Alternative Dietary Strategies Research Articles

Comparing the effects of time-restricted eating on glycaemic control in people with type 2 diabetes with standard dietetic practice: A randomised controlled trial

AimsTo test the efficacy of time-restricted eating (TRE) in comparison to dietitian-led individualised dietary guidance to improve HbA1c in people with Type 2 diabetes mellitus. MethodsIn a parallel groups design, 51 adults (35–65 y) with Type 2 diabetes mellitus and overweight/obesity (HbA1c ≥6.5% (48 mmol/mol), BMI ≥25-≤40 kg/m2) commenced a six-month intervention. Following baseline, participants were randomised to TRE (1000–1900 h) or DIET (individualised dietetic guidance) with four consultations over four months. Changes in HbA1c (primary), body composition, and self-reported adherence (secondary) were analysed using linear mixed models. A non-inferiority margin of 0.3% (4 mmol/mol) HbA1c was set a priori. ResultsForty-three participants (56 ± 8 y, BMI: 33 ± 5 kg/m2, HbA1c: 7.6 ± 0.8%) completed the intervention. HbA1c was reduced (P=0.002; TRE: −0.4% (−5 mmol/mol), DIET: −0.3% (−4 mmol/mol)) with no group or interaction effects; TRE was non-inferior to DIET (−0.11%, 95%CI: −0.50% to 0.28%). Body mass reduced in both groups (TRE: −1.7 kg; DIET: −1.2 kg) via ∼900 kJ/d spontaneous energy reduction (P<0.001). Self-reported adherence was higher in TRE versus DIET (P<0.001). ConclusionsWhen individualised dietary guidance is not available, effective, and/or suitable, TRE may be an alternative dietary strategy to improve glycaemic control in people with Type 2 diabetes mellitus.

Overview of the therapeutic efficacy of marine fish oil in managing obesity and associated metabolic disorders.

In the present scenario, obesity is a challenging health problem and its prevalence along with comorbidities are on the rise around the world. Ingestion of fish becomes trendy in daily meals. Recent research has shown that marine fish oil (FO) (found in tuna, sardines, and mackerel) may offer an alternative method for reducing obesity and problems associated with it. Marine FO rich in long-chain omega-3 polyunsaturated fatty acids (LC n-3 PUFA) and long-chain omega-6 polyunsaturated fatty acids (LC n-6 PUFA) plays an important role in reducing abnormalities associated with the metabolic syndrome and has a variety of disease-fighting properties, including cardioprotective activity, anti-atherosclerotic, anti-obesity, anti-cancer, anti-inflammatory activity. Studies in rodents and humans have indicated that LC n-3 PUFA potentially elicit a number of effects which might be useful for reducing obesity, including suppression of appetite, improvements in circulation, enhanced fat oxidation, energy expenditure, and reduced fat deposition. This review discusses the interplay between inflammation and obesity, and their subsequent regulation via the beneficial role of marine FO, suggesting an alternative dietary strategy to ameliorate obesity and obesity-associated chronic diseases.

Role of Omega-3 Fatty Acids in Improving Metabolic Dysfunctions in Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that impacts women of reproductive age. In addition to reproductive and psychological complications, women with PCOS are also at a higher risk of developing metabolic diseases such as obesity, type 2 diabetes and cardiovascular disease. While weight reduction can help manage these complications in overweight or obese women, many weight loss interventions have been ineffective due to weight stigma and its psychological impact on women with PCOS. Therefore, exploring alternative dietary strategies which do not focus on weight loss per se is of importance. In this regard, omega-3 polyunsaturated fatty acids of marine origin (n-3 PUFAs), which are known for their hypotriglyceridemic, cardioprotective and anti-inflammatory effects, have emerged as a potential therapy for prevention and reversal of metabolic complications in PCOS. Several clinical trials showed that n-3 PUFAs can improve components of metabolic syndrome in women with PCOS. In this review, we first summarize the available clinical evidence for different dietary patterns in improving PCOS complications. Next, we summarize the clinical evidence for n-3 PUFAs for alleviating metabolic complications in PCOS. Finally, we explore the mechanisms by which n-3 PUFAs improve the metabolic disorders in PCOS in depth.

