcomes included major CHD, stroke, end-stage renal failure, amputations, blindness and all-cause death. Results A total of 95 EURODIAB patients with type 1 diabetes developed major outcomes during follow-up. Prognostic factors were age, HbA1c, WHR, albumin/creatinine ratio and HDL-cholesterol level. The discriminative ability of the model was adequate, with a concordance statistic (C-statistic) of 0.74. Discrimination was similar or even better in the independent cohorts, the C-statistics being: EDC, 0.79; FinnDiane, 0.82; and CACTI, 0.73. Conclusions/interpretation Our prognostic model, which uses easily accessible clinical features can discriminate between type 1 diabetes patients who have a good or a poor prognosis. Such a prognostic model may be helpful in clinical practice and for risk stratification in clinical trials.
Gut Microbiota Signatures Predict Host and Microbiota Responses to Dietary Interventions in Obese Individuals
Korpela, K. ; Flint, H.J. ; Johnstone, A.M. ; Lappi, J. ; Poutanen, K. ; Dewulf, E. ; Delzenne, N. ; Vos, W.M. de; Salonen, A. - \ 2014
PLoS ONE 9 (2014)3. - ISSN 1932-6203
dna-extraction methods - intestinal microbiota - metabolic syndrome - species response - resistant starch - healthy humans - double-blind - weight-loss - human colon - differentiate
Background Interactions between the diet and intestinal microbiota play a role in health and disease, including obesity and related metabolic complications. There is great interest to use dietary means to manipulate the microbiota to promote health. Currently, the impact of dietary change on the microbiota and the host metabolism is poorly predictable and highly individual. We propose that the responsiveness of the gut microbiota may depend on its composition, and associate with metabolic changes in the host. Methodology Our study involved three independent cohorts of obese adults (n = 78) from Belgium, Finland, and Britain, participating in different dietary interventions aiming to improve metabolic health. We used a phylogenetic microarray for comprehensive fecal microbiota analysis at baseline and after the intervention. Blood cholesterol, insulin and inflammation markers were analyzed as indicators of host response. The data were divided into four training set – test set pairs; each intervention acted both as a part of a training set and as an independent test set. We used linear models to predict the responsiveness of the microbiota and the host, and logistic regression to predict responder vs. non-responder status, or increase vs. decrease of the health parameters. Principal Findings Our models, based on the abundance of several, mainly Firmicute species at baseline, predicted the responsiveness of the microbiota (AUC = 0.77–1; predicted vs. observed correlation = 0.67–0.88). Many of the predictive taxa showed a non-linear relationship with the responsiveness. The microbiota response associated with the change in serum cholesterol levels with an AUC of 0.96, highlighting the involvement of the intestinal microbiota in metabolic health. Conclusion This proof-of-principle study introduces the first potential microbial biomarkers for dietary responsiveness in obese individuals with impaired metabolic health, and reveals the potential of microbiota signatures for personalized nutrition.
Colorectal cancer risk and dyslipidemia: a case-cohort study nested in an Italian multicentre cohort
Agnoli, C. ; Grioni, S. ; Sieri, S. ; Sacerdote, C. ; Vineis, P. ; Tumino, R. ; Giurdanella, M.C. ; Pala, V. ; Mattiello, A. ; Chiodini, P. ; Iacoviello, L. ; Curtis, A. de; Cattaneo, L. ; Duijnhoven, F.J.B. van - \ 2014
Cancer Epidemiology 38 (2014)2. - ISSN 1877-7821 - p. 144 - 151.