171 Current limitations to implement fiber in U.S. sow and nursery diets, and nutritional strategies to support ideal fiber profile

Abstract The importance of fiber in swine nutrition is increasingly recognized, and the consequences of insufficient dietary fiber can be significant. Consequently, U.S. production nutritionists have begun exploring the incorporation of fiber into their nutrition programs. However, incorporating fiber into diets is not without challenges. Analytical capabilities for assessing fiber content have improved, yet accessing accurate data remains a hurdle. Furthermore, the cost of analysis limits the ability of nutritionists to utilize these advanced methods for ingredient analysis. The lack of information around fiber requirements in the diet may be due to the insufficient methodology that has historically been available to measure the indigestible fraction of the diet. In the nursery phase, research findings on the effects of fiber have been mixed, likely influenced by the health status of the animals. Short-term growth performance trials may not fully capture the benefits of fiber, and more comprehensive, long-term studies focusing on health-related parameters are lacking. Similarly, research on sow nutrition faces challenges due to the limitations of barn structures and feed lines. Sow trials typically involve only a small number of treatments, often requiring before- and after- assessments. Moreover, the benefits of fiber are more apparent in later reproductive cycles, necessitating prolonged research efforts. Given the limited phases in sow diets, primarily lactation and gestation, conducting sow research is both challenging and costly. Evidence from European literature and recent U.S. studies suggests that the total dietary fiber and the level of soluble, fermentable fiber have a crucial role in swine diets, particularly for sows and piglets. However, the availability and affordability of such fiber types in the U.S. are limited. The majority of fiber-rich ingredients in the U.S. consist mostly of insoluble fiber. To address this limitation, technological advancements will be needed to transform available fiber sources into the desired fiber constructs, rather than relying solely on fiber-rich ingredients. A stimbiotic, which encourages fiber fermentation, may be key to achieving the desired fiber profile. The addition of a stimbiotic has been shown to increase the digestibility of fiber. It also increases the capacity of the beneficial microbiome to break down and ferment fiber, which leads to an increase in the production of volatile fatty acids (acetic, propionic and butyric). In conclusion, U.S. swine nutritionist must explore alternative dietary strategies to capturing the ideal fiber composition. Key word: fiber, nursery, sow

Comparison of weight loss induced by daily caloric restriction versus intermittent fasting (DRIFT) in individuals with obesity: study protocol for a 52-week randomized clinical trial

BackgroundThe standard of care for treating overweight and obesity is daily caloric restriction (DCR). While this approach produces modest weight loss, adherence to DCR declines over time and weight regain is common. Intermittent fasting (IMF) is an alternative dietary strategy for reducing energy intake (EI) that involves >60% energy restriction on 2–3 days per week, or on alternate days, with habitual intake on fed days. While numerous studies have evaluated IMF as a weight loss strategy, there are several limitations including lack of a standard-of-care DCR control, failure to provide guideline-based behavioral support, and failure to rigorously evaluate dietary and PA adherence using objective measures. To date, only three longer-term (52-week) trials have evaluated IMF as a weight loss strategy. None of these longer-duration studies reported significant differences between IMF and DCR in changes in weight. However, each of these studies has limitations that prohibit drawing generalizable conclusions about the relative long-term efficacy of IMF vs. DCR for obesity treatment.MethodsThe Daily Caloric Restriction vs. Intermittent Fasting Trial (DRIFT) is a two-arm, 52-week block randomized (1:1) clinical weight loss trial. The two intervention arms (DCR and IMF) are designed to prescribe an equivalent average weekly energy deficit from baseline weight maintenance energy requirements. Both DCR and IMF will be provided guideline-based behavioral support and a PA prescription. The primary outcome is change in body weight at 52 weeks. Secondary outcomes include changes in body composition (dual-energy x-ray absorptiometry (DXA)), metabolic parameters, total daily energy expenditure (TDEE, doubly labeled water (DLW)), EI (DLW intake-balance method, 7-day diet diaries), and patterns of physical activity (PA, activPAL device).DiscussionAlthough DCR leads to modest weight loss success in the short-term, there is wide inter-individual variability in weight loss and poor long-term weight loss maintenance. Evidence-based dietary approaches to energy restriction that are effective long-term are needed to provide a range of evidence-based options to individuals seeking weight loss. The DRIFT study will evaluate the long-term effectiveness of IMF vs. DCR on changes in objectively measured weight, EI, and PA, when these approaches are delivered using guideline-based behavioral support and PA prescriptions.