metabolic syndrome - serum-cholesterol - colon-cancer - lipoprotein levels - blood-cholesterol - glucose - triglyceride - association - nutrition - lipids
Background: Dyslipidemia is an established risk factor for many diseases, but its effect on colorectal cancer risk is less clear. We investigated the association of colorectal cancer risk with plasma triglycerides, total, HDL, and LDL cholesterol in four Italian EPIC centers. Methods: We conducted a case-cohort study on participants recruited to four Italian EPIC centers (Turin, Varese, Naples, and Ragusa; 34,148 subjects). A random subcohort of 850 subjects was obtained and 286 colorectal cancer cases were diagnosed. Triglycerides, total and HDL cholesterol were determined in plasma samples obtained at baseline and stored at -196 degrees C; LDL cholesterol was calculated. Hazard ratios (HR) with 95% confidence intervals (CI), adjusted for potential confounders, were estimated by Cox regression models using the Prentice method. Results: The highest tertiles of total (HR 1.66, 95% CI 1.12-2.45) and LDL cholesterol (HR 1.87, 95% CI 1.27-2.76) were associated with increased colorectal cancer risk compared to lowest tertiles. Risks were greater for men than women, and for postmenopausal than premenopausal women. Highest tertiles of total and LDL cholesterol were also significantly associated with increased risks of colon cancer, distal colon cancer, and rectal cancer, but not proximal colon cancer. Conclusions: Our findings suggest that high levels of total and LDL cholesterol increase colorectal cancer risk, particularly in men and postmenopausal women. However additional studies are needed to clarify the role of plasma lipids in these cancers, particularly in view of the conflicting findings of previous studies. (C) 2014 Elsevier Ltd. All rights reserved.
Impact of diet and individual variation on intestinal microbiota composition and fermentation products in obese men
Salonen, A. ; Lahti, L.M. ; Salojärvi, J. ; Holtrop, G. ; Korpela, K. ; Duncan, S.H. ; Date, P. ; Farquharson, F. ; Johnstone, A.M. ; Lobley, G.E. ; Louis, P. ; Flint, H.J. ; Vos, W.M. de - \ 2014
ISME Journal 8 (2014). - ISSN 1751-7362 - p. 2218 - 2230.
gut microbiota - phylogenetic microarray - resistant starch - metabolic syndrome - health - bifidobacteria - bacterial - capacity - indexes - adults
There is growing interest in understanding how diet affects the intestinal microbiota, including its possible associations with systemic diseases such as metabolic syndrome. Here we report a comprehensive and deep microbiota analysis of 14 obese males consuming fully controlled diets supplemented with resistant starch (RS) or non-starch polysaccharides (NSPs) and a weight-loss (WL) diet. We analyzed the composition, diversity and dynamics of the fecal microbiota on each dietary regime by phylogenetic microarray and quantitative PCR (qPCR) analysis. In addition, we analyzed fecal short chain fatty acids (SCFAs) as a proxy of colonic fermentation, and indices of insulin sensitivity from blood samples. The diet explained around 10% of the total variance in microbiota composition, which was substantially less than the inter-individual variance. Yet, each of the study diets induced clear and distinct changes in the microbiota. Multiple Ruminococcaceae phylotypes increased on the RS diet, whereas mostly Lachnospiraceae phylotypes increased on the NSP diet. Bifidobacteria decreased significantly on the WL diet. The RS diet decreased the diversity of the microbiota significantly. The total 16S ribosomal RNA gene signal estimated by qPCR correlated positively with the three major SCFAs, while the amount of propionate specifically correlated with the Bacteroidetes. The dietary responsiveness of the individual’s microbiota varied substantially and associated inversely with its diversity, suggesting that individuals can be stratified into responders and non-responders based on the features of their intestinal microbiota.
Partly replacing meat protein with soy protein alters insulin resistance and blood lipids in postmenopausal women with abdominal obesity
Nielen, M. van; Feskens, E.J.M. ; Rietman, A. ; Siebelink, E. ; Mensink, M.R. - \ 2014
The Journal of Nutrition 144 (2014)9. - ISSN 0022-3166 - p. 1423 - 1429.