Dietary strategies to promote the abundance of intestinal Akkermansia muciniphila, a focus on the effect of plant extracts

• Alternative dietary intervention strategies for AKK have broad application prospects. • Some plant extracts can significantly increase the abundance of intestinal AKK. • The mechanism may be promoting the secretion of mucins and antibacterial ability. As the next generation of probiotics, Akkermansia muciniphila has attracted a lot of attention and research because of its probiotic properties. However, it is not on the list of strains that can be added to food in any country, and its sensitivity to oxygen and the availability of animal-derived media limit its industrial production. Alternative dietary intervention strategies have broad application prospects. This review uses plant extracts as the main framework to summarize studies on increasing the abundance of A. muciniphila in recent years. Polyphenols, alkaloids, capsaicin, plant-derived carbohydrates, and some Chinese medicines can significantly increase the abundance of A. muciniphila in the gut. Promoting the abundance of A. muciniphila 's mechanisms focused on promoting the secretion of mucins and their antibacterial ability. This paper provides a lot of theoretical basics for the development of dietary strategies that can improve intestinal A. muciniphila abundance in the future.

Diet Supplementation With Sulfur Amino Acids Modulated Fermentation Metabolome and Gut Microbiome in Goats.

Dietary amino acids shift hydrogen metabolism to an alternative hydrogen sink consisting of dissolved hydrogen sulfur (dH2S) rather than methanogenesis; and influences the fermentation metabolome and microbiome associated with particles and liquid fractions in gut regions (foregut, small intestine, and hindgut) of goats. A completely randomized block design with a total of 20 goats (5 goats per treatment) was used to conduct the trial. The goats were fed on a diet that consisted of a concentrated mixture with maize stover roughage (50:50, on a dry matter basis) and randomly assigned to one of the four treatments: without amino acid supplementation (a basal diet), a basal diet supplemented with methionine (Met), a basal diet supplemented with lysine (Lys), and a basal diet supplemented with methionine and lysine (ML). Goats fed Met alone or in combination had less acetate, acetate to propionate ratio, and greater propionate (p < 0.05) in the foregut and hindgut than those fed control or Lys. Nonetheless, the goats fed on the amino acid supplements had higher levels of branched-chain VFA (p < 0.05) in the foregut and hindgut than the control goats. Goats fed on ML had the highest ammonia (p < 0.01), followed by Met or Lys, both in the foregut and hindgut, compared with the control. Those fed on Met alone or in combination, had lower dH2, dCH4 (p < 0.01), and higher dH2S (p < 0.01) in the foregut and hindgut than the control or Lys. The goats that were fed on Met alone or in combination, had higher 16S rRNA gene copies of total bacteria, methanogens, and 18S rRNA gene copies of protozoa, fungi, and fiber-utilizing bacterial species (p < 0.01) associated with particles vs. liquid, both in the foregut and hindgut than the control goats. This study gives insights into the use of sulfur-containing amino acids, as an alternative dietary mitigation strategy of methanogenesis in ruminants and highlights the need for further research in this direction.

Effects of Time-Restricted Feeding on Energy Balance: A Cross-Over Trial in Healthy Subjects.

Time-restricted feeding (TRF) has been recently reported as an effective dietary intervention for losing body weight, implying a negative energy balance, without restricting nutrient intake. However, the detailed energy balance alteration caused by TRF remains unclear. This study was a randomized controlled clinical trial using a within-subject cross-over design. Twelve healthy, normal-weighted volunteers (age: 24 ± 2.3 years; BMI: 21.9 ± 1.71 kg/m2; 7 females) were studied under a rigorous control for calorie intakes, physical activities as well as sleep-wake cycle to evaluate the energy balance systematically. Each participant consumed an isocaloric diet within either a 5.5-hour TRF or 11-hour control schedule. All energy intake and excretion were traced and collected and accessed by bomb calorimetry. Energy expenditure and substrates oxidation were monitored in a metabolic chamber. TRF compared with control schedule is associated with a 22.7% increase in fecal energy loss (Δ = 32.25 ± 9.33 Kcal, p = 0.005) and a trend in increasing 14.5% urine energy loss (Δ = 6.67 ± 3.14 Kcal, p = 0.058) without change energy expenditure. In total, a negative energy balance (Δ = -45.95 ± 19.00 Kcal, p = 0.034), which was equal to -2.6% of total energy intake, has been observed during TRF interventions. In the meantime, glycemic profiles, heart rate, respiration rate as well as metabolic flexibility were also improved during TRF intervention. Taken together, our findings unravel the mystery of how TRF regulates energy balance, supporting the use of TRF as an alternative dietary strategy for weight loss.