randomized controlled-trials - metabolic syndrome - isoflavone supplementation - dietary-protein - elderly-women - weight-loss - metaanalysis - pressure - health - cholesterol
Increasing protein intake and soy consumption appear to be promising approaches to prevent metabolic syndrome (MetS). However, the effect of soy consumption on insulin resistance, glucose homeostasis, and other characteristics of MetS is not frequently studied in humans. We aimed to investigate the effects of a 4-wk strictly controlled weight-maintaining moderate high-protein diet rich in soy on insulin sensitivity and other cardiometabolic risk factors. We performed a randomized crossover trial of 2 4-wk diet periods in 15 postmenopausal women with abdominal obesity to test diets with 22 energy percent (En%) protein, 27 En% fat, and 50 En% carbohydrate. One diet contained protein of mixed origin (mainly meat, dairy, and bread), and the other diet partly replaced meat with soy meat analogues and soy nuts containing 30 g/d soy protein. For our primary outcome, a frequently sampled intravenous glucose tolerance test (FSIGT) was performed at the end of both periods. Plasma total, LDL, and HDL cholesterol, triglycerides, glucose, insulin, and C-reactive protein were assessed, and blood pressure, arterial stiffness, and intrahepatic lipid content were measured at the start and end of both periods. Compared with the mixed-protein diet, the soy-protein diet resulted in greater insulin sensitivity [FSIGT: insulin sensitivity, 34 ± 29 vs. 22 ± 17 (mU/L)-1 · min-1, P = 0.048; disposition index, 4974 ± 2543 vs. 2899 ± 1878, P = 0.038; n = 11]. Total cholesterol was 4% lower after the soy-protein diet than after the mixed-protein diet (4.9 ± 0.7 vs. 5.1 ± 0.6 mmol/L, P = 0.001), and LDL cholesterol was 9% lower (2.9 ± 0.7 vs. 3.2 ± 0.6 mmol/L, P = 0.004; n = 15). Thus, partly replacing meat with soy in a moderate high-protein diet has clear advantages regarding insulin sensitivity and total and LDL cholesterol. Therefore, partly replacing meat products with soy products could be important in preventing MetS. This trial was registered at clinicaltrials.gov as NCT01694056.
Reprint of: A parallel randomized trial on the effect of a healthful diet on inflammageing and its consequences in European elderly people: Design of the NU-AGE dietary intervention study
Berendsen, A.M. ; Santoro, A. ; Pini, E. ; Cevenini, E. ; Ostan, R. ; Pietruszka, B. ; Rolf, K. ; Cano, N. ; Caille, A. ; Lyon-Belgy, N. ; Fairweather-Tait, S. ; Feskens, E.J.M. ; Franceschi, C. ; Groot, C.P.G.M. de - \ 2014
Mechanisms of Ageing and Development 136-137 (2014). - ISSN 0047-6374 - p. 14 - 21.
cardiovascular risk-factors - mediterranean diet - vitamin-d - metabolic syndrome - older-adults - nutritional-status - blood-pressure - fatty-acids - weight-loss - life-style
Background The proportion of European elderly is expected to increase to 30% in 2060. Combining dietary components may modulate many processes involved in ageing. So, it is likely that a healthful diet approach might have greater favourable impact on age-related decline than individual dietary components. This paper describes the design of a healthful diet intervention on inflammageing and its consequences in the elderly. Methods The NU-AGE study is a parallel randomized one-year trial in 1250 apparently healthy, independently living European participants aged 65–80 years. Participants are randomised into either the diet group or control group. Participants in the diet group received dietary advice aimed at meeting the nutritional requirements of the ageing population. Special attention was paid to nutrients that may be inadequate or limiting in diets of elderly, such as vitamin D, vitamin B12, and calcium. C-reactive protein is measured as primary outcome. Discussion The NU-AGE study is the first dietary intervention investigating the effect of a healthful diet providing targeted nutritional recommendations for optimal health and quality of life in apparently healthy European elderly. Results of this intervention will provide evidence on the effect of a healthful diet on the prevention of age related decline.
Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-InterAct Case-Cohort Study
Nielen, M. van; Feskens, E.J.M. ; Mensink, M.R. ; Sluijs, I. van der; Molina, E. ; Amiano, P. ; Ardanaz, E. ; Balkau, B. ; Beulens, J.W.J. ; Boeing, H. ; The InterAct Consortium, A. - \ 2014
Diabetes Care 37 (2014)7. - ISSN 0149-5992 - p. 1854 - 1862.
insulin-resistance - metabolic syndrome - fish intake - dairy consumption - womens health - risk - nutrition - cancer - humans - association
OBJECTIVE The long-term association between dietary protein and type 2 diabetes incidence is uncertain. We aimed to investigate the association between total, animal, and plant protein intake and the incidence of type 2 diabetes. RESEARCH DESIGN AND METHODS The prospective European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study consists of 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 individuals from eight European countries, with an average follow-up time of 12.0 years. Pooled country-specific hazard ratios (HRs) and 95% CI of prentice-weighted Cox regression analyses were used to estimate type 2 diabetes incidence according to protein intake. RESULTS After adjustment for important diabetes risk factors and dietary factors, the incidence of type 2 diabetes was higher in those with high intake of total protein (per 10 g: HR 1.06 [95% CI 1.02–1.09], Ptrend <0.001) and animal protein (per 10 g: 1.05 [1.02–1.08], Ptrend = 0.001). Effect modification by sex (P <0.001) and BMI among women (P <0.001) was observed. Compared with the overall analyses, associations were stronger in women, more specifically obese women with a BMI >30 kg/m2 (per 10 g animal protein: 1.19 [1.09–1.32]), and nonsignificant in men. Plant protein intake was not associated with type 2 diabetes (per 10 g: 1.04 [0.93–1.16], Ptrend = 0.098). CONCLUSIONS High total and animal protein intake was associated with a modest elevated risk of type 2 diabetes in a large cohort of European adults. In view of the rapidly increasing prevalence of type 2 diabetes, limiting iso-energetic diets high in dietary proteins, particularly from animal sources, should be considered.
Distinct associations of complement C3a and its precursor C3 with atherosclerosis and cardiovascular disease
Hertle, E. ; Greevenbroek, M.M.J. van; Arts, I.C.W. ; Kallen, C.J.H. van der; Geijselaers, S.L.C. ; Feskens, E.J.M. ; Jansen, E.H. ; Schalkwijk, C.G. ; Stehouwer, C.D.A. - \ 2014
Thrombosis and Haemostasis 111 (2014)6. - ISSN 0340-6245 - p. 1102 - 1111.
coronary-artery-disease - acylation-stimulating protein - intima-media thickness - low-grade inflammation - metabolic syndrome - anaphylatoxins c3a - insulin-resistance - diabetes-mellitus - endothelial-cells - cigarette-smoke
Complement C3 is a novel risk factor for cardiovascular disease (CVD), but the underlying mechanism is currently unknown. We determined the associations of the anaphylatoxin C3a, the activation product of C3, and of C3 itself with estimates of atherosclerosis and CVD. We studied associations of C3a and C3 with carotid intima-media thickness (cIMT), ankle-arm blood pressure index (AAIx) and CVD in cross-sectional analyses among 545 participants of the Cohort on Diabetes and Atherosclerosis Maastricht (CODAM) study (61% men, 59.4 ± 6.9 years) and examined effect modification by smoking. We conducted linear and logistic regression analyses with adjustments for age, sex, glucose metabolism status, lipids, adiposity, renal function, blood pressure, pack-years smoked, physical activity, use of medication and investigated mediation by inflammation. C3a was independently associated with cIMT (ß=0.032 mm, [95% confidence interval: 0.004; 0.060]) and AAIx (ß=-0.022, [-0.043; –0.001]), but C3 was not. Effect modification by smoking was only observed for CVD (Psmoking*C3a=0.008, Psmoking*C3=0.018), therefore these associations were stratified for smoking behaviour. Both C3a (odds ratio [OR] =2.96, [1.15; 7.62]) and C3 (OR =1.98, [1.21; 3.22]) were independently associated with CVD in heavy smokers. The association of C3 with CVD was independent of C3a. Low-grade inflammation did partially explain the association of C3a with AAIx, but not the other observed associations. This suggests that C3a and C3 have distinct roles in pathways leading to CVD. C3a may promote atherosclerosis and additionally advance CVD in heavy smokers. Conversely, C3 may be associated with CVD in heavy smokers via pathways other than atherosclerosis.