Assessment of Eating Behaviors and Perceptions of Time-Restricted Eating During Pregnancy

BackgroundThe maternal metabolic milieu is challenged during pregnancy and may result in unwarranted metabolic complications. A time-restricted eating (TRE) pattern may optimize the metabolic response to pregnancy by improving glucose metabolism and reducing circulating glucose concentrations, as it does in nonpregnant individuals. ObjectivesThe objectives of this study were to 1) assess eating timing in pregnant women; 2) understand the perceptions of adopting a TRE pattern; 3) determine the barriers and support mechanisms for incorporating a TRE pattern; and 4) identify those most willing to adopt a TRE pattern during pregnancy. MethodsThis was a cross-sectional quantitative and quasi-qualitative online survey study for women who were pregnant at the time of study completion or had given birth in the prior 2 years. Group analyses were performed based off willingness to try a TRE pattern using chi-squared analyses, independent samples t-tests, or an analysis of variance. Three separate reviewers reviewed qualitative responses. ResultsA total of 431 women (BMI, 27.5 ± 0.3 kg/m2) completed the study. Of the participating women, 23.7% reported willingness to try a TRE pattern during pregnancy. Top barriers to adopting a TRE pattern during pregnancy were concerns for 1) safety; 2) nausea; and 3) hunger. The highest ranked support mechanisms were: 1) the ability to choose the eating window; 2) more frequent prenatal visits to ensure the health of the baby; and 3) receiving feedback from a dietician/nutritionist. Women who did not identify as White/Caucasian expressed a higher willingness to try a TRE pattern during pregnancy (P = 0.01). Women who were nulliparous expressed a higher willingness to try a TRE pattern (P = 0.05). DiscussionTRE, an alternative dietary strategy shown to optimize metabolic control, may be effective to prevent and manage pregnancy-related metabolic impairments. To create an effective TRE intervention during pregnancy, the input of pregnant mothers is necessary to increase adherence and acceptability.

Mandated restrictions on the use of medically important antibiotics in broiler chicken production in Canada: implications, emerging challenges, and opportunities for bolstering gastrointestinal function and health — a review

Chicken Farmers of Canada has been progressively phasing out prophylactic use of antibiotics in broiler chicken production. Consequently, hatcheries, veterinarians, and nutritionists have been mandated to contend with less reliance on the use of preventive antibiotics. A topical concern is the increased risk of proliferation of enteric pathogens leading to poor performance, increased mortality, and compromised welfare. Moreover, the gut harbors several taxa such as Campylobacter and Salmonella capable of causing significant illnesses in humans via contaminated poultry products. This has created an opportunity for research and development of dietary strategies designed to modulate gastrointestinal environment for enhanced performance and food safety. Albeit with inconsistent responses, literature data suggest that dietary strategies such as feed enzymes, probiotics/prebiotics, and phytogenic feed additives can bolster gut health and function in broiler chickens. However, much of the efficacy data were generated at controlled research settings that vary significantly with the complex commercial broiler production operations due to variation in dietary, health, and environmental conditions. This review will summarize implications of mandated restrictions on the preventative use of antibiotics and emerging Canadian broiler production programs to meet processor specifications. Challenges and opportunities for integrating alternative dietary strategies in commercial broiler production settings will be highlighted.

A national survey of oncology survivors examining nutrition attitudes, problems and behaviours, and access to dietetic care throughout the cancer journey.