Effect of diet on the intestinal microbiota and its activity
Zoetendal, E.G. ; Vos, W.M. de - \ 2014
Current Opinion in Gastroenterology 30 (2014)2. - ISSN 0267-1379 - p. 189 - 195.
human gut microbiome - 16s ribosomal-rna - human colonic microbiota - metabolic syndrome - fecal samples - cancer-risk - obesity - ecology - enterotypes - health
AB Purpose of review: To summarize and discuss recent findings concerning diet-microbiota-health relations. Recent findings: Mouse and other model animal studies have provided detailed insight into host-microbiota interactions, but cannot be extrapolated easily to humans that have different dietary habits, intestinal architecture, and microbiota composition. In spite of the fact that all humans have a personalized microbiome, the discovery of the high-level clusters, such as enterotypes, offer great potential for stratifying individuals in intervention studies based on their intestinal microbiota. A highly diverse microbiota seems to be key to adult human health. Long-term dietary patterns have been found to be associated with specific microbiota compositions and in some cases enterotypes. Fecal transplantations indicate that homeostasis can be restored and indicate that diet-microbiota-induced disorders can be improved by therapeutic modification of the microbiota. The specificity of complex carbohydrate conversion is the driving ecological force in the colon, while competition for sugars with the host is the driver for the small intestinal ecosystem. At both locations, the microbial fermentation of dietary components occurs in trophic chains and insight into these multispecies conversions is essential to understand the impact of diet on health. Summary: There are clear associations between the microbiota, our diet and our health. However, as microbiota correlations with human health and diet are generally based on baseline comparisons between populations, there is a need for dedicated dietary intervention studies in humans to differentiate between correlation and causality.
Trans fatty acids and cardiovascular health: research completed?
Brouwer, I.A. ; Wanders, A.J. ; Katan, M.B. - \ 2013
European Journal of Clinical Nutrition 67 (2013)5. - ISSN 0954-3007 - p. 541 - 547.
conjugated linoleic-acid - coronary-heart-disease - c-reactive protein - middle-aged men - body-composition - blood-lipids - risk-factors - metabolic syndrome - serum-lipids - moderately overweight
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.
Joint Association of Dietary Pattern and Physical Activity Level with Cardiovascular Disease Risk Factors among Chinese Men: A Cross-Sectional Study
Wang, D. ; He, Y. ; Li, Y.P. ; Luan, D.C. ; Zhai, F.Y. ; Yang, X.G. ; Ma, G.S. - \ 2013
PLoS ONE 8 (2013)6. - ISSN 1932-6203
diabetes prevention program - impaired glucose-tolerance - life-style - metabolic syndrome - blood-pressure - attributable risk - plasma biomarkers - us adults - population - hypertension
The purpose of this cross-sectional study was to investigate the joint associations of physical activity level (PAL) and dietary patterns in relation to cardiovascular disease (CVD) risk factors among Chinese men. The study population consisted of 13 511 Chinese males aged 18-59 years from the 2002 China National Nutrition and Health Survey. Based on dietary data collected by a food frequency questionnaire, four dietary patterns were identified and labeled as "Green Water'' (high consumption of rice, vegetables, seafood, pork, and poultry), "Yellow Earth'' (high consumption of wheat flour products and starchy tubers), "New Affluent'' (high consumption of animal sourced foods and soybean products), and "Western Adopter'' (high consumption of animal sourced foods, cakes, and soft drinks). From the information collected by a 1-year physical activity questionnaire, PAL was calculated and classified into 4 categories: sedentary, low active, active, and very active. As compared with their counterparts from the New Affluent pattern, participants who followed the Green Water pattern had a lower likelihood of abdominal obesity (AO; 50.2%), hypertension (HT; 37.9%), hyperglycemia (HG; 41.5%), elevated triglyceride (ETG; 14.5%), low HDL (LHDL; 39.8%), and metabolic syndrome (MS; 51.9%). When compared to sedentary participants, the odds ratio of participants with very active PAL was 0.62 for AO, 0.85 for HT, 0.71 for HG, 0.76 for ETG, 0.74 for LHDL, and 0.58 for MS. Individuals who followed both very active PAL and the Green Water pattern had a lower likelihood of CVD risk factors (AO: 65.8%, HT: 39.1%, HG: 57.4%, ETG: 35.4%, LHDL: 56.1%, and MS: 75.0%), compared to their counterparts who followed both sedentary PAL and the New Affluent pattern. In addition, adherence to both healthy dietary pattern and very active PAL presented a remarkable potential for CVD risk factor prevention.