Attitudes of cancer survivors to nutrition and nutrition care have rarely been captured. A better understanding of their needs based on a review of their experiences would give voice to this patient group (which has rarely been captured) and allow for better planning of nutritional care. To conduct a national survey to determine: (1) survivors' experience in relation to nutrition and diet-related problems, (2) perceived importance of the role of nutrition to cancer survivors, (3) the experience of accessing dietetic support, (4) the sources where survivors get nutrition information, and (5) their use of alternative dietary strategies. Survivors (any adult ever diagnosed with cancer) who had been diagnosed with or treated for cancer in Ireland within the past 5 years, were asked to complete a 25-item paper-based survey at one of 20 different hospital sites in Ireland. The survey was also hosted online on the websites of major cancer charities. Descriptive statistics were used to examine quantitative data. In total, 1073 valid responses were received (63% female, mean age 57 years (range 18-88)). Breast cancer was the most common (n=362), followed by colorectal (n=121). One third of respondents had metastatic disease. Diet-related problems were reported by 45%. Weight loss was experienced by 44% and amongst those, 42% reported they were 'unhappy or worried' by this, while 27% reportedbeing 'delighted/happy' with their weight loss. Muscle loss was noted by 52%, with 20% reporting they had noticed 'a lot' of muscle loss. Nutrition was rated as 'very/extremely' important to cancer care by 89% of respondents, yet 58% reported being asked about dietary issues by their medical team only 'sometimes', 'rarely' or 'never'. Only 39% had been assessed/treated by a registered dietitian (RD) and 74% rated their advice/care as 'very/extremely' helpful. Worryingly, 39% of survivors with involuntary weight loss, and 29% of survivors on a texture modified diet had not received nutritional care from an RD. Overall, 57% of those who did not see an RD said they wanted more dietetic support (access to a helpline/dietitian/additional reliable information). Of concern, 37% of survivors were following or had tried alternative, unproven dietary strategies (e.g. restrictive diets, herbal remedies, juicing or detoxes), and 32% reported avoiding specific foods, e.g. processed meat or dairy. A majority (56%) felt confused by the often conflicting nutrition information available in the media and offered by people around them. While nutrition is considered highly important by cancer survivors and a high proportion experience potentially serious diet-related problems including weight and muscle loss, fewer than half surveyed had access to a dietitian. Over a third had used at least one alternative dietary strategy, and over half felt confused about nutrition. Comprehensive nutritional screening and referral programmes to oncology dietitians need to be implemented in the ambulatory setting in order to identify and facilitate early management of the nutritional concerns of cancer survivors.

1785P - The patient voice: An Irish survey of nutrition attitudes & access to dietetic care throughout the cancer journey

BackgroundThe attitudes of cancer patients towards nutrition and nutrition care has never been captured in Ireland. An awareness of the nutritional needs and attitudes of cancer patients along with a review of their experiences would help inform service planning. MethodsIn September 2018, a national survey was conducted to examine patient attitudes towards nutrition and access to dietetic services during their cancer journey. Patients diagnosed or treated in Ireland since 2015 were asked to complete a 25-item survey (available online and at 20 hospitals across Ireland). ResultsIn total, 1085 valid responses were received (63% female, mean age 58 years). All major cancer groups were represented & 33% had metastatic disease. Overall, 45% reported suffering from a diet-related problem and 44% reported weight loss since diagnosis. Muscle loss was noted by 52%. Amongst weight losers, 42% were ‘unhappy/worried’ while 27% reported being ‘delighted/happy’. Although 80% are ‘always/usually’ weighed in clinic, just 43% reported that they are ‘always/usually’ asked about diet. Nutrition was rated ‘very/extremely’ important by 89% of respondents. Only 39% had received dietary advice from a dietitian and 74% rated this advice as ‘very/extremely’ helpful. Overall, 57% of those who did not see an RD said they would have liked more support with diet. While 58% reported trying general healthy eating as a result of their diagnosis, 38% and 32% admitted trying at least one alternative dietary strategy or avoiding a specific food due to their diagnosis, respectively. ConclusionsWhile nutrition is highly important to Irish cancer patients, fewer than half surveyed had accessed a dietitian. Weight and muscle loss are common, but their significance is not always understood by patients. Almost half used alternative dietary strategies, highlighting the need to screen oncology patients for potentially restrictive diet or supplement use to guide appropriate referrals and education. Legal entity responsible for the studyThe authors. FundingIrSPEN. DisclosureAll authors have declared no conflicts of interest.

Challenges to drug discovery for celiac disease and approaches to overcome them

ABSTRACTIntroduction: The only available effective treatment for celiac disease (CD) is strict and long-term compliance with a gluten-free diet. Dietary gluten restriction must be strict and long term, but is difficult to achieve in many cases and alternative dietary strategies have been investigated in the past few years.Areas covered: This review highlights the progress that has been made in the development of new therapeutics for CD. Detailed information is provided on the targets of drugs for CD as their related mechanisms of action. The therapies are classified in five mechanisms: modification of gluten, intraluminal therapies, immunomodulation, intestinal permeability and modulation of adaptative response. The actual development phase and future approach are also described and discussed.Expert opinion: There are several limitations in each of the treatment targets related either through complications or the lack of complete response to a normal gluten containing diet. It is clear that the most desired therapy for celiac patients would induce gluten tolerance and progress has been made as per the treatments described herein. Therefore, it is shortly expected that curative or complimentary tools to a gluten free diet will be available that will improve the quality of life of CD sufferers.

Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis.

Carbohydrate-restricted diets may increase low-density lipoprotein cholesterol and thereby cardiovascular risk. A systematic review and meta-analyses were conducted to compare the effects of very low, low, and moderate carbohydrate, higher fat diets versus high-carbohydrate, low-fat diets on low-density lipoprotein cholesterol and other lipid markers in overweight/obese adults. Medline, PubMed, Cochrane Central, and CINAHL Plus were searched to identify large randomized controlled trials (n > 100) with duration ≥ 6 months. Eight randomized controlled trials (n = 1633; 818 carbohydrate-restricted diet, 815 low-fat diet) were included. Quality assessment and risk of bias, a random effects model, and sensitivity and subgroup analyses based on the degree of carbohydrate restriction were performed using Cochrane Review Manager. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol. Carbohydrate-restricted diets showed no significant difference in low-density lipoprotein cholesterol after 6, 12, and 24 months. Although an overall pooled analysis statistically favored low-fat diets (0.07 mmol/L; 95% confidence interval [CI], 0.02-0.13; P = 0.009], this was clinically insignificant. High-density lipoprotein cholesterol and plasma triglycerides at 6 and 12 months favored carbohydrate-restricted diets (0.08 mmol/L; 95%CI, 0.06-0.11; P < 1 × 10-5 and -0.13 mmol/L; 95%CI, -0.19 to -0.08; P < 1 × 10-5, respectively). These favorable changes were more marked in the subgroup with very-low carbohydrate content (< 50 g/d; 0.12 mmol/L; 95%CI, 0.10-0.14; P < 1 × 10-5 and -0.19 mmol/L; 95%CI, -0.26 to -0.12; P = 0.02, respectively). Large randomized controlled trials of at least 6 months duration with carbohydrate restriction appear superior in improving lipid markers when compared with low-fat diets. Dietary guidelines should consider carbohydrate restriction as an alternative dietary strategy for the prevention/management of dyslipidemia for populations with cardiometabolic risk.

Eight weeks of nitrate supplementation improves blood flow and reduces the exaggerated pressor response during forearm exercise in peripheral artery disease.

Peripheral artery disease (PAD) is characterized by a reduced blood flow (BF) and an elevated blood pressure (pressor) response during lower extremity exercise. Although PAD is evident in the upper extremities, no studies have determined BF and pressor responses during upper extremity exercise in PAD. Emerging evidence suggests that inorganic nitrate supplementation may serve as an alternative dietary strategy to boost nitric oxide bioavailability, improving exercising BF and pressor responses during exercise. The present study investigated 1) BF and pressor responses to forearm exercise in patients with PAD ( n = 21) relative to healthy age-matched control subjects ( n = 16) and 2) whether 8 wk of NaNO3 supplementation influenced BF and pressor responses to forearm exercise in patients with PAD. Patients with moderate to severe PAD were randomly assigned to a NaNO3 (1 g/day, n = 13)-treated group or a placebo (microcrystalline cellulose, n = 8)-treated group. Brachial artery forearm BF (FBF; via Doppler) and blood pressure (via finger plethysmography) were measured during mild-intensity (~3.5-kg) and moderate-intensity (~7-kg) handgrip exercise. The absolute change (from baseline) in FBF was reduced (except in the 3.5-kg condition) and BP responses were increased in patients with PAD compared with healthy control subjects in 3.5- and 7-kg conditions (all P < 0.05). Plasma nitrate and nitrite were elevated, exercising (7-kg) ΔFBF was improved (from 141 ± 17 to 172 ± 20 ml/min), and mean arterial pressure response was reduced (from 13 ± 1 to 9 ± 1 mmHg, P < 0.05) in patients with PAD that received NaNO3 supplementation for 8 wk relative to those that received placebo. These results suggest that the BF limitation and exaggerated pressor response to moderate-intensity forearm exercise in patients with PAD are improved with 8 wk of NaNO3 supplementation. NEW & NOTEWORTHY Peripheral artery disease (PAD) results in an exaggerated pressor response and reduced blood flow during lower limb exercise; however, the effect of PAD in the upper limbs has remained unknown. These results suggest that 8 wk of inorganic nitrate supplementation improves the blood flow limitation and exaggerated pressor response to moderate-intensity forearm exercise in PAD.