A composite score combining waist circumference and body mass index more accurately predicts body fat percentage in 6-to 13-year-old children
Aeberli, I. ; Gut-Knabenhans, M. ; Kusche-Ammann, R.S. ; Molinari, L. ; Zimmermann, M.B. - \ 2013
European Journal of Nutrition 52 (2013)1. - ISSN 1436-6207 - p. 247 - 253.
skinfold-thickness measurements - for-disease-control - metabolic syndrome - visceral fat - obesity - adolescents - overweight - risk - prevalence - prevention
Body mass index (BMI) and waist circumference (WC) are widely used to predict % body fat (BF) and classify degrees of pediatric adiposity. However, both measures have limitations. The aim of this study was to evaluate whether a combination of WC and BMI would more accurately predict %BF than either alone. In a nationally representative sample of 2,303 6- to 13-year-old Swiss children, weight, height, and WC were measured, and %BF was determined from multiple skinfold thicknesses. Regression and receiver operating characteristic (ROC) curves were used to evaluate the combination of WC and BMI in predicting %BF against WC or BMI alone. An optimized composite score (CS) was generated. A quadratic polynomial combination of WC and BMI led to a better prediction of %BF (r (2) = 0.68) compared with the two measures alone (r (2) = 0.58-0.62). The areas under the ROC curve for the CS [0.6 * WC-SDS + 0.4 * BMI-SDS] ranged from 0.962 +/- A 0.0053 (overweight girls) to 0.982 +/- A 0.0046 (obese boys) and were somewhat greater than the AUCs for either BMI or WC alone. At a given specificity, the sensitivity of the prediction of overweight and obesity based on the CS was higher than that based on either WC or BMI alone, although the improvement was small. Both BMI and WC are good predictors of %BF in primary school children. However, a composite score incorporating both measures increased sensitivity at a constant specificity as compared to the individual measures. It may therefore be a useful tool for clinical and epidemiological studies of pediatric adiposity.
The association between dietary energy density and type 2 diabetes in Europe: results form the EPIC-InterAct Study
The InterAct Consortium, A. ; Groenendijk-van Woudenbergh, G.J. ; Feskens, E.J.M. - \ 2013
PLoS ONE 8 (2013)5. - ISSN 1932-6203 - 10 p.
impaired glucose-tolerance - life-style - metabolic syndrome - glycemic load - united-states - weight change - us adults - risk - women - mellitus
Background Observational studies implicate higher dietary energy density (DED) as a potential risk factor for weight gain and obesity. It has been hypothesized that DED may also be associated with risk of type 2 diabetes (T2D), but limited evidence exists. Therefore, we investigated the association between DED and risk of T2D in a large prospective study with heterogeneity of dietary intake. Methodology/Principal Findings A case-cohort study was nested within the European Prospective Investigation into Cancer (EPIC) study of 340,234 participants contributing 3.99 million person years of follow-up, identifying 12,403 incident diabetes cases and a random subcohort of 16,835 individuals from 8 European countries. DED was calculated as energy (kcal) from foods (except beverages) divided by the weight (gram) of foods estimated from dietary questionnaires. Prentice-weighted Cox proportional hazard regression models were fitted by country. Risk estimates were pooled by random effects meta-analysis and heterogeneity was evaluated. Estimated mean (sd) DED was 1.5 (0.3) kcal/g among cases and subcohort members, varying across countries (range 1.4–1.7 kcal/g). After adjustment for age, sex, smoking, physical activity, alcohol intake, energy intake from beverages and misreporting of dietary intake, no association was observed between DED and T2D (HR 1.02 (95% CI: 0.93–1.13), which was consistent across countries (I2 = 2.9%). Conclusions/Significance In this large European case-cohort study no association between DED of solid and semi-solid foods and risk of T2D was observed. However, despite the fact that there currently is no conclusive evidence for an association between DED and T2DM risk, choosing low energy dense foods should be promoted as they support current WHO recommendations to prevent chronic diseases.
The Predictive Adaptive Response: Modeling the Life-History Evolution of the Butterfly
Heuvel, J. van den; Saastamoinen, M. ; Brakefield, P.M. ; Kirkwood, T.B. ; Zwaan, B.J. ; Shanley, D.P. - \ 2013
American Naturalist 181 (2013)2. - ISSN 0003-0147 - p. E28 - E42.
phenotypic plasticity - metabolic syndrome - body-size - adaptation - starvation - growth - flight - lepidoptera - temperature - hypothesis
A predictive adaptive response (PAR) is a type of developmental plasticity where the response to an environmental cue is not immediately advantageous but instead is later in life. The PAR is a way for organisms to maximize fitness in varying environments. Insects living in seasonal environments are valuable model systems for testing the existence and form of PAR. Previous manipulations of the larval and the adult environments of the butterfly Bicyclus anynana have shown that individuals that were food restricted during the larval stage coped better with forced flight during the adult stage compared to those with optimal conditions in the larval stage. Here, we describe a state-dependent energy allocation model, which we use to test whether such a response to food restriction could be adaptive in nature where this butterfly exhibits seasonal cycles. The results from the model confirm the responses obtained in our previous experimental work and show how such an outcome was facilitated by resource allocation patterns to the thorax during the pupal stage. We conclude that for B. anynana, early-stage cues can direct development toward a better adapted phenotype later in life and, therefore, that a PAR has evolved in this species
Obesity, non-alcoholic fatty liver disease, and atherothrombosis: a role for the intestinal microbiota?
Knaapen, M. ; Kootte, R.S. ; Zoetendal, E.G. ; Vos, W.M. de; Dallinga-Thie, G.M. ; Levi, M. ; Stroes, E.S. ; Nieuwdorp, M. - \ 2013
Clinical Microbiology and Infection 19 (2013)4. - ISSN 1198-743X - p. 331 - 337.
lipopolysaccharide-binding protein - gut microbiota - insulin-resistance - vitamin-k - metabolic syndrome - cardiovascular-disease - innate immunity - global burden - germfree-mice - high-density
Whereas the association between intestinal microorganisms and health has been widely accepted in the area of infectious disease, recent advances have now implied a role for the intestinal microbiota in human energy balance. In fact, numerous studies support an intricate relationship between the intestinal microbiota and obesity, as well as subsequent insulin resistance and non-alcoholic fatty liver disease. Intestinal microorganisms also seem to be involved in haemostatic tone and atherogenesis. However, as most of the findings stem from observational data, intervention studies in humans using interventions selectively aimed at altering the composition and activity of the intestinal microbiota are crucial to prove causality. If substantiated, this could open the arena for modulation of the intestinal microbiota as a future target in obesity-associated disease, both as a diagnostic test for personalized algorithms and for selective therapeutic strategies