Dietary Anthocyanins against Obesity and Inflammation.

Chronic low-grade inflammation plays a pivotal role in the pathogenesis of obesity, due to its associated chronic diseases such as type II diabetes, cardiovascular diseases, pulmonary diseases and cancer. Thus, targeting inflammation is an attractive strategy to counter the burden of obesity-induced health problems. Recently, food-derived bioactive compounds have been spotlighted as a regulator against various chronic diseases due to their low toxicity, as opposed to drugs that induce severe side effects. Here we describe the beneficial effects of dietary anthocyanins on obesity-induced metabolic disorders and inflammation. Red cabbage microgreen, blueberry, blackcurrant, mulberry, cherry, black elderberry, black soybean, chokeberry and jaboticaba peel contain a variety of anthocyanins including cyanidins, delphinidins, malvidins, pelargonidins, peonidins and petunidins, and have been reported to alter both metabolic markers and inflammatory markers in cells, animals, and humans. This review discusses the interplay between inflammation and obesity, and their subsequent regulation via the use of dietary anthocyanins, suggesting an alternative dietary strategy to ameliorate obesity and obesity associated chronic diseases.

Resistant starch as a novel dietary strategy to maintain kidney health in diabetes mellitus.

The worldwide prevalence of diabetes mellitus is expected to reach 439 million by 2030. Diabetes increases the risk for developing secondary complications such as nephropathy and cardiovascular disease, critical factors that dictate the survival rate of diabetes patients. Compelling evidence has indicated that the positive impact of fermentable carbohydrates in obesity-related diabetes is mediated by the production of short-chain fatty acids and the modulation of colonic microbiota. This review summarizes the potential implications of dietary resistant starch, a class of fermentable fiber, in glucose homeostasis and kidney health in obesity-associated diabetes and examines the mechanisms underlying the protective effect of resistant starch. Though extensive clinical studies are still warranted, replacement of simple carbohydrates with resistant starch could be a highly effective alternative dietary strategy to prevent secondary complications resulting from hyperglycemia.

Therapeutic brain modulation with targeted large neutral amino acid supplements in the Pah-enu2 phenylketonuria mouse model

Phenylketonuria treatment consists mainly of a Phe-restricted diet, which leads to suboptimal neurocognitive and psychosocial outcomes. Supplementation of large neutral amino acids (LNAAs) has been suggested as an alternative dietary treatment strategy to optimize neurocognitive outcome in phenylketonuria and has been shown to influence 3 brain pathobiochemical mechanisms in phenylketonuria, but its optimal composition has not been established. In order to provide additional pathobiochemical insight and develop optimal LNAA treatment, several targeted LNAA supplements were investigated with respect to all 3 biochemical disturbances underlying brain dysfunction in phenylketonuria. Pah-enu2 (PKU) mice received 1 of 5 different LNAA-supplemented diets beginning at postnatal day 45. Control groups included phenylketonuria mice receiving an isonitrogenic and isocaloric high-protein diet or the AIN-93M diet, and wild-type mice receiving the AIN-93M diet. After 6 wk, brain and plasma amino acid profiles and brain monoaminergic neurotransmitter concentrations were measured. Brain Phe concentrations were most effectively reduced by supplementation of LNAAs, such as Leu and Ile, with a strong affinity for the LNAA transporter type 1. Brain non-Phe LNAAs could be restored on supplementation, but unbalanced LNAA supplementation further reduced brain concentrations of those LNAAs that were not (sufficiently) included in the LNAA supplement. To optimally ameliorate brain monoaminergic neurotransmitter concentrations, LNAA supplementation should include Tyr and Trp together with LNAAs that effectively reduce brain Phe concentrations. The requirement for Tyr supplementation is higher than it is for Trp, and the relative effect of brain Phe reduction is higher for serotonin than it is for dopamine and norepinephrine. The study shows that all 3 biochemical disturbances underlying brain dysfunction in phenylketonuria can be targeted by specific LNAA supplements. The study thus provides essential information for the development of optimal LNAA supplementation as an alternative dietary treatment strategy to optimize neurocognitive outcome in patients with phenylketonuria.

Greenhouse-gas mitigation potential of agro-industrial by-products in the diet of dairy goats in Spain: a life-cycle perspective

Goat milk production is an important agricultural resource in the Mediterranean basin. Market demands and scarcity of pastures during drought periods has led to farms becoming more intensive and based on imported concentrate feeds. The use of alternative feedstuffs from agro-industry can help decrease dependence on external concentrates, while preventing the environmental issues associated with livestock production and by-product disposal. From a life-cycle assessment perspective, we investigated the change on greenhouse-gas (GHG) emissions of replacing a conventional dairy goat diet in southern Spain with two alternative dietary strategies, including tomato waste or olive by-products silages. The effect on enteric methane emissions and milk productivity was assessed through specific feeding trials. Experimental data were integrated within a modelling framework comprising different submodels to describe the farm system and associated production chain. A new model describing carbon and nitrogen losses from solid waste was applied to estimate the emissions associated with the baseline scenarios for food by-product management. The assessment revealed that the two dietary strategies achieve GHG reductions (~12–19% per kg milk). In both cases, nitrous oxide and carbon dioxide emissions from crop production were partially reduced through the displacement of typical concentrate ingredients. An additional mitigation effect was obtained when including tomato wastes in the diet because it reduced the methane emissions from enteric fermentation. Results suggested that use of agro-industrial residues for feeding is a feasible mitigation option in this case. However, as organic by-products could have alternative uses (bioenergy, soil amendment), with different implications for land use and soil carbon stocks, a more complete overview of both scenarios is recommended. Potential trade-offs from non-GHG categories may play an important role in a decision-making process.

Large Neutral Amino Acid Supplementation Exerts Its Effect through Three Synergistic Mechanisms: Proof of Principle in Phenylketonuria Mice.

BackgroundPhenylketonuria (PKU) was the first disorder in which severe neurocognitive dysfunction could be prevented by dietary treatment. However, despite this effect, neuropsychological outcome in PKU still remains suboptimal and the phenylalanine-restricted diet is very demanding. To improve neuropsychological outcome and relieve the dietary restrictions for PKU patients, supplementation of large neutral amino acids (LNAA) is suggested as alternative treatment strategy that might correct all brain biochemical disturbances caused by high blood phenylalanine, and thereby improve neurocognitive functioning.ObjectiveAs a proof-of-principle, this study aimed to investigate all hypothesized biochemical treatment objectives of LNAA supplementation (normalizing brain phenylalanine, non-phenylalanine LNAA, and monoaminergic neurotransmitter concentrations) in PKU mice.MethodsC57Bl/6 Pah-enu2 (PKU) mice and wild-type mice received a LNAA supplemented diet, an isonitrogenic/isocaloric high-protein control diet, or normal chow. After six weeks of dietary treatment, blood and brain amino acid and monoaminergic neurotransmitter concentrations were assessed.ResultsIn PKU mice, the investigated LNAA supplementation regimen significantly reduced blood and brain phenylalanine concentrations by 33% and 26%, respectively, compared to normal chow (p<0.01), while alleviating brain deficiencies of some but not all supplemented LNAA. Moreover, LNAA supplementation in PKU mice significantly increased brain serotonin and norepinephrine concentrations from 35% to 71% and from 57% to 86% of wild-type concentrations (p<0.01), respectively, but not brain dopamine concentrations (p = 0.307).ConclusionsThis study shows that LNAA supplementation without dietary phenylalanine restriction in PKU mice improves brain biochemistry through all three hypothesized biochemical mechanisms. Thereby, these data provide proof-of-concept for LNAA supplementation as a valuable alternative dietary treatment strategy in PKU. Based on these results, LNAA treatment should be further optimized for clinical application with regard to the composition and dose of the LNAA supplement, taking into account all three working mechanisms of LNAA treatment.